User:Nwedel/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

Assignment 2:

 * 1) Went to the MeSH database in Pubmed and searched ‘alpha-thalassemia’ and added the subheading ‘diagnosis’. Added additional filters to only get search results for articles in English, that are within the last five years and are limited to only: guidelines, meta-analyses, practice guidelines, reviews and systematic reviews.
 * 2) I looked through the 43 results and found a few that looked promising. However, several were too specific such as focused on prenatal screening or a specific alpha-thalassemia syndrome (ie. H Bart’s hydrops fetalis syndrome). The most promising was the first one “Clinical Classification, Screening and Diagnosis for Thalassemia” from the Hematology/Oncology Clinics of North America. The next most promising was the second one “The Alpha-Thalassemia’s” from the New England Journal of Medicine.
 * 3) I chose the first option, “Clinical Classification, Screening and Diagnosis for Thalassemia” from the Hematology/Oncology Clinics of North America. This article was more recent, published in 2018 and was published in journal specific to blood disorders. This article was also more focused on the information that was most relevant to my search; screening and diagnosis. While the article was general to all thalassemia syndromes, it did mention the effectiveness of each technique for specific alpha-thalassemia syndromes.
 * 4) Three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria:
 * 5) Current knowledge (articles is less than 5 years old)
 * 6) Literature review (secondary source)
 * 7) Published in a reputable medical journal (Hematology/Oncology Clinics of North America)
 * 8) I will use this source along with a few others to explain the different diagnostic tests for alpha-thalassemia and why/when you would need to have the different tests run. This information is currently lacking from the original article.

Proposed Changes: Addition of 'Laboratory Diagnosis' subheading underneath the heading "Diagnosis", after the subheading 'Types'
LW Comments: Agree

Initial laboratory testing should include a complete blood count and red blood cell indices. As well, a peripheral blood smear should be carefully reviewed.

Hemoglobin analysis is important for the diagnosis of alpha-thalassemia. Several different methods are used to separate the different species of hemoglobin molecules (ie. hemoglobin electrophoresis, capillary electrophoresis, high performance liquid chromatography).

'''LW Comments: I think these sentences could use a bit of work. I might put something like "Hemoglobin analysis is important for the diagnosis of alpha thalassemia as it determines the types and percentages of types of hemoglobin present. Several different methods of hemoglobin analysis exist, including hemoglobin electrophoresis, capillary electrophoresis and high performance liquid chromatography."'''

Molecular analysis of DNA sequences (DNA analysis) can be used for the confirmation of alpha-thalassemia diagnosis ("of a diagnosis of alpha thalassemia), particularly for the detection of alpha-thalassemia carriers (deletions or mutations in only one or two alpha globin genes).

LW Comments: Good use of language and wiki-links.

Rationale:

 * 1) Introduce the new subheading "Laboratory Diagnosis" underneath the heading "Diagnosis", after the subheading "Types".
 * 2) * The current diagnosis section does not elaborate on what tests are performed for the diagnosis of alpha-thalassemia.
 * 3) * The added information should be listed after the subheading "Types" because the different variants of alpha-thalassemia have a bearing on which diagnostic test is the most appropriate.
 * 4) Introduce the current best practice diagnostic testing for alpha-thalassemia based on information from BMJ Best Practice and the Hematology/Oncology Clinics of North America.
 * 5) * Important to understand how alpha-thalassemia is diagnosed and how the diagnostic tools change depending on the variant of alpha-thalassemia
 * 6) * Kept the information simple with wiki-links to explanations of the different tests if the reader desires more information

'''LW Comments: Good rationale. I definitely agree with both choice of sources and placement decisions.'''

There was little controversy between the sources that I found in terms of the best practice for laboratory diagnosis of alpha-thalassemia. One of the sources mentioned additional diagnostic and screening testing that could be done as well as some newer modified versions of the current best practice tests. This source also listed the advantages and disadvantages of the different tests, including their clinical relevancy. Since this is a Wikipedia article, I chose to list the most commonly used and least controversial tests that were common between the different sources.

'''LW Comments: Good! Yes, those were wise decisions.'''

Critique of Source:

 * 1) BMJ Best Practice :
 * 2) * Reliable and reputable source with current knowledge (latest evidence-based research)
 * 3) * Practice guidelines that have been vetted by external reviewers (international experts and practicing clinicians) and internal reviewers
 * 4) ** Daily monitoring and continuous updating
 * 5) * Bias: the main author and one of the peer reviewers disclosed potential conflicts of interest
 * 6) **Financial relationship with a proprietary healthcare company is a red flag that indicates an element known to introduce potential bias
 * 7) *** Despite this, due to the strong vetting process of BMJ, this does not impact my decision to use this information
 * 8) ***The information cited in BMJ, is also backed up in other sources
 * 9) Hematology/Oncology Clinics of North America :
 * 10) * Published in a reputable and relevant medical journal as a literature (narrative) review, and is current knowledge
 * 11) * Bias: authors declared that they have no conflicts of interest to disclose
 * 12) *Bias: narrative reviews have some inherent bias
 * 13) **Potentially biased sources search and selection
 * 14) ***strengths and weaknesses of papers not evaluated
 * 15) **However, the article was methodical and well-referenced (evidence-based inferences)

I have no major issues or concerns with my sources.

'''LW Comments: Good choice of sources and well critiqued. Other things to consider would be what kind of articles did they use to create the guidelines? Systematic reviews vs cohort studies vs RCTs? Also, what system did they use to evaluate the guidelines (i.e. GRADE recommendations)?'''