An introduction to COVID-END resources

An introduction to COVID-END resources

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This webinar, is about, uh coveted, resources. And coveton, operates, with the funding, from the government of ontario. The uk's, national institute, of health research, and, a number of individual, donors, so we're very grateful, to those sources, of funding. If we go on to the next slide, um, i'm just going to go through some of the, um. The case for doing things differently, as we transition, from a coveton, what we sometimes, call, the sprint. Approach, that many of us used in the first six to eight months of the covet, 19, evidence, response, to what we now think of as the marathon. In that, uh covet 19, evidence, response. And. This is really important, context, for the resources, that i'm going to walk through but some of you may have heard me speak about. These. Points before, so it'll be relatively, brief. One is, the absolutely. Remarkable. Number. Of single studies being published, every day and, and that's both good because the science is moving very fast but it also creates a very high noise to signal ratio, so if you're, a decision, maker. You're. Every day being bombarded. By. People, bringing you. Or bringing to your attention. The latest, study. And i'll come back to why it's important, not to start with those single studies, but to focus, on the evidence, synthesis. That bring together all the studies, that address, the same question. Second challenge is that one-off, reviews, on long-term, and recurring, issues are quickly out of date, so. You know a review, about. Masks, for example. That was done in april, is pretty, uh relatively. Useless. Uh now and depending on how fast moving the science is so for some clinical, treatment. Something that was done even, back in. October. Would be considered, to be out of date. Third challenge, is that, many of the, reviews, being done are what are called rapid, reviews. And they in particular, but even sometimes, full reviews. Uh are of low quality, so, in addition, to the flood of primary, studies. We've also seen a flood of evidence, syntheses. And, many of the people who are, preparing, those evidence synthesis, are relatively. New to the field of evidence synthesis, so we're seeing, um, a lot of people. Trying to move up a steep learning curve about how to do evidence, synthesis, to a high quality. Then a fourth. Challenge, is, that relatively. Few of the interventions. Relatively, few of the reviews, about interventions. Provide a great evidence, profile. That speaks to the level of certainty, of the available, evidence so you can have a, high quality, review, one that was conducted, in a way that's very, uh systematic. And transparent. But the actual, evidence, contained, in the review. Is such that we have very low certainty, of what we can expect, from the intervention. Uh the fifth thing is that too many, of the evidence synthesis, that we have addressed, the same topics, and i could uh same topic, and i could give you many many examples, the one that's here is, um and we stopped counting, a long time ago but when we were counting there were more than 200. Prognostic. Reviews, so reviews, that, identified. The characteristics. Of people who are at greater risk of infection, or the greater risk of worse, outcomes. And only five of those reviews. Uh brought together, in a single, review, uh five or more, factors. Six. Is, too many key decisions, have no available, evidence synthesis. Um, let alone a living evidence synthesis, that's updated as new studies are published and i'm going to be talking about, uh the. List of have highest, priority. Gaps, in our, existing. Suites of evidence synthesis. And then the final is that the small number of uh. Living evidence synthesis, that exists. Often address the same topic, so, we have. Three of the top groups, uh in the world. Have for living evidence synthesis. All tackling. The same question. Which is uh what should we do about clinical, treatment, so, um, you know it hits in a way unfortunate. That those three teams, aren't working collaboratively. On a sieving, a single living. Evidence synthesis, and instead are doing the same work, um. In their own environments. So that's a little bit, about. Why. Covident. Has. Reacted, in the way that it's done with the resources. That i'm going to come to so this will become a little bit clearer when i get into the resources. See if we can go to the next slide. Um, i'm assuming. That. Most people would be familiar, with why we, would want to start, with. Recently, updated, high quality evidence synthesis. But, these are the four reasons. That we typically. Cite. For those of you who have a statistics. Background. The first one is about getting the point estimate, right the second one's getting as narrower, confidence, interval, as possible.

But If you're like me, and you don't work. In areas. Like clinical, treatments. Where, you often, can get to a very specific, point estimate with the narrow confidence, interval, and instead. A lot of the insight, from evidence synthesis. Comes from understanding. How findings, vary by context. And population. Synthesis, are still critically, important because it's only when we can see all the single studies, in one place, that we can start to see, patterns. In how the findings, vary by context, and population. And we think that's really critical. For questions, related, to. Health system arrangements, and also the economic, and social responses. To covet 19.. And then another, quick point, is, rightly or wrongly. A lot of. Decision, makers. Don't just want to know what the evidence, is saying they want to know what are other jurisdictions. Other countries, or other provinces. And states. Doing. That they should be aware of it may not have been evaluated, yet but it might be considered, innovative. And so they, might want to, have access, to that information, and again you'll see that. With, one of our types of products, we produce. We summarize, not just the best evidence, but also what other, leading jurisdictions. Are doing. So if we move on to the next slide. This is, kind of an overview. Of, the supports, or resources. That we have for those who are supporting, decision, making and i'm going to spend the bulk of the time. Walking, through these and then i'll turn to, some of the resources, we have for researchers. And if we have time, we'll quickly go through the website to show you how to find these, but if you when you first go to the website. You have the choice of clicking on a a button that says resources, for those supporting, decision, making and then this is the menu. That you'll see. So i'm going to talk about each of these in turn. So steve if we go to the next slide, i have a few. Slides, about the inventory. More to give you context, the best way to. Make use of it is to go directly to the website, and navigate, through the the different web pages, but, as background. We pull the, the, evidence, syntheses. From a number of sources, so, these are what we consider, to be high quality, high yield, sources. Uncover. Which is run by colleagues, in edinburgh. The the veterans, affairs, evidence synthesis, program run by colleagues, in seattle. Cochrane, of course, covet mma, is coveted, network meta-analysis. It's led by. Cochran, france with many partners. Epistemonicos. Has. A number of resources. On its website. Including. A very exhaustive. Inventory. Of single studies but here what we're doing is, pulling their own. Evidence synthesis. Products. And then what we call forward, so, when we, were on many many many many listers. When we encounter. Relevant, synthesis, we also put them into the hopper. We have two sources, of synthesis, protocols, so these are. Descriptions. Of planned, systematic. Reviews, so prospero. And the national collaborating, center for methods and tools in canada. And then we have two sources, of what we call process. And synthesis. Ones that have already, been rated for quality, and so on well one is our own in-house, at the mcmaster, health forum our rapid evidence profiles, and the other is the national collaborating, center for methods, and tools, rapid synthesis. So, when they have, already been, um, you know, rated for, quality. Data the last search extracted, that saves us a fair bit of time so that's why we draw on those sources, of process, synthesis.

So If we go to the next slide. The inventory. As you'll see have seen if you've gone to it and as you'll see if we have time for us to quickly walk you through it, is organized. On four different web pages, one focused, on public health measures, so that's. Uh masks. Physical distancing. That type of thing. Second clinical, management, and this is both, the clinical management, of covert 19 but also pandemic, related, conditions. Like. Exacerbations. Of mental health and substance, use problems. Health system arrangements. Which is. In part, how we organize, the system. To get the right. Products, like, vaccines. To people now the vaccines, are coming online but also. Questions, like how do we, prepare, for, and respond, to surges, and infections. When, our hospitals. Become overwhelmed. And then finally economic, and social responses. Which covers, the full gamut, of, financial, protection. Um. You know travel and tourism. All of the other parts of society, that have been uh profoundly, affected by covet 19.. Then we use the term, best, evidence, synthesis, so for any given decision, you might find. Zero, one two three syntheses. Um, zero means we can't find any high quality, synthesis. One means we could find one that was the best match to the question. When we have more than one. Typically. One of two things are happening. Either. Different, syntheses, are dealing with different aspects. Of, the, decision. Or. It's the case that they're dealing with the same aspect. Of the decision. But they vary, in terms of our, criteria. For best so one might be more recent but the other one, may be higher quality. And best for us is defined, by three criteria. So how recent, the search was, uh the quality of the review, and whether there is a grade evidence, profile. Every, review. Then has a hyperlinked. Declarative. Title, so instead of using the title provided. By the group that prepared the evidence synthesis, we write our own, and we try to write it in a way, that makes it easier, for people to scan it and say yes that is relevant. To the decision we're considering, or, no it's not relevant, so, if it's a review about effectiveness. Then, we try to convey. Information. About what is sometimes. Abbreviated. As pico the participants. The interventions. The comparators. Or the outcomes. And the certainty, level for the available, evidence so if there is a grade profile. You'll, often, see language, like there is low certainty, evidence, about the effectiveness. Of, class, face masks, for example. Then we also provide, additional, decision. Relevant, details, like whether, the evidence, synthesis. Is. Living. And we take, the word of the evidence, census, producer. For this so we do not have, our own criteria, as yet but if they assert, it as a living evidence synthesis. Then. We note that. And we now every single, week, go back through the living evidence syntheses, that are in the inventory. And update the date of search and update the declarative, title if the findings, have changed since the last time we looked at it, and we also. Described, the synthesis, type like rapid, versus, full review, and synthesis, question, so for example. Is it about benefits, and harms or is it about. Values. That citizens, believe, should guide the allocation. Of vaccines. So if we go on to the next slide. Just to give you a sense, for, how the inventory. Reduces. The noise to signal ratio, so we have now. Harvested. More than 3. 600. Evidence syntheses. After removing, duplicates, we end up with, more than 2. 600. We then have. Uh. 1250. Or more, in our database. So they were rel they were eligible. So for example, they are an evidence synthesis. They are, relevant, to a decision. And then we have, 175. In the inventory. So we go, all the way down to. You really only need to look at these, 175. Plus. The rest of them are either. Lower, quality, or not decision, relevant. Or, something, else so, a, remarkable. Reduction. In the noise to signal ratio. So if we go on to the next slide. Uh another. Uh resource, that we provide, for those supporting, decision, makers. Are horizon. Scans, for emergent, issues. Um, and our horizon, scanning, panel. Also fits. Plays a role in. Helping, us prioritize. Topics, where we most, uh, need, evidence, synthesis, going forward but i'm going to come to that, a little bit later in the presentation.

Those Priority, topics. For now what i'll say about our horizon, scanning work. Is that the team, prepares, a monthly briefing, note drawing on horizon, scans, done, around the globe. Uh they then, convene. A meeting, or a panel, meeting, um. I think our current membership, is just, a little bit over 40.. These are diverse. What we sometimes, call strategic. And out of the box thinkers, and doers. And they're diverse. Intentionally. They've been selected. Because, they are diverse. In their. Knowledge, and experiences. With different, parts of our taxonomy. So, some may know a lot about public health measures, some may know a lot about clinical, management. Others about health systems. And others about. Different aspects, of the economic, and social response. They're also, diverse. In terms of the role that they play. Some are citizens, and we've just added. A couple of more citizens. Thanks to the leadership, of of maureen, smith our lead for citizen, engagement. We also have service, providers. Like physicians, and others, we have policy, makers. And we have researchers. We cover all who. Regions, but we're a bit light in the southeast, asia. Region, currently, and we, cover, uh all, uh major, who. Languages. Um, one of the recent. Things that we've started doing with the panel as well. Is in addition, to eliciting, from them, the emerging, issues. That we need to be paying attention, to. We also, ask them, to, prioritize. And help us, frame, in a way that will be most decision, relevant. The topics. Where we most urgently, need synthesis, and again i'm going to come back to this. A little bit later. In the presentation. So that's horizon, scans. On to the next slide. So a, third resource. That we provide for those supporting, decision, makers, is essentially. An online, community, of practice, where, people, who are supporting, decision, makers. Can share their experiences. And also. Learn from others who are doing similar, work, so you'll see some of the attributes. That we. Were looking, for when we initially. Issued the invitation. This is an open community, so of course. Different people can join, but we're particularly. Interested, in those who are creating, and or using, evidence synthesis, or related, products. Engaging. Directly, with decision, making. With decision, making. And are keen to learn from others. And willing to explore, challenges, or share experiences. With others, and then, coveton. Itself, has some principles, which we think are important. And we just ask people to confirm, that they're comfortable, with those principles. So if you are, someone who is supporting, decision, making, and you feel that, this describes, you we'd be absolutely, delighted, to have you. Join the listserv. You can be as active as you want. Posting, yourself. Or you can be what we sometimes, call a lurker, i'm a lurker on a number of listservs. I post, on some of them. Or don't post or post very infrequently, but i learn a lot from. Monitoring, the discussion. So that's the covetent. Community. If we now go to the next slide, a fourth resource. That we provide. For those supporting, decision, makers this was developed. By our colleagues, at the africa, center for evidence. And it's called the living, hub, of covet 19, knowledge hub so, living, hub in the sense that, our colleagues, at ace. Are. Regularly. Updating, the hub, um and so it remains. Kind of a source that you can keep coming back to. Um and, what, um, this was created, for is, to address, the reality, that many decision, makers. Were asking, well how do i find an organization. That is supporting, decision, making. On topics. Or in sectors, that i care about. And they may also say that well and i also want a group to, maybe focus more on making recommendations. Or it may be. Presenting. Data. And it may also. They may have a preference, for a particular, geographic. Scope they only want to find. Groups that are working in africa. Or in latin america. Or linguistic. Scope, they're looking for a group that provides. Covert, 19. Knowledge, support. In spanish, or in chinese, or another language, so, incredibly. Helpful way to zero in, on groups, that, you might want to draw from, and or. You know collaborate, with. So the second, point there is the depth. That is used by the african center for evidence so you'll see how they define, a knowledge hub. And they've gone through two, major. Um. Um, kind of, releases. Of the data that are available, to search. In the online living hub, and in the second release, by then they had gone through. 440. Hubs. And 304. Met their inclusion, criteria, so when you search the hub. You're searching, a database, currently, that includes, 304. Hubs and that will. Continue, to grow and change, as. More hubs come online, and perhaps, in future.

When Some hubs. Retire, from activity. So on to the next slide. So some of the additional, supports, so um, some of these. Were more visible. Earlier, in the pandemic. But, and an example, would be the first one the guide. So initially. One of the first things that kovaren, did, was provide, a guide to high-yield, high quality, sources. But now that. Through the inventory. Work. We are. Every, week, going, through those high-yield, high-quality. Sources. Others, don't need to do that work. So the guide. Is. A way to say if you go to the inventory. And don't find the match to the question you're. Dealing with, then you can, instead, go to the guide, and look at other sources, that we. Have found to be helpful. So with our own, rapid evidence service that we provide, for example, at the mcmaster, health forum. When we get a question from decision, makers. And we responded. Anywhere from four hours to three days. The first thing we do is we check the inventory. And then having, checked it if we don't find what we're looking for, we move on to the guide, and when you're going through the guide, you'll see flags. For. The sources, that are already, searched, by the inventory. So you can focus, on. The other sources. Some of the other things that we have, are some tips, for those who are packaging. Evidence, for decision, makers so this is based on a lot of experiences. And how to do this effectively. We also, describe. The evidence support, model that i just mentioned, so. If you are. Part of a response. Team trying to support decision, making, and want to see, a description. Of how one group. Has responded. To support, national, or sub-national. Decision-making. And, do it in a way that, contextualizes. The evidence, for those, decision, makers, in that context. At a particular, moment in time. This may be helpful. And the model. Involves, producing, these rapid evidence, profiles, so it's not a synthesis, it doesn't say, here is the bottom line message, it is a profile.

Of, Available. Syntheses. Or in their absence, single studies. That may be helpful, to you. And those, rapid evidence profiles. As i alluded to before, profile, both research, evidence. And what innovative, jurisdictions. Are doing but. Where they may not yet. Have evaluated. Their efforts. And then finally there are some tips and tools. For those supporting, decision, making. So that's the current. Array of resources. Available, for those supporting, decision, making. Steve i'll just check in with you have there been any. Posts in the chat box so far about this part otherwise, i'll switch gears, and then we'll open it up for discussion. At the. End. Know there's not been any but i would think we'll use the chat options. At the end, exactly, great. So steve can we go on to the next slide which, now i'm going to switch gears, to. Uh resources. For researchers. So the first thing and, is, the. Priorities. For living evidence synthesis, so i alluded to this when i was talking about the work of the horizon, scanning, panel so they help us, identify. Emerging. Issues, so this past month of course, the big focus, was. A whole array, of. Decisions. Related, to vaccine, rollout, now that vaccines. Are. On the verge of being available. So that was an example of a set of emerging, issues, but over time they have helped us, build up, a, list, of topics, that we then check against the inventory. To say well do we already have, a robust. Evidence, for that so an example, would be. At an early meeting they may have said well we need to know the safety, and effectiveness. Of different drug treatments. When we go to the inventory. As i mentioned before, there are three groups in the world, running, living meta-analyses. Of drug treatments. So that is covered up well there is not a need. For more living evidence synthesis, in that space. But for an array of topics. We know there are important decisions, to be made. And we don't have. Any best, living evidence, synthesis, that we can turn to, so i'm going to run through, the current list which we'll be posting. On our website, later this week, and at the end of the list, i'll i'll walk you through, the tips, for teams, that might want to put up their hand to take on one of these topics. And then my last slide will be. Supports, for evidence, synthesizer. So i'll just walk you through that as an additional resource, and then one. That we hope will be up within about a week are, supports, for guideline, developers. So, these are both, specific, to covet 19., so, obviously, there are many, resources. Out there if you're synthesizing. Evidence or developing. Uh guidelines. But these are how do you do that in the particular. Context. Of covet 19.. So steve can we move on to the, priority, topics. So these, topics. Are, organized. By those. Four, parts of the coveted, taxonomy. That i've referred to repeatedly. Public health measures, clinical, management. Health system, arrangements. Uh and economic, and social response, and the horizon, scanning, panel, helps us, with the, prioritization. Within, each of these domains, so in any given month, topics, might move up the list. And, they also. Depending, on what's been added to the inventory, they might move, off the list because we now have, um best evidence synthesis. On those topics. So if you just scan, the public health measures. A big focus, of decision, makers, on how do we support, adherence. To public health measures, like, physical, distancing. Wearing masks. A big interest, in test, track, trace, approaches. Particularly. How do you optimize. Them given your current capacity. In the system so there are times where, contact, tracing, isn't possible, there are so many new infections. That the tracing, system, gets overwhelmed. So how do you. How do you manage, that. Third relates. To. Capacity. Within, public health, units. And their linkages. To the broader, health system. Fourth, the emerging. Recognition. Of the the, greater, geographic. Dispersion, of covet outbreaks, in wave two so in wave one, they were often quite concentrated. And wave two, they're often, much more geographically. Dispersed, so, understanding. Why but also, understanding. How that changes, how we need to respond, to copin 19. And then building. Rapid, response, mechanisms. To support things like outbreak, studies so when we have outbreaks. How do we. Quickly, learn from them. In ways that can help us with future, outbreaks. For clinical, management. I mentioned, that questions, around. Drug treatment. And soon the safety, and effectiveness. Of vaccines. Are. Well handled, or in the latter case will be well handled. By. Living. Meta-analyses. That are, ongoing. By those different groups in the world that i mentioned before. But some of the clinical, topics. For which we don't have, um, living. Best, evidence synthesis. Or at least don't have them addressing. All facets. Of the relevant, decisions.

Those Are long-haul, symptoms, of coping 19, among people. Without severe covet this is sometimes, called long covet. Understanding. Coveted as a syndemic, so often, the people experiencing. Covid19. Infections. Also, have, other infectious, diseases. Or other, chronic. Non-communicable. Diseases. And, so their, experiences. Are complicated. By the co-occurrence. Of covet 19. And a number of other conditions. Third, the concurrent, management, of covet 19. Another, seasonal, infection, so how do we. Deal with. People, walking, into. Offices, and hospitals. With chest, infection, it could be, a regular, pneumonia, it could be a regular, flu or it could be covet 19, how do we help clinicians. With that, and then screening, for and managing, emerging, mental health and substance, use issues. So now if we move on to. Health system arrangements. As i mentioned. This month. The month of november. The big focus, for the horizon, scanning panel was vaccine. So, a massive, set of decisions. Will need to be made in the coming weeks and months about, how we allocate. Vaccines. Uh how we communicate. With the public, and address. Misinformation. About vaccines. How we actually, administer, them so how will we get two doses. Of a vaccine. Into, most, people's, arms. In a timely, way given, many of the current vaccines. Being considered, require, what's called an ultra cold chain they need to be kept at very very cold temperatures. Right up to. Just before the doses, are administered. And also reporting, how do we, link, vaccine. Data. Both the fact that people are vaccinated. But also, adverse, events. Two existing. Information. Systems, including, kovadap's. Uh copa19. Apps when appropriate. I won't go through all the others but you'll see. You know opportunities. To as we respond, to covet. Try to strengthen, health systems. Not steamroll. Them with kind of vertical, programs, so strengthening, government, governance. Leveraging, primary, care. You'll see other comments, around, keeping, health workers. Motivated. And safe but also addressing, shortages. When numbers, high numbers of them become infected. Restoring, non-coveted. Services. After, lockdowns. Where. Hospitals, have had to try to empty. Their regular, cases, to deal with an influx, of covet, patients. And then strategic, purchasing. Packages. Of responses. And then trying to consolidate. The gains, that many countries, have achieved. Because of the need to move to virtual, care. And then finally.

Economic, And social. This list is. Particularly. Long when you get to the inventory, one of the. They really, frustrating. Things is we have so few. Best evidence, syntheses. For the array of economic, and social. Uh responses. To the pandemic. So i won't read through these but you can scan them, and see issues related, to. Financial. Security. Vulnerable, populations. The operations. Of schools. Concerns, around food poverty. Concerns, around countries, reaching what are sometimes, called fiscal, cliffs. And, potentially. Getting into debt traps, as countries, went with the significant. Amounts of money being spent on, on covet 19. And then on to the next slide. You'll see some others, tourism, and travel, for countries. Like those in the caribbean, for example, absolutely. Essential. Gender-based. And domestic, violence. And the list goes on. We also. This month, began, to think about whether there are cross-cutting. Issues. That. Where you, need to think, in a more holistic, way across. The taxonomy. And the example, that you'll see here. Has to do with equity, i'll come back to equity, in a second. So my penultimate. Slide the next one. Is the tips for teams so, if you are a researcher. Who has experience, with evidence syntheses. And you see one of those topics, and you say hey i would love to build a team, uh to prepare. And maintain, a living evidence synthesis, on one of those topics. These are things that have come up from, our horizon, scanning, panel. Deliberations. That you might want to keep in mind so, in addition, to thinking of equity as a cross-cutting. Issue. Any time we approach, a particular. Issue, like. Supporting. The wearing of masks, and physical distancing, and so on, bring an equity, lens to that because, often. Our capacity. To adhere, is profoundly. Influenced. By our need to work, by our incomes. By a variety of other factors. Second. Always think about, in the early days of covet, we are very focused, on, doing the public health measures, because of their benefits. Doing things like closing, schools. But we're now much more attentive, to, weighing, those, public, health benefits. Against, the potential, costs, like, to things like. Educational. Outcomes, for kids. And then think about. If. Government capacity. Is another key variable. So, what a country, like, china, can do. Um, with its approach. To. Data collection. Is very different, from what another country like canada, might be able to do, so this is capacity. In the sense of both administrative, capacity, what can we do but also political. Capacity. To pull off some of these things that are being considered. Other things to keep in mind, interdisciplinarity. So. Covet. And most, of the cova, decisions. Are really, complex. And ideally, you want people. Coming at the evidence. From multiple, different perspectives. Including, having, citizens, around the table. To help interpret, what the science, means. And then finally. If you are going to take on an evidence synthesis. Please. Don't. You know do a one-off, one if it's one of these high-priority. Topics, set yourself, up from the beginning. Ideally, to make it living. So steve i think the final, slide, is, the. Resources. The supports, for evidence synthesizer. So remember the one for guideline, developers, will be coming online hopefully within a week, but if you go to the supports for evidence synthesizers. Could we just go back, you'll see an interactive, flow diagram. You'll then. See, a description, of the importance, of really, understanding. The issue or decision, to inform. And our horizon, scanning, panel again has been incredibly, helpful. In helping us to frame, issues. That enhance, that, would enhance the decision, relevance, of any resulting, synthesis. And then, you can navigate. Through. Once you know what the issuer, decision, is. How do you look to see whether something's, already out there that you can just use, and that would be the case for things in the in our inventory. Or do you need to update an out of date review, and if so how would you approach that, or do you actually need to conduct a, a new review, and when we, uh and on the website, you'll see then there's a series of steps, uh where. Uh the authors, of this, material. Walk you through the covit, supports. Uh that are specific. To conducting, a new review, in this context. So steve i think the last slide is just the. The website. So why don't i check in and see, if any questions, have come in and if we have time, we'll quickly. Walk you through the website, to. Make it absolutely, clear where all of these things can be found but steve have any questions, come in that i can, answer. Uh there is uh there is one again i would just encourage, people to, ask their questions in the chat box, uh the one questions come in so far john, is asking, whether there is any particular, online training, that you offer to public members to become more familiar with the resources, of the system.

Uh For example like cochrane, training for consumers. Uh or does mcma, dance mcmaster, or covident. Or i guess many of the covenant, partners have something, similar. Uh i think so great question, so far what i would say is the best resources, that are targeted, at citizens. Are on the cochran, website, so, uh we probably, need to do a better job, um on our website, of pointing, to those so, with the citizen. Uh. Citizens, that we have recruited, to coveten. So, again under maureen smith's leadership. We now have citizens, sitting on our partners, steering, committee we have them sitting on the horizon, scanning, panel we will soon have them sitting on our different working groups, and one of the, the. Suggestions. That we made in the onboarding, session, is they take advantage, of these amazing, free resources. Available, through cochrane. To get background. On, evidence syntheses, if they're not used to it to an array of issues, that, if they have the time to spend, using these free online. Resources. It would enable, them to contribute, even more, in our discussion. So, right now i would point to. The amazing, cochrane, resources, as kind of the first. Uh stop but we will absolutely. Uh keep this in mind and work with maureen, and her colleagues, to better, profile, these and other resources. Available, through coveted, partners, on the website, going forward. Great thanks john uh there's no other questions. Right now, so. Could we do that yeah that would be great, so i'll what we'll do is we'll just quickly navigate, around the website, just to help you understand. Um, where these different things, are, um. So. When you first come to the website, you'll see that, second, box from the left, resources, to support, decision, making. That is where the bulk of what i have talked about is, and steve if you can just go to the box to the immediate, right. The resources, for researchers. That's the. Second set of resources, that i walked. You through, so if we start, back with the first set of resources. For those supporting, decision, making. I have to expand, my screen, the first is, the inventory. Of. Evidence synthesis, so you'll see, in the menu off to the right, if you want to know more about the contacts, for the inventory, and the approach, we use, you can go to those pages. Then there's also, tips for using the inventory. And we have a. Superb. Um. Document, we'll be linking to shortly. Prepared by our senior advisor, david toby i've been the rate limiting, factor in in getting that up but it will be added, and then you'll see the four. Web pages. For each of the parts of the coveted, taxonomy. So if we click on public health measures. When, it and if you just scroll down a little bit steve, you first see. Um. This. Version. Of it. Steve can you just click on show hide, columns. To show how. When you click on that, you get the additional, columns. Of living evidence, synthesis. Type of synthesis. And type of question. So moving from left to right. You have the decision. So, washing, hands, wearing masks. And so on. Then you have the date of the last search. And unfortunately. These uh, these absolutely, critical, topics that we kind of take for granted. Are. Most decisions, based on on them are based on synthesis, that are now actually remarkably. Old you'll see dates there april, and may. Then you'll see, the quality, rating. Then you'll see, a note about whether, it has an accompanying, grade profile. Then you'll see the key findings, those are the declarative, title. Then you'll see whether it's the living evidence synthesis, and so on. And then you have the citation. So that's the, living evidence synthesis, and if you just scroll down steve. People can get a feel for the types of decisions, we cover. So wearing personal, protective. Equipment. Disinfecting. Surfaces. Physical, distancing. Public focused, behavior, change supports, and so on. Helps worker and essential, health workers, support, service, limitations. But we deal with those wherever they're appropriate, elsewhere, in the taxonomy.

Screening. And then on to. Testing. Quarantining. Isolating. People, if you're. Confirmed, tested, sorry i thought we'd pass testing there's testing. And then lower. Down. Speeding, results. Isolation. Contact, tracing, yeah so that just gives you a feel for the public health measures. Um steve maybe if you could just click on clinical, management. Clinical, management. Is a, very, long. Uh table, because. There have been, so many. Um. Potential. Treatments, that have been looked at, um the top, of the table, first you'll see the prognostic. Factors, but lower down once we get into the treatments. First you'll see the all drug comparisons. So where people have done. Started to do a network meta-analysis. You'll see the overall comparisons. And then they go. Category. Of treatment by category, of treatment with every relevant, comparison. So, the most recent, big topic, was rem deserver. A drug treatment, um and so you'll eventually, get to a row that is specific, to rem joseph, here. So steve maybe, we'll leave the inventory. At that people can explore, that could we go back up to. The, menu, so the next are horizon. Is the horizon, scanning, work. So if you want to keep up to date on this if you just scroll down. Every month. The meeting materials. Are posted. Usually, within a few days of the the last meeting so the group usually, meets. I think it's the last, wednesday, of every month and then, we try to get it out, um. By early the next week so for our meeting on november, 5th you'll see the briefing, note. And you'll see the panel. Meeting report. So that's. The. Horizon, scanning. Then steve can we just go back up. Onto the community. So if you're interested, in joining the community, just scroll down and you'll see, in bold, join the coveton, community, listserv. So that's the place to. To sign up if you want to share your experiences. And learn from others, about how to support decision, making. Then back up. Living hub. So you'll see background, on it and then you'll see the searchable, database. So, on, the right hand side. Are the, i think there's as i mentioned before 304. Centers, so they all start off on the right. And then as you, either, enter, search, terms. Or click on filters. It immediately. Narrows. The. Listing. Of. Hubs. To those, that, meet that criteria. So if, steve just clicked on public health measures. So now we're getting a shorter, list, of, the hubs. That are the ones that specifically. Deal with public health measures. But you can also, add in, other things like geographic. Scope. You know you only want ones that are focused, on, country, level. Uh regional, scope. Uh. You know might be that you want to focus, in on, a particular, region, like africa. So it's very easy, to narrow, in specifically. On the. Knowledge, hub that is most relevant, to you. So back up to the menu. Uh, the last piece is the additional, supports. So that you'll see off to the right. The guide. The, evidence, packaging, resources. Evidence support model tips and tools, so maybe we'll just go to the guide. And that'll be the only other page we'll show you from here. So if you scroll, down, you'll see. Sources. Organized, in major, sections. And you'll see a green, flag, coveted, inventory. So if you look at. Sources. Of living systematic. Reviews. The va. Evidence synthesis, program, we have there because. For a long time and and really other than the coveted, inventory, now, they're the one group out there that flags. Living evidence, synthesis. So that's, hugely, helpful, and when we first set up the inventory.

Those Are the evidence syntheses, that we process, first. And then lower down you'll see. Cochrane, is covered in the coveted, inventory. So is the, uncovered, database. So is covet nma. And so on so, um anything, that's not covered. If you can't find, a relevant, evidence synthesis, in the inventory. You can come here and click on any of these other sources, and quickly search them uh to see if there's, uh relevant, evidence that you can use. So that's the guide, steve could we just, pivot, now to the resources, for researchers. So i mentioned. That the first, of those. Parts of the menu the first part of the menu priorities. For new syntheses, that's the piece. That we'll be adding in the coming days. Should have been done for today, my fault again. Too many things going on and uh on a computer, that's not working but it should be done by the end of the week, the thing that's up is the supports, for evidence synthesizers. So steve if you can. Show that. So one is. The interactive, flow diagram. So you can use, this, to navigate. Around. So it's meant to help you, see the big picture, of the resources. For evidence synthesizers. And then having seen the big picture. You can use it to navigate, around the resources. So you can either use this or you can go back up to the menu. And say okay i specifically. Want help i i've looked, there's nothing out there i can use right now. I can't, find. Even an old, low quality review that i can update and improve the quality of i'm gonna i want i'm gonna have to do a new synthesis. So that's where you get this longer, list, okay. How do i identify, the question, how do i assemble an appropriate, team. Can i use some digital applications. And, and involve. People, volunteers. Around the world. That's the crowd, piece, how do i register, the protocol. How do i search best sources, of primary, studies. And how do i conduct, and report, the review, using robust, methods. So all of that, is sitting there this of course draws, on, years, of work by cochran. Campbell, many other groups about how to do high quality evidence emphasis. But here it's contextualizing. It to covet, so at each step, if there are covid, specific. Supports. Available. It points you to those, to ensure, that you're building on the best of what's out there. So that's a quick run-through. Of the resources. I'd encourage you to. Explore, the, the website, if you have feedback, up for us about how we can. Do better like with the example, of profiling. Citizen, targeted. Resources. Let us know, and we're, certainly, always open to feedback. So that's the quick run through the website. Steve can we. Check in if there are any other questions, otherwise, we'll, move to wrap up. Steve. Yep sorry i was just checking uh there's. One other, question, is, there a document that describes how the taxonomy, of public health measures were defined. Uh no, no so we we, we at one point, had a very detailed. Set of documents, related to the taxonomy. But i. That has not been kept up to date because. The. The process. In a nutshell i can describe the process, which was, um, in the very early, weeks, when, covet, was first. Kind of exploding. Um, we went to a. An effort. To come up with a mutually, exclusive, collectively, exhaustive. List of decisions, so, that was done by, reading and reading and intentionally, trying to find different sources, that would help us build out the taxonomy. Then we consulted. With a number of experts, across, the different domains, to figure out what we needed to change, and adapt, and so on. And then having, landed, then on a working, taxonomy. We've used that going forward, and now, we make ongoing. Adjustments. Um as we encounter. Best evidence, synthesis, so, we might get an evidence synthesis. Where we suddenly realize oh we don't have a a row for this or, the way that the row header the decision. Is framed. Doesn't, actually, align with what the real, issues, are, so we're continuing. To adapt. Up front, it was based on this effort, to be. Mutually exclusive, collectively, exhaustive. And to draw on existing, frameworks, and other sources, to build it out and now it's being continuously. Adapted, based on, what we encounter, in the literature. So again if people have, suggestions. For, uh how to strengthen, it we're certainly, um. Open to making adjustments, as we go. Anything else steve, by way of questions. No that's all the questions, uh for now that have come in john i'd just like to thank everybody for joining us today.

And I just wanted to mention, that uh for our covered end webinars. We will be, hosting, these on a monthly, basis, going forwards. Uh so i would encourage, you to, check, the coden, website, there is a page on there for. Our webinars, and when we have the details, for the webinars, and then the year they'll be posted, and updated, there so we hope you'll. Join us for our future webinars. And thanks for a great presentation, today, john, and. Could i just check one thing with you, am i right that you're recording, these and you'll post the link to the recording, so, if people want to go back or want to bring, a webinar to people's attention. Um they can find the recordings, on the covedent, website. That's right so the same events page, where. All the details about future webinars will be available. We'll make sure that a link to the recording from today's webinar, is available, there so again if you missed part of it or want to go back or you want to share it with colleagues, it'll be available, there. So we hope that everybody takes advantage of that as well, great, excellent, all right thanks everybody for joining us and thanks steve for. Troubleshooting. With my. Failures, to be able to use my laptop. It was a pleasure thanks everybody for joining us today we'll talk to you or hopefully, have you join us again soon. Thank you. Bye-bye. You.

2020-12-10 03:30

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