An Unexpected Discussion; How to Close the Loop?

Screenshot 2014-05-21 17.44.47A few weeks ago, on one of my other digital knowledge translation projects, I wrote about an article published in the Emergency Medicine Journal: “Prehospital use of furosemide for the treatment of heart failure”. The content of the article – making an accurate diagnosis of dyspnea is difficult in the prehospital setting, and that many patients given furosemide prehospital failed to be ultimately diagnosed with heart failure – surprisingly resonated with an unexpected cohort of readers.

In fact, with over 4,000 views in just a few weeks, this post and subsequent discussion ranks among the most popular ever hosted on the site.

Yet, as hosted on the EMJ site, there are three “likes”, an Altmetric score of 30 based on mention in 37 tweets, and zero posted responses.

This article will certainly have some reach in print. But, as far as its digital life – the entire post-publication peer review and discussion is taking place entirely disjoint from the article. Visitors to the EMJ site have no indication of the critical appraisal, nor the discussion among physicians and paramedics, nor does it appear there is any mechanism through which the authors might alerted to these comments unless made happenstance aware.

This is a serious challenge and opportunity for those engaged in knowledge translation – how to transform scholarly publiciation from a static end-product, to truly just the beginning of discussion and discourse as part of a living body of evidence. How should traditional journals embrace and incorporate post-publication peer review and critical appraisal? What sort of editorial process ought be in place to moderate ongoing discussion?  How much difference does Open Access make?

The knowledge engines of medicine are changing. The newly minted digitally facile learner is consuming and connecting with experts and authors through online tools – Twitter, blogs, social media sites – in a way past generations were unable. As I’ve noted before, you can read at least 18 experts’ comments on Targeted Temperature Management – yet all these ideas live in their separate bubbles, with disconnected discussion, and disjoint from the digital home of the original publication.

What ideas do you have for tying all this knowledge together? How would you go about effecting change?  Should the independent bloggers band together to centralize their resources, or ought the journals take the lead on seeking out and collating the unsolicited post-publication peer review?



Ryan Radecki

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