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 Medical Center Utrecht

2. 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.

3. 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 box with up to five short single sentences highlighting new or particularly interesting things

4. 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!

5. Case Detailed description Motivation problem relevant characteristics
findings & particularities
Motivation problem
knowledge gap (education, study book, practice)
Why important?

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

7. 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

8. Search; methods Methods search -see references and practical lecture
-Make it transparent!
-Table 1 with search strategy

9. Search; results Table 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

10. 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

11. 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).

12. Flow chart 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 meningitis
Mortality
AND
Full text availability
Useful:
10 articles
Excluded because or:
-Insufficient outcome (mortality)
-Experimental, non-comparable CSF measurement
Reading full text*
Inclusion criteria:
-Prognostic study
-Mortality as outcome
-CSF composition as prognostic factor 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

13. 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

14. Critical Appraisal; Results
In table
Criteria relevance
Criteria validity
Specific for patient’s case
Own simply applied system
Never forget legends
Similarity determinant
Similarity domain
Similarity outcome

15. Each question has own design
Diagnosis
Prognosis
Therapy
Etiology
Prediction
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
Population at risk
Determinant (Indicator/Comparator)
As in practice
Manipulated
As in practice (exposure/risk factors)
Outcome
reference test or -criterium
Mortality, morbidity,
QoL
Mortality, morbidity, QoL
Type of study
Cross sectional
Follow up (time until outcome)
Follow up, case-control
Design study
Descriptive
Causal
Outcome measure AR
RR/RD RR

16. 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

17. Discussion Interpretation of results on best available evidence
Formulation of recommendation for patient
Explicit motivation on recommendation
Considerations concerning
relevance (restrictions?)
validity (restrictions?)

18. EBCR- summary Text Case Research question Search strategy Flow chart
introduction case & research question
justification management problem
Flow chart
sources, selection, numbers
Tables
Relevance & validity
Results and strength of evidence
interpretation results
recommendation management
comments
Case
Research question
Search strategy
Results & selection criteria
Discussion

19. Evidence based case reports Author requirements see www.bmj.com
Click at under resources for authors, types of articles, practice, Evidence based case reports 

22. Evaluation form Reviewer: Title: Type
Does clinical question pertain to treatment effect? Yes / no
Does clinical question pertain to the added value
of a determinant or test? Yes / no
Does domain involve patients with a confirmed
disease? Yes / no
Does determinant involve treatment? Yes / no
Does outcome involve follow-up? Yes / no

23. Case-Clinical scenario (case description):
insufficient / doubtful / sufficient / good / excellent
Question
Domain:
Determinant:
Outcome:
Relevance:

24. Methods
Search and selection: insufficient / doubtful / sufficient / good / excellent
Critical appraisal: insufficient / doubtful / sufficient / good / excellent
Data extraction: insufficient / doubtful / sufficient / good / excellent
Results
Outcomes: insufficient / doubtful / sufficient / good / excellent

25. Conclusion:
insufficient / doubtful / sufficient / good / excellent
Recommendation:

26. Tops 1 2 3
Tips
Overall rating of report:
insufficient / doubtful / sufficient / good / excellent

27. Weekly target Week 1 presentation: Case illustration.
Clinical question and PICO.
Existing knowledge on the problem (comparison from several books/sources).

28. 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.

29. 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).

30. 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

31. Questions ?

32. 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

33. ALUR SK Rektor UI no 208 tahun 2009 DUGAAN PLAGIARISME
LAPORAN TERTULIS
PIMPINAN UNIVERSITAS
P3T2:
PANITIA PENYELESAIAN PELANGGARAN TATA TERTIB KEHIDUPAN KAMPUS UNIVERSITAS INDONESIA
TIDAK TERBUKTI
TERBUKTI:
SK REKTOR
SK Rektor UI no 208 tahun 2009

34. 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