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Writing Your Case ReportLisa Zaynab Killinger, DC
Palmer Center for Chiropractic Research
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RememberA case report describes the
identification, management, orunusual presentation of a
condition or clinical scenario.
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Case Reports...
Should educate or share important
experiences with others
Are the foundation for future studies
Are healthcare story telling
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Choosing your Case
An unusual occurrence or presentation
An unexpected outcome (The Good, the Bad,
or the Ugly!) A new approach to an old problem (If you
used an uncommon technique, or added a new
intervention, etc)
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Stay within the limits of Case
Reports in your writing:
Not generalizable
Describes what happened in one
case, nothing more.
Does not rule out placebo effect
Does not prove effectiveness of
treatment
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Building Your Case Report:
Abstract Introduction
Methods/Case Report* Intervention and Outcome
Discussion
Conclusions
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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!)
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Did you answer:
What is known about the
condition of interest?
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Case Report or Clinical
Features Section
Describes the history and exam of the
patient
(Thoroughly enough to convince the
reader that you arrived at the
appropriate clinical impression and
management plan!)
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Did you answer:
How did patient present, what
were your exam findings, and
what was your clinicalimpression?
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Methods or
Intervention &Outcome
This section must describe the caregiven in enough detail that the
reader could easily duplicate the
care. (And, hopefully, duplicate
your outcomes!)
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Did you answer:
What did you do, when,
and how?
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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.
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Visual Analog Scale :VAS(Global Well-Being Scale, etc.)
or Verbal Analog Scale
Simply a 10 cm. line
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Rand-36
(SF-36)
A 36 question survey; patient fills it out
A valid and reliable measure of the patients
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.
Th O t
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The Outcome
(Results) Section
Answers:
How did you documentchange (positive or negative
results) in this case?
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Discussion Includes:
Interpretations of your findings
Comparison of your case with other studie(The ones cited in your intro!)
Rationale for management plan
Discussion of limitations/flaws in yourstudy
Discuss possible reasons for the results
you observed (other variables,placebo, etc
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The Discussion Section
Answers:
How does your caseconfirm/refute previous studies
on this topic, and why did you do
what you did?
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Conclusions
Tells the reader what was learnedthrough this case
Describes why the case is significant
Suggests a direction for future
studies.
Dont make unsubstantiated claims!!!
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The Conclusion
Section Answers:
What is the next stepin studying this topic?
H t ill b
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How your case report will be
judged for quality :
Use of outcomes assessments
Lengthy follow-up
Discussion of its limitations! (If
you dont, we will!)
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More Measures of Quality:
Thorough description of methods
Discussion of the placebo effect
Good quality, recent references!!
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A Word About References
References should be numbered in the
order they appear in the article
References need to be listed
immediately following any phrase) from
another author or article. All statements of fact MUST be
referenced.
Research articles are preferred, thentextbooks, then manuals, popular press
articles, etc.
Style Scientific
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StyleScientific
Pulications/Articles
Authors Last name then first initial, other authors Title of article (onlyfirst letter capitalized) Name of
Journal(using standard abbrev and italicized)year of publicationvolume number and issuenumber (issue # in parentheses)page
numbers
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Hurwitz EL, Coulter ID, Adams
AH, et al. Use of chiropracticservices from 1985-1991 in
the United States and
Canada.Am J Public Health.
1998;88(5):771-776.
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Style-Textbooks
Author last name and first initialNameof Book(Italicized; with each main word
capitalized) Edition number
City/country of publication
Publishers name Year of
pubication page numbers
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Peters T. The Pursuit of Wow!New York:Vintage
Books;1994.
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Some things NOT to do when
writing your case report...
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DONT
Write as if you are promoting your technique,product or clinic (case reports are notadvertisements)
Submit without you AND others proofreading
your paper Use patients or doctors name
Try to generalize
Say that you proved effectiveness of
chiropractic!
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Whats wrong with this picture?
Find it and Fix it!
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...This case studydemonstrates that chiropractic
is an effective treatment for
multiple sclerosis.
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...In this case, chiropractic
adjustments to the upper
cervical spine were effective
in resolving the infantile colic.
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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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The cervical films showed a
C3 PRI.
Wh t h ?
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What goes where?
For each sentence thatfollows, decide into which
section of the case study (e.g:
methods, intro) it would most
appropriately fit.
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In this case, we observed adecrease in the number and
severity of headaches..
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Asthma is the most common
chronic condition in children,responsible for staggering
healthcare expenditures, and
thousands of deaths per year
in the United States alone. (2)
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Recent studies have shown
chiropractic care to be aneffective treatment for chronic
tension-type headaches. (13,
14) The results observed inthis case, confirm the findings
of these earlier studies.
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Pace Yourself
This week and next: Choose your case As soon as you choose, start writing
intervention and outcomes sections (from thepatient file)
Allow yourself at least 10-20 total hours tocomplete this case report
Start collecting articles/references on the topicof your case for your intro section (need atleast 5-15)
As soon as you have articles, start circlingsentences to use in your paper (statementsfrom the intro and the results)
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Dont forget your abstract!
Written last; after the paper is done. Includes a main idea/sentence or two from
each section: Intro, Intervention, Outcome,
Discussion, etc.
Should be brief and succinct
Catches readers attention
(Answers: Why should you want to read
this paper?)
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Remember
This is NOT Dr. Killingers assignment Dont come ask me about due dates, page
lengths, grading criteria, etc.
Dont turn your paper in to me!! All questions about the assignment should be
directed to your CCC instructor.