User:Karabesa/sandbox

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Practice Editing Here (Nov 23rd in-class Wiki session work)

 * Combined oral contraceptive pill
 * Citation

Assignment # 3
Proposed Changes:

Rationale for Proposed Change:

Despite independently searching for articles on the effects of increased doses of estrogen in COC pills and the risk of stroke and MI, I recently realized that I actually am citing the same review article that is already linked in the Wikipedia article for this sentence. However, the sentence as it is misrepresents the data proposed in the article. A key takeaway of this review was that while the risk of stroke and MI does increase with higher doses of estrogen, there is still risk for low dose estrogen users. Therefore, the original author’s claim that lower doses appear “safe” is inappropriate and is not backed by the linked review.

Upon further review of this Cochrane Review, I discovered that the article itself was updated in regard to the specific point I have highlighted to change in this word document. Dr. Øjvind Lidegaard, clinical Professor in Obstetrics & Gynaecology at University of Copenhagen noted that the 24 composite studies that make up this systematic review all indicated an increased risk ratio associated with COC pills compared to non-users, therefore the original claim that low dose estrogen COC do not confer increased risk of stroke or MI could not be true. This review was then updated to account for a bias in the analysis conducted and updated to reflect the increased risk of low dose estrogen in COCs for stroke and MI. My update to the Wikipedia article will introduce this same important update.

Citation used:

Roach, R. E., Helmerhorst, F. M., Lijfering, W. M., Algra, A., & Dekkers, O. M. (2015). Combined oral contraceptives: The risk of myocardial infarction and ischemic stroke. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD011054.pub2

Controversies:

-       N/A for this specific claim

Critique of Source:

-       This source conducted a very thorough analysis of bias (see figure 2), assessing exposure ascertainment, outcome assessment, follow-up, and source population.

-       A potential bias present is the ascertainment of diagnosis, as in 6 of the studies the diagnosis of myocardial infarction and ischemic stroke were not objectively confirmed. The study mentions this is a high risk of bias but does not describe a mechanism of accounting for the data.

-       Another potential source of bias or error is the lack of inclusion or discussion on age. The article mentions that as women get older their risk of MI or stroke while on the pill increases. However, this doesn’t seem to be taken into consideration in the meta-analysis shown in figure 3. The paper describes that the data was age-matched for analysis, however the relative risk is reported as one number. I believe it would be clinically relevant to know the difference in relative risk of women 18-30 compared to 31-50+.

-       Lastly, the paper discusses that for most of the studies the exposure to COC pills was ascertained by confirmation of a prescription database. However, this wasn’t true for all studies as some used less objective methods like interviews and questionnaires for women to recall their COC medication and estrogen dosage. This means that some studies had potential for a recall bias, where some women may not recall what dose estrogen they are currently taking.

What to post on the Wikipedia article talk page?

 * This will also be covered on Nov 23rd in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2020/Talk Page Template