Writing Case Reports Michael A. Weiser CORE Research Editor/Writer Doctors Hospital – Case Reports January 16, 2007

Today’ Goals Provide an overview of Case Reports as a “research” vehicle. –Draw a distinction between “scholarly work” and “research.” Discuss the Review of Literature Present the Case Report format and discuss the typical sections of the report. Talk about research dissemination – papers, posters, and presentations.

Scholarly Work or Research? Case Reports are considered “Scholarly Work.” –“N” of 1; Unidentifiable/De-Identified Data; Non-Generalizable Results. Retrospective and Prospective Studies are considered “Research.” –Generalizable findings based on a large sample size.

Why Do Research? Clinical research drives evidence-based medicine, which in turn, impacts clinical practice … Research → Quality. Professional development and growth depends on having adequate skills to: –Critically read and evaluate journal articles –Document interesting cases, and –Understand and engage in conference workshops and presentations.

Writing a Clinical Vignette An unexpected association between diseases or symptoms. An unexpected event in the course of observing or treating a patient. Findings that shed new light on the possible cause of a disease or an adverse effect. Unique or rare features of a disease. Unique therapeutic approaches.

How to Begin? Find a topic or question of interest. Discuss your idea with your peers or a advisor/mentor. Check the literature. Find an appropriate case to report.

Searching the Literature Start with a well-defined Idea. Clearly identify the Topic Areas covered by your Idea. Search those topic areas in Medline/PubMed; –Generally, you want to combine terms to find the intersection of several topics. –A “MeSH” search is best to combine terms.

Surveying the Literature Questions to ask: –Has someone already conducted research on this idea? –If so, can I tailor my idea to tease out more specific details of the idea? Population – Rural vs. Urban Race or Ethnicity Gender Increase the “N” –Is my idea unique?

Evaluating the Literature Are my source materials reliable? –Books –Journals –Conference Proceedings –Scholarly Magazines –Popular Magazines –Web Sites –Advertising Source: Your Research Project, Andy Hunt (2005)

Reference List and/or Bibliography Using/Choosing the proper editorial style. –Personal Choice –Mandated by Specialty College - (I&R) –Mandated by Program Director - (I&R) –Choice based on journal submission guidelines Citing the Literature

The research paper type determines the location of referenced material from the review of literature. –In the “Discussion” section of Case-based reports. Bibliographic Database software – - $ $ – - $ / year. Writing the Paper

Case-Based Reports Are typically: –Based on a single case –…that is not identifiable, where –the resulting paper will not affect the patient’s treatment, and –No institutional affiliation is noted.

Format of a Case Report Introduction Case Description General Information/Discussion Summary/ConclusionReferences

Introduction The introduction should be brief. It introduces the clinical presentation to be discussed, as well as any relevant facts about the clinical condition. It explains the importance of the case being presented and why it is being reported. Cite any points of fact or statistics.

The Case Description The objective of the case description is to let the reader understand the case. –Make sure all the pertinent findings are clearly stated. –Provide only those test and lab results that are relevant to an understanding of the progression of the case – relevant positive and pertinent negative results. Offer normal levels for unusual tests. –Present information in chronological order.

General Information/Discussion The purpose of the discussion is to explain anything that is not clear in the case description and to offer interpretations of findings. Make clear any important point that is not explained in the case descriptions. References should be included. –Cite any recent (relevant) review articles. –Look for incidence and prevalence data.

Summary/Conclusion Provide the reader with some type of closure regarding the case. Indicate where the reader might located additional information about the topic. Mention any major limitation or restriction of your study –Lit. Review only went back 5 years; English language only; Search Parameters if “No articles found.” Point out questions for further research.

Case Report Checklist Introduction Case Description General Information/Discussion By Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting randomized clinical trials: the CONSORT statement. JAMA. 1996;276:

Introduction  Is the rationale for reporting the case adequately explained?  Is the rationale for reporting the case adequately substantiated by references?  The bulk of your references will be in the General Information/Discussion, but you may have to cite sources to here to establish a compelling reason for presenting the case

Case Description  Is the case described adequately?  Is the case described briefly?  Is the case described clearly?  Are the results of laboratory investigations described adequately?  Are the results of less common laboratory investigations accompanied by normal values?

General Information/Discussion  Is the evidence to support the authors' diagnosis presented adequately?  Is the evidence to support the authors' recommendations presented adequately?  Are other plausible explanations considered and refuted?  Do authors indicate directions for future investigation or management of similar cases?

Research Outcomes Research Paper –Targeting a specific audience or journal Research Poster –Targeting a specific poster exhibition or contest Research Presentation –Targeting a specific audience, meeting, or convention

Disseminating Findings: Papers, Posters, & Presentations Papers – Follow Submission Guidelines to the letter. Posters – Watch for the “Call for Posters” from professional organizations – Templates at CORE Web site – Handout Presentations – Present your research to peers and colleagues within your institution and at conferences.

Pathway to Publication