Search results for: flawless handover

Authors: S. Dhivya, M. Abirami, M. Farjana Parveen, M. Keerthiga

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The development of high-speed railway makes people’s lives more and more convenient; meanwhile, handover is the major problem on high-speed railway communication services. In order to overcome that drawback the architecture of Long-Term Evolution (LTE) femtocell networks is used to improve network performance, and the deployment of a femtocell is a key for bandwidth limitation and coverage issues in conventional mobile network system. To increase the handover performance this paper proposed a multiple input multiple output (MIMO) assisted handoff (MAHO) algorithm. It is a technique used in mobile telecom to transfer a mobile phone to a new radio channel with stronger signal strength and improved channel quality.

Keywords: flawless handover, high-speed train, home evolved Node B, LTE, mobile femtocell, RSS

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Authors: Latif Adnane, Benaatou Wafa, Pla Vicent

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Handover is of great significance to achieve seamless connectivity in wireless networks. This paper gives an impression of the main factors which are being affected by the soft and the hard handovers techniques. To know and understand the handover process in The Universal Mobile Telecommunications System (UMTS) network, different statistics are calculated. This paper focuses on the quality of service (QoS) of soft and hard handover in UMTS network, which includes the analysis of received power, signal to noise radio, throughput, delay traffic, traffic received, delay, total transmit load, end to end delay and upload response time using OPNET simulator.

Keywords: handover, UMTS, mobility, simulation, OPNET modeler

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Authors: Mohanad Alhabo, Naveed Nawaz, Mahmoud Al-Faris

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The dense deployment of small cells is a promising solution to enhance the coverage and capacity of the heterogeneous networks (HetNets). However, the unplanned deployment could bring new challenges to the network ranging from interference, unnecessary handovers and handover failures. This will cause a degradation in the quality of service (QoS) delivered to the end user. In this paper, we propose an integrated Grey Rational Analysis Standard Deviation based handover method (GRA-SD) for HetNet. The proposed method integrates the Standard Deviation (SD) technique to acquire the weight of the handover metrics and the GRA method to select the best handover base station. The performance of the GRA-SD method is evaluated and compared with the traditional Multiple Attribute Decision Making (MADM) methods including Simple Additive Weighting (SAW) and VIKOR methods. Results reveal that the proposed method has outperformed the other methods in terms of minimizing the number of frequent unnecessary handovers and handover failures, in addition to improving the energy efficiency.

Keywords: energy efficiency, handover, HetNets, MADM, small cells

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Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

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Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

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Authors: Mohanad Alhabo, Li Zhang, Naveed Nawaz

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In this paper, a non-cooperative game method is formulated where all players compete to transmit at higher power. Every base station represents a player in the game. The game is solved by obtaining the Nash equilibrium (NE) where the game converges to optimality. The proposed method, named Power Efficient Handover Game Theoretic (PEHO-GT) approach, aims to control the handover in dense small cell networks. Players optimize their payoff by adjusting the transmission power to improve the performance in terms of throughput, handover, power consumption and load balancing. To select the desired transmission power for a player, the payoff function considers the gain of increasing the transmission power. Then, the cell selection takes place by deploying Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). A game theoretical method is implemented for heterogeneous networks to validate the improvement obtained. Results reveal that the proposed method gives a throughput improvement while reducing the power consumption and minimizing the frequent handover.

Keywords: energy efficiency, game theory, handover, HetNets, small cells

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Authors: Rujnan Tuna, Ayse Cil Akinci

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Work life takes up an important place in human life, and an employed person faces many stimuli from internal and external environments and is affected by them in a positive or negative way. Also, the handover process, which is the process of sharing information about the patient with other health professionals, is an important criterion to maintain patient care and enhance the quality of care provided. Handover is a key component for sustaining daily basic clinical practices and is also essential to maintain the safe patient care. This investigation followed a descriptive and correlation design in order to establish job stress and the handover efficiency of nurses and the relationship in between. The study was conducted with 192 nurses working in a public hospital in Istanbul between January and March 2017. Descriptive information form, Job Stressors Scale, and Handover Evaluation Scale were used to collect the data of the study. The data were analyzed by using IBM SPSS Statistics 22.0 statistical software. Approvals from participants, managers of institution, and ethics committee were taken for the study. As a result of the research, it was found that job stress was above the median value, and the highest score in the ‘work role conflict’ subdimension. Also, it was found that the effectiveness of the nurses' handover effectiviness was above the median value and the highest score in the ‘quality of information’ subdimension. In the study, there was a negatively weak correlation between ‘work role overload’ subdimension of Job Stressors Scale and ‘interaction and support’ subdimension of Handover Evaluation Scale. There is a need for further study in order to maintain patient safety.

Keywords: handover, job stress, nurse, patient

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Authors: Wafa Benaatou, Adnane Latif

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In this document we studied more in detail the Performances of the vertical handover in the networks WLAN, WiMAX, UMTS before studying of it the Procedure of Handoff Vertical, the whole buckled by simulations putting forward the performances of the handover in the heterogeneous networks. The goal of Vertical Handover is to carry out several accesses in real-time in the heterogeneous networks. This makes it possible a user to use several networks (such as WLAN UMTS and WiMAX) in parallel, and the system to commutate automatically at another basic station, without disconnecting itself, as if there were no cut and with little loss of data as possible.

Keywords: vertical handoff, WLAN, UMTS, WIMAX, heterogeneous

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Authors: Mohab Magdy Mostafa Mohamed

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The objective of this paper is to introduce a vertical handover (VHO) algorithm between wireless LANs (WLANs) and LTE mobile networks. The proposed algorithm is based on the fuzzy control theory and takes into consideration power level, subscriber velocity, and target cell load instead of only power level in traditional algorithms. Simulation results show that network performance in terms of number of handovers and handover occurrence distance is improved.

Keywords: vertical handover, fuzzy control theory, power level, speed, target cell load

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Authors: Pyung Soo Kim

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This paper proposes an optimized reactive fast intermobility anchor point (MAP) handover scheme for Hierarchical Mobile IPv6, called the ORFH-HMIPv6, to minimize packet loss of the existing scheme. The key idea of the proposed ORFHHMIPv6 scheme is that the serving MAP buffers packets toward the mobile node (MN) as soon as the link layer between MN and serving base station is disconnected. To implement the proposed scheme, the MAP discovery message exchanged between MN and serving MAP is extended. In addition, the IEEE 802.21 Media Independent Handover Function (MIHF) event service message is defined newly. Through analytic performance evaluation, the proposed ORFH-HMIPv6 scheme can be shown to minimize packet loss much than the existing scheme.

Keywords: hierarchical mobile IPv6 (HMIPv6), fast handover, reactive behavior, packet loss

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Authors: Shidrokh Goudarzi, Wan Haslina Hassan

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Heterogeneous wireless networks are converging towards an all-IP network as part of the so-called next-generation network. In this paradigm, different access technologies need to be interconnected; thus, vertical handovers or vertical handoffs are necessary for seamless mobility. In this paper, we conduct a review of existing vertical handover decision-making mechanisms that aim to provide ubiquitous connectivity to mobile users. To offer a systematic comparison, we categorize these vertical handover measurement and decision structures based on their respective methodology and parameters. Subsequently, we analyze several vertical handover approaches in the literature and compare them according to their advantages and weaknesses. The paper compares the algorithms based on the network selection methods, complexity of the technologies used and efficiency in order to introduce our vertical handover decision framework. We find that vertical handovers on heterogeneous wireless networks suffer from the lack of a standard and efficient method to satisfy both user and network quality of service requirements at different levels including architectural, decision-making and protocols. Also, the consolidation of network terminal, cross-layer information, multi packet casting and intelligent network selection algorithm appears to be an optimum solution for achieving seamless service continuity in order to facilitate seamless connectivity.

Keywords: heterogeneous wireless networks, vertical handovers, vertical handover metric, decision-making algorithms

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Authors: Mohanad Alhabo, Naveed Nawaz

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The ongoing call or data session must be maintained to ensure a good quality of service. This can be accomplished by performing the handover procedure while the user is on the move. However, the dense deployment of small cells in 5G networks is a challenging issue due to the extensive number of handovers. In this paper, a neighbour cell list method is proposed to reduce the number of target small cells and hence minimizing the number of handovers. The neighbour cell list is built by omitting cells that could cause an unnecessary handover and handover failure because of short time of stay of the user in these cells. A multi-attribute decision making technique, simple additive weighting, is then applied to the optimized neighbour cell list. Multi-tier small cells network is considered in this work. The performance of the proposed method is analysed and compared with that of the existing methods. Results disclose that our method has decreased the candidate small cell list, unnecessary handovers, handover failure, and short time of stay cells compared to the competitive method.

Keywords: handover, HetNets, multi-attribute decision making, small cells

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Authors: Patricia Portugal Marques de Carvalho Lourenco

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This paper presents the richness of product placement usage in Chinese IP dramas. It shows the artistry of storytellers in craftily intertwining the drama’s storyline with the items promoted, resulting in a flawless Chinese tapestry that perfectly blends internet visual entertainment with advertising, significantly enhancing the production’s worth. Successful IQIYI drama We are all alone, is a flawless example of that, attracting collaborative interest from products and brands across a spectrum of market segments, motivated to showcase their utility, value, benefits, and appeal to viewers.

Keywords: product placement, band-aid ads, post ads, barrage advertising, China, internet drama series, Latin Europe

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Authors: Seyyed Masoud Seyyedoshohadaei, Borhanuddin Mohd Ali

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To support group mobility, the NEMO Basic Support Protocol has been standardized as an extension of Mobile IP that enables an entire network to change its point of attachment to the Internet. Using NEMO in IEEE 802.16e (WiMax) networks causes latency in handover procedure and affects seamless communication of real-time applications. To decrease handover latency and service disruption time, an integrated scheme named Optimized Fast NEMO (OFNEMO) was introduced by authors of this paper. In OFNEMO a pre-establish multi tunnels concept, cross function optimization and cross layer design are used. In this paper, an analytical model is developed to evaluate total cost consisting of signaling and packet delivery costs of the OFNEMO compared with RFC3963. Results show that OFNEMO increases probability of predictive mode compared with RFC3963 due to smaller handover latency. Even though OFNEMO needs extra signalling to pre-establish multi tunnel, it has less total cost thanks to its optimized algorithm. OFNEMO can minimize handover latency for supporting real time application in moving networks.

Keywords: fast mobile IPv6, handover latency, IEEE802.16e, network mobility

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Authors: Umar D. M., Aminu A. M., Izaddeen K. Y.

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Deployments of mini macrocell base stations also referred to as femtocells, improve the quality of service of indoor and outdoor users. Nevertheless, mobility management remains a key issue with regards to their deployment. This paper is leaned towards this issue, with an in-depth focus on the most important aspect of mobility management -handover. In handover management, making a handover decision in the LTE two-tier macrocell femtocell network is a crucial research area. Decision algorithms in this research are classified and comparatively analyzed according to received signal strength, user equipment speed, cost function, and interference. However, it was observed that most of the discussed decision algorithms fail to consider cell selection with hybrid access policy in a single macrocell multiple femtocell scenario, another observation was a majority of these algorithms lack the incorporation of user equipment residence parameter. Not including this parameter boosts the number of unnecessary handover occurrence. To deal with these issues, a sophisticated handover decision algorithm is proposed. The proposed algorithm considers the user’s velocity, received signal strength, residence time, as well as the femtocell base station’s access policy. Simulation results have shown that the proposed algorithm reduces the number of unnecessary handovers when compared to conventional received signal strength-based handover decision algorithm.

Keywords: user-equipment, radio signal service, long term evolution, mobility management, handoff

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Authors: Sau Kam Adeline Chan

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World Health Organization had listed ‘Communication during Patient Care Handovers’ as one of its highest 5 patient safety initiatives. Clinical handover means transfer of accountability and responsibility of clinical information from one health professional to another. The main goal of clinical handover is to convey patient’s current condition and treatment plan accurately. Ineffective communication at point of care is globally regarded as the main cause of the sentinel event. Situation, Background, Assessment and Recommendation (SBAR), a communication tool, is extensively regarded as an effective communication tool in healthcare setting. Nonetheless, just by scenario-based program in nursing school or attending workshops on SBAR would not be enough for freshly graduated nurses to apply it competently in a complex clinical practice. To what extend and in-depth of information should be conveyed during handover process is not easy to learn. As such, on-site coaching is essential to upgrade their expertise on the usage of SBAR and ultimately to avoid any clinical error. On-site coaching for all freshly graduated nurses on the usage of SBAR in clinical handover was commenced in August 2014. During the preceptorship period, freshly graduated nurses were coached by the preceptor. After that, they were gradually assigned to take care of a group of patients independently. Nurse leaders would join in their shift handover process at patient’s bedside. Feedback and support were given to them accordingly. Discrepancies on their clinical handover process were shared with them and documented for further improvement work. Owing to the constraint of manpower in nurse leader, about coaching for 30 times were provided to a nurse in a year. Staff satisfaction survey was conducted to gauge their feelings about the coaching and look into areas for further improvement. Number of clinical error avoided was documented as well. The nurses reported that there was a significant improvement particularly in their confidence and knowledge in clinical handover process. In addition, the sense of empowerment was developed when liaising with senior and experienced nurses. Their proficiency in applying SBAR was enhanced and they become more alert to the critical criteria of an effective clinical handover. Most importantly, accuracy of transferring patient’s condition was improved and repetition of information was avoided. Clinical errors were prevented and quality patient care was ensured. Using SBAR as a communication tool looks simple. The tool only provides a framework to guide the handover process. Nevertheless, without on-site training, loophole on clinical handover still exists, patient’s safety will be affected and clinical error still happens.

Keywords: freshly graduated nurse, competency of clinical handover, quality, clinical error

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Authors: Osama Abdallah Mohammed Enan, Amin Babiker A/Nabi Mustafa

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The aim of this study is to evaluate and analyze different parameters of WCDMA (wideband code division multiplication). Moreover, this study also incorporates brief yet throughout analysis of WCDMA’s components as well as its internal architecture. This study also examines different power controls. These power controls may include open loop power control, closed or inner group loop power control and outer loop power control. Different handover techniques or methods of WCDMA are also illustrated in this study. These handovers may include hard handover, inter system handover and soft and softer handover. Different duplexing techniques are also described in the paper. This study has also presented an idea about different parameters of WCDMA that leads the system towards QoS issues. This may help the operator in designing and developing adequate network configuration. In addition to this, the study has also investigated various parameters including Bit Energy per Noise Spectral Density (Eb/No), Noise rise, and Bit Error Rate (BER). After simulating these parameters, using MATLAB environment, it was investigated that, for a given Eb/No value the system capacity increase by increasing the reuse factor. Besides that, it was also analyzed that, noise rise is decreasing for lower data rates and for lower interference levels. Finally, it was examined that, BER increase by using one type of modulation technique than using other type of modulation technique.

Keywords: duplexing, handover, loop power control, WCDMA

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Authors: Mohanad Alhabo, Li Zhang, Naveed Nawaz

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Small cell deployment in 5G networks is a promising technology to enhance capacity and coverage. However, unplanned deployment may cause high interference levels and high number of unnecessary handovers, which in turn will result in an increase in the signalling overhead. To guarantee service continuity, minimize unnecessary handovers, and reduce signalling overhead in heterogeneous networks, it is essential to properly model the handover decision problem. In this paper, we model the handover decision according to Multiple Attribute Decision Making (MADM) method, specifically Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS). In this paper, we propose a hybrid TOPSIS method to control the handover in heterogeneous network. The proposed method adopts a hybrid weighting, which is a combination of entropy and standard deviation. A hybrid weighting control parameter is introduced to balance the impact of the standard deviation and entropy weighting on the network selection process and the overall performance. Our proposed method shows better performance, in terms of the number of frequent handovers and the mean user throughput, compared to the existing methods.

Keywords: handover, HetNets, interference, MADM, small cells, TOPSIS, weight

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Authors: Anshul Gupta, T. Shankar

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In this paper, we had analyzed the call drop to provide a good quality of service to user. By optimizing it we can increase the coverage area and also the reduction of interference and congestion created in a network. Basically handover is the transfer of call from one cell site to another site during a call. Here we have analyzed the whole network by two method-statistic model and analytic model. In statistic model we have collected all the data of a network during busy hour and normal 24 hours and in analytic model we have the equation through which we have to find the call drop probability. By avoiding unnecessary handovers we can increase the number of calls per hour. The most important parameter is co-efficient of variation on which the whole paper discussed.

Keywords: coefficient of variation, mean, standard deviation, call drop probability, handover

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Authors: Silumpa Suboonsan, Suwat Pattaramalai

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In this paper, the performance of internet usage by using Vertical Handover (VHO) between cellular network and wireless local area network (WLAN) on Silom line Bangkok Mass Transit System (BTS) is evaluated. In the evaluation model, there is the WLAN on every BTS station and there are cellular base stations along the BTS path. The maximum data rates for cellular network are 7.2, 14.4, 42, and 100Mbps and for WLAN are 54, 150, and 300Mbps. The simulation are based on users using internet, watching VDOs and browsing web pages, on the BTS train from first station to the last station (full time usage) and on the BTS train for traveling some number of stations (random time). The results shows that VHO system has throughput a lot more than using only cellular network when the data rate of WLAN is more than one of cellular network. Lastly, the number of watching HD VDO and Full HD VDO is higher on VHO system on both regular time and rush hour of BTS travelling.

Keywords: vertical handover, WLAN, cellular, silom line BTS

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Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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Authors: Zhiwei Yan, Jong-Hyouk Lee, Yong-Jin Park, Xiaodong Lee

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In this paper, we analyze NEtwork MObility (NEMO) supporting problems in Content-Centric Networking (CCN), and propose the CCN-NEMO which can well support the deployment of the content-centric paradigm in large-scale mobile Internet. The CCN-NEMO extends the signaling message of the basic CCN protocol, to support the mobility discovery and fast trigger of Interest re-issuing during the network mobility. Besides, the Mobile Router (MR) is extended to optimize the content searching and relaying in the local subnet. These features can be employed by the nested NEMO to maximize the advantages of content retrieving with CCN. Based on the analysis, we compare the performance on handover latency between the basic CCN and our proposed CCN-NEMO. The results show that our scheme can facilitate the content-retrieving in the NEMO scenario with improved performance.

Keywords: NEMO, CCN, mobility, handover latency

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Authors: Sabine Pau, Sophia Volz, Emanuel Bauer, Amelie De Gregorio, Frank Reister, Wolfgang Janni, Florian Ebner

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Purpose: The umbilical cord pH is a well evaluated contributor for prediction of neonatal outcome. This study correlates nenonatal umbilical cord pH with the weekday of delivery, the time of birth as well as the staff hand over times (midwifes and doctors). Material and Methods: This retrospective study included all deliveries of a 20 year period (1994-2014) at our primary obstetric center. All deliveries with a newborn cord pH under 7,20 were included in this analysis (6929 of 48974 deliveries (14,4%)). Further subgroups were formed according to the pH (< 7,05; 7,05 – 7,09; 7,10 – 7,14; 7,15 – 7,19). The data were then separated in day- and night time (8am-8pm/8pm-8am) for a first analysis. Finally, handover times were defined at 6 am – 6.30 am, 2 pm -2.30 pm, 10 pm- 10.30 pm (midwives) and for the doctors 8-8.30 am, 4 – 4.30 pm (Monday- Thursday); 2 pm -2.30 pm (Friday) and 9 am – 9.30 am (weekend). Routinely a shift consists of at least three doctors as well as three midwives. Results: During the last 20 years, 6929 neonates were born with an umbilical cord ph < 7,20 ( < 7,05 : 7,1%; 7,05 – 7,09 : 10,9%; 7,10 – 7,14 : 30,2%; 7,15 – 7,19:51,8%). There was no significant difference between either night/day delivery (p = 0.408), delivery on different weekdays (p = 0.253), delivery between Monday to Thursday, Friday and the weekend (p = 0.496 ) or delivery during the handover times of the doctors as well as the midwives (p = 0.221). Even the standard deviation showed no differences between the groups. Conclusion: Despite an increased workload over the last 20 years, the standard of care remains high even during the handover times and night shifts. This applies for midwives and doctors. As the neonatal outcome depends on various factors, further studies are necessary to take more factors influencing the fetal outcome into consideration. In order to maintain this high standard of care, an adaption of work-load and changing conditions is necessary.

Keywords: delivery, fetal umbilical cord pH, day time, hand over times

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: Clarisse Lawson-Guidigbe, Nicolas Louveton, Kahina Amokrane-Ferka, Jean-Marc Andre

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Trust in automated driving systems is receiving growing attention in the research community. Anthropomorphism has been identified by past research as a trust-building factor. In this paper, we consider three anthropomorphic interfaces integrating three versions of a virtual assistant. We attempt to measure the impact of each of these interfaces on trust in the automated driving system. An experiment following a between-subject design was conducted in a driving simulator (N = 36) to evaluate participants’ performance and experience in two handover situations (a simple one and a critical one). Perception of anthropomorphism and trust was measured using scales, while participants’ experience was measured during elicitation interviews. We found no significant difference between the three interfaces regarding the perception of anthropomorphism, trust levels, or experience. However, regarding participants’ performance, we found a significant difference between the three interfaces in the simple handover situations but not the critical one. Learnings from anthropomorphism and trust measurement scales are discussed and suggestions for further research are proposed.

Keywords: highly automated driving, trust, anthropomorphic design, mindful anthropomorphism, mindless anthropomorphism

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Authors: Sinead Impey, Gaye Stephens, Lucy Hederman, Declan O'Sullivan

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Continued paper use in the clinical area post-Electronic Health Record (EHR) adoption is regularly linked to hardware and software usability challenges. Although paper is used as a workaround to circumvent challenges, including limited availability of a computer, this perspective does not consider the important role paper, such as the nurses’ handover sheet, play in practice. The purpose of this study is to confirm the hypothesis that paper use post-EHR adoption continues as paper provides both a cognitive tool (that assists with workflow) and a compensation tool (to circumvent usability challenges). Distinguishing the different motivations for continued paper-use could assist future evaluations of electronic record systems. Methods: Qualitative data were collected from three clinical care environments (ICU, general ward and specialist day-care) who used an electronic record for at least 12 months. Data were collected through semi-structured interviews with 22 nurses. Data were transcribed, themes extracted using an inductive bottom-up coding approach and a thematic index constructed. Findings: All nurses interviewed continued to use paper post-EHR adoption. While two distinct motivations for paper use post-EHR adoption were confirmed by the data - paper as a cognitive tool and paper as a compensation tool - further finding was that there was an overlap between the two uses. That is, paper used as a compensation tool could also be adapted to function as a cognitive aid due to its nature (easy to access and annotate) or vice versa. Rather than present paper persistence as having two distinctive motivations, it is more useful to describe it as presenting on a continuum with compensation tool and cognitive tool at either pole. Paper as a cognitive tool referred to pages such as nurses’ handover sheet. These did not form part of the patient’s record, although information could be transcribed from one to the other. Findings suggest that although the patient record was digitised, handover sheets did not fall within this remit. These personal pages continued to be useful post-EHR adoption for capturing personal notes or patient information and so continued to be incorporated into the nurses’ work. Comparatively, the paper used as a compensation tool, such as pre-printed care plans which were stored in the patient's record, appears to have been instigated in reaction to usability challenges. In these instances, it is expected that paper use could reduce or cease when the underlying problem is addressed. There is a danger that as paper affords nurses a temporary information platform that is mobile, easy to access and annotate, its use could become embedded in clinical practice. Conclusion: Paper presents a utility to nursing, either as a cognitive or compensation tool or combination of both. By fully understanding its utility and nuances, organisations can avoid evaluating all incidences of paper use (post-EHR adoption) as arising from usability challenges. Instead, suitable remedies for paper-persistence can be targeted at the root cause.

Keywords: cognitive tool, compensation tool, electronic record, handover sheet, nurse, paper persistence

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Authors: A. A. Balkhi, G. M. Mir, Javid A. Sheikh

Abstract:

To cater the demands of increasing traffic with new applications the cellular mobile networks face new changes in deployment in infrastructure for making cellular networks heterogeneous. To reduce overhead processing the densely deployed cells require smart behavior with self-organizing capabilities with high adaptation to the neighborhood. We propose self-organization of unused resources usually excessive unused channels of neighbouring cells with densely populated cells to reduce handover failure rates. The neighboring cells share unused channels after fulfilling some conditional candidature criterion using threshold values so that they are not suffered themselves for starvation of channels in case of any abrupt change in traffic pattern. The cells are classified as ‘red’, ‘yellow’, or ‘green’, as per the available channels in cell which is governed by traffic pattern and thresholds. To combat the deficiency of channels in red cell, migration of unused channels from under-loaded cells, hierarchically from the qualified candidate neighboring cells is explored. The resources are returned back when the congested cell is capable of self-contained traffic management. In either of the cases conditional sharing of resources is executed for enhanced traffic management so that User Equipment (UE) is provided uninterrupted services with high Quality of Service (QoS). The fuzzy logic-based simulation results show that the proposed algorithm is efficiently in coincidence with improved successful handoffs.

Keywords: candidate cell, channel sharing, fuzzy logic, handover, small cells

Procedia PDF Downloads 90

Authors: Anupam Sibal

Abstract:

Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

Procedia PDF Downloads 232

Authors: R. Denkova

Abstract:

Nowadays, aesthetic and psychological researches in some countries show that the aesthetic ideal for women is built by the same pattern of big volumes – lips, cheek, facial disproportions. They all look like made of a matrix. And they lose their unique and emotional aspects of beauty. How to escape this matrix and find the balance? The secret to being a unique injector is good assessment, creating a treatment plan and flawless injection strategy. The newest concepts in this new injection era which meet the requirements of a modern society and deliver balanced and natural looking results are based on the concept of injecting not the consequence, but the reason. Three case studies are presented with full face assessment, treatment plan and before/after pictures. Using different approaches and techniques of the MD codes concept, lights and shadows concept in order to preserve the emotional beauty and identity of the women. In conclusion, the cases demonstrate that beauty exists even beyond the matrix and it is the injector’s mission and responsibility is to preserve and highlight the natural beauty and unique identity of every different patient.

Keywords: beyond the matrix, emotional beauty, face assessment, injector, treatment plan

Procedia PDF Downloads 91

Authors: Paul Holmes, Mike N. G.

Abstract:

Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

Procedia PDF Downloads 44

Authors: Cesar Hernández, Diego Giral, Fernando Santa

Abstract:

The spectral handoff is important in cognitive wireless networks to ensure an adequate quality of service and performance for secondary user communications. This work proposes a benchmarking of performance of the three spectrum handoff models: VIKOR, SAW and MEW. Four evaluation metrics are used. These metrics are, accumulative average of failed handoffs, accumulative average of handoffs performed, accumulative average of transmission bandwidth and, accumulative average of the transmission delay. As a difference with related work, the performance of the three spectrum handoff models was validated with captured data of spectral occupancy in experiments realized at the GSM frequency band (824 MHz-849 MHz). These data represent the actual behavior of the licensed users for this wireless frequency band. The results of the comparative show that VIKOR Algorithm provides 15.8% performance improvement compared to a SAW Algorithm and, 12.1% better than the MEW Algorithm.

Keywords: cognitive radio, decision making, MEW, SAW, spectrum handoff, VIKOR

Procedia PDF Downloads 399