IMPORTANCE OF OPEN ACCESS TO CASE REPORTS

JOSEPH ANABM BCH, DFFP, DUrology, Cert-JCGPT-UK, FRCSED, FRSPH

Editor & Mentor, BMJ West Africa Edition

OBJECTIVES Meet BMJWestAfrica & Joseph Ana Understanding Case Reports Second coming of Case Reports Understanding Open Access Ever-growing influence of Open Access The future for case reports & open access Reviving The Cases Journal !

About the BMJ West Africa Edition: a local edition of The BMJ. Founded

1995. maiden Issue published July 1996

Accredited by MDCN as a Private CPD Provider in Nigeria - May 2011 -

visit: www.bmjwestafrica.com

BMJ West Africa Edition HELPING HEALTH WORKERS IN WEST

AFRICA

KEEP UP TO DATE -----------Putting research results into

practice------

THIS TALK:

IMPORTANCE OF OPEN ACCESS TO CASE REPORTS

FAQs about Case Reports:

- Why publish Case Reports (CR)? - Why Case Report Journals?- Aren't case reports scientifically

discredited?- CRs don’t add much to J. Impact factor?- CRs don’t add to Evidence-Based Medicine?- CRs suffer stigmatisation & discrimination in

appointment and promotion committees?

‘BUT THE WORLD ARE CHANGING’ --------

the Beatles

COUNTER VIEW:- case reports tell those stories which large

studies would lose as they seek to reduce reality into measurable forms.

- case report documents empirical knowledge generated in our daily practice, which is core to our discipline.

- We all have a desire to share our discoveries with others, so that they may avoid our mistakes and learn from our experiences.

Dr. Jean Karl Soler, 2011

The Journal of Medical Case Reports

A report of a single case of a disease, (or ‘incident’) usually with an unexpected presentation, which typically describes the findings, clinical course, and prognosis of the case, often accompanied by a review of other cases previously reported in the biomedical literature to put the reported case in context.

Segen's Medical Dictionary

A GOOD CASE REPORT Valuable (Important), UNIQUE May be Original ( first ever report of such a case) Carry a useful clinical message Must be “good story well told:” same things that make

for a good novel or story—plot, surprise, counterintuitive, insights, links, “characterisation,” excitement, sex, violence, evil, mystery, crime, brutal honesty, rarity

May give the patient’s perspective in the patient’s words The doctor to give his or her “feelings” on the case and

describing his or her thought processes while dealing with the case

May Indeed have multiple perspectives—relatives, other health professionals

Follow up Longitudinal (case series) Draw out learning points. perhaps commentaries on the

learning points Less formulaic ( unpredictability)

Richard Smith, 2011

CASE REPORTS- AN ANCIENT FORM OF COMMUNICATION- PRE-DATES HIPPOCRATES

- RECAL - HIPPOCRATES’S ‘’EPIDEMICS’’

IMPORTANCE OF CASE REPORTS - every new condition begins with a single

case –AIDS, SARS, etc reporting Adverse Drug Reactions . understanding mechanism of disease recognising rare manifestations of disease Contribute definitive and indicative

evidence provides a useful information tool for both

clinicians and patients reinvigorates medicine Counters burn-out

IMPORTANCE OF CASE REPORTS FOR LMICs

(Low & Medium Income Countries)- Original research mostly from the rich world- More of such needed from the LMICs- Case report good for beginners in writing &

publishing and is - amenable to solo effort and is - Cheaper enterprise- Progress to full research paper author- good for confidence building – dont be

afraid of rejection

Health care is in some ways :

- nothing more than an accumulation of case reports just as a population is a collection of people. And just as every person is important and different so is every case - even when "it's just another sore throat".

- Clinicians have the privilege of dealing with individual cases in all their complexity and uniqueness

- Every patient, every "case" can teach us something. - A collection of case reports may reveal what is not

obvious in one case

Richard Smith

former Editor, BMJ & Editor-in-Chief, Cases Journal

CASE REPORTS ARE LIKE ASPIRIN

BORN AGAIN !

, Joseph Ana, 2004

Recent history of CASE REPORT publications

- Case Reports – Endangered Species 2001(R.Mason)

-Why Journal of Case Reports – 2007(Michael Kidd)

-Why Cases Journal – 2008(Richard Smith)

- BMJ case reports 2010

USEFUL TIPS FOR PUBLISHING A CASE REPORT

Chose the right journal, guided by reputation and publishing case reports , targeted audience, speed of decision making, time from acceptance to publication, etc

Go through past issues of the journal, read and follow guidance to authors

submit with a covering note— brief and to the point If accepted, do what the editors ask DON’T BE DISCOURAGED BY REJECTION resubmit to the same journal after corrections Work your way down the hierarchy of journals Finally your case report is published !

SOME GREAT CASE REPORTS ! “The Wolfman” and other cases from Sigmund Freud Cases from other psychoanalysts: Jung, Adler, Melanie

Klein, etc “The Year of Magical Thinking” by Joan Didion Hippocrates “Epidemics” Michael Balint’s “The doctor, his patient, and the

illness” Parkinson’s account of Parkinson’s Disease The first cases of AIDS The first cases of new variant CJD The first cases of side effects of thalidomide Penile injuries from vacuum cleaners Sex in an MRI scanner Jehovah’s witnesses refusing blood transfusion An account by a Dutch GP of his grandmother’s

assisted suicide An account of a mother’s poor care in a Rotherham

hospital in UK

Richard Smith, 2011

Traditional (conventional) Publishing

vs

Open Access Publishing

THE PRIMARY DIFFERENCE

is that in Open Access bills are not paid by readers hence cost does not pose access barrier.

----- that is, if you are not in an LMIC where access to Open Access is restricted by multiple reasons other than cost , e.g. ‘primitive’ internet service --------

INTERNET PLUS

Mobile Telephony And

Applications ↕ The future even for LIMCs

RECAP - TRADITIONAL ( conventional) PUBLISHING

Step 1: Researchers / Writers (authors) submit their articles to journals (may pay a fee to the journal for the submission)

Step 2: Journals get other researchers to review articles for free as a matter of prestige.

Step 3: When a journal accepts an article for publication it generally claims all future publishing rights on the article.

Step 4: The journal pays for the costs of formatting, print publishing, and so forth – these costs are uniformly decreasing as publishing switches from print to online formats. 

Step 5: The journal now accrues all of the profits from these articles via subscriptions or individual article purchases.

Given that both the supplier (author)and the purchaser (subscriber) pay a fee to the journals, and the reviewing work is often done for free, profits are so high.... Contrary to the claim by publishers that they face huge costs!

but OPEN ACCESS Free, immediate access online, digital to

reader Free of copyright & licensing. distribution

and re-use by reader Unrestricted Compatible with peer review, revenue

(profit), prestige, quality Author retains rights to attribution Papers are immediately deposited in a public online

archive such as PubMed Central AUTHOR PAYS after peer review and

acceptance modelBudapest Feb 2002; Bethesda Principles, April 2003; Berlin Oct 2003

(BBB)

OPEN ACCESS FREEDOMTranslation Text miningNo permission Downloading data

required for any reuse

Reproduction of figures

Coursepacks PhotocopyingDeposit in Redistributiondatabases

So, how is OPEN ACCESS important to CASE REPORTS ?

“How are we to ensure the university’s contribution to a fairer world if access to the research it produces about the world is itself a source of inequality?”

John Willinsky, Public Knowledge Project

Open access seeks to eliminate inequity in access to knowledge and health

"It's easy to say what would be the ideal

ONLINE RESOURCE for scholars and scientists:

all papers (including CASE REPORTS – ‘my addition’) in all fields, systematically interconnected, effortlessly accessible and rationally navigable, from any researcher's desk, worldwide for free.”

Stevan Harnad

- online (Open Access) sharing of Case Reports takes everyone towards this ‘ideal’ proposed by Steven Harnad-

If you have an apple and I have an apple and if we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.

George Bernard Shaw

- online sharing of Case Reports through Open Access means more ideas for everyone -

If you have a Case Report and I have a Case Report, and others have Case Reports and we share them on OPEN ACCESS then millions of health practitioners will have multiples of Case Reports to learn from.

Joseph Ana, 2004

Ever-growing influence of Open Access

In 2009, 7.7% of all peer-reviewed were gol OA Laakso M, et al. et al. (2011) The Development of Open Access Journal Publishing from 1993 to 2009. PLoS ONE 6(6): e20961. doi:10.1371/journal.pone.0020961

articles were gold OA

OPEN ACCESS FAVOURS GROWTH OF CASE REPORTS

• Editors and reviewers do not ask:– How important is the work?– Which is the relevant audience?

• Use online tools to sort and filter and peer review scholarly content in locations across the globe

• Editorial criteria sustained :– Ethical √– Properly reported √– (Scientifically rigorous)– (Conclusions supported by the data)

BMJ OPEN

BMJ

“Open Access Megajournals” & Revival of Case Report JournalsPublishers:- BioMed Central–Lead Open Access publisher- BMJ Open- Others: ElsevierDatabases: - PubMedCentral-free online database Mega Journals:- PLoS ONE- BMJ Case Reports- others

OTHERS• SAGE Open • Scientific Reports (Nature)• G3 (Genetics Society of America)• AIP Advances (American Inst Phys) • Physical Review X (American Phys

Society)• Biology Open (Company of Biologists) • Open Biology (Royal Society)• Cell Reports (Elsevier, Cell Press)

COMMON FEATURES OF MEGAJOURNALS

• All are Open Access• Peer-reviewed for rigour not “impact”• Post-publication mechanisms (eg metrics)• Supported by publication fees• Built on a strong brand• Scalable, and can become very large

“Developing countries are poorer not only because they have fewer resources, but because there is a gap in knowledge. That is why access to knowledge is so important.”

Joseph Stiglitz Noble Prize in Economics,

2001

CONSTRAINTS OF OPEN ACCESS IN LMICs

WITH ALL GOODWILL, THERE ARE NOW COMPUTERS, BUT THERE IS NO REGULAR ELECTRICITY, SECURITY, MAINTENANCE, etc

SLOW TRANSFER OF SCIENCE & TECHNOLOGY:

INTERNET AND e-HEALTH CHALLENGES: CONNECTIVITY, SPEED, COST, RELIABILITY (UPS, STABILISERS, POOR QUALITY ACCESSORIES, BOOTLEGGED PRODUCTS, etc)

MEETING THE HEALTH INFORMATION NEEDS OF DEVELOPING COUNTRIES

- CASE REPORTS – OPEN ACCESS- FULL PAPERS – OPEN ACCESS

- COLLATION, ANALYSIS AND DISSEMINATION

- ORGANISATIONS – e.g. HIFA2015 – founded in 2006

A PLATFORM FOR MULTIDISCIPLINARY DISCUSSION OF HEALTH BY STAKEHOLDERS

HIFA2015 ( Health Information for All by 2015) Join HIFA2015 ------ FREE --------- TODAY Online community of health workers

committed to enabling every health worker, caregiver, families to have appropriate Health Information by 2015 –

Launched in 2006 in Kenya (UK Based). Now has over 4,200 regular contributors

from 157 countries! THE STAKEHOLDERS: PATIENTS, FAMILIES, HEALTH WORKERS

CONCLUSION Health care is an accumulation of CASE

REPORTs - just as a population is a collection of people.

Open Access has strong drivers—promoting global science and health, justice, economic efficiency AND is moving ahead very fast because of funders and university mandates for all research to be open access and available to ALL

Open Access has an important role to play in the revival and advancement of Case Reports with its many advantages

APPRECIATION :

BioMedCentral

THANK YOU

visit: www.bmjwestafrica.com