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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 student's 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.

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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.

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CONTEXT: Pneumonia is a common disease worldwide that can be fatal if not diagnosed and treated properly. The gold standard for diagnosing pneumonia is the chest radiograph. PURPOSE: A review of the literature identified the relationship between clinical and radiographic evidence of pneumonia within pediatric, adult and geriatric populations. RESULTS: The chest radiograph was frequently found to be negative in patients suspected of having pneumonia regardless of age. Pediatric populations show distinguishing signs and symptoms when pneumonia is present. Fever and tachypnea in children are strong clinical indicators that a chest radiograph is needed. No single sign or symptom predicted pneumonia with a high degree of certainty in adult and geriatric patients. CONCLUSION: The chest radiograph is a popular diagnostic tool in the care of patients suspected of having pneumonia but has a low diagnostic yield in many cases. The clinical utility of the chest film could be improved by careful clinical examination of the patient before obtaining the radiograph, especially in pediatric patients.

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INTRODUCTION: The exact role of respiratory therapists (RTs) in patient assessment is not well defined. The purpose of this study was to identify local physician expectations of RTs for the application and interpretation of various assessment procedures. METHODS: A survey was developed that called for physicians to indicate on a scale of 1 to 5 (1 = never, 2 = rarely, 3 = occasionally, 4 = often, and 5 = always) how important they perceive it is for RTs to be able to interpret or perform 20 commonly used patient assessment tests or procedures. The survey was mailed to 25 physicians who care for patients in the medical and surgical intensive care units at Loma Linda University Medical Center and the Jerry L Pettis Veterans Administration Memorial Medical Center. RESULTS: Twenty (80%) of the surveys were returned. The assessment procedures rated highest were: to assess lung sounds (4.8), to interpret arterial blood gas values (4.5), to interpret pulmonary function tests (4.4), to assess and interpret vital signs (4.4), and to interview patient to clarify symptoms (4.3). The procedures consistently rated low were: to interpret echocardiography (2.5), to assess abdomen (2.3), to interpret sleep studies (2.2), and to interpret electroencephalogram (1.7). A total expectation score for each completed survey was determined by adding the scores from each of the 20 assessment procedures. The average +/- SD total score was 66.8 +/- 10.4 on a scale of 20 to 100. The total expectation score did not vary by years of experience in patient care or type of medical specialty. CONCLUSIONS: The results indicate that the physicians completing our survey generally have high expectations of RTs for the application of patient assessment techniques that involve direct evaluation of lung performance or condition.

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OBJECTIVE: To assess Peruvian mothers' knowledge and recognition of pneumonia in children under 5 years of age, the mothers' attitude toward seeking medical help if they had a child with signs of pneumonia, and their perception of a Government of Peru pneumonia campaign. METHODS: In this cross-sectional study, 501 mothers were selected randomly from 20 low-income communities of the metropolitan area of Lima, Peru, and were interviewed between June and August 2000. Using SPSS software, descriptive statistics were applied to summarize the demographic data and the data regarding the mothers' knowledge of pneumonia and recognition of signs of the disease. Cross-tabulations and chi-squares were done to assess relationships between variables and to make comparisons. RESULTS: About 84% of the mothers said that they knew what pneumonia is. Most believed that pneumonia is dangerous. A majority (58.7%) indicated that pneumonia is caused by lack of parental care. Only 28.9% believed that a virus causes the disease. More than 80% correctly picked rapid breathing and/or chest retraction from a list of possible signs and symptoms of pneumonia, and 94.6% said they were ready to take their child to the closest health center if they thought their child had pneumonia. Although 57.1% said they had heard about the Government of Peru pneumonia campaign, 69.3% of these mothers said they could not recall the motto of the campaign. Mothers who reported having heard of the campaign through TV were more likely than other mothers to correctly recognize the two major signs of pneumonia presented in the campaign. CONCLUSIONS: Although the percentage of mothers believing they can recognize pneumonia through rapid breathing and chest retraction seems to have increased in recent years, there is still a sizable percentage of mothers who remain uninformed about pneumonia and its possible fatal consequences. Efforts need to continue to educate Peruvian mothers about the causes, recognition of the signs, and treatment of pneumonia. The results suggest that the Government of Peru pneumonia campaign should use television much more, as well as the health centers, where most of the mothers receive medical attention and health information.

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