The methodological quality of 176,620 randomized controlled trials published between 1966 and 2018 reveals a positive trend but also an urgent need for improvement.

Many randomized controlled trials (RCTs) are biased and difficult to reproduce due to methodological flaws and poor reporting. There is increasing attention for responsible research practices and implementation of reporting guidelines, but whether these efforts have improved the methodological quality of RCTs (e.g., lower risk of bias) is unknown. We, therefore, mapped risk-of-bias trends over time in RCT publications in relation to journal and author characteristics. Meta-information of 176,620 RCTs published between 1966 and 2018 was extracted. The risk-of-bias probability (random sequence generation, allocation concealment, blinding of patients/personnel, and blinding of outcome assessment) was assessed using a risk-of-bias machine learning tool. This tool was simultaneously validated using 63,327 human risk-of-bias assessments obtained from 17,394 RCTs evaluated in the Cochrane Database of Systematic Reviews (CDSR). Moreover, RCT registration and CONSORT Statement reporting were assessed using automated searches. Publication characteristics included the number of authors, journal impact factor (JIF), and medical discipline. The annual number of published RCTs substantially increased over 4 decades, accompanied by increases in authors (5.2 to 7.8) and institutions (2.9 to 4.8). The risk of bias remained present in most RCTs but decreased over time for allocation concealment (63% to 51%), random sequence generation (57% to 36%), and blinding of outcome assessment (58% to 52%). Trial registration (37% to 47%) and the use of the CONSORT Statement (1% to 20%) also rapidly increased. In journals with a higher impact factor (>10), the risk of bias was consistently lower with higher levels of RCT registration and the use of the CONSORT Statement. Automated risk-of-bias predictions had accuracies above 70% for allocation concealment (70.7%), random sequence generation (72.1%), and blinding of patients/personnel (79.8%), but not for blinding of outcome assessment (62.7%). In conclusion, the likelihood of bias in RCTs has generally decreased over the last decades. This optimistic trend may be driven by increased knowledge augmented by mandatory trial registration and more stringent reporting guidelines and journal requirements. Nevertheless, relatively high probabilities of bias remain, particularly in journals with lower impact factors. This emphasizes that further improvement of RCT registration, conduct, and reporting is still urgently needed.

Alzheimer: A Decade of Drug Design. Why Molecular Topology can be an Extra Edge?

BACKGROUND: The last decade was characterized by a growing awareness about the severity of dementia in the field of age-related and no age-related diseases and about the importance to invest resources in the research of new, effective treatments. Among the dementias, Alzheimer's plays a substantial role because of its extremely high incidence and fatality. Several pharmacological strategies have been tried but still now, Alzheimer keeps being an untreatable disease. In literature, the number of QSAR related drug design attempts about new treatments for Alzheimer is huge, but only few results can be considered noteworthy. Providing a detailed analysis of the actual situation and reporting the most notable results in the field of drug design and discovery, the current review focuses on the potential of molecular topology as a reliable tool in finding new anti-Alzheimer lead compounds. METHODS: Published works on QSAR applied to the search of anti-Alzheimer's drugs during the last 10 years has been tracked. 2D and 3D-QSAR, HQSAR, topological indexes, etc. have been analyzed, as well as different mechanisms of action, such as MAO, AchE, etc. An example of topological indexes' application to the search of potential anti-Alzheimer drugs is reported. RESULTS: Results show that QSAR methods during the last decade represented an excellent approach to the search of new effective drugs against Alzheimer's. In particular, QSAR based on molecular topology allows the establishment of a direct structure-property link that results in the identification of new hits and leads. CONCLUSION: Molecular topology is a powerful tool for the discovery of new anti-Alzheimer drugs covering simultaneously different mechanisms of action, what may help to find a definitive cure for the disease.

Henry Hollingsworth Smith and His Bibliographical Index and Historical Record: The Beginning of American Surgical Historiography.

OBJECTIVE: To explore the details of Henry Hollingsworth Smith's (1815-1890) achievement as the first physician to organize in a systematic and chronologic manner the details of the history of surgery in America and prepare a register of men who performed surgical operations. BACKGROUND: The life of Smith, the earliest of the nation's surgeons to elucidate the history of American surgery, is little known. His boosting the image of the scalpel wielder helped shape the future of the craft, in particular, surgery's rise as a specialty and profession. METHODS: An analysis of the published medical literature and unpublished documents relating to Smith and his work to document the history of American surgery. RESULTS: During the 1850 s, a time when surgery was not considered a separate branch of medicine but a mere technical mode of treatment, Smith's efforts in surgical history provided much needed encouragement to surgeons in their pursuit of professional recognition. CONCLUSIONS: Although Smith's accomplishment as the nation's first compiler of the history of American surgery has long been forgotten, his effort afforded the men who performed surgical operations their earliest measure of self-respect. As such, Smith belongs in America's pantheon of surgical heroes.

El enfermero de unidades hospitalarias oncológicas: perfil y capacitación profesional / O enfermeiro que atua em unidades hospitalares oncológicas: perfil e capacitação profissional / The nurse that operates in oncology unit hospital: profile and vocational training

Este es un estudio que tuvo como objetivo identificar el perfil de la enfermera que trabaja en las unidades hospitalarias de oncología. Se trata de una revisión integradora y la recolección de datos se llevó a cabo en cuatro bases de datos electrónicas en el período de marzo a mayo de 2013. Se seleccionaron 15 artículos publicados en el período 2004-2013. Los resultados se describen en dos categorías: 1. El perfil social y profesional de las enfermeras que trabajan en unidades hospitalarias de oncología y 2. Formación y preparación de la enfermera para actuar en unidades hospitalarias de oncología. Las enfermeras son mujeres, con edades comprendidas entre 23 y 57 años de experiencia en el campo, con la preparación académica suficiente para la graduación. Identifica la necesidad de un desarrollo científico y técnico profesional a través de la especialización, de postgrado, residencias, capacitación, cursos de actualización y la participación en conferencias. El estudio deberá aumentar la conciencia de las enfermeras y administradores de servicios de salud como el perfil y la preparación adecuada de los que trabajan en las unidades de oncología hospitalaria (AU)

Trata-se de um estudo que teve como objetivo identificar o perfil do enfermeiro que atua em unidades hospitalares oncológicas. É uma revisão integrativa e a coleta de dados foi realizada em quatro bases eletrônicas no período de março a maio de 2013. Foram selecionados 15 artigos, publicados no período de 2004 a 2013. Os resultados foram descritos em duas categorias: 1. O perfil social e profissional do enfermeiro que atua unidades hospitalares oncológicas e 2. Capacitação e preparo do Enfermeiro para atuar em unidades hospitalares oncológicas. Os enfermeiros são do sexo feminino, faixa etária entre 23 e 57 anos e experiência na área, com preparo acadêmico insuficiente durante a graduação. Identificam-se a necessidade de desenvolvimento profissional técnico-científico por meio de especializações, pós-graduação, residências, treinamentos, cursos de atualização e participação em congressos. O estudo deve provocar reflexão dos enfermeiros e gestores dos serviços de saúde quanto ao perfil e preparo adequado para a atuação em unidades hospitalares de oncologia

This is a study that aimed to identify the profile of the nurse working in oncology hospital units. It is an integrative review and data collection was conducted in four electronic databases in the period March-May 2013. 15 articles published in the period 2004-2013 were selected. The results were described in two categories: 1. The social and professional profile of nurses who work oncological hospitals and 2. Training and preparation of the nurse to act in oncological hospitals. The nurses are female, aged between 23 and 57 years, experience in the field, with insufficient academic preparation for graduation. Identifies the need for professional technical and scientific development through specialization, graduate, homes, training, refresher courses and participation in conferences. The study should increase awareness of nurses and managers of health services as the profile and adequate preparation of working in hospital oncology units (AU)

El Reiki como forma terapéutica en el cuidado de la salud: una revisión narrativa de la literatura / O Reiki como forma terapêutica no cuidado à saúde: uma revisão narrativa da literatura / The Reiki as therapeutic form in health care: a narrative literature review

Reiki es una terapia complementaria, caracterizada por la imposición de manos en el ser humano como un objetivo para restablecer el equilibrio físico, mental y espiritual. Este trabajo tiene como objetivo identificar la producción científica en terapia complementaria reiki, mediante una revisión narrativa de la literatura, realizada a través de una búsqueda de la salud Biblioteca Virtual (BVS), entre los años 2007 y 2012. Se detectó un total de 398 artículos, indexados en MEDLINE, LILACS y BDENF, utilizando los descriptores reiki and enfermería y reiki and cuidado. S incluyeron en este estudio 6 artículos, 1 publicado en periódico brasileño y 5 en periódicos extranjeros, disponible solamente el resumen en inglés. Se constató que, de los artículos analizados, se puede afirmar que el reiki, en cuanto que dispositivo de cuidado, provoca cambios significativos en el individuo, especialmente en lo referente a la ansiedad, dolor, estrés, aumento de células de defensa y disminución de la presión arterial. Pocos estudios han sido publicados para demostrar la eficacia del reiki, fundamental en la práctica de enfermería, y por lo tanto de suma importancia disponer de esta herramienta de cuidado, pudiendo asi publicar sus experiencias y estudios, pues cuantos más estudios se publiquen más motivación hay para poner en práctica este dispositivo tan importante para el equilibrio del ser humano (AU)

Reiki é uma terapia complementar, caracterizado pela imposição das mãos no ser humano com objetivo de reestabelecer o equilíbrio, físico, mental e espiritual. Este trabalho visa identificar a produção científica sobre a terapia complementar reiki, a partir de uma revisão narrativa da literatura, realizada através de uma busca na Biblioteca Virtual da Saúde, entre os anos de 2007 a 2012. Foram encontrados um total de 398 artigos, indexados no MEDLINE, LILACS e BDENF, usando os descritores reiki and enfermagem e reiki and cuidado. Foram incluídos no estudo 6 artigos, sendo 1 publicado em periódico brasileiro e 5 em periódicos estrangeiros, disponibilizado apenas o resumo em inglês. Constata-se que, dos artigos analisados, podemos afirmar que o reiki, enquanto dispositivo de cuidado, provoca mudanças significativas no indivíduo, principalmente em relação a ansiedade, dores, estresse, aumento das células de defesa e diminuição dos níveis pressóricos. Poucos estudos têm sido publicados para demonstrar a eficácia do reiki é fundamental na prática da enfermagem e assim de suma importância que este tenha em mãos esta ferramenta do cuidado, podendo assim publicar suas experiências e estudos, pois quanto mais estudos publicados mais motivação se tem para colocar em prática este dispositivo tão importante para o equilíbrio do ser humano

Reiki is a complementary therapy, characterized by the laying on of hands in the human being with the aim of re-establish the physical, mental and spiritual balance. This work involves identifying the scientific production on complementary therapy; reiki from a narrative review of literature, research conducted through a search of the Virtual Health Library (BVS), between the years 2007 to 2012. It was found a total of 398 articles, indexed in MEDLINE, LILACS and BDENF, using the descriptors reiki and nursing and reiki and care. It was included 6 articles in this study, 1 published in Brazilian periodical and 5 in foreign ones. It is available only the abstract in English. It is find that, of the articles analyzed, we can affirm that the reiki, while care device, causes significant changes in the individual, especially in relation to anxiety, pain, stress, increase defense cells and decreased blood pressure. Few studies have been published to demonstrate the effectiveness of reiki, is fundamental in the practice of nursing and thus of the most importance that the professional take into account this care tool and then can publish their experiences and studies, because the more published studies more motivation will be created to put into practice this device so important for the balance of the human being (AU)

[Acupoints selection rules analysis of ancient acupuncture for urinary incontinence based on data mining technology].

Based on ancient literature of acupuncture in Canon of Chinese Medicine (4th edition), the articles regarding acupuncture for urinary incontinence were retrieved and collected to establish a database. By Weka data mining software, the multi-level association rules analysis method was applied to analyze the acupoints selection characteristics and rules of ancient acupuncture for treatment of urinary incontinence. Totally 356 articles of acupuncture for urinary incontinence were collected, involving 41 acupoints with a total frequency of 364. As a result, (1) the acupoints in the yin-meridian of hand and foot were highly valued, as the frequency of acupoints in yin-meridians was 2.6 times than that in yang-meridians, and the frequency of acupoints selected was the most in the liver meridian of foot-jueyin; (2) the acupoints in bladder meridian of foot-taiyang were also highly valued, and among three yang-meridians of foot, the frequency of acupoints in the bladder meridian of foot-taiyang was 54, accounting for 65.85% (54/82); (3) more acupoints selected were located in the lower limbs and abdomen; (4) specific acupoints in above meridians were mostly selected, presenting 73.2% (30/41) to the ratio of number and 79.4% (289/364) to the frequency, respectively; (5) Zhongji (CV 3), the front-mu point of bladder meridian, was seldom selected in the ancient acupuncture literature, which was different from modern literature reports. The results show that urinary incontinence belongs to external genitalia diseases, which should be treated from yin, indicating more yin-meridians be used and special acupoints be focused on. It is essential to focus inheritance and innovation in TCM clinical treatment, and applying data mining technology to ancient literature of acupuncture could provide classic theory basis for TCM clinical treatment.

DERMABASE: el primer acercamiento para la búsqueda bibliográfica de Actas / Dermabase

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Gaceta Sanitaria: ejercicio de memoria / Gaceta Sanitaria: a memory exercice

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Analysis of the most highly cited articles from the 50-year history of CCA.

BACKGROUND: The 50th anniversary of CCA in 2006 prompted analysis of the most highly cited articles from the Journal's history. METHODS: Lists of most highly cited CCA articles were obtained from Current Contents (1974, 1991) and CCA (2006); all based on the ISI/Thomson Scientific database. PubMed search identified country of origin. RESULTS: Distribution of the most highly cited CCA articles was skewed towards those with high total citations. From the beginning, these articles originated from a diverse group of countries. This diversity increased with time to include countries from 4 continents. The most highly cited articles emerged at least 8-16 years following their publication. During the first 35 years of the Journal, there was a significant positive correlation between the total number of citations and the publication date of cited articles. Initially, virtually all most highly cited articles were methods papers, whereas during the past 25 years less than half of them reported methods; clinical research papers and reviews making up the rest. CONCLUSIONS: Results of this analysis may help in editorial policy-making and marketing of the Journal and in assessing the impact of individual countries on the field, and may guide authors' decision in submitting articles to the Journal.