Questions From Users of the Manual

Q: I am writing a manuscript in which I want to include the dates that a list of products were first marketed. The database from which I got the information is a subscriber-only database. This seems to be the only place that has the information I want to use. Are such subscriber-only databases allowable to include in a reference list?

A: This question was one we had to address when working on the chapter on reference citation style and the answer we decided on was YES, these may be included in a reference list. (We did not address it specifically for a subscriber-only database, but this question also arises with reference to journal articles that are password-protected/available only to subscribers.) The rationale was 2-fold. First, if there is another place that the information can be obtained that is not behind a “wall,” then of course you might want to consider using that reference instead of the one that is not easily available to all. But, as you indicated in your case, sometimes there is no “free” site for the information you want to reference, and it’s important to acknowledge your source—even if access to it is limited. Second, thinking back to the days before people were citing much online material (and those days were not that long ago, were they?), reference lists frequently cited books that might be out of print or other sources that might not allow easy access. This doesn’t seem a reason not to include the material, even though it might be an annoyance to online readers to find that the source is not freely available, so YES.

Q: How would you cite a webinar?

A: I would extrapolate from the style recommended for citing an audio presentation:

Christiansen S. Medical copyediting with AMA style [webinar]. December 15, 2011.  http://www.copyediting.com.  Accessed April 6, 2012.

Q: In section 14.12, you state “Use the abbreviation [of units of time] only in a virgule construction and in tables and line art.” Does this mandate the use or merely allow the use of these abbreviations in these instances?

A: The answer is short. It does not mandate so much as allow, although units of measure are almost always abbreviated in column heads and stubs in tables and on axes in line art in our journals because of space considerations.—Cheryl Iverson, MA

 

Questions From Users of the Manual

Q: We do not find anything in the manual on how to treat “24/7.” Would you recommend spelling it out?

A: You are right. We don’t address this. But Webster’s 11th does. Both “24-7” and “24/7” are offered as equal variants. I think the latter is more common and would prefer that, without spelling it out.

Q: I understand that human genes are set all caps and italic, with the protein products set all caps and roman. But what to do with proto-oncogenes? Do the examples in section 15.6.2 indicate that, if the c- prefix is used, the lowercase (retroviral) form of the 3-letter oncogene is always used, regardless of whether we’re dealing with humans or mice? I am often presented with c-KIT, c-Kit, and c-kit in one document and would appreciate a clear explanation.

A: For oncogenes, it would always be c-kit and then, based on page 633 of the style manual, KIT for the human gene homologue and Kit for the mouse gene homologue.

Q: To follow your reference style, if “et al” is used, is a period used after “al”? And should the reference number be set as a superscript?

A: To answer your second question first, yes, the reference number should be set as a superscript if you follow the style set forth in the AMA Manual. And unless “et al” ends the sentence, “al” would not be followed by a period (even though it is an abbreviation).—Cheryl Iverson, MA

Questions From Users of the Manual

Q: Are arabic numerals used for measures of time:  years, months, weeks?

A: I’m assuming you are asking about using numerals vs words.  The short answer is yes; we use arabic numerals for years, months, and weeks.  But if you should also be curious about the use of  arabic vs roman numerals, see section 19.7.5; and for specific nomenclature conventions, see chapter 15.

Q: Do you have a style for citing tweets?

A: Our blog addressed this query on August 23, 2011.  Please take a look at this archived entry.

Q: How do you handle the word continued when it’s used after a title of a table that runs over onto a second page?

A: We don’t address this specifically in the manual, but if you look at one of the longest tables in the manual (the big SI conversion table in chapter 18) you will see that we used “(cont).”  Since then, however, in our own publications, we have switched to spelling the word out (“continued”) to better serve international readers (who may not recognize cont as a “familiar” abbreviation).

Q: If there is a “compound” acronym/abbreviation defined first in a manuscript (eg, chronic myeloid leukemia in chronic phase [CML-CP]) and, later in the same manuscript, just CML is required, should CML be redefined or did the first definition cover it?

A: Good question.  AMA Manual of Style authors agree that there is no need to expand a component of an already introduced compound abbreviation.  For instance, after introducing ST-elevation myocardial infarction (STEMI), there is no need to expand MI.  In your example, there is no need to treat CML as a new abbreviation.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: A colleague and I both remember seeing in a style manual that an en dash should be used between 2 words of equal weight. However, we checked the AMA Manual of Style and saw that this was not a supported use of the en dash. Did this guideline appear in a former edition of the AMA Manual, or did we just pick this idea up from another source?

A: No, I don’t believe we have ever recommended an en dash between 2 words of equal weight. It is the hyphen that we recommend between 2 words of equal weight. See the middle of page 346 of the 10th edition, with the examples of “blue-gray eyes” and “blue-black lesions.” We recommend use of the en dash when the items on either side are not of equal weight (eg, one element consists of 2 words or a hyphenated word or a compound). There are examples at the bottom of page 352 and the top of page 353.

Q: Is it appropriate to abbreviate echocardiography as ECHO or echo in documents that describe the use of echocardiography during the treatment of various types of cancer?

A: We would be unlikely to abbreviate echocardiography (or any related term, such as echocardiogram) to ECHO or echo. We would spell this term out. Only in cases in which there are serious space constraints would we consider abbreviating this term (eg, in a large table), and then we would recommend expanding the abbreviation in a table footnote.

Q: Do you use Web site or website? Traditionally it has always been “Web site,” but in the past few years I have noticed a change to the more informal “website” in many publications. What is your recommendation?

A: On the home page of the AMA Manual, in the navigation bar, there’s a listing for “Updates.” If you take a look there, you’ll see that a relatively recent update (January 18, 2012) indicates that, as of that date, we began to prefer website to Web site.  Check “Updates” periodically to see if there are other, newer updates on material in the manual.

Q: I have a style question I cannot find addressed in your manual. On a manuscript I plan to submit to a journal, the corresponding author has moved since the manuscript was written and this author wants to indicate both her current and her former affiliation. Can you advise on how to phrase this information?

A: The answer to your question is in section 2.3.3 of the manual. See the relevant excerpt below:

The affiliation listed, including departmental affiliation if appropriate, should reflect the author’s institutional affiliation at the time the work was done. If the author has since moved, the current affiliation also should be provided.

Author Affiliations: Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Dr Lloyd is now with the Department of Emergency Medicine, St Luke’s Hospital, Milwaukee, Wisconsin.

Cheryl Iverson, MA

Questions From Users of the Manual

Q: If a product name appears in all caps in a company’s product literature (with or without a trademark symbol or registered symbol), must the editor retain the all caps in a journal article? Companies use caps for graphic impact or emphasis, but caps can be distracting and can make the text difficult to read. Would it be acceptable to substitute only an initial cap for an all-cap product name, particularly if the product is the main subject of the manuscript and occurs frequently?

A: Our journals do not require use of the trademark symbol (™) or the registered symbol (®) as the use of the initial cap frequently used on proprietary names indicates the proprietary nature of the name (see 5.6.16, Legal and Ethical Considerations, Intellectual Property:  Ownership Access, Rights, and Management, Trademark). There are exceptions to the use of the initial cap (eg, pHisoHex; see section 10.8, “Intercapped” Compounds) and in these cases, as in all others, we advise using the name according to the presentation of the legal trademark. To avoid a plethora of caps—which certainly can be distracting—we would suggest varying the way in which the product is referred to (eg, “this product,” “it”) as long as the meaning remains clear.

Q: Your manual indicates that references should be numbered consecutively with arabic numerals in the order in which they are cited in the text. But what about the distinction between references cited in a range and references cited individually? If an author cites references 1 through 5, does this count as only the citation of reference 1, as the first number in the range, or does it count as citation of all 5 references included in the range?

A: It matters not if the references are cited as part of a range or cited individually. Even if a reference is cited as part of a range, when any one of those references is cited later, it retains the same reference number.  This is not specifically stated in the Manual and, perhaps wrongly, we assumed that it would be understood. Thank you for allowing us to clarify this point.

Q: Convention seems to be to use the leading zero in P values, but why is this necessary since P cannot be greater than 1?

A: JAMA and the Archives Journals do not use a zero to the left of the decimal point, since statistically it is not possible to prove or disprove the null hypothesis completely when only a sample of the population is tested (P cannot equal 1 or 0, except by rounding). If convention dictates otherwise, we are unconventional!

Q: I have been unable to find specific rules on the use of nonbreaking hyphens and spaces. Do you have any suggestions for the correct and preferred use of nonbreaking hyphens and spaces?

A: You are right. We do not have any section devoted to this. However, there is information about line breaks scattered throughout the Manual. For example:

  • On page 29 (section 1.20.4), there is information on how to break an e-mail address. The same guidelines apply to breaking URLs.
  • On page 646 (section 15.6.4), there is information on breaking long karyotypes.
  • On page 910 (section 21.5), there is information on breaking long formulas.

There may be other instances like this scattered throughout the Manual where specific guidance is needed. However, individual publishers or clients may have their own preferences that require attention when editing material for their publications.

Q: I am working on a manuscript in which one of the authors has listed the degree MAS (Master of Advanced Studies). This abbreviation is not included in the Manual. Is it acceptable?

A:  This is a perfectly acceptable abbreviation. We simply did not have space to list all possible degrees and their abbreviations in the Manual and attempted to list some of the more common ones.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: What do you recommend regarding the necessity of including state names (or province names or country names) with the names of certain well-known cities?

A: We used to have a list of cities that could stand without a state (or province or country), but we discontinued that with the ninth edition and recommend that a state or country name be included with all cities.  (What is well known to one may not be well known to another.)  For details and exceptions, see section 14.5.

Q: Do you recommend using “eg” or “e.g.”? Since this represents the shortening of 2 words, I believe “e.g.” would be correct.

A: We recommend using “eg,” closed up, with no periods. See the list of Clinical, Technical, and Other Common Terms in section 14.11. It is true that this abbreviation represents 2 words, but within the list in section 14.11 you will note that most of the abbreviations included represent at least 2 words and yet they are joined without periods. This is a fairly common practice.

Q: I can’t find anything in the Manual about “normal saline,” but I seem to remember that this term was not preferred. Help.

A: Your memory is good.  In the ninth edition of the Manual (section 15.11), we did  indicate a preference for isotonic sodium chloride solution over normal saline. However, in the current edition we dropped that preference and consider normal saline acceptable, so there is no need to change it. If an author uses isotonic sodium chloride solution, however, that too may stand.  Both terms are acceptable.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I am a medical writer (and writer, in general) and have always questioned the use of the lowercase “b” in the word “blacks.”  The “w” in “Whites” is normally capitalized when talking about that population.  Although this question is not limited to the AMA Manual of Style, how might I go about getting it changed so that the “b” in “blacks” is also capitalized, for consistency?

A: You will have noticed that in section 11.10.2 of the manual we do not use intial caps on either “white” or “black.”  Webster’s 11th seems to follow this policy also, as you will find definitions related to both races presented without initial caps. I also checked the Chicago Manual and, in section 8.39, they indicate a similar policy. “Common designation of ethnic groups by color are usually lowercased unless a particular publisher or author prefers otherwise.” So, there does seem to be consensus among this small sampling, but it is in the direction of using initial lowercase letters rather than initial caps for these terms.

Q: Are there courses that teach proper use of the AMA Manual of Style?

A: I know of one such course. It is the Medical Writing and Editing Certificate Program that is offered by the University of Chicago Graham School. See https://grahamschool.uchicago.edu/php/medicalwritingandediting/.

Q: I have been working as an APA style editor for nearly 3 years.  I would like to be able to work as an AMA style editor.  I need to learn the AMA style.  Which version of the manual do you recommend?  Is this manual available online?

A: You can visit the AMA Manual of Style Online site (www.amamanualofstyle.com) and you can see that you can purchase a book, an online subscription, or a “bundle” of both. You can also subscribe to the blog and sign up for tweets at no charge. Good luck to you!

Q: Does AMA have a preference for “versus” vs “vs”? If so, can you include the rationale behind the choice?

A: Yes, we prefer “vs” as an abbreviation for “versus” (except in the names of legal cases, where we use the conventional “v”). See the list of abbreviations (14.11) re our preference for how to abbreviate “versus” and also note that we do not require this abbreviation ever to be expanded.  Note too that the use of the lowercase italic “vee” is preferred in legal cases, per convention.  As to our rationale, we have been doing this for so long it is hard to recall exactly.  I suspect it was a combination of “vs” taking up less space than “versus” and being well recognized and understood by all/most.

Q: Is it 0.9 second or 0.9 seconds? The AMA Manual of Style doesn’t seem to address this particular question.

A: This question originally arose on the AMWA Editing-Writing Listserv. There was much good discussion and various sources were cited. After considering all the comments and polling our own staff, we come down on the side of Words Into Type and Edie Schwager’s Medical English Usage and Abusage (for print usage:  prefer the singular).  But when spoken, we prefer the advice of the Chicago Manual (section 10.68)—in general, prefer the plural.—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I thought AMA supported putting no space following a symbol such as > (eg, age <18) if, in the expression, the symbol is acting more as a modifier, not as an operator (eg, 3 < 4), in which case the symbol would have a space (AMA specifies a thin space).  If I’m mistaken, I need to make a mental adjustment.

A:  This is addressed in section 21.10.  We recommend thin spaces with such symbols as greater than, less than, equals, etc.  So, a small mental adjustment might be needed as we make no distinction between the 2 uses you describe.

Q: Is it true that AMA style no longer requires an expansion of CI (confidence interval) at first mention?

A: Yes, it’s true.  As of July 27, 2011, as announced on Twitter, we are no longer requiring that CI be expanded at first mention.  This is posted on the style manual Web site in “Updates to the Manual” and soon will have a special icon within the text to indicate that this material has been updated.

Q: Does AMA have a preferred format for telephone numbers?  How about international numbers?

A:   The manual does not address this question specifically (and perhaps it should).  However, if you look in section 25.11, you will see many examples (both from the United States and elsewhere) for presentation of telephone numbers.—Cheryl Iverson, MA

 

Jarring Jargon

Theodore M. Bernstein, in The Careful Writer: A Modern Guide to English Usage, describes jargon as “meaningless, unintelligible speech,” which is how some people might describe their last conversation with their physician. In science and medicine, many barriers to clear communication exist, with jargon being one of them. In fact, it’s so difficult for physicians and patients to communicate clearly that a federal program has been created to promote simplified health-related language nationwide. The Health Literacy Action Plan is a “national action plan to improve health literacy.” The entire action plan is 73 pages (which is probably their first mistake) and it highlights the fact that we have a problem.

As editors, we know that jargon is to be avoided in medical literature. While jargon may evolve for the most innocuous of reasons, it is a vocabulary specific to a profession that sometimes is esoteric or pretentious and that can be confusing to those not familiar with it (sometimes to those familiar with it as well). “Inside talk” can be just that by design—it keeps outsiders out. Therein lies the source of the negative feelings about jargon.

In addition to being exclusive, some jargon is offensive and unprofessional. Have you ever seen an FLK? Probably. That’d be a funny-looking kid. “We bagged her in the ER” sounds ominous; what it means is that a patient was given ventilatory assistance with a bag-valve-mask prior to intubation in the emergency department. Hopefully the emergency department physician didn’t describe the patient as a GOMER. This means “get out of my emergency room” and could refer to, for instance, an elderly patient who is demented or unconscious and near death and who perhaps should die peacefully rather than occupy emergency department resources. In this example, jargon diminishes the complexity of a situation that should be dealt with in a more thoughtful way. As Bernstein writes, “All the words that describe the kinds of specialized language that fall within this classification [of inside talk] have connotations that range from faintly to strongly disparaging.”

Jargon also sometimes violates rules of grammar, eg, turning nouns into verbs, “The doctor scoped the patient,” or creating back-formations, like “The patient’s extremities were cyanosed,” instead of “The patient’s extremities showed signs of cyanosis.” Jargon can sometimes appear to depersonalize, by defining a person in terms of a disease. A “bypassed patient” may be one who has undergone coronary artery bypass graft surgery rather than one who has been overlooked. Sometimes, patients might be referred to by their organs, such as “the lung in room 502” instead of “the patient in room 502 with lung disease.”

The AMA Manual of Style lists examples of jargon to avoid in section 11.4, Jargon. Some other examples that we’ve collected over the years are listed here:

* Collodion baby is better phrased as collodion baby phenotype or “the infant had a collodion membrane at birth.”

* Surgeons perform operations or surgical procedures, not surgeries.

* Rather than say a patient has a complaint, describe the patient’s primary concern.

* Do not use shorthand (eg, exam for examination, preemie for premature infant, prepped for prepared).

* Euphemisms sometimes are not clear and should be avoided: “The patient died” is preferred to “The patient succumbed or expired”; the same holds true for killed vs sacrificed (in discussion of animal subjects).

* Patients aren’t “put on” medication, they’re treated with medication. Also, patients aren’t “placed on” ventilators, they’re given ventilatory assistance.

Certainly jargon does have its place. It is specialized, and those in the same field can use it to communicate precisely and quickly. However, when it comes to medical and scientific publications, jargon is best avoided. Bernstein ends his entry on “inside talk” with the following: “It must never be forgotten that the function of writing is communication.” Clear enough.—Lauren Fischer

Questions From Users of the Manual

Q: I’m not sure when I should use “rheumatologic” vs “rheumatological.”  Is there a subtle difference I don’t know about?

A: The use of “-ic” vs “-ical” is addressed in the Manual on page 396 in the Correct and Preferred Usage chapter.  You’ll note that there are a few instances in which the choice of ending does make a difference in meaning.  With “rheumatologic” vs “rheumatological” I do not believe there is such a difference in meaning and we would be more likely to choose the “-ic” ending for the rationale described on page 396.

Q: I’ve always followed Edie Schwager’s advice in Medical English Usage and Abusage (p 153):

If you remember to prevent, you’ll never choose the obsolete “preventative” instead of “preventive.”  The noun is prevention, not “preventation.”

Do you agree?

A: We agree with Edie.  We also prefer preventiveWebster’s 11th edition shows the 2 words as equal in meaning but shows a preference for preventive as well.  Consensus!

Q: In section 3.15.3 of the Manual, the words “Web site” are used in examples 1 through 3 and 6, but are not used in examples 4 and 5.  What is the rationale for these differences?

A: This is an excellent question and points out an inconsistency that should be corrected.  I would include “Web site” in examples 4 and 5 as well.  In our next edition, I think we will need to consider if the inclusion of “Web site” is necessary or helpful.  In the current edition, we decided to drop the inclusion of “Available from:” before the URL as we thought that URLs were now well enough known that they did not need this extra identifier.  Perhaps this will also become the case with “Web site.”

Q: When an author’s surname includes 2 names not joined by a hyphen, which name should be included in the reference citation?

A: To assist in answering this question, I consulted Lou Knecht, Deputy Chief, Bibliographic Services Division, at the National Library of Medicine (NLM).  She said that the surname is determined by the preference of the author and she stressed the important role played by the author in presenting this information clearly to the publisher. Publishers also play an important role in clarifying the surname, for example, by using some  typographic device (eg, boldface on the author’s surname in the byline or in the table of contents) to make clear which is the surname.  She notes, “If the journal does not use some sort of surname indicator technique, then both the journal and NLM are left to make their best guesses.  And we frequently guess wrong.”   If NLM is contacted by an author to correct an incorrect surname (ie, the name is presented in direct order in the text and you cannot tell what the surname is), they will gladly do this.  They also monitor authors’ preferences for surname, so once NLM is contacted the first time about an incorrect surname, they enter the complicated surname into a table for the future.  If, however, the surname is published incorrectly, this requires an erratum.—Cheryl Iverson, MA