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 Guideline 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:

Links to 20 sources are provided below:

Free Access

Subscription Required

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 provided link, or by going to the PubMed home page, and selecting "Clinical queries" from the lower center of the screen.

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( 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 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(0 bytes); this information will be included as a footnote to the article. For details, see the Conflict of Interest section.


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.


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!


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( If there are six or fewer authors, list them all; if there are more than six, list the first three followed by "et al." Please note that no periods are used after the 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 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

  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. New York, NY: Springer-Verlag, 1988:521-532.


  1. BMJ Publishing Group. Clinical evidence on tinnitus. Accessed November 12, 2013.


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. See Tips for Creating Original Tables and Algorithms(1 page PDF) and How to Create an Algorithm in Word(6 page PDF). Note that tables and figures that were previously published, and for which we obtain reprint or adaptation permission, must be removed from AFP articles sent to content aggregators, such as EBSCO and MDConsult.

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.

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

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 RecommendationStrength of RecommendationReferencesComments (optional)
Key Clinical Recommendation: Ambulatory blood pressure monitoring is recommended for patients with labile blood pressure and suspected white coat hypertension.Strength of Recommendation: BReferences: 2Comments (optional): Recommendation from consensus guideline based on observational studies
Key Clinical Recommendation: Diuretics and beta-blockers are first-line agents for hypertension.Strength of Recommendation: AReferences: 3Comments (optional): Meta-analysis of randomized trials
Key Clinical Recommendation: Angiotensin receptor blockers provide similar clinical outcomes to ACE inhibitors A.Strength of Recommendation: AReferences: 4,5,6Comments (optional): Consistent findings from randomized controlled trials and recommendation from evidence-based practice guideline
Key Clinical Recommendation: Terazosin is not recommended as a first or second line agent, particularly for African-American patients.Strength of Recommendation: AReferences: 7Comments (optional): Randomized controlled trial

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 RecommendationDefinition
Strength of Recommendation: ADefinition: Recommendation based on consistent and good quality patient-oriented evidence*
Strength of Recommendation: BDefinition: Recommendation based on inconsistent or limited quality patient-oriented evidence*
Strength of Recommendation: CDefinition: Recommendation based on consensus, usual practice, expert opinion, disease-oriented evidence,** and case series for studies of diagnosis, treatment, prevention, or screening
Strength of Recommendation: * 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
Study QualityDiagnosisTreatment/Prevention/ScreeningPrognosis
Study Quality: Level 1 Good quality patient-oriented evidenceDiagnosis: Validated clinical decision ruleTreatment/Prevention/Screening: SR/meta-analysis of randomized controlled trials (RCTs) with consistent findingsPrognosis: SR/meta-analysis of good quality cohort studies
Study Quality:  Diagnosis: Systematic Review (SR)/meta-analysis of high quality studiesTreatment/Prevention/Screening: High quality individual RCT +Prognosis: Prospective cohort study with good follow-up
Study Quality:  Diagnosis: High quality diagnostic cohort study *Treatment/Prevention/Screening: All or none study ++Prognosis:  
Study Quality: Level 2 Limited quality patient-oriented evidenceDiagnosis: Unvalidated clinical decision ruleTreatment/Prevention/Screening: SR/meta-analysis of lower quality clinical trials or of studies with inconsistent findingsPrognosis: SR/meta-analysis of lower quality cohort studies or with inconsistent results
Study Quality:  Diagnosis: SR/meta-analysis of lower quality studies or studies with inconsistent findingsTreatment/Prevention/Screening: Lower quality clinical trial +Prognosis: Retrospective cohort study or prospective cohort study with poor follow-up
Study Quality:  Diagnosis: Lower quality diagnostic cohort study or diagnostic case-control study *Treatment/Prevention/Screening: Cohort studyPrognosis: Case-control study
Study Quality:  Diagnosis:  Treatment/Prevention/Screening: Case-control studyPrognosis: Case series
Study Quality: Level 3 Other evidenceDiagnosis: 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
ConsistentMost 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.
InconsistentConsiderable 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.

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.

[Strength of Recommendation Based on a Body of Evidence]

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.


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. 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 if copyright is being transferred to AFP with the article.

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(1 page PDF) and How to Create an Algorithm in Word(6 page PDF). Note that tables and figures that were previously published, and for which we obtain reprint or adaptation permission, must be removed from AFP articles sent to content aggregators, such as EBSCO and MDConsult.

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 websites 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(1 page PDF). "Identifiable" means that the person in the photo (or a parent of a child subject) could reasonably be expected to recognize himself/herself. 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 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( ( 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 After your manuscript has been accepted for publication, address questions about art to the medical editor.


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).

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.

Author's Guide References

  1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Accessed June 17, 2010.