KEY TAKEAWAYS

• ‘Living’ evidence synthesis requires researchers to find, appraise, and incorporate research into guidelines in frequent cycles.
• This approach is vital in fast-paced areas of medical research, such as COVID-19, to ensure guidelines remain a trusted source of the best evidence.

The COVID-19 pandemic demanded new ways of working in many aspects of healthcare; one such area was the development of guidelines relating to COVID-19 that could keep up with a continual influx of new data. A group of researchers tackled this challenge by undertaking a ‘living’ review to guide weekly updates to Australia’s national COVID-19 guidelines – they present their experience in an article in Nature.

The traditional model of guideline development is underpinned by systematic literature reviews. These are often developed from scratch and become out of date shortly after publication because of the inability to incorporate relevant new evidence as it becomes available. By contrast, the ‘living’ evidence approach requires researchers to continually monitor the literature and develop regular evidence summaries to keep abreast with newly released data. Guidelines based on ‘living’ reviews are more likely to stay up to date and relevant, which is crucial if these are to continue to be a trusted source of best available evidence to clinicians.

‘Living’ evidence synthesis is often facilitated by artificial intelligence mechanisms, such as natural-language processing, and machine-readable FAIR (findable, accessible, interoperable, and reusable digital assets) research data and publication metadata. Crowdsourcing and collaboration can alleviate the human time burden, reducing duplication and redundancy. The authors highlight MAGICapp, a platform facilitating the development of ‘living’ guidelines, and point to initiatives such as COVID-END (COVID-19 Evidence Network to support Decision-making) as an example of how collaborative working can achieve rapid, efficient, and full coverage of evidence synthesis.

“Without trustworthy and up-to-date summaries, the world risks making ill-informed decisions and wasting investment.”

Crucially, multiple updates to the same guideline document will require a more flexible approach to publication and the ‘version of record’. The authors recommend allowing minor updates as addendums to the original publication, with major updates captured in a new article version (along with associated digital object identifier and bibliographic database listing) that is robustly linked to previous versions.

A dynamic approach to evidence synthesis is increasingly accepted by well-known healthcare guiding bodies, including the National Institute for Health and Care Excellence, World Health Organization, and Cochrane, as well as publishers such as The BMJ and Annals of Internal Medicine. However, the authors caution that ‘living’ evidence will only speed up the incorporation of science into policy and practice if it is effectively implemented, and its application beyond the COVID-19 pandemic will require testing across diverse domains.

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