User:Rexpark3/sandbox

1. The article begins with an overview (abstract) of the topic and then subsequently goes on to expound about each aspect in further detail. The contents cover different facets of frostbite, including signs and symptoms, causes, medical treatment, and how this condition has affected popular figures in society/culture. As such, the reader – depending on their background and reason for researching this topic – has a plethora of very relevant but diverse material to deepen their understanding of the topic. Under the “Mechanism” subheading, however, the article mentions that the mechanism for frostbite is different from that of non-freezing cold injury (NFCI), and then proceeds to outline in great detail the mechanism of NFCI. This is not entirely relevant to the reader’s understanding of how frostbite damages the body, and should instead be more succinctly described. A hyperlink to the Wiki page for NFCI could then be provided for further reading.

2. For the most part, the information contained within the article is neutral. No personal pronouns were used at any time, nor was a personal opinion about anything related to the subject of frostbite ever stated.  There are no claims, or frames, that appear heavily biased towards a particular position. However, there were some instances where inadequate sources were used to describe certain sections. For example, the information contained under the Prevention section was cited from the Wilderness Medical Society, a non-profit organization based in the United States. It is important to keep in mind that organizations may gain awareness by being cited in popular articles, and it is best to try to avoid citing sources who may benefit from the exposure. This is particularly relevant for this example because the information attributed to the Wilderness Medical Society is nonspecific, and can be provided by more reliable, generic sources.

3. There are no specific viewpoints in the article that could be overrepresented or underrepresented as the article does not contain any personal opinions. However, many sections within the article describing aspects of frostbite are underrepresented simply because they lack detailed information.

4. This article has a few problems with its citations. Generally, most of the links are functional and lead you to the articles they reference. For all of these functional, accessible links, the source does support the claims in the article. However, one major problem is that a lot of the links direct you to pages that require subscriptions to view the content. If you do not have the subscription, you cannot access the page so it is difficult to confirm whether the information is correct. In addition, this makes it nearly impossible to read more on the subject if you want greater detail. One other issue is that there are two links that don’t take you anywhere. Instead, the links direct you to the “Frostbite” page you were already on. There was also one other link that was attempting to reference a book, but simply did not work. There are several links that send you to blogs and news items. This would be inappropriate if the material cited was scientific. However, the material that was cited was all social and thus citing the news articles was relevant and appropriate. One final problem is that there were two citations that linked to the same page. These should have been referenced as the same citation. Overall, while most links worked and were relevant, there was some lack of consistency in the style of referencing and several links led you to references that could not be accessed.

5. The Frostbite article is not adequately referenced. The majority of information comes from a generally reputable source (MedScape). However, information should be taken from the source articles informing the MedScape article, as opposed to the MedScape article itself. Additionally, there are large sections of text that are devoid of reference. Another potential issue with the references chosen for this article is their relevance. Many of these articles are over 10 years old, and therefore may not reflect current facts regarding frostbite. That being said, there were a few referenced articles which seemed like useful sources, as they were systematic reviews, or review articles from reputable peer reviewed journals. With respect to the reference table itself, the references don’t appear to follow a distinctive, and consistent structure. In fact, many of the references are incomplete, and therefore do not allow the reader to read the primary source. Moreover, the reference list has not been properly edited as many of the articles in the reference list are not actually reference in the Wikipedia article. No bias or conflict of interest was apparent in any of the referenced articles.

6. The page was originally published in 2003, and some sources are within 5 years of this date and can be updated. Many citations are more recent, being published only in the last 5–10 years. There are 2 articles, one from 1970 and one from 1988, which could be replaced with more recent sources as well. The information presented is quite comprehensive, however statistics on prevalence and other epidemiological information, as well as the historical impacts of the disease, could be added. More specific guidelines for avoiding frostbite could also be added, such as what to wear in certain temperatures and how long frostbite takes to develop based on the environment and time of exposure.

7. At the top of the Talk page is a workplan for updates (presumably written by the article’s author or lead editor) outlining each heading and the corresponding changes that will be implemented. This workplan has been updated as recently as March 1, 2017. The next few topics discuss suggestions to improve the content and validity of the article, including anecdotes of frostbite pain, quotes from a textbook (i.e., content contributions) and fact-checking. A few sections also ask for clarification/re-wording of some paragraphs and edits due to the inclusion of irrelevant information. A last section centres around a story of an elephant with frostbite, prompting an interesting discussion as to what constitutes encyclopedic information (and should thus be included in Wiki articles).

8. Overall, the article defined frostbite and described its signs and symptoms, causes, mechanism of action, diagnosis, prevention techniques, treatment options, and epidemiology. We plan on adding citations to sections that are currently uncited, fixing the broken links and citations, and ensuring that the links are redirected to pages that are accessible to the general public. For references we add or replace, we will aim to find sources that are recent and represent high levels of evidence. For example, we will favour reviews, and assess the methodological quality of these reviews if possible (e.g., using AMSTAR to assess systematic reviews). In order to make the article more comprehensive, we will expand on the information in certain sections. For example, we plan on adding more high-quality information on self-care treatment techniques, frostbite prevention techniques (e.g., how to best layer your clothes for cold weather), pathophysiology, and the epidemiology of frostbite. Lastly, we aim to ensure that the content, citations, and links are presented in a straightforward and standardized style to make it easier to consume for diverse individuals.  

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List of unreferenced statements:

Other considerations for standard hospital management include: • wound care: blisters can be drained by needle aspiration, unless they are bloody (hemorrhagic). Aloe vera gel can be applied before breathable, protective dressings or bandages are put on. • antibiotics: if there is trauma, skin infection (cellultitis) or severe injury, antibiotics are indicated. • tetanus toxoid: should be administered according to local guidelines. Uncomplicated frostbite wounds are not known to encourage tetanus. • pain control: NSAIDs or opioids are recommended during the painful rewarming process.

People with potential for large amputations and who present within 24 hours of injury can be given TPA with heparin or enoxaparin. These medications should be withheld if there are any contraindications.

Individuals with frostbite or potential frostbite should go to a protected environment and get warm fluids. If there is no risk of re-freezing, the extremity can be exposed and warmed in the groin or underarm of a companion. If the area is allowed to refreeze, there can be worse tissue damage. If the area cannot be reliably kept warm, the person should be brought to a medical facility without rewarming the area. Rubbing the affected area can also increase tissue damage.

• Frostnip is similar to frostbite, but without ice crystal formation in the skin. Whitening of the skin and numbness reverse quickly after rewarming. • Trench foot is damage to nerves and blood vessels that results exposure to wet, cold (non-freezing) conditions. This is reversible if treated early.

There is a lack of comprehensive statistics about the epidemiology of frostbite. In the United States, frostbite is more common in northern states. In Finland, annual incidence was 2.5 per 100,000 among civilians, compared with 3.2 per 100,000 in Montreal.

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Assignment 2:

Source 1 (Retrieved by Joshua)

Heil K, Thomas R, Robertson G, Porter A, Milner R, Wood A. Freezing and non-freezing cold weather injuries: a systematic review. British Medical Bulletin. 2016;117(1):79-93.

1) Used the search terms “Frostbite therapy review” on PubMed. 2) Some other reviews were found, namely “Frostbite” by Handford and colleagues (2017), and “Preventing and Managing Hypothermia and Frostbite Injury by Fudge (2016). 3) This article was chosen because it is a relatively recent systematic review (i.e., authoritative review) of the epidemiology and current management strategies for cold weather injuries. Though the article is not specific to frostbite (it includes freezing and non-freezing injuries), it is a comprehensive, relevant review of the literature. 4) Reasons why the source was chosen: a. Authoritative review article (systematic review, high level of evidence) with neutral information b. Published recently (2016) c. Freely available on the internet 5) The information in this article will be used to contribute to the “Pre-hospital care” subsection in the Wikipedia “Frostbite.” Specifically, the added information will provide a crude diagnostic test for distinguishing between frostbite and other cold-weather injuries, and will then supply first aid recommendations. It also contains information that can improve the quantity and quality of other subsections of the Wikipedia article, including background information on frostbite, signs and symptoms, and risk factors.

Source 2 (Retrieved by Lori)

Fudge J. Exercise in the Cold. Sports Health: A Multidisciplinary Approach. 2016;8(2):133-139.

1) To find this article I used Google Scholar. I used the search terms “Frostbite Prevention Review” and then narrowed down my search to only include articles from 2013 on. 2) This searching technique identified many articles. Unfortunately, most were either not applicable or did not meet the Wikipedia guidelines. One article that was considered was “Evidence-based review of wilderness first aid practices (Journal of Outdoor Recreation, Education, and Leadership 2017, Vol. 9, No. 2, pp. 217–239 https://doi.org/10.18666/JOREL-2017-V9-I2-8226). This article actually did meet Wikipedia’s guidelines. It was a systematic review and the review process was very clearly outlined. We did not choose to use this article since the section on frostbite was quite small and did not provide as in-depth of an overview as some other articles. 3) This source was chosen because it meets Wikipedia’s guidelines on citation selection and it contains additional information that we feel would be relevant to the article. It is also a very recent article, having been published in 2016 and is thus still relevant. 4) Reasons why the source was chosen: a. It is a recent article, being published in 2016 b. It is a systematic clinical review (there is an outline of how they searched the literature for relevant articles). It must be noted that this is not outlined in as great detail as some other reviews but we felt it was still relevant and acceptable for citation. c. it provides clinical recommendations based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series. d. it has subscription-based access e. it used scientific/medical language and is targeted towards a medical/scientific audience. 5) This article was selected to improve the “prevention” section of the Frostbite article. This article has an extensive section on prevention of cold injuries and will thus give us a large amount of information on the topic. This article also has information on treatment of Frostbite and can be used for that section as well. In addition, the clinical recommendations will be a useful addition to the article.

Source 3 (Retrieved by Hayley)

Sachs C, Lehnhardt M, Daigeler A, Goertz O. The Triaging and Treatment of Cold-Induced Injuries. Deutsches Ärzteblatt International. 2015;112(44):741-747.

1) Using PubMed, I created an advanced search using the MeSH Terms “frostbite” and “treatment”. I then restricted the results to include only systematic reviews and results published within the last 5 years. 2) Using these parameters only four results were returned on PubMed. An additional article obtained through the search was “Perniosis a case report with literature review”. As indicated, this article was primarily a case report with a subsequent literature review. Therefore, it did not contain the information necessary to effectively inform a Wikipedia article. 3) This source was chosen for numerous reasons. First, it represents recent information as it was published in 2015, and reviewed data as recent as 2014. Second, it synthesizes the findings of 10 different studies which were identified using a PubMed search of relevant terms (“frostbite injury”, “non-freezing cold injury” and “frostbite review”). This suggests, that the information reviewed in the article is highly relevant to informing a Wikipedia article on Frostbite. Third, this study, as it is a systematic review, it represents a level of evidence and is an ideal reference for a Wikipedia article as it has already undergone rigorous peer review. 4) As previous described, this article was chosen for the following reasons: a. Recent (published in 2015, reviewed data published from 2009–2014) b. Strong secondary source (systematic review), which has already undergone the peer review process c. Freely available d. Relevant to the topic (frostbite) e. Information presented was neutral (without bias) 5) This source will be used to write the “recommended treatments” section of the Wikipedia article because this it will allow us to outline the overall treatment recommendations based on the systematic review of multiple sources.

Source 4 (Retrieved by Katrina)

McIntosh S, Opacic M, Freer L, Grissom C, Auerbach P, Rodway G et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2014 Update. Wilderness & Environmental Medicine. 2014;25(4):S43-S54.

1) I began my search using PubMed. I searched for the terms “frostbite”, as well as “frostbite pathophysiology” and “frostbite guidelines”. I restricted my search to the literature published within the last five years. 2) Potential sources were initially identified by selecting the articles from the search that seemed relevant to the topic. I then briefly reviewed the abstracts, and excluded those articles which were not systematic reviews, meta-analyses, or practice guidelines. Thus, I was left with a few potential sources such as “The Triaging and Treatment of Cold-Induced Injuries”, which I found to also be an excellent source but, it had already been selected by a classmate. Another I found was “Exercise in the Cold: Preventing and Managing Hypothermia and Frostbite Injury”, and while this source as a systematic review, it did not go into vast detail about the pathophysiology of frostbite. 3) This source was chosen because it was a set of practice guidelines published by a major medical body, the Wilderness Medical Society. Moreover, the source contained detailed information about the pathophysiology of frostbite, which was not described in sufficient detail in the Wikipedia article. 4) Reasons why the source was chosen: a. It is a recent article – published in 2014 b. The information was relevant to the topic of frostbite c. The information presented was neutral, and was without bias d. Information was published by a major medical body 5) This source will be used to improve the “Mechanisms” section of the Wikipedia page. Presently, the section is very sparse. For example, the source describes the four pathological phases of frostbite, each of which can potentially be included and described in detail in the Wikipedia section.   

Source 5 (Retrieved by Justin)

Frostbite [Internet]. Centers for Disease Control and Prevention. 2017 [cited 7 October 2017]. Available from: https://www.cdc.gov/disasters/winter/staysafe/frostbite.html

1) Searched the term “frostbite” on the CDC website and found a page dedicated to frostbite as well as an infographic 2) Other citations that were considered were “Hyperbaric, Frostbite” by Robins and Cooper (2017), and “Deep Frostbite Treated With Hyperbaric Oxygen and Thrombolytic Therapies” by Higdon et al. (2015). 3) This resource is the best choice because it provides clear guidelines for prevention, identification, and treatment of frostbite; three very important factors that can be made clearer on the “Frostbite” Wikipedia page. The evidence used to establish the guidelines come from relevant, recent, well-designed studies 4) Reasons why the source was chosen: a. Source is from a widely respected health/medical authority b. Includes the most up-to-date information, evidenced by recent updating c. Available for anyone to find on the internet d. Information on the web page was neutral 5) This source has information that can be used to update information on the Wikipedia page. This information includes what to wear in order to cover areas that are more prone to frostbite, and what populations are more at-risk for developing frostbite. Also, this source can be used to check that other facts presented on the Wikipedia page are accurate and up to date.

Source 6 (Retrieved by Rex)

Frostbite [Internet]. Medlineplus. 2017 [cited 7 October 2017]. Available from: https://medlineplus.gov/frostbite.html

1) Searched “frostbite” on Medline to find a comprehensive summary of frostbite. The search term “frostbite” was also used in other places including Health Canada and WHO. 2) Other citations considered was a frostbite guide published by Health Canada (Canada H. Extreme cold [Internet]. Health Canada. 2017 [cited 7 October 2017]. Available from: https://www.canada.ca/en/health-canada/services/healthy-living/your-health/environment/extreme-cold.html) Health Canada is an acceptable source for a Wikipedia article. However, this source was ultimately not chosen because it had insufficient quantity of information to improve the Wikipedia article. 3) The source was chosen as it followed Wikipedia’s criteria (described below). Furthermore, the webpage contains a summary of frostbite, as well as several additional links describing frostbite in detail and its treatments, therapies, related issues, prevention techniques, and risk factors. The web page also links journal articles for additional background information. All this information would be valuable in improving the quality and quantity of information on the frostbite Wikipedia page, as well as improving our own knowledge on the topic. 4) The reason why the source was chosen: a. The source is from a National Institutes of Health website, which is a reliable source and follows Wikipedia’s criteria b. Web page is able to be accessed by the general public c. Contains up to date information (was last updated this year) d. Information contained on the webpage was neutral 5) This source can be used to improve the introduction of the Wikipedia article. It can also add more in-depth and easy-to-read information that can be consumed by diverse readers in frostbite signs and symptoms, diagnosis, prevention, treatment, and prognosis.