MM20802

EPIDEMIOLOGY IN CLINICAL
PRACTICE

LECTURE 1
USE OF
EPIDEMIOLOGY IN
CLINICAL PRACTICE

AP DR AZIZAN OMAR
11 MARCH 2024

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 LEARNING OBJECTIVES
MM20802
EPIDEMIOLOGY IN CLINICAL
PRACTICE
1. Define Clinical Epidemiology
2. Describe Clinical Epidemiology LECTURE 1
USE EPIDEMIOLOGY IN CLINICAL
in the practice of medicine PRACTICE

3. Discuss the use of clinical

epidemiology in prevention
AP DR AZIZAN OMAR
11 MARCH 2024
and disease management

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 CASE SCENARIO

How do we make the diagnosis?

What is the best test/ investigation?
What could be the causes?
What is the best treatment plan?
What is her prognosis?
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 HOW DO WE MAKE A DECISION?

Knowledge of the PATIENT’S CHOICE

disease mechanism Informed decision?
Insufficient? Outdated? Values, Belief
Support, Financial

CLINICAL RESEARCH
Evidence-based
Relevant? Updated?
Clinician’s own Validity of evidence
experience
Limited? Bias? Case
differences
CLINICAL
EPIDEMIOLOGY 4
 BASIC EPIDEMIOLOGY
Epidemiology is the study of the distribution and
determinants of health-related states or events (including
disease), and the application of this study to the control of
diseases and other health problems
(Porta, 2014; Ward,2012)

Epidemiology is a basic science that is concerned with the

pattern of disease frequency in the human population - the
distribution of disease by time, place, and person

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 DIFFERENT TYPES OF EPIDEMIOLOGY
1. Descriptive Epidemiology
Focus: Examines the distribution of disease
patterns in terms of time, place, and person.
Purpose: Identifies trends and provides a
foundation for further analytical studies.
2. Analytical Epidemiology
Focus: Investigate the causes and risk factors
of diseases.
Purpose: Aims to establish associations
between exposures and outcomes, helping
understand the underlying mechanisms.
3. Clinical Epidemiology
Focus: Integrates epidemiological methods into
clinical practice.
Purpose: Enhances evidence-based medicine in
making decisions on patient care including
diagnosis, treatment, and management.
NCD Epidemiology
CD Epidemiology
4. Molecular Epidemiology
Focus: Explores the genetic and molecular
factors influencing disease occurrence.
Purpose: Provides insights into the genetic basis
of diseases and their interactions with
environmental factors.
5. Social Epidemiology
Focus: Examines how social factors impact
health and disease.
Purpose: Investigate social determinants of
health, such as socioeconomic status,
education, and community structures.
6. Environmental Epidemiology
Focus: Studies the relationship between
environmental exposures and health outcomes.
Purpose: Identifies and assesses the impact of
environmental factors on public health.
CLINICAL EPIDEMIOLOGY
Clinical epidemiology is the application of epidemiological
principles to clinical issues such as diagnosis, treatment,
and assessment of disease risk and prognosis aimed to
provide an evidence base for clinical care
(Baron, 2015)

Clinical epidemiology is the science of making

predictions about individual patients by counting
clinical events in groups of similar patients and using
strong scientific methods to ensure that the
predictions are accurate.
(Fletcher,2005)

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BASICS OF CLINICAL EPIDEMIOLOGY

https://www.intechopen.com/chapters/44573 8
USE OF CLINICAL EPIDEMIOLOGY IN MEDICINE

BRIDGE BETWEEN

RESEARCH CLINICAL PRACTICE

Evidenced-based data Enhance patient care
Improve outcomes
Advancement in medical practice

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USE OF CLINICAL EPIDEMIOLOGY IN MEDICINE
Outcome research –effectiveness, safety &
1 impact on patients from medical intervention,
treatment & healthcare practices

Risk assessment–quantify the risk associated

2 with certain diseases, treatment, or
interventions

Diagnostic test evaluation –assess the

3 accuracy of a diagnostic test (sensitivity-
specificity) and the limitations

RCTs –evaluate the efficacy of interventions

RESEARCH 4 and advancement of knowledge using clinical
trials
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USE OF CLINICAL EPIDEMIOLOGY IN MEDICINE

Evidence-Based Medicine–clinicians make the

decision based on the best and most updated
evidence available
1

Clinical Practice Guidelines –standardized

recommendations for diagnosis, treatment,
and management of certain conditions
2

Quality Improvement –identify areas for

improvement, assess the impact of 3 CLINICAL
interventions & optimise patient care
PRACTICE
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CLINICAL EPIDEMIOLOGY – PREVENTION & DISEASE

Aims THE ‘DEPTh’ MODEL

Study Diagnostic Etiologic

Challenge Challenge

Clinical
Research

Solid Prognostic Therapeutic

Evidence Challenge Challenge

Clinical
Decision (Grobbee, 2014)
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CLINICAL EPIDEMIOLOGY – PREVENTION & DISEASE

THE ‘DEPTh’ MODEL

DIAGNOSTIC CHALLENGE

• Interpretation of patient’s signs and symptoms

• Interpretation of lab/ investigation results
• How certain is the diagnosis?

• What are other possibilities?

• What evidence are available to support this?
• Case- report? Clinical trials?
• Specificity and sensitivity of the test?

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CLINICAL EPIDEMIOLOGY – PREVENTION & DISEASE

THE ‘DEPTh’ MODEL

ETIOLOGIC CHALLENGE
• What are the causes?
• Risk factors/ health determinants?

• Sometimes causes are not important at the initial

management stage eg; acute appendicitis
• Sometimes is difficult to determine eg; leukemia

• But knowing the cause can help to understand the

disease process
• Important in disease prevention

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CLINICAL EPIDEMIOLOGY – PREVENTION & DISEASE

THE ‘DEPTh’ MODEL

PROGNOSTIC CHALLENGE
• Evidence to estimate patient’s prognosis
• Important for the patient and clinician
• Patient – likelihood of survival, remission, relapse
• Clinician - choice of best intervention or
treatment
• What is the prognosis if treatment is not given?
• The benefits & harms of the treatment –
therapeutics challenge

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CLINICAL EPIDEMIOLOGY – PREVENTION & DISEASE

THE ‘DEPTh’ MODEL

THERAPEUTIC CHALLENGE

• Evidence for the best treatment

• Will the treatment improve the prognosis?
• What are the effects of the treatment on the
course of the disease?
• Benefits? Harms? Side-effects?
• Cost-effectiveness
• Financial and economic burdens

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 REFERENCES

Baron, John A., Henrik Toft Sørensen, and Harold C. Sox, 'Clinical epidemiology', in Jørn Olsen, and others (eds), Teaching
Epidemiology: A guide for teachers in epidemiology, public health and clinical medicine, 4th edn (Oxford, 2015; online
edn, Oxford Academic, 18 June 2015)

Fletcher RW, Fletcher SW. . Clinical Epidemiology: The Essentials. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;
2005: 3, 45

Grobbee, D. E., & Hoes, A. W. (2014). Clinical epidemiology: principles, methods, and applications for clinical research.
Jones & Bartlett Publishers.

IntechOpen - Clinical Epidemiology and Its Relevance for Public Health - https://www.intechopen.com/chapters/44573

Porta M, editor. A Dictionary of Epidemiology. 6th ed. Oxford University Press; 2014

Ward H, Toledano MB, Shaddick G, Davies B, Elliott P. Oxford Handbook of Epidemiology for Clinicians: OUP Oxford; 2012.
2012/05/24/. 417 p

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