What is PIER?

PIER (Physicians' Information and Education Resource) is a Web-based decision-support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for clinicians.

Information in PIER is presented in a "drill down" format, in which the user clicks from an opening guidance statement through to more specific information.

PIER is a collection of modules divided into five topic types:

• Diseases
• Screening and Prevention
• Complementary and Alternative Medicine
• Ethical and Legal Issues
• Procedures

In addition, PIER includes information on quality measures relevant to internal medicine.

There is also a drug resource, accessible from every module page and from the drug table in Disease modules.

Click to see an overview of the different module types and their respective sections.

Click to see a list of the modules currently included in PIER.

To find information in PIER you can either search across the entire site or one of the five topic types or you can click on a topic type to access an alphabetic list of modules within that type.

Disease-based Modules

The disease-based modules are PIER's core. Each module presents a series of succinct guidance statements and practice recommendations, supported by more detailed levels of pertinent rationale and evidence. There are links to abstracts and the full text of carefully selected references; to a comprehensive drug resource; other ACP knowledge resources including its guidelines, MKSAP, Annals of Internal Medicine, and ACP Journal Club; and other resources including PubMed and various Web sites. Tables, figures, algorithms, and video and audio clips are also included.

A disease-based module includes the following sections:

• Prevention
• Screening
• Diagnosis
• Consultation for Diagnosis
• Hospitalization
• Non-drug Therapy
• Drug Therapy
• Patient Education
• Consultation for Management
• Follow-up

Choosing one of these sections presents you with guidance statements and relevant specific recommendations for action. Each guidance statement includes links to supporting rationale, evidence, and comments.

All guidance statements and recommendations are given a strength of recommendation rating to help the clinician assess their usefulness:

• = the preponderance of data supporting this statement is derived from level 1 studies, which meet all of the evidence criteria for that study type
• = the preponderance of data supporting this statement is derived from level 2 studies, which meet at least one of the evidence criteria for that study type
• = the preponderance of data supporting this statement is derived from level 3 studies, which meet none of the evidence criteria for that study type or are derived from expert opinion, commentary or consensus

References drawn from the latest medical literature are also given a level of evidence rating:

• = studies that meet all of the evidence criteria for that study type
• = studies that meet at least one of the evidence criteria for that study type
• = studies that meet none of the evidence criteria for that study type or are derived from expert opinion, commentary or consensus

Each disease module includes five standard tables (history and physical examination, laboratory and other studies, differential diagnosis, drug treatment, and elements of follow-up). Additional tables and figures are included as needed.

Each PIER module includes a section of Additional Resources, categorized by Clinical Information, Educational Resources, or Patient Information.

In addition, the What's New box on both the PIER homepage and the opening screen of each module highlights new, relevant material.

Updating PIER

All PIER modules are reviewed on a regular basis by editorial consultants with the aid of comprehensive literature searches. If relevant clinical material is identified for a module, it is added to the text along with new references. More frequent updates are made when warranted by the release of important new studies, drug therapies, and guidelines. Ongoing editorial changes, including adding new references of interest, are done as needed. The drug database is updated on a monthly basis.

Searching PIER

Searching PIER is different from searching most medical information resources. If you are experienced with searching massive, relatively unstructured collections like Medline, your initial strategy for searching PIER may backfire. When searching Medline, you learn to compose extremely precise queries in order to reduce the quantity of returned results, and to increase the likelihood of finding something relevant among the mass of matching but irrelevant results.

Because all PIER modules of any type use the same highly structured organization and are written as crisply as possible, we can make the search process much less burdensome. Your queries will be simpler, the result returned will be more relevant, and deciphering the results will be easier. When searching within disease topics, you will be able to limit your search to specific clinical areas such as diagnosis, therapy, prevention, etc. By default, much of the content, such as reference citations and drug information, is excluded from the basic search. If you wish to include this material, you may.

From the PIER home page you can search the entire Web site, or limit your search to a Topic type, such as Diseases, Screening and Prevention, Complementary/Alternative Medicine, Ethical and Legal Issues, or Procedures.

Clicking on the Structured Search option allows you to limit your search to specific sections within a module, such as Diagnosis or Therapy.

When you view the pages returned by your search, you may wonder why these particular pages have appeared. The pages of PIER have been tagged with additional keywords, such as clinical categories, synonyms, and terms commonly found in relevant case descriptions. Your search phrase is first sent to a thesaurus, which adds synonyms and other variants of the terms in your search. The pages listed in the search results may not contain the actual terms used in your query, but are conceptual matches relevant to your search. PIER search results take you to the top page of a relevant section, and from there you easily navigate to content of interest.

How to Use the Drug Resource

You can search the drug resource by typing in a brand or generic name.

How to Cite PIER

Use the following format to cite PIER:

Marcantonio ER. Delirium. http://pier.acponline.org/physicians/diseases/d169. [Date accessed: 2003 Jan 18] In: PIER [online database]. Philadelphia, American College of Physicians, 2003.

How to Obtain Permission to Reproduce PIER Contents

Contact Gloria Klaiman to request permission to reproduce text, tables and figures published in PIER.