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vrijdag 23 februari 2018

The Lancet: [Articles] Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlle...

[Articles] Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial
This is the first study showing high level evidence for mesh repair in patients with small hernias of diameter 1–4 cm. Hence we suggest mesh repair should be used for operations on all patients with an umbilical hernia of this size.
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[Articles] Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.
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[Comment] More data, more answers: picking the optimal antidepressant
In an era of increasingly large datasets for health and emphasis on so-called big data analyses, key clinical questions remain unpretentiously simple. For example, do some antidepressants work better than others for depression? And are some more tolerable than others, at least as measured in dropout rates? A quick PubMed search of antidepressant meta-analyses yields more than 2000 hits, but the complexity of understanding which antidepressants are better or more tolerable than others is made particularly daunting by the fact that more than 40 antidepressants are available.
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[Seminar] Chronic lymphocytic leukaemia
Important advances in understanding the pathogenesis of chronic lymphocytic leukaemia in the past two decades have led to the development of new prognostic tools and novel targeted therapies that have improved clinical outcome. Chronic lymphocytic leukaemia is the most common type of leukaemia in developed countries, and the median age at diagnosis is 72 years. The criteria for initiating treatment rely on the Rai and Binet staging systems and on the presence of disease-related symptoms. For many patients with chronic lymphocytic leukaemia, treatment with chemotherapy and anti-CD20 monoclonal antibodies is the standard of care.
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[Comment] CABG the clear choice for patients with diabetes and multivessel disease
Whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is the preferred revascularisation method in patients with multivessel coronary artery disease, particularly in those with diabetes, has been highly debated in the cardiovascular community for more than 20 years.1–4 CABG has been consistently superior to PCI for the endpoint of repeat revascularisation. Each advancement in PCI5,6—from balloon angioplasty to bare-metal stents and drug-eluting stents—has re-challenged CABG's primacy for multivessel disease.
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