Journal of neurotrauma
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Journal of neurotrauma · Aug 2011
ReviewA grading system to evaluate objectively the strength of pre-clinical data of acute neuroprotective therapies for clinical translation in spinal cord injury.
The past three decades have seen an explosion of research interest in spinal cord injury (SCI) and the development of hundreds of potential therapies that have demonstrated some promise in pre-clinical experimental animal models. A growing number of these treatments are seeking to be translated into human clinical trials. Conducting such a clinical trial, however, is extremely costly, not only for the time and money required to execute it, but also for the limited resources that will then no longer be available to evaluate other promising therapies. ⋯ A modified Delphi consensus-building exercise was then conducted with experts in pre-clinical SCI research to refine the criteria and decide upon how to score them. Finally, the grading system was applied to a series of potential neuroprotective treatments for acute SCI. This represents a systematic approach to developing an objective method of evaluating the extent to which the pre-clinical literature supports the translation of a particular experimental treatment into human trials.
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Journal of neurotrauma · Aug 2011
ReviewA systematic review of non-invasive pharmacologic neuroprotective treatments for acute spinal cord injury.
An increasing number of therapies for spinal cord injury (SCI) are emerging from the laboratory and seeking translation into human clinical trials. Many of these are administered as soon as possible after injury with the hope of attenuating secondary damage and maximizing the extent of spared neurologic tissue. In this article, we systematically review the available pre-clinical research on such neuroprotective therapies that are administered in a non-invasive manner for acute SCI. ⋯ Using these criteria, 122 studies were identified and reviewed in detail. Wide variations exist in the animal species, injury models, and experimental designs reported in the pre-clinical literature on the therapies reviewed. The review highlights the extent of investigation that has occurred in these specific therapies, and points out gaps in our knowledge that would be potentially valuable prior to human translation.
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Journal of neurotrauma · Aug 2011
ReviewAssessment of disability in patients with acute traumatic spinal cord injury: a systematic review of the literature.
Given the importance of accurately and reliably assessing disability in future clinical trials, which will test therapeutic strategies in acute spinal cord injury (SCI), we sought to appraise comprehensively studies that focused on the psychometric properties (i.e., reliability, validity, and responsiveness) of all previously used outcome measures in the SCI population. The search strategy included Medline, CINAHL, EMBASE, and Cochrane databases. Two reviewers independently assessed each study regarding eligibility, level of evidence (using Sackett's criteria), and quality. ⋯ Based on our results of quality assessment, the SCIM has the most appropriate performance regarding the instrument's psychometric properties. Nonetheless, further investigations are required to confirm the adequate performance of the SCIM as a comprehensive measure of functional recovery in patients with SCI in rehabilitative care. The expert panel of the Spinal Cord Injury Solutions Network (SCISN) that participated in the modified Delphi process endorsed these conclusions.
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Journal of neurotrauma · Aug 2011
A series of systematic reviews on the treatment of acute spinal cord injury: a foundation for best medical practice.
The treatment of acute spinal cord injury (SCI) is a multidisciplinary effort that spans from the time of injury through to an acute care center, and in some cases the remainder of the individual's life. Recovery from SCI depends on the care received at each point along this spectrum in time. ⋯ This article introduces the series of systematic reviews, summarizes the most notable findings, and gives an overview of the questions asked in each review and the evidence-based recommendations for care. Some of the most important recommendations are as follows: (1) Patients should be immobilized before transport to a hospital using a cervical collar, head immobilization, and a spinal board; (2) MRI is strongly recommended for the prognostication of acute SCI; (3) early surgical intervention (from 8-24 h) should be considered following acute traumatic SCI; (4) SCI patients are at significant risk of cardiovascular and respiratory problems and management should proactively anticipate these potential complications; and (5) outcomes can be improved by management in specialized centers with access to intensive care.
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Journal of neurotrauma · Aug 2011
ReviewAcute management of nutritional demands after spinal cord injury.
A systematic review of the literature was performed to address pertinent clinical questions regarding nutritional management in the setting of acute spinal cord injury (SCI). Specific metabolic challenges are present following spinal cord injury. ⋯ Enteral feeding is the optimal route following SCI. When oral feeding is not possible, nasogastric, followed by nasojejunal, then by percutaneous endoscopic gastrostomy, if necessary, is suggested.