User:Millsa7052/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

Hodgkin Lymphoma

Assignment #2
This is my literature review:

Symptoms


 * 1) How you searched (search strategy)

I used the Cochrane library. Using the advanced search tool, I searched for Hodgkin Lymphoma, and restricted the search to publications since 2015 that were reviews or protocols (to ensure it followed the secondary source guideline) in English. I found 3 review articles and 3 protocols. None were suitable as they did not contain information on symptoms. I attempted adding “symptom” to search. I found no suitable articles. I attempted to increase the date range. I still did not find suitable articles. I then went to PubMed and did an advanced search for “Hodgkin Lymphoma symptoms” in the past 10 years in English with only review articles. I found 1533 results and chose 3 I thought were suitable.


 * 1) What potential sources were identified and considered?

Shanbhag, Satish, and Richard F. Ambinder. “Hodgkin Lymphoma: A Review and Update on Recent Progress.” CA: A Cancer Journal for Clinicians, vol. 68, no. 2, 2017, pp. 116–132., doi:10.3322/caac.21438.

Ansell, Stephen M. “Hodgkin Lymphoma: Diagnosis and Treatment.” Mayo Clinic Proceedings, vol. 90, no. 11, 2015, pp. 1574–1583., doi:10.1016/j.mayocp.2015.07.005.


 * 1) What source was chosen (what made it better than other sources?)

The source “Hodgkin Lymphoma: Diagnosis and Treatment” was chosen. It is better than the other source as it covers the symptoms of Hodgkin Lymphoma (HL) in depth, with frequency. The article “A Review and Update on Recent Progress” lists some of the symptoms of HL but does not discuss constitutional symptoms, which the “Diagnosis and Treatment” article does.


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

It is recent (within the last 5 years, written in 2015). It is a secondary source (a review article) that is written from a scientific and neutral stance. It references other peer reviewed articles and is peer reviewed.


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

The source will help to improve the symptoms section of the article. The symptoms section is missing many references. The symptoms section also has some symptoms repeated and does not seem to be organized in any significant way. Not all of the symptoms have a good explanation beside them, which is inconsistent as some do. This source will help to add references to the symptoms section, remove duplicated symptoms and arrange symptoms, and explain each symptom.

Assignment #3 (Due November 18th)
Question 1: Proposed changes

I will be changing portions of the section Signs and Symptoms. I will be removing "Itchy skin, night sweats, and unexplained weight loss" from their own bullet points and linking them as sub-points in the "Systemic symptoms" point, which explains each symptom better. "Low-grade" fever will be replaced with "fever" as in the reference "Hodgkin Lymphoma Diagnosis and Treatment" constitutional symptoms included "high fever" but not low-grade fever. I will be replacing "Lymph nodes" with "Lymphadenopathy" to have the medical name as the point for each symptom, each with an explanation. I would like to remove the bullet point: red patches on skin, easy bleeding and petechiae as these do not have sources and it is not possible to find a source listing these symptoms. I would like to add the reference "Hodgkin Lymphoma" for the symptoms "Splenomegaly" and "Hepatomegaly" and change 30% and 5% of cases to "often present" and "infrequent" as this is what is stated in the reference and 30% and 5% are not cited. I will also reference the systemic symptoms bullet point as it does not have a reference. Lastly, I will be re-ordering the symptoms based on how often they occur, as listed in the explanations in the article and the reference "Hodgkin Lymphoma Diagnosis and Treatment". Please review the proposed changed section below:

People with Hodgkin lymphoma may present with the following symptoms:


 * Lymphadenopathy: the most common symptom of Hodgkin is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examined. The nodes of the neck and shoulders (cervical and supraclavicular) are most frequently involved (80–90% of the time, on average). The lymph nodes of the chest are often affected, and these may be noticed on a chest radiograph.
 * Systemic symptoms: about one-third of people with Hodgkin's disease may also present with systemic symptoms, including :
 * Pruritus: Itchy skin due to increased levels of eosinophils in the bloodstream.
 * Night sweats.
 * Unexplained weight loss of at least 10% of the person's total body mass in six months or less.
 * Low-grade fever.
 * Fatigue (lassitude).
 * Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms; thus, presence of these indicate that the person's stage is, for example, 2B instead of 2A.
 * Splenomegaly: enlargement of the spleen is often present in people with Hodgkin lymphoma. The enlargement, however, is seldom massive, and the size of the spleen may fluctuate during the course of treatment.
 * Hepatomegaly: enlargement of the liver, due to liver involvement, is infrequent in people with Hodgkin Lymphoma.
 * Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease.
 * Pain following alcohol consumption: Involved nodes are painful after alcohol consumption, though this phenomenon is very uncommon, occurring in only two to three percent of people with Hodgkin lymphoma, thus having a low sensitivity. On the other hand, its positive predictive value is high enough for it to be regarded as a pathognomonic sign of Hodg kin lymphoma. The pain typically has an onset within minutes after ingesting alcohol, and is usually felt as coming from the vicinity where there is an involved lymph node. The pain has been described as either sharp and stabbing or dull and aching.
 * Back pain: nonspecific back pain (pain that cannot be localised or its cause determined by examination or scanning techniques) has been reported in some cases of Hodgkin lymphoma.
 * Cyclical fever: people may also present with a cyclical high-grade fever known as the Pel–Ebstein fever, or more simply "P-E fever". However, there is debate as to whether the P-E fever truly exists.
 * Nephrotic syndrome can occur in individuals with Hodgkin lymphoma and is most commonly caused by minimal change disease.

Question 2: Rationale and References

The section will be better organized if systemic symptoms is gathered under one bullet point. This is also how the systemic symptoms are organized in both sources "Hodgkin Lymphoma: Diagnosis and Treatment" and "Hodgkin Lymphoma - Hematology and Oncology". This allows for the staging explanation to succeed the list of systemic symptoms, which will make the explanation more clear. It also increases clarity and makes understanding of the article easier if the symptoms are listed in the order of frequency in people with Hodgkin Lymphoma.

The use of 30% and 5% for splenomegaly and hepatomegaly are percentages not referenced. There is a reference ("Hodgkin Lymphoma - Hematology and Oncology") that lists these symptoms but says that they are "frequent" and "infrequent". I would like to change the wording from the percentages to "frequent" and "infrequent" so that the points can be referenced. Without references that support the 30% and 5% the section is not appropriately referenced and cannot be trusted information.

Question 3: Controversy

It may be discussed that the systemic symptoms would be better separate instead of under the umbrella bullet point of systemic symptoms, but it is better organized this way for clarity. It removes the repeat mention of these symptoms and allows for a better explanation of each.

Some may argue that the fever bullet should have "low-grade" preceding "fever". However, there is no reference for this or definition of "low-grade" provided. The references listed only list "fever" as a systemic symptom. In order to have each piece of information scientifically referenced, low-grade cannot be included.

If there is a contributer with a source for the "red patches on the skin" there may be the desire to keep this point in the article. However, I could not find this symptom listed on any online source and feel it is innapropriate to list a symptom without a reference.

Question 4: Critique of Source

Source 1: The Mayo Clinic Proceedings is certified by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. It is a recently published secondary source (2015) and is peer reviewed, so it follows Wikipedia's criteria for medical sources. The article is intended for the education of health professionals. The author, Dr Ansell, receives research funding from Seattle Genetics, Inc, and Bristol-Myers Squibb Company, as it listed in the article. This could present bias, however the article is intended for education and the section I reference is regarding symptoms, which likely does not present a COI for a company specializing in cancer biotechnologies (Seattle Genetics Inc.) or pharmaceutical company (Bristol-Myers Squibb Company), unless either company was creating a biotechnology or pharmaceutical to relieve specific symptoms. The article is likely not biased, as it is also peer reviewed.

Source 2: The Merck Manuals is a recently published (2018) secondary source that HON code certified (March 2019) and follows Wikipedia's criteria for medical sources. It is a neutral article that is written without bias. The purpose of the Merck Manual is as a service to the community. The professional version is meant for the education of healthcare professionals. The author of the Hodgkin Lymphoma is a hematologist-oncologist that has been practicing for 3 decades and has no conflicts of interest with regards to the symptoms of Hodgkin Lymphoma.

****** Good work. Although I don't believe any article can be written without bias. When describing signs and symptoms, an author may be easily biased by his/her own experience, which may not reflect the true prevalence of certain S&S. Also, these are not systematic reviews, and no sources are included; there can easily be selection bias of data.

I do agree both are credible sources. ****