1. Overview of the Review Model

Health Nexus operates a structured editorial assessment and peer review system. The principal arrangements are as follows:

Under the double-blind model, author-identifying information is withheld from external reviewers, and reviewer identities are not disclosed to authors during the review process. Editorial personnel may access author information where necessary for manuscript administration, research integrity assessment, and editorial decision-making.

Double-blind review reduces the risk of identity-related bias but cannot guarantee complete anonymity in every circumstance. Authors and reviewers must nevertheless make reasonable efforts to protect the integrity of the anonymization process.

2. Initial Editorial Screening (Desk Review)

Following submission, manuscripts undergo an initial assessment by the Editorial Office and/or an authorized editor. This stage determines whether a submission meets the journal's basic eligibility, scholarly quality, and manuscript preparation requirements.

Initial screening includes consideration of:

• Scope and Relevance: Alignment with the journal's aims, scope, and appropriate research section.
• Originality: The manuscript's contribution to existing knowledge and any relevant overlap with prior publications.
• Methodological Quality: Basic adequacy of the research design, scholarly argument, data analysis, and interpretation.
• Research Ethics: Appropriate declarations concerning ethical approval, informed consent, trial registration, funding, and competing interests.
• Manuscript Preparation: Compliance with article-type requirements, formatting standards, reference style, and submission documentation.
• Anonymization: Proper separation of author-identifying information from the manuscript intended for external review.
• Research Integrity: Required originality and similarity documentation, appropriate AI-use disclosure, and other relevant submission declarations.

Mandatory Submission Documentation

Manuscripts that do not satisfy the journal's eligibility or quality standards may be rejected without external peer review. Other submissions may be returned for technical corrections before further assessment. Initial screening does not constitute an external peer review or guarantee that a manuscript will be sent to reviewers.

3. Assignment to Handling Editor

Manuscripts that pass initial editorial screening are assigned to a Handling Editor or designated Academic Editor with expertise relevant to the submission's subject matter and research methodology.

The Handling Editor is responsible for:

• Assessing the manuscript's suitability for external review.
• Identifying qualified and independent reviewers.
• Coordinating reviewer invitations and reports.
• Managing relevant conflicts of interest.
• Evaluating methodological and scholarly concerns raised during review.
• Reviewing authors' responses and revised manuscripts.
• Preparing an editorial recommendation or exercising delegated decision authority where authorized.

Where a manuscript concerns multiple disciplines, the editor may seek additional expertise to ensure adequate evaluation of its relevant components. An editor with a material competing interest must disclose the conflict and arrange independent handling as appropriate.

4. Reviewer Selection

Reviewers are selected according to their expertise, professional independence, and ability to provide a constructive and scientifically informed evaluation.

Reviewer selection considers:

• Subject Expertise: Demonstrated knowledge relevant to the manuscript's research area.
• Methodological Competence: Appropriate expertise in the study design, analytical approach, clinical methods, or theoretical framework.
• Scholarly Qualifications: Relevant academic training, research experience, publications, or comparable professional expertise.
• Independence: Absence of disqualifying financial, personal, institutional, or professional conflicts of interest.
• Availability: Capacity to complete the review within the agreed period.
• Breadth of Evaluation: Appropriate diversity of expertise and perspectives where relevant to the manuscript.

Externally reviewed research manuscripts are evaluated by at least two independent reviewers. Where reports are contradictory, insufficient, or raise specialized questions, the editor may seek additional assessments. Reviewer selection does not require representation from both Western medicine and TCM unless the research itself warrants expertise in both traditions.

5. Peer Review Evaluation

Reviewers evaluate manuscripts using scholarly and methodological criteria appropriate to the research design and article type. Their reports should identify substantive strengths, limitations, and issues requiring clarification or correction.

Evaluation Criteria

• Originality and Contribution: The scholarly significance of the research question, findings, theoretical analysis, or methodological contribution.
• Scientific Validity: The adequacy of the study design and the reliability of the evidence presented.
• Methodological Rigor: The appropriateness, transparency, and consistency of data collection, experimental procedures, analytical methods, or theoretical approaches.
• Statistical and Analytical Quality: Appropriate statistical analysis, uncertainty assessment, qualitative analysis, or other relevant methods according to the study design.
• Interpretation and Limitations: The relationship between findings, conclusions, supporting evidence, and acknowledged limitations.
• Clinical or Public Health Relevance: The potential contribution to medical knowledge, healthcare practice, population health, or relevant policy questions.
• Disciplinary and Interdisciplinary Relevance: Scholarly contribution within the relevant medical field or, where applicable, the coherence and value of interdisciplinary integration.
• Research Ethics and Integrity: Compliance with applicable ethical requirements, transparent reporting, accurate citation, and appropriate disclosure.
• Presentation and Reporting: Clarity, organization, completeness, and adherence to relevant reporting guidelines.

Reviewer Recommendations

Reviewers normally provide written assessments and one of the following recommendations:

• Accept: The manuscript is considered suitable for publication without substantive revision, subject to final editorial verification.
• Minor Revision: The manuscript requires limited clarification, correction, or improvement without fundamental changes to the research.
• Major Revision: Substantial changes are required to address significant methodological, analytical, theoretical, or reporting concerns.
• Reject: The manuscript contains substantial deficiencies or otherwise does not meet the journal's publication standards.

Reviewer recommendations are advisory. They do not constitute binding editorial decisions. The responsible editor considers the substance, evidence, and consistency of reviewer reports before reaching or recommending an editorial outcome.

6. Review Timeline (Indicative Targets)

Health Nexus seeks to provide timely editorial decisions while maintaining appropriate scientific and ethical assessment. The following periods represent indicative operational targets rather than guaranteed processing times.

Manuscripts rejected during editorial screening may receive an earlier decision. External review may take longer where reviewer invitations must be repeated, additional specialist evaluation is necessary, or substantive ethical or methodological questions arise.

Revision cycles, author response periods, and subsequent rounds of peer review are not necessarily included in the initial decision target. Authors should not interpret indicative review periods as guaranteed acceptance, publication, or completion dates.

7. Author Revisions

Authors invited to revise a manuscript must respond carefully to the scientific, methodological, ethical, and editorial concerns identified during review.

Revised submissions should include:

• Point-by-Point Response: A structured response addressing each reviewer and editorial comment.
• Revised Manuscript: A complete updated version incorporating the changes made.
• Clear Identification of Changes: Tracked changes, highlighted revisions, or another method requested by the Editorial Office.
• Supporting Documentation: Updated analyses, tables, figures, reporting checklists, declarations, or supplementary files where applicable.
• Reasoned Explanations: Scientific or methodological justification when a reviewer recommendation has not been adopted.
• Timely Resubmission: Submission within the deadline communicated by the Editorial Office, or an extension request where justified.

Authors must preserve appropriate anonymization in revised files intended for external review. Responses and changes must not introduce author-identifying information into documents provided to reviewers.

Revised manuscripts may be reassessed by the original reviewers, evaluated by additional experts, or reviewed directly by the responsible editor when appropriate. An invitation to revise does not guarantee acceptance.

8. Final Editorial Decision

Following consideration of the reviewer reports, author responses, revised manuscript, and applicable publication standards, the Handling Editor prepares a recommendation or acts under authorized delegated authority.

The Editor-in-Chief or an authorized delegated editor makes the final editorial decision. Possible outcomes include:

• Acceptance: The manuscript meets the journal's scholarly, methodological, and ethical requirements and may proceed to production following final checks.
• Minor Revision: Limited corrections or clarifications are required before reconsideration.
• Major Revision: Substantial revision is necessary before a further editorial decision can be made.
• Rejection: The submission does not meet the journal's standards or cannot be satisfactorily resolved through revision.

Editorial decisions may take account of reviewer disagreement, the adequacy of author responses, the reliability of the reported findings, and concerns not identified during the initial review.

Acceptance is not determined by a numerical majority of reviewer recommendations. Editors remain responsible for evaluating the substance of the reports and protecting the integrity of the publication process.

9. Ethical Considerations in Peer Review

Health Nexus expects all participants in editorial evaluation to uphold principles of impartiality, confidentiality, professional integrity, and responsible scholarly judgment.

Responsibilities of Reviewers

• Provide objective, constructive, specific, and professionally expressed evaluations.
• Disclose relevant financial, institutional, personal, or professional conflicts of interest.
• Decline or withdraw from assignments when impartiality cannot reasonably be maintained.
• Protect the confidentiality of submitted manuscripts and related materials.
• Identify relevant methodological weaknesses, reporting deficiencies, or potential research integrity concerns.
• Avoid coercive citation requests, discriminatory comments, and inappropriate personal criticism.
• Complete reviews within the agreed timeframe or communicate delays promptly.

Responsibilities of Editors

• Maintain fair and independent editorial evaluation.
• Select reviewers based on relevant expertise and independence.
• Manage potential reviewer and editorial conflicts of interest.
• Protect author and reviewer confidentiality.
• Consider reviewer reports critically rather than automatically adopting recommendations.
• Handle research integrity concerns with appropriate evidence, proportionality, and procedural fairness.
• Apply relevant COPE and ICMJE guidance when addressing publication ethics concerns.

Use of Artificial Intelligence in Peer Review

Further requirements are provided in the AI & Research Integrity Policy.

10. Confidentiality and Anonymity

All submitted manuscripts and related editorial materials are treated as confidential documents. The journal is responsible for protecting the confidentiality of authors, reviewers, research data, unpublished findings, and editorial communications.

• Manuscript Confidentiality: Reviewers must not share, distribute, publish, or disclose unpublished manuscript content without authorization.
• Protection of Unpublished Research: Information, methods, data, or ideas obtained through peer review must not be used for personal research or professional advantage.
• Reviewer Identity: Reviewer identities must not be disclosed to authors except where an applicable journal policy and appropriate authorization expressly permit disclosure.
• Author Anonymity: Author-identifying information is withheld from external reviewers under the double-blind model.
• External Assistance: Reviewers must obtain appropriate editorial permission before involving colleagues or assistants in confidential manuscript assessment.
• Document Handling: Confidential review materials must be stored, accessed, retained, and disposed of according to applicable journal policies and information security requirements.
• Data Protection: Identifiable patient information, restricted datasets, and sensitive research records must receive appropriate protection throughout editorial processing.

The journal may disclose relevant confidential information to appropriate parties where necessary for authorized editorial administration, research integrity assessment, or compliance with applicable legal obligations, subject to appropriate safeguards.

11. Appeals and Complaints

Health Nexus provides mechanisms for authors and other relevant parties to raise substantiated concerns regarding editorial decisions, review procedures, reviewer conduct, or potential publication ethics issues.

Appeals Against Editorial Decisions

Authors may request reconsideration where they identify a material factual, procedural, ethical, or scholarly concern that may have affected an editorial decision.

An appeal should include:

• The manuscript title and relevant submission details.
• Identification of the editorial decision being appealed.
• A clear explanation of the grounds for reconsideration.
• A point-by-point response to disputed reviewer or editorial comments where applicable.
• Relevant scientific evidence, methodological clarification, or supporting documentation.

Handling of Complaints

Complaints concerning peer review conduct, editorial procedures, conflicts of interest, publication ethics, or administrative fairness are assessed according to the journal's Complaints & Appeals Policy.

Appeals are considered by the Editor-in-Chief or an appropriate independent editor or editorial board member who was not involved in the original decision, where practicable. Additional expert review may be requested when necessary.

The submission of an appeal does not guarantee reversal of the original decision. Complaints and appeals are handled with appropriate confidentiality, impartiality, and documentation.

See the Complaints & Appeals Policy for detailed procedures and applicable requirements.

12. Post-Acceptance Process

Following formal acceptance, manuscripts proceed to the journal's production and publication workflow. Acceptance does not eliminate the obligation to resolve outstanding technical, ethical, or publication requirements.

The post-acceptance process may include:

• Final Editorial Verification: Confirmation of required declarations, author information, references, and publication documentation.
• Copyediting: Editorial preparation for clarity, consistency, academic presentation, and compliance with journal style.
• Typesetting and Formatting: Preparation of the final publication layout and associated article files.
• Author Proofreading: Author verification of proofs and correction of typographical, formatting, or other production errors.
• Metadata Preparation: Verification of article titles, author details, affiliations, abstracts, keywords, references, and persistent identifiers where applicable.
• Online Publication: Publication of the final article through the journal's official website and associated scholarly dissemination channels.

Authors must respond to production queries and review proofs carefully. Substantive changes affecting the study's findings, authorship, or scientific interpretation after acceptance may require further editorial assessment. Post-publication issues are handled under the journal's correction, retraction, and publication ethics policies.

13. Editorial Independence

Health Nexus is published by Panorama Scholarly Group (PSG). The journal maintains editorial independence in manuscript assessment, reviewer selection, peer review administration, research integrity decisions, and publication outcomes.

• Academic Decision-Making: Editorial decisions are determined by scientific and scholarly considerations, including methodological quality, originality, research ethics, and relevance to the journal's scope.
• Publisher Independence: The publisher supports journal infrastructure and publishing operations without exercising inappropriate influence over individual manuscript acceptance or rejection.
• Financial Independence: Article processing charges, waiver requests, sponsorship, or other financial arrangements do not determine editorial decisions.
• Conflict Management: Manuscripts involving editors, editorial board members, publisher representatives, or other individuals with potential conflicts must be handled through appropriate independent editorial arrangements.
• Accountability: The Editor-in-Chief and authorized academic editors remain responsible for ensuring that editorial decisions follow the journal's policies and applicable scholarly standards.