I. Introduction

The ATS Clinical Cases is a website based clinical case series in an interactive format published on the American Thoracic Society website.  Its primary purposes are to provide education to faculty, fellows, residents, and medical students as well as to encourage participation by junior faculty and fellows.

II. Who should submit cases?

Many but not all assemblies within the American Thoracic Society will be responsible for submitting cases  to a schedule set forth by the Case Editor.  All Assembly Web Directors are encouraged to query members of their assembly for interesting cases that would have an educational value, in preparation for submission.  Any case that an author wishes to submit should first be discussed with the Assembly Web Director prior to writing. 

Anyone can submit cases for publication.  These cases should follow the same format detailed below and will undergo the same degree of scrutiny as any other submission.  All independent submissions should be sent to the Case Editor, who will assign the case to the appropriate assembly for review.  Alternatively, independent submissions can be sent to the Assembly Web Director of their choice, who will determine if the submission is appropriate to represent the assembly.  The ultimate decisions for submission and publication will rest with the Assembly Web Director, the Case Editor, and the Website Editor. 

III. General Guidelines

We wish to maintain a high standard for writing quality and educational value.  Please compose your case presentation as if you were submitting a manuscript to the American Journal of Respiratory and Critical Care Medicine.  To accomplish this, we will require that one of the authors  of the case be of associate or full professor status, and that the assigned reviewers within the assembly be experts in the subject matter, to help ensure writing quality and the accuracy of the information presented.

The invitation to submit a case does not guarantee acceptance. On the recommendation of the reviewer, the Case Editor or Website Editor may reject the case from publication or may delay its publication until it meets the standards.

Some other general guidelines include the following:

1. Manuscripts should be concise. Verbose reports containing excessive redundancy and repetition are less likely to be accepted.
2. Generic names of drugs should be used instead of trade names.
3. Units of measurement should conform to current scientific usage and can be abbreviated when they follow a number (e.g., cm, nm, mL, L, g, mg, nmol) but not otherwise. Unusual units should be defined.
4. The use of abbreviations and acronyms should be avoided.  If an abbreviation is used, the term should always be first written in full with the abbreviation in parentheses immediately after it. Do not invent new abbreviations where pre-existing ones exist. If you use an abbreviation, make it a sensible one, such as three capital letters without periods.
5. The terms “man” and “woman” should be used instead of “male” or “female.”
6. Refrain from using “Mr. or Mrs. X” or the patient’s initials to describe the patient.  Instead, use the format “A 51 year old man/woman presented with…”

IV. Instructions

Examples of cases can be found on the ATS website.

The following sections are required:

1. Title: Title of the case presentation.  Try to include a unique name that, when searched for through search engines, will be easily recognizable.
2. Reviewed by: Include Assembly name.
3. Name: First name, middle initial, and last name of each author.
4. Institution: Name of department(s) and institution(s) to which the authors belong below each name.
5. History: The length should be about 500 to 1000 words for the case presentation.
6. Physical Exam: Include pertinent positive and negative findings.
7. Data: All pertinent laboratory data, radiographic studies, pathologic specimens, etc. as well as series of events pertaining to the case (hospital course, outpatient follow-up, etc.) should be presented here.
8. Questions: Multiple choice questions pertaining to the case (about the diagnosis, differential, most important diagnostic tests, etc., as well as the answers with explanations.) 3 to 6 questions are acceptable but there must be at least 3 questions.  Each question should have a minimum of 4 answers.  Answers such as “All of the above” and “both B and C” are considered acceptable. 
9. Answers: The didactic portion of the case presentation will be placed here.  The total word length for the answer explanations should be approximately 1000 words or longer. 
10. References: References should be provided if needed at the end of the case.  References should comply with ATS journal style, and journal names abbreviated according to Index Medicus (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi).  Please see below for more details regarding the reference section.

V. Case Formats

There are now two acceptable formats in which to structure your case.  There is the “quiz” format, where all questions and answers are presented at the end of the case presentation, and there is also an “as you go” format, where each question is presented individually and the answer is not able to be displayed until the correct answer is chosen.  The “quiz” format is a more traditional approach to case based presentations, which has been utilized on the website since the series’ inception.  The “as you go” format lends itself to more “real world” scenarios where more information about a case can be revealed question by question until a diagnosis or conclusion can be made.  However, even traditional case presentations can be presented in the “as you go” format. 

A similar but not identical case format to the “as you go” format is the New England Journal of Medicine Clinical Problem Solving series (example Volume 359:75-80 July 3, 2008 Number 1, “A Gut Feeling”).  An example of an ATS Clinical Case published in this format can be found through the following link:

http://www.thoracic.org/sections/clinical-information/ats-clinical-cases/pages/young-man-with-recent-onset-hypertension-and-acute-onset-dyspnea.php

VI. Timeline

1. The authors should send the case to their Assembly Website Director, who is responsible for having the case reviewed. 
2. The Assembly Web Director should then distribute the case to 3 reviewers within the assembly and allow one month for review and revision.  Once reviews have been returned to the Assembly Web Director, they should be shared with the authors who are responsible for revisions.
3. The cases need to be submitted to the Case Editor one month before publication date.  If the Case Editor or Website Editor determines that revisions are necessary, then they need to be done promptly and then resubmitted to the Case Editor. 

Once the final, revised version is sent to us, it will be approved by the Case Editor and then the Website Editorial Chair, and then the Assembly Web Director will be responsible for sending the case to the IT Web Department (webpublishing@thoracic.org).

VII. Forms

The necessary forms are the Website Assignment of Copyright, Financial Disclosure, License Agreement, and Submission forms.  These forms can be found on the ATS Website Instructions for Contributors.

VIII. Figures

Image quality is important, particularly for viewing on the internet.  Images and charts should be saved in the following format:  RGB (Red, Green, Blue), JPG with at least 96 dpi.

IX. References

1. Please ensure that your references include the most current articles and information. All authors' names (do not use "et al."), complete article titles, and inclusive page numbers should be cited.
2. Spell out the names of journals that are not listed.
3. Unpublished observations and personal communications should be referred to as such in the text and not be referred to in the reference list.
4. Submit written permission when citing a personal communication. Manuscripts "submitted for publication" are considered unpublished work and should not be included in the reference list. They should be cited in parentheses in the text as "unpublished data" or "unpublished observations."

Examples of references are listed below:

Journal Articles
Gandevia SC, Gorman RB, McKenzie DK, DeTroyer A. Effects of increased ventilatory drive on motor unit firing rates in human inspiratory muscles. Am J Respir Crit Care Med 1999;160:1598-1603.

In Press
Lakatos E, DeMets DL, Kannel, WB, Sorlie P, MacNamara P. Influence of cigarette smoking on lung function and COPD incidence. Chronic Dis. (In press)

Abstracts
Carr MJ, Undem BJ. Trypsin-induced, neurokinin-mediated contraction of guinea pig isolated bronchus [abstract]. Am J Respir Crit Care Med 2000;161:A466.

Books
Lang TA, Secic M. How to report statistics in medicine. Philadelphia: American College of Physicians; 1997.

Articles in Books
Voyce SJ, Urbach D, Rippe JM. Pulmonary artery catheters. In: Rippe JM, Irwin RS, Alpert JS, Fink MP, editors. Intensive care medicine, 2nd ed. Boston, MA: Little Brown; 1991. p. 48-72.

Government or Association Report
U.S. Public Health Service. Smoking and Health. A Report on the Surgeon General. Washington, DC.: U.S. Government Printing Office; 1979. DHEW Publication No. (PHS)79-50066.

Journal Article in Electronic Format
Manoloff ES, Francioli P, Taffé P, van Melle G, Bille J, Hauser PM. Risk for Pneumocystis carinii transmission among patients with pneumonia: a molecular epidemiology study. Emerg Infect Dis [serial online] 2003 Jan [cited 2004 Jul 14]; vol. 8. Available from: http://www.cdc.gov/ncidod/EID/vol9no1/02-0141.htm

Judd Flesch
Web Director, Clinical Problems Assembly
ATS Clinical Cases Editor