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8      content="An interactive and up-to-date summary of all trials on zinc lozenges for the common cold."
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10
11    <meta
12      property="og:title"
13      content="Zinc lozenges for the common cold: a living review"
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15    <meta
16      property="og:description"
17      content="An interactive and up-to-date summary of all trials on zinc lozenges for the common cold."
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30    <link href="zinc.css" rel="stylesheet" />
31
32    <title>Zinc lozenges for the common cold: a living review - TJCX</title>
33  </head>
34  <body
35    class="bg-light"
36    data-bs-spy="scroll"
37    data-bs-target="#navbar"
38    data-bs-offset="50"
39  >
40    <div class="container">
41      <nav
42        id="navbar"
43        class="border-bottom border-1 navbar sticky-top navbar-expand-lg navbar-light bg-light"
44      >
45        <div class="container-fluid">
46          <a class="navbar-brand" href="#">Zinc for colds</a>
47          <button
48            class="navbar-toggler"
49            type="button"
50            data-bs-toggle="collapse"
51            data-bs-target="#navbarTogglerDemo02"
52            aria-controls="navbarTogglerDemo02"
53            aria-expanded="false"
54            aria-label="Toggle navigation"
55          >
56            <span class="navbar-toggler-icon"></span>
57          </button>
58          <div class="collapse navbar-collapse" id="navbarTogglerDemo02">
59            <ul class="navbar-nav me-auto mb-2 mb-lg-0">
60              <li class="nav-item">
61                <a class="nav-link active" aria-current="page" href="#summary"
62                  >Summary</a
63                >
64              </li>
65              <li class="nav-item">
66                <a class="nav-link" href="#explainer">What is this?</a>
67              </li>
68              <li class="nav-item">
69                <a class="nav-link" href="#forest">Forest plot</a>
70              </li>
71              <li class="nav-item">
72                <a class="nav-link" href="#search-strategy">Search strategy</a>
73              </li>
74              <li class="nav-item">
75                <a class="nav-link" href="#funnel-plot">Funnel plot</a>
76              </li>
77            </ul>
78          </div>
79        </div>
80      </nav>
81      <a class="anchor" id="summary"></a>
82      <div id="leader">
83        <h1 class="display-4 text-center mb-4">
84          According to
85          <strong class="text-decoration-underline fw-bold"
86            ><span id="study-number">17</span> selected studies</strong
87          >, there's a<span id="stupid-n"></span>
88          <strong
89            id="is-significant"
90            class="text-success text-decoration-underline fw-bold"
91            >significant chance</strong
92          >
93          that zinc lozenges reduce cold durations by
94          <strong class="text-decoration-underline fw-bold"
95            ><span id="pct-reduction">17</span>%</strong
96          >.
97        </h1>
98        <p class="mt-5 text-center text-muted">
99          👇 See how changing the included studies changes this result.
100        </p>
101      </div>
102      <hr class="my-5" />
103      <a id="explainer" class="anchor"></a>
104      <h3 class="mt-4">What is this?</h3>
105      <div class="row mb-3">
106        <div class="col-md-6">
107          <p>
108            I explain it more fully in <a href="#">my blog post</a>, but this
109            page is an experiment to see how we can improve medical information
110            on the internet.
111          </p>
112          <p>
113            I believe that good medical communication is
114            <strong>quantitative</strong>, <strong>exhaustive</strong>, and
115            <strong>accessible</strong>—this page strives as much as possible to
116            be all three!
117          </p>
118        </div>
119        <div class="col-md-6">
120          <div class="card shadow-sm border-0">
121            <div class="card-body">
122              <h5 class="card-text">💡 Tips</h5>
123              <ul>
124                <li>
125                  <strong>It's interactive!</strong> Choose which trials you'd
126                  like to include in your analysis (based on trial design,
127                  dosage, zinc formulation, etc.).
128                </li>
129                <li>
130                  <strong>Compare with published reviews.</strong> Click the
131                  column headers to se which trials were included in
132                  peer-reviewed meta-analyses. It's interesting to see
133                  <em>why</em> they got different results!
134                </li>
135                <li>
136                  <strong>The URL is shareable.</strong> Once you've selected
137                  the trials you like, you can share the URL and others will be
138                  able to see your selections.
139                </li>
140                <li>
141                  <strong>I want feedback!</strong> Hate it? Really want to give
142                  me a piece of your mind? Reach out via email
143                  (<a href="mailto:[email protected]">[email protected]</a>) or Twitter (<a href="https://twitter.com/tomjcleveland">@tomjcleveland</a>).
144                </li>
145              </ul>
146            </div>
147          </div>
148        </div>
149      </div>
150
151      <hr class="my-5" />
152      <a id="forest" class="anchor"></a>
153      <h3 class="mt-4">Forest plot</h3>
154      <div class="row mb-3">
155        <div class="col-md-6">
156          <p>
157            Welcome to the forest plot! Each row represents a (randomized,
158            controlled) clinical trial, and the 𝚫 column tells you the percent
159            change in cold duration between the zinc group and the placebo group
160            for that trial (negative numbers mean the zinc group had shorter
161            colds).
162          </p>
163          <p>
164            The middle columns show which trials were included in the existing
165            systematic reviews on zinc lozenges. Try clicking on the headers to
166            see their results!
167          </p>
168        </div>
169      </div>
170      <p class="mt-4 text-end">
171        <small class="text-muted"
172          >Last updated <span class="last-updated">???</span></small
173        >
174      </p>
175      <div class="table-responsive">
176        <table class="table table-hover table-sm">
177          <thead>
178            <tr>
179              <th scope="col">
180                <button id="select-all" class="ps-0 btn btn-link">
181                  Select all
182                </button>
183              </th>
184              <th scope="col">Trial</th>
185              <th scope="col">
186                <button
187                  class="btn btn-sm btn-danger review-btn"
188                  id="jackson_1997"
189                >
190                  Jackson 1997
191                </button>
192              </th>
193              <th scope="col">
194                <button
195                  class="btn btn-sm btn-danger review-btn"
196                  id="jackson_2000"
197                >
198                  Jackson 2000
199                </button>
200              </th>
201              <th scope="col">
202                <button
203                  class="btn btn-sm btn-success review-btn"
204                  id="hemila_2011"
205                >
206                  Hemilä 2011
207                </button>
208              </th>
209              <th scope="col">
210                <button
211                  class="btn btn-sm btn-success review-btn"
212                  id="science_2012"
213                >
214                  Science 2012
215                </button>
216              </th>
217              <th scope="col">
218                <button
219                  class="btn btn-sm btn-success review-btn"
220                  id="hemila_2017"
221                >
222                  Hemilä 2017
223                </button>
224              </th>
225              <th scope="col">𝚫</th>
226              <th scope="col">95% CI</th>
227              <th scope="col">Plot</th>
228            </tr>
229          </thead>
230          <tbody id="tbody"></tbody>
231        </table>
232      </div>
233      <div class="row mb-3">
234        <label for="analysis-select" class="col-sm-2 col-form-label"
235          >Pooling method:
236        </label>
237        <div class="col-sm-10">
238          <select class="form-select form-select-sm my-0" id="analysis-select">
239            <option value="fixed">Fixed effects, inverse variance</option>
240            <option value="random" selected>
241              Random effects, inverse variance
242            </option>
243          </select>
244        </div>
245      </div>
246
247      <hr class="my-5" />
248
249      <a id="search-strategy" class="anchor"></a>
250      <h3>Search strategy and included trials</h3>
251      <div class="row">
252        <div class="col-md-6">
253          <p>
254            Every week I search the
255            <a
256              href="https://www.cochranelibrary.com/central/about-central"
257              target="_blank"
258              rel="noopener noreferer"
259              >Cochrane Central Register of Controlled Trials</a
260            >
261            (CENTRAL), which aggregates results from other popular databases
262            like
263            <a
264              href="https://www.ncbi.nlm.nih.gov/pubmed/"
265              target="_blank"
266              rel="noopener noreferer"
267              >PubMed</a
268            >,
269            <a
270              href="http://embase.com/"
271              target="_blank"
272              rel="noopener noreferer"
273              >Embase</a
274            >, and
275            <a
276              href="http://clinicaltrials.gov/"
277              target="_blank"
278              rel="noopener noreferer"
279              >ClinicalTrials.gov</a
280            >.
281          </p>
282          <p>
283            I then exclude the results that aren't relevant (see adjacent
284            panel). My screening criteria are intentionally lax—the point of
285            this page is to provide an exhaustive list of relevant data, and let
286            visitors decide which trials are worth looking at.
287          </p>
288        </div>
289        <div class="col-md-6">
290          <div class="card shadow-sm border-0">
291            <div class="card-body pb-0">
292              <div
293                class="d-flex justify-content-between align-items-center mb-1"
294              >
295                <span class="fw-bold">Search terms</span>
296                <small class="text-muted"
297                  ><svg
298                    xmlns="http://www.w3.org/2000/svg"
299                    width="16"
300                    height="16"
301                    fill="currentColor"
302                    class="bi bi-clock"
303                    viewBox="0 0 16 16"
304                  >
305                    <path
306                      d="M8 3.5a.5.5 0 0 0-1 0V9a.5.5 0 0 0 .252.434l3.5 2a.5.5 0 0 0 .496-.868L8 8.71V3.5z"
307                    />
308                    <path
309                      d="M8 16A8 8 0 1 0 8 0a8 8 0 0 0 0 16zm7-8A7 7 0 1 1 1 8a7 7 0 0 1 14 0z"
310                    /></svg
311                  >&nbsp; <span class="last-updated"></span
312                ></small>
313              </div>
314              <div class="alert alert-primary d-flex justify-content-between">
315                <div>
316                  <code class="text-primary fw-bold">zinc AND cold</code>
317                </div>
318                <div
319                  class="d-flex justify-content-center align-items-center badge bg-primary"
320                >
321                  110 Trials
322                </div>
323              </div>
324              <div class="fw-bold">Inclusion criteria</div>
325            </div>
326            <ul class="list-group list-group-flush">
327              <li
328                class="list-group-item d-flex justify-content-between align-items-center"
329              >
330                <div>
331                  <div><small class="text-muted label">DESIGN</small></div>
332                  Randomized, controlled trial
333                </div>
334                <svg
335                  xmlns="http://www.w3.org/2000/svg"
336                  width="16"
337                  height="16"
338                  fill="currentColor"
339                  class="bi bi-check-lg"
340                  viewBox="0 0 16 16"
341                >
342                  <path
343                    d="M12.736 3.97a.733.733 0 0 1 1.047 0c.286.289.29.756.01 1.05L7.88 12.01a.733.733 0 0 1-1.065.02L3.217 8.384a.757.757 0 0 1 0-1.06.733.733 0 0 1 1.047 0l3.052 3.093 5.4-6.425a.247.247 0 0 1 .02-.022Z"
344                  />
345                </svg>
346              </li>
347              <li
348                class="list-group-item d-flex justify-content-between align-items-center"
349              >
350                <div>
351                  <div><small class="text-muted label">POPULATION</small></div>
352                  Humans with common cold
353                </div>
354                <svg
355                  xmlns="http://www.w3.org/2000/svg"
356                  width="16"
357                  height="16"
358                  fill="currentColor"
359                  class="bi bi-check-lg"
360                  viewBox="0 0 16 16"
361                >
362                  <path
363                    d="M12.736 3.97a.733.733 0 0 1 1.047 0c.286.289.29.756.01 1.05L7.88 12.01a.733.733 0 0 1-1.065.02L3.217 8.384a.757.757 0 0 1 0-1.06.733.733 0 0 1 1.047 0l3.052 3.093 5.4-6.425a.247.247 0 0 1 .02-.022Z"
364                  />
365                </svg>
366              </li>
367              <li
368                class="list-group-item d-flex justify-content-between align-items-center"
369              >
370                <div>
371                  <div>
372                    <small class="text-muted label">INTERVENTION</small>
373                  </div>
374                  Zinc lozenges (alone)
375                </div>
376                <svg
377                  xmlns="http://www.w3.org/2000/svg"
378                  width="16"
379                  height="16"
380                  fill="currentColor"
381                  class="bi bi-check-lg"
382                  viewBox="0 0 16 16"
383                >
384                  <path
385                    d="M12.736 3.97a.733.733 0 0 1 1.047 0c.286.289.29.756.01 1.05L7.88 12.01a.733.733 0 0 1-1.065.02L3.217 8.384a.757.757 0 0 1 0-1.06.733.733 0 0 1 1.047 0l3.052 3.093 5.4-6.425a.247.247 0 0 1 .02-.022Z"
386                  />
387                </svg>
388              </li>
389              <li
390                class="list-group-item d-flex justify-content-between align-items-center"
391              >
392                <div>
393                  <div>
394                    <small class="text-muted label">COMPARISON</small>
395                  </div>
396                  Placebo lozenges
397                </div>
398                <svg
399                  xmlns="http://www.w3.org/2000/svg"
400                  width="16"
401                  height="16"
402                  fill="currentColor"
403                  class="bi bi-check-lg"
404                  viewBox="0 0 16 16"
405                >
406                  <path
407                    d="M12.736 3.97a.733.733 0 0 1 1.047 0c.286.289.29.756.01 1.05L7.88 12.01a.733.733 0 0 1-1.065.02L3.217 8.384a.757.757 0 0 1 0-1.06.733.733 0 0 1 1.047 0l3.052 3.093 5.4-6.425a.247.247 0 0 1 .02-.022Z"
408                  />
409                </svg>
410              </li>
411              <li
412                class="list-group-item d-flex justify-content-between align-items-center"
413              >
414                <div>
415                  <div>
416                    <small class="text-muted label">OUTCOME</small>
417                  </div>
418                  Duration of cold symptoms
419                </div>
420                <svg
421                  xmlns="http://www.w3.org/2000/svg"
422                  width="16"
423                  height="16"
424                  fill="currentColor"
425                  class="bi bi-check-lg"
426                  viewBox="0 0 16 16"
427                >
428                  <path
429                    d="M12.736 3.97a.733.733 0 0 1 1.047 0c.286.289.29.756.01 1.05L7.88 12.01a.733.733 0 0 1-1.065.02L3.217 8.384a.757.757 0 0 1 0-1.06.733.733 0 0 1 1.047 0l3.052 3.093 5.4-6.425a.247.247 0 0 1 .02-.022Z"
430                  />
431                </svg>
432              </li>
433            </ul>
434            <div class="card-body">
435              <div
436                class="alert alert-success d-flex justify-content-between align-items-center"
437              >
438                <div class="fw-bold">Total included</div>
439                <span class="badge bg-success">17 trials</span>
440              </div>
441            </div>
442          </div>
443        </div>
444      </div>
445
446      <hr class="my-5" />
447
448      <a id="funnel-plot" class="anchor"></a>
449      <h3>Funnel plot</h3>
450      <div class="row">
451        <div class="col-md-6">
452          <p>
453            <a
454              target="_blank"
455              rel="noopener noreferer"
456              href="https://www.bmj.com/content/343/bmj.d4002"
457              >Funnel plots</a
458            >
459            are used to gauge whether the results of candidate reviews are
460            distributed like we'd expect.
461          </p>
462          <p>
463            For a given set of trials, we'd expect large trials to have outcomes
464            that cluster close to the true effect size (the top of the funnel),
465            while smaller trials would have outcomes that are more widely
466            distributed (the bottom of the funnel).
467          </p>
468          <p>
469            In theory, 95% of trial results should lie inside the funnel. In
470            addition, these results should be distributed symmetrically on
471            either side of the pooled effect size (center line).
472          </p>
473        </div>
474        <div class="col-md-6">
475          <canvas id="funnel-plot-chart" width="400" height="200"></canvas>
476        </div>
477      </div>
478
479      <hr class="my-5" />
480
481      <!-- Previously had a comments section, but on second thought...no. -->
482      <!-- <a id="discussion" class="anchor"></a>
483      <div class="card mt-5">
484        <div class="card-body">
485          <h3 class="card-text">Discussion</h3>
486          <p>
487            This discussion is specific to a
488            <strong
489              ><span id="analysis-type" class="fw-bold"></span>-effects</strong
490            >
491            analysis of these trials: <span id="trial-badges"></span>
492          </p>
493          <div class="mt-5" id="disqus_thread"></div>
494        </div>
495      </div>
496
497      <hr class="my-5" /> -->
498
499      <h3 class="text-center">
500        Think we're missing a relevant trial or an published review?
501      </h3>
502      <div class="my-5 d-flex justify-content-center align-items-center">
503        <a
504          target="_blank"
505          rel="noopener noreferer"
506          href="mailto:[email protected]"
507          class="btn btn-primary btn-lg"
508        >
509          Let us know
510        </a>
511      </div>
512
513      <footer class="my-5 text-center">
514        <small>Made by <a href="/">TJCX</a>.</small>
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