Talk:Urinary tract infection/GA1

GA Review

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Reviewer: Visionholder (talk · contribs) 20:11, 12 January 2012 (UTC) I will be reviewing this article shortly. Although I do not have a medical background, I do have a background in biology. Anyone with medical experience (aside from the author, obviously) is also welcome to weigh in on this review. – VisionHolder « talk » 20:11, 12 January 2012 (UTC)

Notes for other reviewers:

• I have checked for copyright violations using only the online sources. I do not have access to the journal articles. If someone can check these sources, I would greatly appreciate it.
• Again, I am not a medical expert, so second opinion from someone with said training would be welcome. Otherwise I will treat it as a standard GAN.

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   See comments below.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   From what I can see online, the sources check out.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   Information about the history of the disease would be informative. (See comments below.)

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars, etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   Just one caption needs clarification (see comments below).

7. Overall:

   Pass/Fail:

   Outcome pending on issues given below.

Comments:

• I have corrected the typos I found and knew how to fix. (For example, there were three typos in the second sentence of the lead.) Any additional bad grammar/spelling I find and cannot fix will be listed below. Otherwise, please review the document yourself and double-check everything.

Thanks.--Doc James (talk · contribs · email) 23:02, 12 January 2012 (UTC)

• If the material in the lead is already discussed and cited in the body (and it should be, by definition), and as long as the claims are not highly controversial, you do not need references in the lead. In the case of the two cited bits in the lead, I think it is safe to delete the references. The second citation is a little questionable, only because he discusses treatment, and I can see the importance of a citation for such crucial information. But again, it's in the body, so you could technically remove it.

Yes this is always a tough call. I know that the guidelines say refs are not needed but if you look at Talk:Syphilis many complains can result if the refs are not there. May be a good solution going forwards would be to use the "no wiki" formatting?--Doc James (talk · contribs · email) 23:02, 12 January 2012 (UTC)

Yes, comments are a good way to handle citations that some people might nit-pick over. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• "Urinary tract infections occur most commonly in women with half having an infection at some point..." Do you mean "with most having an infection..."?

I mean occur more frequently in women than in men. Have reworded.Doc James (talk · contribs · email) 23:02, 12 January 2012 (UTC)

• "Pyelonephritis typically occurs secondary to a bladder infection..." This sounds like doctor lingo... which (IMO) is acceptable in the body, but not in the lead. Yes, it's perfectly acceptable English, but most people would say "Pyelonephritis usually follows an bladder infection..." or something like that. It's just good practice to make the lead as understandable as possible, especially since most page visitors will read the lead and only the lead.

Good idea thanks.Doc James (talk · contribs · email) 22:53, 12 January 2012 (UTC)

• I notice that you are very reluctant to use commas. Unfortunately, Wiki's Manual of Style just advises against overuse, but doesn't talk about standard cases. However it does mention the need for commas before conjunctions, such as: "In complicated cases longer course or intravenous antibiotics may be needed and if symptoms are not improving in two or three days further diagnostic testing is needed." You probably need to add a comma before "and" in this case (and others like it). Likewise, you will need a comma in situations like these: "The most common symptoms of a lower urinary tract infection, otherwise known as a bladder infection, are...". I have fixed this last one, as well as removed an unnecessary comma. Please let me know if this looks okay.

I never use commas and must admit I have no idea how... I am however looking for a volunteer copyediter for this project [1] --Doc James (talk · contribs · email) 22:53, 12 January 2012 (UTC)

Sorry, but I'm not that great of a copyeditor, plus I'm busy rewriting over 100 lemur articles more-or-less by myself. Unfortunately, Wiki needs more copyeditors than it needs editors. However, it's always good to review some basic writing guidelines, and this page can really help if you read it once a year: User:Tony1/How_to_improve_your_writing. If some of these ideas can stick, you'll be well on your way to not needing a copyeditor as much. (That's what I do.) Otherwise, since I'm reading the article again, I'll add comas where needed. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• The article uses too many subheadings, especially given how short these subsections are. Personally, I feel that they would be better off as paragraphs within their parent section. In fact, in the section about causes, "Sex" and "Intercourse" are redundant. In fact, I suspect that all subheadings in the article could be removed given their brevity.

Sex refers to whether someone is male or female (cannot use gender as this is psychological rather than physical). Intercourse refers to a physical act. Thus the two sections. I find section are good to keep the subject matter organized and thus hesitant to remove them. It also makes navigation of the article by people who are looking for a specific issue easier.Doc James (talk · contribs · email) 22:53, 12 January 2012 (UTC)

Because the word "sex" can get confused, especially in this case, it may be best to use "gender". Otherwise, I do see the point of what you are saying. In fact, I thought of that originally, so I went looking for a hard, firm rule on subheader use. Unfortunately, there is none. I understand that there is a functional aspect to this organization, but in truth, most of these sections are so short the target material can easily be found without the headers. I'm not suggesting that you merge sections like "Causes" into a single paragraph. Instead, simply removing the subheaders and leaving the content broken into separate (small) paragraphs will still serve the same level of functionality. For example, if the subheaders under "Treatment" were removed, someone jumping to that section would immediately see what each paragraph is about just by a little bit of skimming (which people do anyway). Admittedly, other sections may take more work on your part—under "Diagnosis", for instance, the "In children" subheading provides the only introduction, so "In children" may have to be added to the very first sentence. As it stands, the page suffers from a lot of white-space and looks like it contains a lot less information than it actually does. Do you see what I'm saying, or do we need a second opinion? – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

I have combined sex and intercourse under gender. The word is used in different ways and I do not have an issue with using it in a no technical sense in this place. Have combined a couple of other sections. I hope this balance is acceptable.Doc James (talk · contribs · email) 16:09, 20 January 2012 (UTC)

I think this is an acceptable compromise, but I can't promise that other editors will agree. But like I said, there are no rules that seem to apply to this, so it seems to boil down to opinion. – VisionHolder « talk » 01:56, 22 January 2012 (UTC)

• Could you write about the history of the disease? I'm sure some readers might like to know about its history and how it was treated before the advent of modern medicine.

I am unable to find any references that comment on the history of the disease.Doc James (talk · contribs · email) 23:40, 12 January 2012 (UTC)

I was able to find this. (I got lucky. This was a beast to search for on Google Books.) We don't need to be comprehensive, but for GA, we do need to cover all the major topics. For the medical articles, Wiki isn't just about providing medical details. The history of a disease (from antiquity) has encyclopedic value as well. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

Okay and I found one other ref.Doc James (talk · contribs · email) 17:12, 20 January 2012 (UTC)

• "Many elderly people however have preexisting incontinence." Maybe re-word to say: "Diagnosis can be complicated by the fact that many elderly people however have preexisting incontinence."

I like that.Doc James (talk · contribs · email) 23:02, 12 January 2012 (UTC)

• "Staph. aureus"—Is this a typical abbreviation in the medical field? I'm used to standard biology using S. aureus. If you feel that the genus needs clarification (since that species has not been mentioned), then you should probably spell it out.

Spelled out Doc James (talk · contribs · email) 09:54, 17 January 2012 (UTC)

• Overciting: "Women are more prone to UTIs than men because, in females, the urethra is much shorter and closer to the anus.^[9] As a women's estrogen levels decrease with menopause her risk of urinary tract infections increase due to the loss of protective vaginal flora.^[9]" Yes, you should cite your sources, but back-to-back references of the same source (unless you are differentiating page numbers) usually just requires a citation at the end of the content. As an example, see my latest good article nomination.

I have "no wikied" the first instances of a ref. I like one ref with each sentence as it prevents people from adding the "citation needed" tag.Doc James (talk · contribs · email) 09:54, 17 January 2012 (UTC)

I definitely understand where you're coming from, and the example I linked to wasn't the best... especially since it cites a single article and I'm waiting for the print version so that I can cite individual page numbers. Your "no wikied" tags (a.k.a. hidden comments) might be a good way to defend against "citation needed" tags, but often the best defense is monitoring the articles you work. I often revert edits that try to change or challenge cited content, stating in the edit comments the reason why (briefly) and encouraging discussion on the talk page. I guess this becomes less of an issue the more sources you cite, since each source will cover a specific topic in a slightly different way and possibly cover unique material. Either way, this isn't an issue for GAN, but something to consider if you ever gear up for FAC. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

I would need to learn grammar before I could write GAs :-) Doc James (talk · contribs · email) 17:14, 20 January 2012 (UTC)

In the sentence "Urinary tract infections are more concerning in pregnancy due to the increased risk of kidney infections" the word "concerning" should be replaced by "disconcerting". "Concerning" means related to, which is not what is meant in that sentence. Check the dictionary for further info. 2001:5C0:1100:2000:24C:69FF:FE6E:7579 (talk) 01:14, 3 February 2014 (UTC)

Break 1

• "The risk of bacteriuria is between..." You need to define technical terms on first use. For example, "The risk of bacteriuria (bacteria in the urine) is between..." Another example, vesicoureteral reflux.

Addressed.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

Thanks. I'm reading through the article again to look for others. The key point here is that although wiki-linking can help explain terms, sometimes people don't want to follow the link to know what you're talking about. Sometimes they just want to understand the sentence. Trust me... this can be hard as an editor of technical articles. When I write about extinct lemurs, succinctly summarizing and paraphrasing material that talks (in gory detail) about dental anatomy or cranial/postcranial anatomy can be a nightmare! – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• Over-linking: There are several words that are linked multiple times throughout the body (not counting the lead). For example, Urinary catheterization, bacteriuria, incontinence, etc. Generally, you only need to link a word once, although I often treat lead links separate from body links.

Yes good point. Addressed all the ones I could find.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

I fixed a few more, and will watch more closely on the second read. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• I feel that "Cause" and "Pathogenesis" could be merged into one section, "Cause and pathogenesis".

Per WP:MEDMOS we tend to keep these separate. Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "...the use of vaginal estrogen pessaries was not as useful..." I know that you mean "in clinical trials", but here you should probably say as such.

As we are writing for a general audience I try to just state the facts without say what type of study or what journal it was published in.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

I changed the wording from "was not" to "has not been". To me, "was" suggests a single case, whereas "has not been" sounds like a sort of track record. That's where I was coming from in my request for clarification. I'm fine with not saying something like "in clinical trials" as long as it doesn't raise questions about the source of the information. Does that make sense? Do you agree? – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• "voiding after sex" I would suggest explaining this term, although I know what you mean.

Sure Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "Reassuringly recurrent UTIs are a rare cause of..." The word "reassuringly" does not sound very encyclopedic. I advise dropping it. Also, that sentence needs to be reworded such that the qualifying sentence is not in paratheses.

Yes. Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• Under "Diagnosis", you mention both leukocytes and white blood cells in the same sentence, link them both to the same page, yet don't associate the two. I suggest saying "leukocytes (white blood cells)" the first time, and either one of the two words thereafter.

Good idea.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• An image caption reads: "Multiple bacilli (rod-shaped bacteria, here shown as black and bean-shaped) shown between white cells at urinary microscopy. This is called bacteriuria and pyuria, respectively." I would note briefly in there that pus is made up of white blood cells, otherwise this might not make sense to some readers.

Pus contains white blood cells among other stuff. I have removed the confusing text.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "The difficulty is contamination may be frequent depending on..." I suggest rewording... maybe: "Contamination poses a frequent challenge..." or something like that.

Sure Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "is used a "clean catch""—typo?

Added a hyphen. It is a "clean-catch midstream urine"Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "...infection with Chlamydia trachomatis or Neisseria gonorrheae much be ruled out." I assume you mean "must be ruled out"? If so, you need to reword, since Wiki articles shouldn't be written as a how-to manual. Instead, "clinicians will rule out..." We assume that they know what to do. ... And again in: "Interstitial cystitis should be considered in...", and so forth throughout the article.

Changed the "ruled out" to "may be the cause of the symptoms" Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

I made some changes to the section, and I would appreciate your review. Otherwise, that section should be good. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

• I am a bit hesitant about headings such as "Epidemiology" and "Pathogenesis"... they are technical terms, although I do see that several medical articles have become featured articles with these headings. If this is the norm for this project, ignore this concern.

Yes the norm per WP:MEDMOS with about 10,000 article following this convention.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

• "In the United States urinary tract infections accounted for nearly seven million office visits, a million emergency department visits, and one hundred thousand hospitalizations a year." If this fluctuates, the way this sentence is worded suggests we need to state the year. If this number is pretty static, then "accounted" should be "account".

The ref in question presents it in this fashion and it is fairly constant per year.Doc James (talk · contribs · email) 10:36, 17 January 2012 (UTC)

Alright, I fixed it. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

All-in-all, this is a very concise article that seems to cover all the basics. I'm glad to see that you are using your expertise to help clean up Wikipedia. A lot of medical articles out there need attention. Are you taking requests? I could name a few... (Herpes labialis, given its prevalence in the general population and the stigmatization surrounding it, would be a good one...) Otherwise, keep up the good work! – VisionHolder « talk » 22:27, 12 January 2012 (UTC)

Thanks for the review. Will try to address the concerns. My work is part of this effort here [2] and it begins by bringing all the articles listed here [3] to GA at least. I have some work ahead of me. If things go well I will consider adding "herpes labialis" to the next round. Herpes simplex is at GA BTW... Doc James (talk · contribs · email) 22:48, 12 January 2012 (UTC)

Yes, I saw that Herpes simplex is GA, but most people are just as likely to search oral herpes as herpes. Anyway, it was just a suggestion. Malaria would also be another good one for GA... but I'm sure the list could go on and on. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

Malaria is indeed on the list and will be getting to it... Doc James (talk · contribs · email) 17:16, 20 January 2012 (UTC)

Additional comments

On the second read, I made the following corrections. Please review and correct me as needed. Otherwise, I also found the following:

• On re-reviewing the lead, I noticed that it only seems to hit the high points of the article. It does not thoroughly summarize the content, such as issues for children/elderly, catheters, or some of the statistics about the disease. The lead is close to being good enough, but it simply isn't long enough for an article this size. I'd say it's about 75% of the way there, if that helps you visualize it.
• "Staphylococcus aureus typically occurs secondary to blood born infections." Sorry for not catching this early, but this sentence needs to stated more clearly.

Changed wording.Doc James (talk · contribs · email) 15:57, 20 January 2012 (UTC)

• More phrases to word in plainer English:
  • "In older children, new onset incontinence may occur."

Fixed Doc James (talk · contribs · email) 15:57, 20 January 2012 (UTC)

• • "They may have a vague presentations with incontinence..."

Better?Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

Sorry, but I don't see the change in the history. – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

• • "Sepsis may be the initial presentation in some cases."

Not sure what you have in mind? Some elderly present to a health care provider with sepsis being the first symptoms.Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

The issue here is that although "presents" is perfectly good English, it's not how most people would say it... and I was hoping we could make the article a little more accessible to the general public (e.g. not reading like medical book). But then again, maybe I'm out-of-line... – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

• • "Staphylococcus aureus typically occurs secondary to blood born infections."

Fixed Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

• • "A prescription for an effective empirical treatment..."

Sure Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

• "In those who use spermicide or a diaphragm as a method of contraception, they are advised to use alternative methods." Does this mean for everyone or just for chronic sufferers? If so, I suggest: "For chronic sufferers of UTI who also use spermicide or a diaphragm as a method of contraception, clinicians suggest alternative methods of birth control." Or something like that...

Sure Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

• "The diagnosis can be difficult in the elderly with no reliable test." The second time through, I'm confused by this statement. Does it mean that there are no reliable tests for UTI for elderly patients?

Yes exactly. A UTI is a clinical diagnosis and in the elderly and children when the symptoms are vague the diagnosis is difficult.Doc James (talk · contribs · email) 17:24, 20 January 2012 (UTC)

• "some resistance has developed in the community..." Please clarify "the community".

Simply means outside of the hospital/health care environment(which would include long term care) Doc James (talk · contribs · email) 15:57, 20 January 2012 (UTC)

In that case, I don't think "in the community" is needed. If it is, please restore it. – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

• "Rates among men over 75 are between 7-10%." This is for UTIs, right? The paragraph starts mixing rates of UTI, Pyelonephritis, and (more generally) bacteriuria, so it's hard to be clear.

No this is for asymtomatic pyuria.Doc James (talk · contribs · email) 15:57, 20 January 2012 (UTC)

• Can you offer a brief description of pre-eclampsia? I wasn't able to.

Sure Doc James (talk · contribs · email) 16:02, 20 January 2012 (UTC)

Very nice. Far better than I could have done. – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

• Tweaking the image captions, I realized that the topics they contain are not mentioned or cited in the article. Images and captions, just like the lead, should summarize cited content in the body.

Have tweaked a little further.Doc James (talk · contribs · email) 16:02, 20 January 2012 (UTC)

In that case, maybe mention pyuria when talking about sepsis in the body? Anyway, the first mention of sepsis isn't explained in the body. – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

Described sepsis and mentioned pyuria in the text.Doc James (talk · contribs · email) 10:36, 22 January 2012 (UTC)

• Citation #30 ("Nurse10") is missing the citation, and therefore broken.

FIxed --Doc James (talk · contribs · email) 12:29, 21 January 2012 (UTC)

• I noticed that you have a tendency to say "urinary tract symptoms". Is this standard (based on the written sources)? As an average reader, the term seems non-nonsensical, and that's why I've tried to catch them and change them to UTI symptoms (since "urinary tract infection symptoms" seems too long). The key thing is to mirror what the sources say or at least use a term that makes sense to people.

If you look at google books [4] it is a common term among docs. But I am happy with UTI symptoms if you think it is more under stable by the general population.Doc James (talk · contribs · email) 12:29, 21 January 2012 (UTC)

Good to know. In that case, I'm fine with urinary tract symptoms. It just sounded like a sloppy short-hand. As long as it follows the sources and isn't overly technical, I'm fine with it. – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

• "...a culture of the urine is recommended." I'm cautious about this because anytime you say something is recommended, it sounds like Wikipedia giving advice. Remember, Wiki isn't a how-to manual, and we don't want to come across as though we are suggesting medical tests or treatment. That's why I had changed it to "physicians (or whatever...) may culture of the urine." Is there another way to say these things? – VisionHolder « talk » 02:28, 22 January 2012 (UTC)

the ref says "Most authorities recommend routine examination and culture of the urine in febrile girls 0 to 24 months of age." thus added "by many medical associations" Doc James (talk · contribs · email) 10:16, 22 January 2012 (UTC)

Sorry for the added items. I'm also sorry for what may feel like a unique type of review. I run a lot of articles through FAC, and I'm used to having to throw the rulebook out the window when a reviewer from a completely different project reviews my articles. Often, the different perspective helps you see when you are talking above the general audience, plus they bring out some of the sticking points their group has discovered but other groups have not yet addressed. I hope you can at least see the reasons behind my suggestions. – VisionHolder « talk » 22:27, 17 January 2012 (UTC)

These are excellent suggestions and will make the article better. While address in the next couple of days. Thanks again for the feedback.Doc James (talk · contribs · email) 02:54, 18 January 2012 (UTC)

Pyridium

Note to self. Must comment on this... Doc James (talk · contribs · email) 23:41, 12 January 2012 (UTC)

Is this something that concerns the GAN? Otherwise, I'm probably going to pass it very soon. Although there may still be some issues with technical language and possibly overuse of headers (depending on the reader's point of view), there's nothing in the MoS that gives me a reason not to pass it. If the article were to someday go on to FAC, then more work will certainly need to be done. – VisionHolder « talk » 21:20, 27 January 2012 (UTC)

Yes wrote something regarding pyridium a while ago.--Doc James (talk · contribs · email) 23:13, 27 January 2012 (UTC)

Closing comments

As best I can tell, this article meets the GA requirements. The article covers all the major topics adequately, and it appears to be technically accurate and well-referenced. – VisionHolder « talk » 00:32, 30 January 2012 (UTC)