Skip to main content
It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.
Find A PhysicianHome  |  Library  |  myDownstate  |  Newsroom  |  A-Z Guide  |  E-mail  |  Contact Us  |  Directions
curve gif

SUNY-Downstate Medical Research Library of Brooklyn: Evidence-Based Nursing Practice

a Libguide

What is a Clinical Question?

Melnyk and Finehout-Overholt (2015, pp 12.) suggest that asking a well-designed clinical question in the PICOT format leads to a search that is efficient and finds the most relevant evidence.  

McMaster University has a good LibGuide that describes how to build a clinical question, how to clarify what type of question you have , and templates to handle different types of clinical problems.

What is Background Information?

Background information is the answer to a general questions about a clinical topic.

Examples of Background Information.:  What is that disorder? What are the adverse effects of that drug?  What are common skin complications of that treatment?

These background questions can be answered by using resources such as textbooks (both in print and electronic), narrative reviews in journals, and reputable drug apps.  Background resources give a general overview of the topic.  They increase knowledge on a topic (and not necessarily on an issue with your patient).  

Background information is meant to increase your knowledge on a particular topic.  Two people looking for background information on the same topic might come up with different citations, because of their differing clinical experiences.  

Foreground Questions

These questions bring together multiple concepts related to a specific clinical situation or research topic.  They are typically divided into two categories:

  • Qualitative Questions aim to discover meaning or gain an understanding of a phenomena.  They ask about an individual's or population's experience of certain situations or circumstances
  • Quantitative Questions aim to discover cause and effect relationships by comparing two or more individuals or groups based on differing outcomes associated with exposures or interventions.

Dartmouth and Yale' s Evidence-Based Medicine (EBM) Pyramid with Explanation 

This is a dynamic easy-to-use Evidence Pyramid with clear explanations of each level

This version was prepared by the University of Pittsburgh Health Science Library System 

Alert:  If a link on any one of  these pages leads you to another university’s blocked library site, don't despair!

Look for access to that  named link on our own DMC Library Information Resources.  Libraries generally have to pay for subscriptions and so restrict their access.

DMC Library has many of these same subscriptions  

Evidence-Based Medicine's Levels of Evidence Pyramid version 6s

The 6S pyramid has provided a conceptual framework for searching information resources for evidence-based healthcare (EBHC) and is used in medical education and clinical informatics applications. 

Foreground questions are best answered by evidence found at different levels of the 6S Pyramid.

Six S Pyramid



Rating System for the  Hierarchy of Evidence to Guide Clinical Interventions 

Once you have completed your literature search to find the best evidence to answer your clinical problem, this framework is one  version used to help you evaluate the strength of the presented evidence.  




Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs)


Evidence obtained from well-designed RCTs


Evidence obtained from well-designed controlled trials without randomization


Evidence from well-designed case-control and cohort studies


Evidence from systematic reviews of descriptive and qualitative studies


Evidence from single descriptive or qualitative studies


Evidence from the opinion of authorities and/or reports of expert committees

Source: Modified from Elwyn et al. (2015) and Harris et al. (2001) .From Improving healthcare quality, patient outcomes, and costs with evidence-based practice

Elwyn, G., Quinlan, C., Mulley, A., Agoritsas, T., Vandik, P. O., & Guyatt, G. (2015). Trustworthy guidelines—excellent; customized care tools—even better. BioMed Central Medicine, 13(1), 199. Modified from Guyatt, G., & Rennie, D. (2002), Users’ guides to the medical literature. Chicago, IL: American Medical Association.