User:NicoleHajjar/sandbox

Welcome to your sandbox!

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.

Link: Project Homepage and Resources

• 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: Wikipedia:CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Bipolar I Disorder

Assignment 2

1) How you searched for a source (search strategy – where you went to find it).

I searched the PubMed database for recent review articles in English for the diagnosis of Bipolar Disorder. My search strategy is pictured below:

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

1. https://www-ncbi-nlm-nih-gov.proxy.queensu.ca/pubmed/26388529
2. https://www-ncbi-nlm-nih-gov.proxy.queensu.ca/pubmed/28888714

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

I chose these sources for 2 main reasons:

1. They both have information specifically on Bipolar I Disorder, which is the topic of our Wikipedia article. It was difficult to search for Bipolar I Disorder specifically, as many articles include information on both Bipolar I and Bipolar II Disorder.
2. They both reference DSM-5 diagnostic criteria for Bipolar I Disorder, which is important as the Wikipedia page currently cites the DSM-4. The DSM-5 was released by the American Psychiatric Association in 2013, so it will be important to update the assessment criteria on Wikipedia.

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

1. Both articles are review articles, which are secondary sources.
2. Both articles were published within the last 5 years (2016 & 2017).
3. Both articles were published in peer-reviewed scientific journals (The Lancet & Mayo Clinic Proceedings).

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

I plan to use these sources to edit the “Medical Assessment” heading under the “Treatment” section of the Bipolar I Disorder Wikipedia page. The current Medical Assessment section does not include current diagnostic criteria and guidelines, and does not cite any sources.

Assignment 3

Proposed Changes

Current: Routine medical assessments are often prescribed to rule-out or identify a somatic cause for bipolar I symptoms. These tests can include ultrasounds of the head, x-ray computed tomography (CAT scan), electroencephalogram, HIV test, full blood count, thyroid function test, liver function test, urea and creatinine levels and if the person is on lithium, lithium levels are taken.

Proposed revision: Routine medical assessments are performed to rule-out secondary causes of mania and depression. These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered.

Final Feedback:

I would change to: ...when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered to assess for secondary causes.

- Simply written and clear.

- terms properly wiki-linked

- no issues with people-first language.

RREIDCAF

Rationale for Proposed Changes

The current section on medical assessment does not cite any sources. I have made changes to the first sentence to explain that the medical assessments that are done are to rule-out secondary causes of mania and depression, which is more specific than the original statement of “bipolar I symptoms”, and is also the terminology used in my source. In the second sentence, I have added some tests (ex: syphilis test and pregnancy test) and removed others (ex: ultrasound of the head) based on the recent medical literature. I have also included the appropriate citation.

As far as controversy is concerned, I could not find any medical literature to support the original mention of ultrasound of the head. The only clinically relevant imaging techniques in the literature are ECG, EEG, CT, and MRI. There is also some controversy surrounding the amount of tests ordered to work-up Bipolar I disorder. The source that I cited suggests performing routine medical assessments (ex: CBC, glucose, etc.) for all patients with new onset psychosis, mania, or depression, and only performing imaging (ECG, EEG, CT, and MRI) when clinically indicated. These clinical indicators include new onset mental status changes, neurological complaints, history of head injury, and delirium.

- For controversy, often people feel that there are 'too many tests' ordered routinely to work-up a disorder, as most turn out negative. We don't routinely do CT, MRI, EEGs on every presentation of Bipolar disorder, but will if there's good clinical indicator (older age at first presentation, fever, neurological signs) and might be worth including that specifier in your proposed change (...pregnancy test, and when clinically warranted, CT, MRI, and EEG.) We also do an ECG because there are some cardiac effects to the medications we use, so maybe putting that before the advanced tests would make more sense. -rreidcaf

Final Feedback

It appears you have integrated my feedback, just make the grammatical changes above before posting to talk page and should be good.

RREIDCAF

Critique of Source

This source is a review article from a recent volume of Mayo Clinic Proceedings, which is a high-quality, peer-reviewed journal. The author did not disclose any conflicts of interest or funding for this publication and no major sources of bias were identified.

However, as this is a review article and not a systematic review, the author has selected the evidence in an unknown way. This means that there is a chance that not all relevant evidence was considered. If high quality evidence that did not support the author's position was not included in the article, then that would threaten the validity of this source. In addition, if the author included low quality evidence because it supported his personal experiences, then that could also threaten validity.

- I would maybe change your last sentence to something along the lines of 'a potential for bias always exists, and some authors may disagree with notable journals and topics published, but on routine critique no major sources of bias were identified'.

Sometimes you get quackery sent to notable journals (and then we get lots of media following these 'new scientific findings') and we have to wait for the journal to publish a retraction or editorial explaining why the article was allowed to be published. Lots of fads start with a misinterpretation of findings published in respectable journals, and sometimes finding those are part of the peer review process (peer reviewed means that at least one person, not the author, read the article before publication; they won't necessarily make sure everything is right, they just make sure that no gross errors were found, and then let the greater readership of the journal view it when it is published, and bias/errors may be found months/years later. -Rreidcaf

Final Feedback

Good finding on that low quality evidence part. I don't have enough time right now to investigate further, but that's a huge potential bias!

RREIDCAF