User:CJW86/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

= Alpha-thalassemia =

Wikipedia Assignment #2

 * 1) First, I formulated a question I wanted to address: which individuals with alpha-thalassemia require a blood transfusion? Then, I searched three evidence-based medicine databases (UpToDate, DynaMed, and BMJ Best Practices) for “alpha thalassemia” and PubMed for blood transfusion thalassemia AND ( Guideline[ptyp] OR Meta-Analysis[ptyp] OR Practice Guideline[ptyp] OR systematic[sb] ) AND "last 5 years"[PDat] and found the following:
 * 2) DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 -. Record No. T114657, Alpha-Thalassemia. Updated 2018 Nov 30, cited 2019 Nov 05. Available from https://www.dynamed.com/topics/dmp~AN~T114657.
 * 3) Benz EJ and Angelucci E. Management and prognosis of the thalassemias. UpToDate. Updated 2019 Aug 08. Accessed 2019 Nov 05.
 * 4) BMJ Best Practice: Kwiatkoski JL. Alpha-thalassaemia. BMJ Best Practice. Updated Aug 2019. https://bestpractice-bmj-com.proxy.queensu.ca/topics/en-gb/250 2019 Nov 05.
 * 5) PubMed: Franchini M1, Forni GL, Liumbruno GM. Is there a standard-of-care for transfusion therapy in thalassemia? Curr Opin Hematol. 2017 Nov;24(6):558-564. Doi: 10.1097/MOH.0000000000000373.
 * 6) All options above were considered. I chose Benz EJ and Angelucci E. Management and prognosis of the thalassemias. UpToDate. Updated 2019 Aug 08. The review in Curr Opin Hematol (2017) was very detailed and compared various guidelines and recommendations from international hematology agencies, however the focus was on optimizing blood transfusion therapies for transfusion-dependent thalassemia (I was looking for clarification on which thalassemias require transfusion.)
 * 7) Selected review: Benz EJ and Angelucci E. Management and prognosis of the thalassemias. UpToDate. Updated 2019 Aug 08. This secondary source is peer reviewed, published in a widely used in clinical decision making resource, and provides recently and continually updated information. Additionally, UpToDate includes a graded rating scale for the strength and quality of their recommendations based on the available evidence
 * 8) The alpha-thalassemia review in UpToDate satisfies MEDRS criteria in that it was written by experts in Hematology, published in a reputable and peer-reviewed clinical decision-making resource used internationally by millions of clinicians (i.e. reputable and mainstream), and is continually updated as new information becomes available (published within the last 5 years.)
 * 9) My plan is to change: “Treatment for alpha-thalassemia may consist of blood transfusions” to “Treatment for alpha-thalassemia may include blood transfusions to maintain hemoglobin at a level that reduces symptoms of anemia. The decision to initiate transfusions depends on the clinical severity of the disease.” This general statement doesn’t go into the specific details of clinical decision making to transfuse, but lets the reader know why transfusions are considered and how the decision to transfuse is made.

Proposed changes
"Treatment for alpha-thalassemia may consist of blood transfusions, and possible splenectomy; additionally, gallstones may be a problem that would require surgery. Secondary complications from febrile episode should be monitored, and most individuals live without any need for treatment."

to

"Treatment for alpha-thalassemia may include may include blood transfusions to maintain hemoglobin at a level that reduces symptoms of anemia. The decision to initiate transfusions depends on the clinical severity of the disease. [My colleague will insert information about splenectomy.] Additionally, gallstones may be a problem that would require surgery. Secondary complications from febrile episode should be monitored, and most individuals live without any need for treatment"

'''LW Comment: Good work on these changes. The language is clear and the appropriate wiki-links are used.'''

Rationale for proposed change
My question was: "which individuals with alpha-thalassemia require a blood transfusion?" The proposed changes help clarify this without going into specific detail or significantly altering the existing Wiki article. This is an important addition to the article for individuals interested in alpha-thalassemia since there is much more information about beta-thalassemia, for which the recommendations for transfusion seem more clear. This may also be useful for a patient with non-symptomatic alpha-thalassemia to know that chronic transfusions may not be necessary but monitoring for anemia will be required.

Potential controversies that were discussed with the group when working on this topic were:

1) Whether the need for transfusion in alpha-thalassemia was linked to specific genotypes. Some resources appear to affirm a link, where as others stated that the decision to transfuse was based on clinical assessment of anemia independent of genotype.

2) Recommendations for treatment may vary based on access to care. The areas that may have the greatest burden of disease may not have access to high medical resources that may be required for frequent blood transfusions. This may increase the necessity of treatments such as splenectomy.

'''LW Comment: True, but why is this an important addition to the article? Are there any controversies with these changes, or potential controversies? You needed a little bit more here.'''

Critique of source
Information was from a widely used clinical resource (UpToDate.) Articles in UpToDate are written by physician authors then undergo a rigorous editorial process. This resource uses recent medical information and is used worldwide by millions of clinicians. Because UpToDate synthesizes evidence, it may be susceptible to publication bias. In addition, if there is a lack of high quality evidence on a given topic, UpToDate may rely on evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws which can lead to confounding and biases. UpToDate articles may also be susceptible to language bias, as authors and reviewers are more likely to synthesize information published in English. Generalizability may be decreased if the synthesized evidence primarily looked at a Western population vs. a global population. The thalassemia article in UpToDate acknowledges that recommendations in national and international guidelines may vary from those that appear in the UpToDate topic review. However, after consulting several international guidelines and additional resources, blood transfusions appear to be the common treatment globally for alpha-thalassemia. To minimize the impact of bias on clinical decision-making, UpToDate uses a grading system for their recommendations.

'''LW Comment: This is not enough. What are the pros and cons of using UpToDate? What are the specific details that make it a good source, and where else could the biases come from? Are conflicts of interest discussed? How do they come up with their recommendations?'''