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 guidelines, 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.

Guidance Statement Ratings

All guidance statements and recommendations are given a strength of recommendation rating (A, B, C) to help the clinician assess their usefulness:

A = The preponderance of data supporting this statement is derived from high-quality studies with minimal bias, including:

• Treatment issues: randomized trials and systematic reviews or meta-analyses
• Diagnosis issues: cohort studies with appropriate reference standards
• Prognosis issues: observational studies with adequate controlling for confounders

B = The preponderance of data supporting this statement is derived from sub-optimal quality studies, such as observational data for treatment issues or others not meeting the criteria above.

C = The preponderance of data supporting this statement is derived from non-experimental evidence such as case series or from expert opinion.

Updating PIER

All PIER modules are reviewed periodically 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.

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.

Is Boolean searching supported? Can I use "OR", "AND", or "NOT" operators?
Yes, Boolean searching is supported. Also + and - can be used at the beginning of words as a shortcut for "AND" and "NOT" ("heart + lung" is the same as "heart AND lung").

Can I use a wildcard such as an asterisk (*)?
Yes, you can substitute the asterisk for one or more characters at the end of a word; your search term should be at least three characters long in order for the wildcard search to be effective.

Can I use parentheses to group words?
Use parentheses for word grouping; use quotation marks to find all documents containing an exact phrase.

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

What is the "score" found on the results page?
The score shown with search results represents an inverse ratio of the number of pages on this Web site and the number of occurences of the search term or terms found on those pages. The more frequently a term is found across the entire Web site the lower the score; a less frequently found term will have a higher score. If you search using a relatively common term in conjunction with a relatively uncommon term, the score will be higher because of the uncommon term, but you will generate more hits because of the common term.

Why can't I find the exact search term within the results?
When you view the pages returned by your search, you may wonder why these particular pages have appeared. It is likely that one or even all of the terms in your search phrase are absent from the most highly scored pages. There are several reasons for this.

1. The pages of PIER have been tagged with additional keywords, such as clinical categories, synonyms, and terms commonly found in relevant case descriptions.

2. Your search phrase is first sent to a thesaurus, which adds synonyms and other variants of the terms in your search.

3. The pages listed in the results may not be the actual pages that contain the terms that match your query. With typical queries, the result list will include page after page within the relevant sections of topics. You are then required to flip back and forth between the results list and the individual pages, whose connections to each other will remain unclear. With PIER, you will always be taken to the top page of the relevant section, from which you can more easily navigate to the 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 in a Reference List or on a CV

Use the following format to cite PIER:

Niven A, Short P. Asthma. In: Korenstein, D, Lynn R, eds. Physicians' Information and Education Resource (PIER) [Internet]. Philadelphia: American College of Physicians; 2012. Available from: http://pier.acponline.org/physicians/diseases/d146/d146.html [updated 2012 Oct 24].

How to Obtain Permission to Reproduce PIER Contents

Contact Aileen McHugh to request permission to reproduce text, tables, and figures published in PIER.

To make comments and suggestions

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