Sponsorship, authorship, and accountability.
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Biomedical subjects
Publications and source records attributed to F Davidoff.
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PURPOSE: The fate of research manuscripts that have been rejected by medical journals is of interest to authors, editors, and peer reviewers, but previous studies were conducted before the widespread availability of computerized literature searches. We update the previous investigations of the fate of rejected research manuscripts by using an electronic literature search and a larger sample, a longer follow-up, and more descriptive journal indexes. METHODS: Using a retrospective cohort study design, we examined 350 manuscripts rejected by the Annals of Internal Medicine, a general medical journal, during 1993 and 1994. We assessed the number of manuscripts that were published after initial rejection, time to eventual publication, journal type (general versus specialty), and journal impact factor (higher scores indicated greater impact) and immediacy index. RESULTS: Of 350 rejected manuscripts, 240 (69%, 95% confidence interval [CI]: 64% to 73%) were eventually published after a mean of 552 days (95% CI: 479 to 544 days, range 121 to 1, 792 days). Of 226 rejected research articles and reviews, 159 (70%, 95% CI: 64% to 76%) were subsequently published in specialty journals. During 1993 and 1994, the mean impact factor for articles published in the Annals was 9.60 (95% CI: 9.56 to 9.64), compared with a mean of 3.09 (95% CI: 2.80 to 3.37) for the journals in which the rejected articles were subsequently published (mean difference 6. 52, 95% CI: 6.24 to 6.81, P < 0.0001). The immediacy index was also lower for these journals. Time to publication had a weak negative correlation with the impact factor of the journal in which the article was published (correlation coefficient -0.15, P = 0.007). CONCLUSIONS: The majority of the manuscripts that were rejected from a large general medical journal were eventually published after an average of 18 months. Most were published in specialty journals with lower impact factor and immediacy index ratings.
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For a very long time, evidence from research has contributed to clinical decision making. Over the past 50 years, however, the nature of clinical research evidence has drastically changed compared with previous eras: its standards are higher, the tools for assembling and analyzing it are more powerful, and the context in which it is used is less authoritarian. The consequence has been a shift in both the concept and the practice of clinical decision making known as evidence-based medicine. Evidence-based decisions, by definition, use the strongest available evidence, are often more quantitatively informed than decisions made in the traditional fashion; and sometimes run counter to expert opinion. The techniques of evidence-based medicine are also helpful in resolving conflicting opinions. Evidence-based medicine did not simply appear in vacuo; its roots extend back at least as far as the great French Encyclopedia of the 18th century, and the subsequent work of Pierre Louis in Paris in the early 19th century. The power of the evidence-based approach has been enhanced in recent years by the development of the techniques of systematic review and meta-analysis. While this approach has its critics, we would all want the best available evidence used in making decisions about our care if we got sick. It is only fair that the patients under our care receive nothing less.
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