Talk:Midazolam/GA1

GA Review

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Reviewer:Tea with toast (talk) 00:13, 7 March 2010 (UTC)

Accessible lead

Just a quick comment The first sentence should provide the broad context in words that are understood by many people. In this case I think the first things to mention are that this is a synthetic molecule used as medicine. The words benzodiazepine and derivative are too "difficult" here. --Ettrig (talk) 08:49, 29 January 2010 (UTC)

Thank you for your comments. I have made changes to the sentence for the lay reader. I think that derivative should be kept because all the other benzodiazepine articles describe it this way and also it is wiki linked for people who don't know what a derivative is. I have added in that it is a drug that is used in medicine. Please read my changes to the lead sentence and see if you think that this issue has been fixed or not.--Literaturegeek | T@1k? 09:00, 29 January 2010 (UTC)

I found only one FA about a drug, bupropion. It's first sentence ends ... antidepressant and smoking cessation aid. I think this description is understandable also for most laymen. Please try to find something like that. It is difficult, but also very valuable. The following is a quotation from Wikipedia:Lead --Ettrig (talk) 11:47, 29 January 2010 (UTC)

The lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article. It is even more important here than for the rest of the article that the text be accessible. ... In general, specialized terminology and symbols should be avoided in an introduction.

Ok, I have rewritten the lead sentence now and also done some more work to the article, improving sourcing etc. Thank you for your suggestions. :) Let me know your thoughts now on the lead.--Literaturegeek | T@1k? 07:01, 30 January 2010 (UTC)

Yes, I think this is an improvement. --Ettrig (talk) 13:56, 30 January 2010 (UTC)

While you're working on the lead, take a look at "Intranasal and buccal midazolam as an alternative to rectal diazepam ...". I personally would prefer to see all jargon reworded in a lead, but I accept that it's often difficult, and so appropriate wikilinks can be used to help the reader to understand. However, the links intranasal and buccal are not helpful (and links to dab pages particularly so). Would something like "Administration of midazolam by nose or mouth is becoming increasingly popular for the emergency treatment of seizures in children, as an alternative to diazepam given rectally." convey the meaning you intended? (or is it 'rectaly' in en-US?). --RexxS (talk) 08:52, 1 February 2010 (UTC)

Thank you for suggestions RexxS. I agree, it is a bit too technical for the lay reader. I have reworded it per your suggestion. However, using the term "mouth" is misleading because it will imply to lay readers and perhaps even some experts the oral route, i.e. swallowing but midazolam is not well absorbed orally. I have added in absorption via gums and cheek.--Literaturegeek | T@1k? 09:40, 1 February 2010 (UTC)

Quick copyedit

I've done a quick copyedit on Indications. Please make use of or revert any changes I've made. I've tried to get rid of awkward constructions like "However ... . However ..." and "in ... in ...", and corrected the use of an acronym without defining it (ICU). I've also tried to wikilink terms that I felt would benefit from further explanation. In doing so, I've temporarily introduced two redlinks: First line agent and Refractory status epilepticus. I don't know what they are and we don't seem to have articles, so perhaps you can have a look at explaining those inline or creating the redirects/articles that they should point to, as it's beyond my competence. Also, can you take another look at these fragments:

propofol has advantages over midazolam when used in the ICU for sedation such as shorter weaning time earlier tracheal extubation.

With prolonged use tolerance, tachyphylaxis can occur and the elimination half-life may increase, up to days.

as I'm not quite sure if there are missing words ("shorter weaning time from earlier tracheal extubation?" "With prolonged use tolerance and tachyphylaxis can occur") or there is another meaning that the construction didn't make clear to me. If you've generally found these suggestions of value, I'd be happy to do more copyediting as time permits me. --RexxS (talk) 10:30, 1 February 2010 (UTC)

Thank you kindly RexxS. Looks like good changes to me. Refractory just means resistant and is discussed in the main status epilepticus article. I have wiki linked the term refractory. In the case of status epilepticus it means resistant to first line treatments. There is already an article on first line treatment so I have made the first line agent a redirect to that article. The propofol sentence was missing the word "and" and the other sentence also was missing a word "and". Thanks for finding these issues.--Literaturegeek | T@1k? 09:14, 3 February 2010 (UTC)

Comment on wording

1. Midaz is describe as an "ultra short-acting"? Short acting yes but not ultra short. Propofol would be ultra should. Midaz is kind of long acting which is why we do not usually use it for procedural sedation anymore.
2. "can be used to diagnose" a benzo overdose? No were have I have seen it recommended that it be used to diagnose a benzo overdose. If maybe you had given a benzo and you know no other med have been used and that the person is not a chronic user than yes it is used, otherwise... Doc James (talk · contribs · email) 01:48, 4 February 2010 (UTC)

Thanks for spotting these problems Doc. I have edited the article to try and resolve these issues.--Literaturegeek | T@1k? 21:54, 4 February 2010 (UTC)

Formating

The OD symptoms would I think look nicer in a table.Doc James (talk · contribs · email) 21:45, 4 February 2010 (UTC)

I tried to put it in a table but it didn't look good. I don't know in what way I should devide the symptoms up into columns. Hmmm. Can you elaborate on what you had in mind.--Literaturegeek | T@1k? 22:07, 4 February 2010 (UTC)

Aesthetically, a good solution to get rid of the large white space displayed on wide displays is to use {{Div col|colwidth}} with the width set in ems. Unfortunately, it only really works well with a single level list. The symptoms list here has a sub-list which doesn't show up well in multiple columns. You can see how it would look at User:RexxS/Multi-col where I set a column width of 20em. Sorry I can't help more in this case. --RexxS (talk) 22:46, 4 February 2010 (UTC)

Thanks for trying.--Literaturegeek | T@1k? 19:20, 5 February 2010 (UTC)

Scope

Wondering about a section on history? Doc James (talk · contribs · email) 23:50, 4 February 2010 (UTC)

I did think about this myself but then realised there isn't really any history worth noting for midazolam. Do you have any ideas of what could be covered for the history section?--Literaturegeek | T@1k? 19:12, 5 February 2010 (UTC)

Some possible areas: When was it first synthesised? Who discovered it? Is there any information on its trials? When did it come into general use? Were the paradoxical side-effects noticed from the start or after general use started? – that sort of thing. Hope that helps. --RexxS (talk) 01:44, 6 February 2010 (UTC)

Thanks for the tips RexxS, it is easier said than done; there is not a lot of notable history on midazolam but I have done my best. Let me know your thoughts on the new history section.--Literaturegeek | T@1k? 23:26, 8 February 2010 (UTC)

Nobody said it was easy! but I think you've done superbly. I've copyedited the section for flow (please revert any changes you don't like). There are two dating points that you might be able to clarify. As it's a History section, it's best to be as precise as possible with dates, so "until recent years" would be better replaced by a date or date range ('early 2000s', '2004', for example) if you can tell from the sources. It also helps to maintain the datum point as the article ages. The same applies to "was later synthesised", which would also benefit from a general indication of what later means - 1980s? 1990s? Hope that helps. --RexxS (talk) 05:28, 9 February 2010 (UTC)

Hehe, thank you. :=) I have made the changes that you suggested, and found some new references.--Literaturegeek | T@1k? 00:09, 10 February 2010 (UTC)

Too many wikilinks

While I have been reviewing this article, I have come across a number of redundant wikilinks and links to unrelated topics. Please know that it is unnecessary for there to be more than one wikilink per item. Please see WP:LINKS for more guidelines. Right now, I've been trying to remove them as I encounter them, but there are quite a lot of them, so it would be nice to have some help. Thanks. Tea with toast (talk) 00:13, 7 March 2010 (UTC)

Thanks for reviewing this article. I will do my best to help out with redundant wikilinks, but a medical article, by its nature, will contain many terms that ought to be internally linked to help the reader, and it's not surprising that different editors may not have noticed a previous link. I've relinked 'refractory' to its wiktionary definition as it gives 'difficult to treat' - agreeing that the wikipedia article Refractory just deals with the 'heat resistant' meaning. I've also re-linked 'elimination half life' at its first occurrence and removed the second link per WP:LINKS. --RexxS (talk) 00:35, 7 March 2010 (UTC)

The overlinking should be much reduced now. --RexxS (talk) 01:34, 7 March 2010 (UTC)

Thanks for your work. --Tea with toast (talk) 04:07, 7 March 2010 (UTC)

Issues needing to be addressed before final review

References are made as of the 7 March 2010 revision

1. Additional citations are needed in "Side effects" and "Tolerance..." sections. Citations are needed when giving statistics and relaying information about "case studies".
2. Notes 19 and 60 need full citation
3. Notes 15 and 23 cite the same text book (I recommend moving the full book citation to "References", first); however, there is no page number given for ref 15
4. In the References section, the first and second refs are broken, and the sixth ref is improperly cited.

I thank the editors for the improvements that have been made thus far and look forward to having these issues resolved. --Tea with toast (talk) 04:07, 7 March 2010 (UTC)

Thank you for spotting these issues. I deleted the case studies mentions which were not cited. The tolerance information was cited in the free full text of reference. I have resolved the issue with the free floating references by deleting all but one of them. They were mostly primary sources or not peer reviewed and as you mentioned a couple of them were dead URLs. All references are now inline citations. I have made the duplicate citations one by using ref name. Hopefully that is all the issues resolved now. :) If not feel welcome to point out any remaining issues and I will try to resolve them. Thank you for volunteering to review the article. :)--Literaturegeek | T@1k? 23:30, 7 March 2010 (UTC)

I am glad to see the improvements that have been made thus far; however, issue #1 has not been fully addressed. Citations are needed in both the "Side effects" and "Tolerance" sections.

Additionally, I think the information in the "Side effects" section is too scattered. I would suggest that the first sentence of the first paragraph list all the documented side effects (including respiratory depression, hypotension, and others described in the section). I would then organize the subsequent paragraphs addressing each category of side effects. Currently, the second paragraph is a "catch all" paragraph without a clear structure. I would condense this so that it describes the memory/cognitive aspect alone. The subsequent paragraphs can address the other specific aspects, as you already have the paragraph dedicated to the "paradoxical effect" and another for "respiratory depression". This is just my personal recommendation, you can adjust as you see fit. Over all, I am pleased with the progress thus far. --Tea with toast (talk) 18:25, 21 March 2010 (UTC)

Thanks for the helpful comments on the structure of Side effects. I'm sure LG will make good use of that. However, I have to take issue with your insistence that every sentence be referenced. All three of the {{cn}} templates you added referred to information that was sourced by a citation either at the end of the paragraph or a couple of sentences later. I've replaced each template with the named ref anyway, but there comes a point where it starts to look odd, when the same citation is added multiple times in the same paragraph. --RexxS (talk) 22:39, 21 March 2010 (UTC)

Sorry for being a nit-pick. In my line of work I am very accustomed to expecting a ref at the end of nearly every sentence, and I fall into this trend whenever I read science articles on wikipedia. For me, I find a helpful alternative is to start a sentence or paragraph by saying "A review by Riss, et. al (2008) found..." that way I'm more likely to accept the subsequent info. I must say, I doubted the contents of ref 13. I didn't think a paper titled "Benzodiazipines and epilepsy" would support statements like "...can cause or worsen depression". You proved my assumptions wrong! --Tea with toast (talk) 03:35, 30 March 2010 (UTC)

Don't worry about coming across as nitpricky, I can see where you are coming from. I believe WP:MEDRS or WP:MEDMOS actually does not recommend including an author's name unless they are very notable. I think that it is sometimes sensible to include "a review found" or a "meta-analysis found" if it is a controversial point. Anyhows, I can see RexxS has added the citations for those statements to where you had requested a citation so looks like your concerns have been resolved (I don't know if you have checked the article yet for those fixes). So what do you reckon Teatoast, is the article a pass or a fail now? :)--Literaturegeek | T@1k? 22:04, 30 March 2010 (UTC)

Assessment

I find that this article meets the good article criteria:

1. Article is well written
2. Article is factually accurate and verifiable
3. Broad in coverage
4. Written in a neutral tone
5. Stable
6. Appropriately illustrated with images

--Tea with toast (talk) 05:29, 2 April 2010 (UTC)

Thank you very much for taking the time to review the article and passing it! :) Much appreciated. :)--Literaturegeek | T@1k? 21:36, 2 April 2010 (UTC)

Recommendations for feature improvements

To get this article started in the right direction for FA assessment, I suggest the following areas for development:

• Restructure paragraphs in "Indications" section. Info in the paragraphs are a bit scattered and need some focus.
• Restructure "Side effects" section. See recommendations found in Talk:Midazolam/GA1#Issues needing to be addressed before final review
• Expand "Pharmacology" section. More information about metabolism would be helpful. --Tea with toast (talk) 05:29, 2 April 2010 (UTC)

Thank you very much for your suggestions. :)--Literaturegeek | T@1k? 21:41, 2 April 2010 (UTC)