FRAMEWORK

I could be WORDY but I would like to share an image.  The word that comes to mind is FRAMEWORK. I use the word FRAMEWORK a lot because it describes the basic set of ideas or concepts that provide support for something.

Whether conducting critical appraisal of clinical research, systematically synthesizing evidence and guidance, rationally resulting in recommendations, mapping medical information for immediate finding during clinical practice, building business cases, generating grant proposals, making manuscripts, or preparing presentations, the FRAMEWORK is key in how it flows. Understand the FRAMEWORK and you understand much more than the individual example.

When selecting resources for finding the most valid relevant evidence for clinical practice a pyramidal framework has served the evidence-based healthcare community since 2001 when Dr. Haynes first published a 4S pyramid model. This grew to a 6S pyramid model by 2009 and the hierarchy of resources (where to search first) was Systems, Summaries, Synopses of syntheses, Syntheses, Synopses of studies, and Studies.

A couple years ago at a meeting of the International Society for Evidence-based Health Care, I presented on the evolution of evidence-based health care (EBHC) and shared the need to consider a space for guidelines (or Systematically derived recommendations) in this FRAMEWORK (see https://www.isehc2014.tw/files/ptt/SL-01-Brian%20S.%20Alper.pdf) and suggested we may need a 9S pyramid.

Dr. Haynes and I have worked together to adjust this FRAMEWORK. We listened to those who are using it in practice and teaching and heard that alliterations were making things more complicated (What is the difference between a synthesis and a systematic review?) and 9-10 layers would make things more difficult, and we also realized that one type of layering (summaries, synopses, syntheses) related to how to approach documents while a different type of layering related to the underlying evidence-based approach: Studies, Systematic Reviews, Systematically Derived Recommendations, Synthesized Summaries for Clinical Reference, and Systems.

We put this together in a simpler form, recognizing it as the fifth iteration in a modern form, and called it the EBHC Pyramid 5.0 – published yesterday at https://ebm.bmj.com/content/early/2016/06/20/ebmed-2016-110447.extract

This post turned out to be a little WORDY. I would like to share the image with you instead but it is published in Evidence-Based Medicine which is a subscription journal. I can post it after 12 months, and I can share it in a PDF with the first 100 people who ask me for it.