Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

Alessandro Liberati and colleagues present an Explanation and Elaboration of the PRISMA Statement, updated guidelines for the reporting of systematic reviews and meta-analyses.

It has been claimed and demonstrated that many (and possibly most) of the conclusions drawn from biomedi-cal research are probably false 1. A central cause for this important problem is that researchers must publish in order to succeed, and publishing is a highly competitive enterprise, with certain kinds of findings more likely to be published than others. Research that produces novel results, statistically significant results (that is, typically p < 0.05) and seemingly 'clean' results is more likely to be published 2,3. As a consequence, researchers have strong incentives to engage in research practices that make their findings publishable quickly, even if those practices reduce the likelihood that the findings reflect a true (that is, non-null) effect 4. Such practices include using flexible study designs and flexible statistical analyses and running small studies with low statistical power 1,5. A simulation of genetic association studies showed that a typical dataset would generate at least one false positive result almost 97% of the time 6 , and two efforts to replicate promising findings in biomedicine reveal replication rates of 25% or less 7,8. Given that these publishing biases are pervasive across scientific practice, it is possible that false positives heavily contaminate the neuroscience literature as well, and this problem may affect at least as much, if not even more so, the most prominent journals 9,10. Here, we focus on one major aspect of the problem: low statistical power. The relationship between study power and the veracity of the resulting finding is under-appreciated. Low statistical power (because of low sample size of studies, small effects or both) negatively affects the likelihood that a nominally statistically significant finding actually reflects a true effect. We discuss the problems that arise when low-powered research designs are pervasive. In general, these problems can be divided into two categories. The first concerns problems that are mathematically expected to arise even if the research conducted is otherwise perfect: in other words, when there are no biases that tend to create statistically significant (that is, 'positive') results that are spurious. The second category concerns problems that reflect biases that tend to co-occur with studies of low power or that become worse in small, underpowered studies. We next empirically show that statistical power is typically low in the field of neuroscience by using evidence from a range of subfields within the neuroscience literature. We illustrate that low statistical power is an endemic problem in neuroscience and discuss the implications of this for interpreting the results of individual studies. Low power in the absence of other biases Three main problems contribute to producing unreliable findings in studies with low power, even when all other research practices are ideal. They are: the low probability of finding true effects; the low positive predictive value (PPV; see BOX 1 for definitions of key statistical terms) when an eff...

Funnel plots, and tests for funnel plot asymmetry, have been widely used to examine bias in the results of meta-analyses. Funnel plot asymmetry should not be equated with publication bias, because it has a number of other possible causes. This article describes how to interpret funnel plot asymmetry, recommends appropriate tests, and explains the implications for choice of meta-analysis model This article recommends how to examine and interpret funnel plot asymmetry (also known as small study effects 2 ) in meta-analyses of randomised controlled trials. The recommendations are based on a detailed MEDLINE review of literature published up to 2007 and discussions among methodologists, who extended and adapted guidance previously summarised in the Cochrane Handbook for Systematic Reviews of Interventions. 7 What is a funnel plot?A funnel plot is a scatter plot of the effect estimates from individual studies against some measure of each study's size or precision. The standard error of the effect estimate is often chosen as the measure of study size and plotted on the vertical axis 8 with a reversed scale that places the larger, most powerful studies towards the top. The effect estimates from smaller studies should scatter more widely at the bottom, with the spread narrowing among larger studies. 9 In the absence of bias and between study heterogeneity, the scatter will be due to sampling variation alone and the plot will resemble a symmetrical inverted funnel (fig 1). A triangle centred on a fixed effect summary estimate and extending 1.96 standard errors either side willCorrespondence to: J A C Sterne jonathan.sterne@bristol.ac.ukTechnical appendix (see

The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.

The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.

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