Authors' Guide

American Family Physician is a semimonthly, peer-reviewed journal of the American Academy of Family Physicians. AFP’s chief objective is to provide high-quality continuing medical education for more than 190,000 family physicians and other primary care clinicians. The editors prefer original articles from experienced clinicians who write succinct, evidence-based, authoritative clinical reviews that will assist family physicians in patient care. AFP considers only manuscripts that are original, have not been published previously, and are not under consideration for publication elsewhere. Articles that demonstrate a family medicine perspective on and approach to a common clinical condition are particularly desirable.

Article Proposals

Authors are strongly encouraged to discuss their article ideas with the editor before beginning work on a manuscript. This step allows tailoring of the topic to AFP’s needs and prevents content overlap with recently published manuscripts or articles in preparation. Authors must be able to demonstrate expertise in their area of interest or manuscript topic. Clinical reviews by medical students are not considered for publication, and it is required that resident physicians, if involved with the manuscript, work with an experienced attending physician who should generally serve as first and corresponding author. Topic proposals should be submitted via electronic mail to afpjournal@aafp.org with the words “Article Proposal for AFP Editor” in the subject heading.

Note: To avoid bias or the perception of bias, AFP will not consider manuscripts sponsored directly or indirectly by a pharmaceutical company, public relations firm, or other commercial entity, or written by an author with a financial interest in a company that makes a product discussed in the manuscript or a competing product. For more information, see Conflict of Interest Form.

Articles and Departments

Authors may submit manuscripts in one of the following categories. All articles should be submitted to Jay Siwek, MD, Editor, via AFP's Editorial Manager online submission system (http://www.editorialmanager.com/afp), unless otherwise noted in this document. For detailed instructions on manuscript submission, see Submitting the Manuscript.

Clinical Review Articles

Most articles in AFP are evidence-based clinical reviews. AFP focuses on clinical conditions that are encountered frequently by practicing family physicians, with an emphasis on diagnosis and treatment of common, important diseases. Clinical reviews generally 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, a brief case summary may be submitted in the form of a Letter to the Editor (see also Curbside Consultation).

Authors are expected to reply to published letters about their article, especially any that question the science involved. Failure to do so will disqualify an author from future publication in AFP.

Close-ups: A Patient's Perspective

Submissions of Close-ups must include a patient story, commentary, patient photograph, resources, signed patient consent form, and author statements form. Photographs must meet minimum quality standards. Submit patient scenarios via e-mail to afpjournal@aafp.org with the subject heading "Close-ups submission [your last name]."

Close-ups submissions should include the following:

A patient story. The length of stories should be approximately 250 words; however, if you wish to submit a slightly longer story for us to edit, you may do so. The story may be obtained from a recorded interview with the patient, a written document prepared by the patient, or your paraphrase of the patient’s words. All submissions are subject to editing.
A commentary. Submit a few sentences (50-100 words) as your commentary on the story. Appropriate comments would be reflections on your relationship with the patient, obstacles you faced or overcame in treating the patient, or acknowledgment of the patient’s struggles and achievements.
A patient photograph. The submission should include a high-quality digital photograph of the patient (preferably) or of a subject matter relevant to the story (e.g., a pair of crutches relating to an injury, a picture painted by the patient, a photograph relating to a hobby or pet). For quality guidelines, see Figures.
List of resources. Provide one to four resources for further information about the key points discussed. Resources might include self-help groups, medical organizations, Web sites on the topic, and so forth.
Signed patient consent form. (1-page PDF file; About PDFs)
Author statements form from the physician who writes the commentary. (1-page PDF file; About PDFs)

Curbside Consultation

Authors may submit a case scenario and clinical question to Caroline Wellbery, MD, Associate Deputy Editor of AFP (afpjournal@aafp.org). Materials are edited to retain confidentiality. An expert clinician will provide a commentary in response to the question.

Editorials

Most editorials in AFP are solicited by the editors; however, freestanding editorials are occasionally accepted. Editorials should range from 250 to 750 words in length and may include six to 12 references. Submit editorials via e-mail to afpjournal@aafp.org with the subject heading "Editorial".

Letters to the Editor

Letters to the editor are published in each issue of AFP. Some letters may be published online only; online letters will be listed in the table of contents of the print version. Authors may comment on a previously published article or present a freestanding letter on an important clinical topic. Letters should be fewer than 400 words in length, with a limit of one table or figure, six or fewer references, and no more than three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission.

Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. Letters will be edited to meet style and space requirements. Send letters to Kenny Lin, MD, Associate Deputy Editor for AFP online (afplet@aafp.org). Letters submitted via regular mail should be sent to: 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672.

Photo Quiz

Photo Quiz presents readers with a clinical challenge based on a photograph or other figure. Submissions should conform to AFP guidelines (View detailed submission instructions.). Send submissions to Photo Quiz, AFP Editorial Office, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672 (afpphoto@aafp.org).

Preparation of the 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, Clinical Evidence, and the National Guidelines Clearinghouse. 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 evidence-based sources of information:

Agency for Healthcare Research and Quality Evidence Reports (AHRQ) (http://www.ahrq.gov/clinic)
Cochrane Database of Systematic Reviews (http://www.cochrane.org)
Clinical Evidence (www.clinicalevidence.com [subscription required, but generally available to U.S. physicians who receive Clinical Evidence in the mail])
Evidence-based guidelines from the National Guidelines Clearinghouse (http://www.guideline.gov)
Institute for Clinical Systems Improvement (ICSI) (http://www.icsi.org)
United States Preventive Services Task Force (USPSTF) (http://www.ahrq.gov/clinic/uspstfix.htm)

A complete list of data sources to consider are contained in the AAFP’s Recommended Resources for Evidence-based CME (http://www.aafp.org/online/en/home/cme/cmea/ebcme/ebcmesources.html).

Links to 20 sources are provided below:

Free Access

Agency for Healthcare Research and Quality Clinical Guidelines and Evidence Reports (AHRQ) (http://www.ahrq.gov/clinic)
Bandolier (http://www.medicine.ox.ac.uk/bandolier/)
Canadian Task Force on Preventive Health Care (http://ctfphc.org/index2.htm)
Cochrane Database of Systematic Reviews (http://www.cochrane.org/) -- abstracts only
Database of Abstracts of Reviews of Effects (DARE) (http://www.crd.york.ac.uk/crdweb/)
Effective Health Care (http://www.york.ac.uk/inst/crd/ehcb.htm)
Institute for Clinical Systems Improvement (ICSI) (http://www.icsi.org/)
National Center for Complementary and Alternative Medicine (http://nccam.nih.gov/)
National Guideline Clearinghouse (NGC) (http://www.guideline.gov/)
U.S. Preventive Services Task Force (USPSTF) (http://www.ahrq.gov/clinic/uspstfix.htm)

Subscription Required

Clinical Evidence (http://clinicalevidence.bmj.com/ceweb/index.jsp) -- BMJ Publishing
Cochrane Database of Systematic Reviews (http://www.cochrane.org/) -- complete reviews
DynaMed (http://www.ebscohost.com/dynamed/)
EBM Online / Evidence-Based Medicine (http://ebm.bmj.com/)
Essential Evidence Plus (http://www.essentialevidenceplus.com/)
Natural Medicines Comprehensive Database (http://www.naturaldatabase.com/(S(mqjs5t55m0wwyhn3oty5cinp))/home.aspx?cs=&s=ND)
Natural Standard (http://www.naturalstandard.com/)
PEPID (http://www.pepid.com/)
Physicians' Information and Education Resource (American College of Physicians' PIER) (http://pier.acponline.org/index.html)
UptoDate (http://www.uptodate.com/home/index.html)

To ensure adequate searching on your topic, we strongly recommend that a minimum of 4 of the above sources be used, in addition to a PubMed search using the Clinical Query function. This is done by using the link below, or by going to the PubMed home page, and selecting "Clinical queries" from the lower center of the screen.
http://www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical

Sample Data Sources paragraph:
Data Sources: A PubMed search was completed in Clinical Queries using the key terms "pacifier," "dummy," and "soother." The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were the Agency for Healthcare Research and Quality evidence reports, Bandolier, Clinical Evidence, the Cochrane database, Database of Abstracts of Reviews of Effects, the Institute for Clinical Systems Improvement, the National Guideline Clearinghouse database, the Trip database, and UpToDate. Search date: November 18, 2009.

Manuscript Format

Manuscripts formatted to conform to the “Uniform requirements for manuscripts submitted to biomedical journals”¹ are acceptable for submission. AFP endorses these guidelines. Format the manuscript with margins of 1 1/2 inches on all sides. Double-space the entire manuscript, including components, and 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 an Evidence Table (each table begins on a new page)
Figures
Acknowledgments
Biographic sketch

The title page, abstract, text, references, and tables should be contained in a single word processor document, ideally in Microsoft Word (DOC) or Rich Text Format (RTF). The acknowledgments and the biographic sketch should be in a separate file in order to accommodate blinded peer review. Each figure should be submitted as a separate computer file as described in this document under Figures.

Number pages consecutively in the upper right-hand corner, beginning with the title page. To accommodate blinded peer review, place the names of authors only in the biographical sketch for each author. See the section in this document on Submitting the Manuscript for details on how to submit your manuscript to AFP.

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

Title Page

This page should contain only the title of the manuscript and the word counts (word count for the entire manuscript and word count for text only--excluding abstract, references, tables, figures). This is to facilitate blinded peer review of the manuscript in the Editorial Manager system. Pertinent information such as names of authors, institutional affiliation, and contact information is entered into Editorial Manager by the authors and will be placed in a pre-formatted cover sheet for editorial use.

Sources of support in the form of grants, equipment, or drugs should be mentioned in the Conflict of Interest Form (2-page PDF file; About PDFs); this information will be included as a footnote to the article. For details, see the Conflict of Interest section of this document.

Abstract

Include an abstract of 150 to 250 words, depending on the length of the text. The abstract should provide 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, highlight key points in the diagnosis and treatment of the condition discussed.

Text

Article length should be 1,500 to 1,800 words (maximum 2,000 words, about six to eight manuscript pages of text), not including the title page, abstract, tables, reference list, etc. Manuscripts of more than 2,000 words of text are rarely accepted.

Do not include a summary or conclusion section in your manuscript; anything that you would ordinarily put in such a section should go into 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 Library reviews, citations from BMJ’s Clinical Evidence, 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 to 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!

Literature Search and Data Sources

Please see the Literature Search and Data Sources description above.

References

Please number references in the text in the order of citation. Use double-line spacing in your reference list; arrange references numerically, not alphabetically. Do NOT use "Endnotes" or any other automated reference function in any word processor.
Titles of journals should be abbreviated according to the style used in PubMed. List the first six authors followed by “et al.”; if there are fewer than six authors, list them all. The average number of references for a full-length article ranges from 15 to 30. Most articles will not exceed 35 references.

References first cited in tables or figure legends must be numbered to remain in sequence with references cited in the text. Note the following examples of reference style:

Standard Journal Article

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

Chapter in a Book

Murray JL. Care of the elderly. In: Taylor RB, ed. Family medicine: principles and practice. 3d ed. New York: Springer-Verlag, 1988:521-532.

Web Site

Clinical evidence on tinnitus. BMJ Publishing Group. Accessed November 12, 2003, at http://www.clinicalevidence.com.

Please note that no periods are used after the authors’ initials or after journal abbreviations. List all authors if there are six or fewer; if there are seven or more, list three followed by "et al." Include beginning and ending page numbers for journal and book references.

Tables

Authors should maximize the educational value of tables. Give complete reference data for each item in a table. For all tables that are borrowed or adapted from other sources, include scanned photocopies of the tables as they appeared in the original source, making sure that complete reference data are included for the original source.

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.

Tables should be interpretable without reference to the text. Each table should have a title and be numbered sequentially with Arabic numerals. Put each table with double-line spacing on a separate page. Use the “Tables” function of your word processor to create the table rather than just using spaces and tabs (which quickly get out of alignment as the manuscript is transferred into other computer formats). In general, make tables part of your main document rather than creating a separate file for each table.

SORT Evidence Table of Key Clinical Recommendations

We would like each article to include an Evidence Table (also called a “SORT” or “Strength of Recommendations Table”) as shown below. This table will help 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 sample below.

Key clinical recommendation	Strength of recommendation	Reference(s)	Comment and references (optional)
Ambulatory blood pressure monitoring is recommended for patients with labile blood pressure and suspected white-coat hypertension.	B	2	Recommendation from consensus guideline based on observational studies (2)
Diuretics and beta blockers are first-line agents for hypertension.	A	3	Meta-analysis of randomized trials (3)
Angiotensin receptor blockers provide clinical outcomes similar to those of ACE inhibitors.	A	4,5,6	Consistent findings from randomized controlled trials (4,5) and recommendation from evidence-based practice guideline (6)
Patients with newly diagnosed hypertension should be evaluated for secondary causes of hypertension.	C	7	Recommendation from a consensus based practice guideline (7)

In general, you should choose approximately three to seven key recommendations for your article. Do not choose statements that merely summarize research findings or represent statements of fact; choose important clinical recommendations that reflect the best available evidence. Comments to justify your choice of references are helpful to the editors. If you are not comfortable assigning the Strength of Recommendation (below), our medical editors will do that for you.

To rate the strength of evidence supporting key clinical recommendations, please use the following guidelines:

In general, only key recommendations for readers require a grade of the "Strength of Recommendation." Recommendations should be based on the highest quality evidence available. For example, Vitamin E was found in some cohort studies (Level 2 study quality) to have benefit for cardiovascular protection, but good-quality randomized trials (Level 1) have not confirmed this effect. It is therefore preferable to base clinical recommendations in a manuscript on the level 1 studies.

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, 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, quality of life. ** Disease-oriented evidence measures intermediate, physiologic, or surrogate endpoints that may or may not reflect improvements in patient outcomes (i.e., blood pressure, blood chemistry, physiological function, and pathological 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
	Diagnosis	Treatment/Prevention/Screening	Prognosis
Study Quality
Level 1 Good quality patient-oriented evidence	- Validated clinical decision rule	- SR/meta-analysis of randomized controlled trials (RCTs) with consistent findings	- SR/meta-analysis of good quality cohort studies
	- Systematic Review (SR)/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	- SR/meta-analysis of lower quality clinical trials or of studies with inconsistent findings	- SR/meta-analysis of lower quality cohort studies or with inconsistent results
	- SR/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.
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.
* 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.

Please use the following algorithm for rating the strength of evidence. For more information on how to apply these ratings, please see the explanatory article published in the February 1, 2004, issue of AFP. Again, if you are unsure how to apply these ratings, the medical editors will do this for you. At a minimum, though, you should create a summary table with recommendations and references for each recommendation.

Shown above is an algorithm for determining the strength of a recommendation based on a body of evidence (applies to clinical recommendations regarding diagnosis, treatment, prevention, or screening). While this provides a general guideline, authors and editors should feel free to 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. The term "figures" refers to illustrations, photographs, radiographs, scans, sonograms, diagrams, graphs, flow charts, algorithms, etc. AFP requires authors to transfer copyright ownership of original figures to the AAFP. For all figures that are borrowed or adapted from other sources, include scanned photocopies of the figures as they appeared in the original source, making sure that complete reference data for the original source are included. Clearly identify figures that have not been previously published and are supplied by a person other than the author and include complete contact information for the owner of the material.

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.

Each figure should be submitted as a separate digital 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.

TIFF (Tagged Image File Format)
PowerPoint (acceptable only for tables or algorithms; not acceptable for imported images)
JPG (only high-resolution images of at least 300 pixels or dots per inch [ppi or dpi])

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. While images with a resolution of 72 ppi (28.35 pixels per cm) are adequate for materials posted on the Web, 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 Web sites or taken from other publications rarely reproduce well, even if we are able to obtain permission to reprint them.

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 include the following:

Symbols, lettering, and arrows in figures should be clearly marked and large enough to remain legible if the size of the illustration is reduced for publication.
Photographs in which a patient is identifiable must be accompanied by the patient’s written permission for publication. Please note that a bar obscuring the eyes does not provide adequate anonymity.
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 your word processor.
The legends for each figure should be typed with double-line spacing and combined on a separate page at the end of the manuscript.

If you are submitting figures in digital format, save each figure as a separate file. Each file should be saved with a name that includes the AFP manuscript number and figure number as referenced in the manuscript. Files should be uploaded at the time of manuscript submission in AFP's Editorial Manager site (http://www.editorialmanager.com/afp) and clearly labeled.

Acceptance of a manuscript for publication is contingent on provision of artwork that meets the above specifications. If you have any questions about the preparation of 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 Author Statements Form [1-page PDF file; About PDFs]).

Biographic Sketch

Include a brief biographic sketch for each author (no more than 100 words). Succinctly summarize each author’s medical training, current position, and academic appointments. Follow the format as it appears in previously published articles in AFP (see: www.aafp.org/afp).

Style Guidelines

Headings. Use ALL CAPITALS to indicate major sections of a paper, and Initial Capitals to indicate subsections.
SI units. Include SI units in parentheses after conventional units (see http://jama.ama-assn.org/misc/auinst_si.dtl).
Measurements. Do not put periods after metric measurements (e.g., 3.5 mmol per L, 11.6 mg per kg).
Numbers. Spell out numbers one through nine. Use numerals for 10 and higher. Exception: 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 the first brand approved. If a drug is not available in the United States, indicate so in parentheses after the name.
Abbreviations. Except for units of measurement, abbreviations are discouraged. When first used, an abbreviation should be preceded by the words for which it stands.
Percentages. Use the word “percent” rather than the percent sign (%) in text. The percent sign may be used in tables and figures to conserve space.
Style questions. For questions about medical writing style, consult the American Medical Association Manual of Style.²
Formatting text. Note the following general text formatting guidelines: (1) do not justify the right margin; (2) do not use bold print or italics; and (3) use a single, standard typeface of letter quality, such as Times New Roman or Arial 12 point.

Evidence-Based CME

The AAFP Commission on Continuing Professional Development (COCPD) has developed new criteria for evidence-based clinical content. CME clinical content is evidence-based (EB CME) if it presents practice recommendations supported by evidence that has been systematically reviewed by an approved source.

Authors are strongly encouraged to write articles for AFP that qualify for EB CME by following the COCPD guidelines, which can be viewed online (http://www.aafp.org/online/en/home/cme/cmea/ebcme.html). You should mention your interest in preparing an article that meets these criteria when you submit the proposal for your manuscript.

Briefly, to qualify for EB CME the author must identify one to three (or more) key clinical recommendations drawn from the list of approved EBM sources (http://www.aafp.org/online/en/home/cme/cmea/ebcme/ebcmesources.html) in the Evidence Table (See SORT table). The author should indicate the EB CME recommendations in the table as shown below:

Key clinical recommendation	Strength of recommendation	Reference(s)	Comment and references (optional)
Ambulatory blood pressure monitoring is recommended for patients with labile blood pressure and suspected white-coat hypertension.	B (EB-CME)	2	Recommendation from evidence-based guideline.

Submitting the Manuscript

Please submit the manuscript via AFP's Editorial Manager system (http://www.editorialmanager.com/afp). The following file formats are acceptable:

Microsoft Word (DOC or DOCX) [preferred]
Rich Text Format (RTF)
Word Perfect (WP5)

View thorough instructions for submitting the article in Editorial Manager (9-page PDF file; About PDFs). These instructions show how to create a login and password for first-time users, and go through each stage of the submission process in detail.

Please see the guidelines regarding figures for information on file formats for art work and photographs. Remember that figures should not be embedded in the word processor document or created using the “Drawing” tools of your word processor.

Author Statements

Manuscripts submitted for publication must be accompanied by an Author Statements Form (1-page PDF file; About PDFs) signed by all authors. This form includes an authorship statement, a copyright transfer statement or a statement of federal employment, and an acknowledgment statement. The signed form should be scanned and submitted in Editorial Manager (http://www.editorialmanager.com/afp) or should be faxed to 913-906-6086.

Copyright Transfer

Each author who was not an employee of the U.S. federal government during preparation of the manuscript must sign the copyright assignment statement in the Author Statements Form (1-page PDF file; About PDFs) which assigns, transfers, and conveys all rights, title, and interest in the work and its accompanying original tables and figures (photographs, radiographs, scans, sonograms, diagrams, graphs, flowcharts, algorithms), including copyright ownership, to the AAFP in the event that the 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 during preparation of the manuscript must sign the statement of federal employment in the Author Statements Form (1-page PDF file; About PDFs) which indicates that the work is not protected by the Copyright Act and that there is no copyright ownership that can be transferred.

Acknowledgment

The corresponding author must sign the acknowledgment statement in the Author Statements Form (1-page PDF file; About PDFs) which affirms that all persons who have made substantial contributions to the work but who are not authors have been named in the acknowledgment and have given their written permission to be named.

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. Each author must sign the Conflict of Interest Form (2-page PDF file; About PDFs), with any financial interest or arrangement disclosed in a separate attachment. 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 those written by an author who has a financial relationship with or interest in any commercial entity that may have an interest in the subject matter of the article within the previous 36 months or in the foreseeable future. It 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, as well as other relationships detailed in our conflict of interest policy. If you have any questions about this policy, please contact us first, so as to a avoid writing an article that we will not be able to consider. Manuscripts that are not accompanied by a Conflict of Interest Statement signed by all authors will not be considered for peer review.

All funding sources supporting a work should be acknowledged on the title page of the manuscript. The editorial staff may inquire further about financial disclosure after the manuscript is submitted. If the manuscript is accepted for publication, any non-disqualifying financial disclosure or potential conflict of interest will be acknowledged at the end of the manuscript text.

Manuscript Processing and Review

Acknowledgment and Manuscript Number

When the manuscript is initially submitted, the corresponding author will receive an automatic e-mail from the Editorial Manager system with a notification that the manuscript has been received. After it has been processed by editorial staff, the corresponding author will receive an automatic e-mail from Editorial Manager that contains the manuscript number. Please refer to this number in any communication about the manuscript.

Peer Review

Manuscripts are initially reviewed by the editors for suitability and adherence to the guidelines outlined above. Acceptable manuscripts are reviewed by at least one family physician and one expert in the subject discussed. The latter may be a family physician or a subspecialist in another discipline.

Editorial Decision

A decision about acceptance, revision, or rejection is sent to the corresponding author, generally within eight to 12 weeks of receipt of the manuscript. All 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 (9-page PDF file; About PDFs).

Return of Manuscripts and Illustrations

If submitted, hard copies of original artwork, photographs, slides, and other illustrations will automatically be returned if the manuscript is not accepted for publication. For manuscripts accepted for publication, any hard copies of illustrations submitted will be returned after the article is published.

Manuscript Editing

When a manuscript is accepted, it will be edited to conform to AFP’s style as well as to improve its educational value. An edited manuscript will be 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.

Checklist for Manuscripts Submitted to AFP

Please review this checklist carefully before submitting your manuscript to ensure its completeness and conformity with AFP style.

Begin with review of key evidence-based sources of information (see Suggested Literature Search).
Reviewed Evidence Summary provided by AFP editors.
Quality of evidence supporting key recommendations on diagnosis and treatment is rated (see SORT table).
Entire manuscript has 1 1/2-inch margins, double-line spacing throughout (including abstract, references, tables, and figure legends). Manuscript arranged and numbered in the following sequence: title page, abstract, text, references, tables, and figure legends. Acknowledgments and biographic sketches for each author should be in a separate document.
Conflict of Interest Form (2-page PDF file; About PDFs) and Author Statements Form (1-page PDF file; About PDFs) signed by each author and scanned and uploaded in Editorial Manager (http://www.editorialmanager.com/afp) at the time of submission or faxed to 913-906-6086. These forms contain the financial disclosure statement, authorship statement, copyright transfer statement or statement of federal employment, and acknowledgment statement.
Title page with full title of the article and word counts for the article.
Factual and specific (rather than general and nonspecific) abstract of 150 to 250 words.
Reference citations within the text and a corresponding reference list, typed double-line spacing, in numerical—not alphabetical—order. Recent references from systematic reviews, original research literature, and evidence-based guidelines preferred (from the past 10 years). Usual range, 10 to 25; maximum, 35. Citations do NOT use "Endnotes" or any other automated reference function.
Each table on a separate page; tables should be part of the main manuscript document rather than in a separate file. All tables and figures have titles, and all figures and other illustrations have descriptive legends. All tables, figures, and illustrations cited at the appropriate places in the text.
Each figure submitted as a separate TIFF, JPG, or PowerPoint file. Artwork meets the criteria in the Figures section of this document.
Signed Photo Release for any photographs in which a person is identifiable.
Complete citations and scanned photocopies of any material previously published; AFP editors will seek permission to reproduce copyrighted material.
Style guidelines reviewed (e.g., SI units included, right-hand margins unjustified, no bold or italic typeface used).
Word count of the entire manuscript and word count of the text alone provided.

References

International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. http://www.icmje.org/index.html. Accessed June 17, 2010.
Iverson C, Christiansen S, Flanagin A, Fontanarosa PB, Glass RM, Gregoline B, et al. American Medical Association Manual of Style. 10th ed. New York: Oxford University Press, 2007.