what is a peer reviewed presentation

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• Published: 05 June 2019

Good Practice for Conference Abstracts and Presentations: GPCAP

• Cate Foster   ORCID: orcid.org/0000-0001-6236-5580 1 ,
• Elizabeth Wager   ORCID: orcid.org/0000-0002-4202-7813 2 , 3 ,
• Jackie Marchington   ORCID: orcid.org/0000-0001-8482-3028 4 ,
• Mina Patel   ORCID: orcid.org/0000-0001-9357-1707 5 ,
• Steve Banner   ORCID: orcid.org/0000-0002-7852-9284 6 ,
• Nina C. Kennard   ORCID: orcid.org/0000-0002-8480-7033 7 ,
• Antonia Panayi   ORCID: orcid.org/0000-0002-1997-3705 8 ,
• Rianne Stacey   ORCID: orcid.org/0000-0002-6516-3172 9 &

the GPCAP Working Group

Research Integrity and Peer Review volume  4 , Article number:  11 ( 2019 ) Cite this article

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Research that has been sponsored by pharmaceutical, medical device and biotechnology companies is often presented at scientific and medical conferences. However, practices vary between organizations and it can be difficult to follow both individual conference requirements and good publication practice guidelines. Until now, no specific guidelines or recommendations have been available to describe best practice for conference presentations.

This document was developed by a working group of publication professionals and uploaded to PeerJ Preprints for consultation prior to publication; an additional 67 medical societies, medical conference sites and conference companies were also asked to comment. The resulting recommendations aim to complement current good publication practice and authorship guidelines, outline the general principles of best practice for conference presentations and provide recommendations around authorship, contributorship, financial transparency, prior publication and copyright, to conference organizers, authors and industry professionals.

While the authors of this document recognize that individual conference guidelines should be respected, they urge organizers to consider authorship criteria and data transparency when designing submission sites and setting parameters around word/character count and content for abstracts. It is also important to recognize that conference presentations have different limitations to full journal publications, for example, in the case of limited audiences that necessitate refocused abstracts, or where lead authors do not speak the local language, and these have been acknowledged accordingly. The authors also recognize the need for further clarity regarding copyright of previously published abstracts and have made recommendations to assist with best practice.

By following Good Practice for Conference Abstracts and Presentations: GPCAP recommendations, industry professionals, authors and conference organizers will improve consistency, transparency and integrity of publications submitted to conferences worldwide.

Peer Review reports

Note on terminology

Company refers to any medical commercial organization involved with research, such as pharmaceutical or biotechnology companies and medical device manufacturers.

Company-sponsored refers to all types of research (preclinical and clinical, pre- and post-marketing) that is directly sponsored and/or funded by a company. While this classification does not necessarily include research performed under other types of funding arrangement, such as investigator-sponsored or investigator-initiated trials or research (where companies are not involved with conference presentations or publications), those involved in submitting investigator-initiated study material to conferences are encouraged to consider following these recommendations.

Conference is used to refer to meetings, often organized by academic societies, that invite submissions (usually as abstracts) presenting research findings on an aspect of medicine or science. Such conferences have a scientific (or programme) committee that reviews and selects presentations to be given at the meeting from the submitted abstracts.

Abstract refers to those submitted for consideration to scientific and medical conferences (see above).

Presentation refers to posters or slides developed from abstracts accepted for presentation at such conferences.

Lead author refers to the person who normally presents study findings at a conference and is usually listed as the first author. This is often the Principal Investigator.

Society sponsor refers to a member of the society that is holding the conference, who acts as sponsor (or guarantor) of a submitted abstract.

Presenting author refers to the person on the author list who attends the conference and presents the poster or abstract.

Non-author presenter or local presenter refers to a person who presents on behalf of the author group, but who is not listed as an author.

Introduction

Research that has been sponsored (see the ‘Note on terminology’ section for precise definitions of these terms) by commercial organizations (e.g. pharmaceutical, medical device and biotechnology companies) is often presented at scientific and medical conferences. These conferences are pivotal for the presentation of data from ongoing research projects and clinical trials to the relevant audience and are often the first opportunity to disclose and discuss potentially practice-changing data. They facilitate early communication of data long before publication of a full manuscript and also provide the opportunity to present results of additional analyses such as secondary and/or exploratory endpoints and post hoc analyses. However, while abstracts submitted to conferences are reviewed by a scientific committee for suitability and interest to the audience prior to acceptance, it is important to note that they are not considered peer-reviewed as they are not subject to the same rigorous peer-review process as are journal articles. Poster and oral presentations based upon accepted abstracts are rarely, if ever reviewed. Furthermore, a recent systematic review showed that less than 50% of all studies accepted as abstracts went on to be published in full following presentation at a conference [ 1 ]. While it is desirable to strive for full publication after a conference presentation to ensure transparency and allow healthcare professionals to make appropriate informed decisions based on the peer-reviewed literature, this is not always practical and/or achievable. Therefore, it is important that abstracts and conference presentations, particularly for company-sponsored research, are developed with as rigorous a process as that of a full publication, because these may ultimately become the only source for a particular analysis.

While there are recommendations on the preparation of journal articles and qualification for authorship [ 2 ], and guidelines for best practices in the publication of company-sponsored research [ 3 , 4 , 5 ], until now, no specific guidelines have been available to describe good practice and best principles for conference presentations. This has resulted in diverse practices and a lack of standard expectations for transparency and ethical approaches. Although some aspects of good practice in Good Publication Practice (GPP) [ 5 ] and in reporting guidelines such as CONSORT and PRISMA for Abstracts [ 6 , 7 ] can be applied to conference presentations, the most widely cited recommendations on authorship from the International Committee of Medical Journal Editors (ICMJE) relate exclusively to publications in peer-reviewed journals [ 3 ]. These recommendations were not designed for, and therefore are not fully applicable to, abstract submissions and conference presentations and are challenging to implement in practice. Building on the acceptance and recognition of the GPP guidelines (first published as GPP for Pharmaceutical Companies in 2003 [ 3 ], updated in 2010 [ 4 ] and most recently published as GPP3 in 2015 [ 5 ]), this article endeavours to extend their principles and to address challenges relating to the presentation of company-sponsored research at academic meetings. These recommendations, on Good Practice for Conference Abstracts and Presentations (GPCAP), focus on company-sponsored research (see the ‘Note on terminology’ section). However, they do not cover other company activities that may be linked to conferences (e.g. satellite symposia organized alongside scientific conferences, medical education and marketing activities) because these are governed by regional and national legislation or codes (e.g. EFPIA code of practice [ 8 ], FDA regulations [ 9 ]). As with the GPP guidelines, GPCAP focuses on the presentation of all types of company-sponsored research and the specific challenges surrounding this, rather than investigator-sponsored or investigator-initiated trials or research (where companies have no role in their presentation or publication), although many of the principles also apply to the presentation of other types of research at scientific meetings. The aim of GPCAP is therefore to provide guidance on good submission and presentation practice for scientific and medical congresses, specifically addressing certain aspects where current publication guidelines are inadequate.

These recommendations were developed after informal discussions among a group of individuals who have wide experience of working with authors to develop abstracts, posters and slides for oral presentations reporting company-sponsored research. The main impetus for this article arose from a meeting regarding GPP3 updates (with which some of the authors had been involved). Prior to this meeting, two authors had noted that even the revised GPP3 guidelines contained limited advice for conference abstracts and presentations. Meeting participants discussed the requirement for clearer guidance and formed a working group to address this gap. At this point, invitations to join the group were extended to potential authors known to have previously presented relevant research at meetings of the International Society of Medical Publication Professionals (ISMPP) or had a known interest in conference presentations. This also ensured a broader global representation and improved the balance between pharmaceutical and medical communication agency representation. The authors all work or have worked for pharmaceutical companies and/or medical communication agencies (see the ‘Competing interest’ section for specific details). After a search for recommendations and guidelines on this topic revealed nothing specific (either in ICMJE or in a search on EQUATOR), the authors developed an initial outline for this article; individuals worked on pre-agreed sections and then a collective review of the full draft, comprising all sections was completed (see ‘Authors’ contributions’ for specific details). The resulting article was posted as a preprint on PeerJ [ 10 ] on 19 October 2017 for open comment. All comments received (and their responses) can be seen with the preprint on the PeerJ website. These comments were used to revise the recommendations. Some authors invited informal consultation from colleagues, and a courtesy legal review, as appropriate, was completed to ensure compliance with employee company policies. The copyright section was reviewed specifically for appropriate interpretation of copyright law. In addition to the preprint, 65 medical societies and medical conference sites, and two for-profit companies that run conferences on behalf of societies, were contacted for comment via contact emails listed on their websites or via ‘contact us’ options found on their websites. The societies and conferences and conference service companies were selected by recommendation from within the author group, to ensure balance across therapeutic areas, geography and variety of website submission sophistication. Only one of these societies/companies responded. All comments received on the preprint by 10 July 2018 were collated and discussed, and this final version was generated. The preprint was viewed by 2769 unique visitors and downloaded 3300 times between 19 October 2017 and 25 March 2019.

The recommendations are given here by topic, and so there is some overlap by intention, to ensure that all the key elements for any given topic appear together and allow readers to browse by topic.

Recommendations

The following principles aim to cover the key areas relevant for submissions to any research-based conference.

Author listings should reflect those who did the research and can take accountability for its conduct, and for the analysis and interpretation of the findings. Criteria for authorship of conference abstracts and presentations should generally be the same as those for full publications, although there can be occasions where local presenters may be included as authors, for example, where a conference requires a presenter to be listed as an author.

All authors should be involved in the development, and approve the final version, of any abstract, poster or slides that bears their names. For studies involving large numbers of researchers it may be most efficient for a subgroup of those involved in the studies to develop conference abstracts and presentations (similar to the use of a writing group to develop publications from large studies).

Posters and slides should list key contributors and describe their contributions to the research and development of the presentation.

Study registration numbers (e.g. ClinicalTrials.gov , EudraCT, PROSPERO) should be included on abstracts, posters and slides.

All sources of funding for the research and its presentation, and any author conflicts of interest, should be disclosed on posters and slides, on the conference submission site, and if space permits, on abstracts.

Any medical writing support and associated funding should be acknowledged on posters and slides, on the conference submission site, and if space permits, on abstracts.

These recommendations are mapped against the development of an abstract and subsequent conference presentation workflow in Fig.  1 , referenced by section number.

Roadmap of recommendations following abstract and presentation development stages

Recommendations for conference organizers

Conference organizers should:

encourage the inclusion of contributor lists on posters and slides;

include a field for trial registration details on abstract forms (outside the word or character limit) and publish this information with the abstract;

include a field for sponsor information on abstract forms (outside the word or character limit) and publish this information with the abstract;

include a field for disclosing medical writing support on abstract forms (outside the word or character limit) and publish this information with the abstract;

use ORCID identifiers (individual researcher identifiers [ 11 ]) to identify authors and presenters;

not set arbitrary limits on the number of authors, and permit the use of study group names; and

distinguish between authors (meeting the ICMJE criteria) and any additional individuals (who are not authors or contributors) included in the submission, for example, as a result of a requirement for a society member to sponsor submissions. With limited space in any printed book of abstracts, this information might be restricted to appearing with the online version of the abstract.

1.0 Authorship

1.1 authors.

1.1.1 The author listing on conference abstracts and presentations should reflect the people who did the research or contributed substantially to the design of the study or to the interpretation of the results, and who were involved in the development of the presentation and who are willing to take responsibility for the findings. Authorship and author order should be agreed by all authors (see 1.1.5 for factors to consider). While the authorship criteria recommended by the ICMJE are widely used for journal articles [ 2 ], GPP3 recognizes that it may be necessary to adopt slightly different criteria for conference abstracts and presentations [ 5 ]. For example, while all named authors should review (at least once), approve the content of abstracts and presentations and be willing to take responsibility for the findings, it may be impractical to expect all authors to contribute to drafting and critically revising abstracts in the same way as for full manuscripts, because of the abstract brevity, time constraints, etc. There is an argument for limiting the authors to a number that can meaningfully comment and review an abstract (see 1.2.1) and using a study group to identify others involved in the wider study. Our collective past experience indicates that it becomes impractical for everyone to be involved in a group with more than 10 authors, which is also the maximum number suggested by GPP3 [ 5 ].

1.1.2 Authorship criteria for all anticipated journal articles and primary conference presentations should, ideally, be agreed at the start of the research, and author listings for subsequent secondary abstracts and presentations should be finalized well before work starts on the secondary material [ 12 ]. As with journal publications, whatever criteria are used to determine authorship should be applied equally to all authors, regardless of whether they are company employees, contractors, independent clinicians, researchers or consultants.

1.1.3 Authors and contributors should have access to all relevant study materials and data to permit them to understand the research findings. Abstracts may need to be developed soon after results are analysed and before a final clinical study report is available. In such cases, authors should always have access to the protocol, statistical tables and any other information necessary to discuss and develop the planned abstract and presentation.

1.1.4 If individuals are authors on abstracts and presentations written in languages in which they are not proficient, companies should work with them and offer whatever reasonable assistance is required to permit them to discuss and review material effectively (e.g. to provide translations for the authors, or a discussion with an interpreter or local investigator/presenter who can read and explain the text). Authors may also choose not to be listed for such a conference abstract and presentation (see also 1.1.6).

1.1.5 Whatever convention is (or will be) used to determine the order of authors on the related full publications in journals should generally also be used to determine the order of listing on conference abstracts and presentations. The final order should be agreed by all authors; however, conference requirements (e.g. listing the presenting author first) must be respected. In cases where first or last co-authorship is requested, the conference organizers should be contacted for guidance.

1.1.6 While the authorship of conference abstracts and presentations should accurately reflect those who were involved in the research, individuals who meet the ICMJE authorship criteria (and may be listed on a subsequent full publication) may choose not to be listed for a conference abstract and presentation (e.g. if they are unable to review and/or approve the material within the deadline). While this individual choice should be respected, significant contributions to the research should be acknowledged where possible; that is, in a contributor list included on the presentation.

1.1.7 Conference organizers should encourage the use of ORCID identifiers to identify authors on abstracts and presentations, to avoid ambiguity between authors with similar or identical names. (Note: many journals and institutions now require authors to include their ORCID identifier at manuscript submission.)

1.2 Contributors/study groups

1.2.1 We encourage conferences (and company sponsors) not to limit the number of authors (or contributors) who may be listed on an abstract or presentation, because this practice may prevent the author list from accurately reflecting who did the work. However, named authors should be limited to those who have actively participated in the development of the abstract (see 1.1.1). GPP3 recommends an author group of fewer than 10 [ 5 ]; above this number, naming a study group may be a more practical approach. Likewise, if the source data come from a study, and the authors involved in that study meet authorship criteria, then the use of a study group name is strongly recommended.

1.2.2 Study group names may be helpful to acknowledge contributions to projects involving a large number of people, in addition to named authors who have contributed both to the research and to developing the presentation. Inclusion of a study name, either in the title or by including a study group in the author listing, will facilitate linkage of conference abstracts and presentations with journal publications. However, this should not be a substitute for including a unique study identifier such as a registration number for clinical trials (e.g. ClinTrials.gov or EudraCT numbers), which is a more reliable linkage method because these can be used as search terms in relevant databases. Provision should be made for study group membership details to be added during abstract submission and made available via the conference website once an abstract has been accepted.

1.3 Presenters and society sponsors

1.3.1 While the ICMJE criteria are a useful starting point for determining authorship, they were not designed for conference abstracts and presentations. Therefore, in certain circumstances, and if all authors agree, it is permissible for somebody who does not (or will not) meet the ICMJE authorship criteria for a journal article to present findings at a conference. For example, a local presenter may be included (preferably in a contributor list and not as an author) if the authors of the conference presentation will not attend a particular meeting, do not speak the language required or are not members of the academic society hosting the meeting. This local presenter, for example, could be an investigator who recruited patients but did not contribute to the study design or interpretation of data and will not be involved in developing journal articles. In the contributor list, this person should be designated as ‘presenter’ to clarify their role. However, if the conference requires that only authors can present, then the new presenter will need to be added to the author list.

1.3.2 Abstract authors (including company authors) attending a conference should always be preferred as presenters over non-author presenters. In cases where an author is not available to present, and the conference acquiesces to a non-author covering the presentation, the non-author presenter should be familiar with the research design and findings and have a good knowledge of the subject area in order to respond to questions about the presentation even if, unlike the authors, they cannot take direct responsibility for the research. An appropriately qualified individual from the sponsoring company (e.g. Medical Director) could present study findings if authors are not available; however, individuals with a commercial role in the sponsoring company (i.e. sales or marketing) should not act as non-author presenters.

1.3.3 All those listed as authors on an abstract or presentation must be able to take accountability for the research (following the spirit of the ICMJE recommendations). Therefore, if conferences require a society member to sponsor a submission, and none of the authors or study investigators is a member, this sponsorship role should be distinguished from that of the study authors if the sponsor/member was not involved with the research. If an existing author happened to be a society member, then no such distinction would be necessary. If the conference wishes to list the society sponsor, then this role should be indicated on the abstract (e.g. by an asterisk) and in a contributor list (not the author list) on the presentation.

Figure  2 illustrates some scenarios to differentiate between authors and non-author presenters.

When is a presenter not an author? Different roles possible for authors and presenters of conference presentations

2.0 Conference abstracts

2.1 To facilitate linkage between conference abstracts and presentations, and subsequent publications, abstracts should include a study identifier such as a registration number (for clinical trials), study name, protocol number or grant number. To encourage this, conference organizers should require this information in a specific field on the submission form and publish it with the abstract.

2.2 Abstracts describing company-sponsored research should always name the sponsor and all funding sources (if more than the sponsor).

2.3 Authors or sponsoring companies may involve professional medical writers to support authors in the drafting of abstracts. All authors should agree to these arrangements and work closely with any writers and approve the final version. Space limitations on abstract submission sites usually preclude writing support acknowledgement. Conference organizers should consider requesting this information and publishing it with the abstract.

2.4 We encourage conference organizers to consider the requirements of reporting guidelines when setting limits on the length of abstracts. For example, CONSORT for Abstracts suggests that around 300 words may be needed to adequately report randomized clinical trials [ 7 ].

2.5 We also encourage conference organizers to maximize the available space for content in abstracts by not counting authors, affiliations, trial registration numbers and sponsor acknowledgments towards the word or character limit.

2.6 Most conferences will not consider reports of findings that have already been published in full (i.e. in a peer-reviewed journal). This requirement must be respected and, even if permitted, presenting findings after their full publication should be avoided. However, abstracts presenting findings or novel analyses that are not included in a full publication may be submitted if the conference permits this. In situations where a journal article is in preparation at the same time as abstract submission, subsequent submission of the article may overtake the abstract in acceptance, at which point the conference needs to be advised, and the journal also, to avoid issues of prior data release. It may be necessary to withdraw the abstract, or it might be possible for the journal and conference to come to a mutually acceptable arrangement regarding either delay of the article or amendment to the intended presentation. Posting summary results on a trial register (e.g. ClinicalTrials.gov , EudraCT) or a clinical study report to meet regulatory requirements is not regarded as full publication by the ICMJE [ 2 ] and should not prevent subsequent presentation at conferences.

2.7 As conference submission requirements become more detailed (and therefore labour-intensive), conference organizers should acknowledge that it is acceptable for the abstract submission process to be completed by a third party (e.g. a medical communications company) on behalf of the submitting author, with that author’s permission. Where feasible, the submission might be checked by the submitting author prior to the actual submission; however, there are some sites where submission has to be completed in one sitting, and on other occasions, time differences (and time pressures) may make this impractical.

3.0 Conference presentations (posters and slides)

3.1 general considerations.

3.1.1 Study identifiers (e.g., trial registration numbers) should be included on presentations to improve linkage between conference presentations and subsequent publications (see also Section 4).

3.1.2 All funding sources for the research, any assistance with the presentation (e.g. medical writing support, editorial assistance or design) or support for conference attendance and authors’ conflicts of interest should be clearly disclosed on posters and slides. For posters and slides, such disclosures should be clearly legible (i.e. not significantly smaller or lighter-coloured than the main text).

3.1.3 Author listing and order on posters and slides should be the same as that on the abstract. Authors should not be added to a presentation after the abstract is accepted. However, if an author is unavailable to work on a presentation after abstract acceptance, their name may be removed from the author list but their contribution (to the study and/or publication) should be acknowledged. If an author other than the first-named author is to present, this should be indicated without changing the author order. The principle is to retain the same information about authors as on the abstract for ease of identifying the related presentation. Similarly, the title of the presentation should not be changed after submission; thus, the titles of the abstract and poster or slides should be identical. [If someone not on the author list is to present, and this is known in time for poster preparation, the relevant name could be added as a footnote, or close to the author list thus: (Presenter: J. Doe, ABC Institute, City, Country).]

3.1.4 All named authors should contribute to the development of, and approve, the presentation (see 1.1.1). Authors should be given sufficient time for presentation development and review. Making significant changes to posters or slides after all-author approval should be avoided. If changes must be made after approval, the actual final version must be sent to all authors. As with journal articles, for large studies, it may be most efficient for a subgroup to coordinate the development of a presentation (similar to a writing group for an article). This should be considered when deciding authorship.

3.1.5 Each author’s contributions to the study and to the development of the presentation should be listed.

3.1.6 Conference presentations should include a list of contributors who have made a significant contribution to the research or the presentation, regardless of whether they are listed as authors or attending the meeting. Ideally, permission for such acknowledgment should be sought in writing.

3.1.7 Because abstracts are usually submitted several months before a conference, they may contain interim or preliminary findings. Therefore, by the time of the conference presentation, some details may have changed. If research findings change substantially between abstract submission and conference presentation and affect the conclusions of the research, we recommend that authors alert the conference to this discrepancy. This is particularly pertinent in the case of oral presentations (because abstracts are typically selected for oral presentations based on the impact of the findings). Regardless of whether the new data change the conclusions of the research, we recommend indicating (e.g. in a footnote) any data that are different from those on the accepted abstract.

3.1.8 Authors or sponsoring companies may involve professional medical writers in the production of posters and slides. Authors should agree to these arrangements and work closely with any writers, editors and/or designers throughout the development of the presentation. Such support should be disclosed on the presentation, along with source(s) of funding (see also 3.1.2).

3.2 Posters

3.2.1 While there are platforms where posters can be made permanently available (e.g. on conference websites or platforms such as F1000 Research), some journals regard this as prior publication which may jeopardize full publication. Authors should therefore check the policies of their target journal(s) and of the sponsor or funder before agreeing to a poster being publicly posted.

3.2.2 Posters are not peer-reviewed by conferences and may not describe all aspects of the research. Posters should therefore not be viewed as a substitute for a full article in a peer-reviewed journal. However, if a poster is publicly available (and, ideally, searchable via an indexing system or DOI), it may be cited until the full publication is available, although some journals consider citation of posters as unpublished information rather than full citations. See Section 6 for citation best practice.

3.2.3 The lead author should be given the first option to attend the poster session(s), but this role may be taken by other authors or a local presenter (if no author can attend or if no authors can present in the language of the conference). The poster presenter should ideally be agreed before the abstract is submitted, although it is understood that circumstances may change by the time of the actual conference (see 1.3.1).

3.2.4 While disclosures, funding sources, acknowledgements and contributions should be clearly noted on the main poster, supplementary sources can be used to expand on these if there is not enough room for detailed information, and may be accessed via a QR code (or similar link). Such content should normally be available until the research is published, in full, in a journal (at which point the link should be deactivated). If QR codes (or similar technology) are used to provide copies of the poster or to link to other scientific content, these should only be available to conference attendees, unless the conference elects to make the posters freely available after the conference. Links for the QR codes may be time-limited to close once the conference is finished. Supplementary materials may include translations. Supplementary material should be provided under the same usage conditions as the poster and indicate who is the copyright holder or licensee.

3.3 Slides for oral presentations

3.3.1 While the lead author is normally expected to present study findings at conferences (and is given the first option to do so), this may not be possible due to local language requirements, availability to travel, or personal circumstances, etc. If the lead author chooses not to present study findings, another author may give the oral presentation. If none of the named authors is available or able to give the presentation, a non-author presenter may present the findings if all authors agree to this and the conference permits it (see also 1.3.1 and 1.3.2). The presenter should be agreed before the abstract is submitted (and only changed if that person becomes unavailable). The lead author should discuss the contents of the presentation and the interpretation of the findings with the presenter (and co-authors, if possible) before the conference to ensure the authors’ views are correctly represented.

3.3.2 If a non-author presenter gives a presentation on behalf of the named authors (or study group), this should be indicated at the beginning of the presentation. The presenter’s conflicts of interest should be noted on the disclosure slide.

3.3.3 Recordings of oral presentations may be posted online by conference organizers but, as with posters, care should be taken to ensure this does not jeopardize full publication in a peer-reviewed journal. Slides alone (without the accompanying talk or speaker notes) may be hard to interpret and not provide full context, so care should be taken if these are made publicly available. As with posters (see 3.2.4), online sources may also be considered to host supplementary materials for presentations if they are made available after the presentation. If slides are made publicly available, this should not occur until after the presentation has been given and should only occur with the agreement of all authors and sponsors, who will need to consider any restrictions around the posting of the data and possible ‘prior publication’ concerns for later use (see 6.1.2).

3.3.4 Some scientific meetings offer Continuing Medical Education (CME) credit for attendance at oral presentations. Local regulations and requirements of the accreditation body for this must be respected.

4.0 Encore abstracts and presentations

4.1. It is permissible to present the same research findings at more than one conference if both the first and subsequent conferences allow this. This practice may be referred to as an ‘encore’ (or more specifically an encore abstract or encore presentation). However, presentations of the same findings to the same audience should be avoided.

4.2 Although encore abstracts are not considered to be redundant publications (unlike publication of the same findings in more than one journal), some conferences elect only to accept findings that have not been presented at other conferences, and such requirements must be respected.

4.3 When considering encore abstracts, the authors and sponsoring company should decide whether it is most appropriate to submit identical abstracts to multiple conferences or whether it is better to emphasize different aspects of a trial (e.g. those of interest to different audiences). Use of study identifiers can help identify that multiple conference abstracts and presentations are from a single study. However, to avoid any confusion, we recommend that encores should be specifically identified as such (e.g. by stating that the presentation is an ‘encore’ and listing where previous abstracts of all or some of the findings were presented) (see also 4.4 and 4.6). We also recommend that previous presentations should be listed on the presentation, if accepted.

4.4 Conference organizers should consider including a means of identifying encore abstracts (e.g. including details of prior presentations) on the abstract submission form. This information should not be included in the abstract word or character count.

4.5 Addition of new data to a previously accepted abstract may not necessarily constitute a new abstract: conference guidelines should be consulted to confirm if this is acceptable. If no specific guidelines are provided, then as a general guide, if the new iteration adds any new data other than an update on analyses already contained in a previous abstract, then the new iteration should be regarded as a new abstract.

4.6 Where encore abstracts, or updated abstracts that include previously presented data, are accepted, their presentations should indicate that this is not the first time of presentation, for example, by a statement on the poster or slides such as “Data/some data first presented at [conference name and date]”.

4.7 Encore checklist: When deciding whether to submit an encore abstract to a conference to reach different audiences, authors and study sponsors should consider the following points.

What is the overlap, if any, with the audience of the earlier conference (e.g. in terms of region, specialism or profession)?

Are there any differences in the licensing status of any products mentioned in the presentation between the first and subsequent conference locations? For example, if the first presentation occurred in a region where a product is licensed, but later presentation(s) will take place in a region where it is not yet licensed, this fact may need to be reflected. For international meetings, remember that participants will attend from several regions, so the licensing status in different countries should be clarified.

Presentation at multiple meetings might delay and/or potentially jeopardize the full publication of research in a peer-reviewed journal. Companies should consider whether resources would therefore be better spent on ensuring a timely submission to a journal rather than preparing several encore abstracts and presentations.

5.0 Copyright considerations

5.1 Copyright transfer or publishing licence agreements that are executed during the abstract submission process are common when abstracts are to be formally published (e.g. in a conference-specific journal issue). These agreements relate only to the abstract, not to any subsequent presentation, unless explicitly agreed otherwise.

5.2 Copyright in a presentation is normally held by the authors, unless they have assigned it either to the conference or the sponsoring company. Re-use of a poster (at a subsequent meeting or in another format, such as a poster book or handout) normally requires permission from the copyright holder(s). It may therefore be simplest for authors to assign usage rights to the sponsor company if encore presentations or other types of re-use are planned. If a company author is included, then the copyright for that individual’s contribution rests with the company (not the employee).

5.3 If a conference wishes to acquire usage rights for abstracts, slides, or posters, we recommend that the conference offers an open access option under a Creative Commons (CC) licence. We encourage the use of the least restrictive CC-BY licence, which will allow authors and sponsoring companies the usage rights for subsequent presentations, as well as future publications. If presentations contain third-party material to which the authors do not hold copyright, it should be the responsibility of the conference organizers to clear rights for any further usage. The authors cannot be expected to anticipate the future use of materials by the conference organizers.

5.4 As for any publication, permission must be sought for use of third-party copyrighted material (e.g. a figure) in a presentation (and again for any encore presentations). Material should not be altered simply to avoid having to obtain permission from the copyright holder.

5.5 Peer-to-peer presentation at a scholarly conference by a researcher is generally considered to be fair dealing (UK) [ 13 ] or fair use (USA) [ 14 ], which does not require copyright permission. Any other use of a presentation by a company outside the conference will most likely be considered commercial use, for which permission from the rights holder(s) will be necessary.

6.0 Citing conference material

6.1 References (or citations) in scientific texts provide readers with source or background material and are used to justify or support statements. To be useable, the referenced material must be both permanently accessible and reliable; therefore, citations to full publications in journals that apply rigorous peer review are the ideal. However, if citations are needed for research that has not yet been fully published in a peer-reviewed journal, abstracts that have undergone scientific review (and on the basis of that have been accepted for presentation by a conference) may be cited, especially if they have also been published in a journal and are therefore permanently accessible and discoverable. Abstracts should not be cited after the full (primary) publication has been accepted by a journal.

6.2 Posters and slides are not peer-reviewed by conferences and are often not permanently or widely accessible or discoverable. Citations to posters or slides should therefore be avoided (see 6.1). However, if a poster or slide set is publicly available (and, ideally, discoverable via an indexing system or DOI), it may be cited until the full publication is available (although some journals consider citation of posters or slides as unpublished information rather than full citations). Authors and sponsor companies should ensure that publishing posters or slides online does not jeopardize full publication in a peer-reviewed journal.

6.3 To avoid citing conference posters or slides, companies should consider other dissemination routes such as listing findings as ‘Data on File’ (i.e. an unpublished data package held by the pharmaceutical company, which then should be supplied to anyone requesting those data).

6.4 If specific findings that were presented at a conference are omitted from a journal article (e.g. because of space constraints), they could be made accessible as supplementary material.

These recommendations summarize the authors’ collective experience with a view to outlining the underlying principles for best practice and providing guidance on the practicalities for navigating conference requirements. We did consider whether some of our recommendations could be accomplished by amendments to company–author agreements, but decided that such recommendations for ‘good practice for author agreements’ were beyond the remit and scope of this article and that GPP3 [ 5 ] adequately covers this aspect of author–sponsor relationship. Many of these recommendations are drawn from the working group’s experience across a variety of disease areas and conferences. However, this is also a limitation, in that by the nature of the authors’ work, their experience lies in conferences and conference submission systems with strong industry involvement. We believe that these recommendations could be applied to any type of scientific/medical conference and are as relevant to academic research as to company-sponsored research. Conferences maintain their value to the scientific community by covering the latest research and providing a forum for discussion: this value must not be lost due to lack of transparency or ethics in the preparation and presentation of the new data. By following these recommendations, industry professionals, authors and conference organizers will improve consistency, transparency and integrity of publications submitted to conferences worldwide.

It is earnestly hoped that future input from conference organizers and societies, as well anyone involved in submitting research to conferences, will augment and strengthen these recommendations. We therefore welcome feedback via the website ( https://gpcap.org ).

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Acknowledgements

Special thanks go to Peter Llewellyn of Network Pharma, for hosting the meeting on GPP3 that acted as a catalyst for getting these recommendations underway.

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CF raised the initial suggestion for guidelines, co-developed preliminary sections of text for the initial draft and discussed comments and revisions, reviewed all versions and approved the submitted version. EW drafted the Principles section and other portions of the text, discussed comments and revisions, reviewed all versions and approved the submitted version. JM consulted on the initial suggestion for these guidelines, drafted the Copyright section and other portions of the text, discussed comments and revisions, reviewed all versions and approved the submitted version. MP co-developed the foundation of the Encore Presentations section, discussed comments and revisions, reviewed all versions and approved the submitted version. SB consulted on the initial suggestion for these guidelines, assisted in the development of the initial draft, reviewed all subsequent drafts and approved the submitted version. NK drafted the abstract and other portions of the text, discussed comments and revisions, reviewed all versions and approved the submitted version. AP developed several sections with the author group, discussed comments and revisions, reviewed all versions and approved the submitted version. RS consulted on the initial suggestion for these guidelines, co-developed preliminary sections of text for the initial draft, discussed comments and revisions, incorporated feedback on the pre-print version, reviewed all versions and approved the submitted version. All authors read and approved the final manuscript.

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Ten simple rules for effective presentation slides

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Affiliation Biomedical Engineering and the Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America

• Kristen M. Naegle

Published: December 2, 2021

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Citation: Naegle KM (2021) Ten simple rules for effective presentation slides. PLoS Comput Biol 17(12): e1009554. https://doi.org/10.1371/journal.pcbi.1009554

Copyright: © 2021 Kristen M. Naegle. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The author received no specific funding for this work.

Competing interests: The author has declared no competing interests exist.

Introduction

The “presentation slide” is the building block of all academic presentations, whether they are journal clubs, thesis committee meetings, short conference talks, or hour-long seminars. A slide is a single page projected on a screen, usually built on the premise of a title, body, and figures or tables and includes both what is shown and what is spoken about that slide. Multiple slides are strung together to tell the larger story of the presentation. While there have been excellent 10 simple rules on giving entire presentations [ 1 , 2 ], there was an absence in the fine details of how to design a slide for optimal effect—such as the design elements that allow slides to convey meaningful information, to keep the audience engaged and informed, and to deliver the information intended and in the time frame allowed. As all research presentations seek to teach, effective slide design borrows from the same principles as effective teaching, including the consideration of cognitive processing your audience is relying on to organize, process, and retain information. This is written for anyone who needs to prepare slides from any length scale and for most purposes of conveying research to broad audiences. The rules are broken into 3 primary areas. Rules 1 to 5 are about optimizing the scope of each slide. Rules 6 to 8 are about principles around designing elements of the slide. Rules 9 to 10 are about preparing for your presentation, with the slides as the central focus of that preparation.

Rule 1: Include only one idea per slide

Each slide should have one central objective to deliver—the main idea or question [ 3 – 5 ]. Often, this means breaking complex ideas down into manageable pieces (see Fig 1 , where “background” information has been split into 2 key concepts). In another example, if you are presenting a complex computational approach in a large flow diagram, introduce it in smaller units, building it up until you finish with the entire diagram. The progressive buildup of complex information means that audiences are prepared to understand the whole picture, once you have dedicated time to each of the parts. You can accomplish the buildup of components in several ways—for example, using presentation software to cover/uncover information. Personally, I choose to create separate slides for each piece of information content I introduce—where the final slide has the entire diagram, and I use cropping or a cover on duplicated slides that come before to hide what I’m not yet ready to include. I use this method in order to ensure that each slide in my deck truly presents one specific idea (the new content) and the amount of the new information on that slide can be described in 1 minute (Rule 2), but it comes with the trade-off—a change to the format of one of the slides in the series often means changes to all slides.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

Top left: A background slide that describes the background material on a project from my lab. The slide was created using a PowerPoint Design Template, which had to be modified to increase default text sizes for this figure (i.e., the default text sizes are even worse than shown here). Bottom row: The 2 new slides that break up the content into 2 explicit ideas about the background, using a central graphic. In the first slide, the graphic is an explicit example of the SH2 domain of PI3-kinase interacting with a phosphorylation site (Y754) on the PDGFR to describe the important details of what an SH2 domain and phosphotyrosine ligand are and how they interact. I use that same graphic in the second slide to generalize all binding events and include redundant text to drive home the central message (a lot of possible interactions might occur in the human proteome, more than we can currently measure). Top right highlights which rules were used to move from the original slide to the new slide. Specific changes as highlighted by Rule 7 include increasing contrast by changing the background color, increasing font size, changing to sans serif fonts, and removing all capital text and underlining (using bold to draw attention). PDGFR, platelet-derived growth factor receptor.

https://doi.org/10.1371/journal.pcbi.1009554.g001

Rule 2: Spend only 1 minute per slide

When you present your slide in the talk, it should take 1 minute or less to discuss. This rule is really helpful for planning purposes—a 20-minute presentation should have somewhere around 20 slides. Also, frequently giving your audience new information to feast on helps keep them engaged. During practice, if you find yourself spending more than a minute on a slide, there’s too much for that one slide—it’s time to break up the content into multiple slides or even remove information that is not wholly central to the story you are trying to tell. Reduce, reduce, reduce, until you get to a single message, clearly described, which takes less than 1 minute to present.

Rule 3: Make use of your heading

When each slide conveys only one message, use the heading of that slide to write exactly the message you are trying to deliver. Instead of titling the slide “Results,” try “CTNND1 is central to metastasis” or “False-positive rates are highly sample specific.” Use this landmark signpost to ensure that all the content on that slide is related exactly to the heading and only the heading. Think of the slide heading as the introductory or concluding sentence of a paragraph and the slide content the rest of the paragraph that supports the main point of the paragraph. An audience member should be able to follow along with you in the “paragraph” and come to the same conclusion sentence as your header at the end of the slide.

Rule 4: Include only essential points

While you are speaking, audience members’ eyes and minds will be wandering over your slide. If you have a comment, detail, or figure on a slide, have a plan to explicitly identify and talk about it. If you don’t think it’s important enough to spend time on, then don’t have it on your slide. This is especially important when faculty are present. I often tell students that thesis committee members are like cats: If you put a shiny bauble in front of them, they’ll go after it. Be sure to only put the shiny baubles on slides that you want them to focus on. Putting together a thesis meeting for only faculty is really an exercise in herding cats (if you have cats, you know this is no easy feat). Clear and concise slide design will go a long way in helping you corral those easily distracted faculty members.

Rule 5: Give credit, where credit is due

An exception to Rule 4 is to include proper citations or references to work on your slide. When adding citations, names of other researchers, or other types of credit, use a consistent style and method for adding this information to your slides. Your audience will then be able to easily partition this information from the other content. A common mistake people make is to think “I’ll add that reference later,” but I highly recommend you put the proper reference on the slide at the time you make it, before you forget where it came from. Finally, in certain kinds of presentations, credits can make it clear who did the work. For the faculty members heading labs, it is an effective way to connect your audience with the personnel in the lab who did the work, which is a great career booster for that person. For graduate students, it is an effective way to delineate your contribution to the work, especially in meetings where the goal is to establish your credentials for meeting the rigors of a PhD checkpoint.

Rule 6: Use graphics effectively

As a rule, you should almost never have slides that only contain text. Build your slides around good visualizations. It is a visual presentation after all, and as they say, a picture is worth a thousand words. However, on the flip side, don’t muddy the point of the slide by putting too many complex graphics on a single slide. A multipanel figure that you might include in a manuscript should often be broken into 1 panel per slide (see Rule 1 ). One way to ensure that you use the graphics effectively is to make a point to introduce the figure and its elements to the audience verbally, especially for data figures. For example, you might say the following: “This graph here shows the measured false-positive rate for an experiment and each point is a replicate of the experiment, the graph demonstrates …” If you have put too much on one slide to present in 1 minute (see Rule 2 ), then the complexity or number of the visualizations is too much for just one slide.

Rule 7: Design to avoid cognitive overload

The type of slide elements, the number of them, and how you present them all impact the ability for the audience to intake, organize, and remember the content. For example, a frequent mistake in slide design is to include full sentences, but reading and verbal processing use the same cognitive channels—therefore, an audience member can either read the slide, listen to you, or do some part of both (each poorly), as a result of cognitive overload [ 4 ]. The visual channel is separate, allowing images/videos to be processed with auditory information without cognitive overload [ 6 ] (Rule 6). As presentations are an exercise in listening, and not reading, do what you can to optimize the ability of the audience to listen. Use words sparingly as “guide posts” to you and the audience about major points of the slide. In fact, you can add short text fragments, redundant with the verbal component of the presentation, which has been shown to improve retention [ 7 ] (see Fig 1 for an example of redundant text that avoids cognitive overload). Be careful in the selection of a slide template to minimize accidentally adding elements that the audience must process, but are unimportant. David JP Phillips argues (and effectively demonstrates in his TEDx talk [ 5 ]) that the human brain can easily interpret 6 elements and more than that requires a 500% increase in human cognition load—so keep the total number of elements on the slide to 6 or less. Finally, in addition to the use of short text, white space, and the effective use of graphics/images, you can improve ease of cognitive processing further by considering color choices and font type and size. Here are a few suggestions for improving the experience for your audience, highlighting the importance of these elements for some specific groups:

• Use high contrast colors and simple backgrounds with low to no color—for persons with dyslexia or visual impairment.
• Use sans serif fonts and large font sizes (including figure legends), avoid italics, underlining (use bold font instead for emphasis), and all capital letters—for persons with dyslexia or visual impairment [ 8 ].
• Use color combinations and palettes that can be understood by those with different forms of color blindness [ 9 ]. There are excellent tools available to identify colors to use and ways to simulate your presentation or figures as they might be seen by a person with color blindness (easily found by a web search).
• In this increasing world of virtual presentation tools, consider practicing your talk with a closed captioning system capture your words. Use this to identify how to improve your speaking pace, volume, and annunciation to improve understanding by all members of your audience, but especially those with a hearing impairment.

Rule 8: Design the slide so that a distracted person gets the main takeaway

It is very difficult to stay focused on a presentation, especially if it is long or if it is part of a longer series of talks at a conference. Audience members may get distracted by an important email, or they may start dreaming of lunch. So, it’s important to look at your slide and ask “If they heard nothing I said, will they understand the key concept of this slide?” The other rules are set up to help with this, including clarity of the single point of the slide (Rule 1), titling it with a major conclusion (Rule 3), and the use of figures (Rule 6) and short text redundant to your verbal description (Rule 7). However, with each slide, step back and ask whether its main conclusion is conveyed, even if someone didn’t hear your accompanying dialog. Importantly, ask if the information on the slide is at the right level of abstraction. For example, do you have too many details about the experiment, which hides the conclusion of the experiment (i.e., breaking Rule 1)? If you are worried about not having enough details, keep a slide at the end of your slide deck (after your conclusions and acknowledgments) with the more detailed information that you can refer to during a question and answer period.

Rule 9: Iteratively improve slide design through practice

Well-designed slides that follow the first 8 rules are intended to help you deliver the message you intend and in the amount of time you intend to deliver it in. The best way to ensure that you nailed slide design for your presentation is to practice, typically a lot. The most important aspects of practicing a new presentation, with an eye toward slide design, are the following 2 key points: (1) practice to ensure that you hit, each time through, the most important points (for example, the text guide posts you left yourself and the title of the slide); and (2) practice to ensure that as you conclude the end of one slide, it leads directly to the next slide. Slide transitions, what you say as you end one slide and begin the next, are important to keeping the flow of the “story.” Practice is when I discover that the order of my presentation is poor or that I left myself too few guideposts to remember what was coming next. Additionally, during practice, the most frequent things I have to improve relate to Rule 2 (the slide takes too long to present, usually because I broke Rule 1, and I’m delivering too much information for one slide), Rule 4 (I have a nonessential detail on the slide), and Rule 5 (I forgot to give a key reference). The very best type of practice is in front of an audience (for example, your lab or peers), where, with fresh perspectives, they can help you identify places for improving slide content, design, and connections across the entirety of your talk.

Rule 10: Design to mitigate the impact of technical disasters

The real presentation almost never goes as we planned in our heads or during our practice. Maybe the speaker before you went over time and now you need to adjust. Maybe the computer the organizer is having you use won’t show your video. Maybe your internet is poor on the day you are giving a virtual presentation at a conference. Technical problems are routinely part of the practice of sharing your work through presentations. Hence, you can design your slides to limit the impact certain kinds of technical disasters create and also prepare alternate approaches. Here are just a few examples of the preparation you can do that will take you a long way toward avoiding a complete fiasco:

• Save your presentation as a PDF—if the version of Keynote or PowerPoint on a host computer cause issues, you still have a functional copy that has a higher guarantee of compatibility.
• In using videos, create a backup slide with screen shots of key results. For example, if I have a video of cell migration, I’ll be sure to have a copy of the start and end of the video, in case the video doesn’t play. Even if the video worked, you can pause on this backup slide and take the time to highlight the key results in words if someone could not see or understand the video.
• Avoid animations, such as figures or text that flash/fly-in/etc. Surveys suggest that no one likes movement in presentations [ 3 , 4 ]. There is likely a cognitive underpinning to the almost universal distaste of pointless animations that relates to the idea proposed by Kosslyn and colleagues that animations are salient perceptual units that captures direct attention [ 4 ]. Although perceptual salience can be used to draw attention to and improve retention of specific points, if you use this approach for unnecessary/unimportant things (like animation of your bullet point text, fly-ins of figures, etc.), then you will distract your audience from the important content. Finally, animations cause additional processing burdens for people with visual impairments [ 10 ] and create opportunities for technical disasters if the software on the host system is not compatible with your planned animation.

Conclusions

These rules are just a start in creating more engaging presentations that increase audience retention of your material. However, there are wonderful resources on continuing on the journey of becoming an amazing public speaker, which includes understanding the psychology and neuroscience behind human perception and learning. For example, as highlighted in Rule 7, David JP Phillips has a wonderful TEDx talk on the subject [ 5 ], and “PowerPoint presentation flaws and failures: A psychological analysis,” by Kosslyn and colleagues is deeply detailed about a number of aspects of human cognition and presentation style [ 4 ]. There are many books on the topic, including the popular “Presentation Zen” by Garr Reynolds [ 11 ]. Finally, although briefly touched on here, the visualization of data is an entire topic of its own that is worth perfecting for both written and oral presentations of work, with fantastic resources like Edward Tufte’s “The Visual Display of Quantitative Information” [ 12 ] or the article “Visualization of Biomedical Data” by O’Donoghue and colleagues [ 13 ].

Acknowledgments

I would like to thank the countless presenters, colleagues, students, and mentors from which I have learned a great deal from on effective presentations. Also, a thank you to the wonderful resources published by organizations on how to increase inclusivity. A special thanks to Dr. Jason Papin and Dr. Michael Guertin on early feedback of this editorial.

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Scientific peer review has existed for centuries and is a cornerstone of the scientific publication process. Because the number of scientific publications has rapidly increased over the past decades, so has the number of peer reviews and peer reviewers. In this paper, drawing on the relevant medical literature and our collective experience as peer reviewers, we provide a user guide to the peer review process, including discussion of the purpose and limitations of peer review, the qualities of a good peer reviewer, and a step-by-step process of how to conduct an effective peer review.

Peer review has been a part of scientific publications since 1665, when the Philosophical Transactions of the Royal Society became the first publication to formalize a system of expert review. 1 , 2   It became an institutionalized part of science in the latter half of the 20 th century and is now the standard in scientific research publications. 3   In 2012, there were more than 28 000 scholarly peer-reviewed journals and more than 3 million peer reviewed articles are now published annually. 3 , 4   However, even with this volume, most peer reviewers learn to review “on the (unpaid) job” and no standard training system exists to ensure quality and consistency. 5   Expectations and format vary between journals and most, but not all, provide basic instructions for reviewers. In this paper, we provide a general introduction to the peer review process and identify common strategies for success as well as pitfalls to avoid.

Modern peer review serves 2 primary purposes: (1) as “a screen before the diffusion of new knowledge” 6   and (2) as a method to improve the quality of published work. 1 , 5  

As screeners, peer reviewers evaluate the quality, validity, relevance, and significance of research before publication to maintain the credibility of the publications they serve and their fields of study. 1 , 2 , 7   Although peer reviewers are not the final decision makers on publication (that role belongs to the editor), their recommendations affect editorial decisions and thoughtful comments influence an article’s fate. 6 , 8  

As advisors and evaluators of manuscripts, reviewers have an opportunity and responsibility to give authors an outside expert’s perspective on their work. 9   They provide feedback that can improve methodology, enhance rigor, improve clarity, and redefine the scope of articles. 5 , 8 , 10   This often happens even if a paper is not ultimately accepted at the reviewer’s journal because peer reviewers’ comments are incorporated into revised drafts that are submitted to another journal. In a 2019 survey of authors, reviewers, and editors, 83% said that peer review helps science communication and 90% of authors reported that peer review improved their last paper. 11  

Expertise: Peer reviewers should be up to date with current literature, practice guidelines, and methodology within their subject area. However, academic rank and seniority do not define expertise and are not actually correlated with performance in peer review. 13  

Professionalism: Reviewers should be reliable and objective, aware of their own biases, and respectful of the confidentiality of the peer review process.

Critical skill : Reviewers should be organized, thorough, and detailed in their critique with the goal of improving the manuscript under their review, regardless of disposition. They should provide constructive comments that are specific and addressable, referencing literature when possible. A peer reviewer should leave a paper better than he or she found it.

Is the manuscript within your area of expertise? Generally, if you are asked to review a paper, it is because an editor felt that you were a qualified expert. In a 2019 survey, 74% of requested reviews were within the reviewer’s area of expertise. 11   This, of course, does not mean that you must be widely published in the area, only that you have enough expertise and comfort with the topic to critique and add to the paper.

Do you have any biases that may affect your review? Are there elements of the methodology, content area, or theory with which you disagree? Some disagreements between authors and reviewers are common, expected, and even helpful. However, if a reviewer fundamentally disagrees with an author’s premise such that he or she cannot be constructive, the review invitation should be declined.

Do you have the time? The average review for a clinical journal takes 5 to 6 hours, though many take longer depending on the complexity of the research and the experience of the reviewer. 1 , 14   Journals vary on the requested timeline for return of reviews, though it is usually 1 to 4 weeks. Peer review is often the longest part of the publication process and delays contribute to slower dissemination of important work and decreased author satisfaction. 15   Be mindful of your schedule and only accept a review invitation if you can reasonably return the review in the requested time.

Once you have determined that you are the right person and decided to take on the review, reply to the inviting e-mail or click the associated link to accept (or decline) the invitation. Journal editors invite a limited number of reviewers at a time and wait for responses before inviting others. A common complaint among journal editors surveyed was that reviewers would often take days to weeks to respond to requests, or not respond at all, making it difficult to find appropriate reviewers and prolonging an already long process. 5  

Now that you have decided to take on the review, it is best of have a systematic way of both evaluating the manuscript and writing the review. Various suggestions exist in the literature, but we will describe our standard procedure for review, incorporating specific do’s and don’ts summarized in Table 1 .

Dos and Don’ts of Peer Review

First, read the manuscript once without making notes or forming opinions to get a sense of the paper as whole. Assess the overall tone and flow and define what the authors identify as the main point of their work. Does the work overall make sense? Do the authors tell the story effectively?

Next, read the manuscript again with an eye toward review, taking notes and formulating thoughts on strengths and weaknesses. Consider the methodology and identify the specific type of research described. Refer to the corresponding reporting guideline if applicable (CONSORT for randomized control trials, STROBE for observational studies, PRISMA for systematic reviews). Reporting guidelines often include a checklist, flow diagram, or structured text giving a minimum list of information needed in a manuscript based on the type of research done. 16   This allows the reviewer to formulate a more nuanced and specific assessment of the manuscript.

Next, review the main findings, the significance of the work, and what contribution it makes to the field. Examine the presentation and flow of the manuscript but do not copy edit the text. At this point, you should start to write your review. Some journals provide a format for their reviews, but often it is up to the reviewer. In surveys of journal editors and reviewers, a review organized by manuscript section was the most favored, 5 , 6   so that is what we will describe here.

As you write your review, consider starting with a brief summary of the work that identifies the main topic, explains the basic approach, and describes the findings and conclusions. 12 , 17   Though not universally included in all reviews, we have found this step to be helpful in ensuring that the work is conveyed clearly enough for the reviewer to summarize it. Include brief notes on the significance of the work and what it adds to current knowledge. Critique the presentation of the work: is it clearly written? Is its length appropriate? List any major concerns with the work overall, such as major methodological flaws or inaccurate conclusions that should disqualify it from publication, though do not comment directly on disposition. Then perform your review by section:

Abstract : Is it consistent with the rest of the paper? Does it adequately describe the major points?

Introduction : This section should provide adequate background to explain the need for the study. Generally, classic or highly relevant studies should be cited, but citations do not have to be exhaustive. The research question and hypothesis should be clearly stated.

Methods: Evaluate both the methods themselves and the way in which they are explained. Does the methodology used meet the needs of the questions proposed? Is there sufficient detail to explain what the authors did and, if not, what needs to be added? For clinical research, examine the inclusion/exclusion criteria, control populations, and possible sources of bias. Reporting guidelines can be particularly helpful in determining the appropriateness of the methods and how they are reported.

Some journals will expect an evaluation of the statistics used, whereas others will have a separate statistician evaluate, and the reviewers are generally not expected to have an exhaustive knowledge of statistical methods. Clarify expectations if needed and, if you do not feel qualified to evaluate the statistics, make this clear in your review.

Results: Evaluate the presentation of the results. Is information given in sufficient detail to assess credibility? Are the results consistent with the methodology reported? Are the figures and tables consistent with the text, easy to interpret, and relevant to the work? Make note of data that could be better detailed in figures or tables, rather than included in the text. Make note of inappropriate interpretation in the results section (this should be in discussion) or rehashing of methods.

Discussion: Evaluate the authors’ interpretation of their results, how they address limitations, and the implications of their work. How does the work contribute to the field, and do the authors adequately describe those contributions? Make note of overinterpretation or conclusions not supported by the data.

The length of your review often correlates with your opinion of the quality of the work. If an article has major flaws that you think preclude publication, write a brief review that focuses on the big picture. Articles that may not be accepted but still represent quality work merit longer reviews aimed at helping the author improve the work for resubmission elsewhere.

Generally, do not include your recommendation on disposition in the body of the review itself. Acceptance or rejection is ultimately determined by the editor and including your recommendation in your comments to the authors can be confusing. A journal editor’s decision on acceptance or rejection may depend on more factors than just the quality of the work, including the subject area, journal priorities, other contemporaneous submissions, and page constraints.

Many submission sites include a separate question asking whether to accept, accept with major revision, or reject. If this specific format is not included, then add your recommendation in the “confidential notes to the editor.” Your recommendation should be consistent with the content of your review: don’t give a glowing review but recommend rejection or harshly criticize a manuscript but recommend publication. Last, regardless of your ultimate recommendation on disposition, it is imperative to use respectful and professional language and tone in your written review.

Although peer review is often described as the “gatekeeper” of science and characterized as a quality control measure, peer review is not ideally designed to detect fundamental errors, plagiarism, or fraud. In multiple studies, peer reviewers detected only 20% to 33% of intentionally inserted errors in scientific manuscripts. 18 , 19   Plagiarism similarly is not detected in peer review, largely because of the huge volume of literature available to plagiarize. Most journals now use computer software to identify plagiarism before a manuscript goes to peer review. Finally, outright fraud often goes undetected in peer review. Reviewers start from a position of respect for the authors and trust the data they are given barring obvious inconsistencies. Ultimately, reviewers are “gatekeepers, not detectives.” 7  

Peer review is also limited by bias. Even with the best of intentions, reviewers bring biases including but not limited to prestige bias, affiliation bias, nationality bias, language bias, gender bias, content bias, confirmation bias, bias against interdisciplinary research, publication bias, conservatism, and bias of conflict of interest. 3 , 4 , 6   For example, peer reviewers score methodology higher and are more likely to recommend publication when prestigious author names or institutions are visible. 20   Although bias can be mitigated both by the reviewer and by the journal, it cannot be eliminated. Reviewers should be mindful of their own biases while performing reviews and work to actively mitigate them. For example, if English language editing is necessary, state this with specific examples rather than suggesting the authors seek editing by a “native English speaker.”

Peer review is an essential, though imperfect, part of the forward movement of science. Peer review can function as both a gatekeeper to protect the published record of science and a mechanism to improve research at the level of individual manuscripts. Here, we have described our strategy, summarized in Table 2 , for performing a thorough peer review, with a focus on organization, objectivity, and constructiveness. By using a systematized strategy to evaluate manuscripts and an organized format for writing reviews, you can provide a relatively objective perspective in editorial decision-making. By providing specific and constructive feedback to authors, you contribute to the quality of the published literature.

Take-home Points

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Dr Lu performed the literature review and wrote the manuscript. Dr Fischer assisted in the literature review and reviewed and edited the manuscript. Dr Plesac provided background information on the process of peer review, reviewed and edited the manuscript, and completed revisions. Dr Olson provided background information and practical advice, critically reviewed and revised the manuscript, and approved the final manuscript.

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Your Guide to the Conference Peer Review Process

Published on 19 Oct 2023

Research conferences serve as a pivotal platform for the scientific community to share and improve their research. Ensuring the validity and quality of the presented studies is crucial to the success of an event, and the peer review process plays an important role in this. 

Planning a scientific conference is no small feat, especially when it comes to managing peer review. Throughout this process, conference peer review software can ease the burden and make mundane tasks (like managing submissions and assigning reviewers) a breeze.

Fourwaves peer-review software

What is peer review?

In general, the peer-review process subjects an author's research to the scrutiny of subject matter experts (peers) and is considered necessary to ensure academic scientific quality and enable said research to be published in different journal articles. Academic journal editors or editorial boards from scientific journals will use peer reviews from the research community to assess the quality of research articles.

Peer review, in the context of research conferences, refers to the evaluation and assessment of submitted research papers or presentation proposals by experts in the relevant field. 

The aim of the peer review process is to ensure that the submitted research is original, methodologically sound, and contributes constructively to the body of work and theme of the conference. More than a gatekeeping tool, peer review serves to augment the quality of presentations and safeguard the credibility of a conference. If you’re still not convinced on the value of it, read more about why conference papers should be peer reviewed .

Common types of peer review

So, peer review is all about having experts take a magnifying glass to research proposals or papers, ensuring they’re top-notch, reliable, and a brilliant addition to your conference. But, there’s more than one way to run a smooth peer review process. Read more about the most common types of peer review .

Single-blind peer review

In a single-blind peer review process, the reviewers are aware of the authors' identities, but the authors are unaware of the names of the reviewers. This traditional model, while sometimes criticized for potential bias, is often appreciated for its straightforwardness. If you’re using single-blind review, you’ll want to be extra careful to avoid nepotism while assigning reviewers.

Double-blind peer review

The double-blind review process conceals the identity of both authors and reviewers, fostering a more unbiased assessment process, and less conflicts of interest. However, completely anonymizing submissions can sometimes be a challenging endeavor. Since reviewers and authors often work within the same field, clues within the research methods or results can sometimes give clues to reviewers about the author of the paper they’re reviewing.

Open peer review

An open peer review process embodies transparency by revealing the identities of both authors and reviewers, fostering an open dialogue and collaboration amidst all parties involved. This peer review model is encouraged for conferences where reviewers want to be highly involved and are happy to provide constructive feedback and revisions to the author in person as well. 

Key steps in the conference peer review process

The peer review process at a research conference is a bit different than the process for accepting submissions to journals . It’s also, usually, far less rigorous. Here’s some tips for navigating the conference peer review process, step by step!

1) Gathering submissions

Fourwaves customizable submission form - Try it free

This is the starting line for every scientific conference. Collecting and managing research submissions can be a cumbersome task, especially when dealing with heaps of entries (which is a good thing to have!). During this stage of the peer review process, you’ll need to set up a submission system , launch a call for papers , and promote that call whenever possible. You’ll also need to allow plenty of time for submission and, if possible, a window for authors to make edits to their original submissions (based on research findings that may have changed since they first submitted). Clearly, it’s a lot to keep track of! Employing peer-review software at this stage can streamline the collection process, ensure data consistency, and make the experience better for authors making submissions to your conference (it doesn’t hurt to make a good first impression).

2) Assigning reviewers

Fourwaves peer-review software - Try it free

At this point in the peer review process, you’ll likely have all your early-stage submissions gathered. Matching all those submissions with reviewers who possess the relevant expertise is the next important step (and it can be a bit of a puzzle). Just like you gathered submissions, you’ll have to do a bit of outreach to find a group of reviewers that are willing to volunteer their time to review for your conference. Make sure you aren’t cutting corners and overloading a smaller group of reviewers with too many reviews. The quality will drop as a result, and you’re less likely to have reviewers that volunteer to return and help the following year. After you’ve gathered a large enough group of reviewers, you have the tricky task of pairing them off with submissions that they are best suited to review. Here, peer review software can help by analyzing keywords, topics, and even past review history to suggest suitable reviewer assignments. During this part of the peer review process, ensure that you filter for nepotism .

3) Scoring submissions

Once reviewers have been assigned to submissions, you’ll need to provide them with a standardized scoring system that can help them in objectively evaluating the work. Providing an evaluation rulebook helps to keep things fair for authors, regardless of which reviewer is assigned to their submission. It also helps you assess whether certain reviewers' average scores are higher than others - something you can take into consideration when making final decisions on which submissions to accept to your conference.

Scoring submissions is an important part of the abstract management process. So, be sure you’re evaluating submitted research on the following factors at the very least: 

• Originality - Does the research add something new or take a unique angle compared to the existing body of knowledge?
• Significance of Findings - Are the findings significant to the existing research?
• Technical Quality - Is the methodology sound and is it presented effectively?
• Relevance to the Theme - Is the research relevant to the topic of the conference?

In this stage of the peer review process, a peer-review system can provide customizable scoring templates or help you keep track of the progress of the reviews. Once all reviews have been submitted, the conference program committee can also use features of peer review software to aid in making final acceptance decisions for the event. They can also wait for authors’ response, further information or minor revisions before accepting the peer-reviewed articles.

4) Notifying authors

Fourwaves peer-review software email feature - Try it free

This is the drumroll moment of the peer review process! Communicating decisions to authors in a timely and organized manner is vital to the reputation of your conference. When reaching out to accepted authors, consider including advice for attending the conference and some guidelines for conference presentations . Also, be sure to include any relevant reviewer comments or feedback that the authors can use to improve their research presentations before the day of the event. Sending out emails (and making sure they have all the correct information for each author) can be quite a time suck. If you have a small conference team or, like most of us, dread a cluttered inbox, automated notifications and status updates facilitated by peer-review software can simplify this process. It’s the best way to send out timely, organized, and clear communication with minimal hassle in the backend.

With Fourwaves for example, you can send mass-emails with personalized fields like name, submission link, event name and date, etc. No more copy-pasting for an endless list of emails. 

How can peer review software help?

Imagine having a smart sidekick to help you navigate through the maze that the peer review process can become. Using peer-review software isn’t just a time-saver, it’s your one-stop-shop for managing submissions, assigning reviewers, ensuring blind-reviewing (when applicable), scoring entries, and communication, all while keeping things transparent and organized! 

Particularly for larger conferences, where the scale of submissions can be overwhelming, leveraging technology ensures a streamlined review and acceptance stage. With just a little bit of a tech boost, you can elevate the accuracy and efficiency of your peer review process.

Just remember: Each conference is unique, so choosing a review type and software that best fits your needs will lead to a more successful peer review process!

From submission collection to reviews and publication.

The power of peer review: Increase conference credibility

The peer review process, while complex, is fundamental in preserving the quality of scientific conferences. By adopting a structured approach to peer review and taking advantage of well-designed, peer-review software, you can ensure an efficient, transparent, and credible review process at your conference. Embracing user-friendly technology in managing peer review not only simplifies logistical challenges but also improves the reputation of your conference. 

An effectively managed peer review process paves the way for scientific advancements and collaborative scholarly engagements. So, let’s continue to hold our conference to a higher standard and make sure every piece of research gets the attention (and the platform) it deserves!

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Eugene McDermott Library

Scholarly and peer reviewed journals.

• Introduction
• Characteristics of Popular and Trade Publications
• Characteristics of Scholarly Journals
• Defining Peer Review
• Finding Peer-Reviewed Articles and Journals
• How to Determine if a Journal Is Peer-Reviewed

Types of Misinformation

Here are a few types of misinformation commonly encountered in print and web publications:

• Satire or parody
• Misleading use of information; False connections
• Imposter content
• Fabricated content
• Manipulated content

The rigorous process of peer review helps to eliminate such content, and instill trust and credibility in scholarly literature.

So What Is Peer Review, Exactly?

Peer reviewed.

"Said of a scholarly journal that requires an article to be subjected to a process of critical evaluation by one or more experts on the subject, known as referees, responsible for determining if the subject of the article falls within the scope of the publication and for evaluating originality, quality of research, clarity of presentation, etc. Changes may be suggested to the author(s) before an article is finally accepted for publication. In evaluation for tenure and promotion, academic librarians may be given publishing credit only for articles accepted by peer-reviewed journals."

Reitz, J.M. (2019). Peer reviewed. In Online Dictionary for Library and Information Science. https://www.abc-clio.com/ODLIS/odlis_p

Peer review is sometimes referred to as “refereed,” or “juried.” The referees are researchers, professors and others who are competent in the subject area.

It is important to note that all peer reviewed publications are scholarly but not all scholarly publications are peer reviewed. Some journals only require that a submitted article is reviewed by the Editor(s).

The Peer Review Process

American Speech-Language-Hearing Association (n.d.). Peer Review Process Visual Guide. https://academy.pubs.asha.org/prep-the-asha-journals-peer-review-excellence-program/peer-review-process/

Peer Review Targets

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40 Peer Review

Learning Objectives

• Identify benefits to collaborative work.
• Examine cultural considerations for offering feedback.
• Use a systematic process for offering feedback.
• Use language constructive language to offer feedback.
• Use feedback to make edits to the speech outline.
• Use feedback to practice speech.

Collaborative work = Stronger Finished Product

The benefits of collaborative work are numerous. Peer review allows us to share our work and receive feedback that will help us to strengthen our final product. 

Important benefits for your speech development are:

• Learning from one another: Learning is collaborative. We can learn just as much from one another as we can from course materials. We have different experiences and interpret course concepts in different ways. Peer review allows us to share these ideas.
• Clarified goals:  When offering review and editing suggestions, we are forced to focus on the assignment goals. This focus allows us to catch things they may have otherwise missed.
• Strengthen speechwriting skills: The process provides opportunities for us to identify and articulate weaknesses in a peer’s outline. When doing this, we are learning at a deeper level and can use our own feedback to strengthen our outlines.
• Idea Clarification:   As students explain ideas to classmates, they can identify where content development may be lacking. This provides opportunities to strengthen the outline content for audience clarification.
• Minimizes Procrastination: Often students will wait until the last minute to prepare their speech outline. The peer review process forces students to prepare in enough time to work through edits and revisions which are necessary for effective speech development.
• Builds Confidence: Public speaking is a nerve-wracking event for many of us. Having others validate our work and provide suggestions for improvement helps us to build confidence that our final product is strong!

Engaging in Peer Review

The peer-review process can be an exceptional tool if you engage in it effectively. Below are tips…

• Read/Listen first: Read through the entire outline or watch the entire speech before offering comments. Once you get a good idea of the content then you can go back through it and give feedback.
• Ask questions: Clarifying questions can provide you with information about your partner’s thought process so you can give more effective feedback. Also, questions can provide your partner with an opportunity to think through how they can better explain concepts or ideas in their speech. Questions are a great learning tool.
• Use the course materials: Use the readings, assignment descriptions, and rubrics to structure your feedback. This will help you focus on useful feedback. Look for both format and content issues. Both of these will be necessary for a successful outline or speech delivery.
• Mix criticism and praise: Knowing our strengths and our weaknesses are equally important for our speech development. Offer feedback on what you think they did well and what you think they need to improve.
• Describe what you are reading or hearing and your understanding of the content (paraphrase and clarify, “this is what I am hearing…”).
• Evaluate the outline or speech based on the rubric, assignment sheet, or class material.
• Suggest steps for improvement.
• Write out your thoughts: Even if you are talking through your feedback, offering written feedback will be more helpful when your partner is revising the work.

Effective approaches to offering feedback

• Use phrases such as, “From what I understand, in this section you are…”, “It seems to me that the focus of this section is…”, “I am not sure I understand the main point here. It seems to me that…”
• Ask questions when you are uncertain about something. “What is the purpose of this section? ” or “Why is it important to your paper? ” or “How do these points connect? or “What do you mean by…?”
• Be specific about content, speech parts, format, etc. The more specific you are, the more helpful you are. “In this section, it appears…” or “This comment is…” or “I am not certain how this support connects….”
• Remember to praise strengths. “Your use of language is great” or “You have strong introduction elements.”

Techniques of Constructive Criticism

The goal of constructive criticism is to improve the behavior or the behavioral results of a person, while consciously avoiding personal attacks and blaming. This kind of criticism is carefully framed in language acceptable to the target person, often acknowledging that the critics themselves could be wrong.

Insulting and hostile language is avoided, and phrases used are like “I feel…” and “It’s my understanding that…” and so on. Constructive critics try to stand in the shoes of the person being criticized and consider what things would look like from their perspective.

Effective criticism should be:

• Positively intended, and appropriately motivated: you are not only sending back messages about how you are receiving the other’s message but about how you feel about the other person and your relationship with him/her. Keeping this in mind will help you to construct effective critiques.
• Specific: allowing the individual to know exactly what behavior is to be considered.
• Objective, so that the recipient not only gets the message but is willing to do something about it. If your criticism is objective, it is much harder to resist.
• Constructive, consciously avoiding personal attacks and blaming, insulting language, and hostile language are avoided. Avoiding evaluative language—such as “you are wrong” or “that idea was stupid”—reduces the need for the receiver to respond defensively.

As the name suggests, the consistent and central notion is that the criticism must have the aim of constructing, scaffolding, or improving a situation, a goal that is usually subverted by the use of hostile language or personal attacks.

Effective criticism can change what people think and do; thus, criticism is the birthplace of change. Effective criticism can also be liberating. It can fight ideas that keep people down with ideas that unlock new opportunities, while consciously avoiding personal attacks and blaming.

Cultural Groups Approach Criticism with Different Styles

A culture is a system of attitudes, beliefs, and behaviors that form distinctive ways of life. Different cultural groups have different ways of communicating both verbally and non-verbally. While globalization and media have moderated many of the traditional differences for younger audiences, it is wise to consider five important areas where cultural differences could play a role when giving and receiving criticism:

• Verbal style in low and high context cultures
• Instrumental versus affective message responsibility
• Collectivism and individualism in cultures
• “Face”
• Eye contact

Verbal Style in Low and High Context Cultures

In low context cultures such as in the United States and Germany, there is an expectation that people will say what is on their mind directly; they will not “beat around the bush.” In high context cultures, such as in Japan and China, people are more likely to use indirect speech, hints, and subtle suggestions to convey meaning.

Responsibility for Effectively Conveying a Message

Is the speaker responsible for conveying a message, or the audience? The  instrumental  style of speaking is sender-orientated; the burden is on the speaker to make him or herself understood. The  affective  style is receiver-orientated and places more responsibility on the listener. With this style, the listener must pay attention to verbal, nonverbal, and relationship clues in order to understand the message. Chinese, Japanese, and many Native American cultures are affective cultures, whereas the American culture is more instrumental. Think about sitting in your college classroom listening to a lecturer. If you do not understand the material, where does the responsibility lie? In the United States, students believe that it is up to the professor to communicate the material to the students. However, when posing this question to a group of Chinese students, you may encounter a different sense of responsibility. Listeners who were raised in a more affective environment respond with “no, it’s not you; it is our job to try harder.” These kinds of students accept responsibility as listeners who work to understand the speaker.

Collectivism and Individualism

Are the speaker and listeners from collectivist or individualistic cultures? When a person or culture has a collective orientation they place the needs and interests of the group above individual desires or motivations. In contrast, cultures with individualistic orientations view the self as most important. Each person is viewed as responsible for his or her own success or failure in life. When you provide feedback or criticism if you are from an individualistic culture, you may speak directly to one individual and that individual will be responsible. However, if you are speaking with someone from a culture which is more collectivist, your feedback may be viewed as shared by all the members of the same group, who may assume responsibility for the actions of each other.

Face  is usually thought of as a sense of self-worth, especially in the eyes of others. Research with Chinese university students showed that they view a loss of face as a failure to measure up to one’s sense of self-esteem or what is expected by others. In more individualistic cultures, speakers and listeners are concerned with maintaining their own face and not so much focused on that of others. However, in an intercultural situation involving collectivist cultures, the speaker should not only be concerned with maintaining his or her own face, but also that of the listeners.

Receiving Feedback

You will receive feedback from a peer to revise your speech content and delivery. Accepting any criticism at all, even effective and potentially helpful criticism, can be difficult. Ideally, effective criticism is positive, specific, objective, and constructive. There is an art to being truly effective with criticism; a critic can have good intentions but poor delivery, for example, “I don’t know why my girlfriend keeps getting mad when I tell her to stop eating so many french fries; I’m just concerned about her weight!” For criticism to be truly effective, it must have the goal of improving a situation, without using hostile language or involving personal attacks.

Receiving criticism is a listening skill that is valuable in many situations throughout life: at school, at home, and in the workplace. Since it is not always easy to do, here are three things that will help to receive effective criticism gracefully:

• Accept that you are not perfect . If you begin every task thinking that nothing will ever go wrong, you are fooling yourself. You will make mistakes. The important thing is to learn from mistakes .
• Be open-minded to the fact that others may see something that you do not . Even if you do not agree with the criticism, others may be seeing something that you are not even aware of. If they say that you are negative or overbearing, and you do not feel that you are, well, you might be and are just not able to see it. Allow for the fact that others may be right, and use that possibility to look within yourself.
• Seek clarity about aspects of a critique that you are not sure of.  If you do not understand the criticism, you are doomed to repeat the same mistakes. Take notes and ask questions.

Sometimes it is easier said than done, but receiving effective criticism offers opportunities to see things differently, improve performance, and learn from mistakes.

Key Takeaways

• Peer review strengthens our final product, offers us a deeper learning experience, and boosts our confidence in our final product.
• Using a systematic method helps us to offer helpful and useful feedback.
• Using language that communicates a desire to help can have a positive influence on the peer review process.

Cho, Kwangsu, Christian D. Schunn, and Davida Charney. “Commenting on Writing: Typology and Perceived Helpfulness of Comments from Novice Peer Reviewers and Subject Matter Experts.”  Written Communication  23.3 (2006): 260-294.

Eli Review. (2014, December 19). Describe-evaluate-suggest: Giving helpful feedback, with Bill Hart-Davidson [Video file]. Retrieved from https://www.youtube.com/watch?v=KzdBRRQhYv4

Graff, Nelson. “Approaching Authentic Peer Review.”  The English Journal  95.5 (2009): 81-89.

Nilson, Linda B. “Improving Student Peer Feedback.”  College Teaching  51.1 (2003): 34-38.

“Using Peer Review to Help Students Improve Writing.”    The Teaching Center .  Washington University in St. Louis. n.d. Web. 1 June 2014.

Public Speaking Copyright © by Dr. Layne Goodman; Amber Green, M.A.; and Various is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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• Types of Presentation
• Additional Suggestions for Success

Communication

• The work should clearly communicate the content without calls for clarification.
• If written for the general public, simplification of terms and provision of background information would allow attendees to easily grasp the concepts and research results being reported. 
• If written for fellow scholars and researchers, the content would presume no need for topic education is necessary, that terminology is consistent with the subject area, and research reporting would be at the level of scholarly writing.
• The work should be free of grammatical and punctuation errors.
• Numbers and data, if used, should be presented in a manner which makes understanding easy to achieve.

Ask yourself:

• Does the content wording and use of terms match the intended audience?
• Is evidence presented logically and use appropriately?
• Is the work clearly and succinctly organized?
• Are discussions and research results of subjects, either individual or groups, presented in an objective and respectful manner?
• Are sensitive topics and issues presented with thoughtfulness and courtesy?
• Works submitted for publication in traditional print resources should follow the publisher’s guide to submissions, especially criteria involving relevant value to the readers.
• Works submitted for publication in an electronic format – web site, digital, PDF, etc. – should be cognizant of the type of format and the format’s strengths in appealing to the reader by use of technology, programming, and audio or video motion.
• Is the work suitable to the audience targeted?
• Does the work present an appropriate and suitable style?
• The work should clearly state the purpose of the work, the goals that were designed, the results that occurred, any differences between the goals and the results, and the importance of the research results to the audience or area of interest.
• The author should demonstrate scholarship in the field by the quality of supporting evidence, research method, research results, and interpretation of those results.
• Is the work objective in its content and presentation?
• Are conclusions reached without predeterminations and outside influence?
• Is there sufficient evidence, both in terms of amount and substance, to effectively support the outcome?
• Does the work provide new evidence or research results that would be of interest to the field, practitioners, and scholars?

Blogs, Listservs, and Social Media

Electronic presentations are a great way to gage collegial ideas and opinions about the topic you have selected to pursue.  These formats can be done at varying and convenient times.

• Online brevity is the best – adopt Twitter’s 140 character limit, and select words carefully.
• Use simple statements.
• DON’T SHOUT.
• Seek feedback and comments.

Exhibits consist of a visual display of a collection, program, initiative, or body of work (i.e. paintings, drawings, prints, posters, photography, sculpture, ceramics, video, installation, multi-media).

• Include a general statement of purpose and statements to provide an intellectual context both for the collection as a whole and for its individual pieces.
• Be prepared to respond to comments and questions.

Facilitated Discussions

Facilitated discussions involve the arranging of attendees into groups, such as tables or round chair setup, and provide topics for discussion.  Topics can be the same for all attendees and groups, or vary by group.

• Provide a brief introduction – remember that you are not the presenter, and the discussions are the purpose of this event.
• Develop discussion points, topics, and questions well in advance by polling registered attendees.
• Be willing to accept ad-hoc discussion topics relevant to the content.
• Provide for adequate Q&A and open comment time at the end.
• Ensure that the majority of time allotted for the event is reserved for discussion and report-back.
• Record group report-back’s on flip charts or other method, so that attendees may view the report-back comments as they are read out, and receive a written copy after the event.
• Foster collegial conversational exchange.
• Mingle among the groups or tables to see if attendees are participating, but avoid becoming involved in their discussions.

Keynote Address

The keynote address is perhaps the most challenging presentation.  What you say and how well you communicate your ideas, research, findings, and experience sets the tone for the event.  High level competency and established experience are the minimum content goals.  See Oral Presentations for additional guidance.

• Presentation much be absolutely relevant to the event.
• This is a stand-alone presentation.
• Be prepared to “wow” the audience with a dynamic content, excellent slides, well developed public speaking skills, and inspiration.
• Professional credibility is presumed.

Oral Presentations

Oral presentations involve the presentation of a paper or research project with or without visual aids.  This is an excellent opportunity to share research findings with colleagues, seek comments, listen to advice, and facilitate discussion and comment.

• Focus on the purpose, methodology, challenges, and findings of the research.
• Report laboratory and data results, if applicable.
• Clearly provide the reason that motivated research interest and commencement.
• Disclose the strengths and weakness of the research process, and what was learned from failures.
• PowerPoint presentations should be well done.  See PowerPoint Use in Presentation for more details.
• Subject mastery is presumed.
• Expect questions and comments that indicate doubt or disagreement, and respond collegially.
• Include a Q&A section at the end of the presentation.
• Provide contact information.

Panel Discussions

Panel discussions involve a limited number of panelists, usually 3-5, presenting and discussing their views on a scholarly topic and responding to audience questions.

• Select speakers from different perspectives to give balanced presentations.
• Before finalizing speaker selection, discuss panel content and purpose to ensure that potential speakers understand the purpose of the panel discussion.
• Ask panelists to state their points concisely and clearly, mindful of the limited time for each panelist.
• Anticipate questions from both the audience and panelists.
• Defer comment and questions from the audience to panelists.
• Provide ample time for individual presentations, statements, general discussion, and Q&A.

Peer Review Publications

Poster sessions.

Posters present a visual display of work on poster boards. Presenters should be able to provide a scholarly introduction to their work and be prepared to entertain the viewers’ questions.

• Include both charts and pictures.
• Develop an eye catching format and design.
• Brevity works best, both for what is on the poster and for answering visitors.
• Have a one-sheet handout for the main take-away points, including your contact information.
• Have business cards available.
• Be prepared for many repeats of your 60-second verbal summary.
• Expect fast and furious turnovers.
• Balance the content – not too sparse but not too detailed and complex.

PowerPoint Use in Presentations

Using PowerPoint or any slide programmed should be viewed as a supplemental visual tool for many types of presentations.  They should not be treated as “the” presentation.

• Don’t read from the slides.
• Look at the screen as little as possible.
• Present from knowledge and experience, not from the slides.
• Slides should be limited in numbers and complexity.
• Charts, graphics, pictures, and other inserts should be simple and visually clear.
• Sound, video, and images add value, if content relevant.
• Use bullet points. PowerPoint slides do not need full sentences, and should never have a paragraph full of information.
• Use images effectively. You should have as little text as possible on the slide. One way to accomplish this is to have images on each slide, accompanied by a small amount of text.
• Slides provide focus and guidance, not full details.
• Never put your presentation on the slides and read from the slides.

Workshops consist of a brief presentation followed by interaction with the audience. The purpose of a workshop is to introduce the audience to your subject and involve them in using a skill or technique.  Learning objectives and anticipated outcomes should be clearly stated.

• Content should be timely and relevant.
• Content should be take-away – attendees should be able to leave the workshop, go back to their jobs, and begin brainstorming ideas, developing strategies, and implementing projects soon.
• Go short on theories and long on how-to methods.
• Develop learning objectives and anticipated outcomes, and build content around these goals.
• Develop an agenda that more resembles a syllabus.
• Select preparation materials, such as articles and documents to read before the workshop.
• Include data but do not overwhelm attendees with too much or complex data.
• Provide a bibliography or list of suggested readings.

Academic Presentation Formula

Newbies are strongly encouraged to follow this formula.  Later and with experience, deviation from the formula is more feasible.

• Introduction/Overview/Hook
• Theoretical Framework/Research Question
• Methodology/Case Selection
• Background/Literature Review
• Discussion of Data/Results
• Q&A, if permitted

The Audience Is Ready to Listen

Avoid presenting too much information about what is already known, and provide this information, if needed, in the introduction.  Only discuss literature and background information that relates directly to the topic and research results being presented.  Keep this portion of the presentation to five minutes or less.  More time will be needed for the presentation of the research results and audience questions and comments.

Practice Practice Practice

Practice the presentation from start to finish before delivering the presentation – several times.  Repeated practicing provides delivery confidence, efficient time management, and better speaking skills.  Make sure the presentation fits within the time parameters. Practicing also makes it flow better.

Keep To the Time Limit

If the time allotted for the presentation is ten minutes, prepare ten minutes of material.  Regardless of the amount of time provided, a little or a lot, finish within or at the end of the allotted time.  Practice the presentation with a stopwatch to ensure complicity.

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What is peer-reviewed?

What does “peer reviewed” mean, how do academic articles improve the quality of your work, how can you tell if an academic journal article is peer reviewed or not, how can you use the library databases to find “peer reviewed” articles, for further information.

Watch this   short video  for a brief overview of the subject.

Alternatively, have a look at the below presentation or read the full article.

You have no doubt seen the mention of “peer reviewed” academic articles in your project outlines and heard your faculty requiring you to base your research on “peer reviewed” articles. But what exactly does the term “peer reviewed” mean? How does using “peer reviewed” articles improve the quality of your work? How can you tell if an article is peer reviewed or not? How can you use the library databases to find “peer reviewed” articles?

A simple definition would be “read thoroughly and checked by fellow experts”. The peer review process guarantees the validity, reliability, and credibility of the article.

In practice, before an article is published in an academic journal, it is sent to a panel of experts in the same field or discipline. These experts read the article carefully, checking for weaknesses or gaps in the arguments, research methodology or results and discussion. The experts also consider whether the article is contributing something new to the field of knowledge and not just repeating information already known. They give feedback to the authors of the article suggesting improvements or changes. The authors improve their article according to the feedback and then resubmit the article for publication. The article is peer reviewed again. If it now reaches the required standard, it will be published. If not, it will be rejected and will not appear in the journal. The peer review process usually takes several months.

Since the academic journal guarantees the validity, reliability, and credibility of the information it publishes, you can be sure that when you base your work on peer reviewed articles you are using the most authoritative sources. This in turn gives your work an air of authority and credibility. The very fact of citing the work of experts demonstrates the seriousness of your own work.

Most, but not all, academic journals use the peer review process to check the quality of articles before publication. There are several ways to check if the article you are interested in has been peer reviewed. One way is to go to the home page of the journal, where you will usually find information about the journal’s peer review process. Here is an example from the Journal of Hospitality and Tourism Management (select “Guide for authors”)

Peer review

This journal operates a double anonymized review process. All contributions will be initially assessed by the editor for suitability for the journal. Papers deemed suitable are then typically sent to a minimum of two independent expert reviewers to assess the scientific quality of the paper.

Source: https://www.elsevier.com/journals/journal-of-hospitality-and-tourism-management/1447-6770/guide-for-authors

If you cannot find this type of statement, then you should begin to have doubts about whether the articles in the journal are peer reviewed or not.

Another way to check if an academic journal uses the peer review process is to visit Ulrichsweb Global Serial Directories . Enter the name of the journal in the search bar and you will see if it is peer reviewed. This is the example for Journal of Hospitality and Tourism Management

How to find out the ranking of an academic journal

When you access the main search bar on the library database, make sure you check the “peer reviewed” box on the left-hand side:

Please consult the library produced document How to identify reliable sources?

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Effective Peer Review: Who, Where, or What?

Peer review is widely viewed as one of the most critical elements in assuring the integrity of scientific literature ( Baldwin, 2018 ; Smith, 2006 ). Despite the widespread acceptance and utilization of peer review, many difficulties with the process have been identified ( Hames, 2014 ; Horrobin, 2001 ; Smith, 2006 ). One of the primary goals of the peer review process is to identify flaws in the work and, by so doing, help editors choose which manuscripts to publish. It is surprising that one of the persistent problems in peer review is assessing the quality of the reviews. Both authors and journal editors expect peer review to detect errors in experimental design and methodology and to ensure that the interpretation of the findings is presented in an objective and thoughtful manner. In traditional peer review, two or more reviewers are asked to evaluate a manuscript on the basis of the expectation that if the two reviewers agree on the quality of the submission, the likelihood of a high-quality review is increased. Unfortunately, studies have not consistently confirmed a high degree of agreement among reviewers. Rothwell and Martynn (2000) evaluated the reproducibility of peer review in neuroscience journals and meeting abstracts and found that agreement was approximately what would be expected by chance. Similarly, Scharschmidt et al. (1994) found similar results in the evaluation of 1,000 manuscripts submitted to the Journal of Clinical Investigation, where clustering of grades in the middle resulted in an agreement being “…only marginally…” better than chance. These observations suggest that we cannot rely on the agreement of reviewers to be an indication of the quality of the reviews. Another potential way to evaluate the quality of reviews would be to assess the ability of reviewers to detect errors in submissions. It is generally accepted that detection of intentional fraud is beyond the scope of typical peer review, but we do expect reviewers to detect major and minor errors as a primary function of the traditional peer review system ( Hwang, 2006 ; Weissman, 2006 ). Schroter et al. (2008) evaluated the ability of reviewers to detect major and minor errors by introducing errors into three previously published papers describing randomized controlled clinical trials. Reviewers detected approximately three of the nine errors introduced in each manuscript. Unfortunately, reviewers who had undergone training in how to conduct a high-quality peer review were not significantly better than untrained reviewers. Similar results have been reported by Godlee et al. (1998) and Baxt et al. (1998) . Baxt et al. (1998) did report that reviewers who rejected or suggested revision of a manuscript identified more errors than those who accepted the manuscript (decision: 17.3% of major errors detected [accept], 29.6% of major errors detected [revise], and 39.1% of major errors detected [reject]). It is almost certainly true that the extent of the failure to recognize errors in submitted manuscripts may differ among scientific disciplines and journals. It also however seems likely that these observations do have some applicability to journals such as JID Innovations . It is critical that both authors and editors are cognizant of these limitations of peer review in their assessment of reviews. These findings compel journals to continue to work to develop new strategies to train and evaluate reviewers. The findings also suggest that factors beyond the failure to detect objective mistakes in a manuscript may be playing a role in the discrepancy in reviewers’ evaluations. One area of ongoing concern in the peer review process is the role of reviewer bias in assessing the scientific work of colleagues ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ).

Bias in the peer review process can take many forms, including collaborator/competitor bias, affiliation bias based on an investigator’s institution or department, geographical bias based on the region or country of origin, racial bias, and gender or sex bias ( Kuehn, 2017 ; Lee et al, 2013 ; Tvina et al, 2019 ). All of these forms of bias present the risk that a decision of the reviewer will not be based solely on the quality or merit of the work but rather be influenced by a bias of the reviewer. We and other journals routinely seek to avoid selecting individuals to review work from their own institutions and ask all reviewers to declare any potential personal conflicts of interest. All these methods require either the editor or the reviewer to identify a bias and fail to address the issue of implicit or unconscious reviewer bias. The dominant method currently utilized for peer review is the so-called single-blind review, in which the identity and affiliations of the authors are known to the reviewers, whereas the identity of reviewers remains unknown to the authors. This has led to concern that knowledge of the identity of the authors and their institutions may be the source of significant reviewer bias, especially implicit bias, in the evaluation of manuscripts. Double anonymized peer review (DAPR), also known as double-blind peer review, has been suggested as a way to address this issue ( Bazi, 2020 ; Lee et al, 2013 ). Studies have compared single-blind with double-blind reviewing and reported that there is no significant difference in the quality of the reviews ( Alam et al, 2011 ; Godlee et al, 1998 ; Justice et al, 1998 ; van Rooyen et al, 1998 ). Although these studies looked at measures such as the number of errors detected, acceptance rate, and distribution of initial reviewer scores, they were not designed to address specific sources of bias such as authors’ gender, institution, or geographic location. Other studies have been undertaken to directly address the issue of bias in the peer review process. Ross et al (2006) compared the acceptance of abstracts submitted to the American Heart Association’s annual scientific meeting during a period when the reviewers knew the identity and origin of the authors (i.e., single-blind review) with when this information was not known by the reviewers (i.e., double-anonymized peer review). They found a significant increase in acceptance of non‒United States abstracts and abstracts from non-English speaking countries when the reviewers were unaware of the country of origin of the abstracts ( Ross et al, 2006 ). They also found a significant decrease in the acceptance of abstracts from prestigious institutions when the reviewers were unaware of the institutions where the work was done. In a similar study, Tomkins et al. (2017) found that papers submitted to a prestigious computer science meeting were more likely to be accepted if they were from famous authors, top universities, and top companies. Okike et al. (2016) documented similar results for manuscripts submitted to the orthopedic literature. They submitted a fabricated manuscript that was presented as being written by two prominent orthopedic surgeons (past Presidents of the American Academy of Orthopedic Surgeons) from prestigious institutions. When reviewed in the traditional single-blind fashion, which included the identity of the authors, the manuscript was accepted by 87% of the reviewers. By contrast, when the identity of the authors was unknown, the manuscript was accepted by 68% of the reviewers ( P  = 0.02) ( Blank, 1991 ). A study conducted at The American Economic Review found that authors at near-top-ranked universities experienced lower acceptance rates when authorship was anonymized ( Blank, 1991 ). Of interest, they also found that for women, there was no difference in the acceptance rate between the double-anonymized and single-blinded reviews; however, for men, the acceptance rate was lower with double-anonymized reviews.

These studies provide strong evidence that knowledge of who and where the study was performed can impact the acceptance of abstracts and manuscripts. This conflicts with the goal of the review process to base our judgments on the quality of what the results demonstrate. It is difficult to estimate how much this may affect the fate of a manuscript at JID Innovations . We do not have evidence that our review process has been impacted by bias as is reported in the studies discussed. However, neither can we state with certainty that such bias is not a factor in the reviews we receive. One of the goals of JID Innovations is to be a truly open-access journal available to all investigators in skin science from around the world. We have sought to be an outlet for studies that challenge existing paradigms or that may report negative results. We want to be seen as providing fair and objective reviews for all authors, regardless of where they work or who they are. If we are to achieve this goal, it is imperative that the who and where of a specific manuscript do not negatively impact the evaluation of the what. We want young investigators, investigators at less prestigious institutions or from less well-known laboratories, and investigators from any country around the world to be confident that their work will be judged by what they report and not by the who and the where.

To be true to this mission, JID Innovations will be initiating DAPR starting in October 2022. This is not being done because we are aware of any issues of bias with our current process of peer review but because we realize that the absence of proof is not proof of absence. As a part of this process, authors will be asked to remove identifying material from manuscripts at the time of submission in preparation for the review process ( https://www.jidinnovations.org/content/authorinfo ). As a result, primary reviewers will see only the what of the manuscript. We realize that this process involves extra work for both the authors and our staff, but we feel the benefits will outweigh this small cost. Indeed, in other journals that have taken this step, surveys have shown that both authors and reviewers ultimately prefer double-anonymized reviews ( Bennett et al, 2018 ; Moylan et al, 2014 ). We realize that achieving 100% anonymization of a manuscript is nearly impossible. Studies have shown that the rate of successful anonymizing, where the reviewers cannot discern the authorship of a manuscript, ranged from 47 to 73%. It is however interesting that even with this rate of success in the anonymizing process, a meta-analysis of trials of double- versus that of single-blind peer review has suggested an impact, with lower acceptance rates with double-anonymized peer review ( Ucci et al, 2022 ). More work clearly needs to be done to assess the value of the DAPR process, and we will be monitoring our results carefully.

The institution of DAPR in JID Innovations will assure our authors that the what of their manuscript is our focus. It does not matter who you are or where you are from. It will also emphasize to our reviewers that our focus is on the what. We will be carefully monitoring the results of this new policy and plan to report back on our experience. We also welcome your feedback on your experience as a reviewer and author for JID Innovations ; send your comments to us at [email protected] .

Finally, this decision should be seen not as the end of our efforts to improve the peer review process but merely as a first step. We will continue to work to improve all aspects of the peer review process for JID Innovations . We firmly believe that the use of double-blind -anonymized peer review will bring us closer to ensuring to our authors and readers that the work that is published by JID Innovations has been selected on the basis of what the paper reports and not on who performed the studies or where they were located.

Conflict of Interest

The author states no conflicts of interest.

• Alam M., Kim N.A., Havey J., Rademaker A., Ratner D., Tregre B., et al. Blinded vs. unblinded peer review of manuscripts submitted to a dermatology journal: a randomized multi-rater study. Br J Dermatol. 2011; 165 563‒7. [ PubMed ] [ Google Scholar ]
• Baldwin M. Scientific autonomy, public accountability, and the rise of “peer review” in the Cold War United States. Isis. 2018; 109 :538–558. [ Google Scholar ]
• Baxt W.G., Waeckerle J.F., Berlin J.A., Callaham M.L. Who reviews the reviewers? Feasibility of using a fictitious manuscript to evaluate peer reviewer performance. Ann Emerg Med. 1998; 32 310‒7. [ PubMed ] [ Google Scholar ]
• Bazi T. Peer review: single-blind, double-blind, or all the way-blind? Int Urogynecol J. 2020; 31 :481–483. [ PubMed ] [ Google Scholar ]
• Bennett K.E., Jagsi R., Zietman A. Radiation oncology authors and reviewers prefer double-blind peer review. Proc Natl Acad Sci USA. 2018; 115 :E1940. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Blank R.M. The effects of double-blind versus single-blind reviewing: experimental evidence from the American Economic Review. Am Econ Rev. 1991; 81 :1041–1067. [ Google Scholar ]
• Godlee F., Gale C.R., Martyn C.N. Effect on the quality of peer review of blinding reviewers and asking them to sign their reports: a randomized controlled trial. JAMA. 1998 280237‒40. [ PubMed ] [ Google Scholar ]
• Hames I. Peer review at the beginning of the 21st century. Sci Ed. 2014; 1 :4–8. [ Google Scholar ]
• Horrobin D.F. Something rotten at the core of science? Trends Pharmacol Sci. 2001; 22 51‒2. [ PubMed ] [ Google Scholar ]
• Hwang W.S. Can peer review police fraud? Nat Neurosci. 2006; 9 :149. [ PubMed ] [ Google Scholar ]
• Justice A.C., Cho M.K., Winker M.A., Berlin J.A., Rennie D. Does masking author identity improve peer review quality? A randomized controlled trial. PEER Investigators [published correction appears in JAMA 1998;280:968. JAMA. 1998; 280 240‒2. [ PubMed ] [ Google Scholar ]
• Kuehn B.M. Rooting out bias. ELife. 2017; 6 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lee C.J., Sugimoto C.R., Zhang G., Cronin B. Bias in peer review. JASIST. 2013; 64 :2–17. [ Google Scholar ]
• Moylan E.C., Harold S., O'Neill C., Kowalczuk M.K. Open, single-blind, double-blind: which peer review process do you prefer? BMC Pharmacol Toxicol. 2014; 15 :55. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Okike K., Hug K.T., Kocher M.S., Leopold S.S. Single-blind vs double-blind peer review in the setting of author prestige. JAMA. 2016; 316 1315‒6. [ PubMed ] [ Google Scholar ]
• Ross J.S., Gross C.P., Desai M.M., Hong Y., Grant A.O., Daniels S.R., et al. Effect of blinded peer review on abstract acceptance. JAMA. 2006; 295 1675‒80. [ PubMed ] [ Google Scholar ]
• Rothwell P.M., Martyn C.N. Reproducibility of peer review in clinical neuroscience. Is agreement between reviewers any greater than would be expected by chance alone? Brain. 2000; 123 1964‒9. [ PubMed ] [ Google Scholar ]
• Scharschmidt B.F., DeAmicis A., Bacchetti P., Held M.J. Chance, concurrence, and clustering. Analysis of reviewers' recommendations on 1,000 submissions to the Journal of Clinical Investigation. J Clin Invest. 1994; 93 1877‒80. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Schroter S., Black N., Evans S., Godlee F., Osorio L., Smith R. What errors do peer reviewers detect, and does training improve their ability to detect them? J R Soc Med. 2008; 101 507‒14. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Smith R. Peer review: a flawed process at the heart of science and journals. J R Soc Med. 2006; 99 178‒82. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tomkins A., Zhang M., Heavlin W.D. Reviewer bias in single- versus double-blind peer review. Proc Natl Acad Sci USA. 2017; 114 12708‒13. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tvina A., Spellecy R., Palatnik A. Bias in the peer review process: can we do better? Obstet Gynecol. 2019; 133 1081‒3. [ PubMed ] [ Google Scholar ]
• Ucci M.A., D'Antonio F., Berghella V. Double- vs single-blind peer review effect on acceptance rates: a systematic review and meta-analysis of randomized trials. Am J Obstet Gynecol MFM. 2022; 4 [ PubMed ] [ Google Scholar ]
• van Rooyen S., Godlee F., Evans S., Smith R., Black N. Effect of blinding and unmasking on the quality of peer review: a randomized trial. JAMA. 1998; 280 234‒7. [ PubMed ] [ Google Scholar ]
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What are Peer-Reviewed Journals?

• A Definition of Peer-Reviewed
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• What are Peer-reviewed Articles and How Do I Find Them? From Capella University Libraries

Introduction

Peer-reviewed journals (also called scholarly or refereed journals) are a key information source for your college papers and projects. They are written by scholars for scholars and are an reliable source for information on a topic or discipline. These journals can be found either in the library's online databases, or in the library's local holdings. This guide will help you identify whether a journal is peer-reviewed and show you tips on finding them.

What is Peer-Review?

Peer-review is a process where an article is verified by a group of scholars before it is published.

When an author submits an article to a peer-reviewed journal, the editor passes out the article to a group of scholars in the related field (the author's peers). They review the article, making sure that its sources are reliable, the information it presents is consistent with the research, etc. Only after they give the article their "okay" is it published.

The peer-review process makes sure that only quality research is published: research that will further the scholarly work in the field.

When you use articles from peer-reviewed journals, someone has already reviewed the article and said that it is reliable, so you don't have to take the steps to evaluate the author or his/her sources. The hard work is already done for you!

Identifying Peer-Review Journals

If you have the physical journal, you can look for the following features to identify if it is peer-reviewed.

Masthead (The first few pages) : includes information on the submission process, the editorial board, and maybe even a phrase stating that the journal is "peer-reviewed."

Publisher: Peer-reviewed journals are typically published by professional organizations or associations (like the American Chemical Society). They also may be affiliated with colleges/universities.

Graphics:  Typically there either won't be any images at all, or the few charts/graphs are only there to supplement the text information. They are usually in black and white.

Authors: The authors are listed at the beginning of the article, usually with information on their affiliated institutions, or contact information like email addresses.

Abstracts: At the beginning of the article the authors provide an extensive abstract detailing their research and any conclusions they were able to draw.

Terminology:  Since the articles are written by scholars for scholars, they use uncommon terminology specific to their field and typically do not define the words used.

Citations: At the end of each article is a list of citations/reference. These are provided for scholars to either double check their work, or to help scholars who are researching in the same general area.

Advertisements: Peer-reviewed journals rarely have advertisements. If they do the ads are for professional organizations or conferences, not for national products.

Identifying Articles from Databases

When you are looking at an article in an online database, identifying that it comes from a peer-reviewed journal can be more difficult. You do not have access to the physical journal to check areas like the masthead or advertisements, but you can use some of the same basic principles.

Points you may want to keep in mind when you are evaluating an article from a database:

• A lot of databases provide you with the option to limit your results to only those from peer-reviewed or refereed journals. Choosing this option means all of your results will be from those types of sources.  
• When possible, choose the PDF version of the article's full text. Since this is exactly as if you photocopied from the journal, you can get a better idea of its layout, graphics, advertisements, etc.  
• Even in an online database you still should be able to check for author information, abstracts, terminology, and citations.
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Acute care models for older people living with frailty: a systematic review and taxonomy

• Thomas Knight 1 ,
• Vicky Kamwa 1 ,
• Catherine Atkin 1 ,
• Catherine Green 2 ,
• Janahan Ragunathan 3 ,
• Daniel Lasserson 4 &
• Elizabeth Sapey 1  

BMC Geriatrics volume  23 , Article number:  809 ( 2023 ) Cite this article

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The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear.

A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible.

Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I.

The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited.

Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence.

Trial registration

PROSPERO registration (CRD42021279131).

Peer Review reports

Introduction

Population ageing and the increasing prevalence of long-term health conditions represent a significant challenge to many advanced health care systems [ 1 ]. Older people, particularly those living with frailty and multimorbidity, are at high risk of sudden health crisis necessitating urgent assessment to identify and treat causative conditions. The acute care pathway collectively defines the clinical processes employed to achieve this function. It typically comprises sequential assessment in community and hospital settings and culminates in emergency hospital admission when necessary.

Older people living with frailty are at high risk of adverse outcomes such as mortality [ 2 ] and have longer average lengths of hospital stay when accessing the acute care pathway [ 3 ]. The conversion rate from ED attendance to emergency admission is 3 times higher in people aged over 85 relative to people under 65 [ 4 ]. As older people represent a growing proportion of ED attendances the demand for hospital bed-based care is likely to rise [ 4 ]. This must be reconciled with downward trends in the number of acute hospital beds at the population level [ 5 ]. Improved integration between health and social care may help mitigate the impact of these changes to some degree but will not abrogate the need for hospital assessment and inpatient bed-based care in the context of sudden deterioration or severe illness [ 6 ]. Adaptations to the acute care pathway may improve the quality of care for older people while simultaneously reducing pressure on an increasingly congested acute care system.

These factors have collectively driven a rapid expansion of studies investigating models of care intended to mitigate the risk of hospital admission or avoid bed-based hospital care entirely [ 7 ]. Previous systematic reviews of acute care models for older people have focused on interventions located at specific points along the acute care pathway [ 8 , 9 , 10 ]. There has been a tendency to group interventions with different eligibility criteria and clinical processes. Differentiating models of care able to manage acute illness from those primarily engaged with rehabilitation and the functional consequence of resolving acute illness is not straightforward. This distinction is important as policy makers and commissioners look to maximise the efficiency of acute hospital bed use and find credible alternatives to acute inpatient care in the community.

It is possible that a more granular classification of the interventions may foster a greater understanding of which elements of the model drive effectiveness and highlight areas of best practice.

A systematic review was undertaken to describe and classify the range of acute care models designed to manage acute medical illness in older people with the objective of deriving a taxonomy of care models. The review also aimed to describe and classify the outcome measures used in studies investigating these models. A secondary objective was to determine whether the proposed taxonomy was useful in understanding any differences in observed outcomes between studies. We took the novel approach of including acute care models operating in hospital and community settings.

Study design

The systematic review was conducted using a two-step process. The first step was undertaken to describe and classify acute care models for older people and the outcome measures used to demonstrate their clinical effectiveness within the current literature. This information was used to create a taxonomy of care models accompanied by a narrative summary. No restrictions were placed on study design at this stage of the process.

The second step looked to describe the effectiveness of each model and restricted analysis to randomised controlled trials or observational studies with an experimental design (including non-randomised trials, cohort studies with comparator groups, before and after longitudinal studies). Previous systematic reviews and meta-analyses were not used to inform the taxonomy. Primary studies from relevant systematic reviews were included if they met the inclusion criteria. The systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The study protocol was registered with PROSPERO (CRD42021279131).

Eligibility criteria and study selection

Inclusion and exclusion criteria were designed to incorporate interventions operating within the hospital and the community. An age threshold of 65 years was used to define care models for older people (mean age of study participants > 65 years. Mean age as opposed to a strict age threshold was employed to ensure care models accepting younger patients with frailty identified using alternative measures, such as validated frailty scores or multi-morbidity were not excluded.

The intervention needed to target acute medical illness or acute exacerbation of chronic disease. There is no consensus definition of acute care. To ensure a focus on acute care, study participants needed to be recruited within 48 h of presentation and the care model had to provide time limited episodes of care (up to 14 days). The requirement for time limited episodes of care was used as a criterion to exclude care models delivering ongoing chronic disease management after resolution of acute illness which were felt likely to employ different care processes and focus on different clinical outcomes. Recruitment direct from the ED was used as a proxy for recruitment within 48 h in studies where this metric was not reported. Community interventions were only included if they were able to provide a credible alternative to hospital bed-based care. This was defined as the capability to provide face-to-face review alongside access to hospital level treatments (eg intravenous treatments) and hospital level diagnostics (eg blood tests, imaging) at home.

A full list of inclusion and exclusion criteria is provided in Table 1 .

Data sources and searches

The search strategy comprised both MeSH terms and keyword text and was performed on 30 th September 2021 with no date restrictions. The search strategy is provided in Supplementary Table 1 . The search was undertaken in 5 electronic databases (Ovid MEDLINE, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of systematic reviews, Cochrane Central Register of Controlled Trials). Hand reference list screening was carried out of all included articles. Systematic reviews were not included directly. All individual studies meeting the inclusion criteria contained within systematic reviews identified by the search were included.

Titles and abstracts were reviewed by two reviewers. (TK reviewed each and at-least one further review from CA, VK, CG, JR). Full-text records were obtained and reviewed against the eligibility criteria. Disagreements were resolved by a third reviewer (DL). Data extraction was undertaken by 1 reviewer (TK). A bespoke data extraction tool was adapted from the TIDIeR checklist to characterise each intervention [ 11 ]. Outcome measurements were classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy [ 12 ].

Data extraction and quality assessment

Risk of bias was assessed using criteria from the Cochrane Handbook. Randomised controlled trials were assessed using RoB-2 tool [ 13 ] and observational studies were assessed using the ROBINS-I tool [ 14 ]. Risk of bias was assessed by 1 reviewer (TK).

Data synthesis

Finding from included articles were grouped and summarised. Due to clinical heterogeneity between studies meta-analysis was not appropriate. A narrative synthesis of the results was undertaken. Visualisations were created using R statistical software (Version 1.3.1093, Vienna. Austria). The geographical location of included studies was mapped using the ggmap package. Source maps were obtained from © Stamen Design, under a Creative Commons Attribution (CC BY 3.0) license. Outcome areas and domains were plotted using the treemap package.

The initial search returned 13,102 relevant articles. Title and abstract screening identified 340 relevant articles for full text review. A total of 90 articles met the eligibility criteria. Hand searching of references identified 13 further articles. Therefore, 103 articles were included in the analysis (see Fig.  1 ). Identified articles were published between April 1991 and April 2021. This comprised 20 randomised controlled trials reported across 26 articles), 6 study protocols (results for 2 had been reported and were included), 38 observational studies with a comparator group reported across 51 articles, and 20 descriptive studies without a comparator group. The search identified 101 conference abstracts which did not contain sufficient information to adequately describe the model of care delivered. These abstracts were not used to inform the taxonomy.

A PRISMA flow diagram for the studies screened and included in the systematic review. Legend: Studies were screened against the inclusion and exclusion criteria described in Table 1 . Reasons for exclusion are provided

The articles could be broadly categorised into four groups based on the model of care they described. These included: bedded acute frailty units (AFU), Hospital at Home models (HaH), ED based in-reach models and acute care home models, see Fig.  2 . A detailed description of the interventions described in each individual study is provided in Supplementary Table 2 . The geographical location of included studies is provided in Fig.  3 .

The Proposed taxonomy of acute care models for older people. Legend: The taxonomy was defined using key features of the care models; Care models were initially differentiated based on location. Acute bedded frailty units operated from a fixed bed base or offering consultation to general medical wards. Hospital at home models were differentiated based on their use of telemedicine. Physician intensive models used face to face review at home as standard. Remote oversight models were primarily delivered by specialist nurses with care supported provided remotely by physicians on a selective basis. Emergency Department in reach models could be differentiated by their staffing model. Nurse led care coordination without direct input from a dedicated geriatrician or care delivered by geriatricians within the Emergency Department. Care home models were differentiated by their primary location of activity, either services offered within the care home or adaptations to the care pathway following transfer to the Emergency Department

A map identifying the countries where the included studies were based. Legend. The map shows the location of included studies identifying: Colours to denote the care model type as defined by the taxonomy. Brown dots represent Hospital at Home models, Violet dots represents bedded Acute Frailty Units. Purple dots Emergency Department in-reach models. Green dots care models. Source maps were obtained from © Stamen Design, under a Creative Commons Attribution (CC BY 3.0) license

Bedded acute frailty units models

The provision of tailored bed-based in-patient care for frail adults as a direct alternative to treatment on a general medical ward was described in 32 articles derived from 24 studies. This included 8 articles [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] reporting results from 6 randomised controlled trials, 1 trial protocol without results [ 23 ], 11 observational studies with a comparator group reported across 15 articles [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 8 descriptive studies without a comparator [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. A detailed description of the care models is provided in Supplementary Table 2 A.

The AFU care model has a strong focus on maintaining and restoring function, but in contrast to a rehabilitation ward intervenes prior to full resolution of acute illness. A range of names were used to identify care models with similar underlying approaches, including Acute Frailty units (AFU), Acute Care for Elders (ACE) units and CGA units. Generic descriptions of the model frequently reference four core components, patient centred care, specifically designed environments, review of medical care and early discharge planning as key characteristics of the model. There was considerable variation in how these shared high-level objectives were operationalised within individual care models.

Treatment was delivered within a geographically distinct bedded unit in 20 studies [ 15 , 16 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 38 , 39 , 42 , 44 , 45 , 46 ], of which 7 specifically reported adaptations to optimise the environment for older people [ 15 , 17 , 18 , 23 , 24 , 39 , 41 ]. The mean number of beds in each unit was 18 (SD 8). The number of beds was not reported in 3 studies [ 25 , 41 , 46 ]. A mobile model providing specialist consultations to patients within general medical bed was described in 3 studies [ 20 , 33 , 36 ] (and an integrated service with variable bed capacity operating within an acute medical unit in 1 study [ 45 ].

Eligibility criteria were heterogenous. Age criteria were reported in studies describing 20 care models [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 44 , 45 ]. Descriptions of the process of patient referral and how eligibility criteria were implemented in practice were uncommon. The presence of additional criteria such as functional impairment or specific geriatric conditions were frequently reported, but it was not possible to establish how these criteria were operationalised. The use of validated frailty assessment tools to define eligible patients were reported in 1 study (reported across 5 articles) [ 26 , 28 , 29 , 30 , 31 ]. Patients from residential care homes were excluded in 2 studies [ 18 , 21 ]. Bed availability was cited as a common determinant of receiving treatment on the AFU.

Hospital at home models

Hospital at home (HaH) models describe the provision of acute medical care within a person’s usual place of residence. The care model aims to replicate acute bed-based care and operate under the assumption that care would be delivered in an acute hospital setting if the model were absent. HaH models were described in 37 articles derived from 27 studies. This included 16 articles [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ] reporting results from 12 randomised controlled, 2 protocols (of which 1 had reported results and was included) [ 63 , 64 ], 9 observational studies with a comparator group reported across 15 articles [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and 4 descriptive studies without a comparator group [ 79 , 80 , 81 , 82 ]. A detailed description of the care models is provided in Supplementary Table 2 B.

There was significant clinical heterogeneity between included HaH models. The model accommodated patients with unselected acute medical illness in 31 studies and specific disease groups in 7 studies (decompensated heart failure = 3 [ 57 , 58 , 62 ], COPD = 4 [ 47 , 51 , 52 , 70 , 79 ]).

Eligibility criteria to define suitability for HaH care were heterogenous. All included studies made the intention to act as an alternative to hospital bed-based care explicit. Clinical discretion exercised by the HaH team was the arbiter of the appropriateness and safety of HaH care in all the identified studies. No standardised approach to assessment was identified and it was not possible to reliably determine the acuity of included patients from the reported data. The majority of HaH studies specifically targeted adults over the age of 65. In models open to adults of all ages, the mean age of participants was over 65 in all cases. Care home residents were excluded in 9 studies [ 53 , 58 , 59 , 63 , 67 , 73 , 74 , 75 , 80 ].

Care was led by a geriatrician in 6 studies, [ 47 , 59 , 61 , 62 , 73 , 78 ] by a general internal medicine physician in 29 studies and a primary care physician in 2 studies [ 60 , 83 ]. The intensity of physician and nursing involvement varied substantially. Physician involvement ranged from multiple daily physical home visits to remote oversight without direct physical assessment. Specific out-of-hours arrangements were reported in 12 studies reported across 19 articles [ 47 , 53 , 54 , 55 , 61 , 62 , 65 , 67 , 68 , 69 , 71 , 72 , 74 , 75 , 76 , 77 , 81 , 82 , 83 ]. The use of telemedicine was described in 5 studies reported across 11 articles [ 47 , 65 , 66 , 68 , 69 , 71 , 72 , 74 , 75 , 76 , 77 ]. Reporting of the study intervention was often restricted to a description of standardised operating procedure. The frequency of assessment achieved in practice was reported in 6 studies [ 52 , 53 , 58 , 74 , 75 , 81 ] and the proportion of patients receiving specific treatments was reported in 3 studies [ 47 , 53 , 80 ].

ED in-reach models

ED in-reach models aim to optimise processes of care for older people in the ED. The care models typically provide care coordination and elements of CGA to reduce the likelihood of admission to acute-bed based care. ED in-reach models were described in 28 studies describing 27 care models. This included 2 randomised controlled trials, [ 84 , 85 ] 1 randomised controlled trial protocol without results [ 86 ], 12 observational studies with a comparator group [ 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ] and 13 descriptive studies without a comparator group [ 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. A detailed description of the care models is provided in Supplementary Table 2 C.

Two distinct approaches to the operational design of services were evident. One approach, described in 11 studies, involved the use of bedded areas located within ED clinical decision units (alternatively referred to as ED short stay units) to provide elements of CGA to older patients who required additional assessment and investigation before a decision regarding acute medical admission could be reached [ 87 , 89 , 90 , 91 , 94 , 96 , 104 , 105 , 107 , 109 , 111 ].

An alternative approach, described in 20 studies, involved the provision of elements of CGA directly within the ED. CGA was undertaken by a geriatrician in 10 care models [ 84 , 88 , 97 , 100 , 101 , 102 , 103 , 108 , 110 ] and by specially trained nurses in 7 care models [ 85 , 86 , 92 , 93 , 95 , 98 , 99 , 106 ]. Studies of this care model frequently cited a reduction in the number of avoidable medical admissions as the primary motivation for the service. The distinction between avoidable and unavoidable admissions was poorly defined.

Eligibility criteria were heterogenous. Age criteria were reported in 13 care models [ 84 , 88 , 91 , 93 , 94 , 95 , 98 , 99 , 102 , 103 , 104 , 106 , 108 , 112 ]. The use of validated frailty assessment tools to define eligible patients were reported in 5 care models [ 84 , 86 , 92 , 99 , 106 ]. Care home residents were excluded in 3 studies [ 86 , 91 , 94 ]. Eligibility criteria were not reported in 5 studies [ 87 , 89 , 91 , 109 , 110 ]. A variety of approaches were adopted to identifying potentially eligible patients in the ED. Screening of all patients attending the ED was reported in 3 studies [ 84 , 88 , 93 ]. The service was accessed by a referral from the ED team in 11 care models [ 89 , 90 , 92 , 95 , 98 , 99 , 100 , 101 , 104 , 109 , 110 ]. The process of referral and patient selection were not consistently reported.

Acute care home models

Models targeting care home residents were reported in 5 studies. All 5 studies had an observational design [ 113 , 114 , 115 , 116 , 117 ]. Two categories of intervention were described. The first involved the presence of dedicated staff trained in acute care present with the care home [ 113 , 117 ]. These staff had the ability to deliver acute interventions in the care home. Privileged access was given to the on-call ED physician in both models (augmented by telemedicine in one study) [ 117 ]. The process which triggered assessment by the on-site team were not defined. A detailed description of the care models is provided in Supplementary Table 2 D.

An alternative model involved a hospital-based team providing out-reach to care homes and early assessment of care home resident presenting to ED. Both care models in this category also had the capability to provide ongoing acute care in the care home when required. This was achieved by a geriatrician-led team with the option to provide daily visits in one model [ 116 ] and a specialist ED nursing team in the other [ 114 , 115 ].

Outcome measurements

Outcomes were classified using the COMET taxonomy. Outcomes were reported across 6 core areas and 15 domains. Mortality was reported (in isolation or as part of a composite outcome) in 35 studies, the reporting time horizon ranged from in-hospital mortality to 1 year. Life impact was reported 27 studies, this included measurement of physical function in 21 studies and cognitive function in 6 studies. The tools used to measure physical function and the time horizons of assessment varied.

Resource use was the most reported core outcome measure. Studies frequently described multiple outcome domains related to resource use. The average length of stay was reported in 34 studies and re-admission rate in 39 studies. Readmission rates were reported over a range of time horizons 30 days to 1 year. Care home admission were reported (in isolation of as part of a composite outcome) in 14 studies over a time horizon of 30 days to 6 months. Economic analysis was reported in 19 studies. Adverse events were reported in 22 studies. A detailed summary of the outcome domains, methods of measurement and associated time horizons is provided in Supplementary Table 3 .

The relative frequency with which the outcome domains were reported across all studies is provided in Fig.  4 A and stratified by care model in Fig.  4 B. Outcomes reported by bedded AFU and HaH were broadly similar, although AFU more commonly reported outcomes related to physical function. Economic analysis was less prevalent in studies investigating ED in-reach models. A focus on aspects of care delivery, such as disposition from the ED and analysis of clinical processes relevant to the quality and adequacy of intervention were more common in studies evaluating ED in-reach.

Tree diagrams: A tree diagrams representing the relative proportion of outcomes reported in all studies. B Tree diagrams representing the relative proportion of studies by study group. Legend. * Treemap representing hierarchical outcome data using nested rectangles. Large rectangle represent core outcome areas, smaller rectangular tiles within each core outcome area represent outcome domains. Each rectangle has an area proportional to the frequency reported within included studies. All studies n  = 103, Bedded acute frailty unit n  = 32, Hospital at Home n  = 38, ED in reach models n  = 28, Care home n  = 5

Effectiveness

Clinical heterogeneity amongst the care models identified and disparity in the outcomes measured used to evaluate the care models precluded meta-analysis. Risk of bias was assessed for each study. Aggregated results of the domain-based risk of bias assessment tools are provided in Fig.  5 and the results of individual study assessments are provided in Supplementary Table 4 .

Summary of bias assessments. A Summary of randomised controlled studies using RoB2 tool. B Summary of non-randomised studies using ROBINS-I tool

The nature of the intervention precluded blinding of participants or personnel to group allocation in all included randomised controlled trials. Partial blinding of outcome assessment was reported in one study investigating the effectiveness of bedded AFUs [ 17 ] and assessment was unblinded in the remainder. Blinding during outcome assessment was reported in 4 randomised controlled trials investigating HaH [ 47 , 52 , 59 , 60 ]. Outcome assessment was unblinded in both randomised controlled trials investigating ED in-reach models [ 84 , 85 ]. All the studies investigating bedded AFUs were undertaken in single sites which may have led to contamination of the control arm. This would be anticipated to favour the null hypothesis [ 15 , 16 , 18 , 19 , 20 , 21 , 22 ]. Contamination of the control arm was less likely in HaH models delivered by distinct clinical teams.

All included observational studies were at serious or critical risk of confounding. The decision to manage patients in the intervention arm is likely to have been selective, based on clinical judgment informed by pre-intervention clinical characteristics. Only 5 studies employed robust statistical techniques to control for confounding [ 65 , 67 , 69 , 78 , 92 ]. Residual confounding from unmeasured prognostic factors posed at risk of bias all included observational studies.

Effectiveness of acute care models

Bedded acute frailty unit models.

No statistical difference in primary outcome was observed in 2 randomised controlled trials (reported across 3 articles) of specialist bed-based care for unselected older medical patients, 1 study measured the composite outcome of death, severe dependence and psychological well-being [ 15 ] and the other physical function at 3 months following discharge [ 19 ]. A planned cost-analysis demonstrated no difference in the total cost of admission between groups [ 16 ]. A single centre randomised controlled trial comparing a specialist unit for acutely unwell patients with cognitive impairment with usual care demonstrated no statistical difference in the composite outcome of days at home [ 17 ]. All included observational studies were judged to be at critical or serious risk of bias.

The largest randomised controlled trial included 1055 participants [ 59 ]. The study was designed to recruit to the HaH intervention at a ratio of 2:1. A significant number of participants moved from the control to the intervention arm due to operational pressures within the hospital. The study found no difference in the primary outcome of living at home at 6 months (the inverse of death or long-term residential care) [ 59 ]. The remaining 11 trials (reported across 15 articles) had smaller sample sizes (mean 81 participants, SD 33). One randomised controlled trial (2 articles) reported a statistically significant reduction in the rate of adverse events [ 50 ] and favourable functional outcomes in the group allocated to HaH care [ 49 ].

HaH care for older people with decompensated heart failure was investigated in 2 randomised controlled trials, 1 reported no difference in mortality or readmission at 6 months [ 62 ] and 1 no difference in mortality or readmission at 12 months [ 57 ]. HaH care for older people with an acute exacerbation of COPD was investigated in 2 randomised controlled trials, 1 reported a statistically significant reduction in readmissions at 6 months and no difference in mortality at 6 months [ 47 ] and 1 reported lower costs at 90 days, driven by shorted length of stay in the HaH group, with no difference in mortality or readmission rate at 90 days [ 52 ]. Economic analysis determined HaH was associated with lower costs in 1 randomised controlled trial of participants with unselected medical-illness [ 53 ]. Nested analysis of patient and carer satisfaction was included in 5 trials [ 47 , 52 , 53 , 59 , 62 ] in 3 trials the findings were reported in separate articles [ 51 , 55 , 66 ]. All showed an increase in measures of patient satisfaction in the HaH intervention group.

One randomised trial compared two contrasting models of HaH. The study arms compared HaH care led by primary care physicians with care led by hospital specialists [ 60 ]. Those in the hospital specialist arm were initially assessed in the ED and discharged within 4 h of assessment with a home-based care plan. The hospital specialist team did not undertake home visits. Those in the primary care physician arm received care exclusively at home. In both arms the plan care was delivered by a dedicated HaH nursing team. The primary care physician model was a associated with a statistically significant reduction in hospital admission at 7 days. A series of articles published as part of a non-randomised controlled trial [ 75 ] reported a reduction in length of admission, [ 75 ] reduced levels of carer stress [ 71 ] and no difference in physical function [ 72 ] in the HaH group.

ED in reach models

No statistical difference in the primary outcome measure was observed in 2 randomised controlled trials investigating ED in-reach models. In one study the provision of geriatrician lead CGA to patients aged over 75 with a clinical frailty scale (CFS) of 4 or above did not affect cumulative length of stay over a 1 year follow up period [ 84 ]. A randomised controlled trial investigating provision of nurse-led care coordination in the ED found no significant effect on the rate of hospital admission [ 85 ]. Uncontrolled before and after studies were a common methodological approach to the assessment of ED in-reach models, employed in 5 studies. All included observational studies were judged to be at serious risk of bias.

This systematic review provides a summary and classification of acute care models for older people living with frailty and an assessment of effectiveness based on current published evidence. The care models identified could be broadly differentiated by the location within the acute care pathway at which they operate. This generic classification provides a degree of structure to a large and complicated field of research, sensitive to the fact that relevant interventions have emerged across hospital and community settings. The spectrum of outcomes reported and differing approaches to measurement suggest consensus on how best to determine the effectiveness of these care models has yet to emerge.

The clinical effectiveness of acute care models for older people was difficult to determine from the available studies. The number of participants within each trial was small. The risk of confounding by indication was pervasive amongst observational studies and statistical techniques to control for cofounding were generally absent or inadequate. These methodological limitations prevented meaningful comparisons of the impact on outcomes between care models. There is a paucity of contemporary data on the effectiveness of acute care models for older people. Some of the most influential studies were conducted over two decades ago. This raises the concern that the clinical processes employed may now be obsolete.

Complex interventions, such as acute care models for older people are often difficult to characterise. The detailed summary of individual interventions provided within this review highlights the contrasting approaches adopted by services under the same umbrella.

Few studies adopted a structured approach to defining the intervention under investigation and the descriptions provided varied in depth and quality. The nature of care provided in the usual care arm of comparative studies was equally difficult to define. The absence of consistent inclusion and exclusion criteria or knowledge of how criteria were operationalised makes it difficult to discern the population targeted by each intervention. Assignment often incorporated a subjective assessment by an individual clinician acting as gatekeeper. Thresholds for admission and discharge are not standardised and risk tolerance may vary at the individual, hospital and system level. This is particularly pertinent to studies investigating the role of HaH and ED in-reach models, predicated on the assumption that care would inevitably require in-patient bed-based care if the intervention was absent. This assumption is inherently difficult to substantiate. All the HaH models included in this systematic review had access to hospital level diagnostics and interventions but the proportion of patients receiving these interventions were inconsistently reported. This obfuscates an objective assessment of acuity and whether hospital admission was warranted.

Comparison with previous literature

Clinical heterogeneity in the studies included in previous systematic reviews and the absence of universally accepted definitions for the care models investigated cloud interpretation of the existing literature. The diverse range of approaches to patient selection, operational design and outcome measurement highlighted in this review suggests caution is warranted when pooling studies in this subject area.

Several systematic reviews investigating acute care models for older people have focused the delivery of comprehensive geriatric assessment (CGA) [ 8 ]. CGA involves multidimensional assessment with particular attention on the functional consequences of illness [ 118 ]. CGA has been shown to increase the likelihood of being alive or returning to home at 3 to 12 months follow up amongst older patients admitted to hospital with acute illness [ 8 ]. Meta-analysis of CGA delivered in bed-based frailty units found a lower risk of functional decline, a higher likelihood of living at home after discharge and no differences in mortality [ 119 ]. CGA delivered in bed-based frailty units may also reduce the incidence of adverse events such as falls, delirium and pressure sores at discharge [ 10 ]. The inclusion of interventions delivered on rehabilitation wards, and patients with surgical and orthopaedic presentations in previous systematic reviews limits generalisation to care models employed at earlier time points in the acute care pathway. The available literature suggests alternatives to usual bed-based care incorporating CGA may be of benefit but offers little to guide how these services should be designed and implemented. When inclusion is limited to interventions employed within 48 h of presentation the evidence of effectiveness is less compelling. This is important given the benefit of CGA is cited as the primary motivation for operational models located upstream in the acute care pathway [ 120 ].

HaH models have also been the subject of systematic review and meta-analysis. A Cochrane review of admission avoidance HaH identified ten randomised controlled trials including 1333 participants of which 850 were included in individual patient level meta-analysis [ 121 ]. The analysis demonstrated a significant reduction in mortality at 6 months (adjusted HR 0.62, 95% CI 0.45–0.87). A more recent systematic review and meta-analysis found patients managed in HaH following discharge from the ED had a lower risk of admission to institutional care (RR 0.16 95% CI 0.03–0.74) and no difference in mortality (RR 0.84 95% CI 0.6–1.2) [ 122 ]. These systematic reviews pooled results from studies investigating HaH in the context of a diverse range of conditions including stroke, cellulitis, fractures and respiratory illness which would be expected to employ very different clinical processes. Applying a more restrictive approach to study inclusion, by only including HaH models with access to hospital level diagnostics and treatments allows greater confidence in the assertion that the HaH models included in the current review offered a true alternative to hospital admission.

Implications for policy and future research

The provision of acute care models for older people are predicated on a logic model rather than empirical evidence of benefit. Further large and rigorously constructed randomised controlled trials may strengthen the evidence base but may not be the most effectual method of influencing local decisions on service provision or the direction of policy.

Research in acute care delivery is complicated by a need to maintain operational performance. Amongst the studies identified, bed availability and restricted operational hours frequently resulted in a large differential between the number of potentially eligible participants and the number of patients ultimately included. Practical considerations aside, the outcomes of interventional studies are likely to be highly dependent on local context and external factors which influence generalisability.

Knowledge in this subject area may be enhanced by developing a consistent approach to outcome reporting and measurement, ideally incorporating the priorities and preferences of patients. Mortality may not be the most appropriate metric of effectiveness given a significant proportion of older people living with frailty requiring acute care for medical illness are entering the last 12 months of life [ 123 ]. Current models of acute care infrequently establish and record individual preferences in relation to location of care in the event of acute medical illness or preferred location of death amongst older people [ 124 ]. A narrow focus on clinical and operational outcomes may simplify study design, facilitate comparisons and provide reassurance around safety but risks ignoring other aspects of care, such as quality of life, which may be more meaningful from the patient perspective.

Given the complexity of the intervention, an understanding of the processes and behaviours which drive successful models may be best approached from a qualitative research paradigm.

Strength and limitations

The primary objective of this systematic review was to describe and categorise acute care models for older people and highlight variation in the outcome measures used to assess them. An extensive search strategy inclusive of the grey literature and indifferent to methodological design was purposefully employed in order to capture a comprehensive representation of the range of models in operation. Every acute hospital encounters older people living with frailty and the potential for variation in approach is vast. Only a small fraction of care models delivered in practice are reported in the literature. The practice of publishing multiple articles from the same original study was relatively common, particularly in literature pertaining to acute bed-based care and HaH models. The account provided is therefore susceptible to both publication and outcome reporting bias.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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DSL is funded by National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, NIHR Community Healthcare MedTech and IVD Cooperative and NIHR Oxford Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or Department of Health and Social Care.

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Thomas Knight, Vicky Kamwa, Catherine Atkin & Elizabeth Sapey

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Janahan Ragunathan

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Knight, T., Kamwa, V., Atkin, C. et al. Acute care models for older people living with frailty: a systematic review and taxonomy. BMC Geriatr 23 , 809 (2023). https://doi.org/10.1186/s12877-023-04373-4

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Received : 11 December 2022

Accepted : 03 October 2023

Published : 05 December 2023

DOI : https://doi.org/10.1186/s12877-023-04373-4

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