Healthwise Helps You Make Better Health Decisions

About Healthwise

Healthwise is a nonprofit organization founded in 1975 with the mission to help people make better health decisions. More than 100 million times a year people like you use Healthwise^® information to take an active role in their health.

The best formula for making health decisions is to combine the most reliable medical facts with your personal feelings. Put more simply: Medical Information + Your Information = Better Health Decisions.

Your decisions influence your overall well-being as well as the quality and cost of your care. By taking an active role in your health, you are likely to be happier with the care you receive and the results you achieve.

Read these Healthwise stories to see how Healthwise helps people make better health decisions.

	Patricia used the Healthwise Knowledgebase to save her own life. Patricia had just finished her Saturday-morning chores when her lungs began burning. She was sweating and had some numbness in her arms. She drew a bath thinking, "I must be having a panic attack-I'll be all right if I can just relax." A few hours later, the 42-year-old still felt like she had "an elephant sitting on my chest." Patricia canceled her usual horse-riding lesson and took a nap instead. When she awoke, she felt even worse. "Then I thought: Check [the Healthwise® Knowledgebase on] the Internet," says Patricia. "I had almost every heart attack symptom described in the Healthwise® Knowledgebase. I knew I had to get to the hospital right away!" Hospital tests confirmed that Patricia had indeed had a heart attack, and the following Tuesday she had triple-bypass heart surgery. Today, Patricia is back in the saddle, riding horses and enjoying life.
	Count on Carolyn Brzezicki-Healthwise clinical specialist and writer, mom, sister, friend, and registered nurse. "Stories like Patricia's inspire our work every day," says Carolyn Brzezicki. "Each of us at Healthwise thinks about our own stories of how we've turned to our information to help our families, friends, and ourselves make better decisions." Carolyn, a Healthwise clinical specialist, writer, and content developer, focuses on helping people live better with diabetes. She also reviews the studies, medical literature, and guidelines to assess how new findings in diabetes may affect the content. Living within just a few miles of her extended family, Carolyn is able to be there for them when they need her-when they're feeling great or not so great. Just like you, she looks for information that's easy to use and understand for her and her family. Her volunteer work in a diabetes-nutrition center, with hospice, and as a facilitator for a bereavement support group reminds her how confusing medical issues can be. So when she's at work, she always thinks about what's most important for people to know and how it should be explained. "Because I'm a registered nurse, family and friends call me with questions about a medical test, a new medicine, or what to do about an issue. I always go straight to the Healthwise Knowledgebase," says Carolyn. "Over the years, Healthwise has helped me in so many ways. I'm so proud of our work and how it makes a real difference in people's lives."
	World-class heart doctor Robert Kloner, MD, PhD, is in your corner. Robert Kloner is one of 295 experts who review Healthwise information for accuracy and currency. He helps us help you make better health decisions on heart-related issues. Dr. Kloner is known as one of America's leading heart experts. For the past 30 years Dr. Kloner has taught at medical schools, participated in major research projects, and contributed to medical journal articles. He is professor of medicine at the Keck School of Medicine of University of Southern California. He is also director of research at the Heart Institute of Good Samaritan Hospital in Los Angeles and an attending cardiologist at Los Angeles County/University of Southern California Medical School. Dr. Kloner previously directed the Cardiac Research Laboratory at Harvard Medical School. He has also edited 18 authoritative medical texts. "Good information is critical to good health and good health care," says Dr. Kloner. "With easy-to-understand, reliable information, people can make good decisions. When I hear stories like Patricia's, I'm especially gratified to be part of the Healthwise review team."

Comments

Healthwise benefits from readers' input to keep our content helpful. Send us your comments by contacting your sponsoring organization or by emailing Healthwise at comments@healthwise.org. If you contact Healthwise, you can expect a reply within about two weeks. For answers to your specific health issues, contact your health professional. Or if you think you need care right away, call 911 or other emergency services.

Last updated: March 2011

Healthwise Medical Review Board

The Healthwise Medical Review Board is directed by our chief medical officer, Dr. Adam C. Husney, and our medical directors, Dr. Kathleen Romito and Dr. Elizabeth T. Russo. Both are board-certified physicians. Dr. Christine Maldonado provides leadership on behavioral health issues for all Healthwise products. There is also a panel of board-certified Associate Medical Directors and Medical Editors who are involved in the planning, product and content development, and the regular and routine review of content written by Healthwise.

Chief Medical Officer:Adam C. Husney, MD, Family Medicine, Boise, Idaho

Medical Director:Kathleen Romito, MD, Family Medicine, Boise, Idaho

Medical Director:Elizabeth T. Russo, MD, Internal Medicine, Boston, Massachusetts

Behavioral Health Specialist:Christine Maldonado, PhD, Behavioral Health, Boise, Idaho

Associate Medical Directors:

• Martin J. Gabica, MD, Family Medicine, Boise, Idaho
• John Pope, MD, Pediatrics, Phoenix, Arizona
• E. Gregory Thompson, MD, Internal Medicine, Boise, Idaho

Medical Editors:

• Steven J. Atlas, MD, MPH, Internal Medicine, Boston, Massachusetts
• Michael F. Bierer, MD, Internal Medicine/Addiction Medicine, Boston, Massachusetts
• L. Ebony Boulware, MD, Internal Medicine, Durham, North Carolina
• Wendy Y. Chen, MD, Hematology/Oncology, Boston, Massachusetts
• O. Kenrik Duru, MD, Internal Medicine, Los Angeles, California
• Joann G. Elmore, MD, MPH, FACP, Internal Medicine/Infectious Disease, Seattle, Washington
• Kathleen M. Fairfield, MD, MPH, DrPH, Internal Medicine, Portland, Maine
• Rafael (Ralph) Gonzales, MD, MSPH, Internal Medicine, San Francisco, California
• Ethan A. Halm, MD, MPH, Internal Medicine, Dallas, Texas
• Richard M. Hoffman, MD, MPH, Internal Medicine, Albuquerque, New Mexico
• Jeffrey N. Katz, MD, Rheumatology, Boston, Massachusetts
• Nancy L. Keating, MD, MPH, Internal Medicine, Boston, Massachusetts
• Jean S. Kutner, MD, MSPH, Geriatrics, Aurora, Colorado
• Michael P. Pignone, MD, MPH, FACP, Internal Medicine, Durham, North Carolina
• Neil R. Powe, MD, MPH, Internal Medicine, Oakland, California
• John W. Williams Jr., MD, MHSc, Internal Medicine, Durham, North Carolina
• John B. Wong, MD, Internal Medicine/Clinical Decision Making, Boston, Massachusetts

The Healthwise Medical Review Board also includes health professionals and medical specialists who review Healthwise content from a specialist's point of view. Their credentials include board certification, licensure, and/or registration; academic appointments at leading medical schools; involvement in research; and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships. This encourages partnerships in the decision-making process. With input from these specialists, and with oversight by one of the Medical Directors or Medical Editors, Healthwise medical writers develop health information based on scientific evidence and current clinical practice.

Before approving reviewers, Healthwise verifies that they have current licenses, registrations, and certifications with state or national agencies. We also verify with bodies that certify in specialty areas, if appropriate. The reviewers must be in good standing with these organizations during the time they review Healthwise content. We check this standing at least every 3 years. In addition, reviewers agree to notify Healthwise immediately if the status of their licenses, registrations, or certifications changes. The following physicians and health professionals are members of the Healthwise Medical Review Board:

Addiction Medicine

Michael F. Bierer, MD, Internal Medicine, Boston, Massachusetts

Allergy and Immunology

Rohit K Katial, MD, Denver, Colorado

Lora J. Stewart, MD, Pediatric Allergy and Immunology, Denver, Colorado

Anesthesiology

John M. Freedman, MD, Anesthesiology, Santa Rosa, California

Cardiology

Stephen Fort, MD, MRCP, FRCPC, Interventional Cardiology, Kelowna, British Columbia, Canada

Robert A. Kloner, MD, PhD, Los Angeles, California

John A. McPherson, MD, FACC, FSCAI, Interventional Cardiology, Nashville, Tennessee

John M. Miller, MD, Electrophysiology, Indianapolis, Indiana

George J. Philippides, MD, FACC, Boston, Massachusetts

Rita F. Redberg, MD, San Francisco, California

Chiropractic

Christine Goertz, DC, PhD, Davenport, Iowa

Dentistry

Arden G. Christen, DDS, MSD, MA, FACD, Indianapolis, Indiana

Steven K. Patterson, BSc, DDS, MPH, Edmonton, Alberta, Canada

Bryan D. Tompson, DDS, FRCDC, Orthodontics, Toronto, Ontario, Canada

Dermatology

Randall D. Burr, MD, Boise, Idaho

Ellen K. Roh, MD, Boston, Massachusetts

Diet and Nutrition

Rhonda O'Brien, MS, RD, CDE, Dietitian and Certified Diabetes Educator, Boise, Idaho

Colleen O'Connor, PhD, RD, Registered Dietitian, London, Ontario, Canada

Emergency Medicine

William H. Blahd Jr, MD, FACEP, New York, New York

David Messenger, BSc, MD, FRCPC, FCCP, Critical Care Medicine, Kingston, Ontario, Canada

Endocrinology, Diabetes, and Metabolism

Alan C. Dalkin, MD, Charlottesville, Virginia

Jennifer Hone, MD, Santa Barbara, California

Matthew I. Kim, MD, Boston, Massachusetts

David C.W. Lau, MD, PhD, FRCPC, Calgary, Alberta, Canada

Epidemiology

Martin Englund, MD, Lund, Sweden

Leslie A. Tengelsen, PhD, DVM, Zoonotic Diseases, Boise, Idaho

Ergonomics

William S. Marras, PhD, CPE, Bioengineering and Ergonomics, Columbus, Ohio

Exercise Physiology

Heather O. Chambliss, PhD, FACSM, Exercise Science, Memphis, Tennessee

Richard B. Kreider, PhD, FACSM, FASEP, Exercise Physiology, Waco, Texas

Family Medicine

Thomas M. Bailey, MD, CCFP, Victoria, British Columbia, Canada

Patrice Burgess, MD, FAAFP, Boise, Idaho

Christine H. Fordyce, MD, Geriatrics, Seattle, Washington

Martin J. Gabica, MD, Boise, Idaho

Adam C. Husney, MD, Boise, Idaho

Marco Mannarino, MD, Edmonton, Alberta, Canada

Kathleen Romito, MD, Boise, Idaho

Donald Sproule, MD, CM, CCFP, FCFP, Montreal, Quebec, Canada

Gastroenterology

Peter J. Kahrilas, MD, Chicago, Illinois

Jerry S. Trier, MD, Boston, Massachusetts

Arvydas D. Vanagunas, MD, FACP, FACG, Chicago, Illinois

Genetics

Siobhan M. Dolan, MD, MPH, Medical Genetics, Bronx, New York

Geriatric Medicine

Carla J. Herman, MD, MPH, Albuquerque, New Mexico

Jean S. Kutner, MD, MSPH, Geriatrics, Aurora, Colorado

Elizabeth A. Phelan, MD, MS, Seattle, Washington

Hematology/Oncology

Wendy Y. Chen, MD, Hematology/Oncology, Boston, Massachusetts

Jeffrey S. Ginsberg, MD, FRCPC, Hematology, Hamilton, Ontario, Canada

Brian Leber, MDCM, FRCPC, Hematology, Hamilton, Ontario, Canada

Joseph F. O'Donnell, MD, Hanover, New Hampshire

Michael S. Rabin, MD, Medical Oncology, Boston, Massachusetts

Jimmy Ruiz, MD, Winston-Salem, North Carolina

Douglas A. Stewart, MD, FRCPC, Medical Oncology, Calgary, Alberta, Canada

Hepatology

W. Thomas London, MD, Philadelphia, Pennsylvania

Hospice and Palliative Medicine

Robin L. Fainsinger, MB, ChB, LMCC, CCFP, Palliative Medicine, Edmonton, Alberta, Canada

Shelly R. Garone, MD, Roseville, California

Infectious Diseases

W. David Colby, IV, MSc, MD, FRCPC, Travel Medicine and Tropical Diseases, London, Ontario, Canada

Christine Hahn, MD, Medical Epidemiology, Boise, Idaho

Peter Shalit, MD, PhD, Internal Medicine, Seattle, Washington

Dennis L. Stevens, MD, PhD, Boise, Idaho

Raymond A. Strikas, MD, MPH, FACS, Atlanta, Georgia

Internal Medicine

Steven J. Atlas, MD, MPH, Boston, Massachusetts

L. Ebony Boulware, MD, Durham, North Carolina

Roger Chou, MD, Portland, Oregon

O. Kenrik Duru, MD, Los Angeles, California

Joann G. Elmore, MD, MPH, FACP, Internal Medicine/Infectious Disease, Seattle, Washington

Kathleen M. Fairfield, MD, MPH, DrPH, Portland, Maine

Rafael (Ralph) Gonzales, MD, MSPH, San Francisco, California

Ethan A. Halm, MD, MPH, Dallas, Texas

Richard M. Hoffman, MD, MPH, Albuquerque, New Mexico

Nancy L. Keating, MD, MPH, Boston, Massachusetts

Brigid McCaw, MD, MPH, MS, FACP, Family Violence, Oakland, California

Brian O'Brien, MD, FRCPC, Halifax, Nova Scotia, Canada

Michael P. Pignone, MD, MPH, FACP, Durham, North Carolina

Anne C. Poinier, MD, Boise, Idaho

Neil R. Powe, MD, MPH, Oakland, California

Caroline Rhoads, MD, Seattle, Washington

Elizabeth T. Russo, MD, Internal Medicine, Boston, Massachusetts

E. Gregory Thompson, MD, Boise, Idaho

John W. Williams Jr., MD, MHSc, Durham, North Carolina

John B. Wong, MD, Internal Medicine/Clinical Decision Making, Boston, Massachusetts

Maternal-Fetal Medicine

William M. Gilbert, MD, Sacramento, California

Midwifery

Frances E. Likis, DrPH, NP, CNM, FACNM, FAAN, Nashville, Tennessee

Neonatal-Perinatal Medicine

Kim E. Dow, MD, FRCPC, Kingston, Ontario, Canada

Jennifer Merchant, MD, Boise, Idaho

Nephrology

Mitchell H. Rosner, MD, Charlottesville, Virginia

Tushar J. Vachharajani, MD, FASN, FACP, Clemmons, North Carolina

Neurology

Colin H. Chalk, MD, CM, FRCPC, Montreal, Quebec, Canada

Karin M. Lindholm, DO, Hailey, Idaho

Steven C. Schachter, MD, Boston, Massachusetts

G. Frederick Wooten Jr., MD, Charlottesville, Virginia

Nursing

Gayle Stauffer, RN, Boise, Idaho

Obstetrics/Gynecology

Rebecca H. Allen, MD, MPH, Providence, Rhode Island

Divya Gupta, MD, Gynecologic Oncology New York, New York

Kirtly Jones, MD, Reproductive Endocrinology, Salt Lake City, Utah

Kevin C. Kiley, MD, FACOG, Albany, New York

Femi Olatunbosun, MB, FRCSC, FACOG, Reproductive Endocrinology, Saskatoon, Saskatchewan, Canada

Deborah A. Penava, MD, FRCSC, MPH, London, Ontario, Canada

Rebecca S. Uranga, MD, Meridian, Idaho

Ophthalmology and Optometry

Carol L. Karp, MD, Miami, Florida

Douglas Rett, OD, FAAO, Boston, Massachusetts

Christopher Joseph Rudnisky, MD, BMs, MPH, FRCSC, Edmonton, Alberta, Canada

Orthopaedics

Davide Bardana, MD, FRCSC, Sports Medicine, Kingston, Ontario, Canada

Freddie H. Fu, MD, Pittsburgh, Pennsylvania

Robert B. Keller, MD, Biddeford, Maine

Kenneth J. Koval, MD, Orthopaedic Trauma, Lebanon, New Hampshire

Patrick J. McMahon, MD, Sports Medicine, Pittsburgh, Pennsylvania

Herbert von Schroeder, MD, MSc, FRCSC, Hand and Microsurgery, Toronto, Ontario, Canada

Otolaryngology

Donald R. Mintz, MD, FRCSC, Vancouver, British Columbia, Canada

Charles M. Myer III, MD, Pediatric Otolaryngology, Cincinnati, Ohio

Pediatrics

Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC, Montreal, Quebec, Canada

Susan Kim, MD, Boise, Idaho

Stephen H. LaFranchi, MD, Pediatric Endocrinology, Portland, Oregon

Martha K. Nicholson, MD, Walnut Creek, California

Louis Pellegrino, MD, Neurodevelopmental Disabilities, Developmental and Behavioral Pediatrics, Syracuse, New York

John Pope, MD, Pediatric Hospitalist, Phoenix, Arizona

Frederick P. Rivara, MD, MPH, Seattle, Washington

Pharmacy

Margaret Hetherington, PharmD, Kingston, Ontario, Canada

Theresa O'Young, PharmD, Clinical Pharmacist, Seattle, Washington

Physical Medicine and Rehabilitation

Margaret M. Doucette, DO, Wound Care and Hyperbaric Medicine, Boise, Idaho

Nancy E. Greenwald, MD, Boise, Idaho

Richard D. Zorowitz , MD, Baltimore, Maryland

Physical Therapy

Mary McVicars Heckel, PT, MAPT, CLT-LANA, CWS, Boise, Idaho

Joan Rigg, PT, OCS, Orthopaedic Physical Therapy, Boise, Idaho

Plastic and Reconstructive Surgery

Keith A. Denkler, MD, Larkspur, California

Podiatry and Podiatric Surgery

Gavin W.G. Chalmers, DPM, FACFAS, Vancouver, British Columbia, Canada

Barry L. Scurran, DPM, Fremont, California

Psychiatry

W. Stewart Agras, MD, FRCPC, Palo Alto, California

David A. Brent, MD, Child and Adolescent Psychiatry, Pittsburgh, Pennsylvania

Evan Eyler, MD, MPH, Adolescent and Psychosomatic Medicine, Burlington, Vermont

Alfred J. Lewy, MD, PhD, Portland, Oregon

Steven Locke, MD, Psychosomatic Medicine and Behavioral Health, Wayland, Massachusetts

Fred R. Volkmar, MD, Pediatric Psychiatry, New Haven, Connecticut

Myron F. Weiner, MD, Geriatric Psychiatry, Dallas, Texas

Lisa S. Weinstock, MD, Mount Kisco, New York

Sidney Zisook, MD, San Diego, California

Psychology

Susan W. Butterworth, PhD, Behavioral Health, Portland, Oregon

Jessica Hamblen, PhD, Post-Traumatic Stress Disorder, White River Junction, Vermont

Christine R. Maldonado, PhD, Behavioral Health, Boise, Idaho

Timothy Stockwell, PhD, Public Policy, Victoria, British Columbia, Canada

Pulmonology

Hasmeena Kathuria, MD, Critical Care and Sleep Medicine, Boston, Massachusetts

Mark A. Rasmus, MD, Critical Care and Sleep Medicine, Boise, Idaho

R. Steven Tharratt, MD, FACP, FCCP, Pulmonology and Critical Care Medicine, Toxicology, Sacramento, California

Radiology

Ronald C. Chen, MD, MPH, Radiation Oncology, Chapel Hill, North Carolina

Myo Min Han, MD, Nuclear Medicine, Oakland, California

Howard B. Schaff, MD, Diagnostic Radiology, Boise, Idaho

Respiratory Therapy

Catherine O'Malley, RRT, Chicago, Illinois

Rheumatology

Richa Dhawan, MD, Shreveport, Louisiana

Jeffrey N. Katz, MD, Rheumatology, Boston, Massachusetts

Nancy Ann Shadick, MD, MPH, Boston, Massachusetts

Speech and Language Pathology

Ann W. Kummer, PhD, CCC-SLP, Cincinnati, Ohio

Surgery

Kenneth Bark, MD, General and Colorectal Surgery, Utica, Michigan

Laura S. Dominici, MD, Breast Surgical Oncology, Boston, Massachusetts

Jeffrey Gilbertson, MD, Vascular Surgery, Boise, Idaho

Vikram S. Iyer, MD, FRCSC, General and Vascular Surgery, Hamilton, Ontario, Canada

John Loeser, MD, FAANS, Neurological Surgery, Seattle, Washington

Michael M. Murr, MD, Gastrointestinal Surgery, Tampa, Florida

David C. Stuesse, MD, Cardiac and Thoracic Surgery, Boise, Idaho

David A. Szalay, MD, Vascular Surgery, Hamilton, Ontario, Canada

Ali Tavakkoli, MD, Bariatric Surgery, Boston, Massachusetts

Brad W. Warner, MD, Pediatric Surgery/Critical Care, St. Louis, Missouri

Christian G. Zimmerman, MD, FACS, MBA, Neurological Surgery, Boise, Idaho

Urology

Peter Anderson, MD, FRCS), Pediatric Urology, Halifax, Nova Scotia, Canada

Avery L. Seifert, MD, FACS, Boise, Idaho

Christopher G. Wood, MD, FACS, Houston, Texas

Last updated: March 2017

Healthwise Content Development Team

Senior Vice President, Content

Christine Calhoun, MPH

Directors

Bill Coffey

Jeannette Curtis, BS

Judi Marsh, MBA

Katy Magee, MA

Patrick Kilby, BA

Content Managers

Carrie Henley, BA

Deborah Dakins, BA

Doug Dana, BA

Maria G. Essig, MS

Monica Rhodes, BA

Senior Special Project Manager

Kathleen M. Ariss, MS

Paul Lehnert, MA

Medical Writers

Bill Amos, JD

Colleen Cronin, MA

Eileen Ellig, BJ

Fran Valentine, BA

Lila Havens, MA

Marianne Flagg, BA

Nathaniel Hoffman, MA

Patrice Dodd, MA

Ryan Powers, MFA

Clinical & Medical Content Specialists

Arlene Hull, MS, CES

Bets Davis, MFA

Carolyn Brzezicki, RN, MS

Chad Parmet, BA

Jan Anderson, RN

Jan Nissl, RN, BS

Julie Beauregard, MLIS

Robin Parks, MS, MSTC

Sara Fuller, BS

Shannon Erstad, RPT, MBA, MPH

Tammie Sherner, MSN, APRN-CNS

Senior Content Strategist

Christopher Hess, BA

Localization Specialists

Echo Savage, MA

Jennifer Adams, MLS

Terry Smith, PhD

Associate Editors

Denele Ivins, BA

Michele Cronen

Pat Truman, MA

Rebecca Whitaker, BA

Terrina Coffer, BA

Tracy Landauer, BA

Medical Librarian/Senior Research Associate

Karri Alderson, MLIS

Medical Accuracy & Consistency Administrator

Bradley Steele

Project Data Administrators

Kim Oliver, BS

Phyllis Tambling, BS

Visual Content Specialists

Angela Heileson, BFA

Brian Igeleman, BA

Casey Miller, BA

David Blum, PhD

Mike Ulrich, BFA

Paul Bush, BS

Samantha Zimmerman

Last updated: March 2017

Healthwise^® Knowledgebase Editorial Policy and Processes

The field of medicine changes constantly. Each day headlines reveal new ways to diagnose, treat, or prevent health problems. Through a comprehensive topic development process, the Healthwise^® Knowledgebase content is regularly updated to keep pace with the changes in medicine and medical practice.

Content Written by Healthwise

Healthwise develops content through the collaborative efforts of content and medical teams using a comprehensive research and review process.

The Healthwise content team includes full-time professional medical researchers, writers, and editors who have extensive experience in scientific research and medical writing. They work closely with members of the Healthwise medical team, including the chief medical officer, the medical director, the associate medical directors, and the Healthwise Medical Review Board.

The Healthwise Medical Review Board includes more than 220 health professionals and medical specialists who review Healthwise content from a specialist's point of view. Their credentials include board certification, licensure/registration and/or certification, academic appointments at leading medical schools, involvement in research, and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships.

Healthwise content starts with evidence-based information. Content team members are experts at presenting balanced, unbiased perspectives without influence from commercial interests. Our Conflict of Interest policy enforces our editorial integrity: "All Healthwise personnel should avoid situations where their personal interests could conflict, or reasonably appear to conflict, with the interests of Healthwise. In this regard, personnel must avoid any outside financial interest that might influence, or appear to influence, their corporate decisions or actions."

Topic Development Process

There are four primary steps in the development process: planning, research, writing, and review.

• Writers, editors, and associate medical directors work together to plan the topic.
• Medical librarians develop a research packet for each topic based on extensive research and evaluation of biomedical literature. Research packets include evidence-based journal and database search results, gold standard textbook chapters, guideline statements, and outcome studies, as well as consumer health information.
• Writing and review cycles include collaboration among medical directors and other clinicians. Writers and editors also collaborate to ensure that the content is in plain language, follows literacy standards, and meets user-centered learning theory and behavior-change principles.
• An associate medical director and at least one specialist review topics during the development process. They ensure accuracy and consistency with current practice standards and identify areas of important development. These independent medical reviewers ensure that Healthwise^® Knowledgebase topics contain accurate, unbiased information.

New Topic Development

Healthwise selects new topics on the basis of several criteria, including requests from consumers and organizations using the Healthwise^® Knowledgebase, prevalence of the condition, and the potential of shared decision-making for consumers who have the condition.

Updating Topics

Healthwise updates topics when warranted by changes in medical practice. The content and medical teams continually review medical news sources and journals so they can quickly identify changes that affect the practice of medicine. When important changes occur, we update topics and include them in the next quarterly release of the Healthwise^® Knowledgebase. In addition, Healthwise reviews and updates topics on a regular basis.

Organizations and people using the Healthwise^® Knowledgebase may suggest changes or additions to topics. Healthwise considers these recommendations during the topic development process and includes them in our updates if they meet our standard criteria and pass the medical review process. If a suggested change applies only to a particular sponsoring organization's readers, and if it passes medical review, then we may make the change for that organization's customized version of the Healthwise^® Knowledgebase. Any change to the Healthwise^® Knowledgebase must first pass medical review.

The last revised date is at the bottom of every topic page and in the credits section of each topic.

Citing the Evidence

The Healthwise^® Knowledgebase contains thousands of unique references to help readers find more information on topics. Our processes and policies ensure that entry points of content give readers reasonable access to references. We include citations that:

• Support statistics, particularly those that play a key role in decision making.
• Support outcomes, effectiveness, or risk data.
• Identify testing or treatment recommendations or guidelines.
• Support prevalence data.

Also, for all self-assessment or risk analysis tools in the Healthwise^® Knowledgebase, we provide information that describes the source of the tool, the scientific basis for the tool, how the tool is maintained on the website, the evaluation process, and the last revised date.

Content Written by Third Parties

Cerner Multum, Inc., Drug Reference (not included in all systems)

The drug reference included in the Healthwise^® Knowledgebase is provided by Cerner Multum, Inc., of Denver, Colorado.

Multum updates daily. New information is incorporated into a database as soon as it appears in the literature or in product labeling. Doctors and pharmacists review the new information and make any necessary changes. Multum conducts weekly Current Content searches on all of its drugs, and it surveys all key periodicals. All leaflets are reviewed by one or more practicing clinical specialists. Healthwise receives monthly updates from Multum. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase.

Conflict of Interest Policy: Multum's content is authored by full-time associates with no affiliations with drug companies. Consultants who work with the information in other capacities are required to have no conflicts of interest.

The date of the last update is at the end of each topic.

National Cancer Institute (NCI) Topics

NCI Physician Data Query (PDQ^®) topics in the Healthwise^® Knowledgebase are provided by the National Cancer Institute, National Institutes of Health, Public Health Service, Department of Health and Human Services.

All PDQ cancer information summaries are peer-reviewed and updated monthly by six editorial boards of oncology specialists in adult treatment, pediatric treatment, supportive care, complementary and alternative medicine, screening, prevention, and cancer genetics. They review current literature from more than 70 biomedical journals, evaluate its relevance, and synthesize it into concise, clear summaries. Healthwise receives monthly updates from the National Cancer Institute. The updates are included in the quarterly releases of the Healthwise^® Knowledgebase.

Conflict of Interest Policy: PDQ Editorial Board members are selected by the editor-in-chief of each board. Potential biases or conflicts of interest are discussed as part of the selection process.

The date of the last update is at the end of each topic.

AISLE7 TM/Healthnotes®

Headquartered in Portland, Oregon, Healthnotes, Inc., dba AISLE7 is the premier provider of reliable, easy-to-use health, food, and lifestyle information.

Each year AISLE7 reviews tens of thousands of articles and more than 600 medical and scientific journals to ensure that the content stays current, factual, and balanced. Citations identify the source, the authors, and where and when the information was first published. The AISLE7 editorial team includes medical doctors, pharmacists, chiropractors, naturopaths, and dietitians. The Medical Advisory Board includes medical doctors and experts affiliated with leading medical schools, such as the Robert Wood Johnson Medical School.

Healthwise receives quarterly updates from AISLE7. The updates are included in the quarterly releases of the Healthwise^®Knowledgebase.

The date of the last review is at the end of each topic.

Last updated: November 2016

Healthwise Quality Standards

Healthwise is committed to providing consumers with high-quality health information so that they can make wise health decisions in partnership with their doctors. We adhere to the following principles:

• We will create health information that is in the consumer's best interest.
• We will not allow commercial interests to determine our content.
• We pledge to protect the privacy of individuals using our website.
• We provide referenced, frequently updated, evidence-based health information.
• We will not knowingly post or publish health content that contains false or misleading claims or promotes ineffective or dangerous products.

Healthwise ensures compliance with these principles through internal review and URAC accreditation.

Last updated: November 2015

Date adopted: May 2005

Healthwise Advertising Policy

Healthwise does not include advertisements in the Healthwise^® Knowledgebase; however, sponsoring organizations may include advertisements outside but adjacent to Healthwise^® Knowledgebase content. These advertisements may have been selected based upon the specific topic being viewed. Advertisements are controlled by the sponsoring organization. For more information, check the advertisement policy of the sponsoring organization.

Last updated: August 2007

Date adopted: August 2000

Healthwise Ownership and Funding Disclosure

Healthwise is committed to producing quality health information for consumers so that they can make wise decisions with their doctors. Healthwise health information is not determined by commercial interests.

Healthwise is a 501(C)(3) nonprofit organization.

Healthwise receives revenue from the following sources:

• Sale of self-care guides
• Licensing of health content and software products to hospitals, health plans, employers, health websites and other organizations. Healthwise may receive revenue based on advertising and e-commerce revenue that is generated on our clients' websites.
• Grants from foundations and government agencies
• Other sources that account for minimal revenues

Last updated: August 2007

Date adopted: August 2000