Find the best workReport it dispassionately…

How does the NEJM choose which papers to

publish?

Manuscripts Received

0

1,000

2,000

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4,000

5,000

6,000

7,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

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90.0%

100.0%

US(%)

World-Wide

Non-US(%)

Research is a Worldwide Enterprise

Submissions in 2010 (n=14,345)

Perspectives

Editor-in-chief

Associate/DeputyEditor

Peer Review

EditorialMeeting

StatisticalReview

Initial Decision

Initial Submission

Assigning the Manuscripts

About 10% of papers are rejected at this stageAssigned manuscripts are sent to the Associate Editors

Editor-in-chief

Associate/DeputyEditor

Peer Review

EditorialMeeting

StatisticalReview

Initial Decision

Initial Submission

• Local experts in major areas of medicine• Being local facilitates in-person meetings • 9 AEs:

Cardiology Infectious Disease Cancer Endocrinology Gastroenterology

Associate Editors

Maternal-FetalMaternal-Fetal NeurologyNeurology Office Practice Office Practice Health PolicyHealth Policy

Things I Look At And Consider

• Title• Cover Letter• Abstract

– Problem– Type of Study– Size of Study– Definitiveness of Result-sometimes

Tables/Figures– Impact on Topic (Biology, Clinical Practice)

Editor-in-chief

Associate/DeputyEditor

Peer Review

EditorialMeeting

StatisticalReview

Initial Decision

Initial Submission

Peer Review

• In peer review an editor asks an active researcher what he or she thinks of a submitted article

• Editors need advice about four different aspects of a given study

Types of Peer Review• Double blind

– Article is de-identified, and identity of reviewer remains confidential.

• Single blind– Reviewer knows identity of authors. Authors

don’t find out identity of reviewers.

• Open– Identity of authors, reviewers known to all– Often reviews are published with the article.

Editors are looking for work that is….

• Important• Informative• Novel• Ethical

Editors use the Reviews

• Once reviews are in the editor reads the paper and the reviews

• The editor, not the reviewer, makes the decision about the paper

• Reviewers’ comments are valuable, but reviewers are only consultants to the thinking process

Reviewers’ Grades of Rejected Papers

A25%

B29%

D13%

F6%

C27%

A B C D F

Reviewers’ Grades of Accepted Papers

A44%

B42%

C11%

D3%

F0%

A B C D F

Original Article Treatment of Acute Otitis Media in Children under 2

Years of Age

Alejandro Hoberman, M.D., Jack L. Paradise, M.D., Howard E. Rockette, Ph.D., Nader Shaikh, M.D., M.P.H., Ellen R. Wald, M.D., Diana H.

Kearney, R.N., C.C.R.C., D. Kathleen Colborn, B.S., Marcia Kurs-Lasky, M.S., Sonika Bhatnagar, M.D., M.P.H., Mary Ann Haralam, C.R.N.P., Lisa M. Zoffel, C.R.N.P., Carly Jenkins, R.N., Marcia A. Pope, R.N., Tracy L.

Balentine, R.N., and Karen A. Barbadora, M.T.

N Engl J MedVolume 364(2):105-115

January 13, 2011

What the Reviews Look Like

• Manuscript Rating: Poor       Excellent   Please evaluate the manuscript using 1 (poor) - 5 (excellent) or not applicable 1 2 3 4 5 N/A

• Originality 5         Scientific accuracy 5           Composition 4          Interest to NEJM readers 5               Recommendation

•   Reject •   Accept After Minor Revision xxx • Accept After Major Revision

Comments• Confidential Comments for the Editors• Please explain your recommendations (confidential for the editors)

• The manuscript is improved, but the writing style and presentation of results still clearly reflect an inherent bias towards emphasizing beneficial effects of antimicrobial therapy and downplaying the adverse events. Although some of the inaccuracies about "watchful waiting" have been corrected there is still work to do as indicated in my comments to the authors. Last, the inclusion of strictly "otoscopic failures" in the clinical failure rate is suboptimal, but is acceptable provided they make the minor changes to results presentation suggested below and eliminate the long section of the discussion that offers a weak justification for the practice. If you have space in this journal, this article would benefit from a brief accompanying commentary on clinical relevance, which I would be pleased to compose if desired.

The Editors Meet

Editor-in-chief

Associate/DeputyEditor

Peer Review

EditorialMeeting

StatisticalReview

Initial Decision

Initial Submission

About 20% of papers fail at this step

Decision Letter #1

• Dear Dr. Hoberman:

Your manuscript, "Amoxicillin-Clavulanate versus Placebo for Acute Otitis Media in Children under 2 Years of Age," has been evaluated by outside reviewers and by the editors. Although we do not find it acceptable for publication in its present form, we would be willing to consider a substantially revised version that responds to the enclosed comments of the outside reviewers and to the editors' points noted below. Please understand that we cannot commit to publication until we have evaluated a revised version.

Please add a consort diagram to show the flow of the study participants.

While you use the term "stringently defined" acute otitis media (AOM) the definition and the children enrolled would appear to qualify as "unequivocal" AOM. This is not a group of patients that the guidelines suggest watchful waiting is a recommended or acceptable strategy. Please address this concern and the use of a placebo.

This study demonstrates that there is short term benefit to amox/clav in young children with unequivocal (short of tympanocentesis/culture) AOM. The question of long term benefit (in terms of hearing impairment, recurrences, etc) cannot be judged from these data. Please reframe the insights accordingly.

The manuscript should also describe what was in the placebo, how compliance was defined/assessed at "overall 85%".

Revision Process

The Journal(In House Editors)

The Author

Decision Letter #2Dear Dr. Hoberman:

We are pleased to inform you that your manuscript, "Amoxicillin-Clavulanate versus Placebo for Acute Otitis Media in Children under 2 Years of Age," has been recommended for publication in the Journal. Our provisional acceptance of your manuscript is contingent on your responding to the editors' points noted below.

It is important to aid the reader in understanding the meaning of the benefit measured. Please provide further detail regarding the clinical significance of the improvements observed. What does a 0.6 improvement on the AOM-SOS scale mean? Suggestions within the attached version of the manuscript point out issues related to this.

You need to be cautious regarding the safety here as this is a small study with respect to observing a safety signal.

Please shorten Tables 1 and 2, as the in print version must fit on a single page. Consider a smaller table for each in print and a full version on-line.

Please address the issues noted in the attached version of the manuscript.

When you send in your revised manuscript, please provide a point-by-point response to the editors' and reviewers' comments in a covering letter and return two copies of the revision, one in which the changes you have made are highlighted and the other a clean copy. Please include a word count for the text. Any changes in authorship must be made in writing, signed by all authors.

Conclusions

Conclusion In children 6 to 23 months of age with stringently defined acute otitis media,

amoxicillin-clavulanate administered for 10 days significantly reduced the time to resolution of symptoms, overall symptom burden, and the rate of

clinical failure, with minor adverse effects.

Conclusion

• Among children 6 to 23 months of age with acute otitis media, treatment with amoxicillin–clavulanate for 10 days tended to reduce the time to resolution of symptoms and reduced the overall symptom burden and the rate of persistent signs of acute infection on otoscopic examination.

Three Major Reasons for Rejection

• Quality – the science is flawed

• Novelty – the science is good, but has previously been published or does not advance the field

• Specialty – it’s good, but not of general interest and belongs in a specialty journal

Possible Decisions

Initial Reject62%

Reject AfterPeer Review31.2%

We’re very interested0.7%

Needs additionalExperiments-2%

We’re interested4%

Articles Published 2010Original Research n=2264.7%

Lettersn=82216.8%

Review Articles n=7127.0%

Images n=1042.5%

Other Articles n=16429%

Editorials n=124100%

Perspectives n=22331%

Types of Research 2010

Impact Factors

Highest Impact Factor 2009

• CA-A Cancer Jrnal for Clinicians 87.925• Acta Crystallographica Section A 49.925• New England Journal of Medicine 47.050• Nat. Rev. of Mol & Cellular Biology 42.198• Annual Review of Immunology

37.902• Physiological Reviews 37.726• Chemical Reviews 35.957• Nature 34.480• Nature Genetics 34.284• Review of Modern Physiology 33.145• Nature Reviews Immunology 32.245