How does the process work

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How does the process work?
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Submissions in 2007 (n13,043)
Perspectives
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Editor in Chief Executive Editor
Deputy Editors
Associate Editors
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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
Statistical Review
Initial Decision
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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
Statistical Review
Initial Decision
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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
Statistical Review
Initial Decision
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Editors ask Peer Reviewers if the work is.

• High Quality
• Novel
• Ethical

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High Quality Clinical Trials

• Journals want the published research to be right.
  Findings from well designed and executed studies
  are more likely to be valid
• Strongest evidence for cause and effect Double
  Blind Randomized Controlled Trial

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High Quality Clinical Trials

• Randomization
• Appropriate control group
• Research subjects and investigators blinded to
  treatment assignment

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High Quality

• All patients screened and randomized are
  accounted for
• Few patients lost to follow-up

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High Quality - Analyses

• Primary and secondary outcomes pre-specified and
  clearly defined
• Data analyzed according to pre-specified plan
• Intention To Treat data analyzed according to
  patients original treatment assignment
• Secondary and post-hoc analyses distinguished
  from primary analyses

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High Quality

• Sample size large enough to provide sufficient
  power to answer research question

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Negative Trials

• We ARE interested in negative trials!
• Negative trials are of interest when
• Negative findings have important implications for
  practice or direction of future research
• Large enough to provide definitive answer to
  question framed

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Uninformative Negative Study

• RCT of 20 patients
• Primary Outcome P value
• Treatment A 30 0.10
• Treatment B 50
• Too small clinically important benefit not ruled
  out

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Informative Negative Study
N Engl J Med Volume 354212213-2224 May 25, 2006
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Study Overview

• In this randomized, controlled trial, there was
  no significant difference in 60-day mortality
  whether monitoring was performed with a
  pulmonary-artery catheter or a central venous
  catheter

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High Quality

• Complete and accurate reporting of adverse events
• Statements such as the drug was generally well
  tolerated are not informative (and often not
  accurate)
• Acknowledge when larger and longer studies are
  required to fully assess safety

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Novelty

• Study breaks new ground, defines new treatments
  or resolves major controversies

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Ethical Clinical Trials

• Adequate informed consent obtained
• Protocol approved by an IRB
• Risks to research subjects minimized and
  reasonable

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Editors use the Reviews

• Once reviews are in the editor reads the paper
  and the reviews
• The editor, not the reviewer, makes the decision
  about the paper
• We value the reviewers comments, but they are
  only consultants to our thinking process

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Associate Editor makes a decision

• Full consideration?
• Manuscript is presented to all the editors
• Minimal consideration?
• Manuscript is on the agenda but discussion is
  minimal

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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
Statistical Review
Initial Decision
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The Editors Meet
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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
About 20 of papers fail at this step
Statistical Review
Initial Decision
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Possible Decisions
Reject After Peer Review 42
Initial Reject 52
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Three Major Reasons for Rejection

• Quality the science is flawed
• Novelty the science is good, but has
  previously been published or does not
  advance the field
• Specialty its good, but not of general
  interest and belongs in a specialty journal

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Initial Submission
Editor-in-chief
Associate/ Deputy Editor
Peer Review
Editorial Meeting
Statistical Review
Initial Decision
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Revision Process
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Articles Published 2007
Original Research n219 5.1
Review Articles n72 37.5
Images n97 3.3
Letters n985 22.3
Editorials n130 92
Perspectives n149 26.6
Other Articles n95 18.2
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Data from the Science Citation Index Impact Factor
Impact Factor The number of citations of a
journals articles from the previous two years
divided by the number of articles published
during those same two years.
Impact Factor
Source Institute for Scientific Information,
Journal Citation Reports, 2008 .
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Data from the Science Citation Index Immediacy
Index
Immediacy Index The number of citations of a
journals articles from the current year divided
by number of articles published during that same
year.
Immediacy Index
Source Institute for Scientific Information,
Journal Citation Reports, 2008 .
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Trial Registration
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