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CLINICAL REVIEW: Paul Glasziou Evidence based case report: Twenty year cough in a non-smoker BMJ 1998; 316: 1660-1661 [Full text]

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chronic cough

Andrew C Miller   (1 June 1998)

good luck with cough therapy

Joseph Braidy   (1 June 1998)

Basic Knowledge Deficit=E.B.M

Carlos A Selmonosky   (1 June 1998)

A paediatric perspective of the 20 year cough

Roger Buchdahl   (1 June 1998)

Evidence based case reports in the undergraduate curriculum

Ivan J Perry   (24 June 1998)

chronic cough 1 June 1998
Andrew C Miller, consultant physician Mayday Hospital, Croydon Send response to journal: Re: chronic cough	Dr Glaszio would have got the same answer much quicker if he had telephoned his local chest physician. Empiric treatment for possible gastro-oesophageal reflux is widely used by chest physicians for unexplained chronic cough. It is to be hoped that the modem will not completely replace the telephone.
good luck with cough therapy 1 June 1998
Joseph Braidy, CHUM Montreal Send response to journal: Re: good luck with cough therapy	Nice application of The Hamilton school teaching! How often this could be done in day-to-day busy practice? I have yet not seen a patient responding so well and so rapidly to simple antireflux therapy, after 20 years of cough!
Basic Knowledge Deficit=E.B.M 1 June 1998
Carlos A Selmonosky Send response to journal: Re: Basic Knowledge Deficit=E.B.M	That a search for the etiology of the patient cough was needed reveals a lack of awareness of a most common one. The supraesophageal complications of esophageal reflux.
A paediatric perspective of the 20 year cough 1 June 1998
Roger Buchdahl, Consultant Paediatrician The Hillingdon Hospital and Royal Brompton & Harefield NHS Trusts Send response to journal: Re: A paediatric perspective of the 20 year cough	Although there is mention of aortic aneursym in Paul Glasziou's case report of the 66 year old lady with a 20 year history of cough there is no reference to congenital abnormality such as a vascular ring or bronchogenic cyst as a possible cause. As a paediatrician I would always include this possibility in my algorithm along with the notorious inhaled foreign body. Perhaps this is why no mention was made of a chest radiograph being performed in this case (although the procedure was suggested in the table). As a paediatrician I am often constrained to treat empiracally. But with a chronic history rarely in the absence of a chest radiograph.
Evidence based case reports in the undergraduate curriculum 24 June 1998
Ivan J Perry, Professor of Public Health Department of Epidemiology & Public Health, University College Cork, Republic of Ireland Send response to journal: Re: Evidence based case reports in the undergraduate curriculum	>The BMJ's evidence based case report [1] is an interesting and welcome >development. Over the past two academic years, we have used the concept of >an evidence based case report in teaching evidence based medicine (EBM) in the penultimate year of our undergraduate course in Epidemiology & Public Health. Students are asked to submit a case report based on the management of a single patient >encountered in the course of their clinical work. They are advised to >identify one key intervention in the management of the case and summarise >the evidence, if any, which supports this intervention. We ask that the >total length of the submission should not exceed 1,000 words, of which not >more than 300 words should be devoted to the description of the clinical >details of the case. Students are advised to use no more than five >references, taking care to select key papers and they are required to >describe the Medline search strategy employed. > >The case report contributes towards the students end-of-year mark in Epidemiology & Public Health. The exercise is designed to help the students relate the theory of >evidence based medicine to the reality of every day clinical practice. Marking the case reports provides good feedback on the effectiveness of our teaching in >evidence based medicine. A high proportion of students display evidence of critical reading of the key references. However, students tend to focus on the evidence >for pharmacological interventions, rather than other forms of therapy or diagnostic strategies. There is a marked reluctance to reflect critically (or even sceptically) on the management of the case. It is clear also that students experience difficulty with the formulation of good questions for EBM. These observations have prompted a review of methods and content in our teaching of EBM and we anticipate that the BMJ's "evidence-based" case reports will become a valuable teaching resource. In this medical school, as elsewhere, we are engaged in a review of the undergraduate curriculum. We aim to promote reflective, self-critical practice combined with an understanding of the scientific method. The standard of evidence based >case reports submitted by our students may emerge as a useful "outcome measure" for this aspect of the curriculum. > >Yours sincerely, > > > >Ivan J. Perry, MD, PhD., >Professor of Public Health, >Department of Epidemiology & Public Health >University College, Cork. > >email: i.perry@ucc.ie > Reference 1.Glasziou P. Twenty year cough in a non-smoker. BMJ 1998; 316: 1660-1661 >