NB: 1. Please fill the form and send the first page in Word format; the second page needs to be filled in, signed by ALL of the authors and a scanned copy is to be sent to us for our record. It is a legal obligation.
2. By submitting the paper the corresponding author assumes responsibility for ensuring that the following declarations are correct; failure to do so may have serious implications in the case of subsequent investigations e.g. for scientific misconduct.
Title of paper: __________________________________________________________
Please find enclosed/attached the above paper which I/we submit for publication in Anaesthesia, Pain & Intensive care.
I/we have followed the Instructions for Authors fully and hereby confirm that;
- Written formal consent for the study (and not just for anaesthesia/surgery) was obtained from all participants. For Case Reports, I/we confirm that written informed consent for publication has been obtained from the patient(s) described (or the assent of the next of kin if the patient has died. NB: This requirement may be waived off by discussion with the editor in some cases.
- The paper itself and the data upon which it is based have not been published or accepted for publishing elsewhere other than an abstract or as part of a thesis for a higher degree, and that the paper is not currently under consideration for publication by any other journal.
- All authors have made a substantial contribution to the conduct of the study and/or preparation of the manuscript in keeping with the guidelines published by the International Committee of Medical Journal editors (Annals of Internal Medicine 1988;108:258-65). All authors have consented to be included in the list of authors, have read the submitted manuscript and have agreed that it should be submitted to APICARE. I/we confirm that nobody deserving authorship has been omitted.
- The clinical trial on which this study is based has been registered with___________
- The data have been , or are due to be presented in part at the following scientific meeting(s)___________________________________________________________
- Potential personal / financial / academic interests relating to this publication of the data are ________________________
- that the manuscript in whole or in part is not currently or has not been previously the subject of an investigation based on the ethical conduct of the study, or concerns over fraud, plagiarism, duplicate publication or authorship/author affiliation.
- I/we have checked all the references carefully and that they are correct and correctly formatted.
- I/we will allow the Editors to make changes to the manuscript, if accepted for publication, during the editing process to improve clarity and standard of the language without altering main points.
- I/we confirm that the journal will have the right to own the copyrights of the manuscript, once it is accepted for publication.
- All sponsors and funding sources are listed here_____________________
- We have also attached the following documents;
- Authors’ Contribution Form, duly filled.
- Institutional Ethical Committee Certificate (if required)
- Patients (or patient’s parent/guardian consent in case of a minor) duly signed to use the patient data or picture/s (if required)
Authors Names & Signatures:
1st Author’s signatures: ______________________________________________________
1st Author’s name and address: ________________________________________________
2nd Author’s signatures: _____________________________________________________
2nd Author’s name and address: _______________________________________________
3rd Author’s signatures: _____________________________________________________
3rd Author’s name and address: _______________________________________________
4th Author’s signatures: ____________________________________________________
4th Author’s name and address: _______________________________________________
5th Author’s signatures: ______________________________________________________
5th Author’s name and address: _______________________________________________
6th Author’s signatures: ______________________________________________________
6th Author’s name and address: _______________________________________________
7th Author’s signatures: _____________________________________________________
7th Author’s signatures and name: ______________________________________________
8th Author’s signatures: _____________________________________________________
8th Author’s signatures and name: _____________________________________________
(Please add if there are more than nine authors)
Corresponding Author’s Declaration
I certify that the contents declared above are correct to the best of my knowledge,
Corresponding Author’s signatures _________________________________ Date: _____________
Corresponding Author’s name: _______________________________________________________
Corresponding Author’s address: _____________________________________________________
E-mail: __________________________________ Phone: __________________________________