User:AF1414/sandbox

Welcome to your sandbox!
This is place to practice clicking the "edit" button and practice adding references (via the citation button). Please see Help:My_sandbox or contact User_talk:JenOttawa with any questions.

Link: Project Homepage and Resources


 * 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

Hereditary nonpolyposis colorectal cancer.

Assignment #2
Student: Alexa Fine

Topic to research: MMR protein immunohistochemistry (IHC) testing in the screening of Lynch syndrome, and more specifically, whether this test should be universal or age-based.

Search Strategy:

-       To identify reliable secondary sources (e.g., literature reviews, systematic reviews, medical guidelines, or position statements) that discuss the topic of interest.

-       PubMed search using the terms “lynch syndrome immunohistochemistry screening”

o   MeSH Terms: colorectal neoplasms, hereditary nonpolyposis; immunohistochemistry; mass screening; early detection of cancer

o   Subheading: diagnosis

Potential sources identified and considered:

-      Snowsill, T., Coelho, H., Huxley, N., Jones-Hughes, T., Briscoe, S., Frayling, I. M., & Hyde, C. (2017). Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation.

-      Mvundura, M., Grosse, S. D., Hampel, H., & Palomaki, G. E. (2010). The cost-effectiveness of genetic testing strategies for Lynch syndrome among newly diagnosed patients with colorectal cancer. Genetics in Medicine, 12(2), 93.

-      Pai, R. K., & Pai, R. K. (2016). A practical approach to the evaluation of gastrointestinal tract carcinomas for Lynch syndrome. The American journal of surgical pathology, 40(4), e17-e34.

Reason for selecting source:

-       Snowsill et al. (2017) was selected, as it is a recent systematic review of Lynch Syndrome published in a reputable journal and indexed in MEDLINE.

-       Chapter 6 provides a detailed description of factors relevant to the implementation of IHC screening tools, including:

o   Current status of IHC implementation.

o   A summary of screening recommendations from professional organizations.

o   Potential barriers of implementation of universal screening.

Three reasons why the source that was selected meets MEDRS criteria:

-       The article summarizes a broad range of scientific evidence, providing a neutral point of view.

-       The evidence quality is high (i.e., it is a systematic review).

-       Up to date evidence, published within the last five years.

How I plan to use the source for improving the article:

-      Currently there is no information in the Wikipedia article regarding IHC screening or universal versus age-based testing.

-      I plan to use this source to write 1-2 sentences about the current state of the literature on this topic including significance, implications and barriers that must be considered.

Proposed Changes: Addition of sentences in the ‘Diagnosis’ section
Revised proposed changes: "Two methods of implementation of IHC testing includes age-based testing and universal testing for all individuals. Currently, there is no widespread agreement regarding which screening method should be used. Age-based testing for IHC has been suggested in part due to cost-benefit analyses, whereas universal testing for all individuals with colorectal cancer ensures individuals with Lynch Syndrome are not missed. "

Original proposed changes: Two methods of implementation of IHC testing includes age-based testing and universal testing for all individuals with colorectal cancer. Currently, there is no widespread agreement regarding which screening method should be used. Age-based testing for IHC has been suggested in part due to cost-benefit analyses and a higher pre-test probability of Lynch Syndrome in older individuals, whereas universal testing for all individuals with colorectal cancer can increase detection of Lynch Syndrome in families and individuals.

- I like how you are not taking one side vs. the other in the debate of age-based vs. universal. - The first time using IHC, I would use immunohistochemistry (IHC) unless this abbreviation has been used previously in the article. - We may not want to specify 'colorectal cancer' in sentence #1 as sometimes the first tumour testing is endometrial cancer - Sentence 2 is great and totally true! - Sentence 3 - the first part is true, just not sure about the 'higher pre-test probability in older individuals'. Are you sure it's not higher pre-test in younger individuals? Grnnbearit (talk) 01:53, 21 November 2019 (UTC)Grnnbearit

Rationale for proposed change
-      There is currently no mention of age-based versus universal IHC testing in the Wikipedia article. The proposed sentences inform the reader about this topic and highlights the lack of consensus on the preferred method of testing.

-      Controversy or varied opinions:

o  There is no universal consensus regarding the method of IHC screening. Proponents of age-based testing support the need to balance benefit of the test versus cost. Universal screening may prove to be cost-effective in the long-term in terms of life-years saved.

o  However, the proposed sentences are not expected to cause controversy because they do not support one method of testing over another.

Critique of Source
-      Strengths:

o  The authors have transparent research methods. There is a chapter outlining the strategy for identifying, reviewing and evaluating studies. The authors also include the inclusion and exclusion criteria, data abstraction and critical appraisal strategies, and methods of data synthesis. Additionally, excluded studies are included in the appendix with the associated rationale for exclusion. This information allows future reviews to reproduce the study methods and method of article selection.

o  Many of the results are shown in tables and figures, which aids the reader in interpreting and visualizing the evidence.

-      Limitations:

o  Only ten studies are included in the analysis, which are clinically and methodologically heterogeneous.

o  The degree of publication bias is unknown, and the authors reported there was an insufficient amount of data to perform a statistical analysis to determine this.

o  This study was published in 2017, with data analysis taking place in 2016, thus there may be new data that may be more relevant or not align with the findings.

o  The authors did not search the grey literature, including unpublished studies or studies in a language other than English.

I really like the source that you chose. The document/paper was put out by the NHS in the UK and is quite thorough. Maybe one day I'll have time to look through all 280 pages! This reference could probably be used for a number of statements actually as they addressed a number of issues. The limitations that you state are good ones though.Grnnbearit (talk) 02:10, 21 November 2019 (UTC)Grnnbearit

Citation
Snowsill, T., Coelho, H., Huxley, N., Jones-Hughes, T., Briscoe, S., Frayling, I. M., & Hyde, C. (2017). Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation.

This reference isn't complete...should include the journal etc I believe (unless I'm missing something regarding criteria for Wiki). But take a look at that and check into wiki citation criteria. Health Technol Assess. 2017 Sep;21(51):1-238.Grnnbearit (talk) 02:10, 21 November 2019 (UTC)Grnnbearit