An international study of the quality of national-level guidelines on driving with medical illness.

BACKGROUND: Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. AIM: To systematically evaluate the quality of selected national guidelines about driving with medical illness. DESIGN: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. METHODS: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79). CONCLUSIONS: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.

Meaning of occupational engagement in life-threatening illness: a qualitative pilot project.

INTRODUCTION: The onset of a personal crisis combined with the resultant disruption in occupational routines may challenge a person's identity as a capable and healthy individual. However, it remains unclear how individuals regain a sense of health and well-being in the period following a personal crisis. RESEARCH OBJECTIVE: To explore occupational engagement and its meaning to individuals following a life-threatening diagnosis. METHOD: Semi-structured interviews were conducted with three women diagnosed with breast cancer. The data were analyzed using a constant-comparative approach to identify common themes. RESULTS: The primary theme that emerged was "Doing = Living." This theme and the underlying themes illustrated the connection between meaningful occupational engagement and one's self-perception as capable and healthy. These findings suggest that occupational engagement may provide the medium through which 'deconstructive' or 'reconstructive' messages concerning the self are relayed between persons and their environment. IMPLICATIONS: In a period of personal crisis, such as a life-threatening diagnosis, individuals may turn to those occupations that are meaningful to regain a sense of control and normalcy in their lives.