Tag Archives: health

How to Do a Peer Review: Part Two

by Sarina Schrager, MD, MS, Family Medicine Editor-in-Chief, and Jose Rodriguez, MD, FAAFP

The Title 
The title of a manuscript is the first area that we expect reviewers to evaluate.  Many people use catchy titles to capture readers’ attention in their papers.  However, because many readers only look at the title when deciding whether to read a paper, we suggest that the title should describe the paper’s content and, if applicable, the study’s results.  For example, if a paper uses medical student focus groups to evaluate a lecture, that is what the title should say. If the curriculum is about social media, the title could be something like “Follow me,” which doesn’t really describe what the paper discusses but is somewhat catchy.  So, you could suggest, “Follow me: an evaluation of an undergraduate course about social media.” Or, “Follow me: medical student focus groups rate social media course.” You can also comment if the title is too long.  Many people like to use colons in their titles, but if the title is too long, it is easy to lose track of what it says. The title is often the only part of the paper that is read. If it doesn’t catch the reader’s attention, they won’t look up the abstract. When possible, highlight the main finding in the title.  Instead of “An evaluation of a novel teaching method,” you could say, “Novel teaching method associated with higher resident satisfaction” or something like that.

Abstract  
If the title is catchy or describes a topic that the reader is interested in, they will go on to the abstract.  For many people, the abstract is the only thing they read. So, an abstract must be clear, well-written, and accurately describe what the paper is going to say. Abstracts, by their nature, are short, usually 150-250 words, and are structured with four sections:  background/objectives, methods, results, and discussion.  A strong abstract makes a brief case for the gap this study aims to fill, then describes how the authors addressed the research question.  We want reviewers to comment on whether the abstract is well written, clear, and accurately describes the study. We also want reviewers to let us know if the main findings are captured in the abstract.

Introduction
Often, when you are chosen as a reviewer, you are a content expert and know the literature on a given topic.  In that case, you will know if an author leaves out essential papers.   It is common for authors to write introductions that are too long because they don’t want to leave anything out.  It is your job as a reviewer to evaluate whether important background articles are included, but the author doesn’t make any detours (i.e., start talking about a peripheral topic).  Writing experts coach authors to start broad in the introduction and narrow the focus, so that the last sentence presents the paper’s research aims and explains how it fills a gap in the literature.  As a rule, the introduction should be about the same length as the other sections of the paper. An excellent guide to writing introductions is this paper by HG Welch: https://cancer.dartmouth.edu/sites/default/files/2019-05/papertrail.pdf. When new authors struggle with writing the introduction, we will often refer them to this paper. Essentially, it outlines how to write a three-paragraph introduction using the questions:

1. What is the global problem?
2. What is the specific issue?
3. How does this paper help?

Methods 
The methods section of a research paper should clearly describe the “how” of the study.  What did the researchers do?  We want enough detail so that someone at a different institution could replicate the study if needed.  If you did pre- and post-evaluations of an educational intervention, what questions did you use, when did you administer the surveys, etc.?  Reviewers want to see a statistical assessment and a justification for the researchers’ choice of statistical methodology.   Reviewers do not want to see any results in the methods section.  Does the methodology of this study make sense to answer the stated research question? Is the methodology based on any theoretical models?  The methods section must describe how the authors got the information that will be shared later in the results section of the paper. Everything in the methods section should map out well to the results section. If the authors do not say how they got the data in this section, they should not report it in the next section. This is also true for the abstract.

A note about statistics: most reviewers will not be expert statisticians (the editors may choose a reviewer who is if the paper needs it).   Most quantitative studies will include basic statistics.  If the authors use some statistical test that you have never heard of, they will need to explain why in the methods section.  All methods sections should have a detailed description of how the data was analyzed (whether quantitative or qualitative).

Results
While the methods section describes what you did, the results section describes what you found.  One common mistake that reviewers often see is the lack of specifics around surveys.  How many people received the survey?  How many people responded?  What is the response rate?  Do you know anything about the people who didn’t respond  (i.e. demographics)?  Findings from the research should be described either in text (in the results section) or in a table.  Some people use the text in the results section to give a high-level overview of the results and highlight key findings, then put the actual data into a table.  Tables traditionally do not count toward a word limit, so they are a great way to add more content without using many words. Reviewers should comment on whether the methods described can produce the results reported. Look for areas where the results are not reflected in the methods and vice versa. The Welch article listed above can be very helpful in crafting methods and results sections as well.

Make sure to read Part 3 of this blog series where we will discuss what to look for in the discussion section, in tables and figures, and in references.

Reflections on Participation in Community Outreach Event

By Sarah Willoughby, LCSW, Freeman Health System

On Sunday, Sept 7, 2025, I attended a community outreach event hosted by the Neighborhood Resilience Project in collaboration with McAuley Ministries and the Society of Teachers of Family Medicine (STFM). This was a partnership through the 2025 STFM Conference on Practice & Quality Improvement in Pittsburgh, PA.

I rode to the main site with Marisol Valentin, the director of McAuley Ministries, who told me about the sad history of the Hill District of Pittsburgh and the area’s increased poverty, violence, and other problems. Then we met Father Paul Abernathy, who had the vision to start the Neighborhood Resilience Project—a trauma-informed community development nonprofit.

He provided a tour of the medical/behavioral health facility and led a round table discussion along with one of the McAuley Ministries board members, two volunteer physicians, chief administrator, the nursing director, and the volunteer coordinator. Together, they described their work in revitalizing the Hill community—a neighborhood negatively affected by gentrification.

Father Abernathy and others realized residents of this neighborhood have experienced individual and community trauma, which is affecting their emotional and physical health. I loved their focus “to promote resilient, healing and healthy communities so that people can be healthy enough to sustain opportunities and realize their potential.” I have spent my entire career—35 years—doing this in various rural and urban areas.

During the last 15 years, the Neighborhood Resilience Project has worked with community members, leaders, volunteers, and donors to strengthen the community by focusing on three pillars:

  • Community Support
  • Health and Well-Being
  • Leadership Development

The Neighborhood Resilience Project’s motto is to engage community members to transform them into a resilient, healing, and healthy community. Programs include a free Health Care Center, a Trauma Response Program, a Backpack Feeding Program, and, during the COVID-19 pandemic, a Vaccination Collaborative.

Father Abernathy was working in a predominantly black and underserved community in Pittsburgh and regularly interacting with men, women, and children who had repeatedly experienced multiple forms of trauma. He was a combat veteran of the Iraq War and realized that trauma in the form of hunger, abuse, homelessness, lack of opportunity, racism, lack of health care, and violence greatly informed the worldview and culture of the community.

Understanding that trauma was the greatest barrier facing the development of his community, Father Abernathy began to ask the question, “how do you heal an entire community that has been inundated with trauma for generations?”

Here are some of the Neighborhood Resilience Project’s recent accomplishments:

  1. Through 2021, the organization has helped facilitate more than 2,500 COVID-19 vaccinations, deployed more than 60 times to homicides related to gun violence, provided more than 14,000 items of food and 5,000 clothing items, provided more than $23,000 in emergency relief and document recovery, and had close to 200 volunteer hours through clinicians alone such as to provide free care to the uninsured in the region.
  2. The organization has hosted groups from across the nation who had been previously trained in the Trauma Informed Community Development Framework for a Summit in June 2021.
  3. The organization utilized “Micro-Community Interventions” in the Hill District and saw an improvement in overall well-being as analyzed by the well-being tool, “ImHealthy.”
  4. The organization has renovated its Free Health Center space to double in size and now offers medical and dental care.
  5. In partnership with the Jefferson Regional Foundation, the Neighborhood Resilience Project is rolling out work in the Mon-Valley – first by training one cohort from the McKeesport, Clairton and Duquesne neighborhoods (for a total of three cohorts) in the Trauma Informed Community Development Framework and then coaching those cohorts through the roll-out phase.

Visiting the Neighborhood Resilience Project and meeting key team members was inspiring to me personally and professionally. We’d like our community residents in the Joplin, MO, area to be healthier, and we struggle to find ways to do this. In April, we had a serious storm in our rural area, causing damage to trees, fences, homes, and sheds. Just this week, a woman whose farm is still significantly damaged and whose life has seriously been impacted told her story.

This “Trauma Informed Community Development” (TICD) model in our community might be helpful to Joplin, as many were devastated by the EF5 tornado in 2011 that killed more than 200 people. I plan to meet with someone from the Neighborhood Resilience Project in the next month and learn more about the imHealthy tool and ”micro interventions” we might be able to implement in our community.

Using While Pregnant

A Life-Changing Knock


By Meheret Mekonnen, MS

The fear of having a newborn taken away—this is a reality for many women who test positive for substances on a urine drug screen during pregnancy. The stigma and complications of substance use disorders are associated with insufficient prenatal care, inadequate nutrition, chronic medical conditions, and domestic violence.¹

Prenatal substance use and neonatal substance exposure have become pressing public health concerns. It is estimated that more than 4.4% of pregnant women in the United States use 1 or more substances during pregnancy.² Opioid use among pregnant women and cases of neonatal abstinence syndrome have risen alarmingly, with a 131% increase in opioid-related diagnoses during delivery hospitalizations from 2010 to 2017.² Each year, approximately 800,000 of the 4.3 million neonates born in the United States are exposed to illicit substances in utero.³ These statistics, along with countless patient testimonials, highlight the critical need for health care professionals to implement screening, brief intervention, and referral to treatment as part of routine care.

One of the many challenges clinicians and institutions face is how to effectively screen pregnant patients. Many facilities still rely on unstandardized substance use screening, often in the form of urine toxicology testing. However, urine drug screens have demonstrated poor positive predictive value and reveal significant disparities in outcomes.⁴ Historically, unstandardized screening and disclosure practices have been shaped by provider bias, particularly against single women with poor psychological, financial, or social functioning; women with delivery complications; Black women; and those receiving care in public health settings.⁵

Leading organizations—including the World Health Organization (WHO), the US Preventive Services Task Force (USPSTF), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the American College of Obstetricians and Gynecologists (ACOG)—strongly recommend standardizing substance use screening as part of comprehensive obstetric care.⁶ Validated screening tools such as the 5Ps (Parents, Peers, Partner, Pregnancy, Past) offer a structured approach to assessing alcohol and substance use during pregnancy.⁷

Critics of universal verbal screening cite concerns about patient honesty, staff burden, and time constraints. Yet, successful models demonstrate that integration into existing clinic workflows, engagement of multidisciplinary stakeholders, and support from institutional leadership can facilitate adoption and acceptance.⁸

More work is needed to address disparities in substance use screening and the broader public health challenge of prenatal substance exposure. However, universal verbal screening is a meaningful step toward building patient trust, mitigating provider bias, and promoting equity in prenatal care.⁹

References

1. Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. 2013;56(1):91–96. Available from: https://journals.lww.com/clinicalobgyn/FullText/2013/03000/Overview_and_Epidemiology_of_Substance_Abuse_in.15.aspx

2. Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017. JAMA. 2021;325(2):146–147.

3. Joseph R, Brady E, Hudson ME, Moran MM. Perinatal substance exposure and long-term outcomes in children: a literature review. 2020.

4. Chin JM, Chen E, Wright T, Bravo RM, Nakashima E, Kiyokawa M, et al. Urine drug screening on labor and delivery. Am J Obstet Gynecol MFM. 2022;4(6):100733. doi:10.1016/j.ajogmf.2022.100733

5. Madora M, Wetzler S, Jose A, Bernstein PS. Pregnant and postpartum people with substance use disorders: understanding the obstetrical care provider’s roles and responsibilities. Matern Child Health J. 2022;26(7):1409–1414.

6. Whittaker A. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. By World Health Organization. Geneva, Switzerland: WHO Press; 2014. Drug Alcohol Rev. 2015;34(3):340–341.

7. Hostage JC, Brock J, Craig W, Sepulveda D. Integrating screening, brief intervention and referral to treatment for substance abuse into prenatal care [3L]. Obstet Gynecol. 2018;131:129S–130S.

8. Chasnoff IJ, Wells AM, McGourty RF, Bailey LK. Validation of the 4P’s Plus© screen for substance use in pregnancy. J Perinatol. 2007;27(12):744–748.

9. Ulrich M, Memmo EP, Cruz A, Heinz A, Iverson RE. Implementation of a universal screening process for substance use in pregnancy. Obstet Gynecol. 2021;137(4):695–701.