User:18jam26/sandbox

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This is place to practice clicking the "edit" button and practice adding references (via the citation button). Please see Help:My_sandbox or contact User_talk:JenOttawa with any questions.

Link: Project Homepage and Resources


 * 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

Assignment #2
1) Lightning Injury

2) PMID: 18395987

3) Ritenour, A. E., Morton, M. J., McManus, J. G., Barillo, D. J., & Cancio, L. C. (2008). Lightning injury: a review. Burns, 34(5), 585-594.

1. How you searched for a source (search strategy – where you went to find it)

I searched on Pubmed for lightning injury secondary sources. I searched “lighting ” and “lighting injury” and “lightning injury/therapy” and “burns, electrical.” https://www.ncbi.nlm.nih.gov/pubmed/18395987

2. What potential sources were identified and considered (give examples of 1 or 2).


 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461597/ - while this paper is also a review, it specifically addresses the neurological and neurophysiological symptoms of lightning strikes. While these may be relevant to include in our wikipedia page, we wanted to find a review article that outlined the overall injuries experienced from a lightning strike
 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529553/ -

3. Why the source was chosen (what made it better than other choices).

This article gave a comprehensive overview of prevention of lightning strike injury, which is lacking in the current Wikipedia article. It is the most current review article that I could find in a literature search.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.


 * Review of primary sources in a reputable medical journal
 * Accurately reflects current knowledge (limited reviews on topic of lightning injury)
 * Not a primary source

5. How do you plan to use the source for improving the article?

This source has a good overview of prevention of lightning strikes that we hope to add to the article. As well, it includes a current section on the epidemiology of lightning injury which will be useful for updating the prevalence and impact of lightning strikes on health.

Assignment # 3
1)   Proposed Changes

I am going to update and improve the "Prevention" section of our Wikipedia page. I will change "Prevention includes avoiding being outdoors during a thunderstorm" to "Preventing lightning injury involves avoiding the outdoors during a thunderstorm". Following that sentence, I will add a sentence to expand on the prevention instructions about avoiding the outdoors, "While no place is entirely safe from lightning strikes, seeking a substantial shelter or an enclosed all-metal car is recommended.”  I will update “If avoiding being outdoors is unavoidable, crouching low is recommended” to “If being outside is unavoidable, staying away from metal objects, tall structures, and open exposed areas is strongly suggested. When there is imminent risk of lightning strike, crouching low with one’s knees and feet together can be used, however this is typically used as a last resort since this position can be difficult to maintain for an extended period of time.” I will also add in a sentence detailing prevention of mass casualties for lightning strikes in groups as follows, “For large groups of people, it is recommended that individuals spread out to avoid mass casualties.” I have detailed all of the tracked changes below:

Prevention Preventing lightning injury includes involves avoiding being the outdoors during a thunderstorm. While no place is entirely safe from lightning strikes, seeking a substantial shelter or an enclosed all-metal is recommended. If avoiding being outdoors is unavoidable, crouching low staying away from metal objects, tall structures, and open exposed areas is recommended strongly suggested. When there is risk of imminent lightning strike, crouching low with ones’ knees and feet together can be used, '''however this is typically used as a last resort since this position can be difficult to maintain for an extended period of time. For large groups of people, it is recommended that individuals spread out to avoid mass casualties. When indoors,''' the use of devices connected to electrical outlets and contact with water is not recommended.

2)    Rationale for proposed change

To improve the "Prevention" section of our Wikipedia page, I will make the following changes based on the following rationales:

1)   I will change "Prevention includes avoiding being outdoors during a thunderstorm" to "Preventing lightning injury includes avoiding being outdoors during a thunderstorm".

a.    Rationale: Improving flow of sentence to improve general comprehension.

2)   Following that sentence, I will add a sentence to expand on the prevention instructions about avoiding the outdoors, "While no place is entirely safe from lightning strikes, seeking a substantial shelter or an enclosed all-metal car is recommended.”

a.    Rationale: Previously, the Wikipedia page lacked information about how to avoid lightning effectively. According to the Advanced Wilderness Life Support textbook, a lightning injury review article (Ritenour et al. 2008), and the Wilderness Medicine Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries (Davis et al. 2014), seeking out shelter in a large building or in a closed all-metal car are effective methods to avoid a lightning strike.

3)   I will update “If avoiding being outdoors is unavoidable, crouching low is recommended” to “If being outside is unavoidable, staying away from metal objects, tall structures, and open, exposed areas is strongly suggested. When there is risk of imminent lightning strike, crouching low with one’s knees and feet together can be used, however this is typically used as a last resort since this position can be difficult to maintain for an extended period of time.”

a.    Rationale: Previously, the Wikipedia page lacked information about avoiding tall objects that could attract lightning and endanger a nearby person, as detailed in the Advanced Wilderness Life Support textbook, a lightning injury review article (Ritenour et al. 2008), and the Wilderness Medicine Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries (Davis et al. 2014). Furthermore, “crouching low” was not specific enough to describe a common ‘lightning position’ that is recommended for lightning strike avoidance in both the Advanced Wilderness Life Support textbook and the Wilderness Medicine Society Practice Guidelines (Davis et al. 2014).

4)   I will also add in a sentence detailing prevention of mass casualties for lightning strikes in groups as follows, “For large groups of people, it is recommended that individuals spread out to avoid mass casualties.”

a.    Rationale: It is important for people seeking information about lightning strike safety and prevention to understand how to respond to thunderstorms and lightning strike exposure when in a large group of people, especially because it impacts how one would respond to this situation. Therefore, with information from the Advanced Wilderness Life Support textbook, a lightning injury review article (Ritenour et al. 2008), and the Wilderness Medicine Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries (Davis et al. 2014), I detailed the evidence for large groups of people spreading far apart during a lightning storm to avoid multiple lightning injuries and mass casualties.


 * GREAT changes - I think this was really low hanging fruit to make this article much more useful for the public. A few simple yet important tips that really didn't make an appearance before our edits. Nice work!

 3)    Identify any controversy or varied opinion about planned changes in your section, and explain how you decided to move forward with the position you have taken. 

There is mixed information about how to determine when a person is in danger of acquiring a lightning injury during a thunderstorm and when to act to prevent the risk. Some sources report "When thunder roars, go indoors", but conversely there are also sources that report a "30-30 rule" that states an individual should seek shelter/take precautions if the thunder to lightning interval is below 30 seconds (i.e. thunder follows a lightning strike in 30 seconds or less of each other). The lighting injury review article by Ritenour et al. from 2008 claims the 30-30 rule to be an appropriate method for preventing lighting strikes from causing injury, however in the more recent Wilderness Medicine Society Practice Guidelines (from 2014), it claims that wherever thunder can be heard, there is risk that lightning can strike in that region as well and thus precautions should be taken. Furthermore, the 2013 Advanced Wilderness Life Support textbook claims that the 30-30 rule has been replaced and this textbook now cautions against this previous rule and recommends seeking shelter whenever thunder is heard. I decided to avoid discussion of these points in this Wikipedia page at this time and decided to keep the previous sentence that "Prevention of lighting injuries involves avoiding the outdoors during a thunderstorm" as this is still accurate and more aligned with more recent sources detailing the avoidance of the outdoors in the presence of thunder.


 * Good call - interesting findings about the conflicting evidence re 30-30 rule. I think you're right to just stick with the simple but accurate statement above. Good for you for diving into multiple sources to find the most accurate/up to date info.

4)    Critique of Source

For the Wilderness Medicine Society's Practice Guidelines for the Prevention and Treatment of Lightning Injuries and the Wilderness Medicine Society's Advanced Wilderness Life Support textbook, it important to consider conflicts of interest that may bias the presented information and influence the credibility of the source. Practice guidelines are systematically developed to support clinical decisions and they generally include a systematic review of the best evidence that subsequently informs clinical practice and health policy, however much of the data included in teh lightning injury practice guidelines includes small, retrospective case reports or series. This is because prospective studies of lightning injuries cannot occur due to logistical and ethical reasons and these small, retrospective studies may introduce selection or confounding bias. Conducting epidemiological studies in the future could improve national databases and improve the quality of data to help us further understand lightning injury.

For the narrative review on Lightning Injuries by Ritenour et al. (2008), there may have been selection bias with the cited sources as there was no rigorous selection process for sources like in a systematic review. Additionally, this paper offers a qualitative review of information, rather than a more objective quantitative review that a meta-analysis can offer. The information is broad in scope, which was helpful for us in detailing lightning injury for the general public, but it is important to consider how this may over generalize or bias our information. Overall, I decided to utilize this source because it offered a comprehensive overview of lightning injury, it is published in a reputable journal, and it was relevant to our topic.

Auerbach, Paul S., et al. Advanced Wilderness Life Support: Prevention, Diagnosis, Treatment, Evacuation. 8.1 ed., Wilderness Medicine Society, 2013.

Davis, C., Engeln, A., Johnson, E. L., McIntosh, S. E., Zafren, K., Islas, A. A., ... & Cushing, T. (2014). Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness & environmental medicine, 25(4), S86-S95.

Ritenour, A. E., Morton, M. J., McManus, J. G., Barillo, D. J., & Cancio, L. C. (2008). Lightning injury: a review. Burns, 34(5), 585-594.