Care Guidelines
Additional Information: Care Guideline Summary
Clinical data collection from the point of care informs the delivery of high-quality individualized healthcare, integrating clinical expertise with external evidence. The CARE guidelines for case reports help authors reduce bias, increase transparency, and provide early signals of what works, for which patients, and under which circumstances
The CARE guidelines, developed by an international group of experts, were designed to increase the accuracy, transparency, and usefulness of case reports. Since the 2013 and 2017 CARE publications in the Journal of Clinical Epidemiology, these guidelines have been endorsed by multiple medical journals and translated into more than ten languages. The CARE guidelines support the efforts of the Equator Network to improve the transparency and accuracy of health research reporting. Online training in writing case reports following the CARE guidelines is available from Scientific Writing in Health and Medicine (SWIHM).
Here are how some healthcare stakeholder groups benefit when CARE informed case reports are written:
1. Patients can review transparent information on therapeutic options.
2. Clinicians improve peer-to-peer communication.
3. Researchers use testable hypotheses from clinical settings.
4. Educators have examples to support case-based learning.
5. Authors receive guidance on writing accurate and transparent case reports.
6. Medical Journals support for the evaluation of case reports.
The CARE guidelines and checklist provide authors tools to write accurate and transparent case reports. They also provide editors and peer reviewers tools to critically evaluate case reports. The CARE tools include the 2013 and 2017 CARE publications, the CARE checklist, case report writing tools, and translations.
Normal cervical alignment rarely observed in a chiropractic office
Care Checklist
CARE Checklist: while not all points might be included, the primary points 1 to 13 must be addressed
1. Title – The area of focus and “case report” should appear in the title
2. Key Words – Two to five key words that identify topics in this case report
3. Abstract – (structured or unstructured)
o Introduction – WHAT is unique and WHY this finding may be associated with a particular intervention?
o The patient’s main concerns and important clinical findings.
o The primary chiropractic and if relevant medical diagnoses, interventions, and outcomes.
o Conclusion—What are one or more “take-away” lessons?
4. Introduction – Briefly summarize why this case is unique with medical literature references.
5. Patient Information
o De-identified demographic and other patient information.
o Main concerns and symptoms of the patient.
o Medical, family, and psychosocial history including genetic information.
o Relevant past interventions and their outcomes.
6. Clinical Findings – Relevant physical examination (PE) and other clinical findings.
7. Timeline – Relevant data from this episode of care organized as a timeline (figure or table).
8. Diagnostic Assessment
o Diagnostic methods (PE, laboratory testing, imaging, surveys).
o Diagnostic challenges.
o Diagnostic reasoning including a differential diagnosis.
o Prognostic characteristics when applicable.
9. Therapeutic Intervention
o Types of intervention (pharmacologic, surgical, preventive).
o Administration of intervention (dosage, strength, duration).
o Changes in the interventions with explanations.
10. Follow-up and Outcomes
o Clinician- and patient-assessed outcomes when appropriate.
o Important follow-up diagnostic and other test results.
o Intervention adherence and tolerability (how was this assessed?)
o Adverse and unanticipated events.
11. Discussion
o Strengths and limitations in your approach to this case.
o Discussion of the relevant medical literature.
o The rationale for your conclusions possibly including neurological pathways.
o The primary “take-away” lessons from this case report.
12. Patient Perspective – The patient should share their perspective on their case by acknowledging the case study content and outcomes.
13. Informed Consent – The patient should give informed consent.
14. References
NOTE, THE PATIENT PERSPECTIVE EFFECTIVELY ELEVATES YOUR CASE STUDY TO A LEGAL DOCUMENT AS PRIMA FACIE EVIDENCE OF EFFICACY IN THIS PARTICULAR CASE
X-ray, an important tool to establish the primary spinal problem
Additional PCS Objectives
Additional PCS Objectives
In addition to the facilitation and encouragement of multiple case study generation based on CARE Guidelines, PCS’s additional object is to pursue the following charitable purposes:
PCS may also support various forms of patient or public education programs. The recent Safer Care Victoria (SCV) Review in Australia into chiropractic care for children under 12 years is a case in point. This review was entirely unnecessary and was effectively a witch-hunt promoted by political medicine without any basis or evidence of harm. Accordingly, PCS made a detailed submission to SCV to provide evidence of a lack of harm to this group of patients at the hands of registered chiropractors, evidence of a high degree of harm and death to this group of patients at the hands of medical practitioners, and fully referenced evidence of benefit from chiropractic care to children under 12 years. A copy of this submission is available to PCS members and supporters upon email request. As it turned out, the SCV Review found no evidence of harm to children, no evidence of malpractice claims and noted exceptional satisfaction ratings arising from patient responses and submissions.
Intriguingly, the SCV Review was triggered by a case where an infant's spine had been damaged following necessary emergency resuscitation procedures during the hospital birth arising from the chest compressions which traumatised the infant's mid-thoracic spine leading to a severe case of colic. This condition was not resolved by any medical care, yet when a chiropractor gave a single specific spinal adjustment and the condition immediately resolved, hysteria was promoted and spread by political medicine to the media and some ill-informed political groups, including the Victorian Minister for Health, thereby triggering the SCV Review. Strangely, this incident of a successful chiropractic treatment outcome coincided with news of multiple infant deaths resulting from medical errors at a local Victorian hospital.
PCS must also raise valid concerns relating to public health. At this time, the COVID-19 issue is presenting many areas of concern, particularly some Government actions based on poor or misunderstood evidence or research, that is leading to many social, health and economic hardships. The concept of a rushed, poorly tested vaccine for Covid-19 raises many areas of concern, particularly where this vaccine is mandatory. PCS plans to devote significant resources to lobby and educate that any such vaccine must have been adequately tested, both in animal and human trials, where the subjects are later exposed to the wild virus. A number of coronavirus vaccines (SARS, MRES) have been trialled since 2005, but every one to date have triggered dreadful enhanced immune responses (EIR), where once exposed to the wild virus after vaccination, the symptoms and outcomes are often worse than the actual disease. Many test animals died. A Covid-19 vaccine must be broadly tested on a significant number of human subjects, who are then exposed to the wild virus, to gauge if the EIR, and the subsequent cytokine storm may be an issue. If instances of serious adverse reactions begin to develop in the vaccinated population, care must be taken to ensure these reactions do not outnumber or exceed health issues posed by a Covid infection. If this occurs, governments must be effective in the rapid withdrawal of such vaccines. In the current climate, this area will be a major focus of PCS activity.
Clearly, dealing with such inequitable reactions, responses, decisions and reporting on matters pertaining to public health issues must also form a major part of the PCS scope.
Membership
PCS Patron Member Application Format
Simply copy this format and complete the sections as shown.
I (name)_______________________________________________________________
Professional Degrees:_________________________________________________
If student, list subject of study:___________________________________________
Of (mailing address)________________________________________________________
Post code or Zip:__________________
Country_____________________________________
Phone including country code:______________________________________
Email:_________________________________________________________________
Hereby apply for Patron Member status of this organisation on the basis that no obligations will attach to my participation and involvement and I agree to abide by the Association Rules. A AU$20 (US$15) once only membership fee is required.
Any contributions I make will be purely on a voluntary and non-binding basis.
Such contributions must entirely be utilised for research, education and the advancement of the Chiropractic profession worldwide.
____________________________________________
Signed
Date:__________________________
Email your application to: admin@patronschiroscience.com
Upon receipt of an application the PCS Association Rules and the complete CARE Guideline package and any newsletters will be emailed to you.
Disc stresses with bending and lifting