Next we're going to talk about barriers

other
than time to using research in practice.
So what are some of the barriers to why
people
are not using research as often as we
think they should.
There's a lack of value for research and
practice.
There's a lack of understanding of
organizations or structure
of the electronic databases that are
available to us.
Some people have difficulty accessing
research materials.
And some people lack computer skills and
other's have a difficulty of understanding
research articles.
We know there is a gap between research
and practice.
One of the issues is a time gap between
research findings and implementation.
One example is a bit extreme, but
interesting.
In 1601, it was discovered that there was
a
benefit of having lime and sauerkraut to
prevent scurvy.
But not until 1975 were there rations
containing vitamin C
that were required on boats for people who
are out to sea for a long period of time.
As you can see over 300 years in
the gap between understanding science and
actually changing practice.
Levels of evidence is another issue.
We know that all research is not equal.
There's lowest levels of evidence, where
it might just be one person's opinion.
And then there's the highest level of
research, which
is really where you have multiple, maybe
randomized control
trials, which can really make a difference
in our
understanding of what's going to be
beneficial to our patients.
So what we want to do is integrate
evidence into practice.
We need a plan where we can involve all of
those affected by
the change in the planning process,
identify the outcomes, and implement a
pilot.
We want to correct at mid-course, so if we
do have an intervention, or we are trying
to
implement a new plan, we have some way of
evaluating to see if we need to change
mid-course.

We want to communicate, we want to

communicate our findings, we want to
communicate our research to our patients,
also and to our colleagues.
And we always want to evaluate.
It's so important to evaluate your
findings and any project
that you're doing you need to have an
ongoing evaluation.
So although we know there are many
barriers to
changing practice, we hope that good
evidence will help
support that along with our work with our
patients
and our constant evaluation of the work
that we're doing.
I'd like to give you an example of
a scientific study that informs public
health messages.
The message here is that research can
really
make a difference in the lives of
families.
In the field of sudden infant death
syndrome or SIDS, there's been a lot
of wonderful research that has been done,
that has really change the lives of
families.
The definition of SIDS is a sudden
unexpected death of an infant
under one year of age with onset of the
fatal episode apparently occurring
during sleep, that remains unexplained
after
a thorough investigation, including
performance of a
complete autopsy and review of the
circumstances of death and the clinical
history.
In the field of SIDS research there have
been many observational studies.
Starting in the early 1990s, in Europe and
the United States
there were studies that showed that
infants in a prone sleep position
or babies who were put to sleep on their
stomach was
associated with the increased risk of SIDS
or sudden infant death syndrome.
In addition, there were some physicians
who were looking at infants'
anatomy and physiology to try to
understand the risk for SIDS.
What we learned in terms of the anatomy
and physiology, was when a baby
was put to sleep on their stomach, on the
prone side, you can see
the esophagus is above the trachea, and
it's possible that they're could be some

compression on to the trachea and make it

harder for a baby to breathe.
So when they found that the babies who
were put
to sleep supine on their back, there was
more of a
ability for the trachea to have more
space, so there was
more ai, space for the air and for them to
breathe.
And they found that there was a real
difference in the anatomy
of the infants who were to sleep on their
back or their stomach.
This finding, along with the observational
studies, influenced the American Academy
of Pediatrics in the United States in 1994
to start a back to sleep campaign.
And this was a large public health
educational campaign to tell
new parents that babies should be put to
sleep on their back.
It was sponsored by the American Academy
of
Pediatrics, and the SIDS Alliance in the
United States.
What we learned was that the international
rates of SIDS dropped precipitously when
these new campaign were started to put
babies to sleep on their back.
And as you can see here, with Japan.
On the bottom, they started out with the
lowest rate in 1990
and continue to stay low but actually even
got lower by 2005.
And that was really because of the
countries represented here culturally,
many of the babies in Japan were already
put to sleep on their backs in 1990.
But in the other countries represented
here,
which are Argentina, Australia, England,
and the United
States, they did not have policies where
babies
were put to sleep on their ba, back.
So here we can see Australia started out
as the highest rate, and now
it went down precipitously by 2005 to as
low a rate as England.
England also started out quite high ,and
dropped precipitously by 1995.
And as I mentioned in 1994 was when the
American Academy of
Pediatrics started their campaign for back
to sleep in the United States.
So let's see what happened in the United
States.
Here it was quite a high rate and then it
dropped

quite a bit to 1995 and continues to drop

until 2005.
And actually the rate has mained, remained
fairly stable from
2005 until the present time in all of
these countries.
The other country here is Argentina which
was sort of in the middle.
But it also continued to drop over time.
So this is just a wonderful way to see how
a public health
campaign can make, can really make a
difference in the lives of children.
Here you can see the percent of infants in
the United States that were put to sleep
in a prone position or on their stomach
compared to the SIDS rate over time.
We start out in 1990 and go until 2006 and
the SIDS rate was quite high
here in 1990 and as I mentioned in 1994 we
had a campaign
for putting babies to sleep on their back
so the rates continued to drop
precipitously here, and stabilized over
the last
ten years and has continued to be stable.
And you can see that in comparison to the
percent of babies who were put to sleep on
their
stomach, which is prone, and it started
out at about
70%, and then by about 1996, it was about
25%.
So this is a nice graph to just show you
how the rates of SIDS
dropped as we changed our policies for
infants being put to sleep on their back.
[SOUND] Question is what was the primary
factor contributing to the risk of SIDS?
A: Infant sleep position.
B: Parent education.
C: Country of birth.
D: Breastfeeding rates.
[BLANK_AUDIO]
The answer is A.
[BLANK_AUDIO]