Instructions for Authors FREE

JAMA is an international, peer-reviewed, general medical journal that is distributed to readers in more than 140 countries.

Manuscripts should be submitted online via the JAMA online manuscript submission and review system at http://manuscripts.jama.com (note: do not include “www” before the URL). At the time of submission, complete contact information (postal/mail address, e-mail address, telephone and fax numbers) for the corresponding author is required. First and last names, e-mail addresses, and institutional affiliations of all co-authors are also required. Manuscripts submitted through the online system should not also be submitted by mail or e-mail. After the manuscript is submitted online, the corresponding author will receive a manuscript number. Each author should complete an authorship form and submit the completed form by regular mail or fax. Please include the manuscript number on the authorship form in the space provided. See Manuscript Checklist, Authorship Form, Manuscript Preparation and Submission Requirements,^1- 2 and other details in these instructions for additional requirements.

Editorial Office Contact Information. JAMA, 515 N State St, Chicago, IL 60610, USA; telephone: (312) 464-4444 or (312) 464-2402; fax: (312) 464-5824; e-mail: jamams@jama-archives.org.

JAMA-EXPRESS.JAMA-EXPRESS provides rapid peer review and publication of major clinical trials and other original research studies that have immediate or public health importance.³ Authors who wish to have manuscripts considered for JAMA-EXPRESS should send the manuscript file and a request letter to jamaexpress@jama-archives.org or call (312) 464-2402. Authors will be notified promptly whether the manuscript is approved for rapid peer review. Authors of those manuscripts determined not to qualify for JAMA -Express may be invited to submit the manuscript for further consideration under the standard review process.

JAMA publishes original contributions, reviews, brief reports, special communications, commentaries, and many other categories of articles. Topics of interest include all subjects that relate to the practice of medicine and the betterment of public health worldwide. The most frequently published types of articles are described herein.

Original Contribution. These reports typically include randomized trials (see Clinical Trial below), intervention studies, cohort studies, case-control studies, epidemiologic assessments, other observational studies, surveys with high response rates (see Survey Research on page 122, cost-effectiveness analyses and decision analyses (for more information see page 126), and studies of screening and diagnostic tests (see also Reports of Diagnostic Tests on page 126). Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria and/or participation or response rates, or data sources, and how these were selected for the study); the essential features of any interventions; the main outcome measures; the main results of the study; a comment section placing the results in context with the published literature and addressing study limitations; and the conclusions. Data included in research reports should be as timely and current as possible (see Timeliness of Data on page 122. A structured abstract is required; for more information, see instructions for preparing structured abstracts on page 124. Recommended length: 3000-3500 words (not including abstract, tables, figures, and references).

Clinical Trial. In these studies, individuals are randomly allocated to receive or not receive a preventive, therapeutic, or diagnostic intervention and then followed up to determine the effect of the intervention. All randomized clinical trials should include a flow diagram, and authors should provide a completed randomized trial checklist and a trial protocol. As of September 13, 2005, trials should be registered in a public registry. (These and other requirements are detailed in Reports of Clinical Trials on page 126). Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria, or data sources, and how these were selected for the study); the essential features of any interventions; the main outcome measures; the main results of the study; a comment section placing the results in context with the published literature and addressing study limitations; and the conclusions. A structured abstract is required; trial registration information (name, number, and URL) should be listed at the end of the abstract (for more information, see instructions for preparing structured abstracts on page 124). Recommended length: 3000-3500 words (not including abstract, tables, figures, and references).

Systematic Review (Including Meta-analysis). These articles are systematic, critical assessments of literature and data sources pertaining to clinical topics, emphasizing factors such as cause, diagnosis, prognosis, therapy, or prevention. All articles or data sources should be searched for and selected systematically for inclusion and critically evaluated, and the search and selection process should be described in the paper. The specific type of study or analysis, population, intervention, exposure, and tests or outcomes should be described for each article or data source. The article data sources should be as current as possible, ideally with the search having been conducted within several months of manuscript submission. Meta-analyses also will be considered as reviews.^1(pp528-529) Authors of meta-analyses are encouraged to follow the instructions provided in Reports of Meta-analyses on page 126. A structured abstract is required; for more information, see instructions for preparing structured abstracts on page 124. Recommended length: 3000-4000 words (not including abstract, tables, figures, and references).

Caring for the Critically Ill Patient. Articles published in this section are primarily original research reports, preferably clinical trials, or systematic reviews (see above classifications for manuscript submission requirements by category of article) that address virtually any aspect of critical illness, from prevention and triage, through resuscitation and acute treatment, to rehabilitation and palliation. Articles that provide new insights into the diagnosis, prognosis, and treatment of critically ill patients, as well as those that explore pathophysiological, technological, ethical, or other related aspects of critical care medicine, are welcome. For reports of original data and systematic reviews, a structured abstract is required; see instructions for preparing structured abstracts on page 124. Recommended length: 3000 to 3500 words (not including abstract, tables, figures, and references).

Brief Report. These manuscripts are short reports of original studies or evaluations or unique, first-time reports of clinical case series. A structured abstract is required; for more information, see instructions for preparing structured abstracts on page 124. Recommended length: 1000-1500 words (not including abstract, tables, figures, and references).

Special Communication. These manuscripts describe an important issue in clinical medicine, public health, health policy, or medical research in a scholarly, thorough, well-referenced, systematic or evidence-based manner. A narrative (unstructured) abstract of 200 words or fewer is required. Recommended length: up to 3000 words (not including tables, figures, or references).

Commentary. These papers may address virtually any important topic in medicine, public health, research, or health policy and generally are not linked to a specific article. Commentaries should be well focused, scholarly, and clearly presented. Recommended length: 1500-2000 words, with 1 table or figure, and approximately 20 references.

A Piece of My Mind. Most essays published in A Piece of My Mind are personal vignettes (eg, exploring the dynamics of the patient-physician relationship) taken from wide-ranging experiences in medicine; occasional pieces express views and opinions on the myriad controversial issues that affect the profession. Length limit: 1800 words.

Letter to the Editor. Letters discussing a recent JAMA article will have the best chance of acceptance if they are received within 4 weeks of the article’s publication. They should not exceed 400 words of text and 5 references; letters not meeting these specifications are generally not considered. They should be double-spaced and a word count should be provided. The text of letters should include the names, academic degrees, and primary institutional affiliations for all authors, and the e-mail address for the corresponding author. Letters must not duplicate other material published or submitted for publication and should not include unpublished data. Letters will be published at the discretion of the editors and are subject to abridgement and editing for style and content.

Research Letter. Research Letters reporting original research should not exceed 600 words of text and 6 references and may include a table or figure. Letters must not duplicate other material published or submitted for publication. In general, Research Letters should be divided into the following sections: To the Editor (which serves as an introduction), Methods, Results, and Comment. They should be double-spaced and a word count should be provided with each letter. They should not include an abstract, but otherwise should follow all of the guidelines in Manuscript Preparation and Submission. Research letters considered for publication undergo external peer review.

The following categories of articles require a presubmission inquiry and discussion with an editor:

Clinical Review. These review articles address a specific question or issue that is relevant for clinical practice and provide an evidence-based, balanced, patient-oriented review on a focused topic. Clinical reviews should include the clinical question or issue and its importance for general medical practice, specialty practice, or public health; description of how the relevant evidence was identified, assessed for quality, and selected for inclusion; synthesis of the available evidence such that the best-quality evidence (eg, well-conducted clinical trials, meta-analyses, and prospective cohort studies) should receive the greatest emphasis; and discussion of controversial aspects and unresolved issues. A structured abstract is required; for more information, see instructions for preparing structured abstracts on page 124. Maximum length: 3000 words of text, with no more than a total of 4 tables and/or figures and no more than 50 references. Authors interested in submitting a Clinical Review manuscript should contact the editorial office prior to manuscript preparation and submission by sending an e-mail to lauerm@ccf.org.

Controversies. The Controversies section provides a forum for debate, discussion, and examination of challenging issues and difficult questions in clinical medicine, research, public health, or health policy. The section uses a “view-counterview” or “point-counterpoint” format, in which 2 articles address the topic or issue and present opposing viewpoints or positions. Manuscripts should be well argued, cogent, and scholarly, with appropriate documentation for scientific content and factual assertions. Recommended length is 2000 words of text, with 20 to 25 references and a maximum of 1 table or figure. Authors interested in submitting a paper for the Controversies section should contact the editorial office prior to manuscript submission by sending an e-mail to phil.fontanarosa@jama-archives.org.

Grand Rounds. These papers present a case-based discussion of a clinically relevant topic. They are to a great extent a faithful reproduction of the actual Grand Rounds presentation that was made by the author. We recommend that the presentation be transcribed or taped to assist the author in maintaining the realism of the presentation. Grand Rounds papers begin with a case presentation or, preferably, an interview with the actual patient who has the disease or condition under discussion. Following the case summary, the topic is presented in the same way as it was at the actual “live” Grand Rounds, addressing the available evidence on epidemiology, etiology, clinical presentation and evaluation, and therapy, when appropriate. A narrative (unstructured) abstract of 200 words or fewer is required. Maximum length: 3500 words, with no more than 50 references and no more than 4 tables and figures. For a recent example see JAMA. 2004:292:1857-1861. Authors interested in submitting a Grand Rounds presentation should contact the editorial office prior to manuscript preparation and submission by sending an e-mail to dcooper@lifebridgehealth.org.

Health Law and Ethics. These manuscripts discuss important issues in law and/or ethics with implications for patient care or physician practice and of general medical interest. The manuscript may report original data, although more often is a scholarly, well-referenced and systematic review of the topic. The manuscript content must be original, and manuscripts derived from previously published material (for example, a law review article) are not acceptable. For reports of original data and systematic reviews, a structured abstract is required; see instructions for preparing structured abstracts on page 124. For all other manuscripts, a narrative (unstructured) abstract of 200 words or fewer is required. Recommended length: up to 4000 words (not including references or abstract). Authors interested in submitting a Health Law and Ethics manuscript should contact the editorial office prior to manuscript and submission by sending an e-mail to helene.cole@jama-archives.org.

On Call.JAMA On Call is a peer-reviewed section devoted to postgraduate medical education and training. It provides an ongoing forum for discourse on educational, professional, and scientific topics of special relevance to residents and fellows. Topics of interest include but are not limited to education and training, career development, technology, international medicine, ethical and medicolegal concerns, psychosocial issues, and historical perspectives. The manuscript content must be original and may represent Original Contributions, systematic Reviews, or scholarly Commentaries (see above classifications for manuscript submission and abstract requirements by category of article). Manuscripts reporting original research may be up to 3000 words (excluding abstract, references, tables or figures); others should be limited to fewer than 2000 words. Manuscripts are subject to internal review by the section editorial board, as well as external peer review. Authors interested in submitting an On Call manuscript should contact the editorial office prior to manuscript preparation and submission by sending an e-mail to robert.golub@jama-archives.org.

Patient-Physician Relationship. Articles published in this section are scholarly, clinically-relevant considerations of various aspects of the patient-physician relationship and its importance in medical care. These articles may be Original Contributions, Clinical Trials, Systematic Reviews (in those cases meeting the JAMA requirements for articles in those categories), or evidence-based essays dealing with a topic important to the relationship between patients and physicians. (For a recent example see JAMA. 2005;293:1100-1106.) For reports of original data and systematic reviews, a structured abstract is required; see instructions for preparing structured abstracts on page 124. For all other manuscripts, a narrative (unstructured) abstract of 200 words or fewer is required. Recommended length: 3000-4000 words. Authors interested in submitting a Patient-Physician Relationship manuscript should contact the editorial office prior to manuscript submission by sending an e-mail to richard.glass@jama-archives.org.

Poetry and Medicine. Poems may be submitted by e-mail or as attachments to e-mail to jamapoems@jama-archives.org.

Review of Books, Journals, New Media. Reviews of books, journals, and new media are invited by the editor and may be submitted by e-mail or as attachments to e-mail to harriet.meyer@jama-archives.org.

Questions about any other categories of articles should be directed to the editorial office.

Authorship Criteria and Contributions. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. One or more authors should take responsibility for the integrity of the work as a whole, from inception to published article. Authorship credit should be based only on (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; and (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. Conditions 1, 2, and 3 must all be met.^1- 2

All authors (ie, the corresponding author and each coauthor) must complete and submit an authorship form with signed statements on (1) authorship responsibility, criteria, and contributions, (2) financial disclosure, and (3) either copyright transfer or federal employment.^1(pp89-93) In addition, authors are required to identify their contributions to the work described in the manuscript.

For reports of original data and systematic reviews, authors’ specific contributions will be published in the Acknowledgment. The authors also must certify that the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere (see also Duplicate/Previous Publication or Duplicate Submission). Authors of manuscripts reporting original data or systematic reviews must provide an access to data statement from at least one named author, often the corresponding author (see also Data Access and Responsibility). If requested, authors should be prepared to provide the data or cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees.

Acknowledgment. The corresponding author must sign the Acknowledgment statement. See Authorship Form on page 127. The Acknowledgment should include the names, affiliations, and specific contributions of all persons who have contributed to the work reported in the manuscript (eg, data collection, analysis, writing or editing assistance) but who do not fulfill authorship criteria, and also indicate whether any compensation was received for such contributions. Authors should obtain written permission from all individuals named in the Acknowledgment.^1(pp96-97) All financial and material support should be reported in the Acknowledgment section of the manuscript, along with detailed information on the roles of each sponsor or funder (see also Funding/Support and Role of Sponsor).

Corresponding Author. If the manuscript is accepted, the corresponding author (or coauthor designee) will serve on behalf of all coauthors as the primary correspondent with the editorial office, to review an edited typescript and proof in a timely manner, and to make decisions regarding release of information in the manuscript to the news media, federal agencies, or both, and will be identified as such in the published article.

Group Authorship. If authorship is attributed to a group (either solely or in addition to 1 or more individual authors), all members of the group must meet the full criteria and requirements for authorship as described above.⁴ A group must designate 1 or more individuals as authors or members of a writing group who meet full authorship criteria and requirements. Other group members who are not authors may be listed in an Acknowledgment.^1(pp93-95)

Conflict of Interest. A conflict of interest may exist when an author (or the author’s institution or employer) has financial or personal relationships that could inappropriately influence (or bias) the author’s decisions, work, or manuscript. All authors are required to report potential conflicts of interest, including specific financial interests relevant to the subject of their manuscript, in their cover letter and on JAMA’s financial disclosure form or in an attachment to the form. Authors without relevant financial interests in the manuscript should indicate no such interest (see Authorship Form on page 127).^5- 6

Authors are required to report detailed information regarding all financial and material support for the research and work, including but not limited to grant support, funding sources, and provision of equipment and supplies. Each author also is required to sign and submit the following financial disclosure statement: “I certify that all my affiliations with or financial involvement, within the past 5 years and foreseeable future (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties) with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript are completely disclosed.”

Authors are expected to provide detailed information about any relevant financial interests or financial conflicts within the past 5 years and for the foreseeable future, particularly those present at the time the research was conducted and up to the time of publication, as well as other financial interests, such as relevant filed or pending patents or patent applications in preparation, that represent potential future financial gain. Although many universities and other institutions and organizations have established policies and thresholds for reporting financial interests and other conflicts of interest, JAMA requires complete disclosure of all relevant financial relationships and potential financial conflicts of interest, regardless of amount or value. If authors are uncertain about what might constitute a potential financial conflict of interest, they should err on the side of full disclosure and should contact the editorial office if they have questions or concerns. In addition, authors who have no relevant financial interests are asked to provide a statement indicating that they have no financial interests related to the material in the manuscript.

This information is for the editorial office and is not shared with peer reviewers. However, for all accepted manuscripts, each author’s disclosures of relevant financial interests and declarations of no relevant financial interests will be published. Decisions about whether financial information provided by authors should be published, and thereby disclosed to readers, are usually straightforward. Although editors are willing to discuss disclosure of specific financial information with authors, JAMA’s policy is one of complete disclosure of all relevant financial interests.

The policy requesting disclosure of conflicts of interest applies for all manuscript submissions, including letters to the editor and book reviews.

Funding/Support and Role of Sponsor. All financial and material support for the research and the work should be clearly and completely identified in an Acknowledgment. The specific role of the funding organization or sponsor in each of the following should be specified: “design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.”^5- 6

Data Access and Responsibility. For all reports (regardless of funding source) containing original data, at least 1 author (eg, the principal investigator) who is independent of any commercial funder should indicate that she or he “had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.”⁵ For industry-sponsored studies, this statement must be provided by an investigator who is not employed by any commercial funder, and an independent data analysis must be conducted by statisticians at an academic institution with access to the raw data set, rather than only by statisticians employed by the company sponsoring the research. Details of this independent statistical analysis, the name and institutional affiliation of the independent statistician, and whether compensation or funding was received for conducting the analyses should be reported in the Acknowledgment.⁶

Duplicate/Previous Publication or Submission. Manuscripts are considered with the understanding that they have not been published previously in print or electronic format and are not under consideration by another publication or electronic medium. Copies of related or possibly duplicative materials (ie, those containing substantially similar content or using the same or similar data) that have been previously published or are under consideration elsewhere must be provided at the time of manuscript submission.^1(pp98-102)

Timeliness of Data. Data included in research reports submitted to JAMA should be as timely and current as possible.⁷ Manuscripts based on data from randomized controlled trials should be reported as soon as possible after the trial has ended, ideally within 1 year after follow-up has been completed. For cohort studies, the date of final follow-up should be no more than 3 to 4 years before manuscript submission. Likewise, data used in case-control or cross-sectional studies should have been collected as recently as possible, but certainly less than 3 to 4 years ago. Authors of manuscripts that report data that have been collected more than 4 years ago should provide an explanation regarding the relevance of the information in light of current knowledge and medical practice.

Survey Research. Manuscripts reporting survey data, such as studies involving patients, clinicians, the public, or others, should report data collected as recently as possible, ideally within the past 2 years.⁷ Survey studies should have sufficient response rates (generally at least 60%) and appropriate characterization of nonresponders to ensure that nonresponse bias does not threaten the validity of the findings. For most surveys, such as those conducted by telephone, personal interviews (eg, drawn from a sample of households), mail, e-mail, or via the Web, authors are encouraged to report the survey outcome rates using standard definitions and metrics, as proposed by the American Association for Public Opinion Research.⁸

Reporting Race/Ethnicity. If race and/or ethnicity is reported, indicate who classified individuals as to race/ethnicity, the classifications, and whether the options were defined by the investigator or the participant. Explain why race and/or ethnicity was assessed in the study.⁹

Ethical Approval of Studies and Informed Consent. For human or animal experimental investigations, appropriate institutional review board approval is required and should be so stated.^1(p140) For those investigators who do not have formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed.¹⁰ For investigations of human subjects, state in the Methods section the manner in which informed consent was obtained from the study participants (ie, oral or written).

Identification of Patients in Descriptions, Photographs, and Pedigrees. A signed statement of informed consent to publish (in print and online) patient descriptions, photographs, and pedigrees should be obtained from all persons (parents or legal guardians for minors) who can be identified (including by the patients themselves) in such written descriptions, photographs, or pedigrees and should be submitted with the manuscript. Such persons should be shown the manuscript before its submission.^1(pp141-142) Omitting data or making data less specific to deidentify patients is acceptable but changing any such data are not acceptable. See patient permission form.

Personal Communications and Unpublished Data. A signed statement of permission should be included from each individual identified as a source of information in a personal communication or as a source for unpublished data, and the date of communication and whether the communication was written or oral should be specified.^1(p125)

Previous Presentation or Release of Information. A complete report following presentation at a meeting or publication of preliminary findings elsewhere (eg, an abstract) can be considered. Media coverage of meeting presentations will not jeopardize consideration, but direct release of information through press releases or news media briefings may preclude consideration by JAMA.¹¹ Rare instances of papers reporting public health emergencies should be discussed with the editor. Authors submitting manuscripts or letters to the editor regarding adverse drug or medical device reactions, reportable diseases, etc, should also report such to the relevant government agency.

Embargo Policy. All information regarding the content and publication date of accepted manuscripts is strictly confidential. Information contained in or about accepted articles cannot appear in print, on radio or television, or in electronic form or be released by the news media until 3 PM Central Time on Tuesday, the day before its publication date (or other specified embargo release date for the rare cases in which articles are released early).¹¹

Unauthorized Use. Published manuscripts become the permanent property of the American Medical Association (AMA) and may not be published elsewhere without written permission. Unauthorized use of the JAMA name, logo, or any content for commercial purposes or to promote commercial goods and services (in any format, including print, video, audio, and digital) is not permitted by JAMA or the AMA.

Authors will be sent notifications of the receipt of manuscripts and editorial decisions by e-mail. During the review process, authors can check the status of their submitted manuscript via the online manuscript submission and review system (http://manuscripts.jama.com).

JAMA receives more than 5000 papers each year and publishes about 7% of unsolicited manuscripts. For additional information see JAMA. 2005;293:1123.¹²

Manuscripts should meet the following criteria: material is original; writing is clear; study methods are appropriate; data are valid; conclusions are reasonable and supported by the data; information is important; and topic has general medical interest. From these basic criteria, the editors assess a paper’s eligibility for publication.

Editorial and Peer Review. All submitted manuscripts are reviewed initially by a JAMA editor. Manuscripts with insufficient priority for publication are rejected promptly. Other manuscripts are sent to expert consultants for peer review. Peer reviewer identities are kept confidential, but author identities are made known to reviewers. The existence of a manuscript under review is not revealed to anyone other than peer reviewers and editorial staff. Information from submitted manuscripts may be systematically collected and analyzed as part of research to improve the quality of the editorial or peer review process. Identifying information remains confidential.

Editing. Accepted manuscripts are edited in accordance with the American Medical Association Manual of Style¹ and returned to the author for approval. Authors are responsible for all statements made in their work, including changes made by the manuscript editor and authorized by the corresponding author.

Reprints. Reprint order forms are included with the edited typescript sent for approval to the corresponding author. Reprints ship 2 weeks after publication.

ePrints. Corresponding authors who provide an e-mail address for publication will receive an electronic link that provides 25 free online accesses to the PDF view of their article.

Manuscripts should be prepared in accordance with the American Medical Association Manual of Style¹ and/or the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.²

Cover Letter. Include a cover letter and complete contact information for the corresponding author (postal/mail address, e-mail address, and telephone and fax numbers) and whether the authors have published or submitted any related papers from the same study (see Duplicate/Previous Publication or Submission on page 122).

Manuscript Components. Include a title page, abstract, text, references, and as appropriate, figure legends, tables, and figures. Start each of these sections on a new page, numbered consecutively, beginning with the title page.

Recommended File Sizes. We recommend individual file sizes of no more than 500 KB and not exceeding 1 MB, with the total size for all files not exceeding 5 MB (not including any video files).

Manuscript File Formats. For submission and review, acceptable manuscript file formats include Word, WordPerfect, PDF, EPS, Text, Postscript, or RTF format. However, if the manuscript is accepted for publication, a PDF text file cannot be used and authors will be asked to send it in Word or WordPerfect format.

Use 10-, 11-, or 12-point font size, double-space text, and leave right margins unjustified (ragged).

Line numbers on each page of text are also helpful for reviewers.

Title Page. The title page should include a word count for text only and the full names, highest academic degrees, and affiliations of all authors. If an author’s affiliation has changed since the work was done, the new affiliation also should be listed.

Abstract. Include a structured abstract of no more than 300 words for reports of original data, reviews and, meta-analyses. (See instructions for preparing structured abstracts on this page) For other major manuscripts, include an unstructured abstract of no more than 200 words that summarizes the objective, main points, and conclusions of the article. Abstracts are not required for editorials, commentaries, and some special features.

Abbreviations. Do not use abbreviations in the title or abstract and limit their use in the text. Expand all abbreviations at first mention in the text.

Units of Measure. Conventional units of measure are preferred, with Système International (SI) units expressed secondarily (in parentheses). In tables and figures, a conversion factor to SI may be presented in the footnote or legend to economize space. Exceptions to this policy include calories, hematocrit, glycosylated hemoglobin, blood cell counts, and ejection fraction, for which conventional units alone should be expressed. The metric system is preferred for the expression of length, area, mass, and volume. For more details, see SI unit conversion table.

Names of Drugs, Devices, and Other Products. Use nonproprietary names of drugs, devices, and other products, unless the specific trade name of a drug is essential to the discussion.^1(pp355-356)

Gene Names and Symbols. Consult the Human Genome Organisation Gene Nomenclature Committee site for gene names and symbols (http://www.gene.ucl.ac.uk/nomenclature).

Reproduced Material.JAMA does not republish text, tables, figures, or other material from other publishers, except under rare circumstances. Please delete any such material and replace with originals.

References. Authors are responsible for the accuracy and completeness of their references and for correct text citation. Number references in the order they appear in the text; do not alphabetize. In text, tables, and legends, identify references with superscript arabic numerals. When listing references, follow AMA style^1(pp28-51) and abbreviate names of journals according to Index Medicus. Note: List all authors and/or editors up to 6; if more than 6, list the first 3 followed by “et al.”

Examples of Reference Style:

1. Carrat F, Bani-Sadr F, Pol S, et al; for the ANRS HCO2 RIBAVIC Study Team. Pegylated interferon alfa-2b vs standard interferon alfa-2b, plus ribavirin, for chronic hepatitis C in HIV-infected patients: a randomized controlled trial. JAMA. 2004;292:2839-2848.

2. Dybul M, Connors M, Fauci AS. Immunology of HIV infection. In: Paul WE, ed. Fundamental Immunology. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1285-1318.

3. The key and critical objectives of JAMA. Available at: http://jama.ama-assn.org/about_current.dtl. Accessed January 5, 2005.

Tables. Number all tables in the order of their citation in the text. Include a title for each table (a brief phrase, preferably no longer than 10 to 15 words). Include all tables in a single file following the manuscript. Refer to Categories of Articles as there may be a limit on the number of tables for the type of manuscript. If a table must be continued, repeat the title on a second sheet, followed by “(cont).” See Instructions for Table Creation.

Figures. Number all figures (graphs, charts, photographs, and illustrations) in the order of their citation in the text. Include a title for each figure (a brief phrase, preferably no longer than 10 to 15 words).

For initial manuscript submissions, figures must be of sufficient quality for editorial assessment and peer review. Please note, however, if the manuscript is accepted, authors will be asked to provide figures that meet the Guidelines for Figures in Accepted Manuscripts. All graphs, charts, illustrations, titles, and legends of accepted manuscripts will be re-created or edited according to JAMA style and standards prior to publication.

Acceptable Figure File Size: To reduce the time that it takes to upload files to the JAMA submission site and for reviewers to download files from the site, we recommend that the file size of figures be compressed before uploading them. This can be done by using compression software or by decreasing the resolution of individual files.

Acceptable Figure File Formats: At submission, the following file formats are acceptable: AI, BMP, DOC, EMF, EPS, JPG, PDF, PPT, PSD, TIF, WMF, or XLS. Figures may be embedded at the end of the manuscript text file or loaded as separate files for submission purposes.

Figure Legends (Captions): Include a legend for each photograph, graph, and illustration at the end of the manuscript (maximum length, 40 words). For photomicrographs, include the type of specimen, original magnification or a scale bar, and stain. For gross pathology specimens, label any rulers with unit of measure.

Number of Figures: Refer to Categories of Articles as there may be a limit on the number of figures for the type of manuscript.

Video. Video file formats acceptable at submission are MOV, AVI, MPEG, RM, and WM, and the file size should not exceed 5 MB with a maximum dimension of 800 pixels wide and/or 600 pixels deep.

All reports of original data, systematic reviews and meta-analyses, and clinical reviews should be submitted with structured abstracts as described below. No information should be reported in the abstract that does not appear in the text of the manuscript. The following is adapted from “More informative abstracts revisited.”¹³

Reports of Original Data. Reports of original data should include an abstract of no more than 300 words using the following headings: Context, Objective, Design, Setting, Patients (or Participants), Interventions (include only if there are any), Main Outcome Measure(s), Results, and Conclusions. For brevity, parts of the abstract may be written as phrases rather than complete sentences. Each section should include the following content:

Context: The abstract should begin with a sentence or 2 explaining the clinical (or other) importance of the study question.

Objective: State the precise objective or study question addressed in the report (eg, “To determine whether . . . ”). If more than 1 objective is addressed, the main objective should be indicated and only key secondary objectives stated. If an a priori hypothesis was tested, it should be stated.

Design: Describe the basic design of the study. State the years of the study and the duration of follow-up. If applicable, include the name of the study (eg, the Framingham Heart Study).

Setting: Describe the study setting to assist readers to determine the applicability of the report to other circumstances, for example, general community, a primary care or referral center, private or institutional practice, or ambulatory or hospitalized care.

Patients or Other Participants: State the clinical disorders, important eligibility criteria, and key sociodemographic features of patients. The numbers of participants and how they were selected should be provided (see below), including the number of otherwise eligible individuals who were approached but refused. If matching is used for comparison groups, characteristics that are matched should be specified. In follow-up studies, the proportion of participants who completed the study must be indicated. In intervention studies, the number of patients withdrawn because of adverse effects should be given. For selection procedures, these terms should be used, if appropriate: random sample (where random refers to a formal, randomized selection in which all eligible individuals have a fixed and usually equal chance of selection); population-based sample; referred sample; consecutive sample; volunteer sample; convenience sample.

Intervention(s): The essential features of any interventions should be described, including their method and duration of administration. The intervention should be named by its most common clinical name, and nonproprietary drug names should be used.

Main Outcome Measure(s): Indicate the primary study outcome measurement(s) as planned before data collection began. If the manuscript does not report the main planned outcomes of a study, this fact should be stated and the reason indicated. State clearly if the hypothesis being tested was formulated during or after data collection.

Results: The main outcomes of the study should be provided and quantified, including confidence intervals (for example, 95%) or P values. For comparative studies, the differences between groups should be expressed with confidence intervals. Explain outcomes or measurements unfamiliar to a general medical readership. Important measurements not presented in results should be declared. As relevant, indicate whether observers were blinded to patient groupings, particularly for subjective measurements. If differences for the major study outcome measure(s) are not significant, the clinically important difference sought should be stated and the confidence interval for the difference between the groups should be given. When risk changes or effect sizes are given, absolute values should be indicated. Approaches such as number needed to treat to achieve a unit of benefit are encouraged when appropriate; reporting of relative differences alone is insufficient. Studies of screening and diagnostic tests should report sensitivity, specificity, and likelihood ratio. If predictive value or accuracy is given, prevalence or pretest likelihood should be given as well. All randomized controlled trials should include the results of intention-to-treat analysis, and all surveys should include response rates.

Conclusions: Provide only conclusions of the study directly supported by the results, along with implications for clinical practice, avoiding speculation and overgeneralization. Indicate whether additional study is required before the information should be used in usual clinical settings. Give equal emphasis to positive and negative findings of equal scientific merit.

Trial Registration: For clinical trials, provide the name of the trial registry, registration number, and URL of the registry.

Systematic Reviews/Meta-analyses. Manuscripts reporting the results of meta-analyses should include an abstract of no more than 300 words using the following headings: Context, Objective, Data Sources, Study Selection, Data Extraction, Data Synthesis, and Conclusions. The text of the manuscript should also include a section describing the methods used for data sources, study selection, data extraction, and data synthesis. Each heading should be followed by a brief description:

Context: A sentence or 2 explaining the importance of the review question.

Objective: State the precise primary objective of the review. Indicate whether the review emphasizes factors such as cause, diagnosis, prognosis, therapy, or prevention and include information about the specific population, intervention, exposure, and tests or outcomes that are being reviewed.

Data Sources: Succinctly summarize data sources, including years searched. The search should include the most current information possible, ideally with the search being conducted within several months before the date of manuscript submission. Potential sources include computerized databases and published indexes, registries, abstract booklets, conference proceedings, references identified from bibliographies of pertinent articles and books, experts or research institutions active in the field, and companies or manufacturers of tests or agents being reviewed. If a bibliographic database is used, state the exact indexing terms used for article retrieval, including any constraints (for example, English language or human subjects). If abstract space does not permit this level of detail, summarize sources in the abstract including databases and years searched, and place the remainder of the information in the Methods section.

Study Selection: Describe inclusion and exclusion criteria used to select studies for detailed review from among studies identified as relevant to the topic. Details of selection should include particular populations, interventions, outcomes, or methodological designs. The method used to apply these criteria should be specified (for example, blinded review, consensus, multiple reviewers). State the proportion of initially identified studies that met selection criteria.

Data Extraction: Describe guidelines used for abstracting data and assessing data quality and validity (such as criteria for causal inference). The method by which the guidelines were applied should be stated (for example, independent extraction by multiple observers).

Data Synthesis: State the main results of the review, whether qualitative or quantitative, and outline the methods used to obtain these results. Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. Numerical results should be accompanied by confidence intervals, if applicable, and exact levels of statistical significance. Evaluations of screening and diagnostic tests should include sensitivity, specificity, likelihood ratios, receiver operating characteristic curves, and predictive values. Assessments of prognosis should summarize survival characteristics and related variables. Major identified sources of variation between studies should be stated, including differences in treatment protocols, co-interventions, confounders, outcome measures, length of follow-up, and dropout rates.

Conclusions: The conclusions and their applications (clinical or otherwise) should be clearly stated, limiting interpretation to the domain of the review.

Clinical Reviews. Clinical Review articles should include an abstract of no more than 250 words with the following sections: Context, Evidence Acquisition, Evidence Synthesis, and Conclusions.

Context: Include 1 or 2 sentences describing the clinical question or issue and its importance in clinical practice or public heath.

Evidence Acquisition: Describe the data sources used, including the search strategies, years searched, and other sources of material, such as subsequent reference searches of retrieved articles. Methods used for quality assessment and inclusion of identified articles should be explained.

Evidence Synthesis: The major findings of the review of the clinical issue or topic should be addressed in an evidence-based, objective, and balanced fashion, with the highest quality evidence available receiving the greatest emphasis.

Conclusions: The conclusions should clearly answer the questions posed if applicable, be based on available evidence, and emphasize how clinicians should apply current knowledge.

Manuscripts reporting the results of randomized controlled trials (RCTs) should include the CONSORT flow diagram showing the progress of patients throughout the trial (see Figure). The CONSORT checklist also should be completed and submitted with the manuscript.¹⁴

Protocols. Authors of RCTs are also encouraged to submit trial protocols along with their manuscripts.

Trial Registration. As a member of the International Committee of Medical Journal Editors (ICMJE), JAMA will require, as a condition of consideration for publication, registration of all trials in a public trials registry that requires the minimum registration data set as determined by the World Health Organization and the ICMJE.^2,15- 16 Trials must be registered at or before the onset of patient enrollment. This policy applies to any clinical trial starting enrollment after July 1, 2005. For trials that began enrollment before this date, registration will be required by September 13, 2005, before considering the trial for publication. For this purpose, the ICMJE defines a clinical trial as any study that prospectively assigns human subjects to intervention or comparison groups to evaluate the cause-and-effect relationship between a medical intervention and a health outcome. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (eg, phase 1 trials), are exempt. The trial registry name, registration number, and the URL for the registry should be included at the end of the abstract.

Reports of Diagnostic Tests. Authors of reports of diagnostic tests are encouraged to submit the STARD flow diagram and checklist (for more information, see Clin Chem. 2003;49:1-6, 7-18 or http://www.clinchem.org/cgi/content/full/49/1/1).

Reports of Meta-analyses. Authors of reports of meta-analyses of randomized trials are encouraged to submit the QUOROM flow diagram and checklist (http://www.consort-statement.org/QUOROM.pdf). Authors of meta-analyses of observational studies are encouraged to submit the MOOSE checklist (http://www.consort-statement.org/MOOSE.pdf).

Reports of Cost-effectiveness Analyses and Decision Analyses. Authors of reports of cost-effectiveness analyses and decision analyses must submit a copy of the decision tree comprising their model. This is for editorial evaluation and review, not for publication, unless it is included in the body of the manuscript itself.

□  1. Review manuscript submission instructions on our Web-based submission and review system (http://manuscripts.jama.com).

□  2. Include a cover letter as an attachment.

□  3. Designate a corresponding author and provide a complete postal/mail address, telephone and fax numbers, and e-mail address.

□  4. Provide first and last names, e-mail addresses, and institutional affiliations for any coauthors.

□  5. On the title page, include a word count for text only, exclusive of title, abstract, references, tables, and figure legends.

□  6. Provide an abstract that conforms to the required abstract format.

□  7. Double-space manuscript and leave right margins unjustified (ragged).

□  8. Check all references for accuracy and completeness. Put references in proper format in numerical order, making sure each is cited in sequence in the text.

□  9. Include a title for each table and figure (a brief, succinct phrase, preferably no longer than 10 to 15 words) and explanatory legend as needed.

□ 10. Have each author read, complete, and sign the Authorship Form with statements of authorship responsibility, criteria, and contributions; financial disclosure; and copyright transfer. After submission, add the manuscript number to the top of each author form and send in the author forms by mail or fax to the editorial office.

□ 11. Indicate specific contributions from each author (see authorship checklist on Authorship Form).

□ 12. Include statement signed by corresponding author that written permission has been obtained from all persons named in the Acknowledgment.

□ 13. For reports of original data, include statement from at least 1 author that she or he “had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.”

□ 14. Include research or project support/funding in the Acknowledgment.

□ 15. Also in the Acknowledgment, specify the role of the funder(s) or sponsor(s) in each of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

□ 16. Include written permission from each individual identified as a source for personal communication or unpublished data.

□ 17. If appropriate, include information on institutional review board/ethics committee approval or waiver and informed consent.

□ 18. Reprinted tables and figures are discouraged. Original material should be provided, except under extraordinary circumstances.

□ 19. Include informed consent forms for identifiable patient descriptions, photographs, and pedigrees.