1. The Bone & Joint Decade - India An IRACON 2003 Indian Rheumatology: New Horizons, New Hopes Artichoke of Population Studies & Clinical Practice Dr Rajesh Pandav, Dr. Denish Moorthy, Dr Binod Patro, Dr Hemant Shukla, Dr Chandrakant S Pandav

4. Recovery Death Incidence Relationship between incidence & prevalence Prevalence

5. Burden of Illness (Assessment) Etiology or Causation Community Effectiveness Efficiency Synthesis & Implementation of Program Monitoring & Reassessment Policy Process Measurement Iterative Loop Diagnosis Therapy Prognosis

6. Outline of presentation 1) Key messages 2) HFA 3) Thoughtful physicians: Difficult Questions 4) EBM 5) Measurement Iterative Loop 6) COPCORD / WHO / ILAR Studies 7) In conclusion ……

7. Clinical Practice Guidelines -Busy Clinician -Information overload -Wide variability in patient care -Need to develop CLINICAL PRACTICE GUIDELINES

8. Practicing EBM: The Needs Evidence-based approach to patient care create the NEED for Clinical Practice Guidelines THERAPY DIAGNOSIS PROGNOSIS

9. Artichoke of Population Studies and Clinical Medicine – 1 Health of patients: -individual patient -patient groups Physicians need to identify & address factors: -patient’s family -community Community: -A resource for physicians

10. Artichoke of Population Studies and Clinical Medicine - 2 To reduce burden of disease: -Integration of disease prevention & - health promotion into routine medical care Chronic diseases: -multiple causes or exacerbating factors -variety of interventions -at multiple levels A population-based perspective: -helpful in chronic disease management

11. Role of physicians in preventive interventions 1) Provision of direct preventive services 2) Management & organization of preventive health services within medical care system 3) Advocacy within clinical settings, communities & organized medicine

12. Outline of presentation 1) Key messages 2) HFA 3) Thoughtful physicians: Difficult Questions 4) EBM 5) Measurement Iterative Loop 6) COPCORD / WHO / ILAR Studies 7) In conclusion ……

13. Health for All Communities Families Societies Individuals Health system Aging of the population Science & technology Information & communication Equity & social justice Determinants of health Gender Human rights Biological Environmental Behavioural Socio-economic Socio-cultural

23. Outline of presentation 1) Key messages 2) HFA 3) Thoughtful physicians: Difficult Questions 4) EBM 5) Measurement Iterative Loop 6) COPCORD / WHO / ILAR Studies 7) In conclusion ……

24. 1)How may I be thorough YET efficient when considering the possible causes of my patient’s problem? 2)How do I characterize the information I have gathered during the medical interview & physical examination? (Probability - Utility) 3)How should I interpret new diagnostic information? (Probability) Thoughtful Physicians : Difficult Questions - 1

25. 4)How do I select the appropriate diagnostic test? (Treatment, Threshold, Probability) 5)How do I choose among several risky treatments? (Expected Value Decision Making) 6)How do I know, how is my patient doing? Thoughtful Physicians : Difficult Questions - 2