Clinical Review
Praxis
Primum non nocere – First, do no harm
Case Reports
Critical Appraisal
Commentary
Research
Clinical Discoveries
Reports of Committees and Task Forces
Program Descriptions
Residents' Views
Hypothesis
First Five Years
Clinical Review Articles
CFP seeks comprehensive, informative clinical review articles, particularly in the “update” and “approach to” categories. Articles must be evidence based and focus on clinical conditions that are regularly encountered by practising family physicians.
Updates: Update articles should focus on mainstream clinical topics in which a change in thinking has taken place, or is taking place. These articles should be designed to answer the question “Where do we stand today?” They should pull together the latest evidence and best current thinking, and give family physicians a practical and comprehensive overview of diagnosis and treatment.
Update articles should be structured as Introduction (with objective), Quality of Evidence, the Main Message, and Conclusion.
Approach to: “Approach to” articles should focus on specific new, alternative or more effective approaches to diagnosis and treatment of conditions seen by family physicians. Outline the approach and point out its advantages and disadvantages. Describe when, where and under what circumstances the approach is most useful or effective. Indicate whether there have been substantive changes in approach recently, given new diagnostic methods or treatments. Describe how the approach differs from others and why. Indicate areas of controversy and alternative approaches.
“Approach to” articles should be structured as Case Introduction, Sources of Information, Main Message and Conclusion. The case described in the introduction should be used to illustrate your points and be wrapped up at the end of the section.
Abstracts for Clinical Review articles should generally be 150 to 200 words.
When recommendations fit the criteria of the Canadian Task Force on Preventive Health Care (A, B, C, etc), these should be included, possibly in a table.
When recommendations are based on specific evidence, provide references and give level of evidence (I to III) in parentheses.
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.
References should be relevant and current.
Clinical Review articles should generally be from 1200 to 2000 words, excluding tables and references.
Praxis
Articles in the Praxis (formerly Practice Tips) section are intended to be short and highly focused on a specific technique for dealing with situations frequently encountered by family physicians.
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 generally not exceed 900 words, including tables or figures.
Primum non nocere – First, do no harm
The column, Primum non nocere – First, do no harm, is dedicated to seemingly excessive or unnecessary health care practices in family medicine. Subjects may be medical or ethical in nature or relate to health policy generally, but they must be relevant to the practice of family medicine.
Submitted texts must include a story, an argumentation, a discussion, and a practical conclusion.
The story (or narrative) presents the facts and provides the context. It must be thought-provoking and well-written. The argumentation illustrates how this situation is an example of over-diagnosis, over-treatment or therapeutic obstinacy. Statements may call into question the scientific evidence or data. They may express personal opinions. The discussion must be dynamic and stimulate reactions. The text must include a conclusion and practical benefits for the practice of family medicine. It must respect the ethical principles. Length should not exceed 1000 words and pertinent and relevant references must be provided.
As a general rule, the submitted text must support the principle of Primum non nocere – First, do no harm and it must help to improve the practice of family medicine.
Case Reports
Canadian Family Physician wants to publish interesting or unusual cases seen in the family practice setting, aspects of which have the potential to be instructive for practising family physicians. Case reports may describe everything from new or unusual presentations of common conditions to unusual adverse reactions to medications. The lead author should be a family medicine resident or family physician.
Case reports should be structured as:
Summary – Up to 150 words summarizing the case presentation and outcome.
Background – Why is this case important for family physicians?
Description of Case – Case description should give a concise account of the case. Include only relevant, diagnostically important data. Chronological sequence provides logical structure.
Investigations – Where applicable.
Differential Diagnosis – Where applicable.
Discussion and Conclusion – Why is the case important and what lessons are to be learned? Concisely compare the case to the literature. Briefly describe the literature search, including databases, MeSH words, and years searched. Select only those strictly relevant to the case reported and its discussion. Include a brief review of similar published cases if relevant.
Bottom Line – up to 5 key points.
Up to four keywords (MeSH headings) should be included.
Important - Consent must be obtained if the patient is in any way identifiable. Care should nevertheless be taken to protect the identity and privacy of the patient.
Maximum number of words is 1200 words, including tables and/or charts.
Critical Appraisal
Articles chosen for a “critical appraisal” tend to be major, important articles in leading journals that have the potential to change the way a condition is understood, diagnosed, managed and treated by family physicians.
The article should assess not only the strength of the studies but the "bottom line" clinical importance for family practice. It should help family physicians decide whether or not they should change their own approach to the condition in question.
Identify the article, authors and journal in standard format. Structure the article to include the research question, the type of article or study, an overview of the findings and conclusions drawn by the authors, a discussion of the methodology, strengths and weaknesses, and the relevance to family practice.
Length should not exceed 1500 words, including tables and charts.
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 commentaries. We also examine the strength and logic of the argument for the position taken by the author. Build a good case for your proposition!
A commentary may be an opinion piece regarding an issue in family medicine. It may be a social commentary. It may even be a philosophical essay on a topic relevant to family medicine.
Commentaries may also be clinical articles dealing with practical issues in family medicine, but tend to be less evidence-based and rely more on the opinion and experience of the authors.
Commentaries should generally range from 900 to 1500 words. Some references are welcome but an extensive list is not required.
Research Articles
CFP seeks research articles that advance our understanding of family medicine and that have the potential to affect the way family physicians practise medicine.
Articles published in CFP appear on our website at CFP.CA, where they join the major international medical journals through the HighWire electronic journal publishing facility of Stanford University.
Full content is available at PubMed Central; abstracts are listed on PubMed.
CFP generally publishes one or more full-text research articles in each issue, along with a number of Web Exclusives that appear on-line at CFP.CA. The full text of on-line articles also appears in PubMed Central and is fully indexed and searchable. Web Exclusive publication allows us to publish more research and in a more timely manner.
Abstracts of research articles are printed in both official languages.
Ethics approval must be indicated for studies with human subjects.
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
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.
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 should cover 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.
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.
Results begin with the response rate. The 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.
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 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.
Procedure 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.
Findings is the term used for "results" 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 should 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.
The 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 rarely exceed 2500 words, excluding tables and references.
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 should examine the 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.
These are short reports of original studies or evaluations or unique, first-time reports of a clinical case or case series which must be of unusual quality and special interest to merit publication.
Subjects of such articles can include novel approaches to treatment, unanticipated adverse outcomes of treatments, unusual presentations of diseases, or insights gained from changes in the way family physicians work (the effects of family physicians becoming part of larger teams, for example).
Method should describe how the clinical discovery was made or examined. Describe the literature search, including databases, MeSH words, and years searched. Select only those articles strictly relevant to the case reported and its discussion.
Discussion should state the importance of the case, case series, or clinical observation and compare the findings to the literature.
Conclusion should describe the change in understanding or in the practice of family medicine.
Abstracts should generally use the same headings as quantitative studies (Objective, Design, Setting, Participants, Main outcome measures, Results, and Conclusion), but these may be adapted when appropriate. Abstracts should not exceed 300 words.
Submissions will be evaluated based on the plausibility of the observations or findings, support from the basic sciences and the relevant literature, the clarity of the concepts presented, and the reproducibility of the procedures. Maximum number of words is 1500, and 10 up to references and 2 tables or figures may be included. Further information about such work can be found by reading the following references.
1. McWhinney IR. Why are we doing so little clinical research? Part 1. Clinical descriptive research. Can Fam Physician 2001;47:1701-2 (Eng), 1713-5 (Fr).
2. McWhinney IR. Why are we doing so little clinical research? Part 2. Why clinical research is neglected. Can Fam Physician 2001;47:1944-6 (Eng), 1952-5 (Fr).
3. McWhinney IR. Assessing clinical discoveries. Ann Fam Med 2008;6(1):3-5.
Reports of Committees and Task Forces
The 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.
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.
Program Descriptions
CFP may occasionally consider publishing exceptional Program Descriptions. For the article to be considered, the program described must have wide applicability either provincially or across Canada, and have the potential for significant impact. Strong preference is given to programs that have been instituted, and for which measurable results are available.
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 data available. Program descriptions that have an evaluation component are preferred to those that do not have an evaluation.
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 4 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.
Residents' Views
CFP is always looking for thoughtful articles from current family medicine residents.
Articles should deal with current issues relevant to the wider family medicine audience. Avoid articles that will be of interest only (or primarily) to other residents. Think of Resident’s Views as a platform from which residents may address the medical community on issues or perspectives you feel need to be brought to the wider audience.
Be sure to search and review past articles that have appeared in Resident’s Views, and avoid duplication of story ideas.
Please contact the Scientific Editor for more information on submitting your paper.
Hypothesis
Articles for the Hypothesis page are intended to provide education on basic research concepts that are of interest to the general readership of the CFP. This might include brief overviews or illustrative examples of research methods and issues. Consider the page an exercise in knowledge translation from the research to the clinical domain. Hence, all submissions should be clinically relevant. Hypothesis is published quarterly in the CFP. Maximum number of words is 850.
First Five Years
First Five Years is a quarterly series in Canadian Family Physician, coordinated by the First Five Years in Family Practice Committee of the College of Family Physicians of Canada.
CFP is looking for thoughtful articles from those in their first 5 years in practice.
Practical tips and thoughtful commentary about the issues faced by those new to practice are welcome. The topics should be useful to those new to practice, but ideally should be relevant a wider family medicine audience as well. First Five Years is a platform from which new-in-practice family doctors can address the medical community on issues or perspectives they feel need to be brought to the wider audience.
Articles should be a maximum of 1500 words. Extensive references are not required.
Articles can be submitted in English or French and will be published in both languages.