The journal NEFROLOGÍA is one of the most important backbones of our Society, having always maintained, thanks to the work of many, an important role in the promotion and diffusion of scientific knowledge in nephrology. On the other hand, the infrastructure that has been developed with time is important and positive. Thus, at the time of taking over from the Direction of the Journal, we have a solid base on which to hold up our work.1-3 At this starting moment, we want to know the realities and manifest, we believe on behalf of everyone, our recognition and acknowledgment to past directors, doctors Luis Hernando and Rafael Matesanz.
It is necessary, however, that NEFROLOGÍA evolves to adapt to profound changes that have occurred in the bosom of the Spanish Society of Nephrology (SEN), which is at an excellent creative and organizational moment, but getting increasingly complex, and to the rapid changing process that medical journals are living in order to adjust to new possibilities of transmission of ideas and knowledge and to the readers¿ needs.
We believe that our journal has an important margin for improvement to get transformed into a more effective tool, in the line of current trends of scientific diffusion, and useful for the readers (at a time in which this represents so many difficulties for the physician snowed under with multiple tasks). For this, we will try to develop an ambitious and competitive project, although being aware of the limitations imposed by our dimensions and the environment of the national scientific development.
In order to concise this project, it is necessary to think about the role and objectives that the scientific journal of a biomedical society should cover. To our opinion, the more important aspects to consider are:
1) The diffusion of the investigational activity.
2) To provide criteria in current topics or scientific debate.
3) To build up a vehicle for continual education.
4) To warrant the critic and expression of post-publication opinions.
We will comment on these topics right away to end up with some practical considerations about the objectives that we will try to achieve in the short term, besides some organizational issues.
DIFFUSION OF THE INVESTIGATIONA ACTIVITY: QUALITY, VISIBILITY, AND IMPACT FACTOR
The first goal of a scientific journal consists in transfer to the specialized community the results of investigative works and clinical experiences, guarantying appropriate levels of methodological quality and achieving a diffusion level as high as possible.
The citation index is one of the most used parameters to analyze the quality of the articles published in medical journals since it is estimated that it expresses their acceptance level and influence on creation of the scientific criterion. A positive relationship has been found showing that the most cited articles are those with good methodological quality bringing novel knowledge.4-6
We should immediately point out, however, that this correlation, although positive and significant, is very weak, indicating that there exist other factors, aside from quality, determining the citation rate of a scientific original article. Of course, there are works with and excellent methodological quality published in journals with little diffusion and other mediocre articles that are published in journals with big diffusion within the specialty.4-11
Evidently, improving the quality contents is not an easy task, and of course cannot be approached from voluntarism.
A key element determining the quality of a journal is peered review (and thus, rejection indexes). This is a process undertaken by high-qualified specialists whose task, because of its nature, is difficult to bring to light from anonymity and recognize. The balance of a rejection index guarantying quality improvement of the journal but not jugulating the reception of original articles constitutes one of the most difficult tasks for the editors of a journal.
The work by Callaham et al.5 shows that the variable best defining the number of citations received by a medical article is the impact factor (IF) of the journal where it is published, and far from this, the factors related with methodological quality of the work. This well known fact conditions the selection of those journals with higher IF by the investigators to send their better works, and thus, we like it or not, at least partially conditions the journal¿s quality.
The concept and the first methodology for the calculation of the IF were introduced in 1955 by Eugene Gardfield as a means to assess the signification of a particular work and its impact on the contemporary literature,7, 8 and it has become a key element (although highly controversial10, 11) of the scientific policy, which uses it to evaluate researchers, institutions, and universities, and to analyze and organize into hierarchies the quality of the journals.4, 9, 12
However, many others consider that IF is a poor index to measure the quality of the medical journals and that it only roughly represents the quality of the articles published in them.13, 14 There are many examples of articles published in high-impact factor journals that do not stand a systematic critical analysis. By analyzing 38,000,000 published works, Gardfield found that only 0.5% of them were cited more than 200 times and more than have of them were never cited.7, 9
Other factors not related with the quality of the articles published have an influence on the IF. These factors relate with the journal¿s capacity to diffuse its products, what has been called «the journal¿s visibility», in which has a decisive role the existence of an attracting and efficient website (16,17), the possibility of placing its contents in bibliographic databases with large international influence (EMBASE, INDEX MEDICUS, MEDLINE, PUBMED Central, etc.), and the language of publication, clearly favoring those publications in English.18, 19. We later on will look deep into these issues when we will discuss what is our idea and goals for the website of the journal NEFROLOGÍA.
The IF is not a priority element to determine the editorial policy of the journal of a relatively small scientific society as ours. However, it does constitute a very important factor that cannot be dodged since it is the variable to compare our journal with others, it determines the flow of quality works, and in some way, it is part of the collective self-esteem.
In the year 2006 (the last one with data published on the JCR), the journal NEFROLOGÍA reached the highest IF in its history (0,609).12 It is a very positive fact. However, in order to get an objective perspective of the problem, we should undertake an analysis of the reality altogether.
Except for the increase observed this year, NEFROLOGÍA has remained for the last years (2000-2006) with a stable IF below 0.5, which unfavorably compares with other medical Spanish journals registered at the 2006 JCR report (fig. 1). Of the group of 10 journals analyzed (we have only included medical journals), NEFROLOGÍA ranks seventh, below five journals that are above an IF of 1 point (Rev Esp Cardiol 2.176, Arch Bronconeumologia 1.851, Medicina Clínica 1.362, Enfermedades Infecciosas y Microbiología Clínica 1.277, and J Invest Allerg Clin 1.028), and below the Revista Española de Enfermedades Digestivas, 0.909 (4,12,20). On the other hand, our journal ranks in the last places among the journals within the ISI thematic area Nephrology & Urology.12
We may conclude that the situation is encouraging if the increase in the 2006 IF was indicative of the start of its definitive rocketing. There are some elements making us think that this will be so. However, we should be cautious since it is not infrequent to observe saw-like variations in the JCR that do not definitely consolidate, as it already happened in the past with NEFROLOGÍA.
In any case, although we are knowledgeable that the objective conditions of nephrology and the situation of Spanish research do not allow us expecting an IF within the international avant-garde for our journal, we will do try to improve it within a reasonable setting at a national level, given our level compared with other Spanish medical specialties and the increasing creative capacity of our Society.
The design of action guidelines to try to improve the IF of the journal is not in contradiction with what has to be its essential goal (on the contrary, they are intimately linked), the improvement of its functionality and utility for the nephrologist, as well as the efficacy of diffusing mechanisms of our scientific production. Without pretending to carry out a detailed analysis, we will next list some of the measures considered of the most interest in the elaboration of an editorial policy aiming at improving the IF:
1) Besides constituting a basic commitment in the relationship with our readers and with SEN, the improvement of the formal quality of the journal and its website undoubtedly contributes to promote its diffusion and that of the articles published.4, 5, 9
2) Trying to increase our presence in the English-speaking scientific world because of its decisive importance in determining the IF.17, 18 So, and thanks to the support of the Board of Directors, from this very first number all the articles in the website will be presented in both languages (English and Spanish) so that they will be accessible from PubMed. We consider that this measure entails a great strategic value.
3) To achieve the link with bibliographic databases with big diffusion and strategic interest. The works published in NEFROLOGÍA appear in databases such as IME, IBECS, MEDLINE and EMBASE,12, 20 which constitute very important diffusion platforms. For this new era, our goal is to achieve its presence in PubMed Central, and in this sense, we have already started to work together with other Spanish journals. To get into this database is not an easy task (there is still no Spanish medical journal included in it), but we estimate that, by being present in it, a biomedical journal can multiply its visibility by 270 times.21
4) Careful selection of topics and prestigious authors for reviews and special articles on current hot topics of clinical impact and controversy. It is estimated that reviews explain at least 30%-40% of the IF obtained for a publication.4, 5, 9 This phenomenon is very noticeable for NEFROLOGÍA: according to data from JCR, the auto-citation profile for our journal in the year 2006 is 64% and the citation rate of original articles is 24.8%, whereas that of review articles is 240%.12
5) Study of categorization of the sections, since it has been shown that this has an impact on IF.14, 15, 22-24
6) Careful balance of the number of works finally published, due its known influence on the determination of the IF.9
THE JOURNAS AS A FACILITATOR IN THE FORMATION OF A CLINICAL AND SCIENTIFIC CRITERION
This is one of most rapidly changing aspects in the creation of medical journals in response to the new problems in the generation of the scientific knowledge, specially the clinical knowledge, and its diffusion. We cannot, at this moment, carry out an in-depth analysis of these phenomena, and some of them were already commented on a previous work,25 but we do can consider some aspects relating with the edition of a medical journal.
Before the exponential increase in the number of publications and complexity of the elements influencing them, more and more strictness is needed and less and less is the medical time available. Therefore, the most prestigious medical journals are adopting formulas for synthesizing and hierarchically ordering the knowledge, also applying concision and strictness.25, 26
These measures include, among others, structuralizing the «abstracts» in order to provide complete and systematic information of the core of published works, publishing clinical trials only when they meet certain parameters internationally agreed,27 or adopting reader-friendly formats in which the essential ideas from the text are clearly outlined.
THE JOURNAL AS A VEHICLE OF CONTINUAL MEDICAL EDUCATION
Continual Medical Education (CME) must be rigorous and independent, and provide easy and attractive products facilitating the access to the professionals.26 The journal NEFROLOGÍA cannot give up to the goal of promoting an editorial line of CME in charge of updating the nephrologic biomedical knowledge. However, due to its feature of being a medical journal sharing other goals and conditioned by the limitations imposed by the IF, the space and contents available for this activity are rendered limited.
Other journals with international or national diffusion complement the contents of their regular issues by including CME contents in supplements or creating a subsidiary journal (such as Nature Clinical Nephrology with regards to Kidney International) or by loading CME contents on a website (NDT for Educational & Blood Pressure Related Disorders).
Since the year 2005, the Spanish Society of Nephrology has got a new journal: «Formación Continuada en Nefrología e HTA» (Continual Medical Education in Nephrology and AHT) to develop this kind of programs within the SEN. The journal is regularly published divulgating high quality contents developed by specialists on each one of the topics.28
On the other hand, the group «Nefrología Basada en la Evidencia» (Evidence-based Nephrology) has initiated a program to elaborate structured abstracts on the nephrology literature and systematic reviews, and an educational line on methodological and clinical aspects.29, 30 The works are published at its website30 and in supplements of the journal NEFROLOGÍA. 29 We believe that this initiative is being done under high quality standards and has been welcomed by the nephrologists.
In order to get coordinated with all these activities, NEFROLOGÍA will have a specific sub-direction.
TO GUARANTEE THE CRITIC AND EXPRESSION OF POST-PUBLICATION OPINIONS
An important feature of the editorial policy of the journal is the pre- and post-publication policy. We want NEFROLOGÍA to be an organism alive, a vehicle of opinions and controversies promoting the culture of critical analysis. The interpellation through letters to the Editor or short opinion articles contributes to the diffusion of the journal and its IF.4, 31 In order to give them advantage, once accepted for publication and while waiting for their appearance in the next issue, the original articles will be uploaded on the web page of NEFROLOGÍA, inviting the users to comment on them, and those critics rigorously done with bibliographic support will be published in the section Letters to the Editor.
THE VEHICLE: THE FORMAT AND CONTENT OF THE ELECTRONIC VERSION
As previously mentioned, the web page of the Journal (www.revistanefrologia.com) deserves a central role in our editorial policy since we consider that it has a decisive role in the diffusion and visibility of our editorial production.
The web page of NEFROLOGÍA has experienced a substantial advance in recent years, within the context of the important boost that electronic communication media of the Spanish Society of Nephrology have received following the initiative of the last Boards of Directors. It includes a free-access web page,32 in which the contents of the journal can be consulted. Its function is exclusively organizational and to give access to the articles published. Until now, only research originals were both in English and Spanish, but not the other contents of the Journal.
In our setting, consultation of web pages is maybe lower than that of other professional settings (basic research), and the paper edition is still preferred by physicians.16 However, this is a rapidly changing situation and the on-line component of the medical journals will predominate soon.
We propose that, besides having an administrative role and being a bibliographic database of the articles published in the Journal, the web page of NEFROLOGÍA progresses more and more to the format and activity of an on-line journal, being attractive, agile and interactive, and complementing the paper version and helping in its diffusion.
The articles on-line could be published more rapidly once peer-review and acceptance for publication has been achieved (even before completing a whole issue). Besides its administrative function and allowing consulting the articles published, the on-line version would allow adding appendixes and extended texts, while reducing the volume of the paper version and contributing to support the pre- and post-publication policy of the Journal4, 9, 31 (comments on published articles or reviews, which content may later on appear as a letter to the Editor in following journal¿s issues, or in electronic consultation and debate fora on current topics that have already been reviewed and published in the Journal, etc.).
The web page would have a space for CME, with a searching engine and links to other interesting pages, as well as access to the work by the Evidence-based Nephrology Group.30
From this issue and on, all the articles published will be on the web in both English and Spanish versions, and there will the possibility to consult them in both languages from Pub-Med. We believe that this measure is important since ¿as we have previously mentioned¿ all the articles, not just the originals of research works, may be cited and this is especially relevant for our journal because review articles receive a considerable number of citations.
Finally, we will try to increase the diffusion of the web page contents by both technically improving our presence in the bibliographic databases where we are already present and working to be included in others of strategic interest (PubMed Central), by trying to create links from other institutional or educational pages and by diffusing our novelties among potentially interested readers through TOC alerts.
THE VEHICLE: THE FORMAT AND CONTENT OF THE PAPER VERSION
The format, i.e., the presentation of the journal¿s contents, is not a trivial matter since it constitutes a determinant element for the diffusion of the journal.
In this sense, we intend to achieve a more friendly-user format for the reader, betting for concision and quality, outlining the key concepts (as other international journals do), and promoting the use of algorithms, boxes, etc.
A good deal of what we think about the journal¿s contents has already been mentioned above. We have nothing else to add regarding research originals that currently have a very decent quality, but which will be improved because of the natural evolution of the Scientific Society and careful attention to the difficult review process of original articles.
Aside from research originals, we believe that it is convenient to reconsider the contents of the journal, in agreement with the current trend of other medical journals that we have mentioned above.
In this sense, we will promote the presence of Editorial Commentaries in order to contextualize the most interesting articles within the frame of the current knowledge on the topic, and we will also promote the Mini-reviews format, which makes an in-depth analysis of particular current topics, as well as the publication of Systematic Reviews and Structured Analyses of Critical Problems (Critically Appraised Topics ¿ CATs), helping so the Evidence-based Nephrology Group. We will also try to touch upon scientifically controversial topics (Controversies in Nephrology) highlighting in few words and in an interesting way, the current situation and obscure matters on the topic. We have already mentioned the issues concerning the section Continual Education, which we want to comprehensively contemplate the topics being considered (although it may be developed along several journal issues) and that, in any case, will adequately coordinate with the remaining activities done by the SEN regarding this matter. In the last place, we want to open a section on Images in Nephrology, following what other journals have done, since we believe that this initiative may have an important educational value and contribute to enlarge the images bank of the SEN.
Just a few words in relation to the Case Reports. The journal receives a good amount of them, generally interesting and of good quality. The publication of a high number of them in each issue would break the journal balance and be against our goals. We should not publish more than 2-3 clinical cases per issue. The message for many of them may be summarized, gaining in efficacy, and be included in the section «Clinical experiences» within the heading Letters to the Editor. We are also considering including an Annual Supplement including a collection of clinical cases classified by categories (clinical nephrology, dialysis, transplant, etc.) that may have an important educational value.
On the other hand, we will work together with the area editors to increase the presence of topics that, so far, have been insufficiently represented in our Journal, such as arterial hypertension, pediatric nephrology, neuropathology and, particularly, experimental nephrology.
Besides, an important element of the editorial policy of NEFROLOGÍA is all that relates with their supplements. Achieving high-quality supplements will be one of the goals of the Editorial Board. We do not want to have many; the important think is their quality.
Evidently, the possibility of editing them relates with their financing, although the availability of financing for an editorial project should not automatically lead to its publication. We must reach an agreement with the editor in charge so that the level of quality for the supplements is the same than for the rest of the Journal.
On the other hand, it is interesting to explore alternative formats, in friendly-user cheaper editions (for instance, of the kind of small fascicles that UpToDate publishes of contents previously published at their website.)
ORGANIZATION
We proposed a model of collegiate direction for NEFROLOGÍA that, similarly to other international journals on nephrology (NDT, Kidney International, Journal of the American Society of Nephrology, etc.) also has an editor-inchief and deputy editors. For this era, we proposed three deputy editors, one in charge of Continual Education, a second one in charge of methodological and quality aspects, and the third one in charge of the website and on-line activity of NEFROLOGÍA.
Regarding the Editorial Board, we believe that for this new stage of the Journal, we must get the most active and dynamic streams involved, which are contributing to the scientific and educational progress of the SEN.
One of the formulas of an Editorial Board best adapting to this idea is that adopted by the journal Nephrology Dialysis & Transplantation, which is organized in thematic areas (basic nephrology, clinical nephrology, hemodialysis, transplant, etc.), each one of them having an editor in charge (a highly prestigious expert) coordinating the thematic area and several editors.
With some brilliant exceptions, which also will have to be taken into account, these thematic areas are grouped in the so-called «Working Groups of the SEN», and counting on them we want to organize a large Editorial Board involving many people wanting to work in this project. The Board would be very representative, organized around areas with clear objectives, and its main working tool for getting in contact and deliberating would be the electronic mail (blogs) and direct communication through teleconferences.
Finally, one of the differentiating elements of a journal contributing to its credibility is the composition of the Editorial Board. Besides the outstanding group that already compounds the Editorial Board of NEFROLOGÍA, we should incorporate new members among the professionals within the SEN, but above all, to obtain collaboration from nephrologists from other countries, especially European and Latin American that because of their prestige and collaboration with the SEN may be useful for NEFROLOGÍA.
Naturally, the constitution of an organization of the kind is a complex process, and although it is very advanced and is already present in the corresponding sections of the Journal, we do not consider it closed and will be completed along the following months. Thank you to all of you.
NEFROLOGÍA EDITING GROUP
Until few months ago, the Journal NEFROLOGÍA and the Annual Meeting were almost the only educational knowledge transmission instruments of the SEN. The current reality shows, however, a tremendous vitality with initiatives done at different levels and using different vehicles for knowledge transmission (Web, Journal of Continual Education on Nephrology, Evidence-based Nephrology, courses, Boards, CDs, textbooks, etc).
This proliferation of educational activities and the need for getting them coordinated made the Board of Directors of the SEN promoting, within the Annual Assembly that took place at the Annual Meeting in Cadiz, the creation of an organization (NEFROLOGÍA Editing Group) coordinating these activities in order to improve the efficiency of the whole group (to establish priorities, to avoid duplicated activities, to establish an style and own mark, etc.) and manage from an editorial perspective the policy that on this area the different Boards of Directors of the SEN may decide.
This is an idea already existing at other scientific societies and that we consider very important and necessary. From the first moment we will work to achieve the ambience of convergence of interests and organizational efficiency that this project requires.
EPILOGUE FOR ACKNOWLEDGEMENTS AND PETITION OF COLLABORATIONS
We would like to finish with an extensive and very sincere chapter of acknowledgments to every people that are collaborating in this phase of NEFROLOGÍA, who are many. Many of the ideas contained in this article belong to them.
The Journal is, and will be even more, one of the strategic elements determining the development of our specialty, and thus requires the collaboration from all of us. So, we are asking for your help, participation, and critic. We are sure of obtaining all that.
Finally, Dr. Quereda, as elected post, would like to thank the trust put on him. The assignment by the Assembly of the SEN to direct the Journal, besides honoring him, definitively commits him with the goal of improving it, with the participation of all of us. He also whishes to thank Dr. Matesanz for his help during the transition period. Of course, we hope to keep on counting with his experience and intelligence in the future.
