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The Case Report

The Case Report. Lisa Zaynab Killinger, DC. Palmer Center for Chiropractic Research.

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The Case Report

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  1. The Case Report

  2. Lisa Zaynab Killinger, DC Palmer Center for Chiropractic Research

  3. What is a “Case Report” or “Case Study”?A report on the case history, management, and/or results seen in one or more patient.OR...Describe the identification, management, or unusual presentation of a condition of interest.

  4. Case Reports... • Should have an educational value to the reader, sharing your experience with others • Are the foundation for future studies • Are “healthcare story telling” • Have clinical education value

  5. Case Reports are written to describe.. • An unusual occurrence or presentation • An unexpected outcome (The Good, the Bad, or the Ugly!) • A new approach to an old problem

  6. Why Should I Publish A Case Report???

  7. Where does the case report fall in the hierarchy of evidence?

  8. Levels of evidence Meta- Analyses RCTs Other Experimental Quasi-Experimental Observational Case reports/Clinical observations

  9. Chiropractic Research: Levels of Evidence Meta-Analyses RCTs Other Experimental Quasi-Experimental Observational Case reports

  10. Limitations of Case Reports: • Not generalizable • Describes what happened in one case, nothing more. • Does not rule out placebo effect • Does not prove effectiveness of treatment

  11. Anatomy of a Case Report • Abstract • Introduction • Methods/Case Report* • Intervention and Outcome • Discussion • Conclusions

  12. Introduction • Introduces the case/condition of interest • Reviews and cites the scientific literature on the topic (Chiro./Non-chiro. Lit.) • States the etiology/common txs./prognosis • Includes recent, high quality references (articles are better than books!)

  13. The Introduction Section Answers:What is known about the condition of interest?

  14. Case Report or Clinical Features • Describes the history and examination of the patient ` (Thoroughly enough to convince the reader that the doctor responsibly arrived at the appropriate clinical impression and management plan!)

  15. The Case Report Section Answers: How did patient present, what were your exam findings, and what was your diagnosis?

  16. Methods orIntervention & Outcome This section must describe the care given in enough detail that the reader could easily duplicate the care. (And, hopefully, duplicate your outcomes!)

  17. The Intervention & Outcome (Methods) Section Answers:What did you do, when, and how?

  18. The Outcome Piece • Describe the changes observed in the pt. • Lists results on outcome measures used (I.e: Rand-36 or Visual Analog scores) • Describes changes in health status, pain, symptoms, unexpected results, etc.

  19. The Outcome (Results) Section Answers:How did you document change (positive or negative results) in this case?

  20. Discussion Includes: • Interpretations of your findings • Comparison of your case with other studies (The ones cited in your intro!) • Rationale for management plan • Discussion of limitations/flaws in your study • Discuss possible reasons for the results you observed (other variables,placebo, etc.)

  21. The Discussion Section Answers:How does your case confirm/refute previous studies on this topic, and why did you do what you did?

  22. Conclusions • Tells the reader what was learned through this case • Describes why the case is significant • Suggests a direction for future studies. • Caution: Don’t make unsubstantiated claims!!!

  23. The Conclusion Section Answers: • What is the next step in studying this topic?

  24. Measures of Quality in Case Reports: • Use of outcomes assessments • Lengthy follow-up • Discussion of its limitations! (If you don’t, the reviewers/readers will!)

  25. More Measures of Quality: • Description of the methods • A good literature review • Discussion of the placebo effect • Good quality, recent references!!

  26. What in the heck are outcome assessments?

  27. Visual Analog Scale :VAS(Global Well-Being Scale, etc.) Simply a 10 cm. line

  28. Rand-36(SF-36) • A 36 question survey; patient fills it out • A valid and reliable measure of the patient’s general health status • A shorter 12 question form is available • Offers a great deal of information on patients’ emotional and physical well being, energy, pain, etc.

  29. What makes an outcome measure or assessment tool ‘good’?

  30. A Word About References • References should be numbered in the order they appear in the article • References need to be listed immediately following the sentence (or phrase) that comes from another author or article. • All statements of fact should be referenced. • Research articles are preferred, then textbooks, then manuals, popular press articles, etc.

  31. Style…Scientific Pulications/Articles • Author’s Last name then first initial, <comma> other authors “ ‘’<Period> Title of article (only first letter capitalized) <period> Name of Journal (using standard abbrev and italicized) <period>year of publication <semicolon>volume number and issue number (issue # in parentheses)<colon>page numbers <period>

  32. Hurwitz EL, Coulter ID, Adams AH, et al. Use of chiropractic services from 1985-1991 in the United States and Canada. Am J Public Health. 1998;88(5):771-776.

  33. Style-Textbooks • Author last name and first initial<period>Nameof Book (Italicized; with each main word capitalized) <period>Edition number <period>City/country of publication <colon>Publisher’s name <semicolon>Year of pubication <colon> page numbers <period>

  34. Peters T. The Pursuit of Wow! New York:Vintage Books;1994.

  35. Some things NOT to do when writing a case report...

  36. DON’T • Write as if you are promoting your product/ clinic (case reports are not advertisements) • Submit without you AND others proofreading your paper • Use patient’s or doctor’s name • Try to generalize • Say that you “proved effectiveness” of a tx.

  37. Where Should You Publish? • Decide on who you want to reach: Large audience? Clinicians? Educators? Chiropractors? Other health professionals? • Your best quality work: Submit to ‘Peer- reviewed’, and indexed journals. • Inexperienced writers: Get help, so you can submit to peer reviewed journals. • Study the requirements/guidelines for submission of various journals.

  38. Some Peer-Reviewed Chiropractic Journals • JMPT-Peer-reviewed and indexed in Medline + • JNMS-P.R and indexed in CINAHL + (gone) • Topics in Clin. Chiro.-PR, CINAHL + (gone) • ICA J. of Clinical Pediatrics – PR (gone)

  39. Some Non Peer-Reviewed Chiropractic “Journals” • ACA Journal • ICA Journal • The Chiropractic Journal (newspaper) • Dynamic Chiropractic (newspaper)

  40. The Morning After (Or, what happens AFTER you submit to a journal)

  41. Well, you wait…..

  42. What Then? • Reviewers are selected to read your article. • Reviewers make formal comments, and give opinions on the paper’s publishability. • You get reviewer comments/suggestions.

  43. You Do This...

  44. Afterwards ... • You make your revisions. • You re-submit. • You get a “galley proof”. • You look it over again. • You submit your brief last minute changes.

  45. And Finally, You Get Published!

  46. For more information on case report writing:Contact Lisa Killinger, DC1-(563)-884-5854(Or look for articles on this topic in the scientific literature!)

  47. What’s wrong with this picture?

  48. “ ...This case study demonstrates that chiropractic is an effective treatment for multiple sclerosis.”

  49. “...In this case, chiropractic adjustments to the upper cervical spine were effective in resolving the infantile colic.”

  50. Asthma is the most common chronic condition in children, responsible for staggering healthcare expenditures, and thousands of deaths per year in this country alone. (?)

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