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Case Report Writing
This document discusses case report writing in traditional medicine. It notes that case reports are valuable for documenting unusual clinical presentations, outcomes of interventions, and other observations that could benefit other practitioners. However, case reporting is challenging in traditional medicine due to poor understanding of diagnostic methods, lack of consensus on approaches, and difficulty interfacing traditional medicine with modern science. The document provides guidelines for writing case reports, including examining patients thoroughly, documenting all observations, logically linking interventions to outcomes, and publishing once meaningful trends are identified that could help others. Overall, it emphasizes the importance of detailed documentation and logical analysis to strengthen case reporting in traditional medicine.
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Case Report Writing
- 1. Case Report Writing: Whatis special about it in traditional medicine? Prof ( Dr ) Sanjeev Rastogi State Ayurveda College, Lucknow University
- 2. A physician mayhave many moods These are my Observations Thinking Experimenting Questioning Celebrating Reporting
- 3. Am I thefirst to Do This ? ďľ Thinking about a new treatment plan ďľ Has anybody thought of this before ? ďľ Experimenting for a new intervention or technique ďľ Has anybody experimented like this before ? ďľ Celebrating the success of an intervention ďľ Has anybody succeed in this before ? ďľ Questioning about the failures ďľ Has anybody failed earlier also doing so ? ďľ Reporting to what is observed ďľ Has anybody reported it before? Wanted to be sure if you are following the trend or Is setting the trend You are following the trend if similar instances are available in the literature You are setting the trend if no one has done it earlier
- 4. What if youwish to set a trend? ďľ Share your experience stories ďľ Document them so that others can also be benefitted by them. ďľ Mind that what you are able to do now for your patients is possibly because someone has done and documented it before you. Doctorâs stories are nothing but the observations of cases presented as reports
- 5. Writing the casereports?
- 6. What are theCase Reports ? Always note and record the unusualâŚPublish it. Place it on permanent record as a short, concise note. Such communications are always of value. â Sir William Osler In practice of medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel finding . Father of modern medicine Sir William Osler
- 7. What a casereport may contain ? ďľ Any thing unusually positive or negative relating to ďľ A clinical presentation ďľ Outcome of an intervention ďľ Outcome of a diagnostic procedure ďľ Prognosis of a disease ďľ Clinical course of a disease ďľ Adversity of otherwise safe intervention
- 8. What a Casereport may contain? ďľ Findings shedding new light on possible pathogenesis of a disease or an adverse effect ďľ Learning from errors ďľ Myth exploded ďľ Adversity due to heavy metals versus using heavy metal compounds in critical conditions ďľ New Disease ďľ Not available in literature ďľ Novel Diagnostic procedure ďľ Newly developed or old device used for new indication ďľ Novel treatment ( new drug / intervention; established drug / procedure in new situation) ďľ Rare disease ďľ Reminder of important clinical lesson ďľ Importance of clinical examination, clinical signs and symptoms ďľ Unexpected outcome ( positive or negative ) including adverse drug reaction ďľ Unusual association of disease / symptoms ďľ Combination of diseases/ symptoms occurring together ďľ Unusual presentation of a common disease/ injury
- 9. Why Case Reports? ďľTo place on Record the uncommon / rare observations related to ďľ A clinical finding / presentation ďľ A clinical incidence ďľ The effects of intervention either positive or negative ďľ The outcome of a disease ďľ For ďľ Either oneâs own use as a clinical record ďľ Or for common benefit of the peers
- 10. Benefits of CaseReporting ďľImmediate ďľPrompts the peers to get benefits from the experiences of others ďľHelps patients of untreatable conditions finding a hope ďľRemote ďľGenerates a better understanding about variability in human population ďľWorks as a clue to plan more serious systematic studies in the target areas
- 11. Historical Case Reports 11 Lancet1896, First use of X-ray to visualize a bullet in situ South African Med J 1967; 41: 1271â 1274.
- 12. Historical Case Reports ďľThree cases of Phocomelia caused as the teratogenic effect of Thalidomide was first noticed by a case report in 1962. ďľ Subsequently led by many such reports ďľ The drug was subsequently withdrawn ďľ Fischel J. Coodin, Irene A. Uchida, and Claude H. Murphy Phocomelia: Report of Three Cases Can Med Assoc J. 1962 Oct 6; 87(14): 735â739. 12
- 13. Beginning of Researchon AIDS ďľ Begun after the publication of a case report in 1981 of Kaposiâs sarcoma in a young homosexual man . ďľ This case report followed by 103 similar case reports published in Lancet in next 5 years. ďľ 24 randomized control trials followed subsequently. Gottleib GJ, Rogoz A, Vogel JV et al. A preliminary communication on extensively disseminated Kaposiâs sarcoma in a young homosexual man. Am J Dermatopathol. 1981; 3:111-4. 13
- 14. When to writeCase Report? Prospective Case reporting Begin the intervention now and report the observations in future Retrospective case reporting Report the observations now for the interventions done in the past Ambispective Case reporting Report the observation for interventions of the past, continue the intervention and report the observation in future
- 15. Who can writea case report ? ďľ Any one who is related directly to the health care delivery ďľ Physician ďľ Clinical aspects of a disease ďľ Results of a drug intervention ďľ Nursing staff ďľ About a drug adversity ďľ About unusual developments in a clinical condition ďľ Pharmacist ďľ About undue results of a drug combination and dosage ďľ Medical students, interns and PG scholars ďľ About the causes of the disease , unusual signs and symptoms of a clinical condition ďľ Specialists involved in pharmaceutics ďľ Special observation made during the drug processing which are clinically relevant
- 16. How to writethe case report? ďľ Content ďľ Novelty of the case ďľ Rarity or uncommonness ďľ Prospective future implications ďľ Honesty in reporting ďľ Unbiased inferences ďľ Transparency of reporting ďľ Proof of findings ďľ Orderly and logical presentation ďľ Frame work of a case report ďľ Essential components of a case report as per CARE guideline ďľ available at https://www.care-statement.org
- 17. CARE guideline checklist TopicItem Description Title 1 The words âcase reportâ should be in the title along with the area of focus Keyword 2 2 to 5 key words that identify areas covered in this case report Abstract 3a IntroductionâWhat is unique about this case? What does it add to the medical literature?. 3b The main symptoms of the patient and the important clinical findings 3c The main diagnoses, therapeutics interventions, and outcomes . 3d ConclusionâWhat are the main âtake-awayâ lessons from this case? . Introductio n 4 One or two paragraphs summarizing why this case is unique with references
- 18. Topic Item Description Patientinformation 5a De-identified demographic information and other patient specific information 5b Main concerns and symptoms of the patient 5c Medical, family, and psychosocial history including relevant genetic information. 5d Relevant past interventions and their outcomes Clinical finding 6 Describe the relevant physical examination (PE) and other significant clinical findings Time line 7 Important information from the patientâs history organized as a timeline Diagnostic assessment 8a Diagnostic methods (such as PE, laboratory testing, imaging, surveys) 8b Diagnostic challenges (such as access, financial, or cultural). 8c Diagnostic reasoning including other diagnoses considered 8d Prognostic characteristics (such as staging in oncology) where applicable
- 19. Topic Item Description Therapeutic intervention 9aTypes of intervention (such as pharmacologic, surgical, preventive, self-care) 9b Administration of intervention (such as dosage, strength, duration) 9c Changes in intervention (with rationale) Follow up and Outcomes 10a Clinician and patient-assessed outcomes(when appropriate) 10b Important follow-up diagnostic and other test results 10c Intervention adherence and tolerability (How was this assessed?) 10d Adverse and unanticipated events Discussion 11a Discussion of the strengths and limitations in your approach to this case 11b Discussion of the relevant medical literature 11c The rationale for conclusions (including assessment of possible causes). 11d The primary âtake-awayâ lessons of this case report .
- 20. Topic Item Description Patient perspective 12When appropriate the patient should share their perspective on the treatments they received Informed consent 13 Did the patient give informed consent? Please provide if requested
- 21. What do notcomprise a good case report ? ďľ A common clinical condition ďľ A common therapeutic approach ďľ A commonly occurring outcome ďľ A commonly occurring adversity ďľ A commonly occurring sign or symptom ďľ A biased reporting favoring one finding over the other ďľ Over drawn inferences not supported through observations
- 22. Limitations of CaseReports ďľ Considered a low level evidence on evidence hierarchy ďľ Highest is RCT ďľ Low generalizability or external validity ďľ Outcome pertains to a single patient, not necessarily replicable on others ďľ Biased reporting favoring the positive and hiding the negative outcomes ďľ Over 90 % published case reports are about the positive outcome ďľ Low publishability ďľ Many scientific journals do not prefer publishing case reports ďľ Tempting the physicians ďľ to try inadequately tested therapies in difficult to be treated conditions ďľ Hence making the patient exposed to risk ďľ Warning the physicians ďľ Unduly by reporting negatively for available therapeutic options ďľ Hence restricting the therapeutic options ďľ Promoting self treatment ďľ Patients having difficult to be cured conditions are tempted to be treated as reported in similar cases
- 23. Case Reporting inTraditional Medicine Diagnostic Approach Treatmen t Approach Inference 1 Modern Diagnosis Modern Treatment Not relevant to Traditional Medicine 2 Ayurvedic Diagnosis Ayurvedic Treatment Not meaningful to rest of the community 3 Modern Diagnosis Ayurvedic Treatment Fairly understandable , hence is a preferred method of reporting 4 Ayurvedic Diagnosis Modern Treatment Not applicable for want of standard diagnostic techniques of Traditional Medicine and their parallel understanding in modern science Udupa Committee report on prospects of research in Ayurveda 1958
- 24. Problems of CaseReporting in Traditional Medicine ďľ Poor understanding of native diagnostic methods ďľ Poor application of native diagnostic methods in practice ďľ Poor consensus about various approaches of diagnosis and treatment used in TM ďľ Poor interfacing between TM and modern medicine making the logical explanation of TM approaches difficult High variability of understanding and highly subjective methods of examination make TM difficult to be translated as an organized system of practice of medicine
- 25. Case Reporting :Moving forward Pragmatically ďľ Examine the patient to the utmost details ďľ Examine all the available records of patient ďľ Keep a note of everything you observe ďľ Make a logical plan of interventions ďľ Keep a close follow-up of the patient for any positive /negative changes ďľ Try to understand logically the reasons for any change observed ďľ Linkup the observation with scientific logic wherever you can ďľ Repeat the same approach to more of similar cases coming to you to identify the trends and to see the variability of responses ďľ Publish the observations once you are convinced that these observations may help others in making the therapeutic choices.