Pakistan Journal of Medical Sciences

Published by : PROFESSIONAL MEDICAL PUBLICATIONS

ISSN 1681-715X

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Conference Proceeding

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Volume 23

April - June 2007 (Part-II)

Number 3


 

Abstract
PDF of this Article

National Conference on Medical Editing
Rawalpindi, Pakistan

Shaukat Ali Jawaid1

 

Pak J Med Sci   May - June 2007   Vol. 23 No. 3    460-474


 1. Shaukat Ali Jawaid
Managing Editor
Pakistan Journal of Medical Sciences,
Karachi - Pakistan.

E-mail: pjms@pjms.com.pk
            shaukat@pulsepakistan.com


Army Medical College Rawalpindi in collaboration with Pakistan Medical Journalists Association (PMJA), National University of Science and Technology (NUST) with the blessings of Higher Education Commission (HEC) organized the first National Conference on Medical Editing at AMC campus from April 23-25th2007. One hundred twelve participants had pre-registered for the conference while a number of people got registered at the conference venue. Prof. Atta-Ur-Rahman Federal Minister and Chairman of Higher Education Commission was the chief gust in the inaugural session on April 23,2007.
Inaugurating the conference Prof.Atta-Ur-Rahman said that the key to quality of an institution lies in the quality of its faculty members and universities are judged by their creativity and their impact on the Society. He further stated that the landscape of our universities is now changing which is evident from the fact that there has been over 40% growth of ISI covered publications from Pakistan in recent years. Higher Education Commission is identifying the brightest and sending them to the best institutions in the world and then attracts them back which has reversed the brain drain.
During the last two and a half years, HEC provided two thousand scholarships mostly for European countries and two thousand five hundred scholarships were offered for indigenous PhD programmes. At present over 70% of faculty members in our universities do not have PhD qualifications with the result that they lack research culture. As such our major emphasis is now on faculty development. We are living in a changing world where higher education, science and technology are the great dividers. The rich are getting richer and the poor, poorer. World is inflicted with poverty, hunger, disease, conflicts, violence and economic uncertainty.
MIT graduates and faculty have founded over four thousand companies which employ over one million people. The annual sale of these companies is 232 billion US dollars and collectively these companies are the 24th largest economy in the World. Socio-economic development, Prof. Atta-ur-Rahman remarked is no longer dependent on natural resources as Knowledge has become the main driving force of world economics which is the basis of socio economic growth. Industrialization is the key to high GDP growth through innovation, production of high value added goods i.e. pharmaceuticals, Information Technology and Biotechnology.
HEC has a vision of concentrating on Human Resource Development tapping in the pool of creativity. Our priority areas are engineering, science and technology, medical and life sciences, agriculture and education. Korea had a successful transition from Agriculture to Knowledge-Based Economy. In 1960, over 50% of their GDP was contributed by Agriculture but in Year 2000 it fell to only 5-10% whereas over 50% is contributed by Engineering, Goods and Electronics. Giving details of HEC plan of action he said that it focuses on faculty development, improving access and learning, excellence in research which is relevant to national priorities. We are trying to develop infrastructure, ensuring good governance and management besides quality assurance. The Key Areas of improvement are low enrollment in higher education, poor standard of faculty and lack of training, low quality of teaching and research and lack of relevant national needs besides poor governance of universities and there is minimal relevance of higher education to national needs which all needs to be improved. Apart from ensuring quality assurance, we are working on providing of linkages to the economy. Our strategy includes improvements in basic sciences like physics, chemistry, mathematics and biology besides applied sciences i.e. engineering, agriculture sciences, biotechnology, medical sciences, pharmaceuticals, social sciences, economics, finance management, innovation and entrepreneurship.
Higher Education Commission has laid down eligibility criteria for faculty appointments, introduced Tenure Track System, laid down criteria for recognition of journals, criteria for college affiliation, quality criteria for PhD programme, introduced international refereeing of Dissertation and international publications. University laboratories have been improved. There has been manifold increase in funding for research. During the Year 2006-2007 HEC approved grants for 319 research scientists to attend conferences while seventy three grants were approved to host conferences. We have guaranteed jobs to fresh PhDs with higher salary structures under tenure track system. We have approved 75% reduction of Income Tax for all academics. Under Foreign Faculty Hiring Programme, two hundred seventy ex-patriot and other scientists have been attracted to return to Pakistan and serve here, he added.
Continuing Prof.Atta-ur-Rahman said that the HEC has provided over three hundred million rupees for National Research Programme for Universities. We have also initiated revision of curriculum and now third revision is in progress. We have also provided Video lecturing facility. Our Digital Library has twenty two thousand full text journals available nationwide free of charge and this facility was made available to two hundred fifty institutions so far. For International Video-lecturing programme, high quality video conferencing equipment is being installed and a series of international lectures have been planned. Core groups in different disciplines have been formed. After these initiatives by the Higher Education Commission now brightest young men and women have started opting for careers in Science and Technology subjects as their first choice. Research publications output of Pakistan has also increased tremendously as compared to 2001. As regards development funding, during the Year 2007, we have earmarked a budget of 14.3 billion rupees for 354 development projects. HEC has a total budget of 14.48 billion rupees in 2007. We are funding ninety nine institutions. Almost 650 million rupees have been earmarked for promotion of research. Prof.Atta-ur-Rahman dispelled the impression created by a few that our universities are being provided too much funding saying that the annual average grant was about US$ 7.5 million which is less than 1% of the budget of this year of any top class university in Asia. For example National University of Singapore has an annual budget of US$800 million. The budget of our universities, Prof.Atta-ur-Rahman opined needs to be increased at least fifty fold instead of being reduced. He was of the view that we need to spend at least 6% of our GDP on education sector and the financial allocation for Higher Education as per international norms should be at least 25-30% of total education budget which was currently just 17%.
Some of the universities in Pakistan are still in a mess that we in HEC has inherited. However, the situation is changing rapidly for the better and a silent revolution is taking place. The real change will be visible by the Year 2008/2009 when hundreds of PhD level faculty will start returning each year. We have launched an unprecedented number of systemic reforms which have benefited the Universities. He reiterated that the key to success is an outstanding faculty. To attract that HEC has introduced Tenure Track System, offered higher grades, research productivity allowance, Income Tax concession, PhD allowance, research grants and faculty development programmes. We have also undertaken establishment of new Engineering, Science and Technology Universities with the collaboration of friendly foreign countries.

Current excitement in health biotechnology

Dr. Anwar Nasim Advisor Science to COMSTECH in his address talked about Current excitements in health biotechnology. He discussed in detail the magic molecule DNA, powerful techniques of DNA manipulation, genetic engineering, Molecular Medicine, Human Genome Project and Gene Therapy. DNA damage, Dr. Anwar Nasim stated leads to different diseases and at present four thousand five hundred diseases are known to have genetic relevance. The importance of biotechnology can be very well imagined from the fact that out of the last twenty noble prizes, twelve have been awarded for discoveries in genetics. The first catalogue of known genes and genetic disorders was published in 1966. More recently in April 2007 Heart valve was grown from stem cells and stem cells also provided hope for the diabetics. Again in April 2007 GM insulin breakthrough was reported.
Polymerase Chain Reaction (PCR) is now used for genetic manipulations, detection of hereditary diseases, identification of genetic fingerprints, diagnosis of infectious diseases, cloning of Genes, Paternity testing and DNA compounding. Speaking about the top ten biotechnologies for improving health Dr.Anwar Nasim listed the following:
1. Molecular technology for diagnosis of infectious diseases.
2. Recombinant technologies to develop vaccines against infectious disease.
3. Technologies for drug and vaccine delivery system.
4. Sequencing pathogens genomes to identify new antimicrobials.
5. Bioinformatics to identify drug targets and to examine pathogen.
6. Recombinant technology to make therapeutic products like Insulin and Interferon.
7. Combinatorial chemistry for drug discovery.

Biotechnological innovations can be incorporated in development process and they have a role in agriculture, health, environment and industry. Biotechnology has a role in not only medicines but also vaccines, diagnostics and Gene therapy. Biotech medicines are useful in anemia, cystic fibrosis, growth deficiency, hemophilia, leukemia, hepatitis, genital warts besides transplant rejection and many forms of cancer.

Medical Journals contribution to National Health

Jane Nicholson Editor, WHO Regional Office for the Eastern Mediterranean made her presentation on “Can Medical Journals contribute to the National Health”. Medical Journals, she said, play a vital role in promotion, patient care, knowledge sharing, influencing health outcomes and informing the policy makers. However, it is important that we know the gap between what is known and what is done in practice. Many of the solutions to health problems are known but are not applied which results in fostering and perpetuating health inequalities. This knowledge gap is also the main obstacle to progress in improving health and health equity, besides attainment of national health goals and the UN millennium development goals. (MDGs).
These days Evidence Based Medicine plays an important role in public health. The best practice in health systems is knowledge sharing. Currently access to knowledge and information about health, she said, is inequitable. However, for many there is an overload of information. Best results can be achieved if we bring together the researchers and policy makers so that policies are based on evidence and the research is based on need. Research, Mrs. Jane Nicholson opined was not an end in itself but it must provide solutions to community health problems.
Medical Journals, Ms Jane Nicholson pointed out link the academic community with the policy makers, decision makers in health system and healthcare professionals as well as the community. As such it is important to promote knowledge sharing so that it can reach to those who need it in different formats. The medical journals can help ensuring that the information reaches to those who need it. It should also reach to those who had participated in it and to those who can use it. The journals can contribute to knowledge by publishing quality research and ensuring that a peer review process is in place. It must also be ensured that journals are published regularly and they are indexed in different databases. They should also try to reach out to readers through editorials, education, policy to practice, evidence based medicine and community medicine. Jane Nicholson also highlighted the importance of two way relationship. She felt that policy makers, health systems decision makers and practitioners need to demand that medical journals deliver the information they need in a way which can be used. They must also engage with researchers and editors to identify problems, find solutions and promote translation of knowledge into practice.
Of the sixty journals published in Pakistan, not many are targeted at the issues which Pakistan needs to address. Again not many of these journals are tackling the key issues of health systems, health policy, health education, health behaviour and lifestyles. Medical journals provide a bridge between research and policy makers. She opined that Pakistan needs a National Committee on Medical Journals which should fix quality criteria for medical journals. There must be a national indexing database.
Earlier Prof. Tahir Saeed Haroon President of Pakistan Medical Journalists Association in his keynote address highlighted the activities and accomplishments of PMJA over the last many years. The Association, he said, has been quite active organizing seminars, symposia and workshops on medical writing, peer review system and has published books on medical writing. Some of its members have played a key role in the establishment of Eastern Mediterranean Association of Medical Editors (EMAME).
Prof. Major Gen. Mohammad Aslam Principal Army Medical College and Chairman of the Organizing Committee welcomed the guest speakers and participants to the conference. He also thanked the National University of Science and Technology besides Higher Education Commission for supporting this academic activity. Dr. Maqbool Jafary presented the vote of thanks and also introduced the invited guest faculty from overseas which included Mrs. Jane Nicholson from WHO EMRO Cairo, Dr. Farhad Handjani General Secretary EMAME from Iran, Dr. Farrokh Habibzadeh, Dr. Arash Etemadi and Dr. M.B. Rokni all from Iran, Dr. Diaa Rizk Chairman Publication Ethics Committee of EMAME from UAE and John Cathy Senior Managing Editor of Annals of Saudi Medicine from Saudi Arabia.
Scientific programme of the conference was spread over five sessions on April 24th and 25th 2007.

Medical Editing process in different countries

Dr. Farhad Handjani from Shiraz University of Medical Sciences, General Secretary of Eastern Mediterranean Association of Medical Editors (EMAME) chaired the first session on April 24, 2007. Brig. Azhar Mubarak Editor Pakistan Armed Forces Medical Journal acted as the moderator.
Dr. Fatema Jawad Chief Editor Journal of Pakistan Medical Association was the first speaker. She discussed duties of an Editor and the difficulties these editors encounter. Editors, she said, are goal keepers of good science but also guardians against fraudulent science. Initial review of the article, she said, includes topic and length of the manuscript. The editor also finds out whether all the necessary statements regarding author’s responsibilities have been provided. An Editor is responsible for the entire contents of the journal hence it is his/her duty to produce a reliable and readable journal. The Editor must select appropriate reviewers and he also enjoys the final authority to accept or reject the manuscript.
A good Editor, she said, must have good knowledge and experience to judge the quality of a manuscript, ability to give unbiased honest judgment and take a firm decision. They should also have the moral strength to stand pressures from influential people, ensure honesty and integrity of the contents and minimum bias by managing conflict of interest and above all must maintain confidentiality of information. An editor has to deal affectionately and carefully with editorial board members, authors, peer reviewers, financers, office staff and those involved in publishing, production of the journal.
The editor should endeavor to have highly qualified and experienced editorial board members. Busy clinicians have very little time with the result that the entire burden falls on a few dedicated staff members. Most of the authors do not bother to read and follow instructions to authors. Most of them write under compulsion i.e. for promotion hence the quality of manuscripts is usually not good. At times there are communication problems between authors and editorial staff. Some times the authors do not respond to queries, comments and suggestions for too long despite reminders. Other problems faced by the editors include financial viability. Finding staff which is computer literate with good command on English language is a luxury in Pakistan. Ideally if resources permit, every journal should have a full time paid Managing Editor. Pharma industry is the major source of revenue through advertisements but they have their own priorities. As such HEC and some other government institutions could be a useful source for funding.
Speaking about the contributors in JPMA Dr. Fatema Jawad said that Karachi contributes 60.5% of manuscripts while other cities in the country contribute 21%, overseas manuscripts 15-20% and our rejection rate in 2006 was about 47.3%. Those edtiors who succeed to resist pressures for early publication can have serious consequences for which they must be prepared, she remarked.
Mr. Shaukat Ali Jawaid Managing Editor Pakistan Journal of Medical Sciences described the processing and editing of manuscripts at Pak J Med Sci. He pointed out that now they receive 90% of manuscripts through e mail. Almost over 80% of the authors do not read and follow instructions to authors which create lot of problems and delays in processing and editing of the manuscripts. During initial online assessment, the manuscripts which have major deficiencies like absence of any essential components of an article, structured abstract, confusing tables and figures, lack latest references, do not conform to ICMJE guidelines are rejected immediately and it accounts for about 30% of the manuscripts received. Original, epidemiological, interesting studies are preferred and they are processed on priority basis. All manuscripts on receipt are immediately acknowledged and authors are communicated reference number which they are supposed to refer in all future correspondence. Most of the manuscripts are reviewed by one internal and one external reviewers but about 20-25% of manuscripts are reviewed by two or three reviewers. The whole peer review process takes about four months though efforts are being made to reduce this period. Pak J Med Sci reviewers data base has ninety reviewers from Pakistan and forty from overseas and this database is constantly being increased. Only a few reviewers from Pakistan do online review while over 80% of them need printed copies of manuscripts and they also has to be reminded again and again. On the contrary foreign reviewers are quick and most of them do a good job within two to three weeks. Even after peer review, most of the manuscripts have to be looked at in detail by the Editor. Our primary acceptance rate, Mr. Shaukat Ali Jawaid stated is about 25% and these manuscripts are accepted after minor editing while another 30% are accepted after revision and rewriting. Thus overall acceptance rate is about 55%. Almost 30% of the manuscripts suffer from serious problems as regards English language and these manuscripts take too much time for rewriting, editing and finally acceptance for publication. No re-written manuscript is published unless it has been seen and approved by the authors.
Despite giving a written undertaking confirming exclusive submission, some authors indulge in simultaneous submission to more than one journal which results in duplicate publication. Hence to check this menace, the journal has blacklisted some of these authors and their manuscripts will not be entertained in future. Average time from receipt of manuscript to acceptance is four to five months while from receipt to final publication it is usually over six to eight months. However, some interesting manuscripts do get processed and published early. In order to reduce time of peer review and publication, reviewers data base is being further increased, number of manuscripts published in each issue has been increased besides publishing additional issues to clear the backlog. However, frequency of publication of journal is not changed as it may not be sustainable in the long run due to financial constraints. He also disclosed that during 2006 they received two hundred sixty eight manuscripts from thirty countries whereas during the same period, one hundred twenty manuscripts were published. Self audit is a regular feature at Pakistan Journal of Medical Sciences which is quite helpful to further improve the quality and standard of the journal. His advice to his editor colleagues was not to flirt but get married to medical journalism.
Dr. Farrokh Habibzadeh Director at large in WAME discussed biomedical editing in Iran. He pointed out that currently there are 113 approved medical journals in Iran of which fourteen are covered in EMBASE, four in SCIE by Thompson/ISI and four in Index Medicus Medline. All these journals are owned and funded by public sector universities of medical sciences. According to Iranian Ministry of Health and Medical Education, 89.79% of research is published in Persian language while only 24.21% gets published in English language journals. It is generally believed that Editorship is a simple thing but in fact it requires proper training and involves serious issues like freedom and independence. The problems faced by the biomedical journals include low submission and low quality of submission, few good quality reviewers, inactive editorial board and poor logistic support. To overcome these problems, Dr. Farrokh Habibzadeh suggested training courses for authors, reviewers, editors, editorial board members and office staff. Increasing the visibility of the journal will increase the number of manuscripts submission, he remarked.
Dr. Diaa Rizk from Al-Ain University United Arab Emirates discussed core skills of effective medical writing. Dr. Diaa Rizk opined that writing for scientific journals require special skills. One must share one’s knowledge as this is the way to achieve immortality. Many papers or research grants are rejected because they are poorly written. The five core writing skills, he said are:
1. Developing a concept
2. Preparing an outline
3. Writing the first draft
4. Toping and tailing
5. Publishing
Before writing one must develop a concept. Why to publish and what to publish? Try to convey your main message to the readers. As regards main message, prepare twenty to twenty five words key message sentences which should form the heart of your paper. Then write down your main study objective and hypothesis and ensure both are related. While writing Introduction find out what is known before this study, why there is a need to add and what are the answers needed to address the problem. Then add how you found answers to these questions. Always avoid lengthy introduction and the last paragraph should summarize how the study was conducted and conclude with the main message. Take care of data analysis, sampling size and address ethical concerns. Results section should contain findings in order of importance. In discussion describe principle conclusions besides highlighting main implications of your study and indicate where further work is needed. The first draft should be written quickly without interruption, without editing keeping to the plan of your outline. Always use past tense in writing. Before final editing of the manuscript, take some break, ask for a second opinion, edit on paper and not on computer screen, edit for clarity and continuity. He concluded his presentation by stating that academicians and biomedical researchers need to acquire the knowledge and skills of writing besides understanding publication guidelines.
Mr. John T. Cathy talked about Editing at Annals of Saudi Medicine. Their journal, he said, accepts original manuscripts up to 3,500 words while brief reports should not contain more than 2000 words. The manuscript must have a structured abstract followed by Introduction, Methods, Results, Discussion with relevant references. Before publication all manuscripts undergo technical editing and this is communicated to the authors. Technical and language editing are part of the whole process to ensure uniformity. Language editing ensures expression of ideas is clear, fluent and concise and conforms to conventions, he added.

Peer Review process, Problems faced
by editors, publication ethics

Prof. Nasir Khokhar along with Prof. Brig. Jahan Ara Pal chaired the second session while Dr. Akhtar Sherin was the moderator. Dr. Farhad Handjani from Shiraz University of Medical Sciences Iran talked about Editorship in EMRO Region: Challenges and possible solutions. Owners of the journals, he said, have high expectations and little knowledge of various activities involved in publishing. Financial constraints and lack of any organizational set up create further problems. Most often they are interested in final outcome and not the path. Different problems faced by Editors include lack of trained manpower, inadequately trained authors, paucity of good quality peer reviewers, problems with indexing and visibility. He also referred to lack of proper work flow plan, lack of adherence to timelines, human resources with knowledge of computer software and other capabilities, lack of professional support and lack of good English Editors.
Continuing Dr. Farhad Handjani said that most of the editorial boards are ceremonial, make little or no contributions and it is difficult to get together all of them. Most of the Editors, he said, are part time, lack proper training, work honorary and mostly it is one man show. Authors are not patient and in order to get published early, indulge in simultaneous submission, rejection of manuscript is taken as personal, authors are not trained in research methodology, ghost authorship and gift authorship are quite common in our region, falsification, fabrication and plagiarism are on the rise due to pressure related to academic promotions.
Talking about the solutions Dr. Farhad Handjani said that Editors should be full time supported with a good experienced and trained team, selection of Editor should be made carefully going for experienced person. Editors should be honest and free from getting influenced. Before starting a journal, one needs to pre-plan for all the things from office space to personnel and finances. International Indexing and Impact Factor has put lot of pressure on journals and Editors. Sometimes national policy regarding journals is not helpful for indexing. There is a need to have a statistician on the editorial board or who should be working closely, if possible provide some incentives to reviewers, training of editors and reviewers will solve most of the problems. He suggested that we should strengthen regional indexing systems and improve their credibility, have variety of contents to attract larger number of readers. Efforts should also be made to study the impact of the journal on local and regional basis of what has been published. This may be the real impact of the journal, he remarked.
Prof. Manzar Salim Cheif Editor Pakistan Journal of Surgery poke about creating and improving co-operation between editors. He was of the view that co-operation is essential to check plagiarism, discuss and find a solution to the problems faced by editors, learn from each others experience and help each other in case of pressure. Co-operation is also desirable to promote scientific writing, encourage research, and improve quality of the journals. This cooperation can be achieved at local level, national level, regional and international level. Different groups can be formed; associations like PMJA can be helpful to achieve these objectives. EMAME and WAME platforms also provide a useful medium for cooperation at international level. Cooperation can also be enhanced by inviting editors to join reviewer’s database by different journals, organizing regular meetings, seminars and symposia besides hands on training workshops. A lot can be achieved and accomplished if we can succeed in having cooperation between the editors of various journals, he added.
Ethics of Peer Review were discussed by Dr. Huma Qureshi Editor Pakistan Journal of Medical Research published by PMRC. Peer review, it was stated, is the cornerstone of modern medicine. All peer reviewed journals rely on expertise and objective review by knowledgeable researchers which ensures quality of the manuscripts accepted for publication. The reviewers are supposed to give their opinion on whether the techniques are appropriate and correct, data analysis is correct, how it should be analyzed and presented. It is the scientific editors who make the final decision whether to accept or reject the manuscript.
The qualities which the editors look in reviewers, Dr. Huma Qureshi said, include their expertise in that particular area, objectivity and they should not have any conflict of interest, they should have good judgment and able to think clearly, logically, they are able to write a good critique which is accurate, readable and helpful to the authors as well as readers. Above all they must have time to do the review in allotted time. The reviewers must maintain confidentiality of the manuscript, do not pass on the paper to other colleagues, do not use this information in their own paper or cite it as it can give rise to serious ethical issues. If the reviewer has a feeling or suspicion of plagiarism or duplicate publication, these concerns should be conveyed to the editor with facts if any. In case of scientific misconduct, appropriate action must be taken by the Editor following established guidelines and procedures. Review must be clear, concise and accurate. The main objective of review is to guide the author. Comments should be constructive. Problems in Pakistan, Dr. Huma Qureshi said is that we do not have enough experienced reviewers, many accept papers under pressure, take long time in reviews, do not keep record of their previous comments but despite all this, these reviewers are indispensable whose services are required by every peer reviewed journal. She suggested that we should initiate a programme of training the reviewers, share good reviewes with other reviewers, advice them to give comments which is helpful for the authors to improve their manuscripts to get published. The editors should not hesitate to politely thank and replace those reviewers who fail to do proper reviews, she added.
Dr. Diaa Rizk from UAE spoke about publication ethics. He pointed out that academic publishing is a scholarly achievement which provides credit and responsibility for intellectual published articles. Medicine is a profession based on trust, integrity and altruism. That is why members of the medical profession and public agree that a culture of zero tolerance should permeate for academic dishonesty with special regard to publication misconduct. He then discussed in detail common types of publication misconduct. Basic publication ethics including allowing the journal to review the raw data, chalk out strategy to minimize affiliation bias. Publication misconduct, Dr. Diaa Rizk opined can only be minimized by combining ethical research conduct, open reporting of results coupled with good clinical practice.
Prof. Nazir Khan Editor Journal of Dow University of Health Sciences discussed challenges in starting a new journal. DUHS, he said, has seven hundred teaching faculty and three thousand students, hence the need was felt to have its own medical journal to publish its research work. Publishing a journal is not economically viable in Pakistan and it is more difficult for a newly launched journal. There are no subscribers and the support from the pharmaceutical industry is not forthcoming easily. However, since DUHS has HEC funding, finances won’t be much of a problem for this journal. One has to set up the whole system of manuscript submission, establishing a reviewer’s database, processing of manuscripts, publication etc and this all requires a team work.
During the discussion it was pointed out that these days open peer review is preferred rather than blinding system as it also improves the quality of reviews. Some participants felt that we should have more seminars, workshops on medical writing, peer review process and hands on workshops on medical editing. Prof. Tasnim Ahsan from JPMC Karachi pointed out that intellectual corruption is rampant in our medical institutions. Lot of data is fabricated and then it also gets published which needs to be checked. Prof. Jahan Ara Pal in her concluding remarks said that we have come a long way in the field of medical writing and then recalled that once she wrote a paper which was published in a local journal for which she was asked to explain why prior permission was not taken from the GHQ. Now the time has come that Army Medical College is hosting this first ever medical conference on medical editing to promote the cause of medical journalism and medical editing which is indeed commendable.

Menace of duplicate publications,
Plagiarism, Publication misconduct

This session was jointly chaired by Dr. M.B. Rokni from Tehran University of Medical Sciences and Lt. Gen. Mahmood Akhtar former Surgeon General of Pakistan Army. Dr. Ahmad Badar Editor Pakistan Journal of Physiology talked about Plagiarism, risks, limits and responsibilities. One of the reviewers wrote to the Editor saying that “I feel that the work has not been carried out in the setting mentioned. Similarly unlike most of the local articles the “English” is very good. I am not pointing to anything in particular but please make sure to secure properly signed undertaking from the authors as I smell a rat”. Dr. Ahmad Badar said that this alerted us hence we selected a most suitable paragraph and checked it through “eTblast” and “Scholar Google” which enabled us to detect plagiarism.
Dr. Ahmad Badar pointed out that there are three menaces for medical writing and they include falsification (to alter fraudulently), fabrication (to construct) and plagiarism (to copy). In Pakistan most of our authors write under pressure and are in a hurry as they need it for selection, promotion or getting higher grades etc. Now internet has brought medical literature into our homes and to our study tables. It is “ease but also a Disease”. It is generally difficult to resist temptation to copy when one finds the exact match to the original idea while searching on the net. Speaking about Net Plagiarizers, he said, the type-I is cut and paste plagiarizers. They use different abstracts and then put various statements together. Most often it lacks continuity. The next type is of whole article plagiarizer. They select an article from an unfamiliar journal and then intelligently modify it knowing fully well that it is unethical but even then they take a calculated risk. An alert editor, knowledgeable reviewers and the net itself offer some of the defense mechanism against plagiarism. Knowledgeable reviewers should be conversant with latest trends in plagiarism and modern tools to counter plagiarism. For this they need to attend refresher courses and follow the check list provided by the Editors. These refresher courses should consist of what is plagiarism, how to avoid it, how to give credit and what should not be cited and common misconceptions and why editors must care. An alert Editor should suspect everyone especially the first time submitter and the frequent submitter submitting manuscripts on diverse topics. They should also be careful if methodology mentioned in the manuscript and institutional capabilities where the author is affiliated do not match. Further if there is no mistake of medical writing and no mistake in statistical analysis besides the text lack continuity, all this must alert the editor. Now different software like etBlast and scholar.google.com are available which helps in checking plagiarism. By using Net intelligently we can beat the Net Plagiarism.
Dr. M.B. Rokni Editor Iranian Journal of Public Health discussed how to discover plagiarism. The best way to discover Dr. Rokni said is to ask the writer her/himself. During our daily routine we come across many writers who plagiarize just to improve their writing style. Some of the practical clues which Dr. Rokni mentioned were sudden changes, tone, vocabulary, structure of the sentences besides level of sophistication. If you feel that the writing is far more sophisticated that you normally expect from the authors of that level, it should alert you. Careful look at Introduction and Discussion is also helpful to discover plagiarism. Inconsistency in citation format or usage, complete lack of citations especially for complex ideas, last minute changes of paper topic or research focus. Strange margins, skewed tables, broken lines in half, mixed style of sub-headings are also indicative of copy and paste job done in haste. Some of the sources to detect plagiarism which Dr. Rokni mentioned are as under:
1. www.google.scholar.com
2. http://invention.swmed.edu.etblast/index.sht
3. www.dogpile.com
4. www.yahoo.com
5. www.altavisa.com
6. www.webcrawler.com 
7. www.lycos.com
8. www.excite.com
Dr. Arash Etemadi also from Tehran University of Medical Sciences, Iran discussed dealing with publication misconduct and referred to the guidelines by Committee on Publication Ethics (COPE) on good publication practices. COPE, he pointed out is a committee of three hundred mostly European based editors. They meet regularly to discuss these issues. They not only publish their findings but also provide code of practice to the editors. Dr. Arash Etemadi was of the view that while dealing with publication misconduct one must focus not only on acts of omission but also on the intention of the researcher, author, editor, reviewer and the publisher involved. Best practice requires complete honesty with full disclosure. Editors are ethically obliged to pursue the case rather than simply rejecting the papers which raise questions of misconduct. Cope does offer guidelines but eventually it is up to the Editor to take the final decision in such cases. Redundant publication could include duplicate publication or Salami slicing. The authors indulge in salami slicing in an attempt to increase their number of publications by re-using the same data. It is acceptable as long as it is intended to convey different message to different readers but it is not acceptable if the degree of overlap is too much. Dr. Arash Etemadi opined that the journals should clearly state their policy on redundant publication in instructions to authors. It is always essential to ask of evidence carefully, if possible get the raw data evaluated by experts. He also briefly talked about change of authorship, unrevealed conflict of interest, ethical problems in conduct of study and complaints against editors.
John Cathey from Saudi Arabia talked about preventing duplicate and fragmented publication at “Annals of Saudi Medicine”. He was of the view that it not only wastes time and efforts of the editorial board and reviewers, it also misguides the readers. Peer review and editing could result in different articles from the same data. Describing the Annals of Saudi Medicine policy John Cathey said that Abstracts and Posters are not considered duplicate publication but authors are expected to disclose prior presentation. Publication in another language is acceptable but it should also be disclosed. ASM practices five year ban on submission but it can be reduced in case of assurance of good behavior. We reject fragmented publications which could also result in publication ban. During 2005-2007 nineteen corresponding authors were put on the watch list. Eleven got five year ban and one two year ban with the result that the number of duplicate publications has declined recently.
Dr. Jamshed Akhtar Associate Editor of JCPSP talked about assessing the quality of peer review: an uphill task. Peer review, he said, is needed to improve quality of research work. At CPSP we have a long list of researchers. To be a reviewer at JCPSP one has to be a member of the teaching faculty, must have attended workshop on research methodology and biostatistics, preferably be a supervisor of FCPS trainees besides having some publications to his/her credit. All manuscripts submitted to JCPSP first undergo an initial assessment which consists of novelty, selection of category, language and evaluation by statistician and assessment by bibliographer. About 50% of the manuscripts are rejected at this stage, some are sent for revision and rewriting while others are sent for peer review. Response from the reviewers is mostly casual, most of them do not bother to respond in time, need reminders and some fail to give consolidated view. Some reviewers use vague language which does not outline deficiencies in the manuscript, biased and personal views are incorporated without any rational, language is rude and attitude appears hostile, conflict of interest is not revealed and in some cases review lacks critical analysis. Some of the reviewers are discouraging; others are dishonest while a few are just inadequate. Some of the reviewers fail to identify even gross inadequacies.
Discussing the role of the Editor, Dr. Jamshed Akhtar said that the Editor is under no obligation to accept the opinion of the referees. There has been a debate whether open review improves the quality of review. He suggested that Editors of various journals can hold meetings to define as to what they have achieved and what still needs to be done. His conclusions were that both authors and reviewers need to show maturity in their approach, it needs more dedication on their part to their job and more workshops are needed to update the knowledge of authors and reviewers.
During the discussion, it was pointed out that one does not have to be on the teaching faculty to be a good reviewer. It all depends on the academic interest of the physicians. PMJA, it was stated has been organizing seminars and workshops all over the country for the last many years on medical writing, peer review workshops but it is possible only if a proper invitation is received from the host institution.

Uniform requirements, Indexation,
Impact Factor, E-publishing

Mr. John Cathey along with Maj. Gen.M. Rehan Burney chaired this session. Prof. Ahmad Iqbal Editor Pakistan Oral and Dental Journal was the moderator.
Dr. Farrokh Habibzadeh from Shiraz Iran discussed common statistical mistakes in published articles in the Middle East Biomedical Journals. These include un-necessary revision, use of inappropriate words and contradictory results besides wrong report of p values. He also gave few examples to highlight his point.
Prof. Mansoor Ahmad Editor Pakistan Heart Journal in his presentation talked about Uniform requirements of submission- a Pakistani viewpoint. He said that there is a clearly laid down guidelines for Authorship, hence all those contributors who do not meet the criteria for authorship should be listed in the acknowledgment section. Only those are eligible to be author who have made substantial contribution to conception, design, and acquisition of data, analysis or interpretation of data. Those who have helped in drafting the article, revising it critically for important intellectual consent besides final approval of the version to be published. He opined that despite many difficulties faced by Editors, genuine progress is visible, we need to encourage research and writing besides organizing workshops on medical writing and research methodology.
Dr. Maqbool H. Jafary Chief Editor Pakistan Journal of Medical Sciences spoke about visibility of a journal: is indexation in Medline crucial? At present Medline, he said, caters to over 5,400 journals but representation from developing countries is just about 4%. Many more journals keep on trying without much success. These results in frustration of the editor, poor visibility of the journal, lack of attraction for the authors, good quality manuscripts get diverted to indexed journals, economic loss and in some cases irregular publication leading to eventual closure of the journal. However, one of the solutions, he suggested, was going on the net. Post full text articles on the online edition of the journal. But there are some hurdles like cost, need for trained manpower and one has to be at one’s toes all the time to ensure access to online edition is not problematic.
He then gave the example of Pakistan Journal of Medical Sciences (www.pjms.com.pk) and said that ever since we have gone online there has been tremendous increase in manuscript being submitted from authors not only from Pakistan but overseas as well. (From 102 in Year 2003 to 268 in the Year 2006) Before 2003 we used to receive manuscript from eleven countries which in 2006 has increased to thirty. The journal (Pak J Med Sci) has now been selected by Science Citation Index Expanded (SCIE) by Thompson/ISI for indexation. EMBASE, Medline, PubMed Central, DOAJ and many other sources of improving visibility were also mentioned. Google Scholar also picks up manuscripts from online editions which also increased visibility and readership. Some researchers believe that with online availability of full text medical journals, indexing in Medline is going to be irrelevant. However, one must have a balanced view. Indexing in Medline is a symbol of quality of a journal, Medline is certainly not irrelevant. However, alternate sources of increased visibility are available. Hence there is no need on the part of the Editors to feel frustrated and efforts should continue to improve the standard of the journal and inclusion in Medline, Dr. Jafary added.
Brig. Azhar Mubarak Editor Pakistan Armed Forces Medical Journal spoke on Journal Impact Factor. The Impact Factor, he said, is a measure of citation of science and social science journals. It indicates how many times papers published in a journal are cited by others in their articles. It has huge but controversial influence on the way published scientific research is perceived and evaluated. Impact Factor was devised by Mr. Eugene Garfield founder of Institute of Scientific Information in United States in 1960 which is now part of Thompson/ISI. He also briefly explained as to how the impact factor of any journal is calculated. The list of Impact Factor of 6088 journals can be downloaded from http://library.aut.ac.ir/jcr.htm. Speaking about the shortcomings of Impact Factor he said that few non-English journals are indexed, delay in processing of an article results in outdating of research, hence less citation. Journals having more review articles have greater citation, it encourages self citation by the editors to improve impact factor of their journal. Other performance indictors Brig. Azhar Mubarak mentioned included Journal Performance Indicator (JPI), Science Citation Index Expanded (SCIE), and H-index: impact of individual scientists and PageRank algorithm. In order to improve Impact Factor, the journal must be published regularly, it should have diverse, active editorial board, and peer review by national and international reviewers, references should be as per ICMJE guidelines, online submission and availability of electronic copy of the journal. He also suggested that there is a need to evolve National Impact Factor which can be done by HEC, PM&DC or the CPSP.
E- Publishing was discussed by Dr. Masood Jawaid Assistant Editor Pakistan Journal of Medial Sciences. He spoke about historical background of E publishing, different models of E publishing, Pakistan scenario and issues in Pakistan concerning E publishing. Some of the advantages of E publishing, he said, are full text availability, online editing, no backlog, increased circulation, new modes besides alerting mechanism. Out of the fifty four biomedical journals published in Pakistan about thirty six are recognized by PM&DC of which only sixteen have online editions. However only three journals i.e. JPMA, Pakistan Journal of Medical Sciences and Rawal Medical Journal offer not only abstract but PDF version as well as full text in HTML format. It also results in manifold increase in submission by authors. The issues involved in Pakistan are awareness about e publishing is not there, even publishers are not fully aware of it. XML tagging software is not available locally and those who provide this service overseas demand lot of money. No journal has proper online submission facility as most of them receive manuscripts through e mail. Electronic Long, Published Short (ELPS) is not practiced by the journals as yet. He also enumerated the advantages of E publishing to the readers, libraries and the publishers. His conclusions were that though E publishing is relatively inexpensive, E publisher survival still depends on the age old virtues of content quality and author credibility.
During the discussion Ms Jane Nicholson from WHO EMRO remarked that Pakistan should have a national database which covers all the journals published from Pakistan so that researchers can have an easy access to local references. At this it was stated that Pakmedinet is one such source which is quite useful though not without some short comings. Mr. Shaukat Ali Jawaid pointed out that the recognition criteria followed by PM&DC for recognition of journals needs to be revised and updated. At present this list has not been revised since 2005 and it contains many journals which ceased publication long time ago or were not being published regularly. He suggested that for recognition of any journal, it should be a must to ensure regular publication, proper peer review process, regular publication of index and no journal should be recognized unless it has sustained publication at least for two years.

Training of Editors

This session was devoted to Training of Editors and the panelists were Major Gen. M. Aslam, Dr. Farhad Handjani, Shaukat Ali Jawaid, and Dr. Ahmad Badar. It was jointly chaired by Dr. Farrokh Habibzadeh and Brig. M. Luqman while Ms Jane Nicholson was the moderator. Major Gen. Aslam briefly talked about as to who should be an Editor.
Dr. Farhad Handjani spoke about the resources available for training. Most of the Editors, he said, have learnt on the job training through trial error basis. One of the aims of EMAME is to improve editorial standards and promote professionalism in medical editing through education, self criticism and self guidance. Regional and international courses are available for training of editors. Attendance at various conferences on medical journalism is quite helpful while many books are also available. Iran is trying to promote medical journalism course which will lead to Master’s degree, linkage between editorial offices of East and West could be another useful source. EMAME has an Editorship Committee headed by Dr.Farrokh Habibzadeh while Jane Nicholson heads the education and training committee. Training workshops will be available and training modules will be circulated. Ministry of Health should promote workshops and courses, training of trainers. Promoting local training of editors by local trainees, he opined, will be ideal and most cost effective.
Mr. Shaukat Ali Jawaid in his presentation highlighted the role of national associations in training of the Editors. He was of the view that an editor must be a keen learner and Continued Professional Development of every professional is extremely important, editors being no exception. One can learn a lot by attending various medical conferences, meeting and have interaction with other editor colleagues. Many editors from the developing countries cannot afford to attend the various courses on training. However, there are alternatives i.e. books, searching on the net and then WAME Listseve, he said, most often has very useful debate and discussions which provides an ideal opportunity for the editors to learn from the experience of other colleagues. EMAME listserve can also be used to promote such a training programme. Editors of various journals can themselves have get-togethers and try to learn from each other. Editors from different countries in the region can visit other countries and learn from other editor colleagues through mutually arranged short visits. Pakistan Medical Journalists Association has provided a forum for editors and it regularly organizes seminars and workshops on medical writing and peer review. This also provides an opportunity to editors to have interaction and learn from each other’s experience.
Dr. Ahmad Badar highlighted the effectiveness of Full Time Editor. Speaking about the current situation in Pakistan, he said, journals keep on appearing and disappearing. Very few sustain in the long run. Very few maintain and again a few attain. Only those journals attain who have full time Editors. The Medical Journal Editors, Dr. Badar said are the goalkeepers, facilitators, trainers but the question arises are they Available?
Throughout the conference this was perhaps the liveliest session which attracted a large number of participants. Many of them were of the view that as doctors they have too many responsibilities and it was neither possible nor feasible for them to be Full time Editors. Many said that they can only devote few hours a week. However, it was felt that in case no full time Managing Editor is available, every journal must have a minimum full time staff so that the authors are kept informed about the developments regarding their manuscripts. All queries and communications received from the authors should be addressed promptly. Non-availability of the trained computer literate staff which can take up some of the responsibilities is yet another problem and even if you train someone, there is no guarantee that he or she will stay on. Financial constraints have put lot of pressure on the Editors. It was felt that PMJA and EMAME should organize workshops on Editorship and medical editing from time to time which could be very helpful. Some also felt that hands on workshop on different topics should be organized at the eve of all such events in future for those who are interested. The panelists and discussants all laid emphasis on better co-ordination and co-operation between editors and learning from each other’s experience.
Lt.Gen. Mushtaq A. Baig Surgeon General Pakistan Army was the chief guest in the concluding session wherein recommendations of the conference were presented by Dr. M.H. Jafary. These recommendations are as under:

Recommendations

1. The Menace of Duplicate Publications
* To discourage duplicate publications, an agreement is necessary between the editors of the medical journals to support each other for the action taken against the offenders.
* The editors should not accept manuscripts without the Letter of Undertaking (LOU), signed by all the authors. This undertaking should clearly highlight that a manuscript is exclusively being submitted to a specific journal.
2. Plagiarism
Editors should develop an understanding that plagiarism, if detected, will strongly be condemned and to take steps to weed it out. Editors should also share between them different software available to detect plagiarism.
3. Regional Index
It was suggested that we must strengthen the regional indexing systems and improve their credibility.
4. National Code of Publication Ethics
Editors of Pakistani Medical Journals should develop a National Code of Publication Ethics, in line with the Code from Committee on Publication Ethics (COPE)
5. Training of Editors/ Writers
a) Majority of the journal editors have learnt the art of editing through on the job training. There is a need for formal training, especially for the new editors, through:
* Local interactions between editors
* National meetings
* International exposure through EMAME and WAME, with the support from WHO EMRO Region
b) Collaborate with the institutions imparting training in the art of medical writing and training e.g., CPSP
c) Recommend the inclusion of the art of medical writing and research methodology in the curriculum of undergraduate medical students.
6. Uniform Requirements for Manuscript Submission
Like the major international journals and many regional and national journals, we in Pakistan should develop the uniform requirements for article submission for the guidance of authors.
7. Promotion of the Art of Medical Editing
a) The editors need to enlist the continued patronage and financial support for the promotion, through training and meetings, from:
* Higher Education Commission (HEC)
* Pakistan Medical and Dental Council.
* National University of Science and Technology (NUST)
* Pakistan Science Foundation (PSF)
* Ministry of Health (MoH) etc.
b) Seek assistance from bodies like HEC to sponsor the delegates to conferences organized by EMAME to participate and present papers.
8. Membership of Professional Bodies
All editors, their staff and all those interested in the art of medical writing and editing should become members of professional bodies like:
* Pakistan Medical Jounalists Association.
* Eastern Mediterranean Association of Medical Editors (EMAME)
* World Association of Medical Editors.
There is strength in numbers and wisdom in collective thinking. Their websites are great source of information and training. More use of these websites needs to be made.
9. Recognition of Biomedical Journals
A National Committee under the auspices of PM&DC or HEC should be formed for evaluation and recognition of Biomedical Journals published in Pakistan. The Committee should comprise of representatives from PM&DC, HEC, CPSP, PMJA, MoH, Academic institutions like KEMU, AKU, DUHS, LUMHS etc. The Committee should recognize only those journals which meet the following criteria:
* The journals which are published regularly as per official declaration.
* The journals who practice peer review system
* The journals which are covered by, at least one of the major indexing services, like EMBASE, Medline, Science Citation Index Expanded (SCIE) by Thompson/ISI etc.
* For the newly published journals, only those with sustained publication for at least two years, according to their declared schedule of publication, should be eligible for recognition.
The list of recognized biomedical journals should be reviewed and updated every two years according to laid down criteria. Those journals failing to meet these criteria should be de-listed.


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