Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial.

OBJECTIVE: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. METHOD: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. RESULTS: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. CONCLUSION: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.

Sleep deprivation as treatment for depression: Systematic review and meta-analysis.

OBJECTIVE: To systematically review evidence on the efficacy and safety of sleep deprivation (SD) as a treatment option for patients with unipolar or bipolar depression. METHODS: A systematic review according to PRISMA guidelines was conducted. The certainty of evidence was assessed using the GRADE approach. Controlled trials were included in efficacy analysis, case series for evaluating complications and qualitative studies for patients' experiences. RESULTS: Eight controlled studies (368 patients), one qualitative study and seven case series (825 patients) were included. One week after treatment start, SD combined with standard treatment did not reduce depressive symptoms compared with standard treatment (standardized mean difference, SMD = -0.29, [95% confidence interval, CI: -0.84 to 0.25], p = 0.29). When excluding a study in elderly patients in a post hoc analysis, the difference was statistically significant (SMD = -0.54 ([95% CI: -0.86 to -0.22], p < 0.001)) but it diminished two weeks after treatment start. No superiority of SD was found compared with antidepressants, but SD may be superior to exercise in certain settings. It is uncertain whether SD affects quality of sleep, quality of life, everyday functioning or length of stay. Apart from switch to mania (ranging between 2.7% and 10.7%), no other serious complications were reported. CONCLUSION: Sleep deprivation has been studied in a wide range of settings resulting in divergent results for the short-term efficacy on depressive symptoms. Post hoc analyses indicated that there may be a significant but transient effect in certain populations. Further studies should focus on identifying subgroups of responders as well as examining feasibility in routine clinical care.

Trabecular bone patterns as a fracture risk predictor: a systematic review.

BACKGROUND: The aim of this systematic review was to evaluate the assessment of trabecular bone patterns in dental radiographs, for fracture risk prediction, compared with the current diagnostic methods. METHODS: The PRISMA guidelines were followed. According to predefined inclusion criteria (PICO), literature searches were focussed on published studies with analyses of trabecular bone patterns on intraoral and/or in panoramic radiographs, compared with Dual X-ray Absorptiometry (DXA) and/or Fracture Risk Assessment Tool (FRAX), with the outcomes; fracture and/or sensitivity and specificity for osteoporosis prediction. The included studies were quality-assessed using the QUADAS-2 tool and the certainties of evidence was assessed using the GRADE approach. RESULTS: The literature searches identified 2913 articles, whereas three were found to meet the inclusion criteria. Two longitudinal cohort studies evaluated the use of trabecular bone patterns to predict bone fractures. In one of the studies, the relative risk of fracture was significantly higher for women with sparse bone pattern, identified by visual assessment of dental radiographs, and in the other study by digital software assessment. Visual assessment in the second study did not show significant results. The cross-sectional study of digital analyses of trabecular bone patterns in relation to osteoporosis reported a sensitivity of 0.70 and a specificity of 0.69. CONCLUSION: Based on low certainty of evidence, trabecular bone evaluation on dental radiographs may predict fractures in adults without a prior diagnosis of osteoporosis, and based on very low certainty of evidence, it is uncertain whether digital image analyses of trabecular bone can predict osteoporosis.

Physical activity on prescription in accordance with the Swedish model increases physical activity: a systematic review.

OBJECTIVES: This study investigates the effects of the core elements of the Swedish model for physical activity on prescription (PAP) by evaluating studies that compared adults who received PAP with adults who did not receive PAP. All participants were adults identified by a healthcare professional as in need of increased physical activity. Primary outcome was level of physical activity. DESIGN: Systematic review. ELIGIBILITY CRITERIA: (1) Published 1999. (2) Systematic review, randomised controlled trial (RCT), non-RCT or case series (for adverse events). (3) ≥12 weeks' follow-up. (4) Performed in the Nordic countries. (5) Presented in English, Swedish, Norwegian or Danish. DATA SOURCES: Systematic searches in PubMed, Embase, the Cochrane Library, AMED, CINAHL and SweMed+ in September 2017. Included articles were evaluated using checklists to determine risk of bias. RESULTS: Nine relevant articles were included: seven RCTs, one cohort study and one case series. Primary outcome was reported in seven articles from six studies (five RCTs, one cohort study, 642 participants). Positive results were reported from three of the five RCTs and from the cohort study. No study reported any negative results. Swedish PAP probably results in an increased level of physical activity (GRADE⊕⊕⊕Ο). CONCLUSIONS: Although the number of the reviewed articles was relatively modest, this systematic review shows that PAP in accordance with the Swedish model probably increases the level of physical activity. As a model for exercise prescription, Swedish PAP may be considered as part of regular healthcare to increase physical activity in patients.

Safety, effectiveness, women's experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta-analyses.

BACKGROUND: Induction of labor is increasing worldwide, and some countries have started to introduce outpatient induction in low-risk women. OBJECTIVES: To assess current knowledge concerning the safety, efficacy, women's experience, and economic costs of outpatient induction compared with inpatient induction. SEARCH STRATEGY: Multiple databases were last searched on October 19, 2021. Studies were selected according to our pre-specified inclusion, selection, and exclusion criteria. SELECTION CRITERIA: PICO; P-women with low-risk pregnancy planned for induction of labor. I-Outpatient induction C-Inpatient induction O-Outcomes according to the core outcome set for induction of labor (COSIOL). DATA COLLECTION AND ANALYSIS: Pooled in meta-analyses. The certainty of evidence was assessed using the GRADE system. MAIN RESULTS: The 20 included studies, including 7956 women, showed an overall low incidence of adverse events and indicated comparable results for inpatient and outpatient induction, but the studies were underpowered for safety-related outcomes. Women's experiences of outpatient induction were mostly positive. Based on three studies, the economic costs consequence is inconclusive. CONCLUSIONS: Due to early randomization, heterogenic study design, and underpowered studies regarding safety outcome, the certainty of evidence is very low. It is uncertain whether outpatient induction affects the risk for neonatal and maternal complications.

Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies - A systematic review and meta-analyses.

Background: Preterm birth is the leading cause of childhood mortality and morbidity. We aimed to provide a comprehensive systematic review on randomized controlled trials (RCTs) on progesterone, cerclage, pessary, and acetylsalicylic acid (ASA) to prevent preterm birth in asymptomatic women with singleton pregnancies defined as risk of preterm birth and multifetal pregnancies. Methods: Six databases (including PubMed, Embase, Medline, the Cochrane Library) were searched up to February 2022. RCTs published in English or Scandinavian languages were included through a consensus process. Abstracts and duplicates were excluded. The trials were critically appraised by pairs of reviewers. The Cochrane risk-of-bias tool was used for risk of bias assessment. Predefined outcomes including preterm birth, perinatal/neonatal/maternal mortality and morbidity, were pooled in meta-analyses using RevMan 5.4, stratified for high and low risk of bias trials. The certainty of evidence was assessed using the GRADE approach. The systematic review followed the PRISMA guideline. Results: The search identified 2,309 articles, of which 87 were included in the assessment: 71 original RCTs and 16 secondary publications with 23,886 women and 32,893 offspring. Conclusions were based solely on trials with low risk of bias (n = 50).Singleton pregnancies: Progesterone compared with placebo, reduced the risk of preterm birth <37 gestational weeks: 26.8% vs. 30.2% (Risk Ratio [RR] 0.82 [95% Confidence Interval [CI] 0.71 to 0.95]) (high certainty of evidence, 14 trials) thereby reducing neonatal mortality and respiratory distress syndrome. Cerclage probably reduced the risk of preterm birth <37 gestational weeks: 29.0% vs. 37.6% (RR 0.78 [95% CI 0.69 to 0.88]) (moderate certainty of evidence, four open trials). In addition, perinatal mortality may be reduced by cerclage. Pessary did not demonstrate any overall effect. ASA did not affect any outcome, but evidence was based on one underpowered study.Multifetal pregnancies: The effect of progesterone, cerclage, or pessary was minimal, if any. No study supported improved long-term outcome of the children. Conclusion: Progesterone and probably also cerclage have a protective effect against preterm birth in asymptomatic women with a singleton pregnancy at risk of preterm birth. Further trials of ASA are needed. Prevention of preterm birth requires screening programs to identify women at risk of preterm birth. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234946].

Hospitalisation associated with a deterioration in oral health.

DATA SOURCES: Ovid MEDLINE and Ovid OLDMEDLINE (January 1950 to January 2010), CINAHL (1982 to January 2010), Cochrane Library (up to 2010) and EMBASE (1981 to January 2010), bibliographies of potentially relevant reports and reviews, handsearching of Community Dentistry and Oral Epidemiology, Gerodontology, Journal of Disability and Oral Health and Special Care in Dentistry. STUDY SELECTION: Longitudinal prospective observational studies in individuals of all ages being hospitalised, that assessed changes of the following outcomes: tooth loss, any measures of periodontal health, dental caries and stomatological diseases. There were no language restrictions. DATA EXTRACTION AND SYNTHESIS: One reviewer scanned the titles and abstracts to select studies. Potentially eligible studies were screened by two reviewers who also data extracted using specially designed forms. Quality was assessed by both reviewers using the Newcastle-Ottawa scale for cohort studies. The authors assessed whether a power calculation was reported for each study and, if so, the magnitude of a change that the study was powered to detect. Heterogeneity between studies was anticipated so a narrative review was planned. RESULTS: Five studies were included and all were assessed to be adequately representative and had sufficient follow-up. Outcome assessments were adequate but validity of the outcome measures was found to be subjective. One investigation included children only, whilst the remainder included adults only. Four of the studies were in intensive care units. Duration of hospitalisation was 5-20 days. This was insufficient a period for caries to develop. A power calculation was reported in only one study. Three out of four studies that reported on plaque accumulation found increasing levels of plaque accumulation during hospitalisation, whilst one did not. Two of three studies assessing gingival inflammation found a statistically significant increase. Two studies found a statistically significant increased incidence of mucositis in intubated patients but not in non-intubated patients. CONCLUSIONS: Hospitalisation is associated with a deterioration in oral health, particularly in intubated patients.

Dental hygiene education for nursing staff in a nursing home for older people.

AIM: This paper is a report of a study evaluating the effect of a repeated education programme for nursing staff in a home for older people. BACKGROUND: A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. Thus, nursing staff need to be educated in oral hygiene measures. METHODS: Forty-three nursing home resident older people (12 men, 31 women, age range 69-99 years) were included in a dental hygiene and gingivitis evaluation using gingival bleeding scores and modified plaque scores. Evaluation was conducted before and 3 weeks after a repeated dental hygiene education for nursing staff at a nursing home in Sweden in 2008. Dental hygiene education had been given 1.5 years previously. FINDINGS: Forty-one residents (12 men and 29 women) were available for evaluation after the repeated dental hygiene education (one died, one had had teeth extracted). There was a reduction in gingival bleeding scores (P < 0.001), and in plaque scores (P < 0.001). CONCLUSION: Repeated dental hygiene education improves the dental hygiene among nursing home resident older people. In order to succeed it may be necessary to address attitudes and perceptions towards oral care in such a dental hygiene education programme for nursing staff. Improved oral hygiene contributes to reducing the incidence of healthcare-associated pneumonia among nursing home resident older people, and thus to reduced healthcare costs.

Evaluation of dental hygiene education for nursing home staff.

AIM: This paper is a report of a study evaluating the long-term effects on the oral hygiene status of older nursing home residents one and a half years after dental hygiene education was given to the staff. BACKGROUND: A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. It is therefore important to educate nursing home staff in oral hygiene measures and to follow up the effects of the education over time. METHODS: Dental plaque measurements were conducted at a Swedish nursing home in 2006-2008. Forty-one residents (12 men, 31 women, aged 69-99 years) fulfilled the inclusion criteria and participated in a dental hygiene evaluation 1.5 years after dental hygiene education was given to the staff at the nursing home. Plaque index scores (year 2008) were compared to those soon after the education (year 2006). FINDINGS: After the dental hygiene education in 2006, 60 nursing home residents (14 men, 46 women) were available for plaque index measurements, whereas 41 residents (12 men, 29 women) were available 1.5 years later. The median plaque index scores were 17.0 (n = 60) in 2006, and 18.0 (n = 41) in 2008 (Mann-Whitney U-test, P > 0.05). CONCLUSION: Dental hygiene education for nursing home staff is important to maintain an adequate level of oral hygiene among older nursing home residents over time. Follow-up of dental hygiene education for nursing home staff is recommended to maintain a sufficient level of oral hygiene among the residents.

A survey of attitudes and perceptions toward oral hygiene among staff at a geriatric nursing home.

The aim of this survey was to test the impact of an oral hygiene educational model on attitudes and perceptions toward oral hygiene among nursing home staff members. A pilot questionnaire was distributed to the nursing staff before and after a course on oral hygiene at a geriatric nursing home in Stockholm in 2008. The nursing staff was of the opinion that they had sufficient time to carry out oral hygiene tasks but considered such tasks unpleasant, mainly because of unwillingness and resistance from the residents. These attitudes and perceptions among the nursing staff did not change significantly after oral hygiene education. Future oral hygiene educational models need to be developed with an aim to alter the perceptions and behavior of the nursing home staff.

Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes.

PURPOSE: The primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs. PATIENTS AND METHODS: In this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff's attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher's exact test and two-way variance analysis (ANOVA). RESULTS: Improvements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C. CONCLUSION: Monthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.

Dental hygiene education for nursing staff.

The aim of this study was to describe a new dental hygiene education program for nursing staff and to report experiences from the program at a nursing home in Stockholm, Sweden (2006). This strategy comprises 3 steps. The first is individual instruction for nursing staff about oral care for patients and hands-on training in toothbrushing technique using an electric toothbrush. The second step was small discussion groups of 4 to 8 nursing staff, led by a dental hygienist and a psychologist. The third step was a theoretical lecture focusing on the associations among dental hygiene, oral health, and general health among the elderly. During the dental hygiene education program, a negative attitude toward oral care was noted among members of the nursing staff, although they did consider oral care important for their patients. Increased self-confidence of staff in providing oral care was noted after completing the dental hygiene education program. Nursing staff members stated that they had received more detailed knowledge about oral care during the program. This dental hygiene education program appears to result in increased knowledge and interest in oral hygiene tasks among the nursing staff and may lead to improved dental hygiene among nursing home residents.

Systematic review of measurement properties of methods for objectively assessing masticatory performance.

The objectives of this study is to identify methods for objectively assessing masticatory performance (MP) and to evaluate their measurement properties. A secondary objective was to identify any reported adverse events associated with the methods to assess MP. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl databases. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the assessment method according to the consensus-based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. All studies were quality assessed separately, initially, and subsequently for each method. Studies that described the use of identical assessment method received an individual score, and the pooled sum score resulted in an overall evidence synthesis. The level of evidence was synthesized across studies with an overall conclusion, that is, unknown, conflicting, limited, moderate, or strong evidence. Forty-six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). No adverse events associated with any assessment methods were reported. In a clinical setting or as a diagnostic method, there are no gold standard methods for assessing MP with a strong level of evidence for all measurement properties. All available assessment methods with variable level of evidence require lab-intensive equipment, such as sieves or digital image software. Clinical trials with sufficient sample size, to infer trueness and precision, are needed for evaluating diagnostic values of available methods for assessing masticatory performance.

Attitudes, awareness and perceptions on evidence based dentistry and scientific publications among dental professionals in the county of Halland, Sweden: a questionnaire survey.

The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden, had a welcoming attitude towards EBD, and indicated an open attitude for learning more about interpretation of evidence from scientific publications. The most commonly perceived barriers towards EBD, were 'lack of time' and 'poor availability of evidence'.

Cost of composite and glass ionomer class II molar restorations and theoretical analyses of cost per year of function at public dental services in Sweden.

The aim was to evaluate the cost of direct composite and glass ionomer class II molar restorations, and the theoretical cost per year of function, at Public Dental Services (PDS) in Sweden, years 2000 and 2005. Costs for patients, Social Insurance Offices (SI; Försäkringskassan), and total cost, were calculated based on fee schedules from all PDS in Sweden. Theoretical cost per year calculations were based on the median survival times (MST) of failed direct composite and glass ionomer class II molar restorations, derived from a set of clinical studies conducted in Nordic general practices. Due to lack of national statistics from SI, the number of direct restorations including more than one surface, made in adults, in general dentistry at PDS in the county of Halland were studied. From the year 2000 to year 2005, the total cost of composite class II molar restorations increased by 25%, whereas the total cost of glass ionomer restorations more than doubled. Theoretical calculations implied a higher cost per year of function for composite restorations in year 2000, whereas in year 2005, glass ionomer restorations had a higher cost per year of function. The cost of direct composite and glass ionomer class II molar restorations increased from year 2000 to 2005, at PDS in Sweden. In the context of planning public health care funding, theoretical models for cost prediction may prove useful.

[Better regulatory framework needed for medical devices]. / Bättre regelverk behövs för medicintekniska produkter - HTA-utredning av läkemedelsavgivande stentar och ballonger vid benartärsjukdom visar på bristerna.

We summarize an HTA report regarding patient values of drug-eluting stents and balloons for treatment of atherosclerotic disease in the lower extremities. We found 17 randomized controlled trials, 4 cohort studies and 13 case series. The total number of studied patients was substantial (about 3,000) but there was a strong heterogeneity regarding site of lesion, symptom pattern, device, drug used and outcome measures, making the analysis difficult and based on relatively small subgroups. We found low certainty of evidence (GRADE ++) for a reduced risk of restenosis in patients with critical ischemia and lesions below the knee, and also a modest beneficial effect on ischemic symptoms in a mixed patient population. However, we also identified a worrying safety signal, with increased risk for amputation in a group of patients with below-the-knee disease and critical ischemia. The results highlight the need for a structured system for validation of medical devices, a system analogous to that currently used for evaluation of new pharmacological products.

Oral Care and Mortality in Older Adults with Pneumonia in Hospitals or Nursing Homes: Systematic Review and Meta-Analysis.

The objectives of the study were to compare the effect of intensified oral care interventions given by dental or nursing personnel on mortality from healthcare-associated pneumonia (HAP) in elderly adults in hospitals or nursing homes with the effect of usual oral care. Systematic literature searches were conducted in PubMed, the Cochrane Library, and the Health Technology Assessment database of the National Health Service Centre for Reviews and Dissemination (August 2015). Randomized controlled trials (RCTs) were considered for inclusion. Data were extracted and risk of bias was assessed independently and agreed on in consensus meetings. Five RCTs, with some or major study limitations, fulfilled the inclusion criteria. Based on meta-analyses, oral care interventions given by dental personnel reduced mortality from HAP (risk ratio (RR) = 0.43, 95% confidence interval (CI) = 0.25-0.76, P = .003), whereas oral care interventions given by nursing personnel did not result in a statistically significant difference in mortality from HAP (RR = 1.20, 95% CI = 0.97-1.48, P = .09), in elderly adults in hospitals or nursing homes from usual oral care. Oral care interventions given by dental personnel may reduce mortality from HAP (low certainty of evidence, Grading of Recommendations Assessment, Development and Evaluation (GRADE) ⊕⊕○○), whereas oral care interventions given by nursing personnel probably result in little or no difference from usual care (moderate certainty of evidence, GRADE ⊕⊕⊕○) in elderly adults in hospitals or nursing homes.

Home-based supervised exercise versus hospital-based supervised exercise or unsupervised walk advice as treatment for intermittent claudication: a systematic review.

OBJECTIVE: To evaluate the effects of home-based supervised exercise vs hospital-based supervised exercise, and the effects of home-based supervised exercise vs unsupervised "go home and walk advice" on daily life and corridor-walking capacity, health-related quality of life and patient-reported functional walking capacity in patients with intermittent claudication. DATA SOURCES: Systematic literature searches were conducted in PubMed, EMBASE, ProQuest, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), the Cochrane Library, and a number of Health Technology Assessment (HTA)-databases in October 2014. STUDY SELECTION: Randomized controlled trials and non-randomized controlled trials (> 100 patients) were considered for inclusion. DATA EXTRACTION: Data extraction and risk of bias assessment was performed independently and discussed in meetings. DATA SYNTHESIS: Seven randomized controlled trials and 2 non-randomized controlled studies fulfilled the inclusion criteria. The included studies had some, or major, limitations. CONCLUSION: Based on a low quality of evidence, home-based supervised exercise may lead to less improvement in maximum and pain-free walking distance, and in more improvement in daily life walking capacity, compared with hospital-based supervised exercise. Home-based supervised exercise may improve maximum and pain-free walking distance compared with "go home and walk advice" and result in little or no difference in health-related quality of life and functional walking capacity compared with hospital-based supervised exercise or "go home and walk advice". Further research is needed to establish the optimal exercise modality for these patients.

Long-term cost of direct Class II molar restorations.

The aim was to evaluate the theoretical long-term treatment costs of direct class II molar restorations (amalgam, composite, glass ionomer) using the Median Survival Times (MSTs) derived from longevity studies conducted in the Nordic countries as time for replacement. Theoretical long-term cost calculations were based on fee schedules from all Public Dental Services (PDS) in Sweden, for patients, Social Insurance Offices (SI), and total cost. Costs over 10 years were calculated and sensitivity calculations were conducted in order to demonstrate the effect of different MSTs on the long-term cost development. Glass ionomer molar class II restorations had the lowest and composite restorations had the highest initial total cost. The highest total cost over 10 years was seen for composite restorations. Amalgam restorations had the lowest long-term total cost, except when the costs were based on the shortest MSTs for each material. As there were considerable differences in the long-term costs for class II molar restorations with different materials, the importance of cost-analyses over time cannot be enough emphasised when decisions about resource allocation in the dental health insurance system are considered.