how to do case reports
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How to do Case ReportsHow to do Case Reports
Albert Moraska, PhDAlbert Moraska, PhDAssistant Research ProfessorAssistant Research Professor
University of Colorado Health Sciences University of Colorado Health Sciences CenterCenter
OutlineOutline
Conducting a Case ReportConducting a Case Report
Summarizing your findingsSummarizing your findings
Insights into the Review Process Insights into the Review Process
Goals of Case Reports Submitted Goals of Case Reports Submitted for Journal Publicationfor Journal Publication
Increase research literacyIncrease research literacy
Stimulate researchStimulate research
Provide forum for individuals to present Provide forum for individuals to present their experiencestheir experiences
Enhance professional developmentEnhance professional development
Why do a Case Report?Why do a Case Report?
Responsibility of a professionResponsibility of a profession
Forward the field / Gain acceptanceForward the field / Gain acceptance
Share informationShare information
Value of a Case ReportValue of a Case Report
Case Report
Pilot / Feasibility Study
Small Clinical Trial
Large Multi-Center Clinical Trial
Marshall’s Case ReportMarshall’s Case Report
Attempt to fulfill Koch's postulates for pyloric Campylobacter
Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ.
A volunteer with histologically normal gastric mucosa received pyloric campylobacter by mouth. A mild illness developed, which lasted 14 days. Histologically proven gastritis was present on the tenth day after the ingestion of bacteria, but this had largely resolved by the fourteenth day. The syndrome of acute pyloric campylobacter gastritis is described. It is proposed that this disorder may progress to a chronic infection which predisposes to peptic ulceration.
Med J Aust. 1985 Apr 15;142(8):436-9.
Conducting a Case ReportConducting a Case Report
Identifying a research topicIdentifying a research topic
Prospective or retrospective Prospective or retrospective
Locate a subjectLocate a subject– ClientsClients– Family / friendsFamily / friends– Medical referralMedical referral
Has this topic been reported before?Has this topic been reported before?
Is this a topic that others would be Is this a topic that others would be interested in?interested in?
Ideas for (simple) measurementsIdeas for (simple) measurements
Consult the literatureConsult the literature
Visual Analog ScalesVisual Analog Scales
GoniometersGoniometers
Clinical significanceClinical significance
Other simple measures: Other simple measures: – number of steps, number of steps, – number of hours slept, number of hours slept, – number of hours in pain, etc. number of hours in pain, etc.
Summarizing Your FindingsSummarizing Your Findings
Writing the Case ReportWriting the Case Report
Abstract (6 pts)Abstract (6 pts)
Introduction (25 pts)Introduction (25 pts)
MethodsMethods– Profile of Client (10 pts)Profile of Client (10 pts)– Treatment Plan (15 pts)Treatment Plan (15 pts)
Results (15 pts)Results (15 pts)
Discussion (20 pts)Discussion (20 pts)
ReferencesReferences
Other documentationOther documentation
The Case Report - AbstractThe Case Report - Abstract
Brief summary – 200 word limitBrief summary – 200 word limit– ObjectiveObjective– MethodsMethods– ResultsResults– ConclusionConclusion
Used by indexing servicesUsed by indexing services
Key wordsKey words
The Case Report - IntroductionThe Case Report - Introduction
Build an argument for doing the studyBuild an argument for doing the study
Background to understand topicBackground to understand topic
Justification for why treatment should Justification for why treatment should benefit benefit
Arguments supported by the literatureArguments supported by the literature
Not an exhaustive review Not an exhaustive review
About 250-500 wordsAbout 250-500 words
The Case Report - MethodsThe Case Report - Methods
Client ProfileClient Profile
Treatment PlanTreatment Plan– Description of treatment techniques used, Description of treatment techniques used,
treatment duration, etc.treatment duration, etc.– Don’t mix in any resultsDon’t mix in any results
Evaluation ProceduresEvaluation Procedures
Sufficient detail such that someone could Sufficient detail such that someone could “repeat the study”“repeat the study”
The Case Report - ResultsThe Case Report - Results
Presenting the dataPresenting the data– In the text - briefly (100-200 words) describe In the text - briefly (100-200 words) describe
any particularly interesting finding and refer any particularly interesting finding and refer to:to:
– Tables Tables great for complex data setsgreat for complex data sets
– Figures Figures great for visual effect great for visual effect
need a figure captionneed a figure caption
Data Presentation StylesData Presentation Styles
Hip Abduction
10
15
20
25
30
35
40
45
50
Baselin
e - P
re
Baselin
e - P
ost
Game
1 - P
re
Game
1 - P
ost
Game
2 - P
re
Game
2 - P
ost
Game
3 - P
re
Game
3 - P
ost
Game
4 - P
re
Game
4 - P
ost
Game
5 - P
re
Game
5 - P
ost
Deg
rees
A - Right
A - Left
B - Right
B - Left
Linear (A - Right)
Linear (A - Left)
Linear (B - Right)
Linear (B - Left)
Don’t be overly complexDon’t be overly complex
Data Presentation StylesData Presentation Styles
Make sure the data you want to get across is Make sure the data you want to get across is easily obtainable by the readereasily obtainable by the reader
Session
Movement 1 2 3 4 5 6 7 8 9 10 Flexion of Elbow 3 1 3 3 3 3 3 2 2 3
Extension of Elbow 3 2 3 4 3 3 3 4 2 3 Supination (Arm straight) 5 4 5 5 4 5 5 4 3 4 Supination (Arm straight/closed fist)
x 6 6 7 5 5 5 4 3 4
Supination (Arm flexed) 3 3 5 5 4 3 3 3 3 3 Pronation (arm straight) 4 4 4 4 4 5 5 4 4 4 Pronation (Arm straight/closed fist)
x 5 5 6 5 5 4 5 4 4
Pronation (Arm flexed) 3 3 3 3 3 4 4 5 4 4
Ulnar Deviation 3 4 5 5 5 5 5 5 5 4 Radial Deviation 4 5 6 6 5 4 4 5 5 4
Digit Extension 4 3 4 5 5 5 5 5 3 3 Wrist Extension 5 5 4 5 6 5 5 4 4 3
Data Presentation StylesData Presentation Styles
Don’t use 3-Dimensional graphsDon’t use 3-Dimensional graphs
Data Presentation StylesData Presentation Styles
Figure 3 Figure 4
Use fixed measurement references
Data Presentation StylesData Presentation Styles
Changes in Postural Measures
02468
10121416
1 2 3 4 5
Treatment Number
Po
sit
ion
(c
m) Forward
HeadCarriage
InternalRotation ofShoulders
Figure 1. Changes in postural measures of Forward head Carriage (FHC) and Internal Rotation of shoulders. FHC was measured in cm from the Occiput to the wall. Internal rotation was measured from the inferior tubercle of the humerus to the wall.
The Case Report - DiscussionThe Case Report - Discussion
Provide meaning to the data:Provide meaning to the data:– Why was this study important?Why was this study important?– What previous unknown is now known?What previous unknown is now known?
Critically evaluate the dataCritically evaluate the data– Describe strengths and limitationsDescribe strengths and limitations
e.g. only used one form treatment e.g. only used one form treatment
Are there more accurate evaluation methods?Are there more accurate evaluation methods?
– Relate findings to other similar studiesRelate findings to other similar studies e.g. compare to other types of treatmentse.g. compare to other types of treatments
The Case Report - DiscussionThe Case Report - Discussion
Your Finding: Systolic BP changes from 160 to 125 mmHg following CST
HypothesisTreatment had an effect!
Alternative HypothesisLying on a table for
60 min could cause the reduction
CounterSmith et al (2005) found that resting
quietly only reduces BP by 5 mmHg for those with moderately elevated BP
Hypothetical Example #1
The Case Report - DiscussionThe Case Report - Discussion
Your finding: Grip strength increased from 20kg to 28kg following treatment
Hypothetical Example #2
Increase is similar to that measured following surgical procedures (Smith et al 2005)
The strength increase observed is greater than that reported following chiropractic manipulation (Smith et al 2005)
The Case Report - ReferencesThe Case Report - References
No specific point value, but… No specific point value, but…
The strength of a report is dependent, in The strength of a report is dependent, in part, on the strength of its citations!part, on the strength of its citations!
Use primary literature sources Use primary literature sources – e.g. peer-reviewed articlese.g. peer-reviewed articles– Not secondary sources: Wikipedia, WebMDNot secondary sources: Wikipedia, WebMD– Textbooks? A few o.k.Textbooks? A few o.k.
Finding ReferencesFinding References
The searchThe search– From the literatureFrom the literature– Internet search engines: Pubmed.govInternet search engines: Pubmed.gov
The locatingThe locating– Some open accessSome open access– Libraries: generally University or MedicalLibraries: generally University or Medical– Contact the authorContact the author– Purchase from journalPurchase from journal
The readingThe reading
Insights into the Review ProcessInsights into the Review Process
The Reviewers (MTF)The Reviewers (MTF)
Group of 6 membersGroup of 6 members
Consists of Consists of – PractitionersPractitioners– EducatorsEducators– Researchers Researchers
Tips on Conducting the StudyTips on Conducting the Study
Use only one treatment modalityUse only one treatment modality
Use reliable measures to assess progressUse reliable measures to assess progress
Novelty of topic may trump quality of study Novelty of topic may trump quality of study
Synthesize data and present it only onceSynthesize data and present it only once
““Negative” data isn’t a show stopper, Negative” data isn’t a show stopper, but…. but….
Tips on Presenting the StudyTips on Presenting the Study
You don’t need to present all the data you You don’t need to present all the data you collectcollect
Don’t use “I” or “we” (“the author(s)”)Don’t use “I” or “we” (“the author(s)”)
Minimize use of direct quotesMinimize use of direct quotes
Be clear and conciseBe clear and concise
Other DocumentationOther Documentation
Informed Consent – Appendix DInformed Consent – Appendix D
HIPAA Guidelines – Appendix EHIPAA Guidelines – Appendix E
Photograph Release Form – Appendix FPhotograph Release Form – Appendix F
Proof of Liability Insurance Proof of Liability Insurance
Institutional Review Board Approval – not Institutional Review Board Approval – not required for a description of practice that required for a description of practice that does not involve research methodology. does not involve research methodology.
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