The act of recording, discussion with colleagues, and publishing our clinical observations with patients remains essential to the art of medicine and patient care. Place it on permanent record as a short, concise note. Such communications are always of value. But how and when should we do this? Early case reports were little more than personal communications between colleagues about unique and interesting patients seen in their respective medical practices. This anecdotal reporting has evolved into an accepted form of scholarly publication with the ability to rapidly disseminate knowledge to a broad medical audience [ 7 ] using the generally accepted format of a title, abstract, introduction background , case presentation, discussion, conclusions, and references.
Many biomedical journals publish case reports and provide authors with guidelines that provide instruction for acceptance criteria, content, and format and give advice on relevant patient case reports that merit publication [ 3 ].
There are already many well-written published articles on how and when to write a good case report please see Recommended further reading section at the end. The utility of the newly created Cases Database will also be discussed. Relevant and useful website links will be used throughout to allow the reader easy access to further information on BMC requirements.
I also hope to impart to the reader a brief overview of case report editorial flow in both JMCR and BMCRN along with the complementary relationship between both journals. I will also give anecdotes of how I personally approach things. What exactly is a case report? From peer-reviewed journals to Wikipedia and yes, I read Wikipedia like we all do definitions are readily available and generally agreed upon.
Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a literature review of other reported cases. Things start at the bedside or in the office with the most important person involved: Patients and their stories including from their friends, coworkers, and family are our portal to writing the case report. Patients both in-patients and out-patients are assessed, we confer with colleagues, appropriate investigations then follow, and treatment if possible begins.
If I encounter an in-patient on call then I follow him or her throughout his or her hospitalization and, I hope, timely discharge. The patient is then followed and reexamined in the office over the course of time to see how the clinical course evolves. I usually wait 6 months over the course of multiple visits before I actually begin to write a case report so as to allow enough time for the clinical course to play out.
Of course if the patient is hospitalized with an acute and rapid illness then this time may be much shorter, but I still follow him or her with daily neurologic examinations. When an interesting condition is encountered in either the hospital or the office setting, I discuss the case in person with both my local neurology colleagues and colleagues of other specialties to see if they have encountered before the clinical scenario that I am dealing with at the time.
This is usually a quick face-to-face nursing station conversation. If the case is particularly challenging then I will contact my local university colleagues for their opinion especially if an urgent transfer needs to be arranged. Indeed, the Internet seems to have become our modern day replacement for office water cooler conversations. Further reading is then supplemented by both PubMed [ 12 ] free and Cases Database also free [ 13 ] see later.
If I feel that a particular patient warrants a case report, then I continue to read more and more. There are also medical list servers and medical online communities to which one can post a case with de-identified images online and petition the advice of colleagues worldwide. I have always preferred an in-person encounter to discuss a case with a colleague or professor, but given the current day and age daily workload, travel costs, time away from the office and family, and so on , I have found Internet-based discussion keeping all patient information anonymous of course very helpful.
The BMC series is a group of open access, peer-reviewed journals that spans most areas of biological and clinical research. Some of these publish case reports within their respective disciplines, and some do not [ 17 ]. JMCR is an online, open access journal under BMC auspices dedicated mainly to the publication of high quality case reports, and aims to contribute to the expansion of current medical knowledge please see specific publication criteria below.
In the 5 years since its launch, JMCR has published over case reports. BMCRN is also an online, open access journal under BMC auspices publishing scientifically sound research across all fields of biology and medicine. The journal provides a home for short publications, case series, and incremental updates to previous work with the intention of reducing the loss suffered by the research community when such results remain unpublished.
BMCRN began publishing case reports in and now has a dedicated section for case reports [ 19 ]. Please read on to see the complementary relationship of case reporting between the two journals, how they relate to other journals in the BMC series, and further information on editorial work flow including specific publication criteria. Since the launch of JMCR in and the more recent introduction of case reports to the BMCRN , which aims to have a broader scope, BMC has acknowledged and continues to acknowledge the value of case reports to the scientific literature.
To further strengthen this commitment, BMC in conjunction with Michael Kidd have developed the invaluable new resource of Cases Database, a continually updated, freely accessible database of thousands of medical case reports from multiple other publishers, including Springer, British Medical Journal, and PubMed Central.
By aggregating case reports and facilitating comparison, Cases Database provides a simple resource to clinicians, researchers, regulators and patients to explore content and identify emerging trends [ 20 ]. It is very helpful in seeing if a particular condition has been reported before and what treatment the authors have performed.
It is an invaluable resource which can be used to check and see if previous cases have been reported before and how other authors have managed their patients with similar clinical conditions. When I last checked, Cases Database had in its repository 27, peer-reviewed medical case reports from journals! How does one determine when to write an actual case report? What constitutes and what are the criteria for publication? JMCR [ 21 ] publishes original and interesting case reports that contribute significantly to medical knowledge.
Manuscripts must meet one of the following criteria: BMCRN [ 22 ] has somewhat different publication criteria: BMCRN considers medical case reports that describe any clinical case. Case reports submitted to BMCRN do not need to be novel, but must be authentic cases and have some educational value along with representing at least an incremental advance in the field.
BMCRN will not consider case reports describing preventive or therapeutic interventions because these generally require stronger evidence. Both journals follow this format and accept submissions with these title structures. I tend to classify case reports in my mind generally as follows: Either type should have clear and concise take-home messages and teaching points.
Over the years that space has grown and, admittedly, I have cases dating back over the entire span of my years in practice now over 13 years which I simply have not gotten around to yet! If a BMC Series journal editorial team considers a submitted case report unsuitable for their respective specialty journal and now a growing list of Springer journals that BMC is now affiliated with , the authors are given the option to transfer their manuscript to BMCRN.
The peer review comments which are open and identifiable at JMCR and blinded at BMCRN are then usually sent to the authors for appropriate revisions and rebuttals unless it is felt that the manuscript should be rejected outright, at which time the editorial office sends the authors an explanatory letter.
After these revisions and rebuttals have been performed, the revised manuscript and rebuttals are sent back to the respective editors for a final decision and recommendations. These decisions and recommendations are then forwarded on to the Editor-in-Chief for final approval for publication.
At JMCR , manuscripts are professionally copyedited before being sent off to the production team for publication, whereas at BMCRN the authors are requested to obtain their own professional copyediting if needed before publication the respective costs being reflected within the different article processing charges for both journals.
When the manuscripts are published in both journals, they are in the preliminary form before being converted to the final form after production. Author satisfaction consistently ranks high for the overall process in both journals. Now let us discuss the brass tacks of writing the actual case report by going through the individual sections that will comprise the manuscript. The first page of the manuscript should be a dedicated title page, including the title of the article.
The title should be a clear and short description of the case with a list of the full names, institutional addresses and email addresses for all authors. There should always be at least one corresponding author who is clearly identified. Abbreviations within the title should always be avoided.
I also try to avoid any puns or overly cute wording within the title and try to keep things strictly descriptive and clear. The title needs to accurately describe the case — after all, this may be all that someone reads. If a cute or clever title is used that obscures what the case is really about, then it may be even less likely that the manuscript is read. It should not exceed words. Abbreviations or references within the Abstract should not be used. The Abstract should be structured into three sections: Background, an introduction about why this case is important and needs to be reported.
Is it an original case report of interest to a particular clinical specialty of medicine or will it have a broader clinical impact across medicine? Are any teaching points identified? I find this is the most important part because this is often all that people will read and its availability will allow easy retrieval from electronic databases and help researchers decide their level of interest in the case report.
The Abstract should be a concise and condensed version of the case report and should include the same main sections of the main text and be as succinct as possible [ 3 ].
This is the last thing that I usually write as it tends to flow easily after I have invested my time in thought and writing of the manuscript. This section is comprised of three to ten keywords representing the main content of the article. It is important for indexing the manuscript and easy online retrieval.
The Introduction JMCR or Background BMCRN section should explain the background of the case, including the disorder, usual presentation and progression, and an explanation of the presentation if it is a new disease. It should also include a brief literature review.
This should give an introduction to the case report from the standpoint of those without specialist knowledge in the area, clearly explaining the background of the topic. It should end with a very brief statement of what is being reported in the article. The Introduction or Background serves as the sales pitch for the rest of the manuscript. This should present all relevant details concerning the case. If it is a case series, then details must be included for all patients.
This section may be broken into subsections with appropriate subheadings. This is one of the most integral sections. The case should be described in a concise and chronological order. One should usually begin with the primary complaint, salient history including significant family, occupational, and other social history along with any significant medications taken or allergies , followed by the physical examination, starting with the vital signs presented at the examination, along with pertinent investigations and results.
There should be enough detail but not too much for the reader to establish his or her own conclusions about the validity. It should contain only pertinent information and nothing superfluous or confusing [ 3 ]. This is an optional section in JMCR for additional comments that provide additional relevant information not included in the case presentation, and that put the case in context or that explain specific treatment decisions.
This section should evaluate the patient case for accuracy, validity, and uniqueness and compare and contrast the case report with the published literature. The authors should briefly summarize the published literature with contemporary references [ 3 ].
Although this section is optional in JMCR and not even listed separately on the BMCRN guidelines website , I find that most authors write this section, or an expanded conclusions section incorporating the elements listed above. I personally write a separate discussion section and conclusions section for each case report that I author.
This should state clearly the main conclusions of the case report and give a clear explanation of their importance and relevance. Information should be included on how it will significantly advance our knowledge of a particular disease etiology or drug mechanism if appropriate.
This should be short and concise with clear take-home messages and teaching points [ 3 ]. This section is an opportunity for patients to add a description of a case from their own perspective. The patients should be encouraged to state what originally made them seek medical advice, give a description of their symptoms, whether the symptoms were better or worse at different times, how tests and treatments affected them, and how the problem is now. This section can be written as deemed appropriate by the patients, but should not include identifying information that is irrelevant to the case reported.
As medicine becomes more person-centered, the voice of the individual patient becomes even more important, both to assist in clinical decision making, and for medical education. This optional section is unique to JMCR , and I believe adds an important new dimension to the traditional case report. Most authors still do not yet take advantage of this, but I hope as time goes on and more and more open access case report manuscripts are published that this section will be routinely used, not just in JMCR but also in BMCRN and all other BMC clinical journals.
I recall one manuscript in particular where the patient himself was requesting publication as soon as possible because of his terminal disease. He wanted his message out there and be available to all to read before he died. Both JMCR and BMCRN publish case reports over a wide range of medical and surgical specialties, and it is important for the reader who may not be within that particular specialty to readily access a quick list of common technical abbreviations.
Also, given the open access nature of both journals, please keep in mind that non-medical professionals may read the manuscript as well.
This section is compulsory for BMC. It should provide a statement to confirm that the patient has given their informed consent for the case report to be published. The written consent should not routinely be sent in along with the manuscript submission because of patient privacy issues , but the BMC editorial office may request copies of the consent documentation at any time.
The following wording is recommended: A copy of the written consent is available for review by the Editor-in-Chief of this journal. Please keep in mind that manuscripts will not be peer reviewed if a statement of patient consent is not present. In practice, I always start with written consent from the patient. I find that most patients and family members are quite agreeable to publication as long as their details are anonymous. BMC has very clear and explicit consent criteria and consent forms in multiple languages.
This is usually done via telephone or postal mail. If I am unable to obtain consent this way in a case involving a patient who has died, then I write in the Consent section the following: As far as the students are concerned, writing a research paper is one of the most difficult and frustrating task for them.
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