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Since the establishment of the Journal of Medical Case Reports in 2006, the number of journals that publish case reports has increased rapidly, and most of these journals are open access. Open access publishing usually requires authors to pay publication fees while offering the articles online, free of charge, and free of most copyright and licensing restrictions. The movement for open access has gained support in the research community, with the publishers BioMed Central and PLOS ONE becoming leaders in scientific publishing in their number of articles and citations. As the number of open access publishers has exploded, so too has the number of publishers that act in bad faith to profit from the open access model. Simple guidelines have been developed and resources are available to help authors choose a suitable journal for publication of their case reports.
Case reports offer unique value to the body of medical knowledge by describing new diseases, disease mechanisms, therapeutic approaches, and adverse or beneficial effects of drugs. The act of recording, discussing with colleagues, and publishing clinical observations as case reports remains essential to the art of medicine and patient care . These short communications generate or enforce hypotheses that may lead to further evaluation in larger study designs . In providing detailed descriptions of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient, case reports reflect clinical experience and support medical progress. By design, the format lacks statistical sampling, placing it at the bottom of the hierarchy of clinical evidence. Case reports do not include controls, have limited sample size (one to a few individuals), and are unblinded, limitations that require a cautious approach to interpretation of findings. General medical journals publish case reports sparingly, often only publishing those that provide new information on adverse events that can be linked to an intervention [3, 4]. Journal editors may limit inclusion of case reports because they are cited less often than meta-analyses and randomized controlled trials, which negatively affects a journal’s impact factor.
The merits of large randomized studies are well known, but many clinicians recognize the value of case reports as a complement to evidence-based medicine. The case-based nature of clinical practice often is at odds with the population-based nature of research studies, where the findings may have little relevance to an individual patient. Narrow inclusion criteria and the absence of co-morbidities in randomized trials often create a disconnection between typical patient populations and populations represented in research studies . Case reports provide enough detail on one or a small number of patients for clinicians to relate to their own practice. They are educational and interesting to read. For the challenging and patient-centered task of reporting on individual cases with inherent heterogeneous human variability in clinical research and the goal of applicability to real-life circumstances, the CARE guidelines provide a framework for completeness and transparency in case reports. The guidelines aid in finding the balance between adequate detail and concise writing .
In response to renewed interest and acknowledgment of their value, the number of peer-reviewed journals that publish case reports has increased in recent years to more than 160 . In the digital era of paperless journals with few space restrictions, the case report has seen a resurgence. The digital format facilitates searches, which is a key factor in their utility . Most of the case report journals are open access and have high acceptance rates. As the number of new scientific journals increases, so do the number of questionable publishers that mislead researchers regarding fees, peer review, and academic credentials. The process of submitting scientific work for publication now includes the need for thorough vetting of potential publishers.
In line with the growing demand for case report publishing opportunities, the number of new peer-reviewed journals that focus on case reports had increased to more than 160 journals produced by 78 publishers by mid-2015. Figure 1 shows that the number of case report journals increased rapidly beginning in 2007, a timeframe that coincides with the Great Recession of the late 2000s and the concomitant decline in federal and other funding for basic science and other research. Some of the new journals cover general medicine and others cover specific therapeutic areas. Most case report journals (94%) are open access and approximately 40% are indexed in PubMed. Clinical issues covered by case report journals include previously unreported adverse effects of drugs or other treatments, unexpected events that occur in the course of observing or treating a patient, observations on disease pathogenesis, presentations and/or management of new and emerging diseases, new therapeutic approaches, ethical challenges in patient management, and strategies for preventing or overcoming medical errors [6, 8].
Open access publishing offers freely available and unrestricted use of research and scholarship, which many researchers see as vital to efficient dissemination of science in the digital world . The open access model usually requires authors to pay submission and publication fees upon acceptance, typically between US $300 and $1200 . The move toward making scholarly publications more accessible through open access has continued to gain supporters among the research community. The open access publisher BioMed Central launched in 2000 with 231 articles published that year in 60 journals. In 2015, the numbers increased to more than 30,000 articles in over 290 journals. In 2014, BioMed Central articles were accessed more than 277 million times and had 426,000 citations . Similarly, the number of publications from the open access publisher PLOS ONE, increased from 138 at its inception in 2006 to 28,107 in 2015 .
As scientific publishing shifts from a business model of subscription revenue to open access, the number of open access journals has exploded. However, the proliferation of journals that will publish seemingly anything for a fee has caused alarm among many in the global research community. Alongside many respected open access publishers, others have entered the space acting in bad faith. Some see it as the “dark side” of open access, a growing collection of pseudo-academic, prestigiously titled journals, many of which have similar but not quite identical websites and names to those of well-known established journals. Many of the websites look sufficiently impressive that non-experts doing online research have trouble distinguishing credible research from junk. Experienced academics have been misled into submitting manuscripts and even serving on editorial boards for pseudo-academic journals, agreements that often are difficult to undo. Most of these journals do not post their publication fees, and often authors are not informed of fees until after submitting a manuscript. Withdrawal of a manuscript, which is necessary before submitting the same paper to a legitimate journal, may require payment of the high fees first . For some authors, this means their work may be lost essentially to the disreputable publisher. Many researchers have complained about poorly executed or absent peer review, hidden fees for submission and publication, and unapproved inclusion of researchers’ names on editorial boards.
Jeffrey Beall, a librarian and associate professor at Auraria Library at the University of Colorado, Denver, coined the term “predatory open access publishing” to describe this situation. He is a critic of open access publishing, blaming the system for creating the problem of predatory publishers. His blog Scholarly Open Access, although removed by Beall for unknown reasons in January 2017, closely monitored the increasing number of open access publishers and alerted readers to individuals, publishers, publications, meetings, and scholarly metrics that, in the view of Mr Beall, appeared to exploit the open access model . He maintained a list of “potential, possible, or probable predatory scholarly open-access publishers” and another list of standalone journals. His criteria for inclusion on the lists were derived from the Code of Conduct for Journal Publishers from the Committee on Publication Ethics (COPE), and Principles of Transparency and Best Practice in Scholarly Publishing from COPE, the Open Access Scholarly Publishers Association (OASPA), and the World Association of Medical Editors [14–16]. Similarly, information in these communications may help authors to discern whether they can trust a particular publisher or journal. The Federal Trade Commission (FTC) in the USA has taken notice of questionable publication practices. In August 2016 it filed a suit against the OMICS Group, a global conglomerate based in India that publishes more than 700 open access journals. The suit claimed that the OMICS Group misled researchers, particularly with regard to their peer-review process (or lack thereof) and high fees that were not readily apparent to authors upon manuscript submission . The purpose of the lawsuit, according to the FTC, is to better inform authors of publishing fees and to have a more transparent peer-review system . The case is still to be litigated in federal court in Nevada at the time of writing this article.
The challenge for watchdogs and authors alike is to decide when a publisher is untrustworthy or simply unprofessional. Some publishers may fall under suspicion due to poor copy editing or amateurish website design, but this may not reflect an outright neglect of scholarly standards. It is important not to blacklist startup publishers who lack experience. Another problem with maintaining lists of disreputable publishers is that because copycat journals are often short-lived, the blacklist will continue to grow but individual entries may quickly become obsolete.
The “Think. Check. Submit.” campaign arose in response to concerns about publishing practices, and the effort is supported by a coalition of scholarly publishing organizations. “Think. Check. Submit.” takes a positive approach to help researchers identify credible journals, providing up-to-date guidance for choosing where to publish [18, 19]. To ascertain whether a journal is trusted, authors are advised to follow this checklist:
In addition to consulting colleagues and academic librarians for journal suggestions, authors have available to them several online resources. BioMed Central previously collaborated with Edanz, a company that assists authors in navigating the publication process, to create the author academy . The free online guide describes best practices in writing and publishing a manuscript, including sections on choosing a journal, writing the manuscript, and publication ethics, among others. BioMed Central now contracts with Nature Research Editing Services and American Journal Experts, both of which offer similar services [20, 21].
Several automated search tools help identify suitable journals as well. Authors insert keywords from their manuscript abstract into a search engine, which then compares the words to many online publications and Edanz Journal Selector covers a broad range of journals. The online tool is free, and Edanz also offers a journal selection service (US $300) in which experts use their publication experience to identify up to four of the best journals for a given paper . The Journal/Author Name Estimator (Jane) focuses on biomedical science journals by searching the Medline database published by the US National Library of Medicine . Other online services offered by publishers Springer and Elsevier suggest journals from their own extensive catalogues [24, 25].
Journal impact factors, calculated and published by Thomson Reuters, measure the average number of citations per published article for papers published over a 2-year period. Despite the fact that the simple metric can be misleading, the impact factor has become, over time, a marker of journal prestige and desirability. The judgment of a paper’s value is often based more on the journal in which it appears than on its content. Many researchers contend that reliance on impact factors undervalues disciplines or study designs, such as case reports, which have lower citation rates. Overall, the number of citations of an article is commensurate with hierarchies of evidence, with meta-analyses receiving more citations than any other study design. Case reports typically receive few citations, although there are notable exceptions . The number of citations of an article, however, does not necessarily reflect how widely the article has been read or the dissemination of the findings in mainstream media .
Efforts to embrace a broader view of value in scientific communication, and perhaps diminish the influence of impact factors, have emerged. Journals of the American Society for Microbiology (ASM) no longer advertise impact factors on their websites. Similarly, in recognizing that impact factors are just one of a number of metrics, Nature journals list a suite of citation-based metrics. Only one case report journal, Taylor & Francis’s Neurocase, has received an impact factor (1.124), dating back to 1998.
Medicine/National Institutes of Health Indexed research databases are often curated to ensure the quality of included publications. Clarivate Analytics (formerly Thomson Reuters) offers The Web of Science™, as one such example, and recently introduced the “Emerging Sources Citation Index” to complement their more selective indexes. This collection reflects the growing number of peer-reviewed publications of regional importance and in emerging fields .
In conclusion, the growth in number of case report journals has provided authors multiple avenues for publication but, at the same time, it has introduced a new level of uncertainty in the journal selection process. Factors to consider when choosing a journal are: the topics the journal covers, the target audience, length restrictions, and the time to publication. Open access publications, such as the Journal of Medical Case Reports from BioMed Central, offer high visibility, relatively rapid publication, and transparent publication policies. The reputation of the journal plays an increasingly important part of the decision, requiring thorough vetting of potential journals.
We thank the reviewers for their insightful and helpful comments on our editorial.
All authors read and approved the final manuscript.
RAR is a Deputy Editor and MRK is the Editor-in-Chief of Journal of Medical Case Reports. JKS has nothing to disclose.
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Richard A. Rison, Email: ude.csu@nosir.
Jennifer Kelly Shepphird, Email: moc.gnitirwskj@nej.
Michael R. Kidd, Email: firstname.lastname@example.org.