Differences between field epidemiology and clinical epidemiology.
Clinical Epidemiology Essay Paper
Clinical Epidemiology Essay Paper
The current medical approach must contemplate the application of clinical epidemiology in the health establishments, patients; in general, epidemiologic research with its analytical designs and clinical trials allow the progress in treatments and managements, as well as defining the quality of auxiliary exams ever more sophisticated by means of the test of tests design and its cost-benefit approach [1,2] On the other hand, the field epidemiology is applied through descriptive studies of the population’s health situation with their analytical approaches to the Situational Health Analysis (SHA), the study of epidemic outbreaks and evaluation of the respective answer of the community interventions [3,4].Clinical Epidemiology Essay Paper. This way, it allows carrying out an integral management of the epidemiology, both communal and individual, which will finally result in preventive medicine and public health
Clinical epidemiology has its application peak in the solution of treatment and management of diseases, contributing the identification of risk factors to certain illnesses and being to date the fundamental part of Evidence Based Medicine, and for that it becomes important the teaching of clinical epidemiology, for it will aid in the education of professionals with judicious capacity and rational use of the best alternatives in diagnostic and treatment, by means of a critical evaluation of the literature [5], as well as helping to stimulate the training of researchers, because it’s implied that the execution of the clinical epidemiology will lead to the development of research [6].
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Research development makes it necessary to use tools that will make research more efficient, such as GoogleDocs, ZOGO, OneNote, which allow to write and edit online texts, or scientific literature search engines that will let us find evidence for the sustain of our activities in the healthcare systems, and in some cases without even looking for them, like with the applications from Google Reader and the RSS/XML, or obtaining portals dedicated to Evidence Based Medicine, or programs such as the statistical calculator Epidat which can simplify our statistical analysis, without even mentioning the multiple statistical softwares available [7].
Other concepts to consider are social epidemiology, which have been gaining ground these last decades and backing up the analysis of the social determinants of health status. This approach has generated big expectation for its integration and multidisciplinary character, but it’s not free of skepticism that relates it with the idealism of a politics’ strategic instrument [8]. Clinical Epidemiology Essay Paper.
However, social epidemiology, like field of clinical epidemiology, is based on the positivist paradigm and uses the statistical methods as analysis foundation. Besides, it is important to mention that currently, it has been generated a whole new research line based on the approach of the social determinants, where it is critical the usage of multilevel statistical models and new technologies that pose a new challenge to young researchers [9].
According to what it is stated, the current medical science tendency is focused in the generation of evidence that contributed in its development and has an impact in the patients’ health. This approach, of EBM, is expressed mainly in the care, in relation to drugs and medical devices, though it is admitted that community interventions through Public Health deserve to be recognized as significant events that have had an impact in the population’s health [10]. In this way, it is necessary to recognize the existence of research that s directed to make evidence of the impact of Public Health’s diverse activities.
Evidence Based Public Health keeps the cause-effect logic, and allows adding the determinants of health, such as lifestyles, culture and environment, to the scientific context that often is what characterizes the good or bad execution of an intervention. Evidence Based Public Health is a new tendency that is joining efforts to offer the best information for an efficient politics decision making [11]. When it is oriented to the research of a population’s health issues whether in the community or the hospital sphere, it contributes remarkably to the solution of very different local and regional realities, thus making a progress in Public Health, especially in out developing countries.
2. Differences between clinical epidemiology and field epidemiology
2.1. Classic or field epidemiology
Epidemiology is an old discipline with roots on scientific and rational structures, based on experience, on what is real. It is of great importance for Public Health and its impact for clinical medicine has risen in the last decades [12].
The comparison between clinical epidemiology and field epidemiology may demonstrate similarities and differences that can result in a contribution to their final application, which is their common desire: the people’s health. Clinical Epidemiology Essay Paper.
Field epidemiology’s primary function is to identify the cause or source of infectious diseases’ outbreaks, containing its dissemination and organizing the infected patients’ treatment as soon as possible [3].
Information obtaining and action are done «in the field», on the ground, namely, in the epidemic territory, there being a dominance of practice over theory. During an outbreak, the field epidemiologist works long hours until he has control over the outbreak. Another specific feature is that it is not only executed by doctors, but also by other specialties professionals, such as nurses, veterinarians, biologists, technicians, etc. [3].
The Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), founded in 1997 and currently located in 53 countries around the world, aims to strengthen, at an international level, the field epidemiologists’ capacity for Public Health [13]. In Peru, is has been developed the Field Epidemiology Residency Program (PREC), in order to train professionals in different specialties to act in their respect jurisdictions, challenging the lack of epidemiology specialists.
This national Program had 4 stages: I Introduction to Epidemiology (2 months), II Basic Epidemiology (4 months), III Intermediate Epidemiology (6 months) and IV Specialized Epidemiology (12 months). Clinical Epidemiology Essay Paper. The designated participants for each Regional Health Direction started to take the classes in their own offices, taught by specialists from the General Epidemiology Office and professors from a macro regional level University’s headquarters with on line tutoring, as well as field practices. Stages II and III were carried out in the University’s headquarters and the selection of the participants to continue on to the next stages were done with a pyramidal system, according to weighted averages and additional exams. The last stage was carried out only Lima-Peru, though it was still open to other provinces [14].
It is discussed that field epidemiology would tend to action without a theoretical framework. This tendency would be based on its most direct reference: the Epidemic Intelligence Service (EIS) of the Center for Disease Control and Prevention (CDC) from the USA government, administrative body of military origin related to the intelligence service, which gives them a more attractive image than a function, closer to a secret agent directed towards the action, the protection of a community against a germ invasion, the avoidance of social alarm and insecurity on the population [4]. Field epidemiology executes its intervention on a daily basis in micro spaces, generally institutional: schools, restaurants, elderly residencies, hospitals whose services can present outbreaks, and uses conventional methods [15].
Thacker SB and Buffington J., who belong to the CDC, call field epidemiology as the 21st century applied epidemiology, based on the philosophy of ‘learn by doing’, supervised by experienced epidemiologists on field research, database analysis, vigilance system evaluation, presenting and publishing scientific research and answering to public questions. On the other hand, it has to be directed toward action regarding the main Public Health problems, the reduction of social inequality, having a greater consideration for psychosocial elements of the illness process, the incorporation of contents and methods from social sciences and working in multidisciplinary teams [16]. Clinical Epidemiology Essay Paper.
In the case of field or applied epidemiology, which is also denominated general epidemiology, it has as a feature the use of epidemiologic methods for the prevention of diseases and promotion of health in the populations, to achieve in an effective way the Public Health objectives, trying to apply a primary prevention.
3. Clinical Epidemiology
In 1938, Jean Paul coined the term clinical epidemiology, and defined it as: ‘a new basic science for preventive medicine’. Therefore, the practical application of clinical epidemiology is a key part of Evidence Based Medicine and clinical decision making [17]. Clinical epidemiology is a discipline that puts into practice the epidemiologic principles into the clinical environment, focusing on patients [18]. What characterizes it is the combination of epidemiologic methods with the objectives of social clinical activity, which are, a good diagnostic and treatment of the ill. The knowledge is integrated with what is obtained from a good bibliographic research and critical reading of scientific reading [1]. It is currently considered the cornerstone of Evidence Based Medicine.
Clinical epidemiology is based mainly on its clinical trials, examining the diagnostic methods, discussing the prognosis, taking part in the evolution of treatments, trying to organize a controlled and randomized study opposite to sick people getting placebos or another indicated drug [1].
Truthfully, it was difficult to distinguish this activity from what would later be called as Evidence Based Medicine (EBM), term introduced in 1992 by the same group that, years before, had founded the discipline called Clinical Epidemiology (CE) [2].
However, both disciplines: field epidemiology and clinical epidemiology share the same methodology and tool, the difference relies on the place where these are applied (Table 1).
Table 1.
The current medical approach must contemplate the application of clinical epidemiology in health establishments, for the benefit of patients, given that epidemiologic research, with its analytical designs and clinical trials, allow the progress in treatments and managements, as well as defining the quality of auxiliary exams ever more sophisticated by means of the test of tests design and its economic approach (cost-benefit, cost-utility, cost-effectiveness), without forgetting the general population. Clinical Epidemiology Essay Paper. It is in the community where field epidemiology is applied, the descriptive studies of the population’s health situation with its analytical approaches to the Situational Health Analysis, the study of epidemic outbreaks and their respective intervention, as well as the posing of hygiene measurements and global prevention for a better quality of life and disease prevention. This way, an integral management is being carried out, both communal and individual, which will finally result in preventive medicine and public health.
David Sackett drew attention over the need to integrate the evidence with the clinical experience and the value of patients in the clinical decision making, referring to it as Clinical Epidemiology and defining it as: ‘the application of epidemiologic principles and methods to the problems challenging clinical medicine. The basic aim of clinical epidemiology is to promote the clinical observation and interpretation methods, which result in valid conclusions’[19].
Clinical epidemiology aims for the production and identification of valid tests, and to its logical extension. It is EBM, which aims for the rational use of evidence in the individual diagnosis and treatment of patients [17]. Clinical Epidemiology represents the way in which classic epidemiology, traditionally directed to general strategies in the public health of communal groups, has been extended to include clinical decisions in the care of individual patients (Figure 1) [20].
Figure 1.
Uses of Clinical Epidemiology.
3.1. Evolution of clinical epidemiology
Clinical epidemiology has perform a center role in 5 recent evolutions (some say revolutions) on the healthcare area: evidence generation, critical evaluation, efficient storage and recovery, evidence based medicine and evidence synthesis (Table 2).
Table 2.
Evolution of the Clinical Epidemiology (Sackett DL. 2000). Clinical Epidemiology Essay Paper.
The effect of using epidemiologic principles has not been simply to improve the usage of clinical judgment and to eliminate the implicit element of epistemology from clinical reasoning. Arthur Elstein declared that decades of psychological research in decision making has demonstrated that: clinical judgment from experts was not as expert as we thought it was, that knowledge transference was more limited than we expected, and that judgment errors are not limited to medicine students nor are eradicated by experience, so that, them being the cognitive errors inherent to clinical reasoning, they can be aggravated through the dependency called ‘experts opinion’ [21].
In 1992, Sackett DL. and Col. decided to substitute the term ‘Clinical Epidemiology’ for ‘Evidence Based Medicine’, meaning that every medical action of diagnosis, prognosis and therapy must be sustained in quantitative, solid proofs, based on the best epidemiologic and clinical research [21]. Thereby, Sacket DL., in one of the first definitions of EBM, he mentioned: ‘conscious, explicit and reasonable use of the best current evidence to make decisions regarding the care of individual patients’ [5].
Sackett DL. mentions the dichotomous existence between the science of epidemiologic reasoning and the art of intuitive judgments of clinical epidemiology. He realized that the application of these epidemiologic principles (plus a bit more of biostatistics) to the beliefs, judgments and intuitions that make up for the art of medicine can considerably improve the accuracy and effectiveness of diagnosis and prognosis [21]. The practice of EBM means to integrate the individual clinical experience with the best external clinical evidence available from systematic research, and recently, in a paper published on 2000, it is described as: ‘the integration of the best research evidence, of clinical experience and the patients’ values’ [5]. Meanwhile, Cuestas E. defines it as ‘the discipline that takes care of the study of the happening of medical decisions regarding its determinants’ [22].
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Broadly, clinical epidemiology takes care of the event of patients’, which range from the appearance of the disease to its result in the form of healing, sequels or death. Clinical Epidemiology Essay Paper. Therefore, the study subjects are ill people who are normally found in health establishments, and their contribution is relevant, especially for diagnosis and secondary and third prevention of the disease.
Clinical epidemiology can be divided into descriptive and analytical. The descriptive part is focused on the variation of clinical prognosis, whereas the analytical is focused on the reasons for this variation, that is to say, the main predictors for the prognosis, diagnosis and treatment, which are key concepts in the clinical epidemiology and the practice of clinical medicine (Figure 2). Also, demographic epidemiology is largely directed to the general population, whereas clinical epidemiology is more focused on the individual [23] (Figure 1). Clinical Epidemiology Essay Paper.
