McMaster University's 6S Pyramid.
(Image: Clinical Information Access Portal)
Similar to the Levels of Evidence pyramid in the Align step, there is also a hierarchical pyramid for types of health information known as the 6S Pyramid. The pyramid classifies individual primary studies as the most common, lowest quality of information, and secondary pre-appraised research as less common and higher quality.
| 6S Level | Definition | Resource examples |
| Systems |
The individual patient’s characteristics are aut linked to the current best evidence that matches his or her specific circumstances and the clinician is provided with key aspects of management. |
Clinical decision support tools in electronic health records |
| Summaries |
High-level evidence-based practice guidelines Resource types: clinical reviews, practice guidelines, position statements |
Websites: National Guideline Clearinghouse, professional organizations Databases: UpToDate, Rehabilitation Reference Center |
| Syntheses |
Summaries of evidence surrounding a specific topic Study types: Meta-analyses, systematic reviews, other review types |
Websites: PubMed Health Databases: BMJ Clinical Evidence, Cochrane Library, PubMed, CINAHL |
| Synopses |
Critically-appraised journal articles Study types: RCTs and high-quality studies with scores for internal and external validity |
Websites: ACP Journal Club |
| Studies |
Primary original research studies Study types: all |
Websites: Google Scholar, TRIP |
Foreground information is the complex, precise information often needed in order to answer a PICO question. Before searching for foreground information, however, make sure you have a good understanding of each of the PICO concepts. If you don't have adequate knowledge about one of your PICO concepts, you will need to pursue background information in order to fully understand the foreground information you find.
Click "Next" below to begin searching for resources.