case study versus case report

Quantitative study designs: Case Studies/ Case Report/ Case Series

Quantitative study designs.

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Case Study / Case Report / Case Series

Some famous examples of case studies are John Martin Marlow’s case study on Phineas Gage (the man who had a railway spike through his head) and Sigmund Freud’s case studies, Little Hans and The Rat Man. Case studies are widely used in psychology to provide insight into unusual conditions.

A case study, also known as a case report, is an in depth or intensive study of a single individual or specific group, while a case series is a grouping of similar case studies / case reports together.

A case study / case report can be used in the following instances:

where there is atypical or abnormal behaviour or development
an unexplained outcome to treatment
an emerging disease or condition

The stages of a Case Study / Case Report / Case Series

Which clinical questions does Case Study / Case Report / Case Series best answer?

Emerging conditions, adverse reactions to treatments, atypical / abnormal behaviour, new programs or methods of treatment – all of these can be answered with case studies /case reports / case series. They are generally descriptive studies based on qualitative data e.g. observations, interviews, questionnaires, diaries, personal notes or clinical notes.

What are the advantages and disadvantages to consider when using Case Studies/ Case Reports and Case Series ?

What are the pitfalls to look for.

One pitfall that has occurred in some case studies is where two common conditions/treatments have been linked together with no comprehensive data backing up the conclusion. A hypothetical example could be where high rates of the common cold were associated with suicide when the cohort also suffered from depression.

Critical appraisal tools

To assist with critically appraising Case studies / Case reports / Case series there are some tools / checklists you can use.

JBI Critical Appraisal Checklist for Case Series

JBI Critical Appraisal Checklist for Case Reports

Real World Examples

Some Psychology case study / case report / case series examples

Capp, G. (2015). Our community, our schools : A case study of program design for school-based mental health services. Children & Schools, 37(4), 241–248. A pilot program to improve school based mental health services was instigated in one elementary school and one middle / high school. The case study followed the program from development through to implementation, documenting each step of the process.

Cowdrey, F. A. & Walz, L. (2015). Exposure therapy for fear of spiders in an adult with learning disabilities: A case report. British Journal of Learning Disabilities, 43(1), 75–82. One person was studied who had completed a pre- intervention and post- intervention questionnaire. From the results of this data the exposure therapy intervention was found to be effective in reducing the phobia. This case report highlighted a therapy that could be used to assist people with learning disabilities who also suffered from phobias.

Li, H. X., He, L., Zhang, C. C., Eisinger, R., Pan, Y. X., Wang, T., . . . Li, D. Y. (2019). Deep brain stimulation in post‐traumatic dystonia: A case series study. CNS Neuroscience & Therapeutics. 1-8. Five patients were included in the case series, all with the same condition. They all received deep brain stimulation but not in the same area of the brain. Baseline and last follow up visit were assessed with the same rating scale.

References and Further Reading

Greenhalgh, T. (2014). How to read a paper: the basics of evidence-based medicine. (5th ed.). New York: Wiley.

Heale, R. & Twycross, A. (2018). What is a case study? Evidence Based Nursing, 21(1), 7-8.

Himmelfarb Health Sciences Library. (2019). Study design 101: case report. Retrieved from https://himmelfarb.gwu.edu/tutorials/studydesign101/casereports.cfm

Hoffmann T., Bennett S., Mar C. D. (2017). Evidence-based practice across the health professions. Chatswood, NSW: Elsevier.

Robinson, O. C., & McAdams, D. P. (2015). Four functional roles for case studies in emerging adulthood research. Emerging Adulthood, 3(6), 413-420.

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The Journal of the Medical Library Association

Distinguishing case study as a research method from case reports as a publication type

Kristine M. Alpi William R. Kenan, Jr. Library of Veterinary Medicine, North Carolina State University, Raleigh, NC http://orcid.org/0000-0002-4521-3523
John Jamal Evans North Carolina Community College System, Raleigh, NC

Author Biography

Kristine m. alpi, william r. kenan, jr. library of veterinary medicine, north carolina state university, raleigh, nc.

Akers KG, Amos K. Publishing case studies in health sciences librarianship [editorial]. J Med Libr Assoc. 2017 Apr;105(2):115–8. DOI: http://dx.doi.org/10.5195/jmla.2017.212 .

Creswell JW. Qualitative inquiry & research design: choosing among five approaches. Los Angeles, CA: SAGE; 2018.

Yin RK. Case study research: design and methods. 4th ed. Los Angeles, CA: SAGE; 2009.

Creswell JW. Research design: qualitative, quantitative and mixed methods approaches. 4th ed. Thousand Oaks, CA: SAGE; 2014.

Yin RK. Case study research and applications: design and methods. 6th ed. Thousand Oaks, CA: SAGE; 2018.

Stake RE. The art of case study research. Thousand Oaks, CA: SAGE Publications; 1995.

Merriam SB. Qualitative research and case study applications in education. San Francisco, CA: Jossey-Bass; 1998.

Yazan B. Three approaches to case study methods in education: Yin, Merriam, and Stake. Qual Rep. 2015;20(2):134–52.

Bartlett L, Vavrus F. Rethinking case study research: a comparative approach. New York, NY: Routledge; 2017.

Walsh RW. Exploring the case study method as a tool for teaching public administration in a cross-national context: pedagogy in theory and practice. European Group of Public Administration Conference, International Institute of Administrative Sciences; 2006.

National Library of Medicine. Case reports: MeSH descriptor data 2018 [Internet]. The Library [cited 1 Sep 2018]. < https://meshb.nlm.nih.gov/record/ui?ui=D002363 >.

National Library of Medicine. Organizational case studies: MeSH descriptor data 2018 [Internet]. The Library [cited 26 Oct 2018]. < https://meshb.nlm.nih.gov/record/ui?ui=D019982 >.

American Psychological Association. APA databases methodology field values [Internet]. The Association; 2016 [cited 1 Sep 2018]. < http://www.apa.org/pubs/databases/training/method-values.aspx >.

ERIC. Case studies [Internet]. ERIC [cited 1 Sep 2018]. < https://eric.ed.gov/?ti=Case+Studies >.

Janke R, Rush K. The academic librarian as co-investigator on an interprofessional primary research team: a case study. Health Inf Libr J. 2014;31(2):116–22.

Clairoux N, Desbiens S, Clar M, Dupont P, St. Jean M. Integrating information literacy in health sciences curricula: a case study from Québec. Health Inf Libr J. 2013;30(3):201–11.

Federer L. The librarian as research informationist: a case study. J Med Libr Assoc. 2013 Oct;101(4):298–302. DOI: http://dx.doi.org/10.3163/1536-5050.101.4.011 .

Medical Library Association. Journal of the Medical Library Association author guidelines: submission categories and format guidelines [Internet]. The Association [cited 1 Sep 2018]. < http://jmla.mlanet.org/ojs/jmla/about/submissions >.

Martin ER. Team effectiveness in academic medical libraries: a multiple case study. J Med Libr Assoc. 2006 Jul;94(3):271–8.

Hancock DR, Algozzine B. Doing case study research: a practical guide for beginning researchers. New York, NY: Teachers College Press; 2017.

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What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

Provide new or unexpected insights into the subject
Challenge or complicate existing assumptions and theories
Propose practical courses of action to resolve a problem
Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

Exemplify a theory by showing how it explains the case under investigation
Expand on a theory by uncovering new concepts and ideas that need to be incorporated
Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Normal distribution
Degrees of freedom
Null hypothesis
Discourse analysis
Control groups
Mixed methods research
Non-probability sampling
Quantitative research
Ecological validity

Research bias

Rosenthal effect
Implicit bias
Cognitive bias
Selection bias
Negativity bias
Status quo bias

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Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating, and understanding different aspects of a research problem .

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyse the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Prevent plagiarism, run a free check.

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

Provide new or unexpected insights into the subject
Challenge or complicate existing assumptions and theories
Propose practical courses of action to resolve a problem
Open up new directions for future research

Unlike quantitative or experimental research, a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible.

However, you can also choose a more common or representative case to exemplify a particular category, experience, or phenomenon.

Exemplify a theory by showing how it explains the case under investigation
Expand on a theory by uncovering new concepts and ideas that need to be incorporated
Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data .

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis, with separate sections or chapters for the methods , results , and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyse its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 25 March 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

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Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I. Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II. Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III. Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE: The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV. Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V. Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009; Kratochwill, Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education . Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 : General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 : One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 : The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 : The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 : It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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PH717 Module 1B - Descriptive Tools

Descriptive epidemiology & descriptive statistics.

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Case Reports and Case Series

Case reports, case series, test yourself.

Categories of Descriptive Epidemiology

A case report is a detailed description of disease occurrence in a single person. Unusual features of the case may suggest a new hypothesis about the causes or mechanisms of disease.

Example: Acquired Immunodeficiency in an Infant; Possible Transmission by Means of Blood Products

In April 1983 it had not yet been shown that AIDS could be transmitted by blood or blood products. An infant born with Rh incompatibility; required blood products from 18 donors over 8 weeks and subsequently developed unusual recurrent infections with opportunistic agents such as Candida. The infant's T cell count was low, suggesting AIDS. There was no family history of immunodeficiency, but one of the blood donors was found to have died of AIDS. This led the investigators to hypothesize that AIDS could be transmitted by blood transfusion.

Link to article by Ammann AJ et al: Acquired immunodeficiency in an infant: possible transmission by means of blood products. The Lancet 1:956-958, 1983.

A case series is a report on the characteristics of a group of subjects who all have a particular disease or condition. Common features among the group may suggest hypotheses about disease causation. Note that the "series" may be small (as in the example below) or it may be large (hundreds or thousands of "cases"). However, the chief limitation is that there is no comparison group. Consequently, common features may suggest hypotheses, but these need to be tested with some sort of analytical study before an association can be accepted as valid.

Example: Discovery of HIV in the United States

This was an extraordinarily important case series (a detailed description of characteristics of a series of people who all have the same disease) that suggested that this new syndrome was associated with sexual activity in male homosexuals. Alerting the medical establishment and proposing a hypothesis was an important milestone in the AIDS epidemic.

Link to article by Gottlieb MS, et al: Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med 1981;305:1425-1431.

There had been a number of case reports of liver cancers in young women taking oral contraceptives. A study was undertaken by contacting all of the cancer registries collaborating with the American College of Surgeons. The investigators wanted to collect information on as many of these rare liver tumors as possible across the US.

Table - Oral Contraceptive Use Among Women Who Developed Liver Cancer

What conclusions can you draw from these data regarding a possible increased risk of liver cancer in woman taking oral contraceptives? Think about it before you look at the answer.

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Epidemiology and Biostatistics pp 35–38 Cite as

Case Reports and Case Series

Bryan Kestenbaum MD, MS 2
First Online: 12 October 2018

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Case reports and case series represent the most basic types of observational study designs. These studies describe the experiences of a single person ( case report ) or a group of people ( case series ) who have a specific disease or condition. Case reports and case series typically describe previously unrecognized diseases or unusual variants of a known disease process. Consequently, data from these studies are particularly useful for alerting the health community to the presence of a new disease and for generating hypotheses regarding possible causes. For example, initial case reports of opportunistic infections among previously healthy homosexual men alerted the health community to the presence of the human immunodeficiency virus (HIV) epidemic. The initial case series describing patients with nephrogenic systemic fibrosis (NSF) raised awareness of this previously unknown condition and motivated subsequent studies that ultimately led to the discovery of gadolinium contrast as the causal agent (Chap. 1).

Nephrogenic Systemic Fibrosis
Observational Study Design
Human Immunodeficiency Virus (HIV)
Health Community
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Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med. 2007;356(5):479–85.

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Study Design 101: Case Report

Case Report
Case Control Study
Cohort Study
Randomized Controlled Trial
Practice Guideline
Systematic Review
Meta-Analysis
Helpful Formulas
Finding Specific Study Types
Case Reports

An article that describes and interprets an individual case, often written in the form of a detailed story. Case reports often describe:

Unique cases that cannot be explained by known diseases or syndromes
Cases that show an important variation of a disease or condition
Cases that show unexpected events that may yield new or useful information
Cases in which one patient has two or more unexpected diseases or disorders

Case reports are considered the lowest level of evidence, but they are also the first line of evidence, because they are where new issues and ideas emerge. This is why they form the base of our pyramid. A good case report will be clear about the importance of the observation being reported.

If multiple case reports show something similar, the next step might be a case-control study to determine if there is a relationship between the relevant variables.

Can help in the identification of new trends or diseases
Can help detect new drug side effects and potential uses (adverse or beneficial)
Educational - a way of sharing lessons learned
Identifies rare manifestations of a disease

Disadvantages

Cases may not be generalizable
Not based on systematic studies
Causes or associations may have other explanations
Can be seen as emphasizing the bizarre or focusing on misleading elements

Design pitfalls to look out for

The patient should be described in detail, allowing others to identify patients with similar characteristics.

Does the case report provide information about the patient's age, sex, ethnicity, race, employment status, social situation, medical history, diagnosis, prognosis, previous treatments, past and current diagnostic test results, medications, psychological tests, clinical and functional assessments, and current intervention?

Case reports should include carefully recorded, unbiased observations.

Does the case report include measurements and/or recorded observations of the case? Does it show a bias?

Case reports should explore and infer, not confirm, deduce, or prove. They cannot demonstrate causality or argue for the adoption of a new treatment approach.

Does the case report present a hypothesis that can be confirmed by another type of study?

Fictitious Example

A physician treated a young and otherwise healthy patient who came to her office reporting numbness all over her body. The physician could not determine any reason for this numbness and had never seen anything like it. After taking an extensive history the physician discovered that the patient had recently been to the beach for a vacation and had used a very new type of spray sunscreen. The patient had stored the sunscreen in her cooler at the beach because she liked the feel of the cool spray in the hot sun. The physician suspected that the spray sunscreen had undergone a chemical reaction from the coldness which caused the numbness. She also suspected that because this is a new type of sunscreen other physicians may soon be seeing patients with this numbness.

The physician wrote up a case report describing how the numbness presented, how and why she concluded it was the spray sunscreen, and how she treated the patient. Later, when other doctors began seeing patients with this numbness, they found this case report helpful as a starting point in treating their patients.

Real-life Examples

Hymes KB. Cheung T. Greene JB. Prose NS. Marcus A. Ballard H. William DC. Laubenstein LJ. (1981). Kaposi's sarcoma in homosexual men-a report of eight cases. Lancet. 2 (8247),598-600.

This case report was published by eight physicians in New York city who had unexpectedly seen eight male patients with Kaposi's sarcoma (KS). Prior to this, KS was very rare in the U.S. and occurred primarily in the lower extremities of older patients. These cases were decades younger, had generalized KS, and a much lower rate of survival. This was before the discovery of HIV or the use of the term AIDS and this case report was one of the first published items about AIDS patients.

Wu, E. B., & Sung, J. J. Y. (2003). Haemorrhagic-fever-like changes and normal chest radiograph in a doctor with SARS. Lancet, 361 (9368), 1520-1521.

This case report is written by the patient, a physician who contracted SARS, and his colleague who treated him, during the 2003 outbreak of SARS in Hong Kong. They describe how the disease progressed in Dr. Wu and based on Dr. Wu's case, advised that a chest CT showed hidden pneumonic changes and facilitate a rapid diagnosis.

Related Terms

Case Series

A report about a small group of similar cases.

Preplanned Case-Observation

A case in which symptoms are elicited to study disease mechanisms. (Ex. Having a patient sleep in a lab to do brain imaging for a sleep disorder).

Now test yourself!

1. Case studies are not considered evidence-based even though the authors have studied the case in great depth.

2. When are Case reports most useful?

When you encounter common cases and need more information When new symptoms or outcomes are unidentified When developing practice guidelines When the population being studied is very large

Evidence Pyramid - Navigation

Meta- Analysis
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Writing a case report...

Writing a case report in 10 steps

Related content
Peer review
Victoria Stokes , foundation year 2 doctor, trauma and orthopaedics, Basildon Hospital ,
Caroline Fertleman , paediatrics consultant, The Whittington Hospital NHS Trust
victoria.stokes1{at}nhs.net

Victoria Stokes and Caroline Fertleman explain how to turn an interesting case or unusual presentation into an educational report

It is common practice in medicine that when we come across an interesting case with an unusual presentation or a surprise twist, we must tell the rest of the medical world. This is how we continue our lifelong learning and aid faster diagnosis and treatment for patients.

It usually falls to the junior to write up the case, so here are a few simple tips to get you started.

First steps

Begin by sitting down with your medical team to discuss the interesting aspects of the case and the learning points to highlight. Ideally, a registrar or middle grade will mentor you and give you guidance. Another junior doctor or medical student may also be keen to be involved. Allocate jobs to split the workload, set a deadline and work timeframe, and discuss the order in which the authors will be listed. All listed authors should contribute substantially, with the person doing most of the work put first and the guarantor (usually the most senior team member) at the end.

Getting consent

Gain permission and written consent to write up the case from the patient or parents, if your patient is a child, and keep a copy because you will need it later for submission to journals.

Information gathering

Gather all the information from the medical notes and the hospital’s electronic systems, including copies of blood results and imaging, as medical notes often disappear when the patient is discharged and are notoriously difficult to find again. Remember to anonymise the data according to your local hospital policy.

Write up the case emphasising the interesting points of the presentation, investigations leading to diagnosis, and management of the disease/pathology. Get input on the case from all members of the team, highlighting their involvement. Also include the prognosis of the patient, if known, as the reader will want to know the outcome.

Coming up with a title

Discuss a title with your supervisor and other members of the team, as this provides the focus for your article. The title should be concise and interesting but should also enable people to find it in medical literature search engines. Also think about how you will present your case study—for example, a poster presentation or scientific paper—and consider potential journals or conferences, as you may need to write in a particular style or format.

Background research

Research the disease/pathology that is the focus of your article and write a background paragraph or two, highlighting the relevance of your case report in relation to this. If you are struggling, seek the opinion of a specialist who may know of relevant articles or texts. Another good resource is your hospital library, where staff are often more than happy to help with literature searches.

How your case is different

Move on to explore how the case presented differently to the admitting team. Alternatively, if your report is focused on management, explore the difficulties the team came across and alternative options for treatment.

Finish by explaining why your case report adds to the medical literature and highlight any learning points.

Writing an abstract

The abstract should be no longer than 100-200 words and should highlight all your key points concisely. This can be harder than writing the full article and needs special care as it will be used to judge whether your case is accepted for presentation or publication.

Discuss with your supervisor or team about options for presenting or publishing your case report. At the very least, you should present your article locally within a departmental or team meeting or at a hospital grand round. Well done!

Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare that we have no competing interests.

Case Report vs Case-Control Study: A Simple Explanation

A case report is the description of the clinical story of a single patient, whereas a case-control study compares 2 groups of participants differing in outcome in order to determine if a suspected exposure in their past caused that difference.

Here’s the evidence pyramid showing the level of evidence for different study designs:

Pyramid representing the levels of evidence for each study design

Estimating the size of populations at risk for malaria: a case study in cattle herders and agricultural workers in Northern Namibia

Francois Rerolle 1 ,
Jerry O. Jacobson 1 ,
Cara Smith Gueye 1 ,
Adam Bennett 1 ,
Sidney Carrillo 1 ,
Henry Ntuku 1 &
Jennifer L. Smith 1

Scientific Reports volume 14 , Article number: 7160 ( 2024 ) Cite this article

51 Accesses

Metrics details

Epidemiology

Cattle herders and agricultural workers have been identified has key high-risk populations for malaria in northern Namibia. Population size estimates for these groups are lacking but are important for planning, monitoring and evaluating the effectiveness of targeted strategies towards malaria elimination in the region. In this analysis, we extend population size estimation methods routinely used in HIV research, specifically social mapping and multiple source capture-recapture, to the context of malaria to estimate how many cattle herders and agricultural workers lived in two regions of northern Namibia over the course of the 2019–2020 malaria season. Both methods estimated two to three times more agricultural workers than cattle herders but size estimates based on the multiple source capture-recapture method were two to three times greater than the mapping-based, highlighting important methodological considerations to apply such methods to these highly mobile populations. In particular, we compared open versus closed populations assumptions for the capture-recapture method and assessed the impact of sensitivity analyses on the procedure to link records across multiple data sources on population size estimates. Our results are important for national control programs to target their resources and consider integrating routine population size estimation of high risk populations in their surveillance activities.

The evolution and future of research on Nature-based Solutions to address societal challenges

Thomas Dunlop, Danial Khojasteh, … Stefan Felder

Effects of climate change and human activities on vector-borne diseases

William M. de Souza & Scott C. Weaver

Ecological countermeasures to prevent pathogen spillover and subsequent pandemics

Raina K. Plowright, Aliyu N. Ahmed, … Annika T. H. Keeley

Introduction

After years of steady decline, progress towards eliminating malaria has stalled across southern Africa and worldwide. Seasonal outbreaks of malaria in Namibia’s northern regions 1 since 2016 have highlighted a need to identify coverage gaps and improve delivery of effective interventions 2 . Previous case–control studies and formative research conducted in two northern provinces, Ohangwena and Zambezi, identified specific occupations and behaviors that define malaria high-risk populations (HRP), as well as key intervention gaps 3 , 4 . Groups with high mobility and outdoor exposure to mosquitos, including seasonal agricultural workers (AW) and cattle herders (CH), are particularly challenging to access through routine surveillance and intervention strategies, which primarily target resident communities at their households. In low endemicity settings such as present-day northern Namibia, HRPs are thought to have a role in sustaining transmission and tailoring prevention and treatment efforts to address gaps in coverage is crucial in order to reach malaria elimination 5 . Yet, the population size of these groups is unknown and due to their high mobility, challenging to estimate through conventional methods.

An estimate of the population size of these groups is an essential input for planning, scaling, monitoring interventions and assess their coverage but also to understand and model patterns of transmission 6 . Population size estimates (PSE) can also mobilize resources and political will to support equitable malaria control programs 6 . When malaria risk is widespread in a community, size estimation can be as straightforward as conducting a household census, but when risk becomes more focused among individuals with specific occupations and behaviors or those who are harder-to-reach, more nuanced and targeted strategies are needed. This is particularly true in contexts where the activity leading to increased exposure may be informal, illicit or stigmatized.

Multiple studies 7 , 8 , 9 , 10 , 11 , 12 , 13 and guidelines 6 focusing on PSE for HRP in the context of HIV exist, but to our knowledge, there are no such equivalents for malaria. Yet, the most accepted PSE methods in use today in the HIV context originally hail from other disciplines and could be readily extended to other infectious diseases, such as malaria. For example, the capture-recapture method was developed in wildlife ecology to study population sizes of animals 14 , while the multiplier method and social mapping and enumeration have long been employed throughout the social sciences. When transmission is clustered among high-risk subpopulations and particularly hard-to-reach populations, researchers have recommended including PSE studies as a part of malaria surveillance systems 15 , following similar guidance for HIV surveillance 16 , 17 .

In this study, we illustrate adapting social mapping and multiple source capture-recapture to the context of malaria HRPs to estimate the population size of cattle herders and agricultural workers in Zambezi and Ohangwena Regions, in northern Namibia. Along the way, we highlight important methodological considerations to link ascertainments of individuals across multiple data sources and account for HRP’s mobility, and discuss challenges and opportunities for the routine use of these approaches.

Study context and overall estimation approach

The PSE was planned as part of a quasi-experimental randomized controlled trial (NCT04094727; September 19, 2019) to evaluate the impact of a tailored package of interventions on malaria and coverage outcomes in agricultural workers and cattle herders in northern Namibia. The study was conducted over the 2019–2020 malaria season (November–June) in 8 health facility catchment areas (HFCA) across Zambezi and Ohangwena Regions, in northern Namibia (Fig. 1 ) where the total population was respectively 23,022 and 9995. The main trial comprised six components: (1) baseline mapping of worksites; (2) baseline worker survey; (3) delivery of malaria interventions in randomized HFCAs; (4) reactive case detection (RACD) at worksites; (5) endline mapping of worksites; (6) endline worker survey. These components differed for the two target populations and regions, as described below. Data collection to support size estimation was incorporated into each component from initial study conception. The mapping-based PSE drew on the baseline and endline mapping data; the multiple source capture-recapture PSE drew on the survey and intervention data. Table 1 lists the criteria to define high-risk agricultural workers and cattle herders in each survey.

Study area and study timeline. Top: study timeline with intervention and RACD conducted between baseline and endline mapping and workers surveys. Bottom: study area in where 8 HFCAs randomly allocated to an intervention or control arm. ESRI imagery from the leaflet R packages was used for the basemap.

Data sources

Baseline and endline mapping of worksites.

Mapping of worksites was conducted to generate a sampling frame for surveys and sites to target the intervention. Specifically, meetings were held with community health workers and community leaders in each region to develop a list of all farms and/or cattle posts that were thought to meet risk criteria. In Ohangwena, a veterinary services database was consulted to identify potential work sites; local leaders drew on this list and their knowledge of permits they had issued to cattle owners to authorize taking their cattle to and from Angola in order to limit the list to cattle posts where workers may engage in cross-border travel. Then, field teams conducted an interviewer-administered questionnaire with the owner or a manager at all worksites thus identified, with data collection by tablet. Data obtained included the number of workers expected to meet the high-risk population criteria defined in Table 1 , over the course of the malaria season (i.e., November–May).

Baseline and endline workers surveys

The baseline and endline worker surveys were conducted among workers at a random sample of the worksites identified by the mapping. The surveys were interviewer-administered with data collection by tablet. The baseline and endline surveys were conducted at the beginning (November–January) and end (May–June) of the malaria season, respectively. Eligibility criteria were similar to those used in the mapping, however with a narrower time period of reference for the risk activity (see Table 1 ).

Intervention

The interventions were rolled out in four randomly sampled HFCAs between baseline and endline, during February and March. They included provision of presumptive treatment with artemether-lumefantrine to workers at worksites, indoor residual spraying (IRS) of worksite structures, and provision of a vector control pack to workers in Zambezi who did not sleep in a sprayed structure. Interventions were delivered in coordination with employers, at visits conducted independently of baseline, endline, and RACD surveys. Intervention participants were screened for eligibility (See Table 1 ). A second planned intervention round was interrupted by the SARS-CoV-2 pandemic in April 2020 and discontinued when Namibia entered lockdown.

The study team visited worksites to screen and interview co-workers of malaria cases reported by health facilities. See Table 1 for eligibility criteria. RACD was conducted in both intervention and control areas from February 2020 to March 2020, when it was discontinued due to the SARS-CoV-2 pandemic.

PSE method 1: social mapping

The mapping-based size estimates were calculated in three steps based on worker counts obtained from worksites owners. First, the retrospective count reported by owners at endline were summed across worksites, based on the question item, “How many total workers [meeting the respective risk criteria] did you have from November 2019 to May 2020?”.

Second, to account for workers at worksites no longer operational by the endline mapping, we calculated a total prospective count reported during baseline interviews at these sites, based on a question item on the number of workers expected to meet the risk criteria between November 2019 and June 2020, which was otherwise identical to the endline item. Then, this sum was corrected for potential projection error by accounting for how the prospective and retrospective worker counts differed at sites that were included in both the baseline and endline. Specifically, the sum was multiplied by the ratio of the endline total divided by the baseline total. Next, this corrected count was added to the sum across endline sites calculated in the first step.

Finally, the result of the above was corrected for potential double-counting of workers who had worked at multiple sites in the respective region during the period by dividing by a mobility factor, which was calculated as the mean number of worksites per worker, based on responses to the endline survey question item, “How many employers/worksites in the [study region] have you worked for between November 2019 and today?”. The mobility adjustment factors and their associated 95% confidence intervals (CI) were estimated for each region and, in Zambezi, separately for agricultural workers and cattle herders. Dividing each summed count by the respective mobility point estimate and its 95% CI limits produced the corresponding PSE point estimate and its 95% CI.

PSE method 2: multiple-source capture-recapture

The multiple source capture-recapture method draws on three or more statistically independent samples of the target population—all of which may be non-probability samples—and applies log-linear regression to estimate the population size based on patterns of overlap of individuals across these data sources or “captures” 18 , 19 . Here, four surveys—conducted at baseline, endline, during the intervention, and during RACD, respectively—served as the captures in each region.

Data management and record linkage

Birth place, birth order and three names variables (traditional, Christian and surname) were used to identify individuals across data sources. See appendix for details.

Records were linked using a flexible algorithm with a hierarchy of three different possible matching types:

Perfect match: same 3 names in any order, same birth place and same birth order

Excellent match: same 3 names in any order and same birth place or same birth order

Good match: two of the same names in any order, same birth place and same birth order

Record linkage was first carried out within surveys for de-duplication and then across datasets to create capture histories for all records. When necessary, better matches were favored (e.g., perfect over excellent matches).

Sensitivity analysis to optimize record linkage parameters

We conducted sensitivity analysis to identify the optimal parameter settings for the clustering algorithms that were used to standardize the names and birth places reported by survey participants, as a preliminary step before record linkage. The two clustering algorithms in OpenRefine 20 software were the n-gram fingerprint method (requiring a parameter n ) and the Levenshtein nearest-neighbor method (requiring a radius of 1, 2, 3, or 4 and a block character setting of 3 or 4). These parameters determine the flexibility of the clustering; stricter settings may fail to identify similar spellings of names that in fact represent the same individual whereas overly flexible ones may erroneously cluster together the names of different respondents.

We selected the optimal values of the three parameters by repeating the clustering and record linkage procedure under all 24 possible combinations of the settings. Then, we manually reviewed a random sample of 100 records for which linkage results differed across the 24 parameter scenarios and classified the performance under each setting as correct or incorrect. Based on these samples, we calculated sensitivity and specificity and plotted a ROC curve to identify the parameter settings that produced the most accurate record linkage.

Statistical analysis

We developed capture histories (i.e., counts of individuals exhibiting each possible pattern of presence or absence across the four surveys) from the linked data. The capture histories were then analyzed by log-linear regression models 18 using the RCapture 19 package in R statistical software 21 to produce the population size estimates. Models were developed under both closed- (i.e., no in- or out-migration) and open-population assumptions. The former allowed for heterogeneity in capture probabilities across surveys and across individuals.

Since the surveys and resulting model results reflect the intervention areas in each region, we applied an upweighting factor to extend the size estimates to control areas (where intervention surveys were not conducted) in the study area. Upweighting factors were calculated as the inverse of the proportion of baseline workers surveyed in intervention areas. Importantly, the baseline survey is assumed to be a representative sample of workers in the study areas and the relative proportion of workers in intervention versus control areas is assumed to be constant over the entire season.

This study was approved by Namibia’s Ministry of Health and Social Services (Approval #17/3/3HN), by the University of Namibia Research Ethics Committee (Approval #MRC/510/2019) and by the UCSF ethical review board (Approval #19-28530). The informed consent process was consistent with local norms, and all study areas had consultation meeting with, and approvals from, village elders. All participants provided informed written consent; caregivers provided consent for all children under 18. The study was conducted according to the ethical principles of the Declaration of Helsinki of October 2002.

Social mapping PSE

In the Zambezi and Ohangwena regions respectively, 426 and 296 worksites were surveyed during both the baseline and endline mapping, with 1912 and 874 HRP workers projected to be employed over the season at baseline and 2353 and 731 HRPs reported to be employed over the season at endline. Therefore, projection factors applied to the prospective counts were 1.23 in Zambezi, where the sum total across sites at endline was greater than the total at baseline, and 0.84 in Ohangwena, where the situation was reversed.

Self reported levels of mobility of workers among worksites were modest. The mean number of worksites per worker from the endline survey was 1.07 [1.05; 1.08] for agricultural workers in Zambezi, 1.08 [1.05; 1.11] for cattle herders in Zambezi and 1.04 [1.02; 1.07] for cattle herders in Ohangwena. In Zambezi, 92.9% (N = 1121) of the 1207 endline survey participants reported working at one site and 7.1% (N = 86) had worked at two sites. In Ohangwena, 71.6% (N = 346) of 483 endline survey participants worked at one site, nine at two sites, and three at three sites, while 25.9% (N = 125) did not respond to the question item.

Table 2 shows the results from the mapping PSE. The calculation began with the number of workers reported in the endline mapping. Then, the number of workers projected in the baseline mapping worksites absent from the endline mapping, corrected by the projection factor, is added. Finally, the total is adjusted for mobility factors, yielding 724 [705; 745] cattle herders and 1914 [1896; 1950] agricultural workers in Zambezi and 725 [705; 739] cattle herders in Ohangwena.

Multiple source capture-recapture PSE

Record linkage.

Overall, response rates for the variables collected for purposes of record linkage (Table S1 ) were 90% or greater in the combined data across surveys and regions. Response rates were lower for Christian name in the Zambezi surveys (78–91%) and birth place and birth order in the RACD survey in Ohangwena (58%).

Varying standardization parameters in OpenRefine 20 led to 24 scenarios that linked differently 651 (13%) of the total 5067 respondents across records. Among the review sample of 100 (15%), sensitivity and specificity varied quite a bit across scenarios (Fig. 2 ), ranging from 29 to 91% and 21 to 96% respectively. Two scenarios closest to the top left corner of the figure stand out. The first one (n-gram = 2, chars = 3, radius = 2, top left orange point) reached very good sensitivity (81%) while maintaining excellent specificity (96%) and was adopted in our subsequent PSE analyses. The second one (n-gram = 2, chars = 3, radius = 3, top centered pink point) had better sensitivity (91%) but at the expense of specificity (63%).

ROC curve. Assessment of how sensitivity and specificity change across the different standardization scenarios, with varying clustering parameters in OpenRefine: n in the n-gram fingerprint method; radius and block chars in the Levenshtein nearest-neighbor method. Scenarios with n-gram = 3 produced almost indistinguishable results as n-gram = 2 and were therefore discarded from the plot.

We also confirmed the extent to which combinations of the identifying variables for the adopted standardization parameters scenario uniquely identified records in the baseline and endline surveys, since to be eligible an individual should not have participated previously. Indeed, in our adopted record linkage algorithm, there were only 2 (0.2%) duplicated records in Zambezi’s baseline survey, none in Ohangwena’s baseline survey and 1 duplicated record in both Ohangwena and Zambezi’s endline surveys, representing 0.2% and 0.08% of records in the respective data source.

In the baseline survey in Ohangwena, 240 cattle herders were interviewed in the intervention areas and 194 in the control areas, yielding an upweighting factor of 1.8 (= [240 + 194]/240). In Zambezi, the upweighting factor was 2.2 (= [769 + 923]/769) for agricultural workers and 1.8 (= [505 + 404]/505) for cattle herders.

In the baseline, intervention, RACD and endline surveys in the intervention areas across both regions, a total of 800, 1300, 83, and 823 HRPs were ascertained, respectively, with 1921 unique HRPs based on record linkage. The Venn diagram in Fig. 3 illustrates the capture histories identified. See Figures S1 , S2 and S3 in the appendix for similar Venn diagram stratified by region and high-risk groups.

Venn diagram. Illustration of overlap of individuals across the four captures: for instance, 318 HRPs were captured both in the baseline and intervention surveys but not in RACD or endline surveys.

Table 3 shows the results of the capture-recapture log-linear regression models, under closed- and open-population assumptions. Under the closed-population assumption, the best fitting model incorporated temporal and individual heterogeneity, allowing capture probabilities to vary both across surveys and workers (Mth models). Based on the AIC, the closed population model performed considerably better than open population models. In addition, the PSEs resulting from the open population models appear unsatisfactory as they are characterized either by an uninformative 95% CI (Ohangwena) or a point estimate only slightly above the total number of workers ascertained in surveys (upweighted to the study area). On the other hand, the open population model has the advantage of providing estimates of the baseline-intervention turnover rate, defined here as the probability a given worker leaves the area between baseline survey (November–January) and intervention (February–March). These turnover estimates were similar across population groups (13–20%) although non-significantly larger for cattle herders than agricultural workers in Zambezi.

Sensitivity analysis of record linkage parameters

We ran the same closed population models on capture histories data resulting from the record linkage under four scenarios that vary parameterization of the clustering algorithm used to standardize names in the unique identifier: the strictest (n-gram = 1, radius = 1, block chars = 4), the most flexible (n-gram = 2, radius = 4, block chars = 3), the best (n-gram = 2, radius = 2, block chars = 3), and the second-best scenario (n-gram = 2, radius = 3, block chars = 3). These correspond respectively to the bottom left blue triangle, the top right pink circle, the top left orange circle, and the top center pink circle on Fig. 2 . Figure 4 shows the ratio of the PSE obtained under each scenario relative to the strictest one (as the reference). The Delta method 22 was used to compute 95% CI.

Impacts of standardization scenarios on PSEs. Assessment of how PSEs are impacted by standardization scenarios, with varying clustering parameters in OpenRefine: n in the n-gram fingerprint method; radius and block chars in the Levenshtein nearest-neighbor method. The dashed vertical black line represents the null where the PSE equals the PSE from the strictest scenario.

Greater flexibility in the record linkage algorithm yielded more matches across surveys, hence resulting in a smaller PSE (ie PSE ratio less than one). In Zambezi, none of the ratios are statistically different from one, meaning the standardization parameters scenarios would have resulted in non-significantly different PSEs. In Zambezi, the biggest difference occurred for agricultural workers with a PSE 0.88 [0.63; 1.12] times smaller in the most flexible scenario compared to the strictest one, representing an absolute difference of (2106–1848 =) 258 workers. In Ohangwena on the other hand, the most flexible and second-best scenarios yielded PSEs statistically significantly lower than the strictest ones with PSE ratios of 0.70 [0.46; 0.94] and 0.72 [0.47; 0.97] respectively. In Ohangwena, the best scenario resulted in a PSE 0.80 [0.51; 1.08] times smaller than the strictest scenario, but this was not statistically significant.

In this study, we leveraged two PSE methods to estimate the total population size, in our study area and over the 2019–2020 malaria season (November–June), of two occupational groups that met risk criteria derived from previous research in northern Namibia: cattle herders and agricultural workers. Size estimates based on the multiple source capture-recapture method (Table 3 ) were two to three times greater than the mapping-based estimates (Table 2 ). Similar differences are common in HIV size estimation studies, where mapping-based estimates are generally viewed as a lower bound 6 , highlighting the need to triangulate PSE results over several methods. Here, work site owners may have intentionally or unintentionally omitted employees whereas the capture-recapture method may have produced a more complete count by drawing on intervention and RACD data in addition to worksite surveys. Both methods estimated two to three times more agricultural workers than cattle herders in Zambezi suggesting that the former group may be more critical to malaria elimination; however, this also depends on the relative infection prevalence, which we did not assess here.

Our results point towards several methodological considerations of assumptions used in closed and open population models used in capture-recapture methods. While model fit and face validity of size estimates resulting from our closed population models appeared superior to those from our open population models, there is no gold standard ‘truth’ to empirically determine which is best. The epidemiological literature tends to focus on closed-population models 23 because of short study time periods over which populations can assumed to be constant. Most prior literature on size estimates in high-risk populations derives from studies in the HIV context 6 , 7 , 8 , 9 , 10 , 11 , 12 where surveys and other data captures are planned to span a brief time frame of about 3–5 months, precisely to limit the risk of change in the population over the course of the study. When aiming to ascertain the total risk population over the course of a several-month malaria season, such a strategy becomes infeasible for highly mobile populations and determining whether the population is truly open or closed over the period is a challenge 24 . The open-population models naturally accommodate the phenomenon of individuals entering and exiting the risk group over time, but even the so-called “closed” model can do so by introducing interaction terms that model temporal variation in the ascertainment probabilities of survey instruments, as was done here. When one has the data available (i.e., at least three data sources) to apply the log-linear 18 , 25 , 26 regression model approach, comparing model fit under each scenario provides a way to assess the open versus closed assumptions.

A second methodological strength of this study that is new to PSE analyses was to vary record linkage scenarios, evaluate them and assess their impact on population size estimates. Capture-recapture methodology relies on the assumption that individuals can be tracked over different capture occasions. When it is not possible to collect a unique identifier, an object such as a study card 27 can be given or, more commonly, a combination of identifying variables (names, gender, places of birth, places of residence, etc.…) are used to uniquely identify individuals across capture occasions. Yet, the selection of these variables, their standardization and the matching algorithms used can vary a lot and subjective decisions are often made on based on face validity. Here, identifying variables (names, birth place and birth order) as well as the matching algorithm (perfect, excellent and good matches) were selected subjectively but we varied standardization parameters to cover 24 different record-linkage scenarios. Comparing them highlighted quite some variability in terms of sensibility and specificity although, and importantly, any of these scenarios would have met face validity. This sensitivity analysis enabled us to choose an appropriate standardization scenario and assess how picking a scenario affects the population size estimates. Figure 4 showed that these scenarios would have not resulted in statistically significantly different estimates in Zambezi but would have led to different results in Ohangwena. These findings highlight the need for thorough assessment and transparent reporting of the quality of any record linkage algorithm used for population size estimates.

A first limitation of our analysis is that eligibility criteria across survey sources (Table 1 ) are not identical and may have ascertained different segments of the high-risk populations. In particular, eligibility criteria in the baseline and endline surveys pertain to narrow windows of time around the date of interview. Yet, these surveys were conducted over multiple weeks which means that, even within one survey, the criteria captured individuals from slightly different populations. Second, unique identifiers were based on self-reported variables which could lead to mismatches, further exacerbated by possible variations in how questions were elicited by different interviewers or answered by participants. To mitigate these limitations, we looked for and picked the best record linkage scenarios for our context, but sensitivity (81%) and specificity (96%) were not perfect. Because some matches were potentially missed, our estimates, if anything, could be viewed as upper boundaries of population sizes. Finally, the mapping exercise revealed some fluctuation in the number of worksites open between baseline and endline. In particular, the coronavirus crisis erupted in March 2020 and may have affected the overall population size for that particular year, limiting the transportability of our results to other more “normal” malaria seasons.

In conclusion, this study estimated the population size of high-risk populations for malaria in two regions of Northern Namibia. The significance of our work is threefold. First, the numerical population size estimates of key high-risk populations for malaria transmission in northern Namibia are important for national programs to target their resources and plan the delivery of their control interventions accordingly. Second, our study showcases how population size estimation methods can be leveraged in malaria research and discusses major methodological considerations for applying capture-recapture PSE to malaria’s high-risk populations. Last, our analysis used data routinely collected by national malaria control programs and proofreads the feasibility of integrating regular population size estimations into their surveillance activities.

Data availability

The datasets used in the multiplier method are available and published along the submission as supplementary materials. The datasets for the capture recapture method are not publicly available and cannot be de-identified since the record linkage algorithm relies on identifying variables (names, age, birth place). We still publish along the submission the datasets post-record-linkage (24 different scenarios form sensitivity analyses) and our for maximum transparency.

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Francois Rerolle, Jerry O. Jacobson, Cara Smith Gueye, Adam Bennett, Sidney Carrillo, Henry Ntuku & Jennifer L. Smith

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F.R. and J.O.J. conducted the analyses. F.R., J.O.J. and J.L.S. designed the analysis and wrote the manuscript. C.S.G., A.B., S.C., H.N. and J.L.S. designed and conducted the parent trial. F.R. and J.O.J. conducted the analyses. All authors reviewed the manuscript.

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Rerolle, F., Jacobson, J.O., Smith Gueye, C. et al. Estimating the size of populations at risk for malaria: a case study in cattle herders and agricultural workers in Northern Namibia. Sci Rep 14 , 7160 (2024). https://doi.org/10.1038/s41598-024-56810-y

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Next-gen B2B sales: How three game changers grabbed the opportunity

Driven by digitalized operating models, B2B sales have seen sweeping changes over the recent period amid rising customer demand for more seamless and transparent services. 1 “ The multiplier effect: How B2B winners grow ,” McKinsey, April 13, 2023. However, many industrial companies are failing to keep pace with their more commercially focused peers and, as a result, are becoming less competitive in terms of performance and customer services.

The most successful B2B players employ five key tactics to sharpen their sales capabilities: omnichannel sales teams; advanced sales technology and automation; data analytics and hyperpersonalization; tailored strategies on third-party marketplaces; and e-commerce excellence across the full marketing and sales funnel. 2 “ The multiplier effect: How B2B winners grow ,” McKinsey, April 13, 2023.

Companies using all of these tactics are twice as likely to see more than 10 percent market share growth than companies focusing on just one. 3 “ The multiplier effect: How B2B winners grow ,” McKinsey, April 13, 2023. However, implementation is not as simple, requiring a strategic vision, a full commitment, and the right capabilities to drive change throughout the organization. Various leading European industrial companies—part of McKinsey’s Industrial Gamechangers on Go-to-Market disruption in Europe—have achieved success by implementing the first three of these five sales tactics.

Omnichannel sales teams

The clearest rationale for accelerating the transition to omnichannel go-to-market is that industry players demand it. In 2017, only about 20 percent of industrial companies said they preferred digital interactions and purchases. 4 Global B2B Pulse Survey, McKinsey, April 30, 2023. Currently, that proportion is around 67 percent. In 2016, B2B companies had an average of five distinct channels; by 2021, that figure had risen to ten (Exhibit 1).

Excelling in omnichannel means enabling customers to move easily between channels without losing context or needing to repeat information. Companies that achieve these service levels report increased customer satisfaction and loyalty, faster growth rates, lower costs, and easier tracking and analysis of customer data. Across most of these metrics, the contrast with analogue approaches is striking. For example, B2B companies that successfully embed omnichannel show EBIT growth of 13.5 percent, compared to the 1.8 percent achieved by less digitally enabled peers. Next to purely digital channels, inside sales and hybrid sales are the most important channels to deliver an omnichannel experience.

Differentiating inside versus hybrid sales

Best-in-class B2B sellers have achieved up to 20 percent revenue gains by redefining go-to-market through inside and hybrid sales. The inside sales model cannot be defined as customer service, nor is it a call center or a sales support role—rather, it is a customer facing, quota bearing, remote sales function. It relies on qualified account managers and leverages data analytics and digital solutions to optimize sales strategy and outreach through a range of channels (Exhibit 2).

The adoption of inside sales is often an advantageous move, especially in terms of productivity. In fact, inside sales reps can typically cover four times the prospects at 50 percent of the cost of a traditional field rep, allowing the team to serve many customers without sacrificing quality of service. 5 McKinsey analysis. Top performing B2B companies are 50 percent more likely to leverage inside sales.

Up to 80 percent of a company’s accounts—often smaller and medium-sized customers, accounting for about half of revenues—can be covered by inside sales teams. 6 Industry expert interviews; McKinsey analysis. The remaining 20 percent often require in-person interactions, triggering the need for hybrid sales. This pertains to highly attractive leads as well.

Hybrid sales is an innovative model combining inside sales with traditional in-person interactions. Some 85 percent of companies expect hybrid sales will be the most common job role within three years. 7 Global B2B Pulse Survey, McKinsey, December 2022. Hybrid is often optimal for bigger accounts, as it is flexible in utilizing a combination of channels, serving customers where they prefer to buy. It is scalable, thanks to the use of remote and online sales, and it is effective because of the multiplier effect of numerous potential interactions. Of companies that grew more than 10 percent in 2022, 57 percent had adopted a hybrid sales model. 8 Global B2B Pulse, April 2023.

How an industrial automation solution player implemented game-changing inside sales

In 2019, amid soaring digital demand, a global leader in industrial digital and automation solutions saw an opportunity to deliver a cutting-edge approach to sales engagement.

As a starting point, the company took time to clearly define the focus and role of the inside sales team, based on product range, customer needs, and touchpoints. For simple products, where limited customer interaction was required, inside sales was the preferred go-to-market model. For more complex products that still did not require many physical touchpoints, the company paired inside sales teams with technical sales people, and the inside sales group supported fields reps. Where product complexity was high and customers preferred many touch points, the inside sales team adopted an orchestration role, bringing technical functions and field sales together (Exhibit 3).

The company laid the foundations in four key areas. First, it took time to sketch out the model, as well as to set targets and ensure the team was on board. As in any change program, there was some early resistance. The antidote was to hire external talent to help shape the program and highlight the benefits. To foster buy-in, the company also spent time creating visualizations. Once the team was up and running, early signs of success created a snowball effect, fostering enthusiasm among both inside sales teams and field reps.

Second, the company adopted a mantra: inside sales should not—and could not—be cost saving from day one. Instead, a significant part of the budget was allocated to build a tech stack and implement the tools to manage client relationships. One of the company’s leaders said, “As inside sales is all about using tech to obtain better outcomes, this was a vital step.”

The third foundational element was talent. The company realized that inside sales is not easy and is not for everyone—so finding the right people was imperative. As a result, it put in place a career development plan and recognized that many inside sales reps would see the job as a stepping stone in their careers. Demonstrating this understanding provided a great source of motivation for employees.

Finally, finding the right mix of incentives was key. The company chose a system based on compensation and KPI leading and lagging indicators. Individual incentives were a function of whether individuals were more involved with closing deals or supporting others, so a mix of KPIs was employed. The result was a more motivated salesforce and productive cooperation across the organization.

Advanced sales technology and automation

Automation is a key area of advanced sales technology, as it is critical to optimizing non-value adding activities that currently account for about two-thirds of sales teams’ time. More than 30 percent of sales tasks and processes are estimated to be partially automatable, from sales planning through lead management, quotation, order management, and post-sales activities. Indeed, automation leaders not only boost revenues and reduce cost to serve—both by as much as 20 percent—but also foster customer and employee satisfaction. (Exhibit 4). Not surprisingly, nine out of ten industrial companies have embarked on go-to-market automation journeys. Still, only a third say the effort has achieved the anticipated impact. 9 McKinsey analysis.

Leading companies have shown that effective automation focuses on four areas:

Lead management: Advanced analytics helps teams prioritize leads, while AI-powered chatbots contact prospective customers via text or email and schedule follow-up calls at promising times—for example, at the beginning or end of the working day.
Contract drafting: AI tools automate responses to request for proposal (RFP) inquiries, based on a predefined content set.
Invoice generation: Companies use robotic process automation to process and generate invoices, as well as update databases.
Sales commission planning: Machine learning algorithms provide structural support, for example, to optimize sales commission forecasting, leading up to a 50 percent decline in time spent on compensation planning.

How GEA seized the automation opportunity

GEA is one of the world’s most advanced suppliers of processing machinery for food, beverages, and pharmaceuticals. To provide customers with tailored quotes and services, the company launched a dedicated configure, price, quote (CPQ) system. The aim of the system was to enable automated quote creation that would free up frontline sales teams to operate independently from their back office colleagues. This, in turn, would boost customer interaction and take customer care to the next level.

The work began with a bottom-up review of the company’s configuration protocols, ensuring there was sufficient standardization for the new system to operate effectively. GEA also needed to ensure price consistency—especially important during the recent supply chain volatility. For quotations, the right template with the correct conditions and legal terms needed to be created, a change that eventually allowed the company to cut its quotation times by about 50 percent, as well as boost cross-selling activities.

The company combined the tools with a guided selling approach, in which sales teams focused on the customers’ goals. The teams then leveraged the tools to find the most appropriate product and pricing, leading to a quote that could be enhanced with add-ons, such as service agreements or digital offerings. Once the quote was sent and agreed upon, the data automatically would be transferred from customer relationship management to enterprise resource planning to create the order. In this way, duplication was completely eliminated. The company found that the sales teams welcomed the new approach, as it reduced the time to quote (Exhibit 5).

Data analytics and hyperpersonalization

Data are vital enablers of any go-to-market transformation, informing KPIs and decision making across operations and the customer journey. Key application areas include:

lead acquisition, including identification and prioritization
share of wallet development, including upselling and cross-selling, assortment optimization, and microsegmentation
pricing optimization, including market driven and tailored pricing, deal scoring, and contract optimization
churn prediction and prevention
sales effectiveness, so that sales rep time allocations (both in-person and virtual) are optimized, while training time is reduced

How Hilti uses machine data to drive sales

Hilti is a globally leading provider of power tools, services, and software to the construction industry. The company wanted to understand its customers better and forge closer relationships with them. Its Nuron battery platform, which harvests usage data from tools to transform the customer experience and create customer-specific insights, provided the solution.

One in three of Hilti’s frontline staff is in daily contact with the company’s customers, offering advice and support to ensure the best and most efficient use of equipment. The company broke new ground with its intelligent battery charging platform. As tool batteries are recharged, they transfer data to the platform and then to the Hilti cloud, where the data are analyzed to produce actionable insights on usage, pricing, add-ons, consumables, and maintenance. The system will be able to analyze at least 58 million data points every day.

Armed with this type of data, Hilti provides customers with advanced services, offering unique insights so that companies can optimize their tool parks, ensuring that the best tools are available and redundant tools are returned. In the meantime, sales teams use the same information to create deep insights—for example, suggesting that companies rent rather than buy tools, change the composition of tool parks, or upgrade.

To achieve its analytics-based approach, Hilti went on a multiyear journey, moving from unstructured analysis to a fully digitized approach. Still, one of the biggest learnings from its experience was that analytics tools are most effective when backed by human interactions on job sites. The last mile, comprising customer behavior, cannot be second guessed (Exhibit 6).

In the background, the company worked hard to put the right foundations in place. That meant cleaning its data (for example, at the start there were 370 different ways of measuring “run time”) and ensuring that measures were standardized. It developed the ability to understand which use cases were most important to customers, realizing that it was better to focus on a few impactful ones and thus create a convincing offering that was simple to use and effective.

A key element of the rollout was to ensure that employees received sufficient training— which often meant weeks of engagement, rather than just a few hours. The work paid off, with account managers now routinely supported by insights that enrich their interactions with customers. Again, optimization was key, ensuring the information they had at their fingertips was truly useful.

Levers for a successful transformation

The three company examples highlighted here illustrate how embracing omnichannel, sales technology, and data analytics create market leading B2B sales operations. However, the success of any initiative will be contingent on managing change. Our experience in working with leading industrial companies shows that the most successful digital sales and analytics transformations are built on three elements:

Strategy: As a first step, companies develop strategies starting from deep customer insights. With these, they can better understand their customers’ problems and identify what customers truly value. Advanced analytics can support the process, informing insights around factors such as propensity to buy and churn. These can enrich the company’s understanding of how it wants its go-to-market model to evolve.
Tailored solutions: Customers appreciate offerings tailored to their needs. 10 “ The multiplier effect: How B2B winners grow ,” McKinsey, April 13, 2023. This starts with offerings and services, extends to pricing structures and schemes, and ways of serving and servicing. For example, dynamic pricing engines that model willingness to pay (by segment, type of deal, and route to market) may better meet the exact customer demand, while serving a customer completely remotely might better suit their interaction needs, and not contacting them too frequently might prevent churn more than frequent outreaches. Analytics on data gained across all channels serves to uncover these needs and become hyperpersonalized.
Single source of truth: Best-in-class data and analytics capabilities leverage a variety of internal and external data types and sources (transaction data, customer data, product data, and external data) and technical approaches. To ensure a consistent output, companies can establish a central data repository as a “single source of truth.” This can facilitate easy access to multiple users and systems, thereby boosting efficiency and collaboration. A central repository also supports easier backup, as well as data management and maintenance. The chances of data errors are reduced and security is tightened.

Many companies think they need perfect data to get started. However, to make productive progress, a use case based approach is needed. That means selecting the most promising use cases and then scaling data across those cases through speedy testing.

And with talent, leading companies start with small but highly skilled analytics teams, rather than amassing talent too early—this can allow them to create an agile culture of continual improvement and cost efficiency.

As shown by the three companies discussed in this article, most successful B2B players employ various strategies to sharpen their sales capabilities, including omnichannel sales teams; advanced sales technology and automation; and data analytics and hyperpersonalization. A strategic vision, a full commitment, and the right capabilities can help B2B companies deploy these strategies successfully.

Paolo Cencioni is a consultant in McKinsey’s Brussels office, where Jacopo Gibertini is also a consultant; David Sprengel is a partner in the Munich office; and Martina Yanni is an associate partner in the Frankfurt office.

The authors wish to thank Christopher Beisecker, Kate Piwonski, Alexander Schult, Lucas Willcke, and the B2B Pulse team for their contributions to this article.

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Comedian Jon Stewart ranted this week that Donald Trump’s civil real-estate case overvaluing his properties was “not victimless,” yet when it came to his own home, Stewart benefited from a similar inflation.

On Monday night, Stewart, 61, unpacked Trump’s $454 million appeal bond , calling out experts framing the former president’s New York civil case as not causing direct harm to any individual.

“The Daily Show” host rolled a clip of CNN’s Laura Coates interviewing “Shark Tank” star Kevin O’Leary, who commented that the ruling didn’t “go over well” with the real estate industry that was now fretting over the possibility of becoming the next target.

Coates responds to O’Leary by highlighting that Trump was found liable for falsifying business records in the second degree, issuing false financial statements, insurance fraud and conspiracy, all due to asset inflation.

“Everything that you just listed off is done by every real estate developer everywhere on Earth in every city. This has never been prosecuted,” O’Leary replied.

In response, Stewart asked: “How is he not this mad about overvaluations in the real world?”

“Because they are not victimless crimes,” he said.

To further his point, Stewart argued that “money isn’t infinite. A loan that goes to the liar doesn’t go to someone who’s giving a more honest evaluation. So the system becomes incentivized for corruption.”

Stewart also contended that failing to declare a higher market value on a property, while paying taxes based on a lower assessed value, constitutes fraudulent behavior.

“The attorney general of New York knew that Trump’s property values were inflated because when it came time to pay taxes, Trump undervalued the very same properties,” Stewart added. “It was all part of a very specific real estate practice known as lying.”

Stewart sold his 6,280-square-foot Tribeca duplex for $17.5 million in 2014.

But it didn’t take long for internet sleuths to look into Stewart’s own property history, which shows his New York City penthouse sold for 829% more than its assessed value, records confirmed by The Post reveal.

In 2014, Stewart sold his 6,280-square-foot Tribeca duplex to financier Parag Pande for $17.5 million .

The property’s asking price at that time is not available in listing records.

But according to 2013-2014 assessor records obtained by The Post, the property had the estimated market-value at only $1.882 million.

2013-2014 Property assessment of Jon Stewart's Tribeca penthouse.

The actual assessor valuation was even lower, at $847,174.

Records also show that Stewart paid significantly lower property taxes, which were calculated based on that assessor valuation price — precisely what he called Trump out for doing in his Monday monologue.

Pande, who purchased the penthouse from Stewart, then resold the property at a nearly 26% loss, according to the Real Deal — at just over $13 million — in 2021.

Timothy Pool, a political commentator known for more right-leaning views, alleged on X that Stewart was being a hypocrite.

Did @jonstewart commit fraud when he sold his penthouse for $17.5M? NY listed its market value at $1.8M an AV at around 800k Who did he He defraud?? I am SHOCKED SHOCKED pic.twitter.com/9okis96VQP — Tim Pool (@Timcast) March 26, 2024

“Did @jonstewart commit fraud when he sold his penthouse for $17.5M? NY listed its market value at $1.8M an AV at around 800k… Who did he defraud?? I am SHOCKED,” he wrote.

“This is right in [Letitia James’] jurisdiction! I look forward to the grand jury indictment,” a user quipped in response to the tweet.

Stewart’s reps did not respond to The Post’s request for comment, but the comedian tweeted Wednesday evening: “OMG!! I’ve been caught doing something not remotely similar to Trump! I guess all I need to do now is start a fraud college, steal classified docs, bankrupt casinos, pay hush money, grab pussies, discriminate in housing, cheat at golf and foment insurrection and you’ll revere me!”

Meanwhile, the New York assessor valuation on Stewart’s former penthouse is the exact same citation method and metric that New York Attorney General Letitia James used to value Trump’s private and personal properties, and then sued him for inflating those assets.

OMG!! I've been caught doing something not remotely similar to Trump! I guess all I need to do now is start a fraud college, steal classified docs, bankrupt casinos, pay hush money, grab pussies, discriminate in housing, cheat at golf and foment insurrection and you'll revere me! — Jon Stewart (@jonstewart) March 27, 2024

Market value was not considered throughout the case.

This includes Trump’s Mar-a-Lago estate in Palm Beach, known as his main residence, which was assessed at only $18 million at the time.

Real estate brokers had valued the property at 50 times more than that amount.

Same for his private 200-acre New York family estate in Westchester, which was assessed between $30 million and $56 million.

Trump's children grew on the estate and would often visit during the summers and weekends.

Trump had valued the property, known as Seven Springs , at $261 million.

The difference between Stewart and Trump’s cases is that a judge ruled that Trump sometimes exaggerated to lenders about how big his properties were, including the square footage of his Trump Tower apartment.

Last month, Manhattan Supreme Court Justice Arthur Engoron ordered Trump to pay $355 million — and temporarily banned him from doing business in the state — relying heavily on the assessed valuations of the properties to determine the ruling.

The $454 million bond to appeal the ruling marks the highest bond ever recorded in United States history against a single individual.

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U.S. Sues Apple, Accusing It of Maintaining an iPhone Monopoly

The lawsuit caps years of regulatory scrutiny of Apple’s wildly popular suite of devices and services, which have fueled its growth into a nearly $3 trillion public company.

Garland Accuses Apple of Violating Federal Antitrust Law

Attorney general merrick b. garland said that apple has employed a strategy that relies on exclusionary anti-competitive conduct that hurts both consumers and developers..

Over the last two decades, Apple has become one of the most valuable public companies in the world. Today, its net income exceeds the individual gross domestic product of more than 100 countries. That is in large part due to the success of the iPhone, Apple’s signature smartphone product. But as our complaint alleges, Apple has maintained monopoly power in the smartphone market, not simply by staying ahead of the competition on the merits, but by violating federal antitrust law. Consumers should not have to pay higher prices because companies break the law. We allege that Apple has employed a strategy that relies on exclusionary, anticompetitive conduct that hurts both consumers and developers. For consumers, that has meant fewer choices, higher prices and fees, lower quality smartphones, apps and accessories, and less innovation from Apple and its competitors. For developers, that has meant being forced to play by rules that insulate Apple from competition. And as outlined in our complaint, we allege that Apple has consolidated its monopoly power, not by making its own products better, but by making other products worse.

By David McCabe and Tripp Mickle

David McCabe reported from Washington, and Tripp Mickle from San Francisco.

The federal government’s aggressive crackdown on Big Tech expanded on Thursday to include an antitrust lawsuit by the Justice Department against Apple, one of the world’s best-known and most valuable companies.

The department joined 16 states and the District of Columbia to file a significant challenge to the reach and influence of Apple, arguing in an 88-page lawsuit that the company had violated antitrust laws with practices that were intended to keep customers reliant on their iPhones and less likely to switch to a competing device. The tech giant prevented other companies from offering applications that compete with Apple products like its digital wallet, which could diminish the value of the iPhone, and hurts consumers and smaller companies that compete with it, the government said.

The Justice Department’s lawsuit is seeking to put an end to those practices. The government even has the right to ask for a breakup of the Silicon Valley icon.

Read the Lawsuit Against Apple

The antitrust suit is the federal government’s most significant challenge to the reach and influence of the company.

The lawsuit caps years of regulatory scrutiny of Apple’s wildly popular suite of devices and services, which have fueled its growth into a nearly $2.75 trillion public company that was for years the most valuable on the planet. It takes direct aim at the iPhone, Apple’s most popular device and most powerful business, and attacks the way the company has turned the billions of smartphones it has sold since 2007 into the centerpiece of its empire.

By tightly controlling the user experience on iPhones and other devices, Apple has created what critics call an uneven playing field, where it grants its own products and services access to core features that it denies rivals. Over the years, it has limited finance companies’ access to the phone’s payment chip and Bluetooth trackers from tapping into its location-service feature. It’s also easier for users to connect Apple products, like smartwatches and laptops, to the iPhone than to those made by other manufacturers.

“Each step in Apple’s course of conduct built and reinforced the moat around its smartphone monopoly,” the government said in the lawsuit, which was filed in the U.S. District Court for the District of New Jersey. It added that the company’s practices resulted in “higher prices and less innovation.”

Apple says these practices make its iPhones more secure than other smartphones. But app developers and rival device makers say Apple uses its power to crush competition.

“This lawsuit threatens who we are and the principles that set Apple products apart in fiercely competitive markets,” an Apple spokeswoman said. “If successful, it would hinder our ability to create the kind of technology people expect from Apple — where hardware, software, and services intersect. It would also set a dangerous precedent, empowering government to take a heavy hand in designing people’s technology.”

Apple is the latest company the federal government has tried to rein in under a wave of antitrust pressure in recent years from both the Justice Department and the Federal Trade Commission, to which the Biden administration has appointed heads sharply focused on changing the laws to fit the modern era. Google, Meta and Amazon are all facing similar suits, and companies from Kroger to JetBlue Airways have faced greater scrutiny of potential acquisitions and expansion.

The lawsuit asks the court to stop Apple from engaging in current practices, including blocking cloud-streaming apps, undermining messaging across smartphone operating systems and preventing the creation of digital wallet alternatives.

The Justice Department has the right under the law to ask for structural changes to Apple’s business — including a breakup, said an agency official, who spoke on condition of anonymity. The official declined to identify what additional action the agency could request in this case but any demands would be tied to how a court rules on the question of whether — and how — Apple broke the law.

It’s unclear what implications the suit — which is likely to drag out years before any type of resolution — would have for consumers. Apple plans to file a motion to dismiss the case in the next 60 days. In its filing, the company plans to emphasize that competition laws permit it to adopt policies or designs that its competitors oppose, particularly when those designs would make using an iPhone a better experience.

Apple has effectively fought off other antitrust challenges. In a lawsuit over its App Store policies that Epic Games, the maker of Fortnite, brought in 2020, Apple persuaded the judge that customers could easily switch between its iPhone operating system and Google’s Android system. It has presented data showing that the reason few customers change phones is their loyalty to the iPhone.

It also has defended its business practices in the past by highlighting how the App Store, which it opened in 2008, created millions of new businesses. Over the past decade, the number of paid app makers has increased by 374 percent to 5.2 million, which Apple has said is a testament to a flourishing marketplace.

Every modern-day tech giant has faced a major federal antitrust challenge. The Justice Department is also pursuing a case against Google’s search business and another focused on Google’s hold over advertising technology. The Federal Trade Commission filed a lawsuit accusing Meta, which owns Facebook, of thwarting competition when it bought Instagram and WhatsApp and another accusing Amazon of abusing its power over online retail. The F.T.C. also tried unsuccessfully to block Microsoft from acquiring Activision Blizzard, the video game publisher.

The lawsuits reflect a push by the regulators to apply greater scrutiny to the companies’ roles as gatekeepers to commerce and communications. In 2019, under President Donald J. Trump, the agencies opened antitrust inquiries into Google, Meta, Amazon and Apple. The Biden administration has put even more energy behind the effort, appointing critics of the tech giants to lead both the F.T.C. and the antitrust division of the Department of Justice.

In Europe, regulators recently punished Apple for preventing music streaming competitors from communicating with users about promotions and options to upgrade their subscriptions, levying a 1.8 billion-euro fine. App makers have also appealed to the European Commission , the European Union’s executive arm, to investigate claims that Apple is violating a new law requiring it to open iPhones to third-party app stores.

In South Korea and the Netherlands , the company is facing potential fines over the fees it charges app developers to use alternative payment processors. Other countries, including Britain, Australia and Japan, are considering rules that would undercut Apple’s grip on the app economy.

The Justice Department, which began its investigation into Apple in 2019, chose to build a broader and more ambitious case than any other regulator has brought against the company. Rather than narrowly focus on the App Store, as European regulators have, it focused on Apple’s entire ecosystem of products and services.

The lawsuit filed Thursday focuses on a group of practices that the government said Apple had used to shore up its dominance.

The company “undermines” the ability of iPhone users to message with owners of other types of smartphones, like those running the Android operating system, the government said. That divide — epitomized by the green bubbles that show an Android owner’s messages — sent a signal that other smartphones were lower quality than the iPhone, according to the lawsuit.

Apple has similarly made it difficult for the iPhone to work with smartwatches other than its own Apple Watch, the government argued. Once an iPhone user owns an Apple Watch, it becomes far more costly for them to ditch the phone.

The government also said Apple had tried to maintain its monopoly by not allowing other companies to build their own digital wallets. Apple Wallet is the only app on the iPhone that can use the chip, known as the NFC, that allows a phone to tap-to-pay at checkout. Though Apple encourages banks and credit card companies to allow their products to work inside Apple Wallet, it blocks them from getting access to the chip and creating their own wallets as alternatives for customers.

The government said that Apple refuses to allow game streaming apps that could make the iPhone a less valuable piece of hardware or offer “super apps” that let users perform a variety of activities from one application.

The government’s complaint uses similar arguments to the claims it made against Microsoft decades ago, in a seminal lawsuit that argued the company was tying its web browser to the Windows operating system, said Colin Kass, an antitrust lawyer at Proskauer Rose. He added that the most compelling allegation — and the one that brings it closest to the Microsoft case — is that Apple could be contractually preventing rivals from developing apps that work with other app providers, as “super apps” could.

Other legal experts noted that companies are legally allowed to favor their own products and services, so the government will have to explain why that is a problem with Apple.

“This case is about technology,” Mr. Kass said. “Can the antitrust laws force a company to redesign its product to make it more compatible with competitors’ products?”

Apple has defended itself against other antitrust challenges by arguing that its policies are critical to make its devices private and secure. In its defense against Epic Games, it argued that restraining the distribution of apps allowed it to protect the iPhone from malware and fraud. The practice benefited customers and made the iPhone more attractive than competing devices with Android’s operating system.

The government will try to show that the effect of Apple’s policies was to hurt consumers, not help them.

“Competition makes devices more private and more secure,” said Jonathan Kanter, assistant attorney general of the Justice Department’s antitrust division. “In many instances, Apple’s conduct has made its ecosystem less private and less secure.”

David McCabe covers tech policy. He joined The Times from Axios in 2019. More about David McCabe

Tripp Mickle reports on Apple and Silicon Valley for The Times and is based in San Francisco. His focus on Apple includes product launches, manufacturing issues and political challenges. He also writes about trends across the tech industry, including layoffs, generative A.I. and robot taxis. More about Tripp Mickle

How to Make Your Smartphone Better

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Trying to spend less time on your phone? The “Do Not Disturb” mode can help you set boundaries and signal that it may take you a while to respond .

To comply with recent European regulations, Apple will make a switch to USB-C charging for its iPhones. Here is how to navigate the change .

Photo apps have been using A.I. for years to give you control over the look of your images. Here’s how to take advantage of that .

The loss of your smartphone can be disruptive and stressful. Taking a few simple steps ahead of time can make things easier if disaster strikes .

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v.11(2); Apr-Jun 2019

Guideline on writing a case report

Basim saleh alsaywid.

1 Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia

2 Department of Research Unit, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

Nada Mansour Abdulhaq

3 Department of Pediatric, Rabigh Branch, King Abdulaziz University, Jeddah, Saudi Arabia

4 Department of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia

Research is an important competency that should be mastered by medical professionals. It provides an opportunity for physicians to develop numerous skills including communication, collaboration, time management, and teamwork. Case report, as a research design, describes important scientific observations that are encountered in a clinical setting to expand our knowledge base. Preparing a case report is far easier than conducting any other elaborative research design. Case report, with its main components, should be focused and delivers a clear message. In this article, the key components of a case report were described with the aim of providing guidance to novice authors to improve the quality of their reporting.

INTRODUCTION

“The best teaching of medicine is that taught by the patient himself” is a famous statement by William Osler which describes the opportunities we have as physicians to learn from our encounters with patients.[ 1 ] This learning experience, based on the observation of clinical cases, can be transferred to others, locally, nationally, and internationally, through communication and reporting. A case report is the first effort for many doctors, and other health professionals to convey a message to the entire medical profession by the means of specialized journal and remain essential to the art of medicine.[ 2 ] The purpose of the case report is to expand our knowledge on clinical manifestation, diagnostic approach, or therapeutic alternative of a disease, ultimately, to improve the quality of care provided to our patients. A case report that is worth reading should, therefore, contain both practical and educational messages.[ 3 , 4 ]

The clinical case report has been an integral part of medical literature throughout history. The oldest example of a preserved clinical case in medical literature is a text from an ancient Egyptian papyrus dating from the 16 th to the 17 th dynasty, 1600 BC, addressing the management of dislocated jawbone.[ 5 ] From Hippocratic case histories, “Epidemics” 400 BC, through Galenic case reports, in the second century AD, case reports were usually used to tell other doctors or colleagues about interesting cases they have encountered. Muslim scholars have reported case histories as well, particularly, Abu Bakr Mohamed Ibn Zakariya Al-Razi (865–929 AD), where he left a large collection of case reports in his 25-volume medical encyclopedia “Kitab Al-Hawi.”[ 5 ]

Those case histories were not a publication but rather a documentation or a message between the medical professionals, and it is usually kept in their records. Case reports have now been developed and accepted as a scholarly publication to disseminate knowledge to a wide medical audience.

GENERAL PRINCIPLES OF CASES REPORT

The case report is a research design where an unexpected or novel occurrence is described in a detailed report of findings, clinical course, and prognosis of an individual patient, which might be, but not mandatory, accompanied by a review of the literature of other reported cases. Although case reports are considered the lowest in the hierarchy of evidence-based practice in the medical literature [ Figure 1 ], it provides essential information for unfamiliar events and shared individual experiences, for better understanding and optimizing patient care. This approach might generate an idea or hypothesis, but it will not be confirmed unless we conduct further confirmatory quantitative experimental or observational study designs such as clinical trials or cohort studies. Despite that, case report provides the medical community with information which cannot be picked up by any other designs. Just to name a few, in 1819, James Parkinson published a case report entitled “An essay on the shaking palsy”[ 6 ] and lead to the discovery of Parkinson's disease. And in 1981, a case report was published in the literature as “Preliminary communication on extensively disseminated Kaposi sarcoma in a young homosexual man”[ 7 ] few years later, HIV from this case report was discovered. Furthermore, in 2012, Ali Zaki reported an article in New England Journal of Medicine titled “Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia” which ultimately, lead to the discovery of Middle East Respiratory Syndrome Coronavirus.[ 8 ] All those previous examples show how important is case report in the advancement of medical practice. The case report might be in the tail of the hierarchy of evidence-based medicine but if properly selected and appropriately reported it might stand a better chance of publication in high impact journals than even a clinical trial.

An external file that holds a picture, illustration, etc.
Object name is UA-11-126-g001.jpg

Hierarchy of evidence base medicine

Some scientist classifies case reports as a qualitative study design, others might consider it a quantitative approach or even a mixed method design.[ 9 ] This polarization of the case report is unfair. However, if we have to categorize it; when we consider all research approaches in medicine, it can be classified into exploratory or confirmatory; then, case reports definitely will be considered an exploratory research approach. Case report can be classified as a single case report, two case reports or case series, which aggregate more than two cases in a report. Case reports are usually retrospective by nature, however, it can be prospectively designed, for example, applying a new diagnostic or management approach or guideline of a particular health condition to discover new cases.[ 10 ]

Cases deemed appropriate for a publication are listed in Table 1 .[ 3 ] Despite these restrictive criteria, any case report could have a reasonable chance of publication even if it was not novel, as long as it was authentic, lead to an incremental advance in medicine or carries an educational value.

Criteria for published case report

STAGES IN PREPARING A CASE REPORT

The source of case reports is clinical setting, every single patient is a potential case report therefore, always keep an eye on unusual cases in your practice either in the ward or in the clinic. Once a potential case is identified, and the patient is in hospital, follow him through hospitalization until discharge. Give the case an appropriate time frame in the course of the disease to observe the development over time. Wait for 6 months during multiple visits, before you start writing a case report to allow adequate time to complete the clinical course.

Once you have a potential case, how would you know if this is an appropriate for reporting or not? Especially if you are a novice physician, once you encounter a possible case and you are suspecting if this patient fulfills one of those criteria which are described in Table 1 . The first step is a high index of suspicion; keep your eyes open for every case, once you suspect a case then ask your colleagues either directly or in a group related to the same discipline, locally, to confirm that this could be a case report. The next step would be asking an expert from the national or international medical community about this case scenario, get their opinion and feedback, including the appropriateness of reporting this case. Once the feedback is positive, perform extensive literature search, through PubMed, Embase, Google Scholar, and databases for case reports to ensure that you retrieve all available information on this topic. Do not forget to look at popular case reports which are not indexed in PubMed and read through previously published case reports that will enhance your understanding of the subject and gives you a general scaffold to prepare your own report.

Once the decision was made to report this case, obtain an informed consent from the patient; otherwise, it will not be accepted for publication. Moreover, take a permission from consultant in-charge of the case before writing your report.

Once you have reviewed the literature and improved your knowledge on the topic, use the patient's note to record the key points in history, examination findings, relevant data results and interpretation, treatment (including operational findings), and outcomes. Delete all patients’ personal information, identifiers or contact detailed from the prepared report, including the radiological or histopathological images before you copy them into your article. Save the prepared report on a password protected hospital computer.

The last step would be checking the journal which is most appropriate for your case report. Those journals provide you with the required criteria and appropriate format to prepare your report, to enhance their acceptability for publication. Many journals are interested in published case reports, but not all. In 2007, the first case report journal was created “Journal of Medical Case Reports” since then, the interest raised and many other journals dedicated for case reports were created including a specific database for all case reports are aggregated and continuously updated from several publishers.[ 3 ]

FORMAT FOR WRITING A CASE REPORTS

The word count for case report may vary from one journal to another, but generally should not exceed 1500 words, therefore, your final version of the report should be clear, concise, and focused, including only relevant information with enough details.[ 3 ] If a shorter version is required by the journal, then you can always edit or trim off the discussion section of your article. The general format adopted for most case reports is detailed in the following subsection and summarized as a checklist in Table 2 .

Checklist for writing a case report

This is the most commonly read part of your article; therefore, it should be relevant, concise, informative, descriptive, and appealing enough to attract readers to your report. It is placed in the first page of the manuscript, but some journal might request you to specify a separate file from the manuscript, labeled as a “title page” file. In preparing the title, avoid unnecessary words, wordplay, double meaning, cute wording, and never uses abbreviations in the title. It is always advisable to add “case report” in your title. Beneath the title, list all authors and their affiliations on the same page including their E-mails account. Most of the case reports are not prepared by a single author, but it should not exceed more than six authors; otherwise, the journal might not accept your case report for publication. Finally, under the subsection of corresponding author, assign one author to communicate with the journal and include all details of communication, such as institutional address, E-mail, and phone numbers.

Who should be the corresponding author? Any person who will submit the article to the journal to get the feedback from the editor of the journal and should be one of the article's authors.

It is the most important part of your article as it will be freely accessible for others to read when retrieved from any medical databases during the relevant search. However, it is the last part written in your article. It should include a brief summary that gives a general idea of the content of the case report. It should not include any references or abbreviations and should not exceed 350 words, preferably <250 words. Check your journal instructions for a detailed guideline on word counts. The abstract is usually arranged into three subsections: background, case presentation, and conclusion. The background should clarify the importance of reporting such a unique case. Afterward, a brief description of the clinical scenario of the patient listing only the important details. Finally, the conclusion should be brief with lesson learned and impact on the interested group.

This is quite important for indexing your article, and it should be from three to ten words, and you should be very careful in your selection, as it would help in retrieving your paper during the search.

Introduction

In this section, the definition and brief description of the pathology, including common presentations and disease progression is discussed, explaining the background of the selected topic. Followed by a brief description of what is about to be reported and the importance of reporting such case. The content should be clear, focused, concise, and attract the reader's attention and interest.

Case presentation

Provide a clear picture of the patient's condition and presentation, and it is best presented in chronological order with sufficient detail and explanation. Describe the relevant demographic information of the patient censoring any details that could lead to the patient being identified. Start with the current medical condition and primary complaint with detailed history including relevant family history, occupational and social history, medication, and allergy. Findings of physical examination should be briefly reported with all relevant investigation, laboratory results and images, and its analysis. Describe the differential diagnosis and the rational of the management approach, including follow-up results and final diagnosis. Avoid any extensive interpretation or defense for the approach you took. This section can be broken up into small subsections if needed, and it should be supplemented with necessary images and tables to facilitate reader's understanding of the case.

Probably, this is an optional section, but it is preferable if reported, as it would explain more of your rational and approach with added additional relevant information about the uniqueness of this case. Compare your findings with what is known in the literature and why you think this case is different. Only discuss what is relevant to your case and do not provide any unproven and unsupported speculation. Acknowledge and explain any ambiguity or unexpected features occurred even if it is contradicting your concept. Explain how this case would contribute to the literature and suggest justifiable recommendations.

The section should include a concise and brief statement, explaining the importance and relevance of your case and it should relate to the purpose of the paper.

Patient's perspective

This new section is an optional, but it adds a new dimension to your paper, as it gives the chance to patients with their own perspective to write and describe their experiences throughout the disease process. Make sure that any patient's identifiers are removed, and his identity is managed appropriately with confidentiality, removing all irrelevant information to the case report.

Before submission, make sure that the patient gave his informed consent for publication, and statement indicating that should be clearly narrated in the report. You do not need to send the consent form on submission, but it should be available if requested. In case of the child, the parent or legal guardian should be consented instead, and if the child is a teenager then both patient and his parent should be consented. Many journals will not proceed with the peer review process unless a statement like “written informed consent was obtained from the patient for publication” is clearly stated. This statement could be in a separate section, as indicated here, or within the content of the report. If the patient is incapacitated or deceased, obtain the consent from the next-of-kin, and this should be stated clearly in the report. If the patient is deceased and next-of-kin is unreachable, you should exhaust all reasonable attempts to obtain the consent. If you fail, then you should state that in your report. If the patient is still alive but unreachable and you did not obtain the consent, do not bother publishing the case.[ 3 ]

Competing of interest

In this mandatory part, all authors should disclose any financial competing interest. If none, then, a statement like “the authors declare that they have no competing interests” should be clearly stated.

Author contribution

In this section, you need to credit all individuals who made a substantial contribution to the production of this study. Criteria of qualification to be an author should be strictly followed and explicitly stated for each author, separately. The first criterion is being a part of the conceptual development, data acquisition or analysis, then involvement in drafting part of the manuscript, and finally approving the final version of the manuscript. If those criteria are not fulfilled, then those individuals should be acknowledged in the next section. Be cautious from excessive authorship as this might lead to rejecting your article.

You need to mention around 15 references if possible, and few of them should be within the past 5 years, but do not exceed more than 25 references.

Cover letter

This is an optional supplementary document, addressed to the editor-in-chief, in a formal letter. Explain why this report is important and why it should be published in this journal.

JOURNAL EVALUATION FOR A CASE REPORT

Writing a case report varies from one physician to another, depending on the expertise of the author who prepared the report. This variation is influenced by many factors ranging from the author's knowledge base to his writing skills. The Peer review process will detect this variation to assure the quality of reporting through critical appraisal. It will assess the report, provide a valuable, supposedly constructive, feedback and helps the editor in a decision regarding the publication. This assessment should be as objective as possible to reach an unbiased decision. Therefore, several schemes were formulated to evaluate the quality of the case report. One of which is the Piersons 5-component scheme which relays on five major components, each component is scored from 0 to two, with a possible total score of 10 and lowest score of zero. The five major components are uniqueness, documentation, interpretation, objectivity, and educational value.[ 11 ] If the calculated score is more than 8, then this report is worth publishing. A score from 6 to 8, indicate possible publication with caution about validity. Any score <6, indicate the insufficient quality of the case report. Further details about this evaluation scheme are explained in Table 3 .

Matrix of case report evaluation

The calculated total score: Score of 9-10: Excellent report and most likely will add new information to the medical literature, Score of 6-8: Can be published but reader should be caution of validity and clinical value, Score of 5 or Less: Report is considered inadequate and inappropriate for publication

Case report remains an important source of information and common method in knowledge dissemination among physicians due to its simplicity in design. It will continue providing new research ideas through hypotheses generation. Finally, as I commenced my article with William Osler, I will end by quoting his other famous statement…. “Always note and record the unusual…. Publish it, place it on permanent record as a short, concise note. Such communication is always of value.”

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgment

You need to mention and acknowledge the source of the research fund if any. Moreover, acknowledging all people who helped you, supervised you, or assisted you in finalizing this report, if they are not fulfilling the criteria to be an author.

International

Israel-Hamas war

Baltimore Key Bridge collapse

Supreme Court hears oral arguments on major abortion pill case

By Devan Cole , Tierney Sneed and Jen Christensen , CNN

Takeaways from the oral arguments

From CNN's Devan Cole, Jen Christensen, Tierney Sneed and Dan Berman

Justices overall appeared skeptical of the challengers of the FDA's approval of and regulations governing mifepristone, a drug used for medication abortions.

With the caveat that anything can happen, here are the key takeaways from oral arguments:

Chief Justice John Roberts and Justice Neil Gorsuch tore into the challengers’ attorney over the impact caused by the lawsuit, suggesting a nationwide injunction was unnecessary.
Conservative Justice Brett Kavanaugh asked whether federal law provides some protections for doctors who object to providing an abortion on moral and religious grounds – a sign that he may not be convinced that the plaintiffs could not demonstrate any injury to them stemming from the agency’s regulations.
Justice Samuel Alito, who wrote the opinion reversing Roe v. Wade, and fellow ardent abortion opponent Justice Clarence Thomas, pushed the question of whether anyone can actually challenge the FDA on drug approvals. The FDA wants to be “infallible,” Alito said at one point.
Alito said that a long-unenforced law, the Comstock Act, banning the mailing of drugs used for abortions was not “obscure” but rather a “prominent” law. Some anti-abortion activists see the law as an avenue to end medication abortion, and perhaps all kinds of abortions.
That the challenge to mifepristone reached the Supreme Court in such a short amount of time was no accident – a result of the “judge-shopping” phenomenon seen recently on major political issues including health care, firearms and abortion.

"Silence" is expected: What it was like inside the courtroom

From CNN's Jalen Beckford

Jessica Ellsworth, representing Danco, which makes mifepristone, argues before the US Supreme Court in Washington, DC, on March 26.

CNN News Associate Jalen Beckford attended oral arguments at the Supreme Court for the first time. Here are his observations:

Upon arrival at the Supreme Court, members of the press and onlookers were greeted by abortion rights groups marching outside the high court.

“My body, my choice!” they shouted as oral arguments in the case over access to the abortion pill mifepristone were soon underway.

The courtroom was a stark contrast to the commotion of the protests outside.

Elizabeth Prelogar, US solicitor general, argues before the US Supreme Court.

Inside the court, "silence" is expected. In the section designated for press, no phones or laptops are allowed, and most reporters resorted to the more traditional pen and pad for their notes.

I watched as seasoned reporters took notes while holding on to every word uttered by the justices, hoping to get an early prediction of what the court would ultimately decide. Nearly two years after the landmark Dobbs decision that overturned Roe v. Wade, I could feel the weight that this case would have in the national debate over abortion rights.

A person listens to arguments before the US Supreme Court regarding access to the abortion pill mifepristone.

Sitting next to me, I saw as a courtroom artist caught every detail of the justices and the historical room, making sure to include the red curtains draped behind them and the large columns surrounding the room.

Although reporters are allowed to leave during the hearing, most stayed put as Elizabeth Prelogar argued on behalf of the FDA, Jessica Ellsworth for Danco Laboratories, and Erin Hawley for the Alliance for Hippocratic Medicine. We all watched intently as they fielded questions from the justices regarding their arguments, often interrupted if they didn’t truly answer the question.

Erin Hawley, senior counsel at Alliance Defending Freedom, argues before the US Supreme Court.

Once we were dismissed, I noticed the crowd seemed to have grown outside the court. I saw signs that read “Bans Off Our Bodies,” and New York Attorney General Letitia James among the onlookers and in support of the protests.

As organizers stood on the steps of the court, reiterating how consequential a decision would be, their words rang as far as the Capitol.

Both abortion rights and anti-abortion groups march outside the Supreme Court.

Justices asked an unusual amount of detailed medical questions

From CNN's Jen Christensen

Several justices asked questions beyond the law during oral arguments, seeking detailed answers about medical procedures and practices related to reproductive care and mifepristone, one of two drugs used in medication abortion.

Justice Ketanji Brown Jackson sought more information on how often doctors might need to perform emergency procedures for a patient who had taken drugs for a medication abortion, even if the physicians object to abortion.

“It’s my understanding that sometimes, the completion, it doesn’t involve surgical intervention. Do you have a sense of how often?” the liberal justice asked.

Jackson also asked Erin Hawley, an attorney representing the abortion pill’s challengers, how close a doctor might need to be to a procedure they object to in order to be “complicit.”

“Like I — I work in the emergency room and this is going on? I’m handing them a water bottle? I’m — like, what do you mean complicit in the process?” Jackson asked.

At another point, conservative Justice Amy Coney Barrett asked about a dilation and curettage, or D&C, the procedure to remove tissue from the uterus, and noted it did not necessarily mean that a doctor was removing a living embryo, since a D&C can happen after a miscarriage. She also asked specific medical questions about the need for tissue to be removed if an abortion wasn’t complete after a medication.

Barrett also pressed whether the elimination of in-person visits to provide mifepristone — a step the FDA ended in 2023 — would “lead to mistakes in gestational aging, which could increase the need for a D&C or the amount of bleeding.”

Medication abortion is available only through the first 10 weeks of pregnancy. Under current regulations, while a person does not need to see a provider in person to receive drugs for a medication abortion, providers still must be available to assess gestational age and whether someone may have an ectopic pregnancy. Most medication abortions occur without an ultrasound.

Analysis: Why Gorsuch is bringing up the increase of nationwide injunctions

From CNN Supreme Court analyst Steve Vladeck

Steve Vladeck, CNN Supreme Court analyst and professor at the University of Texas School of Law, has this to say about the injunction discussion:

"One of the issues lurking in this case, and several other before the Court this term, is the uptick in what Justice Neil Gorsuch calls 'universal' injunctions—court orders that block state or federal policies as applied to anyone based solely on a claimed injury to a small handful of individuals.

We've seen these kinds of injunctions become much more prevalent over the past decade—against both Republican and Democratic policies. And although the Court has yet to rein them in directly, Justice Gorsuch has, as he did in today's arguments, repeatedly suggested that the justices ought to do so.

At the very least, the question of when policies should be blocked on a statewide or nationwide basis because a handful of citizens object to them is an issue that should get more discussion—not just from the courts, but from Congress, which has, to this point, been unwilling to provide more guidance for when these kinds of orders should and should not be allowed."

Oral arguments in abortion pill case conclude

From CNN's Devan Cole

Abortion rights groups march outside the Supreme Court on Tuesday, March 26, in Washington, DC.

Oral arguments have concluded in a major Supreme Court case over access to the commonly used abortion drug mifepristone.

The nine justices heard arguments from three separate attorneys for more than an hour Tuesday morning. A decision in the case is expected by the end of June or early July.

Roberts and Gorsuch ask why a nationwide ban is needed

Chief Justice John Roberts and Justice Neil Gorsuch have peppered the attorney for the abortion pill challengers why her clients were seeking a nationwide relief in the case as opposed to a narrower remedy that would apply only to the plaintiff doctors.

“Why can't the court specify that this relief runs to precisely the parties before the court as opposed to looking to the agency in general and saying agency you can't do this anywhere?” Roberts asked the attorney, Erin Hawley.

For his part, Gorsuch told Hawley that he went back “and looked and there are exactly zero universal injunctions that were issued during Franklin Delano Roosevelt's 12 years in office.”

“And over the last four years or so, the number is something like 60 and maybe more than that,” he continued.

After Alito suggests FDA wants to be "infallible," Jackson wonders: can courts really be the experts then?

From CNN's Tierney Sneed

Justice Ketanji Brown Jackson flipped a question from Justice Samuel Alito on its head to give the US Food and Drug Administration's defenders an opportunity to argue that the agency is better suited to make calls on medical science than the courts.

Alito had suggested that, according to the arguments of the administration and mifepristone manufacturer, the FDA would be “infallible” to any skepticism of its approach.

Jackson returned to the question while Danco’s attorney, Jessica Ellsworth, was arguing, and asked Ellsworth her concerns about judges “parsing” medical and scientific studies.

Ellsworth pointed to some of the questionable types of “misleading” assertions the lower courts used to justify their second guessing of the agency, including a blog post analyzing anonymous anecdotes and studies that have since been retractions.

How FDA’s regulations around mifepristone have changed

From CNN's Jamie Gumbrecht

Empty boxes of mifepristone pills fill a trash can at Alamo Women's Clinic in Albuquerque, New Mexico, in January 2023.

Congress gave the US Food and Drug Administration the authority to regulate drugs more than 60 years ago, and in 1962 it was also given the authority to require that drug companies prove that the drugs are effective. Mifepristone, one of the drugs used in medication abortion in the US, was initially approved in 2000, but regulations around its use have shifted since then.

For a medicine to be approved by the the FDA, drugmakers needs to meet rigorous standards that show that the drug is safe and effective. They do this through data from lab, pre-clinical and clinical studies.

Here's a timeline of FDA's regulations around mifepristone:

2000: Initially, mifepristone was approved for medical termination of pregnancy with several restrictions. It could only be prescribed through seven weeks of gestation and only doctors could prescribe it in-person.

2016: The FDA expanded the use of mifepristone after Danco Laboratories, the drug’s sponsor, submitted additional materials to change the way the drug could be used. The FDA took a closer look at 16 years of data on mifepristone use and took into account the way it was prescribed in other countries, as well as professional organization guidelines. Using data from 20 additional studies that looked at the safety and effectiveness of the drug, the FDA allowed clinicians to prescribe the medicine up to 10 weeks of pregnancy.

2021: Due to the Covid-19 pandemic along with studies looking at the effectiveness and safety of telehealth, the FDA eliminated the in-person dispensing requirement. After additional review of the available safety and effectiveness data, and based on the experience of millions of people who used the drug, the FDA made that change permanent in 2023 and eliminated the in-person dispensing requirement.

Attorney for abortion foes urges justices to restore restrictions around mifepristone

Erin Hawley, with Alliance Defending Freedom, exits the federal courthouse on March 15, 2023, in Amarillo, Texas.

Erin Hawley, an attorney representing the abortion pill’s challengers, told the justices that they should undo the the US Food and Drug Administration's moves in recent years to ease restrictions around the drug, arguing those decisions ran afoul of federal law.

“FDA’s outsourcing of abortion drug harm to respondent doctors forces them to choose between helping a woman with a life-threatening condition and violating their conscience,” she added later.

Hawley is a senior counsel at Alliance Defending Freedom, a conservative advocacy group. She was a law clerk to Chief Justice John Roberts during the same term as her now-husband, Republican Sen. Josh Hawley from Missouri. An experienced advocate who has specialized in anti-abortion litigation, the mifepristone case will mark Hawley’s first appearance at the Supreme Court lectern.

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N.Y. appeals court reduces Trump's bond in his civil fraud case to $175 million, a victory for the former president

A state appeals court ruled that Donald Trump and his co-defendants in the New York civil fraud case have 10 days to post a $175 million bond, down from the $464 million judgment that was originally due Monday.

The 11th-hour ruling from a panel of state Appellate Division judges, all appointed by Democratic governors, is a major victory and relief for the former president, whose attorneys had said coming up with the larger bond was a “practical impossibility.” The ruling also means state Attorney General Letitia James’ office cannot yet begin collecting on the judgment.

“I greatly respect the decision of the appellate division and I’ll post the $175 million in cash or bonds or security or whatever is necessary very quickly within the 10 days, and I thank the appellate division for acting quickly,” Trump said in front of cameras after he left a New York courtroom for a hearing in the hush money case.

Before Monday’s ruling, Trump was liable for $454 million , most of the fraud judgment, but the amount he owed had been increasing by more than $111,000 a day because of added interest.

Trump claimed on social media Friday that he had nearly $500 million in cash that he had planned to use toward his 2024 presidential campaign. The former president, however, hasn’t used his own money toward his presidential campaigns since 2016.

He had also floated the idea last week of mortgaging or selling off his properties, saying he would be forced to do so at “Fire Sale prices.”

His lawyers noted in court filings that bond companies typically “require collateral of approximately 120% of the amount of the judgment” — which in this case would total about $557 million.

Trump's lawyers said in one filing a week ago that they hadn’t been able at that point to secure a bond, and believed it was “a practical impossibility.” They said that they approached 30 surety companies through four separate brokers, trying to negotiate with the world’s largest insurance companies.

The other bond companies will not “accept hard assets such as real estate as collateral,” but “will only accept cash or cash equivalents (such as marketable securities),” his lawyers said.

Trump’s lawyers had asked the state appeals court to either reduce the amount of money he had to post or stay the award without him posting any security while he appeals Engoron’s order.

The decision Monday also puts a stay on the part of the original judgment that barred Trump from serving as a public officer of a company, as well as the prohibitions placed on Weisselberg, McConney, Donald Trump Jr. And Eric Trump.

The court did not grant requests from Trump to prohibit the independent monitor or installing an independent director of compliance.

The AG's office brushed off Monday's ruling in a statement, saying: "Donald Trump is still facing accountability for his staggering fraud. The court has already found that he engaged in years of fraud to falsely inflate his net worth and unjustly enrich himself, his family, and his organization. The $464 million judgment — plus interest — against Donald Trump and the other defendants still stands."

Trump celebrated the ruling in a post on Truth Social, attacking Engoron and reiterating that he believes he did nothing wrong. Speaking to reporters outside an unrelated hearing in his New York criminal case, he called Engoron "a disgrace to this country."

Alina Habba, the former president's lawyer in the civil fraud case, said in a statement, “We are extremely pleased with the ruling issued by the Appellate Division. This monumental holding reigns in Judge Engoron’s verdict, which is an affront to all Americans. This is the first important step in fighting back against Letitia James and her targeted witch hunt against my client which started before she ever stepped foot in office."

On Friday, Trump told Fox News he'd appeal Engoron's ruling "all the way to the U.S. Supreme Court if necessary." He must first go through the state appeals court process before he can bring that challenge before the justices.

Trump has valued his brand at over $10 billion , but a 2021 financial statement put his net worth $4.5 billion. He has said that most of his assets are in real estate — not cash or stock — saying at a deposition in the fraud case last year, that he had “substantially in excess of $400 million in cash.”

Trump may have some financial relief coming in the near future.

On Friday, shareholders in Digital World Acquisition Corp. voted to approve a merger with the former president's Trump Media & Technology Group , the private firm that owns his social media platform Truth Social .

Shares in the newly combined company, Trump Media, could begin to be publicly traded this week, and Trump would have nearly 80 million shares, estimated to be worth around $3 billion.

Under the terms of the merger, Trump is prohibited from selling shares in the merged company for at least six months, but the board of directors, which will likely include his eldest son, Donald Trump Jr., could vote to allow him to sell shares earlier than that.

Rebecca Shabad is a politics reporter for NBC News based in Washington.

Dareh Gregorian is a politics reporter for NBC News.

Trump asks appeals court to review ruling allowing Fani Willis to remain on Georgia election case

ATLANTA (AP) — Former President Donald Trump and other defendants accused of illegally trying to interfere in the 2020 election in Georgia on Friday submitted a formal application to appeal a judge’s ruling allowing Fulton County District Attorney Fani Willis to remain on the case.

Trump and other defendants had tried to get Willis and her office tossed off the case, saying her romantic relationship with special prosecutor Nathan Wade created a conflict of interest. Superior Court Judge Scott McAfee earlier this month found that there was not a conflict of interest that should force Willis off the case but said that the prosecution was “encumbered by an appearance of impropriety.”

McAfee’s ruling said Willis could continue her prosecution if Wade left the case, and the special prosecutor resigned hours later. Lawyers for Trump and other defendants then asked McAfee to allow them to appeal his ruling to the Georgia Court of Appeals, and he granted that request .

The filing of an application with the appeals court is the next step in that process. The Court of Appeals now has 45 days to decide whether it will take up the matter.

The allegations that Willis had improperly benefited from her romance with Wade upended the case for weeks. Intimate details of Willis and Wade’s personal lives were aired in court in mid-February , overshadowing the serious allegations in one of four criminal cases against the Republican former president . Trump and 18 others were indicted in August, accused of participating in a wide-ranging scheme to illegally try to overturn his narrow 2020 presidential election loss to Democrat Joe Biden in Georgia.

Willis used Georgia’s Racketeer Influenced and Corrupt Organizations, or RICO, law , an expansive anti-racketeering statute, to charge Trump and the 18 others. Four people charged in the case have pleaded guilty after reaching deals with prosecutors. Trump and the others have pleaded not guilty.

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IMAGES

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Case report and letters to editor
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Descriptive Study designs: Case report, case series, Ecological and cross-sectional study designs
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COMMENTS

Distinguishing case study as a research method from case reports as a publication type
Case study research is defined as a qualitative approach in which the investigator explores a real-life, contemporary bounded system (a case) or multiple bound systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information, and reports a case description and case themes.
Case Studies/ Case Report/ Case Series
A case study, also known as a case report, is an in depth or intensive study of a single individual or specific group, while a case series is a grouping of similar case studies / case reports together. A case study / case report can be used in the following instances: where there is atypical or abnormal behaviour or development.
Case Reports, Case Series
Editorial. Introduction. Case reports and case series or case study research are descriptive studies to present patients in their natural clinical setting. Case reports, which generally consist of three or fewer patients, are prepared to illustrate features in the practice of medicine and potentially create new research questions that may contribute to the acquisition of additional knowledge ...
Distinguishing case study as a research method from case reports as a
The purpose of this editorial is to distinguish between case reports and case studies. In health, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. As a qualitative methodology, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data ...
Guidelines To Writing A Clinical Case Report
Informed consent in an ethical requirement for most studies involving humans, so before you start writing your case report, take a written consent from the patient as all journals require that you provide it at the time of manuscript submission. In case the patient is a minor, parental consent is required.
Case Study Methodology of Qualitative Research: Key Attributes and
A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate ...
What Is a Case Study?
Revised on November 20, 2023. A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research. A case study research design usually involves qualitative methods, but quantitative methods are ...
Distinguishing case study as a research method from case reports as a
A case study, also known as a case report, is an in-depth study of a particular individual or group. The report will often use the terms: "review of a specific condition, disease, or problem [2, 3] .
Case Study
Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data. Example: Mixed methods case study. For a case study of a wind farm development in a ...
How to Write Case Reports and Case Series
In general, a case series comprises <10 cases; beyond that, it may be feasible to apply formal statistics and may be considered a cohort study. Both case reports and case series are descriptive studies. Case series must have similar cases and hence the inclusion must be clearly defined.
Methodology or method? A critical review of qualitative case study reports
Definitions of qualitative case study research. Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, Citation 1995).Qualitative case study research, as described by Stake (Citation 1995), draws together "naturalistic, holistic, ethnographic, phenomenological, and biographic research methods ...
Writing a Case Study
A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity.
Case Reports and Case Series
Case Series. A case series is a report on the characteristics of a group of subjects who all have a particular disease or condition. Common features among the group may suggest hypotheses about disease causation. Note that the "series" may be small (as in the example below) or it may be large (hundreds or thousands of "cases").
Case Reports and Case Series
Case reports and case series are observational studies that describe the experience of one or more people with a particular disease or condition. 4.2. Case reports and case series can be an important first step in recognizing a new disease. 4.3. Case reports and case series have specific limitations: 4.3.1. Lack of denominator data needed to ...
Case Report
An article that describes and interprets an individual case, often written in the form of a detailed story. Case reports often describe: Unique cases that cannot be explained by known diseases or syndromes. Cases that show an important variation of a disease or condition. Cases that show unexpected events that may yield new or useful information.
Writing a case report in 10 steps
Writing up. Write up the case emphasising the interesting points of the presentation, investigations leading to diagnosis, and management of the disease/pathology. Get input on the case from all members of the team, highlighting their involvement. Also include the prognosis of the patient, if known, as the reader will want to know the outcome.
How to Write the Case Studies and Case Report: Techniques
The case study technique can be helpful in many different contexts, but more clarity is required in how such work is written up to realize the most advantage. It is asserted that case-based method ...
Not Birds of a Feather: Case Reports, Case Studies, and Single-Subject
The purpose is to develop a complete description of the "case" in the context of the research question. Thus, while a case study of a single person's health care treatment may superficially seem similar to a case report, the framework, process, and results are very different. Single-subject research designs (SSRDs) comprise a family of ...
Case Report vs Case-Control Study: A Simple Explanation
A case report is the description of the clinical story of a single patient, whereas a case-control study compares 2 groups of participants differing in outcome in order to determine if a suspected exposure in their past caused that difference. A case report describes the medical case of 1 particular patient. 1.
Case reports and case studies: A discussion of theory and methodology
A case study or report contains the following headings: Introduction, Methods, Results, Discussion, and Conclusions. The introduction contains the research question and a review of the literature to justify the need for the study. The introduction leads to a solid statement 230 JOURNAL OF HAND THERAPY of the purpose of the study.
Case Reports and Case Series
A case series is group of case reports involving patients who were given similar treatment. Case reports and case series usually contain demographic information about the patient (s), for example, age, gender, ethnic origin. When information on more than three patients is included, the case series is considered to be a systematic investigation ...
Centene Health Care Fraud Case: How Private Lawyers Profited
The Centene case is just one example in a thriving industry that allows private lawyers to partner with elected attorneys general and temporarily gain powers usually reserved for the government.
Estimating the size of populations at risk for malaria: a case study in
Previous case-control studies and formative research conducted in two northern provinces, Ohangwena and Zambezi, identified specific occupations and behaviors that define malaria high-risk ...
Key tactics for successful next-gen B2B sales
Companies that achieve these service levels report increased customer satisfaction and loyalty, faster growth rates, lower costs, and easier tracking and analysis of customer data. ... However, to make productive progress, a use case based approach is needed. That means selecting the most promising use cases and then scaling data across those ...
Jon Stewart found to have overvalued his NYC home by 829%
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U.S. Justice Dept. Sues Apple, Claiming iPhone Monopoly in Antitrust
The lawsuit caps years of regulatory scrutiny of Apple's wildly popular suite of devices and services, which have fueled its growth into a nearly $3 trillion public company.
Guideline on writing a case report
Case report can be classified as a single case report, two case reports or case series, which aggregate more than two cases in a report. Case reports are usually retrospective by nature, however, it can be prospectively designed, for example, applying a new diagnostic or management approach or guideline of a particular health condition to ...
Supreme Court hears oral arguments on major abortion pill case
This is the most significant abortion case to land before the high court since Roe v. Wade was overturned in 2022 , dismantling nationwide abortion right protections . Our live coverage has ended.
Trump's bond in his civil fraud case reduced to $175 million by N.Y
A state appeals court ruled that Donald Trump and his co-defendants in the New York civil fraud case have 10 days to post a $175 million bond, down from the $464 million judgment that was ...
Trump asks appeals court to review ruling allowing Fani Willis ...
Trump and other defendants had tried to get Willis and her office tossed off the case, saying her romantic relationship with special prosecutor Nathan Wade created a conflict of interest. Superior ...

Quantitative study designs: Case Studies/ Case Report/ Case Series

Case Study / Case Report / Case Series

The stages of a Case Study / Case Report / Case Series

Which clinical questions does Case Study / Case Report / Case Series best answer?

What are the advantages and disadvantages to consider when using Case Studies/ Case Reports and Case Series ?

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Distinguishing case study as a research method from case reports as a publication type

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Organizing Your Social Sciences Research Assignments

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Case Reports and Case Series

Case Reports and Case Series

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Study Design 101: Case Report

Disadvantages

Design pitfalls to look out for

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Evidence Pyramid - Navigation

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Writing a case report in 10 steps

First steps

Getting consent

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Coming up with a title

Background research

How your case is different

Writing an abstract

Case Report vs Case-Control Study: A Simple Explanation

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Estimating the size of populations at risk for malaria: a case study in cattle herders and agricultural workers in Northern Namibia

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