User:Aburrows077/sandbox

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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.

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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

Assignment #2
Wiki Article: Measles

Vitamin A - Adelaide BURROWS

Goal: We have identified that the topic of Vitamin A under “treatment” needs to be expanded on in a more pertinent context.

Search Strategy: I used both the Cochrane Review and PubMed databases to conduct my literature search. I searched (“Measles”) AND (“Vitamin A”) AND (“Treatment.”) I filtered my results on PubMed to include the article types: Review, Guideline, Practical Guideline and Meta Analyses. Since the majority of research involving Vitamin A treatment on measles mortality was conducted within the last decade, I filtered my results to be within the last 10 years of publication dates and only in the English language. On Cochrane Review, I filtered my results to be within the last 7 years and only in the English language.

Potential Sources Identified and Considered:

1.    '''Sudfeld CR, Navar AM, Halsey NA. Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol. 2010; 39(Suppl 1):i48–55. Available from: DOI 10.1093/ije/dyq021'''

a.    This source provides a comprehensive review of all published literature from 1960-2008 to determine the effect of Vitamin A treatment on measles mortality.

b.    Source retrieved from PubMed.

2.     '''Bester JC. Measles and measles vaccination: a review. JAMA Pediatr. 2016; 170(12): 1209-1215. Available from: DOI 10.1001/jamapediatrics.2016.1787.'''

a.    This source provides a comprehensive review of the efficacy of Vitamin A supplementation in children with measles.

b.    Source retrieved from PubMed.

3.    '''Bello S, Meremikwu MM, Ejemot-Nwadiaro RI, Oduwole O. Routine vitamin A supplementation for the prevention of blindness due to measles infection in children. Cochrane Database of Syst. Rev. 2016; CD007719. Available from: DOI 10.1002/14651858.CD007719.pub4.'''

a.    This source provides an overview of measles and vaccination for healthcare professionals.

b.    Source retrieved from Cochrane Review database.

Selected Source and Rationale:

I chose Source #2 for the following reasons:

o  It is a secondary source, so analysis has already taken place externally which improves reliability.

o  It is recently published (2016) as compared to Source #1 which was published in 2010.

o  Source #3 made no significant conclusions as they did not include any trials assessing whether the supplementation of Vitamin A on children with measles prevents blindness.

Source #2 makes significant clinical conclusions about Vitamin A effectiveness in the treatment of measles.

Reliable Medical Source – Evidence:


 * 1) The source is published by a reliable and legitimate source (JAMA Pediatrics) which is published by the American Medical Association. The journal currently has an impact factor of 12.004.
 * 2) The data reflected in the source is up-to-date and recently published as of 2016, which falls within the past 3 years. As this source conducted a review based on systematic reviews, meta-analyses, narrative reviews, epidemiologic reports, and research studies focusing on review content, the quality of the evidence is high.
 * 3) A scientific consensus is presented, with databases and online repositories of the Centre for Disease Control and Prevention (CDC) and the World Health Organization (WHO) being utilized and cited amongst the evidence presented.

Implementation plan:

This source concludes that 2 doses of Vitamin A (200 000 IU) lower mortality for measles in children younger than 2 years, as well as mortality from measles-associated pneumonia. The source also states that the World Health Organization and American Academy of Pediatrics recommends the use of oral Vitamin A for children diagnosed with measles at a dose of 200 000 IU for 2 consecutive days for children 1 year or older; 100 000 IU for 2 consecutive days for children 6 months to 1 year; and 50 000 IU for 2 consecutive days for children younger than 6 months.

The Wikipedia article is currently vague and unspecific in its presentation of Vitamin A as an effective treatment for measles. Using the evidence presented in this source, we plan to substantiate the existing content on Vitamin A under the “treatment” portion by providing a more reliable and high-quality source of information. We also plan on providing more information related to the use of Vitamin A as a treatment in the pediatric population, as opposed to the false and unsupported information currently included in the Wikipedia article that presents Vitamin A as a widespread treatment for anyone infected with measles.

Assignment #3
Proposed Changes:

Current article:

“A systematic review of trials into its use found no reduction in overall mortality, but it did reduce mortality in children aged under two years.”

This sentence will be modified to substantiate the existing information on Vitamin A under the subheading Medications in the “Treatment” portion of the article. This will be done by providing more details on the exact dosage of Vitamin A found to have reduced mortality in the paediatric population.

I propose the following change:

“A systematic review of trials into its use found no reduction in overall mortality, but two doses (200 000 IU) of Vitamin A was shown to reduce mortality for measles in children younger than two years of age.”

Current article:

“Some groups, like young children and the severely malnourished, are also given vitamin A, which act as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications.”

This sentence will be modified to improve clarity and flow by specifying the indications for appropriate Vitamin A treatment.

I propose the following change:

'''“Diet deficiency is a common indication for Vitamin A treatment, and may be appropriate in populations such as young children and the severely malnourished. Vitamin A acts as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications."'''

ET- Very clear points. I wonder if immunomodulator should be wiki-linked?

Rationale for Proposed Changes:

The reference for this information is (Bester, 2016). The Wikipedia article is currently vague in its presentation of what constitutes effective Vitamin A treatment. In this regard, it is important to elaborate on the exact dosage found to decrease measles-related mortality. I also find it particularly pertinent to include the fact that Vitamin A is only effective in the pediatric population (specifically children under two years of age). Additionally, the “Treatment” portion of the article is unclear about the indications for Vitamin A treatment. Rephrasing the second sentence provides a more clear and concise presentation of the indications one would look for when considering this course of treatment.

The inclusion and modification of the information regarding specific Vitamin A treatment is useful for physicians in practicing informed measles-related care, as well as in providing patients with a general overview of the benefits of Vitamin A treatment should they present with the appropriate indications.

I do not think that either of my proposed changes are controversial. The majority of the information presented in these changes is already included in the article. I am enhancing and modifying the current content with additional information related to pre-established themes in the article.

ET-the rationale makes sense to add from a clinician vantage point.

Critique of Source:

The source I used to obtain the information is a review article that takes into account multiple studies and provides a well summarized consensus on the current status of measles and the measles vaccination in the scientific community. As review articles are a secondary source, analysis of the information has already taken place externally which improves reliability. The source is published by a reliable and legitimate source (JAMA Pediatrics) which is published by the American Medical Association and currently has an impact factor of 12.004. The data reflected in the source is up-to-date and recently published as of 2016, which falls within the past three years.

The Search Strategy/Evidence Review is very thorough and includes systematic reviews, meta-analyses, narrative reviews, epidemiologic reports, and research studies focusing on review content. Online repositories and databases including MEDLINE, PubMed, the World Health Organization and the Centre for Disease Control and Prevention were searched over a 36-year time period (1980 through to 2016), hence the quality of the evidence is broad and high. As this source focuses solely on measles treatment and vaccination, the information included is highly specific.

Since the Methods of Review are not included, there is a potential for bias dependent on how many people selected the included articles, who they were, how they went about their selection process, and if they had any conflicts of interests. From the information available, it appears that the review article had one author who noted their affiliations at the beginning of the article. The author does not appear to have any financial or academic conflicts of interest. Although it is impossible to completely rule out bias given the fact that the article only has one author, the information included in the review article, and specifically the information I chose to include, is entirely factual and comes from high quality, reliable peer-reviewed sources with no known biases. With all of this considered, I feel comfortable using the information from this source to make improvements on the Wikipedia page.

ET- Well thought out discussion.