Research for NHS
        Clinicians
           What is Possible?




   Alex Mitchell, Consultant in Liaison Psychiatry
Contents
Contents

• Part I: Getting Published



• Part II: Being Measured



• Part III: Real World Outputs from Liaison...
Part I: Getting Published
Part I: Getting Published
                                Why Publish?
                         ...
Your Research




The fate of medical research (DeBakey, 1974)
NHS Power -2004 Stats
NHS Power -2004 Stats
Academics
• 494 clinical lecturers (down 17% on 2003)
• 1500 Readers / SnR Lec...
NHS Power -2004 Stats
NHS Power -2004 Stats
Academics
• 494 clinical lecturers (down 17% on 2003)
• 1500 Readers / SnR Lec...
Ca
                                                    re
                                                       e




   ...
A
                                       cc
                                         id
                                  ...
Productivity
Productivity
• Academics
   – 3000 x 5 papers per year
   – N= 15,000

• NHS Medical Staff
   – 120,000 x 1 p...
Productivity
Productivity
• Academics
   – 3000 x 5 papers per year
   – N= 15,000

• NHS Medical Staff
   – 120,000 x 1 p...
Bottleneck 1:   Journals
Bottleneck 1:   Journals




                           => BMJ
Typical Journal Statistics (eg BMJ)
Typical Journal Statistics (eg BMJ)
• 7000 research papers received
• 1000 rejected by...
Conventional Publication Cycle – 24mo
Conventional Publication Cycle – 24mo
         T0                T+1mo           T+3...
First received 26 Sep 2007, final revision 30 Sep 2008, accepted 20 Nov 2008; 540 days
Open Access Publishing
      Discussion Forum (Pub. Stage 1) + Journal (Pub. Stage 2)
Open Publication Cycle – 12mo
Open Publication Cycle – 12mo
         T0                 T+1mo               T+3mo         ...
How Many?
How Many?
• Hospital Specialist

•   75 journals in psychiatry
•   + 50 in neurology
•   + 50 in medicine
•   + ...
The Publishing Landscape
The Publishing Landscape
                    Example      Scope                             Direc...
Some Obscure Psychiatry Titles
Some Obscure Psychiatry Titles
     1.691   WORLD J BIOL PSYCHIATRY
     1.505   NEUROCASE
...
Bottleneck 2: Your Colleagues
Bottleneck 2: Your Colleagues
Overview of Peer Review
Overview of Peer Review

Author Filter       Editorial Filter     Peer Review Filter       Outcome...
Bias from Hidden Reviewers
Bias from Hidden Reviewers
          Friend
                                    Enemy



Unknow...
What Makes a Good Reviewer?
What Makes a Good Reviewer?
• A reviewer was less than 40 years old

• From a top academic ins...
Open & Blind Review & Submission
Open & Blind Review & Submission

• Does revealing reviewers’ identity influence outcome?...
Bottleneck 3: Yourself
Bottleneck 3: Yourself
Problems with Authors
Problems with Authors
• Multiple publication

• Ghost authorship

• Gift authorship

• Conflicts of ...
Ghost Authorship
Ghost Authorship
• An Inquiry by the UK House of Commons Health Select
  Committee into the Influence of ...
How Many Authors?
How Many Authors?
• Deep Impact: Observations from a Worldwide Earth-Based Campaign
K. J. Meech, N. Ageo...
Part II: Being Measured
Part II: Being Measured
                                Impact Factors
                          J...
How to Grade Research…of an Author
How to Grade Research…of an Author

        10% top 10 journals

                      ...
How to Grade Research…of an Author
How to Grade Research…of an Author

        10% top 10 journals
                       ...
PubMed Hits for March 2005 (millions)
PubMed Hits for March 2005 (millions)
The Dreaded “Impact Factor”
The Dreaded “Impact Factor”
  Q. How do you know what published research is important?
       ...
2400 experts
537 citations
What is the Impact factor?
What is the Impact factor?
• Journal IF
• A = citations in the last 2 years in journal
• B = nu...
What is the Impact factor?
What is the Impact factor?
• Journal IF
• A = citations in the last 2 years in journal
• B = nu...
Eugene Garfield
Eugene Garfield

 • Citation Databases
    –   Science citation index (CD)
    –   BIDS
    –   ISI Scienc...
Medical Journals Impact Factors
Medical Journals Impact Factors
Credit: Panayiota Polydoratou and Martin Moyle
One Journal’s Impact Factor Trend
                         3

                        2.5
CMAJ 's impact factor




      ...
Increase in Scientific Output




              http://www.americanscientist.org/my_amsci/restricted.aspx?act=pdf&id=32630...
Type of Article and Impact
Type of Article and Impact




                  Good Paper
Importance of Reviews
    Importance of Reviews
• WHITTINGTON, C. J., KENDALL,T., FONAGY, P., COTTRELL, D.,
  COTGROVE, A....
IF Psychiatry Journals
IF Psychiatry Journals
Part III: Real World Research Outputs
Part III: Real World Research Outputs
                                  Journal outp...
Journal Outputs
Journal Outputs
    Q. What is the effect of a high IF on individual authors?
IF and Submission Ratio
IF and Submission Ratio


• The IF can be considered inversely proportional to the
  chances of ac...
BMJ Manuscript Processing

                                   1000                  Hand written
6000 received
           ...
1 in 10+




1 in 3+
Liaison Journals
Liaison Journals

Impact Factor   Abbreviated Journal Title   Total Cites   Impact Factor   Articles   Ci...
Individual Papers
Individual Papers
      Q. What are the “most important” papers in psychiatry?
   Q. How many times do y...
Top 10 Cited Papers in Psychiatry
Top 10 Cited Papers in Psychiatry
Top 10 Cited Papers in Psychiatry_Year
Top 10 Cited Papers in Psychiatry_Year
Top Non-Scale/Tool Papers?
Top Non-Scale/Tool Papers?
Personal “Impact Factor”
Personal “Impact Factor”
   Q. Who are the most influential authors in psychiatry?
              ...
SURNAME       INITIALS   SPECIALTY             Level

BAILEY        SM         C & A Psychiatry      Platinum

FAIRBURN   ...
Measuring Individuals Research
Measuring Individuals Research
Old Methods (counts)
• Subjective top 4 publications (RAE)
•...
Output Measured
Output Measured   Results
                                  78
                  found:

                 ...
“Exceptional” Output
“Exceptional” Output
Exceptional Citation Growth
Exceptional Citation Growth
Publication Count in Liaison (Anonymous)
Publication Count in Liaison (Anonymous)
500
      464

450

400

350
           ...
Ac
  ad




              0
                  2,000
                          4,000
                                  6,00...
2 Yr Citation Count by Liaison (anonymous)
2 Yr Citation Count by Liaison (anonymous)
2500



       2040
2000


         ...
Ac
  ad




              0
                      10
                                 20
                                 ...
End: 5 Tips
End: 5 Tips
Predictors of Journal Acceptance
Predictors of Journal Acceptance
•   1. Submitting the paper!
•   2. Proofing and high qu...
Predictors of High Impact Citation
Predictors of High Impact Citation
• 1. Publishing in a high impact journal
“There was some delay in submission……. due to a backlog in the to do tray”
Citations vs probability article is online

                              Lawrence S. Online or invisible. Nature 2001;411...
A comment from Rennie Drummond deputy editor
A comment from Rennie Drummond deputy editor
JAMA
JAMA
              There se...
What is the Cost of Research?
What is the Cost of Research?
• CATIE (Clinical Antipsychotic Trials of Intervention Effecti...
Pubmed vs Wok vs Scopus
Pubmed vs Wok vs Scopus
Pubmed
• 5,500 journals
• 18 million articles

Scopus
• 16,000
• 36 millio...
End
End
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
Liaison Faculty09 - Research for NHS Clinicians [Workshop]
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Liaison Faculty09 - Research for NHS Clinicians [Workshop]

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This is a workshop from 19-Mar-09 presented at the Royal College of Psychiatrists Liaison Faculty AGM in Prague. It is aimed at helping NHS clinicians getting published and understanding the pitfalls in publishing. Includes an analysis of productivity by medical colleagues in liaison psychiatry annoymised in this version)

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Liaison Faculty09 - Research for NHS Clinicians [Workshop]

  1. 1. Research for NHS Clinicians What is Possible? Alex Mitchell, Consultant in Liaison Psychiatry
  2. 2. Contents Contents • Part I: Getting Published • Part II: Being Measured • Part III: Real World Outputs from Liaison Psychiatry
  3. 3. Part I: Getting Published Part I: Getting Published Why Publish? Three Bottlenecks Successes
  4. 4. Your Research The fate of medical research (DeBakey, 1974)
  5. 5. NHS Power -2004 Stats NHS Power -2004 Stats Academics • 494 clinical lecturers (down 17% on 2003) • 1500 Readers / SnR Lecturers (down 11% on 2000) • 1146 Professors (up 10% on 2000) • 3113 FTE clinical academics in all specialties • 302 SnR academics in Psychiatry • 40 lecturers in Psychiatry
  6. 6. NHS Power -2004 Stats NHS Power -2004 Stats Academics • 494 clinical lecturers (down 17% on 2003) • 1500 Readers / SnR Lecturers (down 11% on 2000) • 1146 Professors (up 10% on 2000) • 302 SnR academics in Psychiatry • 40 lecturers in Psychiatry • 3113 FTE clinical academics in all specialties NHS Staff • 117,000 NHS doctors (up 5% on 2000) • 34,000 GPs (up 2%) • 30,600 Consultants (up 5%) • 397,000 Nurses (up 2.5%) • 129,000 Allied health professionals (up 4%) • 1,071,462 FTE qualified staff • 3,500 NHS Consultant Psychiatrists vs 350 academic psychiatrists
  7. 7. Ca re e 0 5000 10000 15000 20000 25000 30000 35000 40000 45000 rg ra d es Co 38,411 ns ul As ta so nt ci at e Sp 30,650 ec ia lis t St 2,294 af fg ra Do de ct or s in 5,467 t ra in in g Re gi st ra r 41,697 gr ou Se p ni 2 o rH ou se 16,823 O Ho ff i c us e er Of fi ce 20,601 ra nd FY 1 O th e 4,273 rg ra d Ho es sp ita lP ra 6,888 c t it io ne r Cl in ic al 1,048 As si st an t O 3,476 th e rS ta ff 2,364 G Ps 34,085 Source: DOH Workforce Stats
  8. 8. A cc id en t & em 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 er ge nc y A 618 na es t he tic s C lin ic 4,355 al Consultants by Specialty o nc ol og y 392 De G nt al en G er ro al m up ed 670 ic in e O gr bs ou te p tri 2 cs & gy 6,726 na ec o lo g y Pa ed 1,413 ia tri c gr ou p Pa th 1,902 ol og y gr ou p 2,411 Pu b lic He al th Ps yc 926 hi at ry gr ou p R ad io 3,555 lo gy gr ou p Su 1,928 rg ic al g ro u p 5,754 Source: DOH Workforce Stats
  9. 9. Productivity Productivity • Academics – 3000 x 5 papers per year – N= 15,000 • NHS Medical Staff – 120,000 x 1 paper every 5 years! – N= 24,000 • NHS AHP – 500,000 x 1 paper every 100 years – N= 5,000 • Ratio of Outputs = 15,000 to 29,000 (1:2)
  10. 10. Productivity Productivity • Academics – 3000 x 5 papers per year – N= 15,000 • NHS Medical Staff – 120,000 x 1 paper every 5 years! – N= 24,000 • NHS AHP – 500,000 x 1 paper every 100 years – N= 5,000 • Ratio of Outputs = 15,000 to 29,000 (1:2)
  11. 11. Bottleneck 1: Journals Bottleneck 1: Journals => BMJ
  12. 12. Typical Journal Statistics (eg BMJ) Typical Journal Statistics (eg BMJ) • 7000 research papers received • 1000 rejected by one editor immediately – further 4500 rejected by editors after reading – Only 25% (1500) sent to reviewers – Only 10% reach weekly manuscript meeting • (with Editor, a clinicians and a statistician) – 350 research articles after revisions (and up to 6 peer reviews) • Only 3% (1990-2000) to 6% (2000+) accepted by BMJ => time!
  13. 13. Conventional Publication Cycle – 24mo Conventional Publication Cycle – 24mo T0 T+1mo T+3mo T+6mo Step1 Step 2 Step 3 Step 4 Paper Present to Present at Submit to Completed colleagues conference journal (informal PR) T+7mo T+10mo T+12mo T+14mo Step 5 Step 6 Step 7 Step 8 Editor Agrees to Peer Revision 1 Peer Send for Review Review 2 Review 1 T+15mo T+18mo T+24mo Step 12 Step 9 Step 10 Step 11 Readers letters Revision 2 Proof Restricted (public PR) Publication
  14. 14. First received 26 Sep 2007, final revision 30 Sep 2008, accepted 20 Nov 2008; 540 days
  15. 15. Open Access Publishing Discussion Forum (Pub. Stage 1) + Journal (Pub. Stage 2)
  16. 16. Open Publication Cycle – 12mo Open Publication Cycle – 12mo T0 T+1mo T+3mo T+5mo Step1 Step 2 Step 3 Step 4 Paper Present to Present at Submit to Completed colleagues conference online journal (informal PR) T+6mo T+7mo T+9mo Step 6 Public Step 5 Step 8 comments Editor Publishes Revision Step 7 Peer “discussion paper” Review 1 T+11mo T+12mo Step 11 Step 9 Step 10 Readers letters Online proof Open Access Publication (post-publication) => Good news2
  17. 17. How Many? How Many? • Hospital Specialist • 75 journals in psychiatry • + 50 in neurology • + 50 in medicine • + 25 in misc. fields – 2400 issues per year – 24,000 specialty articles per year – 6.5 journals per day – 65 articles per day
  18. 18. The Publishing Landscape The Publishing Landscape Example Scope Direct Readership Generalist titles The Lancet Generalist, very high impact Generalist (IF5+), closely peer reviewed 1000,000s? Specialty titles BJPsych Covering specialty as whole, Specialists (mainly high impact (IF3+) secondary care) 10,000s-00,000s Sub-specialty J of ECT Specific disease area/therapy Sub-specialists on titles class, low impact disease 1000s Primary care PCP Primary care focus, can be low 1000s titles scientific impact if jnl is new Magazine titles Pulse Not generally peer-reviewed 10,000s+ but highly targetted readership Internal titles Newsletter Not peer-reviewed, not widely 100s+ read, never cites
  19. 19. Some Obscure Psychiatry Titles Some Obscure Psychiatry Titles 1.691 WORLD J BIOL PSYCHIATRY 1.505 NEUROCASE 1.441 PSYCHOPATHOLOGY 1.264 AGING MENT HEALTH 1.229 SUBST USE MISUSE 1.206 ACTA NEUROPSYCHIATRY 1.181 PSYCHIATRY CLINICAL NEUROSCIENCE 1.176 JOURNAL OF ECT 1.062 PERSPECT PSYCHIATR CARE 1.051 NEUROPSYCHIATRIE 1 BEHAVIORAL MEDICINE 0.951 J PSYCHOSOMATIC OBST & GYN 0.752 NORDIC J PSYCHIAT 0.734 ARCH PSYCHIAT NURS 0.733 INT JJOURNAL PSYCHIATRY IN MEDICINE 0.721 STRESS AND HEALTH
  20. 20. Bottleneck 2: Your Colleagues Bottleneck 2: Your Colleagues
  21. 21. Overview of Peer Review Overview of Peer Review Author Filter Editorial Filter Peer Review Filter Outcome Quantitative Grade Grading Published Accept Where to Article Article Submit Appraisal Revise Comments to Reject Reject Author Send elsewhere Qualitative Grade
  22. 22. Bias from Hidden Reviewers Bias from Hidden Reviewers Friend Enemy Unknown + - Revision Acceptance + Author Author - Enemy - Rejection Unknown See Maddox J. Conflicts of interest declared [news]. Nature 1992; 360: 205; Locke S. Fraud in medicine [editorial]. Br Med J 1988; 296: 376–7.
  23. 23. What Makes a Good Reviewer? What Makes a Good Reviewer? • A reviewer was less than 40 years old • From a top academic institution • Well known to the editor choosing the reviewer • Author blinded to the identity of the manuscript's authors • Then the probability of good review was 87% vs 7% Evans AT, McNutt RA, Fletcher SW, Fletcher RH. The characteristics of peer reviewers who produce good-quality reviews. J Gen Intern Med. 1993 Aug;8(8):422-8
  24. 24. Open & Blind Review & Submission Open & Blind Review & Submission • Does revealing reviewers’ identity influence outcome? – Open vs blind peer review • Does revealing Authors’ identity influence outcome? – Open vs blind submission • http://www.slideshare.net/ajmitchell
  25. 25. Bottleneck 3: Yourself Bottleneck 3: Yourself
  26. 26. Problems with Authors Problems with Authors • Multiple publication • Ghost authorship • Gift authorship • Conflicts of Interest • Fraud / Plagarism
  27. 27. Ghost Authorship Ghost Authorship • An Inquiry by the UK House of Commons Health Select Committee into the Influence of the Pharmaceutical Industry October 2004 – 50% of therapeutics articles may be ghost written • Flanagin A et al (1998) Prevalence of Articles With Honorary Authors and Ghost Authors in Peer-Reviewed Medical Journals JAMA 280:222-224 • Of 809 articles – 19% had evidence of honorary (gift) authors – 11% had evidence of ghost authors – 2% had evidence of both
  28. 28. How Many Authors? How Many Authors? • Deep Impact: Observations from a Worldwide Earth-Based Campaign K. J. Meech, N. Ageorges, M. F. A'Hearn, C. Arpigny, A. Ates, J. Aycock, S. Bagnulo, J. Bailey, R. Barber, L. Barrera, R. Barrena, J. M. Bauer, M. J. S. Belton, F. Bensch, B. Bhattacharya, N. Biver, G. Blake, D. Bockelée-Morvan, H. Boehnhardt, B. P. Bonev, T. Bonev, M. W. Buie, M. G. Burton, H. M. Butner, R. Cabanac, R. Campbell, H. Campins, M. T. Capria, T. Carroll, F. Chaffee, S. B. Charnley, R. Cleis, A. Coates, A. Cochran, P. Colom, A. Conrad, I. M. Coulson, J. Crovisier, J. deBuizer, R. Dekany, J. de Léon, N. Dello Russo, A. Delsanti, M. DiSanti, J. Drummond, L. Dundon, P. B. Etzel, T. L. Farnham, P. Feldman, Y. R. Fernández, M. D. Filipovic, S. Fisher, A. Fitzsimmons, D. Fong, R. Fugate, H. Fujiwara, T. Fujiyoshi, R. Furusho, T. Fuse, E. Gibb, O. Groussin, S. Gulkis, M. Gurwell, E. Hadamcik, O. Hainaut, D. Harker, D. Harrington, M. Harwit, S. Hasegawa, C. W. Hergenrother, P. Hirst, K. Hodapp, M. Honda, E. S. Howell, D. Hutsemékers, D. Iono, W.-H. Ip, W. Jackson, E. Jehin, Z. J. Jiang, G. H. Jones, P. A. Jones, T. Kadono, U. W. Kamath, H. U. Käufl, T. Kasuga, H. Kawakita, M. S. Kelley, F. Kerber, M. Kidger, D. Kinoshita, M. Knight, L. Lara, S. M. Larson, S. Lederer, C.-F. Lee, A. C. Levasseur-Regourd, J. Y. Li, Q.-S. Li, J. Licandro, Z.-Y. Lin, C. M. Lisse, G. LoCurto, A. J. Lovell, S. C. Lowry, J. Lyke, D. Lynch, J. Ma, K. Magee-Sauer, G. Maheswar, J. Manfroid, O. Marco, P. Martin, G. Melnick, S. Miller, T. Miyata, G. H. Moriarty-Schieven, N. Moskovitz, B. E. A. Mueller, M. J. Mumma, S. Muneer, D. A. Neufeld, T. Ootsubo, D. Osip, S. K. Pandea, E. Pantin, R. Paterno-Mahler, B. Patten, B. E. Penprase, A. Peck, G. Petitas, N. Pinilla-Alonso, J. Pittichova, E. Pompei, T. P. Prabhu, C. Qi, R. Rao, H. Rauer, H. Reitsema, S. D. Rodgers, P. Rodriguez, R. Ruane, G. Ruch, W. Rujopakarn, D. K. Sahu, S. Sako, I. Sakon, N. Samarasinha, J. M. Sarkissian, I. Saviane, M. Schirmer, P. Schultz, R. Schulz, P. Seitzer, T. Sekiguchi, F. Selman, M. Serra-Ricart, R. Sharp, R. L. Snell, C. Snodgrass, T. Stallard, G. Stecklein, C. Sterken, J. A. Stüwe, S. Sugita, M. Sumner, N. Suntzeff, R. Swaters, S. Takakuwa, N. Takato, J. Thomas-Osip, E. Thompson, A. T. Tokunaga, G. P. Tozzi, H. Tran, M. Troy, C. Trujillo, J. Van Cleve, R. Vasundhara, R. Vazquez, F. Vilas, G. Villanueva, K. von Braun, P. Vora, R. J. Wainscoat, K. Walsh, J. Watanabe, H. A. Weaver, W. Weaver, M. Weiler, P. R. Weissman, W. F. Welsh, D. Wilner, S. Wolk, M. Womack, D. Wooden, L. M. Woodney, C. Woodward, Z.-Y. Wu, J.-H. Wu, T. Yamashita, B. Yang, Y.-B. Yang, S. Yokogawa, A. C. Zook, A. Zauderer, X. Zhao, X. Zhou, and J.-M. Zucconi Science 14 October 2005: 265-269.
  29. 29. Part II: Being Measured Part II: Being Measured Impact Factors Journals vs papers vs individuals H-Index Dissemination
  30. 30. How to Grade Research…of an Author How to Grade Research…of an Author 10% top 10 journals 100% Listed on Pubmed 70% peer reviewed journals 75% Listed on Pubmed 90% Listed on Scopus/WoK 20% other material (eg chapters) 5% Listed on Pubmed 15% Listed on Scopus/WoK
  31. 31. How to Grade Research…of an Author How to Grade Research…of an Author 10% top 10 journals Impact (citations) 70% peer reviewed journals 20% other material
  32. 32. PubMed Hits for March 2005 (millions) PubMed Hits for March 2005 (millions)
  33. 33. The Dreaded “Impact Factor” The Dreaded “Impact Factor” Q. How do you know what published research is important? Q. How do you decide what research to read?
  34. 34. 2400 experts 537 citations
  35. 35. What is the Impact factor? What is the Impact factor? • Journal IF • A = citations in the last 2 years in journal • B = number of articles Impact Factor = A/B • Article IF • A = Total citations of article • B = Age of article Impact Factor = A/B • Personal IF • A = citations in the last 2 years by individual • B = number of articles Impact Factor = A/B
  36. 36. What is the Impact factor? What is the Impact factor? • Journal IF • A = citations in the last 2 years in journal • B = number of articles Impact Factor = A/B • Article IF • A = Total citations of article • B = Age of article Impact Factor = A/B • Personal IF • A = citations in the last 2 years by individual • B = number of articles Impact Factor = A/B
  37. 37. Eugene Garfield Eugene Garfield • Citation Databases – Science citation index (CD) – BIDS – ISI Science Direct – Web of Science – Web of Knowledge – Scopus
  38. 38. Medical Journals Impact Factors Medical Journals Impact Factors
  39. 39. Credit: Panayiota Polydoratou and Martin Moyle
  40. 40. One Journal’s Impact Factor Trend 3 2.5 CMAJ 's impact factor 2 1.5 1 0.5 0 1988 1990 1993 1994 1995 1996 1997 1998 1999 2000 2001 Hoey J, Todkill AM. CMAJ 2003;168:287-8 [online appendix]
  41. 41. Increase in Scientific Output http://www.americanscientist.org/my_amsci/restricted.aspx?act=pdf&id=3263000957901
  42. 42. Type of Article and Impact Type of Article and Impact Good Paper
  43. 43. Importance of Reviews Importance of Reviews • WHITTINGTON, C. J., KENDALL,T., FONAGY, P., COTTRELL, D., COTGROVE, A. & BODDINGTON, E. (2004) Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet, 363, 1341-1345. • Lancet Paper of the Year 2004 • BACKGROUND: Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. METHODS: We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5-18 years and that were published in a peer-reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. FINDINGS: Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. INTERPRETATION: Published data suggest a favourable risk- benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non- publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed.
  44. 44. IF Psychiatry Journals IF Psychiatry Journals
  45. 45. Part III: Real World Research Outputs Part III: Real World Research Outputs Journal outputs Top 10 Psychiatric papers Top 10 Authors
  46. 46. Journal Outputs Journal Outputs Q. What is the effect of a high IF on individual authors?
  47. 47. IF and Submission Ratio IF and Submission Ratio • The IF can be considered inversely proportional to the chances of acceptance
  48. 48. BMJ Manuscript Processing 1000 Hand written 6000 received Immediately Silly mistakes per year rejected Wrong journal 2500 Poorly written 5000 scanned by Rejected by Obvious flaws 1 editor editor Too Obscure 1000 Rejected Methodological 2500 sent by reviewer / concerns for review editor Not interesting 400 rejected 100 accepted 500 discussed 1500 sent to 400 rejected 100 accepted 500 hanging discussed committees 400 rejected 100 accepted 500 discussed 300 accepted per year Acceptance Rate = 1 in 20 (6 per week + 2 short reports)
  49. 49. 1 in 10+ 1 in 3+
  50. 50. Liaison Journals Liaison Journals Impact Factor Abbreviated Journal Title Total Cites Impact Factor Articles Cited Half Life 2.199 PSYCHOSOMATICS 2259 2.199 80 7.5 2.117 GEN HOSP PSYCHIAT 1952 2.117 83 7 2.095 EPILEPSY BEHAV 1937 2.095 178 3.3 2.053 J NEUROPSYCH CLIN N 2396 2.053 55 7.8 1.859 J PSYCHOSOM RES 6203 1.859 157 7.9 1.206 ACTA NEUROPSYCHIATR 201 1.206 45 3.4 1 BEHAV MED 479 1 13 9.2 0.733 INT J PSYCHIAT MED 823 0.733 30 >10.0
  51. 51. Individual Papers Individual Papers Q. What are the “most important” papers in psychiatry? Q. How many times do you think the top papers are cited?
  52. 52. Top 10 Cited Papers in Psychiatry Top 10 Cited Papers in Psychiatry
  53. 53. Top 10 Cited Papers in Psychiatry_Year Top 10 Cited Papers in Psychiatry_Year
  54. 54. Top Non-Scale/Tool Papers? Top Non-Scale/Tool Papers?
  55. 55. Personal “Impact Factor” Personal “Impact Factor” Q. Who are the most influential authors in psychiatry? Q Can influence by measured?
  56. 56. SURNAME INITIALS SPECIALTY Level BAILEY SM C & A Psychiatry Platinum FAIRBURN CJA General Psychiatry Platinum GOODWIN GM General Psychiatry Platinum LACEY JH General Psychiatry Platinum MCKEITH IG Old Age Psychiatry Platinum OWEN MJ General Psychiatry Platinum THORNICROFT GJ General Psychiatry Platinum WILLIAMS RJW C & A Psychiatry Platinum APPLEBY LJ General Psychiatry Gold BHUGRA D General Psychiatry Gold BOLTON PF C & A Psychiatry Gold DAVID AS General Psychiatry Gold GILVARRY EA General Psychiatry Gold GOODMAN R C & A Psychiatry Gold GRUBIN DH Forensic Psychiatry Gold HILL JW C & A Psychiatry Gold HUNTER S General Psychiatry Gold JONES PB General Psychiatry Gold LEE AS General Psychiatry Gold O'CONNOR S General Psychiatry Gold PRIEBE S General Psychiatry Gold SENSKY TE General Psychiatry Gold STRATHDEE G General Psychiatry Gold TREASURE JL General Psychiatry Gold WILSON KMC Old Age Psychiatry Gold ZIGMOND AS General Psychiatry Gold
  57. 57. Measuring Individuals Research Measuring Individuals Research Old Methods (counts) • Subjective top 4 publications (RAE) • Subjective top 10 publications (CEA form D) • Total publications count • Total Peer reviewed publications New Methods (IFs) • Total citations • Citations per publication • Citations per year (last 2 years) • No. publications with same number of citations (H-index) • Citations per year since qualification
  58. 58. Output Measured Output Measured Results 78 found: Sum of the 325 Times Cited Average 4.17 Citations per Item h-index 12
  59. 59. “Exceptional” Output “Exceptional” Output
  60. 60. Exceptional Citation Growth Exceptional Citation Growth
  61. 61. Publication Count in Liaison (Anonymous) Publication Count in Liaison (Anonymous) 500 464 450 400 350 292 300 243 250 203 200 183 183 150 134 114 87 100 78 77 69 67 61 42 40 50 26 21 18 17 10 0 ic ic ic ic ic ic ic ic ic ic ic ic ic ic ic S S S S S S em em em em em em em em em NH em em em NH em em em NH NH NH NH ad ad ad ad ad ad ad ad ad ad ad ad ad ad ad Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac
  62. 62. Ac ad 0 2,000 4,000 6,000 8,000 10,000 12,000 em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic Ac ad em ic NH S N Ac H S ad em ic NH S NH S NH Citation Count by Liaison (anonymous) S Citation Count by Liaison (anonymous) NH S
  63. 63. 2 Yr Citation Count by Liaison (anonymous) 2 Yr Citation Count by Liaison (anonymous) 2500 2040 2000 1600 1500 1020 960 1000 830 820 610 580 520 500 390 250 195 180 175 160 85 85 30 12 5 3 0 ic ic ic ic ic ic ic ic ic ic ic ic ic ic ic Ac H S Ac H S S S S S NH NH NH NH em em em em em em em em em em em em em em em N N ad ad ad ad ad ad ad ad ad ad ad ad ad ad ad Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac Ac
  64. 64. Ac ad 0 10 20 30 40 50 60 em ic Ac ad 54 em ic Ac ad 50 em ic Ac ad 40 em ic Ac ad 38 em ic Ac ad 34 em ic Ac ad 28 em ic Ac ad 27 em ic Ac ad 25 em ic Ac ad 22 em ic Ac ad 18 em ic Ac ad 14 em ic 13 NH S Ac ad 13 em ic Ac ad 12 em ic 12 NH S Ac ad 12 em ic 7 NH S 6 NH S 5 NH S 4 NH S H-Index by Liaison Authors (anonymous) H-Index by Liaison Authors (anonymous) 3
  65. 65. End: 5 Tips End: 5 Tips
  66. 66. Predictors of Journal Acceptance Predictors of Journal Acceptance • 1. Submitting the paper! • 2. Proofing and high quality submission • 3. Co-authorship • 4. Choosing a low impact journal • 5. Improving and re-sending after rejection • 6. Selling in the Cover letter • 7. Speaking with the editor • 8. Getting an invited paper
  67. 67. Predictors of High Impact Citation Predictors of High Impact Citation • 1. Publishing in a high impact journal
  68. 68. “There was some delay in submission……. due to a backlog in the to do tray”
  69. 69. Citations vs probability article is online Lawrence S. Online or invisible. Nature 2001;411:521 http://external.nj.nec.com/~lawrence/papers/online-nature01/
  70. 70. A comment from Rennie Drummond deputy editor A comment from Rennie Drummond deputy editor JAMA JAMA There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive…..for a paper to end up in print.
  71. 71. What is the Cost of Research? What is the Cost of Research? • CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) – National Institute of Mental Health (NIMH) clinical trial cost $67 million, with 1460 participants enrolled = $45,000 per patient for one year or $123 per day • Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) – The National Heart, Lung, and Blood Institute (NHLBI) funding for Fiscal Years (FY) 1993-2004 was $83,170,059, and 42,418 participants enrolled => $2,000 per patient • Diabetes Prevention Program (DPP) Clinical Trial – Funding: FY 1994-2002 was $176 million and 3,234 participants enrolled (45% were minorities). => $54,000 per participant
  72. 72. Pubmed vs Wok vs Scopus Pubmed vs Wok vs Scopus Pubmed • 5,500 journals • 18 million articles Scopus • 16,000 • 36 million articles WOK • 23,000 journals • 40 million articles
  73. 73. End End
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