- Pre-registration nursing students
- No definition of master’s degree in nursing described in the publication
After the search, we collated and uploaded all the identified records into EndNote v.X8 (Clarivate Analytics, Philadelphia, Pennsylvania) and removed any duplicates. Two independent reviewers (MCS and SA) screened the titles and abstracts for assessment in line with the inclusion criteria. They retrieved and assessed the full texts of the selected studies while applying the inclusion criteria. Any disagreements about the eligibility of studies were resolved by discussion or, if no consensus could be reached, by involving experienced researchers (MZ-S and RP).
The first reviewer (MCS) extracted data from the selected publications. For this purpose, an extraction tool developed by the authors was used. This tool comprised the following criteria: author(s), year of publication, country, research question, design, case definition, data sources, and methodologic and data-analysis triangulation. First, we extracted and summarized information about the case study design. Second, we narratively summarized the way in which the data and methodological triangulation were described. Finally, we summarized the information on within-case or cross-case analysis. This process was performed using Microsoft Excel. One reviewer (MCS) extracted data, whereas another reviewer (SA) cross-checked the data extraction, making suggestions for additions or edits. Any disagreements between the reviewers were resolved through discussion.
A total of 149 records were identified in 2 databases. We removed 20 duplicates and screened 129 reports by title and abstract. A total of 46 reports were assessed for eligibility. Through hand searches, we identified 117 additional records. Of these, we excluded 98 reports after title and abstract screening. A total of 17 reports were assessed for eligibility. From the 2 databases and the hand search, 63 reports were assessed for eligibility. Ultimately, we included 8 articles for data extraction. No further articles were included after the reference list screening of the included studies. A PRISMA flow diagram of the study selection and inclusion process is presented in Figure 1 . As shown in Tables 2 and and3, 3 , the articles included in this scoping review were published between 2010 and 2022 in Canada (n = 3), the United States (n = 2), Australia (n = 2), and Scotland (n = 1).
PRISMA flow diagram.
Characteristics of Articles Included.
Author | Contandriopoulos et al | Flinter | Hogan et al | Hungerford et al | O’Rourke | Roots and MacDonald | Schadewaldt et al | Strachan et al |
---|---|---|---|---|---|---|---|---|
Country | Canada | The United States | The United States | Australia | Canada | Canada | Australia | Scotland |
How or why research question | No information on the research question | Several how or why research questions | What and how research question | No information on the research question | Several how or why research questions | No information on the research question | What research question | What and why research questions |
Design and referenced author of methodological guidance | Six qualitative case studies Robert K. Yin | Multiple-case studies design Robert K. Yin | Multiple-case studies design Robert E. Stake | Case study design Robert K. Yin | Qualitative single-case study Robert K. Yin Robert E. Stake Sharan Merriam | Single-case study design Robert K. Yin Sharan Merriam | Multiple-case studies design Robert K. Yin Robert E. Stake | Multiple-case studies design |
Case definition | Team of health professionals (Small group) | Nurse practitioners (Individuals) | Primary care practices (Organization) | Community-based NP model of practice (Organization) | NP-led practice (Organization) | Primary care practices (Organization) | No information on case definition | Health board (Organization) |
Overview of Within-Method, Between/Across-Method, and Data-Analysis Triangulation.
Author | Contandriopoulos et al | Flinter | Hogan et al | Hungerford et al | O’Rourke | Roots and MacDonald | Schadewaldt et al | Strachan et al |
---|---|---|---|---|---|---|---|---|
Within-method triangulation (using within-method triangulation use at least 2 data-collection procedures from the same design approach) | ||||||||
: | ||||||||
Interviews | X | x | x | x | x | |||
Observations | x | x | ||||||
Public documents | x | x | x | |||||
Electronic health records | x | |||||||
Between/across-method (using both qualitative and quantitative data-collection procedures in the same study) | ||||||||
: | ||||||||
: | ||||||||
Interviews | x | x | x | |||||
Observations | x | x | ||||||
Public documents | x | x | ||||||
Electronic health records | x | |||||||
: | ||||||||
Self-assessment | x | |||||||
Service records | x | |||||||
Questionnaires | x | |||||||
Data-analysis triangulation (combination of 2 or more methods of analyzing data) | ||||||||
: | ||||||||
: | ||||||||
Deductive | x | x | x | |||||
Inductive | x | x | ||||||
Thematic | x | x | ||||||
Content | ||||||||
: | ||||||||
Descriptive analysis | x | x | x | |||||
: | ||||||||
: | ||||||||
Deductive | x | x | x | x | ||||
Inductive | x | x | ||||||
Thematic | x | |||||||
Content | x |
The following sections describe the research question, case definition, and case study design. Case studies are most appropriate when asking “how” or “why” questions. 1 According to Yin, 1 how and why questions are explanatory and lead to the use of case studies, histories, and experiments as the preferred research methods. In 1 study from Canada, eg, the following research question was presented: “How and why did stakeholders participate in the system change process that led to the introduction of the first nurse practitioner-led Clinic in Ontario?” (p7) 19 Once the research question has been formulated, the case should be defined and, subsequently, the case study design chosen. 1 In typical case studies with mixed methods, the 2 types of data are gathered concurrently in a convergent design and the results merged to examine a case and/or compare multiple cases. 10
“How” or “why” questions were found in 4 studies. 16 , 17 , 19 , 22 Two studies additionally asked “what” questions. Three studies described an exploratory approach, and 1 study presented an explanatory approach. Of these 4 studies, 3 studies chose a qualitative approach 17 , 19 , 22 and 1 opted for mixed methods with a convergent design. 16
In the remaining studies, either the research questions were not clearly stated or no “how” or “why” questions were formulated. For example, “what” questions were found in 1 study. 21 No information was provided on exploratory, descriptive, and explanatory approaches. Schadewaldt et al 21 chose mixed methods with a convergent design.
A total of 5 studies defined the case as an organizational unit. 17 , 18 - 20 , 22 Of the 8 articles, 4 reported multiple-case studies. 16 , 17 , 22 , 23 Another 2 publications involved single-case studies. 19 , 20 Moreover, 2 publications did not state the case study design explicitly.
This section describes within-method triangulation, which involves employing at least 2 data-collection procedures within the same design approach. 6 , 7 This can also be called data source triangulation. 8 Next, we present the single data-collection procedures in detail. In 5 studies, information on within-method triangulation was found. 15 , 17 - 19 , 22 Studies describing a quantitative approach and the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review.
Five studies used qualitative data-collection procedures. Two studies combined face-to-face interviews and documents. 15 , 19 One study mixed in-depth interviews with observations, 18 and 1 study combined face-to-face interviews and documentation. 22 One study contained face-to-face interviews, observations, and documentation. 17 The combination of different qualitative data-collection procedures was used to present the case context in an authentic and complex way, to elicit the perspectives of the participants, and to obtain a holistic description and explanation of the cases under study.
All 5 studies used qualitative interviews as the primary data-collection procedure. 15 , 17 - 19 , 22 Face-to-face, in-depth, and semi-structured interviews were conducted. The topics covered in the interviews included processes in the introduction of new care services and experiences of barriers and facilitators to collaborative work in general practices. Two studies did not specify the type of interviews conducted and did not report sample questions. 15 , 18
In 2 studies, qualitative observations were carried out. 17 , 18 During the observations, the physical design of the clinical patients’ rooms and office spaces was examined. 17 Hungerford et al 18 did not explain what information was collected during the observations. In both studies, the type of observation was not specified. Observations were generally recorded as field notes.
In 3 studies, various qualitative public documents were studied. 15 , 19 , 22 These documents included role description, education curriculum, governance frameworks, websites, and newspapers with information about the implementation of the role and general practice. Only 1 study failed to specify the type of document and the collected data. 15
In 1 study, qualitative documentation was investigated. 17 This included a review of dashboards (eg, provider productivity reports or provider quality dashboards in the electronic health record) and quality performance reports (eg, practice-wide or co-management team-wide performance reports).
This section describes the between/across methods, which involve employing both qualitative and quantitative data-collection procedures in the same study. 6 , 7 This procedure can also be denoted “methodologic triangulation.” 8 Subsequently, we present the individual data-collection procedures. In 3 studies, information on between/across triangulation was found. 16 , 20 , 21
Three studies used qualitative and quantitative data-collection procedures. One study combined face-to-face interviews, documentation, and self-assessments. 16 One study employed semi-structured interviews, direct observation, documents, and service records, 20 and another study combined face-to-face interviews, non-participant observation, documents, and questionnaires. 23
All 3 studies used qualitative interviews as the primary data-collection procedure. 16 , 20 , 23 Face-to-face and semi-structured interviews were conducted. In the interviews, data were collected on the introduction of new care services and experiences of barriers to and facilitators of collaborative work in general practices.
In 2 studies, direct and non-participant qualitative observations were conducted. 20 , 23 During the observations, the interaction between health professionals or the organization and the clinical context was observed. Observations were generally recorded as field notes.
In 2 studies, various qualitative public documents were examined. 20 , 23 These documents included role description, newspapers, websites, and practice documents (eg, flyers). In the documents, information on the role implementation and role description of NPs was collected.
In 1 study, qualitative individual journals were studied. 16 These included reflective journals from NPs, who performed the role in primary health care.
Only 1 study involved quantitative service records. 20 These service records were obtained from the primary care practices and the respective health authorities. They were collected before and after the implementation of an NP role to identify changes in patients’ access to health care, the volume of patients served, and patients’ use of acute care services.
In 2 studies, quantitative questionnaires were used to gather information about the teams’ satisfaction with collaboration. 16 , 21 In 1 study, 3 validated scales were used. The scales measured experience, satisfaction, and belief in the benefits of collaboration. 21 Psychometric performance indicators of these scales were provided. However, the time points of data collection were not specified; similarly, whether the questionnaires were completed online or by hand was not mentioned. A competency self-assessment tool was used in another study. 16 The assessment comprised 70 items and included topics such as health promotion, protection, disease prevention and treatment, the NP-patient relationship, the teaching-coaching function, the professional role, managing and negotiating health care delivery systems, monitoring and ensuring the quality of health care practice, and cultural competence. Psychometric performance indicators were provided. The assessment was completed online with 2 measurement time points (pre self-assessment and post self-assessment).
This section describes data-analysis triangulation, which involves the combination of 2 or more methods of analyzing data. 6 Subsequently, we present within-case analysis and cross-case analysis.
Three studies combined qualitative and quantitative methods of analysis. 16 , 20 , 21 Two studies involved deductive and inductive qualitative analysis, and qualitative data were analyzed thematically. 20 , 21 One used deductive qualitative analysis. 16 The method of analysis was not specified in the studies. Quantitative data were analyzed using descriptive statistics in 3 studies. 16 , 20 , 23 The descriptive statistics comprised the calculation of the mean, median, and frequencies.
Two studies combined deductive and inductive qualitative analysis, 19 , 22 and 2 studies only used deductive qualitative analysis. 15 , 18 Qualitative data were analyzed thematically in 1 study, 22 and data were treated with content analysis in the other. 19 The method of analysis was not specified in the 2 studies.
In 7 studies, a within-case analysis was performed. 15 - 20 , 22 Six studies used qualitative data for the within-case analysis, and 1 study employed qualitative and quantitative data. Data were analyzed separately, consecutively, or in parallel. The themes generated from qualitative data were compared and then summarized. The individual cases were presented mostly as a narrative description. Quantitative data were integrated into the qualitative description with tables and graphs. Qualitative and quantitative data were also presented as a narrative description.
Of the multiple-case studies, 5 carried out cross-case analyses. 15 - 17 , 20 , 22 Three studies described the cross-case analysis using qualitative data. Two studies reported a combination of qualitative and quantitative data for the cross-case analysis. In each multiple-case study, the individual cases were contrasted to identify the differences and similarities between the cases. One study did not specify whether a within-case or a cross-case analysis was conducted. 23
This section describes confirmation or contradiction through qualitative and quantitative data. 1 , 4 Qualitative and quantitative data were reported separately, with little connection between them. As a result, the conclusions on neither the comparisons nor the contradictions could be clearly determined.
In 3 studies, the consistency of the results of different types of qualitative data was highlighted. 16 , 19 , 21 In particular, documentation and interviews or interviews and observations were contrasted:
Both types of data showed that NPs and general practitioners wanted to have more time in common to discuss patient cases and engage in personal exchanges. 21 In addition, the qualitative and quantitative data confirmed the individual progression of NPs from less competent to more competent. 16 One study pointed out that qualitative and quantitative data obtained similar results for the cases. 20 For example, integrating NPs improved patient access by increasing appointment availability.
Although questionnaire results indicated that NPs and general practitioners experienced high levels of collaboration and satisfaction with the collaborative relationship, the qualitative results drew a more ambivalent picture of NPs’ and general practitioners’ experiences with collaboration. 21
The studies included in this scoping review evidenced various research questions. The recommended formats (ie, how or why questions) were not applied consistently. Therefore, no case study design should be applied because the research question is the major guide for determining the research design. 2 Furthermore, case definitions and designs were applied variably. The lack of standardization is reflected in differences in the reporting of these case studies. Generally, case study research is viewed as allowing much more freedom and flexibility. 5 , 24 However, this flexibility and the lack of uniform specifications lead to confusion.
Methodologic triangulation, as described in the literature, can be somewhat confusing as it can refer to either data-collection methods or research designs. 6 , 8 For example, methodologic triangulation can allude to qualitative and quantitative methods, indicating a paradigmatic connection. Methodologic triangulation can also point to qualitative and quantitative data-collection methods, analysis, and interpretation without specific philosophical stances. 6 , 8 Regarding “data-collection methods with no philosophical stances,” we would recommend using the wording “data source triangulation” instead. Thus, the demarcation between the method and the data-collection procedures will be clearer.
Yin 1 advocated the use of multiple sources of evidence so that a case or cases can be investigated more comprehensively and accurately. Most studies included multiple data-collection procedures. Five studies employed a variety of qualitative data-collection procedures, and 3 studies used qualitative and quantitative data-collection procedures (mixed methods). In contrast, no study contained 2 or more quantitative data-collection procedures. In particular, quantitative data-collection procedures—such as validated, reliable questionnaires, scales, or assessments—were not used exhaustively. The prerequisites for using multiple data-collection procedures are availability, the knowledge and skill of the researcher, and sufficient financial funds. 1 To meet these prerequisites, research teams consisting of members with different levels of training and experience are necessary. Multidisciplinary research teams need to be aware of the strengths and weaknesses of different data sources and collection procedures. 1
When using multiple data sources and analysis methods, it is necessary to present the results in a coherent manner. Although the importance of multiple data sources and analysis has been emphasized, 1 , 5 the description of triangulation has tended to be brief. Thus, traceability of the research process is not always ensured. The sparse description of the data-analysis triangulation procedure may be due to the limited number of words in publications or the complexity involved in merging the different data sources.
Only a few concrete recommendations regarding the operationalization of the data-analysis triangulation with the qualitative data process were found. 25 A total of 3 approaches have been proposed 25 : (1) the intuitive approach, in which researchers intuitively connect information from different data sources; (2) the procedural approach, in which each comparative or contrasting step in triangulation is documented to ensure transparency and replicability; and (3) the intersubjective approach, which necessitates a group of researchers agreeing on the steps in the triangulation process. For each case study, one of these 3 approaches needs to be selected, carefully carried out, and documented. Thus, in-depth examination of the data can take place. Farmer et al 25 concluded that most researchers take the intuitive approach; therefore, triangulation is not clearly articulated. This trend is also evident in our scoping review.
Few studies in this scoping review used a combination of qualitative and quantitative analysis. However, creating a comprehensive stand-alone picture of a case from both qualitative and quantitative methods is challenging. Findings derived from different data types may not automatically coalesce into a coherent whole. 4 O’Cathain et al 26 described 3 techniques for combining the results of qualitative and quantitative methods: (1) developing a triangulation protocol; (2) following a thread by selecting a theme from 1 component and following it across the other components; and (3) developing a mixed-methods matrix.
The most detailed description of the conducting of triangulation is the triangulation protocol. The triangulation protocol takes place at the interpretation stage of the research process. 26 This protocol was developed for multiple qualitative data but can also be applied to a combination of qualitative and quantitative data. 25 , 26 It is possible to determine agreement, partial agreement, “silence,” or dissonance between the results of qualitative and quantitative data. The protocol is intended to bring together the various themes from the qualitative and quantitative results and identify overarching meta-themes. 25 , 26
The “following a thread” technique is used in the analysis stage of the research process. To begin, each data source is analyzed to identify the most important themes that need further investigation. Subsequently, the research team selects 1 theme from 1 data source and follows it up in the other data source, thereby creating a thread. The individual steps of this technique are not specified. 26 , 27
A mixed-methods matrix is used at the end of the analysis. 26 All the data collected on a defined case are examined together in 1 large matrix, paying attention to cases rather than variables or themes. In a mixed-methods matrix (eg, a table), the rows represent the cases for which both qualitative and quantitative data exist. The columns show the findings for each case. This technique allows the research team to look for congruency, surprises, and paradoxes among the findings as well as patterns across multiple cases. In our review, we identified only one of these 3 approaches in the study by Roots and MacDonald. 20 These authors mentioned that a causal network analysis was performed using a matrix. However, no further details were given, and reference was made to a later publication. We could not find this publication.
Because it focused on the implementation of NPs in primary health care, the setting of this scoping review was narrow. However, triangulation is essential for research in this area. This type of research was found to provide a good basis for understanding methodologic and data-analysis triangulation. Despite the lack of traceability in the description of the data and methodological triangulation, we believe that case studies are an appropriate design for exploring new nursing roles in existing health care systems. This is evidenced by the fact that case study research is widely used in many social science disciplines as well as in professional practice. 1 To strengthen this research method and increase the traceability in the research process, we recommend using the reporting guideline and reporting checklist by Rodgers et al. 9 This reporting checklist needs to be complemented with methodologic and data-analysis triangulation. A procedural approach needs to be followed in which each comparative step of the triangulation is documented. 25 A triangulation protocol or a mixed-methods matrix can be used for this purpose. 26 If there is a word limit in a publication, the triangulation protocol or mixed-methods matrix needs to be identified. A schematic representation of methodologic and data-analysis triangulation in case studies can be found in Figure 2 .
Schematic representation of methodologic and data-analysis triangulation in case studies (own work).
This study suffered from several limitations that must be acknowledged. Given the nature of scoping reviews, we did not analyze the evidence reported in the studies. However, 2 reviewers independently reviewed all the full-text reports with respect to the inclusion criteria. The focus on the primary care setting with NPs (master’s degree) was very narrow, and only a few studies qualified. Thus, possible important methodological aspects that would have contributed to answering the questions were omitted. Studies describing the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review due to the inclusion and exclusion criteria.
Given the various processes described for methodologic and data-analysis triangulation, we can conclude that triangulation in case studies is poorly standardized. Consequently, the traceability of the research process is not always given. Triangulation is complicated by the confusion of terminology. To advance case study research in nursing, we encourage authors to reflect critically on methodologic and data-analysis triangulation and use existing tools, such as the triangulation protocol or mixed-methods matrix and the reporting guideline checklist by Rodgers et al, 9 to ensure more transparent reporting.
Acknowledgments.
The authors thank Simona Aeschlimann for her support during the screening process.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
Have you ever thought of how many case studies must a student in medicine or business read in their lifetime? Tens, hundreds, or even thousands! As practice shows, the case study’s content is jam-packed with information and broad descriptions that are unnecessary when conducting a review or simply reading the literature.
We offer a Case Study Summarizer to scan any paper in seconds! You will get some valuable insights about our tool that can help with the most extended case studies in a short time! Moreover, we discuss the definition of the case study, its structure, and its main elements. Let’s begin!
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A case study is typically presented as a report, separated into sections with headings and subheadings. It must contain a description of the issue, an explanation of the relevance of the case, and an analysis with conclusions. It ends with implications and recommendations on how to address the issue.
A case study is a detailed investigation of one person, group, or event. It aims to learn as much as possible about an individual or a group to generalize the findings on other similar cases. The case study can be employed in various fields, including psychology, medicine, social work, etc.
Here are some case study topics from different professional spheres:
There are 8 essential elements in any case study. Check the table below to learn more details about each component.
Element | Constituents | Explanation |
---|---|---|
used for analysis | Describe the case study’s purpose and outline the primary issues and findings without going into specifics. | |
Introduce the case, giving background information on the subject and identifying its significance. | ||
Present the issues you have chosen and support each with facts and evidence to show their significance. | ||
Give a concise overview of your discovered issues and provide workable solutions to each. | ||
the report’s goal and highlight the key takeaways from the findings. | ||
Choose the solution that best addresses each issue. Then explain your decision and how it will aid in fixing the problems. | ||
An extended list of the used sources. | List all of the references included in the report according to the chosen citation style rules. | |
Any visual element used in the analysis. | Enclose any original data relevant to your analysis but not included in the main body. Appendices usually contain charts, graphs, and tables. |
Summarizing is a fundamental skill for everyone since it allows you to distinguish essential information and effectively communicate it to others. In the following paragraphs, we will share a case study summary tutorial.
An executive summary is a detailed overview of a report. It saves readers time by summarizing the essential points of the study. It is frequently written to be shared with people who may not have time to read the complete report, for example, CEOs or department heads.
Although the format may vary, the primary elements of an executive summary are as follows:
Your executive summary’s length will vary depending on the text it summarizes. Typically, it takes 10-15% of the full report’s length . Therefore, an executive summary can range from 1 paragraph to 10 pages.
Take these 5 steps to write a compelling case study summary:
Step 1 – Read the entire study
Before writing the summary, carefully read the research study from beginning to end.
Step 2 – Highlight the major points
As you read, make notes and underline significant facts, relevant conclusions, and suggested actions.
Step 3 – Divide the document into main sections
Determine what each part of the report is about, and summarize each in a few sentences. You can use the executive summary structure mentioned above to guide your writing.
Step 4 – Be concise
Do not write more than 10% of the length of the original document.
Step 5 – Proofread your summary
Reread your case study summary to ensure it makes sense as an independent piece of writing. Set it aside for a while and look at it with fresh eyes to notice any incoherence and redundant or lacking details.
We have prepared an example of a case study summary for you to see how everything works in practice!
Here is the full report: Akron’s Children’s Hospital: Case Study .
Now, check its summarized version:
Akron Children’s Hospital is a leading pediatric hospital in Northeastern Ohio that faces competition and needs to differentiate itself to attract more patients. To gain insight into the decision-making process of patients' parents, the hospital hired a team of researchers led by Marcus Thomas LLC to conduct business and market analysis.
An observational study was conducted to collect consumer data, including perceptions of the hospital and the criteria used to select it. The problem was that a highly competitive medical industry in Northeastern Ohio resulted in reduced patient volume and financial losses at Akron Children’s Hospital.
The proposed solution was to rethink the hospital’s operations and marketing approach to differentiate it from the competitors and attract more patients. Furthermore, the treatment of certain groups of children had to be improved by increasing the number of specializations available at the hospital.
The organization was recommended to develop an efficient marketing strategy, enhance service delivery, and implement highly innovative medical technologies and procedures.
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Updated: May 8th, 2024
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Case study, a term which some of you may know from the "Case Study of Vanitas" anime and manga, is a thorough examination of a particular subject, such as a person, group, location, occasion, establishment, phenomena, etc. They are most frequently utilized in research of business, medicine, education and social behaviour. There are a different types of case studies that researchers might use:
• Collective case studies
• Descriptive case studies
• Explanatory case studies
• Exploratory case studies
• Instrumental case studies
• Intrinsic case studies
Case studies are usually much more sophisticated and professional than regular essays and courseworks, as they require a lot of verified data, are research-oriented and not necessarily designed to be read by the general public.
It very much depends on the topic of your case study, as a medical case study and a coffee business case study have completely different sources, outlines, target demographics, etc. But just for this example, let's outline a coffee roaster case study. Firstly, it's likely going to be a problem-solving case study, like most in the business and economics field are. Here are some tips for these types of case studies:
• Your case scenario should be precisely defined in terms of your unique assessment criteria.
• Determine the primary issues by analyzing the scenario. Think about how they connect to the main ideas and theories in your piece.
• Find and investigate any theories or methods that might be relevant to your case.
• Keep your audience in mind. Exactly who are your stakeholder(s)? If writing a case study on coffee roasters, it's probably gonna be suppliers, landlords, investors, customers, etc.
• Indicate the best solution(s) and how they should be implemented. Make sure your suggestions are grounded in pertinent theories and useful resources, as well as being realistic, practical, and attainable.
• Carefully proofread your case study. Keep in mind these four principles when editing: clarity, honesty, reality and relevance.
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In order to be a leader in your industry, you need to know how to perform a competitive analysis. A competitor analysis is more than a simple SWOT analysis where you find the strength and weaknesses of your market segment. Evaluating your competitors is highly important and must be done through complete market research using an analysis template like the one that we're going to present in this article.
Finding out where your competition excels doesn't have to be a burden if you have the right strategy and necessary tools.
Why perform a competitor analysis, how to conduct your competitive analysis, step 1. find your top competitors, step 2. analyze your competitors popularity, step 3. identify the public perception of competitors, step 4. analyze your competitors' social media strategy, step 5. perform an seo competitor analysis.
Competitor analysis in digital marketing is the process of finding strengths and weaknesses of your competitors, relative to those of your own product or service.
There is no exact competitive analysis definition. Yet, you need to know that the strengths within a competitive analysis are the things that make you unique, your key selling point, the ideas around your whole business - which can be about the product or the team. On the opposite side, the weaknesses point out some deficiencies, and things you could improve, when it comes to your brand, or take advantage from, when it comes to the weaknesses of your competitors.
The competitive analysis has the role to make a valid and accurate market positioning and a report on what you are doing best, and where your competitors excel, and learn from that to win more potential customers. A competitive analysis also means picking the right competitors and looking at analytics that include business metrics, digital marketing analysis, social media metrics.
By doing an accurate competitor analysis you'll be able to receive a lot of data and insights for making better business decisions. Similar to an internal research, by evaluating quantitative and qualitative data, if you research your competitors, you will uncover effective strategies and new ideas for increasing your business' performance, be it on social media, on online, or in the physical store.
A well-performed competitor analysis will allow you to:
For a better understanding of how your competitor analysis framework should look like, we've performed a competitive market research on the cosmetic niche. We've analyzed several metrics on this market segment to conduct a competitive analysis as in-depth as possible, with most of the data being pulled out from brand mention monitoring.
Brand monitoring, when done with the right tools, is more versatile than you'd think. Running an in-depth brand mentions competitive analysis could help you make sure that you are not overlooking any efficient strategies that might be working wonders for your competitors.
They are talking about your company
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Even though you might be aware of some of your market leaders, there might be a few you're missing.
For our case study example, we searched for top leading beauty brands. As social media is a highly important segment within this industry, one of the analyses we've performed was to find the top-performing brands on social media, by the number of followers.
You can also search on Google for the relevant keywords in your business and see the top brands that are ranking for those keywords. And use a spying tool to find out important analytics on every website you want, such as the Mozbar browser extension.
Also, check out Social Media to figure out the businesses that pop out in results in your market. The research we performed helped us understand the niche a little better. Therefore, based on this research performed, we've chosen to continue our competitive analysis on the following brands:
It’s too complicated and actually impossible to manually track all your competitors’ records and activity, as much manual web scraping you'd be doing.
So, even if you know your competition , the question remains: how do you find who is the most popular brand in your niche?
Most popular = most mentioned
Tools like BrandMentions can make things easier.
Therefore, to answer to our main question, "how to perform a competitive analysis", you need to start performing an in-depth research of your competition. Brand Mentions allows you to track keywords, brands, product names or whatever you need.
Going back to the beauty niche we are analyzing, let's figure out the most popular brands here. We took BrandMentions for a spin, to find out the most popular beauty brand into a very competitive niche by analyzing and monitoring social media metrics. We analyzed the mentions for these beauty brands for a short period of time, October 14 - November 15 , Worldwide for all languages.
After analyzing the results, we saw that Sephora has some interesting discoveries. Compared to the rest of the beauty sites, Sephora has the highest number of mentions on web and social. In the printscreen below, we can see all mentions for each brand categorized by source (web and social).
By far, Sephora outranks the rest of beauty brands on the total amount of mentions on web and social.
The number of mentions could be explained by the fact that Sephora has more influencers that talk about it on Twitter. Results showed that the brand is mentioned by influencers with over 50k followers on Twitter compared to other beauty brands.
BrandMentions has a filter that allows you to filter mentions to see the Twitter posts from people that have a specific number of followers. The Twitter account for each brand was excluded.
Just by taking a look at your competitors and monitoring their brands, you can get a bunch of data:
And yes, all mentions matter, but some matter more than others.
When looking into your competitor’s yard, look at their best practices and try to figure out what worked best for them.
You must have heard at least once people saying that all publicity is good publicity, as long as they spell your name right. Or that the only thing worse than being talked about is not being talked about. But is it really so? How much does the public perception influence a brand's popularity? Let's find out!
The Sentiment Analysis feature allowed us to have a better understanding on the public perception of the analyzed brands. If we first identified the competitors and looked for the most popular ones, now we can have a look at how they are perceived in the online world.
How did we do that exactly?
We monitored all brands with BrandMentions as we said before, and from all mentions we started to filter them out. Filters are a blessing in this situation, giving you full control over the segment of mentions that you want to analyze.
Trying to manually find all the negative brand mentions that interest you is like trying to find a needle in a haystack.
After analyzing the sentiment analysis for each individual beauty brand ,we came to realize that most of them share a higher positive experience with the users.
By looking at the data, for all brands or just some of them, we can draw lots of conclusions. For instance, comparing to other brands, Benefit has the highest number of web and social mentions that have a positive sentiment analysis. If we look at the next graph, we can easily see that Benefits stands out:
Another thing we can observe is the fact that Benefit has the highest number of web mentions with a positive sentiment, as well. But the brand that is leading the positive social mentions is Sephora.
Even though Sephora has the highest number of positive social mentions, overall, compared to the rest of the beauty brands, it has the highest number of negative sentiment. Which might be a downsize for the brand.
Below you can see a comparison with the other cosmetics brand on positive and negative sentiment analysis.
We can see that most of the mentions are from social media and more specifically, from Twitter. The connection with the previous results might be stronger. Often time it has happened that people are more driven to write online about a negative experience, rather than a positive one.
We saw that the negative sentiment had the lowest value compared with the positive and neutral sentiment, with a single exception. Morphe had a higher neutral sentiment than the negative one. Check out the graphic below:
Urban Decay has the most naturally ordered distribution of the sentiment analysis for the mentions analyzed on web and social.
We are not saying that bad publicity couldn't be good publicity for some businesses or individuals. But for most businesses and niches, bad publicity and negative brand mentions are never a reason for joy but an occasion for a crisis communication meeting.
Another interesting thing to observe in the graph above is that Morphe has the highest negative sentiment analysis on social media.
People love it the most, but they also hate is the most, compared to the rest of the brands. If we look particularly at the brand to evaluate the total number of positive vs. negative sentiments, we can see that in the end, a positive experience overcomes the negative one, in terms of absolute numbers.
We've previously talked about Morphe saying that it has a higher number of neutral sentiments, the only brand with this particularity. We can understand that people have mixed feelings when it comes to this brand: You either love it or hate it.
Both positive and negative mentions have a big impact on the purchase decision of a client.
Although it might sound bad to spy on your competition , this marketing technique is a fully transparent, popular, and white-hat one. How else would we all improve ourselves and our brands if we were to not compare our endeavors with the others? And this is where a brand monitoring tool comes to rescue us.
When doing competitor spying, we are actually building PR relationships.
Both directly and indirectly.
Directly by getting to know your common audience better (the one your competition shares with you) through your competitors’ eyes, win ties with important outlets in the industry, etc.
In addition, while keeping “your enemies” closer, you indirectly relate to and establish a relationship with them. By constantly trying to keep up the pace with or outrun the brightest ones in the niche, and struggling not to ever fall in the pitfalls of black-hat marketing techniques other companies deploy in their strategies, you simply get better and better. In other words, you widen your professional circle.
Competitor spying is the more polite version of eavesdropping. There's no harm in doing it as long as you're using the tools to improve yourself and not disrupt the other.
You can easily gain insights on your competitors' performance and dig into their success strategies and use the lessons to your own benefit.
Tracking mentions for your competitor can lead you into discovering social media campaigns, new content ideas, top-performing social channel alongside types of content shared on each platform, plus trending hashtags used and top influencers for each competitor.
For instance, in our case, in the beauty niche, the results might surprise you. If you thought Instagram would be the most used Social Media platform for beauty products, you might be wrong.
According to the analysis performed in BrandMentions, it turned out that Twitter has the highest number of mentions for every beauty brand compared to the other social media marketing platforms.
If you thought that Instagram was the king of the beauty industry, you are wrong.
Of course, Instagram is a powerful Social Media channel, but maybe there's more in that direction. There are some insights related to this social platform, nonetheless. We know that Facebook became stricter about sharing data with third parties, so we can't see private posts. Instagram has shifted the strategy in this direction as well. Instagram started to hide likes in select countries earlier this year, and it will soon do the same in the United States.
This method affects the way we see data, on top of the fact that there are lots of users with private user accounts where even if you have an account you can't see their posts, likes, and stories.
After analyzing all the social mentions for all the beauty brands on all social platforms, here's what we discovered:
It seems that Twitter is a great way to start an influencer marketing strategy; it is also the most popular social media site. Finding all the information will help all marketers, brand managers, and community managers to build the best social media strategies for beauty brands.
When we looked at the distribution of web and social mentions for the beauty brands, we discovered 2 categories:
It's obvious that social is the king here. We won't bother you with tons of charts and data on all the analysed brands, yet, you need to know that within Brand Mentions you can perform any type of analysis you want when it comes to social mention analysis.
If we analyze one of the competitors, Morphe, we can see that it is more popular on Instagram by the number of mentions. It is seconded by a small number by Anastasia Beverly Hills.
Morphe has lots of mentions on Instagram, but it is on the 8th place when it comes to Instagram followers with 10.3m.
When it comes to answering the question on how to do a competitive analysis we know that what matter most are the insights you get to find out. And here are some great insights we've extracted for the most popular social media beauty sites scrutinized within our competitive analysis:
1. For the MAC Brand:
2. For the Sephora Brand:
3. For the Morhphe Brand:
4. For the Benefit Brand:
After analyzing all the mentions for all the beauty brands, there are lots of insights to help you create social media marketing strategies and find out the top competitors in your niche.
Knowing how to analyze your SEO competition is an important step in determining your overall keyword and SEO strategy. There are many factors involved in the process, and without the correct framework, it can get complicated. Here you can find the steps for the SEO competitor analysis explained, as clear and simple as possible. Within the screenshot below you can see the main steps that you need to take to make sure you perform an SEO competitive analysis at the highest level.
We used BrandMentions to analyze the beauty content and all the mentions for each beauty brand : MAC cosmetics, Kylie cosmetics, Anastasia Beverly Hills, Sephora, NYX, Too Faced, Urban Decay, Morphe, Tarte, Benefit.
Each created project had the name of the brand, and we added the keywords, domain URL, Facebook and Twitter account for higher accuracy in finding relevant mentions. We let the tool do its magic and analyze the beauty content on social media and the web.
For the metrics and discoveries made, we used filters and features available in BrandMentions, such as Sentiment Analysis analyzer, web and social sources, mentions from Twitter accounts with a specific number of followers and more. Check out the data for designing your winning social media strategy.
Also, the trigger was when we found a research on Statista with most followed cosmetics brands on Instagram; so we thought of performing a deeper analysis on the topic, and finding the most popular beauty site on Social Media, not only on Instagram. We wanted to see if there more we needed to know. And yes, there was so much more.
For an effective competitive research, there are multiple things that need to be taken into consideration, beside web and social listening. Things like brand awareness , customer experience, target audience, the search engines you are interested in, target market, the service or product features, the competitors sales, etc. This is not a complete guide to obtain competitive advantages that applies for all. But a competitor analysis template that helps you best identify your competitors and your main competitor strengths and weaknesses.
The best time to start finding out information about your competitors is now. So even if you are a content marketer, a small online store owner or a big ecommerce business , an online marketing specialist or you're in the sales teams, you need to start digging into competitive intelligence.
Confidence in your brand is important, but it’s only the beginning. To make a real impact, you need to back up your claims with solid proof. That’s where case study videos come in. Let your satisfied customers do the talking giving new leads an authentic view into your products and services. Let’s look at how to create case study videos easily.
Article Last Updated: August 23, 2024
Types of case study videos, why are case study videos important, how and where to use your case study video, how to create an impactful case study video.
Who doesn’t enjoy a captivating story? That’s likely why case study videos have become so popular. They’re more than just stories as they offer a deep dive into real-world scenarios, featuring genuine people and authentic businesses. Through these videos, companies showcase the real impact of their products and services, whether it’s through documenting product development , cultural shifts, or community impact.
To bring these stories to life, tools like Zight can be incredibly useful. With Zight’s features like screen recording , GIF creation , and easy file sharing , you can capture every moment and detail seamlessly. Imagine using Zight to record a customer’s success journey or create engaging visuals to complement your narrative. It’s all about making your case study videos as compelling and impactful as possible.
The question is, what does a good case study video look like? Our guide below will cover every aspect of case study videos, from their purpose, creating compelling videos, exploring what makes them successful, and sharing practical case study video examples and tips to help you craft impactful case study videos that resonate and drive results. Let’s get into it.
A case study video is a type of video content that demonstrates how other people are successfully using and benefiting from a product. It focuses on real customer success stories to show the value of a company’s products or services. In a crowded market of claims and promises, these videos serve as credible proof that your business delivers on its promises.
The strength of a case study video comes from its relatability. When potential customers see themselves in your stories, it fosters a true connection. Seeing real people handle challenges makes your business appear more trustworthy and your solutions more appealing. After all, who could offer a more credible opinion to potential customers than someone who’s experienced your services firsthand?
Both written and video case studies aim to convert customers, but video case studies have several specific advantages:
Like in any film or video genre, you’ll notice certain styles and tones that recur frequently. This is also true for case study videos, where you’ll come across several common types as you explore case study videos.
That said, there are different types of case study videos that your business can produce, with different levels of complexity. Each type of case study video has a specific customer problem and appeals to different aspects of your audience’s decision-making process. Depending on your objectives and the topic, choosing the right style of case study video can effectively communicate the message you want to share.
This type of video is quite simple to make and is one of the easiest case study videos to make. In customer testimonial videos, you interview your happy customers about their experience with your business and its impact on their lives. Since it involves just a straightforward interview with the customer, you only need one filming location and minimal editing to create the video.
Product or service review case study videos provide a thorough look at your offering’s features, functionality, and benefits. They offer an objective assessment and serve as valuable resources for new customers.
Target Audience : These videos target potential customers who are researching your product or service and need detailed information to make an informed decision.
This video is a standout example of customer testimonials. Instead of simply listing features, the interviews highlight the challenges the company faced and how Zoom provided effective solutions . The video’s concise length keeps viewers engaged while still delivering a complete and compelling story in one location.
Customer reviews are authentic insights that highlight a product’s real-world performance. Much like a customer testimonial video, a customer review video features a happy customer discussing your product or service. However, there’s a key difference: in a customer review video, the customer focuses more on the specific features of the product or service, rather than just the value it provided them.
Depending on your approach, such videos may include footage of the customer using your product on camera. Generally, most case study video testimonials follow a Q&A style of storytelling .
Creating a customer review video is straightforward. The interview portion requires just one shoot location and minimal editing. If you decide to add footage of the product in action, the shoot and editing process will be more complex.
Target Audience : These videos are aimed at potential customers who are actively researching your product or service. They provide detailed information to help them make an informed purchase decision.
This customer review case study video features Lana Blakely who explains how Notion has transformed her personal and professional life. She breaks down specific features like databases, templates, and task management tools, showing real-life examples of how she uses the app to stay organized. The video includes screen recordings of how she navigates the Notion workspace, providing viewers with a visual understanding of how the platform functions. Any potential customer actively looking for Notion will find information about the tool and can be able to make an informed decision.
This is the most complex type of case study video. A case study narrative video involves on-camera interviews with customers and B-roll visuals, such as footage of the customer using your product or your team engaging with the customer. Additionally, these videos often incorporate graphics and text overlays. Due to its complexity, creating this type of video content demands more shoot time, strategic planning, and extensive editing .
Narrative case study videos focus on storytelling , aiming to engage viewers emotionally by presenting a compelling narrative highlighting a customer’s journey from problem to solution, often emphasizing the transformative aspects.
Target Audience : Narrative case study videos are particularly effective for creating an emotional connection with viewers, engaging a wide range of audiences, including those in the awareness and consideration stages.
This video by LLLLITL is a case study of Dove’s “Turn Your Back” campaign, which was designed to raise awareness about the issue of body image. The video uses powerful storytelling to connect with viewers on an emotional level.
Case study videos can significantly enhance your video marketing strategy , particularly for B2B companies . They provide a rich, multi-faceted way to showcase a product or service and offer benefits beyond financial gains. Here is why they are important:
After perfecting your case study video, it’s time to share it with your target audience. But where should you promote it?
Now that you have seen some examples of case study videos, you can now create your case study video. Case studies don’t always stick to a strict timeline or template, but some key steps are usually involved in creating a case study video. Follow these steps to create an engaging case study video that will resonate with your audience.
The first step in crafting an attention-grabbing case study video is selecting the right story. You need a story that resonates with your target audience and showcases clear results.
For instance, if you run a software company like Zight, don’t just feature any client who used your software. Highlight businesses that experienced a boost in efficiency with your platform . Numbers like these provide concrete proof of your product’s effectiveness.
Your audience is looking for solutions, so your story should present a compelling example of how you’ve delivered just that. A thoughtfully chosen story sets the stage for a truly engaging case study video.
The next key step is to craft the right questions. These will be the basis of your case study video.
This thoughtful questioning will help create a well-rounded story, listing the problem, the solution, and the impact of your product or service.
You might have a great customer success story and perfectly crafted questions, but they won’t make an impact if they don’t resonate with your target audience’s needs and interests.
Imagine you’re showcasing Zight. Your audience could range from tech-savvy professionals to small business owners who aren’t as familiar with advanced tools. If your case study highlights a large corporation using Zight’s advanced features , it might not connect with a small business owner looking for simple and effective screen recording solutions .
Before diving in, do some audience research. What challenges are they facing? What solutions are they after? Tailor your case study video to address these, using language and examples that speak directly to their needs.
To craft an engaging storyline for your case study video, you need to guide the viewer through a story that resonates. Start with a compelling introduction that highlights a common problem your audience faces, making it instantly relatable.
For instance, if you’re showcasing Zight, an issue could be the struggle businesses face with lengthy communication chains that slow down decision-making. Many teams feel this pain, making it an effective hook. Then, introduce Zight as the solution. This is where you spotlight its unique features—like screen recording and sharing capabilities—that streamline communication and boost productivity .
Support your claims with testimonials or expert opinions to add credibility. Hearing from satisfied users can make a significant impact.
Finally, wrap up by showcasing measurable results . Use statistics or before-and-after comparisons to emphasize how Zight made a difference. Conclude with a clear call-to-action, guiding the viewer on what steps to take next.
Conducting background interviews is essential before you start filming. These pre-shoot conversations offer valuable insights that can enhance your storyline. They help you understand the full scope of the customer’s experience , adding richness and depth to your case study video.
These interviews also help you identify key talking points and decide who should be featured in the video. Whether it’s the CEO providing strategic insights or a front-line employee sharing day-to-day benefits, understanding this in advance ensures you capture the most relevant content, saving you time and effort during production.
The video script is the backbone to create engaging video content, pulling together visuals, dialogue, and pacing to create a cohesive story. Here’s how to craft one that leaves an impact:
Wrap up with a compelling call-to-action , guiding viewers on what to do next, whether that’s visiting your website or reaching out to your sales team.
Including data and statistics adds credibility to your case study video. While a compelling story captures attention, solid data reinforces your claims and makes your video campaigns more convincing.
Incorporate charts, graphs, or other visuals to present the data. Visual elements help make complex information more digestible and memorable. Ensure the data aligns with your storyline and addresses the needs or concerns of your audience.
The location you choose for your case study video adds depth and context to your story. Opt for a setting that complements the narrative and enhances its authenticity. For instance, if your case study involves educational software, filming in a classroom or school can make the story feel more genuine.
Your location should also resonate with your audience. Remember to consider practical aspects like lighting , sound, and permissions. The perfect location can fall flat if it has poor acoustics or requires difficult-to-obtain permits.
A carefully planned shot list is essential for a smooth filming experience. It details every shot you need, acting as a guide for your production team.
For example, if you’re capturing a customer testimonial, your shot list might include:
Your shot list should specify the type of shots—wide, medium, or close-up—and any particular camera movements like pans or zooms. This ensures you capture all the crucial elements of your video marketing campaign from product details to emotional moments.
A shot list also helps you manage time and resources efficiently, allowing you to anticipate special equipment or lighting needs ahead of time, and preventing last-minute scrambling.
This is where all your planning comes to life. Stick to your shot list and script during the shoot, but be open to capturing spontaneous moments that could enhance the story. High-quality equipment is necessary for clear audio and well-lit scenes —these technical details can elevate your final product.
Editing is where you shape the story , choosing the best shots to create a compelling narrative. Use cutaways, transitions, and background music to keep the pacing dynamic and the viewer engaged.
Pay attention to color grading, sound mixing, and special effects, ensuring they match the tone and message of your video. Avoid overdoing effects, as they can easily overshadow the content.
Now that you’ve seen how major brands craft their case study videos, let these examples spark ideas for your own. Use them to motivate your sales team , improve your video marketing strategy, and captivate your audience.
In addition, incorporating tools like Zight offers practical solutions such as screen recording and GIF creation, these videos not only tell a compelling story but also demonstrate how your product can deliver tangible results. What are you waiting for? Sign up and get started .
Create & share screenshots, screen recordings, and GIFs with Zight
Klaus Vedfelt
By Ibrahim Kanan & Tony DeSpirito
The healthcare sector offers a compelling mix of defensive characteristics and growth potential driven by innovation. It also features ample dispersion that presents stock pickers with an opportunity to parse potential leaders and laggards in pursuit of above-market return.
As active equity investors , we’re not content to accept what the market has to offer. Our mission is to assess companies on their underlying fundamentals to target those stocks that, we believe, have the potential to outperform the broad market over a three- to five-year time horizon.
This mission takes on greater significance in what we see as a new era of more normalized interest rates and volatility 0 an environment in which a rising tide no longer lifts all boats and stock selection becomes more important to portfolio outcomes.
While attractive opportunities are on offer across all sectors and industries, our daily work as stock pickers has revealed that the opportunity for selectivity is more prominent in some areas of the market - a function of greater dispersion and industry-level nuance that can be concealed at the broad index level. Case in point: The tech sector led the market in the first half of this year, but the lion’s share of that return came from semiconductors - the not-so-secret sauce to enabling AI.
More surprising may be the importance of selection in the healthcare sector. As shown in the chart below, healthcare ranks among the top three sectors for return differentiation across individual stocks. This suggests greater opportunity to apply fundamental research to parse potential winners and losers in pursuit of index-beating returns.
Healthy stock-picking opportunities Average return dispersion across selected sectors, 2003-2023
Source: BlackRock Fundamental Equities, with data from Refinitiv, Dec. 31, 2003-Dec. 31, 2023. Chart shows the average dispersion of annual return across the noted sectors in the Russell 1000 Index. Dispersion is defined as interdecile range, or the difference between the 10th (TOP) and 90th percentile of stock returns within each sector. “Remaining sectors” include energy, comms services, financials, materials, industrials, consumer staples, real estate and utilities.
We have felt this firsthand in our work analyzing stocks for inclusion in the BlackRock Equity Dividend Fund and BlackRock Large Cap Value ETF , where healthcare was the second-largest sector exposure and a top contributor to return despite relatively muted performance at the index level in 2023. (Healthcare returned 2% in 2023 versus an S&P 500 return of 26%.)
The big picture around healthcare makes it an appealing sector for long-term investors. It tends to do relatively well no matter the economic backdrop, given that healthcare needs do not change with GDP. It benefits from the secular tailwind of aging populations, as age begets greater healthcare needs and associated increases in health-related spending. It’s also a diverse sector that is rife with innovation. And despite all of this, the healthcare sector has been trading at an attractive valuation that is below the broad market average.
Importantly, however, not all healthcare stocks offer the same appeal, and investing at the index level could expose portfolios to big risk. The reason: U.S. healthcare benchmarks include heavy weightings in mature pharmaceutical companies - and these face an onslaught of revenue-busting patent expirations that could weigh on their performance, as well as that of the healthcare indexes.
When drug patents expire and cheaper generics come to market, drug maker revenues inevitably decline. Our analysis shows several major U.S. pharma companies losing patent protection on up to 70% of their revenue by 2030.
These companies’ profits are also at risk of disproportionate decline, as it’s usually the oldest and highest-margin products that are losing patent protection. This is because drug makers tend to increase prices incrementally each year after a new product launch. Their manufacturing costs, however, remain stable - allowing gross margins to rise. Companies also spend less on marketing as a drug matures and gains popular recognition. By the time these drugs hit patent expiration and fall off a company’s line-up, they typically have grown to become the highest-margin products.
Another complicating factor: When a drug patent expires, the same sales force is selling one less product, rendering the business less productive. Companies must find something new to sell to justify the fixed cost of their sales force, or otherwise shrink their business. The options here are limited:
1) Spend more on research and development (R&D) of new products. The rub: Returns on R&D have been declining and the process requires substantial time.
2) Negotiate a deal to buy a (hopefully) blockbuster drug. The rub: Companies typically overpay on high expectations for an essentially unknown, never-marketed product.
At the same time, the Inflation Reduction Act (IRA) imposes further price pressure by giving Medicare the authority to negotiate prices on select drugs. That process is underway, with results (and potential price reductions) due in September.
Given all of the above, valuations of many U.S. pharma companies require close scrutiny. Pricing that underestimates the pending impact of the patent cliff can make some of these stocks “value traps” - sporting a low price-to-earnings multiple that is actually much higher when accounting for their patent expirations and the associated earnings impact.
Active stock pickers can seek to avert much of the risk at the index level by avoiding those companies most exposed and directing their investments to more interesting pockets of healthcare. Among them:
European pharmaceutical companies. In general, these companies face a much less severe patent issue and have better drug pipelines, offering greater return potential and quality on a par with U.S. counterparts.
Makers of GLP-1 “diabesity” drugs. GLP-1s are a notable exception to our U.S. pharma aversion. We believe these promising new therapies for diabetes and weight loss have ample runway as they just begin their success journey.
Drug distributors. The patent cliff can be a boon for drug distributors in that they are able to distribute generic alternatives, which usually offer higher profit margins than branded products. Plus, volumes are higher as more generics become available once patent protection lapses.
The above case study is just one example of how active stock selection can help to achieve alpha, or above-market return, through a deep understanding of sector-level dynamics. We believe the ability to parse potential winners and losers based on underlying company fundamentals and observations of the industry environment should bring increasing value to portfolios, especially against a backdrop of heightened market dispersion.
© 2024 BlackRock, Inc. or its affiliates. All rights reserved.
Investing involves risk, including possible loss of principal. Investment in a specific sector can entail greater volatility given the narrower focus of the investment universe and concentration in sector-specific risks. Investments in health services industries may be affected by changes in regulations, advancing technological developments and product liability lawsuits.
This material is not intended to be relied upon as a forecast, research or investment advice, and is not a recommendation, offer or solicitation to buy or sell any securities or to adopt any investment strategy. The opinions expressed are as of August 2024 and may change as subsequent conditions vary. The information and opinions contained in this post are derived from proprietary and nonproprietary sources deemed by BlackRock to be reliable, are not necessarily all-inclusive and are not guaranteed as to accuracy. As such, no warranty of accuracy or reliability is given and no responsibility arising in any other way for errors and omissions (including responsibility to any person by reason of negligence) is accepted by BlackRock, its officers, employees or agents. This post may contain “forward-looking” information that is not purely historical in nature. Such information may include, among other things, projections and forecasts. There is no guarantee that any forecasts made will come to pass. Reliance upon information in this post is at the sole discretion of the reader. Past performance is no guarantee of future results.
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USRRMH0824U/S-3798496
This post originally appeared on the iShares Market Insights.
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Report by Romina Bandura , Madeleine McLean , and Caroline Smutny
Published August 26, 2024
Digital technologies define a modern economy by allowing companies, governments, and citizens to connect, transact, and gain access to goods and services. Within a country’s digital ecosystem, digital public infrastructure (DPI) enables citizens to interact with governments and to pursue economic opportunities. As outlined by the United Nations Development Programme, if DPI is applied to the financial sector it could accelerate the economic growth of Global South countries by 20–33 percent by 2030.
While not a new concept, the term DPI gained prominence during India’s 2023 Group of 20 (G20) presidency, and is defined as “as a set of shared digital systems that should be secure and interoperable, that can be built on open standards and promote access to services for all, with governance and community as core components of DPI.” A country’s DPI encompasses components such as a digital ID, a payment system, and a data exchange platform. Despite a common definition, there is no universal operating standard or model for DPI, and as such, countries are developing the concept in different ways to fit their own needs.
This paper describes how some countries in the Global South are approaching DPI by examining the positive elements and challenges facing each approach. As leaders in their respective regions, this paper highlights the DPI cases of India, Ukraine, Brazil, and Zambia, emphasizing different aspects of their approaches. As countries develop their digital ecosystems, these four case studies can provide guidance in moving forward and give both citizens and their governments a better understanding of the impacts that this infrastructure can have on their lives.
India has built a robust DPI, starting with an identification system. Just 15 years ago, one-third of the population ( approximately 400 million people ) had no form of official government identity, leaving much of the population unbanked, without access to credit, and unable to claim public benefits or social services. Rolled out in 2009 , India’s Aadhaar (meaning “foundation”) digital identity system allows Indian citizens to register for a unique biometric identity number. This enables government agencies, companies, banks, and others to verify a person’s identity instantaneously. By 2022, around 1.3 billion Indian citizens were registered on Aadhaar.
Complementing the digital ID, India deployed an open payment system , Unified Payments Interface (UPI), in 2016 , which has made payments “ as easy as sending a text or scanning a QR code ,” with no added transaction costs for merchants or consumers.
In addition to Aadhaar and UPI, India’s DPI has a “data layer” to allow citizens to virtually store, authenticate, and consensually share a myriad of personal data ranging from driver’s licenses and vehicle registrations to tax documents and medical records.
Taken together, these three layers comprise the core digital architecture of the “India Stack,” a system of interoperable, government-backed platforms that are “ stacked ” together to provide users with access to everything from public benefits to loan applications (Figure 1).
The ecosystem and actors underpinning the India Stack are complex. Government agencies, tech firms, semi-public corporations, universities, and nongovernmental organizations (NGOs) all contribute different elements of the digital infrastructure. Aadhaar is owned and operated by the government; UPI is run by a public-private partnership; and other apps are built by NGOs and tech firms before being sold to state and local governments.
The India Stack has become a powerful tool for financial inclusion. Citizens can now open bank accounts in minutes rather than weeks, and account ownership doubled between 2011 and 2021, reaching 78 percent of the population. Hundreds of millions in India’s welfare system can now receive “ direct benefit transfers ” to their Aadhaar-linked bank accounts, reducing bureaucratic red tape, slashing corruption, and saving the government $34 billion between 2013 and March 2021. During the Covid-19 pandemic, the system helped disburse emergency funds with remarkable efficiency.
India’s bid to go cashless in 2016 through its demonetization push raised the profile of its DPI model. For the fiscal year 2022–23, UPI processed roughly $1.7 trillion in transactions, accounting for over three-quarters of India’s digital retail transactions. This share is expected to rise to 90 percent by 2027 , even as the total volume of digital payments quadruples . Businesses can now access financial data from cash-based merchants who previously had evaded taxation, allowing the businesses to develop better underwriting capabilities and to extend credit to underserved entrepreneurs who formerly had been dependent on predatory lenders. The government has also benefited from increased tax collection efficiency, while consumers and merchants have earned greater interest income from going cashless.
Hundreds of millions in India’s welfare system can now receive “direct benefit transfers” to their Aadhaar-linked bank accounts, reducing bureaucratic red tape, slashing corruption, and saving the government $34 billion between 2013 and March 2021.
India’s DPI model is spreading abroad through several channels. India’s Modular Open-Source Identity Platform (MOSIP), deployed in 2018 , is marketed as a cost-effective way for low-income countries with limited IT capacity to kickstart their DPI journey. With many developing countries lacking a national ID system—let alone a digital one—for their citizens, MOSIP has generated international interest. The Philippines was the first large-scale MOSIP test case, and 76 million of the nation’s 110 million citizens have been issued digital IDs through its PhilSys system. Other pilot projects are currently underway in 16 more countries . Emerging in 2020, the export arm of the National Payments Corporation of India, NPCI International , is focused on deploying UPI abroad. In early 2023, NPCI International announced its new agreements to allow QR-based UPI payments in Cambodia, France, Hong Kong, Japan, Malaysia, the Philippines, South Korea, Taiwan, Thailand, and Vietnam.
The growing visibility and adoption of India’s technological solutions also bring greater scrutiny to its products, thus identifying potential risks. Challenges include cybersecurity concerns, data privacy, and the risk of government surveillance. Tens of millions of Aadhaar records have reportedly been exposed in a series of data breaches , and analysts have warned about privacy and data protection concerns . Critics also argue that the Indian government is subsidizing merchants using UPI to promote the system’s growth while eroding demand for credit cards. Finally, the state’s regulatory oversight has not kept pace with its digital push.
Despite these challenges, President Narendra Modi aspires to turn India into a world leader in digital technologies and made DPI the centerpiece of his country’s 2023 G20 presidency. Offering a more inclusive, bottom-up approach to sustainable development and growth, the India Stack resembles a “ low-cost, software-based version of China’s infrastructure-led Belt and Road Initiative .”
Ukraine’s digitalization journey began in 2014, when a wave of anti-corruption protests against the administration of former president Victor Yanukovych compelled a group of civic activists and tech entrepreneurs to overhaul the country’s notoriously corrupt government procurement system. Their efforts produced Ukraine’s flagship e-procurement system, ProZorro (meaning “transparent”). Noted for being “ more transparent and better integrated with commercial marketplaces than the U.S. [procurement] system ,” the platform has saved the Ukrainian government roughly $1 billion a year and turned the “ most corrupt nation in Europe ” into a recommended model of digital procurement reform.
President Volodymyr Zelensky’s vision to create a “ state in a smartphone ” in order to offer citizens 100 percent of government services online has driven a strategic, systematic, and cross-sectoral approach to the digitalization of government services. Announced in 2019, Zelensky’s digitalization agenda has produced major institutional shifts, policy reforms, and digital breakthroughs. His administration transferred responsibility for digital development to an empowered Ministry for Digital Transformation and appointed chief digital transformation officers in each government agency, both at the national and regional levels. At the policy level, the government has adopted various anti-corruption measures, digitalization initiatives, and digital skills development campaigns, all of which have complemented the rollout of new e-government services and digital solutions.
President Volodymyr Zelensky’s vision to create a “state in a smartphone” in order to offer citizens 100 percent of government services online has driven a strategic, systematic, and cross-sectoral approach to the digitalization of government services.
Between 2016 and 2020, Ukraine digitized nearly all of its government registries. While only 8 percent of Ukrainians used online public services in 2019, by 2020 nearly half of the population utilized digital public services. Ukraine is the first country in the world where digital smartphone passports “ have the same legal weight as the hard copy form of documents .”
Ukraine’s DPI is based on the Diia app and the related data exchange platform Trembita .
An Estonia-based system, Trembita was launched in Ukraine to facilitate the secure exchange of data between users and state databases. In conjunction with the Vulyk automation system , which stores digital records from roughly 600 administrative service centers across the country, Trembita’s standardization of data formatting and data sharing paved the way for the launch of Diia in 2020. The Diia app (meaning “action”) is an e-government web platform and mobile application that gives citizens access to government services via their smartphones. Like Ukraine’s other digital public goods, Diia was designed to reduce corruption and increase efficiency by making citizen-to-government interaction more direct, transparent, and impersonal. The Diia platform can be linked to different payment systems. Diia’s economic impact was valued at $455 million in 2021 and $1.34 billion in 2022. The core app has spawned a broader digital ecosystem of Diia-linked applications, offering public services ranging from digital literacy programs to entrepreneurial promotion.
Russia’s full-scale invasion of Ukraine in February 2022 has both complicated and accelerated Ukraine’s digital leap forward. Before the war, millions of Ukrainians were already using Diia to access digital IDs and medical records, pay taxes, receive pensions, and register vehicles and companies. With this foundation in place, the government was able to rapidly scale up Diia’s capacity to address wartime necessities, including registering internally displaced persons, recording property damage, logging the movement of Russian forces, purchasing war bonds, and accessing critical public information.
Diia’s user base has grown significantly since the start of the Russian invasion, and the platform now boasts over 21 million users and provides access to over 120 public services . The app has been downloaded on 70 percent of the smartphones in Ukraine, and new features are added regularly. Ukraine’s remarkable DPI progress—scaled in the context of active hostilities—is widely considered a model of public sector resilience and adaptability .
While the invasion has accelerated digitalization, it also threatens to upend it. By the end of 2022, the total cost of repairing Ukraine’s telecommunications sector, damaged by Russian attacks, was estimated at $1.79 billion . The obvious physical damage has been compounded by cyberattacks, a hallmark of Russia’s destabilization efforts worldwide. Ukraine’s implementation of state-of-the-art cybersecurity protections has thus far safeguarded personal data and kept government services online. As an important security measure, Diia does not store data directly and instead relies on Trembita and Vulyk to access information from decentralized databases. With over 100 dispersed government registries and databases, Ukraine’s data storage system is less vulnerable to external attacks than centralized systems such as the India Stack.
In terms of exporting Ukraine’s digital technologies to developing countries, the United States Agency for International Development (USAID) plans to provide at least $650,000 to help jump-start the proliferation of Diia-like systems and the digital technology services that underpin them. This is just the starting point: USAID plans to work with private sector investors to facilitate the dissemination of this technology as well. Through additional funding, USAID has pledged to assist partner countries in South America and sub-Saharan Africa to complete technical assessments and take other steps necessary to develop their own Diia-like apps for government services. In March 2024, Ukraine made Diia available for export as open-source code to support the digitalization of government services abroad.
Brazil’s lengthy digitalization journey has centered around citizen-first policies and government best practices. Having assumed the G20 presidency in 2024, Brazil is using this forum to further a DPI agenda within the developing world. It has declared DPI as one of the four priorities of the G20 Digital Economy Working Group .
At the core of Brazil’s DPI are two main platforms: Gov.br and Pix . Gov.br is a digital ID system used by the entire federal government; it emerged from government attempts to streamline the varying ID systems across Brazil’s 27 states together and to make those and other IDs interoperable. In 2004 , Brazil acquired the capability to digitize biometric data, which led the electoral court to use it for voter registration . Over the past two decades, the government’s investments in digital technologies and data security have resulted in the Gov.br system. Importantly, the program has focused on increasing interoperability for streamlined public service delivery. Today, approximately 146 million citizens have registered their digital identities and signatures to access government resources .
While Gov.br focuses on digital governance and ID, Pix forms the backbone of Brazil’s digitized payment infrastructure. In 2020, the Central Bank of Brazil created Pix, an instant payment system. Since it requires having a bank or payment account, Pix can be understood as the facilitator between individual accounts and businesses. By increasing the speediness of transactions and eliminating transfer costs, Pix supports financial inclusion efforts. Since its launch in 2020, Pix has registered approximately 70 percent of the population and 79 percent of the businesses in Brazil. Today, it facilitates $300 billion worth of transactions per month. The Bolsa Familia, Brazil’s social welfare program, uses the Pix system to distribute financial assistance to approximately 14 million families, significantly reducing poverty rates across the country.
Despite the many opportunities available, Brazil’s DPI faces challenges related to data security, digital literacy, and trust. Approximately 36 million people lack internet access, and registration remains low in rural areas . Moreover, users often lack digital skills or do not understand how the system works, and fraud linked to Pix appears to be increasing. Finally, cyberattacks and user error have resulted in a series of technical issues facing ConecteSUS , the platform citizens use to access vaccination and healthcare information.
Despite the many opportunities available, Brazil’s DPI faces challenges related to data security, digital literacy, and trust.
The government of Brazil is working to address these issues and has announced plans to launch a national data policy to provide guidelines on data usage and protections across government agencies. This policy will outline specifically where and how a person’s data will be used. The World Bank’s Espírito Santo Digital Acceleration Project has pledged $76 million to improve digital literacy and skills, build additional infrastructure, and strengthen data protection. The digital literacy programs will primarily focus on women and girls, addressing the digital gender gap.
Neither Gov.br nor Pix are exportable technologies, but Brazil has taken a leading role in highlighting the benefits of DPI for development. In 2023, Brazil participated in approximately 15 bilateral discussions on digital government initiatives and shared its experiences with the African Union to help strengthen digitalization projects in Africa. As president of the G20, Brazil has the opportunity to prioritize DPI as a strategic tool to help meet the United Nation’s Sustainable Development Goals.
Zambia’s DPI journey has been propelled by strong political support. Appetite for DPI is evident in the recent wave of policies focused on e-governance, digital IDs, financial services, and the passage of official data exchange and protection legislation .
The Smart Zambia Institute (SZI), housed in the Office of the President, coordinates all e-government developments across agencies. Established through the Electronic Government Act No. 41 in 2021, SZI’s stated mandate is to coordinate information and communications technology (ICT) developments across the country and to build platforms that “ facilitate Government (G2G), Government to Business (G2B) and Government to Citizens (G2C) services in a secure and robust environment .” Zamportal , the “one-stop shop” to access Zambia’s e-government offerings and to make digital e-service payments, houses over 250 services across 26 agencies.
Working to create a unified digital ID, Zambia has adopted the new biometric Integrated National Registration Information System. This public-private collaboration represents the first overhaul of Zambia’s ID system since 1965 and is in the process of distributing digital IDs to everyone over the age of 16. This new system is expected to cost $54.8 million and will streamline processes, provide increased access to government services, and improve the national e-Know Your Customer platform. Moreover, the government has emphasized the importance of the interoperability of systems throughout Zambia’s digital transformation. The 2023 Electronic Government (General) Regulations state that all e-government services must “maintain and promote integrated and interoperable systems in the provision of services.”
Given that government-to-people and people-to-government services are at the nexus of its DPI, Zambia has focused on the development of government-to-people (G2P) payments. For example, the country is currently partnering with MOSIP and OpenG2P to provide financial assistance to combat the impacts of drought, which is affecting much of southern Africa. The country has also undergone a national financial switch , enabling bank-to-bank, bank-to-mobile, and bank-to-other payments to take place.
Zambia has seen a widespread shift toward digital payments and digital tools. As a result of these efforts, in 2023 mobile phone ownership increased 2.3 percent and mobile money subscribers reached 17.3 million people. As of 2024, approximately 7 million Zambians (out of a population of 20 million) possess a digitized ID, giving them access to e-government portals. The value of mobile money transfers rose 127 percent from 2017 to 2021, and the government has been working toward increasing the interoperability of its databases so that citizens have a more seamless e-government experience. Electronic government services have the potential to save Zambia approximately 0.9–1.1 percent of the country’s GDP, as laid out in the 2023–2026 National Electronic Government Plan .
Although the Zambian government has made significant strides in building the country’s digital public infrastructure, challenges persist. The costs of building hard infrastructure (e.g., ICT, energy, and internet connection), especially in rural areas, mean that low-income households are limited in the digital services they can use. In addition, there is insufficient coordination across government agencies, which slows down the operation and sustainability of digital services. Finally, limited digital literacy and technical skills, a lack of willingness to adapt to new technologies, and a high turnover rate of information and communication technology specialists have all diminished the potential to pursue leapfrog development of DPI.
Limited digital literacy and technical skills, a lack of willingness to adapt to new technologies, and a high turnover rate of ITC specialists out of the public sector have all diminished the potential to pursue leapfrog development of DPI.
Zambia is continuously working with stakeholders to build and strengthen its DPI. In 2023, the government entered into a memorandum of understanding with the Centre for Digital Public Infrastructure at the International Institute of Information Technology Bangalore to support the SZI’s implementation and scaling-up of DPI. Also in 2023, Zambia entered into an agreement with the government of Malawi to lower data prices and build internet connectivity through the Diplomatic Data Corridor. In June 2024, Zambia joined the 50-in-5 Campaign , a partnership of foundations, government agencies, and multilateral development banks aimed at developing safe and inclusive DPI. Moreover, to combat digital illiteracy, the SZI is actively working to increase digital fluency and awareness of digital services and has established several digital transformation centers across the country to support digital learning.
The four case studies outlined above represent a diverse set of country circumstances. However, the impact that DPI can have, including streamlining government services, strengthening financial inclusion efforts, and integrating forgotten citizens into society, is evident across India, Ukraine, Brazil, and Zambia. Given the plethora of DPI approaches being developed, countries have the opportunity to learn from each other by sharing best practices and mitigating technology-related risks.
Romina Bandura is a senior fellow with the Project on Prosperity and Development at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Madeleine McLean is a program coordinator and research assistant with the Project on Prosperity and Development at CSIS. Caroline Smutny is a program coordinator and research assistant for the Project on Critical Minerals Security at CSIS.
The authors would like to thank the following experts for their inputs: Fabro Steibel, executive director, Institute for Technology & Society; Gulsanna Mamediieva, adviser to the vice prime minister for innovation, Development of Education, Science & Technologies, Ministry of Digital Transformation of Ukraine; Shatakratu Sahu, research analyst and co-convenor, Global Technology Summit, Carnegie India; and Robert Karanja, senior director, Africa, Co-Develop Fund.
This paper is made possible through the generous support of the Bill & Melinda Gates Foundation.
This report is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
© 2024 by the Center for Strategic and International Studies. All rights reserved.
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Metastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary tract.
Case 1: an 86-year-old Japanese man was diagnosed with a small bladder tumor by computed tomography scan during post operative follow-up of malignant melanoma in the choroid of the left eye. Cystoscopy revealed black, nonpapillary tumors, suggesting metastatic malignant melanoma. Because no apparent invasive growth to muscle layer was observed by magnetic resonance imaging, transurethral resection was performed. Pathological appearance was compatible with metastatic malignant melanoma. No recurrence in urinary tract was observed; however, multiple liver metastasis was diagnosed at 3 months after surgery. Case 2: a 57-year-old Japanese man was diagnosed with right hydronephrosis due to ureteral tumor. He had a past history of subungual malignant melanoma to the left thumb 2 years prior to his visit. Right nephroureterectomy was performed, and pathological evaluation revealed metastatic malignant melanoma. He revisited 2 years later due to dysuria, and a large bladder tumor was revealed by ultrasound. Cystoscopy showed black-colored nonpapillary tumor, suggesting malignant melanoma. Total cystectomy was recommended; however, the patient withheld consent. Therefore, we performed transurethral resection. The resulting pathological finding was compatible with metastatic malignant melanoma without invasion to muscle layer. He remained free from local recurrence and metastasis for 22 years after surgery.
We successfully performed metastasectomy for bladder and ureteral metastases without recurrence in the urinary tract. Long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have the potential to improve survival.
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Malignant melanoma commonly occurs in the skin and metastasizes to lymph nodes (42–59%), lungs (18–36%), and liver (14–20%) [ 1 ]. Although bladder metastasis of malignant melanoma is reported in 14–22% of autopsy cases [ 2 ], clinically apparent cases reported in the English-language literature accounted for 31 cases, suggesting that metastatic lesions to the urinary tract are difficult to detect while patients are alive because they are less likely to exhibit symptoms [ 3 , 4 , 5 ]. Here, we report two cases of malignant melanoma metastasizing to urinary tract that were successfully treated with surgical intervention.
An 86-year-old Japanese man underwent left-eye enucleation due to malignant melanoma of the choroid 4 years prior to his visit. After surgery, computed tomography (CT) scan was performed every 6 months to screen for metastasis, with the most recent contrast CT scan revealing a small tumor in the bladder with weak enhancement (Fig. 1 A). The patient was then referred to our department, where cystoscopy was performed. The examination showed two black, nonpapillary tumors on the anterior wall of the bladder measuring approximately 5 mm and less than 1 mm, respectively (Fig. 1 B). Cytology of the urine was negative. MRI revealed small tumor showing high intensity on T1WI and low intensity on T2WI at anterior bladder wall without apparent invasive growth into the muscle layer (Fig. 1 C). Since the size of the tumors was small and less likely to invade the muscle layer, we decided to perform transurethral resection of bladder tumor (TUR-Bt). In the surgery, we incised the bladder mucosa from approximately 1 cm away from the tumors. Histological examination revealed proliferation of atypical cells with rounded hyperchromatic nuclei and intracytoplasmic melanin granules with a nodular appearance at the submucosal layer (Fig. 1 D, E). Immunohistochemically, the tumor cells were positive for Melan A and HMB-45 (Fig. 1 F). The appearance was similar to primary melanoma (data not shown) and compatible with metastasis of malignant melanoma. No apparent muscular invasion was observed.
Clinical and pathological appearance of case 1. Sagittal imaging of contrast computed tomography (nephrogenic phase) is shown ( A ). A small tumor with weak enhancement is suggested on the anterior side of the bladder. Cystoscopic appearance shows two nonpapillary black tumors ( B ). The bladder tumor shows high intensity in T1 weighted image (left), low intensity in T2 weighted image (right). No apparent muscle invasion is revealed in T2 weighted image of magnetic resonance imaging examination ( C ). Histological findings are shown ( D – F ). Atypical cells with intracytoplasmic melanin granules proliferate in the submucosal layer ( D , E ). The tumor cells are positive for Melan A (counterstaining with Giemsa, F )
The patient recovered without postoperative events. Three months after TUR-Bt, multiple liver metastases were discovered on CT scan. Since genetic analysis revealed no mutation in BRAF , treatment by immune checkpoint inhibitor was considered. However, the patient chose best supportive care without additional medical treatment. The general condition remained stable without recurrence in urinary tract at 6 months after surgery.
A 57-year-old Japanese man visited a private clinic with the chief complaint of right abdominal discomfort. Ultrasound examination revealed right hydronephrosis. Because CT scan suggested that the hydronephrosis was due to ureteral tumor (Fig. 2 A), the patient was referred to our department. The patient had undergone surgical intervention for subungual malignant melanoma to the left thumb 2 years prior to his visit. Retrograde pyelography showed complete obstruction of upper ureter, and the obstructed portion was matched to the ureteral tumor diagnosed by CT scan. Although urine cytology was negative, CT scan findings were compatible with ureteral carcinoma; therefore, we performed right nephroureterectomy. The resected specimen showed yellow–white and partially black colored pedunculated tumor to the upper ureter, and no satellite tumors were evident in the urinary tract (Fig. 2 B). Pathological findings showed submucosal proliferation of polygonal to spindle-shaped cells with oval to irregular-shaped nuclei and intracytoplasmic melanin granules (Fig. 2 C). The tumor cells were positive for Melan A and HMB-45, prompting a diagnosis of ureteral metastasis of known malignant melanoma. The patient recovered without postoperative event. A month after surgery, full-body radiological examination by CT scan, MRI, and bone scintigraphy was performed. Results revealed no apparent metastasis. Two years later, the patient revisited with a complaint of dysuria. Ultrasound and CT scan showed bladder tumor measuring approximately 4 cm in diameter (Fig. 2 D), and cystoscopy revealed black-colored nonpapillary tumor, suggesting malignant melanoma (Fig. 2 E). Because the tumor was large and invasion could not be ruled out, we recommended total cystectomy; however, the patient withheld consent. Therefore, we performed transurethral resection of bladder tumor (TUR-Bt). Pathological diagnosis of the resected specimens was compatible with malignant melanoma similar to the previously resected ureteral tumor (Fig. 2 F–H). Fortunately, no apparent invasion to muscle layer was observed, and the patient remained free from local recurrence and metastasis for 22 years after TUR-Bt.
Clinical and pathological appearance of case 2. Contrast computed tomography (early phase) reveals solid mass with weak enhancement in the upper ureter ( A , white arrow). Macroscopic appearance (cutting surface) of resected right kidney and the ureter is shown ( B ). Yellow–white and partially black colored pedunculated tumor in the upper ureter (yellow arrow). Contrast computed tomography (excretory phase) shows large bladder tumor ( D ), and cystoscopy reveals black-colored nonpapillary tumor ( E ). Histological appearances of ureteral tumor ( C ) and bladder ( F – H ) show submucosal proliferation of polygonal to spindle-shaped cells with oval nuclei and intracytoplasmic melanin granules. The tumor cells were positive for Melan A
Secondary bladder neoplasms have been reported to represent 2–3% of all malignant bladder tumors; however, the majority of these spread directly from adjacent organs, including colon, prostate, rectum, and cervix [ 6 , 7 ]. In metastatic secondary bladder neoplasm, the most common primary site is stomach (4.3% of all secondary bladder neoplasms), followed by skin (3.9%), lung (2.8%), and breast (2.5%) [ 6 , 7 , 8 ]. The most common histological type of secondary bladder neoplasm has been reported to be adenocarcinoma, with malignant melanoma being less common. However, a higher incidence of bladder metastasis of malignant melanoma was reported in autopsy cases. Sheehan et al . analyzed 5200 autopsy cases and reported 21 cases of metastatic bladder tumors, with 8 of these (38%) being metastatic malignant melanomas [ 9 ]. Bates reported as a possible reason for the frequency of secondary tumors to urinary and male genital tracts being higher in autopsy cases that autopsy cases were more likely to have disseminated disease [ 10 ]. In addition, sampling bias toward unusual lesions and convenience of observation by autopsy for outer layer of hollow organ were discussed with the conclusion that it is simpler to diagnose secondary neoplasia at autopsy than on the basis of biopsy.
Metastatic malignant melanoma of the bladder is typically reported to present as asymptomatic macroscopic hematuria and diagnosed by cystoscopy and histopathological features considered with clinical history of previous melanoma. Diagnostic criteria to determine whether malignant melanoma of the bladder is a primary tumor include (1) absence of any previous skin lesions, (2) absence of cutaneous malignant melanoma, (3) absence of primary visceral malignant melanoma, (4) absence of recurrence pattern showing consistency with the primary tumor diagnosis, and (5) atypical melanocytes at the tumor margin upon microscopic examination [ 9 ]. In our two cases, each patient had an apparent past history of primary melanoma, and the bladder tumor was pathologically compatible with primary tumor. Therefore, we diagnosed metastatic malignant melanoma of the bladder in both cases.
Ureteral metastasis of malignant melanoma is extremely rare. To the best to our knowledge, this is the ninth case report [ 11 , 12 , 13 , 14 ]. In addition, malignant melanoma occurred in the bladder metachronously. Because the tumor was located in the submucosal region (not the superficial region), metastasis was considered rather than intraluminal seeding from ureteral melanoma. Although all tumors were located in the submucosal area, no apparent muscle invasion was observed. Therefore, the tumors were completely resected without local recurrence.
When distant multiple metastases are discovered in patients with malignant melanoma, surgical intervention may be less indicated. However, complete resection may have the potential to improve overall survival (OS) in some cases. Deutsch et al . reported the patients with abdominal visceral metastases undergoing surgical resection had superior overall survival compared with patients treated with medical agents only, including new agents (18 months versus 7 months; P < 0.001) [ 15 ]. The study included 366 cases with metastasis in the gastrointestinal tract, 697 cases in the liver, 138 cases in the adrenal glands, 38 cases in the pancreas, 109 cases in the spleen, and 305 cases with multiple sites. Patients with metastasis to the gastrointestinal tract undergoing complete curative resection had the greatest benefit from metastasectomy (median OS of 64 months). However, no apparent benefit for OS was observed in patients receiving palliative surgery. The study included a large number of cases and yielded significant results; however, a limitation is that it was a retrospective analysis. Further prospective study is recommended to clarify the significance of metastasectomy.
Although there was no metastasis in another organs at surgery (complete metastasectomy was performed in this period), liver metastasis appeared at 3 months after TUR-Bt in case 1. On the other hand, long-term disease control (22 years) was observed in case 2 by complete resection. According to literature, complete curative metastasectomy may have benefit for patient survival, especially in metastasis to gastrointestinal tract; however, there was no evidence of metastasectomy in patients with metastasis to urinary tract. Therefore, accumulation and analysis of the cases with urinary tract metastasis will be necessary to clarify the benefit of metastasectomy.
On contrast CT scan, metastatic melanoma usually manifested as hyper vascular mass [ 16 ]. MRI showed high intensity on T1WI and low intensity mass on T2WI [ 17 ]. In our cases, weak enhancement was observed by contrast CT scan in both cases. In addition, MRI appearance of the bladder tumor on MRI was consistent with that of conventional malignant melanoma in case 1. Although no reports described the specific appearance of metastasis to genitourinary systems, appearance in the current cases was similar to that of metastasis to other organs. MRI may be useful in developing a differential diagnosis for bladder metastasis because common urothelial carcinoma revealed iso-intensity on T1WI and iso- to slightly high-intensity compared with the muscle layer on T2WI [ 17 , 18 ].
As follow-up, imaging examination at every 3–12 months for 2 years, then every 6–12 months for another 3 years was recommended for patients with stage IV NED with cutaneous melanoma [ 19 ]. Screening for metastasis was performed by CT scan at every 6 months in case 1, and bladder metastasis manifested as small tumors. Postoperative (after nephroureterectomy) follow-up was insufficient in case 2, and larger bladder melanoma was found, suggesting the significance of sufficient follow-up by routine imaging examination.
Metastatic malignant melanoma to the urinary tract has been reported as a rare secondary tumor. We successfully performed metastasectomy for bladder and ureteral metastases without local recurrence. In addition, long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have significant potential to improve survival.
The supporting data and materials for this report are available on request from the corresponding author.
Computed tomography
Magnetic resonance imaging
Transurethral resection of bladder tumor
No evidence of disease
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The authors thank Ms. Miyuki Akino of the Department of Urology, Faculty of Medicine, University of Miyazaki, for her assistance with ethical protocols.
We did not receive financial support for this study.
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Department of Urology, Faculty of Medicine, Miyazaki University, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
Takashi Ueno, Kaoru Ito, Takaya Murashima, Masato Fujii, Takahiro Nagai, Shoichiro Mukai, Atsuro Sawada & Toshiyuki Kamoto
Department of Pathology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
Takumi Kiwaki
Department of Urology, Dokkyo Medical University, Tochigi, Japan
Hironori Betsunoh
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TU drafted the manuscript, performed the examination, observation, and approved the final version of the manuscript. HB, KI, TM, MF, and TN performed examinations, surgery, and cared for the patient and approved the final version of the manuscript. TK (Takumi Kiwaki) diagnosed and reviewed the pathological specimens and approved the final version of the manuscript. SM, AS, and TK (Toshiyuki Kamoto) drafted the report and contributed the final version of the manuscript. All authors read and approved the final manuscript.
Correspondence to Shoichiro Mukai .
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This case report was approved by the Ethics Committee of Miyazaki University (approval number: C-0172). Consent to participant was obtained from the patient.
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Ueno, T., Kiwaki, T., Betsunoh, H. et al. Metastasis of malignant melanoma to urinary tract: a case report. J Med Case Reports 18 , 396 (2024). https://doi.org/10.1186/s13256-024-04716-8
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DOI : https://doi.org/10.1186/s13256-024-04716-8
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Assessing the impact of straw burning on pm 2.5 using explainable machine learning: a case study in heilongjiang province, china.
2. materials and methods, 2.1. fengyun-3 series global active fire products, 2.2. land cover, 2.3. auxiliary data, 2.3.1. climate-related variables, 2.3.2. dem and aod data, 2.3.3. chinahighpm 2.5, 2.4. feature selection, 2.5. random forest model, 2.6. interpretable analysis, 2.7. data preparation for temporal and spatial models, 3. results and discussion, 3.1. comparison with modis fire points, 3.2. spatial distribution of fire points, 3.3. temporal patterns and variations, 3.4. monthly variations in crop fire points, 3.5. correlation and collinearity analyses of input features, 3.6. accuracy of the temporal and spatial models, 3.7. impacts of straw burning and other influencing factors on pm 2.5, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.
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Xu, Z.; Liu, B.; Wang, W.; Zhang, Z.; Qiu, W. Assessing the Impact of Straw Burning on PM 2.5 Using Explainable Machine Learning: A Case Study in Heilongjiang Province, China. Sustainability 2024 , 16 , 7315. https://doi.org/10.3390/su16177315
Xu Z, Liu B, Wang W, Zhang Z, Qiu W. Assessing the Impact of Straw Burning on PM 2.5 Using Explainable Machine Learning: A Case Study in Heilongjiang Province, China. Sustainability . 2024; 16(17):7315. https://doi.org/10.3390/su16177315
Xu, Zehua, Baiyin Liu, Wei Wang, Zhimiao Zhang, and Wenting Qiu. 2024. "Assessing the Impact of Straw Burning on PM 2.5 Using Explainable Machine Learning: A Case Study in Heilongjiang Province, China" Sustainability 16, no. 17: 7315. https://doi.org/10.3390/su16177315
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A case study analysis requires you to investigate a business problem, examine the alternative solutions, and propose the most effective solution using supporting evidence. Preparing the Case. Before you begin writing, follow these guidelines to help you prepare and understand the case study: Read and Examine the Case Thoroughly
1. Examine and describe the business environment relevant to the case study. Describe the nature of the organization under consideration and its competitors. Provide general information about the market and customer base. Indicate any significant changes in the business environment or any new endeavors upon which the business is embarking. 2.
Case study is unbounded and relies on gathering external information; case analysis is a self-contained subject of analysis. The scope of a case study chosen as a method of research is bounded. However, the researcher is free to gather whatever information and data is necessary to investigate its relevance to understanding the research problem.
How to Analyze a Case Study Adapted from Ellet, W. (2007). The case study handbook. Boston, MA: Harvard Business School. A business case simulates a real situation and has three characteristics: 1. a significant issue, 2. enough information to reach a reasonable conclusion, 3. no stated conclusion. A case may include 1. irrelevant information 2.
Case Study Analysis is a widely used research method that examines in-depth information about a particular individual, group, organization, or event. It is a comprehensive investigative approach that aims to understand the intricacies and complexities of the subject under study. Through the analysis of real-life scenarios and inquiry into ...
A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community. The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics.
Briefly introduce the problems and issues found in the case study. Discuss the theory you will be using in the analysis; Present the key points of the study and present any assumptions made during the analysis. Findings. This is where you present in more detail the specific problems you discovered in the case study.
A case study analysis is a form of writing that analyzes a specific situation, event, object, person, or even place. The said analysis should be written and structured to lead to a conclusion. Typically, you cannot analyze the subject of this essay via quantitative methods.
Step 3. Use the note taking sheet provided by ELS (back page) to record your ideas/analysis. to write the case study. An effective case study report should. Clearly identify the core problem(s) Analyse the issues underlying the problem. Discuss and justify alternative solutions using theory / experience.
6 parts of a case analysis. Explore these parts of a case analysis to understand the process of performing one a little better: 1. Preparation. Just like with any study, it's important to first prepare to conduct the case analysis. To begin, review the details of the case you're analyzing to make sure you understand it thoroughly.
3 Writing a case study in APA Step By Step. 3.1 Title Page in APA for Case Study Project. 3.2 APA Title Page Example. 3.3 The Abstract for an APA case study. Whether you study social sciences or life sciences, you're likely to encounter a case study analysis in your academic journey. These papers demand a lot from students.
Analyze the situation: Gather all the relevant information and data provided in the case study. Identify the key issues, stakeholders, and any potential constraints or challenges that need to be considered. 3. Develop a hypothesis: Based on your analysis, formulate a hypothesis or a proposed solution to the problem.
How to Write a Case Study Step-by-Step . Craft a Compelling Headline: Highlight the main success with a clear, direct title. Start with a Strong Introduction: Provide a broad overview and hook the reader. Discuss Unique Client Challenges: Highlight specific industry-related challenges. Highlight the Solution: Showcase your strategies and key results. ...
Furthermore, the ability to describe in detail how the analysis was conducted ensures rigour in reporting qualitative research. Data sources: The research example used is a multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Data analysis was conducted using a ...
To write a case study analysis in nursing, follow these steps: Introduction: Begin with a brief overview of the patient, the diagnosis, and the purpose of the case study. Patient History: Present the patient's background, including age, gender, medical history, and any relevant social or family history.
A case study recap serves as a powerful tool for distilling complex findings into a concise, digestible format. This summary acts as a bridge between the detailed analysis and the key takeaways, allowing readers to quickly grasp the essence of the study. By highlighting the most significant outcomes, challenges overcome, and lessons learned, a ...
A case study analysis must not merely summarize the case. It should identify key issues and. problems, outline and assess alternative courses of action, and draw appropriate. conclusions. The case ...
Preparing a case study assignment will involve you undertaking the steps outlined below. Generally, steps 1 - 4 apply to both analytical case studies and problem-solving case studies. Steps 5 and 6 only apply to problem-solving case studies. Nevertheless, ensure you follow the instructions for the particular assignment.
Within-case analysis . In 7 studies, a within-case analysis was performed. 15-20,22 Six studies used qualitative data for the within-case analysis, and 1 study employed qualitative and quantitative data. Data were analyzed separately, consecutively, or in parallel. The themes generated from qualitative data were compared and then summarized.
Step 1 - Read the entire study. Before writing the summary, carefully read the research study from beginning to end. Step 2 - Highlight the major points. As you read, make notes and underline significant facts, relevant conclusions, and suggested actions. Step 3 - Divide the document into main sections.
The ordering process is fully online, and it goes as follows: • Select the topic and the deadline of your case study. • Provide us with any details, requirements, statements that should be emphasized or particular parts of the writing process you struggle with. • Leave the email address, where your completed order will be sent to.
Benefit offers a higher positive experience by analyzing sentiment analysis for the whole web and social mentions. After analyzing all the mentions for all the beauty brands, there are lots of insights to help you create social media marketing strategies and find out the top competitors in your niche. Step 5.
Case study videos can significantly enhance your video marketing strategy, particularly for B2B companies. They provide a rich, multi-faceted way to showcase a product or service and offer benefits beyond financial gains. ... Then, dive into the specifics: Analyze the customer's decision-making process with questions like, "What pulled you ...
Our analysis shows several major U.S. pharma companies losing patent protection on up to 70% of their revenue by 2030. ... The above case study is just one example of how active stock selection ...
Case Study: India India has built a robust DPI, starting with an identification system. Just 15 years ago, one-third of the population ( approximately 400 million people ) had no form of official government identity, leaving much of the population unbanked, without access to credit, and unable to claim public benefits or social services.
Introduction Metastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary ...
A version of this article appears in print on , Section A, Page 10 of the New York edition with the headline: New Study Re-evaluates 'Worst Case' Scenario for Antarctica's Thwaites Glacier.
To demonstrate the effectiveness of an integrated MBSA&E-UQ approach, a case study involving a simplified analysis of a Transonic Truss-Braced Wing (TTBW) concept vehicle is performed. This integration enables a more comprehensive evaluation of system performance and behavior under uncertainty and a more robust approach for system design and ...
Straw burning is recognized as a significant contributor to deteriorating air quality, but its specific impacts, particularly on PM2.5 concentrations, are still not fully understood or quantified. In this study, we conducted a detailed examination of the spatial and temporal patterns of straw burning in Heilongjiang Province, China—a key agricultural area—utilizing high-resolution fire ...