The further we get into the pandemic, the more we are learning and the more we need to scrutinize. There has been an understandable rush to publish during this unprecedented time. Initially that seems entirely positive, but is it? There are many studies being unleashed that would normally not make the cut during the peer review process. Due to this, we have to make sure that we are judging each study both individually and in the context of the wider body of evidence. In most cases, we should not immediately jump to conclusions that are new and novel due to a single study or commentary.
Having said that, we are operating in the relative unknown and desperately want to do everything we can to keep our patients safe and well. No one can read all the studies published daily relating to COVID-19. Most days now there are over 300 new studies/commentaries/observations released. Many are extremely helpful, but some may lead us down rabbit holes that sabotage our goals of quality patient care.
Additionally, our patients are besieged with information from the news that is very often focused on the shock and macabre of the entire situation. How can we as healthcare providers keep ourselves informed and be ready to answer the slew of questions from our patients?
After reading an immense number of articles on COVID-19 here is a non-comprehensive list of some of my recommendations.
Study design matters. This does not mean non-randomized controlled studies don’t count. There are very few of those right now due to the speed that the pandemic came upon us, but there are more and more systematic reviews being published.
Look for consistency of the evidence. Even with lower quality studies, if they are all reaching the same conclusion on a particular subject, the data can be approached with more confidence.
Be wary of commentaries on theories. Once again, these are often picked up by the media and presented almost as facts. When the news stories hit, be prepared to research the source. Is there any human data supporting it?
When multiple hospitals are contributing to the data examined, are they all matched in their care algorithms? Differing standards can significantly impact the quality of the data.
Have all the participants in the study had a definite conclusion to their disease? Many studies have included significant participant numbers, but a large number of patients included were still in the hospital when the study period ended. Did they die, progress, recover, this will clearly impact the conclusions of the study?
The CDC has had some hiccups in their response to this health crisis to say the least. For many reasons they have not been the appropriate leaders that we would like to see during this time. However, there is a significant amount of guidance on their web page that can be very helpful for providers and patients alike.
For diabetes specifically, few studies are reporting out T1D and T2D separately. This is just something to keep in mind.
Preprints may be considered much more than in the past. Depending on the study design, these articles may provide guidance during this time. Often the peer review process has been significantly rushed during the pandemic, so not having gone through peer review may be less of a factor.
Establish a plan to inform your patient population on the latest evidence that is pertinent to them.
Ask a colleague. No one can know everything about this disease. We need to work as a collaborative medical community to share information and insights.
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