Over the year, many APM reviewers have made outstanding contributions to the peer review process. They demonstrated professional effort and enthusiasm in their reviews and provided comments that genuinely help the authors to enhance their work.
Hereby, we would like to highlight some of our outstanding reviewers, with a brief interview of their thoughts and insights as a reviewer. Allow us to express our heartfelt gratitude for their tremendous effort and valuable contributions to the scientific process.
Heidrun Männle, Ortenau Clinic Offenburg-Kehl, Germany
Margaret I Fitch, University of Toronto, Canada
Santiago Lozano-Calderón, Massachusetts General Hospital, USA
Noriaki Sakakura, Aichi Cancer Center Hospital, Japan
Stergios Boussios, Medway NHS Foundation Trust, UK
Jeong-Kui Ku, Armed Forces Capital Dental Hospital, Korea
Mathieu Jozwiak, University Hospital Cochin, France
Katsuhiro Ito, Center for Cancer Immunotherapy and Immunobiology, Japan
Yuichi Saito, Teikyo University, Japan
Yi-No Kang, Taipei Medical University, Taiwan
Matias Noll, Instituto Federal Goiano, Brazil
Szymon Skoczynski, Medical University of Silesia, Poland
Jerome J. Graber, University of Washington, USA
Debbie Selby, Sunnybrook Hospital, Canada
Kwok Ying Chan, Grantham Hospital, Hong Kong
Cornelius J. Werner, RWTH Aachen University, Germany
Issam Tanoubi, Montreal University, Canada
Mar Riveiro-Barciela, Vall d’Hebron Hospital, Barcelona
Denes Stefler, University College London, UK
Janusz Włodraczyk, Jagiellonian University, Poland
Nobuari Takakura, Tokyo Ariake University, Japan
Alpo Vuorio, University of Helsinki, Finland
Ray Samuriwo, Cardiff University, UK
Tomoki Nakamura, Mie University Hospital, Japan
Dr. med. Heidrun Männle currently serves as a Senior Physician at the Ortenau Clinic Offenburg-Kehl, Section Gynecology and Obstetrics, Breast Cancer and Genital Cancer Center, Germany. She is an experienced surgeon focusing on gynecological oncology and breast cancer, with additional qualification in palliative care. Her current research areas include the influence of delay or rejection of treatment on gynecological malignancies and breast cancers, with a special interest in studying patients’ rationale behind as well as their personal wishes. Further interests include supportive measures from complementary medicine, in particular apitherapy.
Dr. Männle considers peer review as an important process in science for the critical review of scientific articles, “Peer review is an independent look on articles, which may discover new aspects and point out errors. Articles are thus improved through constructive criticism.”
What makes a constructive criticism? To Dr. Männle, a good review takes up the points to be corroborated and makes constructive suggestions for improvement. Good reviewers pay particular attention to the question of whether the study idea is original and well-defined. The results should provide an advance in current knowledge. Another important point is whether the results are interpreted appropriately and whether all conclusions are justified and supported by the results. A destructive review, on the other hand, remains superficial and general. It does not consider the abovementioned aspects and is not uncommon for it to be offensive.
Speaking of finding spare time to review, Dr. Männle responds, “I carefully select the articles which I wish to review and where I feel confident to review according to reviewing ethics. Working on topics of interest is not a burden for me. Under these conditions, both authors and reviewers profit from each other. Thus, I always find enough time for review tasks.”
From a reviewer’s perspective, Dr. Männle urges that authors should follow reporting guidelines (such as STROBE, PRISMA, STARD and CARE), “Reporting guidelines help authors to structure their work and increase the chances of their articles to get published. Therefore, I recommend following such guidelines.”
Margaret I. Fitch
Margaret I Fitch, PhD, is a Professor (Adjunct) at the Bloomberg Faculty of Nursing at the University of Toronto, Canada. In addition to working as an independent consultant regarding oncology nursing, psychosocial oncology, and qualitative research, she is currently teaching at the University of Rwanda in their newly established graduate program for oncology nursing. Throughout her career, Dr. Fitch has maintained a program of research in supportive cancer care with a special emphasis on understanding patient experiences and stakeholder engagement. Over the years, she has worked closely with various patient support organizations to foster peer support and, more recently, peer navigation programs.
In Dr. Pitch’s opinion, peer review provides an opportunity to add perspective to an article and assist the author(s) in communicating their results clearly. It offers an avenue to ensure the quality of the publication and the clarity of communication that will help readers make use of the work. It also allows us as a scientific community to continue to build on knowledge instead of merely repeating what is already known.
Dr. Pitch highlights a few key points to be a good reviewer, “In reviewing an article, the first aspect I think about is clarity – can I understand easily what the author is trying to share? If that is not evident, the article is not going to achieve its intention. Then I look to the details of the work that was completed and whether it is scientifically sound. Finally, I look at the authors’ interpretation, making certain the conclusions do not outstrip the data.”
What motivates Dr. Pitch to keep reviewing papers? She says, “I feel it is a professional responsibility to engage in reviewing manuscripts. I appreciate what others offer to my own work and how that input can strengthen what I am communicating. I would hope that others feel likewise. The collective effort will, in the end, improve what we can do as a scientific community.”
Lastly, Dr. Pitch further lays emphasis on the importance for authors to complete the conflict of interest forms recommended by ICMJE and share with the reviewers and readers what personal gain they have realized, as that personal gain may in some cases result in an individual not being as objective about the results of a project.
Dr. Santiago Lozano-Calderón MD, PhD is an Attending Surgeon and Assistant Professor in Orthopaedic Surgery at the Massachusetts General Hospital/Harvard Medical School, USA. Specifically, his focus is in orthopaedic oncology. His research covers a wide array of prospective and retrospective studies involving the musculoskeletal system, such as benign and malignant tumors, metastatic disease, surgical reconstruction, and outcomes after surgery. Recently, a lot of his research has focused on the use of carbon fiber implants, including intramedullary nails and plates in various anatomic locations such as the humerus, femur, and tibia. The goals of this research are to analyze the overall implant survival, examine complications and predictors of complications, analyze imaging studies, and collect and analyze patient reported outcomes of patients treated with carbon fiber implants. In addition, a heavy focus of his recent research has been on miRNA biomarkers in osteosarcoma. The ultimate objective is to be able to identify highly sensitive and specific markers in liquid biopsies that ultimately will help to identify the patients that will or will not respond to chemotherapy. Thet are also hoping to identify markers that are potential predictors of local recurrence, metastatic disease, and disease specific and overall survival. In the near future, they hope to do more mRNA research with different types of sarcoma. Lastly, their unit does a lot of research in artificial intelligence, creating calculators for prognostic evaluation of patients with bone and soft-tissue sarcomas and patients with metastatic bone disease. You may connect with Dr. Lozano-Calderón through Instagram @mghorthoonc.
Dr. Lozano-Calderón believes peer review is necessary because without it, people might publish misleading, inaccurate, and low-quality papers, whether it be intentional or non-intentional. In the scientific community, we learn from each other through publications, so there needs to be a method of ensuring that what is being published is trustworthy. Peer review is an extremely important component of the research process as it helps to validate the material that is being published. Knowing that papers are being reviewed by numerous experts in the field helps to preserve the scientific legitimacy that accompanies research articles.
As a reviewer, Dr. Lozano-Calderón strives to see well-structured research studies with a clear study question and well-organized methods and results that go into a fluid discussion and appropriate conclusions based on the methods and findings of the paper. Originality is always a plus, but a must is a prudent paper with cautious and responsible statements, “My main motivator to review is always to improve patient care worldwide. We learn so much from each other through publications, and it would be a mistake to attach a price tag to that. We all must work together to share our findings in order to continue to advance medicine.
Dr. Lozano-Calderón considers data sharing as an important step to foster transparency in research, “Although it can be difficult to decide what data to share given the stricter regulations nowadays, it may aid in general research, especially for rare conditions. In my line of work, for example, bone and soft tissue sarcomas are very rare forms of cancer, so collaborating with other institutions to garner a larger sample size is highly beneficial.”
Dr. Sakakura is a specialist in the surgical treatment of thoracic diseases, especially malignant thoracic tumors, including lung cancer, mediastinal neoplasms, and metastatic thoracic tumors. He currently serves as the Chief Physician of the Department of Thoracic Surgery at the Aichi Cancer Center Hospital, Japan. He graduated from the Nagoya University School of Medicine in 2000 and received his Ph.D. degree in 2010 for his research on the subcategorization of resectable non-small cell lung cancer involving neighboring structures.
Currently, his main responsibilities include performing extensive invasive surgeries in patients with highly advanced thoracic tumors, salvage operations following chemoradiation therapy, and re-do surgeries. He also performs robot-assisted minimally invasive surgeries. An “open-thoracotomy-view approach” using vertical port placement and confronting upside-down monitor setting has been introduced in the Aichi Cancer Center Hospital for robotic lung resections. Dr. Sakakura constantly strives to arrive at the most effective surgical treatment strategies for patients with serious conditions using a patient-specific, tailored approach.
In Dr. Sakakura’s opinion, the multi-review process is an essential step in the production of high-quality scientific manuscripts. There should be at least three reviewers who are experts in the relevant field. The different viewpoints of several reviewers refine a manuscript and make it more logical, scientific, and readable. However, the opinions of reviewers are not absolutely definitive. Since reviewers may make unnecessary or unfocused comments, the Editor-in-Chief and members of the Editorial Board must objectively evaluate these comments in order to avoid misjudging the true value of a manuscript. In addition, the reviewers and the content of their reviews should finally be disclosed in order to develop a peer review system with checks and balances.
Dr. Sakakura believes that reviewers should practice constructive, unbiased criticism. Even high-quality manuscripts with a valuable message may be negatively reviewed if the message of the manuscript differs from the reviewer’s viewpoint. In general, authors put a lot of effort into writing a manuscript, so in order to refine their manuscripts, reviewers should provide constructive suggestions for all manuscripts, including well-written manuscripts. In addition, they should constructively suggest and provide ideas for improving the quality of unacceptable manuscripts. Therefore, as well as articles being reviewed, the reviewers and their reviews should also be evaluated. This could be facilitated by the publication of the reviewers and their reviews.
To Dr. Sakakura, peer review is a demanding but an enjoyable task, as long as the manuscripts are not too voluminous. His works have been successfully published through many peer reviews. Peer review is a valuable task in assisting in the publication of new scientific knowledge.
On the importance of Conflicts of Interest (COI) disclosure, Dr. Sakakura indicates that it is desirable for authors to complete the COI forms recommended by ICMJE. In this way, the authors can show that their study does not contradict any ethical principles.
Prof. Stergios Boussios trained in Medical Oncology at the University Hospital of Ioannina, Greece (2010–2013). He was awarded European School of Oncology (ESO) and Hellenic Society of Medical Oncology (HeSMO) fellowships for clinical and laboratory research at the Royal Marsden Hospital, London, UK (2014–2015). Prof. Boussios holds a PhD (2016). His thesis examined the role of circulating cancer cells and cancer cells with blastic phenotype and epithelial mesenchymal transition in peripheral blood of patients with Carcinomas of Unknown Primary site (CUP). In 2017, he was selected by the European Society of Medical Oncology (ESMO) Fellowship and Award Committee to be part of the ESMO Leaders Generation Programme. Since April 2018, he has served as consultant at the Medway NHS Foundation Trust, Kent, UK. He is actively involved in translational research in cancer and is principal investigator in phase I-III studies. In October 2020, Prof. Boussios offered an honorary academic appointment at the King’s College London (School of Cancer and Pharmaceutical Sciences). You may get to know more about Prof. Boussios through Linkedin or his homepage.
“The benefits of peer review are real,” says Prof. Boussios when he is asked to share his views on peer review, “It actually acts as a quality-control system and applies checks and balances for ideas and scientific discoveries, before they are widely accepted by the scientific community. Novel findings or ideas might not move into the mainstream of our understanding of biological processes if they are viewed as simple statements from the discoverers. It should be ensured that peer reviewing remains an important element in the whole process that transfers experiment into shared information.”
In Prof. Boussios’ opinion, reviews should be clear, constructive and consistent. Clarity is important because authors will not be able to respond, if they do not fully understand what the concerns are. Constructive suggestions for how concerns may be resolved are crucial. In order to be constructive, this process requires a high level of rigor, objectiveness, and transparency from both the authors and reviewers. Consequently, the overall recommendation should be consistent with the comments provided by the reviewer. Strengths should be highlighted – a good review does not just criticize but also highlights what the authors have done well. Last but not least, the review should always be polite; it is unprofessional to use derogatory language or take a harsh or sarcastic tone.
From a reviewer’s perspective, Prof. Boussios stresses the importance of the use of reporting guidelines: The primary role of reporting guidelines is to help researchers write up their research to maximize the value to others. Adherence to reporting guidelines will increase the completeness and transparency of health research publications, thereby providing readers with sufficient details to enable them to critically appraise the study. Over time, the use of reporting guidelines may have a beneficial influence on the quality of research by raising general awareness of key methodological issues. At the writing stage, reporting guidelines provide a useful reminder of fundamental details that should be addressed in the paper. Generic, methodology-focused guidelines such as CONSORT, STROBE, PRISMA, STARD and CARE suggest minimum sets of reporting requirements that should always be included when reporting this particular type of study.
Lastly, Prof. Boussios would like to say a few words to encourage all the other reviewers: “To me, peer review is probably the most important component of how modern science is done. Whatever little I have achieved so far in my academic career, it has been possible only because of the enormous contributions of the anonymous reviewers. Scientists are by definition passionate about their ideas, hypotheses and design of experiments and trials. At that point, a peer reviewer’s concern could frequently be a crucial flaw in an earth-shattering idea that a scientist had put forward. Overall, I feel that it is a privilege to have the opportunity to provide feedback on others’ findings within a context of honesty and a great sense of respect for their hard work.”
Jeong-Kui Ku, DDS, MsD, PhD, FIBCOMS, is the Fellow of the International Board for the Certification of Specialists in Oral and Maxillofacial Surgery. He is currently the Head of Oral & Maxillofacial Department, Armed Forces Capital Dental Hospital, Medical Command, Seongnam, Republic of Korea and will move to the Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea starting from May 2021.
Dr. Ku’s research focus is on bone healing after dental implant placement, bone grafting, trauma, extraction, tumor resection, and jaw atrophy. The main objective of his research is to develop biomaterials such as demineralized dentin matrix from extracted teeth and 3D printed alloplastic bone substitutes containing rhBMP-2, and to regenerate and reconstruct maxillofacial bone effectively and reproducibly. In addition, his recent research has involved a multidisciplinary approach with emphasis on Hospital Dentistry for the oral care of inpatients, pain control, food intake, and the applications of a range of diagnostic tools. Please visit Dr. Ku’s profile for more information.
Peer reviews have been an official part of scientific communication since The Philosophical Transactions of the Royal Society first published in 1665. Peer review is a widely-accepted means of research study validation and final revision, based on critical review by qualified professionals with expert knowledge of the related subject. To Dr. Ku, peer review involves critical review of a manuscript by individuals with proven competencies in the topic concerned. Thus, the peer review process provides a means of definitively evaluating the technical and presentational merits of submitted articles and provides a means of improving their presentation in terms of accuracy, clarity, readability, and quality. In addition, reviewers are obligated to identify errors, for example, logic, structure, references, and methodology. Although a reviewer may or may not have greater experience than the authors, experienced reviewers provide insights that improve the technical qualities of papers, while less experienced reviewers are more likely to focus on the quality of presentation and topics such as structure, syntax, grammar, word choice, emphasis, repetition, and clarity for descriptive information.
In Dr. Ku’s opinion, peer reviewing is a valuable, involved process. Peer reviews, when properly conducted, enhance reader’s interest and improve readability and technical content. The process allows reviewers to access cutting-edge information in a field that overlaps with their interests and provides access to novel concepts, approaches, perspectives, and relevant citations.
Dr. Ku concluded by reiterating the importance of seeking institutional review board approval for retrospective studies, “Strict ethical regulations must be followed during human research studies. Research studies on humans inevitably involve many variables and confounding factors can affect data selection and interpretation. In particular, retrospective studies require assurance of participant anonymity and consideration of the effects of the research on institutional assets (e.g., on retained samples) and other aspects not fully appreciated by researchers. It is mandatory that when the researchers include and remind a statement to the effect that the research was conducted after obtaining institutional review board approval and complied with relevant international guidelines.”
Dr. Mathieu Jozwiak is senior intensivist (MD, PhD) in the Medical ICU of University Hospital Cochin, Paris, France. His research areas include hemodynamics, echocardiography, cardiovascular physiology, hemodynamic monitoring and prediction of fluid responsiveness. To learn more about Dr. Jozwiak, you may visit his LinkedIn page here.
In Dr. Jozwiak’s opinion, peer review is an essential step in the production of high-quality scientific manuscripts. It is a constructive criticism of work. It is essential for helping the authors to clearly highlight their key findings, to ensure that there is no overstatement in the interpretation of data, and to ensure that the authors have contextualized their findings and adequately discussed their significance.
To Dr. Jozwiak, “honesty, scientific soundness and constructive mindset” are the key qualities a reviewer should possess. Even though reviewing papers is not profitable, he keeps motivating himself to do so, as he believes that it is part of the researchers’ work. Through peer review, he can be aware of new developments in his field of research, he can share with the authors his point of view, he can participate in the improvement of scientific knowledge, and at the same time, learn from others.
From a reviewer’s point of review, Dr. Jozwiak thinks that ethical approval/statement is a necessity for all types of research, which must be conducted, regardless of the experimental design in respect of patients. Based on his experience, there is a real improvement in the quality of scientific work when the authors follow the research guidelines, such as STROBE. For the sake of scientific honesty, it is necessary that the authors mention their conflicts of interest which could influence their interpretation of the results.
Dr. Ito is a first-year Ph.D. student and is doing research on immunotherapy for urological malignancies in Center for Cancer Immunotherapy and Immunobiology, Kyoto, Japan. He graduated from Kyoto University Faculty of Medicine in 2011 and underwent urology residency course in Tenri Hospital from 2011 to 2015. He worked as a clinical fellow in urological robotic and laparoscopic surgery from 2016 to 2020. Currently, Dr. Ito is focused on how to improve immunotherapy efficacy for patients with advanced disease. Although immunotherapies showed certain response rate for urologic malignancies, the outcomes for those with advanced disease or impaired performance status are poor. To overcome this, he tries to identify what obstacles prevent immune attack toward cancer and how to modulate the immune condition.
The role of peer review, to Dr. Ito, is to ensure the scientific validity. For authors including himself, it is sometimes difficult to look at the manuscript without bias. Only independent reviewers can check whether the manuscript is scientifically correct or not. “Pure” experiments are nearly impossible, especially in biology. It is important for peer review to clarify the extent to which the trials and observations reveal and what is not.
Dr. Ito further explains that the most important task for reviewers is to help authors improve the manuscript, “I usually describe what I feel from the manuscript without bias and suggest ways to make the manuscript clearer. If there would be significant flaws, reviewers should logically and clearly point them out. Since most papers have only a few limited peer reviewers, unbiased opinion is quite important. I think peer review is not a place to debate or defeat authors but a place to verify scientific soundness.”
Speaking of Conflict of Interest (COI) disclosure, Dr. Ito thinks that scientific data is fragile and easily distorted, whether it is intentional or not. Therefore, describing COI is important for not only reviewers but also authors to remind them of the potential biases.
“Even if it is not so rewarding, I believe peer review has contributed greatly to the development of science. Also, it is certain that the reviewer experience is beneficial for my own research. We can get “reader’s perspective” through reviewing. We will be able to write a paper considering what reviewers or readers might care about,” says Dr. Ito.
Yuichi Saito, MD, PhD, is an Associate Professor at Teikyo University School of Medicine, Tokyo, Japan. He is also working as a part-time researcher at Saitama Cardiovascular and Respiratory Center, Saitama, Japan. His focus is on thoracic oncology, molecular biology and infectious lung disease. Currently, he has several research themes: 1) Adjuvant chemotherapy of non-small cell lung cancer, 2) Inter-tumour heterogeneity of PD-L1 expression in primary lung cancer, 3) Development of EGFR-LAMP (loop-mediated isothermal amplification) kit, which is a diagnostic tool for rapid diagnosis, 4) Development of a new surgical technique “Sandwich Marking Technique”, which enables us to localize small pulmonary peripheral nodules intraoperatively by using cone-beam computed tomography. For more information about Dr. Saito, please visit here.
Dr. Saito believes a good peer review system guarantees transparency, logic, objectivity, fairness which science originally has. Furthermore, it grows good scientists with positive and critical perspective. It is not fun for anyone to be criticized, but good criticism makes it possible to gain deep scientific insight. In the long term, good scientists are born of good critics, he believes.
Dr. Saito explains, “Peer review system mutually ensures objectivity and a critical perspective. A good review encourages authors to think deeply about their research theme and to get other perspectives of issues in the study. And good researchers often need positive critical opinion from good reviewers. Reviewers should keep logic, criticism, fairness, and honesty in mind. Those factors ensure the quality and strengthen the logic of the study. A good study could be complemented and completed by quality reviews.”
From a reviewer’s point of view, Dr. Saito thinks that it is important for authors to share not only original data but also methodology in any research fields. Reproducibility is most important proof method to discover the truth in science. And it is guaranteed by sharing research data because any other researchers can retest and analysis.
“A false science makes atheists; a true science prostrates men before the Deity. All right efforts of reviewers can help great achievements in any studies. It is so precious for good scientists to believe it,” says Dr. Saito.
Yi-No Kang, MA, is a consultant in Evidence-Based Medicine Center at Wan Fang Hospital, Taipei Medical University, and serves as instructor in Department of Emergency Medicine in Taipei Medical University Hospital, Taiwan. Specifically, his focus is in evidence-based healthcare and medical education. In addition to studies regarding clinical skills instruction and evidence-based practice, his research interests cover diverse topics in healthcare, for instance, oncology (e.g. gastric cancer, colorectal cancer, prostate cancer), urology (e.g. herniorrhaphy and male fertility), ophthalmology (dry eye), anesthesiology (e.g. obstetrics anesthesia), clinical neurology (e.g. spine surgery and migraine), nephrology (e.g. chronic kidney disease), as well as cardiology (e.g. Marfan syndrome). He is also an invited instructor in meta-analysis workshop by Cochrane Taiwan, and trains health professionals to do synthesis according to Cochrane handbook. You may find out more about Dr. Kang through here.
To Dr. Kang, blinded and rigorous peer review is critical to scientific development, and a robust review process may reduce rough works and pseudoscience. A good review system could identify inappropriate methodology, misleading statements, and problematic conclusion after a serious process with numerous experts in the discipline. Apart from error correction, scholars might learn from peers during the review process since reviewers’ comments may inspire diverse perspectives. Consequently, researchers could perfect their works during peer review.
“Making objective judgement based on scientific thinking is the first principle,” says Dr. Kang when he is asked what a reviewer should bear in mind during review, “And giving comments with constructive opinions would be my second rule. Thus, my first focus usually is methodology and results after I skim the paper. Then, rationales and relevant descriptions are checked. Finally, I evaluate whether explanations, interpretations, and conclusions of findings are reasonable.”
In Dr. Kang’s opinion, reporting guidelines (such as CONSORT and PRISMA) could help authors in academic writing, and also are good for reviewers to thoroughly evaluate critical points of a scientific report. He thus encourages authors to follow reporting guidelines as drafting manuscripts.
“I know the importance of review in scientific community; therefore, I am willing to squeeze my time for extra review tasks. I usually read and review papers in early morning before morning meeting,” says Dr. Kang.
Matias Noll, MD, PhD, is Associate Professor of Public Health and Sport Sciences at the Instituto Federal Goiano, State of Goiás, Brazil. Since 2020, Dr Matias has been the coordinator from the Master Program in Professional and Technological Education in this Institute. He is also a Visiting researcher from the Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. He received his PhD in Health Sciences from the Medical School, Federal University of Goiás (UFG), Brazil. To date, he has published over 120 peer-reviewed research papers, some of which are in high impact journals, e.g. Scientific Reports, Clinical Nutrition, Anatomical Sciences Education, Science Communication, Obesity Reviews, etc. He is Section Editor from PlosOne and reviewer from more than 25 international Journals. He is the coordinator from the Child and Adolescent Health Research Group (GPSaCA) and is supervising more than 15 students, from undergraduate to doctorate levels. For more details about Dr. Noll, please visit his ResearchGate page or ORCID page.
According to Dr. Noll, peer review plays an essential role in science. Only peer review can effectively evaluate a manuscript. This process is an excellent opportunity to guarantee a high quality and reliable information. Moreover, it is a good opportunity to help colleague scientist improve their work, or at least give them valuable comments which may be important for a new submission. Dr. Noll adds, “We need to keep in mind that we also are always in the other side, and we need qualified reviewers reading our manuscript too.”
In Dr. Noll’s opinion, a good review must go in a constructive way, even though the quality is low and the manuscript has several weaknesses. The reviewer should give feedbacks with suggestions to improve the text and also to improve future researches. This is essential to stimulate a high impact science and with social implication – Maybe it is a young researcher on the other side and, consequently, constructive comments would be motivating. Dr. Noll further elaborates, “I always check, in the first moment, if the idea is original and the if the structure is coherent: aim, method, results and conclusions. After that, I go to the discussion section and later to the introduction, to check how the authors have interpret their results and how they dialogue with the current literature.”
According to Dr. Noll, it is indispensable to obtain ethical approval for all types of observational and experimental studies. Protecting participants regarding health and individual information is essential. Moreover, when the authors have an ethical approval, it assures that their work does not disrespect any ethical law or right, and thus the research team could also be protected. Going back to the beginning, simply systematic review and using database from governments are out to this requirement.
“Reviewing papers is an excellent moment to learn new methods and techniques. Moreover, beyond contributing with good quality of science, during review, we have the opportunity to have in our hand the newest knowledge made by well recognized scientists. These are my motivations,” concludes Dr. Noll.
Szymon Skoczyński, MD, PhD, is a scientist, clinician and academic teacher. He currently serves as an Assistant Professor in the Department of Pneumonology, Upper Silesian Medical Center, Medical University of Silesia – Katowice (Poland), as well as a Consultant and Coordinator of the Temporary Hospital for Patient with COVID-19, Pyrzowice, Poland (Impact Factor 74.091). His scientific and clinical interests are on noninvasive mechanical ventilation (NIV), interventional pulmonology, NIV facilitated bronchoscopy, ECMO, lung ultrasound, assessment of air metabolomics in exhaled air, dyspnea mechanisms, and COVID-19. He is the supervisor and auxiliary promotor in several scientific projects, e.g. The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure. He is also involved as a team leader or member in several projects concerning oxygenation techniques including: HFNC and ECMO, NIV, as well as lung ultrasound assessment in COVID-19 patients.
“Taking into account that medical science influences clinical practice, healthy peer review system should be a guardian of true science and track fraud,” says Dr. Skoczynski, who believes that a healthy peer review system requires professionalism and dedication, and most importantly objectivism. To him, accepting to peer review is an equivalence that the revision will be done in an objective way. In cases of papers reviewed by more than two reviewers, the editor should be cautious especially in cases when reviewers’ suggestions differ significantly. In those cases, it should be practiced to ask another external reviewer for additional opinion.
What makes a good reviewer? Dr. Skoczynski reckons that the reviewer should be an expert in the particular field in which the manuscript is written, but most importantly “blinded”, which means not being aware who the authors of the manuscript are. Unfortunately, this may be difficult to achieve in narrow scientific fields. Based on this, the qualities of a good reviewer should mimic skills which are appreciated in good dedicated teachers, namely, wishing to guide but not discriminate their students.
Speaking of data sharing, Dr. Skoczynski believes that it is the future of medical science, as it has the potential to accelerate the quality and spread of science. Broad implementation of data sharing will result in the increase of research quality and will decrease the risk of pathological behaviours. Obviously there are, and there will be novel developments in which data sharing may and/or should not take place, until the time when a particular development is patented. In more common and better assessed areas of science, the idea of data sharing should be broadly accepted, because it facilitates further developments. Unfortunately, this is still a topic for future actions.
“I am constantly motivated to peer review. The best explanation may be cited from one of my publications: ‘External peer review is a hallmark of science’. Published in a peer-reviewed journal is a sign of quality, meaning that the work has been scrutinised by knowledgeable and independent peers. Moreover, peer review also serves the purpose of improving the work after the authors have done their best and, thus, being a reviewer carries a responsibility. However, it comes with a little reward; reviewing is usually done without financial compensation and often outside working hours. But reviewing is rewarding itself! Besides, being pro bono exposes you as a reviewer to novel findings and adds a new perspective to your own research and scientific writing. And you can add ‘Peer reviewer for Journal of X’ to your CV,” says Dr. Skoczynski.
Jerome J. Graber
Dr. Jerome J. Graber is an Associate Professor of Neurology and Neurosurgery at the University of Washington Alvord Brain Tumor Center, part of Seattle Cancer Care Alliance in Seattle, Washington, USA. He is a neurologist board certified in neuro-oncology, hospice and palliative medicine and neuroimaging. The main focus of his practice is the care of patients with primary and metastatic tumors of the nervous system, as well as neurological complications of cancer. He is also involved in research on neuroimaging, clinical trials, symptom assessment and management, as well as medical education. More information about Dr. Graber can be accessed here.
Peer review is incredibly important, according to Dr. Graber, to ensure there has been critical scientific assessment of published research to attempt to verify the validity of hypotheses that are being developed and scientific claims based on research. When done well, it improves the quality of published work, and hopefully improves trust in medical literature within the scientific community and the public.
Nonetheless, the current peer review system is not without challenges. With the massive shifts in publishing methods and ethics, there is also a burgeoning awareness of the peer review process among journalists and the general public. Unfortunately, in Dr. Graber’s opinion, there is little formal, rigorous training in peer review in medical education, and few standards to guide or uphold. Peer review is also not usually subject to any monitoring or feedback to ‘review the reviewer’ and help them improve this important skill. As clinicians are more and more limited by administrative, research and clinical demands, he fears that scientific journals will have a harder time finding quality reviewers to spend the time required to thoroughly evaluate submitted research in a timely fashion.
As a reviewer, Dr. Graber emphasizes that reviewers should take into account the type of research being published and audience of the journal. To him, reviewers must be mindful of their own ‘blind spots’ as well, and when they cannot thoroughly evaluate important aspects of the work under review.
On the use of reporting guidelines, Dr. Graber thinks for clinical trials and other ‘applied research’ with a clear objective (i.e. getting a new treatment approved for use), some of these guidelines can help provide a simplified, standard format to help readers evaluate the research process. By themselves, however, they do not verify the quality of the research.
“I peer review for numerous journals because I care immensely about the quality of the medical literature that is published, I learn tremendously from being part of the process and it certainly improves my own work,” says Dr. Graber.
Dr. Debbie Selby is a full time Palliative Care Physician at Sunnybrook Hospital in Toronto, Canada. Her research interests include Medical Assistance in Dying and symptom management in palliative care.
According to Dr. Selby, peer review is an important process to ensure published research has followed appropriate methods, analysis and is relevant to the described patient populations. She explains, “Well considered reviewer comments very frequently improve the paper being submitted. From my own experience, there has been tremendous value in reviewers seeing other angles I had not considered, or pointing out portions of a paper that were not as clear as they could be. While reviews can take a significant amount of time and effort, it is an effort well spent to ensure research is clear, unbiased, and well presented.”
The key goal of an institutional review board (IRB) is to protect human subjects from physical or psychological harm through reviewing research protocols and related materials. In Dr. Selby’s opinion, all published studies are required to seek IRB review and approval as it adds an extra layer of certainty not just that the study is being carried out using proper investigative methods, but also that all research meets high ethical standards. This is true not just for prospective treatment trials but also for observational and retrospective studies.
Kwok Ying Chan
Dr. Kwok Ying Chan is now a palliative care consultant working in Grantham Hospital in Hong Kong. His field of research interests includes both early integrated and renal palliative care. He has published more than 30 research studies in some renowned journals including American Journal of Kidney Disease. Dr. Chan is both an international reviewer and editor. He is the guest editor leading the neuro-palliative care issue in Annals of Palliative Medicine in 2017. He has pioneered the Integrated Hematology Palliative Care program in Hong Kong and is recently awarded the Best Oral Presentation for the program at the 2021 HA convention.
Openness, effectiveness, timely actions and a pool of experienced reviewers are the few key elements Dr. Chan believes a healthy peer review system should possess. To him, most authors would like to have useful comments and relatively shorter turnaround time under this system.
Even with a healthy system, biases are unavoidable in peer review. Dr. Chan suggests the following steps to minimize any potential biases: 1) review articles that are related to one’s field; 2) first review with overall impression (potential to publish or not); 3) then look for any major flaws; and 4) give comments to each part of the manuscript, and ask for other peer review in case of doubt or the presence of biases.
Seeing the prevalence of research data sharing in academic writing, Dr. Chan thinks it is a good trend as we can access and share the information for further study. In addition, some readers might also be interested about the details of the study samples.
“Even though peer reviewing is anonymous and not moneymaking, I think it is worthwhile and my honour to be a reviewer in the scientific field,” says Dr. Chan.
Cornelius J. Werner
Dr. Cornelius J. Werner, MD, is the Chief Physician of Department of Neurology and Geriatrics, Johanniter-Hospital Stendal, and Associate Professor at RWTH Aachen University, Medical Faculty, Aachen, Germany. His research is focused on rehabilitation of neurologically caused disorders of language and deglutition as well as the interaction of frailty and neurological disorders in older patients, with particular emphasis on aphasia after stroke and neurogenic dysphagia in neurodegenerative disorders such as Huntington's Disease. Current projects include novel data analytic strategies to identify predictors of therapeutic success of intensive aphasia therapy, novel tools in identifying aspiration events in neurogenic dysphagia and the cortical control of the oral phase of swallowing, among others. You may connect with Dr. Werner through LinkedIn.
In Dr. Werner’s opinion, a major obstacle to the existing peer review system is the lack of reward in properly reviewing papers. This leads to long delays in finding reviewers, as well as reviewers not having or investing much time and effort, which in turn can result in unfair and biased reviews. As a corollary, this might also be a factor in the rise of the so-called “predatory journals” which exploit the need of young scientists to get rapid and benevolent reviews.
On enhancing the objectivity of a review, Dr. Werner indicates that a review can never be completely objective, as simply choosing the matter of research at hand might seem worthwhile to the authors, but not to the reviewers. Still, basing the review on whether proper presentation of the data and adequate methodology are present can achieve some sort of objective review. The limits of this approach are obvious, of course.
History has shown what happens when there is no institutional review board approval for research. To Dr. Werner, for a determined scientist, the end sometimes seems to justify all means. But science does not exist in a moral or social vacuum, and it should not.
“By reviewing, you get a chance of glimpsing other scientists’ thought processes and ideas on how to approach a particular problem which you wouldn’t have seen otherwise. Some are truly brilliant. Then again, some are outright lazy!” says Dr. Werner.
Issam Tanoubi, MD, MA(ed), DESAR, is an Anesthesiologist at CIUSSS de l’Est-de-l'Ile-De-Montréal and Associate Professor of Anesthesiology at Montreal University, Canada. He is also a director of the simulation based medical education (CorSim) research committee (Center For Medical Simulation of University of Montreal CAAHC), a board member of the interdisciplinary research group on cognition and professional reasoning (GirCoPro) and a board member of the simulation fellowship program (UdeM). His current research focuses on airway management, acquiring expertise in healthcare, patient safety enhancement, and crisis resource management. You may follow Dr. Tanoubi on Twitter @ITanoubi.
Speaking of the current trend of peer review, Dr. Tanoubi reckons that the existing review system is perfectly adequate. The review would benefit from being blinded to the manuscripts’ authors. Inviting and motivating reviewers to achieve a constructive review is also a significant challenge. Several journals reward the reviewers with a voucher to reduce publication costs, but this practice could be associated with a conflict of interest. Non-profit incentives, such as highlighting best reviews, or offering continuing professional development (CPD) credits could be an intelligent alternative.
How to ensure a review is objective has been an important yet unresolved question. To Dr. Tanoubi, an objective review should be devoid of any conflict of interest and should be done with an honest commitment to enhancing the manuscript readability. The reviewer should ensure to do so without time or other kind of pressure leading him/her to make choices based on personal feelings or experiences rather than on the quality of the manuscript. Reviewing should also be performed without a pre-acquired and fixed idea on the subject — the more curious the reviewer, the better.
The institutional board review (IRB) is carried out before the implementation of the research project. Its goal is to solidify the methodology and detect major methodological flaws. In Dr. Tanoubi’s opinion, in the absence of IRB approval, these flaws will constitute, after the end of a research project, causes of publication rejections. Before the start of the study, the IRB also encourages the researchers to reflect on the justification for all their methodological choices, which will indeed be questioned during the review process. IRB approval improves and limits criticism of the research methodology and therefore improves its chances of publication.
“Beyond all the ideas that can motivate reviewers, a review can inspire the reviewer. A review allows the reviewer to learn about the research methodologies and the analysis of the results. The reviewer also understands how a project should ideally be presented, and this learning translates into the quality of one’s own manuscripts. The exercise of reviewing forces to do further reading on the topic to provide a thoughtful review,” says Dr. Tanoubi.
Dr. Mar Riveiro-Barciela serves as an Internal Medicine specialist at the Liver Unit of the Vall d’Hebron Hospital (Barcelona). She is the principal investigator of clinical trials and independent research projects, mainly on viral hepatitis and autoimmune disorders of the liver, with more than 80 indexed manuscripts published. She achieved her PhD at the Autonomous University of Barcelona (UAB), where she is an Assistant Professor. She is also a member of CIBERehd and the Scientific Committee of Spanish Association for the Study of the Liver (AEEH). You may follow Dr. Riveiro-Barciela on Twitter @mar_riveiro.
In Dr. Riveiro-Barciela’s opinion, peer review is a useful and needed way to ensure the selection for publication of manuscripts that may impact on daily clinical practice because of their methodological quality and novelty results. To her, there are several important things a reviewer should possess: general and updated knowledge on the topic, some statistical motions and, last but not least, common sense.
From a reviewer’s perspective, Dr. Riveiro-Barciela lays emphasis on the use of reporting guidelines (e.g. STROBE and PRISMA) during preparation of a manuscript, given that they are a practical method to try to achieve a high-standard manuscript, ensuring the inclusion of all the important points that should be addressed in a scientific article.
“I choose to review for APM because the journal publishes articles on a wide spectrum of disorders, including clinical cases,” says Dr. Riveiro-Barciela.
Dr. Denes Stefler is a senior research fellow at the Department of Epidemiology and Public Health, University College London, UK. His research focuses on dietary habits and other lifestyle factors and their relationship with chronic diseases, such as cardiovascular disease and cancer. He has a particular interest in Eastern European populations, but has also worked extensively with UK and other European datasets. In his current and previous works, he has been examining the differences in health status between Eastern and Western European countries, as well as disease variations within Eastern Europe in order to find those contributing factors, particularly dietary habits, which could explain why people in Eastern Europe have lower life expectancy and worse health than Western European counterparts. Additionally, he is also interested in how someone’s cultural background can impact on their dietary habits, and how traditional diets may influence our health. Dr. Stefler’s profile can be accessed here.
Good-quality peer review is one of the corner stones of good research, according to Dr. Stefler. Although it is not perfect, and it has been criticized a lot, the peer review system provides a crucial division between reliable and unreliable evidence. However, to maintain this role, the peer review process has to be as objective as possible, and reviewers should be ideally blinded to the personal details and affiliation of manuscript authors. Journal editors also have important responsibility in keeping the reviewer selection process objective, and therefore the peer review system “healthy”.
In Dr. Stefler’s opinion, during review, reviewers need to keep in mind that although the manuscript in front of them is probably the best version that the authors could put together at that point, it is still a work in progress, and constructive criticism can improve it considerably. But to make the reviewer’s comments useful for the authors, these comments need to be as specific as possible. And the language used should not “crush” the accomplished work but instead, if possible, they should provide suggestions on how to make it better.
Speaking of the emergence of institutional review board (IRB) for research screening and approval, Dr. Stefler indicates that external scrutiny is important not just for specific manuscripts and publications but for entire research projects as well. Making sure that the proposed work is ethical and methodologically sound is absolutely unavoidable in the 21st century. If the issues identified by IRBs are not picked up in the preliminary phases and would come to light later, that could discredit several years of work, waste large amounts of money, and, depending on the extent of these issues, it could seriously harm the life and health of study participants.
“I view peer review as an extremely important part of the research process, so I think contributing to it is part of a researcher’s work. However, I agree that it should be rewarded more, particularly considering that it is often time consuming and doing it well requires substantial mental effort. Some organizations and websites (i.e. Publons) can help to collate and showcase a researcher’s review work, which is useful I think. And it also looks good on one’s CV,” says Dr. Stefler.
Dr. Janusz Włodraczyk is currently an Assistant Professor at the Department of Thoracic Surgery of the Collegium Medicum of the Jagiellonian University in Cracow, a leading esophageal cancer treatment center in Poland. He completed fellowships in general surgery, thoracic surgery and surgical oncology. His focuses lie mainly in thoracic oncology, including lung cancer, mediastinal malignancies and esophageal cancer, as well as in multidisciplinary management (combined chemotherapy/radiation/surgery) of esophagogastric carcinoma and lung cancer, and benign esophageal disease. He is particularly interested in esophageal surgery and related surgical techniques (minimal invasive esophagectomy - laparoscopy, robotics). In his research, an important place is occupied by the molecular biology of esophageal cancer. In past years, he was given an opportunity to become a scholarship holder of the Technical University of Munich and University of Heidelberg.
Reviewing scientific papers allows to maintain high standards for the whole science. Thanks to this process, the reliability and respect for ethical standards specific to the reviewers are maintained. Dr. Włodraczyk strongly believes that we are in need of unbiased journalism, and because of that, he is proud to be a part of the community that supports this kind of science.
To Dr. Włodraczyk, the peer-review process should be transparent and contain informative, analytical-critical and evaluative elements. Reviewers should always express their own opinions, given that the language should bear the hallmarks of objectivity. The different points of view of reviewers should not constitute an obstacle in the evaluation of the scientific work.
Furthermore, it is Dr. Włodraczyk’s belief that scientific work should comply with the code of ethics and the law. For this reason, he urges authors to follow reporting guidelines, such as PRISMA and STROBE, which can help maintain a high standard of academic work. Without following the reasonable guidelines, the scientific community cannot work properly or provide trusted sources for other authors and scientists.
“It is a difficult job, especially for an active surgeon, to find time to review. However, it is a meaningful recognition and a distinction for reviewers in the scientific community,” says Dr. Włodraczyk.
Nobuari Takakura, PhD, is Professor and Chair of the Department of Acupuncture and Moxibustion at Tokyo Ariake University of Medical and Health Sciences, Japan. He is a licensed acupuncturist, moxibustionist, massage and shiatsu therapist. His research is on increasing the rigor of acupuncture research. Since 2007, his research has focused on acupuncture and the placebo effect. He is the internationally renowned inventor of the double-blind acupuncture needle which blinds participant and acupuncturist, enabling true acupuncture and placebo effects to be determined. Currently, he is conducting three clinical studies, all funded by the Japan Society for the Promotion of Science. The first study is on chronic neck pain, the second on chronic low back pain and the third is a trial of acupuncture for spasticity as a post-stroke sequela using his double-blind acupuncture needles. Dr. Takakura is also a consultant on a National Institutes of Health (NIH) 5-year double-blind randomized controlled trial of acupuncture for the treatment of vulvodynia, a condition that affects 7 million American women and is characterized by chronic vulvar pain and painful sexual intercourse. You may find out more about Dr. Takakura though ResearchGate and his lab’s homepage.
In Dr. Takakura’s opinion, a healthy peer review system is dependent on the reviewer’s adherence to honesty, fairness, and etiquette in reviewing a manuscript. Establishing a system to evaluate reviews as a legitimate contribution to science by universities, research institutes, and journals, etc. would not only strengthen the peer review system, but also science in general. The content of reviews should be made public to increase transparency. Publishing the names of reviewers of good reviews, of course with their consent, would increase the incentive for peer review and lead to a sound review system.
Speaking of the good practices of peer reviewers, Dr. Takakura indicates that they should allot enough time to read a manuscript to ensure a quality review. The manuscript must be reviewed carefully, critically, and constructively based on whether the research background was thoroughly investigated, the objectives were appropriately set, the research was conducted using the correct methods to achieve the objectives, and the results were accurately and clearly expressed and discussed rationally based on the results.
On conflict of interest (COI) disclosure, Dr. Takakura strongly believes that authors must disclose any potential COI, as it is essential to ensure the works remain unbiased and do not unfairly affect scientists or science.“As an act of service and professional courtesy, I feel it is my duty to review other scientists’ papers as they have taken the time to review my work,” says Dr. Takakura.
Dr. Alpo Vuorio, MD. PhD, is a specialist in occupational medicine. He currently serves as the adjunct professor at the University of Helsinki, Finland. His research is mainly related to inherited cholesterol disease and familial hypercholesterolemia (FH). He is also interested in FH genetics, treatment and risk factors related to this disease. Recently, he is studying how environmental factors (like air pollution) may impact on atherosclerosis. Other research projects are related to aviation health and system safety. You may connect with Dr. Vuorio on Twitter @VuorioAlpo.
To Dr. Vuorio, peer review plays an important role in science. It validates if a research study is reliable and was carried out carefully. The limitations of the study can also be discussed. Eventually, the quality of the research can be improved. During the process, reviewers should bear in mind that they should remain objective, efficient and without conflict of interest.
From the perspective of a reviewer, Dr. Vuorio stresses that it is important for a research study to apply for institutional review board approval. To him, ethics is the cornerstone of research – there is no room without ethical approval to carry out research.
“Peer reviewing is fascinating that you can always learn a lot and it helps you to improve your own articles,” says Dr. Vuorio.
Dr. Samuriwo is a research academic working as a Lecturer in the Cardiff University School of Healthcare Sciences, UK. His research and teaching centre on values in health and social care. He has conducted several studies that have contributed to wider knowledge and advanced the pedagogy of values in health and social care. His work on values is expressed at the unique intersection of four key aspects of health and social care – palliative care, healthcare professional education, patient safety, and wound healing.
A healthy peer review system, according to Dr. Samuriwo, is one in which the authors and reviewers have a shared understanding of what makes a good paper and the criteria that are needed to meet the standard for publication. Another hallmark of a healthy system is a good editorial team which oversees the discussion between the authors and reviewers. However, the most important aspect of a healthy system is that authors, reviewers and editors recognise, value, and appreciate the contribution of one another to the publication of papers that advance knowledge in a given field.
Peer review is integral to advancing knowledge, understanding, wisdom, and innovation in any field of human inquiry. In Dr. Samuriwo’s opinion, peer review has added importance in health and social care because the research, evidence and narratives that are part of received wisdom influence the quality and safety of care that people receive. The fundamental purpose of peer review in health and social care is to ensure that published works are of the best possible quality, innovative, build on existing knowledge, and provide novel insights or ways of thinking. Writing for publication is challenging; thus, authors require supportive feedback to produce work of the highest standard.
From a reviewer’s perspective, Dr. Samuriwo believes that it is essential for authors to adhere to reporting guidelines during preparation of their manuscripts. The use of reporting guidelines provides the authors and reviewers with shared language and frame of reference that they can use to prepare and evaluate the paper respectively. Evaluating papers is made easier when they are structured and presented in line with a recognised reporting framework.
“Being a peer reviewer is fascinating because it enables one to take part in a form of intellectual discourse with the authors and editor about the merits as well as the contribution of a paper to wider knowledge relating to a specific topic. This type of intellectual debate is integral to the advancement of thought and wisdom in all fields of human endeavours, which has added importance in the era of the ongoing COVID19 pandemic. Peer reviewing is also interesting because it enables established researchers and/or academics to engage with, and provide support to people new to the field in the peer review process,” says Dr. Samuriwo.
Dr. Tomoki Nakamura is an orthopaedic surgeon at Mie University Hospital, Japan. His research area includes bone and soft tissue sarcoma, and metastatic bone tumor. The list of works of Dr. Nakamura can be found here.
Peer review, in Dr. Nakamura’s opinion, is very important in science. Submitted manuscripts should be improved through peer review since peer-reviewers can see other aspects of the topics that the authors might not be able to. Good reviewers should possess the standard knowledge and experience of the targeted field. They sometimes have to compare the methods presented in the manuscript with their own experience. However, they should ensure they remain unbiased throughout the whole process.
As a reviewer, Dr. Nakamura sees the importance for authors to disclose Conflict of Interest (COI) for their research. Only when the authors disclose their COIs can the readers judge who and which company are related to the study project, as well as the quality of the study, especially for clinical trials.