What drives the Acceptability of Intelligent Speed Assistance (ISA)? Modeling acceptability of ISA

6370 individuals responded in Belgium (Flanders region) and 1158 persons in The Netherlands on a web-survey about ISA. A model has been estimated, by using SEM, to find out which predefined indicators would be relevant to define the acceptability of ISA. Background factors, contextual issues, and ISA-device related factors were used as indicators to predict the level of acceptability. The factors that were used in the model were based on the methods used in past ISA trials, acceptance and accep-tability theories and models. The effectiveness of ISA (1), equity (2), effectiveness of ITS (3) and personal and social aims (4), were the four variables that had the largest total effect on the acceptability of ISA. Effectiveness was found a relevant predictor for acceptance in many trials (Morsink et al, 2006). The model showed that the willingness of drivers to adopt ISA increases if they experience the system in practice: if people are convinced that ISA will assist to maintain the legal speed in different speed zones, the acceptance will be higher (Van der Pas et al., 2008). Hence, trials seem a good way to demonstrate the effectiveness of ISA. However, trials typically do not allow many people to try out ISA. Therefore, communi-cation strategies that focus on the ISA-effectiveness would be helpful to convince people about the benefits of using such a system. Often when new driver support technologies are intro-duced – especially when it could restrict certain freedom in driving – a majority of the population is reluctant when it comes to ‘buy or use’ the system. In some studies (see Morsink et al., 2006; Marchau et al., 2010) the willingness to pay was reported to be a good predictor for acceptability. However, in the present study the effect of willing-ness to pay was very low or even absent; hence it may be as-sumed that better indicators are put in the model than the willing-ness to pay. With respect to context indicators, ‘personal and social aims’ seemed to be the variable with the highest influence on accep-tability. Drivers, who rate social aims above personal aims with respect to speed and speeding, will accept ISA more. Personal and social aims had also a high influence on most of the device spe-cific indicators. Furthermore, drivers who speed for their personal benefit were found to rather speed more often. Drivers who speed in high-speed zones would also be less inclined to accept ISA. This is in line with previous findings (e.g. Jamson et al., 2006), frequent speeders would support ISA less; those drivers who would benefit most of ISA would be less likely to use it. This is an important finding when considering the strategies for implementing ISA. Some studies (e.g. Morsink et al., 2006) indicated that to increase the acceptability, implementation strategies and campaigns could focus on other benefits of ISA (like reducing speeding tickets, emissions etc.). According to our study these secondary effects have rather small effects to increase acceptability. Drivers who like to speed would even care less for these secondary benefits of ISA. The youngest group of drivers (<25 years old) would influence responsibility awareness negatively. These younger drivers are also less convinced that certain behaviour or circumstances could cause accidents. Many studies indicated that young drivers over-estimate their own driving skills, drive faster and are less aware of accident causes (Shinar et al., 2001). For the implementation of ISA – although there is no direct relationship between younger age and acceptability – a different strategy is needed to convince this group of drivers. Awareness campaigns and communication should be deployed during their education, however, road safety education and training stops during secondary school or higher education (OECD, 2006). Drivers between 25 and 45 years old would also be less inclined to accept ISA, mainly considered out of indirect effects in the esti-mated model. This group of drivers may be labelled as one of the most active groups of drivers. Another aspect is that both of the "significant found age groups were influenced by social norms. This may be very important in implementation strate-gies. For instance, role models could be used in ISA driving. This strategy was also used in the Belgian trial to gain more publicity and attention. The positive image and the improved information communication of ISA as a possible measure in road-safety have led to several voted resolutions in the Belgian federal parliament and senate (Vlassenroot et al. 2007)

Medical record: systematic centralization versus secure on demand aggregation

<p>Abstract</p> <p>Background</p> <p>As patients often see the data of their medical histories scattered among various medical records hosted in several health-care establishments, the purpose of our multidisciplinary study was to define a pragmatic and secure on-demand based system able to gather this information, with no risk of breaching confidentiality, and to relay it to a medical professional who asked for the information via a specific search engine.</p> <p>Methods</p> <p>Scattered data are often heterogeneous, which makes the task of gathering information very hard. Two methods can be compared: trying to solve the problem by standardizing and centralizing all the information about every patient in a single Medical Record system or trying to use the data "as is" and find a way to obtain the most complete and the most accurate information. Given the failure of the first approach, due to the lack of standardization or privacy and security problems, for example, we propose an alternative that relies on the current state of affairs: an on-demand system, using a specific search engine that is able to retrieve information from the different medical records of a single patient.</p> <p>Results</p> <p>We describe the function of Medical Record Search Engines (MRSE), which are able to retrieve all the available information regarding a patient who has been hospitalized in different hospitals and to provide this information to health professionals upon request. MRSEs use pseudonymized patient identities and thus never have access to the patient's identity. However, though the system would be easy to implement as it by-passes many of the difficulties associated with a centralized architecture, the health professional would have to validate the information, i.e. read all of the information and create his own synthesis and possibly reject extra data, which could be a drawback. We thus propose various feasible improvements, based on the implementation of several tools in our on-demand based system.</p> <p>Conclusions</p> <p>A system that gathers all of the currently available information regarding a patient on the request of health-care professionals could be of great interest. This low-cost pragmatic alternative to centralized medical records could be developed quickly and easily. It could also be designed to include extra features and should thus be considered by health authorities.</p

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Hospital incidence and annual rates of hospitalization for venous thromboembolic disease in France and the USA

Objective The study was designed to describe the hospital incidences and annual hospitalization rates for venous thromboembolic disease by age and sex in France and the United States on the closest possible methodological bases. Methods French statistics are from the PMSI MCO (Programme de médicalisation des système d'information de médecine, chirurgie et obstétrique (French national hospital discharge register)) national database. These are compiled for each calendar year by collating résumé de sortie anonymisé (RSA, anonymous discharge summary) files forwarded and validated by health establishments with admissions in medicine, surgery, obstetrics, and odontology. They are compared to the data issued from the US National Hospital Discharge Survey which is equivalent to the PMSI in France and uses the International Classification of Diseases-9 for encoding the data. These data were published in the Morbidity, Mortality Weekly Report of the Centre for Disease Control. Results In the US, 547,996 hospital stays involve venous thromboembolic diseases, 348,558 deep venous thrombosis (DVT), and 277,549 pulmonary embolism (PE). Of these 78,511, or 14%, include a diagnosis of both DVT and PE. The hospital incidence of venous thromboembolic disease is 1.4%, DVT 0.9%, and PE 0.7%. In France, of the 26,658,228 annual hospital stays, 273,931 include venous thromboembolic disease, 179,286 DVT, and 139,345 PE while 44,700, i.e. 16.3%, include both DVT and PE. The hospital incidence of venous thromboembolic disease is thus 1.0%, DVT 0.6%, and PE 0.5%. The overall annual hospitalization rates for venous thromboembolic disease, DVT, and PE are respectively 274, 179, and 139 per 100,000 inhabitants in France and 239, 146, and 121 per 100,000 inhabitants in the US. Conclusion Venous thromboembolic diseases occur in France and the US in 1% of all hospital stays and are responsible for an annual hospitalization rate that exceeds 200 per 100,000. The scale of these annual incidences should prompt us to question the quality of prevention put in place and/or its efficacy. </jats:sec

Abstract 465: Evolution of Cardiovascular Lifestyle Behaviours Occurring in Hypercholesterolemic Patients Concomitantly to the Intake of Phytosterol-supplemented Yoghurt.

Objective: to assess the evolution of cardiovascular lifestyle behaviours in hypercholesterolemic patients occurring concomitantly with changes in their daily intake of phytosterol-supplemented yoghurt (Phyto-SY). METHODS: Nationwide prospective observational study conducted in Spanish and French general practice Each GP proposed lifestyle modification to 5 consecutive patients presenting with hypercholesterolemia, (taking or not hypocholesterolemic drugs) and recommended daily consumption of Phyto-SY. Study design included an inclusion visit, a patient’s self-monitoring assessment after 1 month and a final end-visit after four months. Main evaluation criterion : nutritional lifestyle score. Secondary criteria: Total, LDL and HDL cholesterol, waist circumference, daily walking time. Results: 2376 hypercholesterolemic patients, 56.2 years old ± 11.9 (women 54.8%) were included. Nutritional lifestyle score decreased from 15.4 ± 5.4 to 8.7± 4.0 (p&lt;0,0001), either in never-treated patients (15.3 ± 5.4 to 8.6 ± 3.9; p&lt;0,0001) or in patients treated with hypocholesterolemic drugs (15.5 ± 5.4 to 8.9 ± 4.1; p&lt;0,0001). Total cholesterol decreased 10.6% (&lt;0.0001), HDL-C increased 8.0% (&lt;0.0001), and LDL-C decreased 12.7% (&lt;0.0001). Frequency of walking (&gt;30 min) increased from 59.3% to 78.3% (p&lt;0.0001); by contrast overweight frequency decreased from 22.8% to 17.5% (p&lt;0.0001) and waist circumference from 94.6 ± 13.3 cm to 93.0 ± 12.8 (p&lt;0.0001). Conclusion: Improvement in nutritional lifestyle score, involving regular consumption of Phyto-SY over 4 months was significantly linked to a healthier lifestyle and to beneficial modification of atherogenic lipid profile, thereby reflecting patient empowerment in a “real life” context. </jats:p