How to do Case Reports

1. How to do Case Reports Albert Moraska, PhD Assistant Research Professor University of Colorado Health Sciences Center

2. Outline • Conducting a Case Report • Summarizing your findings • Insights into the Review Process

3. Goals of Case Reports Submitted for Journal Publication • Increase research literacy • Stimulate research • Provide forum for individuals to present their experiences • Enhance professional development

4. Why do a Case Report? • Responsibility of a profession • Forward the field / Gain acceptance • Share information

5. Value of a Case Report Case Report Pilot / Feasibility Study Small Clinical Trial Large Multi-Center Clinical Trial

6. Marshall’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.

7. Conducting a Case Report

8. Identifying a research topic • Prospective or retrospective • Locate a subject • Clients • Family / friends • Medical referral • Has this topic been reported before? • Is this a topic that others would be interested in?

9. Ideas for (simple) measurements • Consult the literature • Visual Analog Scales • Goniometers • Clinical significance • Other simple measures: • number of steps, • number of hours slept, • number of hours in pain, etc.

10. Summarizing Your Findings

11. Writing the Case Report • Abstract (6 pts) • Introduction (25 pts) • Methods • Profile of Client (10 pts) • Treatment Plan (15 pts) • Results (15 pts) • Discussion (20 pts) • References • Other documentation

12. The Case Report - Abstract • Brief summary – 200 word limit • Objective • Methods • Results • Conclusion • Used by indexing services • Key words

13. The Case Report - Introduction • Build an argument for doing the study • Background to understand topic • Justification for why treatment should benefit • Arguments supported by the literature • Not an exhaustive review • About 250-500 words

14. The Case Report - Methods • Client Profile • Treatment Plan • Description of treatment techniques used, treatment duration, etc. • Don’t mix in any results • Evaluation Procedures • Sufficient detail such that someone could “repeat the study”

15. The Case Report - Results • Presenting the data • In the text - briefly (100-200 words) describe any particularly interesting finding and refer to: • Tables • great for complex data sets • Figures • great for visual effect • need a figure caption

16. Data Presentation Styles • Don’t be overly complex

17. Data Presentation Styles • Make sure the data you want to get across is easily obtainable by the reader

18. Data Presentation Styles • Don’t use 3-Dimensional graphs

19. Data Presentation Styles Use fixed measurement references Figure 3 Figure 4

20. Data Presentation Styles 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.

21. The Case Report - Discussion • Provide meaning to the data: • Why was this study important? • What previous unknown is now known? • Critically evaluate the data • Describe strengths and limitations • e.g. only used one form treatment • Are there more accurate evaluation methods? • Relate findings to other similar studies • e.g. compare to other types of treatments

22. The Case Report - Discussion Hypothetical Example #1

23. The Case Report - Discussion 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)

24. The Case Report - References • No specific point value, but… • The strength of a report is dependent, in part, on the strength of its citations! • Use primary literature sources • e.g. peer-reviewed articles • Not secondary sources: Wikipedia, WebMD • Textbooks? A few o.k.

25. Finding References • The search • From the literature • Internet search engines: Pubmed.gov • The locating • Some open access • Libraries: generally University or Medical • Contact the author • Purchase from journal • The reading

26. Insights into the Review Process

27. The Reviewers (MTF) • Group of 6 members • Consists of • Practitioners • Educators • Researchers

28. Tips on Conducting the Study • Use only one treatment modality • Use reliable measures to assess progress • Novelty of topic may trump quality of study • Synthesize data and present it only once • “Negative” data isn’t a show stopper, but….

29. Tips on Presenting the Study • You don’t need to present all the data you collect • Don’t use “I” or “we” (“the author(s)”) • Minimize use of direct quotes • Be clear and concise

30. Other Documentation • Informed Consent – Appendix D • HIPAA Guidelines – Appendix E • Photograph Release Form – Appendix F • Proof of Liability Insurance • Institutional Review Board Approval – not required for a description of practice that does not involve research methodology.