THE CASE BOOK. DR. S. YOHANNA. 2015 REVISION COURSE.
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Transcript of THE CASE BOOK. DR. S. YOHANNA. 2015 REVISION COURSE.
OBJECTIVES OF THE CASE BOOKTO 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
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
(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.
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.”