User:MPBalanaser/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.

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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

Wikipedia Article: Caffeine

INDIVIDUAL IMPROVEMENT PLAN ASSIGNMENT #3:
 PROPOSED CHANGES 

Original Target Sentences: The ICD-10 includes a diagnostic model for caffeine dependence, but the DSM-5 does not. The APA, which published the DSM-5, acknowledged that there was sufficient evidence in order to create a diagnostic model of caffeine dependence for the DSM-5, but they noted that the clinical significance of this disorder is unclear. The DSM-5 instead lists "caffeine use disorder" in the emerging models section of the manual.

Proposed Changes: The ICD-11 includes caffeine dependence as a distinct diagnostic category, which closely mirrors the DSM-5’s proposed set of criteria for “caffeine-use disorder”. Caffeine use disorder refers to dependence on caffeine characterized by failure to control caffeine consumption despite negative physiological consequences. The APA, which published the DSM-5, acknowledged that there was sufficient evidence in order to create a diagnostic model of caffeine dependence for the DSM-5, but they noted that the clinical significance of the disorder is unclear. Due to this inconclusive evidence on clinical significance, the DSM-5 classifies caffeine-use disorder as a “condition for further study”.

 RATIONALE FOR PROPOSED CHANGES 

 Change #1 

Sentence Removed: The ICD-10 includes a diagnostic model for caffeine dependence, but the DSM-5 does not.

Replacement Sentence: The ICD-11 includes caffeine dependence as a distinct diagnostic category, which closely mirrors the DSM-5’s proposed set of criteria for “caffeine-use disorder”.

Rationale: The rationale for this change was simply to update outdated information. This article quotes the World Health Organization’s (WHO) International Classification of Diseases 10 (ICD-10), which is not the most recent edition of the ICD. I have updated the sentence to reflect the ICD-11 guidelines on caffeine dependence, and how this relates to the DSM-5’s caffeine use disorder criteria.

Controversy/Varied Opinions: There shouldn’t be much controversy regarding the updating of ICD-10 to ICD-11 information, as this is simply an update of out of date information. One potential area of controversy for this proposed change is the likening of the ICD-11’s caffeine dependence diagnostic category to the DSM-5’s caffeine use disorder criteria. They are functionally equivalent, but use different terminology that could make similarities difficult to recognize at first glance. I chose to go ahead with this change because it is technically true, and will be helpful in allowing the layperson unfamiliar with the ICD-11 or DSM-5 to more simply understand how they define caffeine dependence. In addition, this is a divergence from the ICD-10, which differed from the DSM-5 in how it categorized caffeine use disorders (in the ICD-10, it was under the category “other stimulants and caffeine”). This divergence might confuse those more familiar with the ICD-10.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. Arlington, VA: American Psychiatric Association; 2013. DSM-5

World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision).

 Change #2 

Sentence Added: Caffeine use disorder refers to dependence on caffeine characterized by failure to control caffeine consumption despite negative physiological consequences.

Rationale for Change: I added this sentence to elaborate on the link between the ICD-11’s “caffeine dependence” and the DSM-V’s “caffeine use disorder”. The diagnostic criteria are fairly similar, and although they are named differently, they are both referring to caffeine dependence. There are many more details about the specifics of the diagnostic criteria, but I didn’t think it would be necessary to include these in an overview Wikipedia article, and readers can always consult the linked sources (ICD-11 and DSM-V) if they are curious.

Controversy/Varied Opinions: There shouldn’t be any controversy about this sentence specifically, since it accurately defines caffeine use disorder according to the DSM-V and ICD-11. The only area of potential controversy is similar to that of Change #1, where making equivalencies between the DSM-V and ICD-11 requires one to look past the terminology used and analyze the actual diagnostic criteria. Some might argue that the DSM-V’s caffeine-use disorder is fundamentally different from the ICD-11’s caffeine dependence diagnostic criteria. I went ahead with the edit because based on my analysis of both criteria, they are similar enough to be considered functionally equivalent in a diagnostic context.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. Arlington, VA: American Psychiatric Association; 2013. DSM-5

World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision).

 Change #3 

Sentence Removed: The DSM-5 instead lists "caffeine use disorder" in the emerging models section of the manual.

Replacement Sentence: Based on this clinical ambiguity, the DSM-5 classifies caffeine-use disorder as a “condition for further study”.

Rationale for Change: I decided to change this sentence because after reading the caffeine-use disorder section in the DSM-5, I found the original sentence to be misleading. Caffeine use disorder is listed as a condition for further study in the DSM-5 in order to encourage further research on caffeine use disorders, but that doesn’t mean that the existing diagnostic criteria is clinically insignificant. I wanted to emphasize that although the APA was unable to determine explicit clinical significance of caffeine use disorder, there is still a diagnostic model for caffeine-use disorder included in the DSM-5 that can be used by physicians in certain clinical situations. The word “instead” in the original sentence made it seem like caffeine use disorder was completely clinically insignificant based on the APA’s unclear clinical findings. I think the replacement sentence I crafted does a better job of capturing the nuances of the DSM-5’s description of caffeine use disorder.

Controversy/Varied Opinions: This change is explained in the above section, and shouldn’t cause much controversy because it is simply a statement of an element of the DSM-5’s classification of caffeine use disorder. It is possible that someone might have a varied opinion and prefer to say that caffeine use disorder is listed in the emerging models section of the DSM-V. I went ahead with the change because it is more correct according to where caffeine use disorder is situation in the DSM-V to describe it as a condition for further study as opposed to an emerging model.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. Arlington, VA: American Psychiatric Association; 2013. DSM-5

American Psychiatric Association (2013). "Substance-Related and Addictive Disorders" (PDF). American Psychiatric Publishing. pp. 1–2. Archived from the original (PDF) on 15 August 2015. Retrieved 10 July 2015.

 CRITIQUE OF SOURCES 

Both of the main sources used to inform my proposed changes to the Caffeine Wikipedia article are robust clinical practice guidelines. The ICD-11 and the DSM-V are internationally recognized clinical practice guidelines compiled by experts, based on the most rigorous and applicable research on the topics they discuss. However, this does not mean they are invulnerable to bias. Both the ICD-11 and the DSM-V are susceptible to English language bias, in that both are written in English. Even though they can be translated to other languages, there are certainly nuances that are missed, and certain languages in which translations are not available. The DSM-V is produced by the American Psychiatric Association (APA), so is likely biased towards American physicians and researchers, and the populations they serve. There are also likely concerns about the applicability of elements of the DSM-5 to ethnic minorities in the USA, especially indigenous peoples, which is definitely a potential source of cultural and social bias.

The ICD-11 is produced by the WHO, which is an international organization, but likely has a bias towards European physicians and researchers and the populations they serve. When using of either of these practice guidelines in Canada, it is important for physicians to filter the information through the lens of what is applicable to specific needs of Canadian populations, especially indigenous Canadians, and reflect upon how these needs might differ from the information in the practice guidelines that are available.

With specific regards to caffeine dependence/caffeine use disorder as it appears in the ICD-11 and DSM-V, implicit potential social and cultural biases could definitely have an impact on their diagnostic use depending on culture, ethnicity, or geographic location of those utilizing them. One of the things that makes caffeine use disorder difficult to diagnose is that it can be difficult to determine what constitutes a divergence from normal functioning, as many of the effects are subtle and depend on the baseline expression of the individual patient. Cultural bias of practice guidelines towards particular groups at the exclusion of others could lead to over or under-diagnosis os caffeine use disorder or caffeine dependence, depending on how individuals from particular groups represent themselves and their symptoms.

Finally, it is also important to note that practice guidelines are like encyclopedias in a sense that there are often long breaks between the publication of new editions. The DSM-V was published in 2013, which was almost 7 years ago. Obviously much has changed in the past 7 years, and so it is important when using these sources to remember that they aren’t necessarily reflective of the most recdent and accurate medical research, and that in many cases, additional analysis of more recent and varied publications may be necessary to make an informed decision about a particular diagnosis.

LITERATURE SEARCH ASSIGNMENT #2:
1) How you searched for a source (search strategy – where you went to find it).

The sentences I have chosen to edit specifically reference the DSM-5 and its guidelines. I started by entering the Queen’s University Library Portal, and going to the PsychiatryOnline Database. From there, I went to the DSM Library drop-down, and located the full DSM-5.

Citation: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

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

1. World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en

-      The ICD-11 is another important source – it is the updated version of the ICD-10 referred to in the Caffeine Wikipedia article.

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

The source (DSM-5) was chosen because it contains the psychiatric practice guidelines for clinicians specific to North America, whereas the ICD-11 is more predominantly used in European countries. While ultimately both are important, I have focused on the DSM-5 here since we are in Canada.

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

This source meets the MEDRS criteria because: it is a reliable, third-party, published secondary pre-appraised source, it is considered clinical practice guidelines, and is the product of a major medical organization, the American Psychiatric Association. According to WP:MEDRS, these are all elements that make the DSM-5 a reliable medical source.

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

I plan to use the DSM-5 to improve the article by ensuring its claims about the DSM-5’s stance on caffeine are correct. The article describes the DSM-5’s caffeine guidelines very loosely and without much precision. I will use the DSM-5 to more explicitly define its caffeine guideline, specifically relating to diagnostic models of caffeine dependence, and caffeine withdrawal.

COMMENTS:

1.

'''You did a very good job editing this part of the Wikipedia article. The language is very eloquent which is absolutely fitting for a scientific discussion, but for the Wikipedia article, the language should be understandable to a 12-year-old. You might want to consider linguistically simplifying some words and expressions such as "clinical ambiguity". Despite this minor criticism, your edits show that you fully understood the task and your contribution will be a great addition to the Wikipedia article.'''

2.

'''I really enjoy how structured you approached this task. It makes it very easy to understand your rational behind what you did. I would be careful with unscientific expressions that reflect your opinion rather than facts (e.g. "There shouldn't be much controversy..."). Updating diagnostic manuals such as the DSM-5, in fact, leads to massive controversies. In a scientific discussion, we only want to state what we know (e.g. from literature, and if literature does not have an answer, then we can also say that). Overall, your changes and the rational you give for them are relevant and make sense.'''

3.

'''This is a very well thought out critique and shows that you are able to critically question the sources. You might want to consider making a clearer distinction between your own opinion and facts. For example, saying that the APA "is likely biased towards American physicians and researchers, and the populations they serve" seems to be your opinion rather than a well-researched fact. Overall, very well done!'''