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K-9 CRP 3.9 Epidemiologi Klinik
K-9 CRP 3.9 Epidemiologi Klinik
Klinik
(Clinical
Epidemiology)
Patients are likely to have many
questions :
Am I sick ?
?
How will it affect me ?
Terminology:
Clinical epidemiology derived from
two parent diciplines: CLINICAL
MEDICINE and EPIDEMIOLOGY
Clinical Medicine
Clinicians are, by and large concerned on
individual patients they largely oriented
towards the mechanism of disease and
foster to belief that to understand medicine
is to understand the detail the process of
disease in individual patients through basic
medical science like anatomy, histology,
physiology, biochemistry etc, how it occurs
at pathognetic and mechanistic level.
EPIDEMIOLOGY
Study of distribution and
determinants of health related
states in a specific population,
and theapplication of the study
to the control of health problems
in that population
Clinical because it seeks to answer clinical
questions and to guide clinical decision making
with the best available evidence
Epidemiology because many of the methods
used to answer these questions have been
develop by epidemiologist and because the care
of individual patients is seen in the context of the
larger population of which the patient is a
member.
John R. Paul (President of the American
Society of Clinical Investigation, 1968):
Application of principles and methods of
Epidemiology to problems in Clinical
Medicine
Basic Principles
Basic purpose of Clinical
Epidemiology is to Foster
Methods in clinical observation
and interpretation.
1. Clinical Questions
2. Health Outcome
1. Clinical Question : questions
addressed by clinical
epidemiology are the same
questions confronting doctors
and patients:
Issues Answers
1. Is a person sick or well? What abnormalities are Normality /
associated with having a disease ? Abnormality
2. How accurate are diagnostic tests used to find a Diagnosis
disease ?
3. How often does a disease occur ? Frequency
4. What factors are associated with increase Risk
likelihood of a disease ?
5. What condition results in disease ? Cause
What is the pathognetic mechanism ?
6. What are the consequences of having a disease Prognosis
7. How does treatment change the future course Treatment
of a disease ?
2. Health Outcomes
The clinical events of primary interest in
clinical epidemiology are the health
outcomes of particular concern to
patients
OUTCOMES OF DISEASE (THE
FIVE Ds)
DEATH A BAD OUTCOME IF UNTIMELY
CASECONTROLSTUDY:
CARDIOVASCULAR DISEASE:
(HYPERTENSION RESERPIN)
1. Nondifferential misclassification
If the error in classification exposure or disease
status are independent of the level of the other
variable.
Subjects may answer a question about the
exposure with a socially aceptable, even
sometimes inaccurate, response, regardless
wether they have the disease of interest. Exposre
of interest: prior intake of food of high in
saturated fat; respondents may underreported
intake of food of high fat content because they
think low fat diet are more acceptable to
investigator.
2. Differential misclassification
Occurs when the misclassification of one variable
depends on the status of the other: information on
exposure status depends on wether the subject has
the disease. A case of myocardial infarction is more
likely to overestimate the level of dietary fat intake
than a control subject. Bias would lead to an
overestimate of the relationship between dietary fat
intahe and risk of developing myocardial infarction
A. RECALL BIAS:
Result from differential ability of subjects to
remember previous activities and exposures.
Patients who have serious disease may search
their memory for an exposure in an attempt to
explain or to understand why they acquired the
illness. Control subjects who dont have the
disease may be less likely to remeber an
exposure, because less meaning and less
important for them
B. Interviewer bias:
when interviewers are employed to
determine exposure in case-control studies,
results may be influenced by how
interviewers collect information: if they are
aware of research hypothesis, the
interviwers, intentionally or unintentionally,
may inflience the responses of the subjects
3. CONFOUNDING
Mixing of the effects of an extraneous variable with
yhe effect of exposure of interest ( mixing of the
primary effect of interst with the effect of one or
more extraneous factors. )
Association: high total serum cholesterol
risk of Infarction
myocardial
CIGARETTES SMOKING
CONFOUNDING