Methodological and users' surveys on the use of the LILACS database in Cochrane reviews identified desirable improvements to the database.

BACKGROUND: Latin American and Caribbean Health Sciences Literature (LILACS) is the main reference database in the region; however, the way in which this resource is used in Cochrane systematic reviews has not been studied. OBJECTIVES: To assess the search methods of Cochrane reviews that used LILACS as a source of information and explore the Cochrane community's perceptions about this resource. METHODS: We identified all Cochrane reviews of interventions published during 2019, which included LILACS as a source of information, and analysed their search methods and also ran a survey through the Cochrane Community. RESULTS: We found 133 Cochrane reviews that reported the full search strategies, identifying heterogeneity in search details. The respondents to our survey highlighted many areas for improvement in the use of LILACS, including the usability of the search platform for this purpose. DISCUSSION: The use and reporting of LILACS in Cochrane reviews demonstrate inconsistencies, as evidenced by the analysis of search reports from systematic reviews and surveys conducted among members of the Cochrane community. CONCLUSION: With better guidance on how LILACS database is structured, information specialists working on Cochrane reviews should be able to make more effective use of this unique resource.

Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations.

BACKGROUND: Diabetic macular oedema (DME) is a worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. Clinical practice guidelines (CPGs) are synthesis documents that seek to improve patient care. OBJECTIVES: To identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations. ELIGIBILITY CRITERIA: CPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME. SOURCES OF EVIDENCE: Sensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites. METHODS: We extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG. RESULTS: The 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention. CONCLUSIONS: Most of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients' values and preferences.

What you need to know about scoping reviews. / Lo que tienes que saber sobre las revisiones panorámicas.

The increasing amount of evidence has caused an increasing amount of literature reviews. There are different types of reviews systematic reviews are the best known, and every type of review has different purposes. The scoping review is a recent model that aims to answer broad questions and identify and expose the available evidence for a broader question, using a rigorous and reproducible method. In the last two decades, researchers have discussed the most appropriate method to carry out scoping reviews, and recently the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) reporting guideline was published. This is the fifth article of a methodological collaborative series of narrative reviews about general topics on biostatistics and clinical epidemiology. This review aims to describe what scoping reviews are, identify their objectives, differentiate them from other types of reviews, and provide considerations on how to carry them out.

La cantidad creciente de evidencia ha provocado a su vez un aumento en el número de revisiones de la literatura. Existen distintos tipos de revisiones donde las más conocidas son las revisiones sistemáticas, y cada tipo de revisión posee objetivos distintos. La revisión panorámica (o scoping review) es un modelo reciente que busca dar respuestas a preguntas amplias, a la vez que intenta identificar y exponer la evidencia disponible para una pregunta en particular, a través de un método riguroso y reproducible. En las últimas dos décadas se ha discutido cuál es el método más apropiado para realizarlas, siendo la extensión de Preferred Reporting Items For Systematic Reviews and Meta-Analyses para Scoping reviews (PRISMA-ScR) la guía de reporte más recientemente incorporada. Este artículo es el quinto de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica. Esta revisión tiene como objetivo describir qué son las revisiones panorámicas, identificar sus objetivos, diferenciarlas de otros tipos de revisiones de literatura, y dar algunas consideraciones sobre cómo estas se pueden llevar a cabo.

Registered trials address questions already answered with high-certainty evidence: A sample of current redundant research.

OBJECTIVE: To identify clinical trials registered later than 2015, that study the effect of an intervention on a primary outcome whose "Certainty of Evidence" (CoE) has already been rated "high" in a Cochrane SR. STUDY DESIGN AND SETTING: We searched the Cochrane Library for all SRs from 2015. We analyzed SRs of interventions and excluded withdrawn reviews or those with no Summary of Findings (SoF) table. We retrieved the GRADE CoE ratings of each SR's primary outcomes in the SoF tables and identified those rated "high." We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials to identify records of clinical studies that tackled those outcomes and were registered after the date of publication of the respective 2015 SR. RESULTS: We selected 602 SRs. Eighty-one contained a "high" CoE rating on at least one primary outcome, totaling 152 primary outcomes rated "high." We found 39 clinical trials registered for primary outcomes with evidence already rated as "high" in a 2015 Cochrane SR. CONCLUSION: This study shows the existence of clinical trials registered to study primary outcomes whose CoE has already been rated "high" in a Cochrane SR.

Macrolides for the treatment of COVID-19: a living, systematic review. / Macrólidos para el tratamiento de COVID-19: Una revisión sistemática viva.

OBJECTIVE: This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: A living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases. METHODS: We included randomized trials evaluating the effect of macrolides as monotherapy or in combination with other drugs versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number: CRD42020181032 Protocol preprint DOI: 10.31219/osf.io/rvp59.

OBJETIVO: Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de los macrólidos para el tratamiento de pacientes con COVID-19. DISEÑO: Revisión sistemática viva. BASE DE DATOS: La búsqueda de evidencia se realizó en el repositorio centralizado L·OVE (Living OVerview of Evidence) COVID-19; una plataforma que mapea las preguntas PICO para identificar la evidencia en la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L·OVE se adaptó para ampliar el rango de evidencia que cubre y hoy se mantiene a través de búsquedas regulares en 39 bases de datos. MÉTODOS: Se incluyeron estudios experimentales que evaluaban el efecto de los macrólidos, como monoterapia o en combinación con otros fármacos, versus placebo o ningún tratamiento en pacientes con sospecha o confirmación de COVID-19. Se buscó identificar experimentos clínicos aleatorizados que evaluaran macrólidos en infecciones causadas por otros coronavirus, como MERS-CoV y SARS-CoV. Dos revisores examinaron de forma independiente la elegibilidad de cada estudio, extrajeron los datos y evaluaron el riesgo de sesgo. Se evaluó el efecto de los macrólidos sobre la mortalidad por todas las causas; necesidad de ventilación mecánica invasiva; oxigenación por membrana extracorpórea, duración de la estancia hospitalaria, insuficiencia respiratoria, eventos adversos graves, tiempo hasta la negatividad de la RT-PCR del SARS-CoV-2. La certeza de la evidencia para cada desenlace se evaluó siguiendo la aproximación GRADE. Esta revisión se mantendrá viva y disponible abiertamente durante la pandemia de COVID-19. Se someterán actualizaciones de su publicación cada vez que cambien las conclusiones o cuando haya actualizaciones sustanciales. RESULTADOS: Se identificó un experimento clínico aleatorio que evaluó el uso de azitromicina en combinación con hidroxicloroquina en comparación con el uso de hidroxicloroquina sola, en pacientes hospitalizados por COVID 19. Las estimaciones para todos los resultados evaluados resultaron en un poder estadístico insuficiente para llegar a conclusiones válidas. La calidad de la evidencia para los resultados principales fue baja a muy baja. CONCLUSIONES: El uso de macrólidos en el tratamiento de pacientes con COVID 19 no ha mostrado efectos beneficiosos en comparación con el tratamiento estándar. La evidencia para todos los desenlaces no es concluyente. Se necesitan estudios sobre un mayor número de pacientes con COVID 19, para determinar los efectos del uso de macrólidos sobre los desenlaces relacionados con la enfermedad. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number: CRD42020181032 Protocol preprint DOI: 10.31219/osf.io/rvp59.

Living systematic review: new inputs and challenges. / La revisión sistemática viva: nuevos aportes y desafíos.

This is the second article from a collaborative methodological series of biostatistics and clinical epidemiology narrative reviews. This review aims to describe living systematic reviews relevance, the considerations that should be taken when producing one, and the challenges proper of this type of review. The living systematic review is a continuous update that maintains a systematic reviews rigor and methodological quality. The living format is appropriate when the review aims to answer a priority question in terms of health decision-making, the existent certainty of the evidence for this question is low or very low, and new evidence will likely appear soon. To carry out a successful living systematic review, researchers should consider different things, such as: having a continuous and automated search, having update criteria, evaluating how to update the meta-analysis and how to perform the editorial process, and publishing in a friendly format, among others. As living systematic reviews are a new proposal, they will likely change in the future to improve their performance, so we will have to keep an eye on its future updates.

Este artículo es el segundo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica. El objetivo de este trabajo es describir la pertinencia, las consideraciones y los desafíos de las revisiones sistemáticas vivas. La revisión sistemática viva es una propuesta de actualización continua, que conserva el rigor y la calidad metodológica de una revisión sistemática. El modelo vivo es adecuado cuando la revisión busca responder una pregunta prioritaria para la toma de decisiones en salud, la certeza de la evidencia para esa pregunta es baja y es muy probable que surja nueva evidencia al respecto. Para que una revisión sistemática viva sea exitosa debe considerar varios aspectos, por ejemplo: que la búsqueda sea continua y automatizada, que existan criterios de actualización de la revisión, que se evalúe cómo se llevará a cabo la actualización del metanálisis y cómo será el proceso editorial, y que la publicación se amigable, entre otras. Al ser una propuesta relativamente nueva deberá enfrentar múltiples cambios que permitan su mejor funcionamiento, por lo que debemos estar atentos a estos cambios venideros.

Macrólidos para el tratamiento de COVID-19: una revisión sistemática viva / Macrolides for the treatment of COVID-19: a living, systematic review

OBJETIVO Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de los macrólidos para el tratamiento de pacientes con COVID-19. DIDEÑO Revisión Sistemática Viva. BASE DE DATOS: La búsqueda de evidencia se realizó en el repositorio centralizado L·OVE (Living OVerview of Evidence) COVID-19; una plataforma que mapea las preguntas PICO para identificar la evidencia en la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L·OVE se adaptó para ampliar el rango de evidencia que cubre y hoy se mantiene a través de búsquedas regulares en 39 bases de datos. MÉTODOS: Se incluyeron estudios experimentales que evaluaban el efecto de los macrólidos, como monoterapia o en combinación con otros fármacos, versus placebo o ningún tratamiento en pacientes con sospecha o confirmación de COVID-19. Se buscó identificar experimentos clínicos aleatorizados que evaluaran macrólidos en infecciones causadas por otros coronavirus, como MERS-CoV y SARS-CoV. Dos revisores examinaron de forma independiente la elegibilidad de cada estudio, extrajeron los datos y evaluaron el riesgo de sesgo. Se evaluó el efecto de los macrólidos sobre la mortalidad por todas las causas; necesidad de ventilación mecánica invasiva; oxigenación por membrana extracorpórea, duración de la estancia hospitalaria, insuficiencia respiratoria, eventos adversos graves, tiempo hasta la negatividad de la RT-PCR del SARS-CoV-2. La certeza de la evidencia para cada desenlace se evaluó siguiendo la aproximación GRADE. Esta revisión se mantendrá viva y disponible abiertamente durante la pandemia de COVID-19. Se someterán actualizaciones de su publicación cada vez que cambien las conclusiones o cuando haya actualizaciones sustanciales. RESULTADOS: Se identificó un experimento clínico aleatorio que evaluó el uso de azitromicina en combinación con hidroxicloroquina en comparación con el uso de hidroxicloroquina sola, en pacientes hospitalizados por COVID 19. Las estimaciones para todos los resultados evaluados resultaron en un poder estadístico insuficiente para llegar a conclusiones válidas. La calidad de la evidencia para los resultados principales fue baja a muy baja. CONCLUSIONES: El uso de macrólidos en el tratamiento de pacientes con COVID 19 no ha mostrado efectos beneficiosos en comparación con el tratamiento estándar. La evidencia para todos los desenlaces no es concluyente. Se necesitan estudios sobre un mayor número de pacientes con COVID 19, para determinar los efectos del uso de macrólidos sobre los desenlaces relacionados con la enfermedad.

OBJECTIVE This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: a living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases.METHODS: We included randomized trials evaluating the effect of macrolides ­ as monotherapy or in combination with other drugs ­ versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients.

La revisión sistemática viva: nuevos aportes y desafíos / Living systematic review: new inputs and challenges

Este artículo es el segundo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica. El objetivo de este trabajo es describir la pertinencia, las consideraciones y los desafíos de las revisiones sistemáticas vivas. La revisión sistemática viva es una propuesta de actualización continua, que conserva el rigor y la calidad metodológica de una revisión sistemática. El modelo vivo es adecuado cuando la revisión busca responder una pregunta prioritaria para la toma de decisiones en salud, la certeza de la evidencia para esa pregunta es baja y es muy probable que surja nueva evidencia al respecto. Para que una revisión sistemática viva sea exitosa debe considerar varios aspectos, por ejemplo: que la búsqueda sea continua y automatizada, que existan criterios de actualización de la revisión, que se evalúe cómo se llevará a cabo la actualización del metanálisis y cómo será el proceso editorial, y que la publicación se amigable, entre otras. Al ser una propuesta relativamente nueva deberá enfrentar múltiples cambios que permitan su mejor funcionamiento, por lo que debemos estar atentos a estos cambios venideros.

This is the second article from a collaborative methodological series of biostatistics and clinical epidemiology narrative reviews. This review aims to describe living systematic reviews' relevance, the considerations that should be taken when producing one, and the challenges proper of this type of review. The living systematic review is a continuous update that maintains a systematic review's rigor and methodological quality. The living format is appropriate when the review aims to answer a priority question in terms of health decision-making, the existent certainty of the evidence for this question is low or very low, and new evidence will likely appear soon. To carry out a successful living systematic review, researchers should consider different things, such as: having a continuous and automated search, having update criteria, evaluating how to update the meta-analysis and how to perform the editorial process, and publishing in a friendly format, among others. As living systematic reviews are a new proposal, they will likely change in the future to improve their performance, so we will have to keep an eye on its future updates.