Systematic reviews and meta-analyses play a crucial role in evidence-based medicine, combining data from multiple studies on a topic to arrive at more robust conclusions than if individual studies are considered in isolation. However, it’s possible that poorly conducted literature reviews introduce bias into the findings and undermine the validity of systematic reviews. The lack of consensus guidelines on the transparent reporting of literature searches compounds this problem and has led to the development and recent publication of the Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search (PRISMA-S) extension to the PRISMA Statement.

PRISMA-S was published in Systematic Reviews by Melissa Rethlefsen and colleagues. Designed to complement the PRISMA Statement and its existing extensions, the checklist of 16 items provides consensus-based guidance on reporting the literature search components of systematic reviews under the following headings:

• information sources and methods
• search strategies
• peer review
• managing records.

The checklist is designed for use in all fields of research and to cover the whole range of literature review types including scoping reviews, mixed methods reviews and metanarrative reviews. Importantly, PRISMA-S also provides guidance on reporting searches of sources other than literature databases, such as web search engines and study registries, for which there is little existing guidance.

The authors hope that PRISMA-S will be adopted by researchers – and by journals as part of the peer review process – to promote greater transparency and reproducibility of systematic literature reviews.

With the checklist available and a webinar planned to discuss how best to implement PRISMA-S, the authors hope that PRISMA-S will be adopted by researchers – and by journals as part of the peer review process – to promote greater transparency and reproducibility of systematic literature reviews.

After reading the PRISMA-S article, click here for a brief survey and to receive your authorization code for your Credit Tracker. This serves as documentation for the activity.

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The development of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was a landmark step in enhancing the rigour of systematic review reporting and was widely endorsed by the scientific community. However, since its publication there have been many developments in the conduct of systematic reviews. These include new methods to synthesise and present findings, assess risk of bias, register review protocols, and share data, to name a few. Due to these advances, the updated PRISMA 2020 statement has been developed, which may prove to be another key milestone in improving the reporting of systematic reviews.

In the PRISMA 2020 statement, Page and colleagues present an updated 27-item manuscript checklist (with an accompanying explanation and elaboration document), an abstract checklist and a new study flow diagram. While there are a variety of changes from the 2009 publication, noteworthy new or updated recommendations within the PRISMA 2020 reporting items include:

• Full search strategies should be provided for all databases used (item #7).
• Details on how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process should be given (item #8).
• Authors should report how outcomes were defined, which results were sought, and methods for selecting a subset of results from included studies (item #10a).
• Details on study eligibility, preparation of data for synthesis, synthesising and displaying of results, possible causes of heterogeneity, and sensitivity analyses should be reported (item #13a–13f).
• Methods for, and results of, assessment of certainty (or confidence) should be reported in the body of evidence for an outcome (items #15 and #22).
• Authors should list citations of studies that met many but not all of the inclusion criteria (i.e. ‘near-misses’) and explain why they were excluded (item #16b).
• Authors should summarise the characteristics and risk of bias among studies, and present results of all syntheses, heterogeneity analyses, and sensitivity analyses (item #20a–20d).
• Amendments to information provided at registration or in the protocol should be described and explained (item #24a–24c).
• Authors should declare any competing interests (item #26).
• Authors should indicate whether data, analytic code and other materials used in the review are publicly available and where they can be found (item #27).

The PRISMA statement website will include helpful fillable templates of the new checklists to download and complete, and an editable template for each flow diagram. A web-based application that allows users to complete the checklist via a user-friendly interface is also currently under development and may facilitate reporting.

Overall, it is expected that implementation of the PRISMA 2020 statement will enhance the transparency, accuracy, and completeness of systematic review reporting, which should benefit the scientific community involved in developing systematic reviews. Importantly, improved reporting of systematic reviews may also have a downstream benefit for patients by facilitating evidence-based decision-making. It is therefore recommended that authors and writers fully utilise the PRIMSA 2020 statement and associated checklists when developing future systematic reviews. We also encourage journals to update their guidelines to include the completed checklist in their submission requirements for upcoming manuscripts.

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Summary by Josh Lilly PhD from Aspire Scientific

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With thanks to our sponsor, Aspire Scientific Ltd

Since the Consolidated Standards of Reporting Trials, or CONSORT, guidelines for reporting randomised controlled trials were published in 2010, checklists covering a host of other study designs have been released and are readily available on the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) website. These checklists are designed to standardise reporting for different study designs and ensure that the core components for quality are included in publications.

Within this repertoire of reporting guidelines is the preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA), published in 2018 in JAMA. Created as an extension of the original PRISMA guidelines, PRISMA-DTA retains 8 of the original PRISMA statements, with a further 2 new and 17 modified items. Now, an article published in The BMJ provides an accompanying explanation and elaboration of the PRISMA-DTA guidelines to aid with their interpretation and implementation. Designed for use alongside the PRISMA-DTA statement, the article provides illustrative examples for each item along with an explanation of why the item is important for inclusion in publications.

Diagnostic test accuracy (DTA) studies evaluate the ability of a test to detect a prespecified target condition, estimating the test’s sensitivity and specificity. Systematic reviews of DTA studies can provide insights into test performance and allow the accuracy of different tests to be compared. As such, they are an important tool in evidence-based decision making in medicine.

The PRISMA-DTA reporting guidelines represent a minimum set of components to inform readers about the review process and the findings, aiming to improve the completeness and transparency of DTA systematic reviews.

Nevertheless, authors are encouraged to include any additional information needed to facilitate critical appraisal and replicability of the findings. The authors hope that the PRISMA-DTA guidelines will help readers to appraise the quality of DTA systematic reviews and their generalisability, ultimately increasing their usefulness.

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Summary by Julianna Solomons PhD, CMPP from Aspire Scientific

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A meta-analysis systematically assesses multiple scientific studies to derive conclusions on a specific research topic that may not be clear from individual studies alone. Meta-analyses are used to drive evidence-based decisions in medicine and are often considered to top the hierarchy of evidence for biomedical research. However, a recent article by Jop de Vrieze published in Science questions whether we should always trust the outcomes of these studies.

Using the example of conflicting analyses reporting on the link between media violence and aggression, de Vrieze explores how meta-analyses may produce differing results due to the “many researcher degrees of freedom”. For example, authors may opt to exclude certain study types or apply strict or loose quality criteria to their analyses. Furthermore, de Vrieze considers that author choices may be influenced by biases including financial or ‘intellectual conflicts of interest’, such as a preference to confirm what their own studies have previously shown or to align with certain policies.

As the number of meta-analyses grows, from less than 1000 published in 2000 to 11,000 published in 2017, it may be time to think more carefully about how we conduct and interpret these studies. As described by de Vrieze, some believe that ‘scientists shouldn’t be involved in meta-analyses that include their own work’, while others note that ‘finding suitable authors for a meta-analysis is hard when the people with the most expertise in an area are excluded.’ In controversial cases it may be helpful for research groups with opposing views to set up new analyses together. Overall, transparency is of the utmost importance, so that other researchers can fully understand how a particular outcome has been reached and duplicate the analysis if they wish. In this regard, guidelines such as PRISMA, which aim to improve the reporting of systematic reviews and meta-analyses, are key. Others argue it’s time to go a step further and publish protocols before analyses are conducted and the results known.

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Summary by Louise Niven, DPhil from Aspire Scientific

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