User:Rjwilliamson/sandbox

Welcome to your sandbox!

Link to Project Resource Page
Project Homepage and Resources

Practice Editing Here (Nov 23rd in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).
 * My Article: Concussion
 * Resource Citation: What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed?

Assignment # 3
Proposed Changes

My proposed changes pertain to the Concussion #Treatment section under #Return-to-school:

The section with changes made (represented by bold and strikeout) is as follows:

The resumption of low-risk school activities should not begin [ as soon as ] until the student [ feels well enough ] has completed an initial period of cognitive rest totalling at least 24-48 hours. The return to school should be gradual and step-wise.[93] Rushing back to cognitive activities, such as school, has been associated with longer-lasting symptoms and extended recovery time. Since students may appear 'normal', continuing education of relevant school personnel may be needed to ensure appropriate accommodations are made such as part-days and extended deadlines. Accommodations should be based on the monitoring of symptoms that are present during the return-to-school transition including headaches, dizziness, vision problems, memory loss, difficulty concentrating, and abnormal behaviour.

References

1. Zimmerman SD, Vernau BT, Meehan WP 3rd, Master CL. Sports-Related Concussions and the Pediatric Patient. Clin Sports Med. 2021 Jan;40(1):147-158. doi: 10.1016/j.csm.2020.08.010. PMID: 33187605.

2. Purcell LK, Davis GA, Gioia GA. What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review. Br J Sports Med. 2019 Feb;53(4):250. doi: 10.1136/bjsports-2017-097853. Epub 2018 Mar 2. PMID: 29500251.

Rationale for Proposed Changes

The return-to-school section was previously very short and vague, lacking specific information. I began with rephrasing the first sentence with the addition of a specific cognitive rest timeline based on up to date recommendations as opposed to the general “feels well enough” from before. The next sentence was fine, but I added a follow-up sentence explaining to readers the reasoning behind that statement with relation to recovery time (why return-to-school must be gradual). I added to the end of the next sentence on school personnel, again to explain the reasoning and give specific examples of accommodations. I also updated the source to a very recent article (published this year) as the current one was out-of-date. The final sentence I used to add specific symptoms that may impact the speed of the return-to-school process. The goal of my changes was to make the section less vague and provide readers with more specific, structured guidelines based on current research.

Controversy/Varied Opinions

There is variation in the recommendations for cognitive rest duration following a concussion regarding how long is actually beneficial to the patient. It is important to weigh the benefits of extended rest against the consequences of longer absence from school, which often results in differing opinions on the topic. Based on a variety of sources I read, including my 2 chosen sources, I found that the current research shows that the first 48 hours of complete cognitive rest show marked improvement in a person’s long-term recovery. After this 48-hour period there is not a consensus agreement among researchers, as the returns are minimal and the consequences of an extended absence from school may outweigh them. For this reason, I only proposed recommending the first 48 hours of rest, after which it would be up to the patient/family and their physician on a case-by-case basis.

Critique of Source

For my first source (Sports-Related Concussions and the Pediatric Patient) I noticed that some of the claims made in their article are backed my anecdotal evidence of one or two primary studies, rather than an entire review. The process of choosing these sources is also not indicated and could therefore be highly biased and chosen based on the authors opinions. For this reason, I tried to stay away from using the information that they say is backed by individual studies, and instead focused on the information that is backed by a consensus guideline. I also confirmed some of the information I drew from this source by checking that it matched what was said in my other source (such as the symptom list). For my second source (What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review) the search strategy was much more clearly identified and very comprehensive. A specialist librarian was consulted, and multiple databases searched (including grey literature) with a risk of bias assessment performed on the chosen sources. The only issue noted was that they included studies as old as 1985 which would be considered very out of date on the topic of concussions, but seemed to present the data based on a consensus which would limit the impact of old evidence that does not align with recent studies.

What to post on the Wikipedia article talk page?

 * This will also be covered on Nov 23rd 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 2020/Talk Page Template