A bibliometric analysis of evidence-based medicine publications of Endocrinology and Metabolism Research Institute of Iran in Scopus Database

Abstract

Purpose

The aim of this study is to identify patterns in information sharing between Evidence-Based Medicine journals to determine key evidence dissemination areas from co-authorship, co-occurrence and citation networks and to provide a scientific horizon for improving the dissemination of Evidence Based Medicine Research in Iran. And show the trend of Evidence Based Medicine research at Endocrinology & Metabolism Research Institute (EMRI), Tehran University of Medical Sciences.

Methods

This was a bibliometric study. Scopus database was used for retrieving and analyzing the publications. We analyzed the relationship between co-authorship and citation and visualized them. Co-occurrence keywords in EBM articles in the Scopus database, and developed subject charts and research field relationship.

Results

Journal of Diabetes and Metabolism Disorders (GDMD) contains a large collection of information of relevance to Evidence Based Medicine and its contents are widely cited across many journals in Iran. The investigation of co-authorship network showed that 121 EBM articles from 191 authors, Akbar Soltani has the highest citations in EBM research and he is a pioneer in this subject area. The scientific contributions of GDMD to EBM is mostly in disease control and therapy. An Evidence Based Medicine Research Center focused more on these areas such as education, treatment and research, Evidence Based Clinical Practice, Evidence Based Policymaking and to improve clinical reasoning and clinical thinking. In co-occurrence author keywords, the highest publications were in osteoporosis. From the main journals that had published the most were the journal of diabetes and metabolic disorders (GDMD) .From citation organizations, EMRI contains large collections of information of relevance to EBM and are widely cited across 171 organizations in Iran.

Conclusions

An Evidence Based Medicine Research Center scientific production contain several key clusters. With authors, organizations and subject area being the source of the majority of articles. The EBM co-authorship author’s network in Iran is comprised of 191 authors in 23 clusters in major groups, the largest and most productive in this network is led by Akbar Soltani with Bagher Larijani,Shirin Hasani Ranjbar, Arash Moayyari, Arash Hossen-nazhad, Iraj Nabipour, Ramin Heshmat ,Hamideh Mosapour,Azadeh Aletaha, ,Mahbobeh Khabaz- Mafinejad as central members. The findings shows that EBM research topics are widely communicated to other medical fields like osteoporosis and obesity and have begun to shift from Evidence Based clinical Practice to Evidence based management.

Background

Since the 1990s, Evidence-Based Medicine has initiated and more widely accepted. It is defined as integration of the best research evidence with clinical expertise and patient values [1].Today EBM is more relevant to Evidence-Based Clinical Practice in health care setting and circumstances in daily practice [2].These emphasized the role of EBM in making decisions for diagnosis and treatment of patients. The scientific research and effectiveness of them are more important to policy making by governments and other medical organizations. In Evidence- Based Medicine Research center, the main commission has focused on clinical practice, scientific research and medical education and submit reports for policy making. In this paper, we describe the extent of the EBM literature in Evidence Based Medicine Research Center in Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences. We use Co-occurrence Keywords for content analysis, which involves the frequency of pairs of words or phrases used as subject headings or the keywords suggested by the authors or journals to indicate the key research content of an article. The use of co-occurrence keywords allows us to investigate subject structure and relationship within a knowledge domain through clustering. Co-authorship authors for scientific collaboration and citation documents was used. Considering the importance of bibliographic indicators for evaluation of research outputs in Evidence Based Medicine. It clarify how many articles your organization has published. Using citation analysis to measure the scientific impact by others. In this paper, we describe the extent of the EBM literature in Endocrinology & Metabolism Research Institute1, Tehran University of Medical Sciences.

Methods

Source of data

The first phase

The SCOPUS database have been used for extraction of published articles in the fields of Evidence-Based Medicine. It is the largest abstract and citation database of peer-reviewed literature for analyzing and refining search results and measure the research performance in Evidence-Based Medicine and the subject headings included Mesh terms which are part of the controlled indexing vocabulary developed by the USA National Medical Library (NLM). Mesh database used to extract keywords for EBM and make syntax for Evidence-Based Medicine Research Center as affiliation to identify all publications related to EBM during 2004-2019.248 article retrieved and 121 articles remained for analysis.

Visualization

The second phase

Data analyzed with both VOS viewer software version 1.6.15 and Gephi2 for bibliographic data visualization, including Co-authorship authors to identify highly productive authors, co-authorship organizations, and co-authorship countries to find out geographical distribution by country in scientific collaboration, co-occurrence author keywords to study number of documents in which bibliometric key term used and citations to determine influential authors.

Results

EBM literature in SCOPUS database

The year on year accumulation of EBM articles in SCOPUS database are shown in Fig. 1. Of the 121 articles, the line graph demonstrates the numbers of publications between 2004 and 2019.The number of publications increased drastically in 2019 and rising sharply to a peak of 16 articles. However, for the next years, publication rate declined steadily, reaching an annual low of publications in 2015. In 2014, there was a sudden increase. The number of publications doubled. In 2010 to 2007, publication rates remained steady, and there was then a sharp rise between 2007 and 2006.In 2005, on the other hand, this decreased slightly over the given period.

Fig. 1.

Yearly publication of EBM literatures

Bibliometric analysis

EBM topics

Figures 2 and 3 show co-occurrence author keywords and co-occurrence all keywords visualized using VOS viewer, for the Scopus articles.

Fig. 2.

co-occurrence author keywords in Evidence-Based Medicine

Fig. 3.

Co-occurrence all keywords in Evidence-Based Medicine

Of the 302 keywords, each circle or node in Fig. 2 represents all keywords .Node size represents the frequency of the term, the node bigger the frequency higher. Node color represents the year of the most frequent use of the term.2004–2009 is purple, 2010 to 2015 is green and 2016 to 2019 is dark yellow. According relationships, we have divided the EBM research subjects into 16 clusters with different categories and the most central terms in each cluster name: Osteoporosis, Bone mineral density, Evidence-Based Medicine, Likelihood ratio, Primary hyperparathyroidism.

In Fig. 3 showing the co-occurrence all keywords and prevalence the most important clusters in the EBM network. The total number of terms was 1085 in 15 clusters in different categories with color. Nodes (circles) in this view reflects the terms or subject. The size of each circle is equal to the frequency occurrences of the term or topic for assessing titles and abstracts .Also, the connecting lines between subjects indicates the Link Strength between subjects in terms of frequency occurrence (Tables 1, 2, and 3).

Table 1.

Ten top EBM research subjects

hot topic	Frequency occurrence	Total Link Strength
Osteoporosis	11	48
Bone Mineral Density	7	30
Evidence-Based-Medicine	7	30
Diagnosis	3	15
Likelihood ratio	4	14
Prevalence	2	11
Vitamin D	3	17
Mutation	3	10
Clinical reasoning Clinical Exam	2 2	8 8

Table 2.

Top EBM research subjects in Evidence-Based Medicine research center

Research subjects	Description
Treatment	Diagnosis, evidence-based examination, drug medicine, prognosis, evaluation, clinical policy-making, clinical guidelines, RCT
Education	Medical education, Critical thinking, clinical thinking, healthcare education, teaching methods, medical education models, education reform, medical students, information services, medical informatics, medical library and information science
Administration	Clinical paths, hospital administration, evidence-based policy-making
Research	Systematic reviews, meta-analysis, network meta-analysis, rapid reviews, scoping review, scientometry, big data, data science. RCTs, health technology assessment, safety, validity.
Information resources	Medical periodicals, EBM databases, EBM E-Learning platform, EBM app

Table 3.

Top keywords per year

The graph indicate the number of publications from 2004 to 2019.The number of articles rose rather consistently up until 2oo6;however,ther was a slight decrease in 2010 and as up 2011,2014 and 2016 the number of publications again tended upwards. Between 2016 and 2018, the number of publications remained nearly stable.

As can be seen in Fig. 4, the main analysis shows in Tables 4 amd 5.

Fig. 4.

Main authors, keywords and journals based on each paper

Table 4.

Top Journals per year based on papers

Table 5.

Main authors, keywords and journals based on each paper

Co‐authorship organization

This scientific network contains 31 clusters in different colors. Accordingly, the cluster attributed to Endocrinology and Metabolism Research Institute is larger than the rest; its co-authorship rate is also more than other institutions. As shown in Fig. 5, red cluster describes Endocrinology and Metabolism Research Institute, blue cluster denotes Bushehr University of Medical Sciences, and Brown cluster represents Endocrinology and Metabolism research center, Shiraz University of Medical Sciences. These three clusters are the most important clusters of institutions co-authorship networks in this study. In Fig. 6 the Evidence Based Medicine Research Center has strong link strength with Metabolic Disorders Research Center, Chronic Disease Research Center and Endocrinology and Metabolism Research Center.

Fig. 5.

Co-authorship organization

Fig. 6.

Co-authorship organization with Evidence Based Medicine Research center

For each of the 6 countries, the total link strength of the co-authorship links with other countries selected .Iran with 73 documents and 807 citations has the strongest total link with the US with a score of 6 and United Kingdom with a score of 5 (Fig. 7; Table 6).

Fig. 7.

Co-authorship authors

Table 6.

Scientific collaboration with other countries

Country	Documents	Citations	Total Link Strength
Iran	73	807	13
Unites states	4	26	6
United Kingdom	4	17	5
Canada	2	18	3
Austria	2	5	2
Australia	1	0	1

This network contains 23 clusters in different colors. The circles reflect the authors, the size of the circles represents the strongest co-authorship links with other authors. Akbar Soltani with 73 documents and 807 citations has the strongest link strength with a score of 339. It shows that the central author for this study is Akbar Soltani. He is key person in the early development of EBM in Tehran University of Medical Sciences.

Figure 8 shows the network of the 191 most frequently cited authors. The size of the node represents the frequency of citation and its color represents the time period in which most of the person’s cited papers were published: before 2008 is purple, 2008 to2012 green and 2012 to 2019 yellow. The thickness of the connecting lines indicates the strength of the relationship, with stronger relationships being shown by thicker lines. The clustering analysis could be used to separate the core Iranian authors into four groups shown in Fig. 8.

Fig. 8.

Citation authors

Discussion

The EBM literature in Evidence Based Medicine Research center contains several key clusters, with organizations and key authors being the source of the majority of articles. Outside Endocrinology and Metabolism Clinical Science Institute, EBM research center, in Tehran University of Medical Sciences, the original place of EBM, is the dominant producer of EBM publications and Medical Education.

The increasing importance of EBM in Iran requires the production of new evidence and is enthralling new methodology, standards, clinical research and the application of clinical evidence in daily practice. This may lead to strengthening of evidence-based practice in medicine and other fields in healthcare and promotion of EBM through education and training. For example, in otolaryngology field, evidence-based medicine (EBM) has more impact on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals. In this study as a quasi-experimental, (before‐and‐after) study underwent the modified Fresno test. It demonstrated that EBM education and practice of the learned materials in journal clubs could improve the knowledge and skills of residents [3].

In another study, demonstrated the key role of EBM to prevention and evidence-based treatments of Spinal cord injury (SCI) related osteoporosis, no recommendations could be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment.In this study, future high-quality RCT studies with higher sample sizes and more homogeneity were strongly recommended to provide high-quality evidence and made applicable recommendations for prevention and treatment of SCI-related bone loss [4].

Evidence-based medicine is becoming an important of human life span, which crucial developmental processes occur. Since peers play a critical role in the psychosocial development of most adolescents. Peer education was currently considered as a health promotion strategy in adolescents. It defined as a system of delivering knowledge that improves social learning and provides psychosocial support. The impact of this approach on adolescents is most important. Peer education could be an effective tool for promoting healthy behaviors among adolescents. The development of this approach on the settings, context, and the values and expectations of the participants. Designing such programs requires proper preparation, training, supervision, and evaluation [5]. Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under “time constraint” is the diagnostic approach. physician need some diagnostic approaches to decrease both diagnostic time and errors. It seems that highly experienced clinicians utilize some special tactics in this regard. Evidence- based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic evaluations. Evaluation experts’ strategies and assessed what EBM could add to these tactics. The diagnostic strategies of some veteran internists in their busy outpatient clinics and proposed an evidence- based diagnostic model engaging clinical experience and research evidence. It appeared that every clinician utilized a set of “key pointer” questions for decision-making. In addition to use of evidence-based resources for making differential diagnosis and estimating utility of various diseases, clinicians should use “key pointers” with significant likelihood ratios and from independent systems to reduce time and errors of history taking. Clinical trainees could improve their practice by constructing their own set of pointers from valid research evidences. Using the diagnostic model, EBM can help physicians to struggle against their “time constraint“ [6].

In comparison of other studies, the trainee doctors’ attitudes and knowledge of EBM to obtain the basis required for developing appropriate teaching and learning opportunities evaluated. It demonstrated that the majority of trainee physicians at a Tehran University hospital lack adequate knowledge about basic concepts of EBM. Furthermore, most of them continue to use traditional sources of knowledge rather than evidence-based medicine resources. Fortunately, there is still a tendency to learn evidence-based medicine and take part in EBM training courses [7].

Evidence-based medicine stresses on the advantages of the most instances in medical decision-making. While ‘probabilistic or evidence-based’ reasoning seems to involve more mathematical formulas at the first look, this attitude is more dynamic and less imprisoned by the rigidity of mathematics comparing with ‘deterministic or mathematical attitude’. In the field of medical diagnosis, appreciation of uncertainty in clinical encounters and utilization of likelihood ratio as measure of accuracy seem to be the most important characteristics of evidence-based physicians. Other characteristics include use of series of tests for refining probability, changing diagnostic thresholds considering external evidences and nature of the disease, and attention to confidence intervals to estimate uncertainty of research-derived parameters [8].

Clinical treatment is a primary focus for EBM in Iran and elsewhere, being related to prevention, diagnosis, treatment etc.; paying attention to critical diseases such as hypertension, diabetes mellitus, cancer, and other diseases to examine the cost-effectiveness and safety of drugs. Relatively little research on quality of life and economic analysis has been done in Iran. There is a great need to broaden EBM research into medical education, medicine, surgery, nursing, dentistry, and clinical librarianship to improve training and education, to construct an evidence resource and to promote multi-disciplinary cooperation and development. EBM practice demands changes in curriculum content, methods and models, and the integration of education and training in EBM into everyday clinical practice, giving practitioners the ability to identify problems and to formulate clinical questions and conduct the necessary investigations to overcome this situation [9–11].

Conclusions

According to the current results, the EBM cooperation network in Tehran University of Medical Sciences and Endocrinology and Metabolism Clinical Science Institute is comprised of major groups. According to all achieved results, these organizations do more evidence production and methodology research than other places. We suggest that other organizations which need to have scientific collaboration and strength their capacity to deliver high quality of health care and used evidence in daily practice.

Abbreviations

EBM

Evidence-Based Medicine

MeSH

Medical Subject Headings

NLM

National Library of Medicine

VOSviewer

Visualizing scientific landscapes

Author contributions

AA participated in the design of the study, collected data, analyzed data and wrote draft of the manuscript. AS helped to write draft of the manuscript. RA collected data. BL conceived of the study, participated in its design, and helped to collect data & and draft the manuscript. All authors read and approved.

Data availability

Not applicable.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no competing interests.