According to the MECIR conduct standards, item 41, it is now mandatory for authors to provide a PRISMA study flow diagram in their reviews. It is essential that you use a reference management software in the study selection process, which will help you record information for the below purposes. Please note that for new reviews you should combine all previous searches so that this reflects the culmination of the searching process. For updates where this may not be possible (due to lack of information on previous searches), you can do a diagram for the searches undertaken for the update in question. Further guidance is available on our website along with contact details for the editorial base team.MECIR conduct standardswebsite editorial base team CGNOC PRISMA Study Flow Diagram Advice Identification SEARCH PROCESS 1: Database searching, e.g. MEDLINE, EMBASE and CENTRAL SEARCH PROCESS 2: Additional resources This box corresponds with the methods section “Searching other resources”. You must search grey literature, international trial registers and reference lists, and contact individuals and organisations about any unpublished or ongoing studies. The relevant MECIR standards are points MECIR standards The CGNOC website has full guidance on the steps involved in the search identification process.CGNOC website If you have any doubts contact Jane Hayes. PRELIMARY SCREENING: no. of records screened after de-duplication Screening Records excluded: Records which don’t meet inclusion criteria details of which do not need to be recorded individually Remember all steps from here onwards should be done independently in duplicate. It is recommended that you use a predefined screening sheet for this phase. Amongst other things this will help determine the primary reason for exclusion. See Handbook Ch Handbook Eligibility Eligibility ELIGIBILITY: no. of full-text articles assessed This is the total number of articles that have been considered possible or in need of further scrutiny. At this point you should be applying your full inclusion criteria. Any studies identified as ongoing or awaiting classification should be noted Records excluded: Any excluded studies which the reader could plausibly expect to be included need to be listed under ‘Excluded Studies’. Only a small number of studies should fulfil this criteria. See section of the Handbook.Handbook MECIR, item 40MECIR, item 40, states that relevant studies must be included irrespective of whether data are reported in a ‘useable’ way; although they can’t be included in the MA, such studies can still be considered in the discussion. It is essential to bear this in mind when selecting studies. Included INCLUDED STUDIES: no. of studies included in qualitative analysis This is the total number of studies included irrespective of whether they provide data. MECIR, item 42MECIR, item 42, states that you should collate multiple reports of the same study, so that each study rather than each report is the unit of interest in the review. Cochrane Editorial Unit website provides practical guidance on this. Cochrane Editorial Unit website INCLUDED STUDIES: no. of studies included in meta-analysis This is the number of studies that provided useable data and so were included in meta-analysis Included The authors should inform CGNOC of any additional RCTs they found through searching additional databases or contacting trialists so these can be added to our databases. For more information on PRISMA please see: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement. PLoS Med 6(6): e doi: /journal.pmed For more information, visit This row should show how many included studies contributed to each comparison. If you have a large number of comparisons then contact the editorial base for advice on how best to present this. Comparison 4 Comparison 3Comparison 2Comparison 1

CGNOC PRISMA Study Flow Diagram Example Identification SEARCH PROCESS 1: MEDLINE – 150 refs EMBASE – 420 refs CENTRAL – 109 refs SEARCH PROCESS 2: International trial register – 6 refs PRELIMINARY SCREENING: no. of records screened after de-duplication 400 Screening Records excluded: 390 Records which don’t meet inclusion criteria details of which do not need to be recorded individually Eligibility Eligibility ELIGIBILITY: no. of full-text articles assessed 10 Records excluded: 7 Reasons for exclusion must be recorded under ‘Excluded Studies’ (e.g. not an RCT, on going studies, studies awaiting classification Included INCLUDED STUDIES: no. of studies included in qualitative analysis 3 INCLUDED STUDIES: no. of studies included in meta-analysis 3 Included SEARCH PROCESS 3: Personal communications – 1 ref Grey literature – 2 refs