Retraction Notice: A review of research and development of semi-supervised learning strategies for medical image processing

Accurate and robust segmentation of organs or lesions from medical images plays a vital role in many clinical applications such as diagnosis and treatment planning. With the massive increase in labeled data, deep learning has achieved great success in image segmentation. However, for medical images, the acquisition of labeled data is usually expensive because generating accurate annotations requires expertise and time, especially in 3D images. To reduce the cost of labeling, many approaches have been proposed in recent years to develop a high-performance medical image segmentation model to reduce the labeling data. For example, combining user interaction with deep neural networks to interactively perform image segmentation can reduce the labeling effort. Self-supervised learning methods utilize unlabeled data to train the model in a supervised manner, learn the basics and then perform knowledge transfer. Semi-supervised learning frameworks learn directly from a limited amount of labeled data and a large amount of unlabeled data to get high quality segmentation results. Weakly supervised learning approaches learn image segmentation from borders, graffiti, or image-level labels instead of using pixel-level labeling, which reduces the burden of labeling. However, the performance of weakly supervised learning and self-supervised learning is still limited on medical image segmentation tasks, especially on 3D medical images. In addition to this, a small amount of labeled data and a large amount of unlabeled data are more in line with actual clinical scenarios. Therefore, semi-supervised learning strategies become very important in the field of medical image processing.

This selective historical review summarizes research on learning strategies conducted in the past 50 years and summarizes how the field has evolved. Two goals guide the review: (1) update the literature on the origins of the learning strategies research ‘movement’ and (2) highlight in the supplement the work of one of the early contributors, Claire Ellen Weinstein, whose pioneering work endures up to now. This review fills the gap of other recent reviews by including research on learning strategies began in the 1960s and 1970s that received significant funding from military sources but remained largely hidden in technical reports and hard to find academic documents. The outcomes of this review reveal that the field is thriving, with two major unifying themes. First, there is a focus on metacognition and second, there is a focus on the whole learner and interventions that address cognitive, metacognitive, affective, physical, cultural, and social needs. The research of Dr. Weinstein (who passed June 23, 2016) has framed past and current learning strategies research agendas and includes her development, validation, and implementation of the Learning and Study Strategies Inventory (LASSI) in traditional and online learning contexts. This review and supplemental section’s personal stories include many of the early learning strategies research findings, definitions, and interventions that remain in use across the nation and world today. Future research issues and areas needing more focused attention in the years ahead given our increasing complex, digital, and diverse world are summarized in final sections of this review.

Language learning strategy (LLS) research has been on the decline since the mid-1990s, when there was a boom in strategy research. This decline is, in part, due to growing criticisms of categorizations of learning strategies (Dörnyei, 2005), the data collection instruments used (Dörnyei, 2005; Woodrow, 2005), and contradictory and questionable results (Hadwin & Winne, 1996). In more recent years some research has been conducted under the umbrella of terms such as strategic learning and self-regulation, which aim to distance themselves from the past problems of LLS research. This article uses a recent study of strategic learning to illustrate how strategy research can be conducted in the current academic environment. The study shows that research frameworks need to be context-specific rather than generalized across languages and learning tasks. The study also illustrates the usefulness of qualitative data collection instruments over previously and widely applied questionnaires.

FigureThe concept of peer review can be interpreted very differently among nurses and healthcare professionals. Some think of a subject expert reviewing a manuscript for a journal's editorial staff. Others think of regulatory bodies requiring hospitals to have an internal process to ensure that healthcare team members are competent and able to perform within their scope of practice.1 Still others think of peer review as a quality assurance process in which healthcare team members audit each other's documentation to validate care standardization. We provide insight into a nursing peer review process designed to evaluate performance, and the journey to its implementation. A well-defined peer review process and tool, utilized in conjunction with a nurse's annual performance evaluation, is one way to infuse meaningful peer input into a performance appraisal. This system allows nurses to provide insight into one another's strengths and opportunities for growth. A detailed approach was used to create, develop, and sustain a nursing peer review program that's flexible enough to be used by all staff members within a pediatric hospital system. In addition to promoting professional growth among nursing staff, this process also meets the current peer review standards set by the Magnet Recognition Program® and The Joint Commission. The ultimate goal of sharing this information is to help other organizations that are just beginning the peer review process and those that have struggled in the past with development and implementation to bring about a sustainable change. This, in turn, will promote nursing cohesiveness and professionalism as we work together to bring healthcare into a new era. Organizational standardization Our organization embarked on an initiative to create a standardized peer review process that would be utilized by all nursing departments. The process needed to be integrated organizationally and applicable to clinical nurses within both inpatient and outpatient environments. This journey began with a review of the current literature and an examination of the current peer review practice at other Magnet® facilities. Through this process, it was discovered that the majority of these facilities utilized and defined peer review in a variety of ways. We identified variation in the management of the peer review process within our own organization. Acknowledging the vast array of discrepancies within and external to the organization, a task force of clinical nurses was developed to redefine the way our organization administered the clinical nurse peer review process. This task force also included two leadership liaisons who served as resources to the clinical nurses during this development and provided insight into the management side of the peer review process. There were four steps in our process: (1) defining a peer, (2) developing a peer review form, (3) transforming the process, and (4) implementing the process. Who's a peer? The first step in our work involved evaluating, discussing, and reaching a consensus on the definition of peer. In order to standardize the peer review process, the task force recognized a true definition was needed to measure success with the new process. Looking at previous peer review practice in the organization, many nurses and department directors had different definitions and ideas of what it meant to be a peer. Some departments included other disciplines in a nurse's specialty for evaluations, whereas others utilized only fellow nursing staff members. The task force agreed that the purpose of peer review is to foster professional growth and development among staff members by utilizing a process through which measurable outcomes are assessed. After much dialog, the task force adopted the definition of peer utilized by the American Nurses Association, which defines a peer as an individual of the same rank or standing according to the established standards of practice.2 Form development The next step in redefining the peer review process was to develop a new peer review tool that could be transferrable and applicable among the various nursing specialties and departments. Key areas identified by the task force for development of this tool included creating a short, concise form that's easy to understand with limited directions and applicable to all clinical nursing departments. To achieve this goal, the task force worked collaboratively to establish eight domains that would provide nurses with a peer evaluation framework. These domains were established through open dialog, including question-and-answer sessions, review of current job descriptions, and evaluation of other tools utilized by various Magnet facilities. Through this work, a common set of core expectations were identified and utilized in the development of each domain. These domains encompass the essential clinical nurse job functions, behavioral competencies, and basic roles and responsibilities throughout the organization. The domains can be found in Table 1.Table 1: The eight domains of peer evaluationTo further guide and support high-quality peer feedback, three to five specific, measurable objectives were created and listed under each domain for nurses to measure performance. These objectives were developed to guide peers in evaluating each nurse by providing focused, pertinent feedback. The task force wanted to eliminate vague, nonspecific feedback that didn't facilitate the identification of future growth opportunities. The objectives created by the task force assist peers in identifying evidence from the nurse's daily work, communication, time management, and interdisciplinary interactions. Each domain also included a comment field, allowing nurses the autonomy to provide open-ended feedback and elaborate on outstanding work or opportunities for the employee's growth and improvement. The comment section was extremely important in the solicitation of meaningful feedback because it allowed nurses to provide examples to reinforce the ratings selected for the objectives. The directions on the new tool clearly state that comments are mandatory for certain ratings to allow for elaboration and examples. The task force believed a Likert rating scale was essential to standardize the peer review process. The previous process utilized a vague, numerical score that hadn't historically provided nurses with adequate descriptions of their work ethic and performance. Lower scores were considered negative responses, whereas higher scores equated to positive responses. After review of the current literature, the task force employed a 4-point Likert scale comprising "not met," "approaching," "meets expectations," and "exceeds expectations." In addition to the scaled questions, an open-ended question "Do you feel comfortable working with this nurse?" was added to the form. Utilizing a mixed-method methodology, Likert scale, and open-ended question format allowed the evaluating nurse a better opportunity to provide real-life contextual examples related to the evaluated nurse's care.3 Process transformation After the peer evaluation tool was created, the task force focused its attention on creating a framework to aid departments in implementing the new peer review process. Throughout our hospital, there are units of vastly different sizes. Some nursing departments have four to six clinical nurses, whereas other departments have as many as 150 to 200 clinical nurses on staff. The variability in staff sizes meant that the task force had to be creative in determining how many peer reviewers should evaluate each nurse annually and how these reviewers should be selected. With the new process, each nurse receives feedback from two to four RNs. Limiting the number of peer evaluations eliminated the previous dissatisfaction and/or barrier of evaluators being asked to fill out 20 to 30 peer evaluations a month due to exceedingly large nursing departments. The task force also allowed clinical nurses to select one to two peers of their choice to provide feedback; the management team selected the remaining peers. Implementation After the task force completed the new peer review tool and process recommendations, the nursing department directors and the CNO gave the approval for implementation. The standardized peer review form, along with the revised process, was implemented using various educational modalities. The first presentation was provided to the inpatient and outpatient nursing directors to inform them about the new form and the revised process. The directors were provided with handouts outlining the changes and educational fact sheets for the staff members to use as a reference. The task force increased its availability to ensure educational consistency to all clinical nurses by attending and presenting at unit-based councils, charge nurse meetings, and department-wide staff development programs. The feedback received from the different educational presentations was extremely positive. Feedback discussed the tool's ease of use, applicability to all nursing departments, appropriate form length, and measurable objectives that allowed nurses to comment on focused job roles and responsibilities. Other feedback included the improved functionality of the new rating scale and the process change that limited the number of requests for peer evaluations. Some directors expressed resistance to changing their current peer review practice. Certain directors thought feedback from four nurses wasn't enough if the department had a high number of nursing staff members. After an open discussion with the task force chairperson and the directors of large departments, it was agreed that meaningful feedback from four people would be adequate. Other directors mentioned that they liked the idea of adding specific clinical skills for peer evaluation. However, we couldn't add specific skills because they wouldn't universally apply to the various nursing department specialties. The task force collected all comments and feedback, and created a frequently asked questions document to address these concerns and explain the thought process behind the decisions made about the tool and recommendations. Directors were then provided with answers to and rationales for their specific questions and concerns, creating a consistent message and clarity to all departments. All education and implementation occurred over the course of 4 months. During this time, the task force worked with web development to formulate an electronic version of the peer evaluation document for the purpose of online submission. The electronic document was widely popular because it eliminated the use of paper and facilitated tool access for all clinical nurses. Staff members were able to complete the tool online and submit the evaluation through the organization's intranet directly to the person who requested the feedback. The task force also concluded that in order for this new tool and process to remain functional and meaningful, continued evaluation of its use would be essential. Reaching the top As we diligently work to move the nursing profession forward, it's important to remember that peer review can positively impact not only an individual's nursing practice, but also an entire hospital system. Nurses are at the forefront of healthcare transformation and are integral to sustainable practice improvement. By empowering clinical nurses to lead this initiative, we've been able to successfully introduce, develop, and support a valuable peer review process across our organization. Utilizing a comprehensive peer review tool can help organizations improve patient outcomes and patient satisfaction.

The vital importance of nature to people, and of people to the future of that nature, is self-evident. The understanding of those linkages is, nonetheless, being critically transformed and enriched by research that transcends the barriers between ecology and other traditional disciplines. Such studies are not new, but the dramatic growth in their number and influence is, and reflects the growing need for such work in rapidly changing times and circumstances. People and Nature is founded upon a recognition of these developments, and of the need of authors and readers for a journal that is focussed on them. The motivation and opportunity to conduct interdisciplinary, cross-disciplinary, multidisciplinary, and transdisciplinary research involving ecology and related disciplines has blossomed in recent years (from this point on, we use interdisciplinary research as a catch-all also including cross-disciplinary, multidisciplinary, and transdisciplinary research, while recognising that these can refer to markedly different things). It is increasingly understood that knowledge of the interactions between people and nature is crucial to both. There is a need to sustain and foster creative dialogues between ecology and a host of other disciplines in order to elaborate understandings of people and nature that are both critical and applied in scope. This means dialogues across the natural sciences, social sciences and the humanities. People and Nature is a venue (and invitation) for disciplinary engagements that encompass, for example, economics, geography, history, law, literature, medicine, philosophy, politics, psychology, and sociology, as well as other related disciplines. The British Ecological Society has added new titles to its family of journals as the field of ecology has developed, with the establishment of Journal of Ecology in 1913, Journal of Animal Ecology in 1932, Journal of Applied Ecology in 1964, Functional Ecology in 1987, and Methods in Ecology and Evolution in 2010. People and Nature is a further extension of this highly successful approach. While these other internationally significant journals, and most conspicuously Journal of Applied Ecology, have published papers at the interface of ecology and other disciplines, the focus has been on ecology itself, and thus viewing interdisciplinary scholarship as the adjunct of questions that are fundamentally ecological in intent. People and Nature takes a rather broader view, which can loosely be characterised as a requirement that all contributions have something meaningful to say both about the “People” and the “Nature” components of its title. Breaking down the barriers between disciplines brings its own challenges to authors, reviewers, and readers of articles. Although People and Nature presumes and encourages conversations across quite different arenas of knowledge production, this ambition can encounter remarkably durable disciplinary wisdoms about how research should be framed. People and Nature is committed to working to minimise the challenges associated with disciplinary difference. First, we feel strongly that researchers doing high-quality work should be able to expect a professional, respectful, and constructive publishing experience regardless of their disciplinary norms. We strive to welcome and evaluate every submission on its own terms; we cannot promise to “get it” on first read, but we can promise to try. We recognise that a large proportion of work within the scope of People and Nature is undertaken by researchers from disciplines beyond ecology, sometimes this is in collaboration with ecologists, but often it is not. Our ethos is inclusive and we have set up our submission, peer review, and publication processes with a number of features to ensure our journal caters to different needs. Importantly, we welcome conceptual and empirical research and we do not prioritise one over the other. All research styles have an important role to play when addressing issues within our scope. Relatedly, we are not prescriptive when it comes to word limits or section headings. Of course, our editorial board will assess manuscript formats for appropriateness but we recognise that different disciplines have different conventions and norms and therefore do not ask authors to conform to arbitrary word limits or fixed structures. Second, when scoping the journal, we heard from a lot of researchers who had experienced painful review processes for their interdisciplinary work. We commit to being a leading light of interdisciplinary editing and peer review. It can be difficult for journal editors to make decisions on interdisciplinary work that is often necessarily reviewed by people working in very different spheres. Understandably, reviewers tend to comment more critically on aspects of work with which they are most familiar and provide fewer comments on aspects they know less about. This can be problematic for authors who, for example, use mixed methodologies. The editorial board we recruited is intimately familiar with interdisciplinary research and peer review, and has the tools and the confidence to make active and fair editorial decisions. The editors know that interpreting differences of opinions from contrasting peer reviews takes work, both for ourselves and for authors, but it is crucial to ensure that People and Nature articles can speak across boundaries. Further to this, in recognition of the splintering of largely separate conversations in different niche (but often interdisciplinary) journals, we are working with authors to ensure that their papers actively speak to a range of relevant fields and disciplines. People and Nature thus aspires to be not a collection of unlike contributions to different literatures, but rather the nexus where these various literatures about human-nature relationships convene. This aspiration will take years to achieve, and steering from an editorial team expert in interdisciplinary integration. For this reason and its own sake, a diversity of voices on our growing editorial board is key: our Associate Editors currently hail from 18 countries and innumerable fields and disciplines, with a 46%:54% male:female gender balance. As well as ensuring that the editorial board has the right tools to make objective decisions, we have introduced two important additions to our peer review process. We ask reviewers to specify in their reports which aspects of a manuscript they are most comfortable assessing. This is a small, but important, way to help handling editors assess reviews in their proper context. When we have received the required number of reviews on a manuscript, all of the comments to the authors are then passed first to all reviewers who are invited to enter into a conversation on fellow reviewers’ reports. We hope that this will draw out disciplinary differences in reviews and help editors to ensure that any requested revisions to manuscripts are appropriate. Third, while the primary audience of our journal will be academic researchers, we recognise that topics within our scope are of importance to practitioners and policymakers, and we want to ensure that we actively engage with them. We welcome submissions from these groups and our Perspective article type is particularly suited to non-academic audiences. Access to primary research is a perennial problem for those who do not work for an academic institution and this is one reason we decided that the Journal would be fully open access—all articles are published under a CC-BY licence, free to read, and reuse. We also recognise that such a broad scope will in turn have a very broad readership and we hope that people will engage with all of our content, whether or not it is from their discipline. To facilitate this, like one of our sister BES journals, Functional Ecology, all articles have a plain language summary published alongside them as part of their supporting information. We recognise the international nature of research within our scope and, like all the BES journals, allow authors to publish their abstract in another language of their choice alongside the English abstract. In general, as a BES journal we benefit from a dedicated and highly experienced in-house editorial office team, giving us the ability to provide a level of service and additional promotion for authors that is unavailable to many journals. Early interest in the journal has been excellent and, in order to help ensure fast publication for our authors, content is being published as soon as it is ready and will subsequently be collected into balanced issues published quarterly. We hope our first volume will help set the agenda in this interdisciplinary space, and that subsequent volumes will expand it further. As People and Nature develops, we will endeavour to learn from, and adapt, our processes to provide the best interdisciplinary publication experience that we can for authors, reviewers and readers. We cannot do this in isolation. We want to build a community around this exciting new venture. We have welcomed pre-submission enquiries since before we opened for submissions, and we are still happy to provide feedback to potential authors before they submit. We also welcome feedback from the community more broadly. Do you have suggestions to improve our peer review process or article layout, for example? Is your subject area not represented on our editorial board? If you have any feedback do get in touch with our office. To foster a two-way conversation we have established a blog (which includes all of our plain language summaries of papers) and a Twitter feed, and encourage discussion and debate within the journal’s pages. Please join us on this journey.

Dear NANN Colleagues, Over the past 2 years, the editorial board at Advances in Neonatal Care (ANC) with our recommendations as Co-Editors moved to implement changes in our manuscript peer review process. Some of our reviewers have written us about these changes, but we realized that other peer reviewers may not have noticed and authors may not be fully aware of the changes. Therefore, in this editorial, we highlight some of the current issues around scholarly peer review and the current peer review process used by ANC. PEER REVIEW HISTORY The use of peer reviewers is considered the “gold standard” in publishing to ensure that scholarly work is rigorous, accurate, and novel. In a recent issue of the Scholarly Kitchen, a blog sponsored by the Society for Scholarly Publishing,1 Melinda Baldwin, a physicist, was interviewed about her recent publication about the history of peer review.2 Dr Baldwin pointed out that while use of peers to review published work began in the mid-19th century with a few scholarly societies, widespread adoption of peer review publications did not occur until the 1970s. Peer review of manuscripts was widely adopted at the same time that research funding institutions like the National Institutes of Health were using peer reviewers to “judge” the credibility of grant applications. Peer review in journals was felt to be one way of justifying to funders the truthfulness and value of the grants they had funded.2 Widespread adoption of peer review in both research and clinical journal articles became common place by the 1980s. ACCEPTED PEER REVIEW PROCESSES When peer review was first initiated, both the reviewers (2-3) and author(s) knew the identity of the other individual(s) involved in the process. However, the Royal Society of London posited that reviewers would provide unfettered feedback if they were not named.2 Peer reviewers' identities were then blinded so that authors would not be aware of who provided feedback on their work. Subsequently reviewers were also blinded to the identity of authors. Blinding the identity of the author was thought to ensure independence and minimize bias in the recommendations an individual reviewer would provide to improve the manuscript.3 However, when reviewers are experts in their field, they often know and can recognize the work of their colleagues even when the author is not named. Therefore, the validity of a truly “blind” review is often called into question, especially when the community of scholars around a particular topic is relatively small. Currently, there are a wide variety of accepted practices in peer review.3,4 Many journals continue to use a double-blinded review process where both the author and reviewers are not known to each other. However, single-blinded review has become the most common form of review.3 In single-blinded reviews the author is identified to the reviewer, but the reviewers are not known to the authors. Other journals like the British Medical Journal employ a totally transparent peer review process.5 Authors and reviewers are both aware of the identity of the other, and if the manuscript is accepted for publication, the original submission, the reviewers' comments, the authors response to the reviewers, and the final manuscript are all available online. This process is felt to provide not only transparency within the process but also accountability and credit to the reviewers for the time and effort they provide in the process of publication of scholarly works.6,7 Finally, hybrid models of peer review include one of the above processes along with postpublication commentary and discussion to critique the quality of the work. The value of the manuscript is believed to be revealed in the discourse and ongoing citation record based on the commentary and discussion. Thus, the discussion can add to the impact and value of the work. Research about the peer review process has not provided information about a clear advantage of one review process over another.3 SUPPORT of ANC PEER REVIEWS Regardless of the process used for peer review, editors and authors alike must respect the time commitment involved in a thoughtful peer review. To support ANC reviewers, specific questions important to the journal are listed to facilitate the review. In addition, reviewers are provided continuing education credit for the time they take to complete the review. Finally, annually we recognize the ANC reviewers by publishing their names in ANC. Most recently ANC 's publisher, Wolters Kluwer (Lippincott) has designed a peer review training course available at the following Web site: http://wkauthorservices.editage.com/peer-reviewer-training-course/. We hope our current and future reviewers will check out the free course. For those who want to understand the peer review process even more thoroughly, there is a more comprehensive course available that does have a fee attached. ANC PEER REVIEW PROCESSES Currently, ANC uses single-blinded peer review. Our rationale for changing from double- to single-blinded review was twofold. First, in the neonatal nursing community, it is often difficult to fully blind a manuscript even with the authors' names and institutional affiliations not identified. In addition, the time from submission to peer review completion was often increased because manuscripts had to be sent back to authors for blinding of items they may have missed. Like double-blinded peer review, single-blinded reviewers are required to disclose any potential conflicts of interest that would preclude them from providing an unbiased peer review. Our peer reviewers are asked to complete the peer review within 2 weeks of accepting the assignment to shorten the time from the initial submission to author feedback. We also have recently changed our process and only send the manuscript to 2 peer reviewers to decrease the burden on our pool of ANC reviewers. See Figure 1 for a flowchart of the ANC review process.Figure 1: ANC peer review process flowchart.Thank you to all of our peer reviewers for sharing their expertise and taking the time to provide thoughtful review to our authors. We hope that others will consider joining our peer review team. If you are interested in finding out more about peer reviewing for ANC please contact us. Debra Brandon, PhD, RN, CCNS, FAAN Co-Editor; Advances in Neonatal Care [email protected] Jacqueline M. McGrath, PhD, RN, FNAP, FAAN Co-Editor; Advances in Neonatal Care [email protected]

From strategy to implementation - clinical and academic perspectives

The American Journal of Psychiatry Residents' Journal: Training the Next Generation of Academic Psychiatrists.

Civility in Nursing Peer Review: Giving and Receiving Feedback

Peer Review: The Best of the Blemished?

In recent years, flipped classroom has been more and more popular in education field. The research studies learning strategies in an extra-curricular English teaching institution where the teaching model of flipped classroom is used. With qualitative research method, research objects are four students and a teacher in one class. After data analysis, the article gets three conclusions: Firstly, in flipped classroom, students’ learning strategies are passive and not rich. Secondly, in flipped classroom, compared to face-to-face teaching, taking notes is better to be applied in online learning before class. And the realization of students’ repeating learning needs the support of learning motivation and the supervision of parents. At last, in flipped classroom, teachers can practice teaching strategy of game-based teaching better. The research gives two implications: Firstly, Strengthen supervision and guiding role of teachers and parents in order to take advantages of flipped classroom better. Secondly, teachers should guide students to form their own learning strategies, and make a positive impact on students using their own teaching strategies.

14 - EVALUATION OF LEARNING STRATEGIES RESEARCH METHODS AND TECHNIQUES

A hallmark of professional practice, nursing peer review is the process by which practicing RNs systematically assess, monitor, and give feedback to peers about the quality of nursing care measured against professional standards of practice.1 Nursing peer review supports self-regulation of clinical

Background Whole medicine and health systems like traditional and complementary medicine systems (T&CM) are part of healthcare around the world. One key feature of T&CM is its focus on patient-centered and multimodal care and the integration of intercultural perspectives in a wide range of settings. It may contribute to good health and well being for people as part of the Sustainable Development Goals of the United Nations. The authentic, rigorous, and fair evaluation of such a medical system, with its inherent complexity and individualization, imposes methodological challenges. Hence, we propose a broad research strategy to test and characterize its possible contribution to health. Methods To develop a research strategy for a specific T&CM system, Anthroposophic Medicine (AM), applying multimodal integrative healthcare based on a four-level concept of man, we used a three-phase consensus process with experts and key stakeholders, consisting of (1) premeeting methodological literature and AM research review and interviews to supplement or revise items of the research strategy and tailor them to AM research, (2) face-to-face consensus meetings further developing and tailoring the strategy, and (3) postmeeting feedback and review, followed by finalization. Results Currently, AM covers many fields of medical specialties in varied levels of healthcare settings, such as outpatient and inpatient; primary, secondary, and tertiary care; and health education and pedagogy. It is by definition integrated with conventional medicine in the public healthcare system. It applies specific medicines, nursing techniques, arts therapies, eurythmy therapy, rhythmical massage, counseling, and psychotherapy, and it is provided by medical doctors, nurses, therapists, midwives, and nutritionists. A research strategy authentic to this level of complexity should comprise items with a focus on (I) efficacy and effectiveness, divided into (a) evaluation of the multimodal and multidisciplinary medical system as a whole, or of complex multimodal therapy concept, (b) a reasonable amount of methodologically rigorous, confirmatory randomized controlled trials on exemplary pharmacological and nonpharmacological therapies and indications, (c) a wide range of interventions and patient-centered care strategies with less extensive formats like well-conducted small trails, observational studies, and high-quality case reports and series, or subgroup analyses from whole-system studies, or health service research; (II) safety; (III) economics; (IV) evidence synthesis; (V) methodologic issues; (VI) biomedical, physiological, pharmacological, pharmaceutical, psychological, anthropological, and nosological issues as well as innovation and development; (VI) patient perspective and involvement, public needs, and ethics; (VII) educational matters and professionalism; and (IX) disease prevention, health promotion, and public health. Conclusion The research strategy extends to and complements the prevailing hierarchical system by introducing a broad “evidence house” approach to evaluation, something many health technology assessment boards today support. It may provide transparent and comprehensive insight into potential benefits or risks of AM. It can serve as a framework for an evidence-informed approach to AM for a variety of stakeholders and collaborating networks with the aim of improving global health.

Dispirited Away: The Peer Review Process