"5S" Pyramid of Evidence Resources

   5S Pyramid.jpg

Systems Systems Summaries Summaries Synopses Synopses Syntheses Syntheses Studies Studies Expert Opinion Search

Click on pyramid sections for lists of resources

Based on Haynes RB, ACP J Club 2006;145(3):A8 

 I.     Systems

These are decision support tools that are integrated into computerized order entry systems or electronic medical records in such a way that you can link directly to the information you need at the point where you need it. These systems aren't yet fully developed, but the resources being linked to are often the standalone applications mentioned below that are already easily accessible. 

II.    Summaries = Critically-appraised topics and guidelines


A clinical information resource providing comprehensive reviews on primary care, internal medicine, and pediatric topics. Content is enhanced by many graphics and links to Lexi-Comp's drug reference and PubMed abstracts. Evidence gaps are filled by expert opinion.  There is no institutional access to UpToDate, but personal subscriptions and free trials are available.

Clinical Evidence

An online and print resource written in question-and-answer format that summarizes the best available evidence on the effects of prevention and treatment interventions on common clinical problems. Expert opinion is not provided.

ACP PIER (Physicians' Information and Education Resource)

A decision-support tool created by the American College of Physicians to provide evidence-based, point-of-care information to clinicians. Modules are in a modified outline format with links to tables, levels of evidence, PubMed, and other external Web sites. There is currently no institutional access to PIER, but ACP members can register for free access.


A Micromedex module that provides disease summaries on general and emergency medicine topics. A drill-down approach is used to expand each section with more detailed information and links to the Drugdex database. Click on "Disease" tab to access and search by specific database or specific topic.

First Consult

A point-of-care clinical resource with modules covering medical topics, differential diagnosis, patient education, and procedures. Content is organized in a bulleted outline format. There is no institutional access to First Consult, but personal subscriptions and free trials are available.


A clinical reference tool with topic summaries organized in outline format and external links to PubMed abstracts, professional guidelines, and patient information.  Evidence gaps are generally not filled by expert opinion. Updated daily.

National Guideline Clearinghouse

A searchable database of practice guidelines authored by professional societies, government agencies, and nonprofit organizations that are current within the past 5 years.


A journal and searchable database of evidence-based article and topic reviews in multiple specialties. Online access to journal issues is delayed approximately 4 months.

Best Evidence Topics (BETs)

A database of topic reviews in emergency medicine, primary care, and pediatrics. Developed at Manchester Royal Infirmary (UK), clinically relevant questions are addressed with the best available evidence regardless of whether it is top-level.

III.   Synopses = Critically-appraised individual journal articles

ACP Journal Club

A database of critically-appraised systematic reviews and original research from 100+ journals covering general internal medicine and its subspecialties.

Evidence-Based Medicine
Evidence-Based Nursing

Evidence-Based Mental Health

Online journals with article reviews from the BMJ Publishing Group structured very similarly to ACP Journal Club but with coverage focused on family medicine, nursing, and mental health. Issues can be browsed by following the links above or searched via the Journals@Ovid full text database.

BMJ Evidence Updates

A database of articles selected from 170+ journals and rated for clinical relevance and newsworthiness by at least three practitioners for each discipline for which the article might be pertinent. Comments are added by reviewers, but there is no formal critical appraisal. Free registration is required.

Essential Evidence Plus (formerly InfoPOEMS/InfoRetriever)

A database of critically reviewed original research from 100+ journals relevant to family practice and other primary care specialties. There is no institutional access to Essential Evidence Plus, but personal subscriptions and free trials are available.

IV.   Syntheses = Systematic Reviews

Cochrane Database of Systematic Reviews     

A database of systematic reviews authored and updated by the Cochrane Collaboration.

Database of Abstracts of Reviews of Effects (DARE)

A database of non-Cochrane systematic reviews maintained by the Center for Reviews and Dissemination at the University of York, UK. A critical review of each systematic review is also provided. 


For systematic reviews, perform a subject search and then use the "Systematic Reviews" limit in the "Subject Subsets" scroll box.


For systematic reviews, perform a subject search and view results in “Systematic Reviews” column. 

V.   Studies = Original Research


Perform a subject search and then use the limits in the "Clinical Queries" scroll box to isolate the best evidence.


Enter search terms and select appropriate limits from “Clinical Study Categories” scroll boxes to isolate the best evidence.

Cochrane Central Register of Controlled Trials

A repository for randomized controlled trials identified and incorporated into Cochrane systematic reviews by the various review groups. This is a more comprehensive source for RCTs than MEDLINE because meeting abstracts and unique EMBASE records are also included. 

VI.   Expert Opinion

Note: Evidence in these resources may vary from expert opinion to high-level evidence but updates are generally less frequent and level-of-evidence grading systems are lacking.


A clinical knowledge base covering many topics and specialties in addition to internal medicine and primary care (e.g., surgery, trauma, emergency medicine). A large library of interactive images is a major strength.

Harrison's Online

The electronic version of Harrison's Principles of Internal Medicine but more frequently updated. A separate image search and links to the Diagnosaurus and Gold Standard drug database are useful additions.

Scientific American Surgery (formerly ACS Surgery)  

A comprehensive textbook of general surgery produced jointly by the American College of Surgeons and WebMD.


For review articles, perform a subject search and then check the "Review Articles" box on the main search page.


For review articles, perform a subject search, click on the "Limits" link at the top, and then check the "Review" box under "Type of Article".

VII.    Search


A search engine developed by the University of Texas Health Science Center that searches for and organizes the best evidence from Web-based textbooks, the National Guideline Clearinghouse, Cochrane systematic reviews, and PubMed.

TRIP (Turning Research Into Practice)

A search engine developed in the UK that searches Web-based E-textbooks, evidence-based synopses, guidelines, and systematic reviews. PubMed results can be filtered by type of question. Medical image and patient information searches are also available.

This page developed by Tom Emmett, MD, MLS and Sue London, MLS.

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