BACKGROUND: Acute cough associated with the common cold (CACC) causes significant impairment in quality of life. Effective treatment approaches are needed for CACC. We conducted a systematic review on the management of CACC to update the recommendations and suggestions of the CHEST 2006 guideline on this topic.
METHODS: This systematic review of randomized controlled trials (RCTs) asked the question: Is there evidence of clinically relevant treatment effects for pharmacological or non-pharmacological therapies in reducing the duration/severity of acute CACC? Studies of adults and pediatric patients with CACC were included and assessed for relevance and quality. Based upon the systematic review, guideline suggestions were developed and voted on using the American College of Chest Physicians organization methodology.
RESULTS: Six systematic reviews and four primary studies identified from updated literature searches for each of the reviews or from hand searching were included and reported data on 6,496 participants with CACC who received one or more of a variety of interventions. The studies used an assortment of descriptors and assessments to identify CACC.
CONCLUSIONS: The evidence supporting the management of CACC is overall of low quality. This document provides treatment suggestions based on the best currently available evidence, and identifies gaps in our knowledge and areas for future research.
BACKGROUND: Optimizing body composition for healthy aging in the community is a significant challenge. There are a number of potential interventions available for older people to support both weight gain (for those who are underweight) and weight loss (for overweight or obese people). While the benefits of weight gain for underweight people are generally clearly defined, the value of weight loss in overweight or obese people is less clear, particularly for older people.
OBJECTIVES: This umbrella review aimed to measure the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to explore theirqualitative perceptions.
INCLUSION CRITERIA TYPES OF PARTICIPANTS: The participants were older adults, 60 years of age or older, living in the community.
TYPES OF INTERVENTIONS: The review examinedsix types of nutritional interventions: (i) dietary programs, (ii) nutritional supplements, (iii) meal replacements, (iv) food groups, (v) food delivery support and eating behavior, and (vi) nutritional counselling or education.
TYPES OF STUDIES: This umbrella review considered any quantitative systematic reviews and meta-analyses of effectiveness, or qualitative systematic reviews, or a combination (i.e. comprehensive reviews).
TYPES OF OUTCOMES: The quantitative outcome measures of body composition were: (i) nutritional status (e.g. proportion of overweight or underweight patients); (ii) fat mass (kg), (iii) lean mass or muscle mass (kg), (iv) weight (kg) or BMI (kg/m), (v) bone mass (kg) or bone measures such as bone mineral density, and (vi) hydration status.
PHENOMENA OF INTEREST: The phenomena of interestwere the qualitative perceptions and experiences of participants.
SEARCH STRATEGY: We developed an iterative search strategy for nine bibliometric databases and gray literature.
METHODOLOGICAL QUALITY: Critical appraisal of 13 studies was conducted independently in pairs using standard Joanna Briggs Institute tools. Six medium quality and seven high quality studies were identified.
DATA EXTRACTION: Data was extracted independently in pairs from all 13 included studies using the standard Joanna Briggs Institute data extraction tool.
DATA SUMMARY: Only quantitative studies of effectiveness were included. The strength of evidence assessing the effectiveness of interventionswas graded using a traffic light system (green, amber, red). An overall assessment of the quality of the evidence for each comparison was undertaken.
RESULTS: More systematic reviews investigating weight gain than those investigating weight loss were included. Studies onweight gain showed improved body composition for oral nutritional supplements on its own, for oral nutritional supplements in combination with resistance exercise training, and for oral nutritional supplements in combination with nutrition counselling. Studies on weight loss showed that diet in combination with exercise, diet in combination with exercise and nutrition counselling, and nutrition counselling on its own all can lead to reduced weight in older people. The outcomes of lean mass and weight/BMI were responsive to nutritional interventions, but fat mass did not vary. There were no qualitative reviews identified.
CONCLUSIONS: Although effective interventions for weight gain and weight loss to optimize body composition of older people in the community were identified,making long term, clinically relevant changes in body composition is difficult. Multiple interventions are more effective than single interventions.
CONTEXTE: L'utilisation de la médecine complémentaire et alternative (MCA) dans les populations pédiatriques est commun encore, à ce jour, il n'y a pas eu de synthèse de la preuve de son efficacité dans cette population. Cet aperçu de l'examen systématique évalue les preuves pour ou contre l'efficacité de la CAM pour n'importe quelle condition l'enfance.
MÉTHODES: Medline, Cochrane et AMED ont été fouillés depuis sa création jusqu'en Septembre 2009. Les listes de référence des articles récupérés ont été recherchées à la main. Les experts dans le domaine de la CAM ont été contactés. Aucune restriction de langue ont été appliquées.
RÉSULTATS: 17 examens systématiques ont été inclus dans cet aperçu, couvrant l'acupuncture, la chiropractie, la phytothérapie, l'homéopathie, hypnothérapie, massages et le yoga. Les résultats ont été peu convaincante pour la plupart des conditions bien qu'il y ait des preuves pour suggérer que l'acupuncture peut être efficace pour les nausées et vomissements postopératoires, et que l'hypnothérapie peut être efficace pour réduire la douleur liée à la procédure. La plupart des critiques omis de mentionner l'incidence des effets indésirables de CAM.
CONCLUSIONS: Bien qu'il y ait des signes encourageants pour l'hypnose, l'acupuncture et la phytothérapie, il ya suffisamment de preuves pour suggérer que d'autres sont CAM efficace pour le traitement des maladies infantiles. La plupart des critiques systématiques inclus dans cet aperçu sont de piètre qualité, comme l'étaient les essais cliniques randomisés au sein de ces critiques, de réduire encore le poids de cette preuve. La recherche future dans CAM pour les enfants doit être conforme aux normes d'information énoncées dans les lignes directrices CONSORT et PRISMA.
INTRODUCTION: Each year, children suffer up to 5 colds and adults have two to three infections, leading to time off school or work, and considerable discomfort. Most symptoms resolve within 1 week, but coughs often persist for longer.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for common cold? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 21 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics or anti-inflammatory drugs, antibiotics, antihistamines, decongestants for short-term and for long-term relief, decongestants plus antihistamines, echinacea, steam inhalation, vitamin C, and zinc (intranasal gel or lozenges).
Because use of herbal remedies is increasing, a risk-benefit profile of commonly used herbs is needed. This article provides a clinically oriented overview of the efficacy and safety of ginkgo, St. John's wort, ginseng, echinacea, saw palmetto, and kava. Wherever possible, assessments are based on systematic reviews of randomized clinical trials. Encouraging data support the efficacy of some of these popular herbal medicinal products, and the potential for doing good seems greater than that for doing harm. The published evidence suggests that ginkgo is of questionable use for memory loss and tinnitus but has some effect on dementia and intermittent claudication. St. John's wort is efficacious for mild to moderate depression, but serious concerns exist about its interactions with several conventional drugs. Well-conducted clinical trials do not support the efficacy of ginseng to treat any condition. Echinacea may be helpful in the treatment or prevention of upper respiratory tract infections, but trial data are not fully convincing. Saw palmetto has been shown in short-term trials to be efficacious in reducing the symptoms of benign prostatic hyperplasia. Kava is an efficacious short-term treatment for anxiety. None of these herbal medicines is free of adverse effects. Because the evidence is incomplete, risk-benefit assessments are not completely reliable, and much knowledge is still lacking.
