User:Poppinchampagne/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

________ ASSIGNMENT #3 ________
Original source:

Shafi, M. M., Santarnecchi, E., Fong, T. G., Jones, R. N., Marcantonio, E. R., Pascual-Leone, A., & Inouye, S. K. (2017). Advancing the Neurophysiological Understanding of Delirium. Journal of the American Geriatrics Society, 65(6), 1114–1118. doi:10.1111/jgs.14748

Edited source:

Nitchingham, A., Kumar, V., Shenkin, S., Ferguson, K. J., & Caplan, G. A. (2018). A systematic review of neuroimaging in delirium: predictors, correlates and consequences. In International Journal of Geriatric Psychiatry (Vol. 33, pp. 1458–1478). John Wiley and Sons Ltd. https://doi.org/10.1002/gps.4724

Proposed changes A:

“Despite similar heterogeneity in study design as described in an older 2008 analysis, a 2017 systematic review summarizes evidence of associated white matter disease (including cerebral atrophy, ventricular enlargement, and white matter lesions), abnormal changes in diffusion MRI characteristics and brain metabolites (reflecting microscopic tissue damage and non-neuronal nervous cell activity), and abnormal connectivity between different functional regions of the brain (consistent with interruptions in executive function, sensory processing, attention, emotional regulation, memory, and orientation as seen in delirium). ”

Edits (structural + clarification): Evidence for changes in structural and functional markers include: changes in white-matter integrity (white matter lesions), decreases in brain volume (likely as a result of tissue atrophy), abnormal functional connectivity of brain regions responsible for normal processing of executive function, sensory processing, attention, emotional regulation, memory, and orientation, differences in autoregulation of the vascular vessels in the brain, reduction in cerebral blood flow and possible changes in brain metabolism (including cerebral tissue oxygenation and glucose hypometabolism). Altogether, these changes in MRI-based measurements invite further investigation of the mechanisms that may underlie delirium, as a potential avenue to improve clinical management of people suffering with this condition.

Additional proposed changes with respect to improving the clarity of this paragraph:

Proposed changes B:

“Although neuroimaging offers a non-invasive way to understand delirium, it has been challenge to establish correlates with delirium.”

Edits (mainly structural + update of reference): Neuroimaging provides an important avenue to explore the mechanisms that are responsible for delirium. Despite progress in the development of magnetic resonance imaging (MRI), the large variety in imaging-based findings has limited our understanding of the changes in the brain that may be linked to delirium.

Proposed changes C:

''“Many attempts to image people with concurrent delirium are unsuccessful. In addition, there is a more general bias selecting younger and fitter participants amenable to scanning, especially if using intensive techniques such as MRI.”''

Edits (structural + clarification + source): Some challenges associated with imaging people diagnosed with delirium include participant recruitment and inadequate consideration of important confounding factors such as history of dementia and/or depression, which are known to be associated with overlapping changes in the brain also observed on MRI.

Rationale for change A: The field of neuroimaging is constantly updating with respect to understanding the pathophysiological mechanisms underlying conditions like delirium. The proposed changes highlight the most up-to-date systematic review which includes findings about changes in white matter integrity, functional connectivity and cerebral metabolism that may be associated with delirium.

Rationale changes B and C: The current state of the neuroimaging section on the delirium page lacked clarity and structure, which made its read difficult and confusing. Proposed changes B and C are mainly structural in order to allow for a better flow of information and improve the clarity of the paragraph for the reader.

Controversy: The proposed changes here do not directly challenge any issues with respect to controversy. Instead, these changes attempt to ensure that the provided resources on neuroimaging of delirium are up to date and accessible for interested readers. Although there are no direct controversy in the proposed changes, one challenge that was encountered related to the vocabulary that needed to be used to communicate the findings from the neuroimaging systematic review. Although an attempt to maintain a “lay” language communication was made, some of the wording employed were specific to the field of neuroimaging (ie, functional connectivity or autoregulation). Given that I completed my doctoral studies in the field of neuroimaging, I felt I was in an appropriate position to incorporate those changes, although I can appreciate that this may limit the “access” to this information. Most of this terminology was present in the original text, however, suggesting that some depth with respect to this information is appropriate in this setting.

Critique of Source: The systematic review proposed was published in the “International Journal of Geriatric Psychiatry”, which has an impact factor of 2.94, and a strong focus on providing and communicating the results of original research on the causes, treatments and care for mental disorders affecting the elderly (i.e., delirium). This journal provides an adequate avenue to share such findings with good potential for exposure and outreach.

The list of authors and their potential conflicts of interest, reported on page 1474 of the manuscript, was assessed in order to ensure that the findings reported by the authors were not biased. The references included in this systematic review along with the method employed by the authors to conduct their search of the literature was also reviewed in order to ensure that the sources reviewed was adequate.

A thorough review of both the source, and the authors associated with the literature used for this assignment, was fundamental toward ensuring that the updated and proposed changes were informed by novel findings communicated with the objective to improve the care and/or understanding of delirium, and not derived from collateral and/or conflicting financial interest, or bias.

________ ASSIGNMENT #2 ________
Allen Champagne (“neuroimaging”)

Nitchingham, A., Kumar, V., Shenkin, S., Ferguson, K. J., & Caplan, G. A. (2018). A systematic review of neuroimaging in delirium: predictors, correlates and consequences. In International Journal of Geriatric Psychiatry (Vol. 33, pp. 1458–1478). John Wiley and Sons Ltd. https://doi.org/10.1002/gps.4724

How did I search for the source?

I conducted a few PudMed based searches related to the topic of interest, along with specific keywords that were associated with my assigned material (“advances in neuroimaging of delirium).

“(("delirium"[MeSH Terms] OR "delirium"[All Fields]) AND ("neuroimaging"[MeSH Terms] OR "neuroimaging"[All Fields])) AND ("2014/11/06"[PDat] : "2019/11/04"[PDat])”

“(("depressive disorder"[MeSH Terms] OR ("depressive"[All Fields] AND "disorder"[All Fields]) OR "depressive disorder"[All Fields] OR "depression"[All Fields] OR "depression"[MeSH Terms]) AND ("neuroimaging"[MeSH Terms] OR "neuroimaging"[All Fields]) AND ("review"[All Fields] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields])) AND ("2014/11/06"[PDat] : "2019/11/04"[PDat])”

“(("dementia"[MeSH Terms] OR "dementia"[All Fields]) AND ("neuroimaging"[MeSH Terms] OR "neuroimaging"[All Fields]) AND ("review"[All Fields] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields])) AND ("2014/11/06"[PDat] : "2019/11/04"[PDat])”

“"magnetic resonance imaging"[All Fields] AND (("Adv Mind Body Med"[Journal] OR "advances"[All Fields]) AND ("review"[Publication Type] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields])) AND (Review[ptyp] AND "2009/11/07"[PDat] : "2019/11/04"[PDat] AND "humans"[MeSH Terms])”

Which sources were considered?

The search for resources was focused on both reviews and systematic reviews, as recent as possible, in order to gather a pool of findings that are summarized and peer-reviewed. Other reviews were considered, including ( https://doi.org/10.1016/j.jpsychores.2008.05.021 ; 2008), however, the selected source was most recent (2018), which was preferred.

Why was the source chosen?

The source provided below highlights important advances in our understanding of the physiological and structural changes that may be associated with the clinical development of delirium in patients.

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


 * The proposed source is a secondary source which conforms with the requirements from the MEDRS criteria.
 * The proposed source is peer-reviewed and do not present with editorial biases.
 * The following article did not show any conflicts of interest, which is important to consider in terms of the validity of the findings, in order to avoid bias.

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

The source cited in the original wikipedia article linked to an older reference (2017), which was edited below (2018).

Original source: Shafi, M. M., Santarnecchi, E., Fong, T. G., Jones, R. N., Marcantonio, E. R., Pascual-Leone, A., & Inouye, S. K. (2017). Advancing the Neurophysiological Understanding of Delirium. Journal of the American Geriatrics Society, 65(6), 1114–1118. doi:10.1111/jgs.14748

Edited source: Nitchingham, A., Kumar, V., Shenkin, S., Ferguson, K. J., & Caplan, G. A. (2018). A systematic review of neuroimaging in delirium: predictors, correlates and consequences. In International Journal of Geriatric Psychiatry (Vol. 33, pp. 1458–1478). John Wiley and Sons Ltd. https://doi.org/10.1002/gps.4724

“Despite similar heterogeneity in study design as described in an older 2008 analysis, a 2017 systematic review summarizes evidence of associated white matter disease (including cerebral atrophy, ventricular enlargement, and white matter lesions), abnormal changes in diffusion MRI characteristics and brain metabolites (reflecting microscopic tissue damage and non-neuronal nervous cell activity), and abnormal connectivity between different functional regions of the brain (consistent with interruptions in executive function, sensory processing, attention, emotional regulation, memory, and orientation as seen in delirium). ”

Edits (structural + clarification): Evidence for changes in structural and functional markers include: changes in white-matter integrity (white matter lesions), decreases in brain volume (likely as a result of tissue atrophy), abnormal functional connectivity of cortical hubs within the brain (responsible for normal processing of executive function, sensory processing, attention, emotional regulation, memory, and orientation in the brain), differences in cerebrovascular autoregulation, reduction in cerebral blood flow and possible changes in cerebral metabolism markers such as cerebral tissue oxygenation and glucose hypometabolism. Altogether, these changes in MRI-based measurements warrant further investigation of the pathophysiological mechanisms that may underlie delirium, as a potential avenue to improve clinical management of people.

Additional proposed changes with respect to improving the clarity of this paragraph:

“Although neuroimaging offers a non-invasive way to understand delirium, it has been challenge to establish correlates with delirium.”

Edits (mainly structural + update of reference): Neuroimaging provides an avenue to explore the mechanisms that underlie delirium. Despite progress in the development of magnetic resonance imaging (MRI), the heterogeneity in imaging-based findings has limited our understanding of the functional and structural changes that may be linked to delirium.

''“Many attempts to image people with concurrent delirium are unsuccessful. In addition, there is a more general bias selecting younger and fitter participants amenable to scanning, especially if using intensive techniques such as MRI.”''

Edits (structural + clarification + source): Some challenges associated with imaging people diagnosed with delirium include difficulties related to methodological limitations and restricted generalisability of the results. Specifically, sources of bias included participant recruitment and inadequate consideration of important confounders such as history of dementia and/or depression, which are known to be associated with overlapping pathophysiological mechanisms observed on MRI.