Meta-analyses and systematic reviews can account for publication bias by including evidence from unpublished studies and the grey literature. The presence of publication bias can also be explored by constructing a funnel plot in which the estimate of the reported effect size is plotted against a measure of precision or sample size. The premise is that the scatter of points should reflect a funnel shape, indicating that the reporting of effect sizes is not related to their statistical significance. However, when small studies are predominately in one direction (usually the direction of larger effect sizes), asymmetry will ensue and this may be indicative of publication bias.