User:Trickoflight/sandbox

SGL 13 Article: Gangrene Link: https://en.wikipedia.org/wiki/Gangrene

Wikipedia Assignment #2 - Sources

References:

1. Trevor Robinson:

2. Justin Dirk:

3. Alan Huynh:

4. Syed Ibrahim:

5. Sarah Wong:

6. Tania Yavorska:

Trevor Robinson Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H, Zhan S. Interventions for treating gas gangrene (Review). Cochrane database of systematic reviews. 2015;12:1-30. doi:10.1002/14651858.CD010577.pub2. 1.    To find this resource I simply searched ‘gas gangrene’ in the Cochrane database of systematic reviews. I found only 1 resource in the database using this search method. 2.    I identified one other potential academic resource for gas gangrene and it was a published lecture given at the Society for General Microbiology titled: ‘Gas gangrene: an open and closed case’ by. Richard W. Titball (2005). 3.    I decided to choose the systematic review from Cochrane because systematic reviews are the strongest form of evidence. In comparison, the published lecture was written/delivered by an expert and is not as reliable. Additionally, the lecture was delivered in 2005 and the Cochrane review article was published in 2015, so it is more likely to contain current, up to date research. 4.    This resource is a systematic review which is listed as an ideal source of information for medical information on Wikipedia. In general, Wikipedia prefers non-primary sources, since initial research can contain invalidated or controversial results. Additionally, this paper is published in the Cochrane database of systematic reviews, which is a very reputable source with high methodological standards, further adding to this studies value. Lastly, this review was published in 2015 and represents current, up-to-date information on the topic of gas gangrene and its treatment options. 5.    I plan on using this systematic review to verify and expand on the gas gangrene section of the Wikipedia page and to update the treatment methods accordingly.

Sarah Wong

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of america. Clinical Infectious Diseases. 2014;59(2), 10-52. doi: https://doi.org/10.1093/cid/ciu296. Accessed October 7, 2017.

1. I found this source under the references of the BMJ Best Practice article on gangrene. The article referenced 58 sources, of which 5 were key sources. Of the key sources, only this source was published within the past 5 years.

2. I considered one other potential source, which was a consensus document titled: “Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)” by L. Norgren, W.R. Hiatt, J.A. Dormandy, M.R. Nehler, K.A. Harris, and F.G.R. Fowkes on behalf of the TASC II Working Group (2007). The document outlined diagnosis and management of peripheral arterial disease, including gangrene, based on expert consensus from sixteen international societies and a systematic literature search and recommendation grading system.

3. I chose this source because it also provides recommendations on diagnosis and management of Fournier and gas gangrene, based upon consensus from 10 multidisciplinary experts in America; the panel performed a systematic literature search and evaluated sources based on the Infectious Diseases Society of America’s grading system. Thus, both sources were equal in their systematic methodology. However, the first source was published in 2014, whereas the second source was published in 2007. Therefore, the first source may have more recent information on disease management. As well, the second source only mentions ischemic gangrene as a complication of critical limb ischemia and very briefly outlines management of the gangrene. The first source provides more detail into the management of Fournier and gas gangrene.

4. 1. This article is a secondary source, as it is a practice guideline created by experts who performed a systematic literature review. Because it is a secondary source instead of a primary source, it takes into account multiple viewpoints and is less likely to report flawed or biased information. 2. Wikipedia values guidelines issued by major professional medical or scientific societies. This guideline is issued by the Infectious Diseases Society of America, thus rendering it more reputable. 3. Wikipedia also values up-to-date information, preferring sources published within the past 5 years. This article was published in 2014, so it contains recent information on gangrene diagnosis and management.

5. The Wikipedia article contains a small section on gas gangrene and only lists Fournier gangrene under “Other” types of gangrene. I plan to use this article to expand on the management of gas and Fournier gangrene.

Syed Ibrahim Wiki style Bonne, Stephanie L.; Kadri, Sameer S. (2017). "Evaluation and Management of Necrotizing Soft Tissue Infections". Infectious Disease Clinics of North America. 31 (3): 497–511. ISSN 1557-9824. doi:10.1016/j.idc.2017.05.011. AMA style Bonne SL, Kadri SS. Evaluation and Management of Necrotizing Soft Tissue Infections. Infect Dis Clin North Am. 2017;31(3):497-511. doi:10.1016/j.idc.2017.05.011.

To find this article, I searched “gangrene practice guidelines” on PubMed. After filtering by review articles, there were thirty eight articles, but this one seemed to be the best.

One of the articles, titled “Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons,” discussed diabetic complications resulting in gangrene and amputation. Although published by a reputable association, this article is quite dated (published in 2000). Another article titled “Surgical Management of Severe Colitis in the Intensive Care Unit”, was more recent (published in 2015), but it focused on colitis and mentioned gangrene only once.

Compared to the other articles, I chose this article as it is a recent, relevant, and comprehensive. This article was published last month (Sept 2017). Moreover, it examines necrotizing infections, including their pathophysiology, diagnosis, and treatment. This in-depth review cites over 60 other papers. However, it is important to remember that this is a narrative review rather than a systematic review and may be affected by selective article choices and personal experience of the authors.

Wikipedia’s medical citation are required to be recent (< 5 years old), secondary articles, from a reputable source. This article meets all three criteria as it is a review article published in the Infectious Disease Clinics of North America journal a few weeks ago.

This paper can help improve multiple sections of the Gangrene Wikipedia page including causes, types and treatment. For example, data from Table 1 (microbiologic classification of necrotizing soft tissue infections) can complement the causes of wet gangrene. As well, the information from the pathophysiology and diagnosis sections of this article can introduced these new sections to the Wikipedia page.

� Alan Huynh

Farber A, Eberhardt RT. The Current State of Critical Limb Ischemia. JAMA Surgery. August 2016:1070-1077. doi:10.1001/jamasurg.2016.2018.

1. To find this article, I searched the PubMed database using the search query “Gangrene treatment”, with results filtered for articles published in the last 5 years, and article type as reviews.

2. Several articles were reviewed before arriving at my current source. These included an article entitled “Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016.” I elected not to use this article due to its narrow scope of discussion, as it discusses only Fournier’s gangrene. Another article, entitled “Frostbite” was also excluded from my list, as it discusses at length the treatment strategies of frostbite itself with gangrene as a keyword, but not a key concept.

3. I chose my current source because of several reasons. First, the article is relevant to the etiology of gangrene. Second, it is relevant to the treatment of gangrene. Gangrene is largely caused by vascular insufficiency, and its treatment and prevention is often times surgical. Thirdly, the article is published very recently, and succinctly describes the diagnosis, treatment, and management of critical limb ischemia.

4. The source is a secondary source -- it is not original research, but rather, a review of recent literature conducted by the authors. Wikipedia recognizes the value in the use of secondary sources. The article is also up to date, as it was published just over a year ago. Wikipedia prefers articles published less than 5 years ago. Finally, the article is published in JAMA Surgery, a very reputable journal which often forms the basis of clinical guidelines. Wikipedia prefers articles written and published in a reputable source.

5. I hope to use this paper to expand on the ‘prevention’, ‘pathophysiology’ and ‘treatment’ sections, as the article describes at length the efficacy of several treatments. Table 2 in the article is a great example of the type of discussion present in the article -- in it, the authors describe outcomes of several touted therapies, and subsequent recommendations in patient care. This will prove invaluable in both the prevention and treatment sections. An entire section is devoted to the pathophysiology of critical limb ischemia, which is closely linked to the development of gangrene.

� Justin Dirk

Liu R, Li L, Yang M, Boden G, Yang G. Systematic review of the effectiveness of hyperbaric oxygenation therapy in the management of chronic diabetic foot ulcers. Mayo Clinic Proceedings. 2013;88(2):166-175. doi:0.1016/j.mayocp.2012.10.021.

1. Search Strategy: On Mayo Clinic, a search was done on “hyperbaric oxygen treatment”. References were then looked at and the above systematic review article was looked a as a source for the info provided in the Mayo clinic, and was deemed acceptable.

2. One article that was considered was an article titled Spontaneous C. septicum gas gangrene: A literature review. Although it was considered, it was determined not ideal as it is a literature review versus a systematic review and therefore was considered lower on the evidence pyramid. Literature reviews have the potential for a researcher to bias what was taken into consideration to advance their own opinion and thus must be used with caution.

3. The source was chosen because it was relevant to the topic, and helps fill a gap in the knowledge on the wiki page. As well, it is a systemic review and meta-analysis and thus is considered very strong evidence. Finally, it is backed by many peer-reviewed journals with a structured approach, as well as an amalgamation of study data and statistics.

4. According to the WP:MEDRS, this article fits many of the criteria. As this is a systematic review and meta analysis, it is a secondary source and is at the top of the evidence pyramid. It is also an aggregate of many peer-reviewed journals, and thus summarizes the scientific consensus on the topic. Finally, It is also relevant and recent, being only 4 years old, and summarizes many articles from a depth of research on the topic.

5. As the treatment section of the wikipedia article is lacking, and needs more up to date and varied treatments, this article will help suggest a different course to help with a specific type of gangrene. It also gives rise to causes of gangrene, focusing specifically on Diabetic gangrene.

� Tania Yavorska

Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. Circulation. 2017;135(12):e726-e779. .

1) how they searched for their source (search strategy – where you went to find it) My goal was to find an overview of the current practices used in the management of gangrene. I searched DynaMed for "gangrene" and identified 80 related results. I selected "Management of acute and critical limb ischemia", as this summary was sufficiently general in its scope and covered one of the major causes of gangrene (peripheral artery disease). Of particular interest to me was the section on critical limb ischemia, as gangrene was listed as one of the symptoms of this condition. When reviewing this section, I noticed that most of the information was referenced to a specific set of guidelines by AHA/ACC. I then used PubMed to find the referenced article (available through PubMed Central). 2) Initially, I also searched the Cochrane database information on gangrene. The following article was identified: Vemulapalli S, Patel MR, Jones WS. Limb Ischemia: Cardiovascular Diagnosis and Management from Head to Toe. Curr Cardiol Rep. 2015;17:57. https://doi.org/10.1007/s11886-015-0611-y This source was considered as it provides an overview of acute and critical limb ischemia, diagnostic criteria, as well as a brief description of available treatments. The information was presented in an easily understandable and concise manner. The reason I ultimately chose to look for another source is that there was no indication as to how reliable and comprehensive the information provided was. The authors did not include the strategy they used in compiling the information for this article. 3) I chose the 2016 AHA/ACC guidelines over the Limb Ischemia article for the following reasons: While both articles meet the Wikipedia criteria of being a secondary source, I chose the 2016 AHA/ACC guidelines as they are much more comprehensive in scope. The publication details how the literature search was carried out, the timelines covered and the databases used, whereas the Limb Ischemia article did not. The year of the publication of the guidelines is more recent (2016 vs 2015) The writing group for the AHA/ACC guidelines included individuals from many institutions and backgrounds, and was much larger than the Limb Ischemia article; having a large number of contributing authors and institutions reduces the risk of bias 4) Wikipedia guidelines state that secondary sources are preferred. AHA/ACC guidelines are a secondary source and rely on evidence from a wide range of primary sources Wikipedia recommends using official organization guidelines. American Heart Association is one such organization This source is the most current set of guidelines (recency is important) DynaMed is listed as a recommended resource by Wikipedia The article is accessible to the public through PubMed Central 5) This source will be useful in describing the current treatments available for gangrene in people chronic limb ischemia. This condition affects many people with peripheral artery disease and is common in people with diabetes, and thus will be beneficial for inclusion in the article on gangrene.

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Wikipedia Assignment #1 - Evaluating 1.	Is everything in the article relevant to the article topic? Is there anything that distracted you? While the majority of the content on the page for gangrene is relevant, there is some content that is irrelevant and distracting. For example, near the end of the ‘Treatment’ section, the article discusses the prevalence of limb amputations in the US and predicts future prevalence. This sentence is irrelevant and distracts the reader from the topic since the cited source is not strictly referring to amputations due to gangrene and includes amputations regardless of the etiology. In addition, the ‘History’ section includes some debatably irrelevant content about famous people in history that fatally contracted gangrene. While details of the progression and development of treatment methods through history is relevant to the topic, the inclusion of famous people with gangrene is irrelevant and should be restricted to the famous person’s own Wikipedia page. If we decide to include one famous person as an example, where do we stop? The history page could end up including a list of all famous people who contracted or died from gangrene which is distracting to the reader on a medical Wikipedia page. Lastly, the ‘See Also’ section seems completely irrelevant since it describes a famous death from gangrene, without a reference, and contributes little to the article.

2.	Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position?

The article is largely neutral. Any comparison claims that it makes are backed up by citations from reliable sources, thus making it a neutral fact (eg. The statement that surgical removal is the standard treatment for gangrene is sourced from the National Health Service of England). However, in the “History” section, the article claims that maggot therapy is increasing in credibility and efficacy, but it does not provide any factual data to support this, thus making it seem like a biased claim.

3.	Are there viewpoints that are overrepresented, or underrepresented? ‘Types’ section focuses on Wet, Dry and Gas types of gangrene in some detail, as well as lists several other types. It is unclear whether this is an accurate classification (e.g. gas gangrene is listed as a separate category but is actually a sub-type of wet gangrene). ‘Other’ types are not described at all, and are underrepresented compared to the wet, dry, and gas gangrene. The description of the causes under each type would be more appropriate under the ‘Causes’ section, while a more detailed description on the differences in presentation and diagnosis of each type would be more relevant, and is largely not included in the article. Although there is a brief mention that gangrene can affect internal organs and not only limbs, the pictures and text largely focus on the extremities, and it is unclear why. Treatment section is rather scattered and focuses largely on the management of gangrene caused by an infection, while dry gangrene is barely mentioned. In addition, there is more focus on the use of debridement and antibiotic therapy, and while a few other potential treatments are mentioned, none are discussed in detail. This section could benefit from a better structure and discussion of treatment subdivided by type, by cause, by location of the affected area or by severity.

4.	Check a few citations. Do the links work? Does the source support the claims in the article? This article contains 25 citations and the links to each of these works correctly. However, there are a few problems. While many citations are scholarly, they are not necessarily up to date. For example, citation 6 refers to a systematic review by Yang et al in 2013, but there is a newer version of the article that was published in Dec 2015. Additionally, some of the sources have questionable reliability (e.g. #26 cites a blog page dealing with music trivia). Most of the sources support the claims. However, there are at least two instances in which claims lack citations (e.g. under the Dry section).

5.	Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are they secondary sources? Are these neutral sources? If biased, is that bias noted? Generally, the facts used to produce the article, when cited, use appropriate sources. Authoritative secondary sources, such as textbooks, government websites (e.g. NHS), and Cochrane systematic reviews are cited. The article makes appropriate use of primary sources. For example, the article cites a primary research article when suggesting that heparin-induced thrombocytopenia may cause gangrene. Indeed, their use of the qualifier ‘may’ appropriately showcases that the data is preliminary, and was not subject to the same level of rigor as other statements of fact. As the sources used were mainly textbooks and systematic reviews, we could not find any instances of non-neutrality. Many reviews included an analysis of bias, which is promising. Unfortunately, several statements of facts within the article are uncited. These include the majority of the section on treatment of gangrene -- half of the section is uncited. Of particular note is an uncited statement made in the ‘history’ section of gangrene, which purports that therapy making use of maggots to eat away dead tissue is utilized in modern medicine. These should be reviewed and citations added.

6.	Is any information out of date (within 5 years from the publication date)? Is anything missing that could be added? Out of the 25 citations, only 7 of them were within the 5 years, and the citations are few and far between throughout the article. The article, although has some organization, is quite short. It touches on many topics but they are not explored. Pathophysiology is mentioned in types, but it could be more elaborated on, such as how the bacteria spread, what types of tissues are affected more than others etc. Epidemiology could also be mentioned, showing the demographic of who is affected and possible reasons for these, not just comorbidities that may cause these diseases. A section on prevention or management of comorbidities may be worthwhile to help people at risk for gangrene. Expand on causes, such as specific types of microbes, risk factors etc. Finally, although treatment was explored, a more specific description of things like the antibiotics, types of amputations etc. would paint a clearer picture of what may be needed to treat this disease.

7.	Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic? The talk page is permeated with animated discussions regarding the content of the article. Of particular note is a recurrent complaint regarding the use of “graphic” pictures in the article. Some authors -- and readers -- are unpleased with the pictures of gangrenous toes greeting the readers. There has been debate as to whether it is appropriate to remove the images, hide them from view until the reader elects to open the file, or to keep the images. Proponents of the image state that to remove the pictures would constitute censorship; they further question why someone would search for information on gangrene without desiring pictorial representation of the condition. Other parts of the talk page contain discussions regarding lack of citations for various treatment methods, including a (now removed) statement that advertised the use of a drug without reason. There are also several comments proposing to include potential causes of gangrene that are currently not mentioned (specifically, frostbite and heroin injection are mentioned).

8.	Outline the article as it stands. What do you plan to contribute? •	Lead section: adjust to better reflect the contents of the article •	‘Causes’: expand (e.g. add specific bacteria); include risk factors (alcohol, smoking, drugs) •	‘Types’: Verify that the types of gangrene mentioned (dry, wet, gas, and other) are accurate and correspond to a medical classification; if appropriate, re-organize the article to focus more on the underlying causes (vascular disease, infection, etc.) •	Add a ‘Pathophysiology’ section, including how the bacteria spread •	Add a ‘Prevention’ section that describes management of common risk factors •	Add an ‘Epidemiology’ section, including reasons for prevalence in specific geographies and populations •	‘Treatment’: update to reflect current best practices, add a discussion of benefits and drawbacks of current interventions, and add any promising emerging treatments •	Fact check (e.g. “maggot therapy has regained some credibility and is sometimes employed with great efficacy in cases of chronic tissue necrosis.” (no citation provided) •	Filter/update any irrelevant content (e.g. general amputation stats, historical cases) •	Provide citations for uncited content •	“See also”: Add relevant links (e.g. necrotizing fasciitis, sepsis)