key: cord-0766449-b59zvrai
authors: Reynard, Charles; Darbyshire, Daniel; Prager, Gabrielle; Jafar, Anisa Jabeen Nasir; Naguib, Mina; Oliver, Govind; van den Berg, Patricia; Body, Richard; Ambroziak, Harriet; Carley, Simon
title: Systematic literature search, review and dissemination methodology for the COVID-19 pandemic
date: 2021-06-08
journal: BMJ Simul Technol Enhanc Learn
DOI: 10.1136/bmjstel-2020-000817
sha: 3bf66c0c7a6151027199de3f4b41f248d1e279cb
doc_id: 766449
cord_uid: b59zvrai

PURPOSE OF THE STUDY: SARS-CoV-2 has caused healthcare systems globally to reorganise. A pandemic paradox emerged; while clinicians were desperate for information on a new disease, they had less time to find and evaluate the vast volume of publications at times of significant strain on healthcare systems. A multidisciplinary team undertook a weekly literature search capturing all COVID-19 publications. We also monitored free open access medical education (FOAMed) sources for emerging themes. Title and abstract screening pooled the most relevant papers for emergency medicine. Three summary types were created, a ‘Top 5 Flash Update’, a journal club and a rapid response to emerging FOAMed themes. From these summaries, three modes of dissemination were used: short written summaries, blogs and podcasts. These were amplified through social media. STUDY DESIGN: A retrospective review was conducted assessing the impact of this knowledge dissemination strategy for the period of March to September 2020. RESULTS: In total, 64 687 papers were identified and screened. Of the papers included in the ‘Top 5’, 28.3% were on epidemiology, 23.6% treatment, 16.7% diagnostics, 12% prognosis, 8.7% pathophysiology with the remaining 10.7% consisting of PPE, public health, well-being and ‘other’. We published 37 blogs, 17 podcasts and 18 Top 5 Flash Updates. The blogs were read 138 343 times, the Top 5 Flash Updates 68 610 times and the podcasts had 72 501 listens. CONCLUSION: A combination of traditional academic and novel social media approaches can address the pandemic paradox clinicians are facing.

BACKGROUND SARS-CoV-2, the cause of COVID-19, emerged in China in late 2019 from a zoonotic source. 1 As of January 2021, it has become a global pandemic infecting nearly 100 million people of which two million died. 2 There has been a need to find answers to this new disease at a pace and scale that matches the spread of the virus itself, which in turn led to a rapid increase in the number of publications on the topic. This haste has, at times, led to publications in high-impact journals that were a lower level of evidence than usual and of lower quality than concurrently published non-COVID literature. 3 This unprecedented scenario has resulted in some very high-profile retractions, which in turn has led many to question the very ethics of scientific publication. 4 5 The increase in new research about COVID-19 parallels the day-to-day clinical challenge for healthcare professionals tasked with managing an acute severe illness which is not only a threat to patients but also to our colleagues and indeed ourselves. Keeping up with the unprecedented pace and scale of new publications presents a major challenge. Combining this with working in a difficult clinical environment creates the pandemic paradox. Such difficulty in managing large numbers of publications has been described as trying to 'drink from a firehose'. 6 7 Non-traditional knowledge dissemination methods have developed online in forms such as 

blogs and the FOAMed community. The St Emlyn's blog and podcast are a free and open access platform that publishes topics related to emergency and critical care. 8 It was started in 2012 and is rated as one of the most influential international blogs/ podcasts in emergency care. 9 In 2020, it was accessed over 860 000 times worldwide. This paper describes a systematic and collaborative approach to filtering the flow of information from original sources through peer review and critical appraisal and then through to dissemination using both traditional and non-traditional methods.

In March 2020, we convened a multidisciplinary team (MDT) of emergency physicians, medical virologists and public health specialists. We aimed to help bridge the evolving science and clinical practice in relation to COVID-19 with those practicing emergency medicine (EM) as the intended audience. We initiated a surveillance programme to continually identify new published evidence, which was maintained at the same pace until the end of September 2020. To survey the emerging literature, we undertook a weekly, automated search of PubMed using prospectively agreed search terms to perform a structured systematic literature search (see box 1).

Following a title screen and abstract review, papers considered the most relevant and informative to EM were pooled. We also undertook a specific review of high-impact and relevant journal sites including the Lancet, the New England Journal of Medicine (NEJM), the British Medical Journal (BMJ), Medical Virology and the Journal of the American Medical Association. Similarly, given the speed of publication, preprints were identified on the medRxiv website and reviewed in full when deemed relevant. Further, we distributed a call for submissions of relevant literature via a Google Form portal, which was publicised by the Royal College of Emergency Medicine (RCEM) and disseminated through social media, webinars and word of mouth. The weekly writing team initially consisted of the MDT, but this was quickly expanded to include research teams from around the UK (each team is listed and thanked in the Acknowledgements). This democratised the process and decreased the risk of bias that would be unavoidable with a single team. They screened identified papers based on (1) relevance to EM practice, (2) level of evidence and (3) methodological quality. Any conflicts were resolved by consensus; if this was not possible, then SC cast the deciding vote (figure 1). Of those papers selected, they were given a categorical impact rating which was agreed by consensus: worth a peek, head turner and game changer. 'Game changer' was a paper that could potentially warrant a change in clinical practice. 'Head turner' papers were directly relevant but lacking in specific areas that preclude them from directly changing practice. 'Worth a peek' papers were indirectly relevant to an aspect of EM practice but contained potentially useful insights. The MDT retained editorial oversight and peer-reviewed the weekly writing team's submission.

The MDT also responded rapidly to developing topics within the pandemic. These were identified by monitoring for themes within the FOAMed community, including social media and other FOAMed websites. We/they provided an in-depth analysis of large trials, for example, the Randomised Evaluation of COVID-19 therapy trial (RECOVERY) 10 , and emerging clinical phenomena such as the association of venous thrombosis and COVID-19. 11 This also provided experiential information from those involved in the early phase of the pandemic. This experiential information was used as a way of sharing ideas and good practice and was aimed at those yet to experience an influx of patients.

To present the most relevant literature, we generated three weekly outputs: the RCEM Top 5, journal club and rapid responses (see figure 1 ). These were disseminated through written summaries, podcasts and blogs. The 'Top 5 Flash Update' was created with the aim of giving succinct written summaries and an informal review of the papers. This was disseminated by RCEM to all members and shared widely on social media. We conducted a journal club and disseminated it as a podcast and blog. This was an in-depth review of papers with expert discussion and an audience question and answer. It was a joint venture between the University of Manchester, RCEM and the Box 1 Search terms ("COVID-19"(All Fields) OR "COVID-2019"(All Fields) OR "severe acute respiratory syndrome coronavirus 2"[Supplementary Concept)] OR "severe acute respiratory syndrome coronavirus 2"(All Fields) OR "2019-nCoV"(All Fields) OR "SARS-CoV-2"(All Fields) OR "2019nCoV"(All Fields) OR (("Wuhan"(All Fields) AND ("coronavirus"(MeSH Terms) OR "coronavirus"(All Fields))) AND (2019/12(PDAT) OR 2020(PDAT)))) OR sars-cov-19(All Fields) OR ("coronavirus"(MeSH Terms) OR "coronavirus"(All Fields) 

St Emlyn's blog and podcast. Rapid responses were curated into blogs and podcasts.

We used non-traditional means of dissemination. This was initially through synchronous and asynchronous Twitter and Facebook posts linked to the St Emlyn's blog and podcast. This reach was further amplified through retweets and likes from members of the FOAMed community. We collated data on the reach and impact of the process using the following methods :

Update was obtained from RCEM records. 2. Page views of COVID-19 specific articles from the St Emlyn's blog were obtained from the WordPress platform. 3. Audience for the St Emlyn's podcast were obtained from the Podbean platform.

Results are based on the period from 1 March 2020 and 1 September 2020. During this period, 64 687 papers were identified using the aforementioned search terms (figure 2 A total of 37 blog posts were published on St Emlyn's during the study period. Twenty-three were rapid responses to new emerging themes; 14 of the blogs were related to the journal club. One of the themes was the early experience of EM clinicians in the outbreak in northern Italy, and an interview with an EM physician, Dr Robert Cosentini from Papa Giovanni XXIII Hospital in Bergamo, Italy, was conducted and received 30 098 listens. Table 2 shows the geographical distribution and unique users from the top 10 countries accessing the St Emlyn's blog during the study period.

Seventeen podcasts were published on the St Emlyn's site during the study period. These were downloaded 72 501 times, with 7 covering the journal club and 10 covering rapidly emerging topics. Of these rapid response topics, the interview with an Italian EM clinician was an outlier accounting for 41.5% of all downloads.

This paper describes the broad international reach of a multimodal and multimedia approach to evidence collation, appraisal and dissemination that straddles traditional academic and novel social media platforms. The data demonstrate users across a wide geographical distribution who engaged with the evidencebased summaries.

It is commonly stated that the time taken for evidence to translate from publication through to clinical practice is measured in years. 12 This delay may not apply during a novel pandemic when there is little established practice and all knowledge is to a degree 'new'. Paradoxically, the absence of prior knowledge about COVID-19 led to an explosion in the number of papers published, many of which were of questionable scientific merit. 13 It is clearly ineffective for every individual, especially those tied up in clinical work, to seek, sort, critique and summarise this body of emerging evidence. There is a logical argument for this task to be centralised and organised into a systematic approach to knowledge translation with outputs presented in an easily accessible format. Our data presented demonstrate that this can be achieved using a combination of techniques that span Original research traditional information dissemination methods such as email, combined with social media platforms, blogs and podcasts. We have also demonstrated the appetite for variety in the type of media from the audio-only podcast to the short 'bite size' Top 5 Flash Update. Interestingly, one of the most popular resources deployed was the rapid response experiential narrative of an Italian EM physician. While expert opinion does represent a lower level of evidence, it adds value when there is a paucity of evidence. This insight appears to have been sought by physicians, perhaps in part because the Italians were hit early in the global pandemic. 14 Throughout the pandemic, other traditional publishing groups (such as BMJ, Lancet and NEJM) and #FOAMed sites have collated and curated COVID-19 information, but few have adopted a formalised multimodal collaborative approach that targets specific clinical groups (in this case emergency care clinicians) as described in this paper. This multimodal approach to knowledge dissemination reflects how we now live our lives through technology, and we believe this is a significant factor in the success of the project.

In this paper, we have focused on data obtained from blogs and podcasts on the St Emlyn's and RCEM platforms, which are where the information was accessible to clinicians. However, a significant degree of sharing/dissemination took place through other social media platforms such as Facebook and Twitter. As we did not create a specific hashtag for these evidence-based updates at the beginning of this project, we have been unable to track the dissemination through these and other online platforms.

While the search terms used were broad and consistent, the study selection was not according to the rigorous systematic review methodology. This was deliberate, as its purpose was to filter large volumes of evolving literature for research likely to have the most impact and relevance for those working in EM trying to remain up to date with the COVID-19 pandemic.

We were unable to determine how much cross-over existed between platforms. The St Emlyn's and RCEM sites undoubtedly have a cross-over of users, but the degree to which this occurs is unknown. However, the broad geographical reach of the St Emlyn's site does not match the geographical distribution of members and fellows of RCEM.

A clinician-led approach incorporating both traditional and social media-based platforms allowed the rapid dissemination of research to clinicians in EM. During a period of rapidly changing research information, this became an important and widely received source of information translation.

Report of the WHO-China joint mission on coronavirus disease

An interactive web-based dashboard to track COVID-19 in real time

Scientific quality of COVID-19 and SARS CoV-2 publications in the highest impact medical journals during the early phase of the pandemic: a case control study

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet

Cardiovascular disease, drug therapy, and mortality in COVID-19

Learning to drink from a fire hose

Drinking from the firehose of scientific publishing

Social-media-enabled learning in emergency medicine: a case study of the growth, engagement and impact of a free open access medical education blog

Social media index (SMi)

NEJM. Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report | NEJM

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

The answer is 17 years, what is the question: understanding time lags in translational research

An alarming retraction rate for scientific publications on coronavirus disease 2019 (covid-19)

Estimation of COVID-19 outbreak size in Italy

Provenance and peer review Not commissioned; externally peer reviewed.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Charles Reynard http:// orcid. org/ 0000-0002-7534-2668