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Top 7 Medical Case Presentation Templates with Samples and Examples
Sarojit Hazra
How does information expand beyond essential recollection? Facts alone can diminish in value over time. Context and implementation are crucial to form deep connections and roots. Here comes the role of case studies for clinical personnel in the medical field.
In the always-growing healthcare industry, medical case presentation is essential as it is a suggestion for new researchers. A medical case study is a report where a medical practitioner shares a patient's case. It comprises every detail related to patients. It is beneficial for describing a new medical condition, management options, or treatment for diseases.
Medical case presentations contribute significantly to the evolution of medical knowledge and research.
Case study analysis is essential for every business or industry, like the medical industry. It helps in managing the twists and turns of the industry. Want to take some ideas? Have a look at SlideTeam’s blog Case Analysis Templates .
Let us highlight some significant benefits of medical case presentation:
- Case study presentations are extremely good at depicting realistic clinical frameworks.
- It helps to enhance student participation alongside the joy of learning.
- These are ideal for sharing the latest information on the clinical landscape.
- It promotes critical thinking.
- It can also make better clinical outcomes.
If you are in the healthcare sector, another important tool is the medical dashboard. For a deeper insight, quickly take a look at Medical dashboard Templates .
Each of the slides is 100% editable and customizable. The 100% customizable nature of the templates allows you to edit your presentations. The content-ready slides give you the much-needed structure. Below, let’s explore a wide array of ready to use, content ready medical case presentation templates fit for your organization.
Template 1: Case Study on Blockchain Application in Healthcare: Medical Staff Credential Verification
Blockchain is becoming a potential solution to verify medical credentials. Though these are open to the public, they can be restricted through permissions. Are you finding it difficult to understand and implement? SlideTeam introduces this PPT Template that highlights how to operationalize medical staff verification process using blockchain technology. It explains that healthcare-based systems can also be used to verify the credentials of medical staff. Solutions-based blockchain to track the experiences of medical professionals. The PPT slides are designed with suitable icons, designs, graphs and other relevant material. Grab it quickly and draft your case study as per the client’s requirements.
Click to Download
Template 2: Cost Benefits IOT Digital Twins Implementation Use Cases in the Medical Domain
This PPT template is designed to focus on the use cases in the medical domain, including research and development, diagnosis, surgery, medical equipment, etc. The slide offers a brief description of the mentioned use cases to understand the scenario better. Use it as an essential tool and captivate your audience. Get it Now!
Template 3: Major Use Cases for Tracking Medical Assets Asset Tracking and Management IoT
Want to simplify medical complexities? The asset tracking solution is here to accompany you. It enables the medical sector to locate patients, clinicians, and medications more accurately and quickly. IoT development has made this task much more accessible by guiding you through every significant aspect of a medical asset-tracking solution. Introducing our slide exhibiting use cases of medical tools that can be tracked with IoT technology . Medical assets, including medical tools, medical equipment tracking, medications , etc., are shown in the layout with their use cases and impacts. Each topic is depicted in separate tables with appropriate icons.
Template 4: AIoT Healthcare Applications in Medical Imaging
AIoT is making the medical sector smarter and wiser to improve data management and human-machine interaction. When AIoT is applied to healthcare, enables virtual monitoring and accurate diagnosis of patients to develop a personalized patient experience. Here, we introduce our premium PPT Templates showcasing applications of Artificial Intelligence of Things (AIoT) in radiology. You can provide detailed information about remote diagnosis , personalized treatment , and real-time monitoring. Adapt it now to increase your presentation threshold and educate your audience.
Template 5: Case Study of Leading Medical Devices Manufacturing Organization
An array of disruptive themes is shaping the medical device industry, and cloud computing is one of them. Soon, cloud computing will have a more significant impact on this industry. So, for your convenience, we are presenting our slide covering a case study of blue cloud with lending medical devices manufacturing organization. It covers significant topics like client objective, problem, our solution, and results chronologically. Consisting of three essential stages, this template is excellent for educating and enticing your audience.
Template 6: IoT Technology Use Case for Medical Treatment
IoT, or the Internet of Things, is gaining significance across industries, and the medical sector is no exception. It has taken medical treatment to a new level. This custom-built PowerPoint Template exhibits the use of IoT technology in domains of the healthcare industry. It provides a digital solution for patient treatment. The key elements are primary care, acute care, virtual hospital, etc., which are depicted along with descriptions, benefits, and additional comments. Each illustration is highlighted, colored and has a relevant icon for instantaneous identification.
Template 7: IoT Medical Healthcare Technology Use Cases
The transformation of healthcare into digital healthcare has resulted in the rise of IoMT, or medical IoT . It refers to connected devices in medical healthcare and has become one of the fastest-growing industries in the IoT market. It would help if you dived deeper to manage, monitor, and preserve IoT devices in medical healthcare. This PPT presentation demonstrates uses of IoT Medical Healthcare Technology in monitoring patient health. Moreover, the slide includes remote patient monitoring, reduced waiting time, identifying chronic diseases, and drug management. Download this template design and present your case study with ultimate professionalism.
HEALTH CONSULTATION WILL BE QUICKER, SAFER AND SECURE
Case studies have a great history as an educational tool for clinicians. These are highly beneficial for nurturing deeper insights and learning. Access to such visually appealing and comprehensively presented Top 7 Medical Case Presentation Templates enables medical professionals to quickly present their patients' case studies. Be it tracking of medical assets, application of IoT in the clinical field, IoT medical healthcare technology uses, and so on, these templates serve as essential equipment in implementing all.
P.S. For perfection and success, you should dig into SlideTeam's fantastic blog, Medical Report Templates .
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The Ultimate Patient Case Presentation Template for Med Students
- April 6, 2024
- / Reviewed by: Amy Rontal, MD
Knowing how to deliver a patient presentation is one of the most important skills to learn on your journey to becoming a physician. After all, when you’re on a medical team, you’ll need to convey all the critical information about a patient in an organized manner without any gaps in knowledge transfer.
One big caveat: opinions about the correct way to present a patient are highly personal and everyone is slightly different. Additionally, there’s a lot of variation in presentations across specialties, and even for ICU vs floor patients.
My goal with this blog is to give you the most complete version of a patient presentation, so you can tailor your presentations to the preferences of your attending and team. So, think of what follows as a model for presenting any general patient.
Here’s a breakdown of what goes into the typical patient presentation.
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7 Ingredients for a Patient Case Presentation Template
1. the one-liner.
The one-liner is a succinct sentence that primes your listeners to the patient.
A typical format is: “[Patient name] is a [age] year-old [gender] with past medical history of [X] presenting with [Y].
2. The Chief Complaint
This is a very brief statement of the patient’s complaint in their own words. A common pitfall is when medical students say that the patient had a chief complaint of some medical condition (like cholecystitis) and the attending asks if the patient really used that word!
An example might be, “Patient has chief complaint of difficulty breathing while walking.”
3. History of Present Illness (HPI)
The goal of the HPI is to illustrate the story of the patient’s complaint. I remember when I first began medical school, I had a lot of trouble determining what was relevant and ended up giving a lot of extra details. Don’t worry if you have the same issue. With time, you’ll learn which details are important.
The OPQRST Framework
In the beginning of your clinical experience, a helpful framework to use is OPQRST:
Describe when the issue started, and if it occurs during certain environmental or personal exposures.
P rovocative
Report if there are any factors that make the pain better or worse. These can be broad, like noting their shortness of breath worsened when lying flat, or their symptoms resolved during rest.
Relay how the patient describes their pain or associated symptoms. For example, does the patient have a burning versus a pressure sensation? Are they feeling weakness, stiffness, or pain?
R egion/Location
Indicate where the pain is located and if it radiates anywhere.
Talk about how bad the pain is for the patient. Typically, a 0-10 pain scale is useful to provide some objective measure.
Discuss how long the pain lasts and how often it occurs.
A Case Study
While the OPQRST framework is great when starting out, it can be limiting. Let’s take an example where the patient is not experiencing pain and comes in with altered mental status along with diffuse jaundice of the skin and a history of chronic liver disease. You will find that certain sections of OPQRST do not apply. In this event, the HPI is still a story, but with a different framework. Try to go in chronological order. Include relevant details like if there have been any changes in medications, diet, or bowel movements.
Pertinent Positive and Negative Symptoms
Regardless of the framework you use, the name of the game is pertinent positive and negative symptoms the patient is experiencing. I’d like to highlight the word “pertinent.” It’s less likely the patient’s chronic osteoarthritis and its management is related to their new onset shortness of breath, but it’s still important for knowing the patient’s complete medical picture. A better place to mention these details would be in the “Past Medical History” section, and reserve the HPI portion for more pertinent history. As you become exposed to more illness scripts, experience will teach you which parts of the history are most helpful to state. Also, as you spend more time on the wards, you will pick up on which questions are relevant and important to ask during the patient interview. By painting a clear picture with pertinent positives and negatives during your presentation, the history will guide what may be higher or lower on the differential diagnosis. Some other important components to add are the patient’s additional past medical/surgical history, family history, social history, medications, allergies, and immunizations.
The HEADSSS Method
Particularly, the social history is an important time to describe the patient as a complete person and understand how their life story may affect their present condition. One way of organizing the social history is the HEADSSS method: – H ome living situation and relationships – E ducation and employment – A ctivities and hobbies – D rug use (alcohol, tobacco, cocaine, etc.) Note frequency of use, and if applicable, be sure to add which types of alcohol consumption (like beer versus hard liquor) and forms of drug use. – S exual history (partners, STI history, pregnancy plans) – S uicidality and depression – S piritual and religious history Again, there’s a lot of variation in presenting social history, so just follow the lead of your team. For example, it’s not always necessary/relevant to obtain a sexual history, so use your judgment of the situation.
4. Review of Symptoms
Oftentimes, most elements of this section are embedded within the HPI. If there are any additional symptoms not mentioned in the HPI, it’s appropriate to state them here.
5. Objective
Vital signs.
Some attendings love to hear all five vital signs: temperature, blood pressure (mean arterial pressure if applicable), heart rate, respiratory rate, and oxygen saturation. Others are happy with “afebrile and vital signs stable.” Just find out their preference and stick to that.
Physical Exam
This is one of the most important parts of the patient presentation for any specialty. It paints a picture of how the patient looks and can guide acute management like in the case of a rigid abdomen. As discussed in the HPI section, typically you should report pertinent positives and negatives. When you’re starting out, your attending and team may prefer for you to report all findings as part of your learning. For example, pulmonary exam findings can be reported as: “Regular chest appearance. No abnormalities on palpation. Lungs resonant to percussion. Clear to auscultation bilaterally without crackles, rhonchi, or wheezing.” Typically, you want to report the physical exams in a head to toe format: General Appearance, Mental Status, Neurologic, Eyes/Ears/Nose/Mouth/Neck, Cardiovascular, Pulmonary, Breast, Abdominal, Genitourinary, Musculoskeletal, and Skin. Depending on the situation, additional exams can be incorporated as applicable.
Now comes reporting pertinent positive and negative labs. Several labs are often drawn upon admission. It’s easy to fall into the trap of reading off all the labs and losing everyone’s attention. Here are some pieces of advice:
You normally can’t go wrong sticking to abnormal lab values.
One qualification is that for a patient with concern for acute coronary syndrome, reporting a normal troponin is essential. Also, stating the normalization of previously abnormal lab values like liver enzymes is important.
Demonstrate trends in lab values.
A lab value is just a single point in time and does not paint the full picture. For example, a hemoglobin of 10g/dL in a patient at 15g/dL the previous day is a lot more concerning than a patient who has been stable at 10g/dL for a week.
Try to avoid editorializing in this section.
Save your analysis of the labs for the assessment section. Again, this can be a point of personal preference. In my experience, the team typically wants the raw objective data in this section. This is also a good place to state the ins and outs of your patient (if applicable). In some patients, these metrics are strictly recorded and are typically reported as total fluid in and out over the past day followed by the net fluid balance. For example, “1L in, 2L out, net -1L over the past 24 hours.”
6. Diagnostics/Imaging
Next, you’ll want to review any important diagnostic tests and imaging. For example, describe how the EKG and echo look in a patient presenting with chest pain or the abdominal CT scan in a patient with right lower quadrant abdominal pain. Try to provide your own interpretation to develop your skills and then include the final impression. Also, report if a diagnostic test is still pending.
7. Assessment/Plan
This is the fun part where you get to use your critical thinking (aka doctor) skills! For the scope of this blog, we’ll review a problem-based plan. It’s helpful to begin with a summary statement that incorporates the one-liner, presenting issue(s)/diagnosis(es), and patient stability. Then, go through all the problems relevant to the admission. You can impress your audience by casting a wide differential diagnosis and going through the elements of your patient presentation that support one diagnosis over another. Following your assessment, try to suggest a management plan. In a patient with congestive heart failure exacerbation, initiating a diuresis regimen and measuring strict ins/outs are good starting points. You may even suggest a follow-up on their latest ejection fraction with an echo and check if they’re on guideline-directed medical therapy. Again, with more time on the clinical wards you’ll start to pick up on what management plan to suggest. One pointer is to talk about all relevant problems, not just the presenting issue. For example, a patient with diabetes may need to be put on a sliding scale insulin regimen or another patient may require physical/occupational therapy. Just try to stay organized and be comprehensive.
A Note About Patient Presentation Skills
When you’re doing your first patient presentations, it’s common to feel nervous. There may be a lot of “uhs” and “ums.”
Here’s the good news: you don’t have to be perfect! You just need to make a good faith attempt and keep on going with the presentation.
With time, your confidence will build. Practice your fluency in the mirror when you have a chance. No one was born knowing medicine and everyone has gone through the same stages of learning you are!
Practice your presentation a couple times before you present to the team if you have time. Pull a resident aside if they have the bandwidth to make sure you have all the information you need.
One big piece of advice: NEVER LIE. If you don’t know a specific detail, it’s okay to say, “I’m not sure, but I can look that up.” Someone on your team can usually retrieve the information while you continue on with your presentation.
Example Patient Case Presentation Template
Here’s a blank patient case presentation template that may come in handy. You can adapt it to best fit your needs. One-Liner: Chief Complaint: History of Present Illness: Past Medical History: Past Surgical History: Family History: Social History: Medications: Allergies: Immunizations: ROS: Objective: Vital Signs : Temp ___ BP ___ /___ HR ___ RR ___ O2 sat ___ Physical Exam:
General Appearance:
Mental Status:
Neurological:
Eyes, Ears, Nose, Mouth, and Neck:
Cardiovascular:
Genitourinary:
Musculoskeletal:
Most Recent Labs:
Previous Labs:
Diagnostics/Imaging:
Impression/Interpretation:
Assessment/Plan:
One-line summary:
#Problem 1:
Assessment:
#Problem 2:
Final Thoughts on Patient Presentations
I hope this post demystified the patient presentation for you. Be sure to stay organized in your delivery and be flexible with the specifications your team may provide. Something I’d like to highlight is that you may need to tailor the presentation to the specialty you’re on. For example, on OB/GYN, it’s important to include a pregnancy history. Nonetheless, the aforementioned template should set you up for success from a broad overview perspective. Stay tuned for my next post on how to give an ICU patient presentation. And if you’d like me to address any other topics in a blog, write to me at [email protected] ! Looking for more (free!) content to help you through clinical rotations? Check out these other posts from Blueprint tutors on the Med School blog:
- How I Balanced My Clinical Rotations with Shelf Exam Studying
- How (and Why) to Use a Qbank to Prepare for USMLE Step 2
- How to Study For Shelf Exams: A Tutor’s Guide
About the Author
Hailing from Phoenix, AZ, Neelesh is an enthusiastic, cheerful, and patient tutor. He is a fourth year medical student at the Keck School of Medicine of the University of Southern California and serves as president for the Class of 2024. He is applying to surgery programs for residency. He also graduated as valedictorian of his high school and the USC Viterbi School of Engineering, obtaining a B.S. in Biomedical Engineering in 2020. He discovered his penchant for teaching when he began tutoring his friends for the SAT and ACT in the summer of 2015 out of his living room. Outside of the academic sphere, Neelesh enjoys surfing at San Onofre Beach and hiking in the Santa Monica Mountains. Twitter: @NeeleshBagrodia LinkedIn: http://www.linkedin.com/in/neelesh-bagrodia
Related Posts
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- May 6, 2024
The Ultimate ICU Patient Presentation Template for Med Students
- May 3, 2024
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- March 26, 2024
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Clinical Case Study Presentation Template
Number of slides: 10
A clinical case study is a report where medical practitioners share a patient’s case. Generally, clinical case studies are valuable tools for medical research as they provide detailed information on the development of a disease or illness in particular individuals. Use this PowerPoint template to document extraordinary patient cases and share your findings with the healthcare community. You can also use these slides to report the progress of your patient’s disease and work on the proper treatment alongside your team.
- About this template
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Free Template for presenting a Clinical Case Study in PowerPoint
Patient’s clinical profile.
Before starting, share the patient’s clinical profile. This slide is great to describe your patient’s clinical history, underlying conditions, and other relevant health information. You can include demographic data and specific facts related to your patient but remember to keep their anonymity.
Clinical Treatment Slide
This is one of the most important sections of your patient’s case study. You’ll find a creative slide to explain the medical treatment stage by stage. You can go deep into the medicines or drugs the patient used and their reaction in different stages of the treatment. This means you’ll be able to cover the evolution of your patient from the beginning and provide detailed insights.
Medical Team Slide
As in any research, you should acknowledge the professionals that worked with you. So, here’s a slide to showcase the whole medical team involved in the case study. You can add photos and short descriptions of each team member. Make sure to ask for professional images and double-check the spelling of role titles and names.
Roadmaps for Clinical Case Study Presentations
If you’re wondering how to present a patient case study in PowerPoint, the best way to do so is by taking full advantage of its visual elements. Here you’ll find creative roadmaps, diagrams, and icons
Medical PowerPoint Slides
The Clinical Case Study PowerPoint template has a clean and minimalistic style that makes your work stand out in high-level professional slides.
Medical icons in PowerPoint
You’ll find medical icons on every PowerPoint slide. Use them to organize your information and direct your audience’s attention exactly where you want it to be.
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A guide on how to structure a case presentation
This article contains...
-History of presenting problem
-Medical and surgical history
-Drugs, including allergies to drugs
-Family history
-Social history
-Review of systems
-Findings on examination, including vital signs and observations
-Differential diagnosis/impression
-Investigations
-Management
Presenting patient cases is a key part of everyday clinical practice. A well delivered presentation has the potential to facilitate patient care and improve efficiency on ward rounds, as well as a means of teaching and assessing clinical competence. 1
The purpose of a case presentation is to communicate your diagnostic reasoning to the listener, so that he or she has a clear picture of the patient’s condition and further management can be planned accordingly. 2 To give a high quality presentation you need to take a thorough history. Consultants make decisions about patient care based on information presented to them by junior members of the team, so the importance of accurately presenting your patient cannot be overemphasised.
As a medical student, you are likely to be asked to present in numerous settings. A formal case presentation may take place at a teaching session or even at a conference or scientific meeting. These presentations are usually thorough and have an accompanying PowerPoint presentation or poster. More often, case presentations take place on the wards or over the phone and tend to be brief, using only memory or short, handwritten notes as an aid.
Everyone has their own presenting style, and the context of the presentation will determine how much detail you need to put in. You should anticipate what information your senior colleagues will need to know about the patient’s history and the care he or she has received since admission, to enable them to make further management decisions. In this article, I use a fictitious case to …
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How to Make a Medical Case Presentation
Last updated on July 5th, 2023
Effective communication lies at the heart of healthcare services. Whether it’s conveying complex medical information to patients, discussing treatment plans with families, or presenting a medical case to colleagues, the ability to deliver clear, concise, and engaging presentations is vital.
A well-designed presentation template tailored for a Medical Case can significantly enhance the effectiveness of a medical case presentation, offering a structured format that aids comprehension and maintains audience engagement.
This article offers a deep dive into the art of medical case presentations, discussing their importance, the benefits of using a dedicated PowerPoint template, and providing a detailed review of a highly recommended template. So, health professionals, doctors, institutions and consultants working in the healthcare space can create effective Medical presentations.
Understanding Medical Case Presentations
Medical case presentations are a staple in the healthcare industry. They’re used to share patient information, discuss differential diagnoses, and decide on the best course of action for treatment. They form a critical part of healthcare education and interdisciplinary communication, providing a platform for knowledge sharing, problem-solving, and clinical decision-making.
Who Creates Medical Case Presentations?
Medical Case presentations are often created by a wide range of healthcare professionals, including doctors, medical students, nurses, research scientists, and healthcare administrators.
The context and audience can greatly influence the structure and style of the presentation. For instance, a presentation to a room full of medical colleagues may delve deeper into technical details and use more medical jargon, while a presentation to non-medical stakeholders would need to be more simplified and jargon-free.
Key Components of a Medical Case Presentation
A typical medical case presentation includes the patient’s information, presenting complaints, medical history, clinical findings, investigations, diagnosis, treatment, and follow-up. The ability to succinctly present this information in a logical and structured manner is a valuable skill for healthcare professionals, enabling clear communication and efficient decision-making.
How to Prepare the Outline of a Medical Case Presentation? Structuring Your Presentation
Just as with any story, your medical case presentation should have a clear beginning, middle, and end.
- Start by introducing the patient and their presenting complaints.
- Next, delve into the clinical findings, diagnosis process, and the chosen treatment plan.
- Conclude with the patient’s response to treatment and the follow-up plan.
Visual slides can be incredibly helpful, offering a quick and effective way to communicate complex information. This is where a good PowerPoint template can be invaluable, especially those created by professional presentation template designers, including metaphors, illustrations, infographics and a wide range of slide layouts for medical presentations.
Benefits of Using a Medical Case PPT Template
Using a PowerPoint template for your medical case presentations offers several benefits versus starting a Medical presentation from scratch. Here are three reasons:
- First, it promotes efficiency by providing a ready-made structure, saving you the time and effort of designing each slide from scratch.
- Second, it ensures consistency, lending a professional look to your presentations.
- Lastly, it enhances clarity by providing a predictable and logical flow, which can greatly improve your audience’s understanding and retention of information.
A 100% editable Medical Case PPT Template
One highly recommended template for medical case presentations is the Medical Case Study PowerPoint Template provided by SlideModel. This medical PPT template offers a range of layouts designed specifically for medical presentations, each catering to different parts of the case presentation.
For example, it has separate slide layouts for presenting patient information, medical history, clinical findings, and so on. Each slide has been designed keeping in mind the unique needs of that section, with clear headings, bullet points, and spaces for visual aids.
This Medical Case Presentation template features the following slides:
- Cover slide with Medical Case Study
- 2 Agenda slides with different layouts
- Who we are slide
- Case study slide
- Problem statement slide
- Solution slide
- Results slide
- Timeline with ECG diagram (Heart rhythm)
- Thank you slide
The template is also customizable, allowing you to adjust colors, fonts, and graphics to match your specific needs or institutional branding.
Delivering an effective medical case presentation is no small feat, but with the right tools and strategies, it becomes much more manageable. Using a Medical Case PowerPoint template for your medical case presentations can save you time, enhance your professionalism, and boost clarity.
With careful planning, a clear structure, and a strong PowerPoint template, you can transform your medical case presentations from good to great. Remember, the goal is not just to share information, but to do so in a way that engages your audience and promotes clear understanding. Happy presenting!
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9 Creative Case Study Presentation Examples & Templates
Learn from proven case study presentation examples and best practices how to get creative, stand out, engage your audience, excite action, and drive results.
9 minute read
helped business professionals at:
Short answer
What makes a good case study presentation?
A good case study presentation has an engaging story, a clear structure, real data, visual aids, client testimonials, and a strong call to action. It informs and inspires, making the audience believe they can achieve similar results.
Dull case studies can cost you clients.
A boring case study presentation doesn't just risk putting your audience to sleep—it can actuallyl ead to lost sales and missed opportunities.
When your case study fails to inspire, it's your bottom line that suffers.
Interactive elements are the secret sauce for successful case study presentations.
They not only increase reader engagement by 22% but also lead to a whopping 41% more decks being read fully , proving that the winning deck is not a monologue but a conversation that involves the reader.
Let me show you shape your case studies into compelling narratives that hook your audience and drive revenue.
Let’s go!
How to create a case study presentation that drives results?
Crafting a case study presentation that truly drives results is about more than just data—it's about storytelling, engagement, and leading your audience down the sales funnel.
Here's how you can do it:
Tell a story: Each case study should follow a narrative arc. Start with the problem, introduce your solution, and showcase the results. Make it compelling and relatable.
Leverage data: Hard numbers build credibility. Use them to highlight your successes and reinforce your points.
Use visuals: Images, infographics, and videos can enhance engagement, making complex information more digestible and memorable.
Add interactive elements: Make your presentation a two-way journey. Tools like tabs and live data calculators can increase time spent on your deck by 22% and the number of full reads by 41% .
Finish with a strong call-to-action: Every good story needs a conclusion. Encourage your audience to take the next step in their buyer journey with a clear, persuasive call-to-action.
Visual representation of what a case study presentation should do:
How to write an engaging case study presentation?
Creating an engaging case study presentation involves strategic storytelling, understanding your audience, and sparking action.
In this guide, I'll cover the essentials to help you write a compelling narrative that drives results.
What is the best format for a business case study presentation?
4 best format types for a business case study presentation:
- Problem-solution case study
- Before-and-after case study
- Success story case study
- Interview style case study
Each style has unique strengths, so pick one that aligns best with your story and audience. For a deeper dive into these formats, check out our detailed blog post on case study format types .
What to include in a case study presentation?
An effective case study presentation contains 7 key elements:
- Introduction
- Company overview
- The problem/challenge
- Your solution
- Customer quotes/testimonials
To learn more about what should go in each of these sections, check out our post on what is a case study .
How to motivate readers to take action?
Based on BJ Fogg's behavior model , successful motivation involves 3 components:
This is all about highlighting the benefits. Paint a vivid picture of the transformative results achieved using your solution.
Use compelling data and emotive testimonials to amplify the desire for similar outcomes, therefore boosting your audience's motivation.
This refers to making the desired action easy to perform. Show how straightforward it is to implement your solution.
Use clear language, break down complex ideas, and reinforce the message that success is not just possible, but also readily achievable with your offering.
This is your powerful call-to-action (CTA), the spark that nudges your audience to take the next step. Ensure your CTA is clear, direct, and tied into the compelling narrative you've built.
It should leave your audience with no doubt about what to do next and why they should do it.
Here’s how you can do it with Storydoc:
How to adapt your presentation for your specific audience?
Every audience is different, and a successful case study presentation speaks directly to its audience's needs, concerns, and desires.
Understanding your audience is crucial. This involves researching their pain points, their industry jargon, their ambitions, and their fears.
Then, tailor your presentation accordingly. Highlight how your solution addresses their specific problems. Use language and examples they're familiar with. Show them how your product or service can help them reach their goals.
A case study presentation that's tailor-made for its audience is not just a presentation—it's a conversation that resonates, engages, and convinces.
How to design a great case study presentation?
A powerful case study presentation is not only about the story you weave—it's about the visual journey you create.
Let's navigate through the design strategies that can transform your case study presentation into a gripping narrative.
Add interactive elements
Static design has long been the traditional route for case study presentations—linear, unchanging, a one-size-fits-all solution.
However, this has been a losing approach for a while now. Static content is killing engagement, but interactive design will bring it back to life.
It invites your audience into an evolving, immersive experience, transforming them from passive onlookers into active participants.
Which of these presentations would you prefer to read?
Use narrated content design (scrollytelling)
Scrollytelling combines the best of scrolling and storytelling. This innovative approach offers an interactive narrated journey controlled with a simple scroll.
It lets you break down complex content into manageable chunks and empowers your audience to control their reading pace.
To make this content experience available to everyone, our founder, Itai Amoza, collaborated with visualization scientist Prof. Steven Franconeri to incorporate scrollytelling into Storydoc.
This collaboration led to specialized storytelling slides that simplify content and enhance engagement (which you can find and use in Storydoc).
Here’s an example of Storydoc scrollytelling:
Bring your case study to life with multimedia
Multimedia brings a dynamic dimension to your presentation. Video testimonials lend authenticity and human connection. Podcast interviews add depth and diversity, while live graphs offer a visually captivating way to represent data.
Each media type contributes to a richer, more immersive narrative that keeps your audience engaged from beginning to end.
Prioritize mobile-friendly design
In an increasingly mobile world, design must adapt. Avoid traditional, non-responsive formats like PPT, PDF, and Word.
Opt for a mobile-optimized design that guarantees your presentation is always at its best, regardless of the device.
As a significant chunk of case studies are opened on mobile, this ensures wider accessibility and improved user experience , demonstrating respect for your audience's viewing preferences.
Here’s what a traditional static presentation looks like as opposed to a responsive deck:
Streamline the design process
Creating a case study presentation usually involves wrestling with an AI website builder .
It's a dance that often needs several partners - designers to make it look good, developers to make it work smoothly, and plenty of time to bring it all together.
Building, changing, and personalizing your case study can feel like you're climbing a mountain when all you need is to cross a hill.
By switching to Storydoc’s interactive case study creator , you won’t need a tech guru or a design whizz, just your own creativity.
You’ll be able to create a customized, interactive presentation for tailored use in sales prospecting or wherever you need it without the headache of mobilizing your entire team.
Storydoc will automatically adjust any change to your presentation layout, so you can’t break the design even if you tried.
Case study presentation examples that engage readers
Let’s take a deep dive into some standout case studies.
These examples go beyond just sharing information – they're all about captivating and inspiring readers. So, let’s jump in and uncover the secret behind what makes them so effective.
What makes this deck great:
- A video on the cover slide will cause 32% more people to interact with your case study .
- The running numbers slide allows you to present the key results your solution delivered in an easily digestible way.
- The ability to include 2 smart CTAs gives readers the choice between learning more about your solution and booking a meeting with you directly.
Light mode case study
- The ‘read more’ button is perfect if you want to present a longer case without overloading readers with walls of text.
- The timeline slide lets you present your solution in the form of a compelling narrative.
- A combination of text-based and visual slides allows you to add context to the main insights.
Marketing case study
- Tiered slides are perfect for presenting multiple features of your solution, particularly if they’re relevant to several use cases.
- Easily customizable slides allow you to personalize your case study to specific prospects’ needs and pain points.
- The ability to embed videos makes it possible to show your solution in action instead of trying to describe it purely with words.
UX case study
- Various data visualization components let you present hard data in a way that’s easier to understand and follow.
- The option to hide text under a 'Read more' button is great if you want to include research findings or present a longer case study.
- Content segmented using tabs , which is perfect if you want to describe different user research methodologies without overwhelming your audience.
Business case study
- Library of data visualization elements to choose from comes in handy for more data-heavy case studies.
- Ready-to-use graphics and images which can easily be replaced using our AI assistant or your own files.
- Information on the average reading time in the cover reduces bounce rate by 24% .
Modern case study
- Dynamic variables let you personalize your deck at scale in just a few clicks.
- Logo placeholder that can easily be replaced with your prospect's logo for an added personal touch.
- Several text placeholders that can be tweaked to perfection with the help of our AI assistant to truly drive your message home.
Real estate case study
- Plenty of image placeholders that can be easily edited in a couple of clicks to let you show photos of your most important listings.
- Data visualization components can be used to present real estate comps or the value of your listings for a specific time period.
- Interactive slides guide your readers through a captivating storyline, which is key in a highly-visual industry like real estate .
Medical case study
- Image and video placeholders are perfect for presenting your solution without relying on complex medical terminology.
- The ability to hide text under an accordion allows you to include research or clinical trial findings without overwhelming prospects with too much information.
- Clean interactive design stands out in a sea of old-school medical case studies, making your deck more memorable for prospective clients.
Dark mode case study
- The timeline slide is ideal for guiding readers through an attention-grabbing storyline or explaining complex processes.
- Dynamic layout with multiple image and video placeholders that can be replaced in a few clicks to best reflect the nature of your business.
- Testimonial slides that can easily be customized with quotes by your past customers to legitimize your solution in the eyes of prospects.
Grab a case study presentation template
Creating an effective case study presentation is not just about gathering data and organizing it in a document. You need to weave a narrative, create an impact, and most importantly, engage your reader.
So, why start from zero when interactive case study templates can take you halfway up?
Instead of wrestling with words and designs, pick a template that best suits your needs, and watch your data transform into an engaging and inspiring story.
Hi, I'm Dominika, Content Specialist at Storydoc. As a creative professional with experience in fashion, I'm here to show you how to amplify your brand message through the power of storytelling and eye-catching visuals.
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Home Powerpoint Medical Case Study Presentation Template
Medical Case Study Presentation Template
The Medical Case Study Presentation Template is a case sheet that provides a concise yet comprehensive overview of a patient’s diagnosis report.
It offers medical professionals a convenient and visually appealing way to showcase important information such as the patient’s name, age, place of residence, blood group, and symptoms.
The template features a blue-tinted larger column sheet, allowing users to add detailed reports and delve into the specifics of the case.
With its One Pager layout, specifically tailored for Google slide themes, the Medical Case Presentation Template enables healthcare professionals to present the reports in a quick and easily digestible manner, ensuring effective communication and understanding among the audience. Get easy-to-use medical templates now!
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Will your templates work with my version of PowerPoint?
Yes, our templates are compatible with various versions of Microsoft PowerPoint, ensuring smooth usage regardless of your software version.
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Our templates work smoothly with Microsoft PowerPoint and Google Slides. Moreover, they’re compatible with Apple Keynote, LibreOffice Impress, Zoho Show, and more, ensuring flexibility across various presentation software platforms.
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How To Present a Patient: A Step-To-Step Guide
Last Updated on June 24, 2022 by Laura Turner
Updated and verified by Dr. Lee Burnett on March 19, 2022.
The ability to deliver oral case presentations is a core skill for any physician. Effective oral case presentations help facilitate information transfer among physicians and are essential to delivering quality patient care. Oral case presentations are also a key component of how medical students and residents are assessed during their training.
At its core, an oral case presentation functions as an argument. It is the presenter’s job to share the pertinent facts of a patient’s case with the other members of the medical care team and establish a clear diagnosis and treatment plan. Thus, the presenter should include details to support the proposed diagnosis, argue against alternative diagnoses, and exclude extraneous information. While this task may seem daunting at first, with practice, it will become easier. That said, if you are unsure if a particular detail is important to your patient’s case, it is probably best to be safe and include it.
Now, let’s go over how to present a case. While I will focus on internal medicine inpatients, the following framework can be applied to patients in any setting with slight modifications.
Oral case presentations are generally made to a medical care team, which can be composed of medical and pharmacy students, residents, pharmacists, medical attendings, and others. As the presenter, you should strive to deliver an interesting presentation that keeps your team members engaged. Here are a few things to keep in mind:
- Be confident: Speak clearly at the loudest volume appropriate to protect patient privacy, vary your tone to emphasize the most important details, and maintain eye contact with members of your team.
- Don’t fidget : Stand up straight and avoid unnecessary, distracting movements.
- Use your notes : You may glance at your notes from time to time while presenting. However, while there is no need to memorize your presentation, there is no better way to lose your team’s attention than to read your notes to them.
- Be honest: Given the importance of presentations in guiding medical care, never guess or report false information to the team. If you are unsure about a particular detail, say so.
The length of your presentation will depend on various factors, including the complexity of your patient, your audience, and your specialty. I have found that new internal medicine inpatients generally take 5-10 minutes to present. Internal medicine clerkship directors seem to agree. In a 2009 survey , they reported a range of 2-20 minutes for the ideal length of student inpatient presentations, with a median of 7 minutes.
While delivering oral case presentations is a core skill for trainees, and there have been attempts to standardize the format , expectations still vary among attending physicians. This can be a frustrating experience for trainees, and I would recommend that you clarify your attending’s expectations at the beginning of each new rotation. However, I have found that these differences are often stylistic, and content expectations are generally quite similar. Thus, developing a familiarity with the core elements of a strong oral case presentation is essential.
How to Present a Patient
You should begin every oral presentation with a brief one-liner that contains the patient’s name, age, relevant past medical history, and chief complaint. Remember that the chief complaint is why the patient sought medical care in his or her own words. An example of an effective opening is as follows: “Ms. X is a 78-year-old female with a past medical history of chronic obstructive pulmonary disease who presents to the hospital after she felt short of breath at home.”
Following the opener, elaborate on why the patient sought medical care. Describe the events that preceded the patient’s presentation in chronological order. A useful mnemonic to use when deciding what to report is OPQRST , which includes: • The Onset of the patient’s symptoms • Any Palliative or Provoking factors that make the symptoms better or worse, respectively • The Quality of his or her symptoms (how he or she describes them) • The Region of the body where the patient is experiencing his or her symptoms and (if the symptom is pain) whether the patient’s pain Radiates to another location or is well-localized • The Severity of the symptoms and any other associated Symptoms • The Time course of the symptoms (how they have changed over time and whether the patient has experienced them before) Additionally, include any other details here that may support your final diagnosis or rule out alternative diagnoses. For example, if you are concerned about a pulmonary embolism and your patient recently completed a long-distance flight, that would be worth mentioning.
The review of systems is sometimes included in the history of present illness, but it may also be separated. Given the potential breadth of the review of systems (a comprehensive list of questions that may be asked can be found here ), when presenting, only report information that is relevant to your patient’s condition.
The past medical history comes next. This should include the following information: • The patient’s medical conditions, including any that were not highlighted in the opener • Any past surgeries the patient has had and when they were performed • The timing of and reasons for past hospitalizations • Any current medications, including dosages and frequency of administration
The next section should detail the patient’s relevant family history. This should include: • Any relevant conditions that run in the patient’s family, with an emphasis on first-degree relatives
After the family history comes the social history. This section should include information about the patient’s: • Living situation • Occupation • Alcohol and tobacco use • Other substance use You may also include relevant details about the patient’s education level, recent travel history, history of animal and occupational exposures, and religious beliefs. For example, it would be worth mentioning that your anemic patient is a Jehovah’s Witness to guide medical decisions regarding blood transfusions.
Once you have finished reporting the patient’s history, you should transition to the physical exam. You should begin by reporting the patient’s vital signs, which includes the patient’s: • Temperature • Heart rate • Blood pressure • Respiratory rate • Oxygen saturation (if the patient is using supplemental oxygen, this should also be reported) Next, you should discuss the findings of your physical exam. At the minimum, this should include: • Your general impressions of the patient, including whether he or she appears “sick” or not • The results of your: • Head and neck exam • Eye exam • Respiratory exam • Cardiac exam • Abdominal exam • Extremity exam • Neurological exam Additional relevant physical examination findings may be included, as well. Quick note: resist the urge to report an exam as being “normal.” Instead, report your findings. For example, for a normal abdominal exam, you could report that “the patient’s abdomen is soft, non-tender, and non-distended, with normoactive bowel sounds.”
This section includes the results of any relevant laboratory testing, imaging, or other diagnostics that were obtained. You do not have to report the results of every test that was ordered. Before presenting, consider which results will further support your proposed diagnosis and exclude alternatives.
The emergency department (ED) course is classically reported towards the end of the presentation. However, different attendings may prefer to hear the ED course earlier, usually following the history of present illness. When unsure, report the ED course after the results of diagnostic testing. Be sure to include initial ED vital signs and any administered treatments.
You should conclude your presentation with the assessment and plan. This is the most important part of your presentation and allows you to show your team how much you really know. You should include: • A brief summary (1-2 lines) of the patient, the reason for admission, and your likely diagnosis. This should also include information regarding the patient’s clinical stability. While it can be similar to your opener, it should not be identical. An example could be: “Ms. X is a 78-year-old female with a past medical history of chronic obstructive pulmonary disease who presents with shortness of breath in the setting of an upper respiratory tract infection who is now stable on two liters of supplemental oxygen delivered via nasal cannula. Her symptoms are thought to be secondary to an acute exacerbation of chronic obstructive pulmonary disease.” • A differential diagnosis . For students, this should consist of 3-5 potential diagnoses. You should explain why you think each diagnosis is or is not the final diagnosis. Be sure to rule out potentially life-threatening conditions (unless you think your patient has one). For our fictional patient, Ms. X, for example, you could explain why you think she does not have a pulmonary embolism or acute coronary syndrome. For more advanced trainees, the differential can be more limited in scope. • Your plan . On regular inpatient floors, this should include a list of the patient’s medical problems, ordered by acuity, followed by your proposed plan for each. After going through each active medical problem, be sure to mention your choice for the patient’s diet and deep vein thrombosis prophylaxis, the patient’s stated code status, and the patient’s disposition (whether you think they need to remain in the hospital). In intensive care units, you can organize the patient’s medical problems by organ system to ensure that no stone is left unturned (if there are no active issues for an organ system, you may say so).
Presenting Patients Who Have Been in the Hospital for Multiple Days
After the initial presentation, subsequent presentations can be delivered via SOAP note format as follows:
- The Subjective section includes details about any significant overnight events and any new complaints the patient has.
- In the Objective section, report your physical exam (focus on any changes since you last examined the patient) and any significant new laboratory, imaging, or other diagnostic results.
- The Assessment and Plan are typically delivered as above. For the initial patient complaint, you do not have to restate your differential diagnosis if the diagnosis is known. For new complaints, however, you should create another differential and argue for or against each diagnosis. Be sure to update your plan every day.
Presenting Patients in Different Specialties
Before you present a patient, consider your audience. Every specialty presents patients differently. In general, surgical and OB/GYN presentations tend to be much quicker (2-3 minutes), while pediatric and family medicine presentations tend to be similar in length to internal medicine presentations. Tailor your presentations accordingly.
Presenting Patients in Outpatient Settings
Outpatients may be presented similarly to inpatients. Your presentation’s focus, however, should align with your outpatient clinic’s specialty. For example, if you are working at a cardiology clinic, your presentation should be focused on your patient’s cardiac complaints.
If your patient is returning for a follow-up visit and does not have a stated chief complaint, you should say so. You may replace the history of present illness with any relevant interval history since his or her last visit.
And that’s it! Delivering oral case presentations is challenging at first, so remember to practice. In time, you will become proficient in this essential medical skill. Good luck!
Kunal Sindhu, MD, is an assistant professor in the Department of Radiation Oncology at the Icahn School of Medicine at Mount Sinai and New York Proton Center. Dr. Sindhu specializes in treating cancers of the head, neck, and central nervous system.
2 thoughts on “How To Present a Patient: A Step-To-Step Guide”
To clarify, it should take 5-10 minutes to present (just one) new internal medicine inpatient? Or if the student had 4 patients to work up, it should take 10 minutes to present all 4 patients to the preceptor?
Good question. That’s per case, but with time you’ll become faster.
Comments are closed.
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Clinical Case Presentation Template
Present your patient’s history and the impact of medication using this presentation template..
Use high-resolution stock photos, icons, charts and graphs alongside the bullet-point form of text to summarize your patient’s case.
This presentation template offers you the opportunity to present clinical cases to peers and attendings. You can also use it to present patient history and course of treatment during your oral board certification exam.
- Change colors, fonts and more to fit your branding
- Access free, built-in design assets or upload your own
- Visualize data with customizable charts and widgets
- Add animation, interactivity, audio, video and links
- Download in PDF, PPTX, MP4 and HTML5 format
- Share online with a link or embed on your website
Ace clinical case presentation on your next exam with this impactful template, or take a look at our other presentation templates for a better fit.
Edit this template with our Presentation Software
Template Specifications
9 Slides, 1366 x 768 pixels – 16:9 Aspect Ratio (HD Presentation Quality)
Customizable
This template can be fully customized. You can edit content, change image(s), apply custom colors, input your own fonts and logo, and more.
Download as a PDF to share with your recipient or generate a shareable link for online sharing.
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- presentations
- presentation
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How to make an oral case presentation to healthcare colleagues
The content and delivery of a patient case for education and evidence-based care discussions in clinical practice.
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A case presentation is a detailed narrative describing a specific problem experienced by one or more patients. Pharmacists usually focus on the medicines aspect , for example, where there is potential harm to a patient or proven benefit to the patient from medication, or where a medication error has occurred. Case presentations can be used as a pedagogical tool, as a method of appraising the presenter’s knowledge and as an opportunity for presenters to reflect on their clinical practice [1] .
The aim of an oral presentation is to disseminate information about a patient for the purpose of education, to update other members of the healthcare team on a patient’s progress, and to ensure the best, evidence-based care is being considered for their management.
Within a hospital, pharmacists are likely to present patients on a teaching or daily ward round or to a senior pharmacist or colleague for the purpose of asking advice on, for example, treatment options or complex drug-drug interactions, or for referral.
Content of a case presentation
As a general structure, an oral case presentation may be divided into three phases [2] :
- Reporting important patient information and clinical data;
- Analysing and synthesising identified issues (this is likely to include producing a list of these issues, generally termed a problem list);
- Managing the case by developing a therapeutic plan.
Specifically, the following information should be included [3] :
Patient and complaint details
Patient details: name, sex, age, ethnicity.
Presenting complaint: the reason the patient presented to the hospital (symptom/event).
History of presenting complaint: highlighting relevant events in chronological order, often presented as how many days ago they occurred. This should include prior admission to hospital for the same complaint.
Review of organ systems: listing positive or negative findings found from the doctor’s assessment that are relevant to the presenting complaint.
Past medical and surgical history
Social history: including occupation, exposures, smoking and alcohol history, and any recreational drug use.
Medication history, including any drug allergies: this should include any prescribed medicines, medicines purchased over-the-counter, any topical preparations used (including eye drops, nose drops, inhalers and nasal sprays) and any herbal or traditional remedies taken.
Sexual history: if this is relevant to the presenting complaint.
Details from a physical examination: this includes any relevant findings to the presenting complaint and should include relevant observations.
Laboratory investigation and imaging results: abnormal findings are presented.
Assessment: including differential diagnosis.
Plan: including any pharmaceutical care issues raised and how these should be resolved, ongoing management and discharge planning.
Any discrepancies between the current management of the patient’s conditions and evidence-based recommendations should be highlighted and reasons given for not adhering to evidence-based medicine ( see ‘Locating the evidence’ ).
Locating the evidence
The evidence base for the therapeutic options available should always be considered. There may be local guidance available within the hospital trust directing the management of the patient’s presenting condition. Pharmacists often contribute to the development of such guidelines, especially if medication is involved. If no local guidelines are available, the next step is to refer to national guidance. This is developed by a steering group of experts, for example, the British HIV Association or the National Institute for Health and Care Excellence . If the presenting condition is unusual or rare, for example, acute porphyria, and there are no local or national guidelines available, a literature search may help locate articles or case studies similar to the case.
Giving a case presentation
Currently, there are no available acknowledged guidelines or systematic descriptions of the structure, language and function of the oral case presentation [4] and therefore there is no standard on how the skills required to prepare or present a case are taught. Most individuals are introduced to this concept at undergraduate level and then build on their skills through practice-based learning.
A case presentation is a narrative of a patient’s care, so it is vital the presenter has familiarity with the patient, the case and its progression. The preparation for the presentation will depend on what information is to be included.
Generally, oral case presentations are brief and should be limited to 5–10 minutes. This may be extended if the case is being presented as part of an assessment compared with routine everyday working ( see ‘Case-based discussion’ ). The audience should be interested in what is being said so the presenter should maintain this engagement through eye contact, clear speech and enthusiasm for the case.
It is important to stick to the facts by presenting the case as a factual timeline and not describing how things should have happened instead. Importantly, the case should always be concluded and should include an outcome of the patient’s care [5] .
An example of an oral case presentation, given by a pharmacist to a doctor, is available here .
A successful oral case presentation allows the audience to garner the right amount of patient information in the most efficient way, enabling a clinically appropriate plan to be developed. The challenge lies with the fact that the content and delivery of this will vary depending on the service, and clinical and audience setting [3] . A practitioner with less experience may find understanding the balance between sufficient information and efficiency of communication difficult, but regular use of the oral case presentation tool will improve this skill.
Tailoring case presentations to your audience
Most case presentations are not tailored to a specific audience because the same type of information will usually need to be conveyed in each case.
However, case presentations can be adapted to meet the identified learning needs of the target audience, if required for training purposes. This method involves varying the content of the presentation or choosing specific cases to present that will help achieve a set of objectives [6] . For example, if a requirement to learn about the management of acute myocardial infarction has been identified by the target audience, then the presenter may identify a case from the cardiology ward to present to the group, as opposed to presenting a patient reviewed by that person during their normal working practice.
Alternatively, a presenter could focus on a particular condition within a case, which will dictate what information is included. For example, if a case on asthma is being presented, the focus may be on recent use of bronchodilator therapy, respiratory function tests (including peak expiratory flow rate), symptoms related to exacerbation of airways disease, anxiety levels, ability to talk in full sentences, triggers to worsening of symptoms, and recent exposure to allergens. These may not be considered relevant if presenting the case on an unrelated condition that the same patient has, for example, if this patient was admitted with a hip fracture and their asthma was well controlled.
Case-based discussion
The oral case presentation may also act as the basis of workplace-based assessment in the form of a case-based discussion. In the UK, this forms part of many healthcare professional bodies’ assessment of clinical practice, for example, medical professional colleges.
For pharmacists, a case-based discussion forms part of the Royal Pharmaceutical Society (RPS) Foundation and Advanced Practice assessments . Mastery of the oral case presentation skill could provide useful preparation for this assessment process.
A case-based discussion would include a pharmaceutical needs assessment, which involves identifying and prioritising pharmaceutical problems for a particular patient. Evidence-based guidelines relevant to the specific medical condition should be used to make treatment recommendations, and a plan to monitor the patient once therapy has started should be developed. Professionalism is an important aspect of case-based discussion — issues must be prioritised appropriately and ethical and legal frameworks must be referred to [7] . A case-based discussion would include broadly similar content to the oral case presentation, but would involve further questioning of the presenter by the assessor to determine the extent of the presenter’s knowledge of the specific case, condition and therapeutic strategies. The criteria used for assessment would depend on the level of practice of the presenter but, for pharmacists, this may include assessment against the RPS Foundation or Pharmacy Frameworks .
Acknowledgement
With thanks to Aamer Safdar for providing the script for the audio case presentation.
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[1] Onishi H. The role of case presentation for teaching and learning activities. Kaohsiung J Med Sci 2008;24:356–360. doi: 10.1016/s1607-551x(08)70132–3
[2] Edwards JC, Brannan JR, Burgess L et al . Case presentation format and clinical reasoning: a strategy for teaching medical students. Medical Teacher 1987;9:285–292. doi: 10.3109/01421598709034790
[3] Goldberg C. A practical guide to clinical medicine: overview and general information about oral presentation. 2009. University of California, San Diego. Available from: https://meded.ecsd.edu/clinicalmed.oral.htm (accessed 5 December 2015)
[4] Chan MY. The oral case presentation: toward a performance-based rhetorical model for teaching and learning. Medical Education Online 2015;20. doi: 10.3402/meo.v20.28565
[5] McGee S. Medicine student programs: oral presentation guidelines. Learning & Scholarly Technologies, University of Washington. Available from: https://catalyst.uw.edu/workspace/medsp/30311/202905 (accessed 7 December 2015)
[6] Hays R. Teaching and Learning in Clinical Settings. 2006;425. Oxford: Radcliffe Publishing Ltd.
[7] Royal Pharmaceutical Society. Tips for assessors for completing case-based discussions. 2015. Available from: http://www.rpharms.com/help/case_based_discussion.htm (accessed 30 December 2015)
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- ID Grand Rounds Case Presentations
Below are a few examples of the fantastic cases and case presentations our first-year fellows are engaged with:
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Case 1: A seventeen-month-old girl who refuses to walk. Case 2: A fifteen-year-old boy with aplastic anemia, neutropenia, and a necrotic nasopharyngeal mass.
September 22, 2020
Case 1: A 33 year old woman with a shoulder mass Case 2: A 58 year old man with AML and subcutaneous nodules
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Case 1: A 5 year old boy with new onset intractable seizures Case 2: A 28 year old man with HIV and diffuse large B cell lymphoma, who presents with a new headache and gait imbalance.
September 8, 2020
Part One: A man with lung cancer and a brain lesion; a woman with an acute severe headache Part Two: A woman with an acute headache
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Case 1: A 7 year old girl with new onset seizures Case 2: A 67 year old man with AML and nausea, vomiting, and diarrhea
August 11, 2020
Case 1: A man with AIDS, subacute pancytopenia, several weeks of weight loss, and one week of fevers Case 2: A man with one year of weakness, fatigue, and skin lesions found to have brisk hypercalcemia
July 28, 2020
A 30 year old man with headaches, transient right hand weakness/numbness, and world finding difficulty
June 30, 2020
Case 1: A man with 4 days of progressive headache culminating in septic shock Case 2: A man with progressive neurologic dysfunction and nodular spinal cord enhancement
June 16, 2020
Case 1: A 77 year old man from South America with chronic diarrhea Case 2: A 4 year old boy with neck stiffness
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eTable 1. List of Statin Exposures With NDC and Dose
eTable 2. Demographics and Comorbidities for the Four Exposure Groups
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- Error in Discussion JAMA Network Open Correction March 29, 2024
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Davis JW , Weller SC , Porterfield L , Chen L , Wilkinson GS. Statin Use and the Risk of Venous Thromboembolism in Women Taking Hormone Therapy. JAMA Netw Open. 2023;6(12):e2348213. doi:10.1001/jamanetworkopen.2023.48213
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Statin Use and the Risk of Venous Thromboembolism in Women Taking Hormone Therapy
- 1 Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, Galveston
- 2 Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston
- 3 Department of Family Medicine, School of Medicine, University of Texas Medical Branch, Galveston
- Correction Error in Discussion JAMA Network Open
Question Is statin therapy associated with decreased risk of venous thromboembolism (VTE) in perimenopausal women exposed to hormone therapy (HT)?
Findings In this case-control study of 223 949 women aged 50 to 64 years, the risk of VTE was 53% higher in women recently exposed to HT without current statin therapy and 25% higher in women with recent HT exposure and current statin therapy compared with women who were not exposed to recent HT or statins.
Meaning These findings suggest statins are associated with reduced risk of VTE in women exposed to HT and that HT may not be contraindicated in women taking statins.
Importance Although hormone therapy (HT) in perimenopausal women is associated with increased risk for venous thromboembolism (VTE), it is unclear to what extent statins may mitigate this HT-associated risk.
Objective To estimate VTE risk in women aged 50 to 64 years taking HT with or without statins.
Design, Setting, and Participants This nested case-control study analyzed data from a commercially insured claims database in the US. Eligible participants included women aged 50 to 64 years with at least 1 year of continuous enrollment between 2008 and 2019. Data analysis occurred from January 2022 to August 2023.
Exposure Filled prescriptions for estrogens, progestogens, and statins were recorded in the 12 months prior to index. Recent HT was defined as any estrogen or progestogen exposure within 60 days before the index date. Current statin exposure was defined as 90 or more days of continuous exposure prior to and including the index date. Statin intensity was defined by the statin exposure 30 days prior to index.
Main Outcomes and Measures Cases were identified with VTE diagnoses (diagnostic codes) preceded by at least 12 months without VTE and followed within 30 days by anticoagulation, an inferior vena cava filter placement, or death. Controls were matched to cases (10:1) on date and age. Conditional logistic regression models estimated risk for HT and statin exposures with odds ratios (OR), adjusted for comorbidities. Conditional logistic regression models were used to estimate VTE risk for HT and statin exposures with odds ratios (ORs), adjusted for comorbidities. Intensity of statin therapy was measured as a subgroup analysis.
Results The total sample of 223 949 individuals (mean [SD] age, 57.5 [4.4] years) included 20 359 cases and 203 590 matched controls. Of the entire sample, 19 558 individuals (8.73%) had recent HT exposure and 36 238 individuals (16.18%) had current statin exposure. In adjusted models, individuals with any recent HT exposure had greater odds of VTE compared with those with no recent HT exposure (OR, 1.51; 95% CI, 1.43-1.60). Individuals receiving current statin therapy had lower odds of VTE compared with those with no current statin exposure (OR, 0.88; 95% CI, 0.84-0.93). When compared with those not recently taking HT or statins, the odds of VTE were greater for those taking HT without statins (OR, 1.53; 95% CI, 1.44-1.63) and for those taking HT with statins (OR, 1.25; 95% CI, 1.10-1.43), but were lower for those taking statins without HT (OR, 0.89; 95% CI, 0.85-0.94). Individuals taking HT with statin therapy had 18% lower odds of VTE than those taking HT without statins (OR, 0.82; 95% CI, 0.71-0.94) and there was greater risk reduction with higher intensity statins.
Conclusions and Relevance In this case-control study, statin therapy was associated with reduced risk of VTE in women taking HT, with greater risk reduction with high-intensity statins. These findings suggest that statins may reduce risk of VTE in women exposed to HT and that HT may not be contraindicated in women taking statins.
Menopause-associated symptoms (eg, hot flashes, vaginal dryness, disruptions in sleep patterns, and cognitive changes) are common and can affect quality of life. 1 - 3 Hormone therapy (HT) is an effective treatment for many of these symptoms. 4 , 5 However, concerns regarding increased risk of venous thromboembolism (VTE), stroke, or myocardial infarction can prevent many symptomatic women from receiving HT. 6 - 8 HT may double the risk of VTE, 9 - 11 although the clinical trials were conducted with oral, conjugated equine estrogen (CEE), 9 , 12 and newer studies suggest risk may be lower with other types of estrogen, 13 - 17 routes of administration, 15 , 17 - 19 and earlier initiation of therapy. 20 - 22
In the decades since initial HT trials were conducted, statin therapy has been associated with reduced risk for major cardiovascular events 23 , 24 and VTE, 25 , 26 but few studies have estimated statin’s ability to mediate HT-associated VTE risk. Studies of concomitant HT and statin therapy suggest that the antiinflammatory and antithrombotic effects of statin therapy may mediate the risk of adverse cardiovascular events associated with HT. A UK study 27 (1987-2008) in postmenopausal women found VTE risk from oral HT exposure was 51% higher for those not taking statin therapy and 21% higher for those taking statin therapy compared with those not exposed to oral HT. Similar reductions have been found for other adverse HT outcomes. 28 - 30
Studies suggesting statins may mediate the risk of VTE associated with HT need validation in the US population because of different formulary, prescribing patterns and higher VTE incidence. VTE incidence in the UK ranged from 150 to 175 cases per 100 000 person-years between 2017 and 2019, whereas the US rate was 214 cases per 100 000 person-years between 2015 and 2019. 31 Also, statin use among US women older than 40 years increased from 16% in 2002 to 2003 to 26% in 2012 to 2013, 32 whereas the use of estrogen products (oral, vaginal, and transdermal) in women older than 50 years decreased from approximately 12.5% in 2006 to 9.2% in 2015, with larger reductions in oral estrogen products. 33 Thus, this study explored whether statin therapy mediates VTE risk in US women aged 50 to 64 years exposed to exogenous hormones.
This nested case-control study was approved by The University of Texas Medical Branch institutional review board with a waiver of informed consent because the data were deidentified, in accordance with 45 CFR §46. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline 34 and was designed within the Optum deidentified Clinformatics Data Mart Database containing claims for approximately 62 million unique enrollees. Excluding Medicare Advantage subscribers, there are approximately 15 million annual members, one-third of whom have had continuous enrollment for 3 or more years. Because VTE incidence is low, Clinformatics is 1 of the few US databases sufficiently large enough to study VTE risk factors. The database contains information on outpatient and inpatient diagnoses and filled prescriptions. The age and sex distribution in the database is similar to that of the US population, but historically minoritized racial and ethnic groups are slightly underrepresented (13% vs 19% Hispanic and 10% vs 14% Black). 35
The study cohort was limited to women aged 50 to 64 years with more than 1 year of continuous enrollment between January 1, 2007, and December 31, 2019. Observations without sex (0.01%) or age (0.00007%) were excluded. Cases and matched controls were selected between January 1, 2008, and December 1, 2019, to allow a 12-month look-back period and 30-day follow-up period. The age range was selected because of the average age at menopause, 36 higher rates of menopausal HT use in this age range, 33 and the tendency to transition from commercial insurance to Medicare at age 65 years. The study focused on statin therapy and HT as part of a larger project on VTE; design details, including International Classification of Diseases, Ninth Revision [ICD-9] , International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) , and Current Procedural Terminology codes were reported previously. 15
Cases were defined as women with a VTE diagnostic code during the observation period followed by a prescription for an anticoagulant (excluding heparin flushes), intravascular vena cava filter, or death within 30 days of the VTE diagnosis (index date). 31 Controls were randomly sampled (without replacement) and matched to cases by index date (month) and age (±2 years) at a 10:1 ratio. A large ratio was used to estimate low-frequency categories. Women were excluded if they had less than 12 months of enrollment data, an acute or chronic VTE diagnosis, an intravascular vena cava filter placement in the year prior to the index date, or exposure to anticoagulants within 14 days prior to the index date.
HT exposure was defined as a filled prescription for any estrogen and/or progestogen, and the duration of the prescription (30 or 90 days) was used to determine timing of exposure. Exposure was evaluated regardless of route (oral or nonoral) or indication (eg, menopausal HT or contraception). Timing of HT exposure was defined as recent (≤60 days before index) vs past and none, because previous research indicated VTE risk diminishes after 60 days. 15 National drug codes for hormones were identified using Red Book 37 and/or from a list supplied by the US Food and Drug Administration 33 (list published previously 15 ).
Statin exposure was defined by duration and continuity of filled prescriptions. Current statin exposure was defined as continuous filled prescriptions for 90 days or more prior to and including the index date. The comparison category was shorter, discontinuous, or no exposure in the past year. Intensity of therapy 30 days prior to the index date was defined as high (atorvastatin ≥40 mg or rosuvastatin ≥20 mg) or low to moderate (all other doses) according to American Heart Association guidelines. 38 Red Book 37 national drug codes were used to identify statin prescriptions, formulations, and doses (eTable 1 in Supplement 1 ).
Risk for VTE with statin and/or HT exposures was estimated with adjusted odds ratios (ORs) and 95% CIs. 39 Because of the matched design, conditional logistic regression models were used. 17 , 27 , 30 Covariates included region of residence, age at index date, history of cancer except for nonmelanoma skin cancer (categorized as no cancer, nonmetastatic cancer, and metastatic cancer), history of prothrombotic conditions or other types of thrombosis (ie, superficial thrombophlebitis), varicose veins within the previous year, and hospitalization (with or without surgery) or trauma within 30 days of the index date. In addition, coronary artery disease, stroke, lipid disorders, and smoking within the past year were included because they may affect the likelihood of prescribing HT or statin therapy. Finally, the Elixhauser set of comorbidities was included to control for general health status. 40 The Elixhauser Comorbidity Index 41 has been validated for estimating mortality and includes chronic conditions such as obesity, liver disease, and diabetes. Known factors associated with increased risk of VTE (eg, cancers and hypercoagulable conditions) were removed from the index and used as separate covariates. The final Elixhauser Comorbidity Index was summed and coded into terciles (0 comorbidities, 1-2 comorbidities, and ≥3 comorbidities).
Models estimated the association of HT and statin exposures with VTE risk, controlling for covariates. Sensitivity analyses examined the stability of main associations across stratified subsamples with different comorbidity burdens. Because conditional and unconditional analyses can yield similar results when few matching criteria are used, 42 unconditional analyses were used on stratified subsamples to avoid loss of observations. An interaction term in the full sample with a conditional analysis assessed whether association modification occurred between statin and HT exposures.
To estimate the combined association of current statin and recent HT exposures across the distribution of risk factors, women were coded into 4 groups by their HT and statin exposure status. ORs were estimated for HT exposure without statin therapy, HT exposure with statin therapy, and statin therapy without HT exposure with reference to women with neither recent HT nor current statin therapy. Another model estimated the association of statin intensity with additional subgroups for lower and higher intensity therapy. A 2-sided P < .05 was considered statistically significant. All statistical analyses were conducted using SAS statistical software version 9.22 (SAS Institute). Data analysis occurred from January 2022 to August 2023.
Of the 74 600 patients identified with a first, acute VTE and 22 380 610 eligible controls in the Clinformatics database, a total of 223 949 women (mean [SD] age, 57.5 [4.4] years) were included; we identified 20 359 cases that met inclusion criteria, and all were successfully matched to 203 590 controls. The flowchart for sample selection was published previously. 15 Women in the study sample were approximately equally distributed in 5-year or 6-year age intervals (50-54 years, 55-60 years, and 61-65 years). Cases had a higher proportion of comorbidities and factors associated with increased risk of VTE than controls ( Table 1 ). A total of 11 389 cases (55.94%) and 45 700 controls (22.45%) had 3 or more comorbidities; 5294 cases (26.00%) and 11 370 controls (5.58%) had cancer; 2743 cases (13.47%) and 9775 controls (4.80%) had coronary artery disease; and 4710 cases (23.13%) and 19 263 controls (9.46%) smoked. Among the VTE cases, 10 995 (54.01%) had pulmonary emboli (with or without deep vein thrombosis), 9364 (45.99%) had deep vein thrombosis without pulmonary emboli, and 1197 (5.88%) died within 30 days following diagnosis.
Recent exposures to any HT occurred in 19 558 individuals (8.73%) including 2130 cases (10.46%) and 17 428 controls (8.56%). Of those exposures, 14 810 (75.72%) were menopausal estrogen or estrogen-progestogen combinations (10 585 [71.47%] oral and 4223 [28.51%] nonoral), 2476 (12.66%) were estrogen-progestin contraceptives, 1486 (7.60)% were progesterone only, and 786 (4.02%) were estrogen-testosterone combinations. Those with recent HT exposure tended to be younger (69 272 [33.89%] unexposed and 8444 [43.17%] exposed at <55 years of age).
For statin therapy, 36 238 individuals in the entire sample (16.18%), including 3717 cases (18.26%) and 32 521 controls (15.97%), had current or continuous exposure for at least 3 months before and including the index date; 17 569 (7.85%) had shorter or discontinuous exposures; and 170 142 (75.97%) had no exposure in the past year. Shorter or intermittent exposure was not significantly different from no exposure (OR, 1.05; 95% CI, 0.99-1.12) but was significantly different from 3 or more months of current or continuous exposure (OR, 1.18; 95% CI, 1.10-1.25), indicating that the intermittent and no exposure groups could be combined. Those with current or continuous statin exposure tended to be older (54 508 [29.04%] unexposed and 16 404 [45.27%] exposed at >60 years of age), have hyperlipidemia diagnoses (54210 [28.88%] unexposed and 31 235 [86.19%] exposed), or have coronary artery disease (7501 [4.00%] unexposed and 5017 [13.84%] exposed) than those without current or continuous exposure. Among those currently exposed to statins, 29 011 (80.06%) were exposed to low or moderate intensity statins and 7227 (19.94%) were exposed to high intensity statins in the 30 days prior to the index date.
After adjustment for all covariates in a conditional model, the OR for any recent HT exposure (regardless of statin exposure) was elevated 51% compared with those without recent HT exposure (model 1 OR, 1.51; 95% CI, 1.43-1.60) ( Table 2 ). The OR for current or continuous statin therapy (regardless of HT exposure) was 12% lower than less or no statin therapy (OR, 0.88; 95% CI, 0.84-0.93). There was slightly less risk reduction with low or moderate intensity statin therapy (OR, 0.90; 95% CI, 0.85-0.95) and slightly more risk reduction with high-intensity statin therapy (OR, 0.82; 95% CI, 0.75-0.90) compared with those without current statin exposure (not shown). Results for HT and statin therapy were consistent across the total sample with and without a conditional analysis, between the total sample and subsamples without cancer or hypercoagulability conditions, and subsamples with above and below median comorbidity burdens ( Table 2 ). The singular exception was the higher association of HT exposure in subsamples with fewer comorbidities. There was no significant interaction of HT and statin therapy with VTE risk.
The combined main effects of statin and HT were estimated for the 4 groups created by HT and statin exposures. As hypothesized, the OR was highest for women exposed to HT without statin therapy compared with the reference group with neither recent HT nor statin exposure (model 1 in Table 3 ). The OR for the 16 350 individuals with HT exposure but without statin therapy was elevated by 53% over the 171 361 individuals in the reference group (OR, 1.53; 95% CI, 1.44-1.63). The OR for the 3208 individuals with HT exposure combined with statin therapy was 25% higher than that for the reference group (OR, 1.25; 95% CI, 1.10-1.43). A direct comparison between those receiving HT with statin therapy and those receiving HT without statin therapy showed a significantly lower (18%) OR for those with statin therapy (OR, 0.82; 95% CI, 0.71-0.94). Finally, the lowest risk was for those exposed to statin therapy without HT exposure; the OR was 11% lower than the reference group (OR, 0.89; 95% CI, 0.85-0.94). See eTable 2 in Supplement 1 for risk factor distributions for the 4 exposure groups.
When subgroups exposed to statins were subdivided into low and moderate vs high-intensity therapy, a larger protective association was observed with high-intensity therapy compared with the reference group without recent HT or statin exposure (model 2 in Table 3 ). ORs were elevated 53% with recent HT exposure without statins (OR, 1.53; 95% CI, 1.44-1.63) and were elevated 29% with low and moderate statin intensity (OR, 1.29; 95% CI, 1.12-1.49), but were not elevated with high statin intensity (OR, 1.06; 95% CI, 0.77-1.45) compared with those without recent HT and without current statin therapy. A direct comparison between HT without statin therapy and HT with low and moderate statin intensity showed a 16% reduction (OR, 0.84; 95% CI, 0.73-0.98), and a comparison with HT with high statin intensity showed a 31% reduction (OR, 0.69; 95% CI, 0.50-0.95). The OR for those without recent HT exposure showed a 9% reduction with low and moderate intensity but a 16% reduction with high-intensity statin therapy (OR, 0.84; 95% CI, 0.76-0.92) compared with the reference group without HT and without statin therapy.
To our knowledge, this is the first large case-control study in a US claims database to assess the association of risk of VTE with HT and statin exposures in women of postmenopausal age. In weighing the benefits of menopausal symptom relief against reported risks of VTE from clinical trials 6 , 10 and cohort studies, 11 , 17 this study provides insight into additional factors associated with the risk profile of HT users. Specifically, we found that the risk-benefit profile for HT may be more favorable when taking concomitant statin therapy. In this study, results indicated HT-associated VTEs may be reduced with statin therapy. Recent HT exposure elevated risk 53% without statin exposure, but elevated risk 25% when combined with statin therapy compared with the reference group without HT and without statin exposure—a significant 18% reduction. Higher intensity statin therapy reduced risk 31% compared with the reference group and mitigated HT-associated risk, providing evidence of a dose-response effect in the association.
The overall risk reduction for those with recent HT and concomitant statin therapy was similar to previous studies, 27 , 28 although observational studies conducted 2 decades ago were limited by the low prevalence of statin usage. This study and a UK study 27 each showed an almost 20% reduction in HT risk with statin therapy, although the UK study used an earlier time period (1987-2008), broader age range (50-79 years), and focused on oral menopausal HT exposures. In contrast with this study, the UK study 27 did not detect significant reductions with higher intensity statins. The difference may be due to different definitions of statin intensity and/or the proportion of women exposed to statins. The Heart and Estrogen/Progestin Replacement cohort reanalysis 28 showed a 47% lower rate of VTE in women receiving HT and statins compared with women receiving HT without statins (hazard ratio, 0.53; estimated from 4.13 per 1000 person-years after 3 years of follow-up for women exposed to HT and statins and 7.85 for women exposed to HT but not statins).
The overall 51% increase in risk for VTE with HT exposure found in this study is consistent with other studies. A large UK case-control study 17 found any menopausal HT exposure in the past 90 days increased the OR by 43%, oral exposures increased the OR by 58%, and CEE exposures almost doubled the OR compared with no HT exposure. Clinical trial estimates indicating HT may double the risk for VTE 9 , 10 may be higher because of older age of HT initiation and use of oral CEE. 15 , 17 This study therefore affirms and expands previous findings.
In this study, the HT-associated risk of VTE was slightly higher for those with fewer comorbidities and slightly lower for those with more comorbidities compared with no HT exposure. This difference was likely due to greater exposure to contraceptives (and higher risk estrogen and progestin formulations) in the younger US women with fewer comorbidities. 15 A notable difference between this sample and the UK samples 17 , 27 was the number of women in the US sample on higher-risk combined hormone contraceptives. 15 Women older than 50 years exposed to combined hormonal contraceptives had 5 to 9 times higher risk of VTE compared with those with no hormone exposure. 15
The overall reduction in VTE risk with statin therapy observed in this study (12%) was smaller than estimated in previous observational studies but similar to the reduction found in randomized clinical trials (RCTs). Cohort studies 25 suggest statin exposure may reduce VTE risk by 25%, whereas RCTs indicate a 15% reduction in risk 25 and accentuation by intensity of therapy. 25 , 26 , 43 , 44 Differences between cohort and RCT findings may be attributable to differences in patient populations, 45 as well as duration of statin exposure. Statin effectiveness studies typically have a longer median statin exposure time (approximately 4 years) 25 than in this study, where VTE reduction was observed with 90 or more days. In this study, statin therapy did not interact with HT, but instead had independent associations with reduction in VTE.
There are several limitations to this study. Most importantly, this study is a nested case-control design in an administrative claims database and contains all inherent limitations of a secondary, observational data set. Although the study cannot directly prove causality, the time-restricted design offered an unbiased estimation of exposure risk for the population in the base cohort. Misclassification was minimized by using a strict case definition. Although other studies 17 , 27 , 30 , 46 included probable cases in their analyses, we combined diagnostic claim codes with confirmatory events (ie, hospitalization, death, or anticoagulant prescription within 30 days of diagnosis) to increase diagnostic accuracy and detection of definite cases. 47 We also adjusted for comorbidities that could potentially confound estimates and controlled for coronary artery disease, stroke, and lipid disorders to minimize indication bias. However, even with statistical controls to minimize bias, some residual confounding may remain when treatment groups are not randomly assigned.
Other limitations include a limited look-back period, rather than a lifetime medical history, and limited information on patient characteristics. The database contained data on patient age, sex, and region of residence, but lacked data on race and ethnicity, income, educational level, and indications for prescriptions. Race and ethnicity is associated with VTE, 48 , 49 but may be mediated by comorbidities, region, and/or socioeconomic status. 49 In this study, we controlled for comorbidities and region of residence. Socioeconomic status was indirectly controlled for because all patients had private health insurance. The data set also did not have information on over-the-counter medications (such as aspirin), which may 50 or may not 51 have an independent protective association with VTE in this population.
Despite these limitations, medication and diagnostic detail contained in the large administrative claims database allowed for the estimation of associations for low prevalence exposures and outcomes. This was especially true for estimating risk for those with both hormone and statin exposures. Furthermore, there were sufficient women to make inferences about intensity of statin therapy.
In this case-control study of women with VTE and matched controls, we found statin therapy was associated with reduced, but not eliminated, risk of VTE associated with exogenous hormones. Although women who are at higher cardiovascular risk may take statins, and thus may seem unlikely candidates for HT, statin therapy appears to mitigate some of the risk from HT. HT may not be contraindicated in women who are candidates for statin therapy. These findings suggest that statins may improve the HT risk-benefit profile for women with perimenopausal symptoms. An RCT evaluating the absolute risk of thrombosis with concomitant statin therapy is needed to elucidate the full safety profile.
Accepted for Publication: October 31, 2023.
Published: December 15, 2023. doi:10.1001/jamanetworkopen.2023.48213
Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Davis JW et al. JAMA Network Open .
Correction: This article was corrected on March 29, 2024, to fix an error in the Discussion.
Corresponding Author: Susan C. Weller, PhD, Department of Population Health Science, School of Public and Population Health, University of Texas Medical Branch, 300 Harborside Dr, Galveston, TX 77555-1153 ( [email protected] ).
Author Contributions: Mr Davis and Dr Weller had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Davis, Weller, Porterfield, Wilkinson.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Davis, Weller, Porterfield, Wilkinson.
Critical review of the manuscript for important intellectual content: All authors.
Statistical analysis: Davis, Weller, Chen, Wilkinson.
Obtained funding: Weller.
Administrative, technical, or material support: Weller, Porterfield, Wilkinson.
Supervision: Weller.
Conflict of Interest Disclosures: Mr Davis reported receiving a grant from the CVS Health Foundation and honoraria from GE Healthcare and Novartis AG outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by a grant from the Texas Academy of Family Physicians Foundation (to Dr Weller).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2 .
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Treating infected non-healing venous leg ulcers with medical-grade honey: a prospective case series.
1. Introduction
2.1. case 1, 2.2. case 2, 2.3. case 3, 2.4. case 4, 2.5. case 5, 2.6. case 6, 2.7. case 7, 2.8. case 8, 2.9. case 9, 2.10. general population data, 3. discussion, 4. materials and methods, 4.1. patient recruitment, 4.2. l-mesitran wound care products, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.
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Click here to enlarge figure
Case | Gender/Age (Years) | VLU Location/Dimensions (cm) | Wound Age (Weeks)/ Previous Treatment | Relevant Comorbidities | Local Signs of Infection | Time for Infection Resolution (Weeks) | Time for Wound Healing (Weeks) |
---|---|---|---|---|---|---|---|
1 | Female 79 | Right 6 × 6 | 4 povidone-iodine solution and mupirocin calcium cream | CVI, AHT, COPD, heart failure, atrial fibrillation, obesity, limited mobility | slough, high amount of exudate malodor, pain, erythema, delayed healing | 4 | 11 |
2 | Female 80 | Right 3 × 3 | 20 povidone-iodine solution | CVI, AHT, obesity | slough, moderate amount of exudate, edema, delayed healing | 3 | 18 |
3 | Female 91 | Right: 5 × 4 Left lateral: 3 × 3 Left posterior: 6 × 5 | 2 povidone-iodine solution | CVI, DVT, heart failure, atrial fibrillation, limited mobility | necrotic tissue, moderate amount of exudate, erythema, edema, pain | Right: 3 Left posterior: 2 Left lateral: 1 | Right: 5 Left posterior: 6 Left lateral: 3 |
4 | Female 84 | Right 9 × 6 | 4 not treated | CVI, COPD, CVD, heart failure, atrial fibrillation, obesity, permanent immobility | necrotic tissue, malodor, edema, pain moderate amount of exudate, erythema, hyperthermia, delayed healing | 2 | 4 |
5 | Female 87 | Left 5 × 4 | 1 not treated | CVI, AHT, PAD, limited mobility | slough, low amount of exudate, rolled and macerated edges | 2 | 6 |
6 | Male 83 | Right 5 × 5 | 2 not treated | CVI, AHT, T2DM, heart failure, atrial fibrillation, limited mobility | necrotic tissue, edema, erythema, pain | 2 | 11 |
7 | Female 88 | Left 17 × 10 | >16 antiseptic solutions & antibiotic creams | CVI, AHT, heart failure, atrial fibrillation, obesity, permanent immobility | slough, moderate amount of exudate, edema, pain, delayed healing | 2 | 3 |
8 | Female 84 | Left 12 × 1 | 2 povidone-iodine solution | CVI, multiple myeloma, limited mobility | slough, erythema, moderate amount of exudate | 1 | 3 |
9 | Female 75 | Left 6 × 5 | 4 silver sulfadiazine cream | CVI, AHT, T2DM, limited mobility | necrotic eschar, slough, moderate amount of exudate, erythema, edema, pain, delayed healing | 2 | 6 |
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- Case report
- Open access
- Published: 05 July 2024
The effect of transcranial alternating current stimulation on cognitive flexibility and attention of children with intellectual disability: a case report
- Zahra Ghahri Lalaklou 1 ,
- Elahe Haghighat-Manesh 2 ,
- AmirHossein Montazeri Ghahjavarestani 3 &
- Ezzatollah Ahmadi 1
Journal of Medical Case Reports volume 18 , Article number: 310 ( 2024 ) Cite this article
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Intellectual disability is a neurodevelopmental disorder characterized by significant impairments in intellectual functioning and adaptive behavior. Cognitive flexibility and attention are crucial cognitive domains often affected in children with intellectual disability. This case report explores the novel use of transcranial alternating current stimulation, a noninvasive brain stimulation technique, to enhance these cognitive functions. The study’s novelty lies in its focus on alpha-wave frequency transcranial alternating current stimulation targeting specific Brodmann areas and its potential sustained impact on cognitive flexibility and attention in the pediatric population with intellectual disability.
Case presentation
The case study involved two elementary school students, both 7 years old with mild intellectual disability, one male and one female, both with Turkic ethnicity, from Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran. Both participants underwent a 2-week intervention with daily 20-minute sessions of transcranial alternating current stimulation at an alpha-wave frequency (10 Hz), targeting Brodmann areas F3 and P3. Cognitive flexibility and attention were assessed using the Wisconsin Card Sorting Test and the Clock Test, administered at four time points: pre-intervention, week 1, week 2, and 1 month post-intervention. Statistical analysis showed significant improvements in both Wisconsin Card Sorting Test and Clock Test scores for both participants compared with baseline, with sustained enhancement over time.
The findings from this case report indicate that transcranial alternating current stimulation may be a promising intervention for improving cognitive flexibility and attention in children with intellectual disability. The significant and sustained improvements observed suggest that transcranial alternating current stimulation could have a meaningful clinical impact on the cognitive development of this population. However, further research is needed to confirm the efficacy of transcranial alternating current stimulation and to explore its broader applicability and long-term effects in larger, more diverse populations.
Peer Review reports
Intellectual developmental disorder (IDD), also known as intellectual disability (ID), is a neurodevelopmental disorder characterized by significant impairments in intellectual functioning and adaptive behavior across multiple domains, including conceptual, social, and practical skills. These impairments typically manifest during the developmental period, typically before age 18 years. IDD is estimated to affect approximately 10 in 1000 individuals worldwide. Intellectual functioning is assessed using standardized tests of intelligence, with individuals with IDD typically scoring two or more standard deviations below the population mean. Academic difficulties are common in individuals with IDD, particularly in reading, writing, arithmetic, time management, and financial literacy. While IDD is a neurodevelopmental disorder, it should be distinguished from neurocognitive disorders, which involve a loss of cognitive functioning rather than a lifelong impairment [ 8 ]. Individuals with ID often exhibit impairments in executive functioning, a set of higher-order cognitive processes that govern planning, decision-making, and adaptability [ 3 ]. Cognitive flexibility, a crucial aspect of executive functioning, underpins creative thinking and manifests as the ability to adjust cognitive states in response to changing situations or task demands [ 1 ]. It encompasses the capacity to generate diverse perspectives on a specific problem or scenario and seamlessly transition between different modes of thought when confronted with stimuli that challenge existing cognitive patterns [ 16 , 28 ]. Cognitive flexibility manifests in two primary forms: adaptive flexibility, signifying the ability to modify the mental framework through which solutions to problems are perceived, and automatic flexibility, representing the rapidity with which individuals produce various distinct ideas related to a given situation [ 15 ].
Various methods exist for evaluating cognitive flexibility, including employing neurocognitive assessments. The Wisconsin Card Sorting Test (WCST) stands as a prominent neurocognitive tool for assessing cognitive flexibility [ 20 , 30 ]. This task demands that participants categorize a series of cards according to shifting rules and adapt their strategies accordingly when the rules unexpectedly change. Typically, individuals with reduced cognitive flexibility encounter difficulties in adjusting to evolving guidelines [ 12 ]. Navigating an increasingly complex world necessitates sophisticated cognitive control mechanisms. The abundance of information and potential actions demands efficient attention, decision-making, and coordination to avoid being overwhelmed. To manage this multiplicity and minimize confusion, evolution has equipped us with neural systems that integrate lower-level sensory and motor processes around a unifying theme, an internal goal. This capacity for cognitive control undoubtedly involves extensive neural circuitry, but the prefrontal cortex (PFC) is widely recognized as a key player [ 21 ]. Attention, another constituent of executive functions, encompasses all aspects of human cognition that an individual can regulate, as well as all cognitive processes associated with limited resources or capacity management. Attention can be further categorized into selective attention, sustained attention, and self-regulatory attention [ 27 ]. The selective attention of participants was assessed using the Clock Test, requiring them to attend to the ticking of a clock and respond whenever a beat was skipped. The data on reaction time during the task served to gauge the individual’s attentional levels [ 23 ]; a cross-platform, open-source programming language was employed to create the experimental protocol. As cognitive flexibility and attention are critical for intellectual functioning, transcranial alternating current stimulation (tACS) was implemented to enhance these domains in children with intellectual disability.
Transcranial alternating current stimulation is a noninvasive brain stimulation (NIBS) technique that has gained widespread popularity over the past decade. This method involves the direct application of alternating electric currents to the scalp, allowing it to modulate neural activity primarily in the cerebral cortex [ 9 ]. tACS typically employs a sinusoidal waveform, characterized by a gradual transition between positive and negative voltage values over each half-cycle. Consequently, the current direction alternates between anodal and cathodal electrodes, corresponding to the two halves of the waveform [ 9 , 14 ]. The underlying concept of tACS is to mimic the brain’s naturally occurring rhythmic patterns of electrophysiological activity, as observed through electroencephalography (EEG) and magnetoencephalography (MEG). The cost, portability, tolerability, and safety profiles of tACS are superior to other noninvasive stimulation techniques. This makes tACS a feasible tool for modulating intrinsic brain rhythms and associated brain functions without imposing additional excitatory or inhibitory burdens [ 9 ].
The mechanism of tACS is characterized by four main modes of action: first, frequency entrainment, which occurs when the tACS frequency matches that of the endogenous oscillations, resulting in the stimulation wave coinciding with the endogenous wave at a consistent phase across cycles [ 5 ]; second, rhythm resonance, where the stimulation frequency directly influences the endogenous oscillation, potentially facilitating synchronization; third, temporal biasing of spikes, where the interaction between the stimulation and internal currents modulates the timing of neural firing, potentially enhancing the activation of specific neuronal populations during each stimulation cycle; fourth, network entrainment, where strong tACS amplitudes can entrain irregular neural activity, and imposed pattern, where exceptionally strong stimulation is required to override endogenous oscillations and induce a new oscillatory pattern [ 9 , 19 ]. tACS has emerged as a promising brain stimulation technique for elucidating the neural mechanisms underlying various cognitive domains, including conflict and error processing, and enhancing cognitive performance, such as working memory and long-term memory [ 2 , 11 ]. tACS is a noninvasive brain stimulation method that allows to directly modulate brain oscillations of a given frequency. Using this method, it was recently shown that increasing alpha (10 Hz) oscillations improved creative ideation with figural material [ 10 ]. Considering the extensive body of research demonstrating the efficacy of tACS in cognitive and psychiatric domains, this study investigates the potential of tACS to modulate cognitive flexibility and attention in children with intellectual disability.
The case study focuses on two elementary-school students diagnosed with mild intellectual disability (ID), referred to as patient 1 (male) and patient 2 (female), both 7 year old, with Turkic ethnicity, attending Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran. The study aimed to investigate the potential of transcranial alternating current stimulation (tACS) in enhancing cognitive flexibility and attention in children with ID. Table 1 describes patient information.
The diagnosis was confirmed through a general assessment before entering the primary education level (age 6–6.5 years) followed by a specialized intelligence test administered by the Education Organization. Both participants met the diagnostic criteria for ID and were enrolled in special schools for children with ID. Notably, they did not receive any formal intervention for ID prior to enrollment in the special education program.
Family interviews identified a history of delayed verbal development in both children. The boy’s first words emerged after 3 years old, while the girl’s emerged at 2 years 8 months.
The first child’s medical history revealed a maternal age of 28 years and a paternal age of 42 years at conception. Delivery occurred via cesarean section at 37 weeks gestation. This child is the second-born, with a 13-year-old brother diagnosed with intellectual disability, hyperactivity, and attention deficit. A history of intellectual disability is present in the maternal lineage (maternal grandmother); however, the limited access to specialized diagnosis and education precludes the determination of its severity.
The second child’s mother was 41 years old, and the father was 49 at conception. Delivery occurred naturally at 39 weeks gestation. This child is the third-born, with older siblings aged 23 and 17 years who have no history of intellectual disability. No familial history of genetic disorders was reported.
Physical examination revealed no abnormal craniofacial features or skin pigmentation in either child. Specialist evaluations for Down syndrome, Fragile X syndrome, and Prader–Willi syndrome were not conducted. Owing to the segregation of educational settings for intellectual disability and autism spectrum disorder (ASD), both children underwent ASD screening, which yielded negative results.
A neurological examination revealed myopia diagnosed at age 7 in patient 1 (who presently wears glasses). No hearing, vision, or movement impairments were detected in patient 2.
Materials and methods
The type of research method is a case study, a quasi-experimental research design in which a subject’s change in the dependent variable is measured [ 7 ]. Participants were drawn from a population of second-grade children with mild intellectual disability attending Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran, during the 2019–2020 academic year ( n = 9). Two students (one male, one female) meeting inclusion criteria (parental consent, IQ of 50–70, normal sensory/movement function, adequate comprehension, and successful baseline tasks) and lacking exclusion criteria (non-cooperation from family or participants, sensory problems such as deafness and blindness and movement problems such as finger problems) were selected. tACS targeting Brodmann areas F3 (left medial prefrontal cortex) and P3 (left lateral parietal cortex) [ 31 ] was employed at 10 Hz, coinciding with the alpha frequency band. This alpha-band stimulation (10 Hz) was administered for 20 minutes daily, six days per week, across two consecutive weeks (12 sessions in total). This specific protocol aimed to influence cognitive flexibility and attention in children with intellectual disability. The tools and tests that are utilized are introduced in the following.
Wisconsin Card Sorting Test
Cognitive flexibility was assessed using the computerized WCST, a 128-card version, obtained from the psychology experiment building language (PEBL) platform (Fig. 1 ). In this task, participants sorted 128 cards with one of the four key cards according to one of three predefined criteria (color, shape, or number). The criterion changed periodically without prior notice, requiring participants to adapt their sorting strategy on the basis of feedback. The WCST demonstrates strong validity (> 0.86) for measuring cognitive deficits after brain damage [ 17 ], and its reliability in the Iranian population has been reported at 0.85 using the retest method [ 22 ].
The Wisconsin Card Sorting Test
Mackworth Clock Test
The Clock Test (Mackworth, 1948) assesses sustained visual attention. Participants monitor a large, circular clock-like display with a black-and-white pointer making short jumps every second, like the second hand of an analog clock (Fig. 2 ). The light jumps to another circle at irregular intervals, occurring 12 times in 30 s. The task requires pressing a button upon detecting double jumps. The subject watches the clock and determines when it passes a beat. The hand advances in discrete steps per second, completing a group of 100 steps of the circle. Participants, typically seated 50 cm from the screen, press a key upon detecting a double jump. Responses within 8 seconds are scored as hits, missed signals within 8 seconds as misses, and premature responses as false alarms. The test offers customizable parameters (test length, signal jump distance) via a preferences window, allowing for flexible experimental designs. Durations of 30 minutes, 1 hour, or 2-minute practice sessions are available, and signal jump distance can be doubled or quadrupled. Upon completion, the test automatically displays a completion message and provides a detailed results summary through a dedicated window [ 18 ]. This test, instrumental in understanding continuous attention and alertness, exhibits a significant decline in signal detection accuracy after 30 minutes of continuous performance. Various forms, including computerized versions, remain relevant in research, particularly for assessing sobriety.
Methodology
The study employed a mixed-methods approach to evaluate the effectiveness of the implemented interventions. Descriptive statistics (frequency, percentage, mean, standard deviation, min/max) were used to characterize the research findings. To assess the statistical stability of observed pre–post intervention changes, a visual analysis method and the reliable change index (RCI) were implemented. The RCI, calculated using Eq. 1 , determines whether observed changes exceed measurement error, thereby indicating actual versus spurious effects. In this formula, the difference between the post-test score of each subject and their pre-test score is divided by twice the square of the measurement standard error [ 13 ].
The standard deviation [ 29 ] error was also calculated using Eq. 2 :
The present study employed a two-pronged approach to assess the efficacy of transcranial electrical brain stimulation with alternating current on the cognitive flexibility and attention of children with intellectual disability. Firstly, a statistical threshold based on the z -score (1.96) was used to determine the significance of pre-test to post-test score changes. This ensured that observed improvements exceeded chance findings with 95% confidence. Secondly, the recovery percentage formula (Eq. 3 ) adapted from Ref. [ 7 ] was applied to quantify the intervention’s impact. A recovery percentage exceeding 30% for pre-test versus post-test scores (both immediate and follow-up) served as an indicator of a positive and durable effect.
This combined approach strengthens the reliability and generalizability of the findings, offering valuable insights into the potential of tACS as a therapeutic tool for this population.
Intervention protocol
Prior to the intervention, baseline data were collected for two participants (one male, one female). This included quantitative electroencephalography (QEEG) brain mapping, computerized versions of the WCST and Clock Test, and demographic information. Subsequently, participants received tACS at 10 Hz (alpha frequency) for 20 minutes daily, six days per week, for two consecutive weeks (12 sessions in total).
Phase 1 (sessions 1–6):
Bilateral tACS targeted the F3 and P3 brain regions using a Neurostim device with elastic head and arm straps, carbon electrodes, and disposable sponge pads. Alpha wave stimulation (10 Hz) was administered for 20 minutes per session. WCST and Clock Tests were administered after the sixth session.
Phase 2 (sessions 7–12):
tACS administration continued under the same protocol (frequency, duration, and target regions) as in phase 1. WCST and Clock Tests were performed after the 12th session, determining the changes in brain waves, and the data were recorded.
Post-intervention:
One month after the final tACS session, participants underwent follow-up assessments to evaluate the intervention’s long-term impact and stability. These included executive function tests and QEEG brain mapping.
This single case study involved two participants, a 7-year-old boy and a 7-year-old girl, diagnosed with mild intellectual disability at 4 and 3 years old, respectively. Their continuous attention was assessed using the Clock Test (Table 2 ).
Table 2 summarizes the observed changes in reaction time and accuracy for both subjects. Pre-test scores serve as baseline measurements. Results indicate that both participants exhibited improvements in attention after the intervention. The boy showed increasing average correct answers (26 to 31) and decreasing average incorrect answers (34 to 29) on post-tests and follow-up. His average reaction time also improved across assessments. Similarly, the girl displayed higher average correct answers (32 to 46) and lower average incorrect answers (28 to 14) post-intervention. Her reaction time decreased consistently from the pre-test to the follow-up.
Table 3 presents the stability index of the attention variable for further analysis.
Table 3 presents the stability index for continuous attention (Clock Test) across pre-test, post-test, and follow-up assessments for both subjects. Both subjects displayed improvements in attention stability as indicated by positive changes in correct answers and reduced negative changes in reaction time and incorrect answers across assessments. The boy’s stability index for correct answers reached statistical significance for all comparisons versus the pre-test. Similarly, the girl’s stability index for correct answers exceeded the threshold for significance (> 1.96) in post-test week 2 and follow-up. These findings suggest sustained improvements in attention following the intervention.
In Table 4 , the results of the attention recovery percentage are given.
Table 4 demonstrates the percentage improvement in attention for both subjects following tACS intervention. Compared with baseline (pre-test), significant gains were observed at week 1 and week 2 in several parameters. These findings suggest a positive effect of tACS on sustained attention performance.
In Table 5 , the descriptive data of the cognitive flexibility variable of the subjects are given.
Table 5 reveals significant improvements in cognitive flexibility for both subjects. Compared with baseline (pre-test), the boy demonstrated sustained enhancement in both correct answers (increased post-test and follow-up) and conceptual level responses (similarly increased). The girl likewise exhibited significant gains in correct answers across all post-test and follow-up assessments, and her conceptual level scores also improved in these assessments. These findings suggest a positive impact of tACS on cognitive flexibility in both subjects.
Table 6 presents the stability index of the subjects’ cognitive flexibility variable.
Table 6 reveals significant improvement in subject 1’s conceptual level scores on the Wisconsin Test, persisting through the follow-up stage. Additionally, the absolute value of the stability index for subject 1’s correct answers and total errors exceeded 1.96 in all comparisons between the pre-test and subsequent assessments (post-test, follow-up). This indicates statistically significant and stable changes in these scores following the intervention. Similarly, subject 2 demonstrated significant gains in conceptual level scores throughout the study period, with stable changes in both correct answers and total errors across pre-test, post-test, and follow-up comparisons (absolute stability index > 1.96). Notably, subject 2 also exhibited a stable change in unique errors between the pre-test and second-week post-test. These findings support the hypothesis that tACS has a positive impact on cognitive flexibility, as evidenced by enhanced performance at both the conceptual level and other aspects of the Wisconsin Test. The randomized nature of the attention test and Wisconsin cards, coupled with the time interval between tests and the participants’ age, suggests a low likelihood of a training effect influencing the outcomes. Table 7 presents the results of the cognitive flexibility recovery percentage.
Table 7 highlights notable gains in cognitive flexibility for both subjects. Compared with baseline (pre-test), recovery percentages exceeded 30% across all subsequent assessments (post-test weeks 1 and 2, follow-up). This finding suggests a potentially potent impact of tACS on cognitive flexibility in both participants.
This study aims to examine the effect of tACS on the cognitive flexibility and attention of children with intellectual disability. In the first hypothesis, the results showed that tACS had a significant effect on the attention of children with intellectual disabilities in such a way that the amount of attention when comparing the pre-test score with the post-test of the first and second week and follow-up was more than 30%. This is in the direction of improvement, which shows the positive effect of tACS on the subjects’ attention. No studies have been published to investigate the effectiveness of tACS on the cognitive flexibility and attention of ID children as in the current study. Still, this result is consistent with one study that applied a single session of 40 Hz tACS over F3/F4, with an improvement in inhibitory control, visual attention, processing speed, and working memory [ 2 ]. Additionally, a case study employing a home-based tACS protocol involving 70 40-Hz stimulation over the left angular gyrus revealed significant improvements in memory, executive function, and attention. Notably, these benefits were maintained over a 3-month follow-up period. This extended protocol also provided valuable insights into treatment tolerability and patient compliance, demonstrating 100% adherence without adverse events or severe side effects. In a separate case report, a 15-session 40-Hz stimulation regimen targeting the dorsolateral prefrontal cortex (DLPFC) and contralateral supraorbital area (SOA) led to improvements in memory, visuospatial abilities, executive function, attention, orientation, and verbal recall. These enhancements persisted even after a 4-month follow-up [ 2 ]. A previous study demonstrated a significant effect of transcranial direct current stimulation (tDCS) on sustained attention, with the active tDCS group exhibiting improved performance over repeated sessions compared with the sham group. Measurable active–sham differences emerged by the third treatment visit, suggesting a synergistic effect between CT and tDCS with repeated administration. Similar findings of improved attention following 12–16 hours of CT training have been reported in individuals with fetal alcohol spectrum disorders [ 4 ]. A comprehensive meta-analysis encompassing 102 published tACS studies involving 2893 participants yielded compelling evidence of cognitive enhancement across nine distinct cognitive domains. Notably, substantial improvements were observed in executive control, with moderate to large effect sizes. Additionally, mild to modest gains were detected in attention, long-term memory, working memory, and fluid intelligence. Taken together, these findings underscore the potential utility of tACS as both an investigational tool for deciphering the neurophysiological underpinnings of cognition and a rehabilitative intervention for cognitive enhancement [ 6 ].
Consistent with the second hypothesis, our results demonstrated a significant positive effect of tACS on cognitive flexibility in children with intellectual disability. This finding corroborates previous research investigating the impact of tDCS on decision-making and cognitive flexibility in individuals with gambling disorder, where tDCS applied bilaterally over the dorsolateral prefrontal cortex (DLPFC; F3/F4) was shown to enhance both decision-making and cognitive flexibility in this population [ 26 ]. A systematic review of existing research findings indicates that tACS can effectively ameliorate symptoms of attention deficit hyperactivity disorder (ADHD), particularly cognitive impairments [ 24 ]. Notably, a clinical trial demonstrated the positive impact of an eight-session tDCS regimen combined with cognitive training on working memory, verbal fluency, and immediate and delayed recall [ 25 ].
Multicentre double-blind clinical trials with larger sample sizes are warranted to further investigate the efficacy of tACS in children with intellectual disability. These trials could also address the potential utility of different stimulation protocols, either across individuals or within the same participants, to evaluate the specificity of any observed effects and to explore potential synergies between different stimulation parameters. Further well-designed double-blind controlled trials with larger sample sizes and extended follow-up periods are essential to replicate the current findings and to identify reliable response predictors while controlling for various confounding factors. In this context, integrating electrophysiological recordings and modeling techniques is encouraged to optimize stimulation protocols and elucidate the underlying mechanisms mediating the effects of tACS.
This single case study investigated the potential of tACS in improving executive functions and brain waves in two children with intellectual disabilities (both aged 7 years) in Khosrowshah, Iran (2019–2020). Participants received daily 20-minute alpha-wave (10 Hz) tACS, targeting Brodmann areas F3 and P3, sessions for two consecutive weeks, with pre- and post-intervention assessments. Quantitative electroencephalography brain maps and cognitive performance measures (WCST, Clock Test) were obtained at four time points: pre-intervention, post-week 1, post-week 2, and 1 month follow-up. Stability indexes and recovery percentages were calculated to analyze the response to the intervention.
Results revealed significant and stable improvements in both subjects. Notably, incorrect responses on the WCST and Clock Test decreased across all comparisons (pre- to post-week 1, pre- to post-week 2, post-week 2 to follow-up), exceeding the stability index threshold (> 1.96) for both mean error and response time. These findings suggest a stable improvement in cognitive performance, particularly in cognitive flexibility and sustained attention.
Limitations include the small sample size (two purposefully selected children), limiting generalizability, and potential moderating factors like socioeconomic status and family dynamics (uncontrolled variables). Additionally, the 2-week intervention duration might need to be increased for sustained effects.
Future research with more extensive, diverse samples and extended intervention periods is recommended to solidify these preliminary findings. Additionally, controlling for moderating variables and comparing participants based on socioeconomic and family characteristics could enhance result consistency.
This study contributes to the growing body of literature exploring noninvasive brain stimulation as a potential tool for enhancing cognitive function in children with intellectual disabilities. While further research is warranted, these initial findings hold promise for developing novel therapeutic interventions in this population.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Abbreviations
Attention deficit hyperactivity disorder
Dorsolateral prefrontal cortex
Electroencephalography
Intellectual disability
Intellectual developmental disorder
Magnetoencephalography
Noninvasive brain stimulation
Prefrontal cortex
Quantitative electroencephalography
Reliable change index
Supraorbital area
- Transcranial alternating current stimulation
Transcranial direct current stimulation
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Faculty of Psychology and Educational Sciences, Azarbaijan Shahid Madani University, Tabriz, Iran
Zahra Ghahri Lalaklou & Ezzatollah Ahmadi
Department of Basic Sciences, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
Elahe Haghighat-Manesh
Universitat Autònoma de Barcelona, Barcelona, Spain
AmirHossein Montazeri Ghahjavarestani
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ZG and EA designed the study, ZG and EH performed tests, ZG and AM analyzed and interpreted the data. ZG was a major contributor in writing the manuscript, EA, EH, and AM revised the manuscript. All authors read and approved the final manuscript.
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Correspondence to Zahra Ghahri Lalaklou or Ezzatollah Ahmadi .
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This case study was conducted with ethical approval from Research Ethics Committees of Azarbaijan Shahid Madani University (reference no. IR.AZARUNIV.REC.1401.001). Written informed consent for participation was obtained from the parents/legal guardians of the children involved in the study.
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Ghahri Lalaklou, Z., Haghighat-Manesh, E., Montazeri Ghahjavarestani, A. et al. The effect of transcranial alternating current stimulation on cognitive flexibility and attention of children with intellectual disability: a case report. J Med Case Reports 18 , 310 (2024). https://doi.org/10.1186/s13256-024-04625-w
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Received : 19 March 2024
Accepted : 07 June 2024
Published : 05 July 2024
DOI : https://doi.org/10.1186/s13256-024-04625-w
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Summarize the major points of the case. Provide a limited number (e.g. 3) of takeaway points for the audience. Tailor summary and takeaway points to your audience. Critical Thinking Skills. Successful patient case presentations: Integrate disease and drug knowledge, clinical evidence, and patient factors.
This medical presentation template for neurology... Medical. 16:9 / Like . Download . Download and open in Google Slides . Download as a PowerPoint file ... Download the Facial Paralysis Case Study presentation for PowerPoint or Google Slides. A clinical case is more than just a set of symptoms and a diagnosis.
7 Ingredients for a Patient Case Presentation Template. 1. The One-Liner. The one-liner is a succinct sentence that primes your listeners to the patient. A typical format is: " [Patient name] is a [age] year-old [gender] with past medical history of [X] presenting with [Y]. 2.
Clinical Case Study Presentation Template. Number of slides: 10. Signup Free to download. A clinical case study is a report where medical practitioners share a patient's case. Generally, clinical case studies are valuable tools for medical research as they provide detailed information on the development of a disease or illness in particular ...
Presenting patient cases is a key part of everyday clinical practice. A well delivered presentation has the potential to facilitate patient care and improve efficiency on ward rounds, as well as a means of teaching and assessing clinical competence. 1 The purpose of a case presentation is to communicate your diagnostic reasoning to the listener, so that he or she has a clear picture of the ...
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4 best format types for a business case study presentation: Problem-solution case study. Before-and-after case study. Success story case study. Interview style case study. Each style has unique strengths, so pick one that aligns best with your story and audience. For a deeper dive into these formats, check out our detailed blog post on case ...
Illuminate your medical case studies with our specialized medical case study PPT and Google Slides template. A medical case study is an in-depth analysis of a patient's health condition, encompassing their medical history, symptoms, diagnosis, treatment, and outcomes, providing valuable insights for medical education and research.
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The Medical Case Study PowerPoint Template is a 10-slide presentation providing a variety of infographic layouts. These slides include several presentation icons, and clip art PowerPoint shapes relevant to the healthcare industry. For example, the icon of heart rate graph, human heart, stethoscope, first aid, operation symbols, and health ...
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The Medical Case Study Presentation Template is a case sheet that provides a concise yet comprehensive overview of a patient's diagnosis report. It offers medical professionals a convenient and visually appealing way to showcase important information such as the patient's name, age, place of residence, blood group, and symptoms. ...
Free Google Slides theme, PowerPoint template, and Canva presentation template. Detail patients' symptoms, diagnosis and treatments with this Clinical Case presentation. It is interactive and animated to catch your audience's attention! In addition, there are several Stories illustrations to support the medical information that you provide.
The ability to deliver oral case presentations is a core skill for any physician. Effective oral case presentations help facilitate information transfer among physicians and are essential to delivering quality patient care. Oral case presentations are also a key component of how medical students and residents are assessed during their training.
Patient Case Presentation. Sep 29, 2009 • Download as PPT, PDF •. 46 likes • 190,303 views. AI-enhanced description. J. Jennifer Heasley. This document summarizes a medical case involving a 27-year-old African American female patient who presents with migraines, fatigue, and dysmennorhea. Her medical history and lab results are presented.
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Medical case studies typically include a thorough review of existing literature, as well as a detailed analysis of the patient's medical records and other relevant data. This template is given with a fantastic picture with three text placeholders and medical icons for impactful medical presentations. Find more medical case study PowerPoint ...
A case presentation is a narrative of a patient's care, so it is vital the presenter has familiarity with the patient, the case and its progression. The preparation for the presentation will depend on what information is to be included. Generally, oral case presentations are brief and should be limited to 5-10 minutes.
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Below are a few examples of the fantastic cases and case presentations our first-year fellows are engaged with: October 3, 2023. Case 1: An 8-year old boy with fever and maculopapular rash Case 2: A 67-year-old woman with one week of fevers, abdominal pain, and diarrhea. September 12, 2023. Case 1: A 37-year-old man with painful neck swelling
Background Pulmonary aspergillosis is a prevalent opportunistic fungal infection that can lead to mortality in pediatric patients with underlying immunosuppression. Appropriate and timely treatment of pulmonary aspergillosis can play a crucial role in reducing mortality among children admitted with suspected infections. Case presentation The present study reports three cases of inappropriate ...
This nested case-control study was approved by The University of Texas Medical Branch institutional review board with a waiver of informed consent because the data were deidentified, in accordance with 45 CFR §46. ... In this case-control study of women with VTE and matched controls, we found statin therapy was associated with reduced, but not ...
Download the Oncology Case Study presentation for PowerPoint or Google Slides. A clinical case is more than just a set of symptoms and a diagnosis. It is a unique story of a patient, their experiences, and their journey towards healing. Each case is an opportunity for healthcare professionals to exercise their expertise and empathy to help ...
Hodgkin's lymphoma (HL) is an extremely rare cause of ocular inflammation that is usually not considered in the typical workup of uveitis and other eye diseases. A few cases of ocular inflammation were reported previously showcasing HL with absence of typical symptoms of HL at presentation. Acknowledging the potential ocular inflammation associated with HL can prompt ophthalmologists to ...
Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. Innovative and improved therapies are thus required to resolve local infection and enhance the wound healing process. The objective of this study was to evaluate the effectiveness of medical-grade honey (MGH) for the treatment of clinically infected and non-healing VLUs. This prospective case series ...
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The type of research method is a case study, a quasi-experimental research design in which a subject's change in the dependent variable is measured [].Participants were drawn from a population of second-grade children with mild intellectual disability attending Shahid Fahmideh School for Exceptional Children in Khosrowshah, Iran, during the 2019-2020 academic year (n = 9).