User:Sdemay/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

= Alpha-Thalassemia =

Wikipedia Assignment #2
1) The question I looked to answer was “When is a splenectomy an appropriate treatment approach for alpha-thalassemia?” I conducted a search in PubMed by searching for MeSH terms for “Alpha-Thalassemia” and “Splenectomy”. I then added filters by language of “English”, publication date of “5 years”, and article type including “guideline, meta-analysis, practice guideline, review, and systematic review”. One review article was found. I also searched BMJ Best Practice for “alpha-thalassemia”. I then went to the “guidelines” section and found International and North American management guidelines. Five guidelines were found.

2) Gallagher PG. Diagnosis and management of rare congenital nonimmune hemolytic disease. Hematology Am Soc Hematol Educ Program. 2015;2015(1):392-9. doi: 10.1182/asheducation-2015.1.392

I considered this article because it discusses the treatment options, including splenectomy for hemolytic disease, including alpha hemoglobinopathies; however, the focus of this article is not specifically on alpha-thalassemia and the relevant information on this topic was brief.

Thalassemia Foundation of Canada. Guidelines for the Clinical Care of Patients with Thalassemia in Canada. http://www.thalassemia.ca/wp-content/uploads/Thalassemia-Guidelines_LR.pdf. Published 2016. Accessed November 5, 2019.

I considered this article because it includes up-to-date information (published 2016) and includes relevant information on splenectomy in thalassemia treatment; however, the information on splenectomy is brief and the guideline does not contain information specific to different genotypes of alpha-thalassemia.

3) I chose the following source:

Thalassemia International Foundation. Guidelines for the management of non-transfusion-dependent thalassemia (NTDT) (2nd edition). https://issuu.com/internationalthalassaemiafederation/docs/ntdt-final- combined. Published 2017. Accessed November 5, 2019.

I chose this source because it is the most relevant to my question, up-to-date, and at the highest level of evidence since it is an International guideline. The article has a focus on the most common genotypes of alpha-thalassemia, thus the information is more relevant in comparison to other identified sources that were too broad in scope by including all hemolytic diseases. Also, it contains the most information on splenectomy by including an entire chapter specifically on this treatment approach.

4) Three reasons why the source meets Wikipedia’s reliable medical sources criteria:

1. The source is a secondary source (guideline) that provides an overview of the topic.

2. The source was published by a reputable medical organization (Thalassemia International Foundation).

3. The source is up-to-date evidence, published within the last 5 years (2017).

5) I plan on using this source to update the “treatment” section of the Wikipedia article on alpha-thalassemia. Currently, the article states only that splenectomy is a possible treatment. My aim is to add a few sentences explaining when a splenectomy is an appropriate treatment approach, how it can improve patient outcomes, and the risks associated with this treatment.

Wikipedia Assignment #3
Proposed Changes

The following 2 sentences will be added to the “Treatment” section of the article:

Splenectomy is a possible treatment option to increase total hemoglobin levels in cases of worsening anemia due to an overactive or enlarged spleen, or when transfusion therapy is not possible. However, splenectomy is avoided when other options are available due to an increased risk of serious infections and thrombosis.

'''LW Comments: Excellent! These sentences are clear and free of jargon, and you have appropriately wiki-linked splenectomy and thrombosis.'''

Rationale for Proposed Change

Currently, the article only mentions that splenectomy is possible. This is inadequate because it leaves readers asking many questions and needing to explore outside sources to find answers. I included the first sentence in my proposed change in order to provide readers with the situations in which a splenectomy would be an appropriate treatment option. This is important when relating the information to a person living with alpha-thalassemia. I included the second sentence because of the controversy surrounding splenectomy as a treatment for alpha-thalassemia. I wanted to outline the procedural risks to explain why it is not a common treatment option. Thus, my position is to outline that a splenectomy is a possible treatment option, but I address the controversy by outlining the associated risks and by informing readers that this is not a common treatment option.

'''LW Comments: Good! I agree. You balanced the controversy part of it well.'''

The reference to support my content is the following international guideline document:

Thalassemia International Foundation. Guidelines for the management of non-transfusion-dependent thalassemia (NTDT) (2nd edition). https://issuu.com/internationalthalassaemiafederation/docs/ntdt-final-combined. Published 2017. Accessed November 5, 2019.

Critique of Source

The source that I chose is an international clinical practice guideline document, which is at the highest point on the hierarchy of evidence pyramid. The guideline has some strengths and weaknesses as a source. Strengths include a lower likelihood of bias due to the nature of practice guidelines collecting systematic reviews and consensus from experts. Specifically, this guideline states that it contains collective recommendations from an international group of experts. Although most references in the guideline include reviews, other types of evidence were included, such as retrospective cohort studies. This is one weakness since guidelines are the most optimal when they collect data from systematic reviews and inclusion of cohort studies could introduce bias. Another weakness is that the guideline does not indicate whether the authors have any financial conflicts of interest, thus it is not possible to tell whether the recommendations are biased. Also, the guideline does not use the GRADE method for recommendations, so the reader does not know the level of evidence behind the recommendations (ex. strong vs. weak). These items may have impacted my extracted information if results were biased by potential conflicts of interest or if reported recommendations were weak. Thus, the results or use of splenectomy may have been overestimated.

'''LW Comments: Good critique of the source. Practice guidelines are particularly good as secondary sources, and being international as well is an added bonus. Yes, the use of cohort studies does weaken the validity as a secondary source, as you rightly note the lack of GRADE method recommendations.'''