Dealing with inappropriate-, low-quality-, and other forms of challenging peer review, including hostile referees and inflammatory or confusing critiques: Prevention and treatment.

Within the context of journal peer review, when high-quality referee input is coupled with appropriate editorial oversight from a journal's leadership, the result can be the selection and publication of high-quality manuscripts that are ideally targeted to the journal's readership's interests. However, in its worse forms, flawed referee input and indifferent- or misdirected journal leadership can result in damage to the quality of materials published and the relationships among, and careers of, the involved parties. This article identifies methods that journals can employ to select journal leaders and educate authors, referees, and editors in an attempt to prophylax against problematic peer review. The article then identifies 17 categories of inappropriate or flawed critiques. Next it outlines a plan of action: 1) to prevent potentially harmful reviews from reaching authors, and 2) for instructing authors on how to respond to perceived challenging or problematic reviews, or perceived erroneous journal decisions. Elsewhere, the article introduces an approach to diffuse hostilities that may follow the publication of controversial articles. The synthesis within this article approaches peer review as a continuous quality improvement exercise in which referees, authors, and journal leadership will gain a broader understanding of the standards of biomedical publication and professionalism.