The paths from research to improved health outcomes

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Abstract
Research that should change practice is often ignored for years—for example, crystalloid (rather than colloid) for shock,2 supine position after lumbar puncture,3 bed rest for any medical condition,3 and appropriate use of anticoagulants and aspirin in patients with atrial fibrillation.4 Antman et al documented the substantial delays between cardiovascular trial results and textbook recommendations.5 However, even when best practices are well known, they are often poorly implemented: national surveys show that most hypertensive patients are undetected, untreated, or inadequately controlled,6 which has led to the current interest in knowledge translation.7