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Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding current best evidence
  1. R Brian Haynes, MD, PhD
  1. McMaster University Hamilton, Ontario, Canada

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    Practical resources to support evidence-based healthcare decisions are rapidly evolving. New and better services are being created through the combined forces of increasing numbers of clinically important studies, increasingly robust evidence synthesis and synopsis services, and better information technology and systems. The need for these resources is spurred by demands for higher quality at lower cost from health services, but the impact of better information resources is being blunted by noisy pretenders promising “the earth” but yielding just the dirt. Providers and consumers of evidence-based health care can help themselves to best current evidence by recognising and using the most evolved information services for the topics that concern them.

    The figure provides a “4S” hierarchical structure, with original “studies” at the base, “syntheses” (systematic reviews) of evidence just above the base, “synopses” of studies and syntheses next up, and the most evolved evidence-based information “systems” at the top. Information seekers should begin looking at the highest level resource available for the problem that prompted their search.

    Figure “4S” levels of organisation of evidence from research.


    A perfect evidence-based clinical information system would integrate and concisely summarise all relevant and important research evidence about a clinical problem and would automatically link, through an electronic medical record, a specific patient's circumstances to the relevant information. The user would then consult the system—in fact, be reminded by the system—whenever the patient's medical record was reviewed. The information contained in the system would be based on an explicit review process for finding and evaluating new evidence as it is published and then reliably updated whenever important new research evidence became available. The clinician and patient could therefore always have the benefit of the current best evidence. The system would not tell decision makers what to do. Those judgments would need to integrate the system's …

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