Dr. D.L. Richardson, Superintendent, The Providence City Hospital,” had led members of the Medical Society on a tour of the building. In “The Providence City Hospital,” he summarized the history in this address/speech. The 150-bed hospital opened March 1, 1910, for contagious diseases; from 1895-1910, Rhode Island Hospital had treated those cases. In May 1910 the Board of Hospital Commissioners made an urgent request to devote one ward for advanced tuberculosis. In June 1912 the hospital added a 54-bed tuberculosis building. Dr. Richardson believed this was “the only hospital…in the United States that opens its doors to all the so-called contagious diseases.” Such a unit was “made possible by the introduction of aseptic nursing, the credit for which all belongs to Dr. Chapin.” The hospital treated cases as diverse as chicken pox, diphtheria, measles, smallpox, and scarlet fever. The average daily census was 71.7 in 1910, up to 122.3 in 1912. Tuberculosis, though, remained the key disease: “The demand for beds for tuberculosis is far in excess of the capacity of the present ward. Perhaps only one-half of those actually put on our waiting list ever reach the hospital.”

In “Prophylactic and Therapeutic Vaccine Therapy in Typhoid Fever,” James Hamilton, Jr., MD, discussed the theory behind these treatments. He cautioned, “I think too many of us are too prone to become enthusiastic and enthusiastically attribute too much to the curative effects of vaccine.”

Over the past five years, a number of people have asked me, “How do you compare one medical journal with another”? The inquirer usually follows by saying, “Surely, there must be objective measures other than impact factor”? (1). I recently discussed journal performance with the Society’s board of directors, and several of those present recommended I share the information with readers. Below I list ten measures of performance and use AJRCCM to illustrate them.

One measure is number of submitted manuscripts. Submissions to AJRCCM increase on average by 3% a year, and have almost doubled between 1985 (962) and 2003 (1,836). Some may think a steady increase in submissions is to be expected. Not true. Over an equivalent time, submissions to the Annals of Internal Medicine decreased from 2,234 in 1982 to 2,131 in 2001 (2).

A second measure of performance is journal distribution and profitability. The print circulation of AJRCCM is 18,000, which compares favorably with 23,000 for Circulation despite the far higher number of cardiologists than of pulmonologists or intensivists. The online Journal is now averaging more than 930,000 hits a month (Figure 1), as compared with 100,042 hits a month received by AJP: Lung. Number of hits is an important measure of performance, because authors submitting a manuscript want the widest possible exposure for their work.

The Public Library of Science, a coalition of researchers and physicians founded 4 years ago by Nobel Prize winner and former National Institutes of Health director Harold Varmus, M.D., has launched PLoS Medicine, a free online medical journal. “The traditional model of publishing biomedical research fails to take advantage of technological advances that make the scientific literature more useful for scientists, physicians, and the general public,” said Dr. Varmus, who is now president of Memorial Sloan-Kettering Cancer Center in New York. The peer-reviewed journal will be funded through a “modest charge” of $1,500 to the researchers publishing the work, the coalition said in a statement. “We believe funding can be generated at the front end by the organizations that sponsor the work, rather than at the back end through ever-increasing subscription rates,” said PLoS Executive Director Vivian Siegel.

An article published in Britain’s The Guardian says that “Ghostwriting has become widespread in such areas of medicine as cardiology and psychiatry, where drugs play a major role in treatment. Senior doctors, inevitably very busy, have become willing to ‘author’ papers written for them by ghostwriters paid by drug companies.” In some cases, doctors have written articles from data compiled by drug company employees; the doctors never see the raw data. Authors of these papers receive thousands of dollars to give talks to other doctors at drug company-sponsored events. Most British psychiatrists get about $2,090 plus air fare and hotel accommodations while American psychiatrists received around $3,000. Some are paid as much as $10,000.

Marcia Angell, former editor of the New England Journal of Medicine, found that finding a research psychiatrist who does not have financial ties to a drug company is very difficult. Government money for medical research began to lessen about the time that Prozac was put on the market. Since then, scientists have turned to pharmaceutical companies for funding. The Guardian quotes Marcia Angell as writing: ‘”Researchers serve as consultants to companies whose products they are studying, join advisory boards and speakers’ bureaus, enter into patent and royalty arrangements… promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings….”‘ Thirteen journals, including NEJM and the Lancet, have denounced the drug companies’ practice of limiting researchers’ access to raw data from trials that the companies fund. Some journals are thinking about requiring scientists to state, in writing, that they actually wrote the paper they ha ve submitted.

The Agency for Healthcare Research and Quality (AHRQ) has launched a monthly peer-reviewed, web-based medical journal that showcases patient safety lessons drawn from actual cases of medical errors. Called AHRQ WebM&M (Morbidity and Mortality Rounds on the web), the web-based journal (webmm.ahrq.gov) was developed to educate health care providers about medical errors in a blame-free environment.

In hospitals across the country, clinicians routinely hold morbidity and mortality (M&M) conferences to discuss specific cases that raise issues regarding medical errors and quality improvement. Until now, there has been no comparable national or international forum to discuss and learn from medical errors. AHRQ saw the opportunity to use the web to host an ongoing national M&M conference aimed at improving patient safety by sharing information from anonymous cases.

“The AHRQ WebM&M web site offers the medical community a unique opportunity to learn about patient safety from the experiences of their colleagues across the country and around the world,” says AHRQ director Carolyn M. Clancy, MD. “The anonymity safeguards will enable physicians to share their experiences without fear of reprisal. Their involvement will contribute to the education of other providers about how to prevent medical errors and improve patient safety.”

Every month, five selected cases of medical errors and patient safety problems–one each in medicine, surgery/anesthesiology, obstetrics-gynecology pediatrics, and other fields, including psychiatry, emergency medicine, and radiology–will be posted along with commentaries from distinguished experts and a forum for readers’ comments. Each month, one case will be expanded into an interactive learning module (”Spotlight Case”) featuring readers’ polls, quizzes, and other multimedia elements and offering continuing medical education credits. Cases are limited to near misses or those that involve no permanent harm.

The web site was developed for AHRQ under a contract to an editorial team at the University of California, San Francisco. The editorial team is led by Robert M. Wachter, MD, associate chairman of UCSF’s Department of Medicine and chief of the medical service at UCSF Medical Center. The editorial board and advisory panels include many of the nation’s experts in patient safety.

A recent randomized, controlled trial conducted in Italy sheds new light on the use of spinal manipulation in the treatment of acute back pain and sciatica with disc protrusion. Results of the study, published in a recent issue of The Spine Journal, indicate that active spinal manipulation relieves pain more effectively than a sham simulation, leading to fewer days of localized pain and fewer days of radiating pain, and with no side-effects.

The study population consisted of 102 adults seen in two medical rehabilitation centers in Rome. All of the patients demonstrated the following characteristics: moderate to severe low back pain, moderate to severe radiating pain in one leg, and MRI evidence of disc protrusion in the spinal segments believed to be associated with the pain. Obese patients with acute LBP were excluded, as were patients with chronic LBP, disc protrusion with a ruptured annulus, and those who had already received spinal manipulation.

Upon admission to the study, each patient was interviewed and given a complete physical examination. During the interview, researchers collected detailed information on low back pain and leg pain (using a pair of visual analog scores), including the location of pain and the patient’s overall quality of life with the pain.

Participants were randomized into two types of manipulation groups active and simulated. Individuals in the active manipulation group received a maximum of 20 sessions over a 30-day period, with each session lasting five minutes. Active manipulation consisted of examining the range of motion in the patient’s back, followed by soft-tissue manipulation and “brisk rotational thrusting away from the greatest restriction.” The purpose of manipulation was to restore movement to the “physiological motor unit” (with each motor unit consisting of two vertebrae, disc and surrounding structures). Subjects in the simulated manipulation group received soft muscle pressing that was similar to manipulation, but did not follow any specific patterns or involve rapid thrusts. All manipulations were performed by two experienced chiropractors with similar formal training from a U.S. chiropractic college.

The Uniform Requirements (UR) have become the most important and widely accepted (by > 500 biomedical journals) guide to writing, publishing, and editing in international biomedical publications. UR are a compact, convenient, and essential tool for any would-be author in the field of medicine. This does not detract in any way from the importance of several mainstream reference works on medical writing, which are generally geared to providing information on specific points for authors or editors.

In 1978, the initial goal of the first meeting, in Vancouver, of the group that produced the UR was the establishment of guidelines for the development of formats for manuscripts for journal submission. The Vancouver group later evolved into the International Committee of Medical Journal Editors (ICMJE) and issued a number of editorial policy statements concerning publication-related ethical principles. The various ethical issue-related statements and the guidelines for manuscript submission were incorporated into a single text in the 2003 version of the UR, which are also named the Vancouver Style, after the city of their conception.

Initially, the main advantages, at least from the point of view of the author, have included the perception that since the UR format for an original research article is uniform and widely accepted, if an original research paper were totally rejected by one journal, it would need only a minimum of reworking before resubmission were possible to another journal. While this is in general true, it must ‘also be stressed that over the years the UR have come to increasingly emphasize the concomitant importance of the instructions to authors of individual journals.

A Dutch study published last month in the Journal of the American Medical Association established a link between the use of proton-pump inhibitors, which are used for heartburn relief, and pneumonia. According to the study, people who were taking PPIs were 89 percent more likely to develop pneumonia than people who had stopped taking the medication. Similarly, patients taking H2 blockers had a 63 percent higher risk of developing pneumonia compared with former users of those medications.

Experts surmise that the acid blockers could be creating an environment within the stomach where harmful bacteria can survive, according to published reports.

Don’t be afraid of needles–especially if you suffer from arthritis pain. A study published in the British Medical Journal shows that acupuncture may be an effective treatment for osteoarthritis of the knee. Researchers gave 97 patients older than age 45, who had never received acupuncture, the anti-inflammatory medication diclofenac and either authentic or placebo acupuncture treatments. The same certified professional performed all acupuncture procedures, using needles with adhesive ends that didn’t penetrate the skin during the placebo procedures. Those who received the true acupuncture took less medication and reported better knee function at the end of 12 weeks.

I. Statement of purpose

I. A. About the uniform requirements

A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the National Library of Medicine, were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE gradually has broadened its concerns to include ethical principles related to publication in biomedical journals.

The ICJME has produced multiple editions of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Over the years, issues have arisen that go beyond manuscript preparation, resulting in the development of a number of Separate Statements on editorial policy. The entire Uniform Requirements document was revised in 1997; sections were updated in May 1999 and May 2000. In May 2001, the ICMJE revised the sections related to potential conflict of interest. In 2003, the committee revised and reorganized the entire document and incorporated the Separate Statements into the text. The committee prepared this revision in 2005.

The total content of the Uniform Requirements for Manuscripts Submitted to Biomedical Journals may be reproduced for educational, not-for-profit purposes without regard for copyright; the committee encourages distribution of the material.

Journals that agree to use the Uniform Requirements are encouraged to state in their instructions to authors that their requirements are in accordance with the Uniform Requirements and to cite this version. Journals that wish to be listed on www.ICMJE.org as a publication that follows the Uniform Requirements should contact the ICMJE secretariat office.

The ICMJE is a small working group of general medical journals not an open membership organization. Occasionally, the ICMJE will invite a new member or guest when the committee feels that the new journal or organization will provide a needed perspective that is not already available within the existing committee.