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Evidence-Based Medicine Resources: 4S Pyramid of Evidence Resources

An introduction to searching the literature in evidence-based medicine, with resources organized into "pyramid" models.

The 4S Pyramid

Systems Computerized Decision Support Systems (CDSS) Synopses Summaries of Individual Studies Syntheses Systematic Reviews Studies Original Published Journal Articles Search

Search

TRIP (Turning Research Into Practice) Database Plus

Simultaneously searches evidence-based websites 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.

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Systems

Current information for clinical practice, searchable by specific medical problems, based on the best available evidence.

UpToDate

A clinical information resource, which offers up-to-date, fully referenced expert answers to patient-care, diagnosis, and treatment questions. Topic reviews are written by recognized authorities who review the topic, synthesize the evidence, summarize key findings, and provide specific recommendations.

(Access restrictions: UpToDate is only accessible from UPHS and School of Medicine locations. Remote access is not permitted.)

Clinical Evidence

Summarizes the current state of knowledge about the prevention and treatment of clinical conditions, based on thorough searches and appraisal of the literature. It describes the best available evidence from systematic reviews, RCTs, and observational studies where appropriate, and if there is no good evidence it says so.

BestBets

A database of evidence-based answers to real-life clinical questions, with additional teaching material, using a systematic approach to reviewing the literature. BETs were developed in the Emergency Department of Manchester Royal Infirmary, UK.

Consultant - Veterinary

This veterinary diagnostic support system is used to suggest possible diagnoses or causes for clinical signs and symptoms and to provide a brief synopsis of the diagnosis/cause including: 1) a general description, 2) species affected, 3) the signs/symptoms associated with it, and 4) a list of recent literature references.

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Synopses

Abbreviated descriptions of a wide range of studies or systematic reviews (syntheses).

ACP Journal Club

The editors of this journal screen the top 100+ clinical journals and identify studies that are methodologically sound and clinically relevant. An enhanced abstract, with conclusions clearly stated, and a commentary are provided for each selected article. Published by the American College of Physicians-American Society of Internal Medicine.

Dynamed Plus

A clinical reference tool with clinically-organized summaries for more than 3,200 topics, which monitors the content of medical journals and systematic evidence review databases through journal review services. Each article is evaluated for clinical relevance and scientific validity, and the new evidence is then integrated with existing content, with overall conclusions being drawn from the best available evidence. A version for mobile devices is also available.

Bandolier

Bandolier is an independent journal about evidence-based healthcare published in the UK. It includes "information about evidence of effectiveness (or lack of it), and puts the results forward as simple bullet points of those things that worked and those that did not: a bandolier with bullets. Information comes from systematic reviews, meta-analyses, randomised trials, and from high quality observational studies."

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.

BMJ EvidenceUpdates

A service in which articles from a variety of journals are systematically reviewed and rated for clinical relevance and newsworthiness, by at least 3 practitioners for each discipline for which the article might be pertinent. Provides a searchable bibliographic database, as well as email updates to users alerting them to new research in their stated fields of interest. Free registration is required.

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Syntheses

Systematic reviews of the literature on a given medical topic.

The Cochrane Database of Systematic Reviews

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.

Database of Abstracts of Reviews of Effect (DARE)

Full-text database containing structured abstracts of systematic reviews from a variety of medical journals. DARE is produced by the National Health Services' Centre for Reviews and Dissemination (NHS CRD) at the University of York. DARE records cover topics such as diagnosis, prevention, rehabilitation, screening, and treatment.

National Guideline Clearinghouse

A comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Health Care Research and Quality, in partnership with the American Medical Association and the American Association of Health Plans. Updated weekly.

Note: Guideline evidence varies from expert opinion to high levels of evidence.

JBI COnNECT+ (Joanna Briggs Institute)

The Joanna Briggs Institute specializes in promoting and supporting evidence-based healthcare by providing access to resources for professionals in nursing, midwifery, medicine, and allied health. With over 64 collaborating centers and groups, servicing over 90 countries, the Institute is a recognised global leader in evidence-based healthcare. JBI COnNECT+ is an online web-based facility that provides users with resources and tools to search, appraise, summarise, embed, utilise and evaluate evidence-based information.

Health Services/Technology Assessment Texts (HSTAT)

Full-text clinical practice guidelines, technology assessments, and health information, developed by the National Library of Medicine.

Systematic Reviews searches in PubMed and MEDLINE:

  • PubMed: Click on "Limits" above the search field, and select Systematic Reviews under the box marked "Subsets." Enter your search query at the top of the screen and search.
  • MEDLINE: Enter your search query. Click on the "Edit Limits" button; select "Systematic Reviews" under "Subject Subsets."

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Studies

Including randomized controlled trials (RCTs), cohort studies, case-controlled studies, and case reports.

CINAHL
A database providing authoritative coverage of the literature related to nursing and allied health. Indexes over 950 journals, but also includes healthcare books, nursing dissertations, selected conference proceedings, standards of professional practice, educational software and audiovisual materials in nursing. Primarily indexes abstracts, but also includes some full text. You may use the Search Options to refine your retrieval to Clinical Queries including: Therapy, Prognosis, Review, Qualitative, and Causation. You have a choice of High Sensitivity, High Specificity, or Best Balance for each Query selection.

EMBASE

Provides current and comprehensive information on drugs and pharmacology, and all other aspects of human medicine and related disciplines. The database covers over 2,000 biomedical titles not currently offered by MEDLINE, particularly international titles.

Cochrane Central Register of Controlled Trials
A bibliographic database of definitive controlled trials, providing a source of data for systematic reviews. Provides coverage where existing bibliographic databases may be inadequate for the identification of all relevant studies. Published by the International Cochrane Collaboration in co-operation with the National Library of Medicine (NLM) and with Reed Elsevier.

Clinical Queries searches in PubMed, MEDLINE, and CINAHL:

  • PubMed: Click on "clinical queries" (in the center column of the screen). This specialized search is intended for clinicians and has built-in search "filters" in the drop-down box at the left. Four study categories – therapy, diagnosis, etiology, prognosis – are provided, and you may indicate whether you wish your search to be more broad (i.e., include most relevant articles but probably including some less relevant ones) or more narrow (i.e., including mostly relevant articles but probably omit a few).
  • MEDLINE: Clinical Queries (See PubMed) is searchable in Ovid; click on the "Edit Limits" button, select "Clinical Queries," and select from the list of Clinical Queries searches.
  • CINAHL: To search for clinical queries in CINAHL, scroll down on the main search page to the box marked "Clinical Queries." Select from the list of clinical queries subjects.

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Acknowledgements

This page based on EBM - Sources of Evidence from Cornell University, the Dartmouth EBM Page Generator, and Haynes RB, Evid Based Med 2001;6:36-38.

Created February 2011.