Wikipedia talk:WikiProject Medicine

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Responses from Wikipedia editors to Wikisurgery-type article on Talk page of Wikipedia article How to use a scalpel

Here is the article and the first 2 responses:

Article

This subsection has text and images from an interactive multimedia training program on 
[[Wikisurgery] for basic 
surgical skills, called PrimeSkills in Surgery.
You can use this subsection on its own or follow the whole program (further details at the end of 
this subsection).

How to use a scalpel

Introduction

A scalpel may appear alarming at first.

This is a useful safety reaction and should mean that you will learn carefully and steadily.

A small minority of trainees develop an aggressive gung-ho tendency when holding a scalpel.

This should be suppressed completely.

If it persists, the trainee should not continue with the program.

Holding a scalpel

For fine work with a No 15 blade, hold the scalpel like a pen.

This is the correct way of holding a pen, using a tripod grip.

The three parts of the tripod are the side of the middle finger and the tips of the index and thumb.

(Other ways of holding a pen, such as placing it between the sides of the thumb, index and ring finger, are unacceptable.)

This grip enables the surgeon to:

Flex and extend the digits, so that the scalpel moves in and out during delicate dissections.

Rotate the handle of the scalpel with the thumb, so the scalpel can cut small diameter curves.

The most usual grip with a No 10 or 22 blade is as if you are holding a table knife.

(This is the polite way of holding a table knife)

The handle rests in the palm of the hand.

The digits and hand are largely on top of the scalpel unlike with the pen grip.

This means that the scalpel can be held close to the surface of the tissues when cutting, without the digits and hand getting in the

way as in the pencil grip.

The grip is quite gentle.

For tougher tissues, such as the skin on the back, grip more firmly and place your index finger on the top of the handle rather than

on the side.

This will let you increase the downward pressure of the blade on the tissue.

For more delicate tissue, hold the handle between the thumb on one side and the four fingertips on the other.

The handle does not touch the hand.

Holding the scalpel in the fist or like a dagger is far too clumsy.

DO NOT dissect with the handle of the scalpel.

You will be concentrating on the site of dissection and may accidentally cut your assistant.

DO NOT hold the scalpel in your hand while using another instrument.

You may accidentally cut the patient as you concentrate on the dissection area.

ALWAYS pass the scalpel to someone else handle first.

Preferrably, place the scalpel in a dish for the scrub nurse to pick out.

DO NOT throw the scalpel down onto the bench (or onto the patient.)

How to cut with a scalpel

The part of the blade that does the cutting is the curve and not the tip.

This means that you need to drag the curve of the blade across the tissue.

Scratching with the tip of the blade is a beginner's error.

(A scalpel with a straight blade should be reserved for stab incisions such as for a drain tube.)

You will feel the curved blade cutting into the tissue.

Go slowly and gently at first with repeated strokes in the same place, until you see how much the blade is cutting the tissue.

Brace your hands and fingers so that you make controlled movements without the blade suddenly slipping.

Press harder at the beginnings and ends of incisions to allow for the less efficient cutting action at the tip and the back of the blade.

Rock the handle to enhance this effect.

For a right handed surgeon, incisions are most easily made from left to right, cutting towards the surgeon.

Cutting from right to left is more difficult.

Curved incisions are made by rotating the scalpel.

Curves up to 4cm. radius or so are best made by rotating the scalpel between finger and thumb.

Curves larger than 4cm. need rotation of the scalpel using the wrist, elbow, and finally the shoulder.

For a right handed surgeon, clockwise curves are easier to do than anticlockwise ones.

Be prepared for a greater tendency to miss the planned track and more slips when cutting an anticlockwise curve.

Incisions need to be made with the blade perpendicular to the tissues to avoid slicing.

Slicing will devascularise the thinner side of the incision.

(NB. Slicing with the blade held at an angle to the tissues is done deliberately when dissecting with a scalpel.)

For gosh sakes, what is this? This is a Project talk page; please put this in a subpage if an illustrated guide is needed. SandyGeorgia (Talk) 05:06, 23 June 2008 (UTC)

Planning

As well learning HOW to cut with a scalpel, learning WHERE to cut is vitally important.

Each incision has a start point, a path, a depth and a finish point.

e.g. The positions of the start and finish points of an ellipse incision will determine the final line of the scar.

The path and the depth of the incision determine whether there is enough clearance around a tumour.

With real tissues, once an incision is made, there is no going back.

Mistakes are not acceptable.

On simulated tissue, learn to plan your incisions with this degree of precision.

Next subsection, click on Scalpel 08 Exercises
Last subsection, click on  Scalpel 06 How scalpels work
Surgical Education and Training page, click on Surgical Education and Training
Whole program on WikiSurgery.com, click on PrimeSkills in Surgery
Whole program on CD-ROM, click on Michael Edwards

[[User:Michael Harpur Edwards|Michael Harpur EdwardsMichael Harpur Edwards (talk) (talk) 13:33, 18 June 2008 (UTC)]] 14.40, 18 June 2008 (UTC)

Editor comments on above sections

As per Wikipedia_talk:WikiProject_Medicine/Archive8#Linking WikiProject Medicine to Wikisurgery, an example where a useful external link. However directly hosting this is a problem as Wikipedia is not a how-to guide - an external link to your site describing this is clearly fine (by me). Otherwise change in approach is needed to move away from a guide to a more encyclopaedic coverage, eg last sentance of "On simulated tissue, learn to plan your incisions with this degree of precision." would perhaps come under "Surgeons now practice their technique on artificial simulated tissue"

There is really good material here, just question of how best to use/incorporate it :-) David Ruben ^Talk 22:09, 18 June 2008 (UTC)

I also think that an external link to this page on Wikisurgery is a much preferable approach. Wikipedia is NOT a how-to guide; it is also not written for the convenience of medical students or the edification of surgeons (or other professionals). Please consider WP:MEDMOS#Audience as well, when you're trying to decide whether material is appropriate for this general encyclopedia. WhatamIdoing (talk) 22:37, 18 June 2008 (UTC)

I would welcome further discussion about a possible linkage with Wikisurgery based on these very positive responses.

Michael Harpur Edwards (talk) 08.30: 19 June 2008 (UTC)

Michael, It's usually considered poor form to move discussions around until you get the answer you want. (We call it "asking the other parent".) You should pick one location or the other to have this conversation. Whichever you choose, you need to post a link to it at the other location. WhatamIdoing (talk) 19:21, 19 June 2008 (UTC)

I seem to be in trouble all the time. Sorry. I am only trying to follow the advice of the editors. I am not familiar with the procedure when more than one location is involved. I do not know how to post a link between 2 locations.

How would you suggest I progress this exciting possibility of a link between Wikisurgery and Wikipedia? I am in your hands. Michael Harpur Edwards (talk) 21.08 19 June 2008 (UTC)

Michael Harpur Edwards, by "link" do you mean something other than an ordinary external link on any article? --Una Smith (talk) 20:09, 19 June 2008 (UTC)

Hello Una, Thanks for the information about Wikiversity. Could you first help me sign this page? I am finding it very difficult. is this correct?Michael Harpur Edwards (talk) 21.36 19 June 2008 (UTC)

Hello Una, I'll try again. Please look at item 25 and 37. These pages describe what Wikisurgery is, and how it might be a information source complementary to Wikipedia. The example article on How to use a scalpel produced a positive response from the editors. Unwittingly I seem to have transgressed some protocol by putting the article and comments on thisd talk page.

Can you suggest what I might do to progress the venture? Many thanks. Michael Harpur Edwards (talk) 21.54 19 June 2008 (UTC)

Michael, Your first discussion is at Talk:Scalpel#More about Scalpels on Wikisurgery. This discussion on this page is at Wikipedia talk:WikiProject Medicine#Responses from Wikipedia editors to Wikisurgery-type article on Talk page of Wikipedia article How to use a scalpel. Pick one or the other, and paste its link into the other location (inside double square brackets) with an invitation for any interested editors to join the conversation there.

Una's question, in case it's not obvious, is whether you want to see just this:

• How to use a scalpel on Wikisurgery

in the ==External links== section at the end of the Scalpel article. If that's what you want, then I'll add it for you. If you want something else, please explain what you want. WhatamIdoing (talk) 22:35, 19 June 2008 (UTC)

Several contributors here have suggested using external links from Wikipedia pages to Wikisurgery. To do that, you can simply do what is usually done, and add a plain link in the external links section. Or you can get a little fancier, a la links to Wikimedia Commons and Wikitravel. See for example Harpers Ferry, West Virginia: edit that page so you can see how its links to Wikimedia Commons and Wikitravel are achieved. A clue: {{wikitravel|Harpers Ferry}} uses Template:Wikitravel. Anyone can make a template. That said, MHE, the more I read the more I want to encourage you to relocate your project from Wikisurgery to Wikiversity; you seem to be rather alone on Wikisurgery. You are asking very basic questions about how to develop content in a wiki environment. --Una Smith (talk) 22:47, 19 June 2008 (UTC)

Actually, MHE has a conflict of interest, and so technically shouldn't add the links himself. But he could certainly propose them on the talk page, with a simple "I've been working on this page (link goes here), and does anyone else think that it would be a good addition to the external links for this article?" request. WhatamIdoing (talk) 23:24, 19 June 2008 (UTC)

Is there COI? The site is a wiki, and could perhaps be edited by a community much like Wikipedia. What if the content were on Wikiversity; would it be improper for contributors on either site to add links between Wikipedia and Wikiversity? Is there COI? What if the content were on Wikipedia; we encourage contributors to add links to and from articles here. Is there COI? Sometimes. Looking at this Wikisurgery site, it seems to be a one-man operation. (Pun intended. ;-) --Una Smith (talk) 05:35, 20 June 2008 (UTC)

I would delete links like this from External links per WP:NOT. SandyGeorgia (Talk) 05:37, 23 June 2008 (UTC)

Revived

Hi everyone,

In the last two weeks, the external link between

[Wikipedia scalpel] and [More about scalpel] has been deleted.

I guess that this is on the grounds per WP:NOT, that wikipedia is not a how to do it manual giving technical details.

However I note that many surgical articles in Wikipedia do contain explicit how to do it information, to the great enrichment of the texts.

Eg

http://en.wikipedia.org/wiki/Scalpel#Gripping_a_medical_scalpel

http://en.wikipedia.org/wiki/Episiotomy

http://en.wikipedia.org/wiki/Fine_needle_biopsy#Procedure

http://en.wikipedia.org/wiki/Chest_tube

http://en.wikipedia.org/wiki/Seldinger_technique

[The thyroidectomy article] gives headings for the main steps of an operation to remove the thyroid gland, but these steps have been waiting for the how to do it information to be supplied by Wikipedians since December 2006. A link to Wikisurgery could provide the solution.

I note that the [External link of the Wikipedia Surgery articles] includes detailed how to do it information in the

[Manual of Surgery] However I think it is possible to improve on a surgical manual published in 1921, which recommends that surgical instruments be sterilised by boiling in a fish kettle or by soaking in carbolic solution. Up to date information could be easily provided by an external link to Wikisurgery

To give some increased credibility to the information on Wikisurgery, please note that the basic surgical skills program was published on CD-ROM as PrimeSkills in Surgery, ISBN 0-9536414-0-6.

©1999 Scalpel Information Systems, and the basic laparoscopy program was published as CurrentTechniques in Surgery - Laparoscopic Cholecystectomy , ISBN 1-57276-034-6 ©1997 SilverPlatter Education and Scalpel Information Systems.The program qualified the users Grade A Continuing Medical Education credits with the Americal Medical Association.

I have had a look at Wikiversity, but could not find a section covering surgery.

I hope I have not transgressed any protocols with this text.

I should be pleased to see whether the editors would like to request external links with Wikisurgery for any of the Surgical articles in Wikipedia (to overcome any conflict of interest issues).

Michael Harpur Edwards (Talk) 20:22, 06 June 2008 (UTC).Michael Harpur Edwards (talk) 20:22, 6 July 2008 (UTC)

Michael, as far as I can tell, the link was never in the Scalpel article to begin with. WhatamIdoing (talk) 05:55, 7 July 2008 (UTC)

Accepting offer from WhatamIdoing

I should be delighted to accept the offer from WhatamIdoing on 19 June 2008 to have

• How to use a scalpel on Wikisurgery

in the ==External links== section at the end of the Scalpel article. Michael Harpur Edwards (talk) 15:15, 9 July 2008 (UTC)

 Done Note that this is not a guarantee that the normal editors of the article will approve, still subject to WP:EL rules, etc., etc. -- but it seems like a reasonable link to me, and it certainly is a "unique resource beyond what the article would contain if it became a Featured article." WhatamIdoing (talk) 05:41, 10 July 2008 (UTC)

Many thanks. Michael Harpur Edwards (talk)Michael Harpur Edwards (talk) 11:00, 10 July 2008 (UTC)

request article: coarse facial features

When was the last time you read about cretinism? Well, it's hard to look up something like coarse facial features in a medical dictionary. It's often referred to though. anyone up for an article like this? 128.125.28.232 (talk) 20:03, 24 June 2008 (UTC)

I don't think that this is an encyclopedic topic. Axl (talk) 07:13, 25 June 2008 (UTC)

If there is no reference to support its relevance it will be extremely hard to write an encyclopedia article about. JFW | T@lk 08:12, 25 June 2008 (UTC)

Apart from cretinism, coarse facial features may be due to adult myxoedema or a host of conditions including gargoylism, the derogatory term formerly applied to children with some forms of mucopolysaccharidosis such as Hurler syndrome and Hunter syndrome. NRPanikker (talk) 15:30, 25 June 2008 (UTC)

so what does it mean? can you describe it? 207.151.251.53 (talk) 22:16, 27 June 2008 (UTC)

How about acromegaly? Antelan^talk 22:42, 27 June 2008 (UTC)

A disambiguation page may be needed here. There are many uses of "coarse facial features" on the web and in PubMed, and even in Wikipedia, on pages that list signs and symptoms of numerous diseases. However, what constitutes "coarse" is rarely defined and evidently varies considerably from disease to disease. --Una Smith (talk) 02:44, 28 June 2008 (UTC)

Good to know. We should just go interview 25 teacher-doctors on what they think coarse facial features means, publish a website with their interview answers, then post it on wikipedia. I bet we'd get a good mixture of answers. 75.43.212.236 (talk) 04:14, 3 July 2008 (UTC)

Please read no original research before undertaking such a project. Publishing it in a medical journal makes more sense. JFW | T@lk 06:26, 3 July 2008 (UTC)

WPMED scope

Is Human embryogenesis within the scope of WPMED? Or is it more of a biology topic? It's not really a medical condition or treatment, although of course every med student is required to learn about it. What do you think? WhatamIdoing (talk) 16:53, 25 June 2008 (UTC)

Medicine can cover anything related to health. SandyGeorgia (Talk) 16:56, 25 June 2008 (UTC)

True, but perhaps too sweeping. Under that rule we could legitimately declare not just Water and Food, but also household furnaces, air conditioning, electricity, and roads to be within the scope of WPMED, since the absence of these things is frequently associated with health problems in susceptible persons. WhatamIdoing (talk) 17:19, 25 June 2008 (UTC)

Embryology is a biolgy topic but relevant to medicine as any dysmorphia (inborn cardiac defects, cleft palate etc) has a basis in dysregulation of embryology. I thing this article is suitable for {{WPMED}} tagging. JFW | T@lk 18:13, 25 June 2008 (UTC)

I think you provided the answer to your own question. IMHO, something that is a core part of medical school curricula certainly falls under WPMED scope; otherwise, what was the point of absorbing Wikipedia:WikiProject Preclinical Medicine? :) Fvasconcellos (t·c) 18:32, 25 June 2008 (UTC)

I think there should be a department in wikiproject medicine that soley focuses on tagging articles with WPMED template - mainly articles that lie in other wikiprojects but are TAUGHT in medical schools. All of those subjects are fair game. If it is a word in a medical dictionary it is, with some exceptions, fair game. If it is a topic on the USMLE or other basic science medical school exam, it's fair game. This is a huge project, and I would propose that it should be its own department within WP;med. Tkjazzer (talk) 04:29, 26 June 2008 (UTC)

Can you explain the goal behind tagging the maximal number of articles? WhatamIdoing (talk) 04:55, 26 June 2008 (UTC)

I don't include developmental biology, anatomy, physiology, or pharmacology within the scope of WPMED, and I have no interest in recapitulating the curriculum of any medical school. --Una Smith (talk) 15:30, 26 June 2008 (UTC)

I don't see any reason why they should be tagged, but I also don't see any reason why they couldn't be. My personal demon, the blood donation article, is marked as WP:MED, but it could also be seen as pharmaceutical manufacturing. If the wikimedia foundation wanted to create a paper copy of the encyclopedia targeted towards medical topics or somesuch it might be relevant, but I don't really see how it matters either way what the project flags. Somedumbyankee (talk) 15:46, 26 June 2008 (UTC)

I would have not found wp;med if it were not for the template on a talk page. the more we spread out and open up in other disciplines we might recruit some health conscious people who edit in biochemistry and physiology. They may want to learn more about the relationship of a biochemical process in relation to medicine and it is nice for medical students to have a section that is catered for the health science community and not written by and for molecular biologists. the more eyes the better. since there is nothing wrong with tagging and since the templates can be expandable/hidden if it starts to get excessive, I see nothing wrong with tagging articles that aren't necessary topics on WebMD as different diseases, but involve proteins which are mutated in specific genetic diseases (both acquired and congenital). Tkjazzer (talk) 18:27, 26 June 2008 (UTC)

I'm sure that is why citizendium.org uses "health sciences" instead of "medicine" in their equivalent of projects. Tkjazzer (talk) 18:31, 26 June 2008 (UTC)

I don't think that its advertising value is an adequate justification for spamming all the articles that we can. Too many tags = way too much administrative overhead. I'm willing to include major articles on developmental biology (for example), but I don't think we want everything in those areas. The mere fact that it might possibly be relevant background material for a medical condition isn't a good enough justification for me.

I've been struggling recently with the number of anatomy articles. There are billions of little bits in the human body, and nearly everyone of them has a stub on Wikipedia. I haven't been removing WPMED tags from them, partly because of my suspicion that WP Anatomy is some day going to become a task force under WPMED. There are hundreds of WPMED-tagged articles that really belong to the Anatomy project, and the fact is that the WPMED members who aren't also WPANATOMY members are highly unlikely to improve these articles. We're not contributing anything to the encyclopedia by slapping our project banner on these pages.

Genetics is another area. It might be nice if your doc knows what a neutral mutation is, but are we really going to help that article, or the dozens like it? Don't you think that MCB and the newly formed Genetics projects are much more likely supporters for that article?

More than 60% of assessed "WPMED" articles are rated as low priority, and I expect this to hold true for the remaining 1300 or so that are currently tagged and need assessing. This disproportionate number of low priority articles is largely because we've (automatically, in many cases) tagged so many articles that are in the allied sciences.

I don't know what the solution is, but I'm not convinced that we're on the right track here. WhatamIdoing (talk) 01:34, 28 June 2008 (UTC)

If you let molecular biologists and geneticists write these articles without imput from the clincial standpoint, then the articles are lacking something. period. One major thing they are lacking is read-a-bility. so many articles start about specific gene mutations, which chromosome, etc before saying anything readable. Yes that information is great to the geneticist who wrote it, but if it is clinically relevant, than eventually we need to write clinical related stuff in the introduction - stuff that medical students, especially future medical students may need to have access too. I don't know how long you have been practicing and away from the academic center, but many many many many medical students utilize wikipedia to look stuff up. And in doing so, many add bits and pieces to the articles. But those articles are seriously lacking a solid workgroup to oversee them. Wikipedia is going to continue to grow, I see nothing wrong with the citizendium approach of tagging multiple workgroups to an article. Sorry, I meant wikiprojects - speaking in citizendium terms - get them mixed up. I don't know if that means anything. I hope there isn't some kind of vote that bans me from adding WPMED tags, because there are a lot of articles out there with no tag at all that fall in the medicine category. I don't seem much harm in tagging and I hope others do not either. 75.43.212.236 (talk) 04:23, 3 July 2008 (UTC) [same person as above]

I see no reason why a person writing for WikiProject Genetics can't produce an article that is readable, or reasonably complete. If you're running into that problem, then they need a note about the quality of their articles. Note, please, that many WPMED members are also Genetics members. We doubtless do not check our medical knowledge at the door of an article on genetics just because there's no WPMED tag on it. Furthermore, have you ever seen a study of patients' comprehension that indicates that physicians are good at communicating information? I haven't -- and I've seen many to the contrary.

Banner bloat is bad for Wikipedia. It increases our administrative overhead at the expense of writing articles. Having more than one banner provides no additional value to the 1.0 team. I have assessed about ten thousand articles for this project. I can assess simple articles at a sustainable rate of more than 100 articles per hour, which is much faster than the usual rate. However, every minute spent assessing articles is a minute not spent writing the encyclopedia. Slapping six project tags on an article because they're all kind of related to the article means that six editors have to assess the article. Every single article so tagged costs Wikipedia at least five minutes of editor attention -- and there are more than two million articles on the English Wikipedia.

By contrast, not adding our banner costs the WPMED project nothing: we are still allowed to improve articles that are not tagged for this project. So I'm increasingly inclined to be intelligent about what we tag. If WPMED is not clearly a major player for the article, then we should make room for those that are. WhatamIdoing (talk) 01:11, 5 July 2008 (UTC)

Lyme disease

OK, I suspect this will not be a popular request, but I was asked by SandyGeorgia to look at Lyme disease, which had been delisted as a Good Article under the relentless pressure of advocacy for minoritarian viewpoints ("chronic" Lyme, Lyme disease as a biowarfare experiment gone awry, etc) overwhelming WP:WEIGHT. I'm working on it, but I think additional input from any interested editors from the project would be helpful in addressing some of the issues there. MastCell ^Talk 18:43, 25 June 2008 (UTC)

I'm there. Antelan^talk 19:31, 25 June 2008 (UTC)

The recent paper in NEJM here should make a useful source to distinguish between real medicine and crankism. JFW | T@lk 20:44, 25 June 2008 (UTC)

Yes, I originally thought it might be that simple - cite reputable sources and accurately represent their content. However, that was naive of me. These folks had the Infectious Diseases Society of America investigated for antitrust violations for producing guidelines which (in line with the weight of clinical evidence) discourage the use of long-term antibiotic treatment for "chronic" Lyme disease ([1], [2]). This is a new one for me - docs being accused of greedy profiteering for arguing against the use of risky and unecessary medication - but apparently they were in cahoots with the insurance industry, every physician's best friend. MastCell ^Talk 21:32, 25 June 2008 (UTC)

Oh, useful reading before you get involved: Stalking Dr. Steere Over Lyme Disease, from the New York Times. On the other hand, if you need motivation, the quality of Internet information on Lyme disease has officially been recognized as crappy by a reliable source (PMID 15626946). MastCell ^Talk 22:51, 25 June 2008 (UTC)

Update

I guess I'll start a summary here so I don't have to keep adding an AN/I thread. Recruiting here and here: also Grann, David (2001-06-17). "Stalking Dr. Steere Over Lyme Disease". The New York Times. Retrieved 2008-06-30.

• Shine a lite (talk · contribs · deleted contribs · page moves · block user · block log) blocked for attempting to conduct an offsite campaign of meatpuppetry
• Foundinkualalumpur (talk · contribs · deleted contribs · page moves · block user · block log) blocked as a blatantly disruptive single-purpose account
• Rosyatwiki (talk · contribs · deleted contribs · page moves · block user · block log), blocked, first edit is attacks here.
• Wanaqueling (talk · contribs · deleted contribs · page moves · block user · block log) blocked, is an admitted meatpuppet of the just-blocked Foundinkualalumpur (talk · contribs), created a few hours after Foundinkualalumpur's indefinite block to carry on the same arguments
• Shahmoney (talk · contribs · deleted contribs · page moves · block user · block log) is already indefinitely blocked
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• Freyfaxi (talk · contribs · deleted contribs · page moves · block user · block log) blocked for 31 hours, recognized IP 69.120.212.35 (talk · contribs · deleted contribs · page moves · block user · block log), returned from block to edit Lyme disease controversy with more of same: [3]

New

• Roohub (talk · contribs · deleted contribs · page moves · block user · block log), sockpuppet, blocked
• Wikipedia:Requests for checkuser/Case/Shine a lite
• BB thread SandyGeorgia (Talk) 05:22, 6 July 2008 (UTC)

• Bapb (talk · contribs · deleted contribs · page moves · block user · block log)

• LeoBellew (talk · contribs · deleted contribs · page moves · block user · block log), first post was to vote in the AfD on Lyme disease controversy. [4]

• Amdurbin (talk · contribs · deleted contribs · page moves · block user · block log), dormant account misrepresents source to continue bioweapons fringe theory, added to CU.[5] SandyGeorgia (Talk) 06:20, 10 July 2008 (UTC) Acknowledged 152.23.75.244 (talk · contribs). [6] SandyGeorgia (Talk) 21:58, 10 July 2008 (UTC)

Human anatomy

... is in Category:Pages where template include size is exceeded, per Wikipedia:Template limits, which causes some of that miserably ridiculous long list of templates at the end of the article to get dropped. (How I learned about this jolly little problem :-) Can someone figure out what to do with that miserable list of transcluded templates at the end of human anatomy? SandyGeorgia (Talk) 03:16, 29 June 2008 (UTC)

Much of it might need to be integrated with the article. That's the point in the templates. JFW | T@lk 07:33, 29 June 2008 (UTC)

Jumping.

is it possible to replace the sesamoid bone in both knees with something bigger, so when you use the muscle you get better leverage. and if so, after muscle training, would you be able to jump higher or run faster. just a quick thought!

mike —Preceding unsigned comment added by 88.105.111.27 (talk) 12:21, 29 June 2008 (UTC)

Please take it to the reference desk. This page is about ongoing collaborations on editing medical articles. But to answer your question... what makes you think that the patella provides any leverage? JFW | T@lk 12:24, 29 June 2008 (UTC)

MCOTW

It's that time of the month again:

We have a basic science topic for a change. Assistance from all members would be highly appreciated. JFW | T@lk 12:24, 29 June 2008 (UTC)

Looking for an admin

Multiple chemical sensitivity could benefit from semi-protection again. We have another POV anon determined to quote her(?) favorite website instead of the original source, which doesn't quite say what the website claims. I'm at the 3RR limit and my eyes crossed when I saw the complicated form at the 3RR noticeboard. It's someone else's turn for a while. WhatamIdoing (talk) 22:06, 30 June 2008 (UTC)

I've attempted to give some backup on this. This IP editor, 99.230.235.148 (talk · contribs · deleted contribs · logs · filter log · block user · block log), is consistently removing sourced material that disagrees with his or her position, is restructuring the article to give more prominence to the minority viewpoint by moving mainstream opinions to an "other theories" section, et cetera. Somedumbyankee (talk) 16:52, 2 July 2008 (UTC)

 Done--Fabrictramp | talk to me 17:49, 2 July 2008 (UTC)

Question about PubMed as a source

In working on WP:DEP, I came across Thyrotoxic crisis, which is a copypaste from this PubMed article. I know US Federal Government stuff isn't copyrighted. Are articles on PubMed considered a non-copyrighted government publication, or is it simply a reprint of a copyrighted (by the authors) work? Thanks!--Fabrictramp | talk to me 16:40, 2 July 2008 (UTC)

I've redirected it to hyperthyroidism, as we've done with thyroid storm, thyrotoxicosis, and other generally synonymous terms. In general, the abstract you see on PubMed is often copyrighted to the publishing journal. The copyright to journal articles (including the abstracts indexed on PubMed) is generally held by the journal, not by the federal government. There's an increasing move toward open-source publishing, but even so we shouldn't be in the business of cut-and-pasting PubMed abstracts. Thanks for picking up on this instance. MastCell ^Talk 18:09, 2 July 2008 (UTC)

And thank you for a bit of education. :) --Fabrictramp | talk to me 18:11, 2 July 2008 (UTC)

Missing article

There's an AfD on Bed Blockers (UK term for person stuck in the hospital due to lack of appropriate care/housing for legally and/or morally appropriate discharge) here that might interest some of you. What interests me is that I can't find any Wikipedia articles on discharge planning. Have I overlooked something? Is there an obvious name for this? WhatamIdoing (talk) 18:46, 2 July 2008 (UTC)

No, because in the US a lack of appropriate care, housing, or ethical appropriateness are not contraindications to discharge. :) Boy, I've gotten cynical. Most of the terms in vernacular use among American house staff are a bit more... charged... than "bed blocker". In all seriousness, an article on discharge planning might be useful - there is a reasonably-sized literature on the topic. It might also be folded into an article title like length of stay or hospital bed management. MastCell ^Talk 19:04, 2 July 2008 (UTC)

Featured article candidacy

Subarachnoid hemorrhage is up for featured article candidacy. This article has received significant attention from many members of WPMED and has now also been externally peer reviewed. Your comments are most appreciated at Wikipedia:Featured article candidates/Subarachnoid hemorrhage. Thank you. JFW | T@lk 23:49, 2 July 2008 (UTC)

More eyeballs needed at the FAC. Doing well at the moment. JFW | T@lk 08:57, 8 July 2008 (UTC)

Chronic fatigue syndrome

Some expert eyes are needed at Chronic fatigue syndrome and on a big group of forks added since March. There has been great consensus there for months since the people editing and talking have a distinct shared POV and they want replace the name CFS with myalgic encephalopathy or myalgic encephalomyelitis.

Since March a bunch of forks using ME/CFS were made, ME/CFS nomenclatures, ME/CFS pathophysiology, ME/CFS hypotheses, ME/CFS descriptions, ME/CFS therapies, ME/CFS treatments, ME/CFS history, ME/CFS controversies, ME/CFS outbreaks, Cultural references, and Notable people with CFS.

These forks get made and edited almost exclusive by the same three editors from the main page

Ward20 (talk · contribs · deleted contribs · page moves · block user · block log)

Jagra (talk · contribs · deleted contribs · page moves · block user · block log)

Strangelv (talk · contribs · deleted contribs · page moves · block user · block log)

I do not attacking these editors that are doing what they think is right to help patients and advocate their cause, I just think some balance can help from people with knowledge on medicine. Thanks! RetroS1mone talk 04:41, 3 July 2008 (UTC)

I have stepped away from that article but I was quite involved a few months ago. I tried to prevent forkage and was much more in favour of shortening the content to sources that didn't fail WP:MEDRS. Anyway, I don't think there's any consensus for removing the name "ME" from these article titles, however nonsensical that term is (many have no myalgia and there is no histological evidence of encephalomyelitis apart from nonspecific changes on SPECT scans - and then only by certain investigators).

I have noticed your recent edits and support all of them. Just follow the general consensus forming process and ask for community input if you cannot resolve particular issues. JFW | T@lk 06:32, 3 July 2008 (UTC)

Solitary pulmonary nodule

Until a few days ago we didn't have this article and now it's coming up on the main page's T:DYK soon, so I would appreciate it if some of you could have a look and give it a good copy-edit. --Steven Fruitsmaak (Reply) 21:53, 3 July 2008 (UTC)

Reliable sources

A discussion that seems to be going round in circles on WP:MEDRS. More eyes would probably be useful, although it has a significant potential of getting rather drawn out. JFW | T@lk 08:27, 4 July 2008 (UTC)

Article rename for more medically correct title (Kidney stone)

Hi, there is currently a discussion underway at Talk:Kidney_stone#Rename_article_to_renal_calculi.3F regarding the potential renaming of kidney stone to renal calculi, kidney calculi etc. With reference to MEDMOS policy, "the article title should be the scientific or recognised medical name rather than the lay term". This would certainly qualify for this article, but there is concern that this would reduce accessibility too considerably. Where does this fit into the wider policy? Discussion specific to this proposed rename may be more suitable on the talk page itself, as you wish.78.86.59.175 (talk) 13:08, 4 July 2008 (UTC)

Thanks for the notice. My input (which I've made there as well) is that nephrolithiasis is a condition of having stones in the kidneys. The article currently covers both the stones and the condition. There could be material for two articles here, both linking to one another. Antelan^talk 15:26, 4 July 2008 (UTC)

Changes to the WP:1.0 assessment scheme

As you may have heard, we at the Wikipedia 1.0 Editorial Team recently made some changes to the assessment scale, including the addition of a new level. The new description is available at WP:ASSESS.

• The new C-Class represents articles that are beyond the basic Start-Class, but which need additional references or cleanup to meet the standards for B-Class.
• The criteria for B-Class have been tightened up with the addition of a rubric, and are now more in line with the stricter standards already used at some projects.
• A-Class article reviews will now need more than one person, as described here.

Each WikiProject should already have a new C-Class category at Category:C-Class_articles. If your project elects not to use the new level, you can simply delete your WikiProject's C-Class category and clarify any amendments on your project's assessment/discussion pages. The bot is already finding and listing C-Class articles.

Please leave a message with us if you have any queries regarding the introduction of the revised scheme. This scheme should allow the team to start producing offline selections for your project and the wider community within the next year. Thanks for using the Wikipedia 1.0 scheme! For the 1.0 Editorial Team, §hepBot (Disable) 20:56, 4 July 2008 (UTC)

Further explanation of new assessment at Wikipedia:Wikipedia Signpost/2008-06-23/Dispatches. SandyGeorgia (Talk) 00:06, 5 July 2008 (UTC)

Help at Idiopathic thrombocytopenic purpura

Hello, The ITP page could really use a few citations. I've added two "fact" tags over the last few months and there are a number of others. I don't know enough to be comfortable with getting the right citations. Any help would be welcome. Hobit (talk) 17:25, 5 July 2008 (UTC)

It's been on my list for awhile, but I haven't gotten around to it. Busy week coming up, but I'll try to look at it ASAP. MastCell ^Talk 17:53, 5 July 2008 (UTC)

• Thanks to Bigdumbdinosaur who sourced 2 of the 3 things! Hobit (talk) 18:10, 8 July 2008 (UTC)

Liaison psychiatry

The Liaison psychiatry could really use some attention from the Medicine project. A new editor came through and did quite a bit of expansion, but he didn't really source any of it (he added a bunch of refs but they were all for "this book exists" rather than actually supporting any claims made about the field), and I suspect quite a bit of it may be his own research (which he has admitted to in the Editor help board). From a web search, if his user name is his real name, he's a professor in the UK who has an interest in Liaison psychiatry. I've tagged it for issues and cleaned up what I could, but an expert who knows more about the field should really give it a going over. From the earlier version, before he started editing[7], I also wonder if it shouldn't be redirected to psychosomatic medicine, as it was listed as an alternate name? Either way, if someone would like to tackle checking the article, and help make sure OR and personal theories aren't being added, it would be appreciated. -- [[::User:Collectonian|Collectonian]] ([[::User talk:Collectonian|talk]] · [[::Special:Contributions/Collectonian|contribs]]) 10:35, 6 July 2008 (UTC)

He's also now made a second account in an attempt to "establish consensus" for his bad edits. Again, project help would be helpful. The article is currently protected but he's filling the talk page with a bunch stuff that shows he has no clue (like arguing the History of biology only lists books as refs with no page numbers), and accusing me of defamation for asking the project to come offer another view. -- [[::User:Collectonian|Collectonian]] ([[::User talk:Collectonian|talk]] · [[::Special:Contributions/Collectonian|contribs]]) 18:06, 6 July 2008 (UTC)

Please fix error on wikipedia hematocele entry

http://en.wikipedia.org/wiki/Hematocele assumes the condition only occurs on the testes and sounds like a result of personal experience rather than research. —Preceding unsigned comment added by 66.119.62.12 (talk) 16:28, 6 July 2008 (UTC)

Thank you for your suggestion. When you feel an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes — they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WhatamIdoing (talk) 06:01, 7 July 2008 (UTC)

Website with APA licensing of DSM-IV

Can someone help out with Talk:Schizophrenia#Free full text DSM-IV on Schizophrenia and Other Psychotic Disorders; if it can be verified, it's great news. SandyGeorgia (Talk) 03:38, 8 July 2008 (UTC)

Discussion moved to Wikipedia talk:Copyrights#Website hosting free full text of APA DSM-IV. SandyGeorgia (Talk) 00:17, 9 July 2008 (UTC)

Dispatches: Sources in biology and medicine

Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 03:54, 8 July 2008 (UTC)

Well, I cannot agree with the endorsement of journal impact factor. It is a measure of citation rate, not of good or bad article quality. Some notorious bad articles have very high citation rates. Many very good articles have low citation rates. --Una Smith (talk) 03:46, 10 July 2008 (UTC)

Oooh, yes. I can think of a couple of examples. Just about anything AIDS-related by Peter Duesberg, for example. But the impact factor is about the journal, not the individual articles. It therefore is of limited use in evaluating any specific article. WhatamIdoing (talk) 06:00, 10 July 2008 (UTC)

Medical resource exchange

At Wikipedia:WikiProject Resource Exchange you can request sources if you can't access them: could we set up something similar for medical resource, e.g. full text articles you can't access? --Steven Fruitsmaak (Reply) 10:43, 8 July 2008 (UTC)

I think that is an excellent idea, but we must be careful not to run foul of copyright matters. Publishers will not be best pleased if we start happily trading PDFs that they would normally have sold for $$$$.

However, it should be possible to ask members with access to verify a citation without sending around PDFs or passwords. I would happily verify any citation for BMJ Group and AMA journals. JFW | T@lk 16:18, 8 July 2008 (UTC)

Yes, I'm sure a "verification service" (e.g. "Could someone check PMID xxxxx and see if it actually supports statement Y in article Z") would be an excellent idea and certainly poses no copyright issues. Fvasconcellos (t·c) 16:30, 8 July 2008 (UTC)

I have full-text access to a wide range of medical journals, and I'd be happy to verify specific claims, though iffy on emailing whole PDF's or otherwise skirting copyright. MastCell ^Talk 05:31, 9 July 2008 (UTC)

OK, I have access to a wide range of journals as well, let's start a subpage for this! --Steven Fruitsmaak (Reply) 16:32, 10 July 2008 (UTC)

Same here the CMA gives full access to a large number of journals as part of membership. Do not know what others get.Doc James (talk) 04:54, 11 July 2008 (UTC)

Looking for input

In the course of work I've run into an interesting phenomenon that is probably worthy of a wikipedia article: medical studies conducted under exemptions from informed consent. They're sometimes called 50.24 studies in the US after the regulation that allows them.

Obviously studies without consent have been conducted unethically, but attempts to do research of this fashion and comply with the spirit of the Declaration of Helsinki are a separate affair. It shouldn't be surprising that these are rare (I'm only aware of four), but one was a trial of Hemopure which is somewhat notorious.

Is anyone aware if these kinds of trials take place in other countries? If it's solely a US phenomenon, I'll just call the article 50.24 study and it can be moved if necessary. Otherwise I'm at a bit of a loss for a name. SDY (talk) 17:27, 8 July 2008 (UTC)

I recall the trials of amiodarone during cardiac arrest: Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation. Of note: "This study was approved by the Human Subjects Review Committee at the University of Washington, with an exception from informed consent, in compliance with interpretation of the federal policy for the protection of human subjects in place at that time." Axl (talk) 17:53, 8 July 2008 (UTC)

The ALIVE trial. This changed our clinical practice. Carried out in Toronto, "The human-subjects review committee of the University of Toronto approved the study, including its provisions for waiver of informed consent." Axl (talk) 18:03, 8 July 2008 (UTC)

(edit conflict) A 1996 FDA exemption to informed consent in trials involving out-of-hospital emergency care is at PMID 10161558. I don't think it has been superceded, though we should make sure. The trial of lorazepam vs diazepam for status epilepticus was another high-profile instance where informed consent was waived. A perspective on the issue of informed consent waivers from the New England Journal of Medicine is here (hopefully you can get the full text). A piece on the impracticibility of informed consent in a Canadian stroke-care network is here - interestingly, the requirement for informed consent in this setting biased patient recruitment such that the consented patients were not representative of the general population of stroke victims. There is probably a good article to be written in there somewhere. MastCell ^Talk 18:08, 8 July 2008 (UTC)

Virtual colonoscopy

Can anyone find wide support for today's anonymous edit that changed "2 mm" to "10 mm" at Virtual colonoscopy? It's not my field, so I don't want to weigh in, but this contradicts everything I've read. - Dan Dank55 (talk)(mistakes) 20:04, 9 July 2008 (UTC)

Not sure. I know CT pneumocolon is not reliable for lesions less than 10 mm, but whether this extends to VC is not clear. If you're in doubt and have sources, just revert it. JFW | T@lk 21:00, 9 July 2008 (UTC)

Toxin theory of cancer

Because of Dressed to Kill (book), which claims that wearing brassieres causes breast cancer, I've started wondering what article(s) might cover the Toxin theory of cancer. This is the idea that the human body can't handle its own metabolic byproducts, which are "toxins", and if they build up, or concentrate in an area, then you get cancer. It's wildly popular in the alternative medicine press and is the idea that underlies all the recommendations for fasting, juicing, eating only organic vegetables, drinking distilled water, and more as ways of preventing or treating all forms of cancer. It's utterly unsubstantiated by any mainstream research of any kind. Do we have a page on this somewhere? WhatamIdoing (talk) 06:15, 10 July 2008 (UTC)

This is stuff very closely related to the whole concept of carcinogenesis. The fact that toxins cause cancer is obviously not controversial (see benzopyrenes and lung cancer, asbestos and lung cancer and mesothelioma) but the theory you are referring to is obviously untested. Is that what they call it, "toxin theory"? JFW | T@lk 19:33, 10 July 2008 (UTC)

I don't know what it's called. I'm not sure it's really called anything. See this for an example. The focus was originally on metabolic byproducts, not benzene and asbestos. The "solution" is that you need to change your diet, "cleanse" your body with enemas and natural supplements, and so forth. This BMJ paper refers to "intestinal autointoxication" as one possible name from the 19th century. WhatamIdoing (talk) 20:19, 10 July 2008 (UTC)

Thank you very much for depressing me by pointing out our article on Dressed to Kill (book). Everyone knows that bras can detect and prevent cancer, not cause it (cf. PMID 9326908). Anyhoo... the problem is one of scope: like many alt-med concepts, this one is vague and means different things to different people. How would we delimit an article and choose sources? I foresee a battleground without much hope of building a solid, manageable article. But then, I'm a cynic (or, as I prefer, an informed realist) when it comes to Wikipedia. MastCell ^Talk 20:52, 10 July 2008 (UTC)

Intestinal toxemia appears to be another interesting name for it. I think I'll put this on my "someday maybe I'll have some free time" list. (Thanks, MastCell, for the smile.) WhatamIdoing (talk) 20:54, 10 July 2008 (UTC)

Speaking of intestinal autointoxication, there's always the perennial favorite mucoid plaque, currently in between SPA's... MastCell ^Talk 21:33, 10 July 2008 (UTC)

External link to Retractor (medical)

I have been referred here from the Retractor (medical) talk page Would the editors of this article consider an external link to Retractors (medical) from How retractors work in Wikisurgery? This article links to other articles in Wikisurgery, including those describing many different types of retractor with photographs of them in action. I hope I have signed this text correctly using 4 tildes at the end of the page. Michael Harpur Edwards (talk) 10:52, 10 July 2008 (UTC)

Alarm bells

Probably because I'm paranoid, but this edit summary somewhat bothers me. Generally outside pushes on content (esp. unsourced content) don't make me happy but if the ASSH is legit it's less troublesome. Though still somewhat troublesome. Ever since I found out about wikipedia review I've been even more nervous of unsourced content. WLU (talk) 20:35, 10 July 2008 (UTC)

If there is any trouble, the author needs to be reminded that he cannot appeal to authority and needs to adhere to policies and guidelines like everyone else. But I can't see any other issues apart from unsourced content there. JFW | T@lk 22:01, 10 July 2008 (UTC)

Great, thanks, that addresses my concern. Anyone monitoring hand and hand injury pages might see something similar but right now the editor has only one contribution. WLU (talk) 22:12, 10 July 2008 (UTC)

Hyperhidrosis

Okay, I'm a little tired of this game. The anon (always a different IP) keeps adding the name of its favorite brand of antiperspirant and deleting the References section. Over and over and over. Can we get this page semi-protected? WhatamIdoing (talk) 03:01, 11 July 2008 (UTC)

Poeple can use a proxy server to effectly change there IP address. Therefore they will coming up as something differnt each time.

Doc James (talk) 04:45, 11 July 2008 (UTC)

True, which is why I'm suggesting semi-protection, which will prevents any anonymous IP from editing the article, instead of just blocking the ever-changing IP number. WhatamIdoing (talk) 05:13, 11 July 2008 (UTC)

 Done no sweat :) Cheers, Casliber (talk · contribs) 15:04, 11 July 2008 (UTC)

Oh no you did not just say that! Antelan 16:09, 13 July 2008 (UTC)

XD Cheers, Casliber (talk · contribs) 21:26, 13 July 2008 (UTC)

Magnetic resonance neurography

This is a little out of my area of expertise - anyone more familiar with radiology wanna comment? i.e. widely used etc. Cheers, Casliber (talk · contribs) 15:06, 11 July 2008 (UTC)

Samuel Johnson

As per here, I would like some input on how to describe a page on posthumous diagnoses for Samuel Johnson's Tourette syndrome. Information, such as naming conventions, recommended patterns for page set up, etc, would be greatly appreciated. Thanks. Ottava Rima (talk) 20:22, 12 July 2008 (UTC)

We need a name for the daughter article that encompasses all issues, and perhaps we can avoid the section heading "Depression and madness". (Also, there are additional sources on his Tourette syndrome; I added the two that provide free, full text.) SandyGeorgia (Talk) 20:33, 12 July 2008 (UTC)

I would have put the "madness" in quotes, but wiki always seems to have a fit when I do that. :) Ottava Rima (talk) 20:34, 12 July 2008 (UTC)

I'm thinking of an even more general section heading, since the descriptions then of his behaviors can be viewed in the context of current understanding. If he had TS/OCD, then "madness" is antiquated. The folks here will likely be able to come up with a contemporary, neutral, general heading. Also, I'm not sure on the separation of the issues by headings, since depression is often part and parcel with OCD. SandyGeorgia (Talk) 20:38, 12 July 2008 (UTC)

That would make sense on the separate page about his Tourettes. However, it might lead to the unwanted conclusion that the contemporaries were leading up to that point, i.e. we should contextualize (somewhere) his actions in an 18th century setting. They didn't have the medical knowledge or the treatments that we have now, and there was a fear that Johnson would be locked away like Christopher Smart (which was why he defended Smart quite a few times). Ottava Rima (talk) 20:46, 12 July 2008 (UTC)

I don't think his contemporaries could have been leading to that point; they simply didn't know what TS was, the connection to OCD, or the link between OCD and depression (see History of Tourette syndrome). Johnson died in 1784. Jean Marc Gaspard Itard, reported the first case of Tourette syndrome, Marquise de Dampierre, in 1825. Georges Gilles de la Tourette published an account of nine patients (including Itard's Marquise de Dampierre) with Tourette's in 1885. Johnson's contemporaries had none of that knowledge. SandyGeorgia (Talk) 22:52, 12 July 2008 (UTC)

Maybe this discussion would be more appropriate on a talk page. --Steven Fruitsmaak (Reply) 23:20, 12 July 2008 (UTC)

This will be a new article, and thats why we are adding this to this talk page to find out naming conventions, patterns, etc, for making a new article on this kind of subject. Ottava Rima (talk) 23:43, 12 July 2008 (UTC)

Yes, it's on three talk pages now, but it all should be at Talk:Samuel Johnson. At any rate, feedback is appreciated. SandyGeorgia (Talk) 23:53, 12 July 2008 (UTC)

Charles Darwin's illness and Franklin D. Roosevelt's paralytic illness may provide useful comparisons. --Arcadian (talk) 03:33, 13 July 2008 (UTC)

Thanks! Thats exactly what I was looking for. Ottava Rima (talk) 15:49, 13 July 2008 (UTC)

Collaboration

JFW | T@lk 06:30, 13 July 2008 (UTC)

Does the scope of WikiProject Medicine include.....?

Does the scope of this wikiproject also include articles on medical professionals? Likewise, does it include articles on professional medical bodies and also on prizes and awards related to the medical profession?Kwib (talk) 15:11, 13 July 2008 (UTC)

Please ignore my question. I have answered it by simply looking at articles that would fit into the categories mentioned to see if they are part of the project scope.Kwib (talk) 15:16, 13 July 2008 (UTC)