Each submission is checked for suitability when received by the editorial office, and may be rejected without review if it is outside the scope of the journal, is obviously of insufficient quality, or is missing important sections.

The journal invites external experts (not only Editorial Board members) to review each article that is considered suitable for consideration. The publication decision is made by the Editor-in-Chief after receiving at least two external reviewer reports with recommendations.

Authors are encouraged to suggest suitable reviewers, but the Editor-in-Chief and the editorial office reserves the right to select different reviewers. The reason for asking authors to suggest reviewers is that they are best placed to know who is an expert in the field. In addition, the suggested reviewers may be suitable for other articles on the same topic. Therefore, obtaining these names can help the editorial office to ensure that it is approaching suitable people to review all articles.

The journal uses double-blind peer review (neither the authors nor the reviewers know the identity of each other) to avoid bias.

On receipt of at least two reviews, the Editor-in-Chief will make a decision of (1) accept, (2) minor revision, (3) major revision, or (4) reject. The reasons for the decision will be communicated to the authors. 

When the decision of minor/major revision is made, and the authors do not revise their articles satisfactorily after receiving reviewer reports, then the Editor-in-Chief reserves the right to reject the article. When revised articles are received they will either be sent out for further review or the Editor-in-Chief will make a decision depending on the level of revision requested.

The time to review and make a decision is extremely variable since it is sometimes difficult to find suitable reviewers, and there may be delays in receiving reviewer reports. The Editor-in-Chief and editorial office make all efforts to minimize the time from submission to first decision. 

Note that articles that do not report original research (e.g. letters to the editor, editorials) are not externally reviewed and the Editor-in-Chief makes the decision to publish.