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What is the 6S pyramid?

The 6S evidence pyramid above is designed to help health practitioners prioritize evidence. The higher up the pyramid your evidence falls, the more weight you should give it in your clinical decision making process. Not every topic will have evidence at all levels – use the highest level that is available. 

Currently, we do not have access to Systems level evidence at Mount Royal. The resources listed below will help you look for evidence at each of the remaining levels.

The image above is based on levels discussed in the following article:

DiCenso, A., Bayley, L., & Haynes, R. B. (2009). Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12. 99-101.

Tools that Find Evidence from More than One Level of the Pyramid

Search by Level

DiCenso, Bayley, and Haynes (2009), state "an evidence-based clinical information system integrates and concisely summarises all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information" (pp. 99-100).

Currently, as students at Mount Royal, you do not have access to information at a systems level.

The National Collaborating Centre for Methods and Tools states:

Summaries provide an outline of management options for a given health issue. Summaries incorporate the highest quality and most synthesized sources of research evidence.

Summaries include clinical and practice guidelines. Here is an example of a clinical practice guideline: Adult Asthma Care: Promoting Control of Asthma (2017)

Guideline Search Tool

Tips for Searching Trip Database

  • The asterisk * allows you to search for different word endings e.g. child* looks for both child and children
  • (Title:keyword) will limit your search results to documents where the keyword appears in the title e.g.
    • (Title:child*) will find documents where child or children is part of the title
    • (Title:pregnan*) COVID will look for documents that have pregnancy or pregnant in the title and mention COVID somewhere in the title or document text.

Tips for Searching for Guidelines in PubMed

  • While not perfect, a quick way to search for guidelines in PubMed is to add guideline to your search words.

Additional Sources of Canadian Practice Guidelines

A synopsis of a synthesis is an article that summarizes or critically appraises a systematic review or meta-analysis.

Here are some places you may find synopses of syntheses. Please note if the synopsis is summarizing the findings of a single study, it would appear further down the pyramid (see the Synopses of Single Studies tab for more information). Here is an example of a synopsis of a synthesis: Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics

*** Please note - the title of the synopsis may be confusing, as it uses the terms systematic review and meta-analysis which we associate with a synthesis. However, if you look at the source, you will see it is very short and contains a commentary section where they critique the systematic review mentioned in the title. That is why it is a synopsis. Compare it with the actual systematic review that the synopsis is critiquing to get a sense of how the two layers are different.

Syntheses are typically systematic reviews (sometimes with meta-analyses, sometimes without), which critically evaluate the available research evidence on a topic and attempt to come to a larger truth. These types of studies are associated with quantitative research. Meta-syntheses systematically look at the findings from qualitative studies on a topic, and could also be placed in this layer of the pyramid.

Please note: Literature reviews, narrative reviews, or articles simply labelled "Review" are not considered rigorous enough to qualify as syntheses in the evidence pyramid. They are reviews that summarize but do not critically evaluate the research or do not provide enough detail by which the topic was searched and articles selected for their work to be replicated by others. They provide great background on a topic, but should not be weighted equally with other evidence in this layer.

You may find systematic reviews and meta-analyses listed in many health related databases.

A synopsis is a published critique of a single research study. Here is an example. They are published in a number of journals, including those listed below:

Single studies are peer reviewed journal articles reporting the results of original research.

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