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Background A living systematic review (LSR) is an emerging review type that makes use of continual updating. In the COVID-19 pandemic, we were confronted with a shifting epidemiological landscape, clinical uncertainties and evolving evidence. These unexpected challenges compelled us to amend standard LSR methodology. Objective and outline Our primary objective is to discuss some challenges faced when conducting LSRs in the context of the COVID-19 pandemic, and to provide methodological guidance for others doing similar work. Based on our experience and lessons learned from two Cochrane LSRs and challenges identified in several non-Cochrane LSRs, we highlight methodological considerations, particularly with regards to the study design, interventions and comparators, changes in outcome measure, and the search strategy. We discuss when to update, or rather when not to update the review, and the importance of transparency when reporting changes. Lessons learned and conclusion We learned that a LSR is a very suitable review type for the pandemic context, even in the face of new methodological and clinical challenges. Our experience showed that the decision for updating a LSR depends not only on the evolving disease or emerging evidence, but also on the individual review question and the review teams’ resources.

Objective To describe and record the evolution of EBM in China. Study Design and Setting We conducted the study following the general methodology of oral history. The interviews were done at Lanzhou University, between 18th and 22nd April 2019 using pre-defined questions. All interviews were videorecorded. Two investigators extracted and analyzed the information from the interviews independently. Results One international expert and ten Chinese experts participated in the interviews. After the introduction of EBM in China in the mid-1990s, more than 20 EBM centres have been established. According to the interviewees, Gordon Guyatt, David Sackett and Iain Chalmers are the international experts who played the most important role in the development of EBM in China. China has contributed to EBM on the international level by conducting systematic reviews, developing reporting checklists, and introducing the principles of EBM into Traditional Medicine. The Chinese Cochrane Centre and the EBM Centre of Lanzhou University were ranked the top two EBM Centres in China by the interviewees. Conclusion EBM has been developing in China for nearly a quarter of a century. Many achievements have been reached, however, EBM is still facing many challenges in China, including shortages of funding support and personnel, as well as limited local high-quality evidence.

Objective To assess the methodological and reporting quality of Chinese- and English -language systematic reviews and meta-analyses (SRs/MAs) published by Chinese authors between 2016 and 2018. Study Design and Setting We searched MEDLINE and Chinese Science Citation Database (CSCD) for SRs/MAs led by Chinese authors published between 2016 and 2018. We used random sampling to select 10% of the eligible SRs/MAs published in each year from CSCD, and then matched the same number of SRs/MAs in MEDLINE. Reporting quality was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and methodological quality using the Assessment of Multiple Systematic Reviews (AMSTAR-2) tool. Stratified analyses were conducted to compare the differences of quality between Chinese- and English language SRs/MAs. Results We identified 336 SRs/MAs (168 in Chinese and 168 in English). The reporting quality in Chinese-language SRs/MAs was slightly lower than English-language SRs/MAs (mean PRISMA scores: 20.58 vs. 21.71 in 2016, 19.87 vs. 21.24 in 2017, and 21.29 vs. 22.38 in 2018). Less than half of both Chinese- and English-language SRs/MAs complied with item 5 (protocol and registration), item 7 (information sources), item 8 (search) and item 27 (funding)). The methodological quality in Chinese -language SRs/MAs was also slightly lower than English -language SRs/MAs (mean AMSTAR-2 scores: 8.07 vs. 9.36 in 2016; 9.21 vs. 10.26 in 2017; 8.86 vs. 9.28 in 2018). Three items (item 2: established a protocol; item 4: use a comprehensive literature search; and item 10: report the sources of funding) were adhered to by less than 10% of both Chinese- and English -language SRs/MAs. Only one (0.6%) Chinese-language SRs/MA and nine (5.4%) English-language SRs/MAs were rated as high methodological quality. Conclusion The reporting and methodological quality of English-language SRs/MAs conducted by authors from China between 2016 and 2018 were slightly better than those of Chinese -language SRs/MAs.

BACKGROUND The lack of information regarding the burden of acute bacterial meningitis in Latin America leads to a reduction in the estimated incidence rates of the disease, and impairs public health decisions on the use and follow-up of preventive interventions, particularly, the evaluation of existing vaccination policies. The use of the real-time PCR in diagnostic routine procedures has resulted in a substantial increase in confirmed bacterial meningitis cases. However, in resource-poor countries, these assays are only available in reference laboratories. Sample transportation to these laboratories is a critical constraint, as it requires specialized, high cost courier services. To overcome this barrier we evaluated the use of FTATM Elute filter paper cards for the conservation and processing of samples under normal environmental conditions, as they would be when transported from remote and under-equipped healthcare facilities to the reference centers. A total of 401 samples received in 2015 as part of Sao Paulo's national surveillance for routine diagnosis were selected for this study. METHODS The sensitivity and specificity of real-time PCR were evaluated using fresh serum and cerebrospinal fluid (CSF) samples processed using our laboratory's standard DNA extraction, and processing the same samples after being dried and stored on FTATM card, and DNA extracted following the manufacturer's instructions. RESULTS The sensitivities for detection of Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae from CSF dried and stored on FTATM cards were 98%, 92%, and 100%, respectively, and with serum samples were 73%, 88%, and 100%, respectively. When compared to our laboratory's standard methodology, results showed high concordance, with Kappa index ranges of 0.9877-1.00 for CSF, and 0.8004-1.00 for serum samples. CONCLUSION The use of FTATM cards for CSF and serum conservation and transport represents a rapid, reliable, and cost-effective alternative that will allow obtaining valuable epidemiological information that would otherwise be lost.

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method: NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results: Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion: This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country.

Background The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) is a prevalent face-to-face interview method for measuring quality of life by integrating respondent-generated dimensions. To apply this method in clinical trials, a paper-administered alternative would be of interest. Therefore, our study aimed to analyze the agreement between the SEIQoL-DW and a paper questionnaire version (SEIQoL-PF/G). Methods In a crossover design, both measures were completed in a random sequence. 104 patients at a heart surgery hospital in Germany were randomly assigned to receive either the SEIQoL-DW or the SEIQoL-PF/G as the first measurement in the sequence. Patients were approached on their earliest stable day after surgery. The average time between both measurements was 1 day (mean 1.3; SD 0.8). Agreement regarding the indices, ratings, and weightings of nominated life areas (cues) was explored using Bland-Altman plots with 95% limits of agreement (LoA). Agreement of the SEIQoL indices was defined as acceptable if the LoA did not exceed a threshold of 10 scale points. Data from n = 99 patients were included in the agreement analysis. Results Both measures led to similarly nominated cues. The most frequently nominated cues were “physical health” and “family”. In the Bland-Altman plot, the indices showed a mean of differences of 2 points (95% CI, − 1 to 6). The upper LoA showed a difference of 36 points (95% CI, 30 to 42), and the lower LoA showed a difference of − 31 points (95% CI, − 37 to − 26). Thus, the LoAs and confidence intervals exceeded the predefined threshold. The Bland-Altman plots for the cue levels and cue weights showed similar results. The SEIQoL-PF/G version showed a tendency for equal weighting of cues, while the weighting procedure of the SEIQoL-DW led to greater variability. Conclusions For cardiac surgery patients, use of the current version of the SEIQoL-PF/G as a substitute for the SEIQoL-DW is not recommended. The current questionnaire weighting method seems to be unable to distinguish weighting for different cues. Therefore, the further design of a weighting method without interviewer support as a paper-administered measure of individual quality of life is desirable.

Background Web-surveys are increasingly used in population studies. Yet, web-surveys targeting older individuals are still uncommon for various reasons. However, with younger cohorts approaching older age, the potentials for web-surveys among older people might be improved. In this study, we investigated response patterns in a web-survey targeting older adults and the potential importance of offering a paper-questionnaire as an alternative to the web-questionnaire. Methods We analyzed data from three waves of a retirement study, in which a web-push methodology was used and a paper questionnaire was offered as an alternative to the web questionnaire in the last reminder. We mapped the response patterns, compared web- and paper respondents and compared different key outcomes resulting from the sample with and without the paper respondents, both at baseline and after two follow-ups. Results Paper-respondents, that is, those that did not answer until they got a paper questionnaire with the last reminder, were more likely to be female, retired, single, and to report a lower level of education, higher levels of depression and lower self-reported health, compared to web-respondents. The association between retirement status and depression was only present among web-respondents. The differences between web and paper respondents were stronger in the longitudinal sample (after two follow-ups) than at baseline. Conclusions We conclude that a web-survey might be a feasible and good alternative in surveys targeting people in the retirement age range. However, without offering a paper-questionnaire, a small but important group will likely be missing with potential biased estimates as the result.

Purpose of review To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. As most cases of dysplasia occur at the glottic level and data on diagnosis and management are almost exclusively from this location, laryngeal dysplasia in this position paper is taken to be synonymous with dysplasia of the vocal folds. Summary LD has long been recognized as a precursor lesion to laryngeal squamous cell carcinoma (SCC). Tobacco and alcohol consumption are the two single most important etiological factors for the development of LD. There is currently insufficient evidence to support a role of reflux. Although varying levels of human papillomavirus have been identified in LD, its causal role is still uncertain, and there are data suggesting that it may be limited. Dysplasia has a varying presentation including leukoplakia, erythroleukoplakia, mucosal reddening or thickening with exophytic, “tumor-like” alterations. About 50% of leukoplakic lesions will contain some form of dysplasia. It has become clear that the traditionally accepted molecular pathways to cancer, involving accumulated mutations in a specific order, do not apply to LD. Although the molecular nature of the progression of LD to SCC is still unclear, it can be concluded that the risk of malignant transformation does rise with increasing grade of dysplasia, but not predictably so. Consequently, grading systems are inherently troubled by the weak correlation between the degree of the dysplasia and the risk of malignant transformation. The best data on LD grading and outcomes come from the Ljubljana group, forming the basis for the World Health Organization classification published in 2017.