Research vs clinical "case reports"

[Jorje286]

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Can somebody formalize the difference between scientific research and "case reports"? I know that both expressions are a bit vague and the difference might be quite blurry, but I'm wondering if there is any formal separation between the two. Of course, by intution, case reports don't involve novel experiments or an experimental design, but the situation of a patient with a somewhat novel case is simply described.

Just some background on why I'm asking this: My neurobiology professor asked us to write a review paper about three primary papers of our choice on a topic we chose. He specifically said that clinical case reports shouldn't be used. The topic I chose was "consciousness in the vegetative state" which is basically about trying to find a paradigm to test for consciouss in patients in the vegetative state. One of the papers had nothing to do with patients, and the study was performed on normal volunteers. In the second paper, the results of the first paper were partly used to test for consciousness in a patient in the vegetative state. In addition, new experiments were performed on the patient along with experiments on normal volunteers for comparison. In the third paper, several experiments were performed on a patient in a chronic vegetative state, and they involved fMRI and PET. They were like 4 experiments, each with a very different aim (testing for auditory cognition..etc).

I believe there was extensive "scientific research" in all of them. But he judged them to be "case reports" and as a result gave me a B+ on the course (it would've been an A otherwise). I'm really pissed because I think he's ridiculously on the wrong side, and because I submitted an abstract of the paper two months before the deadline of submission of the paper (he wanted it) and he told me nothing about being out of topic. The problem is that I'm planning to get in neuroscience. I have had straight A's all year, and then you have this B+ peeking out on the subject that I want to pursue. I think it might affect my application so I'm probably going to talk about this with the director of the bio department. Just wondering what you guys think about this.

 

[RxnMan]

Can somebody formalize the difference between scientific research and "case reports"?...

Case reports describe one specific patient encounter: the labs taken, the patient history provided, the patient presentation, the differential considered, and the outcome. Kinda like an educational anectdote. Clinical research may be considered under the umbrella of scientific research, but for a case report to be considered part of clinical research you'd really need to be talking about lots of cases, as in a case series.

And if your prof excluded them in the assignment, they're the boss.

...In the second paper, the results of the first paper were partly used to test for consciousness in a patient in the vegetative state...on the patient along with experiments on normal volunteers for comparison...In the third paper, several experiments were performed on a patient in a chronic vegetative state, and they involved fMRI and PET. They were like 4 experiments, each with a very different aim (testing for auditory cognition..etc)...

One patient = anectdote ~ case report. Without actually seeing the papers, I would bet that these two conform pretty well to the description I presented above.

So for looking at 2 out of 3 papers that don't fall within your prof's guidelines, you got a B+. Pretty good, I say.

 

[Jorje286]

One patient = anectdote ~ case report. Without actually seeing the papers, I would bet that these two conform pretty well to the description I presented above.

Even if it includes a novel experimental design and some heavy experimentation? The papers aren't simple descriptions of a case. They are pretty much "scientific experiments." If you're interested, I coupld send you the papers.

 

[strangeglove]

A case report describes a single patient with an unusual presentation of an illness, their diagnosis and treatment (including regularly used tests such as resting PET scans), along with a discussion of why the patient was interesting. Any experimental manipulation in a human (e.g. thalamic stimulation in minimally conscious patients) qualifies as an experiment as long is there is a control condition, even with an N of 1. No control condition=case report. How can someone expect you to write a review about consciousness without invoking a study of humans?

 

[RxnMan]

Even if it includes a novel experimental design and some heavy experimentation? The papers aren't simple descriptions of a case. They are pretty much "scientific experiments." If you're interested, I coupld send you the papers.

Case reports sometimes include novel applications (e.g. off-label viagra for neonate pulm HTN). And who says that the experimental design is novel? The authors? 🙄

And besides, I just plugged "consciousness in the vegetative state" into PubMed and got 321 hits. With that many papers, you didn't have to settle for 2 case reports - You could have found a couple of randomized trials.

 

[Jorje286]

Any experimental manipulation in a human (e.g. thalamic stimulation in minimally conscious patients) qualifies as an experiment as long is there is a control condition, even with an N of 1. No control condition=case report. How can someone expect you to write a review about consciousness without invoking a study of humans?

I agree. And the two studies I used that involve one patient had extensive experiments with control conditions. I admit one study was pretty short, but I complemented it with two other commentaries that contest the results, and a reply by the original authors that included a new experiment performed on the patient and on normal volunteers. By all means, there was extensive "science" in there.

And besides, I just plugged "consciousness in the vegetative state" into PubMed and got 321 hits. With that many papers, you didn't have to settle for 2 case reports - You could have found a couple of randomized trials.

I don't think there is any study on a large number of patients (large enough at least to be statistically significant). I think the point was to find a paradigm to test for consciousness and see if it could be of any use when using it on a patient in the vegetative state. My criteria simply was to find a study where there's a real extensive "science" in there with experimentation. I assumed case reports are simply descriptions of case without scientific experimentation (control experiments..etc).

 

[RxnMan]

...Any experimental manipulation in a human (e.g. thalamic stimulation in minimally conscious patients) qualifies as an experiment as long is there is a control condition, even with an N of 1. No control condition=case report...

I don't get your comment. How can you have a human control and a subject with a N = 1? You could run a PCR that had controls (+ and -, showing that your Taq worked, for example), but a human study with controls implies more than one person.

...How can someone expect you to write a review about consciousness without invoking a study of humans?...

As how the OP described his assignment, his prof only said he could not look at case studies. Again, the authors may have done a bunch of stuff to one patient ("experiments"), but they aren't doing a study (ie N > 10 or so at least). If you wanted to prove the observed effects in this one patient, you'd either need to prove it existed in human volunteers, or go to animals.

I understand that neuroscience as a field may be limited by a small number of subjects (progress in clinical research in general is limited by the fact that our subjects are humans). But that doesn't change a series of tests done on one person into a study. And the OP chose their topic. Neurobiology has more than just one research question...

...I don't think there is any study on a large number of patients (large enough at least to be statistically significant)...

Then you chose a poor subject. Yes, you may be interested in it, but a student should never choose to do a paper on a subject where they cannot find enough evidence to fulfill the basic requirements of the assignment.