OBJECTIVE:The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competence. DESIGN: Prospective cohort study.SETTING: An outpatient driving evaluation clinic. PARTICIPANTS:One hundred nineteen community-dwelling, active drivers with a valid driver's license, aged 60 and older referred for driving evaluation. MAIN OUTCOME MEASURES:The CDT and a driving test using a STISIM Drive simulator.RESULTS: The CDT showed a high level of accuracy in predicting driving simulation outcome (area under the receiver-operator curve, 0.90; 95% confidence interval, 0.82 to 0.95). CDT scoring scales were comparable and all correlations between CDT scores and driving performance were negative, implying that as the CDT score decreases, the number of errors increases. Interrater reliability of CDT scores was 0.95. Subjects scoring less than 5 out of 7 points on the CDT made significantly more driving errors, hazardous and in total (Po.001). CONCLUSIONS:The CDT can help establish problems with executive function and indicate the need for a formal driving evaluation. Our CDT scoring scale is a reliable, valid, and time-effective screening tool for identifying elderly drivers in need of further evaluation. D riving places demands on attention, memory, problem solving, and information processing, cognitive skills that often decline with aging. Older drivers crash at a rate second only to the youngest drivers.1,2 Older driver involvement in fatal crashes is projected to increase 155% by 2030, accounting for 54% of the total projected increase in fatal crashes among all drivers.3 As the population ages and the number of older drivers increases, declining driver competence becomes an urgent public health problem and a challenge for health professionals to recognize impaired driving ability in the elderly. Declining driving competence is associated with impairments in vision, functional abilities, and cognition. However, it is especially true that cognitive impairment is overlooked in the context of a brief office visit as are issues related to driving ability. Cognitive impairment and dementia are surprisingly prevalent among older apparently healthy individuals, affecting up to one third of people aged over 65 years, yet it remains undiagnosed in 25% to 90%. [4][5][6][7] Consequently, the impact on driving ability persists unnoticed. The responsibility for determining the driving fitness of older adults is increasingly falling upon the medical profession; however, clinicians have few tools and few data on which to base decisions about driving. A brief and time-efficient screening test is needed to assist clinicians to identify older drivers who may represent a public health hazard and need to undergo a driving evaluation.The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competen...

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Background:Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid-resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic severe acute respiratory syndrome coronavirus 2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020).Methods:Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on ‘red’ (coronavirus disease 2019, COVID-19) and ‘green’ (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs.Results:Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least fivefold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52–100% protection).Conclusions:FFP3 respirators may therefore provide more effective protection than FRSMs for HCWs caring for patients with COVID-19, whether or not AGPs are undertaken.Funding:Wellcome Trust, Medical Research Council, Addenbrooke’s Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.

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IntroductionMalignant pleural effusions (MPEs) commonly occur in patients with advanced cancer. Drainage of fluid is used to relieve symptoms and improve quality of life.ObjectiveTo improve our understanding of how therapeutic aspiration affects symptoms and activities in patients with MPE.MethodsPatients presenting to the Pleural Clinic at Norfolk and Norwich University Hospital with a confirmed or suspected MPE participated in up to three semistructured interviews during their diagnostic/therapeutic pathway. Interviews were analysed using framework analysis by two researchers independently.ResultsSixteen patients participated. Symptoms reported before drainage included breathlessness, cough, chest pain, fatigue and anorexia. Symptoms affected their activities, including walking, bending over and socialisation. Patients described anxiety about the underlying diagnosis and fear of over-reliance on others. Expectations of drainage outcome varied, with some hoping for a cure and others hoping for any improvement. After drainage, breathlessness, chest pain and cough improved in some patients. They reported feeling and sleeping better, but fatigue and poor appetite remained. Participants were more active after aspiration, but the duration of improvement was a few days only. Despite this, patients still felt the procedure worthwhile.ConclusionOverall health and respiratory symptoms improved following drainage, but constitutional symptoms did not improve. This may be because constitutional symptoms are caused by the underlying cancer. This study suggests that clinicians should consider a range of symptoms, rather than just breathlessness, in planning outcomes for clinical trials. These results are important to inform patients about the potential benefits and duration of symptom improvement after therapeutic aspiration.

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