User:Nunavut1999/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.

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 (Practice) =

Wikipedia Assignment #2: (COPY FOR REFERENCE)
Sentences to improve: The disorder may coexist (in a half of cases)[12] with polymyalgia rheumatica (PMR), which is characterized by sudden onset of pain and stiffness in muscles (pelvis, shoulder) of the body and is seen in the elderly. GCA and PMR are so closely linked that they are often considered to be different manifestations of the same disease process. Other diseases associated with temporal arteritis are systemic lupus erythematosus, rheumatoid arthritis, and severe infections.[citation needed]

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

In BMJ Best Practice I searched for information on "Giant Cell Arteritis" and found the information in the "diagnosis" section. Particularly, I used the differential diagnosis section to compare differentiating signs/symptoms and differentiating tests sections for polymyalgia rheumatica, rheumatoid arthritis and systemic lupus erythematosus.

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


 * APA Citation for BMJ Best Practice that was identified and used:

Warrington, K. J., & BMJ Publishing Group,. (2018). BMJ best practice.


 * I also conducted a search on PubMed, but ended up not using it.

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

Most reviews on PubMed do not discuss the relationship of GCA with polymyalgia rheumatica, systemic lupus erythematosus, rheumatoid arthritis, etc. together, but BMJ BP does. Moreover, the sentence that I am editing is from the “signs and symptoms” section of the Wiki page, but most PubMed reviews discuss diagnostic imaging, gene expression, etc. for GCA which are not relevant. There is already a separate imaging section in the Wiki article. However, BMJ BP looks in detail at the signs and symptoms. That is why I didn’t use any PubMed papers, even though I had identified this resource.

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

1 - BMJ BP evidence syntheses are secondary sources, which are higher up on the hierarchy of evidence.

2 - It was written in December 2018 and reviewed in October 2019, so it is very recent.

3 - Not only is BMJ BP a major medical authority, but also it is peer-reviewed.

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

A citation was missing for the last sentence in the section that I am editing, which my source can cover. Moreover, the line may be misread to mean that systemic lupus erythematosus, rheumatoid arthritis, etc. are diseases that may co-exist with GCA, when in reality, they are diseases that may mimic GCA. Using my source, I will fix this shortcoming. Moreover, I can also use my source to further explain how to differentiate between GCA and polymyalgia rheumatica using symptoms.

Proposed Changes
My proposed changes will affect the "Associated conditions" sub-section under the "Signs and symptoms" section. Particularly, I am editing the second paragraph of this sub-section.

(Changes are in bold. Words that will be removed are strikethrough .)

The disorder may coexist (in a half of cases) with polymyalgia rheumatica (PMR), which is characterized by sudden onset of pain and stiffness in muscles (pelvis, shoulder) of the body and is seen in the elderly. GCA and PMR are so closely linked that they are often considered to be different manifestations of the same disease process. However, although they can co-exist, PMR usually lacks the cranial symptoms, including headache, pain in the jaw while chewing, and vision symptoms, that are present in GCA. Other diseases that resemble associated with temporal arteritis are systemic lupus erythematosus, rheumatoid arthritis, and many severe infections as well as cancers and haematological malignancies '''among others. ''' The sentences in the changes are written very well. I think the last sentence will be confusing for non-medical readers and may cause some panic. It is important for clinicians to know this, but I think patients may find it overwhelming.

Rationale for Proposed Change
Edit #1: I decided to add a line about the difference between PMR and GCA symptoms. This is because just as HIV and AIDS are often confused as the same disease, unaware readers may accidentally confuse PMR and GCA as the same presentation based on the emphasis in the preceding line. However, it is important for readers to be able to differentiate between these two diseases. I won't be changing the preceding line as it has a good point and is well written, so I am addressing the differences between the diseases instead. These differentiating symptoms were identified from the BMJ BP page for GCA, particularly from the differential diagnosis section for PMR (see reference #3).

There may be some controversy regarding whether the differentiating factor of cranial symptoms for GCA versus PMR is really necessary or relevant for the page. However, I will argue that it is important to emphasize to readers that GCA and PMR are indeed different diseases, since the present format may misleadingly hint that they are components of the same disease, and BMJ BP uses the cranial symptoms as a major distinguisher between the two. Moreover, I have used simple language to explain the different medical terms and jargon found on the BMJ BP page, but my use of the complex term "cranial symptoms" may be controversial since many readers may not know what "cranial" means. However, no other word is as accurate or encompassing as this term in this context from a symptom's perspective and is a relatively simpler medical term, so I have mediated this controversy by linking the word to it's Wikipedia definition for those readers who need additional explanation. Good idea to say that they are connected but not the same thing. Good idea to link the words.

Edit #2: I also edited the last line, because considering the preceding topic, this line may be misread to mean that systemic lupus erythematosus, rheumatoid arthritis, etc. are diseases that may co-exist with GCA. I wanted to clarify that they are actually diseases that mimic GCA on a differential diagnosis list. I also added "cancers and haematological malignancies among others" to the list as they are a class of diseases that are important to compare with GCA and are higher up on the list of differential diagnoses in the BMJ BP page - the source from which the understanding for this edit was obtained.

Again, there may be controversy regarding the changed terminology and addition of the new disease group to the list. However, as explained above, I will argue that it is important to not confuse readers with improper terminology and to also remind readers of the risk of malignancies that are associated with similar symptoms as GCA. Moreover, I recognize that there is a lot of medical jargon in this line, but there are no simple synonyms for these diagnoses. Thus, I have mediated this controversy by linking the diagnoses to it's Wikipedia definition for those readers who need additional explanation about the diseases, just as the original author of this line had done. I think removing this line because of the medical jargon and what I mentioned above would be appropriate.

Critique of Source
The main source used to make the edits involves reference #3 from BMJ BP. Initially, I had planned to use PubMed papers, but I quickly noted that these recent review papers were biased towards a certain topic or theme, such as diagnostic imaging, gene expression, etc. which are not relevant to the sentences that are being edited. As such, I opted to use the more generalized and symptom-based BMJ BP source for GCA.

BMJ BP is an evidence-based point-of-care tool (practice guideline) that provides clinical decision support. However, using a simplified version of the AGREE tool, it is seen that biases and validity concerns still exist for this source.

Scope and Purpose:


 * The GCA guideline provides information on the basics, prevention, diagnosis, treatment, follow up and guideline links for healthcare professionals dealing with patients with all stages of GCA. Thus, a wide range of information is explored.

Stakeholder Involvement / Editorial Independence:


 * Looking at the credentials of the author, Dr. Kenneth J. Warrington, we see that he is a professor of Medicine in Mayo Clinic. The main author’s employer receives payments from Eli Lilly and GlaxoSmithKline for his role as investigator in giant cell arteritis clinical trials. The main author has also conducted consulting work for Sanofi and is an author of a number of references cited in this topic. Therefore, there is definitely much selection bias for the articles chosen due to financial conflict and affiliations as a researcher!
 * The reviewers, Dr. Gene Hunder and Dr. Kuntal Chakravarty, do not have any disclosures and are both rheumatologists from Mayo Clinic or BHRT University Hospital (Queen’s Hospital) of the UK, so individual biases due to their professional specialty may exist. No other major red flags are seen here, but more information would be needed to confirm.
 * There were no other external review or inclusion of non-physician experts or community/patient stakeholders for this point-of-care tool.
 * BMJ Best Practice is a relatively renowned medical authority and publisher.

Rigour of Development / Clarity of Presentation / Applicability:


 * Conscious and unconscious biases of the BMJ BP authors and reviewers can affect the overall message of the pages, especially based on an individual’s outlook, education/training and past experiences when deciding which papers to use and while writing clinical decision recommendations. In other words, personal experience or conventional wisdom may have been used to guide recommendations and information as opposed to a more structural approach.
 * Publication bias is common in these point-of-care resources, as many of the papers used were published in the UK and USA and are thus subject to English language bias.
 * Both the author and reviewers are from the UK, so there may be some selection bias of their recommendations and the evidence used.
 * Reviewing the BMJ BP page's references section reveals the use of several cohort, case-control and case studies, which are lower down in the hierarchy of EBM, and there is ambiguity as to whether these papers were scrutinized throughly for their individual biases and validity issues. The strengths and weaknesses of included papers were not evaluated or shared.
 * The references section uses many outdated papers (going back as far as the 1990s), which are not qualified for Wikipedia use as per the WP:MEDRS guideline, so there is some concern about the applicability of some of these papers and the filtered knowledge used in the BMJ BP page in the present day.

However, considering the reputation of BMJ BP, the peer-review process and the fact that the page was written/reviewed quite recently make this source still quite reliable for the purposes of the sentences that I am editing. My Wiki sentences cover a topic for which objective medical knowledge (not statistics or recommendations) is required and information for this topic has not changed much with time. The particular information that was used from BMJ BP is quite generalized, so the above concerns of source validity do not impact my edits to a significant extent. Good use of a tool to look at validity. You are right that many references will be older, as this is an established relationship of diseases, and other features like imaging are areas of interest now. Good pick up after reviewing the literature.