Case Reports

We are in "mid-term" week. One part of one exam deals with case reports. In the hierarchy of evidence based practice (EBP) the case report as pretty much at the bottom - aka it is a very basic form of evidence (it is amazing how hard it was to find a link to this hierarchy, perhaps it is not as widely accepted as I thought - perhaps just the specifics are not as generalizable?). But it's place in the pecking order is no reason to look down on these very important studies.

The following info comes from my interpretation of Writing Case Reports (I have decided not to cite anything, but just to link to it, I believe that is acceptable, you let me know...):

Case reports...

• ..."illustrate EBP" through the therapeutic alliance as described by Sackett and colleagues. They integrate clinical experience as the author describes their decision making process, the qualitative aspect that patient choice exemplifies and lastly with the use of the best available research evidence through the citations used throughout the study.
• ..."help develop hypotheses for future research" by providing a unique clinical question or observation that may not otherwise have been brought up. Because the case report cannot test cause and effect relationships it can discuss the current thinking about a possible relationship between research variables and hypotheses that may be carried out in randomized controlled trials (the higher level of studies, trumped mainly by systematic reviews). There are numerous instances where case reports are written in response to a lack of current literature on the topic of interest.
  
• ..."build problem-solving skills" as a reader or as an author. As a reader it is valuable to follow a colleagues process of problem-solving and possibly pick-up a skill or two. To write a successful case report requires that your problem-solving skills be at a high level. From researching the literature on your topic to reflecting on your process of problem-solving to lastly accepting and utilizing the feedback that the peer-review process provides you will in fact build tremendously on your skills.
• ..."support, enhance, or cast doubt on theory underlying practice" by describing the application of theory thus shedding light on how the theory holds up in a clinical situation. In relation to this, the case report can then challenge the existing theory and hopefully spark a respectful debate on the topic to ideally lead to optimized patient/client outcomes.
• ..."help develop guidelines and pathways" by providing examples of specific patient populations with greater accuracy and a time frame of reference. The practice variation is vital for a profession to be aware of as there may be techniques available that may be more efficient. Furthermore, an accumulation of case reports can be a stronger level of evidence than a single case report as trends begin to emerge and informal conclusions can begin to formulate and thus lead to new thinking.
  

"Unrelated to the rest of the post" quote:
"Indecision may or may not be my problem" - Jimmy Buffet