Introduction

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introduction to Clinical Epidemiology by Diederick E. Grobbee, MD

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Introduction

  1. 1. Introduction Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
  2. 2. Clinical Epidemiology <ul><li>The use of epidemiologic principles and methods to address questions with relevance to patient care </li></ul><ul><li>Inherently multidisciplinary </li></ul><ul><li>Not a science, but a discipline to be applied in medical science </li></ul>
  3. 3. The Basics of Clinical Epidemiologic Study Design <ul><li>From a relevant question to a valid answer </li></ul><ul><li>The epidemiologic method provides an architecture for design and interpretation of applied clinical research </li></ul>
  4. 4. Challenges in clinical practise (hierarchical) <ul><li>1. Explanation of clinical profile: given the patient profile, what is the patient's illness? </li></ul><ul><li>Explanation of illness: &quot;Why did this illness occur in this patient at this time?“ </li></ul><ul><li>Prediction of course: given the patient's illness, its etiology, the clinical and non-clinical profile, etc., what will be the future course of </li></ul><ul><ul><li>the illness </li></ul></ul><ul><ul><li>its manifestations, depending on (absence of) treatment </li></ul></ul><ul><li>Treatment decision </li></ul><ul><li>Treatment execution </li></ul>
  5. 5. <ul><li>Challenge 1-3 require knowledge </li></ul><ul><li>Diagnostic knowledge </li></ul><ul><li>Etiologic knowledge </li></ul><ul><li>Prognostic knowledge </li></ul><ul><li>FOCUS OF CLINICAL EPIDEMIOLOGY </li></ul>
  6. 6. Clinial epidemiological study design <ul><li>Mission: </li></ul><ul><li>Design of the occurrence relation </li></ul><ul><li>Design of the data collection (study design proper) </li></ul><ul><li>Design of the data analysis </li></ul>
  7. 7. Occurrence relation <ul><li>Occurrence of outcome as a function of determinants within a certain clinical domain (type of patients) </li></ul><ul><li>outcome = f (D) </li></ul><ul><li>Elements: </li></ul><ul><li>1. determinant(s) </li></ul><ul><li>2. outcome </li></ul><ul><li>3. domain </li></ul>
  8. 8. Domain <ul><li>Type of patients to whom the results of the study should (ideally) be applicable </li></ul><ul><li>Speaks on generalisability </li></ul><ul><li>Not restricted to study population (eg., UMMC, 2002) </li></ul><ul><li>“ Package insert” of a study </li></ul>
  9. 9. Study design critically depends on clinical problem / challenge <ul><li>diagnostic research </li></ul><ul><li>etiologic research </li></ul><ul><li>prognostic research </li></ul><ul><li>intervention / therapeutic research </li></ul><ul><li>Each has particular characteristics with </li></ul><ul><li>a major impact on study design </li></ul>
  10. 10. Two main types of clinical epidemiologic research: <ul><li>Descriptive: Prognostic or Diagnostic </li></ul><ul><li>Causal: Etiologic (incl. intervention) </li></ul>

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