Uncertainty and Certainty.

Deciding to post a manuscript preprint

Peer Review: The Best of the Blemished?

Challenges and opportunities of electronic publishing

Using preprints in evidence synthesis: Commentary on experience during the COVID-19 pandemic

The received wisdom is that peer review is a thankless task. Peer reviewers are overworked, unpaid, unacknowledged and generally unrewarded. Peer-review processes are not standardized, and each journal or grant review body has its way of deciding what should be approved for publication or funding, respectively. Peer review has also been a secretive process that was largely unstudied until the 1990s. The evidence on peer review in journals has improved in that time, although the central conclusion still holds: peer review is best for improving the quality of articles that editors decide to publish but it is not an objective decision-making process for selecting the best articles. A publication in a major journal is no guarantee of quality and will probably contain several errors, since peer review is poor at eradicating those errors or detecting research misconduct. Sensible journal editors have accepted this reality, and acknowledge the flaws in the system they supervise. Beyond this honest appraisal of peer review, journals can help by introducing open peer-reviewer processes whereby the identity of authors and peer reviewers are not hidden to each other. The research evidence suggests that open peer review does not affect the quality of decision-making at a journal but improves the quality of the conversation between the authors, reviewers and journals. The JRSM has an open peer-review process. The identity of peer reviewers, however, is still usually hidden from readers. Sometimes authors are kind enough to thank peer reviewers in their acknowledgements at the end of a paper. Some journals list peer reviewers without linking them to specific papers – a policy that the JRSM used to follow. A few other journals pay reviewers a small amount or offer them institutional or membership discounts, an existing JRSM benefit. Nonetheless, the reward that peer reviewers receive is paltry in relation to their effort and the contribution that a good peer reviewer can make to improve a paper. Many peer reviewers justify the effort as a necessary contribution to scientific discourse but also as a contribution to their personal development. Many are simply interested enough in the topic to lend their services. Scientific journals only thrive because of the passion of peer reviewers and the patience of readers. From 2010, the JRSM will be taking a bold step in improving the transparency of peer review. We will name peer reviewers on each peer-reviewed article that we publish. This journal does not have the resources to conduct a randomized trial before making this change as bigger journals are able to do. But the editorial team believes that it is the right decision in terms of openness. Any peer reviewers who do not wish to be named can simply decline to peer review the article they have been sent. We would welcome your views on this small but important development.

Peer Review and the PJOHNS: Principles, Problems, and Promise

Peer Review in Transplantation.

FigureThe concept of peer review can be interpreted very differently among nurses and healthcare professionals. Some think of a subject expert reviewing a manuscript for a journal's editorial staff. Others think of regulatory bodies requiring hospitals to have an internal process to ensure that healthcare team members are competent and able to perform within their scope of practice.1 Still others think of peer review as a quality assurance process in which healthcare team members audit each other's documentation to validate care standardization. We provide insight into a nursing peer review process designed to evaluate performance, and the journey to its implementation. A well-defined peer review process and tool, utilized in conjunction with a nurse's annual performance evaluation, is one way to infuse meaningful peer input into a performance appraisal. This system allows nurses to provide insight into one another's strengths and opportunities for growth. A detailed approach was used to create, develop, and sustain a nursing peer review program that's flexible enough to be used by all staff members within a pediatric hospital system. In addition to promoting professional growth among nursing staff, this process also meets the current peer review standards set by the Magnet Recognition Program® and The Joint Commission. The ultimate goal of sharing this information is to help other organizations that are just beginning the peer review process and those that have struggled in the past with development and implementation to bring about a sustainable change. This, in turn, will promote nursing cohesiveness and professionalism as we work together to bring healthcare into a new era. Organizational standardization Our organization embarked on an initiative to create a standardized peer review process that would be utilized by all nursing departments. The process needed to be integrated organizationally and applicable to clinical nurses within both inpatient and outpatient environments. This journey began with a review of the current literature and an examination of the current peer review practice at other Magnet® facilities. Through this process, it was discovered that the majority of these facilities utilized and defined peer review in a variety of ways. We identified variation in the management of the peer review process within our own organization. Acknowledging the vast array of discrepancies within and external to the organization, a task force of clinical nurses was developed to redefine the way our organization administered the clinical nurse peer review process. This task force also included two leadership liaisons who served as resources to the clinical nurses during this development and provided insight into the management side of the peer review process. There were four steps in our process: (1) defining a peer, (2) developing a peer review form, (3) transforming the process, and (4) implementing the process. Who's a peer? The first step in our work involved evaluating, discussing, and reaching a consensus on the definition of peer. In order to standardize the peer review process, the task force recognized a true definition was needed to measure success with the new process. Looking at previous peer review practice in the organization, many nurses and department directors had different definitions and ideas of what it meant to be a peer. Some departments included other disciplines in a nurse's specialty for evaluations, whereas others utilized only fellow nursing staff members. The task force agreed that the purpose of peer review is to foster professional growth and development among staff members by utilizing a process through which measurable outcomes are assessed. After much dialog, the task force adopted the definition of peer utilized by the American Nurses Association, which defines a peer as an individual of the same rank or standing according to the established standards of practice.2 Form development The next step in redefining the peer review process was to develop a new peer review tool that could be transferrable and applicable among the various nursing specialties and departments. Key areas identified by the task force for development of this tool included creating a short, concise form that's easy to understand with limited directions and applicable to all clinical nursing departments. To achieve this goal, the task force worked collaboratively to establish eight domains that would provide nurses with a peer evaluation framework. These domains were established through open dialog, including question-and-answer sessions, review of current job descriptions, and evaluation of other tools utilized by various Magnet facilities. Through this work, a common set of core expectations were identified and utilized in the development of each domain. These domains encompass the essential clinical nurse job functions, behavioral competencies, and basic roles and responsibilities throughout the organization. The domains can be found in Table 1.Table 1: The eight domains of peer evaluationTo further guide and support high-quality peer feedback, three to five specific, measurable objectives were created and listed under each domain for nurses to measure performance. These objectives were developed to guide peers in evaluating each nurse by providing focused, pertinent feedback. The task force wanted to eliminate vague, nonspecific feedback that didn't facilitate the identification of future growth opportunities. The objectives created by the task force assist peers in identifying evidence from the nurse's daily work, communication, time management, and interdisciplinary interactions. Each domain also included a comment field, allowing nurses the autonomy to provide open-ended feedback and elaborate on outstanding work or opportunities for the employee's growth and improvement. The comment section was extremely important in the solicitation of meaningful feedback because it allowed nurses to provide examples to reinforce the ratings selected for the objectives. The directions on the new tool clearly state that comments are mandatory for certain ratings to allow for elaboration and examples. The task force believed a Likert rating scale was essential to standardize the peer review process. The previous process utilized a vague, numerical score that hadn't historically provided nurses with adequate descriptions of their work ethic and performance. Lower scores were considered negative responses, whereas higher scores equated to positive responses. After review of the current literature, the task force employed a 4-point Likert scale comprising "not met," "approaching," "meets expectations," and "exceeds expectations." In addition to the scaled questions, an open-ended question "Do you feel comfortable working with this nurse?" was added to the form. Utilizing a mixed-method methodology, Likert scale, and open-ended question format allowed the evaluating nurse a better opportunity to provide real-life contextual examples related to the evaluated nurse's care.3 Process transformation After the peer evaluation tool was created, the task force focused its attention on creating a framework to aid departments in implementing the new peer review process. Throughout our hospital, there are units of vastly different sizes. Some nursing departments have four to six clinical nurses, whereas other departments have as many as 150 to 200 clinical nurses on staff. The variability in staff sizes meant that the task force had to be creative in determining how many peer reviewers should evaluate each nurse annually and how these reviewers should be selected. With the new process, each nurse receives feedback from two to four RNs. Limiting the number of peer evaluations eliminated the previous dissatisfaction and/or barrier of evaluators being asked to fill out 20 to 30 peer evaluations a month due to exceedingly large nursing departments. The task force also allowed clinical nurses to select one to two peers of their choice to provide feedback; the management team selected the remaining peers. Implementation After the task force completed the new peer review tool and process recommendations, the nursing department directors and the CNO gave the approval for implementation. The standardized peer review form, along with the revised process, was implemented using various educational modalities. The first presentation was provided to the inpatient and outpatient nursing directors to inform them about the new form and the revised process. The directors were provided with handouts outlining the changes and educational fact sheets for the staff members to use as a reference. The task force increased its availability to ensure educational consistency to all clinical nurses by attending and presenting at unit-based councils, charge nurse meetings, and department-wide staff development programs. The feedback received from the different educational presentations was extremely positive. Feedback discussed the tool's ease of use, applicability to all nursing departments, appropriate form length, and measurable objectives that allowed nurses to comment on focused job roles and responsibilities. Other feedback included the improved functionality of the new rating scale and the process change that limited the number of requests for peer evaluations. Some directors expressed resistance to changing their current peer review practice. Certain directors thought feedback from four nurses wasn't enough if the department had a high number of nursing staff members. After an open discussion with the task force chairperson and the directors of large departments, it was agreed that meaningful feedback from four people would be adequate. Other directors mentioned that they liked the idea of adding specific clinical skills for peer evaluation. However, we couldn't add specific skills because they wouldn't universally apply to the various nursing department specialties. The task force collected all comments and feedback, and created a frequently asked questions document to address these concerns and explain the thought process behind the decisions made about the tool and recommendations. Directors were then provided with answers to and rationales for their specific questions and concerns, creating a consistent message and clarity to all departments. All education and implementation occurred over the course of 4 months. During this time, the task force worked with web development to formulate an electronic version of the peer evaluation document for the purpose of online submission. The electronic document was widely popular because it eliminated the use of paper and facilitated tool access for all clinical nurses. Staff members were able to complete the tool online and submit the evaluation through the organization's intranet directly to the person who requested the feedback. The task force also concluded that in order for this new tool and process to remain functional and meaningful, continued evaluation of its use would be essential. Reaching the top As we diligently work to move the nursing profession forward, it's important to remember that peer review can positively impact not only an individual's nursing practice, but also an entire hospital system. Nurses are at the forefront of healthcare transformation and are integral to sustainable practice improvement. By empowering clinical nurses to lead this initiative, we've been able to successfully introduce, develop, and support a valuable peer review process across our organization. Utilizing a comprehensive peer review tool can help organizations improve patient outcomes and patient satisfaction.

Group Peer Review: The Breakfast of Champions.

BackgroundThe Patient-Centered Outcomes Research Institute (PCORI) is obligated to peer review and to post publicly “Final Research Reports” of all funded projects. PCORI peer review emphasizes adherence to PCORI’s Methodology Standards and principles of ethical scientific communication. During the peer review process, reviewers and editors seek to ensure that results are presented objectively and interpreted appropriately, e.g., free of spin.MethodsTwo independent raters assessed PCORI peer review feedback sent to authors. We calculated the proportion of reports in which spin was identified during peer review, and the types of spin identified. We included reports submitted by April 2018 with at least one associated journal article. The same raters then assessed whether authors addressed reviewers’ comments about spin. The raters also assessed whether spin identified during PCORI peer review was present in related journal articles.ResultsWe included 64 PCORI-funded projects. Peer reviewers or editors identified spin in 55/64 (86%) submitted research reports. Types of spin included reporting bias (46/55; 84%), inappropriate interpretation (40/55; 73%), inappropriate extrapolation of results (15/55; 27%), and inappropriate attribution of causality (5/55; 9%). Authors addressed comments about spin related to 47/55 (85%) of the reports.Of 110 associated journal articles, PCORI comments about spin were potentially applicable to 44/110 (40%) articles, of which 27/44 (61%) contained the same spin that was identified in the PCORI research report. The proportion of articles with spin was similar for articles accepted before and after PCORI peer review (63% vs 58%).DiscussionJust as spin is common in journal articles and press releases, we found that most reports submitted to PCORI included spin. While most spin was mitigated during the funder’s peer review process, we found no evidence that review of PCORI reports influenced spin in journal articles. Funders could explore interventions aimed at reducing spin in published articles of studies they support.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Editors of the journal and the Section Editors for this issue. EDITORS John F. ButterworthJohn F. ButterworthAfter graduating from the Virginia Commonwealth University (VCU) School of Medicine, Virginia, USA in 1979, Dr Butterworth served as trauma research fellow in the Division of Neurological Surgery at VCU. He completed his surgical internship at the University of Massachusetts Medical Center, USA. He completed his residency in anesthesiology and a research fellowship at the Brigham and Women's Hospital, Massachusetts, USA, before joining the obstetric anesthesia staff at the Brigham. He moved to the Wake Forest University School of Medicine, North Carolina, USA in 1985. In his 20 years at Wake Forest, Dr Butterworth served as vice chair for research, section head of cardiothoracic anesthesia in the Department of Anesthesiology and Director of the Office of Clinical Trials Research for the medical school. In 2005, he moved to the Indiana University School of Medicine, USA and served as the R. K. Stoelting Professor and Chairman of the Department of Anesthesia. In 2011, he returned to VCU as Professor and Chairman of the Anesthesiology Department, and served in those roles until his retirement in 2020. Dr Butterworth has served on the board of the International Anesthesia Research Society, including a term as chair. He has also served on the boards of directors of the American Society of Regional Anesthesia and Pain Medicine and the Medical Society of Virginia as well as a trustee of the Richmond Academy of Medicine, USA. In addition, he served on the board and as president of the North Carolina Society of Anesthesiologists and on the board of the Indiana Society of Anesthesiologists. In 2018, the Medical Society of Virginia honoured Dr Butterworth with the Clarence A. Holland, M.D. award. The award recognizes MSV member physicians who have high personal integrity and have been outstanding leaders in their fields. Dr Butterworth has had an active research career with more than 150 publications in refereed journals. His interests are in local anesthetics, regional anesthesia, and cardiovascular pharmacology, pharmacokinetics, management and outcomes. He has written or edited several textbooks, monographs and numerous book chapters. He currently serves on the editorial boards of several journals: Regional Anesthesia and Pain Medicine, Anesthesia and Analgesia, Anesthesiology, and the Journal of Thoracic and Cardiovascular Surgery, and is co-Editor in Chief of Current Opinion in Anesthesiology. Kai ZacharowskiKai ZacharowskiProfessor Kai Zacharowski, MD PhD ML FRCA holds the position of the Ordinarius and has been the Director of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt, Germany, since 2009. From 2006 to 2008, he held the position of Chair of Anaesthesia and Intensive Care Medicine at the University Hospital Bristol, UK. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, patient blood management and clotting, big data in anaesthesia and intensive care medicine, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz, Germany and his PhD from Queen Mary, University of London, UK (where he was working with the Nobel laureate Prof. Sir John Vane who discovered how aspirin works). Since 2016, he is one of the few members of the oldest academy of science in the world, Leopoldina. His scientific contributions are published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science (in PubMed has currently over 460 contributions listed (http://www.ncbi.nlm.nih.gov/pubmed?term=zacharowski)) and were awarded with numerous awards for Innovative Clinical Research (e.g. in 2021 the Exzellenz-Award, in 2020 the Future Medicine Science Award, in 2018 the MSD Gesundheitspreis (3rd), in 2016 the German Price for Patient Safety, in 2015 the Humanitarian Award together with the US-Presidents Barack Obama and Joe Biden, in 2014 the Lohfert Award for Patient Safety and in 2012 the United States Air Forces - Medal of Distinction). He is serving as Editor-in-Chief for Current Opinion of Anesthesiology and the Journal of Anaesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in critical care medicine, emergency medicine and anaesthesia. He is also the CEO of the Lohfert Foundation and the Founder and CEO of the PBM Foundation. From 2014 to 2018, Prof. Zacharowski served as President of the Multiple Joint Committee Intensive Care Medicine (UEMS) (https://www.uems.eu/) and as ESAIC Council Member for Germany (http://www.esahq.org/about-us/the-esa/council). From 2013 to 2018, Prof. Zacharowski served as a delegate for Germany UEMS Section & European Board of Anaesthesiology and, from 2013 to 2020, as Deputy Medical Director of the University Hospital Frankfurt. Prof. Zacharowski is serving as President of the European Society of Anaesthesiology & Intensive Care for the years 2020–2021 and practicing anaesthesia and critical care medicine in Frankfurt. SECTION EDITORS Nirvik PalNirvik PalNirvik Pal, MBBS, MD, FASE is an Associate Professor in Anesthesiology at Virginia Commonwealth University, Richmond, Virginia, USA, and serves as the Program Director for the adult cardiothoracic anesthesiology fellowship. He is double board-certified in anesthesiology in India and the USA. He earned his medical graduation (MBBS) and post-graduation in anesthesiology (MD) degree in India, after which he worked extensively for three years as a Senior Resident in cardiothoracic anesthesiology (fellowship equivalent) at All India Institute of Medical Sciences, New Delhi, India. After completion, he did advanced training for another year in adult cardiac anesthesiology at the University of Western Ontario, Canada. He is certified in adult perioperative transesophageal echocardiography by the National Board of Echocardiography (NBE) and serves as a Fellow of the American Society of Echocardiography (ASE). He worked as a Visiting Professor in Cardiothoracic Anesthesiology at Washington University in St Louis, Missouri, USA for almost three years, before completing his residency in anesthesiology and ABA certification. Dr Pal is internationally trained in providing anesthesia for complex congenital cardiac surgery, advanced adult cardiac surgeries, mechanical devices for heart failure surgeries and advanced thoracic surgeries, including lung transplantation. He serves as a peer reviewer for research grants and a member of the Guidelines Writing Committee at the Society of Cardiac Anesthesiologists (SCA). He is a member of the Clinical Circulation Committee for the American Society of Anesthesiologists (ASA). He is an Editorial Board member of the journal Seminars in Cardiovascular Anesthesiology (SCVA). At Virginia Commonwealth University (VCU), Richmond, Virginia, USA, he is a member of the Institutional Board Review (IRB) for Virginia Commonwealth University. Dr Pal‘s research initiatives have primarily included outcomes analysis in the real-world application of clinical anesthesiology and cardiac surgery. He takes a keen interest in critical appraisal of scientific literature and clinical trials. He is a strong believer in post-processing peer review for all clinically significant articles published. Along with his multiple original studies, he has successfully generated multiple contemporary critical appraisals in letter-to-editor, commentary, opinion, and editorials for highest impact medical journals like NEJM, JAMA, Circulation. He is a passionate mentor for trainees and early career junior faculty in building a scientific career. Torsten LoopTorsten LoopTorsten Loop has been Professor of Anesthesiology at the University Hospital in Freiburg, Germany as Vice Chair for over 10 years. Dr Loop's clinical and scientific interests are in the field of thoracic anesthesia, lung transplantation and intensive care medicine. Current projects deal with interdisciplinary registry research on perioperative, interdisciplinary management of thoracic surgery patients, lung protective ventilation and intensive care medicine issues. Shamsuddin AkhtarShamsuddin AkhtarDr Akhtar received his medical degree from Aga Khan University Medical School in Karachi, Pakistan. He subsequently moved to the United States for residency and post-graduate training, culminating in a fellowship in critical care. After completing his fellowships, he joined as faculty in Department of Anesthesiology, Yale School of Medicine, USA. He is currently a Professor in the Department of Anesthesiology with adjunct appointment in the Department of Pharmacology, Yale School of Medicine. His area of clinical excellence and focus educationally has been in high-risk non-cardiac surgery and perioperative geriatric care, which includes intensive care. Dr Akhtar has written numerous articles, book chapters, edited monographs, and books. Over the years, he has participated in developing a geriatric anesthesiology curriculum, and the promotion of geriatric anesthesiology/perioperative care and critical care education. He has also presented in various capacities at local, national and international levels. He is a member of Editorial board and reviewer for various journals including Anesthesia and Analgesia, Critical Care Medicine, Journal of Cardiothoracic and Vascular Anesthesia and Drugs and Aging. He is also a member of American Society of Anesthesiology Committee on Geriatric Anesthesia, Editorial Board member for Anesthesiology Continuous Education (ACE) and Past-President, Society for Advancement of Geriatric Anesthesia.

Peer review is often criticized for being flawed, subjective and biased, but research into peer review has been hindered by a lack of access to peer review reports. Here we report the results of a study in which text-analysis software was used to determine the linguistic characteristics of 472,449 peer review reports. A range of characteristics (including analytical tone, authenticity, clout, three measures of sentiment, and morality) were studied as a function of reviewer recommendation, area of research, type of peer review and reviewer gender. We found that reviewer recommendation had the biggest impact on the linguistic characteristics of reports, and that area of research, type of peer review and reviewer gender had little or no impact. The lack of influence of research area, type of review or reviewer gender on the linguistic characteristics is a sign of the robustness of peer review.

The social contract of peer review revisited and reinforced: An idea to reduce the strain for reviewers

Editorial Policy

Peer review under the spotlight in the UK