case medical research journal

Search the world's largest collection of clinical case reports

Browse case reports by:

Publish in BMJ Case Reports

Global health case reports.

These are case reports that focus on the causes of ill health, the social determinants of health and access to healthcare services, prevailing local and national issues that affect health and wellbeing, and the challenges in providing care to vulnerable populations or with limited resources.

Read the full collection now

Images in… :

24 January 2024

Unusual association of diseases/symptoms :

31 July 2023

Obstetrics and gynaecology :

5 March 2024

18 October 2023

Case report :

Case Reports by specialty

• Anaesthesia
• Dentistry and oral medicine
• Dermatology
• Emergency medicine
• Endocrinology
• General practice and family medicine
• Geriatric medicine
• Haematology
• Infectious diseases
• Obstetrics and gynaecology
• Ophthalmology
• Orthopaedics
• Paediatrics
• Respiratory medicine
• Rheumatology

Global Health Competition

Every year BMJ Case Reports selects authors of global health case reports to join our editorial team as a global health associate editor.

This is an opportunity to gain some editorial experience or join our team on research and educational projects. Students and graduates may apply.

Simply select Global Health Competition when you submit.

Latest Articles

Case Reports: Unusual association of diseases/symptoms :

Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation) :

22 May 2024

Case Reports: Findings that shed new light on the possible pathogenesis of a disease :

15 May 2024

Case Medical Research Latest Publications

Total documents, published by case journals.

• Latest Documents
• Most Cited Documents
• Contributed Authors
• Related Sources
• Related Keywords

A Phase II Study of Daratumumab, Clarithromycin, Pomalidomide And Dexamethasone (D-ClaPd) In Multiple Myeloma Patients Previously Exposed to Daratumumab

Early dietary treated patients with phenylketonuria can achieve normal growth and mental development., augmenting massed prolonged exposure with a stellate ganglion block to treat ptsd, effect of applying cuff air leak pressure as intraoperative cuff pressure on postoperative complications, changes in pain level with the use of the regulated expiratory method., patient satisfaction with virtual post operative visits: hip arthroscopy, a study to assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of single-ascending and multiple doses of akcea-ttr-lrx in healthy japanese participants, a study of alectinib, entrectinib, or vemurafenib plus cobimetinib in participants with stages i-iii non-small cell lung cancer with alk, ros1, ntrk, or braf v600e molecular alterations, filipino multicomponent intervention to maintain cognitive performance among high risk population (finomain), keeping infants term - a controlled high-risk patient enquiry, export citation format, share document.

• Search by keyword
• Search by citation

Page 1 of 144

A rare incidence of severe dermatological toxicities triggered by concomitant administration of all-trans retinoic acid and triazole antifungal in patients with acute promyelocytic leukemia: a case series and review of the literature

All-trans retinoic acid (ATRA) is an indispensable part of the treatment of acute promyelocytic leukemia (APL). Although, mild cutaneous toxicities like mucocutaneous xerosis, rash, and pruritus are well repor...

• View Full Text

Community-acquired pneumonia associated with immunosuppression due to follicular thyroid cancer: a case report

We present the case of a woman with cancer, which weakened the immune system and increased the risk of infection. Thus, infections are a frequent complication of cancer. The development of community-acquired p...

Wandering spleen presenting in the form of right sided pelvic mass and pain in a patient with AD-PCKD: a case report and review of the literature

Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal...

Recurrent fever leading to the diagnosis of an angiosarcoma of the adrenal gland: a case report

Angiosarcoma of the adrenal gland is a very rare malignant vascular neoplasm. The clinical symptoms are atypical or completely absent. Angiosarcomas of the adrenal gland are therefore often discovered incident...

Local intralesional talimogene laherparepvec therapy with complete local response in oral palatine mucosal melanoma: a case report

Mucosal melanoma, an aggressive type of malignancy different from the cutaneous melanomas commonly seen in the head and neck region, represents < 1% of all malignant melanomas. The pathogenesis of mucosal mela...

The effect of unusual presentation on delayed diagnosis of prostate cancer: a case series

Early diagnosis of prostate cancer is key to achieving a cure and its proper management leads to a good prognosis. In Ghana a large percentage of patients present with advanced disease and unusual presentation...

Central giant cell granuloma in the posterior region of mandible mimicking a fibro-osseous lesion and hemangioma: a case report

A central giant cell granuloma (CGCG) is a benign, proliferative, intraosseous, and non-odontogenic lesion occurring primarily in children and young adults. On the histological level, it is characterized by nu...

Splenic artery pseudoaneurysm; a cause or consequence: a case report

Splenic artery pseudoaneurysm is a rare complication of recurrent pancreatitis usually presenting as an incidental finding on abdominal computed tomography.

Fistulising skin metastases in Crohn’s disease: a case report and review of the literature

Metastatic Crohn’s disease is a rare disorder characterized by various granulomatous skin lesions that occur independently of gastrointestinal tract involvement. However, currently there is no standardized car...

Detection of two synchronous histologically different renal cell carcinoma subtypes in the same kidney: a case report and review of the literature

Renal cell carcinoma (RCC) is the dominant primary renal malignant neoplasm, encompassing a significant portion of renal tumors. The presence of synchronous yet histologically distinct ipsilateral RCCs, howeve...

Large congenital cervical mass in a neonate: prenatal diagnosis and postnatal management of teratoma: a case report

Cervical teratomas are rare congenital neoplasms that can cause neonatal airway obstruction if large.

Navigating diagnostic challenges—distinguishing malignant melanoma and clear cell sarcoma of soft tissues: a case report and review of the literature

Within the spectrum of melanocytic-differentiated tumors, the challenge faced by pathologists is discerning accurate diagnoses, with clear cell sarcoma of soft tissues standing out as a rare and aggressive neo...

Resolution of severe gastroparesis induced by parasympathetic surge following facial trauma: a case report

Gastroparesis is a condition that affects the motility of the gastrointestinal (GI) tract, causing a delay in the emptying process and leading to nausea, vomiting, bloating, and upper abdominal pain. Motility ...

Successful pregnancy with intracytoplasmic sperm injection after bacterial contamination of embryo culture in in vitro fertilization: a case report

Bacterial infection of embryo culture medium is rare but may be detrimental. The main source of embryo culture contamination is semen. Assisted reproduction centers currently lack consensus regarding the metho...

Unveiling a foreign body masquerading as periarticular calcification: a case report

Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms ar...

Portal vein thrombosis as extraintestinal complications of Crohn’s disease: a case report and review of literature

Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic ...

Long-lasting severe anemia following treatment with natalizumab for relapsing–remitting multiple sclerosis: a case report

Natalizumab is a monoclonal antibody used to treat patients with relapsing–remitting multiple sclerosis. Anemia is a recognized side effect, but it is usually mild and of a short duration when natalizumab is s...

Endovascular treatment in Danon disease: a case report

Danon disease is a lysosomal storage disorder with X-linked inheritance. The classic triad is severe hypertrophic cardiomyopathy, myopathy, and intellectual disability, with different phenotypes between both g...

Unusual phenotype in 35delG mutation: a case report

Mutations in the GJB2 gene, which encodes the protein connexin 26 and is involved in inner ear homeostasis, are identified in approximately 50% of patients with autosomal recessive nonsyndromic hearing loss, m...

In situ ascending aortic thrombus in a patient with metastatic lung adenocarcinoma and no aortic atherosclerosis or cisplatin exposure: a case report

An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first...

Management of complete intra-articular distal femur and patellar fractures in an achondroplastic young adult; small is challenging’ revisited: a case-report

People with achondroplasia exhibit distinct physical characteristics, but their cognitive abilities remain within the normal range. The challenges encountered during surgical procedures and perioperative care ...

Demonstrating antibiotic stewardship while diagnosing and treating bilateral pseudoseptic arthritis: a case report

Although viscosupplementation is a commonly used treatment for osteoarthritis and is widely regarded as a safe treatment option, it is associated with the rare complication of pseudoseptic arthritis. Most exis...

Chronic radiation proctitis refractory to steroid enema was successfully treated by metformin and sodium butyrate: a case report

Radiation proctitis (RP) is a significant complication of pelvic radiation. Effective treatments for chronic RP are currently lacking. We report a case where chronic RP was successfully managed by metformin an...

Carbon ion radiotherapy for mesonephric adenocarcinoma of the uterine cervix: a case report

Mesonephric adenocarcinoma is an extremely rare subtype of uterine cervical cancer that is associated with a poor prognosis and for which a standardized treatment protocol has not been established. Carbon ion ...

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Perioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after caroti...

Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report

A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor.

Takotsubo cardiomyopathy following pacemaker insertion complicated with polymorphic ventricular tachycardia: a case report

Takotsubo cardiomyopathy is a novel form of rapidly reversible heart failure occurring secondary to a stressor that mimics an acute coronary event. The underlying etiology of the stressor is highly variable an...

Sirenomelia or mermaid syndrome with a cleft lip in a Tanzanian newborn: a case report

Sirenomelia or sirenomelia sequence, also known as mermaid syndrome, is a rare congenital anomaly involving the caudal region of the body. The syndrome is characterized by partial or complete fusion of lower e...

Mature cystic teratoma with co-existent mucinous cystadenocarcinoma: describing a diagnostic challenge—a case report

Mature cystic teratoma co-existing with a mucinous cystadenocarcinoma is a rare tumor that few cases have been reported until now. In these cases, either a benign teratoma is malignantly transformed into adeno...

Primary omental smooth muscle tumor in an adult male: a diagnostic dilemma for leiomyoma: a case report

The greater omentum comprises peritoneal, adipose, vascular, and lymphoid tissues. Most omental malignancies are metastatic tumors, and the incidence of primary tumors is rare. We report on a prior omental smo...

Unusual presentation of Sjogren’s syndrome during pregnancy: a case report

Pregnancy imposes significant physiological changes, including alterations in electrolyte balance and renal function. This is especially important because certain disorders might worsen and make people more su...

A giant peripheral ossifying fibroma of the maxilla with extreme difficulty in clinical differentiation from malignancy: a case report and review of the literature

Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma dev...

Remission induced by renal protective therapy in nephrotic syndrome with thin basement membrane in an older patient: a case report

Adult nephrotic syndrome is a well-known kidney disease that causes heavy proteinuria, hypoalbuminemia, hypercholesterolemia, edema, and hypertension. The treatment varies according to its underlying cause but...

Lymphoma presenting as preauricular tumor in unilateral parotid gland agenesis: a case report and review of literature

Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first...

Colonic lymphomatous polyposis mantle cell lymphoma: a case report and review of literature

Mantle cell lymphoma is a rare lymphoma of the gastrointestinal tract that may present as multiple lymphomatous polyposis. We report a case of lymphomatous polyposis with a review of the literature.

Cardiac evaluation in amiodarone-induced thyroid dysfunction with suspected cardiac ischemia?: a case report and review of the literature

Amiodarone-induced thyroid dysfunction (AIT) is a side-effect associated with the use of Amiodarone for the treatment of refractory arrythmias. Resulting hyperthyroidism can precipitate cardiac complications, ...

Nexplanonectomy—the surgical removal of an embolized implanted contraceptive device: a case report and review of the literature

Nexplanon implants are a common hormonal contraceptive modality. Though rare, these devices can embolize into the injured wall of the basilic vein, through the right heart, and finally wedge itself into a pulm...

An isolated vaginal metastasis from rectal cancer: a case report

Vaginal metastasis from colorectal cancer is a rare occurrence, typically associated with other metastatic lesions. Isolated metastasis is exceedingly uncommon, with only a few cases documented in the literatu...

Melanotic neuroectodermal tumor of infancy: a case report

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare clinically benign, pigmented, tumor of neural crest origin which commonly occurs in the maxilla. It is a rare tumor that may pose difficulty in diffe...

Metastasis of small cell lung cancer to bilateral extraocular muscles: a case report

Orbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature.

Mycophenolate-induced colitis in a patient with lupus nephritis: a case report and review of the literature

Mycophenolate mofetil (MMF) is an immunosuppressive drug that is frequently prescribed to patients with rheumatological diseases. MMF’s side effects include abdominal discomfort, nausea, vomiting, and other ga...

Pembrolizumab response in stage IV luminal-type breast cancer with high microsatellite instability: a case report

Pembrolizumab (PEM), an immune checkpoint inhibitor (ICI), is often used for triple-negative breast cancer, but can also be used to treat solid tumors that exhibit high microsatellite instability (MSI-High). H...

Refractory pneumonia caused by Prevotella heparinolytica : a case report

Prevotella heparinolytica is a Gram-negative bacterium that is commonly found in the oral, intestinal, and urinary tracts. It has been extensively studied in lower respiratory tract infections in horses, which ha...

Giant intraperitoneal non-pancreatic pseudocyst: a case report

Non-pancreatic pseudocysts are rare lesions that typically form from the omentum and mesentery. These cysts have a thick fibrotic wall made up of fibrous tissue and may show signs of calcifications and inflamm...

Neglected Sprengel’s deformity in an 80-year-old female cadaver: a case report

Sprengel’s deformity is a congenital abnormality of the shoulder girdle. Because scapular retraction, such as the Green procedure, is usually performed during childhood to improve esthetics and shoulder functi...

An 11-month-old boy with tuberculous meningitis presenting as progressive limb weakness, fever, developmental retardation, and loss of consciousness: a case report

Tuberculous meningitis (TBM) accounts for about 1% of all tuberculosis cases and about 5% of extrapulmonary tuberculosis cases. However, it poses major importance because approximately half of those affected d...

Successful preimplantation genetic testing for fibrodysplasia ossificans progressiva: a case report

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant condition that leads to significant disability and morbidity, characterised by the formation of heterotopic hard tissues within connecti...

An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report

We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. I...

Optic neuritis and mydriasis after vaccination: a case report

Optic neuritis (ON) is an inflammatory demyelinating condition of the optic nerve, with various causes. Its incidence is higher in children and young adults than in older adults of both genders, but is more co...

Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature

Headache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for...

• Editorial Board
• Manuscript editing services
• Meet the Editors
• Instructions for Editors
• Sign up for article alerts and news from this journal

Annual Journal Metrics

2022 Citation Impact 1.0 - 2-year Impact Factor 0.628 - SNIP (Source Normalized Impact per Paper) 0.284 - SJR (SCImago Journal Rank)

2023 Speed 33 days submission to first editorial decision for all manuscripts (Median) 148 days submission to accept (Median)

2023 Usage  4,048,208 downloads 2,745 Altmetric mentions

• More about our metrics

• Follow us on Twitter

Journal of Medical Case Reports

ISSN: 1752-1947

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

• Open access
• Published: 27 June 2011

The case study approach

• Sarah Crowe 1 ,
• Kathrin Cresswell 2 ,
• Ann Robertson 2 ,
• Guro Huby 3 ,
• Anthony Avery 1 &
• Aziz Sheikh 2  

BMC Medical Research Methodology volume  11 , Article number:  100 ( 2011 ) Cite this article

782k Accesses

1038 Citations

37 Altmetric

Metrics details

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

Peer Review reports

Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables 1 , 2 , 3 and 4 ) and those of others to illustrate our discussion[ 3 – 7 ].

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables 2 , 3 and 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 – 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables 2 and 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 – 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8 )[ 8 , 18 – 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table 9 )[ 8 ].

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

Yin RK: Case study research, design and method. 2009, London: Sage Publications Ltd., 4

Google Scholar  

Keen J, Packwood T: Qualitative research; case study evaluation. BMJ. 1995, 311: 444-446.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J, et al: Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009, 6 (10): 1-11.

Article   Google Scholar  

Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, et al: The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). 2008, [ http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf ]

Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T, et al: Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010, 41: c4564-

Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P, the Patient Safety Education Study Group: Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010, 15: 4-10. 10.1258/jhsrp.2009.009052.

Article   PubMed   Google Scholar  

van Harten WH, Casparie TF, Fisscher OA: The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002, 60 (1): 17-37. 10.1016/S0168-8510(01)00187-7.

Stake RE: The art of case study research. 1995, London: Sage Publications Ltd.

Sheikh A, Smeeth L, Ashcroft R: Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002, 52 (482): 746-51.

PubMed   PubMed Central   Google Scholar  

King G, Keohane R, Verba S: Designing Social Inquiry. 1996, Princeton: Princeton University Press

Doolin B: Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998, 13: 301-311. 10.1057/jit.1998.8.

George AL, Bennett A: Case studies and theory development in the social sciences. 2005, Cambridge, MA: MIT Press

Eccles M, the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implementation Science. 2006, 1: 1-8. 10.1186/1748-5908-1-1.

Article   PubMed Central   Google Scholar  

Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A: Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005, 365 (9456): 312-7.

Sheikh A, Panesar SS, Lasserson T, Netuveli G: Recruitment of ethnic minorities to asthma studies. Thorax. 2004, 59 (7): 634-

CAS   PubMed   PubMed Central   Google Scholar  

Hellström I, Nolan M, Lundh U: 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005, 4: 7-22. 10.1177/1471301205049188.

Som CV: Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005, 18: 463-477. 10.1108/09513550510608903.

Lincoln Y, Guba E: Naturalistic inquiry. 1985, Newbury Park: Sage Publications

Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.

Mays N, Pope C: Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000, 320: 50-52. 10.1136/bmj.320.7226.50.

Mason J: Qualitative researching. 2002, London: Sage

Brazier A, Cooke K, Moravan V: Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008, 7: 5-17. 10.1177/1534735407313395.

Miles MB, Huberman M: Qualitative data analysis: an expanded sourcebook. 1994, CA: Sage Publications Inc., 2

Pope C, Ziebland S, Mays N: Analysing qualitative data. Qualitative research in health care. BMJ. 2000, 320: 114-116. 10.1136/bmj.320.7227.114.

Cresswell KM, Worth A, Sheikh A: Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010, 10 (1): 67-10.1186/1472-6947-10-67.

Article   PubMed   PubMed Central   Google Scholar  

Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358: 483-488. 10.1016/S0140-6736(01)05627-6.

Article   CAS   PubMed   Google Scholar  

Yin R: Case study research: design and methods. 1994, Thousand Oaks, CA: Sage Publishing, 2

Yin R: Enhancing the quality of case studies in health services research. Health Serv Res. 1999, 34: 1209-1224.

Green J, Thorogood N: Qualitative methods for health research. 2009, Los Angeles: Sage, 2

Howcroft D, Trauth E: Handbook of Critical Information Systems Research, Theory and Application. 2005, Cheltenham, UK: Northampton, MA, USA: Edward Elgar

Book   Google Scholar  

Blakie N: Approaches to Social Enquiry. 1993, Cambridge: Polity Press

Doolin B: Power and resistance in the implementation of a medical management information system. Info Systems J. 2004, 14: 343-362. 10.1111/j.1365-2575.2004.00176.x.

Bloomfield BP, Best A: Management consultants: systems development, power and the translation of problems. Sociological Review. 1992, 40: 533-560.

Shanks G, Parr A: Positivist, single case study research in information systems: A critical analysis. Proceedings of the European Conference on Information Systems. 2003, Naples

Pre-publication history

The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2288/11/100/prepub

Download references

Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

Author information

Authors and affiliations.

Division of Primary Care, The University of Nottingham, Nottingham, UK

Sarah Crowe & Anthony Avery

Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK

Kathrin Cresswell, Ann Robertson & Aziz Sheikh

School of Health in Social Science, The University of Edinburgh, Edinburgh, UK

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Sarah Crowe .

Additional information

Competing interests.

The authors declare that they have no competing interests.

Authors' contributions

AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

Rights and permissions

This article is published under license to 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.

Reprints and permissions

About this article

Cite this article.

Crowe, S., Cresswell, K., Robertson, A. et al. The case study approach. BMC Med Res Methodol 11 , 100 (2011). https://doi.org/10.1186/1471-2288-11-100

Download citation

Received : 29 November 2010

Accepted : 27 June 2011

Published : 27 June 2011

DOI : https://doi.org/10.1186/1471-2288-11-100

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Case Study Approach
• Electronic Health Record System
• Case Study Design
• Case Study Site
• Case Study Report

BMC Medical Research Methodology

ISSN: 1471-2288

• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Heart Views
• v.18(3); Jul-Sep 2017

Guidelines To Writing A Clinical Case Report

What is a clinical case report.

A case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports usually describe an unusual or novel occurrence and as such, remain one of the cornerstones of medical progress and provide many new ideas in medicine. Some reports contain an extensive review of the relevant literature on the topic. The case report is a rapid short communication between busy clinicians who may not have time or resources to conduct large scale research.

WHAT ARE THE REASONS FOR PUBLISHING A CASE REPORT?

The most common reasons for publishing a case are the following: 1) an unexpected association between diseases or symptoms; 2) an unexpected event in the course observing or treating a patient; 3) findings that shed new light on the possible pathogenesis of a disease or an adverse effect; 4) unique or rare features of a disease; 5) unique therapeutic approaches; variation of anatomical structures.

Most journals publish case reports that deal with one or more of the following:

• Unusual observations
• Adverse response to therapies
• Unusual combination of conditions leading to confusion
• Illustration of a new theory
• Question regarding a current theory
• Personal impact.

STRUCTURE OF A CASE REPORT[ 1 , 2 ]

Different journals have slightly different formats for case reports. It is always a good idea to read some of the target jiurnals case reports to get a general idea of the sequence and format.

In general, all case reports include the following components: an abstract, an introduction, a case, and a discussion. Some journals might require literature review.

The abstract should summarize the case, the problem it addresses, and the message it conveys. Abstracts of case studies are usually very short, preferably not more than 150 words.

Introduction

The introduction gives a brief overview of the problem that the case addresses, citing relevant literature where necessary. The introduction generally ends with a single sentence describing the patient and the basic condition that he or she is suffering from.

This section provides the details of the case in the following order:

• Patient description
• Case history
• Physical examination results
• Results of pathological tests and other investigations
• Treatment plan
• Expected outcome of the treatment plan
• Actual outcome.

The author should ensure that all the relevant details are included and unnecessary ones excluded.

This is the most important part of the case report; the part that will convince the journal that the case is publication worthy. This section should start by expanding on what has been said in the introduction, focusing on why the case is noteworthy and the problem that it addresses.

This is followed by a summary of the existing literature on the topic. (If the journal specifies a separate section on literature review, it should be added before the Discussion). This part describes the existing theories and research findings on the key issue in the patient's condition. The review should narrow down to the source of confusion or the main challenge in the case.

Finally, the case report should be connected to the existing literature, mentioning the message that the case conveys. The author should explain whether this corroborates with or detracts from current beliefs about the problem and how this evidence can add value to future clinical practice.

A case report ends with a conclusion or with summary points, depending on the journal's specified format. This section should briefly give readers the key points covered in the case report. Here, the author can give suggestions and recommendations to clinicians, teachers, or researchers. Some journals do not want a separate section for the conclusion: it can then be the concluding paragraph of the Discussion section.

Notes on patient consent

Informed consent in an ethical requirement for most studies involving humans, so before you start writing your case report, take a written consent from the patient as all journals require that you provide it at the time of manuscript submission. In case the patient is a minor, parental consent is required. For adults who are unable to consent to investigation or treatment, consent of closest family members is required.

Patient anonymity is also an important requirement. Remember not to disclose any information that might reveal the identity of the patient. You need to be particularly careful with pictures, and ensure that pictures of the affected area do not reveal the identity of the patient.

• KRS Website
• Education Guides
• Mobile Apps & Resources
• Case Medical Research

Mobile Apps & Resources: Case Medical Research

• App of the Month

To keep you updated on the go, our ‘app of the month’ highlights one free informational app every month!

Past Features

• About Herbs
• ACP Clinical Guidelines
• AHRQ Electronic Preventive Service Selector (ePSS)
• AIDSinfo HIV/AIDS Guidelines
• AO Surgery Reference
• Bugs & Drugs
• Canada COVID-19
• CardioSmart Heart Explorer
• CDC Opioid Guideline
• Chief Complaint
• Choosing Wisely Canada
• Daily Rounds
• Dermatology Database
• Developmental Disabilities
• Diabetes Canada CPG
• Diagnosaurus DDx
• Drugs.com Medication Guide
• EMS Medical Control Protocols
• Endocrine Society Clinical Practice Guidelines
• EvidenceAlerts
• Eye Handbook
• Family Medicine Study Guide
• Hypertension Canada Guidelines
• iCCS - Canadian Cardiovascular Society
• Medical Lab Tests
• MSD Manual Guide to Obstetrics
• NCCN Guidelines
• Nursing Dictionary
• Physiopedia
• Pocket Anatomy
• Prescribe Smart
• Prevent Group B Strep (GBS)
• Prime: PubMed Journals & Tools
• Prognosis: Your Diagnosis
• RCH Emergency Nurse Practitioner
• Recovery Record for Clinicians
• Research Digest
• Sepsis Clinical Guide
• Skyscape Medical Library
• Spina Bifida Association
• STI Guidelines
• Thrombosis Canada
• Touch Surgery: Surgical Videos
• U.S. Prevention Services TaskForce (USPSTF) Recommendations
• VBAC Resource for Midwives
• Via Therapy
• WHO Academy
• In the ‘Evidence’ section, we assess how easily an app user can identify the app’s currency and support from the evidence
• In the ‘Usability’ section, we assess the organization of information and other usability factors that may contribute to user experience

Our complete grading criteria for evidence and usability are embedded in the review.

Please note that the reviewers are not healthcare professionals, and so cannot appraise the quality of any recommendations within the app. The reviews are not endorsements.

View the AHS policy on Mobile Wireless Devices and Services.

Complete Evaluation

Image Source: AIDSinfo HIV/AIDS Guidelines, Apple App Store. ​Retrieved on February 5, 2019 from  https://itunes.apple.com/us/app/case-medical-research/id1049999731?mt=8

Internet connection required for use: Yes ;  Text search field: Yes ;  Browsable content by subject: Yes ;  Advertisements: No ;  Pop-up advertisements:  No ;  In-app purchases: No

No additional features, other than the Search Alerts and Customization options. 

• Last Updated: May 23, 2024 3:10 PM
• URL: https://krs.libguides.com/mobile

Quick Links

• Request a Literature Search
• Request an Article
• Request Education and Training
• Request a Book, CD, or DVD
• Renew a Book

Get in Touch

• Ask KRS a Question
• Suggest an Item for KRS Collection
• Report a Problem

• Technical Support
• Find My Rep

You are here

Journal of International Medical Research

Preview this book.

• Description
• Aims and Scope
• Editorial Board
• Abstracting / Indexing
• Submission Guidelines

Submit your manuscript today at http://mc.manuscriptcentral.com/jimr .

Please see the Submission Guidelines tab for more information on how to submit your article to the journal.

Page charge information

Publication in the journal is subject to payment of a page charge. The page charge serves to support the journal and ensures that articles are freely accessible online in perpetuity under a Creative Commons licence . The current rate is £325 GBP per printed page. The page charge fee is based on the page count estimate made after submission and is payable upon provisional acceptance for technical editing. The page charge is payable only when a manuscript is accepted after peer review, before it is published. The page charge is subject to taxes where applicable. Please see further details here .

Please direct any queries to [email protected] .

The Journal of International Medical Research is a peer-reviewed, open access journal which focuses on original clinical and preclinical research, systematic and perspective reviews, meta-analyses, and case reports, with every article accepted by peer review given a full technical edit to make all papers highly accessible to the international medical community. The journal will be of particular interest to authors from countries where English is not the first language. We are looking for research that adds to the existing literature and shows innovation and relevancy. Authors must follow EQUATOR Network reporting guidelines for any manuscript they wish to submit to the journal. Authors must also follow our publishing policies .

You are free to submit a manuscript on your area of research at any time. We also have lists of Special Topics and Special Collections for you to consider.

The journal takes pride in the quality of its rigorous peer review, editing and publishing service, and in ensuring that articles are thoroughly checked to eliminate unethical publishing and any errors in content, formatting, presentation, typography and layout:

Rigorous peer review: All manuscripts are subjected to single-blind peer review with comments required from at least two independent peer reviewers and ultimate decisions made by the Editors.

Thorough technical edit: Accepted manuscripts receive an in-depth technical edit to make sure the content is understood and accepted by the medical community worldwide. This editing stage makes the journal particularly appealing to authors where English is not their first language.

Free-to-view articles: Once the technical edit queries have been answered to the satisfaction of the journal, your paper will be published and made available freely to anyone on our website and on PubMed Central under a creative commons licence.

Prestigious indexing: The journal is indexed by PubMed: MEDLINE and by Scopus and is ranked in the Clarivate Analytics: Science Citation Index ®

• Clarivate Analytics: BIOSIS Previews
• Clarivate Analytics: Current Contents - Life Sciences
• Clarivate Analytics: Science Citation Index Expanded (SCIE)
• Directory of Open Access Journals (DOAJ)
• Elsevier: EMBASE
• Index Medicus
• PubMed: MEDLINE

Manuscript submission guidelines can be accessed on Sage Journals .

• Read Online
• Current Issue
• Email Alert
• Permissions
• Foreign rights
• Reprints and sponsorship
• Advertising

Institutional Backfile Purchase, E-access (Content through 1998)

To order single issues of this journal, please contact SAGE Customer Services at 1-800-818-7243 / 1-805-583-9774 with details of the volume and issue you would like to purchase.

Upcoming Events

Recent posts.

• Harvard Business School Publishing: Best Sellers in the CRJ
• CALL FOR CASES: Special Issue on “Business at the Quarter-Century”: Disruptive Forces, Crises, and Emerging Opportunities
• Harvard Publishing Best Sellers in Information Technology
• 2024 Conference Keynote Speaker T. Grandon Gill
• What Makes a Good Case? NACRA Webinar 1/19/2024

Recent Comments

• February 2024
• January 2024
• December 2023
• December 2022
• October 2022
• Press Release
• Uncategorized
• Entries feed
• Comments feed
• WordPress.org
• Case Research Journal

The Case Research Journal is published by the North American Case Research Association. The CRJ is the leading academic journal for cases in business and related disciplines in North America. The Case Research Journal publishes outstanding field-research-based, decision focused teaching cases drawn from research in real organizations, dealing with issues in all administration-related disciplines. Occasionally, the Journal publishes papers concerning case research, case writing or case teaching. All manuscripts are double-blind refereed by Editorial Board members and ad hoc reviewers in the appropriate discipline. The journal publishes four issues a year and has an acceptance rate of approximately 20 percent. In addition to appearing in a print version of the journal, cases published in the CRJ are distributed online through our publishing partners, including Harvard Business School Press, Ivey, The Case Centre and McGraw-Hill, among others.

CRJ REPUTATION

We are often asked about how the  Case Research Journal  is ranked. Journal rankings are typically based on citations of articles, which do not apply to teaching cases. As such, the CRJ does not appear on most journal ranking lists. These rankings are a proxy for the impact of the articles. For cases, we can assess impact from the distribution reach of the journal and the adoption of cases for classroom use. To our knowledge, the CRJ has the broadest distribution of any peer-reviewed case journal. Our cases are distributed through Harvard Business School Press, Ivey Publishing, The Case Centre, Pearson Collections, McGraw Hill Create, StudyNet, and CCMP. Annually, there are over 50,000 adoptions of CRJ cases through our distribution partners. NACRA members who have published cases in the CRJ are provided with information about the number of adoptions of their specific cases along with their annual royalty statements.

An article in a recent issue of the Academy of Management’s Learning and Education Journal (AMLE) does provide rankings of journals with the content domain of management education based on reputation with active scholars. The  Case Research Journal  was ranked #10, with a “B+” rating in that article. None of the nine journals ranked above the  CRJ  are case journals, and other case journals on the list were ranked lower. Further, several of the journals ranked below the CRJ on this list are ranked as “A” journals elsewhere, including on the ABDC journal list. We therefore see this article as objective support for our perception of the  CRJ  as the premier case journal. Reference: Currie, Russell R. & Pandher, Gurupdesh (2013), “Management Education Journals’ Rank and Tier by Active Scholars,” Academy of Management Learning & Education, Vol. 12, No. 2, 194-218.

We believe that the stature of our Editorial Team is a good reflection of the quality and stature of the journal. Our Editorial Board is composed of outstanding case researchers from some of the top institutions around the globe. Additional factors contributing to our journal’s outstanding reputation include its longevity (published since 1980) and rigorous double blind peer review process of both cases and instructor’s manuals (≈20% acceptance rate). The CRJ is listed in Cabell’s Directory for multiple disciplines. Its ISSN number is 2328-5095.

To submit your case, please click https://mc04.manuscriptcentral.com/nacra-crj

CRJ Call for Cases: Special Issue of Short Cases

The Case Research Journal will publish a special issue of SHORT CASES with a submission deadline of March 10, 2023 for targeted publication in early 2024. For more information, please download the call here , or email one of the specials issue editors below

Special Issue Editors:

Karin Schnarr, Wilfrid Laurier University, [email protected] Grishma Shah, Manhattan College, g [email protected] Meredith Woodwark, Wilfrid Laurier University, [email protected]

• Member Directory
• Annual Conference
• Privacy Policy

• Peer Review
• Submit Manuscript
• Author Guidelines
• Editor Guidelines
• Instructions

International Journal of Medical Case Reports and Medical Research OPEN ACCESS | Volume 1 - Issue 2 - 2023 ISSN No:2994-6905 | Journal DOI : 10.61148/2994-6905/IJMCRMR

• About Journal

International Journal of Medical Case Reports and Medical Research : Open Access

About the journal.

ISSN:   2994-6905

Crosref,   Google Scholar , ICI,  PubMed Indexed  Articles ,   Academic Resource Index ,   ISI ,   DRJI ,  WorldCat

Aditum brings about an open access peer-reviewed online bimonthly journal, International Journal of Medical Case Reports and Medical Research (IJMCRMR) designed to publish International Journal of Medical Case Reports and Medical Research in all areas of medical departments. All  clinicians, academicians, healthcare professionals, researchers are invited to this platform to publish their case reports online and also, they can come across latest  International Journal of Medical Case Reports and Medical Research a rticles published in our journals library.

IJMCRMR  desire to endow with superlative quality case reports and case series to increase the awareness in individuals with reference to various potential cases in any category of disease spectrum for a healthier living and early screening which cover their particular clinical and diagnosis issues.

IJMCRMR is journal which covers all the medical departments; we welcome authors from all over the world to submit their valuable articles to our journal to process it further.

After publication, articles are freely available through online without any restrictions or any other subscriptions to researchers across the globe.

IJMCRMR  welcomes all types of articles like research, case report, short communication, review, Hypothesis, Method and protocol, Editorials, Perspectives, Letter to the editor, etc from every corner of the globe.

This journal is a member of and follows the guidelines of the Committee on Publication Ethics (COPE).

Open Access Publication and Creative Commons Licensing:

This is an online open access bimonthly journal, and all articles published under this are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share A like 4.0 License, which allows others to remix, share, tweak, and build upon the work non-commercially, as long as proper credit is given and the new conception are licensed under the identical terms.

Ahead of Print policy:

Articles published online under the Ahead of Print models are regarded as published and can be cited and quoted using the DOI as the reference source or with citation provided for every article. Aditum has a policy that corrections will not be made after publication of an article online without following accepted measures for making necessary corrections to the scientific record.

You can use this list to carry out a final check of your submission before you send it to the journal for review else you can coordinate with editorial coordinator for any queries.

Manuscript submissions: [email protected]

Biomedical Systems

Blinded Experiment

Analysis Of Clinical Trials

Drug Design

Evidence-Based Medicine

Evidence-Based Research

Clinical Practice

Multicenter Trial

Vaccine Trial

Therapeutic Misconception

Nursing Research?

Targeted Drug Delivery

Clinical Biostatistics

Functional Disorder

Clinical Formulation

Pericarditis

Clinical Investigation

Endocrinology

Gastroenterology

Healthy Patient Studies

In Vitro Testing

In Vivo Testing

Case reports in Nanotechnology

Case Reports in Psychology

Clinical Reviews

Global Health Reports

Gynaecology Case reports

Health Care Reports

Immunology reports

Joint fluid analysis

Medical Case Reports

Neurology case reports

Ophthalmology case reports

Stem cells case reports

Cardiovascular Case Reports

Case reports in Cancer Science

Case Reports in Clinical Pathology

Case reports in diabetes

Diagnostic Trials

Phases of Clinical Research

Data Validation

Crossover Study

Aditum Publishing LLC

16192 Coastal Highway Lewes, DE 19958, USA

Quick Links

• Reviewer Guidelines
• Waiver Policy

Useful Links

• Publication Ethics
• Article Processing Charges

© 2020 - 2024 Aditum Open Access Journals. All Rights Reserved.

Open Access By Aditum Open Access Journals id licensed under Creative Commons Attribution 4.0 International License. Based On a Work at aditum.org

• Search Menu
• Sign in through your institution
• Advance articles
• Themed Content
• AI and Machine Learning
• Gastrointestinal
• Genitourinary
• Head and Neck
• Interventional
• Medical Physics: Diagnostic
• Medical Physics: Radiotherapy
• Musculoskeletal and Soft Tissue
• Nuclear Medicine and Molecular Imaging
• Obstetrics and Gynaecology
• Paediatrics
• Radiation Protection
• Radiotherapy and Oncology
• Respiratory and Chest
• Why publish in BJR|Case Reports
• Author Guidelines
• Submission Site
• Reviewer Guidelines
• Open Access
• Read and Publish
• Self-Archive Policy
• Author Testimonials
• About BJR|Case Reports
• About British Institute of Radiology
• Editorial Board
• Advertising & Corporate Services
• BIR Journals
• Journals on Oxford Academic
• Books on Oxford Academic

Case Collections

BJR | Case Reports features themed content in order to highlight interesting and educational clinical cases on particular themes. If you have an idea for a case collection please contact the BJR | Case Reports office at [email protected] . 

Call for papers

Imaging infectious diseases

Advances in nuclear medicine imaging  

• About The British Institute of Radiology
• Advertising and Corporate Services

Affiliations

• Online ISSN 2055-7159
• Copyright © 2024 British Institute of Radiology
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

How to modernize without compromising history: a case study of the Franzello Aeromedical Library’s journey in updating collections, capabilities, and facilities

• Melanie Lazarus Dean and Professor of Medical Education, United States School of Aerospace Medicine, Air Force Research Laboratory, Wright-Patterson Air Force Base, OH https://orcid.org/0000-0001-7710-7656
• Theresa Bedford Assistant Dean of Operations Research & Evidence Based Medicine United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH
• Sara Craycraft Librarian, United States School of Aerospace Medicine, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH
• Elizabeth Irvine Librarian, United States School of Aerospace Medicine, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH
• Cathy Stahl Library Technician, United States School of Aerospace Medicine Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, O
• Kristen Young Branch Chief, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Background : Academic libraries play a significant role in the student learning process. However, student needs and preferences as well as new paradigms of learning are driving libraries to transition from quiet book repositories to places of collaboration and open information. This descriptive, mixed methods case presentation explores the transition of one library, the United States Air Force School of Aerospace Medicine Franzello Aeromedical Library, in three key areas: collection, capability, and facility. Due to the niche subject matter and audience the library serves, this case also describes how the Franzello Aeromedical Library’s distinct collection and capability remained intact throughout modernization.

Case Presentation : The Franzello Aeromedical Library’s modernization project aimed to augment the library as a cutting-edge resource supporting USAFSAM's education, consultation, and research mission to equip Aerospace Medicine Airmen with the skills and knowledge for healthcare delivery in austere environments. This project was approached using five phases: 1) best practices baseline, 2) baseline evaluation of library visitor needs, 3) collection weeding, 4) capability, and 5) space design and construction.

Conclusion : As a result of this complex two-year project, several recommendations were gleaned. Use the effort as an opportunity to market library services to new audiences. Ensure all stakeholders are at the table from day one and in perpetuity to save time, and consider using purposeful decision-making models, such as Courses of Action, to make tough calls. Be prepared for delays by padding your timeline and compromise where necessary to keep the project alive. Finally, the authors recommend using in-project discovery and findings to plan for future need justification.

Author Biographies

Melanie lazarus, dean and professor of medical education, united states school of aerospace medicine, air force research laboratory, wright-patterson air force base, oh.

Dean and Professor of Medical Education, United States School of Aerospace Medicine, Air Force Research Laboratory, Wright-Patterson Air Force Base, OH

Theresa Bedford, Assistant Dean of Operations Research & Evidence Based Medicine United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Assistant Dean of Operations Research & Evidence Based Medicine United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Sara Craycraft, Librarian, United States School of Aerospace Medicine, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Librarian, United States School of Aerospace Medicine, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Elizabeth Irvine, Librarian, United States School of Aerospace Medicine, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Cathy stahl, library technician, united states school of aerospace medicine franzello aeromedical library, united states school of aerospace medicine, wright-patterson air force base, o.

Library Technician, United States School of Aerospace Medicine Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, O

Kristen Young, Branch Chief, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Branch Chief, Franzello Aeromedical Library, United States School of Aerospace Medicine, Wright-Patterson Air Force Base, OH

Thibodeau P. When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center library and archives. J Med Lib Assoc 2010; 98(1): 25-28.

Forrest C, Bostick, SL. Welcoming, flexible, and state-of-the-art: approaches to continuous facilities improvement. IFLA Journal. 2013; 39(2): 140-150. DOI: https://doi.org/10.1177/0340035213486408 .

Lynn VA, FitzSimmons M, Robinson CK. Special report: symposium on transformational change in health sciences libraries: space, collections, and roles. J Med Libr Assoc. 2011 Jan;99(1):82-7. DOI: 10.3163/1536-5050.99.1.014.

Babski D. Renovating and Rebuilding to Advance Our Future [Internet]. National Library of Medicine; 2023 [cited 3 Jan 2024]. https://nlmdirector.nlm.nih.gov/2023/01/11/renovating-and-rebuilding-to-advance-our-future/ .

Shipman JP, Stoddart JM, Peay WJ. Building projects: redefining hospital libraries. J Med Libr Assoc. 2012 Jul;100(3):166-70. doi: 10.3163/1536-5050.100.3.005. PMID: 22879804; PMCID: PMC3411257.

Tobia RC, Feldman JD. Making lemonade from lemons: a case study on loss of space at the Dolph Briscoe, Jr. Library, University of Texas Health Science Center at San Antonio. J Med Libr Assoc. 2010 Jan;98(1):36-9. doi: 10.3163/1536-5050.98.1.013. PMID: 20098652; PMCID: PMC2801967.

Chen X, Fenfei O, Heting C. The academic library meets web 2.0: applications and implications. J Acad Librariansh. 2009; 35(4):324-331. DOI: https://doi.org/10.1016/j.acalib.2009.04.003 .

DeHart RL. The United States Air Force School of Aerospace Medicine. Mil Med. 1983 Feb;148(2):110-12. DOI: https://doi.org/10.1093/milmed/148.2.110 .

Long E. School of aerospace medicine dedicates aeromedical library in honor of former director. [Internet]. Wright patterson air force base. Dayton, OH. Air force research laboratory. [rev. 27 Jun 2011; Cited 5 May 2023]. https://www.wpafb.af.mil/News/Article-Display/Article/399826/school-of-aerospace-medicine-dedicates-aeromedical-library-in-honor-of-former-d/ .

U.S. air force school of aerospace medicine. [Internet]. Wright patterson air force base. Dayton, OH. Air force research laboratory. [Rev. 2023; cited 5 May 2023]. https://www.afrl.af.mil/711HPW/USAFSAM/ .

Wagenhals LW, Levis AH. Course of action development and evaluation. George Mason Univ Fairfax VA center of excellence in command control communications and intelligence; 2000.

Stake RE. The art of case study research. Thousand oaks, CA: Sage; 1995.

Copyright (c) 2024 Melanie Lazarus, Theresa Bedford, Sara Craycraft, Elizabeth Irvine, Cathy Stahl, Kristen Young

This work is licensed under a Creative Commons Attribution 4.0 International License .

Current Issue

ISSN 1558-9439 (Online)

• Download PDF
• Share X Facebook Email LinkedIn
• Permissions

Clinical Research Risks, Climate Change, and Human Health

• 1 Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
• 2 Program for Ethics and Care Ecologies (PEaCE), Hamilton Health Sciences, Toronto, Ontario, Canada
• 3 Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
• Editor's Note Climate Change and Health—A New JAMA Series Mary M. McDermott, MD; Kirsten Bibbins-Domingo, PhD, MD, MAS JAMA
• Viewpoint Patient-Centered Climate Action and Health Equity Aaron S. Bernstein, MD, MPH; Kristin L. Stevens, MS; Howard K. Koh, MD, MPH JAMA
• Medical News & Perspectives How Climate Change Is Already Affecting Health Jennifer Abbasi JAMA
• Medical News & Perspectives Climate Change Takes a Toll on Mental Health in Africa Melissa Suran, PhD, MSJ JAMA
• JAMA Insights Introduction to JAMA Climate Change and Health Series Kristie L. Ebi, PhD, MPH; Jeremy J. Hess, MD, MPH JAMA

For clinical research to be deemed ethically acceptable, it is necessary that a study have a favorable benefit-risk ratio. 1 This requirement is met when risks and harms are minimized, potential benefits are maximized, and the potential benefits outweigh the potential risks. 1

• Editor's Note Climate Change and Health—A New JAMA Series JAMA

Read More About

D’Souza J , Samuel G. Clinical Research Risks, Climate Change, and Human Health. JAMA. 2023;330(23):2247–2248. doi:10.1001/jama.2023.23724

Manage citations:

© 2024

Artificial Intelligence Resource Center

Cardiology in JAMA : Read the Latest

Browse and subscribe to JAMA Network podcasts!

Others Also Liked

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing
• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• Graduate Education
• Graduate Student Experience

Current Graduate Student Resources

Academic resources.

The Graduate Education Office, in collaboration with other university entities and our SOM academic programs, provides resources for academic success including: University Policies, School of Graduate Studies Policy and Program Academic Specific Resources for Postbaccalaureate, Masters and Doctoral Education.

Browse student academic resources.

Wellness Resources

A student's time in graduate school encompasses not only academics, but self-growth and establishing a community that supports and encourages development in all aspects of life. Explore our Student Experience page for: Wellness Resources, University Division of Student Affairs and the SOM Diversity, Equity and Inclusive Excellence (DEIE).

View our wellness resources for graduate students.  

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• About Adverse Childhood Experiences
• Risk and Protective Factors
• Program: Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action
• Adverse childhood experiences can have long-term impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include: 1

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with: 1

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination. 2 3 4 5 6

Quick facts and stats

ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs. 7

Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs. 1

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live. 5 6 ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work. 7

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. 8

ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. 9 Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide. 1 10 11 12 13 14 15 16 17

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress. Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning. 18

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. 18 These effects can also be passed on to their own children. 19 20 21 Some children may face further exposure to toxic stress from historical and ongoing traumas. These historical and ongoing traumas refer to experiences of racial discrimination or the impacts of poverty resulting from limited educational and economic opportunities. 1 6

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We all have a role to play.

• Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005. DOI: http://dx.doi.org/10.15585/mmwr.mm6844e1 .
• Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Science Direct. 2022; 22:7; 1105-1114. DOI: https://doi.org/10.1016/j.acap.2022.04.010 .
• Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood M. Risk Behaviors and Experiences Among Youth Experiencing Homelessness—Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts. Journal of Community Health. 2022; 47: 324-333.
• Experiencing discrimination: Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health | Annual Review of Public Health https://doi.org/10.1146/annurev-publhealth-090419-101940 .
• Sedlak A, Mettenburg J, Basena M, et al. Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Executive Summary. Washington, DC: U.S. Department of Health an Human Services, Administration for Children and Families.; 2010.
• Font S, Maguire-Jack K. Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse Negl. 2016;51:390-399.
• Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2 .
• Bellis, MA, et al. Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences Across Europe and North America: A Systematic Review and Meta-Analysis. Lancet Public Health 2019.
• Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 | MMWR
• Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7.
• Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N. Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstetrics & Gynecology . 2021;138(5):770-776. https://doi.org/10.1097/AOG.0000000000004570 .
• Sulaiman S, Premji SS, Tavangar F, et al. Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review. Matern Child Health J . 2021;25(10):1581-1594. https://doi.org/10.1007/s10995-021-03176-6 .
• Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. Journal of Pediatric Psychology . 2021;46(7):801-813. https://doi.org/10.1093/jpepsy/jsab027 .
• Mersky JP, Lee CP. Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC pregnancy and childbirth. 2019;19(1). https://doi.org/10.1186/s12884-019-2560-8 .
• Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. No youth left behind to human trafficking: Exploring profiles of risk. American journal of orthopsychiatry. 2019;89(6):704.
• Diamond-Welch B, Kosloski AE. Adverse childhood experiences and propensity to participate in the commercialized sex market. Child Abuse & Neglect. 2020 Jun 1;104:104468.
• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
• Narayan AJ, Kalstabakken AW, Labella MH, Nerenberg LS, Monn AR, Masten AS. Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction. Am J Orthopsych. 2017;87(1):3. https://doi.org/10.1037/ort0000133 .
• Schofield TJ, Donnellan MB, Merrick MT, Ports KA, Klevens J, Leeb R. Intergenerational continuity in adverse childhood experiences and rural community environments. Am J Public Health. 2018;108(9):1148-1152. https://doi.org/10.2105/AJPH.2018.304598 .
• Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. J Adolesc Health. 2013;53(4 Suppl):S32-38. https://doi.org/10.1016/j.jadohealth.2013.05.004 .

Adverse Childhood Experiences (ACEs)

ACEs can have a tremendous impact on lifelong health and opportunity. CDC works to understand ACEs and prevent them.