Investigating human influences in systematic reviews and meta-analyses to improve the reliability and validity of evidence syntheses

每年在医疗保健治疗上花费数十亿英镑，目的是改善和拯救生命。但并不是所有的临床研究都发表了，发表的东西也不可靠。通过将类似的研究汇集在一起，评估它们的质量和综合效果，可以使用更可靠的结果来指导未来的临床和政策决策。这种回顾研究的方法的黄金标准被称为系统回顾。这些大型报告以清晰和公平的方式总结了所有相关研究，以了解新治疗方法的优点和缺点。它们是被大量引用的文章，被认为是向患者护理提供信息所必需的客观和透明的研究设计。越来越多的报告称，正在发表的系统评价与其高质量声誉不符。系统评价因造成研究浪费而受到关注，它们的质量差异很大，具有误导性，并服务于相互冲突的利益。当出版期刊要求作者申报利益冲突时，他们涉及到关于过去几年从行业获得资金的狭隘标准。虽然系统评审中最佳实践的明确指南可供作者使用，但它们并不提供关于评审团队本身的指导。审查有时是由对结果感兴趣的人进行的(偏见)。或者，审查小组可能不会采取所有必要的努力来寻找和展示决策者理解所需证据的全貌(被动性)。审查小组的成员可能对治疗方法有自己的看法，这可能会决定审查的完成方式。审查小组可能没有足够的技能或资源来进行高质量的审查(资源不足)。不灵活的审查方法可能会导致昂贵的审查项目，这些审查项目没有反映对患者重要的问题。此外，有时评论是在没有资金的情况下发表的，作者的动机也没有受到质疑。在研究复杂的医疗保健问题时，人类对系统评价的影响可能尤其重要。考虑到系统评价被誉为公平和客观的过程，不良的行为可能比临床研究更有问题。卫生保健证据可能得不到公平的评估，患者可能会因此而蒙受损失，因为卫生服务可能无法提供最好的治疗。方法：为了充分探索团队中的研究人员可以影响系统评价的方式，我计划：1)搜索和回顾记录问题的研究，系统评价可能因团队影响而发生。2)与研究方法专家合作，为系统审查团队强调风险和解决方案，帮助确保我的研究结果对未来进行的系统审查产生影响。4)制作一个专门的网站和指南，以清晰和可访问的格式介绍系统评估中人类影响的风险，以帮助人们评估自己的系统评估。5)与研究人员一起完善和修改测试指南，确保它们对进行或使用系统评估的人有用。这项研究将产生什么影响？这项研究将描述是什么构成了一个合适的团队，以及什么类型的团队影响会导致系统的评估问题。该框架和指南将帮助从事或为涉及系统审查的研究买单的人了解他们在规划、资助或进行系统审查时需要考虑哪些因素。为了影响更广泛的研究议程，将创建一个用户友好的网站，解释研究的目标、方法和结果。这项研究将导致更好的系统性评价，为患者和公众的健康服务提供信息，并影响未来的健康研究。

Billions of pounds are spent each year on health care treatments with the aim of improving and saving lives. But not all clinical research is published and what is published not be reliable. By bringing together similar studies, assessing their quality, and combined effects, more reliable findings can be used to guide future clinical and policy decisions. The gold standard of this method of reviewing studies is called systematic review. These large reports summarise all relevant studies in a clear and fair way to understand the benefits and drawbacks of new treatments. They are highly cited articles and regarded as objective and transparent research designs that are necessary to inform patient care.There are increasing reports that systematic reviews are being published that do not live up to their high quality reputation. Systematic reviews are receiving attention for contributing to research waste, varying massively in their quality, being misleading and serving conflicted interests. When authors are asked by publishing journals to declare conflicts of interest, they relate to narrow criteria about funds received from industry within the last few years. Whilst clear guidelines for best practice in systematic reviews are available for authors, they do not provide guidance on review teams themselves. Reviews are sometimes carried out by people who have an interest in what the results are (bias). Or review teams might not take all the necessary efforts to find and present a full picture of the evidence needed for decision makers to understand (passivity). Members of the review team might have their own view on a treatment and this might shape the way the review is done. Review teams may not be sufficiently skilled or have the resources to carry out a high quality review (insufficient resources). Inflexible review methods may result in expensive review projects which do not reflect issues that matter to patients. Also, sometimes reviews are published without funding and authors' motivation for this is not questioned. The effects that human influence has on systematic reviews may be especially important when looking at health care problems that are complex.Considering the reputation of systematic reviews as fair and objective processes, poor conduct could be more problematic than in clinical research. Health care evidence might not be evaluated fairly and patients may suffer because the health service may not provide the best treatments as a result. Methods: To fully explore the ways in which the researchers in the team can influence systematic reviews I plan to: 1) Search for and review studies documenting problems with systematic reviews that can occur due to team influence. 2) Work with experts in research methods to highlight risks and solutions for systematic review teams, helping to ensure that the findings of my research impact on systematic reviews that are carried out in the future. 4) Produce a dedicated website and guidance in a clear and accessible format about the risks of human influence in systematic reviews to help people assess systematic reviews for themselves.5) Test guidance with researchers to refine and revise, ensuring that they are useful to people who do or use systematic reviews.What impact will this research have? This research will describe what makes an appropriate team and what types of team influence can cause problems to systematic reviews. The framework and guidance will help people who do or pay for research that involves a systematic review to understand what factors they need to consider when planning, funding or doing a systematic review. To influence the wider research agenda a user-friendly website that explains the goals, methods and results of the research will be created. This research will lead to better systematic reviews, to inform health care decision making for health services for patients and the public and to influence future health research.