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 (McMaster University Health Sciences Library). 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.
Image: McMaster University's 6S Pyramid. (Clinical Information Access Portal)
| 6S Level | Definition | Resource Examples |
| Systems |
The individual patient’s characteristics are automatically 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: ECRI Guidelines Trust, Trip Database, professional organizations Databases: DynaMedex, PEPID, 5-Minute Consult, UpToDate, Essential Evidence Plus, ClinicalKey, AccessMedicine |
| Syntheses |
Summaries of evidence surrounding a specific topic Study types: Meta-analyses, systematic reviews, other review types |
Websites: PubMed Clinical Queries Databases: Cochrane Library, PubMed, Epistemonikos |
| 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 Database |
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.