User:Naomigazendam/sandbox

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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

Noonan Syndrome

Assignment 2
Allanson, J. E. (2019, August 8). Noonan Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK112411

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

As per Dr. Badalato’s recommendation, I used GeneReviews through the NCBI Bookshelf. I searched Noonan syndrome in order to find out information regarding management and causes.

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

There were 2 articles available through GeneReviews about Noonan syndrome. However, the other article discussed Noonan Syndrome with Multiple Lentigines (NSML) rather than Noonan Syndrome (NS)

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

This source was chosen as GeneReviews is very reputable and trustworthy for finding reviews, written by experts, for genetic disorders. It was the only article that was relevant to information for management and causes for NS.

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

-not an editorial or blog

-reliable secondary source written by experts

-published in a respected database

-accurately reflect current knowledge

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

Within management, there is information about initial evaluations right after diagnosis, treatment of manifestations, surveillance and agents to avoid. For causes, there is information genotype-phenotype correlations.

Management - Proposed Changes
The treatment of Noonan syndrome varies greatly for people depending on resultant complications but tend to be quite standard, reflecting the treatment of the general population. Management guidelines, divided by systems, including general, developmental, dental, growth and feeding, cardiovascular, audiological, haematological, renal and skeletal, that account for actions to be taken at diagnosis, after diagnosis and if symptomatic, have been published by an American consortium.

Specifically, treatment of cardiovascular complications resemble that of the general population and treatment of bleeding diathesis is guided by the specific factor deficiency or platelet aggregation.


 * Neuropsychological testing is recommended to find strengths and challenges to tailor support needed for school and career.
 * Educational customization such as an individualized education program plan is sometimes needed for school-aged children.
 * Speech therapy if speech and articulation issues present
 * Physical therapy and occupational therapy for gross- and fine-motor delays
 * Hypotonia and motor difficulties often impact handwriting. Accommodations for lessening handwriting demands will improve performance and save long-term hand function.

Anesthesia risk
Although a few people with Noonan syndrome have been reported to develop malignant hyperthermia, the gene mutation of diseases known to be associated with malignant hyperthermia is different than that of Noonan syndrome.

Rationale for Proposed Changes
For my first change, I added the opening paragraph. I felt that there was lack of clarity regarding management/treatment considering NS may present differently for many people and that the treatment/management will resemble standard care of general population. I also wanted to mention the management guidelines which is much more comprehensive and detailed. In our meeting, we had discussed cardiovascular issues and haematological issues so I added a sentence about those. I also changed the anesthesia risk to make it clear that it is not associated with NS (as we had discussed in our meeting). All of these changes are really important for people looking up NS as it provides a base of what to expect moving forward after a diagnosis. I have cited where the information is from.

Critique of Sources
I was worried that the source from Gene Reviews is from 2001 but it has been updated in 2019. The management guidelines are however, from 2013 which is more recent. Both sources have Dr. Allanson as an author, an expert in the field which is considered a strength, and do not appear to be based on "conventional wisdom or advice". The Gene Reviews source went through a rigorous peer review process but I could not determine the process of finding the references making it difficult to comment on bias. In briefly reviewing some of the provided sources, they appear strong. For the management guidelines, only English sources were reviewed introducing the English bias. There appeared to be a well-defined question to initiate the search but it may have been further limited because it was just on PubMed and only included reports (and relevant references). It is possible that there is a publication bias for the topic of management, as statistically insignificant results may be published less often. The selection and quality of the references chosen for the guidelines appear strong.