The field of medicine has changed by leaps and bounds over the past 10 years with thousands of new techniques, methods and approaches being introduced as well as non-medical influences like computers and the Internet. How does the oldest, highest-ranking neurosurgical journal in the world keep up? It’s simple: Innovation and quality. The Journal of Neurosurgery has made several changes over the past few years in response to the changing needs of its subscribers, including: Initiating a new spine edition; launching an on-line, topic-based journal; reducing acceptance to publication time; and decreasing costs while increasing sales.
The Basic Facts
Nearly 55 years ago, the Journal of Neurosurgery became the first medical journal dedicated to the newly blossoming field of neurological surgery. When John A. Jane, MD, PhD, was selected Editor in 1992, there had been just five editors before him. The Journal was started in 1944, the official scientific publication of the Harvey Cushing Society in 1959, and became a monthly publication in 1962.
Today, the Journal of Neurosurgery remains the official journal of The American Association of Neurological Surgeons, and has a circulation of over 12,000 in more than 50 countries. The Journal has a higher Scientific Citation Index ranking than all other neurosurgical journals combined and is ranked third among all surgical journals in the world.
In addition, increased revenues over the past several years from the Journal have played an integral role in supporting the educational mission of the AANS.
The Editorial Board of the Journal is responsible for all content and business decisions. The Board includes: Howard M. Eisenberg, MD, Baltimore, MD; Julian T. Hoff, MD, Ann Arbor, MI; John P. Girvin, MD, London, ONT; Donald P. Becker, MD, Los Angeles, CA; Edward R. Laws, Jr., MD, Charlottesville, VA; Robert A. Ratcheson, MD, Cleveland, OH; M. Peter Heilbrun, MD, Salt Lake City, UT; Charles J. Hodge, MD, Syracuse, NY: Edward H. Oldfield, MD, Bethesda, MD; Ralph G. Dacey, Jr., MD, St. Louis, MO; H. Richard Winn, MD, Seattle, WA; Lawrence F. Marshall, MD, San Diego, CA; Edward C. Benzel, MD, Albuquerque, NM; James T. Rutka, MD, Toronto, ONT, and Volker K. H. Sonntag, MD, Phoenix, AZ.
The editorial offices of the Journal are located on the University of Virginia campus in Charlottesville. There are 15 staff members who are responsible for managing the publication, editing the manuscripts, fulfilling subscriptions, designing tables, processing submissions, and layout and design.
A New Spine Edition
In January, 1999, the Journal of Neurosurgery will launch a new spine edition. It will be dedicated to the radiology, pathology, biomechanics, neurophysiology and molecular biology of the spinal cord, vertebra and supporting structures.
“Approximately 70 percent of the work neurosurgeons do in practice is spine,” Dr. Jane, said. “But, currently, only about one-sixth of the articles accepted for publication in the Journal are spine-related. Neurosurgeons are not the only ones doing spine surgery and this is an opportunity for us to reinforce the fact that we are the leaders in this field.”
The Editorial Board and staff of the Journal considered several alternatives — including purchasing several existing neurosurgical publications — before deciding to add a spine edition. The Journal of Neurosurgery: Spine will be published quarterly beginning in January, 1999.
“After a year, we will evaluate the new edition,” Dr. Jane said. “This may become a separate journal with its own editorial board in the future.”
Submissions to the spine edition will go through the same rigorous review process as submissions to the Journal. After the inaugural year, any changes to the edition will have to be approved by the full Editorial Board of the JNS.
“The idea to expand was brought forth more than two years ago, ” Managing Editor J. Keller Kaufman-Fox said. “Deciding to start the new edition was a very thorough and rational process.”
Neurosurgical Focus
When NEUROSURGERY://ON-CALL® , the official Web site of the AANS and Congress of Neurological Surgeons, was launched two-and-a-half years ago, the Journal Editorial Board recognized a golden opportunity to deliver timely information to the neurosurgical community. Neurosurgical Focus, an on-line monthly journal that concentrates on one neurosurgical topic each issue. Associate Editor Martin Weiss, MD, chooses the monthly topic and the topic editor for each edition. Manuscripts are submitted and peer-reviewed just like the Journal of Neurosurgery.
“The advantage to Neurosurgical Focus is that it is timely, complete and there’s a variety in style and content,” Dr. Weiss said. “We work only a month or two ahead and each topic editor has his own strengths. The format also allows you to see varying approaches, opinions and techniques for the same problem all at the same time.”
Over 800 users typically visit Neurosurgical Focus each month. The journal is accessed through the Professional Pages Section of N://OC® (www.neurosurgery.org). The new issue is posted on the 15th of the month, and hard-copy reprints of articles can be ordered through the JNS office.
Reduced Time From Acceptance to Print
A record 1120 manuscripts were submitted to the Journal in 1997 and about 25 percent were accepted. One of the goals of the JNS over the past several years has been to reduce the time between acceptance and actual publication. In 1994, the average length of time between acceptance and publication was 8.3 months, and by 1997 that time was reduced to 4.4 months, well below the industry average.
“We strive to get the research out as quickly as possible,” Kaufman-Fox said. “Every day there are advances, and the longer these manuscripts wait in a filing cabinet, the less fresh they are. The scientific community relies on the timely exchange of ideas and information and we did not feel that a 6-month turnaround was acceptable.”
One of the primary reasons for the reduced turnaround time is less composition time.
“We brought the composition, or design aspect of the publication in house,” Kaufman-Fox said. “This makes the whole process much more efficient. We also send most of our files electronically back and forth to the printer and this cuts down on time.”
The changes have also reduced the Journal’s printing and composition bills by nearly half since 1994.
International Marketing
The Journal is more than just an American publication, with approximately 40 percent of subscribers and 60 percent of manuscript submissions coming from outside of the United States. In the past two years, the JNS staff has traveled to neurosurgical meetings in Germany, the Netherlands, Japan and Turkey to sell subscriptions, demonstrate Neurosurgical Focus, sell back issues on CD-Rom and the Journal. In 1998, the Journal will travel to meetings in Germany, Japan and Chile.
“The Journal is the oldest and the highest ranked neurosurgical journal in the world, but we can’t just sit back on our laurels and wait for subscribers and authors to come to us,” Kaufman-Fox said. “There are a lot of choices out there and it’s important we maintain a strong presence. It’s also beneficial to go out and actually talk with our subscribers and authors and see what they like and don’t like about the publication.”
FROM SUBMISSION TO PRINT…HOW YOUR MANUSCRIPT BECOMES PUBLISHED
Every year more than 1100 manuscripts in large envelopes find their way to Charlottesville, Virginia, in hopes of being published in the Journal of Neurosurgery. But, what happens to a manuscript and how does it eventually end up in the “accepted for publication” pile?
Step One: The Front Door.
All submissions are opened and date stamped on arrival. The basic format of the paper is checked to ensure the author has followed the contributor’s instructions. Approximately 20 percent of submissions are sent back to the author at this stage because the manuscript was not prepared in Journal style.
“The most common mistakes are that the references aren’t in alphabetical order and the figures aren’t cited correctly,” Managing Editor J. Keller Kaufman-Fox said. “I can’t stress enough how important it is to read the Instructions to Contributors and to call if you have a question. We’re here to help you at least get the paper to the next stage.”
The Instructions to Contributors are located in the back of each issue of the Journal, or can be obtained by calling the JNS office.
If the submission is in the correct format, it is entered into the database, given a manuscript number, categorized by type of paper, and an acknowledgement letter is sent to the author.
Step Two: The Review Process.
John Jane, MD, PhD, editor of the Journal, initially classifies each manuscript and selects the four reviewers. The manuscript is sent to the first, or primary, reviewer, who makes his comments and passes it on to the second reviewer. If the first two reviewers are in agreement, the manuscript and comments are sent back to either one of the co-chairmen, Drs. Julian Hoff or Howard Eisenberg. The Chairman reviews the manuscript, makes comments, and then synthesizes all of the reviewer’s comments for final review by Dr. Jane.
If the first two reviewers did not agree, the manuscript is sent to the third and/or fourth reviewers before going to the selected chairman. Any reviewer can send a manuscript to an “outside” reviewer at any time. During the course of a year, each JNS Editorial Board member can expect to be the primary reviewer on approximately 100 manuscripts and review approximately 150 additional manuscripts on a second, third or fourth review. The two chairmen each review over 550 manuscripts each year, and Dr. Jane performs the final review on each manuscript that has been submitted.
Besides a general review for scientific significance, accuracy and logic, the papers are given a “priority score” that indicates how important the reviewer feels that the paper be published and read by the neurosurgical community. The priority score is based on four elements: Scientific merit, neurosurgical significance, reader interest and publishing grade.
It takes about 30 days for the initial review process to be completed. If the paper is accepted, the author is notified and the manuscript moves on to the next stage. However, only two to three percent of manuscripts are accepted as is with no revisions.
Dr. Jane reviews all of the reviewers comments and drafts a letter to the author either suggesting revisions to the paper, or outright rejecting it. In either case, at this time the author is sent back a letter explaining the status of the paper, the reviewers comments and the manuscript.
“Most of the articles we receive are technically very good, but they just don’t make the priority score,” Dr. Jane said. “This is an education process for everyone and that is why it is so important for the authors to see the reviewer’s comments and take note of the strengths and weaknesses of the paper and to feel they were treated fairly.”
A paper that has been sent back for revisions has not been officially rejected or accepted. Often times in revisions, reviewers ask that the author use a different statistical method, compare the paper to a similar published paper, provide more materials and methods detail, or make other adjustments. After the revisions have been completed, the manuscript is resubmitted and sent back to the reviewers. From there, it is either accepted, rejected or sent back for more revisions.
Step Three: Acceptance!
Approximately 25 percent of the manuscripts submitted to the Journal of Neurosurgery are accepted. The author is notified of the acceptance and the manuscript is placed in the “accepted” drawer by type of article — clinical, laboratory investigation, case report, technical note or historical vignette. Once a month, all of the accepted papers are taken out and Dr. Jane chooses the papers and the order for an upcoming issue — usually three to four months in advance of publication.
Step Four: Edit, edit, edit
Once the articles have been chosen, the staff of the Journal takes over. The manuscript is requested on computer disk and is translated into the Journal’s computer system. Each paper receives between 4 to 8 hours of heavy editing and proofreading during which the authors may be called upon to answer questions. The figures and any art are sent directly to the printer for digital preparation. Tables are developed and edited, and each reference s checked at its original source.
Once the article has been edited, the text is dropped into an actual proof of the page as it will appear in the Journal. This galley goes to proofreading to be edited for grammar and spelling. The tables are also placed on the page. After proofreading, the author is sent a copy to review and has 48 hours to fax in any changes. The page goes through one last editing and proofreading before the electronic files and layout heads off to the printer. The figures, any art and the advertisements are added at the printer and a “blue line” proof is sent back to the Journal office about three weeks later when everything is checked one more time.
“The amount of time and detail that is spent on each article is substantial,” Kaufman-Fox said. “Just checking all the references at their original source is a big job. We check the original source, not just any source where the reference has been cited before, because we have found references that have been listed wrong dozens of times.”
The Journal is printed by Cadmus Journal Services in Easton, MD, and is mailed 10 days prior to the issue month.
Meet John A. Jane, MD, PhD
Not many names are more recognizable in present day neurosurgery than John Jane. He is an educator, a program chairman, an editor, a researcher, a lecturer, a surgeon who performs more than 500 surgeries a year, and a devoted husband, father and grandfather. He is Chairman and Professor of the Department of Neurosurgery at the University of Virginia, Editor of the Journal of Neurosurgery and developer of various neurosurgical techniques.
The words of actor and patient Christopher Reeve brings tears to his eyes, the sight of one of his grandchildren creates an instant smile on his lips, and his face beams with pride when he talks about his son, John Jane Jr., MD, a neurosurgical resident. The Bulletin found Dr. Jane in Charlottesville, VA, fresh out of his garden and willing to sit down and chat.
Q: What do you feel is some of the most exciting research being done in neurosurgery today?
A: The applications of gene therapy are remarkable. Nothing has really happened yet, but the potential is there to revolutionize a great deal of what we do as neurosurgeons.
Q: What types of articles would you like to see more of in the Journal?
A: It would be nice to have more randomized clinical trials and more science, but not necessarily basic science. I would also like to see more pediatric and spine submissions.
Many of our authors concentrate so much on “positive” results, but sometimes disproving your hypothesis is equally important and can have a significant impact on how other researchers approach their projects in the future.
Q: In your own practice, you have not specialized and practice all aspects of neurosurgery. Which types of cases do you enjoy the most?
A: The pediatric cases, definitely.
Q: You have been known to slip in and out of cities, and even countries, in the same day, do you enjoy traveling?
A: No, not at all. If I never traveled again, that would be fine with me. I would much rather be at home either in my garden and with my family, or at the Journal or operating.
Q: Your son, John Jr., is a neurosurgical resident in the UVA program, how has that worked out?
A: Between us, it has worked out fine and we can easily leave the OR and work behind us when it’s time to go home. It did take some time for the other residents to trust him, but that has worked itself out now that it’s clear that he’s not telling tales about the day’s happenings at home. On a personal side, it has been absolutely wonderful to work next to my son.
Q: During their fifth year, you send your residents to England for a year. Why?
A: I started that back in 1970 as a deal with a friend over there. My residents gain a huge operative experience, see a different view and love the whole thing. They gain a great deal of independence over there, which is something that’s hard to establish here because they are so closely supervised. They always come home better surgeons and that’s why we continue the program.
Q: What have you learned from being Christopher Reeve’s surgeon?
A: Chris is an amazing person. He has successfully reenergized and focused interest on the field of neural regeneration and brought it up to the forefront of research.
He has also had an impact on legislation that will affect research funding for all neuroscience. He thinks, and I agree, that if you take a strong stand and believe in what you’re doing, you can accomplish just about anything.