User:GursharanS041/sandbox

Measles

Wikipedia Project Pt. II: Literature Search

Goal: we have identified that the topic of salivary testing should be added to the Wikipedia article as a part of the diagnostic process for measles

Search Strategy:

I used the PubMed and Cochrane Review databases to conduct my search. Within both databases, I searched “(measles) AND (saliva)”. I filtered results to view review articles only through PubMed. I separately conducted a search using the term “(measles) AND (IgA)” in both databases.

Potential Sources:

1.     Dimech, W., Mulders, M.N. A review of testing used in seroprevalence studies on measles and rubella. Vaccine. 2016. 34:35 (4119-4122). Available from: doi 10.1016/j.vaccine.2016.06.006

a.     This source was retrieved from PubMed. At a cursory glance, it provides a thorough review of relevant literature (1998-2014) pertaining to serological tests used to diagnose measles.

2.     Simon, J.K. et al. Mucosal IgA responses in healthy adult volunteers following intranasal spray delivery of a live attenuated measles vaccine. Cochrane Central Register of Controlled Trials. 2011. 18: 3 (355-361). Available from: doi https://doi-org.proxy.queensu.ca/10.1128/CVI.00354-10

a.     This publication sought to determine the responses of adults to the measles vaccine. Oral fluid tests were used to determine of immunoglobin production.

3. Dimech, W., Mulders, M.N. A 16-year review of seroprevalence studies on measles and rubella. Vaccine. 2016. 34 (4110-4118). Available from: doi 10.1016/j.vaccine.2016.06.002

a. A systematic review from which article #1 was derived; obtained through the citations of article #1 (relevant for the Critical Appraisal of Article 1)

Selected Source and Rationale:

Source #1 (above) was selected as it is a secondary source. The available literature specifically pertaining to salivary determination of a measles diagnosis is sparse, particularly where secondary sources of information are concerned. This review article effectively summarizes relevant information and is transparent with regards to the search and data extraction methodology. Furthermore, it assesses the various facets of seroprevalence testing in both a quantitative and qualitative manner, increasing the generalizability of results.

Reliable Medical Source – Evidence:

1.     The source is published in a legitimate medical journal (Vaccine), the impact factor (IF) of which is 3.269 (2018). This is acceptable, given the convention that IF >3 is respectable.

2.     The source uses relatively up-to-date evidence, having been published in 2016 and including information current up to 2014.

3.     The source effectively summarizes scientific consensus by citing WHO standardized guidelines (see “3.3 Reporting of Results”) against which to judge the studies included in the review.

Implementation plan:

The current Wikipedia article does not cover the diagnosis of measles very thoroughly. The information retrieved will contribute to making this section of the article more robust. This piece of evidence concludes that diversity amongst seroprevalence testing methodologies renders it difficult to definitively recommend one method of diagnosing measles above all others. This is important to emphasize in the Wikipedia article, given the diversity of the population who will be accessing it. Integrating these results with other findings about diagnosing measles may help readers develop a more comprehensive understanding of appropriate diagnostic modalities and where they can look in the literature to find more specific information.

Wikipedia Project Pt. III: Individual Improvement Plan

Proposed Changes:

Current article: "For people unable to have their blood drawn, saliva can be collected for salivary measles-specific IgA testing."

This sentiment will be expanded by adding information about using salivary tests to diagnose measles in order to make the "Diagnosis" section of the Wikipedia article more robust.

I propose adding in the following sentences: "Salivary tests used to diagnose measles involve collecting a saliva sample and testing for the presence of measles antibodies. This method is not ideal, as saliva contains many other fluids and proteins which may make it difficult to collect samples and detect measles antibodies. Saliva also contains 800 times fewer antibodies than blood samples do, which makes salivary testing additionally difficult."

ET-Very clear

Rationale for Proposed Changes:

The reference for this is information [1] (Dimech, 2016), above. This information is pertinent because the current Wikipedia article briefly mentions that salivary testing is possible, but fails to explain the method of testing or the relevance of this information. I propose adding 3 sentences: the first briefly explains what the process of salivary testing would involve from the patient's perspective, and the latter two explain why salivary testing is not commonly performed. It seems fair to assume that most patients would prefer to undergo a simple salivary test rather than having blood drawn to detect measles - the information I provide in this section outlines why this may not be possible or accurate except for in dire circumstances. This information can diminish barriers to communicating with physicians and improve patient understanding if someone does require a measles diagnostic test.

I do not think that my proposed change is particularly controversial. The basis for the topic I have written about is already present in the existing article; I have simply added a more robust explanation of salivary testing with the goal of improving understanding about diagnostic options for measles. If anything, the information I propose adding may reduce controversy about serum vs. salivary testing by further delineating the advantages and disadvantages of the latter method.

ET-Well thought out.

Critique of Source:

The source I used to obtain this information is a review article which broadly gathered information about diagnostic methods for both measles and rubella. Interestingly, this article is an expansion of a particular subtopic covered by the same authors' systematic review, which more broadly addressed the disease in question.

Search strategy & Study Selection: The search strategy and review methodology seem to be adequate, although there is room for some improvement. The strategy is outlined in the original systematic review (3) and briefly described in the article at hand (1). To their credit, the authors conducted a broad search between the years 1998-2014, specified that language of study was not given special priority and described their inclusion/exclusion criteria. However, only a single database was searched for published literature; grey literature was not searched, nor were authors contacted regarding additional data. Furthermore, the methodology of study selection was not described in this article. So, although the results are not quantifiably assessed using a funnel plot, we can speculate that publication bias may be possible in this review.

Conflict of Interest: The study was sponsored by the World Health Organization. This is stated in article 3 ("Acknowledgements") but not specifically in Article 1. This disclosure is unlikely to bias the results of the study, however.

Quality assessment: The quality of the information from individual articles was not quantitatively assessed in this review, which is additionally concerning. A small section of the systematic review is dedicated to describing source articles' assessment of risk of bias. Selected articles in this review project were apparently compared against the World Health Organization's standard guidelines for assessing seroprevalence; however, the findings of this comparison/quality assessment were not given.

Reporting of Results: Finally, the article is scoping in nature, meaning that it covers a number of topics related to diagnosis of measles in scant detail and not a lot of information pertaining to salivary diagnosis is present. No quantitative summary of the results - particularly in Article 1, pertaining to seroprevalence testing using salivary samples - would have been appropriate in this circumstance. In other words, too much clinical heterogeneity exists to make conclusive quantitative comparisons or to establish a summary measure using meta-analysis techniques.

External validity: This review is descriptive in nature, and provides enough detail about the setting and populations involved in each of its component studies that the overall paper has relatively high external validity. In particular, Table 4 in article 3 describes relevant information for clinicians or epidemiologists seeking to learn broadly about disease prevalence. With regards to salivary testing, Article 1 presents fairly granular data which can be applied in practice or for further research across settings.

Conclusion & Implications: Despite these underlying issues, this article and the few informational points I chose to include from it seem valid overall; information is cited from peer-reviewed sources and seems plausible given my background understanding of the subject. Also, the information I have chosen to include is factual rather than opinionated. Thus, feel comfortable sharing the information derived from this source in the context that I have included it here. There are no glaringly obvious sources of bias, and any potential sources of bias (i.e.: those which may be possible given a scant Methodology section in the article) do not warrant negating the information I have used from this article.

ET-Very detailed and in depth review.