Returning to Our Roots
Since its inception as Decubitus under the direction of Roberta S. Abruzzese, EdD, RN, FAAN, founding editor, Advances in Skin & Wound Care has morphed into a highly recognized biomedical journal in the specialty of wound care. Our editorial calendar and genre are diverse, including editorial thought and content encompassing qualitative and quantitative health services research, clinical trials, professional issues, and basic research using various wound models, including animals and human-based clinical cases. The intention of this editorial is to encourage the submission of cogent clinical case reports and case series to the journal. We need novel and interesting cases seen by wound care clinicians at the point of service that involve the patient perspective.1
Published clinical case reports provide fundamental information for good patient care because they can describe important scientific and clinical observations that may be overlooked in traditional clinical trials.1 Writing and submitting a case report or case series may seem daunting, but like any other complex task, it can be approached by reducing it to the important subelements. One important skill is to be a critical reader-a consumer of information in the field. I like the quote from author Stephen King, "If you don't have the time to read, you don't have the time or the tools to write." By reading various journals, you can become familiar with the writing style, author instructions, and review process for manuscript publication (see our manuscript submission page: http://www.lwwesubmissions.com). Furthermore, by critically reading and evaluating wound care journals, and clinical and case series on a regular basis, readers develop core knowledge of what constitutes clear and concise clinical writing.
The Clinical Case Reports and Case Series
Why should we focus on case reports and case series? How do they contribute to the evidence continuum in clinical research, specifically for wound care? Over the last several decades, evidence-based medicine has become a cornerstone of medical literature analysis, along with strength of evidence ratings. Likewise, the criterion standard, double-blind randomized clinical trials, although laudable, all started with hypothesis-driven questions developed through individual clinical cases, case series, and meta-analysis of case series.
Medical case reports and case series are important because they may potentially describe a new facet of a disease process, identify the adverse effects of a drug (adverse or beneficial), identify or study a mechanism of disease, and be useful in medical education and identification of rare manifestations of a disease process.2 Consider a rare, but devastating, consequence of diabetes-scleredema diabeticorum, which is an unusual deep autoimmune tissue injury in patients with diabetes that is characterized by presenting as a hard indurated area at the nape of the neck.3 This lesion has the potential of becoming infected and presents as a weeping wound.3 In 1996, a case series outlined a similar manifestation named "Scleredema of Buschke: A Report of Seven Cases."4
Case reports should be meaningful and structured, conveying an important message, clinical finding, or "pearl" that will possibly change the way we diagnose and treat a wound. The format could follow the usual "IMRAD" (Introduction, Methods, Results, and Discussion) format,2,5 if appropriate to the case or series. Case series can often add power to a finding, by comparing and contrasting each case against a metric or standard. A well-constructed case report should create a "recognition pattern"6 for readers to identify similar cases from their own clinical practice. Topics such as the identification of a novel disease, an unusual or complex case, unusual presentation of a common problem, innovative treatment, or medical or ethical issues may produce case reports that are effective, important, and educational.
For many treatments, case reports and case series are the only available evidence.7 At Advances in Skin & Wound Care, we encourage the submission of more case reports, case series, and meta-analysis of a series of case reports.
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