Study protocol for "In-vehicle sensors to detect changes in cognition of older drivers".

BACKGROUND: Driving is a complex behavior that may be affected by early changes in the cognition of older individuals. Early changes in driving behavior may include driving more slowly, making fewer and shorter trips, and errors related to inadequate anticipation of situations. Sensor systems installed in older drivers' vehicles may detect these changes and may generate early warnings of possible changes in cognition. METHOD: A naturalistic longitudinal design is employed to obtain continuous information on driving behavior that will be compared with the results of extensive cognitive testing conducted every 3 months for 3 years. A driver facing camera, forward facing camera, and telematics unit are installed in the vehicle and data downloaded every 3 months when the cognitive tests are administered. RESULTS: Data processing and analysis will proceed through a series of steps including data normalization, adding information on external factors (weather, traffic conditions), and identifying critical features (variables). Traditional prediction modeling results will be compared with Recurring Neural Network (RNN) approach to produce Driver Behavior Indices (DBIs), and algorithms to classify drivers within age, gender, ethnic group membership, and other potential group characteristics. CONCLUSION: It is well established that individuals with progressive dementias are eventually unable to drive safely, yet many remain unaware of their cognitive decrements. Current screening and evaluation services can test only a small number of individuals with cognitive concerns, missing many who need to know if they require treatment. Given the increasing number of sensors being installed in passenger vehicles and pick-up trucks and their increasing acceptability, reconfigured in-vehicle sensing systems could provide widespread, low-cost early warnings of cognitive decline to the large number of older drivers on the road in the U.S. The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost early warnings of cognitive change for this large number of older drivers in the U.S. and elsewhere.

Development and testing of a DVT risk assessment tool: providing evidence of validity and reliability.

BACKGROUND: Hospital-acquired deep vein thrombosis (DVT) and pulmonary embolisms (PE) are preventable problems that can increase mortality. Early assessment and recognition of risk as well as initiating appropriate prevention measures can prevent DVT or PE. AIMS: The purpose of this research project was to develop a DVT risk assessment tool and test the tool for validity and reliability. METHODS: Three phases were undertaken in developing and testing the JFK Medical Center DVT risk assessment tool. Investigation and clarification of risk and predisposing factors for DVT were identified from the literature, expert nursing knowledge, and medical staff input. Second, item development and weighting were undertaken. Third, parametric testing for content validity measured the differences in mean assessment tool scores between a group of patients who developed DVT in the hospital and a demographically similar group who did not develop DVT. Interrater reliability was measured by having three different nurses score each patient and compare the differences in scores among the three. FINDINGS: The DVT group had significantly higher scores on the JFK DVT assessment scale than did those who did not experience DVT. Interrater reliability showed a strong correlation among the scores of the three nurses (.98). DISCUSSION: Providing a valid and reliable tool for measuring the risk for DVT or PE in hospitalized patients will enable nurses to intervene early in patients at risk. Basing DVT risk assessment on the evidence provided in this study will assist nurses in becoming more confident in recognizing the necessity for interventions in hospitalized patients and decreasing risk. IMPLICATIONS: Nurses can now evaluate patients at risk for DVT or PE using the JFK Medial Center's risk assessment tool.