THE CASE BOOK. DR. S. YOHANNA 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 GYNAE. - 2 F.P.- 1 MED.- 3 PAED.- 3 SURG. - 2 OPHTH.- 2 E.N.T. - 1 PSYCH.- 2 ORTHO.- 1 FAM. CASE STUDY- 1

CASE REPORT FORMAT. 1. PERSONAL DATA. 2. THE CASE REPORT. 3. DISCUSSION. 4. REFERENCES.

PERSONAL DATA. NAME. OCCUPATION AGE. HOSP. NO. SEX. DATE ADMITTED ADDDRESS. 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 1 st 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.