Wikipedia:Peer review/Tracheal intubation/archive1

Tracheal intubation

This peer review discussion has been closed.
I've listed this article for peer review because I would like to eventually submit this as a FAC, and I would like to get constructive feedback beforehand. Thanks, DiverDave (talk) 00:06, 7 September 2010 (UTC)

• Impressive work. The quality of the references are outstanding. I'll give a few first impressions then see if I can dig in for more. Remind me in a day or so if you want. 1) There is too much space given to the history given that subtopic's importance to the overall idea. Try to summarize it so space is properly prioritized in the article. In fact do that for everything, but I don't have the clinical knowledge to say whether that's been done for other subtopics. Don't throw away the history material since it's interesting, instead move it to a daughter article ala WP:SS 2) The very last paragraph should be merged in with other related material. It's not separate enough to stand on it's own. 3) When the Barash reference is cited specifically, it's used as "... in Barash & al. (2009)". There are only three authors on that work and in all the reference standards I know of, et al is not used unless there are more authors than that (5 I think in APA). Also, I've never actually seen & al. used. In this case, probably all three authors names should be spelled out. - Taxman ^Talk 14:31, 17 September 2010 (UTC)

Thanks for the recommendations, Taxman. I have made the following changes:

• transferred text relating to history into new article:History of tracheal intubation;
• merged last paragraph into previous paragraph; and
• corrected Barash reference as per your suggestion.

Thanks for the pointers, and please let me know if there is anything else I should do to get this article up to FA quality. DiverDave (talk) 02:50, 18 September 2010 (UTC)

No problem. It's a really good article and you made good fixes. You may get a little flack about the lead section not really summarizing each of the parts of the article, but it does give a good intro to the topic, so it's not bad IMO. I can't say I'm totally up to date on current standards for FA's but if you have access to your sources I'm confident that you'll be able to make a successful run at FAC and handle whatever comes up. You may need to have some time available if somebody finds something difficult to fix. Taxman ^Talk 23:00, 23 September 2010 (UTC)

Oh, also the alt text tool link to the right showed that all images have alt text except one. I didn't check them against the alt text guidelines, but you should. Those are really critical for people that need them. - Taxman ^Talk 23:03, 23 September 2010 (UTC)

Thanks for another excellent suggestion, Taxman. I did not know about the alt text tool until now. I have just added alt text to all the image files in the article. I don't know if I did this correctly, because no text appears when I hover over the images with a mouse. However, when I use the alt text tool link, the text does appear in the gray boxes for all except the image file included in the infobox. My guess is that the infobox template probably suppresses alt text, or something like that. Anyway, thanks again for helping me to improve my wiki skills! DiverDave (talk) 14:23, 24 September 2010 (UTC)

2 cents by Casliber

• Okay, when writing prose, I generally try to avoid parentheses unless necessary (except when writing scientific names after common names, where I feel they are nicer looking than commas) - so the beginning I'd rather see the segment in the first sentence demarkated by commas. I am wondering whether "usually simply referred to as intubation" is better as "usually abbreviated as intubation" - more succinct.

• is the placement of a flexible plastic catheter into the trachea. "+ maintain an airway?" maybe needs to be in the first sentence as that is why we do it (as I am in psychiatry, I haven't had to do this in a loooong time)

Thanks for the helpful suggestions, Casliber! I have modified the first sentence a bit to reflect your suggestions. I think of abbreviations as not being real words (e.g., acronyms), so I am not sure that "intubation" is really an abbreviated term in the strict sense. Still mulling it over.... DiverDave (talk) 06:32, 25 September 2010 (UTC)

• Otherwise looking pretty good - nothing glaring jumps out at me as not being there - the main issue which is commonplace with these types of articles is the balancing act between precise medical terms and plain english - i.e. trying to introduce the latter as long as exact meaning is preserved. I'll scan again for that but am a bit blind to jargon when I use it daily :) Casliber (talk · contribs) 20:09, 26 September 2010 (UTC)

Oh, you do mention proximal and distal somewhere - that'd be good to link or explain. Casliber (talk · contribs) 20:10, 26 September 2010 (UTC)

The terms "proximal" and "distal" are both linked in the 2nd paragraph of the lead section. DiverDave (talk) 00:51, 29 September 2010 (UTC)

Some thoughts on the lead from RexxS

Having no formal background in medicine, I often find problems with jargon in medical articles. I wonder if you might consider looking again particularly at the lead, to see if there are places where more common English words might benefit the casual reader more than the precise medical term.

• An example:
  • "... is the placement of a flexible plastic catheter into the trachea ..."
  • "... is the placement of a flexible plastic tube into the windpipe ..."

  It's fine to link a medical term to allow a non-expert to find out what the term means, but having to do it too often disrupts the flow of reading, so using a commoner word (even if less precise) is something to consider for the lead.

• Have a look at:
  • "The most widely used route is orotracheal, in which an endotracheal tube is passed through the oropharynx, glottis and larynx into the trachea."

  I'm not uneducated (AGF that one!), but without a detailed knowledge of anatomy, I struggled to make sense of what was happening. The link to oropharynx gives me "The Oropharynx (oral part of the pharynx) reaches from the Uvula to the level of the hyoid bone. It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil." That article isn't your problem, but I was none the wiser after following the link. Anyway, isn't the point that the tube goes in through the mouth, via the throat to the airway leading to the lungs? Is the nasotracheal procedure the same thing but starting from the nose?

Depending on who you think the target audience may be, I think it might be possible to rephrase some of the lead to be more summative (if less precise) in order to allow a wider range of readers to understand it more easily. By all means, be precise and detailed in the body of the article, but I'd recommend looking for phrases in the lead like "the distal tip of the tube" and considering whether something like "the far end of the tube" would convey the same summary information, without "dumbing down" the article too much.

Apologies if you've already considered the above, and I do know that medical articles in an encyclopedia are likely to require technical terms, so feel free to make whatever use of my thoughts above that you wish. I'll look harder at individual sections later. Regards --RexxS (talk) 16:16, 25 September 2010 (UTC)

Thanks for your suggestions, RexxS. These will be difficult to implement, as it is impossible to write an article about tracheal intubation without using certain specific anatomical and medical terms, such as catheter, oropharynx, nasopharynx, glottis, larynx, trachea, distal, proximal, pulmonary aspiration, gastric acid, etc.. My original approach was that since I have to use these words, why not use them and link them all right up front, as we do with most articles? However, your point is well taken. Although I find it painful to replace precise terms with less precise ones, I have done my best to colloquialize the lead section. At present, I cannot think of a way to replace the words "distal" and "proximal" that is not awkward. Plesae take a look at the changes I have made, and by all means let me know if you can think of other ways to make this article more accessible to lay people. BTW, you will not be hurting my feelings in the least if you go ahead and make these changes yourself. :) Regards, DiverDave (talk) 17:01, 26 September 2010 (UTC)

Thanks Dave. To give you some idea, I asked my son to read the lead as it was, and tell me how he understood it; then to read it as it is now. He was quite clear that before the first reading he thought intubation always involved an incision in the neck; after the first reading, he still thought that, and couldn't see that the text contradicted his belief; after the second reading, he understood the difference between orotracheal, nasotracheal, and a tracheotomy. I'd say that was mission accomplished! I'm sorry I haven't looked at the other sections yet, but I'll try to find time this week. --RexxS (talk) 19:12, 26 September 2010 (UTC)