Test-retest reliability of touchscreen DriveSafe DriveAware.

INTRODUCTION: This prospective study examines the test-retest reliability of touchscreen DriveSafe DriveAware (DSDA). In a future study, the authors intend assessing the usefulness of DSDA to measure progress of patients undergoing treatment for neurological conditions. Evidence of test-retest reliability is required first. METHODS: Australian adults with current driver's licences (N = 39) aged 20 to 91 years (Mage  = 58) recruited from a convenience sample were assessed with DSDA. The assessment was repeated 6 weeks, 6 months, and 12 months later to match planned assessments of patients undergoing neurosurgical treatment in future research. DSDA classification, DriveSafe subtest score, and DriveAware subtest scores were analysed as a whole sample, and in three age groups. RESULTS: DSDA classification and DriveAware scores were consistent over repeated tests. DriveSafe scores increased between test 1 and 2 (p = .006), and thereafter no significant change from test 2 to 4. DriveSafe scores of older participants (70+ years) increased between test 1 and 2 more notably than younger participants' scores. No DriveSafe scores decreased over time. CONCLUSION: DSDA classification and DriveAware scores demonstrated test-retest reliability for all age groups. DriveSafe scores did not demonstrate test-retest reliability between test 1 and 2 for participants 70+ years. However, DriveSafe scores demonstrated test-retest reliability after test 2, possibly indicating an initial learning effect for the DriveSafe score only. The authors posit that this result may have been influenced by older adults' reduced familiarity with iPad technology at first assessment. Further longitudinal research is required to confirm whether these results are consistent in a sample population with diagnosed cognitive impairment. Future research will assess whether repeated assessment of DSDA may be useful for monitoring and screening cognitive fitness to drive in patients who have undergone neurosurgical treatment and whether declining scores may indicate cognitive changes in ability to drive.

Comparing outcome scales for unruptured intracranial aneurysms: A prospective cohort study.

Outcomes on the modified Rankin Scale (mRS) are commonly used to guide and evaluate the management of unruptured intracranial aneurysms (uIA). However, the mRS is unlikely to measure all the relevant aspects of the clinical health of a patient. The current study therefore investigated the relationship between the mRS and additional measures of outcome. Between January 2011 and January 2016 patients with a new diagnosis of uIA were prospectively examined at referral and 12-month follow-up. Assessment included the Physical and Mental Component Scores of the Short Form 36 (SF-36), the computerized driver screening instrument DriveSafe (DS), and the mRS. Minimally Important Change (MIC) for each outcome measure was used to identify adverse outcomes for individual patients. A total of 128 patients (98 surgery; 30 untreated) completed the minimal dataset for analysis. In the surgical group, 6% (95% CI 3-14%) experienced morbidity at 12-months, as defined by the MIC for mRS. This risk rate increased to 51% (95% CI 41-61%) when defined as an MIC on any outcome. A combined MIC also identified a downgrade in outcomes, not detectable on the mRS, in 42% (95% CI 26-61%) of untreated patients. Correlation and regression analyses were unable to identify any significant relationships between the different outcomes instruments. In sum, there were considerably more adverse outcomes reported by quality of life (SF-36) and functional (DS) instruments than by the mRS for either treated or untreated uIA. To obtain a more complete representation of patient outcomes requires administration of a multi-dimensional assessment.

Epidemiology, clinical characteristics and resource implications of pandemic (H1N1) 2009 in intensive care units in Ireland.

OBJECTIVE: To describe the incidence, clinical characteristics and outcomes of critically ill patients in Ireland with pandemic (H1N1) 2009 infection, and to provide a dynamic assessment of the burden of such cases on Irish intensive care units. DESIGN, SETTING AND PARTICIPANTS: Multicentre prospective observational study of all adult patients admitted to any of the 30 ICUs in the Republic of Ireland between 15 July 2009 and 30 May 2010. MAIN OUTCOME MEASURES: Patient demographics, clinical characteristics and ICU mortality; ICU admissions, bed-days, bed occupancy rates and distribution. RESULTS: Seventy-seven adult patients with pandemic (H1N1) 2009 infection were admitted to 27 of 30 Irish ICUs. The median age was 43 years (IQR, 30-56 years); 67 patients (88%) were aged under 65; 39 (51%) were male. Sixty-two patients (82%) had comorbid conditions, including obesity (36%), respiratory disease (34%) and malignancy or immunosuppression (20%). Eight (11%) were pregnant, and 27 (36%) were smokers. Sixty-seven patients were mechanically ventilated, 24 (32%) required renal replacement therapy, 39 (51%) received vasopressors and four (5%) received extracorporeal membrane oxygenation. Of 14 patients (18%) who died in the ICU, two had no pre-existing comorbidities. The ICU admission rate of patients with pandemic (H1N1) 2009 infection was 22.5/million population. A total of 1882 ICU bed-days (557.5 bed-days/million adult population) were consumed, equating to a 3.9% bed occupancy rate, with a peak of 14.0% in October 2009. Median length of stay was 12 days (IQR, 7-34 days). CONCLUSION: The 2009 influenza A (H1N1) pandemic was a significant burden on Irish ICUs, predominantly affecting the tertiary centres. The demographics and clinical characteristics were similar to those described in the southern hemisphere, suggesting such data may inform future resource planning for similar threats.