Healthwise helps you make better health decisions.

Healthwise is a nonprofit organization founded in 1975 with the mission to help people make better health decisions. Nearly 75 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.

	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 WebMD®,” 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.
	You can count on Susan Van Houten—Healthwise medical writer, grandmother, and former ER nurse. “Helping people like Patricia make important medical decisions is our sole focus,” says Susan Van Houten. “We know our work makes a difference in people’s lives, every day.” The people at Healthwise are very much like the people who use our information. We’re health care consumers too. We care for our own health and for the health of our kids and parents. And, we all share a commitment to the Healthwise mission. Susan is a mother of 6, grandmother of 10, and daughter of her 78-year-old mother. Several people in her family deal with chronic diseases like hypertension and diabetes. Just like you, she wants health information to be easy to use for herself and her family. Unlike many of our readers, Susan is an expert in developing health information and has been doing so at Healthwise for 14 years. She is also a nurse who practiced in hospitals for 25 years, 15 of which were as the director of an emergency room. “I’ve seen firsthand how valuable it is for people to have good information,” Susan says. “Helping you make better health decisions is important to me—and to all of us at Healthwise.”
	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.”

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Date last updated: 12/01/2006

TThe Medical Review Board is directed by our chief medical officer, Dr. Steven L. Schneider, and our medical director, Dr. Adam C. Husney; both are board-certified family medicine physicians. There are eight board-certified associate medical directors. Together, these ten physicians conduct initial and final reviews of all Healthwise® Knowledgebase topics written by Healthwise, and they are involved in the planning and updating of all Healthwise publications and products.

Chief Medical Officer: Steven L. Schneider , MD, Family Medicine; Physician, Primary Health Wellness Center, Boise, ID

Medical Director: Adam C. Husney , MD, Family Medicine; Physician, Boise Minor Emergency Center, PA, Boise, ID

Associate Medical Directors:

• Patrice Burgess , MD, Family Medicine; Assistant Clinical Professor, University of Washington, Family Practice Residency of Idaho, Boise, ID
• Renée M. Crichlow , MD, Family Medicine; Assistant Clinical Professor, University of Washington, Montana Family Practice Residency, Billings, MT
• Martin J. Gabica , MD, Family Medicine; Physician, Primary Health Wellness Center, Boise, ID
• William M. Green , MD, Emergency Medicine; Medical Director, Sexual Assault Forensic Evaluation Team and Clinical Professor, Department of Internal Medicine, Division of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
• Anne C. Poinier , MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Boise, ID
• Joy Melnikow , MD, MPH, Family Medicine; Associate Professor, Department of Family Practice, University of California Davis, Sacramento, CA
• Caroline S. Rhoads , MD, Internal Medicine; Associate Professor of Medicine, University of Washington, Seattle, WA
• Kathleen Romito , MD, Family Medicine; Physician, Primary Health Wellness Center, Boise, ID
• Michael J. Sexton , MD, Pediatrics; Medical Director, CARES Program, St. Luke's Children's Hospital, Boise, ID; Associate Clinical Professor, Family Medicine, University of Washington, Seattle, WA
• E. Gregory Thompson , MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Meridian, ID

Other members of the Medical Review Board review Knowledgebase topics from the specialist's point of view. With the input of these specialists, Healthwise medical writers develop topics based on scientific evidence and current clinical practice.

Members of the Medical Review Board are experts in their specialty area. Their credentials include board certification, academic appointments at the nation's leading medical schools, active 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.

The following physicians and health professionals have been selected for the Medical Review Board:

Addiction Medicine

Enoch Gordis , MD, Addiction Medicine

Director Emeritus, National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health, Bethesda, MD

Allergy and Immunology

Harold S. Nelson , MD, Allergy and Immunology

Senior Staff Physician, National Jewish Medical and Research Center; Professor of Medicine, University of Colorado; Chairman, Pulmonary Disease Advisory Panel, Denver, CO

Anesthesiology, Pain Management

Daniel B. Carr , MD, Anesthesiology, Pain Management

Saltonstall Professor of Pain Research, Departments of Anesthesia and Medicine, New England Medical Center, Boston, MA

Cardiology

Stephen Fort , MD, MRCP, FRCPC, Interventional Cardiology

Associate Professor and Director, Cardiac Catheterization Laboratories, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS

Julien I. E. Hoffman , MD, Pediatric Cardiology

Professor Emeritus of Pediatrics, Cardiovascular Research Institute, University of California, San Francisco, CA

Robert A. Kloner , MD, PhD, Cardiology

Professor of Medicine, Section of Cardiology, University of Southern California, Los Angeles; Director of Research, The Heart Institute of Good Samaritan Hospital, Los Angeles, CA

Larry A. Latson , MD, Pediatric Cardiology and Critical Care

Pediatric Cardiology Medical Director, Department of Pediatric and Congenital Heart Diseases, The Cleveland Clinic Foundation, Cleveland, OH

George J. Philippides , MD, FACC, Cardiology

Assistant Professor, Boston University School of Medicine, Boston, MA

Neil J. Stone , MD, FACC, FACP, Cardiology

Clinical Professor of Medicine, Northwestern University Medical School; Attending Staff, Northwestern Memorial Hospital, Chicago, IL

Laurence M. Epstein , MD, Cardiac Electrophysiology

Brigham and Women's Hospital, Cardiovascular Division; Assistant Professor of Medicine, Harvard Medical School, Boston, MA

Complementary and Alternative Medicine

Marc S. Micozzi , MD, Complementary and Alternative Medicine

Policy Institute for Integrative Medicine, Thomas Jefferson University Hospital, Philadelphia, PA

Dentistry

Arden G. Christen , DDS, MSD, MA, FACD, Dentistry

Professor and Director of Preventive/Community Dentistry, Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, IN

Steven K. Patterson , BSc, DDS, MPH, Dentistry

Faculty and Director of Continuing Dental Education, Department of Dentistry, University of Alberta, Edmonton, AB

Dermatology

Randall D. Burr , MD, Dermatology

Associate Faculty, University of Washington Medical School, Seattle, WA; Consultant, VA Medical Center and Family Practice Residency Program; Ada West Dermatology, Boise, ID

Diet and Nutrition

Ruth Schneider , RD, MPH, Dietitian

Dietetic Internship Coordinator and Clinical Assistant Professor, Idaho State University; Private Practice, Boise; Adjunct Instructor, Boise State University, Boise, ID

Emergency Medicine

William M. Green , MD, Emergency Medicine

Associate Medical Director, Healthwise, Incorporated; Medical Director, Sexual Assault Forensic Evaluation Team and Clinical Professor, Department of Internal Medicine, Division of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA

H. Michael O' Connor , MD, Emergency Medicine

Chairman and Professor, Department of Emergency Medicine, Queen's University, Kingston, ON

Endocrinology and Metabolism

Alan C. Dalkin , MD, Endocrinology and Metabolism

Associate Professor of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia Health Sciences, Charlottesville, VA

Lois Jovanovic , MD, Endocrinology and Metabolism

Director, Sansum Medical Research Institute; Clinical Professor of Medicine, University of Southern California, Santa Barbara, CA

Stephen H. LaFranchi , MD, Pediatric Endocrinology

Director, Pediatric Endocrinology Training Program; Head, Pediatric Endocrinology Division; Associate Chair for Education Professor, Oregon Health and Science University, Portland, OR

Family Medicine

Thomas M. Bailey , MD, Family Medicine

Clinical Assistant Professor, Department of Family Practice, University of British Columbia, Victoria, BC

Patrice Burgess , MD, Family Medicine

Associate Medical Director, Healthwise, Incorporated; Clinical Assistant Professor, University of Washington, Family Practice Residency of Idaho, Boise, ID

Renée M. Crichlow , MD, Family Medicine

Associate Medical Director, Healthwise, Incorporated; Assistant Clinical Professor, University of Washington, Montana Family Practice Residency, Billings, MT

Martin J. Gabica , MD, Family Medicine

Associate Medical Director, Healthwise, Incorporated; Physician, Primary Health Wellness Center, Boise, ID

Adam C. Husney , MD, Family Medicine

Medical Director, Healthwise, Incorporated; Physician, Boise Minor Emergency Center, PA, Boise, ID

Joy Melnikow , MD, MPH, Family Medicine

Associate Medical Director, Healthwise, Incorporated; Associate Professor, Department of Family Practice, University of California Davis, Sacramento, CA

Kathleen Romito , MD, Family Medicine

Associate Medical Director, Healthwise, Incorporated; Physician, Primary Health Wellness Center, Boise, ID

Steven L. Schneider , MD, Family Medicine

Chief Medical Officer, Healthwise, Incorporated; Physician, Primary Health Wellness Center, Boise, ID

David S. Smith , MD, Family Medicine

Assistant Professor, Family/Community Medicine, Medical College of Wisconsin; Director, Family Practice Residency Program, St. Michael Hospital; Medical Director, Down Syndrome Clinic of Wisconsin, Milwaukee, WI

Gastroenterology

Paul E. Hyman , MD, Pediatric Gastroenterology

Professor of Pediatrics and Chief, Pediatric Gastroenterology, Kansas University Medical Center, Kansas City, KS

Peter J. Kahrilas , MD, Gastroenterology

Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University School of Medicine, Chicago, IL

W. Thomas London , MD, Hepatology

Senior Member, Division of Population Science and Director, Liver Cancer Prevention Center, Fox Chase Cancer Center; Senior Member and Adjunct Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA

Jerome B. Simon , MD, Gastroenterology

Professor, Department of Medicine, Queen's University, Kingston, ON

Jerry S. Trier , MD, Gastroenterology

Professor Emeritus, Harvard Medical School, Boston, MA

Arvydas D. Vanagunas , MD, Gastroenterology

Associate Professor of Medicine, Northwestern University School of Medicine, Chicago, IL

Genetics

John B. Moeschler , MD, Genetics, Pediatric

Director, Clinical Genetics, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Renée H. Martin , PhD, FCCMG, Medical Genetics

Professor, Department of Medical Genetics, University of Calgary, Calgary, AB

Gerontology

Carla J. Herman , MD, Gerontology

Associate Professor of Medicine, Chief, Division of Gerontology, and Member, Epidemiology and Preventive Medicine, University of New Mexico, Albuquerque, NM

Hematology

Christopher T. Coughlin , MD, Hematology/Oncology, Radiation Oncology

Radiation Oncologist, Dartmouth-Hitchcock Medical Center; Professor of Medicine, Dartmouth Medical School, Lebanon, NH

Jeffrey S. Ginsberg , MD, Hematology

Professor, McMaster University, Department of Medicine, Hamilton, ON

Joseph O'Donnell , MD, Hematology/Oncology

Chief, Oncology Section, Veterans Affairs Medical Center, White River Junction, VT; Senior Advising Dean and Director of Community Programs, Dartmouth Medical School, Hanover, NH

Infectious Diseases

W. David Colby , MSc, MD, FRCPC, Infectious Disease

Associate Professor, Department of Microbiology and Immunology and the Department of Medicine, University of Western Ontario; Director, University Hospital Travel Medicine and Tropical Diseases Service, London, ON

Christine Hahn , MD, Infectious Disease, Medical Epidemiology

Epidemiologist, Idaho Department of Health and Welfare, Boise, ID

Jeanne Marrazzo , MD, MPH, Infectious Disease, STD/HIV Prevention Epidemiology

Assistant Professor of Medicine, Division of Infectious Diseases, University of Washington; Medical Director, Seattle STD/HIV Prevention and Training Center, Seattle, WA

Peter Shalit , MD, PhD, Internal Medicine (HIV/AIDS)

Clinical Assistant Professor of Medicine, Division of Allergy and Infectious Diseases, University of Washington; Attending Physician, AIDS Clinic, Harborview Medical Center, Seattle, WA

Stanford T. Shulman , MD, Pediatric Infectious Diseases

Professor of Pediatrics, Northwestern University Medical School, and Chief, Division of Infectious Diseases, Children's Memorial Hospital, Chicago, IL

Marvin Turck , MD, Infectious Disease

Professor of Medicine, University of Washington; Chief Editor, The Journal of Infectious Diseases, Seattle, WA

Internal Medicine

Henry S. Elzinga , MD, Internal Medicine

VA Medical Center, Boise, ID

Anne C. Poinier , MD, Internal Medicine

Physician, St. Luke's Internal Medicine, Boise, ID

Caroline S. Rhoads , MD, Internal Medicine

Associate Medical Director, Healthwise, Incorporated; Associate Professor of Medicine, University of Washington, Seattle, WA

E. Gregory Thompson , MD, Internal Medicine

Physician, St. Luke's Internal Medicine, Meridian, ID

Maternal-Fetal Medicine

Gregory A.L. Davies , MD, FRCSC, FACOG, Maternal-Fetal Medicine

Associate Professor, Departments of Obstetrics and Gynaecology and Diagnostic Imaging, and in the School of Physical and Health Education, Chair of the Division of Maternal-Fetal Medicine, Queen's University, Kingston, ON

William M. Gilbert , MD, Maternal-Fetal Medicine

Professor and Vice Chairman, Department of Obstetrics and Gynecology, and Fellowship Director, Maternal-Fetal Medicine Program, University of California Davis, Sacramento, CA

Nephrology

David C. Mendelssohn , MD, FRCPC, Nephrology

Associate Professor of Medicine, University of Toronto; Chief and Director, Department of Nephrology, Humber River Regional Hospital, Toronto, ON

Neurology

David N. Alexander , MD, Neurology

Director, Stroke Rehabilitation Service, Daniel Freeman Memorial Hospital; Associate Clinical Professor, Neurology, University of California, Los Angeles School of Medicine, Los Angeles, CA

Colin Chalk , MD, CM, FRCPC, Neurology

Associate Professor, Department of Neurology and Neurosurgery, McGill University, Montreal, QC

Seymour Diamond , MD, Headaches

Director, Diamond Headache Clinic; Director, Inpatient Headache Unit, Columbus Hospital; Adjunct Professor, Chicago Medical School; Editor-in-Chief, Headache Quarterly, Chicago, IL

Tracy A. Glauser , MD, Pediatric Neurology

Assistant Professor of Pediatrics and Neurology; Director, Children's Comprehensive Epilepsy Program, Children's Hospital Medical Center, Cincinnati, OH

Barrie J. Hurwitz , MD, Neurology

Associate Professor, Division of Neurology, Duke University Medical Center, Durham, NC

Peter J. Whitehouse , MD, PhD, Neurology

Director, Integrative Studies, Case Western Reserve University, Cleveland, OH

G. Frederick Wooten , MD, Neurology

Chairman and Professor, Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA

Obstetrics/Gynecology

Ross S. Berkowitz , MD, Obstetrics/Gynecology, Gynecologic Oncology

Oncology Professor of Gynecology and Director of Gynecology and Gynecologic Oncology, Brigham and Women's Hospital; Professor of Gynecology, Harvard Medical School, Boston, MA

Robert A. Hatcher , MD, MPH, Obstetrics and Family Planning

Professor of Gynecology and Obstetrics and Director, Family Planning Program, Emory University School of Medicine, Atlanta, GA

Kirtly Jones , MD, Obstetrics/Gynecology, Reproductive Endocrinology

Associate Professor and Chief, Division of Reproductive Endocrinology, University of Utah School of Medicine, Salt Lake City, UT

Deborah A. Penava , MD, FRCSC, Obstetrics/Gynaecology

Assistant Professor, Department of Obstetrics and Gynaecology, University of Western Ontario, London, ON

George F. Sawaya , MD, Obstetrics, Gynecology and Reproductive Sciences

Assistant Professor in Residence, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA

Stephen D. Smith , MD, FACOG, Obstetrics/Gynecology

Private Practice, Missoula, MT

Oncology

B. J. Kennedy , MD, MACP, Medical Oncology

Healthwise is grateful for many years of excellent reviews by Dr. Kennedy prior to his death in 2003. Dr. Kennedy was Regents' Professor of Medicine, Emeritus, and Masonic Professor of Oncology, Emeritus, at the University of Minnesota School of Medicine, Division of Oncology, Minneapolis, MN.

Paul Montgomery , MD, Hematology/Oncology

Medical Oncologist, Mountain States Tumor Institute; Codirector, Bone Marrow Transplant Program, St. Luke's Regional Medical Center, Boise, ID; Clinical Instructor, University of Washington, Seattle, WA

Ophthalmology

Ian MacDonald , MD, CM, CCFP, Ophthalmology

Professor and Chair, Department of Ophthalmology, University of Alberta, Edmonton, AB

Scott H. Pressman , MD, Pediatric Ophthalmology

The Eye Associates, Boise, ID; Clinical Instructor, University of Utah, Salt Lake City, UT

Jill Ann Smith , MD, Ophthalmology/Glaucoma

Clinical Instructor, Ophthalmology, Harvard Medical School's Massachusetts Eye and Ear Infirmary, Boston; Newton Wellesley Eye Associates, Newton, MA

Orthodontics

William F. Hohlt , DDS, Orthodontics

Associate Professor with Tenure, Indiana University School of Dentistry, Indianapolis, IN

Orthopaedics

Michael J. Coughlin , MD, Orthopaedics

Clinical Professor, Orthopaedic Surgery and Rehabilitation, Oregon Health and Science University, Portland, OR; Orthopaedic Surgeon, Boise, ID

Freddie H. Fu , MD, Orthopaedics

David Silver Professor and Chairman, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA

Robert B. Keller , MD, Orthopaedics

Professor of Community and Family Medicine and Surgery, Dartmouth Medical School; Associate Clinical Professor, Orthopaedic Surgery, University of Massachusetts Medical School, North Dartmouth, MA

Frederick A. Matsen III , MD, Orthopaedics

Assistant Professor and Chairman, Department of Orthopaedics, and Adjunct Professor, Center of Bioengineering, University of Washington Medical Center, Seattle, WA

Patrick J. McMahon , MD, Orthopaedics, Sports Medicine

Assistant Professor, Orthopaedic Surgery, University of Pittsburgh School of Medicine; Assistant Team Physician, University of Pittsburgh Athletic Department, Pittsburgh, PA

Thomas S. Renshaw , MD, Orthopaedics

Professor of Orthopaedic Surgery, Yale University, New Haven, CT

Otolaryngology

Charles M. Myer III , MD, Pediatric Otolaryngology

Professor, Department of Pediatric Otolaryngology, Children's Hospital Medical Center; Professor, University of Cincinnati College of Medicine, Department of Otolaryngology, Head and Neck Surgery, Cincinnati, OH

Palliative Medicine

Ira Byock , MD, Palliative Medicine

Director, The Palliative Care Service, Missoula, MT

Daniel R. Tobin , MD, Palliative Medicine

Adjunct Assistant Professor in Psychiatry, Dartmouth Medical School, Lebanon, NH; Principal Investigator, Robert Wood Johnson National Demonstration "Promoting Excellence in End-of-Life Care," in coordination with The National Chronic Care Consortium, Albany, NY

Pediatrics

Emmett Francoeur , MDCM, CSPQ, FRCPC, Pediatrics

Associate Professor, Department of Pediatrics, McGill University, and Director, Learning Progress Clinic and Child Development Programme, Montreal Children's Hospital, Montreal, QC

Michael J. Sexton , MD, Pediatrics

Associate Medical Director, Healthwise, Incorporated; Medical Director, CARES Program, St. Luke's Children's Hospital, Boise, ID; Associate Clinical Professor, Family Medicine, University of Washington School of Medicine, Seattle, WA

Podiatry

Barry Scurran , DPM, Podiatry and Podiatric Surgery

Assistant Physician-in-Chief, The Permanente Medical Group, Hayward, CA

Psychiatry

W. Stewart Agras , MD, FRCPC, Psychiatry (Eating Disorders)

Professor and Associate Chair, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA

Malin Clark , MD, FRCPC, Adolescent Psychiatry

Assistant Professor of Psychiatry, University of Saskatchewan, Saskatoon, SK

John R. Hughes , MD, Addiction Psychiatry

Professor, Departments of Psychiatry, Psychology, and Family Practice, University of Vermont College of Medicine, Burlington, VT

Douglas G. Jacobs , MD, Psychiatry

Associate Clinical Professor of Psychiatry, Harvard Medical School; Director, National Mental Illness Screening Project, Wellesley, MA

Yifrah Kaminer , MD, MBA, Child and Adolescent Psychiatry

Professor, Department of Psychiatry and Alcohol Research Center, University of Connecticut, Farmington, CT

Alfred J. Lewy , MD, PhD, Psychiatry

Richard H. Phillips Professor, Biological Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR

Fred R. Volkmar , MD, Pediatric Psychiatry

Professor of Child Psychiatry and Professor of Pediatrics and Psychology, Yale University, New Haven, CT

Lisa S. Weinstock , MD, Psychiatry

Private practice specializing in Psychopharmacology and Perinatal Psychiatry, Mount Kisco, NY

Sidney Zisook , MD, Psychiatry

Professor of Psychiatry, University of California, San Diego, CA

Pulmonology

Robert L. Cowie , MB, ChB, MD, MSc, FCP[SA], MFOM, Respiratory Medicine

Professor, University of Calgary Departments of Medicine and Community Health Sciences; Director of Tuberculosis Services, Calgary Health Region; Director, Calgary COPD and Asthma Program, Calgary, AB

Susanna A. McColley , MD, Pediatric Pulmonology

Director, Cystic Fibrosis Center, Division of Pediatric Pulmonary and Critical Care Medicine, The Children's Memorial Center, Chicago, IL

Lee B. Reichman , MD, MPH, Pulmonology

Executive Director, New Jersey Medical School National Tuberculosis Center, and Professor of Medicine, Preventive Medicine and Community Health, New Jersey Medical School, Newark, NJ

R. Steven Tharratt , MD, FACP, FCCP, Pulmonology, Critical Care Medicine

Associate Professor of Medicine; Chief of Clinical Pharmacology and Medical Toxicology, Division of Pulmonary and Critical Care Medicine; Medical Director, Respiratory Care Department, University of California Davis Medical Center, Sacramento, CA

Ken Y. Yoneda , MD, Pulmonology, Critical Care Medicine

Associate Professor in Residence, Department of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA

Radiology

Paul D. Traughber , MD, Interventional Radiology

Radiology Group, St. Alphonsus Regional Medical Center, Boise, ID

Rheumatology

Stanford M. Shoor , MD, Rheumatology

Internist and Chief of Professional Education, Kaiser Foundation Hospital, Santa Clara, CA; Clinical Associate Professor of Medicine (Immunology), Stanford University, Stanford, CA

Sleep Disorders

Jan Ulfberg , MD, PhD, Internal Medicine, Sleep Disorders

Associate Professor of Medicine, Uppsala University, Sweden; Medical Director, Sleep Disorders Centers, Avesta Hospital, Sweden, and Inland Hospital, Norway.

Stress Management

Paul J. Rosch , MD, Stress Management, Cardiovascular Disease

Clinical Professor of Medicine and Psychiatry, New York Medical College; President, American Institute of Stress, New York, NY

Surgery

Brent T. Shoji , MD, General Surgery

Assistant Professor of Surgery, Harvard Medical School; Chief of General Surgery, Harvard Vanguard Medical Associates, Boston, MA

Brad W. Warner , MD, Pediatric Surgery/Critical Care

Associate Professor of Surgery, University of Cincinnati College of Medicine; Codirector, Extracorporeal Life Support Service, Children's Hospital Medical Center, Cincinnati, OH

Urology

Peter Anderson , MD, FRCS(C), Pediatric Urology

Professor of Urology and Director of the Residency Training Program, Dalhousie University; Professor of Urology, Queen Elizabeth II Health Sciences Centre, Halifax, NS

Philip Belitsky , MD, Urology

Professor of Urology, QEII Health Sciences Centre, Halifax, NS

Christopher E. Kelly , MD, Urology/Female Urology

Assistant Professor of Urology, New York University School of Medicine, New York, NY

Andrew R. McCullough , MD, FACS, Urology

Assistant Clinical Professor of Urology, Director of Male Sexual Health and Fertility, New York University School of Medicine, New York, NY

J. Curtis Nickel , MD, FRCSC, Urology

Professor, Department of Urology, Queen's University; Staff Urologist, Department of Urology, Kingston General and Hotel Dieu Hospitals, Kingston, ON

Avery L. Seifert , MD, Urology

Private practice, Boise, ID; Clinical Instructor, University of Washington School of Medicine, Seattle, WA

Vascular Surgery

Frederick F. Bartlett , MD, Vascular Surgery

Clinical Instructor, Harvard Medical School; Associate Chief, General/Vascular Surgery, Mt. Auburn-Based Health Centers and Harvard Community Health Plan, Boston, MA

Date last updated: 12/01/2006

The field of medicine changes constantly. Each day there are headlines about new ways to diagnose medical conditions, breakthroughs in treatments, and newly discovered ways to prevent health problems. Through a comprehensive topic development process, the Healthwise Knowledgebase software is regularly updated.

Content Written by Healthwise

Healthwise Knowledgebase topics are developed through the collaborative efforts of the Healthwise health information and medical teams using a comprehensive research and review process.

The Healthwise health information 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 eight associate medical directors, and the Healthwise Medical Review Board.

The Healthwise Medical Review Board includes more than 90 specialists from across the United States and Canada. Members of the Medical Review Board are experts in their specialty area. Many of them have academic appointments at the nation's leading medical schools, are actively involved in research, are practicing medicine, and are published in peer-reviewed journals and medical textbooks. They share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships.

Healthwise content is founded on evidence-based information. Our authors are experts at presenting balanced, unbiased perspectives without influence from commercial interests. Our Conflict of Interest policy enforces the editorial integrity of our writers: "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."

Interactive topics within the Healthwise Knowledgebase may include self-assessment tools. For those self-assessment tools that help people reach conclusions about health care decisions or that may be relevant to optimizing health outcomes, we have cited the source of the assessment tool. We have not cited references for surveys that help people understand their own personal behavior.

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.
• The medical librarian develops a research packet for each topic based on extensive research and evaluation of biomedical literature. Research packets contain results of literature searches, key evidence-based medical journal articles, published clinical outcome studies, guideline statements, and consumer health information.
• The writing and review phases are interwoven with collaboration among medical directors and other clinicians.
• As topics are written, both an associate medical director and at least one specialist review them. Topics are reviewed to ensure accuracy and consistency with current practice standards and to identify areas of important development. These independent medical reviewers ensure that Healthwise Knowledgebase topics contain accurate, unbiased information.

New Topic Development

New topics are selected on the basis of several criteria, including requests from consumers and organizations using the Healthwise Knowledgebase, prevalence of the condition, and the degree of shared decision-making potential available to consumers with the condition.

Updating Topics

Topics are updated when warranted by changes in medical practice. The health information and medical teams continuously review the wire services and journals so they can quickly identify changes that affect the practice of medicine. When important changes occur, topics are updated and included in the next quarterly release of the Healthwise Knowledgebase.

In addition, topics are reviewed and updated on a regular basis. The schedule varies by topic.

• Topics that have ongoing research and rapidly changing treatment, such as Coronary Artery Disease, are reviewed for update annually.
• Topics that change less frequently, such as Bunions, are reviewed for update every 2 years.

Organizations and people using the Healthwise Knowledgebase may suggest changes or additions to topics. These recommendations are considered during the topic development process and are included 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 it may be made for that organization's customized version of the Healthwise Knowledgebase. Any change made to the Healthwise Knowledgebase must first pass medical review.

The date of the last update is found at the bottom of every topic page and in the Credits section of each topic.

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.

The update process at Multum is ongoing on a daily basis. 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 uses weekly Current Content searches on all of its drugs in addition to surveying 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.

The date of the last update is found 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.

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

National Organization for Rare Disorders, Inc. (NORD)

The National Organization for Rare Disorders, Inc., of Danbury, Connecticut, provides topics on rare diseases for the Healthwise Knowledgebase.

The NORD topics are updated on an ongoing basis as new information is reported that is applicable to a condition. In addition, all topics are periodically reviewed to ensure that all information remains current and accurate. Healthwise receives quarterly updates from NORD. The updates are included in the quarterly releases of the Healthwise Knowledgebase.

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

American Self-Help Clearinghouse Information

The American Self-Help Group Clearinghouse, of Cedar Knolls, New Jersey, provides information on self-help groups.

Healthwise receives semiannual updates from the American Self-Help Clearinghouse. The updates are included in the quarterly releases of the Healthwise Knowledgebase. The content verification date is found at the end of each listing.

Healthnotes® (not included in all systems)

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

Each year Healthnotes 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 Healthnotes 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 semiannual updates from Healthnotes. The updates are included in the quarterly releases of the Healthwise Knowledgebase.

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

Date last updated: 02/15/2006

Healthwise is committed to providing consumers with high-quality health information so that they can make wise decisions with their doctors.

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Date last updated: 08/25/2000

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Healthwise creates Prescription-Strength Information^™ resources that people can use for making wise decisions with their doctors. Healthwise is firmly committed to respecting the privacy of individuals.

Healthwise does not release, trade, or sell any individually identifiable information gathered from users of the Healthwise^® Knowledgebase to people or organizations outside of Healthwise, Incorporated.

Healthwise information content is licensed to other organizations that make it available to consumers. Healthwise is not responsible for the privacy practices of organizations that have licensed Healthwise information. Consumers should review the privacy policies of the organizations from which they access Healthwise information.

Date last updated: 05/06/2004

Healthwise, Incorporated, 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.

Date last updated: 08/25/2000

Healthwise, Incorporated, 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. There is no ownership interest in our organization or our products.

Healthwise receives revenue from the following sources:

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Date last updated: 08/25/2000

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Medical information in the Text of the Software is based on current medical literature and on physician review. However, use of the Text is not intended to replace the advice of a doctor. The Text is intended to help people make better health care decisions and take a greater responsibility for their own health. YOU EXPRESSLY ACKNOWLEDGE AND AGREE THAT HEALTHWISE IS NOT RESPONSIBLE FOR THE RESULTS OF YOUR DECISIONS RESULTING FROM THE USE OF THE TEXT, INCLUDING, BUT NOT LIMITED TO, YOUR CHOOSING TO SEEK OR NOT TO SEEK PROFESSIONAL MEDICAL CARE, OR YOUR CHOOSING OR NOT CHOOSING SPECIFIC TREATMENT BASED ON THE TEXT.

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USE OF NATIONAL CANCER INSTITUTE MATERIALS Healthwise has an agreement with The National Cancer Institute ("NCI") for the use of the Physician Data Query (PDQ^®) data files ("NCI Content") in which the following provisions must be met. You shall accommodate these provisions in its use of the Healthwise material.

i. PDQ is a registered trademark of the National Cancer Institute and must be so referenced in all published material pertaining to PDQ files. The PDQ name must always be used in any public reference to the data files. Healthwise shall include in the Software and you shall not alter or delete the notice making users aware at the point of initially entering the PDQ files that the source of the data provided is the National Cancer Institute's PDQ files.

ii. Healthwise shall include in the Software and you shall not alter or delete the following use restrictions (and any updates thereto) in the User License Agreement document and in all updated versions thereof and online in the system "help" message for use restrictions: "Some material in Physician Data Query (PDQ^®) is from copyrighted publications of the respective copyright claimants. Users of PDQ are referred to the publication data appearing in the bibliographic citations, as well as to the copyright notices appearing in the original publication, all of which are hereby incorporated by reference."

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USE OF NORD'S RARE DISEASE DATABASE MATERIALS

HEALTHWISE has an agreement with the National Organization for Rare Disorders (NORD) for the use of the Rare Disease Database (NORD Content) in which the following provisions must be met. You shall accommodate these provisions in its use of the Software.

i. You agree that you will not alter, delete, or otherwise change any portion of the NORD Content.

ii. You shall be permitted to download, print and distribute individual topics from the NORD Content, providing that such copies include all appropriate copyright information of copyright of the Content by NORD.

iii. Healthwise shall include in the software, and you shall not alter or delete, the following disclaimer, either separately or incorporated with a Healthwise disclaimer, with the NORD content:

The information provided in this report is not intended for diagnostic purposes. It is provided for information purposes only. This information is presented for further understanding that could lead to the prevention, treatment, and/or cure of rare disorders. NORD recommends that affected individuals seek the advice or counsel of his or her own personal physician(s).

It is possible that the title of the topic is not the name you selected. Please check the SYNONYMS listing to find the alternate names(s) and disorder subdivision(s) covered by this report.

This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder.

iv. You will not misrepresent the NORD Content or purpose of the NORD Content in your marketing or sales activities.

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Date last updated: 05/18/2005

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Medical information in the proprietary health information of the Software ("Text") is based on current medical literature and on physician review. However, use of the Text is not intended to replace the advice of a doctor. The Text is intended to help people make better health care decisions and take a greater responsibility for their own health. YOU EXPRESSLY ACKNOWLEDGE AND AGREE THAT HEALTHWISE, ITS SUPPLIERS, LICENSEES AND SUBLICENSEES ARE NOT RESPONSIBLE FOR THE RESULTS OF YOUR DECISIONS RESULTING FROM THE USE OF THE TEXT, INCLUDING, BUT NOT LIMITED TO, YOUR CHOOSING TO SEEK OR NOT TO SEEK PROFESSIONAL MEDICAL CARE, OR YOUR CHOOSING OR NOT CHOOSING SPECIFIC TREATMENT BASED ON THE TEXT.

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8. NORD'S RARE DISEASE DATABASE The information provided in this report is not intended for diagnostic purposes. It is provided for information purposes only. This information is presented for further understanding that could lead to the prevention, treatment, and/or cure of rare disorders. NORD recommends that affected individuals seek the advice or counsel of his or her own personal physician(s).

9. NO HEALTHWISE ENDORSEMENT HEALTHWISE has not reviewed and does not endorse any information, products, or services other than those clearly marked as being from HEALTHWISE.

Date last updated: 05/18/2005

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Date last updated: 06/13/2001

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.