vaccine journal cover letter

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• v.19(3); 2021 Jul

Scientific Publishing in Biomedicine: How to Write a Cover Letter?

Zahra bahadoran.

1 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Parvin Mirmiran

Khosrow kashfi.

2 Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, School of Medicine, City University of New York, New York, USA

Asghar Ghasemi

3 Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

A cover (covering) letter is a brief business letter introducing the scientific work alongside the submission process of a manuscript and is required by most scientific peer-review journals. A typical cover letter includes the name of the editor and the journal, date of submission, the characteristics of the manuscript, the importance of the work and its relevance to prospective audiences, declarations such as author agreements, conflicts of interest statement, funding source (s), and ethical statements. The letter also includes the contact information of the corresponding author (s) and may also include suggestions of potential reviewers. Spending enough time to draft an informative, comprehensive, and concise cover letter is quite worthwhile; a poorly drafted one would not persuade the editor that the submitted work is fit for publication and may lead to immediate rejection. Here, we provide a practical guide to draft a well-written, concise, and professional cover letter for a scientific medical paper.

The Cambridge dictionary defines a cover letter as “a letter that contains information about the thing it is sent with”. The cover letter is commonly known as a motivation letter submitted along with the curriculum vitae (CV) or a job application for employment ( 1 ) or academic position ( 2 ), and it is not clear why and how it was introduced into the scientific field ( 3 ). In scientific writing and publishing, a cover/covering letter is a letter to the editor’s target journal ( 4 ).

Providing a cover letter alongside the submission process is now required by most scientific journals. In fact, some high-quality and prestigious journals pay specific attention to the cover letter ( 3 ). Amongst the different steps of the publication process, the cover letter is the last step and is often overlooked ( 5 ). One of the most common complaints voiced by editors regarding submitted manuscripts is that the authors neglect to write a well-written cover letter, including a statement justifying the importance of their work ( 6 ). Missing this opportunity may have unintentional consequences, rejection without further consideration instead of being sent for external peer-review ( 5 , 6 ). Contrary to this view, some believe that the cover letter’s content overlaps with the manuscript’s abstract and gives mostly redundant information already found within the online submission system ( 3 ). The cover letter may also be a “misleading commercial advertisement” where it would not represent the content of the manuscript ( 3 ).

Although many editors may not read or seriously consider the cover letters of the submitted manuscripts ( 3 , 4 ), neglecting the importance of the cover letter may be a risk for the authors. Therefore, spending an adequate amount of time to write a coherent and persuasive cover letter is worth it. Following our previous publication on choosing a journal in a new series entitled Scientific Publishing in Biomedicine ( 7 ), here, we provided a practical guide to draft a well-written, professional, and concise cover letter needed to be accompanied by an original scientific paper, either with the initial submission or subsequently at revision/resubmitting stage. Since there are subtle differences in writing a cover letter for an original research paper versus a review article or an opinion, some points for drafting a cover letter for such papers are also discussed.

2. The Function of the Cover Letter

A cover letter is “a brief business letter”, which introduces the submitted manuscript to a prospective editor (s) ( 8 ). There are essentially two types of letters; the first is the one that is initially submitted with the manuscript (cover letter), and the second is when a revision is being submitted (revised letter). The first letter introduces the work at the initial manuscript submission ( 9 ), while the second one is needed following an invitation to revise and resubmit the manuscript. Here, the authors respond to the suggestions/criticisms of the reviewers ( 10 ). In this paper, “cover letter” and “second letter” refer to the first/submit letter and the revised letter, respectively.

A well-written cover letter is an effective tool for authors to sell their work to the journal editor and make a “good first impression”. A cover letter is a summary that highlights the main points, emphasizes the novelty, and communicates the potential implications of the submitted work ( 3 ). A cover letter allows the authors to persuade the editors regarding the novelty/originality and significance of the research in a less formal manner than in the manuscript itself ( 6 ). A well-written and informative cover letter helps the journal’s editor to be informed about the work and its significance. Regardless of the novelty and significance of the submitted manuscript, editors may miss those points without providing insights in a cover letter ( 5 ).

3. The Content of a Cover Letter

3.1. first cover letter (submit letter).

One point of view is that the cover letter’s content should be covered in the manuscript’s abstract ( 3 ). A typical cover letter includes the name of editor (s) and the journal, date of submission, the characteristics of the manuscript (i.e., title, type of the manuscript, e.g., review, original, case report), the importance of the work and its relevance to the readership of the journal, verification of the originality of the work, the authors’ confirmation that the manuscript is currently submitted only to this journal, declarations and ethical statements, suggested potential reviewers, and contact information of the corresponding author of the submitted work ( 5 , 6 ). Other manuscript characteristics, including the length and number of tables and figures, can also be indicated. If the manuscript belongs to a special issue or is being submitted upon an official invitation from the journal’s editorial office, it should also be addressed. The main contents of the first cover letter are described in Table 1 .

The most critical element of a cover letter is a “statement of novelty/significance/implication.” The authors are advised to carefully write a brief and concise description of their work’s impact toward communicating its significance ( 6 ). The authors are strongly advised not to copy the abstract into the cover letter and instead explain in their own words the significance of the work and the reason for submitting it to the journal ( 11 ). If this information is lacking, the editors may rely on the reviewers who may not appreciate the significance of the work and just focus on the technical issues rather than the scientific value of the work ( 5 ). Providing a clear and robust statement of novelty and significance would be more critical for editors and potential reviewers with diverse and interdisciplinary backgrounds ( 6 ).

The statements are expected to answer the following questions: (1) why is the work important? (e.g., emphasizing a new measurement, a new diagnostic method or criterion, a newly discovered biological process); and (2) how does the work advance current knowledge in the field? The best approach to answer this question is by describing the current state of knowledge in the field and clarifying how the work provides an added value by answering a previously unanswered question, finding the solution to a problem, or improving existing methods ( 5 ). Checking the recently published papers on similar topics in the journal provides new insights for the authors to clarify in the cover letter as to how the manuscript follows the publication trends of the journal and will add something new that would be relevant to the trend ( 12 ).

The cover letter is also expected to emphasize why the manuscript will attract the journal’s readers ( 5 ). The authors also need to consider the journal’s Aims and Scope to underscore how the manuscript would fit within the journal’s scope and attract potential readers ( 13 ). Instead of stating simply that the manuscript is “of interest to the field” or “novel,” the authors should address specific aspects of the journal’s Aims and Scope statement, e.g., “We believe that this manuscript is appropriate for publication by [journal name] since it… [reference to the journal’s aims and scope] ( 11 ).

For a review, opinion, or a trends paper, emphasizing the timeline and novelty is needed, as stated by Sacristán, the editor of trends in molecular medicine: “The synthesis and conceptual advance should be particularly stated in terms of what is new and has been trending in the field for the last one to five years”. She also recommends that the authors need to provide a future perspective beyond the main take-home message of the manuscript for a trends paper and take a strong and novel stance on a hypothesis or idea for a cover letter of an opinion manuscript ( 14 ).

The cover letter must contain some predefined statements, including the “author agreement” statement ( 13 ). An “author agreement” is a statement to confirm that “all authors have read and approved the final version of the manuscript being submitted” ( 8 ). Furthermore, “the authors warrant that the manuscript is their original work, has not received prior publication and is not under consideration for publication elsewhere” ( 8 ). Some journals may request the corresponding author to confirm that he/she will take responsibility for informing co-authors of editorial decisions, reviews received, and any changes or revisions made; additionally, the editor (s) should be informed about any closely related manuscript (s) simultaneously submitted for consideration to the same or another journal ( 15 ). The authors also should declare if any part of the submitted work has been previously published elsewhere, even as an abstract ( 16 ); e.g., “there is some overlap in the content of the introduction section, which we have noted in the text”.

Depending on the journal’s policy, other statements, including “conflict of interest statement”, “funding source declarations”, and “permission note”, may also be required to be included in the cover letter ( 8 , 11 ). As indicated by Elsevier, a conflict of interest statement, known as a disclosure statement, is a declaration from the author that “there is no financial/personal interest or belief that could affect their objectivity”. The publisher emphasizes that the authors should declare and state the potential conflict’s source and nature in cases where a conflict of interest exists. A funding source declaration is defined by the publisher as “a declaration of any funding or research grants (and their sources) received in the course of study, research or assembly of the manuscript”. Elsevier also defines the permission note as a statement that declares that “permission has been received to use any material in the manuscript such as a figure, which is not original content” ( 8 , 17 ). Other statements like “Statement of English native editing” may also be added.

Furthermore, informing the editor (s) regarding any information that will support the submission (e.g., original or confirmatory data, supplementary materials, relevance, topicality) can be helpful ( 8 ). Other operational information, typically provided within checkboxes of the journal’s submission system, is not required to be included in the cover letter ( 5 ).

3.2. Second Cover Letter

The second cover letter, which accompanies the revised version of the manuscript, must be a model of clarity and must address every issue posed by the editor and reviewers ( 10 ). If the revised manuscript is sent for the second round of peer-review, the reviewer (s) will see the letter. The content of the header and footer sections of the revised letter is similar to that of the submitted cover letter. The letter should be directed to the editor as addressed in the first letter unless the authors are informed that a new editor will process the revised version ( 10 ). The first paragraph should start with an “expression of polite gratitude”, e.g., “we would like to thank you for the opportunity to revise and resubmit our manuscript.” The “manuscript ID” or “identification number,” usually assigned by the journal in the first submission, should be addressed in the first paragraph ( 10 ).

The second paragraph usually “signals attention to the reviewers’ comments” by providing an explicit reference to the comments made by the reviewers and the editor. Furthermore, it may contain a positive statement regarding the results, methodology, conclusions, etc., in which case the authors need to acknowledge reviews’ insights ( 10 , 18 ). For example, “We sincerely appreciate all the valuable comments and suggestions made, which helped us improve the revised version of our manuscript” or “we found the reviewers’ comments helpful in guiding us to revise the manuscript.” Such statements will help the authors in creating a polite, formal tone throughout the letter. The paragraph should be followed by providing the editor with a roadmap or a summary of the revisions, addressing “the response to comments attachment.” A point-by-point response to the specific comments of the reviewers must be provided. If the authors disagree with a point raised by a reviewer, a rebuttal or counterstatement may be in order. A scientific and polite approach should spell out why the authors disagree, never losing sight of the reviewer’s opinion ( 19 ).

The footer section (closing salutation) of the letter returns to polite formalities, using statements like “we hope that the revised version of our manuscript is now acceptable to the reviewers, and suitable for publication in the [name of journal], we look forward to hearing from you at your earliest convenience” ( 10 ).

4. Organization

Although it is not a rule, the cover letter’s content can be organized within a cover letter header (opening salutation), three main paragraphs (the body of cover letter), and a cover letter footer (closing salutation), as described in Table 1 .

The cover letter should be initiated by addressing the editor (s) and the target journal; however, the author’s affiliation and contact information may also be included at the top of page ( 4 ). The name of the editor (s) can be easily found on the journal’s information page. If it is known, the authors must address the editor who will receive the manuscript and handle the peer-review process ( 13 ). If there are several co-editors, the person the author feels has the most appropriate background, and specialty of the topic should be addressed. In cases where such information is lacking, authors can mention all editors by name or address the letter to “dear editors” ( 12 ); however, it has been recommended to avoid writing “dear editor” ( 16 ). Also, the submission date and the journal’s name where the manuscript will be submitted are required ( 13 ).

In the first paragraph of the cover letter body, to introduce the submitted work, the title and the type of manuscript, authors’ name, journal name, and manuscript length are presented ( 4 ). In addition, it is mentioned that whether the manuscript is submitted upon an invitation or belongs to a special issue. The importance of the study, including novelty, potential implications, and its take-home message, are addressed in the second paragraph of the cover letter body. In addition, it is explained why the work would be attractive for journal readers. The third paragraph of the cover letter body includes some statements including authorship agreement, conflicts of interest, funding source, and ethical considerations. If required, potential reviewers are also suggested here.

Within the closing salutation, the authors can appreciate the editor for taking the time to read the cover letter and considering the submitted work for potential publication.

5. Some Practical Tips: The Length, and Dos and Don’ts

The authors need to spend plenty of time crafting their cover letters. They are advised to avoid too many details and keep it within one page (less than 200 words), like an introduction or a brief overview ( 4 , 11 ). The authors should check the guide for authors and cover letter suggestions provided by the journal, including all the requirements, e.g., specific disclosures, statements, and potential reviewers. Some publishers (e.g., Springer, https://www.springer.com/gp/authors-editors/journal-author/cover-letters/1398, Taylor & Francis, https://authorservices.taylorandfrancis.com/publishing-your-research/making-your submission/writing-a-journal-article-cover-letter/) provide sample cover letters that the authors can use. Figure 1 provides a sample for a cover letter.

If the authors address previously published papers in the cover letter, then appropriate citation should be considered. The authors should carefully check the letter for any spelling and grammatical errors ( 11 , 20 ). They should make sure that they correctly spell the name of the journal’s editor (s) ( 4 ). Being careless regarding the editor’s name or the change of a journal’s name in a cover letter of a resubmitted manuscript, can be embarrassing and make a bad impression ( 4 ). It is suggested that the cover letter be written on the authors’ institutional letterhead to display professionalism and reliability ( 20 , 21 ).

5.2. Don’ts

When authors suggest a number of potential reviewers, they should avoid suggesting their friends and colleagues, as this would be viewed as a conflict of interest. Collaborators whom the authors have published with in the past five years should not be suggested either; an editor may easily be informed of such associations by a quick search of PubMed or other databases ( 22 ). The authors should avoid using complex sentence structures, jargon, and acronyms and keep the text straightforward and easy to read ( 11 , 20 ). The authors should also avoid including unrelated personal information or glorifying their past research papers or any of their academic accolades ( 20 ). They must not be rude towards the editors or complement the editor’s accomplishments ( 4 ). The novelty statement should not exaggerate or overstate the findings of the work; furthermore, any conclusion stated should be completely supported by the data provided in the manuscript ( 23 ). Finally, authors are recommended not to write a generic cover letter that could be used for any manuscript and could be sent to any journal ( 21 ).

6. Conclusion

In summary, a cover letter should highlight the novelty, importance, take-home message, and goodness-of-fit of the manuscript to the journal. These are critical information that can persuade an editor that the submitted work merits publication consideration in the journal. The cover letter should not be general but should be custom-written for the target journal. Although the submitted manuscript may usually pass through the peer-review process and get published regardless of the cover letter, a well-written, informative, and concise cover letter increases the chance of gaining acceptance.

Authors' Contribution: Study concept and design, Zahra Bahadoran and Asghar Ghasemi; Drafting of the manuscript, Zahra Bahadoran, Parvin Mirmiran, and Asghar Ghasemi; Critical revision of the manuscript for important intellectual content, Khosrow Kashfi and Parvin Mirmiran.

Conflict of Interests: The authors have no conflict of interest.

Funding/Support: This study was supported by the Shahid Beheshti University of Medical Sciences (grant number 28127).

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Writing a Successful Journal Cover Letter (Free Templates)

Even great manuscripts often stand out based on the title or its contents alone. They need great cover letters.

Cover letters for journal submission are an underrated part of the submission process. Don’t overlook them. They’re a valuable step to getting your research noticed, published, and all the good things that come after that.

The truth is, most journal editors just don’t have the time to thoroughly read every submitted article in full to decide if it’s suitable for their journal. They use cover letters to help them filter out the most interesting and appropriate submissions first.

Cover letters also help identify articles completely out of the journal’s scope and that would be better off getting a quick letter of rejection.

If your manuscript doesn’t have a cover letter and the 12 other articles on the editor’s desk do, it’s likely that your paper will be looked at last. Putting in that extra effort, just like on a job application, lets you sell your research, avoid quick rejections, and more likely make it to peer review.

We also have some journal cover letter templates and examples for you, so you don’t have to start from zero. Read on.

What do you put in a journal cover letter?

Your cover letter needs certain basic elements. Generally they are:

• Editor and target journal
• Salutation (Dear Dr. …)
• Indication you’re submitting your manuscript, along with its title, and the category of manuscript you’re submitting (Original Report, Review , Case Study, etc.) based on what the journal accepts
• Background information regarding your work – what is already known about the subject matter?
• What your study was
• Why you performed the study (rationale)
• Briefly, what methods you used and what your key findings were
• Why your manuscript is a great fit for this journal
• (optional, depending on the journal and on if you want to do this) Recommended reviewers
• (optional, depending on the journal) Funding information
• Closing line (Sincerely, etc.) and the name and contact details for the manuscript’s corresponding author

Those are the key elements. It’s how you express them and the quality of your message that mean the different between a dry overview and an attractive promotion of your work.

Many journals don’t have a prescribed format for the cover letter. On the other end of the spectrum are PLOS ONE’s guidelines , which give specifics on what to include, including selecting Academic Editors from its directory.

Always check the guidelines first to be sure you give the journal what it wants. Those are basics. With a grasp of those, there are many ways to polish your cover letter into a valuable sales tool for your work.

What to do and what to avoid in your journal cover letter

Most “problems with journal cover letters relate to simply not spending enough time and care on it. Or even not doing it at all. These are easily fixed if you’re a skilled English writer. If not, they’re still easily fixed with a little help.

All of the following are critical. Make sure you DO:

• Check the name of your target journal.
• Address the cover letter to the relevant person. It is not enough to simply say “Dear Editor” or “To whom it may concern.” Include the name, title and position of the editor you are addressing.
• Avoid superlatives – about the journal, yourself and your own work. It’s pretty unlikely your work is “groundbreaking” or “trailblazing,” though it may by the “first time ever” that a certain approach was taken with a certain population.
• Check the formatting. This varies by journal. It includes US vs. UK vs. Oxford English spelling, correct page numbering, use of templates, and much more.
• Get a colleague to read your cover letter before you send it.

“ A typical cover letter just repeats the abstract. That’s a huge missed opportunity. You need to think of what the journal wants. Try to tailor your manuscript’s novel and interesting points specifically to the your target journal’s aims and scope. It may mean an extra half-hour of work for you, but if it helps get you published, isn’t it worth that small investment of time? “ — Geraldine Echue , PhD, CMPP Edanz Managing Editor

But don’t do this…

The following may not be critical, but they’re common areas that authors mess up. Sometimes they don’t know they’re doing it or they’re just trying their best. So be aware

Make sure you DON’T :

• Take shortcuts. Your cover letter is very important for getting your manuscript to peer review; give it time and attention.
• Cut and paste your abstract, or sections of it, into the cover letter. That’s low-effort and low-readability. Reword it to make it pop.
• Over-praise the editor or target journal – it’s not necessary to use such phrases as “your esteemed journal.” A manuscript will be sent for peer review based on the quality of the cover letter and study, not because you say nice things about the journal.
• Forget to use the Word (or other software’s) spellcheck and, ideally, use a tool like Grammarly and/or Hemingway to help grammar and readability. These are no substitute for a professional edit, though.
• Be overly proud about your English skills. Just like you go to the dentist to get your teeth fixed, you can hire a professional editor and subject matter expert to get your English fixed.

Not that a lot of these also reply to resubmission letters and responses to peer review . The underlying themes are care, courtesy, and excellent English suitable for your audience.

And two more big DOs

• DO get a professional edit or proofread if you’re not a native speaker of English or just not that great at writing.

DO have a professional write your cover letter for you if you want to save some time and make sure you got everything just as the journal wants it. The Edanz Cover Letter Development service can handle this for you.

Set phrases and common expressions

The journal letter maintains a formal tone, so there are certain stock phrases you can use and in some cases must use. As a result, there are a number of phrases which are common to cover letters.

These include:

• To our knowledge, this is the first report showing…
• We believe our findings will appeal to the readership of [target journal name].
• Please address all correspondence to:
• We look forward to hearing from you at your earliest convenience.

“I’ve found about 60% of authors don’t submit a cover letter at all. It seems they just expect something magical to happen with their manuscript. Journal editors struggle with this: they’re not necessarily subject-area specialists. They wonder, ‘Why is the paper important?'” — Gareth Dyke , PhD Edanz Author Education Manager

Commonly required statements

Many journals and publishers require that all cover letters should contain the following sentences:

• We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.
• All authors have read and approved the final manuscript and agree with its submission to [target journal name].

Competing interests

If all authors have no competing interests, you should include a statement indicating as such:

The authors have no conflicts of interest to declare.

If an author does have competing interests, it’s a good idea to include details of these in your cover letter. You might also include funding information:

This study was supported by a grant from the [funding body].

Other required statements

Some other potentially required information:

• Clinical trial registration database and number
• Has this manuscript been published in another language? If so, has that journal editor given permission for this submission?
• What other publications related to the same study have been published? (especially for clinical trial related manuscripts)
• Has the data in your study been presented or been published in any other format? For studies involving human subjects, was informed consent obtained? Was permission obtained from an ethics committee? Was the study carried in accordance with Declaration of Helsinki guidelines?
• Was permission obtained for the reproduction or modification of previously published figures and tables (especially for review articles).

The journal’s guidelines will typically give specific directions on which of these to include, if any. And if you have any questions, get in touch with them directly.

Journal submission tips and hacks from the experts

Most of these are plain common sense, but if you’re in a hurry, you might overlook them. Some are less commonly known.

Be personal, use the editor’s name

Do your homework. Look up the name of the Editor-in-Chief or the specific Section Editor for the journal you’re submitting to and address the letter to them directly.

Use Dear Dr. (or Professor) + their Last name . If you’re not sure of their title, Google them to see if they have a LinkedIn page, ResearchGate page, or works published in the last couple of years. If you still can’t confirm their title, use Dear Full name as shown on the journal’s webpage .

It’s like a cover letter for a job; you need to personalize your cover letter to demonstrate your interest in that particular journal, and not make it look like you’d just be happy to get your paper accepted anywhere.

You should also explain why your study will be of specific interest to the readers of the journal.

Check the Aims & Scope on the journal website to see who their target audience is and tailor your reasoning to them.

Tell them what you want to publish

This may seem obvious, but sometimes authors submit cover letters without including the title of their manuscript and what type of article it is.

This should appear in the very first paragraph of your letter and will help the editor see immediately if the topic is of interest and judge whether they have space for the article type you’re submitting for the current issue.

Even more, it will show that you thoroughly read the guidelines. If you say you’re submitting “Original Research” when the journal calls it “Research Articles”, you’re not making a very good first impression.

Summarize the highlights of your work

It’s not enough to simply include the title of your manuscript in the cover letter and hope that alone will attract the editor.

Try to keep the cover letter to one page, but always include a brief summary of your study outlining the reasons why you conducted the work, your aims, and the major results you observed. If that makes you go a bit longer, it’s not a big deal.

Don’t include statistics or a lot of data; a compelling summary of the study is sufficient. If the editor is interested, they’ll look into your manuscript more deeply for further details.

Sell yourself

Cover letters are your chance to talk directly with the journal editor and convince them that your paper is more interesting than the next one sitting on their desk. Talk about any real-world implications of your findings or the significance of your results for the field. Don’t be too speculative or over-exaggerate your findings, but do take this important opportunity to feature the importance of your work.

Don’t forget your “must have” statements

Editors want to know that your manuscript has not been submitted elsewhere or is under consideration at another journal.

They want to know any relevant conflict of interest information and any roles the funding body played in the study.

The author instructions may or may not have explicit information on what they want you to write, but it’s good practice to state this information upfront. This way, the editor doesn’t have to dig through the manuscript to know if you’ve met the basic ethical requirements for publication.

See it in action: Edanz video on writing cover letters

We laid out the basics of a cover letter in this video.

And if you don’t want to start with a blank document…

Get a cover letter template

It’s all easier said than done, right?

Download a template to plug-and-play your text.

Download the above short-form or long-form cover letter from the Edanz Learning Lab template collection .

“When I became a journal editor, I really learned how important cover letters are. We need them to learn more about submissions and to make more informed decisions on whether to send manuscripts out for peer review. As a journal editor, I greatly appreciate a carefully written cover letter; it saves me time and it shows me the authors really care. It also helps with reviewer selections … something I rarely have time to do.” — Gareth Dyke , PhD Editor-in-Chief of Taylor & Francis journal ‘Historical Biology’

By the way, not all cover letters are the same, though most are. PLOS ONE cover letters are a notable exception and have certain requirements for what you need to tell them, such as which of their Academic Editors you want to review your submission. See their guidelines here .

So, all set to do your cover letter? Now go find a forever home for your manuscript and tell them why they’re the perfect fit for you.

Want to dig deeper into the publication process, soup to nuts, ideas to publication? Take simple, expert-designed courses to walk you through it all, at the Edanz My Learning Lab .

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What should be included in a cover letter?

You may be required to submit a cover letter with your submission. Individual journals may have specific requirements regarding the cover letter's contents, so please consult the individual journal's Guide for Authors.

A cover letter is a simple, brief business letter, designed to introduce your manuscript to a prospective Editor.  If the Guide for Authors does not specify what to include in your cover letter, you may wish to include some of the following items:

• Specify special considerations that should be given to the paper (if any).
• A brief background regarding the research involved or how the data was collected.
• Details of any previous or concurrent submissions.
• It's also useful to provide the Editor-in-Chief with any information that will support your submission (e.g. original or confirmatory data, relevance, topicality).
• The inclusion (or exclusion) of certain Reviewers (if  propose/oppose reviewers  isn't an available step in the submission process).
• Bring to the Editor’s attention any  Conflict of Interest or Permissions information  which may be relevant.  Be sure to upload any accompanying forms or declarations as required to your submission.

Please note: When your manuscript is received at Elsevier, it's considered to be in its 'final form' ready to be reviewed, so please check your manuscript carefully before you submit it to the Editor. A guide to the publication process and getting your article published in an Elsevier journal is available on the Elsevier Publishing Campus .

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Cover letters

A good cover letter can help to “sell” your manuscript to the journal editor. As well as introducing your work to the editor you can also take this opportunity to explain why the manuscript will be of interest to a journal's readers, something which is always as the forefront editors’ mind. As such it is worth spending time writing a coherent and persuasive cover letter.

The following is an example of a poor cover letter:

Dear Editor-in-Chief, I am sending you our manuscript entitled “Large Scale Analysis of Cell Cycle Regulators in bladder cancer” by Researcher et al. We would like to have the manuscript considered for publication in Pathobiology. Please let me know of your decision at your earliest convenience. With my best regards, Sincerely yours, A Researcher, PhD

Instead, check to see whether the journal’s Instructions for Authors have any cover letter requirements (e.g. disclosures, statements, potential reviewers). Then, write a letter that explains why the editor would want to publish your manuscript. The following structure covers all the necessary points that need to be included.

• If known, address the editor who will be assessing your manuscript by their name. Include the date of submission and the journal you are submitting to.
• First paragraph: include the title of your manuscript and the type of manuscript it is (e.g. review, research, case study). Then briefly explain the background to your study, the question you sought out to answer and why.
• Second paragraph: you should concisely explain what was done, the main findings and why they are significant.
• Third paragraph: here you should indicate why the readers of the journal would be interested in the work. Take your cues from the journal’s aims and scope. For example if the journal requires that all work published has broad implications explain how your study fulfils this. It is also a good idea to include a sentence on the importance of the results to the field.
• To conclude state the corresponding author and any journal specific requirements that need to be complied with (e.g. ethical standards).

TIP: All cover letters should contain these sentences:

• We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.
• All authors have approved the manuscript and agree with its submission to [insert the name of the target journal].

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Before submitting your manuscript, thoroughly check its quality one more time. Evaluate it critically—could anything be done better?

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2022 Citation Impact 4.5 - 2-year Impact Factor 4.7 - 5-year Impact Factor 1.661 - SNIP (Source Normalized Impact per Paper) 1.307 - SJR (SCImago Journal Rank)

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Scientific Publishing in Biomedicine: How to Write a Cover Letter?

Affiliations.

• 1 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• 2 Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, School of Medicine, City University of New York, New York, USA.
• 3 Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
• PMID: 34567139
• PMCID: PMC8453652
• DOI: 10.5812/ijem.115242

A cover (covering) letter is a brief business letter introducing the scientific work alongside the submission process of a manuscript and is required by most scientific peer-review journals. A typical cover letter includes the name of the editor and the journal, date of submission, the characteristics of the manuscript, the importance of the work and its relevance to prospective audiences, declarations such as author agreements, conflicts of interest statement, funding source (s), and ethical statements. The letter also includes the contact information of the corresponding author (s) and may also include suggestions of potential reviewers. Spending enough time to draft an informative, comprehensive, and concise cover letter is quite worthwhile; a poorly drafted one would not persuade the editor that the submitted work is fit for publication and may lead to immediate rejection. Here, we provide a practical guide to draft a well-written, concise, and professional cover letter for a scientific medical paper.

Keywords: Cover Letter; Medical Scientific Journals; Scientific Publishing; Scientific Writing.

Copyright © 2021, International Journal of Endocrinology and Metabolism.

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Insights into vaccines for elderly individuals: from the impacts of immunosenescence to delivery strategies

Schistosoma mansoni vaccine candidates identified by unbiased phage display screening in self-cured rhesus macaques

• Daisy Woellner-Santos
• Ana C. Tahira
• Sergio Verjovski-Almeida

Heterologous cAd3-Ebola and MVA-EbolaZ vaccines are safe and immunogenic in US and Uganda phase 1/1b trials

• Amelia R. Hofstetter
• the VRC 208 and RV 422 study team

Intranasal vaccine for Lyme disease provides protection against tick transmitted Borrelia burgdorferi beyond one year

• Maria Cristina Gingerich
• Maria Gomes-Solecki

An intranasal combination vaccine induces systemic and mucosal immunity against COVID-19 and influenza

• Dongming Zhou

Announcements

Note to authors about sars-cov-2 strain names.

Please note we strongly recommend to our authors writing about SARS-CoV-2 that they follow WHO approved nomenclature for variant strains. We recommend the Pango nomenclature, but GISAID and Nexstrain are also approved.

npj Vaccines Journal Metrics

npj Vaccines has a 2-year impact factor of 9.2 (2022), article downloads of 925,948 (2022) and 8 days from submission to first editorial decision (2022).

Editors’ Choice: COVID-19 4 years on

While mortality associated with COVID-19 has reduced remarkably with the arrival and broad adoption of effective vaccines, it is still a major public health concern, with up to two million new infections reported annually. In this special collection, the editors of npj Vaccines identify articles that illustrate the amazing progress made, but also the challenges that still lay ahead.

Special Collection: Streptococcus A vaccines

Streptococcus pyogenes (Strep A) is a worldwide cause of morbidity and mortality, and there is a hypothesis that Strep A vaccines are substantially undervalued. The editors gathered articles focussing on innovative ways to assess the value of vaccination. The approaches outlined in this collection should also be useful for the assessment of the value proposition for other vaccines.

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A replicating RNA vaccine confers protection in a rhesus macaque model of Crimean-Congo hemorrhagic fever

• David W. Hawman
• Shanna S. Leventhal
• Heinz Feldmann

Direct comparison of SARS-CoV-2 variant specific neutralizing antibodies in human and hamster sera

• Annika Rössler
• Antonia Netzl
• Janine Kimpel

High production of IL-12 by human dendritic cells stimulated with combinations of pattern-recognition receptor agonists

• Brian C. Gilmour
• Alexandre Corthay
• Inger Øynebråten

Realising the potential of correlates of protection for vaccine development, licensure and use: short summary

On 27–29 th of September 2022, Wellcome convened an international multi-stakeholder workshop to discuss the use of Correlates of Protection (CoP) to accelerate vaccine development, the hybrid format meeting was attended by 80 delegates including developers, manufacturers, regulators, public health officials and policy-makers from 17 countries, including 7 LMIC’s.

• Deborah F. King
• Helen Groves
• David C. Kaslow

Strep A: challenges, opportunities, vaccine-based solutions and economics

• David E. Bloom
• Richard W. Titball
• Jonathan Carapetis

Strep A: challenges, opportunities, vaccine-based solutions, and economics

The role of correlates of protection in overcoming barriers to vaccine development and demonstrating efficacy.

• Charlotte Weller

• Yingying Hou
• Rongsheng Tong

FcRn regulates antigen presentation in dendritic cells downstream of DEC205-targeted vaccines

• Christophe Macri
• Matthew Paxman
• Justine D. Mintern

Trending - Altmetric

Duration of SARS-CoV-2 mRNA vaccine persistence and factors associated with cardiac involvement in recently vaccinated patients

Update on the development of Group A Streptococcus vaccines

Maternal and neonatal outcomes of COVID-19 vaccination during pregnancy, a systematic review and meta-analysis

Adjuvanted recombinant hemagglutinin H7 vaccine to highly pathogenic influenza A(H7N9) elicits high and sustained antibody responses in healthy adults

Science jobs, faculty recruitment, westlake university school of medicine.

Faculty positions are open at four distinct ranks: Assistant Professor, Associate Professor, Full Professor, and Chair Professor.

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Postdoc in systems immunology with expertise in AI and data-driven approaches for deciphering human immune responses to vaccines and diseases.

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To reshape graduate education as well as research and development to better serve local, national, regional, and global sustainable development.

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We aim to foster cutting-edge scientific and technological advancements in the field of molecular tissue biology at the single-cell level.

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Contact Monica Mungle for help if edits are needed to the top section.

Original Investigation

Caring for the critically ill patient, brief report, research letter, systematic review (without meta-analysis), narrative review, special communication, clinical challenge, diagnostic test interpretation, a piece of my mind, letter to the editor, letter in reply.

• Randomized Clinical Trial
• Parallel-Design Double-blind Trial
• Crossover Trial
• Equivalence and Noninferiority Trial
• Cluster Trial
• Nonrandomized Controlled Trial

Meta-analysis

• Cohort Study
• Case-Control Study
• Cross-sectional Study
• Case Series
• Economic Evaluation
• Decision Analytical Model
• Comparative Effectiveness Research
• Genetic Association Study
• Diagnostic/Prognostic Study
• Quality Improvement Study
• Survey Study
• Qualitative Study

Manuscript Submission

Copies of previous editorial and reviewer comments, cover letter, manuscript style, manuscript components, recommended file sizes, manuscript file formats, abbreviations, units of measure, names of drugs, devices, and other products, gene names, symbols, and accession numbers, reproduced and re-created material, online-only supplements and multimedia.

What to Expect

Editorial and Peer Review

The jama network advantage.

• JAMA-Express

Authorship Form and Publishing Agreement

Publication.

• Postpublication Online Commenting

Reprints/e-Prints

Corrections, previous publication, related manuscripts and reports, and preprints, previous or planned meeting presentation or release of information, embargo policy, research article public access, depositing in repositories, and discoverability.

Editorial Policies for Authors

Authorship and Disclosures

Authorship criteria and contributions, role of the corresponding author, changes in authorship, name change policy, group authorship, conflicts of interest and financial disclosures, funding/support and role of funder/sponsor, data access, responsibility, and analysis, acknowledgment section, equator reporting guidelines, use of causal language, timeliness of data, statistical methods and data presentation, reporting demographic information for study participants, ethical approval of studies and informed consent, patient identification, use of ai in publication and research, personal communications and unpublished data, manuscripts that pose security risks.

Journal Policies, Forms, Resources

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Publishing agreement, unauthorized use.

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Contact Information

JAMA , Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, 330 N Wabash Ave, Chicago, IL 60611-5885; telephone: (312) 464-4444; fax: (312) 464-5824; email: [email protected] . Manuscripts should be submitted online at http://manuscripts.jama.com .

Determine My Article Type

Categories of articles.

Original Investigation full info

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

• ≤5 tables and/or figures
• Structured abstract

Data Sharing Statement

Follow EQUATOR Reporting Guidelines

Caring for the Critically Ill Patient full info

Original research reports, preferably clinical trials or systematic reviews that address virtually any aspect of critical illness, from prevention and triage, through resuscitation and acute treatment, to rehabilitation and palliative care.

• See also requirements for Clinical Trial , Meta-analysis , and Systematic Review

Brief Report full info

Short reports of original studies or evaluations or unique, first-time reports of clinical case series.

It is very rare for this journal to publish case reports.

• 15 references
• ≤3 tables and/or figures

Research Letter full info

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

• No more than 7 authors
• ≤6 references
• ≤2 small tables and/or figures
• No Abstract or Key Points

Back to top

Clinical Review and Education

Systematic Review (without meta-analysis) full info

This article type requires a presubmission inquiry. See the "full info" below for requirements and contact information.

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 ).

• 50-75 references
• A PRISMA-style flow diagram should be included as an online supplement
• Include a table with ratings of the quality of the studies/evidence
• Subtitle should be "A Systematic Review"

Narrative Review full info

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 should 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.

• 2000-3500 words
• 3-part structured abstract
• No Key Points
• Subtitle should be "A Review"

Special Communication full info

This journal publishes very few of these types of articles.

These manuscripts describe an important issue in clinical medicine, public health, health policy, or medical research in a scholarly, thorough, well-referenced, systematic, and evidence-based manner.

• 50 references
• ≤4 tables and/or figures
• Requires a presubmission inquiry

Clinical Challenge full info

Presents an actual patient case with a specific disease or condition with an accompanying clinical image.

• "What Would You Do Next?" with 4 single-phrase plausible treatment options describing possible courses of action with 1 being preferred
• Case presentation: 250 words
• Discussion: 500-600 words
• ≤10 references
• 1-2 small figures
• Patient permission required

Diagnostic Test Interpretation full info

This article requires a presubmission inquiry.

Presentation of the results of a diagnostic test from a single patient with exploration of the clinical application of the test result; intended to help clinicians understand the underlying rationale in ordering tests, interpreting test results, and acting on the diagnostic test findings.

• How Do You Interpret These Test Results? (or What Would You Do Next?) with 4 plausible responses
• Case presentation: 200 words
• Discussion: 650 words

Viewpoint full info

May address virtually any important topic in medicine, public health, research, discovery, prevention, ethics, health policy, or health law and generally are not linked to a specific article.

• 1200 words (or 1000 words with 1 small table or figure)
• ≤7 references at submission
• ≤3 authors, with no more than 2 affiliations per author

A Piece of My Mind full info

Personal vignettes (eg, exploring the dynamics of the patient-physician relationship) taken from wide-ranging experiences in medicine; occasional pieces express views and opinions on the myriad issues that affect the profession.

• ≤1600 words
• Patient permission may be needed

Poetry full info

Original poems related to the medical experience, whether from the point of view of a health care worker or patient, or simply an observer.

• No longer than 44 lines

Correspondence

Letter to the Editor full info

Letters discussing a recent article in this journal should be submitted within 4 weeks of the article's publication in print.

• ≤5 references (1 of which should be to the recent article)

Letter in Reply full info

Replies by authors of original articles to letters from readers.

Determine My Study Type

Randomized Clinical Trial full info

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

• ≤5 tables and/or figures, including CONSORT flow diagram
• Subtitle should be "A Randomized Clinical Trial"
• Trial registration and ID
• Trial protocol
• CONSORT checklist
• Follow CONSORT Reporting Guidelines

Parallel-Design Double-blind Trial full info

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

Crossover Trial full info

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

Equivalence and Noninferiority Trial full info

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

Cluster Trial full info

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

Nonrandomized Controlled Trial full info

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

• ≤5 tables and/or figures, including a trial flow diagram
• Subtitle should be "A Nonrandomized Controlled Trial"
• TREND checklist

Meta-analysis full info

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

• Subtitle should include "A Meta-analysis"
• Follow PRISMA Reporting Guidelines or MOOSE Reporting Guidelines

Cohort Study full info

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

• Follow STROBE Reporting Guidelines

Case-Control Study full info

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

Cross-sectional Study full info

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

Case Series full info

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

• Follow Reporting Guidelines

Economic Evaluation full info

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

• Follow CHEERS Reporting Guidelines

Decision Analytical Model full info

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

Comparative Effectiveness Research full info

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

• Follow ISPOR Reporting Guidelines

Genetic Association Study full info

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

• Follow STREGA Reporting Guidelines

Diagnostic/Prognostic Study full info

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

• Follow STARD Reporting Guidelines or TRIPOD Reporting Guidelines

Quality Improvement Study full info

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

• Follow SQUIRE Reporting Guidelines

Survey Study full info

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

• Follow AAPOR Best Practices for Survey Research
• Optional: Survey instrument as supplemental file

Qualitative Study full info

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

• Follow SRQR Reporting Guidelines or COREQ Reporting Guidelines

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 Reports of 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 ). Follow EQUATOR Reporting Guidelines .

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

These manuscripts are original research reports, preferably clinical trials, or systematic reviews (see above classifications for manuscript submission requirements by category of article) that address virtually any aspect of critical illness, from prevention and triage, through resuscitation and acute treatment, to rehabilitation and palliative care. Manuscripts that provide new insights into the diagnosis, prognosis, and treatment of critically ill patients, as well as those that explore pathophysiological, technological, ethical, or other related aspects of critical care medicine, are welcome. Follow EQUATOR Reporting Guidelines . For reports of original data and systematic reviews, a structured abstract is required; see instructions for preparing Abstracts for Reports of Original Data or Abstracts for Reviews . A list of 3 Key Points is required (see guidance on preparing Key Points ). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and online-only material) with no more than a total of 5 tables and/or figures.

These manuscripts are short reports of original studies or evaluations or unique, first-time reports of clinical case series. Follow EQUATOR Reporting Guidelines . A structured abstract is required; for more information, see instructions for preparing Abstracts for Reports of Original Data . A list of 3 Key Points is required (see guidance on preparing Key Points ). Recommended length: 1200 words (not including abstract, tables, figures, acknowledgments, references, and online-only material) with no more than a total of 3 tables and/or figures and no more than 15 references. Note: It is very rare for this journal to publish case reports.

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

This article type requires a presubmission inquiry to [email protected] .

The journal will consider 2 types of review articles:

Systematic Reviews

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. 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: A Review (note: the word "narrative" is not included in the subtitle)

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. Follow EQUATOR Reporting Guidelines .

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: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and online-only material), with no more than a total of 5 tables and/or figures 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.

Prospective authors interested in submitting a review manuscript should prepare a detailed outline of the proposed article. There should also be a brief summary of the extent and quality of the literature supporting the proposed review. Alternatively, if a draft of the manuscript has been completed, this can be sent. Prospective authors should also summarize their publication record in the field. Send this information to the editorial office via email to Mary McDermott, MD, at [email protected] .

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.

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 to 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.

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- to 3-sentence summary of the major conclusions of the review.

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).

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 preparation and submission of Tables .

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. Note: All figures will be re-created. For each proposed illustration, the authors should provide a list of the elements to be included in the illustration; 3-4 relevant recent references; example illustrations, if available; a working figure title and legend; and an explanation of how this new illustration would add to the published literature. We encourage videos, if appropriate, to illustrate a point made or process described in the Review.

Follow additional instructions for preparation and submission of Figures and Video .

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.

The first 2 to 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.

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.

Figures that illustrate pathophysiology or clinical presentation may be included. Note: All figures will be re-created. For each proposed illustration, the authors should provide a list of the elements to be included in the illustration; 3-4 relevant recent references; example illustrations, if available; a working figure title and legend; and an explanation of how this new illustration would add to the published literature. We encourage videos, if appropriate, to illustrate a point made or process described in the Review.

Note: This journal publishes very few of these types of articles. These manuscripts describe an important issue in clinical medicine, public health, health policy, or medical research in a scholarly, thorough, well-referenced, systematic, and evidence-based manner.

A structured abstract 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. For a recently published example, see JAMA . 2019;322(20):1996-2016 .

Clinical Challenge presents an actual patient scenario about a specific disease or condition with an accompanying clinical image.

Authors should provide 4 single-phrase plausible treatment options describing possible courses of action with one of these being the most correct response for the question "What Would You Do Next?" Manuscripts should include a brief discussion of the relevant clinical issues and provide well-supported (evidence-based) explanations discussing the 4 potential courses of action. For a recently published example, see JAMA . 2022;327(24):2448-2449. doi:10.1001/jama.2022.8384 .

All diagnostic and treatment recommendations should be supported by referencing recent authoritative texts or journal articles. Preferably, these recommendations should be supported by governmental or multisociety guidelines, clinical trials, meta-analyses, or systematic reviews. The text should have a maximum length of 850 words, consisting of no more than 250 words for the case presentation, question, and 4 one-sentence answers, followed by no more than 600 words that include the diagnosis and a brief discussion. There should be no more than 3 authors. At least 1 of the authors, ideally the corresponding author, should have sufficient expertise and experience with the topic. There should be no more than 10 references, and no more than 2 small figures totaling 3 image components (Figure 1, with no more than 2 components, for the case presentation; and Figure 2, with no more than 1 component, for the diagnosis and discussion).

Provide a short title that briefly describes the disease entity or case presentation and does not include the diagnosis. Do not include the patient's race, ethnicity, or country of origin in the title or the first line of the article. If this information is clinically relevant and necessary, it can be included in the case description.

In addition, the JAMA Network Patient Permission form must be completed and signed by the patient (or a family member if the patient has died, is a minor, or is an adult without decisional capacity) and included at the time of manuscript submission. Please read Patient Identification before submitting your manuscript.

The image and case presentation should be from the same patient and must not have been published previously. In some cases, additional figures may be included to accompany the answer explanations (see description of additional figure(s) above). 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 350 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 reformatted to journal style.

For more information on how to submit figures, see Figures.

We would like to receive common problems presenting uncommonly, rather than unusual or rare conditions (ie, "zebras"). These cases should be of interest to clinicians; they should be problems that clinicians are likely to encounter and have an outstanding image that illustrates the disorder and contributes to the diagnostic challenge.

Manuscripts not meeting these guidelines will not be considered.

Diagnostic Test Interpretation presents the results of a diagnostic test from a single patient and explores the clinical application of the test result. The Diagnostic Test Interpretation is intended to help clinicians understand the underlying rationale in ordering tests, interpreting test results, and acting on the diagnostic test findings.

The diagnostic test result must be obtained from the care of an actual patient and must include that patient's written permission. The JAMA Network Patient Permission form should be read and completed and signed by the patient (or a family member if the patient has died, is a minor, or is an adult without decisional capacity) and included at the time of manuscript submission. The results of laboratory, pathologic, or radiographic tests are appropriate but clinical images are not. Results of the diagnostic test of interest (and related tests) and the range of reference values should be included after the case. Authors of manuscripts based on clinical images should consult the instructions for Clinical Challenge .

Provide a short title that briefly describes the disease entity or case presentation and does not include the diagnosis. Do not include the patient's race, ethnicity, or country of origin in the title or first line of the article. If this information is clinically relevant and necessary, it can be included in the case description.

Manuscripts for Diagnostic Test Interpretation should have the following sections:

Case presentation. The case presentation should be brief and focus on the diagnostic test in question. At the end of the case presentation the pertinent diagnostic test results and reference ranges should be provided (200 words). Include: JAMA Exclude: Specialty Journals, JNO Comments: How do you interpret these test results? How do you interpret these test results? (or What would you do next?) Four plausible responses should be provided. While most Diagnostic Test Interpretation articles will pose the question "How do you interpret these results?" a subset may more appropriately focus on the next best step regarding workup of the abnormal test result. In these cases, the question "How do you interpret these test results?" can be replaced with "What would you do next?" Either question should be presented in the format of a multiple choice question with a single correct (or best) answer. The answers may be brief phrases or short sentences, should be similar in length, and should be arranged alphabetically by first word in the answer. Response options should not describe treatments (about 50 words). Include: CAR,ONC Exclude: JAMA, DER, IMD, NEU, OPH, PED, OTO, PSY, SUR, JNO Comments: How do you interpret these test results? Test characteristics. A brief review of the diagnostic test should be provided (approximately 200 words). For biomarkers, this should include a brief description of the related physiology. Test accuracy should be reported using sensitivity and specificity or likelihood ratios, and predictive values should be provided for common clinical scenarios. Please use likelihood ratios whenever possible, since they do not depend on disease prevalence. The prevalence of the disease should be stated so that the pretest probability may be estimated. For example, "For patients with a typical disease prevalence of 10%, the predictive values of positive and negative test results are approximately 50% and 1%, respectively." Discussion of the application and utility of the diagnostic test should be based on a high-quality systematic review or authoritative practice guideline. If a more recent, original study supersedes or adds meaningfully to the prior synthesis of research, that article also should be cited. The approximate fee for the test should be provided. For example, some fees for laboratory tests can be obtained from the Medicare fee schedules . Radiology procedure fees can be found at the Medicare Physician Fee Schedule website . Application of test result to this patient. A brief discussion of how the diagnostic test result will facilitate the next steps in a patient's management should be presented. Please also address the correct answer to the question about test interpretation in this section (200 words). What Are Alternative Diagnostic Testing Approaches? If there are different testing strategies that can be used to evaluate patients to establish a diagnosis, please discuss them (100 words). Patient Outcome. Long-term follow-up (most recent as possible) regarding the patient's condition and outcome of treatment is necessary (100 words). Clinical Bottom Line. Please provide a bulleted list of 3-5 items that reflect the most important message readers should obtain from this article.

The overall text of the manuscript should have a maximum of 850 words, no more than 10 references, and no more than 3 authors. At least 1 of the authors, ideally the corresponding author, should have sufficient expertise and experience with the topic. The case presentation must not have been previously published.

For an example of this article type, see JAMA . 2022;327(13):1284-1285. doi:10.1001/jama.2022.2037 .

If there are questions about patient identifiability, please contact the editorial office. Authors interested in submitting a manuscript for Diagnostic Test Interpretation should contact the editorial office prior to manuscript preparation and submission by sending an email to Kristin Walter at [email protected] .

Viewpoints may address virtually any important topic in medicine, public health, research, discovery, prevention, ethics, health policy, or health law and generally are not linked to a specific article. Viewpoints should be well focused, scholarly, and clearly presented but should not include the findings of new research or data that have not been previously published.

Viewpoints must have no more than 3 authors. Editors encourage diversity of gender, race, ethnicity, geographic location, and discipline for Viewpoint authors, and the first author should have sufficient expertise and experience with the topic to provide an authoritative opinion. 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, which should be as current as possible. Viewpoints not meeting these guidelines will not be considered.

Most essays published in A Piece of My Mind are personal vignettes (eg, exploring the dynamics of the patient-physician relationship) taken from wide-ranging experiences in medicine; occasional pieces express views and opinions on the myriad issues that affect the profession. If the patient(s) described in these manuscripts is identifiable, a Patient Permission form , which provides consent for publication, must be completed and signed by the patient(s) or family member(s) and submitted with the manuscript. Manuscripts that describe identifiable patients that do not have a signed form will not be reviewed. Omitting data or making data less specific to deidentify patients is acceptable, but changing any such data is not acceptable. Fictional or composite accounts are not permitted.

Manuscripts are not published anonymously or pseudonymously and must have no more than 3 authors. All manuscripts must be submitted formally via the journal's manuscript submission system; we do not review drafts or unfinished manuscripts prior to submission. Length limit: 1600 words.

Poems related to the medical experience, whether from the point of view of a health care worker or patient, or simply an observer, will be considered. Poems should be original, not previously published or under consideration elsewhere, no longer than 44 lines, and with individual lines no longer than 55 characters (including spaces). Authors should submit each poem separately (ie, one poem per submission record, and only one author per poem). Submissions containing multiple poems will be returned with instructions to split into individual files. Do not submit artwork, music/audio, or other accompanying materials, which are not considered. All poems must be submitted online via the online manuscript submission and review system . Authors of poems that are accepted for publication are required to complete Authorship Forms and transfer copyright to the publisher as part of a publishing agreement. An email with links to the Authorship Form will be sent to authors for completion before final acceptance. Author requests to republish poems are generally granted by our permissions department following a formal request.

Questions about submitting poems (but not submissions) may be sent to [email protected] .

Letters discussing a recent article in this journal should be submitted within 4 weeks of publication of the article in print. 3 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 article. 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 email 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 being considered for publication ordinarily will be sent to the authors of the original article, who will be given the opportunity to reply. Letters will be published at the discretion of the editors and are subject to abridgement and editing for style and content. To read more about Letters, see the AMA Manual of Style .

Replies by authors should not exceed 500 words of text and 6 references. They should have no more than 3 authors.

Clinical Trial

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

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

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

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

Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria, or data sources, and how these were selected for the study); the essential features of any interventions; the primary and secondary outcome measures (consistent with those reported in the trial protocol); the main results of the study; a discussion section placing the results in context with the published literature and addressing study limitations; and the conclusions.

A structured abstract is required, and trial registration information (registry name, trial ID, and URL) must be listed at the end of the abstract; for more information, see instructions for preparing Abstracts for Reports of Original Data . A list of 3 Key Points is required (see guidance on preparing Key Points ). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Randomized Clinical Trial" or, for Nonrandomized Controlled Trials, "A Nonrandomized Controlled Trial." To read more about clinical trials, see the AMA Manual of Style .

Trial Registration:

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

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

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

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

Authors of manuscripts reporting clinical trials must submit trial protocols (including the complete statistical analysis plan) along with their manuscripts. Protocols in non-English languages should be translated into English. This should include the original approved protocol and statistical analysis plan, and all subsequent amendments to either document. Do not submit a summary version that was published as an article in another journal. If the manuscript is accepted, the protocol and statistical analysis plan will be published as a 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. The CONSORT checklist also should be completed and submitted with the manuscript. 10

Figure. Profile of a Randomized Clinical Trial

Trial Protocol

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

A structured abstract is required, and trial registration information (registry name, trial ID, and URL) must be listed at the end of the abstract; for more information, see instructions for preparing Abstracts for Trial Protocols . A list of 3 Key Points is required (see guidance on preparing Key Points ). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Trial Protocol."

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

A structured abstract is required; for more information, see instructions for preparing Abstracts for Meta-analysis . A list of 3 Key Points is required (see guidance on preparing Key Points ). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and online-only material), with no more than a total of 5 tables and/or figures and no more than 50-75 references. The subtitle should include the phrase "A Meta-analysis." To read more about meta-analyses, see the AMA Manual of Style .

Other Observational Studies

These manuscripts include Cohort Study, Case-Control Study, Cross-sectional Study, Case Series, Economic Evaluation, Decision Analytical Model, Comparative Effectiveness Research, Genetic Association Study, Diagnostic/Prognostic Study, Quality Improvement Study, Survey Study, and Qualitative Study. Each manuscript should clearly state an objective or hypothesis; the design and methods (including the study setting and dates, patients or participants with inclusion and exclusion criteria and/or participation or response rates, or data sources, and how these were selected for the study); the essential features of any interventions or exposures; the main outcome measures; the main results of the study; a discussion section placing the results in context with the published literature and addressing study limitations; and the conclusions and relevant implications for clinical practice or health policy. Data included in research reports must be original and should be as timely and current as possible (see Timeliness of Data ). Follow EQUATOR Reporting Guidelines .

A structured abstract is required; for more information, see instructions for preparing Abstracts for Reports of Original Data . A list of 3 Key Points is required (see guidance on preparing Key Points ). Maximum length: 3000 words of text (not including abstract, tables, figures, acknowledgments, references, and supplemental material) with no more than a total of 5 tables and/or figures and no more than 50-75 references.

Format My Manuscript

Manuscript preparation and submission requirements.

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

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

As recommended by the ICMJE, "if the manuscript has been submitted previously to another journal, it is helpful to include the previous editors' and reviewers' comments with the submitted manuscript, along with the authors' responses to those comments." 4 It is not uncommon for manuscripts to have been submitted to and peer reviewed by other journals and sharing this information will not bias an editor's decision for this journal. Thus, authors are encouraged to submit these previous comments in their entirety and indicate how they have revised the manuscript in response to these comments, which may expedite the review process. In the submission system, there is a file type for Previous Peer Review and Editorial Comments.

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

Manuscripts should be prepared in accordance with the AMA Manual of Style , 11th edition, 2 and/or the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals . 4

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

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).

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

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

The title page should be the first page of your manuscript file. It should include a manuscript title; the full names, highest academic degrees, and affiliations of all authors (if an author's affiliation has changed since the work was done, the new affiliation also should be listed); name and complete contact information for corresponding author; and manuscript word count (not including title, abstract, acknowledgment, references, tables, and figure legends).

Titles should be concise, specific, and informative. 2(p8) Please limit the length of titles to 100 characters (including spaces) for reports of research and other major articles and 60 characters for shorter article types such as opinion articles and Letters as well as for subtitles to major articles. For scientific manuscripts, do not use overly general titles, declarative titles, titles that include the direction of study results, or questions as titles. For reports of clinical trials, 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. Depending on the context, avoid inclusion of specific locations (eg, state, province, or country) and specific years. To read more about titles, see the AMA Manual of Style .

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

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

Question: Focused question based on the study hypothesis or goal/purpose. Limit to 1 sentence. Findings: Results of the study/review. Include the design (eg, clinical trial, cohort study, case-control study, meta-analysis). Focus on primary outcome(s) and finding(s). Do not emphasize secondary outcomes. Report basic numbers only but state if results are statistically significant or not significant; do not include results of statistical tests or measures of variance (see example below). Can include 1 to 2 sentences. Meaning: Key conclusion and implication based on the primary finding(s). Limit to 1 sentence. Example of Research Article Question: What is the immunogenicity of an inactivated influenza A vaccine with and without adjuvant? Findings: In this randomized clinical trial that included 980 adults, the proportion achieving an effective antibody response was 84% with adjuvant vs 2% without adjuvant, a significant difference. Meaning: In an influenza pandemic the use of an adjuvant with inactivated influenza A vaccine may be warranted. Include: All Journals except JNO and JHF Exclude: JNO and JHF Comments: Example of Review Article 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.

Include a structured abstract for reports of original data, meta-analyses, and systematic reviews. Abstracts should be prepared in JAMA Network style—see instructions for preparing abstracts below. Abstracts are not required for Editorials, Viewpoints, and special features. No information should be reported in the abstract that does not appear in the text of the manuscript. To read more about abstracts, see the AMA Manual of Style .

Abstracts for Reports of Original Data:

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

Importance: The abstract should begin with a sentence or 2 explaining the clinical (or other) importance of the study question. Objective: State the precise objective or study question addressed in the report (eg, "To determine whether..."). If more than 1 objective is addressed, the main objective should be indicated and only key secondary objectives stated. If an a priori hypothesis was tested, it should be stated. Design: Describe the basic design of the study and include the specific study type (eg, randomized clinical trial, cohort, cross-sectional, case-control, case series, survey, meta-analysis, bibliometric analysis). State the years of the study and the duration of follow-up. For older studies (eg, those completed >3 years ago), add the date of the analysis being reported. If applicable, include the name of the study (eg, the Framingham Heart Study). As relevant, indicate whether observers were blinded to patient groupings, particularly for subjective measurements. Setting: Describe the study setting to assist readers to determine the applicability of the report to other circumstances, for example, multicenter, population-based, primary care or referral center(s), etc. Participants: State the clinical disorders, important eligibility criteria, and key sociodemographic features of patients (or other study participants). The numbers of eligible participants and how they were selected should be provided, including the number approached but who refused or were excluded. For selection procedures, these terms should be used, if appropriate: random sample (where random refers to a formal, randomized selection in which all eligible individuals have a fixed and usually equal chance of selection); population-based sample; referred sample; consecutive sample; volunteer sample; convenience sample. If matching is used for comparison groups, characteristics that are matched should be specified. In follow-up studies, the proportion of participants who completed the study must be indicated.

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

Intervention(s) (for clinical trials) or Exposure(s) (for observational studies): The essential features of any interventions, or exposures, should be described, including their method and duration. The intervention, or exposure, should be named by its most common clinical name, and nonproprietary drug names should be used. Main Outcome(s) and Measure(s): Indicate the primary study outcome measurement(s) as planned before data collection began. If the manuscript does not report the main planned outcomes of a study, this fact should be stated and the reason indicated. State clearly if the hypothesis being tested was formulated during or after data collection. Explain outcomes or measurements unfamiliar to a general medical readership. Results: Summary demographic information (eg, characteristics such as sex and age) and the number of study participants should be reported in the first sentence of the Results paragraph. The main outcomes of the study should be reported and quantified, including final included/analyzed sample. When possible, present numerical results (eg, absolute numbers and/or rates) with appropriate indicators of uncertainty, such as confidence intervals. Include absolute numbers and/or rates with any ratio measures and avoid redundant reporting of relative data (eg, % increase or decrease). Use means and standard deviations (SDs) for normally distributed data and medians and ranges or interquartile ranges (IQRs) for data that are not normally distributed. Avoid solely reporting the results of statistical hypothesis testing, such as  P  values, which fail to convey important quantitative information. For most studies,  P  values should follow the reporting of comparisons of absolute numbers or rates and measures of uncertainty (eg, 0.8%, 95% CI −0.2% to 1.8%;  P  =.13).  P  values should never be presented alone without the data that are being compared. See also Reporting Standards and Data Presentation . Measures of relative risk also may be reported (eg, relative risk, hazard ratios) and should include confidence intervals. Studies of screening and diagnostic tests should report sensitivity, specificity, and likelihood ratio. If predictive value or accuracy is reported, prevalence or pretest likelihood should be given as well. All randomized clinical trials should include the results of intention-to-treat analysis as well. In intervention studies, the number of patients withdrawn because of adverse effects should be given. Approaches such as number needed to treat to achieve a unit of benefit may be included when appropriate. All surveys should include response/participation rates. Conclusions and Relevance: Provide only conclusions of the study that are directly supported by the results. Give equal emphasis to positive and negative findings of equal scientific merit. Also, provide a statement of relevance indicating implications for clinical practice or health policy, avoiding speculation and overgeneralization. The relevance statement may also indicate whether additional study is required before the information should be used in clinical settings. Trial Registration: For clinical trials only (not nontrial observational studies), the name of the trial registry, registration number, and URL of the registry must be included. See Trial Registration .

Abstracts for Meta-analysis:

Manuscripts reporting the results of meta-analyses should include an abstract of no more than 350 words using the headings listed below. The text of the manuscript should also include a section describing the methods used for data sources, study selection, data extraction, and data synthesis. Each heading should be followed by a brief description:

Importance: A sentence or 2 explaining the importance of the systematic review question that is used to justify the meta-analysis. Objective: State the precise primary objective of the meta-analysis. Indicate whether the systematic review for the meta-analysis emphasizes factors such as cause, diagnosis, prognosis, therapy, or prevention and include information about the specific population, intervention, exposure, and tests or outcomes that are being analyzed. Data Sources: Succinctly summarize data sources, including years searched. The search should include the most current information possible, ideally with the search being conducted within several months before the date of manuscript submission. Potential sources include computerized databases and published indexes, registries, meeting abstracts, conference proceedings, references identified from bibliographies of pertinent articles and books, experts or research institutions active in the field, and companies or manufacturers of tests or agents being reviewed. If a bibliographic database is used, state the exact indexing terms used for article retrieval, including any constraints (for example, English language or human study participants). If abstract space does not permit this level of detail, summarize sources in the abstract including databases and years searched, and place the remainder of the information in the Methods section. Study Selection: Describe inclusion and exclusion criteria used to select studies for detailed review from among studies identified as relevant to the topic. Details of selection should include particular populations, interventions, outcomes, or methodological designs. The method used to apply these criteria should be specified (for example, blinded review, consensus, multiple reviewers). State the proportion of initially identified studies that met selection criteria. Data Extraction and Synthesis: Describe guidelines (eg, PRISMA , MOOSE ) used for abstracting data and assessing data quality and validity. The method by which the guidelines were applied should be stated (for example, independent extraction by multiple observers). Indicate whether data were pooled using a fixed-effect or random-effects model. Main Outcome(s) and Measure(s): Indicate the primary study outcome(s) and measurement(s) as planned before data collection began. If the manuscript does not report the main planned outcomes of a study, this fact should be stated and the reason indicated. State clearly if the hypothesis being tested was formulated during or after data collection. Explain outcomes or measurement unfamiliar to a general medical readership. Results: Provide the number of studies and patients/participants in the analysis and state the main quantitative results of the review. When possible, present numerical results (eg, absolute numbers and/or rates) with appropriate indicators of uncertainty, such as confidence intervals. Include absolute numbers and/or rates with any ratio measures and avoid redundant reporting of relative data (eg, % increase or decrease). Use means and standard deviations (SDs) for normally distributed data and medians and ranges or interquartile ranges (IQRs) for data that are not normally distributed. Avoid solely reporting the results of statistical hypothesis testing, such as  P  values, which fail to convey important quantitative information. For most studies,  P  values should follow the reporting of comparisons of absolute numbers or rates and measures of uncertainty (eg, 0.8%, 95% CI −0.2% to 1.8%;  P  = .13).  P  values should never be presented alone without the data that are being compared. See also Reporting Standards and Data Presentation . Meta-analyses should state the major outcomes that were pooled and include odds ratios or effect sizes and, if possible, sensitivity analyses. Evaluations of screening and diagnostic tests should include sensitivity, specificity, likelihood ratios, receiver operating characteristic curves, and predictive values. Assessments of prognosis should summarize survival characteristics and related variables. Major identified sources of variation between studies should be stated, including differences in treatment protocols, co-interventions, confounders, outcome measures, length of follow-up, and dropout rates. Conclusions and Relevance: The conclusions and their applications (clinical or otherwise) should be clearly stated, limiting interpretation to the domain of the review.

Abstracts for Systematic Reviews or Special Communications:

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.

Abstracts for Narrative Reviews or Special Communications:

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.

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).

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. To read more about abbreviation use, see the AMA Manual of Style .

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

To read more about units of measure, click here .

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

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

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

The submission and publication of content created by artificial intelligence, language models, machine learning, or similar technologies is discouraged, unless part of formal research design or methods, and is not permitted without clear description of the content that was created and the name of the model or tool, version and extension numbers, and manufacturer. Authors must take responsibility for the integrity of the content generated by these models and tools. See also Use of AI in Publication and Research .

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:

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

For more examples of electronic references, click here .

Tables and Figures

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

See also Tables and Figures .

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

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

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

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

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

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

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

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

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

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

Table Creation

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

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

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

Missing data and blank space in the table field (ie, an empty cell) may create ambiguity and should be avoided; use abbreviations such as NA for not applicable or not available. Each piece of data needs to be contained in its own cell. Do not try to align cells with hard returns or tabs; alignment will be imposed in the production system if the manuscript is accepted. To show an indent, add 2 spaces.

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

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

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

Table 1. Baseline Values in the Editors' Health Study

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

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

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

Table 2. Blood Pressure Values Stratified by Age

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

Table 3. Patient Data by Study Group

Table 4. Patient Data by Study Group

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

Table Footnotes

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

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

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

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

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

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

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

Number all figures (graphs, charts, photographs, and illustrations) in the order of their citation in the text. The number of figures should be limited. Avoid complex composite or multipart figures unless justified. See Categories of Articles for limits on the number of figures and/or tables according to article type.

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

Graphs, charts, some illustrations, titles, legends, keys, and other elements related to figures in accepted manuscripts will be re-created and edited according to JAMA Network style and standards prior to publication. 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 or to deidentify patients but must not misrepresent or alter interpretation of the image by selectively eliminating relevant visual information. Juxtaposition of elements from different parts of a single image or from different images, as in a composite, must be clearly indicated by the addition of dividing lines, borders, and/or panel labels.

The submission and publication of images created by artificial intelligence, machine learning tools, or similar technologies is discouraged, unless part of formal research design or methods, and is not permitted without clear description of the content that was created and the name of the model or tool, version and extension numbers, and manufacturer. Authors must take responsibility for the integrity of the content generated by these models and tools. See also Use of AI in Publication and Research .

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

Acceptable Figure Files for Initial Submission and Review

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

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

Figure File Requirements for Publication

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

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

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

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

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

Figure Titles and Legends (Captions)

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

Figures With Labels, Arrows, or Other Markers

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

Number of Figures

Refer to Categories of Articles because there may be a limit on the number of figures by article type.

General Figure Guidelines

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

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

Table of Figure Requirements

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

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

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

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

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

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

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

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

Flow diagram

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

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

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

Survival plot

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

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

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

Box-and-whisker plot (box plot)

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

Each element should be described (the ends of the boxes, the middle line, and the whiskers). Data points that fall beyond the whiskers are typically shown as circles.

Forest plot

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

The data are presented both tabularly and graphically.

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

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

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

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

Scatterplot

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

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

Illustration

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

Required minimum resolution for publication: ≥350 ppi

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

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

Photographs and other clinical images

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

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

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

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

Line drawings

To illustrate anatomy or procedures.

Line drawings are almost always black and white.

Required minimum resolution for publication: ≥600 ppi

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

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

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, authors are responsible for the accuracy and presentation of all such material.

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

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. All online-only tables should be cited in the relevant text of the main manuscript. 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.

If data are better displayed in a separate Excel file, this can be submitted, provided that the Excel file is cited as an eTable and is numbered in the order cited in the text. If multiple Excel files of data are submitted, these should be placed in a single Excel file, with multiple tabs (sheets) at the bottom of the file. The first tab (sheet) should include a table of contents with eTable numbers and titles, and the subsequent tabs (sheets) should be labeled as eTable 1, eTable 2, etc. Please note: the journal is not a data repository; large data sets should be deposited into publicly accessible data repositories, and a link should be provided in the Methods or Results section and the Data Sharing Statement .

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. All online-only figures should be cited in the relevant text of the main manuscript. 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.

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

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

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

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

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

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

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

Guidelines for Optimal Video Quality

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

Additional Considerations for Filming Surgical Procedures

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

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

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

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

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

After Submission

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

All submitted manuscripts are reviewed initially by one of the editors. Manuscripts are evaluated according to the following criteria: material is original and timely, writing is clear, study methods are appropriate, data are valid, conclusions are reasonable and supported by the data, information is important, and topic has general interest to readers of this journal. From these basic criteria, the editors assess a paper's eligibility for publication. Manuscripts with insufficient priority for publication are rejected promptly. Other manuscripts are sent to expert consultants for peer review. The journal uses a single-anonymized peer review process: peer reviewer identities are kept confidential (unless reviewers choose to reveal their names in their formal reviews); author identities are made known to reviewers. The existence of a manuscript under review is not revealed to anyone other than peer reviewers and editorial staff. Peer reviewers are required to maintain confidentiality about the manuscripts they review and must not divulge any information about a specific manuscript or its content to any third party without prior permission from the journal editors. Reviewers are instructed to not submit confidential manuscripts, abstracts, or other text into a chatbot, language model, or similar tool. At submission, authors may choose to have manuscripts that are not accepted by the journal referred to one of the JAMA Network specialty journals and/or JAMA Network Open along with reviewers' comments (if available). 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.

At the time of manuscript submission, authors may preselect the option to have their manuscript and reviewers' comments automatically referred to one of the JAMA Network specialty journals if the manuscript is not accepted by JAMA .

JAMA -EXPRESS

JAMA -EXPRESS provides rapid peer review and publication of major clinical trials and other original research studies that have immediate or public health importance. Authors who wish to have manuscripts considered for JAMA -EXPRESS should send the manuscript file and a request letter to [email protected] or call (312) 464-4444. Authors will be notified promptly whether the manuscript is approved for rapid peer review. Authors of those manuscripts determined not to qualify for rapid review may be invited to submit the manuscript for further consideration under the standard review process.

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

After Revision/Acceptance

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

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

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

If accepted for publication, all articles are published quickly in one of JAMA 's weekly print/online issues; selected articles are published Online First.

After Publication

Postpublication correspondence.

For accepted manuscripts, the corresponding author will be asked to respond to letters to the editor.

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

Requests to publish corrections should be sent to the editorial office. Errors and requests for corrections are reviewed by editors and authors, and, if warranted, a Correction notice summarizing the errors and corrections is published promptly and linked online to the original article, and the original article is corrected online with the date of correction. 15

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

About Previous Release of Information, Embargo, and Access

Manuscripts are considered with the understanding that they have not been published previously and are not under consideration by another publication.

Copies of all related or similar manuscripts and reports by the same authors (ie, those containing substantially similar content or using the same, similar, or a subset of data) that have been previously published or posted electronically or are under consideration elsewhere must be provided at the time of manuscript submission. All related previously published articles should be cited as references and described in the submitted manuscript along with explanation of how the submitted manuscript differs from the related previously published article(s).

Manuscripts that have been previously posted on a preprint server may be submitted for consideration for publication. When the manuscript is submitted, authors must provide information about the preprint, including a link to it and a description of whether the submitted manuscript has been revised or differs from the preprint.

See also Previous or Planned Meeting Presentation or Release of Information and Research Article Public Access, Depositing in Repositories, and Discoverability.

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

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

See also Previous Publication, Related Manuscripts and Reports, and Preprints . For more information, see the AMA Manual of Style .

Authors should not disclose the fact that their manuscript has been accepted to anyone, except coauthors and contributors, without permission of the editor until it is published. All information regarding the content and publication date of accepted manuscripts is strictly confidential. Unauthorized prepublication release of accepted manuscripts and information about planned publication date may result in rescinding the acceptance and rejecting the paper. This policy applies to all categories of articles, including research, review, opinion, correspondence, 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. 2 , 5 See also Previous or Planned Meeting Presentation or Release of Information .

The journal makes all JAMA research articles free public access 6 months after publication on the journal website.

Authors of research articles may deposit the accepted version (ie, the peer-reviewed manuscript that you submitted on which this decision is based) of the manuscript in a repository of your choice on or after the date of publication provided that it links to the final published version on the journal website. You may not deposit the published article (version of record), which is the final copyedited, formatted, and proofed version published by the journal. The journal will deposit a copy of the published research article into PubMed Central (PMC) at the time of publication, where it will be publicly available 6 months after publication. A few weeks after publication, you may obtain your PMCID on the PMC site at: https://www.ncbi.nlm.nih.gov/pmc/pmctopmid/ . These options apply only to research articles. Non-research articles may not be deposited into repositories.

In addition, the journal will add metadata to all articles to ensure web-based search engine discoverability and will provide publicly discoverable information about your article to PubMed/Medline and numerous other bibliographic databases on the day of publication.

Author Responsibilities

Most of the JAMA Network journals' editorial policies for authors are summarized in these instructions. Citations and links to the AMA Manual of Style: A Guide for Authors and Editors 2 and other publications with additional information are also provided.

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

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

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

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

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; Confirmation of Reporting Conflicts of Interest and Funding; and Publishing Agreement. 2(pp128-133) In addition, authors are required to identify their specific contributions to the work described in the manuscript. Requests by authors to designate equal contributions or shared authorship positions (eg, co-first authorship) may be considered if justified and within reason. 6 An email with links to the Authorship Form will be sent to authors for completion after manuscripts have been submitted.

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

Nonhuman artificial intelligence, language models, machine learning, or similar technologies do not qualify for authorship. If these models or tools are used to create content or assist with writing or manuscript preparation, authors must take responsibility for the integrity of the content generated by these tools. Authors should report the use of artificial intelligence, language models, machine learning, or similar technologies to create content or assist with writing or editing of manuscripts in the Acknowledgment section or Methods section if this is part of formal research design or methods. See also Use of AI in Publication and Research , Reproduced and Re-created Material , and Image Integrity .

The authors also must certify that the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under their authorship has been published or is being considered for publication elsewhere (see also About Previous Release of Information, Embargo, and Access ). 2 Authors of manuscripts reporting original data or systematic reviews must provide an access to data statement from 1 or 2 named authors, often the corresponding author (see also Data Access, Responsibility, and Analysis ). If requested, authors should be prepared to provide the data and must cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees.

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

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

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

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

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

The JAMA Network recognizes that authors may change their names for personal reasons, and the editors respect authors' rights to autonomy and privacy in this regard. Authors who request confidential name changes after publication because of changes in identity, marital status, religion, or other reasons may have their names changed in articles without indication of the reason for the change and without a formal correction notice. If an author prefers this change to be public, a formal Correction notice can be issued, with or without the reason per author preference. The journal will not request the approval of coauthors, but the requesting author may wish to notify coauthors if this change will affect subsequent citations to the article. The requester may be asked to notify the corresponding author about this change to the published article; alternatively, the journal may inform the corresponding author of this change (without explaining the reason for the change). The journal will make this change to the online and PDF versions of the published article and will notify postpublication indexes and databases as a standard process but cannot guarantee when or if the change will be reflected in these indexes and databases.

If authorship is attributed to a group (either solely or in addition to 1 or more individual authors), all members of the group must meet the full criteria and requirements for authorship as described above, and all group member authors must complete Authorship Forms. 6 If all members of a group do not meet all authorship criteria, a group must designate 1 or more individuals as authors or members of a writing group who meet full authorship criteria and requirements and who will take responsibility for the group. 2 , 6 Group names should appear at the end of the byline and should not be interspersed within the list of individually named authors. Group authors may not be included for article types with limited numbers of authors (eg, opinion articles).

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

Nonauthor Collaborators: Other group members who do not meet the criteria for authorship (eg, investigators, advisors, assistants) may be identified. For group author manuscripts, a Nonauthor Collaborator Template (with names, academic degrees, institution, location, role/contribution, and subgroup) must be completed during revision. The template will be available to authors with the request for revision. The collaborators will be published in an online Supplement based on this template and will be deposited to PubMed.

To read more about authorship, click here .

A conflict of interest may exist when an author (or the author's institution or employer) has financial or personal relationships or affiliations that could influence (or bias) the author's decisions, work, or manuscript. All authors are required to report potential conflicts of interest including specific financial interests relevant to the subject of their manuscript in the Acknowledgment section of the manuscript 2 and in the Disclosure of Potential Conflicts of Interest section of the Authorship Form. Note: These forms will be requested after a manuscript has been submitted, but authors should also include conflict of interest disclosures in the Acknowledgment section of the submitted manuscript.

Definitions and Terms of Conflicts of Interest Disclosures:

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

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

Any potential conflicts of interest "involving the work under consideration for publication" (during the time involving the work, from initial conception and planning to present), Any "relevant financial activities outside the submitted work" (over the 3 years prior to submission), and Any "other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing" what is written in the submitted work (based on all relationships that were present during the 3 years prior to submission).

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

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

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

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

All financial and material support for the research and the work should be clearly and completely identified in an Acknowledgment section of the manuscript. At the time of submission, information on the funding source (including grant identification) must also be completed via the online manuscript submission and review system. The specific role of the funding organization or sponsor in each of the following should be specified: "design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication." 7 To read more about reporting funding and other support, see the AMA Manual of Style .

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

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

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

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

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

Authors should report the use of artificial intelligence, language models, machine learning, or similar technologies to create content or assist with writing or editing of manuscripts in the Acknowledgment section or the Methods section if this is part of formal research design or methods. This should include a description of the content that was created or edited and the name of the language model or tool, version and extension numbers, manufacturer, date(s) of use, and confirmation that the authors take responsibility for the integrity of the content generated. (Note: this does not include basic tools for checking grammar, spelling, references, etc.) See also Use of AI in Publication and Research and Statistical Analysis Subsection .

Requirements for Reporting

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

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

Research reports should be timely and current and should be based on data collected as recently as possible. Manuscripts based on data from randomized clinical trials should be reported as soon as possible after the trial has ended, ideally within 1 year after follow-up has been completed.

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

General Considerations

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

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

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

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 prespecified secondary, subgroup, and/or sensitivity analyses. Comparisons arrived at during the course of the analysis or after the study was completed should be identified as post hoc. For analyses of more than 1 primary outcome, corrections for multiple testing should generally be used. For secondary outcomes, address multiple comparisons or consider such analyses as exploratory and interpret them as hypothesis-generating. The reporting of all outcomes should match that included in study protocols. For randomized clinical trials, protocols with complete statistical analysis plans should be cited in the Methods section and submitted as online supplementary content. 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 used for the analysis. State any a priori levels of significance and whether hypothesis tests were 1- or 2-sided. Also include the statistical software used to perform the analysis, including the version and manufacturer, along with any extension packages (eg, the svy suite of commands in Stata or the survival package in R). Do not describe software commands (eg, SAS proc mixed was used to fit a linear mixed-effects model). If analysis code is included, it should be placed in the online supplementary content.

Reporting Standards and Data Presentation

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

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

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

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

Researchers are encouraged to report studies that include diverse and representative participants and to indicate participant inclusion and exclusion criteria and how the findings generalize to the population(s) that are the focus of or are compatible with the research question. Aggregate, deidentified demographic information (eg, age, sex, race and ethnicity, and socioeconomic indicators) should be reported for all research reports along all prespecified outcomes. Demographic variables collected for a specific study should be reported in the Methods section. Demographic information assessed should be reported in the Results section, either in the main article or in an online supplement or both. If any demographic characteristics that were collected are not reported, the reason should be stated. Summary demographic information (eg, baseline characteristics of study participants) should be reported in the first line of the Results section of Abstracts.

Reporting Age

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

Reporting Sex and Gender

The term sex should be used when reporting biological factors and gender should be used when reporting gender identity or psychosocial/cultural factors. The methods used to obtain information on sex, gender, or both (eg, self-reported, investigator observed or classified, or laboratory test) should be explained in the Methods section. 12 The distribution of study participants or samples should be reported in the Results section, including for studies of humans, tissues, cells, or animals. All participants should be reported, not just the category that represents the majority of the sample. Studies that address pregnancy should follow these recommendations, and if the gender identity of participants was not assessed, use the terms "pregnant participants," "pregnant individuals," "pregnant patients," etc, as appropriate.

In research articles, sex or gender should be reported and defined, and how sex or gender was assessed should be described. Whenever possible, all main outcomes should be reported by sex (or gender if appropriate). In nonresearch reports, choose sex-neutral terms that avoid bias, suit the material under discussion, and do not intrude on the reader's attention.

Reporting Race and Ethnicity

The Methods section should include an explanation of who identified participant race and ethnicity and the source of the classifications used (eg, self-report or selection, investigator observed, database, electronic health record, survey instrument).

If race and ethnicity categories were collected for a study, the reasons that these were assessed also should be described in the Methods section. If collection of data on race and ethnicity was required by the funding agency, that should be noted.

Specific racial and ethnic categories are preferred over collective terms, when possible. Authors should report the specific categories used in their studies and recognize that these categories will differ based on the databases or surveys used, the requirements of funders, and the geographic location of data collection or study participants. Categories included in groups labeled as "other" should be defined.

Categories should be listed in alphabetical order in text and tables.

Race and ethnicity of the study population should be reported in the Results section.

For additional information, see " Updated Guidance on Reporting Race and Ethnicity in Medical and Science Journals " and the Summary Guide for Preferred Terms When Reporting Race and Ethnicity .

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

A signed statement of informed consent to publish patient descriptions, photographs, video, and pedigrees should be obtained from all persons (parents or legal guardians for minors) who can be identified (including by the patients themselves) i/n such written descriptions, photographs, or pedigrees and should be submitted with the manuscript and indicated in the Acknowledgment section of the manuscript. Such persons should be offered the opportunity to see the manuscript before its submission. 2(pp229-232)

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

Patient Permission Form:

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

AI Used in Manuscript Preparation

When traditional and generative AI technologies are used to create, review, revise, or edit any of the content in a manuscript, authors should report in the Acknowledgment section the following:

• Name of the AI software platform, program, or tool
• Version and extension numbers
• Manufacturer
• Date(s) of use
• A brief description of how the AI was used and on what portions of the manuscript or content
• Confirmation that the author(s) take responsibility for the integrity of the content generated

Note this guidance does not apply to basic tools for checking grammar, spelling, references, and similar.

AI Used in Research

When AI (eg, large language model [LLM] or natural language processing [NLP], supervised or unsupervised machine learning [ML] for predictive/prescriptive or clustering tasks, chatbots, or similar other technologies) is used as part of a scientific study, authors should:

• Follow relevant reporting guidelines for specific study designs when they exist and report each recommended guideline element with sufficient detail to enable reproducibility.
• Avoid inclusion of identifiable patient information in text, tables, and figures.
• Be aware of copyright and intellectual property concerns - if including content (text, images) generated by AI, and indicate rights or permissions to publish that content as determined by the AI service or owner.

Also address the following:

Methods Section

• Include the study design and, if a relevant reporting guideline exists, indicate how it was followed, with sufficient detail to enable reproducibility.
• Describe how AI was used for specific aspects of the study (eg, to generate or refine study hypotheses, assist in the generation of a list of adjustment variables, create graphs to show visual relationships).
• For studies using LLMs, provide the name of the platform or program, tool, version, and manufacturer; specify dates and prompt(s) used and their sequence and any revisions to prompts in response to initial outputs.
• For studies reporting ML and algorithm development, include details about data sets used for development, training, and validation. Clearly state if algorithms were trained and tested only on previously collected or existing data sets or if the study includes prospective deployment. Include the ML model and describe the variables and outcome(s) and selection of the fine-tuning parameters. Describe any assumptions involved (eg, log linearity, proportionality) and how these assumptions were tested.
• Indicate the metric used to evaluate the performance of the algorithms, including bias, discrimination, calibration, reclassification, and others as appropriate.
• Indicate the methods used to address missing data.
• Indicate institutional review board/ethics review, approval, waiver, or exemption.
• Describe methods or analyses included to address and manage AI-related methodologic bias and inaccuracy of AI-generated content.
• Indicate, when appropriate, if sensitivity analyses were performed to explore the performance of the AI model in vulnerable or underrepresented subgroups.
• Provide a data sharing statement, including if code will be shared.

Results Section

• When reporting comparisons, provide performance assessments (eg, against standard of care), include effect sizes and measures of uncertainty (eg, 95% CIs) and other measurements such as likelihood ratios, and include information about performance errors, inaccurate or missing data, and sufficient detail for others to reproduce the findings.
• Report the results of analyses to address methodologic bias and population representation.
• If examples of generated text or content are included in tables or figures, be sure to indicate the source and licensing information, as noted above.

Discussion Section

• Discuss the potential for AI-related bias and what was done to identify and mitigate such bias.
• Discuss the potential for inaccuracy of AI-generated content and what was done to identify and manage this.
• Discuss generalizability of findings across populations and results of analyses performed to explore the performance of the AI model in vulnerable or underrepresented subgroups.

A signed statement of permission should be included from each individual identified as a source of information in a personal communication or as a source for unpublished data, and the date of communication and whether the communication was written or oral should be specified. 2(p199) Personal communications should not be included in the list of references but added to the text parenthetically.

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

Journal Policies

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

All authors are required to complete and submit a Publishing Agreement that is part of the journal's electronic Authorship Form. In this agreement, authors will transfer copyright or a publication license; 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 or a publication license on the author's behalf.

Published articles become the permanent property of the American Medical Association (AMA) and may not be published elsewhere without written permission. Unauthorized use of the journal's 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 the JAMA Network or the AMA.

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

2. Iverson C, Christiansen S, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors . 11th ed. Oxford University Press; 2020. http://www.amamanualofstyle.com

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

4. International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Updated May 2023. Accessed May 18, 2023. http://www.icmje.org/recommendations/

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

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

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

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

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

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

11. American Association for Public Opinion Research. Best practices for survey research. Accessed March 23, 2023. https://aapor.org/standards-and-ethics/best-practices/

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

13. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA . 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053

14. Journal Editors and Authors Group. Statement on scientific publication and security. Science . 2003;299(5610):1149. doi:10.1126/science.299.5610.1149 . Published correction appears in Science . 2003;299(5614):1845.

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

Last Updated: April 25, 2024

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