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Three Editors' Perspectives FREE TO VIEW

Alfred Soffer, MD, Master FCCP; A. Jay Block, MD, Master FCCP; Richard S. Irwin, MD, Master FCCP
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

Copyright © 2009 American College of Chest Physicians

Chest. 2009;136(5_suppl):e16-e18. doi:10.1378/chest.09-2262
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In its 75-year history, Diseases of the Chest/CHEST has had only seven editors in chief. During that time, the journal changed names, moved from all paper to electronic, and changed focus from tuberculosis to all diseases related to pulmonary, critical care, and sleep medicine. Past Editors in Chief Alfred Soffer, MD, Master FCCP, and A. Jay Block, MD, Master FCCP, and current CHEST Editor in Chief Richard S. Irwin, MD, Master FCCP, shared their thoughts on what has made the journal so successful for the last 75 years and where the journal is headed in the future.

Dr. Soffer: A large part of the success of the journal comes from the use of out-of-office or independent medical consultants to review articles. Although this is standard practice now for medical journals, prior to 1968 when I became editor in chief, the decision to accept or reject an article in CHEST was based, in most cases, on the editor in chief's decision. When I became editor, I required that every article be sent out for review by outside consultants. In 25 years, I was able to establish a robust network of > 8,000 medical consultants to review our articles.

During my tenure, I also ensured that every article we published was the best it could possibly be. On submission, the majority of articles would undergo at least one revision, incorporating suggestions from the editorial board, the editor, and out-of-office consultants. In most cases, these suggestions were welcomed by the authors and helped make the articles much stronger and, thus, strengthened the image of the journal.

Dr. Block:CHEST has been successful because it has adapted to the needs of clinical chest physicians and health-care professionals. When CHEST first started out as Diseases of the Chest in the 1930s, it was primarily a tuberculosis journal. Years later, as tuberculosis began to be eradicated due to antibiotic drug breakthroughs, Diseases of the Chest shifted its focus to broader topics, including lung cancer, cough, other respiratory infections, thoracic surgery techniques, and so on. Its multidisciplinary nature has served its readers and the members of the ACCP very well, and it has never wavered from its true mission to educate physicians about aspects of patient care. CHEST has always served the practicing clinician.

Dr. Irwin:CHEST is unique because for the past 75 years, it has combined a focused clinical orientation with its multidisciplinary coverage of topics. It truly reflects the ACCP's mission of improving patient care through education. The amalgamation of expert commentaries, high-quality clinical research, reviews of current topics, and case-based educational sections has developed over the years and been tweaked by each editor. And, we're not done yet. Each of the editors in chief has had as a guiding principle: what do our readers need and want to read now and in the future?

Dr. Soffer: There is no school for journal editors; you learn on the job. You also need a number of years to make your impact on a journal. When I assumed the position of editor, the editorial board and I placed a high priority on encouraging submission of articles of clinical relevance and originality. As authors realized that strict acceptance and rejection policies were in effect, and they learned that thoughtful revision recommendations were implemented, the caliber of articles submitted increased sharply. The distinguished scientists who served on our editorial boards made it possible to effect these changes.

Dr. Block: Each editor built on CHEST's success, and each editor was committed to maintaining the journal's clinical focus.

Dr. Irwin: The one word answer to this question is continuity. Unlike many of our sister journals in the respiratory field, ACCP, beginning in 1946, has allowed for an editor in chief to remain in the job for more than a short 5-year term. Because it usually takes between 1 and 2 years for an editor in chief to “learn the ropes” and implement new ideas and assess how the journal is doing on its new course, a short 5-year term does not allow for the necessary continuity to make mid-course corrections when things are not going in the right direction.

Dr. Soffer: Changes to CHEST paralleled changes happening in medicine. The journal was first focused mainly on pneumonia and tuberculosis – the most significant lung infections of that time. As the world changed and pulmonary medicine became more sophisticated, the spectrum of what was included in pulmonary medicine also changed. Diseases of the Chest began to publish studies in COPD and asthma. After a number of years, we realized it was impossible to discuss lung diseases effectively without incorporating the cardiovascular system. The change of the name to CHEST was reflective of the concept that, in addition to evaluation of cardiopulmonary medicine, we would aim to publish studies involving the physiology of cardiopulmonary medicine in health and disease.

Dr. Block: In the course of my 12 years as editor in chief, there were several key changes.

The focus on some topic areas shifted. Cardiology was one area that began to change a bit. CHEST has always been an interdisciplinary journal and had been overlapping into cardiology for many years, but there were so many cardiology journals in the field that I wanted to focus on some other areas of chest- and breathing-related clinical science. In addition, sleep medicine (and specifically sleep-disordered breathing and snoring) was an emerging field for pulmonary physicians, and CHEST began publishing more sleep-oriented clinical research and reviews. Finally, critical care had been increasingly moving into the domain of the pulmonologist, and it made sense for CHEST to have a significant amount of critical care content. Al Soffer had begun this and had published the paper by Bone and colleagues on the definitions of sepsis in 1992. It's crucial that CHEST be relevant to ACCP members' clinical experience, and I wanted to ensure the journal continued to reflect what was happening in the real world of medicine. Any changes that happened were intended to grow CHEST's reputation and relevance among clinicians.

Another major area of change involved technology. During my editorship, the journal went fully online, where it became accessible by millions of people around the world. CHEST immediately became a more highly recognized international journal due to its accessibility through the World Wide Web. CHEST also moved to an online submission and peer review system. As a result, CHEST submissions increased by nearly 40% in 1 year from about 2,400 to > 3,300. The submissions also shifted from being approximately 65% North American and 35% international to almost the exact reverse.

Dr. Irwin: During the first 4 1/2 years of my stewardship, the journal took on a new look that heralded the beginning of a new era in response to the ever-changing medical publishing field; and its impact factor soared. The cover became fresher and more modern, but, purposely did not lose the identity of its heritage. In parallel, while the journal added content and technology to become more reflective of contemporary times and needs for a more diverse readership (poetry, transparency in health care, medical ethics, editorial cartoon, medical writing tips, translating basic research into clinical practice, procedure videos, and animations) and began focusing more on critical care and sleep medicine, it continued to address the needs of the clinical readership (original clinical research, pearls, and clinical reviews).

Dr. Soffer: First, the articles published on ARDS were among the most historical studies published during my tenure. The articles made a significant contribution to world medicine and helped establish CHEST as an authoritative source of ARDS research. Secondly, I wish to emphasize the importance of the investigations concerning the safe use of the antithrombotic agent warfarin. These investigations provided a historical understanding of how warfarin could be used more safely by using the dosage recommendations established by the American College of Chest Physicians.

Dr. Irwin: It takes years to determine the answer to this question. But, since July 2005, ACCP evidence-based guidelines in antithrombotic and thrombolytic therapy and in the diagnosis and management of cough are two of the most frequently read articles in CHEST.

Dr. Soffer: Cellular biology is where medicine is headed, and CHEST will follow this lead.

Dr. Irwin: The successful journal of the future, whether it be 2010 or 2019, will need to publish content that will be meaningful and essential to a more diverse group of readers and subject matter that is easier and faster to read and access. In this regard, CHEST will need to find ways to enhance teaching, and the content will need to become more reflective of contemporary societal issues and the practice of medicine. For example, in 2008, we launched multiple new initiatives, such as publishing a monthly editorial cartoon entitled “Second Opinion” that covers the medical news in a different way than others and immortalizes the medical-political issues of our time. While “Second Opinion” has primarily dealt with issues common to the United States, we have no doubt that it will take on a more global perspective as globalization of medical issues continues to evolve. We have also started publishing poems that touch on the art and humanity of medicine in the series entitled “Pectoriloquy” and, a new section “Transparency in Health Care” deals with patient safety issues. Moreover, to enhance the educational experience of our readers, we have begun publishing online animations of respiratory physiologic concepts in our series entitled “Interactive Physiology Grand Rounds” and will soon initiate videos of a wide spectrum of respiratory, critical care, and sleep procedures in our series “Procedure Videos Online.” In addition to adding new content and enhanced ways of displaying it, we have tightened up on our Instructions to Authors in the spirit of improving the accuracy of reporting results; and we are providing free access for our CHEST subscribers to our complete archive of CHEST articles going back to the first issue in 1935.

While our crystal ball is a bit cloudy on what the publishing environment will look like for CHEST in 2019, one thing is certain—we will be utilizing in an ever-increasing way the advances and the power of information technology.




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