CI Template

Tips for each section: 

Evidence-based Answer

Evidence Summary

Recommendations from Others

Authors

References

Tables

CI Template and Tips 

Format: Font is Times New Roman 12 pt, double-spaced and with the headings in bold

Contributors for CI #XXXX

Add role, name, and email address for each contributor (Author, coauthor, editor, librarian, and peer reviewer)

Ex: Author: John Smith         Email: jsmith@fpin.org

       Librarian: Doug Smith    Email: dsmith@fpin.org

Question

Type exact text of question here

1. If there has been any modification to the question, it must be approved by the Editor–in-Chief. 

Evidence-based Answer – 50-100 Words

Tips

1. Answer the question, even if the level of evidence is low (case reports) and the Strength of Recommendation is low (“C”) and the answer is based on clinical opinion only.
   1. There is no such thing as a clinical question that cannot be answered; through there are many clinical questions that  cannot be answered with good evidence.
2. When possible, the first sentence should answer the question.
3. Assign a Strength of Recommendation (SOR) to each conclusion or recommendation in the Evidence-based Answer. 
   1. Give a phrase stating what the evidence for the SOR was – eg (multiple well done RCTs, expert opinion, low quality cohort studies, etc.)
4. Make sure each statement with an SOR is supported in the Evidence Summary section
5. Spell out first use of abbreviations with abbreviation in parentheses, e.g.  Strength of Recommendation (SOR). 
   1. Try to use ones that are standard, scan well, and are not easily confused with others in the text.  There is no real benefit to abbreviating a single word (hypertension – HTN).  
   2. In general, there should be no abbreviations in the question.  Don’t abbreviate terms rarely used throughout the CI.
6. Avoid citing references in EBA.  Referring to a table is fine. 

 Evidence Summary – 300-400 Words

Tips

1. Make sure that the evidence summarized in this section supports one of the statements in the Evidence-based Answer section
2. Keep any background or introduction short (1-3 sentences).  For many problems, this is not necessary.  Remember that you are writing for clinicians, not students.
   1.  If the intro is something most interns would know, then you don’t need to include it.  However, this is a good place to describe definitions of conditions for those situations where a clear delineation is helpful.  Eg stating that DM is a problem is not helpful, giving the definition of an Apparent Life Threatening Event can be.
3. Summarize what your search found (number of studies, type of studies).
   1. Keep this part short, but it is useful. 
4. Use sub-headings for various interventions, if appropriate, to organize this section
5. Whenever possible, quantify the results of studies (for example, it would be better to say that a particular side effect happens to 10% of people how take a drug than to say that the effect is “more common” in people who take the drug)
6. Comment on the quality of the studies, and identify potential biases when possible.
7. Whenever possible, try to use the same measures of effect, throughout the summary.
   1. For example, it is better to consistently use NNT or RR measures than to mix them.  p values do not provide any measure of the effect. Confidence intervals, when available, are preferable to p values.
8. Use a table to summarize quantitative results when possible. 
9. If NPV and PPV are given, prevalence needs to be reported as well.
10. Table should be place at the end of the document, after the references
11. Spell out numbers under 10 (e.g. one, two, three, . . . nine) and any that begin a sentence (e.g. “Sixty”). 
12. Avoid starting with numbers that don’t scan quickly when written out.  “Two hundred” is OK, “Two hundred seventy eight” is not.
13. Keep sentences short
14. Use the active voice (e.g.  The American Cancer Society recommends (active) versus, It is recommended by the American Cancer Society (passive).
15. Make sure that references are cited consecutively.  Place the citation number after the punctuation mark.  Usually, this should be the end of the sentence. 
16. Avoid using authors’ names in text:  ‘Shelley, etal. created a hybrid….’
17. Avoid the use of ‘COPD patient’; use ‘patients with COPD’ or (other alternatives) instead

 Recommendations from Others – 75-125 Words

Tips

1. Choose one to three recommendations that you believe are most important for clinicians to know.  Official guidelines from or contracted by the Department of Health and Human Services (DHHS) (NIH, CDC, AHQR, etc); medical societies (AAFP, ACG, AAP, ACOG, etc), and nationally recognized advocacy groups (ACS, AHA, ADA, etc) are preferred.
2. This is not the section for more evidence. This is the section for authoritative references. If you cannot find any of the above, then you can cite the relevant section in the best textbook(s) (preferably electronic knowledge resources that are updated regularly such as UpToDate, DynaMed or PEPID PCP)you can find.  Other options might be review articles from reputable journals (e.g. NEJM, JFP, JABFM, AFP, Annals of Family Medicine, Annals of Internal Medicine, Pediatrics, Am J Ob Gyn, etc.) that, while not explicitly a systematic review (which, if it exists, should be quoted in the “Evidence Summary”, would nonetheless be expected to reflect best clinical/authoritative opinion and include the key evidence.  To summarize, in order of preference:

  1)    DHHS guidelines

  2)    National Medical Society Guidelines

  3)    National Advocacy Groups

  4)    Frequently Updated and Well Referenced Electronic Knowledge Resources OR well down review articles (not systematic reviews, which are “evidence based” by definition) from reputable journals. 

3. Tables are helpful when there are diverse recommendations from several prominent organizations. 
4. Consider FDA recommendations for medications/devices.  (Indications)

 Authors

1. List all of the authors, co-authors, along with their degrees, institutional affiliations, city and state.
   1. Author
   2. Co-author
   3. Librarian Co-author

References10-12 maximum

Tips

1. At the end of each reference please add the appropriate Level of Evidence (LOE) from the CEBM LOE table.  Please put this LOE in parentheses [e.g. (LOE 2b)].
2. Use the reference styles found in the instructions to authors’ document (available at www.fpin.org).  The most current list of suggested reference styles for commonly used types of CI references can be found by clicking here.
3. The style for references should generally follow the format set forth in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.
4. The Journal of Family Practice prefers italicized journal and book titles and the use of inclusive page numbers, i.e., 54-59, not 54-9.  See our reference sheet for JFP citations.
5. If a website is listed as a reference, check that it is still current and date the reference Eg.  www.ILoveFPIN.com  (last accessed 4/1/2007).
6. If you use word editor software to create reference list (MSWord – endnote feature is the biggest culprit), convert the reference list to text, and remove linkages from CI. 

 Table

1. If you are including a table please add it at the end of the manuscript.
2. Make sure the table is referred to from the appropriate place in the text.  Number references in the table consecutively from that place in the text.  Cite sources for data/recommendations.  Give definitions of abbreviations.