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Website Review: Review of Patient-Oriented Websites on Diverticular Disease
Gastroenterology 2015;149:256–259
PRINT AND DIGITAL MEDIA REVIEWS Joel H. Rubenstein, Section Editor Website Review: Review of Patient-Oriented Websites on Diverticular Disease The majority of individuals in Western countries will develop asymptomatic diverticulosis as they age. Diverticular disease, including diverticulitis and diverticular bleeding, affects a small minority of individuals with diverticulosis. Nonetheless, diverticular complications are among the most common gastrointestinal indications for hospitalization in the United States. Patients often have questions regarding diverticulosis and diverticular disease, and the medical literature in this area is evolving rapidly. Patient-oriented websites can be a valuable source of information. Four popular online health information websites (Medicinenet.com, NIDDK.nih.gov, Patient.co.uk and emedicinehealth.com) were reviewed and compared for important qualities such as accuracy, breadth of content, and readability.
MedicineNet (www.medicinenet.com/ diverticulosis/article.htm) MedicineNet is a physician authored, patient-oriented, interactive website owned by WebMD. The diverticular disease section is written by a gastroenterologist. The main webpage is framed around 11 pertinent questions covering etiology, symptoms, diagnosis, complications, treatment, and prevention. These sections provide well-informed overviews of theories of pathogenesis and diverticular complications. However, the sections on diagnosis, treatment, and prevention are more limited and outdated. For example, barium enema is emphasized as a diagnostic test for diverticulosis. In addition, uncomplicated diverticulitis is not distinguished clearly from functional symptoms associated with diverticulosis. The website’s format is extremely busy, with multiple animated advertisements and unrelated links, and the
language level is fairly advanced. However, there is a printable format that is much easier to read, and the site includes useful graphics and a short, illustrated slideshow.
NIDDK (www.niddk.nih.gov/healthinformation/health-topics/digestivediseases/diverticular-disease/) This website is sponsored by the National Institutes of Diabetes and Digestive and Kidney Diseases, and is the only website reviewed that did not contain advertisements. Patient-oriented information is available in detailed, summary, and Spanish versions. The summary version provides basic information that would be useful for patients with limited medical knowledge or for those whose primary language is not English. The comprehensive version includes a more in-depth and technical discussion of etiology, symptoms, diagnosis, complications, treatment, and dietary fiber. This was the best referenced website with the most accurate and up-to-date medical information. It is also the only website reviewed by an expert in the field. Nonetheless, it has not been updated for several years, and the use of the term “diverticular disease” in place of diverticulitis and diverticular bleeding can be confusing. The website’s layout is uncomplicated and includes very basic, black and white graphics and a printable PDF.
Patient.co.uk (www.patient.co.uk/health/ diverticula-including-diverticulosisdiverticular-disease-and-diverticulitis) This is a British website written and edited by UK physicians. A general practitioner and a dietitian are the primary authors of the diverticular disease content. There are 7 main sections, including information on background, etiology,
REVIEWER RATING MedicineNet
NIDDK (detailed version)
Patient.co.uk
eMedicineHealth
Symptom description
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Differential diagnosis
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Testing/diagnosis
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Treatment
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Complications
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Citations of supporting references
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Image quality
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Ease of navigation
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Stars: «: poor; ««: adequate; «««: fair; ««««: good; «««««: excellent.
July 2015
symptoms, complications, and treatment as well as practical information on dietary fiber. The content is thorough, accurate, and presented clearly and simply using British English and medication names. However, several recent developments are not accounted for, including the debate over the association between fiber and diverticulosis. In addition, the diagnosis and treatment sections, aside from dietary recommendations, are brief. The site includes 1 simple but illustrative graphic, and the text can be printed, downloaded as a PDF, and translated into 91 different languages. Although the website contains advertisements, these are much less intrusive than the WebMD-affiliated sites.
Print and Digital Media Reviews
257
Practical Algorithms in Pediatric Gastroenterology. Ron Shaoul, editor. 110 pp. $58.00. Basel, Switzerland, Karger, 2014. ISBN: 978-3-31802509-5. Web address for ordering: www.karger.com. REVIEWER RATING Coverage of relevant topics
«««««
Improvement over previously available media
««««
eMedicineHealth (www. emedicinehealth.com/diverticulosis_ and_diverticulitis/article_em.htm)
Style of presentation and formatting
«««««
Like MedicineNet, eMedicineHealth is also a tributary of WebMD. This website’s format is very similar to the MedicineNet website with overlapping contributors, sidebars, and graphics. The content is presented in 2 intermixed sections written by separate nongastroenterologist physicians. The main page leads readers through a series of topics including etiology, symptoms, diagnosis, when to seek care, treatment, surgery, diet, prevention, and prognosis. This section tends to mix content regarding diverticulitis, diverticulosis, and diverticular bleeding. A separate topic overview summarizes the etiology, diagnosis, and treatment of diverticulitis, and provides a series of well-organized links to more in-depth material. Overall, the information contained on this website is comprehensive and accurate, although somewhat dated, particularly with respect to surgical recommendations. This website’s format has similar pitfalls to the medicine.net site, in that it contains numerous distracting advertisements, and unrelated photos and animations. In addition, the merged content sections can be difficult to navigate. Bottom Line: All 4 websites have different strengths and generally provide accurate and comprehensive information about diverticulosis and its complications. For patients desiring a more interactive experience with color illustrations, the diverticulitis topic overview and related links on the emedicinehealth website would be a good choice. The patient. co.uk site is the best resource for language translations. Overall, the NIDDK website provides the most reliable, up-todate material in a simple but clear format.
Stars:
MARGOT L. HERMAN, MD LISA L. STRATE, MD, MPH Department of Medicine Division of Gastroenterology University of Washington School of Medicine Seattle, Washington
Funding This work was supported in part by grants from the National Institutes for Diabetes, Digestive and Kidney Diseases, R01 DK084157 and R01 DK101495.
Quality of figures
N/A
Overall
«««««
«: poor; ««: adequate; «««: fair; ««««: good; «««««: excellent.
Practical Algorithms in Pediatric Gastroenterology is part of the series Practical Algorithms in Pediatrics. It contains a well-rounded presentation of algorithms covering a comprehensive list of topics relevant to the care of children and adolescents with gastrointestinal symptoms and conditions. The book is organized as a series of 51 algorithms covering topics including various gastrointestinal conditions such as acute gastroenteritis, chronic diarrhea, and gastrointestinal foreign bodies to gastroesophageal reflux and vomiting. There are a series of algorithms on various motility disorders, including achalasia, fecal incontinence, and chronic intestinal pseudo-obstruction. Other algorithms include intestinal malabsorption, gastrointestinal polyps, and inflammatory bowel diseases. There are algorithms on surgical conditions such as abdominal masses, peritonitis, and right lower quadrant pain. Liver algorithms include increased aminotransferase levels, acute hepatitis, hepatomegaly, and liver failure. There are also algorithms for acute and chronic pancreatitis. Most algorithms are contained on 1 page, with the opposite page containing enumerated footnotes that provide explanation, background, and additional details to explain various steps and recommendations contained within the corresponding algorithm. This book is written for the target audience of “general and family practitioners, pediatricians and trainees who are not exposed on a day-to-day basis to pediatric gastroenterology problems.” As a reference for this audience, the various algorithms in the book achieve this goal with varying success. Some of the algorithms are well-written, clearly organized, and well-annotated with ample instruction and contextualization for the general practitioner or pediatrician. For example, the algorithm on perianal disease contains an excellent balance of differential diagnosis and approach to medical evaluation. The same is true of the algorithms for neonatal vomiting and nausea and vomiting.
PRINT AND DIGITAL MEDIA REVIEWS Joel H. Rubenstein, Section Editor Website Review: Review of Patient-Oriented Websites on Diverticular Disease The majority of individuals in Western countries will develop asymptomatic diverticulosis as they age. Diverticular disease, including diverticulitis and diverticular bleeding, affects a small minority of individuals with diverticulosis. Nonetheless, diverticular complications are among the most common gastrointestinal indications for hospitalization in the United States. Patients often have questions regarding diverticulosis and diverticular disease, and the medical literature in this area is evolving rapidly. Patient-oriented websites can be a valuable source of information. Four popular online health information websites (Medicinenet.com, NIDDK.nih.gov, Patient.co.uk and emedicinehealth.com) were reviewed and compared for important qualities such as accuracy, breadth of content, and readability.
MedicineNet (www.medicinenet.com/ diverticulosis/article.htm) MedicineNet is a physician authored, patient-oriented, interactive website owned by WebMD. The diverticular disease section is written by a gastroenterologist. The main webpage is framed around 11 pertinent questions covering etiology, symptoms, diagnosis, complications, treatment, and prevention. These sections provide well-informed overviews of theories of pathogenesis and diverticular complications. However, the sections on diagnosis, treatment, and prevention are more limited and outdated. For example, barium enema is emphasized as a diagnostic test for diverticulosis. In addition, uncomplicated diverticulitis is not distinguished clearly from functional symptoms associated with diverticulosis. The website’s format is extremely busy, with multiple animated advertisements and unrelated links, and the
language level is fairly advanced. However, there is a printable format that is much easier to read, and the site includes useful graphics and a short, illustrated slideshow.
NIDDK (www.niddk.nih.gov/healthinformation/health-topics/digestivediseases/diverticular-disease/) This website is sponsored by the National Institutes of Diabetes and Digestive and Kidney Diseases, and is the only website reviewed that did not contain advertisements. Patient-oriented information is available in detailed, summary, and Spanish versions. The summary version provides basic information that would be useful for patients with limited medical knowledge or for those whose primary language is not English. The comprehensive version includes a more in-depth and technical discussion of etiology, symptoms, diagnosis, complications, treatment, and dietary fiber. This was the best referenced website with the most accurate and up-to-date medical information. It is also the only website reviewed by an expert in the field. Nonetheless, it has not been updated for several years, and the use of the term “diverticular disease” in place of diverticulitis and diverticular bleeding can be confusing. The website’s layout is uncomplicated and includes very basic, black and white graphics and a printable PDF.
Patient.co.uk (www.patient.co.uk/health/ diverticula-including-diverticulosisdiverticular-disease-and-diverticulitis) This is a British website written and edited by UK physicians. A general practitioner and a dietitian are the primary authors of the diverticular disease content. There are 7 main sections, including information on background, etiology,
REVIEWER RATING MedicineNet
NIDDK (detailed version)
Patient.co.uk
eMedicineHealth
Symptom description
«««
««««
««««
««««
Differential diagnosis
«
««
««
«««««
Testing/diagnosis
«««
«««««
««
««««
Treatment
«««
««««
«««
««««
Complications
««««
«««««
«««
««««
Citations of supporting references
«
««««
««
««
Image quality
««««
««
««
««««
Ease of navigation
««
««««
««««
««
Stars: «: poor; ««: adequate; «««: fair; ««««: good; «««««: excellent.
July 2015
symptoms, complications, and treatment as well as practical information on dietary fiber. The content is thorough, accurate, and presented clearly and simply using British English and medication names. However, several recent developments are not accounted for, including the debate over the association between fiber and diverticulosis. In addition, the diagnosis and treatment sections, aside from dietary recommendations, are brief. The site includes 1 simple but illustrative graphic, and the text can be printed, downloaded as a PDF, and translated into 91 different languages. Although the website contains advertisements, these are much less intrusive than the WebMD-affiliated sites.
Print and Digital Media Reviews
257
Practical Algorithms in Pediatric Gastroenterology. Ron Shaoul, editor. 110 pp. $58.00. Basel, Switzerland, Karger, 2014. ISBN: 978-3-31802509-5. Web address for ordering: www.karger.com. REVIEWER RATING Coverage of relevant topics
«««««
Improvement over previously available media
««««
eMedicineHealth (www. emedicinehealth.com/diverticulosis_ and_diverticulitis/article_em.htm)
Style of presentation and formatting
«««««
Like MedicineNet, eMedicineHealth is also a tributary of WebMD. This website’s format is very similar to the MedicineNet website with overlapping contributors, sidebars, and graphics. The content is presented in 2 intermixed sections written by separate nongastroenterologist physicians. The main page leads readers through a series of topics including etiology, symptoms, diagnosis, when to seek care, treatment, surgery, diet, prevention, and prognosis. This section tends to mix content regarding diverticulitis, diverticulosis, and diverticular bleeding. A separate topic overview summarizes the etiology, diagnosis, and treatment of diverticulitis, and provides a series of well-organized links to more in-depth material. Overall, the information contained on this website is comprehensive and accurate, although somewhat dated, particularly with respect to surgical recommendations. This website’s format has similar pitfalls to the medicine.net site, in that it contains numerous distracting advertisements, and unrelated photos and animations. In addition, the merged content sections can be difficult to navigate. Bottom Line: All 4 websites have different strengths and generally provide accurate and comprehensive information about diverticulosis and its complications. For patients desiring a more interactive experience with color illustrations, the diverticulitis topic overview and related links on the emedicinehealth website would be a good choice. The patient. co.uk site is the best resource for language translations. Overall, the NIDDK website provides the most reliable, up-todate material in a simple but clear format.
Stars:
MARGOT L. HERMAN, MD LISA L. STRATE, MD, MPH Department of Medicine Division of Gastroenterology University of Washington School of Medicine Seattle, Washington
Funding This work was supported in part by grants from the National Institutes for Diabetes, Digestive and Kidney Diseases, R01 DK084157 and R01 DK101495.
Quality of figures
N/A
Overall
«««««
«: poor; ««: adequate; «««: fair; ««««: good; «««««: excellent.
Practical Algorithms in Pediatric Gastroenterology is part of the series Practical Algorithms in Pediatrics. It contains a well-rounded presentation of algorithms covering a comprehensive list of topics relevant to the care of children and adolescents with gastrointestinal symptoms and conditions. The book is organized as a series of 51 algorithms covering topics including various gastrointestinal conditions such as acute gastroenteritis, chronic diarrhea, and gastrointestinal foreign bodies to gastroesophageal reflux and vomiting. There are a series of algorithms on various motility disorders, including achalasia, fecal incontinence, and chronic intestinal pseudo-obstruction. Other algorithms include intestinal malabsorption, gastrointestinal polyps, and inflammatory bowel diseases. There are algorithms on surgical conditions such as abdominal masses, peritonitis, and right lower quadrant pain. Liver algorithms include increased aminotransferase levels, acute hepatitis, hepatomegaly, and liver failure. There are also algorithms for acute and chronic pancreatitis. Most algorithms are contained on 1 page, with the opposite page containing enumerated footnotes that provide explanation, background, and additional details to explain various steps and recommendations contained within the corresponding algorithm. This book is written for the target audience of “general and family practitioners, pediatricians and trainees who are not exposed on a day-to-day basis to pediatric gastroenterology problems.” As a reference for this audience, the various algorithms in the book achieve this goal with varying success. Some of the algorithms are well-written, clearly organized, and well-annotated with ample instruction and contextualization for the general practitioner or pediatrician. For example, the algorithm on perianal disease contains an excellent balance of differential diagnosis and approach to medical evaluation. The same is true of the algorithms for neonatal vomiting and nausea and vomiting.