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Am Fam Physician. 2001;64(3):352

AFP has long been known for clinical updates that provide diagnostic and treatment recommendations drawn from the best available evidence. Now AFP is planning to introduce a rating system that will identify the strength of evidence for key clinical recommendations contained in clinical updates. Although various rating systems for levels of evidence are described in the medical literature, AFP has chosen to use an ABC rating scale. Authors writing for AFP are being asked to adopt the following rating system to identify the strength of evidence for recommendations in their articles:

  • Level A (meta-analyses/randomized clinical trials [RCTs]): Evidence from high-quality meta-analyses, or outcomes-based RCTs.

  • Level B (nonrandomized studies): Evidence from well-designed, nonrandomized clinical trials, clinical cohort studies or case-control studies with consistent findings. Other evidence, such as high-quality, historical and uncontrolled studies.

  • Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Authors should take note of the updated “Information for Authors” in this issue, on page 519. Authors are also encouraged to obtain the more detailed background information on use of the rating system that is available through the “Information for Authors” link on AFP's home page ( Here, authors will find a convenient list of online resources for identifying evidence-based clinical recommendations.

AFP encourages authors to provide evidence-based clinical updates based on systematic reviews. Clinical updates and systematic reviews differ in important ways. Systematic reviews seek to answer a focused clinical question using rigorous analysis of relevant research studies. An example of a focused clinical question is “Should we prescribe antibiotics for acute otitis media?” A systematic review designed to answer this question is presented on page 469 in this issue's “Cochrane for Clinicians: Putting Evidence into Practice,” by Charles B. Eaton, M.D., professor of family medicine and director of primary research in the Department of Family Medicine at Brown University School of Medicine Memorial Hospital of Rhode Island, Pawtucket, R.I.

The new AFP department “Cochrane for Clinicians” debuted in the May 1, 2001 issue and will appear regularly. The concept was developed by one of AFP's medical editors, Clarissa Kripke, M.D., with input from Dr. Eaton and Dr. Lorne Becker, M.D., professor and chair of the Department of Family Medicine at State University of New York, Syracuse, N.Y.

Clinical updates, as opposed to systematic reviews, selectively review the medical literature in a discussion of a broad topic, such as the diagnosis and treatment of gout. The best clinical updates base their discussion on systematic reviews and incorporate all relevant research findings on the management of a given disorder. For guidelines on writing a good evidence-based clinical update, authors planning to write for AFP should consult the “Information for Authors” and accompanying documents available online (

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