Abstract
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.