Instructions for Authors FREE

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

Manuscript Submission. We encourage authors to submit manuscripts via e-mail. Send manuscripts to the Editor, JAMA, at jamams@jama-archives.org. Include a cover letter and complete contact information for the corresponding author: address, telephone and fax numbers, and e-mail address. Tables, figures, and text should be included in the same file if possible. Manuscripts submitted by e-mail should not also be submitted by mail or fax. See Manuscript Checklist and details in these instructions for additional requirements. Editorial office contact information: JAMA, 515 N State St, Chicago, IL 60610, USA; telephone: (312) 464-2402; fax: (312) 464-5824; e-mail: jamams@jama-archives.org.

Previous Publication or Duplicate 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 being considered elsewhere must be provided at the time of manuscript submission.^1(pp98-102)

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.² 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, and the like should also report such to the relevant government agency.

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 All such manuscripts must be screened and approved for JAMA-EXPRESS before submission. 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.

JAMA publishes original contributions, reviews, brief reports, special communications, commentaries, and many other categories of articles. Authors do not need to define manuscript categories before submission. 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 Contributions. Randomized trials, intervention studies, studies of screening and diagnostic tests, cohort studies, cost-effectiveness analyses, case-control studies, and surveys with high response rates. Registered trials should include the registry and registration number. 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. For more information, see instructions for preparing structured abstracts on page 111. Typical length: up to 3500 words (not including abstract, tables, figures, and references).

Systematic Reviews. 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 selected systematically for inclusion and be critically evaluated, and the 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. Meta-analyses also will be considered as reviews.^1(pp528-529) For more information, see instructions for preparing structured abstracts on page 111. Typical length: up to 3000 words (not including tables, figures, and references).

Clinical Reviews. 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. 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.

Brief Reports. These manuscripts are short reports of original studies or evaluations or unique, first-time reports of clinical case series. Typical length: up to 1500 words (not including abstract, tables, figures, and references).

Special Communications. 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. Typical length: up to 3000 words (not including tables, figures, or references, or an unstructured abstract of 200 words).

Commentaries. Unsolicited papers that 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. Typical length: 1500-2000 words, with 1 table or figure, and approximately 20 references.

Letters 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. Such letters should not exceed 400 words of text and 5 references.

Research Letters reporting original research also are welcome and should not exceed 600 words of text and 6 references and may include a table or figure. In general, Research Letters should be divided into the following sections: To the Editor (which serves as an introduction), Methods, Results, and Comment.

Letters should be double-spaced and a word count should be provided with each letter. We prefer that letters be submitted electronically, to jama-letters@jama-archives.org. Letters can also be faxed to the editorial office at (312) 464-5225 (also mail a hard copy).

Manuscripts should meet the following criteria: material is original; writing is clear; study methods are appropriate; the data are valid; conclusions are reasonable and supported by the data; information is important; and topic has general medical interest. From these basic criteria, we assess a paper’s eligibility for publication. We receive more than 5000 papers each year and publish about 7% of unsolicited manuscripts.

Designate a corresponding author and provide a complete address, telephone and fax numbers, and e-mail address. The corresponding author will be identified as such in the published article.

Authorship Requirements. 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.⁴

Authors are required to identify their contributions to the work described in the manuscript. With the cover letter include the authorship form with statements on (1) authorship responsibility, criteria, and contributions, (2) financial disclosure, and (3) either copyright transfer or federal employment. Each of these 3 statements must be read and signed by all authors.^1(pp89-93) (4) The corresponding author must sign the Acknowledgment statement, indicating the names and 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. Authors should obtain written permission from all individuals named in an Acknowledgment.^1(pp96-97) See Authorship Criteria and Responsibility Form.

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.⁵ 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)5

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 Criteria and Responsibility Form).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.

This policy 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 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.⁶

Data Access and Responsibility. For reports containing original data, at least 1 author who is independent of any commercial funder (eg, the principal investigator) 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.”⁶ For industry sponsored studies, the data analysis should be conducted by statisticians at an academic center, rather than only by statisticians employed by the company sponsoring the research.

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 known by 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.

Rejected Manuscripts. Rejected manuscripts will not be returned to authors. Print copies of original illustrations, photographs, and slides will be returned if requested.

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.

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 CT on Tuesday, the day before its publication date.²

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.

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.⁴

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.) 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 special features.

Ethical Requirements. 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.⁷ For investigations of human subjects, state in the Methods section the manner in which informed consent was obtained from the study participants.

Include a signed statement of informed consent to publish (in print and online) patient descriptions, photographs, and pedigrees 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. 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 is not acceptable. See patient permission form.

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.

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

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. 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.”

Authors are responsible for the accuracy and completeness of their references and for correct text citation.

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;292:2389-2848.

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. Key and critical objectives of JAMA. Available at: http://jama.ama-assn.org/about_current.dtl. Accessed December 9, 2004.

Number all tables and figures in the order of their citation in the text. Include a title for each table and figure—a brief phrase, preferably no longer than 10 to 15 words.

Tables. Include all tables in a single file following the manuscript. If a table must be continued, repeat the title on a second sheet, followed by “(cont).” See Instructions for table creation.

Figures. For initial manuscript submissions, figures must be of sufficient quality for peer review. Include all figures in a single file following the manuscript and any tables.

Digitally processed photographs must not be altered. Include internal scale markers in photomicrographs and electron micrographs.

At the time of manuscript revision or acceptance, publication-quality photographic images will be requested. All graphs and illustrations will be re-created according to JAMA style and standards prior to publication. Original illustrations, photographs, and slides from rejected manuscripts will be returned to authors if requested.

Figure Legends (captions). Include a legend for each figure at the end of the manuscript (maximum length, 40 words). For photomicrographs, include the type of specimen, original magnification, and stain.

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.”⁸

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:

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

2. 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.

3. 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).

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

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:

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

2. 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.

3. Data Sources. Succinctly summarize data sources, including years searched. 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.

4. 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.

5. 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).

6. 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.

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

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 retreived 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 trials should include the CONSORT flow diagram showing the progress of patients throughout the trial (see Figure). The CONSORT checklist (see Table) also should be completed and submitted with the manuscript.⁹ 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.^4,10 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 research project that prospectively assigns human subjects to intervention or comparison groups to study 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.

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).

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).

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.