User:Jr9023/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

Concussion

Assignment #2

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

On OVID, search terms "Concussion" and "mild traumatic brain injury" were linked using OR, and this was linked to "pathophysiology" using AND. I then narrowed the search to Reviews, Systematic Reviews, and Meta-Analyses within the 2014-present time period.


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

Hiskens, M. I., Angoa‐Pérez, M., Schneiders, A. G., Vella, R. K., & Fenning, A. S. (2019). Modeling sports‐related mild traumatic brain injury in animals—A systematic review. Journal of Neuroscience Research. doi: https://doi-org.proxy.queensu.ca/10.1002/jnr.24472

Romeu-Mejia, R., Giza, C. C., & Goldman, J. T. (2019). Concussion pathophysiology and injury biomechanics. Current Reviews in Musculoskeletal Medicine, 12(2), 105-116.


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

I chose the latter source, concussion pathophysiology and injury biomechanics. The former article was a good study, however, because of the nature of the article, a systematic review, the question was too focussed for the purpose of the section I am editing. For pathophysiology, I wanted a relevant article that addresses many broader aspects and topics in a comprehensive manner, including biochemistry, which is focussed upon heavily within the Pathophysiology section of the Wikipedia article.


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

The article I chose follows the MEDRS criteria. Firstly, the article represents a secondary source. It is a review article published by a third party journal. The article is also published in an unbiased manner, all conflicts of interests are disclosed, with only one of the three authors reporting receiving grant funding from Concussion Research institutions. The review was also very recently published, within the past year. Furthermore, access to the journal is open to the public and is not behind a paywall.


 * 1) How do you plan on using the source for improving the article?

The final paragraph of the Wikipedia article section on “Pathophysiology” attempts to editorialize the article and provide consensus. However, much of the research is done on animal models and is not definitive. Furthermore, in the entire text of that paragraph, only one source is cited from 2005. I plan on using the source to either corroborate or update that paragraph with more relevant information incorporated from this recent review article.

Assignment #3
 Proposed Changes 

The section of the article to which I propose changes is the last paragraph of the "Pathophysiology" section. The original section is as follows:

In summary, and extrapolating from animal studies, the pathology of a concussion seems to start with the disruption of the cell membrane of nerve cells. This results in a migration of potassium from within the cell into the extracellular space with the subsequent release of glutamate which potentiates further potassium shift, in turn resulting in depolarization and suppression of nerve activity.

The section, with my proposed changes (in bold and strikeout):

[ In summary, and extrapolating from ] Using animal studies, the pathology of a concussion seems to start with mechanical shearing and stretching forces [ the ] disrupting [ of ] the cell membrane of nerve cells through "mechanoporation". This results in [ a migration of ] potassium outflow from within the cell into the extracellular space with the subsequent release of excitatory neurotransmitters including glutamate which leads to enhanced potassium extrusion[ potentiates further potassium shift ], in turn resulting in sustained depolarization, [ suppression of ] impaired nerve activity and potential nerve damage. Human studies have failed to identify changes in glutamate concentration immediately post-mTBI, though disruptions have been seen 3 days to 2 weeks post-injury .

 Rationale for Proposed Changes 

The first sentence starting with "In summary, and extrapolating from..." was inconsistent with the contents of the "Pathophysiology" section. The paragraph introduced new concepts not originally introduced earlier in the Pathophysiology section, therefore this would not be considered a summarizing paragraph. Furthermore, for broader audiences, it could come across as being definitive in a human context despite being based on animal models of mTBI.

The 2019 narrative review article uses the term "mechanoporation" to describe the disruption in nerve cells leading to enhanced potassium permeability across the membrane. Aspects of this review article were added to corroborate some of the evidence presented in the original paragraph, including the release of excitatory neurotransmitters, such as glutamate, which play a role in the pathology. The words "suppression of" were removed, as these biochemical events lead to hyperexcitability, which in turn can lead to impaired function, not necessarily suppression. Addressing the issue of translatability of animal studies towards humans, a sentence was added at the end to provide an example of how human studies do no align perfectly with the findings from animal models. This highlights the fact that this research is not definitive, which provides readers a more complete picture of the gaps in the literature.

 Critique of Source 

The source used is a narrative review. Narrative reviews have several shortcomings compared to a stronger source of evidence, such as a more rigorously performed systematic review. The sources used within a narrative review are individually selected by the reviewer and therefore, can be biased towards the reviewer favouring only certain research that has been produced. This is highlighted by the fact that the selection criteria and appraisal for the articles presented in the review was absent. Furthermore, narrative reviews can be subject to selection bias based on the research that is included within the review. One problem that exists is that the information shared within the source may exclude another branch of research being done in animal models for mTBI that present data or findings contrary to the presented studies. This influences the information shared on Wikipedia as it does not give readers access to information from both sides. Community reviewers may be skeptical to include information from this secondary source and may value the input from an editor that uses a systematic review instead of a narrative review due to the minimization of bias.