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June 30.

 1. AAFP
 2. Publications
 3. American Family Physician
 4. Authors Guide


AFP AUTHORS' GUIDE


AMERICAN FAMILY PHYSICIAN (AFP) IS A MONTHLY, EDITORIALLY INDEPENDENT,
PEER-REVIEWED JOURNAL OF THE AMERICAN ACADEMY OF FAMILY PHYSICIANS. AFP’S
MISSION IS TO EMPOWER FAMILY PHYSICIANS TO IMPROVE THE HEALTH OF PATIENTS AND
COMMUNITIES AS THE LEADING SOURCE OF MEDICAL INFORMATION WHILE ADVANCING SCIENCE
AND HEALTH EQUITY. THE CIRCULATION OF AFP’S PRINT JOURNAL IS MORE THAN 175,000
AND AFP IS CONSISTENTLY RATED THE NUMBER ONE JOURNAL AMONG PRIMARY CARE
PHYSICIANS. AFP EDITORS SEEK ORIGINAL ARTICLES FROM EXPERIENCED CLINICIANS WHO
WRITE CONCISE, EVIDENCE-BASED, AUTHORITATIVE CLINICAL REVIEWS TO AID FAMILY
PHYSICIANS IN PATIENT CARE. SUBMITTED MANUSCRIPTS MUST BE ORIGINAL, NOT
PREVIOUSLY PUBLISHED, AND NOT UNDER CONSIDERATION FOR PUBLICATION BY ANY OTHER
PUBLICATION. ARTICLES DEMONSTRATING A FAMILY MEDICINE PERSPECTIVE AND AN
APPROACH TO COMMON CLINICAL CONDITIONS ARE PARTICULARLY DESIRABLE.


AUTHORS' GUIDE SECTIONS

Article Proposals Articles and Departments Preparation of the Manuscript
References Style Guidelines Submitting the Manuscript Author Statements Conflict
of Interest Policy Manuscript Processing and Review AFP Videos



AUTHORS' GUIDE DOCUMENTS

Author Attestation Author Credentialing Form Authors' Responses to Reviews
Author Statements Biographic Sketch Form Consent for Publication Likelihood
Ratios, Predictive Values, Post-test Probabilities Literature Search and Data
Sources Manuscript Checklist Patient Handout Instructions Sample History &
Physical Examination Tables Sample Q&A Article Format SORT: Evidence Table of
Clinical Recommendations Tips for Creating an Algorithm in Word Tips for
Creating Original Tables and Algorithms Tips for Creating Titles



AUTHORS' GUIDE - CME CONFLICT OF INTEREST


--------------------------------------------------------------------------------


ARTICLE PROPOSALS

Before beginning work on a manuscript, authors should submit an article proposal
to afpjournal@aafp.org with the words “Article Proposal for AFP Editor” in the
subject line. This allows tailoring of the topic to AFP’s needs and prevents
overlap with recently published content or articles in preparation.

Authors must demonstrate expertise in their area of interest or manuscript
topic. The most experienced author should take the lead in evaluating the
available evidence and writing the manuscript. Article bylines may include a
maximum of three contributing authors. In our experience, allowing more than
three authors leads to an uneven-quality paper.

Resident physicians must work with an experienced attending physician who serves
as the first and corresponding author. Students can be coauthors for only the
following departments: Diary of a Family Physician, FPIN’s Clinical Inquiries,
FPIN’s Help Desk Answers, Letters to the Editor, Photo Quiz, Practice
Guidelines, video submissions, and the AFP Community Blog. Clinical review
articles, editorials, and other submissions with student authors are not
considered for publication.

When submitting an article proposal, the lead author must complete an Author
Credentialing form, and all authors must log into their AAFP account and
complete a Conflict of Interest form. If authors do not have an AAFP account,
they need to create one to access the Conflict of Interest form.

Note: To avoid bias or the perception of bias, our strict conflict of interest
policy precludes us from considering manuscripts sponsored directly or
indirectly by a pharmaceutical company, medical education company, or other
commercial entity or ineligible company, or those written by an author who has a
financial relationship with or interest in any commercial entity or ineligible
company that may have an interest in the subject matter of the article within
the previous 36 months or in the foreseeable future. This policy also includes
serving on a commercial speaker's bureau or advisory board, or receiving
commercial research support related to the subject matter of the article, among
other relationships outlined in our conflict of interest policy.

--------------------------------------------------------------------------------


ARTICLES AND DEPARTMENTS


CLINICAL REVIEW ARTICLES

Submit articles to Sumi M. Sexton, MD, Editor-in-Chief, using AFP’s Editorial
Manager submission system. For instructions, see Submitting the Manuscript.
Updated information about AFP’s acceptance rates and timelines to publication is
also available.

AFP articles are evidence-based clinical reviews. AFP focuses on clinical
conditions and diseases that are encountered frequently by practicing family
physicians, with an emphasis on diagnosis and treatment. Clinical reviews should
be 1,500 to 1,800 words in length.

AFP does not publish original research articles. Although case reports are not
featured as articles, brief case summaries may be submitted in the form of
a Letter to the Editor (see also Curbside Consultation and Diary of a Family
Physician).

Authors are expected to reply to accepted Letters to the Editor about their
article, especially any that question the science involved. Failure to do so
disqualifies an author from future publication in AFP.


CURBSIDE CONSULTATION

Curbside Consultation is a feature that addresses legal, psychological, and
ethical issues that physicians may encounter in their day-to-day practice. Each
piece contains a case scenario with a clinical question, a commentary section,
and a resolution of the scenario. Examples are available in the Curbside
Consultation department collection.

Authors may submit a topic proposal to Caroline Wellbery, MD, Associate Deputy
Editor at afpjournal@aafp.org. If the topic is approved, the author should
prepare a brief scenario that describes the challenge to resolve, ending with a
clinical question. Although the case is hypothetical, it should be presented as
a query to a consultant. The commentary then addresses the pertinent issues
presented in the case and should be limited to approximately 1,000 words. The
piece should conclude with a resolution of the case scenario, which can include
actionable advice for the family physician. One to two small tables (if
warranted) can be added, and up to 15 references can be used.


DIARY OF A FAMILY PHYSICIAN

The goal of Diary of a Family Physician is to share experiences and foster a
sense of camaraderie among readers. We are looking for stories that provide a
real-life flavor of day-to-day practice. These may reflect the broad range of
experience in family medicine and diverse clinical settings (e.g., solo or group
practice, rural, urban, hospitals, nursing homes, emergency department/urgent
care, house calls, telehealth, residency programs, community health centers,
universities). Submissions should be sent to afpjournal@aafp.org. Examples are
available in the Diary of a Family Physician department collection.

Content may focus on the joys and challenges of everyday family practice,
clinical treatment tips, personal experiences with patients and their families,
or diagnostic puzzles that can be addressed adequately in the space provided.

Diary submissions should be 150 to 300 words. Six to seven entries should be
provided in a submission (representing different hours or patient encounters on
a busy day in family medicine with the inclusion of an evening hour if
appropriate to describe a longer day or interesting personal or family event).
Avoid providing information that might allow anyone to identify a patient. Avoid
stories that promote a specific commercial product or political opinions.
Diverse perspectives are welcome, but the focus should be on the clinical
experience. First person is preferred when referring to yourself, but third
person may be acceptable in certain cases, such as when referring to the
patient.


EDITORIALS

Most editorials in AFP are solicited by the editors; however, freestanding
editorials are occasionally accepted. Editorials should range from 500 to 800
words in length and may include six to 12 references. Submit editorials
to afpjournal@aafp.org with the subject heading "Editorial."


LETTERS TO THE EDITOR

Letters to the editor are published in most issues of AFP in print or online
only. Online only letters are listed in the print table of contents. Authors may
comment on a previously published article or submit a freestanding letter on an
important clinical topic. Letters must be submitted in a Word document and be
less than 400 words, with a limit of one table or figure, six or fewer
references, and no more than three authors. If the letter is in response to a
previously published article, that article should be listed as one of the
references. Letters must not be submitted to any other publication. Possible
conflicts of interest must be disclosed at the time of submission. All authors
must sign an Author Statement form and log into their AAFP account to complete a
Conflict of Interest form. If authors do not have an AAFP account, they need to
create one to access the Conflict of Interest form. These forms should be
completed and submitted with the Letter to the Editor submission. If an author
of an accepted letter has a conflict of interest that is not deemed to be
disqualifying, the editor will add a disclosure statement at the end of the
letter.

Submission of a letter grants the AAFP permission to publish the letter in any
of its publications in any form. Accepted letters are edited to meet style and
space requirements. Send letters to Kenny Lin, MD, Deputy Editor of AFP at
afplet@aafp.org. 


PHOTO QUIZ

Photo Quiz presents readers with a clinical challenge based on a photograph or
other figure. Submissions should conform to AFP guidelines. Send submissions to
afpphoto@aafp.org. Please note that we receive many submissions each month and
it can take six to eight weeks for a decision about acceptance.

Photo Quizzes should be original and not published or under consideration for
publication elsewhere. Articles that demonstrate a family medicine perspective
on and approach to a common clinical condition are particularly desirable.

Authorship:

 * The first/corresponding author must be an experienced physician and
   preferably the same author. Residents and medical students may be coauthors.
 * All authors must sign and submit an author statement form.
 * All authors must log into their AAFP account and complete a Conflict of
   Interest form, with any financial relationship or interest disclosed in a
   separate email to afpjournal@aafp.org. If authors do not have an AAFP
   account, they need to create one to access the Conflict of Interest form. The
   AAFP requires all authors to disclose any commercial association that might
   pose a conflict of interest in connection with the submitted manuscript. View
   more information about what constitutes a conflict of interest.

Images:

 * Authors should submit original color photographs, slides, radiographs, or
   digital images that conform to the illustration guidelines outlined in
   "Figures" under Preparation of the Manuscript.
 * Figures should be original images. Do not obtain images from textbooks,
   journals, the Internet, etc. Acceptance of your Photo Quiz constitutes
   transfer of copyright.
 * Images must be in focus and clearly show the feature you describe for
   readers.
 * If you add wording, arrows, etc., also provide a clean image for our
   production department to work with.
 * Each figure should be submitted as a separate digital file, not embedded in a
   Word document.
 * Photographs in which a patient is identifiable (i.e., the patient would be
   able to identify themselves) must be accompanied by a signed Consent for
   Publication form granting AFP permission to publish the photo. Please note
   that obscuring the eyes does not provide adequate anonymity.

Text:

The text of your Photo Quiz should include the following elements: 1) title, 2)
introduction paragraph presenting the clinical scenario, 3) a question with one
correct and three or four incorrect answers, 4) discussion of correct answer, 5)
brief explanation of incorrect answers, and 6) a summary table. The following
are specific instructions for each element (view PQ template):

 * The Photo Quiz department intends to help our readers improve their clinical
   skills through learning about common clinical conditions with visual
   components. The primary avenues for this are images (e.g., a skin rash),
   radiographs, sonograms, and ECGs.
 * Photo Quiz is not a case report. It uses case-based teaching to illustrate
   and educate on a common clinical topic. Two primary criteria for publishing a
   Photo Quiz are 1) the problem is commonly seen by practicing family
   physicians and 2) the image shows a typical example. Thus, we prefer images
   that show typical pathology or common variants rather than
   “once-in-a-lifetime” cases.
 * The title should hint at the diagnosis without giving it away.
 * The introduction paragraph presents the scenario that goes with the image.
   Include clinical information that would logically be included for the
   presenting complaint.
 * The question should be one to four sentences in length and contain the
   appropriate information needed to answer the question using the image. The
   question can be arranged in any of the following formats:
   
   
   * Reader chooses the correct diagnosis: “Based on the patient’s history and
     physical examination findings, which one of the following is the most
     likely diagnosis?"
   * Your answer choices can include other physical findings, laboratory values,
     typical pathology, appropriate treatment, typical clinical course,
     appropriate treatment setting, etc.: “Based on the patient’s history and
     physical examination findings, which one of the following (physical
     finding, laboratory value, etc.) is most likely?”
   * Reader chooses the appropriate treatment for the condition: “Based on the
     patient’s history and physical examination findings, which one of the
     following treatment options is most appropriate?”
      
 * Please provide one correct and three or four incorrect answer choices.
   Answers should come from an appropriate differential diagnosis for the
   condition you present.
 * The discussion of the correct diagnosis should cover important key features
   of the diagnosis, including defining features, epidemiology, and clinical
   findings. Begin with a short explanation of why the photo make the diagnosis
   correct. Please limit your discussion to 300–500 words.
 * Follow your discussion with brief (one to two sentences) explanations of each
   incorrect answer, describing why they are incorrect or not typical of the
   photo.
 * Create a Summary Table listing your answer choices and key characteristics of
   each (see PQ template). Make sure the information in the table is consistent
   with what you present in the main text.

--------------------------------------------------------------------------------


PREPARATION OF THE MANUSCRIPT


CHECKLIST

Please review this manuscript checklist carefully before submitting your
manuscript to ensure it includes all required components and conforms
with AFP style. This checklist is required and will be uploaded with your
manuscript.


LITERATURE SEARCH AND DATA SOURCES

In a short paragraph, please succinctly describe your search strategy, the key
word(s) used, the date(s) of the search, and the data sources you accessed in
identifying the highest-quality evidence on your topic. By "data sources," we
mean sources such as Cochrane reviews and Agency for Healthcare Research and
Quality, in addition to a PubMed search using the Clinical Query function. Do
not list the actual references you found in each source; simply include them in
your bibliography.

We strongly recommend that you search the following freely accessible
evidence-based sources of information and also consult our Evidence-based
Medicine Toolkit.

As part of your paragraph, please also include a statement about the use of
individual characteristic classification variables (e.g., race, gender, sexual
orientation), if applicable. Please see the sample paragraph below.

If studies used individual characteristic classification variables in analyses
or models and you choose to include this information, you should  consider the
following and clarify in the manuscript: (1) what the variables are truly
measuring (i.e., is self-identified race acting as an indicator of systemic
racism?); (2) what hypothesis or research question justifies their inclusion;
and (3) how the variables were defined/identified in the included studies.

If you believe that there are studies that have important information even
though there were questions about how individual characteristic classification
variables were identified, please include a statement to that effect in your
manuscript. As an example of the limitations inherent in this process, we
acknowledge that many studies more than a few years old offered participants
only the binary male/female option for gender identity. A brief statement that
acknowledges this issue when that study is utilized is acceptable.

The AFP Diversity, Equity, and Inclusion Committee is happy to help with issues
like this. Please contact the editor assigned to your manuscript with questions
about how to review and evaluate this information in a particular study.

Some examples of how two individual characteristic classification variables, in
this case race and gender, are not clearly identified or are identified
inappropriately include, but are not limited to, the following:

 * Race and gender are key demographics leading to specific outcome
   recommendations, yet there is no mention in the study about how race and
   gender were defined.
 * The study investigators assigned race/ethnicity or gender based on the
   patient's appearance, the patient's first or last name, or other subjective
   assessment.
 * Authors make overarching statements about entire ethnicities or races in
   their conclusions based on country location of the study.
 * Authors offered only male/female as binary options for gender and made
   overarching assumptions about other demographic groups that are nonbinary.

Sample Data Sources paragraph:

Data Sources: A PubMed search was completed in Clinical Queries using the key
terms gout and hyperuricemia. The search included meta-analyses, randomized
controlled trials, clinical trials, and reviews. The Agency for Healthcare
Research and Quality Effective Healthcare Reports, the Cochrane database,
DynaMed, and Essential Evidence Plus were also searched. We critically reviewed
studies that used patient categories such as race and/or gender but did not
define how these categories were assigned, stating their limitations in the
text. Search date: November 18, 2023.

Websites for Sources of Evidence-Based Clinical Information:

Free Access Websites

ACCESSSS

McMaster University’s compendium of pre-appraised evidence to support clinical
decisions. Content is presented in a hierarchical way, with the highest level of
available evidence listed first.

Agency for Healthcare Research and Quality
In particular, see AHRQ’s Evidence Reports on clinical topics.
Note: AFP publishes many of these reports in the Implementing AHRQ Effective
Health Care Reviews department collection.

Cochrane Database of Systematic Reviews
Free for abstracts only, which in most cases provide the key findings of
interest. The complete review requires a subscription. The Cochrane database
contains systematic reviews of narrowly focused clinical questions (e.g.,
colchicine for treating acute gout attacks) as opposed to broad, general reviews
of topics (e.g., management of an acute gout attack).
Note: AFP publishes summaries of Cochrane abstracts in Cochrane for Clinicians.

ECRI Guidelines Trust

Repository of evidence-based clinical practice guidelines, appraised using the
National Academy of Medicine’s Standards for Trustworthy Clinical Practice
Guidelines. 

National Center for Complementary and Integrative Health
The National Center for Complementary and Integrative Health (NCCIH) conducts
research and provides information on complementary and integrative health
approaches.

Trip (Turning Research Into Practice)
Contains links to a wide range of journal articles, medical organization
clinical guidelines, online medical references, and other sources. A limited
version is freely available; additional content requires an annual subscription.

U.S. Preventive Services Task Force
Premier source of evidence-based, graded recommendations for clinical preventive
services.
Note: AFP publishes Recommendations and Reports from the USPSTF and CME case
studies in the Putting Prevention Into Practice series.

Subscription Required Websites

Most of these are point-of-care clinical information and decision support tools.
These websites provide important background information, but authors should
review the primary source to use as a citation for the article.

DynaMed

Essential Evidence Plus
Includes POEMS (collections of patient-oriented evidence that matters).

NatMed
Database of dietary supplements, natural medicines, and complementary,
alternative, and integrative therapies.

PEPID

UpToDate

To ensure adequate searching on your topic, we strongly recommend that the above
sources be reviewed, in addition to a PubMed search using the Clinical Query
function. This is done by using the provided link, or by going to the PubMed
home page, and selecting “Clinical queries” from the lower center of the screen.


MANUSCRIPT FORMAT

Manuscripts formatted to conform to the International Committee of Medical
Journal Editors Recommendations for the Conduct, Reporting, Editing, and
Publication of Scholarly Work in Medical Journals are acceptable for
submission.1 AFP endorses these guidelines. Double-space the entire manuscript
with 1-inch margins. Arrange the manuscript in the following sequence, with each
section beginning on a new page:

 * Title page
 * Abstract
 * Text
 * Literature Search and Data Sources
 * References
 * Tables, including a SORT: Evidence Table of Key Clinical Recommendations
   (each table begins on a new page)

The title page, abstract, text, literature search and data sources, references,
and tables should be in a single Microsoft Word document (DOC or DOCX). Number
pages consecutively in the upper right-hand corner and remove all identifying
information.

Please carefully review the detailed instructions for each section that follows:


TITLE PAGE

This page should contain only the title of the manuscript, word count for the
entire manuscript, and word count for text only (excluding abstract, literature
search and data sources, references, tables, figures). Omit identifying
information, such as authors’ names.

Sources of support in the form of grants, equipment, or drugs should be
disclosed upon submission and when completing a Conflict of Interest Form; this
information will be included as a footnote to the published article. For
details, see AFP’s Conflict of Interest policy.


ABSTRACT

Include an abstract of 100 to 200 words, depending on the length of the text,
that provides factual and specific (rather than general and nonspecific)
information summarizing the main points of the manuscript. For example, instead
of saying, “This article will describe the differential diagnosis of chest pain
in adolescents,” say, “The most common causes of chest pain in adolescents
include musculoskeletal strain, hyperventilation syndrome, and anxiety.” For
clinical reviews, emphasize key points in the diagnosis and treatment of the
condition discussed. All information provided in the abstract should also be
available in the body of the article or in tables or figures.


TEXT

Articles should be 1,500 to 1,800 words (maximum 2,000 words), unless you
received instructions from our editors specifying otherwise. These word counts
do not include the title page, abstract, literature search and data sources,
references, tables, figures. Manuscripts longer than 2,000 words are rarely
accepted.

Do not include a summary or conclusion section; anything that you would
ordinarily put in such a section should go in the abstract.

Provide appropriate reference citations to support key clinical recommendations,
statistical information, reports of previous studies, controversial statements,
etc. Use the following guidelines in choosing references:

 * Avoid citing other clinical review articles—you should emphasize original
   research articles, systematic reviews, Cochrane reviews, , validated clinical
   decision rules, randomized trials, and evidence-based practice guidelines
   where possible. Clinical review articles may be cited as sources for tables,
   figures, or general background information.
 * Emphasize recent references (within the past 10 years); in general, avoid
   letters to the editor, editorials, and references that are older than 10
   years or of historic interest only.
 * Avoid references from obscure or non–English-language journals.
 * Do not cite abstracts, unpublished observations, manuscripts in preparation
   or submitted for publication, or personal communications.
 * To avoid plagiarism, do not use the language, content, or concepts of another
   source without an appropriate reference. Do not use extensive verbatim or
   near-verbatim portions of text from another source, even with appropriate
   citation.

Begin the writing process by identifying key clinical questions and
controversies related to your topic, and then answer them with the best
available evidence. Do not write the article and then find selected references
to support your opinions!


REFERENCES

Number references in the text in the order of citation. Arrange references
numerically, not alphabetically. Do NOT use EndNotes or any other automated
reference function.

Abbreviate journal titles according to the style used in PubMed. If there are
three or fewer authors, list them all; if there are more than three, list the
first three followed by ", et al." Do not use periods after authors’ initials.
Include beginning and ending page numbers for journal and book references.

The average number of references for a full-length article ranges from 30 to 40.
Most articles should not exceed 50 references.

References first cited in tables or figure legends must be numbered to remain in
sequence with references cited in the text.

Reference Examples

Standard Journal Article

 1. Weiss BD. Nonpharmacologic treatment of urinary incontinence. Am Fam
    Physician. 1991;44(2):579-586.
 2. Gold D, Bowden R, Sixbey J, et al. Chronic fatigue. A prospective clinical
    and virologic study. JAMA. 1990;264:48-53.

Chapter in a Book

 1. Murray JL. Care of the elderly. In: Taylor RB, ed. Family Medicine:
    Principles and Practice. 3rd ed. Springer-Verlag, 1988:521-532.

Website

 1. BMJ Publishing Group. Clinical evidence on tinnitus. Accessed November 12,
    2013. http://www.clinicalevidence.com 


TABLES

Authors should maximize the educational value of tables. Tables should be
succinct, as long lists are less helpful. They should be sorted in a clinically
meaningful way (e.g., most accurate, most common, most effective) with an
explanatory footnote, or otherwise alphabetically if there is not enough data to
support a particular order. Provide complete reference data for each item in a
table, even if you consider the table to be “original,” and note whether the
table has been previously published elsewhere. For all tables that are borrowed
or adapted from other sources, include full PDFs of the original sources and
ensure that complete reference data are provided.

Do NOT attempt to obtain reprint permission from the original
publisher. AFP will seek permission from the copyright owner to publish the
material in print and other formats. However, it is possible that the
rightsholder will not grant permission for use of copyrighted materials,
and AFP reserves the right to withhold tables or figures from print and other
formats based on the rightsholder’s terms. We discourage reuse or adaptation of
tables from the following sources: JAMA journals, AAP, APA, and UpToDate.  Due
to the increasing difficulty with obtaining permission to adapt previously
published material, we strongly encourage authors to create original tables and
figures. See Tips for Creating Original Tables and Algorithms and How to Create
an Algorithm in Word. 

Tables should be interpretable without reference to the text. Each table should
have a title, be numbered sequentially with Arabic numerals (except the SORT:
Evidence Table of Key Clinical Recommendations), and be on a separate page.

Use Microsoft Word’s “Tables” function to create the table. Do not just use
spaces and tabs, which quickly become misaligned as the manuscript is edited and
revised. We also do not accept tables as embedded images (e.g., screenshots). In
general, include tables in your main document rather than in separate files.

For tables that include drug pricing, please use information from GoodRx to find
representative undiscounted prices, not using GoodRx coupons.

Clinical Decision Tools: Please mention and include links to relevant clinical
decision tools and calculators, especially those published in AFP’s
Point-of-Care Guides and on the medical calculator website MDCalc.

Costs of laboratory tests, imaging studies, and clinical procedures: Where
relevant, please include approximate, representative costs for tests or
procedures, especially in tables where comparative cost is discussed. We use
Healthcare Bluebook as the source for pricing when possible. If you use another
source, please provide a complete citation for it.


SORT: EVIDENCE TABLE OF KEY CLINICAL RECOMMENDATIONS

Each article should include an evidence table called a SORT or Strength of
Recommendations Table. This table helps readers understand the main points of
your article, and the strength of evidence that supports its recommendations.
The table should contain the key clinical recommendations and strength of
recommendation ratings for your article as shown in the example below:

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation

Evidence rating

Comments

Obtain an ECG in patients presenting with chest pain.1,2

C

Consensus guideline based on observational studies

Patients with two normal highly sensitive troponin tests an hour apart can
safely be sent home.10

B

Meta-analysis of randomized trials

Patients with chest pain should immediately receive oxygen and if not allergic
an aspirin tablet.17,18

A

Consistent findings from randomized controlled trials and recommendation from
evidence-based practice guideline

ECG = electrocardiogram.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or
limited-quality patient-oriented evidence; C = consensus, disease-oriented
evidence, usual practice, expert opinion, or case series. For information about
the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The SORT table is intended to highlight the most important three to seven
recommendations from your article for clinicians. Each recommendation must be
accompanied by a SORT rating of A, B, or C. Your recommendations should
emphasize interventions and approaches that improve patient-oriented outcomes
(e.g., morbidity, mortality, quality of life) over disease-oriented evidence
(e.g., biomarkers, surrogate endpoints).

 * You should have three to seven recommendations. Try to identify a range of
   recommendations (for example, one each about screening, prevention,
   diagnosis, and two about treatment).
 * Each statement should be in the form of a recommendation and should not just
   present a fact or piece of medical trivia. For example, “Use the Wells score
   to determine the risk of DVT in patients with leg pain” is a recommendation,
   but “Of patients presenting with leg pain, 16% have a DVT” is not.
 * An “A” recommendation should be based on consistent evidence of improved
   patient-oriented outcomes from well-designed studies. Use clear, directive
   language, as this is a recommendation that should be applied to most
   patients, such as “Patients 50 to 74 years of age should receive screening
   for colorectal cancer." 
 * A “B” recommendation is based on lower-quality evidence of improved
   patient-oriented outcomes or inconsistent evidence. These statements should
   use language such as “Consider…” or “…is a practice option” or “…may be
   effective.”
 * A “C” recommendation is often something that is a standard of care, but for
   which there have been no clinical trials or trials have only reported
   disease-oriented outcomes. In this case, the recommendation statement should
   reflect the strength of recommendation, and the “Comments” column should
   clarify that this is a recommendation based on “expert opinion in the absence
   of clinical trials” or “evidence from clinical trials with blood pressure
   reduction as the outcome.”

If you are not comfortable assigning the strength of recommendation (below),
please attempt to follow the guidelines but acknowledge your uncertainty and our
medical editors will carefully review your work. To rate the strength of
evidence supporting key clinical recommendations, please use the following
guidelines:

Strength of Recommendation

Definition

A

Recommendation based on consistent and good-quality patient-oriented evidence*

B

Recommendation based on inconsistent or limited-quality patient-oriented
evidence*

C

Recommendation based on consensus, usual practice, expert opinion,
disease-oriented evidence,** and case series for studies of diagnosis,
treatment, prevention, or screening

*—Patient-oriented evidence measures outcomes that matter to patients:
morbidity, mortality, symptom improvement, cost reduction, and quality of life.
**—Disease-oriented evidence measures intermediate, physiologic, or surrogate
endpoints that may or may not reflect improvements in patient outcomes (e.g.,
blood pressure, blood chemistry, physiologic function, and pathologic findings).

Use the table below to determine whether a study measuring patient-oriented
outcomes is of good or limited quality, and whether the results are consistent
or inconsistent between studies:

Type of Study

Study Quality

Diagnosis

Treatment/Prevention/Screening

Prognosis

Level 1 Good-quality patient-oriented evidence

Validated clinical decision rule

Systematic review/meta-analysis of randomized controlled trials (RCTs) with
consistent findings

Systematic review/meta-analysis of good-quality cohort studies

 

Systematic review/meta-analysis of high-quality studies

High-quality individual RCT +

Prospective cohort study with good follow-up

 

High-quality diagnostic cohort study *

All or none study ++

 

Level 2 Limited-quality patient-oriented evidence

Unvalidated clinical decision rule

Systematic review/meta-analysis of lower-quality clinical trials or of studies
with inconsistent findings

Systematic review/meta-analysis of lower-quality cohort studies or with
inconsistent results

 

Systematic review/meta-analysis of lower-quality studies or studies with
inconsistent findings

Lower-quality clinical trial +

Retrospective cohort study or prospective cohort study with poor follow-up

 

Lower-quality diagnostic cohort study or diagnostic case-control study *

Cohort study

Case-control study

 

 

Case-control study

Case series

Level 3 Other evidence

Consensus guidelines, extrapolations from bench research, usual practice,
opinion, disease-oriented evidence (intermediate or physiologic outcomes only),
and case series for studies of diagnosis, treatment, prevention, or screening.

*—High-quality diagnostic cohort study: cohort design, adequate size, adequate
spectrum of patients, blinding, and a consistent, well-defined reference
standard.
+—High-quality RCT: allocation concealed, blinding if possible,
intention-to-treat analysis, adequate statistical power, adequate follow-up (>
80%).
++—An all-or-none study is one where the treatment causes a dramatic change in
outcomes, such as antibiotics for meningitis or surgery for appendicitis, which
precludes study in a controlled trial.

Consistency Across Studies

Consistent

Most studies found similar or at least coherent conclusions (coherence means
that differences are explainable). 

or

If high-quality and up-to-date systematic reviews or meta-analyses exist; they
support the recommendation.

Inconsistent

Considerable variation among study findings and lack of coherence. 

or

If high-quality and up-to-date systematic reviews or meta-analyses exist, they
do not find consistent evidence in favor of the recommendation.

For more information on how to apply these ratings, please see this
AFP explanatory article. Use this algorithm for determining the strength of a
recommendation based on a body of evidence (applies to clinical recommendations
regarding diagnosis, treatment, prevention, or screening). Although this
provides a general guideline, authors and editors should adjust the strength of
recommendation based on the benefits, harms, and costs of the intervention being
recommended.


FIGURES

AFP encourages the submission of original figures that clarify the text. Figures
include illustrations, photographs, radiographs, scans, sonograms, diagrams,
graphs, flow charts, algorithms, etc. AFP requires authors to transfer copyright
ownership of original figures to the AAFP.

Clearly identify figures that have not been previously published and are
supplied by a person other than the author and provide complete contact
information for the owner of the material. For figures supplied by your
institution or a colleague, clearly indicate whether that institution/person is
retaining copyright (in which case we will need to contact them) or whether
copyright is being transferred to the AAFP.

For all figures that are borrowed or adapted from other sources, include full
PDFs of the original sources and ensure that complete reference data are
provided.

Do NOT attempt to obtain reprint permission from the original
publisher. AFP will seek permission from the copyright owner to publish the
material in print and other formats. However, it is possible that the
rightsholder will not grant permission for use of copyrighted materials,
and AFP reserves the right to withhold tables or figures from print and other
formats based on the rightsholder’s terms. Due to the increasing difficulty with
obtaining permission to adapt previously published material, we strongly
encourage authors to create original tables and figures. See Tips for Creating
Original Tables and Algorithms and How to Create an Algorithm in Word. 

Each figure should be submitted as a separate file and numbered sequentially as
it appears in the text. Diagnostic images (e.g., ECGs, sonograms, radiographs),
artwork, line drawings, and nondigital photographs should be scanned at a
resolution of at least 600 DPI before submission and saved as TIFF files. Only
the following file formats are acceptable; others will be returned to the author
for reformatting and resubmission.

 * TIF/TIFF (Tagged Image File Format)
 * PNG (Portable Network Graphic)
 * JPG/JPEG (only high-resolution images of at least 300 pixels or dots per inch
   [ppi or dpi])
 * Microsoft Word (DOC or DOCX; acceptable ONLY for tables or algorithms; NOT
   acceptable for imported images)
 * Microsoft PowerPoint (PPTX; acceptable ONLY for algorithms; NOT acceptable
   for imported images)

Image resolution is typically measured in pixels per inch, or ppi (some use the
term "dots per inch," or dpi). The image’s resolution and its dimensions
determine the overall file size of the image, as well as the quality of the
output. Images with a resolution of 72 ppi (28.35 pixels per cm) are adequate
for materials posted on the Web; however, this resolution is inadequate for
print media. If your file size is less than 200 kb, it is almost certainly of
too low a resolution for a print journal. For color and grayscale images of 3 to
5 inches, we recommend a resolution of 300 ppi (118.11 pixels per cm). Line
drawings in black and white require a higher resolution of 600 ppi (236.22
pixels per cm). An image generated by a digital camera as a 72 ppi JPEG file may
still be acceptable if it measures at least 14 inches wide or high.

We strongly prefer original photographs/images because images downloaded from
websites or taken from other publications rarely reproduce well, even if we are
able to obtain permission to reprint them. We also encourage you to consider
producing original videos to accompany your article to clarify clinical exams,
procedures, etc. Find more information on creating and submitting AFP videos
here: https://www.aafp.org/pubs/afp/authors.html#10.

Because the quality of original illustration varies, it may be necessary to have
the art you supply redrawn to meet AFP’s artistic standards. AFP’s art
department is available to assist authors in the creation of original,
high-quality artwork to illustrate manuscripts accepted for publication. This
service is provided at no charge to authors but is subject to editorial
judgment.

Other guidelines for artwork:

 * Symbols, labels, and arrows in figures should be clearly marked and large
   enough to remain legible if the size is reduced for publication. For
   photographs, also provide a separate, clean version.
 * Photographs in which a person is identifiable MUST be accompanied by
   the patient’s written permission for publication. "Identifiable" means that
   the person in the photo (or a parent/guardian) could reasonably be expected
   to recognize himself/herself. This includes visible tattoos and jewelry. A
   bar obscuring the eyes does not provide adequate anonymity and is not
   acceptable [see NEJM, August 24, 1989, p. 550].
 * Because of the poor quality inherent in reproducing previously published
   images, photographs and radiographic images from textbooks and journals
   cannot be reproduced in AFP, regardless of whether permission has been
   obtained from the publisher.
 * Do not save images within a Microsoft Word or PowerPoint document or use the
   “Drawing” features of Word.
 * Legends for each figure should be combined on a separate page at the end of
   the manuscript, including complete reference data for each figure. If a
   figure is original, explicitly label it as such. Indicate whether any figures
   have been previously published elsewhere.

Save each figure as a separate file, with a name that includes the figure number
as referenced in the manuscript. Files should be uploaded at the time of
manuscript submission in AFP's Editorial Manager site and clearly labeled.

Acceptance of a manuscript for publication is contingent on provision of artwork
that meets the above specifications. For questions about preparing art or
digital images for your manuscript, contact Dave Klemm, AFP Medical Art
Coordinator, at afpjournal@aafp.org. After your manuscript has been accepted for
publication, address questions about art to the medical editor.


ACKNOWLEDGMENTS

You may acknowledge professional help in the preparation or review of your
manuscript. Written permission is required to publish the names of persons
acknowledged; see the Author Statements Form. To accommodate blinded peer
review, acknowledgments should be submitted in a separate file from the
manuscript.


BIOGRAPHIC SKETCH

Please complete a brief Biographic Sketch form for each author, which includes
information on current affiliations, medical training, and contact details. To
accommodate blinded peer review, biographic sketch forms should be submitted in
separate files from the manuscript.

AFP Authors’ Guide Reference

 1. International Committee of Medical Journal Editors. Recommendations for the
    conduct, reporting, editing, and publication of scholarly work in medical
    journals. Updated January 2024. Accessed January 23,
    2024. http://www.icmje.org/index.html

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AFP STYLE GUIDELINES

Headings. Use ALL CAPITALS to indicate major sections of the manuscript , and
Initial Capitals for subsections.

SI Units. Include SI units in parentheses after conventional units
(https://academic.oup.com/amamanualofstyle/si-conversion-calculator).

Measurements. Do not include periods after metric measurements.

Numbers. Spell out numbers one through nine. Use numerals for 10 and greater.
Exceptions: always use numerals in dosages, percentages, degrees of temperature,
and metric measurements.

Drug names. Use the generic name for all drugs. Include the trade name in
parentheses after the first mention of a drug in the text. Trade names used
in AFP are typically the first brand that was approved. If a drug is not
available in the United States, indicate so in parentheses after the drug name.

Abbreviations. Except for units of measurement, abbreviations are discouraged.
If used, an abbreviation should be preceded by the words for which it stands.
For example, computed tomography (CT). This need only be done on the first use,
not throughout the manuscript.

Percentages. Use the percent sign (%) rather than the word “percent.”

Style questions. For questions about medical writing style, consult the American
Medical Association Manual of Style.1

Formatting text. Do not justify the right margin; do not use bold print or
italics; use a single, standard 12-point typeface (e.g., Times New Roman,
Arial); and double-space the entire manuscript.

Reference

 1. American Medical Association. AMA Manual of Style: A Guide for Authors and
    Editors. 11th ed. Oxford University Press, 2020.

--------------------------------------------------------------------------------


SUBMITTING THE MANUSCRIPT

Please submit the manuscript as a Microsoft Word document (DOC or DOCX)
via AFP’s Editorial Manager system.

View instructions for submitting the article in Editorial Manager. These
instructions show how to create a login and password for first-time users and
explain each stage of the submission process in detail.

Please see the Figures section for guidelines on file formats for artwork and
photographs. Do not save images within the Microsoft Word or PowerPoint document
or use the “Drawing” features of Word.

--------------------------------------------------------------------------------


AUTHOR STATEMENTS

Submitted manuscripts must be accompanied by an Author Statements form signed by
all authors. This form includes an authorship statement, a copyright transfer
statement or statement of federal employment, and an acknowledgment statement.
Upload your signed form to AFP’s Editorial Manager system at the time of
manuscript submission.


COPYRIGHT TRANSFER

Each author who was not an employee of the U.S. federal government when this
manuscript was prepared must complete the copyright assignment statement in
the Author Statements Form, which assigns, transfers, and conveys all rights,
title, and interest in the work and its accompanying original tables and
figures, including copyright ownership, to the AAFP in the event that this work
is published by the AAFP. All accepted manuscripts become the permanent property
of the AAFP and may not be published elsewhere without written permission from
the AAFP.


FEDERAL EMPLOYMENT

Each author who was an employee of the U.S. federal government when this
manuscript was prepared must sign the statement of federal employment in
the Author Statements Form, which indicates that the work is not protected by
the Copyright Act and there is no copyright of which ownership can be
transferred.


ACKNOWLEDGMENT

The corresponding author must sign the acknowledgment statement in the Author
Statements Form, which affirms that all persons who have made substantial
contributions to the work reported in the manuscript but who are not authors are
named in the Acknowledgment section of the manuscript and have given their
written permission to be named.


ARTIFICIAL INTELLIGENCE TECHNOLOGIES

Artificial intelligence technologies (AI), machine learning, and similar
technologies, including chatbots like ChatGPT (Chat Generative Pretrained
Transformer), have been used in the drafting of scientific manuscripts. Authors
who choose to use this technology must disclose at the time of manuscript
submission their use of AI, the type of AI utilized, and how they used AI. In
addition, when incorporating AI-generated statements, authors must provide
correct references in the established literature for all AI-generated items to
ensure accuracy and appropriate attribution. AI technology does not qualify for
authorship credit, since it cannot guarantee the veracity of the language
generated, but its use must be acknowledged in the manuscript.

--------------------------------------------------------------------------------


CONFLICT OF INTEREST POLICY

The AAFP requires all authors to disclose any commercial association that might
pose a conflict of interest in connection with the submitted manuscript. All
authors must log into their AAFP account and complete a Conflict of Interest
form, with any financial relationship or interest disclosed in a separate email
to afpjournal@aafp.org. If authors do not have an AAFP account, they need to
create one to access the Conflict of Interest form.

To avoid bias or the perception of bias, AFP will not consider manuscripts
sponsored directly or indirectly by a pharmaceutical company, medical education
company, or other commercial entity or ineligible company* (as defined by the
Accreditation Council for Continuing Medical Education [ACCME]) or those written
by an author who has or whose spouse/partner has a financial relationship with
or interest in any commercial entity or ineligible company that may have an
interest in the subject matter of the article within the previous 36 months or
in the foreseeable future. This policy includes, but is not limited to, the
following relationships/interests:

 * Consultant or Advisory Board
 * Employment
 * Honorarium
 * Manuscript preparation assistance
 * Partnership
 * Receipt of equipment or supplies
 * Research grants or support
 * Speakers’ Bureaus
 * Stock/Bond holdings (excluding mutual funds)
 * Ownership
 * Other financial support
 * Other personal or professional relationships

To avoid writing an article that we will not be able to consider, please contact
us first with any questions about this policy. Manuscripts without signed
Conflict of Interest forms from all authors will not be considered for peer
review.

All funding sources supporting a manuscript should be acknowledged on the title
page. The editorial staff may inquire further about financial disclosure after
submission. If accepted for publication, any nondisqualifying financial
disclosure or potential conflict of interest will be acknowledged at the end of
the manuscript text. More information on our editorial policies can be found in
this editorial.

Note: If you develop, or your spouse/partner develops, new financial
relationships with or interests in a relevant commercial entity or ineligible
company after initially completing the Conflict of Interest form but before
publication, please let us know and complete an updated form immediately. Any
such changes may preclude your article from publication.

*“Commercial entities” include pharmaceutical companies, medical education
companies, or other entities producing, marketing, re-selling, or distributing
health care goods or services to patients or health care professionals. The
ACCME uses a similar definition for "ineligible company" with additional
examples.


ADVOCACY BIAS POLICY

Certain medical topics are more controversial than others, and therefore run the
risk of attracting authors who have strong advocacy positions on the topic,
leading to what could be called “advocacy bias.” In this context, “advocacy
bias” refers to a strong preference for a position borne out of something other
than scientific controversy (i.e., the science is conflicting, and one may
reasonably argue for one approach over another), but primarily based on
religious, political, social, or other non-medical considerations. In general,
we prefer relatively neutral authors who can cover topics in a way that is less
subject to this type of bias.

For topics at risk of advocacy bias, authors will be carefully vetted to ensure
a relatively neutral presentation, and we may exclude those who we deem to have
an undue degree of advocacy bias. However, there are instances in which it is
acceptable and even desirable to have “advocacy” authors write for AFP. These
include presentations where we specifically address various advocacy viewpoints,
such as our series of pro/con editorials, “Controversies in Family Medicine,” or
Curbside Consultation. Letters to the Editor are another venue where advocacy
authors can be given a platform. All instances are subject to editorial review
and approval, as is the case with all our content. More information regarding
controversial topics in family medicine and AFP’s approach to such topics can be
found in these editorials:

Editorials: Ethics, Education, and American Family Physician

Editorials: Controversial Topics in Family Medicine and Our Duty to Engage

--------------------------------------------------------------------------------


MANUSCRIPT PROCESSING AND REVIEW


ACKNOWLEDGMENT AND MANUSCRIPT NUMBER

When your manuscript is submitted, the corresponding author receives an
automated notification email from the Editorial Manager system that the
manuscript has been received. After it has been processed by editorial staff,
the corresponding author receives an email containing the manuscript number.
Please refer to this number in any communication about your manuscript. Failure
to adhere to our Authors’ Guide will cause delays in the processing of your
article. Details regarding acceptance rates and publication timelines are
available in our annual report.  


PEER REVIEW

Manuscripts are reviewed by the editors for suitability and adherence to AFP
guidelines. Acceptable manuscripts are reviewed by at least one family physician
and one expert in the subject area.


EDITORIAL DECISION

A decision about acceptance, revision, or rejection is sent to the corresponding
author, generally within 10 to 12 weeks of receipt of the manuscript. Acceptable
manuscripts require some revision based on reviewers’ comments and medical
editor guidance. Instructions showing how to handle each comment and a sample
response letter are provided in the Authors’ Responses to Reviews.


MANUSCRIPT EDITING

Once a manuscript is accepted, it is edited to conform to AFP’s style and
improve its educational value. The edited manuscript is sent to the
corresponding author for review before publication. Authors are responsible for
all statements made in their work, including any changes made by the editors and
authorized by the corresponding author. Authors also review a final proof before
publication.


PROFESSIONALISM

Please be considerate and respectful in your communication with AFP staff and
medical editors, including being responsive to queries from our editors and
replying in a timely manner. We take many factors into consideration when
deciding whether to invite authors to write for AFP again. Although our top
priority is producing high-quality content for our readers, the failure of any
author to comply with these requests of professionalism may result in not being
reinvited to write for AFP.

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AFP VIDEOS

Videos help expand the knowledge and expertise of AFP’s readers. Videos can be
freestanding or accompany clinical review articles. All videos are peer-reviewed
by at least two medical editors and, if accepted, are published on the AFP
YouTube channel. Videos are promoted on the AFP's Video Collection Page, which
receives 2.5 million unique visitors each month and 31 million unique visitors
each year, including from AAFP members.

We are seeking original, high-quality, concise, clinically impactful videos that
teach office procedures, physical examination skills, and clinical findings. We
consider existing videos and welcome proposals for videos on new topics. The
first author of the video must be an experienced physician. Residents and
medical students may be coauthors. We cannot provide financial support or
equipment.

Seek approval for your submission by sending a completed video proposal form to
Chris Bunt, MD, at afpvideos@aafp.org.

Once approved, submit your video to afpvideos@aafp.org using a common,
cloud-based service (e.g., Google Drive, OneDrive). Include a Word document
containing the video title, a plain language description of the video, and a
copyright transfer form. Completed consent forms are required from anyone
appearing in the video (e.g., physicians, patients).


TECHNICAL REQUIREMENTS

Delete or obscure any identifying information about the patient, hospital, or
health care system, including the date. Our goal is to avoid commercialization
of any product, hospital system, or institution. When referring to drugs or
devices, use generic names or descriptions.

The video file should be complete, in final format, and at as high a resolution
as possible. Any editing is the authors’ responsibility, and AFP staff may
request additional edits following peer review. AFP staff may abridge the video
for content, length, or quality.

Submit your video in a mpeg or QuickTime (.mov) format. If possible, include a
still image from the video for use in print or on a nonanimated website page.

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