User:Judypl2023/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

Delirium- Assignment #2
Oh, E.S., Fong, T.G., Hshieh, T.T., & Inouye, S.K.(2017).Delirium in Older persons: Advances in Diagnosis and Treatment.Journal American Medical Association,  318 (12), 1161-1174. https://www.ncbi.nlm.nih.gov/pubmed/28973626

How did I search for the source?

I searched in pubmed for:

Search (Prevention) AND delirium Sort by: Best Match Filters: Review; published in the last 5 years

Which sources were considered?

Pubmed:

Neufeld, K.J., Yue, J., Robinson, T.N, Inouye, S.K & Needham, D.M. (2016). Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: A systematic review and Meta-Analysis. Journal of American Geriatry, 64( 4), 705-714. https://www.ncbi.nlm.nih.gov/pubmed/27004732

COMMENT- of note, Sharon Inouye is one of the biggest researchers in the delirium field and developed the ELDER LIFE prevention program

Oh, E.S., Fong, T.G., Hshieh, T.T., & Inouye, S.K.(2017).Delirium in Older persons: Advances in Diagnosis and Treatment.Journal American Medical Association,  318 (12), 1161-1174. https://www.ncbi.nlm.nih.gov/pubmed/28973626

Cochrane database:

Herling, S.F., & al (2018). Intervention for preventing intensive care unit delirium in adults. Cochrane Database of systematic Reviews. https://doi.org/10.1002/14651858.CD009783.pub2

Why was the source chosen?

The source being used discussed the result of utilizing non-pharmacologic and pharmacologic measures in the prevention of delirium. The source address many components found in the prevention of delirium in the Wikipedia article with current, peer-reviewed research. The source also complied to Wikipedia’s MEDRS criteria (see below).

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


 * 1) MEDRS recommends sources published in a marginal journal such as MEDLINE, Embase and the Cochrane Library
 * 2) MERDS criteria recommends the use of published secondary sources, the source being used is a literature review
 * 3) MEDRS recommends the use of recently published sources, the source being used was published in 2017

How do I plan to use the source for improving the article?

See below changes plan to improve the article;

Delirium may be prevented by non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing problematic medications. Ensuring a therapeutic environment (e.g. individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted sleep with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization) can also yield benefit toward preventing delirium. Pharmacologic prevention and treatment such as antipsychotics remains controversial and are not recommended for prevention of delirium.

Assignment # 3
Source:

Oh, E.S., Fong, T.G., Hshieh, T.T., & Inouye, S.K.(2017).Delirium in Older persons: Advances in Diagnosis and Treatment.Journal American Medical Association,  318 (12), 1161-1174. https://www.ncbi.nlm.nih.gov/pubmed/28973626

Proposed Changes: Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors,   systematically addressing the common contributing factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing problematic medications and the simultaneous use of multiple or problematic medications. Ensuring a therapeutic environment (e.g. individualized care; clear communication; adequate reorientation and lighting during daytime; promoting uninterrupted sleep hygiene with minimal noise and light at night; minimizing bed relocation; having familiar objects like family pictures; providing earplugs; and providing adequate nutrition, pain control, and assistance toward early mobilization) can also yield benefit toward preventing delirium.

COMMENT- suggest changing a sentence to, " removing or minimizing problematic medications." Sometimes you can reduce dose if elimination is not possible.

Rationale for proposed change:

Change 1: non-pharmacologic approaches focused on risk factors systematically addressing the common contributing factors

This change allows a more fluid transition in expressing the non-pharmacologic prevention compared to the initial wording to make the paragraph more comprehensive.

Change 2: visual or hearing impairment, sleep deprivation, functional decline and removing problematic medications and the simultaneous use of multiple or problematic medications

These changes adds more concrete example of non-pharmacologic prevention for delirium as mentioned in the 2017 systematic review which has been documented of being effective in the prevention and treatment of delirium.

Controversy: I initially had added a recommendation to the pharmacologic prevention of delirium. After discussion with my group, physician tutor, and reading my source I realized that the research into pharmacologic prevention and treatment is weak and insufficient to make proper recommendations.

COMMENT- I agree with your point but wonder if there is wisdom in stating this in a sentence at the end?

Critique of Source:

The article identified is a recent systematic review (2017). It analyzed articles in ovid MEDLINE, embase and the Cochrane library. This literature search was restricted to 6 years (2011-2017), they excluded studies based solely in the ICU and they excluded non-English-language articles.

The exclusion of non-English language articles criteria creates a bias, as they might not include all the research that has been accomplished in this field. Additionally, they identified insufficient and weak evidence which limited their recommendation. This information has limited the amount of information shared regarding pharmacologic preventions because of limited/ weak research in this area. The nonpharmacologic section has strong supportive research and is identified as the cornerstone of delirium prevention and treatment at this time. COMMENT- agree