Clinical epidemiology

what, who, and whither

      Abstract

      Clinical epidemiology, the what, was introduced by John Paul in 1938, as a new basic science for preventive medicine. Its definition subsequently took on a more bedside tone, but continues to be adapted to the needs of its practitioners. Clinical epidemiology, the who, centers on Alvan Feinstein and the way that he led the field and nurtured so many of its practitioners. Clinical epidemiology, the whither, describes its more recent development and its impact on five evolutions and revolutions: in evidence generation, its rapid critical appraisal, its efficient storage and retrieval, evidence-based medicine, and evidence synthesis.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Paul J.R.
        Clinical epidemiology.
        J Clin Invest. 1938; 17: 539-541
        • Paul J.R.
        Clinical epidemiology. Revised edition. University of Chicago Press;, Chicago1966
        • Silverman W.A.
        • Andersen D.H.
        • Blanc W.A.
        • Crozier D.N.
        A difference in mortality rate and incidence of kernicterus among premature infants allotted to two prophylactic antibacterial regimens.
        Pediatrics. 1956; 18: 614-625
        • Chalmers T.C.
        • Eckhardt R.D.
        • Reynolds W.E.
        • Feifenstein R.W.
        • Deane N.
        • Smith C.W.
        • Cigarroa J.G.
        • Davidson C.S.
        The treatment of acute infectious hepatitis. Controlled studies of the effects of diet, rest, and physical reconditioning on the acute course of disease and on the incidence of relapses and residual abnormalities.
        J Clin Invest. 1955; 34: 1163-1234
        • Sackett D.L.
        • Haynes R.B.
        • Tugwell P.
        Clinical epidemiology; a basic science for clinical medicine. 1st ed. Little, Brown;, Boston1985 (p. xiii.)
        • Feinstein A.R.
        Boolean algebra and clinical taxonomy. I, Analytic synthesis of the general spectrum of a human disease.
        N Engl J Med. 1963; 269: 929-938
        • Sackett D.L.
        • Haynes R.B.
        • Tugwell P.
        Clinical epidemiology; a basic science for clinical medicine. 1st ed. Little, Brown;, Boston1985 (p. xiii.)
        • Sackett D.L.
        Clinical epidemiology.
        Am J Epidemiol. 1969; 89: 125-128
        • Sackett D.L.
        • Winkelstein Jr, W.
        The relationship between cigarette usage and aortic atherosclerosis.
        Am J Epidemiol. 1967; 86: 264-270
        • Feinstein A.R.
        Clinical epidemiology. I. The populational experiments of nature and of man in human illness.
        Ann Intern Med. 1968; 69: 807-820
        • Feinstein A.R.
        Clinical epidemiology. II. The identification rates of disease.
        Ann Intern Med. 1968; 69: 1037-1061
        • Feinstein A.R.
        Clinical epidemiology. III. The clinical design of statistics in therapy.
        Ann Intern Med. 1968; 69: 1287-1312
        • Feinstein A.R.
        Clinical judgment. Williams & Wilkins;, Baltimore1967
        • Feinstein A.R.
        Clinical epidemiology. I. The populational experiments of nature and of man in human illness.
        Ann Intern Med. 1968; 69: 807-820
        • Feinstein A.R.
        Clinical epidemiology; the architecture of clinical research. W.B. Saunders;, Philadelphia1985
        • Feinstein A.R.
        An additional basic science for clinical medicine.
        Ann Intern Med. 1983; 99: 843-848
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies.
        J Chronic Dis. 1987; 40: 373-383
        • Feinstein A.R.
        Clinical biostatistics. XIV. The purposes of prognostic stratification.
        Clin Pharmacol Ther. 1972; 13: 285-297
        • Ransohoff D.F.
        • Feinstein A.R.
        Problems of spectrum and bias in evaluating the efficacy of diagnostic tests.
        N Engl J Med. 1978; 299: 926-930
        • Sackett D.L.
        • Gent M.
        Controversy in counting and attributing events in clinical trials.
        N Engl J Med. 1979; 301: 1410-1412
        • Guyatt G.
        • Sackett D.
        • Taylor D.W.
        • Chong J.
        • Roberts R.
        • Pugsley S.
        Determining optimal therapy–randomized trials in individual patients.
        N Engl J Med. 1986; 314: 889-892
      1. Sackett D.L. Haynes R.B. Compliance with therapeutic regimens. Johns Hopkins University Press;, Baltimore1976
        • Fletcher R.H.
        • Fletcher S.W.
        • Wagner E.H.
        Clinical epidemiology. 3rd ed. Williams and Wilkins;, Baltimore1996
        • Sackett D.L.
        • Haynes R.B.
        • Guyatt G.H.
        • Tugwell P.
        Clinical epidemiology. Little, Brown;, Boston1991
        • Feinstein A.R.
        Clinical epidemiology; the architecture of clinical research. W.B. Saunders;, Philadelphia1985
        • Weiss N.S.
        Clinical epidemiology. 2nd ed. Oxford University Press;, Oxford1996
        • Kramer M.S.
        Clinical epidemiology and biostatistics. Springer-Verlag;, Berlin1988
        • Last J.
        What is “clinical epidemiology”?.
        J Public Health Policy. 1988; 9: 159-163
        • Holland W.
        Inappropriate terminology.
        Int J Epidemiol. 1983; 12: 5-7
        • Sackett D.L.
        Three cheers for clinical epidemiology.
        Int J Epidemiol. 1984; 13: 117-119
        • Sackett D.L.
        The fall of “clinical” research and the rise of “clinical-practice research.
        Clin Invest Med. 2000; 23: 331-333
        • Spitzer W.O.
        Clinical epidemiology.
        J Chronic Dis. 1986; 39: 411-415
        • Sackett D.L.
        Clinical epidemiology.
        Am J Epidemiol. 1969; 89: 125-128
        • Mulrow C.D.
        • Cook D.J.
        Systematic reviews; synthesis of best evidence for health care decisions. American College of Physicians;, Philadelphia1998
        • Bernier C.L.
        • Yerkey A.N.
        Cogent communication. Greenwood Press;, Westport, CT1979 (, p. 39)
      2. McKibbon KA, Wilczynski NC, Haynes RB. Where are high quality clinically relevant studies published? International Congress on Peer Review in Biomedical Publication. Barcelona, Spain, September 14, 2001.

        • Ramsey P.G.
        • Carline J.D.
        • Inui T.S.
        • Larson E.B.
        • LoGerfo J.P.
        • Norcini J.J.
        • Wenrich M.D.
        Changes over time in the knowledge base of practicing internists.
        JAMA. 1991; 266: 1103-1107
        • Ad Hoc Working Group for Critical Appraisal of the Medical Literature
        A proposal for more informative abstracts of clinical articles.
        Ann Intern Med. 1987; 106: 598-604
        • Haynes R.B.
        • Wilczynski N.L.
        • McKibbon K.A.
        • Walker C.J.
        • Sinclair J.C.
        Developing optimal search strategies for detecting clinically sound studies in MEDLINE.
        J Am Med Inform Assoc. 1994; 1: 447-458
      3. Takeshita H, Davis D, Straus SE. Clinical evidence at the point of care in acute medicine: a handheld useability case study. Hum Factors, in press.

        • Laupacis A.
        • Sackett D.L.
        • Roberts R.S.
        An assessment of clinically useful measures of the consequences of treatment.
        N Engl J Med. 1988; 318: 1728-1733
        • Straus S.E.
        Individualizing treatment decisions.
        Eval Health Prof. 2002; 25: 210-224
        • Evidence-Based Medicine Working Group
        Evidence-based medicine. A new approach to teaching the practice of medicine.
        JAMA. 1992; 268: 2420-2425
        • Ball C.M.
        • Phillips R.S.
        Evidence-based on call. Churchill Livingstone;, Edinburgh2002
        • Mulrow C.D.
        The medical review article.
        Ann Intern Med. 1987; 106: 485-488
        • Oxman A.D.
        • Guyatt G.H.
        A consumers' guide to subgroup analyses.
        Ann Intern Med. 1992; 116: 78-84
        • Naylor C.D.
        Grey zones of clinical practice.
        Lancet. 1995; 345: 840-842