Search

Purpose: To evaluate the safety and technical success of the AndraValvulotome™ device (Andramed GmbH, Reutlingen, Germany) in patients with peripheral arterial disease (PAD) requiring bypass surgery using the great saphenous vein (GSV) as graft. Methods: This was a multicenter, post-market observational study conducted in 2021 in 11 German centers. Safety and efficacy data were prospectively collected and analyzed. Primary endpoints were the absence of device-related serious adverse events until 30 ± 7 days follow-up, the clinical efficacy of valvulotomy, which was defined as pulsatile blood flow in the bypass and the number of insufficiently destroyed vein valves. Secondary endpoints were the number of valvulotomy passages, the primary patency rate of the venous bypass (determined by a color-duplex sonography showing a normal blood flow through the bypass and absence of stenosis or occlusion), and the primary technical success defined as the absence of product-specific (serious) adverse events and clinical efficacy. Results: Fifty-nine patients were enrolled. The mean age of the patients was 71 years (46–91), and 74.6% were males. The vein material used for bypass grafting had a median length of 47.5 cm (range 20–70 cm) with a median diameter of 5.0 mm (range 3–6 mm) and 4.0 mm (range 2–6 mm) in the proximal and distal segments, respectively. The technical success rate was 96.6%. The primary patency rate was 89.9% at 30 days follow-up. The clinical efficacy was rated as very good in 81% of patients, fair in 17%, and poor in 2%. Between 1 and 5 (average 2.9) valvulotome passages were performed. One product-related serious adverse event was recorded (bypass vein dissection). Conclusion: The AndraValvulotome™ can be considered a safe and effective device to disrupt venous valves during in situ non-reversed bypass surgeries using GSV grafts in patients with PAD. [ABSTRACT FROM AUTHOR]

For studies relying on rater judgments of a vulnerable population, such as returning combat veterans, high consistency between primary and secondary raters is necessary. This study examined the inter-rater reliability of a primary and two secondary raters on scoring simulated driving assessments. Seven volunteer drivers were rated in two rounds (Round 1 n=4, Round 2 n=3). Driver performance was rated for two driving scenarios, a) ten-minute city/highway scenario, and b) six-minute suburban/residential scenario to measure driving errors. Based on a set 90% cut point for intra-class correlations (ICC), we examined each rated variable for each rater pairing. After round 1, secondary raters did not achieve the 90% cut point and participated in further training. Analysis of inter-rater reliability following round 2 showed improved inter-rater reliability, i.e., 99.3% for city/highway and 98% for the suburban/residential conditions. Our results suggest that by pinpointing incongruencies in raters' assessment of driving errors, strategies including problem identification, verifying driving errors via the simulator playback function, and establishing parameters for rating each error, can resolve such inconsistencies to significantly improve their inter-rater reliability. [ABSTRACT FROM AUTHOR]

This special issue reports on papers presented at a simulation user group meeting held in association with the University of Florida, Gainsville. This is the sixth in a series of special issues that have reported on driving simulator applications presented at simulation users conferences [1 - 5]. The meeting attracted 32 attendees from 5 different countries. This special issue includes 8 papers covering a wide range of research topics. The papers in this volume address in-vehicle systems, simulator sickness, simulator validation, driver behaviour and investigation of rider behaviour with a novel motorcycle simulator. [ABSTRACT FROM AUTHOR]

Combat veterans (CV) are experiencing mild traumatic brain injury and/or post traumatic stress disorder (mTBI/PTSD) which may hinder driving performance. Simulators provide a safe environment for testing individuals with impairments, but simulator sickness (SS) may occur and has not been studied in CV. In this retrospective study, we determined the occurrence of SS [total SS (TSS) score from the Simulator Sickness Questionnaire] at baseline, after an initial 5-minute acclimation drive, and after an entire 20-minute drive within and between 21 CV compared to 23 healthy controls (HC). Baseline differences in TSS were significant and were probably due to demographic differences (age and gender) and pre-experimental experience. Susceptibility to SS occurred in CV at two time periods and increased as driving exposure progressed. A significant increase in TSS existed between baseline and after the initial 5-minute acclimation drive in CV [t(-2.59), 8.10, p=0.02] and HC [t(-2.51), 6.41, p=0.02]; and between baseline and after the entire 20-minute drive in CV [t(-3.94), 8.07, p<.01] and HC [t(-4.05), 4.10, p<.01]. A main effect of TSS between groups approached significance (F=2.78, p=0.057) with CV having higher TSS scores than HC. Overall, these findings suggest that CV may have pre-existing conditions that make them more susceptible to SS; and that CV experienced SS more severely compared to HC, every time during the three time periods. Findings must be confirmed in an age and gender matched trial with a larger sample. [ABSTRACT FROM AUTHOR]

Purpose: To determine the correlations of the Useful Field of View (UFOV), compared to other clinical tests of Parkinson's disease (PD); vision; and cognition with measures of on-road driving assessments and to quantify the UFOV's ability to indicate passing/failing an on-road test in people with PD. Methods: Nineteen randomly selected people with idiopathic PD, mean age = 74.8 (6.1), 14 (73.7%) men, 18 (94.7%) Caucasians, were age-matched to 104 controls without PD. The controls had a mean age of 75.4 (6.4), 59 (56.7%) men, 96 (92.3%) Caucasians. Both groups were referred for a driving evaluation after institutional review board approval. Results: Compared to neuropsychological and clinical tests of vision and cognition, the UFOV showed the strongest correlations (r > .75, p < 0.05) with measures of failing a standardized road test and number of driving errors. Among PD patients, the UFOV Risk Index score of 3 (range 1-5) was established as the optimal cutoff value for passing the on-road test, with sensitivity 87 percent and specificity 82 percent, AUC = 92 percent (SE 0.61, p = .002). Similarly, the UFOV 2 (divided attention) optimum cutoff value is 223 ms (range 16-500 ms), sensitivity 87.5 percent, specificity 81.8 percent, AUC = 91 percent (SE 0.73, p = .003). The UFOV 3 (selected attention) optimal cutoff value is 273 ms (range 16-500 ms), sensitivity 75 percent, specificity 72.7 percent, AUC = 87 percent (SE 0.81, p = .007). Conclusion: In this pilot study among PD patients, the UFOV may be a superior screening measure (compared to other measures of disease, cognition, and vision) for predicting on-road driving performance but its rigor must be verified in a larger sample of people with PD. [ABSTRACT FROM AUTHOR]

Driving, an instrumental activity of daily living, requires safe person-environment interactions. The effectiveness (safety) of four United States Federal Highway Administration intersection design guidelines in the recovery phase of a turn was tested on older and younger adults. Using kinematics measures from an instrumented vehicle, drivers negotiating improved and unimproved intersections were examined in Gainesville, Florida. The findings from a 2 x 2 repeated measures ANOVA (within-subject variable = intersection condition: improved versus unimproved; between-subject variable = age: young versus old) yield support for three manoeuvres: extended receiving lane, right-turn channelisation with acceleration lane and left-turn offset, but not for no acute turn angle. One interaction effect (age x intersection) existed and age effects (favouring older drivers) appeared for three manoeuvres, yet showed little practical significance, suggesting that these design guidelines benefit older and younger drivers alike. This study informs occupational therapists that enhancements in the environment have an impact on safer driving, particularly at urban intersections. A replication of the concept of this study, that is, testing intersection design guidelines in the United Kingdom, may generate valuable information on the plausibility of environmental design guidelines and their effects on the driving performance of older and younger adults. [ABSTRACT FROM AUTHOR]

Researchers are calling for increased studies with regard to differences between older men and women drivers. This literature review focuses on gender comparisons for self-regulation of driving and driving cessation. We reviewed 20 articles and assigned levels of evidence. Seven studies were level II (eg, prospective cohort) and 13 were level III (eg, cross-sectional). Subsequently, 5 evidence-based recommendations were made to address gender-specific needs of older men and women. Additional research is needed to clarify gender patterns for self-regulation and cessation and increase the level of evidence supporting gender-specific driving interventions. [ABSTRACT FROM AUTHOR]

A meta-synthesis approach was used to identify, assess, and synthesize six qualitative studies on older driver safety and community mobility. Included studies had rich narrative results and thematic findings on older adults' and stakeholders' needs, factors influencing safety, and goals. The authors performed iterative data analysis, coded deductively and inductively, and developed themes from the constant comparison method. A core construct emerged: older adults' driving ability is innately connected to their identities and desire to maintain their independence. The five overarching themes--assessing risk, acceptance versus denial, cessation beliefs, communication, and involved others--Linform occupational therapy clinicians and researchers of opportunities for role expansion. The findings point to underlying beliefs that influence decision making and driving safety that can be explored using qualitative, survey, or experimental studies. Furthermore, these findings may facilitate changes in occupational therapy practice, such as enhancing driver evaluations. [ABSTRACT FROM AUTHOR]

It is anticipated that the number of older adults with impairments or limitations will increase from approximately 14 million today to more than 28 million in 2030. The intent of this article is to illustrate the place of public health and population-level data in understanding current and future impacts on rehabilitation practitioners, the services they provide, and the clients they serve. Rehabilitation professionals can use public health data, like the Census and Behavioral Risk Factor Surveillance System, to facilitate data-driven planning. To explain this notion, we introduce basic public health concepts as well as aging and disability-related data examples. [ABSTRACT FROM AUTHOR]

The Rosenberg Self-Esteem Scale (RSES) demonstrates sound psychometric properties but has not been analyzed by item response theory (IRT). We used the Rasch model to determine the item-level psychometrics of the RSES in 986 noninstitutionalized elderly. The instrument showed appropriate item fit statistics and person separation index, but had limitations in the number and spread of items, unidimensionality, the logical progression of difficulty among the items, negative statements included in the rating scale, and the contextual relevance of items underlying the self-esteem construct. Based on clinical and cost implications, we offered suggestions to improve the RSES as a clinically meaningful measure of self-esteem in this population. [ABSTRACT FROM AUTHOR]

Older driver safety is a complex phenomenon, extending beyond the person level to multiple system characteristics, such as epidemiologic, environment, and policy. Studying multiple factors in older driver safety requires the use of an integrated socioecological approach. In a cross-sectional design, we used a public health model and the 2003 General Estimates System database to determine main risk factors and their measures of association in the presence or absence of injury among older adults involved in motor vehicle accidents. Compared to the findings of the existing literature, participants demonstrated similar person-level crash-related injury characteristics. However, the socioecological model elucidated the importance of environment-level and vehicle-level factors as significant determinants of older driver safety. [ABSTRACT FROM AUTHOR]