User:Nivyp/sandbox

Assignment #2

1) How did I search for the source?

The topic I was interested in finding more information about the symptoms used to diagnose alpha-thalassemia. Initially, I searched Pubmed using the MESH database. I used the MESH term “alpha-thalassemia” and added the MESH subheading “diagnosis.” I then added filters by language of “English”, publication date of “5 years”, and article type including “guideline, meta-analysis, practice guideline, review, and systematic review.”

2) Which other sources were considered?

Origa, R., & Moi, P. (2016). Alpha-thalassemia. In GeneReviews®[Internet]. University of Washington, Seattle.

Piel, F. B., & Weatherall, D. J. (2014). The α-thalassemias. New England Journal of Medicine, 371(20), 1908-1916.

3) Why was the source chosen?

The source I chose was: Viprakasit, V., & Ekwattanakit, S. (2018). Clinical classification, screening and diagnosis for thalassemia. Hematology/Oncology Clinics, 32(2), 193-211. This source was chosen because it is the most recent article I could find, as it was published in 2018. It was also published in a journal specific to blood disorders, This article was more recent, published in 2018 and was published in journal specific to blood disorders (Hematology/Oncology Clinics of North America). This article covered information that was relevant to my chosen topic on the characteristics used to diagnose alpha-thalassemia, and it went to detail regarding particular clinical characteristics I was looking for, such as frontal bossing.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria?

Firstly, the source selected was published last year so it meets the MEDRS criteria of being updated within the last 5 years. Secondly, it is a literature review and therefore a secondary source. Lastly, it was published in a reputable medical journal (Hematology/Oncology Clinics of North America.)

5) How do I plan on using this source for improving the article?

I plan on using this source to add more information to the “Symptoms” section of the Wikipedia article. Specifically, I plan to add more clinical characteristics associated with alpha-thalassemia, as well as a short explanation for why each symptom may occur. For example, currently, in the article it states “pronounced forehead” as a sign/symptom of alpha-thalassemia. Using this source, I would like to add information about why this occurs (frontal bossing due to the expansion of bone marrow because of increased hematopoiesis).

Assignment #3

Proposed Changes:

We would like to change the signs and symptoms section in terms of its organization. Specifically, we would like to divide them into two sections, "Common" and "Uncommon."

Signs and symptoms of alpha-thalassemia

Common	Uncommon
Anemia: People with alpha-thalassemia can experience both a decrease in the production of red blood cells (RBC) and an increase in the destruction of RBCs which can result in other symptoms such as fatigue and dizziness. Enlarged spleen Gallstones Delayed growth	Jaundice Pronounced forehead: This occurs due to the expansion of the bone marrow in the frontal bone in the skull. The bone marrow expands because more blood cells are being produced in order to compensate for the anemia. Extramedullary hematopoesis (blood formation outside of the bone marrow) Hypertension (in pregnancy)

LW Comments: I like the table format, but it is a little confusing with the Common and Uncommon signs and symptoms side by side like this. Usually with a table like this you relate whatever is in the left column to its corresponding right column. Two ways to make this more clear would be to either get rid of the grid lines in the table proper, or to put uncommon signs and symptoms in the row below common signs and symptoms (we can talk more about this during the session on Nov 25).

Good use of language and wiki-links. Your explanations are good for the pronounced forehead and extramedullary hematopoiesis.

The sentence I will be adding is an explanation for why a pronounced forehead can occur in alpha-thalassemia. I have italicized it above, and included it here: "This occurs due to overexpansion of bone marrow of the frontal bone in the skull. The bone marrow expands because more blood cells are being produced in order to compensate for the anemia."

LW Comment: I might change this to "This occurs due to expansion of the bone marrow in the frontal bone in the skull..."

I have hyper-linked the relevant Wikipedia articles to technical and medical terms not yet introduced in the article. I also avoided the use of the word “patient" in order to utilize "people-first" language.

Rationale for proposed change:

The rationale for adding an explanation for "pronounced forehead" is because it is not very obvious why a pronounced forehead would occur in alpha-thalassemia. People from the general population most likely will not understand the reasoning behind it, and upon reading it may feel confused as it to why this could occur. The source I utilized to find an explanation for why pronounced forehead occurs is article on Alpha-thalassaemia from BMJ Best Practice. I chose this source because it provided a comprehensive list of the signs and symptoms associated with alpha-thalassemia and also provided explanations for why they occur and how common/uncommon each one is. This source was updated in August 2019, making it recent, and it is published in a reputable source (BMJ Best Practice).

LW Comment: Good rationale and source!

It is unlikely that there will be any controversy or varied opinion about my planned change, as I am not removing "pronounced forehead" from the article, just adding an explanation for readers on why it occurs. My explanation is supported by BMJ Best Practice, which is a reputable scientific source with low bias, because the guidelines are reviewed and approved by multiple experts in the field before publication.

Critique of Source:

BMJ Best Practice is a reputable source that is widely respected and used by clinicians worldwide for up-to-date medical knowledge and guidelines. The article I am referencing was recently updated in August 2019. It is unlikely that the guidelines I am referencing are biased because they are reviewed and edited by multiple experts in the field of thalassemia before published as a guideline. I looked at the list of contributors to see if any of the authors had a conflict of interest. The main contributor, Dr. Kwiatkowski, is the Director of the Thalassemia Program at the Children’s Hospital of Philadelphia and a Professor of Pediatrics at the Perelman School of Medicine, which indicates she is an expert in her field and a reputable source of information. However, she has also disclosed her participation in research trials of iron chelation sponsored by Novartis and ApoPharma, and has consulted for Ionis Pharmaceuticals, bluebird bio, Agios, and Celgene. From my reading of the guidelines, I did not see any conflict of interest or bias as a result of this participation, but is definitely something to consider and could have potentially influenced her writing. The peer reviewers of the guideline (Drs. Chui, Giordano, Harteveld) did not have any disclosures or competing interests other than Dr. Chui, who is an author of a number of references cited in this topic and has research grants or salary from the US National Institutes of Health greater than 6 figures USD. Self-citation of Dr. Chui's own work could be a potential source of bias depending on the quality and the content of the articles that were cited but after examination, his articles do not reflect any overt bias and were all published in reputable journals (i.e. American Society of Hematology, British Journal of Haematology). BMJ also uses the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system, which is a framework for developing and presenting summaries of evidence of high-quality. The GRADE framework is a systematic approach for clinical guidelines and is the most widely adopted tool for grading the quality of evidence and making recommendations worldwide. By using the GRADE framework, BMJ is able to critically appraise the articles they include, rate the quality of evidence, and ultimately create a reproducible and transparent framework for evaluating the potential bias and level of quality in their guidelines. This limits the possible level of bias in their guidelines and increases their reputability as a source. The types of articles used to develop the guidelines can also contribute to the quality of the guidelines. For example, there are a few retrospective cohort studies included in the references. Drawing upon information from systematic reviews would provide a higher level of evidence quality, compared to using other types of articles like retrospective cohort studies or case reports.

LW Comments: Good! Excellent critique and you bring up several very appropriate points. Just watch some of your grammar.