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Clinicians around the world understand the need for research and publication of gathered evidence to inform practice and improve patient outcomes. The introduction of the Oxford Centre for Evidence-based Medicine (CEBM) Levels of Evidence guideline in 2011, has been invaluable over the past decade, particularly for those inexperienced in analysing medical literature. It provides a clear guide as to the strength of evidence that can be assigned to different study methodologies, thus indicating the quality of evidence attributable to publications. Chia et al set out to examine the strength of evidence reported during five distinct years spaced at three-year intervals (2007, 2010, 2013, 2016 and 2019) in the previously identified top four peer-reviewed ENT journals (Annals of Otology, Rhinology & Laryngology; JAMA Otolaryngology-Head and Neck Surgery; The Laryngoscope; and Otolaryngology-Head and Neck Surgery). Overall, 4297 articles were identified. Over the 12-year study period, the proportion of clinical research papers rose by 6.5%, and that of female first authors rose by 10.7%. The 3558 clinical research papers identified were categorised according to the Oxford CEBM levels of evidence, using the primary research question of the study. Level one studies increased consistently during the study period (from 0.9% to 3.6%). This reflects a parallel observation of increases in performance of systematic reviews (from 3.2% to 8.4%), despite relative stasis in the number of performed randomised controlled trials in 2007 versus 2019, respectively. The year of publication was not associated with the distribution of level of evidence in the journals studied. Interestingly, the proportion of level four studies remained relatively unchanged (56.3% in 2019), indicating that case series and cohort studies still resemble the most commonly reported studies. Encouragingly, this study demonstrates that, over time, the quality of clinical research has been increasing gradually, and that more women are taking leading roles in the publication of research within otolaryngology journals. It would be most interesting to understand how the latter affects the former – maybe there is a keen female researcher out there needing a publication?

Recent Levels of Evidence in Otolaryngology Journals.
Chia C, Cheung P, Wibowo J, et al.
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Lucy Dalton

University Hospitals Birmingham, UK.

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