Part 4: Apply Research-to-Bedside Appropriately.
You are interested to read the headline “Red wine reduces risk of heart disease”. Not taking the headline at face value, you look at the study more closely: the investigators are experts in their fields; the data was gathered prospectively in humans; the study is published in a reputable journal; and you’ve assessed causation vs correlation.
The question is where to go from here. What can you recommend based on the research you have seen? How can this influence your practice?
Watch out for the one-hit wonder
One of the first things to keep in mind is that ONE study, no matter how well-designed and how promising, does not provide sufficient evidence to change clinical practice. The robustness of the results must be tested by multiple trials to ensure they are consistent.
If available, the Cochrane Reviews, meta-analyses and systematic reviews are an excellent way to get this information. They summarize the results of many studies giving you a more complete picture. Another great resource for those interested in evidence-based answers to nutrition-related questions is Practice-based Evidence in Nutrition (PEN).
RED WINE example: There are promising results regarding the impact of red wine on chronic disease risk, often from well-designed studies, but when you look closely at the literature, the consistency across studies is an issue. As a whole, current knowledge with respect to the benefits of red wine is equivocal – some show benefit, while others show no difference – certainly not enough to encourage red wine drinking in the general population (1).
Divide and conquer
With new evidence and studies emerging every week, it can be tough to stay on top of the latest and greatest and literature reviews are not always available. That’s where working as a team can be helpful:
- Attend clinical rounds if you work in hospital – may be geared toward physicians, but you can learn a lot about current knowledge and new research
- Take advantage of continuing education sessions in your area. If there are none – plan one!
- Form a journal club with colleagues. Choose a topic and review relevant studies together.
- Contribute to a PEN pathway or take part in a literature review
Knowledge translation, transfer and exchange is two-way street between researchers and users. Do you have a burning clinical question? Consider working with a local researcher to develop a research study or collaborate on a current project.
Once you’ve concluded that there is scientific merit to the results, you need to take the research and apply it to real people. There are many things to consider in this case but first and foremost is safety.
- Who were the test subjects in the research?
- Who will benefit?
- Who might be harmed?
- Any contraindications or nutrient-medication interactions?
A recommendation that applies to healthy adults might not be appropriate for other demographics. In our example, even if the evidence indicating that red wine reduces risk of heart disease was conclusive, it should obviously not be recommended for women who are pregnant or breastfeeding, or breast cancer survivors.
Personalized implementation – benefit vs. risks
With mass media coverage, often clients will bring new research to your attention, particularly if the results are personally relevant to them. Even if the literature is inconsistent, clients are often keen to run with the newest findings. As a clinician, you should clarify what is known about potential benefits, so that clients can make an informed choice, and establish any potential risks, should clients decide to adopt dietary change.
In our example, while red wine and health has some scientific merit there are several potential concerns:
- Weight gain related to extra caloric intake
- Too much of a good thing – risk of excessive alcohol intake
As a practitioner you need to to translate research findings in a way that is appropriate for your clients to mitigate any potential risks. For example, reminding clients that moderation in alcohol intake still applies – excessive alcohol intake, regardless of source, increases risk for heart disease (1). Encouraging flavonoid intake from a variety of sources, including strawberries and apples and not just red wine, could be a useful tactic in reducing risk of adverse outcomes related to alcohol intake while still achieving benefit.
That’s it! You are ready to wage War on Spurious Science and make safe, practical and effective recommendations.
1. Van Horn L, McCoin M, Kris-Etheron M, Burke F, Carson JAS, Champagne CM, Karmally W, Sikand G. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008; 108:287-331.