Peer review for biomedical publications: we can improve the system

The lack of formal training programs for peer reviewers places the scientific quality of biomedical publications at risk, as the introduction of ‘hidden’ bias may not be easily recognized by the reader. The exponential increase in the number of manuscripts submitted for publication worldwide, estimated in the millions annually, overburdens the capability of available qualified referees. Indeed, the workload imposed on individual reviewers appears to be reaching a ‘breaking point’ that may no longer be sustainable. Some journals have made efforts to improve peer review via structured guidelines, courses for referees, and employing biostatisticians to ensure appropriate study design and analyses. Further strategies designed to incentivize and reward peer review work include journals providing continuing medical education (CME) credits to individual referees by defined criteria for timely and high-quality evaluations. Alternative options to supplement the current peer review process consist of ‘post-publication peer review,’ ‘decoupled peer review,’ ‘collaborative peer review,’ and ‘portable peer review’. This article outlines the shortcomings and flaws in the current peer review system and discusses new innovative options on the horizon. See related article: http://www.biomedcentral.com/content/pdf/s12916-014-0128-z.pdf. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0179-1) contains supplementary material, which is available to authorized users.


GENERAL GUIDELINES
Unpublished manuscripts under review are privileged and confidential documents. Reviewers are expected to protect manuscripts from any form of exploitation, to refrain from citing a manuscript or the work it describes before publication, and to not use the data it contains for the advancement of their own research agenda.
The ideal reviewer consciously adopts an impartial attitude toward the manuscript under review. Reviewers should strive to be an author's ally, with the aim of facilitating effective and accurate scientific communication.
If you are able to review, please accept the assignment within 3 days. If we do not hear from you within that time, we will proceed with an alternate reviewer.
If you believe that you cannot judge a given article impartially or complete a review within the given timeframe, please follow the login instructions and select 'Decline to Review' as soon as possible. In the response field, please include the following: o A reason for declining to review the manuscript. o Suggested colleague(s) qualified to review this paper.
Reviews should be completed within two weeks (14 days from acceptance of assignment). If you have already accepted an assignment, but know that you cannot finish the review within that time, please contact the Editorial Office at (303) 602-1815 to determine what action should be taken.

ASSESSING THE MANUSCRIPT
In an effort to standardize the review process for the Journal of Trauma and Acute Care Surgery, we ask that you consider the following questions when assessing a manuscript for possible publication: Why was the study done? Does it address either an important unsolved problem of clinical relevance or a basic scientific topic relevant to trauma and acute care surgery? Do you think that there is sufficient evidence to justify the study? Have the authors explicitly stated a study purpose or a hypothesis?

How was the study done?
What is the design and is it explicitly stated by the authors in the methods?

Is the study population defined well?
Do the authors explicitly define inclusion and exclusion criteria? Are all of the patients accounted for in the results section?

Are the outcome measures appropriate?
Are the selected variables suitable to the study purpose or hypothesis? Are confounding variables assessed?

Are the analytical methods appropriate?
Was the hypothesis sufficiently tested? Were appropriate statistical analyses or laboratory diagnostics performed? Was a power analysis done?
What is the significance of the work? Does the study present novel results that will add to the literature? Are previous similar studies discussed? Are potential study limitations addressed? Are the conclusions warranted by the data?

PLANNING YOUR REVIEW
Please be prepared to comment on the following aspects of the manuscript, as far as they are applicable, in your review: Overall novelty/interest of the research question Coherence and completeness of the background Clarity of hypothesis or study objectives Adequacy of methods or experimental approach Soundness of data interpretation and conclusions Clarity of writing, strength and organization of the paper Relevance, accuracy and completeness of bibliography Number and quality of figures, tables and illustrations

GETTING STARTED
Before filing comments, you will be asked several preliminary questions. These include: Do you have any conflicts of interest relating to this manuscript? Do you agree with the authors' level of evidence rating for this study? Do you have reason to believe that this manuscript (in whole or part) has published before? Would you be willing to write an editorial critique to appear with this paper, if accepted? Should this manuscript be reviewed by a biostatistician?

CME CREDIT
Reviewers for the Journal of Trauma may earn CME credit for completing reviews.
Once all requested reviews are filed and a final decision is made, the editor will grade the quality of your review. CME credit will be awarded if your review is found to be timely and constructive, regardless of your decision. Certificates are generally emailed within 2 months of a final decision.
To be eligible to earn CME credit, you will need to answer the following four questions: Are you interested in earning continuing education credit? (AMA PRA Category 1 Credit™) How long did it take to complete this review? Performing this review has improved my knowledge and ability to assess the scientific literature in order to make informed decisions in my practice.
Performing this review has improved my critical thinking and writing skills within my area of expertise.
The editor will evaluate your review and assign a score between 0 and 100 to reflect the quality of the review. A score of 70 or above is needed in order to earn CME credit. (Please note that this evaluation of your review is distinct from the quality of the article. Credit will be awarded if your review is thorough and constructive, regardless of your decision term) At the end of each month, our publisher's Continuing Education Department personnel will download a report from Editorial Manager that contains your responses and the editor's scoring. For eligible reviews, the publisher's CME Department will email a certificate to the reviewer. In accordance with provider guidelines, physicians (MDs and DOs) will earn up to 3 AMA PRA Category 1 Credit™ credits commensurate with the amount of time spent doing the review.

LEVELS OF EVIDENCE
The Journal requires authors of clinically-oriented studies to indicate a Level of Evidence and study type at the end of their abstract. Please note that only clinical studies receive levels of evidence; basic science, animal studies, reviews, etc. do not require Levels of Evidence.
To quickly determine the level under which a study falls, please consult the following table:  Experimental design permits appropriate statistical assessment and ensures that the question(s) being asked can be answered.

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In longitudinal clinical studies, the patients are stratified by year and studied to account for changes in clinical care that occur over time.

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All variables that may influence findings are controlled (as far as possible).

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Variables of interest are listed, assay procedures are described, and scientific devices are identified.
 Statistical assays are pre-planned and appropriate for experimental design.
 Manuscript text contains statement about institutional approval of a study (including IRB and IACUC protocol numbers), as well as adherence to guidelines on the treatment of animals and human subjects.

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Results are presented in a logical, systematic fashion.

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Values of each measured variable are stated with error limits and statistical significance.

Conclusions 
The reported findings are interpreted and related to the stated hypothesis, as well as placed in clinical or physiologic perspective.

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Conclusion is succinct and confined to the study being reported, and avoids reference to other unrelated studies.

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The conclusion cites and briefly addresses all limitations of the current study.

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The authors refrain from imputing significance when statistical assessment does not reach the level of significance.
 For a clinical study, the conclusions emphasize how the findings might influence patient management or outcome.
 For a laboratory study, the conclusions suggest how findings shed light on the understanding of biologic processes and disease mechanisms.

Author Contributions 
The substantive contributions of all authors are accounted for in a short Author Contributions statement at the end of the text. Authors must fulfill all three of the following criteria: (i) each author must make substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data (ii) each author must participate in drafting the article or critically revising it for intellectual content (iii) each author must give final approval of the version to be published.  Tables are clearly annotated with conventional symbols for statistical significance.

C CO ON NT TA AC CT T U US S
Interested in becoming a J Trauma Acute Care Surg reviewer? Please send a note of interest and your CV to the editor at info@jtrauma.org.