Reconstruction using massive allografts after resection of extremity osteosarcomas the study design: A retrospective cohort study

ObjectiveTo investigate the demographic and clinical factors associated with antidepressant use for depressive disorder in a psychiatric healthcare setting using a retrospective cohort study design.SettingData were extracted from a de-identified data resource sourced from the electronic health records of a London mental health service. Relative risk ratios (RRRs) were obtained from multinomial logistic regression analysis to ascertain the probability of receiving common antidepressant treatments relative to sertraline.ParticipantsPatients were included if they received mental healthcare and a diagnosis of depression with antidepressant treatment between March and August 2015 and exposures were measured over the preceding 12 months.ResultsOlder age was associated with increased use of all antidepressants compared with sertraline, except for negative associations with fluoxetine (RRR 0.98; 95% CI 0.96 to 0.98) and a combination of two selective serotonin reuptake inhibitors (SSRIs) (0.98; 95% CI 0.96 to 0.99), and no significant association with escitalopram. Male gender was associated with increased use of mirtazapine compared with sertraline (2.57; 95% CI 1.85 to 3.57). Previous antidepressant, antipsychotic and mood stabiliser use were associated with newer antidepressant use (ie, selective norepinephrine reuptake inhibitors, mirtazapine or a combination of both), while affective symptoms were associated with reduced use of citalopram (0.58; 95% CI 0.27 to 0.83) and fluoxetine (0.42; 95% CI 0.22 to 0.72) and somatic symptoms were associated with increased use of mirtazapine (1.60; 95% CI 1.00 to 2.75) relative to sertraline. In patients older than 25 years, past benzodiazepine use was associated with a combination of SSRIs (2.97; 95% CI 1.32 to 6.68), mirtazapine (1.94; 95% CI 1.20 to 3.16) and venlafaxine (1.87; 95% CI 1.04 to 3.34), while past suicide attempts were associated with increased use of fluoxetine (2.06; 95% CI 1.10 to 3.87) relative to sertraline.ConclusionThere were several factors associated with different antidepressant receipt in psychiatric healthcare. In patients aged >25, those on fluoxetine were more likely to have past suicide attempt, while past use of antidepressant and non-antidepressant use was also associated with use of new generation antidepressants, potentially reflecting perceived treatment resistance.

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The Association between Early Artificial Amniotomy and Chorioamnionitis in Nulliparous Induction of Labor

International Scholarly Research Notices ◽

10.1155/2014/628452 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8

Author(s):

Laura G. Cooney ◽

Jamie A. Bastek

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Vaginal Delivery ◽

Study Design ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Induction Of Labor ◽

Cesarean Section Rate ◽

Cervical Dilation ◽

Nulliparous Women

Objectives. To investigate whether early artificial amniotomy (AROM) <4 cm in nulliparous women admitted for induction of labor was associated with an increased rate of chorioamnionitis and cesarean section or a decreased time to vaginal delivery. Study Design. A retrospective cohort study was performed on nulliparous women with a term, singleton gestation and intact membranes who presented for induction of labor (January 2008 to December 2011). Chorioamnionitis was defined using ICD9 codes. Results. 1,567 women were enrolled; 25.4% underwent early AROM. Overall, the prevalence of chorioamnionitis was 12.4%, the rate of cesarean section was 32.2%, and the time from 4 cm cervical dilation to vaginal delivery was 413 min. Compared to women without AROM < 4 cm, early AROM did not affect overall chorioamnionitis rates (10.2 versus 13.2%, P=0.12) but was associated with an increased cesarean section rate (40.2 versus 29.5%, P<0.001). However, among those who delivered vaginally, AROM < 4 cm decreased the rate of chorioamnionitis (8.4 versus 14.6%, P=0.01), which persisted when controlling for potential confounders (OR 0.55, 95% CI 0.33–0.92), and decreased the time from 4 cm dilation to vaginal delivery (329 versus 472 min, P<0.001). Conclusions. Our findings do not suggest that early AROM is associated with an increased rate of clinical chorioamnionitis.

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