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Stamatelos P, Economou A, Yannis G, Stefanis L, Papageorgiou SG. Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines. Mov Disord Clin Pract 2024; 11:198-208. [PMID: 38164044 DOI: 10.1002/mdc3.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson's disease (PD) patients. OBJECTIVES Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several guidelines have been published, the exact procedure along with the neurologist's role in this procedure remains obscure. METHODS We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national guidelines, five recommendation papers, and one consensus statement). RESULTS The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients. CONCLUSIONS Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Yannis
- Department of Transportation Planning and Engineering, School of Civil Engineering, National Technical University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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Cheal B, Bundy A, Patomella AH. Performance Analysis of Driving Ability (P-Drive): Investigating Construct Validity and Concordance of Australasian Data. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231221960. [PMID: 38268445 DOI: 10.1177/15394492231221960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
On-road assessment is optimal for determining medical fitness-to-drive but unreliable if determined by global pass/fail decisions alone. Occupational therapists need standardized, psychometrically sound on-road scoring procedures. Performance Analysis of Driving Ability (P-Drive) is a promising on-road test developed in Sweden, but it has not been standardized for Australasia. We investigated the psychometric properties and concordance with an on-road decision of data gathered with the Australasian version of P-Drive. P-Drive was administered to older and cognitively impaired drivers (N = 134) aged 18 to 91 years (mean age 68) who were referred to 10 driving clinics in Australia and New Zealand to determine driving performance. Rasch analysis provided evidence for construct validity and concordance of the data gathered. An optimal cut-off score of 85 was set, yielding evidence of good sensitivity at 88% and specificity at 88%. The Australasian version of P-Drive produces valid and reliable data regarding on-road driving performance.
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Affiliation(s)
- Beth Cheal
- The University of Sydney, Camperdown, New South Wales, Australia
- Western Sydney University, Campbelltown, New South Wales, Australia
| | - Anita Bundy
- The University of Sydney, Camperdown, New South Wales, Australia
- Colorado Stated University, Fort Collins, USA
| | - Ann-Helen Patomella
- The University of Sydney, Camperdown, New South Wales, Australia
- Karolinska Institutet, Huddinge, Sweden
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Krasniuk S, Crizzle AM. Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers. Am J Occup Ther 2024; 78:7801205020. [PMID: 38215305 DOI: 10.5014/ajot.2024.050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
IMPORTANCE Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING A driving assessment clinic. PARTICIPANTS Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES On-road pass-fail outcomes. RESULTS Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.
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Affiliation(s)
- Sarah Krasniuk
- Sarah Krasniuk, PhD, MSc, is Postdoctoral Fellow, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander M Crizzle
- Alexander M. Crizzle, PhD, MPH, CE, is Associate Professor and Director, Driving Research and Simulation Laboratory, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
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Quintas JL, Trindade IOA, Gameiro KSD, Pitta LSR, Camargos EF, Nóbrega OT. Neuropsychological domains and fitness to drive in mild cognitive impairment or Alzheimer's disease. ACCIDENT; ANALYSIS AND PREVENTION 2023; 191:107188. [PMID: 37423139 DOI: 10.1016/j.aap.2023.107188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
Cognitive deficits associated with mild cognitive impairment (MCI) or Alzheimer's disease (AD) can impact driving. This integrative review investigated which cognitive domains were associated with poor driving performance or unfitness to drive in studies with outcomes measured in simulator or on-road driving in patients with MCI or AD. The review was conducted by searching for articles published between 2001 and 2020 in the MEDLINE (via PubMed), EMBASE, and SCOPUS databases. Studies addressing patients with other dementias (e.g., vascular or mixed dementia, Lewy body dementia, Parkinson's disease) were excluded. Of 404 articles initially selected, 17 met the eligibility criteria for this review. Based on the findings of this integrative review, attentional capacity, processing speed, executive functions and visuospatial skills were the functions whose declines were most frequently reported in a context of unsafe driving by older adults with MCI or AD. Reports were remarkably heterogeneous in methodological aspects whereas quite limited in cross-cultural coverage and in sample recruited, what prompts for further trials in the field.
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Affiliation(s)
- Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil
| | | | | | | | | | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, QC, Canada.
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Mirabet E, Tortosa-Perez M, Tortosa F, González-Sala F. Evaluation of Psychophysical Fitness in Drivers over 65 Years of Age. Healthcare (Basel) 2023; 11:1927. [PMID: 37444761 DOI: 10.3390/healthcare11131927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The deterioration of cognitive and psychophysical ability associated with aging has an effect on road safety, especially in the driving of vehicles. The current study's main objective is to evaluate the psychophysical aptitudes in drivers over 65 years of age in a sample of drivers in Spain. METHODS The sample was formed of a total of 1663 drivers who attended a Driver Recognition Center. The evaluation of their psychophysical aptitudes was carried out following the Medical-Psychological Exploration Protocol for Driver Recognition Centers, edited by the Ministry of Health and the General Directorate of Traffic. RESULTS The results show increased restrictions in the evaluation of driving ability with age, which are especially significant after 75 years of age. Regarding sex, 70.1% of women have an approved evaluation, compared to men aged between 65-69, although from 69 onwards, the percentage of approved women decreases significantly. The loss of visual capabilities and poor performance in psycho-technical tests are the main causes associated with an evaluation with restrictions, with the number of restrictive conditions increasing with age. CONCLUSIONS There is an increase in the number of cases with age-related restrictions, especially in the case of women and ophthalmologic-related problems, although the majority of drivers over 65 years old continue driving, thus continuing with a practice that has been related to the well-being and quality of life of older adults.
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Affiliation(s)
- Enrique Mirabet
- Instituto de Investigación en Tráfico y Seguridad Vial-INTRAS, Universidad de Valencia, 46010 Valencia, Spain
| | - Macarena Tortosa-Perez
- Departamento de Psicología, Universidad Internacional de Valencia-VIU, 46002 Valencia, Spain
| | - Francisco Tortosa
- Instituto de Investigación en Tráfico y Seguridad Vial-INTRAS, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco González-Sala
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Valencia, 46010 Valencia, Spain
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Rosenfeld M, Goverover Y, Weiss P. Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005025. [DOI: 10.3389/fresc.2022.1005025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
BackgroundDriving is associated with independence, well-being, quality of life, and an active lifestyle. Driving requires cognitive, motor, and visual skills, including self-awareness and processing speed. This study examines whether driver self-awareness, motor processing speed, and cognitive processing speed can predict fitness to drive among individuals referred to occupational therapy evaluation due to concerns about their driving ability.MethodIn this cross-sectional study, 39 participants were referred to off- and on-road driving evaluation to determine their fitness to drive due to changes in health status, advanced age, license renewal requirement, or prior automobile accidents. A registered occupational therapist (OT) classified 23 of the participants as fit to drive and 16 as unfit to drive. Motor and cognitive processing speed were assessed by the Stationary Perception-Reaction Timer and the Color Trails Test, respectively. Driving self-awareness was assessed by comparing the DI and OT evaluations to the participants' estimation of their own on-road driving performance.ResultsThe fit-to-drive participants had a better motor and cognitive processing speed than those unfit-to-drive. The unfit-to-drive group overestimated their driving ability, whereas the fit-to-drive group accurately or almost accurately estimated their driving ability. Driving self-awareness was a significant predictor of participants' fitness to drive.ConclusionsThis study demonstrates the importance of self-awareness for predicting fitness to drive among people at risk for compromised driving skills. Thus, driving self-awareness should be addressed as part of fitness-to-drive evaluations and interventions.
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Validation of Vehicle Driving Simulator from Perspective of Velocity and Trajectory Based Driving Behavior under Curve Conditions. ENERGIES 2021. [DOI: 10.3390/en14248429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With their advantages of high experimental safety, convenient setting of scenes, and easy extraction of control parameters, driving simulators play an increasingly important role in scientific research, such as in road traffic environment safety evaluation and driving behavior characteristics research. Meanwhile, the demand for the validation of driving simulators is increasing as its applications are promoted. In order to validate a driving simulator in a complex environment, curve road conditions with different radii are considered as experimental evaluation scenarios. To attain this, this paper analyzes the reliability and accuracy of the experimental vehicle speed of a driving simulator. Then, qualitative and quantitative analysis of the lateral deviation of the vehicle trajectory is carried out, applying the cosine similarity method. Furthermore, a data-driven method was adopted which takes the longitudinal displacement, lateral displacement, vehicle speed and steering wheel angle of the vehicle as inputs and the lateral offset as the output. Thus, a curve trajectory planning model, a more comprehensive and human-like operation, is established. Based on directional long short-term memory (Bi–LSTM) and a recurrent neural network (RNN), a multiple Bi–LSTM (Mul–Bi–LSTM) is proposed. The prediction performance of LSTM, MLP model and Mul–Bi–LSTM are compared in detail on the validation set and testing set. The results show that the Mul–Bi–LSTM model can generate a trajectory which is very similar to the driver’s curve driving and have a preferable generalization performance. Therefore, this method can solve problems which cannot be realized in real complex scenes in the simulator validation. Selecting the trajectory as the validation parameter can more comprehensively and intuitively reflect the simulator’s curve driving state. Using a speed model and trajectory model instead of a real car experiment can improve the efficiency of simulator validation and lay a foundation for the standardization of simulator validation.
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Sawada T, Tomori K, Sakaue K, Higashikawa Y, Ohno K, Okita Y, Seike Y, Fujita Y, Umeda M. Evaluating the Content Validity of a New On-Road Driving Test. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1873476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tatsunori Sawada
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kounosuke Tomori
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | | | | | - Kanta Ohno
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Yousuke Seike
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Yoshio Fujita
- Department of Rehabilitation, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Masaru Umeda
- School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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Sakamaki K, Nishizawa S, Katsuki M, Kawamura S, Koh A. On-Road Driving Assessment in a Driving School Course and the Results of a Cognitive Function Test After Stroke in a Depopulated Rural Area in Japan: Case Series of Eight Patients. Cureus 2021; 13:e15293. [PMID: 34211804 PMCID: PMC8236213 DOI: 10.7759/cureus.15293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Returning to driving after a stroke is a step toward independence and improving quality of life. Cognitive function after stroke is one of the essential factors that affect driving ability, and on-road driving assessment in driving school courses is beginning to spread in Japan. We started on-road driving assessment in 2018, and we herein report eight patients who underwent on-road driving assessment in the last three years, presenting both off-road cognitive function tests and on-road driving assessment results. Methods Of the 320 consecutive stroke patients from 2018 to 2020, we retrospectively investigated the eight patients’ characteristics who underwent on-road driving assessment. We performed cognitive function tests, including behavioral inattention test (BIT), trail-making test, Wechsler Adult Intelligence Scale-III, and behavioral assessment of the dysexecutive syndrome. Patients who meet BIT > 35, at least three other subitem criteria, and no unevaluable subitems can undergo on-road driving assessment by a driving instructor. With the recommendation of the driving instructors, we comprehensively decided the permission to drive. Results All eight patients could return to driving after on-road driving assessment. Two patients could return to driving after nearly a year. Conclusion The patients did not meet all the cut-offs of the cognitive function test, but they were judged to return to driving by driving instructors. We finally permitted all eight patients to drive. On-road driving assessment in the driving school course might be helpful for determining the permission to return to driving.
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Affiliation(s)
- Keita Sakamaki
- Department of Rehabilitation Medicine, Itoigawa General Hospital, Itoigawa, JPN
| | - Shin Nishizawa
- Department of Rehabilitation Medicine, Itoigawa General Hospital, Itoigawa, JPN
| | - Masahito Katsuki
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
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Bellagamba D, Vionnet L, Margot-Cattin I, Vaucher P. Standardized on-road tests assessing fitness-to-drive in people with cognitive impairments: A systematic review. PLoS One 2020; 15:e0233125. [PMID: 32421733 PMCID: PMC7233547 DOI: 10.1371/journal.pone.0233125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/28/2020] [Indexed: 11/18/2022] Open
Abstract
Objective The on-road assessment is the gold standard because of its ecological validity. Yet existing instruments are heterogeneous and little is known about their psychometric properties. This study identified existing on-road assessment instruments and extracted data on psychometric properties and usability in clinical settings. Method A systematic review identified studies evaluating standardized on-road evaluation instruments adapted for people with cognitive impairment. Published articles were searched on PubMed, CINHAL, PsycINFO, Web of Science, and ScienceDirect. Study quality and the level of evidence were assessed using the COSMIN checklist. The collected data were synthetized using a narrative approach. Usability was subjectively assessed for each instrument by extracting information on acceptability, access, cost, and training. Results The review identified 18 published studies between 1994 and 2016 that investigated 12 different on-road evaluation instruments: the Performance-Based Driving Evaluation, the Washington University Road Test, the New Haven, the Test Ride for Practical Fitness to Drive, the Rhode Island Road Test, the Sum of Manoeuvres Score, the Performance Analysis of Driving Ability, the Composite Driving Assessment Scale, the Nottingham Neurological Driving Assessment, the Driving Observation Schedule, the Record of Driving Errors, and the Western University’s On-road Assessment. Participants were mainly male (64%), between 48 and 80 years old, and had a broad variety of cognitive disorders. Most instruments showed reasonable psychometric values for internal consistency, criterion validity, and reliability. However, the level of evidence was poor to support any of the instruments given the low number of studies for each. Conclusion Despite the social and health consequences of decisions taken using these instruments, little is known about the value of a single evaluation and the ability of instruments to identify expected changes. None of the identified on-road evaluation instruments seem currently adapted for clinical settings targeting rehabilitation and occupational priorities rather than road security alone. Study registration PROSPERO registration number CRD42018103276.
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Affiliation(s)
- David Bellagamba
- Department of Occupational Therapy, School of Social Work & Health Sciences, HETSL, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Line Vionnet
- Department of Occupational Therapy, School of Social Work & Health Sciences, HETSL, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Isabel Margot-Cattin
- Department of Occupational Therapy, School of Social Work & Health Sciences, HETSL, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Paul Vaucher
- School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland.,Unit of Traffic Medicine and Psychology, University Center for Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Wallis KA, Matthews J, Spurling GK. Assessing fitness to drive in older people: the need for an evidence-based toolkit in general practice. Med J Aust 2020; 212:396-398.e1. [PMID: 32335920 DOI: 10.5694/mja2.50588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Geoffrey K Spurling
- Discipline of General Practice, University of Queensland, Brisbane, QLD.,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait, Islander Primary Health Care, Queensland Health, Brisbane, QLD
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