April 2004 Bulletin

JAAOS Annual Report

Continued growth seen

The past 11 years have seen the rapid growth and acceptance of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) as a well-respected source of information on diagnosis and treatment of musculoskeletal conditions. Circulation of the English edition increased from 17,604 in 1993 to 29,500 in 2003. However, in the last several years, the foreign language translations have dramatically increased the audience for the information in JAAOS to the point that worldwide readership now has reached almost 40,000.

Whereas in 1993 only a print version was available, we now are experiencing increasing utilization of electronic versions, especially the online journal with its abstracts translated into seven languages. Recognizing the importance of online information and education, JAAOS began a new type of article in 2003, “Web and Wireless Review” (WWR), which reviews and rates sources of online information and programs relevant to the orthopaedic surgeon. After extensive study, JAAOS also has begun using Rapid Review, a system to facilitate online article submission, online peer review and expedited manuscript processing. Tracking of manuscript flow is expedited and extremely precise, while costs associated with mailing and manuscript handling are decreased. We are also considering expanding the number of issues published annually.

Journal evolution

The number of articles per issue increased to nine during 2003. The new WWR series debuted with the article, “Web Resources for the Electronic Medical Office” in the January/February issue (vol. 11:1) and subsequently became a regular feature.

Alan M. Levine, MD, Editor-in-Chief of the Journal of the American Academy of Orthopaedic Surgeons.

This is the third new regular series, joining “Perspectives on Modern Orthopaedics” (PMO), which was initiated in the July/August 1998 issue (vol. 6:4) with the article, “Alternative Bearing Surfaces for Total Joint Arthroplasty,” and “Advances in Diagnostics and Therapeutics” (ADT), which was initiated in January/February 2002 (vol. 10:1) with “Fluoroquinolones.” The goal of the WWR series is to introduce to orthopaedic surgeons, especially those who are not so facile at online activities, the wide array of Internet resources that are relevant to their education and the education of their patients, or that can facilitate their practice of medicine. To date, the series has reviewed resources relevant to the electronic medical office as well as a number of Web sites that provide information in various specialty areas for physicians and patients.

When this feature is accessed via the online version of JAAOS, there are direct links to the reviewed sites. It also serves to draw users to the JAAOS Online Web site.

The editorial board continues to believe that a defined three-year “curriculum” maintains the balance and distribution of articles that our readership seeks in JAAOS. However, the number of authors submitting unsolicited articles of quality to JAAOS has risen; thus, by necessity, the number of solicited articles has diminished dramatically. The associate editors, nevertheless, continue to solicit authors for contributions for the ADT and PMO series on a fixed schedule. This continues to be a very important process in maintaining the distribution and balance of subjects of JAAOS articles.

We have continued to actively track both the timeliness and quality of article reviews. The associate editors objectively grade the quality of each review for an article. We periodically evaluate the cadre of reviewers and retire those who repeatedly are not timely or whose reviews are substandard. Each year we try to add a group of new reviewers in the subspecialty areas. We continue to try to improve the review process by distributing the blinded reviews for an article to each reviewer, thus allowing reviewers to see their reviews in context.

Electronic editions of JAAOS
JAAOS on CD-ROM (1993-2003) has again been produced with the help of an educational grant from Aventis and will be distributed with the March/April edition of JAAOS to all AAOS fellows, candidate members, emeritus members, and international affiliate members. It will be available for sale to others.

Included on both JAAOS on CD-ROM and JAAOS Online are hyperlinks for references cited in each article to their abstracts on MEDLINE. This feature makes both electronic editions very powerful and convenient educational and research tools. Complete subject and author indexes for the first 11 volumes were added to both the CD-ROM and JAAOS Online.

JAAOS Online
Demand for JAAOS content continues to increase dramatically, as indicated by the number of downloaded documents. The average number of visits per day has risen from about 250 in January 2001 to almost 1,000 in October 2003. The online version is becoming increasingly important to convey educational material to the international community.

The Spanish and Portuguese language abstracts are the most frequently used of the seven foreign languages available. The number of articles downloaded per month (PDF files) has tripled in the last 18 months, to approximately 15,000 per month. JAAOS

Since 1998, when JAAOS was first listed on MEDLINE, it has become the most widely and intensively read domestic orthopaedic journal (PERQ survey, 1998-2003), an advantage we continue to hold. The percentage of the universe of PERQ survey respondents who read four/four of the last issues of JAAOS is larger than for any domestic journal in the field. The percentage of content read is highest among orthopaedic surgeons in all settings. Among hospital-based orthopaedic surgeons, JAAOS is read cover-to-cover by almost 50 percent more readers than any other orthopaedic journal.

JAAOS subscriptions
The total number of JAAOS readers continues to grow steadily and reached a high of 29,500 this year. That number is composed primarily of AAOS members, AAOS international members, residents and postgraduate fellows. There are also 2,000 paid subscribers.

International distribution in translation has become a very important source of subscriptions, distribution of the editorial content, and royalty income for JAAOS. The first translation agreement was made eight years ago with Centro Scientifica Editore. Through this agreement, five or six JAAOS articles are published each quarter in an Italian translation with a print run of 5,000 copies.

Through the persistent efforts of the international department of the AAOS, a Spanish translation of JAAOS was initiated in January 2002. It currently has more than 1,000 subscribers and is nearly identical in format to the English version. It is published through Medicina STM Editores in Barcelona, Spain, and both print and online versions are available by subscription.

A Turkish version published by ACT Medikal debuted with the January/February 2003 issue and has a print run of 1,300 copies. The Portuguese version began with the July/August 2003 issue and has a print run of 5,000 copies. It is sold by subscription through Pharmpress in Sao Paulo, Brazil. Negotiations are ongoing for translation and distribution of JAAOS in China.

To date, we have been unable to replace a grant that provided distribution of JAAOS to all orthopaedic residents and postgraduate fellows in the United States. This grant concluded in June 2002. Although the AAOS Board of Directors has agreed to continue to fund this critical educational program for residents, we are still actively pursuing alternative sources of funding. Aventis Pharmaceuticals has continued to supply an educational grant ($50,000) to support production and distribution of the CD-ROM to all Academy members. Based on the usage of the CD-ROM by our subscribers (more than 50 percent) and the added features each year, we are making strong efforts to have this grant support continue.

Future directions
Since the launch of the journal in 1993, many changes have occurred. The breadth of information on musculoskeletal topics has rapidly expanded, and more authors wish to be published in JAAOS. In fact, since the inception of JAAOS in 1993, almost no article topic has been repeated.

The number of articles per issue has increased from six to nine, with new formats introduced to highlight the new areas of information. The number of pages of editorial material has increased from approximately 60 to 80, while the length of the average article remains the same or is slightly shorter. To maintain diversity and reader interest, we try to include one article from each of eight areas (sports, spine, pediatrics, trauma, lower extremity, upper extremity, tumor, and general) in each journal.

Although we need to solicit articles to maintain a wide diversity of topics, we are unable to do so because of the extensive backlog of high-quality manuscripts. Even with 80 percent of unsolicited proposals declined, no solicitations in the last 24 months, a much more stringent peer-review process, and few topics repeated over the 10-year span, we now have a backlog of enough accepted articles to publish seven issues (more than one year), with enough material in the review queue to fill a second year.

As JAAOS continues to grow, we are considering increasing the number of issues from six to 12 per year. The staff and editorial board of JAAOS felt that a reasonable business plan and transition strategy could be assembled to increase the frequency of publication. The plan would increase pages by 50 percent but issues by 100 percent and help utilize the backlog of material.

To evaluate the feasibility of such a proposal, a study was contracted to critically evaluate JAAOS. That study has now been completed and the consultant report has been presented to the Council on Education, which endorsed its findings but suggested that staff provide them with further analysis of the issues and a more detailed financial analysis. When all of the necessary reviews have been completed, the final reports and action plan will be presented to the Board of Directors for consideration at the June 2004 meeting.

This article is excerpted from the report given to the AAOS Board of Directors in March by Alan M. Levine, MD, Editor-in-Chief of the Journal of the American Academy of Orthopaedic Surgeons.

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