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Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht
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Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Dec 13, 2015

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Page 1: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 2: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 3: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 4: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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!

Page 5: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Case

• Detailed description– relevant characteristics– findings & particularities

• Motivation problem – knowledge gap (education, study book, practice)– Why important?

Page 6: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Clinical question

• Translation ‘clinical bottom-line’, follows from description of problem. – Domain (patient)– Determinant (intervention, comparison)– Outcome (outcome)

Page 7: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 8: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Search; methods

Methods search

-see references and practical lecture

-Make it transparent!

-Table 1 with search strategy

Page 9: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 10: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 11: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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).

Page 12: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 13: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 14: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 15: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 16: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 17: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Discussion

• Interpretation of results on best available evidence

• Formulation of recommendation for patient

• Explicit motivation on recommendation• Considerations concerning

– relevance (restrictions?)– validity (restrictions?)

Page 18: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 19: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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 

Page 20: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.
Page 21: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.
Page 22: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 23: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 24: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 25: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

• Conclusion:

insufficient / doubtful / sufficient / good / excellent

• Recommendation:

insufficient / doubtful / sufficient / good / excellent

Page 26: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Tops

1

2

3

Tips

1

2

3

• Overall rating of report:

insufficient / doubtful / sufficient / good / excellent

Page 27: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Weekly target

Week 1 presentation:

• Case illustration.

• Clinical question and PICO.

• Existing knowledge on the problem (comparison from several books/sources).

Page 28: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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.

Page 29: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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).

Page 30: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 31: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

Questions ?

Page 32: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 33: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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

Page 34: Evidence-Based Case Reports Methods of design and reporting Indah S. Widyahening with team from the Julius Center for Health Sciences & Primary Care, University.

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