Clinical epidemiology

2021 ◽  
pp. 149-160
Author(s):  
Fiona F. Stanaway ◽  
Naomi Noguchi ◽  
Clement Loy ◽  
Sharon Reid ◽  
Jonathan C. Craig
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Research ◽  
Clinical Epidemiology ◽  
Epidemiological Methods ◽  
Controlled Trials ◽  
Global Public Health ◽  
Relevant Study ◽  
Study Designs

Clinical epidemiology is a science that extends the principles and methods of epidemiology to clinical practice and clinical research. In this chapter, we provide an overview of clinical epidemiological methods and how these approaches can be used to improve global public health. We have focused primarily on using evidence in decision-making in this chapter, rather than study design and conduct elements, such as randomized controlled trials, which are covered in detail elsewhere. Consequently, we have provided a framework for critical appraisal and reporting of relevant study designs (how to use and report), rather than a detailed discussion about how such studies should be designed and conducted (how to do).

scholarly journals “Technologies of Reflexivity”: Generating Biopolitics and Institutional Risk to Supplement Global Public Health Security

2017 ◽  
Vol 8 (4) ◽  
pp. 658-685
Author(s):  
Mark L FLEAR
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Human Rights ◽  
Global Public Health ◽  
Health Security ◽  
Institutional Risk ◽  
Organisational Identity ◽  
Decision Making Processes ◽  
Scientific Technical ◽  
Multiple Levels

AbstractCritiques of global public health security (GPHS) and proposed solutions tend to overlook the potential of the individuals and groups that are subject to and governed by GPHS – “the governed” – to contribute their “on the ground” knowledge and experience to decision-making in order to improve regulatory responses. This article argues for the development of a more reflexive approach as a way of ensuring the epistemic integration of these knowledges with the scientific-technical knowledges that currently dominate decision-making processes. I identify human rights as the conceptual lens that is most likely to enable reflexivity by the governed and regulators, and understanding and communication between them. The governed can use perceived or actual breaches of human rights to articulate “on the ground” knowledges as institutional risks to reputation and standing and, in turn, threaten the production and legitimation of organisational identity, socio-political orders and projects of rule. The particular sensitivity of regulators to these risks could compel epistemic integration. This more reflexive approach to GPHS promises to improve the knowledge base, efficacy, accountability and legitimacy of decision-making at multiple levels: WHO, EU, national and “on the ground”.

Epidemiology

2021 ◽  
pp. 39-46
Author(s):  
Roger Detels
Keyword(s):  
Public Health ◽  
Epidemiological Methods ◽  
Human Populations ◽  
Human Pathogens ◽  
Related Factors ◽  
Public Health Professionals ◽  
Health Related ◽  
Specific Organ ◽  
Study Designs ◽  
Relationship Of

Epidemiology is the basic science of public health, because it is the science that describes the relationship of health and/or disease with other health-related factors in human populations, such as human pathogens. Furthermore, epidemiology has been used to generate much of the information required by public health professionals to develop, implement, and evaluate effective intervention programmes for the prevention of disease and promotion of health. Unlike pathology, which constitutes a basic area of knowledge, and cardiology, which is the study of a specific organ, epidemiology is a philosophy and methodology that can be applied to learning about and resolving a very broad range of health problems. It is not enough to know what the various study designs and statistical methodologies are. The ‘art’ of epidemiology is knowing when and how to apply the various epidemiological strategies creatively to answer specific health questions. The uses and limitations of the various epidemiological study designs are presented in this chapter to illustrate and underscore the fact that the successful application of epidemiology requires more than knowledge of study designs and epidemiological methods. This introductory chapter attempts to define epidemiology, to present ways in which epidemiology is used in the advancement of public health, and finally, to discuss the range of applications of epidemiological methodologies.

scholarly journals Minimal clinically important difference: The basics

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8149-e8149
Author(s):  
Julieta Aldana Salas Apaza ◽  
Juan Víctor Ariel Franco ◽  
Nicolás Meza ◽  
Eva Madrid ◽  
Cristobal Loézar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Research ◽  
Minimal Clinically Important Difference ◽  
Clinical Epidemiology ◽  
Evidence Synthesis ◽  
State Of Health ◽  
Current State ◽  
Clinically Important Difference ◽  
Basic Concepts ◽  
Patient’S Perception

This article is part of a collaborative methodological series of narrative reviews on biostatistics and clinical epidemiology. This review aims to present basic concepts about the minimal clinically important difference and its use in the field of clinical research and evidence synthesis. The minimal clinically important difference is defined as the smallest difference in score in any domain or outcome of interest that patients can perceive as beneficial. It is a useful concept in several aspects since it links the magnitude of change with treatment decisions in clinical practice and emphasizes the primacy of the patient’s perception, affected by endless variables such as time, place, and current state of health, all of which can cause significant variability in results.

scholarly journals COVID-19 Research: Challenges to Interpret Numbers and Propose Solutions

2021 ◽  
Vol 9 ◽  
Author(s):  
Marc J. Struelens ◽  
Paolo Vineis
Keyword(s):  
Public Health ◽  
Epidemiological Methods ◽  
Democratic Accountability ◽  
Research Issues ◽  
Research Themes ◽  
Public Data ◽  
Misleading Interpretation ◽  
Study Designs ◽  
Virus Emergence ◽  
Public Health Strategies

The response of the scientific community to the COVID-19 pandemic has been unprecedented in size, speed and discovery output. Within months of virus emergence, the SARS-CoV-2 genomics, replication, evolution and dissemination dynamics as well as natural history, infection risk and prognostic factors and biology of the disease have been gradually deciphered. More than 250 articles on COVID-19 published in Frontiers in Public Health have contributed to these insights. We discuss here some of the key research themes and challenges that have been addressed. We provide our perspective on current research issues with surveillance data quality and limitations of epidemiological methods. We warn against the potential misuse or misleading interpretation of public data of variable quality and the use of inadequate study designs for the evaluation of effect of non-pharmaceutical interventions. We conclude by interrogating possible public health strategies for pandemic control as well as discuss the ethical responsibilities and democratic accountability of researchers in their role as experts and policy advisors.

Applying developmental programming to clinical obstetrics: my ward round

2015 ◽  
Vol 6 (5) ◽  
pp. 407-414 ◽  
Author(s):  
R. C. Painter
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Research ◽  
Pregnant Women ◽  
Research Agenda ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Developmental Programming ◽  
Obesity And Diabetes

The theory of developmental programming is supported by accumulating evidence, both observational and experimental. The direct application of the principles of developmental programming by clinicians to benefit pregnant women remains an area of limited attention. Examining a selection of inpatients at an obstetric referral center, I searched for situations in which clinical decision making could be driven by the principles of developmental programming. I also looked for situations in which the clinical research agenda could be dictated by these concepts. In the decision to undertake preventive measures to avoid preeclampsia, the offspring’s perspective may support more liberal application of calcium and aspirin. Consideration of the long-term health perspective of the offspring could drive choices in the management of obesity and diabetes in pregnancy. The administration of corticosteroids in women delivering by elective cesarean at term may have modest short-term benefits, but additional trials are necessary to investigate long-term offspring health. The offspring of women suffering hyperemesis gravidarum may benefit from nutritional therapy. The long-term health of the offspring could affect couples’ choice for IVF or expectant management. Applying the principles of developmental programming to the management of pregnant women could drive clinical decision making and is driving the clinical research agenda. Increasingly, developmental programming concepts are becoming an integral part of clinical practice, as well as determining the choice of outcomes in trials in obstetrics and fertility medicine. The presented cases underscore the need for more research to guide clinical practice.

scholarly journals 1427. Key Clinical Research Questions Asked During Epidemic Respiratory Outbreaks: A Systematic Review of the Literature Published on Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S719-S720
Author(s):  
Carlyn L Harris ◽  
Gail Carson ◽  
Harish Nair
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Middle East ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Research ◽  
Middle East Respiratory Syndrome ◽  
Infection Prevention And Control ◽  
Research Protocols ◽  
Research Questions ◽  
Study Designs

Abstract Background As evidenced by the COVID-19 pandemic, rapid collection of data on clinical characterization, treatment, and diagnostics to inform rapid public health response is paramount in an outbreak of a novel infectious agent. In 2018, The World Health Organization R&D Blueprint identified a list of priority diseases for accelerated research based on their potential to cause a public health emergency. Among these diseases were Severe acute respiratory syndrome-coronavirus (SARS-CoV) and Middle East respiratory syndrome-coronavirus (MERS-CoV). To facilitate a rapid research response during an outbreak, standardized research protocols must be prepared before the outbreak occurs. The aim of this systematic review is to identify the most common clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV to inform future clinical research protocol development for coronaviruses. Methods Medline, Embase, and Global Health bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to the clinical research question addressed. Results From the research questions and objectives, eleven themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control, transmission, susceptibility, psychosocial, and aetiology. Case series made up the highest proportion of study designs, while clinical trials made up the lowest. 83% of the SARS-CoV studies were published after the end of the outbreak. Themes and key clinical questions asked during outbreaks of SARS and MERS Conclusion The thematic analysis was used to identify the key clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV and study designs were recommended to answer these questions. By defining the key clinical research questions, this study provides a first step in creating standardized clinical research protocols and defining core data variables to be collected during future outbreaks of respiratory coronaviruses. Disclosures All Authors: No reported disclosures

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