A National Survey of Older Driver Refresher Programs: Practice Readiness for a Rapidly Growing Need

ABSTRACT

Objectives. This national survey identified the content and structure of existing older driver refresher programs in Canada, along with the perceived facilitators and barriers for providing such services. Methods. A cross-Canada telephone survey was conducted with a convenience sample of 27 program managers representing 18 driver refresher programs and nine general health promotion programs for older individuals. Results. Two types of driver programs were identified: pre-road training (including classroom-style group education programs) and on-road training. Only one of the 18 driver refresher programs included visual perception and physical retraining: both interventions have some evidence of effectiveness in improving driving performance. Most program managers emphasized a strong perceived value of supporting/creating driver refresher programs to maintain safe driving. Conclusion. Findings of this study support the urgent need for evidence-based policy development and a strategic plan to ready our nation for the growing number of older drivers who require refresher programs.     

Recruitment and Communication Process for Participation in the 2005 AEM Consensus Conference on the Ethical Conduct of Resuscitation Research: Methodology, Challenges, Lessons Learned

The 2005 Academic Emergency Medicine Consensus Conference, “Ethical Conduct of Resuscitation Research,” was designed with the goal of developing consensus on important issues for human subjects and researchers surrounding the 1996 federal regulations jointly published by the Department of Health and Human Services and the Food and Drug Administration and known as the Final Rule. These regulations, which guide the conduct of research using the emergency exception from informed consent or waiver of informed consent, have been the subject of much debate in the resuscitation research community. Therefore, the editorial board of Academic Emergency Medicine chose this topic as the subject of their annual consensus conference. This report outlines the methods by which individuals and organizations were recruited to participate, how the conference was advertised, and the way in which participants and nonparticipants were encouraged to communicate before and after the conference. The limitations and potential biases of these methods and activities are also presented.     

Preoperative Management of Endocrine,Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.     

Identification of relevant categories for inpatient physical therapy care using the International Classification of Functioning,Disability and Health: a Brazilian survey

BackgroundHospitalized patients are at risk for the loss of function and impairment. Physical therapists aim to improve functionality and prevent disabilities. The International Classification of Functioning, Disability and Health (ICF) propose a universal language to classify the functionality of patients across different health care settings and over diverse health conditions.ObjectivesTo identify the International Classification of Functioning, Disability and Health categories that describe most common and relevant patient problems managed by physical therapists in Brazilian hospitals in the acute and post-acute care settings.SubjectsThe participants were physical therapists who worked in hospitals with a minimum work experience of two years.MethodsA consensus-building, two-round, emailed survey was conducted using the Delphi technique.ResultsFor the development of an ICF short list, 47 physical therapists from the acute care setting and 30 physical therapists from the post-acute care setting responded to the Delphi exercise. Most of the professionals were from the cardiorespiratory physical therapy area. A 80% level of consensus or higher was established for the selection of the categories of the ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors). We obtained two short lists to be used in clinical practice comprising 39 ICF categories for acute care settings and 53 for post-acute care settings.ConclusionThis study is the first to identify the most relevant aspects for physical therapy in Brazilian hospitals using the ICF framework. Our results can help to promote the adoption of the ICF in physical therapy clinical practice in the hospital setting.     

System-wide Clinical Assessment of Functioning Based on the International Classification of Functioning,Disability and Health in China: Interrater Reliability,Convergent, Known Group,and Predictive Validity of the ICF Generic-6

ObjectiveTo validate the International Classification of Functioning, Disability and Health (ICF) Generic-6 in daily routine clinical practice in Mainland China. Specific objectives were to analyze (1) interrater reliability, (2) convergent validity, (3) known group validity, and (4) predictive validity of the ICF Generic-6.DesignMulticenter prospective cohort study.SettingFifty hospitals from 20 provinces of Mainland China.ParticipantsA total of 4510 patients from departments of rehabilitation, orthopedics, neurology, cardiology, pneumology, and cerebral surgery of the participating hospitals with different health conditions were included in this study.InterventionNot applicable.Main Outcome MeasuresThe assessment was undertaken by nurses with ICF Generic-6 in combination with a numeric rating scale. Interrater reliability was evaluated with intraclass correlation coefficients (ICC). Convergent validity was evaluated with Spearman correlation coefficients between ICF Generic-6 and Medical Outcomes Short Form (SF)-12 items. Known group validity was examined by comparing discharge scores between different discharge destinations. Predictive validity was determined by using ICF Generic-6 baseline scores for estimating length of hospital stay with a loglogistic survival model with gamma shared frailty and cost of in-hospital treatment with a mixed effects generalized linear regression model of the gamma family.ResultsThe interrater reliability of items and score of ICF Generic-6 was good with ICCs ranging from 0.67-0.87. ICF Generic-6 items were further correlated with respective SF-12 items. Discharge scores of patients differed significantly by discharge destination. The ICF Generic-6 admission score was a significant predictor of length of stay and treatment cost.ConclusionsThe ICF Generic-6 administered in combination with a 0-10 numeric rating scale is a reliable and valid tool for the collection of minimal information on functioning across various clinical settings.