Transcript Publishing Case Reports - Texas Tech University Health Sciences

Practical
Publishing
for Residents
Case Reports
Rey Vivo, MD
Assistant Professor of Medicine
Texas Tech University Health Sciences Center
Objectives
• Benefits and Barriers
• Overview of Publication Types
– Emphasis on Case Reports
• Practical Guide
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Selecting a Case
Choosing among Medical Journals
Preparing the Manuscript
Submission and Review processes
Other Tips for Success
Why bother to publish?
• Academic triad: (1) clinical service/patient care,
(2) medical education, (3) research
• Scholarship
– “prior to the completion of training, each resident must
demonstrate acceptable scholarly activity…original research, case
reports, or review of clinical and research topics.” – ACGME
– Promotes lifelong learning
– Reinforces future academic career
• Literature search and critical appraisal
• Advances science; expands body of medical evidence
• Bolsters curriculum vitae and career
Potti, et al. Am J Med. 2003;115:510-4.
Levine, et al. J Gen Intern Med. 2005;20:155-9.
Challenges to students/residents
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Lack of time
Lack of interest
Lack of money
Lack of teaching program or materials
Lack of faculty time/interest/role models/mentors
Lack of a research director/consultants
Lack of computers or software
Potti, et al. Am J Med. 2003;115:510-4.
What successful residents say…
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Start early
Set aside adequate time and adhere to a timeline
Work with a strong mentor
Choose a research topic that genuinely interests you
Keep the project simple yet innovative
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Provide adequate protected time and encouragement
Improve the technical resources available
Enhance or establish a research curriculum
Match trainees with appropriate mentors
Make funding available
Rivera, et al. J Gen Intern Med. 2005;20:366-9.
It’s all worth it!
Types of publications
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Case Reports
Case Series
Review
Hypothesis-driven Research
– Retrospective vs. prospective
– Basic science, clinical outcomes, quality improvement
• Essays
Always note and record the
unusual…publish it…place it on
permanent record as a short, concise
note…such communications are always
of value.
— Sir William Osler
Case Reports
• “...a striking anecdote was the case of
Phineas Gage, the man who had a 4-ft iron
bar blown through his frontal lobes and
whose immortal remains are now in the
Harvard Museum…had it been realized that
one could interfere with…the cerebral
hemispheres without killing the patient
and…cause no obvious intellectual defect,
neurosurgery might have been conceived 40
years earlier.”
• A case in American Journal of
Dermatopathology was one of the first
published reports on what later became
known as AIDS.
Nathan. Lancet. 1967;2:607.
McCarthy and Reilly. Fam Med. 2000;32:190-5.
The Perfect Fit
Case Reports and Residents
• High volume of patients encountered, some of whom
may have reportable findings.
• Easy to do and less less time-consuming than other
forms of scholarly work.
Nahata. Ann Pharmacother. 2008;42:273-7.
Step-by-step Guide
1. Look for a good case.
2. Read, read and read some more.
3. Obtain informed consent (required by some journals).
-- Make your intentions to publish known.
4. Complete the appropriate work-up to confirm the
diagnosis.
-- An autopsy may be necessary sometimes.
5. Involve consultants early.
6. Identify potential journals (note word count!).
7. Begin writing!
Wright and Kouroukis. CMAJ. 2000;163:429-31.
Candidate Cases
1. The unique case that appears to represent a newly
described syndrome or disease.
2. The case with an unexpected association of 2 diseases
that may represent a causal relation.
3. The “outlier” case representing a variation from the
expected pattern.
4. The case with a surprising evolution that suggests a
therapeutic or adverse drug effect.
A common case with an uncommon presentation or
an uncommon case with a common presentation.
Wright and Kouroukis. CMAJ. 2000;163:429-31.
What do journals look for?
• Clinical significance of key point/s
• Originality/uniqueness of case
• Quality, clarity, and conciseness of writing
• Ask yourself:
– “What would this article add to existing knowledge?”
– “How significant are the take-home messages?”
– “How would this information change patient care?”
Nahata. Ann Pharmacother. 2008;42:273-7.
Leading Medical Journals
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4.
8.
9.
14.
15.
25.
32.
New England Journal of Medicine
Lancet
JAMA
Annals of Internal Medicine
Archives of Internal Medicine
American Journal of Medicine
Mayo Clinic Proceedings
Journal of General Internal Medicine
American Journal of the Medical Sciences
Southern Medical Journal
www.journal-ranking.com
Case Reports
Images in Clinical Medicine
Case Report
Diagnostic Dilemma, Images in
Dermatology, ECG Image of the
Month, Images in Radiology
Case Report
Case Report
Case Report
Case Report
Other primary care journals
• Consultant
• Hospital Physician
• Resident and Staff
Physician
• ACP Hospitalist
• Hospitalist
• Academic Emergency
Medicine
• American Family
Physician
• Archives of Family
Medicine
• Journal of Family Practice
• Journal of the American
Board of Family Practice
Developing the Manuscript
1. Prepare an outline.
2. Draft the case description.
3. Search pertinent literature.
4. Draft the discussion and conclusion.
5. Write the introduction.
6. Write the abstract.
7. List references.
8. Review, edit, revise.
9. Repeat #7 as many times as needed.
10. Prepare title page and cover letter.
Nahata. Ann Pharmacother. 2008;42:273-7.
Outline
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Abstract
Introduction
Case Description
Discussion
– Literature review
• Conclusion
– Summary/Recommendations
Case Description
• Demographics (age, sex, height, weight, race, occupation)
– Avoid patient identifiers (date of birth, initials)
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Chief complaint and present illness
Complete history (medical, family, social, occupational, medications)
Pertinent findings on physical examination
Pertinent laboratory, imaging, other diagnostic data.
– Provide the reference range for laboratory values
– Paraphrase the salient results of the diagnostic procedures
– Provide photographs of images, histopathology, etc.
• Narrate events in chronological order
– Detail differentials, challenges to diagnosis/treatment
Cohen. Am J Health-Syst Pharm. 2006; 63:1888-92
Discussion
• Summarize the salient features of the case report
• Compare and contrast the nuances of the case report with the
existing literature
• Justify the uniqueness of the case
• List the limitations of the case report and describe their relevance
• Confirm the accuracy of the descriptive patient case report
• Draw recommendations and conclusions
Cohen. Am J Health-Syst Pharm. 2006; 63:1888-92
Conclusion
• Provide a justified conclusion
– Avoid over-reaching statements
• Provide evidence-based recommendations
• Describe how the information learned applies to one’s own practice
• List opportunities for research
• Ensure that this section is brief and does not exceed one paragraph
Introduction
• Describe the subject matter
• State the purpose of the case report
• Provide background information and pertinent definitions
• Describe the strategy of the literature review and search terms
• Introduce the patient case to the reader
• Make the introduction brief and less than three paragraphs
Cohen. Am J Health-Syst Pharm. 2006; 63:1888-92
Abstract
• Introduction and objective/s
• Case report
• Discussion
• Conclusion
Cohen. Am J Health-Syst Pharm. 2006; 63:1888-92
References
• National Library of Medicine Style Guide for
Authors
– http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=citmed.TOC&depth=2
• Be aware of limitations
Manuscript checklist
Sorinola, et al. BMC Medical Education. 2004;4:4.
Authorship
• First listed: usually the primary author (the one who
contributed the most)
• Last listed: typically the senior author who supervised
the work; often also the corresponding author
• Middle authors: may be listed according to
amount/weight of contribution
• Critical to decide order before initiating the work
• Note whether journal has restrictions on # of authors
(particularly case reports)
Submission process
• Review the journal’s “Author’s Information”
• Familiarize yourself with the online submission process
• Prepare all documents
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Cover letter
Title page
Manuscript
Figures/Tables/Charts
• Timeline
After submission…
Understanding the Review Process
• ACCEPTED
– Address comments
– Revisions
– Proofread galley
proofs
• Rejected
– Review comments
– Reflect
– Seek advice
– Revise
– Re-submit
Galley Proof
Sample Proof
Cover Letter
Galley Proof
Title Page
Response Letter
A word on Essays
Essays
• JAMA
– A Piece of My Mind
• Annals
– On Being a Doctor
• NEJM
– Perspective
• JGIM
– Reflections
• Academic Medicine
– Teaching and Learning Moments
Bonus Tips
• Aim for high-impact journals.
• Check out journals who publish electronically ahead of
print.
• Be OC when reviewing your manuscript.
• Solicit feedback thoughtfully and aggressively.
• Be flexible.
Persistence. Persistence. Persistence.
Summary
1. Always keep your eyes (and ears) open for an
interesting case.
2. Verify, by literature search, the novelty of your case.
3. Write, write, write!
4. Seek advice from others who have published.
5. Submit and revise as needed.
6. If at first you don’t succeed, try again! There are MANY
journals.
7. Do NOT limit yourself to patient care alone…strive to
contribute to medicine in meaningful ways!!!
Thank you