INFORMATION FOR AUTHORS

Revised March 2007

COMMENTARIES

Commentaries are meant to be thoughtful, provocative, opinion pieces that present fresh thinking in family medicine. They stimulate debate or propose a new way of looking at a problem. Originality, ingenuity, and relevance to practising family physicians are the criteria by which we judge editorials. We also examine the strength and logic of the argument for the position taken by the author. Build a good case for your proposal! Commentaries are published in both English and French and should be no longer than 1500 words. Some references are welcome but an extensive list is not required.

REFLECTIONS

Reflections are personal stories or experiences that illustrate unique or intriguing aspects of life as seen by family physicians. The stories should be personal, have human interest, and be written from the heart. They are not meant to be analytical. Writing style should be direct and in the first person and articles should be no more than 1200 words in length.

LETTERS FROM…

“Letters from..” are personal stories or experiences that illustrate unique or intriguing aspects of medical work in other countries as seen by family physicians. Examples include work done during locums or overseas development work. The stories should be personal, have human interest, and be written from the heart. They are not meant to be analytical. Writing style should be direct and in the first person and articles should be no more than 1200 words in length.

RESEARCH ARTICLES

We are registered with PubMed Central. All our peer-reviewed articles will be kept on that database and will be freely available to searchers. A link from PubMed gives access to the full text. Articles in the print version of Canadian Family Physician may be published in full text or as the abstract. Full text is available on-line at CFP’s website and at the PubMed Central database. Having the full text available from a PubMed search increases the chances of articles being cited by other researchers.

Clinical Trial Registration

CFP will consider clinical trials beginning on or after January 1, 2007, only if the trial is registered before the first patient is enrolled (prospective registration). Authors wishing to submit results of clinical trials to CFP will be required to include the trial registration number and trial registry name at the end of the abstract. If the results of the trial are published in CFP, the registration number and registry name will form part of the published article.

Clinical Trial Registries (ICMJE, Jan 2006):

www.actr.org.au
www.clinicaltrials.gov
www.ISRCTN.org
www.umin.ac.jp/ctr/index.htm
www.trialregister.nl/trialreg/index.asp

1. Quantitative Research

• Introduction should indicate the current state of knowledge, give the context of the study, and be supported by key references. The study objective should be clearly stated at the end of the introduction. What is new or important about this study should be stated clearly.

• Method should include the design, setting, sample frame, selection of participants (inclusion and exclusion criteria), intervention, and outcome measurement instruments' validity and reliability. Describe statistical testing proposed and sample size calculation. Design should be appropriate to the question. Ethics approval must be indicated for studies with human subjects.

• Results should be clearly presented in text and tables without overlap. Note the response rate, if appropriate. A figure showing the sampling strategy is useful. Results should relate to the research question. Confidence intervals should be used whenever possible. Statistics given should be appropriate to study design and numbers. Results section should not include commentary.

• Discussion states what new information has been found. Describe clinical and statistical significance, how results compare with the literature, possible explanations for results, and future directions for research. Limitations and how they might have affected the results should be discussed. Speculation must be reasonable.

• Conclusion should summarize the main findings of the study, relate back to the study's objective(s), and be supported by data found in the study.

• References should be relevant, current, complete, and accurate.

• Abstracts should be structured: Objective, Design, Setting, Participants, Interventions, Main outcome measures, Results, and Conclusion and should not exceed 300 words. Up to four key words (MeSH headings) should be included.

• Articles should be no more than 2000 words, excluding tables and references.

2. Surveys

• Introduction should describe the reason for the survey, especially what new information it is intended to find. Describe the context for the survey and support with key references. The study question should be clearly stated as the objective at the end of the introduction.

• Method should first describe the setting and then present the population base (sample frame) and the sampling procedures used (inclusion and exclusion criteria). Describe development of the survey instrument and indicate its validity and accuracy (references) and whether it was pilot tested before use. Present your analysis strategy and sample size estimation. Ethics approval must be indicated for studies with human subjects.

• Results begin with the response rate. Then results should be clearly presented in text and tables without overlap. Statistical analysis should be appropriate to the study design and sample size. We recommend using confidence intervals. No commentary should be included.

• Discussion states what new information has been found. Describe clinical and statistical significance, how the results compare with those in the literature, possible explanations for results, and future directions for research. Comment on the quality of the denominator and numerator from your results. Limitations and their possible effects on results should be mentioned.

• Conclusions should summarize the main findings of the study, relate back to the study objective, and be supported by data found in the study.

• References should be relevant, current, complete, and accurate.

• Abstracts should be structured under Objective, Design, Setting, Participants, Main outcome measures, Results, and Conclusions and should not exceed 300 words. Up to four key words (MeSH headings) should be included.

• Articles should be no more than 2000 words, excluding tables and references.

3. Qualitative Research

• Introduction should indicate the current state of knowledge in the area through a concise literature review. While many qualitative studies do not begin with a theoretical model as a framework, when such a model is used, it should be described. Specify what new information this study will provide. The overall purpose of the study and the specific research question should be clearly described.

• Method. The qualitative method chosen should be justified (eg, in-depth interviews, focus groups, participant observation).
• The study context and the role of the researcher in the study should be described.
• The development of the purposeful sample should be given to reflect the diversity of settings or circumstances of the study topic. Sample size should be adequate to answer the question by reaching saturation.
• Information (data) gathering, such as audiotaping, transcribing, and keeping field notes, should be described in enough detail to permit readers to understand the process.
• Procedures for data analysis should be clearly described to enhance trustworthiness. These procedures can include standardized coding techniques, triangulation, member-checking, use of field notes, theme saturation, and a conscious search for contradictory observations.
• Ethics approval must be indicated.

• Findings. Results are denoted as "findings" in qualitative studies. The interpretations, themes, or concepts created in the analysis should appear to flow logically from the description of the analytic process and should be supported by appropriate quotations. Enough quotations should be cited to ensure that readers get a sense of the richness and quality of the evidence supporting the analysis.

• Discussion. State what new information has been discovered. Interpretations and conclusions drawn from the data should be consistent with the evidence presented in the study. The significance of this study in relation to other literature should be addressed and areas for further inquiry suggested. Speculation should be reasonable. Future directions for research should be indicated. Limitations and their effect on findings should be discussed.

• Conclusion should summarize the main findings of the study, relate back to the study objective, and be supported by the data found in the study.

• Abstract should include the headings Objective, Design, Setting, Participants, Method, Main findings, and Conclusion and should not exceed 300 words. Up to four key words (MeSH headings) should be included.

• Qualitative studies should be no more than 3000 words, excluding tables and references.

4. Systematic Reviews

• Introduction should give background and context to the research question. The question should be clearly stated (as the objective), describing population, maneuver, and outcome where applicable.

• Data Sources should describe search strategies used to identify relevant articles. Include databases and key MeSH words.

• Study selection should cite as many primary references as possible. Review references should be used only if they meet the standards of a scientific review. The author's own articles may be cited if they are primary articles. Explicit methods for including or excluding articles in the analysis should be described.

• Synthesis. Validity of the primary studies cited should be assessed according to critical appraisal principles: a summary table of all studies analyzed is recommended. Information from primary studies should be integrated systematically, explaining the variation in findings in this literature. The rationale for the analysis should be clear to readers.

• Discussion should explain what new information has been uncovered. Variation in individual studies and their contribution to the final results should be discussed. Compare the results to existing literature; suggest areas for future research; and note the limitations of the review. Suggest the effect of unpublished or unretrievable literature.

• Conclusions should summarize the main findings of the study, be related to the objective(s), and be supported by evidence provided in the article.

• Systematic reviews should be structured as Introduction (with objective), Data sources, Study selection, Synthesis, Discussion, and Conclusion.

• Abstracts should be structured under the headings Objective, Data sources, Study selection, Synthesis, and Conclusion and should not exceed 300 words. Up to four keywords (MeSH headings) should be included.

• Systematic reviews should be no more than 2000 words, excluding tables and references.

CLINICAL REVIEW ARTICLES

Articles for the Clinical Review section of Canadian Family Physician are peer-reviewed.

1. Updates

• Introduction should clearly describe the subject to be discussed. Indicate why it is important and relevant to family physicians.

• A Quality of Evidence section should follow the introduction. It should include details of your literature search: databases searched, MeSH words used, and criteria by which you chose articles to cite. Indicate the strengths and weaknesses of the literature by describing the level of evidence for major points as adapted from the Canadian Task Force on Preventive Health Care.

Levels of evidence

Level I: At least one properly conducted randomized controlled trial, systematic review, or meta-analysis
Level II: Other comparison trials, non-randomized, cohort, case-control, or epidemiologic studies, and preferably more than one study
Level III: Expert opinion or consensus statements

• Based on the above, give an overall summary statement of the quality of evidence. A precis of this information should appear in the abstract.

• In the body of the article, important points should be supported by references whose strength of evidence (above) is described by the author. Controversies in the subject should be highlighted and alternative viewpoints noted. Some justification for the stance taken by the author should be given.

• Conclusion should be justified by the information presented in the paper and should include a practical, take-home message for practising family physicians.

• Update articles should be structured as Introduction (with objective), Quality of Evidence, a detailed description of the message, and Conclusion.

• Abstracts should include the headings Objective, Quality of evidence (summary statement), Main message, and Conclusion and should not exceed 175 words. Up to four key words (MeSH headings) should be included.

• References should be relevant and current.

• Update articles should be no more than 2000 words, excluding tables and references.

2. An Approach to...

• Introduction starts with a short case as it would present to a family physician. If the case describes a real patient, we require written consent (click here for the Form) from patient. Describe the subject to be discussed and why it is important for family physicians. Indicate whether there have been substantive changes in approach recently, given new diagnostic methods or treatments.
• A Sources of Information section should follow the introduction. Describe where the approach came from and who was responsible for it. Make clear how much is based on authors' opinions or experience and how much on the literature. If recommendations are based on research studies, indicate the overall strength of that evidence. (see box on levels of evidence)
• The Main Message of the article should outline the approach and point out its advantages and any disadvantages. Describe how the approach differs from others and why. Indicate areas of controversy and alterative approaches. Use tables and figures to convey your message clearly. Where recommendations are based on specific evidence, provide references and give level of evidence (I to III). Where recommendations fit the criteria of the Canadian Task Force on Preventive Health Care (A, B, C, etc), add these in. The case described in the introduction should be used to illustrate your points and wrapped up at the end of this section.
• Conclusion should pull together the main points of the article in a few sentences.
• An Approach to . . . articles should be structured: Case Introduction, Sources of Information, Main Message and Conclusion.
• Abstracts should include: Objective, Sources of Information, Main Message, Conclusion, and should not exceed 175 words.
• References should include the main sources of information and any recent high-quality articles.
• An Approach to... articles should be no more than 2000 words, excluding tables and references


• A one-page patient handout could be included with the article.


• Note: Differences between CME Updates and An Approach to...
  
  Both types of articles are aimed at providing education to practising family physicians. The CME Updates bring readers up-to-date in specific areas and provide the strength of evidence for new treatments and techniques. In An Approach to.. articles, the focus is on how family physicians would identify a problem and work through it to determine diagnosis and treatment. An Approach to... papers are more driven by authors' experience and opinion, but do contain the relevant evidence. We ask authors to describe how the approach was developed, what it is based on, and how strong the evidence supporting it is. If you are unsure which type of paper is more suitable for your subject, please contact the Scientific Editor, Dr. Diane Kelsall at dkelsall@cfpc.ca.

PROGRAM DESCRIPTIONS

• Introduction should state clearly the problem being addressed and why it is important to family physicians. Specific objectives of the program should be described. and appropriate literature cited concisely.

• Program should be described in sufficient detail for someone else to reproduce it. The original problem should be addressed by the program. A concise evaluation of the program should be described along with any preliminary data available. The evaluation is important, but is of secondary importance to the description of the program.

• Discussion should compare the program with others in that field and indicate why it is an improvement over existing programs. Limitations should be described. Planned improvements should be presented.

• Conclusion should summarize the main components of the program, relate to the problem addressed, and be justified by the information presented.

• Program descriptions should be structured as problem being addressed, Objective of program, Description of program, Discussion, and Conclusion.

• Abstracts should include the headings problem being addressed, Objective of program, Program description and Conclusion and should not exceed 175 words. Up to four key words (MeSH headings) should be included.

• References should be current and complete.

• Descriptive articles should be no more than 2000 words, excluding tables and references. Program descriptions are peer-reviewed.

REPORTS OF COMMITTEES AND TASK FORCES

• Title should indicate clearly the purpose of the report.

• Authors of the manuscript being submitted should be named. Names of committee members who did not write the manuscript should be listed separately. For a series of reports, committee members should be listed only in the first part, to which readers of following parts will be referred. In cases of collaborative authorship, the name of the committee will be used as author and its members listed separately. A corresponding author should be clearly identified, to ensure both appropriate contact during the editorial process and reaction to readers' enquiries after publication.

• Introduction should describe briefly the situation that prompted creation of the committee and should give dates of relevant events. Describe the objectives of the committee.

• Composition of committee. Explain how committee members were selected. Sponsorship, grants, or other financial support for the committee's work must be acknowledged.

• Method should describe briefly how the committee developed the principal report.

• Report (main body of the manuscript) should be written as a stand-alone article and not just lifted from the task force or committee working report. Summary tables and figures are appropriate.

• Committee reports should be structured as Introduction, Composition of the committee, Method, body of the report, and Conclusion.

• Abstract should include Objective, Composition of the committee, Method, Report, and Conclusion and should not exceed 175 words.

• Information for ordering the principal report, and cost of doing so, should be given; it will be published at the end of the report.

• Reports should be no longer than 2000 words. Reports are peer-reviewed.
• Note: For submission of original guidelines, please contact the Editor, Diane Kelsall, at dkelsall@cfpc.ca.

CURRENT PRACTICE

The Current Practice section of Canadian Family Physician includes Practice Tips and Case Reports, as well as ongoing series such as Motherisk, Pediatric Pearls and Dermacase.

1. Practice Tips

• Introduce the problem being addressed and mention how the technique was discovered.

• Describe indications for application and known or suspected contraindications.

• Provide a list of materials. Describe the technique in a step-by-step manner with attention to potential pitfalls and with enough detail to permit other physicians to carry out the procedure. Provide an illustration appropriate to the essential part of the technique or a difficult aspect of its application. Estimate costs, if known.

• Discuss your experience with the technique. How has it changed your practice? Provide an estimate of efficacy, and discuss possible alternatives. Indicate whether this tip has been described before (briefly describe your literature search). A tip does not have to be entirely original material, but should have a definite clinical application.

• Cite a maximum of five references.

• Length should not exceed 1200 words or 800 with tables or figures.

2. Case Reports

• Introduction should tell why family physicians should read this report and why the case is special.

• Case description should give a concise account of the case. Include only relevant, diagnostically important data. Chronological sequence provides logical structure. Consent (click here to download the consent form) must be obtained from the patient or a designated relative. The form is available on the website.

• Discussion should make a case for your case. Why is it important and what lessons are to be learned? Compare the case to the literature. Describe the literature search, including databases, MeSH words, and years searched. Select only those strictly relevant to the case reported and its discussion.

• Conclusion should describe the change in understanding or in the practice of family medicine.

• Case reports should be structured as Introduction, Description of case, Discussion, and Conclusion. Up to four keywords (MeSH headings) should be included.

• No abstract is required.

• Maximum number of words is 1200 with a table.

CRITICAL APPRAISAL

This section includes reviews of important articles in the literature relevant to family physicians. Reviews are by family physicians, not experts on the topics. They assess not only the strength of the studies but the "bottom line" clinical importance for family practice. We invite you to comment on the reviews, suggest articles for review, or become a reviewer.

Please contact Associate Editor Michael Evans by e-mail michael.evans@utoronto.ca or by fax 416 603-5821 before preparing a review.

RESIDENTS’ VIEWS

Canadian Family Physician is looking for thoughtful articles from current Family Medicine residents. Please contact the Residents' Views Coordinator at residentsviews@cfpc.ca for more information on submitting your paper.

FILLER

We are looking for very short articles and quotations to fill any empty spaces in the printed version of CFP. Fillers are designed to entertain readers or provoke thought. Articles should be less than 250 words. Ideas include:

• A memorable patient encounter.
• Papers or people (e.g. teachers, colleagues) who have had a large influence on you.
• An informative mistake.
• Quotations.

Note: if the filler refers to an identifiable person, written permission is required. If a patient is identifiable, please use the patient consent form available on the CFP website at www.cfp.ca, under “for authors”.