The time lag between when research is completed and when it is used in clinical practice can be as long as two decades. This chapter considers the dissemination and implementation of research findings. It also explores better ways to make research findings understood and used. On the one hand, we recognize the need to get new research into practice as soon as possible. On the other hand, we challenge the trend toward rapid implementation. When results are put into practice prematurely, patients may suffer unnecessary consequences of insufficiently evaluated interventions. We offer several examples of Nobel Prize winning interventions that had unintentional harmful effects that were unknown when the prize was awarded. To address these problems, we support the need for greater transparency in reporting studies results, open access to clinical research data, and the application of statistical tools such as forest plots and funnel plots that might reveal data irregularities.

Almost all efficacious stroke treatments confer moderate-to-large benefits, but not staggeringly huge benefits. However, moderate treatment effects can be clinically very worthwhile for the patient. To detect moderate-large treatment benefits, trials must avoid bias and random error. Studies with weak designs (personal experience, observational studies with historical controls, and observational studies with concurrent, non-randomized controls) will not sufficiently control bias and random error to enable reliable discrimination of a true moderate-to-large benefit from false positives and false negatives. Randomized clinical trials are required. 'Ingredients' for a good trial – Proper randomization and concealment of allocation (i.e. clinician cannot have foreknowledge of next treatment allocation)/Outcome evaluation blind to the allocated treatment/Analysis by allocated treatment (including all randomized patients: intention-to-treat)/Large numbers of major outcomes and correspondingly narrow CIs/Conclusion based on pre-specified primary hypothesis and outcome/Chief emphasis on findings in overall study population. Advantages of systematic reviews (over traditional unsystematic, narrative reviews) – Use explicit, well-developed methods to reduce bias/Summarize large amounts of data explicitly/Provide all available data/Increase statistical power and precision/Look for consistencies/inconsistencies/Improve generalizability. Cochrane Reviews – Generally higher quality than other systematic reviews/Periodically updated/Available over internet/Abstracts available free of charge/Full reviews available free of charge in over 100 low- and middle-income countries