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Instructions for Authors

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Contact Information

JAMA Network Open, Frederick P. Rivara, MD, MPH, Editor, Department of Pediatrics, Child Health Institute, University of Washington, 6200 NE 74th St, Ste 120B, Seattle, WA 98115-8160; telephone: (312) 464-5437; email: jamanetworkopen@jamanetwork.org. Manuscripts should be submitted online at https://manuscripts.jamanetworkopen.com.

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How Do I?

Know if My Article Is Right for JAMA Network Open

JAMA Network Open is interested in reports of original research on clinical care, health policy, and global health across all health disciplines and countries for clinicians, investigators, and policy makers. The journal is interested in a wide range of medical and health subject areas.

Papers that are not suitable for the journal include non–research articles, those not relevant to medicine/health, case reports, animal preclinical studies, reviews, and unsolicited opinion.

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Comments: "How Do I Determine My Article Type" section

How Do I?

Determine My Article Type

Categories of Articles

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Exclude: none
Comments: Table section
Research
Article Type
Description
Requirements
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Exclude: None
Comments: Original Investigation section now in every i4a

Clinical trial
Meta-analysis
Intervention study
Cohort study
Case-control study
Epidemiologic assessment
Survey with high response rate
Cost-effectiveness analysis
Decision analysis
Study of screening and diagnostic tests
Other observational study

Include: JAMA
Exclude: JNO + SJ
Comments: Clinical Trial section from pre-2019 rebuild of i4a. Delete when JAMA i4a updated for Study Types
Include: JAMA, PED
Exclude: CAR, DER, FPS, IMD, NEU, ONC, OPH, OTO, PSY, SUR
Comments: Caring for the Critically Ill Patient
Include: JAMA
Exclude: JNO + SJ
Comments: Entire section (including anchor) is for JAMA only. Delete when JAMA i4a updated for Study Types
Include: JAMA, CAR, NEU, ONC
Exclude: JNO, DER, FPS, IMD, OPH, PED, OTO, PSY, SUR
Comments: Brief Report
Include: DER
Exclude: JNO, JAMA, CAR, FPS, IMD, NEU, ONC, PED, PH, OTO, PSY, SUR
Comments: Brief Report
Include: OPH
Exclude: JNO, JAMA, CAR, DER, FPS, IMD, NEU, ONC, PED, OTO, PSY, SUR
Comments: Brief Report
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Comments: Research Letter, Clinical Review and Education

Concise, focused reports of original research. Can include any of the study types listed under Original Investigation.

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Comments: "How Do I Determine My Study Type" section

Study Types

How Do I?

Determine My Study Type

Include: JNO + SJ
Exclude: JAMA
Comments: Study Types Table section
Study Type
Description
Requirements

A trial that prospectively assigns participants to intervention or comparison groups to study the cause-and-effect relationship between an intervention and a health outcome. Interventions include but are not limited to drugs, surgical procedures, devices, behavioral treatments, educational programs, dietary interventions, quality improvement interventions, process-of-care changes, and the like.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Randomized Clinical Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Data Sharing Statement
  • Follow CONSORT Reporting Guidelines

A randomized trial that prospectively assigns participants to 2 or more groups to receive different interventions. Participants and those administering the interventions are unaware of which intervention individual participants are receiving.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Randomized Clinical Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Data Sharing Statement
  • Follow CONSORT Reporting Guidelines

A trial in which participants receive more than 1 of the treatments under investigation, usually in a randomly determined sequence, and with a prespecified amount of time (washout period) between sequential treatments.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Randomized Clinical Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Data Sharing Statement
  • Follow CONSORT Reporting Guidelines

A trial designed to assess whether the treatment or intervention under study (eg, a new intervention) is no worse than an existing alternative (eg, an active control). In these trials, authors must prespecify a margin of noninferiority that is consistent with all relevant studies and within which the new intervention can be assumed to be no worse than the active control.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Randomized Clinical Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Data Sharing Statement
  • Follow CONSORT Reporting Guidelines

A trial that includes random assignment of groups rather than individuals to intervention and control groups.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Randomized Clinical Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Data Sharing Statement
  • Follow CONSORT Reporting Guidelines

A trial that prospectively assigns groups or populations to study the efficacy or effectiveness of an intervention but in which the assignment to the intervention occurs through self-selection or administrator selection rather than through randomization. Control groups can be historic, concurrent, or both. This design is sometimes called a quasi-experimental design.

  • 3000-3500 words
  • ≤5 tables and/or figures, including CONSORT flow diagram
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Nonrandomized Controlled Trial"
  • Trial registration and ID
  • Trial protocol
  • CONSORT checklist
  • Follow TREND Reporting Guidelines

A document that describes the organization and plan for a randomized clinical trial, including the trial’s objective(s), design, methodology, outcomes to be measured, and statistical analysis plan.

  • 3000-3500 words
  • ≤5 tables and/or figures
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should be "A Trial Protocol"
  • Trial registration and ID
  • Trial protocol
  • Follow SPIRIT Reporting Guidelines

A systematic review that includes a statistical technique for quantitatively combining the results of multiple studies that measure the same outcome into a single pooled or summary estimate.

  • 3000-3500 words
  • ≤5 tables and/or figures
  • 50-75 references
  • Structured abstract
  • Key Points
  • Subtitle should include “A Meta-analysis”
  • Follow PRISMA Reporting Guidelines

An observational study that follows a group (cohort) of individuals who are initially free of the outcome of interest. Individuals in the cohort may share some underlying characteristic, such as age, sex, diagnosis, exposure to a risk factor, or treatment.

An observational study designed to determine the association between an exposure and outcome in which study participants are selected by outcome. Those with the outcome (cases) are compared with those without the outcome (controls) with respect to an exposure or event. Cases and controls may be matched according to specific characteristics (eg, age, sex, or duration of disease).

An observational study of a defined population at a single point in time or during a specific interval, in which exposure and outcome are ascertained simultaneously.

An observational study that describes a selected group of participants with similar exposure or treatment and without a control group. A case series may also involve observation of larger units such as groups of hospitals or municipalities, as well as smaller units such as laboratory samples.

  • 3000-3500 words
  • ≤5 tables and/or figures
  • 50-75 references
  • Structured abstract
  • Key Points
  • Follow Reporting Guidelines

A study using formal, quantitative methods to compare 2 or more treatments, programs, or strategies with respect to their resource use and expected outcomes. This includes cost-effectiveness, cost-benefit, and cost-minimization analyses.

A mathematical modeling study that compares consequences of decision options by synthesizing information from multiple sources and applying mathematical simulation techniques, usually with specific software. Reporting should address the relevant non-cost aspects of the CHEERS guideline.

A study that compares different interventions or strategies to prevent, diagnose, treat, and monitor health conditions to determine which work best for which patients, under what circumstances, and are associated with the greatest benefits and harms.

A study that attempts to identify and characterize genomic variants that may be associated with susceptibility to multifactorial disease.

A prospective study designed to develop, validate, or update the diagnostic or prognostic accuracy of a test or model.

A study that uses data to define, measure, and evaluate a health care practice or service to maintain or improve the appropriateness, quality, safety, or value of that practice or service.

A survey study includes a representative sample of individuals who are asked to describe their opinions, attitudes, or behaviors. Survey studies should have sufficient response rates (generally ≥60%) and appropriate characterization of nonresponders to ensure that nonresponse bias does not threaten the validity of the findings.

  • 3000-3500 words
  • ≤5 tables and/or figures
  • 50-75 references
  • Structured abstract
  • Key Points
  • Follow AAPOR Reporting Guidelines
  • Optional: Survey instrument as supplemental file

A study based on observation and interview with individuals that uses inductive reasoning and a theoretical sampling model and that focuses on social and interpreted, rather than quantifiable, phenomena and aims to discover, interpret, and describe rather than to test and evaluate. This includes mixed-methods studies that combine quantitative and qualitative designs in a sequential or concurrent manner.

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Comments: Article type section
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Comments: Research

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Research
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Comments: New changes to OI text require splitting to JAMA, SJ, and JNO versions.
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Comments: New changes to OI text require splitting to JAMA, SJ, and JNO versions.
Include: JNO
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Comments: New changes to OI text require splitting to JAMA, SJ, and JNO versions.

Original Investigation

These reports typically include randomized trials (see Clinical Trial), intervention studies, cohort studies, case-control studies, epidemiologic assessments, and other observational studies. A study type is required. Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study type and 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 discussion section placing the results in context with the published literature and addressing study limitations; and the conclusions and relevant implications for clinical practice or health policy. Data included in research reports must be original and should be as timely and current as possible (see Timeliness of Data). Follow EQUATOR Reporting Guidelines.

A structured abstract is required; for more information, see instructions for preparing Abstracts for Reports of Original Data. A list of 3 Key Points is required (see guidance on preparing Key Points). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and online-only material) with no more than a total of 5 tables and/or figures.

Include: JAMA
Exclude: JNO + SJ
Comments: Section is now JAMA only. Delete when JAMA i4a updated for Study Types
Include: JAMA,PED
Exclude: JNO, CAR, DER, FPS, IMD, NEU, ONC, OPH, OTO, PSY, SUR
Comments: Caring for the Critically Ill Patient
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Comments: Research Letter

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Research Letter

Research Letters are concise, focused reports of original research. These should not exceed 600 words of text and 6 references and may include up to 2 tables or figures. Online supplementary material is not allowed. Research Letters may have no more than 7 authors. The text should include the full name, academic degrees, and a single institutional affiliation for each author and the email address for the corresponding author. Other persons who have contributed to the study may be indicated in an Acknowledgment, with their permission, including their academic degrees, affiliation, contribution to the study, and an indication if compensation was received for their role. Letters must not duplicate other material published or submitted for publication. In general, Research Letters should be divided into the following sections: Introduction, Methods, Results, and Discussion. They should not include an abstract, but otherwise should follow all of the guidelines in Manuscript Preparation and Submission Requirements. Letters not meeting these specifications are generally not considered.

Include: JNO + SJ
Exclude: JAMA
Comments: Copy E and F (Trial Protocol)

Clinical Trial

These manuscripts include reports of Randomized Clinical Trials, Parallel-Design Double-blind Trials, Crossover Trials, Equivalence and Noninferiority Trials, Cluster Trials, and Nonrandomized Controlled Trials.

The ICMJE defines a clinical trial as any research project that prospectively assigns human participants to intervention or comparison groups to study the cause-and-effect relationship between an intervention and a health outcome.4 Interventions include but are not limited to drugs, surgical procedures, devices, behavioral treatments, educational programs, dietary interventions, quality improvement interventions, process-of-care changes, and the like. All manuscripts reporting clinical trials, including those limited to secondary exploratory or post hoc analysis of trial outcomes, must include the following:

  • Copy of the original trial protocol, including the complete statistical analysis plan and any amendments. The journal recommends using the SPIRIT reporting guidelines when preparing original protocols (see Protocols).
  • CONSORT flow diagram (see Figure).
  • Completed trial checklist (see Checklist).
  • Registry at an appropriate online public clinical trial registry (see Trial Registration requirements).
  • A Data Sharing Statement to indicate if data will be shared or not. Specific questions regarding the sharing of data are included in the manuscript submission system.

For additional guidance on reporting Randomized Clinical Trial, Parallel-Design Double-blind Trial, Crossover Trial, Equivalence and Noninferiority Trial, Cluster Trial, and Nonrandomized Controlled Trial, see Study Types.

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 primary and secondary outcome measures (consistent with those reported in the trial protocol); the main results of the study; a discussion section placing the results in context with the published literature and addressing study limitations; and the conclusions.

A structured abstract is required, and trial registration information (registry name, trial ID, and URL) must be listed at the end of the abstract; for more information, see instructions for preparing Abstracts for Reports of Original Data. A list of 3 Key Points is required (see guidance on preparing Key Points). Maximum length: 3500 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Randomized Clinical Trial" or, for Nonrandomized Controlled Trials, "A Nonrandomized Controlled Trial."

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Trial Registration:

In concert with the ICMJE, JAMA Network requires, as a condition of consideration for publication, registration of all trials in a public trials registry that is acceptable to the ICMJE (ie, the registry must be owned by a not-for-profit entity, be publicly accessible, and require the minimum registration data set as described by ICMJE).4,8,9

Acceptable trial registries include the following and others listed at http://www.icmje.org:

  • anzctr.org.au
  • clinicaltrials.gov
  • isrctn.org
  • trialregister.nl
  • umin.ac.jp/ctr

All clinical trials, regardless of when they were completed, and secondary analyses of original clinical trials must be registered before submission of a manuscript based on the trial. Secondary data analyses of primary (parent) clinical trials should not be registered as separate clinical trials, but instead should reference the trial registration number of the primary trial. Please note: for clinical trials starting patient enrollment after July 2005, trials must have been registered before onset of patient enrollment. For trials that began before July 2005 but that were not registered before September 13, 2005, trials must have been registered before journal submission. Trial registry name, registration identification number, and the URL for the registry should be included at the end of the abstract and also in the space provided on the online manuscript submission form.

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Protocols:

Authors of manuscripts reporting clinical trials must submit trial protocols (including the complete statistical analysis plan) along with their manuscripts. Protocols in non-English languages should be translated into English. This should include the original approved protocol and statistical analysis plan, and all subsequent amendments to either document. If the manuscript is accepted, the protocol and statistical analysis plan will be published as a supplement.

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CONSORT Flow Diagram and Checklist:

Manuscripts reporting the results of randomized trials must include the CONSORT flow diagram showing the progress of patients throughout the trial. The CONSORT checklist also should be completed and submitted with the manuscript.10

Figure. Profile of a Randomized Clinical Trial

Trial Protocol

These manuscripts are documents that describe the organization and plan for a randomized clinical trial, including the trial’s objective(s), design, methodology, all outcomes to be measured, and statistical analysis plan. All trial protocol manuscripts must include a copy of the trial protocol including the complete statistical analysis plan (see Protocols). All clinical trials that have begun randomization must be registered at an appropriate online public registry (see Trial Registration requirements). Follow SPIRIT Reporting Guidelines.

A structured abstract is required, and trial registration information (registry name, trial ID, and URL) must be listed at the end of the abstract; for more information, see instructions for preparing Abstracts for Trial Protocols. A list of 3 Key Points is required (see guidance on preparing Key Points). Maximum length: 3500 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Trial Protocol."

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Meta-analysis

These manuscripts are systematic, critical assessments of literature and data sources pertaining to clinical topics, emphasizing factors such as cause, diagnosis, prognosis, therapy, or prevention, and that includes a statistical technique for quantitatively combining the results of multiple studies that measure the same outcome into a single pooled or summary estimate. 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 manuscript. The specific type of study or analysis, population, intervention, exposure, and tests or outcomes should be described for each article or data source. The data sources should be as current as possible, ideally with the search having been conducted within several months of manuscript submission. Authors of reports of meta-analyses of clinical trials should submit the PRISMA flow diagram and checklist. Authors of meta-analyses of observational studies should submit the MOOSE checklist. Follow EQUATOR Reporting Guidelines.

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Comments: "A structured abstract is required..."
Include: JNO
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Comments: "A structured abstract is required..."

A structured abstract is required; for more information, see instructions for preparing Abstracts for Meta-analysis. A list of 3 Key Points is required (see guidance on preparing Key Points). Maximum length: 3500 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material), with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Meta-analysis."

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Comments: Other Observational Studies. Copy G

Other Observational Studies

These manuscripts include Cohort Study, Case-Control Study, Cross-sectional Study, Case Series, Economic Evaluation, Decision Analytical Model, Comparative Effectiveness Research, Genetic Association Study, Diagnostic/Prognostic Study, Quality Improvement Study, Survey Study, and Qualitative Study. 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 or exposures; the main outcome measures; the main results of the study; a discussion section placing the results in context with the published literature and addressing study limitations; and the conclusions and relevant implications for clinical practice or health policy. Data included in research reports must be original and should be as timely and current as possible (see Timeliness of Data). Follow EQUATOR Reporting Guidelines.

A structured abstract is required; for more information, see instructions for preparing Abstracts for Reports of Original Data. A list of 3 Key Points is required (see guidance on preparing Key Points). Maximum length: 3500 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references.

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Comments: Format My Manuscript

How Do I?

Format My Manuscript

Manuscript Preparation and Submission Requirements

Manuscript Submission

All manuscripts must be submitted online via the online manuscript submission and review system.

At the time of submission, complete contact information (affiliation, postal/mail address, email address, and telephone numbers) for the corresponding author is required. First and last names, email addresses, and institutional affiliations of all coauthors are also required. After the manuscript is submitted, the corresponding author will receive an acknowledgment confirming receipt and a manuscript number. Authors will be able to track the status of their manuscripts via the online system. After manuscript submission, all authors of papers under consideration for publication will be sent a link to the Authorship Form to complete and submit (see sample Authorship Form). See other details in these instructions for additional requirements.2,4

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Cover Letter

Include a cover letter and complete contact information for the corresponding author (affiliation, postal/mail address, email address, and telephone number) and whether the authors have published, posted, or submitted any related papers from the same study (see Previous Publication, Preprint Server Posting, and Related Manuscripts and Reports).

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Manuscript Style

Manuscripts should be prepared in accordance with the AMA Manual of Style, 10th edition,2 and/or the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals.4

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Manuscript Components

Include in the manuscript file a title page, abstract, text, references, and as appropriate, figure legends and tables. Start each of these sections on a new page, numbered consecutively, beginning with the title page. Figures should be submitted as separate files (1 file per figure) and not included in the manuscript text.

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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).

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Manuscript File Formats

For submission and review, please submit the manuscript as a Word document. Do not submit your manuscript in PDF format.

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

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Title Page

The title page should be the first page of your manuscript file. It should include a manuscript title; 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); name and complete contact information for corresponding author; and manuscript word count (not including title, abstract, acknowledgment, references, tables, and figure legends).

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Title

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Comments: Paragraph ("Titles should be concise...")
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Comments: Paragraph ("Titles should be concise...")

Titles should be concise, specific, and informative.2(p8) Please limit the length of titles to 150 characters for reports of research and other major articles and 100 characters for Invited Commentaries. For scientific manuscripts, do not use overly general titles, declarative titles, titles that include the direction of study results, or questions as titles. For reports of clinical trials and meta-analyses, include the type of study as a subtitle (eg, A Randomized Clinical Trial, A Meta-analysis). For reports of other types of research, do not include study type or design in the title or subtitle.

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Key Points

Include: Specialty Journals, JNO
Exclude: JAMA
Comments: Only for the line below ("With the manuscript...")

In the manuscript, include a separate section called "Key Points" before the Abstract.

Include: JAMA
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Comments: Only for the line below ("In the manuscript...")

This feature provides a quick structured synopsis of the findings of your manuscript (required only for research and review manuscripts), following 3 key points: Question, Findings, and Meaning. Limit this section to 75-100 words or less.

Question: Focused question based on the study hypothesis or goal/purpose. Limit to 1 sentence.

Findings: Results of the study/review. Include the design (eg, clinical trial, cohort study, case-control study, meta-analysis). Focus on primary outcome(s) and finding(s). Do not emphasize secondary outcomes. Report basic numbers only but state if results are statistically significant or not significant; do not include results of statistical tests or measures of variance (see example below). Can include 1 to 2 sentences.

Meaning: Key conclusion and implication based on the primary finding(s). Limit to 1 sentence.

Example of Research Article

Question: What is the immunogenicity of an inactivated influenza A vaccine with and without adjuvant?

Findings: In this randomized clinical trial that included 980 adults, the proportion achieving an effective antibody response was 84% with adjuvant vs 2% without adjuvant, a significant difference.

Meaning: In an influenza pandemic the use of an adjuvant with inactivated influenza A vaccine may be warranted.

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Comments: Example of Review Article
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Abstracts

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Comments: Paragraph ("Include a structured abstract for reports...")
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Comments: Paragraph ("Include a structured abstract for reports..."). Copy I

Include a structured abstract. Abstracts should be prepared in JAMA Network style—see instructions for preparing abstracts below. Abstracts are not required for Invited Commentaries. No information should be reported in the abstract that does not appear in the text of the manuscript.

Abstracts for Reports of Original Data:

Reports of original data should include an abstract of no more than 350 words using the headings listed below. For brevity, parts of the abstract may be written as phrases rather than complete sentences. Each section should include the following content:

Importance: 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 and include the specific study type (eg, randomized clinical trial, cohort, cross-sectional, case-control, case series, survey, meta-analysis, bibliometric analysis). State the years of the study and the duration of follow-up. For older studies (eg, those completed >3 years ago), add the date of the analysis being reported. If applicable, include the name of the study (eg, the Framingham Heart Study). As relevant, indicate whether observers were blinded to patient groupings, particularly for subjective measurements.

Setting: Describe the study setting to assist readers to determine the applicability of the report to other circumstances, for example, multicenter, population-based, primary care or referral center(s), etc.

Participants: State the clinical disorders, important eligibility criteria, and key sociodemographic features of patients (or other study participants). The numbers of eligible participants and how they were selected should be provided, including the number approached but who refused or were excluded. 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. 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.

Note: The preceding 3 sections are usually combined for accepted papers during the editing process as "Design, Setting, and Participants," but for manuscript submission these sections should be kept separate.

Intervention(s) (for clinical trials) or Exposure(s) (for observational studies): The essential features of any interventions, or exposures, should be described, including their method and duration. The intervention, or exposure, should be named by its most common clinical name, and nonproprietary drug names should be used.

Main Outcome(s) and 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. Explain outcomes or measurements unfamiliar to a general medical readership.

Results: Summary demographic information (eg, characteristics such as sex and age) and the number of study participants should be reported in the first sentence of the Results paragraph. The main outcomes of the study should be reported and quantified, including final included/analyzed sample. When possible, present numerical results (eg, absolute numbers and/or rates) with appropriate indicators of uncertainty, such as confidence intervals. Use means and standard deviations (SDs) for normally distributed data and medians and ranges or interquartile ranges (IQRs) for data that are not normally distributed. Avoid solely reporting the results of statistical hypothesis testing, such as P values, which fail to convey important quantitative information. For most studies, P values should follow the reporting of comparisons of absolute numbers or rates and measures of uncertainty (eg, 0.8%, 95% CI −0.2% to 1.8%; P = .13). P values should never be presented alone without the data that are being compared. See also Reporting Standards and Data Presentation. Measures of relative risk also may be reported (eg, relative risk, hazard ratios) and should include confidence intervals. Studies of screening and diagnostic tests should report sensitivity, specificity, and likelihood ratio. If predictive value or accuracy is reported, prevalence or pretest likelihood should be given as well. All randomized clinical trials should include the results of intention-to-treat analysis as well. In intervention studies, the number of patients withdrawn because of adverse effects should be given. Approaches such as number needed to treat to achieve a unit of benefit may be included when appropriate. All surveys should include response/participation rates.

Conclusions and Relevance: Provide only conclusions of the study that are directly supported by the results. Give equal emphasis to positive and negative findings of equal scientific merit. Also, provide a statement of relevance indicating implications for clinical practice or health policy, avoiding speculation and overgeneralization. The relevance statement may also indicate whether additional study is required before the information should be used in clinical settings.

Trial Registration: For clinical trials only (not nontrial observational studies), the name of the trial registry, registration number, and URL of the registry must be included. See Trial Registration.

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Comments: Abstracts for Trial Protocols. Copy J
Abstracts for Trial Protocols:

Trial protocol manuscripts should include an abstract of no more than 350 words using the headings listed below. For brevity, parts of the abstract may be written as phrases rather than complete sentences. Each section should include the following content:

Importance: The abstract should begin with a sentence or 2 explaining the clinical (or other) importance of the study question for this randomized trial.

Objective: State the precise objective or study question to be addressed in the trial (eg, "To compare x with y"). If more than 1 objective is addressed, the main objective should be indicated and only key secondary objectives stated.

Design: Describe the basic design of the trial and include the specific trial type (eg, randomized clinical trial, parallel-design double-blind trial, crossover trial, equivalence and noninferiority trial, cluster trial, nonrandomized controlled trial). Describe the primary and secondary outcomes and how they will be measured and analyzed. As relevant, indicate whether observers will be blinded to patient groupings, particularly for subjective measurements, and if the analysis will be intention to treat. The outcomes should be consistent with the posting on a trial registry site (eg, clinicaltrials.gov).

Setting: Describe the trial setting, for example, multicenter, primary care or referral center(s), etc. State the years of the study and the duration of follow-up.

Participants: State the clinical disorders, important eligibility criteria, and key sociodemographic features of patients (or other trial participants). The numbers of eligible participants and how they were selected should be provided, including the number approached but who refused or were excluded. Describe the randomization process for included participants.

Note: The preceding 3 sections are usually combined for accepted papers during the editing process as "Design, Setting, and Participants," but for manuscript submission these sections should be kept separate.

Discussion: Provide a brief summary of the trial status (including participant recruitment start date and approximate date recruitment will end), any issues involved in conducting the trial, and potential implications.

Trial Registration: Provide the name of the trial registry, registration number, and URL of the registry. See Trial Registration.

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Abstracts for Meta-analysis:

Manuscripts reporting the results of meta-analyses should include an abstract of no more than 350 words using the headings listed below. 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:

Importance: A sentence or 2 explaining the importance of the systematic review question that is used to justify the meta-analysis.

Objective: State the precise primary objective of the meta-analysis. Indicate whether the systematic review for the meta-analysis 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 analyzed.

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, meeting abstracts, 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 study participants). 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 and Synthesis: Describe guidelines (eg, PRISMA, MOOSE) used for abstracting data and assessing data quality and validity. The method by which the guidelines were applied should be stated (for example, independent extraction by multiple observers). Indicate whether data were pooled using a fixed-effect or random-effects model.

Main Outcome(s) and Measure(s): Indicate the primary study outcome(s) and 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. Explain outcomes or measurement unfamiliar to a general medical readership.

Results: Provide the number of studies and patients/participants in the analysis and state the main quantitative results of the review. When possible, present numerical results (eg, absolute numbers and/or rates) with appropriate indicators of uncertainty, such as confidence intervals. Use means and standard deviations (SDs) for normally distributed data and medians and ranges or interquartile ranges (IQRs) for data that are not normally distributed. Avoid solely reporting the results of statistical hypothesis testing, such as P values, which fail to convey important quantitative information. For most studies, P values should follow the reporting of comparisons of absolute numbers or rates and measures of uncertainty (eg, 0.8%, 95% CI −0.2% to 1.8%; P = .13). P values should never be presented alone without the data that are being compared. See also Reporting Standards and Data Presentation. Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. 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 and Relevance: The conclusions and their applications (clinical or otherwise) should be clearly stated, limiting interpretation to the domain of the review.

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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.

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Units of Measure

Laboratory values are expressed using conventional units of measure, with relevant Système International (SI) conversion factors expressed secondarily (in parentheses) only at first mention. Articles that contain numerous conversion factors may list them together in a paragraph at the end of the Methods section. In tables and figures, a conversion factor to SI should be presented in the footnote or legend. The metric system is preferred for the expression of length, area, mass, and volume. For more details, see the Units of Measure conversion table on the website for the AMA Manual of Style.2

To read more about units of measure, click here.

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Names of Drugs, Devices, and Other Products

Use nonproprietary names of drugs, devices, and other products and services, unless the specific trade name of a drug is essential to the discussion.2(pp567-569) In such cases, use the trade name once and the generic or descriptive name thereafter. Do not include trademark symbols.

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Gene Names, Symbols, and Accession Numbers

Authors describing genes or related structures in a manuscript should include the names and official symbols provided by the US National Center for Biotechnology Information (NCBI) or the HUGO Gene Nomenclature Committee. Before submission of a research manuscript reporting on large genomic data sets (eg, protein or DNA sequences), the data sets should be deposited in a publicly available database, such as NCBI's GenBank, and a complete accession number (and version number if appropriate) must be provided in the Methods section or Acknowledgment of the manuscript.

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Reproduced Material

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Please verify that all information and materials in the manuscript are original. The journal generally does not republish text, tables, figures, or other material from other publishers, except in rare circumstances. If you believe that you must include content that is owned by a third party, please let us know and provide information about all material that has been previously published and, when applicable, include author(s), title of article, title of journal or book or other publication, and complete citation, doi, and/or URL. The publisher or other third party’s permission to reproduce in all licensed versions of this journal, including a CC-BY license, should be submitted when the manuscript is submitted. If you do not have owner permission, please remove that content and replace it with other content that you own or have such permission to use.

See Permission to Reproduce Copyright-Protected Material Form.

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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 and abbreviate names of journals according to the journals list in PubMed. List all authors and/or editors up to 6; if more than 6, list the first 3 followed by "et al." Note: Journal references should include the issue number in parentheses after the volume number.

Examples of reference style:

  1. Youngster I, Russell GH, Pindar C, Ziv-Baran T, Sauk J, Hohmann EL. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficileinfection. JAMA. 2014;312(17):1772-1778.
  2. Murray CJL. Maximizing antiretroviral therapy in developing countries: the dual challenge of efficiency and quality [published online December 1, 2014]. JAMA. doi:10.1001/jama.2014.16376
  3. Centers for Medicare & Medicaid Services. CMS proposals to implement certain disclosure provisions of the Affordable Care Act. http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4221. Accessed January 30, 2012.
  4. McPhee SJ, Winker MA, Rabow MW, Pantilat SZ, Markowitz AJ, eds. Care at the Close of Life: Evidence and Experience. New York, NY: McGraw Hill Medical; 2011.

For more examples of electronic references, click here.

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Statistical Methods and Data Presentation

General Considerations

Authors are encouraged to consult "Reporting Statistical Information in Medical Journal Articles."1 In the Methods section, describe statistical methods with enough detail to enable a knowledgeable reader with access to the original data to reproduce the reported results. Such description should include appropriate references to the original literature, particularly for uncommon statistical methods. For more advanced or novel methods, provide a brief explanation of the methods and appropriate use in the text and consider providing a detailed description in an online supplement.

In the reporting of results, when possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty, such as confidence intervals (see Reporting Standards and Data Presentation). Avoid relying solely on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information. For observational studies, provide the numbers of observations. For randomized trials, provide the numbers randomized. Report losses to observation or follow up (see Missing Data). For multivariable models, report all variables included in models, and report model diagnostics and overall fit of the model when available (see Statistical Procedures).

Define statistical terms, abbreviations, and symbols, if included. Avoid nontechnical uses of technical terms in statistics, such as correlation, normal, predictor, random, sample, significant, trend. Do not use inappropriate hedge terms such as marginal significance or trend toward significance for results that are not statistically significant. Causal language (including use of terms such as effect and efficacy) should be used only for randomized clinical trials. For all other study designs (including meta-analyses of randomized clinical trials), methods and results should be described in terms of association or correlation and should avoid cause-and-effect wording.

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Sample Size Calculations

For randomized trials, a statement of the power or sample size calculation is required (see the EQUATOR Network CONSORT Guidelines). For observational studies that use an established population, a power calculation is not generally required when the sample size is fixed. However, if the sample size was determined by the researchers, through any type of sampling or matching, then there should be some justification for the number sampled. In any case, describe power and sample size calculations at the beginning of the Statistical Methods section, following the general description of the study population.

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Descriptive Statistics

It is generally not necessary to provide a detailed description of the methods used to generate summary statistics, but the tests should be briefly noted in the Methods section (eg, ANOVA or Fisher exact test).

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Statistical Procedures

Identify regression models with more than 1 independent variable as multivariable and regression models with more than 1 dependent variable as multivariate. Report all variables included in models, as well as any mathematical transformations of those variables. Provide the scientific rationale (clinical, statistical, or otherwise) for including variables in regression models.

For regression models fit to dependent data (eg, clustered or longitudinal data), the models should account for the correlations that arise from clustering and/or repeated measures. Failure to account for such correlation will result in incorrect estimates of uncertainty (eg, confidence intervals). Describe how the model accounted for correlation. For example, for an analysis based on generalized estimating equations, identify the assumed correlation structure and whether robust (or, sandwich) variance estimators were used. Or, for an analysis based on mixed-effects models, identify the assumed structure for the random effects, such as the level of random intercepts and whether any random slopes were included. Fixed-effects estimation should be described as conditional likelihood. Avoid the term fixed effects for describing covariates.

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Missing Data

Report losses to observation, such as dropouts from a clinical trial or those lost to follow-up or unavailable in an observational study. If some participants are excluded from analyses because of missing or incomplete data, provide a supplementary table that compares the observed characteristics between participants with complete and incomplete data. Consider multiple imputation methods to impute missing data and include an assessment of whether data were missing at random. Approaches based on "last observation carried forward" should not be used.

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Primary Outcomes, Multiple Comparisons, and Post Hoc Comparisons

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Both randomized and observational studies should identify the primary outcome(s) before the study began, as well as any prespecified secondary, subgroup, and/or sensitivity analyses. Comparisons arrived at during the course of the analysis or after the study was completed should be identified as post hoc. For analyses of more than 1 primary outcome, corrections for multiple testing should generally be used. For secondary outcomes, address multiple comparisons or consider such analyses as exploratory and interpret them as hypothesis-generating. The reporting of all outcomes should match that included in study protocols. For randomized clinical trials, protocols with complete statistical analysis plans should be cited in the Methods section and submitted as supplemental content (see Clinical Trial). Randomized clinical trials should be primarily analyzed according to the intention-to-treat approach. Deviations from strict intention-to-treat analysis should be described as "modified intention-to-treat," with the modifications clearly described.

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Statistical Analysis Subsection

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At the end of the Methods section, briefly describe the statistical tests used for the analysis. State any a priori levels of significance and whether hypothesis tests were 1- or 2-sided. Also include the statistical software used to perform the analysis, including the version and manufacturer, along with any extension packages (eg, the svy suite of commands in Stata or the survival package in R). Do not describe software commands (eg, SAS proc mixed was used to fit a linear mixed-effects model). If analysis code is included, it should be placed in the supplemental content.

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Reporting Standards and Data Presentation

Analyses should follow EQUATOR Reporting Guidelines and be consistent with the protocol and statistical analysis plan, or described as post hoc.

When possible, present numerical results (eg, absolute numbers and/or rates) with appropriate indicators of uncertainty, such as confidence intervals. Use means and standard deviations (SDs) for normally distributed data and medians and ranges or interquartile ranges (IQRs) for data that are not normally distributed. Avoid solely reporting the results of statistical hypothesis testing, such as P values, which fail to convey important quantitative information. For most studies, P values should follow the reporting of comparisons of absolute numbers or rates and measures of uncertainty (eg, 0.8%, 95% CI −0.2% to 1.8%; P = .13). P values should never be presented alone without the data that are being compared. If P values are reported, follow standard conventions for decimal places: for P values less than .001, report as "P<.001"; for P values between .001 and .01, report the value to the nearest thousandth; for P values greater than or equal to .01, report the value to the nearest hundredth; and for P values greater than .99, report as "P>.99." For studies with exponentially small P values (eg, genetic association studies), P values may be reported with exponents (eg, P = 1×10−5). In general, there is no need to present the values of test statistics (eg, F statistics or χ² results) and degrees of freedom when reporting results.

For secondary and subgroup analyses, there should be a description of how the potential for type I error due to multiple comparisons was handled, for example, by adjustment of the significance threshold. In the absence of some approach, these analyses should generally be described and interpreted as exploratory, as should all post hoc analyses.

For randomized trials using parallel-group design, there is no validity in conducting hypothesis tests regarding the distribution of baseline covariates between groups; by definition, these differences are due to chance. Because of this, tables of baseline participant characteristics should not include P values or statements of statistical comparisons among randomized groups. Instead, report clinically meaningful imbalances between groups, along with potential adjustments for those imbalances in multivariable models.

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Tables and Figures

Restrict tables and figures to those needed to explain and support the argument of the article and to report all outcomes identified in the Methods section. Number each table and figure and provide a descriptive title for each. Every table and figure should have an in-text citation. Verify that data are consistently reported across text, tables, figures, and supplementary material.

See also Tables and Figures.

Frequency data should be reported as "No. (%)," not as percentages alone (exception, sample sizes exceeding ~10,000). Whenever possible, proportions and percentages should be accompanied by the actual numerator and denominator from which they were derived. This is particularly important when the sample size is less than 100. Do not use decimal places (ie, xx%, not xx.xx%) if the sample size is less than 100. Tables that include results from multivariable regression models should focus on the primary results. Provide the unadjusted and adjusted results for the primary exposure(s) or comparison(s) of interest. If a more detailed description of the model is required, consider providing the additional unadjusted and adjusted results in supplementary tables.

Tables have a minimum of 2 columns. Comparisons must read across the table columns.

Do not duplicate data in figures and tables. For all primary outcomes noted in the Methods section, exact values with measures of uncertainty should be reported in the text or in a table and in the Abstract, and not only represented graphically in figures.

Pie charts and 3-D graphs should not be used and should be revised to alternative graph types.

Bar graphs should be used to present frequency data only (ie, numbers and rates). Avoid stacked bar charts and consider alternative formats (eg, tables or splitting bar segments into side-by-side bars) except for comparisons of distributions of ordinal data.

Summary data (eg, means, odds ratios) should be reported using data markers for point estimates, not bars, and should include error bars indicating measures of uncertainty (eg, SDs, 95% CIs). Actual values (not log-transformed values) of relative data (for example, odds ratios, hazard ratios) should be plotted on log scales.

For survival plots, include the number at risk for each group included in the analysis at intervals along the x-axis scale. For any figures in which color is used, be sure that colors are distinguishable.

All symbols, indicators, line styles, and colors in statistical graphs should be defined in a key or in the figure legend. Axes in statistical graphs must have labels. Units of measure must be provided for continuous data.

Note: All figures are re-created by journal graphics experts according to reporting standards using the JAMA Network style guide and color palette.

Tables

  • Number all tables in the order of their citation in the text.
  • Include a brief title for each table (a descriptive phrase, preferably no longer than 10 to 15 words).
  • Include all tables at the end of the manuscript file.
  • Refer to Study Types for limits on the number of tables.
  • NOTE: Do not embed tables as images in the manuscript file or upload tables in image formats, and do not upload tables as separate files.

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Table Creation

Use the table menu in the software program used to prepare the text. Tables can be built de novo using Insert→Table or copied into the text file from another document (eg, Word, Excel, or a statistical spreadsheet).

Avoid using tabs, spaces, and hard returns to set up the table; such tables will have to be retyped, creating delays and opportunities for error.

Tables should be single-spaced and in a 10- or 12-point font (do not shrink the point size to fit the table onto the page). Do not draw extra lines or rules—the table grid will display the outlines of each cell.

Each piece of data needs to be contained in its own cell. Do not try to align cells with hard returns or tabs; alignment will be imposed in the production system if the paper is accepted. Although individual empty cells are acceptable in a table, be sure there are no empty columns. To show an indent, add 2 spaces.

When presenting percentages, include numbers (numerator and denominator).

Include statistical variability where applicable (eg, mean [SD], median [IQR]). For additional detail on requirements for data presentation in tables, see Statistical Methods and Data Presentation.

Place each row of data in a separate row of cells, and note that No. (%) and measures of variability are presented in the same cell as in the example Table 1 below:

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Table 1. Baseline Values in the Editors' Health Study

SI conversion factors: To convert cholesterol to mmol/L, multiply values by 0.0259.

Note that JAMA Network journals report laboratory values in conventional units. In a table, provide a footnote with the conversion factor to SI units. For a calculator of SI and conventional units, see the AMA Manual of Style.2

To present data that span more than 1 row, merge the cells vertically. For example, in Table 2 the final column presents the P value for overall age comparisons.

Table 2. Blood Pressure Values Stratified by Age

The table should be constructed such that the primary comparison reads horizontally. For example, see Table 3 (incorrect) and Table 4 (correct).

Table 3. Patient Data by Study Group
Table 4. Patient Data by Study Group

If a table must be continued, repeat the title and column headings on the second page, followed by "(continued)."

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Table Footnotes

Footnotes to tables may apply to the entire table, portions (eg, a column), or an individual entry.

The order of the footnotes is determined by the placement in the table of the item to which the footnote refers.

When both a footnote letter and reference number follow data in a table, set the superscript reference number first followed by a comma and the superscript letter.

Use superscript letters (a, b, c) to mark each footnote and be sure each footnote in the table has a corresponding note (and vice versa).

List abbreviations in the footnote section and explain any empty cells.

If relevant, add a footnote to explain why numbers may not sum to group totals or percentages do not add to 100%.

For more detail on the components and recommended structure of tables, see the AMA Manual of Style.2

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Figures

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Number all figures (graphs, charts, photographs, and illustrations) in the order of their citation in the text. The number of figures should be limited. Avoid complex composite or multipart figures unless justified. See Study Types for limits on the number of figures.

For initial manuscript submissions, figures must be of sufficient quality and may be embedded at the end of the file for editorial assessment and peer review. If a revision is requested and before a manuscript is accepted, authors will be asked to provide figures that meet the requirements described in Figure File Requirements for Publication.

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Graphs, charts, some illustrations, titles, legends, keys, and other elements related to figures in accepted manuscripts will be re-created and edited according to JAMA Network style and standards prior to publication. Supplemental figures will not be edited or re-created (see Supplements and Multimedia).

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Image Integrity

Preparation of scientific images (clinical images, radiographic images, micrographs, gels, etc) for publication must preserve the integrity of the image data. Digital adjustments of brightness, contrast, or color applied uniformly to an entire image are permissible as long as these adjustments do not selectively highlight, misrepresent, obscure, or eliminate specific elements in the original figure, including the background. Selective adjustments applied to individual elements in an image are not permissible. Individual elements may not be moved within an image field, deleted, or inserted from another image. Cropping may be used for efficient image display or to deidentify patients but must not misrepresent or alter interpretation of the image by selectively eliminating relevant visual information. Juxtaposition of elements from different parts of a single image or from different images, as in a composite, must be clearly indicated by the addition of dividing lines, borders, and/or panel labels.

When inappropriate image adjustments are detected by the journal staff, authors will be asked for an explanation and will be requested to submit the image as originally captured prior to any adjustment, cropping, or labeling. Authors may be asked to resubmit the image prepared in accordance with the above standards.

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Acceptable Figure Files for Initial Submission and Review

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Each figure for the main article may be uploaded as a separate file or appended to the end of the manuscript with the figure titles and legends. Supplemental figures must be combined into the PDF of the supplement (see Supplements and Multimedia). Note: If a revision is requested and before acceptance, authors must upload each figure for the main article as a separate file and follow the instructions in Figure File Requirements for Publication.

See the Table of Figure Requirements for additional guidance for specific types of figures for suggested resolution and file formats. In general each figure should be no larger than 1 MB.

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Figure File Requirements for Publication

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Each figure for the main article must be uploaded as a separate file. Supplemental figures must be combined into the PDF of the supplement (see Supplements and Multimedia).

See the Table of Figure Requirements for additional guidance and file formats for specific types of figures.

Files created by vector programs are best for accurately plotting and maintaining data points. JAMA Network journals are unable to use file formats native to statistical software applications to prepare figures for publication; most statistical software programs allow users to save or export files in digital vector formats.

Images created digitally (by digital camera or electronically created illustrations) must meet the minimum resolution requirements at the time of creation. Electronically increasing the resolution of an image after creation causes a breakdown of detail and will result in an unacceptable poor-quality image. Each component of a composite image must be uploaded separately at submission and individually meet the minimum resolution requirement.

Color photographs should be submitted in RGB mode using profiles such as Adobe RGB or sRGB. Digital cameras capture images in RGB. Do not change any color settings once the file is on the computer. Black-and-white photographs (eg, radiographs, ultrasound images, CT and MRI scans, and electron micrographs) can be submitted in either RGB or grayscale modes.

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Figure Titles and Legends (Captions)

At the end of the manuscript, include a title for each figure. The figure title should be a brief descriptive phrase, preferably no longer than 10 to 15 words. A figure legend (caption) can be used for a brief explanation of the figure or markers if needed and expansion of abbreviations. For photomicrographs, include the type of specimen, original magnification or a scale bar, and stain in the legend. For gross pathology specimens, label any rulers with unit of measure. Digitally enhanced images must be clearly identified in the figure legends as enhanced or manipulated, eg, computed tomographic scans, magnetic resonance images, photographs, photomicrographs, x-ray films.

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Figures With Labels, Arrows, or Other Markers

Photographs, clinical images, photomicrographs, gel electrophoresis, and other types that include labels, arrows, or other markers must be submitted in 2 versions: one version with the markers and one without. Provide an explanation for all labels, arrows, or other markers in the figure legend. The Figure field in the File Description tab of the manuscript submission system allows for uploading of 2 versions of the same figure.

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General Figure Guidelines

  • Primary outcome data should not be presented in figures alone. Exact values with measure of variability should be reported in the text or table as well as in the abstract.
  • All symbols, indicators (including error bars), line styles, colors, and abbreviations should be defined in a legend.
  • Each axis on a statistical graph must have a label and units of measure should be labeled.
  • Do not use pie charts, 3-D graphs, and stacked bar charts as these are not appropriate for accurate statistical presentation of data and should be revised to another figure type or converted to a table.
  • Error bars should be included in both directions, unless only 1-sided variability was calculated.
  • Values for ratio data—odds ratios, relative risks, hazard ratios—should be plotted on a log scale. Values for ratio data should not be log transformed.
  • For footnotes, use letters (a, b, c, etc) not symbols.
  • Do not submit figures with more than 4 panels unless otherwise justified.

For images featuring patients or other identifiable persons, it is not acceptable to use black bars across the eyes in an attempt to deidentify. Cropping may be acceptable as long as the condition under discussion is clearly visible and necessary anatomic landmarks display. If the person in the image is possibly identifiable (not only by others but also by her/himself), permission for publication is required (see Patient Identification).

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Table of Figure Requirements
Figure Type
Correct Usage and Creation

Bar graph

To present frequency data (numbers or percentages). Each bar represents a category.

Bar graphs are typically vertical but when categories have long titles or there are many of them, they may run horizontally.

The scale on the frequency axis should begin at 0, and the axis should not be broken.

If the data plotted are a percentage or rate, error bars may be used to show statistical variability.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Line graph

To demonstrate the relationship between 2 or more quantitative variables, such as changes over time.

The dependent variable appears on the vertical axis (y) and the independent variable on the horizontal axis (x); the axes should be continuous, not broken.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Flow diagram

To show participant recruitment and follow-up or inclusions and exclusions (such as in a systematic review).

Follow EQUATOR Reporting Guidelines

Acceptable File Formats for Initial Submission: .ai, .docx, .emf, .eps, .jpg, .pdf, .ppt

Acceptable File Formats for Revision and Publication: .ai, .docx, .emf, .eps, .pdf

Survival plot

To display the proportion or percentage of individuals (represented on the y-axis) remaining free of or experiencing a specific outcome over time (represented on the x-axis).

The curve should be drawn as a step function (not smoothed).

The number of individuals followed up for each time interval (number at risk) should be shown underneath the x-axis.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Box-and-whisker plot

To show data distribution from 1 or more groups, particularly aggregate/summary data.

Each element should be described (the ends of the boxes, the middle line, and the whiskers). Outlier data are typically shown as circles plotted beyond the whiskers.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Forest plot

To illustrate summary data, particularly in meta-analyses and systematic reviews.

The data are presented both tabularly and graphically.

The sources (with years and citations, when relevant) should comprise the first column.

Provide indicators of both directions of results at the top of the plot on either side of the vertical line (eg, favors intervention).

Typically, proportionally sized boxes represent the weight of each study and a diamond shows the overall effect at the bottom of the plot.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Dot plot

To display quantitative data other than counts or frequencies on a single scaled axis according to categories on a baseline (horizontal or vertical). Point estimates are represented by discrete data markers, preferably with error bars (in both directions) to designate variability.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Scatterplot

To show individual data points plotted according to coordinate values with continuous, quantitative x- and y-axis scales.

A curve that is generated mathematically may be fitted to the data to summarize the relationship among the variables.

Acceptable File Formats for Initial Submission: .ai, .bmp, .docx, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, .xls

Acceptable File Formats for Revision and Publication: .ai, .emf, .eps, .pdf, .wmf, .xls

Illustration

To explain physiological mechanisms, describe clinical maneuvers and surgical techniques, or provide orientation to medical imaging.

Required minimum resolution for publication: ≥350 ppi

Acceptable File Formats for Initial Submission: .ai, .docx, .eps, .jpg, .pdf, .ppt, .psd., tif

Acceptable File Formats for Revision and Publication: .ai, .eps, .jpg, .pdf, .psd, .tif

Photographs and other clinical images

To display clinical findings, experimental results, or clinical procedures, including medical imaging, photomicrographs, clinical photographs, and photographs of biopsy specimens.

Legends for photomicrographs should include details about the type of stain used and magnification.

Required minimum resolution for publication: ≥350 ppi

Acceptable File Formats for Initial Submission: .eps, .jpg, .pdf, .ppt, .psd, .tif

Acceptable File Formats for Revision and Publication: .eps, .jpg, .psd, .tif

Line drawings

To illustrate anatomy or procedures.

Line drawings are almost always black and white.

Required minimum resolution for publication: ≥600 ppi

Acceptable File Formats for Initial Submission: .docx, .jpg, .pdf, .ppt, .psd, .tif

Acceptable File Formats for Revision and Publication: .jpg, .psd, .tif

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Supplements and Multimedia

Authors may submit supporting material to accompany their article for supplemental publication when there is insufficient space to include the material in the main article. This material should be important to the understanding and interpretation of the report and should not repeat material in the main article. The amount of supplemental material should be limited and justified. Supplemental material should be original and not previously published.

Supplemental material will undergo editorial and peer review with the main manuscript. If the manuscript is accepted for publication and if the supplemental material is deemed appropriate for publication by the editors, it will be posted online at the time of publication of the article as additional material provided by the authors. This material will not be edited or formatted; thus, authors are responsible for the accuracy and presentation of all such material.

Supplemental material should be submitted in a single Word document with pages numbered consecutively. Each element included in the supplemental material should be cited in the text of the main manuscript (eg, eTable in the Supplement) and numbered in order of citation in the text (eg, eTable 1, eTable 2, eFigure 1, eFigure 2, eMethods). The first page of the supplemental document should list the number and title of each element included in the document.

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Supplemental Text

Supplemental text should be set in Times New Roman font, 10 point in size, and single-spaced. The main heading of the supplemental text should be in 12 point and boldface; subheadings should be in 10 point and boldface.

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Supplemental References

All references cited within the supplemental document must be included in a separate reference section, including those that also were cited in the main manuscript. They should be formatted just as in the main manuscript and numbered and cited consecutively in the supplemental material.

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Supplemental Tables

Supplemental tables should be inserted in the document and numbered consecutively according to the order of citation as eTable 1, eTable 2, etc. The text and data in supplemental tables should be Arial font, 10 point in size, and single-spaced. The table title should be set in Arial font, 12 point, and bold. Headings within tables should be set in 10 point and bold. Table footnotes should be set in 8 point and single-spaced. See also instructions for Tables above. If a table runs on to subsequent pages, repeat the column headers at the top of each page. Wide tables may be presented using a landscape orientation.

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Supplemental Figures

Supplemental figures should be inserted in the document and numbered consecutively according to the order of citation as eFigure 1, eFigure 2, etc. Figure titles should be set in Arial font, 12 point, bold, and single-spaced. Text within figures should be set as Arial font, 10 point. Figure legends should be set in 8 point and single-spaced. Graphs and diagrams should be exported directly out of the software application used to create them in a vector file format, such as .wmf, and then inserted into the Word document. Image file formats such as .jpg, .tif, and .gif are generally not suitable for graphs. Photographs, including all radiological images, should be prepared as .jpg (highest option) or .tif (uncompressed) files at a resolution of 300 dpi and width of 3-5 inches, but the resolution of photographic files with an original resolution ≤300 dpi should not be increased digitally to achieve a 300-dpi resolution. Photographs should be inserted in the document with the "Link to File" button turned off. Wide figures may be presented using a landscape orientation.

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Video

For editorial and review of an initial submission, submit videos according to the following specifications:

  • Acceptable file formats: .mov, .wmv, .mpg, .mpeg, .mp4, or .avi
  • Maximum file size: ≤25 MB
  • Preferred dimensions: 1920x1080 (HD) or greater (4k UHD footage is acceptable)
  • Minimum dimensions: 640 pixels wide by 360 pixels deep
  • Recommended frame rate: 24 fps (or 23.976 fps), 25 fps, and 30 fps (or 29.97 fps)
  • Maximum length: ≤5 minutes
  • Desired aspect ratio: 4:3 (standard) or 16:9 (widescreen)
  • If compression is required to reduce file size for uploading, please use a minimum bit rate of 10,000 kbit/s – 20,000 kbit/s
  • When filming, please use a landscape orientation, not a portrait orientation. This is especially important when filming video or taking photographs with a smartphone or a mobile device.

Verify that the videos are viewable in QuickTime or Windows Media Player before uploading.

For each video, provide an in-text citation (eg, Video 1). At the end of the manuscript file, include a title (a brief phrase, preferably no longer than 10 to 15 words) and a caption that includes the file format and a brief explanation for each video. The same title and caption must be entered in the designated fields in the manuscript submission system when uploading each video. If multiple video files are submitted, number them in the order in which they should be viewed.

If patient(s) are identifiable in the video, authors must submit a Patient Permission form completed and signed by each patient. See also Patient Identification.

If the author does not hold copyright to the video, the author must obtain permission for the video to be published in the journal. This permission must be for unrestricted use in all print, online, and licensed versions of the journal.

NOTE: If your manuscript and accompanying videos are accepted for publication, the video files will be placed into a journal video frame and will be edited by JAMA Network video production staff according to journal style. In addition, a JAMA Network staff person may contact you to resubmit your videos to meet our production specifications. For example, a larger size may be needed, and if your videos were submitted with embedded text such as titles, annotations, labels, or captions, we will ask you to remove the text at this stage and resubmit the video without text, and JAMA Network video production will re-create all text using our house style.

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Guidelines for Optimal Video Quality

  • Use plenty of diffuse light; avoid shadows.
  • When filming, please use a landscape orientation, not a portrait orientation. This is especially important when filming video or taking photographs with a smartphone or a mobile device.
  • Use the appropriate white-balance based on your lighting conditions. Different cameras have different settings, but most have presets for incandescent (yellow) light, fluorescent light, daylight, and tungsten light. Please make sure to select the correct one so that the color of your footage renders accurately.
  • Do not overexpose the image; a bit underexposed is preferable.
  • Use a tripod. This is especially important in close-ups.
  • Avoid excessive zooming. Use the optical zoom only; do not use a digital zoom.
  • Turn off all camera special effects.
  • Avoid using autofocus. Manual focus is more accurate. Keep the camera at a fixed distance from the subject.
  • Instruct people on camera to speak clearly and face the camera when speaking. Try to avoid large movements while speaking or immediately after speaking. Allow pauses before and after speaking for easier editing.
  • If the situation permits, ensure that individuals being filmed are not wearing white clothing or clothing with busy patterns or stripes, especially shirts, jackets, and ties. Subdued medium blue, brown, tan, beige, and green colors all work well for shirt and clothing choices.
  • Do not include an introduction by the physician as a "talking head" explaining a procedure. All footage should be of the procedure or relevant subject matter only.
  • Record a few extra seconds before and after each cut or after changing the camera's position. This allows for easier editing.

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Additional Considerations for Filming Surgical Procedures

  • Coordinate with the surgical staff to establish a vantage point for the camera that has a clear view of the surgical field.
  • Before the procedure, if the situation permits, identify the surgical staff's positions for access into and out of the surgical field to ensure there is no immediate obstruction of the camera.
  • During the procedure, avoid typical obstructions of the camera's main view such as arms reaching across the field or soiled surgical sponges. Where possible, keep the heads, hands, and any instruments away from the immediate sightline of the camera. This will ensure that all moments of the procedure are captured in full view and focus.
  • If the situation permits a choice of glove type, use brown or tan. White gloves reflect bright light; vividly colored surgical gloves can distract the viewer from the teaching point of the video.
  • If the situation permits, avoid rapid movements for procedural steps that should be noticed and understood. To demonstrate a key moment or use of an instrument, movement that is deliberate and steady will allow a standard camera to focus properly.

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Audio

For editorial and review of an initial submission, submit audio files according to the following minimum requirements:

  • Acceptable file formats: .mp3, .wav, or .aiff
  • Maximum file size: 25 MB
  • To achieve the best quality, use a setting of 256 kbps or higher for stereo or 128 kbps or higher for mono.
  • Maximum length: ≤5 minutes
  • Sampling rate should be either 44.1 kHz or 48 kHz.
  • Bit rate should be either 16 or 24 bit.
  • To avoid audible clipping noise, please make sure that audio levels do not exceed 0 dBFS.

For each audio file, provide an in-text citation. At the end of the manuscript, include a title (a brief phrase, preferably no longer than 10-15 words) and a caption that includes the file format and a brief explanation for each audio.

NOTE: If your manuscript is accepted for publication, JAMA Network video production staff may contact you to request an original uncompressed audio file in .wav or .aiff format. There is no maximum file size requirement for publication at this stage.

What to Expect

After Submission

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Editorial and Peer Review

Authors will be sent notifications of the receipt of manuscripts and editorial decisions by email. During the review process, authors can check the status of their submitted manuscript via the online manuscript submission and review system. Authors should not disclose the fact that their manuscript has been submitted to anyone, except coauthors and contributors, without permission of the editor.

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All submitted manuscripts are reviewed initially by one of the editors. Manuscripts are evaluated according to the following criteria: material is original and timely, 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 interest to readers of this journal. From these basic criteria, the editors assess a paper's eligibility for publication. Manuscripts with insufficient priority for publication are rejected promptly. Other manuscripts are sent to expert consultants for peer review. The journal uses a single-blind peer review process: peer reviewer identities are kept confidential (unless reviewers choose to reveal their names in their formal reviews); 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. Peer reviewers are required to maintain confidentiality about the manuscripts they review and must not divulge any information about a specific manuscript or its content to any third party without prior permission from the journal editors. 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. Final decisions regarding manuscript publication are made by an editor who does not have any relevant conflicts of interest.

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Submitted manuscripts may be reviewed with software to detect plagiarism and inappropriate duplication.

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Appeals

Authors may appeal decisions. All appeals are reviewed by the editor in chief, on a case-by-case basis, or a designated editor if the editor in chief is recused from the review.

What to Expect

After Revision/Acceptance

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Authorship Form and Publishing Agreement

All authors are required to complete an Authorship Form and Publishing Agreement. See Authorship Criteria and Contributions.

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Editing

Accepted manuscripts are edited in accordance with the AMA Manual of Style,2 and returned to the corresponding author (or her/his designee) for approval. Authors are responsible for all statements made in their work, including changes made during editing and production that are authorized by the corresponding author.

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Embargo

Authors should not disclose the fact that their manuscript has been accepted to anyone, except coauthors and contributors, until it is published without permission of the editor or as described in the guidance on Previous or Planned Meeting Presentation or Release of Information and Embargo Policy.

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Publication

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If accepted for publication, all articles are published online only.

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What to Expect

After Publication

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Postpublication Online Commenting

Readers may post online comments following publication. Authors are encouraged to respond and engage in the postpublication conversation.

Corrections

Requests to publish corrections should be sent to the editorial office. Corrections are reviewed by editors and authors, published promptly, and linked online to the original article.15

Author CME

First authors of peer-reviewed articles are eligible to receive CME credit. See CME From the JAMA Network.

What to Expect

About Previous Release of Information, Embargo, and Access

Previous Publication, Preprint Server Posting, and Related Manuscripts and Reports

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 all related or similar manuscripts and reports (ie, those containing substantially similar content or using the same or similar data) that have been previously published or posted, or are under consideration elsewhere must be provided at the time of manuscript submission.

Public dissemination of manuscripts prior to, simultaneous with, or following submission to this journal, such as posting the manuscript on preprint servers or other repositories, will necessitate making a determination of whether publication of the submitted manuscript will add meaningful new information to the medical literature or will be redundant with information already disseminated with the posting of the preprint. Authors should provide information about any preprint postings, including copies of the posted manuscript and a link to it, at the time of submission of the manuscript to this journal.

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Previous or Planned Meeting Presentation or Release of Information

Meeting presentation: A complete manuscript submitted to the journal following or prior to presentation at a scientific meeting or publication of preliminary findings elsewhere (ie, as an abstract) is eligible for consideration for publication. Authors considering presenting or planning to present the work at an upcoming scientific meeting should indicate the name and date of the meeting on the manuscript submission form. For accepted papers, the editors may be able to coordinate publication with the meeting presentation. Authors of submitted papers, including those accepted but not yet published, should not disclose the status of such papers during such meeting presentations that occur before the work is published. Authors who present information contained in a manuscript that is under consideration by this journal during scientific or clinical meetings should not distribute complete reports (ie, copies of manuscripts) or full data presented as tables and figures to conference attendees or journalists. Publication of abstracts in print and online conference proceedings, as well as posting of slides or videos from the scientific presentation on the meeting website, is acceptable. However, for manuscripts under consideration by this journal, publication of full reports in meeting proceedings or online, issuing detailed news releases reporting the results of the study that go beyond the meeting abstract, or participation in formal news conferences will ordinarily jeopardize chances for publication of the submitted manuscript in this journal.5 Media coverage of presentations at scientific meetings will not jeopardize consideration, but direct release of information through press releases or news media briefings may preclude consideration of the manuscript by this journal.5 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 this information to the relevant government agency.

Authors should not release information about accepted manuscripts via social media until publication.

See also Previous Publication, Preprint Server Posting, and Related Manuscripts and Reports.

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Embargo Policy

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Authors should not disclose the fact that their manuscript has been accepted to anyone, except coauthors and contributors, without permission of the editor until it is published. All information regarding the content and publication date of accepted manuscripts is strictly confidential. Unauthorized prepublication release of accepted manuscripts and information about planned publication date may result in rescinding the acceptance and rejecting the paper. This policy applies to all categories of articles. Information contained in or about accepted articles cannot appear in print, audio, video, or digital form or be released by the news media until the specified embargo release date.2,5 See also Previous or Planned Meeting Presentation or Release of Information.

Open Access

All research articles that are accepted for publication will be made immediate free access on the journal website following payment of article processing charges (APC) of $3000 and grant of a publication license to the journal and will be deposited on your behalf in PubMed Central for free access following deposit. There are 2 open access licenses described below, depending on the source of APC funding.

A. CC-BY License

Eligibility: Available for authors of manuscripts reporting research funded by a not-for-profit foundation or government agency or unfunded research. Note: If your open access funding source is commercial, only a CC-BY-NC-ND license is available.

Author requirements: Payment of $3000 and grant of a publication license to the journal.

License rights: Immediate open access on journal website on the day of publication, retention of copyright, and a CC-BY license that permits others to distribute, remix, tweak, and build on the work, even commercially, without permission provided that credit is given to the original authors and journal.

B. CC-BY-NC-ND License

Eligibility: Available to authors of manuscripts reporting research funded by a commercial funding source.

Author requirements: Payment of $3000 and grant of a publication license to the journal.

License rights: Immediate open access on journal website on day of publication, retention of copyright, and a CC-BY-NC-ND license that permits others to distribute the work without permission, provided that credit is given to the original authors and journal and that the article is not altered or used commercially.

Open Access Waivers and Discounts

Waivers and discounts on open access article processing charges are available for eligible authors from Hinari Core Offer countries.

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Depositing Research Articles in Approved Public Repositories

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Open access research articles will be deposited into PubMed Central (PMC). A few weeks after publication, you may obtain your PMCID on the PMC site at https://www.ncbi.nlm.nih.gov/pmc/pmctopmid/.

Editorial Policies for Authors

Author Responsibilities

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Authorship and Disclosures

Most of the JAMA Network journals' editorial policies for authors are summarized in these instructions. Citations and links to the AMA Manual of Style: A Guide for Authors and Editors2 and other publications with additional information are also provided.

Authorship Criteria and Contributions

Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.2 One or more authors should take responsibility for the integrity of the work as a whole, from inception to published article. According to the guidelines of the International Committee of Medical Journal Editors (ICMJE),4 authorship credit should be based on the following 4 criteria:

  1. substantial contributions to conception or design of the work, or the acquisition, analysis, or interpretation of data for the work; and
  2. drafting of the work or revising it critically for important intellectual content; and
  3. final approval of the version to be published; and
  4. agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Each author should be accountable for the parts of the work he or she has done. In addition, each author should be able to identify which coauthors are responsible for specific other parts of the work and should have confidence in the integrity of the contributions of any coauthors.

All those designated as authors should meet all 4 criteria for authorship, and all who meet the 4 criteria should be identified as authors. Those who do not meet all 4 criteria should be acknowledged (see Acknowledgment Section).

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All authors (ie, the corresponding author and each coauthor) must read, complete, and submit an electronic Authorship Form with required statements on Authorship Responsibility, Criteria, and Contributions; Disclosure of Potential Conflicts of Interest; and Publishing Agreement.2(pp128-133) In addition, authors are required to identify their specific contributions to the work described in the manuscript. Requests by authors to designate equal contributions or shared authorship positions (eg, co–first authorship) may be considered if justified and within reason.6 An email with links to the Authorship Form will be sent to authors for completion after manuscripts have been submitted (see sample Authorship Form).

For reports of original data, authors' specific contributions will be published in the Acknowledgment section (see Manuscript Preparation and Submission Requirements, Acknowledgment Section).2 All other persons who have made substantial contributions to the work reported in this manuscript (eg, data collection, analysis, or writing or editing assistance) but who do not fulfill the authorship criteria should be named with their specific contributions and affiliations in an Acknowledgment in the manuscript. Written permission to include the names of individuals in the Acknowledgment section must be obtained.

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 About Previous Release of Information, Embargo, and Access).2 Authors of manuscripts reporting original data or systematic reviews must provide an access to data statement from 1 or 2 named authors, often the corresponding author (see also Data Access, Responsibility, and Analysis). If requested, authors should be prepared to provide the data and must cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees.

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Role of the Corresponding Author

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A single corresponding author (or coauthor designee in the event that the corresponding author is unavailable) will serve on behalf of all coauthors as the primary correspondent with the editorial office during the submission and review process. If the manuscript is accepted, the corresponding author will review an edited manuscript and proof, make decisions regarding release of information in the manuscript to the news media or federal agencies, handle all postpublication communications and inquiries, and will be identified as the corresponding author in the published article.

The corresponding author also is responsible for ensuring that the Acknowledgment section of the manuscript is complete (see Acknowledgment Section) and that the conflict of interest disclosures reported in the Acknowledgment section of the manuscript are accurate, up-to-date, and consistent with the information provided in each author's potential conflicts of interest section in the Authorship Form (see Conflicts of Interest and Financial Disclosures).

The corresponding author also must complete the Acknowledgment statement part of the Authorship Form confirming that all persons who have contributed substantially but who are not authors are identified in the Acknowledgment section and that written permission from each person acknowledged has been obtained (see sample Authorship Form and Acknowledgment Section).

Requests for co–corresponding authors will be considered on a very limited basis if justified, but no more than 2 co–corresponding authors will be permitted. In such cases, a primary corresponding author must be designated as the point of contact responsible for all communication about the manuscript and article, manage the tasks described above, and will be listed first in the corresponding author section.6

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Changes in Authorship

Authors should determine the order of authorship among themselves and should settle any disagreements before submitting their manuscript. Changes in authorship (ie, order, addition, and deletion of authors) should be discussed and approved by all authors. Any requests for such changes in authorship after initial manuscript submission and before publication should be explained in writing to the editor in a letter or email from all authors.2(pp128-133)

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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, and all group member authors must complete Authorship Forms (see sample Authorship Form).6 If all members of a group do not meet all authorship criteria, a group must designate 1 or more individuals as authors or members of a writing group who meet full authorship criteria and requirements and who will take responsibility for the group.2,6 Other group members who do not meet the criteria for authorship may be listed as collaborators in an Acknowledgment.2(pp128-133) Both authors and collaborators can be noted in published articles and in PubMed records. Group authors may not be included for article types with limited numbers of authors (eg, opinion articles).

For articles with a large number of authors (eg, >50), a long list of authors will not fit in the byline of a print/PDF version of the article. In such cases, a group byline will be recommended with the individual names of each author listed at the end of the article. All author names would still be individually indexed, displayed, and easily searchable in bibliographic records such as PubMed.6

To read more about authorship, click here.

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Conflicts of Interest and Financial Disclosures

A conflict of interest may exist when an author (or the author's institution or employer) has financial or personal relationships or affiliations that could 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 the Acknowledgment section of the manuscript2 and in the Disclosure of Potential Conflicts of Interest section of the Authorship Form. Note: These forms will be requested after a manuscript has been submitted, but authors should also include conflict of interest disclosures in the Acknowledgment section of the submitted manuscript.

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Comments: Definitions and Terms of Conflicts of Interest Disclosures

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Definitions and Terms of Conflicts of Interest Disclosures:

Authors are expected to provide detailed information about all relevant financial interests, activities, relationships, and affiliations (other than those affiliations listed in the title page of the manuscript) including, but not limited to, employment, affiliation, funding and grants received or pending, consultancies, honoraria or payment, speakers' bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Following the guidelines of the ICMJE,4 the definitions and terms of such disclosures include

Any potential conflicts of interest "involving the work under consideration for publication" (during the time involving the work, from initial conception and planning to present),

Any "relevant financial activities outside the submitted work" (over the 3 years prior to submission), and

Any "other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing" what is written in the submitted work (based on all relationships that were present during the 3 years prior to submission).

Authors without conflicts of interest, including relevant financial interests, activities, relationships, and affiliations, should indicate such in their disclosures and include a statement of no such interests in the Acknowledgment section of the manuscript. Failure to include this information in the manuscript may delay evaluation and review of the manuscript. Authors should err on the side of full disclosure and should contact the editorial office if they have questions or concerns.

Although many universities and other institutions and organizations have established policies and thresholds for reporting financial interests and other conflicts of interest, the JAMA Network requires complete disclosure of all relevant financial relationships and potential financial conflicts of interest, regardless of amount or value. For example, authors of a manuscript about hypertension should report all financial relationships they have with all manufacturers and owners of products, devices, tests, and services used in the management of hypertension, not only those relationships with entities whose specific products, devices, tests, and services are mentioned in the manuscript. If authors are uncertain about what constitutes a relevant financial interest or relationship, they should contact the editorial office.

For all accepted manuscripts, the corresponding author will have been asked to confirm that each coauthor's disclosures of conflicts of interest and relevant financial interests, activities, relationships, and affiliations and declarations of no such interests are accurate, up-to-date, and consistent with the disclosures reported in the Acknowledgment section of the manuscript because this information will be published in the Acknowledgment section of the article. Decisions about whether such information provided by authors should be published, and thereby disclosed to readers, are usually straightforward. Although editors are willing to discuss disclosure of specific conflicts of interest with authors, JAMA Network policy is one of complete disclosure of all potential conflicts of interest, including relevant financial interests, activities, relationships, and affiliations (other than those affiliations listed in the title page of the manuscript). The policy requiring disclosure of conflicts of interest applies for all manuscript submissions, including letters to the editor. If an author's disclosure of potential conflicts of interest is determined to be inaccurate or incomplete after publication, a correction will be published to rectify the original published disclosure statement, and additional action may be taken as necessary.

All authors must also complete the Disclosure of Potential Conflicts of Interest section of the Authorship Form.7

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Comments: Funding/Support and Role of Funder/Sponsor

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Funding/Support and Role of Funder/Sponsor

All financial and material support for the research and the work should be clearly and completely identified in an Acknowledgment section of the manuscript. At the time of submission, information on the funding source (including grant identification) must also be completed via the online manuscript submission and review system. 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; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication."7

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Data Access, Responsibility, and Analysis

For all reports (regardless of funding source) containing original data, at least 1 named author (eg, the principal investigator), and no more than 2 authors, must 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."7 This exact statement should be included in the Acknowledgment section at the end of the manuscript. Modified statements or generic statements indicating that all authors had such access are not acceptable. In addition, for all reports containing original data, the names and affiliations of all authors (or other individuals) who conducted and are responsible for the data analysis must be indicated in the Acknowledgment section of the manuscript. If the individual who conducted the analysis is not named as an author, a detailed explanation of his/her contributions and reasons for his/her involvement with the data analysis should be included.

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Data Sharing Statement

For reports of randomized clinical trials, authors are required to provide a Data Sharing Statement to indicate if data will be shared or not. Specific questions regarding the sharing of data are included in the manuscript submission system. If authors choose to share or not share data, this information will be published in a Data Sharing Statement in an online supplement linked to the published article. Authors will be asked to identify the data, including individual patient data, a data dictionary that defines each field in the data set, and supporting documentation (eg, statistical/analytic code), that will be made available to others; when, where, and how the data will be available (eg, a link to a data repository); types of analyses that are permitted; and if there will be any restrictions on the use of the data. Authors also have the option to explain why data may not be shared.

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Acknowledgment Section

The Acknowledgment section is the general term for the list of contributions, disclosures, credits, and other information included at the end of the text of a manuscript but before the references. The Acknowledgment section includes authors' contributions; information on author access to data; disclosure of potential conflicts of interest, including financial interests, activities, relationships, and affiliations; sources of funding and support; an explanation of the role of funder(s)/sponsor(s); names, degrees, and affiliations of participants in a large study or other group (ie, collaborators); any important disclaimers; information on previous presentation of the information reported in the manuscript; and the contributions, names, degrees, affiliations, and indication if compensation has been received for all persons who have made substantial contributions to the work but who are not authors.2

All other persons who have made substantial contributions to the work reported in the manuscript (eg, data collection, analysis, and writing or editing assistance) but who do not fulfill the authorship criteria should be named with their specific contributions in an Acknowledgment in the manuscript.

Authors must obtain written permission to include the names of all individuals included in the Acknowledgment section, and the corresponding author must confirm that such permission has been obtained in the Authorship Form.

Editorial Policies for Authors

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Requirements for Reporting

EQUATOR Reporting Guidelines

Include: All Journals
Exclude: JNO
Comments: "Authors of reports of studies..."
Include: JNO
Exclude: All other journals
Comments: "Authors of research articles...". Copy Z

Authors of research articles should follow the EQUATOR Reporting Guidelines. See specific Study Types for detailed guidance on reporting.

Include: All other Journals
Exclude: JNO
Comments: Reporting Clinical Trials

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Use of Causal Language

Causal language (including use of terms such as effect and efficacy) should be used only for randomized clinical trials. For all other study designs (including meta-analyses of randomized clinical trials), methods and results should be described in terms of association or correlation and should avoid cause-and-effect wording.

Timeliness of Data

Research reports should be timely and current and should be based on data collected as recently as possible. Manuscripts based on data from randomized clinical 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 5 years before manuscript submission. Likewise, data used in case-control or cross-sectional studies should have been collected as recently as possible, but no more than 5 years before manuscript submission. Manuscripts in which the most recent data have been collected more than 5 years ago ordinarily will receive lower priority for publication; thus, authors of such manuscripts should provide a detailed explanation of the relevance of the information in light of current knowledge and medical practice as well as the most recent date(s) of analysis of the study.

Include: FPS
Exclude: JAMA, CAR, DER, IMD, NEU, ONC, OPH, PED, OTO, PSY, SUR, JNO
Comments: Level of Evidence
Include: All Journals
Comments: To the end of the document

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Reporting Demographic Information for Study Participants

Aggregate, de-identified demographic information (eg, age, sex, race/ethnicity, and socioeconomic indicators) should be reported for all research reports and systematic reviews along with all prespecified outcomes. All demographic variables assessed should be reported in the Methods section. All demographic information collected should be reported in the Results section, either in the main article and/or in an online supplement. If any demographic characteristics that were collected are not reported, this should be explained. Summary demographic information (eg, baseline characteristics of study participants) should be reported in the first line of the Results section of Abstracts.

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Reporting Age

Study inclusion or exclusion criteria by age or age group should be defined in the Methods section. Stratification by age groups should be based on relevance to disease, condition, or population (eg, <5 or >65 years). The ages for study participants should be reported in aggregate (ie, mean and SD or median and IQR or range) in the Results section.

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Reporting Sex/Gender

The term sex should be used when reporting biological factors and gender should be used when reporting gender identity or psychosocial/cultural factors. The methods used to obtain information on sex, gender, or both (eg, self-reported, investigator observed or classified, or laboratory test) should be explained in the Methods section.12 If only one sex is reported, or included in the study, the reason the other sex is not reported or included should be explained in the Methods section, except for studies of diseases/disorders that only affect males (eg, prostate disease) or females (eg, ovarian disease).

The sex distribution of study participants or samples should be reported in the Results section, including for studies of humans, tissues, cells, or animals. Study results should disaggregate and report all outcome data by sex.

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Reporting Race/Ethnicity

An explanation of who classified individuals as to race, ethnicity, or both, the classifications used, and whether the options were defined by the investigator or the participant should be included in the Methods section. The reasons that race/ethnicity was assessed in the study also should be described in the Methods section. Race/ethnicity of the study population should be reported in the Results section.

Ethical Approval of Studies and Informed Consent

For all manuscripts reporting data from studies involving human participants or animals, formal review and approval, or formal review and waiver, by an appropriate institutional review board or ethics committee is required and should be described in the Methods section.2(p226) For those investigators who do not have formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed.13 For investigations of humans, state in the Methods section the manner in which informed consent was obtained from the study participants (ie, oral or written) and whether participants received a stipend. Authors of research studies involving humans should not make independent determinations of exemption or exclusion of IRB or ethical review; they should cite the institutional or regulatory policy for that determination and indicate if the data are deidentified and publicly available or protected by prior consent or privacy safeguards. Editors may request that authors provide documentation of the formal review and recommendation from the institutional review board or ethics committee responsible for oversight of the study.

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Patient Identification

A signed statement of informed consent to publish patient descriptions, photographs, video, 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 and indicated in the Acknowledgment section of the manuscript. Such persons should be offered the opportunity to see the manuscript before its submission.2(pp229-232)

Omitting data or making data less specific to deidentify patients is acceptable, but changing any such data is not acceptable. Only those details essential for understanding and interpreting a specific case report or case series should be provided. Although the degree of specificity needed will depend on the context of what is being reported, specific ages, race/ethnicity, and other sociodemographic details should be presented only if clinically or scientifically relevant and important.2 Cropping of photographs to remove identifiable personal features that are not essential to the clinical message may be permitted as long as the photographs are not otherwise altered. Please do not submit masked photographs of patients. Patients' initials or other personal identifiers must not appear in an image.

Patient Permission Form:

The Patient Permission form for publication of identifying material is available here. Translated versions in Arabic, Chinese, French, German, Hindi, Italian, Japanese, Portuguese, and Spanish are available on request.

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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.2(p199) Personal communications should not be included in the list of references but added to the text parenthetically.

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Manuscripts That Pose Security Risks

Authors and reviewers are expected to notify editors if a manuscript could be considered to report dual use research of concern (ie, research that could be misused by others to pose a threat to public health and safety, agriculture, plants, animals, the environment, or material).14 The editor in chief will evaluate manuscripts that report potential dual use research of concern and, if necessary, consult additional reviewers.

Journal Policies, Forms, Resources

Journal Policies

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Decisions and Management of Editorial Conflicts of Interest

Final decisions regarding manuscript publication are made by the editor in chief or a designated editor who does not have any relevant conflicts of interest. The journal has a formal recusal process in place to help manage potential conflicts of interest of editors. In the event that an editor has a conflict of interest with a submitted manuscript or with the authors, the manuscript, review, and editorial decisions are managed by another designated editor without a conflict of interest related to the manuscript.

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Publishing Agreement

Include: All Journals
Exclude: JNO
Comments: Publishing Agreement paragraph and Unauthorized Use
Include: JNO
Exclude: All other journals
Comments: "All authors are required to complete..." Copy AA

All authors are required to complete and submit a Publishing Agreement that is part of the journal's Authorship Form. See also Open Access.

References

  • 1. Cummings P, Rivara FP. Reporting statistical information in medical journal articles. Arch Pediatr Adolesc Med. 2003;157(4):321-324. doi:10.1001/archpedi.157.4.321

  • 2. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007. http://www.amamanualofstyle.com.

  • 3. Golub RM. Correspondence course: tips for getting a letter published in JAMA. JAMA. 2008;300(1):98-99. doi:10.1001/jama.300.1.98

  • 4. International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. http://www.icmje.org. Updated 2014. Accessed September 23, 2016.

  • 5. Fontanarosa PB, Flanagin A, DeAngelis CD. Update on JAMA's policy on release of information to the public. JAMA. 2008;300(13):1585-1587. doi:10.1001/jama.300.13.1585

  • 6. Fontanarosa P, Bauchner H, Flanagin A. Authorship and team science. JAMA. 2017;318(24):2433-2437. doi:10.1001/jama.2017.19341

  • 7. Fontanarosa PB, Flanagin A, DeAngelis CD. Reporting conflicts of interest, financial aspects of research, and role of sponsors in funded studies. JAMA. 2005;294(1):110-111. doi:10.1001/jama.294.1.110

  • 8. DeAngelis CD, Drazen JM, Frizelle FA, et al; International Committee of Medical Journal Editors. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. JAMA. 2004;292(11):1363-1364. doi:10.1001/jamainternmed.2014.6933

  • 9. DeAngelis CD, Drazen JM, Frizelle FA, et al; International Committee of Medical Journal Editors. Is this clinical trial fully registered? a statement from the International Committee of Medical Journal Editors. JAMA. 2005;293(23):2927-2929. doi:10.1001/jama.293.23.jed50037

  • 10. The CONSORT statement. http://www.consort-statement.org/consort-2010. Updated 2014. Accessed September 23, 2016.

  • 11. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 8th ed. Oakbrook Terrace, IL: American Association for Public Opinion Research; 2015. http://www.aapor.org/Publications-Media/AAPOR-Journals/Standard-Definitions.aspx. Accessed September 23, 2016.

  • 12. Clayton JA, Tannenbaum C. Reporting sex, gender, or both in clinical research? JAMA. 2016;316(18):1863-1864. doi:10.1001/jama.2016.16405

  • 13. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. https://jamanetwork.com/journals/jama/fullarticle/1760318. Accessed January 2, 2014.

  • 14. Journal Editors and Authors Group. Statement on scientific publication and security. Science. 2003;299(5610):1149. http://www.sciencemag.org/site/feature/data/security/statement.pdf. Accessed February 28, 2012.

  • 15. Christiansen S, Flanagin A. Correcting the medical literature: "to err is human, to correct divine." JAMA. 2017;318(9):804-805. doi:10.1001/jama.2017.11833

Last Updated: September 12, 2019

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