Clinical Epidemiology

Name: Muhammad Hassan

Father Name: Muhammad Qadeer
Roll Number: 25
Semester: Eight (8th)
Topic: Clinical Epidemiology, (normalities, abnormalities and diagnostic, prognostic tests)
Submitted to: Ayesha Shahnawaz
 Epidemiology:
Epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency,
pattern) and determinants (causes, risk factors) of health-related states and events (not just
diseases) in specified populations (neighborhood, school, city, state, country, global).
Clinical Epidemiology:
Clinical epidemiology is the study of the patterns, causes, and effects of health and disease in
patient populations and the relationships between exposures or treatments and health outcomes.
OR
The science of making about individual patients by counting clinical events in similar patients,
using strong scientific methods for studies of groups of patients to ensure that the predictions are
accurate.
Used as an aid to clinical decision making.
Lead to valid conclusion by avoiding being misled by systematic error (bias) and chance.
Methods of Clinical Epidemiology:
1) Formulate question (hypothesis)
2) Choose study design
3) Choose study population and sample from that
4) Collect and analyze data
5) Interpret results
Abnormalities of Clinical Epidemiology:
In clinical medicine – especially in laboratory testing – it is common to label values that
are unusual as being abnormal. If, for example, a blood sample is sent to a hospital
hematology laboratory for measurement of hemoglobin concentration the result form that
is returned may contain the following guidance (the absolute values will differ for
different laboratories and units will differ by country):

Male Reference Range Female Reference Range

130-170 g/L 115/155 g/L

This reference range is derived as follows: a large number (several hundred)

of samples from people believed to be free of disease (usually blood donors) are
measured and the reference range is defined as that central part of the range which
contains 95% of the values. By definition, this approach will result in 5% of individuals
who may be completely well, being classified as having an abnormal test result.
Normality of Clinical Epidemiology:
In practice, as with hemoglobin concentration above, many distributions in medical
statistics may be described by the Normal, also known as Gaussian distribution. It is
worth noting that the statistical term for ‘Normal’ bears no relation to the general use of
the term ‘normal’ by clinicians. In statistics, the term simply relates to the name of a
particular form of frequency distribution. The curve of the Normal distribution is
symmetrical about the mean and bell-shaped.

Heights of 1,000 men in South Wales. Note: This figure is known as a histogram and is
used for displaying grouped numerical data in which the relative frequencies are
represented by the areas of the bars (as opposed to a bar chart used to display categorical
data, where frequencies are represented by the heights of the bars).The superimposed
continuous curve denotes the theoretical Normal distribution.
Prognostic test:
A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of
recovery from a disease or the chance of the disease recurring (coming back).
Prediction or forecast of the course of a disease based on anticipation from the usual natural
history of the disease or peculiarities unique to the case.
Prognostic indicators tell the doctor the likely behavior of the cancer and its responsiveness to
treatment.
Prognostic test in Clinical Epidemiology:
Prognostic markers (biomarkers) are characteristics that help to identify or categorize people
with different risks of specific future outcomes. They may be simple clinical measures such as
body mass index, but are more often pathological, biochemical, molecular or genetic measures or
attributes. Identifying those who are not at risk can facilitate intervention choice, and aid patient
counselling.
Measures of Prognosis:
Case fatality rate – Proportion of newly diagnosed cases that die from a given disease in a
specified period
Survival rate – Proportion of persons surviving, regardless of cause of death.
Diagnostic test:
A diagnostic test is used to determine the presence or absence of disease when a subject shows
sign or symptoms of the disease.
OR
Diagnostic test are variety of procedures done by physicians to screen for, detect and monitor
disease and conditions. It is used to gather clinical information necessary for making a diagnosis.
There are following way to check the diagnostic test for Clinical epidemiology:
i. Patient Profile v. Screening test
ii. Clinical Reasoning vi. Likelihood ratios
iii. Cutoff points vii. Positive and Negative value
iv. ROC curves viii. Sensitivity and specificity
Evaluation of Diagnostic test:
 Predictive value of the test: Probability of the test result that reflects the true disease
status of an individual.
a) Positive predictive value: Probability of disease in an animal with a positive
(abnormal) test result.
b) Negative predictive value: Probability that an animal does not have the disease
when the test result is negative (normal).
  Likelihood ratio: compares the proportion of animals with or without disease, in relation
to their test results.
a) LR + = proportion of affected individuals test positive / proportion healthy
individuals test positive.
b) LR - = proportion of affected individuals test negative / proportion healthy
individuals test negative.

Techniques for Evaluation of Diagnostic Test:

Medical decision making is critical.
 Diagnostic testing – diseased are differentiated from non-diseased and/ or those with
other diseases with similar symptoms.
 Screening – in healthy subjects- identification of unrecognized diseases in apparently
healthy ones.
 Gold standard test – definitive test – determines whether disease is truly present or not.
The best example is Post Mortem Examination.
 Sensitivity – proportion of true positives detected.
 Specificity – proportion of true negatives detected.
 False Positive Rate – likelihood of a positive test result in a patient known to be free of
disease.
 False Negative rate – likelihood of a negative test result in a patient known to have
disease.

Diagnostic Test Prognostic Test

Goal Discriminate from non-diseased Forecast probable course and
disease termination
Time Dimension No Yes
Direction of Study Cross-section Longitudinal
Begins with Subject with sign/symptoms or Patients and try to predict
positive screening prognosis
Measure Disease Prevalence Incidence of outcome measure
(e.g. complications, mortality)
Nature of outcome Dichotomous (diseased/non- Dichotomous (death/survival) or
diseased) quantitative (e.g. 1-year mortality
is 30%, survival analysis).
Predictive index Positive/Negative Positive or negative (prognosis is
short) or probability