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Comments for assignment 3:

I agree that a well written and respected textbook such as Fitzpatrick is an excellent source of information. However, I think it is not complete free of potential bias. One of the goals of this assignment is to ask you guys to think about the potential bias with each resource. I hope you can comment on this a little bit more. One thought would be that the authors are likely dermatologists practicing in tertiary care centres rather than primary care physicians or community dermatologists who will also see a large number of patients with AK. Can you find any practice guidelines for general dermatologists or family physicians that also comment on this topic?

Some wording changes to consider (feel free to change it, I mostly tired to remove the word "patient" as Wikipedia wants to avoid using this word)

People with compromised immune system from medical conditions (such as AIDS) or immunosuppressive therapy (such as chronic immunosuppression after organ transplantation, or chemotherapy for cancer) are at increased risk for developing AKs. (source) They may develop AK at an earlier age or have an increased number of AK lesions compared to immunocompetent people. (source, I assume this is also from Fitzpatrick)

In response to your suggestions (I used the suggested text above as my edit) and also found a clinical practice guideline to cite as well as Fitzpatrick's. Although the practice guideline was from Australia I still believe the information presented within on the risk factors for AK development are accurate and trustworthy despite the practice guideline being from another country and slightly outdated (published in 2008)

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= Actinic Keratosis. =

Assignment 2
Scott Gunn

One of the agreed upon changes was to update the subsection on immunosuppression under “other risk factors”. The immunosuppression section does not have a medical citation supporting it and is listed as “needs medical citation”. The one sentence under that section could also be expanded to include information about timing of AK development when a patient is on immunosuppressives.

Dermatology textbook:

Kang, Sewon et al. Fitzpatrick's Dermatology In General Medicine, 9E. Mcgraw-Hill Education LLC, 2012.

Search strategy
Began search in pubmed with the following search strategy:

“keratosis, actinic” [MeSH Terms] AND “immunosuppression” [MeSH Terms] OR “immune tolerance” [MeSH Terms] AND Review [ptyp]

I also searched the Cochrane Library for any Cochrane Reviews surrounding the etiology or development of actinic keratoses, and finally I used AccessMedicine to find Dermatology textbooks and searched for the section on etiology/risk factors for the development of actinic keratosis.

Potential resources identified and considered
Werner, R.N. et al. "The Natural History Of Actinic Keratosis: A Systematic Review". British Journal Of Dermatology, vol 169, no. 3, 2013, pp. 502-518. Wiley, doi:10.1111/bjd.12420. Accessed 5 Nov 2019.

Gupta, Aditya K et al. "Interventions For Actinic Keratoses". Cochrane Database Of Systematic Reviews, 2012. Wiley, doi:10.1002/14651858.cd004415.pub2. Accessed 5 Nov 2019.

Why the source was chosen
I chose to use Fitzpatrick’s Dermatology as it is a trusted secondary source in the dermatology field. Moreover, while both the systematic review (Werner et al.) and Cochrane Review (Gupta et al.) are reliable sources of evidence, they did not include as much detail about how immunosuppression affects risk of developing actinic keratoses.

Three reasons the source meets MEDRS criteria
This source satisfies the Wikipedia criteria because it is a recently published medical textbook (published in 2012, within the suggested 5-7 year range), is published by an academic independent third party (McGraw-Hill Education), and as a medical textbook it is considered a reliable secondary source.

How the source will be used to improve the article
I plan to use this source to update the “risk factors” subheading which needs a reliable medical citation and could include more information about the risk of developing actinic keratoses while immunosuppressed (i.e. development of AKs occurs sooner in individuals on immunosuppressive medication).

Proposed Changes
Under "Other risk factors" subheading:

Immunosuppression: People who take immunosuppressive drugs, such as organ transplant patients, or patients with AIDS or undergoing chemotherapy are at increased risk for developing AKs.[medical citation needed]

I plan to update the reference as there is currently no medical reference supporting the immunosuppression statement. I will use Fitzpatrick's Dermatology as the medical source to support this statement and add the following phrase to the end of the sentence:

"...for developing AKs, meaning they tend to develop more AKs and begin developing them earlier in life"

Rationale for changes
The immunosuppression statement had no medical reference despite medical knowledge surrounding immunosuppressives and increased risk of developing AKs. The statement could also include more information about the risk of developing actinic keratoses while immunosuppressed since this is not addressed at all.

There is no real controversy or disagreement in the field about the effects of immunosuppression on AK development.

Critique of Source
Fitzpatrick's Dermatology is a well trusted secondary resource published by an academic publishing company which minimizes concerns of bias, however because it is a textbook it does not undergo the same peer review processes as a systematic review or meta-analysis would which leaves room for improvement in the strength of support of this citation. Furthermore, medical knowledge advances at a fast pace meaning even the most recent editions of medical textbooks may be outdated as they can easily be more than 5 years old as is the case with the 9th edition of Fitzpatrick's Dermatology. That being said, the contributors and editors of the textbook are all experts in their respective sub-fields of dermatology and are expected to collect the most recent findings and guidelines to compile them in the textbook along with the scientific background and explanations behind them. With all of this in mind, I am fairly confident that the information I plan to use is of high quality and unbiased.