Costs incurred
Nine studies ( Bohlius 2003 ; Eysenbach 2001 ; Hadhazy 1999 ; Hetherington 1987 ; Kelly 2002 ; Kelly 2004 ; McGrath 1998 ; Reveiz 2004 ; Wille‐Jorgensen 2001 ) did not meet the inclusion criteria as there was no comparison of different methods of obtaining missing data.
Brown 2003 , Gibson 2006 , Guevara 2005 and Shukla 2003 , the four observational, comparative studies, did not report on the methodology used and therefore assessments of risk of bias for these studies are incomplete.
We assessed risk of bias for the two randomised studies by looking at the methods used for allocation sequence generation, allocation concealment and blinding. Allocation concealment was adequate for Higgins 1999 and unclear for Milton 2001 . Allocation sequence generation and blinding were not reported.
Five of the six studies assessed methods for obtaining missing data (i.e. data available to the original researchers but not reported in the published study).
All five studies provided information on the proportion of missing data obtained.
Brown 2003 used a non‐randomised design to compare contacting 112 authors (of 139 studies) via 39 e‐mails and 73 letters. The study was designed as a comparative study but data per study arm were not reported. Twenty‐one replies (19%) were received. One study published in the period 1980‐1984 elicited no response, nine 1985‐1989 studies elicited two responses, 41 1990‐1994 studies elicited six responses, 38 1995‐1999 studies elicited eight responses and 21 2000‐2002 studies elicited four responses.
Gibson 2006 used a non‐randomised design to compare contacting authors by e‐mail, letter or both. Two hundred and forty‐one studies (40%) had missing or incomplete data. They were unable to locate 95 authors (39%). Of the remaining 146 authors, 46 authors (32%) responded to information requests. The response rate differed by mode of contact ‐ letter (24%), e‐mail (47%) and both (73%). Response was significantly higher with e‐mail compared to using letters (hazard ratio 2.5; 95% confidence interval (CI) 1.3 to 4.0). Combining letter and e‐mail had a higher response rate, however, it was not significantly different from using e‐mail alone (reported P = 0.36). The combination of methods (letter plus e‐mail follow‐up) rather than multiple contacts using the same method was more effective for eliciting a response from the author. Response rates from US authors did not differ from those of other countries. The older the article, the less likely the response.
Guevara 2005 used a non‐randomised design to compare e‐mail versus letter versus fax. Fifteen authors (60%) responded to information requests. E‐mail resulted in fewer attempts and a greater response rate than post or fax. Authors of studies published after 1990 were as likely to respond (67% versus 50%, reported P = 0.45) as authors of studies published earlier. Similarly, corresponding authors were no more likely to respond (58% versus 9%, reported P = 0.44) than secondary authors, although few secondary authors were contacted.
Higgins 1999 used a randomised comparison of single request for missing information (by e‐mail or surface mail) (n = 116) versus a multistage approach involving pre‐notification, request for missing information and active follow‐up (n = 117) and found no significant difference between the two groups (risk ratio (RR) 1.04; 95% CI 0.74 to 1.45) in response rate.
Milton 2001 compared, using a randomised design, the response of clinical trial investigators to requests for information signed by either Richard Smith (RS), editor of the British Medical Journa l (n = 96), or an unknown researcher (n = 48) and found no significant differences between signatory groups in response rates. By three weeks, 34% in the former and 27% in the unknown researcher's group had responded (odds ratio (OR) 1.35; 95% CI 0.59 to 3.11). No baseline data had been provided by three weeks. By the end of the study, at five weeks, 74% and 67% respectively had responded (OR 1.42; 95% CI 0.62 to 3.22) and 16 out of 53 studies in the RS group and five out of 27 authors in the unknown researcher's group had provided baseline data (OR 1.90; CI 0.55 to 6.94).
One of the five studies assessed the extent to which data obtained answers to the questions posed by those seeking the data.
Higgins 1999 compared, using a randomised design, the completeness of information retrieved between study arms (single request for missing information (by e‐mail or surface mail) (n = 116) versus multistage approach involving pre‐notification, request for missing information and active follow‐up (n = 117)) and found no significant difference between the two study methods.
Two of the five studies assessed the type of missing data obtained.
Brown 2003 used a non‐randomised design to compare contacting 112 authors (of 139 studies) via 39 e‐mails and 73 letters and received 21 replies (19%), of which nine provided relevant outcome and quality data, one provided additional data on study quality only and one provided information regarding duplicate publications. Eleven studies provided no useful information. Data per study arm were not reported.
Guevara 2005 used a non‐randomised design to compare e‐mail versus letter versus fax and reported that requests for clarification of methods resulted in a greater response (50% versus 32%, P = 0.03) than requests for missing data. Once again, data per study arm were not reported.
Two of the five studies assessed the time taken to obtain missing data (i.e. time from when efforts start until data are obtained).
Gibson 2006 used a non‐randomised design to compare e‐mail versus letter versus fax and reported that the time to respond differed significantly by contact method (P < 0.05): e‐mail (3 +/‐ 3 days; median one day), letter (27 +/‐ 30 days; median 10 days) and both (13 +/‐ 12 days; median nine days).
Guevara 2005 used a non‐randomised design to compare e‐mail versus letter versus fax and reported that e‐mail had a shorter response time than post or fax.
One of the five studies assessed the number of attempts made to obtain missing data.
Gibson 2006 used a non‐randomised design to compare e‐mail versus letter versus fax and reported that the number of items requested per authors averaged two or more. The number of items requested did not influence the probability of response. In addition, multiple attempts using the same methods did not increase the likelihood of response.
One of the five studies assessed the resources required to obtain missing data.
Brown 2003 used a non‐randomised design to compare contacting 112 authors (of 139 studies) via 39 e‐mails and 73 letters and reported total costs of 80 GBP for printing and postage. Cost was not reported per study arm.
One of the six included studies assessed methods to obtain unpublished studies (i.e. data for studies that have never been published).
Shukla 2003 , using a non‐randomised design, assessed two different approaches to seek unpublished information from the drug industry. The outcome of a general request letter was compared with efforts to identify unpublished data and then contacting the industry to provide further specific detail. With the first approach, no unpublished information was obtained. With the second approach, relevant unpublished information was obtained for four of five of the systematic reviews (in the form of manuscripts or oral/poster presentations).
No information was available for the following secondary outcome measures.
Despite extensive searches we identified only six studies as eligible for inclusion in this review. Of these, five were published as abstracts and one as a full paper. Due to lack of high‐quality studies the results should be interpreted with caution. Five studies, two randomised studies and three observational comparative studies evaluated different methods for obtaining missing data (e.g. data available to the original researchers but not reported in the published study). Two studies found that correspondence with study authors by e‐mail resulted in the greatest response rate with the fewest number of attempts and the shortest time to respond, when compared with correspondence by fax or letter. Combining letter and e‐mail had a higher response rate, however, it was not significantly different from using e‐mail alone. Another study found that you were more likely to solicit a response from authors whose studies were published more recently. In addition, requests for clarification of the study methods appeared to result in a greater response rate than requests for missing data about the study results.
The effect of a single request for missing information (by e‐mail or surface mail) versus a multistage approach (pre‐notification, request for missing information and active follow‐up) did not appear to affect the rate of response or the completeness of information retrieved; neither did the number of attempts made to obtain missing data or the number of items requested. Interestingly, the use of a well‐known signatory also had no significant effect on the likelihood of authors responding to a request for unpublished information. Only one study evaluated the effects of different methods to obtain unpublished data (e.g. data for studies that have never been published). This found that leg‐work ahead of time to clarify and request the specific unpublished study information required can prove to be more fruitful than sending of a non‐specific request. The Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2009 ) suggests that review authors also consider contacting colleagues to find out if they are aware of any unpublished studies; we did not find any studies addressing the effectiveness of this approach.
When considering the findings from this review it is important to consider the limitations in the completeness of the available data and how this weakens the strength of any recommendations we are able to draw. The general problem that a large proportion of conference abstracts do not get published in full has been shown by others ( Scherer 2007 ) and it was recently found that about two‐thirds of the research studies presented at Cochrane Colloquia do not get published in full ( Chapman 2010 ). We encountered this problem in this review with five of the six studies being available only as abstracts at Colloquia. They lacked information about the study methodology and detailed results, and were never written up and published in full. Despite attempts to contact the authors of these studies we were only able to obtain additional information for one of the five studies. Ironically, our systematic review is subject to the same problems of obtaining missing data which our review is trying to address. Assessment of risk of bias was also hampered by incomplete data; the four observational studies did not report on the study methods and only one of the two randomised studies reported on the method of allocation concealment. The Brown 2003 study was designed as a comparative study, however only combined results were reported. The study is therefore reported in this review as though it was a non‐comparative study report of the experience of contacting original authors.
Missing and incomplete data continue to be a major problem and potential source of bias for those carrying out systematic reviews. If data were missing from study reports at random then there would be less information around but that missing information would not necessarily be biased. The problem is that there is considerable evidence showing that studies are more likely to be published and published more quickly if they have significant findings ( Scherer 2007 ). Even when study results are published, there is evidence to show that authors are more likely to report significant study outcomes as opposed to non‐significant study outcomes ( Kirkham 2010 ). The findings from our review support the current recommendations in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2009 ) that those carrying out systematic reviews should continue to contact authors for missing data, recognising that this might not always be successful, particularly for older studies. In the absence of being able to contact authors to obtain missing data, review authors should also consider the potential benefits of searching prospective clinical trial registries and trial results registers for missing data. For example, in 2007 the US government passed legislation that the findings for all US government funded research should be included on www.clinicaltrials.gov within one year of study completion, thus making available previously unpublished information. The setting up of websites for systematic review projects, listing the studies identified to date and inviting submission of information on studies not already listed ( Lefebvre 2008 ), has also been proposed as a way of identifying unpublished studies.
The strength of the evidence included in this review is limited by the completeness of the available data; five of the six studies included in this review lacked information about the study methodology and their results. Despite extensive searching only one study assessed methods for obtaining unpublished data. Further robust, comparative, well‐conducted and reported studies are needed on strategies to obtain missing and unpublished data.
We are very grateful to Julian Higgins who provided us with additional information regarding the First Contact study.
#1 ("study identification" next general) or ("study identification" next "publication bias") or ("study identification" next "prospective registration") or ("study identification" next internet) or ("data collection") or ("missing data") or ("information retrieval" next general) or ("information retrieval" next "retrieval techniques") or ("information retrieval" next "comparisons of methods"):kw in Methods Studies
#2 (request* or obtain* or identify* or locat* or find* or detect* or search or "ask for") NEAR/3 (grey or unpublished or "un published" or "not published"):ti or (request* or obtain* or identify* or locat* or find* or detect* or search or "ask for") NEAR/3 (grey or unpublished or "un published" or "not published"):ab
#3 (request* or obtain* or identify* or locat* or find* or detect* or search or "ask for") NEAR/3 (missing or missed or insufficient or incomplete or lack* or addition*):ti or (request* or obtain* or identify* or locat* or find* or detect* or search or "ask for") NEAR/3 (missing or missed or insufficient or incomplete or lack* or addition*):ab
#4 (missing or incomplete or unpublished or "un published" or "not published") NEAR/3 (data or information or study or studies or evidence or trial or trials):ti or (missing or incomplete or unpublished or "un published" or "not published") NEAR/3 (data or information or study or studies or evidence or trial or trials):ab
#5 (bad or ambiguous or insufficient or incomplete) NEAR/6 report*:ti or (bad or ambiguous or insufficient or incomplete) NEAR/3 report*:ab
#6 (#1 OR #2 OR #3 OR #4 OR #5)
1. ((request$ or obtain$ or identify$ or locat$ or find$ or detect$ or search or ask for) adj3 (grey or unpublished or "un published" or "not published") adj3 (data or information or evidence or study or studies or trial? or paper? or article? or report? or literature or work)).tw.
2. ((request$ or obtain$ or identify$ or locat$ or find$ or detect$ or search or ask for) adj3 (missing or insufficient or incomplete or lack$ or addition$) adj3 (data or information or evidence)).tw.
3. ((bad or ambiguous or insufficient or incomplete) adj6 reporting).tw.
4. 1 or 2 or 3
5. (2000$ or 2001$ or 2002$ or 2003$ or 2004$ or 2005$ or 2006$ or 2007$ or 2008$ or 2009$).ep.
5. (2004$ or 2005$ or 2006$ or 2007$ or 2008$ or 2009$).em.
Characteristics of included studies [ordered by study id].
Methods | This was a non‐randomised comparative study. Within the context of 4 systematic reviews on the prevention of NSAID‐induced gastro‐intestinal toxicity trial authors were contacted by e‐mail (preferentially) or letter, providing a semi‐personalised information retrieval sheet. | |
Data | Context of 4 systematic reviews on the prevention of NSAID‐induced gastro‐intestinal toxicity; 112 authors (of 139 studies) were contacted | |
Comparisons | E‐mail (n = 39) versus letter (n = 73) providing a semi‐personalised information retrieval sheet. However, the results were not presented separately for each approach. | |
Outcomes | Additional information retrieved through contact with trial authors Costs incurred | |
Notes | This study was published as an abstract | |
Allocation concealment? | Unclear | Non‐randomised comparison therefore not applicable |
Allocation sequence generation? | Unclear | Non‐randomised comparison therefore not applicable |
How allocation occurred? | Unclear | Not reported |
Attempts to balance groups? | Unclear | Not reported |
Use of blinding? | Unclear | Not reported |
Methods | This was a non‐randomised comparative study. The mode of contact and response levels of authors who had been asked to provide missing or incomplete data for a systematic review on diet and exercise interventions for weight loss was examined. | |
Data | A systematic review on diet and exercise interventions for weight loss | |
Comparisons | E‐mail versus letter versus both (total n = 146; sample size per study arm not reported) | |
Outcomes | Proportion of responders over time among the different modes of contact Response rates from United States compared to other countries | |
Notes | This study was published as a full‐text paper | |
Allocation concealment? | Unclear | Non‐randomised comparison therefore not applicable |
Allocation sequence generation? | Unclear | Non‐randomised comparison therefore not applicable |
How allocation occurred? | Unclear | Not reported |
Attempts to balance groups? | Unclear | Not reported |
Use of blinding? | Unclear | Not reported |
Methods | This was a non‐randomised comparative study. As part of a Cochrane Review comparing the effects of inhaled corticosteroids to cromolyn, authors of all included trials were contacted to clarify methods and/or to obtain missing outcome data. Authors listed as corresponding authors were contacted by Remaining authors were contacted if there was no response by the corresponding author | |
Data | Cochrane Review comparing the effects of inhaled corticosteroids to cromolyn; study authors of all 25 included trials were contacted to clarify methods and/or to obtain missing outcome data | |
Comparisons | E‐mail versus letter versus fax (total n = 25; sample size per study arm not reported) | |
Outcomes | Response rate Time to response | |
Notes | This study was published as an abstract | |
Allocation concealment? | Unclear | Non‐randomised comparison therefore not applicable |
Allocation sequence generation? | Unclear | Non‐randomised comparison therefore not applicable |
How allocation occurred? | Unclear | Unclear |
Attempts to balance groups? | Unclear | E‐mail was the preferred method of contact |
Use of blinding? | No | No blinding |
Methods | This was a randomised comparison. Contact persons or authors (primary investigators) of published studies were eligible for the study if (i) the study had been identified as probably or definitely fulfilling the criteria for inclusion in a Cochrane Review, (ii) any information needed to complete the systematic review was missing from the published report, and (iii) a postal, or e‐mail, address was available for them. The reviewers should have completed assessment of studies for inclusion in the review and any data extraction. | |
Data | Randomised trial of Cochrane Review authors where the reviewer was uncertain how first contact should be made with the investigator of a primary study which was included in the Cochrane Review in order to obtain missing information | |
Comparisons | Single request for missing information (by e‐mail or surface mail) (n = 116) versus multistage approach involving pre‐notification, request for missing information and active follow‐up (n = 117) | |
Outcomes | Primary outcome: Amount of missing information retrieved from the investigator within 12 weeks of sending the original letter. A 4‐point ordinal scale was used: Secondary outcomes: The time taken to receive some or all of the requested information Any response or acknowledgement from the investigator or someone else involved with the study or its data Cost, in terms of postage and telephone call time | |
Notes | This study was called 'First Contact' and was published as an abstract. The study's website is available at http://www.mrc‐bsu.cam.ac.uk/firstcontact/index.html Additional information was obtained from study authors | |
Allocation concealment? | Yes | Central randomisation with minimisation to attempt to balance confounders |
Allocation sequence generation? | Unclear | Central randomisation |
How allocation occurred? | Unclear | Randomised comparison therefore not applicable |
Attempts to balance groups? | Unclear | Randomised comparison therefore not applicable |
Use of blinding? | Unclear | Not reported |
Methods | This was a randomised comparison. Authors of eligible RCTs of interventions for essential hypertension published since 1996 and forming part of a methodological systematic review were randomised to receive a mailed questionnaire with a cover letter signed by Richard Smith (RS) or Julie Milton (JM), on stationery appropriate to each. After 3 weeks non‐responders were sent a questionnaire by recorded mail, with the same signatory. After a further 5 weeks, JM attempted to telephone non‐responders, telling authors randomised to RS as signatory that she was calling on his behalf. | |
Data | Authors of 144 eligible RCTs of interventions for essential hypertension published since 1996 and forming part of a methodological systematic review | |
Comparisons | Using a well know signatory (n = 96) versus an unknown researcher (n = 48) on the cover letter of a mailed questionnaire | |
Outcomes | Response of clinical trial investigators to requests for information | |
Notes | This study was published as an abstract | |
Allocation concealment? | Unclear | Allocation was performed by an independent statistician |
Allocation sequence generation? | Unclear | Not reported |
How allocation occurred? | Unclear | Randomised comparison therefore not applicable |
Attempts to balance groups? | Unclear | Randomised comparison therefore not applicable |
Use of blinding? | Unclear | Not reported |
Methods | This was a non‐randomised comparative study. Over 4 years, for each of 5 systematic reviews of drugs at CCOHTA, 2 different approaches were used to seek unpublished information from the drug industry. With the first approach, a general request letter was sent. With the second approach, unpublished studies were identified ahead of time via handsearching of conference abstracts, review articles and bibliographies of included studies plus electronic searches of BIOSIS Previews. A Google search was also run. Unpublished studies were identified and industry was asked to provide further specific detail. | |
Data | Five systematic reviews of drugs at CCOHTA. Number of trials not reported. | |
Comparisons | Identifying unpublished studies ahead of time and then asking industry to provide further specific detail versus general request by letter for unpublished studies | |
Outcomes | Unpublished information obtained from the drug industry | |
Notes | This study was published as an abstract | |
Allocation concealment? | Unclear | Non‐randomised comparison therefore not applicable |
Allocation sequence generation? | Unclear | Non‐randomised comparison therefore not applicable |
How allocation occurred? | Unclear | Not reported |
Attempts to balance groups? | Unclear | Not reported |
Use of blinding? | Unclear | Not reported |
CCOHTA: Canadian Co‐ordinating Office for Health Technology Assessment NSAID: non‐steroidal anti‐inflammatory drug RCT: randomised controlled trial
Study | Reason for exclusion |
---|---|
Study that looked at contacting authors to obtain missing data. It was excluded because there was no comparison of different methods of obtaining missing data. | |
Study that looked at use of the internet to identify unpublished studies. It was excluded because there was no comparison of different methods of obtaining unpublished studies. | |
Study that looked at contacting authors to obtain missing data. It was excluded because there was no comparison of different methods of obtaining missing data. | |
Study that looked at surveying content experts to identify unpublished studies. It was excluded because there was no comparison of different methods of obtaining unpublished studies. | |
This study contacted authors of studies for individual patient data using letters. It was excluded because there was no comparison of different methods of obtaining missing data. | |
Study that looked at contacting authors to obtain missing data. It was excluded because there was no comparison of different methods of obtaining missing data. | |
Study that looked at contacting authors to obtain missing data. It was excluded because there was no comparison of different methods of obtaining missing data. | |
Study that looked at surveying content experts to identify unpublished studies. It was excluded because there was no comparison of different methods of obtaining unpublished studies. | |
Primary authors and/or sponsoring pharmaceutical companies of studies in general surgery which might contain colorectal patients were contacted per mail, e‐mail and/or personal contacts. The responses from the 3 methods were not compared. |
Taryn Young (TY) developed and Sally Hopewell (SH) provided comments on the protocol. Both authors reviewed the search results, selected potential studies for inclusion, worked independently to do a formal eligibility assessment and then extracted data from included studies. TY drafted the review with input from SH.
Internal sources.
None known.
Brown 2003 {published data only}.
Bohlius 2003 {published data only}.
Chapman 2010.
Holocaust-Era Assets
Unpublished Research papers, relating to Holocaust-Era Assets, made available online
Symposium participants are invited to send their papers, electronically or in hardcopy, to [email protected] or to Lida Churchville National Archives Library, Rm. 2380 8061 Adelphi Rd, College Park, MD 20740
PERSONAL COMMUNICATION
IN TEXT
(Communicator, personal communication, Date of communication ) .
L. Mardis (personal communication, July 29, 2019) reported that the library's guides underwent usability testing.
(L. A. Mardis, personal communication, January 22, 2020 ) .
(L. A. Mardis, class handouts, January 21, 2020).
REFERENCE LIST
Mardis, L. A. (2018, October 19). Social media success in academic libraries [Interview]. Maryville, MO: Northwest
Missouri State University.
(For more examples, see p. 340 of the 7th edition)
Goldberg, I. K. (2003). Screening for Bipolar Spectrum Disorders [Measurement instrument]. http://psychiatryassociatespc.com/doc/Goldberg's_bipolar_screening_scale.pdf
IN TEXT
In this study, Goldberg's (2003) Screening for Bipolar Spectrum Disorders was used to identify whether individuals were most likely suffering from major (unipolar) depression.
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Searching for unpublished studies..
A consortium consisting of York Health Economics Consortium and the Cochrane Information Retrieval Methods Group has looked into the issue of searching for unpublished studies and obtaining access to unpublished data and has produced the following report and bibliography:
Arber M, Cikalo M, Glanville J, Lefebvre C, Varley D, Wood H. Annotated bibliography of published studies addressing searching for unpublished studies and obtaining access to unpublished data. York: York Health Economics Consortium; 2013.
This work was a sub-project of a larger project entitled “Searching for unpublished trials using trials registers and trials web sites and obtaining unpublished trial data and corresponding trial protocols from regulatory agencies”.
Other outputs of this project include:
Schroll, JB, Bero, L, Gotzsche, P. Searching for unpublished data for Cochrane reviews: Cross sectional study. BMJ 2013;346:f2231
Wolfe, N, Gotzsche, PC and Bero, L. Strategies for obtaining unpublished drug trial data: A qualitative interview study. Systematic Reviews. 2013; 2:31. http://www.systematicreviewsjournal.com/content/2/1/31
The project was a collaboration between the San Francisco Branch of the United States Cochrane Center, Nordic Cochrane Centre, Cochrane Acute Respiratory Infections Group, York Health Economics Consortium and the Cochrane Information Retrieval Methods Group. This sub-project was undertaken by staff of York Health Economics Consortium and Carol Lefebvre of Lefebvre Associates Ltd, for which some funding was provided by the Cochrane Collaboration under the Methods Innovation Funding initiative.
We thank the authors for allowing us to link to the full text of the report from this site.
Publication bias clearly is a major threat to the validity of any type of review, but particularly of unsystematic, narrative reviews. Obtaining and including data from unpublished trials appears to be one obvious way of avoiding this problem. Hopewell and colleagues conducted a review of studies comparing the effect of the inclusion or exclusion of ‘grey’ literature (defined here as reports that are produced by all levels of government, academics, business and industry in print and electronic formats but that are not controlled by commercial publishers) in meta-analyses of randomized trials (Hopewell 2007b) . They included five studies (Fergusson 2000, McAuley 2000, Burdett 2003, Hopewell 2004) , all of which showed that published trials had an overall greater intervention effect than grey trials. A meta-analysis of three of these studies suggested that, on average, published trials showed a 9% larger intervention effect than grey trials (Hopewell 2007b) .
The inclusion of data from unpublished studies can itself introduce bias. The studies that can be located may be an unrepresentative sample of all unpublished studies. Unpublished studies may be of lower methodological quality than published studies: a study of 60 meta-analyses that included published and unpublished trials found that unpublished trials were less likely to conceal intervention allocation adequately and to blind outcome assessments (Egger 2003). In contrast, Hopewell and colleagues found no difference in the quality of reporting of this information (Hopewell 2004).
A further problem relates to the willingness of investigators of located unpublished studies to provide data. This may depend upon the findings of the study, more favourable results being provided more readily. This could again bias the findings of a systematic review. Interestingly, when Hetherington et al., in a massive effort to obtain information about unpublished trials in perinatal medicine, approached 42,000 obstetricians and paediatricians in 18 countries they identified only 18 unpublished trials that had been completed for more than two years (Hetherington 1989) .
A questionnaire assessing the attitudes toward inclusion of unpublished data was sent to the authors of 150 meta-analyses and to the editors of the journals that published them (Cook 1993). Researchers and editors differed in their views about including unpublished data in meta-analyses. Support for the use of unpublished material was evident among a clear majority (78%) of meta-analysts while journal editors were less convinced (47%) (Cook 1993). This study was recently repeated, with a focus on the inclusion of grey literature in systematic reviews, and it was found that acceptance of inclusion of grey literature has increased and, although differences between groups remain (systematic review authors: 86%, editors: 69%), they may have decreased compared with the data presented by Cook et al. (Tetzlaff 2006).
Reasons for reluctance to include grey literature included the absence of peer-review of unpublished literature. It should be kept in mind, however, that the refereeing process has not always been a successful way of ensuring that published results are valid (Godlee 1999) . The team involved in preparing a Cochrane review should have at least a similar level of expertise with which to appraise unpublished studies as a peer reviewer for a journal. On the other hand, meta-analyses of unpublished data from interested sources are clearly a cause for concern.
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Author. “Title of Manuscript/Document.”. date of composition (at least year), along with "the name and location of the library, research institution, or personal collection housing the material."
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(Last Name Page Number)
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Author. “Title of the Paper.” date of composition. Name of the Course, Name of the Institution, type of work (optional). : this does not extend to MA or PhD theses, which are public-facing works. instead.
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(Last Name Page Number)
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ACAP LEARNING RESOURCES
Author, a. a., & author, b. b. (year). title of work in italics [description of unpublished manuscript]. department name, university name. https://xxxxxx, author, a. a., & author, b. b. (year). title of work in italics (publication no. ###). name of database or archive. https://doi.org/xxxxxx.
Use specific manuscript descriptions, e.g. [Unpublished manuscript]. [Manuscript in preparation]. [Manuscript submitted for publication]. Always use a DOI if the resource has one. Include a URL if there isn't a DOI available and if it resolves without authentication.
Leemans, S. J. J. & Artem, P. (2019). Proofs with stochastic-aware conformance checking: An entropy-based approach [Unpublished manuscript]. Faculty of Science and Technology, Queensland University of Technology. https://eprints.qut.edu.au/129860/
Winegard, B. M., Winegard, B. M., Geary, D. C., & Clark, C. J. (2018). The status competition model of cultural production . PsyArXiv. https://doi.org/10.31234/osf.io/apw5e/
Parenthetical Style
See theorem one as follows "for any log L and model M (given as SDFAs), it holds that 0 ≤ recall(L, M) ≤ 1 and 0 ≤ precision(L, M) ≤ 1" (Leemans et al., 2019, p. 2).
In this example, the architecture of Frank Lloyd Wright is used for its functional and aesthetic qualities (Winegard et al., 2018).
Narrative Style
Leemans et al. (2019) proposes "for any log L and model M (given as SDFAs), it holds that 0 ≤ recall(L, M) ≤ 1 and 0 ≤ precision(L, M) ≤ 1" (p. 2).
Winegard et al. (2018) use the architecture of Frank Lloyd Wright house as an example for its functional and aesthetic qualities.
This page contains a reference example for an unpublished dissertation or thesis.
Harris, L. (2014). Instructional leadership perceptions and practices of elementary school leaders [Unpublished doctoral dissertation]. University of Virginia.
Unpublished dissertation or thesis references are covered in the seventh edition APA Style manuals in the Publication Manual Section 10.6 and the Concise Guide Section 10.5
Note : Note number. Author First Last Name, “Title” (Type of dissertation, Location of Publisher, Year of Pub.), pages cited, URL or database (if online).
Sample Note :
43. Afrah Daaimah Richmond, “Unmasking the Boston Brahmin: Race and Liberalism in the Long Struggle for Reform at Harvard and Radcliff, 1945-1990” (PhD diss., New York University, 2011), 211-12, ProQuest Dissertations & Theses.
Bibliography :
Author Last, First Name. “Title.” Type of Dissertation, Location of Publisher, Year of Pub. URL or database (if online).
Sample Citation :
Culcasi, Karen Leigh. “Cartographic Representations of Kurdistan in the Print Media.” Master’s Thesis, Syracuse University, 2003.
Note number. Author First Last Name, “Title” (Sponsor, Location, Year). URL or database (if online).
43. Irineu de Carvalho Filho and Renato P. Colistete, “Education Performance: Was it All Determined 100 Years Ago? Evidence from Sao Paulo, Brazil” (Paper presented at the 70th annual meeting of the Economic History Association, Evanston, IL, September 24-26, 2010). http://mpra.ub.uni-muenchen.de/24494/1/MPRA_paper_24494.pdf.
Bibliograpyy :
Author Last, First Name. “Title of Speech or lecture.” Sponsor, Location, Year. URL or database (if online).
Crane, Gregory R. “Contextualizing Early Modern Religion in a Digital World.” Lecture, Newberry Library, Chicago, September 16, 2011.
Carvalho Filho, Irineu de, and Renato P. Colistete. “Education Performance: Was it All Determined 100 Years Ago? Evidence from Sao Paulo, Brazil.” Paper presented at the 70 th annual meeting of the Economic History Association, Evanston, IL, September 24-26, 2010. http://mpra.ub.uni-muenchen.de/24494/1/MPRA_paper_24494.pdf.
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Meta-analyses are particularly vulnerable to the effects of publication bias. Despite methodologists’ best efforts to locate all evidence for a given topic the most comprehensive searches are likely to miss unpublished studies and studies that are published in the gray literature only. If the results of the missing studies differ systematically from the published ones, a meta-analysis will be biased with an inaccurate assessment of the intervention’s effects.
As part of the OPEN project ( http://www.open-project.eu ) we will conduct a systematic review with the following objectives:
▪ To assess the impact of studies that are not published or published in the gray literature on pooled effect estimates in meta-analyses (quantitative measure).
▪ To assess whether the inclusion of unpublished studies or studies published in the gray literature leads to different conclusions in meta-analyses (qualitative measure).
Inclusion criteria: Methodological research projects of a cohort of meta-analyses which compare the effect of the inclusion or exclusion of unpublished studies or studies published in the gray literature.
Literature search: To identify relevant research projects we will conduct electronic searches in Medline , Embase and The Cochrane Library ; check reference lists; and contact experts.
Outcomes: 1) The extent to which the effect estimate in a meta-analyses changes with the inclusion or exclusion of studies that were not published or published in the gray literature; and 2) the extent to which the inclusion of unpublished studies impacts the meta-analyses’ conclusions.
Data collection: Information will be collected on the area of health care; the number of meta-analyses included in the methodological research project; the number of studies included in the meta-analyses; the number of study participants; the number and type of unpublished studies; studies published in the gray literature and published studies; the sources used to retrieve studies that are unpublished, published in the gray literature, or commercially published; and the validity of the methodological research project.
Data synthesis: Data synthesis will involve descriptive and statistical summaries of the findings of the included methodological research projects.
Results are expected to be publicly available in the middle of 2013.
Peer Review reports
A meta-analyses as part of a systematic review aims to provide a thorough, comprehensive and unbiased account of the literature [ 1 , 2 ]. However, potentially important studies could be missing from a meta-analysis because of selective publication and inadequate dissemination of results. Despite methodologists’ best efforts to locate all eligible evidence for a given topic the most comprehensive searches are likely to miss unpublished studies and studies that are not commercially published and, therefore, are not indexed in respective databases (so called gray literature, such as conference abstract, dissertations, policy documents, book chapters). If the results from missing studies differ systematically from the published data, a meta-analysis may become biased with an inaccurate assessment of the intervention’s effects. For instance, positive, significant findings are more likely to be published than non-significant findings, and a meta-analysis which is based mainly on published literature may end up overestimating the efficacy of the intervention [ 3 – 5 ].
However, the impact of gray literature and unpublished studies on the conclusions of meta-analyses has not been comprehensively clarified. For example, there is some evidence that suggests that published randomized controlled trials (RCTs) tend to be larger and show an overall greater treatment effect than gray trials [ 6 ]. But the identification of relevant unpublished studies or studies published in the gray literature and their inclusion in meta-analyses can be particularly time-consuming and challenging. There is also some controversy as to whether unpublished studies and studies published in the gray literature should be included in meta-analyses because they might be incomplete and their methodological quality (validity) can be difficult to assess. A publication by Cook and colleagues in 1993 showed that 78% of authors of meta-analyses felt that unpublished studies should be included in meta-analyses compared to only 47% of journal editors [ 7 ]. Therefore, research is needed to help assess the potential implications for reviewers of not including gray literature and unpublished studies in meta-analyses of health care interventions.
In terms of the above mentioned controversies regarding the inclusion of unpublished studies and studies published in the gray literature on the results of meta-analyses, we will conduct a systematic review with the following objectives:
▪ To assess the impact of studies that were not published or only published in the gray literature on pooled effect estimates in meta-analyses (quantitative measure)
▪ To assess whether the inclusion of unpublished studies or studies published in the gray literature impacts the conclusions of meta-analyses (qualitative measure)
This systematic review will be part of the OPEN Project (To O vercome failure to P ublish n E gative fi N dings) which was developed with the goal of elucidating the scope of non-publication of studies through a series of systematic reviews. In an earlier issue of this journal (‘Systematic Reviews’), our group has already published a protocol for a systematic review which evaluates the extent of non-publication of research studies, which were approved by ethics committees, registered in trial registries or presented as conference abstracts [ 8 ].
To identify the relevant research evidence we will conduct electronic literature searches in the following databases: Ovid Medline (1946 to present), Ovid Medline Daily Update, Ovid Medline in process & other non-indexed citations, Ovid Embase (1980 to present), The Cochrane Library (most current issue) and Web of Science . No language restrictions will be applied.
In addition, the bibliographies of any eligible articles identified will be checked for additional references and citation searches will be carried out for all included references using ISI Web of Knowledge.
A search strategy for the electronic literature search in Ovid Medline has already been designed with the support of a librarian/information specialist. This strategy was translated as appropriate for the other databases (for the full search strategies see Appendix A). In addition, we will contact various experts in the field for further eligible studies.
Selection of methodological research projects.
A methodological research project will be considered eligible for inclusion in this systematic review if it reviews a cohort of meta-analyses (that is, more than one meta-analyses) that:
▪ compare pooled effect estimates of meta-analyses of health care interventions according to publication status (that is, published versus unpublished studies or gray literature) or
▪ examine whether the inclusion of unpublished studies or gray literature impacts the overall findings or conclusions of a meta-analyses
We will consider ‘published’ articles to be manuscripts that appeared in peer-reviewed journals. Our working definition of gray literature will correspond to the definitions used by the authors of eligible methodological research projects and which also conforms to the definition of ‘gray literature’ described earlier in this protocol (see Background). A meta-analysis is defined as the calculation of a summary estimate of treatment effect by pooling the results of two or more studies.
A specifically designed data extraction form will be developed and two reviewers will independently extract all relevant data from eligible methodological research projects. The following information will be collected:
Characteristics of the methodological research project
Baseline data (for example, author names, affiliation, language and year of publication, funding, type of report (for example, full publication, abstract))
Area of health care/medical specialty
Number of meta-analyses included
Characteristics of the meta-analyses included in the methodological research project
Type of meta-analyses (for example, individual patient data meta-analyses)
Number of studies included in meta-analyses (overall, median, range)
Number of participants included in meta-analyses (overall, median, range)
Main purpose of meta-analyses (efficacy versus safety)
Source used to retrieve unpublished studies, studies published in the gray literature and published studies
Characteristics of the studies included in the meta-analyses
Number of unpublished studies, studies published in the gray literature and published studies
Number of participant in unpublished studies, in studies published in the gray literature and in published studies
Number of statistically significant positive or negative unpublished studies, studies published in the gray literature and published studies
Type of unpublished studies (for example, RCTs, observational studies), studies published in the gray literature (for example, abstracts, dissertation, letter, book chapters) and published studies (for example, RCTs, observational studies)
Year of publication of unpublished studies, studies published in the gray literature and published studies
Language and country of unpublished studies, studies published in the gray literature and published studies
Funding source of unpublished studies, studies published in the gray literature and published studies
Type of data source in which gray, unpublished and published studies were identified
Methodological quality (for example, blinding, follow-up time, sample size calculation) of unpublished studies, studies published in the gray literature and published studies (this aspect can only be evaluated if the methodological research project provides enough information)
We will systematically consider the validity and generalizability of the identified evidence provided by each of the methodological research projects by evaluating the following aspects:
Internal validity:
Role of confounding factors: The results of published studies may differ from those of unpublished studies because of factors other than publication status, such as study design, type of participants, characteristics of the intervention, and methodological quality; in this context, did the researcher of the meta-analyses select comparison groups that were matched (for example, did the unpublished studies or studies published in the gray literature share similar aims, designs, and sample sizes as the published ones)?; if not, were suitable adjustments for potentially confounding factors made?
Definition of publication status: Are explicit criteria given to categorize or define unpublished studies, studies published in the gray literature and published studies?
Selection process: Are search criteria given to identify unpublished studies, studies published in the gray literature and published studies?
External validity (generalizability):
Did the researcher of the methodological research project select a broad-ranging sample of meta-analyses that reflect the current literature in the field of interest (for example, in terms of size, diversity of topic)?
How was the sample determined (for example, random sample)?
Did two researchers carry out data extraction independently?
Did the researchers provide a complete dataset (regarding the characteristics of the methodological research project and included meta-analyses)?
The extent to which the effect estimate in a meta-analyses changes with the inclusion or exclusion of unpublished studies and gray literature ( quantitative measurement ). If possible, we will calculate a ratio of risks or odds ratios between the results of unpublished studies and studies published in the gray literature and the results of published studies and estimate the percentage change (pooled risk ratio from unpublished studies and gray literature divided by pooled risk ratio from published studies). A weighted pooled overall estimate will be calculated taking into account number of studies, participants and events.
The impact of the inclusion of unpublished studies or studies published in the gray literature on conclusions of meta-analyses (qualitative measurement). The impact will be estimated by calculating the proportion of meta-analyses which show a change in their conclusions according to publication status of the included studies; categorization will be as follows:
Change from negatively significant to positively significant
Change from inconclusive to positively significant
Change from positively significant to inconclusive
Change from negatively significant to inconclusive
Change from inconclusive to negatively significant
Change from positively significant to negatively significant
Change from not clinical relevant to clinical relevant
Change from not clinical relevant to inconclusive
Change from clinical relevant to inconclusive
Change from clinical relevant to not clinical relevant
Change from inconclusive to clinical relevant
Change from inconclusive to not clinical relevant
Significance and clinical relevance will be defined according to the definitions provided in the methodological research project.
The anticipated unit of analyses is the meta-analyses included in the methodological research project.
Heterogeneity for pooled outcome measures will be assessed by standard methods including Chi 2 -test and calculation of the I 2 value [ 9 ].
Funnel plots will be used to assess the association between point estimates of log odds ratio (a measure of extent of association between meta-analyses’ characteristics and change in summary estimates) and a measure of precision if more than ten methodological research projects provide necessary information. Funnel plots will be visually assessed and appropriate formal statistical tests following recommendations formulated by Sterne et al . will be used to test for asymmetry [ 5 ]. In the instance of suspected reporting bias authors will be contacted.
Data synthesis will involve a combination of descriptive and statistical summaries of the impact of the inclusion or exclusion of unpublished studies and gray literature on the results of meta-analyses (identified by methodological research projects).
The decision on whether or not to combine the results of the included methodological research projects will depend on the assessment of heterogeneity. Where methodological research projects will be judged to be sufficiently homogenous in their design a meta-analyses of these research projects will be carried out. The estimated ratios of unpublished and published in the gray literature only versus published treatment effects generated from each methodological evaluation will then be used to summarize the overall difference in risk ratios between unpublished and published in the gray literature only and published studies. The 95% confidence interval for the combined effect will be estimated using a random effects model.
The following subgroup analyses are planned:
On the level of the methodological research project
Number of meta-analyses included in the methodological research project
Number of participants included in the methodological research project
On the level of the meta-analyses
Number of studies (unpublished studies versus studies published in the gray literature versus both)
Number of participants included in studies (unpublished studies versus studies published in the gray literature versus both)
Design of studies (unpublished studies versus studies published in the gray literature versus both)
Source of database: gray literature (for example, conference abstracts or research letters) published in an easily accessible database versus unpublished studies for which immense efforts are required to be identified (for example, contact with pharmaceutical industry)
Type of research work (drug versus non-drug studies, clinical research versus basic research)
Area of health care
No sensitivity analyses are planned. However, should the instance arise where a methodological research project with doubtful eligibility is identified (as determined by individual review and analyses of the validity of the methodological research project), sensitivity analyses may be undertaken. Possible sensitivity analyses may be based on the following:
▪ Methodological quality/validity of the methodological research project; only methodological research projects with low risk of bias will be considered. A methodological research project will be of high risk of bias when the external validity and/or the validity of the included meta-analyses are doubtful.
This systematic review seeks to comprehensively synthesize the growing body of research that is related to the impact of including unpublished studies and studies published in the gray literature in meta-analyses. By considering multiple characteristics and potential confounders related to unpublished studies and studies published in the gray literature, we hope to identify sufficient evidence to conclude whether (or to what extent) inclusion of unpublished studies and studies published in the gray literature has an impact on the pooled effect estimates and the conclusions from a meta-analyses. The findings, including risk factors for unpublished studies and studies published in the gray literature, will have important implications for researchers conducting meta-analyses since they need to be informed about the impact and extent of (not) including unpublished and gray studies in meta-analyses. In addition, this systematic review in combination with the results of other systematic reviews that are part of the OPEN Project will serve to raise awareness about the impact of publication bias and the complexity of this issue. These reviews will also serve as a foundation for a recommendations workshop which will enable key members of the biomedical research community (for example, funders, research ethics committees, and journal editors) to develop future policies and guidelines to lessen the frequency of non-publication and related biases.
We acknowledge that more than half of all systematic reviews do not involve meta-analysis in their analyses. Despite the fact that our main outcomes focus on the impact of unpublished and gray studies on pooled effect estimates in meta-analyses, our findings will also be valuable for systematic reviews. It is obvious, if we find a statistical difference in the pooled effect estimates in meta-analyses, it is also likely that gray and unpublished literature impacts descriptive results of systematic reviews. Beside effect estimates, we will also evaluate differences in the methodological quality and study characteristics (such as number of participants, language or methodological quality) between unpublished, gray and published studies. These results will also be valuable for systematic reviews to appraise the potential impact of publication bias.
Line 10 to 14 and 16 to 35 are not shown because they are part of the search strategy for our 1 st systematic review [ 8 ] and, therefore, have no consequence for this search.
exp Publishing/sn
*publishing/
publication bias/
selection bias/
exp manuscripts as topic/
((data or finding? or information or evidence or study or studies or trial? or paper? or article? or report* or literature or work or manuscript? or abstract* or result?) adj6 (unpublish* or un-publish* or unreport* or un-report* or nonpublish* or non-publish* or nonpublicat* or non-publicat* or (publication? adj3 rate?) or "not publish*")).ti,ab.
(underreport* or under-report* or selective report* or selective publish* or selective publicat* or (final* adj2 (report* or publish* or publicat* or manuscript? or paper? or article?)) or (full? adj2 (report* or publish* or publicat* or manuscript? or paper? or article?)) or (subsequent* adj2 (report* or article? or paper? or publi* or manuscript?)) or (sub-sequent* adj2 (report? or article? or paper? or publi* or manuscript?)) or (complete* adj2 (report* or article? or paper? or publish* or publicat* or manuscript?))).ti,ab.
(bias* adj3 (publish* or publicat*)).ti,ab.
exp animals/ not humans/
meta-analysis as topic/
Guidelines as Topic/ or Practice Guidelines as Topic/
exp Clinical Trials as Topic/
meta-analysis.pt.
(guideline or practice guideline).pt.
(guideline? or metaanaly* or meta-analy* or metanaly* or meta-synthe* or metasynthe* or meta-regressi* or metaregressi*).ti,ab.
(systematic* adj3 (review* or overview*)).ti,ab.
exp Technology Assessment, Biomedical/
(health technology assessment? or HTA).ti,ab.
((implication? or impact? or influenc* or effect? or differen*) adj6 (publication bias* or unpublish* or un-publish* or unreport* or un-report* or nonpublish* or non-publish* or nonpublicat* or non-publicat* or "not publish*")).ti,ab.
((implication? or impact? or influenc* or effect? or differen*) adj6 (selective report* or selective publish* or selective publicat* or (final* adj2 (report* or publish* or publicat* or manuscript? or paper? or article?)) or (full? adj2 (report* or publish* or publicat* or manuscript? or paper? or article?)) or (subsequent* adj2 (report* or article? or paper? or publi* or manuscript?)) or (sub-sequent* adj2 (report? or article? or paper? or publi* or manuscript?)) or (complete* adj2 (report* or article? or paper? or publish* or publicat* or manuscript?)))).ti,ab.
((unpublish* or un-publish* or unreport* or un-report* or nonpublish* or non-publish* or nonpublicat* or non-publicat* or "not publish*") adj6 publish*).ti,ab.
(underreport* or under-report* or selective report* or selective publish* or selective publicat* or (final* and (report* or publish* or publicat* or manuscript? or paper? or article?)) or (full? and (report* or publish* or publicat* or manuscript? or paper? or article?)) or (subsequent* and (report* or article? or paper? or publi* or manuscript?)) or (sub-sequent* and (report? or article? or paper? or publi* or manuscript?)) or (complete* and (report* or article? or paper? or publish* or publicat* or manuscript?))).ti.
(unpublish* or un-publish* or unreport* or un-report* or nonpublish* or non-publish* or nonpublicat* or non-publicat* or "not publish*" or bias*).ti.
47 and (3 or 4)
47 and (36 or 37)
56 and (6 or 7)
*meta-analysis as topic/
*Guidelines as Topic/ or *Practice Guidelines as Topic/
47 and (58 or 59)
(6 or 7) and (3 or 8)
54 or 55 or 57 or 60 or 61
(unpublish* or un-publish* or unreport* or un-report* or nonpublish* or non-publish* or nonpublicat* or non-publicat* or "not publish*").ti,ab.
remove duplicates from 69
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We thank Patrick Oeller and Laura Cabrera for their input during development and piloting of our data extraction form.
The OPEN Project ( http://www.open-project.eu ) is funded by the European Union Seventh Framework Programme (FP7 - HEALTH.2011.4.1-2) under grant agreement n° 285453.
Authors and affiliations.
German Cochrane Center, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, 79110, Freiburg, Germany
Christine Schmucker, Annette Bluemle, Susan Portalupi, Britta Lang, Erik von Elm & Joerg J Meerpohl
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, 4031, Switzerland
Matthias Briel
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg, 79104, Germany
Edith Motschall & Guido Schwarzer
Centre for Paediatric Clinical Studies, University Medical Center Tuebingen, Tuebingen, 72070, Germany
Dirk Bassler & Katharina F Mueller
Cochrane Switzerland, IUMSP, University Hospital Lausanne, Lausanne, 1005, Switzerland
Erik von Elm
the OPEN Consortium, Germany
Christine Schmucker
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Correspondence to Joerg J Meerpohl .
Competing interests.
We declare that all authors and contributing members have no competing interests.
JM is the lead researcher of this project. JM and CS, along with EvE and SP, developed the methodologies of the systematic review protocol and led the writing of the protocol. EM designed the search strategy. DB, MB and GS contributed significantly to the writing and revision of the protocol. All authors critically revised the protocol and read and approved the final version.
Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Schmucker, C., Bluemle, A., Briel, M. et al. A protocol for a systematic review on the impact of unpublished studies and studies published in the gray literature in meta-analyses. Syst Rev 2 , 24 (2013). https://doi.org/10.1186/2046-4053-2-24
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Received : 23 January 2013
Accepted : 15 April 2013
Published : 02 May 2013
DOI : https://doi.org/10.1186/2046-4053-2-24
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Meta-analyses are particularly vulnerable to the effects of publication bias. Despite methodologists' best efforts to locate all evidence for a given topic the most comprehensive searches are likely to miss unpublished studies and studies that are published in the gray literature only. If the results of the missing studies differ systematically from the published ones, a meta-analysis will ...
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