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The "peer-review" of scientific manuscripts is an honorable and important task to optimize the quality of a medical journal. The reviewer has the following 2 tasks: first, to provide to the editor an overall assessment of the manuscript and make a recommendation regarding the acceptance, revision or rejection of a scientific manuscript. Second, to supply the authors with objective and constructive criticism and also with detailed suggestions for improvement of a manuscript -aiming to improve its scientific quality.The aim of this paper is to provide recommendations for a systematic assessment in order to further improve the quality of the peer review process. Both general principles specific criteria are addressed. Our target is to further enhance the academic value of the journal Handchirurgie, Mikrochirurgie, Plastische Chirurgie by optimizing the peer review process.

In February 2009 a major case of scientific misconduct was discovered. The American pain researcher Dr. S. Reuben had published 21 papers over a period of 15 years that were found to be fraudulent. Suddenly many advances in postoperative pain therapy which had been assumed to be correct seemed questionable. In this review article the lessons which can be learnt from this case are described. This review also reveals that it is almost impossible for reviewers or readers of scientific journals to detect scientific fraud. However, several warning signs can be identified that might be useful when reading clinical papers. In retrospect many of these signs were detectable in Reuben's studies. Based on the fraudulent papers of Reuben it will be shown how and to what extent falsified results can affect other types of literature, such as practice guidelines, meta-analyses, review articles and oral presentations.

The positive experiences regarding peer review practice go back to the 1990s and can be traced in the position paper of the German Medical Association concerning quality assurance in the field of pathology. This evolved into the initiative of pathologists in Saxony to implement the peer review practice within the remit of their State Medical Association. Since the 14(th) of May 1999 various institutes as well as medical group practices in pathology and cytology have joined forces to undertake voluntary inter-institutional quality control measures. The aim was to improve the process and especially the outcome quality by reviewing each other's quality (analysing samples) on the basis of defined criteria. A positive review outcome report, which will have to be unanimously agreed upon by all participants, will lead to a positive recommendation for a certificate issued by the Medical Association of Saxony. Between 1999 and 2011 a total of 56 peer review proceedings took place. The potentials for improvement concern the problem of "kitchen pathology" still being used in the context of macroscopic description, the quality of microscopic description including the use of correct nomenclature, the quality of tumour classification and immune histological investigations. Statements concerning the advantage of the peer review method in particular refer to the integration of resident pathologists. Due to the long period of implementation of the peer review system und the small number of proceedings, it is not possible to come to a clear conclusion about the improvement or deterioration of quality. During a period of more than 10 years three peer review proceedings were not successful. In this situation, it is appropriate to ask the question of how restrictive peer reviews should be. The three most important aspects for the pathologists in Saxony are: self-determination, learning from each other, and a commitment to quality improvement. So this method set an example of how a quality management method can persist for more than 10 years through voluntary engagement. And the initiative of pathologists in Saxony has given an important impetus to the development of other peer review systems in various health care organisations or disciplines in Germany.

This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

In this paper, our experience with training courses for quality circle moderators is reported. Basic principles of the peer review method in general and the specific model of the topic-oriented quality circle approach in the ambulatory care in Sudbaden is described. Peer review in quality circle groups demands specific participants' skills. Thus, training courses for quality circle leaders have been set up to prepare moderators for their task. Attention is given to the goals and contents of training courses for physicians. Key elements are the supervisory role of the moderator and specific tasks in handling the group dicussions. Evaluation questionnaires after the courses showed that the participants (n = 41) judged the programme very positively.

This article was written to give researchers and clinicians a short synopsis of ethical and thorough design, conduct, analysis, publication, and interpretation of randomised controlled clinical trials according to the European quality standards of Good Clinical Practice (GCP). The paper consists of two parts. In the first part we introduce important elements of study design, especially study hypothesis, criteria of inclusion and study population, sample size calculation, validity considerations, bias and confounding, randomisation, stratification, and masking of treatment assignment. Different treatment allocation like multiple parallel groups, factorial experiment, cross-over, and sequential design are presented. Requirements of ethical standards according to the Declaration of Helsinki are discussed for their necessity in any experimentation in humans. Principles of informed consent are demonstrated with emphasis on special conditions in anaesthesia, emergency medicine, and intensive care research. In the second part of this article we explain issues of baseline assessment, experimental intervention, data recording, and data monitoring, particularly of negative or hazardous treatment effects. Topics of data analysis and reporting of trial results in publications are illustrated with regard to their influence on subsequent interpretation.