We consider two transceivers equipped with multiple antennas that intend to communicate i.e. both of which transmit and receive data in a TDD fashion. Assuming that the responses of the physical communication channels between these two nodes are linear and reciprocal (time invariant or with very slow time variations), and by exploiting the closed loop conversation between these nodes, we have proposed efficient algorithms allowing to adaptively identify the Best Singular Mode (BSM) of the channel (those algorithms are for training, blind, and semi-blind channel identification). Unlike other proposed algorithms, our proposed adaptive algorithms are robust to noise as the involved step-size allows a trade-off to reduce the impact of the additive noise at the expense of some estimation delay. In practice, however, the reciprocity of the equivalent channels is lost because of the mismatch between the transmit and the receive filters of the communicating nodes. This mismatch causes significant degradation in the performance of the BSM estimation. Therefore, we have also proposed adaptive self-calibrating algorithms (which do not require any additional RF circuitry) that account for such a mismatch. In addition, we have conducted a convergence analysis of the BSM algorithm and extended it to estimate multiple modes simultaneously. Finally, we have also proposed an adaptive, iterative algorithm that is capable of allocating power in such a way that maximizes the capacity of a SISO OFDM communication system. / Thesis (Ph.D, Electrical & Computer Engineering) -- Queen's University, 2010-07-21 16:53:33.077

Background: Communication is one of the nurse anaesthetist’s non-technical skills. In anaesthesia, potent drugs are administered during induction and intubation, therefore it is necessary that the exchange of information during these procedures are correctly perceived by the recipient. Consequently, a well-developed communication skill is part of nurse anaesthetist’s core competencies in order to maintain patient safety. Aim: The aim of the study is to investigate how closed-loop communication [CLC] is used between nurse anaesthetists and anesthesiologists during induction and intubation, and to observe which environmental factors affected the communication. Method: The study had a quantitative and qualitative descriptive approach. Observation protocols inspired by CLC and Nurse Anaesthetists’ Non-Technical Skills [N-ANTS] were used during data collection of a total of 20 observations at an operation unit in Sweden. Results: The anaesthesia personnel used CLC in more than half of the observations. However, the use of CLC varied depending on whether the surgeries were planned or emergent, and which profession administered the drugs. According to N-ANTS, most of the exchanged communication was considered to be of good quality. Communication during induction and intubation was for instance, affected by preparations, roles, priorities and technical equipment and devices. Conclusion: The result indicates that the use of standardized communication methods and the minimization of distractions, increases the quality of communication and reduces the risk of interruptions during induction and intubation.

Introduktion: Under de senaste 20 åren har icke-tekniska färdigheters betydelse för patientsäkerheten belysts mer och mer i forskningen. Interprofessionell utbildning med CRM som simulatorkoncept används för att träna icke-tekniska färdigheter och teamarbete men att träna under pågående operation är ovanligt. Syfte: Syftet är att utvärdera hur deltagarna upplever användandet av icke-tekniska färdigheter under en interprofessionell lärandeaktivitet på en dagkirurgisk operation. Metod: Tvärsnittsstudie med enkät som deltagarna (N=239) blev tillfrågade att svara på efter deltagande vid operation. Enkäten utvärderas deltagarnas upplevelse av kommunikation och teamarbete. Deskriptiv statistik och analys med Chi2, Wilcoxon sign rank test och Kruskal-Wallis användes. Resultat: Användandet av kommunikation inom och mellan professionerna har rankats som mycket högt av majoriteten av deltagarna i alla frågor, vid kontroll med Chi2 analys är det statistiskt signifikanta svar. Deltagarna upplever en ökad förståelse för andra professioner i teamet efter deltagande och de flesta anser att de blir en mer effektiv medlem i teamet och samt att patienter har fördel av att ett team löser patientens problem. Ingen statistisk signifikant skillnad sågs mellan professionerna. Slutsats: Träning under en pågående operation är möjligt att genomföra samt är uppskattat av deltagarna och viktigt för deras utveckling av icke-tekniska färdigheter Nyckelord: Icke-tekniska färdigheter, interprofessionellt lärande, CRM, SBAR, closed-loop-kommunikation. / Introduction: During the past two decades, there has been increased interest in non-technical skills and how they affect patient safety. The number of articles published in the field has increased. Interprofessional education with the concept of CRM has been shown to be an effective way to train non-technical skills and teamwork, but training during ongoing surgery is uncommon.  Purpose: The purpose is to evaluate how the participants experienced the use of non-technical skills in an interprofessional learning activity during ambulatory surgery. Method: This was a cross-sectional study in which the participants (N=239) were asked to answer an evaluation survey following ambulatory surgery, concerning their experience of communication and teamwork. Descriptive statistics and inferential statistics with chi-square, Wilcoxon signed-rank test and Kruskal-Wallis were used to analyse the material.  Results: The use of communication within and between the professions was ranked as very high by the majority of the participants in all the questions in the survey, and control using chi-square showed the results to be statistically significant. The participants experienced an increased understanding of the other professions in the team, and deemed that they had become more effective team members. They were also of the opinion that patients have an advantage when a medical team solves their problems. There were no statistically significant results between the professions. Conclusion: Training can be implemented during ongoing surgery. This is a popular activity with participants, and is vital for their development of non-technical skills. Keywords: Non-technical skills, interprofessional education, CRM, SBAR, closed-loop communication

The emergency nurse specialist provides advanced nursing care to critically ill patients in the emergency care setting. The resuscitation room at the emergency department is where critically ill patients are treated and cared for. It is fundamental for nurses to create an opportunity for patients to participate in their given care. Person centered care sees the person as an individual and requires nurses to work from the individual's need, and not only as a person with a medical condition. Including the patient in clinical decisions and making them a part of the team is vital for person centered care. Communication with the nurse specialist, patient and family is a necessary prerequisite for person centered care. Poor communication amounts to almost 70 percent of deviation rapports. Standardised means of communication amongst healthcare staff have been put in place to reduce these risks. The use of closed loop communication can have significant reductions in errors made when caring for critically ill patients. The aim of the study was to observe communication in the resuscitation room.  The study used a quantitative research design. Ten real-time observations were conducted at a tertiary teaching hospital in Stockholm, Sweden. Two observers were present in the resuscitation room using an observational sheet to document communication.  Closed loop communication was not seen to be used by all healthcare staff and was found to be dependent on the team working. Communication with the patient was the highest overall documented speech in the resuscitation room, which could suggest good patient participation.  The results show predominantly positive amounts of time spent communicating with the patient. Whereas closed loop communication was used equally as much as non-closed loop communication. / Sjuksköterskor med specialistutbildning inom akutsjukvård ger avancerad omvårdnad till kritiskt sjuka patienter i en akutvårdskontext. Kritiskt sjuka patienten ges omvårdnad och medicinsk vård på akutmottagningen i ett akutrum. Det är grundläggande för sjuksköterskan att i akutrummet skapa en möjlighet för patienten att vara delaktig i sin egen vård. Personcentrerad vård bidrar till det att skapa den möjligheten och är ett förhållningssätt där patienten ses som en individ med individuella behov och inte enbart som en person med en medicinsk åkomma. Att inkludera patienten i kliniskt beslutsfattande och göra den till en del av teamet är grundläggande inom den personcentrerade vården och kommunikationen mellan akutsjuksköterskan, patienten och familjen är av största vikt. Dålig kommunikation bidrar även till att patientsäkerheten försämras och 70 % av alla avvikelserapporteringar innefattar bristfällig kommunikation. Därför används standardiserad kommunikation mellan sjukvårdspersonal för att minska risken för bristfällig kommunikation. Användandet av closed loop kommunikation kan bidra till att kommunikationen vid vårdande av kritiskt sjuka patienter förbättras vilket minskar risken för misstag.  Syftet med studien var att observera kommunikation på akutrummet  Studien använde en kvantitativ forskningsdesign. Tio realtidsobservationer utfördes på ett akutsjukhus i Stockholm, Sverige. Två observatörer var närvarande på akutrummet och observerade kommunikation med hjälp av ett verktyg skapat för ändamålet.  Closed loop kommunikation användes inte av all vårdpersonal utan var beroende av vilket larmteam som tjänstgjorde. Andelen kommunikation med patienten var den högst mätta parametern gällande tal på akutrummet vilket skulle kunna tyda på god patientdelaktighet.  Resultatet visar en övervägande positiv andel tid som spenderas genom att kommunicera med patienten på akutrummet. Användandet av closed loop kommunikation var lika vanligt som kommunikation som inte kategoriseras som closed loop.

Every year, tens of thousands of patients in North America die from preventable errors. Incident learning can decrease this number, but is not currently reaching its full potential in health care. The goal of this research was to propose strategies to effectively report and learn from incidents to drive quality improvement. A detailed literature review, focus groups, in-depth interviews, and thematic analysis were used to identify potential process improvement strategies from aviation and nuclear power and assess these strategies for feasibility and desirability in health care. This work was guided by World Health Organization recommendations and Rasmussen’s risk management framework. An extensive list of strategies to address existing shortcomings was ultimately proposed for consideration in health care. These strategies can serve as guidelines to proactively improve incident learning processes. This should help create more effective systems and in turn, improve patient safety.

Every year, tens of thousands of patients in North America die from preventable errors. Incident learning can decrease this number, but is not currently reaching its full potential in health care. The goal of this research was to propose strategies to effectively report and learn from incidents to drive quality improvement. A detailed literature review, focus groups, in-depth interviews, and thematic analysis were used to identify potential process improvement strategies from aviation and nuclear power and assess these strategies for feasibility and desirability in health care. This work was guided by World Health Organization recommendations and Rasmussen’s risk management framework. An extensive list of strategies to address existing shortcomings was ultimately proposed for consideration in health care. These strategies can serve as guidelines to proactively improve incident learning processes. This should help create more effective systems and in turn, improve patient safety.