Thursday, April 26, 2012
The national site distraction.gov has a number of powerful stats and even more powerful videos from across the country that brings home the message about distracted driving. One that I found very interesting was a young woman from NJ whose friend was killed by a distracted driver and who admitted that she needed a reminder to not be distracted (so she put a picture of her dead friend on her dashboard)
Here's one story - Ashley age 16
How can you prevent distracted driving?1. Stow your phone in an inaccessible place (purse, glove compartment.)
2. Turn your ringer off until you have arrived.
3. Consider if you are tired or having difficulty concentrating and pay extra attention while driving. (phone off, tunes off)
4. Anticipate that other drivers will be distracted. Is that driver weaving over a line while driving? Might be alcohol but more likely is texting!
5. Anticipate pedestrians texting and being unaware to sound (with ear buds) as they cross the street.
6. Anticipate bicyclists are equally distracted.
7. Help friends and family eliminate distractions. For example, have messages that signal friends and family that you have to concentrate on driving ('have to go now, traffic is tough.")
CLINICIAN NOTE: Due the prevalence of this problem, clinicians should screen all patients who come to them with injury (pedestrian, motor vehicle, etc.) and ask if they were texting or listening to music (with ear buds) when the injury happened.
In Philadelphia in 2009, a talented young school teacher was killed while running in Fairmount Park because a huge branch (30 feet) fell from a tree that was 50 feet or the equivalent to five stories.
Since she could not hear due to loud music and ear buds, she did not hear it snap and fall. The branch struck her, broke her neck and severely injured her head and limbs.
A reversible element a clinician must screen for is urinary infection (taking into consideration that asymptomatic bactiuria should not be treated.) Functional status is also important. If gait is unsteady or arthritis is severe and transfers take a long time, incontinence can results. If there are sensory deficits (vision, hearing) o if it takes far longer to get to the toilet than is planned, women can have leakage. Sometimes, soft cognitive deficits (which can be hidden) are the reason why strategies to address incontinence don't work.
Medications also play a role - these include caffeine and alcohol as well as diuretics.
As seen in the chart, multiple medications can have a urinary effect. It is reasonable to consider that if a patient has polypharmacy, she should be screened for incontinence.