Bridging the gap between science-led research and evaluation of clinical practice: the role of service innovation audits and case studies.

Abstract

Dear Editors, Two recent publications in BMJ Nutrition, Prevention and Health 1 2 have been subject to mixed reactions from members of both nutrition science and clinical practice communities. As a centre bridging both scientific research and clinical practice, we have heard and considered valid arguments from both schools of thinking.3 Nutrition science argues that the publication of research based on clinical audits and in particular, n=1 case studies, lack the scientific rigour to justify any implementation in the clinical setting, partly because of a lack of control over variables including unknown confounders and the presence of bias. Proponents of the latter may argue that clinical audits and novel case studies are crucial in supporting implementation of science into practice via recognition of new trends or outliers in clinical findings and practice patterns. Showcasing n=1 cases may also provide motivation to colleagues, helping them to challenge preconceived ideas and consider the difference between research and clinical practice, then to think through and apply similar approaches to help their own patients—ultimately leading to better practice.4 However, these views are not dichotomous, but complementary, whereby practice should inform science and science should inform practice. It can be summarised from the work of Sackett et al 5 that without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent research evidence may be inapplicable to or inappropriate for an individual patient. Equally, without current best evidence, practice risks becoming rapidly out of date, to …