Instructions for Authors

Overview

The Canadian Journal of Emergency Medicine (CJEM) is a peer-reviewed journal that publishes articles of interest to EM care providers in rural, urban, or academic settings. CJEM focuses on content relevant to clinical practice, emergency medical services, research, medical education and continuing medical education pertinent to emergency medicine. CJEM is the official journal of the Canadian Association of Emergency Physicians.

Scope and Content

We welcome article submissions that cover any of the following areas. We ask that authors recognize that CJEM will make the final decision into which category an accepted article will be placed.

• Original Research
  • EM Advances
  • ED Administration
  • Pediatric EM
  • Pharmacotherapy
  • Toxicology
  • EMS
  • Community EM
• Education
• State of the Art (systematic reviews, preferably meta-analyses)
• Case Reports
• Knowledge Applied to Practice
  • CJEM's Journal Club
  • Medical Mythology
  • Diagnostic Challenge
  • Methodology
  • Tips from the Trenches
• International EM
• Editorials
• Resident Issues
• Humour and Humanity

In addition, CJEM publishes letters, and media reviews.

CJEM publishes articles in English or French; however, French language articles will be considered only if the bulk of the work was performed in Canada and the primary author is Canadian. They will be reviewed, edited and published in French with an English abstract. Translation to French is provided for most editorials, issues of national significance, and CAEP position statements or guidelines.

CJEMprovides high quality content in an easy-to-read format; therefore brevity and active voice are encouraged. Accepted articles will be edited for clarity, brevity and style.

Manuscript Preparation

Authors should conform to the general guidelines laid out in "Uniform Requirements for Manuscripts Submitted to Biomedical Journals."[1] Articles prepared in accordance with these guidelines will not be rejected for reasons of style or format. For grammar, style, and punctuation, CJEM uses the American Medical Association's Manual of Style for editorial style.[2]

Formatting

Manuscripts should be double-spaced throughout, from title page to references. Authors should use a consistent 12-point font, preferably Times New Roman. Right margins should be unjustified (ragged). Number the pages consecutively, beginning with the title page, and provide a running header. Do not include any special formats (including Endnotes or Track Changes), small caps, paragraph adjustment and auto-numbering, because all make the editorial process more difficult. The manuscript must include:

Title page: The title page should include the article title, the authors' name(s) as they should appear in print, and the affiliations of all authors. The name, address, telephone number, fax number, and e-mail address for the corresponding author should be provided, in addition to a word count. All papers must include a statement on the title page declaring whether the authors have any financial or other conflicts of interest related to the submission. If there are conflicts, then they must be listed.

Abstracts: Structured abstracts (Objectives, Methods, Results, Conclusions) of up to 250 words are required for original research articles, systematic review articles and meta-analyses. Case reports should include an unstructured abstract of 150-200 words that summarizes the problem or objective, the main points, and the conclusions of the article. Abstracts are not required for editorials, resident issues, controversies and commentaries, methodology, medical mythology, international EM, news items or Humour and Humanity pieces. For papers written in English, the abstracts will be translated into French. For papers written in French, the abstracts will be translated into English.

Ethical considerations: For investigations involving human subjects, the "Methods" section should specify the nature of the patient consent that was obtained at the time of enrolment. Authors must clarify that an appropriate ethics committee or investigational review board approved the research.

Laboratory Results: All results should be reported using SI units.

References: References should be formatted in the same manner used by PubMed, e.g., Mengual RP, Feldman MJ, Jones GR. Implementation of a novel prehospital advance directive protocol in southeastern Ontario. CJEM. 2007 Jul; 9(4):250-9.

Within the text, references should be numbered in the order they appear using standard text and angular brackets <ref> rather than superscript (e.g., <1>). DO NOT USE ANY special formatting for sections or references. References should report all authors up to 3. When there are more than 3 authors, the first 3 should be cited, followed by "et al."

If a manuscript not meeting these requirements is submitted, the manuscript will be returned without review, with a note reiterating the need to follow the instructions for format. Once the corrected manuscript is returned, it will enter the standardized screening process.

Manuscript Submission

As of January 5, 2009, all new manuscripts must be submitted electronically via Manuscript Central’s Scholar One tracking system for new submissions at http://mc.manuscriptcentral.com/cjem. All submissions should be accompanied by a brief cover letter. Within the cover letter, the corresponding author should identify potential conflicts of interest and financial disclosures, specify each author's contribution to the work, and indicate that all coauthors have provided their permission to publish the manuscript. Each individual figure should be uploaded as a separate digital file. Please note that we do not publish colour photographs. If the authors wish to publish their photo or figure in colour, then they are responsible for the cost of doing so. Figures must meet the specifications outlined in the Canadian Medical Association Guidelines for Submitting Tables, Figures and Graphics.[4] If figures, illustrations, tables or other material have been taken or adapted from a previous publication, the authors are responsible for acquiring written permission from the publishers to reproduce these items and providing said written permission to CJEM. If patients could possibly be identified by photographs or descriptions within the manuscript, authors are responsible for acquiring written consent from the patients to publish their photographs or descriptions. Questions or comments regarding manuscript submission can be sent to cjem@caep.ca.

Previous Publication

In accordance with "Uniform Requirements”,[1] manuscripts will be considered with the understanding by CJEM that they have not been previously published nor are they under consideration by another journal. Authors are referred to "Uniform requirements" for detailed guidelines on previous publication and exceptions.

Review and Editorial Processes

All submissions are initially reviewed by the Editor-in-Chief or one of the Senior Associate Editors. Articles judged unsuitable for CJEM will be returned to the authors at this time. Those meeting screening criteria will be forwarded for blinded peer review. Peer review comments will be forwarded electronically to a decision editor, who will decide whether the article should be categorized as “Accept”, "Revise and Accept”, “Revise and Resubmit” or “Reject”. This decision editor will compose an editor's response letter to the author. In most cases, authors can expect an editor's response within 12 weeks of original manuscript submission.

Revisions of manuscripts originally submitted via Manuscript Central’s Scholar One must also be submitted via http://mc.manuscriptcentral.com/cjem. Only revisions of manuscripts originally submitted prior to January 5, 2009 should continue to be sent via e-mail to cjem@caep.ca. All revisions will be reviewed by the decision editor, who will determine whether review comments have been addressed. The decision editor, sometimes in concert with the Editor-in-Chief or a Senior Associate Editor, will make a final decision regarding publication. Accepted articles will be edited for clarity, brevity and style, and authors will have the opportunity to review and approve revisions prior to publication. Manuscripts submitted to CJEM will be treated with respect and confidentiality.

After acceptance, transfer of copyright must be made in writing to the Managing Editor at cjem@caep.ca. Authors can download the copyright form at http://mc.manuscriptcentral.com/cjem. Published manuscripts become the property of the CJEM and may not be published elsewhere without permission.

Financial disclosure (Conflict of Interest)

Prior to publication, all authors will be required to sign a financial disclosure form, indicating any financial interests or potential conflicts of interest they have relating to the manuscript.

Additional Instructions

EM Advances and Education submissions should be 2000-3000 words. For State of the Art, the article length should be 3000-4000 words.

Original Research

These articles present primary data arising from original research. Authors of randomized clinical trials should conform to the criteria specified in the CONSORT statement.[5] Effective September 2007, all clinical trial reports submitted to CJEM must be registered with an accepted clinical trials registry, such as ClinicalTrials.gov[6] or the International Committee of Medical Journal Editors (ICMJE),[1] and the registration number should be included in the manuscript. Researchers initiating studies should register as soon as Ethics Board approval has been obtained, while those who have already started trials prior to September 2007 should make a post hoc registration. Although CJEM encourages people to use ClinicalTrials.gov as their registry site[6], any recognized international registry will be accepted.

Discussion about the role of trials registries can be found in an editorial by Laine et al.[7] EMS studies should follow the Utstein criteria when appropriate.[8] .

Authors of retrospective medical record reviews should, where appropriate, incorporate the design elements discussed by Gilbert and colleagues.[9] CJEM has established minimal criteria for publication of medical record reviews based on these criteria. These medical record review criteria can be found on the CJEM website. Authors reporting the performance of a diagnostic test should follow the STARD initiative.[3]

"EM Advances" articles should be from 2000-3000 words, excluding tables, figures and references.

• The Introduction should discuss study justification, and a priori objectives and hypotheses.
• The Methods section should include a description of the overall study design, the study setting, time period, patients studied (with eligibility criteria), a description of the intervention, the primary and secondary outcome measures, and the statistical analysis employed.
• The Results section should include primary and secondary results, with appropriate tables and figures.
• The Discussion section should highlight the important study findings and discuss these in the context of previous published literature. In addition, the Discussion should identify limitations of the research and future directions.
• Conclusions should be stated in 1 paragraph and should be supported by the data.
• A structured Abstract must also be included (see above).

Pharmacotherapy: The goal of this section is to provide evidence-based reviews of current trends in pharmacology and therapeutics, and of drug therapies commonly used in the ED. Reviews may focus on new pharmaceutical modalities relevant to the EDor on new indications for older medications.

Reviews should include a brief Introduction discussing the background of the agent(s) under review and defining the paper's objective. This should be followed by a “Pharmacology and pharmacokinetics” section that includes comparisons to other drugs within the same class. This section should have sufficient detail to allow the prescriber to understand the basic pharmacology (mechanism) of the new agent and to appreciate some of the pharmacokinetic principles that dictate dosing of the agent (e.g., onset, duration, clearance [renal vs. hepatic], half-life). The body of the review should be included in the section on Clinical Evidence. It should critically evaluate the current evidence – both negative and positive - that surrounds the use of this agent. Important points to be covered include efficacy, safety and cost on the use of this agent, as well as limitations and unanswered questions that arise from the current literature on the topic of focus. Finally, the author should outline the current role of the agent of focus as it pertains to use in the ED.

Pediatric EM: Submitted articles should be related to the clinical practice or administrative aspects of pediatric emergency medicine.

Community EM: Topics for this section should be related to clinical practice in the non-academic setting. Authors are encouraged to submit original research related to administrative or clinical topics specific to this clinical practice.

ED Administration: Submitted articles should be related to administrative aspects of emergency medicine.

Toxicology: Submissions should be related to the nature, effects and detection of toxins and their treatment.

EMS: Submissions for this section should be related to prehospital response and/ or treatment.

Education

This section focuses on original research related to the process of education in Emergency Medicine. Didactic teaching, clinical training methods and clinical and formal evaluation techniques are all topics for this section.

State of the Art

This section is devoted to topical reviews of the recent and past scientific literature. Review articles should attempt to define the "State of the Art" for the topic or research question addressed. Systematic reviews are preferred. Narrative reviews will not be considered for publication. All articles or data sources should be selected systematically for inclusion in the review and critically evaluated, and the selection process should be described in the paper. Expected length for a "State of the Art" review is 3000-4000 words (not including tables, figures and references). Authors of systematic reviews incorporating meta-analysis should refer to the QUOROM statement on improving the quality of reports of meta-analysis of randomized controlled trials.[10] Authors of systematic reviews without meta-analysis should refer to the systematic review series edited by Cook and colleagues[11] and Mulrow and coworkers.[12]

Authors of systematic review articles should:

• define a clear and clinically relevant research question
• retrieve and describe relevant reviews published to date
• document their limitations and justify the need for a more comprehensive review.[13]
• define the search strategy used to identify primary articles [14]
• describe the methods used to select primary studies
• specify inclusion and exclusion criteria (criteria for selecting primary studies should be based on population studied, intervention or exposure, study outcomes, and study methodology)
• perform a blinded assessment of the quality of the selected articles
• assess the reliability of this process by measuring the agreement of 2 evaluators [15,16]
• account for all studies identified by the search and justify exclusions
• describe the method of combining study results
• discuss variation within and between studies
• state their conclusions
• compare their conclusions to the literature and current standard of care
• outline the limitations of the review
• suggest areas for future research

The Abstract for a systematic review should include the following headings: Objectives, Data source, Study selection, Data extraction, Data synthesis, and Conclusion.

Case Reports

Case reports are most valuable if they:

• illustrate an important error or practice point for emergency physicians
• identify a previously undescribed finding or phenomenon
• describe a therapy that could lead to future research or a change in practice.

All cases for consideration should have a “take home” clinical message pertinent to Canadian Emergency Physicians. Article length for case reports should be 1000-2000 words.

Authors should conform to the general guidelines laid out in "Uniform Requirements."¹ Manuscripts submitted to "Case Reports" should include:

• a brief Introduction (1-2 paragraphs describing why the topic is important)
• the case report, consisting of a succinct summary of relevant historical, physical, laboratory and imaging findings, emergency department diagnosis, management, and disposition, and relevant follow-up information (e.g., patient outcome, findings at laparotomy)
• a Discussion, summarizing what the case illustrates and what the teaching points are
• a 1-paragraph Conclusion
• an Abstract (<200 words) for translation into French.

Knowledge Applied to Practice

CJEM Journal Club: "CJEM Journal Club" consists of 2 sections. "Critically Appraised Topics" (CATs) is devoted to evidence-based review of specific EM-related questions. Questions are answered by using a focused literature review and presenting the results in a CAT format. The aims of this section are to address clinical or administrative questions, to demonstrate the application of evidence-based medicine methods in answering such questions, and to accumulate a CAT database for emergency physicians.

"Selected Articles" is devoted to evidence-based article reviews. The aims of this section are to demonstrate the use of the critical review format, to review articles of interest to emergency physicians, and to determine the relative validity and usefulness of these articles. To assist readers in keeping abreast of the relevant EM literature, timely reviews of important articles/topics will be a factor in the decision to accept. Review articles address 3 key questions:

• What are the results?
• Are the results valid?
• Will the results help me care for my patients?

In each issue of CJEM, we hope to have important articles reviewed by emergency physicians with a special interest or expertise in the topic under discussion. The preferred review methodology, including critical review forms, is described in "Users Guide to the Medical Literature," a series published in the Journal of the American Medical Association.[17] Authors wishing to view samples of appropriate article review format may visit the NHS Research and Development Centre for Evidence-Based Medicine Web site[18] or peruse articles published in ACP Journal Club.[19]

CATs and selected article reviews are selected for publication based on the quality of the review and the topic's level of interest to emergency physicians. Article length should be 600-1200 words.

Diagnostic Challenge: Authors may submit brief case summaries accompanied by one or two images that will stimulate diagnostic discussion. Diagnosis and explanation should be distinct from the case presentation. Article length should be 500-1000 words.

Tips from the Trenches: The purpose of this section is to publish very brief reports of clinical techniques or pearls.  Article length should be 1000-1500 words.

Images: This section should include interesting, high quality clinical images with accompanying text that briefly reviews the important features of the related case. Article length should be 250 words.

Medical Mythology

Articles for this section explore medical practices that are still used by practitioners, but are unverifiable through clinical trials or evidence-based medicine. Word count should range between 500-1000 words.

International EM

This is a forum for descriptive articles on emergency medicine experiences in countries other than Canada. Articles should contain elements of human interest or of disease or practice patterns that are unique or unusual and of interest to Canadian emergency physicians. Accompanying visual images are strongly encouraged. Article length should be 1000-1500 words.

Editorials

Although normally by invitation, authors may submit a focused discussion on major current problems of emergency physicians or on controversial matters with significant implications for emergency medicine. Article length should be 1000-1500 words.

Humour and Humanity

Submissions should reflect the challenges of working in medicine. Generally they should be humorous and/or provide some human interest and add to our understanding of the physician experience, particularly in Canada. Articles should be less than 1000 words in length.

Letters

Letters should be addressed to the editor, should be submitted electronically via Manuscript Central's Scholar One tracking system for new submissions at http://mc.manuscriptcentral.com/cjem. Letters will be considered for publication if they relate to topics of interest to emergency physicians in urban, rural, community or academic settings. Letters are generally not peer reviewed but may be edited for brevity and clarity. Letters will be limited to 400 words and 5 references. Letters responding to a previously published CJEM article should reach CJEM head office within 6 weeks of the article's publication. Authors whose work is discussed will be given an opportunity to respond.

Additional Resources

Authors are encouraged to submit articles in many areas of research.  The methodological guidelines for reporting different types of studies have been summarized and validated in a number of publications.  Authors should check their manuscripts with these reporting guidelines, to ensure that all important information for journal editors and readers is present.  The most common reporting guidelines for different published study designs are summarized below (see Table 1).  Please be advised that this list is not comprehensive for all possible study designs, but does cover all major study types commonly published.

Contacting CJEM Editors

Prospective authors with questions regarding a submission, or those who wish to discuss a paper in the development stage are encouraged to contact the Editor-in-Chief or the appropriate Section Editor. Please note: e-mail correspondence is preferred.

Further information can be obtained from the Editor-in-Chief or the Managing Editor at cjem@caep.ca.

References

1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Available online.
2. Iverson C, Flanagin A, Fontanarosa PB, et al., eds. AMA Manual of Style – A Guide for Authors and Editors. 10^th edition. New York, NY: Oxford University Press; 2007.
3. Canadian Medical Association. Canadian Medical Association Guidelines for Submitting Tables, Figures and Graphics. Available online.
4. The CONSORT Group. The CONSORT statement. Available at: http://www.consort-statement.org/.
   Last accessed October 17, 2007.
5. The US National Institutes of Health. ClinicalTrials.gov. Available at: http://clinicaltrials.gov.
   Last accessed August 20, 2007.
6. Laine C, Horton R, DeAngelis CD et al. Clinical trial registration: looking back and moving ahead. CMAJ. 2007 Jul 3; 177(1):57-8.
7. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Task Force of the American Heard Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med 1991 Aug; 20(8):861-74.
8. Gilbert EH, Lowenstein SR, Koziol-McLain J, et al. Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med 1996 Mar; 27(3):305-8.
9. Bossuyt PM, Reitsma JB, Bruns DE. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Clin Chem. 2003 49:1-6. Available at http://www.consort-statement.org/mod_product/uploads/STARD%20Statement%202003.pdf. Last Accessed August 20, 2007.
10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999 Nov 27; 354(9193):1896-900.
11. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 1997 Mar 1; 126(5):376-80.
12. Mulrow C, Langhorne P, Grimshaw J. Integrating heterogeneous pieces of evidence in systematic reviews. Ann Intern Med 1997 Dec 1; 127(11):989-95.
13. Hunt DL, McKibbon KA. Locating and appraising systematic reviews. Ann Intern Med 1997 Apr 1; 126(7):532-8.
14. Higgins JPT, Green S, editors. Developing and documenting a search strategy for studies and organizing search results.Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd. Available online.
    Last accessed August 20, 2007.
15. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996 Feb; 17(1):1-12.
16. Detsky AS, Naylor CD, O'Rourke K, et al. Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol. 1992 Mar; 45(3):255-65.
17. McGinn TG, GuyattGH, Wyer PC, et al. Users’ Guides to the Medical Literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA 2000 Jul 5; 284(1):79-84.
18. Centre for Evidence-Based Medicine. CEBM Centre for Evidence-Based Medicine. Available at: http://www.cebm.net.
    Last accessed August 20, 2007.
19. American College of Physcians. The American College of Physicians Journal Club. Available at: http://www.acpjc.org.
    Last accessed August 20, 2007.