A Journey of Innovation: 40 years of Pioneering Medical Education at the Aga Khan University Medical College in Karachi, Pakistan

This article presents an overview of Aga Khan University's (AKU) pioneering medical education initiatives over the past 40 years, exploring its impact on healthcare in the region and its commitment to advancing medical education and research in the developing world. Established in 1983 as the first private university in Pakistan, AKU has evolved into a global institution with a focus on improving healthcare standards and addressing healthcare needs in the developing world. The article also discusses the undergraduate and postgraduate medical education programs at AKU Medical College, Pakistan, highlighting their unique features and pioneering approaches to medical education. The institution's journey highlights its ability to adapt to the evolving healthcare landscape while maintaining a focus on quality and excellence, offering a model for other institutions striving to meet healthcare needs in low- and middle-income countries.

The emergence of MedTok: a qualitative analysis of popular medical TikTok videos

Social media is increasingly being used by the public as a medium for health information. Unfortunately, misinformation has become widely available on these sites, often being provided using content that is designed to be more popular and engaging, and it is difficult for the public to differentiate between what is true and what is false. TikTok is one of these platforms and has been rapidly growing over the last few years. As an increasing number of people look to TikTok for their health information, it is important that quality information is accessible and popular on the platform. We conducted a review of TikTok videos using the top 10 videos to show when searching for 13 common conditions. Characteristics of both the creator and video were recorded and analyzed. Videos on conditions commonly diagnosed younger were commonly produced by younger creators with the condition, often based on their own experiences. Conversely, videos on conditions commonly diagnosed older were commonly produced by healthcare professionals providing educational information. Though for conditions affecting older individuals healthcare professionals may be able to create didactic, educational videos, for those affecting younger individuals, it may be beneficial to partner with younger creators, or "influencers," to produce more viral content. Further studies may expand on these ideas to encompass more facets of healthcare. As this study did not analyze the quality of the information in the videos, future research should also focus on determining the quality of popular content on TikTok and other social media platforms.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the First Half of 2023

Description The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members. We also announce our inclusion in PubMed Central.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the 2nd Half of 2022

Description The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.

Analysis of the Reporting Requirements of Clinical Case Reports Dedicated Journals: Towards Updating the CARE Guideline

Background

Following personalized medicine and the development of e-publishing, a large number of case report-dedicated journals have emerged. But the lack of integrated guidelines is a major obstacle to the quality of this evidence. The purpose of this study is to analyze the reporting requirements of case report-dedicated journals to update and strengthen the CARE guidelines.

Material and Methods

Quantitative and qualitative research approach has been done using the content analysis method. All case report-dedicated journals were selected from Scopus (54 out of a total of 68 journals). By referring to these journals' websites, all the contents of the authors' guideline section and two sample articles were examined as a unit of analysis. Quantitative data includes frequency and percentile; qualitative data was conducted through open coding, creating categories, and abstraction.

Results

51% of journals are related to Elsevier and Hindawi publications. 14.8% of journals have been launched in the form of companions. 52% of journals endorse the CARE guidelines. Among the CARE elements, title, consent form (100%), discussion, abstract (94.4%), and introduction (90.7%) had the most frequent elements, and timeline and patients' perspective had the least repetition in the authors' guideline. Also, 19 new reporting elements and 27 types of case reports were identified.

Conclusions

Improving the reporting and content quality of case reports is very important to benefit from knowledge synthesis services. Medical journals publishing case reports should follow a more integrated process. An updated version of reporting guidelines needs to be available for publishers and editors of journals.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the 1st Half of 2022

Description The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our reviewers, authors and board members.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the 2nd Half of 2021

Description As we celebrate the start of 2022, the HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our reviewers, authors, and board members.

Overall and COVID-19-specific citation impact of highly visible COVID-19 media experts: bibliometric analysis

OBJECTIVE

To evaluate whether the COVID-19 experts who appear most frequently in media have high citation impact for their research overall, and for their COVID-19 peer-reviewed publications in particular and to examine the representation of women among such experts.

DESIGN

Cross-linking of data sets of most highly visible COVID-19 media experts with citation data on the impact of their published work (career-long publication record and COVID-19-specific work).

SETTING

Cable news appearance in prime-time programming or overall media appearances.

PARTICIPANTS

Most highly visible COVID-19 media experts in the USA, Switzerland, Greece and Denmark.

INTERVENTIONS

None.

OUTCOME MEASURES

Citation data from Scopus along with discipline-specific ranks of overall career-long and COVID-19-specific impact based on a previously validated composite citation indicator.

RESULTS

We assessed 76 COVID-19 experts who were highly visible in US prime-time cable news, and 50, 12 and 2 highly visible experts in media in Denmark, Greece and Switzerland, respectively. Of those, 23/76, 10/50, 2/12 and 0/2 were among the top 2% of overall citation impact among scientists in the same discipline worldwide. Moreover, 37/76, 15/50, 7/12 and 2/2 had published anything on COVID-19 that was indexed in Scopus as of 30 August 2021. Only 18/76, 6/50, 2/12 and 0/2 of the highly visible COVID-19 media experts were women. 55 scientists in the USA, 5 in Denmark, 64 in Greece and 56 in Switzerland had a higher citation impact for their COVID-19 work than any of the evaluated highly visible media COVID-19 experts in the respective country; 10/55, 2/5, 22/64 and 14/56 of them were women.

CONCLUSIONS

Despite notable exceptions, there is a worrisome disconnect between COVID-19 claimed media expertise and scholarship. Highly cited women COVID-19 experts are rarely included among highly visible media experts.

Lag times in the publication of network meta-analyses: a survey

OBJECTIVE

We assessed the extent of lag times in the publication and indexing of network meta-analyses (NMAs).

STUDY DESIGN

This was a survey of published NMAs on drug interventions.

SETTING

NMAs indexed in PubMed (searches updated in May 2020).

PRIMARY AND SECONDARY OUTCOME MEASURES

Lag times were measured as the time between the last systematic search and the article submission, acceptance, online publication, indexing and Medical Subject Headings (MeSH) allocation dates. Time-to-event analyses were performed considering independent variables (geographical origin, Journal Impact Factor, Scopus CiteScore, open access status) (SPSS V.24, R/RStudio).

RESULTS

We included 1245 NMAs. The median time from last search to article submission was 6.8 months (204 days (IQR 95-381)), and to publication was 11.6 months. Only 5% of authors updated their search after first submission. There is a very slightly decreasing historical trend of acceptance (rho=-0.087; p=0.010), online publication (rho=-0.080; p=0.008) and indexing (rho=-0.080; p=0.007) lag times. Journal Impact Factor influenced the MeSH allocation process, but not the other lag times. The comparison between open access versus subscription journals confirmed meaningless differences in acceptance, online publication and indexing lag times.

CONCLUSION

Efforts by authors to update their search before submission are needed to reduce evidence production time. Peer reviewers and editors should ensure authors' compliance with NMA standards. The accuracy of these findings depends on the accuracy of the metadata used; as we evaluated only NMA on drug interventions, results may not be generalisable to all types of studies.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the 1st Half of 2021

Description As we reach the midway point of 2021, the HCA Healthcare Journal of Medicine would like to thank those behind the scenes that make this publication possible. Our journal would not have been possible without the assistance of our reviewers, authors and board members.

What Has Changed in the Last Decade in the Turkish Archives of Otorhinolaryngology?

Objective

The primary aim of the study was to perform sequential analyses together with a citation analysis on the characteristics of the studies published in the Turkish Archives of Otorhinolaryngology (TAO) in the periods of 2010-2014 and 2015-2019.

Methods

The studies published in the indicated periods were reviewed for study type, study topic, language and country of origin. Then, the citation analysis of the articles was performed through the Google Scholar and Web of Science (WoS) databases for the indicated periods. The estimated annual impact factors (EIF) of TAO from 2017 to 2020 were calculated by dividing the total number of citations performed in the projected year to the total number of citable articles published in the preceding two years.

Results

The total numbers of articles published from 2010 to 2014 and from 2015 to 2019 were 144 and 214, respectively. In 2010 to 2014, the most frequent study topic was head and neck with case reports ranking highest among study types. In 2015-2019, the most frequent study type had changed to original investigation and topic to general otorhinolaryngology. There was a remarkable increase in the total number of citations in 2015-2019 according to Google Scholar and WoS databases. Also, there was a remarkable increase in the EIF values for 2019 and 2020.

Conclusion

Although the increase in the number of citations and impact factor values cannot be appreciated as a single indicator for the success of a journal, the results of the presented study showed a promising advancement in the scientific quality of the TAO, driven by the inclusion of the journal to national and international indexes and by changing the language of the journal to English, as well as the well-orchestrated editorial efforts.

Characteristics of scholars who review for predatory and legitimate journals: linkage study of Cabells Scholarly Analytics and Publons data

OBJECTIVES

To describe and compare the characteristics of scholars who reviewed for predatory or legitimate journals in terms of their sociodemographic characteristics and reviewing and publishing behaviour.

DESIGN

Linkage of random samples of predatory journals and legitimate journals of the Cabells Scholarly Analytics' journal lists with the Publons database, employing the Jaro-Winkler string metric. Descriptive analysis of sociodemographic characteristics and reviewing and publishing behaviour of scholars for whom reviews were found in the Publons database.

SETTING

Peer review of journal articles.

PARTICIPANTS

Reviewers who submitted peer review reports to Publons.

MEASUREMENTS

Numbers of reviews for predatory journals and legitimate journals per reviewer. Academic age of reviewers, the total number of reviews, number of publications and number of reviews and publications per year.

RESULTS

Analyses included 183 743 unique reviews submitted to Publons by 19 598 reviewers. Six thousand and seventy-seven reviews were for 1160 predatory journals (3.31% of all reviews) and 177 666 reviews for 6403 legitimate journals (96.69%). Most scholars never submitted reviews for predatory journals (90.0% of all scholars); few scholars (7.6%) reviewed occasionally or rarely (1.9%) for predatory journals. Very few scholars submitted reviews predominantly or exclusively for predatory journals (0.26% and 0.35%, respectively). The latter groups of scholars were of younger academic age and had fewer publications and reviews than the first groups. Regions with the highest shares of predatory reviews were sub-Saharan Africa (21.8% reviews for predatory journals), Middle East and North Africa (13.9%) and South Asia (7.0%), followed by North America (2.1%), Latin America and the Caribbean (2.1%), Europe and Central Asia (1.9%) and East Asia and the Pacific (1.5%).

CONCLUSION

To tackle predatory journals, universities, funders and publishers need to consider the entire research workflow and educate reviewers on concepts of quality and legitimacy in scholarly publishing.

Gender disparity between authors in leading medical journals during the COVID-19 pandemic: a cross-sectional review

OBJECTIVES

Evaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.

DESIGN

Cross-sectional review.

DATA SOURCES

Medline database.

ELIGIBILITY CRITERIA

Articles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.

DATA EXTRACTION

Key data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors' likely gender; this was quantified using adjusted ORs (aORs).

RESULTS

We included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; p<0.001). Men were more likely to author articles reporting original research and those with corresponding authors based outside the USA and Europe.

CONCLUSIONS

Women were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women's authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.

PROSPERO REGISTRATION NUMBER

CRD42020186702.

How well do doctors understand a scientific article in English when it is not their first language? A randomised controlled trial

INTRODUCTION

English is the lingua franca of science. How well doctors understand English is therefore crucial for their understanding of scientific articles. However, only 5% of the world's population have English as their first language.

METHODS

Objectives: To compare doctors' comprehension of a scientific article when read in their first language (Norwegian) versus their second language (English). Our hypothesis was that doctors reading the article in Norwegian would comprehend the content better than those reading it in English.

DESIGN

Parallel group randomised controlled trial. We randomised doctors to read the same clinical review article in either Norwegian or English, before completing a questionnaire about the content of the article.

SETTING

Conference in primary care medicine in Norway, 2018.

PARTICIPANTS

130 native Norwegian-speaking doctors, 71 women and 59 men. One participant withdrew before responding to the questionnaire and was excluded from the analyses.

INTERVENTIONS

Participants were randomly assigned to read a review article in either Norwegian (n=64) or English (n=66). Reading time was limited to 7 min followed by 7 min to answer a questionnaire.

MAIN OUTCOME MEASURES

Total score on questions related to the article content (potential range -9 to 20).

RESULTS

Doctors who read the article in Norwegian had a mean total score of 10.40 (SD 3.96) compared with 9.08 (SD 3.47) among doctors who read the article in English, giving a mean difference of 1.32 (95% CI 0.03 to 2.62; p=0.046). Age was independently associated with total score, with decreased comprehension with increasing age.

CONCLUSION

The difference in comprehension between the group who read in Norwegian and the group who read in English was statistically significant but modest, suggesting that the language gap in academia is possible to overcome.

Journalists' views on media coverage of medical tests and overdiagnosis: a qualitative study

OBJECTIVE

Promotional media coverage of early detection tests is an important driver of overdiagnosis. Following research evidence that global media coverage presents the benefits of testing healthy people far more frequently than harms, and gives little coverage to overdiagnosis, we sought to examine journalists' views on media reporting of tests, overdiagnosis, and strategies to improve critical reporting on tests.

DESIGN

Qualitative study using semistructured telephone interviews. Interviews were conducted between February and March 2020 and were audiorecorded and transcribed verbatim. Framework thematic analysis was used to analyse the data.

PARTICIPANTS AND SETTING

Twenty-two journalists (mainly specialising in health reporting, average 14.5 years' experience) based in Australia.

RESULTS

This sample of journalists acknowledged the potential harms of medical tests but felt that knowledge of harms was low among journalists and the public at large. Most were aware of the term overdiagnosis, but commonly felt that it is challenging to both understand and communicate in light of strong beliefs in the benefits of early detection. Journalists felt that newsworthiness in the form of major public health impact was the key ingredient for stories about medical tests. The journalists acknowledged that factors, like the press release and 'click bait culture' in particular, can influence the framing of coverage about tests. Lack of knowledge and training, as well as time pressures, were perceived to be the main barriers to critical reporting on tests. Journalists felt that training and better access to information about potential harms would enable more critical reporting.

CONCLUSIONS

Effectively communicating overdiagnosis is a challenge in light of common beliefs about the benefits of testing and the culture of current journalism practices. Providing journalists with training, support and better access to information about potential harms of tests could aid critical reporting of tests.

An Acknowledgement to the HCA Healthcare Journal of Medicine's Reviewers and Editors for the 2nd Half of 2020

Description As the HCA Healthcare Journal of Medicine reaches the end of our first year in publication, we want to thank those who have provided invaluable support for the journal from July to December 2020. Our journal would not have been possible without the assistance of our reviewers, authors and board members.

Publishing at any cost: a cross-sectional study of the amount that medical researchers spend on open access publishing each year

OBJECTIVE

To estimate the financial costs paid by individual medical researchers from meeting the article processing charges (APCs) levied by open access journals in 2019.

DESIGN

Cross-sectional analysis.

DATA SOURCES

Scopus was used to generate two random samples of researchers, the first with a senior author article indexed in the 'Medicine' subject area (general researchers) and the second with an article published in the ten highest-impact factor general clinical medicine journals (high-impact researchers) in 2019. For each researcher, Scopus was used to identify all first and senior author original research or review articles published in 2019. Data were obtained from Scopus, institutional profiles, Journal Citation Reports, publisher databases, the Directory of Open Access Journals, and individual journal websites.

MAIN OUTCOME MEASURES

Median APCs paid by general and high-impact researchers for all first and senior author research and review articles published in 2019.

RESULTS

There were 241 general and 246 high-impact researchers identified as eligible for our study. In 2019, the general and high-impact researchers published a total of 914 (median 2, IQR 1-5) and 1471 (4, 2-8) first or senior author research or review articles, respectively. 42% (384/914) of the articles from the general researchers and 29% (428/1471) of the articles from the high-impact medical researchers were published in fully open access journals. The median total APCs paid by general researchers in 2019 was US$191 (US$0-US$2500) and the median total paid by high-impact researchers was US$2900 (US$0-US$5465); the maximum paid by a single researcher in total APCs was US$30115 and US$34676, respectively.

CONCLUSIONS

Medical researchers in 2019 were found to have paid between US$0 and US$34676 in total APCs. As journals with APCs become more common, it is important to continue to evaluate the potential cost to researchers, especially on individuals who may not have the funding or institutional resources to cover these costs.

Disclosure of study funding and author conflicts of interest in press releases and the news: a retrospective content analysis with two cohorts

OBJECTIVES

To examine how often study funding and author conflicts of interest are stated in science and health press releases and in corresponding news; and whether disclosure in press releases is associated with disclosure in news. Second, to specifically examine disclosure rates in industry-funded studies.

DESIGN

Retrospective content analysis with two cohorts.

SETTING

Press releases about health, psychology or neuroscience research from research universities and journals from 2011 (n=996) and 2015 (n=254) and their associated news stories (n=1250 and 578).

PRIMARY OUTCOME MEASURE

Mention of study funding and author conflicts of interest.

RESULTS

In our 2011 cohort, funding was reported in 94% (934/996) of journal articles, 29% (284/996) of press releases and 9% (112/1250) of news. The corresponding figures for 2015 were: 84% (214/254), 52% (131/254) and 10% (58/578). A similar pattern was seen for the industry funding subset. If the press release reported study funding, news was more likely to: 22% if in the press release versus 7% if not in the press release (2011), relative risk (RR) 3.1 (95% CI 2.1 to 4.3); for 2015, corresponding figures were 16% versus 2%, RR 6.8 (95% CI 2.2 to 17). In journal articles, 27% and 22% reported a conflict of interest, while less than 2% of press releases or news ever mentioned these.

CONCLUSIONS

Press releases and associated news did not frequently state funding sources or conflicts of interest. Funding information in press releases was associated with such information in news. Given converging evidence that news draws on press release content, including statements of funding and conflicts of interest in press releases may lead to increased reporting in news.

Systematic examination of preprint platforms for use in the medical and biomedical sciences setting

OBJECTIVES

The objective of this review is to identify all preprint platforms with biomedical and medical scope and to compare and contrast the key characteristics and policies of these platforms.

STUDY DESIGN AND SETTING

Preprint platforms that were launched up to 25 June 2019 and have a biomedical and medical scope according to MEDLINE's journal selection criteria were identified using existing lists, web-based searches and the expertise of both academic and non-academic publication scientists. A data extraction form was developed, pilot tested and used to collect data from each preprint platform's webpage(s).

RESULTS

A total of 44 preprint platforms were identified as having biomedical and medical scope, 17 (39%) were hosted by the Open Science Framework preprint infrastructure, 6 (14%) were provided by F1000 Research (the Open Research Central infrastructure) and 21 (48%) were other independent preprint platforms. Preprint platforms were either owned by non-profit academic groups, scientific societies or funding organisations (n=28; 64%), owned/partly owned by for-profit publishers or companies (n=14; 32%) or owned by individuals/small communities (n=2; 5%). Twenty-four (55%) preprint platforms accepted content from all scientific fields although some of these had restrictions relating to funding source, geographical region or an affiliated journal's remit. Thirty-three (75%) preprint platforms provided details about article screening (basic checks) and 14 (32%) of these actively involved researchers with context expertise in the screening process. Almost all preprint platforms allow submission to any peer-reviewed journal following publication, have a preservation plan for read access and most have a policy regarding reasons for retraction and the sustainability of the service.

CONCLUSION

A large number of preprint platforms exist for use in biomedical and medical sciences, all of which offer researchers an opportunity to rapidly disseminate their research findings onto an open-access public server, subject to scope and eligibility.

[Russian media about medical innovations and technologies]

The current state of demand for medical information in the media has a high practical significance for the mass audience. Medicine is a science-intensive, rapidly developing field. In this regard, it is necessary to systematically inform the public about the achievements of medicine - in science, technology and industry, explaining the essence and possible consequences of a scientific discovery, popularizing methods of treatment of a particular disease, introducing society to innovative technological processes in the medical field, achievements and developments of the medical and pharmaceutical industry. The paper reviews the experience of media coverage of medical issues in the aspect of familiarity with innovations and technologies in the context of historical development both in our country and abroad. It also describes the presentation of medical topics in modern media - in periodicals, on radio, on television - in popular science programs or TV movies, in electronic sources. In addition, the article analyzes the genre diversity of the presentation of medical topics. The paper provides information about the media coverage of the main directions of the national project "Health" and its innovative directions.

'There were some clues': a qualitative study of heuristics used by parents of adolescents to make credibility judgements of online health news articles citing research

OBJECTIVE

To identify how parents judge the credibility of online health news stories with links to scientific research.

DESIGN

This qualitative study interviewed parents who read online stories about e-cigarettes and human papillomavirus (HPV) vaccination published by top-tier US news organisations. Researchers asked participants to describe elements of a story that influenced their judgement about content credibility. Researchers analysed transcripts using inductive and deductive techniques. Deductive analysis drew on cognitive heuristics previously identified as being used by the public to judge online health information. Inductive analysis allowed the emergence of new heuristics, especially relating to health.

SETTING

The US National Cancer Institute's Audience Research Lab in Maryland, in August-November 2018.

PARTICIPANTS

Sixty-four parents with at least one child between the ages of 9 and 17 residing in Maryland, Virginia, or the District of Columbia participated. Researchers randomly assigned 31 parents to the HPV vaccination story and 33 to the e-cigarette story.

RESULTS

Evidence of existing heuristics, including reputation, endorsement, consistency, self-confirmation, expectancy violation and persuasive intent emerged from the interviews, with participants deeming stories credible when mentioning physicians (reputation heuristic) and/or consistent with information provided by personal physicians (consistency heuristic). Participants also described making credibility judgements based on presence of statistics, links to scientific research and their general feelings about news media. In relation to presence of statistics and links, participants reported these elements increased the credibility of the news story, whereas their feelings about the news media decreased their credibility judgement.

CONCLUSIONS

Parents used a constellation of heuristics to judge the credibility of online health news stories. Previously identified heuristics for online health information are also applicable in the context of health news stories. The findings have implications for initiatives in education, health communication and journalism directed towards increasing the public's engagement with health news and their credibility judgements.

Journal editors' perspectives on the communication practices in biomedical journals: a qualitative study

OBJECTIVE

To generate an understanding of the communication practices that might influence the peer-review process in biomedical journals.

METHOD

Recruitment was based on purposive maximum variation sampling. We conducted semistructured interviews. Data were analysed using thematic analysis method.

PARTICIPANTS

56 journal editors from general medicine (n=13) and specialty (n=43) biomedical journals. Most were editor-in-chiefs (n=39), men (n=40) and worked part time (n=50).

RESULTS

Our analysis generated four themes (1) providing minimal guidance to peer reviewers-two subthemes described the way journal editors rationalised their behaviour: (a) peer reviewers should know without guidelines how to review and (b) detailed guidance and structure might have a negative effect; (2) communication strategies of engagement with peer reviewers-two opposing strategies that journal editors employed to handle peer reviewers: (a) use of direct and personal communication to motivate peer reviewers and (b) use of indirect communication to avoid conflict; (3) concerns about impact of review model on communication-maintenance of anonymity as a means of facilitating critical and unburdened communication and minimising biases and (4) different practices in the moderation of communication between authors and peer reviewers-some journal editors actively interjected themselves into the communication chain to guide authors through peer reviewers' comments, others remained at a distance, leaving it to the authors to work through peer reviewers' comments.

CONCLUSIONS

These journal editors' descriptions reveal several communication practices that might have a significant impact on the peer-review process. Editorial strategies to manage miscommunication are discussed. Further research on these proposed strategies and on communication practices from the point of view of authors and peer reviewers is warranted.