Converging pathways: bringing community, student initiatives, and a systematic review project in COVID-19 pandemic

Introduction: In early January 2020, when the COVID-19 pandemic broke out, in vitro and animal studies showed preliminary positive results for repurposing drugs. Healthcare professionals had to critically assess the vast and emerging literature with an evidence-based approach to best clinical practices. Objective: The objective of this paper was to describe and reflect on the integration of a meta-research with a university extension program to promote critical reading of COVID-19 scientific studies among undergraduates. The meta-research aims to map the evidence and to estimate the prevalence of biases in comparative studies evaluating repurposing drugs for the treatment of COVID-19 during the pandemic. Methods: We integrated an online training on literature critical appraisal with a systematic review of methods. We searched for “COVID-19” and repurposed drug-related terms in MEDLINE, Embase, Cochrane Library, and LILACS by January 10th, 2022. Two independent researchers reviewed titles and abstracts and comparative studies had data fully extracted, including risk-of-bias. Results: A total of 171 students in Brazil signed into the online critical appraisal course. Of those, 24 were invited to collaborate with the meta-research, after robust evidence critical appraisal training. During the COVID-19 pandemic (2020-2021), 30.896 references assessed repurposing drug were identified and 6.246 papers were included. Our preliminary data showed 146 randomized controlled trials (RCT) with the word “randomized” in the title and 146 cohort studies identified by the word “cohort” in the title or abstract. Conclusions: The health emergency, there was an important volume of articles on interventions for COVID-19. Our preliminary results suggest that less than 5% of these studies were comparative longitudinal studies, being that most of the pertinent articles represent a challenge to be critically assessed, and probably have low level of evidence for clinical decision making. Our extension activity highlighted the interests of undergraduate healthcare students in developing skills on critical review of scientific articles. Thus, the experience of integrating university extension activity with research allows linking the community with knowledge generation.