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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.

Cardiac Arrest

Assignment # 3- please post an anonymous copy here!

Proposed Changes

Before Changes (Original)	After (Edited Version)
[From ‘Names’ Section of Society and Culture] In 2006 the American Heart Association presented the following definitions of sudden cardiac arrest and sudden cardiac death: "Cardiac arrest is the sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation. If corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac arrest should be used to signify an event as described above, that is reversed, usually by CPR and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac death should not be used to describe events that are not fatal".	In 2021, the American Heart Association clarified that “heart attack” is often mistakenly used to describe cardiac arrest. While a heart attack refers to death of heart muscle tissue as a result of blood supply loss, cardiac arrest is caused when the heart’s electrical system malfunctions. Furthermore, the American Heart Association explains that “if corrective measures are not taken rapidly, this condition progresses to sudden death. Cardiac arrest should be used to signify an event as described above, that is reversed, usually by CPR and/or defibrillation or cardioversion, or cardiac pacing. Sudden cardiac death should not be used to describe events that are not fatal".
Rationale for Proposed Change:	This change is rather minor but brings the American Heart Association definition up to date. More specifically, the 2006 source is rather outdated when compared to the 2021 definition that relates ‘heart attack’ to ‘cardiac arrest’ concerning the misuse of language. To encourage Wikipedia-friendly language, three medical terms (defibrillation, cardioversion, and cardiac pacing) have been hyperlinked to other Wikipedia pages. There is no controversy.
[From ‘Slow Code’ Section of Society and Culture] In some medical facilities, the resuscitation team may purposely respond slowly to a person in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the person's family, a practice known as "show code". This is generally done for people for whom performing CPR will have no medical benefit.	A ‘slow code’ is a slang term for the practice of deceptively delivering sub-optimal CPR to a person in cardiac arrest, when CPR is considered to have no medical benefit. A “show code” is the practice of faking the response altogether for the sake of the person’s family. (Perkins, G. D., Gräsner, J.-T., Semeraro, F., Olasveengen, T., Soar, J., Lott, C., Van de Voorde, P., Madar, J., Zideman, D., Mentzelopoulos, S., Bossaert, L., Greif, R., Monsieurs, K., Svavarsdóttir, H., Nolan, J. P., Ainsworth, S., Akin, S., Alfonzo, A., Andres, J., … Zideman, D. A. (2021). European Resuscitation Council guidelines 2021: Executive summary. Resuscitation, 161, 1–60. https://doi.org/10.1016/j.resuscitation.2021.02.003)
Rationale for Proposed Change:	The current section about slow codes uses vague language such as, “in some medical facilities”. This rephrasing of these two sentences creates a clearer definition of slow codes and how they differ from show codes. This definition of slow codes also comes from a more current source, namely the 2021 European Resuscitation Council Guidelines, a more reputable source than a New York Times article from 1987. There is no controversy.
[From ‘Slow Code’ Section of Society and Culture] Such practices are ethically controversial, and are banned in some jurisdictions.	Such practices are ethically controversial, and are banned in some jurisdictions. In 2021, the European Resuscitation Council Guidelines stated that, “clinicians should not partake in ‘slow codes’”. (Perkins, G. D., Gräsner, J.-T ., Semeraro, F., Olasveengen, T., Soar, J., Lott, C., Van de Voorde, P., Madar, J., Zideman, D., Mentzelopoulos, S., Bossaert, L., Greif, R., Monsieurs, K., Svavarsdóttir, H., Nolan, J. P., Ainsworth, S., Akin, S., Alfonzo, A., Andres, J., … Zideman, D. A. (2021). European Resuscitation Council guidelines 2021: Executive summary. Resuscitation, 161, 1–60. https://doi.org/10.1016/j.resuscitation.2021.02.003).
Rationale for Proposed Change:	The previous section had no citation or information to illustrate that the practice of slow codes is banned in some jurisdictions. To emphasize this point, information has been included about the European guidelines’ stance on their usage. [Controversy regarding this section is addressed in the following change]
[From ‘Slow Code’ Section of Society and Culture] Such practices are ethically controversial, and are banned in some jurisdictions.	The American College of Physicians ethics manual states, "Because it is deceptive, physicians or nurses should not perform half-hearted resuscitation efforts”. (Sulmasy, L. S., & Bledsoe, T. A. (2019). American College of Physicians Ethics Manual. Annals of Internal Medicine, 170. https://doi.org/10.7326/m18-2160).
Rationale for Proposed Change:	In the previous edit, clarification arises in terms of European Resuscitation Council Guidelines. Furthermore, an expansion of this explanation towards the American College of Physicians--which may be more grounding to much of Wikipedia’s audience--proves beneficial to the article’s gravity. Additionally, use of the word ‘deceptive’ and ‘half-hearted’ further the modern negative connotation of a slow code in the USA. The negative outlook on slow codes presented in our chosen sources outweigh controversy in terms of the planned changes in our section; this controversy concerns the ethical perspective of slow code performance. Although some determine slow codes to be justifiable in certain jurisdictions and in specific cases, the majority of physicians in the Western hemisphere have dubbed the futile code to be unethical.

Critique of Sources

Before Changes (Original)	After (Edited Version)
[From ‘Names’ Section of Society and Culture] Citation 124 is invalid/an improper link. Citation 124 supports the sentence, “In many publications the stated or implicit meaning of "sudden cardiac death" is sudden death from cardiac causes”. Original Source: Dorland's Illustrated Medical Dictionary, Elsevier.	124. Dorland’s Illustrated Medical Dictionary proper citation in resources section/when linked to the first sentence of this section. New Source: Newman, D. W. A. (2020). Dorland's Illustrated Medical Dictionary. Elsevier.
Rationale for Source:	Citation 124 was an invalid hyperlink before editing. Furthermore, the correction of this link to a simple book citation proves to be more credible. As this is a dictionary, there was no concern regarding the possibility of bias or negative impact on my plans for use of the information presented.
[From ‘Slow Code’ Section of Society and Culture] Citation 128 is a citation of an outdated College of Physicians and Surgeons of Ontario guideline from 2006. Citation 128 supports the sentence “This is generally done for people for whom performing CPR will have no medical benefit”. Original Source: Physician Advisory Service (May 2006). "Decision-making for the End of Life". College of Physicians and Surgeons of Ontario. Archived from the original on 2013-05-09. Retrieved 2013-04-06.	Removal of the citation through rewording of the first sentence of this section and replacement with a citation from the 2021 European Resuscitation Guidelines. After Changes: A ‘slow code’ is a slang term for the practice of deceptively delivering sub-optimal CPR to a person in cardiac arrest, when CPR is considered to have no medical benefit. New Source: (Perkins, G. D., Gräsner, J.-T., Semeraro, F., Olasveengen, T., Soar, J., Lott, C., Van de Voorde, P., Madar, J., Zideman, D., Mentzelopoulos, S., Bossaert, L., Greif, R., Monsieurs, K., Svavarsdóttir, H., Nolan, J. P., Ainsworth, S., Akin, S., Alfonzo, A., Andres, J., … Zideman, D. A. (2021). European Resuscitation Council guidelines 2021: Executive summary. Resuscitation, 161, 1–60. https://doi.org/10.1016/j.resuscitation.2021.02.003).
Rationale for Source:	Citation 128 is an outdated College of Physicians and Surgeons of Ontario guideline from 2006. The new CPSO guidelines for End of Life care do not have any reference to the practice of a ‘slow code’ or a ‘show code’. As such, this section has been reworded and a citation has been included from the 2021 European Resuscitation Guidelines to support the information about slow codes being historically administered to those for whom CPR would have no medical benefit. This new source meets MEDRS criteria as it is a guideline, it summarizes scientific consensus by a professional medical society, and conflicts of interest are declared, and thus the article is free of bias.
[From ‘Slow Code’ Section of Society and Culture] N/A	New Source: Sulmasy, L. S., & Bledsoe, T. A. (2019). American College of Physicians Ethics Manual. Annals of Internal Medicine, 170. https://doi.org/10.7326/m18-2160.
Rationale for Source:	This citation was added to support the mention of American guideline consensus on the impermissibility of slow codes. This source is reputable, the information is up to date (2019), the source is not primary, and thus it meets MEDRS criteria to be a source for Wikipedia.

Summary - Talk Page

We propose to adjust the following content into the Society and Culture section: (1) an updated definition of sudden cardiac arrest and sudden cardiac death, (2) a redefinition of the slang term ‘slow code’ as per the 2021 European Resuscitation Guidelines, (3) providing citations and examples of how ‘slow codes’ are banned in some jurisdictions, and (4) updating two citations within the section.

1. We propose to alter the 2006 definition of cardiac arrest in the article to the 2021 definition; this is a minor change yet will bring credibility to the updated page.

1. Secondly, we propose to redefine the slang term for ‘slow code’, providing clarity on the deceptive nature of the practice.

We plan to alter the sentence from:

“In some medical facilities, the resuscitation team may purposely respond slowly to a person in cardiac arrest, a practice known as ‘slow code’, or may fake the response altogether for the sake of the person's family, a practice known as ‘show code’. This is generally done for people for whom performing CPR will have no medical benefit.”

To an updated:

“A ‘slow code’ is a slang term for the practice of deceptively delivering sub-optimal CPR to a person in cardiac arrest, when CPR is considered to have no medical benefit. A “show code” is the practice of faking the response altogether for the sake of the person’s family.”

1. We noticed that the tone regarding ‘slow code’ improperly suggests that this practice is both common and generally more controversial than in reality; to counter this, a greater emphasis should be presented regarding the international prohibition of this ethically controversial practice.

We plan on adding two sentences to the end of the slow code section to emphasize the current practice of slow codes. These are:

“In 2021, the European Resuscitation Council Guidelines stated, “Clinicians should not partake in ‘slow codes’.”

And

“The American College of Physicians ethics manual states, "because it is deceptive, physicians or nurses should not perform half-hearted resuscitation efforts."

1. We noticed that citation 124 is an invalid hyperlink and should be altered to a proper dictionary citation. Secondly, citation 128 is an archived CPSO guideline and thus should be deleted along with the evidence or information shared from it.

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: Wikipedia:CARL Medical Editing Initiative/Fall 2021/Talk Page Template