Case Reports: An Odyssey in Ethical Publication

Sept. 4, 2024

ASM is embarking on a new journey with the launch of the journal ASM Case Reports. The new, fully open access journal was announced in Jan. 2024 and began accepting submissions at the end of August. The first case reports will be published in 2025. Case reports are a valuable educational tool for diagnosis and disease progression and can raise awareness of emerging concerns and underreported pathogeneses. Detailed descriptions of signs, symptoms, diagnosis, treatment and prognosis of individuals and/or cohorts present unique ethical considerations, particularly regarding the privacy and anonymity of patients. The ASM Journals Ethics team has laid out a recommended series of tasks to help authors succeed in publishing ethically written, highest quality case reports in the areas of clinical microbiology and infectious disease.
  

Urania, the muse of astronomy and science
Urania, the muse of astronomy and science
Source: Wikimedia Commons/ Follower of Louis TocquƩ
If the muses have called you to draft your epic tale of microbial battle, you must be well-prepared to embark on that odyssey. Just as access to the right tools and knowledge are essential to successful clinical intervention, a well-prepared author will have a much easier voyage to publication. The standard ethics requirements still apply, but here we have highlighted special considerations when writing a clinical history. For example, authors are expected to follow CARE guidelines for case reports when preparing their manuscript. The following tasks will help authors navigate and avoid pitfalls and delays in their quest for publication. 

First Task: Obtaining Proper Ethical Approval 

Laozi wrote that a journey of 1,000 miles begins with a single step. The first step in chronicling your case report is obtaining proper ethical approvals. When performing research on human subjects, a letter of approval from an Institutional Review Board (IRB), or a statement documenting the reason approval has been deemed unnecessary, are critical. If your report involves animals, an Institutional Animal Care and Use Committee (IACUC) approval or waiver is necessary. In the event your institution does not have an IRB or IACUC approval board, a statement that your research is aligned with the Declaration of Helsinki or the International Guiding Principles for Biomedical Research Involving Animals should be sufficient. Be prepared to present this documentation for your manuscript to continue forward. 

Second Task: Protecting Privacy and Obtaining Informed Consent 

Informed consent is an important precursor to ethical case report publication. Be prepared to provide documentation of consent upon request, or your quest will stall. Laws and regulations, as well as social mores and customs, surrounding informed consent vary by location. Authors are responsible for ensuring that they have followed all applicable legal and cultural requirements for all relevant locations. If consent is deemed to be unnecessary or unobtainable, include a justification statement explaining the reasoning behind that decision.

Personnel should be trained and qualified to explain to patients the purpose and risks of participating in publication. Written consent is preferred. However, if written consent is unavailable, verbal consent may be documented. Patients should be aware that, once published, it is not possible to completely erase all traces of images or other documentation from internet databases. 

All identities, including those of both personnel and patients, must remain confidential. Use as few identifiable details and features as possible to maintain the case report narrative and scientific meaning. Know what constitutes Personally Identifiable Information (PII)—it is important to understand that PII does not solely consist of single data points. The reader should not be able to piece together the information to discover an individual's identity.  

Pseudonyms should never be based on someone’s real name. The laws and regulations around PII and consent vary jurisdictionally, so it is up to the authors to ensure that data is properly anonymized.  

If your case study involves other institutions or locations, you, as the author, must ensure that the research and manuscript comply with the laws for every location involved. 

The following chart is for illustrative purposes and is not an exhaustive list of all types of PII

A table listing various types of data and suggestions for redaction
Example description: In 2023, Minor patient M1 was injured in the back seat of a small vehicle traveling in the Walloon region of Belgium and taken to a local hospital for treatment. (Click to enlarge image)
Source: American Society for Microbiology

Third Task: Illustrating the Record 

Graphics and images will bring your case study to life and may be particularly useful, as observable symptoms and/or laboratory results can be definitively diagnostic. All ASM image guidelines apply to case reports. This means that duplicate images should be acknowledged in the figure legends, and tooling lines should be used to indicate individual image boundaries in mosaics or composites. Any adjustments to an image, such as contrast or brightness levels, must be applied to the whole image. Generative AI may not be used to create visual content. 

Images cannot be edited to add or remove an element from the composition. Case reports are an exception only when it is necessary to conceal identifying features and maintain anonymity.  

If you intend to include images created by someone else with your case study, be sure to include citations and document proper permissions. Always remember to protect the identities of human subjects when using their images in a figure.   

A statue of Achilles with black boxes covering his face and name on the plinth to protect his identity.
Redacted image for a case report discussing a Greek warrior killed in battle at the city of Troy due to complications of an injury exacerbated by a unique neonatal intervention.
Source: Wolfgang Sauber, CC BY-SA 4.0, via Wikimedia Commons

Final Task: Creating the Manuscript 

The final task of your quest does not have to be the most difficult. As a member of the Committee on Publication Ethics (COPE), ASM follows COPE publication guidelines. Case reports must follow editorial guidelines and policies. When writing your manuscript, maintain data availability and proper data citation methods.  

Ensure that descriptions encourage “fairness, equity, consistency and clarity in use and reporting of race and ethnicity and that inclusive language supports diversity and conveys respect.” Correct and preferred usage of terms avoid language that imparts bias toward or against groups or individuals. 

Many resources are available online to help smooth the way. ASM has suggestions for language editing services, abbreviations and naming conventions and how to properly cite data. Many organizations have useful resources on human subject research, animal research and even training for staff involved in the collection and analysis of data. 

The key to successful publication lies in preparation. Completing the previous tasks at the outset will eliminate most roadblocks and detours. The staff at ASM Case Reports and the Journals Ethics team can answer questions or concerns regarding a report. Always remember you are not alone on this journey.  
 


ASM Case Reports is ASM’s newest fully open access journal. The journal aligns with ASM’s mission, providing a dedicated platform for the highest-quality case reports in clinical microbiology and infectious diseases. We are now now accepting submissions!


Author: Alicea Hibbard, MHA

Alicea Hibbard, MHA
Alicea Hibbard, MHA, joined the American Society for Microbiology as the Ethics and IDEAA Senior Associate in 2023.