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Lin CC, Hill CE, Kerber KA, Burke JF, Skolarus LE, Esper GJ, de Havenon A, De Lott LB, Callaghan BC. Patient Travel Distance to Neurologist Visits. Neurology 2023; 101:e1807-e1820. [PMID: 37704403 PMCID: PMC10634641 DOI: 10.1212/wnl.0000000000207810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The density of neurologists within a given geographic region varies greatly across the United States. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care. METHODS We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least 1 outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles 1-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel. RESULTS We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of them, 96,213 (17%) traveled long distance for care. The median driving distance and time were 81.3 (interquartile range [IQR]: 59.9-144.2) miles and 90 (IQR: 69-149) minutes for patients with long-distance travel compared with 13.2 (IQR: 6.5-23) miles and 22 (IQR: 14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), amyotrophic lateral sclerosis [ALS] (32.1%), and MS (22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (first quintile: OR 3.04 [95% CI 2.41-3.83] vs fifth quintile), rural setting (4.89 [4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41 [3.14-3.69] and 5.27 [4.72-5.89], respectively). Nearly one-third of patients bypassed the nearest neurologist by 20+ miles, and 7.3% of patients crossed state lines for neurologist care. DISCUSSION We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles 1-way for care, and travel burden was most common for lower-prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurologic subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.
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Affiliation(s)
- Chun Chieh Lin
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT.
| | - Chloe E Hill
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Kevin A Kerber
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - James F Burke
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lesli E Skolarus
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Gregory J Esper
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lindsey B De Lott
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Brian C Callaghan
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
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Rivera-Izquierdo M, Valverde-Cano LM, Martínez-Ruiz V, Sánchez-Pérez MR, Atienza-Martín FJ, Martín-delosReyes LM, Jiménez-Mejías E. Prevention of road crashes in older adults: perspectives on facilitators, barriers and the role of the family doctor. BMC Geriatr 2021; 21:635. [PMID: 34742244 PMCID: PMC8572416 DOI: 10.1186/s12877-021-02569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People over 64 years have a high fatality rate when they are involved in traffic accidents. Besides, older victims of road crashes are expected to rise in the future due to population aging. The purpose of the study was to document their perception on the role of the family doctor, the main facilitating factors, and the perceived barriers to the temporary or permanent restriction of their driving. METHODS This qualitative study used focus group methodology. A sample of 16 people over 65 years old was obtained through a series of segmentation criteria at an active participation centre for older adults in a small town in Jaén province (Spain). All were invited to participate in a discussion during which they were asked to express their opinions and subjective experiences concerning the role of their family doctor. The group conversation was taped, fully transcribed and analysed, and codes were generated with both deductive and inductive methods. RESULTS After merging the codes to generate themes, we identified 9 relevant categories: perception of age-related risk, road safety, role of public authorities, driver assessment centre, role of the family doctor, role of the family, proposals for addressing traffic accidents in older adults, consequences of the driving prohibition, and public transport. All categories help to explain the subjective driving and traffic safety experiences of older road users. CONCLUSIONS Although family doctors do not usually ask their older patients about road driving, they are highly valued by these patients. Thus, family doctors have a great potential to act, along with the family members, for the benefit of older patients' traffic safety, in ways that can prevent their involvement in road crashes and reduce the negative consequences of having to stop driving if necessary.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Edificio A, 8ª planta, 18016, Granada, Spain
- Doctorate Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- Chair of Teaching and Research in Family Medicine SEMERGEN-UGR, University of Granada, 18016, Granada, Spain
| | - Luz María Valverde-Cano
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Edificio A, 8ª planta, 18016, Granada, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Edificio A, 8ª planta, 18016, Granada, Spain.
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Granaha, Spain.
| | - María Rosa Sánchez-Pérez
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Granaha, Spain
| | | | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Edificio A, 8ª planta, 18016, Granada, Spain
- Doctorate Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Avenida de la Investigación 11, Edificio A, 8ª planta, 18016, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
- Chair of Teaching and Research in Family Medicine SEMERGEN-UGR, University of Granada, 18016, Granada, Spain
- Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Granaha, Spain
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Protocol for the conceptualization and evaluation of a screening-tool for fitness-to-drive assessment in older people with cognitive impairment. PLoS One 2021; 16:e0256262. [PMID: 34469443 PMCID: PMC8409688 DOI: 10.1371/journal.pone.0256262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Due to aging and health status people may be subjected to a decrease of cognitive ability and subsequently also a decline of driving safety. On the other hand there is a lack of valid and economically applicable instruments to assess driving performance. Objective The study is designed to develop a valid screening-tool for fitness-to-drive assessment in older people with cognitive impairment externally validated on the basis of on-road driving performance. Methods In a single-centre, non-randomized cross-sectional trial cognitive functioning and on-road-driving-behavior of older drivers will be assessed. Forty participants with cognitive impairment of different etiology and 40 healthy controls will undergo an extensive neuropsychological assessment. Additionally, an on-road driving assessment for external validation of fitness to drive will be carried out. Primary outcome measures will be performance in attention, executive functions and visuospatial tasks that will be validated with respect to performance on the on-road-driving-test. Secondary outcome measures will be sociodemographic, clinical- and driving characteristics to systematically examine their influence on the prediction of driving behavior. Discussion In clinical practice counselling patients with respect to driving safety is of great relevance. Thus, having valid, reliable, time economical and easily interpretable screening-tools on hand to counsel patients is of great relevance for practitioners. Ethics and dissemination Ethics approval was obtained from the Ethics Committee at the Ludwig-Maximilians-University Munich. The trial results will be disseminated through peer-reviewed publications and various conferences. Trial registration 18–640. Trial registration: German Clinical Trials Register. Registration number: DRKS00023549.
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Abazid RM, Ewid M, Sherif H, Smettei OA, Salim Khan A, Altorbag AA, Alharbi MF, Aljaber AN, Alharbi SM, Altorbak NA, Altorbak SA, Almeman A. Are cardiac patients in Saudi Arabia provided adequate instructions when they should not drive? Avicenna J Med 2019; 9:148-153. [PMID: 31903390 PMCID: PMC6796302 DOI: 10.4103/ajm.ajm_69_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Driving capability can be significantly affected by different heath disorders; cardiovascular diseases (CVDs) should be considered when assessing patients for medical fitness to drive (MFTD). The aim of this study was to evaluate the awareness of Saudi patients about driving recommendations and to assess the incidence of motor vehicle accidents (MVAs) among cardiac patients. Materials and Methods: We conducted a cross-sectional survey-based study. Male patients diagnosed with CVDs and who were visiting outpatient departments were invited to complete a questionnaire regarding their awareness of driving recommendations. Patients’ demographics, clinical diagnosis, echocardiography parameters, and time-to-CVD diagnosis were all obtained from the patients’ medical records. Women were excluded because it was illegal for women to drive in Saudi Arabia during the study period. Results: In total, 800 men were included, with a mean age of 54 ± 12 years. Driving counseling had been provided to 241 participants (30%). Of these, 207 (25%) were advised not to drive for a period of between one week and six months. Five percent of the patients had a history of MVAs during the follow-up period of 6.2 ± 4 years. We found that the presence of a dyspnea ≥2, according to the New York Heart Association (NYHA), and a history of loss of consciousness (syncope/pre-syncope) were significantly associated with accidents (46% vs. 20%, P < 0.0001 and 41% vs. 10%, P < 0.0001, respectively). Conclusion: Patient–physician discussion about MFTD was only performed with 30% of the patients with CVDs in Saudi Arabia. Dyspnea NYHA class ≥2 or a prior history of syncope were significantly associated with the incidence of MVAs.
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Affiliation(s)
- Rami M Abazid
- Department of Nuclear Medicine, London Health Sciences Centre, London, Canada, Department of Cardiac Imaging, Prince Sultan Cardiac Center Qassim PSCCQ, Buraydah, El Qassim, Saudi Arabia
| | - Mohammed Ewid
- Faculty of Medicine, Suliman Al Rajhi Colleges, Buraydah, El Qassim, Saudi Arabia, Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Hossam Sherif
- Faculty of Medicine, Suliman Al Rajhi Colleges, Buraydah, El Qassim, Saudi Arabia, Critical Care Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Osama A Smettei
- Department of Cardiac Imaging, Prince Sultan Cardiac Center Qassim PSCCQ, Buraydah, El Qassim, Saudi Arabia
| | - Abdul Salim Khan
- Department of Cardiology, Prince Mohammad Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Abdullah A Altorbag
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Mohammad F Alharbi
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Abdulrahman N Aljaber
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Suliman M Alharbi
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Nora A Altorbak
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Sarah A Altorbak
- Department of medicine, College of Medicine, Qassim University, El Qassim, Saudi Arabia
| | - Ahmad Almeman
- Department of Pharmacology, College of Medicine, Qassim University, El Qassim, Saudi Arabia
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Joshi CN, Vossler DG, Spanaki M, Draszowki JF, Towne AR. "Chance Takers Are Accident Makers": Are Patients With Epilepsy Really Taking a Chance When They Drive? Epilepsy Curr 2019; 19:221-226. [PMID: 31328536 PMCID: PMC6891831 DOI: 10.1177/1535759719858647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This review compiles scientific data about the real dangers faced by people with
epilepsy (PWE) who drive. Those include risks of motor vehicle accidents (MVA)
in PWE as compared with controls (individuals without epilepsy) and as compared
with persons with other medical conditions that impact fitness to drive. Data
regarding Accident rates as related to seizure free intervals (SFI), single vs.
multiple seizure events, and/or antiseizure drug (ASD) taper and reintroduction
are discussed. Variation in state, national, and international laws and guidance
for non-commercial and commercial drivers is highlighted, along with some
related reasons for driving restrictions. The review concludes by emphasizing
the importance of physicians educating patients about local driving laws and
about risks of ASD non-adherence. The need for a broader, multi-stakeholder
re-examination of driving regulations for PWE is noted.
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Affiliation(s)
- Charuta N Joshi
- 1 Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - David G Vossler
- 2 UW Medicine
- Valley Medical Center and University of Washington, Seattle, WA, USA
| | - Marianne Spanaki
- 3 Department of Neurology, Wayne State University, Detroit, MI, USA
| | | | - Alan R Towne
- 5 Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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Batais MA, Alamri AK, Alghammass MA, Alzamil OA, Almutairi BA, Al-Maflehi N, Almigbal TH. Diabetes and driving recommendations among healthcare providers in Saudi Arabia. A significant gap that requires action. Saudi Med J 2018; 39:386-394. [PMID: 29619491 PMCID: PMC5938653 DOI: 10.15537/smj.2018.4.22179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess healthcare providers’ knowledge and awareness of the recommendations for drivers with insulin-treated diabetes in Saudi Arabia. Methods: A cross-sectional study was conducted among healthcare providers working at 4 tertiary hospitals in Riyadh, Saudi Arabia between April 2016 and December 2016 using a self-administered questionnaire. Results: A total of 285 healthcare providers completed the survey (response rate 88.5%). Most (70.2%) were aware of the safe driving recommendations for patients with insulin-treated diabetes. However, the need to check blood glucose levels before driving was underestimated by almost one-third (30.2%). Only one-quarter (24.6%) identified the correct level of blood glucose level that is safe for a patient when driving, and 28.4% identified the recommended time for checking blood glucose before driving. Participants who were aware of the recommendations for safe driving had a significantly higher average knowledge score (68.8%) than those who were not aware (58.8%; p<0.001). There was a significant difference in the average knowledge score among medical specialties (p=0.002) and job levels (p<0.001). Conclusions: Most healthcare providers identified the importance of evaluating their patients for ability to drive safely, but we found some important areas of knowledge deficit. Professional intervention to improve healthcare providers’ awareness and knowledge regarding diabetes and driving is the first step in improving detection and reporting high-risk drivers with diabetes to prevent future driving mishaps.
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Affiliation(s)
- Mohammed A Batais
- Diabetes and Family Medicine, Family and Community Medicine Department, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Moon S, Ranchet M, Akinwuntan AE, Tant M, Carr DB, Raji MA, Devos H. The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions. Gerontology 2018; 64:291-299. [PMID: 29444506 DOI: 10.1159/000486511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/27/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. OBJECTIVE To investigate the effect of advanced age on driving safety in drivers with medical conditions. METHODS We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55-64 years, n = 1,386), young-old (65-74 years, n = 1,013), old-old (75-84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. RESULTS The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20-9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87-4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88-4.12) compared to the middle-aged. CONCLUSION Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maud Ranchet
- University of Lyon, IFSTTAR, TS2 LESCOT, Lyon, France
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark Tant
- Center for Evaluation of Fitness to Drive and Car Adaptations, VIAS Institute, Brussels, Belgium
| | - David Brian Carr
- Department of Medicine and Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mukaila Ajiboye Raji
- Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas, USA
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Fisher RS, Drazkowski JF. A Comment on Driving and Neurologic Impairment. Mayo Clin Proc 2017; 92:1326-1327. [PMID: 28870352 DOI: 10.1016/j.mayocp.2017.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Robert S Fisher
- Department of Neurology & Neurological Sciences, Stanford University Medical Center, Palo Alto, CA.
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