Authors' Guide
Article Proposals
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
Clinical Review Articles
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).
Close-ups: A Patient's Perspective
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 statement form from the physician who writes the commentary. (1-page PDF file; About PDFs)
Curbside Consultation
Editorials
Letters to the Editor
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, assistant editor, AFP (afplet@aafp.org). Letters submitted via regular mail should be sent to: 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672.
Photo Quiz
Preparation of the Manuscript
Suggested Literature Search
- 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)
In addition, you will receive an “Evidence Summary” from the Deputy Editor with any relevant Cochrane reviews, evidence-based guidelines, POEMs, diagnostic test studies, and clinical decision rules.
Basing your article on the relevant information from the above sources will help ensure that it reflects the best available evidence, reduce the number of revisions required, and streamline the process of qualifying for the “AAFP Evidence-Based CME” designation (see: http://www.aafp.org/online/en/home/cme/cmea/ebcme.html).
Manuscript Format
- Title page
- Abstract
- Text
- References
- Tables, including an Evidence Table (each table begins on a new page)
- Figures
- Acknowledgments
- Biographic sketch
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
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
Text
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.
Acknowledgments
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.
- Murray JL. Care of the elderly. In: Taylor RB, ed. Family medicine: principles and practice. 3d ed. New York: Springer-Verlag, 1988:521-532.
- Clinical evidence on tinnitus. BMJ Publishing Group. Accessed November 12, 2003, at http://www.clinicalevidence.com.
Tables
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
| 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) |
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. |
|
| 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. |
|||

Figures
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])
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.
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@georgetown.edu. After your manuscript has been accepted for publication, address questions about art to the medical editor.
Biographic Sketch
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
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
- Microsoft Word (DOC) [preferred]
- Microsoft Word 2007 (DOCX)
- Rich Text Format (RTF)
- Word Perfect (WP5)
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
Copyright Transfer
Federal Employment
Acknowledgment
Conflict of Interest Form
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
Peer Review
Editorial Decision
Return of Manuscripts and Illustrations
Manuscript Editing
Checklist for Manuscripts Submitted to AFP
- 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 202-687-7230. 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.
- 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. N Engl J Med 1997;336:309-16.
- 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.