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J R Soc Med. 2016 June; 109(6): 215.
Published online 2016 June 14. doi:  10.1177/0141076816652593
PMCID: PMC4908480

From evidence cart to smart phone

Where do you stand on Brexit? You might find this a hard question since facts are difficult to establish. Sober analysis is lost amid the feverish passions of protagonists. The effects on health and science may not be top priorities for politicians, but they should be important considerations. In an attempt to cut through the red rage of emotion, clinicians and scientists from Imperial College explain why a vote for Brexit is a mistake.1

I expect many readers will disagree with our editorialists, and even if they do agree with them their vote will be won or lost for other reasons. Whatever the outcome of the referendum on 23 June, the challenges to UK’s health services remain stark. In the dash for health service reform, new care models, and the promised land of innovation, the value of evidence needs to be reinforced.

Like other innovations, those designed to improve evidence-informed practice are difficult to implement and evaluate. The world famous ‘evidence cart’ pioneered at Oxford’s John Radcliffe Hospital in the 1990s was an attempt to bring the library to the bedside. While the cart helped improve decision-making based on searches of evidence resources, its bulk and reliance on power cables made it an impractical companion on wards rounds and emergency departments. Smart phones have made these issues irrelevant, but the challenge remains of integrating relevant evidence with clinical data to promote optimal patient care.2

Marshall et al.3 argue that the ‘know-do’ gap in health services research may be greater than in clinical research. Many service changes are implemented, they say, unguided by research evidence. Walk-in centres, integrated care programmes and independent sector treatment centres are just three examples of service changes ‘that have gone badly awry’. In an age where Barnsley Football Club has a poet in residence and the All England Tennis Club employs an artist in residence, a researcher in residence on a clinical team might be the catalyst to achieving participatory research that brings about successful service transformation?

Whether in or out of Europe, you might want to consider the main finding of this month’s research paper, which finds no support for low, aspirational, BMIs among adult patients on hospital discharge.4 Whether you prefer your evidence best delivered by cart, smart phone or researcher in residence, research evidence has the power to surprise and challenge received wisdom.

References

1. Majeed A, Hansell A, Saxena S, Millett C, Ward H, Harris M, et al. How would a decision to leave the European Union affect medical research and health in the United Kingdom? J R Soc Med 2016; 109: 216–218. [PubMed]
2. Straus S, Eisinga A, Sackett D. What drove the Evidence Cart? Bringing the library to the bedside. J R Soc Med 2016; 109: 241–247.
3. Marshall M, Eyre L, Lalani M, Khan S, Mann S, de Silva D, et al. Increasing the impact of health services research on service improvement: the researcher-in-residence model. J R Soc Med 2016; 109: 220–225. [PubMed]
4. Freemantle N, Ray D, Falcaro M, McNulty D, Shallcross L, Wood J, et al. BMI upon discharge from hospital and its relationship with survival: an observational study utilising linked patient records. J R Soc Med 2016; 109: 230–238. [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press