SUBMISSION OF MANUSCRIPTS

Manuscripts for British Journal of Anaesthesia should be submitted online. Once you have prepared your manuscript according to the instructions below please visit the online submission web site. Instructions on submitting your manuscript online can be viewed here.

All editorial communications should be addressed to: Prof. C. S. Reilly, Editor-in-Chief, British Journal of Anaesthesia, Academic Unit of Anaesthesia, Floor K, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel: +44 (0) 114 226 1087; Fax: +44 (0) 114 226 1462; E-mail: bja@sheffield.ac.uk.

AIMS OF THE JOURNAL

The British Journal of Anaesthesia publishes original work in all branches of anaesthesia, including the application of basic sciences. In addition, the journal publishes review articles, case reports and reports of new equipment.

AUTHOR SELF-ARCHIVING/PUBLIC ACCESS POLICY FROM MAY 2005

For information about this journal's policy, please visit our Author self-archiving policy

OPEN ACCESS

British Journal of Anaesthesia authors have the option, at an additional charge, to make their paper freely available online immediately upon publication, under the Oxford Open initiative. After your manuscript is accepted, you will be asked to indicate whether or not you wish to pay to have your paper made freely available immediately. If you do not select the Open Access option, your paper will be published with standard subscription-based access and you will not be charged.

OPEN ACCESS CHARGES

Optional Oxford Open charges:
For a Corresponding author based at an institution with an online subscription to British Journal of Anaesthesia:
Regular charge - £900 / $1800 / €1350
List B developing country charge** - £450 / $900 / €675
List A developing country charge** - £0 / $0 / €0

For a Corresponding author based at an institution that does not subscribe to the online journal:
Regular charge - £1500 / $3000 / €2250
List B developing country charge** - £750 / $1500 / €1125
List A developing country charge** - £0 /$0 / €0

*Visit http://www.oxfordjournals.org/jnls/devel/ for list of qualifying countries.

Orders from the UK will be subject to a 17.5% VAT charge. For orders from elsewhere in the EU you or your institution should account for VAT by way of a reverse charge.  Please provide us with your or your institution’s VAT number.

The above Open Access charges are in addition to any page charges and colour charges that might apply.

If you choose the Open Access option you will also be asked to complete an Open Access charge form online. You will be automatically directed to the appropriate version of the form depending on whether you are based at an institution with an online subscription to British Journal of Anaesthesia. Therefore please make sure that you are using an institutional computer when accessing the form. To check whether you are based at a subscribing institution please use the Subscriber Test link for British Journal of Anaesthesia.

SOME REASONS FOR DIFFICULTY

There are several principal reasons for rejection of papers:

1. Poor experimental design or inadequate investigation (or both). Detailed guidance on this aspect is beyond the scope of the present document but inadequate sample size and/or insufficient power are common faults.
2. Bad presentation. This results from inexperience in writing scientific or clinical reports. Various manifestations of the problem may be combined in one manuscript. These include:
   1. Failure to conform to the accepted layout of a scientific paper (see page 132).
   2. Failure to distinguish between jargon and technical terminology (see appendix).
   3. Excessive verbosity. Most manuscripts may be reduced by at least 30% with advantage.
   4. Unsatisfactory or confusing presentation of data in tables or figures (see pages 135, 136).
3. Poor English style and syntax. Although journals are not sympathetic to this problem in papers from the English-speaking countries, British Journal of Anaesthesia has a long tradition of helping authors from other countries. Inevitably, however, the provision of this help causes delay.
4. Insufficient material. Try not to break down studies into the smallest publishable units.

GUIDANCE FOR THE EARLY STAGES

Before beginning to write, analyse your objectives carefully.

• What is the question which you have tried to answer?
• What message is to be conveyed?
• Do the data and your interpretation of them justify the message?
  It is recommended that guidance is obtained from colleagues experienced in research and in writing scientific manuscripts.
• Statistical analysis is usually an essential component of the process of assessing the validity and implications of any results presented in a paper. Initial statistical advice should be sought before, rather than after, the data have been collected. Do not use 'recipes' for statistical analysis which you do not understand. Do not use the methods of the professional statistician unless you have a reasonable understanding of what they mean.
• Do not assume that figures that have been prepared for audiovisual presentation will be suitable for publication in a journal; the dimensions are nearly always unsuitable for the printed page (see below).
• Consult recent issues of the British Journal of Anaesthesia and try to find a paper which conforms, in general format, to the paper you plan to write.
• Please make sure that the legal considerations which are noted in the formal Guide to Contributors have been fulfilled. It is important to remember also that the internationally agreed code on the ethics of human experimentation (Helsinki Declaration) should be adhered to. A breach of this code will result in automatic rejection. It is essential to state that local Institutional Ethics Committee approval and informed patient consent have been obtained, where appropriate. When studies have been conducted in animals, it is essential to indicate the appropriate Home Office Licence number in the United Kingdom or note that approval has been granted by local Animal Research Committees in other countries.
• British Journal of Anaesthesia participates in a uniform requirement agreement on submission of manuscripts (International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to Biomedical Journals. BMJ 1988; 296: 401-405).
• Manuscripts must be accompanied by a covering letter signed by all the authors. This should include: (a) Information on prior or duplicate publication or submission elsewhere of any part of the work. Please note that it is unethical to submit the same complete work to two journals simultaneously; a clear rejection by an editor is required before submission to a second journal should be considered; (b) a statement of financial or other relationships that might lead to conflict of interests; (c) a statement that the manuscript has been read and approved by all authors; (d) the name, address, telephone number, fax number and email address, if applicable, of the corresponding author who is responsible for communicating with the other authors about revisions and final proofs.
• Manuscripts should indicate the title of the paper, the name(s), full address(es) of the author(s), and be in letter quality heavy type (not dot matrix), double-spaced, with a wide margin. Contributors should retain a copy in order to check proofs and in case of loss. Please do not use endnotes, footnotes, etc. for references.

The typical layout of the manuscript is:

• Title page
• Summary, including Keywords
• Introduction (not headed)
• Methods
• Results
• Discussion
• Acknowledgements
• List of references
• Tables (including legends to tables)
• Legends to illustrations

The pages should be numbered in the top right-hand corner, the title page being page one, etc. Start each section on a separate page.

TITLE PAGE

A separate page which includes the title of the paper. Titles should provide a reasonable indication of the contents of the paper. Avoid enigmatic or vague titles such a 'A new method of scavenging'. Titles in the form of a question, such as 'Is halothane teratogenic?', are often acceptable.

The title page should include the name(s) and address(es) of all author(s). It should be made clear which address refers to which author. An author's present address, differing from that at which the work was carried out, or special instructions concerning the address for correspondence, should be given as a footnote on the title page and referenced at the appropriate place in the author list by superscript numbers (^{1 2 3} etc.) If the address to which proofs should be sent is not that of the first author, clear instructions should be given in a covering note, not on the title page.

A short running title containing not more than 50 characters (including spaces) should be included.

SUMMARY

The summary will be printed at the beginning of the paper. It should be on a separate sheet, in structured format (Background; Methods; Results; and Conclusions) for all original articles (Clinical Investigations and Laboratory Investigations) but not for Reviews, Case Reports, or Commentaries. It should give a succinct account of the problem, in up to 250 words. It may be used as it stands by abstracting journals. References are not used in this section, except in exceptional circumstances.

KEYWORDS

Three to five keywords should be included on the summary page under the heading Keywords. They should be classified according to this list: Keywords. This can also be found on the Manuscript Central (online submission) site.

INTRODUCTION

The introduction should give a concise account of the background of the problem and the object of the investigation. It should clearly state the aims of the study. Previous work should be quoted only if it has direct bearing on the present problem. For example, a description and evaluation of a system for scavenging anaesthetic gases from an operating theatre need not include an account of the previous literature of the problems of operating theatre contamination by anaesthetic gases and the many studies of morbidity, etc. which may or may not be associated with such contamination. As a rule, the introduction to a paper should not require more than about 200 words.

If a preliminary account of the results has been given in a published abstract, it is customary to refer to this.

METHODS

The title of this section may be 'methods', 'materials and methods' or 'patients and methods'. Under no circumstances should the terms 'patients' and 'materials' be regarded as interchangeable. While brevity is essential, the methods must be described in sufficient detail to allow the experiment to be interpreted, and repeated if necessary, by the reader. Previously documented standard methods need not be recounted in detail, but appropriate reference to the original should be cited.

Sometimes detailed laboratory techniques may be filed separately in a recognized library and a note to this effect given in the manuscript. Where measurements are made, an indication of the error of the method in the hands of the author should be given. The name of the manufacturer of instruments used for measurement should be given with an appropriate catalogue number or instrument identification (e.g. Radiometer PHM 7). When a manufacturer is unlikely to be known to readers of the journal, the address should be provided also. In the case of solutions for laboratory use, the methods of preparation and precise concentration should be stated.

DRUGS

When a drug is first mentioned, it should be given by the international non-proprietary name, followed by the chemical formula in parentheses if the structure is not well known, and (if relevant) by the proprietary name (with an initial capital letter). A figure giving the molecular configuration of the drug is necessary only in the case of the earliest reports of a new drug. The author should indicate in an accompanying note to the editor the source from which he has obtained the molecular configuration; it is an important requirement that the author should check the accuracy of the configuration in every detail. Drug dosages are normally given by the name of the drug followed by the dose (e.g. diazepam 0.1 mg kg-1). Do not confuse drug dose with concentration.

COMPLEX PROGRAMME OF RESEARCH

Where the programme of research is complex such as might occur in a cardiovascular study in animals, it may be preferable to provide a table or figure to illustrate the plan of the experiment, thus avoiding a lengthy explanation.

PATIENTS

Data on the mean age (range), weight, sex, height, criteria for selection, etc. should be presented, with an indication of the general state of health and type of operation being undertaken. Animal data on sex, strain and weight should be included. Although it is usually possible to make such a statement in a short paragraph, more complex information may be preferable as a table. However, tables and figures are expensive to produce and should not be used unnecessarily. Where it has been necessary to seek permission from the patients for the type of study being undertaken, this should be indicated.

CLINICAL TRIALS

In accordance with the Clinical Trial Registration Statement from the International Committee of Medical Journal Editors (see here), all clinical trials in British Journal of Anaesthesia must be registered in a public trials registry at or before the onset of participant enrollment. This requirement applies to all clinical trials that begin enrollment after 1 January 2009. For trials that began enrollment before 1 January 2009, registration is strongly recommended and if the trial reported was not registered, please comment on this matter in the covering letter.

Research is considered to be a clinical trial if it involves prospective assignment of human subjects to an intervention or comparison group to study the relation between a health-related intervention and a health outcome. Further details of which clinical trials are covered by this policy is available in the updated ICMJE guidelines available here.

The registry must be accessible to the public at no charge, searchable, open to all prospective registrants, and managed by a not-for-profit organization. The registry must include the following information: a unique identifying number, a statement of the intervention(s), study hypothesis, definition of primary and secondary outcome measurements, eligibility criteria, target number of subjects, funding source, contact information for the principal investigator, and key dates (registration date, start date, and completion date). The following registries are recommended by ICMJE: Clinical Trials, ISRCTN Register, UMIN Clinical Trials Registry, Australia New Zealand Clinical Trials Registry, Nederlands Trial Register.

In accordance with the ICMJE’s recommendation, British Journal of Anaesthesia will also accept registration of clinical trials in any of the primary registers that participate in the World Health Organization’s International Clinical Trial Registry Platform (see here). Primary registers are WHO selected registers managed by not-for-profit entities that will accept registrations for any interventional trials, delete duplicate entries from their own register, and provide data directly to the WHO. Please note that registration in any WHO partner register is insufficient.

Authors are requested to provide the exact URL and unique identification number for the trial registration at the time of submission. This information will be published in the article and we ask that you include the URL and identification number on the title page of your manuscript.

Clinical trial reports should also comply with the Consolidated Standards of Reporting Trials (CONSORT) and include a flow diagram presenting the enrollment, intervention allocation, follow-up, and data analysis with number of subjects for each (see here). Please also refer specifically to the CONSORT Checklist of items to include when reporting a randomized clinical trial.

Results posted in the same clinical trials registry in which the primary registration resides will not be considered prior publication if they are presented in the form of a brief abstract (500 words or less) or a table.

ANAESTHESIA

Descriptions of methods of anaesthesia are often unnecessarily cumbersome. The following model is presented as an example of economy of words: The patients were premedicated with either morphine 10 mg and atropine 0.6 mg (group A) or diazepam 10 mg (group B), both given 1 h before operation. Anaesthesia was induced with thiopental [give rate of injection where appropriate], in a dose sufficient to abolish the eyelash reflex. Succinylcholine 80 mg was given to facilitate orotracheal intubation with a cuffed tube. Anaesthesia was maintained with halothane 0.5-1.0% and nitrous oxide 60% in oxygen, the patient breathing spontaneously from a Magill system. A similar description should be used for animal anaesthesia.

STATISTICAL ANALYSIS

Statistical methods must be described with enough detail to enable a knowledgeable reader with access to the original data to verify the report and results. Where possible, findings should be quantified and presented with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Confidence intervals provide a more informative way to deal with a significance test than a simple P value. If appropriate a power analysis should be performed before starting the study to determine the number of subjects which need to be studied in each group to detect a given change.

Additional guidance on statistics may be obtained from Guidelines for Statistical Reporting in Articles for Medical Journals (Bailar JC, Mosteller F. Annals of Internal Medicine 1988; 108: 266-273).

RESULTS

Description of experimental results should be concise. Data should not be repeated unnecessarily in text, tables and figures, and unwarranted numbers of digits should be avoided. It is not usually necessary to provide all the data from a complex study: only those values which are essential to the communication should be given. However, results should be presented in a manner so that the reader can check the statistical inferences. If the data are so numerous that this is not possible, the editor must be sent a full set with the submission of the original manuscript and the readers should be informed as to where they can obtain a similar full set of results. The editor has the right to request sighting of the original data collected. As a rule, the following general approach should be adopted:

1. Prepare all the data in the form of tables.
2. Decide which data are to be presented in the communication.
3. Can the essential data be presented succinctly in the text? If not, the essential tables or simplified tables should be prepared.

Tables are important communications and should be accompanied by a legend which makes the table self-explanatory. However, the legend must not contain experimental details, which should be given in the methods section.

Graphs and histograms based on the results should be considered only in the following circumstances:

1. where a figure will present the data more clearly than is possible in a table.
2. when an important trend or comparison has to be made for which a graphic presentation is clearly superior to a table or text.

For detailed guidance on the format of presentation of results, the reader is referred to previous issues of the journal. A common example, however, occurs in the case of a comparison of the findings in two groups of patients who have been treated with different drug regimens. The following example that required revision is based on a submitted manuscript, with the permission of the authors:

In the results section there should be no attempt at a discussion of the findings.

DISCUSSION

This requires discipline by the writer for two reasons: first, they may feel that the task is nearly completed and that they are subject to fewer constraints; second, many authors seem to wish to read into their data more than is actually there. The form of a discussion should normally follow this pattern:

1. Summary of the major findings.
2. Qualifying remarks in relation to these findings; for example, mention any important uncertainties in the methods of measurement. In laboratory studies, try to relate the concentrations used to those encountered clinically.
3. Succinct comparison of the present data and relevant data from previous studies.
4. Deductions-which may explain important differences between the data of the present study and the data of previous studies.
5. Conclusions from the present study. The original contribution to knowledge from the present study is stated.
6. The implications of the conclusions for anaesthetic practice and the indications for further enquiry in this area of interest. Authors should remember at all times, but especially in writing the discussion, that they will spoil their manuscript by excessive length. A discussion of more than three pages is often too long.

FUNDING

Details of all funding sources for the work in question should be given in a separate section entitled 'Funding'. This should appear before the 'Acknowledgements' section.

The following rules should be followed:

• The sentence should begin: ‘This work was supported by …’
• The full official funding agency name should be given, i.e. ‘National Institutes of Health’, not ‘NIH’ (full RIN-approved list of UK funding agencies) Grant numbers should be given in brackets as follows: ‘[grant number xxxx]’
• Multiple grant numbers should be separated by a comma as follows: ‘[grant numbers xxxx, yyyy]’
• Agencies should be separated by a semi-colon (plus ‘and’ before the last funding agency)
• Where individuals need to be specified for certain sources of funding the following text should be added after the relevant agency or grant number 'to [author initials]'.

An example is given here: ‘This work was supported by the National Institutes of Health [AA123456 to C.S., BB765432 to M.H.]; and the Alcohol & Education Research Council [hfygr667789].’

ACKNOWLEDGEMENTS

It is inappropriate to acknowledge routine assistance from nursing or surgical colleagues without which any form of clinical research would not be possible. It is essential to acknowledge all sources of financial assistance and any conflicts of interest.

REFERENCES

Except for review articles, long lists of references are usually inappropriate. Restrict references to those that have direct bearing on the work described and cite only references to books and articles published in Index Medicus and Index Veterinarius journals.

• References must be numbered consecutively in the order in which they are first mentioned in the text, with the exception of review articles, when references should be arranged alphabetically in the reference list and numbered accordingly in both list and text.
• References in text, tables and legend should be identified by Arabic numbers appearing in the text in superscript, for example 5 or 5-7 or 5[space]16 for unrelated references. When a table or figure is first mentioned, its reference must continue the sequence.
• Papers which carry a different system of reference will be returned to the authors for re-typing. The scope for major printer's errors in attempting to rectify inappropriate schemes is considerable.
• References in the text. If it is considered essential to cite names of the authors of a study in the text (in addition to the identifying number), up to three names should be cited (A; B and C; D, E and F). In the case of four or more authors, 'G and colleagues', 'G and co-workers', 'G and others'.are acceptable. The expression 'et al.' is not used in the text.
• An informal reference to previous work (Z's study or Y's study) is permissible only in a paragraph which contains the reference cited formally.
• Abstracts that are more than three years old should not be used as references.
• Text references to 'unpublished observations' or 'personal communications' should not be included in the final list of references. Personal communications should be cited in the text as (Brown AB, personal communication, year). Authors are responsible for verifying that the wording of references to unpublished work is approved by the persons concerned. This should be provided in writing with the first submission of the manuscript.
• Papers which have been submitted and accepted for publication should be included in the list, with the phrase 'in press' replacing volume and page number. Authors should be prepared to give the volume and page number at the time of proof correction. Abstracts should also be sent with the original submission.
• Information from manuscripts submitted but not yet accepted should be cited in the text as unpublished observations.
• There should be a table of references at the conclusion of the paper, commencing on a new sheet. It should be prepared as follows. The names and initials of more than six authors and/or editors should be abbreviated to three names followed by et al. A maximum of 30 references is allowed for an original article.
• Journals. Names and initials of six authors (if more than six, list three followed by et al.), title of paper, abbreviated title of journal, year of publication, volume number, first and any change in last page numbers:
  
  _{Brown BR jr, Gandolphi AJ. Adverse effects of volatile anaesthetics. Br J Anaesth 1987; 59: 14-23}
• Monographs. Name of author and initials, title of book (italics), number of edition, town of origin, publisher, year of publication, first and any change in last page numbers (if relevant):
  
  _{Moore DC, Regional Block, 4th edn. Springfield, Illinois: Charles C Thomas, 1979}
• Chapter in a book. The reference for an article forming part of a book should take the form:
  
  . Hull CJ. Opioid infusions for the management of post-operative pain. In: Smith G, Covino BG, eds. Acute Pain. London: Butterworths, 1985; 155-79

It is a serious error to include in the list of references items which are not accurate. It is essential, therefore, that authors check the accuracy of all references which have been listed. It is important also to check that the references listed do indeed appear in the text and vice versa.

PREPARATION OF TABLES

All tables should be on separate sheets and accompanied by legends. Legends should be informative but brief and not contain information which is more appropriate to Methods. It is preferable to present the data not in table format, but in normal text, with columns separated only by tabs. The tables should be numbered consecutively using Arabic numerals. Units in which results are expressed should be given in parentheses at the top of each column and not repeated in each line of the table. Ditto signs are not used. Avoid overcrowding the tables and the excessive use of words. The format of tables should be in keeping with that normally used by the journal; in particular, vertical lines should not be drawn. Please be certain that the data given in tables are correct, as changes at the proof stage are particularly expensive.

ILLUSTRATIONS AND FIGURES

Colour figures: because of the high cost of colour printing, there is a charge to authors of £350 per colour figure.
It should be borne in mind that reduction of figures results in an accompanying reduction of boldness (thickness) of all parts of the figure. It is thus inappropriate to use a variety of boldness of axes, graph lines and lettering in one figure, or to present a figure drawn to a large scale in fine lines and with small, fine lettering. The problem of computer-produced diagrams may be obviated by programming the computer to produce a diagram of the same size as that of the final published diagram or, alternatively, to produce lines and lettering of large thickness so that photoreduction results in the appropriate size. Photographs and micrographs should be annotated.

Care should be taken that the labelling of axes does not extend the dimensions of the figure substantially. Avoid suppression of the zero point (the axes may be broken(/ /) if required). (See also Units, symbols and abbreviations below). It should be emphasized that the dimensions of a figure prepared for a slide are often unsuitable for reproduction on the printed page. Symbols which are to appear in the figure (and not in the legend) should be chosen from the examples shown below:

Accuracy in the preparation of figures is essential as is the appropriate use of symbols and abbreviations (see below), as alteration to figures or the re-drawing of them by the publisher is an expensive matter and the cost may have to be borne by the author.

UNITS, SYMBOLS AND ABBREVIATIONS

British Journal of Anaesthesia, in common with other journals in the UK and many other countries, uses the SI system of units with a few notable exceptions (pH and intravascular and ventilatory pressure measurements, which should be given in units of calibration, e.g. mm Hg, cm H2O). Blood-gas tensions and the partial pressures in the gas phase should be given in the appropriate SI unit (kPa for kilopascal). It is not intended to give a detailed account of the SI system, the notation of units, symbols and abbreviations in this document. Readers are referred to Units, Symbols and Abbreviations. A Guide for Biological and Medical Editors and Authors, 4th Edn. Baron DN, ed. (1988), published by and available from the Royal Society of Medicine, 1 Wimpole Street, London W1M 8AE.

Particular problems have arisen in relation to the notation of units which was introduced at the same time as the change to the SI system. Avoid the use of the solidus (/) in favour of various units of the expression set on one line. In the case of expressions 'below the line' superscript -1, -2, etc. as appropriate is given. Thus for drug dosage we write:

A Guide for Biological and Medical Editors and Authors (Baron, 1988) lists also the abbreviations which may be used by authors without previous definition of their meaning. As noted above, all other abbreviations must be defined, once in the summary and once in the text.

In addition, the 'Pappenheimer' system of abbreviations of respiratory terms (Pappenheimer JR, Comroe JH, Cournand A, Ferguson JKW, Filley GF, Fowler WS, Gray JS, Helmholtz HF, Otis AB, Rahn H, Riley RL. Standardisation of definitions and symbols in respiratory physiology. Federation Proceedings 1950; 9: 602-605) is acceptable without definition.

Spelling, etc. British spelling should be used with 'z' rather than 's' spelling in, e.g. organize, organization.

CORRESPONDENCE AND BOOK REVIEWS

Each issue of the journal will contain correspondence and book reviews. Correspondence arising from papers in a recent issue is published without delay, and for this reason, will be given priority over that pertaining to original research. The Editor may change, delete or modify in any way all items of correspondence.

All communications designed for publication should be submitted on a separate page in letter quality heavy type (not dot matrix), double-spaced, on one side only of the paper, with a wide margin. Contributors should send three copies of all correspondence to the editor and retain a copy in case of loss. Contributions must also be submitted on disk. All authors must sign the accompanying submission letter. Authors should provide a contact E-mail and fax number.

PROOFS

These should be corrected and returned to the publisher by post or fax within 48 h of receipt. Overseas contributors may fax a copy of the proofs to the publisher but should return their proofs by air mail also.

REPRINTS

On publication, the corresponding author will be sent the URL for online access to their article. Offprints can be purchased if application is made on the order form attached to the proofs. The order form should be returned with the proofs. Orders from the UK will be subject to a 17.5% VAT charge. For orders from elsewhere in the EU you or your institution should account for VAT by way of a reverse charge.  Please provide us with your or your institution’s VAT number.

FURTHER READING FOR AUTHORS

While it is hoped that this extended guide to contributors will be of value to those writing for British Journal of Anaesthesia, it should not be regarded as comprehensive instruction for those preparing manuscripts. A number of simple texts and papers have been prepared on this subject and it is essential that the author preparing his first manuscript should avail himself of these. We commend particularly Professor Hugh Dudley's book entitled The Presentation of Original Work in Medicine and Biology, published by Churchill Livingstone in 1977.

In addition, we recommend that authors should be familiar with Eric Partridge's Usage and Abusage-A Guide to Good English, published by Hamish Hamilton in several editions. Sir Ernest Gower's The Complete Plain Words, revised by Sir Bruce Fraser, is published by Penguin Books and is a treasure-house of common sense in writing. In the matter of spelling, British Journal of Anaesthesia follows the Shorter Oxford English Dictionary.

APPENDIX

Common sources of difficulty include the following:

• Blood-gases: specify carbon dioxide, P_CO2, etc.
• Blood pressure: avoid this term in favour of arterial pressure, etc. Specify mean, systolic, diastolic.
• Case: this should not be regarded as interchangeable with the term 'patient'. An account of the management of a patient may be referred to as a 'case history' or 'case report'.
• Chronic bronchitics: avoid this expression when you mean patients with chronic bronchitis.
• Data: plural.
• Demographics: often used incorrectly to refer to patient characteristics.
• Due to: avoid unless in the description of a financial debt. Because of and as a result of are preferable.
• Employed: prefer used.
• Fall and Rise: avoid these expressions which suggest a gravitational influence. Decrease or reduction and increase are preferable.
• Groups: avoid expressions such as 'thiopental patients' and 'cholecystectomy patients' in favour of 'patients receiving thiopental' and 'patients undergoing cholecystectomy'. It is permissible, however, to refer to the 'thiopental group' or 'cholecystectomy group'.
• High and Low: avoid if you mean large and small.
• Incidence: this refers to the proportion of a defined group developing a condition within a stated period. Frequency is the number of subjects (expressed usually as a percentage) with a condition. Prevalence is frequency at one point in time.
• Length (of time or drug effect): prefer duration.
• Level: avoid in favour of concentration.
• Multiple adjectives: avoid using an adjective in apposition to a noun, e.g. 'concentration of sodium' is preferable to 'sodium concentration'.
• Postoperatively and preoperatively: prefer after operation or before operation.
• Postoperative (preoperative) treatment: acceptable.
• Relaxants: avoid in favour of 'neuromuscular blocking drugs'.
• Rotameter: note capital letter.
• Sacrifice: this is ritualism. Killed is preferable.
• Showed: prefer was present or occurred.
• Significant: avoid expressions such as 'highly significant' or 'very highly significant', in favour of significant with a probability value in brackets.
• Sleep-dose: this is vague. Prefer a dose sufficient to abolish the eyelash reflex, etc.
• Stable (of measurements): prefer unchanged or virtually unchanged.
• Teflon: note capital letter
• Tendency to change: changed.

It is important to avoid conversational expressions such as:

• 'the patient was ventilated' (the lungs were ventilated)
• 'the patient was intubated' (the trachea was intubated)
• 'the patient was placed on a ventilator' (ventilation was controlled artificially)
• 'the patient was taken off the ventilator' or 'the patient was weaned from the ventilator' (artificial ventilation was discontinued)
• 'the patient was extubated' (the tracheal tube was removed).

FIRST DRAFT

There were 43 patients in the pethidine group and 41 in the morphine group. Table 2 shows that the two drug groups were evenly matched in terms of age, weight and duration of operation.

Sixty to ninety minutes after the injection, there was a reduction of anxiety score of 2.9 points in the pethidine group (highly significant P < 0.001) and a reduction of 1.3 points in the morphine group (significant P < 0.01). The difference in the magnitude of the reduction of anxiety between the two groups was not statistically significant. Both groups showed a further significant reduction to normal in the anxiety rating when tested again 24 hours after the operation.

Twenty-four hours post-operatively each patient was asked if she recalled seeing any picture cards before the operation. Only 12 out of 43 pethidine patients (28%) could remember all three pictures, while 27 out of 40 morphine patients (68%) were able to recall all three picture cards (Table 3). This indicates a significantly greater incidence of amnesia with pethidine than with morphine (P < 0.01) using this test. This persisted for 24 hours in three pethidine and five morphine patients.

Local erythema was present in twelve pethidine patients and in ten morphine patients ninety minutes after injection. This disappeared in the pethidine patients but was still present in the ten morphine patients twenty-four hours after surgery (PM < 0.01).

SECOND VERSION

Forty-three patients received pethidine and 41 received morphine. The groups were similar in age, weight and duration of operation (Table 2). Sixty to 90 min after injection there was a mean reduction in the anxiety score of 2.9 after pethidine (P < 0.001) and 1.3 after morphine (P < 0.01). The difference between the two groups was not significant. Both groups showed a further significant reduction to the normal range when tested 24 h after the operation.

Twenty-four hours after operation each patient was asked if she recalled seeing any picture cards before operation. Only 12 of 43 in the pethidine group (28%) could recall all three pictures, compared with 27 of 40 in the morphine group (68%) (P < 0.01) (Table 3). This persisted for 24 h in three patients in the pethidine group and five in the morphine group. Ninety minutes after injection, local erythema was present in 12 of the pethidine group and 10 of the morphine group. This was still present 24 h after surgery only in the 10 who had received morphine.