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 * 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
Matthew Hynes - Non-pharmacologic Interventions

Soiza, R. L., & Myint, P. K. (2019). The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium. Medicina (Kaunas, Lithuania), 55(8), 491. doi:10.3390/medicina5508049

How did I search for the source?

I expanded on preliminary search of:

Delirium AND non-pharmacological management AND guidelines

Utilizing the MeSH function I used a final search functions of:

(( "Delirium/prevention and control"[Mesh] OR "Delirium/rehabilitation"[Mesh] OR "Delirium/therapy"[Mesh] )) AND "Early Medical Intervention/methods"[Mesh]

Which sources were considered?

O'Hanlon S, O'Regan N, MacLullich AMJ, et alImproving delirium care through early intervention: from bench to bedside to boardroomJournal of Neurology, Neurosurgery & Psychiatry 2014;85:207-213.

Zoremba, N. Med Klin Intensivmed Notfmed (2017) 112: 320. https://doi-org.proxy.queensu.ca/10.1007/s00063-015-0123-y

Soiza, R. L., & Myint, P. K. (2019). The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium. Medicina (Kaunas, Lithuania), 55(8), 491. doi:10.3390/medicina5508049

'''Why was the source chosen? ‘'''

The source (SIGN 157) was chosen as it is recent (2019), it is more comprehensive than the other review articles, and it is well regarded as a national clinical guideline. SIGN 157 is carefully curated with the insight of many subject matter experts, rendering it an excellent and up-to-date source of information for all topics concerning risk-reduction and management of delirium.

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


 * MERDS criteria recommends sources that do not present any original research; SIGN 157 is a review article and does not present any original research
 * MERDS criteria recommends neutral sources without editorial bias. SIGN 157 is a national clinical guideline and consulted many professionals, ideally minimizing editorial bias
 * MERDS criteria recommends well written articles with proper grammar and prose. As a national clinical guideline, SIGN 157 is well designed to be widely distributed and easily digestible

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

I intend to use the information found within the source to adjust the Non-pharmacologic interventions section and add a needed citation:

Original:

Such interventions are the first measures in managing active delirium and has many overlaps with delirium preventative strategies, including optimizing the hospital environment by reducing ambient noise, providing proper lighting for the time of day, minimizing room changes and restraint use.

Edited:

These interventions are the first steps in managing acute delirium and there are many overlaps with delirium preventative strategies. In addition to treating immediate life-threatening causes of delirium (e.g. low O2, low blood pressure, low glucose, dehydration), interventions include optimizing the hospital environment by reducing ambient noise, providing proper lighting, offering pain relief, promoting healthy sleep-wake cycles, and minimizing room changes. Although multicomponent care and comprehensive geriatric care are more specialized for a person experiencing delirium, several studies have been unable to find evidence showing they reduce the duration of delirium. [citation]

First sentence: Only structural changes and adjustments to clarify the sentence.

Second sentence: Included the addition of interventions for acute life-threatening causes with examples, as well as the addition of two examples for optimizing the hospital environment. These adjustments were important as they highlight the potential immediate risks of delirium and how they must be addressed in order to proceed with additional interventions.

Third sentence: Added important distinction that multicomponent + comprehensive care do not actually reduce the duration of delirium. This is important to include as these are commonly referred to non-pharmacologic interventions, yet there is no evidence to support their use.

Overall: As can be seen in the original, there was a citation needed, which is now included.

Assignment #3
We propose several changes to the Non-pharmacologic Interventions section. The suggested updated paragraph is as follows:

ORIGINAL PARAGRAPH
Such interventions are the first measures in managing active delirium and has many overlaps with delirium preventative strategies, including optimizing the hospital environment by reducing ambient noise, providing proper lighting for the time of day, minimizing room changes and restraint use.

PROPOSED CHANGES
These interventions are the first steps in managing acute delirium and there are many overlaps with delirium preventative strategies. In addition to treating immediate life-threatening causes of delirium (e.g. low O2, low blood pressure, low glucose, dehydration), interventions include optimizing the hospital environment by reducing ambient noise, providing proper lighting, offering pain relief, promoting healthy sleep-wake cycles, and minimizing room changes. Although multicomponent care and comprehensive geriatric care are more specialized for a person experiencing delirium, several studies have been unable to find evidence showing they reduce the duration of delirium.

RATIONALE FOR PROPOSED CHANGES
The reference text for the proposed changes is The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium, as is cited in the paragraph.

First sentence: Only structural changes and adjustments to clarify the sentence.

Second sentence: Included the addition of interventions for acute life-threatening causes with examples, as well as the addition of two examples for optimizing the hospital environment. These adjustments were important as they highlight the potential immediate risks of delirium and how they must be addressed in order to proceed with additional interventions.

Third sentence: Added important distinction that multicomponent + comprehensive care do not actually reduce the duration of delirium. This is important to include as these are commonly referred to non-pharmacologic interventions, yet there is no evidence to support their use.

Overall: As can be seen in the original, there was a citation needed, which is now included.

Notes on Potential Controversy: The definition of comprehensive geriatric care is not standardized. The term is used consistently in secondary sources, yet there is no clarification on what it exactly entails. Investigation into primary sources cited within the secondary sources did not offer further insight. Discussion with our tutor resolved in leaving the term as it has an implied meaning and is consistently used in texts on delirium.

CRITIQUE OF SOURCE
No publication can be immune to bias; however, SIGN157 has implemented several strategies to limit bias as much as possible. Regarding conflicts of interest, everyone involved with the development of the SIGN157 guideline was required to report financial conflicts of interest for the duration of their involvement. SIGN157 also outlined one academic conflict of interest that was declared during development of the guideline, and subsequently restricted one contributor from a particular section. The Scottish Intercollegiate Guidelines Network has a NICE accreditation for producing clinical guidelines (https://www.nice.org.uk/accreditation) and must meet a sufficiently high standard for guideline development. The methodology used for the development of SIGN157 was also equity impact assessed (https://www.sign.ac.uk/sign-50.html). The Scottish Intercollegiate Guidelines Network receives its core funding for the development of guidelines from Healthcare Improvement Scotland which is part of the Scottish National Health Service.

Soiza, R. L., & Myint, P. K. (2019). The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on Risk Reduction and Management of Delirium. Medicina (Kaunas, Lithuania), 55(8), 491. doi:10.3390/medicina5508049