Lecture: Tips for case report writing.pptx

- Case report considered as a base of the evidence pyramid. - Case report had a crucial role in explaining abnormal data and elaborating some research theories or questions. - Writing a case report needs to be stick for the CARE CHECKLIST. - Abstract is written in the beginning of the case report, but it will be the last part to be written. - Don’t forget deidentified patient data. - Don’t forget Informed Consent.

1. Tips for A case Report Writing Presented by : Mostafa Meshref Assistant lecturer of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. 1

2. Agenda - What is a case report? -What are the reasons for publishing a case report? -Importance and magnitude of case report writing. - Selection of a case report (Which case report is suitable for publication?). - Tips that may help. - Writing Sequence. - CARE Checklist. - Take a home message. - References. 2

3. What is a case report? - A Case Report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of a patient. - Case Reports may contain a demographic profile of the patient, but usually describes an unusual or novel occurrence. - Case reports usually describe an unusual or novel occurrence and as such, remain one of the cornerstones of medical progress and provide many new ideas in medicine.  3

4. Evidence pyramid (evidence based- medicine) Medical scientists and practitioners rank evidence according to its quality. When these types of evidence are ranked as levels, one on top of the other, the resulting image takes the form of a pyramid, because the higher the quality of evidence, the rarer it is, and the lower the quality of evidence, the more ubiquitous it is. Editorial, expert opinions and case reports are at the base of the pyramid. The highest quality evidence (level 1 evidence) is the systematic review: Evidence pyramid Evidence pyramid and type of the study design 4

5. WHAT ARE THE REASONS FOR PUBLISHING A CASE REPORT? An unexpected association between diseases or symptoms. An unexpected event in the course observing or treating a patient. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect. Unique or rare features of a disease. Unique diagnostic or therapeutic approaches or variation of anatomical structures. To contribute to medical education: Case reports can be a valuable teaching tool for medical students and residents. They can provide real-world examples of how diseases present, are diagnosed, and are treated. 5

6. IMPORTANCE AND MAGNITUDE OF CASE REPORT WRITING . 1 - Case reports are an undervalued component of the medical literature. 2 - Case reports play a crucial role in medicine and scientific research. 3-Case reports form the foundation of the evidence-based pyramid; these early observations inform larger, more rigorous research studies which can have far-reaching implications for population and public health. 4-Case reports allow clinicians to share experiences that may deviate from the accepted standards of care , either because a case does not fall within the scope of established guidelines or due to patient preference regarding treatment. 5- Education for future practitioners : Case reports act as valuable teaching tools for medical students and residents. By showing real-world scenarios of disease presentation, diagnosis, and treatment, they provide crucial context to theoretical knowledge. 6

7. Case reports have an important role in: (1) Identifying Rare or Unusual Cases. (2) Generating New Hypotheses. (3) Providing Early Warning Signal . (4) Improving Medical Education . (5) Shaping Healthcare Policy and patient safety. (6) Documentation of Medical History. 7

8. Magnitude of Case report A single case report can significantly influence medical practice, particularly when it reveals some novelty and significance of the information presented. 1-Global Impact: hinges entirely new or challenges conventional wisdom. 2- Cumulative Knowledge: t he accumulation of numerous case reports over time contributes to a comprehensive understanding of various medical conditions and treatments. Over time, a collection of case reports on a particular topic can paint a clearer picture of a disease or treatment, influencing future clinical practice guidelines. 3- Foundation for Large-Scale Studies: They provide a foundation upon which further research and clinical decisions can be based. (Spark new research questions, hypotheses and Prompt the development of larger-scale studies like clinical trials. 4- Public Awareness:  Case reports can be used to raise awareness about specific health issues. By sharing real-life stories, they can educate the public about risk factors, symptoms, and treatment options, empowering individuals to make informed decisions about their health. 5- Ethical Considerations:  Case reports can contribute to ethical discussions and debates within the medical field. By exposing ethical dilemmas and raising questions about patient privacy, informed consent, and responsible research practices, they can lead to improvements in ethical standards. 8

9. Selection of a case report (Which case report is suitable for publication? ) 9

10. *Most journals publish case reports that deal with one or more of the following : Unusual observations. Adverse response to therapies. Unusual combination of conditions leading to confusion of the diagnosis. Illustration of a new theory. Question regarding a current theory. 10

11. So, What I will do (or) what I should observe? * Identifying the Category of My Case Report, Is my case report having one of the following or not ? 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 pathogenesis of a disease or an adverse effect. Unique or rare features of a disease. Unique therapeutic approaches . A positional or quantitative variation of the anatomical structures . 11

12. First Tips that may help: First : Select a case and identify the message you wish to communicate , as well as your audience. Is this case report about an outcome, a diagnostic assessment, an intervention, a new or rare disease, or something else? Second : Gather the necessary information to accurately write WHAT happened as a timeline and as a narrative . Create the timeline of your case report—a visual summary of WHAT happened in the case report (see examples of timelines that follow the CARE guidelines) before writing the narrative section. Third : Complete the remainder of the case report using specialty-specific information, if necessary, with appropriate scientific references and explanations. Support WHY an outcome occurred with reference to the scientific and historic literature whenever possible. Write the abstract last. Fourth: De-Identification : Patient information must be de-identified and informed consent obtained prior to submitting your case report to a journal. 12

13. Writing Sequence **There is a standard steps for writing the case report called (The 2013 CARE Checklist ): (will be discussed at the end of the lecture). Start by: 1- Title – The diagnosis or intervention of primary focus followed by the words “case report”. - T he title is followed by the authors and their affiliations. 13

14. 2- Key Words – 2 to 5 key words that identify diagnoses or interventions in this case report (including "case report"). 3- Abstract – (structured or unstructured) The last part to be written at the case report. However, it is located at the beginning of the case report manuscript. ملخص الحالة (آخر خطوة في الكتابة، ولكنها تكتب في مقدمة الحالة) The abstract should summarize the case, the problem it addresses , and the message it conveys. Abstracts of case studies are usually very short, preferably not more than 150 words. It includes: Introduction (or Background) – What is unique about this case and what does it add to the scientific literature? The patient’s main concerns and important clinical findings. The primary diagnoses, interventions, and outcomes. Conclusion – What are one or more “take-away” lessons from this case report? 14

15. 4- Introduction – Briefly summarizes why this case is unique and may include medical literature references. The introduction gives a brief overview of the problem that the case addresses . - Citing relevant literature where necessary. - The introduction generally ends with a single sentence describing the patient and the basic condition that he or she is suffering from. **The introduction as general roles: 1-What we know? 2-What don’t we know ? 3- What our case or our research will add to the literature? 15 What we Know? What don’t we know? What will we add?

16. 5- the case presentation: This section provides the details of the case in the following order: -A brief history and important and relevant positive and negative findings with details of investigations. This includes: - Patient description. - Case history. - Physical examination results. - Results of pathological tests and other investigations. - Treatment plan (doses, regimens, scientific names, labelled or approved drugs, and don’t use off-labelled drug). - Expected outcome of the treatment plan. - Patient prognosis. - Actual outcome (follow-up visits). 16

17. * Don’t forget deidentified patient data. **Don’t forget Informed Consent and Patient Perspective . - The patient should provide informed consent and the author should provide this information if requested. - Some journals have consent forms which must be used regardless of informed consents you have obtained. Rarely, additional approval (e.g., IRB or ethics commission) may be needed. 17

18. Example 18 Case presentation, Clinical findings and examination Follow up brain imaging and labs Detailed history examination lab, imaging, medication follow-up prognosis.

19. Case Progression and final outcomes 19

20. 6- Discussion This is the most important part of the case report. T he part that will convince the journal that the case is publication worthy . This section should start by expanding on what has been said in the introduction , focusing on why the case is noteworthy and the problem that it addresses. Explain the objective of reporting the case. Describe what others have written before about the condition or any related feature. Describes the existing theories and research findings on the key issue in the patient's condition . This will help in decreasing the confusion or the main challenge in the case . Mention studies which support your case presentation (if present) and the possible interpretations. Note: Some journals may ask for a summary of the existing literature on the topic. (If the journal specifies a separate section on literature review, it should be added before the Discussion). 20

21. Example of the discussion 21 -Expanding knowledge about the case - why the case is unique? - Explain important case findings - Mention similar cases - Explanation of the findings of your case.

22. 7- Conclusion A case report ends with a conclusion or with summary points . This section should briefly give readers the key points covered in the case report . Here, the author can give suggestions and recommendations to clinicians, teachers, or researchers . D epending on the journal's specified format. (some journals don’t require this section in writing a case report, so better to refer to author guidelines when you submit to a journal) . 22 Example:

23. Care checklist 23

24. 24

25. Take a home message Case report considered as a base of the evidence pyramid. Case report had a crucial role in explaining abnormal data and elaborating some research theories or questions. Writing a case report needs to be stick for the CARE CHECKLIST. Abstract is written in the beginning of the case report, but it will be the last part to be written. Don’t forget deidentified patient data. Don’t forget Informed Consent. 25

26. References for further reading case reports: explanation and elaboration document CARE guidelines for case reports: explanation and elaboration document; link: https://www.jclinepi.com/article/S0895-4356(17)30037-9/fulltext 2013 CARE Checklist link: https://www.care-statement.org/checklist Writing a Case Report; link: https://www.care-statement.org/writing-a-case-report Guidelines To Writing A Clinical Case Report; link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686928/#:~:text=A%20case%20report%20is%20a,up%20of%20an%20individual%20patient . Ten Steps to Writing an Effective Case Report (Part 1); link : https://www.enago.com/academy/ten-steps-to-writing-an-effective-case-report-part-1/ Ten Steps to Writing an Effective Case Report (Part 2); link: https://www.enago.com/academy/ten-steps-to-writing-an-effective-case-report-part-2/ - ARE guidelines for case reports: explanation and elaboration document 26

27. 27 For more information and feedback please, contact me at: [email protected] mostafameshref1988 @gmail.com