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academia clinic18 august 2009preferred reporting items systematic reviews metaanalyses prisma statementfreedavid moher phd alessandro liberati md drph jennifer tetzlaff bsc douglas g altman dsc prisma groupdavid moher phdfrom ottawa methods centre ottawa hospital research institute university ottawa ottawa ontario canada universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy centre statistics medicine university oxford oxford united kingdomsearch papers author alessandro liberati md drphfrom ottawa methods centre ottawa hospital research institute university ottawa ottawa ontario canada universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy centre statistics medicine university oxford oxford united kingdomsearch papers author jennifer tetzlaff bscfrom ottawa methods centre ottawa hospital research institute university ottawa ottawa ontario canada universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy centre statistics medicine university oxford oxford united kingdomsearch papers author douglas g altman dscfrom ottawa methods centre ottawa hospital research institute university ottawa ottawa ontario canada universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy centre statistics medicine university oxford oxford united kingdomsearch papers author prisma groupsearch papers authorauthor article disclosure informationhttpsdoiorg10732600034819151420090818000135 sectionssupplemental materialaboutvisual abstractpdf toolsadd favoritesdownload citationstrack citationspermissions sharefacebooktwitterlinkedinredditemail editors note order encourage dissemination prisma statement article freely accessible annals internal medicine web site wwwannalsorg also published plos medicine bmj journal clinical epidemiology open medicine authors jointly hold copyright article details use see prisma web site wwwprismastatementorgsystematic reviews metaanalyses become increasingly important health care clinicians read keep date field 1 2 often used starting point developing clinical practice guidelines granting agencies may require systematic review ensure justification research 3 health care journals moving direction 4 research value systematic review depends done found clarity reporting publications reporting quality systematic reviews varies limiting readers ability assess strengths weaknesses reviewsseveral early studies evaluated quality review reports 1987 mulrow examined 50 review articles published four leading medical journals 1985 1986 found none met eight explicit scientific criteria quality assessment included studies 5 1987 sacks colleagues 6 evaluated adequacy reporting 83 metaanalyses 23 characteristics six domains reporting generally poor one 14 characteristics adequately reported mean 77 standard deviation 27 1996 update study found little improvement 7in 1996 address suboptimal reporting metaanalyses international group developed guidance called quorom statement quality reporting metaanalyses focused reporting metaanalyses randomized controlled trials 8 article summarize revision guidelines renamed prisma preferred reporting items systematic reviews metaanalyses updated address several conceptual practical advances science systematic reviews box 1box 1 conceptual issues evolution quorom prisma download figure download powerpoint terminologythe terminology used describe systematic review metaanalysis evolved time one reason changing name quorom prisma desire encompass systematic reviews metaanalyses adopted definitions used cochrane collaboration 9 systematic review review clearly formulated question uses systematic explicit methods identify select critically appraise relevant research collect analyze data studies included review statistical methods metaanalysis may may used analyze summarize results included studies metaanalysis refers use statistical techniques systematic review integrate results included studiesdeveloping prisma statementa threeday meeting held ottawa ontario canada june 2005 29 participants including review authors methodologists clinicians medical editors consumer objective ottawa meeting revise expand quorom checklist flow diagram neededthe executive committee completed following tasks prior meeting systematic review studies examining quality reporting systematic reviews comprehensive literature search identify methodological articles might inform meeting especially relation modifying checklist items international survey review authors consumers groups commissioning using systematic reviews metaanalyses completed including international network agencies health technology assessment inahta guidelines international network gin survey aimed ascertain views quorom including merits existing checklist items results activities presented meeting summarized prisma web site wwwprismastatementorgonly items deemed essential retained added checklist additional items nevertheless desirable review authors include relevant 10 example useful indicate whether systematic review update 11 previous review describe changes procedures described original protocolshortly meeting draft prisma checklist circulated group including invited meeting unable attend disposition file created containing comments revisions respondent checklist subsequently revised 11 times group approved checklist flow diagram summary paperalthough direct evidence found support retaining adding items evidence domains believed relevant example item 5 asks authors provide registration information systematic review including registration number available although systematic review registration yet widely available 12 13 participating journals international committee medical journal editors icmje 14 require clinical trials registered effort increase transparency accountability 15 aspects also likely benefit systematic reviewers possibly reducing risk excessive number reviews addressing question 16 17 providing greater transparency updating systematic reviewsthe prisma statementthe prisma statement consists 27item checklist table 1 see also table s1 downloadable word template researchers reuse fourphase flow diagram figure 1 see also figure s1 downloadable word template researchers reuse aim prisma statement help authors improve reporting systematic reviews metaanalyses focused randomized trials prisma also used basis reporting systematic reviews types research particularly evaluations interventions prisma may also useful critical appraisal published systematic reviews however prisma checklist quality assessment instrument gauge quality systematic reviewtable 1 checklist items include reporting systematic review metaanalysisfigure 1 flow information different phases systematic review download figure download powerpoint quorom prismathe new prisma checklist differs several respects quorom checklist substantive specific changes highlighted table 2 generally prisma checklist decouples several items present quorom checklist applicable several checklist items linked improve consistency across systematic review reporttable 2 substantive specific changes quorom checklist prisma checklistthe flow diagram also modified including studies providing reasons excluding others review team must first search literature search results records records screened eligibility criteria applied smaller number articles remain number included articles might smaller larger number studies articles may report multiple studies results particular study may published several articles capture information prisma flow diagram requests information phases review processendorsementthe prisma statement replace quorom statement journals endorsed quorom hope journals support prisma registering prisma web site underscore authors others importance transparent reporting systematic reviews encourage supporting journals reference prisma statement include prisma web address instructions authors also invite editorial organizations consider endorsing prisma encourage authors adhere principlesthe prisma explanation elaboration paperin addition prisma statement supporting explanation elaboration document produced 18 following style used reporting guidelines 1921 process completing document included developing large database exemplars highlight best report checklist item identifying comprehensive evidence base support inclusion checklist item explanation elaboration document completed several facetoface meetings numerous iterations among several meeting participants shared whole group additional revisions final approval finally group formed dissemination subcommittee help disseminate implement prismadiscussionthe quality reporting systematic reviews still optimal 2227 recent review 300 systematic reviews authors reported assessing possible publication bias 22 even though overwhelming evidence existence 28 impact results systematic reviews 29 even possibility publication bias assessed guarantee systematic reviewers assessed interpreted appropriately 30 although absence reporting assessment necessarily indicate done reporting assessment possible publication bias likely marker thoroughness conduct systematic reviewseveral approaches developed conduct systematic reviews broader array questions example systematic reviews conducted investigate costeffectiveness 31 diagnostic 32 prognostic questions 33 genetic associations 34 policy making 35 general concepts topics covered prisma relevant systematic review whose objective summarize benefits harms health care intervention however modifications checklist items flow diagram necessary particular circumstances example assessing risk bias key concept items used assess diagnostic review likely focus issues spectrum patients verification disease status differ reviews interventions flow diagram also need adjustments reporting individual patient data metaanalysis 36we developed explanatory document 18 increase usefulness prisma checklist item document contains example good reporting rationale inclusion supporting evidence including references whenever possible believe document also serve useful resource teaching systematic review methodology encourage journals include reference explanatory document instructions authorslike evidencebased endeavor prisma living document end invite readers comment revised version particularly new checklist flow diagram prisma web site use information inform prismas continued developmentreferences1 oxman ad cook dj guyatt gh users guides medical literature vi use overview evidencebased medicine working group jama 1994272136771 pmid 7933399 crossrefmedlinegoogle scholar2 swingler gh volmink j ioannidis jp number published systematic reviews global burden disease database analysis bmj 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milan italy centre statistics medicine university oxford oxford united kingdomacknowledgment following people contributed prisma statement doug altman dsc centre statistics medicine oxford united kingdom gerd antes phd university hospital freiburg freiburg germany david atkins md mph health services research development service veterans health administration washington dc virginia barbour mrcp dphil plos medicine cambridge united kingdom nick barrowman phd childrens hospital eastern ontario ottawa ontario canada jesse berlin scd johnson johnson pharmaceutical research development titusville new jersey jocalyn clark phd plos medicine time writing bmj london united kingdom mike clarke phd uk cochrane centre oxford united kingdom school nursing midwifery trinity college dublin ireland deborah cook md departments medicine clinical epidemiology biostatistics mcmaster university hamilton ontario canada roberto damico phd universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy jonathan j deeks phd university birmingham birmingham united kingdom pj devereaux md phd departments medicine clinical epidemiology biostatistics mcmaster university hamilton ontario canada kay dickersin phd johns hopkins bloomberg school public health baltimore maryland matthias egger md department social preventive medicine university bern bern switzerland edzard ernst md phd frcp frcpedin peninsula medical school exeter united kingdom peter c gtzsche md msc nordic cochrane centre copenhagen denmark jeremy grimshaw mbchb phd frcfp ottawa hospital research institute ottawa ontario canada gordon guyatt md departments medicine clinical epidemiology biostatistics mcmaster university hamilton ontario canada julian higgins phd mrc biostatistics unit cambridge united kingdom john pa ioannidis md university ioannina campus ioannina greece jos kleijnen md phd kleijnen systematic reviews ltd york united kingdom school public health primary care caphri university maastricht maastricht netherlands tom lang tom lang communications training davis california alessandro liberati md universit di modena e reggio emilia modena italy centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy nicola magrini md nhs centre evaluation effectiveness health careceveas modena italy david mcnamee phd lancet london united kingdom lorenzo moja md msc centro cochrane italiano istituto ricerche farmacologiche mario negri milan italy david moher phd ottawa methods centre ottawa hospital research institute ottawa ontario canada cynthia mulrow md msc annals internal medicine philadelphia pennsylvania maryann napoli center medical consumers new york new york andy oxman md norwegian health services research centre oslo norway ba pham mmath toronto health economics technology assessment collaborative toronto ontario canada time first meeting group glaxosmithkline canada mississauga ontario canada drummond rennie md frcp facp university california san francisco san francisco california margaret sampson mlis childrens hospital eastern ontario ottawa ontario canada kenneth f schulz phd mba family health international durham north carolina paul g shekelle md phd southern california evidencebased practice center santa monica california jennifer tetzlaff bsc ottawa methods centre ottawa hospital research institute ottawa ontario canada david tovey frcgp cochrane library cochrane collaboration oxford united kingdom time first meeting group bmj london united kingdom peter tugwell md msc frcpc institute population health university ottawa ottawa ontario canadagrant support prisma funded canadian institutes health research universit di modena e reggio emilia italy cancer research uk clinical evidence bmj knowledge cochrane collaboration glaxosmithkline canada dr liberati funded part grants italian ministry university cofinprin 2002 prot 2002061749 cofinprin 2006 prot 2006062298 dr altman funded cancer research uk dr moher funded university ottawa research chair none sponsors involvement planning execution writeup prisma documents additionally funder played role drafting manuscriptdisclosures none disclosedcorresponding author david moher phd ottawa methods centre ottawa hospital research institute ottawa hospital general campus critical care wing eye institute 6th floor 501 smyth road ottawa ontario k1h 8l6 canada email email protectedcacurrent author addresses dr moher ms tetzlaff ottawa methods centre ottawa hospital research institute ottawa hospital general campus critical care wing eye institute 6th floor 501 smyth road ottawa ontario k1h 8l6 canadadr liberati universit di modena e reggio emilia centro cochrane italiano istituto ricerche farmacologiche mario negri via la masa 19 20156 milan italydr altman centre statistics medicine university oxford wolfson college annexe linton road oxford ox2 6ud united kingdom membership prisma group provided acknowledgment previousarticlenextarticle advertisement figuresreferencesrelateddetailssee alsothe prisma statement reporting systematic reviews metaanalyses studies evaluate health care interventions explanation elaboration alessandro liberati douglas g altman jennifer tet