PONE-D-24-11821Amid the chaos: a qualitative study of anesthesiologists' perspectives on Japanese perianesthesia nursesPLOS ONE

Dear Dr. TAMAI,

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Academic Editor

PLOS ONE

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Too long article that can be shorter by modifying extra data. Ref can be improved and more updated and needs more clarification in conclusion part. it would be better if the authors try to explain about the usefulness of the study findings for international audiences.

Reviewer #2: First, I congratulate the authors for choosing the topic of advanced nurse anesthetist practice, from the perspective of doctors and not nurses.

The study investigated the perception of anesthesiologists regarding the role of the nurse anesthetist in advancing practice in the Japanese healthcare system. The nurse anesthetist system was implemented in Japan in 2010, 14 years later, the authors sought to understand the perception based on the experience of anesthetists who play the role of supervisor of this advanced practice nurse. The abstract explains the content of the manuscript and encourages the reader to read the full text. The advanced practice nurse (APN) is a way of inserting this professional into health services, especially to cover the shortage of doctors in general specialties, such as anesthesiology. The problem is well founded, with current bibliographic references on the topic. The method is appropriate and responds to the objective of the study, by choosing the interview (in-depth) as a way of obtaining qualitative data. The participant eligibility criteria led to obtaining a representative sample of the set of qualified narratives from the professionals who volunteered to participate in the interviews. The ethical issues of the field research were presented with clarity and sufficient detail to understand the sensitive nature of the topic, while preserving confidentiality. The interview's trigger question - "Could you please outline the primary responsibilities of perianesthesia nurses in your hospital?" – elicited narratives that allowed an in-depth analysis. It also used a questionnaire with a set of open-ended questions. The analysis procedures were anchored in the framework method”, which are well described and encourage the reader to understand how the categories were established.

Despite this, there are some points in the manuscript that could be better presented to ensure the scientific criteria of qualitative studies.

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Reviewer #1: No

Reviewer #2: Yes: Ivone Evangelista Cabral, RN, PhD. Associate Professor and Researcher. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Brasil

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Attachments

Attachment

Submitted filename: S4 Appendix SRQR.docx

PONE-D-24-11821R1Variabilities and contentions in anesthesiologists' perspectives on Japanese perianesthesia nurses: a qualitative studyPLOS ONE

Dear Dr. TAMAI,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Oct 24 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Stefano Turi

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments 

Dear Authors thank you for submitting your revised version of the manuscript. However, in my opinion, I think that you did not completely follow the indications of Reviewer 1 "Too long article that can be shorter by modifying extra data". I suggest to shorten the article and to present differently some parts in order to make your work more easily interpretable.

Thank you

Stefano Turi 

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The manuscript brings to light the growing role of advanced practice nurses in anesthesia in Japan. The study aims to uncover anesthesiologists' perspectives on PANs and the PAN system. The authors have meticulously incorporated the recommendations from the initial manuscript evaluation and adhered to the SQUIRE checklist to report the qualitative research results. The method description provides a comprehensive understanding of the study's implementation. The results were effectively communicated using narratives, tables, and figures. The discussion distills new knowledge into five distinct categories: Anesthesiologists' perspectives on the implementation of the PAN system in Japan; High appraisal of current PANs Anesthesiologists' expectations; Anesthesiologists' perspectives on PAN anesthesia; and Anesthesiologists' perspectives on the PAN system. Given these points, it is my belief that the manuscript possesses scientific merit worthy of publication since was applied rigor and all the steps of the study's implementation.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Ivone Evangelista Cabral, PhD Nurse

Adjunct Professor

State University of Rio de Janeiro, Brasil

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Variabilities and contentions in anesthesiologists' perspectives on Japanese perianesthesia nurses: a qualitative study

PONE-D-24-11821R2

Dear Dr. Mikiko Tamai,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Academic Editor

PLOS ONE