Are COVID-19 systematic reviews up to date and can we tell? A cross-sectional study.

BACKGROUND: COVID-19 led to a rapid acceleration in the number of systematic reviews. Readers need to know how up to date evidence is when selecting reviews to inform decisions. This cross-sectional study aimed to evaluate how easily the currency of COVID-19 systematic reviews published early in the pandemic could be determined and how up to date these reviews were at the time of publication. METHODS: We searched for systematic reviews and meta-analyses relevant to COVID-19 added to PubMed in July 2020 and January 2021, including any that were first published as preprints. We extracted data on the date of search, number of included studies, and date first published online. For the search date, we noted the format of the date and where in the review this was reported. A sample of non-COVID-19 systematic reviews from November 2020 served as a comparator. RESULTS: We identified 246 systematic reviews on COVID-19. In the abstract of these reviews, just over half (57%) reported the search date (day/month/year or month/year) while 43% failed to report any date. When the full text was considered, the search date was missing from 6% of reviews. The median time from last search to publication online was 91 days (IQR 63-130). Time from search to publication was similar for the subset of 15 rapid or living reviews (92 days) but shorter for the 29 reviews published as preprints (37 days). The median number of studies or publications included per review was 23 (IQR 12-40). In the sample of 290 non-COVID SRs, around two-thirds (65%) reported the search date while a third (34%) did not include any date in the abstract. The median time from search to publication online was 253 days (IQR 153-381) and each review included a median of 12 studies (IQR 8-21). CONCLUSIONS: Despite the context of the pandemic and the need to easily ascertain the currency of systematic reviews, reporting of the search date information for COVID-19 reviews was inadequate. Adherence to reporting guidelines would improve the transparency and usefulness of systematic reviews to users.

Weekly updating of guideline recommendations was feasible: the Australian National COVID-19 clinical evidence Taskforce.

OBJECTIVES: To investigate how quickly evidence was incorporated into the Australian living guidelines for COVID-19 during the first 12 months of the pandemic. STUDY DESIGN AND SETTING: For each study concerning drug therapies included in the guideline from April 3, 2020 to April 1, 2021, we extracted the publication date of the study, and the guideline version the study was included in. We analyzed two subgroups of studies as follows: those published in high impact factor journals and those with 100 or more participants. RESULTS: In the first year, we published 37 major versions of the guidelines, incorporating 129 studies that investigated 48 drug therapies informing 115 recommendations. The median time from first publication of a study to incorporation in the guideline was 27 days (interquartile range [IQR], 16 to 44), ranging from 9 to 234 days. For the 53 studies in the highest impact factor journals, the median was 20 days (IQR 15 to 30), and for the 71 studies with 100 or more participants the median was 22 days (IQR 15 to 36). CONCLUSION: Developing and sustaining living guidelines where evidence is rapidly incorporated is a resource- and time-intensive undertaking; however, this study demonstrates that it is feasible, even over a long period.

Organisational responses to mitigate the effects of COVID-19 on healthcare workers: a qualitative case study from Bogotá, Colombia.

BACKGROUND: Healthcare organisations have undergone organisational change to respond to COVID-19. This pandemic has presented challenges for employee adjustment, with impacts on the availability and coordination of human resources in healthcare. This study aimed to characterise the organisational actions regarding the coordination of human resources in healthcare within Bogotá, Colombia, to respond to the COVID-19 pandemic. METHODS: We followed a case study approach to understand the response to the emergency taking into account the narratives of managerial actors who have been directly involved in the planning of guidelines oriented to face the pandemic or in the implementation of health services for COVID-19. Twenty-two interviews with multiple health system organisations within Bogotá were conducted between May and September 2020 and analysed thematically. RESULTS: Three themes emerged from the analysis of the interview data: to retain human resources, to implement actions to improve the mental and physical health of the healthcare workers, and to enhance healthcare workers knowledge, skills and availability to respond to COVID-19. CONCLUSIONS: Organisational actions led by hospital managers to retain, protect, and train human health resources in the dynamic context of the COVID-19 pandemic were identified. Other system-wide organisations like scientific associations contributed to the coordination of human resources across hospitals to respond to COVID-19 in Bogotá, Colombia. The actions of hospital managers, and roles of system-wide intermediary organisations, in coordinating human resources need to be explored in other health system contexts facing COVID-19.

Most published systematic reviews of remdesivir for COVID-19 were redundant and lacked currency.

OBJECTIVE: To investigate the completeness and currency of published systematic reviews of remdesivir for COVID-19 and to compare this with a living guidelines approach. STUDY DESIGN AND SETTING: In this cross-sectional study, we searched Europe PMC on May 20, 2021 for systematic reviews of remdesivir (including preprints, living review updates). Completeness and currency were based on the inclusion of four major randomized trials of remdesivir available at the time of publication of the review (including as preliminary results and preprints). RESULTS: We included 38 reviews (45 reports), equivalent to a new publication every 9 days. 23 (51%) reports were out of date at the time of publication. Eleven reviews that were current on publication had a median survival time of 10 days (range 4-57). A third of reviews cited other systematic reviews, but only four provided justifications for why another review was necessary. Eight (21%) of the reviews were registered in PROSPERO. The Australian COVID-19 Clinical Evidence Taskforce living guidelines were updated within 14 days for three of the remdesivir trials, and within 28 days for the fourth. CONCLUSION: There was considerable duplication of systematic reviews of remdesivir, and half were already out of date at the time of publication.

Implementing COVID-19 surveillance through inter-organizational coordination: a qualitative study of three cities in Colombia.

Introducing comprehensive surveillance is recommended as an urgent public health measure to control and mitigate the spread of coronavirus disease 2019 (COVID-19) worldwide. However, its implementation has proven challenging as it requires inter-organizational coordination among multiple healthcare stakeholders. The purpose of this study was to examine the role of soft and hard mechanisms in the implementation of inter-organizational coordination strategies for COVID-19 surveillance within Colombia, drawing on evidence from the cities of Bogotá, Cali and Cartagena. The study used a case study approach to understand the perspectives of local and national authorities, insurance companies and health providers in the implementation of inter-organizational coordination strategies for COVID-19 surveillance. Eighty-one semi-structured interviews were conducted between June and November 2020. The data were analysed by codes and categorized using New NVivo software. The study identified inter-organizational coordination strategies that were implemented to provide COVID-19 surveillance in the three cities. Both soft (e.g. trust and shared purpose) and hard mechanisms (e.g. formal agreements and regulations) acted as mediators for collaboration and helped to address existing structural barriers in the provision of health services. The findings suggest that soft and hard mechanisms contributed to promoting change among healthcare system stakeholders and improved inter-organizational coordination for disease surveillance. The findings contribute to evidence regarding practices to improve coordinated surveillance of disease, including the roles of new forms of financing and contracting between insurers and public and private health service providers, logistics regarding early diagnosis in infectious disease and the provision of health services at the community level regardless of insurance affiliation. Our research provides evidence to improve disease surveillance frameworks in fragmented health systems contributing to public health planning and health system improvement.

The Role of Intersectoral Action in Response to COVID-19: A Qualitative Study of the Roles of Academia and the Private Sector in Colombia.

BACKGROUND: The integration of health services with other sectors is hypothesised to support adaptation of health systems in response to coronavirus disease 2019 (COVID-19). This study identified barriers and enablers associated with intersectoral coordination at an early stage of the pandemic. The study focused on the roles played by the academic and private sector in different areas of public health planning and delivery concerning COVID-19 in Colombia. METHODS: A qualitative approach was used to understand stakeholders' experiences and perceptions of intersectoral working in response to COVID-19 in three Colombian cities (Bogotá, Cali and Cartagena). Between March and November 2020, data was collected via semi-structured interviews conducted online with 42 key actors, including representatives of governmental bodies, universities, and professional associations. The dataset was analysed thematically using a combination of inductive and deductive methods. RESULTS: Organizations adjacent to the health system, including universities and the private sector, supported responses to COVID-19 by providing evidence to inform decision-making, additional service capacity, and supporting coordination (eg, convening intersectoral "roundtables"). The academic and private sector involvement in intersectoral coordination was stimulated by solidarity (being the "right thing to do") and motivation for supporting local companies (reopening the economy). Intersectoral working was influenced by pre-existing (substantive) and emerging (situational) enablers and barriers. CONCLUSION: This study showed that intersectoral coordination has played an important role in responding to COVID-19 in Colombia. Coordination was influenced by substantive and situational enablers and barriers. Based on our findings, policy-makers should focus on addressing substantive barriers to coordination, including the pre-existing tensions and mistrust among national and local healthcare actors, strict regulations and limited financial and human resources, while providing support for situational enablers, including alignment of public and private actors' interests, intersectoral government support and establishing frequent communication channels and formal spaces of interaction among sector, in processes of decision-making.

Systematic review of experiences and perceptions of key actors and organisations at multiple levels within health systems internationally in responding to COVID-19.

BACKGROUND: COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. METHODS: Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. RESULTS: Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified  at the local health system level. CONCLUSIONS: The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. TRIAL REGISTRATION: CRD42020202875.

Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: study protocol.

BACKGROUND: Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of 'major system change'-or coordinated change among a variety of healthcare organizations and other relevant stakeholders- to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity 'bottlenecks' as well as successful practices and forms of innovation that have emerged locally, which have the potential for being 'scaled up' across Colombia's health services. METHODS/DESIGN: This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform health service planning. The stakeholders will include planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of planning meetings. DISCUSSION: The study's findings will aid evaluation of the relevance of the concept of major system change in a context of 'crisis' decision-making and contribute to international lessons on improving health systems' capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team's ways of working.