Challenges of systematic reviewing integrative health care.

This article is based on an extensive review of integrative medicine (IM) and integrative health care (IHC). Since there is no general agreement of what constitutes IM/IHC, several major problems were identified that make the review of work in this field problematic. In applying the systematic review methodology, we found that many of those captured articles that used the term integrative medicine were in actuality referring to adjunctive, complementary, or supplemental medicine. The objective of this study was to apply a sensitivity analysis to demonstrate how the results of a systematic review of IM and IHC will differ according to what inclusion criteria is used based on the definition of IM/IHC. By analyzing 4 different scenarios, the authors show that, due to unclear usage of these terms, results vary dramatically, exposing an inconsistent literature base for this field

Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis

A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe

A Program Evaluation of an Academic Integrative Healthcare Center: Barriers to, and facilitators in, applying Integrative Medicine to Primary Care

A number of earlier studies have evaluated various aspects of Integrative Health Care (IHC). However, little is known about specific parameters of IHC integration in academic institutions. This dissertation presents the findings from a two-year program evaluation conducted at a university-based academic medical center and clinic for IHC. A major objective of the research was to identify perceived barriers and facilitators of IHC and address potential models of successful integration. The study employed a mixed-methods approach incorporating qualitative observations and interviews conducted with key-stakeholders, patients and health care providers. In addition, quantitative analyses incorporating demographic data and participants’ responses to a patient satisfaction scale were conducted. The majority of the themes from the literature and interviews include structural factors, especially external barriers for IHC (i.e., costs, insurance payment and regulations) and internal barriers (i.e., lack of profits, clinic or appointment waiting time). Whereas shared values, culture, and communication to foster trust, empathy and knowledge exchange are essential for actualizing IHC integration. In addition, collaborative, and team-based approaches that influence the design of the integration and can influence the evolutionary path of IHC. Although signs of integration were apparent, significant challenges still remained that prevented IHC providers from operating as academic hospital providers. An integrated interdisciplinary change strategy is needed that engages the IHC providers in mainstream transdisciplinary healthcare, education and research opportunities. Successful IHC integration will need to continue to addresses wider structural and political barriers

External validity and model validity: a conceptual approach for systematic review methodology. Evid Based Complement Altern Med

Background. Evidence rankings do not consider equally internal (IV), external (EV), and model validity (MV) for clinical studies including complementary and alternative medicine/integrative health care (CAM/IHC) research. This paper describe this model and offers an EV assessment tool (EVAT©) for weighing studies according to EV and MV in addition to IV. Methods. An abbreviated systematic review methodology was employed to search, assemble, and evaluate the literature that has been published on EV/MV criteria. Standard databases were searched for keywords relating to EV, MV, and bias-scoring from inception to Jan 2013. Tools identified and concepts described were pooled to assemble a robust tool for evaluating these quality criteria. Results. This study assembled a streamlined, objective tool to incorporate for the evaluation of quality of EV/MV research that is more sensitive to CAM/IHC research. Conclusion. Improved reporting on EV can help produce and provide information that will help guide policy makers, public health researchers, and other scientists in their selection, development, and improvement in their research-tested intervention. Overall, clinical studies with high EV have the potential to provide the most useful information about "real-world" consequences of health interventions. It is hoped that this novel tool which considers IV, EV, and MV on equal footing will better guide clinical decision making

Nerve Conduction Changes in Experimental Diabetes*

The problem of diabetic neuropathy has not been studied experimentally to the same extent as have other manifestations of diabetes mellitus. One reason may be that neurological symptoms have not been apparent in animals that have been made diabetic. Lukens (2) stated in his review of al-loxan diabetes that nervous system lesions had not been observed. Pancreatectomized animals have been prepared in large numbers, but no men-tion has been made of neurological complications. Minor neurological deficit, particularly of the sensory functions, could easily have been over-looked (3). The data presented below demonstrate a de-crease in conduction velocity under in vitro con-ditions in the peripheral nerves from alloxanized rats but only if these rats also become diabetic. Because of the toxic effects of alloxan, a group of pancreatectomized rats was also prepared and showed essentially the same slowing of conduction. Treatment with insulin of the animals before the experiment or addition of insulin in vitro did not restore conduction velocity to normal values. Methods Sprague-Dawley rats 1 were used. The rats weighed between 300 and 450 g and were over 5 months old. The animals were injected with alloxan monohydrate in citrate buffer in amounts of 40 to 50 mg per kg (4). Litter mates were used as controls. Intravenous in-jection method was used, and injections were given after 18 hours of starvation. Some of the injected animals did not become diabetic. These animals were used a

Review Article How to Assess the External Validity and Model Validity of Therapeutic Trials: A Conceptual Approach to Systematic Review Methodology

Copyright © 2014 R. Khorsan and C. Crawford.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in anymedium, provided the originalwork is properly cited. Background. Evidence rankings do not consider equally internal (IV), external (EV), and model validity (MV) for clinical studies including complementary and alternative medicine/integrative medicine (CAM/IM) research. This paper describe this model and offers an EV assessment tool (EVAT©) for weighing studies according to EV and MV in addition to IV. Methods. An abbreviated systematic review methodology was employed to search, assemble, and evaluate the literature that has been published on EV/MV criteria. Standard databases were searched for keywords relating to EV, MV, and bias-scoring from inception to Jan 2013. Tools identified and concepts described were pooled to assemble a robust tool for evaluating these quality criteria. Results. This study assembled a streamlined, objective tool to incorporate for the evaluation of quality of EV/MV research that is more sensitive to CAM/IM research. Conclusion. Improved reporting on EV can help produce and provide information that will help guide policy makers, public health researchers, and other scientists in their selection, development, and improvement in their research-tested intervention. Overall, clinical studies with high EV have the potential to provide the most useful information about “real-world” consequences of health interventions. It is hoped that this novel tool which considers IV, EV, and MV on equal footing will better guide clinical decision making. 1