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Dr Kaufmann1 suggests that readers should use the ‘New Evidence Pyramid’ which conveys a hierarchy of quality across primary studies2 rather than the ‘EBHC Pyramid 5.0’ which conveys a hierarchy of comprehensiveness across types of information resources (primary studies, systematic reviews, guidelines and synthesised summaries for clinical reference).3 However, these pyramids are complementary and address very different issues. The hierarchy of validity of primary studies (and the recognition that quality varies so the hierarchy …
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