How the BMJ triages submitted manuscripts

1
How the BMJ triages submitted manuscripts

• Richard Smith
• Editor, BMJ
• www.bmj.com/talks

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What I want to talk about

• Why should you triage studies?
• The aims of BMJ triage of submitted manuscripts
• The killer triage question for you
• The BMJs approach to triage
• The key questions for triaging papers

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Why should you triage studies that you might come
across

• You should pay attention to studies that are
  valid and have a relevant message for your
  practice--that will make a difference for your
  patients
• This is less than 1 of original studies
  published in medical journals

4
The aims of BMJ triage of submitted manuscripts

• To identify good papers and send them to
  reviewers as fast as possible
• To identify papers we dont want to publish and
  give succinct but good reasons for not publishing
  them.
• To identify awful papers and reject them
  immediately.

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The aims of BMJ triage of submitted manuscripts

• To identify those papers that might or might not
  be sent for review--and ask others
• To identify papers where we, the editors, can
  make a decision and which we might want to
  publish

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The first question for you

• If this study is true would it be a POEM
  (Patient Oriented Evidence that Matters)?
• If it wouldnt, move on
• You will probably be able to discard 70 of
  studies with this question alone

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BMJ approach I

• Read covering letter.
• Pay small attention. This is a sell.

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BMJ approach II

• Look for signs that this is a totally unsuitable
  paper
• Written by hand
• Typed on an ancient typewriter.
• Full of spelling mistakes.
• Biblical quotations.
• A cure for schizophrenia or cancer
• The answer to SIDS.
• Incomprehensible first two paragraphs.

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BMJ approach III

• Read title page
• Is this an original study or some other kind of
  contribution?
• Are these authors where the study is likely to be
  sound?
• Dont get too carried away by the authors.
  Unknown authors regularly produce great work.
  Known authors sometimes produce dreadful
  papers.

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BMJ approach IV

• Do not read TWIBS or What this paper adds
• These are what the authors would like the paper
  to say rather than what it does say
• Remember that if we do publish this study we need
  to sort this out

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BMJ approach V

• Read structured abstract
• Have you got a clear fix on what the paper is
  about and how it is structured?
• If you havent, its looking bad
• Try to make sense of what the paper is about from
  the introduction
• If you cant, reject it

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BMJ approach VI

• Continuing with the structured abstract
• Have the authors asked a question that we want to
  know the answer to?
• We may not for the following reasons
• Too specialist.
• Too inconsequential
• Too far removed from patient care or public
  policy
• Too well known but remember that lots of things
  that are well known have no evidence to support
  them.

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BMJ approach VII

• Dont reject papers that ask an interesting
  question but get a negative answer
• The question is more important than the result

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Triage questions treatment papers

• Is it a randomised controlled trial or a
  systematic review (see later)?
• If it is not an RCT, is it reasonable not to have
  done one?
• Look for an answer to the question in the paper.
  If you cant find one, reject.
• If it is an RCT, was it really randomised?
• If it wasnt, reject unless you can find a good
  reason for not randomising

15
Triage questions diagnosis paper

• Is the test compared prospectively and blind with
  a gold standard?
• Does the test population include patients with
  the condition, with related conditions that could
  be confused with the main condition, and people
  without the condition?
• Does the paper include information on
  sensitivity, specificity, etc?
• If the answer to any of these questions is no, we
  probably dont want it.

16
Triage questions prognosis studies

• Is there an cohort of patients followed followed
  prospectively from when they were first
  identified with the disease?
• Are 80 of patients followed up?
• If the answer to these questions is no, we
  probably dont want it.

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Triage questions systematic reviews

• Was a clear question asked?
• Was a search described?
• Were quality criteria set?
• Were studies that didnt meet them discarded or,
  if included, done so with a justification or
  discussion of the effect of doing so?
• If not to any of these questions, reject.

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Triage questions qualitative research

• Were qualitative methods appropriate for the
  question? Is it a why or how study rather
  than a does it work or how often study?
• Is there evidence that the data were analysed by
  two people independently?
• If the answer is no to either question, you
  should probably reject

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Triage questionsQuestionnaire survey

• We probably dont want. This is people saying
  what they do rather than evidence on what they do
• But is it telling us something important that we
  probably cant get information on in any other
  way?
• Or might it be a peg for an educational article.
• If the response rate is below 55 we almost
  certainly dont want it.

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Triage questionseconomic evaluation

• Is the underlying methodology valid? For example,
  is an evaluation of treatment based on a
  randomised trial or a systematic review?
• If the answer is no, reject

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Triage questionscase study

• Might it make a lesson of the week or a drug
  point?
• If no, reject
• Lessons of the week must be
• not so common that everybody should know it
• nor so rare that it wouldnt matter if you didnt
• a good read

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Triage questionsdrug point

• Does the report simply say that a drug was given
  and something happened to the patient without any
  extra evidence that there was a causative link?
• If yes, reject
• Extra evidence includes
• rechallenge
• More than one case
• Physiological or pharmacological explanation
• Seen with other similar drugs

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Triage questionsQuality improvement report

• Does the attempt at improvement describe an
  initial assessment of the problem, the
  introduction of a change, and a further
  assessment?
• If the answer is no to any of these, reject
• It doesnt matter whether the change led to
  improvement
• Remember we want to know the broad context

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Triage questions two sorts of studies we dont
want

• Prevalence study
• Boring
• Usually not possible to generalise beyond the
  particular population
• Cost of illness study
• Boring
• Value is in the exactness, which is usually of
  interest to only a few
• Again hard to generalise

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Conclusion

• If your study would survive this triage or if you
  are uncertain we will be pleased to receive it
• Send it too if you are uncertain
• Dont despair if your study wouldnt seem to
  survive--there are many other journals
• Dont be upset if you submit your article and it
  is rejected. The process is inevitably somewhat
  arbitrary. We often see papers we have rejected
  in the Lancet (and, Im sure, vice versa