Drive aware training: A computerized training program for older drivers' detection of road hazards.

OBJECTIVE: Cognitive training for reducing crash rate can be delivered to older drivers via in-person on-road sessions, a driving simulator, or using computer-based cognitive methods. Despite established effectiveness, in-person on-road assessment and rehabilitation are expensive, and limited professional service may not be readily accessible; simulator-based training may not fit every driver due to simulator sickness. In comparison, computerized training is easier to implement and could be delivered with little cost to older drivers with computer access. Based on the Drive Aware Task, a validated measure of attentional processes in hazard detection, we developed a computerized cognitive training method with a focus on hazard detection. In this study, we examined the effectiveness of this newly-developed interactive training program in improving older drivers' detection of road hazards. METHODS: Using a matched-pair design, nine triads of three older drivers (aged 65 or above) with matched pretest performance and gender were formed. For each triad, each participant was randomly allocated to one of the three groups: 1) active training group to receive the two training sessions (1.5-2.5h per session); 2) passive training group to receive two video-watching sessions (i.e., watch the video of training session performance from the corresponding paired participant); 3) no-contact control group. Older drivers' performances on hazard detection and simulated driving were measured before and after training. RESULTS: The active training group showed significant training effects on the computerized hazard detection task and simulated driving performance, while there were only marginal effects in the passive training group and no effects in the no-contact control group. A post-training survey suggested older drivers were receptive to the Drive Aware training program. CONCLUSIONS: The computerized Drive Aware training program has the potential to be used as a prevention and intervention tool to improve older drivers' hazard detection performance. Future studies should examine the effectiveness of this tool in more diverse samples and in long-term outcomes.

A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery.

OBJECTIVES: To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS. BACKGROUND: There is no prospective data examining the need, feasibility, and safety of over-expansion of current generation DES beyond nominal diameter. METHODS: Patients with flow-limiting coronary atheroma requiring IVUS assessment of the LMS were recruited. Standardized measurements of the distal LMS were made. Subsequently, patients requiring post dilation of current generation DES within the LMS were entered into a PCI registry. RESULTS: Overall, 125 patients were recruited into the initial study. Mean cross-sectional area (CSA) of the distal LMS was 22.6 mm(2) (SD ± 5.4 mm(2) ). Mean maximal vessel diameter was 5.7 mm (SD ± 0.7 mm). Increasing plaque burden was associated with reduced CSA (P < 0.001). In 31 consecutive patients undergoing IVUS guided PCI of the LMS with 5.5 and 6.0 mm balloon catheters, mean maximal stent diameters were >5.0 mm with the Biomatrix Flex 9 crown and Promus Element Large vessel platforms. No intraprocedural complications occurred. Mean follow up was 13.4 months. Clinical restenosis rate was 3.2%, with 2 deaths unrelated to index procedure. CONCLUSIONS: The majority of patients with angiographic coronary atheroma have a mean LMS diameter of >4 mm indicating the requirement for post dilation beyond nominal diameter all of current generation DES in almost all patients when treating the LMS. This is achievable with current DES platforms with no intraprocedural complication. Clinical follow up indicates excellent short-term efficacy.

Comparison of radiation dose and the effect of operator experience in femoral and radial arterial access for coronary procedures.

Radial access coronary procedures are associated with fewer access site complications compared to femoral access. There is controversy regarding greater radiation exposure to patient and operator using radial access. We aimed to compare radiation dose during coronary procedures for the 2 access routes and assess the effect of operator experience with radial access on radiation dose. Fluoroscopy time (FT) and dose-area product (DAP) were recorded for all radial access and femoral access procedures during default femoral access, transition phase (femoral access and early radial access), and default radial access. Femoral access cases (n = 848, 412 diagnostic, 436 percutaneous coronary interventions [PCIs]) and radial access cases (n = 965, 459 diagnostic, 506 PCIs) were assessed. For diagnostics, median FT for radial access was longer than for femoral access (4.43 minutes, interquartile range [IQR] 2.55 to 8.18, vs 2.34 minutes, IQR 1.49 to 4.18, p <0.001) and associated with larger DAP (radial access 1,837 µGy·m(2), IQR 1,172 to 2,783, vs femoral access 1,657 µGy·m(2), IQR 1,064 to 2,376, p <0.001). For PCI, FT was longer for radial access (median 12.02 minutes, IQR 7.57 to 17.54, vs femoral access 9.36 minutes, IQR 6.13 to 14.27, p <0.001)-this did not translate into an increased DAP (femoral access median 3,392 µGy·m(2), IQR 2,139 to 5,193, vs radial access 3,682 µGy·m(2), IQR 2,388 to 5,314, p = NS). For diagnostic radial access, FT decreased from the transition phase (n = 134) to the default radial access phase (n = 323, 5.12 minutes, IQR 3.07 to 9.40, vs 4.21 minutes, IQR 2.49 to 7.52, p = 0.03). This was not observed for PCI. In conclusion, transition from femoral access to radial access for diagnostics and PCI increased FT. DAP increased for diagnostic radial access but not PCI compared with femoral access. FTs for radial access diagnostic cases decreased with experience.