Unveiling the invisible: receivers use object weight cues for grip force planning in handover actions.

Handover actions are part of our daily lives. Whether it is the milk carton at the breakfast table or tickets at the box office, we usually perform these joint actions without much conscious attention. The individual actions involved in handovers, that have already been studied intensively at the level of individual actions, are grasping, lifting, and transporting objects. Depending on the object's properties, actors must plan their execution in order to ensure smooth and efficient object transfer. Therefore, anticipatory grip force scaling is crucial. Grip forces are planned in anticipation using weight estimates based on experience or visual cues. This study aimed to investigate whether receivers are able to correctly estimate object weight by observing the giver's kinematics. For this purpose, handover actions were performed with 20 dyads, manipulating the participant role (giver/receiver) and varying the size and weight of the object. Due to the random presentation of the object weight and the absence of visual cues, the participants were unaware of the object weight from trial to trial. Kinematics were recorded with a motion tracking system and grip forces were recorded with customized test objects. Peak grip force rates were used as a measure of anticipated object weight. Results showed that receiver kinematics are significantly affected by object weight. The peak grip force rates showed that receivers anticipate object weight, but givers not. This supports the hypothesis that receivers obtain information about the object weight by observing giver's kinematics and integrating this information into their own action execution.

The Inconspicuous Learner Handover: An Exploratory Study of U.S. Emergency Medicine Program Directors' Perceptions of Learner Handovers from Medical School to Residency.

Phenomenon: Central to competency-based medical education is the need for a seamless developmental continuum of training and practice. Trainees currently experience significant discontinuity in the transition from undergraduate (UME) to graduate medical education (GME). The learner handover is intended to smooth this transition, but little is known about how well this is working from the GME perspective. In an attempt to gather preliminary evidence, this study explores U.S. program directors (PDs) perspective of the learner handover from UME to GME. Approach: Using exploratory qualitative methodology, we conducted semi-structured interviews with 12 Emergency Medicine PDs within the U.S. from October to November, 2020. We asked participants to describe their current perception of the learner handover from UME to GME. Then we performed thematic analysis using an inductive approach. Findings: We identified two main themes: The inconspicuous learner handover and barrier to creating a successful UME to GME learner handover. PDs described the current state of the learner handover as "nonexistent," yet acknowledged that information is transmitted from UME to GME. Participants also highlighted key challenges preventing a successful learner handover from UME to GME. These included: conflicting expectations, issues of trust and transparency, and a dearth of assessment data to actually hand over. Insights: PDs highlight the inconspicuous nature of learner handovers, suggesting that assessment information is not shared in the way it should be in the transition from UME to GME. Challenges with the learner handover demonstrate a lack of trust, transparency, and explicit communication between UME and GME. Our findings can inform how national organizations establish a unified approach to transmitting growth-oriented assessment data and formalize transparent learner handovers from UME to GME.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland.

BACKGROUND: Handovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. METHODS: After ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. MAIN FINDINGS: A total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. CONCLUSIONS: Surgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

Optimizing Wireless Connectivity: A Deep Neural Network-Based Handover Approach for Hybrid LiFi and WiFi Networks.

A Hybrid LiFi and WiFi network (HLWNet) integrates the rapid data transmission capabilities of Light Fidelity (LiFi) with the extensive connectivity provided by Wireless Fidelity (WiFi), resulting in significant benefits for wireless data transmissions in the designated area. However, the challenge of decision-making during the handover process in HLWNet is made more complex due to the specific characteristics of electromagnetic signals' line-of-sight transmission, resulting in a greater level of intricacy compared to previous heterogeneous networks. This research work addresses the problem of handover decisions in the Hybrid LiFi and WiFi networks and treats it as a binary classification problem. Consequently, it proposes a handover method based on a deep neural network (DNN). The comprehensive handover scheme incorporates two sets of neural networks (ANN and DNN) that utilize input factors such as channel quality and the mobility of users to enable informed decisions during handovers. Following training with labeled datasets, the neural-network-based handover approach achieves an accuracy rate exceeding 95%. A comparative analysis of the proposed scheme against the benchmark reveals that the proposed method considerably increases user throughput by approximately 18.58% to 38.5% while reducing the handover rate by approximately 55.21% to 67.15% compared to the benchmark artificial neural network (ANN); moreover, the proposed method demonstrates robustness in the face of variations in user mobility and channel conditions.

A Hybrid Handover Scheme for Vehicular VLC/RF Communication Networks.

Visible light communication (VLC) is a promising complementary technology to its radio frequency (RF) counterpart to satisfy the high quality-of-service (QoS) requirements of intelligent vehicular communications by reusing LED street lights. In this paper, a hybrid handover scheme for vehicular VLC/RF communication networks is proposed to balance QoS and handover costs by considering the vertical handover and horizontal handover together judging from the mobile state of the vehicle. A Markov decision process (MDP) is formulated to describe this hybrid handover problem, with a cost function balancing the handover consumption, delay, and reliability. A value iteration algorithm was applied to solve the optimal handover policy. The simulation results demonstrated the performance of the proposed hybrid handover scheme in comparison to other benchmark schemes.

Analysis of the Effect of Base Station Motion on Underwater Handovers for Base-Station-Based Underwater Wireless Acoustic Networks.

In base-station-based underwater wireless acoustic networks (B-UWANs), effective handover mechanisms are necessary to ensure seamless data services for mobile nodes such as autonomous underwater vehicles (AUVs). Unlike terrestrial base stations (BSs), moored buoy BSs in B-UWANs experience motion responses due to wave loads under environmental conditions, posing unique challenges to the handover process. This study examines how BS motion affects handover decision errors, which arise when AUVs incorrectly initiate handovers to unintended BSs due to BS motion. By utilizing the AUV-BS distance as a handover triggering parameter, our analysis reveals a significant increase in decision errors within the overlapping regions when both the current and target BSs are in motion, especially when moving in the same direction. In addition, these errors intensify with the magnitude of BS motion and are exacerbated by smaller BS network radii. Based on these simulation results, we present an analytical framework that not only measures the influence of BS motion on the AUV-BS distance but also provides strategic insights for refining underwater handover protocols, thereby enhancing operational reliability and service continuity in B-UWANs.

A Blockchain-Assisted Security Protocol for Group Handover of MTC Devices in 5G Wireless Networks.

In the realm of the fifth-generation (5G) wireless cellular networks, renowned for their dense connectivity, there lies a substantial facilitation of a myriad of Internet of Things (IoT) applications, which can be supported by the massive machine-type communication (MTC) technique, a fundamental communication framework. In some scenarios, a large number of machine-type communication devices (MTCD) may simultaneously enter the communication coverage of a target base station. However, the current handover mechanism specified by the 3rd Generation Partnership Project (3GPP) Release 16 incurs high signaling overhead within the access and core networks, which may have negative impacts on network efficiency. Additionally, other existing solutions are vulnerable to malicious attacks such as Denial of Service (DoS), Distributed Denial of Service (DDoS) attacks, and the failure of Key Forward Secrecy (KFS). To address this challenge, this paper proposes an efficient and secure handover authentication protocol for a group of MTCDs supported by blockchain technology. This protocol leverages the decentralized nature of blockchain technology and combines it with certificateless aggregate signatures to mutually authenticate the identity of a base station and a group of MTCDs. This approach can reduce signaling overhead and avoid key escrow while significantly lowering the risk associated with single points of failure. Additionally, the protocol protects device anonymity by encrypting device identities with temporary anonymous identity markers with the Elliptic Curve Diffie-Hellman (ECDH) to abandon serial numbers to prevent linkage attacks. The resilience of the proposed protocol against predominant malicious attacks has been rigorously validated through the application of the BAN logic and Scyther tool, underscoring its robust security attributes. Furthermore, compared to the existing solutions, the proposed protocol significantly reduces the authentication cost for a group of MTCDs during handover, while ensuring security, demonstrating commendable efficiency.

Reaching consensus on the definition of person-centred handover practices in emergency departments: A modified online Delphi.

AIM: To reach consensus on the definition and attributes of 'person-centred handover practices' in emergency departments. BACKGROUND: Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person-centred handover practices may enhance the delivery of person-centred care in emergency departments. DESIGN: A three-round online Delphi survey. METHODS: Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. RESULTS: Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. CONCLUSION: Person-centred handover practices have not been implemented in emergency departments. Yet, person-centred handover practices may enhance the delivery of person-centred care, which has multiple benefits for patients and healthcare practitioners. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Person-centred care is not generally implemented in emergency departments. Person-centred handover practices can lead to person-centred care. Handover practices in emergency departments are a high-risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person-centred handover practices in emergency departments. REPORTING METHOD: The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. IMPACT (ADDRESSING): Improve handover practices and patient care. Improve person-centred care in emergency departments. PATIENT OR PUBLIC CONTRIBUTION: Emergency care practitioners and nurses experienced in handover practices and/or person-centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study.

AIM: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. DESIGN: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. METHODS: We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. RESULTS: Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. CONCLUSION: Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. RELEVANCE TO CLINICAL PRACTICE: Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. REPORTING METHOD: We adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: We interviewed patients on study wards pre and post intervention.

Implementation and Evaluation of the SBAR Communication Model in Nursing Handover by Pediatric Surgery Nurses.

PURPOSE: Situation, Background, Assessment, Recommendations (SBAR) is recommended as a standardized model to improve communication between health professionals and increase patient safety. Correct use of the SBAR model reduces communication errors, facilitates rapid decision-making, and increases patient safety. Therefore, effective use of the SBAR model among health care professionals contributes to safer patients. This study examines the implementation and evaluation of the SBAR communication model in nursing handover by pediatric surgical nurses. DESIGN: The study had a pretest-post-test semi-experimental design. METHODS: Data were collected between April 1 and June 30, 2022 from 24 nurses, who worked at two pediatric surgery units of a training research hospital in Turkey. Ethical approval and written informed consent were obtained prior to the study. FINDINGS: The mean age of the nurses was 26.00 ± 3.43 years and 75% were female. The mean score obtained from the handover rating scale was 60.33 ± 11.11 (18 to 70). The pretest and post-test scores obtained from the SBAR communication model questionnaire were 60.00 ± 20.64 (20 to 90) and 92.50 ± 9.89 (60 to 100), respectively. 66.7% of the nurses answered no to the statement "Using the SBAR communication model did not contribute positively to the handover." The majority answered yes to the items other than this statement, the ratio of those who answered yes and no to the statement "The SBAR communication model caused me to waste time during the handover" was equal, and the majority completed the SBAR handover form. CONCLUSIONS: Some of the nurses felt that the SBAR communication model made a positive contribution to shift performance, while others felt that it did not. Although half of the nurses considered the SBAR communication model to be a waste of time, it was observed that no negative events occurred during the use of the model and that the nurses were willing to use the SBAR communication model. Therefore, it is recommended that in-service training programs be organized to increase the use of the SBAR communication model and that the use of SBAR should be continuously reviewed and improved.

[Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development]. / Implementation der patientennahen Übergabe in der neurologischen Frührehabilitation.

Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development Abstract. Background: Nursing handovers are considered high-risk tasks but are also an important resource for conveying pertinent insights in the patients' situation and engaging them in the care process. As part of a broader action research project, a participatory approach was used to implement bedside handovers. Aims: It seemed central to sustainable change to gain insights which underlying factors motivate nurses to change handover practices. Methods: A qualitative design was chosen, in which five exploratory interviews were conducted with nurses. Results: The biggest challenges are privacy concerns and dealing with cognitively impaired patients. The motivations for bedside handover are a less error-prone transfer of information and a more accurate impression of the patient, in addition to a patient contact which is experienced as valuable. Discussion: The change in handover structure is accompanied by changes in the ward culture. The challenges faced by the staff require high communication skills to bridge them. The main factor for the preference of the handover form is the effect on the patients. Limitations: Transferability is limited due to the high contextual relevance. Transfer: With the help of a structured implementation strategy, even rituals can be modified. The bedside handover has a beneficial influence on patient-centredness.

The use of checklists in the intensive care unit: a scoping review.

BACKGROUND: Despite the extensive volume of research published on checklists in the intensive care unit (ICU), no review has been published on the broader role of checklists within the intensive care unit, their implementation and validation, and the recommended clinical context for their use. Accordingly, a scoping review was necessary to map the current literature and to guide future research on intensive care checklists. This review focuses on what checklists are currently used, how they are used, process of checklist development and implementation, and outcomes associated with checklist use. METHODS: A systematic search of MEDLINE (Ovid), Embase, Scopus, and Google Scholar databases was conducted, followed by a grey literature search. The abstracts of the identified studies were screened. Full texts of relevant articles were reviewed, and the references of included studies were subsequently screened for additional relevant articles. Details of the study characteristics, study design, checklist intervention, and outcomes were extracted. RESULTS: Our search yielded 2046 studies, of which 167 were selected for further analysis. Checklists identified in these studies were categorised into the following types: rounding checklists; delirium screening checklists; transfer and handover checklists; central line-associated bloodstream infection (CLABSI) prevention checklists; airway management checklists; and other. Of 72 significant clinical outcomes reported, 65 were positive, five were negative, and two were mixed. Of 122 significant process of care outcomes reported, 114 were positive and eight were negative. CONCLUSIONS: Checklists are commonly used in the intensive care unit and appear in many clinical guidelines. Delirium screening checklists and rounding checklists are well implemented and validated in the literature. Clinical and process of care outcomes associated with checklist use are predominantly positive. Future research on checklists in the intensive care unit should focus on establishing clinical guidelines for checklist types and processes for ongoing modification and improvements using post-intervention data.

Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions.

Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION:  A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN: • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW: • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study.

BACKGROUND: The unprecedented increase in the nurses' workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU. METHOD: This is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA). RESULTS: The results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001). CONCLUSION: The use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

A scoping review of clinical handover mnemonic devices.

Since the Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in 1999, clinical handovers (or handoffs) and their relationship with the communication of patient safety have raised concerns from the public, regulatory bodies, and medical practitioners. Protocols, guidelines, forms, and mnemonic devices have been created to ensure safer clinical handovers. An initial literature search did not find a framework to describe the clinical processes and functions of each mnemonic device and its elements. The absence of a systematic framework could hinder the study across and the reusability of the established clinical handover mnemonic devices. This study aims to develop a universal framework to describe the clinical processes and functions essential for patient safety during handover. We queried PubMed.gov and obtained 98 articles related to clinical handovers. We examined the citing sources of the mnemonics mentioned in these articles. A total of 42 handover mnemonics with 238 elements were identified. Our review noted that there was no taxonomy to describe the clinical functions and process associated with the clinical handover mnemonic devices. We used grounded theory to address this gap and built a new taxonomy from the 42 mnemonics. A researcher read all mnemonics, developed a taxonomy for tagging clinical handover mnemonics, and categorized all mnemonic elements into correct processes and functions. After that, the second researcher, a medical practitioner, examined the taxonomy and made suggested corrections for the labelled functions of all mnemonic elements. Both researchers agreed on the taxonomy and the labelled processes and functions of different mnemonic elements. The taxonomy contains three processes and twenty functions in clinical handovers. Clinical processes like 'medical condition', 'medical history', 'medical evaluation', 'care plan', 'outstanding care/tasks/results', and 'patient information', as an administrative process, were widely adopted in clinical handover mnemonics. Moreover, mnemonic elements on communication manner and information validation had been identified in the list of clinical handover mnemonics. Although we recognize challenges because of both the vast number of clinical handover scenarios and the task of placing them under a few predefined groups, our findings suggest that such a taxonomy, as developed for this study, could assist medical practitioners to devise a clinical handover mnemonic to best fit their workplace.

Effects of informal learner handover in clinical dental education.

BACKGROUND: It is currently under discussion whether Learner Handovers (LH) are beneficial, disadvantageous, or useful in Health Professions Education. Research has not been conducted to determine the extent of existing informal learner handover (ILH) through faculty discussions. In addition to providing stakeholders with added context, examining the nature of ILH may also provide insight into the bias associated with Learner Handover. METHODS: Transcripts from a series of semi-structured Focus Group Discussions (FGDs) and interviews (from January to March 2022) were iteratively reviewed to identify relevant patterns and correlations. The study involved the voluntary participation of 16 active clinical dental faculty members with a variety of designations. We did not discard any opinions. RESULTS: It was found that ILH had a mild impact on students' training. ILH effects can be categorized into four key areas: (1) faculty behavior with students, (2) faculty expectations from students, 3) teaching approach, and 4) faculty feedback practices. Furthermore, five additional factors were identified as having a greater influence on ILH practices. CONCLUSIONS: In clinical dental training, ILH has a minor effect on faculty-student interactions. Faculty perceptions and ILH are strongly influenced by other factors contributing to the student's 'academic reputation. As a result, student-faculty interactions are never free of prior influences, so stakeholders need to take them into consideration when creating a formal LH.

The effect of using desktop VR to practice preoperative handovers with the ISBAR approach: a randomized controlled trial.

AIM: The aim was to investigate whether second-year undergraduate nursing students practicing the Identification-Situation-Background-Assessment-Recommendation (ISBAR) communication approach in a desktop virtual reality (VR) application had a non-inferior learning outcome compared with the traditional paper-based method when sorting patient information correctly based on the ISBAR structure. METHODS: A non-inferior parallel group assessor blinded randomized controlled trial, conducted in simulation sessions as part of preparation for clinical placements in March and April 2022. After a 20-minute introductory session, the participants were randomized to self-practice the ISBAR approach for 45 minutes in groups of three in either an interactive desktop VR application (intervention) or traditional paper-based (TP) simulation. The primary outcome concerned the proportion of nursing students who sorted all 11 statements of patient information in the correct ISBAR order within a time limit of 5 min. The predefined, one-sided, non-inferiority limit was 13 percentage points in favor of traditional paper-based simulation. RESULTS: Of 210 eligible students, 175 (83%) participated and were allocated randomly to the VR (N = 87) or TP (N = 88) group. Practicing in the desktop VR application (36% of everything correct) was non-inferior to the traditional paper-based method (22% everything correct), with a difference of 14.2 percentage points (95% CI 0.7 to 27.1) in favor of VR. The VR group repeated the simulation 0.6 times more (95% CI 0.5 to 0.7). Twenty percent more (95% CI 6.9 to 31.6) of the students in the VR group reported liked how they practiced. All the other outcomes including the System Usability Scale indicated non-inferiority or were in favor of VR. CONCLUSIONS: Self-practicing with the ISBAR approach in desktop VR was non-inferior to the traditional paper-based method and gave a superior learning outcome. TRIAL REGISTRATION NUMBER: ISRCTN62680352 registered 30/05/2023.

A Video-Based Study of Emergency Medical Services Handoffs to a Pediatric Emergency Department.

BACKGROUND: Emergency medical services (EMS) to emergency department (ED) handoffs are important moments in patient care, but patient information is communicated inconsistently. OBJECTIVE: The aim of this study was to describe the duration, completeness, and communication patterns of patient handoffs from EMS to pediatric ED clinicians. METHODS: We conducted a video-based, prospective study in the resuscitation suite of an academic pediatric ED. All patients 25 years and younger transported via ground EMS from the scene were eligible. We completed a structured video review to assess frequency of transmission of handoff elements, handoff duration, and communication patterns. We compared outcomes between medical and trauma activations. RESULTS: We included 156 of 164 eligible patient encounters from January to June 2022. Mean (SD) handoff duration was 76 (39) seconds. Chief symptom and mechanism of injury were included in 96% of handoffs. Most EMS clinicians communicated prehospital interventions (73%) and physical examination findings (85%). However, vital signs were reported for fewer than one-third of patients. EMS clinicians were more likely to communicate prehospital interventions and vital signs for medical compared with trauma activations (p < 0.05). Communication challenges between EMS clinicians and the ED were common; ED clinicians interrupted EMS or requested information already communicated by EMS in nearly one-half of handoffs. CONCLUSIONS: EMS to pediatric ED handoffs take longer than recommended and frequently lack important patient information. ED clinicians engage in communication patterns that may hinder organized, efficient, and complete handoff. This study highlights the need for standardizing EMS handoff and ED clinician education regarding communication strategies to ensure active listening during EMS handoff.

User QoS-Based Optimized Handover Algorithm for Wireless Networks.

Due to the development of wireless network technology, various applications relying on good network quality are widely used on mobile devices. Taking the commonly used video streaming service as an example, a network with high throughput and low packet loss rate can meet the service requirements. When the moving distance of the mobile device is greater than the signal coverage of the AP, it will trigger the handover process to connect to another AP, and cause the network to disconnect and reconnect instantaneously. However, frequently triggering the handover procedure will cause a significant drop in network performance and affect the operation of application services. In order to solve this problem, this paper proposes the OHA and OHAQR. The OHA considers whether the signal quality is good or bad, and uses the corresponding HM method to solve the problem of frequent handover procedures. The OHAQR integrates the QoS requirements of the throughput and packet loss rate into the OHA with the Q-handover score, to provide high-performance handover services with QoS. Our experimental results show that the OHA and OHAQR have 13 and 15 handovers in a high-density scenario, respectively, and are better than the other two methods. The actual throughput and packet loss rate of the OHAQR are 123 Mbps and 5%, respectively, and the network performance is better than that of other methods. The proposed method shows excellent performance in ensuring the network QoS requirements and reducing the number of handover procedures.

An Adaptive TTT Handover (ATH) Mechanism for Dual Connectivity (5G mmWave-LTE Advanced) during Unpredictable Wireless Channel Behavior.

Fifth Generation (5G) signals using the millimeter wave (mmWave) spectrums are highly vulnerable to blockage due to rapid variations in channel link quality. This can cause the devices or User Equipment (UE) to suffer from connection failure. In a dual connectivity (DC) network, the channel's intermittency issues were partially solved by maintaining the UE's connectivity to primary (LTE advanced stations) and secondary (5G mmWave stations) simultaneously. Even though the dual-connected network performs excellently in maintaining connectivity, its performance drops significantly due to the inefficient handover from one 5G mmWave station to another. The situation worsens when UE travels a long distance in a highly dense obstacle environment, which requires multiple ineffective handovers that eventually lead to performance degradation. This research aimed to propose an Adaptive TTT Handover (ATH) mechanism that deals with unpredictable 5G mmWave wireless channel behaviors that are highly intermittent. An adaptive algorithm was developed to automatically adjust the handover control parameters, such as Time-to-Trigger (TTT), based on the current state of channel condition measured by the Signal-to-Interference-Noise Ratio (SINR). The developed algorithm was tested under a 5G mmWave statistical channel model to represent a time-varying channel matrix that includes fading and the Doppler effect. The performance of the proposed handover mechanism was analyzed and evaluated in terms of handover probability, latency, and throughput by using the Network Simulator 3 tool. The comparative simulation result shows that the proposed adaptive handover mechanism performs excellently compared to conventional handovers and other enhancement techniques.