OBJECTIVE To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic... more OBJECTIVE To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). DATA SOURCES MEDLINE (OvidSP), PubMed (NLM), EMBASE (Embase.com), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). DATA EXTRACTION Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. DATA SYNTHESIS In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. CONCLUSION Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.
Proceedings of the National Academy of Sciences, 1993
The common acute lymphoblastic leukemia antigen [(CALLA) CD10, neutral endopeptidase 24.11 (NEP)]... more The common acute lymphoblastic leukemia antigen [(CALLA) CD10, neutral endopeptidase 24.11 (NEP)] is a cell-surface zinc metalloprotease expressed by a subpopulation of early murine B-lymphoid progenitors and by bone marrow stromal cells that support the earliest stages of B lymphopoiesis. In previous in vitro studies in which uncommitted murine hematopoietic progenitors plated on a stromal cell layer differentiate into immature B cells, the inhibition of CD10/NEP increased early lymphoid colony numbers. To further characterize CD10/NEP function during lymphoid ontogeny in vivo, we utilized a Ly5 congenic mouse model in which the lymphoid differentiation of uncommitted hematopoietic progenitors from Ly5.1 donors was followed in sublethally irradiated Ly5.2 recipients treated with a specific long-acting CD10/NEP inhibitor (N-[L-(1-carboxy-2-phenyl)ethyl]-L-phenylalanyl-beta- alanine (SCH32615)). The expression of Ly5.1, B220, and surface IgM (sIgM) was utilized to characterize donor-...
A successful regional trauma care system should concentrate severely injured patients within trau... more A successful regional trauma care system should concentrate severely injured patients within trauma centers, and should improve severity-adjusted outcomes. We compared injured patients' outcomes in New York City's level 1 trauma centers and nontrauma centers. We analyzed 1998-2000 New York Statewide Planning and Cooperative Research System (SPARCS) data for 103,725 adult discharges from 70 New York City hospitals (15 level I trauma centers), using ICD-9CM codes 800-950. Their 227 DRG's were aggregated into 7 clinical injury classes. A severity index was extracted from each refined DRG, and deaths, age, and gender were analyzed. Regression analysis predicted death from age, gender, severity index, and trauma center discharge, with separate analyses of the three largest clinical classes, and estimated excess mortality because of trauma center discharge. Level 1 trauma centers discharged 48.2% of injured patients, with higher mean annual discharges per hospital (1,046 discharges per TC vs. 437 per NTC, p < 0.001). Trauma centers discharged more than half the central nervous system, general/gastrointestinal, cardiothoracic, and vascular injuries. Trauma center patients were 12.5 years younger than NTC patients (p < 0.0005), and were disproportionately men (64.7% TC vs. 47.2% NTC, p < 0.0005). For the entire patient cohort, and for central nervous system, orthopaedic and general/gastrointestinal injuries, severity, age, and gender adjusted mortality risk was significantly greater at trauma centers than nontrauma centers. New York City's trauma system concentrates injured patients in trauma centers on the basis of injury class rather than severity, but does not produce improved adjusted mortality outcomes for injured patients.
OBJECTIVE To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic... more OBJECTIVE To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). DATA SOURCES MEDLINE (OvidSP), PubMed (NLM), EMBASE (Embase.com), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). DATA EXTRACTION Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. DATA SYNTHESIS In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. CONCLUSION Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.
Proceedings of the National Academy of Sciences, 1993
The common acute lymphoblastic leukemia antigen [(CALLA) CD10, neutral endopeptidase 24.11 (NEP)]... more The common acute lymphoblastic leukemia antigen [(CALLA) CD10, neutral endopeptidase 24.11 (NEP)] is a cell-surface zinc metalloprotease expressed by a subpopulation of early murine B-lymphoid progenitors and by bone marrow stromal cells that support the earliest stages of B lymphopoiesis. In previous in vitro studies in which uncommitted murine hematopoietic progenitors plated on a stromal cell layer differentiate into immature B cells, the inhibition of CD10/NEP increased early lymphoid colony numbers. To further characterize CD10/NEP function during lymphoid ontogeny in vivo, we utilized a Ly5 congenic mouse model in which the lymphoid differentiation of uncommitted hematopoietic progenitors from Ly5.1 donors was followed in sublethally irradiated Ly5.2 recipients treated with a specific long-acting CD10/NEP inhibitor (N-[L-(1-carboxy-2-phenyl)ethyl]-L-phenylalanyl-beta- alanine (SCH32615)). The expression of Ly5.1, B220, and surface IgM (sIgM) was utilized to characterize donor-...
A successful regional trauma care system should concentrate severely injured patients within trau... more A successful regional trauma care system should concentrate severely injured patients within trauma centers, and should improve severity-adjusted outcomes. We compared injured patients' outcomes in New York City's level 1 trauma centers and nontrauma centers. We analyzed 1998-2000 New York Statewide Planning and Cooperative Research System (SPARCS) data for 103,725 adult discharges from 70 New York City hospitals (15 level I trauma centers), using ICD-9CM codes 800-950. Their 227 DRG's were aggregated into 7 clinical injury classes. A severity index was extracted from each refined DRG, and deaths, age, and gender were analyzed. Regression analysis predicted death from age, gender, severity index, and trauma center discharge, with separate analyses of the three largest clinical classes, and estimated excess mortality because of trauma center discharge. Level 1 trauma centers discharged 48.2% of injured patients, with higher mean annual discharges per hospital (1,046 discharges per TC vs. 437 per NTC, p < 0.001). Trauma centers discharged more than half the central nervous system, general/gastrointestinal, cardiothoracic, and vascular injuries. Trauma center patients were 12.5 years younger than NTC patients (p < 0.0005), and were disproportionately men (64.7% TC vs. 47.2% NTC, p < 0.0005). For the entire patient cohort, and for central nervous system, orthopaedic and general/gastrointestinal injuries, severity, age, and gender adjusted mortality risk was significantly greater at trauma centers than nontrauma centers. New York City's trauma system concentrates injured patients in trauma centers on the basis of injury class rather than severity, but does not produce improved adjusted mortality outcomes for injured patients.
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