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

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Assessing impacts of dike construction on the flood dynamics of the Mekong Delta

Recent flood dynamics of the Mekong Delta have raised concerns about an increased flood risk downstream in the Vietnamese Mekong Delta. Accelerated high dike building on the floodplains of the upper delta to allow triple cropping of rice has been linked to higher river water levels in the downstream city of Can Tho. This paper assesses the hydraulic impacts of upstream dike construction on the flood hazard downstream in the Vietnamese Mekong Delta. We combined the existing one-dimensional (1-D) Mekong Delta hydrodynamic model with a quasi-two-dimensional (2-D) approach. First we calibrated and validated the model using flood data from 2011 and 2013. We then applied the model to explore the downstream water dynamics under various scenarios of high dike construction in An Giang Province and the Long Xuyen Quadrangle. Calculations of water balances allowed us to trace the propagation and distribution of flood volumes over the delta under the different scenarios. Model results indicate that extensive construction of high dikes on the upstream floodplains has had limited effect on peak river water levels downstream in Can Tho. Instead, the model shows that the impacts of dike construction, in terms of peak river water levels, are concentrated and amplified in the upstream reaches of the delta. According to our water balance analysis, river water levels in Can Tho have remained relatively stable, as greater volumes of floodwater have been diverted away from the Long Xuyen Quadrangle than the retention volume lost due to dike construction. Our findings expand on previous work on the impacts of water control infrastructure on flood risk and floodwater regimes across the delta

An analytical framework for strategic delta planning : negotiating consent for long-term sustainable delta development

Sectoral planning on water, agriculture and urban development has not been able to prevent increased flood risks and environmental degradation in many deltas. Governments conceive strategic delta planning as a promising planning approach and develop strategic delta plans. Such plans are linked to actions and means for implementation in the short-term, in line with long-term strategic choices. This paper introduces an analytical framework that focuses on the role of actors, innovative solutions and participatory planning tools in negotiating consent for the strategic choices in a delta plan and its implementation. Cases of Bangladesh, the Netherlands and Vietnam are discussed as a plausibility probe to explore the framework's potential. The probe reveals that the framework is promising to explain the process and outcomes of strategic delta planning in urbanizing deltas. The paper ends with an initial research agenda to stimulate research and discussion on this new delta planning approach

The inpact of cataract surgery on depressive symptoms for bilateral cataract patients in Ho Chi Minh City, Vietnam

Background: Depression is common among older populations with cataract. However, the impact of cataract surgery on depression in both developed and developing countries remains unclear. The aim of this study is to determine the impact of cataract surgery on depressive symptoms and to examine the association between objective visual measures and change in depressive symptoms after surgery among a Vietnamese population in Ho Chi Minh City. Methods: A cohort of older patients with bilateral cataract were assessed the week before and one to three months after first eye surgery only or first- and second-eye cataract surgeries. Visual measures including visual acuity, contrast sensitivity, and stereopsis were obtained. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression Scale (CES-D). Descriptive analyses and a generalized estimating equations (GEE) analysis were undertaken to determine the impact of cataract surgery on depressive symptoms.Results: Four hundred and thirteen participants were recruited into the study before cataract surgery. Two hundred and forty-seven completed the follow-up assessment after surgery. There was a significant decrease (improvement) of one point in the depressive symptoms score (p = 0.04) after cataract surgery, after accounting for potential confounding factors. In addition, females reported a significantly greater decrease (improvement) of two points in depressive symptom scores (p = 0.01), compared to males. However, contrast sensitivity, visual acuity, and stereopsis were not significantly associated with change in depressive symptoms scores. First-eye cataract surgery or both-eye cataract surgery did not modify the change in depressive symptoms score. Conclusion: There was a small but significant improvement in depressive symptoms score after cataract surgery for an older population in Vietnam

An analytical framework for strategic delta planning: negotiating consent for long-term sustainable delta development

Sectoral planning on water, agriculture and urban development has not been able to prevent increased flood risks and environmental degradation in many deltas. Governments conceive strategic delta planning as a promising planning approach and develop strategic delta plans. Such plans are linked to actions and means for implementation in the short-term, in line with long-term strategic choices. This paper introduces an analytical framework that focuses on the role of actors, innovative solutions and participatory planning tools in negotiating consent for the strategic choices in a delta plan and its implementation. Cases of Bangladesh, the Netherlands and Vietnam are discussed as a plausibility probe to explore the framework's potential. The probe reveals that the framework is promising to explain the process and outcomes of strategic delta planning in urbanizing deltas. The paper ends with an initial research agenda to stimulate research and discussion on this new delta planning approach.Accepted Author ManuscriptPolicy Analysi