Human factors in the causation of road traffic crashes

Road traffic crashes (RTCs) are responsible for a substantial fraction of morbidity and mortality and are responsible for more years of life lost than most of human diseases. In this review, we have tried to delineate behavioral factors that collectively represent the principal cause of three out of five RTCs and contribute to the causation of most of the remaining. Although sharp distinctions are not always possible, a classification of behavioral factors is both necessary and feasible. Thus, behavioral factors can be distinguished as (i) those that reduce capability on a long-term basis (inexperience, aging, disease and disability, alcoholism, drug abuse), (ii) those that reduce capability on a short-term basis (drowsiness, fatigue, acute alcohol intoxication, short term drug effects, binge eating, acute psychological stress, temporary distraction), (iii) those that promote risk taking behavior with long-term impact (overestimation of capabilities, macho attitude, habitual speeding, habitual disregard of traffic regulations, indecent driving behavior, non-use of seat belt or helmet, inappropriate sitting while driving, accident proneness) and (iv) those that promote risk taking behavior with short-term impact (moderate ethanol intake, psychotropic drugs, motor vehicle crime, suicidal behavior, compulsive acts). The classification aims to assist in the conceptualization of the problem that may also contribute to behavior modification-based efforts.     

驱动压导向呼气末正压通气对老年患者腹腔镜前列腺癌根治术后肺功能的影响

目的 探讨驱动压导向的个体化呼气末正压(PEEP)通气对老年患者腹腔镜前列腺癌根治术后肺功能的影响。方法 选择2021年8月至2022年6月行择期腹腔镜前列腺癌根治术的老年患者60例,年龄≥65岁,BMI 18～30 kg/m²,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组：驱动压(ΔP)导向组(P组)和对照组(C组),每组30例。P组采用ΔP导向的PEEP,C组给予PEEP 5 cmH₂O。记录气腹-Trendelenburg体位建立后即刻(T₀)、PEEP滴定完成后30 min(T₁)、1 h(T₂)、2 h(T₃)、术后30 min(T₄)时HR、MAP并行血气分析,记录PaO₂、PaCO₂,计算氧合指数(OI)。记录T₀—T₃时的气道峰压(Ppeak)、气道平台压(Pplat)、动态肺顺应性(Cdyn)等呼吸力学指标并计算ΔP。于术前1 ...     

Seizures occurring while driving in patients with and without diagnosis of epilepsy: Frequency and association with automobile accidents

Seizure may occur during any human activity, including driving. The objectives of this study were to report the frequency of seizure occurring while driving, clarify patient characteristics and analyze the behavioral patterns of drivers afflicted by seizure. A single-center, retrospective study was conducted using prospectively acquired data. Data of 658 adult seizure patients who visited our emergency department between January 2011 and December 2016 were used for analysis, focusing on daily activities immediately before seizure. Nineteen of the 658 patients (2.9%) sustained seizure while driving. The 658 patients were dichotomized on the basis of whether he or she had been diagnosed with epileptic seizure (ES). Seven of the 307 patients with ES vs. 12 of the 351 patients without ES sustained seizure while driving. The frequencies did not differ significantly between the two groups (2.3% vs. 3.4%, p = 0.49). Structural lesions on brain imaging studies were found in 6 of the 12 patients without ES (50%). Sixteen of the 19 patients (84%) caused automobile accidents after seizure. Among the 7 patients with ES, antiepileptic drugs had not been prescribed in 3 (43%). Although seizures occurring while driving have been studied extensively, most researchers focused on patients with ES. This study was unique because it focused on patients without ES, and the current findings that seizures in patients without ES outnumbered seizures in those with ES may be informative to clinical neuroscientists and emergency physicians. Prospective studies are expected to identify individuals at risk for first seizure occurring while driving.     

Benefits of information technology training to National Health Service staff in Wales

The use of computers in the National Health Service (UK) as a workplace is fundamental to its future. However, there is evidence of a paucity of information technology skills within the workforce and therefore, information technology skill training is essential. The National Health Service in Wales has been using the European Computer Driving Licence qualification to educate its staff in order to cover this skill gap. This paper reports on an evaluation of the perceived benefits to staff, both clinical and non-clinical, working for the National Health Service in Wales of information technology training through the European Computer Driving Licence qualification. Results show that there is an increase in confidence in terms of tasks undertaken but also towards other general life skills. Additionally, for those respondents with clinical contact, there is a perceived increase both in the time available with and the quality of care, given to patients. As the continued move towards a computer orientated healthcare system occurs, the information technology skills obtained through but not limited to training schemes such as European Computer Driving Licence will become of paramount importance, particularly as the single most important failure for technology-related projects in healthcare is a lack of readiness.     

E-scooter and E-bike injury pattern profile in an inner-city trauma center in upper Manhattan

BackgroundElectric bikes and scooters are becoming popular means of short-distance transportation in major cities. Regulations for safe riding established by ride-sharing companies and local governments have not been effectively implemented. Inner-city hospitals are at the frontline of receiving traumas related to e-bikes and e-scooters and are receiving an increasing number of injuries. The works of literature reporting these injuries are limited.MethodThis study reviewed all the trauma activations at a major trauma center in NYC from 04/2019 to 08/2021. Patients with e-bike and e-scooter injuries were included in the study. Socio-demographics of riders, passengers, injury patterns, and outcomes were reviewed. Logistics regression was used to analyze the factors associated with Injury Severity Scale.ResultsWe reviewed 1979 patient charts of trauma activation in the Emergency Department. We included 88 scooters, 24 E-bike, and 5 nonrider scooter injuries. 91% were male and 9% were Female victims. The majority were African American patients (34%) and Hispanic patients (46%). 87% belonged to the 18–50 years age group, and 13% were above 50 years and below 18 years were excluded from the study. 36% of victims were under the influence of drugs or alcohol and only 25% of riders wore helmets. 58% of patients were discharged from the ED, 42% required hospital admission, and 14% required ICU care. Odds of non-mild injury (moderate to critical injury) in comparison to mild injury were significantly greater with increasing age.ConclusionsThe use of e-bikes and e-scooters is increasing as a means of affordable short-distance transportation but with evidence of significant injuries with varying severity. These findings suggest a need to review public policy regarding e-bike and electric scooter use regulations for the safety of riders and pedestrians; Driving While Intoxicated (DWI) law enforcement, mandatory helmet, education, speed control, creation of special lanes, and no car zones.     

驾驶员情绪状态对驾驶决策的Logistic回归分析

目的分析驾驶员的情绪特征对驾驶决策的预测作用。方法采用爱荷华赌博任务对驾驶员进行决策类型的分类,情绪状态量表测量驾驶员的情绪状态,通过Logistic回归分析预测情绪状态对不同决策类型驾驶员的影响。结果①积极情绪与消极情绪对不同类型的驾驶决策具有预测作用(χ2=50.639,df=2,P0.05);②驾龄、性别作为调节变量对不同类型驾驶决策具有预测作用(χ2=23.811,df=8,P0.01)。结论①在情绪状态量表中,积极情绪状态得分越高,消极情绪状态得分越低的驾驶员,决策类型是勇于冒险的可能性更大;②当考虑到性别与驾龄时,决策类型更多的受到新手消极情绪状态和女性积极情绪状态的影响。     

Examining the process of driving cessation in later life

Driving cessation for many older people is associated with a poorer quality of life and can lead to health problems such as depression. This paper aims to reveal the process of giving-up driving, examining in particular triggers for giving-up driving, how information on alternative modes of transport is sought and how new transport and travel behaviour is integrated into older people’s lives. It examines the challenges faced and how these are overcome and what impact the process has on self-reported quality of life, as articulated by the participants themselves. To this end, twenty-one individuals from three locations in the United Kingdom (UK) were followed over a period of 10 months, through five waves of data collection. Each participant took part in three interviews, a focus group and completed a diary of travel behaviour. Findings suggest that although a similar pattern was found between the trigger and life post-car, not all older people go through the stages of giving-up driving in the same way. Instead, a range of responses are seen, from contemplation of gradually reducing driving, through to stopping abruptly, with the route taken having consequences for the eventual outcome for any individual. Triggers for contemplating driving cessation could be varied and often involved health and social factors. Importantly, people who engaged in pre-planning reported a relatively higher quality of life beyond the car, whilst for those who were more reactive and engaged in little or no pre-planning a poorer quality of life resulted. In addition (and in conjunction with planning), other factors, such as flexibility in travel destinations, the role of family and friends, and wider support networks are also seen as important. With such evidence of the importance of pre-planning it is suggested that more could be done to support giving-up driving and encouraging contemplation at a younger age to mitigate the negative effects experienced by some.     

Raves, drugs, dealing and driving: qualitative data from a West Australian sample

This qualitative paper from a study of 83 people who attended raves or dance parties in Perth, Western Australia describes what respondents saw as the attractions and less good things about the rave/dance party scene, their views of the place of drug use within the scene, experiences obtaining and providing drugs and addresses the issue of driving while intoxicated. Non-drug factors such as lighting, music, dancing, the non-violent atmosphere, sense of social cohesion and relative lack of predatory male sexual behaviour were the major attractions of the scene, yet it was noted that these were enhanced by the effects of dance drugs, especially ecstasy. There were dual concerns that younger participants were at increased risk of drug-related harm and brought unwanted drug-related media attention and disrepute on the scene. The study supports the view that raves are not 'drug supermarkets', with most respondents obtaining their drugs many days before the event. A substantial minority of respondents described travelling to or from raves with drivers who were drugaffected. Less than half those who discussed the issue said they considered whether the driver was under the influence. This is of concern and has implications for policing practices, peer education and rave-related materials.