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Evidence Based Practice

Designed to familiarize health science students with concepts and strategies used in EBP. Includes levels of evidence, question formulation (PICO), and information sources for evidence.

Evidence Pyramid for Studies

This pyramid illustrates the levels of evidence strength for different types of studies, found in databases like CINAHL and MEDLINE. Evidence strength decreases as you move down the pyramid, while at the same time the number of articles increases. As you can see, Systematic Reviews are at the top of this pyramid, because they provide the strongest evidence by pooling the evidence from many individual studies.

The Expanded Evidence Pyramid

This pyramid includes other sources for evidence, not all of which are available to you at BU, such as a Computerized Decision Support System. Generally speaking, those that are available for you to search are indicated by the green 'Search' bracket below.

As you look for the best evidence to answer a clinical question, a good rule of thumb is to begin your search as high up in the pyramid as you can. Summaries, Synopses, and Syntheses appraise the evidence in multiple studies so are especially good sources to locate relevant studies.

From EBM, Ruth Lilly Medical Library, Indiana University School of Medicine

Qualitative Research Pyramid

Further definition

LEVEL  DESCRIPTION WHERE FOUND (EXAMPLES)
Systems  = Computerized Decision Support, electronic medical record that links patient problems to best evidence (relatively rare)    Workplace
Summaries = Critically-Appraised Topics and Evidence-Based Guidelines     AHRQ National Guideline Clearinghouse
Synopses = Critically-Appraised Journal Articles or SRs Database of Abstracts of Reviews of Effects (DARE)
Syntheses = Systematic Reviews Cochrane Database of Systematic Reviews | PubMed | CINAHL | PsycINFO
Studies = RCTs, Cohort Studies, Case-Control Studies, Case Series/Reports PubMed | CINAHL | PsycINFO
Expert Opinion = Review Articles or Textbooks PubMed | CINAHL | PsycINFO

Matching questions to studies

Even though you may not be able to find a systematic review on your question, nevertheless certain types of studies will provide good evidence, depending on the question. For example:

Most Common Type of Questions:

Preferred type of study:

Diagnosis
How to select and interpret diagnostic tests

Comparison of new test to a 'gold standard' test

Effectiveness of Therapy
How to select treatments that do more good than harm and
that are worth the efforts and costs of using them

Randomized controlled trials
Cohort studies

Prognosis
How to estimate the patient’s likely clinical course over time
based on factors other than the intervention and anticipate
likely complications of disease

Cohort studies
Case control studies

Harm/Etiology
How to identify causes for disease, including iatrogenic forms

Cohort studies
Case control studies

Meaning
How to identify beliefs, perceptions, attitudes

Qualitative studies (multiple design)

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