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PubMed1999

Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive.

BACKGROUND: Although legislation has been introduced in Saskatchewan for mandatory reporting by physicians of patients considered medically unfit to drive, little is known about physicians' attitudes, knowledge or resources with regard to evaluating medical fitness to drive. METHODS: The objective of this study was to determine Saskatchewan physicians' attitudes, knowledge, training, resources and current educational needs with regard to evaluating medical fitness to drive. A questionnaire survey of all physicians in the province who were identified as likely to be involved in determining medical fitness to drive was conducted between October and December 1996. RESULTS: Of the 1102 physicians who received a questionnaire, 690 (62.6%) responded, of whom 167 were excluded because they were not involved in assessing fitness to drive. Thus, 523 (55.9%) of the 935 eligible physicians surveyed completed the questionnaire. Most (57.6% [298/517]) of the respondents indicated that they do not hesitate to report patients medically unfit to drive; however, 59.5% (307/516) felt that the physician-patient relationship is negatively affected by reporting. Overall, 85.5% (444/519) of the respondents felt that restricted licensing is a fair alternative for people who might otherwise be denied a full licence. The availability of restricted licensing positively influenced the decision to report for 60.3% (313/519) of the respondents. Significantly more rural physicians than urban physicians believed that the need to drive was greater for rural residents than for urban dwellers (81.2% [95/117] v. 64.2% [257/400], p < 0.001). Physician knowledge regarding specific medical conditions and fitness to drive was generally poor. The resource most commonly used in determining medical fitness to drive was the Physicians' Guide to Driver Examination (71.1% [361/508] of respondents). The most useful continuing medical education methods indicated by physicians for assessing medical fitness to drive included conference presentations, workshops and journal articles. INTERPRETATION: Most of the Saskatchewan physicians surveyed supported restricted licensing, and the availability of restricted licensing made them more likely to report patients considered medically unfit to drive. The physician-patient relationship was felt to be negatively affected by reporting.

Attitude of Health Personnel↗
PubMed2004

Validation of the stroke drivers screening assessment for people with traumatic brain injury.

Cognitive impairments resulting from brain injury affect driving performance. The question of fitness to drive often arises during rehabilitation. Healthcare professionals need reliable criteria against which decisions about driving fitness can be made. Nouri et al. developed the Stroke Drivers Screening Assessment (SDSA), which was found predictive of on-road driving performance in stroke patients. The purpose of this study was to determine whether the SDSA, either alone or combined with other tests, predicted fitness to drive in brain injured people. Fifty-two participants were assessed on the SDSA plus additional cognitive tests. Their fitness to drive was examined on the public road. The SDSA predictions based on equations developed for stroke patients were not an accurate predictor of road test performance. Discriminant analysis was used to identify tests predictive of fitness to drive. Results indicated that a combination of the SDSA, the Stroop and the AMIPB Information Processing tasks correctly classified 87% of cases and may be useful predictors of driving fitness following brain injury. However, cross-validation on an independent sample of people with brain injury is required.

Adult↗
PubMed1993

[Psychoses and driving fitness--development of criteria for clinical assessment].

The legal foundations for driver fitness evaluation in psychiatric conditions are enumerated in the 1985 "Illness and road traffic" expert opinion of the advisory medical council with the Federal Ministry of Transport. In case of the endogenous psychoses, in-patient episodes will invariably give rise to a call for expert psychiatric appraisement, notwithstanding the fact that reliable and valid criteria, with the exception of a standardized driving sample, continue to be almost non-existent. Carried out between 1989 and 1991 with support from the Federal Employment Institute in the framework of an employment creation project as well as from Bundesanstalt für Strassenwesen, the present study hence had been aimed at correlation-statistical identification of as valid driving ability predictors as possible in post-acute patients with a diagnosis of schizophrenic psychosis (ICD 295.3). The patients' pre-discharge fitness for driving, for one, was assessed using a number of psychological procedures and, for the other, was examined during a 60 minute practical driving sample, involving both city and autobahn driving. Driving behaviour during the practical trial was taken down according to pertinent categories, with subsequent judgment of overall driving performance both by self-ratings and by driving instructor ratings by means of a school grades scale of 1 to 6. With reference to pertinent studies elsewhere, our test battery had consisted of procedures for testing visual perception, reaction, selective and split attention, personality structure, anxiety, and risk-taking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

[Driving fitness/driving capacity of patients treated with methadone].

To answer the question whether or not therapeutic methadone doses significantly reduce traffic-related performance of drivers on medically supervised methadone programmes, 34 methadone substitution patients, all of them volunteers, were subjected to a test series: the focus of the study was a psychophysical test battery consisting of 10 individual performance tests to assess essential functions with regard to driving ability, such as concentration, attention, reaction capability, memory, perception and sensorimotor coordination. In evaluating the results of the psychophysical tests, multiple drug use and subjective methadone influence at the time of the examination were taken into consideration but current methadone blood level was neglected. The results were compared to those of a control group. The methadone group (n = 34) consisted of 25 men and 9 women aged between 18 and 38. At the time of the study, the majority of the test persons (29) were on low dosage methadone maintenance (up to 60 mg/day). In the urine samples of approximately 2/3 of the test persons, evidence was found for multiple drug use together with other psychotropic substances, the most frequent (14) being cannabis metabolites. Referring to their driving practices, a mere 4 out of 29 drivers had not committed any driving offences. A comparison of the psychophysical performance of the whole methadone group (n = 34) with a control group demonstrated that the methadone substitution patients achieved rather lower results in almost all variables. These performance deficits were particularly conspicuous in sustained attention, sensorimotor coordination and reaction capability. 12 "methadone only" participants, i.e. methadone probands without any additional consumption of psychotropic substances showed-partly considerably-better performance than the methadone group as a whole and also achieved normal results in relation to the test norm. Nevertheless, once again, results tended to be of lower level in comparison to the control group. "Methadone only" substitution patients, in particular those volunteers without a current subjective methadone influence-reached practically the same results as the corresponding control subjects, or at least average results based on test norm. However, the study revealed distinctive performance impairment (e.g. in sustained attention, reaction capability) when other psychotropic substances (including alcohol and cannabis!) were taken as well during the subjective methadone phase. The performance deficits were predominantly caused by a slowing down of reactions. Our study illustrates that, under certain conditions, long-term methadone maintenance under strict medical supervision does not have any significant unfavourable impact on the psychophysical performances in driving ability as examined in this study. Thus, these research findings support the previous Zurich experiences, according to which driving ability--and in the end also driving aptitude--of the methadone substitution patients does not depend on the methadone therapy itself, nor on the amount of the daily methadone intake. In making the final medical judgement on driving ability, the presence of a mixed drug use and the personality of the person in question are of far greater importance.

Accidents, Traffic↗
PubMed2003

Driving experience, crashes and traffic citations of teenage beginning drivers.

Teenagers were surveyed by telephone every 6 months from their freshman to senior high school years (N=911). Self-reported crash involvements and citations were examined for each teenager's first year of licensure and first 3500 miles driven. Based on survival analysis, the risk of a first crash during the first month of licensure (0.053) was substantially higher than during any of the next 11 months (mean risk per month: 0.025). The likelihood of a first citation during the first month of licensure (0.023) also was higher than during any of the subsequent 11 months (mean risk per month: 0.012). Similarly, when viewed as a function of cumulative miles driven, the risk of a first crash or citation was highest during the first 500 miles driven after licensure. Fewer parental restrictions (e.g. no nighttime curfew) and a lower grade point average (GPA) were associated with a higher crash risk. Male gender, a lower GPA and living in a rural area were associated with a higher citation rate.

Accidents, Traffic↗
PubMed1999

The driving habits of adults aged 60 years and older.

OBJECTIVES: We describe the driving habits of adults aged 60 years and older who were interviewed in the context of a community survey focused on mental disturbances. Our goal was to identify clinical cues that might signal driving difficulty in older adults who might present to the primary care physician for health care. DESIGN: A population-based survey. SETTING: Continuing participants in a follow-up study of community-dwelling adults who were living in East Baltimore in 1981. PARTICIPANTS: Subjects were 1920 continuing participants of the Baltimore sample of the Epidemiologic Catchment Area Program; 589 were aged 60 years and older and provided information on driving habits. MEASUREMENTS: Respondents were asked about their driving status: had they made adaptations to driving and had they experienced any adverse driving events in the 2 years before the interview. Driving behaviors were assessed in relation to chronic disease, sensory impairment, functional status, and mental status. RESULTS: Former drivers were more likely to be older, female, and nonwhite. Diabetes, vision impairment, functional impairment, and making an error on the copy design task of the Mini-Mental State Examination (MMSE) were associated with no longer driving. Women were more likely to report having made adaptations to driving, as were persons with heart disease, arthritis, vision impairment, and those who made an error on the copy design task of the MMSE. Heart disease and hearing impairment were associated with report of an adverse driving event. In multivariate models that included terms for potentially influential characteristics such as age, gender, and miles driven, only the copy design task was associated with driving status, and only heart disease was associated with driving adaptation and adverse driving events. CONCLUSION: Simple tests that tap visuospatial ability, such as the copy design task of the MMSE, may warrant additional study for use in driving assessment of older adults in primary care. The results underscore the importance of making an inquiry about driving as a separate and independent component of functional assessment.

Accidents, Traffic↗
PubMed1989

[Testing the automobile driver in cases of uncertain qualification prognosis].

The qualification of a person to drive a motor vehicle is the presupposition for the required permission. The prognosis on future human behaviour, which is indispensible for a judgement on such a qualification, is difficult. Only in a few of these cases a clear "good"-prognosis or "bad"-prognosis can be found out. Frequently only an "uncertain"-prognosis is to be justified as a matter of fact. It is only to be said by the regulations of law, whether in cases of uncertain qualification prognosis the driver's licence should be given or denied or whether a driver's licence already given should be withdrawn or not. Starting points for theory and dogmatics on prognosis-decisions due to law and orientated in the knowledge of empiric sciences are to be found in administrative law as well as in criminal law. For example: penal regulations which call for prognosis should be interpreted in the manner that as a sanction (only to be imposed in cases of "bad"-prognosis) the milder measure is to be used at first. Only after an unsuccessful attempt with this milder measure it is allowed to take a more incisive measure (Frisch). In planning law the dilemma with prognosis should be overcome by reflexive feedback within the scope of a new type of procedural law, which would make a process of learning and evaluation possible and enforcable. From these starting points common legal principles on a "test-method" can be developed, which may be used in cases of "uncertain"-prognosis. Such a test-method may help for example to decide on execution relaxations due to the Law on Execution of the Sentence (OLG Celle). The decree on driver's licences on probation (valid since 1.11.1986) contains the most extensive regulations concerning the application of test-methods within driver's licences law. The solution of the problem shown there should be extended: Not only the first driver's licence should only be given on probation but also a renewed one. Even motorists coming conspicuous after the lapse of probation-time should be induced to behave appropriately in traffic by a test-method, which does not force qualification prognosis. So far a further development of point-system for repeated offenders is to be recommended. The test-method could be made quite more effective by refinement of the list of measures (e. g. injunction to participate in follow-up assistance or follow-up examination).

Accidents, Traffic↗