Robert L. Wilkins

Medication adherence issues in patients treated for COPD

Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.

Critical-Thinking Ability in Respiratory Care Students and Its Correlation With Age, Educational Background, and Performance on National Board Examinations

BACKGROUND: Critical thinking is an important characteristic to develop in respiratory care students. METHODS: We used the short-form Watson-Glaser Critical Thinking Appraisal instrument to measure critical-thinking ability in 55 senior respiratory care students in a baccalaureate respiratory care program. We calculated the Pearson correlation coefficient to assess the relationships between critical-thinking score, age, and student performance on the clinical-simulation component of the national respiratory care boards examination. We used chi-square analysis to assess the association between critical-thinking score and educational background. RESULTS: There was no significant relationship between critical-thinking score and age, or between critical-thinking score and student performance on the clinical-simulation component. There was a significant (P = .04) positive association between a strong science-course background and critical-thinking score, which might be useful in predicting a students ability to perform in areas where critical thinking is of paramount importance, such as clinical competencies, and to guide candidate-selection for respiratory care programs.

Contamination Level of Stethoscopes Used By Physicians and Physician Assistants

The Journal of Physician Assistant Education | 2007 Vol 18 No 2 INTRODUCTION The stethoscope is a popular instrument used by health care providers to evaluate the lung, heart, and abdominal sounds of their patients. Although clinicians are instructed about microbiology and the importance of maintaining clean medical instruments, the stethoscope may not be thought of as a potential source of nosocomial infection. Numerous studies in the past decade have reported the level of bacterial contamination on stethoscopes belonging to physicians and nurses (Table 1). The large majority of the stethoscopes examined in these studies were contaminated: most with Gram-positive organisms, primarily Staphyolococcus species.1-8 In addition, in some studies the stethoscopes used by physicians were found to be more contaminated than those of nurses and others.1-3,7 Some of the studies examined the effectiveness of different cleaning agents and the selfreported frequency of clinicians cleaning their own stethoscope. The most effective cleaning agent identified was 70% isopropyl alcohol.1-2,4,6 The reported frequency of stethoscope cleaning varied significantly in each study but many participants reported cleaning their scopes infrequently.1,7 To the best of our knowledge, no studies have been published comparing the prevalence of stethoscope contamination between physicians and physician assistants (PAs). The objectives of this study were to: (1) identify the degree of bacterial contamination present on stethoscopes used by PAs and physicians in the outpatient setting; (2) identify the reported frequency of stethoscope cleaning by physicians and PAs; and (3) determine whether profession, gender, or years of experience predict the degree of bacterial stethoscope contamination. Contamination Level of Stethoscopes Used By Physicians and Physician Assistants Robert L. Wilkins, PhD, RRT, FAARC; Ruben D. Restrepo, MD, RRT, University of Texas Health Science Center at San Antonio, Texas

The Description of Adventitious Lung Sounds by Physician Assistants

Introduction: The objectives of this study were to (1) assess the terminology used by physician assistants (PAs) in describing adventitious lung sounds (ALS), (2) identify the relationship between background variables and the terms used to describe ALS, and (3) identify the ability of PAs to accurately recognize various ALS. Methods: We surveyed 115 PAs who listened to five different ALS and wrote descriptions of each sound. We used the chi‐square test to assess the relationship between the terms used and background variables. Results: One hundred and one (88%) of the participants described sound 1 (fine inspiratory discontinuous ALS) as “rales” or “crackles.” Sound two (coarse discontinuous ALS) was described as “rhonchi” by 58 participants (50%). Sound 3 (polyphonic high‐pitched continuous ALS) was described as “wheeze” by 90 participants (78%). Sound 4 (low‐pitched monophonic continuous ALS) was described with a variety of terms but most often as “rhonchi” or “wheeze” by 31 participants (27%). Sound 5 (high‐pitched monophonic ALS) was described as “wheeze” or “stridor” by 84 participants (74%). Only 36 of the 115 participants used a qualifying adjective to describe the ALS. Years of experience was positively correlated with the ability of the participants to correctly identify sound 1. The overall accuracy of the PAs was 58% in describing the ALS samples. This accuracy level is very similar to those of respiratory therapists and physicians reported in previous studies. Conclusions: PAs use the terms “rales” and “crackles” interchangeably to describe discontinuous ALS. They use the term “rhonchi” inappropriately to describe discontinuous ALS associated with excessive secretions. High‐pitched polyphonic and monophonic wheezing were well recognized, but low‐pitched wheezing was not and was described inconsistently. The majority of the PAs in this study did not use a qualifying adjective. The PAs participating in this study are skilled at identifying most ALS and compare favorably to the aforementioned health care professions. PA educators are encouraged to teach the importance of using qualifying adjectives and use of the term “rhonchi” only for low‐pitched continuous ALS.