Collective Conversational Peer Review
Collective Conversational Peer Review of Journal Submission
Abstract
Background:
Methods:
Results:
Conclusion:
Introduction
Materials and Methods
Data Analysis
Results
Following is the original version of the WhatsApp conversational review, which began with a statement of invitation from the moderator(RB), and in which each participant appraised and reviewed the paper to determine its effectiveness.
[11/10/22, 12:36:27 PM] Journal peer Review Group: Messages and calls are end-to-end encrypted. No one outside of this chat, not even WhatsApp, can read or listen to them.
[11/10/22, 12:36:27 PM] You created group “JECP Peer Review”
[11/10/22, 12:38:29 PM] N.H joined using your invite
[11/11/22, 10:34:27 AM] You added VP.
[11/11/22, 10:36:13 AM] VP: Greetings everyone and good morning.
[11/11/22, 10:37:28 AM] VP: RB sir, since you are the editor for this journal do we need to request for collective reveiw in email? Also, do we have a scope for this review to publish in your journal like we did earlier?
[11/11/22, 10:47:17 AM] RB: I've already asked and communicated to the editor in chief earlier about our collective conversational review workflow.
They shall be giving us multiple reviews over the coming months and if we can generate sufficient insights in each review we may publish them separately as in our first paper on this topic or we can also at some point of time collate all these reviews and publish another paper on the collective utility of these
[11/16/22, 9:23:22 PM] You changed the subject to “Peer Review Group”
[11/16/22, 9:27:02 PM] AS: reviewpaper.pdf • 25 pages document omitted
[11/16/22, 9:30:27 PM] AS: Here is the paper which is under review.
Everybody is requested to go through the paper, and after finishing please share your opinion here so that we can have a productive discussion on the paper. Thank you!
[11/16/22, 10:08:15 PM] RB: Research question :
"What are the factors associated with receiving consultation and surgery within
the benchmarks for hip and knee replacement?"
[11/16/22, 10:10:17 PM] RB: Past review of literature hypothesis :
"Some influential factors, including age [23, 24], patient’s preference for surgeons [25,
99 26], priority levels [26], and incomplete referral form [26, 27] might impact wait times for
consultation and wait time for surgery."
[11/18/22, 8:45:10 AM] RB: No further inputs as to how these authors tried to answer their research question?
Have any of you read the article in fulo to understand their study design?
[11/18/22, 8:46:37 AM] RB: Once you understand their study design you can proceed to the next step of downloading the CASP checklist for that particular study design and then verify your article data with the evaluation parameters given in their checklist
[11/18/22, 8:48:13 AM] VP: This research question was very unclear to me sir
[11/18/22, 8:52:38 AM] RB: Why is the question unclear?
Imagine you need to get a hip replacement for yourself because of a sudden avascular necrosis of the head of the femur due to some adverse drug reaction and it's getting delayed as there is a long waiting time for the consultation as well as after that a long period of waiting as the surgery is offered on priority based on certain factors that are not very clear yet and you need to find out what are those
[11/18/22, 8:53:29 AM] RB: We have one such patient right now in our PaJR group
[11/18/22, 8:54:48 AM] VP: Oh got it clear now sir.
[11/18/22, 8:55:23 AM] RB: If you look at their methodology to answer that question do you think it could be a retrospective case control study?
If yes why? If not why not?
[11/18/22, 9:03:11 AM] RB: AS, please make us admin
[11/18/22, 9:03:35 AM] AS: sure sir.
[11/18/22, 9:03:51 AM] RB changed the subject to “Journal peer Review Group”
[11/18/22, 9:07:11 AM] AS: i will provide my thoughts and query regarding the paper today at night.
[11/18/22, 9:15:31 AM] RB: The discussion so far :
[11/11, 10:06 AM] VP: Greetings everyone and good morning.
[11/11, 10:07 AM] VP: RB, sir since you are the editor for this journal do we need to request for collective reveiw in email? Also, do we have a scope for this review to publish in your journal like we did earlier?
[11/11, 10:17 AM] RB: I've already asked and communicated to the editor in chief earlier about our collective conversational review workflow.
They shall be giving us multiple reviews over the coming months and if we can generate sufficient insights in each review we may publish them separately as in our first paper on this topic or we can also at some point of time collate all these reviews and publish another paper on the collective utility of these
[11/16, 9:00 PM] AS: Here is the paper which is under review.
Everybody is requested to go through the paper, and after finishing please share your opinion here so that we can have a productive discussion on the paper. Thank you!
[11/16, 9:38 PM] RB: Research question :
"What are the factors associated with receiving consultation and surgery within
the benchmarks for hip and knee replacement?"
[11/16, 9:40 PM] RB: Past review of literature hypothesis :
"Some influential factors, including age [23, 24], patient’s preference for surgeons [25,
99 26], priority levels [26], and incomplete referral form [26, 27] might impact wait times for
consultation and wait time for surgery."
[11/18, 8:15 AM] Rakesh Biswas: No further inputs as to how these authors tried to answer their research question?
Have any of you read the article in fulo to understand their study design?
[11/18, 8:16 AM] RB: Once you understand their study design you can proceed to the next step of downloading the CASP checklist for that particular study design and then verify your article data with the evaluation parameters given in their checklist
[11/18, 8:18 AM] VP: This research question was very unclear to me sir
[11/18, 8:22 AM] RB: Why is the question unclear?
Imagine you need to get a hip replacement for yourself because of a sudden avascular necrosis of the head of the femur due to some adverse drug reaction and it's getting delayed as there is a long waiting time for the consultation as well as after that a long period of waiting as the surgery is offered on priority based on certain factors that are not very clear yet and you need to find out what are those
[11/18, 8:23 AM] RB: We have one such patient right now in our PaJR group
[11/18, 8:24 AM] VP: Oh got it clear now sir.
[11/18, 8:25 AM] RB: If you look at their methodology to answer that question do you think it could be a retrospective case control study?
If yes why? If not why not?
[11/18, 8:37 AM] AS: i will provide my thoughts and query regarding the paper today at night.
[11/19/22, 12:42:40 AM] AS: Sir, they have added the factors mentioned here in the past literature hypothesis, and besides they also added some other factors like :
- primary affected joints -diagnosis( osteoarthritis or others).
[11/19/22, 12:49:32 AM] AS: Yes sir, as far i know retrospective case control study is the one that uses existing data to compare two groups, i think it could be a retrospective case control study because they also have 2 group of people, one with receiving consultation & the second one with receiving surgery.
[11/19/22, 1:30:11 AM] DD: CASP-Qualitative-Checklist-2018_fillable_form_221119_002426.pdf • 7 pages document omitted
[11/19/22, 8:26:50 AM] RB: This check list is for a qualitative study design evaluation.
Do you think the paper we are reviewing has a qualitative study design?
Please the checklist for a quantitative case control study
[11/19/22, 9:51:35 AM] RB: One can download all the different appraisal checklists for different study designs here : 👇
https://casp-uk.net/casp-tools-checklists/
[11/19/22, 9:52:32 AM] RB: CASP-Case-Control-Study-Checklist-2018 (1).pdf • 6 pages document omitted
[11/19/22, 9:54:21 AM] RB: AS, Can you go through this checklist and see if the paper being reviewed answers the questions asked in this list satisfactorily?
Please share each question one by one here so that the team can help you find the answer to it in the article under review.
[11/19/22, 9:57:12 AM] AS: okay sir, i will go thorough the checklist and will share the questions one by one along with my thoughts on it.
[11/19/22, 9:59:21 AM] RB: Yes we'll need to close them one by one before we move to the next question and eventually cover the entire study review to completion
[11/20/22, 7:04:53 PM] AS: Greetings,
Hope you have already read the paper. We can have a productive discussion over some questions.
[11/20/22, 7:05:08 PM] AS: image omitted
[11/20/22, 7:05:28 PM] AS: Did the study address a clearly focused issue?
[11/20/22, 7:06:02 PM] AS: I think it did so because all the information was collected from the Orthopedic Patient and the a database, so the population under study was valid.
Secondly, it tried to point out the beneficial & harmful effects of the established benchmark, as they mentioned that use of
prioritization improved timely access to orthopedic surgeons for consultation within
the benchmark of 90 days, but a priority classification has not been implemented
provincially across Canada.
But I am not sure whether they have studied the risk factors or not. Did you find any associated risk factors?
[11/20/22, 7:07:16 PM] RB: Mentioning may not be enough unless it's supported by data
[11/20/22, 7:09:16 PM] AS: okay sir, i got it. Trying to find out relevant data
[11/20/22, 7:12:07 PM] RB: I think their retrospective case (not sure yet about the control) study was focused on : Research question :
"factors associated with receiving consultation and surgery within
the benchmarks for hip and knee replacement."
I guess we can move ahead to the next points in the check list
[11/20/22, 7:13:17 PM] DD: Is there any common benchmark all across the world for hip and knee replacement?
[11/20/22, 7:14:27 PM] RB: No common benchmark for any medical intervention across the globe
[11/20/22, 7:23:22 PM] AS: image omitted
[11/20/22, 7:23:34 PM] AS: Did the authors use an
appropriate method to answer their question?
[11/20/22, 7:24:15 PM] AS: sir, need you valuable opinion regarding the question.
[11/20/22, 7:32:24 PM] RB: Can you also share the same text in the images as a whatsapp message because when we collate all the messages to share them widely (like copy paste them from here into our individual online learning portfolios), it would be easier to do it as text and difficult and time consuming to do the same for the images.
[11/20/22, 7:40:06 PM] AS: okay sir
[11/20/22, 7:41:41 PM] RB: 👆I guess have been doing it here and even above 👍👏
[11/20/22, 7:46:30 PM] AS: Previously, Question 1 was : Did the study address a clearly focused issue?
Option: Yes, Can't Tell, No
HINT: An issue can be 'focused' In terms of
• the population studied
Whether the study tried to detect a
beneficial or harmful effect
• the risk factors studied
[11/20/22, 7:47:10 PM] AS: Previously, Question 2 was : Did the authors use an
appropriate method to
answer their question?
Options: Yes, Can't Tell, No
HINT: Consider
• Is a case control study an appropriate
way of answering the question under
the circumstances
• Did it address the study question
[11/20/22, 7:47:53 PM] AS: Is it okay now, sir?
[11/20/22, 7:49:19 PM] RB: Now let's see if we can find out the characteristics of the controls in this currently presumed case control study.
[11/20/22, 7:51:53 PM] DD: Is your case based on a single patient undergoing hip or knee replacement?
If It is the case,n of 1 trial may have more utility than a CCT.
Not sure.
Because many factors like patients economic status,range of disability,access to Healthcare system for them are huge and frequently overlooked confounders
[11/20/22, 8:03:00 PM] AS: Here, the number of patients undergoing hip replacement is 808 & knee replacement is 1159.
[11/21/22, 9:15:18 PM] AS: Sir, can we forward to the next question?
[11/21/22, 9:22:09 PM] RB: 👆
[11/22/22, 10:22:28 AM] DD: Is this a case control study?or a retrospective cohort study?
[11/22/22, 10:27:21 AM] RB: Share some literature to guide us as to what it really fits into.
Also can we identify two different populations here? One that received standard intervention (aka comparator) and the other that recieved the study intervention?
[11/22/22, 10:49:14 AM] DD: There is no control/comparator,that's what makes me think if it's a retrospective cohort,rather than a case control study.
I will go through the entire pdf and revert back to you guys by tonight.
[11/22/22, 10:55:16 AM] DD:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176693/
AS, go through this link on overview and classification on study designs.
You can also find from part 2 to 10,through Google,by the same authors.
Type 'Study designs by Rakesh Agarwal and Priya Ranganathan'
[11/22/22, 1:09:05 PM] AS: okay, i am looking into it
[11/23/22, 9:23:34 PM] DD: AS, please try to define the objective of your study much more comprehensively
[11/24/22, 9:43:01 PM] Arefin Sadat: DD, thank you, that article was really helpful for me and contained valuable information.
Btw, at this point, i think its a retrospective cohort study.
And also, two different population is not visible here. So it’s not a case-control study.
What is others opinion?
[11/24/22, 9:44:37 PM] DD: What's the objective/aim of your paper?
[11/24/22, 9:49:02 PM] RB: Look up the CASP checklist for a cohort study
[11/24/22, 9:51:11 PM] RB: 👆Quote
Objectives: To determine factors associated with receiving consultation and surgery within
28 the benchmarks for hip and knee replacement in the single-entry model (SEM).
Unquote, DD
[11/24/22, 10:01:31 PM] AS: CASP-Cohort-Study-Checklist-2018_fillable_form.pdf • 7 pages document omitted
[11/24/22, 10:10:46 PM] AS: CASP cohort study checklist-
Q1) Did the study address a clearly focused issue?
Option: 1) Yes 2) Can’t Tell 3) No
HINT: A question can be ‘focused’ in terms of-
• the population studied
• the risk factors studied
• is it clear whether the study tried to detect a beneficial or harmful effect
• the outcomes considered
[11/24/22, 10:12:03 PM] AS: RB, sir, I think we already have covered this question. Can we go for Q2?
[11/24/22, 10:51:55 PM] RB: Yes please let's.
[11/24/22, 11:00:54 PM] AS: Q2) Was the cohort recruited in an acceptable way?
Options: 1) Yes 2) Can’t Tell 3) No
HINT: Look for selection bias which might compromise the generalisability of the findings:
• was the cohort representative of a defined population
• was there something special about the
cohort
• was everybody included who should have been
[11/24/22, 11:33:54 PM] DD: AS, study design here don't have a comparator.
Absence of comparator doesn't define a cohort study design.
We can try to find a comparator for your paper.
Comparators can be active comparator,inactive comparator or even a non initiator comparator.
Randomized clinical trials (RCTs) are considered the gold standard to assess the effects of a treatment on a specific outcome because randomization and blinding remove many potential sources of bias. However, observational studies are often better positioned to evaluate the effectiveness and safety of drug exposures with respect to rare outcomes of interest (e.g., cancer,SEM in this paper's case) because they can include large and diverse study populations with extended follow-up. They are also critical to describing drug/intervention effects in real-world settings, as RCTs are often restricted to highly select populations with tightly controlled treatment monitoring.
For your study design can choose to have any one type of comparator(which can even be a cohort study which has done the similar study without SEM model(and share the link to those findings in reference for your paper).
Or your design can also try to have a 'non initiator comparator'.(Consider SEM as the intervention,and would the results be any different,if there isn't this 'intervention'?)
And also Google 'outcome detection bias' and try to see if your study has this bias,and also try to find how you can address that bias(if there is any)
[11/24/22, 11:40:16 PM] DD: This message was deleted.
[11/25/22, 10:00:31 AM] RB: Good DD. So what are studies without comparators called?
Case studies? The ones we are regularly doing in our own PaJR research group?
[11/25/22, 10:01:05 AM] RB: But is this paper a quantitative case study?
[11/25/22, 10:01:47 AM] DD: Yep,simple observational case study.
Our PaJR group has also interventions from the authors,which is never the case in case control/cohort/any observational study?
[11/25/22, 10:45:24 AM] DD: Critical-Appraisal-Questions-for-a-Case-Study_221125_101455.pdf • 2 pages document omitted.
[11/25/22, 10:46:31 AM] DD: AS, does this above checklist be more appropriate than the previous one shared?
Not sure.
It would also be great if you can make a checklist to critically appraise 'Critical appraisal checklists'
[11/27/22, 7:42:03 AM] DD: RK and AS, completed reading the entire paper.
Basically the researcher collected pts information from a database...isn't it?
As per my understanding, it is cross sectional secondary data analysis.
[11/27/22, 9:15:06 AM] RB: Secondary data analysis is a general term for another reviewer analysing any collected data in the sense that we are also doing a secondary analysis of their collected data , which was collected by the doctors in the course of their routine entries into their case files.
One can use labels such as tertiary and quaternary analysis depending on how many hands the data is changing but I guess that may not be necessary.
Interestingly Einstein didn't do a single primary data collection in his life. All of his work is interpretation of others data.
Again cross sectional and longitudinal have many connotations.
Have they not collected all this data over a period of time? Or have they just collected it one point of time and never after that?
[11/27/22, 9:28:01 AM] SS: Sir, the data used in this journal includes patients who had surgery of hip and knee replacements between 2011 to 2019. So, how can this be a cross sectional study? It is not a data from a single fixed point in time.
[11/27/22, 9:42:03 AM] RB: Right
DD, what do you say to this?
[11/27/22, 11:24:43 AM] DD: So,is it longitudinal study?
[11/27/22, 11:36:25 AM] AS: Sir, as per I know, isn’t in a longitudinal study the data collected from the same individuals in two different periods of time?
Here, the data is collected from the individuals once, but the process was over a period of time.
Can we call it a longitudinal study?
[11/27/22, 11:40:54 AM] SS: I think no AS, we still can't call it longitudinal study. Because longitudinal study simply refers to collecting data from the same individual repeatedly over a period of time, which is not the case here. Only what they did was collect data of diff pt over a period of 8 yrs. RB and DD, your take on this Sir?
[11/27/22, 11:45:54 AM] SS: But I also do feel that they did follow the individual patients over the course of time ( or rather indirectly learnt of the patient's journey from consultation to Sx and post Sx developments from the record/Surgeon's blog). So, can it be a longitudinal study?
[11/27/22, 11:48:31 AM] SS: In short I think the data abt individual pts were collected indirectly over a period of time and the process to collect research data was 8 yrs long. So.... longitudinal
[11/27/22, 11:48:37 AM] SS: 🤔
[11/27/22, 11:49:13 AM] RB: What evidence can you find in their study of individual patient longitudinal data collection?
[11/27/22, 11:51:00 AM] RB: Well done AS, DD and SS.
So one of our feedback to the authors can be to clarify their study design?
Let's now try to find what were their expected outcomes from their study?
[11/27/22, 12:07:12 PM] SS: Sir, not concrete evidence. But, my not so good logic. If not the pt is tracked through his journey how can they know when the pt got consulted, when pt got operated and abt post Sx outcomes (this is in a way same as examining the pt over a stretch of time period). These they I guess indirectly (like we learn abt the detail multiyear journey of a pt from others' blogs by opening the blog once). So, in a indirect way the researchers did examine the same individuals to detect if any changes that might occur over a period of time.
[11/27/22, 12:40:35 PM] RB: This is good evidence if you can demonstrate the data points over time for each individual patient in their study. Have they shared in their study any of the data points you mentioned ?
If not then we could ask them to do that in the review along with clarifying their study design. It's fine that sometimes when we begin our research we may not have a plan but eventually if we can find what we had expected to find it should be ok.
So what were their expected outcomes at the beginning?
[11/27/22, 1:49:45 PM] SS: Sir, they did not provide any data abt individual pts. But they did provide tables at the end of the review paper where one can find quantitative data in details abt the factors delaying their consultation and Sx. They didn't discuss/follow pts after the Sx in details to show wht is the actual benefit of SEM in pt outcome and recovery.
Their objective was to determine factors associated with receiving consultation and Sx within the benchmarks for HKR Sx in SEM.
I guess their expected outcome was by finding out and understanding the clearcut impact (negative/positive) of these factors(prioritisation) in a SEM, wait time can be shortened, improving pt outcome.
But, in the end they concluded though pts with high priority could have a consultation booked early than those with low priority, but prioritization in a SEM may not help have Sx within 182 days after initial consultation.
[11/27/22, 2:48:57 PM] RB: Well summarized 👏👏
So are the dots from their initial data capture to this conclusion easily joinable for their audience?
If not how can they be made clearer?
What is the nature or structure of their SEM? Why did it demonstrate such results? Is it a failure of the model or failure of the system? How can one improve the system?
[11/28/22, 10:06:24 AM] RB: [11/28, 8:32 AM] Rajeev Joshi Iami:
How does patient awareness help in this regard?
One solution is instead of paying say 50000 for normal delivery and 100000 for LSCS, if 75000 is paid for delivery by any mode; probably allegation of "money only" will reduce. There may be some decline in LSCS also. But such solutions are not acceptable to people as well as insurance companies.
So who is bothered about rising rate of LSCS?
[11/28, 8:37 AM] RB: Great idea but again the ball is in the policy makers court and if only we had policy makers who would like to play with it toward optimal outcomes rather than dramatic ones.
[11/28, 8:39 AM] +91: Who are policy makers here..?
[11/28, 8:42 AM] RB: Ideally they should be by the people and for the people but as you rightly pointed out in this "by the people for the people" game, the policy makers who could be in a position of power to make policies, are often invisible
[11/28, 8:45 AM] +91: No they are effective but In our country no one can do any reform without Clinicians consent and we dont consent...Never.
Look at how CGHS and Ayushman Bharath rates are being disregarded in hospitals..
[11/28, 8:51 AM] RJ: CGHS and AB rates are not affordable to hospitals. So many hospitals do not opt for it. Some who opt recover difference from patients. Some cheat by extracting money from govt by showing excess cases I.e. procedures not done are claimed. There should be rationale for charges. It is seriously lacking.
[11/28, 8:53 AM] +91 : AB rates are 40% higher than CGHS...
[11/28, 9:17 AM] RJ: Even then they are too less to be affordable.
Experience of doctor not considered.
Only tier of city considered but within city there are areas where rates of property are high and low and range in between not considered.
Risk factors in patient not considered.
Facilities in hospitals not considered e.g availability of ICU vs non availability.
There are many such variables which need to be factored in. It will create competition in hospitals to improve services, reduce risk to patient and improve patient safety.
Financial incentives for better services will be appreciated than burdening hospitals with NABH documentation..!!
[11/28, 9:31 AM] RB: DD, does this remind you of the paper you are currently collectively peer reviewing?
Also the same paper may remind you of how neet allocation is done?
[11/28/22, 10:07:36 AM] RB: 👆 SS, DD, did the current paper authors try a model strategy that is similar to the neet seat allocation strategy?
[11/28/22, 10:08:34 AM] DD: Our paper under review here can be developed into a retrospective cohort study
[11/28/22, 10:08:48 AM] DD: *improved
[11/28/22, 10:09:48 AM] RB: By adding controls?
But meanwhile what was their strategy?
In your review if you are finally going to ask for a major revision what are the points you will ask them to improve on to improve their paper?
[11/28/22, 10:09:51 AM] DD: https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_cohortstudies/ep713_cohortstudies_print.html
AS and SS, this link may be useful.
[11/28/22, 10:10:08 AM] DD: Define their study design,to start with
[11/28/22, 10:11:05 AM] RB: Let us always make it a point to quote the relevant portions whenever we share links because otherwise people may not like to click on them to learn more.
[11/28/22, 10:11:38 AM] RB: We already concluded that above.
What else?
[11/28/22, 10:11:56 AM] DD: 'Summary of a retrospective cohort study in which the investigators go back several decades to employee records of a tire manufacturing company to identify a cohort of subjects, some of whom were exposed to solvents and others were not. They then determine whether they subsequently died.
In essence, the investigators jump back in time to identify a useful cohort which was initially free of disease and 'at risk.' They then use whatever records are available to determine each subject's exposure status at the begin of the observation period, and they then ascertain what subsequently happened to the subjects in the two (or more) exposure groups. Retrospective cohort studies are also 'longitudinal,' because they examine health outcomes over a span of time. The distinction is that in retrospective cohort studies all of the cases of disease have already occurred before the investigators initiate the study. In contrast, exposure information is collected at the beginning of prospective cohort studies before any subjects have developed any of the outcomes or interest, and the 'at risk' period begins after baseline exposure data is collected and extends into the future.'
[11/28/22, 10:12:39 AM] DD: Is the aim of the study to assess efficacy of SEM model?
Why was this study done?
[11/28/22, 10:13:58 AM] DD: Why was SEM model implemented in first place?
[11/28/22, 10:15:16 AM] RB: Great question!
So going by your starting point from cohort or retrospective analysis, we need to know what were the comparators for what intervention (was it the model or the hip replacement) and what were the expected outcomes they were targeting evaluation?
[11/28/22, 10:15:56 AM] Dr. Dinesh Datta: Aim is not to assess efficacy of SEM.Because if that's the aim,RCT should be done.
Looks like it's an observational study.
And authors want to observe what happened to the defined cohort in so and so country.
[11/28/22, 10:17:01 AM] DD: So,step 1 would be to identify and define the 'cohort' population,which author wants to observe.
[11/28/22, 10:17:59 AM] DD: And then assess if it's a valid cohort,if this cohort study applies to cohorts in other places?(Like,in this cohort,SEM maybe useful(?),but does it mean SEM will be useful in similar cohorts elsewhere?
[11/28/22, 10:18:55 AM] DD: And also compare it with other cohorts which are already published,which have observed the hip and knee replacement outcomes without an SEM model.
[11/28/22, 10:20:10 AM] DD: And then we should also account for confounders,to assess that is it due to the SEM model,the hip and knee replacement consultation times improved?
[11/28/22, 10:20:33 AM] RB: SS, have we done this? Can you share?
[11/28/22, 10:20:45 AM] DD: Right now,the paper is an observational study,which did secondary data analysis.
Just like a newspaper article.
[11/28/22, 10:21:16 AM] DD: There isn't much analysis as well.
[11/28/22, 10:21:20 AM] RB: Let's go for this,AS. Take help of DD to find out similar studies.
[11/28/22, 10:22:16 AM] DD: And also define if it's a closed cohort or an open cohort.
[11/28/22, 10:23:05 AM] RB: OK give this feedback to the reviewers and ask them for a major revision.
All of you please share your final reviews here before sending it to the editor as they shouldn't be the same. Please let us go through it first, AS and SS.
[11/28/22, 10:23:37 AM] DD: 1.Identify the study subjects; i.e. the cohort population.
2.Obtain baseline data on the exposure; measure the exposure at the start. (The exposure may be a particular event, a permanent state or a reversible state.)
3.Select a sub-classification of the cohort—the unexposed control cohort—to be the comparison group.
4.Follow up; measure the outcomes using records, interviews or examinations. (Note: Outcomes must be defined in advance and should be specific and measurable.)
5.Do the data analysis where the outcomes are assessed and compared
[11/28/22, 10:24:48 AM] DD: We can call it a 'simple observational case study'
As of now.
But it can be worked upon and developed into a cohort study.
[11/28/22, 10:25:52 AM] DD: My few cents,to improvise the current paper into a worthwhile cohort study.
(Ofcourse,even after making it into a cohort study,we have to critically appraise it using CASP tools)
[11/28/22, 10:27:23 AM] RB: Well done.
Please share your final review with constructive criticism to the authors here before you upload it to the journal website.
[11/28/22, 10:28:00 AM] RB: Please share if you could figure out what is the exposure or intervention here.
[11/28/22, 10:29:41 AM] DD: Population is defined in the paper
Intervention is SEM model
Comparator is similar cohort without SEM model
Expected outcome is to observe if SEM model improved time of consultation.
(Actual Expected outcome should be,if SEM model improved patient outcomes)
[11/28/22, 10:31:47 AM] DD: This message was deleted.
[11/28/22, 10:38:43 AM] RB: Alright. Ask the authors if this is what they intended.
[11/28/22, 10:39:37 AM] DD: AS and SS, are these the interventions and outcomes you intended?
[11/28/22, 10:40:59 AM] DD: Population is patients of so and so age group in so and so country undergoing hip and knee replacement.
Intervention is SEM model for Hip and knee replacement?
Or do you guys intend something else?
[11/28/22, 10:42:40 AM] RB: Why would they intend? It's only the authors who can intend
[11/28/22, 10:43:00 AM] DD: They weren't the authors?
[11/28/22, 10:43:46 AM] RB: Did you receive an official email to review this paper?
[11/28/22, 10:44:46 AM] DD: I don't think so😅😂.
I got a whatsapp chat joining link to this group.
[11/28/22, 10:44:58 AM] RB: The authors are from another country.
[11/28/22, 10:45:46 AM] RB: I think if you read the deidentified paper you would realize that neither of us could have been authors.
[11/28/22, 10:46:08 AM] DD: I got another one for reviewing.
[11/28/22, 10:47:32 AM] DD: Why is that so?
I couldn't realise that.
I was thinking the author is in this group lol.
[11/28/22, 10:50:02 AM] DD: I thought the authors are AS and AM.
Whom I assumed are from abroad medical college.
[11/28/22, 10:54:09 AM] RB: Alright.
[11/28/22, 10:57:09 AM] RB: 👆Do you want our editorial assistant to send you a formal review invite for this because you have more or less nailed this review and can post your final constructive criticisms to their website.
Or maybe if you would just like to guide the formally invited reviewers AS and SS with your version of the constructive criticism that too would work.
[11/28/22, 10:58:45 AM] DD: Yep,I'll work along with SS and AS for this paper.
And would love to get more invites once I'm back from my vacation.
[11/28/22, 11:01:16 AM] RB: Alright please share your current constructive criticism for this paper all in one text message and let AS and SS and VP provide their inputs on it in the form of further queries.
[11/28/22, 11:02:06 AM] DD: image omitted.
[11/28/22, 11:32:25 AM] SS: Sir, for me it is hard to join the dots in this journal. First of all what I understood is they tried to determine influencing factors associated with consultation and Sx of HKR in SEM. Then see whether prioritization in a SEM actually reduces wait time or not. They left some links 6,17,18 to understand abt prioritization but I think it would have been been if they could summarize the criteria of preparing the priority list in the article itself.
I feel the sample size was not adequate to draw a conclusion and more importantly they did left out factors like available resources, pt readiness, economic status, gender, geographic variation. I feel they also play a role. Also, they didn't say anything abt final pt outcome which should have been the main focus. They didn't discuss possible solutions to implement this model more effectively.
For me this appears like a data centric study with no elaborate discussion.
Also, I find some sentences contradictory like 92,93,94,95,96 "After the implementation of the SEM in the Eastern Health region of the New foundland, the median wait times for HKR consultation were reduced dramatically. The percentage of pts receiving Sx within 182 days dropped from 95% in 2014 to 65% in 2019 for HR and 92% in 2014 to 65% in 2019 for knee replacement. This seems like after implementing SEM wait time for Sx increased. Or is it I am failing to understand it?? To understand whether it is failure as a model or system I think a bit more elaborate discussion is needed. But my preliminary assumption is SEM is more of a failure of system because either the process is not clearly laid out taking into consideration all the influencing factors or the PPL responsible for implementing this model is not well equipped/aware how to deal with the various challenges or implement it successfully. This are my initial thoughts abt this paper Sir.
[11/28/22, 11:35:29 AM] RB: Your initial thoughts are very well done 👏👏
I think you can just post this as your review and ask for major revision
AS, share yours.
[11/28/22, 12:57:07 PM] AS: I am in a hurry in the hospital for a while, but will definitely reach here & share my final thoughts asap.
[11/28/22, 1:51:06 PM] RB: You need to also substantiate certain statements in your review of this journal article such as :
Why don't you think their sample size is adequate?
[11/28/22, 1:54:11 PM] RB: SS, if you were to do this study how would you calculate the sample size?
[11/28/22, 6:32:58 PM] AS: 1. Make the initial discussion more clear on how the idea of SEMs is implemented to make it successful to reduce the wait time or improve access to HKR.
2. please explain the design of the study.
3. describe the outcome of the study in a PICO format.
4. In line 239-244, they mentioned-
"However, a priority classification has not been implemented provincially across Canada. Every clinic and hospital manage wait times for consultation correspondence with priority levels across the provinces. The Western Canada Waiting List(WCWL) project developed a priority referral score for HKR that primary care providers may use to ensure that patients with more urgent levels can meet a specialist for consultation sooner than those with lower levels, but the tool has not been used in real practice."
Then what standard is being maintained to ensure that the actual severe patient is getting the urgent access to HKR?
5. The future scope of the study is well described, but the limitation of this study is not mentioned.
Sir, here are my initial thoughts regarding the paper.
[11/28/22, 7:03:02 PM] RB: Well done both AS and SS.
Please submit these to the journal website with major revision as your decision and then they'll ask me to finalize the decision.
[11/28/22, 7:05:29 PM] AS: Okay sir, we are working on it.
[11/28/22, 7:13:17 PM] RB: Meanwhile would you like to publish a preliminary draft of how we reached till this point also sharing all the conversations around this paper, similar to how the first collective review was published keeping the journal, authors etc deidentified
[11/28/22, 8:04:43 PM] AS: Yes, sir. I would like to publish the preliminary draft. I think it will make me learnt newer things and also be a great experience.
[11/28/22, 8:15:00 PM] RB: Can publish the first draft in your online learning portfolio and share the link. Begin with an introduction etc.
[11/28/22, 8:23:30 PM] DD: image omitted.
[11/28/22, 8:37:50 PM] AS: Okay sir
[11/29/22, 10:55:26 AM] AS: image omitted
[11/29/22, 10:59:45 AM] AS: Sir, we are almost done with this review. If other members are interested, can we start working on this new review?
[11/29/22, 11:02:47 AM] RB: Yes sure. Please go ahead but also share it that we are starting now in text with the editor in chief of this journal. Will text you his number and email.
[11/29/22, 11:04:54 AM] AS: Okay, sir. Looking forward to it.
[11/29/22, 11:06:00 AM] RB: Ask him to put you in touch with his editorial assistants so that they can direct you to some link where each one of you can individually upload your review.
[11/29/22, 11:06:38 AM] AS: Okay, sir. Working on it.
[11/29/22, 11:07:36 AM] DD: AS, can you ask them to share the paper and review link to my email id as well?
[11/29/22, 11:09:29 AM] AS: Sure. I will mail attaching your email id.
[11/29/22, 11:16:07 AM] AS: VP and SS, would you like to work on that new paper review?
[11/29/22, 11:22:02 AM] DD: image omitted.
[11/29/22, 11:32:28 AM] SS: Sir, after seeing the no. 1967 and that too from only one clinic of Newfoundland and Labrador I thought we'll if I do collect the data from a clinic in Kolkata and do the same from a suburban area possibility is the conclusion can be different. Why? Because PCI in Kolkata is obviously more than that of a suburb area so PPL after consultation can get the Sx done but PPL from suburb may not be able to afford it ever after consultation. For a survey 10% of the total population not exceeding 1000 is considered enough, as per that it is enough in this case. But, collecting data from a single geographic location.....I think I would have may be collected say 200 each from diff clinics from diff geographic regions. I framed the sentence wrong by saying the sample size was not adequate. For me the sample size is biased geographically.
[11/29/22, 11:35:25 AM] SS: No. wise it is adequate but quality wise it is not maybe.
[11/29/22, 11:37:22 AM] RB: So the question shifts from "what is sample size and how to calculate it"
to
What is sample quality and how to validate it?
DD, please help with your inputs too.
[11/29/22, 11:39:45 AM] DD: SS, once go through this pdf.
[11/29/22, 11:39:46 AM] DD: 20328.pdf • 4 pages document omitted
[11/29/22, 11:40:56 AM] DD: Basically we have to do mean estimation of population they are studying.
And it also depends on confidence interval.
[11/29/22, 11:41:59 AM] DD: We also have several softwares and online tools to help us in determining appropriate sample size.
Links to the tools are given in the above pdf.
[11/29/22, 11:45:09 AM] SS: https://tools4dev.org/resources/how-to-choose-a-sample-size/
[11/29/22, 11:47:12 AM] DD: image omitted
[11/29/22, 11:48:18 AM] DD: RCSISamplesizeguide2018.pdf • 36 pages document omitted
[11/29/22, 11:48:27 AM] DD: SS, check this out.
[11/29/22, 11:51:09 AM] SS: I think no sample can be perfect but one should try to be as close as possible so that the sample represents the population under lens. In this case since they ar talking abt HKR so I think financial status and resource availability should have been considered apart from other factors already discussed previously, so as to make the model a bit more close to represent the population.
[11/29/22, 11:51:36 AM] SS: Yes true.
[11/29/22, 11:51:59 AM] DD: Calculate the Standard deviation using Confidence intervals mentioned in the paper under review.
[11/29/22, 11:52:09 AM] SS: It's vaaaasst.
[11/29/22, 11:53:01 AM] DD: Only pages 3 to 20 are relevant for our paper.
[11/29/22, 11:53:54 AM] SS: Ok will read it by the end of the day after class.
[11/29/22, 12:01:51 PM] DD: Power
Statistical significance
Confidence interval
Standard deviation
Effect size
Measure of variability
SS, get hold of these terms.
[11/29/22, 12:02:29 PM] DD: https://www.calculator.net/sample-size-calculator.html.
[11/29/22, 12:02:41 PM] DD: Or simply use this tool.
[11/29/22, 12:38:29 PM] SS: Okay.
[11/29/22, 12:39:02 PM] SS: Best I try both.
[11/29/22, 12:39:57 PM] DD: You can learn about those while you are applying them.
Hope u completed 3rd year(SPM?)
AS,who has recently cleared 3rd year may assist you
[11/29/22, 12:40:58 PM] SS: Yes. Okay.
[11/29/22, 4:54:19 PM] RB: Amazed by our three active reviewers here.
[11/29/22, 5:13:39 PM] AS: Sir, the credit goes to you.
It was the first review for all of us, but you believed in us and made us feel that we could do it, and together we finally did it. Can't wait to work more with these genius team members, DD, SS and VP.
[11/29/22, 5:14:33 PM] DD: It was first for mine as well. Looking forward to work more with you.
Review Report
Comment 1: Make the initial discussion more clear on how the idea of SEMs is implemented to make it successful to reduce the wait time or improve access to HKR.
Comment 2: please explain the design of the study.
Comment 3: describe the outcome of the study in a PICO format.
Comment 4: In line 239-244, they mentioned-
"However, a priority classification has not been implemented provincially across Canada. Every clinic and hospital manage wait times for consultation correspondence with priority levels across the provinces. The Western Canada Waiting List(WCWL) project developed a priority referral score for HKR that primary care providers may use to ensure that patients with more urgent levels can meet a specialist for consultation sooner than those with lower levels, but the tool has not been used in real practice."
Then what standard is being maintained to ensure that the actual severe patient is getting the urgent access to HKR?
Comment 5: The future scope of the study is well described, but the limitation of this study is not mentioned.
Comment 6: Although some links (6,17,18) were provided to understand how prioritisation was done, but it would be far better if you could summarise the criteria for preparing the priority list in the article.
Comment 7: Factors like available resources, patient readiness, economic status, gender, and geographic variation should have been considered before drawing a generalised conclusion about the whole system of SEM.
Comment 8: I feel the sample size though adequate numerically, was not an accurate representation of the population to draw a fair conclusion. No sample can be perfect, but one should try to be as close as possible so that the sample accurately represents the population under examination. In this case, since you are talking about HKR so I think financial status and resource availability should have been considered apart from other factors already discussed previously to make the model a bit close to representing the population. The data was collected from a particular clinic, making it biased both geographically and in resource availability wise also.
Comment 9: Also, there was nothing mentioned about the final patient outcome(negative/positive) that should have been included as a part of the main focus/aim of this paper. No significant discussion was done about the possible solutions to implement this model more effectively.
Comment 10: I find some sentences ambiguous, like 92,93,94,95,96 - "After the implementation of the SEM in the Eastern Health region of the New foundland, the median wait times for HKR consultation were reduced dramatically. The percentage of pts receiving Sx within 182 days dropped from 95% in 2014 to 65% in 2019 for HR and 92% in 2014 to 65% in 2019 for knee replacement.”
Please explain the summary that is mentioned here.
Comment 11: It would be better to specify the study model more clearly. A bit more elaborate discussion is needed.
Implications of the Study
Conclusions
Acknowledgments
Ethics Approval and Consent to Participate
Disclosure Statement
Consent for Publication
Data Sharing
Funding Source
Authors’ Contributions
References
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