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Letter: Peer review or federal peering?
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The peer review process (aka peer reviewology).
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Risk-benefits of peer review.
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Peer review and third party prepayment. Does third party involvement require peer review?
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Discussion between reviewers does not improve reliability of peer review of hospital quality.
OBJECTIVES: Peer review is used to make final judgments about quality of care in many quality assurance activities. To overcome the low reliability of peer review, discussion between several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability. The authors assessed the impact of discussion between 2 reviewers on the reliability of peer review. METHODS: A group of 13 board-certified physicians completed a total of 741 structured implicit record reviews of 95 records for patients who experienced severe adverse events related to laboratory abnormalities while in the hospital (hypokalemia, hyperkalemia, renal failure, hyponatremia, and digoxin toxicity). They independently assessed the degree to which each adverse event was caused by medical care and the quality of the care leading up to the adverse event. Working in pairs, they then discussed differences of opinion, clarified factual discrepancies, and rerated the record. The authors compared the reliability of each measure before and after discussion, and between and within pairs of reviewers, using the intraclass correlation coefficient for continuous ratings and the kappa statistic for a dichotomized rating. RESULTS: The assessment of whether the laboratory abnormality was iatrogenic had a reliability of 0.46 before discussion and 0.71 after discussion between paired reviewers, indicating considerably improved agreement between the members of a pair. However, across reviewer pairs, the reviewer reliability was 0.36 before discussion and 0.40 after discussion. Similarly, for the rating of overall quality of care, reliability of physician review went from 0.35 before discussion to 0.58 after discussion as assessed by pair. However, across pairs the reliability increased only from 0.14 to 0.17. Even for prediscussion ratings, reliability was substantially higher between 2 members of a pair than across pairs, suggesting that reviewers who work in pairs learn to be more consistent with each other even before discussion, but this consistency also did not improve overall reliability across pairs. CONCLUSIONS: When 2 physicians discuss a record that they are reviewing, it substantially improves the agreement between those 2 physicians. However, this improvement is illusory, as discussion does not improve the overall reliability as assessed by examining the reliability between physicians who were part of different discussions. This finding may also have implications with regard to how disagreements are resolved on consensus panels, guideline committees, and reviews of literature quality for meta-analyses.
Quality assurance reviews: how they differ from peer reviews.
Research papers and reports written by scientists and engineers in the United States Environmental Protection Agency are reviewed by the agency's quality assurance staff. EPA papers and reports are subjected to peer reviews that check for the validity of conclusions and the general agreement with the body of technical knowledge in the subject area. Quality assurance reviews differ from peer reviews in that the focus of the quality assurance review is on the following criteria: Consistency: Were reasonable and consistent units of measurement and generally acceptable formulas used throughout? Are the appropriate number of significant figures reported? Correctness: Were matrix-compatible methods used? Were measurements within the working range of the method? Can measurements be traced to a recognized standard or source (e.g., the National Institute of Standards and Technology)? Can calculations be verified, starting from representative raw data and proceeding to the summary data presented in the paper or report? Coherence: Do the stated conclusions follow from the data presented? Are the assumptions clearly stated? Are inconsistencies between data and conclusions discussed? Clarity: Are special terms and acronyms defined? Can a person with a general technical background in the subject understand the paper or report? Conformance: Did the study follow the test/quality assurance plan, with appropriate calibrations and other quality-control checks, audits, and data validations? If not, is there a discussion of problems? Concordance: Were data quality objectives met? Were the data quality indicator goals achieved for precision, accuracy, representativeness, comparability, and completeness? The importance of these quality assurance review criteria are discussed along with examples from current work.
Peer review in toxicologic pathology.
Peer review of histopathology findings in safety assessment studies involving rodents and other animals is a relatively recent procedure in toxicologic pathology. It serves to ensure the integrity of the pathology evaluation in safety studies, encourages consistency of diagnostic criteria and use of common terminology, and provides a method of continuing education for participants. The use of a standardized system of pathology nomenclature and diagnostic criteria, such as the Society of Toxicologic Pathologist's Guides for Toxicologic Pathology, is of great value in the procedure. Pathology reviews may involve government-sponsored bioassay programs, in-house industrial corporations, or individual peer reviews suggested or required by government regulatory agencies. Pathology Working Groups can be an integral part of the review process. The extent of the peer review is primarily dependent on the study results; however, other variables such as confidence of the data, study size and duration, complexity, and purpose are also important considerations. Essential components of any peer review, however, include selection of tissues/lesions for review, by a reviewing pathologist, discrepancy resolution, data modification, and documentation of all aspects of the review process. Specific procedures for pathology peer review are discussed. Disagreements among pathologists discovered in peer reviews can be resolved by several methods and examples will be presented. The entire pathology peer review process should be a learning experience for all involved and can help ensure the integrity of animal toxicology studies used for important regulatory decisions involving the use of chemicals in our society.
Development of the review quality instrument (RQI) for assessing peer reviews of manuscripts.
Research on the value of peer review is limited by the lack of a validated instrument to measure the quality of reviews. The aim of this study was to develop a simple, reliable, and valid scale that could be used in studies of peer review. A Review Quality Instrument (RQI) that assesses the extent to which a reviewer has commented on five aspects of a manuscript (importance of the research question, originality of the paper, strengths and weaknesses of the method, presentation, interpretation of results) and on two aspects of the review (constructiveness and substantiation of comments) was devised and tested. Its internal consistency was high (Cronbach's alpha 0.84). The mean total score (based on the seven items each scored on a 5-point Likert scale from 1 to 5) had good test-retest (Kw = 1.00) and inter-rater (Kw = 0.83) reliability. There was no evidence of floor or ceiling effects, construct validity was evident, and the respondent burden was acceptable (2-10 minutes). Although improvements to the RQI should be pursued, the instrument can be recommended for use in the study of peer review.
Legal aspects of peer review. Patrick v Burget in the U.S. Supreme Court: its impact on peer review.
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Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations.
The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer-reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high-risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4-6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4-6 months should be used.
An examination of sources of peer-review bias.
Peer-review ratings of 1,983 posters submitted for three annual conferences of a professional society were examined for evidence of bias. Hypotheses derived from the literature on the better-than-average effect were tested by analyzing 7,383 sets of ratings. Reviewers who authored posters gave lower average ratings than reviewers who did not author posters. Posters having authorship that included at least one reviewer received higher ratings than those having only nonreviewing authors. Reviewers' experience and professional role were also explored as biasing factors. The ratings were converted into z scores, and differences in reliability and acceptance decisions were examined. Implications for current peer-review practices are discussed.
Peer review. A study commissioned by the Federal Council of the Australian Medical Association of peer review systems in the United States of America, Canada and West Germany.
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