I think we did not apply Evidence Based Practice (EBP) efficiently in our medical practice. EBP should be part of the medical system as mandatory approach for health care. It should be a foundation for our hospitals guidelines and practice. In my opinion implementing EBP will reduce the time needed to  transfer knowledge into practice. 

the question Ahmad .. how we will do that? 

As I mentioned in my previous comment, the leadership should adopt the EBP in health care system, then the health care provider can adapt it. So, the use of EBP should be mandatory and systematic.  Thus, the health care provider will follow the updates, discuss and share it and then apply the EBP process to change the practice if applicable. 

Many thanks Ahmad 

A few years ago  a position article in NEJM  stated that we are now in the rera of TRANSLATION FAILURE. In fact  even Evidence Based Medicine facts which could be expected to be easy to " translate " prooved to be dificult.  New drugs - even with small benefit  ( for instance - cholinomymetics for Alzheimer"s Dis )- have been easy to introduce ...  On the oposite EBM  facts like adopting a " healthy life style "  by as many as possible are still far  from the public even now after several decades ..... A proactive strategy should be elaborated for each domain in need for translation  from EBM to practice !  Mass Health Education  all along  the education system for the public and  intensive Continuous Medical Education for  all  health professionals could be a  way. 

Thank you Prof. Arthur for the valuable contribution 

It seems to me that there is not a lag but a movement away from  research evidence in my field.   Birth, the most common reason for hospitalization is a series of financially motivated fabrications about risks that are for the most part a product of hospital birth interventions and concommitantly the danger of hospital birth are censored.   As the cesarean rates rise yearly, hospital birth outcomes get worse and worse in terms of maternal mortality and morbidity.   Here is a letter which is in press in BJOG, but it will be lost as most letters are, rather than used to educate.   I do not see a 17 year lag.  I see a veritable censorship of the evidence  in my field.  

The 5 quality planned homebirth studies: Janssen (2002), Janssen (2009), Hutton (2009), de Jonge (2009) & Birthplace (2011), studied 348,583 planned attended homebirths.  They show planned homebirth with a trained attendant has equivalent perinatal newborn outcomes but significantly less maternal morbidity and mortality than planned hospital births.  Hospital births involve higher infection rates, less personal treatment, and overuse of cesareans, inductions, augmentations, epidurals, EFM, AROM, and Vaginal exams compared to homebirths.  1 in 2,345 low risk women die at hospital births (1) and 1 in 1000 low-risk women almost die, ending up in Intensive care, from planned hospital birth (2). Not a single maternal death was documented at homebirth in the presence of a trained practitioner in the past 40 years.          In the US over 300 women die annually of avoidable cesareans and inductions. Only about 50 term newborns die of Newborn GBS per year in the US.  Vaginal exams significantly increase rates of Newborn GBS Disease (3)  Yet, instead of avoiding vaginal exams, a million women a year with term pregnancies are told they harbor a dangerous bacteria, GBS,  that is actually part of their natural intestinal flora or 30% of women,  and given massive doses of IV antibiotics in labor to lower, but not remove the risk of GBS infection.  Those women are not told of their much higher risk of dying if they plan a hospital birth.  Cord prolapse is the only event with better outcomes in hospital, but is completely preventable during attended labor by avoiding vaginal exams.  Fetal heart decelerations rarely happen at homebirth and are treated by position change and pain relief. Shoulder dystocia has better outcomes at homebirth. (4)  There is no quality research supporting induction for postdates. (5)  Meconium aspiration and TTN can be prevented by delaying the delivery of the body until the newborns lungs are drained. Ultrasound does not result in better outcomes, just more worried mothers. The only way for a birthing mother to be certain to survive birth is to have a homebirth with a well trained attendant.   (in press BJOG 2016)

1.  Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Induction of labour. CMAJ. 2014;186(16):1247.

2. Danilack VA, Nunes AP, Phipps MG. Unexpected complications of low-risk pregnancies in the United States Caused by delivering in hospital. Am J Obstet Gynecol 2015; 212:809.e1-6.

3.   Heath PT et. al. Group B streptococcal disease in infants: a case control study. Arch Dis Child 2009. 94: 674-680.

4.Kallianidis AF, Smit M, van Roosmalen J. Shoulder dystocia in primary midwifery care in the Netherlands. Acta Obstet Gynecol Scand. 2015

5.Cohain  JS. To what extent do English language RCT meta-analysis justify induction of low risk pregnancy for Postdates? J Gynecol Obstet Biol Reprod (Paris). 2015;44(5):393-7.      

very interesting contribution Jody  

This is a culture change and requires leadership and system evolution.  Some systems in the US has accomplished this but the culture of these institutions supported the slow evolution to EBM.  Culture change does not come without difficulties and some institutions have only been able to introduce EBM into some parts of the system, not all.  It requires vision and leadership to drive and support the system changes.  

I think the issue is not so black and white. The question/ answers needs to consider strength of evidence, it's effect size, it's replication if primary research, it's clinical relevance to patient outcomes. Too often guidelines are based on mixed levels of evidence. Too often research lacks longitudinal data, and important information gained from long-term follow up. I suggest that the issue is not only an issue of failure to use appropriate and evidence informed approaches to knowledge transfer there are also structural barriers to how research is conducted (e.g. graduate students with limited funds, vested interests, lack of evaluation blinding, poor quality peer-review, inadequate attention to common confounders, lack of standardized outcome measures ). EBP and EBM systematic  approaches to knowledge syntheses are better than prior narrative reviews however are limited by quality inputs.

Many thanks Dr. Diana & Dr. Marc for the contribution .. appreciated 

Some people distinguish translation from implementation.  For them, the former is development of practical clinical applications from basic research; whereas the latter involves the widespread adoption of clinical applications.  It is usually the latter to which the "17 years" is said to apply.  

But, that certainly is not the case.  Some innovations in health care are implemented very quickly.  An example is the spread of laparoscopic cholecystectomy beginning in the mid-1980s or various forms of fiberoptic endoscopy.  Those made economic sense to the potential adopters.  They involved less physician time (laparoscopic cholecystectomy) or were enough less traumatic that more patients would accept them (virtually all endoscopy and endoscopic procedures).  That made a "business case" for adoption, one way to accelerate spread.

Another way is to tie the "innovation" to a system that makes it easy to adopt/use.  For example, it is easier to adopt clinical guidelines based on evidence that can be built into electronic decision-support systems.  If, the clinician has to look up the guideline instead of having it presented in a usable form, it is less likely to be adopted.

Without going into detail, it is worth reading the summary material in Everett Rogers' seminal book on diffusion of innovation published in 1962 and, I believe, still in print.  It gives a number of principles that lead to more rapid adoption.

 " Medical Innovations "- including new and promissing drugs or new and successful surgical  procedures are relatively  easily adopted. But what about such a major mass health need like to influence as many  people as possible to adopt what is called " a healthy mode of life " . ? This a major Translation Failure !