Transcript THE CASE BOOK

THE CASE BOOK.
DR. S. YOHANNA.
2015 REVISION COURSE.
OBJECTIVES OF THE CASE BOOK
TO DEMONSTRATE:
1. BROAD KNOWLEDGE & SKILLS IN FM.
2. APPROPRIATE USE OF RESOURCES.
3. ROLE IN VARIOUS LEVELS OF CARE:
- HEALTH PROMOTION, EDUCATION
- DISEASE PREVENTION
- TREATMENT
- LIMITATION OF DISABILITY
- REHABILITATION
OBJECTIVES
4. IMPACT OF DISEASE ON FAMILY, AND VICE
VERSA.
5. FOLLOW UP & CONTINUING CARE.
6. COMMITMENT TO C.M.E.
7. ATTITUDE TO PATIENT, FAMILY, AND
COMMUNITY.
SELECTION OF PATIENTS
• COMMON CONDITIONS IN FM.
• PERSONALLY MANAGED BY YOU.
• CLEAR LESSONS FOR FM IN NIGERIA.
• DEMONSTRATE OBJECTIVES OF THE CASE
BOOK.
Before you start writing a Case report, ask
yourself:
1. Which of the objectives am I trying to
illustrate?
2. What key principle or concept of FM does
this patient illustrate?
CASE DISTRIBUTION: 20
• OBSTET.
-2
• OPHTH.
-2
• GYNAE.
-2
• E.N.T.
-1
• PSYCH.
-2
• ORTHO.
-1
• F.P.
-1
• MED.
-3
• PAED.
-3
• SURG.
-2
• FAM. CASE STUDY- 1
CASE REPORT FORMAT.
1. PERSONAL DATA.
2. THE CASE REPORT.
3. DISCUSSION.
4. REFERENCES.
PERSONAL DATA.
•
•
•
•
NAME
AGE
SEX
ADDDRESS
. OCCUPATION
. HOSP. NO.
. DATE ADMITTED
. DATE DISCHARGED
• Paed Cases: Add patient’s wt.
• O/G Cases: Add parity, LMP, EDD (if preg)
THE BODY OF THE CASE.
• HISTORY
• EXAMINATION
• PROVISIONAL DIAGNOSIS
• INVESTIGATIONS
• TREATMENT
• FOLLOW UP
History
•
•
•
•
•
•
Presenting complaint
HPC, including FIFE
Review of (relevant) systems
Past Medical History
Family & Social History
Drug history
History: Additionally ...
• In children:
– Pregnancy & delivery history
– Growth & dev history
– Nutritional history
– Immunizations
• In women/Obs & Gynae cases:
– Obs & Gynae history
Examination
• General
• Systemic, starting with the system directly
affected
(Provisional) Diagnosis
• Should arise from the history and examination
findings.
• May be reviewed after relevant investigations,
or as the illness evolves.
• Helpful to have one or two differentials – but
not mandatory, especially where the
presentation is very obvious.
Investigations
• Factors to consider:
– Relevance: will this investigation influence your
diagnosis, or management of the patient?
– Cost-effectiveness: are there cheaper alternatives,
can this patient afford the costs?
– Feasibility, time to obtain results, etc
– Availability in your locality
Treatment
• Consider similar factors as in Investigations
• Must be evidence-based
• Must be rational: correct diagnosis, correct meds,
correct combination(s), correct doses, frequency
of administration, correct duration.
• Don’t be the 1st to experiment with a new drug,
and don’t be the last to abandon an old one.
• As far as possible, the treatment should not be
worse than the illness being treated.
Follow up
• Shows evidence of continuity of care.
• At least 1 – 2 follow up visits, could be more,
depending on the illness.
• Home visit is helpful, but not mandatory. There must
be a clear aim for such a visit.
• Ideal to have discharged the patient from follow up
before you start writing the case report.
• Avoid “inconclusive” cases - where patients absconded,
defaulted etc.
• Preferable not to have too many patients that ended in
death.
DISCUSSION.
• DEFINE OR DESCRIBE THE PROBLEM
• DISCUSS THE PATIENT (NOT THE DISEASE) WITH
ADEQUATE LITERATURE REVIEW.
• SUMMARIZE KEY LESSONS FOR FM
• MAKE RECOMMENDATIONS, WHERE NECESSARY.
THE DISCUSSION MAKES THE
DIFFERENCE
BETWEEN A GOOD CASE REPORT
AND A BAD ONE.
DISCUSSION.
•
•
•
•
Explains the basis for arriving at a particular
diagnosis.
Demonstrates good literature search and
understanding of current concepts regarding
the care of patients.
Details possible management options, and
clarifies why the particular options adopted
for the index patient were used.
Provides answers to controversial decisions
and management issues.
DISCUSSION
• Brings out clear lessons, and
recommendations.
• Demonstrates that the case report meets the
specified objectives for the Case Book.
• Justifies the inclusion of the case report in
your Case book.
• Attempts to answer questions that could arise
in the examination.
REFERENCES.
• ABOUT 10 PER CASE.
• GOOD BLEND OF LOCAL AND FOREIGN
LITERATURE.
• NOT MORE THAN 10 YEARS SINCE
PUBLICATION.
• VANCOUVER METHOD.
PRESENTATION.
SIZE OF THE BOOK: 150 pages recommended.
This comes to about 7 pages per case report
LAYOUT: Refer to Residents’ Handbook
• TITLE PAGE.
• PRELIMINARY PAGES.
• INTRODUCTION.
• THE CASE REPORTS.
• CONCLUSION.
CHECKLIST: GENERAL.
1. Layout of the Case Book.
2. Use of English.
3. Distribution of cases.
4. Style of presentation of the cases.
5. Illustrations & Figures.
6. References.
REFERENCES.
• Vancouver.
• Local & foreign references.
• Textbook & journal references.
• Date of publication.
GENERAL HINTS.
•
•
•
•
•
Start early: Part 1 Stage. Finish in good time.
Relate well with your trainers.
Write one case at a time.
Peer Review – but avoid plagiarism.
Accept corrections, at least till you get your
FMCFM. Cf Rehoboam
• Review 2-3 times before the Exams.
• Faith and works: It is God’s grace & favour.
“The race is not always to the swift.”
THANK YOU.