In 1996, David Sackett and colleagues authored the seminal article regarding evidence-based medicine in the BMJ, stating that evidence-based medicine is the 'conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.'1 This definition is still largely used today to describe an approach to healthcare that ensures evidence from research is used in combination with clinician expertise and patient preferences. The year 1996 was a big one for evidence-based practice, as in addition to the publication of Sackett's widely used definition, a small research organization focused on getting evidence into the hands of health professionals was formed in Adelaide, Australia. This small organization, titled the Joanna Briggs Institute, would soon grow into a large international collaboration of health professionals, academics and researchers, all aspiring to a world where evidence-based healthcare is the norm.2

When it was first proposed, evidence-based healthcare was seen by some as a radical and completely different approach to healthcare, thus requiring significant education of the health workforce. From its inception, the Joanna Briggs Institute has focused on providing education regarding the importance of evidence-based healthcare and the conduct of systematic reviews globally. From the tireless work of organizations 'spreading the good word' about the importance of evidence, since the 1990s, evidence-based healthcare has largely gained acceptance internationally.3 Despite this, even 20 years later, there is still a need for widespread education regarding the principles of evidence-based healthcare for health professionals.4

One way to ensure health professionals are aware of the importance of evidence-based healthcare is to embed this learning in their undergraduate curriculum. In this issue of the International Journal of Evidence-based Healthcare, Young et al. describe the attitudes towards evidence-based healthcare of undergraduate medical programme educators, and their confidence in teaching this field. However, it is not just our future workforce who require educating, and Williams et al. report on their project to design, develop and evaluate printed education materials for evidence-based practice dissemination for those currently practising.

However, education regarding evidence-based healthcare is only the beginning. Once the importance of evidence-based healthcare has been acknowledged by health professionals, the evidence regarding a particularly clinical question requires extracting and synthesizing in an unbiased way.5 A systematic review is the best method to achieve this, and a highlight of this issue is the study by Atlantis et al. regarding dietary intake and supplementation of specific polyunsaturated fatty acids in chronic obstructive pulmonary disease.

Once colleagues understand the importance of evidence, implementation and practice change can be initiated. The implementation of evidence into practice can be difficult; however, Pather et al.'s article in this issue provides a solid example of a process that can be undertaken to create change and improve compliance with best practice, even in time-poor and complex settings such as the intensive care unit. Practice change does not necessarily occur easily or quickly, and even when change can be achieved, it is not always sustained. Santos et al. provide an important report on their journey of sustaining falls reduction in their academic medical centre.

Although the field of evidence-based healthcare has evolved significantly over the past 20 years, many of the core principles remain the same today. These include the need to ensure health professionals receive education regarding the importance of evidence-based practice, the importance of conducting systematic reviews to answer key clinical questions, and ensuring that strategies are designed to implement and sustain practice change with the aim to improve patient outcomes. This issue of the International Journal of Evidence-based Healthcare provides key exemplars of these important processes in the evidence-based healthcare cycle.

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