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Evidence-Based Case ReportsMethods of design and reporting
Indah S. Widyaheningwith team from the Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht
Evidence-based case reports• show how evidence can be applied at all stages of
patient care.
• define the clinical question in four parts: Patient, Intervention, Comparison, Outcome (PICO)
• show that you have searched for, cited, and
summarised studies of appropriate relevance, design, and quality, and should state which bibliographic databases you have used.
• answer the research question or state that there is no
answer available.www.bmj.com
Evidence-based case reports
• A brief methods section explaining where you found the information.
• Max 1200 words (provide word count!).• Max 24 references.• Max 4 illustrations (clinical photographs, imaging, line
drawings, figures, tables)
• A summary boxsummary box with up to five short single sentences highlighting new or particularly interesting things
www.bmj.com
Contents of EBCR• Clinical Case clinical scenario / case
• Question clinical question (PICO)
• Methods -search strategy/selection (fig1: flow chart)
-critical appraisal sorting (Table)
• Results evaluation selected articles (Table?)
• Discussion strong and weak points articles
• Conclusion answer question about patient!
Case
• Detailed description– relevant characteristics– findings & particularities
• Motivation problem – knowledge gap (education, study book, practice)– Why important?
Clinical question
• Translation ‘clinical bottom-line’, follows from description of problem. – Domain (patient)– Determinant (intervention, comparison)– Outcome (outcome)
EBM clinical question
What is it?
-critical question related to an acute + realistic problem concerning patient management for which a knowledge gap exists
-specific, answerable
What is the aim?Obtain clarity & certainty about the best patient management
Search; methods
Methods search
-see references and practical lecture
-Make it transparent!
-Table 1 with search strategy
Search; resultsTable 1: search strategy• Source files searched (internet)• Combination of search terms (OR, AND)• Numbers
Table 1: Search strategy
Database Search strategy hits Selection articles
Pubmed ((“magnetic resonance imaging” [MeSH]) AND (mammography) AND (“breast neoplasms”[MeSH])) AND (specificity[Title/Abstract]) Limits
57 6
Embase (breast cancer) AND (MR) AND (premenopausal)
2 1
Cochrane Breast neoplasms AND Magnetic Resonance Imaging
19 0
Select; methods
• Reduction number titles
• Prior definition of exclusion and inclusion criteria- study type (design)
- domain, determinant, outcome
• Screening title/abstract
• With doubt: screening full text
Select; results
Figure 1: flow chart selection (flow chart)• Search results different databases (number)• Clear exclusion criteria• Numbers not selected (per exclusion
criterium)
Number articles, selected for further assessment (critical appraisal).
PubMed
Cerebrospinal fluid
Embase
Screening title abstract*
Filtering doubles
79 51
18 13
Exclusion criteria:-Animals-Neonates-Adults-Therapeutic study-CSF composition not specified
Children with pneumococcal
meningitisMortality
AND
AND
Screening title abstract*
Full text availability
Useful:10
articles
18
Excluded because or:-Insufficient outcome (mortality)-Experimental, non-comparable CSF measurement-Therapeutic study
Reading full text*
Inclusion criteria:-Prognostic study-Mortality as outcome-CSF composition as prognostic factor
13
27
1 article found by screening references
Not useful (domain: adults also
included)
Search date: 30 November 2005*All decisions were made by consensus or at least 2 authors
Flow chart
Critical Appraisal; Methods
• Relevance for patient (patient included?)– Domain, Determinant, Outcome– Search similarities & differences
• Validity study (well performed?)– Selection/selection bias– Information bias– Confounding
order
Critical Appraisal; Results
• In table
– Criteria relevance
– Criteria validity
• Specific for patient’s case
• Own simply applied system
• Never forget legends
Sim
ilari
ty d
om
ain
Sim
ilari
ty
det
erm
inan
t
Sim
ilari
ty o
utc
om
e
Diagnosis Prognosis Therapy EtiologyPrediction Presence/
absence disease
Course of disease
Result of treatment
Relation of a risk (etiology) factor
Domain (Patient)
Patient suspected of disease
Patient with
diagnosis and
probability endpoint
Patient with
diagnosis and
probability endpoint
Population at risk
Determinant (Indicator/Comparator)
As in practice As in practice Manipulated As in practice (exposure/risk factors)
Outcome reference test or -criterium
Mortality, morbidity,
QoL
Mortality, morbidity,
QoL
Mortality, morbidity, QoL
Type of study Cross sectional
Follow up (time until outcome)
Follow up (time until outcome)
Follow up, case-control
Design study Descriptive Descriptive Causal Causal
Outcome measure AR AR RR/RD RR
Each question has own design
Strength of evidence; results
Summarizing table• ‘Best available evidence’ • Consideration of quality (relevance and validity)
and amount information/studies best available evidence
• Results and precision
• Consistency - discrepancy result
Discussion
• Interpretation of results on best available evidence
• Formulation of recommendation for patient
• Explicit motivation on recommendation• Considerations concerning
– relevance (restrictions?)– validity (restrictions?)
EBCR- summary
• Case
• Research question
• Search strategy
• Results & selection criteria
• Discussion
Text• introduction case & research
question• justification management problem
Flow chart • sources, selection, numbers
Tables• Relevance & validity• Results and strength of evidence
Text• interpretation results• recommendation management• comments
Evidence based case reportsAuthor requirements see
www.bmj.com
• Click at www.bmj.com under resources for authors, types of articles, practice, Evidence based case reports
Reviewer: Title:
TypeDoes clinical question pertain to treatment effect? Yes / noDoes clinical question pertain to the added value of a determinant or test? Yes / noDoes domain involve patients with a confirmed disease? Yes / noDoes determinant involve treatment? Yes / noDoes outcome involve follow-up? Yes / no
Evaluation form
Case-Clinical scenario (case description): insufficient / doubtful / sufficient / good / excellent
Question •Domain:
insufficient / doubtful / sufficient / good / excellent •Determinant:
insufficient / doubtful / sufficient / good / excellent •Outcome:
insufficient / doubtful / sufficient / good / excellent •Relevance:
insufficient / doubtful / sufficient / good / excellent
Methods
• Search and selection: insufficient / doubtful / sufficient / good / excellent
• Critical appraisal: insufficient / doubtful / sufficient / good / excellent
• Data extraction: insufficient / doubtful / sufficient / good / excellent
Results
• Search and selection: insufficient / doubtful / sufficient / good / excellent
• Critical appraisal: insufficient / doubtful / sufficient / good / excellent
• Outcomes: insufficient / doubtful / sufficient / good / excellent
• Conclusion:
insufficient / doubtful / sufficient / good / excellent
• Recommendation:
insufficient / doubtful / sufficient / good / excellent
Tops
1
2
3
Tips
1
2
3
• Overall rating of report:
insufficient / doubtful / sufficient / good / excellent
Weekly target
Week 1 presentation:
• Case illustration.
• Clinical question and PICO.
• Existing knowledge on the problem (comparison from several books/sources).
Weekly target
Week 2 presentation:• (revised) PICO• Description on literature search strategy • Description about articles found during
the search, report on their relevance and validity after critical appraisal (for sub-group with problem on therapy), presented in a table.
Weekly target
Week 3 presentation:
• Description about articles found during the search, report on their relevance and validity after critical appraisal (presented in a table).
Weekly target
Week 4 presentation:
Complete EBCR with the following structure: • Case illustration• Clinical question and PICO• Methods : literature search (flowchart) and critical
appraisal (table)• Result as stated in the selected articles • Discussion: strengths and weaknesses of the selected
evidences • Conclusion & recommendation for patient
Questions ?
PLAGIARISME
Plagiarisme adalah tindakan seseorang yang mencuri ide atau pikiran yang telah dituangkan dalam bentuk tertulis dan/atau tulisan orang lain dan yang digunakannya dalam tulisannya seolah-olah ide atau tulisan orang lain tersebut adalah ide, pikiran dan/atau tulisan sendiri sehingga merugikan orang lain baik material maupun non material, dapat berupa pencurian sebuah kata, frasa, kalimat, paragraf, atau bahkan pencurian bab dari tulisan atau buku seseorang, tanpa menyebut sumbernya, termasuk dalam Plagiarisme adalah Plagiarisme diri
SK Rektor UI no 208 tahun 2009
ALUR
DUGAAN PLAGIARISME
LAPORAN TERTULIS
PIMPINAN UNIVERSITAS
P3T2:
PANITIA PENYELESAIAN PELANGGARAN TATA TERTIB KEHIDUPAN
KAMPUS UNIVERSITAS INDONESIA
TERBUKTI:
SK REKTOR
TIDAK TERBUKTI
SK Rektor UI no 208 tahun 2009
PENCEGAHAN PLAGIARISME
Pernyataan bebas plagiarisme pada halaman kedua setelah judul Tugas kuliah/Makalah/Karya
ilmiah/Laporan/Penelitian/Skripsi/Tesis/Disertasi
SK Rektor UI no 208 tahun 2009
