A modified genetic algorithm (MGA) optimization procedure, alongside time series machine learning (ML) classifiers, is proposed to minimize handovers in a digital twin-based visible light communication (VLC) system. Frequent handovers have a direct impact on the overall performance of the VLC system due to the inherent connection downtime of a handover process. The handover scheme proposed in this article considers the receiver trajectory information to minimize handovers, maintaining the system performance below the forward error correction limit. Simulation results indicate that the proposed scheme outperforms a power-based handover scheme, achieving handover reductions of 42.47%. Therefore, the MGA combined to the ML models approach is an effective means of minimizing handovers, as well as improving overall VLC system performance.
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AIM: Implementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover.METHODS: A mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process.RESULTS: We observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated.CONCLUSION: Use of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed.
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OBJECTIVE: Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, local context is considered of equal importance to improve the handover process. Our objective was to determine what recommendations on standardized shift handover nurses make, if we combine evidence from the literature with the local context of the nurses.DESIGN: A RAND-modified Delphi consensus process that combines evidence from systematic reviews with expert opinion of local nurses and an evaluation of the consensus process with a survey.SETTING: One academic medical center in the Netherlands.PARTICIPANTS: Twenty nurses from surgical, medical, neurological, psychiatric, cardiology, children's and gynecology departments.RESULTS: Four systematic reviews on nursing handover were included to compose provisional recommendations on how, what, where and the preconditions of shift handover. Nurses reached consensus on a final set of 18 recommendations for a nursing shift handover blueprint: how (1 recommendation), what (12 recommendations), where (3 recommendations) and the preconditions (2 recommendations), which were structured with the mnemonic NURSEPASS. The nurses assessed the method as an effective approach to develop a local blueprint.CONCLUSIONS: Evidence-based consensus is a feasible method to combine evidence from the literature with local context. We anticipate that implementation of the resulting tailored blueprint for nursing shift handover will be facilitated due to the method used. Through evaluation of its effectiveness, we intend to add to the body of evidence on development and implementation of effective nursing handover, which is an essential link for continuity and safety of care.
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Context: Inadequate handovers between hospital and home can lead to adverse health outcomes. A group particularly at risk is patients at the end of life because of complex health problems, frequent care transitions, and involvement of many professionals. Objectives: To investigate health care providers' views and experiences with regard to the transition from hospital to primary care in palliative care. Methods: This was a descriptive qualitative study. Three focus group discussions were held with 28 nurses and two focus groups with nine physicians. Participants were recruited from primary and hospital care. The focus groups were audiorecorded, transcribed verbatim, and analyzed thematically. Results: The following themes emerged from the data: lack of identification of and communication about the last phase of life; incomplete and insufficient handover; and uncertainty about responsibilities. Professionals emphasize the importance of proper handovers and transitional processes in these vulnerable patients. The transition between hospital to primary care is hindered by a lack of identification of the palliative phase and uncertainties about patient awareness. Direct communication between professionals is needed but lacking. The handover itself is currently primarily focused on physical aspects where psychosocial aspects were also found necessary. Furthermore, uncertainties with regard to physicians' responsibility for the patient seem to further hinder professionals in the transitional process. Conclusion: Efforts should be made to enhance knowledge and skills around identification of palliative needs and communication with patients about the end of life, especially in the hospital setting.
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The purpose of the design-based research reported here is to show – as a proof of principle – how the idea of scaffolding can be used to support primary teachers in a professional development programme (PDP) to design and enact language-oriented science lessons. The PDP consisted of six sessions of 2.5 h each in which twelve primary school teachers took part over a period of six months. It centralised the language support that pupils need to reason during science lessons. In line with the idea of scaffolding, the structure of the PDP targeted teachers' gradual independence in designing lessons. The first research question is how scaffolding was enacted during the PDP. The analysis of video recordings, field notes, researcher and teacher logs, and teacher design assignments focused on the enactment of three scaffolding characteristics: diagnosis, responsiveness and handover to independence. The second research question concerns what teachers learned from the participation in the PDP that followed a scaffolding approach. The data analysis illustrates that these teachers had learned much in terms of designing and enacting language-oriented science lessons. In terms of diagnosis and responsiveness, our PDP approach was successful, but we problematise the ideal of scaffolding approaches focused on handover to independence.
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Background: after hospitalisation for cardiac disease, older patients are at high risk of readmission and death. Objective: the cardiac care bridge (CCB) transitional care programme evaluated the impact of combining case management, disease management and home-based cardiac rehabilitation (CR) on hospital readmission and mortality. Design: single-blind, randomised clinical trial. Setting: the trial was conducted in six hospitals in the Netherlands between June 2017 and March 2020. Community-based nurses and physical therapists continued care post-discharge. Subjects: cardiac patients ≥ 70 years were eligible if they were at high risk of functional loss or if they had had an unplanned hospital admission in the previous 6 months. Methods: the intervention group received a comprehensive geriatric assessment-based integrated care plan, a face-to-face handover with the community nurse before discharge and follow-up home visits. The community nurse collaborated with a pharmacist and participants received home-based CR from a physical therapist. The primary composite outcome was first all-cause unplanned readmission or mortality at 6 months. Results: in total, 306 participants were included. Mean age was 82.4 (standard deviation 6.3), 58% had heart failure and 92% were acutely hospitalised. 67% of the intervention key-elements were delivered. The composite outcome incidence was 54.2% (83/153) in the intervention group and 47.7% (73/153) in the control group (risk differences 6.5% [95% confidence intervals, CI -4.7 to 18%], risk ratios 1.14 [95% CI 0.91-1.42], P = 0.253). The study was discontinued prematurely due to implementation activities in usual care. Conclusion: in high-risk older cardiac patients, the CCB programme did not reduce hospital readmission or mortality within 6 months.
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Hoe kun je als organisatie in het publieke domein de digitale transitie zo inrichten dat deze zowel voor de organisatie als voor klanten succesvol is? Uit onderzoek blijkt dat het belangrijk is dat deze dienstverlening persoonlijk wordt. In dit artikel gaan we verder in op de uitkomsten van dit onderzoek. Ook delen we een experiment met een chatbot die een voorbereiding van het gesprek met de medewerker aanbiedt.
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For older adults, acute hospitalization is a high-risk event with poor health outcomes, including functional decline. In absence of practical guidelines and high quality randomized controlled trials, this Delphi study was conducted. The aim of this study was to obtain consensus on an exercise intervention program, a core outcome set (COS) and handover information to prevent functional decline or restore physical function in acutely hospitalized older patients transitioning from hospital to home. An internal panel of experts in the field of exercise interventions for acutely hospitalized older adults were invited to join the study. In the Delphi study, relevant topics were recognized, statements were formulated and ranked on a 9-point Likert scale in two additional rounds. To reaching consensus, a score of 7–9 was classified as essential. Results were expressed as median and semi-interquartile range (SIQR), and consensus threshold was set at SIQR≤0.5. Fifteen international experts from eight countries participated in the panel. The response rate was 93%, 93% and 80% for the three rounds respectively. After three rounds, consensus was reached on 167 of the 185 (90.3%) statements, of which ninety-five (51.4%) were ranked as essential (median Likert-score ≥7.0, SIQR ≤0.5). This Delphi study provides starting points for developing an exercise intervention, a COS and handover information. The results of this Delphi study can assist physical therapists to provide a tailored exercise intervention for older patients with complex care needs after hospital discharge, to prevent functional decline and/or restore physical function.
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Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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