Epidemiology and reporting characteristics of systematic reviews.
Epidemiology and reporting characteristics of systematic reviews.
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DOI：
10.1371/journal.pmed.0040078
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发表时间：
2007-03-27
期刊：
影响因子：
15.8
通讯作者：
Altman DG
中科院分区：
文献类型：
--
作者：
Moher D;Tetzlaff J;Tricco AC;Sampson M;Altman DG
系统综述（SRs）在众多利益相关者中越来越受欢迎。我们着手获取已发表的系统综述的代表性横断面样本，并从广泛的流行病学、描述性和报告特征方面对其进行检查，包括以前未检查过的新出现的方面。
我们在Medline中搜索了2004年11月期间收录的、用英语撰写的系统综述。对引用文献进行了筛选，符合纳入标准的文献被保留。使用一份包含51个项目的数据收集表收集数据，该表旨在评估系统综述的流行病学和报告细节以及与偏倚相关的方面。对数据进行了描述性分析。共确定了300篇系统综述，这表明当前每年的发表率约为2500篇，涉及超过33700项独立研究，包括30万参与者中的三分之一。大多数（272篇[90.7%]）系统综述发表在专业期刊上。大多数综述（213篇[71.0%]）被归类为治疗性综述，其中位数为包含1112名参与者的16项研究。超过三分之一（122篇[40.7%]）的综述未报告资金来源。综述通常搜索中位数为3个电子数据库和2个其他来源，但只有约三分之二（208篇[69.3%]）报告了搜索的年份。大多数（295篇中的197篇[66.8%]）综述报告了质量评估信息，而很少（294篇中的68篇[23.1%]）报告评估了发表偏倚。略多于一半（300篇中的161篇[53.7%]）的系统综述报告对其结果进行了统计合并，其中大多数（161篇中的147篇[91.3%]）评估了研究间的一致性。很少（53篇[17.7%]）系统综述报告是对先前已完成综述的更新。没有一篇综述有注册号。只有一半（300篇中的150篇[50.0%]）的综述在标题或摘要中使用了“系统综述”或“荟萃分析”一词。在报告若干特征的质量方面，Cochrane综述和非Cochrane综述之间存在很大差异。
系统综述现在大量产生，我们的数据表明其报告质量不一致。如果作者和期刊认可并遵循更广泛认可的循证报告指南，这种情况可能会得到改善。这些结果证实了读者不应不加批判地接受系统综述的观点。
收集了近期系统综述的流行病学、描述性和报告特征的数据。描述性分析发现报告质量存在不一致。
在医疗保健中，评估关于疾病病因或预防、诊断或治疗最佳方法的所有可用证据非常重要。决策不应仅仅基于——例如——最新的或规模最大的研究，而应在充分考虑到目前为止针对相关问题进行的所有高质量研究的结果之后做出。这种方法被称为“循证医学”（EBM）。一份基于对明确界定的问题的研究搜索、对所发现研究的质量评估以及对研究结果的综合的报告被称为系统综述（SR）。进行系统综述本身被视为一个研究项目，所涉及的方法可能相当复杂。特别是，与其他形式的研究一样，尽可能减少偏倚非常重要。在发展系统综述概念和应使用的方法方面起主导作用的是一个名为Cochrane协作网的国际网络（见下文“附加信息”），该网络于1992年启动。然而，系统综述现在变得很常见。许多发表在期刊和其他地方的文章都被描述为系统综述。
由于系统综述被声称是最佳证据来源，因此它们应该进行得当，并且偏倚不应影响综述中得出的结论，这一点很重要。仅仅因为一篇讨论特定主题证据的论文的作者声称他们“系统地”进行了综述，并不保证他们的方法是合理的，他们的报告是高质量的。然而，如果他们报告了其方法的细节，那么这可以帮助综述的使用者决定他们所看到的综述是否有他们可以信赖的结论。这篇《公共科学图书馆·医学》文章的作者想了解现在有多少系统综述正在发表，它们在哪里发表，以及它们在解决什么问题。他们还想看看系统综述的方法报告得如何。
他们选取了一个月，并查找该月添加到医学文献主要列表中的所有系统综述。他们发现了300篇，涉及一系列主题和各种医学期刊。他们估计每年出现的综述中约有20%是由Cochrane协作网发表的。他们发现很多情况下所使用方法的重要方面没有被报告。例如，约三分之一的系统综述没有报告如何（如果有的话）评估搜索中发现的研究的质量。一项重要的评估，即分析“发表偏倚”，仅在约四分之一的案例中被报告已进行。大多数报告失败出现在“非Cochrane”综述中。
作者得出结论，系统综述的报告标准差异很大，因此读者不应不加批判地接受系统综述的结论。为了改善这种情况，他们敦促制定关于如何报告系统综述的指南。系统综述的作者以及发表它们的期刊都应该遵循这些指南。
请通过本摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0040078
同一期《公共科学图书馆·医学》上有一篇社论讨论了这篇研究文章及其与医学出版的相关性
詹姆斯·林德图书馆是有关循证医学方法的一个很好的信息来源
Cochrane协作网的网站是有关系统综述的一个很好的信息来源。特别是有一个新手指南和面向医疗保健“消费者”的信息。从该网站还可以看到Cochrane协作网发表的系统综述的摘要（一些国家的读者还可以免费查看完整的系统综述）
有关循证医学实践的信息可从美国医疗保健研究与质量局以及加拿大卫生药品与技术局获取
Systematic reviews (SRs) have become increasingly popular to a wide range of stakeholders. We set out to capture a representative cross-sectional sample of published SRs and examine them in terms of a broad range of epidemiological, descriptive, and reporting characteristics, including emerging aspects not previously examined. We searched Medline for SRs indexed during November 2004 and written in English. Citations were screened and those meeting our inclusion criteria were retained. Data were collected using a 51-item data collection form designed to assess the epidemiological and reporting details and the bias-related aspects of the reviews. The data were analyzed descriptively. In total 300 SRs were identified, suggesting a current annual publication rate of about 2,500, involving more than 33,700 separate studies including one-third of a million participants. The majority (272 [90.7%]) of SRs were reported in specialty journals. Most reviews (213 [71.0%]) were categorized as therapeutic, and included a median of 16 studies involving 1,112 participants. Funding sources were not reported in more than one-third (122 [40.7%]) of the reviews. Reviews typically searched a median of three electronic databases and two other sources, although only about two-thirds (208 [69.3%]) of them reported the years searched. Most (197/295 [66.8%]) reviews reported information about quality assessment, while few (68/294 [23.1%]) reported assessing for publication bias. A little over half (161/300 [53.7%]) of the SRs reported combining their results statistically, of which most (147/161 [91.3%]) assessed for consistency across studies. Few (53 [17.7%]) SRs reported being updates of previously completed reviews. No review had a registration number. Only half (150 [50.0%]) of the reviews used the term “systematic review” or “meta-analysis” in the title or abstract. There were large differences between Cochrane reviews and non-Cochrane reviews in the quality of reporting several characteristics. SRs are now produced in large numbers, and our data suggest that the quality of their reporting is inconsistent. This situation might be improved if more widely agreed upon evidence-based reporting guidelines were endorsed and adhered to by authors and journals. These results substantiate the view that readers should not accept SRs uncritically. Data were collected on the epidemiological, descriptive, and reporting characteristics of recent systematic reviews. A descriptive analysis found inconsistencies in the quality of reporting. In health care it is important to assess all the evidence available about what causes a disease or the best way to prevent, diagnose, or treat it. Decisions should not be made simply on the basis of—for example—the latest or biggest research study, but after a full consideration of the findings from all the research of good quality that has so far been conducted on the issue in question. This approach is known as “evidence-based medicine” (EBM). A report that is based on a search for studies addressing a clearly defined question, a quality assessment of the studies found, and a synthesis of the research findings, is known as a systematic review (SR). Conducting an SR is itself regarded as a research project and the methods involved can be quite complex. In particular, as with other forms of research, it is important to do everything possible to reduce bias. The leading role in developing the SR concept and the methods that should be used has been played by an international network called the Cochrane Collaboration (see “Additional Information” below), which was launched in 1992. However, SRs are now becoming commonplace. Many articles published in journals and elsewhere are described as being systematic reviews. Since systematic reviews are claimed to be the best source of evidence, it is important that they should be well conducted and that bias should not have influenced the conclusions drawn in the review. Just because the authors of a paper that discusses evidence on a particular topic claim that they have done their review “systematically,” it does not guarantee that their methods have been sound and that their report is of good quality. However, if they have reported details of their methods, then it can help users of the review decide whether they are looking at a review with conclusions they can rely on. The authors of this PLoS Medicine article wanted to find out how many SRs are now being published, where they are being published, and what questions they are addressing. They also wanted to see how well the methods of SRs are being reported. They picked one month and looked for all the SRs added to the main list of medical literature in that month. They found 300, on a range of topics and in a variety of medical journals. They estimate that about 20% of reviews appearing each year are published by the Cochrane Collaboration. They found many cases in which important aspects of the methods used were not reported. For example, about a third of the SRs did not report how (if at all) the quality of the studies found in the search had been assessed. An important assessment, which analyzes for “publication bias,” was reported as having been done in only about a quarter of the cases. Most of the reporting failures were in the “non-Cochrane” reviews. The authors concluded that the standards of reporting of SRs vary widely and that readers should, therefore, not accept the conclusions of SRs uncritically. To improve this situation, they urge that guidelines be drawn up regarding how SRs are reported. The writers of SRs and also the journals that publish them should follow these guidelines. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040078. An editorial discussing this research article and its relevance to medical publishing appears in the same issue of PLoS Medicine A good source of information on the evidence-based approach to medicine is the James Lind Library The Web site of the Cochrane Collaboration is a good source of information on systematic reviews. In particular there is a newcomers' guide and information for health care “consumers”. From this Web site, it is also possible to see summaries of the SRs published by the Cochrane Collaboration (readers in some countries can also view the complete SRs free of charge) Information on the practice of evidence-based medicine is available from the US Agency for Healthcare Research and Quality and the Canadian Agency for Drugs and Technologies in Health
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影响因子：
168.9
作者：
Chan, AW;Altman, DG
通讯作者：
Altman, DG
影响因子：
39.2
作者：
Moher, D;Schulz, KF;Altman, DG
通讯作者：
Altman, DG
影响因子：
1.9
作者：
Glenny, AM;Esposito, M;Worthington, HV
通讯作者：
Worthington, HV
影响因子：
15.1
作者：
Delaney, A;Bagshaw, SM;Ferland, A;Manns, B;Laupland, KB;Doig, CJ
通讯作者：
Doig, CJ
DOI：
10.1002/0470870168
发表时间：
2005-01-01
期刊：
PUBLICATION BIAS IN META-ANALYSIS: PREVENTION, ASSESSMENT AND ADJUSTMENTS
影响因子：
--
作者：
Rothstein, Hannah R.;Sutton, Alexander J.;Borenstein, Michael
通讯作者：
Borenstein, Michael