EDITORIAL

As Editor-in-Chief of Surgical Neurology International, I was recently asked to be part of a panel of Editors of Neurosurgical Journals at the 2019 Congress of Neurological Surgeons (11/22/19), to discuss how to be a reviewer.

“Do You Need to Know How To Write to be A Reviewer?”

My response would be, “It helps.” If you are asked to join an editorial board, and have not been the primary author on at least several peer reviewed papers, do yourself and the journal a favor, and decline the offer.

What Papers Should I Agree to Review?

When you have been the primary author on several peer reviewed papers and decide to accept the invitation to serve as a reviewer, it is important to review not only papers directly in your field, but also those on related topics. I believe it is not fair to decline the multitude of reviews needed to support most journals on topics that might not be your main interest. In short, you shouldn’t just “pick and choose,” unless you have a conflict of interest.

Definitions of a Conflict of Interest

Note, there are multiple definitions of a conflict of interest; (1) you have worked with the authors before, (2) you have a ”bias” for/against the subject/authors, (3) you have a financial conflict, or (4) you have industry ties that disqualify you from being a reviewer. Further, as a reviewer, you also need to make sure that articles are not inappropriately tied to industry. You have to determine: (1) was the article funded by industry, (2) are you being asked to review an article or is it a white paper or infomercial/commercial (e.g., not a scientific study), (3) were specific products/instruments discussed, and if so, you have to determine whether the authors/product have been fully vetted and or fully tested, and (4) finally, do the procedures/instrumentation pose a significant potential risk/threat to patient safety?

Performing a Review

Perform an Overview

The first step in reviewing an article is to perform an overview. This is best gleaned by first reading the title and abstract, and re-reading the purpose and conclusion of that abstract. Next, reading the last sentence of the introduction, and the first and last sentences of the discussion should indicate to you whether there is a premise/hypothesis that is later answered whether directly or indirectly, by the study design. You will need to answer whether there is in fact, an article present. Next, look to the methods section to check it for validity. Determine if the study design is adequate, is the sample size large enough, are the statistics appropriate, and is the study safe, and ethical? Document that there was an IRB (Internal Review Board), and also answer whether the IRB participants did their job, providing adequate informed consent. Other major considerations include; were the operations/procedures warranted, or was there overdiagnosis of disease, overuse of medical devices, and, therefore, unnecessary surgery.[ 2 ]

Analysis of Methods and Results Sections

The methods section should directly contribute to the results. One of the most common errors is finding clinical methods data within the first one to two paragraphs of the results section. Rather, the results section should offer paragraphs headed by first sentences that summarize the results for each part of the study designed. In short, results should not include a myriad of disorganized data (repetition). Rather, the results should be presented in an organized fashion, short/succinct analyses of the data for each facet of the study. Further, where appropriate, accurate tables and figures can keep extraneous data out of the text, and contribute to a short, well-organized results section.

Assessment of the Discussion: Is There a New Contribution to the Literature?

The discussion and conclusion sections should enable you to determine whether the article makes a new contribution to the literature. These sections should also analyze the results utilizing those found in the preceding literature. Critical to discussion sections is the avoidance of long and rambling unfocused diatribes. Too often, this section reads like a chapter rather than a focused review of the appropriate and relevant papers. Less experienced or some writers have a tendency to include extraneous studies that detract from the main point of the article.

Conclusion

The conclusion should typically be just one or two short sentences, and should summarize the article’s main findings.

Limitations

Many articles have a short section on limitations. This should be brief. However, you as a reviewer, will want to ask yourself whether the limitations invalidate the article. It is important that this section be keep short, concise, and to the point.

References

The number and type of references cited should be appropriate to the type of article being written. As a reviewer ask yourself whether key references were missed? Remember, you can easily check PubMed. Also, however, make sure the authors have avoided irrelevant references.

Red Flags for Reviewers

What are the red flags for poorly written articles? First and foremost, inexperienced authors typically write overly extensive and verbose introductions and discussion sections. Other statements you as a reviewer should look out for include: “This is the first paper…” Invariably, this is not the case. Additionally, as a reviewer, be suspicious if the data are too good; this may indicate that the study, at best, was not adequately performed, or at worse, was invalid. Remember when Carraggee et al. in 2011 looked at the 13 Bone Morphogenetic Protein/INFUSE studies (Medtronic, Memphis TN, USA) sponsored by industry, none of the studies reported any complications.[ 1 ]

When to Consult the Editor in Chief (Eic)

There are certainly occasions when you need to talk to the editor in chief. There are several issues that may warrant consulting with the EIC: is the study unethical or unsafe, is it a commercial/infomercial, was it already published elsewhere, and was it previously submitted and rejected by your journal. Further, if you suspect plagiarism, your EIC should be kept informed.

Conclusion

Reviewing is a hard job, but the intellectual rewards are limitless. Reviewing keeps you in touch with new developments, it challenges you intellectually, and continues your education beyond residency/fellowship. Further, it allows interaction with new ideas and new and long standing colleagues.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management.

References

1. Carragee EJ, Ghanayem AJ, Weiner BK, Rothman DJ, Bono CM. A challenge to integrity in spine publications: Years of living dangerously with the promotion of bone growth factors. Spine. 2011. 11: 463-8

2. Epstein NE. “Evidence of Overuse of Medical Services Around the World” By Brownlee et al., Lancet, 2017: Does This Apply to Transforaminal Lumbar Interbody Fusions (TLIF)?. Surg Neurol Int. 2019. 10: 154-