On the basis of evaluations by the editors and peer reviewers, submitted manuscripts are either rejected or returned to authors with suggestions for improvement through revision. Authors should realize that a request for revision does not guarantee acceptance, because revised manuscripts are subject to editorial review and may also have additional peer review. Several rounds of review and revision may occur before a final decision is reached. Acceptance of manuscripts expressing viewpoints, perspectives, or opinions may be based solely on editorial review, but reports of original data and other major articles almost always undergo peer review, statistical review, and revision before acceptance for publication (see 1.0, Types of Articles). Journals with more than 1 editor may hold meetings during which submitted manuscripts and their reviews, and also revised manuscripts, are presented and discussed before decisions are reached regarding revision or acceptance for publication.
The decisions for rejection, revision, and acceptance all belong to the editor, not the peer reviewers. The term referee, meaning a person to whom a paper is referred for review, is sometimes used synonymously with peer reviewer. However, in the United States referee can be misleading because that term often implies one who has authority for decisions, particularly in sports events. In biomedical publishing, editors have that decision responsibility. Peer reviewers have an important and helpful but advisory role, essentially serving as consultants to editors.