scholarly journals Determining Fitness to Drive for Drivers with Dementia: A Medical Practitioner Perspective

2019 ◽  
Vol 30 (2) ◽  
pp. 9-17 ◽  
Author(s):  
Joanne Bennett ◽  
Eugene Chekaluk ◽  
Jennifer Batchelor

Currently in Australia medical fitness to drive decisions for people with dementia are largely conducted by front line medical practitioners. Little is known about the processes that these practitioners use to make these decisions, and how current guidelines assist in making determinations about driving capacity. A short survey was completed by 42 practitioners. The results of the survey supported previous findings that practitioners do not feel comfortable with making the decision regarding fitness to drive for people with dementia. Practitioners relied largely on self-report or informant information regarding current driving practices. Although practitioners reported that the level of cognitive functioning was the most important factor in determining safe driving, only 25% of practitioners employed cognitive assessments. Whilst the vast majority of practitioners were aware of the fitness to drive guidelines, over half did not find them to be sufficient in enabling determinations of driving capacity. Due to this, almost all practitioners reported that they believe they have missed cases of unsafe driving in this population with over 85% endorsing the need for a more objective tool. Significantly, over three quarters of practitioners reported that they have never received training on how to make fitness to drive decisions. Given that the current driver licensing system for people with dementia depends on medical fitness to drive reviews, the lack of confidence by practitioners regarding making fitness to drive decisions can have a detrimental impact on both the safety of the individual drivers, but also the community as a whole.

Author(s):  
Susmitha Vemu ◽  
Triveni Manchu ◽  
Meenakshi Lella

Background: An unqualified medical practitioner without any formal registration and practicing allopathic medicine in rural areas in India can be called Rural Medical Practitioner (RMP). RMPs enjoy a great deal of practice in rural areas by taking advantage of lacunae in the public health system. Government of India is currently popularising generic medicines, but still certain doubts exist even among doctors and how far the RMPs are aware of generic medicines is a big issue. They influence a lot of uneducated people, so the knowledge, attitude and practices they follow have a large impact on society.Methods: A cross sectional, prospective study was undertaken to assess the knowledge, attitude and the practices of 152 RMPs on generic medicines for a period of three months. A 23-item questionnaire was well designed, pre-validated and distributed to RMPs in and around Guntur district. The results were analysed using descriptive statistics.Results: 92% of the participants were aware of generic drugs. More than 80% believed that they are equivalent in terms of efficacy and safety to their branded counterparts and are available at reasonable prices. 95.4% RMPs believed that prescribing generic drugs will decrease the pharmaco-economic burden of the country. Almost all of them agreed on the need for the updates and education on generics by means of continuing medical education (CMEs).Conclusions: The participants had good amount of knowledge on generic drugs but there are concerns regarding quality and therapeutic efficacy of generic drugs. Proper awareness about the generic prescription practice may improve the patient compliance by reducing economic burden to the patients.


2020 ◽  
Author(s):  
Laith Al Azawi ◽  
Aisling O’Byrne ◽  
Lily Roche ◽  
Desmond O’Neill ◽  
Margaret Ryan

AbstractBackgroundTransport mobility, and access to driving, is an important factor in social inclusion and well-being. Doctors have an important role to play in supporting safe mobility through applying the knowledge developed in the field of traffic medicine and incorporating state of the art national and international medical fitness to drive (MFTD) guidelines. Little is known about the profile of MFTD in postgraduate curricula for core and higher specialist training.AimsWe profiled the inclusion of MFTD in the curricula of postgraduate core, higher and streamlined medical and surgical specialties in the Republic of Ireland and the UK. Methods: All publicly available syllabi of basic and higher/ streamlined specialist training in postgraduate medical and surgical colleges in both jurisdictions were analysed (N = 122).ResultsIn Ireland, 25% of basic training schemes included MFTD in the curriculum. Two-thirds of curricula of higher specialty and streamlined training schemes also included MFTD. For the UK, 44% of core and 36% of higher training schemes curricula included MFTD. Just under one-quarter of all curricula reviewed included MFTD for more than one medical condition or treatment. Common topics in both Irish and UK curricula included seizures/epilepsy, syncope and visual disturbances.ConclusionThere are notable deficits in MFTD training for specialists in Ireland and the UK. Common conditions which can significantly impair MFTD such as stroke, diabetes and alcohol use disorders are severely underrepresented and curricula should be revisited to include relevant training and guidance for MFTD for trainees.Main MessagesDoctors have an important role in supporting safe driving among patients with a range of medical conditionsBasic and higher specialist training curricula in a range of specialities in the British Isles are deficient in content relating to medical fitness to driveCurricular development for specialist training should include provision of concise and speciality-relevant guidance on medical fitness to driveResearch QuestionsWhat barriers exist currently to the inclusion of medical fitness to drive and how could these be mitigated?What are the specialty-relevant prioritizations of medical conditions related to medical fitness to drive for inclusion in each curriculum?What resources and evidence are available to specialist training programmes to support the guidance for medical fitness to drive in their curricula?


2002 ◽  
Vol 45 (4) ◽  
pp. 772-782 ◽  
Author(s):  
Larry E. Humes ◽  
Dana L. Wilson ◽  
Nancy N. Barlow ◽  
Carolyn Garner

This study reports the results of a large number of hearing-aid benefit measures obtained from 134 elderly hearing-aid wearers during the first year of hearing-aid usage. Benefit measures were obtained after 1 month, 6 months, and 1 year of hearing-aid use by all participants. In addition, follow-up measurements of hearing-aid benefit were performed on 49 of these same hearing-aid wearers following 2 years of hearing-aid use. All participants in this study were fit binaurally with identical full-concha in-the-ear (ITE) hearing aids that used linear Class-D amplifiers with output-limiting compression. Benefit measures included several objective tests of speech recognition, as well as the subjective self-report scales of the Hearing Aid Performance Inventory (HAPI; B. E. Walden, M. E. Demorest, & E. L. Hepler) and the Hearing Handicap Inventory for the Elderly (HHIE; I. Ventry & B. Weinstein, 1982). Although group means changed only slightly over time for all of the benefit measures, significant differences were observed for some of the benefit measures, especially among the subjective, self-report measures of benefit. In almost all of the cases exhibiting significant changes, performance was significantly worse (less benefit) at both the 6-month and 1-year post-fit interval compared to the measurements at 1 month post-fit. In general, the individual data from the 134 participants who were represented in the 1-year data set were consistent with the trends in the group data described above. Regarding longer term changes in benefit following 2 years of hearing-aid use, minimal changes were again observed. In all, there was little evidence for acclimatization of hearing-aid benefit in this study in either the group or the individual data.


2017 ◽  
pp. 437-446
Author(s):  
Maria Ciesielska

Men’s circumcision is in many countries considered as a hygienic-cosmetic or aesthetic treatment. However, it still remains in close connection with religious rites (Judaism, Islam) and is still practiced all over the world. During the Second World War the visible effects of circumcision became an indisputable evidence of being a Jew and were often used especially by the so-called szmalcownicy (blackmailers). Fear of the possibility of discovering as non-Aryan prompted many Jews hiding on the so-called Aryan side of Warsaw to seek medical practitioners who would restore the condition as it was before the circumcision. The reconstruction surgery was called in surgical jargon “knife baptizing”. Almost all of the procedures were performed by Aryan doctors although four cases of hiding Jewish doctors participating in such procedures are known. Surgical technique consisted of the surgical formation of a new foreskin after tissue preparation and stretching it by manual treatment. The success of the repair operation depended on the patient’s cooperation with the doctor, the worst result was in children. The physicians described in the article and the operating technique are probably only a fragment of a broader activity, described meticulously by only one of the doctors – Dr. Janusz Skórski. This work is an attempt to describe the phenomenon based on the very scanty source material, but it seems to be the first such attempt for several decades.


2019 ◽  
Author(s):  
Curtis David Von Gunten ◽  
Bruce D Bartholow ◽  
Jorge S. Martins

Executive functioning (EF) is defined as a set of top-down processes used in reasoning, forming goals, planning, concentrating, and inhibition. It is widely believed that these processes are critical to self-regulation and, therefore, that performance on behavioral task measures of EF should be associated with individual differences in everyday life outcomes. The purpose of the present study was to test this core assumption, focusing on the EF facet of inhibition. A sample of 463 undergraduates completed five laboratory inhibition tasks, along with three self-report measures of self-control and 28 self-report measures of life outcomes. Results showed that although most of the life outcome measures were associated with self-reported self-control, none of the life outcomes were associated with inhibition task performance at the latent-variable level, and few associations were found at the individual task level. These findings challenge the criterion validity of lab-based inhibition tasks. More generally, when considered alongside the known lack of convergent validity between inhibition tasks and self-report measures of self-control, the findings cast doubt on the task’s construct validity as measures of self-control processes. Potential methodological and theoretical reasons for the poor performance of laboratory-based inhibition tasks are discussed.


Author(s):  
Sunny J. Dutra ◽  
Marianne Reddan ◽  
John R. Purcell ◽  
Hillary C. Devlin ◽  
Keith M. Welker

This chapter not only draws from previous authoritative measurement overviews in the general field of emotion, but also advances these resources in several key ways. First, it provides a specific focus on positive valence systems, which have not yet received specific methodological attention. Second, the field of positive emotion (PE) has expanded in recent years with new and innovative methods, making an updated review of methodological tools timely. Third, the chapter incorporates discussion of PE disturbance in clinical populations and the methods best suited to capture PE dysfunctions. This chapter also outlines some tools that can allow researchers to capture a broad array of PE quantified by self-report, behavioral coding, and biological correlates as seen through changes in the central and peripheral nervous system (i.e., brain and body). After reviewing PE measurement methods and correlates, this chapter includes several methods for studying PE beyond the individual level (i.e., interpersonal) and traditional laboratory settings (i.e., ambulatory or experience sampling). It provides key examples of their applications to study PE in clinical populations while acknowledging several of their basic advantages and disadvantages.


Sign in / Sign up

Export Citation Format

Share Document