The BMJ's practice section includes several types of article. We welcome proposals of articles - please email these to practice@bmj.com

Change page

This occasional series aims to alert clinicians to the immediate need for a change in practice to make it consistent with current evidence. Our criteria for each proposed change are that:

• It targets a single therapeutic or diagnostic intervention for a reasonably common clinical problem
• It is underpinned by compelling and robust evidence
• It is both feasible and beneficial.

The main text should have four sections with these subheadings:

• The clinical problem
• The evidence for change (should include a box of literature search and selection methods, and indicate the strength of the evidence when citing each study eg “randomised controlled trial/case series of 121 patients”)
• Barriers to change
• How should we change our practice?

These articles should comprise no more than 800 words of main text with up to 10 references and a box of up top five key single sentence bullet points summarising the proposal for change.

If you would like to propose a change in clinical practice please email your proposal, briefly indicating how it fits the above criteria, to changepage@bmj.com

Guideline summaries

The BMJ publishes summaries of selected new guidelines, such as those produced by NICE. These are usually commissioned before the guidelines are launched and are ideally published contemporaneously with the actual guidelines. We do, however, consider unsolicited summaries of guidelines that are newly published or are about to be published. We will give priority to guidelines that:

• Cover common or important clinical problems relevant to general medical readers
• Are evidence based, using systematic and transparent methods to describe identify, select, assess and synthesise the evidence and to formulate the recommendations (guidelines will need to meet our criteria.
• Have clear and adequate methods for taking into account potential biases or competing interests among guideline developers
• Are new - we do not usually publish summaries of updated guidelines unless these are substantively different from the original.

Summaries should be no longer than 1200 words (main text, excluding Background) and shoud include these subheadings:

• Why read this? Please explain in no more than 4 to 5 sentences
• Recommendations. Focus on recommendations addressing important changes in practice, or areas of controversy or uncertainty in practice. Provide explicit statements of the quality of evidence and strength of recommendations, preferably using the GRADE system (we encourage but do not insist on this particular system)
• Overcoming barriers. Describe in just one paragraph any potential barriers to implementation and how these might be overcome
• Background. Provide, for web-only publication, any evidence of inconsistent practice prompting this guideline, a summary of methods for the guideline, future research topics, and references (which should include the full guidelines).

Easily missed

This occasional series aims to highlight conditions that may be often missed at first presentation in primary care. Our series criteria are that:

• there is evidence of underdiagnosis, misdiagnosis and/or delayed diagnosis of the condition in primary care (if no published evidence exists, audit data would be of interest)
• the condition is likely to present at least once a year to the average full-time primary care practitioner in the UK; or the condition is serious and delayed diagnosis is likely to worsen prognosis
• there are easily defined diagnostic features and/or tests with known predictive characteristics; and
• timely recognition will benefit the patient

The main text should have sections with these subheadings:

• Case history – briefly describe how a patient might present and be diagnosed in primary care (3-4 sentences maximum); this should be a case that might have been easily missed
• A brief description of the condition (1-2 sentences at most)
• Box entitled “How common is it?” provide 1) prevalence data, and 2) evidence of underdiagnosis, delayed diagnosis or misdiagnosis (not evidence of delayed presentation), which may include audit or medicolegal data if no other evidence is available"
• Section “Why is it missed?” – briefly describe factors known to contribute to missing this diagnosis
• Section “Why does this matter?” – briefly describe the consequences of missed diagnosis
• Section “How is it diagnosed?” – subdivide this into “Clinical” and “Investigations”, and focus on key clinical features or tests readily available in primary care, including predictive values or sensitivities and specificities
• Section “How is it managed?” – this should be no more than 3-4 sentences, as this is not the focus of the paper.

Articles should be up to 800 words long (main text), with up to 10 references, and a box of up to four key succinct bullet points on when to consider the diagnosis and how to diagnose it.

If you would like to propose a topic, please email your proposal, briefly outlining the evidence that it fits the four criteria above, to easilymissed@bmj.com.

Rational Imaging and Rational Testing

These two occasional series update clinicians on the best use of different imaging methods or diagnostic tests for common or important clinical presentations whose management will be influenced by ordering the right investigation.

The main text should have three sections with these subheadings:

• The patient
• What is the next investigation? Describe the nature and role of 2-3 imaging methods or tests, and the limitations or benefits of each)
• Outcome. What happened to the patient as a result of investigation?

These articles should comprise no more than 1000 words of main text with up to 10 references; one or two high-resolution images for Rational Imaging or one or two tables and figures for Rational Testing; and a box of up to four learning points (single sentence bullet points summing up the main lessons from the article). When these articles are based on real cases—which is generally necesssary for Rational Imaging but not for Rational Testing articles—we will need each patient’s consent to publication in the BMJ.

Uncertainties page

The Uncertainty series aims to highlight areas of practice where evidence is poor or unclear, and where uncertainty remains in management; this may include interventions where we think we have certainty, but on closer examination, find evidence for their effectiveness to be weak.

The main text should have sections with these subheadings:

• Introduction – 4 to 5 sentences succinctly describing the uncertainty around the clinical problem, which should be phrased as a question in the article title
• “What is the evidence of uncertainty?” – briefly describe your search strategy, then the type and quality of the evidence confirming uncertainty or showing variation in clinical practice; if a relevant systematic review does not exist on this topic, please ensure this is also mentioned
• “Is ongoing research likely to provide relevant evidence?” – identify the key research question that would address the evidence gap (preferably in a PICO format - population, intervention, comparison, and outcome) and indicate studies are underway that may do so.
• “What should we do in the light of the uncertainty?” – provide practical guidance to clinicians on what to do

Articles should be about 800 to 1000 words long (main text), with up to 15 references.

If you would like to propose an uncertainty in practice for this series, please email your proposal to uncertainties@bmj.com

10 minute consultations

The articles in this occasional series aim to advise general practitioners on the best way to use the first consultation for a common clinical problem. There is no need to cover what should be done in a subsequent consultation or in the long term: the whole point is to cover what can be said and done in 10 minutes.

These articles should be evidence based and should, when appropriate, refer readers to valid and well written patient information. Articles should be no longer than 600 words, with one box, figure, or table plus a box of three or four suggestions for further reading. These articles do not have a formal list of references. The main text should have three sections:

• a short case history (if this is about a real patient we will need their consent to publication).
• What you should cover
• What you should do

Patient’s journeys

The purpose of this series of occasional articles is to help doctors understand patients' experience of illness. The articles explore the effects of illness on patients' lives and on their relationships with healthcare professionals, family, friends, and carers. Their value is that they explain the patient's point of view. They should therefore be written by patients (who may also be doctors). Because the BMJ is international, the article should focus on day-to-day problems faced by the individual rather than on issues arising directly from local healthcare services.

The BMJ cannot guarantee publication of an article until it has been formally submitted and accepted. To reduce the risk of rejection, and because patients may not be experienced authors, the BMJ's patient editor, Peter Lapsley (plapsley@bmj.com), is happy to offer advice on draft articles. Throughout the process, we expect to deal directly with the patient and not via any intermediary.

Lessons from patient’s journeys: As the BMJ’s chief purpose is to help doctors make better decisions, we expect patients' journeys to have one or more messages for doctors. The commonest we've noticed (and the list is not exclusive) are:

• Doctors did not appreciate aspects of a condition that were very important to patients
• Doctors missed making the correct diagnosis for too long.
• Doctors were unaware of new or underused interventions that could have profoundly affected their patients' lives. (Such interventions must have a robust evidence base.)

Article length: Between 1000 and 1300 words long. The clinical commentary and the text in accompanying boxes (see below) is not included in this word count.Clinical commentaries for patient's journeys: Each patient's journey article should be accompanied by a commentary of no more than 500 words written by the patient's doctor. This should outline the nature, symptoms, and typical course of the condition, especially if it is relatively rare. Most importantly, it should explain what the doctor has learned from the patient's case and what lessons it holds for other doctors.

Patient's journeys and their clinical commentaries have no formal references. But it is helpful to include one box identifying useful resources for patients and clinicians such as patient support groups. Web addresses (URLs) should be listed and each website may be described in a sentence or two. There might also be a box identifying what was good and less good about the management of the illness.

We prefer patients to be identified, but they may remain anonymous if they wish. We will not use partial or fictitious names. We will not normally publish patients' or carers' postal addresses - just their town of residence. For any patient who is not an author but is mentioned or quoted in the article or appears in a photograph, please send us their signed consent to publication.

Quality improvement reports

We are keen to publish interesting and important descriptive reports on how people try to change and improve health services. Such reports do not fit easily into the standard IMRaD format for research papers.

Quality improvement reports should not exceed 2000-2500 words and 24 references and are structured like this:

• brief description of context: relevant details of staff and function of department, team, unit, patient group
• outline of problem: what were you trying to accomplish?
• key measures for improvement: what would constitute improvement in the view of patients?
• process of gathering information: methods used to assess problems
• analysis and interpretation: how did this information help your understanding of the problem?
• strategy for change: what actual changes were made, how were they implemented, and who was involved in the change process?
• effects of change: did this lead to improvement for patients – how did you know?
• next steps: what have you learnt/achieved and how will you take this forward?

Quality improvement reports have structured abstracts with these subheadings: problem, design, setting, key measures for improvement, strategies for change, effects of change, lessons learnt.

Lessons of the week

These are usually case reports or case series alerting readers to potential clinical problems. They should be less than 1200 words long and accompanied by a single sentence of up to 15 words stating the lesson. You will have to obtain all patients' written and informed consent to publication using the BMJ. We welcome illustrations.

The lesson should be as specific as possible and aimed at general readers. The BMJ's editors and peer reviewers use the following questions to assess lessons of the week:

• How common is the condition? (It should not be so rare that it is irrelevant to most BMJ readers).
• How commonly is the condition missed?
• How serious is it if missed?
• Will this report contribute to preventing missed cases?

The ideal lesson of the week would relate to a common condition, which is relatively commonly missed, serious if missed and where the report will help prevent further missed cases. The following exclusion criteria may also be useful:

• "Cock ups" and delayed diagnosis with no significant clinical consequences.
• Cases where everything possible was done but it ended in disaster anyway.
• Finger pointing ("someone else messed it up and we sorted it out").
• Single cases of unusual presentations of very rare illnesses.

Evidence based case reports

These reports show how evidence can be applied at all stages of patient care, and describe a clinical dilemma raised by a real patient. We will need the patient’s written and informed consent to publication using the BMJ.

These articles should not exceed 1200 words. Please define the clinical question in four parts; patient, intervention, comparison, and outcome. The report should show that you have searched for, cited, and summarised studies of appropriate relevance, design, and quality, and should state which bibliographic databases you have used.

Finally, the report should answer the research question or state that there is no answer available.