Comments of Why Multiple Chronic Diseases? Why now? What is going on around the world?

The approach

During the March 2009 meeting, participants were invited to lead (main) or identify lead contributors for specific book chapters focused on each of the neglected areas that they had identified.

By the end of the month, all chapters had been assigned to a lead contributor who had committed to having the first draft ready by the summer of 2009. At that point, the initial senior editorial group had also been confirmed (Dr. Lyons joined the editorial group at the end of the year), and a technical support team and a roster of potential contributors had been established.

All of the lead contributors agreed to follow a series of principles to ensure maximum transparency to future audiences, and to prevent any unnecessary perception of conflicts of interest or bias. They:

- Used language that would be accessible to different potential audiences, including policy-makers, clinicians, managers and researchers. A lay summary would make the essence of each chapter easy to grasp for the general public.

- Disclosed their affiliation with organizations that may have an interest in the management of poly-pathologies in general, or with a specific topic in particular.

- Made explicit any personal or organizational biases that may influence the tone and emphasis given to the topic being addressed.

- Avoided over-emphasizing or focusing just on issues that related to their professional activities or organizational goals, be they political, financial or academic.

- Acknowledged, whenever possible, the work of individuals and organizations with opposing views or with competing interests.

- Made their contributions without financial or political incentives.

The contributors also agreed to follow a structured format for each of the chapters, with the following sections:

- A vignette outlining a vision of the future using a 20- to 30-year horizon.

- A brief summary highlighting the main points covered in the rest of the chapter, using language that could be understood by any interested reader.

- Why is the topic important? This section described the magnitude of the challenge associated with this specific topic, providing as much data as possible, including all regions in the world, while trying to address the perspectives of different groups of stakeholders (patients and their caregivers, policy-makers, managers, funders and academics).

- What do we know? Here, contributors summarized the research literature available on the topic, highlighting the implications for each of the above groups of stakeholders. In each chapter, contributors ensured that they had drawn from the initial literature search, as well as from their own collections of resources.

- What do we need to know? This section emphasized the knowledge gaps that exist around this topic, and why it would be important to fill them.

- What innovative strategies could fill the gap? The contributors ended each chapter with proposed innovative efforts that could be pursued to fill the identified gaps, focusing on methodological issues, resource needs (technological, financial and human) and the role that OPIMEC could play in the process.

Six of the chapters were produced initially in Spanish and four in English (those that dealt with epidemiological issues, prevention and health promotion, supportive and palliative care, and demedicalization of care).

One of the senior editors (FM) supported contributors writing in Spanish and another (AJ) those working in English. The latter, fluent in both languages, was responsible for reviewing all of the initial drafts, for harmonizing their content, eliminating redundant content, and identifying areas for improvement.

The revised draft chapters, with suggested changes, were sent to each of the lead contributors, who in turn produced refined versions. In most cases, two iterations of revisions were completed before the initial drafts were considered to be ready for translation.

Once each of the drafts had been translated to the alternate language, the same bilingual senior editor (AJ) reviewed them for accuracy and, whenever appropriate, edited the content further, in both languages.

The translated files were then sent to the respective lead contributors for verification and approval. Once approved by them, the draft chapters were uploaded to the OPIMEC platform by the support team, in a format that included separate interactive sections designed to allow readers to make comments and suggestions for improvement (Figure 3).

 Figure 3. Interactive table of contents with a section sample


 Source: OPIMEC. [Web site]. [access May 5th, 2010]. Available at: 

While the chapters were being uploaded, the editors and lead contributors produced a list of peers they felt could provide useful comments on each of the drafts, selecting them from among colleagues they knew or the authors of key articles they had used as references. The editors then sent an electronic message to the members of this list, inviting them to read the chapters and make comments, either anonymously or by registering as members of the OPIMEC community. In all cases, the support team was available to provide technical assistance under supervision by one of the editors (AC).

Throughout the process, the terms contributor and contributorship were considered to be more consistent with modern approaches to acknowledging the work of members of collaborative groups than the more traditional author or authorship (30).

A minimum of a month after the chapters were uploaded to the platform, the editors reviewed all of the comments received and produced lists of substantive changes that were sent to the lead contributors for incorporation into the drafts.

The revised versions were then reviewed thoroughly by the editors (RS, RL and AJ in English, and PM, AC and AJ in Spanish), who could make modifications to the main text online. Those individuals who made substantive comments, as judged by the editors by consensus, were recognized as book contributors.

Existing comments

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Un proyecto ambicioso que quizas las nuevas tecnologias nos permitan conseguir,

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Me parece fundamental la existencia de algo parecido a un Código Deontológico previo, eliminar los intereses particulares para centrarnos en lo realmente importante, las personas. Otro aspecto a destacar es el lenguaje, el conocimiento debe difundirse y llegar al máximo de personas posible.

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