The Launch of Tweetbook: Cardiovascular Interventions

Tweetbook: Cardiovascular Interventions is an online-only, peer-reviewed journal accepting case reports in interventional cardiology. Cases will be hosted online at https://www.WikiDoc.org/index.php/Tweetbook:_Cardiovascular_Interventions, and tweeted for community discussion on Twitter.

Can you tell us about Tweetbook: Cardiovascular Interventions?

David L. Fischman, MD: Many journals, especially high-impact journals in interventional cardiology, no longer accept case reports. So it is very difficult to get a journal to look at a case report. Part of it is that they are worried about their impact factor. Two years ago, I had a case report which I thought was a very interesting case. I sent it to one of the journals and they informed me, “We are not accepting case reports.” This journal’s available information actually said that they were accepting cases, but they told me they were so inundated with case submissions that it was done. I sent my case to another journal and they informed me it will take a year to review. Two years later, my case is still sitting there. I didn’t withdraw my manuscript; I should, but I am curious to see how long it will be there for review. It was with this experience in mind that Tweetbook: Cardiovascular Interventions was born. 

I sought out Dr. Michael Gibson at the American College of Cardiology meeting in March (Editor's note: Read our accompanying interview with Dr. Gibson). He is working on a project called WikiDoc (https://www.wikidoc.org), a very large, online platform to discuss everything in medicine. It is similar to an encyclopedia, but instead of “Wikipedia”, it is “WikiDoc”. With Mike’s WikiDoc project in mind, I mentioned the fact that getting case reports published is difficult and we discussed using WikiDoc as a repository. The thought was that authors would submit case reports to WikiDoc, the cases would then get peer reviewed, and then, if accepted, published directly on WikiDoc. Published cases are then tweeted from the WikiDoc platform, so our community can have an interactive conversation about that case report. We can ask questions and discuss it further, rather than just putting it in print somewhere and that’s the end of it. Social media now gives us a way to have a public, interactive conversation. On Twitter, we already do have conversations, that is true — we have 280 characters and show a few pictures of a case, but we don’t really get in-depth. Importantly, when cases are posted on Twitter, they are not peer-reviewed nor are there any references. Tweetbook: Cardiovascular Interventions gives us an opportunity to offer up cases for discussion on Twitter that are both peer-reviewed and accompanied by references.

Michael Savage, MD: The beauty of Tweetbook: Cardiovascular Interventions is that it serves more than one purpose. Number one, it is an open platform for people to have a venue to publish case reports, because as David said, there are only a few cardiology journals (Cath Lab Digest being one) that publish case reports. The neatest thing about it is the potential depth of the peer review. In your standard journal, a ‘peer reviewer’ or some editorial expert reviews a paper, but it is not part of the public discussion. It is simply to get the paper accepted. With Tweetbook, we have that level of peer review, but add the additional peer review of social media, meaning that people on Twitter can either agree with it, criticize it, talk about their own experiences, or just provide their own comments on how to manage a complicated case. The interactive aspect with the audience is the beautiful thing about the concept.

Case reports can have educational value.

Dr. Fischman: This is not research, which is what journals like, i.e., randomized trials. Yet there is an educational value, because the case reports are unique, sharing things that are seen very rarely. It could be once-in-a-lifetime experiences. There is value in sharing these. People remember: I have seen this before, let me go back and read about it. That is why the cases on Tweetbook will be peer reviewed, thus giving some merit to the cases under discussion. We don’t want it to be a “show and tell”, but something unique, different, or something that highlights an important aspect of what we do, so the reader may be able to employ that in their procedural aspects or their clinical care.

Dr. Savage: I do wax nostalgic for greater publication of case reports, because going back 20 years ago, most journals did publish case reports. I think they are so inundated with greater research, meta-analyses, and other review articles that it is almost an economic issue. It is rare to have cases printed in journals. Case reports have been thrown out into the circular file of most of the higher impact journals. Meanwhile, a few times when I have put out various cases on Twitter, the following day, someone replied that they were so glad to see the tweet, because it helped them recognize something or know what to do on a difficult technical issue. Particularly when it is a topic that gets widely discussed, there is value in having interesting cases with a practical, clinical value.

Dr. Fischman: Beyond the clinical value, surprisingly, a fair portion of clinical trials are sparked by case reports.¹ We know in our own lab that has happened — we have come up with clinical trials based on a simple case report that was published. 

How did Tweetbook come together, and how long did it take you to get up and running?

Dr. Fischman: I think it took about 4 months for the process, once Dr. Gibson was involved, to put it into place. It took from March to July to nail down how things were going to be done from a systematic standpoint and determine how the case reports would come to us and be reviewed, and we needed people to review them. We have about 20 individuals that have agreed to serve as peer reviewers. 

Dr. Savage: Of the people on our editorial board, many are high level academic interventional cardiologists that embraced the idea when David approached them about this concept. I think people see it as valuable and unique.

What have you seen with the increase in clinicians who are active on Twitter?

Dr. Fischman: From an academic perspective, one of the things I have seen is people asking, what I put out on Twitter, can I put that on my CV? Does what I promote and do on Twitter count? There is a lot of talk in academic circles about what is going to be acceptable if someone is active on Twitter with discussions or cases that have some academic merit, but really aren’t publications. The question is, what can a young academician do? They are not necessarily going to be writing all these large, high-level research papers. We think this is a relatively simple way for them to get their foot in the door. Tweetbook: Cardiovascular Interventions is not just throwing something on Twitter. It is a peer-reviewed publication. One of the discussions among our editorial board members — because everybody was very enthusiastic about this idea — was that we could make it even more relevant as it gets going by taking it to Pubmed (i.e., indexing it in the Library of Congress). It is a goal. As for the present, it gives an opportunity to the young academician to get published and get them started on that path.

Certainly, it would be citable.

Dr. Fischman: Yes. If a case is on Twitter, it is not citable, but if you have a case published on WikiDoc, it is citable, because it is peer reviewed. 

What kind of turnaround are you expecting?

Dr. Fischman: As quickly as possible, but no more than 4 weeks. It works just like any journal. We have a corresponding editor, who will look at the manuscript and make sure everything is properly formatted, including videos. Videos are possible for demonstration purposes. Once the case is formatted, it is tagged with a number and sent for peer review. We ask the peer reviewers to get it back with their comments as soon as possible, and we are putting on a two-week deadline, but roughly, we hope from the moment it is sent for a 4-week turnaround. We have limited the length and the references. We are looking for 1000 words and 5 references: case reports, not clinical research studies. That should give ample time for our editorial board to review and provide comments.

Any final thoughts?

Dr. Fischman: The initial thought was a focus on interventional cardiology, but WikiDocs is “everything medicine”. If it works for interventional cardiology, why not open it up to other aspects of cardiology, like imaging in cardiology, which lends itself very well to Twitter, as well as other disciplines such as electrophysiology? Beyond that, I will leave it to Dr. Gibson in terms of broadening it further, to pulmonary medicine, endocrinology…it would be possible within any of the disciplines, because WikiDoc covers everything. It could be a great format for case reports throughout medicine.

Dr. Savage: Even though the title we are using is Tweetbook: Cardiovascular Interventions to make it clear we are geared toward interventional cardiology, we have tried to encourage or hint at a chance to broaden the scope. Among the topics listed on the WikiDocs Tweetbook page are some non-invasive imaging techniques, so there is a little crack in the door to encourage the non-interventionalists to interact and send interesting cases that have imaging attached.

Reference

1. Albrecht J, Meves A, Bigby M. Case reports and case series from Lancet had significant impact on medical literature. J Clin Epidemiol. 2005 Dec; 58(12): 1227-1232.