Quantifying multifaceted needs captured at the point of care. Development of a Disabilities Terminology Set and Disabilities Complexity Scale.

AIMS: To develop a Disabilities Terminology Set and quantify the multifaceted needs of disabled children and their families in a district disability clinic population. METHOD: Data from structured electronic clinic letters of children attending paediatric disability clinics from June 2007 to May 2012 in Sunderland, north-east England collected at the point of clinical care were analysed to determine appropriate terms for consistent recording of each need and issue. Terms were collated to count the number of needs per child. RESULTS: A Systemized Nomenclature of Medicine - Clinical Terms subset of 296 terms was identified and published, and 8392 consultations for 1999 children were reviewed. The required number of clinic appointments correlated strongly with the number of needs identified. Children with intellectual disabilities in addition to cerebral palsy and epilepsy had more than double the number of conditions, technology dependencies, and family-reported issues than those without. Disabled children who subsequently died had the highest burden of needs (p=0.007). INTERPRETATION: Detailed data about needs generated outputs useful for local care pathway development and service planning. Sufficient evidence was provided for successful business cases leading to the appointment of additional paediatric disability consultants. Counting numbers of needs and issues quantifies complexity in a straightforward way. This could underpin needs-based commissioning of services.

A practical approach to glare assessment for train cabs.

The assessment of glare is a key consideration in the design of a railway driver's cab. However, unlike assessment of other factors, such as forward visibility, there are no standardised approaches for performing assessments of glare. This paper describes an approach for assessing the impact of glare in a full size mock-up of a railway cab. While it is unrealistic to evaluate every possible lighting condition that may potentially occur in the vehicle cab in service, a pragmatic and practical approach is taken to provide a good level of indicative information about the cab design's likely glare performance. This involves assessing internal light sources, such as internal lights and illuminated controls, and simulating external light sources (e.g. the sun, other trains' headlights) by illuminating the cab mock up windscreen, side and door windows with a single light source manually located in a sequence of discrete positions and orientations and assessing the resulting glare impacts. The paper describes a structured process for assessing and recording the impact of glare and recommending mitigations.