The Crocker Institute


The Crocker Institute: The CaseRe3 Repository for Integrative Health Care Case Reports

Martha Menard, director of the Crocker Institute, has been developing a digital open access repository since 2009 when she met colleagues from the Registered Massage Therapists' Association of British Columbia at a conference and began collaborating on a way to make complementary and integrative health care case reports widely accessible to practitioners in these disciplines.

"DSpaceDirect's easy start-up process, customization options and support confirmed that we had made the right choice." -- Martha Menard, Director, The Crocker Institute

Case reports are a rich source for descriptive information and observational data that are often required as a final or capstone project in complementary health care educational programs. The majority of such case reports languish in file drawers and gather dust on shelves... and orphaned case reports become part of the unread and unavailable gray literature. The CaseRe3 repository provides a publication venue and permanent archive for student, faculty and alumni/practitioner case reports. The repository also includes previously published case reports from peer-reviewed journals, reproduced with the publishers' permission.

Menard, who is responsible for day-to-day operations, repository maintenance and overall design, chose DSpace over Fedora for the original implementation in 2011. "The team decided to go with DSpace because of its history, wide install base, successful use by so many universities, and most importantly, its advanced Java architecture with Postgres--we knew we would never outgrow it." DSpace support for multiple file types was also a key factor in making the decision.

"As an educator I know that case reports are a key part of a student's clinical education program. To encourage students to do rich and interesting case reports access to multimedia resources in the repository was important. Using audio that captures a patient's experience in their own words, for example, makes what could be an onerous research chore for students more dynamic," explained Menard. "And it's an attractive feature for practitioners, that helps meet our goal of encouraging evidence-informed practice across disciplines."

DSpaceDirect Decision

When DSpaceDirect became available Menard was looking for ways to spend more of her time curating resources and developing new ways for practitioners, educators, and researchers to use case reports. Even though the DSpace repository application is out-of-the box, it takes some technical expertise to manage systems and customize a repository, and her background is not in IT. Timing, hosting company issues and a desire to stick with the easier to manage, hosted version of DSpace helped make the decision to switch to DSpaceDirect.

"DSpaceDirect's easy start-up process, customization options and support confirmed that we had made the right choice," said Menard, "We had a deadline that was a month out and we made it thanks to DuraSpace DSpaceDirect staff members Carissa (Smith) and Tim (Donohue). They have both been terrific to work with."

A key DSpaceDirect CaseRe3 customization was the ability to browse and search beyond author and title. Adding discipline and technique as search options makes the CaseRe3 user experience more valuable to students and researchers.

"We are now encouraging authors to submit their raw data sets with their case reports. In the traditional evidence hierarchy, case reports are usually considered to have little value because a single individual's case does not provide a strong link between cause and effect. But capturing an individual patient's history, description of their treatment, and its results provides rich information about the 'whole practice' of many complementary health disciplines, which can be useful for not only for practitioners looking at different treatment approaches across multiple disciplines, but also for researchers developing clinical protocols for future studies. Although the raw data from a single case report is not valuable by itself, aggregating similar case reports by condition and outcome measure could allow for developing virtual case series, which could be used to estimate sample sizes for a larger and more rigorous type of study, or to see patterns that suggest future research hypotheses to be tested."

To create an entry portal for the repository that describes its development, explains how it works and how it can be used by different audiences, she used Squarespace. This website is linked to the DSpaceDirect repository on each page; users can go directly to the repository by clicking the highlighted link in the footer of every page on the portal. In addition to providing a visually appealing 'home page' for the repository, the website functions as an online brochure that explains the concept of open access to institutional administrators who may be interested in providing this publishing and archiving opportunity for their students, faculty, and alumni.


Menard is also considering establishing an online learning management system that will include a self-guided tutorial on conducting peer review. This training course would include an assessment for users to successfully complete in order to serve as future peer reviewers for the repository. As she points out, "At some point, as the repository grows, we will need to crowdsource the peer review process. Even a small group of reviewers won't be able to keep up with the volume of submitted case reports, as multiple institutions and journals join."

Menard concluded, "We are very happy with the DSpaceDirect service. We are planning for an overflow of content and interest in CaseRe3 now and look forward to continuing to grow our DSpace hosted repository."