scholarly journals Physicians’ views on the usefulness of practical tools for assessing the driving ability of older drivers: a cross-sectional study

2020 ◽  
Vol 8 (3) ◽  
pp. e000332
Author(s):  
Paul Sebo
Keyword(s):  
Information Sources ◽  
Medical Specialty ◽  
Perceived Usefulness ◽  
Older Drivers ◽  
Driving Ability ◽  
Patient Questionnaire ◽  
Fitness To Drive ◽  
Cross Sectional ◽  
Reference Guide ◽  
Traffic Medicine

ObjectiveWe aimed to explore Swiss physicians’ views on the usefulness of a self-administered questionnaire completed by older drivers before the consultation and a reference guide summarising current Swiss guidelines on the fitness-to-drive assessment of older drivers. We also aimed to assess the frequency with which physicians used the information sources provided by the Swiss traffic medicine website.DesignQuestionnaire-based cross-sectional study.SettingThe study was conducted in four cantons of Western Switzerland (Geneva, Vaud, Neuchâtel and Jura).ParticipantsAll physicians certified to carry out fitness-to-drive assessments in the canton of Geneva (medical assessors; n=69) and a random sample of 500 general practitioners practising in the cantons of Vaud, Neuchâtel and Jura were invited to participate. They were asked to report their estimated average number of fitness-to-drive assessments per week and to rate on a 5-point Likert scale the perceived usefulness of the preconsultation patient questionnaire and reference guide, and the frequency of use of the information sources provided by the traffic medicine website. We computed the proportion of physicians who found the assessment tools very/somewhat useful and the proportion of physicians who always/often used the traffic medicine website. We compared the responses according to medical specialty (medical assessors vs general practitioners) using design-based F tests and weighted logistic regressions.Results268 physicians (47%) agreed to participate in the study. Their median number of assessments was 2 per week (IQR 2). Overall, the majority of physicians found the questionnaire (75%) and reference guide (89%) very/somewhat useful. Only 17% of the sample always/often used the traffic medicine website. There were no statistically significant associations in multivarible analysis between the medical specialty and the perceived usefulness of the questionnaire and reference guide and the frequency of use of the traffic medicine website.ConclusionMany physicians find the preconsultation patient questionnaire and reference guide useful to guide them for assessing the driving ability of older drivers, but only a minority regularly use the information sources provided by the traffic medicine website. Future studies should explore the reasons why many physicians do not use these available sources of information.

scholarly journals GPs’ awareness of car driving among oldest patients – exploratory results from a primary care cohort

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0145
Author(s):  
Verena Leve ◽  
Michael Pentzek ◽  
Angela Fuchs ◽  
Horst Bickel ◽  
Dagmar Weeg ◽  
...  
Keyword(s):  
Primary Care ◽  
Driving Safety ◽  
Driving Ability ◽  
Fitness To Drive ◽  
Cross Sectional ◽  
Old Patients ◽  
Very Old ◽  
Patient Interviews ◽  
Cognitive Limitations ◽  
Safety Risks

BackgroundIncreasingly more very old people are active drivers. Sensory, motor and cognitive limitations or medication can increase safety risks. Timely attention to driving safety in the patient-doctor relationship can promote patient-centred solutions.AimDo general practitioners (GPs) know which patients drive a car? Is fitness to drive addressed with patients?Design & SettingCross-sectional data from patient interviews and GP survey in the ninth follow-up phase of the German AgeCoDe/AgeQualiDe prospective primary care cohort study.MethodSample: Patients in the age group 85+ and their GPs; independent reports on driving activity from GP and patient; information from GPs on whether driving ability was discussed with the patient; validity parameters, bivariate characterisation of subgroups (non-parametric significance tests, effect size)ResultsSelf-reports of 553 patients are available (69.5% female; mean age 90.5 years; 15.9% drive a car), for 427 patients GP data are also available: GPs recognise 67.1% correctly as drivers and 94.9% as non-drivers. GPs say that they have discussed fitness to drive with 32.1% of potentially driving patients. Among drivers who are not recognised and with whom driving has not been discussed, there are more patients with a low educational level.ConclusionThe GP’s assessment of driving activity among very old patients shows moderate sensitivity and good specificity. Driving ability is discussed seldom. An appropriate question could increase GPs’ awareness of older patients’ automobility.

scholarly journals Predicting On-Road Driving Skills, Fitness to Drive, and Prospective Accident Risk in Older Drivers and Drivers with Mild Cognitive Impairment: The Importance of Non-Cognitive Risk Factors

2021 ◽  
Vol 79 (1) ◽  
pp. 401-414
Author(s):  
Max Toepper ◽  
Philipp Schulz ◽  
Thomas Beblo ◽  
Martin Driessen
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older Drivers ◽  
Accident Risk ◽  
Fitness To Drive ◽  
Cognitive Predictors ◽  
Driving Skills ◽  
Cognitive Risk ◽  
Cognitive Risk Factors

Background: On-road driving behavior can be impaired in older drivers and particularly in drivers with mild cognitive impairment (MCI). Objective: To determine whether cognitive and non-cognitive risk factors for driving safety may allow an accurate and economic prediction of on-road driving skills, fitness to drive, and prospective accident risk in healthy older drivers and drivers with MCI, we examined a representative combined sample of older drivers with and without MCI (N = 74) in an observational on-road study. In particular, we examined whether non-cognitive risk factors improve predictive accuracy provided by cognitive factors alone. Methods: Multiple and logistic hierarchical regression analyses were utilized to predict different driving outcomes. In all regression models, we included cognitive predictors alone in a first step and added non-cognitive predictors in a second step. Results: Results revealed that the combination of cognitive and non-cognitive risk factors significantly predicted driving skills (R2adjusted = 0.30) and fitness to drive (81.2% accuracy) as well as the number (R2adjusted = 0.21) and occurrence (88.3% accuracy) of prospective minor at-fault accidents within the next 12 months. In all analyses, the inclusion of non-cognitive risk factors led to a significant increase of explained variance in the different outcome variables. Conclusion: Our findings suggest that a combination of the most robust cognitive and non-cognitive risk factors may allow an economic and accurate prediction of on-road driving performance and prospective accident risk in healthy older drivers and drivers with MCI. Therefore, non-cognitive risk factors appear to play an important role.

Relationships Between Cognitive and Driving Self-Awareness in Older Drivers

2020 ◽  
Author(s):  
Laurence Paire-Ficout ◽  
Sylviane Lafont ◽  
Marion Hay ◽  
Amandine Coquillat ◽  
Colette Fabrigoule ◽  
...  
Keyword(s):  
Experimental Study ◽  
Cohort Study ◽  
Cognitive Ability ◽  
Cognitive Skills ◽  
Self Regulation ◽  
Older Drivers ◽  
Driving Ability ◽  
Digit Symbol Substitution Test ◽  
Self Awareness ◽  
Subjective Data

Abstract Objectives Many older drivers incorrectly estimate their driving ability. The present study aimed to determine whether, and if so, to what extent unawareness of cognitive abilities affects self-awareness of driving ability. Methods Two successive studies were conducted. A cohort study investigated cognitive self-awareness and an experimental study examined driving self-awareness in older drivers. In each one, self-awareness was assessed by cross-analyzing objective (respectively Trail-Making Tests A & B and the Digit Symbol Substitution Test and driving performance of on-road assessment) and subjective data (responses about everyday cognitive skills and driving ability). Older drivers were then classified as being over-, correct or underestimators. The three cognitive and driving self-awareness profiles were then cross-analyzed. Results In the cohort study, 1,190 drivers aged 70 years or older were included. The results showed that 42.7% of older drivers overestimated their cognitive ability, 42.2% estimated it correctly, and 15.1% underestimated it. The experimental study included 145 participants from the cohort. The results showed that 34% of participants overestimated, 45% correctly estimated, and 21 % underestimated their driving ability. There was a significant relationship between cognitive and driving self-awareness profiles (p=0,02). This overlap was more marked in overestimators. Discussion Significant overlap between cognitive and driving self-awareness provides useful and new knowledge about driving in the aging population. Misestimation of cognitive ability could hamper self-awareness of driving ability, and consequently self-regulation of driving. It is now crucial to develop measures that promote self-awareness of ability.

scholarly journals Determinants of successful guideline implementation: a national cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying-hui Jin ◽  
Li-Ming Tan ◽  
Khalid S. Khan ◽  
Tong Deng ◽  
Chao Huang ◽  
...  
Keyword(s):  
Guideline Development ◽  
Guideline Implementation ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
The West ◽  
Cross Sectional ◽  
Adherence To Guidelines ◽  
Multi Stage ◽  
Geographical Regions ◽  
Tertiary Hospitals

Abstract Background CPGs are not uniformly successful in improving care and several instances of implementation failure have been reported. Performing a comprehensive assessment of the barriers and enablers is key to developing an informed implementation strategy. Our objective was to investigate determinants of guideline implementation and explore associations of self-reported adherence to guidelines with characteristics of participants in China. Methods This is a cross-sectional survey, using multi-stage stratified typical sampling based on China's economic regional divisions (the East, the Middle, the West and the Northeast). 2–5 provinces were selected from each region. 2–3 cities were selected in each province, and secondary and tertiary hospitals from each city were included. We developed a questionnaire underpinned by recommended methods for the design and conduct of self-administered surveys and based on conceptual framework of guideline use, in-depth related literature analysis, guideline development manuals, related behavior change theory. Finally, multivariate analyses were performed using logistic regression to produce adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results The questionnaire consisted of four sections: knowledge of methodology for developing guidelines; barriers to accessing guideline; barriers to guideline implementation; and methods for improving guideline implementation. There were 1732 participants (87.3% response rate) from 51 hospitals. Of these, 77.2% reported to have used guidelines frequently or very frequently. The key barriers to guideline use were lack of education or training (46.2%), and overly simplistic wording or overly broad scope of recommendations (43.8%). Level of adherence to guidelines was associated with geographical regions (the northeast P < 0.001; the west P = 0.02; the middle P < 0.001 compared with the east), hospital grades (P = 0.028), length of practitioners’ practice (P = 0.006), education background (Ph.D., P = 0.027; Master, P = 0.002), evidence-based medicine skills acquired in work unit (P = 0.012), and medical specialty of practitioner (General Practice, P = 0.006; Surgery, P = 0.043). Conclusion Despite general acknowledgement of the importance of guidelines, the use of guidelines was not as frequent as might have been expected. To optimize the likelihood of adherence to guidelines, guideline implementation should follow an actively developed dissemination plan incorporating features associated with adherence in our study.

scholarly journals Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1400-1407 ◽  
Author(s):  
Adam N Romman ◽  
Connie M Hsu ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Rene Przkora ◽  
...  
Keyword(s):  
Pain Management ◽  
Medicare Part D ◽  
Medical Specialty ◽  
Medicare Part ◽  
Provider Type ◽  
Cross Sectional ◽  
Part D ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

scholarly journals Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017757 ◽  
Author(s):  
Ingrid Hjulstad Johansen ◽  
Valborg Baste ◽  
Judith Rosta ◽  
Olaf G Aasland ◽  
Tone Morken
Keyword(s):  
Relative Risk ◽  
Workplace Violence ◽  
Medical Specialty ◽  
Cross Sectional Survey ◽  
Work Time ◽  
Cross Sectional ◽  
Medical Specialties ◽  
Work Settings ◽  
Representative Samples ◽  
Violence Against Doctors

ObjectivesThe aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades.DesignRepeated cross-sectional survey.SettingAll healthcare levels and medical specialties in Norway.ParticipantsRepresentative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158).Main outcome measuresRelative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty.ResultsThere were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95).ConclusionsA substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors’ education and within work settings.

scholarly journals Recruitment of Older Drivers from Primary Care Clinics for on-Road Fitness-to-Drive Testing: Results of a Pilot Study

2014 ◽  
Vol 62 (7) ◽  
pp. 1388-1390
Author(s):  
Marian E. Betz ◽  
David B. Carr ◽  
Carolyn DiGuiseppi ◽  
Jason S. Haukoos ◽  
Steven R. Lowenstein ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Older Drivers ◽  
Fitness To Drive ◽  
Primary Care Clinics

DEMOGRAPHIC STUDY ON SMARTPHONE PREFERENCE AMONG STUDENTS IN NIGERIAN UNIVERSITIES

2021 ◽  
Vol 6 (1) ◽  
pp. 650
Author(s):  
Simon Ayo Adekunle ◽  
Oiza Lauren Dimowo
Keyword(s):  
University Students ◽  
Perceived Usefulness ◽  
Full Time ◽  
Brand Name ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Postgraduate Students ◽  
Frequency Table ◽  
Study Population ◽  
Demographic Attributes

This study investigated smartphone preference among undergraduate and postgraduate students in Nigerian universities. Specifically, the study examined the extent to which students’ demographic attributes such as gender, age, usage experience and educational level influence their preference for smartphones. The study also identified and ranked smartphone brands based on selected factors like brand name, brand attachment, perceived usefulness, social influence, price, aesthetic value and product design and features. A cross-sectional survey research design was used for the study. The study population comprised all full-time university students in Nigeria both at undergraduate and postgraduate levels. Questionnaire was designed and electronically administered using Google Form to the target respondents. After three weeks (10th June to 1st July 2020), five hundred and forty-three (543) responses were collated. However, seventy-eight (78) were found to be invalid. As a result, four hundred and sixty-five (465) responses that formed the sample size were used for the study. The data collected were statistically analyzed using frequency table, percentages, mean, standard deviation and t-test with the aid of Statistical Packages for Social Sciences (SPSS) software. The study found that Samsung is the most preferred smartphone among students. It was also revealed that the first three most important factors that influence students' preference for smartphones are brand name, perceived usefulness, and design/features. The study revealed that demographic attributes do not significantly influence smartphone preference among university students. The study, therefore, recommends that demographic attributes such as gender, age, usage experience and programme should not be significantly considered by manufacturers and marketers of smartphones in product differentiation. Keywords: Brand name, demographics, preference, smartphone, students.    

scholarly journals Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital

2018 ◽  
Vol 36 (07) ◽  
pp. 669-677 ◽  
Author(s):  
Adam K. Lewkowitz ◽  
Nandini Raghuraman ◽  
Julia D. López ◽  
George A. Macones ◽  
Alison G. Cahill
Keyword(s):  
Infant Feeding ◽  
Low Income ◽  
Tertiary Care ◽  
Feeding Practices ◽  
Cross Sectional Study ◽  
Perceived Usefulness ◽  
Breastfeeding Initiation ◽  
Infant Feeding Practices ◽  
Cross Sectional ◽  
Low Income Women

Objective To determine infant feeding practices of low-income women at a Baby-Friendly Hospital and to ascertain breastfeeding interventions they believe would increase exclusive breastfeeding. Study Design This cross-sectional study occurred at a tertiary care Baby-Friendly Hospital. Low-income women without breastfeeding contraindications were recruited at scheduled obstetrician/gynecologist appointments within 6 to 9 months of delivering a term, nonanomalous infant. Participants completed a survey. Outcomes included infant feeding patterns and perceived usefulness of proposed breastfeeding interventions. Results Of 149 participants, 129 (86.6%) initiated breastfeeding; by postpartum day 2 (PPD2), 47 (31.5%) exclusively breastfed, 51 (34.2%) breastfed with formula, and 51 (34.2%) exclusively formula fed. On a scale of 1 (“strongly agree”) to 5 (“strongly disagree”), women who supplemented with formula on PPD2 were significantly more likely than those who exclusively formula fed to agree education on neonatal behavior, 1 (interquartile range [IQR] 1, 2) versus 2 (IQR 1, 3); p = 0.026 and on-demand access to breastfeeding videos on latch or positioning, 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.043; 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.021, respectively, would have helped them exclusively breastfeed. Conclusion Though low-income women at a Baby-Friendly Hospital had high breastfeeding initiation rates, the majority used formula by PPD2. To increase breastfeeding rates among low-income women, future interventions should provide appropriate and effective breastfeeding interventions.

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