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and the level of scientific evidence of the publications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several bibliometric studies have investigated the field of Spanish dermatology&#46; For example&#44; Belinchon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> performed a bibliometric study of scientific output of Spanish centers and institutions in international journals&#46; Miralles et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#8211;4</span></a> performed a detailed study&#44; published in 3 parts&#44; of scientific output in <span class="elsevierStyleItalic">Actas Dermatosifiliogr&#225;ficas</span><span class="elsevierStyleSmallCaps">&#44;</span> while Aleixandre Benavent et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;6</span></a> analyzed scientific output of several Spanish dermatology journals&#46; More recently&#44; Batalla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> and Aranegui et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> presented significant results concerning scientific output&#44; funding&#44; and levels of scientific evidence of Spanish dermatology centers in comparison with centers in other countries in 2008&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To date&#44; no study has analyzed scientific output in terms of type of investigation&#44; research topic&#44; and level of evidence of clinical research performed over a period of more than 1 year&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objectives of this study were to&#58; 1&#41; describe the number of clinical research articles with respect to the total scientific output of Spanish dermatology and venereology centers and institutions between 2005 and 2014 inclusive&#59; 2&#41; identify the most frequent clinical research topics and those with greatest cumulative scientific impact&#59; and 3&#41; determine the level of scientific evidence of published clinical research articles&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">Bibliometric study of clinical research articles published between 2005 and 2014&#44; inclusive&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Inclusion and Exclusion Criteria for Publications</span><p id="par0030" class="elsevierStylePara elsevierViewall">The inclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Articles indexed in Medline or Embase in which the affiliation &#40;field for correspondence&#41; indicates the author belongs to a Spanish dermatology and venereology institution or center&#46; The affiliations of other authors were not considered as this information is not available in a consistent fashion in the databases analyzed and for all journals over the study period&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Articles with definitive publication date between 2005 and 2014&#44; inclusive</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Articles that met the following 3 criteria to be considered as clinical research&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> a&#41; Studies performed in patients&#44; individuals&#44; health systems&#44; or articles based on patients&#46; This includes study of samples obtained from patients and healthy individuals&#44; such as biopsies&#44; dermoscopic images&#44; laboratory measurements&#44; etc&#46; b&#41; Studies answering a research question that can be posed in clinical practice&#44; with the aim of resolving practical problems concerning patient management&#44; including investigation of the etiology&#44; diagnosis&#44; prognosis&#44; treatment&#44; prevention&#44; and prevalence of diseases and investigation of the economics of health systems&#46; We included systematic reviews of these fields&#46; c&#41; Studies with level of evidence<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>4 according to the Centre for Evidence-Based Medicine &#40;CEBM&#41; &#40;Oxford&#41; classification&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> That is&#44; case reports and publications based on expert opinion without explicit evaluation methodology &#40;which would make them systematic reviews&#41;&#44; or those based on physiology&#44; laboratory research&#44; or basic science were excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">To assign the level of evidence&#44; an investigator &#40;AML&#41; reviewed the title and abstract of all articles included&#44; and if the information was not sufficient to determine the level of evidence&#44; the full text was inspected&#46; If doubts about the level of evidence persisted after review of the full text&#44; the articles were reviewed by another investigator &#40;IGD or MD&#41;&#44; and the level of evidence was assigned according to a consensus decision of the two&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The exclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Principally nondermatological topics of the article</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Articles without a definitive publication date &#40;Epub ahead of print&#41;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main variables of interest are grouped according to whether the variables were quantitative&#44; topical&#44; or qualitative&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Quantitative indicators included the number of articles of clinical research&#47;articles published&#59; number of articles&#47;journal and rate of annual growth&#44; defined as &#40;number of articles selected per year-number of articles in previous year&#41; divided by number of articles selected in the year&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The topic objective of the research articles was assessed by absolute frequency of repetition of words referring to dermatological diseases&#46; Three sources of information were analyzed separately&#58; title&#44; keywords provided by the author&#44; and keywords&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The qualitative indicator used was level of scientific evidence corresponding to each article according to the CEBM classification&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Electronic Search</span><p id="par0090" class="elsevierStylePara elsevierViewall">Articles were retrieved with the Scopus database&#46; Scopus was preferred to other alternatives as the database for searches because it includes all documents indexed in Medline and Embase and because information on citations to each document can be extracted&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The date of the search was November 6&#44; 2015&#46; The search strategy was as follows&#58; &#40;AFFILCOUNTRY &#40;spain OR espana OR spanien OR espagne OR espanha&#41; AND AFFILORG &#40;dermat&#42;&#41;&#41; AND PUBYEAR &#62; 2004 AND PUBYEAR &#60; 2015</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Scientific Output</span><p id="par0100" class="elsevierStylePara elsevierViewall">The search returned 8617 articles&#44; of which 12&#46;81&#37; &#40;1104 articles&#41; met the inclusion criteria&#46; The reasons for exclusion of articles are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; The main reason for exclusion was not reaching minimum required level of scientific evidence according to the CEBM&#44; 5805 articles &#40;67&#46;37&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The journal with the largest number of published articles was <span class="elsevierStyleItalic">Actas Dermatosifiliogr&#225;ficas</span>&#44; which accounted for 29&#46;53&#37; &#40;326 articles&#41;&#46; The 10 journals with the largest number of articles are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46; The annual rate of growth of scientific output is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#46; The year with greatest growth was 2014&#44; with a rate of 23&#46;8&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Research Topics</span><p id="par0110" class="elsevierStylePara elsevierViewall">The dermatological diseases for which most articles were published were melanoma&#44; with 134 articles &#40;12&#46;13&#37;&#41;&#44; psoriasis with 120 &#40;10&#46;86&#37;&#41;&#44; nonmelanoma skin cancer with 125 &#40;11&#46;32&#37;&#41;&#44; and eczema&#47;dermatitis with 86 &#40;7&#46;79&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the frequency of these terms&#46; With respect to article topics with most number of bibliographic citations&#44; melanoma was once again the most frequent topic &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Level of Scientific Evidence</span><p id="par0115" class="elsevierStylePara elsevierViewall">When the articles were classified according to the level of evidence of the CEBM&#44; we found that 93&#46;39&#37; &#40;1031 articles&#41; had level of evidence 4&#44; that is&#44; they were case reports or publications based on expert opinion without an explicit assessment&#44; or based on physiology&#44; laboratory research&#44; or basic science&#46; The classification of articles is reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Main Findings</span><p id="par0120" class="elsevierStylePara elsevierViewall">We present a bibliometric study in terms of output&#44; topic&#44; and level of scientific evidence of Spanish dermatology centers or institutions across a broad period with the inclusion of all articles included in the main databases&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Scientific Output</span><p id="par0125" class="elsevierStylePara elsevierViewall">In the study period&#44; we see a notable overall scientific output&#46; However&#44; articles that meet the criteria to be considered as clinical research only represent a small percentage of the total&#46; The main reason for exclusion of studies was failure to attain a level of scientific evidence of 4 or less according to the CEBM classification&#46; This suggests that most of the publications are primarily reports of single isolated cases or&#44; alternatively&#44; publications based on expert opinion without an explicit methodology for assessment&#46; Aranegui et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> in a previous study of publications in 2008&#44; showed that the level of scientific evidence of articles published by Spanish dermatologist was lower than that of other countries such as France or the United Kingdom&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The journal with the most number of articles was <span class="elsevierStyleItalic">Actas Dermatosifiliogr&#225;ficas</span>&#44; the journal of the Spanish Academy of Dermatology and Venereology &#40;abbreviated in Spanish as AEDV&#41;&#46; This might be explained by the fact that Spanish dermatologists are more familiar with this journal and also because it is possible to publish in Spanish&#46; Furthermore&#44; access to this journal is free for academics and almost 97&#37; of practicing dermatologists in Spain are affiliated to the institution&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> The time period for the study was chosen taking into account when <span class="elsevierStyleItalic">Actas Dermatosifiliogr&#225;ficas</span> became fully indexed on the assumption that a large number of articles by Spanish centers would be published in this journal&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">With regards the rate of annual growth&#44; we see a clear trend towards progressive growth in the number of articles published&#44; and positive increases during several consecutive years followed by discrete percentage decreases&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Research Topics</span><p id="par0140" class="elsevierStylePara elsevierViewall">The skin diseases with the most number of corresponding publications are in line with data from other studies with different designs&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">11&#44;12</span></a> Skin cancers&#44; with melanoma at the head&#44; are the topic with most number of publications&#46; Melanoma is a skin disease with increasing incidence in which important progress has been made in recent years with the incorporation of new molecular targets and therapeutic options&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> It is also one of the main causes of death in young subjects&#44; and so has substantial media coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> The above factors are probably responsible for the large number of publications on this process&#46; The next skin disease on the list is psoriasis&#44; which is also one of the diseases that has undergone a therapeutic revolution in recent decades and which also represents a systemic inflammatory disease with a high prevalence of multiple physical and psychological comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> Nonmelanoma skin cancer&#44; given its frequency and morbidity and mortality in our population&#44; and contact dermatitis&#44; probably due to the support from very active working group in Spain&#44; complete the ranking of diseases with most number of publications&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The skin diseases present in the most cited number of articles correspond to the diseases with the most number of articles published&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Level of Scientific Evidence</span><p id="par0150" class="elsevierStylePara elsevierViewall">On analysis of the level of scientific evidence of the articles of clinical research included&#44; it is noteworthy that most have a level of evidence of 4&#46; This group includes case series and cross-sectional studies&#46; These types of studies may be more numerous because of the easier design and conduct compared with other studies&#46; However&#44; a recent study assessed the scientific impact and quality of articles published in dermatology anywhere in the world found that countries from northern Europe such as Norway and Sweden have a lower overall number of publications but a high level of methodological quality with high scientific impact&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">The results of this study should be considered in light of certain limitations&#46; First&#44; the criterion for attributing a scientific publication to a Spanish dermatology institution according to the affiliation of the corresponding author means that studies in which dermatologists who work or collaborate in studies directed by non-dermatological institutions would not be included&#46; Therefore some national and international publications in which Spanish dermatologists have participated might not have been included&#46; We chose this criterion because indexing of the affiliations of authors in the bibliographic database would provide more complete information&#44; but it is not homogeneous over time and cannot be used to establish temporal comparisons&#46; Second&#44; the study period analyzed ranged from 2005 to 2014&#44; inclusive&#46; This range was not larger because regular indexing of the main Spanish journal of dermatology and venereology&#44; <span class="elsevierStyleItalic">Actas Dermatosifiliogr&#225;ficas</span>&#44; did not begin until 2005&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">The results of this study enable an overall and also temporal assessment of scientific output of Spanish dermatology centers and institutions&#46; The level of scientific evidence of most of the articles was 4&#44; corresponding to cases series and cross-sectional studies&#46; Although case reports are of high educational value and can sometimes represent scientific novelty&#44; the literature of greatest interest and utility for clinicians is that with a high level of evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> The results of this study can serve as a point for reflection for the Spanish dermatology community and a stimulus for improving the methodological quality of the research that is performed&#46; We should focus our efforts on high quality scientific output with a high level of evidence&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">This article is based on the results of the Dermatology Research Map &#40;abbreviated in Spanish to MaIND&#41; project&#44; conducted with the support of the <span class="elsevierStyleItalic">Juan de Az&#250;a</span> grant from the Healthy Skin Foundation of the AEDV&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of Interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bibliometric indicators provide a useful measure of the number of clinical research articles published in scientific journals and their quality&#46; This study aimed to assess the amount and quality of research carried out in Spanish dermatology centers and to describe the research topics&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in MEDLINE or Embase in which the corresponding author&#39;s affiliation was a Spanish hospital dermatology department or other center&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of 8&#44;617 articles found&#44; 1&#44;104 &#40;12&#46;81&#37;&#41; met the inclusion criteria&#46; The main reason for excluding articles was that they did not have an evidence level of 4 or better&#46; The main vehicle for reporting was the journal <span class="elsevierStyleSmallCaps">Actas Dermosifiliogr&#225;ficas</span>&#44; which published 326 articles &#40;29&#46;53&#37;&#41;&#46; Melanoma&#44; the disease the researchers studied most often&#44; accounted for 134 articles &#40;12&#46;13&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Limitations</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A limitation to bear in mind when interpreting the results is that we relied on the corresponding author&#39;s affiliation to identify articles reflecting research from a Spanish dermatology center&#46; Thus&#44; studies in which dermatologists participated would not be recognized if they were directed by other specialists&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Only a small portion of articles published from Spanish dermatology centers can be considered clinical research&#44; mainly because many publications provide a low level of scientific evidence&#46; Most publications are case reports&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes y objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los art&#237;culos de investigaci&#243;n cl&#237;nica publicados en revistas cient&#237;ficas y los indicadores bibliom&#233;tricos que de ellos derivan son un m&#233;todo &#250;til para medir la cantidad y la calidad de la investigaci&#243;n cl&#237;nica realizada&#46; El objetivo de este estudio es conocer la cantidad&#44; calidad y tem&#225;tica de la producci&#243;n cient&#237;fica de centros e instituciones de dermatolog&#237;a espa&#241;oles&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio bibliom&#233;trico de los art&#237;culos de investigaci&#243;n cl&#237;nica con fecha definitiva de publicaci&#243;n entre el a&#241;o 2005 al 2014&#44; ambos inclusive&#44; en las bases de datos Medline o Embase&#44; en cuya direcci&#243;n de autor de correspondencia figure un centro o instituci&#243;n de dermatolog&#237;a espa&#241;ola y que cumplan los criterios de investigaci&#243;n cl&#237;nica en dermatolog&#237;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">De los 8&#46;617 art&#237;culos encontrados&#44; 1&#46;104 &#40;12&#44;81&#37;&#41; cumplieron los criterios de inclusi&#243;n&#46; El principal criterio de exclusi&#243;n &#8212;67&#44;37&#37; de los art&#237;culos&#8212;fue tener un nivel de evidencia cient&#237;fico mayor de 4&#46; La revista en la que se publicaron m&#225;s art&#237;culos fue <span class="elsevierStyleSmallCaps">Actas Dermosifiliogr&#225;ficas</span> con 326 art&#237;culos &#40;29&#44;53&#37;&#41;&#46; La enfermedad con un mayor n&#250;mero de art&#237;culos fue el melanoma&#44; con 134art&#237;culos &#40;12&#44;13&#37;&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Limitaciones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El criterio para atribuir una publicaci&#243;n cient&#237;fica a una instituci&#243;n dermatol&#243;gica espa&#241;ola en funci&#243;n de la direcci&#243;n del autor de la correspondencia hace que estudios en los que participan dermat&#243;logos que trabajan en estudios dirigidos por instituciones no dermatol&#243;gicas no sean incluidos&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Solo una peque&#241;a proporci&#243;n de los art&#237;culos que publican las instituciones de dermatolog&#237;a espa&#241;olas pueden ser considerados investigaci&#243;n cl&#237;nica&#46; El principal motivo es el bajo nivel de evidencia cient&#237;fica&#46; La mayor&#237;a de las publicaciones son reportes de casos cl&#237;nicos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Molina-Leyva A&#46; Investigaci&#243;n cl&#237;nica en dermatolog&#237;a y venereolog&#237;a de centros e instituciones espa&#241;olas&#44; 2005-2014&#46; Resultados del estudio MaINDH&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;52&#8211;57&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Schematic of flow of articles included in and excluded from the study&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Ten journals with most number of publications&#46;</p>"
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Percentage annual growth in the study period&#46;</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="7" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Most Frequent Keywords That Make Reference to Skin Diseases of Articles of Clinical Research</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Topic Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Skin tumors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skin neoplasms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">314&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Basal cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Basal cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skin tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Squamous cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">nevi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nevus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Actinic keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">702</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">245</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">90</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Psoriasis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Dermatitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contact&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allergic contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Allergic contact&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1631762.png"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="7" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Most Frequent Keywords That Make Reference to Skin Diseases of Most Cited Articles</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Journal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skin neoplasms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Most Frequent Keywords in the Articles Analyzed With Reference to Skin Diseases&#44; Classified According to Their Presence in the Title&#44; Keywords Assigned by the Journal&#44; and Keywords Assigned by the Author&#44; and Most Frequent Keywords that Make Reference to Skin Diseases of Articles With Most Number of Citations&#46;</p>"
        ]
      ]
      4 => array:8 [
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