Should an institution that has commercial rights in a new drug or device be allowed to evaluate the technology?
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BACKGROUND TO THE DEBATE: In the United States, the passage of the Bayh-Dole Act in 1980 encouraged universities to license inventions for commercial development. Although this financial incentive can stimulate academic researchers to discover new drugs and devices, there is concern that the possibility of monetary reward could distort investigators' objectivity. (+info)
A retrospective review of the neuropsychological test performance of physicians referred for medical infractions.
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Physician-related errors are rising, resulting in an increase in disciplinary actions by licensing medical authorities. It has been previously reported that cognitive impairment may be responsible for 63% of all physician-related medical adverse events. In this paper we examine neuropsychological testing results from 148 physicians referred for assessment by the California Medical Board (CMB) for various infractions. The neuropsychological test performance of the physicians was compared to normative reference samples. Overall, they performed in the average range on most measures; however, they demonstrated relative deficits on tests of sequential processing, attention, logical analysis, eye-hand coordination, verbal and non-verbal learning. These findings reveal that this cohort of physicians is performing lower than expected on tests of intellectual and neuropsychological functioning. Applying a neuropsychological framework to the assessment of physicians may uncover potential cognitive factors that contribute to medical practice errors. (+info)
Persistence of effects of the Checkpoints program on parental restrictions of teen driving privileges.
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OBJECTIVES: We describe intervention effects on parent limits on novice teenage driving. METHODS: We recruited parents and their 16-year-old children (n = 469) with learner's permits and randomized them from August 2000 to March 2003. Intervention families received persuasive newsletters related to high-risk teenage driving and a parent-teenager driving agreement; comparison families received standard information on driver safety. We conducted interviews when the adolescents obtained a learner's permit, upon licensure, and at 3, 6, and 12 months postlicensure. RESULTS: Intervention parents and teenagers reported stricter limits on teen driving compared with the comparison group at 12 months, with direct effects through 3 months and indirect effects through 12 months postlicensure. CONCLUSIONS: A simple behavioral intervention was efficacious in increasing parental restriction of high-risk teen driving conditions among newly licensed drivers. (+info)
Predictive validity of dental hygiene competency assessment measures on one-shot clinical licensure examinations.
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The purpose of this study was to examine the predictive validity of traditional and nontraditional dental hygiene competency assessment measures on one-shot clinical licensure examinations in a baccalaureate dental hygiene program. Traditional assessment data including overall grade point average (GPA), Clinical GPA, National Board Dental Hygiene Examination (NBDHE) scores, and Central Regional Dental Testing Service (CRDTS) scores along with nontraditional assessment data in the form of Portfolio scores were collected from seventy-four students. Factor analysis and subsequent linear regression modeling were used to explore the ability of four variables (Overall GPA, NBDHE, Portfolios, and Clinical GPA) to predict one-shot clinical licensure examination (CRDTS) scores. A two-factor solution was obtained with one factor defined as dental hygiene cognition and the second factor defined as dental hygiene clinical performance. Factor scores were subsequently used in a linear predictive model to assess the shared and unique contribution of factors to the one-shot clinical licensure examination score. The shared contribution of both factors only accounted for 13.9 percent of variance in the outcome measure of one-shot clinical licensure examination scores. The lack of concordance between previously validated measures of dental hygiene student competency or predictors of student success (Overall GPA, NBDHE, and Portfolios) and a one-shot clinical licensure examination (CRDTS) raises serious concern about the validity of our current dental hygiene licensing procedure which uses the CRDTS clinical examination to make decisions about granting licenses to practice. (+info)
Visual function and car driving: longitudinal results 5 years after cataract surgery in a population.
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AIMS: To determine visual function in drivers who had cataract surgery 5 years previously, and to analyse longitudinal data, by comparing preoperative and postoperative changes in subjective driving ability and objective visual function. METHODS: All patients (810) who underwent cataract surgery, during a 1 year period, were prospectively studied. Data regarding present driving status were collected from self administered questionnaires and visual acuity (VA) data were measured before and after surgery. All patients who were alive 5 years later were invited to participate with a new eye examination and questionnaire. RESULTS: Before surgery 36 active drivers (16%) did not fulfil the visual requirements for driving; with improved glasses this number could be reduced to 24 (11%). 5 years after surgery, the corresponding figures were 5% and 3% (5/174), respectively. Before surgery 50% stated visual difficulties while driving in daylight and 79% in darkness. A few months and 5 years after surgery the corresponding figures were 6% and 5%, respectively, for daytime driving and 34% and 44%, respectively, for night-time driving. CONCLUSIONS: Long term results regarding cataract surgery in car drivers are beneficial. 5 years after surgery only a few patients drove not fulfilling the requirements, but there were a larger proportion of patients with problems driving in darkness compared with a few months after surgery. (+info)
Wisconsin's experience with the Graduated Driver Licensing Law.
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In 2000, Wisconsin enacted the Graduated Driver Licensing (GDL) Law in an effort to reduce the number of teen deaths and injuries due to motor vehicle crashes. The GDL program targets high-risk teen driving behaviors by mandating more hours of supervised driving, limiting nighttime driving, restricting vehicle passengers, requiring seatbelt use, and mandating absolute sobriety for all teen drivers. In the first 3 years of graduated driver licensing, Wisconsin saw a 15% decrease in the number of motor vehicle collisions involving 16-year-old drivers. While this decline is encouraging, it lags behind the effectiveness documented by other states with GDL laws. The current study evaluates informational or attitudinal barriers that may prevent the effective implementation of Wisconsin's GDL law. Knowledge and attitude surveys were administered to 15-17 year olds and their parents. Parents (n=26) and teens (n=26) were knowledgeable about the 30 hours of supervised driving during the learner's permit phase and extremely knowledgeable about the 9-month nighttime and passenger restrictions of the probationary phase. While 76% of parents supported GDL, 70% of teens disapproved of the law. The reasons for disapproval varied, parents often cited inconvenience and restrictiveness. Teens most often cited passenger restrictions as the reason for disapproval. Overall, negative attitudes, more than lack of knowledge, may weaken compliance with Wisconsin's GDL law and, in turn, limit the reduction of teen crashes. (+info)
Which older patients are competent to drive? Approaches to office-based assessment.
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OBJECTIVE: To review three proposed approaches to office-based assessment of older drivers and to evaluate recommendations made about dementia and driving. QUALITY OF EVIDENCE: The American Medical Association's (AMA's) Physcian's Guide to Assessing and Counseling Older Drivers gives recommendations for office-based assessment of older patients' medical fitness to drive. Other approaches examined were those outlined in the sixth edition of Determining Medical Fitness to Drive produced by the Canadian Medical Association (CMA) and SAFE DRIVE. Recommendations for dementia and driving from these documents and other sources were reviewed. All evidence was level III. MAIN MESSAGE: The AMA document usefully identified ways to detect drivers at risk and key areas for assessment (vision, cognition, motor function). Recommendations on evaluating these areas require validation. .he CMA guide and SAFE DRIVE were overly broad in their recommendations. How best to detect cognitive impairment that tocld affect driving remains unclear. CONCLUSION: Office-based approaches to identifying older drivers who are either unsafe to drive or require more extensive evaluation need to be validated. (+info)
In-office evaluation of medical fitness to drive: practical approaches for assessing older people.
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OBJECTIVE: To provide background for physicians'in-office assessment of medical fitness to drive, including legal risks and responsibilities. To review opinion-based approaches and current attempts to promote evidence-based strategies for this assessment. QUALITY OF EVIDENCE: MEDLINE, EMBASE, CINAHL, PsyclNFO, Ageline, and Sociofile were searched from 1966 on for articles on health-related and medical aspects of fitness to drive. More than 1500 papers were reviewed to find practical approaches to, or guidelines for, assessing medical fitness to drive in primary care. Only level III evidence was found. No evidence-based approaches were found. MAIN MESSAGE: Three practical methods of assessment are discussed: the American Medical Association guidelines, SAFE DRIVE, and CanDRIVE. CONCLUSION: There is no evidence-based information to help physicians make decisions regarding medical fitness to drive. Current approaches are primarily opinion-based and are of unknown predictive value. Research initiatives, such as the CanDRIVE program of the Canadian Institutes of Health Research, can provide empiric data that would allow us to move from opinion to evidence. (+info)