Conducting multiple living systematic reviews rapidly without compromising quality is possible with an innovative approach: L·OVE COVID-19 initiative

Article type
Rada G1, Acuña MP2, Alvares C3, Araneda G4, Ávila C5, Baladia E6, Bohorquez S7, Bravo R8, Carrasco C9, Carvajal-Juliá N10, Chahuan J11, Corbalán J1, Pérez M5, Pérez Gaxiola G12, Pérez-Bracchiglione J9, Pesce F13, Pizarro AB14, Poloni D15, Prieto P16, Ragusa M17, Rojas MX18, Santillan-Garcia A19, Sepúlveda J5, Torres López LA18, Urrea G10, Vargas M9, Verdejo C10, Verdugo F5, Vergara Merino L10, Villar J18, Cuadrado C20, Ferrada C20, Peña E16, Ortiz L21, Olguin P10, Ojeda P21, Neumann J16, Morel-Marambio M21, Meza N9, Madrid E9, Izcovich A17, González C16, Goez-Mogollon L18, Gempeler A22, Garnham R10, Franco JVA23, Flores I24, Escobar-Liquitay C23
1Cochrane Chile
2Unidad de Infectología, Hospital Dr Sótero del Río, Santiago
3Fundación Sanitas
4Escuela de Salud Publica Universidad de Chile
5Epistemonikos Foundation
6Red de Nutrición Basada en la Evidencia, Academia Española de Nutrición y Dietética, Pamplona
7Universidad de Jaen
8UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile
9Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Associate Centre, School of Medicine, Universidad de Valparaíso
10School of Medicine, Universidad de Valparaíso
11Pontificia Universidad Católica de Chile
12Hospital pediátrico de Sinaloa
13Living Knowledge
14Facultad de Enfermería, Pontificia Universidad Javeriana, Coordinadora de red de consumidores Cochrane Colombia
15Department of Internal Medicine, School of Medicine, Universidad de Valparaíso
16Escuela de Salud Publica, Universidad de Chile
17Servicio de medicina interna del Hospital Alemán
18Departamento de investigaciones, Fundación Cardioinfantil-IC
19Hospital Universitario de Burgos
20School of Public Health, Universidad de Chile
21Centro Evidencia UC, Centro asociado Cochrane Chile
22Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali
23Departamento de Investigación - Instituto Universitario Hospital Italiano
24Universidad de Antioquia, Centro Asociado Cochrane Colombia
Background: The evidence about COVID-19 is being produced at high speed, so it is very difficult for decision makers to keep up. It seems appropriate, then, to put into practice a novel approach able to provide the scientific community and other interested parties with up-to-date, quality evidence that is actionable, and rapidly and efficiently produced.

Objectives: To systematically assess the evidence for multiple questions relevant to COVID-19, and to update them using a living approach.

Methods: We designed a protocol for multiple parallel living systematic reviews in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for primary studies which answer different questions related to COVID-19 using both a centralised repository (Epistemonikos database) and a manual search in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. We also searched for literature in several other sources, including grey literature and trial registries. All the evidence was organised in an open platform (L·OVE - Living OVerview of Evidence) that is continuously updated using artificial intelligence and a broad network of experts. At least two researchers independently selected studies, extracted data, and assessed the risk of bias of included studies. We synthesised data for each question using meta-analysis, when possible, and prepared Summary of Findings tables according to the GRADE approach.

Results: We compiled a list of questions by liaising with local stakeholders and consulting with clinical experts. We set a team of 56 researchers from 14 organisations, who selected their questions according to their areas of expertise. We established a central team composed of methods experts, software engineers, information specialists, project managers, professional writers and journalists. A common protocol was written for all the reviews, and individual protocols were adapted to each individual review and made public. We released a short article in plain language and a preliminary report of the review as soon as all the data had been analysed. These were widely disseminated through social networks and sent to relevant authorities. Then, we submitted the full review for publication.
Twenty days after the kickoff of the project, at the moment of submission of this abstract, 17 systematic reviews have been initiated. Six are already completed and six are finishing data extraction. Most of the reviews have needed reassessment of new evidence after completing the initial screening, and one review has needed two updates after its release. It is likely that many more reviews will be initiated in the next weeks as the COVID-19 pandemic evolves.

Conclusions: A production model of multiple living systematic reviews in the same topic is feasible with a large team of researchers, a central coordinating team, and the appropriate technological tools to streamline and manage the process.

Patient or healthcare consumer involvement: No