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UpToDate: Beyond UpToDate

Gumberg Library Quick Links

Going Beyond UpToDate

Although UpToDate is an excellent source, it does have limitations, so it's important to explore other sources when answering clinical questions.

The EBP Pyramid from NYU Health Sciences Libraries portrays a visual guide to the quality of evidence from different sources. The better the evidence, the higher it is on the pyramid.

On the EBP Pyramid as it pertains to resources available through Gumberg Library, UpToDate is at the bottom in the Background Information/Expert Opinion category, while Cochrane Library & PubMed are at the top of the pyramid since they contain systematic reviews, which are considered better evidence. 


You can often find better evidence through UpToDate by checking the references at the end of an article. You should also consider searching one of the EBP databases listed below.

For a more detailed look at where Gumberg resources fall on the EBP Pyramid, check out the Clickable EBP Pyramid.

General EBP Databases

These are resources for finding EBP articles, reviews, and more.

Searching With PICO

Use PICO to narrow and focus your questions. It is important to be very specific. 

P Patient, Population, or Problem
I Intervention
C Comparison or Control
O Outcome

Here is an example:

P: In high school football players who have received head injuries...

I: ...would weekly checks of the air within the helmet padding...

C: ...when compared to checking air pressure before the season and again mid-season...

O: ...lead to lower concussion rates. Is the evidence enough for the school district to require weekly checks of high school football player's helmets?

In this example, the focus is on high school football players with head injuries. This study could be narrowed even more by selecting a certain football position to study. This study compares weekly helmet checks to the only two checks a season. Is there a decrease in concussions rates with weekly checks? If there is enough evidence, should the school district require athletic trainers and football staff to check the helmets weekly? If the school district does changes their helmet-checking requirements and schedules, this would be an evidence based practice.

Can you think of an example?

Also, see Centre for Evidence Based Medicine's guide.

EBP Guides