Preappraised Evidence Guidance
Acquiring the best evidence can be 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.
Below is the pyramid to display "preappraised evidence guidance." The linked article (Alper et al., 2016) explains the rationale.
Alper, B. S., & Haynes, R. B. (2016). EBHC pyramid 5.0 for accessing preappraised evidence and guidance. Evidence-based medicine, 21(4), 123–125. https://doi.org/10.1136/ebmed-2016-110447
Clinical Guideline Resources
“Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”(Institute of Medicine, 1990)
Since the demise of the National Guideline Clearinghouse in 2018, there are less centralized locations for clinical practice guidelines. Below is a brief list of US guideline repositories. International guideline repositories are listed on the Practice Guidelines page of the Clinical Professional research guide.
- CURRENT Practice Guidelines in Primary Care 2024Book sections include Screening & Prevention; Special Populations; Management
- ECRI Guidelines Trust
Collection of clinical guidelines with TRUST scorecards. Requires free account/login. - USPSTF U.S. Preventative Services Task ForceUSPSTF makes evidence-based recommendations about clinical preventive services.
- Veterans Association Clinical Practice GuidelinesThe guidelines on this site are those endorsed by the VA/DoD Evidence Based Practice Work Group.
Meta Search Engines
- ACCESSSSFrom the McMaster University Health Information Research Unit, conducts searches simultaneously in several evidence-based information services BMJ Best Practice, Systematic Guidelines and Reviews and pre-appraised original studies.
- TRIP Database This link opens in a new windowThis free-version of a clinical search engine allows users to quickly find high-quality research evidence to support practice or care. The (unsubscribed) Pro version allows filtering and linking to full-text. However, article full-text may be found in a separate, library search.
Studies: Primary Research Articles
- PubMed@USC This link opens in a new windowLimit search to publication types: Randomized Controlled Trials, Cohort Studies, Case-Control Trials, etc.
- PubMed Clinical QueriesChoose Category (question type) and Scope to obtain relevant study types.
Synthesized Summaries for Clinical Reference
Frequently updated summaries of evidence and systematically derived recommendations become top level evidence when searching for practical guidance for Evidence-Based Health Care, just below Clinical Decision Support Systems which also include individual patient data from the EHR. Current, subscribed resources providing synthesized summaries for clinical reference (below) have varying degrees of quality, currency and comprehensiveness.
- BMJ Best Practice This link opens in a new windowEvidence-based overviews of medical topics, continually updated. BMJ Best Practice incorporates much of the research evidence from its previous publication BMJ Clinical Evidence and adds expert opinion and guidelines to cover diagnosis, prognosis, treatment and prevention.
- ClinicalKey This link opens in a new windowSee the Clinical Overviews for a preappraised topic summary. Also includes ebooks, journals, patient education handouts, drug monographs, images and videos.
- Essential Evidence PlusTopics and tools including POEMs - Patient Oriented Evidence that Matters
- UpToDate This link opens in a new windowAn evidence-based resource covering multiple medical specialties. Includes topic monographs, patient education, practice updates, drug interactions, guidelines, and medical calculators.
Systematic Reviews & Meta-analysis
Systematic Reviews and Meta-Analysis are widely considered the gold-standard approach to summarizing and synthesizing evidence. Study design on its own is not enough to evaluate for evidence quality. Study methodology must be critically appraised for limitations and quality of evidencel. Practice recommendations may then be ranked by strength of evidence validity and reliability using a grading system such as the one developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group.
Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21(4):125-127. doi:10.1136/ebmed-2016-110401
- MEDLINE (Ovid) This link opens in a new windowLimit search to publication types: Systematic Review, Meta-Analysis, and/or Guidelines
- PubMed@USC This link opens in a new windowLimit search to publication types: Systematic Review, Meta-Analysis, and/or Guidelines.
Studies: Unpublished Trials
- ClinicalTrials.gov This link opens in a new windowRegistry and results database; includes information about publicly & privately funded studies including; completed & ongoing trials, research design, results, and contact information.
Appraise the Evidence
Now that you have searched for evidence, continue to Step 3: Appraising the Evidence.