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HOW TO PUT IT TOGETHER: CREATE A CLINICAL POSTER OF YOUR EXPERTISE

Darlene Reid, Professor

Susan Harris, Professor Emeritus

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Learning Objectives

At completion of the session, participants will be able to:

1) Define a case study/report and a case series

2) Describe four examples of types of case reports

3) List at least four components of what to include in a case report/series poster

4) Describe the different components of a poster presentation of a program

5) Describe key formatting issues of a poster presentation

Polling question

Who has experience using PowerPoint to put together a

• Slide presentation

• Poster presentation

Polling question

How many participants have presented a case study as a

• poster presentation,

• slide presentation, or

• submitted an case history to a newsletter or journal for publication

Polling question

How many participants have presented a program as a

• poster presentation,

• slide presentation, or

• submitted an article for publication or a report to an administrator

Polling question

Who is considering the possibility of presenting a case history or program

• as a poster presentation at the upcoming PABC Physio Forum or a Physio Forum in the future.

• As a slide or poster presentation within your hospital or institution

• As a slide or poster presentation at a national or international meeting

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PUTTING TOGETHER A CASE REPORT POSTER

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DEFINITION OF TERMS Case Report (Quantitative)

A case report is a systematic, non-experimental description of clinical practice

A case report systematically describes practice but does not involve research methodology

(Domholdt, 2000)

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DEFINITION OF TERMS Case Study (Qualitative)

A case study is a method of structuring a qualitative research project by detailed analysis of a well-defined unit or case

A case study is a type of descriptive research

(Domholdt, 2000)

DEFINITION OF TERMS

Case Series: Quantitative

A group or series of case reports involving patients who were given similar treatment.

Case series usually contain detailed information about the individual patients: demographic information (e.g., age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and post-treatment follow-up.

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Because case reports typically describe clinical practice involving one or more patients, they are perfect for clinicians to conduct!

McEwen I (Editor): Writing Case Reports: A How-to Manual for Clinicians, 3rd ed. APTA; 2009.

To order [item no. C-12]:

1-800-999-APTA

www.apta.org/store

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First Steps

1) Be aware of the research evidence that underlies your practice. Research should be explicitly used to guide practice.

2) Do a literature search (PubMed, CINAHL) on your topic to explore what’s already out there.

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First Steps (continued)

3) For example, if you decide that you’ve had success with AFOs in improving functional walking in the community, find out what’s already been done first!

4) If many large studies have already demonstrated this effect, then you know you’re an evidence-based practitioner (but a case report on the topic will contribute little “new” evidence).

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Types of Case Reports

Case reports can be used to:

• highlight a novel technique or area of practice

• present an unusual or interesting clinical finding or scenario

• describe a unique or particularly successful treatment approach

• describe a “practice pearl” of wisdom

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Case Report Guidelines: Physiotherapy Canada

Introduction

Methods: case description, intervention, outcome measures

Results

Discussion

Word limit: 2500; <30 references; <6 tables or figures

Case Report Components:

PABC Practice Forum Poster

Author(s), title of case report/series, institutions

Introduction

Case Presentation

PT Management and Outcomes

Discussion

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Case Report Poster Components:

Title & Author Information

Poster title [large font] Names of all who have contributed to the case

report/case series [smaller font]

Your institution and any associated institutions [smaller font]

Funding support [here or at bottom of poster]

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Professional Template for a 48x48 Case Report Poster Presentation

Your name and the names of the people who have contributed to this presentation go here. The names of associated institutions go here.

Response to Treatment

Significance/Uniqueness of Case

Introduction

Patient Description

Charts/Graphs/Pictures Contact & Printing Information

Intervention

The introduction should be brief tell why the case is important and why it is being reported (for

example, because it adds to the understanding of a clinical problem). For the sake of brevity,

cite a few recent review articles rather than many individual studies. Case reports usually respond to one of the following generic topics, but use specific information from the case being

presented. 1) An unexpected association between diseases or symptoms. (For example, AIDS came to be

recognized, in part, because Kaposi's sarcoma and Pneumocystis carinii pneumonia were

reported in homosexual men in 1981.)

2) An unexpected event in the course of observing or treating a patient. (The transdermal

absorption of nitroglycerin and its dilating effect on blood vessels came to be understood after a

physician reported headache in a patient who handled TNT powder in his daily work.)

3) Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.

4) Unique therapeutic approaches.

Send your completed poster template to

research@grmerc.net

Conclusions

References

Use the literature to establish any previous work related to your research question. Make

clear to your reader whether this is the first ever reported, or how many have been reported previously. The essential characteristic of a publishable case report is educational value. After all, nobody is going

to change the way they practice medicine based upon one case report.

In addition, it is not true that a report must tell of a unique finding. Some case reports are published

because they support the findings of previously published cases or because they are useful reminders of an important point in diagnosis or treatment.

Describe the patient including gender, age, height weight, BMI, social history (including tobacco and

alcohol use), use of illegal substances, medication being used, notable results of physical

examination and laboratory tests, and differential diagnosis or diagnoses considered, just to name a few. When in doubt, think about the patient information you would like to know as background

information and provide it in this section. Don’t go overboard; we don’t need to know how many

toilets are in the patient’s primary residence. Give all of the basics, and add the specifics important to the case.

Remember: When writing up your case report, refrain from using any identifying data, such as date of birth, date of service, patient name/initials or medical record number. Do not use case when

referring to a person - a case is an instance of disease, a patient is a person.

Don’t Be Constrained by These Headings

For most of your audience, this section will hold the most interest, and will also be the biggest

attention-grabber for the casual passer-by. They may not care for your title of “A Rare Case of Okra

Toxicity in Bexar County” but the full color 3D CT of a tortured liver will suck them right in. Remember: Any pictures which contain patient identifiers (i.e., facial shots, unusual tattoos) will

require a signed release form from the patient. Check with the GRMERC Research Department fo

Describe all therapeutic interventions conducted during the course of treatment. Provide the

results of only relevant examinations and laboratory tests, usually those with positive results.

List the laboratory's ranges of normal values for any unusual tests performed.

Describe the outcome of treatment including final diagnosis.

The purpose of the discussion is to explain anything that isn't clear in the case description and

to offer interpretations of findings. It’s also the spot to indicate why the intervention used for

your case was different from similar cases reported previously. Make clear any important point that isn't explained in the case descriptions. For example, if you reported that liver enzymes

were elevated but no significant liver dysfunction was found, tell the reader in the discussion section why the enzymes were elevated. Also discuss implications for the field.

Discussion

The big finish, where you get to blow your audience away with your final, pithy

comment. This should be brief, three sentences tops. If you’re at a loss for words,

you can either do a combined Discussion/Conclusions section, or just do a conclusions section that reiterates the importance of your case.

While it is a nice thing to include references, if you’re crunched for space, these are the first things to go. If the choice is between including a really good looking graph

or the references, ditch the references and show the graph.

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Case Report Poster Components:

Introduction & Uniqueness of Case

Tell why the case is important and why it is being reported

Cite a few relevant background articles

Describe rationale, contextual issues, and unique features of your case

Case Report Poster Components:

PATIENT DESCRIPTON

Age, gender, health history, diagnosis, other presenting concerns

Assessment results (with specific test scores, numeric values)

Clinical concern that needs to be addressed

Can be presented as a table to save space

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Table 2. Birth Weight, Gestational Age, and Parental Concerns

Infant (age at

assessment)

Birth Weight (grams)

Gestational Age (weeks)

Parental Concerns

Infant 1 (9.5 months)

3202 40 Floppy, delayed motor skills, underweight

Infant 2 (9.7 months)

2495 (borderline SGA)

38 Floppy, delayed motor skills, possible cerebral palsy

Infant 3 (13 months)

3402 37.5 Gross motor delays, low muscle tone

SGA = small for gestational age

Case Report Poster Components:

Intervention and Outcome Measures

• Describe the therapeutic intervention (frequency, duration, specific dosage, etc.)

• List the outcome measures used to assess intervention effects

• Provide information on how reliability of outcome measures was established, e.g., inter-rater percent agreement

Case Report Poster Components:

RESULTS

Provide reliability results for outcome measure(s)

Provide intervention results (response to treatment)

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Case Report Poster Components:

DISCUSSION

Limitations of the case report

Clinical implications of the results

Future research directions

Key learning points from the case(s)

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Case Report Poster Components:

REFERENCES & ACKNOWLEDGEMENTS

Provide key references (in abbreviated form if space is limited):

Harris SR et al. Physio Can. 2012;25:10-14.

Acknowledge funding support or support from colleagues, supervisor, or statistician

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Effects of Aerobic Conditioning & Strength Training in DS

Participant: 10.5 year-old girl with DS

Intervention: Home exercise program combining aerobic and strength training: 30-60 min/day for 6 weeks

Outcomes: Heart rate, respiration rate, oxygen consumption, strength, flexibility, BMI, GM scales of BOTMP.

Lewis & Fragala-Pinkham. Pediatric PT. 2005

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Effects of Aerobic Conditioning & Strength Training in DS

Results: Improved sub-maximal heart and respiratory rates, aerobic performance, mm. strength and endurance and GM skills.

Conclusions: “For this subject, a combined aerobic and strength-training program resulted in improved C-P functions not observed in previous studies of subjects with DS.”

Lewis & Fragala-Pinkham. Pediatric PT. 2005

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How to Get Started!

First -- read the research

literature!

If you are a clinician, partner with academic colleagues.

Many recent PT graduates are knowledgeable about developing and writing case reports.

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How to Get Started!

Get a copy of APTA case reports manual for your clinic or office.

Read published examples of case reports in the PT/OT literature.

Collaborate with a colleague to pilot inter-rater reliability on outcome measures.

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Some Final Words from the Experts

Case reports are an ideal mechanism to illustrate how clinicians integrate the best available research evidence, clinical experience and patient choice.

[Dr. Irene McEwen: Writing Case Reports:

A How-to Manual for Clinicians]

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Some Final Words from the Experts

Case reports, which every clinician should be able to write,

are nothing more than documentation of practice. In

practice, we often fail to operationally define terms and to

explicitly state our rationales for examination, treatment,

and measurements of outcome.

[Jules Rothstein, Editor Emeritus, Physical Therapy]

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Some Final Words from the Experts

This highlights an additional benefit of case reports. Through the writing of case reports and ensuing discussion, we clarify clinical terminology, concepts, and approaches to problem-solving.

[Dr. Jules Rothstein, Editor-in-Chief Emeritus, Physical Therapy]

Polling question

Who feels that you have gained sufficient knowledge and tools to put together a poster presentation of a case study or case series?

• Not confident

• Somewhat confident

• Would feel confident if I worked with a knowledgable colleague

• Am confident to work independently on the poster with some or minimal assistance.

PUTTING TOGETHER A PROGRAM POSTER

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Program Posters

can be used to:

• highlight a novel program

• present a well-developed program that exemplifies a unique team of practitioners

• describe a unique or particularly successful program approach

• describe “practice pearls” of wisdom

Clinical Program:

PABC Practice Forum Poster

• Author(s), title of case report/series, institutions

• Introduction

• Format of Program

• Program Evaluation

• Successes of Program

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Poster title

• Use very large and bold font for title (70 pt)

• Use smaller fonts for authors

• User smaller or less prominent font for institutions and agencies

• Be sure to include logos of supporting hospitals, agencies institutions, or other sponsors.

Introduction describe background, rationale and evidence base Format of Program

• Can be described with different subsections.

• Select the best subtitles and subsections that best fit your program

• The poster template provides some suggestions and the examples at the end of the presentation provide other examples.

• Use pictures, flow diagrams and other illustrations that best reflect the organization of your program.

Program Evaluation and Successes

• Program evaluation can be described using outcomes that are meaningful to the health care practitioner, patient/participant, or funder.

• Describe all that apply

• List standardized questionnaires or tests uses

• Use pictures, diagrams or other illustrations to complement the text.

• Be sure to use your bragging rights to describe outstanding features of your program.

Other Components of a Poster

• Challenges

• Recommendations

• Future Directions

• References – nice but not essential

• Other Acknowledgements

o Very important

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If time

Demonstration of flexibility of poster template.

Polling question

Who feels that you have the knowledge and the tools to put together a poster presentation of your program?

• Not confident

• Somewhat confident

• Would feel confident if I worked with a knowledgable colleague

• Am confident to work independently on the poster with some or minimal assistance.

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Thank You for Your Attention!

Questions?

Comments?