HROPen: one year on

Cover HRO

Published 27 September 2018

As ESHRE's open-access journal HROpen settles into its second year, editor-in-chief Siladitya Bhattacharya reviews progress so far and reaffirms its mission that reproductive science need not be the preserve of the few.

A year ago, in the very first issue of HROpen I wrote: 'Our vision is to create a shared repository for scientific and clinical knowledge for patients and clinicians which can facilitate joint decision-making.' In other words, we aimed to publish high quality reproductive science which was believable and accessible. One year on, it's time to ask, to what extent have we achieved our aim?

High quality science
At a time when the sheer volume of the scientific literature is staggering, it is easy to overlook the fact that the primary purpose of medical journal papers is to report discoveries which have the potential to improve health care.
Advances in research can be radical, but they are much more likely to be incremental in nature, building on previous progress. Citations, which are conventionally seen as the currency of success in scientific publishing, tend to be driven by results which are new, exciting and unexpected. Most of these novel findings are not replicated – something which has called into question the authenticity of research and fuelled calls for ways of minimising error. We have traditionally believed results supported by p-values of less than 0.05. In reality, regardless of the p-value, the veracity of a research finding can be undermined by a low prior probability, small sample size, a clinically insignificant margin of difference (effect size) and testing multiple associations without a priori planning.

We are just beginning to accept the fact that validation of the truth through replication is just as important as a seminal discovery, and much more important in the long run in establishing the evidence base which ultimately can change clinical practice for the better.

Reluctance to publish the 'nth' study on the same topic (especially with negative results) can lead to publication bias or encourage unplanned interrogation of the data in an attempt to unearth fresh associations. Multiple independent studies (including those which are considered neither 'novel' nor associated with positive results) can allow reliable conclusions to be drawn through appropriately conducted meta-analyses. Triangulation or integration of results from different approaches with different sources of bias (either additive or opposing), has been advocated as a way of providing reliable answers to research questions, while pre-publication of protocols can prevent unplanned analyses. We are keen to support these types of studies, which increase our confidence in causal associations and the effectiveness of interventions or describe plans for high quality research. Ultimately, we value results which can be used to improve patient care over findings which are 'new' but need further confirmation by other researchers. It goes without saying that all our papers need to be methodologically sound and are subjected to rigorous peer review.

Access to all
If scientists are the producers and journals the curators, the consumers of medical research are policy makers, health care providers, and consumers. Our free online access has allowed greater reach and diffusion of scientific information to key stakeholders beyond the academic community.

Whilst metrics such as citation counts and impact factor represent dissemination of knowledge among scientists, they do not measure the impact of knowledge on health wealth, society and the economy. Evaluation of broad non-academic impact requires the interrogation of a wider set of sources, including news articles, political debates and social media posts. Our data show us that articles from HROpen have been downloaded over 57,000 times in the past 12 months, by readers in over 80 countries.

HROpen remains the only journal in reproductive health to include a plain Eenglish summary which eschews jargon and technical terms whilst explaining the meaning and relevance of the scientific facts.

The open-access format allows patients to access these summaries to better understand their conditions and make informed decisions about their own care. The civic mission of a medical journal must ultimately be to disseminate scholarship leading to improved health.

Our journey
We started small. Over the past year, we have received 93 submissions and published 43 of them. These include 26 primary research articles, five reviews, one protocol, eight guidelines or ‘ESHRE Pages’ and two commentaries – a balanced assortment of primary research, reviews and guidelines. I wish to pay tribute to our Associate Editors, editorial office team and external peer reviewers for their extraordinary commitment in maintaining the high standards our readers have come to expect from the ESHRE journals. I also wish to thank authors who have published their work in HROpen and our readers who have accessed them.

The next step in our journey is to be indexed in PubMedCentral (application in progress). As the journal becomes more established, we anticipate indexing in other third party databases, including Clarivate’s Emerging Sources Citation Index (ESCI), which may lead to later inclusion in their Journal Citation Reports and the award of the well-established metric applied to journals: the Impact Factor. We know that Impact Factor is important from the perspective of authors who publish in HROpen, but we will remain steadfast in our aim to publish science which is credible and has impact rather than findings which dazzle but cannot be duplicated.

Knowledge about healthcare should not be the preserve of the very few who have the ability to pay or the training to penetrate jargon. By making reproductive science accessible to all, HROpen remains a transformative force for the application of research evidence in everyday clinical decisions. A year on from our first issue, I believe that we have fulfilled our promise.