prisma-review-agent 0.2.3

PRISMA 2020 systematic literature review agent powered by Pydantic AI

PRISMA Agent — Pydantic AI Systematic Review

A standalone, agent-based systematic literature review tool following PRISMA 2020 guidelines. Built with pydantic-ai for structured LLM interactions and typed outputs via OpenRouter.

Architecture

prisma-review-agent/
├── models.py           # Pydantic v2 models (Article, Protocol, Evidence, GRADE, etc.)
├── clients.py          # HTTP clients: PubMed (NCBI E-utilities), bioRxiv, SQLite cache
├── agents.py           # 12 pydantic-ai agents with typed outputs + runner functions
├── evidence.py         # Evidence extraction + source grounding validation gate
├── validation.py       # Source grounding validator — rapidfuzz fuzzy matching
├── pipeline.py         # Async orchestrator — 16-step PRISMA pipeline with cache
├── export.py           # Export: Markdown, JSON, BibTeX, CSV formats
├── main.py             # Standalone CLI with argparse + interactive mode
└── prisma_review_agent/
    └── cache/          # PostgreSQL cache sub-package
        ├── models.py        # CacheEntry, SimilarityConfig, StoredArticle
        ├── similarity.py    # SHA-256 fingerprinting + weighted fuzzy scoring
        ├── store.py         # CacheStore — async PostgreSQL CRUD
        ├── article_store.py # ArticleStore — article persistence + full-text search
        ├── skill.py         # pydantic-ai CacheAgent with @agent.tool tools
        ├── admin.py         # list/inspect/clear cache entries
        └── migrations/001_initial.sql

Design Principles

• Agent-per-task: Each PRISMA step that requires LLM reasoning has a dedicated pydantic-ai Agent with a typed output_type. No raw string parsing — the LLM returns validated Pydantic models.
• No hardcoded heuristics: Evidence extraction, screening, bias assessment, and synthesis are all handled by specialized LLM agents. No keyword lists or regex scoring.
• Source grounding: Every extracted evidence span is verified against its source article using rapidfuzz fuzzy matching before being included. Ungrounded spans are silently dropped.
• Typed throughout: Every data structure is a Pydantic BaseModel with validation. Structured outputs from agents are parsed and validated automatically by pydantic-ai.
• PostgreSQL result cache: Reviews with ≥ 95% similar criteria are served from cache in seconds instead of minutes. All fetched articles are indexed for future source reuse.
• Async pipeline: The orchestrator uses asyncio for concurrent LLM calls (bias + GRADE + limitations run in parallel).
• Standalone: No web framework dependency. PostgreSQL is optional — the pipeline degrades gracefully without it.

Installation

From PyPI (recommended)

pip install prisma-review-agent

From source

git clone https://github.com/tekrajchhetri/prisma-review-agent.git
cd prisma-review-agent
python -m pip install uv
uv install

Quick Start

Set API Key

export OPENROUTER_API_KEY="sk-or-v1-..."

# Optional: higher PubMed rate limits (10 req/s vs 3 req/s)
export NCBI_API_KEY="your-ncbi-key"

Alternatively, pass the key inline with --api-key (takes precedence over the env var):

prisma-review --title "CRISPR gene therapy" --api-key "sk-or-v1-..."

CLI — installed package

After pip install prisma-review-agent the prisma-review command is available globally:

# Simple review
prisma-review \
  --title "CRISPR gene therapy efficacy" \
  --inclusion "Clinical trials, human subjects, English" \
  --exclusion "Animal-only studies, reviews, commentaries"

# Full PICO specification
prisma-review \
  --title "GLP-1 agonists for type 2 diabetes: a systematic review" \
  --objective "Evaluate efficacy of GLP-1 RAs vs placebo for glycemic control" \
  --population "Adults with type 2 diabetes mellitus" \
  --intervention "GLP-1 receptor agonists" \
  --comparison "Placebo or standard care" \
  --outcome "HbA1c reduction, weight change, adverse events" \
  --inclusion "RCTs, English, 2019-2024, peer-reviewed" \
  --exclusion "Case reports, editorials, conference abstracts" \
  --model "anthropic/claude-sonnet-4" \
  --max-results 30 \
  --hops 2 \
  --rob-tool "RoB 2" \
  --extract-data \
  --export md json bib

# Interactive mode
prisma-review --interactive

CLI — from source (without installing)

python main.py --title "..." --interactive

Plan Confirmation (CLI)

By default, the pipeline pauses after generating the search strategy, shows the plan, and waits for your input before fetching any articles.

# Default — prompts for confirmation when running in a terminal
prisma-review \
  --title "CRISPR gene therapy efficacy" \
  --inclusion "Clinical trials, human subjects" \
  --exclusion "Animal-only studies"

# Auto mode — no prompt (for scripts, CI, batch jobs)
prisma-review \
  --title "CRISPR gene therapy efficacy" \
  --auto \
  --export ttl jsonld

# Limit re-generation attempts to 2
prisma-review \
  --title "CRISPR gene therapy efficacy" \
  --max-plan-iterations 2

Confirmation prompt:

══════════════════════════════════════════════════
  Generated Search Plan (Iteration 1)
══════════════════════════════════════════════════
Research question: CRISPR gene therapy efficacy in clinical trials

PubMed queries (3):
  1. CRISPR gene therapy clinical trials efficacy
  2. CRISPR-Cas9 human trials outcomes
  3. gene editing therapy safety efficacy RCT

MeSH terms: CRISPR-Cas Systems, Gene Therapy, Clinical Trials as Topic
Rationale: Focused on clinical evidence to match inclusion criteria...
══════════════════════════════════════════════════
Confirm plan? [yes / no / <feedback>]:

• Press Enter or type yes → proceed to article retrieval
• Type no → halt with rejection message and exit 1
• Type feedback (e.g., "add pediatric studies") → plan is re-generated with your input

Python API

import asyncio
from pathlib import Path
from prisma_review_agent import (
    PRISMAReviewPipeline,
    ReviewProtocol,
    RoBTool,
    to_markdown,
    to_json,
)

protocol = ReviewProtocol(
    title="Gut microbiome and depression",
    objective="Examine the relationship between gut microbiota composition and depressive disorders",
    pico_population="Adults with major depressive disorder",
    pico_intervention="Gut microbiome profiling",
    pico_comparison="Healthy controls",
    pico_outcome="Microbiome diversity, specific taxa abundance",
    inclusion_criteria="Human studies, English, 2018-2024",
    exclusion_criteria="Animal studies, reviews, case reports",
    max_hops=10,
    rob_tool=RoBTool.NEWCASTLE_OTTAWA,

    # Domain-specific charting questions — answered per included article and stored
    # in DataChartingRubric.custom_fields (question text → extracted answer).
    # Leave out entirely to use only the built-in sections A–G.
    charting_questions=[
        "What sequencing method was used (16S rRNA, shotgun metagenomics, or other)?",
        "Which taxonomic level was the primary analysis performed at?",
        "What alpha-diversity indices were reported (Shannon, Simpson, Chao1, …)?",
        "Was the gut-brain axis or HPA axis explicitly discussed?",
        "Were dietary intake data collected and reported?",
    ],

    # Override the four default appraisal domain names for this review type.
    # Unspecified positions (here: 3 and 4) keep their defaults.
    appraisal_domains=[
        "Participant Recruitment and Microbiome Sampling Quality",
        "Sequencing and Bioinformatic Pipeline Quality",
    ],
)

async def run():
    pipeline = PRISMAReviewPipeline(
        api_key="sk-or-v1-...",
        model_name="anthropic/claude-sonnet-4",
        protocol=protocol,
        max_per_query=25,
        related_depth=1,
    )
    result = await pipeline.run()

    # Export
    Path("review.md").write_text(to_markdown(result))
    Path("review.json").write_text(to_json(result))

    # Access structured data
    print(f"Included: {result.flow.included_synthesis} studies")
    for article in result.included_articles:
        rob = article.risk_of_bias.overall.value if article.risk_of_bias else "?"
        print(f"  [{article.pmid}] {article.authors} ({article.year}) — RoB: {rob}")

    for span in result.evidence_spans[:5]:
        print(f"  Evidence [{span.paper_pmid}]: {span.text[:100]}...")

asyncio.run(run())

Python API — Plan Confirmation

Use the confirm_callback parameter to intercept the generated plan from any Python environment (scripts, Jupyter, web APIs) without any terminal dependency.

import asyncio
from prisma_review_agent.models import ReviewPlan, PlanRejectedError, MaxIterationsReachedError
from prisma_review_agent.pipeline import PRISMAReviewPipeline
from prisma_review_agent.models import ReviewProtocol

protocol = ReviewProtocol(
    title="CRISPR gene therapy efficacy",
    inclusion_criteria="Clinical trials, human subjects",
    exclusion_criteria="Animal-only studies",
)

def confirm(plan: ReviewPlan) -> bool | str:
    """Inspect the plan and return True, False, or feedback text."""
    print(f"Iteration {plan.iteration}: {len(plan.pubmed_queries)} PubMed queries")
    for q in plan.pubmed_queries:
        print(f"  - {q}")
    answer = input("Approve? [yes/no/feedback]: ").strip()
    if answer.lower() in ("yes", "y", ""):
        return True
    if answer.lower() in ("no", "abort"):
        return False
    return answer  # feedback string → triggers re-generation

async def main():
    pipeline = PRISMAReviewPipeline(
        api_key="sk-or-v1-...",
        model_name="anthropic/claude-sonnet-4",
        protocol=protocol,
    )
    try:
        result = await pipeline.run(
            confirm_callback=confirm,
            max_plan_iterations=3,
        )
        print(f"Review complete: {result.flow.included_synthesis} studies included")
    except PlanRejectedError as e:
        print(f"Stopped: {e}")
    except MaxIterationsReachedError as e:
        print(f"Too many iterations: {e}")

asyncio.run(main())

Auto mode — skip confirmation entirely:

# No confirmation prompts; runs end-to-end
result = await pipeline.run(auto_confirm=True)

Structured Report Output (result.prisma_review)

Every successful run with at least one included study produces a PrismaReview object on result.prisma_review. It is a complete, publication-ready PRISMA 2020 document with all major sections as typed Pydantic models.

import asyncio
from prisma_review_agent.models import ReviewProtocol
from prisma_review_agent.pipeline import PRISMAReviewPipeline

async def run():
    protocol = ReviewProtocol(
        title="Machine learning for ADHD diagnosis",
        objective="Evaluate ML classifiers for ADHD detection from EEG signals",
        inclusion_criteria="EEG studies, human subjects, ML classifier reported",
        exclusion_criteria="Animal studies, reviews without primary data",
    )
    pipeline = PRISMAReviewPipeline(
        api_key="sk-or-v1-...",
        protocol=protocol,
        enable_cache=False,
    )
    result = await pipeline.run(auto_confirm=True)

    review = result.prisma_review
    if review:
        # Access structured sections
        print(review.abstract.background)
        print(review.abstract.conclusion)
        print(f"{len(review.results.themes)} themes identified")
        for theme in review.results.themes:
            print(f"  - {theme.theme_name}: {', '.join(theme.key_findings[:2])}")
        print(review.conclusion.recommendations)

asyncio.run(run())

Per-study structured data:

review = result.prisma_review
if review and review.results.extracted_studies:
    for study in review.results.extracted_studies:
        print(f"[{study.metadata.source_id}] {study.metadata.title[:60]}")
        print(f"  Design: {study.design.study_design}")
        print(f"  Country: {study.design.country_or_region}")
        print(f"  Year: {study.metadata.year}")

Configurable rendering format:

Pass output_synthesis_style to control how results are rendered. Default is "paragraph"; also supports "question_answer", "bullet_list", "table".

result = await pipeline.run(
    auto_confirm=True,
    output_synthesis_style="question_answer",
)
review = result.prisma_review
for qa in (review.results.question_answer_summary or []):
    print(f"Q: {qa.question}")
    print(f"A: {qa.answer}\n")

Backward compatibility: All existing flat fields (result.synthesis_text, result.structured_abstract, result.introduction_text, result.conclusions_text) are automatically backfilled from the structured report and continue to work unchanged.

Per-Rubric Section Output Formats

Configure how each data charting section (A–G + custom) renders its answer. Five format types are supported: descriptive (default), yes_no, table, bullet_list, numeric. For table, bullet_list, and numeric sections a prose summary is also generated automatically.

Simple API — section_output_formats dict:

from prisma_review_agent.models import ReviewProtocol

protocol = ReviewProtocol(
    title="Digital biomarkers for Parkinson's disease",
    objective="Identify ML-based biomarkers from wearable sensor data",
    inclusion_criteria="Wearable sensor studies, PD patients, ML classifier",
    exclusion_criteria="Non-PD populations, no ML methods",
    section_output_formats={
        "Study Design":                  "table",
        "Participants: Disordered Group": "yes_no",
        "Features and Models":           "bullet_list",
        "Data Collection":               "table",
    },
)
result = await pipeline.run(auto_confirm=True)

# Access structured section outputs per study
for rubric in result.data_charting_rubrics:
    for section_title, out in rubric.section_outputs.items():
        print(f"[{rubric.source_id}] {section_title} ({out.format_used})")
        print(out.formatted_answer)
        if out.section_summary:
            print(f"  Summary: {out.section_summary}")

Full config API — custom titles, ordering, and formats:

from prisma_review_agent.models import ReviewProtocol, RubricSectionConfig

protocol = ReviewProtocol(
    title="Emotion recognition from physiological signals",
    objective="...",
    inclusion_criteria="...",
    exclusion_criteria="...",
    rubric_section_config=[
        RubricSectionConfig(section_key="F", section_name="ML Models & Performance", order=1, output_format="table"),
        RubricSectionConfig(section_key="B", section_name="Study Design",            order=2, output_format="table"),
        RubricSectionConfig(section_key="C", section_name="Patient Cohort",          order=3, output_format="yes_no"),
        RubricSectionConfig(section_key="G", section_name="Key Findings",            order=4, output_format="bullet_list"),
    ],
)

Export per-rubric outputs:

from prisma_review_agent.export import to_rubric_markdown, to_rubric_json

# Markdown: one heading per study, one sub-heading per section
Path("rubric_extraction.md").write_text(to_rubric_markdown(result))

# JSON: list of {source_id, title, sections: {title: {format_used, formatted_answer, section_summary}}}
Path("rubric_extraction.json").write_text(to_rubric_json(result))

The combined per-study outputs are also available on result.prisma_review.methods.data_extraction (one StudyDataExtractionReport per included study, sections in configured order).

Validation: Invalid format values raise ValueError at ReviewProtocol construction time. Unknown section names in section_output_formats log a UserWarning and are ignored. If the LLM cannot produce the requested format for a section it falls back to descriptive and logs a warning — formatted_answer is never empty.

confirm_callback return value semantics:

Return value	Meaning	Pipeline action
True	Plan approved	Continue to article retrieval
False	Plan rejected	Raise PlanRejectedError
"" (empty string)	Treated as approval	Continue to article retrieval
"<feedback text>"	Re-generate with feedback	Call agent again with feedback; increment iteration

FastAPI Integration

The pipeline's confirm_callback and progress_callback hooks make it straightforward to build a live UI on top of FastAPI. The pattern uses asyncio.Event to bridge the synchronous callback with an async HTTP round-trip, and Server-Sent Events (SSE) for real-time progress streaming.

Pattern 1 — Plan confirmation with polling

import asyncio
import uuid
from fastapi import FastAPI, HTTPException
from pydantic import BaseModel as PydanticBase
from prisma_review_agent.models import (
    ReviewPlan, ReviewProtocol, PlanRejectedError, MaxIterationsReachedError,
    RubricSectionConfig,
)
from prisma_review_agent.pipeline import PRISMAReviewPipeline

app = FastAPI()

# In-memory session store — use Redis or a DB in production
_sessions: dict[str, dict] = {}


class ReviewRequest(PydanticBase):
    title: str
    inclusion: str = ""
    exclusion: str = ""
    section_output_formats: dict[str, str] = {}     # optional per-section formats
    rubric_section_config: list[dict] = []          # optional full config


class ConfirmRequest(PydanticBase):
    session_id: str
    response: str   # "yes" | "no" | feedback text


@app.post("/review/start")
async def start_review(req: ReviewRequest):
    session_id = str(uuid.uuid4())
    confirm_event: asyncio.Event = asyncio.Event()
    session: dict = {
        "confirm_event": confirm_event,
        "confirm_response": None,
        "plan": None,
        "progress": [],
        "status": "starting",
        "result": None,
    }
    _sessions[session_id] = session

    rubric_cfg = [RubricSectionConfig(**c) for c in req.rubric_section_config]
    protocol = ReviewProtocol(
        title=req.title,
        inclusion_criteria=req.inclusion,
        exclusion_criteria=req.exclusion,
        section_output_formats=req.section_output_formats,
        rubric_section_config=rubric_cfg,
    )
    pipeline = PRISMAReviewPipeline(
        api_key="sk-or-v1-...",
        model_name="anthropic/claude-sonnet-4",
        protocol=protocol,
    )

    def confirm_callback(plan: ReviewPlan) -> bool | str:
        """Called by the pipeline when a plan is ready — blocks until UI responds."""
        session["plan"] = plan.model_dump()
        session["status"] = "awaiting_confirmation"
        confirm_event.clear()
        # Run the event wait in the event loop — pipeline resumes when /confirm fires
        asyncio.get_event_loop().run_until_complete(confirm_event.wait())
        return session["confirm_response"]

    def progress_callback(message: str) -> None:
        session["progress"].append(message)
        session["status"] = "running"

    asyncio.create_task(_run_pipeline(pipeline, session, confirm_callback, progress_callback))
    return {"session_id": session_id, "status": "starting"}


async def _run_pipeline(pipeline, session, confirm_cb, progress_cb):
    try:
        result = await pipeline.run(
            confirm_callback=confirm_cb,
            progress_callback=progress_cb,
        )
        session["result"] = result.model_dump(mode="json")
        session["status"] = "complete"
    except PlanRejectedError:
        session["status"] = "rejected"
    except MaxIterationsReachedError as e:
        session["status"] = f"max_iterations: {e}"
    except Exception as e:
        session["status"] = f"error: {e}"


@app.get("/review/{session_id}/plan")
async def get_plan(session_id: str):
    """Poll until plan is ready (status = 'awaiting_confirmation'), then show it in the UI."""
    session = _sessions.get(session_id)
    if not session:
        raise HTTPException(404, "Session not found")
    if session["status"] == "awaiting_confirmation" and session["plan"]:
        return {"status": "awaiting_confirmation", "plan": session["plan"]}
    return {"status": session["status"]}


@app.post("/review/confirm")
async def confirm_plan(req: ConfirmRequest):
    """POST the user's decision here — pipeline unblocks and continues."""
    session = _sessions.get(req.session_id)
    if not session:
        raise HTTPException(404, "Session not found")
    response = req.response.strip()
    if response.lower() in ("yes", "y", ""):
        session["confirm_response"] = True
    elif response.lower() in ("no", "abort"):
        session["confirm_response"] = False
    else:
        session["confirm_response"] = response  # feedback → plan re-generation
    session["confirm_event"].set()
    return {"status": "acknowledged"}


@app.get("/review/{session_id}/status")
async def get_status(session_id: str):
    session = _sessions.get(session_id)
    if not session:
        raise HTTPException(404, "Session not found")
    return {
        "status": session["status"],
        "progress": session["progress"],
        "result": session["result"],
    }

Pattern 2 — Real-time progress with Server-Sent Events (SSE)

For a live progress feed (like a terminal-style log in the UI), replace polling with SSE:

import asyncio
from fastapi import FastAPI
from fastapi.responses import StreamingResponse

app = FastAPI()

@app.get("/review/{session_id}/stream")
async def stream_progress(session_id: str):
    """Stream pipeline progress events as SSE to the browser."""
    session = _sessions.get(session_id)
    if not session:
        return StreamingResponse(iter([]), media_type="text/event-stream")

    last_idx = 0

    async def event_generator():
        nonlocal last_idx
        while True:
            messages = session["progress"]
            if len(messages) > last_idx:
                for msg in messages[last_idx:]:
                    yield f"data: {msg}\n\n"
                last_idx = len(messages)
            if session["status"] in ("complete", "rejected", "error") or \
               session["status"].startswith("error") or \
               session["status"].startswith("max_iterations"):
                yield f"data: [DONE] {session['status']}\n\n"
                break
            if session["status"] == "awaiting_confirmation":
                yield f"event: plan_ready\ndata: awaiting_confirmation\n\n"
            await asyncio.sleep(0.5)

    return StreamingResponse(event_generator(), media_type="text/event-stream")

Note: The in-memory _sessions dict works for single-process development. In production, use Redis pub/sub (for SSE fan-out) and store session state in a persistent store. The asyncio.get_event_loop().run_until_complete(event.wait()) call in confirm_callback works in a single-threaded asyncio loop; if the pipeline runs in a thread pool, use loop.call_soon_threadsafe(event.set) instead.

Suggested UI for the Plan Confirmation Phase

Inspired by research review tools (see design reference in the project), the plan confirmation screen should feel like a structured "contract" the user approves before the pipeline does any expensive work. Suggested layout (following the KSynth-style design):

┌─────────────────────────────────────────────────────────────────┐
│  ← New PRISMA Review                              [Protocol tab selected]
│                                                                 │
│  Protocol │ Progress │ Synthesis │ PRISMA Flow │ … │ Export    │
├─────────────────────────────────────────────────────────────────┤
│                                                                 │
│  ┌──── Generated Search Plan — Iteration 1 ──────────────────┐ │
│  │                                                            │ │
│  │  Research Question                                         │ │
│  │  "CRISPR gene therapy efficacy in clinical trials"        │ │
│  │                                                            │ │
│  │  PubMed Queries (3)                          [Edit ✎]     │ │
│  │  ┌────────────────────────────────────────────────────┐   │ │
│  │  │ 1. CRISPR gene therapy clinical trials efficacy    │   │ │
│  │  │ 2. CRISPR-Cas9 human trials outcomes               │   │ │
│  │  │ 3. gene editing therapy safety efficacy RCT        │   │ │
│  │  └────────────────────────────────────────────────────┘   │ │
│  │                                                            │ │
│  │  bioRxiv Queries (2)                         [Edit ✎]     │ │
│  │  ┌────────────────────────────────────────────────────┐   │ │
│  │  │ 1. CRISPR Cas9 gene editing safety                 │   │ │
│  │  │ 2. CRISPR therapy clinical outcomes preprint       │   │ │
│  │  └────────────────────────────────────────────────────┘   │ │
│  │                                                            │ │
│  │  MeSH Terms                                               │ │
│  │  [CRISPR-Cas Systems] [Gene Therapy] [Clinical Trials]   │ │
│  │                                                            │ │
│  │  Key Concepts                                             │ │
│  │  [efficacy] [safety] [clinical trial] [gene editing]     │ │
│  │                                                            │ │
│  │  Rationale                                                │ │
│  │  "Focused on clinical evidence matching inclusion         │ │
│  │   criteria for human trial results…"                      │ │
│  │                                                            │ │
│  │  ┌──── Feedback (optional) ──────────────────────────┐   │ │
│  │  │ Add pediatric studies, extend date range…         │   │ │
│  │  └───────────────────────────────────────────────────┘   │ │
│  └────────────────────────────────────────────────────────────┘ │
│                                                                 │
│  [✗ Reject]                    [↻ Regenerate]   [✓ Approve →] │
└─────────────────────────────────────────────────────────────────┘

Key UX decisions:

• Plan appears inline in the "Progress" tab (not a modal) — so the user can scroll up to review the protocol they entered before approving
• Queries are editable before approval — send edited queries back as feedback text via confirm_callback
• MeSH terms and key concepts render as pill badges (matching the "Charting Questions" style from the screenshot)
• Feedback textarea is pre-populated with "" and only sent if non-empty; empty submit = "yes"
• Reject posts response: "no" and redirects to the project list
• Regenerate posts the feedback text; the plan card replaces itself with the new iteration
• Approve posts response: "yes" and transitions the Progress tab to the live SSE log view

Progress tab after approval (SSE stream view):

┌─────────────────────────────────────────────────────────────────┐
│  Running · 0 included                           [Cancel]        │
├─────────────────────────────────────────────────────────────────┤
│  ✓ Plan approved (Iteration 1)                                  │
│  ✓ Searching PubMed: 3 queries…                                 │
│  ✓ 47 records retrieved                                         │
│  ✓ Deduplication: 6 duplicates removed                          │
│  ⟳ Screening title/abstract: 41 records…          [||||     ]  │
│    · [PMID:33283989] ✓ Include — "CRISPR-Cas9 for SCD…"        │
│    · [PMID:38661449] ✓ Include — "Exagamglogene Autotemcel…"   │
│    · [PMID:29301234] ✗ Exclude — "Animal model only"           │
└─────────────────────────────────────────────────────────────────┘

This mirrors the "Running · 0 included" sidebar state in the KSynth screenshot and the evidence card grid in the Evidence tab.

Enhanced Output Formats

The PRISMA Agent now includes comprehensive structured outputs for systematic review documentation:

Data Charting Rubric (CSV)

Structured extraction of study characteristics across 7 sections (A-G):

• Section A: Publication Information (title, authors, year, journal, DOI, database)
• Section B: Study Design (goals, design type, sample size, tasks, settings)
• Section C: Disordered Group Participants (diagnosis, assessment, demographics)
• Section D: Healthy Controls (inclusion, matching criteria)
• Section E: Data Collection (data types, tasks, equipment, datasets)
• Section F: Features & Models (feature types, algorithms, performance metrics)
• Section G: Synthesis (key findings, limitations, future directions)

PRISMA Narrative Rows (CSV)

Condensed 6-cell summary format derived from charting data:

• Study design/sample/dataset
• Methods (feature extraction, modeling, validation)
• Outcomes (key performance results + findings)
• Key limitations
• Relevance notes
• Review-specific questions

Critical Appraisal Rubric (CSV)

Quality assessment across 4 domains:

• Domain 1: Participant & Sample Quality (5 items)
• Domain 2: Data Collection Quality (3 items)
• Domain 3: Feature & Model Quality (5 items)
• Domain 4: Bias & Transparency (4 items)

Each domain includes item-level ratings (Yes/Partial/No/Not Reported/N/A) and overall concern (Low/Some/High).

Enhanced Markdown

Professional systematic literature review brief with HTML styling, figures, and comprehensive documentation including:

• Executive Summary with key findings and statistics
• Background & Rationale with PICO framework
• Detailed Methods with eligibility criteria tables and search strategies
• Comprehensive Results with PRISMA flow diagrams, study characteristics, and visual data representations
• Discussion with implications for practice and research
• Conclusions with key takeaways
• References in academic format
• Detailed Appendices with data charting rubrics, critical appraisal results, and evidence spans

The enhanced format produces publication-ready SLR briefs with professional styling, color-coded sections, and visual elements suitable for stakeholder presentations and academic publications.

Export Options

# Default enhanced format
prisma-review --title "..." --export enhanced_md

# All structured formats
prisma-review --title "..." --export enhanced_md charting_csv narrative_csv appraisal_csv

# Individual formats
prisma-review --title "..." --export charting narrative appraisal json

# RDF / Linked Data formats
prisma-review --title "..." --export ttl           # Turtle RDF
prisma-review --title "..." --export jsonld        # JSON-LD
prisma-review --title "..." --export ttl jsonld md # all three together

# Persist a queryable pyoxigraph store
prisma-review --title "..." --export ttl --rdf-store-path review.ttl

RDF / Linked Data Export

Export results as RDF using the SLR Ontology (v0.2.0). The Turtle and JSON-LD files are self-contained linked-data documents that can be loaded into any SPARQL endpoint (Apache Jena, Oxigraph, Blazegraph, etc.) or processed with standard RDF tools.

Namespace prefixes used:

Prefix	URI
slr:	https://w3id.org/slr-ontology/
prov:	http://www.w3.org/ns/prov#
dcterms:	http://purl.org/dc/terms/
fabio:	http://purl.org/spar/fabio/
bibo:	http://purl.org/ontology/bibo/
oa:	http://www.w3.org/ns/oa#
xsd:	http://www.w3.org/2001/XMLSchema#

Python API:

from prisma_review_agent.export import to_turtle, to_jsonld

turtle_str = to_turtle(result)
jsonld_str = to_jsonld(result)

Pyoxigraph SPARQL Store

For in-process SPARQL queries, load the result directly into a pyoxigraph store:

from prisma_review_agent.export import to_oxigraph_store

store = to_oxigraph_store(result)

# Find all included sources
rows = store.query("""
    PREFIX slr: <https://w3id.org/slr-ontology/>
    PREFIX dcterms: <http://purl.org/dc/terms/>
    SELECT ?src ?title WHERE {
        ?src a slr:IncludedSource ;
             dcterms:title ?title .
    }
""")

# Check provenance timestamp
rows = store.query("""
    PREFIX prov: <http://www.w3.org/ns/prov#>
    SELECT ?review ?t WHERE { ?review prov:generatedAtTime ?t }
""")

# Save store to disk for later re-use
store.save("review_store.ttl")

Or from the CLI — pass --rdf-store-path to write the store after export:

prisma-review --title "..." --export ttl --rdf-store-path review_store.ttl

Note: The system processes ALL studies that pass screening criteria through complete data charting and critical appraisal. There are no artificial limits on corpus size — from small pilot reviews (5-10 studies) to comprehensive systematic reviews (50+ studies).

Pipeline Steps (17-step Enhanced PRISMA)

Step	Agent	Output Type	Description
1. Search Strategy	search_strategy_agent	SearchStrategy	Generates PubMed + bioRxiv queries from protocol
2. PubMed Search	— (HTTP)	list[Article]	E-utilities esearch + efetch
3. bioRxiv Search	— (HTTP)	list[Article]	bioRxiv API keyword matching
4. Related Articles	— (HTTP)	list[str]	elink neighbor_score
5. Citation Hops	— (HTTP)	list[Article]	Forward (cited-by) + backward navigation
6. Deduplication	— (logic)	list[Article]	DOI/PMID dedup
7. Title/Abstract Screening	screening_agent	ScreeningBatchResult	LLM batch screening (inclusive)
8. Full-text Retrieval	— (HTTP)	dict[str, str]	PMC efetch
9. Full-text Screening	screening_agent	ScreeningBatchResult	LLM batch screening (strict)
10. Evidence Extraction	evidence_extraction_agent	BatchEvidenceExtraction	LLM identifies claims + evidence spans
11. Data Extraction	data_extraction_agent	StudyDataExtraction	Per-study structured data
12. Risk of Bias	rob_agent	RiskOfBiasResult	Per-study RoB 2 / ROBINS-I / NOS
13. Data Charting	data_charting_agent	DataChartingRubric	Structured charting across 7 sections (A-G)
14. Critical Appraisal	critical_appraisal_agent	CriticalAppraisalRubric	Quality assessment across 4 domains
15. Narrative Rows	narrative_row_agent	PRISMANarrativeRow	Condensed 6-cell summary format
16. Synthesis	synthesis_agent	str	Grounded narrative with PMID citations
17. Bias + GRADE	bias_summary_agent + grade_agent	str + GRADEAssessment	Parallel assessment
18. Limitations	limitations_agent	str	Review limitations section

Agents Reference

Agent Architecture

Each agent is defined as a module-level pydantic_ai.Agent with:

• Typed output: Pydantic model that the LLM must conform to
• System prompt: Static instructions + dynamic context from RunContext[AgentDeps]
• Deferred model: defer_model_check=True — model is provided at runtime via build_model()
• Dependencies: AgentDeps dataclass carrying protocol + API credentials

from agents import AgentDeps, build_model, rob_agent
from models import ReviewProtocol

deps = AgentDeps(
    protocol=ReviewProtocol(title="..."),
    api_key="sk-or-v1-...",
    model_name="anthropic/claude-sonnet-4",
)
model = build_model(deps.api_key, deps.model_name)

# Run directly
result = await rob_agent.run(
    "Title: ...\nAbstract: ...",
    deps=deps,
    model=model,
)
rob: RiskOfBiasResult = result.output
print(rob.overall)  # RoBJudgment.LOW

Selecting a Model

Pass any OpenRouter model ID via --model on the CLI or the model_name argument in Python.

CLI

# Claude Sonnet 4 (default)
prisma-review --title "..." --model anthropic/claude-sonnet-4

# Gemini 2.5 Pro
prisma-review --title "..." --model google/gemini-2.5-pro

# GPT-4o
prisma-review --title "..." --model openai/gpt-4o

# DeepSeek (cost-effective)
prisma-review --title "..." --model deepseek/deepseek-chat

Python API

pipeline = PRISMAReviewPipeline(
    api_key="sk-or-v1-...",
    model_name="google/gemini-2.5-pro",   # ← change here
    protocol=protocol,
)

Interactive mode — prompts you to type a model name at startup:

prisma-review --interactive
# Enter model ID when prompted, or press Enter for the default

Supported Models (via OpenRouter)

Any model available on OpenRouter works. Tested with:

Model	ID	Notes
Claude Sonnet 4	anthropic/claude-sonnet-4	Best balance of quality/speed
Claude Haiku 4	anthropic/claude-haiku-4	Faster, good for screening
Gemini 2.5 Pro	google/gemini-2.5-pro	Good structured output
GPT-4o	openai/gpt-4o	Strong general performance
DeepSeek Chat	deepseek/deepseek-chat	Cost-effective
Llama 3.1 70B	meta-llama/llama-3.1-70b-instruct	Open-source option

Data Models

Core Models

Model	Purpose
Article	Research article with metadata, full text, RoB, extracted data
EvidenceSpan	Single evidence sentence with source, claim label, relevance score
ReviewProtocol	Full PRISMA protocol: PICO, criteria, databases, registration
PRISMAFlowCounts	PRISMA flow diagram counts for all stages
PRISMAReviewResult	Complete review result with all outputs

LLM Output Models

Model	Used By	Description
SearchStrategy	search_strategy_agent	PubMed/bioRxiv queries, MeSH terms
ScreeningBatchResult	screening_agent	Batch of include/exclude decisions
RiskOfBiasResult	rob_agent	Per-domain RoB with overall judgment
StudyDataExtraction	data_extraction_agent	Study design, findings, effect measures
GRADEAssessment	grade_agent	GRADE domains + overall certainty
BatchEvidenceExtraction	evidence_extraction_agent	Evidence spans per article

Export Formats

Markdown

Full PRISMA 2020 structured report with:

• Abstract, Introduction (rationale + PICO), Methods (criteria, search strategy, selection, RoB)
• Results (flow table, study characteristics, synthesis, RoB, GRADE)
• Discussion (limitations), Other Information (registration, funding)
• References, Appendix (evidence spans)

JSON

Complete PRISMAReviewResult serialized via model_dump_json().

BibTeX

Standard @article{} entries for all included studies.

Caching

HTTP Cache (SQLite)

SQLite cache (prisma_agent_cache.db) stores raw HTTP responses with a 72-hour TTL:

• PubMed search results
• Article metadata and full text
• Related article links
• bioRxiv search results

Disable with --no-cache or enable_cache=False.

Review Result Cache (PostgreSQL)

When --pg-dsn is provided, completed review results are cached in PostgreSQL. On subsequent runs with ≥ 95% similar criteria (configurable), the full result is served from cache in seconds rather than minutes.

# Run with PostgreSQL cache
prisma-review \
  --title "GLP-1 agonists for type 2 diabetes" \
  --inclusion "RCTs, English, 2019-2024" \
  --pg-dsn "postgresql://user:pass@localhost/prisma_db" \
  --cache-threshold 0.95 \
  --export md

# Force a fresh run (bypass cache)
prisma-review --title "..." --pg-dsn "..." --force-refresh

Setup — run the migration once before first use:

psql "$PRISMA_PG_DSN" -f prisma_review_agent/cache/migrations/001_initial.sql

Or set the DSN via environment variable:

export PRISMA_PG_DSN="postgresql://user:pass@localhost/prisma_db"
prisma-review --title "..."

The Markdown export includes a cache banner when a result is served from cache:

⚡ Served from cache (similarity 97.3%) — matched: *GLP-1 agonists for type 2 diabetes*

Article Store (PostgreSQL)

All fetched articles are persisted to the article_store table (same PostgreSQL connection). Full-text content is indexed with a GIN/tsvector index for fast retrieval. On subsequent runs, stored full text is used as the primary source before falling back to live PubMed fetch — reducing API calls and improving reproducibility.

CLI Reference

prisma-review [OPTIONS]

Protocol:
  --title, -t          Review title / research question
  --objective          Detailed objective
  --population         PICO: Population
  --intervention       PICO: Intervention
  --comparison         PICO: Comparison
  --outcome            PICO: Outcome
  --inclusion          Inclusion criteria
  --exclusion          Exclusion criteria
  --registration       PROSPERO registration number

Search:
  --model, -m          OpenRouter model (default: anthropic/claude-sonnet-4)
  --databases          Databases to search (default: PubMed bioRxiv)
  --max-results        Max results per query (default: 20)
  --related-depth      Related article depth (default: 1)
  --hops               Citation hop depth 0-4 (default: 1)
  --biorxiv-days       bioRxiv lookback days (default: 180)
  --date-start         Start date YYYY-MM-DD
  --date-end           End date YYYY-MM-DD
  --rob-tool           RoB 2 | ROBINS-I | Newcastle-Ottawa Scale

Pipeline:
  --no-cache           Disable SQLite cache
  --extract-data       Enable per-study data extraction
  --auto               Skip plan confirmation; run end-to-end without prompts
  --max-plan-iterations  Max plan re-generation attempts before aborting (default: 3)

Cache (PostgreSQL):
  --pg-dsn             PostgreSQL DSN (or set PRISMA_PG_DSN env var)
  --force-refresh      Bypass cache and run fresh pipeline
  --cache-threshold    Similarity threshold for cache hit (default: 0.95)
  --cache-ttl-days     Cache entry TTL in days; 0=never expire (default: 30)

Output:
  --export, -e         Export formats: md json bib ttl jsonld (default: md)
  --rdf-store-path     Save pyoxigraph RDF store to this Turtle file path
  --interactive, -i    Interactive protocol setup

Extending

Add a New Agent

1. Define the output model in models.py:

class MyOutput(BaseModel):
    field: str
    score: float

2. Create the agent in agents.py:

my_agent = Agent(
    output_type=MyOutput,
    deps_type=AgentDeps,
    system_prompt="...",
    defer_model_check=True,
    name="my_agent",
)

async def run_my_agent(data: str, deps: AgentDeps) -> MyOutput:
    model = build_model(deps.api_key, deps.model_name)
    result = await my_agent.run(data, deps=deps, model=model)
    return result.output

3. Integrate into pipeline.py.

Add a New Data Source

1. Create a client class in clients.py following the PubMedClient pattern.
2. Add it to PRISMAReviewPipeline.__init__().
3. Add a search step in pipeline.py.

Dependencies

Package	Version	Purpose
pydantic-ai	>=1.0	Agent framework with typed outputs
pydantic	>=2.0	Data validation and serialization
httpx	>=0.25	Async-capable HTTP client
psycopg[async]	>=3.1	Async PostgreSQL driver (optional)
psycopg-pool	>=3.1	Async connection pooling (optional)
rapidfuzz	>=3.0	Fuzzy string matching for cache similarity + source grounding
rdflib	>=6.0	RDF graph construction and Turtle / JSON-LD serialization
pyoxigraph	>=0.3	Fast in-process SPARQL store for queryable RDF output

License

Apache 2.0 — see LICENSE.