User:14ar9/sandbox

Comment on assignment 3

Well written, some minor wording changes:

"While topical 5-FU is a widely used and cost effective treatment for AKs and is generally well-tolerated, its potential side-effects can include: pain, crusting, redness, and local swelling . These adverse effects can be mitigated or minimized by reducing the frequency of application or taking breaks between uses." (We can be more neutral in describing these adverse effects. The word "substantial" may alert some lay audience. 5-FU is generally very well tolerated and I think objectively stating the potential side-effects would allow us to convey the message adequately.)

I think you did a very good job discussing the potential bias from the clinical practice guideline from a very selected group of specialists. You are absolutely right that consultant dermatologists can practice in a very different setting and likely have very different levels of support compared to family physicians or nurse practitioners. Did you come across any consensus recommendations or guidelines from family physician groups or nurse practitioner groups?

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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

= Actinic Keratosis = Alison Ross

Assignment 1
Done.

Assignment 2
In our initial group meeting, we noticed that while our article does a good job detailing the various management strategies for actinic keratosis (AK), there was a general lack of discussion of potential side effects. After meeting with our tutor, Dr. Ren, we felt that this was an area where we could improve the article, in the purview that lay people likely consult Wikipedia whilst debating potential treatment options. While the article does list adverse reactions for some of the medical treatment options, there is no mention of such for fluorouracil cream, one of the most common medications for AK. Therefore, we decided to focus our additions to this specific sub-section. The reference I chose was…

Berker, D., McGregor, J., Mohd Mustapa, M., Exton, L. & Hughes, B. (2017), British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. Br J Dermatol, 176: 20-43. doi:10.1111/bjd.15107

1) Search strategy:

The above reference was found by accessing the “TRIP Medical Database” and searching “(Topical fluorouracil) AND (Actinic Keratosis)”. The search results were then refined by selecting only “Secondary Evidence” (including Systematic Review, Evidence-based Synopses and Guidelines) and filtering by “quality”. I chose this database because it is open-access and easily filters results based on the hierarchy of evidence.

2) Potential sources identified and considered:

Using the search strategy described above, many sources of evidence were identified. Two other sources that I considered were:

Berman, B., & Sadegh, A. (2018). Actinic keratosis. Retrieved from https://bestpractice.bmj.com/topics/en-gb/616.

Lindblad, A. J., & Bhayat, Q. (2018). Actinic Keratosis: Out Damned Spot! Alberta College of Family Physicians (ACFP): Tools for Practice. Retrieved from https://gomainpro.ca/wp-content/uploads/tools-for-practice/1517006089_tfp204actinickeratosesfv.pdf

3) Why the source was chosen:

The reason this source was chosen over the other options listed above was because it was more focused on the treatment options for actinic keratosis, rather than the disease as a whole. Because of this, it contained more in depth discussion of the specific pros and cons of the various treatment options for AK, including fluorouracil cream.

4) Three reasons why the source meets the MEDRS criteria:

Some of the reasons this source meets the MEDRS criteria include: (1) it was published in a peer-reviewed medical journal (the British Journal of Dermatology), (2) it is a guideline formulated by a major medical body, and (3) it is very recent and up-to-date (published in 2018).

5) How the source will be used to improve the article:

The source will be used for adding information regarding the side effects of medical treatments of AK. Specifically, we hope to use this article to add a sentence about the potential adverse reactions of fluorouracil cream, since this is not yet discussed within the article.

#1: Proposed Changes
''The planned 1-2 sentences are clear, written in simple language, free of jargon and understandable to a 12-year-old (grade 8). Technical and medical terms are wiki-linked if they have not yet appeared in the article. "People-first" language is used and the word "patient" is avoided (i.e. "People with diabetes" rather than "diabetics"). 2 marks.''

I propose adding the following sentence to the section on medication, specifically in the subheading pertaining to topical Fluorouracil (5-FU) cream:

"While topical 5-FU is a widely used and low-cost treatment for AKs, it can cause substantial side-effects, specifically: soreness, crusting, redness and local swelling . These can be minimized by reducing the frequency of application or taking breaks between uses."

#2. Rationale for Proposed Changes:
''Each of the new sentences proposed for the article has been justified by the student. This justification includes why the change is necessary, where the information came from and why the content they are adding or replacing is inadequate. 3 marks.''

I have chosen to add these two sentences to the article in order to create a more balanced discussion of possible treatment options for people with actinic keratosis. Specifically, I believe it is important to add information to the article about possible adverse reactions of different treatments so that patients can understand that all treatments come with specific pros and cons. Moreover, I felt that while the article does touch on side effects for some of the other treatments, there is no mention of side effects of 5-FU cream. This is not ideal because it unfairly portrays 5-FU as the only treatment option without drawbacks, creating bias within the article. For these reasons, I felt that this was a key area of improvement for the article, in order equip the reader with a less biased perspective on treatment options and to facilitate more informed discussion between patients and their healthcare providers.

#3. Controversy or Varied Opinions:
''The student has shown areas of ambiguity or controversy for the proposed change and the position taken has been clearly justified. 2 marks.''

I attempted to add in information about potential side effects of 5-FU in a non-biased way. Specifically, I wanted to underline for the reader that 5-FU cream does come with a risk of adverse reactions, as do all the topical therapy options for AK. However, I did not want to detract too significantly from the fact that 5-FU is still one of the most commonly used medications for the treatment of AK, and for good reason. For example, within the clinical practice guideline from which I drew the information, 5-FU is graded with A in terms of "strength of recommendation" and 1++ in terms of "level of evidence", suggesting it is a solid option for treating AK. It is for this reason that I decided to include an additional few words on how widely used it is as a treatment option, as well as ways to minimize negative side effects. I feel that taken together, this serves to provide a more holistic picture of the pros and cons of 5-FU as a topical treatment.

#4. Critique of Source:
''The student has identified any validity issues or potential bias within the secondary source they have chosen to support their proposed change. The student's written content demonstrates an understanding of the strengths and weaknesses of the evidence they have identified. The student can speculate on potential bias of their source and whether (and how) that might have affected their extracted information. 3 marks.''

The secondary source I chose was a clinical practice guideline published by the British Association of Dermatologists. This is generally quite good, since these types of publications are considered to be at the very top of the hierarchy of evidence-based medicine. Some strengths of this particular clinical practice guideline include the use of GRADE methodology (quantification of the quality of evidence and strength of recommendation) for the various treatment options described within, the dermatological expertise of the authors involved, the consultation with many different stakeholders as reviewers, and the lack of financial conflicts of interest.

However, as we learned in class, even rigorous sources of evidence (such as clinical practice guidelines) are not necessarily free from bias. For example, one major weakness of this publication is the lack of diversity amongst the authors. The guideline was published by the "Guideline Development Group" (GDG), which consisted solely of consultant dermatologists. While the GDG did attempt to consult with a variety of stakeholders and reviewers (including nursing groups, general practitioners and patient advocacy groups), their recommendations were only "actively considered", which doesn't necessarily remove the problems associated with limited panel composition. This is exemplified by the fact that in the MEDSR criteria for wikipedia lists clinical practice guidelines published by specific professional societies as weaker sources of evidence compared to those published by international or even national bodies. Another weakness in the article is English Language Bias, since the authors only searched for and considered articles published in the English language.

While both of these factors represent weaknesses of the publication, I do not believe that they pose a significant threat to the overall validity of this reference.