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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

Alpha-Thalassemia.

Assignment #2
1.    For this assignment, I wanted to identify clinical practice guidelines relevant to our topic of alpha-thalassemia. Clinical practice guidelines were of particular interest to me as they can be high-quality, secondary sources. They also lay out information starting from the very foundation of a disorder and are often written in less complex language than other secondary sources, which are factors of our article that are lacking. In order to find an appropriate clinical practice guideline, I searched “BMJ Best Practice” in the Bracken Library databases search bar. Once directed to BMJ Best Practice I searched “alpha-thalassemia” in the search bar. This directed me to the general alpha-thalassemia webpage where I clicked on the “Guidelines” tab to access the associated clinical practice guidelines.

2.    Once on the guidelines tab of alpha-thalassemia on BMJ Best Practice I found a number of relevant guidelines to the completion of this assignment and my previously mentioned goals. A number of these guidelines were considered too specific, as my contribution is focused on editing the introduction of the alpha-thalassemia Wikipedia page. As such, clinical practice guidelines such as “guidelines for the management of non-transfusion-dependent thalassemia” were ruled out. In the end, the most promising articles were “Guidelines for the Clinical Care of Patients with Thalassemia in Canada” and “Standards of Care Guidelines for Thalassemia.”

3.    Of these two options I chose the “Guidelines for the Clinical Care of Patients with Thalassemia in Canada.” The information contained within the chosen clinical practice guideline is more recent, being published in 2016, compared to 2012 in the guideline that was not chosen. Additionally, the guideline that I chose had a more acute focus on outlining the mechanisms through which alpha-thalassemia develops, particularly with relation to the impacted genes. The article I did not choose, while high quality, in addition to being somewhat outdated, simply has too narrow of a focus on the macroscopic resulting impacts of alpha-thalassemia, rather than the genetic mechanisms through which it is acquired and the changes that it makes that the cellular level.

4.    Three of the reasons why the selected article meets the reliable medical sources (MEDRS) guidelines put forth by Wikipedia are:

a.    Secondary Source – Clinical Practice Guideline

b.    Current Source – Published within the past 5 years (2016)

c.    High-Quality Clinical Practice Guideline – Published by the Thalassemia Foundation of Canada and recognized as high-quality by BMJ Best Practice

5.    As previously mentioned, I plan to use this source to improve the introduction of our Wikipedia article. In particular, the source that I have chosen was shown to be the most appropriate in its ability to inform revisions of what a “thalassemia” actually is from its very foundation, as well as clearly identifying and explaining the genetic mechanisms through which alpha-thalassemia is transmitted. Lastly, the article will allow for our group to create additions to the introduction regarding the cellular level changes of alpha-thalassemia to erythrocytes and hemoglobin.

Assignment #3
* Completed with Tony Li

Proposed Changes:

Replace :

“Alpha-thalassemia is a form of thalassemia involving the genes HBA1 and HBA2. Alpha-thalassemia is due to impaired production of alpha chains from 1, 2, 3, or all 4 of the alpha globin genes, leading to a relative excess of beta globin chains.”

With :

"Thalassemias are a group of inherited blood conditions which result in the impaired production of hemoglobin, which is the molecule that carries oxygen in the blood. Normal hemoglobin consists of two alpha chains and two beta chains; in alpha-thalassemia, there is a quantitative decrease in the amount of alpha chains, resulting in fewer normal hemoglobin molecules. Furthermore, alpha-thalassemia also leads to the production of unstable beta globin molecules which result in red blood cell destruction."

* Insert after first sentence in original Introduction and replacing completely the second sentence.

'''LW Comment: Nicely done! This is very clear and concise, you have avoided using jargon and used wiki-links appropriately.'''

Rationale for Proposed Change:

Rationale:

The proposed changes to this article surround the need to clarify the Introduction, in particular, making it more accessible to the layperson. In its current state, the Wikipedia article for Alpha-thalassemia has an Introduction that is inadequate in its ability to clearly and definitively explain to a non-medical reader what the particular pathophysiology of the disease is. The language used is fairly unapproachable and written at a level that requires a degree of knowledge that should not be expected of someone from the general public. In particular, we took issue with the lack of explanation of what a "thalassemia" actually is, the lack of explanation briefly of what the functionality of hemoglobin is, and the overall the expectation of readers to have a fairly sophisticated understanding of genetics in order to understand some of the nuance of the pathophysiology of the disease. Broadly, all of these changes are necessary in order to make the Wikipedia article more approachable and understandable to those in the general public, as Wikipedia is commonly used as a primary source of information for individuals who wish to access knowledge about a topic in a comprehensive and concise fashion.

The first sentence that we propose to change offers to solve the issues of not having a proper definition for "thalassemias" and describing the role of hemoglobin in the blood, which are key features missing from the original Introduction. Important related pages of Wikipedia have been referenced to support the understanding of our proposed change, but in general would not be critical as the new sentence makes the article more approachable to the layperson without taking away from the complexity and nuance that is necessary for somewhat complicated genetic disorders. The second sentence that we propose to change acts to address the issue in the original article of having a lack of explanation of what the pathophysiology of the disease is, in part due to broad and convoluted sentences about higher level genetics concepts. Instead, this has been changed to once again reflect the nuance of the disease at hand and not take away from its complexity, while still laying out clearly what the changes that are required to allow this disorder to appear in an individual, with associated links for more information. Lastly, our third proposed sentence takes on the issue in the original article of not explaining concisely how the genotype of the disease appears as a particular phenotype, and how this manifests physically.

'''LW Comment: Excellent rationale. You are right, the original introduction does not help matters much, and your additional sentences would be a big help.'''

The below listed reference was the source for all three sentences that are proposed to be added to the Wikipedia article for Alpha-thalassemia.

Reference Used:

Lanzkowsky's Manual of Pediatric Hematology and Oncology 6th Edition (2016)

LW Comment: Good choice of resource.

Controversy :

I do not believe that any major controversy should arise as a result of these changes. That being said, the original author(s) may have written the Introduction in such a way that they did not want to detract from the complexity of the topic. As such, there could be a foreseeable controversy if the original author(s) did not agree with the changes we propose which make the article more accessible by being written in more lay language. It could also be seen that these changes are not as concise as the original article was written, and as such are convoluted and do not add to the article. I would argue with these statements and justify these changes as a result of the medium that the article is being published on. It is widely understood that Wikipedia is a first stop source in which medical experts and lay people alike come to receive a broad overview of particular topics. It is crucial that these articles are written in such a way that they are not so complex that information is essentially unavailable to the general public about a topic that they may have a vested interest in knowing more about. In this way, I believe that these proposed changes do an excellent job in both making the article more accessible, while still maintaining a level of complexity and accuracy to the nuance of the subject at hand.

LW Comment: Good discussion of implications of changing the first few sentences of the article, but correctly identified that there is nothing controversial in the new sentences themselves.

Critique of Source: The textbook that was used for these changes is a highly respected secondary-source within the field of medical genetics. That being said, there arise some issues when using textbooks as they are less ideal than some other secondary-sources. In particular, textbooks are generally considered to have lower quality of evidence than something like a systematic review or a meta-analysis. While textbooks are considered secondary-sources because of their gathering of findings from a number of inputs, they are often also integrated with the expert opinion of one or a few authors. As such, this source is more susceptible to bias than other secondary-sources. It was still chosen as the Introduction of any Wikipedia article requires a level of foundational knowledge that is most clearly disseminated through a source such as a textbook. This, along with the strongly held belief in the field of the credibility of the source serve as strengths in face of the weaknesses previously discussed.

'''LW Comment: Well said. Good critique and evaluation of the source.'''