External Peer Research Articles

AGA Clinical Practice Update on Endoscopic Enteral Access: Commentary.

The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update is to facilitate understanding and improve the clinical practice of endoscopic enteral access. This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.

Using Quality Assurance to Drive Change and Enhancement in Our New Tertiary Landscape

Since 2021, QAA has been working collaboratively with colleges, universities, sector agencies and the Scottish Funding Council (SFC) to support development of Scotland’s new Tertiary Quality Enhancement Framework (TQEF). In 2023, QAA Scotland was asked by the SFC to oversee design of two key components of the TQEF - an approach to external peer review and follow-up activity, and national thematic enhancement activity. This paper outlines progress so far working with staff and students from across Scotland’s colleges and universities, our partner quality and sector agencies and the SFC.

The Attention Game: How External Peers Shape Headquarters’ Attention to Subsidiaries

External peers influence a multinational’s (MNE) attention to its subsidiaries. When external peers pay attention to their foreign subsidiaries, this prompts MNEs to pay attention to their own subsidiaries in the same market. As MNEs operate in multiple contexts, the selection of relevant external peers is complicated. Using a cognitive perspective we address the following: Who are the external peers managers monitor? What subsidiaries benefit from external peer attention to their own subsidiaries? When are external peers relied upon? Applying the cognitive perspective, attention occurs independent of subsidiary actions, driven by managers’ cognitive frameworks and in response to external peers.

Development of international guidelines by Tuina practitioners for specific acupoints of paediatrics Tuina (2022 version).

To establish a standardized framework encompassing the precise locations, manipulations, functions and indications of specific acupoints in the field of paediatric Tuina. The development of consensus involved three distinct stages. Initially, a list of paediatric Tuina specific acupoints was compiled based on an extensive literature review, which was subsequently supplemented through expert interviews. In the second stage, the Delphi method was employed to assess the significance of acupoint locations, manipulations, functions, and indications. In situations where the questionnaire survey failed to yield agreement or when the experts held reservations, the nominal group approach was utilized during the expert consensus meeting. The final version of the technical standardized material was ultimately determined during an expert consensus conference. After undergoing external peer review and evaluation, the completed draft was prepared for public dissemination RESULTS: The comprehensive list identified a total of 66 specific acupoints. The location and manipulation questionnaire consisted of 156 items based on the literature database, while the function and indication questionnaire contained 116 items. Two rounds of Delphi surveys were conducted for the location and manipulation category, and another two rounds of Delphi surveys were conducted for the function and indication category. During the experts consensus meeting The panel of experts conducted in-depth discussions on 61 questions, resulting in the formulation of technical guidelines for the locations, manipulations, functions, and indications of 64 paediatric Tuina acupoints. Subsequently, the research team compiled and edited the draft of the technical guidelines for acupoints of paediatric Tuina, which was finalized after external review and feedback. This study successfully established the recognized technical standards for practitioners of paediatric Tuina, thereby standardizing clinical practices and providing a foundation setting the framework for future research. The guidelines offer theoretical insights and recommendations for conducting clinical studies comparing different acupoint sites, as well as modifying or enhancing treatment regimens.

Slovenia’s Food-Based Dietary Guidelines 2024: Eating for Health and the Planet

The dietary guidelines of Slovenia, ‘12 Steps to Healthy Eating’, were first published in 2000 and revised in 2011. The ‘Food Guide Pyramid’ was initially published in 2000 and subsequently revised in 2015. ‘The Healthy Plate’ was first introduced in 2007. In February 2023, the Slovenian Strategic Council for Nutrition proposed new Food-Based Dietary Guidelines (FBDGs) that integrate both health and environmental considerations. In September 2023, the creation of new FBDGs was included in the Action Plan for implementing the Resolution on the National Program on Nutrition and Physical Activity for Health 2015–2025. In October 2023, the Ministry of Health of Slovenia appointed the core working group of 10 multidisciplinary experts from fields such as nutrition, food science medicine, public health, environment, pharmacy, and agriculture led by Prof. Dr. Nataša Fidler Mis, who drafted the guidelines. In February 2024, the World Health Organization Regional Office for Europe organized a virtual international workshop to assist Slovenia in developing food-based dietary guidelines. In May 2024, an international expert meeting was organized by the Ministry of Health of Slovenia, the Ministry of the Environment, Climate, and Energy, and the National Institute of Public Health of Slovenia to present the first scientific draft of the SLO FBDG for external international peer review. The meeting included lectures from world-leading experts to present healthy diets from sustainable food systems, integrate climate and sustainability aspects into the new SLO FBDG, discuss the findings with the Slovenian core working group, extended working group of the SLO FBDG, and invited experts. The final version of SLO FBDG is expected to be released by the end of 2024.

Artificial intelligence approaches for phenotyping heart failure in U.S. Veterans Health Administration electronic health record.

Heart failure (HF) is a clinical syndrome with no definitive diagnostic tests. HF registries are often based on manual reviews of medical records of hospitalized HF patients identified using International Classification of Diseases (ICD) codes. However, most HF patients are not hospitalized, and manual review of big electronic health record (EHR) data is not practical. The US Department of Veterans Affairs (VA) has the largest integrated healthcare system in the nation, and an estimated 1.5 million patients have ICD codes for HF (HF ICD-code universe) in their VA EHR. The objective of our study was to develop artificial intelligence (AI) models to phenotype HF in these patients. The model development cohort (n=20000: training, 16000; validation 2000; testing, 2000) included 10000 patients with HF and 10000 without HF who were matched by age, sex, race, inpatient/outpatient status, hospital, and encounter date (within 60days). HF status was ascertained by manual chart reviews in VA's External Peer Review Program for HF (EPRP-HF) and non-HF status was ascertained by the absence of ICD codes for HF in VA EHR. Two clinicians annotated 1000 random snippets with HF-related keywords and labelled 436 as HF, which was then used to train and test a natural language processing (NLP) model to classify HF (positive predictive value or PPV, 0.81; sensitivity, 0.77). A machine learning (ML) model using linear support vector machine architecture was trained and tested to classify HF using EPRP-HF as cases (PPV, 0.86; sensitivity, 0.86). From the 'HF ICD-code universe', we randomly selected 200 patients (gold standard cohort) and two clinicians manually adjudicated HF (gold standard HF) in 145 of those patients by chart reviews. We calculated NLP, ML, and NLP+ML scores and used weighted F scores to derive their optimal threshold values for HF classification, which resulted in PPVs of 0.83, 0.77, and 0.85 and sensitivities of 0.86, 0.88, and 0.83, respectively. HF patients classified by the NLP+ML model were characteristically and prognostically similar to those with gold standard HF. All three models performed better than ICD code approaches: one principal hospital discharge diagnosis code for HF (PPV, 0.97; sensitivity, 0.21) or two primary outpatient encounter diagnosis codes for HF (PPV, 0.88; sensitivity, 0.54). These findings suggest that NLP and ML models are efficient AI tools to phenotype HF in big EHR data to create contemporary HF registries for clinical studies of effectiveness, quality improvement, and hypothesis generation.

Policy variation in the external evaluation of research for tenure at U.S. universities

Abstract There is a robust literature documenting differences in peer review processes for scholarly outlets. Knowledge of this variability has provoked thoughtful debate about the best approach for promoting rigor and innovation in scientific research (e.g. single-blind vs. double-blind review, or more recently, double-blind vs. open review). We aim to expand this conversation to external peer review processes specified in rank and tenure guidelines. We qualitatively analyze a corpus of publicly available rank and tenure procedures at research-intensive universities in the United States. Results indicate significant variation in (1) the required minimum and maximum number of external reviews, (2) the candidate’s role in the reviewer selection process, (3) the level of ensured anonymity for reviewers, and (4) attention to potential conflict of interest scenarios. We argue that many of the debates about best practices in research evaluation for journals and funding agencies are also relevant for rank and tenure procedures. Moreover, rank and tenure policies may be subject to unique tensions, such as cases where external reviews are formally cast as disinterested assessments by referees but informally understood as letters of recommendation by sponsors. We discuss the relevance of our findings for existing work on the perceived clarity of evaluation criteria—especially how guideline ambiguity can be linked to inequality and how labor issues can conflict with idealized assessment principles.

Modelling the effects of emotional engagement and peer interaction on the continuous intention to use asynchronous e-learning.

Even though asynchronous e-learning has become popular among universities, few studies have examined how students intend to continue using it for their learning. This study proposed a theoretical model that aims to examine the effects of external factors-emotional engagement and peer interaction-and two constructs of technology acceptance model (TAM) on students' continuous intention to use asynchronous e-learning. A total of 259 students participated in a survey. The data were analysed using two steps in SEM AMOS. confirmatory factor analysis was conducted for assessing model measurement, and structural equation modelling was applied for assessing relationships among constructs and testing hypothesis. The results showed that emotional engagement had a significant effect on students' continuous intention to use asynchronous e-learning through the perceived ease of use of asynchronous e-learning and not through its perceived usefulness. Furthermore, peer interaction had a significant effect on students' continuous intention to use asynchronous e-learning. Moreover, the constructs of the technology acceptance model-perceived ease of use and perceived usefulness-had direct and significant effects on students' continuous intention to use asynchronous e-learning. Several implications and suggestions were discussed.

Facilitating Faculty Retention and Professional Development through External Peer Mentor Networks

Facilitating Faculty Retention and Professional Development through External Peer Mentor Networks

Mixed-methods randomised study exploring the feasibility and acceptability of eye-movement desensitisation and reprocessing for improving the mental health of traumatised survivors of intensive care following hospital discharge: protocol

IntroductionPost-traumatic symptoms are common among patients discharged from intensive care units (ICUs), adversely affecting well-being, increasing healthcare utilisation and delaying return to work. Non-pharmacological approaches (eg, music, therapeutic touch and...

Protective factors for resilience in adolescence: analysis of a longitudinal dataset using the residuals approach

IntroductionThe residuals approach, in which residual scores from regression models are used as a proxy for resilient functioning, offers great potential to increase understanding of resilience processes. However, its application in child and adolescent wellbeing research is limited to date. We use this approach to examine how adversity exposure impacts later wellbeing (life satisfaction, and internalising mental health difficulties) in the early-to-middle adolescence transition; whether gender and ethnic differences in resilience exist; which internal and external factors confer protective effects for resilience; and, whether the protective effect of these factors differs by gender and level of adversity exposure.MethodSecondary analysis of the #BeeWell longitudinal data set (N = 12,130 adolescents, aged 12/13 at T1 and 13/14 at T2, representative of Greater Manchester, England) was undertaken, using a series of linear regressions to establish adversity indices for later wellbeing, before assessing the protective effects of internal and external factors on resilience.ResultsMultiple adversity factors (e.g., home material deprivation, sexuality discrimination, bullying) were found to impact later wellbeing. Girls and white adolescents presented lower levels of resilience than their peers. Internal psychological factors (self-esteem, emotional regulation, optimism) consistently conferred the strongest protective effects, but behavioural/activity factors (physical activity, sleep) also contributed to resilience. Among external factors, friendships and peer support were the most salient. Physical activity yielded stronger protective effects among boys (compared to girls). Effects of protective factors were stronger among those at lower (compared to higher) levels of adversity exposure.ConclusionThe residuals approach can make a considerable contribution to our understanding of the interplay between adversity exposure and access to protective factors in determining adolescent wellbeing outcomes. Moreover, its application provides clear implications for policy and practice in terms of prevention (of adversity exposure) and intervention (to facilitate resilience).

Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration.

To examine the role of patient-perceived access to primary care in mediating and moderating racial and ethnic disparities in hypertension control and diabetes control among Veterans Health Administration (VA) users. We performed a secondary analysis of national VA user administrative data for fiscal years 2016-2019. Our primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control (<140/90 mmHg) and diabetes control (HgbA1c < 9%) among patients with known disease. We used the inverse odds-weighting method to test for mediation and logistic regression with race and ethnicity-by-perceived access interaction product terms to test moderation. All models were adjusted for age, sex, socioeconomic status, rurality, education, self-rated physical and mental health, and comorbidities. We included VA users with hypertension and diabetes control data from the External Peer Review Program who had contemporaneously completed the Survey of Healthcare Experience of Patients-Patient-Centered Medical Home. Hypertension (34,233 patients) and diabetes (23,039 patients) samples were analyzed separately. After adjustment, Black patients had significantly lower rates of hypertension control than White patients (75.5% vs. 78.8%, p < 0.01); both Black (81.8%) and Hispanic (80.4%) patients had significantly lower rates of diabetes control than White patients (85.9%, p < 0.01 for both differences). Perceived access was lower among Black, Multi-Race and Native Hawaiian and Other Pacific Islanders compared to White patients in both samples. There was no evidence that perceived access mediated or moderated associations between Black race, Hispanic ethnicity, and hypertension or diabetes control. We observed disparities in hypertension and diabetes control among minoritized patients. There was no evidence that patients' perception of access to primary care mediated or moderated these disparities. Reducing racial and ethnic disparities within VA in hypertension and diabetes control may require interventions beyond those focused on improving patient access.

The role of scientific journals in times of war

In times of war raging on European soil, the academic community can help by doing what it knows best – documenting important evidence and publishing research. The experience of the Croatian Medical Journal (CMJ) editors during the Homeland War shows how a scientific journal can help during wartime (Marušić &amp; Marušić, 2002). The CMJ published numerous scientific articles on various aspects of war (Marušić &amp; Marušić, 2012; Marusic, Markulin, Lukic, &amp; Marusic, 2006). To attract more authors to write about war and to improve the quality of the submissions CMJ editors introduced an authorhelpful prereview (Marusic &amp; Marusic, 2001). CMJ editors worked with the authors to help them prepare their manuscripts until they were ready for an external peer review. Editorial staff working closely with authors formed the cornerstone of CMJ editors' work and became a unique approach in the world of medical journals (Marušić &amp; Marušić, 2002, 2022).In October 2022, the directors of the postgraduate doctoral program Translational Research in Biomedicine (TRIBE), decided to use that experience and together with the editorial board of the ST-OPEN journal, which is now led by the former editors of CMJ, launch the Giving Voice project to help Ukrainian authors write reports about the war in Ukraine. We named the project Giving Voice because we wanted to give a platform to voices that often are not heard loud enough, particularly those that do not belong to academic elites: students, refugees, vulnerable and marginalized groups, and others whose lives have been disrupted by war.In collaboration with the ST-OPEN editorial staff, we are inviting interested authors from Ukraine to send us their manuscripts. ST-OPEN is an interdisciplinary journal so we welcome contributions from all scientific fields. We will re-employ the author-helpful prereview. Our help will include assistance with study planning, statistics, writing, and English language editing to make the obtained data publishable. Other experts who would like to become a part of our network of mentors are more than welcome. All articles will go through a formal external review process, so we cannot guarantee that all will be accepted for publication, but we will do our best to make them publicationready.Although many projects are aimed at helping the academic community in Ukraine, to our knowledge, our approach is unique. Additional details about the Giving Voice project, already published articles, and similar projects are listed on the project website (Sapunar, 2022). As members of the academic community, we can make a difference within our professional realm. We should not only be a simple service for publishing articles but also, perhaps more importantly, agents of change for the scientific community. As directors of the TRIBE doctoral program, we aim to educate scientists to solve research problems and write reports about them. We should not only try to provide future scientists with knowledge and skills or gather them around the key values – we should also help create enlightened agents of change and equip them with leadership qualities accompanied by social and moral accountability (Frenk et al., 2010). We will extend the same efforts to the authors and mentors who decide to take part in the Giving Voice project.

A protocol to study the impact of implementation of National Accreditation Board for Hospitals &amp; Healthcare Providers (NABH) standards among health care workers in a tertiary care hospital in India

Background: The healthcare system is now transforming widely with new technology including the introduction of a variety of medical gadgets, clinical trials, telemedicine, health insurance, health tourism, and outsourcing programs. Recent research focused on the quality of healthcare has proved useful for evaluating satisfaction and improvement of services in an organization. The World Medical Assembly asserts that in order to enhance patient outcomes on an individual level and community health, healthcare providers and organizations have an ethical and professional commitment to continuously improve the quality of services and patient safety. The National Accreditation Board for Hospitals &amp; Healthcare Providers - Quality Council of India - (NABH) formed a constituent board to design and oversee an accreditation scheme for healthcare institutions to ensure the quality of care. Healthcare accreditation organizations and certification programs have progressed international efforts to raise the standard of healthcare since the 1970s. The accreditation process, which is carried out by qualified external peer reviewers, allows a healthcare organization to be officially recognized for achieving performance standards. The objectives of this protocol are to understand the perception and impact of healthcare workers towards implementation of NABH standards and to study the impact of pre and post assessment of NABH with the help of 10 important key performance indicators in hospitals. Methods: A descriptive cross-sectional design will be adopted in the study. It includes collection of data from the medical record department records for pre-assessment and direct questionnaire to the participants for post-assessment of NABH standards. The pre-assessment data of quality indicators will be collected from the previous records of NABH files from the quality assurance department. Expected result: The expected result of the study will identify the different impacts of implementation of NABH standards after pre and post assessment in an organization.

A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology

The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology—introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists—and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence—level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.

The gender gap in performance reviews

Performance reviews are correlated with compensation, promotion, and career decisions in the labor market. Using data from Reflektive, formerly an employee performance management company, I examine gender differences in over 100,000 performance reviews for 170 companies across 12 different industries. I find that women rate their performance lower than men, and these differences persist when accounting for external manager and peer reviews of the worker's performance. The gender gap in how women versus men rate themselves as compared to their managers persists across different types of industries, firms, reviewers, and workers, highlighting the generalizability of the results. These findings may have implications for self-promotion in other high-stakes labor market settings.

Quality Assurance Scheme of Undergraduate Medical Education in Medical Colleges of Bangladesh: Past, Present and Future

Improving quality of medical education is a key contributing factor to improving the quality of healthcare. The rapid increase in number of medical colleges in Bangladesh, especially in the private sector, makes its vital to have effective quality assurance system in place. Quality assurance resembles a state in which medical colleges take on challenges to address different aspects of quality in undergraduate medical education through check and balance in a methodical approach. In 1998, the World Health Organization (WHO) supported the Center for Medical Education (CME) and the Directorate General of Health Service (DGHS) to develop and publish the National Guidelines &amp; Tools for the Quality Assurance Scheme (QAS) for medical colleges in Bangladesh. Since then that guideline has been serving as resource material and guide for institutionalization of the QAS based on the three principles of accountability, self-evaluation, and external peer review, with the latest revision done in 2012. At the institutional level, the scheme was proposed to be managed by the Academic Council, Academic Coordination Committee, the four (previously three) Phase Coordination Groups, Subject Coordinators, and Faculty Review &amp; Development Committee. The operational framework is based on course appraisal, faculty development and review scheme and external review. A model of “pair of medical colleges” was also proposed as to oversee the QAS activities of each other and report to the National Quality Assurance Body (NQAB). This review paper aims to highlight the history of QAS in our medical colleges, their achievements to date and challenges as well as scopes for future improvement to enhance the quality of medical education in Bangladesh. Mugda Med Coll J. 2022; 5(2): 104-109

Strategies for Including the Excluded in Education: A Case of Children with Intellectual Disabilities

This article has been prepared to disclose a number of strategies that need to be implemented to ensure the inclusion of students with intellectual disabilities in education. This research is guided by interpretive paradigm accompanied by institutional ethnography. Eight special education teachers, four resource classroom teachers, and five experts working in the field of inclusive education were chosen as the sample of the study by employing purposive sampling technique. In-depth interview and desk review were used as the main techniques to collect information and then the information were transcribed, edited, classified, and thematized by considering the objective of this study. External audit, peer review and thick description have been used as major techniques to maximize the credibility and authenticity of this article. Results of this study reveal that almost all students with intellectual disabilities were receiving educational services in segregated settings though there are policy provisions of providing inclusive education. Therefore, different strategies such as providing multi-tiered supports, developing sense of belongingness, educating in the mainstream classroom, mobilizing peers, formulating alternative learning standards, creating cooperative learning environment, etc. should be employed to optimize the inclusion of these children in education.

Reviewing Promotion Dossiers as a Professional Responsibility

Promotion is accompanied by additional responsibility, few more important than serving as a formal external reviewer of promotion dossiers. Promotion and tenure committees rely on external peer review to provide an outside perspective regarding the impact of the candidate’s work and how they compare to peers with the same or higher academic rank. What the external reviewer writes and opines impacts the promotion and/or tenure decision. When presented with this opportunity, a faculty member needs to respond to the request, familiarize themselves with the candidate and their promotion and/or tenure criteria, conduct a critical read of the dossier, and write an evaluative letter. This commentary serves as a call for faculty members at the rank of associate and full professor to engage as a reviewer when called upon, provides advice about how to approach an external review and write the letter, and discusses how schools and professional organizations can participate in this process.

Demise of the USMLE Step-2 CS exam: Rationalizing a way forward

The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship.