The Orthopaedic Forum   |    
The Future of Orthopaedic Information Management
Joseph Bernstein, MD1; Jaimo Ahn, MD, PhD1; Christian Veillette, MD, MSc, FRCSC2
1 University of Pennsylvania School of Medicine, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104. E-mail address for J. Bernstein: orthodoc@post.harvard.edu
2 Division of Orthopaedic Surgery, University of Toronto, Toronto Western Hospital/University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 03;94(13):e95 1-5. doi: 10.2106/JBJS.K.01507
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Not long ago, if you were reading an article of this type, it was safe to assume that you were holding a printed journal. Today, while some readers might have a document in hand, many are sitting in front of a computer monitor, and still others are reading on a smartphone, tablet, or other wireless device. Accordingly, as paper is replaced by pixels, readers around the world can readily access their reading material at the point of need. Yet this foray into the digital domain does not represent unalloyed progress: the Internet has provided everyone with a printing press, allowing experts, quacks, and all those in between the ability to publish medical material with at least a veneer of authority. Thus, the challenge for the consumer is not so much to find some medical information, but to find valid, trusted, and pertinent medical information1.
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    Joe Bernstein
    Posted on July 10, 2012
    Reply to Dr Ring
    U Penn

    Dr Ring makes an important point. Implicit in his comments, I think, is the question “Why do we need more than one journal?” After all, when it comes to search, we approach “the literature” as a monolith, and do not consider the provenance of the papers as much, if at all. A well done study in lesser quality journal contributes to a systemic review or meta-analysis just as much as a well done study in a leading journal. A “central submission using the Uniform Requirements where the study can be easily reassigned for consideration by another journal within the same system” certainly seems like a logical step in that direction.Yet right now, even though “eventually all of [his] papers get published somewhere”, Dr Ring’s group I am sure follows some hierarchy regarding the order in which his submissions are made. Dr Ring wants to publish in the JBJS, in CORR, in JOR-- not just “somewhere”. There is (at present) value to authors in keeping a hierarchy, and there certainly is value to publishers of top journals to keeping a hierarchy. And any step that tends to blur the lines between the top publications and their beneath-consideration lesser rivals is something that is sure to meet resistance, at many levels.

    Nonetheless, as journals become less and less constrained by page budgets (by publishing online), we may see the gradual evolution to fewer and fewer journals, as the ones left standing publish more and more. PLoS ONE, for example, says it will publish any study that is ostensibly valid, regardless of how important the paper may be (or not). In other words, the only reason a paper would be rejected at such a journal is that it is not valid. And if that standard is applied, why should there ever be a second journal? All it will house are the invalid studies….

    David Ring, MD PhD
    Posted on July 04, 2012
    More on Peer Review
    Massachusetts General Hospital

    Great article! I would like to add to the discussion some comments on the future of our journals. My team and I submit and publish about 30-40 peer-reviewed original research articles a year. In spite of the Uniform Requirements for Biomedical Journals started decades ago, when we are rejected by one journal, we need to reformat and resubmit the article to another journal, being sure to follow all of their specific guidelines and prepare conflict of interest and copyright forms that are all variations on a theme. I also am an Editor and Reviewer for over a dozen journals, so I'm can tell you that in the current system a paper that goes through peer review at 4 journals before it is published, is reviewed by a dozen people, which is probably an unwise use of resources. I often review the same paper several times for different journals (with the editor's knowledge, permission, and encouragement). Eventually all of our papers get published somewhere, so I think we can devise a better system. I can envision a central submission using the Uniform Requirements where the study can be easily reassigned for consideration by another journal within the same system. The peer reviewer's job would be to make sure the data are clearly and accurately reported and interpreted. It would be possible to either assign a tier of journal (e.g. general or subspecialty). An alternative would be to attach a summary of the peer review summarizing the strengths and shortcomings of the study, and perhaps a standardized review of the scientific quality of the study.

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