K. Dean Reeves, M.D.

Hi Dr. Reeves, can you tell me where you found Wikipedia guidelines stating it is permissible (or recommended) that primary sources can be summarized but their respective conclusions can not be used as discussed in your edit summary for your reversion? Thank you. If you cannot find this, we may have to discuss undoing those changes again to be in line with Wikipedia rules/guidelines such as WP:MEDRS, WP:NOR, and WP:SYNTH. TylerDurden8823 (talk) 21:26, 29 October 2014 (UTC)

Tear TYlerDurden8823,

I made contact with wikipedia directly at: info-en@wikimedia.org I understand now that the NOR policy means you can't offer FINDINGS or CONCLUSIONS from original research on the page. However: - Can you mention that there is level I and II research available, cite them WITHOUT CONCLUSIONS, and direct readers to a site in which they can read the original articles? - If a review was lacking because it was done before key literature was published, can that be mentioned along with listing the citations of the missing references, again without listing content from the original research? - If impartial academic review or original research (Most notable Essential Evidence Plus; Similar to Cochran but reviewing individual articles) reviews original research, can the results of such academic reviews be mentioned on the page.

Thank you,

K. Dean Reeves, M.D. University of Kansas

The reply I received was the following: Dear Dean Reeves,

That is fine, the "No Original Research" content policy only requires that content listed on Wikipedia be verifiable and attributable in other reliable sources <https://en.wikipedia.org/wiki/WP:RS> and that no conclusions be made based on original material.

Yours sincerely, James Lu

Tyler, I am grateful for your guidance and your education, which I sorely needed as a novice to this system, but your interpretation of NOR, MEDRS and SYNTH appear to be too strict per my reading and according to the above. Now that the World Series is over (I am from Kansas City) I will look at your changes. (Thank you, I will assume they are helpful) I will be making more changes per comments above via Mr. Lu. Constructive criticism is wonderful and I will keep looking at those guidelines and have them printed out as I proceed.

May I ask, what is your keen interest in this area?

Do you think we better ask for mediation early on?

Dean Reeves

Recent Prolotherapy Edits

Not a problem Dr. Reeves. In the future, I think it would be easier for you to ask questions at the Wikipedia: Wikiproject Medicine talk page. There are several experienced editors there and many of them work tirelessly on medical pages. I asked an experienced editor who made several large edits on the page and he agreed that the added content contained a significant amount of information that should not be there. If the information is not yet present in a literature review, we usually don't cover it (i.e., we don't use generic statements such as "more research is needed" or "there is a need for additional high-quality randomized controlled trials", etc. because it would be on so many pages in Wikipedia and is often true for years and years). The best we can do is simply update articles as newer reviews emerge. Additionally, we usually (some of these were kept) do not like to use primary studies as references in articles per WP:MEDRS and secondary or tertiary sources are strongly preferred (usually secondary such as literature reviews, systematic reviews, meta-analyses, etc even though those are not perfect and have their own issues). As for what Mr. Lu said, here is the problem-many of the sources did not explicitly say that they offered level 1 or level 2 evidence for the use of prolotherapy for a specific indication and that is using those sources in a manner that violates WP:NOR and WP:SYNTH. This is the problem here according to synth "Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources. Similarly, do not combine different parts of one source to reach or imply a conclusion not explicitly stated by the source". Most of those sources did not explicitly discuss the level of evidence offered. What is really needed (and will probably emerge soon if we wait a while) is a review discussing the levels of evidence offered by such studies or stating there is low, moderate, or high-quality evidence for the use of prolotherapy for indication X.

If you look around on other medically-themed pages, you won't see most of them discussing levels of evidence in the format of level I, II, II, etc. evidence. There was also no citation verifying the USPSTF's definition of the evidence levels and in the future I think that would be an important thing to include as well so readers can verify that the USPSTF indeed defines the evidence levels this way. Furthermore, on the WP:MEDRS page you'll see that recent secondary sources (say within the last 5 years) are preferred (though older sources can be used (e.g., a really good review from a notable journal came out 7-8 years ago and newer reviews haven't been so good, then by all means use it, we don't want to fall victim to WP:Recentism. I hope this clears things up. If not, might I suggest asking at the Wikiproject Medicine talk page. There are many editors there far more experienced than I whom you can speak to there. As for my interest in prolotherapy, I just think it's an interesting and still somewhat controversial topic. There's really no need to explain beyond that since it's not relevant to my editing. I edit a wide variety of medicine pages and non-medicine pages as well. Please be sure to let me know if you have additional questions, concerns, comments, etc. At this point, mediation is not necessary (that's usually for VERY vigorous/heated debates that are looking like they will turn into edit wars (which should absolutely be avoided-if there's a debate, take it to the article's talk page). I think you'll get your answers (if my response didn't adequately answer the posed questions) on the Wikiproject: Medicine talk page. You can discuss the proposed content there and ask if (and why) anyone would have the same concerns I had. TylerDurden8823 (talk) 15:54, 1 November 2014 (UTC)

Thanks, Tyler. You obviously know your stuff. Lets do this right. If I may, since you already know this topic, may I rely on you primarily then? I will go over the changes first and then, mindful of the above, see what I can usefully do. I will try not to make your fine work more difficult. If it would be better, I might be able to suggest changes here rather than on line to see what you think first?

) Dean

Reference Errors on 1 November

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References

We at Wikipedia love evidence-based medicine. Please cite high-quality reliable sources. We typically use review articles, major textbooks and position statements of national or international organizations. A list of resources to help edit such articles can be found here. The edit box has a build in citation tool to easily format references based on the PMID or ISBN. WP:MEDHOW walks through editing step by step. We also provide style advice about the structure and content of medicine-related encyclopedia articles. The welcome page is another good place to learn about editing the encyclopedia. If you have any questions, please feel free to drop me a note. Doc James (talk · contribs · email) 02:06, 2 November 2014 (UTC)

Dear Doc James:

You have done some excellent editing. Thank you. I do need to interact with you more at this point, however. You are aware that the evidence based pyramid consists of Filtered information

 Systematic Reviews
 Critically-Appraised Topics (Evidence synthesis and Guidelines)
 Critically-Appraised Individual Articles (Article Synopses) 

Unfiltered information

  Randomized Controlled Trials 
  Cohort Studies 
  Case Controlled Studies 
  Background Information/Expert Opinion

Wikipedia guidelines indicate a preference for filtered information. There is no more reliable source of Critical SECONDARY Appraisal of Individual Articles than Essential Evidence Plus. They only select about 280 articles a year as worthy of a POEMS assessment. They grade the article impartially. There are topics that have not yet undergone systematic review or topical review. Essential Evidence is a worthy of secondary evaluation that meets your criteria.

I would appreciate your reversal of the changes or further explanation. I will await your response. Please get on line and check out Essential Evidence.

Kind regards,

Dr Reeves

OSD Treatment With Dextrose Injection (Prolotherapy) has been Strongly Secondarily Reviewed and Deemed Appropriate for Treatment By Many Academic Sources

Essential Evidence "Patient Oriented Evidence that Matters - POEMS"

http://www.essentialevidenceplus.com/product/features_dailyip.cfm "An injection of a solution of 12.5% dextrose and 1% lidocaine is an effective treatment of Osgood-Schlatter disease (OSD) symptoms in young athletes. (LOE = 1b-)" "Daily POEMs identify the most valid, relevant research that may change the way you practice. Monthly, the complete set is compiled and sent for additional summary review. Each Daily POEM is also added to the Daily POEMs database in Essential Evidence Plus, for easy future reference. Ongoing since 1996, our editors now review more than 1,200 studies monthly from more than 100 medical journals, presenting only the best and most relevant as POEMs. The acclaimed POEMs process applies specific criteria for validity and relevance to clinical practice. About 1 in 40 studies qualifies."

New England Journal of Medicine Journal Watch

http://www.jwatch.org/pa201111090000002/2011/11/09/dextrose-injections-have-osgood-schlatter November 9, 2011 Topel at al was reviewed by NEJM Journal Watch under the heading of "Dextrose Injections Have Osgood-Schlatter Disease on Its Knees. The conclusion of Cornelius W. Van Niel, MD, the Associate Editor of NEJM Pediatrics and Adolescent MedicineSection was "Dextrose injections have shown efficacy in other tendon and connective tissue conditions; they are thought to reduce neovascularity, pain-producing neuropeptides, or both. This study shows a promising option for adolescent athletes with stubborn OSD: either dextrose/lidocaine or lidocaine-only injections can help them play without performance-altering discomfort, and dextrose injections can help them play symptom free".

===Priority Updates in Research Literature (PURLs) in the Journal Of Family Practice=== http://www.jfponline.com/fileadmin/jfp_archive/pdf/6108/6108JFP_PURL.pdf The Jounral of Family Practice selected the article for review for their monthly PURLs review of important research. Their conclusion was "Consider giving dextrose/lidocaine injections to adolescents with Osgood-Schlatter disease (OSD) that persists despite physical therapy." Strength of recommendation. A . Based on one well-designed, randomized controlled trial.

Medscape Multispeciality Review Continuing Education

(http://www.medscape.org/viewarticle/751311) Medscape Multispecialty Review chose the article for continuing on-line education with the title "Dextrose Injections Control Symptoms of Knee Pain in Teens", and presented the article in summary with extensive high points, followed by questions for readers to apply for AMA category I credit. Here are the questions: A. Which of the following best describes effects of lidocaine or dextrose injections vs usual care for OSD in adolescent athletes?

   o No difference for asymptomatic sport
   o Superior for unaltered sport
   o Similar for NPPS score
   o None of the above

B. 15-year-old athlete with OSD is treated with dextrose with lidocaine injections for knee pain. Which of the following outcomes is most likely to occur compared with treatment with lidocaine-only injections?

   o  Better performance at sports
   o  Improved sleep
   o  More likely to be asymptomatic
   o  Better school attendance

Standard Recertification Testing in Family Practice

The use of dextrose for treatment of OSD has appeared in standard recertification testing in family practice. Yes I can provide this reference but this is superfluous given the above. Please also note that Wikipedia itself in the OSD section lists the study in the following way. https://en.wikipedia.org/wiki/Osgood%E2%80%93Schlatter_disease "Medical injections to the patellar area such as Hyperosmolar Dextrose injections are effective and safe for treating tendon and cartilage degeneration.[25]"

You cannot ask for more evidence of strong secondary review.

Hi Dr. Reeves, just so you know, Doc usually prefers to have comments left on his talk page if you wish to discuss the matter further and continue the conversation. I would discuss it there. TylerDurden8823 (talk) 22:27, 2 November 2014 (UTC)

Hi, it looks as if you may have not yet have grasped some key concepts: Wikipedia is not considered to be a reliable source (WP:CIRCULAR). Most Wikipedia editors are (nearly) anonymous, so even in the aggregate, we can't be trusted by readers to have gotten things right (WP:NOR). Accordingly readers need a cited reliably published secondary source which they can check in order to determine if a primary source deserves their trust or even their attention (WP:UNDUE). Wikipedia cannot provide that trustworthy determination. Real-world experts are often disconcerted by this editing environment, but there is an answer. If the 'real-world you' assesses a neglected primary source to be trustworthy and noteworthy, (s)he can cite that source in a secondary work in the peer-reviewed literature. Then that becomes fair game for citation on Wikipedia. In most cases, however, the more practical answer is to wait until someone else reviews it. After all, Wikipedia has no deadline (wp:NODEADLINE). Another alternative that sometimes arises is to use the primary source, but not to put its findings in the "voice of the encyclopedia": "A small clinical study by Jones and Smith in 2014 reported that..." We try to avoid overusing such statements, but when used with care they can have some value. To do so, it is usually best to first discuss them on the article talkpage, so that it is clear to editors why it was necessary to use them. LeadSongDog come howl! 21:34, 3 November 2014 (UTC)