Geographic origin of publications in surgical journals

BACKGROUND: Publications in peer-reviewed journals are the main determinants of research rating and funding. The present study assesses worldwide scientific contributions in the field of surgical research. METHODS: Fifteen major surgical journals were selected for a bibliometric search in Medline/PubMed over a 6-year period (2000-2005). All articles with abstracts were totalled according to country of corresponding author. Publications (total and corrected for population size) and journal impact factor were assessed according to country. RESULTS: A total of 18,717 articles were identified. Fifteen countries generated 88.8 per cent of these: the USA produced 42.1 per cent, Japan 9.1 per cent and the UK 7.6 per cent. When corrected for population size, the Netherlands, Sweden and Switzerland topped the ranking; the USA was sixth. Ireland and Switzerland scored the highest mean impact factor. CONCLUSION: The USA is the most productive country in terms of absolute number of surgical publications in the selected journals. However, when population size is taken into consideration, certain smaller European countries were more prolific.     

Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery

BACKGROUNDThere is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.AIMTo ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.METHODSA search of the Web of Science database was carried out, identifying any articles relating to HIV published in orthopaedic journals. These were assessed for geographic origin and level of evidence. RESULTSOf 48.7% of orthopaedic journals listed on the Web of Science database had published articles relating to HIV. There were 168 articles about HIV in orthopaedic journals with only 40.5% (n = 68) published in the time frame we analysed (January 2007 to September 2017). Very few articles came from low-income countries and any articles published from that setting were collaborations. All of the articles were low level of evidence. CONCLUSIONThere is a need for more high level orthopaedic and trauma research investigating the effects of HIV, particularly research from low-income countries, where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.     

An evaluation of Irish general surgical research publications from 2000 to 2009

BackgroundMaintaining a high standard of research, and being competitive in the funding application process requires a coordinated and focused research strategy. The first step in the formulation of such a strategy is the identification of those centres, and specifically those areas of study, in which Irish surgical research has previously performed strongly. The aim of this paper was to evaluate all surgical research produced in the Republic of Ireland in the first ten years of the new millennium.MethodsAll publications originating from adult Irish general surgical units between the years 2000–2009 were identified from Pubmed and Medline databases. All publications were examined for senior author, originating institute, theme, research model and publishing journal.ResultsThere were a total of 590 publications in Irish general surgical units during the study period. The top publishing hospitals were Institution 1 (129:21%), Institution 2 (82:13.9%) and Institution 3 (81:13.7%). One hundred and thirty three papers were published in journals with impact factors >4.5. Papers were more likely to be published in journals with impact factors >4.5 if they came from Institution 1 (38 papers) p = 0.001, published on breast (50 papers) p < 0.001 or upper gastrointestinal topics (35 papers) p < 0.001, or published on bench research (76 papers) p < 0.001. Publications increased from the first half of the decade to the second, with the largest increases seen in Institution 1 (40–89), Institution 4 (21–42) and Institution 6 (11–37).ConclusionsIreland continues to produce high quality surgical research, characterised by number of articles produced per 10⁶ inhabitants. This study shows that the number of articles published in the second half of the decade almost doubled from 221 to 369 and that the mean journal impact factor for all articles published was 2.87.     

Worldwide arthroplasty research productivity and contribution of Turkey

Purpose

Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our knowledge, no studies have documented the main characteristics of arthroplasty publications from different countries. This study aimed to evaluate the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers.

The fifty most cited Latin-American articles in the orthopaedic literature

Purpose

The number of citations of an article is a marker of its academic influence. Several medical specialties, including orthopaedics, have ranked the articles with more citations. We identified the 50 most cited orthopaedic articles from Latin-America and analyzed the characteristics that made them citable.

Methods

Science Citation Index Expanded was searched for citations of articles originated in Latin-America, published in any of the 63 journals in the category “Orthopaedics” from 1988 to 2013. We created a list ranking the 50 most commonly cited articles and determined the citation density (Citations/years since publication). Information noted for each article included authors, year of publication, country of origin, source journal, article type, and field of research.

Results

Latin-American countries were the origin of 1 % of orthopaedic articles. The top 50 most cited articles had between 29 and 150 citations (mean, 44.48); the citation density ranged from 1.43 to 15.5 citations/years (mean, 5.25). The articles were published in 19 of the 63 journals (11 general and eight sub-specialty journals), and all were published in English. Most articles (n = 29) were published in 2000 or later. The majority were clinical articles (n=40), and the most common fields were arthroscopy (n = 15) and hip surgery (n = 13). The top 50 articles originated mainly from Brazil (n = 20) and Argentina (n = 15).

Conclusions

This top 50 list displays articles that have become important references for the orthopaedic scientific community. Researchers may use this work to make their future publications more influential on future investigators.     

Bibliometric analysis of COVID-19 related publications in Indian orthopaedic journals

BackgroundThe COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics.MethodsA cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied.ResultsA total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2^nd April 2020 to 31^st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word.ConclusionThe Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.     

Worldwide Trends of Research on Periprosthetic Osteolysis: A Bibliometric Study Based on VOSviewer

BackgroundDue to the increasing number of joint arthroplasty operations, surgeons have begun to devote more attention to the problem of periprosthetic osteolysis. In recent years, numerous studies have focussed on periprosthetic osteolysis, but there have been no relevant bibliometric studies.MethodsWe searched the Web of Science database for relevant articles concerning periprosthetic osteolysis published from 1965 to 2021. The following data were extracted: authors’ name, article title, publication journal, impact factor (IF) of the journal in the publication year, keywords, topic of the article, publication country/region, the sum of times cited, H-index and funding sources. VOSviewer and Excel 2019 were used to conduct the bibliometric study and visualise the analysis.ResultsA total of 1255 publications were included. In all selected articles, “orthopaedics” became the dominant topic (662 of 1255, 52.75%). The most productive years were 2018 and 2019, with a total of 83 publications. The Journal of Arthroplasty published the most articles on periprosthetic osteolysis (110 publications). The United States of America published the most articles (525, 41.83%). The latest keywords “continuous intramedullary infusion”, “erythromycin”, “autophagy”, “bone-resorbing cells” and “proinflammatory cytokines” both appeared in five articles in 2017.ConclusionThis bibliometric study showed that there is a growing trend in published articles related to periprosthetic osteolysis. Journal of Arthroplasty was the top productive journal on periprosthetic osteolysis. The United States of America dominates studies of periprosthetic osteolysis. “Continuous intramedullary infusion”, “erythromycin”, “autophagy”, “bone-resorbing cells” and “proinflammatory cytokines” may be new research hotspots in the field of periprosthetic osteolysis.     

Evaluation and evolution of the scientific production by Spanish anesthesiology departments

OBJECTIVES: To count the scientific publications coming from Spanish departments of anesthesiology and rank them by productivity using various bibliometric tools. To examine the evolution of productivity between 1992 and 2001. METHOD: Abstracts of articles from Spanish anesthesiology departments were located on Medline. Hospital departments were ranked by productivity based on number of publications. Other classifications were established based on the international impact of articles measured by "net" impact factor (IF) of the journals and "relative" IF (according to the category assigned by Journal Citation Reports [JCR]). The evolution of scientific productivity was analyzed by five-years periods. RESULTS: We located 644 entries for articles published in Spanish journals and 182 for articles in journals outside Spain. Ten departments of anesthesiology produced 68% of the articles in non-Spanish journals. Hospital Clinic i Provincial in Barcelona was the most productive (55 publications, 27 in foreign journals). Hospital del Mar published articles in journals with the highest IF (mean 2.63). When IF results were adjusted by JCR category, Hospital Clinic i Provincial had the best quantitative and qualitative indexes. Hospital Torrecardenas had the best evolution in scientific productivity in the last five years. CONCLUSION: The scientific productivity of Spanish anesthesiology departments has evolved favorably over the past 10 years, led by Hospital Clinic i Provincial.     

Thromboprophylaxis across orthopaedic surgery: Bibliometric analysis of the most cited articles

PurposeOne of the most common adverse events after orthopaedic surgery, with a potential for subsequent serious morbidity and mortality is venous thromboembolism (VTE). Bibliometric analysis has been performed regarding many topics and across orthopaedics. As DVT prophylaxis is a major component of both orthopaedic surgery considerations and research, a bibliometric analysis in this area would prove beneficial in not only in understanding the research done in the field thus far, but would also direct future research efforts.MethodsThe Web of Science (WoS) database from the Institute of Scientific Information (ISI) was used to compile articles for bibliometric analysis using Boolean search: ((Orthopaedic1 OR Orthopaedic1) AND (thromboprophylaxis OR Thromboembolism OR Deep vein thrombosis OR thrombus OR embolism OR anticoagulation OR Embolus OR prophylaxis)).ResultsThe Top 100 cited articles included in the final list generated a total of 21,099 citations. The highest cited article was Prevention of venous thromboembolism by Geerts et al. published in Chest, which had a total of 2802 on WoS, and a calculated citation density of 215.54 of citations/years since publication. Comparing the overall citation against the year of publication there was a slight positive trend favoring more recent publications (R-value: 0.142; adjusted R-squared: 0.01; p = 0.16). Analysis of an articles Level of Evidence (LOE), 17 were grade with a level of I.ConclusionsOrthopaedic thromboprophylaxis is an ever-changing field that is at the forefront of orthopaedic literature. The significant trend favoring high quality research within orthopaedic thromboprophylaxis demonstrates the importance of this topic and there was a need for a guide to best understand the evolution of DVT prophylaxis.     

Characteristics and Trends of Orthopedic Publications between 2000 and 2009

Background

This study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed.

Methods

Orthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors'' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database''s management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated.

Results

A total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles).

Conclusions

The number of published orthopedic articles has been increasing over the last decade. The number of orthopedic articles, journals publication, and funding sources were dominated by research conducted in the United States, while share and growth of Asian countries including Japan, the Republic of Korea, and China were notable.     

Expected versus real impact factors of publications from Spanish departments of anesthesiology (1991-1996)

OBJECTIVE: To identify publications by Spanish anesthesiologists in journals indexed by Journal Citation Report from 1991 through 1996; to count the number of citations received and compare the results with the impact factor (IF) of the journals in which they were published. MATERIAL AND METHODS: Articles for which the first author was a member of a Spanish anesthesiology department were searched for in MEDLINE, Science Citation Index and EMBASE. Only publications for which the IF was known were included for analysis. We then counted the number of citations each article received over the two years following publication, recording the source journal in which the citation appeared and country of origin of each citing author.We then calculated the real IF (RIF) of each article, the RIF of all the Spanish articles, and the mean RIF. Also calculated for each article was the expected IF (EIF), based on the IF of the source journal, the overall EIF and the mean EIF. RESULTS: One hundred seventy-two articles were published; 49 of them were letters to the editors. Specialist anesthesiology journals published 72.7%. A total of 186 citations were received. American authors cited the articles more often than did other Spanish authors. Thirty-seven citations (19.9%) were self-citations. Ninety-two articles (53.5%) were never cited.With letters to the editor excluded, the RIF was 85.48 and the global EIF was 213.28; the mean EIF was 1.734 and the RIF was 0.695. Therefore, the rate of citation of the Spanish authors in the period studied was only 40% of the citation rate of the entire population of authors from all countries. The authors of the published articles worked mainly in hospitals in Barcelona, Madrid, La Coru?a, Valencia, Cantabria and Murcia. Hospital Germans Trias i Pujol (Badalona, Barcelona) had the largest number of publications and the highest EIF (39.41). Hospital del Mar (Barcelona) had the highest mean RIF and the highest global RIF.A gradual increase in the annual productivity of Spanish scientists can be discerned in a progressive increase in the number of publications as well as their EIF and RIF. CONCLUSIONS: Research by Spanish anesthesiologists is concentrated in only a few hospitals. Although the number of publications is increasing, their international repercussion has still not reached the desired level.     

Bibliometric analysis of orthopaedic related publications by Indian authors from the last decade

PurposeBibliometric studies have been established methods of analysing publications on a particular topic. These studies have been done on various orthopaedic topics and are increasing. The advantages of these studies have been highlighted in previous publications. Although some studies have been done on Indian publications from other specialties, those analysing Indian Orthopaedic Publications are lacking.MethodsWe performed a search in Scopus to look for all publications related to orthopaedics from India. Our search strategy in Scopus included ((TITLE-ABS-KEY(Orthopaedics OR Orthopaedics) AND AFFIL(India)) AND PUBYEAR > 2009 AND PUBYEAR < 2020) which resulted in 3270 articles on 02/11/2021. We analyzed the most publishing universities, city, state, specialty, authors, and anatomic location of these publications. We also mined the data to draw word clouds based on data obtained from the titles of articles, keywords and the affiliations of each of the articles published.ResultsTamil Nadu and New Delhi and their institutes appear to be the epicenter of publication activities in Orthopaedics in India. There has been a healthy trend of growth of articles in the orthopaedic specialty. Since there is a significant overlap of technology and engineering, it is not surprising to see engineering and technology institutes among the top 10 published institutes and even journals for the publications on orthopaedics.ConclusionThere has been a steady increase in the number of publications in the last decade. New Delhi and its Universities and Institutes appear to contribute the majority of citations and publications related to orthopaedics. Journal of Clinical Orthopaedics and Trauma was the most publishing journal for Indian authors on Orthopaedic related articles.     

A bibliometric evaluation of publications in urological journals among European Union countries between 2000-2005

OBJECTIVES: To perform a bibliometric evaluation of publications from European Union (EU) countries in the international urological journals between 2000-2005 according to their national origin and in relation to international context. METHODS: Articles except reviews, editorials, letters, and reports published during 2000-2005 in 19 international urological journals were screened using Web of Science database. The total number of publications and the cumulative impact factor were determined for the first 15 EU member states (EU15), the USA, and the world. These data were related for every country to the population size and the socio-economic indicators gross domestic product, gross domestic expenditure on research and experimental development, and expenditure on health care. RESULTS: A total of 19.709 articles were published of which 6.878 (34.9%) came from the EU15 countries and 7.927 (40.2%) from the USA. About 15% of all papers from the EU15 countries were in collaboration with USA researchers. In the EU, the number of publications and the cumulative impact factor were dominated by United Kingdom, Germany, and Italy with about 52% of all papers and 50% of the cumulative impact factor. If adjusted for demographic and socio-economic factors the smaller countries Austria, Denmark, Finland, the Netherlands, and Sweden (alphabetical order) revealed a distinctly higher publication rate. CONCLUSIONS: This study based on bibliometric analyses in urological journals demonstrated a feasible solution to validate and compare the contribution of the various EU countries towards the urological research.     

Research relating to three-dimensional (3D) printing in spine surgery: a bibliometric analysis

Purpose

Although numerous publications on three-dimensional printing (3DP) in spine surgery have been published, bibliometric analysis studies are scarce. Thus, this study aimed to present a bibliometric analysis of the status, hot spots, and frontiers of 3DP in spine surgery and associated research disciplines.

Methods

All publications relating to the utilization of 3DP in spine surgery from 1999 to May 9, 2022, were retrieved from the Web of Science. The bibliometric analysis was performed using CiteSpace software, and information on the country, institution, author, journal, and keywords for each publication was collected.

Results

A total of 270 articles were identified. From 2016 onward, a significant increase in publications on spinal surgery was observed. China was the most productive and influential country (98 publications) and H-index (22), followed by the USA and Australia. The most productive institution was Capital Medical University (9 publications). P. S. D’urso (8 publications, 46 citations) and R. J. Mobbs (8 publications, 39 citations) were the most prolific authors. European Spine Journal contributed the highest number of publications. The eight main clusters were: “rapid prototyping” #0, “3D printed” #1, “spine fusion” #2, “scoliosis” #3, “spine surgery” #4, “patient-specific” #5, “nervous system” #6, and “neuronavigation” #7. The strongest keyword bursts in 3DP in spine surgery were “fixation,” “drill template,” “instrumentation,” “fusion,” “complication,” and “atlantoaxial instability.”

Conclusion

This analysis provides information on research trends and frontiers in the application of 3DP in spine surgery, as well as research and collaboration partners, institutions, and countries.

     

The 50 Most-cited Articles in Orthopaedic Surgery From Mainland China

Background

Citation analysis has been widely used to evaluate the impact of articles in medical and surgical specialties. Although China is the most populous country in the world, and although more than 50,000 orthopaedic surgeons practice there, to our knowledge no formal citation analysis of Chinese orthopaedic articles has been performed.

Questions/purposes

We identified the 50 most-cited orthopaedic articles from mainland China and evaluated these articles in terms of their language of publication, source journals, and topics.

Methods

Science Citation Index Expanded was searched in July 31, 2014 for citations of articles published in 70 selected journals since the inception of the database. The 50 most-cited orthopaedic articles originating in mainland China were identified. Basic information, including title, authors, year of publication, article type, journal in which the work was published, city, institution, number of citations, decade published, and topic or subspecialty of the research were recorded.

Results

The number of citations for the top 50 papers ranged from 181 to 31 (mean, 52). These articles were published between 1981 and 2010. The decade of 2000 to 2009 was the most prolific, with 36 of the top 50 articles published during this time. All articles were written in English and they were published in a total of 16 journals. The journal Spine published the largest number of articles (12), followed by Clinical Orthopaedics and Related Research^® (seven). The journal Lancet had the highest impact factor (39.207 for 2013) among any of the journals that published articles we identified. The top 50 articles originated mainly from Beijing (16) and Shanghai (12), with basic research being the focus of the majority (27 of 50; 54%); the remaining were clinical studies. Bone was the most-investigated topic in basic research; the spine was the most-common topic among the identified clinical studies.

Conclusions

The 50 most-cited articles that we identified should be considered influential, although a large gap remains between mainland China and the global orthopaedic community in terms of citations per article. Nevertheless, insofar as the most-recent decade of our survey generated the most articles in this top-50 list, we would characterize mainland China’s effect on musculoskeletal research as increasing, and as funding increases to programs in mainland China, we anticipate this trend will continue in the future.     

过去30年间关于短肠综合征研究的全球趋势文献计量分析

背景与目的：短肠综合征是一类因广泛小肠切除而引起的罕见疾病,近年来逐渐引起学者关注。然而目前却暂无该病文献计量学方面的相关研究。因此,本研究通过文献计量分析这一方法描述近30年来短肠综合征研究的热点和趋势。方法：通过Web of Science核心合集（WoSCC）数据库检索1991—2021年间与短肠综合征相关的出版文献,并以纯文本格式导入VOSviewer和CiteSpace软件。数据使用文献计量方法进行处理,对作者、国家、机构、高被引文献、共被引、关键词和参考文献进行文献可视化分析。结果：共检索到3 439篇文献,包括12 457位作者,2 557家机构,74个国家/地区和779种期刊,文献共引用了来自8 713种期刊合计43 194位作者的64 834篇文章。其中,美国的贡献最为卓越,Wales PW是产出最多的作者,多伦多大学是发文最多的机构,Journal of Pediatric Surgery是该领域的核心期刊。关键词分析显示,Short Bowel Syndrome、Intestinal Failure、Children、Parenteral Nutrition是高频...     

Análise bibliométrica no campo da anestesiologia no período de 2009‐2018

ObjectiveThe limited number of bibliometric studies in the literature have generally focused on the top‐cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods.MethodsThe articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword “Anesthesiology” in the “Research Area” category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis.ResultsA review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971‐5,849) articles for the year 2019. There was a high‐level, positive significant correlation between the number of publications and Gross Domestic Product (r = 0.776, p < 0.001).ConclusionThe findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.     

Which countries publish in important anesthesia and critical care journals?

Using a MEDLINE-based analysis, we studied the national origin of articles published in important anesthesia, pain, critical care, and emergency medicine journals. All journals in English listed in the Science Citation Index (SCI) of Journal Citation Reports under the subheadings Anesthesiology (n = 17) and Emergency Medicine & Critical Care (n = 13) were analyzed with the help of MEDLINE. Issues from 1996 and 1997 were included and summarized. Letters, abstracts, editorials, meeting reports, and news were not included. MEDLINE printouts were studied, and we classified the country of origin of the first author. The following subsets were defined: Anesthesia, Regional Anesthesia and Pain, Clinical Monitoring and Computing, Intensive Care Medicine and Resuscitation, and Emergency Medicine and Trauma. A total of 10,643 publications in 30 journals were published during 1996 and 1997. Of the 30 journals, 17 originate in the United States (US) and 8 from United Kingdom (UK). In 14 of the 17 US journals, >50% of the publications came from the US. The US was the most active nation, with a total of 4,283 articles (40.2% of all contributions), followed by the UK with 1,418 articles (13.3%). When looking at the number of publications with regard to inhabitants or impact factor per million inhabitants, small highly industrialized nations (Finland 35.41 and Sweden 33.9 articles/million inhabitants) were significantly more active than large highly industrialized countries (US 16.2, Germany 6.1, Japan 4.5 articles/million inhabitants). It is presumed that indicators of productivity in medical research are the number of articles published and the cumulative impact factor. During 1996 and 1997, the US was the most active nation with regard to publications in important journals in the areas of anesthesia, pain, critical care, and emergency medicine. Small highly industrialized nations, however, had a higher activity rate than larger countries. IMPLICATIONS: In a MEDLINE-based analysis, we examined the number of publications in important anesthesia, pain, critical care, and emergency medicine journals (n = 30) for the years 1996 and 1997 and analyzed these with regard to national origin. The United States was by far the most active nation in this medical area (4283 articles [40.2%]), followed by the United Kingdom (13.3%). With regard to publications per million inhabitants, small highly industrialized nations contributed overproportionally to publications in this area.