Developing ‘high impact’ guideline-based quality indicators for UK primary care: a multi-stage consensus process Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations Research gaps identified during systematic reviews of clinical trials: glass-ionomer cements Effect of vitamin D supplementation on inflammation: protocol for a systematic review Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Using qualitative comparative analysis in a systematic review of a complex intervention The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. How to Appraise the Effectiveness of Treatment A Systematic Review of Randomized Controlled Interventions for Parents' Distress in Pediatric Leukemia The 2011 Dietary Reference Intakes for Calcium and Vitamin D: what dietetics practitioners need to know. Herbal and dietary therapies for primary and secondary dysmenorrhoea. The Benefit of Lithium Carbonate Adjunct in Refractory Depression — Fact or Fiction? * Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Guidelines for the prevention of intravascular catheter-related infections. Flavonoids and cognitive function: a review of human randomized controlled trial studies and recommendations for future studies
Background  Quality indicators ( QIs ) are an important tool for improving clinical practice and are increasingly being developed from evidence -based guideline recommendations . We aim ed to identify , select and apply guideline recommendations to develop a set of QIs to measure the implementation of evidence -based practice using routinely recorded clinical data in United Kingdom ( UK ) primary care . Methods We review ed existing national clinical guidelines and QIs and used a four-stage consensus development process to derive a set of ‘ high impact ’ QIs relevant to primary care based upon explicit prioritisation criteria . We then field tested the QIs using remotely extracted , anonymised patient records from 89 r and omly sample d primary care practice s in the Yorkshire region of Engl and . Results Out of 2365 recommendations and QIs originally review ed , we derived a set of 18 QIs ( 5 single , 13 composites – comprising 2–9 individual recommendations ) for field testing . QIs predominantly addressed chronic disease management , in particular diabetes , cardiovascular and renal disease , and included both processes and outcomes of care . Field testing proved to be critical for further refinement and final selection . Conclusions We have demonstrated a rigorous and transparent methodology to develop a set of high impact , evidence -based QIs for primary care from clinical guideline recommendations . While the development process was successful in developing a limited set of QIs , it remains challenging to derive robust new QIs from clinical guidelines in the absence of established systems for routine , structured recording of clinical care Abstract Introduction : Successful population ‐level antiretroviral therapy ( ART ) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and , ultimately , the end of AIDS . Although many people living with HIV are adhering well , others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy . Despite the importance of ART adherence , supportive interventions have generally not been implemented at scale . The objective of this review is to summarize the recommendations of clinical , research , and public health experts for scalable ART adherence interventions in re source ‐limited setting s. Methods : In July 2015 , the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in re source ‐limited setting s. This article summarizes that discussion with recent up date s. It is not a systematic review , but rather provides practical considerations for programme implementation based on evidence from individual studies , systematic review s , meta‐analyses , and the World Health Organization Consoli date d Guidelines for HIV , which include evidence from r and omized controlled trials in low‐ and middle‐income countries . Interventions are categorized broadly as education and counselling ; information and communication technology‐enhanced solutions ; healthcare delivery restructuring ; and economic incentives and social protection interventions . Each category is discussed , including descriptions of interventions , current evidence for effectiveness , and what appears promising for the near future . Approaches to intervention implementation and impact assessment are then described . Results and discussion : The evidence base is promising for currently available , effective , and scalable ART adherence interventions for re source ‐limited setting s. Numerous interventions build on existing health care infrastructure and leverage available re sources . Those most widely studied and implemented to date involve peer counselling , adherence clubs , and short message service ( SMS ) . Many additional interventions could have an important impact on ART adherence with further development , including st and ardized counselling through multi‐media technology , electronic dose monitoring , de central ized and differentiated models of care , and livelihood interventions . Optimal targeting and tailoring of interventions will require improved adherence measurement . Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence , so that they do not limit the potential of ART to help bring about the end of AIDS Background To report the results of an audit concerning research gaps in clinical trials that were accepted for appraisal in authored and published systematic review s regarding the application of glass-ionomer cements ( GIC ) in dental practice Methods Information concerning research gaps in trial precision was extracted , following a framework that included classification of the research gap reasons : ‘ imprecision of information ( results ) ’ , ‘ biased information ’ , ‘ inconsistency or unknown consistency ’ and ‘ not the right information ’ , as well as research gap characterization using PICOS elements : population ( P ) , intervention ( I ) , comparison ( C ) , outcomes ( O ) and setting ( S ) . Internal trial validity assessment was based on the underst and ing that successful control for systematic error can not be assured on the basis of inclusion of adequate methods alone , but also requires empirical evidence about whether such attempt was successful . Results A comprehensive and interconnected coverage of GIC-related clinical topics was established . The most common reasons found for gaps in trial precision were lack of sufficient trials and lack of sufficient large sample size . Only a few research gaps were ascribed to ‘ Lack of information ’ caused by focus on mainly surrogate trial outcomes . According to the chosen assessment criteria , a lack of adequate r and omisation , allocation concealment and blinding/masking in trials covering all review ed GIC topics was noted ( selection - and detection/performance bias risk ) . Trial results appear to be less affected by loss-to-follow-up ( attrition bias risk ) . Conclusion This audit represents an adjunct of the systematic review articles it has covered . Its results do not change the systematic review ’s conclusions but highlight existing research gaps concerning the precision and internal validity of review ed trials in detail . These gaps should be addressed in future GIC-related clinical research Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 BACKGROUND In 2010 , the Canadian Thoracic Society ( CTS ) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older , and adults , including an up date d Asthma Management Continuum . The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline up date process , focusing , in this first iteration , on topics of controversy and ⁄or gaps in the previous guidelines . METHODS Four clinical questions were identified as a focus for the up date d guideline : the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy ; the initiation of adjunct therapy to inhaled corticosteroids ( ICS ) for uncontrolled asthma ; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever , and as a reliever and a controller ; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan . The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics . In addition , literature search es were performed to identify relevant systematic review s and r and omized controlled trials . The panel formally assessed and grade d the evidence , and made 34 recommendations . RESULTS The up date d guideline recommendations outline a role for inclusion of assessment of sputum eosinophils , in addition to st and ard measures of asthma control , to guide adjustment of controller therapy in adults with moderate to severe asthma . Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations . New recommendations for the adjustment of controller medication within written action plans are provided . Finally , priority areas for future research were identified . CONCLUSIONS The present clinical practice guideline is the first up date of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee 's new guideline development process . Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide up date s reflecting new evidence Background Systematic review s evaluating complex interventions often encounter substantial clinical heterogeneity in intervention components and implementation features making synthesis challenging . Qualitative comparative analysis ( QCA ) is a non-probabilistic method that uses mathematical set theory to study complex phenomena ; it has been proposed as a potential method to complement traditional evidence synthesis in review s of complex interventions to identify key intervention components or implementation features that might explain effectiveness or ineffectiveness . The objective of this study was to describe our approach in detail and examine the suitability of using QCA within the context of a systematic review . Methods We used data from a completed systematic review of behavioral interventions to improve medication adherence to conduct two substantive analyses using QCA . The first analysis sought to identify combinations of nine behavior change techniques/components ( BCTs ) found among effective interventions , and the second analysis sought to identify combinations of five implementation features ( e.g. , agent , target , mode , time span , exposure ) found among effective interventions . For each substantive analysis , we reframed the review ’s research questions to be design ed for use with QCA , calibrated sets ( i.e. , transformed raw data into data used in analysis ) , and identified the necessary and /or sufficient combinations of BCTs and implementation features found in effective interventions . Results Our application of QCA for each substantive analysis is described in detail . We extended the original review findings by identifying seven combinations of BCTs and four combinations of implementation features that were sufficient for improving adherence . We found reasonable alignment between several systematic review steps and processes used in QCA except that typical approaches to study abstract ion for some intervention components and features did not support a robust calibration for QCA . Conclusions QCA was suitable for use within a systematic review of medication adherence interventions and offered insights beyond the single dimension stratifications used in the original completed review . Future prospect i ve use of QCA during a review is needed to determine the optimal way to efficiently integrate QCA into existing approaches to evidence synthesis of complex interventions Revised guidelines for the use of antimicrobial therapy in patients with intra-abdominal infections were recently developed by the Therapeutic Agents Committee of the Surgical Infection Society ( Mazuski et al. , Surg Infect 2002;3:161 - 173 ) . These were based , insofar as possible , on evidence published over the past decade . The objective of this document is to describe the process by which the Committee identified and review ed the published literature utilized to develop the recommendations and to summarize the results of those review s. English- language articles published between 1990 and 2000 related to antimicrobial therapy for intra-abdominal infections were identified by a systematic MEDLINE search and an examination of references included in recent review articles . If current literature with regard to a specific issue was lacking , relevant articles published prior to 1990 were identified . All prospect i ve r and omized controlled trials , as well as other articles selected by the Committee , were evaluated individually and collectively . Data with regard to patient numbers , types of infections , and results of interventions were abstract ed . Studies were categorized according to their design , and all included trials were grade d according to quality . On the basis of this evidence , the Committee formulated recommendations for antimicrobial therapy for intra-abdominal infections and grade d those recommendations . After receiving comments from invited review ers and the general membership of the Society , the guidelines were finalized and su bmi tted to the Council of the Surgical Infection Society for approval . The final recommendations related to the selection of patients needing therapeutic antimicrobials , acceptable antimicrobial regimens , duration of antimicrobial use , and the identification and treatment of higher-risk patients . Although numerous publications pertaining to these topics were identified , but nearly all of the prospect i ve r and omized controlled trials represented comparisons of different antimicrobial regimens for the treatment of intra-abdominal infections . A few prospect i ve trials evaluated the need for  therapeutic antimicrobial therapy  in patients with peritoneal contamination following abdominal trauma . The quality of these prospect i ve trials was highly variable . Many did not limit enrollment to patients with complicated intra-abdominal infections , lacked blinding of treatment assignment , did not provide a complete description of the criteria used to determine therapeutic success or failure , failed to identify the reasons why patients were excluded from analysis , or did not include an intention-to-treat analysis . For many issues , no prospect i ve r and omized controlled trials were encountered , and guidelines had to be formulated using evidence from studies with historical controls or uncontrolled data , or on the basis of expert Before implementing a new therapy , we should ascertain the benefits and risks of the therapy and assure ourselves that the re sources consumed during the intervention will not be exorbitant . In the hierarchy of research design s , the results of r and omized controlled trials , especially if systematic ally review ed , are considered the highest level of evidence . We suggest a three-step approach to using an article from the medical literature to guide your patient care . We recommend that readers ask whether the study can provide valid results , review the results , and consider how the results can be applied to patient care . Given the time constraints of busy surgical practice s and surgical training programs , applying this analysis to every relevant article will be challenging . However , the basis of this process is essentially what we all do many times each week when making decisions about whether and how to treat patients . Making this process explicit with guidelines to assess the strength of the available evidence can serve to improve patient care . It also allow us to defend therapeutic interventions based on available evidence and not anecdote Objective . This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing . Methods . A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010 . Results . Seven r and omized controlled trials met the inclusion criteria including in total 1045 parents participants . A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children . Outcome measures are assessed by self-report , observer report , behavioral/psychological , and physiological measures . The most prominent method ological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors . The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions . Conclusions . Recommendations for future RCTs are provided , and particular attention to the quality of trial design and reporting is highlighted The Institute of Medicine Committee to Review Dietary Reference Intakes for Calcium and Vitamin D comprehensively review ed the evidence for both skeletal and nonskeletal health outcomes and concluded that a causal role of calcium and vitamin D in skeletal health provided the necessary basis for the 2011 Estimated Average Requirement ( EAR ) and Recommended Dietary Allowance ( RDA ) for ages older than 1 year . For nonskeletal outcomes , including cancer , cardiovascular disease , diabetes , infections , and autoimmune disorders , r and omized clinical trials were sparse , and evidence was inconsistent , inconclusive as to causality , and insufficient for Dietary Reference Intake ( DRI ) development . The EAR and RDA for calcium range from 500 to 1,100 and 700 to 1,300 mg daily , respectively , for ages 1 year and older . For vitamin D ( assuming minimal sun exposure ) , the EAR is 400 IU/day for ages older than 1 year and the RDA is 600 IU/day for ages 1 to 70 years and 800 IU/day for 71 years and older , corresponding to serum 25-hydroxyvitamin D ( 25OHD ) levels of 16 ng/mL ( 40 nmol/L ) for EARs and 20 ng/mL ( 50 nmol/L ) or more for RDAs . Prevalence of vitamin D inadequacy in North America has been overestimated based on serum 25OHD levels corresponding to the EAR and RDA . Higher serum 25OHD levels were not consistently associated with greater benefit , and for some outcomes U-shaped associations with risks at both low and high levels were observed . The Tolerable Upper Intake Level for calcium ranges from 1,000 to 3,000 mg daily , based on calcium excretion or kidney stone formation , and from 1,000 to 4,000 IU daily for vitamin D , based on hypercalcemia adjusted for uncertainty result ing from emerging risk relationships . Urgently needed are evidence -based guidelines to interpret serum 25OHD levels relative to vitamin D status and intervention Background Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological complaint . Common treatment for dysmenorrhoea is medical therapy such as nonsteroidal anti-inflammatories ( NSAIDs ) or oral contraceptive pills ( OCPs ) which both work by reducing myometrial activity ( contractions of the uterus ) . The efficacy of conventional treatments such as nonsteroidals is considerable , however the failure rate is still often 20 - 25 % . Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders . Herbal and dietary therapies number among the more popular complementary medicines yet there is a lack of taxonomy to assist in classifying them . In the US , herbs and other phytomedicinal products ( medicine from plants ) have been legally classified as dietary supplements since 1994 . Included in this category are vitamins , minerals , herbs or other botanicals , amino acids and other dietary substances . For the purpose of this review we use the wider term herbal and dietary therapies to include the assorted herbal or dietary treatments that are classified in the US as supplements and also the phytomedicines that may be classified as drugs in the European Union . Objectives To determine the efficacy and safety of  herbal and dietary therapies  for the treatment of  primary and secondary dysmenorrhoea  when compared to each other , placebo , no treatment or other conventional treatments ( e.g. NSAIDS ) . Search methods Electronic search es of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials , CCTR , MEDLINE , EMBASE , CINAHL , Bio extracts , and PsycLIT were performed to identify relevant r and omised controlled trials ( RCTs ) . The Cochrane Complementary Medicine Field 's Register of controlled trials ( CISCOM ) was also search ed . Attempts were also made to identify trials from the National Research Register , the Clinical Trial Register and the citation lists of review articles and included trials . In most cases , the first or corresponding author of each included trial was contacted for additional information . Selection criteria The inclusion criteria were RCTs of herbal or dietary therapies as treatment for primary or secondary dysmenorrhoea vs each other , placebo , no treatment or conventional treatment . Interventions could include , but were not limited to , the following ; vitamins , essential minerals , proteins , herbs , and fatty acids . Exclusion criteria were : mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD . Data collection and analysis Seven trials were included in the review . Quality assessment and data extraction were performed independently by two review ers . The main outcomes were pain intensity or pain relief and the number of adverse effects . Data on absence from work and the use of additional medication was also collected if available . Data was combined for meta- analysis using Peto odds ratios for dichotomous data or weighted mean difference for continuous data . A fixed effects statistical model was used . If data suitable for meta- analysis could not be extracted , any available data from the trial was extracted and presented as descriptive data . Main results MAGNESIUM :  Three small trials were included that compared magnesium and placebo . Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less . There was no significant difference in the number of adverse effects experienced . VITAMIN B6 : One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6 . MAGNESIUM AND VITAMIN B6 : Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial . The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain .  VITAMIN B1 : One large trial showed vitamin B1 to be more effective than placebo in reducing pain .  VITAMIN E : One small trial comparing a combination of vitamin E ( taken daily ) and ibuprofen ( taken during menses ) versus ibuprofen ( taken during menses ) alone showed no difference in pain relief between the two treatments . OMEGA-3 FATTY ACIDS : One small trial showed fish oil ( omega-3 fatty acids ) to be more effective than placebo for pain relief . JAPANESE HERBAL COMBINATION : One small trial showed the herbal combination to be more effective for pain relief than placebo , and less additional pain medication was taken by the treatment group . Authors ' conclusions Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily , although this conclusion is tempered slightly by its basis on only one large RCT . Results suggest that magnesium is a promising treatment for dysmenorrhoea . It is unclear what dose or regime of treatment should be used for magnesium therapy , due to variations in the included trials , therefore no strong recommendation can be made until further evaluation is carried out . Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea Our group attempted to vali date previous cl aims of rapid success with lithium carbonate adjunct therapy in  antidepressant-resistant depression . Seven depressed patients volunteered for a study of placebo controlled , double-blind design . During their treatment on general hospital psychiatric wards , these patients received antidepressant medication for a period of at least 21 days . While continuing to receive antidepresant medication after the 21 day period , four of the patients then received lithium carbonate , and three received placebo . This combination pharmacological therapy continued for a 48 hour period . After this time , six of the seven patients showed no significant improvement . The remaining patient , who had received lithium carbonate , improved markedly over the 48 hour period . However , this patient relapsed within one week . A review of the two most extensive studies cl aim ing significant results with the lithium carbonate adjunct therapy was performed . We feel that they , as presented , leave serious doubt as to the validity of their conclusions . We conclude that on the basis of our work up to this point in time and the analysis of previous reports cl aim ing otherwise , no valid evidence exists for a consistent therapeutic effect of lithium carbonate adjunct in antidepressant-resistant depression . It was also found that method ologic contamination necessitated the exclusion of an additional six patients from the double-blind trial . We conclude that in order to objective ly examine the rapidly exp and ing field of biological psychiatry , teaching of clinical staff in basic research procedure should be stressed as apart of routine ward orientation The development of clinical practice guidelines for the treatment of anemia in chronic kidney disease has been instrumental in identifying and reducing variations in the use of erythropoiesis-stimulating agents and iron replacement . Challenges to the effectiveness and safety of recommendations made in these guidelines were magnified when recent clinical trials showed no benefit or harm with respect to cardiovascular outcomes in subjects r and omized to higher target hemoglobin levels . To address these concerns , Kidney Disease : Improving Global Outcomes ( KDIGO ) convened an international conference to examine the problems and shortcomings of existing anemia guidelines , which are a prime example of duplication of efforts to derive recommendations from a limited evidence base . The meeting was attended by representatives of the major guideline developing organizations , who agreed to avoid future duplicative efforts and to save re sources in generating a common evidence report , whose recommendations could then be prioritized and implemented locally . This is a report to the international nephrology community of the recommendations for and timeline of the next anemia guidelines . It has been review ed by the conference participants and approved as a position statement by the KDIGO Board of Directors BACKGROUND Although many catheter-related bloodstream infections ( CRBSIs ) are preventable , measures to reduce these infections are not uniformly implemented . OBJECTIVE To up date an existing evidence d-based guideline that promotes strategies to prevent CRBSIs . DATA SOURCES The MEDLINE data base , conference proceedings , and bibliographies of review articles and book chapters were search ed for relevant articles . STUDIES INCLUDED Laboratory-based studies , controlled clinical trials , prospect i ve interventional trials , and epidemiologic investigations . OUTCOME MEASURES Reduction in CRBSI , catheter colonization , or catheter-related infection . SYNTHESIS The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters ; maximal sterile barrier pre caution s during central venous catheter insertion ; use of a 2 % chlorhexidine preparation for skin antisepsis ; no routine replacement of central venous catheters for prevention of infection ; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies ( ie , education and training , maximal sterile barrier pre caution s , and 2 % chlorhexidine for skin antisepsis ) . CONCLUSION Successful implementation of these evidence -based interventions can reduce the risk for serious catheter-related infection Evidence in support of the neuroprotective effects of flavonoids has increased significantly in recent years , although to date much of this evidence has emerged from animal rather than human studies . Nonetheless , with a view to making recommendations for future good practice , we review 15 existing human dietary intervention studies that have examined the effects of particular types of flavonoid on cognitive performance . The studies employed a total of 55 different cognitive tests covering a broad range of cognitive domains . Most studies incorporated at least one measure of executive function/working memory , with nine reporting significant improvements in performance as a function of flavonoid supplementation compared to a control group . However , some domains were overlooked completely ( e.g. implicit memory , prospect i ve memory ) , and for the most part there was little consistency in terms of the particular cognitive tests used making across study comparisons difficult . Furthermore , there was some confusion concerning what aspects of cognitive function particular tests were actually measuring . Overall , while initial results are encouraging , future studies need to pay careful attention when selecting cognitive measures , especially in terms of ensuring that tasks are actually sensitive enough to detect treatment effects
Serious adverse events attributable to vitamin D supplementation were rare across all studies .
On the basis of studies review ed to date , the strongest evidence supports further research into adjunctive vitamin D therapy for tuberculosis , influenza , and viral upper respiratory tract illnesses .
OBJECTIVE To review the existing human controlled intervention studies of vitamin D as adjunctive therapy in setting s of infection and provide recommendations for design and implementation of future studies in this field on the basis of the evidence review ed .