This chapter covers methods for keeping abreast of the accumulating evidence to help a review team understand when a systematic review might need updating. This includes the processes that can be put into place to monitor relevant publications, and algorithms that have been proposed to determine whether or when it is appropriate to revisit the review to incorporate new findings. The chapter outlines a vision for regularly updated reviews, known as ‘living’ systematic reviews, which are continually updated, with new evidence being identified and incorporated as soon as it becomes available. It also addresses concerns about the regular repeating of statistical tests in meta-analyses as they are updated over time. Cochrane actively discourages use of the notion of statistical significance in favour of reporting estimates and confidence intervals. Nevertheless, sequential approaches are an established method in randomized trials, and may play a role in a prospectively planned series of trials in a prospective meta-analysis.
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