Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text]

A Decade of Social Media Influence on Foot and Ankle Literature

Category: Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; Other Introduction/Purpose: The topics, articles and discussions that arise within Foot and Ankle Orthopaedic literature are increasingly determined by their presence on social media outlets. The influence of social media mentions on Foot and Ankle Orthopaedic literature has not yet been investigated. The primary purpose of this study is to identify the social media outlets that were most associated with the Altmetric attention score (AAS). The secondary aim is to characterize the top 100 most highly cited articles within Foot and Ankle literature with the top 100 scoring Altmetric articles. Methods: We conducted a query of the Altmetric database for all journal titles containing the words ‘Foot’ and ‘Ankle.’ In accordance with other investigations, articles were only included after 2010, since this was beginning of academic social media participation. We assessed the frequency and percent of articles by journal, collecting variables including impact factor, AAS, along with average mentions within news, blogs, policy, patents, Twitter, peer review, Weibo, Facebook, Wikipedia, Google+, LinkedIn, Reddit, Pinterest, F1000, Q&A, online video, Syllabi, and traditional metrics such as number of Mendeley readers and citations (Table 1). We used a Spearman, semi-partial, and partial correlation test to detect the association between AAS and media outlet mentions, Mendeley readers or Dimensions citations. Finally, we ranked one article list with the 100 most popular articles on social media and one with the 100 most cited articles. Articles were examined for overlap, topic, article type, and level of evidence. Results: Our search returned 4,365 articles. Foot and Ankle International had the highest frequency of articles, though the Journal of Foot and Ankle Research had the highest AAS (Table 1). News and Twitter mentions had the greatest association with AAS. The top study designs for the AAS articles were prospective (n=35), retrospective (n=25), and systematic reviews (n=17), compared to the most highly cited articles which had retrospective (n=32), review (n=31), and observational studies (n=26) (p<0.001). When examining the top 100 highest AAS scoring articles with the 100 most cited, there was only one article in both groups. Compared to the most highly cited articles, the highest ranked AAS articles had a better average level of evidence (Cited: 3.4 vs. AAS: 2.9, p=0.001). Conclusion: Twitter and mentions within news are the most correlated with AAS. Although traditional metrics for article influence often reference an article’s citation count, attaining social media relevance is becoming more important than before. There is currently very little overlap among the most highly cited and the most mentioned articles on social media. Future research is needed to address whether citation counts or social media presence have more influence on actual clinical practice. [Table: see text]

Authorship and Citations in Foot and Ankle International from 1980-2017

Category: Other Introduction/Purpose: Orthopaedic foot and ankle surgery is a young and rapidly evolving orthopaedic subspecialty. Little is known regarding the authors contributing to the field. The purpose of this study is to characterize the demographics of the authors publishing foot and ankle research since the inception of the research journal of the American Orthopaedic Foot and Ankle Society. Methods: All publications in the journal Foot and Ankle International between 1980 and 2017 were reviewed. Papers were characterized in terms of number of authors, number of institutions, and number of references. The first and corresponding authors were also characterized in terms of country of origin, gender, and degree qualification. Each of these characteristics was tested for trends over time. Results: In total, 5,323 publications were reviewed, including 4,297 research articles, 367 case reports, 262 editorials, 159 letters, and 121 technique tips. The mean number of authors per paper increased from 2.3 during the 1980s to 4.3 during the 2010s (p<0.001). The percent of publications with female first authors increased from 4.9% during the 1980s to 13.2% during the 2010s (p<0.001). The country of origin shifted markedly away from the United States during the 1980s towards Europe and other countries during the 2010s (Figure 1). Podiatrists consisted of 1.3% of first authors and 1.4% of corresponding authors—these proportions did not meaningfully change over time (p>0.05). The mean number of references to other work increased from 13.8 during the 1980s to 24.4 during the 2010s (p<0.001). Conclusion: The authors of the foot and ankle literature have changed markedly over the past 4 decades. Most notably, there have been shifts towards female and international authorship. The number of authors per paper has also nearly doubled over time. Such trends are likely to continue as the field of foot and ankle grows.

Increasing female authorship of foot and ankle academic literature over 24 years

Category: Other Introduction/Purpose: Under-representation of women in surgery is commonly attributed to lacking mentorship and exposure in medical school, societal perceptions regarding career priorities, and concerns of “fitting in” in a work culture predominantly comprised of men. Furthermore, this disparity is also reflected in research productivity across academic medicine with male faculty being more likely to publish research compared to female colleagues. In this study we aim to describe the representation and longevity of female investigators among the authors of three foot and ankle research journals from 1993 to 2017. Methods: In this retrospective bibliometric analysis, authors of original research from three prominent foot and ankle research journals (Foot and Ankle International, The Journal of Foot and Ankle Surgery, Foot and Ankle Clinics) were extracted from PubMed. For authors with a complete first name listed, gender was determined by matching first name using an online database containing 216,286 distinct names across 79 countries and 89 languages. Proportion of female first, middle, and senior authors were determined over time, as well as total publication count per author. A sub-analysis of authors first publishing between 2007-2012 was followed for 5 years to identify how often authors continued to publish after first publication. Student t-test, chi-square analysis, and Cochran-Armitage trend tests were used to determine significance between groups. Results: From 1993 to 2017, 8,132 original articles were published in three foot and ankle research journals. A total of 6,597 (81.1%) had first names listed, identifying 25,329 total authors, of which 22,961 (90.7%) were successfully matched to a gender. 9,273 unique authors were identified (female: 19.2%). Female representation increased for first and senior authors from 6.5% and 5.9% (1993-1997) to 16.9% and 13.1% (2013-2017, p<0.001). Compared with male authors, female authors published fewer articles (mean: 1.7 vs 2.4, p<0.001). Of 2,691 authors who first published during 2006 to 2011, 369 authors (13.0%; female: 8.1% vs male 15.0%, p<0.001) continued to publish 5 years after their first publication. Female authors were more likely to only publish one article (75.6% vs 69.4%, p=0.016). Conclusion: Female representation in academic foot and ankle research has increased over two-fold over the past 2 decades. Despite these advances, compared to male authors, female authors are less likely to continue publishing 5 years after initial publication, and on average publish fewer articles. Although women are increasingly supported in the surgical workforce, our findings suggest that disparities in academic productivity exist in foot and ankle surgery. Further analysis of barriers to research amongst women may result in more equitable academic advancement and promotion for female foot and ankle surgeons.