Volume 198 - Issue 1
Improving effectiveness of clinical medicine: the need for better translation of science into practice
Authors: Robert G Fassett, Bill Lancashire and Anne Rasmussen
Med J Aust 2013; 198 (1): 26. || doi: 10.5694/mja12.11621
Published online: 21 January 2013
Published online: 21 January 2013
To the Editor: Scott and Glasziou’s recent article about the challenges of integrating best research evidence into practice had excellent examples of the 20%-30% of treatments that remain widely used despite being shown to be ineffective or harmful.1 We also note the National Health and Medical Research Council initiative in creating a Research Translation Faculty to improve research relevance and its uptake into practice.
A recent ...
To the Editor: Scott and Glasziou’s recent article about the challenges of integrating best research evidence into practice had excellent examples of the 20%–30% of treatments that remain widely used despite being shown to be ineffective or harmful.1 We also note the National Health and Medical Research Council initiative in creating a Research Translation Faculty to improve research relevance and its uptake into practice.
A recent example of this challenge is the commonly recommended regular removal of asymptomatic peripheral intravenous catheters every 2–3 days as an infection control strategy. Contemporary evidence, including a Cochrane review2 and a local, rigorous, randomised controlled trial,3 confirms that removing catheters on time-based, rather than clinically based, criteria is ineffective.
Contrary to this research and its obvious benefits for patients, doctors and hospital budgets, many infectious diseases experts are resisting change. We are mindful that although catheter replacement recommendations come from infectious diseases physicians, the burden of enacting catheter replacement falls instead on the junior medical and surgical residents and trainees.
We encourage our infectious diseases colleagues to challenge these policies and instead promote the translation of strong science into practice by implementing clinically based intravenous catheter replacement. This will protect our patients from unnecessary procedures, and help ensure our trainees’ time is used productively.
We are comforted that our frustrations in applying research are shared by your authors. We agree that change strategies, such as the engagement of clinicians, are crucial. However, in this age of evidence-based medicine, it is wearisome that tradition and opinion continue to ignore science.
Competing interests
No relevant disclosures.
References
- Scott IA, Glasziou PP. Improving effectiveness of clinical medicine: the need for better translation of science into practice. Med J Aust 2012; 197: 374-378. 0_BABBGCBI
- Webster J, Osborne S, Rickard CM, Hall J. Clinically indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2010; (3): CD007798. 0_i1142867
- Rickard CM, Webster J, Wallis MC, et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet 2012; 380: 1066-1074. 0_CBBCCJCI