EBHC pyramid 5.0 for accessing preappraised evidence and guidance.

The 6S pyramid has provided a conceptual framework for searching information resources for evidence-based healthcare (EBHC) and is used in medical education and clinical informatics applications. This model has evolved into EBHC pyramid 5.0 which adds systematically derived recommendations as a major type of information and simplifies the overall framework to five major layers of information types. Practising evidence-based healthcare (EBHC) is integrating the best research evidence with clinical expertise and patients’ circumstances and values. However, the best research evidence may seem unattainable when information is constantly developing. Finding it is daunting with numerous textbooks and guidelines, millions of studies in PubMed and many other sources. Fortunately, resources to overcome such information overload and provide rapid access to valid clinical knowledge continue to evolve. Haynes proposed a 4S pyramid model in 2001 for practical guidance in selecting resources for rapidly finding the best evidence for EBHC. The 4S hierarchy has original studies already appraised for scientific merit as the foundation (‘preappraised evidence’), then progressively more clinically usable information including syntheses (systematic reviews) of evidence, synopses (structured abstracts) of preappraised studies and syntheses (systematic reviews), and at the top the most clinical workflow-specific evidence-based information systems, for example, computerised decision support systems integrated with electronic health records. This was extended to a 5S pyramid model in 2006 by adding summaries—continuously updated, online medical texts that integrate lower levels (studies, syntheses and synopses) with clinical expertise—near the top of the pyramid, recognising that summaries could provide the fastest route to the best research evidence for preventing or managing health problems. The 6S model in 2009 separated synopses into synopses of studies and synopses of syntheses (figure 1). Evidence-based information services and resources have continued to progress. Alper proposed a 9S pyramid model in 2014 to clarify how evidence-based guidelines fit in the progression from evidence to point-of-care guidance. Guidelines, when carried out well and current, are a collection of systematically Figure 1 6S pyramid for finding preappraised evidence. 10.1136/ebmed-2016-110447 DynaMed, EBSCO Health, Ipswich, Massachusetts, USA University of Missouri, Columbia, Missouri, USA McMaster University, Hamilton, Ontario, Canada Correspondence to: Dr Brian S Alper, DynaMed, EBSCO Health, 10 Estes Street, Ipswich, MA 01938, USA; [email protected] ▸ http://dx.doi.org/10.1136/ ebmed-2016-110401 ▸ http://dx.doi.org/10.1136/ ebmed-2016-110498 Evid Based Med August 2016 | volume 21 | number 4 | 123 Perspective group.bmj.com on November 2, 2017 Published by http://ebm.bmj.com/ Downloaded from