Best Evidence Pyramid and Clinical Resources
Evidence-Based Clinical Practice Resources
Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.)
Image from here.
Evidence at the TOP of the pyramid is easier to find and apply.
Items at the BOTTOM of the pyramid are closer to raw data and require more interpretation / appraisal.
TRIP (Turning Research into Practice) Database
Simultaneously searches evidence-based sources of systematic reviews, practice guidelines, and critically appraised topics and articles--including most of those listed above and many more. Also searches MEDLINE's Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.
Filtered Resources appraise the quality of studies and often make recommendations for practice.
Systematic Reviews / Meta-Analyses
The Cochrane Database of Systematic Reviews
Note: We no longer have a subscription for Cochrane via this source. Use EBM Reviews instead.
- Gold Standard for high-quality systematic reviews
- Abstracts for Cochrane Reviews are indexed in PubMed with links to the full-text
- Cochrane Reviews include completed reviews and protocols (reviews in progress)
- Consists of detailed, structured topic reviews of hundreds of articles. Teams of experts complete comprehensive literature reviews, evaluate the literature, and present summaries of the findings of the best studies.
- Published by the International Cochrane Collaboration.
All EBM Reviews (includes Cochrane)
- Also known as EBM Reviews or Evidence-based Medicine Reviews, Cochrane Library, Cochrane Database of Systematic Reviews
- Includes ACP Journal Club
- Search Tips: EBM Reviews
The Database of Abstracts of Reviews of Effect (DARE)
- Structured abstracts of systematic reviews from a variety of medical journals
- Structured Abstracts (NOT full-text articles)
- DARE is produced by the National Health Service Centre for Reviews and Dissemination (NHS CRD) at the University of York, England.
- Complements the Cochrane Reviews by offering a selection of quality assessed reviews in those subjects where there is currently no Cochrane Review.
- Brief critical appraisals of previously published reviews of the effects of health care
- Topics include : diagnosis, prevention, rehabilitation, screening, and treatment.
- DARE is not indexed in PubMed, but the original research articles may be listed.
PubMed - Systematic Reviews & Meta Analyses
- PubMed Clinical Queries no longer limit to Systematic Reviews. This limit can be found with other PubMed filters.
- Identifies systematic reviews and other similar types of studies found in biomedical journals included in the PubMed database. PubMed gathers together a much larger collection than other evidence-based practice resources
- No evaluation of comparative quality of different reviews on a topic
- Abstracts supplied by authors / journals. No separate evaluation of quality of research
- These articles * may * require critical appraisal
How to limit to Systematic Reviews in PubMed:
In PubMed, run your search, and then apply filters to pull up high level evidence.
- To find a Systematic Review, search for your topic in PubMed. On the left side, of the results screen, open the Article Type Filter for more options > Choose Systematic Review. Click to apply this filter to your results.
- To find a meta-analysis, search your topic in PubMed. On the left side of the results screen, open the Article Type Filter for more options > Choose Meta-Analysis. Click to apply this filter to your results.
- Use the AW Library PubMed link to access even more full-text.
Systematic Reviews in Ovid MEDLINE :
- Enter your search query;
- Click on the Additional Limits icon
- Under Subject Subsets, select Systematic Reviews.
Critically-Appraised Topics (CATs) evaluate and synthesize multiple research studies.
- Authors of critically-appraised topics evaluate and synthesize multiple research studies.
- Each topic is critically appraised according to the current best evidence.
- DynaMed's Levels of Evidence Brochure
Nursing Reference Center Plus (Ebsco)
- Includes Evidence-based Care Sheets
- Replaces The National Guideline Clearinghouse after funding ceased as of July 2018.
- A comprehensive database of evidence-based and trustworthy clinical practice guidelines and related documents
- Requires FREE registration.
- Browse guideline briefs of expertly vetted guidelines.
- Each Brief includes ECRI's new TRUST Scorecard which evaluates how a guideline stacks up against the Institute of Medicine Standards for trustworthiness.
- Note: Guideline evidence varies from expert opinion to high levels of evidence.
- High quality evidence-based info about complementary and alternative medicine,
- Herbal medicines, dietary supplements, and integrative therapies.
- Evidence Grades reflect the level of available scientific evidence for or against the use of each therapy for a specific medical condition.
- From the National Cancer Institute (NCI)
- Treatment summaries for adults and children, written for physicians and patients.
- Summaries are specific to cancer type and site and are updated frequently.
- Prevention and palliative care summaries are also available.
- Links to the literature are provided.
Critically-Appraised Individual Articles evaluate and synopsize individual research studies.
- CATs are critical summaries of a research article. They are concise, standardized, and provide an appraisal of the research.
- If a CAT already exists for an article, it can be read quickly and the clinical bottom line can be put to use as the clinician sees fit. If a CAT does not exist, the CAT format provides a template to appraise the article of interest.
"Evidence-Based" Journal series (e.g., Evidence-Based Medicine, Evidence-Based Mental Health, Evidence-Based Nursing) Primary research articles within the discipline are selected for quality and clinical relevance. A structured abstract and expert commentary are provided for each study.
Check the Library's A-Z Journals List for additional Evidence-based ... journal subscriptions.
Unfiltered Resources
Evidence is not always available via filtered resources. Searching the primary literature may be required. It is possible to use specific search strategies in Medline and other databases to achieve the highest possible level of evidence.
PubMed Clinical Queries - Clinical Study Categories
To limit your PubMed search to the best evidence-producing studies: Click on "Clinical Queries" (towards the bottom of the screen). For comprehensive searches, use the full PubMed.
- Clinical Queries use preconfigured search strategies to pull up research-based citations on clinical topics in the areas of : therapy, diagnosis, etiology, diagnosis, or prognosis
- Broad Scope = More Sensitive Results (i.e., include most relevant articles but probably including some less relevant ones
- Narrow Scope = More Specific Results (i.e., including mostly relevant articles but probably omit a few)
- Note : Filtered by publication type, but not quality
- Use Filters / Limits to seach by specific publicaton types (RCT, case report, case series, review, etc.)
- Search one publication at a time.
Ovid Medline
- To limit your Ovid MEDLINE search to the best evidence-producing studies, use Clinical Queries (See PubMed above ). Run your search, then click on the Additional Limits Clinical Queries in Ovid Medline includes : reviews, therapy, diagnosis, prognosis, causation-etiology, economics, costs, and qualitative
- Set the scope of your search with specificity (narrow) or sensitivity (broad) options, in addition to "best balance" between the two.
CINAHL
- Cumulative Index to Nursing and Allied Health Literature
- To limit your CINAHL search to the best evidence-producing studies:
- Click on the "Limits" icon to use Clinical Queries as above
- Or limit to Research
- Or limit to Evidence-based Practice.
- This is a journal subset applied to articles from evidence based practice journals (including Cochrane), as well as articles about evidence based practice, research articles (including systematic reviews, clinical trials, meta analyses, qualitative studies), commentaries on research studies (applying practice to research), case studies if they meet the criteria of the use of research and/or evidence based practice terms.
Google Scholar
- If using an Ascension Wisconsin computer, this GS url should tap into Ascension Wisconsin Library full-text offerings.
- Searches the full-text of scholarly journals, but requires a carefully-crafted search strategy to get useful results.
- These articles will require additional evaluation and appraisal.
Background Information/Expert Opinion
Note: Evidence in these resources may vary from expert opinion to high levels of evidence.
Medscape
- Contains eMedicine's high-quality medical topic reviews
- Peer-reviewed clinical medicine. eMedicine's professional content undergoes multiple levels of physician peer review.
- Physician authors and editors contribute to the eMedicine Clinical Knowledge Base, which contains articles on 7,0000 diseases and disorders. The evidence-based content provides the latest practice guidelines in 62 medical specialties.
- Requires FREE personal login to access clinical content.
- Or use the Generic Username : affinity1 Password : library
Harrison's Online (via AccessMedicine)
- Searchable and continually updated version of Harrison's Principles of Internal Medicine.
Clinical Overviews (part of ClinicalKey)
- High quality medical topic summaries related to patient care.
- Grades the available evidence.
- Part of Clinical Key
- Point -of-care tool
AccessMedicine
- Full-text medical books. Includes Harrison's Online, Current Medical Diagnosis and Treatment, William's Obstetrics, Hurst's the Heart and many more ...
- Also includes drug info, differential diagnosis, and guidelines.
Lippincott Nursing Procedures (via R2)
2019 edition.
Lippincott Manual of Nursing Practice (via R2)
2019 edition.
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Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.
Updated 27 October 2022.
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