User:AmirWachtel/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

Assignment #2:
1. How you searched for a source (search strategy):

I searched the term ‘Giant Cell Arteritis’ (GCA) on the Dynamed database. From this search I selected a ‘condition article’ about giant cell arteritis, which included a broad review of the condition. Once in this article I focused on the ‘Management’ section which summarizes information garnered from various studies and systematic reviews.

2. What potential sources were identified and considered?

I also considered a systematic review from the Cochrane database. Please find the citation below:

Mollan  SP, Sharrack  N, Burdon MA, Denniston  AK. Aspirin as adjunctive treatment for giant cell arteritis. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD010453. DOI: 10.1002/14651858.CD010453.pub2.

3. Why the source was chosen (What made it better than other choices).

The Cochrane Review resource attempted to answer a focused research question, how safe and effective is low-dose aspirin, as an adjunctive, in treating giant cell arteritis? In comparison, the Dynamed resource gave a generalized review of the condition and its treatment. It analyzed multiple sources for each of these sections and focused more heavily on explaining the actual condition, as opposed to answering a question related to it. For example, I was assigned to add information on the Wikipedia article pertaining to the expected clinical course for GCA and the DynaMed resource includes a section that investigates the relapse rate of patients taking glucocorticoids based on a systematic review that examined 34 studies.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

The DynaMed resource meets the following three Wikipedia reliable medical sources criteria:


 * It is a secondary source
 * It is up to date: it was last updated on June 25, 2019
 * It summarizes scientific consensus

5. How do you plan to use the source for improving the article?

I plan on using the resource to add 1-2 sentences that will further clarify the expected clinical course of treatment. I hope to answer such questions as how long does it take to feel better or how long do most people end up taking the treatment for.

Assignment #3:

1) Proposed Changes:

The wikipedia article for Giant Cell Arteritis (GCA) does not include any information regarding relapse of the condition. I plan to include the following two sentences at the end of the third paragraph of the article, "While studies vary as to the exact relapse rate of giant cell arteritis, relapse of this condition does occur. It most often happens at low doses of prednisone (<20mg/day), during the first year of treatment, and the most common signs of relapse are headache and polymyalgia rheumatica. " The new sentences on relapse are written very well, and will be informative to patients.


 * Please note that I did not link any article to 'prednisone' because it is linked to another wikipedia article earlier in the paragraph where I hope to insert my additional sentence.
 * Also note that, upon further reflection and discussion with Dr. Joneja, I placed my two additional sentences at the very end of the 'Signs and Symptoms' section of the article as it appeared to flow better with the article in that location.

2/3) Rationale for proposed change:

Reports on the incidence of relapse in GCA vary from 34-74%, which means that relapse of this condition is a real possibility for people that have had GCA in the past. Relapse of GCA does occur, it is not mentioned a single time in the original article and I believe it is important for a complete discussion of this condition to include it.

Please note, that after consulting with Dr. Joneja I switched my source from the DynaMed article discussed in assignment #2, to the UpToDate article as UpToDate was recommended as a better resource. When consulting with Dr. Joneja, I originally mentioned that I was hoping to alter the information listed in the 'Treatment' section of the Wikipedia GCA article. The article currently says that steroid treatment is often tapered 2-4 weeks following initiation of the treatment but the previous DynaMed source said that the proper protocol was to taper the treatment in 1-2 weeks. Dr. Joneja verified that the DynaMed source was incorrect and this was when she recommended that I change my source to the UpToDate article cited above. It was upon reading this source and further discussion that I decided to include two additional sentences about the relapse of GCA instead of modifying the 'Treatment' section of the Wikipedia article.

The source that I am using is an article in UpToDate that discusses the treatment of GCA. According to Dr. Joneja it is a gold-standard point-of-care medical resource for rheumatic diseases. The full citation for my article is: Docken, WP. Treatment of giant cell arteritis. In: UpToDate, Curtis, MR (Ed), UpToDate, Waltham, MA, 2018. Good explanation. Relapse is good for patients to know about.

4) Critique of Source:

The article cited in UpToDate is a narrative review that covers the broad topic of treating Giant Cell Arteritis (GCA). Therefore, it appears susceptible to several weaknesses common to narrative reviews:


 * Potential Bias : While the article cited in UpToDate mentions the names and professional affiliations of the main author and editors it does not explicitly mention an absence of conflicts of interest. Furthermore, while the sources cited in the article appear relevant and of an appropriately high level of evidence, for example, it includes multiple systematic reviews, there is no description of the search strategy nor the selection strategy used by the author. This means that we cannot be certain how the author found the sources they used and we don't know why they selected the specific sources they did.


 * No formal appraisal of sources : The article in UpToDate does not include a formal appraisal of the sources the author used. Scanning the works cited section indicates that the sources were selected from peer-reviewed journals and that they include systematic reviews, meta analyses and randomized control trials (RCTs), however, without a formal appraisal we cannot be fully confident as to the quality of the author's sources.
 * Qualitative Summary : Because this is a narrative review that attempts to cover a broad topic as opposed to a single focused question, the summary at the end of the article is a qualitative summary in which the author makes recommendations based on his own expertise, which he has attempted to back up with his sources throughout the article. However, unlike systematic reviews, this summary is not quantitative and is not graphically represented, i.e. with a forest plot. Without a quantitative component explaining how the author came up with the various points in their summary it is difficult to fully appreciate why the author made the recommendations they did.
 * Unique points of criticism for UpToDate : UpToDate does not have any archives for its older content, it is not possible to cite specific versions of UpToDate articles, and it can be a difficult source to access since it requires a fee (these points were mentioned in the Wikipedia article I cited here).

Although there is a potential for bias in this article, I chose an UpToDate treatment article as my source based on the recommendation of Dr. Joneja, my understanding that UpToDate is considered a gold-standard medical resource, and that the author appears to be a respected leader in his field, Dr. Docken is an associate professor of medicine at Harvard Medical School. Furthermore, the UpToDate website states that, "UpToDate accepts no advertising or sponsorships, a policy that ensures the integrity of our content and keeps it free of commercial influences." Bias or controversy that might come up might be from an individual physician's experience with patients and relapse.

While the author did not include a formal appraisal of the sources they used, according to the UpToDate editorial page, UpToDate staff hand-search over 430 peer-reviewed journals, perform electronic searches of databases and extract information from accepted guidelines, information produced by governmental and non-governmental institutions (i.e. WHO), and major national & international scientific meetings. Supporting that, all the sources in this article appear to come from peer-reviewed journals and are all of a high quality of evidence including systematic reviews, meta-analyses, and RCTs.

Even though, this source seems to exclude a quantitative component backing up the recommendations the author includes in their summary, UpToDate claims that it utilizes a structured approach in synthesizing all the recommendations included in its articles. This process includes, "carefully defining the patient population of interest, the alternative management strategies, and the outcomes of importance to patients (PICO format: Population, Intervention, Comparators, Outcomes)." So while the article I cited does not include an explanation for how the author generated each point in the summary we can assume that there was a structured approach behind each one.

Lastly, while I cannot access older versions of the article, this version was last updated in August 2018, which is well under the 5 year window of expiration that Wikipedia recommends for its sources and although UpToDate articles can be difficult to access due to the associated fees, the link to this article appears to work, and therefore, accessibility is not an issue.

Excellent examination of up to date. Different physicians use different point of care tools, and I have had great experience with this tool. It is a great point to note that it is an expensive resource. We as physicians also assume that the content has been rigorously reviewed.