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JAMA Surgery Instructions For Authors

Editorial Office Contact Information

JAMA Surgery, Northwestern University; telephone: (312) 464-4444; e-mail: jamasurg@jamanetwork.org. Authors should submit inquiries about manuscripts by email.

Editorial Policies for Authors

Most of JAMA Surgery’s editorial policies for authors are summarized in these instructions. Citations and links to the AMA Manual of Style: A Guide for Authors and Editors1 and other publications with additional information are also provided.

Authorship Criteria and Contributions and Authorship Form

Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.1 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), as revised in 2013,2 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 four criteria should be acknowledged (see Acknowledgment Section).

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; Conflicts of Interest and Funding; and Publishing Agreement. In addition, authors are required to identify their contributions to the work described in the manuscript.1(pp128-133) Authorship Forms will be sent to authors for completion after manuscripts have been submitted (see sample Authorship Form).

For reports of original data and systematic reviews, authors’ specific contributions will be published in the Acknowledgment section (see Manuscript Preparation and Submission Requirements, Acknowledgment Section).1 All other persons who have made substantial contributions to the work reported in this 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. Written permission to include the names of individuals in the Acknowledgment section must be obtained (see Manuscript Preparation and Submission Requirements, Acknowledgment Section).

The authors also must certify that the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere (see also Duplicate/Previous Publication or Submission).1 Authors of manuscripts reporting original data or systematic reviews must provide an access to data statement from at least 1 named author, 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.

Role of the Corresponding Author

The corresponding author (or coauthor designee) 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, federal agencies, or both, and will be identified as the corresponding author in the published article. The corresponding author is responsible for ensuring that the Acknowledgment section of the manuscript is complete (see Acknowledgment Section) and is responsible for ensuring 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 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 for more details).

Changes in Authorship

Authors should determine the order of authorship among themselves and should settle any disagreements among themselves before submitting their manuscripts. 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.

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 described above, and all group member authors must complete the Authorship Form.3 If all members of a group do not meet all authorship criteria, a group must designate at least 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.1,3 Other group members who do not meet the criteria for authorship may be listed as collaborators in the Acknowledgment. Both authors and collaborators will be noted in published articles and in PubMed records. Group authors may not be included on articles with limited numbers of authors.

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 that could inappropriately influence (or bias) the author’s decisions, work, or manuscript. All authors are required to disclose potential conflicts of interest, including specific financial interests relevant to the subject of their manuscript, in the Acknowledgment section of the manuscript,1 and to declare whether they have or do not have any conflicts of interest in the JAMA Surgery Authorship Form. This form will be requested after a manuscript has been submitted, but authors also should include conflict of interest disclosures in the Acknowledgment section of the submitted manuscript.

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,2 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 and include a statement of no such interests in the Acknowledgment section and title page 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, JAMA Surgery 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 Surgery ’s 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.

Authors also are required to report detailed information regarding all financial and material support for the research and work, including but not limited to grant support, funding sources, and provision of equipment and supplies, in the Acknowledgment section and title page of the manuscript.

Funding/Support and Role of Funder/Sponsor

All financial and material support (eg, grant identification, transfer agreement) for the research and the work should be clearly and completely identified in an Acknowledgment section of the manuscript. 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.”

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, should indicate that she or he "had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis."4 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.

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 (see sample Authorship Form); 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.1

All other persons who have made substantial contributions to the work reported in this 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 (see sample Authorship Form).

Duplicate/Previous Publication or Submission

Manuscripts are considered with the understanding that they have not been published previously in print or electronic format and are not under consideration by another publication or electronic medium. Copies of related or possibly duplicative materials (ie, those containing substantially similar content or using the same or similar data) that have been previously published or are under consideration elsewhere must be provided at the time of manuscript submission1(pp148-155),4 (see Previous or Planned Meeting Presentation or Release of Information).

Timeliness of Data

Research reports submitted to JAMA Surgery 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. Because manuscripts in which the most recent data have been collected more than 5 years ago (ie, prior to 2011) ordinarily will receive lower priority for publication, authors of such manuscripts should provide a detailed explanation of the relevance of the information in light of current knowledge and medical practice.

Clinical 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.2 Interventions include but are not limited to drugs, surgical procedures, devices, behavioral treatments, 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 a copy of the trial protocol including the complete statistical analysis plan (see Protocols), a flow diagram, and a completed trial checklist (see CONSORT Flow Diagram and Checklist). All clinical trials must be registered at an appropriate online public registry (see Trial Registration requirements). These and other requirements for manuscript preparation are detailed in Categories of Articles, Clinical Trial. For additional guidance on reporting cluster trials, noninferiority and equivalence trials, pragmatic trials, and trials with patient-reported outcomes, see Extensions of the CONSORT Statement.

Trial Registration:

As a member of ICMJE, JAMA Surgery 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).2,5,6 Acceptable trial registries include the following and others listed at http://www.icmje.org:

For this purpose, a clinical trial is any research project that prospectively assigns human participants to intervention or comparison groups to evaluate the cause-and-effect relationship between an intervention and a health outcome. 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. 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. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (eg, phase 1 trials), are exempt. 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.

Protocols:

Authors of manuscripts reporting clinical trials must submit trial protocols (including the complete statistical analysis plan) along with their manuscripts. If the manuscript is accepted, the protocol will be published as an online supplement.

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 (see Figure). The CONSORT Checklist should be completed and submitted with the manuscript.

Survey Research

Manuscripts reporting survey data, such as studies involving patients, clinicians, the public, or others, should report data collected as recently as possible, ideally within the past 2 years. Survey studies should have sufficient response rates (generally at least 60%) and appropriate characterization of nonresponders to ensure that nonresponse bias does not threaten the validity of the findings. For most surveys, such as those conducted by telephone, personal interviews (eg, drawn from a sample of households), mail, e-mail, or via the web, authors are encouraged to report the survey outcome rates using standard definitions and metrics, such as those proposed by the American Association for Public Opinion Research.4 In addition, authors should submit the survey instrument if possible as an online-only supplementary file (see Online-Only Supplements and Multimedia).

Reports of Diagnostic Tests

Authors of reports of diagnostic tests are encouraged to submit the STARD flow diagram and checklist.

Reports of Cost-effectiveness Analyses and Decision Analyses

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

Reporting Race/Ethnicity

If race and/or ethnicity is reported, indicate in the Methods section who classified individuals as to race/ethnicity, the classifications, and whether the options were defined by the investigator or the participant. Explain why race and/or ethnicity was assessed in the study.7

Reporting Sex

Report the sex distribution of study participants or samples in the Methods section, including studies of humans, tissues, cells, or animals. If only one sex is reported, or included in the study, explain why the other sex is not reported or included, except for studies of diseases/disorders that only affect males (eg, prostate disease) or females (eg, ovarian disease).

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.1(p226) For those investigators who do not have formal ethics review committees, the principles outlined in the Declaration of Helsinki should be followed.8 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. 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.

Identification of Patients in Descriptions, Photographs, Video, and Pedigrees

A signed statement of informed consent to publish (in print and online) 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, video, 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.1(p229-232) 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.1 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 may not appear in an image.

Patient Permission Form:

The Patient Consent form for publication of identifying material is available here.

Personal Communications and Unpublished Data

A signed statement of permission should be included from each individual identified as a source of information in a personal communication or as a source for unpublished data, and the date of communication and whether the communication was written or oral should be specified.1(p199) Personal communications should not be included in the reference list.

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).9 The editor in chief will evaluate manuscripts that report potential dual use research of concern and, if necessary, consult additional reviewers.

Previous or Planned Meeting Presentation or Release of Information

A complete report following presentation at a meeting or publication of preliminary findings elsewhere (eg, 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 presentations that occur before the work is published. Authors who present information contained in a manuscript that is under consideration by JAMA Surgery 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 postings of slides or videos from the scientific presentation on the meeting website, is acceptable. However, for manuscripts under consideration by JAMA Surgery, publication of full reports in proceedings or online, issuing detailed news releases reporting the results of the study, or participation in formal news conferences will jeopardize chances for publication of the submitted manuscript in JAMA Surgery. 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 by JAMA Surgery. 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.

Embargo Policy

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, including Original Investigations, Reviews, Editorials, Viewpoints, Letters, etc. 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.

Publishing Agreement

All authors are required to complete and submit a Publishing Agreement that is part of the JAMA Surgery electronic Authorship Form. In this agreement, authors will transfer copyright; or indicate that they are employed by a federal government; or indicate that they are an employee of an institution that considers the work in the manuscript a work for hire, in which case an authorized representative of that institution will assign copyright on the author’s behalf.

Public Access

All research articles are made free access online 12 months after publication on the journal website. All articles are made free access on The JAMA Network Reader on the day of publication.

Depositing Research Manuscripts With an Approved Public Repository

All JAMA Surgery articles reporting original research are made freely available 12 months after publication, subject to certain conditions. JAMA Surgery’s editors and publishers believe that the public is best served by accessing the freely available research articles on the journal site, to ensure access to the final published version, any corrections, and related web features. However, some funding organizations require that authors of manuscripts reporting research deposit those manuscripts with an approved public repository, such as PubMed Central or Europe PubMed Central. Authors have the JAMA Surgery’s permission on the following conditions:

  • 1. Permission is granted only for manuscripts reporting research funded by not-for-profit organizations to be deposited in not-for-profit, publicly available repositories.
  • 2. Permission is granted to post either the accepted version of the submitted manuscript or a copy of the published article.
  • 3. Authors must ensure that the posted content links back to the published article on the JAMA Surgery website to provide readers with access to the final version plus any corrections and letters, as well as the article-related features only available on JAMA Surgery’s website.
  • 4. Authors who submit their manuscripts to an approved public repository, such as PubMed Central or Europe PubMed Central, must indicate that the content may not be made available to the public sooner than 12 months after publication in JAMA Surgery. If authors adhere to these requirements, they may submit the final accepted version of the manuscript or a published copy of the article to the repository, if and only if the repository ensures that the deposited manuscript will not be made available to the public during the 12-month embargo following publication in JAMA Surgery.

The published article is protected by copyright at the time of publication and thereafter (see JAMA Network Conditions of Use). This research access policy does not include permission to use the JAMA Network logo and trademarks. The JAMA Surgery article of record is the final published version; JAMA Surgery assumes no responsibility for earlier versions because substantive changes and corrections may occur during the post acceptance editing process. Authors may contact JAMA Surgery with any questions at jamasurg@jamanetwork.org.

Unauthorized Use

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

Editorial Review and Publication

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

Editorial and Peer Review

All submitted manuscripts are reviewed initially by a JAMA Surgery editor. 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 surgical interest. 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. Peer reviewer identities are kept confidential, but author identities are made known to reviewers. The existence of a manuscript under review is not revealed to anyone other than peer reviewers and editorial staff. 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.

Editing

Accepted manuscripts are edited in accordance with the AMA Manual of Style, 10th edition,1 and returned to the corresponding author (or his/her designee) for approval. Authors are responsible for all statements made in their work, including changes made during editing and production and authorized by the corresponding author.

Publication

If accepted for publication, all articles are generally published Online First and then again in a print/online issue or Online Only.

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

Reprints/e-prints

Reprints and e-prints may be ordered online at www.ama-authorreprints.com when the edited manuscript is sent for approval to the corresponding author.

Categories of Articles

JAMA Surgery publishes Original Investigations, Reviews, Special Communications, Viewpoints, and other categories of articles. Topics of interest include all subjects that relate to the practice of surgery and the betterment of public health. The most frequently published types of articles are described herein.

Original Investigation

These reports typically include randomized trials (see Clinical Trial), intervention studies, cohort studies, case-control studies, epidemiologic assessments, other observational studies, surveys with high response rates (see Survey Research), cost-effectiveness analyses and decision analyses (see Reports of Cost-effectiveness Analyses and Decision Analyses), and studies of screening and diagnostic tests (see also Reports of Diagnostic Tests). Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria and/or participation or response rates, or data sources, and how these were selected for the study); the essential features of any interventions; the main outcome measures; the main results of the study; a 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). A structured abstract is required; for more information, see instructions for preparing structured Abstracts. Maximum length: 3000 words of text (not including acknowledgment, abstract, tables, figures, references, and online-only material) with no more than a total of 5 tables and/or figures.

Clinical Trial

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. Interventions include but are not limited to drugs, surgical procedures, devices, behavioral treatments, 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 a copy of the trial protocol including the complete statistical analysis plan (see Protocols), a flow diagram (Figure), and a completed trial checklist (see CONSORT Flow Diagram and Checklist). All clinical trials must be registered at an appropriate online public registry (see Trial Registration requirements).

Flow Diagram

Figure. Profile of a Randomized Clinical Trial

For additional guidance on preparing manuscripts reporting cluster trials, noninferiority and equivalence trials, and pragmatic trials, see Extensions of the CONSORT Statement. Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria, or data sources, and how these were selected for the study); the essential features of any interventions; the main outcome measures; the main results of the study; a 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 (name, number, and URL) must be listed at the end of the abstract; for more information, see instructions for preparing structured Abstracts. Maximum length: 3000 words of text (not including acknowledgment, abstract, tables, figures, references, and online-only material) with no more than a total of 5 tables and/or figures.

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. 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. A structured abstract is required; for more information, see instructions for preparing structured Abstracts for Meta-analysis. Maximum length: 3500 words of text (not including acknowledgment, abstract, tables, figures, references, and online-only material), with no more than a total of 4 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase “A Meta-analysis.”

Research Letter

Research Letters reporting original research should not exceed 600 words of text (not including acknowledgment, abstract, tables, figures, and references) 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 e-mail 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: To the Editor (which serves as an introduction), Methods, Results, and Discussion. Research Letters should be double-spaced and a word count should be provided with each letter. They should not include an abstract, but otherwise should follow all of the guidelines in Manuscript Preparation and Submission Requirements. Letters not meeting these specifications are generally not considered.

Reviews

The journal will consider 3 types of review articles:

Systematic Reviews

Advances in Diagnosis and Treatment

Narrative Review

These types of Review articles differ by the scope and level of analysis of the literature searches and the titles used. Systematic Reviews require a complete systematic search of the literature using multiple databases, covering many years, and grading of the quality of the cited evidence. Advances in Diagnosis and Treatment also require a complete systematic search of the literature, but only of the last 5 years of published literature. An assessment of quality of the evidence is not required but is recommended. Narrative Reviews do not require a rigorous literature search but should rely on evidence and should be written by established experts in the field. See below for more detail on each type of Review.

Titles for these Reviews should include a concise description of the main topic. Use specific and not overly broad wording for the title; the type of review should be indicated in the subtitle. For example:

Behavioral Treatment of Obesity: A Systematic Review

Behavioral Treatment of Obesity: Advances in Diagnosis and Treatment

Behavioral Treatment of Obesity: A Review (note: the word “narrative” is not included in the subtitle)

Systematic Review (without meta-analysis)

Systematic Reviews are critical assessments of the literature and data sources pertaining to clinical topics, emphasizing factors such as cause, diagnosis, prognosis, therapy, or prevention. Systematic Reviews without meta-analysis are published as Reviews; those with meta-analysis are published as Original Investigations (see Meta-analysis). Systematic Reviews should address a specific question or issue that is relevant for clinical practice and provide an evidence-based, balanced, patient-oriented review on a focused topic.

The basic structure of manuscripts reporting Systematic Reviews should include the following: Abstract (structured abstract of no more than 350 words); Introduction (150-250 words); Methods (150-250 words); Results (1000-1250 words, with the following subsections, if appropriate, depending on the specific question or issue addressed: Pathophysiology, Clinical Presentation, Assessment and Diagnosis, Treatment, and Prognosis); Discussion (1000 words); and Conclusions (2-3 sentences).

Maximum length: 3500 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 and no more than 50-75 references. For an example of a published Systematic Review, see JAMA. 2014;312(6):631-640 and below for the general structure of a Systematic Review article.

Specific Components of a Systematic Review

Key Points (75-100 words)

This feature provides a quick structured synopsis of the Review, following 3 key points: Question, Findings, and Meaning. Limit to no more than 100 words. This is different from the Abstract.

Example

Question: What are the most effective medical treatments for adult chronic sinusitis?

Findings: In this systematic review, symptoms of chronic sinusitis were improved with saline irrigation and topical corticosteroid therapy compared to no therapy. Compared with placebo, 3-week courses of systemic corticosteroids or oral doxycycline were associated with reduced polyp size, and a 3-month course of macrolide antibiotic was associated with improved symptoms in patients without polyps.

Meaning: First-line therapy for chronic sinusitis should begin with daily topical intranasal corticosteroid in conjunction with saline irrigation; subsequent therapies should be based on the patient's polyp status and severity of symptoms.

Abstract (350 words)

A structured abstract is required; Systematic Review articles should include a structured abstract of no more than 350 words using the headings listed below.

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

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

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

Findings: Include a brief summary of the number of articles included, numbers of various types of studies (eg, clinical trials, cohort studies), and numbers of patients/participants represented by these studies. Summarize the major findings of the review of the clinical issue or topic in an evidence-based, objective, and balanced fashion, with the highest-quality evidence available receiving the greatest emphasis. Provide quantitative data.

Conclusions and Relevance: The conclusions should clearly answer the questions posed if applicable,  be based on available evidence, and emphasize how clinicians should apply current knowledge. Conclusions should be based only on results described in the abstract Findings subsection.

Introduction (150-250 words)

The first 2-3 sentences of the Introduction should draw in readers such that they want to continue reading the article and should establish the importance of the Review. Reviews should include the clinical question or issue and its importance for general medical practice, specialty practice, or public health. The first paragraph should provide a general summary of the clinical problem (eg, obesity). The next paragraph should focus on the specific aspect of the clinical problem the article will explore (eg, treatments for obesity). The epidemiology of the disease or condition should be briefly summarized and generally should include disease prevalence and incidence. The third paragraph should discuss exactly what material will be covered in the Review (eg, obesity treatments reported in trials with a minimum follow-up of 2 years including 80% of the original cohort).

Methods/Literature Search (150-250 words)

The literature search should be as current as possible, ideally with end dates within a month or two before manuscript submission. A search of the primary literature should be conducted, including multiple bibliographic databases (eg, PubMed/MEDLINE, Embase, CINAHL, PsycINFO). This can be facilitated by collaborating with a medical librarian to help with the search.11

Briefly describe characteristics of the literature searched and included in the review, following the PRISMA reporting guidelines, including the bibliographic databases and other sources searched, search terms used, dates included in the search, date the literature search was conducted, screening process, language limitations, and inclusion and exclusion criteria. The rating system used to evaluate the quality of the evidence should be specified (see table below) and the methods used to evaluate quality should be described, including number of quality raters, how agreement on quality ratings was assessed, and how disagreements on quality ratings were resolved.

The highest-quality evidence (eg, randomized clinical trials, meta-analyses, systematic reviews, and high-quality prospective cohort studies) should receive the greatest emphasis. Clinical practice guidelines ordinarily should not be used as a primary component of the evidence base for the systematic review, although relevant guidelines should be addressed in the Discussion section of the article.

The search methods should be described in sufficient detail so the search can be reproduced based on the information provided in the manuscript. A summary of the methods of the literature search including this information should be included in the main article; details can be included in an online-only supplement. A PRISMA-style flow diagram showing this information should also be included as an online-only supplement. In addition, a completed PRISMA checklist should be submitted for the items completed that apply to systematic reviews (the checklist items that apply to meta-analyses do not need to be completed for systematic reviews without meta-analysis). The checklist will be used during review but will not be published.

Results (1000-1250 words)

First, briefly report the results of the literature search, including the number of articles reviewed and included, numbers of various types of studies (eg, clinical trials, cohort studies) included, and the aggregate numbers of patients included in the reviewed studies. Also provide a brief summary of the quality of the evidence. Details of this information can be included in a PRISMA-style flow diagram and table(s).

Next, the subsections listed below should generally appear in the Results sections of most Reviews although all of these subsections may not be necessary for some topics, depending on the specific question or issue addressed. The word counts following each subsection are suggested to assist with keeping the overall Results section limited to 1000-1250 words.

Pathophysiology (150-250 words). Provide a brief overview of the pathophysiology of the disease. The intent is to provide readers with sufficient background information about the underpinnings of a disease to provide context for the rest of the article.

Clinical Presentation (150-250 words). Briefly describe the clinical characteristics that result in a patient seeking medical care for the condition or what features of the disease should lead a clinician to evaluate or treat it.

Assessment and diagnosis (250-300 words). Describe the clinical examination for evaluation of the disease and explain the most salient physical examination findings. If laboratory or imaging studies are necessary, provide the sensitivity and specificity and diagnostic accuracy of these tests and consider providing positive and negative likelihood ratios. Sequences of diagnostic tests are best presented as algorithms or in tables.

Treatment (250-500 words). Treatments should be based on the most recently available and highest level of evidence. Treatment options should be summarized in the text and presented in detail in tables along with an indication of the strength of evidence supporting the individual treatments. In general, treatment recommendations should be supported by a systematic review of the literature, either performed by the author of the Review or published in the form of a high-quality review or guideline. If possible, the costs for various treatments should be provided.

Prognosis (100-150 words). A section outlining the overall prognosis for the condition, once treated, should be included.

Discussion (Approximately 1000 words)

Key findings should be summarized in the first paragraph of the Discussion section. All statements made should be supported by evidence. It is very important to not simply list findings from the studies reviewed. This information is best presented in tables. The Discussion should provide a critical synthesis of data and information based on the results of the review, an assessment of the quality of studies summarized, and a description of how studies can be interpreted and used to guide clinical practice. The limitations of the evidence and of the review should be discussed, and gaps in evidence should be addressed. A discussion of controversial or unresolved issues and topics in need of future research also should be included.

Clinical Practice Guidelines: In the Discussion section, describe current clinical practice guidelines, relevant to the topic of the review, if available, and whether the conclusions of this review agree with, or disagree with, the current clinical practice guidelines. If this is done and there is more than 1 guideline, a table should be prepared comparing the major features that differ between the guidelines. Guideline quality should be discussed using the standards outlined for the JAMA Clinical Guidelines Synopsis.

Conclusions

Include a 2-3 sentence summary of the major conclusions of the review.

Tables

Construct tables that summarize the search results. Tables summarizing treatments should have information organized by category of treatment and then by individual treatments. Columns should include the name of the treatment, strength of evidence supporting the treatment, the treatment's effect (preferably shown as the treatment's effect as compared to control on the measured outcome together with 95% confidence intervals), adverse effects, and very brief comments, if necessary. Lengthy text-based tables should be avoided. Additional or lengthy tables may be published online only, if justified.

Ratings of the quality of the evidence. Tables summarizing evidence should include ratings of the quality of the evidence. Use the rating scheme listed below with ratings of 1-5 for Reviews that include individual studies (modified from the Oxford Centre for Evidence-based Medicine for ratings of individual studies).

Quality Rating Scheme for Studies and Other Evidence

1

Properly powered and conducted randomized clinical trial; systematic review with meta-analysis

2

Well-designed controlled trial without randomization; prospective comparative cohort trial

3

Case-control studies; retrospective cohort study

4

Case series with or without intervention; cross-sectional study

5

Opinion of respected authorities; case reports

There are several other preferred systems for rating the quality of evidence in Review articles. For Reviews that synthesize findings from numerous studies into a single summary recommendation, use the rating scale shown above or the Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation or the recommendations in the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. For reviews that include diagnostic studies, use The Rational Clinical Examination Levels of Evidence table.

Follow additional instructions for Table preparation and submission.

Figures

A PRISMA-style flow diagram should be included as an online supplement that summarizes the results of the literature search and the numbers of articles/records/studies and patients/participants represented in the studies identified, screened, eligible, and included in the final review.

Additional figures that illustrate pathophysiology or clinical presentation may be considered. We encourage videos, if appropriate, to illustrate a point made or process described in the Review.

Follow additional instructions for Figure and Video preparation and submission.

Advances in Diagnosis and Treatment Review

Advances in Diagnosis and Treatment Reviews provide the latest information about management of diseases and conditions, emphasizing what is new, and are typically written by senior experts in the field. Advances in Diagnosis and Treatment manuscripts require a complete systematic review of the last 5 years of published literature. If necessary to document advances, the review can include more than the last 5 years and this should be explained. An evaluation of the quality of evidence is recommended but not required. Advances in Diagnosis and Treatment Reviews should address a specific question or issue that is relevant for clinical practice and provide an evidence-based, balanced, patient-oriented current review on a focused topic.

The basic structure of manuscripts reporting Advances in Diagnosis and Treatment Reviews should include the following: Abstract (structured abstract of no more than 350 words); Introduction (150-250 words); Methods (150-250 words); Results (1000-1250 words, with the subsections Advances in Diagnosis and Advances in Treatment); Discussion (1000 words); and Conclusions (2-3 sentences).

Maximum length: 3500 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 and no more than 50-75 references. For an example of this type of article, see JAMA. 2015;314(7):708-717 and below for the general structure of Advances in Diagnosis and Treatment Review article.

Specific Components of Advances in Diagnosis and Treatment

Key Points (75-100 words)

This feature provides a quick structured synopsis of the Advances in Diagnosis and Treatment Review, following 3 key points: Question, Findings, and Meaning. Limit to no more than 100 words. This is different from the Abstract.

Example

Question: What advances in diagnosis, prevention, and management of diabetes have been introduced in the last 5 years?

Findings: The diabetes epidemic is secondary to the high prevalence of overweight and obesity contributing to the development of type 2 diabetes and resulting in severe morbidity and mortality; research shows that reducing the burden of microvascular and cardiovascular disease has been effective in management of diabetes.

Meaning: Improved glycemic control, better management of risk factors for the complications of diabetes, and more effective treatment of cardiovascular disease and microvascular complications have resulted in a more optimistic outlook for people with diabetes.

Abstract (350 words)

Advances in Diagnosis and Treatment Reviews should include a structured abstract of no more than 350 words using the headings listed below.

Importance: Include 1 or 2 sentences describing the clinical question or issue, and explain the reason an update of recent advances in diagnosis and treatment is needed.

Objective: State the precise primary objective of the review and indicate the aspects of diagnosis and treatment that are being reviewed.

Evidence Review: Describe the information sources used, including the search strategies, years searched (limit to the last 5 years, unless otherwise justified), other sources of material, such as subsequent reference searches of retrieved articles, and criteria used for inclusion of identified articles. If a quality assessment is included, explain the methods used for quality assessment of the evidence.

Findings: Include a brief summary of the number of articles included, numbers of various types of studies (eg, clinical trials, cohort studies), and numbers of patients/participants represented by these studies. Summarize the major findings of the review summarizing the advances in diagnosis and the advances in treatment in an evidence-based, objective, and balanced fashion, with the highest-quality evidence receiving the greatest emphasis. Provide quantitative data.

Conclusions and Relevance: The conclusions should emphasize the major advances in diagnosis and treatment, be based on evidence reported in the abstract findings subsection, and mention how these advances should be applied in clinical practice.

Introduction (150-250 words)

The first 2-3 sentences of the Introduction should draw in readers in such that they want to continue reading the article and should establish the importance of the Review. The clinical question or issue and its importance for general medical practice, specialty practice, or public health should be clearly indicated, and the reasons for providing an update in diagnosis and treatment should be described. The first paragraph should provide a general summary of the clinical issue (eg, obesity), with a brief summary of the current epidemiology of the disease. The next paragraph should focus on the specific advances in diagnosis and treatment the article will explore (eg, advances in surgical treatments for obesity). The third paragraph should discuss what material will be covered in the Review (eg, outcomes of novel surgical treatments reported in trials with a minimum follow-up of 2 years including 80% of the original cohort).

Methods/Literature Search (150-250 words)

The literature search should be as current as possible, ideally with end dates within a month or two before manuscript submission and should be limited to the last 5 years. A search of the primary literature should be conducted, including multiple bibliographic databases (eg, PubMed/MEDLINE, Embase, CINAHL, PsycINFO). This can be facilitated by collaborating with a medical librarian to help with the search.11

Briefly describe characteristics of the literature searched and included in the review, following the PRISMA reporting guidelines, including the bibliographic databases and other sources searched, search terms used, dates included in the search, date the literature search was conducted, screening process, language limitations, and inclusion and exclusion criteria. The search methods should be described in sufficient detail such that the search can be reproduced based on the information provided in the manuscript. A summary of the methods of the literature search including this information should be included in the main article; details can be included in an online-only supplement.

The highest-quality evidence (eg, randomized clinical trials, meta-analyses, systematic reviews, and high-quality prospective cohort studies) should receive the greatest emphasis. An evaluation of the quality of evidence is recommended but not required. If a quality assessment is included, the rating system used to evaluate the evidence (see table below) should be specified and the methods used to evaluate quality should be described, including number of quality raters, how agreement on quality ratings was assessed, and how disagreements on quality ratings were resolved.

Clinical practice guidelines ordinarily should not be used as a primary component of the evidence base for the Advances in Diagnosis and Treatment Reviews, although relevant current guidelines should be addressed in the Discussion section of the article (see below).

Results (1000-1250 words)

First, briefly report the results of the literature search, including the number of articles reviewed and included, numbers of various types of studies (eg, clinical trials, cohort studies) included, and the aggregate numbers of patients included in the reviewed studies. Also, if the quality of evidence was assessed, provide a brief summary of the quality of the evidence. Details of this information can be included in a PRISMA-style flow diagram (in an online supplement) and table(s) as needed.

The Results sections of Advances in Diagnosis and Treatment Reviews should include specific sections (Advances in Diagnosis, Advances in Treatment) summarizing the latest information in the areas related to diagnostic and therapeutic advances. Other sections, such as new information relevant to pathophysiology, clinical presentation, or prognosis, may be included, depending of the clinical topic or issue. Overall the Results section should include 1000-1250 words.

Advances in Diagnosis (250-500 words). Describe advances in clinical assessment, laboratory testing, imaging studies, or other diagnostic procedures, including clinical utility and application of these advances. For laboratory or imaging studies, provide the sensitivity and specificity and diagnostic accuracy of these tests and consider providing likelihood ratios. Sequences of novel diagnostic tests may be presented in a table or as an element of a proposed diagnostic algorithm. Comparison of the advances in diagnosis with previously established diagnostic approaches may be discussed. If possible, the costs of the advances in diagnostic approaches should be included.

Advances in Treatment (250-500 words). Advances in treatment should be based on the most recently available and highest level of evidence. Treatment options should be summarized in the text and presented in detail in tables along with an indication of the strength of evidence supporting the individual treatments, if an assessment of study quality was performed. Comparison of the advances in treatment with previously established treatments may be discussed. If possible, the costs for the advances in treatment should be provided.

Discussion (Approximately 1000 words)

The key findings of the review, highlighting the advances in diagnosis and treatment, should be summarized in the first paragraph of the Discussion section. All statements made should be supported by evidence. The Discussion should provide a critical synthesis of data and information based on the results of the review and how the advances in diagnosis and treatment can be interpreted and used to guide clinical practice. The limitations of the evidence and of the review should be discussed, gaps in evidence should be addressed, and advantages and caveats related to the advances in diagnosis and treatment, compared with established diagnostic and therapeutic approaches, may be included. A discussion of controversial or unresolved issues and topics in need of future research also should be included.

In the Discussion section, also describe current clinical practice guidelines, relevant to the advances in diagnosis and therapy addressed in the review, if available, and whether the conclusions of this Review agree with, or disagree with, the current clinical practice guidelines. If this is done and there is more than 1 guideline, a table should be prepared comparing the major features that differ between the guidelines. Guideline quality should be discussed using the standards outlined for the JAMA Clinical Guidelines Synopsis.

Conclusions

Include a 2-3 sentence summary of the major conclusions of the review.

Tables

Construct tables that summarize the epidemiology, advances in diagnostic approaches, and advances in therapies available for the disease during the last 5 years. In some cases, all 3 topics may not all be relevant to the review topic and tables may be appropriately modified to fit the review. If appropriate, include a fourth table that compares the findings of the review and current clinical practice recommendations or diagnostic and therapeutic uncertainty or controversies.

Table 1: Major epidemiologic and burden of disease facts

Table 2: Major diagnostic tools available

Table 3: Major therapies available

Table 4: Current clinical practice recommendations and/or diagnostic and therapeutic uncertainty, and controversies

Tables summarizing treatments should have information organized by category of treatment and then by individual treatments. Columns should include the name of the treatment, strength of evidence supporting the treatment, the treatment's effect (preferably shown as the treatment's effect as compared to control on the measured outcome together with 95% confidence intervals), adverse effects, and very brief comments, if necessary. Lengthy text-based tables should be avoided. Additional or lengthy tables may be published online only, if justified.

Ratings of the quality of the evidence. If a quality assessment of the evidence was performed, tables summarizing evidence should include ratings of the quality of the evidence. Use the rating scheme listed below with ratings of 1-5 for Reviews that include individual studies (modified from the Oxford Centre for Evidence-based Medicine for ratings of individual studies).

Quality Rating Scheme for Studies and Other Evidence

1

Properly powered and conducted randomized clinical trial; systematic review with meta-analysis

2

Well-designed controlled trial without randomization; prospective comparative cohort trial

3

Case-control studies; retrospective cohort study

4

Case series with or without intervention; cross-sectional study

5

Opinion of respected authorities; case reports

There are several other preferred systems for rating the quality of evidence in Review articles. For Reviews that synthesize findings from numerous studies into a single summary recommendation, use the rating scale shown above or the Oxford Centre for Evidence-based Medicine's Levels of Evidence and Grades of Recommendation or the recommendations in the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. For reviews that include diagnostic studies, use The Rational Clinical Examination Levels of Evidence table.

Follow additional instructions for Table preparation and submission.

Figures
A PRISMA-style flow diagram should be included that summarizes the results of the literature search and the numbers of articles/records/studies and patients/participants represented in the studies identified, screened, eligible, and included as an online-only supplement.

Additional figures that illustrate pathophysiology or clinical presentation may be considered. We encourage videos, if appropriate, to illustrate a point made or process described in the Review.

Follow additional instructions for Figure and Video preparation and submission.

Narrative Review

Narrative Reviews on clinical topics provide an up-to-date review for clinicians on a topic of general common interest from the perspective of internationally recognized experts in these disciplines. The focus of Narrative Reviews will be an update on current understanding of the physiology of the disease or condition, diagnostic consideration, and treatment. These reviews should address a specific question or issue that is relevant for clinical practice. Narrative Reviews do not require (but may include) a systematic review of the literature search. Recommendations should be supported with evidence and should rely on recent systematic reviews and guidelines, if available, emphasizing factors such as cause, diagnosis, prognosis, therapy, or prevention.

The basic structure of manuscripts reporting Narrative Reviews should include the following: Abstract (structured abstract of no more than 300 words); Introduction (150-250 words); Methods, if included (150-250 words); Discussion/Observations (1000-1250 words, with the following subsections, if appropriate: Pathophysiology, Clinical Presentation, Assessment and Diagnosis, Treatment, and Prognosis); and Conclusions (2-3 sentences).

Typical length: 2000-3500 words (maximum), with no more than a total of 5 tables and/or figures, and no more than 50-75 references. For an example of this type of article, see JAMA. 2015;314(23):2544-2554.

Specific Components of a Narrative Review

Abstract (300 words)

Narrative Review articles should include a 3-part structured abstract of no more than 300 words using the headings listed below:

Importance: An overview of the topic and discussion of the main objective or reason for this review.

Observations: The principal observations and findings of the review.

Conclusions and Relevance: The conclusions of the review that are supported by the information, along with clinical applications. How the findings are clinically relevant should be specifically stated.

Introduction (150-250 words)

The first 2-3 sentences of the Introduction should draw in readers in such that they want to continue reading the article and should establish the importance of the Review. Reviews should include the clinical question or issue and its importance for general medical practice, specialty practice, or public health. The first paragraph should provide a general summary of the clinical problem (eg, obesity). The next paragraph should focus on the specific aspect of the clinical problem the article will explore (eg, treatments for obesity). Briefly summarize the epidemiology of the disease. This information should include disease prevalence and incidence and perhaps discussion of the presence and frequency of any relevant subpopulations and any geographic or seasonal variations of the disease if these are relevant. The third paragraph should discuss exactly what material will be covered in the Review (eg, obesity treatments).

Methods (150-250 words)

A Methods section is not required for Narrative Reviews, but may be included to summarize a literature search that was conducted for this Review. If included, briefly describe the characteristics of the literature searched and included in the review, including the bibliographic databases and other sources searched, search terms used, dates included in the search, date the literature search was conducted, and any process used to evaluate the literature.

Discussion/Observations (1000-1250 words)

The principal observations of the Narrative Review generally should include the subsections listed below, although each section may not be necessary for some topics. The word counts following each subsection are suggested to assist with keeping the overall Observations section limited to 1000-1250 words.

Pathophysiology (150-250 words). Provide a brief overview of the pathophysiology of the disease. The intent is to provide readers with sufficient background information about the underpinnings of a disease to provide context for the rest of the article.

Clinical Presentation (150-250 words). Briefly describe the clinical characteristics that result in a patient seeking medical care for the condition or what features of the disease should lead a physician to evaluate or treat it.

Assessment and Diagnosis (250-300 words). Describe the clinical examination for evaluation of the disease and explain the most salient physical examination findings. If laboratory or imaging studies are necessary, provide the sensitivity and specificity and diagnostic accuracy of these tests and consider providing positive and negative likelihood ratios. Sequences of diagnostic tests are best presented as algorithms or in tables.

Treatment (250-500 words). Treatments should be based on the most recently available and highest level of evidence. Treatment options should be summarized in the text and presented in detail in tables along with an indication of the strength of evidence supporting the individual treatments. In general, treatment recommendations should be supported by a systematic review or a high-quality guideline. If possible, the costs for various treatments should be provided.

Prognosis (100-150 words). A section outlining the overall prognosis for the condition, once treated, should be included.

Conclusions

Include a 2-3 sentence summary of the major conclusions of the review.

Tables

For most Narrative Reviews, tables should be included that summarize the epidemiology, diagnostic tools, and therapies available for the disease. In some cases, these 3 topics may not all be relevant to the review topic and tables may be appropriately modified to fit the review. Include a fourth table that compares the findings of the review and current clinical practice recommendations or diagnostic and therapeutic uncertainty or controversies.

Table 1: Major epidemiologic and burden of disease facts

Table 2: Major diagnostic tools available

Table 3: Major therapies available

Table 4: Current clinical practice recommendations and/or diagnostic and therapeutic uncertainty, and controversies

Tables summarizing treatments should have information organized by category of treatment and then by individual treatments. Columns may include the treatment, strength of evidence supporting the treatment, the effect of the treatment (preferably shown as the treatment's effect as compared to control on the measured outcome together with 95% confidence intervals), adverse effects, and very brief explanatory comments, if necessary. Lengthy text-based tables should be avoided. Additional or lengthy tables may be published online only, if justified.

Follow additional instructions for Table preparation and submission.

Figures

Figures that illustrate pathophysiology or clinical presentation may be included. We encourage videos, if appropriate, to illustrate a point made or process described in the Review.

Follow additional instructions for Figure and Video preparation and submission.

Surgical Innovation

These manuscripts succinctly review specific innovative topics or questions in surgery. These topics include innovations in the delivery of clinical care but can also include cutting-edge developments in education, quality, safety, policy, or other nonclinical areas relevant to practicing surgeons. Each manuscript should follow a standard format and answer the questions below. The questions should be retained in the manuscript as subheads.

  • What is the innovation?
  • What are the key advantages over existing approaches?
  • How will this affect clinical care?
  • Is there evidence supporting the benefits of the innovation?
  • What are the barriers to implementing this innovation more broadly?
  • In what time frame will this innovation likely be applied routinely?

They should be well focused, scholarly, and clearly presented and must have no more than 3 authors. Maximum length: up to 1200 words of text—or 1000 words of text with 1 small table or figure—and no more than 7 references. Papers not meeting these guidelines will not be considered. Authors interested in submitting a manuscript for Surgical Innovation should contact the editorial office prior to manuscript preparation and submission by sending an email to Justin B. Dimick, MD, MPH, at jdimick@med.umich.edu.

Viewpoint

These papers may address virtually any important topic in medicine, public health, research, ethics, health policy, or health law and generally are not linked to a specific article. Viewpoints should be well focused, scholarly, and clearly presented and must have no more than 3 authors. The text should include the full name, academic degrees, and no more than 2 institutional affiliations for each author. Maximum length: up to 1200 words of text—or 1000 words of text with 1 small table or figure—and no more than 7 references. Viewpoints not meeting these guidelines will not be considered.

JAMA Surgery Clinical Challenge

A JAMA Surgery Clinical Challenge presents a single patient scenario about a specific disease or condition with an accompanying clinical image. We would like to receive cases depicting unusual presentations of common problems, rather than rare disorders. These cases should be of interest to clinicians and should be problems that practicing clinicians are likely to at least occasionally encounter. These cases should have outstanding images to illustrate the disorder.

Authors should provide a case presentation, the question (ie, “What is the diagnosis?”), 4 single-sentence answers choices, the diagnosis, and a brief discussion. The brief discussion should include the relevant clinical issues and provide well-supported explanations discussing the correct diagnosis. The text should have a maximum length of 650 words, consisting of no more than 250 words for the case presentation, question, and 4 answers, followed by no more than 400 words that include the diagnosis and a brief discussion. There should be no more than 3 authors, no more than 10 references, and no more than 2 figures totaling 3 image components (ie, no more than 1 figure with 2 components for the case presentation and no more than 1 figure with 1 component for the diagnosis and discussion). The image and case presentation should be from the same patient and must not have been published previously. The Patient Permission form must be completed by the patient and included at the time of manuscript submission. All images submitted should be high-quality .jpg or .tif files. Submit the original version of all image files at the highest resolution possible without labels. In general, the original image file should have a minimum resolution of 300 dpi at a width of about 5 inches. Do not increase the original resolution, resize, or crop the image; where applicable, we will crop to maintain patient confidentiality. If any labels, arrowheads, or A/B panel indicators are desired, provide a separate labeled version of the figure(s) for reference. All labels will be retypeset in JAMA Surgery style. For more information on how to submit figures, see
Guidelines for Figures in Accepted Manuscripts. Manuscripts not meeting these guidelines will not be considered.

Letter to the Editor

Letters discussing a recent JAMA Surgery article should be submitted within 4 weeks of the article’s publication. Letters received after 4 weeks will rarely be considered. Letters should not exceed 400 words of text and 5 references, 1 of which should be to the recent JAMA Surgery article. They should be double-spaced and a word count should be provided. Letters may have no more than 3 authors. The text should include the full name, academic degrees, and a single institutional affiliation for each author and the e-mail address for the corresponding author. Letters must not duplicate other material published or submitted for publication and should not include unpublished data. Letters not meeting these specifications are generally not considered. Letters will be published at the discretion of the editors and are subject to abridgement and editing for style and content. Alternatively, comments on papers published in JAMA Surgery can be submitted using the Comments tab on the online article. Comments promote discussion among readers and authors but are not indexed in PubMed.

Special Communication

JAMA Surgery publishes very few of these types of articles, and only by invitation from the editor in chief of JAMA Surgery. These manuscripts describe an important issue in surgery, public health, health policy, or research in a scholarly, thorough, well-referenced, systematic, and evidence-based manner. A narrative (unstructured) abstract of no more than 200 words is required. Maximum length: 3000 words of text (not including tables, figures, or references) with no more than a total of 4 tables and/or figures and no more than 50 references.

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, e-mail address, telephone and fax numbers) for the corresponding author is required. First and last names, e-mail addresses, and institutional affiliations of all 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 an Authorship Form to complete and submit (see sample Authorship Form). See Manuscript Checklist, Manuscript Preparation and Submission Requirements, and other details in these instructions for additional requirements.

Cover Letter

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

Manuscript Style

Manuscripts should be prepared in accordance with the AMA Manual of Style, 10th edition,1 and/or the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals.2

Manuscript Components

Include in the manuscript file a title page, abstract, text, acknowledgments, 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 or composite figure) and not included in the manuscript text.

Recommended File Sizes

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

Manuscript File Formats

For submission and review, the acceptable manuscript file format is Word. 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).

Title Page

The title page should be the first page of your main 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 abstract, acknowledgment, or references).

Title

Titles should be concise, specific, and informative and should contain the key points of the work.1(p8) Please limit the length of titles to 150 characters for reports of research and other major articles and 100 characters for Editorials, Viewpoints, Commentaries, and Letters. For scientific manuscripts, overly general titles are not desirable and questions and declarative sentences should be avoided. For reports of clinical trials, meta-analyses, and systematic reviews, include the type of study as a subtitle (eg, A Randomized Clinical Trial, A Meta-analysis, A Systematic Review). For reports of other types of research, do not include study type or design in the title or subtitle.

Abstracts

Include a structured abstract of no more than 350 words for reports of original data and meta-analyses. Abstracts should be prepared in JAMA Surgery style— see instructions for preparing structured abstracts for specific article types below. For other major manuscript types not listed below, include an unstructured abstract of no more than 200 words that summarizes the objective, main points, and conclusions of the article. Abstracts are not required for Editorials, Viewpoints, and some special features.

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. State the years of the study and the duration of follow-up. If applicable, include the name of the study (eg, the Framingham Heart Study). 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, general community, a primary care or referral center, private or institutional practice, or ambulatory or hospitalized care.

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

Note: For accepted manuscripts, the above 3 sections are usually combined 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 of administration. The intervention or exposure should be named by its most common clinical name, and nonproprietary drug names should be used.

Main Outcome 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: The main outcomes of the study should be reported and quantified, including baseline characteristics and final included/analyzed sample. Include absolute numbers and measures of absolute risks (such as increase/decrease or absolute differences between groups), along with confidence intervals (for example, 95%) or P values. Approaches such as number needed to treat to achieve a unit of benefit may be included when appropriate. 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, and all surveys should include response rates.

Conclusions and Relevance: Provide only conclusions of the study 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, the name of the trial registry, registration number, and URL of the registry must be included.

Abstracts for Meta-analyses:

Manuscripts reporting the results of meta-analyses should include an abstract of no more than 350 words using the following headings: Importance, Objective, Data Sources, Study Selection, Data Extraction and Synthesis, Main Outcome Measure(s), Results, and Conclusions and Relevance. 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 review question.

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

Data Sources: Succinctly summarize data sources, including years searched. The search should include the most current information possible, ideally with the search being conducted within several months before the date of manuscript submission. Potential sources include computerized databases and published indexes, registries, abstract booklets, conference proceedings, references identified from bibliographies of pertinent articles and books, experts or research institutions active in the field, and companies or manufacturers of tests or agents being reviewed. If a bibliographic database is used, state the exact indexing terms used for article retrieval, including any constraints (for example, English language or human 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 used for abstracting data and assessing data quality and validity (such as criteria for causal inference) and whether data were pooled using a fixed effects or random effects model. The method by which the guidelines were applied should be stated (for example, independent extraction by multiple observers).

Main Outcome 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 measurement unfamiliar to a general medical readership.

Results: State the main quantitative results of the review, including baseline characteristics and final included/analyzed studies and/or sample(s). Include the number of studies and patients/participants included in the analysis. Include absolute risks whenever possible (such as increase/decrease or absolute differences between groups), along with confidence intervals (for example, 95%) or P values. . Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. Numerical results should be accompanied by confidence intervals, if applicable, and exact levels of statistical significance. Evaluations of screening and diagnostic tests should include sensitivity, specificity, likelihood ratios, receiver operating characteristic curves, and predictive values. Assessments of prognosis should summarize survival characteristics and related variables. Major identified sources of variation between studies should be stated, including differences in treatment protocols, co-interventions, confounders, outcome measures, length of follow-up, and dropout rates.

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

Abstracts for Reviews:

Review articles should include an abstract of no more than 300 words with the following sections: Importance, Objective, Evidence Review, Findings, and Conclusions and Relevance.

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

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

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

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

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

Key Points

With the manuscript, a separate Supplemental file called "Key Points," should be submitted.

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, systematic review). 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 1-2 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.

Example of Review Article

Question: What are the most effective medical treatments for adult chronic sinusitis?

Findings: In this systematic review, symptoms of chronic sinusitis were improved with saline irrigation and topical corticosteroid therapy compared to no therapy. Compared with placebo, 3-week courses of systemic corticosteroids or oral doxycycline were associated with reduced polyp size, and a 3-month course of macrolide antibiotic was associated with improved symptoms in patients without polyps.

Meaning: First-line therapy for chronic sinusitis should begin with daily topical intranasal corticosteroid in conjunction with saline irrigation; subsequent therapies should be based on the patient’s polyp status and severity of symptoms.

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.

Statistical Methods and Data Presentation

General Considerations

Authors are encouraged to consult “Reporting Statistical Information in Medical Journal Articles.”10 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" below). 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" below). For multivariable models, report all variables included in models, and report model diagnostics and overall fit of the model when available (see "Statistical Procedures" below).

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. For observational studies, methods and results should be described in terms of association or correlation and should avoid cause-and-effect wording. Randomized trials may use terms such as effect and causal relationship.

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.

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).

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.

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.

Primary Outcomes, Multiple Comparisons, and Post hoc Comparisons

Both randomized and observational studies should identify the primary outcome(s) before the study began, as well as any pre-specified 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 online supplementary 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.

Statistical Analysis Subsection

At the end of the Methods section, briefly describe the statistical tests and software used for the analysis. State the level 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 online supplementary content.

Reporting Standards and Data Presentation

Analyses should follow EQUATOR Network 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 .10, 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-1 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.

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 recreated by journal graphics experts according to reporting standards using The JAMA Network style guide and color palette.

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 units should be provided in a 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.

Names of Drugs, Devices, and Other Products

Use nonproprietary names of drugs, devices, and other products, unless the specific trade name of a drug is essential to the discussion.

Gene Names, Symbols, and Accession Numbers

Authors describing genes or related structures in a manuscript should include the names and accession numbers 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.

Reproduced Material

Please verify that all information and materials in the manuscript are original. JAMA Surgery 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, nd complete citation, doi, and/or URL. The publisher or other third party’s permission to reproduce in print and online and in licensed versions of JAMA Surgery should be submitted to JAMA Surgery when the manuscript is submitted. (See Permission to Reproduce Copyright-Protected Material Guidelines.)

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. Haut ER, Lau BD, Kraenzlin FS, et al. Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma. Arch Surg. 2012;147(10):901-907.
  • 2. American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2009 Participant Use Data File. Chicago, IL: American College of Surgeons; October 2010.
  • 3. The Joint Commission. Specifications manual for National Hospital Inpatient Quality measures. http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx. Accessed May 6, 2012.

Tables

Number all tables in the order of their citation in the text. Include a title for each table (a brief phrase, preferably no longer than 10 to 15 words). Include all tables at the end of the manuscript file. Refer to Categories of Articles because there may be a limit on the number of tables for the type of manuscript. If a table must be continued, repeat the title on the second page, followed by “(continued).”

Instructions for Table Creation

These instructions are available here.

Figures

Number all figures (graphs, charts, photographs, and illustrations) in the order of their citation in the text. Include a title for each figure (a brief phrase, preferably no longer than 10-15 words). For initial manuscript submissions, figures must be of sufficient quality for editorial assessment and peer review. If the manuscript is accepted, authors will be asked to provide figures that meet the Guidelines for Figures in Accepted Manuscripts. Graphs, charts, titles, and legends in accepted manuscripts will be re-created or edited according to JAMA Surgery style and standards prior to publication. All illustrations of accepted manuscripts will be redrawn by medical illustrators. Online-only figures will not be edited or re-created (see Online-Only Supplements and Multimedia).

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 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 JAMA Surgery 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.

Guidelines for Figures in Accepted Manuscripts:

These guidelines are available here.

Acceptable Figure File Size

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

Acceptable Figure File Formats

At submission, the following file formats are acceptable: .ai, .bmp, .doc, .emf, .eps, .jpg, .pdf, .ppt, .psd, .tif, .wmf, or .xls. Figures should be submitted as separate files (1 file per figure or composite figure) and not included in the manuscript text.

Figure Titles and Legends

At the end of the manuscript, include a title and legend for each figure. The figure title should be a brief descriptive phrase, preferably no longer than 10 to 15 words. The figure legend can be used for a brief explanation of the figure or markers if needed (preferred maximum length, 40 words) 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, or x-ray films.

Figures With Labels, Arrows, or Other Markers

Photographs, clinical images, photomicrographs, gel electrophoresis, and the like 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 form allows for uploading of 2 versions of the same figure.

Number of Figures

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

Online-Only Supplements and Multimedia

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

Online-only material will undergo editorial and peer review with the main manuscript. If the manuscript is accepted for publication and if the online-only 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, the authors are responsible for the accuracy and presentation of all such material.

Online-only material should be submitted in a single Word document (Supplement) with pages numbered consecutively. Each element included in the online-only material should be cited in the text of the main manuscript (eg, "see 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 online-only document should list the number and title of each element included in the Supplement.

Online-Only Text

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

Online-Only References

All references cited within the online-only 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 online-only material.

Online-Only Tables

Online-only 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 online 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.

Online-Only Figures

Online-only 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.

Video

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

  • Acceptable file formats: .mov, .wmv, .mpg, .mpeg, .mp4, or .avi
  • Maximum file size: 25 MB
  • Minimum dimensions: 480 pixels wide; height may vary
  • Desired aspect ratio: 4:3 (standard) or 16:9 (widescreen)
  • Maximum length: 5 minutes
  • Verify that the videos are viewable in QuickTime or Windows Media Player.

For each video, provide a citation in the appropriate place in the manuscript text and include a title (a brief phrase, preferably no longer than 10-15 words) and a caption at the end of the manuscript. In the video caption, specify the video file format and briefly describe the content of the video (preferably no longer than 100 words). The same title and caption must be entered in the designated fields on the web-based 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 with the manuscript the Patient Permission form completed and signed by the patient. See also Identification of Patients in Descriptions, Photographs, Video, and Pedigrees.

If the author does not hold copyright to the video, the author must obtain permission for the video to be published in JAMA Surgery. This permission must be for unrestricted use in all print, online, and licensed versions of JAMA Surgery. (See Permission to Reproduce Copyright-Protected Material Form.) Submit the completed form to the editorial office.

Postacceptance requirements: If the manuscript and accompanying video(s) are accepted for publication, journal staff will contact you to request the original full-size video without superimposed text, labels, arrows, logos, or other graphical elements. As needed, video files may be edited according to journal style. Note: there is no minimum file size requirement once it has been accepted.

See also Additional Guidelines and Consideration for Optimal Video Quality.

Audio

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

  • Acceptable file formats: .mp3, .wav, or .aiff
  • Maximum file size: 10 MB
  • To achieve the best quality, when saving audio files as an mp3, use a setting of 256 kbps or higher for stereo or 128 kbps or higher for mono.
  • 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 a citation in the appropriate place in the manuscript text and include a title (a brief phrase, preferably no longer than 10-15 words) and a caption at the end of the manuscript.

Postacceptance requirements: if the manuscript and accompanying audio(s) are accepted for publication, journal staff will contact you to request the original uncompressed audio file. Note: there is no minimum file size requirement once it has been accepted.

Manuscript Checklist

  • 1. Review manuscript submission requirements in these instructions and in our web-based submission and review system.
  • 2. Include a cover letter as an attachment.
  • 3. Designate a corresponding author and provide a complete affiliation, postal/mail address, telephone and fax numbers, and e-mail address.
  • 4. Provide first (given) and last (family) names, e-mail addresses, and institutional affiliations for any coauthors.
  • 5. On the title page, include a word count for text only, exclusive of the title, abstract, acknowledgments, references, tables, and figure legends.
  • 6. Provide an abstract that conforms with the required abstract format (see specific Categories of Articles).
  • 7. Double-space manuscript and leave right margins unjustified (ragged).
  • 8. Check all references for accuracy and completeness. Put references in proper format and in numerical order, making sure each is cited in sequence in the text.
  • 9. Include a title for each table and figure and online-only Supplement (a brief, succinct phrase, preferably no longer than 10-15 words) and explanatory legend as needed.
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REFERENCES

Last updated: July 2016