Assessment of health-related quality of life.

In addition to mortality, morbidity, and patient satisfaction, health-related quality of life (HRQOL) is an outcome of health care as well as a consequence of illness or injury. Consequently, instruments to assess HRQOL have become important outcome measures for the evaluation of health care. The last 2 decades have seen the development of hundreds of HRQOL instruments, which are increasingly being incorporated in clinical trials. However, for HRQOL instruments to be valid outcome measures, a variety of factors must be addressed, including conceptual and methodological issues. In addition, there must be careful selection and thoughtful administration. The present report discusses these issues in addition to the scoring and interpretation considerations for the valid assessment of HRQOL. We provide an overview of generic, disease-specific, and utility measures. Using disease-specific instruments pertinent to respiratory care, we discuss their validity, reliability, responsiveness, and minimum clinically important difference. We conclude with recommendations regarding which HRQOL tools have documented evidence that they are psychometrically sound for application to research and clinical practice in respiratory care.

Poor perception of airway obstruction in children with asthma.

The aims of this study were to evaluate children's perception of asthma symptoms and to determine a clinically useful method for identifying poor patient perception of airway obstruction. Three methods were used to analyze the relationships among indices of lung function and perception of breathlessness in 35 children. Approximately half the children in our sample did not perceive either airway obstruction or bronchodilation. We propose that <20% improvement in visual analog scale scores post-bronchodilation may provide a simple index for identifying patients with poor perception of airway obstruction, who may be at risk for fatal or near-fatal asthma.

Development of an instrument to assess stress levels and quality of life in children with asthma.

The purpose of this study was to develop and evaluate a new instrument, About My Asthma (AMA), to assess stressors affecting quality of life in children with asthma. The AMA is a 55-item, 4-point Likert-type scale. Concurrent validity was established by comparing the AMA with the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Increased levels of stress measured by the AMA correlated with a decreased quality of life measured by the PAQLQ. We conclude that the AMA is a valid and reliable instrument to measure the quantity and type of stressors experienced by children who have asthma.

Octave waveband analysis to determine sound frequencies and intensities produced by nebulizers and humidifiers used with hoods.

BACKGROUND: health-care practitioners should be aware of how their equipment and practices can increase the patient's risk for noise-induced hearing loss. PURPOSE: We conducted this study to determine the type of noise produced by humidifiers and nebulizers used with hoods in the neonatal intensive care unit (NICU). We performed octave waveband analysis to determine sound intensities and frequencies because degree of hearing loss from noise exposure is related to the intensity of sound, frequency of sound and duration of exposure. METHODS: We studies 4 simple humidifiers, 3 heated humidifiers, and 4 nebulizers. Sound levels were measured at various frequencies, flows, and water levels using Peace and Shiley oxygen hoods. RESULTS: The findings show that sound levels were significantly louder (p.0.001) for nebulizers compared to humidifiers. Aquapak nebulizers pose the greatest risk for hearing loss because they produce sound at the highest frequencies and volumes. The peak sound levels of humidifiers not only were significantly lower but also occurred at the lowest sound frequencies, which are the least damaging to hearing. Sound levels were generally higher across sound frequencies at higher flows and with the Peace Hood. CONCLUSION: We conclude that heated humidifiers produce lowest sound intensities at the lowest sound frequencies and, consequently, are most appropriate for use in the NICU.

A survey of high school seniors' career choices: implications for allied health.

This paper describes a research study conducted using a survey instrument to determine what factors influence high school seniors when making decisions related to future careers and college education. Students were asked to indicate what careers they intended to pursue, what people and factors influenced their careers choices, and their familiarity with and impressions of the allied health professions. The majority indicated that personal satisfaction, employment opportunities, and income were the most important factors influencing their career choices. Although 76.5% of the respondents had a favorable impression of allied health, only 15% indicated that they were very familiar with the allied health professions. The results here and in other studies point to lack of knowledge rather than lack of interest as the leading cause of enrollment vacancies in allied health curricula.

Analysis of resistance to gas flow in nine adult ventilator circuits.

We measured the resistance in nine complete ventilator circuits, partial circuits and 7, 8, and 9 mm ID endotracheal tubes at flow rates of 20 to 120 liters per minute. We found a statistically significant (p less than 0.01) increase in resistive pressure with increases in flow rate, as the diameter of the ETT decreased, and as each component of the ventilator circuit was added to the ETT. There was a curvilinear increase in resistive pressure to increase in flow rate. However, when resistances were computed, the Bennett cascade "circuit" created higher resistance at 20 lpm than at flow rates up to 120 lpm. The Bennett cascade humidifier added the greatest resistive pressure, 3.5 to 8.5 cm H2O, the Engstrom Edith, 0.5 to 6.5 cm H2O, and the Conchapak added the least, 0.0 to 2.5 cm H2O at flow rates of 20 to 120 lpm. After all the components of the ventilator circuit were attached to the ETTs, there was approximately a 97 to 450 percent increase in resistive pressure compared to the resistive pressure created by the ETTs alone.

Sound levels inside incubators and oxygen hoods used with nebulizers and humidifiers.

Degree of hearing loss in the infant is related to high-intensity or high-frequency sound (noise). We measured sound levels of 6 models of pneumatic nebulizers and 8 models of humidifiers at various flowrates, FIO2 settings, and water levels, when they were attached to incubators and oxygen hoods; we also evaluated sound levels from 2 models of ultrasonic nebulizers at various output settings. Among the pneumatic nebulizers, the recommended 58-dbA maximum sound level was exceeded by the Aquapak 621, Ohio Deluxe, and Puritan All-Purpose devices. The Bard Parker, Foregger, and Inspiron pneumatic nebulizers' sound levels were 58 dbA or below except during the dry water-level condition. Among the humidifiers, all produced sound levels below the recommended 58-dbA maximum except the Travenol humidifier; the Bennett Cascade, Conchapak, Foregger, and Hudson humidifiers produced mean sound levels in the 43.0- to 43.5-dbA range. Sound levels increased under all conditions when the devices were used with oxygen hoods. The ultrasonic nebulizers produced low sound levels, but the high-frequency ultrasound they also produce may be undesirable for infants; this question requires further investigation.

Current and future credentialing in respiratory therapy.

Increasing demands by society in the United States for better, more efficient, and readily available health care have led to development of numerous categories of health practitioners. After a decade of vigorous growth, the emergence of new kinds of specialized health personnel raises questions of legal authority and quality of care. The multiplicity of health care professions often results in duplication of effort, fragmentation of services, and overlapping of job responsibilities, which contribute to ineffective regulation of health care personnel. Historically, credentialing has been the hallmark of professional accountability. All forms of credentialing are intended to provide the public with safe and effective care, but unfortunately the current system has led to ineffective regulation of health care personnel. Respect for professionalism has diminished in the public eye as consumers are questioning whether the elaborate, multiple, and costly mechanisms of current credentialing really protect society. Three types of credentialing currently in use are accreditation of institutions and educational programs, licensure of practitioners, and certification or registration of practitioners. These mechanisms of credentialing are not adequately assuring the competency of health practitioners; therefore, proposed alternatives such as institutional licensure, administrative regulation, national certification, and proficiency examinations should be explored.