User:18ss192/sandbox

Comments on assignment 3:

Some minor wording changes:

If clinical examination findings are not typical of AK and the possibility of in situ or invasive squamous cell carcinoma (SCC) cannot be excluded based on clinical examination alone, a biopsy or excision can be considered for definitive diagnosis by histologic examination of the lesional tissue”

I think each physician have his/her own threshold to request tissue diagnosis (histology/pathology) based on experience, resource availability, and the specific clinical scenario for each individual patient, and I agree that it is not always required in clinical practice.

You did a great job pointing out the potential bias from the chosen source. Can you please also comment on whether other credible and independent source agreed on the opinion from BMJ?

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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 =

Assignment 2:
With our tutor, we discussed the role histology plays in classifying AK and identified an incorrect sentence within the article. Currently, the fourth paragraph in the introduction states that AK “can be confirmed by looking at cells from the lesion under a microscope in a biopsy procedure.” This statement is misleading and does not clearly distinguish between cytology (the study of cells) and histology.

Chosen Reference:

Actinic keratosis - Symptoms, diagnosis and treatment | BMJ Best Practice. (2019). Retrieved from https://bestpractice.bmj.com/topics/en-gb/616. Date retrieved November 6.


 * 1) Search Strategy

The above reference was found by accessing the “TRIP Medical Database” and searching “(Actinic Keratosis) AND (diagnosis)”. The search results were then filtered by selecting for secondary evidence only and ordering by “quality.”


 * 1) Potential Sources

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

Heppt, Markus V., et al.. "Epithelial Precancerous Lesions." Fitzpatrick's Dermatology, 9e Eds. Sewon Kang, et al. New York, NY: McGraw-Hill,, http://accessmedicine.mhmedical.com.proxy.queensu.ca/content.aspx?bookid=2570&sectionid=210434201.


 * 1) Why the source was chosen

BMJ Best Practice is a trusted resource that provides healthcare professionals and students with the ability to research certain symptoms and differential diagnoses very quickly. Although the above two resources are also comprehensive in their review of AK, I believe the article in BMJ Best Practice takes a more organized approach and covers the same information in more easily understood terms. As BMJ Best Practice is a tool created for healthcare professionals, I believe my chosen article also does a better job in framing AK in a realistic, clinical perspective, more so than resources such as Fitzpatrick’s Dermatology textbook.


 * 1) Three reasons why selected source meets MEDRS criteria


 * 1) Up to date and in line with current AK diagnosis as the article was last edited in 2018 and last reviewed October 2019.
 * 2) It is a peer-reviewed secondary source written by experts in their field.
 * 3) It provides unbiased information; frames interventions, symptoms, etc. in neutral language.


 * 1) Plan on using source to improve the article

Under the guidance of our tutor, we agreed that AK is confirmed by looking at tissue rather than cells alone, as the study of cells refers to cytology and does not provide information on significant tissue architecture. We would move forward by editing the incorrect statement to specify the critical role of histology in diagnosing AK through biopsy.

Assignment 3
1. Proposed Changes:

I propose editing the following sentence: “ [AK] Diagnosis is suspected clinically on physical exam by a physician or other health care provider, but can be confirmed by looking at cells from the lesion under a microscope in a biopsy procedure.”

I propose the following sentence change: "If clinical examination findings are not typical of AK and there is suspicion of progression to squamous cell carcinoma (SCC), tissue is examined through a skin biopsy. ”

2. Rationale for Proposed Change:

Currently, the existing statement is misleading and does not clearly distinguish between cytology (the study of cells) and histology. It also suggests that clinical examination alone is not enough to diagnose AK and that biopsy is required. This is incorrect. The proposed change 1) emphasizes the use of histology (i.e. investigation of tissue architecture) in skin biopsies over the study of cells and 2) provides a more accurate context as to when a skin biopsy may be used for diagnosis.

3. Controversy/Varied Opinion:

No possible controversy or ambiguity. AK is confirmed by looking at tissue rather than cells alone, as the study of cells refers to cytology and does not provide information on significant tissue architecture. Biopsy is not always necessary for diagnosis.

4. Critique of Source:


 * BMJ does not cover all possible diagnosis methods, treatments, follow up, drugs, or any contraindications or side effects.
 * BMJ provides only generalized information, with no focus on development or treatment for specific populations or regions.
 * Sources used by BMJ may be susceptible to bias or written by authors with conflicts of interest (e.g. drug research that is supported and/or funded by pharmaceutical companies).
 * Authors of BMJ articles, specifically, may also have competing interests that are a) not disclosed or b) disclosed, but very vaguely.
 * References used to create article may also be susceptible to publication bias, when the outcome of a research study influences the decision whether to publish or otherwise distribute it.
 * As BMJ provides systematically developed statements to support providers and patient decisions, may inadvertently cause "cookbook medicine" where physicians are blindly following recommendations without a) necessary critical appraisal or b) framing information in the context of their specific patient.
 * No inclusion of non-physician experts/patient representatives in creation nor review of AK article.
 * Financial conflicts of interest where there may be a direct monetary benefit to author(s) either from industry or from recommendations (increased referrals or procedures).