Evidence-based Medicine Articles Research Articles

A 12-Year Review of Clinical Practice Patterns in Dupuytren Contracture Based on Continuous Certification by the American Board of Plastic Surgery.

The American Board of Plastic Surgery collects data on 20 common plastic surgery operations as part of the Continuous Certification process. The goal of this study was to describe clinical trends in Dupuytren contracture repair since 2008 as they relate to evidence-based medicine articles published in this timeframe. Cumulative tracer data for Dupuytren contracture were reviewed for the period from February of 2008 to March of 2020 and compared with evidence-based medicine articles published in Plastic and Reconstructive Surgery . Topics were categorized as (1) pearls, addressed in both the tracer data and evidence-based medicine articles, (2) topics only addressed in tracer data, and (3) topics only addressed in evidence-based medicine articles. As of March of 2020, 230 cases of Dupuytren contracture had been entered. The median age at time of surgery was 65 years (range, 38 to 91 years). Practice patterns from 2008 through 2014 were compared with those between 2015 and 2020. The most common surgical technique was limited fasciectomy (62 percent of cases). Differences in practice between these time periods included decrease in the use of radical fasciectomy (34 percent versus 16 percent, p = 0.002), increase in percutaneous cordotomy (0 percent versus 13 percent), and increase in the use of collagenase injections (0 percent versus 9 percent, p = 0.001). Use of Bier blocks increased (1 percent versus 7 percent), and tourniquet use decreased (97 percent versus 80 percent). Significant changes were also noted in postoperative management. By examining American Board of Plastic Surgery tracer data, the authors have described national trends in presentation and surgical techniques for Dupuytren contracture repair over a 14-year period.

Evidence-Based Medicine in the Field of Ophthalmology during the COVID-19 Pandemic.

Purpose To describe the evolution of COVID-19 related publications in the field of ophthalmology. Methods All articles published in the field of ophthalmology and relevant to COVID-19 were identified by conducting a search on PubMed and Scopus databases using the string ((ophthalmology) OR (eye) OR (ocular)) AND ((corona) OR (COVID-19) OR (pandemic)). Search was conducted on September 30, 2020. Each eligible publication was independently graded by two experienced ophthalmologists based on the level of evidence-based medicine (EBM), with scores ranging from 1 (the highest level of EBM) to 5 (the lowest level). The average level of EBM was also evaluated for each month from February through September. Finally, we analyzed the interval (in days) between submission and acceptance for publication as well as the percentage of manuscripts that required revision before being accepted. Results Our search yielded a total of 425 relevant publications. Of these publications, 359 (84.5%), 59 (13.9%), and 7 (1.6%) were rated as level 5, 4, and 3, respectively; none of the publications was rated as level 1 or 2. From February 2020 through September 2020, we found a significant increase in the relative proportion of level 3 and 4 publications compared to level 5 publications (rho = 0.108, p=0.024). Moreover, the number of citations per article was significantly correlated with the level of EBM (rho = 2.44, p < 0.0005); however, we found no correlation between the number of citations and either the month of publication or the ranking of the journal in which the article was published. The mean interval between submission and acceptance for publication was 20.4 days (SD: 20.2 days), and 48.2% of submitted manuscripts were accepted without revision. From February through September, the interval between submission and acceptance increased significantly (rho = 0.515, p < 0.0005); however, we found no significant change in the percentage of publications that were accepted without revision over this same time period. Conclusions In the early months of the COVID-19 pandemic, primarily lower-level EBM articles were published, and these publications were accepted relatively quickly. However, this effect was temporary, and over time the EBM levels improved and the interval between submission and acceptance increased, indicating an increase in publication standards.

A Fourteen-year Review of Practice Patterns and Evidence-based Medicine in Operative Metacarpal Fracture Repair.

Background:The American Board of Plastic Surgery has been collecting practice data on metacarpal fracture operative repair since 2006 as part of its Continuous Certification process. These data allow plastic surgeons to compare their surgical experience to national trends. Additionally, these data present the opportunity to analyze those trends in relation to evidence-based medicine.Methods:Data on metacarpal fracture operative repair from May 2006 to December 2014 were reviewed and compared with those from January 2015 to March 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and evidence-based medicine.Results:In total, 1160 metacarpal fracture repair cases were included. Outpatient (as opposed to inpatient) operative repairs have been trending upward, from 50% to 61% (P < 0.001). Most repairs were performed under general anesthesia (68%), and there was a decrease in the use of regional anesthesia between our two cohorts (14%–9%; P = 0.01). An open reduction with internal fixation was the most popular technique (51%), and a decrease in the use of closed reduction with splinting was observed (16%–10%; P = 0.001). Stiffness was the most commonly reported adverse event. Topics addressed in evidence-based medicine articles but not tracer data included interosseous wiring, which has shown success in spiral shaft fracture treatment with minimal complications, and nonoperative management.Conclusion:As evidence-based recommendations continue to change with additional research inquiry, tracer data can provide an excellent overview of the current practice of metacarpal fracture repair and how effectively physicians adapt to remain aligned with best practices.

Analysis Of Articles on Evidence-Based Medicine

The aim of this study is to conduct a bibliometric analysis of articles on evidence-based medicine. Using Bibliometrix and VOSviwer software, the most efficient author, country, organization, and journals were identified. Web of Science articles between the years of 1975-2019 were downloaded with a search strategy and analyzed with Bibliometrix and VOSviwer software. It has been observed that evidence-based medicine articles were grouped under three main clusters (Management and Decision Support, Drug and Experiment and Measurment). The first three countries that have the highest international collaboration rate are Switzerland, New Zealand, and Sweden. The first five countries regarding publication numbers are the USA, United Kingdom, Canada, Australia, and Germany. While Khan and Green have the highest grade in h and g index; Baglı, Castagnetti and Fossum have the highest grade in m index. Guyatt is the author who has the highest number of citations whereas Phillips is the one who has the most publications. While, on one hand, evidence-based medicine extends its function in illness and drug treatments, on the other hand, it is used as policy input to improve the education, curriculum, and the health system. Policy-makers, decision-makers, educators, and researchers can develop strategies according to the findings identified above.

QS10: Clinical Practice Patterns and Evidence-based Medicine in Dupuytren’s Contracture: A Twelve-year Review of Continuous Certification Tracer Data From The American Board of Plastic Surgery

Purpose:Since 2008, The American Board of Plastic Surgery (ABPS) has collected clinical practice data on Dupuytren’s contracture repair as part of their Continuous Certification (CC) process. Submitted twice every ten years by each plastic surgeon, this collection can help describe clinical trends in Dupuyren’s contracture repair as they relate to Evidence-Based Medicine (EBM) articles published in this timeframe.Methods:Cumulative tracer data for Dupuytren’s contracture repair from February, 2008 through December, 2014 were reviewed and compared to data from January, 2015 through March, 2020 with the goal of identifying national practice trends. These trends were then evaluated alongside EBM reviews published in 2010, 2014 and 2017.Results:As of March 2020, 230 cases of Dupuytren’s contracture were included in the tracer. The median age at time of surgery was 65 years (range, 38-91 years), and the average age of disease onset was 47 years. The most common surgical technique was limited fasciectomy, comprising 62% of cases. There were no postoperative adverse events reported in 77% of cases. The most common complications were loss of finger flexion (3%) and skin loss (2%). Topics addressed in EBM articles but not tracer data included adjuvant treatments and non-operative techniques such as tamoxifen administration. The use of minimally invasive procedures such as percutaneous cordotomy (0% vs. 13%) and collagenase injections (0% vs. 9%, p = .001) showed significant increases between the two time periods. More invasive procedures such as radical fasciectomy decreased in popularity (34% vs. 16%, p = .002). Use of Z-plasty also decreased between 2015 and 2020 (67% vs. 45%, p < .001). General anesthesia was the most commonly used form of anesthesia, being employed in 54% of tracer cases. There was an increase in the use of Bier block regional anesthesia (1% vs. 9%, p = 0.029) as well as in the use of epinephrine for hemostasis (0 vs. 8%, p = 0.006). Significant changes were also noted in post-operative management, including a decrease in the employment of formal postoperative hand therapy. This is consistent with evidence showing that it has no significant clinical benefit.Conclusion:The tracer data collected on Dupuytren’s contracture repair over a twelve-year period allow us to describe national trends in presentation and surgical techniques, and can help plastic surgeons evaluate their surgical practice in the context of these trends and EBM.

Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures.

From 2005 to 2020, the American Board of Plastic Surgery collected data on 20 common plastic surgery operations as part of the Maintenance of Certification process. These data allow the authors to examine national trends in zygomatico-orbital fracture repair over a 15-year period. Tracer data for zygomatico-orbital fracture repair were reviewed in cohorts from 2005 to 2013 and 2014 to 2020. Results were categorized based on their presence in evidence-based medicine articles published during this period. Differences between years were assessed using the t test or chi-square test as appropriate. Four hundred thirty patients were included as of March of 2020. Average age was 37 years (range, 6 to 85 years), and 76 percent were male. Operations took place on average 10 days from injury. There were significant decreases in the use of subciliary (31.9 percent versus 10.0 percent; p < 0.001), gingival buccal (84.3 percent versus 56.4 percent; p < 0.001), and lateral brow (45.2 percent versus 22.3 percent; p < 0.001) incisions, with an increase in lower lid external incisions (15.2 percent versus 30.9 percent; p < 0.001); 2.7 percent of patients had a complication requiring readmission and 4.5 percent required reoperation. The incidence of postoperative diplopia was 7.7 percent, and the infection rate was 1.7 percent. This article reviews the American Board of Plastic Surgery tracer data for zygomatico-orbital fracture repair. The Maintenance of Certification tracer data provide a national database with longer follow-up and more specific information than comparable databases. Analysis of these data over time enables the authors to describe practice trends and gives surgeons the opportunity to compare their outcomes to national norms.

Clinical Practice Patterns in Nonsyndromic Craniosynostosis: A Review of Continuous Certification Tracer Data From the American Board of Plastic Surgery.

Abstract Since 2003, the American Board of Plastic Surgery has collected data on 20 plastic surgery operations as part of the Maintenance of Certification process. The goal of this study was to describe national trends in craniosynostosis repair as they relate to Evidence-Based Medicine (EBM) articles published during this timeframe. Cumulative tracer data for nonsyndromic craniosynostosis were reviewed from 2006 to March 2020, and compared with EBM articles published in Plastic and Reconstructive Surgery. Topics were categorized as: As of March 2020, 940 cases of nonsyndromic craniosynostosis had been entered. The median age at the time of surgery was 8 months (range, 1–204 months). Practice patterns from 2006 through 2013 were compared with those between 2013 and 2020. The most common surgical technique from 2006 through 2013 was anterior regional cranioplasty, and from 2013 to 2020 was orbital rim advancement. Differences in practice between these time periods included an increase in patients with asymptomatic clinical presentation (27% versus 42%, P &lt; 0.001) and presentation with papilledema (1% versus 4%, P = 0.003). Use of preoperative MRI significantly increased (1% versus 6%, P &lt; 0.001). Significant changes were noted in surgical technique and methods of fixation. By examining the American Board of Plastic Surgery tracer data, the authors can describe national trends in presentation, imaging, and surgical techniques for non -syndromic craniosynostosis repair over a 14-year period.

Lessons from American Board of Plastic Surgery Maintenance of Certification Tracer Data: A 16-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Cleft Palate Repair.

As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.

Abstract 58: Clinical Practice Patterns And Evidence-based Medicine In Cleft Palate Repair: A Sixteen-year Review Of Maintenance Of Certification Tracer Data From The American Board Of Plastic Surgery

Purpose: As a component of the Maintenance of Certification (MOC) process from 2003 to 2019, the American Board of Plastic Surgery (ABPS) tracked 20 common plastic surgery operations, or tracer procedures. By evaluating the data collected over 16 years, we are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. Methods: Cumulative data for the tracer procedure on primary cleft palate repair that had been accumulated since 2003 were reviewed as of April, 2014 and September, 2019. To assess points covered by evidence-based medicine articles, cleft palate Evidence-Based Medicine (EBM) articles published in Plastic and Reconstructive Surgery were reviewed. Changes in tracer data from 2014 to 2019 were compared using a Chi square test, Fisher’s exact test, or Student’s t-test as appropriate. Results: 2,850 cases (1,507 male, 1,343 female) had been entered into the tracer as of September, 2019. The median age of patients operated on was 12 months. 15% of patients had a “previous airway problem”. 3% of patients receiving a two-stage repair. Several significant changes in operative techniques were noted including a decrease in pushback, Von Langenbeck and Furlow palatoplasty. Several additional questions in the ABPS tracer are not addressed in the EBM literature, a few of which provide potential topics for further study. These include use of greater than 24 hours of postoperative antibiotics, and injection of epinephrine, which changed significantly from 2014 to 2019. 94.2% of the 2850 patients reported in the ABPS tracer data experienced no postoperative adverse events. 58 complications, or 34.9% of all complications, did not fit into any of the categories specified in the tracer data. Conclusion: ABPS MOC tracer data enables surgeons to evaluate their outcomes in light of national statistics. We have used these tracer data combined with published evidence-based medicine articles relevant to cleft palate repair to identify trends in cleft palate repair from 2014 to 2019. By providing an overview of areas of focus in the MOC tracer data as well as EBM articles, we hope to provide a venue for surgeons to further evaluate their own practice through review of the literature. We have additionally identified areas of cleft palate research that have not been addressed by the tracer and may be valuable to include in the MOC tracer module in the future. Finally, areas collected in the tracer but not addressed in the literature provide opportunities for further research into aspects of cleft palate repair.

Does the Removal of Textbook Reading from Emergency Medicine Resident Education Negatively Affect In-Service Scores?

IntroductionIn-service exam scores are used by residency programs as a marker for progress and success on board exams. Conference curriculum helps residents prepare for these exams. At our institution, due to resident feedback a change in curriculum was initiated. Our objective was to determine whether assigned Evidence-Based Medicine (EBM) articles and Rosh Review questions were non-inferior to Tintinalli textbook readings. We further hypothesized that the non-textbook assigned curriculum would lead to higher resident satisfaction, greater utilization, and a preference over the old curriculum.MethodsWe collected scores from both the allopathic In-training Examination (ITE) and osteopathic Emergency Medicine Residency In-service Exam (RISE) scores taken by our program’s residents from both the 2015–2016 and 2016–2017 residency years. We compared scores pre-curriculum change (pre-CC) to scores post-curriculum change (post-CC). A five-question survey was sent to the residents regarding their satisfaction, preference, and utilization of the two curricula.ResultsResident scores post-CC were shown to be non-inferior to their scores pre-CC for both exams. There was also no significant difference when we compared scores from each class post-CC to their respective class year pre-CC for both exams. Our survey showed significantly more satisfaction, utilization, and preference for this new curriculum among residents.ConclusionWe found question-based learning and Evidence-Based Medicine articles non-inferior to textbook readings. This study provides evidence to support a move away from textbook readings without sacrificing scores on examinations.

Educational impact after 10 years of implementation of a portfolio for undergraduate medical students

A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

Why Evidence-Based Medicine Matters to Aesthetic Surgery

This issue of Aesthetic Surgery Journal marks the one-year anniversary of Dr. Foad Nahai’s editorial heralding an increased focus on evidence-based medicine (EBM) in the pages of the Journal .1 This year, the Journal will increase the visibility of EBM articles by showcasing the Level of Evidence (LOE) pyramid to identify pertinent articles with a ranking of Level 1, 2, or 3. Levels of Evidence are but one of the tools used in EBM to assess the validity of data presented in scientific studies, thereby enabling us to make more informed decisions and take better care of our patients. During the past year, as discussions about EBM have become more frequent, many plastic surgeons have questioned what exactly EBM is, why it is necessary, and how will it affect their practice and their patients. David Sackett2 has defined EBM as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Several key words in this definition guide us toward not only what EBM is but, just as importantly, what EBM is not. First, EBM is conscientious. It is based on a concerted and thoughtful effort to apply information in a different way and, as such, requires as significant a change in our ways of thinking and our culture as a change in our daily processes. Second, EBM is explicit. When applying EBM principles, we purposefully and systematically seek out the most appropriate information, examine it in a critical way, and incorporate this information as we implement a balanced action plan. It is important to note that the information that we seek is the current best information—not the information that we wish we had or will have in the future—and is thus limited by research and clinical reports. …

Visualization studies on evidence‐based medicine domain knowledge (Series 1): Mapping of evidence‐based medicine research subjects

To use visualization methods to illustrate and compare major subjects, domains, and developments in evidence-based medicine (EBM) in recent years. We analyzed MeSH terms and keywords in EBM articles in the MEDLINE and CNKI databases, and developed subject charts, research field relationship charts, and strategy coordination charts using word co-occurrence, PFNET algorithms, and visualization methods. Rapid developments and growth are taking place in EBM in China and around the world. Studies on humans comprised 94.4% of the EBM studies that we identified, while animal studies accounted for 2.6% (three quarters of these animal studies were on primates). The six countries with the largest number of EBM articles and the eight host nations for the 108 journals with the most EBM publications were from high-income countries. In China, 31 provinces, municipalities, and autonomous regions have published EBM articles, although most of these publications come from the more highly-developed areas of the country. The investigation of word co-occurrence showed that EBM articles outside of China involve seven main fields: "Therapy", "Methods", "Standards", "Research", "Education", "Nursing" and "Organization and Administration". Five of these fields ("Therapy", "Nursing", "Research", "Education" and "Management") were common to China but the top seven fields for this country included "Traditional Chinese Medicine (TCM)" and "Information resources"; and did not include "Methods" and "Standards". Furthermore, studies on "Nursing" and "Research" were not as advanced in China as in other countries. There are similarities between China and the rest of the world in several areas in the EBM literature but also some important differences. Throughout the world, the most resource-rich regions o organizations tend to have the most well-developed EBM. These regions and organizations are pdocuing more evidence and conducting more methodology research than the less resourced regions and organizations. There is an urgent need for these regions and organizations to strengthen their use of evidence, to learn more about the philosophy that underpins EBM, and to improve accessibility to, and use of, evidence in choices about health care.

Visualization studies on evidence‐based medicine domain knowledge (series 2): structural diagrams of author networks

To investigate the output of evidence-based medicine (EBM) researchers in China and elsewhere by examining the EBM domains they work within and the networks that exist among them; using visualization methods to analyze these relationships. This maps the current situation and helps with the identification of areas for future growth. We used co-citation matrixes with Pathfinder networks and hierarchical clustering algorithms, and constructed a co-author matrix which were analyzed with a whole network approach. The analyzed matrixes were visualized with the UCINET program. Much of the development of EBM has been centered around three authors, David Sackett, Gordon Guyatt and L Manchikanti, within three different clusters. The main authors of EBM articles in China were divided into nine academic domains. The relations among core authors of articles indexed by the Science Citation Index (SCI) was loose. There was a stronger co-authorship network among core authors in the Chinese literature, with three groups and 21 cliques. Nine distinct academic communities appeared to have formed around Li Youping, Liu Ming and Zhang Mingming. The EBM literature contains several key clusters, with universities in high-income countries being the source of the majority of articles. Outside China, McMaster University in Canada, the original home of EBM, is the dominant producer of EBM publications. In China, Sichuan University is the main source of EBM publications. The EBM cooperation network in China is comprised of three major groups, the largest and most productive in this sample is led by Li Youping with Liu Ming, Zhang Mingming, Li Jing, Wang Li, Wu Taixiang, and Liu Guanjian as central members.

Introduction to the International Working Group for Global Women's Health Research 2010 Symposium Proceedings.

Abstract There is no more critically important health issue for obstetricians that the health of the mother and child from conception through parturition and lactation. Yet much of the medical literature surrounding the ultimate ideal for maternal health is fraught with assumptions. The current prevailing view is that somehow is an outcome equivalent to or superior to live birth. Yet evidence for this opinion is conspicuously lacking. So strongly is the abortion is better than live birth opinion held, that many leading peer-reviewed journals dismiss evidence-based medicine articles which challenge pro-abortion ideology. This censorship of the mounting evidence of the harms of on women leads to a certain suspicious monotony, deadly to scientific inquiry.

総合医学・内科誌インパクトファクター上位３誌の被引用回数とＭＥＤＬＩＮＥ Ｐｕｂｌｉｃａｔｉｏｎ Ｔｙｐｅｓの２００２‐４年調査

Background: In May 2006, a search was conducted of the 20 highest cited articles related to Evidence Based Medicine (EBM) through MEDLINE Publication Types. The New England Journal of Medicine's (N Engl J Med's) and Lancet's articles were cited for the most part in the top cited twenty articles. Therefore, an investigation with the highest Impact Factors of the top three cited journals was carried out. Moreover, MEDLINE's Publication Type data was added.Purpose: This article explains that the cluster of highest cited articles was related to EBM. Bibliometric analysis of the N Engl J ed, JAMA and Lancet was used, which had more than 3800 articles or reviews from 2002 to 2004 in the “Web of Science”.Method: The category “MEDICINE, GENERAL & INTERNAL ”of“ Journal Citation Reports” was searched with the highest Impact Factor of the three journals' articles cited the most times by using the Web of Science's General Search. Further to that, the MEDLINE's Publication Type was searched to find a relation to EBM articles, Reviews, or other Publication Types, for example, a Comparative Study, and so on.Results:1: The articles of N Engl J Med were quoted 1.5 times for the three journals over three years. EBM related articles were cited from 2.3 to 3.0 times. Review articles, however, were cited 0.95 times.2: The articles of JAMA were quoted 0.9 times for the three journals during three years. EBM related articles were cited from 1.7 to 1.4 times. Practice Guideline articles were cited 9.3 times.3: The articles of Lancet were quoted 0.7 times for the three journals over three years. EBM related articles were cited from 1.2 to 1.6 times.Conclusion: It was proven that EBM relation Publication Type articles were quoted more often than in any other article.

日本三大死因をキーワードとして抽出した被引用回数上位論文のＰｕｂＭｅｄにおけるＰｕｂｌｉｃａｔｉｏｎ Ｔｙｐｅｓ調査：ＥＢＭとの相関を中心に

Background: Kyushu University Medical librarians are transferred to other branches or central libraries before a good enough understanding of EBM (Evidence Based Medicine). In this paper, I will elucidate why EBM articles are imperative for database users. I will investigate the use of title words associated to articles cited the most times relating to the three Japanese major causes of death in PubMed Publication Types.Purpose: This article searches the relation between Web of Science Cited Times and PubMed Publication Types as the indicator of the importance of EBM articles.Method: The articles of which the title contains the words “cancer”, “breast cancer”, “myocardial infarction”, or “stroke” were retrieved on the Web of Science. Moreover the information of PubMed Publication Types was added to the top 20 most cited articles of the search results. Then the articles were compared with the perspectives of journal name, cited references, times cited, publication year, page, and publication types.Results: Ratio of the articles which have evidence is from 50% to 70% on the areas of breast cancer, myocardial infarction, and stroke, however, each publication type had less than 11% in PubMed.Conclusion: It was shown that evidence to Publication Type articles was quoted more often than in other articles.

An evidence-based approach to studies in cirrhosis and portal hypertension: medical management of mild to moderate ascites

Previous articles in this series have examined the critical appraisal of isolated structured clinical questions using the framework of evidence-based medicine. When patients are identified with a disease-specific process, however, an integrated approach for addressing multiple questions is required. This article, the sixth in the evidence-based medicine series for this journal, integrates critical appraisal techniques to examine the decision-making process used when evaluating a patient with cirrhosis and new-onset mild to moderate ascites. In the following clinical scenario, an approach is described for determining prognosis after the development of ascites and whether salt restriction and oral diuretics are effective therapies. The format is similar to other evidence-based medicine articles published in the Journal of the American Medical Association. The evidence-based medicine concepts have been expanded from previous articles, and examples from the hepatology literature have been used.

An evidence-based approach to studies of gastrointestinal therapies

This article provides an evidence-based medicine framework to critically assess the validity of study design and clinical significance of study results in the context of gastrointestinal therapies for a common clinical scenario. Without systems for critically appraising and applying clinical research, we may become dependent on outdated information. When used in conjunction with clinical judgment, critical appraisal of clinical research facilitates the provision of the very best care to patients. This article, which examines a trial about the gastrointestinal safety of cyclooxygenase (COX)-II–selective nonsteroidal anti-inflammatory drugs (NSAIDs), 1 follows the format of other evidence-based medicine articles in the Canadian Medical Association Journal, 2 the Journal of the American Medical Association, 3 and Gastroenterology. 4 The evidence-based medicine concepts have been expanded from previous articles and examples from the gastrointestinal literature have been used. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2003;1:57-63