Research Trends in Evidence-Based Medicine: A Joinpoint Regression Analysis of More than 50 Years of Publication Data

Background Evidence-based medicine (EBM) has developed as the dominant paradigm of assessment of evidence that is used in clinical practice. Since its development, EBM has been applied to integrate the best available research into diagnosis and treatment with the purpose of improving patient care. In the EBM era, a hierarchy of evidence has been proposed, including various types of research methods, such as meta-analysis (MA), systematic review (SRV), randomized controlled trial (RCT), case report (CR), practice guideline (PGL), and so on. Although there are numerous studies examining the impact and importance of specific cases of EBM in clinical practice, there is a lack of research quantitatively measuring publication trends in the growth and development of EBM. Therefore, a bibliometric analysis was constructed to determine the scientific productivity of EBM research over decades. Methods NCBI PubMed database was used to search, retrieve and classify publications according to research method and year of publication. Joinpoint regression analysis was undertaken to analyze trends in research productivity and the prevalence of individual research methods. Findings Analysis indicates that MA and SRV, which are classified as the highest ranking of evidence in the EBM, accounted for a relatively small but auspicious number of publications. For most research methods, the annual percent change (APC) indicates a consistent increase in publication frequency. MA, SRV and RCT show the highest rate of publication growth in the past twenty years. Only controlled clinical trials (CCT) shows a non-significant reduction in publications over the past ten years. Conclusions Higher quality research methods, such as MA, SRV and RCT, are showing continuous publication growth, which suggests an acknowledgement of the value of these methods. This study provides the first quantitative assessment of research method publication trends in EBM

Indonesian vegetation response to changes in rainfall seasonality over the past 25,000 years

The hydrologic response to climate forcing in the Indo-Pacific warm pool region has varied spatially over the past 25,000 years. For example, drier conditions are inferred on Java and Borneo for the period following the end of the Last Glacial Maximum, whereas wetter conditions are reconstructed for northwest Australia. The response of vegetation to these past rainfall variations is poorly constrained. Using a suite of 30 surface marine sediment samples from throughout the Indo-Pacific warm pool, we demonstrate that today the stable isotopic composition of vascular plant fatty acids (13 Cfa) reflects the regional vegetation composition. This in turn is controlled by the seasonality of rainfall consistent with dry season water stress. Applying this proxy in a sediment core from offshore northeast Borneo, we show broadly similar vegetation cover during the Last Glacial Maximum and the Holocene, suggesting that, despite generally drier glacial conditions, there was no pronounced dry season. In contrast, 13Cfa and pollen data from a core off the coast of Sumba indicate an expansion of C 4 herbs during the most recent glaciation, implying enhanced aridity and water stress during the dry season. Holocene vegetation trends are also consistent with a response to dry season water stress. We therefore conclude that vegetation in tropical monsoon regions is susceptible to increases in water stress arising from an enhanced seasonality of rainfall, as has occurred in past decades. © 2014 Macmillan Publishers Limited