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What's New in the Healthwise® Knowledgebase

Version 10.6

August 2015

What's New in the Healthwise Knowledgebase lists new documents, noteworthy enhancements to existing documents, and medically significant changes to existing documents. We do not list every change, such as editorial changes, made for this release. Refer to Tech Docs for a complete list of new and updated documents.

  • New Decision Points
  • New Health and Disease Topics
  • New Medical Test Topics
  • Enhanced Content
  • New NCI Topics
  • New Medication Topics
  • New Aisle 7 (CAM) Content
  • Decision Point Updates
  • Health and Disease Topic Updates
  • Illustration and Interactive Health Tool Updates
  • NCI Topic Updates
  • Medication Topic Updates
  • Aisle 7 (CAM) Content Updates
  • Topic Title Changes and Topic Replacements
  • Medical Guideline Review
  • What's Next

New Decision Points

  • Lung Cancer: Should I Have Screening?: This new topic aids in the decision about whether to commit to annual low-dose CT screenings for lung cancer. It includes answers to frequently asked questions and a comparison of the pros and cons of this decision.

New Health and Disease Topics

  • Antidepressant Withdrawal: This new topic describes what can happen if you stop taking your antidepressant too suddenly. It explains that although you may feel ill for a while, the symptoms are not dangerous. It also explains treatment for this problem.
  • Calf Muscle Injury: This new topic describes what a calf muscle injury is and how to treat this kind of injury.
  • Chikungunya Fever: This new topic describes chikungunya fever, which has begun to appear in the United States and Canada. It describes what the symptoms are and how to treat them.
  • Diabetes Action Plan: This new topic is a form that the patient or doctor can print out before an office visit. It tells the patient what to bring to the visit, provides space for the doctor to fill in test results, and helps the patient and doctor discuss questions and future tests.
  • Diabetes: Making Medical Decisions as Your Health Changes: This new topic is for the person who is living with serious complications of diabetes. It includes considerations about quality of life and about personal preference for treatment.
  • Dilation and Curettage (D&C): This new topic describes the dilation and curettage procedure. It includes how it is done, how well it works, and what to expect during recovery.
  • Does Aspirin Prevent Cancer?: This new topic explains why it's best to talk to your doctor first if you are thinking of taking aspirin to prevent cancer.
  • Middle East Respiratory Syndrome (MERS): Middle East Respiratory Syndrome (MERS). This new topic describes MERS, an illness that first infected people in Saudi Arabia in 2012 and has since spread to other countries. At this time, the risk of contracting MERS in North America remains low.
  • Night Sweats: This new topic discusses heavy night sweating that is not caused by menopause. It explains that night sweats can be caused by many things, some of which are minor. But some serious conditions also can cause it. The topic explains that people should talk to their doctor about night sweats if they happen often or occur along with other symptoms, such as fever or unplanned weight loss.
  • Radiation for Early-Stage Breast Cancer: This new topic discusses the use of radiation for women who have early-stage breast cancer, including when hypofractionated radiation therapy is an option.
  • Sleep and Your Health: This new topic explains how not getting enough sleep affects your health. It also talks about the things that can get in the way of sleep and gives tips for getting help.
  • Transcatheter Aortic Valve Replacement: This new topic describes a procedure that can replace the aortic valve without open-heart surgery. It's done through an incision in the groin. The topic describes when the procedure is done, how well it works, what to expect after treatment, and what the risks of the procedure are.
  • Unwanted Hair in Women: This new topic describes the cause of hirsutism, which is excess male-pattern hair in women. The topic also describes treatments for the condition.
  • Vaccines to Prevent the Flu: This new topic describes what the types of flu vaccines are, who they are approved for, and who should get them.

New medicine content

The following new pieces of drug content have been created. They replace retired content about drugs that are tied to quality measures issued by organizations such as NCQA, the Joint Commission, and the Centers for Medicare and Medicaid Services.

For each of the medicines listed below, the new content describes why the medicine is used and provides information about side effects and cautions. Examples of the medicine are included.

New Medical Test Topics

  • Autoimmune Disease Tests: This new topic explains tests that can be done to look for several conditions that occur because a person's immune system attacks his or her own body. These tests can look for conditions such as rheumatoid arthritis, scleroderma, and lupus. The topic includes information on why and how the test is done and what the results mean.
  • Celiac Disease Antibodies: This new topic explains that the celiac disease antibodies test is done to help diagnose celiac disease or to check how well a gluten-free diet is working. It tells how to prepare for the test and what is done during the test. It explains how the test feels and what the results mean.
  • Clostridium Difficile Toxins: This new topic explains why the Clostridium Difficile toxins test is done and what it can show. It tells how to prepare for the test and what is done during the test. It explains how the test feels and what the results mean.
  • Creatine Kinase: This new topic describes the test for the enzyme creatine kinase (CK) and the isoenzymes that are part of it. It focuses on the tests that are done for signs of muscle damage. The topic tells how to prepare for the test, how it is done and how it feels, and how to understand the results.
  • High-Sensitivity C-Reactive Protein: This new topic explains why high-sensitivity C-reactive protein testing is done and what it can show. It tells how to prepare for the test and what is done during the test. It explains how the test feels and what the results mean.
  • Medicine Levels in Blood: This new topic explains what therapeutic drug monitoring is and why it is important when you are taking some medicines. It tells how to prepare for the test, how it is done and how it feels, and how to understand the results.
  • Seizure Medicine Levels in Blood: This new topic explains therapeutic drug monitoring and why it is important when you are taking medicine to control seizures. It tells how to prepare for the test, how it is done and how it feels, and how to understand the results.

Enhanced Content

The following documents have been revised to help readers focus on the key points for the specific health issue.

  • Accidental Needle Sticks: This topic now includes information about HIV infection in health professionals.
  • Alanine Aminotransferase (ALT): This topic now includes information about the gamma glutamyl transferase (GGT) test.
  • Arthritis: Should I Have Hip Replacement Surgery?: This decision has been enhanced for plain language and revised to include the most recent information about the benefits and risks of hip replacement surgery.
  • Aspartate Aminotransferase (AST): This topic now includes information about the gamma glutamyl transferase (GGT) test.
  • Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?: This decision aid has been revised to focus on people who don't have heart disease and haven't had a heart attack or stroke. Changes also include new numbers about how many people might have a heart attack depending on their risk level for a heart attack and whether they are taking aspirin. Numbers also have been updated to show how many people might have a serious bleeding problem from aspirin.
  • Breast Cancer Screening: When Should I Start Having Mammograms?: This decision aid has been revised to include the most recent information about the benefits and risks of mammography. Numbers also have been updated in this decision aid to show the number of breast cancer deaths with and without mammograms and the number of cancers found that would never cause a problem. New numbers have been added to show the number of breast cancers found in women who have annual mammograms, the number of lives saved with and without mammograms, and the number of false-positive test results and unnecessary biopsies that occur with annual mammograms.
  • Cancer Support: Being an Active Patient: This topic has been revised using plainer language with a more encouraging tone.
  • Colorectal Cancer: Which Screening Test Should I Have?: This decision aid has been revised to emphasize that all of the colorectal cancer screening tests lower your chance of getting and dying from colon cancer. The issue of which to choose depends on a person's preference for the type of screening and how often he or she wants to have the test. Numbers also have been updated in this decision aid to show how many colorectal cancers and deaths from colorectal cancer are avoided by having each type of screening. We added new numbers to show the risks (such as serious bleeding) of screening tests.
  • Grief: When Major Loss Challenges Your Beliefs: This topic has been revised with a plainer, more engaging writing style. We have added content to explain the importance of spiritual health.
  • Hormone Treatment for Breast Cancer: This topic has been enhanced by adding more information (including side effects) about the hormone medicines used in this type of treatment.
  • Liver Function Tests: This topic now includes the gamma glutamyl transferase (GGT) test.
  • Physical Activity Helps Prevent a Heart Attack and Stroke: This topic has been revised to focus on the benefits of activity to help prevent heart attacks and strokes.
  • Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes: This decision aid has been revised to include the most recent information about who benefits more from making major lifestyle changes or taking metformin. These include women who have had gestational diabetes, people who have a BMI of 35 or more, people age 60 and older, and people younger than 60. Statistics also have been updated in this decision aid to show the number of people who get type 2 diabetes with different treatments after 10 years of follow-up.
  • Prostate Cancer Screening: Should I Have a PSA Test?: This decision aid has been revised to include the most recent information about the risks and benefits of PSA testing and what PSA results tell you and what they do not. Numbers also have been updated in this decision aid to show the number of prostate cancer deaths and prostate cancers found with and without PSA testing, and the number of false-positive test results. And a new number has been added to show the number of men who are diagnosed with prostate cancer that may get cancer treatment they don't need.
  • Quick Tips: Healthy Pregnancy Habits: This topic now includes a reminder to avoid amusement park or other thrill rides during pregnancy because of the sudden starts and stops and jarring motions.
  • Scoliosis in Children and Teens: This topic has been updated so that the content focuses on children and teens.
  • Statins: Should I Take Them to Prevent a Heart Attack or Stroke?: This decision aid has been revised to focus on people not currently diagnosed with heart or blood vessel disease.

New NCI Topics

Refer to Tech Docs for a complete list of new National Cancer Institute content.

New Medication Topics

Medication topics from Cerner Multum, Inc., are not included in all systems. Added topics may include new information and/or the addition of new drug names. Refer to Tech Docs for a complete list of new titles.

New Aisle 7 (CAM) Content

Refer to Tech Docs for a complete list of new Aisle 7 (CAM) content.

Decision Point Updates

We continually monitor changes in medicine to ensure our topics are accurate and up-to-date. In the following documents, we made medically significant revisions, added new medical information, or removed outdated medical information. While medically significant changes are listed here, documents that have minor revisions, such as editorial or consistency changes, are not listed.

Health and Disease Topic Updates

We continually monitor changes in medicine to ensure our topics are accurate and up-to-date. In the following documents, we made medically significant revisions, added new medical information, or removed outdated medical information. While medically significant changes are listed here, documents that have minor revisions, such as editorial or consistency changes, are not listed.

  • Acetaminophen: We removed teaspoons from the dose table. The American Academy of Pediatrics advises using only metric-based dosing to avoid dosing errors used with common kitchen spoons.
  • Acetaminophen Use in Young Children: We removed teaspoons from the dose table. The American Academy of Pediatrics advises using only metric-based dosing to avoid dosing errors used with common kitchen spoons.
  • Alopecia Areata: In "How is it treated?" we added information on anthralin, an ointment that looks and feels like tar and that may help hair grow again. We removed information on psoralen with ultraviolet A light (PUVA) therapy because of the increased risk of skin cancer and high relapse rate.
  • Cholesterol and Triglycerides Tests:
    • Results: We added a table of ideal cholesterol and triglyceride numbers for adults. We also included more information about risk screening.
  • Chronic Fatigue Syndrome: In "How is CFS diagnosed?" we added a set of diagnostic criteria.
  • Crohn's Disease:
    • What Happens: We now say that inflammatory bowel disease increases the risk of melanoma and that your doctor may recommend regular screening by a dermatologist.
  • Diabetic Retinopathy: We now include anti-VEGF medicines as a standard treatment for macular edema.
  • Hair Loss:
    • Home Treatment: We now say scalp concealers or hair thickeners such as Couvre or Toppik can give the appearance of having fuller hair until the next time the hair is washed.
    • Medications: We no longer include Psoralen with ultraviolet A light (PUVA) therapy as a treatment option because of the increased risk of skin cancer and high relapse rate.
  • Heart Attack and Unstable Angina:
    • Medications: We added angiotensin II receptor blockers (ARBs) to the list of blood pressure medicines.
  • Inflammatory Bowel Disease and Cancer Risk: We now say that inflammatory bowel disease also increases the risk of melanoma and that your doctor may recommend regular screening by a dermatologist.
  • Lung Cancer:
    • Other Treatment: We added nivolumab (Opdivo) to the list of treatments for lung cancer.
  • Quick Tips: Giving Over-the-Counter Medicines to Children: In "Giving the right amount," we removed teaspoons from dosages. The American Academy of Pediatrics advises using only metric-based dosing to avoid dosing errors used with common kitchen spoons.
  • Types of Insulin: We added information about the U-300 concentration of basal insulin.
  • Ulcerative Colitis:
    • What Happens: We now say that inflammatory bowel disease also increases the risk of melanoma and that your doctor may recommend regular screening by a dermatologist.
  • Urinary Tract Infections in Children:
    • Treatment Overview: In "Treatment if the condition gets worse or recurs," we now say that if tests show a structural problem in the urinary tract (such as vesicoureteral reflux) that increases a child's risk for recurrent UTIs, the doctor may consider preventive antibiotics.
    • Medications: In "Preventive antibiotics," we now say that preventive antibiotics may be considered if tests show a structural problem in the urinary tract. We also say that preventive treatment may last from 3 to 6 months.

In the following documents, we added edoxaban (Savaysa) as an anticoagulant medicine to treat atrial fibrillation, deep vein thrombosis, and pulmonary embolism.

For coronary artery bypass graft surgery, we now put more emphasis on what happens after surgery—that a patient may attend cardiac rehab, will take medicines, and may need to make lifestyle changes.

In the following documents, we added information about inhaled insulin.

In the following documents, we updated our citation to the 2015 U.S. Preventative Services Task Force recommendation on thyroid screening.

Illustration and Interactive Health Tool Updates

In the following documents, we made medically significant revisions, added new medical information, or removed outdated medical information. While medically significant changes are listed here, documents that have minor revisions, such as editorial or consistency changes, are not listed.

Illustration updates

Interactive health tool updates

NCI Topic Updates

Refer to Tech Docs for a complete list of updated National Cancer Institute content.

Medication Topic Updates

Medication topics from Cerner Multum, Inc. are not included in all systems. Updates may include new information and/or the addition of new drug names. Refer to Tech Docs for a complete list of updated titles.

Aisle 7 (CAM) Content Updates

Refer to Tech Docs for a complete list of updated Aisle 7 (CAM) content.

Topic Title Changes and Topic Replacements

Topic title changes

Topic replacements

We archived the following searchable topics, and we name the replacement topics below. Refer to Tech Docs for a complete list of archived documents.

Drug details

Over the past few quarters, Healthwise has been archiving its drug details. This process is now complete, and drug details are no longer linked to Knowledgebase topics. This was done as part of a policy change on drug content. Healthwise will continue to provide hundreds of other pieces of drug content in the Knowledgebase and, for those clients who license Multum, nearly 2,000 pieces on specific medications.

In addition, we have created 23 new pieces of drug content for those drugs tied to quality measures issued by organizations such as NCQA, the Joint Commission, and the Centers for Medicare and Medicaid Services. These pieces will be linked in the Knowledgebase for Version 10.6. We are also working on adding new content that provides a behavioral approach to medication adherence.

Please refer to Tech Docs for a complete list of drug details that were archived this quarter.

Medical Guideline Review

To ensure the medical accuracy and consistency of Healthwise consumer health content, our medical content specialists, physicians, and librarians regularly review medical guidelines and association statements, gold-standard journals, news, and evidence-based publications and databases.

The medical guidelines listed below are examples of updated guidelines we reviewed for this release.

  • American Academy of Allergy, Asthma and Immunology (2014). Food allergy: A practice parameter update.
  • American Diabetes Association and European Association for the Study of Diabetes (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach.
  • American Heart Association (2015). Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association.
  • American Heart Association, American College of Cardiology, and American Society of Hypertension (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension.
  • Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (2012). Chronic fatigue syndrome/myalgic encephalomyelitis: A primer for clinical practitioners.
  • BMJ Clinical Evidence (2014). Systematic review: Hallux valgus (bunions).
  • European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group (2015). Insulin pump risks and benefits: A clinical appraisal of pump safety standards, adverse event reporting, and research needs.
  • Pediatrics (2014). Committee on Injury, Violence, and Poison Prevention (2011, reaffirmed 2014). Policy statement: Child passenger safety.
  • Pediatrics (2014). Task Force on Sudden Infant Death Syndrome (2011, reaffirmed 2014). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment.
  • U.S. Preventive Services Task Force (2014). Healthy diet and physical activity: Counseling adults with high risk of CVD.

What's Next

New topics

The following topics are a sample of the topics that are being developed. They are expected to release within the next six months.

  • Antithyroid Antibody Tests
  • Caregiving for an Adult With Diabetes
  • Weight-Loss Medicines