Time for gender mainstreaming in editorial policies

The HIV epidemic has been continuously growing among women, and in some parts of the world, HIV‐infected women outnumber men. Women's greater vulnerability to HIV, both biologically and socially, influences their health risk and health outcome. This disparity between sexes has been established for other diseases, for example, autoimmune diseases, malignancies and cardiovascular diseases. Differences in drug effects and treatment outcomes have also been demonstrated. Despite proven sex and gender differences, women continue to be underrepresented in clinical trials, and the absence of gender analyses in published literature is striking. There is a growing advocacy for consideration of women in research, in particular in the HIV field, and gender mainstreaming of policies is increasingly called for. However, these efforts have not translated into improved reporting of sex‐disaggregated data and provision of gender analysis in published literature; science editors, as well as publishers, lag behind in this effort. Instructions for authors issued by journals contain many guidelines for good standards of reporting, and a policy on sex‐disaggregated data and gender analysis should not be amiss here. It is time for editors and publishers to demonstrate leadership in changing the paradigm in the world of scientific publication. We encourage authors, peer reviewers and fellow editors to lend their support by taking necessary measures to substantially improve reporting of gender analysis. Editors' associations could play an essential role in facilitating a transition to improved standard editorial policies.     

Ethical responsibilities of editors, reviewers, and authors

Scientific misconduct, which is neither new nor unique, is prevalent in the medical literature. Although fabrication of data obviously is unethical, and although ethical rules of conduct for certain aspects of medical studies, such as informed consent, are theoretically accepted worldwide, numerous authors do not adhere to ethical rules of conduct. Ethically, the editor is responsible, as a gatekeeper, for ensuring that material to be published is accurate and valid. Thus, the editor's main responsibility is to the reader. Nonetheless, the editor also must serve the author by selecting unbiased reviewers and by providing the assurance that material will be selected for publication based solely on the scientific quality of the material. Peer reviewers are obligated to maintain a posture of confidentiality throughout the review process. Authors are responsible for adequate planning before undertaking a study, and for safeguarding patients' rights during the study. The author must read all cited references completely, strive for accuracy, and be certain that the material reported is valid, because it will be used in the treatment of patients. Hopefully, awareness of the ethical problems related to medical writing will provide a clearer understanding of the ethical aspects of medical writing.     

HIV vaccine research--South Africa's ethical-legal framework and its ability to promote the welfare of trial participants.

An effective ethical-legal framework for the conduct of research is critical. We describe five essential components of such a system, review the extent to which these components have been realised in South Africa, present brief implications for the ethical conduct of clinical trials of HIV vaccines in South Africa and make recommendations. The components of an effective ethical-legal system that we propose are the existence of scientific ethical and policy-making structures that regulate research; research ethics committees (RECs) that ethically review research; national ethical guidelines and standards; laws protecting research participants; and mechanisms to enforce and monitor legal rights and ethical standards. We conclude that the ethical-legal framework has, for the most part, the necessary institutions, and certain necessary guidelines but does not have many of the laws needed to protect and promote the rights of persons participating in research, including HIV vaccine trials. Recommendations made include advocacy measures to finalise and implement legislation, development of regulations, analysis and comparison of ethical guidelines, and the development of measures to monitor ethical-legal rights at trial sites.     

Biomedical publication for neurosurgery residents: a program and guide

One of the most pressing obligations in academic neurosurgery is the publication of clinical and basic science research results. Publication documents intellectual property and communicates findings among researchers working to improve neurosurgical treatment. It documents productivity, justifies funding for research, creates reputations, and builds careers. Nonetheless, the actual writing of reports is a skill often learned by osmosis in academic medicine. To give residents the tools necessary to negotiate the biomedical publication process successfully, we developed a publications program based on the premise that residents seeking an academic career must be prepared to generate publishable reports with maximum efficiency. The program consists of a "publication kit," a series of seminars, and one-on-one tutorials with academic biomedical editors that permit residents individually to improve the quality of their reporting. We describe this program, provide guidelines that can help residents write high-quality papers and publish their work more efficiently, and summarize important content regarding the framework for a successful paper, the elements of a conventional research report, brief guidelines for specific types of papers, reporting standards for clinical trials and meta-analyses, keys to citation in bibliographic indexes, and ethical and legal considerations related to research approval, confidentiality requirements, copyright law, permission to use previously published material, and conflict of interest. Residents who are able to view their work with a sharp critical focus and are educated about the standards of biomedical publication are better prepared to succeed in building a career in academic medicine.     

An editor׳s considerations in publishing industry-sponsored studies

The fundamental responsibility of a journal editor is to assure that studies accepted for publication provide rigorous original scientific information and reviews that are considered important to the readership. The fundamental requirements of such reports from an editor׳s perspective include objectivity and transparency in each of the study design, implementation of investigation methods, acquisition of data, inclusive analysis and interpretation of results, appropriate application of statistical methods, presentation of outcomes in the context of a balanced and comprehensive review of relevant literature, and meaningful conclusions. In proceeding on these presumptions, editors then have the responsibility of obtaining rigorous, objective, and constructive reviews of these reports so that they can make an unbiased decision regarding their disposition. The fundamental objective in this is to enhance the ultimate scientific validity and value of the work if and when it is accepted for publication. Guidelines have been advanced by several organizations to identify how such editorial responsibilities can be fulfilled. These guidelines also pertain to investigators, authors, and sponsors of the studies, which the various reports and reviews describe. The present article reviews these guidelines as they relate to both industry-sponsored and investigator-initiated investigations and as relevant to the variety of reports that a scientific/medical journal such as Urologic Oncology: Seminars and Original Investigations receives for publication.     

Treating transsexuals in India: History, prerequisites for surgery and legal issues

Authors in their clinical practice came across transsexual patients, who were determined to get their gender affirmed by undergoing a change of sex. This motivated the authors to review the literature extensively regarding transsexualism and report their experience. Opinions were taken from legal luminaries practicing in related fields. They also took inputs from several patients who were at various stages of psychiatric analysis and hormone therapy and also those, who had completed their treatment procedures. A paucity of the Indian inputs in medical literature concerning transsexualism was noted by the authors They also found deficiencies in the Indian Law, as applied to the individuals undergoing gender affirmation surgery (GAS). In this paper they have enumerated these deficiencies. Though GAS has been legally allowed in U.K. since 1967, in America since 1972, and in various other countries, Indian Laws are silent on the issue. An Indian surgeon dealing with transsexual patients is faced with a number of issues like consent for the procedure, safe guarding the surgeon or gender team from future litigation. Another issue is postoperative sexual and legal status of the patient. Present Indian Laws regarding marriage, adultery, sexual and unnatural offences, adoptions, maintenance, succession, labour and industrial laws will require modifications when dealing with these individuals and protecting their rights. Authors have tried to deal with all these issues that an individual surgeon faces when he manages a transsexual patient.     

Institutional review board approval: why it matters

The modern institutional review boards originated in the 1970s. They exist to protect human subjects participating in research from potential harm. The Belmont Report provided the ethical principles (respect for persons, beneficence, and justice) that should be observed while conducting research on human subjects. Compliance with the ethical principles of the Belmont Report is a first step in successful submissions to an institutional review board. Regulations regarding conflict of interest represent an attempt to ensure that research is not biased by financial or other interest and to maintain public trust.     

The first ten years of The Foot: a retrospective analysis of publication patterns, 1991–2000

Background: The Foot commenced publication in 1991 to provide an international forum for clinical foot and ankle research. As the journal has just reached the end of its first decade, it is timely to look back and review publication patterns over this time.Methods: A retrospective analysis of every paper published in The Foot between 1991 and 2000 was undertaken. Articles were evaluated to determine the article type (i.e.: original research, literature review, case report, etc), the topic area, the country of origin of the primary author and the professional background of the primary author.Results: The majority of papers published have been original research (44%), followed by case reports (32%) and literature reviews (18%). The topic area of papers has been diverse, covering 23 different categories, with most papers pertaining to foot surgery (27%). Authors from 27 different countries have published in the journal, with most papers submitted by authors from the UK (67%). The most frequent publishers in the journal were orthopaedic surgeons (63%), followed by podiatrists (25%). Between 1991 and 2000, there has been a steady increase in the number of papers published by podiatrists, and a small increase in the number of papers published by authors outside the UK.Conclusions: These results confirm the status of The Foot as a truly international, multidisciplinary forum for the publication of clinical foot and ankle research.     

Making difficult ethical decisions in patient care during natural disasters and other mass casualty events

OBJECTIVE: Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief. STUDY DESIGN: A survey of pertinent literature was performed to assess experience and opinions on the condition of medical care in terrorist attacks and natural disasters, the ethical challenges of disaster medical care, and the professional responsibilities and responsiveness in disasters. CONCLUSIONS: It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims.     

Ethics education at the engineering/medicine interface.

There is a functioning interface between engineering and medicine. There are also wide-spread indications in the scientific community that there is increased concern for ethical matters in science and that the time has arrived for more instruction in this area. One reason for this in bioengineering is the rapidly growing complexity of technology in both engineering and medical biology. The ensuing difficulty in communication cannot be remedied just with more technical information. Instead bioengineers need an improved understanding of medical education and practice, and medical ethics is fundamental to this. Ethical considerations are crucial to decision making and therefore to all areas of professional endeavor in bioengineering. As a framework for ethics education, bioengineers need to gain a better understanding both of medical education in general and of medical practice, particularly the case study method in education and the nature of decision making in medical practice. Key subject areas in medical ethics for bioengineers include rights and duties of physicians, determination of death, team ethics, patient privacy and informed consent, research ethics, and malpractice. An ethics curriculum for bioengineers should be taught using both informal but regular exposure to clinical activities and clinicians, and formal classroom work. In the medical ethics classroom setting, writing assignments are essential to provoke each student to the introspection and commitment needed to form a personal professional ethos.     

Ethics Education at the Engineering/Medicine Interface

There is a functioning interface between engineering and medicine. There are also widespread indications in the scientific community that there is increased concern for ethical matters in science and that the time has arrived for more instruction in this area. One reason for this in bioengineering is the rapidly growing complexity of technology in both engineering and medical biology. The ensuing difficulty in communication cannot be remedied just with more technical information. Instead bioengineers need an improved understanding of medical education and practice, and medical ethics is fundamental to this. Ethical considerations are crucial to decision making and therefore to all areas of professional endeavor in bioengineering. As a framework for ethics education, bioengineers need to gain a better understanding both of medical education in general and of medical practice, particularly the case study method in education and the nature of decision malung in medical practice. Key subject areas in medical ethics for bioengineers include rights and duties of physicians, determination of death, team ethics, patient privacy and informed consent, research ethics, and malpractice. An ethics curriculum for bioengineers should be taught using both informal but regular exposure to clinical activities and clinicians, and formal classroom work. In the medical ethics classroom setting, writing assignments are essential to provoke each student to the introspection and commitment needed to form a personal professional ethos.     

Ethical Issues With Informed Consent From Potential Living Kidney Donors

Living organ donation and participation in clinical research trials have several features in common from an ethical perspective. The primary similarity is risk justification: the risk of harm to living organ donors and clinical research participants is justified by a resulting benefit to one or more other individuals. Some authors hold that organ donation and clinical trial participation are full-fledged duties. Such an implicit likening of the two leads to several considerations regarding informed consent in each situation. Informed consent raises ethical concerns in every medical context, and some of those concerns, such as competence, understanding, autonomy, and free or voluntary choice, are uniquely relevant to living organ donation and clinical trial participation. Most countries regulate informed consent procedures for living organ donation in great detail, and although informed consent procedures for clinical trial participation are somewhat less detailed, their rules are subject to review by ethics committees. It would be constructive for research participation informed consent procedures and living organ donation informed consent procedures to learn from one another.     

Arthroscopy scapulothoracic articulation (introduction of this method)]

The authors have introduced arthroscopy of scapulothoracic. They have treated 37 years old patient who suffer from bursitis with pain and crepitus. They have used arthroscopy procedure. The first publication about scapulothoracic arthroscopy was in 1992. The method has been written very rarely by foreigner authors in medical journals.     

Editorial Commentary: Return to Sport After Surgical Treatments of the Acromioclavicular Joint Dislocation Seems to Be Almost Perfect in the Literature

Systematic reviews identify completed studies that address a research question and evaluate the results of these studies to arrive at conclusions about a body of research. They should be encouraged because the findings, with power enhanced by the larger sample size available from the combined studies, often represent an important scientific contribution. The systematic review findings also can be a useful background for developing practice guidelines in the future. One of limitations of this approach is a risk of publication bias. Studies with negative results are more likely to remain unpublished or excluded from the review owing to a lack of reporting outcome of the specific interest. Although publication bias is difficult to eliminate, it should be addressed by the authors with appropriate statistical procedures that may be helpful in detecting its presence. Negative results should not be masked by overall good outcomes. This rather long caveat relates to a recent review showing that return to sport after surgical treatments of acromioclavicular joint dislocation seems to be almost perfect in the literature. Perfection is rare, so publication bias could be a limitation of the review.     

Urologic Oncology: Seminars and Original Investigations. A Twenty-Fifth Anniversary History

This narrative reviews the history of Urologic Oncology: Seminars and Original Investigations from its inception and founding through its development to reach its current status. It describes the difficulties it experienced during its initial years when it almost folded, its resuscitation when it was designated as the “official journal” of the Society of Urologic Oncology, its merger with Seminars in Urologic Oncology to strengthen the content of both journals in a new format, its acceptance for indexation by the National Library of Medicine, its progress to monthly publication in addressing the needs of both authors and readership, and its current status as a leading multidisciplinary journal in urologic oncology. As a founding editor and managing editor for the first 5 years and then as editor-in-chief for the next 20 years, the author has been integrally involved in each step of the Journal's development and maturation. The Journal has been referred to as “the journal that almost never was” as it now has reached its 25th year of publication. This article commemorates the Journal's 25th Anniversary and gratefully acknowledges all of those investigators, authors, reviewers, editors, publishers and the readership who have contributed to the Journal's ongoing success.     

A worldwide assessment of medical journal editors' practices and needs--results of a survey by the World Association of Medical Editors.

OBJECTIVES: To identify editors interested in participating in a global organisation and communication network of medical editors; to assess current use of the peer-review process; and to determine current computer capabilities, needs, and interests of medical journal editors around the world. DESIGN: Mail survey of senior editors at 727 medical journals. SETTING: Fifty-seven countries worldwide. RESULTS: Two hundred and sixty-nine editors (37%) responded. Eighty-seven per cent of responding editors expressed interest in a global organisation of medical editors. Almost all editors (94%) reported using peer-review systems. Practices varied widely across journals, but in most cases were not highly correlated with the countries' level of development: 44% reported formal orientation for reviewers; 71% used specific instructions; 39% required reviewers to disclose conflicts of interest; 36% masked the identity of authors; and 42% graded reviews for quality. Seventy-eight per cent of editors reported using a computer in their work and 47% had Internet access; two-thirds of those without access expected to have Internet access within 18 months. CONCLUSIONS: There was strong interest among respondents in a global organisation for medical editors. Peer review was widely reported by medical journal editors throughout the world, although specific practices varied widely. Half of the responding editors reported having access to the Internet, making participation in a worldwide computer network of editors feasible.