Writing a Clinical Case Study

By Dr Zunaid Alli / 15 Jan 2021

Dr Zunaid Alli provides his tips for getting your case studies considered for academic publication

The practice of aesthetic medicine in the UK is made up of a wide range of medical professionals. In a review of backgrounds of presenters at an international conferencemrelated to aesthetic medicine, the author noted 83% of the speakers had not contributed to any peer-reviewed literature that was relevant to the subject of their presentation.1

They concluded that the results might fall below the threshold deemed acceptable for practitioners presenting themselves as experts in a branch of medicine and might reflect a critical dearth of evidence-based practices in aesthetic medicine.

As the evidence-base for aesthetic medicine continues to grow, it should be noted that there are challenges to publication due to the subjective nature of outcomes.2 Through my experience in training aesthetic practitioners in the UK, I believe these barriers may include:

• English may not be the practitioner’s first or main language or perhaps not the medium of study of primary medical degree or qualification

• Scientific or clinical research design, analysis or academic writing may not have been taught during tertiary study

• Post-qualification, there are very limited amounts of taught courses in medical academic writing

• Most aesthetic practitioners work as lone clinicians with a lack of senior support or mentorship

• Aesthetic treatments are often not deemed ‘medical’, so practitioners are often not hired or sponsored to conduct clinical research

In this context, case studies may be helpful in providing data for this level of evidence. Case studies are ways to explain, describe, or explore phenomena.3 They are based on in-depth investigation of a single individual, group or event to investigate the causes of underlying principles.4 There is important applicability for lone practitioners in aesthetic medicine as case studies may help in clinical decision making about best patient care in evidence-based practice. The scope of this article is to assist aesthetic practitioners with some tools and tips to be able to use their own clinical experiences, as well as to work through the barriers that they may face, in order to be able to write a case study for academic publication and help progress the aesthetics field.

Journals and submission criteria

As a general rule for publication to journals, a prospective author needs to be aware that a submission for one particular case study needs to be made to one journal at a time. It is not recommended to submit the same article to multiple journals and to await the first accepted submission. It may be feasible for the prospective author to submit the case study to subject specific journals first, followed by specialty or subspecialty specific journals as a second and wider subject specific journals thereafter.

Some journals will accept articles that are already written, while others may prefer to work with the author to outline their specific requirements first, as is the case with the Aesthetics journal.

Images form an important part of a case study, so authors should ensure that if images are submitted with the case study, that they are of exceptionally high quality and with high resolution. Any before and after pictures need to have consistent parameters.

As a general rule, I have found that a case study generally consists of 800-1,500 words in the main body of the article and it is acceptable to allow for at least six to 10 references per 500 words. This is dependent on the subject area and the availability of published references on the topic. Authors should ensure that all work is appropriately referenced and paraphrased to avoid plagiarism.

The case study article should be thoroughly referenced according to the guidelines set forth by the editors of the journal. The format for the referencing will usually be according to generally acceptable academic formats such as the Harvard method of citation, American Medical Association, American Psychological Association, Modern Humanities Research Association or footnote referencing, Modern Language Association and the National Library of Medicine.

While submission to most journals is free, prospective authors should be aware of underlying costs such as submission fees, editorial costs or publication costs, which they may be made aware of prior to publication.

Examples of journals and publications for aesthetic medicine include: Aesthetics journal, PRIME journal, Journal of Aesthetic Nursing, Aesthetic Medicine magazine, Journal of Cosmetic Dermatology, The Journal of Aesthetic and Clinical Dermatology and Plastic and Reconstructive Surgery – Global Open, to name a few. Note that not all of these are peer-reviewed, however may still be very useful for sharing knowledge and experiences.

Case study writing

First you should think about the topic of the article or case study. Most journals like to publish cases that are unique or different to what has been published before, showcase excellent clinical outcomes, or have interesting findings or learning outcomes. One example could be the resolution of an aesthetic dermal filler complication of a patient presenting with bruising and haematoma. You should formulate a research question or statement based on the presentation of the patient. I find that a brainstorming session is key to direct the focus of the case to choose one or more suitable areas as the main focus of the case study (see Figure 1 as an example). Following this, a detailed literature search would be done to enable detailed scientific analysis of the case.

Literature review

For the purposes of this article, the research statement chosen as a focus from Figure 1 would be the management of bruising and haematomas following dermal filler injection for lip augmentation.

A detailed search for evidence-based publications should follow. You should sift through these articles for the most relevant and updated ones to help support the research question. A period of appraisal and analysis of the articles will allow for a detailed summary of the major themes identified, such as conclusions or outcomes, that support or contradict the findings/management. The references for each of these will now start the compilation of the reference list.

It is best to use larger and authenticated search engines such as PubMed, Embase, Google Scholar, BMJ Best Practice, ACE Group (for guidelines and protocols), or other published source in aesthetic medicine. NICE guidelines may also be used and referenced if appropriate. In terms of search terms or medical search words, it is recommended to use the Boolean search strategy to help streamline the results found. This is using words such as AND (narrows search results), OR (broadens search results), and NOT (narrow search results by eliminating specific words or phrases).5 Using a PubMed Central search or a keyword search may also be helpful. Most search engines will have capability to search an author’s surname if it is known or between a date range, for example.

It is helpful to include American spelling of medical terms, such as haematoma vs. hematoma, to allow for a more detailed search. The results will need to be manually evaluated and appraised for content in relation to the research question/statement.

The structure and writing up

The blurb or the modified abstract would come first, but as case studies are usually word restricted, they are not always required. This section provides a short snapshot of the details of the study so as to capture the attention of the reader. It may be used on the inside cover of a journal, contents page or index, or on social media posts.

Introduction

The introduction needs to be short and to the point. Consider, why is this article being written, what makes it different and unique? What has the author learnt from it or what is the reader likely to learn from it? Set the scene by giving the clinical background of this case in paragraph form. For a case study, your intro should include: the age of the patient, why they presented to clinic and their concerns.

Body

The body of the article brings the clinical scenario to light and explores your research question and literature search together. It should also provide a linkage as to what published articles or guidelines say versus the clinical management of the patient. This section is advised to make up at least two thirds of the entire word count. It should include details about the consultation, treatment plan, pre and post procedure approach, as well as any side effects or complications, and the patient outcome and follow-up.

Conclusion

The conclusion is also succinct and aids in summarising the main points and findings. As this is a clinical case, summarise what went well, what could have been done better and include some information on further learning. You would usually not require referencing in your conclusion unless you are bringing to light new information, which you generally should have done in the sections above. It is advised that both the introduction and conclusion share roughly one third of the word count.

Submission

It is useful to note that most journals are strict on word counts and any deviation from the agreed counts should be stated with explanation on submission. Allow for time to proofread and allow for colleagues or peers to critique with enough time allocated for editing. Following this, each journal will have their own process to follow after submission. Do not expect editors to correct errors in sentence construction or word use. If any editing is suggested, be prepared to take constructive criticism on board and use this to rework your article. This needs to be done beforehand to ensure that a well thought out and written article is submitted. Do not be disappointed if your article is not published, as some journals may decline for publication after submission of a piece of work that you have worked on for a while. As previously described, re-edit and submit to the next journal on your list.

Ensure that submission dates and deadlines are adhered to at all costs. Editors usually have strict deadlines and if there are any problems with editing and submission, it is important to communicate this with your editor. If you are submitting to a peer-reviewed journal, expect that the process may be significantly longer due to submission of the case study to multiple researchers for comment, followed by ratification and discussion and then re-editing before publication.

Summary

The writing of a case study for publication is an excellent way for prospective authors to get started with academic writing. It is important to keep focused on the research question and to search for current best evidence using search terminology to support the clinical subject area. Write up the article using clear, understandable language and be prepared to do a fair amount of retrospective editing on the article before publication.

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