Tips for writing a case report for the novice author

A case report is a description of important scientific observations that are missed or undetectable in clinical trials. This includes a rare or unusual clinical condition, a previously unreported or unrecognized disease, unusual side effects to therapy or response to treatment, and unique use of imaging modalities or diagnostic tests to assist diagnosis of a disease. Generally, a case report should be short and focussed, with its main components being the abstract, introduction, case description, and discussion. This article discusses the essential components of a case report, with the aim of providing guidelines and tips to novice authors to improve their writing skills

MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study

<p>Abstract</p> <p>Background</p> <p>Exertional dyspnea is the most prominent and disabling feature in idiopathic pulmonary fibrosis (IPF). The Medical Research Chronic (MRC) chronic dyspnea score as well as physiological measurements obtained during cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT) are shown to provide information on the severity and survival of disease.</p> <p>Methods</p> <p>We prospectively recruited IPF patients and examined the relationship between the MRC score and either CPET or 6MWT parameters known to reflect physiologic derangements limiting exercise capacity in IPF patients</p> <p>Results</p> <p>Twenty-five patients with IPF were included in the study. Significant correlations were found between the MRC score and the distance (r = -.781, p < 0.001), the SPO₂at the initiation and the end (r = -.542, p = 0.005 and r = -.713, p < 0.001 respectively) and the desaturation index (r = .634, p = 0.001) for the 6MWT; the MRC score and <it>V</it>O₂peak/kg (r = -.731, p < 0.001), SPO₂at peak exercise (r = -. 682, p < 0.001), VE/VCO₂slope (r = .731, p < 0.001), VE/VCO₂at AT (r = .630, p = 0.002) and the Borg scale at peak exercise (r = .50, p = 0.01) for the CPET. In multiple logistic regression analysis, the only variable independently related to the MRC is the distance walked at the 6MWT.</p> <p>Conclusion</p> <p>In this population of IPF patients a good correlation was found between the MRC chronic dyspnoea score and physiological parameters obtained during maximal and submaximal exercise testing known to reflect ventilatory impairment and exercise limitation as well as disease severity and survival. This finding is described for the first time in the literature in this group of patients as far as we know and could explain why a simple chronic dyspnea score provides reliable prognostic information on IPF.</p

CHALLENGES IN THE CLASSIFICATION OF FIBROTIC ILD

According to current international guidelines the idiopathic interstitial pneumonias (IIPs) are grouped into three categories; major, rare, and unclassifiable. Idiopathic pulmonary fibrosis (IPF) is one of the major IIPs and has been recognised as a distinct clinical entity since 2001. This has led to significant advances in our understanding and treatment of the disease and to the identification of new therapeutic targets. While multidisciplinary team assessment yields a definite diagnosis in many cases of interstitial lung disease (ILD), 15-25% of patients remain unclassifiable. This can be due to inadequate clinical, pathological, or radiological data (e.g., where a biopsy is not performed) or because results of investigations show major discrepancies, overlapping features, or mixed patterns. Patients with unclassifiable disease tend to be of similar age to those with IPF and older than those with connective tissue disorders. Survival of patients with unclassifiable disease is intermediate between IPF and non-IPF ILD. There is no single recommended treatment for patients with unclassifiable disease. However, the ILD-GAP index has recently been validated in this group and can risk-stratify patients based on four easily measurable variables. "Disease behaviour classification" (DBC) is an alternative, pragmatic approach to managing patients with unclassifiable disease. The ILD-GAP index has been shown to provide strong prognostic information in these hard-to-treat patients. In the future, new diagnostic tools such as protein biomarkers may become available to help guide therapeutic decisions

An Examination of the Impact of Commercial Parking Utilization on Cyclist Behavior in Urban Environments

There is little research on the behavioral interaction between bicycle lanes and commercial vehicle loading zones in the United States. These interactions are important to understand, to preempt increasing conflicts between truckers and bicyclists. In this study, a bicycling simulator experiment examined bicycle and truck interactions. The experiment was successfully completed by 48 participants. The bicycling simulator collected data regarding a participant’s velocity, lane position, and acceleration. Three independent variables were included in this experiment: pavement marking (white lane markings with no supplemental pavement color (white lane markings), white lane markings with solid green color applied to conflict areas (solid green), and white lane markings with dashed green color applied to conflict areas (dashed green)); signage (with and without a truck warning sign); and truck maneuver (no truck in the load zone, truck parked in the load zone, and truck pulling out of the load zone). The following bike-truck interactions were observed from the simulation. Bicyclists had the highest mean velocity when there was a white lane marking and no warning sign, and had the lowest mean velocity when there was a solid green pavement, no warning sign, and an exiting truck. Of the three independent variables, truck maneuvering had the greatest impact by decreasing mean bicyclist velocity. Bicyclists had the least lateral divergence when there was a white lane marking, a warning sign, and no truck. Of the three independent variables, truck maneuvering (parked and exiting) increased lateral movements, while solid green pavement markings decreased lateral variability. Bicyclists had the highest acceleration when there was a white lane marking, no truck, and a warning sign. Of the three independent variables, truck maneuvering had the greatest impact by increasing bicyclist acceleration. The results showed that truck presence does have an effect on bicyclist’s performance, and this effect varies on the basis of the engineering and design treatments employed. The findings of the current study showed that when a truck is present in a loading zone, solid green pavement causes bicyclists to have a lower velocity and lower divergence from the right edge of the bike lane, and employment of a warning sign causes a higher divergence from the right edge of the bike lane.Pacific Northwest Transportation Consortiu