Predictors of student satisfaction with allied health educational program courses.

UNLABELLED: Little information is available regarding the effectiveness of various teaching methods and styles on student learning and satisfaction in allied health educational programs. We used the IDEA Center's course evaluation system to determine which teaching competencies were most predictive of students' satisfaction and progress on objectives. METHODS: At the conclusion of each quarter, all students in 13 different allied health programs were asked to complete standardized course evaluations. Students responded to 20 questions grouped into five teaching competencies. Student satisfaction was assessed using survey questions to rate course and instructor excellence. All questions used a 5-point Likert scale. RESULTS: There were 2,924 student evaluations returned (72.5% response). Teaching competencies predicted 62% of the variation in course satisfaction, 67% of the variation in teacher satisfaction, and 58% of the variation in progress on relevant objectives (p<0.001. Stimulating student interest was the strongest predictor of course satisfaction and progress on relevant objectives (p<0.001. Structuring classroom experiences was the strongest predictor of teacher satisfaction (p<0.001. CONCLUSION: By developing specific teaching competencies, instructors may improve student satisfaction and progress on relevant objectives. Educational institutions may also be able to utilize this information to create faculty developments plans in an effort to improve teaching and student satisfaction levels.

Research in the allied health professions: why fund it? A report of the ASAHP Research Committee.

Many professionals work closely with physicians and nurses to provide healthcare that is safe, patient-centered, efficient, equitable, timely, and effective. These professionals represent many and varied allied health disciplines. Each allied health professional is ethically accountable for bringing a theoretically-sound and evidence-based approach to problem-solving in healthcare delivery. Although allied health research is in its infancy, the breadth and depth of its potential contributions to effective healthcare research and its interprofessional application may be under-recognized, particularly by funding agencies. The purpose of this paper is to define allied health, clarify its theoretical and scientific foundation, emphasize the breadth of its application to evidence-based practice, and document its relevance to, and suitability for, funding through national organizations.

A randomized, controlled study to evaluate the role of an in-home asthma disease management program provided by respiratory therapists in improving outcomes and reducing the cost of care.

BACKGROUND AND PURPOSE: Asthma management programs (AMP) may reduce costs and improve outcomes in patients with moderate to severe asthma. However, it is not known which personnel are best able to deliver such interventions and what settings are most effective. The purpose of this study was to compare the effects of an in-home AMP provided by respiratory therapists (RTs) to an AMP provided by nurses (RNs) and to usual care (UC) provided in physician offices or clinics. METHODS: Subjects (age 18-64) who had been admitted to the emergency department (ED) or hospital for acute asthma exacerbation were randomized to three groups: AMP-RT, AMP-RN or UC. The AMP groups received five (5) weekly home visits to provide assessment and instruction; the UC group was instructed to return to their physician for routine follow-up. Outcomes assessed at 6 months included hospitalizations, in patient days, hospitalization cost, ED visits and cost, clinic visits, pulmonary function, symptoms, health related quality of life (HRQOL), asthma episode self-management score (AESM), environmental assessment, and patient satisfaction (PS). Variables were compared using ANOVA with a Neuman-Keuls follow-up for multiple comparisons using an intent-to-treat approach. RESULTS: Upon enrollment, (n = 159) there were no differences (p > .05) between groups for age, gender, pulmonary function or HRQOL (SF-36 and St. Georges Respiratory Questionnaire - SGRQ). At 6 months, both AMP groups (AMP-RN n = 54; AMP-RT n = 46) had significantly fewer (p < 0.05) hospitalizations and in-patient days, lower hospitalization costs, and greater HRQOL physical component summary change scores (PCS) and PS than UC (n = 59). AMP-RT also had greater PEFR, SGRQ Total and SGRQ Symptoms change scores when compared to UC and significantly better AESM and PS scores as compared to AMP-RN and UC. CONCLUSIONS: An in-home asthma management program can be effectively delivered by respiratory therapists and may reduce hospitalizations, in-patient days, cost and improve measures of HRQOL and PS in a population prone to asthma exacerbation.

The effect of a pediatric asthma management program provided by respiratory therapists on patient outcomes and cost.

OBJECTIVE: The objective was to determine whether a pediatric asthma disease management program (ADMP) provided by respiratory therapists can improve patient outcomes and reduce cost. DESIGN: This was a pre-and post-intervention observational study. METHODS: Hospitalizations, non-intensive care unit (ICU) hospital days, ICU days, emergency department visits, doctor's office visits, school days missed, and associated costs were collected on 18 children with moderate to severe asthma, ages 3 to 18 years, 12 months before and after implementation of the ADMP. The ADMP consisted of eight home visits for assessment, environmental review, and patient education. RESULTS: There were significant reductions (P < .05) in hospitalizations, hospitalization cost, ICU days, non-ICU days, length of stay, emergency department visits and cost, physician office visits and cost, and school days missed. CONCLUSIONS: A pediatric in-home ADMP provided by respiratory therapists can improve outcomes and reduce cost in patients with moderate to severe asthma.

Education and credentialing in respiratory care: where are we and where should we be headed?

Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. Respiratory therapists, through primary, secondary, and tertiary prevention activities, can positively affect peoples'quality of life. This advanced level professional will work in the intensive-and acute-care settings, applying sophisticated cardiopulmonary technologies, as well in clinics, physician offices, home care, long-term and rehabilitation facilities, industry, educational institutions, and research facilities. The alternative to this advanced practice is for the profession to remain a task-oriented technical field, focused on procedures and the technical aspects of oxygen and aerosol therapy, mechanical ventilatory support, and related diagnostic and monitoring techniques. Although there is a dignified and important role for the provision of the technical aspects of respiratory care, the authors believe that the future role of the respiratory specialist is that of physician extender. Higher-order performance will result in higher-order contributions to health care. This role will require increased numbers of baccalaureate and graduate degree programs in respiratory care and increased numbers of respiratory therapists who hold higher degrees,including the master's degree in respiratory care and doctoral degrees in related fields. Community colleges, 4-year colleges, and universities should be encouraged to develop effective articulation agreements and mechanisms to offer the bachelor of science degree in respiratory care to the community college student. Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.

Delivered oxygen concentrations using low-flow and high-flow nasal cannulas.

INTRODUCTION: Nasal cannulas are commonly used to deliver oxygen in acute and chronic care settings; however, there are few data available on delivered fraction of inspired oxygen (F(IO(2))). The purposes of this study were to determine the delivered F(IO(2)) on human subjects using low-flow and high-flow nasal cannulas, and to determine the effects of mouth-closed and mouth-open breathing on F(IO(2)). METHODS: We measured the pharyngeal F(IO(2)) delivered by adult nasal cannulas at 1-6 L/min and high-flow nasal cannulas at 6-15 L/min consecutively in 10 normal subjects. Oxygen was initiated at 1 L/min, with the subject at rest, followed by a period of rapid breathing. Gas samples were aspirated from a nasal catheter positioned with the tip behind the uvula. This process was repeated at each liter flow. Mean, standard deviation, and range were calculated at each liter flow. F(IO(2)) during mouth-open and mouth-closed breathing were compared using the dependent test for paired values, to determine if there were significant differences. RESULTS: The mean resting F(IO(2)) ranged from 0.26-0.54 at 1-6 L/min to 0.54-0.75 at 6-15 L/min. During rapid breathing the mean F(IO(2)) ranged from 0.24-0.45 at 1-6 L/min to 0.49-0.72 at 6-15 L/min. The mean F(IO(2)) increased with increasing flow rates. The standard deviation (+/- 0.04-0.15) and range were large, and F(IO(2)) varied widely within and between subjects. F(IO(2)) during mouth-open breathing was significantly (p < 0.05) greater than that during mouth-closed breathing. CONCLUSIONS: F(IO(2)) increased with increasing flow. Subjects who breathed with their mouths open attained a significantly higher F(IO(2)), compared to those who breathed with their mouths closed.

How to make an effective poster.

Poster presentations given at scientific meetings are widely used in medicine, nursing, and allied health professions to communicate research findings. A good poster presentation can be an effective way to share the results of your research with your peers, in a collegial and non-threatening atmosphere. Feedback received during a poster session can be invaluable in refining your research and preparing for publication in a peer reviewed journal. A typical poster presentation follows the same format as a scientific paper. Poster sections include a title banner, the abstract, introduction, method, results, discussion, conclusions, and tables and figures. Technical details of poster production include decisions on what materials and methods to use to print and display your poster, font size, whether to use a professional graphics department for production, and cost. Presentation of your research at a professional meeting can be a rewarding experience, and is a useful step toward publishing your research in a respected science journal.

An assessment of the appropriateness of respiratory care delivered at a 450-bed acute care Veterans affairs hospital.

INTRODUCTION: Respiratory care is expensive and time-intensive, inappropriate care wastes resources, and failure to provide necessary and appropriate respiratory care may adversely affect patient outcomes. OBJECTIVE: To determine the appropriateness of basic respiratory care delivered at a 450-bed Veterans Affairs hospital during a 3-month interval. METHODS: We determined (1) the percentage of delivered respiratory care that was not indicated (based on standardized clinical practice guidelines), (2) the percentage of respiratory care that was indicated but not ordered (based on standardized clinical practice guidelines), and (3) the labor cost and potential savings of protocol-based respiratory care at our hospital. We selected 5 assessment days, occurring at 2-week intervals. All patients who received basic respiratory care underwent a complete respiratory care assessment, including medical records review, patient interview, physical assessment, and measurement of blood oxygen saturation (via pulse oximetry) and inspiratory capacity. Intensive care patients were excluded from the study. The assessment instrument provided a standardized format based on American Association for Respiratory Care clinical practice guidelines. RESULTS: We assessed 75 patients. A mean of 24.8% of the delivered respiratory therapies reviewed were not indicated. The percentages of ordered but not indicated therapies were: oxygen 17.7%; all categories of aerosolized medications (bronchodilators, mucolytics, anti-inflammatory agents) 32.4%; chest physiotherapy 37.5%; lung expansion therapy 7.7%. A mean of 11.8% of the patients assessed were not receiving respiratory care that was indicated. The percentages of indicated but not ordered therapies were: oxygen 5.3%; bronchodilator 5.3%; lung expansion therapy 36%. CONCLUSION: A mean of 24.8% of the basic respiratory care procedures delivered were not indicated and 11.8% of patients were not receiving care that was indicated. Inappropriate utilization of respiratory care services may increase costs and adversely affect morbidity, mortality, and duration of stay. We believe that implementation of respiratory care assessment protocols based on nationally accepted clinical practice guidelines can reduce unnecessary care, optimize care delivered, and may reduce costs and improve outcomes.