Original Article
Turk J Anaesthesiol Reanim 2017; 45: 16-25
DOI: 10.5152/TJAR.2016.16680
Scientific Publication Performance of Turkish Anaesthesia Clinics in High Impact Factor International Journals Between 2005 and 2014: A Bibliometric Analysis Hüseyin Oğuz Yılmaz1, Rovnat Babazade2, Oğuz Alp Turan3, Betül Babazade4, Onur Koyuncu5, Alparslan Turan6 Department of Anaesthesiology and Reanimation, Etimesgut Sait Ertürk State Hospital, Ankara, Turkey Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, USA 3 Faculty of Biomedical Engineering, Case Western Reserve University, Oh, USA 4 Department of Therapy and Rehabilitation, Cleveland Clinic Children, Oh, USA 5 Department of Anaesthesiology and Reanimation, Mustafa Kemal University Tayfur Ata Sökmen School of Medicine, Hatay, Turkey 6 Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Oh, USA 1
Abstract
2
Objective: International scientific publication productivity is a tangible indicator for the accuracy of scientific policies. The quality of scientific publications is not increasing despite the fast increase in the publication count in Turkey. The international publication activities of Turkish anaesthesia clinics have not been previously explored. Thus, we aimed to evaluate the high quality scientific productivity of Turkish anesthesia clinics within the last 10 years. Methods: We searched for studies conducted by anaesthesiologists in Turkey within the last 10 years and published in journals listed under the medical subject categories of anaesthesiology and critical care using ‘Thomson Reuters InCites’ and PubMed databases. We recorded publication year, subject, method, citation count and origin of each paper and conducted descriptive analyses. Results: There were 630 papers meeting our inclusion criteria. Among those, 525 (83%) were studies on anaesthesia, 66 (10%) were studies on critical care and 39 (6%) were studies on pain. The average citation count was 9.90. There were 376 controlled/randomized controlled trials, 98 observational studies, 66 laboratory studies, 64 case series/reports, 5 reviews and 21 letters to the editor. Studies were conducted by universities (82.4%), by training and research hospitals (15.56%), by state and military hospitals (0.63%) and by physicians in private practice (1.27%). Baskent University had the highest publication count, Istanbul University had the highest citation count and Trakya University had the highest publication count per faculty teaching staff. Conclusion: The high-impact scientific productivity of Turkish anesthesia clinics is in a downward trend in the last 10 years, and the average citation count is lower than the global average. Keywords: Turkey, anaesthesia, national bibliography, bibliometric analysis, anaesthesia publications from Turkey
Introduction
M
easuring international publication activities is one of the important indicators used to assess the level of scientific development of countries (1). Although it is criticized intensively (2-4), indexes prepared on the basis of international publications and the citations to these publications are frequently used by states, higher education institutions, independent evaluation institutions, and even the media in the world and in our country to evaluate the scientific performance and rank among the institutions (5-13). Measuring publication activities can also be seen as one of the concrete indicators of whether the science policy is being carried out properly. The same approach can be used on a smaller scale, for science branches and professional organizations. Prepared by the Council of Higher Education (CHE) in 2009, a report on the scientific indicators of Turkey indicates that the relative citation factor of Turkey is below the world average in all areas (14). Subsequently, the fact that the number of international publications is accepted by the CHE and universities as a basic criterion for academic promotions, and the incentives granted has rapidly increased the importance given to international scientific publications and the number of publications (15, 16). However, despite the increase in the number of publications, the same increase in the assessment criteria of the publication quality is not seen (8, 17, 18).
16
Address for Correspondences: Hüseyin Oğuz Yılmaz E-mail: [email protected] ©Copyright 2017 by Turkish Anaesthesiology and Intensive Care Society - Available online at www.jtaics.org
Received : 16.05.2016 Accepted : 14.11.2016 Available Online Date : 18.01.2017
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics The number of publications which discusses the difficulties of making scientific publications in the field of anaesthesia, proposes solutions, or shares experiences is limited in our country (19, 20). Studies have been conducted to examine the contributions of emergency medicine (21-24), pathology (25), endocrine surgery (26), and cardiology (27) to the international literature. However in Turkey, as far as we know, there is not yet an analysis that evaluates the scientific studies which are published in high-impact journals listed in international indexes in the field of anaesthesia. The assessment of the current situation is necessary for planning and managing the development of our speciality and institutions in terms of scientific publication performance. For these reasons, we aimed to review the contribution of anaesthesia institutions in our country to international literature, to rank them in terms of scientific performance, and to evaluate the course within the last 10 years by examining the articles published by Turkey in international high impact factor (IF) anaesthesia journals.
Methods A bibliometric analysis has been made in this research, including the articles on the subject of anaesthesia, pain, and intensive care and published by the anaesthesiologists in Turkey in the last 10 years (2005--2014). These journals are listed in the subject category of anaesthesia and intensive care in the "Thomson Reuters In Cities” database and have an IF above 1. Data were evaluated by 4 researchers (H.O.Y., R.B., F.B.B., O.A.T.) in parts, and in case of doubt, they were re-evaluated by H.O.Y. and A.T. for final decision. To determine the journals to be evaluated, we listed the journals which were in the subject categories of anaesthesiology and critical care medicine, and which had an IF over 1 in 2013 in the “In Cities Journal Citation Reports (JCR)” database, then we transferred them to the data table we have created. At the time of the interrogation, there was no separate category of pain, and the journals about pain were listed in the subject category of “anesthesiology.” To determine the publications to be evaluated, we made a search on the PubMed database, including the keywords “Turkey” and “anaesthesia, pain, intensive care” in the field of author affiliations on February 6, 2015, and we limited the results within the dates ranging from January 1, 2005, to December 31, 2014. The exact query text was as follows: “(Turkey [Affiliation] OR Türkiye [Affiliation] OR Anestezi [Affiliation]) AND (anesthesia [Affiliation] OR Anesteziyoloji [Affiliation] OR Anaesthesiology [Affiliation] OR reanimation [Affiliation] ] OR critical care [Affiliation] OR intensive care [Affiliation] OR pain [Affiliation] OR regional [Affiliation] OR anestezi [Affiliation] OR agri[Affiliation] OR yoğun bakım [Affiliation]) AND (“2005/01/01” [PDat]: “2014/12/31”[PDat]).” We transferred the publications that we found to our data table including the publication name, publication year, and the journal name they were published in. We then filtered the list to include the articles that were
published only in the journals that we had determined before, and we started detailed examination. First, we reviewed the abstracts of the publications one by one and excluded the publications that were not about of anaesthesia, intensive care, or pain or did not have an anaesthesiologist on the author list. Then, we classified the remaining publications according to their subjects (anaesthesia, pain, intensive care), according to the type of the publication (review/compilation/letter, case report/serie, laboratory study, clinical study), and according to the type of institution (university hospital, education and research hospital (ERH), state hospital, private hospital). While determining the name of the institution, we considered the institution of the first anaesthetist from Turkey in the list of authors. In cases of doubt, we resorted to the full texts of publications. In order to make an evaluation about the citations counts of publications and institutions, we found the articles one by one in the Web of Science (WoS) database between August, 15 and August 25, 2015, and recorded the total number of citations until the date of the query. By using descriptive methods, we determined the course of the publication count according to the topics and types of publications over the years. Because their organization and abilities are quite different, we sorted university hospitals and ERHs separately by the number of publications, the number of citations, and the number of publications per academic staff. We identified the number of academic staff by counting the professors, associate professors, and assistant professors that listed on the web pages of the anaesthesia departments of university websites in December 2015. We did not include the instructors and specialists in this count. We did not make the last ranking for ERHs because the data were not adequate on the websites of most ERHs. Many ERH were affiliated with newly established universities in 2013 and 2014 and their names were changed. As we evaluated the publications of the last 10 years retrospectively, we decided to consider these institutions not as university hospitals but as ERH in accordance with their previous organizational structures.
Results A total of 51 journals were found in the JCR database under the subject categories of anaesthesiology and intensive care medicine, and it was seen that 46 of them had an IF above 1 in 2013. The list of the journals and 5-year IFs of the journals in 2013 are given in Table 1. In the first literature search, 2,585 publications from Turkey were found in the PubMed database. 1,895 publications that were not published in the selected journals, and 69 publications that did not have the selected subjects or did not have an anaesthetist from Turkey in the list of authors were removed from the list. After data cleaning, 630 publications matching all of the previously determined criteria were detected (Figure 1). The distribution of the publications to the determined journals is given in Table 1.
17
Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 1. The number of studies from Turkey published between 2005 and 2014 in the journals listed in the subject categories of anaesthesia and intensive care medicine in the database of the Web of Science (WoS) Incities, with an impact factor (IF) higher than 1 in 2013 Item no Full name of the journal 1 Chest 2 Anesthesiology 3 Critical Care Medicine 4 Pain 5 Intensive Care Medicine 6 Critical Care 7 British Journal of Anaesthesia 8 Journal of Neurotrauma 9 Resuscitation 10 Anaesthesia 11 Anaesthesia and Analgesia 12 European Journal of Pain 13 Current Opinion in Critical Care 14 Seminars in Respiratory and Critical Care Medicine 15 European Journal of Anaesthesiology 16 Journal of Trauma-Injury Infection and Critical Care 17 Shock 18 Clinical Journal of Pain 19 Neurocritical Care 20 Current Opinion in Anesthesiology 21 Critical Care Clinics 22 Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie 23 Injury-International Journal of the Care of the Injured 24 Journal of Neurosurgical Anesthesiology 25 Pediatric Critical Care Medicine 26 Acta Anaesthesiologica Scandinavica 27 Minerva Anestesiologica 28 Journal of Critical Care 29 Pain Practice 30 Critical Care and Resuscitation 31 Regional Anaesthesia and Pain Medicine 32 Journal of Trauma and Acute Care Surgery 33 Respiratory Care 34 Burns 35 International Journal of Obstetric Anaesthesia 36 Pediatric Anaesthesia 37 American Journal of Critical Care 38 Schmerz 39 Journal of Cardiothoracic and Vascular Anaesthesia 40 Anaesthesia and Intensive Care 41 Journal of Clinical Monitoring and Computing 42 BMC Anesthesiology 43 Medicina Intensiva 44 Journal of Clinical Anaesthesia 45 Journal of Anaesthesia 46 Critical Care Nurse
18
IF in 5-year Number of publications 2013 IF from Turkey 7.132 6.916 0 6.168 5.53 4 6.147 6.404 4 5.836 6.341 0 5.544 5.27 2 5.035 5.411 3 4.354 4.286 17 3.968 4.062 0 3.96 3.771 1 3.846 2.879 17 3.422 3.349 54 3.218 3.604 4 3.183 2.829 0 3.022 2.65 0 3.011 2.207 100 2.961 3.204 3 2.732 2.811 0 2.703 3.148 5 2.604 2.618 1 2.526 2.439 2 2.495 2.498 0 2.495 2.401 6 2.462 2.388 2 2.347 2.099 17 2.326 2.692 5 2.31 2.233 50 2.272 1.905 29 2.191 2.51 17 2.183 - 7 2.154 - 0 2.12 2.536 9 1.97 1.99 0 1.84 2.037 8 1.836 1.91 1 1.832 1.72 13 1.742 1.802 50 1.6 2.211 0 1.504 1.169 0 1.482 1.32 37 1.47 1.357 23 1.448 - 8 1.333 - 6 1.24 0.891 0 1.21 1.263 52 1.117 1.004 73 1.074 1.155 0
% 0.00 0.63 0.63 0.00 0.32 0.48 2.70 0.00 0.16 2.70 8.57 0.63 0.00 0.00 15.87 0.48 0.00 0.79 0.16 0.32 0.95 0.00 0.32 2.70 0.79 7.94 4.60 2.70 1.11 0.00 1.43 0.00 1.27 0.16 2.06 7.94 0.00 0.00 5.87 3.65 1.27 0.95 0.00 8.25 11.59 0.00
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics It was seen that of 630 publications, 525 (83%) were in the field of anaesthesia, 66 (10%) were in the field of intensive care medicine, and 39 (6%) were in the field of pain. A total of 6,236 citations were made to 530 publications in the journals listed in WoS, and the average number of citations was 9.90. While 83% of the publications were in the field of anaesthesia, the average citation count of anaesthesia articles was 9.54; while the studies about intensive care constituted 10% of the total publications, the average citation count was 9.1; and while the publications related to pain constituted 6% of the total publications, the average citation count was 15.95. The number of publications, the total citation count, and the average number
of citations according to subject categories are given in Table 2. The course of the citation counts according to the subject of the publication is graphically given in Figure 2, and the detailed annual numbers of publications are given in Table 3. When the publications were grouped and analysed according to the study types, more than half of the publications were found to be composed of clinical studies. 376 controlled/randomized controlled clinical trials, 98 retrospective or prospective observational clinical trials, 66 laboratory trials, 64 case series/reports, 5 compilations, and 21 letters to the editor were published in the selected journals. The course of the number of publications according to the study type is graphically shown in Figure 3, and detailed annual publication numbers are given in Table 4.
2585 The number of publications evaluated for convenience at the end of first search
When the publications were examined according to the type of institution, 520 (82.4%) publications were seen to be made by the doctors of university hospitals, 98 (15.56%) by the doctors of ERH, 4 (0.63%) by the doctors of public/military hospitals, and 8 by the doctors of private institutions. A total of 59 university hospitals and 21 ERHs which published in compliance with the specified criteria was found. Başkent University was the institution which had the most number of publications, Istanbul University had the most number of citations, and Trakya University had the most number of publications per academician. Among the ERHs, Ankara Education and Research Hospital and Ankara Dışkapı Yıldırım Beyazit Education and Research Hospital were the institutions with the highest number of publications and citations received. The detailed ranking of the institutions according to the determined
Excluded (n=1895) Studies published in the journals with the impact factor (IF) lower than 1.
•
699 Detailed examination was performed Excluded (n=69) Not in the subjects of anesthesia, pain and intensive care No anaesthetist from Turkey in the list of authors
• • 630 Publications accordant with determined criteria
Figure 1. CONSORT diagram
Table 2. The numbers of publications, total citations, and the mean number of citation according to the subjects categories
Existing study
Subject category Number of publications %a
Number of citations
Mean number of citations b
TUBITAK report c
Number of Number of publications citations
Mean number of citations *
Anaesthesia 525 83 5.009 9.54 Intensive care
66
10
605
9.17
Pain
39
6
622
15.95
Total
630
6.236
9.90
1.685 12.792
7.59
Less than 100% in total due to round-off error. Number of citations listed in WoS database August 2015. c Ulakbim. Tıbbi Bilimler (2004--2014). http://ulakbim.tubitak.gov.tr/tr/hizmetlerimiz/tibbi-bilimler-2004-2014. a
b
Table 3. The distribution of the number of publications according to the subjects of studies between2005 and 2014 Annual number of publications Subject category
2005
2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
Anaesthesia
83
60 57 69 48 58 35 26 43 46 525
Intensive care
13
8 8 2 6 4 6 4 3 12 66
Pain
6
4 5 5 9 6 0 0 2 2 39
102
72 70 76 63 68 41 30 48 60 630
Total by years
19
Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 4. The distribution of the numbers of publications according to the types of studies between 2005 and 2014 Annual number of publications
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
Letter to editor
0
0
0
0
0
1
0
0
7
13
21
Review
1 1 2 0 0 0 0 0 0 1 5
Case series/report
14 11 8 6 4 6 2 3 5 5 64
Laboratory study
10 9 11 12 6 6 3 4 1 4 66
Observational study
15 14 8 11 9 9 8 5 8 11 98
Controlled/Randomized controlled study 62
37
41
47
44
46
28
18
27
26
376
Total by years
72
70
76
63
68
41
30
48
60
630
102
Table 5. Ranking of anaesthesia departments in universities, on studies conducted about anaesthesia, intensive care, and pain between 2005 and 2014, according to the numbers of studies, numbers of citations and numbers of studies per academic staff Numbers of Number of University publications %* citations
20
Ranking
According to the According to the According to the numbers of numbers of number of publications publications citations per academic staff **
Başkent University
44
6.98
286
1
6
4
Istanbul University
42
6.67
583
2
1
12
Hacettepe University
30
4.76
371
3
5
6
İnönü University
28
4.44
393
4
4
2
Trakya University
26
4.13
433
5
3
1
Kocaeli University
25
3.97
177
6
11
3
Erciyes University
24
3.81
546
7
2
7
Gazi University
23
3.65
213
8
8
16
Gülhane Military Medical Academy
17
2.70
201
9
9
17
Ege University
16
2.54
117
10
15
34
Dokuz Eylül University
15
2.38
135
11
12
29
Uludağ University
14
2.22
226
12
7
14
Akdeniz University
14
2.22
134
13
13
28
Ondokuz Mayıs University
14
2.22
85
14
19
23
Atatürk University
14
2.22
67
15
20
9
Bülent Ecevit University
13
2.06
104
16
17
5
Selçuk University
12
1.90
47
17
27
8
Çukurova University
11
1.75
186
18
10
18
Adnan Menderes University
10
1.59
88
19
18
19
Ankara University
10
1.59
53
20
25
32
Celâl Bayar University
9
1.43
122
21
13
20
Karadeniz Technical University
9
1.43
112
22
16
31
Abant İzzet Baysal University
9
1.43
61
23
24
10
Gaziantep University
8
1.27
44
24
29
24
Marmara University
7
1.11
63
25
21
21
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics Yeditepe University
7
1.11
59
26
23
15
Bezm-i Âlem Vakıf University
6
0.95
37
27
32
36
Mustafa Kemal University
6
0.95
19
28
36
27
Kırıkkale University
6
0.95
18
29
37
13
Cumhuriyet University
5
0.79
46
30
28
25
Harran University
5
0.79
44
31
30
30
Düzce University
5
0.79
38
32
31
26
Eskişehir Osmangazi University
4
0.63
52
33
26
35
Necmettin Erbakan University
4
0.63
10
34
42
43
Süleyman Demirel University
3
0.48
56
35
24
38
Dicle University
3
0.48
15
36
38
40
Fatih University
3
0.48
10
37
43
11
Fırat University
3
0.48
3
38
45
39
Yüzüncü Yıl University
2
0.32
35
39
33
22
Sütçü İmam University
2
0.32
32
40
35
47
Afyon Kocatepe University
2
0.32
12
41
39
37
Ufuk University
2
0.32
12
42
40
33
Gaziosmanpaşa University
2
0.32
2
43
46
44
İstanbul Bilim University
1
0.16
33
44
34
51
Mersin University
1
0.16
11
45
41
48
Maltepe University
1
0.16
7
46
44
49
Giresun University
1
0.16
1
47
47
45
Bozok University
1
0.16
0
48
No citation
50
Dumlupınar University
1
0.16
0
49
No citation
46
Muğla Sıtkı Koçman University
1
0.16
0
50
No citation
42
Pamukkale University
1
0.16
0
51
No citation
41
Total
522
5,399
*Ratio to total number of publications **Calculated considering total number of professors, associate professors, and assistant professors determined on the pages of the departments of anaesthesia in the websites of related institutions in December 2015. Lecturers and specialist physicians were not included.
10-years course of the number of publications according to the publication types
120
70
100
60
80 60
Total by years
40
Anaesthesia
20
Intensive care
0
Pain 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Figure 2. Ten-years course of the numbers of publications according to the subjects
Number of publications
Number of publications
10-years course of the number of publications according to the subjects
50 40 Controlled/ randomized controlled Observational
30 20
Case series/report Laboratory study Review
10 0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Letter to editor
Figure 3. Ten-years course of the numbers of publications according to publication types
21
Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 6. Ranking of anaesthesia departments in Education and Research Hospitals, on studies conducted about anaesthesia, intensive care, and pain between 2005 and 2014, according to the numbers of studies, and numbers of citations Ranking Number of Number of Education and Research Hospital (ERH) publications citations
According to number of citations
Ankara Education and Research Hospital
24
334
1
1
Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital
13
107
2
2
İzmir Katip Çelebi University Atatürk Education and Research Hospital
7
53
3
4
Ankara Numune Education and Research Hospital
7
26
4
7
İstanbul Okmeydanı Education and Research Hospital
5
69
5
3
Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital
4
22
6
8
İstanbul Şişli Hamidiye Etfal Education and Research Hospital
3
38
7
5
Ankara Atatürk Education and Research Hospital
3
16
8
9
Adana Numune Education and Research Hospital
3
14
9
10
Ankara Türkiye Yüksek İhtisas Education and Research Hospital
3
11
10
11
İstanbul Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital
2
29
11
6
İstanbul Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital
2
9
12
12
İstanbul Kartal Dr.Lütfi Kırdar Education and Research Hospital
2
3
13
17
Ankara Keçiören Education and Research Hospital
2
0
14
21
İzmir Bozyaka Education and Research Hospital
2
0
15
22
İzmir Tepecik Education and Research Hospital
2
0
16
23
İstanbul Haydarpaşa Numune Education and Research Hospital
1
8
17
13
Hitit University Çorum Education and Research Hospital
1
7
18
14
İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Education and Research Hospital
1
5
19
15
Recep Tayyip Erdoğan University Education and Research Hospital
1
4
20
16
İstanbul Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital
1
3
21
18
İstanbul Bakırköy Dr.Sadi Konuk Education and Research Hospital
1
2
22
19
Trabzon Kanuni Education and Research Hospital
1
2
23
20
Ankara Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital
1
0
24
24
Etlik Zübeyde Hanım Women’s Health Education and Research Hospital
1
0
25
25
İstanbul Bağcılar Education and Research Hospital
1
0
26
26
İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
1
0
27
27
Konya Education and Research Hospital
1
0
28
28
criteria is given in Tables 5 and 6. No publications were found in the selected journals belonging to 28 university hospitals and 46 ERH, which are not listed in the table.
Discussion 22
According to number of publications
Three criteria that bring “international publication activities” in the foreground gain a general acceptance in evaluat-
ing academic performance: 1) the number of publications in international scientific journals, 2) publication in scientific journals searched by scientific indexes, and 3) the number of citations to publications (8). The reputation of the journal in which the publication takes place can also be regarded as an indication of publication quality (28). Today, databases such as WoS, Scopus, and Google Scholar list the scientific peri-
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics odicals and citations to these periodicals. We also preferred using WoS database to choose the journals that we would evaluate and to determine the number of citations because it offered a well-established and reliable service and was often used in performance evaluations in our country. The PubMed database was preferred to determine the publications to be evaluated because it updates the data more frequently, the search engine was more flexible, and because it was completely free of charge. We reached a total of 630 publications by using our method that we built to determine high-quality international publications. In the report (6) in which all international publications of the same period of time were examined in Turkey by the National Academic Network and Information Centre (NANIC), of a total of 1,685 publications, including 1,117 anaesthesia and 568 intensive care medicine publications were reported. In the report of NANIC, no limit was set for the IF, the clinic which made the publication was not considered, and all the publications in the subject category were just counted electronically. When two analyses are evaluated together, it can be deduced that roughly 37% of all international publications were published in high-impact journals. While the average number of citations for all publications was indicated as 7.59 in the same report, we found that the average number of citations for the studies evaluated by us was 9.90. The world average number of citations in the same subject categories is 14.77 (6). Although the IF of our published studies in high-quality journals is slightly higher, the IF of our anaesthesia institutions in both assessments is below the world average. It was seen that 173 (27.46%) of the 630 studies published in the journals that we selected were in the European Journal of Anaesthesia and Journal of Anaesthesia. These two journals originate from Europe and Japan, respectively, and they are in the 15th and 45th places in the IF ranking. When the rest of the publication list was examined in detail, it was seen that the publications in Turkey were published in journals of Europe at a higher ratio. Despite declining in recent years, the numerical superiority of the United States still continues in the international scientific journals, and the journals with the highest IF are mostly US-based (3). In SCI and SCI-E, there are no anaesthesia, pain, or intensive care journals of Turkish origin. Turkish Anaesthesiology and Reanimation Journal was started to be searched in PubMed in 2016. Providing the criteria to enter the indexes, more national publications will increase both the overall quality of the publications and the IF of our studies (29). Detailed bibliographic analyses performed in all scientific branches have shown that the number of publications in Turkey has increased over the years, but there has been no progress in the number of international co-authored publications (14, 30). We did not conduct an analysis in our work about international collaborations, but it is considered that increasing the number of multicentered, international co-authored studies in the field of anaesthesia will increase the number of our publications which will take place in high-impact journals.
It is seen that the number of publications has decreased in all publication categories within the last 10 years. The lowest numbers of publications were observed in 2011 and 2012. This decrease was attributed to the reorganization of the ethics committees necessary to initiate and carry out the studies after the “Regulation on Clinical Investigations No. 28030” which entered into force in 2011. Although the number of publications started to increase as of 2013 due to the amendment of the related regulation in 2013 and the compliance of the clinics with the new methods, the figures of 10 years ago have not been reached yet. The most consistent and continuous studies in terms of the assessment of the performance of a single science branch were conducted and regularly published by Onat in the field of cardiovascular medicine (27, 31-39). Similarly, Onat reported that a significant decrease occurred in the number of publications in the field of cardiovascular medicine since 2004 (33), the lowest levels were reached particularly in 2011 (36), and a trend of a quantitative increase started since 2013, although not in terms of quality (38). Onat has attributed the decline in the number and quality of academic publications to the reduction of academic competence and interest in research, the retrenchment of the state support in the field of research, the inability to keep the experienced academic staff in state-affiliated universities and hospitals due to the current system based on performance, and the limitation of academic working time because of the increasing burden of outpatient care. It was seen that the vast majority of publications was about anaesthesia, and the publications in the fields of intensive care and pain accounted for only 15% of the total publication volume. It is noteworthy that the studies in intensive care increased rapidly in 2014. However, when the publications in 2014 were examined in detail, it was seen that 6 of 12 publications were in the form of “a letter to the editor.” The fact that the subspecialties of intensive care and pain subsidiary to the department of anaesthesia has newly been established can explain our shortcomings in both fields. Another explanation is the need for a large number of patients, data, longterm observations, and advanced statistical analyses to make sufficiently strong analyses in the fields of pain and intensive care and to produce high-quality publications. It is quite difficult for single department to be able to meet these criteria alone. This makes it very difficult to publish thes studies in high-impact journals. As a matter of fact, 11 of the 13 journals with no publications from Turkey are the journals specialized in the field of intensive care and 2 in the field of pain (Table 1). In addition, 4 of the top 5 journals in terms of IF were about intensive care and pain. To improve the academic performance in these fields, it is necessary to head toward interdisciplinary collaborations and to seek cooperation in international multicentre studies (30, 40). The picture is quite promising in academic performance analysis in terms of the types of publications. Clinical trials constituted more than half of the studies published in high-quality journals, and a majority of them were reported as randomized controlled clinical trials. Swaminathan et al.
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Turk J Anaesthesiol Reanim 2017; 45: 16-25 (41) evaluated the clinical trials of clinical anaesthesia departments in 2007 and reported that Turkey was the country that produced randomized clinical trials at the highest rate of 88%. This outcome of 2007 can be explained by the fact that receiving informed consent is relatively easier than in the developed countries, and the regulatory legislation and controls are more flexible. The fact that clinical investigations began to be tightly controlled reduced this rate in 2011, but it is still at a level that can be considered successful. The next step is the creation of joint work commisions and advisory boards required to keep the quality of all conducted randomized controlled trials high, and the formation of structures that will give support about statistical issues and scientific writing. Almost all of our high-impact publications were made by university hospitals and ERHs, and the proportion of other institutions was 2%. Although the task and ability to conduct research and development belongs to university hospitals and ERH, it should not be ignored that the vast majority of human resources is in state hospitals. Inclusion of the anaesthetists working outside of the research institutions in research activities, will undoubtedly improve scientific performance. It is also noteworthy that many university hospitals and ERH have no publications in high-impact journals. After providing the minimum requirements for transition to academic positions, academicians are changing their institution and city due to various concerns. This might be affecting the continuity of scientific research activity in the institutions they have left and might be preventing the increase in quality. When Tables 5 and 6 are examined, it is seen that some institutions that publish a large number of publications fall behind in ranking in terms of the number of publications per academic staff. This is an indicator that institutions' scientific publication performance is bound to a limited number of researchers. The basic necessity for solving the problems we have mentioned is to make the culture of scientific research and scientific writing independent from individuals and to institutionalize it. In the short term, the creation of structures that can provide consultancy and service at the national level may be the first step to a solution. We believe that giving the culture of scientific research and writing in an applied way beginning from the studentship, facilitating the access to scientific data for all physicians working in institutions, including small-scale hospitals, and the establishment of institutional structures to provide methodological counselling in proportion to the size of the institutions will compensate the deficiency in this field.
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Our work has many limitations due to methodology.First, our data quality is limited to the quality of the databases we use. Possible spelling mistakes at author addresses could have affected our search result. The classification used by the WoS database for periodicals may not be covering all the publications in this field. Likewise, periodicals published in more than one discipline may have been listed in a different subject category even though they publish the topics that anaesthetists interests in. This issue has caused some of the studies to be left out of our investigation. Because it would
take a long time to individually review all the publications due to our limited sources; through the method that we used to select high-quality publications, we think that we have formed a proper sample. Other limitations often relate to the performance analyses of institutions. Limiting our work with the articles published in the journals with an IF of 1 leads to ranking differences in performance evaluation. For example, the ranking is quite different in the report in which all publications in SCI and SCI-E are reviewed by NANIC (6). However, not anaesthesiology clinics, but the universities have been sorted in that report and by analysing the electronic data, all science branches publishing in that subject category have been included in the evaluation. In this sense, our study presents superiority in terms of evaluating the performance of anaesthesia clinics in particular. Another limitation arises from the 10-year time interval we used. This wide time interval is inevitably accompanied by the changes in the structures of institutions and the number of faculty staff. Faculty staff may have transitioned between institutions and even the list of faculty members may have changed completely. In addition, the number of faculty members has been obtained over the internet sites of the institutions, and it is possible that they did not have updated information. In addition to this, only the institution of the first Turkish anaesthesiologist in the list was evaluated. In multicentred studies, more than one institution may have contributed in equal amounts, which may have led to a lower number of publications for some institutions. However, since an evaluation involving all authors requires highly sophisticated methods of analysis, we could not make these evaluations. Finally, these ranking will not be fair for the universities established less than 10 years ago. Annual evaluation and publication of the academic performance will solve this problem to a certain extent. Our findings should be evaluated carefully considering all of these limitations. In recent years, several serious studies have been conducted in the field of bibliometry in our country (2, 3, 5, 6, 13--16, 40, 42). We believe that repetition of the analyses by receiving professional support from these departments will greatly reduce the limitations in the future.
Conclusion Our study is the first analysis that examines the scientific publication production performance of anaesthesia clinics in Turkey. It has been observed that our international scientific publications tend to decrease in the last 10 years, the improvement in the last 2 years is not yet in sufficient level, and the average number of citations is below the world average. We believe that the performance analyses to be performed at certain intervals will be useful in terms of determining the publishing policy and objectives of our speciality and institutions. Peer-review: Externally peer-reviewed. Author Contributions: Concept - A.T., H.O.Y., R.B.; Design A.T., H.O.Y., R.B.; Supervision - A.T.; Resources - H.O.Y., R.B., O.A.T., B.B., A.T.; Materials - H.O.Y.; Data Collection and/or Pro-
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics cessing - H.O.Y., R.B., O.A.T., B.B., A.T.; Analysis and/or Interpretation - H.O.Y., O.K., A.T.; Literature Search - H.O.Y.; Writing Manuscript - H.O.Y., O.K.; Critical Review - A.T. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support.
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Turk J Anaesthesiol Reanim 2017; 45: 16-25
DOI: 10.5152/TJAR.2016.16680
Scientific Publication Performance of Turkish Anaesthesia Clinics in High Impact Factor International Journals Between 2005 and 2014: A Bibliometric Analysis Hüseyin Oğuz Yılmaz1, Rovnat Babazade2, Oğuz Alp Turan3, Betül Babazade4, Onur Koyuncu5, Alparslan Turan6 Department of Anaesthesiology and Reanimation, Etimesgut Sait Ertürk State Hospital, Ankara, Turkey Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, USA 3 Faculty of Biomedical Engineering, Case Western Reserve University, Oh, USA 4 Department of Therapy and Rehabilitation, Cleveland Clinic Children, Oh, USA 5 Department of Anaesthesiology and Reanimation, Mustafa Kemal University Tayfur Ata Sökmen School of Medicine, Hatay, Turkey 6 Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Oh, USA 1
Abstract
2
Objective: International scientific publication productivity is a tangible indicator for the accuracy of scientific policies. The quality of scientific publications is not increasing despite the fast increase in the publication count in Turkey. The international publication activities of Turkish anaesthesia clinics have not been previously explored. Thus, we aimed to evaluate the high quality scientific productivity of Turkish anesthesia clinics within the last 10 years. Methods: We searched for studies conducted by anaesthesiologists in Turkey within the last 10 years and published in journals listed under the medical subject categories of anaesthesiology and critical care using ‘Thomson Reuters InCites’ and PubMed databases. We recorded publication year, subject, method, citation count and origin of each paper and conducted descriptive analyses. Results: There were 630 papers meeting our inclusion criteria. Among those, 525 (83%) were studies on anaesthesia, 66 (10%) were studies on critical care and 39 (6%) were studies on pain. The average citation count was 9.90. There were 376 controlled/randomized controlled trials, 98 observational studies, 66 laboratory studies, 64 case series/reports, 5 reviews and 21 letters to the editor. Studies were conducted by universities (82.4%), by training and research hospitals (15.56%), by state and military hospitals (0.63%) and by physicians in private practice (1.27%). Baskent University had the highest publication count, Istanbul University had the highest citation count and Trakya University had the highest publication count per faculty teaching staff. Conclusion: The high-impact scientific productivity of Turkish anesthesia clinics is in a downward trend in the last 10 years, and the average citation count is lower than the global average. Keywords: Turkey, anaesthesia, national bibliography, bibliometric analysis, anaesthesia publications from Turkey
Introduction
M
easuring international publication activities is one of the important indicators used to assess the level of scientific development of countries (1). Although it is criticized intensively (2-4), indexes prepared on the basis of international publications and the citations to these publications are frequently used by states, higher education institutions, independent evaluation institutions, and even the media in the world and in our country to evaluate the scientific performance and rank among the institutions (5-13). Measuring publication activities can also be seen as one of the concrete indicators of whether the science policy is being carried out properly. The same approach can be used on a smaller scale, for science branches and professional organizations. Prepared by the Council of Higher Education (CHE) in 2009, a report on the scientific indicators of Turkey indicates that the relative citation factor of Turkey is below the world average in all areas (14). Subsequently, the fact that the number of international publications is accepted by the CHE and universities as a basic criterion for academic promotions, and the incentives granted has rapidly increased the importance given to international scientific publications and the number of publications (15, 16). However, despite the increase in the number of publications, the same increase in the assessment criteria of the publication quality is not seen (8, 17, 18).
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Address for Correspondences: Hüseyin Oğuz Yılmaz E-mail: [email protected] ©Copyright 2017 by Turkish Anaesthesiology and Intensive Care Society - Available online at www.jtaics.org
Received : 16.05.2016 Accepted : 14.11.2016 Available Online Date : 18.01.2017
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics The number of publications which discusses the difficulties of making scientific publications in the field of anaesthesia, proposes solutions, or shares experiences is limited in our country (19, 20). Studies have been conducted to examine the contributions of emergency medicine (21-24), pathology (25), endocrine surgery (26), and cardiology (27) to the international literature. However in Turkey, as far as we know, there is not yet an analysis that evaluates the scientific studies which are published in high-impact journals listed in international indexes in the field of anaesthesia. The assessment of the current situation is necessary for planning and managing the development of our speciality and institutions in terms of scientific publication performance. For these reasons, we aimed to review the contribution of anaesthesia institutions in our country to international literature, to rank them in terms of scientific performance, and to evaluate the course within the last 10 years by examining the articles published by Turkey in international high impact factor (IF) anaesthesia journals.
Methods A bibliometric analysis has been made in this research, including the articles on the subject of anaesthesia, pain, and intensive care and published by the anaesthesiologists in Turkey in the last 10 years (2005--2014). These journals are listed in the subject category of anaesthesia and intensive care in the "Thomson Reuters In Cities” database and have an IF above 1. Data were evaluated by 4 researchers (H.O.Y., R.B., F.B.B., O.A.T.) in parts, and in case of doubt, they were re-evaluated by H.O.Y. and A.T. for final decision. To determine the journals to be evaluated, we listed the journals which were in the subject categories of anaesthesiology and critical care medicine, and which had an IF over 1 in 2013 in the “In Cities Journal Citation Reports (JCR)” database, then we transferred them to the data table we have created. At the time of the interrogation, there was no separate category of pain, and the journals about pain were listed in the subject category of “anesthesiology.” To determine the publications to be evaluated, we made a search on the PubMed database, including the keywords “Turkey” and “anaesthesia, pain, intensive care” in the field of author affiliations on February 6, 2015, and we limited the results within the dates ranging from January 1, 2005, to December 31, 2014. The exact query text was as follows: “(Turkey [Affiliation] OR Türkiye [Affiliation] OR Anestezi [Affiliation]) AND (anesthesia [Affiliation] OR Anesteziyoloji [Affiliation] OR Anaesthesiology [Affiliation] OR reanimation [Affiliation] ] OR critical care [Affiliation] OR intensive care [Affiliation] OR pain [Affiliation] OR regional [Affiliation] OR anestezi [Affiliation] OR agri[Affiliation] OR yoğun bakım [Affiliation]) AND (“2005/01/01” [PDat]: “2014/12/31”[PDat]).” We transferred the publications that we found to our data table including the publication name, publication year, and the journal name they were published in. We then filtered the list to include the articles that were
published only in the journals that we had determined before, and we started detailed examination. First, we reviewed the abstracts of the publications one by one and excluded the publications that were not about of anaesthesia, intensive care, or pain or did not have an anaesthesiologist on the author list. Then, we classified the remaining publications according to their subjects (anaesthesia, pain, intensive care), according to the type of the publication (review/compilation/letter, case report/serie, laboratory study, clinical study), and according to the type of institution (university hospital, education and research hospital (ERH), state hospital, private hospital). While determining the name of the institution, we considered the institution of the first anaesthetist from Turkey in the list of authors. In cases of doubt, we resorted to the full texts of publications. In order to make an evaluation about the citations counts of publications and institutions, we found the articles one by one in the Web of Science (WoS) database between August, 15 and August 25, 2015, and recorded the total number of citations until the date of the query. By using descriptive methods, we determined the course of the publication count according to the topics and types of publications over the years. Because their organization and abilities are quite different, we sorted university hospitals and ERHs separately by the number of publications, the number of citations, and the number of publications per academic staff. We identified the number of academic staff by counting the professors, associate professors, and assistant professors that listed on the web pages of the anaesthesia departments of university websites in December 2015. We did not include the instructors and specialists in this count. We did not make the last ranking for ERHs because the data were not adequate on the websites of most ERHs. Many ERH were affiliated with newly established universities in 2013 and 2014 and their names were changed. As we evaluated the publications of the last 10 years retrospectively, we decided to consider these institutions not as university hospitals but as ERH in accordance with their previous organizational structures.
Results A total of 51 journals were found in the JCR database under the subject categories of anaesthesiology and intensive care medicine, and it was seen that 46 of them had an IF above 1 in 2013. The list of the journals and 5-year IFs of the journals in 2013 are given in Table 1. In the first literature search, 2,585 publications from Turkey were found in the PubMed database. 1,895 publications that were not published in the selected journals, and 69 publications that did not have the selected subjects or did not have an anaesthetist from Turkey in the list of authors were removed from the list. After data cleaning, 630 publications matching all of the previously determined criteria were detected (Figure 1). The distribution of the publications to the determined journals is given in Table 1.
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Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 1. The number of studies from Turkey published between 2005 and 2014 in the journals listed in the subject categories of anaesthesia and intensive care medicine in the database of the Web of Science (WoS) Incities, with an impact factor (IF) higher than 1 in 2013 Item no Full name of the journal 1 Chest 2 Anesthesiology 3 Critical Care Medicine 4 Pain 5 Intensive Care Medicine 6 Critical Care 7 British Journal of Anaesthesia 8 Journal of Neurotrauma 9 Resuscitation 10 Anaesthesia 11 Anaesthesia and Analgesia 12 European Journal of Pain 13 Current Opinion in Critical Care 14 Seminars in Respiratory and Critical Care Medicine 15 European Journal of Anaesthesiology 16 Journal of Trauma-Injury Infection and Critical Care 17 Shock 18 Clinical Journal of Pain 19 Neurocritical Care 20 Current Opinion in Anesthesiology 21 Critical Care Clinics 22 Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie 23 Injury-International Journal of the Care of the Injured 24 Journal of Neurosurgical Anesthesiology 25 Pediatric Critical Care Medicine 26 Acta Anaesthesiologica Scandinavica 27 Minerva Anestesiologica 28 Journal of Critical Care 29 Pain Practice 30 Critical Care and Resuscitation 31 Regional Anaesthesia and Pain Medicine 32 Journal of Trauma and Acute Care Surgery 33 Respiratory Care 34 Burns 35 International Journal of Obstetric Anaesthesia 36 Pediatric Anaesthesia 37 American Journal of Critical Care 38 Schmerz 39 Journal of Cardiothoracic and Vascular Anaesthesia 40 Anaesthesia and Intensive Care 41 Journal of Clinical Monitoring and Computing 42 BMC Anesthesiology 43 Medicina Intensiva 44 Journal of Clinical Anaesthesia 45 Journal of Anaesthesia 46 Critical Care Nurse
18
IF in 5-year Number of publications 2013 IF from Turkey 7.132 6.916 0 6.168 5.53 4 6.147 6.404 4 5.836 6.341 0 5.544 5.27 2 5.035 5.411 3 4.354 4.286 17 3.968 4.062 0 3.96 3.771 1 3.846 2.879 17 3.422 3.349 54 3.218 3.604 4 3.183 2.829 0 3.022 2.65 0 3.011 2.207 100 2.961 3.204 3 2.732 2.811 0 2.703 3.148 5 2.604 2.618 1 2.526 2.439 2 2.495 2.498 0 2.495 2.401 6 2.462 2.388 2 2.347 2.099 17 2.326 2.692 5 2.31 2.233 50 2.272 1.905 29 2.191 2.51 17 2.183 - 7 2.154 - 0 2.12 2.536 9 1.97 1.99 0 1.84 2.037 8 1.836 1.91 1 1.832 1.72 13 1.742 1.802 50 1.6 2.211 0 1.504 1.169 0 1.482 1.32 37 1.47 1.357 23 1.448 - 8 1.333 - 6 1.24 0.891 0 1.21 1.263 52 1.117 1.004 73 1.074 1.155 0
% 0.00 0.63 0.63 0.00 0.32 0.48 2.70 0.00 0.16 2.70 8.57 0.63 0.00 0.00 15.87 0.48 0.00 0.79 0.16 0.32 0.95 0.00 0.32 2.70 0.79 7.94 4.60 2.70 1.11 0.00 1.43 0.00 1.27 0.16 2.06 7.94 0.00 0.00 5.87 3.65 1.27 0.95 0.00 8.25 11.59 0.00
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics It was seen that of 630 publications, 525 (83%) were in the field of anaesthesia, 66 (10%) were in the field of intensive care medicine, and 39 (6%) were in the field of pain. A total of 6,236 citations were made to 530 publications in the journals listed in WoS, and the average number of citations was 9.90. While 83% of the publications were in the field of anaesthesia, the average citation count of anaesthesia articles was 9.54; while the studies about intensive care constituted 10% of the total publications, the average citation count was 9.1; and while the publications related to pain constituted 6% of the total publications, the average citation count was 15.95. The number of publications, the total citation count, and the average number
of citations according to subject categories are given in Table 2. The course of the citation counts according to the subject of the publication is graphically given in Figure 2, and the detailed annual numbers of publications are given in Table 3. When the publications were grouped and analysed according to the study types, more than half of the publications were found to be composed of clinical studies. 376 controlled/randomized controlled clinical trials, 98 retrospective or prospective observational clinical trials, 66 laboratory trials, 64 case series/reports, 5 compilations, and 21 letters to the editor were published in the selected journals. The course of the number of publications according to the study type is graphically shown in Figure 3, and detailed annual publication numbers are given in Table 4.
2585 The number of publications evaluated for convenience at the end of first search
When the publications were examined according to the type of institution, 520 (82.4%) publications were seen to be made by the doctors of university hospitals, 98 (15.56%) by the doctors of ERH, 4 (0.63%) by the doctors of public/military hospitals, and 8 by the doctors of private institutions. A total of 59 university hospitals and 21 ERHs which published in compliance with the specified criteria was found. Başkent University was the institution which had the most number of publications, Istanbul University had the most number of citations, and Trakya University had the most number of publications per academician. Among the ERHs, Ankara Education and Research Hospital and Ankara Dışkapı Yıldırım Beyazit Education and Research Hospital were the institutions with the highest number of publications and citations received. The detailed ranking of the institutions according to the determined
Excluded (n=1895) Studies published in the journals with the impact factor (IF) lower than 1.
•
699 Detailed examination was performed Excluded (n=69) Not in the subjects of anesthesia, pain and intensive care No anaesthetist from Turkey in the list of authors
• • 630 Publications accordant with determined criteria
Figure 1. CONSORT diagram
Table 2. The numbers of publications, total citations, and the mean number of citation according to the subjects categories
Existing study
Subject category Number of publications %a
Number of citations
Mean number of citations b
TUBITAK report c
Number of Number of publications citations
Mean number of citations *
Anaesthesia 525 83 5.009 9.54 Intensive care
66
10
605
9.17
Pain
39
6
622
15.95
Total
630
6.236
9.90
1.685 12.792
7.59
Less than 100% in total due to round-off error. Number of citations listed in WoS database August 2015. c Ulakbim. Tıbbi Bilimler (2004--2014). http://ulakbim.tubitak.gov.tr/tr/hizmetlerimiz/tibbi-bilimler-2004-2014. a
b
Table 3. The distribution of the number of publications according to the subjects of studies between2005 and 2014 Annual number of publications Subject category
2005
2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
Anaesthesia
83
60 57 69 48 58 35 26 43 46 525
Intensive care
13
8 8 2 6 4 6 4 3 12 66
Pain
6
4 5 5 9 6 0 0 2 2 39
102
72 70 76 63 68 41 30 48 60 630
Total by years
19
Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 4. The distribution of the numbers of publications according to the types of studies between 2005 and 2014 Annual number of publications
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total
Letter to editor
0
0
0
0
0
1
0
0
7
13
21
Review
1 1 2 0 0 0 0 0 0 1 5
Case series/report
14 11 8 6 4 6 2 3 5 5 64
Laboratory study
10 9 11 12 6 6 3 4 1 4 66
Observational study
15 14 8 11 9 9 8 5 8 11 98
Controlled/Randomized controlled study 62
37
41
47
44
46
28
18
27
26
376
Total by years
72
70
76
63
68
41
30
48
60
630
102
Table 5. Ranking of anaesthesia departments in universities, on studies conducted about anaesthesia, intensive care, and pain between 2005 and 2014, according to the numbers of studies, numbers of citations and numbers of studies per academic staff Numbers of Number of University publications %* citations
20
Ranking
According to the According to the According to the numbers of numbers of number of publications publications citations per academic staff **
Başkent University
44
6.98
286
1
6
4
Istanbul University
42
6.67
583
2
1
12
Hacettepe University
30
4.76
371
3
5
6
İnönü University
28
4.44
393
4
4
2
Trakya University
26
4.13
433
5
3
1
Kocaeli University
25
3.97
177
6
11
3
Erciyes University
24
3.81
546
7
2
7
Gazi University
23
3.65
213
8
8
16
Gülhane Military Medical Academy
17
2.70
201
9
9
17
Ege University
16
2.54
117
10
15
34
Dokuz Eylül University
15
2.38
135
11
12
29
Uludağ University
14
2.22
226
12
7
14
Akdeniz University
14
2.22
134
13
13
28
Ondokuz Mayıs University
14
2.22
85
14
19
23
Atatürk University
14
2.22
67
15
20
9
Bülent Ecevit University
13
2.06
104
16
17
5
Selçuk University
12
1.90
47
17
27
8
Çukurova University
11
1.75
186
18
10
18
Adnan Menderes University
10
1.59
88
19
18
19
Ankara University
10
1.59
53
20
25
32
Celâl Bayar University
9
1.43
122
21
13
20
Karadeniz Technical University
9
1.43
112
22
16
31
Abant İzzet Baysal University
9
1.43
61
23
24
10
Gaziantep University
8
1.27
44
24
29
24
Marmara University
7
1.11
63
25
21
21
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics Yeditepe University
7
1.11
59
26
23
15
Bezm-i Âlem Vakıf University
6
0.95
37
27
32
36
Mustafa Kemal University
6
0.95
19
28
36
27
Kırıkkale University
6
0.95
18
29
37
13
Cumhuriyet University
5
0.79
46
30
28
25
Harran University
5
0.79
44
31
30
30
Düzce University
5
0.79
38
32
31
26
Eskişehir Osmangazi University
4
0.63
52
33
26
35
Necmettin Erbakan University
4
0.63
10
34
42
43
Süleyman Demirel University
3
0.48
56
35
24
38
Dicle University
3
0.48
15
36
38
40
Fatih University
3
0.48
10
37
43
11
Fırat University
3
0.48
3
38
45
39
Yüzüncü Yıl University
2
0.32
35
39
33
22
Sütçü İmam University
2
0.32
32
40
35
47
Afyon Kocatepe University
2
0.32
12
41
39
37
Ufuk University
2
0.32
12
42
40
33
Gaziosmanpaşa University
2
0.32
2
43
46
44
İstanbul Bilim University
1
0.16
33
44
34
51
Mersin University
1
0.16
11
45
41
48
Maltepe University
1
0.16
7
46
44
49
Giresun University
1
0.16
1
47
47
45
Bozok University
1
0.16
0
48
No citation
50
Dumlupınar University
1
0.16
0
49
No citation
46
Muğla Sıtkı Koçman University
1
0.16
0
50
No citation
42
Pamukkale University
1
0.16
0
51
No citation
41
Total
522
5,399
*Ratio to total number of publications **Calculated considering total number of professors, associate professors, and assistant professors determined on the pages of the departments of anaesthesia in the websites of related institutions in December 2015. Lecturers and specialist physicians were not included.
10-years course of the number of publications according to the publication types
120
70
100
60
80 60
Total by years
40
Anaesthesia
20
Intensive care
0
Pain 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Figure 2. Ten-years course of the numbers of publications according to the subjects
Number of publications
Number of publications
10-years course of the number of publications according to the subjects
50 40 Controlled/ randomized controlled Observational
30 20
Case series/report Laboratory study Review
10 0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Letter to editor
Figure 3. Ten-years course of the numbers of publications according to publication types
21
Turk J Anaesthesiol Reanim 2017; 45: 16-25 Table 6. Ranking of anaesthesia departments in Education and Research Hospitals, on studies conducted about anaesthesia, intensive care, and pain between 2005 and 2014, according to the numbers of studies, and numbers of citations Ranking Number of Number of Education and Research Hospital (ERH) publications citations
According to number of citations
Ankara Education and Research Hospital
24
334
1
1
Ankara Dışkapı Yıldırım Beyazıt Education and Research Hospital
13
107
2
2
İzmir Katip Çelebi University Atatürk Education and Research Hospital
7
53
3
4
Ankara Numune Education and Research Hospital
7
26
4
7
İstanbul Okmeydanı Education and Research Hospital
5
69
5
3
Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital
4
22
6
8
İstanbul Şişli Hamidiye Etfal Education and Research Hospital
3
38
7
5
Ankara Atatürk Education and Research Hospital
3
16
8
9
Adana Numune Education and Research Hospital
3
14
9
10
Ankara Türkiye Yüksek İhtisas Education and Research Hospital
3
11
10
11
İstanbul Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital
2
29
11
6
İstanbul Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital
2
9
12
12
İstanbul Kartal Dr.Lütfi Kırdar Education and Research Hospital
2
3
13
17
Ankara Keçiören Education and Research Hospital
2
0
14
21
İzmir Bozyaka Education and Research Hospital
2
0
15
22
İzmir Tepecik Education and Research Hospital
2
0
16
23
İstanbul Haydarpaşa Numune Education and Research Hospital
1
8
17
13
Hitit University Çorum Education and Research Hospital
1
7
18
14
İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Education and Research Hospital
1
5
19
15
Recep Tayyip Erdoğan University Education and Research Hospital
1
4
20
16
İstanbul Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital
1
3
21
18
İstanbul Bakırköy Dr.Sadi Konuk Education and Research Hospital
1
2
22
19
Trabzon Kanuni Education and Research Hospital
1
2
23
20
Ankara Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital
1
0
24
24
Etlik Zübeyde Hanım Women’s Health Education and Research Hospital
1
0
25
25
İstanbul Bağcılar Education and Research Hospital
1
0
26
26
İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital
1
0
27
27
Konya Education and Research Hospital
1
0
28
28
criteria is given in Tables 5 and 6. No publications were found in the selected journals belonging to 28 university hospitals and 46 ERH, which are not listed in the table.
Discussion 22
According to number of publications
Three criteria that bring “international publication activities” in the foreground gain a general acceptance in evaluat-
ing academic performance: 1) the number of publications in international scientific journals, 2) publication in scientific journals searched by scientific indexes, and 3) the number of citations to publications (8). The reputation of the journal in which the publication takes place can also be regarded as an indication of publication quality (28). Today, databases such as WoS, Scopus, and Google Scholar list the scientific peri-
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics odicals and citations to these periodicals. We also preferred using WoS database to choose the journals that we would evaluate and to determine the number of citations because it offered a well-established and reliable service and was often used in performance evaluations in our country. The PubMed database was preferred to determine the publications to be evaluated because it updates the data more frequently, the search engine was more flexible, and because it was completely free of charge. We reached a total of 630 publications by using our method that we built to determine high-quality international publications. In the report (6) in which all international publications of the same period of time were examined in Turkey by the National Academic Network and Information Centre (NANIC), of a total of 1,685 publications, including 1,117 anaesthesia and 568 intensive care medicine publications were reported. In the report of NANIC, no limit was set for the IF, the clinic which made the publication was not considered, and all the publications in the subject category were just counted electronically. When two analyses are evaluated together, it can be deduced that roughly 37% of all international publications were published in high-impact journals. While the average number of citations for all publications was indicated as 7.59 in the same report, we found that the average number of citations for the studies evaluated by us was 9.90. The world average number of citations in the same subject categories is 14.77 (6). Although the IF of our published studies in high-quality journals is slightly higher, the IF of our anaesthesia institutions in both assessments is below the world average. It was seen that 173 (27.46%) of the 630 studies published in the journals that we selected were in the European Journal of Anaesthesia and Journal of Anaesthesia. These two journals originate from Europe and Japan, respectively, and they are in the 15th and 45th places in the IF ranking. When the rest of the publication list was examined in detail, it was seen that the publications in Turkey were published in journals of Europe at a higher ratio. Despite declining in recent years, the numerical superiority of the United States still continues in the international scientific journals, and the journals with the highest IF are mostly US-based (3). In SCI and SCI-E, there are no anaesthesia, pain, or intensive care journals of Turkish origin. Turkish Anaesthesiology and Reanimation Journal was started to be searched in PubMed in 2016. Providing the criteria to enter the indexes, more national publications will increase both the overall quality of the publications and the IF of our studies (29). Detailed bibliographic analyses performed in all scientific branches have shown that the number of publications in Turkey has increased over the years, but there has been no progress in the number of international co-authored publications (14, 30). We did not conduct an analysis in our work about international collaborations, but it is considered that increasing the number of multicentered, international co-authored studies in the field of anaesthesia will increase the number of our publications which will take place in high-impact journals.
It is seen that the number of publications has decreased in all publication categories within the last 10 years. The lowest numbers of publications were observed in 2011 and 2012. This decrease was attributed to the reorganization of the ethics committees necessary to initiate and carry out the studies after the “Regulation on Clinical Investigations No. 28030” which entered into force in 2011. Although the number of publications started to increase as of 2013 due to the amendment of the related regulation in 2013 and the compliance of the clinics with the new methods, the figures of 10 years ago have not been reached yet. The most consistent and continuous studies in terms of the assessment of the performance of a single science branch were conducted and regularly published by Onat in the field of cardiovascular medicine (27, 31-39). Similarly, Onat reported that a significant decrease occurred in the number of publications in the field of cardiovascular medicine since 2004 (33), the lowest levels were reached particularly in 2011 (36), and a trend of a quantitative increase started since 2013, although not in terms of quality (38). Onat has attributed the decline in the number and quality of academic publications to the reduction of academic competence and interest in research, the retrenchment of the state support in the field of research, the inability to keep the experienced academic staff in state-affiliated universities and hospitals due to the current system based on performance, and the limitation of academic working time because of the increasing burden of outpatient care. It was seen that the vast majority of publications was about anaesthesia, and the publications in the fields of intensive care and pain accounted for only 15% of the total publication volume. It is noteworthy that the studies in intensive care increased rapidly in 2014. However, when the publications in 2014 were examined in detail, it was seen that 6 of 12 publications were in the form of “a letter to the editor.” The fact that the subspecialties of intensive care and pain subsidiary to the department of anaesthesia has newly been established can explain our shortcomings in both fields. Another explanation is the need for a large number of patients, data, longterm observations, and advanced statistical analyses to make sufficiently strong analyses in the fields of pain and intensive care and to produce high-quality publications. It is quite difficult for single department to be able to meet these criteria alone. This makes it very difficult to publish thes studies in high-impact journals. As a matter of fact, 11 of the 13 journals with no publications from Turkey are the journals specialized in the field of intensive care and 2 in the field of pain (Table 1). In addition, 4 of the top 5 journals in terms of IF were about intensive care and pain. To improve the academic performance in these fields, it is necessary to head toward interdisciplinary collaborations and to seek cooperation in international multicentre studies (30, 40). The picture is quite promising in academic performance analysis in terms of the types of publications. Clinical trials constituted more than half of the studies published in high-quality journals, and a majority of them were reported as randomized controlled clinical trials. Swaminathan et al.
23
Turk J Anaesthesiol Reanim 2017; 45: 16-25 (41) evaluated the clinical trials of clinical anaesthesia departments in 2007 and reported that Turkey was the country that produced randomized clinical trials at the highest rate of 88%. This outcome of 2007 can be explained by the fact that receiving informed consent is relatively easier than in the developed countries, and the regulatory legislation and controls are more flexible. The fact that clinical investigations began to be tightly controlled reduced this rate in 2011, but it is still at a level that can be considered successful. The next step is the creation of joint work commisions and advisory boards required to keep the quality of all conducted randomized controlled trials high, and the formation of structures that will give support about statistical issues and scientific writing. Almost all of our high-impact publications were made by university hospitals and ERHs, and the proportion of other institutions was 2%. Although the task and ability to conduct research and development belongs to university hospitals and ERH, it should not be ignored that the vast majority of human resources is in state hospitals. Inclusion of the anaesthetists working outside of the research institutions in research activities, will undoubtedly improve scientific performance. It is also noteworthy that many university hospitals and ERH have no publications in high-impact journals. After providing the minimum requirements for transition to academic positions, academicians are changing their institution and city due to various concerns. This might be affecting the continuity of scientific research activity in the institutions they have left and might be preventing the increase in quality. When Tables 5 and 6 are examined, it is seen that some institutions that publish a large number of publications fall behind in ranking in terms of the number of publications per academic staff. This is an indicator that institutions' scientific publication performance is bound to a limited number of researchers. The basic necessity for solving the problems we have mentioned is to make the culture of scientific research and scientific writing independent from individuals and to institutionalize it. In the short term, the creation of structures that can provide consultancy and service at the national level may be the first step to a solution. We believe that giving the culture of scientific research and writing in an applied way beginning from the studentship, facilitating the access to scientific data for all physicians working in institutions, including small-scale hospitals, and the establishment of institutional structures to provide methodological counselling in proportion to the size of the institutions will compensate the deficiency in this field.
24
Our work has many limitations due to methodology.First, our data quality is limited to the quality of the databases we use. Possible spelling mistakes at author addresses could have affected our search result. The classification used by the WoS database for periodicals may not be covering all the publications in this field. Likewise, periodicals published in more than one discipline may have been listed in a different subject category even though they publish the topics that anaesthetists interests in. This issue has caused some of the studies to be left out of our investigation. Because it would
take a long time to individually review all the publications due to our limited sources; through the method that we used to select high-quality publications, we think that we have formed a proper sample. Other limitations often relate to the performance analyses of institutions. Limiting our work with the articles published in the journals with an IF of 1 leads to ranking differences in performance evaluation. For example, the ranking is quite different in the report in which all publications in SCI and SCI-E are reviewed by NANIC (6). However, not anaesthesiology clinics, but the universities have been sorted in that report and by analysing the electronic data, all science branches publishing in that subject category have been included in the evaluation. In this sense, our study presents superiority in terms of evaluating the performance of anaesthesia clinics in particular. Another limitation arises from the 10-year time interval we used. This wide time interval is inevitably accompanied by the changes in the structures of institutions and the number of faculty staff. Faculty staff may have transitioned between institutions and even the list of faculty members may have changed completely. In addition, the number of faculty members has been obtained over the internet sites of the institutions, and it is possible that they did not have updated information. In addition to this, only the institution of the first Turkish anaesthesiologist in the list was evaluated. In multicentred studies, more than one institution may have contributed in equal amounts, which may have led to a lower number of publications for some institutions. However, since an evaluation involving all authors requires highly sophisticated methods of analysis, we could not make these evaluations. Finally, these ranking will not be fair for the universities established less than 10 years ago. Annual evaluation and publication of the academic performance will solve this problem to a certain extent. Our findings should be evaluated carefully considering all of these limitations. In recent years, several serious studies have been conducted in the field of bibliometry in our country (2, 3, 5, 6, 13--16, 40, 42). We believe that repetition of the analyses by receiving professional support from these departments will greatly reduce the limitations in the future.
Conclusion Our study is the first analysis that examines the scientific publication production performance of anaesthesia clinics in Turkey. It has been observed that our international scientific publications tend to decrease in the last 10 years, the improvement in the last 2 years is not yet in sufficient level, and the average number of citations is below the world average. We believe that the performance analyses to be performed at certain intervals will be useful in terms of determining the publishing policy and objectives of our speciality and institutions. Peer-review: Externally peer-reviewed. Author Contributions: Concept - A.T., H.O.Y., R.B.; Design A.T., H.O.Y., R.B.; Supervision - A.T.; Resources - H.O.Y., R.B., O.A.T., B.B., A.T.; Materials - H.O.Y.; Data Collection and/or Pro-
Yılmaz et al. International Publication Performance of Turkish Anesthesia Clinics cessing - H.O.Y., R.B., O.A.T., B.B., A.T.; Analysis and/or Interpretation - H.O.Y., O.K., A.T.; Literature Search - H.O.Y.; Writing Manuscript - H.O.Y., O.K.; Critical Review - A.T. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support.
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