Dunja Dreesens

19 Furthermore, research has shown that it usually takes approximately 17 years before research results find their way into healthcare practice (22, 23). Meaning that the translation, or implementation of this knowledge, takes 17 years before it is used in practice and reaches patients. Figure 3: Leaks in the evidence pipeline from research to daily practice (based on Glasziou & Haynes, BMJ Evidence-based Nursing, 2005) To make matters worse, other research pointed out that the pipeline through which the knowledge flows is a leaking pipeline. At every step of the knowledge translation process due to various reasons and blockages knowledge drips away and does not reach daily practice (see figure 3) (24, 25). The starting point of ‘valid research’ in figure 2 is essential as will become clear in the next world. The world of evidence-basedmedicine Another world in health care is evidence-based medicine (EBM). EBM is nowadays omnipresent in health care. Sackett et al in 1996 described evidence-based medicine as integrating “the best external evidence with individual clinical expertise and patients’ choice” (see figure 4) (26). Over the years, however, it has become clear that EBM did not completely deliver on its promise. The pillar ‘research evidence’ has received much more emphasis than the other two pillars, especially in evidence-based clinical practice guidelines. This emphasis on research evidence is troublesome for several reasons. One reason being that certain patient groups, such as women, minorities, children, and the elderly, were and still are often underrepresented or excluded from research trials. Another reason is that multi-morbidity is not taken into account (27). The applicability of the research results for certain patient groups is therefore limited. Contrary to Sackett et al’s intentions, a hierarchy of evidence has (unintentionally) evolved in EBM. Perhaps influenced by Cochrane’s emphasis on summarizing RCTs, most in the EBM-community Figure 4: Three pillars of evidence-based medicine (based on Sackett et al, BMJ, 1996) Chapter 1