User:Marmariv/sandbox

Welcome to your sandbox! My article: Cardiac Arrest

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Practice Editing Here (Nov 15th in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!
Article title and section: Cardiac Arrest- Prevention

Proposed Change #1

Adding before the last sentence of the first paragraph of the ‘Prevention’ section: Exercise is an effective preventative measure for cardiac arrest in the general population but may be risky for those with pre-existing conditions (Fanous and Dorian). The risk of a transient catastrophic cardiac event increases in individuals with heart disease during and immediately after exercise (Fanous and Dorian). However, both the lifetime and acute risk of cardiac arrest are decreased in individuals with heart disease that perform regular exercise, suggesting the risks of exercise are outweighed by the benefits (Fanous and Dorian).

Rationale for Proposed Change

The Wikipedia article mentions that cardiac arrest lacks positive outcomes and accordingly, preventative measures are being promoted, exercise is one of them. The article then mentions several preventative measures used for those that have a greater risk of heart disease and fails to note exercise as an option. Exercise has been long thought to improve cardiovascular health and fitness, however stressing an already strained heart with exercise may be a concern that many have. Unease over intensive exercise has also been exacerbated in recent years with large-scale media frenzies over athletes that have suffered cardiac arrest, a supposed paradox. The additional sentences acknowledge the concerns that some may have about exercise and cardiac risk, but then reinforce the importance of regular exercise in mitigating the risk of adverse cardiac events in both at-risk and general populations.

Areas of Controversy

Expected controversies around the additions to the ‘Prevention’ section of the ‘Cardiac Arrest’ article will mainly be associated with the need for more detailed information on the role of exercise. As mentioned in opening paragraph, exercise, along with diet and smoking cessation are points of emphasis in care. However, no guidelines regarding intensity, length, or type of exercise are given. Later improvements should focus on expanding upon this. Furthermore, there are controversies about the incorporation of exercise as preventative treatment for some pre-existing cardiac abnormalities. Furthermore, the article from which information was sourced cites abhorrent physiological changes that can be found in athletes that have trained intensively for extended durations. The added sentences may minimize the risk that these physiological changes play in the actual risk of adverse cardiac events in athletes.

Critique of Source

Source 1: Fanous Y, Dorian P. The prevention and management of sudden cardiac arrest in athletes. CMAJ. 2019 Jul 15;191(28):E787-E791. doi: 10.1503/cmaj.190166. PMID: 31308007; PMCID: PMC6629536.

Fanous and Dorian (2019) is a review article about the effects of exercise on the management and prevention of sudden cardiac arrest in athletes. The article is recent (2019) and is a thorough review of 48 cited articles. This suggests the two authors dedicated a significant amount of time to synthesize the field of information pertaining to the topic of prevention. The cited articles are of high quality and are review articles found in the Cochrane library and Ovid databases. However, the cited articles are observational in nature. There is also a lack of a clearly stated exclusion and inclusion criteria for the articles used during the literature review. The authors state the key words used to search Ovid and Cochrane but fail to specify how they selected articles beyond this. As a result, results should be taken with the knowledge that confounding factors and potential biases may have influenced the data. Additionally, the authors have declared no conflict of interests and have reputable standing at authoritative and respected institutions.

Proposed Change #2 (not a change, but an addition)

Under Code Teams, after the sentence that reads “A number of "early warning" systems also exist which aim to quantify the person's risk of deterioration based on their vital signs and thus provide a guide to staff”, we propose adding the sentence “Rapid response can be divided into afferent and efferent parts. The afferent limb is the detection of a person at risk of deterioration and the efferent limb is the intervention implemented to resolve the problem.” Then the next sentence will read, as per the current article page, “specialist staff are being used more effectively in order to augment the work already being done at ward level.”

Rationale for Proposed Addition

The rapid response system is a vital part of prevention of cardiac arrest. While the article discusses code teams, we believe it can use more detail about what actually constitutes this prevention strategy. By putting emphasis on the two arms of the response, afferent and efferent, we hope to demonstrate that prevention depends not only on interventions such as CPR, medications, defibrillation, but also on the recognition of a person at risk as well timely and effective activation of the cascade of events that follow.

Area of Controversy

The concept of afferent and efferent branches may be unfamiliar in some healthcare systems. Some healthcare providers reviewing this article may be confused by or disagree with this model due to being unfamiliar with it. However, the idea of separating rapid response into detection and intervention likely exists in these settings under a different name and after reviewing the systematic review source, they may appreciate the way rapid response is clearly conceptualized by the authors. Additionally, this structured response system may not be reflective of systems used in different areas of the world where resources may be more scarce, which leads to more condensed code interventions. Nevertheless, it is of value to readers to learn about this model of care as it has proven to be effective in North America.

Critique of Source

Hall KK, Lim A, Gale B. The Use of Rapid Response Teams to Reduce Failure to Rescue Events: A Systematic Review. J Patient Saf. 2020 Sep;16(3S Suppl 1):S3-S7. doi: 10.1097/PTS.0000000000000748. PMID: 32809994; PMCID: PMC7447182.

The information that informs this change comes from a systematic review published in 2020. The review is robust as it encompasses 10 years of data and includes three systematic reviews and three meta-analyses. A limitation is that the studies included in analysis are observational and retrospective, so the lack of randomization and controls may result in overestimation of benefits of structured rapid response systems. It is, however, very difficult to have control groups on this topic because rapid response teams are a standard of care in healthcare settings. Lastly, the work was funded by the US Department of Health and Human Services, a reputable government organization, and the authors have no conflict of interest to disclose.

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template