User:Jnt91/sandbox

Welcome to your sandbox!
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

Polypharmacy

Assignment 2
Student: Jessica Tomasi (06056783)

Focus: Medical Uses: Justification of appropriate polypharmacy

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

I searched PubMed using the terms “medicine optimisation” and applied filters for “Practice Guidelines”, “Systematic Reviews”, and “5 years”. This search returned 760 results.

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

Cadogan, C. A., Ryan, C., & Hughes, C. M. (2015). Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many. Drug Safety, 39(2), 109–116. doi: 10.1007/s40264-015-0378-5

National Institute for Health and Care Excellence. (2015). NICE guidelines [NG5]: Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. Retrieved from: https://www.nice.org.uk/guidance/ng5.

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

Source 2b was selected over 2a because although 2a appeared in the search described above and presents pertinent information, it is a “review” article, not a systematic review. Many sources which appeared in the initial search described systematic reviews or guidelines relevant to specific groups of patients; 2b makes overarching recommendations on strategies that are broadly applicable across the healthcare system rather than interventions for specific diseases or conditions.

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


 * Source 2b is a practice guideline, and therefore, a secondary source (i.e., the author did not conduct the research)
 * Source 2b is a practice guideline published by the National Institute for Health and Care Excellence, a reputable health authority in the UK.
 * Source 2b was published within the last 5 years, and when reviewed this year (2019) it was deemed still valid and remained unchanged.

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

I intend to use this source to replace the numbered list in the “Medical uses” section of the article with more digestible statements regarding “appropriate polypharmacy” supported by more recent research (sources [16] and [17] were published in 1992 and 1987, respectively), and to substantiate some of the claims made in the following paragraphs.

Assignment 3
Proposed changes

The current article contains the following sentences under the heading “Medical Uses”, which our group agreed are confusing to readers, and from outdated sources specific only to mental health diagnoses:

Considerations often associated with thoughtful, therapeutic polypharmacy include:

1.     Drugs given for a single somatic locale act on biochemical mechanisms present throughout the body such that their nonlinear interactions can produce an (unknown except empirically) global physiological state of health;

2.     The more independent variables, "handles", to manipulate, the greater the likelihood of finding and stabilizing a small available parametric space of healthy function while minimizing unwanted effects.

My proposed change is to replace the above sentences with the following:

''While polypharmacy is typically regarded as undesirable, prescription of multiple medications can be appropriate and therapeutically beneficial in some circumstances. “Appropriate polypharmacy” is described as prescribing for complex or multiple conditions in such a way that necessary medicines are used according to best evidence to preserve safety and well-being. Polypharmacy is clinically indicated in some conditions, including diabetes mellitus, but should be discontinued when evidence of benefit from the prescribed drugs no longer outweighs potential for harm (described below in Contraindications) .''

Rationale for proposed change

As stated above, the section of text that I am proposing to replace is not written in simple language, nor free of jargon. It does not obviously belong under the heading “Medical Uses” and, in the group’s opinion, was disruptive to the flow of the article and unnecessarily complicated for a lay audience. The sources cited by the existing text were published in 1992 and 1987, and are specific to psychiatric interventions.

I have proposed three replacement sentences to succinctly indicate to readers that there are justifiable “Medical Uses” of polypharmacy, describe the circumstances under which polypharmacy is “appropriate”, and mitigate bias by alluding to contraindications described later in the article. The language used in these proposed sentences is intentionally simple and free of jargon; “diabetes mellitus” will be wiki-linked.

The content of the proposed sentences was sourced from an evidence-based synopsis published by The King’s Fund in 2013 (Polypharmacy and medicines optimization: Making it safe and sound) and subsequently cited in 2015 NICE (National Institute for Health and Care Excellence) guidelines (Medicine optimization: the safe and effective use of medicines to enable the best possible outcomes).

As evidenced by the extensive “Contraindications” section of the article, the practice of polypharmacy is not trivial and necessitates effective and ongoing management. While the intention of my proposed changes is to justify the use of appropriate polypharmacy, the selected source was objective and concerned with the potential for harm associated with polypharmacy, which I have attempted to reflect in the proposed sentences.

Critique of source

My selected source is primarily concerned with ensuring safe and evidence-based polypharmacy. To that end, it seeks to mitigate inappropriate and harmful prescription and mismanagement of multiple medications by acknowledging and addressing significant caveats. Because polypharmacy is not exclusively encouraged or discouraged by the source, the possibility of bias is reduced. I have attempted to represent this impartiality in my proposed changes. The source lists extensive primary and secondary references, and its authors are experts in the fields of medical management and prescribing and hold no obvious conflicts of interest. Reference to the selected source in subsequently published guidelines by NICE (a reputable health authority in the UK), and its listing in the TRIP database are additional indications of rigour. That said, the source is an evidence-based synopsis, not a systematic review, thus several potential threats to validity exist. References may have been selectively chosen and the strength of referenced papers was not evaluated or was not shared. There is no clarity regarding which research was used or not used, and personal experience and/or conventional wisdom on the part of the authors may have colored the content of the source. Feedback:

You have done a fantastic job with this assignment, from selecting a high quality practice guidelines to formulating the proposed statement change. It is well written and thought out. It also shows a side of Polypharmacy that was not at all considered in the wikipedia article and very valid. You also critiqued your source quite well. Well done!

Agata Szlanta