Writing a Case Report & Photo Quiz ( and a little about Posters )

1. Writing a Case Report & Photo Quiz (and a little about Posters) The Nuts & Bolts Robert Lennon, MD, JD LT MC USN

2. What makes a good reportable case?

3. Definitely… • Changes the course of medical science • Illustrates a new principle • Supports or refutes a current theory

4. And of course… • Presents a previously misunderstood condition or response • Unreported adverse response to drug therapies • Unrecognized cause-and-effect presentations

5. Don’t Forget: Touch-Feely Stuff • An event that had a significant impact on patient, physician, or both. • A case that causes a physician to reevaluate how he /she cared for patients • A case that suggests opportunities for patient education

6. Really: Anything Sufficiently Interesting • An unusual series of events that caused confusion or tx dilemmas • New observation of the impact of one disease process on another • A tx for one condition that results in an unexpected outcome for a different condition

7. Photo Quiz&Poster Presentation Both are concise, visually appealing versions of a case presentation

8. Elements: POSTER PHOTO QUIZ Title Authors HPI Question   Discussion Summary Table  References • Title • Authors • Intro  • Case Report  • Images • Discussion  • Conclusion CASE REPORT • Title • Authors • Intro • Case Report   • Discussion • Conclusion • References

9. Reducing the Risk of Breast Cancer Seehusen DA, Edwards JA, Junnila JL, Oh RC, Runkle GPMadigan Army Medical Center Does tamoxifen reduce breast cancer risk in women with a family history of colon cancer? 5 year Breast Cancer Mortality • Methods: • Double-blinded, placebo-controlled randomized trial • Intervention: Tamoxifen 20mg daily for five years • 10,000 subjects enrolled Control Tamoxifen (per 5,000 subjects)) • Background: • Tamoxifen effective in breast cancer prevention • Family History of colon cancer increases risk Results: 50% reduction in 10 year risk of breast cancer in women ages 40-59 with a first degree relative with colorectal adenocarcinoma treated with prophylactic tamoxifen

10. Put graphic of Desvenlafexine Poster here

11. Workshop Time!

12. Approach • We’ll describe each element of Case Report • Time provided to work on each element Poster Photo Quiz Pick a style, pull it up from your CD, and overwrite the sample with your case.

13. Title, Author Spontaneous Hematomas in a 61-Year-Old Woman John Yosay, MD, LT, MC, USN Naval Hospital Jacksonville, Jacksonville, Florida 5

14. Intro/Case vs. HPI • Very Similar; tweak to interchange Intro & Case HPI: very brief; no need for intro as questions will prompt reader in desired direction

15. Introduction • 3 sentences that answer the reader’s thoughts: “Your title intrigues me. Why should I read the rest of your poster?” “So what?” “Why should I care?”

16. Case Presentation • Imagine consulting a specialist: present your case. • 10 lines or less! • Just the facts!

17. Photo Quiz HPI • Like the case presentation; think of it an expert consult… • Concise but informative. • 10 lines or less. • May reference pictures here.

18. Your Turn • Take 15 minutes to write your: Intro & Case Presentation HPI 15

19. Pictures!

20. More Pictures

21. Discussion • Concise, informative • Gives the info they need to be confident in your conclusion Compare & contrast to the literature (NOT a grand rounds!)

22. Photo Quiz Discussion – The Question Your differential diagnosis in multiple choice answer format a. incorrect b. correct c. incorrect d. incorrect e. incorrect

23. Photo Quiz Discussion – the answer Page 2 of 2 for the Photo Quiz: ¶ 1: Answer w/ explanation ¶ 2: Emphasize: Why should primary care doc care?

24. Photo Quiz Discussion – explanations Each incorrect answer is then addressed in its own paragraph. • A brief analysis for each DDx. • Each answer should have a citation

25. Your Turn • Take 30 minutes to craft your: Discussion Questions & Answers 30

26. Conclusion • The bookend to your introduction • Gives the take-home of why reading this case or poster was worthwhile.

27. Photo QuizSummary Table

28. Your Turn! Take 15 minutes to draft your: Conclusion Summary Table 15

29. And finally…References • 1. Plavix Prescribing Information. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Accessed 26 April 2011, at http://products.sanofi-aventis.us/plavix/plavix.html. • 2. McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med 2006;119(8):624. • 3. Reeves RR, Wise PM, Cox SK. SSRIs & the risk of abnormal bleeding. J Psychosoc Nurs Men Health Serv 2007;45(4):15-21. • 4. Kamath J, Handratta V. Desvenlafaxine succinate for major depressive disorder: a critical review of the evidence. Expert Rev Neurother 2008 Dec;8(12):1787-97. • 5. Swagerty D, Takahashi P. Elder Mistreatment. Am Fam Physician May 15, 1999. • 6. National Center on Elder Abuse. Accessed 26 April 2011, at http://www.ncea.aoa.gov. • 7. Franchini M, Favaloro EJ, Lippi G. Mild hemophilia. J Thromb Haemost 2010;8(3):421. • 8. Harrison’s Principles of Internal Medicine, 16th edition. Kasper D et al, McGraw-Hill pp680. • 9. Aster R, Bougie D. Drug-Induced Immune Thrombocytopenia. N Engl J Med 2007;357:580-587. • 10. Cines D, Blanchette V, Chir B. Immune Thrombocytopenic Purpura. N Engl J Med 2002;346:995-1008.

30. Summary "I will impart a knowledge of the Art" - Hippocrates • You can do this!  • You can teach others to do this!

31. Thank You ! Questions?