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Charlton JL, Koppel S, Hua P, St. Louis RM, Di Stefano M, Darzins P, Odell M, Porter MM. CHARACTERISTICS OF LOW AND HIGH DISTANCE DRIVERS: FINDINGS FROM THE OZCANDRIVE/CANDRIVE OLDER DRIVER COHORT STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J L Charlton
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - S Koppel
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - P Hua
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - R M St. Louis
- Monash University Accident Research Centre, Melbourne, Victoria, Australia
| | - M Di Stefano
- La Trobe University, Melbourne, Victoria, Australia
| | - P Darzins
- Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - M Odell
- Victorian Institute of Forensic Medicine, Southback, Victoria, Australia
| | - M M Porter
- Faculty of Kinesiology and Recreation Management, and Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada
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Koppel S, Stephens AN, Charlton JL, Di Stefano M, Darzins P, Odell M, Marshall S. The Driver Behaviour Questionnaire for older drivers: Do errors, violations and lapses change over time? Accid Anal Prev 2018; 113:171-178. [PMID: 29407664 DOI: 10.1016/j.aap.2018.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 06/07/2023]
Abstract
The aim of the current study was to examine how self-reported aberrant driving behaviours change across a three time-points in a group of older drivers. Two hundred and twenty-seven older drivers (males = 69.6%) from the Candrive/Ozcandrive longitudinal study completed the Driving Behaviour Questionnaire (DBQ) each yearacross three time-points (i.e., Year 1, Year 2, Year 3). At the third time-point, older drivers ranged in age from 77 to 96 years (M = 81.74 years; SD = 3.44 years). A longitudinal confirmatory factor analysis showed that a modified 21-item, 3-factor (errors, lapses and violations) DBQ was invariant across the time period, suggesting that the structure of the questionnaire was stable across each time-point. Further, multiple domain latent growth analysis on the resultant factors for errors, lapses and violations showed that the frequency of errors remained similar across the three-year period, while violations and lapses showed very marginal decreases in frequency. These changes were independent of the absolute number of these behaviours; Drivers with higher violations or lapses in Year one, showed similar decreases in frequency as those who self-reported lower frequencies of the behaviours. These results suggest that the DBQ is a reliable tool to measure older drivers' self-reported aberrant driving behaviours, and that these behaviours do not show much change across time. Future research should validate the self-reported responses from the DBQ with more objective measures such as those collected through naturalistic driving study (NDS) methodology or on-road driving tasks.
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Affiliation(s)
- S Koppel
- Monash University Accident Research Centre, Monash University, Australia.
| | - A N Stephens
- Monash University Accident Research Centre, Monash University, Australia
| | - J L Charlton
- Monash University Accident Research Centre, Monash University, Australia
| | | | - P Darzins
- Eastern Health, Australia; Monash University Eastern Health Clinical School, Australia
| | - M Odell
- Victorian Institute of Forensic Medicine, Australia
| | - S Marshall
- Ottawa Hospital Research Institute, Canada
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Koppel S, Charlton JL, Hua P, Liu PY, Pham H, Stephan K, Logan D, St Louis RM, Gao G, Griffiths D, Williams G, Witharanage T, Di Stefano M, Darzins P, Odell M, Porter MM, Mazer B, Gelinas I, Vrkljan B, Marshall S. Are older drivers' driving patterns during an on-road driving task representative of their real-world driving patterns? Traffic Inj Prev 2018; 19:S173-S175. [PMID: 30841798 DOI: 10.1080/15389588.2018.1532219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns. METHODS Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle. RESULTS During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198). CONCLUSIONS These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.
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Affiliation(s)
- S Koppel
- a Monash University Accident Research Centre , Victoria , Australia
| | - J L Charlton
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Hua
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Y Liu
- a Monash University Accident Research Centre , Victoria , Australia
| | - H Pham
- a Monash University Accident Research Centre , Victoria , Australia
| | - K Stephan
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Logan
- a Monash University Accident Research Centre , Victoria , Australia
| | - R M St Louis
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Gao
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Griffiths
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Williams
- a Monash University Accident Research Centre , Victoria , Australia
| | - T Witharanage
- a Monash University Accident Research Centre , Victoria , Australia
| | | | - P Darzins
- c Eastern Health , Victoria, Australia
| | - M Odell
- d Victorian Institute of Forensic Medicine , Victoria, Australia
| | - M M Porter
- e Faculty of Kinesiology and Recreation Management, and Centre on Aging , University of Manitoba , Canada
| | - B Mazer
- f McGill University , Winnipeg, Canada
| | - I Gelinas
- f McGill University , Winnipeg, Canada
| | - B Vrkljan
- g McMaster University , Hamilton, Canada
| | - S Marshall
- h Ottawa Hospital Research Institute , Ottawa, Canada
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Charlton J, Koppel S, Darzins P, Di Stefano M, Macdonald W, Odell M, D’Elia A, Porter M. CHANGES IN DRIVING PATTERNS OF OLDER AUSTRALIANS: FINDINGS FROM THE CANDRIVE/OZCANDRIVE COHORT STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J. Charlton
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - S. Koppel
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - P. Darzins
- Eastern Health, Burwood, Victoria, Australia,
| | | | | | - M. Odell
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia,
| | - A. D’Elia
- Monash University Accident Research Centre, Monash University, Victoria, Australia,
| | - M.M. Porter
- University of Manitoba, Winnipeg, Manitoba, Canada
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Martin-Khan M, Gray L, Edwards H, Wootton R, Varghese P, Lim K, Darzins P, Dakin L. COMPREHENSIVE GERIATRIC ASSESSMENT PROCEDURE ONLINE, INCORPORATING INTERRAI ACUTE CARE ASSESSMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Martin-Khan
- The University of Queensland, Brisbane, Queensland, Australia,
| | - L.C. Gray
- Centre for Research in Geriatric Medicine, The University of Queensland, Woolloongabba, Queensland, Australia,
| | - H. Edwards
- Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - R. Wootton
- Centre for Research in Geriatric Medicine, The University of Queensland, Woolloongabba, Queensland, Australia,
| | - P. Varghese
- Queensland Health, Brisbane, Queensland, Australia,
| | - K. Lim
- University of Melbourne, Melbourne, Victoria, Australia,
| | - P. Darzins
- Eastern Health, Box Hill, Victoria, Australia
| | - L. Dakin
- Queensland Health, Brisbane, Queensland, Australia,
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Koppel S, Charlton JL, Richter N, Di Stefano M, Macdonald W, Darzins P, Newstead SV, D'Elia A, Mazer B, Gelinas I, Vrkljan B, Eliasz K, Myers A, Marshall S. Are older drivers' on-road driving error rates related to functional performance and/or self-reported driving experiences? Accid Anal Prev 2017; 103:1-9. [PMID: 28365398 DOI: 10.1016/j.aap.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Affiliation(s)
- S Koppel
- Monash University Accident Research Centre, Monash University Australia.
| | - J L Charlton
- Monash University Accident Research Centre, Monash University Australia
| | - N Richter
- Monash University Accident Research Centre, Monash University Australia
| | | | | | | | - S V Newstead
- Monash University Accident Research Centre, Monash University Australia
| | - A D'Elia
- Monash University Accident Research Centre, Monash University Australia
| | | | | | | | | | - A Myers
- University of Waterloo, Canada
| | - S Marshall
- Ottawa Hospital Research Institute, Canada
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Abstract
Objectives: Venous leg ulcers represent a major clinical problem, with poor rates of healing. Ideal treatment is compression bandaging. The effect of compression on neurovascular tissues involved in wound repair is unclear. This study aims to assess the effect of four-layer compression therapy (40 mmHg) on neurovascular function and wound healing in people with chronic venous leg ulcers – 15 people (55 years or older) with venous leg ulcers for more than six weeks. Methods: Basal microvascular perfusion measurement (MPM), oxygen tension (tc pO2) measured at sensor temperatures of 39°C and 44°C and sensory nerve function using electrical cutaneous perception thresholds (ECPT) at 5, 250 and 2000 Hz (corresponding to C, A δ and A β fibres) were assessed adjacent to the ulcer site, and at a mirror location on the non-ulcerated limb. Testing was undertaken before and after therapy for 5–12 weeks of four-layer compression bandaging. Results: There was significant improvement in tc pO2 at 44°C and ECPT at 2000 Hz ( P<0.05) compared with pre-intervention. Changes in basal MPM, tc pO2 at 39°C and ECPT at 5 and 250 Hz after compression therapy did not reach statistical significance. Conclusion: Four-layer compression bandaging in people with venous leg ulcers improved some components of neurovascularture in people with chronic venous leg ulcers. Whether this improvement has contributed to wound healing in this study requires further investigation.
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Affiliation(s)
- R Ogrin
- Austin Health, Endocrinology Centre of Excellence, Heidelberg Repatriation Hospital, Heidelberg
| | - P Darzins
- Monash Ageing Research Centre, Monash University, Kingston Centre, Monash, Australia
| | - Z Khalil
- Department of Biochemistry and Molecular Biology, The University of Melbourne, Melbourne, Victoria, Australia; College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
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8
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Berndt A, May E, Darzins P. On‐road assessment for people with dementia: How to achieve the Goldilocks point (not too easy, not too hard, but just right). Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Berndt
- University of South AustraliaAdelaideSAAustralia
| | - E. May
- University of South AustraliaAdelaideSAAustralia
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9
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Strang DG, Gagnon M, Molloy DW, Darzins P, Etchells E, Bédard M, Davidson W. Development of a standardized, comprehensive "ideal drug detail". Can J Clin Pharmacol 2001; 8:73-7. [PMID: 11493934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVES To develop a standardized, comprehensive ideal drug detail for use in face-to-face education about individual drugs. METHODS A random sample of 603 physicians and pharmacists was selected and stratified to include input from each of the following specialties: family practice, internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, geriatric medicine and clinical pharmacology. Thirty-one potential items were generated by the investigators from a preliminary survey of a local convenience sample of physicians and pharmacists. A modified Delphi consensus process was used in the large sample to determine which items should be included in the ideal drug detail. In each round of the Delphi process, respondents rated each item on a seven-point scale of importance and were then given feedback of the cumulative ratings for each item. Rounds were continued until consensus was obtained on all items. RESULTS The response rate to the first round was 55.3%; 85.5% of these respondents responded to the second round. Response rates varied between specialties from 44% to 70%. Attempts to contact nonresponders to measure potential nonrespondent bias were unsuccessful. Consensus was obtained on 19 items after the first round, and on the remaining 12 items after the second round. Four items were dropped because they were unimportant. There was variation in modal response between specialties on eight items. CONCLUSIONS Consensus was obtained among a sizable and interested sample of Canadian physicians and pharmacists on the items of information needed to prescribe a drug appropriately. Subsequent work will refine this list into a usable template to develop ideal drug details for specific drugs, to develop an assessment process to measure quality of information, and to assess the impact of this program on prescribing and patient outcomes.
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Affiliation(s)
- D G Strang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba R3J 0L3, Canada.
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10
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Abstract
An important determinant of whether people can live in community settings is the absence of significant handicap. People with considerable disabilities can live without handicap if they have adequate supports. Handicap, rather than disability, limits peoples' residence options. Disability assessment tools are commonly used to guide where people can live--these assess neither the resources available nor the personal-care handicap present. The Handicap Assessment and Resource Tool (HART) was designed to provide information about the personal-care issues (clothing, hygiene, nutrition, mobility, safety, residence and supports) relevant to choice of residence. The HART was tested by occupational therapists who are frequently expected to provide recommendations regarding disabled clients' residence options. It is a client-centred tool that addresses key occupational performance components of personal care. Pilot testing in hospital and community settings shows the HART is a comprehensive and practical tool that is acceptable to users and clients.
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Affiliation(s)
- A Vertesi
- Hamilton Health Sciences Corporation-Henderson Hospital site, Ontario.
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11
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Darzins P, LoGiudice D. Clinical testing in general practice. What is the evidence? Aust Fam Physician 1999; 28:1241-4. [PMID: 10650597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Evidence based medicine (EBM) is a term being used widely in reference to diagnostic tests and treatments. In EBM a test or a treatment is only utilised when there is solid evidence that the likelihood of benefit to the patient outweighs the risk of harm. However, EBM is rarely considered in the clinical aspects of medicine: history taking and examination. In looking for clinical signs doctors need to consider the accuracy of those signs and the implications that false negative or false positive results will have for their patient. OBJECTIVE The issues of sensitivity and specificity of clinical medicine are explored via the example of dementia testing in general practice. DISCUSSION The article demonstrates that although two commonly used screening tests for dementia have a high sensitivity (75%) and specificity (70%), there is little benefit in the routine use of these assessments for screening in general practice. Clues from appropriate history taking may be of greater diagnostic use.
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Affiliation(s)
- P Darzins
- National Ageing Research Institute, University of Melbourne
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12
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LoGiudice D, Darzins P. Is it dementia? Aust Fam Physician 1999; 28:669-72. [PMID: 10431422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Dementia is a disorder of memory and thinking, severe enough to interfere with a person's life. In the early stages of the disease, an accurate diagnosis may be difficult to make. OBJECTIVE To outline the assessment of people who present with cognitive difficulties, and discuss important conditions which may mimic dementia, and diagnostic criteria for dementia. DISCUSSION The assessment of people with cognitive difficulties includes the exclusion of conditions such as depression, delirium and normal changes of ageing. The accurate diagnosis of dementia allows the institution of early and appropriate management and support of affected people and their families.
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Darzins P, Hull M. Older road users. Issues for general practitioners. Aust Fam Physician 1999; 28:663-7. [PMID: 10431421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND As our population ages it is anticipated that a greater number of older drivers will be on the roads. This raises the possibility of an increased number of road crashes. Predictors of increased risk of road accidents need to be identified in order for appropriate advice to be given on how to reduce the road risk. OBJECTIVE This article aims to provide insights about the problems posed by older drivers together with practical guidance for general practitioners. DISCUSSION Advice from medical practitioners is often heeded by older patients in relation to their ability to drive. Using resources such as Assessing Fitness to Drive will aid the GP in making an informed decision in relation to this.
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Affiliation(s)
- P Darzins
- University of Melbourne, National Ageing Research Institute, Parkville, Victoria
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14
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Abstract
OBJECTIVE To compare results of a specific capacity assessment administered by the treating clinician, and a Standardized Mini-Mental Status Examination (SMMSE), with the results of expert assessments of patient capacity to consent to treatment. DESIGN Cross-sectional study with independent comparison to expert capacity assessments. SETTING Inpatient medical wards at an academic secondary and tertiary referral hospital. PARTICIPANTS One hundred consecutive inpatients facing a decision about a major medical treatment or an invasive medical procedure. Participants either were refusing treatment, or were accepting treatment but were not clearly capable according to the treating clinician. MEASUREMENTS AND MAIN RESULTS The treating clinician (medical resident or student) conducted a specific capacity assessment on each participant, using a decisional aid called the Aid to Capacity Evaluation. A specific capacity assessment is a semistructured evaluation of the participant's ability to understand relevant information and appreciate reasonably foreseeable consequences with regard to the specific treatment decision. Participants also received a SMMSE administered by a research nurse. Participants then had two independent expert assessments of capacity. If the two expert assessments disagreed, then an independent adjudication panel resolved the disagreement after reviewing videotapes of both expert assessments. Using the two expert assessments and the adjudication panel as the reference standard, we calculated areas under the receiver-operating characteristic curves and likelihood ratios. The areas under the receiver-operating characteristic curves were 0.90 for specific capacity assessment by treating clinician and 0.93 for SMMSE score (2p =.48). For the treating clinician's specific capacity assessment, likelihood ratios for detecting incapacity were as follows: definitely incapable, 20 (95% confidence interval [CI] 3. 6, 120); probably incapable, 6.1 (95% CI 2.6, 15); probably capable, 0.39 (95% CI 0.18, 0.81); and definitely capable, 0.05 (95% CI 0.01, 0.29). For the SMMSE, a score of 0 to 16 had a likelihood ratio of 15 (95% CI 5.3, 44), a score of 17 to 23 had a likelihood ratio of 0. 68 (95% CI 0.35, 1.2), and a score of 24 to 30 had a likelihood ratio of 0.05 (95% CI 0.01, 0.26). CONCLUSIONS Specific capacity assessments by the treating clinician and SMMSE scores agree closely with results of expert assessments of capacity. Clinicians can use these practical, flexible, and evaluated measures as the initial step in the assessment of patient capacity to consent to treatment.
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Affiliation(s)
- E Etchells
- Department of Medicine, The Toronto Hospital, University of Toronto, Toronto, Ont., Canada
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15
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Abstract
The elderly are a heterogeneous population group who range from well and completely independent individuals to a smaller proportion who are frail, require help and are high users of the healthcare system. Since health is a state of well-being which includes the domains of social, spiritual, psychological and physical function, each of these domains must be evaluated when we are measuring the health of older adults. In this article, we discuss some of the more important aspects of these domains. If we focus exclusively on the diseases which occur in older adults we will miss important aspects of their health status. We may miss the interactions of several different disease processes occurring in 1 individual, and the impact of those diseases on the individual's ability to live independently and his or her quality of life. In this article, we not only justify the measurement of function, cognition, affect and quality of life in the elderly but we also describe the necessary measurement qualities of instruments used to measure health-related quality of life in the elderly. We provide some examples of measurement approaches with which we as researchers and health workers are familiar.
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Affiliation(s)
- I Turpie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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16
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Patterson C, Molloy DW, Guyatt GH, Bedard M, North J, Hassard J, Willison K, Jubelius R, Darzins P. Systematic implementation of an advance health care directive in the community. Can J Nurs Adm 1997; 10:96-108. [PMID: 9384018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In Canada, advance directives have been developed to ensure individual's decisions about health care are known in the event of mental incapacity. This randomized control trial examined the proportion of chronically ill elders receiving Victorian Order of Nurses (VON) services in the home who would complete an advance directive, factors associated with directive completion, treatment choices, and satisfaction with care. The participants consisted of 163 elders with a chronic illness residing within the Hamilton-Wentworth and Haldimand-Norfolk regions in South Central Ontario. Seventy percent of the experimental group completed the directive. Younger patients (p = 0.01) and patients with particular nurses (p = 0.04) were more likely to complete a directive. Psychosocial variables such as mood, depression, and uncertainty in illness did not influence directive completion. Satisfaction with involvement in health care decisions was not changed by this intervention (p = 0.576).
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Affiliation(s)
- C Patterson
- School of Nursing, McMaster University, Ontario
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17
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Abstract
BACKGROUND The notion that sun exposure is a risk factor for age-related macular degeneration (AMD) is widespread, but studies have not shown this conclusively. METHODS To test the hypothesis that AMD cases have greater ocular sun exposure than control subjects, the authors compared 409 cases with 286 control subjects resident in Newcastle, Australia. Sensitivity to sun and glare of the participants was characterized. Sun exposure was estimated from detailed histories and was validated against sun-seeking or avoidance behavior expected, given sun sensitivity and history of treatment for skin neoplasia. RESULTS Contrary to the authors' hypothesis, control subjects had greater median annual ocular sun exposure (865 hours) than cases (723 hours), Mann-Whitney U (U) = 45704, z = -4.9, P > 0.0001. Cases had poorer tanning than did control subjects (mean 2 = 18.2, 4 df, P = 0.001) and as young adults were more sensitive to glare, odds ratio (OR), 2.5; 95% confidence intervals (CIs), 1.8 to 3.5. After stratifying by tanning ability, in the poor-tanning group, the median annual sun exposure of control subjects (685 hours) exceeded that of cases (619 hours), U = 6556, z = -1.9, P = 0.06. Among people who tanned well, control subjects also had significantly greater annual sun exposure than did cases (940 vs. 770 hours), U = 16263, z = -3.7, P = 0.0002. CONCLUSIONS Sensitivity to glare and poor tanning ability are markers of increased AMD risk. Sun sensitivity confounds study of the postulated AMD-sunlight link. Despite analyses stratified by sun sensitivity, sun exposure was greater in control subjects than in cases with AMD.
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Affiliation(s)
- P Darzins
- McMaster University, Division of Geriatric Medicine, Hamilton, Ontario, Canada
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18
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Molloy DW, Bédard M, Guyatt GH, Patterson C, North J, Jubelius R, Hassard J, Willison K, Darzins P, Harrison C. Attitudes training issues and barriers for community nurses implementing an advance directive program. Perspectives 1997; 21:2-8. [PMID: 9282061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D W Molloy
- Department of Medicine, McMaster University, Ontario
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19
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Strang D, Gagnon M, Molloy W, Bedard M, Darzins P, Etchells E, Davidson W. National survey on the attitudes of Canadian physicians towards drug-detailing by pharmaceutical representatives. Ann R Coll Physicians Surg Can 1996; 29:474-8. [PMID: 12380577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Our objective was to study the attitudes of Canadian physicians toward product presentations by pharmaceutical representatives (PRs), the use of inducements by the pharmaceutical industry, and methods to improve the quality of prescribing information provided to physicians. DESIGN We used a mailed survey. PARTICIPANTS A random sample of 550 Canadian physicians in all settings was chosen. OUTCOME MEASURES The main outcome measure was the proportion of respondents agreeing with a series of statements. RESULTS The response rate was 262 of 525 deliverable surveys (50 per cent). Respondents had a mean of 4.2 interactions per week with PRs. Of the 262 respondents (5.8 per cent of data were incomplete), 193 (80 per cent) believed that PRs overemphasize their products' effectiveness, 108 (45 per cent) thought PRs do not present fairly the drugs' negative aspects, and 223 (92 per cent) felt that PRs have production promotion as a goal. Most, 175 (70 per cent), believe that drug-detailing affects physicians' prescribing behavior. Most, 210 (86 per cent), considered drug samples acceptable, but fewer agreed that other inducements were acceptable. Of the respondents, 183 (74 per cent) agreed that PRs should be required to use guidelines for standardized, comprehensive drug-detailing, and 165 (65 per cent) agreed that face-to-face drug-detailing by PRs using standardized guidelines would be an effective way to receive information. CONCLUSIONS There is dissatisfaction among Canadian physicians about the quality of information provided by the pharmaceutical industry. Standardized, comprehensive guidelines would be accepted by physicians as one improvement.
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Affiliation(s)
- D Strang
- Dept. of Internal Medicine, University of Manitoba, 409 Tache Ave., Winnipeg MB R2H 2A6, Canada
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20
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Abstract
OBJECTIVE To validate reference standards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments. METHODS We administered five measures of capacity to 96 older subjects from nursing homes, retirement homes, and homes for the aged. The measures included two reference standard evaluations: an assessment by a specially trained nurse in collaboration with a multidisciplinary team (Competency Clinic assessment) and geriatrician assessment using a decisional aid. Three screening instruments were also included: a Generic Instrument designed for any advance directive, a Specific Instrument designed for the "Let Me Decide" advance directive, and the Standardized Mini-Mental Status Examination (SMMSE). The screening instruments and the geriatrician's assessment were administered twice to half of the respondents to determine interrater agreement. RESULTS The chance-corrected agreement for the assessment by two geriatricians was 0.78, and for agreement between the geriatricians and Competency Clinic assessments it was 0.82. Agreement for the Generic and Specific screening instrument assessments by two observers was 0.77 and 0.90, respectively. The areas under the Receiver Operating Characteristic curve relating the results of the three screening instruments to the Competency Clinic assessment were 0.82 for the Generic Instrument, 0.90 for the Specific Instrument, and 0.94 for the SMMSE; chance is an unlikely explanation for the difference between these three values (P < or = .01). CONCLUSIONS Using rigorous methods, health workers can make reproducible and valid assessments of capacity to complete an advance directive. The SMMSE accurately differentiates people who can learn about and ultimately complete advance directives from those who cannot.
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Affiliation(s)
- D W Molloy
- Geriatric Research Group, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ganesan R, Standish T, Molloy DW, Darzins P, Orange JB. New treatments for dementia. Myth, magic, and science. Can Fam Physician 1994; 40:1149-57. [PMID: 8019192 PMCID: PMC2380209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dementia could affect 778,000 Canadians by the year 2031. While current treatment is mainly supportive, a race to find new treatments for this dreaded disease takes varied approaches and currently accounts for 10% of drug company resources. Tacrine is the first drug licensed by the US Food and Drug Administration for use in Alzheimer's disease. New treatments raise several ethical issues and involve society's attitude toward death and dying.
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Affiliation(s)
- R Ganesan
- McMaster University in Hamilton, Ont
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Orange JB, Molloy DW, Lever JA, Darzins P, Ganesan CR. Alzheimer's disease. Physician-patient communication. Can Fam Physician 1994; 40:1160-8. [PMID: 8019193 PMCID: PMC2380218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The number of cognitively impaired elderly in Canada has increased greatly during the past two decades; nearly all have Alzheimer's disease (AD). The memory problems and changes in language and communication of these patients place tremendous strain on physicians who are searching for a differential diagnosis and are trying to communicate with them. Reviewing the salient language and communication features of AD patients leads to strategies for improving effective physician-patient communication.
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Affiliation(s)
- J B Orange
- Department of Communicative Disorders, University of Western Ontario, London
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Darzins P, Jones G, Smith BJ. Bone density of élite female athletes with stress fractures. Med J Aust 1991; 154:492-3. [PMID: 2005853 DOI: 10.5694/j.1326-5377.1991.tb121197.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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