From standard systematic reviews to living systematic reviews.

Systematic reviews (SRs) have become a central tool for evidence-based health care over the last 30 years. The number of SRs being published has increased steadily. However, concerns have been raised regarding the duplication of work, methodological flaws and the currency of many systematic reviews, also in the context of the COVID-19 pandemic. Living systematic reviews (LSRs) offer a new approach to updating systematic reviews, particularly in high-priority research fields that face the challenge of dynamically evolving and sometimes uncertain evidence. Continual updates serve to ensure that LSRs remain current and methodologically rigorous. As a new element of the evidence ecosystem, LSRs can inform living guidelines and recommendations, user-adapted formats, decisions at the patient and system level as well as gaps in primary research.

Awareness, value and use of the Australian living guidelines for the clinical care of people with COVID-19: an impact evaluation.

BACKGROUND AND OBJECTIVE: The Australian National COVID-19 Clinical Evidence Taskforce is developing living, evidence-based, national guidelines for treatment of people with COVID-19. These living guidelines are updated each week. We undertook an impact evaluation to understand the extent to which health professionals providing treatment to people with COVID 19 were aware of, valued and used the guidelines, and the factors that enabled or hampered this. METHODS: A mixed methods approach was used for the evaluation. Surveys were conducted to collect both quantitative and qualitative data and were supplemented with qualitative interviews. Australian healthcare practitioners potentially providing care to individuals with suspected or confirmed COVID-19 were invited to participate. Data were collected on guideline awareness, relevance, ease of use, trustworthiness, value, importance of updating, use, and strengths and opportunities for improvement. RESULTS: A total of 287 people completed the surveys and 10 interviews were conducted during November 2020. Awareness of the work of the Taskforce was high and the vast majority of respondents reported that the guidelines were very or extremely relevant, easy to use, trustworthy and valuable. More than 50% of respondents had used the guidelines to support their own clinical decision-making; and 30% were aware of other examples of the guidelines being used. Qualitative data revealed that amongst an overwhelming morass of evidence and opinions during the COVID-19 pandemic, the guidelines have been a reliable, united source of evidence-based advice; participants felt the guidelines built confidence and provided reassurance in clinical decision-making. Opportunities to improve awareness and accessibility to the guidelines were also explored. CONCLUSIONS: As of June 2021, the guidelines have been published and updated more than 40 times, include more than 140 recommendations and are being used to inform clinical decisions. The findings of this impact evaluation will be used to improve processes and outputs of the Taskforce and guidelines project, and to inform future living guideline projects.