Issues To Consider Before
Submitting a Manuscript
Redundant or
Duplicate Publication
Redundant or
duplicate publication is publication of a paper that overlaps
substantially with one already published.
Readers of primary
source periodicals deserve to be able to trust that what they are
reading is original unless there is a clear statement that the
article is being republished by the choice of the author and editor.
The bases of this position are international copyright laws, ethical
conduct, and cost-effective use of resources.
Most journals do
not wish to receive papers on work that has already been reported in
large part in a published article or is contained in another paper
that has been submitted or accepted for publication elsewhere, in
print or in electronic media. This policy does not preclude the
journal considering a paper that has been rejected by another
journal, or a complete report that follows publication of a
preliminary report, such as an abstract or poster displayed for
colleagues at a professional meeting. Nor does it prevent journals
considering a paper that has been presented at a scientific meeting
but not published in full or that is being considered for
publication in a proceedings or similar format. Press reports of
scheduled meetings will not usually be regarded as breaches of this
rule, but such reports should not be amplified by additional data or
copies of tables and illustrations.
When submitting a
paper, the author should always make a full statement to the editor
about all submissions and previous reports that might be regarded as
redundant or duplicate publication of the same or very similar work.
The author should alert the editor if the work includes subjects
about which a previous report has been published. Any such work
should be referred to and referenced in the new paper. Copies of
such material should be included with the submitted paper to help
the editor decide how to handle the matter.
If redundant or
duplicate publication is attempted or occurs without such
notification, authors should expect editorial action to be taken. At
the least, prompt rejection of the submitted manuscript should be
expected. If the editor was not aware of the violations and the
article has already been published, then a notice of redundant or
duplicate publication will probably be published with or without the
author's explanation or approval.
Preliminary
reporting to public media, governmental agencies, or manufacturers,
of scientific information described in a paper or a letter to the
editor that has been accepted but not yet published violates the
policies of many journals. Such reporting may be warranted when the
paper or letter describes major therapeutic advances or public
health hazards such as serious adverse effects of drugs, vaccines,
other biological products, or medicinal devices, or reportable
diseases. This reporting should not jeopardize publication, but
should be discussed with and agreed upon by the editor in advance.
Acceptable
Secondary Publication
Secondary
publication in the same or another language, especially in other
countries, is justifiable, and can be beneficial, provided all of
the following conditions are met.
1. The authors have
received approval from the editors of both journals; the editor
concerned with secondary publication must have a photocopy, reprint,
or manuscript of the primary version.
2. The priority of
the primary publication is respected by a publication interval of at
least one week (unless specifically negotiated otherwise by both
editors).
3. The paper for
secondary publication is intended for a different group of readers;
an abbreviated version could be sufficient.
4. The secondary
version faithfully reflects the data and interpretations of the
primary version.
5. The footnote on
the title page of the secondary version informs readers, peers, and
documenting agencies that the paper has been published in whole or
in part and states the primary reference. A suitable footnote might
read: "This article is based on a study first reported in the
[title of journal, with full reference]."
Permission for such
secondary publication should be free of charge.
Protection of
Patients' Rights to Privacy
Patients have a
right to privacy that should not be infringed without informed
consent. Identifying information should not be published in written
descriptions, photographs, and pedigrees unless the information is
essential for scientific purposes and the patient (or parent or
guardian) gives written informed consent for publication. Informed
consent for this purpose requires that the patient be shown the
manuscript to be published.
Identifying details
should be omitted if they are not essential, but patient data should
never be altered or falsified in an attempt to attain anonymity.
Complete anonymity is difficult to achieve, and informed consent
should be obtained if there is any doubt. For example, masking the
eye region in photographs of patients is inadequate protection of
anonymity.
The requirement for
informed consent should be included in the journal's instructions
for authors. When informed consent has been obtained it should be
indicated in the published article.
Reporting
guidelines for specific study designs
Research reports
frequently omit important information. The general requirements
listed in the next section relate to reporting essential elements
for all study designs. Authors are encouraged in addition to consult
reporting guidelines relevant to their specific research design. For
reports of randomized controlled trials authors should refer to the
CONSORT statement ( http://www.consort-statement.org/).
This guideline provides a set of recommendations comprising a list
of items to report and a patient flow diagram.
Requirements for
Submission of Manuscripts
Summary of
Technical Requirements
- Double space all
parts of manuscripts.
- Begin each
section or component on a new page.
- Review the
sequence: title page, abstract and key words, text,
acknowledgments, references, tables (each on separate page),
legends.
- Illustrations,
unmounted prints, should be no larger than 203 × 254 mm (8 ×
10 inches).
- Include
permission to reproduce previously published material or to use
illustrations that may identify human subjects.
- Enclose transfer
of copyright and other forms.
- Submit required
number of paper copies.
- Keep copies of
everything submitted.
Preparation of
Manuscript
The text of
observational and experimental articles is usually (but not
necessarily) divided into sections with the headings Introduction,
Methods, Results, and Discussion. Long articles may need subheadings
within some sections (especially the Results and Discussion
sections) to clarify their content. Other types of articles, such as
case reports, reviews, and editorials, are likely to need other
formats. Authors should consult individual journals for further
guidance.
Type or print out
the manuscript on white bond paper, 216 × 279 mm (8.5 × 11
inches), or ISO A4 (212 × 297 mm), with margins of at least 25 mm
(1 inch). Type or print on only one side of the paper. Use double
spacing throughout, including for the title page, abstract, text,
acknowledgments, references, individual tables, and legends. Number
pages consecutively, beginning with the title page. Put the page
number in the upper or lower right-hand corner of each page.
Manuscripts on
Disks
For papers that are
close to final acceptance, some journals require authors to provide
a copy in electronic form (on a disk); they may accept a variety of
word-processing formats or text (ASCII) files.
When submitting
disks, authors should:
1. be certain to
include a print-out of the version of the article that is on the
disk;
2. put only the
latest version of the manuscript on the disk;
3. name the file
clearly;
4. label the disk
with the format of the file and the file name;
5. provide
information on the hardware and software used.
Authors should
consult the journal's instructions to authors for acceptable
formats, conventions for naming files, number of copies to be
submitted, and other details.
Title Page
The title page
should carry 1) the title of the article, which should be concise
but informative; 2) the name by which each author is known, with his
or her highest academic degree(s) and institutional affiliation; 3)
the name of the department(s) and institution(s) to which the work
should be attributed; 4) disclaimers, if any; 5) the name and
address of the author responsible for correspondence about the
manuscript; 6) the name and address of the author to whom requests
for reprints should be addressed or a statement that reprints will
not be available from the authors; 7) source(s) of support in the
form of grants, equipment, drugs, or all of these; and 8) a short
running head or footline of no more than 40 characters (count
letters and spaces) at the foot of the title page.
Authorship
All persons
designated as authors should qualify for authorship, and all those
who qualify should be listed. Each author should have participated
sufficiently in the work to take public responsibility for
appropriate portions of the content. One or more authors should take
responsibility for the integrity of the work as a whole, from
inception to published article.
Authorship credit
should be based only on 1) substantial contributions to conception
and design, or acquisition of data, or analysis and interpretation
of data; 2) drafting the article or revising it critically for
important intellectual content; and 3) final approval of the version
to be published. Conditions 1, 2, and 3 must all be met. Acquisition
of funding, the collection of data, or general supervision of the
research group, by themselves, do not justify authorship.
Authors should
provide a description of what each contributed, and editors should
publish that information. All others who contributed to the work who
are not authors should be named in the Acknowledgments, and what
they did should be described (see Acknowledgments).
Increasingly,
authorship of multicenter trials is attributed to a group. All
members of the group who are named as authors should fully meet the
above criteria for authorship. Group members who do not meet these
criteria should be listed, with their permission, in the
Acknowledgments or in an appendix (see Acknowledgments).
The order of
authorship on the byline should be a joint decision of the
coauthors. Authors should be prepared to explain the order in which
authors are listed.
Abstract and Key
Words
The second page
should carry an abstract (of no more than 150 words for unstructured
abstracts or 250 words for structured abstracts). The abstract
should state the purposes of the study or investigation, basic
procedures (selection of study subjects or laboratory animals;
observational and analytical methods), main findings (giving
specific data and their statistical significance, if possible), and
the principal conclusions. It should emphasize new and important
aspects of the study or observations.
Below the abstract
authors should provide, and identify as such, 3 to 10 key words or
short phrases that will assist indexers in cross-indexing the
article and may be published with the abstract. Terms from the
Medical Subject Headings (MeSH) list of Index Medicus should be
used; if suitable MeSH terms are not yet available for recently
introduced terms, present terms may be used.
Introduction
State the purpose
of the article and summarize the rationale for the study or
observation. Give only strictly pertinent references and do not
include data or conclusions from the work being reported.
Methods
Describe your
selection of the observational or experimental subjects (patients or
laboratory animals, including controls) clearly. Identify the age,
sex, and other important characteristics of the subjects. Because
the relevance of such variables as age, sex, and ethnicity to the
object of research is not always clear, authors should explicitly
justify them when they are included in a study report. The guiding
principle should be clarity about how and why a study was done in a
particular way. For example, authors should explain why only
subjects of certain ages were included or why women were excluded.
Authors should avoid terms such as "race," which lacks
precise biological meaning, and use alternative descriptors such as
"ethnicity" or "ethnic group" instead. Authors
should specify carefully what the descriptors mean, and tell exactly
how the data were collected (for example, what terms were used in
survey forms, whether the data were self-reported or assigned by
others, etc.)..
Identify the
methods, apparatus (give the manufacturer's name and address in
parentheses), and procedures in sufficient detail to allow other
workers to reproduce the results. Give references to established
methods, including statistical methods (see below); provide
references and brief descriptions for methods that have been
published but are not well known; describe new or substantially
modified methods, give reasons for using them, and evaluate their
limitations. Identify precisely all drugs and chemicals used,
including generic name(s), dose(s), and route(s) of administration.
Reports of
randomized clinical trials should present information on all major
study elements, including the protocol (study population,
interventions or exposures, outcomes, and the rationale for
statistical analysis), assignment of interventions (methods of
randomization, concealment of allocation to treatment groups), and
the method of masking (blinding).
Authors submitting
review manuscripts should include a section describing the methods
used for locating, selecting, extracting, and synthesizing data.
These methods should also be summarized in the abstract.
Ethics
When reporting
experiments on human subjects, indicate whether the procedures
followed were in accordance with the ethical standards of the
responsible committee on human experimentation (institutional or
regional) and with the Helsinki Declaration of 1975, as revised in
1983. Do not use patients' names, initials, or hospital numbers,
especially in illustrative material. When reporting experiments on
animals, indicate whether the institution's or a national research
council's guide for, or any national law on, the care and use of
laboratory animals was followed.
Statistics
Describe
statistical methods with enough detail to enable a knowledgeable
reader with access to the original data to verify the reported
results. When possible, quantify findings and present them with
appropriate indicators of measurement error or uncertainty (such as
confidence intervals). Avoid relying solely on statistical
hypothesis testing, such as the use of P values, which fails
to convey important quantitative information. Discuss the
eligibility of experimental subjects. Give details about
randomization. Describe the methods for and success of any blinding
of observations. Report complications of treatment. Give numbers of
observations. Report losses to observation (such as dropouts from a
clinical trial). References for the design of the study and
statistical methods should be to standard works when possible (with
pages stated) rather than to papers in which the designs or methods
were originally reported. Specify any general-use computer programs
used.
Put a general
description of methods in the Methods section. When data are
summarized in the Results section, specify the statistical methods
used to analyze them. Restrict tables and figures to those needed to
explain the argument of the paper and to assess its support. Use
graphs as an alternative to tables with many entries; do not
duplicate data in graphs and tables. Avoid nontechnical uses of
technical terms in statistics, such as "random" (which
implies a randomizing device), "normal,"
"significant," "correlations," and
"sample." Define statistical terms, abbreviations, and
most symbols.
Results
Present your
results in logical sequence in the text, tables, and illustrations.
Do not repeat in the text all the data in the tables or
illustrations; emphasize or summarize only important observations.
Discussion
Emphasize the new
and important aspects of the study and the conclusions that follow
from them. Do not repeat in detail data or other material given in
the Introduction or the Results section. Include in the Discussion
section the implications of the findings and their limitations,
including implications for future research. Relate the observations
to other relevant studies.
Link the
conclusions with the goals of the study but avoid unqualified
statements and conclusions not completely supported by the data. In
particular, authors should avoid making statements on economic
benefits and costs unless their manuscript includes economic data
and analyses. Avoid claiming priority and alluding to work that has
not been completed. State new hypotheses when warranted, but clearly
label them as such. Recommendations, when appropriate, may be
included.
Acknowledgments
List all
contributors who do not meet the criteria for authorship, such as a
person who provided purely technical help, writing assistance, or a
department chair who provided only general support. Financial and
material support should also be acknowledged.
Groups of persons
who have contributed materially to the paper but whose contributions
do not justify authorship may be listed under a heading such as
"clinical investigators" or "participating
investigators," and their function or contribution should be
describedÑfor example, "served as scientific advisors,"
"critically reviewed the study proposal," "collected
data," or "provided and cared for study patients."
Because readers may
infer their endorsement of the data and conclusions, all persons
must have given written permission to be acknowledged.
References
References should
be numbered consecutively in the order in which they are first
mentioned in the text. Identify references in text, tables, and
legends by Arabic numerals in parentheses. References cited only in
tables or figure legends should be numbered in accordance with the
sequence established by the first identification in the text of the
particular table or figure.
Use the style of
the examples below, which are based on the formats used by the NLM
in Index Medicus. The titles of journals should be
abbreviated according to the style used in Index Medicus.
Consult the List of Journals Indexed in Index Medicus,
published annually as a separate publication by the library and as a
list in the January issue of Index Medicus. The list can also
be obtained through the library's web site (http://www.nlm.nih.gov/).
Avoid using
abstracts as references. References to papers accepted but not yet
published should be designated as "in press" or
"forthcoming"; authors should obtain written permission to
cite such papers as well as verification that they have been
accepted for publication. Information from manuscripts submitted but
not accepted should be cited in the text as "unpublished
observations" with written permission from the source.
Avoid citing a
"personal communication" unless it provides essential
information not available from a public source, in which case the
name of the person and date of communication should be cited in
parentheses in the text. For scientific articles, authors should
obtain written permission and confirmation of accuracy from the
source of a personal communication.
The references must
be verified by the author(s) against the original documents.
The Uniform
Requirements style (the Vancouver style) is based largely on an ANSI
standard style adapted by the NLM for its databases. Notes have been
added where Vancouver style differs from the style now used by NLM.
Articles in
Journals
1. Standard
journal article
List the first six authors followed by et al.
(Note: NLM now lists up through 25 authors; if there are more than
25 authors, NLM lists the first 24, then the last author, then et
al.)
- Vega KJ, Pina I,
Krevsky B. Heart transplantation is associated with an increased
risk for pancreatobiliary disease. Ann Intern Med 1996 Jun 1;124
(11):980-3.
As an option, if a
journal carries continuous pagination throughout a volume (as man y
medical journals do) the month and issue number may be omitted.
(Note: For
consistency, the option is used throughout the examples in Uniform
Requirements. NLM does not use the option.)
Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with
an increased risk for pancreatobiliary disease. Ann Intern Med
1996;124:980-3.
More than six
authors:
Parkin DM, Clayton D, Black RJ, Masuyer E, Friedl HP, Ivanov E, et
al. Childhood leukaemia in Europe after Chernobyl: 5 year follow-up.
Br J Cancer 1996;73:1006- 12.
2. Organization
as author
The Cardiac Society of Australia and New Zealand. Clinical exercise
stress testing. Safety and performance guidelines. Med J Aust 1996;
164: 282-4.
3. No author
given
Cancer in South Africa [editorial]. S Afr Med J 1994;84:15.
4. Article not in
English
(Note: NLM translates the title to English, encloses the translation
in square brackets, and adds an abbreviated language designator.)
Ryder TE, Haukeland EA, Solhaug JH. Bilateral infrapatellar
seneruptur hostidligere frisk kvinne. Tidsskr Nor Laegeforen
1996;116:41-2.
5. Volume with
supplement
Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and
occupational lung cancer. Environ Health Perspect 1994;102 Suppl
1:275-82.
6. Issue with
supplement
Payne DK, Sullivan MD, Massie MJ. Women's psychological
reactions to breast cancer. Semin Oncol 1996;23(1 Suppl 2):89-97.
7. Volume with
part
Ozben T, Nacitarhan S, Tuncer N. Plasma and urine sialic acid in
non-insulin dependent diabetes mellitus. Ann Clin Biochem 1995;32(Pt
3):303-6.
8. Issue with
part
Poole GH, Mills SM. One hundred consecutive cases of flap
lacerations of the leg in ageing patients. N Z Med J 1994;107(986 Pt
1):377-8.
9. Issue with no
volume
Turan I, Wredmark T, Fellander-Tsai L. Arthroscopic ankle
arthrodesis in rheumatoid arthritis. Clin Orthop 1995;(320):110-4.
10. No issue or
volume
Browell DA, Lennard TW. Immunologic status of the cancer patient
and the effects of blood transfusion on antitumor responses. Curr
Opin Gen Surg 1993:325-33.
11. Pagination
in Roman numerals
Fisher GA, Sikic BI. Drug resistance in clinical oncology and
hematology. Introduction. Hematol Oncol Clin North Am 1995
Apr;9(2):xi-xii.
12. Type of
article indicated as needed
Enzensberger W, Fischer PA. Metronome in Parkinson's disease
[letter]. Lancet 1996;347:1337. Clement J, De Bock R. Hematological
complications of hantavirus nephropathy (HVN) [abstract]. Kidney Int
1992;42:1285.
13. Article
containing retraction
Garey CE, Schwarzman AL, Rise ML, Seyfried TN. Ceruloplasmin
gene defect associated with epilepsy in EL mice [retraction of Garey
CE, Schwarzman AL, Rise ML, Seyfried TN. In: Nat Genet
1994;6:426-31]. Nat Genet 1995;11:104.
14. Article
retracted
Liou GI, Wang M, Matragoon S. Precocious IRBP gene expression
during mouse development [retracted in Invest Ophthalmol Vis Sci
1994;35:3127]. Invest Ophthalmol Vis Sci 1994;35:1083-8.
15. Article with
published erratum
Hamlin JA, Kahn AM. Herniography in symptomatic patients
following inguinal hernia repair [published erratum appears in West
J Med 1995;162:278]. West J Med 1995;162:28-31.
Books and
Other Monographs
(Note: Previous
Vancouver style incorrectly had a comma rather than a semicolon
between the publisher and the date.)
16. Personal
author(s)
Ringsven MK, Bond D. Gerontology and leadership skills for
nurses. 2nd ed. Albany (NY): Delmar Publishers; 1996.
17. Editor(s),
compiler(s) as author
Norman IJ, Redfern SJ, editors. Mental health care for elderly
people. New York: Churchill Livingstone; 1996.
18. Organization
as author and publisher
Institute of Medicine (US). Looking at the future of the
Medicaid program. Washington: The Institute; 1992.
19. Chapter in a
book
(Note: Previous Vancouver style had a colon rather than a p
before pagination.) Phillips SJ, Whisnant JP. Hypertension and
stroke. In: Laragh JH, Brenner BM, editors. Hypertension:
pathophysiology, diagnosis, and management. 2nd ed. New York: Raven
Press; 1995. p. 465-78.
20. Conference
proceedings
Kimura J, Shibasaki H, editors. Recent advances in clinical
neurophysiology. Proceedings of the 10th International Congress of
EMG and Clinical Neurophysiology; 1995 Oct 15-19; Kyoto, Japan.
Amsterdam: Elsevier; 1996.
21. Conference
paper
Bengtsson S, Solheim BG. Enforcement of data protection, privacy
and security in medical informatics. In: Lun KC, Degoulet P, Piemme
TE, Rienhoff O, editors. MEDINFO 92. Proceedings of the 7th World
Congress on Medical Informatics; 1992 Sep 6-10; Geneva, Switzerland.
Amsterdam: North-Holland; 1992. p. 1561-5.
22. Scientific
or technical report
Issued by funding/sponsoring agency: Smith P, Golladay K.
Payment for durable medical equipment billed during skilled nursing
facility stays. Final report. Dallas (TX): Dept. of Health and Human
Services (US), Office of Evaluation and Inspections; 1994 Oct.
Report No.: HHSIGOEI69200860. Issued by performing agency: Field MJ,
Tranquada RE, Feasley JC, editors. Health services research: work
force and educational issues. Washington: National Academy Press;
1995. Contract No.: AHCPR282942008. Sponsored by the Agency for
Health Care Policy and Research.
23. Dissertation
Kaplan SJ. Post-hospital home health care: the elderly's access
and utilization [dissertation]. St. Louis (MO): Washington Univ.;
1995.
24. Patent
Larsen CE, Trip R, Johnson CR, inventors; Novoste Corporation,
assignee. Methods for procedures related to the electrophysiology of
the heart. US patent 5,529,067. 1995 Jun 25.
Other Published
Material
25. Newspaper
article
Lee G. Hospitalizations tied to ozone pollution: study estimates
50,000 admissions annually. The Washington Post 1996 Jun 21;Sect.
A:3 (col. 5).
26. Audiovisual
material
HIV+/AIDS: the facts and the future [videocassette]. St. Louis
(MO): Mosby-Year Book; 1995.
27. Legal
material
Public law:
Preventive Health Amendments of 1993, Pub. L. No. 103-183, 107 Stat.
2226 (Dec. 14, 1993).
Unenacted bill:
Medical Records Confidentiality Act of 1995, S. 1360, 104th Cong.,
1st Sess. (1995).
Code of Federal
Regulations:
Informed Consent, 42 C.F.R. Sect. 441.257 (1995).
Hearing:
Increased Drug Abuse: the Impact on the Nation's Emergency Rooms:
Hearings Before the Subcomm. on Human Resources and
Intergovernmental Relations of the House Comm. on Government
Operations, 103rd Cong., 1st Sess. (May 26, 1993).
28. Map
North Carolina. Tuberculosis rates per 100,000 population, 1990
[demographic map]. Raleigh: North Carolina Dept. of Environment,
Health, and Natural Resources, Div. of Epidemiology; 1991.
29. Book of the
Bible
The Holy Bible. King James version. Grand Rapids (MI): Zondervan
Publishing House; 1995. Ruth 3:1-18.
30. Dictionary
and similar references
Stedman's medical dictionary. 26th ed. Baltimore: Williams &
Wilkins; 1995. Apraxia; p. 119-20.
31. Classical
material
The Winter's Tale: act 5, scene 1, lines 13-16. The complete
works of William Shakespeare. London: Rex; 1973.
Unpublished
Material
32. In press
(Note: NLM prefers "forthcoming" because not all items
will be printed.) Leshner AI. Molecular mechanisms of cocaine
addiction. N Engl J Med. In press 1996.
Electronic
Material
33. Journal
article in electronic format
Morse SS. Factors in the emergence of infectious diseases. Emerg
Infect Dis [serial online] 1995 Jan-Mar [cited 1996 Jun 5];1(1):[24
screens]. Available from: URL: http://www.cdc.gov/ncidod/EID/eid.htm
34. Monograph in
electronic format
CDI, clinical dermatology illustrated [monograph on CD-ROM].
Reeves JRT, Maibach H. CMEA Multimedia Group, producers. 2nd ed.
Version 2.0. San Diego: CMEA; 1995.
35. Computer
file
Hemodynamics III: the ups and downs of hemodynamics [computer
program]. Version 2.2. Orlando (FL): Computerized Educational
Systems; 1993.
Tables
Type or print out
each table with double spacing on a separate sheet of paper. Do not
submit tables as photographs. Number tables consecutively in the
order of their first citation in the text and supply a brief title
for each. Give each column a short or abbreviated heading. Place
explanatory matter in footnotes, not in the heading. Explain in
footnotes all nonstandard abbreviations that are used in each table.
For footnotes use the following symbols, in this sequence:
![[ Footnote symbols sequence ]](symbols.gif)
Identify
statistical measures of variations, such as standard deviation and
standard error of the mean.
Do not use internal
horizontal and vertical rules.
Be sure that each
table is cited in the text.
If you use data
from another published or unpublished source, obtain permission and
acknowledge them fully.
The use of too many
tables in relation to the length of the text may produce
difficulties in the layout of pages. Examine issues of the journal
to which you plan to submit your paper to estimate how many tables
can be used per 1000 words of text.
The editor, on
accepting a paper, may recommend that additional tables containing
important backup data too extensive to publish be deposited with an
archival service, such as the National Auxiliary Publication Service
in the United States, or made available by the authors. In that
event an appropriate statement will be added to the text. Submit
such tables for consideration with the paper.
Illustrations
(Figures)
Submit the required
number of complete sets of figures. Figures should be professionally
drawn and photographed; freehand or typewritten lettering is
unacceptable. Instead of original drawings, x-ray films, and other
material, send sharp, glossy, black-and-white photographic prints,
usually 127 × 173 mm (5 × 7 inches) but no larger than 203 × 254
mm (8 × 10 inches). Letters, numbers, and symbols should be clear
and even throughout and of sufficient size that when reduced for
publication each item will still be legible. Titles and detailed
explanations belong in the legends for illustrations not on the
illustrations themselves.
Each figure should
have a label pasted on its back indicating the number of the figure,
author's name, and top of the figure. Do not write on the back of
figures or scratch or mar them by using paper clips. Do not bend
figures or mount them on cardboard.
Photomicrographs
should have internal scale markers. Symbols, arrows, or letters used
in photomicrographs should contrast with the background.
If photographs of
people are used, either the subjects must not be identifiable or
their pictures must be accompanied by written permission to use the
photograph (see Protection of Patients' Rights to Privacy).
Figures should be
numbered consecutively according to the order in which they have
been first cited in the text. If a figure has been published,
acknowledge the original source and submit written permission from
the copyright holder to reproduce the material. Permission is
required irrespective of authorship or publisher except for
documents in the public domain.
For illustrations
in color, ascertain whether the journal requires color negatives,
positive transparencies, or color prints. Accompanying drawings
marked to indicate the region to be reproduced may be useful to the
editor. Some journals publish illustrations in color only if the
author pays for the extra cost.
Legends for
Illustrations
Type or print out
legends for illustrations using double spacing, starting on a
separate page, with Arabic numerals corresponding to the
illustrations. When symbols, arrows, numbers, or letters are used to
identify parts of the illustrations, identify and explain each one
clearly in the legend. Explain the internal scale and identify the
method of staining in photomicrographs.
Units of
Measurement
Measurements of
length, height, weight, and volume should be reported in metric
units (meter, kilogram, or liter) or their decimal multiples.
Temperatures should
be given in degrees Celsius. Blood pressures should be given in
millimeters of mercury.
All hematologic and
clinical chemistry measurements should be reported in the metric
system in terms of the International System of Units (SI). Editors
may request that alternative or non-SI units be added by the authors
before publication.
Abbreviations and
Symbols
Use only standard
abbreviations. Avoid abbreviations in the title and abstract. The
full term for which an abbreviation stands should precede its first
use in the text unless it is a standard unit of measurement.
Sending the
Manuscript to the Journal
Send the required
number of copies of the manuscript in a heavy-paper envelope,
enclosing the copies and figures in cardboard, if necessary, to
prevent the photographs from being bent. Place photographs and
transparencies in a separate heavy-paper envelope.
Manuscripts must be
accompanied by a covering letter signed by all coauthors. This must
include 1) information on prior or duplicate publication or
submission elsewhere of any part of the work as defined earlier in
this document; 2) a statement of financial or other relationships
that might lead to a conflict of interest (see below); 3) a
statement that the manuscript has been read and approved by all the
authors, that the requirements for authorship as stated earlier in
this document have been met, and that each author believes that the
manuscript represents honest work; and 4) the name, address, and
telephone number of the corresponding author, who is responsible for
communicating with the other authors about revisions and final
approval of the proofs. The letter should give any additional
information that may be helpful to the editor, such as the type of
article in the particular journal that the manuscript represents and
whether the author(s) would be willing to meet the cost of
reproducing color illustrations.
The manuscript must
be accompanied by copies of any permissions to reproduce published
material, to use illustrations or report information about
identifiable people, or to name people for their contributions.
A peer-reviewed
journal is one that has submitted most of its published articles for
review by experts who are not part of the editorial staff. The
number and kind of manuscripts sent for review, the number of
reviewers, the reviewing procedures, and the use made of the
reviewers' opinions may vary, and therefore each journal should
publicly disclose its policies in its instructions to authors for
the benefit of readers and potential authors.
Owners and editors
of medical journals have a common endeavor-the publication of a
reliable and readable journal, produced with due respect for the
stated aims of the journal and for costs. The functions of owners
and editors, however, are different. Owners have the right to
appoint and dismiss editors and to make important business decisions
in which editors should be involved to the fullest extent possible.
Editors must have full authority for determining the editorial
content of the journal. This concept of editorial freedom should be
resolutely defended by editors even to the extent of their placing
their positions at stake. To secure this freedom in practice, the
editor should have direct access to the highest level of ownership,
not only to a delegated manager.
Editors of medical
journals should have a contract that clearly states the editor's
rights and duties in addition to the general terms of the
appointment and that defines mechanisms for resolving conflict.
An independent
editorial advisory board may be useful in helping the editor
establish and maintain editorial policy.
All editors and
editors' organizations have the obligation to support the concept of
editorial freedom and to draw major transgressions of such freedom
to the attention of the international medical community.
Conflict of
interest for a given manuscript exists when a participant in the
peer review and publication process-author, reviewer, and editor-has
ties to activities that could inappropriately influence his or her
judgment, whether or not judgment is in fact affected. Financial
relationships with industry (for example, through employment,
consultancies, stock ownership, honoraria, expert testimony), either
directly or through immediate family, are usually considered to be
the most important conflicts of interest. However, conflicts can
occur for other reasons, such as personal relationships, academic
competition, and intellectual passion.
Public t rust in
the peer review process and the credibility of published articles
depend in part on how well conflict of interest is handled during
writing, peer review, and editorial decision making. Bias can often
be identified and eliminated by careful attention to the scientific
methods and conclusions of the work. Financial relationships and
their effects are less easily detected than other conflicts of
interest. Participants in peer review and publication should
disclose their conflicting interests, and the information should be
made available so that others can judge their effects for
themselves. Because readers may be less able to detect bias in
review articles and editorials than in reports of original research,
some journals do not accept reviews and editorials from authors with
a conflict of interest.
Authors
When they submit a
manuscript, whether an article or a letter, authors are responsible
for recognizing and disclosing financial and other conflicts of
interest that might bias the ir work. They should acknowledge in the
manuscript all financial support for the work and other financial or
personal connections to the work.
Reviewers
External peer
reviewers should disclose to editors any conflicts of interest that
could bias their opinions of the manuscript, and they should
disqualify themselves from reviewing specific manuscripts if they
believe it to be appropriate. The editors must be made aware of
reviewers' conflicts of interest to interpret the reviews and judge
for themselves whether the reviewer should be disqualified.
Reviewers should not use knowledge of the work, before its
publication, to further their own interests.
Editors and
Staff
Editors who make
final decisions about manuscripts should have no personal financial
involvement in any of the issues they might judge. Other members of
the editorial staff, if they participate in editorial decisions,
should provide editors with a current description of their financial
interests (as they might relate to editorial judgments) and
disqualify themselves from any decisions where they have a conflict
of interest. Published articles and letters should include a
description of all financial support and any conflict of interest
that, in the editors' judgment, readers should know about. Editorial
staff should not use the information gained through working with
manuscripts for private gain.
Authors
Scientists have an
ethical obligation to submit creditable research results for
publication. Moreover, as the persons directly responsible for their
work, scientists should not enter into agreements that interfere
with their control over the decision to publish the papers they
write.
Editors and
Staff
Editors who make
final decisions about manuscripts should have no personal financial
involvement in any of the issues they might judge. Other members of
the editorial staff, if they participate in editorial decisions,
should provide editors with a current description of their financial
interests (as they might relate to editorial judgements) and
disqualify themselves from any decisions where they have a conflict
of interest. Published articles and letters should include a
description of all financial support and any conflict of interest
that, in the editors' judgement, readers should know about.
Editorial staff should not use the information gained through
working with manuscripts for private gain.
Editors should
require authors to describe the role of outside sources of project
support, if any, in study design; in the collection, analysis and
interpretation of data; and in the writing of the report. If the
supporting source had no such involvement, the authors should so
state. Because the biases potentially introduced by the direct
involvement of supporting agencies in research are analogous to
methodological biases of other sorts (e.g., study design,
statistical and psychological factors), the type and degree of
involvement of the supporting agency should be described in the
Methods section. Editors should also require disclosure of whether
or not the supporting agency controlled or influenced the decision
to submit the final manuscript for publication.
Editors must assume
initially that authors are reporting work based on honest
observations. Nevertheless, two types of difficulty may arise.
First, errors may
be noted in published articles that require the publication of a
correction or erratum of part of the work. It is conceivable that an
error could be so serious as to vitiate the entire body of the work,
but this is unlikely and should be handled by editors and authors on
an individual basis. Such an error should not be confused with
inadequacies exposed by the emergence of new scientific information
in the normal course of research. The latter require no corrections
or withdrawals.
The second type of
difficulty is scientific fraud. If substantial doubts arise about
the honesty of work, either submitted or published, it is the
editor's responsibility to ensure that the question is appropriately
pursued (including possible consultation with the authors). However,
it is not the task of editors to conduct a full investigation or to
make a determination; that responsibility lies with the institution
where the work was done or with the funding agency. The editor
should be promptly informed of the final decision, and if a
fraudulent paper has been published, the journal must print a
retraction. If this method of investigation does not result in a
satisfactory conclusion, the editor may choose to publish an
expression of concern with an explanation.
The retraction or
expression of concern, so labeled, should appear on a numbered page
in a prominent section of the journal, be listed in the contents
page, and include in its heading the title of the original article.
It should not simply be a letter to the editor. Ideally, the first
author should be the same in the retraction as in the article,
although under certain circumstances the editor may accept
retractions by other responsible people. The text of the retraction
should explain why the article is being retracted and include a
bibliographic reference to it.
The validity of
previous work by the author of a fraudulent paper cannot be assumed.
Editors may ask the author's institution to assure them of the
validity of earlier work published in their journals or to retract
it. If this is not done they may choose to publish an announcement
to the effect that the validity of previously published work is not
assured.
Manuscripts should
be reviewed with due respect for authors' confidentiality. In
submitting their manuscripts for review, authors entrust editors
with the results of their scientific work and creative effort, on
which their reputation and career may depend. Authors' rights may be
violated by disclosure of the confidential details of the review of
their manuscript. Reviewers also have rights to confidentiality,
which must be respected by the editor. Confidentiality may have to
be breached if dishonesty or fraud is alleged but otherwise must be
honored.
Editors should not
disclose information about manuscripts (including their receipt,
their content, their status in the reviewing process, their
criticism by reviewers, or their ultimate fate) to anyone other than
the authors themselves and reviewers.
Editors should make
clear to their reviewers that manuscripts sent for review are
privileged communications and are the private property of the
authors. Therefore, reviewers and members of the editorial staff
should respect the authors' rights by not publicly discussing the
authors' work or appropriating their ideas before the manuscript is
published. Reviewer s should not be allowed to make copies of the
manuscript for their files and should be prohibited from sharing it
with others, except with the permission of the editor. Editors
should not keep copies of rejected manuscripts.
Opinions differ on
whether reviewers should remain anonymous. Some editors require
their reviewers to sign the comments returned to authors, but most
either request that reviewers' comments not be signed or leave the
choice to the reviewer. When comments are not signed the reviewers'
identity must not be revealed to the author or anyone else.
Some journals
publish reviewers' comments with the manuscript. No such procedure
should be adopted without the consent of the authors and reviewers.
However, reviewers' comments may be sent to other reviewers of the
same manuscript, and reviewers may be notified of the editor's
decision.
The public's
interest in news of medical research has led the popular media to
compete vigorously to get information about research as soon as
possible. Researchers and institutions sometimes encourage the
reporting of research in the popular media before full publication
in a scientific journal by holding a press conference or giving
interviews.
The public is
entitled to important medical information without unreasonable
delay, and editors have a responsibility to play their part in this
process. Doctors, however, need to have reports available in full
detail before they can advise their patients about the reports'
conclusions. In addition, media reports of scientific research
before the work has been peer reviewed and fully published may lead
to the dissemination of inaccurate or premature conclusions.
Editors may find
the following recommendations useful as they seek to establish
policies on these issues.
1. Editors can
foster the orderly transmission of medical information from
researchers, through peer-reviewed journals, to the public. This can
be accomplished by an agreement with authors that they will not
publicize their work while their manuscript is under consideration
or awaiting publication and an agreement with the media that they
will not release stories before publication in the journal, in
return for which the journal will cooperate with them in preparing
accurate stories (see below).
2. Very little
medical research has such clear and urgently important clinical
implications for the public's health that the news must be released
before full publication in a journal. In such exceptional
circumstances, however, appropriate authorities responsible for
public health should make the decision and should be responsible for
the advance dissemination of information to physicians and the
media. If the author and the appropriate authorities wish to have a
manuscript considered by a particular journal, the editor should be
consulted before any public release. If editors accept the need for
immediate release, they should waive their policies limiting
prepublication publicity.
3. Policies
designed to limit prepublication publicity should not apply to
accounts in the media of presentations at scientific meetings or to
the abstracts from these meetings (see Redundant or Duplicate
Publication). Researchers who present their work at a scientific
meeting should feel free to discuss their presentations with
reporters, but they should be discouraged from offering more detail
about their study than was presented in their talk.
4. When an article
is soon to be published, editors may wish to help the media prepare
accurate reports by providing news releases, answering questions,
supplying advance copies of the journal, or referring reporters to
the appropriate experts. This assistance should be contingent on the
media's cooperation in timing their release of stories to coincide
with the publication of the article.
Electronic
publishing (which includes the Internet) is publishing. Authors,
editors, and publishers of biomedical journals who post medical and
health information connected to these publications on the Internet
should follow the policies established by the International
Committee of Medical Journal Editors as the "Uniform
Requirements for Authors Submitting Articles to Biomedical
Journals" and related statements.
The nature of the
Internet requires some special considerations within these well
established and accepted policies. As a minimum, sites should
indicate the names of editors, authors, and contributors and their
affiliations, relevant credentials, and relevant conflicts of
interest; documentation and attribution of references and sources
for all content; information about copyright; disclosure of site
ownership; and disclosure of sponsorship, advertising, and
commercial funding.
Linking from one
health or medical Internet site to another may be perceived as a
recommendation of the quality of the second site. Journals thus
should exercise caution in linking to other sites. If links to other
sites are posted as a result of financial considerations, such
should be clearly indicated. All dates of content posting and
updating should be indicated. In electronic, as in print layout,
advertising and promotional messages should not be juxtaposed with
editorial content. Any commercial content should be clearly
identified as such.
Most medical
journals carry advertising, which generates income for their
publishers, but advertising must not be allowed to influence
editorial decisions. Editors must have full responsibility for
advertising policy. Readers should be able to distinguish readily
between advertising and editorial material. The juxtaposition of
editorial and advertising material on the same products or subjects
should be avoided, and advertising should not be sold on the
condition that it will appear in the same issue as a particular
article.
Journals should not
be dominated by advertising, but editors should be careful about
publishing advertisements from only one or two advertisers as
readers may perceive that the editor has been influenced by these
advertisers.
Journals should not
carry advertisements for products that have proved to be seriously
harmful to health-for example, tobacco. Editors should ensure that
existing standards for advertisements are enforced or develop their
own standards. Finally, editors should consider all criticisms of
advertisements for publication.
Supplements are
collections of papers that deal with related issues or topics, are
published as a separate issue of the journal or as a second part of
a regular issue, and are usually funded by sources other than the
journal's publisher. Supplements can serve useful purposes:
education, exchange of research information, ease of access to
focused content, and improved cooperation between academic and
corporate entities. Because of the funding sources, the content of
supplements can reflect biases in choice of topics and viewpoints.
Editors should therefore consider the following principles.
1. The journal
editor must take full responsibility for the policies, practices,
and content of supplements. The journal editor must approve the
appointment of any editor of the supplement and retain the authority
to reject papers.
2. The sources of
funding for the research, meeting, and publication should be clearly
stated and prominently located in the supplement, preferably on each
page. Whenever possible, funding should come from more than one
sponsor.
3. Advertising in
supplements should follow the same policies as those of the rest of
the journal.
4. Editors should
enable readers to distinguish readily between ordinary editorial
pages and supplement pages.
5. Editing by the
funding organization should not be permitted.
6. Journal editors
and supplement editors should not accept personal favors or
excessive compensation from sponsors of supplements.
7. Secondary
publication in supplements should be clearly identified by the
citation of the original paper. Redundant publication should be
avoided.
All biomedical
journals should have a section carrying comments, questions, or
criticisms about articles they have published and where the original
authors can respond. Usually, but not necessarily, this may take the
form of a correspondence column. The lack of such a section denies
readers the possibility of responding to articles in the same
journal that published the original work.
Editors may receive
manuscripts from different authors offering competing
interpretations of the same study. They have to decide whether to
review competing manuscripts submitted to them more or less
simultaneously by different groups or authors, or they may be asked
to consider one such manuscript while a competing manuscript has
been or will be submitted to another journal. Setting aside the
unresolved question of ownership of data, we discuss here what
editors ought to do when confronted with the submission of competing
manuscripts based on the same study.
Two kinds of
multiple submissions are considered: submissions by coworkers who
disagree on the analysis and interpretation of their study, and
submissions by coworkers who disagree on what the facts are and
which data should be reported.
The following
general observations may help editors and others dealing with this
problem.
Differences in
Analysis or Interpretation
Journals would not
normally wish to publish separate articles by contending members of
a research team who have differing analyses and interpretations of
the data, and submission of such manuscripts should be discouraged.
If coworkers cannot resolve their differences in interpretation
before submitting a manuscript, they should consider submitting one
manuscript containing multiple interpretations and calling their
dispute to the attention of the editor so that reviewers can focus
on the problem. One of the important functions of peer review is to
evaluate the authors' analysis and interpretation and to suggest
appropriate changes to the conclusions before publication.
Alternatively, after the disputed version is published, editors may
wish to consider a letter to the editor or a second manuscript from
the dissenting authors. Multiple submissions present editors with a
dilemma. Publication of contending manuscripts to air authors'
disputes may waste journal space and confuse readers. On the other
hand, if editors knowingly publish a manuscript written by only some
of the collaborating team, they could be denying the rest of the
team their legitimate coauthorship rights.
Differences in
Reported Methods or Results
Workers sometimes
differ in their opinions about what was actually done or observed
and which data ought to be reported. Peer review cannot be expected
to resolve this problem. Editors should decline further
consideration of such multiple submissions until the problem is
settled. Furthermore, if there are allegations of dishonesty or
fraud, editors should inform the appropriate authorities.
The cases described
above should be distinguished from instances in which independent,
non-collaborating authors submit separate manuscripts based on
different analyses of data that are publicly available. In this
circumstance, editorial consideration of multiple submissions may be
justified, and there may even be a good reason f or publishing more
than one manuscript because different analytical approaches may be
complementary and equally valid.
The International
Committee of Medical Journal Editors (ICMJE) is an informal group
whose participants fund their work on the URM. The ICMJE is not a
membership organization. Editors are encouraged to join
organizations that offer educational programs, meetings,
publications, and other opportunities to interact with colleagues.
Examples of such groups are given below.
Council of Science
Editors (CSE) http://www.councilscienceeditors.org/
The European Association of Science Editors (EASE) http://www.ease.org.uk/
Society for Scholarly Publishing (SSP) http://www.sspnet.org/
The World Association of Medical Editors (WAME) http://www.wame.org/
Authors of the
Current Uniform Requirements and Separate Statements
The ICMJE
participating journals and organizations and their representatives
who approved the revised Uniform Requirements in May 2000 should be
cited as authors of the documents on this website.
Frank Davidoff, Annals
of Internal Medicine; Fiona Godlee, BMJ; John Hoey, Canadian
Medical Association Journal; Richard Glass, JAMA; John
Overbeke, Nederlands Tijdschrift voor Geneeskunde; Robert
Utiger, New England Journal of Medicine; M.Gary Nicholls, New
Zealand Medical Journal; Richard Horton, The Lancet;
Magne Nylenna, Tidsskrift for Den Norske legeforening;
Liselotte Hojgaard, Ugeskrift for Laeger. Sheldon Kotzin,
U.S. National Library of Medicine.
The following
members of the ICMJE helped author the 1997 version and should be
acknowledged in citations of the May 2000 version.
Linda Hawes Clever,
Western Journal of Medicine; Lois Ann Colaianni, U.S.
National Library of Medicine; George Lundberg, JAMA; Richard
G. Robinson, New Zealand Medical Journal; Richard Smith, BMJ;
Bruce P. Squires, Canadian Medical Association Journal;
Martin VanDer Weyden, The Medical Journal of Australia; and
Patricia Woolf, Princeton University.
Inquiries about the
Uniform Requirements only should be sent to Christine Laine, MD, MPH
at the ICMJE secretariat office, American College of
Physicians-American Society of Internal Medicine, 190 N.
Independence Mall West, Philadelphia, PA 19106-1572, USA. Phone,
215-351-2660; fax, 215-351-2644; e-mail: claine@mail.acponline.org.
Please do not send inquiries about individual journal styles and
policies to this address.
This
document may be copied and distributed without charge for
not-for-profit, educational purposes. A digital version is available
on various web sites, including the ICMJE web site (http://www.icmje.org/).
The Uniform
Requirements has been published in several journals. Please cite a
version that appeared in the primary journal literature on or after
1 January 1997; for example:
International
Committee of Medical Journal Editors. Uniform Requirements for
Manuscripts submitted to Biomedical Journals. Ann Intern Med.
1997;126:36-47.
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