Vascular access clinical evidence and clinical practice

March 10, 2016 0

When you next read an article or attend a conference ask yourself who is the intended audience? I have often voiced the opinion that we sometimes have a disconnect between research and clinical practice. To clarify, I’m a big fan of research studies that are valid, reliable and demonstrate a degree of probability. We need them. But, what about the evidence produced from alternative sources such as review articles, case studies and experiential opinion. Moreover, who decided limit the definition of what is classed as evidence? And more importantly, what evidence is being denied a voice in the decision making and guideline development process.

Why would I make these comments. Well the answer is simply really. Most of us have to either put research into practice or devise research studies to investigate practice. In addition, we have those amongst us that are working really hard to get non-specialist teams who deliver routine IV care to understand the standards we expect them to achieve. In other words. We need evidence that we can apply in a working world.

I pleased to say that I am not just a lone voice in this debate on evidence and clinical practice. Hayes (1990) published a short conversation piece on the “Loose connections between peer-reviewed clinical journals and clinical practice”.  The approach adopted by Hayes (1990) is a very interesting discussion on who publishes and who reads journal papers. The following is a summary of the lines of communication in biomedical journals as identified by Hayes (1990):

  • Scientist to scientist – These studies are usually preliminary in nature and are classed as a communication from scientist to scientist. They have the potential to add to the knowledge base and hopefully generate further more rigorous research. The danger of this type of publication is that it may be mistaken for communication between scientist and clinician.
  • Scientist to practitioner – These are articles describing rigorous trials that need to be communicated to those putting evidence into practice. The danger here is that the paper may be missed by a part of the clinical audience who do not routinely access the scientific journals.
  • Practitioner to practitioner – These are publications in clinical journals that are usually presented as a review article. The function of the review article is to inform current clinical practice and to enable the readership to identify gaps in their knowledge.
  • Practitioner to scientist – These publications usually take the form of case studies. A note of caution is raised with regard to using case studies to determine the general broad management of patient care. But, they do have a role in highlighting areas of interesting practice. Therefore, they have a role in understanding the complexities of care at what is usually a single patient episode. It is highlighted that case studies have a particular role in generating new research topics. Therefore, publishing case reports remains justified.

Viewing a publication or a conference paper presentation in light of who is the intended audience is a very liberating experience. I look forward to researchers, authors and presenters defining their intended audience in the future.


Haynes, R.B. (1990) Loose connections between peer-reviewed clinical journals and clinical practice. Annals of Internal Medicine. 113(9), p.724-728. doi:10.7326/0003-4819-113-9-724