Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants’ reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants’ quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.     

Barium and strontium leaching from aged glass particle/resin matrix dental composites.

OBJECTIVES: This study characterizes the loss of Ba and Sr from glass particle/resin-matrix dental composites during simulated aging. METHODS: X-ray wavelength dispersive spectrometry and secondary ion mass spectrometry were used to analyze the Ba and Sr content from the surfaces of three commercial dental composites after aging for 4 and 8 months in humid air, artificial saliva, water, and 50% ethanol. RESULTS: Aging in artificial saliva caused the greatest leaching of Ba or Sr for all the specimens, compared with either lesser or no leaching for aging in ethanol and water. Differences in leaching were observed between the different composites. Composites aged in artificial saliva also picked up elements in the saliva solution and displayed crystallite formation on the surface. Samples aged in ethanol displayed cracking which was not observed for water or artificial saliva. SIGNIFICANCE: Dental composites display ion leaching from their surfaces over periods of four to eight months. Three mechanisms are proposed to explain differences in leaching for the various composites and aging solutions. Surface mineralization is also proposed to occur as a self-repair mechanism in artificial saliva.     

Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health.

The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p<0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.