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10.11.2014, admin
Upper Respiratory Tract Infection Symptoms, Causes, Treatment - What is the outlook for a patient suffering from an upper respiratory infection? What is the outlook for a patient suffering from an upper respiratory infection?In general, the outcome of upper respiratory infection is good. Question: What home remedies were effective in reducing the symptoms of your upper respiratory infection? BACKGROUND: A high prevalence of complementary and alternative medicine (CAM) use has been documented in children with chronic illnesses. CONCLUSIONS: Given the disproportionate number of inconclusive reviews, there is an ongoing need for high quality research to assess the potential role of CAM in children.
Complementary and alternative medicine (CAM) refers to a broad range of healing philosophies, approaches and therapies that exist largely outside the institutions where conventional medicine is taught and provided (exclusive definition). Conversely, over the last two decades, evidence-based medicine (EBM) has substantially changed the approach to patients in clinical practice. High-quality research and its perpetual critical assessment in accordance with EBM standards is the best way to clarify the role of CAM in the medical arena (diagnosis, therapy, funding, reimbursement, etc.). We subsequently analysed the specific reasons why reviews were considered inconclusive, as provided by the authors.
All data were retrieved from the CRG and stored in an electronic database, using SPSS 18.0 (SPSS, Chicago, Illinois, USA). To ensure the transparency and objectivity of this review, we adhered to the PRISMA statement [23] and checklist of items, in order to include as much as possible, for a systematic overview rather than a meta-analysis. Table 2: Characteristics of included reviews with a “negative” recommendation [29–37].
Between 1995 and 2012, 170 reviews (from the field of CAM as provided by the Cochrane data base) were considered eligible and 135 reviews were subsequently included (figs 1 and 2). The origin of Cochrane reviews by continent was as follows: Europe (45), Asia (40), Australia (26), North America (16) and Africa (8).
Table 3: Number of studies included in Cochrane reviews and conclusiveness of the review. The results of our study do not provide consistent evidence to suggest that CAM is effective for a variety of paediatric conditions.
The disproportionately high number of inconclusive reviews, when compared with other paediatric subspecialities [39, 40], strongly emphasises that CAM needs to undergo the same rigorous evaluation process with standardised techniques as conventional medicine (i.e. Although defining clinical uncertainty and thereby generating new research questions is a fundamental driving force for EBM, clinicians at the bedside will find this frustrating and unhelpful. If the above outlined approach is bound to be successful, one would expect an increasing number of high quality (and probably conclusive) reviews that are based on sophisticated research data. It is also noteworthy that the vast majority of reviews published in the CRG database originate from western, industrialised countries (fig. Also of note, the majority of reviews evaluated interventions assessing “dietary supplements”. Given the limited financial and human resources that are nowadays available in the medical arena, future emphasis must be on conditions for which new treatment modalities would have an important impact on the health system, children, families and healthcare workers.
It will be important that future research addresses safety issues, as well as assessing effectiveness of CAM in children. However, it is important to note that some inherent weaknesses may be applicable to our data synopsis. Second, a further possible shortcoming of our study was that we did not include data from sources other than the Cochrane database(e.g. In conclusion, based on our findings and in line with previous studies [2, 38], there is a need for more high quality research in children to assess whether there is a potential role for CAM in children.
42 Schmidt B, Roberts RS, Davis P, Doyle LW, Barrington KJ, Ohlsson A, et al; Caffeine for Apnea of Prematurity Trial Group. 51 Higgins JP, Altman DG, Gotsche P, Jui P, Moher D, Oxman AD, et al, Cochrane Bias Methods Group Cochrane Statistical Methods Group. Swiss Medical Weekly, established 1871, is an international journal following the Platinum Open Access model. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. Conversely, evidence-based medicine is considered an important contributor in providing the best quality of care.
Main outcome variables were: percentage of reviews that concluded that a certain intervention provides a benefit, percentage of reviews that concluded that a certain intervention should not be performed, and percentage of studies that concluded that the current level of evidence is inconclusive.
An increasing and generally high prevalence of CAM use by children and adolescents with chronic illnesses has been documented in industrialised countries [1–3].


EBM has contributed to improving the quality of medicine in general and in paediatrics in particular [14–16]. Thirty-five Cochrane reviews were excluded because they dealt with conventional therapies (fig.
In our study, only a minority of systematic reviews provided data to answer the question as to whether a certain intervention should or should not be performed (5 positive, 9 negative, 26 partly conclusive). However, by identifying important gaps in the evidence, Cochrane reviews have the potential to promote high-quality randomised controlled trials in the field of CAM (as has been demonstrated in other fields of medicine, e.g. This may in part be attributable to the fact that large randomised controlled trials require adequate funding, which in many circumstances can best be provided by pharmaceutical companies. While some therapeutic modalities, such as homeopathy and reiki, are based on beliefs that lie outside the scope of science and may lack scientific plausibility [45], it is noteworthy that lack of scientific plausibility is not always and necessarily equivalent to a lack of efficacy. This is of great importance since CAM is commonly considered by its users as a safe medical method, and this contributes to its widespread prevalence.
It has been demonstrated that children who consult naturopathy and chiropractic practitioners are significantly less likely to receive the recommended vaccinations and are significantly more likely to suffer from a vaccine-preventable disease [49]. First, Cochrane reviews themselves may be at risk of suffering from major weaknesses with regard to both clinical relevance (e.g. This will probably result in more systematic reviews that will come to clear conclusions (i.e. Use of complementary and alternative medicine in healthy children and children with chronic medical conditions in Germany. Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. Comple-mentary and alternative medicine use in children with cancer and general and specialty pediatrics. Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology – a randomized multicenter crossover pilot trial. Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial.
Complementary and alternative medicine use among adults and children: United States, 2007. Cochrane reviews in pregnancy: the role of perinatal randomized trials and systematic reviews in establishing evidence. Cochrane CAM reviews commentary: is there more to quality than the research method itself?
Informed consent: advising patients and parents about complementary and alternative medicine therapies. Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age.
Vitamin A supplementation for reducing the risk of mother-to-child transmission of HIV infection. Vitamin A supplementation for the prevention of morbidity and mortality in infants six months of age or less. The evidence-base for complementary medicine in children: a critical overview of systematic reviews. Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Pediatric vaccination and vaccine preventable disease acquisition: associations with care by complementary and alternative medicine providers. Accidental intakes of remedies from complementary and alternative medicine in children – analysis of data from the Swiss Toxicological Information Centre.
Bacterial infections, people with weak immune systems, and those with complications of upper respiratory infections (listed above) may have less favorable prognosis.
He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983.
There he was involved in research in radiation biology and received the Huisking Scholarship. Asian countries,[18] United States (including Hawaii), Canada ,[19] and Scotland)[20] due to bacterial resistance.


While there are compelling data concerning increasing CAM use in adults, the use of CAM by children is not only less well studied, but also appears to have a considerable prevalence. This development has led to the publication of a growing number of guidelines in the field of paediatrics [17, 18]. Initially, all Cochrane reviews in the general field of CAM in children provided by the CRG were screened for potential eligibility (i.e.
The results of these reviews will provide the physician at the bedside with invaluable information about both optimal and unnecessary or potentially harmful treatment modalities, as detailed in table 1 and table 2. Inconclusive reviews usually conclude that, after an extensive literature search and appraisal, “insufficient trial evidence was found to guide clinical practice”.
Thus, the recommendations issued in these reviews are most applicable to the field of CAM as practised in industrialised countries, and will only in part be useful for the majority of children being cared for in the developing world.
Importantly, recent research by the Cochrane collaboration has demonstrated that results of drug and device studies may be distorted through sponsorship by manufacturing and pharmaceutical companies (i.e.
Moreover, it is important to take into consideration the clinical context of using certain therapies [22]: while vitamin preparations may be considered CAM therapies under certain circumstances, they may represent standard therapy in other clinical situations (vitamin K administration to prevent haemorrhagic events in neonates), they may have profound immunological properties (probiotics), or may be characterised as strong growth factors (vitamin A for lung development) [46].
Therefore, prior to issuing recommendations for or against the use of some CAM in children, more rigorous testing of therapies using standardised techniques and systematic reporting of adverse events in practice and research needs to be put in place [47], as is the case for conventional medicine [48].
Also, the use of CAM products may lead to unintentional household poisoning, although symptoms of toxicity are usually mild [50]. His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
CAM use by hospitalised children, as well as in outpatient settings, ranges from 1.8% to 84% [4–7]. Moreover, with the advent and further development of EBM in modern medicine, clear and ambitious requirements for what is considered acceptable evidence have been defined. One possible and important way to increase research quality and overcome common reasons for failure to generate specific recommendations (most importantly low number of study participants) will be the formation of national and international research networks.
The substantial proportion of reviews from the United Kingdom may in part be attributed to the fact that the Centre for Evidence-Based Medicine is located in Oxford, England, and that the use of EBM plays an important role in the provision of healthcare in the United Kingdom. For children, this is a particularly relevant because they are unable to give informed consent to treatment, and therefore rely upon appropriate decisions about their care being made on their behalf [38]. Moreover, the use of systematic reviews as provided by the CRG plays an important role in providing and disseminating the best available evidence in the field of CAM, thus contributing to the provision of good medical care at the bedside. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. A recent trial showed prevalence rates between 36% in general paediatrics and 61.9% in children with epilepsy [8]. Today, the gold standard of EBM is the randomised controlled trial and systematic reviews of randomised controlled trials. However, other underlying factors – both political and administrative ones – related to the British National Health Service may also contribute to this phenomenon.
Other inventions in the field of CAM that may merit critical assessment in a randomised clinical trial may not find adequate sponsorship. The provision of high-quality data on the efficacy of CAM therapies in children will enable the physician to inform both patients and parents about potentially beneficial CAM options, especially if they involve less risk or fewer adverse effects than conventional therapy [21].
Herbal medicine, homeopathy, reflexology and acupuncture are among the most popular treatments [9, 10]. Therefore, adequate funding from independent organisations will be vital to tackle and solve this issue. Although we used an up-to-date definition of CAM as provided by Wieland and co-workers [22], this operationalisation cannot be considered to be exhaustive, and will be subject to expansion over time.
Ludwig Gortner, Sven Gottschling, Alexander Larsen and Georg Kutschke were involved in data retrieval and data analysis. The reasons for this high prevalence of use are diverse and might include dissatisfaction with conventional medicine and positive reports from friends and family [11, 12].
In some cases, however, the context of the therapy determines whether the therapy itself would be considered CAM or not (e.g.
Children whose parents use CAM are almost five times more likely to use CAM than children whose parents do not use it [13]. If then considered pertinent to the field of CAM in children, the reviews were subsequently included in the data synopsis (fig.



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