Talk:Streptococcal pharyngitis

A record of some comments I made on Simple talk:

I have to say I'm not a great fan of this page as it stands, though I see it's got a GA on enWP. IMO it's not even close to that standard. Our version goes on too long, and in too much detail. As a result some things which are absolutely fundamental get left far too late. You need to say right early on why tests are done. The reasons are 1. The physician usually can't see what causes it just by looking, and 2. In fact, the symptoms are most often caused by viruses, not bacteria. Also, the intro should say clearly that most cases clear up in a few days with no treatment at all. It takes 24/48 hours to do a 'throat culture' (I've never seen the results come back in less than two days!).
The issue of uncontrolled prescribing of antibiotics leading to multiple resistance is extremely important. A generation of young doctors is learning why anitbiotics should not be prescribed unless clearly necessary, yet some medical articles like this blithely talk in language of a generation ago. What I'm saying is that simplification is not the only issue once one is in a technical area like this; and (once again) it is often unwise to import whole articles from enWP. Macdonald-ross (talk) 13:43, 10 February 2012 (UTC)

Am happy to try to address these concerns

1. Per the main page of simple Wikipedia "Simple does not mean short. Writing in Simple English means that simple words are used. It does not mean readers want basic information." Thus I do not understand the statement that this article is too long.

2. Per " The reasons are 1. The physician usually can't see what causes it just by looking" physicians in academic institutions frequently use the Modified Centor score to determine when culture is necessary and when it is not. As a significant portion of the population are asymtomatic carries of group A strep if we cultured everyone who walked in the door regardless of symptoms it would result in over treatment and thus potentially harm thus we do take symptoms into account.

 • The treatment box in the Cantor section suggests "Antibiotic based on culture or RADT" for Cantor scores as low as 2. Are you really saying physicians should or would prescribe antibiotics for minor symptoms? Macdonald-ross (talk)

If the person has two or more symptoms than the recommendation is to test and if the test is positive for GAS treat with antibiotics.--Doc James (talk · contribs · email) 07:06, 12 February 2012 (UTC)

3. Yes most sore throats are caused by viruses however those with 4 or 5 of the modified Centor criteria have a greater than 50% chance of having group A strep. Thus "2. In fact, the symptoms are most often caused by viruses, not bacteria." is not entirely true.

 • OK, I accept that. I was not arguing that antibiotics should not be used. I was (and am) concerned about the rapid evolution of resistance to antibiotics due to over-zealous prescribing for minor symptoms. Macdonald-ross (talk)

Yes so am I. We however treat GAS with penicillin and this bacteria has not yet developed resistance. --Doc James (talk · contribs · email) 07:06, 12 February 2012 (UTC)

4. The clinical important issue is not that "most cases clear up in a few days with no treatment at all". The reason why we treat people with group A strep is to primarily to prevent rheumatic fever. I have added this point to the lead.

 • That's a big improvement. Macdonald-ross (talk)

5. Most cases last "3-5 day duration and treatment reduces symptoms by about one day, and also reduce contagiousness"

 • Reducing symptoms & contagiousness by a day is a benefit (though a minor one), but adds to bacterial resistance to the antibiotic used. Should we not say that?Macdonald-ross (talk)

As stated above we are using penicillin V, one of the oldest antibiotics and one of narrow spectrum. The literature does not comment on concerns of resistance when it comes to treating this condition thus neither should we. Articles on the common cold, urinary tract infection, and acute bronchitis do address the issue of inappropriate antibiotic use as they apply and the literature makes comments in this context. For strep throat antibiotics are deemed appropriate due to the risk of RF and resistance while possible has not occurred in GAS during the last 80 years.--Doc James (talk · contribs · email) 07:06, 12 February 2012 (UTC)

6. I am not sure what part of the article you find incorrect but would be happy to discuss if you come with recent review articles. Having spent 6 month replacing heart valves in Brasil and this has reinforced for me the fact that "strep throat" is not universally a benign disease. --Doc James (talk · contribs · email) 05:34, 12 February 2012 (UTC)

Thank you very much for your reply. The addition to the intro is a big improvement. I've interspersed some comments on points which still trouble me. Macdonald-ross (talk) 06:37, 12 February 2012 (UTC)

Attempted to address more fully.Doc James (talk · contribs · email) 07:06, 12 February 2012 (UTC)

Vocabulary that is not simple

The following words are not simple and need to be removed/rewritten or linked. Then, linked articles should be created simply. I did a few, but these still need attention in the article.

• abscess
• diagnosis
• enlarged
• medication
• outlook
• subtracted
• watchful

Something like diagnosis is going to come up in almost every one of these medical articles. It might be a good idea for the project to have a style guide for their simplification before these come over to Simple. Gotanda (talk) 10:32, 13 February 2012 (UTC)

Agree and will work on creating one. It will be a few weeks before I have time.Doc James (talk · contribs · email) 18:21, 15 February 2012 (UTC)

Have made some changes. For others people may simply need to use a dictionary if they do not understand the word in question. Reading the paragraph can also give people an idea what the words in the headings mean. I could substitute "Usual course" for "outlook" but "outlook" is not really a complicated word.Doc James (talk · contribs · email) 06:49, 19 March 2012 (UTC)

Words like "outlook" appear simple to native speakers of English, but outlook requires a vocabulary of 4,000 words for a non-native reader of English to understand. Guessing the meaning of words from context is generally harder than most people expect. Readers need to understand at least 98% of the words to guess from context, if not more. Gotanda (talk) 09:59, 20 March 2012 (UTC)

Wiktionary definitions not very helpful

I just wanted to explain why I undid linking "irritated" to Wiktionary. Many of definitions there are quite poor. It is also seems that links do not go to the specific entry/part of speech/form but to the headword. In the case of irritated, the definition is "If you are irritated, you are a little angry." which has nothing to do with the usage in the article. Linking to Wiktionary in this way just adds to the task load for readers, but leads them away from the actual meaning. It is much better for readers if we actually simplify directly in the article. Thanks, Gotanda (talk) 01:40, 20 March 2012 (UTC)

I really can't see the point of us having a wiktionary if the two cannot be used to help each other when needs be, Gotanda - there's a difference between "simplifying" and "writing for children", and at the moment, if we're gonna simplify every little thing down to the minutest detail, this article is going to be a bloody mess. Where do you suggest we go from here? BarkingFish (talk) 02:11, 20 March 2012 (UTC)

We do say "your wound looks angry" as synonymous to "your wound is infected" that it is not that far off the mark. Doc James (talk · contribs · email) 15:47, 20 March 2012 (UTC)

I undid the link, explained why, and let you know as a courtesy. The link would take a reader to a definition that would only be confusing. Adding confusing or contradictory information to an article makes it worse not better. I think that much is clear. I have tried to improve articles that are part of your project. I have also offered some constructive suggestions which have not been acted on by Content Rules. I am well aware of what simplifying means in the context of this website. I don't think any of my edits on pages related to the medical project have been damaging or counterproductive. Gotanda (talk) 06:13, 20 March 2012 (UTC)

What I do when simplifying is to check any links to wikt to make sure they do explain the sense of the word being linked. I have reworked many wikt definitions and entered many new terms. However, in principle, wikt is one of our main tools, and it is our policy to use it whenever we can sensibly do so. There are indeed some dopey definitions there, but like all versions of wikipedia it can be improved step by step. The benefit of improving a wikt page is that it helps people editing other Simple pages, whereas an explanation on a particular page helps only that page and those readers. Macdonald-ross (talk) 07:45, 20 March 2012 (UTC)

Sure, when Wiktionary definitions make sense they add to understanding and readability. Improving Wiktionary entries is a good idea too. But, in this case, and in others from these medical articles, the usage is for a more specialized definition. Gotanda (talk) 09:50, 20 March 2012 (UTC)

Then this is something where we need to have a cross-project meeting with some of wiktionary's editors, and see if there is a better way that we can utilize their project - maybe splitting entries into different meanings and interwiki linking directly to the relevant meaning would be a help. There has to be some way we can use their work in such a way as to help our own. As Macdonald-ross rightly says above, it is our policy to use it whenever we can sensibly do so - and in this case I realized that the wiktionary definition wasn't right, and added the 2nd definition of irritate to the entry, in order to not confuse those people who would use it. Maybe it would be a good idea to mark each entry with what it is relevant to (Medicine, Illness, etc) so that we can make use of what should be a valuable resource which is getting overlooked because of things like Gotanda mentions above. BarkingFish (talk) 13:48, 20 March 2012 (UTC)

I'm sure you could just import the {{anchor}} template and do exactly as BarkingFish says, using [[wikt:irritated#definition number|irritated]]. Osiris (talk) 13:46, 20 March 2012 (UTC)

You could even imbed an anchor without using the template, though it's cleaner to use {{anchor}}. Assuming nobody has reverted me over there, try the link now: irritate. Osiris (talk) 13:56, 20 March 2012 (UTC)

You all are making this a bigger issue than it is. As long as the correct definition is on the page then that is all we need to do. Even if people don't know the english language they are likely to know how to use a dictionary in their own language so will understand they have to read all the definitions and see which one fits the context of the sentence they were reading. Have a little faith in our readers. -DJSasso (talk) 14:31, 20 March 2012 (UTC)

Well, while in this case physical irritation is easily distinguishable from emotional irritation, there are many words whose multiple meanings are subtle in their differences. In some cases an editor might feel it important to make sure the reader has understood the exact meaning, especially given that the readers who click on the link will be the ones who are less familiar with the word to begin with. I don't see any great need for it in this case, personally, but if BarkingFish or Gotanda feel it's important, then there's no real harm in making it absolutely clear. Osiris (talk) 14:55, 20 March 2012 (UTC)

Outdent - Let me make this clear. I think it was absolutely fine as it was, it is Gotanda who thinks that it is confusing for people. I am simply trying to placate them and try and find something which works. If I didn't think it was right in the first place, I wouldn't have updated the definition myself and linked it. We're the encyclopedia,. they are the dictionary. We don't define what they should be doing, an d they don't publish encyclopedic articles. The two have a natural connection which is getting broken by things like this. We need to fix it.BarkingFish (talk) 16:33, 20 March 2012 (UTC)

Work in progress

Like all of Wikipedia this is a work in progress. I appreciate the feedback and am planning on spending the next 10 years working on this project. Hopefully we will be able to pull in more people to build upon what we have started. I have had a number of people express interest (beyond content rules) in being involved with simplification and have been directing them this way. If this method is a successful other content areas may also become involved with the potential for expanding the editor base of simple Wikipedia. Doc James (talk · contribs · email) 15:56, 20 March 2012 (UTC)