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Comorbid Insomnia along with Osa (COMISA): Present Aspects involving Affected person Management.
70; 95%CI 0.66-0.75). Additionally, intensive periodontal treatment (for example, flap surgery) could lower the pneumonia risk by about 66% compared to no periodontal treatment (adjusted HR 0.34; 95%CI 0.19-0.62).Conclusions Conducting periodontal treatment is associated with a reduced risk of pneumonia. When looked at from a healthcare delivery perspective, this nationwide study can present further evidence that providing patients with thorough oral and dental examinations, and following periodontal treatment if necessary, might reduce the incidence of subsequent pneumonia events.Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Medline (Ovid), Embase, Web of Science, Latin American & Caribbean Health Sciences Literature (LILACS) and SIGLE database.Study selection Randomised controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, case-control studies and cross-sectional studies.Data extraction and synthesis Two reviewers screened papers independently and assessed the risk of bias. Data categorised based on the study design. The primary outcome was the odds ratio (OR)/relative risk (RR) and confidence interval (CI) for hypertension in individuals with periodontitis.Results Diagnoses of moderate-to-severe (OR = 1.22; 95% CI 1.10-1.35) and severe periodontitis (OR = 1.49; 95% CI 1.09-2.05) were associated with hypertension. Diagnosis of periodontitis increased odds of occurring hypertension (OR = 1.68; 95% CI 0.85-3.35). Patients with periodontitis exhibited higher mean systolic (weighted mean difference [WMD] of 4.49 mmHg; 95% CI 2.88-6.11) and diastolic blood pressures (2.03 mmHg; 95% CI 1.25-2.81). There was inconclusive evidence that periodontal therapy reduces blood pressure (3-12.5 mmHg of systolic and 0-10 mmHg of diastolic blood pressures).Conclusions Periodontitis could be associated with increased risk of hypertension. Further, the management of periodontitis could impact on the management of hypertension. However, there is still a need for more high-quality research.Data sources The authors searched Medline via PubMed, Scopus, Web of Science, the Cochrane Library and ClinicalTrials.gov for published and unpublished clinical trials. Only randomised clinical trials, with either a parallel or crossover design, reporting the tooth sensitivity of participants undergoing in-office dental bleaching and comparing pain frequency and severity with oral premedication of a non-steroidal or other anti-inflammatory drug compared with a placebo were used in the review. Studies that evaluated the topical administration of drugs or desensitising agents were not reviewed.Study selection In total,5,050 randomised clinical studies were screened and 11 studies were included in the various meta-analyses. Nine studies examined the effect of pre-emptive analgesics on the risk of sensitivity and ten studies evaluated the effect of drugs on the severity of sensitivity; seven of these studies were assessed as having a low risk of bias.Data extraction and synthesis This systematic review and meta-as in all randomised controlled trials reviewed. Based on a visual inspection of the funnel plots of all outcomes, the authors concluded that there was no publication bias.Conclusions The data did not support the pre-emptive use of anti-inflammatory drugs in preventing or reducing the intensity of pain caused by in-office tooth bleaching.Design A cost-effectiveness analysis of caries management in primary molars using Hall technique (HT) versus conventional restoration (CR) from a pre-existing dataset from a randomised split-mouth trial, within primary care in Scotland, with a five-year follow-up.Case selection Computer-generated block randomisation was used to match asymptomatic primary molars of 3-10-year-old children recruited from primary care, to either HT or CR arms.Economic evaluation A cost-effectiveness analysis was undertaken. A five-year horizon was chosen. A societal perspective was adopted. Estimation of direct, indirect and opportunity costs were presented. Costs were discounted at 1.5%. Molar survival was chosen as the effectiveness measure.Data analysis Statistical significance of primary outcome (survival) was examined using the log-rank test. Bootstrapping produced a sampling distribution of mean cost and effectiveness with a 95% confidence interval around a mean value. An incremental cost-effectiveness ratio (ICER) was provided.Results HT molars had superior survival of 99% (95% CI 98-100%) compared to CR at 92% (95% CI 87-97%). selleck compound Initials costs indicated HT to be more expensive than CR; however, direct costs, including retreatments, were cheaper for HT when using both NHS Scotland and NHS England cost data. Indirect/opportunity costs, including time and travel of parents, were significantly less for HT. Total cumulative costs were significantly lower in HT (32 GBP; 95% CI 31-34) than CR (49 GBP; 34-69). HT dominated CR, being less costly and more effective with a mean ICER of 2.38 GBP spent additionally while losing 1% of molar survival with CR over HT.Conclusions HT molars are cost-effective, compared to CR, when managing asymptomatic carious primary molars after five years' follow-up.Data sources A search of electronic databases (Embase and PubMed) was carried out along with manual and grey searches of published and unpublished journals. Publication year was from first available until 23 August 2018.Study selection Titles and abstracts from the original search were reviewed by two authors. Studies were chosen for full-text analysis and data extraction after inter-reviewer agreement. Disagreement was resolved by discussion and Cohen's kappa was used to measure inter-reviewer agreement. An initial search gave 2,197 articles and, following screening, 18 publications were included in the study. Five articles were case series and ten were case reports describing one to nine cases. Three publications reported on comparatively large sample sizes, one prospectively and two retrospectively. None of the studies had control groups or blinding. The QUADAS-2 tool was used for quality assessment. Studies were deemed to have high, low or unclear levels of bias by two examiners. All were considered high risk of bias.
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