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Lecture 3

NURS 205 Lecture Notes - Lecture 3: Allergic Rhinitis, Systematic Review, Common Cold

Course Code
NURS 205
Brendalyn Ens

of 2
CADTH Critical Appraisal 101 Workshops
Ens / Kamel / Jennings / Pohar 2012
Critical Appraisal Tool (CAT): SYSTEMATIC REVIEW
Note: This guide is intended to highlight the most important features of critical appraisal. It is not all-inclusive, and does not represent any specific
currently-available critical appraisal tool (CAT).
TITLE: “Heated, Humidified Air for the Common Cold
AUTHORS: Singh, M. & Singh, M. (2013)
Can I believe the results?
Identify the PICOTs for this article.
(PICO = Patient – Intervention – Comparator –
Outcomes – Timeframe – Study types)
P = patients of all ages (children and adults), suffering from common cold or acute
viral rhino-pharyngitis
I = warm vapour inhalation (heated, humidified air)
C = Room temperature air or humidified air
O = PRIMARY: Reduction in clinical severity of symptoms
T = 2010 2013
S = Randomized Controlled trials only
What are the effects & benefits of inhaling heated water vapour (steam) to reduce
severity of symptoms of the common cold in adults & children?
Did the authors mention how they chose to
include and exclude studies from the SR?
Authors did not include a flow chart or diagram illustrating
inclusion/exclusion process, but did identify all selected studies in the
Data Collection methods section (page 4) and in more detail
beginning Page 6 under “Description of studies”
Characteristics of the 6 included studies (394 trial participants) were
identified and detailed (including individual study appraisals) on
pages 15-23
Excluded studies (3) were listed with reasons for the exclusion on Pg
Reasons for exclusion of studies included: inappropriate device,
inappropriate intervention, or inappropriate diagnosis (allergic
Is the search for papers comprehensive in
credible databases?
Is the search strategy reproducible (could
others do again it now)?
1 flag
Search methods were detailed (with search terms) on Page 4.
89 records were originally found (Page 6) in at least 3 different
flag: It was not clear in this SR that 2 researchers conducted the
search (2+2+2 formula not clearly presented)
Previous search strategies used for older systematic reviews in 1999,
2003, 2005 and 2010 were included on page 27 (Appendix 1)
The search strategy is thought to be reproducible again now as all
databases are still available and open-access.
CARS tool use suggests all are credible databases/websites.
Were all populations in included studies
similar (trying to determine homogeneity versus
Heterogeneity was reported to be assessed using eyeballing, Chi
square test, and f2 statistic. (page 6)
In the discussion section of the paper, authors indicated that in all
included studies the sample sizes were small and there was significant
heterogeneity across studies. (page 12_
Chi Square = 8.74, df = 1 (p < 0.003) f2 statistic = 89% were reported.
Despite this heterogeneity and due to only a few studies available on
this topic, the systematic review was still conducted.
Page 3
CADTH Critical Appraisal 101 Workshops
Ens / Kamel / Jennings / Pohar 2012
Were any conflicts of interest for
researchers stated? Look at declarations of
conflicts of interest and sources of funding
No mention of conflicts of interest for either researcher was found in
the article. Given that this was a Cochrane Review, strict author
requirements for COI and funding source is known to be required.
Cochrane guidelines for Systematic reviewers has a protocol.
No mention of sources of funding for this systematic review was
What are the results?
Identify all the main results/conclusions of
this article.
Are the results supported adequately with
tables & figures such as forest plots (or
other)? Describe
The major conclusion from all included studies were:
o 3 specific trials found benefits of steam for symptom relief with the
common cold (Odds Ratio 0.31; 95% CI 0.16 0.60)
o Results on symptom indices (volume of nasal secretions) were
equivocal (equal)
o No studies indicated worsening of clinical symptoms
o 1 study suggested worsening nasal resistance for use
o Minor side effects (discomfort, irritation) were reported in some
o There is a difference in results of studies conducted in the UK versus
those in the USA even though similar equipment and methods were
Will the results help me in my decision-making?
Are the authors’ conclusions supported by
other good evidence?
This SR was completed in 2013.
There have been no further supporting (or negative) studies or
published since the date this study was published. The results of this
SR appear to stand as current knowledge on this clinical topic.
Can the results be applied to my local
population and does the author provide
suggestions as to how this could occur?
Authors mentioned in the discussion section (Page 12) that
differences in study results between UK and USA could be due to
different epidemiology or rhinoviral infections in different
geographic areas. Also, climate and seasonal differences may be a
factor in using the results.
It is unknown what the current epidemiology is for Canadian
rhinoviral infections.
However, based on the results of this SR, general nursing advice
suggesting use of heated, humidified air could be provided to
patients to help them better manage the uncomfortable symptoms
of the common cold.