Ksr ebm-16-12-16

EBM- Evidences to bring forward in Ayurveda

EBMEBM“The Evidences to bring forward in Ayurveda Medicine”

Dr KSR PrasadDr KSR PrasadOn 16-12-2016@PG Induction-2016, Wardha

Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/

EBMEBM- Evidences to bring forward in Ayurveda

EBM ‐ “The Evidences to bring forward in Ayurveda Medicine”

Dr KSR PrasadOn 16-12-2016@PG Induction-2016 WardhaOn 16-12-2016@PG Induction-2016, Wardha


Wh t i E id B d M di iEBM- Evidences to bring forward in Ayurveda

What is Evidence Based Medicine • Evidence based medicine is the integration of• Evidence based medicine is the integration of best relevant scientific research evidences i h li i l i j d d iwith clinical expertise judgments and patient

values and preferences


I t d tiEBM- Evidences to bring forward in Ayurveda

Introduction • Ayurveda being the traditional medicine, present day scientific world feels that is do not p yhave any EBM based structures and Evidences of concepts and treatmentsof concepts and treatments

• Ayurveda is not a household or folklore bl b lltreatment publicities but it is a well

constructed therapeutics built on validated concepts after through discussions


T th tEBM- Evidences to bring forward in Ayurveda

Truth storyP t d i tifi l li i• Present day scientific values are lingering around the truth

• It is like a three blind rats running for the• It is like a three blind rats running for the search of truth – They can never see the truth– They can never see the truth

» Ayurveda has a specific system of balancing the Dosha and Dhatugto bring in to normalcy through a sequence of procedure – at present it is called as “Block‐Box”present it is called as Block‐Box method of research



?• Assume that you are the health professional• A community in your area is concerned with its high rate of childhood obesity andits high rate of childhood obesity and requests your help.

• How do you proceed?– You need an Evidence for your statementYou need an Evidence for your statement

• It is Evidence Based Medicine


EBMEBM- Evidences to bring forward in Ayurveda

EBM• At present era first described in 1992

– As a new approach to teaching medicinepp g– Called as a “revolution” in medical practice

All h th t d l ith P ti t• All approaches that deals with a Patient, Physician, Nursing and Medicine (ChikitsaChatushpada) are the components of EBM– Not a new trend at least for Ayurveday


D fi itiEBM- Evidences to bring forward in Ayurveda

Definition • Evidence based medicine (EBM) was originally defined as the conscientious, g yexplicit, and judicious use of current best evidence in making decisions about thebest evidence in making decisions about the care of individual patients.

h “ h f b h• Otherwise – “The integration of best research evidence with clinical expertise and patient values.”


St t EBMEBM- Evidences to bring forward in Ayurveda

Steps to EBM• Make a need in to an answerable question• Search for the best evidenceSearch for the best evidence• Assess the evidence• Check how one’s clinical expertise on an individual patient is possible p p

• Evaluate the entire scenario • You get the EBM


C iti i EBMEBM- Evidences to bring forward in Ayurveda

Criticism on EBM• De‐emphasizes patient values

– Doshabeda “Vikara”

• Doesn’t account for individual variation P k i– eg: Prakruti

• Devalues clinical judgmentj g– Swasa as a symptom and disease do not have similar treatment in generalsimilar treatment in general

• Leads to therapeutic nihilism = ?


Th ti ihiliEBM- Evidences to bring forward in Ayurveda

Therapeutic nihilism• Therapeutic nihilism is a contention that curing people, or societies, of their ills by g p p ytreatment is impossible.

• In medicine it was connected to the idea that• In medicine, it was connected to the idea that many "cures" do more harm than good, and h h l h bthat one should instead encourage the body to heal itself.– Eg: Radiation therapy


P di hiftEBM- Evidences to bring forward in Ayurveda

Paradigm shift• A clinical experience is thought as an unsystematicA clinical experience is thought as an unsystematic

observations and instrumental diagnosis is brought as ultimate

• Understanding the basic physiological mechanisms shift as pathology and its result oriented observational p gystudies are thought as outdated

• In an article only "Introduction" and "Discussion" yare considered as appropriate and relevant

• one must be cautious in the interpretation of pinformation derived from clinical experience and intuition, for it may at times be misleading.


Wh EBMEBM- Evidences to bring forward in Ayurveda

Why EBMN f id (i l / h i l) New types of evidence (instrumental /chemical) are being generated which can create changes in th ti t t t dthe way patients are treated

Although evidence is needed on a daily basis, ll h dusually physicians don’t get it. Reasons are many ‐

1. Lack of time (busy practice)

2. Out-of-date textbooks (Ayurveda is 2000 years old), and

3. The disorganization of information 3 e d so ga at o o o at o

4. Printing of non reliable articles in predatory medical journals


using evidence more criticallyvalidity: most articles should be ignored

using evidence more critically

EBM Journal Process

• 140+ journals scannedNumber Needed to Readto find 1 valid is 20+140 journals scanned

– 60,000 articles• Is it valid? (<5%)

– Intervention: RCTIntervention: RCT– Prognosis: inception cohort– Etc

• Is it relevant?Is it relevant?– 6‐12 GPs & specialists asked:

Relevant? Newsworthy?

N b N d d t R d• < 0.5% selected Number Needed to Readto find 1 valid & relevant is 200+

more critically EBP: informing decisions with the best up‐to‐date evidence

Wh EBM i A d i i dEBM- Evidences to bring forward in Ayurveda

Why EBM in Ayurveda is in need• There is a need of showing the Ayurveda traditional

Knowledge statistically and clinically significant ith t ti l ti b twithout any negative correlation between a

physician’s knowledge for up to date care of patient It i t k th t th h i i d h d• It is to know that the physician do have good care knowledge after so many years of leaving his medical school because of the 2000 years time tested valuesschool because of the 2000 years time tested values

• EBM makes Knowledge translation – increasing the uptake of the best available evidence into practiceuptake of the best available evidence into practice –which is always a challenge


T t tEBM- Evidences to bring forward in Ayurveda

Treatment h b k• There are many books writes classical

Be aware that treatment options should be based onprescriptions or guides

themselves as markersshould be based on clinical need and the effectiveness of

• In fact the prescriptions are derived at only with

treatment options, and that decisions y

the consensus of patient after concluding the

should be arrived at through assessment and discussion withafter concluding the

concerns and needs and discussion with

the patient


R ibili & Skill d l


Responsibility & Skill development i h ibili f• It is the responsibility of

the concerned physician to ll t th i f ti

Must be aware of their responsibility to

maintain theircollect the information regarding the patients condition and the suitable

maintain their knowledge and skills throughout therecondition and the suitable

skills or therapeutics prescribed to the patient

throughout there careers.

prescribed to the patient looking at his disease severity and economical

Scholars are expected to keep up to date and to apply knowledgeseverity and economical

conditions to apply knowledge necessary for good

clinical care.


clinical care.

Wh t id / kill t d lEBM- Evidences to bring forward in Ayurveda

What evidences /skills to develop f h i h kill d l k• Most of the time the skill development takes a

duration of time and half of it becomes mostly td t d ithi 5 f d tioutdated within 5 years of duration

– But the 2000 years Ayurveda is not outdated • The other half is not bothered by any body as it never comes in to lime light or implemented by h b dthe Governing bodies – Thus the skills development is an uninterrupted

ill i h d fprocess till we are in the concerned area of “Recommending a therapeutics for Patient”







Level I: Meta‐analysis of multiple RCTs (‘ ld d d’)(‘gold standard’)Level II: Individual RCTsLevel III: Quasi‐experimentalLevel IV: Non‐experimental; qualitativeLevel V: Program evaluation; QI; RU; case reportsLevel VI: Opinion of respected p pauthorities





using evidence more systematicallyTotal mortality from trials of β‐

blockers in 2° prevention after MI.

systematically

blockers in 2 prevention after MI.

Black square & horizontal line correspond to odds ratio (OR) & 95% confidence interval (CI) for each trial. The size of the black square reflects the weight of eachsquare reflects the weight of each trial. The diamond represents the combined OR & 95 CI, showing a 22% reduction in odds of death

Egger, M. et al. BMJ 1997;315:1533‐1537

22% reduction in odds of death


P ti EBMEBM- Evidences to bring forward in Ayurveda

Practice EBM• 1. Ask a focused question.q• 2. Acquire (systematically search for) epidemiological evidence to help answer question.

• 3. Appraise evidence found for its validity, effect size, precision (ideally all the relevant evidence)

• 4. Apply the evidence in practice:– a. amalgamate the valid evidence with other relevant information (values & preferences, clinical/health issues, & system issues) and make an evidence‐based decision; andb act (implement) the decision in practice– b. act (implement) the decision in practice

• 5. Assess your performance (write an article)


Cli i l Q ti “PICO”EBM- Evidences to bring forward in Ayurveda

Clinical Questions ‐ “PICO”lExample:

• In a 5 year old child with conjunctivitis y j(patient) will topical antibiotics (intervention) compared to no treatment (comparison) lead p ( p )to quicker symptom relief (outcome)?

• In a 5 year old child with conjunctivitisIn a 5 year old child with conjunctivitis (patient) will topical antibiotics (intervention) compared to no treatment (comparison) leadcompared to no treatment (comparison) lead to improved cure rates (outcome)?


EBP E id B d P tiEBM- Evidences to bring forward in Ayurveda

EBP – Evidence Based Practice



Take Home Message • Try to ask one patient for ‐

1. What causes the disease?2 How was the disease diagnosed?2. How was the disease diagnosed? 3. How was the patient treated?4 Wh i h l hi f h di ?4. What is the natural history of the disease?5. Consider formulating a PICO

And try to find some evidence for it



Thank YouThank You


Ksr ebm-16-12-16

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