ObjectiveIn paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute paediatric asthmatics can be an effective treatment. BiPAP works by unloading fatigued inspiratory muscles, a direct bronchodilation effect, offsetting intrinsic PEEP and recruiting collapsed alveoli that reduces the patient's work of breathing and achieves their total lung capacity quicker. Unfortunately, paediatric emergency department (PED) BiPAP is underused and quality analysis is non-existent. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition.InterventionsPED BiPAP CQIP descriptive analytics.SettingAcademic PED.Participants1157 patients.InterventionsA PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics.Primary and secondary outcomesSafety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition.Results1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H2O range 12–28; EPAP 8 cmH2O (8,8) range 6–10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (p<0.001) while tidal volume increased (p<0.001). Patient disposition: 325 paediatric intensive care units (PICU), 832 wards, with 52 of these PED ward patients were discharged home with only 2 hours of PED BiPAP with no returning to the PED within 72 hours.ConclusionsBiPAP is a safe and effective therapeutic option for paediatric patients with asthma presenting to a PED or emergency department. This BiPAP CQIP showed significant patient compliance, no complications, improved therapeutics times, very low intubations and decreased PICU admissions. CQIP analysis demonstrated that using a higher IPAP, low EPAP with longer I:E optimises the patient's BiPAP settings and showed a significant improvement in PAS, RR and tidal volume. BiPAP should be considered as an early treatment in the PED severe or non-responsive moderate asthmatics.

Objective: Mental health care in the growing US Muslim population is a relevant topic given ongoing discrimination and self-stigma similar to that seen in other racial and religious communities. Data concerning efforts to integrate religious practice or spiritual concepts into mental health education are limited. Therefore, the objective of this study was to analyze views about psychiatric illness and treatment before and after a mental health symposium at a community mosque led by faith leaders and mental health professionals. Methods: A total of 31 matched presurveys and postsurveys were collected from participants at the symposium to assess attitudes about psychiatric illness and treatment before and after the intervention. The surveys were analyzed using SAS. Results: At baseline, the highly religious and educated population that participated in the survey had high levels of agreement with the conceptualization of psychiatric illness as a biological problem and less so as a spiritual problem. Even so, at baseline, only approximately half of the participants indicated that they would talk to a medical doctor about mental health problems, and participants were significantly less positive about taking psychotropic medication for illness, compared with after the intervention. Educational attainment was positively associated with the conceptualization of psychosis as a biological problem, with willingness to speak to a medical doctor, and with willingness to take antidepressant medications. Conclusions: The findings of this study suggest the potential effectiveness of coordinated interventions by religious leaders and mental health professionals to address the reluctance of Muslims to use psychotropic medication treatment when indicated. Limitations of this study include the self-selection of a highly-educated subset of the greater Muslim population that may already have been interested in a mental health symposium. For the future, research should consider the use of psychoeducation in general religious services to reach a more representative sample of practicing Muslims.

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