1. Indian Rheumatology: New Horizons, New Hopes
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
Date : 27th November Time : 10 am to 1 pm
Venue : AIIMS (Jawaharlal Auditorium) Delhi

4. Relationship between incidence & prevalence
Recovery
Death

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

6. Outline of presentation
Key messages
HFA
Thoughtful physicians: Difficult Questions
EBM
Measurement Iterative Loop
COPCORD / WHO / ILAR Studies
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
DIAGNOSIS
THERAPY
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. preventive interventions
Role of physicians in
preventive interventions
Provision of direct preventive services
Management & organization of preventive health services within medical care system
Advocacy within clinical settings,
communities & organized medicine

12. Outline of presentation
Key messages
HFA
Thoughtful physicians: Difficult Questions
EBM
Measurement Iterative Loop
COPCORD / WHO / ILAR Studies
In conclusion ……

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

23. Outline of presentation
Key messages
HFA
Thoughtful physicians: Difficult Questions
EBM
Measurement Iterative Loop
COPCORD / WHO / ILAR Studies
In conclusion ……

24. Thoughtful Physicians : Difficult Questions - 1
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)

25. Thoughtful Physicians : Difficult Questions - 2
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?