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Applied Evidence
Applied Evidence is a series of clinically oriented, evidence-based review articles that summarize the best available evidence for a broader topic, such as diagnosis or management of a common condition. These articles should be no more than 2200 words long, have no more than 4 tables or figures, and approximately 30 references. They should use the highly structured format developed for this series. Please contact Editor Jeff Susman, MD (JFP@fammed.uc.edu) prior to submitting a manuscript. These reviews generally are planned well in advance with support from the editorial staff. Authors are invited to choose from a list of prospective topics for our Applied Evidence series. Please click here to view the list of topics.
Author guidelines for Applied Evidence articles
The journal's mission is to provide family physicians with evidence-based information, supplemented by expert commentary on topics that are changing the practice of medicine. Applied Evidence is a 6- to 8-page review of the best available clinical evidence on a timely topic, supported by clear level-of-evidence and strength-of-recommendation ratings as defined by the Strength of Recommendation Taxonomy (SORT). Authors should supplement such evidence with expert commentary on how to apply the recommendations to practice.
While an Applied Evidence article is not intended to be a systematic review or meta-analysis, it should reflect a thorough search of the highest quality sources of evidence-based information. Such sources include the following:
Info Retriever. This proprietary software—at www.infopoems.com—costs $249, but can be downloaded and used without charge for one month. The software contains useful information, including POEMs (Patient-Oriented Evidence that Matters), abstracts from the Cochrane Library, and DARE (Database of Abstracts of Reviews of Effectiveness). Also featured are many clinical rules, diagnostic test accuracy information, and evidence on the usefulness of history and physical exam maneuvers.
The Cochrane Library. This is a valuable collection of well-done, systematic reviews of therapy, which includes DARE and a controlled trial registry. If your institution does not subscribe to The Cochrane Library, abstracts from Cochrane can be found at http://www.update-software.com/cochrane/ .
PubMed. This resource of the National Library of Medicine is located at www.ncbi.nlm.nih.gov/PubMed/ . Particularly useful is the Clinical Queries feature you can use to add search filters to clinical terms and obtain more focused results.
Other useful internet sites:
Preparing your article
Before starting to write, select the best quality evidence from among your search results. Attached is a Table to help translate evidence into SORT ratings.
Limit your manuscript to between 2000–2500 words, and the number of art elements (charts, graphs, tables) to 3 or 4. Refer to the following outline as a guide to the article’s general format.
1) Title page — Include article title, author(s) affiliations, address of corresponding author, phone, fax, and email address.
2) Article title — Write a title that reflects new information, changes in patient care, or a clear clinical benefit. Readers should infer that the article will teach them something they don't already know.
3) Practice Recommendations — A bulleted list of 3 or 4 "take home" points – ie, the clinical pearls you want every reader to remember. The strength of each recommendation should be noted, as per the SORT system.
4) Lead paragraph(s) — Please state the point of your article immediately, and explain why the information is important to clinical practice now. Avoid starting with well-known demographic information.
5) Headings — JFP uses three levels of headings within the text.
6) Figures and tables — Figures display a brief title at top that tells the main teaching point of the figure. At bottom, a caption explains the illustration, graph, or flowchart completely and succinctly. A reader in a hurry should be able to look at each art element and thoroughly understand its meaning without having to search the text for an explanation. Likewise, tables carry a descriptive title and use footnotes, as needed, to qualify data and other entries.
7) References — Please limit references to around 30.
How recommendations are graded for strength, and underlying individual studies are rated for quality
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 a benefit for cardiovascular protection, but good-quality randomized trials (level 1) have not confirmed this effect. Therefore, it is 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,* or case series for studies of diagnosis, treatment, prevention, or screening. |
Use the following scheme 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 quality |
Diagnosis |
Treatment/prevention/screening |
Prognosis |
| Level 1—good-quality patient-oriented evidence |
Validated clinical decision rule
SR/meta-analysis of high-quality studies
High-quality diagnostic cohort study† |
SR/meta-analysis of RCTs with consistent findings
High-quality individual RCT‡
All-or-none study§ |
SR/meta-analysis of good-quality cohort studies
Prospective cohort study with good follow-up |
| Level 2—limited-quality patient-oriented evidence |
Unvalidated clinical decision rule
SR/meta-analysis of lower-quality studies or studies with inconsistent findings
Lower-quality diagnostic cohort study or diagnostic case-control study§ |
SR/meta-analysis of lower-quality clinical trials or of studies with inconsistent findings
Lower-quality clinical trial‡
Cohort study
Case-control study |
SR/meta-analysis of lower-quality cohort studies or with inconsistent results
Retrospective cohort study or prospective cohort study with poor follow-up
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), or 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, and quality of life. Disease-oriented evidence measures intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (i.e., blood pressure, blood chemistry, physiologic function, and pathologic findings).
†—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 (greater than 80 percent).
§—In an all-or-none study, the treatment causes a dramatic change in outcomes, such as antibiotics for meningitis or surgery for appendicitis, which precludes study in a controlled trial.
SR = systematic review; RCT = randomized controlled trial. < /EM >
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