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Practice Editing Here (Nov 15th in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!

 * 1) Proposed Changes (3 marks): “Signs & Symptoms” section

Cardiac arrest is not preceded by any warning symptoms in approximately 50 percent of people. For those who do experience symptoms, they will be non-specific. This can present in the form of new or worsening:


 * chest pain
 * fatigue
 * blackouts
 * dizziness
 * shortness of breath
 * weakness
 * vomiting

When cardiac arrest is suspected due to signs of unconsciousness or abnormal breathing, a bystander should attempt to feel a pulse for 10 seconds; if no pulse is felt, it should be assumed the victim is in cardiac arrest. As a result of loss of blood flow to the brain (cerebral perfusion), the victim will rapidly lose consciousness and can stop breathing. Near-death experiences are reported by 10 to 20 percent of people who survived cardiac arrest, which demonstrates a certain level of cognitive processes that are still active during resuscitation.


 * 1) Rationale for proposed change (3 marks): Each of the new sentences proposed for the article has been justified by the students. This justification includes why the change is necessary, where the information came from, and why the content they are adding or replacing is inadequate in its current form.

The first sentence (in red) was added in order to provide clarity regarding the length of time a pulse should be palpated for on a victim of cardiac arrest. The original information in the article was ambiguous, stating that the “inability to feel a pulse” was indicative of probable cardiac arrest. In reality, based on higher level evidence and clinical guidelines, cardiac arrest victims may have a weak or thready pulse; however, monitoring the length of time between each pulse is necessary to identify the type of emergent cardiac event occurring. It is necessary to make this change, given that a reader may misinterpret this and perhaps assume that a victim with a very weak pulse (or long pause between each pulse) is not in cardiac arrest, and should not be treated accordingly. The information regarding feeling for a pulse for 10 seconds was taken from a recent clinical guideline published by the American Heart Association, which focused on cardiopulmonary resuscitation and emergency cardiovascular care.(1)


 * 1) Area of controversy (if applicable) (1 mark): The students have shown areas of ambiguity or controversy for the proposed change and the position taken has been clearly justified. (note if there is no possible controversy or ambiguity, skip this section and add 1 mark to question 2 for a total grade of 10)

There is variability in how cardiac arrest is initially identified. Some recent studies have identified that emergency dispatchers often call for bystanders to observe for signs of unconsciousness or abnormal breathing.(2) Only a few sources elaborate on the further step to feel for a pulse for a duration of 10 seconds, and given that this extra step is oriented towards a layperson that would be present near the victim, adding this extra piece of information. Further, in setting a 10 second window during which pulse should be observed, the importance of not waiting too long before chest compressions is emphasized.(1)


 * 1) Critique of source (2 marks): The students have identified any validity issues or potential bias within the secondary source they have chosen to support their proposed change. The students’ written content demonstrates an understanding of the strengths and weaknesses of the evidence they have identified. The students can speculate on the potential bias of their source and whether (and how) that might have affected their extracted information.

The American Heart Association is governed by policies and procedures that minimize the risk of conflict of interest. However, the authors of the clinical practice guideline disclosed their affiliations with various institutions and companies, such as Stryker Corporation - a company specializing in medical technology and devices.(1) This indicates that there may indeed be potential conflicts of interest at play that may ultimately have influenced guideline development. It is important to note that clinical practice guidelines, as a whole, are widely seen as the standard of care in treating many medical conditions, given that they are consensus and evidence-based, and are developed in consultation with numerous clinical experts in the field. One weakness of using clinical practice guidelines is that evidence is often drawn from homogenous patient populations that have similar presentations. However, we recognize that cardiac arrest victims may not always present with the same identifiable symptoms that include unconsciousness, abnormal breathing, and lack of pulse. Rare presentations of cardiac arrest may be excluded in our use of this source.(3)

References


 * 1) Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916
 * 2) Drennan IR, Geri G, Brooks S, Couper K, Hatanaka T, Kudenchuk P, Olasveengen T, Pellegrino J, Schexnayder SM, Morley P, Mancini MB. Diagnosis of out-of-hospital cardiac arrest by emergency medical dispatch: a diagnostic systematic review. Resuscitation. 2020 Nov 27.
 * 3) Chong CC. Pros and cons of clinical practice based on guidelines. Hong Kong Med J. 2018 Oct 1;24:440-1.

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template