Protopapas and Athanasiou Journal of Medical Case Reports 2011, 5:164 http://www.jmedicalcasereports.com/content/5/1/164 E D I T O R I A L Evolving dimensions in medical case reporting Aristotle D Protopapas1* and Thanos Athanasiou2 Abstract Medical case reports (MCRs) have been undervalued in the literature to date. It seems that while case series emphasize what is probable, case reports describe what is possible and what can go wrong. MCRs transfer medical knowledge and act as educational tools. We outline evolving aspects of the MCR in current practice. JOURNAL OF MEDICAL CASE REPORTS Open Access The full translational potential of medical case reports (MCRs) is not always considered by authors, periodicals or readers, as MCRs are often perceived as a low-budget form of publication for fledgling medical writers. The acceptance rate for MCRs and their priority for publica- tion are lower than those for other manuscripts in tradi- tional journals. It is important to emphasize that prospective, retrospective and observational randomized controlled trials are always constructed on the basis of data obtained from individual patients whose cases are the units that create the cohort, allowing the investiga- tor to define end points and make inferences by calcu- lating effect sizes. It is safe to say that all classes of evidence (Classes I through III) are constructed using the accumulated units of observation comprising indivi- dual cases. Although MCRs are limited by the fact that they cannot be generalized beyond the context of the individual patient or patients described [1] and thus are not suitable for inference, they offer a high degree of opportunity to transfer medical knowledge and act as educational tools, and in a very direct way. In this editorial, we attempt to outline the evolving dimensions of MCRs in four particular areas of medical education: (1) reporting of adverse events (AEs), (2) new diseases or exceptional environments, (3) medical inno- vation and (4) appropriate use of media in terms of ethics, standardization and creativity (Figure 1). MCRs of adverse events: errors of omission or errors of commission? An AE is an unwanted event that occurs in the course of treatment, especially in a clinical trial. MCRs may be the first warning of catastrophic AEs [2,3]. * Correspondence: aristotelis.protopapas02@imperial.ac.uk 128 Old Brompton Road, London, SW7 3SS, UK Full list of author information is available at the end of the article The Journal of Medical Case Reports encourages con- structive MCRs of AEs, especially the unreported side effects or adverse interactions involving medications or unexpected events in the course of treating a patient [4]. An isolated AE can be important in forming part of the evidence in the healthcare sciences [5]. Some meth- odologies of randomized controlled trials lead to the exclusion of such isolated AEs from their data sets, which renders an isolated MCR of an AE even more valuable. It is especially crucial to highlight translational AEs, where in vitro or animal experiments have not been reproduced in humans, with resultant ramifications for patient safety [6]. The evidence in national and interna- tional AE databases should be consulted, and each AE should be logged appropriately [7]. Overall, an AE should be reported in an exacting, scientific way. A root cause analysis should be included, and a survey of evidence-based recommendations should conclude the report. Below we present a brief algorithm from the generic template of JMCR[4] that summarizes the above-mentioned contentions: 1. Introduction: The Introduction should state the indications of the intervention, a brief overview of exist- ing evidence and current evidence-based recommenda- tions, preferably tabulated and classified [8]. 2. Case presentation: Are case presentations an error of omission or errors of commission? Adherence to recommendations and good practice are essential. 3. Discussion: The Discussion section should translate findings to clinical best practices and patient safety. In cases in which a case report describes an AE that occurred within the setting of a randomized controlled trial, this should be clearly stated and details of the ran- domized controlled trial, such as its registration and © 2011 Protopapas and Athanasiou; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.