Clinical epidemiology

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Clinical epidemiology is a subfield of epidemiology specifically focused on issues relevant to clinical medicine. The term was first introduced by virologist John R. Paul in his presidential address to the American Society for Clinical Investigation in 1938. [1] [2] It is sometimes referred to as "the basic science of clinical medicine". [3]

Contents

Definition

When he coined the term "clinical epidemiology" in 1938, John R. Paul defined it as "a marriage between quantitative concepts used by epidemiologists to study disease in populations and decision-making in the individual case which is the daily fare of clinical medicine". [4] According to Stephenson & Babiker (2000), "Clinical epidemiology can be defined as the investigation and control of the distribution and determinants of disease." [5] Walter O. Spitzer has highlighted the ways in which the field of clinical epidemiology is not clearly defined. However, he felt that, despite criticism of the term, it was a useful way to define a specific subfield of epidemiology. [6] In contrast, John M. Last felt that the term was an oxymoron, and that its increasing popularity in many different medical schools was a serious problem. [4]

Clinical epidemiology aims to optimise the diagnostic, treatment and prevention processes for an individual patient, based on an assessment of the diagnostic and treatment process using epidemiological research data. [7] [8] A central tenet of clinical epidemiology is that every clinical decision must be based on rigorously evidence-based science. The objectives of clinical epidemiology are primarily to develop epidemiologically sound clinical guidelines and standards for diagnosis, disease progression, prognosis, treatment and prevention. The data obtained in epidemiological studies are also applicable for the epidemiological justification of preventive programmes for communicable and noncommunicable diseases. [9]

There are various types of epidemiological studies in use: case-control studies, cohort studies, experimental controlled randomised trials (RCTs). Experimentation, in general, is a general scientific method of testing causal hypotheses by means of an intervention (controlled influence) in the natural course of the phenomenon under study. In order to assess the result of the intervention, the experiment necessarily involves comparable groups - experimental and control, i.e. the study is controlled. The division of patients into groups should be done casually, by randomisation.[ citation needed ]

A key aspect of clinical epidemiology is the evaluation of the effectiveness of treatment and prevention medicines. [10] The effectiveness of preventive and curative medicines is divided into potential effectiveness (the maximum achievable effect of interventions at a given level of science) and real effectiveness (the effect that is available in practice).[ citation needed ]

See also

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Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.

<span class="mw-page-title-main">Epidemiology</span> Study of health and disease within a population

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in a defined population.

A cohort study is a particular form of longitudinal study that samples a cohort, performing a cross-section at intervals through time. It is a type of panel study where the individuals in the panel share a common characteristic.

<span class="mw-page-title-main">Preventive healthcare</span> Prevention of the occurrence of diseases

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

<span class="mw-page-title-main">Travelers' diarrhea</span> Stomach and intestinal infection

Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool while traveling. It may be accompanied by abdominal cramps, nausea, fever, headache and bloating. Occasionally bloody diarrhea may occur. Most travelers recover within three to four days with little or no treatment. About 12% of people may have symptoms for a week.

<span class="mw-page-title-main">Women's Health Initiative</span> Long-term U.S. health study

The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three clinical trials (CT) and an observational study (OS). In particular, randomized controlled trials were designed and funded that addressed cardiovascular disease, cancer, and osteoporosis.

<span class="mw-page-title-main">Number needed to treat</span> Epidemiological measure

The number needed to treat (NNT) or number needed to treat for an additional beneficial outcome (NNTB) is an epidemiological measure used in communicating the effectiveness of a health-care intervention, typically a treatment with medication. The NNT is the average number of patients who need to be treated to prevent one additional bad outcome. It is defined as the inverse of the absolute risk reduction, and computed as , where is the incidence in the control (unexposed) group, and is the incidence in the treated (exposed) group. This calculation implicitly assumes monotonicity, that is, no individual can be harmed by treatment. The modern approach, based on counterfactual conditionals, relaxes this assumption and yields bounds on NNT.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 80 different hierarchies have been proposed for assessing medical evidence. The design of the study and the endpoints measured affect the strength of the evidence. In clinical research, the best evidence for treatment efficacy is mainly from meta-analyses of randomized controlled trials (RCTs). Systematic reviews of completed, high-quality randomized controlled trials – such as those published by the Cochrane Collaboration – rank the same as systematic review of completed high-quality observational studies in regard to the study of side effects. Evidence hierarchies are often applied in evidence-based practices and are integral to evidence-based medicine (EBM).

David Lawrence Sackett was an American-Canadian physician and a pioneer in evidence-based medicine. He is known as one of the fathers of Evidence-Based Medicine. He founded the first department of clinical epidemiology in Canada at McMaster University, and the Oxford Centre for Evidence-Based Medicine. He is well known for his textbooks Clinical Epidemiology and Evidence-Based Medicine.

<span class="mw-page-title-main">Vaccine efficacy</span> Reduction of disease among the vaccinated comparing to the unvaccinated

Vaccine efficacy or vaccine effectiveness is the percentage reduction of disease cases in a vaccinated group of people compared to an unvaccinated group. For example, a vaccine efficacy or effectiveness of 80% indicates an 80% decrease in the number of disease cases among a group of vaccinated people compared to a group in which nobody was vaccinated. When a study is carried out using the most favorable, ideal or perfectly controlled conditions, such as those in a clinical trial, the term vaccine efficacy is used. On the other hand, when a study is carried out to show how well a vaccine works when they are used in a bigger, typical population under less-than-perfectly controlled conditions, the term vaccine effectiveness is used.

A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and non-governmental organizations (NGOs). Common types of interventions include screening programs, vaccination, food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity, drug, tobacco, and alcohol use, and the spread of infectious disease, e.g. HIV.

<span class="mw-page-title-main">Natural history of disease</span>

The natural history of disease is the course a disease takes in individual people from its pathological onset ("inception") until its resolution. The inception of a disease is not a firmly defined concept. The natural history of a disease is sometimes said to start at the moment of exposure to causal agents. Knowledge of the natural history of disease ranks alongside causal understanding in importance for disease prevention and control. Natural history of disease is one of the major elements of descriptive epidemiology.

Pharmacoepidemiology is the study of the uses and effects of drugs in well-defined populations.

<i>Journal of Clinical Epidemiology</i> Academic journal

The Journal of Clinical Epidemiology is a peer-reviewed journal of epidemiology. The journal was originally established as the Journal of Chronic Diseases in 1955 as a follow-up to Harry S. Truman's 1951 Presidential Task Force on national health concerns and the subsequently written Magnuson Report.

Population impact measures (PIMs) are biostatistical measures of risk and benefit used in epidemiological and public health research. They are used to describe the impact of health risks and benefits in a population, to inform health policy.

<span class="mw-page-title-main">Nutritional epidemiology</span> Field of medical research on disease and diet

Nutritional epidemiology examines dietary and nutritional factors in relation to disease occurrence at a population level. Nutritional epidemiology is a relatively new field of medical research that studies the relationship between nutrition and health. It is a young discipline in epidemiology that is continuing to grow in relevance to present-day health concerns. Diet and physical activity are difficult to measure accurately, which may partly explain why nutrition has received less attention than other risk factors for disease in epidemiology. Nutritional epidemiology uses knowledge from nutritional science to aid in the understanding of human nutrition and the explanation of basic underlying mechanisms. Nutritional science information is also used in the development of nutritional epidemiological studies and interventions including clinical, case-control and cohort studies. Nutritional epidemiological methods have been developed to study the relationship between diet and disease. Findings from these studies impact public health as they guide the development of dietary recommendations including those tailored specifically for the prevention of certain diseases, conditions and cancers. It is argued by western researchers that nutritional epidemiology should be a core component in the training of all health and social service professions because of its increasing relevance and past successes in improving the health of the public worldwide. However, it is also argued that nutritional epidemiological studies yield unreliable findings as they rely on the role of diet in health and disease, which is known as an exposure that is susceptible to considerable measurement error.

Antimicrobial stewardship (AMS) refers to coordinated efforts to promote the optimal use of antimicrobial agents, including drug choice, dosing, route, and duration of administration.

David DuPuy Celentano is a noted epidemiologist and professor who has contributed significantly to the promotion of research on HIV/AIDS and other sexually transmitted infections (STIs). He is the Charles Armstrong chair of the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. He holds joint appointments with the school’s departments of Health Policy and Management, Health Behavior and Society, and International Health, and the Johns Hopkins University School of Medicine’s Division of Infectious Diseases.

<span class="mw-page-title-main">Elizabeth Barrett-Connor</span>

Elizabeth Louise Barrett-Connor was Chief of the Division of Epidemiology and Distinguished Professor at the University of California, San Diego. She investigated the role of hormones in pathogenesis of cardiovascular disease, diabetes and osteoporosis.

References

  1. ↑ Paul, John R. (1938-09-01). "President's Address Clinical Epidemiology 1". The Journal of Clinical Investigation . 17 (5): 539–541. doi:10.1172/JCI100978. ISSN   0021-9738. PMC   434807 . PMID   16694597.
  2. ↑ Sackett, David L. (December 2002). "Clinical epidemiology". Journal of Clinical Epidemiology . 55 (12): 1161–1166. doi:10.1016/S0895-4356(02)00521-8. PMID   12547442.
  3. ↑ Dieckmann, K.-P.; Pichlmeier, U. (2004-04-01). "Clinical epidemiology of testicular germ cell tumors". World Journal of Urology . 22 (1): 2–14. doi:10.1007/s00345-004-0398-8. ISSN   1433-8726. PMID   15034740. S2CID   23425914.
  4. 1 2 Last, John M. (1988). "What Is "Clinical Epidemiology?"". Journal of Public Health Policy . 9 (2): 159–163. doi:10.2307/3343001. ISSN   0197-5897. JSTOR   3343001. PMID   3417857. S2CID   34722641.
  5. ↑ Stephenson, J M; Babiker, A (1 August 2000). "Overview of study design in clinical epidemiology". Sexually Transmitted Infections . 76 (4): 244–247. doi:10.1136/sti.76.4.244. PMC   1744174 . PMID   11026877.
  6. ↑ Spitzer, Walter O. (1986-01-01). "Clinical epidemiology". Journal of Chronic Diseases . 39 (6): 411–415. doi:10.1016/0021-9681(86)90107-4. ISSN   0021-9681. PMID   3711249.
  7. ↑ "Primary care epidemiology: its scope and purpose". academic.oup.com. Retrieved 2023-01-28.
  8. ↑ "Clinical Epidemiology". umock.com. Retrieved 2023-01-28.
  9. ↑ Daz-Vlez, Cristian; Soto-Cceres, Vctor; E., Ricardo; Apolaya Segura, Moiss A.; Galn-Rodas, Edn (2013). Clinical Epidemiology and Its Relevance for Public Health in Developing Countries. doi:10.5772/54901. ISBN   978-953-51-1121-4 . Retrieved 2023-01-28.{{cite book}}: |work= ignored (help)
  10. ↑ "Clinical Epidemiology - The epidemiological method in clinical practice and research". medicina.ulisboa.pt. 30 June 2011. Retrieved 2023-01-28.


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