***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Disease-specific st and ards for directing patient management are becoming increasingly important . These st and ards , however , are often not followed because they are not sufficiently integrated into the clinical care setting . In this study we describe the development and evaluation of a Computer-Assisted Management Protocol ( CAMP ) of care guidelines for diabetes mellitus . While other studies have shown improved compliance with rule-based reminders , the CAMP customizes disease-specific care guidelines to individual patients over time . We evaluated the effect of the CAMP on compliance with guidelines in a prospect i ve , r and omized controlled study . The study was performed at a family practice clinic where much of the patient record is maintained electronically on The Medical Record ( TMR ) . The management protocol was developed from st and ards published by the American Diabetes Association . Fifty-eight providers were r and omized to either receive or not receive the CAMP for diabetes . Compliance with st and ards  was assessed by chart audits of all encounters with diabetic patients during the study interval . The following conclusion was made : the Computer-Assisted Management Protocol result ed in a statistically significant improvement in compliance with diabetes care st and ards BACKGROUND The causes of chronic cough in China and its relations with geography , seasonality , age , and sex are largely uncertain . METHODS A prospect i ve , multicenter survey was conducted to evaluate patients with chronic cough across five regions in China by using a modified diagnostic algorithm . The effects of geography , seasonality , age , and sex on spectrum of chronic cough were also investigated . RESULTS The current study evaluated 704 adult patients , including 315 men ( 44.7 % ) and 389 women ( 55.3 % ) . The causes of  chronic cough  were determined in 640 subjects ( 90.9 % ) . Common causes included cough variant asthma ( CVA ) ( 32.6 % ) , upper airway cough syndrome ( UACS ) ( 18.6 % ) , eosinophilic bronchitis ( EB ) ( 17.2 % ) , and atopic cough ( AC ) ( 13.2 % ) . Collectively , these four causes accounted for 75.2 % to 87.6 % across five different regions without significant difference ( P > .05 ) , although there was variation on single causes . Gastroesophageal reflux-related cough was identified in 4.6 % of causes . Seasonality , sex , and age were not associated with the spectrum of chronic cough ( all P > .05 ) . CONCLUSION CVA , UACS , EB , and AC were common causes of chronic cough in China . Geography , seasonality , age , and sex were not associated with the spectrum of chronic cough BACKGROUND We up date d the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome . METHODS Two population , intervention , comparison , outcome ( PICO ) questions were addressed by systematic review : ( 1 ) Can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough ? and ( 2 ) Are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux ? RESULTS We found no high- quality studies pertinent to either question . From available r and omized controlled trials ( RCTs ) addressing question # 1 , we concluded that ( 1 ) there was a strong placebo effect for cough improvement ; ( 2 ) studies including diet modification and weight loss had better cough outcomes ; ( 3 ) although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome , proton pump inhibitors ( PPIs ) demonstrated no benefit when used in isolation ; and ( 4 ) because of potential carryover effect , crossover studies using PPIs should be avoided . For question # 2 , we concluded from the available observational trials that ( 1 ) an algorithmic approach to management resolved chronic cough in 82 % to 100 % of instances ; ( 2 ) cough variant asthma and upper airway cough syndrome ( UACS ) ( previously referred to as postnasal drip syndrome ) from rhinosinus conditions were the most commonly reported causes ; and ( 3 ) the reported prevalence of reflux-cough syndrome varied widely . CONCLUSIONS The panelists ( 1 ) endorsed the use of a diagnostic/therapeutic algorithm addressing causes of common cough , including symptomatic reflux ; ( 2 ) advised that although lifestyle modifications and weight reduction may be beneficial in suspected reflux-cough syndrome , PPIs demonstrated no benefit when used in isolation ; and ( 3 ) suggested that physiological testing be reserved for refractory patients being considered for antireflux surgery or for those in whom there is strong clinical suspicion warranting diagnostic testing BACKGROUND It is not clear whether careful history taking with detailed question ing of the characteristics of cough is diagnostically useful . OBJECTIVE To determine if the character , timing , or complications of chronic cough were helpful in determining its cause . METHODS A prospect i ve , descriptive study of consecutive , unselected , immunocompetent patients referred to our university outpatient clinic because of chronic cough .  All patients were evaluated by a previously published and vali date d systematic diagnostic protocol , a self-administered question naire , and by observing the character of involuntary and voluntary coughs . The final diagnosis of the cause of cough required fulfillment of pretreatment criteria plus having cough disappear or substantially improve as a complaint with specific therapy . RESULTS Eighty-eight patients met inclusion criteria and were fully evaluated . The mean + /- SD age was 53.1 + /- 16 years ( range , 15 - 83 years ) and 24 were males and 64 were females with a mean + /- SD history of cough for 6.6 + /- 9.8 years ( range , 1 month-44 years ) . The cause of chronic cough was established in 86 ( 98 % ) of 88 patients . Eighty-one ( 92 % ) of 88 had cough disappear as a complaint . Cough was as a result of a single cause in 39 % and multiple causes in 59 % . Gastroesophageal reflux disease , postnasal drip syndrome , and asthma were the 3 most common causes of chronic cough and accounted for 90 % of diagnoses . Gastroesophageal reflux disease , postnasal drip syndrome , and asthma were again found to be the 3 most common causes of chronic cough irrespective of patient estimated quantity of daily sputum production . These 3 conditions caused chronic cough in 99.4 % of patients with the following characteristics : ( 1 ) nonsmoker ; ( 2 ) not receiving an angiotensin-converting enzyme inhibitor drug ; and ( 3 ) normal or nearly normal and stable chest radiograph . With respect to the spectrum and frequency of diagnoses and their interrelationships with the character , timing , and complications of cough , multiple stepwise linear regression analysis showed that none of the variability of the character , timing , or complications of cough could be explained by any specific diagnosis . CONCLUSIONS A carefully taken history with detailed question ing of the character , timing , and complications of chronic cough is not likely to be useful in diagnosing the cause of cough . The cause can be determined and successfully treated with specific therapy in the greatest majority of cases . Chronic cough is often caused by multiple , simultaneously contributing causes . Postnasal drip syndrome , asthma , and gastroesophageal reflux disease remain the 3 most common causes of chronic cough and there is a clinical profile that nearly always predicts their presence in immunocompetent patients Chronic cough with established diagnostic protocol s has been well described in secondary and tertiary centres . Little information is available about adult patients to a general respiratory clinic where no such protocol s exist . The objective of this study is to determine clinical characteristics , laboratory findings , diagnostic spectrum and outcomes of specific therapy  in adult patients with chronic cough in a general respiratory clinic . In this prospect i ve , longitudinal , descriptive study for patients with chronic cough defined as more than 8 weeks , we studied , according to a question naire , chest radiography , spirometry and reversibility , methacholine challenge and other measures . Treatment was prescribed on the basis of diagnosis informed by investigation results .We evaluated 147 patients ( 102 females ) of a mean age of 48 years and complaining of cough an average of 24 weeks . On the basis of a successful response to treatment , the causes of cough were determined in 92 % and the frequencies were asthma in 39 % , COPD in 11 % , chronic upper airway cough syndrome ( CUACS ) in 9 % , gastro-oesophageal reflux disease ( GERD ) in 9 % and no diagnosis in 8 % . Cough was due to one condition in 82 % . Our treatment success rate was 92 % . The most frequent causes of chronic cough ( asthma , COPD , CUACS and GERD ) could be determined in a general respiratory clinic with a sequential approach . The frequencies are different from those in a tertiary cough clinic , but outcome of specific therapy is successful in our patients HYPOTHESIS Trauma from chronic coughing produces airway inflammation similar to diseases causing cough . DESIGN Prospect i ve , cross-sectional , controlled , clinicopathologic correlation study in four groups : group 1 , cough from intrapulmonary diseases ; group 2 , cough from extrapulmonary diseases ; group 3 , cough that was unexplained ; and group 4 , nonsmoking , asymptomatic control subjects . METHODS Patients with chronic cough underwent a st and ardized workup including endobronchial biopsies before treatment . Causes were determined by a favorable response to therapy . Bronchial biopsy sample s from control subjects were obtained from surgical specimens . RESULTS There were 24 adult subjects ( 13 women and 11 men ) with mean cough duration of 8.6 + /- 7.4 years ( + /- SD ) . Thirteen patients had cough due to a specific disease : intrapulmonary diseases in 5 patients , and extrapulmonary diseases in 8 patients . Eleven patients had unexplained cough . Compared to control subjects , there was minimal-to-moderate chronic inflammation in all coughers ( p < or = 0.0004 ) , in group 1 ( p < or = 0.039 ) , group 2 ( p = 0.061 ) , and group 3 ( p < or = 0.025 ) diseases that were not correlated with cough duration . There was no difference in type of inflammation , cough duration , or smoking history between groups , nor were there histologic differences between subjects with explained causes of cough compared with unexplained cough . CONCLUSIONS Our findings suggest that airway inflammation associated with chronic cough , assessed on morphologic appearance and inflammatory cell counting in hematoxylin-eosin-prepared sample s , may be due to the trauma of coughing , and the inflammation may be similar to that seen with diseases putatively thought to cause chronic cough . Investigators must be cautious when attributing pathogenic importance to observed inflammatory changes in airways of coughing subjects OBJECTIVES We assessed the reliability and validity of two measures of change , one retrospective ( the Global Rating of Change Scale [ GRCS ] ) and one prospect i ve ( the Punum Ladder ) , and the relative utility of the two methods of assessing change and establishing the minimal important difference ( MID ) of the Cough Quality of Life Question naire ( CQLQ ) , a reliable and valid cough-specific quality -of-life ( QoL ) instrument . STUDY DESIGN AND SETTING A prospect i ve , longitudinal study assessing the change in cough-related QoL over 6 months in participants with chronic cough was carried out in a tertiary care cough clinic . Before seeing a physician , subjects completed eight Punum Ladders and the CQLQ . At 1 and 6 months , eight Punum Ladders , the CQLQ , and seven GRCSs were completed . Punum Ladders and GRCSs were psychometrically tested , and MIDs were calculated . RESULTS Reliability and validity of GRCSs and Punum Ladders were acceptable . However , closer analysis of the relation between change scores and  CQLQ pretest and posttest scores showed that the GRCS was only related to patient 's present state , whereas the Punum Ladder was associated with both initial and present states . This compromises the validity of the GRCS . Crosstab comparisons revealed that GRCS ratings made more liberal estimates of change in the CQLQ than the Punum Ladder ; this is reflected in their respective MIDs ( 10.58+/-10.63 vs. 21.89+/-15.38 ) . CONCLUSION The prospect i ve Punum Ladder is likely to be more useful , because it reflects the actual change in QoL over time in a less biased and more accurate way than the retrospective GRCS 
    Output:
    
Conclusions Although the quality of evidence was low , the published literature since 2006 suggests that CHEST 's 2006 Cough Guidelines and management algorithms for acute , subacute , and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe .