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Evidence Based Practice & Evidence Pyramid

Evidence-Based Practice is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

Evidence Pyramid: Systematic reviews and meta-analysis are at the top of what is known as the “Evidence Pyramid”. As you move up the pyramid the amount of available evidence on a given topic decreases, but the relevancy and quality of that evidence increases. Systematic reviews and meta-analysis are considered to be the highest quality evidence on a clinical topic. However, you may not always be able to find the highest level of evidence to answer your question. You then need to consider moving down the pyramid.

EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved.
Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

Finding the Evidence (Library & Internet Resources)

CSI Library Subscribed Databases

  1. Cochrane Library  (over 8,000 Cochrane Reviews available in full-text.)

    Cochrane Library is a collection of databases. At its core is the Cochrane Reviews. Each Cochrane Review is a systematic review that has been prepared and supervised by a Cochrane Review Group (editorial team). Each Cochrane review addresses a clearly formulated question; for example: Can antibiotics help in alleviating the symptoms of a sore throat? All the existing primary research on a topic that meets certain criteria is searched for and collated, and then assessed using stringent guidelines, to establish whether or not there is conclusive evidence about a specific treatment. Cochrane Reviews are the gold standard in evidence-based health care

    To learn how to search the database, follow the Cochrane Library Training Tutorials

  1. CINAHL Complete  (over 6 million records; full-text for 1200 journals; indexing for 5500 journals)

    CINAHL Complete search page offers several options for finding evidence-based nursing literature. To do that, enter your search terms, and then scroll down until you see some of the options under Search Options - Limit your results.

    a. The Evidence-Based Practice box will limit your search to Evidence-Based practice articles and journals, as well as certain types of studies.

    b.  The Randomized Controlled Trials box limits to articles so identified.

    c. The Publication Type box has several options that might be considered strong evidence, including Clinical TrialSystematic ReviewRandomized Controlled TrialEvidence-Based Practice and Meta Analysis. You can combine several of these options by holding down the CTRL key on your keyboard as you choose multiple options.

NOTE: Don't check all of these boxes or choose all these publication types at once. No articles will match ALL of these criteria. Try each of these three options in separate searches.

In addition, CINAHL offers Evidence-Based Care Sheets on a number of popular topics. These brief documents are produced by CINAHL and offer summations of relevant, high-quality evidence.  To find these documents click on Evidence-Based Care Sheets in the blue bar at the top of the search screen.

  1. MEDLINE Complete (30 million citations; full text for over 1,400 biomedical journals, indexing for over 4600 journals)

    Enter your search terms. Under Search Options - Limit your results, check the EBM Reviews box, or locate Subject Subset, and select Systematic Reviews.

Internet Resources (Free)

  • TRIP Database (Turning Research Into Practice, Free basic version): a clinical search engine designed to help clinicians identify the best available evidence with which to answer clinical questions.
  • PDQ (Physician Data Query): NCI's Comprehensive Cancer Database - Free Resource. The PDQ cancer information summaries are from the National Cancer Institute (NCI) written for physicians and patients.  They are peer-reviewed, evidence-based summaries on topics including adult and pediatric cancer treatment, supportive and palliative care, screening, prevention, genetics, and complementary and alternative medicine.
  • EPC Evidence-Based Reports from AHRQ (Agency for Healthcare Research & Quality)
    EPC Reports offer comprehensive, science-based information on common costly medical conditions and new health care technologies and strategies. Your search results cover complete titles of released evidence reports, comparative effectiveness reviews, technical briefs, Technology Assessment Program reports, and U.S. Preventive Services Task Force evidence syntheses.