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      A systematic review that is "rapid" and "living": a specific answer to the COVID-19 pandemic

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          This study aims to describe “rapid living” systematic reviews, an innovative methodological design used to systematically synthesize emerging evidence in the field of rehabilitation during the COVID-19 pandemic.

          Study design and setting

          A methodological paper, with a formative approach to rapid living systematic reviews.

          Results

          Based on our experience, we propose the following definition of rapid living SR: " A dynamic method of knowledge synthesis that allows for the constant updating of new emerging evidence and refinement of its methodological quality ". This method has the benefit of accelerating the conduct of traditional systematic reviews and allows for a synergistic adaptation of methodology based on the quality of the evidence with a flexibility to update results, methods and collaborations.

          Conclusion

          Our proposed methodology has been helpful to synthesize the rapidly evolving evidence in the field of rehabilitation during the pandemic. Similarly, it may be useful when a rapid answer is urgently needed to make informed decisions. The COVID-19 disease has shown that moderns medical science has the ability to produce new knowledge at a rate never seen before. Therefore, our proposed rapid living systematic reviews provides the scientific community with a method to rapidly synthesize evidence when facing health emergencies.

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          Most cited references26

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          Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis

          Bradley Langford, Miranda So, Sumit Raybardhan … (2020)
          Background Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood. Aims To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19. Sources We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection. Content Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory-tract or non-bloodstream sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.4–6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6–18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3–9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3–13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%). Implications Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
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            Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers

            Roger Chou, Tracy Dana, David I Buckley … (2020)
            Background: Health care workers (HCWs) are at risk for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Purpose: To examine the burden of SARS-CoV-2, SARS-CoV-1, and Middle Eastern respiratory syndrome (MERS)-CoV on HCWs and risk factors for infection, using rapid and living review methods. Data Sources: Multiple electronic databases including the WHO Database of Publications on Coronavirus Disease and medRxiv preprint server (2003 through 27 March 2020, with ongoing surveillance through 24 April 2020), and reference lists. Study Selection: Studies published in any language reporting incidence of or outcomes associated with coronavirus infections in HCWs and studies on the association between risk factors (demographic characteristics, role, exposures, environmental and administrative factors, and personal protective equipment [PPE] use) and HCW infections. New evidence will be incorporated on an ongoing basis by using living review methods. Data Extraction: One reviewer abstracted data and assessed methodological limitations; verification was done by a second reviewer. Data Synthesis: 64 studies met inclusion criteria; 43 studies addressed burden of HCW infections (15 on SARS-CoV-2), and 34 studies addressed risk factors (3 on SARS-CoV-2). Health care workers accounted for a significant proportion of coronavirus infections and may experience particularly high infection incidence after unprotected exposures. Illness severity was lower than in non-HCWs. Depression, anxiety, and psychological distress were common in HCWs during the coronavirus disease 2019 outbreak. The strongest evidence on risk factors was on PPE use and decreased infection risk. The association was most consistent for masks but was also observed for gloves, gowns, eye protection, and handwashing; evidence suggested a dose–response relationship. No study evaluated PPE reuse. Certain exposures (such as involvement in intubations, direct patient contact, or contact with bodily secretions) were associated with increased infection risk. Infection control training was associated with decreased risk. Limitation: There were few studies on risk factors for SARS-CoV-2, the studies had methodological limitations, and streamlined rapid review methods were used. Conclusion: Health care workers experience significant burdens from coronavirus infections, including SARS-CoV-2. Use of PPE and infection control training are associated with decreased infection risk, and certain exposures are associated with increased risk. Primary Funding Source: World Health Organization.
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              An overview of clinical research: the lay of the land.

              David A Grimes, Kenneth F Schulz (2002)
              Many clinicians report that they cannot read the medical literature critically. To address this difficulty, we provide a primer of clinical research for clinicians and researchers alike. Clinical research falls into two general categories: experimental and observational, based on whether the investigator assigns the exposures or not. Experimental trials can also be subdivided into two: randomised and non-randomised. Observational studies can be either analytical or descriptive. Analytical studies feature a comparison (control) group, whereas descriptive studies do not. Within analytical studies, cohort studies track people forward in time from exposure to outcome. By contrast, case-control studies work in reverse, tracing back from outcome to exposure. Cross-sectional studies are like a snapshot, which measures both exposure and outcome at one time point. Descriptive studies, such as case-series reports, do not have a comparison group. Thus, in this type of study, investigators cannot examine associations, a fact often forgotten or ignored. Measures of association, such as relative risk or odds ratio, are the preferred way of expressing results of dichotomous outcomes-eg, sick versus healthy. Confidence intervals around these measures indicate the precision of these results. Measures of association with confidence intervals reveal the strength, direction, and a plausible range of an effect as well as the likelihood of chance occurrence. By contrast, p values address only chance. Testing null hypotheses at a p value of 0.05 has no basis in medicine and should be discouraged.
              Article 0 comments Cited 161 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Epidemiol
                Journal ID (iso-abbrev): J Clin Epidemiol
                Title: Journal of Clinical Epidemiology
                Publisher: Published by Elsevier Inc.
                ISSN (Print): 0895-4356
                ISSN (Electronic): 1878-5921
                Publication date PMC-release: 2 June 2021
                Publication date (Electronic): 2 June 2021
                Affiliations
                [1 ]Department of Biomedical, Surgical and Dental Sciences. University “La Statale”, Milan, Italy
                [2 ]Laboratory of Evidence-based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
                [3 ]Department of Experimental and Clinical Medicine, “Politecnica delle Marche” University, Ancona, Italy
                [4 ]Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
                [5 ]Centre for Disability Prevention and Rehabilitation at Ontario Tech University and CMCC, Oshawa, Ontario, Canada
                [6 ]IRCCS Fondazione Don Gnocchi, Milan, Italy
                Author notes
                [* ]Corresponding Author.
                Article
                Publisher Item ID: S0895-4356(21)00177-3
                DOI: 10.1016/j.jclinepi.2021.05.025
                PMC ID: 8170906
                PubMed ID: 34089780
                SO-VID: accbb1c7-82cd-4155-a927-b53b478b8b70
                Copyright © © 2021 Published by Elsevier Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date accepted : 27 May 2021
                Categories
                Subject: Article

                ScienceOpen disciplines: Public health
                Keywords: rapid living systematic review,covid-19,methodology research
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: rapid living systematic review, covid-19, methodology research

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