Short Version: Why Patients Stop Taking Their Controller Medications

-Many stop taking their medications when they don't show symptoms.

-Compliance implies passive and disinterested. Adherence implies an activated patient who willingly accepts their role and responsibility. So let's stop calling it compliance and start calling it adherence.

-Non-adherence increases morbidity, mortality, and healthcare costs.

-Most common reasons for Intentional Non-adherence:
  1. Concerns about adverse effects - 65% of new prescriptions for inhaled corticosteroids are not refilled. Inhalation route of steroid administration does not necessarily equate to HPA axis suppression (i.e., growth retardation) or bone density issues.
  2. Medications are too expensive - Many pharmaceutical firms offer rebates or special pricing for low income patients.
  3. Not really that sick - Denial is a problem with asymptomatic patients. Conversation should be on the difference between effective long-term symptom control and a 100% cure.
  4. Not wanting to get “hooked” - An counter to this perception would be to stress that the eventual goal is to achieve an improved overall quality of life.
  5. Medications no longer work - When a regimen of inhaled corticosteroids is successful, subsequent doses may not be perceived as having any impact, as their role is now more preventative.
  6. To gain attention - It is important that parents realize, especially with asthma, the possibility a recurrence of symptoms may indeed be the direct result of the child willfully deciding not taking their medications as directed. 
-Respiratory therapists possess all of the skills, attributes and talents needed to help foster sustained adherence.


The Five Things I Always Carry In My Pocket As A RT

1 Pen
Kind of obvious. I don't buy pens anymore because I always lose them. The best pens are the free ones.

2. Report Sheet AKA The Brain. 
Because It's really difficult to remember more than 6 patients and all their settings. 

3. Scissors 
The ones with the smooth edges are better than the sharp OR scissors. I have stabbed myself in the butt while sitting down. Never again. Scissors are just so useful. Where I work not all of the patients rooms have scissors stocked in their carts.

4. Pen Light 
I work night shift. It's essential to use a pen light to check ETT tube placements, meds, flow meter settings and etc. without turning on all the lights in the room. I see some coworkers have used their phones to look for things in the dark. It just doesn't look as professional / bad ass as a pen light.

5. Sharpie Marker
Labeling drugs and stuff that needs to be replaced.

Other stuff that I carry on my body:

You're not a respiratory therapist without one. 

Because half the clocks at the hospital need new batteries or are set to the wrong time. 

Other stuff I would like to carry but I don't have space and I'm not going to wear a fanny pack:

22mm adapter
It's a fact: 22mm adapter > 18mm adapter

ETT tape
I always have trouble finding good tape. I can't stuff it in my pocket because it always collects lint and then it looks gross.

Adhesive remover
Because it's mean to rip tape off a kids face without it. 

Clamps help me break adapters apart when our equipment gets crusted with salt. 

America's Most Profitable Prodcuts 2014

1. iPhone
> Operating margin: 41%
> Product revenue: $91.3 billion
> Market share: 45.0%
> Industry: Computer hardware

2. Marlboro
> Operating margin: 32%
> Product revenue: $18.7 billion
> Market share: 40.3%
> Industry: Tobacco

Anybody else surprised?

3. Monster
> Operating margin: 26%
> Product revenue: $2.1 billion
> Market share: 34.6%
> Industry: Soft drinks

4. Jack Daniels Tennessee Whiskey

> Operating margin: 25%
> Product revenue: $2.0 billion
> Market share: 2.4% (U.S.; largest American whiskey)
> Industry: Alcohol

5. Coca-Cola
> Operating margin: 24%
> Product revenue: $13.7 billion
> Market share: 42.4%
> Industry: Soft drinks

6. Enfamil
> Operating margin: 24%
> Product revenue: $2.0 billion
> Market share: 40.0%
> Industry: Packaged foods and meats

7. Harley-Davidson Motorcycles
> Operating margin: 17%
> Product revenue: $4.1 million
> Market share: 54.9%
> Industry: Motorcycles

Read more: America’s Most Profitable Products - Harley-Davidson, Inc. (NYSE:HOG) - 24/7 Wall 

Thoughts On E-Cigarettes 2014

Are electronic cigarettes healthier than normal cigarettes? The studies so far have been inconclusive. 

The American Lung Association is "very concerned about the potential health consequences of electronic cigarettes as well as the unproven claims that they can be used to help smokers quit," according to their site. There are few reports on batteries overheating with incompatible chargers but I know my readers too smart for something like that to happen. University College London study said E-cigs worked better for people trying to quit smoking than any other nicotine replacement, but the University of California San Francisco found the opposite is true.

I still have mixed feelings about them.

On one hand you have E-cigs that are marketing towards children with colorful and fruity flavors. E-Cig consumption among high school students has doubled from 2011-2012. Since we don't know the long term affects of E-cigs, will this overall negatively affect one's health?

According to DNews with their video on Is Marijuana Smoke Healthier Than Tobacco Smoke?, it's not the chemicals that are hurting you but the smoke itself. Does that include E-cigs?

On the other hand you have countless success stories from the Reddit electronic cigarette forum that tell the tales of how E-cigs have helped them quit. I personally know two people that are smoking few and fewer cigarettes now because of E-cigs. Will they ever stop completely? Who knows? It's also cheaper.

I will never truly understand what strength of vice grip nicotine has on someone since I've never been in that situation myself. I might of smoked for two months in my experimental college phase but then realized that I was too poor to smoke. +1 for poverty!

The best answer I can give is to try E-Cigs if you definitely have a goal to quit and have exhausted other options. Research the different doses and flavors as much as possible. Understand the risks (dehydration). Obtain a quality kit and juice. Stay away from Diacetyl. Maybe start with a juice that is similar to your favorite brand of cigarettes and then slowly wean yourself off the cigarettes as you start vaping.

Now you are saving a little money and still getting your nicotine fix. Can you wean yourself off the nicotine now?

Here are some quick links:

Quick FAQ on e-cigs
Reddit Eectrong cigarette forumReddit E-cig supplier list

ADC ADSCOPE 603 Stethoscope Review

Price: $32.25
Place: Amazon
Rating: 4.5 / 5

Pros: Lifetime warranty on metal parts. Identity tag. Price. Extra ear pieces.
Cons: Identity tag falls apart. Heavy head. 

The standard stethoscope among many practitioners is the 3M Littmann Classic II S.E. Since mine finally broke after 5 years, I decided to look for cheaper options without sacrificing quality since the Littmann is $105 MSRP (though you could find it for ~$75 online). I learned to take better care of my stethoscope by wiping it down with a alcohol pad every day. The oils in my neck ate away at the stethoscope for years not that I have a very oily neck or anything. I also twirled it around a lot (Don't do that).

After reading through many reviews I ended up with the ADC 603 Stethoscope. From the guys that make our miller and mac intubation blades, the ADC Stethoscope is the same length (22 cm) as the Littmann and looks nearly identical. The Litmman offers a 5 year warranty on metal parts. The ADC offers lifetime warranty. You'll more likely to lose your stethoscope or have it stolen before those warranties though.

The ADC came in a nice box similar to my older Littmann. The box contains the stethoscope, hard and soft ear guards, a spare diaphragm, and identity tag that snaps at the bifurcation point. My Litmann did not contain a identity tag. The sound quality itself is on par with the Littmann. The tubing is thick enough to block out ambient noise but not inflexible. 

The only real problem I have with this stethoscope is the chest piece. It seems a little heavier than the Littmann SE II so it slides off my neck sometimes. The identity tag is a two piece hard plastic that sits at the bifurcation point. There have been times where my stethoscope would hit the desk the the tag would just come apart. I fixed the issue using small amounts of tape on the undersides.
The ID tag also saved my stethoscope on a few occasions. I occasionally leave it at work and it would find it's way back to my work mailbox.

ADC is the best stethoscope for this price point and I would not hesitate to buy another one.