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Integration of Orthopaedic Journals and the Internet

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Table 1 Comparison of Journal Articles and Internet Pages

Journal articles

Internet Pages

Experienced editorial staff
High Reputation
      Professional rewards for publishing
Searchable through Medline
Peer Review system
      Good & bad
Expensive (barrier to access)
Time consuming
Not fully available

Cheap
Available
Updatable
Resists organization
Comprehensive Peer Review (possible)
Chaotic
Commercial
Misleading

The peer review system used by the journals is often cited as a key advantage

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and by contrast the Internet is condemned because there "is no peer-review"
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. This comment ignores the fact that the majority of medical teaching is not peer reviewed. Bedside teaching, operative technique, rounds and teaching seminars are seldom subjected to rigorous review, nor are most presentations at workshops and teaching courses. Yet the majority of orthopaedic CME occurs in this situation. Peer review has its critics. There are relatively few studies on the inter-rater reliability of peer review in orthopaedics.
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Further, there is considerable controversy over journal bias
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and the fairness and appropriateness of blind peer-review
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Medscape General Medicine.  2005;7(1):11. Standardization vs Diversity: How Can We Push Peer Review Research Forward? Karen Shashok Available at http://www.medscape.com/viewarticle/498238

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as currently practiced by the journals
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Ann C. Weller, BA,MA Editorial Peer Review: its Strengths and Weaknesses Information Today, Inc. Copyright 2001 (ASIST Monograph Series) 342 pages ISBN: 1-57387-100-1

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. Fister's summary(2005)
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was "We now have plenty of evidence to support the contention that peer review is "expensive, slow, subjective and biased, open to abuse, patchy at detecting important methodological defects, and almost useless at detecting fraud or misconduct."
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Godlee F, Jefferson T. Introduction. In: Godlee F, Jefferson T, eds. Peer review in health sciences. London: BMJ Books, 1999: xi-v.

" Overall the Cochrane Review of the subject
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concluded "little empirical evidence is available to support the use of editorial peer review as a mechanism to ensure quality of biomedical research. However, the methodological problems in studying peer review are many and complex. At present, the absence of evidence on efficacy and effectiveness cannot be interpreted as evidence of their absence." Since peer review will be an important part of orthopaedic informatics for the foreseeable future it is important for reviewers to learn how to do it effectively
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Peer review on the Internet has the potential for being more immediate, open and productive because alteration and updating of electronic material in response to critique is faster and easier. The "wiki" model
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Main Page - Wikipedia, the free encyclopedia (2007) Website Available at http://en.wikipedia.org/wiki/Main_Page

in which the material presented may be amended by multiple users is also very attractive
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, provided there is supervision by a competent scientific editor. Orthopaedia OrthopaedicsOneis an orthopaedic 'wiki' with participation limited to those with an orthopaedic qualification. The assumption inherent in open authorship is that different points of view will be aired and synthesized with overall improvement in the way in which the material is presented. With all these pressures it is safe to predict that "publication" will not remain unchanged.
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BMJ. 2002 Dec 21;325(7378):1478-81. Papyrus to PowerPoint (P 2 P): metamorphosis of scientific communication. LaPorte RE, Linkov F, Villasenor T, Sauer F, Gamboa C, Lovalekar M, Shubnikov E, Sekikawa A, Sa ER. Available at http://www.bmj.com/cgi/content/full/325/7378/1478

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Medscape General Medicine 4(4), 2002. Medscape General Medicine: The Next Steps in an Ongoing Experiment in Medical Publishing George D. Lundberg, MD; Bill Silberg; Christina Myers; Sara Mariani, MD, PhD; Mindy Hung, MA; Steve Zatz, MD; Roger Holstein Available at http://www.medscape.com/viewarticle/443817


There are now many Open Access Journals
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in the orthopaedic field. These journals "publish" on the Internet without charging for access to the material
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Eura Medicophys 2007; 43: 203-213 Open Access in the Biomedical field: a unique opportunity for researchers (and research itself) Giglia E Available at http://www.minervamedica.it/index2.t?show=R33Y2007N02A0203

. Authors (or their institutions) are responsible for a fee to cover the costs of the website. By and large these journals offer a traditional approach to peer review and do not take full advantage of the electronic medium and hypertext. These advantages include linkage to other works, illustrations and videos on the Internet and exploiting the full potential of feedback from the readership. Few journals allow links to be incorporated in the text, instead requiring the traditional "endnotes". Works of orthopaedic scholarship rarely provoke responses apart from decorous letters to the editor. This leads to a false sense of completion when a work is published. It would be most stimulating to consider a new work as a challenge for others to take up or round out. This current paper, for example, has made an effort to collect the important examples of published orthopaedic informatics. There are bound to be gaps and deficiencies; it would be more efficient to modify the paper to correct these deficiencies as they come to light than to publish a series of addenda, (conflicting) corrections, or to prepare a whole new paper. This notion of "Collaborative Scholarship" presents, of course, a whole new set of problems - What is authorship? Who decides to accept  additions? How are the academic rewards of an on-going scholarly "thread" to be apportioned?

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