Amy J. Markowitz, JDamyjmarkowitz@alum.wellesley.edu

415-307-0391

Responding to Reviews, Internal and External

Reviews, internal and external

• Read through the reviews twice

• You will be offended by everything the first time, and begin to appreciate some of the merits by the second time

• Consult with your co-authors

Take a step-wise approach

• Begin the explanatory Response to Editor letter simultaneously with your revisions

• The tone should be respectful but not obsequious• Address each comment, in numeric order, citing to

the page and line where you’ve made the revisions - as relevant, add the actual text to the letter once it is finalized in the manuscript

• Where logical, group comments so that they are more easily addressed, eg, comments from each of three reviewers that address the same issue in methods, results, or discussion

What if the reviewer has completely missed the point?

Consider whether:• You have presented the idea abstrusely; try

rewriting unless this undermines the integrity of the idea

• The reviewer (generally an expert in the field, wed to their point of view) a) has a vested interest in your being incorrect, b) has just been proven wrong by your results, or c) did not read the paper carefully

Re-consult

• Check your intra-reviewer-rater reliability

• What if MOM and DAD disagree????

• Get your gumption up, be thoughtful, and make a decision - you must resubmit - now’s the time…

Greg’s Reviewer’s Misread

Some aspects of the results presentation could be clearer. Some of the presentation of results such as those in figure 3 does not make it clear how many patients were seen at each follow-up visit. We have attempted to make the results more clear, with a special emphasis on the number of subjects with follow-up. As suggested, we have changed figure 3 so that the numbers of patients at each follow-up visit are clearer and have included those numbers in the figure itself.

Original Figure 3 and Legend

Abundance of Caution

Response and Lessons Learned

• Dealing with easy fixes, eg, adding the “n=“

• Dealing with the complimentary bombshell

Praising with faint damn?Reviewer #2:1. The manuscript is written well and makes appropriate use of tables and

figures.2. The methods are strong and the conclusions are supported by the results.3. As noted by the authors, a significant deficiency of the study is the number of

patients in whom coronary sinus samples could not be obtained and the drop-out rate during follow-up. I recognize the practical limitations of clinical studies and the challenges of acquiring data, but manuscript would be more robust if the authors were able to improve the follow-up data

Thank you for your comments. We have not been able to obtain additional follow-up on the subjects enrolled in this study. As described, we made efforts to demonstrate that the baseline characteristics of those that did and did not follow-up (or those with and without coronary sinus blood) did not differ. In addition, we believe the addition of a comparison group that arises from the same general “study base” and that also underwent an ablation procedure should strengthen our findings. Ultimately however, we do certainly acknowledge these limitations.

Ralph’s Reviews

Reviewer #4: First of all let me acknowledge that I appreciate the complexity ofevaluating any mass media campaign, particularly one that is very shortterm with limited funding.

This is an interesting and complex paper as currently constructed. Ifound many parts difficult to follow and lacking in methodologicaldetails necessary to properly interpret the results. Having said that,I think, with much revision, some parts merit publication (if not byMedical Care, perhaps elsewhere). I am trying to make my commentsconstructive.

I absolutely disagree that this campaign is an example of a wide-scaleMM campaign to affect office visit and antibiotic use... In summary, I think

there is too much in this one paper. … The MM campaign does not fly with me at all.

Ralph’s Response

The easy fix:

I absolutely disagree that this campaign is an example of a wide-scale MM campaign to affect office visit and antibiotic use... In summary, I think there is too much in this one paper. … The MM campaign does not fly with at all with me.

• Please see response to Reviewer #4, Comment #7 regarding media exposure/impressions.• Both the preceding office and household educational intervention (Gonzales R et al. Health

Services Research 2005;40:101-16) and the mass media campaigns were based on the logic that reducing office visits was one possible (and perhaps, most effective) means for reducing inappropriate antibiotic use; the other key means was increasing appropriate prescribing behavior by providers. The small media materials for households and patients incorporated information that was designed to assist families to make appropriate decisions about whether medical care was warranted for symptoms of colds or bronchitis, to challenge assumptions that antibiotics are required for colds or bronchitis, and to put the issue of antibiotic use for ARIs on the agenda for discussion with a provider. The mass media messages contained less detail than the household and clinic materials for patients, but were also designed to provoke questioning about the need for antibiotics for various respiratory symptoms and illnesses. We recognized that if a healthcare decision-maker in the family (e.g., the mother) no longer believed that antibiotics would help colds and coughs, she might be less likely to seek care. This is based on the multitude of studies that have found that desire and perceived need for antibiotics—for symptom relief—is a major reason that patients seek care for these illnesses. In social marketing terms, in this project a critical difference between doers and non-doers was the idea that antibiotics were necessary for treatment of ARIs (see W Smith references below; also, William Smith was the chief AED consultant on the Get Smart Campaign).

• Smith, W. (1998). Social marketing: What's the big idea? Social Marketing Quarterly, Vol. IV, Number 2, 5-17.• AED. Social Marketing Lite: Ideas for Folks with Small Budgets and Big Problems. http://www.aed.

org/ToolsandPublications/upload/Social%20Marketing%20Lite.pdf or at http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/17/30/ea.pdf

Response and Lessons Learned

Dear Dr. Gonzales,

I am pleased to inform you …

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How many papers have we got here?

What if the reviewer has completely missed the point?

• Tough. You must explain to the journal editors

why it is that you have chosen not to revise in

accordance with the reviewer’s comment, and be

prepared to support your point of view.

Kathy’s DilemmaChest: Round 2

Reviewer: 1• Yang et al have addressed my comments adequately.

Reviewer: 2• Yang and colleagues have made a very minor effort to

revise their paper and to satisfactorily answer concerns that I had in the original paper. Most importantly, they have made no effort to look at the relationship between Pseudomonas aeruginosa surveillance cultures and the appropriateness of empiric therapy that was used.

Reviewer: 3• Dr Yang responded to all my previous comments.

Response and Lessons Learned

• Submit elsewhere?

• Change the focus?

• Consult with a non-co-author colleague?

Shave and a Haircut

• Address stylistic editorial comments after the substantive revisions

• Stylistic issues frequently relate to length• Reduce to tabular or graphic form any appropriate

demographic descriptions of study subjects, or less intrinsic data and descriptors

• Do not repeat in text what is best presented in a table or figure

• Give your co-authors one last shot, WITH A DEADLINE, then: pull the trigger