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The commodification of education in all forms has created a lucrative trade, particularly within the realm of continuing professional education. Mandated across a wide spectrum of industries, and particularly salient in healthcare due to rapid advances in medicine and technology, professional education is said to be the vehicle that keeps practitioners informed of the latest developments in their respective fields. While outwardly noble in intent, the lack of application of sound adult educational paradigms and the stranglehold on quality and content criteria held by programme accrediting bodies has largely fostered an environment ripe with top-down passive material transmission. Proprietors of professional education have used its compulsory nature primarily as a means of increasing revenues and have missed the opportunity to overhaul a broken system characterised as valuing quantity over quality. A review of research in the healthcare continuing educational system in the United States as viewed through the lens of andragogical theory reveals a landscape absent of educational accountability, governed by stakeholder agencies more interested in enforcing the maintenance of a programme roster or transcript than creating legitimate learning experiences.

The nature of the changing economic climate has resulted in drastic changes in the postsecondary education landscape. With record numbers of adult learners seeking to further their education, they are faced with numerous outlets, including traditional liberal universities and a variety of for-profit colleges and vocational schools that have shifted from their historical practice of operating primarily as certificate-granting programs to the practice of awarding degrees. While models of operation and sources of funding are largely different between the two educational models, similarities do exist, and staunch criticism and defense has arisen from both sides in regard to approach, results, and legitimacy. This article seeks to examine whether proprietary models of higher education are indeed legitimate alternatives to traditional institutions within the constraints of the current capitalist system, and it presents arguments from both sides while examining implications for students and society at large.

We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1995 and April 2011. The update of this clinical practice guideline is the result of reviewing a total of 54 clinical trials and systematic reviews on incentive spirometry. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system. 1: Incentive spirometry alone is not recommended for routine use in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 2: It is recommended that incentive spirometry be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications. 3: It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 4: Routine use of incentive spirometry to prevent atelectasis in patients after upper-abdominal surgery is not recommended. 5: Routine use of incentive spirometry to prevent atelectasis after coronary artery bypass graft surgery is not recommended. 6: It is suggested that a volume-oriented device be selected as an incentive spirometry device. [ABSTRACT FROM AUTHOR]