SCIENCE BASED PRACTICE:SCIENCE BASED PRACTICE:WHAT IT MEANS &WHY?? WHAT IT MEANS &WHY??

Dr.Remya Krishnan, PhD ( Ayurveda)

Associate Professor (Applied Pharmacology)

Special Thanks to:

Dr.Rajkumar ,PhD (Ayurveda)

Associate Professor ( Diagnostics ),

RGAMC, Mahe ( Govt of Puducherry)

drremyaraj@gmail.com

SO MANY QUESTIONS . . . SO MANY QUESTIONS . . . Evidence-Based Practice (EBP): What is the best approach

for curing an infective fever in apatient?What clinical practice guidelines are provided by the science

pertinent to the situation in specific in this patient in specific ?

Here we need to do these things : 1. Know the science

2. Recognise the science 3. Appraise the clinical situation by science. 4. Appraise the patient by science 5. Translate the “science of treatment” into the patient . 6. Evaluate the result based on science

Role of Basic science Role of Basic science Evidence-based practice (EBP) – utilizes the BASIC

SCIENCE evidence in making patient care decisions . EBP translates guidelines in Science into practice

Science of Ayurveda comprises of siddhanthas ( Basic Science evidence ) and tatwas (Applied Science evidence) in the form of practice guidelines and reminders to be employed in medical decision process.

Applied Research (R) - applies a standardised methodology based on Basic science by employing science based guidelines in diagnosis / management of a particular clinical situation in a particular patient

Important in delivery of evidence Avoid team work , make independent science based evidence

based decisions (“ shastram jyothi: prakashaartham darshanam buddhiratmanah”)

Call for independent scientific reasoning and application On the target application of science based guidelines . Evaluation and documentation of outcome based on scientific

parameters .

Evidence must begin from Science and ends in Science

WHAT IS EVIDENCE-BASED PRACTICE? Conscientious use of Patient and Situation oriented

Science Based Evidence (SBE) to make TIMELY decisions

What is required ?

1. Appraisal of patient based on parameters in

science

2. Appraisal of disease and state and stage of the

disease based on parameters in science

3. Translation of outcome of appraisal ( SBE) into the

patient infront .

LEVELS OF EVIDENCE IN DIAGNOSIS LEVELS OF EVIDENCE IN DIAGNOSIS III Evidence – Diagnosis of the disease by Roga

pareeksha (nidana panchaka) parameters in science

( Silver evidence) II Evidence – Diagnosis of hetu and roga ( Golden

evidence ) I Evidence – Diagnosis based on the patient response

to the disease in specific (Diamond evidence) The same disease manifests with variable symptoms and intensity in separate individuals for which , there are specific scientific evidence based reasons.

Level 1 Evidence is the Diamond evidence in diagnosis

LEVELS OF EVIDENCE IN TREATMENT LEVELS OF EVIDENCE IN TREATMENT

III Evidence- Science based guidelines against the disease in general ( Silver evidence )

II Evidence- Science based guidelines against the cause and the disease- hetu and vyadhi ( Golden evidence )

I Evidence- Science based guidelines targeted to the patient specific response to the disease (Diamond evidence)

Level I Evidence is the Diamond evidence in treatment

EVIDENCE-BASED PRACTICEEVIDENCE-BASED PRACTICE

The process of doing the “right thing” in the “right situation” in “right time” (samyak prayoga – siddhi).

Adopt: Accurate Clinical guidelines ( science based

rationale) Logical reasoning based on intended guidelines Identify key/critical activities that must occur in predictable manner Protocols Detailed procedures for implementing the actions in guidelines

QUALITY IMPROVEMENTQUALITY IMPROVEMENT

Process that utilizes a system to monitor and evaluate the quality and appropriateness of care based on evidence-based practice and research

ASPECTS OF QUALITY IMPROVEMENTASPECTS OF QUALITY IMPROVEMENT On-going process to improve quality of care Every individual doctor with clear scientific knowledge ,

knowledge based aims and clear outcome measures of results are to be achieved based on evidence based guidelines

Implementing TRANSFORMATION from the current erroneous “Medicine oriented approach “to “Science oriented approach” in all Ayurvedic teaching institutes , hospitals and clinics by proper education for evidence based practice and providing circulating guidelines and reminders on the same . Evaluate the process changes to see if changes are being uniformly applied and evaluated

FOCUS FOCUS

1. What are we trying to accomplish? Approval for

science and attainment of patient health or approval of drug and attainment of wealth?????

2. How will we know and establish that the

change we perform is an improvement?

3. How can we improve in science based medical

practice and constantly update ourselves in

knowledge ??

Science based GUIDELINESScience based GUIDELINES

Need both qualifiable as well as quantifiable measures Need to know the difference between your practice and

Science based practice Education on science based evidence based guidelines Data bases on science based guidelines for diagnosis

and management .

BARRIERS TO EVIDENCE-BASED PRACTICEBARRIERS TO EVIDENCE-BASED PRACTICE

Lethargic community . Lack of professional attitude and enthusiasm for

intellectual growth. Organizational constraints – lack of support from

governing bodies and organizations of Ayurveda towards Science Based Evidence Based Ayurveda .

Peer pressure to continue with practices that are steeped in tradition – “we’ve always done it this way and we are not changing now”

BARRIERS TO EVIDENCE-BASED PRACTICEBARRIERS TO EVIDENCE-BASED PRACTICE

Lack of knowledge/awareness unfamiliar with scientific intentions , science based guidelines and guideline accessibility

Lack of confidence in the guideline developement and utilisation

Inability to incorporate these guidelines into the clinical decision making process

ARE WE WRONG?!ARE WE WRONG?!

Conduct a self appraisal on the reasons for your diffidence as a medical practitioner ?

Admit your failures as failures as soon as you realise them .

Admit your mistakes as mistakes as soon as you recognise them.

Admit your ignorance as ignorance . Recognition of self ignorance immensely help us for

intellectual progress . Get rid of ego, pride and all negative emotions . Get ready for learning , arguments in science and

application of science in practice !

Science based practice is integral Science based practice is integral

Science and Science based evidence based practice are integral to the delivery of quality patient care

Each informs the other and improves upon the other It requires dedication to science and compassion to

serve humanity , burning desire to develop independent vision in science and scientific reasoning skills (shastra sahitha tarka), creativity, leadership and thereby succeed in profession.

“Doing the right thing” in all these areas contributes to an environment of excellence, quality patient care and professional satisfaction !

You are a Change Agent !

Welcome , Ayurvedic community !!