The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage

Background: Management of chest drains after thoracic surgery remains an area with little consensus. To optimize chest drainage algorithms with electronic chest drainage systems, a randomized controlled trial comparing low variable suction (−5 cm H 2 O) versus high variable suction (−20 cm H 2 O) was conducted. Methods: This was a prospective open label randomized trial in patients undergoing lobectomy. Sample size was calculated from a clinical relevant difference in chest drain duration as 1 full day. End points were chest drain duration and length of hospitalization. Data were analyzed by Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression. Results: The study randomized 106 patients. There was no statistical significant difference in chest drain duration and length of stay between the low-suction and the high-suction groups: Median chest drain duration and hospitalization were 25 hours (interquartile range [IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p = 0.97) and 5 days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p = 0.75), respectively. Multivariate analysis demonstrated that the diffusing capacity of the lung for carbon monoxide was the only significant predictor of chest drain duration (p = 0.015) and length of hospitalization (p = 0.003). Complications requiring reinsertion of the chest drain were significantly more frequent in the low-suction group (p = 0.03). Conclusions: There was no clinically relevant difference in chest drain duration or length of hospitalization, but reinsertions of chest drains were significantly more frequent in the low-suction group, a finding suggesting that low suction levels should not be used after lobectomy. Trial registry number is ISRCTN10408356. </p

Religious practice, religious change: Evangelicals and Catholics in Santiago de Chile's civil society

Religious life in contemporary Chile is marked by both a sustained growth of Pentecostal churches and by an increase in those without religion affiliation. These developments suggest that Chile is an interesting case study for exploring religious change. This research aims to understand and interpret how religious change is experienced among religiously involved individuals, and how the formerly dominant Catholic and recently powerful Pentecostal churches are reacting to this changing environment. The thesis draws on social differentiation theory; viewing secularisation as the specification and specialisation of the religious sphere and not its disappearance in modern societies. The thesis undertook explorative qualitative comparative case study, including ethnographic interviews, participant observation and secondary data analysis as its main methods. The Catholic Chapel of Del Carmen and the Zelada Temple of the First Methodist Pentecostal Church of Chile, two churches located in Santiago´s city centre, were selected in order to understand how the two main denominations in the country were changing in an urban and modernising location. The thesis is organised into six chapters. The first presents and discusses the main versions of the secularisation theory and the public role of churches, in order to locate my cases in the sociological discussion of religion in modern societies. I further locate discussion in religiosity in Latin America, and in Chile in particular. In the second chapter I reflect on the methodological aspects of the research, namely the research problem and research objectives, and the rationale and choice of an ethnographic approach. I also review the main research methods: ethnographic interviews, participant observation and secondary data analysis. The third chapter provides a descriptive analysis of the particular field of this research, namely the municipality of Estación Central and the two churches where fieldwork took place, in Santiago, Chile. I describe this location as an appropriate place to observe religious change and its consequences, given its urban character and the social mobility of its inhabitants. Chapter 4 is the first of three ‘findings’ chapters. It focuses on the intergenerational transmission of religion, and examines how the new generation of Evangelicals - the most commonly used term to refer to the main branch of Latin American Protestants - are problematising and adapting certain religious practices within this new social context as a means of integrating in contemporary Chilean culture. In Chapter 5, I analyse how both the Pentecostal Methodist Church and the Catholic Church engage, in different ways, with leadership challenges emerging from a changing environment. I suggest that Weber’s idea of charisma is useful to understand the contrasting but also the similar processes that both churches are undergoing. Chapter 6 analyses the problem of how religious-based morality is exercised in the context of an increasingly secular society. I discuss how religious individuals conceive and practise the moral teachings of their churches, revealing contrasts between Catholics and Evangelicals. At the institutional level, I argue that the Catholic and Evangelical churches reflect different approaches to the public role of religion in a secularising society. The concluding section reflects on the findings as a whole and seeks to understand the ways in which they contribute to and are reflective of the emergence of a vibrant civil society

Spontaneous and visually driven high‐frequency oscillations in the occipital cortex: Intracranial recording in epileptic patients

High‐frequency oscillations (HFOs) at ≥80 Hz of nonepileptic nature spontaneously emerge from human cerebral cortex. In 10 patients with extraoccipital lobe epilepsy, we compared the spectral‐spatial characteristics of HFOs spontaneously arising from the nonepileptic occipital cortex with those of HFOs driven by a visual task as well as epileptogenic HFOs arising from the extraoccipital seizure focus. We identified spontaneous HFOs at ≥80 Hz with a mean duration of 330 ms intermittently emerging from the occipital cortex during interictal slow‐wave sleep. The spectral frequency band of spontaneous occipital HFOs was similar to that of visually driven HFOs. Spontaneous occipital HFOs were spatially sparse and confined to smaller areas, whereas visually driven HFOs involved the larger areas including the more rostral sites. Neither spectral frequency band nor amplitude of spontaneous occipital HFOs significantly differed from those of epileptogenic HFOs. Spontaneous occipital HFOs were strongly locked to the phase of delta activity, but the strength of δ‐phase coupling decayed from 1 to 3 Hz. Conversely, epileptogenic extraoccipital HFOs were locked to the phase of delta activity about equally in the range from 1 to 3 Hz. The occipital cortex spontaneously generates physiological HFOs which may stand out on electrocorticography traces as prominently as pathological HFOs arising from elsewhere; this observation should be taken into consideration during presurgical evaluation. Coupling of spontaneous delta and HFOs may increase the understanding of significance of δ‐oscillations during slow‐wave sleep. Further studies are warranted to determine whether δ‐phase coupling distinguishes physiological from pathological HFOs or simply differs across anatomical locations. Hum Brain Mapp , 2012. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90310/1/21233_ftp.pd

Antidepressants for insomnia in adults

Background Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer-term use of hypnotics and the limited availability of psychological treatments. Objectives To assess the effectiveness, safety and tolerability of antidepressants for insomnia in adults. Search methods This review incorporated the results of searches to July 2015 conducted on electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), MEDLINE (1950 to 2015), Embase (1980 to 2015) and PsycINFO (1806 to 2015). We updated the searches to December 2017, but these results have not yet been incorporated into the review. Selection criteria Randomised controlled trials (RCTs) of adults (aged 18 years or older) with a primary diagnosis of insomnia and all participant types including people with comorbidities. Any antidepressant as monotherapy at any dose whether compared with placebo, other medications for insomnia (e.g. benzodiazepines and 'Z' drugs), a different antidepressant, waiting list control or treatment as usual. Data collection and analysis Two review authors independently assessed trials for eligibility and extracted data using a data extraction form. A third review author resolved disagreements on inclusion or data extraction. Main results The search identified 23 RCTs (2806 participants). Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. Combining results was not possible. Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). There was no difference in the fluoxetine study (low quality evidence). There were either no adverse events or they were not reported (very low quality evidence). Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participants) compared TCA with placebo; five used doxepin and one used trimipramine. We found no studies of amitriptyline. Four studies (518 participants) could be pooled, showing a moderate improvement in subjective sleep quality over placebo (standardised mean difference (SMD) -0.39, 95% confidence interval (CI) -0.56 to -0.21) (moderate quality evidence). Moderate quality evidence suggested that TCAs possibly improved sleep efficiency (mean difference (MD) 6.29 percentage points, 95% CI 3.17 to 9.41; 4 studies; 510 participants) and increased sleep time (MD 22.88 minutes, 95% CI 13.17 to 32.59; 4 studies; 510 participants). There may have been little or no impact on sleep latency (MD -4.27 minutes, 95% CI -9.01 to 0.48; 4 studies; 510 participants). There may have been little or no difference in adverse events between TCAs and placebo (risk ratio (RR) 1.02, 95% CI 0.86 to 1.21; 6 studies; 812 participants) (low quality evidence). 'Other' antidepressants with placebo: eight studies compared other antidepressants with placebo (one used mianserin and seven used trazodone). Three studies (370 participants) of trazodone could be pooled, indicating a moderate improvement in subjective sleep outcomes over placebo (SMD -0.34, 95% CI -0.66 to -0.02). Two studies of trazodone measured polysomnography and found little or no difference in sleep efficiency (MD 1.38 percentage points, 95% CI -2.87 to 5.63; 169 participants) (low quality evidence). There was low quality evidence from two studies of more adverse effects with trazodone than placebo (i.e. morning grogginess, increased dry mouth and thirst). Authors' conclusions We identified relatively few, mostly small studies with short-term follow-up and design limitations. The effects of SSRIs compared with placebo are uncertain with too few studies to draw clear conclusions. There may be a small improvement in sleep quality with short-term use of low-dose doxepin and trazodone compared with placebo. The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events. There was no evidence for amitriptyline (despite common use in clinical practice) or for long-term antidepressant use for insomnia. High-quality trials of antidepressants for insomnia are needed

¿Cuánto aporta la religión a la sociedad civil? Una mirada institucional

This article aims to advance in the understanding of the religious phenomenon and its contribution to Chilean society. Considering the processes of secularization and religious change in Chile, and especially in the context of the constitutional discussion, it is essential to identify and value the contribution of religious institutions to Chilean society, in order to collaborate in the reflection on the place of religion in a society in transformation. This article presents an overview of the subject, empirically analyzing the contribution of organizations of different religious denominations to different areas of civil society. The findings of this study illustrate that religious institutions and faith-based organizations participate in different areas of so-called social and educational services.El presente artículo se orienta a avanzar en la comprensión del fenómeno religioso y su contribución a la sociedad chilena. Considerando los procesos de secularización y cambio religioso en Chile, y especialmente en el contexto de la discusión constitucional, resulta fundamental identificar y valorar el aporte de las instituciones religiosas a la sociedad chilena, para así colaborar en la reflexión sobre el lugar de la religión en una sociedad en transformación. Este artículo presenta un panorama del tema, analizando empíricamente el aporte de organizaciones de distintas denominaciones religiosas a distintos ámbitos de la sociedad civil. Los hallazgos de este estudio permiten ilustrar que las instituciones religiosas y organizaciones basadas en la fe participan de distintos ámbitos de los denominados servicios sociales y educacionales

Improving Long-Term Care Facilities’ Crisis Response: Lessons From the COVID-19 in Chile

Context: The COVID-19 pandemic hit Chile hard and affected older people the most. Through its National Service for Older Adults, the country implemented a strategy to prevent and mitigate infection and spread in long-term care facilities (LTCF), reaching regulated and registered residences and, for the first time, informal and unregistered residences. Objective: Identify the challenges and lessons from the COVID-19 response in LTCF with respect to the support received, the implementation of infection control measures, workforce challenges experienced and the measures adopted to promote residents’ wellbeing. Methods: An online questionnaire was sent to all LTCF managers (N = 385, Response Rate = 32.4%). Statistical tests compare results to identify differences across LTCF characteristics: residence size, location and management type (private, public or subsidized, or informal). Findings: Irrespective of their location, size or management, managers highlight common challenges during the crisis. They include limited personal protective equipment (PPE) availability, staff shortages, low quality of replacement staff, reduced staff mental health, and the difficulty to understand and implement protocols. Managers acknowledge receiving institutional support in the form of PPE provision and opportunities for staff training, but managers noted the need to expand this support to cover staffing surge needs, staff psychological needs, and ensure the continuity of clinical support for residents as well. Managers share a common demand for a more coordinated response from public institutions. Managers recognize that the pandemic and the measures implemented to mitigate it negatively affected staff morale and residents’ wellbeing. Many noted that peer-to-peer support was a mechanism to support staff. Limitations: Results might be subject to selection bias. Data collection covered a limited period of time at the early stage of the pandemic. Implications: Findings are relevant to assess the COVID-19 response and to better prepare for another COVID-19 wave or similar health or environmental threats in the future