HCA Healthcare Journal of Medicine
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Deidentifying a patient case in accordance
with the Health Insurance Portability and Ac-
countability Act (HIPAA) goes beyond simply
removing the patient’s name and date of birth.
The Safe Harbor method for deidentification
includes 18 items to remove, including geo-
graphic divisions smaller than a state, all ele-
ments of date (including date of service), age
above 90 (refer to the patient as “elderly” or
“over 89”), and any unique identifying number
(eg, medical record number [MRN]).
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Describe the case concisely and in chronological
order, starting with the chief complaint and
significant family, occupational, and social his-
tory.
5
Provide key details of the patient’s pre-
sentation and clinical findings from the physical
exam, vitals at the time of examination, and
any images. Follow with significant labs and
tests and describe any treatments, procedures,
or interventions. Use standard measurement
units and include the normal range for positive
labs. When using abbreviations, spell out the
word for the first use, and use standard abbre-
viations when available. Also, use the generic
name for all medications unless a specific name
brand is the emphasis of the case.
Focus the case presentation on positive
findings from the history or exam, including
negative findings only when relevant to the
case or the diagnosis. Finish with a prognosis,
follow-up results, if available, and long-term
outcomes. Avoid superfluous or other extrane-
ous facts that detract from the understanding
of the case.
5
Tables are an eective way to present content
when there is a long list of tests/labs or sig-
nificant demographic or exam data to present.
Figures (or images) should be used to show
physical, microscopic, histological, or other visual
representations of the disease. Aer making
sure that no identifiable information is includ-
ed in a patient image, consider adding arrows
or another means of helping the reader locate
specific aspects of the images referred to in the
description. Refer to any tables or figures in this
section using targets or callouts (eg, “Figure 2”).
Tables and figures should be numbered se-
quentially in the order they are described in the
text. Tables should have a descriptive title, and
figures should include a caption that describes
the image in complete sentences.
The Discussion
The discussion is the authors’ opportunity to
distinguish key features of their case, highlight
its uniqueness, and identify and compare their
case to similar cases in the literature. Appropri-
ate comparisons can only be made if the litera-
ture is relevant and up to date. A similar case in
the literature does not necessarily detract from
the current case. Instead, it provides an oppor-
tunity to contrast and define unique elements
between cases. All statements of fact and any
literature presented must be properly cited in
the text.
Beyond these basics, the discussion provides
an opportunity to compare the current case to
previous literature, contrast findings with pre-
vious treatment strategies or outcomes, and
provide reasons for possible outcome dier-
ences. Authors of previously published works
likely had similar challenges and applied similar
strategies but may or may not have had the
same patient outcomes. The discussion also
provides the authors a chance to explain the
unique responses of their patients to medica-
tions or treatment and provide limited specula-
tion about their success or failure. In short, the
discussion is a chance for the authors to em-
ploy their clinical expertise to help the reader
understand the significance of their case and
how to respond should they see a similar case.
The Conclusion
The conclusion starts with a summary, includ-
ing key elements of the case and its clinical im-
pacts. Do not reiterate case details, but provide
a short statement to describe the case, course
of treatment, and outcomes. A concluding
statement should follow that highlights the rel-
evance of the case, whether it is generalizable,
and the contributions the case makes to the
literature or potential changes in treatment.
Construct your conclusion carefully, avoiding
overzealous statements, and make sure your
conclusion matches the content and tone ex-
pressed in the abstract conclusion.
References
The HCA Healthcare Journal of Medicine follows
American Medical Association (AMA) guidelines
for formatting and referencing. Briefly, refer-
ences are numbered consecutively by first use
in the main text, using commas to separate
when multiple sources are cited.
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