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Evidenz in der Gesundheitsversorgung / Evidence in Health Care| Volume 174, P20-31, November 2022

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From conventional to living guidelines – faster updates for better informed guidance? A scoping review

Open AccessPublished:August 27, 2022DOI:https://doi.org/10.1016/j.zefq.2022.07.004
From conventional to living guidelines – faster updates for better informed guidance? A scoping review
Previous ArticleDas Delphi-Verfahren: Methodik, Varianten und Anwendungsbeispiele
Next ArticleClinical trial research agenda on COVID-19 – the first two years in Germany and beyond

      Abstract

      Objective

      The goal of living guidelines is keeping recommendations in guidelines up-to-date as new evidence becomes available. This review aims at scoping the prevalence and formal characteristics of living guidelines in the field of medicine and explore differences between formats.

      Methods

      A selective search of living guidelines in MEDLINE via PubMed, Google Scholar and six relevant online repositories for guidelines (MAGICApp, AWMF, GIN, NICE, WHO-Iris, BIGG) was conducted. Authors and editors were contacted to receive previous non-living guideline versions. Living guidelines were subsequently analyzed according to pre-defined methodological criteria as described below (inter-comparison). Differences between living and their conventional (non-living) versions were assessed (intra-comparison).

      Results

      83 living guidelines were identified and selected for further screening, out of which 26 were eligible for analysis. 61.5% were new publications (de-novo guidelines) and 38.5% updates of pre-existing guidelines. There are some concepts defining, for example, the update cycle (AWMF, maximum of 12 months) but not all living guidelines follow or refer to existing concepts. The analysis shows that living guidelines in line with the established standards for (non-living) clinical guidelines involve an evidence standard, an extensive consensus process (often in the form of a Delphi process), and the inclusion of stakeholders (patients/relatives) in the development process, despite the high frequency of updates. When comparing living and conventional guidelines with the descriptive approach changes were found in update frequency (being more frequent with living guidelines, annually at the latest) and publication format (towards more digital) and public consultation (living guidelines offered more possibilities), no substantial methodological differences were observed in the description of consensus processes, changes in number of recommendations, inclusion of patient representatives. Given the small number of comparable pairs, the results reflect a tendency in the analyzed sample.

      Conclusions

      The definition and development of living guidelines varied. Standardization (i. e. in the form of a checklist, procedure template) is needed to assess quality of the living process.

      Zusammenfassung

      Hintergrund

      Living Guidelines zielen darauf ab, Empfehlungen klinischer Leitlinien stets aktuell zu halten, indem diese überarbeitet werden, sobald neue Erkenntnisse vorliegen. Ziel dieser Arbeit ist es, eine Übersicht über die Verbreitung, die formalen Charakteristika und Unterschiede zwischen den Formaten von Living Guidelines im Bereich der Medizin zu schaffen.

      Methode

      Eine selektive Literaturrecherche in MEDLINE via PubMed, Google Scholar und sechs relevanten digital verfügbaren Registern für Leitlinien (MAGICApp, AWMF, GIN, NICE, WHO-Iris, BIGG) wurde durchgeführt. Autor*innen und Herausgebende wurden kontaktiert und um Zusendung vorausgehender Versionen im konventionellen, Non-Living-Format gebeten. Living Guidelines wurden anhand a priori festgelegter Kriterien (inter-comparison) sowie hinsichtlich der Unterschiede zwischen non-Living und Living Formaten (intra-comparison) analysiert (für eine genaue Beschreibung der Kriterien wird auf die Beschreibung im Text verwiesen).

      Ergebnisse

      Es wurden 83 Living Guidelines für das Screening ausgewählt und 26 davon als passend für die Analyse identifiziert. 61,5% waren neue Publikationen (De-novo-Leitlinien) und 38,5% revidierte Aktualisierungen bereits bestehender Leitlinien. Es existieren Konzepte, die feste Kriterien für Living Guidelines, z. B. im Hinblick auf Aktualisierungsintervalle, festsetzen (AWMF, max. 12 Monate). Nicht alle Living Guidelines beziehen sich auf bestehende Konzepte zum Living-Prozess.
      Die Analyse zeigt, dass Living Guidelines im Einklang mit den etablierten Standards für (Non-Living-) klinische Leitlinien einen Evidenzstandard, einen umfassenden Konsensprozess (oft in Form eines Delphi-Prozesses) und die Einbeziehung von Interessenvertreter*innen (Betroffene/Angehörige) in den Entwicklungsprozess beinhalten, trotz der hohen Aktualisierungsfrequenz. Beim Vergleich von Living Guidelines und konventionellen Leitlinien wurden mit dem deskriptiven Ansatz Veränderungen in der Aktualisierungshäufigkeit (Living Guidelines werden häufiger, spätestens jährlich, aktualisiert) und im Publikationsformat (hin zu mehr digitalen Formaten) sowie in der öffentlichen Konsultation (häufiger bei Living Guidelines) festgestellt, während bei der Beschreibung der Konsensprozesse, den Veränderungen in der Anzahl der Empfehlungen und der Einbeziehung von Betroffenen oder deren Interessensvertreter*innen keine wesentlichen methodischen Unterschiede beobachtet wurden. Angesichts der geringen Anzahl vergleichbarer Paare sind die Ergebnisse als Tendenz zu interpretieren.

      Schlussfolgerung

      Die Definition und Schritte in der Entwicklung der analysierten Living Guidelines variierten. Eine weitere Standardisierung (z. B. in Form einer Checkliste oder eines Manuals) zur Beurteilung der Güte und Qualität des Living-Prozesses erscheint erforderlich.

      Keywords

      Schlüsselwörter

      Introduction

      Clinical practice guidelines support physicians, patients and other stakeholders to make decisions that are relevant to individual patient care in a broad body of scientific evidence [
      • Graham R.
      • Mancher M.
      • Wolman D.M.
      • Greenfield S.
      • Steinberg E.
      Clinical Practice Guidelines We Can Trust.
      National Academies Press, Washington, DC2011
      ]. The Institute of Medicine (2011) defines clinical practice guidelines as “statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options.” [
      • Graham R.
      • Mancher M.
      • Wolman D.M.
      • Greenfield S.
      • Steinberg E.
      Clinical Practice Guidelines We Can Trust.
      National Academies Press, Washington, DC2011
      ]. The development of a guideline is extensive in terms of time and costs. Multiple experts, professions and associated stakeholders are involved and have to agree on the certainty of the relevant evidence and reach consent on recommendations. To ensure the high quality of a clinical guideline a number of standards have been established [

      Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - ständige Kommission Leitlinien (2020). Das AWMF-Regelwerk “Leitlinien” (Aufl.). http://www.awmf.org/leitlinien/awmf-regelwerk.html [Accessed 18 February 2022]

      ,
      • Brouwers M.
      • Kho M.E.
      • Browman G.P.
      • Burgers J.S.
      • Cluzeau F.
      • Feder G.
      • Fervers B.
      • Graham I.D.
      • Grimshaw J.
      • Hanna S.
      • Littlejohns P.
      • Makarski J.
      • Zitzelsberger L.
      AGREE II: Advancing guideline development, reporting and evaluation in healthcare.
      CMAJ. 2010; 182: E839-E842https://doi.org/10.1503/cmaj.090449
      ]. The development takes its time and due to an exponential growth in scientific evidence, clinical guidelines are often no longer up-to-date at the time of their publication [
      • García L.M.
      • Sanabria A.J.
      • Álvarez E.G.
      • Trujillo-Martín M.M.
      • Etxeandia-Ikobaltzeta I.
      • Kotzeva A.
      • Rigau D.
      • Louro-González A.
      • Barajas-Nava L.
      • Díaz Del Campo P.
      • Estrada M.-D.
      • Solà I.
      • Gracia J.
      • Salcedo-Fernandez F.
      • Lawson J.
      • Haynes R.B.
      • Alonso-Coello P.
      The validity of recommendations from clinical guidelines: a survival analysis.
      CMAJ. 2014; 186: 1211-1219https://doi.org/10.1503/cmaj.140547
      ]. This poses specific problems, since - as the COVID19-pandemic has shown – a rapidly changing evidence base should trigger frequent updating of recommendations. In this context, a recent study on the validity of recommendations in clinical guidelines showed that 92 percent (95% confidence interval 86.9–97.0) of the recommendations were valid 1 year after their development. This probability decreased at 2 (85.7%), 3 (81.3%) and 4 years (77.8%) [
      • García L.M.
      • Sanabria A.J.
      • Álvarez E.G.
      • Trujillo-Martín M.M.
      • Etxeandia-Ikobaltzeta I.
      • Kotzeva A.
      • Rigau D.
      • Louro-González A.
      • Barajas-Nava L.
      • Díaz Del Campo P.
      • Estrada M.-D.
      • Solà I.
      • Gracia J.
      • Salcedo-Fernandez F.
      • Lawson J.
      • Haynes R.B.
      • Alonso-Coello P.
      The validity of recommendations from clinical guidelines: a survival analysis.
      CMAJ. 2014; 186: 1211-1219https://doi.org/10.1503/cmaj.140547
      ]. The Association of the Scientific Medical Societies in Germany‘s guideline register requires to update a guideline at least after 5 years [

      Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - ständige Kommission Leitlinien (2020). Das AWMF-Regelwerk “Leitlinien” (Aufl.). http://www.awmf.org/leitlinien/awmf-regelwerk.html [Accessed 18 February 2022]

      ]. This finding demonstrates a potential gap between growing scientific knowledge and its implementation in the clinical work with patients.
      The concept of living guidelines represents one approach to close the gap [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ]. “Living guidelines aim to provide timely advice for decision makers by optimizing the guideline development process […] to allow updating individual recommendations as soon as new relevant evidence becomes available” [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ].
      This goal can be achieved, for example, by publishing and managing the guidelines online, updating only individual recommendations in a living format and/or recruiting a living guideline panel, in the form of a committee, which commits to being available in the shortest possible time [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ]. One platform that supports the development and publication of living guidelines is MAGICApp (https://app.magicapp.org). However, also other digital, web based and cross-platform tools as well as repositories of guideline creation and dissemination are required which, through continuous updating, allow a higher level of usage to be expected. Examples can be found on the websites of AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.), International Database of GRADE guidelines (BIGG), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), World Health Organization (WHO-Iris).
      In a systematic review of methodological handbooks (2014), which analyzed 35 handbooks, the problem was identified that there is no guidance described on how to conduct a living process, nor is there a consistent understanding of when a guideline is dynamic or can be considered a living guideline [
      • Vernooij R.W.
      • Sanabria A.J.
      • Sola I.
      • Alonso-Coello P.
      • Garcıa L.M.
      Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks.
      Implement Sci. 2014; 9: 1-9
      ]. There was no further research after this systematic review, which was published in 2014 and may therefore no longer be up to date [
      • Vernooij R.W.
      • Sanabria A.J.
      • Sola I.
      • Alonso-Coello P.
      • Garcıa L.M.
      Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks.
      Implement Sci. 2014; 9: 1-9
      ]. According to the study protocol, a systematic review on the guideline update process is already being planned, but has not yet been published [
      • Cardwell K.
      • Quigley J.
      • Clyne B.
      • Tyner B.
      • Carrigan M.
      • Smith S.
      • Ryan M.
      • O'Neill M.
      Processes for updaing guidelines: protocol for systematic review [version 1; peer review: 1 approved with reservations].
      HRB Open Res. 2021; 4https://doi.org/10.12688/hrbopenres.13448.1
      ]. The aim of this review is therefore to evaluate the current scientific landscape of living guidelines in the field of medicine and to identify the state-of-the-art by analyzing existing living guidelines and comparing them with their previous non-living guidelines. For this, criteria were analyzed to find out whether one of the established guideline processes is changed due to frequent updating.
      The criteria were defined by the working group. Since this is an initial schematic analysis, the criteria are based on methodological papers on living guidelines and the AWMF regulations [

      Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - ständige Kommission Leitlinien (2020). Das AWMF-Regelwerk “Leitlinien” (Aufl.). http://www.awmf.org/leitlinien/awmf-regelwerk.html [Accessed 18 February 2022]

      ,
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ,
      • Schünemann F.
      • Meerpohl J.J.
      • Schwingshackl L.
      • Kopp I.B.
      • Schünemann H.J.
      Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.
      Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2021; 163: 76-84https://doi.org/10.1016/j.zefq.2021.01.009
      ].
      The following questions are addressed:Question A: What are the characteristics of published living guidelines regarding the following criteria: Screening and update frequency, use of living systematic reviews (LSR), standard for quality of evidence and strength of recommendations, consensus process, involvement of stakeholders (e.g. patient, caregiver or other third party representatives) in the development process and publication format?Question B: Is there a difference between living and non-living guidelines regarding the following criteria: Screening frequency, publication format, consensus process, consensus-based and evidence-based recommendations, public consultation of the guideline prior to publication, and involvement of non-medical stakeholders in the development process?
      Thus, the overall aim of this review is to provide a deeper insight into the living concept and exploring the differences and similarities of living and non-living formats.

      Methods

      Search strategy

      Selective searches were conducted on 29th July 2021. The publications indexed in MEDLINE via PubMed and Google Scholar using the search terms “living AND guideline” OR “living AND evidence” OR “living AND recommendation” were extracted. The abstracts and titles of articles identified through electronic searches were independently screened by two reviewers (ES-H, MS). MEDLINE via PubMed is one of the leading databases in the national library of medicine and focuses on biomedical and health articles. Publications about living guidelines from the medical field should be found here. In addition, Google Scholar was chosen to broaden the search radius and directly include published living guidelines. A search exclusively via scientific databases causes the risk of finding guidelines only if additional publications were published.
      After this initial first search and a first analysis of the retrieved literature, six online repositories for guidelines (MAGICApp, AWMF, GIN, NICE, WHO-Iris, BIGG) were identified. These six guideline repositories were identified through the broad search in MEDLINE via PubMed and Google Scholar and were known to the guideline experts in our working group as common databases for guidelines. These repositories were screened independently (ES-H, MS) in a second search approach for published guidelines in a living format, using again the before mentioned keywords. Rayyan was used as software to collect, rate and extract the data (https://www.rayyan.ai/) [
      • Ouzzani M.
      • Hammady H.
      • Fedorowicz Z.
      • Elmagarmid A.
      Rayyan - a web and mobile app for systematic reviews.
      Syst Rev. 2016; 5: 1-10https://doi.org/10.1186/s13643-016-0384-4
      ]. Since the platform MAGICApp is designed to be specifically a living evidence ecosystem where all uploaded recommendations can potentially be modified by the authors, the used search strategy included all available publications covering the terms “guideline” or “recommendation” (so without necessarily naming it “living”). The search term was broadened here to ensure no living format is missed.
      An aimed registration of the systematic reviews’ protocol at PROSPERO was submitted on 25th July 2021 but declined (reason: no direct health-related outcome reported), hence the systematic review was not registered.

      Inclusion criteria

      A publication was eligible for inclusion if: (a) it represents a published living guideline or it covered methodological aspects of a (living) guideline process or if it could be seen as a complementary document to an existing living guideline, (b) the publication language was English or German, (c) its focus was on clinical issues (diagnosis and treatment) with a broad definition in the health care sector, (d) it was not considered grey literature or short articles/announcement, (e) it was published within the last five years until the end of August 2021 and (f) information about the period of updating was available, without such information it is not clear whether the guideline can be considered actually living.

      Data extraction/analysis

      To allow comparison on a descriptive level without considering the actual clinical content, all detected living guidelines were subsequently analyzed and information was extracted independently by four reviewers (ES-H, MS, CP, MF) with regard to the following a-priori defined criteria which were considered key by the working group. The use of standardized assessment tools (e.g. AGREE II) were considered but for the aim of the scoping review the following general characteristics were chosen: publication country, year (version), professional society, format of publication, field, screening and update frequency, platforms, reporting of standards for quality of evidence and recommendations, number of recommendations, use of living systematic reviews, reporting of consensus processes and involvement of non-medical stakeholders and public consultation prior to publication.

      Comparison with non-living guidelines

      To compare differences between current living and previous non-living guidelines, the authors and editors of all 26 included living guidelines were systematically contacted via e-mail in the period from 18th October to 22nd November 2021. In case of non-response, the respective authors and editors were contacted again. The request towards the editors and authors comprised three questions: 1) to grant access to previously published versions of the guideline in a non-living format, 2) to share their considerations for choosing the current living format and 3) to describe the main difference they personally perceive between living and non-living guideline approaches. The aim of this comparison was to investigate observed similarities and differences from the perspective of editors and authors regarding the practical use of living guidelines. The non-living guidelines were analyzed according to the same scheme as the living guidelines to ensure a systematic approach.

      Results

      In the following sections the identification, systematic analysis, and two separate comparisons between the guidelines are presented. Section Overview provides an overview of the selected living guidelines (and their main characteristics). All selected living guidelines are presented in Table 1. Section inter-guideline comparison gives a more detailed overview of the living guidelines and describes the comparison between the selected living guidelines further referred to as the inter-guideline comparison. Section intra-guideline comparison describes the comparison between living guidelines and their (if existing) previous non-living format version further referred to as the intra-guideline comparison.

      Overview of retrieved living guidelines (descriptive criteria)

      Figure 1 (PRISMA) summarizes the identification and selection of the living guidelines. The flow diagram shows the identification and selection process of the available literature according to the PRISMA statement [
      • Page M.J.
      • McKenzie J.E.
      • Bossuyt P.M.
      • Boutron I.
      • Hoffmann T.C.
      • Mulrow C.D.
      • Shamseer L.
      • Tetzlaff J.M.
      • Akl E.A.
      • Brennan S.E.
      • Chou R.
      • Glanville J.
      • Grimshaw J.M.
      • Hróbjartsson A.
      • Lalu M.M.
      • Li T.
      • Loder E.W.
      • Mayo-Wilson E.
      • McDonald S.
      • Moher D.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      Syst Rev. 2021; 10: 1-11https://doi.org/10.1186/s13643-021-01626-4
      ]. The initial list of 83 living guidelines was retrieved from the before mentioned internet-based platforms and databases. Out of these, five were excluded since they had not been published yet. Another 12 guidelines turned out to be guidelines in a non-living format or considered non-living according to the authors. 23 publications were excluded from analyses since update/revision was not clearly stated. One guideline could not be analyzed since it was only available in Japanese.
      Figure thumbnail gr1
      Figure 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. First approach identifying relevant publications and published living guidelines via databases. Second approach to identify further living guidelines via repositories and registers. Abbreviations: n: number of guidelines and publications; AWMF: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., BIGG: International Database of GRADE guidelines, GIN: Guidelines International Network, MAGICApp: a digital authoring and publication platform for the evidence ecosystem, NICE: National Institute for Health and Care Excellence, WHO: World Health Organization.*missing information about updating interval or unspecified updating depending on new evidence. Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
      As a consequence of the current COVID-19 pandemic, almost half of the included living guidelines were related to COVID-19 (n = 12, 46.2%) [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ] and many COVID-19 guidelines defined as rapid-guidelines were published by NICE. Three of these COVID-19 rapid guidelines could also be detected in MAGICApp [

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ]. The structure of these three guidelines is like other included guidelines in terms of both template and scope and were therefore added to the analyses. The other 16 NICE COVID-19 rapid guidelines were excluded from this review due to their limited scope (e.g. restricted to single recommendations, such as 1.3 “Do not offer a vitamin D supplement to people solely to treat COVID-19, except as part of a clinical trial”, [

      National Institute for Health and Care Excellence (NICE) (2020). COVID-19 rapid guideline: vitamin D (NG187). https://www.nice.org.uk/guidance/ng187.

      ]). Finally, 26 living guidelines were included in the review analysis [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ,
      • Vogel J.P.
      • Tendal B.
      • Giles M.
      • Whitehead C.
      • Burton W.
      • Chakraborty S.
      • Cheyne S.
      • Downton T.
      • Navarro D.F.
      • Gleeson G.
      • Gordon A.
      • Hunt J.
      • Kitschke J.
      • McDonald S.
      • McDonnell N.
      • Middleton P.
      • Millard T.
      • Murano M.
      • Oats J.
      • Homer C.S.E.
      Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.
      Aust N Z J Obstet Gynaecol. 2020; 60: 840-851https://doi.org/10.1111/ajo.13270
      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ] (see Table 1). As mentioned almost half of the included living guidelines were related to COVID-19, the other remaining 13 (50.1%) guidelines relate to other medical topics (e.g. Oncology, Gastroenterology, see column ‘Field’ in Table 1).
      Table 1Table of all living guidelines included in the review with their descriptive criteria.
      Publication CountryYear (version)Professional societyTitleReferenceFormat of publicationFieldScreening frequencyUpdate frequencyPlatformsApplied standard for equality of evidence and recommendationsUse of living systematic reviewsReporting of process of consensusInvolvement of patients, caregivers or third-parties
      Germany2021 (v3.0)DEGAMSchutz vor Über- und Unterversorgung – gemeinsam entscheiden

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      		PDFGeneral medicineannuallydepending on screening, at least every 3 yearsAWMF, Website of professional society, published in journalyesnoyesno
      2021 (v6.0)DGVSS3 – Leitlinie Colitis ulcerosa

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      		PDFGastroenterologyannuallyannuallyAWMF, Website of professional society, published in journalyesnoyesyes
      2020 (v5.0)DGGG, DKGGestationelle und nichtgestationelle Trophoblasterkrankungen

      National Institute for Health and Care Excellence (NICE) (2020). COVID-19 rapid guideline: vitamin D (NG187). https://www.nice.org.uk/guidance/ng187.

      		PDFGynaecologyannuallyannuallyAWMF, Website of professional societynonoyesyes
      2021 (v5.0)DGIIN, DIVI, DGP, DGIS3-Leitlinie Empfehlungen zur stationären Therapie von Patienten mit COVID-19
      • Schünemann F.
      • Meerpohl J.J.
      • Schwingshackl L.
      • Kopp I.B.
      • Schünemann H.J.
      Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.
      Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2021; 163: 76-84https://doi.org/10.1016/j.zefq.2021.01.009
      		PDF, Videos, MAGICAppCOVID-19weeklyevery 2-3 monthsAWMF, Website of professional societyyesyesnono
      2021 (v2.0)DGZMKUmgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      		PDFDentistryno infoannuallyAWMF, Website of professional societyyesnoyesno
      2021 (v5.1)DGNDiagnose und Therapie der Multiplen Sklerose, Neuromyelitis-Optica-Spektrum-Erkrankungen und MOG-IgG-assoziierte Erkrankungen

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      		PDFNeurologyno infoannuallyAWMF, Website of professional societyyesnoyesyes
      2021 (v2.0)DGPHäusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID-19 Pandemie 

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      		PDFHome Careevery 6 monthsannual at the latestAWMF, Website of professional society, published in journalyesnoyesno
      2020 (v4.0)DGGGDiagnostik, Therapie und Nachsorge maligner Ovarialtumoren

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      		PDF, AppOncologyannuallyannuallyAWMF, Website of professional society, OnkologieAppyesnoyesyes
      2021 (v1.0)DGEpi, DGPH, DGKJ, DGPIMaßnahmen zur Prävention und Kontrolle der SARS-CoV-2 Übertragung in Schulen
      • Ouzzani M.
      • Hammady H.
      • Fedorowicz Z.
      • Elmagarmid A.
      Rayyan - a web and mobile app for systematic reviews.
      Syst Rev. 2016; 5: 1-10https://doi.org/10.1186/s13643-016-0384-4
      		PDFCOVID-193 monthsno infoGIN, AWMFyesnoyesyes
      United Kingdom2021 (v1.0)ERSManagement of hospitalised adults with coronavirus disease-19 (COVID-19): A European Respiratory Society living guideline
      • Page M.J.
      • McKenzie J.E.
      • Bossuyt P.M.
      • Boutron I.
      • Hoffmann T.C.
      • Mulrow C.D.
      • Shamseer L.
      • Tetzlaff J.M.
      • Akl E.A.
      • Brennan S.E.
      • Chou R.
      • Glanville J.
      • Grimshaw J.M.
      • Hróbjartsson A.
      • Lalu M.M.
      • Li T.
      • Loder E.W.
      • Mayo-Wilson E.
      • McDonald S.
      • Moher D.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      Syst Rev. 2021; 10: 1-11https://doi.org/10.1186/s13643-021-01626-4
      		Free PMC articleCOVID-19no inforegualryBIGG, PubMedyesnoyesyes
      2020 (v1.0)NICEcovid19-rapid-guideline: managing the long-term effects of COVID-19

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      		Online version, PDF, MAGICAppCOVID-19weekyno infoMagicApp, NICE, GIN, PubMedyesnonoyes
      2021 (v11.0)NICEcovid19-rapid-guideline: managing COVID-19

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      		Online version, PDF, MAGICAppCOVID-19no inforegularyNICE, MAGICApp, PubMedyesnonoyes
      2021 (v4.0)NICEcovid19-rapid-guideline: vaccine-induced immune thrombocytopenia and thrombosis
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      		Online version, PDF, MAGICAppCOVID-19weeklydepending on screeningNICE, MAGICApp, PubMedyesnoyesyes
      Switzerland2021 (v5.0)WHOTherapeutics and COVID-19

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      		PDF, MAGICApp, WHO App, BMJCOVID-19dailydepending on screeningWHO Website, BIGG, MAGICApp, PubMedyesyesnoyes
      2021 (v3.1)WHOA living WHO guideline on drugs to prevent COVID-19

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      		PDFCOVID-19dailydepending on screeningWHO website, BIGG, MAGICApp, PubMedyesyesyesyes
      2021 (v1.4)WHOCOVID-19 clinical management: living guidance

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      		PDFCOVID-19monthlymonthlyWHO websiteyesyesyesyes
      2021 (v2.3)WHOWHO Guidelines for Malaria

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      		MAGICApp, PDFMalariano infowhen new evidence is availableWHO website, BIGGyesnoyesyes
      Canada2021 (March)Ontario Neurotrauma FoundationLiving guideline for pediatric concussion care

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      		Web-version, PDF, Community Handouts, family versionNeurologymonthlyno infoWebsiteyesnoyesno
      USA2021 (v1.0)American Society of HematologyAmerican Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      		Online version, PDFMedicine, COVID-19monthlyno infoGIN, PubMed, NICEyesyesyesyes
      Australia2021 (January)ATAGIAustralian Immunisation Handbook

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      		Online version, mobile AppVaccination3 times per yeardepending on screeningGINyesnonoyes
      2021 (v1.2)ANZMUSC, Clinical Trials Network, ARA, Cochrane Musculoskeletal, NPS MedicineWise consortiumAn Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      		MAGICApp, PDFRheumatologyevery 3 monthsannuallyMAGICAppyesnoyesno
      2021 (versions different for each chapter)Stroke Foundation(Australian and New Zealand) Clinical Guidelines for Stroke Management

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      		MAGICApp, PDFNeurologyprioritised topics are under monthly surveillance, others 6-12 monthsno infoMAGICAppyesnoyesyes
      2021 (v42.0)National COVID-19 Clinical Evidence TaskforceAustralian guidelines for the clinical care of people with COVID-19

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      		MAGICApp, online version, PDFCOVID-19weeklyweekly, when new evidences becomes availableMAGICAppyesyesyesyes
      2021 (v1.0)National COVID-19 Clinical Evidence TaskforceAustralian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      		MAGICApp, PDFCOVID-19weeklywhen new evidence becomes availableMAGICAppyesyesyesno
      2020 (v1.2)NHMRCAustralian Evidence-Based Clinical Guidelines for Diabetes

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      		MAGICApp, PDFDiabetesmonthlydepending on screeningMAGICAppyesnonoyes
      International2021 (v2.3)WHOWHO Guideline on self-care interventions for health and well-being

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      		MAGICApp, PDFGeneral health and well-beingwhen new evidence becomes availablewhen new evidence becomes available MAGICApp, WHO website, BIGG, PubMedyesnoyesyes
      Note. DEGAM = Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V., DGVS = Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, DGGG = Interdisziplinäre Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, DKG = Deutsche Krebsgesellschaft e.V., DGIIN = Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin, DIVI = Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin, DGP = Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, DGI = Deutsche Gesellschaft für Infektiologie, DGZMK = Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde, DGN = Deutsche Gesellschaft für Neurologie, DGP = Deutsche Gesellschaft für Pflegewissenschaft e.V., DGEpi = Deutsche Gesellschaft für Epidemiologie, DGPH = Deutsche Gesellschaft für Public Health, DGKJ = Deutsche Gesellschaft für Kinder- und Jugendmedizin, DGPI = Deutsche Gesellschaft für Pädiatrische Infektiologie, ERS = European Respiratory Society, NICE = National Institute for Health and Care Excellence, WHO-Iris = World Health Organization, Institutional Respository for Information, ATAGI = Sharing, National Health and Medical Research Council, Australian Technical Advisory Group on Immunisation, ANZMUSC = Australia and New Zealand Musculoskeletal, ARA = Australian Rheumatology Association, NHMRC = National Health and Medical Research Council, MAGICApp = Making GRADE the Irresistible Choice, AWMF = Arbeitsgesellschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, GIN = The Guidelines International Network, BIGG = The International Database of GRADE Guidelines.
      To allow the comparison on an intra-guideline and inter-guideline level it was of interest whether the living guidelines were newly created guidelines (de-novo) or updated versions of already published guidelines in a previous non-living format. Over half of the retrieved living guidelines are de-novo (n = 16, 61, 5%) [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ], subsequently ten guidelines (38.5%) are updates of existing guidelines [

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ] (see Table 1).
      Regarding the country of publication, nine living guidelines were published in Germany [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ], four in the United Kingdom [
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ], four in Switzerland [

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ], one in the USA [
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ], six in Australia [

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ] and one in Canada [

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ]. Another living guideline was classified as “international” since different countries were involved in the publication [

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ] (see Table 1).

      Inter-guideline comparison – the living process

      In the following section the results of the comparison between the 26 selected living guidelines are reported. Criteria to characterize the methodological process of guideline development were defined a priori by the working group and all identified guidelines were analyzed according to these criteria.
      The criterion “screening frequency” defines in which interval searches for new evidence are performed. The living guidelines were divided into three subcategories: the first category included short-term screening interval guidelines (n = 13, 50%), where new evidence was searched either daily, weekly, monthly or up to an interval of every 3 months [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ]. The second category (n = 3, 11.5%) – mid-term screening interval- included guidelines which screened either after three months, three times a year or up to every six months [

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ]. The third category (n = 10, 38.5%) – long-term screening interval – included all guidelines which stated either an annual screening (n = 4) [

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ], or did not precisely define a screening interval (n = 6) [
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ] but reported that an updated version will be published latest after 12 months. Therefore, it was assumed that the screening process itself would be performed at least once a year. Consecutive criterion is “updating frequency”. Following the screening of new evidence most guidelines decide whether the newly identified data is sufficient for updating the living guideline, hence the majority of the analyzed living guidelines report such an update interval depending on screening (n = 15, 57.7%), but latest at the end of 12 months [
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ]. Further seven living guidelines (26.9%) reported that an update is triggered on an annual basis [

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ] and a smaller fraction of four living guidelines (15.4%) reported that an update is triggered in shorter time intervals (two on a weekly basis [

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ], one on a monthly basis [

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ] and one every 2–3 months [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ]).
      The “use of living systematic reviews or living meta-analysis” was a further criterion. Seven living guidelines (26.9%) reported the use of such dynamic living reviews (LSR) or meta-analyses where newly identified evidence is included [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ]. These seven living guidelines all belong to the short-term screening interval category. No mid- or long-term screening living guideline included LSR or living meta-analyses.
      Other criteria of interest were the “reported standards for quality of evidence and strength of recommendations”. In total, 25 living guidelines (96.2%) reported that systematic standards were applied, most frequently GRADE [
      • Zhang Y.
      • Akl E.A.
      • Schünemann H.J.
      Using systematic reviews in guideline development: the GRADE approach.
      Res Synth Meth. 2019; 10: 312-1239https://doi.org/10.1002/jrsm.1313
      ] (n = 17, 65.4%) [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ]. All short- and mid-term screening interval living guidelines reported any standard for rating quality of evidence and defining the strength of recommendations (e.g., OCEBM, customized standards) and most long-term interval living guidelines (90%).
      Furthermore, the “reporting of how consensus was reached” between the guideline members, was investigated. Out of all analyzed living guidelines, 20 (76.9%) reported the process or applied standards (e.g. Delphi-Method) of reaching consensus [

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) (2021). Schutz vor Über- und Unterversorgung - gemeinsam entscheiden (Living Guideline). AWMF online (053-045LG).

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Pflegewissenschaft e.V. (DGP), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM), Deutsche Gesellschaft für Gerontologie und Geriatrie e.V. (DGGG), Bundesinitiative ambulante psychiatrische Pflege (bapp), Deutsche Gesellschaft für Public Health e.V. (DGPH), & Deutscher Berufsverband für Pflegeberufe, DBFK (2021). Häusliche Versorgung, soziale Teilhabe und Lebensqualität bei Menschen mit Pflegebedarf im Kontext ambulanter Pflege unter den Bedingungen der COVID19-Pandemie - Living Guideline: AWMF online (184-002LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ]. More specifically, this was reflected in 69.2% of the short-term, 66.7% of the mid-term and 90% of the long-term screening interval living guidelines. Other sources included for reaching consensus were an independent expert advisory board, a clinical expert review or a steering committee.
      Another criterion was the “reported involvement of other stakeholders” (e.g. patients, caregivers). 19 out of 26 living guidelines (73.1%) reported such an involvement (69.2% of short-term, 66.7% of mid-term, 80% long-term screening interval guidelines) [

      Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI), & Deutsche Gesellschaft für Epidemiologie e.V. (DGEpi) (2021). Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen - Lebende Leitlinie: AWMF online (027-076).

      ,
      • Chalmers J.D.
      • Crichton M.L.
      • Goeminne P.C.
      • Cao B.
      • Humbert M.
      • Shteinberg M.
      • Antonious K.M.
      • Ulrik C.S.
      • Parks H.
      • Wang C.
      • Vandendriessche T.
      • Qu J.
      • Stolz D.
      • Brightling C.
      • Welte T.
      • Aliberti S.
      • Simonds A.K.
      • Tonia T.
      • Roche N.
      Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.
      Eur Respir J. 2021; 57https://doi.org/10.1183/13993003.00048-2021
      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Krebsgesellschaft e.V. (DKG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Nuklearmedizin e.V. (DGN), Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. (DGKL), Arbeitsgemeinschaft für gynäkologische Onkologie der DGGG und DKG (AGO) - Kommision Uterus, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), et al. (2020). Gestationelle und nichtgestationelle Trophoblasterkrankungen - Living Guideline: AWMF online (032-049).

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ].
      As “publication format”, most frequently a static PDF version is used. Except for one guideline [

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ], all living guidelines (n = 25, 96.2%) are available as PDF documents. The second most frequently used format is MAGICApp, which is an online platform for guidelines and evidence summaries. Out of the retrieved living guidelines for this review nearly half of them (n = 14, 53.9%) are available on MAGICApp [

      Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin e.V. (DGIIN), Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e.V. (DIVI), Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Gesellschaft für Infektiologie e.V. (DGI), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI), Deutsche Gesellschaft für Hygiene und Mikrobiologie e.V. (DGHM), et al. (2021). S3-Leitlinie - Empfehlungen zur stationären Therapie von Patienten mit COVID-19: AWMF online (113/001).

      ,

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,

      World Health Organization (WHO) (2021). COVID-19 clinical management: living guidance: WHO(WHO/2019-nCoV/clinical/2021.1). https://apps.who.int/iris/handle/10665/338882.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      ,

      Australia & New Zealand Musculoskeletal Clinical Trials Network - Dr Vanessa Glennon (2021). An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis (1st edn): Magicapp (5497). https://app.magicapp.org/#/guideline/5497.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      World Health Organization (WHO) (2021). WHO Guidelines for Malaria (2nd edn): Magicapp (36). https://app.magicapp.org/#/org/36/guidelines.

      ,

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      ,

      Living Evidence for Diabetes Consortium (2020). Australian Evidence-Based Clinical Guidelines for Diabetes (1st edn): Magicapp (4496). https://app.magicapp.org/#/guideline/4496.

      ]. The third most frequently used dissemination format is granting free access to an online version mostly on the webpages of related professional societies. Nine living guidelines were published in an online/web-based format (guideline being directly embedded in the website) [

      National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), & Royal College of General Practitioners (RCGP) (2021). COVID-19 rapid guideline: managing the long-term effects of COVID-19: National Institute for Health and Care Excellence (NICE) (NG188).

      ,

      The National Institute for Health and Care Excellence (NICE) - NICE. COVID-19 rapid guideline: Managing COVID-19: Magicapp (5952). https://app.magicapp.org/#/guideline/5952.

      ,

      The National Institute for Health and Care Excellence (NICE) (2021). COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) (4th edn): Magicapp (5776). https://app.magicapp.org/#/guideline/5776.

      ,

      World Health Organization (WHO) (2021). Therapeutics and COVID-19: living guideline (WHO/2019-nCoV/therapeutics/2021.3).

      ,

      World Health Organization (WHO) (2021). A living WHO guideline on drugs to prevent covid-19. WHO-2019-nCoV-prophylaxes-2021.1.

      ,
      • Cuker A.
      • Tseng E.K.
      • Nieuwlaat R.
      • Angchaisuksiri P.
      • Blair C.
      • Dane K.
      • Davila J.
      • DeSancho M.T.
      • Diuguid D.
      • Griffin D.O.
      • Kahn S.R.
      • Klok F.A.
      • Lee A.I.
      • Neumann I.
      • Pai A.
      • Righini M.
      • Sanfilippo K.M.
      • Siegal D.
      • Skara M.
      • Schünemann H.J.
      American Society of Hematology 2021 guidelines on the use of anticoagulation for thrombophylaxis in patients with COVID-19.
      Blood Adv. 2021; 5: 3951-3959https://doi.org/10.1182/bloodadvances.2021005493
      ,

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian guidelines for the clinical care of people with COVID-19 (42nd edn): Magicapp (5571). https://app.magicapp.org/#/guideline/5571.

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ].

      Intra-guideline comparison living vs. non-living guidelines

      Intra refers to the comparison of living guidelines with their respective previous versions in a non-living format. 16 living guidelines were created de-novo and therefore no comparison with a previous non-living version was possible. After contacting all editors of the selected 26 guidelines via e-mail, 15 responses were received. Considering the responses, three guidelines had to be removed since they were incorrectly labeled as living guidelines by the review group (the editors themselves do not define their guideline as a living guideline) [

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus: AWMF online (021-023OL). https://www.awmf.org/leitlinien/detail/ll/021-023OL.html.

      ,

      National Health and Medical Research Council (NHMRC) (2020). Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2nd edn): Magicapp (4630). https://app.magicapp.org/#/guideline/4630.

      ,

      Australian Government - National Health and Medical Research Counsil, & Australian Commission on Safety and Quality in Health Care (ACSQHC) (2021). Australian Guideline for the Prevention and Control of Infection in Healthcare (11th edn): NHMRC (5482). https://app.magicapp.org/#/guideline/5482.

      ]. In total, seven guidelines in non-living formats were received and therefore comparable to the updated versions in a living format [
      • Kucharzik T.
      • Dignass A.U.
      • Atreya R.
      • Bokemeyer B.
      • Esters P.
      • Herrlinger K.
      • Kannengießer K.
      • Kienle P.
      • Langhorst J.
      • Lügering A.
      • Schreiber S.
      • Stallmach A.
      • Stein J.
      • Sturm A.
      • Teich N.
      • Siegmund B.
      • Andus T.
      • Autschbach F.
      • Bachmann O.
      • Baretton G.
      • Zemke J.
      Aktualisierte S3-Leitlinie Colitis ulcerosa der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS).
      Zeitschrift für Gastroenterologie. 2018; 56: 1087-1169https://doi.org/10.1055/a-0651-8174
      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), & Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) (2019). Gestationsbedingte und nicht-gestationsbedingte Trophoblasterkrankungen (S2k) (032/049).

      ,

      Deutsche Gesellschaft für Neurologie, & Kompetenznetz Multiple Sklerose (2014). DGN / KKNMS Leitlinie zur Diagnose und Therapie der MS (030-050).

      ,

      Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF (Leitlinienprogramm Onkologie) (2016). S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, (Langversion 2.0).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2013 (2014 update)). Australian Immunisation Handbook (10th edn): Australian Government Department of Health (10613).

      ,

      National Stroke Foundation (2010). Clinical Guidelines for Stroke Management. Melbourne, Australia.

      ,

      Ontario Neurotrauma Foundation (2014). Guidelines for Diagnosing and Managing Pediatric Concussion (1st edn). Toronto.

      ] (see Table 2).
      Table 2Table of the living guidelines compared to their preceded versions.
      TitleReferenceFormatFormat of publicationScreening FrequencyUpdate FrequencyNumber of evidence-based recommendationsNumber of consensus-based recommendationsDescription of consensus-processInvolvement of patients, caregivers or third-partiesPublic consultation before publication
      S3 – Leitlinie Colitis ulcerosa

      Australian National COVID-19 Clinical Evidence Taskforce (2021). Australian Guidelines for SARS-CoV-2 infection prevention and control of COVID-19 in healthcare workers: Magicapp (4826). https://app.magicapp.org/#/guideline/4826.

      		living guidelinePDFannuallyannually96 (63**)57 (37**)yesyesyes
      S3 – Leitlinie Colitis ulcerosa

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus: AWMF online (021-023OL). https://www.awmf.org/leitlinien/detail/ll/021-023OL.html.

      		non-living guidelinePDFno infoafter 4 years99 (64**)55 (36**)yesyesno
      Gestationelle und nichtgestationelle Trophoblasterkrankungen

      National Institute for Health and Care Excellence (NICE) (2020). COVID-19 rapid guideline: vitamin D (NG187). https://www.nice.org.uk/guidance/ng187.

      		living guidelinePDFannuallyannuallynone (S2k)73 (100**)yesyesno
      Gestationelle und nichtgestationelle Trophoblasterkrankungen

      National Health and Medical Research Council (NHMRC) (2020). Australian Guidelines to Reduce Health Risks from Drinking Alcohol (2nd edn): Magicapp (4630). https://app.magicapp.org/#/guideline/4630.

      		non-living guidelinePDFno infoat least after 5 yearsnone (S2k)71 (100**)yesyesno
      Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      		living guidelinePDFno infoannuallynone (S2k)223 (100**)yesyesyes
      Diagnose und Therapie der Multiplen Sklerose

      Australian Government - National Health and Medical Research Counsil, & Australian Commission on Safety and Quality in Health Care (ACSQHC) (2021). Australian Guideline for the Prevention and Control of Infection in Healthcare (11th edn): NHMRC (5482). https://app.magicapp.org/#/guideline/5482.

      		non-living guidelinePDFno infoafter 3 years*not quantifiablenone (S2e)yesnono
      S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren

      Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK), Deutsche Gesellschaft für Kinderzahnheilkunde (DGKiZ), Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG), Deutsche Gesellschaft für Parodontologie (DG PARO), Deutschen Gesellschaft für Zahnerhaltung (DGZ), Bundeszahnärztekammer (BZÄK), et al. (2021). S1-Leitlinie - Umgang mit zahnmedizinischen Patienten bei Belastung mit Aerosol-übertragbaren Erregern: AWMF online (083-046).

      		living guidelinePDF, Appannuallyannually52 (51**)49 (49**)yesyesyes
      S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren
      • Kucharzik T.
      • Dignass A.U.
      • Atreya R.
      • Bokemeyer B.
      • Esters P.
      • Herrlinger K.
      • Kannengießer K.
      • Kienle P.
      • Langhorst J.
      • Lügering A.
      • Schreiber S.
      • Stallmach A.
      • Stein J.
      • Sturm A.
      • Teich N.
      • Siegmund B.
      • Andus T.
      • Autschbach F.
      • Bachmann O.
      • Baretton G.
      • Zemke J.
      Aktualisierte S3-Leitlinie Colitis ulcerosa der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS).
      Zeitschrift für Gastroenterologie. 2018; 56: 1087-1169https://doi.org/10.1055/a-0651-8174
      		non-living guidelinePDFno infoafter 3 years45 (52**)41 (48**)yesyesno
      Australian Immunisation Handbook

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      		living guidelinePDF, Website, App3 times per yeardepending on screeningnot definednot definednoyesno
      Australian Immunisation Handbook

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), & Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) (2019). Gestationsbedingte und nicht-gestationsbedingte Trophoblasterkrankungen (S2k) (032/049).

      		non-living guidelinePDFregularlyno infonot definednot definedyesyesyes
      (Australian and New Zealand) Clinical Guidelines for Stroke Management

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      		living guidelinePDF, MAGICAppmonthlydepending on screening191 (71**)79 (29**)yesyesyes
      (Australian and New Zealand) Clinical Guidelines for Stroke Management

      Deutsche Gesellschaft für Neurologie, & Kompetenznetz Multiple Sklerose (2014). DGN / KKNMS Leitlinie zur Diagnose und Therapie der MS (030-050).

      		non-living guidelinePDFno infoevery 3-5 years214 (64**)121 (36**)yesyesyes
      Living guideline for peiatric concussion care

      World Health Organization (WHO) (2021). WHO Guideline on self-care interventions for health and well-being (2nd edn): Magicapp (5511). https://app.magicapp.org/#/guideline/5511.

      		living guidelinePDF, Webversionmonthlydepending on screening59 (51**)56 (49**)yesnono
      Guidelines for diagnosing and managing pediatric concussion

      Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF (Leitlinienprogramm Onkologie) (2016). S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, (Langversion 2.0).

      		non-living guidelinePDFno infoafter 3 years60 (77**)18 (23**)yesyesno
      Note. LG = living guideline, non-LG = non-living guideline, S2e and S2k, as well as S3-Guidelines are classifications of different Guideline-development levels, defined by AWMF. S2e-Guidelines only contain evidence-based recommendations. S2k-Guidelines only contain consensus-based recommendations. S3-Guidelines are the union of these two levels. The Stroke living guidelines can be found in MAGICApp divided by chapters. These numbers are a total sum of all chapters. *Recommendations not quantifiable; according to authors former guideline does not meet the requirements for guideline standards according to AWMF. **Relative numbers.
      Six non-living guidelines are updated at a frequency of three up to five years, whereas for all seven living guidelines, screening for new evidence is performed at least annually (see the analysis in results section inter-guideline comparison). One of the non-living guidelines was regularly reviewed and electronically updated on the publishers’ website [

      Australian Technical Advisory Group on Immunisation (ATAGI) (2013 (2014 update)). Australian Immunisation Handbook (10th edn): Australian Government Department of Health (10613).

      ]. Four living guidelines [

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ,

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ] differ in publication format from their respective versions, with the living formats being available on the MAGICApp website, as a mobile application, or online on the publishers' website. All guidelines, whether living or non-living are available as PDF.
      Regarding the consensus process criterion, the analysis showed that all seven non-living guidelines describe a consensus process. In comparison, six living guidelines reported a consensus process, with one not doing so [

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ].
      As described in Table 2, two pairs had no quantifiable or no defined number of recommendations. The number of recommendations in the Australian Immunisation Handbook was not defined and the comparison between the versions of the multiple sclerosis guideline was not included since the classification changed from formerly evidence based to now consensus-based in the living format [

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2020). Australian Immunisation Handbook. Canberra: Australian Government Department of Health. immunisationhandbook.health.gov.au.

      ,

      Deutsche Gesellschaft für Neurologie, & Kompetenznetz Multiple Sklerose (2014). DGN / KKNMS Leitlinie zur Diagnose und Therapie der MS (030-050).

      ,

      Australian Technical Advisory Group on Immunisation (ATAGI) (2013 (2014 update)). Australian Immunisation Handbook (10th edn): Australian Government Department of Health (10613).

      ]. Considering the relative numbers of evidence-based recommendations, a paired two-sample t-test between five guideline pairs showed no significant difference in the evidence-based recommendations between living guidelines and their non-living versions (t(4) = 0.74, p = .50). Additionally, another paired two-sample t-test equally did not show a significant difference between the consensus-based recommendations in the living and the preceded non-living guidelines (t(4) = 0.74, p = .50).
      Five out of the seven non-living guidelines did not carry out a public consultation. Two non-living guidelines stated that a public consultation was conducted [

      Australian Technical Advisory Group on Immunisation (ATAGI) (2013 (2014 update)). Australian Immunisation Handbook (10th edn): Australian Government Department of Health (10613).

      ,

      National Stroke Foundation (2010). Clinical Guidelines for Stroke Management. Melbourne, Australia.

      ]. Four living guidelines reported to have posted a version of the guideline online for public comment [

      Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (2021). SD-Leitlinie Colitis ulcerosa - Living Guideline: AWMF online (021-009). 10.1055/a-1296-3444.

      ,

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ,

      Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Deutsche Gesellschaft für Radioonkologie e.V. (DEGRO), Deutsche Gesellschaft für Ultraschall in der Medizin e.V. (DEGUM), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e.V. (DGAV), Deutsche Gesellschaft für Endokrinologie e.V. (DGE), Deutsche Gesellschaft für Rehabilitationswissenschaften e.V (DGRW), et al. (2020). Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren: AWMF online (032-035OL).

      ,

      Stroke Foundation (2021). Australian and New Zealand Clinical Guidelines for Stroke Management (1st edn): Magicapp.

      ]. In addition, six living and non-living guidelines, with the exception of one living guideline [

      Reed, N., Zemek, R., Dawson, J., & Ledoux, A. E. A. (2021). Living Guideline for Pediatric Concussion Care. https://doi.org/10.17605/OSF.IO/3VWN9.

      ] and one non-living guideline [

      Deutsche Gesellschaft für Neurologie e.V. (DGN), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG), Gesellschaft für Neuropädiatrie e.V. (GNP), Schweizerische Gesellschaft für Neurologie, Österreichische Gesellschaft für Neurologie (ÖGN), Berufsverband deutscher Neurologen, B. D., et al. (2021). Diagnose und Therapie mit Multiple Sklerose, Neuromyelitis Optica Spektrum und MOG-IgG-assoziierte Erkrankungen - Living Guideline: AWMF online (030-050LG).

      ], involved non-medical stakeholders in the development process.
      With reference to the three questions mentioned above (see comparison with non-living guidelines under methods), the authors and editors stated that regular and rapid updates are the key argument in deciding for the living format. According to the editors, published high-quality studies can be integrated into the guideline in a timely manner, which is not feasible in a non-living format. The living format is perceived as a continuation of the process of guideline optimization. It allows a rapid further development of the evidence situation and topicality about methodological knowledge, which is important for patient care. In addition, the large number of publications on COVID-19 makes it necessary to update this topic repeatedly in short intervals, according to the editors. An overview of the editors' and authors' responses can be found in the Table 3.
      Table 3Responses from authors and editors of the included living guidelines.
      ResponsesConsiderations for choosing a living formatEssential difference between non-living and living format
      Response 1no info▪ main difference: methods for searching for new evidence to update the guidelines

      ▪ living guideines: monthly search for new publications, historically: search for new literature every 3-7 years

      ▪ content updates only in response to relevant new evidence
      Response 2▪ rapid further development of the evidence base

      ▪ dynamic evolution of infection incidence

      ▪ it is timely in light of methodological findings and on principle within the COVID-19 evidence ecosystem and its focus at living reviews and living guidelines      		no info
      Response 3▪ always intended to create a living guideline

      ▪ expected a rapid evolution of evidence that would be important for patient care      		no info
      Response 4▪ to keep the guideline continuously up to date▪ Essential difference: The administration of maintaining and updating the living guideline
      Response 5▪ decision by professional society to change several guidelines with the aim of achieving greater topicality▪ shorter update cycle, thus also less extensive research

      ▪ to improve quality through higher topicality
      Response 6▪the flood of publications on COVID-19 necessitated several updates on this topic▪ Normal guidelines are updated only every 4-5 years; high-quality studies published in the meantime cannot be integrated into the guideline in a timely manner

      ▪ living guideline has clear advantages, but is more costly in terms of continuous updating
      Response 7▪did not really change the guideline to the “living guideline” principle

      ▪ while creating the current guideline, they looked for a concept that would allow regular and rapid updating: the “living guideline” principle came in handy      		▪old updating principle is burdensome and lengthy (because it is always a partial restart)

      ▪ the “living guideline” principle keeps the guideline always fresh, is expectable (namely at least 1x / year) and never lets the process of guideline optimization come to a standstill (in a positive sense)

      ▪ It is also a good tool to quickly address problems and criticisms that arise in the implementation and/or everyday use in the guideline
      Response 8▪ New therapy trends arise during the year, which affects only a few recommendations but is relevant for therapists and payers▪ To increase applicability/usability through timeliness (Guideline will not be used if it is revised only after 3-5 years)
      Note. N = 8, in order to preserve the anonymity of the authors and editors, their names are not mentioned.

      Discussion

      This review aims to best of our knowledge for the first time at assessing the prevalence and formal characteristics of living guidelines in the field of medicine. The “evidence-practice” or “know-do” gap [

      World Health Organization (WHO) (2005). Bridging the “know–do” gap meeting on knowledge translation in global health. Geneva: WHO.

      ] has been described for many years. The concept of living guidelines [
      • Weißbach L.
      Welche Inhalte sollte eine „living guideline“ besetzen?.
      Der Urologe. 2012; 51: 57-59https://doi.org/10.1007/s00120-011-2714-4
      ] might contribute to close this gap. Therefore, a selective search of literature and guideline repositories was conducted yielding in a total of 83 living guidelines. Applying stricter definitions of a living process (update within one year) which is described in the literature [

      Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - ständige Kommission Leitlinien (2020). Das AWMF-Regelwerk “Leitlinien” (Aufl.). http://www.awmf.org/leitlinien/awmf-regelwerk.html [Accessed 18 February 2022]

      ], only 26 living guidelines could be considered for further analyses. Of note, out of the initially identified n = 83 living guidelines, n = 23 had to be excluded due to missing information regarding specified update interval and thus could not be characterized as genuinely living approaches. This result shows very impressively the lack of an overarching understanding of Living and in particular the updating process. As already showed in the introduction according to Akl et al. (2017), the updating process of a living guideline is particularly characteristic [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ]. The rapid increase in Living Guidelines in the Covid-19 pandemic illustrates the importance of rapid recommendations as new evidence becomes available.
      It can be speculated that this finding reflects the need to increase flexibility and release new versions depending on new evidence in the field of medicine. This flexibility in not defining a periodicity might be to the advantage of the real clinical needs [
      • Pieper D.
      • Ober P.
      • Dressler C.
      • Schmidt S.
      • Mathes T.
      • Becker M.
      Effizientere Leitlinienerstellung–eine narrative Übersichtsarbeit.
      Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2019; 146: 1-6https://doi.org/10.1016/j.zefq.2019.08.004
      ].
      Even though availability of living guidelines could be observed in the last five years by 83 (respectively 26) identified publications, almost half of these guidelines were related to COVID-19. It can be speculated that the needs and circumstances of the pandemic (to deliver new evidence on time) might have served as an acceleration for the development and use of living guidelines. In order to implement up-to-date recommendations, platforms are needed that enable rapid publication. It was observed on MAGICApp that a fraction of the online entries comprised only a few single recommendations to a specific clinical question. Maybe web-based tools will make it easier in the future to address distinct clinical questions and their corresponding recommendation without being part of a larger, more comprehensive guideline. This aspect accounts for the flexibility of a living guideline in terms of adapting its content.
      Another aspect is the flexibility in terms of formal appearance and publication format. Except for one, all evaluated living guidelines still use a static PDF version, so PDF is still the most common format, complemented in half of the cases by online tools such as MAGICApp or in fewer cases customized web-based versions and specifically developed apps which may increase the use of the guideline at point of care. It might be of further interest to investigate the impact the publication format has on the implementation and use of living guidelines.
      The majority of available living guidelines screen for new evidence in short-term intervals (within the next three months). This tendency towards very short intervals is presumably related to the need for timely new advice during the COVID-19 pandemic (9 out of 13 living guidelines using short-term intervals were related to COVID-19). In general, screening and updating of the guideline may fit the need of the area of interest and the expected amount of new evidence and should be clearly stated by the authors when describing the process of updating.
      Akl et al. [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ] proposed in their series of articles that living systematic reviews (LSR) serve as a basis for translating new evidence into clinical practice recommendations. Roughly one quarter of the selected living guidelines reported the use of such LSRs all of which belonged to the short-term screening category. This point may be interpreted that the use of LSR is yet not fully an integral part of living guidelines and may be suitable especially for guidelines with more frequent screening and updating cycles.
      To evaluate potential differences to previous non-living versions, seven matching predecessor versions were identified and used for head-to-head comparisons between guidelines. According to the editors, the main difference from a previous non-living version appears is rooted in the methodology of the respective guidelines regarding the process of identifying new evidence to update existing recommendations. However, the living format is more complex due to a continuous update process of its recommendations. Furthermore, the benefit of the MAGICApp was underlined as a guideline development and publication platform, integrating the GRADE methodology with its update capacity. Transparent reporting of applied standards (reaching consensus, grading of evidence, strength of recommendations) and involvement of third parties and public consultations before publication were applied by most (5 out of 7) living- and non-living guidelines in the intra-comparison. Given the limited number of guidelines in the intra-guideline comparison, this finding must remain purely descriptive. Nevertheless, no evidence was found that living-formats necessarily lack the participation of patients and/or care-givers or are less open to external contributions. By comparing the number of recommendations no statistically significant differences could be observed between living and non-living versions. This might imply, that living guidelines do not have to be necessarily shortened (regarding the extent of recommendations) to ensure efficient and more frequent updating. However, the results must be interpreted with caution due to a limited amount of data and therefore must be considered exploratory.
      The synopsis of all included guidelines displays that living guidelines might not be considered as a novel approach, but rather as an optimization of standard procedures [
      • Paige E.
      • Agostino J.
      • Phillips C.
      • Elliott J.
      • Cadilhac D.A.
      • Connell C.
      • Kowalski M.
      • O'Donoughue Jenkins L.
      • Daluwatta A.
      • Banks E.
      Living Guidelines for absolute cardiovascular disease risk assessment and management.
      Heart, Lung and Circulation. 2019; 28: 829-832https://doi.org/10.1016/j.hlc.2019.01.014
      ]. Previous reviews [
      • Akl E.A.
      • Meerpohl J.J.
      • Elliott J.
      • Kahale L.A.
      • Schünemann H.J.
      • Network L.S.R.
      Living systematic reviews: 4. Living guideline recommendations.
      J Clin Epidemiol. 2017; 91: 47-53https://doi.org/10.1016/j.jclinepi.2017.08.009
      ,
      • Vernooij R.W.
      • Sanabria A.J.
      • Sola I.
      • Alonso-Coello P.
      • Garcıa L.M.
      Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks.
      Implement Sci. 2014; 9: 1-9
      ] could not find systematic standards for living guidelines in methodological manuals, the practical implementation analyzed in this review concludes also no generic concept of living guidelines.
      In the methodological chapters of guidelines or supplementary methodological publications guideline’s editors describe the process of development. Who was involved, which work groups were formed and performed which tasks in the development and how consent was reached. Considering the described processes (which varied in the degree of structure, e.g. how many groups were defined, how consensus was reached) and from the perspective of this review’s authors Figure 2 demonstrates necessary steps to ensure a standardized development and therefore also the quality of a living guideline. The update of living guidelines is a recurrent process always following the same procedure. The GRADE approach provides a framework, supporting and guiding the iterative process of evaluating available evidence, implementing, and developing evidence-based recommendations as well as administrating every step.
      Figure thumbnail gr2
      Figure 2The iterative process of the living guideline following the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
      A limitation of this review could be that even by using the term “living” as a search string, not all existing living guidelines were identified. On the one hand, it turned out that some guidelines were declared as “living”, which after the queries were not defined as a living guideline by the respective editors and authors. One of the a-priori defined criterion was an update interval within 12 months. A discussed advantage of living guidelines is the independence of fixed time intervals for updating and only to revise on demand if new evidence is sufficient for triggering an update [
      • Pieper D.
      • Ober P.
      • Dressler C.
      • Schmidt S.
      • Mathes T.
      • Becker M.
      Effizientere Leitlinienerstellung–eine narrative Übersichtsarbeit.
      Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2019; 146: 1-6https://doi.org/10.1016/j.zefq.2019.08.004
      ]. Therefore, some actual living guidelines might have been excluded, which formally could have been considered living. On the other hand, the question arises as to whether guidelines exist that follow the formal criteria of a living process but are not labeled as living guideline. The current COVID-19 pandemic and its need for timely evidence-based recommendations might have accelerated the use of living formats. By almost half of the selected guidelines being related to COVID-19 there is a clear bias towards this topic in the results of this scoping review. Due to the non-exhaustive search strategy, the present review makes no claim to completeness of all available living guidelines. Nevertheless, to elicit a broad spectrum of living guidelines, generic keywords were used. The number of duplicates (roughly a fifth part of the total amount of findings) indicates that published living guidelines are disseminated on multiple platforms and the applied search method might have covered the majority of the currently available living guidelines in English and German language at the time of search. In this context the possibility of bias by selection of German as second language should also be mentioned. Since the present review is a first selective analysis, very broad criteria were chosen. For future work, established criteria for assessing the quality of a guideline (e.g. the AGREE II tool) should be used as a standardized procedure. The lacking systematic quality evaluation should be considered as a potential limitation of our work.
      The fact that there is no uniformity between the living guidelines indicates how important a standard procedure is. A checklist supporting the development of a living guideline and generating a uniform standard would substantially contribute to a homogenization of living concepts (in areas where it serves ensuring the quality of the guideline). By screening the structure and the procedure of the living guidelines and partly their previous versions, criteria of a living process could be elaborated.

      Conclusion

      It can be concluded that the development and therefore availability of living guidelines is on the rise. Recently published living guidelines varied in the range of extensive and comprehensive versions similar to previous non-living formats to short and single-recommendation guidelines focusing on specific clinical questions. A clear trend towards shortening the living guidelines when adapting from non-living to living could not be observed. To ensure the guideline’s quality, tools tailored to assess the development and especially the update process could be a useful and necessary part in the trend towards faster updates and therefore better-informed guidance.

      Funding

      This research project is part of the G-BA (Gemeinsamer Bundesausschuss) funded project SISYPHOS – Strukturierte Implementierung digitaler, systematisch aktualisierter Leitlinienempfehlungen zur optimierten Therapeutenadhärenz bei Schizophrenie, funding reference number 01VSF20024.

      Conflict of interest

      C. Pielenz: none. M. Schneider: none. E. Salveridou-Hof: none, M. Flick: none. G. Gaigl: none. N. Khorikian-Ghazari: none. D. Güler: none. T. Halms: none. A. Kapfhammer: none. C. Lorenz: none. A. Röh: none. E. Wagner: none. P. Falkai received research support/honoraria for lectures or advisory activities from: Abbott, Boehringer-Ingelheim, Janssen, Essex, Lundbeck, Otsuka, Recordati, Richter, Servier and Takeda. He holds a payed position as chairman of the Psychiatric Department of the University Munich; is full professor at the Psychiatric Department of the University Munich. He has received and is currently receiving grants from several national and international foundations and institutions, e.g. from the “German Science Foundation”, the “German Ministry of Science” and the “German Ministry of Health”. S. Leucht reported personal fees from Alkermes, Angelini Pharma, Eisai, Gedeon Richter, Janssen Pharmaceuticals, Johnson & Johnson, Lundbeck, Medichem, Merck Sharp & Dohme, Otsuka Pharmaceutical, Casen Recordati, Rovi, Sandoz, Sanofi, Sunovion, Teva Pharmaceuticals, Boehringer Ingelheim, and LTS Lohmann. W. Gaebel is a member of the Lundbeck International Neuroscience Foundation. A. Hasan has been invited to scientific meetings by Lundbeck, Janssen-Cilag, and Pfizer, and he received paid speakerships from Janssen, Recordati, Otsuka and Lundbeck. He was a member of Roche, Otsuka, Lundbeck, Rovi, Recordati and Janssen advisory boards.

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      Article info

      Publication history

      Published online: August 27, 2022
      Accepted: July 21, 2022
      Received in revised form: June 29, 2022
      Received: March 17, 2022

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      DOI: https://doi.org/10.1016/j.zefq.2022.07.004

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