User:FIONARAYMOND/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

= Giant Cell Arteritis  =

Proposed Change
I will not be targeting any specific sentences, instead I will be adding information to the end of Section 4: Treatment.

Specifically the sentences I have proposed to add are:

"The active component of Tocilizumab is a humanized antibody that targets the interleukin-6 receptor, which is a key cytokine involved in the progression of Giant Cell Arteritis. Tocilizumab has been found to be highly effective at minimizing both recurrence, and flares of Giant Cell arteritis when used both on its own or concurrently with corticosteroids." This is a worthwhile addition and complements the rest of the changes very well. It is well written.

Rationale for Proposed Change
I feel that this information is important to add because this section was quite small, and mainly focused on prednisone, which is currently the standard treatment. After consultation with Dr. Joneja, who is our tutor for this project, she agreed that there needs to be more information regarding treatment with Tocilizumab, specifically because although prednisone is still the standard treatment, she would recommend Tocilizumab to patients who present with Giant Cell Arteritis (barring other limiting factors and/or contraindications). The citation I have chosen to use is a systematic review of the two existing clinical trials of Tocilizumab, and is fairly recent (approximately 2 years old), and because Tocilizumab is a relatively new treatment, this systematic review contains relevant information regarding treatment of Giant Cell Arteritis. I specifically included one sentence on how Tocilizumab works, and one sentence regarding its efficacy as a treatment. Because prednisone is the current standard treatment one can see that there might be controversy surrounding this information, however the literature supports Tocilizumab is a highly effective treatment and as it is fairly new it is likely that treatment guidelines have not yet been updated to match this information. Therefore although at surface level this could be seen as controversial, I do not anticipate dispute regarding this proposed update to the article. This is an exciting development for the treatment of GCA.

Critique of Source
Mariano, V.J. & W.H. Frishman. (2018). Tocilizumab in Giant Cell Arteritis. Cardiology in Review, 26(6), 321-330. https://doi.org/10.1097/CRD.0000000000000204

The source that I will be using (indicated above) is a systematic review. When assessing the validity of systematic review it is important to consider the following:

1)Well defined clinical question.

This criterion is satisfied in this systematic review. The question could be: Is treatment with Tolicizumab effective in the treatment of Giant Cell Arteritis when compared to both steroid use and placebo. Which would qualify as a well defined clinical question.

2)The search is complete and thorough.

I believe this criterion is satisfied but mainly because there are currently only two clinical trials for this drug regarding the treatment of Giant Cell Arteritis in existence and therefore it was not difficult to ensure that the search was complete. Because of this low number of clinical trials case series' were also included in this systematic review however the majority of the focus/analysis was on the clinical trials. There was a lack of transparency as to how the search was conducted, which could potentially lead to difficulty in reproducibility; however because within my focus all relevant articles were utilized this did not influence my choice to include this article as my source.

3)The selection is unbiased, reproducible, and includes multiple reviewers.

There was no conflict of interest identified in any of the reviewers. The selection point does not necessarily apply here because all studies found were included or "selected". This systematic review includes 15 case series, which is not necessarily standard for systematic review but was likely included in this situation because of the low number of clinical trials. It is difficult to appreciate whether this selection process would be reproducible. I do not believe that this negatively affected the validity of this review. Finally this study did include multiple reviewers (2) and therefore minimally satisfied this subsection of criterion, but potentially could have had more.

4)The studies included in the review are high quality (and if they are not, the quality does not significantly influence the results).

The two clinical trials that were included were high quality (including randomization, double-blinding, and placebo-controls). The case series do not meet this quality standard but because they were not necessarily the focus of this systematic review I believe that they do not significantly influence the results. It is important that the findings of the clinical trials are not confirmed with these case series; I did not note evidence of this.

5)The results include a description of included studies and graphic visualization of these studies.

The results include a thorough description of the two clinical trails as well as of the case series' and there is also graphic visualization of these studies. However there is no graphic visualization that combines the results of these clinical trials such as a Forrest plot. This criterion is only partially satisfied, but I do not believe that it significantly effects the results of the study, as the thorough description is included.

In conclusion, upon thorough assessment of the validity of this systematic review I am confident utilizing it to inform my editing of this article. A very good critique of the source. This is a good example of a new treatment being evaluated quickly.

Assignment 2
The sentence I am targeting for editing in our group’s Wikipedia article is in reference to alternative treatments for giant cell arteritis, as this sentence was minimal and should have more information included.

1)    How you searched for a source (search strategy – where you went to find it).

I went to Cochrane Library and searched: (giant cell arteritis or temporal arteritis) and tocilizumab. I did not apply any filters. The source I chose was: “Tocilizumab in Giant Cell Arteritis.”

2)    What potential sources were identified and considered (give examples of 1 or 2).

I identified two potential articles as sources to consider when editing our article:

1- Mariano, V.J. & W.H. Frishman. (2018). Tocilizumab in Giant Cell Arteritis. Cardiology in Review, 26(6), 321-330. https://doi.org/10.1097/CRD.0000000000000204

2- .Rinden, T., Miller, E. & R. Nasr. (2019). Giant Cell Arteritis: an update review of an old disease. Cleveland Clinic Journal of Medicine, 86(7), 466-472. Doi: 10.3949/ccjm.86a.18103.

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

I chose the source “Tocilizumab in Giant Cell Arteritis” because it is a systematic review of the 2 RCT’s that have ever been done on the effectiveness of this biological agent. It discusses the successes of Tocilizumab in treatment as well as some of the side effects. Based on the information provided I think this would be most useful to edit the sentence I have been assigned for the Wikipedia article.

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

1- The article is a systematic review, and therefore a published secondary source

2- I found the article via a reliable third party- Cochrane Library

3- This evidence should be considered up to date as it was only published in 2018 and is a review of the two RCTs that have been completed to study this medication.

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

This article does not have enough information regarding treatment with the biological agent Tocilizumab. It does not provide information as per effectiveness or side effects. It is a new treatment and currently is not the standard for giant cell arteritis, but per consultation with our supervising physician, Dr. Joneja, this treatment is what she would ideally recommend to her patients presenting with this disease. For these reasons I think it is important that this information is added, and the article “Tocilizumab in Giant Cell Arteritis” provides this information