User:Raahulan05/sandbox

Proposed Changes
Currently under the "Diagnosis" section, the article reads:

Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the following symptoms: cough, coryza, or conjunctivitis. Observation of Koplik's spots is also diagnostic. Laboratory confirmation is however strongly recommended.

The proposed addition would include a differential diagnosis as follows:

Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the following symptoms: cough, coryza, or conjunctivitis. Observation of Koplik's spots is also diagnostic. It is important to consider and rule out other possible diagnoses that include parvovirus, dengue fever, Kawasaki disease, and scarlet fever. Laboratory confirmation is however strongly recommended.

ET-Good inclusion and very clear.

Rationale for Proposed Change
The added sentence introduces that a differential diagnosis exists which highlights other diseases that may have a similar clinical presentation to measles. This information comes from the Centre for Disease Control (CDC) Manual for the Surveillance of Vaccine Preventable Diseases. The added information gives more insight to the public that some diseases may present similar to measles, as the current measles page does not have any mention of similar presentations.

Critique of Source
The measles Wikipedia page has protective safeguards to prevent false and inaccurate information from being disseminated on the page. This is because, the topic is subject to controversy because of vaccines and the anti-vaxxer movement. However, adding the differential diagnosis does not have any considerable implications in the controversy surrounding vaccine use.

The proposed addition to the diagnosis chapter of the measles Wikipedia page uses the CDC's Manual for the Surveillance of Vaccine Preventable Diseases as secondary source to support the differential diagnosis. The guidelines manual was published by a reputable national health agency and regularly edited and updated by health professionals. Their own internal reports highlight the culture of scientific integrity that the CDC maintains. This includes various levels of review and oversight before any publications can be made public.

The chapter on measles in the manual has an exhaustive list of primary sources that the authors referenced and constantly update which helps strengthen the confidence in the validity of results. As a guidelines-based chapter, the source could include more systematic reviews and an inclusion of patient stakeholders as these would improve the applicability of the guidelines (i.e.improves generalizability). The report is solely revised and edited my health experts. A potential source of bias that was considered while deciding to use this source was reporting bias. Because the CDC is a governmental department, there is the chance of withholding or disseminating information on the basis of the current political direction of government. For example, if the government was trying to promote vaccine rates, there may be more positive reporting in the manual. However, given the stringent guidelines of the CDC is scientific integrity, this bias seemed to be minimal.

ET-Well thought out.

Wikipedia Project Pt. II: Literature Search
Goal:There is a need for a differential diagnosis of measles, specifically with external exanthems, that should be added to the Wikipedia page concerning measles.

Search Strategy:

The PubMed database and the point-of-care resource UpToDate were used in the search strategy. For PubMed, the search included the Medical Subject Headings (MeSH) terms measlesand diagnosis, differential. On UpToDate, a simple search strategy of measles AND differential diagnosis was used.

Search protocol for PubMed:

"Diagnosis, Differential"[Mesh] AND "Measles"[Mesh]

Potential Sources:

1.     Buonsenso, D., Macchiarulo, G., Supino, M. C., La Penna, F., Scateni, S., Marchesi, A., Reale, A., & Boccuzzi, E. (2018). LABORATORY BIOMARKERS TO FACILITATE DIFFERENTIAL DIAGNOSIS BETWEEN MEASLES AND KAWASAKI DISEASE IN A PEDIATRIC EMERGENCY ROOM: A RETROSPECTIVE STUDY. Mediterranean Journal of Hematology and Infectious Diseases, 10(1), e2018033. https://doi.org/10.4084/mjhid.2018.033

a.    At first glance, this paper offers an evaluation criterion using laboratory results in order to differentiate diagnosis between Kawasaki disease and measles.

2.    Gastanaduy, P., Redd, S., Clemmons N., Lee, A., Hickman, C., Rota, P., & Patel M. (2019). Manual for the surveillance of vaccine-preventable diseases, Chapter 7: Measles. Centers for Disease Control and Prevention

a.    This manual on the various vaccine-preventable diseases includes a chapter specific to measles. The chapter includes a differential diagnosis and the necessary additional tests to rule out other diseases that present similar to measles.

Selected Source and Rationale:

The third source, Manual for the Surveillance of Vaccine-Preventable Diseaseswas selected because it comes from a reliable source, a national health organization. It is a secondary source (whereas the first potential source was a retrospective study (primary source) and has been written and edited by multiple health experts and peer reviewed. The manual was first written in 1996, however it is constantly updated and reviewed. The last review of the measles chapter was May 13, 2019, highlighting the article’s recency. The review article gives a global view of measles, while also having specific information on differential diagnosis.

Reliable Medical Source – Evidence

1. The chapter from the manual is published by a national health organization(Centre of Disease Control and Prevention). The information is accessible and available in medical databases as well as directly though the CDC.

2. The chapter is a secondary source that references many primary sources and other health organization articles and all information disseminated is evidence-based and traceable to other sources.

3. Much of the investigations and queries on measles were done in previous decades, however the chapter is constantly being reviewed and updated, ensuring that the article has up-to-date evidence.

Implementation Plan

The diagnosis chapter in the measles Wikipedia page is brief and does not have any mention of differential diagnosis. To mitigate this problem area of the page, this source will have two purposes. It can be used to provide insight on the various diagnoses that need to be ruled out when. The secondary use of the article can be used to also highlight the necessary testing to confirm a measles diagnosis as well. It is important that the information is communicated in an accessible fashion due to the large and diverse population that will access the measles’ Wikipedia page.