Evidence-based practice –new direction in medical education
Jitendra D. Lakhani
Professor & Head, Department of Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth,
Piparia, Vadodara-391760, Gujarat, India
The world is changing and we are learning new ways of living. In today's technologically advanced world of computers and internet, there is explosion of information of all kinds. Electronic data, guidelines and medical information are available round the clock at bedside and in doctor's consulting office through smart phones, tablets and computers. Lay people also have easy access to information – most of which might not be reliable. Media, computers and internet have information which may be conflicting. Patients get confused about available information and are not able to judge right, partly right and wrong notifications. Even scientific journals also have conflicting reports.
The question which may arise in one's mind is - why medical world today is insisting that doctors should practice medicine which is evidence based? The answer is, being evidence based yet combined with clinical experience and patient's preferences, therapy decided by EBM is rational, authentic, most feasible and thus, very effective. The support for gathering evidence is available through electronic records, randomized controlled trials, meta-analysis and critically appraised studies which can be easily accessed even bedside through modern gadgets. This can be a great help in day to day practice provided that one is equipped with skills of getting right kind of information within short time, such that precious time for decision making and patient counseling is not imperiled. EBM teaches to select the most reliable and useful information of the available and make it applicable to the individual patient.
Evidence based Medicine (EBM) is one of the most revered tool of today's era that all healthcare personnel like doctors, dental surgeons, nurses, physiotherapists, pharmacists and healthcare administrators should be able to use. Effective application of this contrivance, ‘EBM practice' known as EBP (evidence based practice) is admired by academicians, administrators and economists all over the world because it is rational, predictable and financially prudent; information is based on recent evidences and so has practical applicability. EBP if used in day to day management of patients is definitely useful in a given patient and also in decision making for community. Rich body of knowledge and treatment strategy which may be derived through hypothesis, pathogenic mechanism and expert's experience may not be untrue but today's medical world needs validation. Evidence has to be generated for objectivity. Imperialism would be replaced with evidence based concepts. Tomorrow’s health professionals may face this paradigm shift as the highest challenge. Priming the concept of EBM in learning phase will make them more confident and skillful. Community acceptance also may be better when evidence based care is practiced. Visionaries, Administrators and Medical Educators of Sumandeep Vidyapeeth, have taken a lead in the technology based medical education by incorporating EBM as part of curricula in all medical and paramedical courses. The university has adapted EBES (Evidence Based Education System) - a system by which evidence based education is integrated with conventional medical teaching with a vision to empower tomorrow's health care professionals in technologically advanced system of medicine. To inculcate culture and concept of EBM in medical and paramedical undergraduate students may need innovations. Practice of EBM may be targeted at needs of an individual and also of community. Again the evidence generation at both local and global level is a work of tomorrow's health professionals. At Sumandeep Vidyapeeth, medical students are involved in the community project done under banner of "Evidence Generating Community Health Project" (EviGenCHIP),a process by which scientific evidence is generated by taking up community problem and finding out best solution which is based on the philosophy of PSBH (Problem Solving for Better Health which was pioneered by "Dreyfus Health Foundation, New York Our idea is to let "EBM" and "Evidence based healthcare" be domain of everybody and not of few medical intellectuals. EBM is not an expert's prefecture or a new subspecialty. Let us not make it a "holy cow", which is worshipped only, but use to its fullest for better healthcare and decision making – for community.
Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of Rural Bengal
Dr Avisek Guptar1, Dr Gautam Sarker2*, Dr Palash Das3, Dr Kashif Shahnawaz4, Dr Ranabir Pal5
1 Demonstrator,Bankura Sammilani Medical College, Bankura,West Bengal
2 Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital Kishanganj-855 107, Bihar, India.
3 Associate Professor, College of Medicine and Sugore Dutta Hospital, Kolkata
4 Assistant Professor, Department of Community Medicine,MGM Medical College, Bihar, India
5 Additional Professor, Community Medicine and Family Medicine, All India Institute of Medical Science, Jodhpur,Rajasthan-342005, India
Introduction: Adolescent population at the crossroad of childhood and adulthood start to pick lifestyle related risk
factors for cardiovascular diseases.
Methods: To find out the prevalence of lifestyle associated cardiovascular risk factors and risk correlates a study
was conducted among 452 adolescent students of class IX-XII of four higher secondary schools; males
Effects of Cryotherapy on sensation and pinch strength
Bhairavi Bhandari1, Lata Parmar2.
1PG Student; 2Principal, College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Vadodara-391760,
Background: Cryotherapy is commonly used in physical therapy with many known benefits; many patients are
treated with cryotherapy, but the effects of cryotherapy on sensation and pinch strength are not conclusive. The
purpose therefore was to know the effects of cryotherapy on sensation and pinch strength.
Methods: An experimental study, thirty females, aged 18 to 26 years participated. Baseline measurements were
taken for sensation and pinch strength. Participants were asked to immerse their hand in 100 of cold water for
fifteen minutes; post Cryotherapy measurements of TPD and pinch strength were taken. Aesthesiometer used to
measure TPD and pinch gauge hydraulic dynamometer was used to measure pinch strength.
Results: Wilcoxon Signed Ranks Test was used for analysis. The z-scores although negative, TPD sensations…
Effect of obstructive sleep apnea on hypertension
Akkara S A1, Shah D A2, Akkarra A G3, Singhania A A4
1Professor & HOD; 2Associate Professor, Dept. of Respiratory Medicine
3Professor & HOD; 4Associate Professor, Dept. of Otorhinolaryngology and Head and Neck Surgery
Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Campus, Piparia, Waghodia,
Vadodara, Gujarat – 391760.
Aim: To find out using the Berlin questionnaire the presence of high risk of Obstructive Sleep Apnea Syndrome
(OSAS) in patients of hypertension and to find its relation with severity of hypertension.
Methods: All patients of essential hypertension undergoing treatment in our institute were included in the study.
All patients filled up the Berlin questionnaire. The questionnaire was scored for positivity and the data was
analysed for rate of positivity and relationship with severity of hypertension.
Results and discussion: 964 patients were included in the study.…
A research study on morbidity including Silicotuberculosis among the mine workers of Rajasthan
Prakash Tyagi1*, Rajesh Mehta2
1Executive Director, GRAVIS, India.
2Prof & Head, Dept of Community Medicine, GMERS Medical College, Valsad, Gujarat, India
Background: Stone mines of Western Rajasthan are famous worldwide for its sandstone and white marble. In the
drought-stricken state of Rajasthan (in particular in its Western part) mining provides essential support to
livelihood generation to more than 2 million people. Mineworkers in these mines work in unsafe conditions, are
underpaid, undernourished and suffer with various health problems like silicosis and tuberculosis. This inspired us
to estimate the morbidity profile of the mine workers in Jodhpur district of Rajasthan.
Material and methods: Using purposive sampling, 221 workers who responded to an appeal for health check up
at the various mines and/or at the residential habitats were selected and conducted between August 2009…
Comparative evaluation of microbial colony counts on sutures with and without use of periodontal pack: a split mouth, randomized controlled study
Shah M A1*, Shah B K2, Dave D H3, Shah S S4
1,2Professor; 3Professor & HOD; PG Student, Department of Periodontics, KMSDCH, Sumandeep Vidyapeeth,
Piparia, Vadodara-391760, Gujarat, India
Background & Aim: Periodontal dressings are commonly used following surgical procedures due to varied
reasons. Though several studies have been done on periodontal dressings, not many have stressed upon the
microbial load due to plaque retention. This study was undertaken to evaluate the use of the periodontal dressing
following routine periodontal flap surgery to no dressing, in terms of added microbial load due to increased plaque
Methods: 20 patients from the Dept. of Periodontics, K. M. Shah Dental College and Hospital, undergoing flap
surgical procedures in bilaterally identical areas were selected. Following the flap surgical procedure, half…
Protective effect of ethanolic extract of seeds of Coriandrum sativum l. in acetic acid-induced ulcerative colitis in male wistar rats
S.Poojari1, R.Bhargavi2, M. Mohan*3
1,2Assistant Professor; 3Professor & Head, Department of Pharmacology, Priyadarshini College of
Pharmaceutical Sciences, Narapally, Chowdaryguda (V), Ghatkesar (M), R.R.District, 500088, Andhra Pradesh
Objective: To evaluate the protective effect of ethanolic extract of dried seeds of Coriandrum sativum L. (C.sativum) in acetic acid-induced ulcerative colitis in rats.
Methods: Male Wistar rats were divided into various treatment groups (n=5). The animals were administered with 2ml of acetic acid (4% v/v) via intrarectal route to induce colitis. Prednisolone (2mg/kg) was used as a standard drug and C.sativum was administered at a dose of 100 and 300 mg/kg p.o. Macroscopic scoring, colon weight to length ratio, colonic superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), lipid peroxidation
(LPO), myeloperoxidase (MPO) levels and histopathological changes were recorded after the treatment regimen of 11 days.
STUDENT RESEARCH COMMUNIQUÉ
Prehypertension and its correlation with cardiovascular risk factors – A study among health sciences students in Malaysia
Mohit Shahi1*, Chow Wen Li2
1Senior Lecturer; 2Student, Department of Pathology, School of Medicine, Taylor's University, Subang Jaya,
Introduction: The levels of blood pressure (BP) are important as it is a potential risk factor that predisposes towards cardiovascular disease (CVD) when the levels are high. After the introduction of the term prehypertension by Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) (2004), there are heightened interests on the correlation between high-normal levels of BP with CVD risk factors.
Methodology: A questionnaire containing information about eating habits, family history and social habits was given out. Other than that, anthropometric measurements were taken according to the protocol provided by the United States Institutes of Health.
Results: There were a total of 87 respondents that participated in…
Orthodontic considerations of extraction – A review
Mallikarjun Reddy 1, Santosh Kumar Goje2, Zarana Purohit3, Kunal Patel4
1Reader; 2Professor & HOD; 3,4MDS Student, Dept. of Orthodontics, K.M. Shah Dental College and hospital,
Sumandeep Vidyapeeth, Piparia. – 391760
Incorporation of soft tissue consideration, retention, changing trend in appliance design and treatment biomechanics has led to a lot of controversy in decision of extraction in orthodontics. Hence an attempt was made to review the orthodontic considerations for the choice of extraction in an orthodontic treatment. The literature was refined with the advanced search option for case reports, meta-analysis, and randomized control trial, retrospective
and prospective studies. We observed that extraction of second premolar was more advantageous in orthodontic treatment.
Key words: Extraction, Malocclusion, Therapeutic extraction.
CASE REPORT/CASE SERIES
Jess Fixator : an alternative for treating 1st metatarsal head fracture
Smit Navin Shah 1, Yogesh Bapuji Patil 2, Haard Joshi 3, Paresh P. Golwala 4
1 Assistant Professor, 2, 3 PG student, 4 Professor & Head, Department of Orthopaedics, SBKS Medical
Institute & Research Centre & Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara
First Metatarsal head bears the major part of the transmitted forces in foot in weight bearing and gait. Hence managing first metatarsal head fracture needs a sound approach to achieve a good post injury functional life especially in a young active individual. JESS Fixator working on principle of ligamentotaxis has been used in fractures at various other sites. Same principle can also be used for intra articular fractures of first metatarsal head as described in the presenting case of a young male labourer. Thus it is an innovative method to address such vital fractures…
Unusual bony metastasis in a case of Oesophageal Carcinoma
Shah J A1, Chauhan N V2, Singhania A A3, George A4
1Resident; 2Assistant Professor; 3Associate Professor; 4Professor & Head
Department of Otorhinolaryngology and Head and Neck Surgery SBKS Medical Institute & Research Center,
Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
Cancer oesophagus is the ninth most common cancer and is the sixth most common cause of cancer related deaths in the world. It usually presents in advanced stage with loco-regional node and visceral involvement. Bone metastasis is uncommon. Here we are reporting a case of a 55-year-old male, with progressive dysphagia to solids and semisolids for 1 year. Rigid endoscope guided biopsy confirmed that histology was well differentiated squamous cell carcinoma. Computed Tomography (CT) scan of the neck and thorax revealed oesophageal malignancy with enlarged neck lymph nodes on left side and metastasis in left greater wing of sphenoid, part oftemporal bone and lateral…
LETTER TO EDITOR
Family health exercise: Our experience at KIST Medical College, Nepal
Rano Mal Piryani1, Suneel Piryani2, Amita Pradhan3, Srijana Pandey4, Ang Sherpa5, Trilok Pati Thapa6,
Balmansingh Karki7, Mahesh Khakurel8 , Bimala Shrestha9
1, 3-9Nepal Police Hospital & Nepal Police Medical College, Maharajganj Kathmandu, Nepal
2Institute of Medicine, Maharajganj Kathmandu, Nepal