Charon Pierson
Charon Pierson
Editor, Journal of the American Association of Nurse Practitioners

nurses in OR2.jpgJournals in clinically related disciplines may feature manuscripts with a clinical focus, yet much of the guidance about reviewing manuscripts is focused on the research manuscript For reviewers accustomed to doing research or reviewing research manuscripts, the switch to reviewing clinically focused work can be difficult. Additionally, clinicians not experienced in scholarly writing might be reluctant to even agree to review a submitted manuscript.

General guidelines about the ethical conduct of peer review apply to all reviewers , but the following specific considerations will improve the experience for reviewers of clinical manuscripts.

1. The purpose of clinical manuscripts is to inform clinicians of new applications of research to practice. The important point to remember is a clinical article should be organized around a clinical question, not a research question. Reviewers need to ask themselves, will this manuscript lead clinicians to a new understanding of a disease process, therapies, behavioral interventions, assessment techniques, or genetic foundations of some condition. If the answer is no, then the manuscript is not likely to appeal to a clinician.

2. Clinical advances lag behind research, so timeliness is very important in clinically focused articles. If the information is “old news” then the manuscript is not likely to appeal to a busy clinician trying to translate evidence into practice. A reviewer’s expert knowledge of the field is a valuable asset here.

3. Clinicians are busy people tasked with caring for patients or running departments. They make many decisions in a day that have great impact on the lives of people. A useful article for this audience will contain accurate, complete, and current evidence presented in an easy to read style and format. A concise abstract, helpful tables, figures, photographs, and links to additional resources are key elements that will attract a busy clinician. A summary statement that clearly identifies a “take home” message will drive interested readers to the article.

4. Information on drug therapy is a particular issue for clinically focused manuscripts. Statistical significance in drug comparisons is not particularly helpful (p values), yet that is likely what is reported in research. Clinicians need information about clinical significance or importance of the findings. The author should provide a concise description of the magnitude of the effect of a drug and should clarify whether or not the research is sufficient to change clinical practice. For example, research that demonstrates a 2mm Hg decrease in blood pressure by drug A over drug B may produce statistical significance, but that difference is not clinically important enough to change a patient’s medication regimen. This is an important area for comment by the reviewer.

5. Evidence-based practice is the hallmark of health care in the 21st Clinicians make decisions based on current scientific evidence, their own clinical expertise, and patient factors. Some of those patient factors include financial issues, literacy of the patient, and personal preferences or religious beliefs of patients. For example, low cost generic drugs might be as effective as higher priced trademarked drugs; complicated regimens of multiple medications might not be feasible for low literacy or homeless patients; and some interventions, although highly clinically effective, might be in opposition to patients’ religious beliefs. A good reviewer will address these specific issues if applicable.

6. A clinically focused manuscript might include a case study of a real patient to illustrate the application of evidence to practice. Reviewers should always question whether or not the patient could be identified from the clinical data, including any photographs, radiographs, or genetic information provided. Protection of patients’ privacy is a serious ethical issue for journals and many require a patient consent to publish a case study. If this is not clear in the manuscript, the reviewer should raise the question.

Peer review is an important part of the production of scholarly work. When peer review is done well, authors benefit from the opportunity to improve their work; editors benefit from the clinical or research expertise of reviewers; and most importantly, the consumers of scholarly work such as journal readers, clinicians, patients, institutions, and the public, are reassured of the value and accuracy of the scientific record.

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