CLINICIANS AS RESEARCHERS: PUBLISHING CASE REPORTS Hana Al-Sobayel, PT, MSc., PhD.

Physical Therapy Consultant

King Saud University 4/26/11

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Outline

¨  Overview ¨  Preparation ¨  Writing ¨  Publishing ¨  Barriers

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Case Report Publication

Overview

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A case report, published in the American Journal of Dermatopathology in 1981, was one of the first published accounts of what is now called AIDS

Value of Case Reports

¨  Valuable contribution to the advancement of medical science.

¨  Case reports are “scientific observations . . . that are carefully documented so that they may be a valuable education and research resource.” (McCarthy et al. 2000)

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Hierarchy of Evidence

Systemic Review/Meta-analysis

RCT

Non randomized controlled trials/Cohort Studies / Case-Control Studies/Audit of case

series/Case reports

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Case Report Publication

Preparation

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What Kind of Cases Should be Reported?

¨  Unique & unusual presentation ¨  Illustrate a new principle or theory ¨  Questions regarding current theory or practice ¨  Adverse response to treatment ¨  Unusual combination of conditions or events that

cause confusion ¨  Personal impact

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Before Writing

¨  Identify the journal ¨  Review “instructions for Authors” ¨  Read several case reports ¨  Ask patient to sign consent

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Case Report Publication

writing

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Components of Case Report

¨  abstract/introduction ¨  Case history/description ¨  literature review ¨  Discussion ¨  conclusions/recommendations.

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Abstract

¨  Quickly scan the content of the paper ¨  Less than 100 words

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Introduction

¨  Brief overview of a larger problem

¨  Citations from literature

¨  Closing sentence about

the case

“ Osteochondroma, or osteocartilaginous exostosis, is the most common skeletal neoplasm. Osteochondromas are benign and may be solitary or multiple…”

“There is potential for malignant degeneration, estimated at approximately 1%. Solitary osteochondroma may occur spontaneously or after irradiation or accidental injury. When multiple, there is a strong familial incidence and is known as hereditary multiple exostoses (HME)…”

“We report the first case of solitary osteochondroma arising from the anterior body of C4…”

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Case History/Report

¨  Drawn from chart notes ¨  Description of the

patient

¨  Details of physical examination and results

¨  Essential information to highlight the striking feature of the case

“A 24-year-old male was referred by an internist for chiropractic evaluation and radiographic examination at a local imaging center for a chief complaint of cervicalgia and pain in the left trapezius of 1-month duration.”

“Upper extremity deep tendon reflexes were 2+ and symmetric bilaterally. An orthopedic examination revealed provocation of pain with cervical distraction maneuver. Testing for neural compression and vascular signs was negative.”

“The lesion was considered an incidental finding, and for the patient's presenting complaint, the diagnosis of cervical disk displacement (Fig 2) (confirmed with MRI), cervicalgia, myospasm, and accompanying vertebral segmental dysfunction was given.”

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Case History/Report

¨  Treatment, outcome, and follow-up ¨  Tables, flow-charts, radiographs, etc.

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Literature Review

¨  Clinical question ¨  MeSH headings used for searching ¨  Brief and concise ¨  Designed to assure the uniqueness of the case ¨  Provide a backdrop for and the position of the new

information in the biomedical literature.

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Discussion

¨  Most important section ¨  State the significance of the information ¨  Discuss the current literature in light of the case ¨  A hypothesis about the new information might be

generated ¨  Data collection process ¨  Discussion of the outcomes

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Summary/Conclusions/Recommendations

¨  Brief summary – the Take Home Message ¨  Lessons learned from the case ¨  Questions and recommendations for research

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Case Report Publication

Publishing

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Journal

¨  Check instructions for Authors ¨  1000 – 1500 words ¨  10 – 20 citations

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Barriers

¨  Time ¨  Intimidation by publication process ¨  Editorial review ¨  Journals

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References

•  Aitken LM, Marshall AP. Writing a case study: ensuring a meaningful contribution to the literature. Aust Crit Care. 2007 Nov;20(4):132-6. Epub 2007 Oct 23. PubMed PMID: 17936637.

•  Cohen H. How to write a patient case report. Am J Health Syst Pharm. 2006 Oct 1;63(19):1888-92. PubMed PMID: 16990637.

•  Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med. 2006 Summer;5(2):72-82. PubMed PMID: 19674676; PubMed Central PMCID: PMC2647062.

•  McCarthy LH, Reilly KE. How to write a case report. Fam Med. 2000 Mar;32(3):190-5. PubMed PMID: 10726220.

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THANK YOU

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