Erica Amari

What works for people with bipolar disorder? Tips from the experts

OBJECTIVES Little is known about how patients successfully manage their bipolar disorder (BD). This is a remarkable gap in the BD literature, given that current treatments are inadequate and information about beneficial self-management strategies could have clinical and theoretical implications. Here, we present results from a study of self-management strategies used by a sample of high-functioning individuals with BD. METHODS The objectively rated Multidimensional Scale of Independent Functioning (MSIF) was used to confirm high functioning status (score <3) amongst a sample of individuals self-described as functioning well with BD type I or II (N=32). Participants completed quantitative scales to assess psychiatric history, current symptoms, functioning and quality of life, and underwent either an individual interview or focus group to answer open questions about the self-management strategies they used to maintain or regain wellness. RESULTS Wellness strategies fell into the following themes: 1) Sleep, rest, exercise and diet; 2) Ongoing monitoring; 3) Enacting a plan; 4) Reflective and meditative practices; 5) Understanding BD and educating others; 6) Connecting with others. CONCLUSIONS The wellness strategies described by the current sample have substantial overlap with those identified in the sole comparable qualitative study. They are also broadly consistent with, and serve to elaborate on proposed mechanisms of therapeutic action in adjunctive psychosocial interventions for BD. The findings constitute hopeful stories for people affected by the disorder and suggest further research to confirm and refine mechanisms of beneficial effect in BD.

Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children – a prospective evaluation

Introduction:  Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration.

Relationship between age and spontaneous ventilation during intravenous anesthesia in children

Background:  Maintaining spontaneous ventilation in children, using total intravenous anesthesia (TIVA), is often desirable, particularly for airway endoscopy. The aim of this study was to evaluate the effect of age on the dose of remifentanil tolerated during spontaneous ventilation under anesthesia maintained with infusions of propofol and remifentanil and to provide guidelines for the administration of remifentanil and propofol to maintain spontaneous ventilation in children.

Defining rules for the identification of critical ventilatory events

Purpose: The automated recognition of critical clinical events by physiological monitors is a challenging task exacerbated by a lack of standardized and clinically relevant threshold criteria. The objective of this investigation was to develop consensus for such criteria regarding the identification of three ventilatory events: disconnection or significant leak in the anesthesia circuit, decreased lung compliance or increased resistance, and anesthetic overdose from inhaled anesthetics.Methods: We individually administered a structured interview to five expert anesthesiologists to gain insight into the cognitive processes used by clinicians to diagnose ventilatory events and to determine the common heuristics (rules of thumb) used in clinical practice. We then used common themes, identified from analysis of the structured interviews, to generate questions for a series of web-based questionnaires. Using a modified Delphi technique, iterative questionnaire administration facilitated rapid consensus development on the thresholds for the specific rules used to identify ventilatory events.Results: A threshold for 75% agreement was described for each scenario in a healthy ventilated adult. A disconnection or significant leak in the anesthesia circuit is diagnosed with peak airway pressure (<5 cm H2O or change of 15 cm H2O), ETCO2 (0 mmHg, 40% drop, or value below 10 mmHg for a duration of 20 sec), and inspired-expired volume difference (300 mL). Increased resistance or decreased lung compliance is diagnosed with high peak airway pressure (40 cm H2O or a 20 cm H2O change), asymmetry of capnogram, and changes in measured compliance or resistance. Anesthetic overdose from inhaled anesthetics is diagnosed with high end-tidal anesthetic agent concentration (2 MAC in a patient less than 60 yr of age or 1.75 MAC in a patient over 60 yr of age), low systolic blood pressure (below 60 mmHg), and low modified electroencephalogram (bispectral index or entropy).Conclusion: This investigation has provided a set of consensus-based criteria for developing rules for the identification of three critical ventilatory events and has presented insight into the decision heuristics used by clinicians.RésuméObjectif: La reconnaissance automatisée des événements cliniques critiques par des moniteurs physiologiques constitue un défi rendu difficile par le manque de critères de seuils standardisés et pertinents d’un point de vue clinique. L’objectif de cette étude était de parvenir à un consensus par rapport aux critères nécessaires à l’identification de trois événements respiratoires : une déconnexion ou une fuite considérable du circuit anesthésique, une compliance pulmonaire diminuée ou une résistance accrue, et une overdose anesthésique résultant des anesthésiques inhalés.Méthode: Nous avons individuellement mené des entretiens structurés de cinq anesthésiologistes experts afin d’avoir un aperçu des processus cognitifs utilisés par les cliniciens pour dépister les événements respiratoires et de déterminer les connaissances heuristiques communes (règle empirique) utilisées dans la pratique clinique. Ensuite, nous nous sommes servis des thèmes communs identifiés par l’analyse des entretiens structurés afin de générer des questions pour une série de questionnaires en ligne. À l’aide d’une méthode de Delphi modifiée, l’administration itérative des questionnaires a permis le développement rapide d’un consensus concernant les seuils pour les règles spécifiques utilisées dans l’identification des événements respiratoires.Résultats: Pour chaque scénario chez un adulte sain ventilé, un seuil de concordance de 75 % a été décrit. Une déconnexion ou fuite considérable du circuit anesthésique est diagnostiquée lors d’une pression maximale du conduit aérien (< 5 cm H2O ou changement de 15 cm H2O), ETCO2 (0 mmHg, chute de 40 %, ou valeur en dessous de 10 mmHg pour une durée de 20 sec), et d’une différence de volume inspiré-expiré (300 mL). Une résistance accrue ou une compliance pulmonaire réduite est diagnostiquée lors d’une pression maximale du conduit aérien élevée (40 cm H2O ou un changement de 20 cm H2O), un capnogramme asymétrique, et de changements dans la compliance ou la résistance mesurées. Une overdose anesthésique provoquée par les anesthésiques inhalés est diagnostiquée lors d’une concentration d’anesthésique télo-expira-toire élevée (2 MAC chez un patient de moins de 60 ans ou 1,75 MAC chez un patient de plus de 60 ans), de pression systolique basse (inférieure à 60 mmHg) et d’électroencéphalogramme modifié bas (index bispectral ou moniteur entropy).Conclusion: Cette étude a permis de déterminer un ensemble de critères basés sur un consensus pour le développement de règles permettant l’identification de trois événements respiratoires critiques et a donné un aperçu des connaissances heuristiques utilisés par les cliniciens pour prendre des décisions cliniques.

Using social media to reach Chinese and South Asian communities in British Columbia: the story of a peer-led diabetes prevention programme on Facebook

Minority populations can face cultural and accessibility barriers when seeking education and support for diabetes self–management. While culturally adapted education programmes have been studied, it has not been combined with the benefit of peer–support and the accessibility of social media. This project aimed to create and assess the feasibility, acceptability, and usability of a peer–led, culturally relevant diabetes prevention programme to be delivered over a popular social networking platform, Facebook, using mixed methods. Six participants of Chinese and South Asian ethnicities completed the 12–week programme led by a peer leader for each group. Interviews and scales were conducted before, during, and after the programme. Results indicated that the delivery of health information over Facebook is feasible and acceptable for those who are comfortable with social media. The peer leaders were engaged and the ability to view discussions was useful, though a larger group would have led to more robust discussions.