A finales de los años noventa, y al comienzo del nuevo milenio, las redes inalámbricas han evolucionado bastante, pasando de ser sólo una tecnología prometedora para convertirse en un requisito para las actividades cotidianas en las sociedades desarrolladas. La infraestructura de transporte también ha evolucionado, ofreciendo comunicación a bordo para mejorar la seguridad vial y el acceso a contenidos de información y entretenimiento. Los requisitos de los usuarios finales se han hecho dependientes de la tecnología, lo que significa que sus necesidades de conectividad han aumentado debido a los diversos requisitos de las aplicaciones que se ejecutan en sus dispositivos móviles, tales como tabletas, teléfonos inteligentes, ordenadores portátiles o incluso ordenadores de abordo (On-Board Units (OBUs)) dentro de los vehículos. Para cumplir con dichos requisitos de conectividad, y teniendo en cuenta las diferentes redes inalámbricas disponibles, es necesario adoptar técnicas de Vertical Handover (VHO) para cambiar de red de forma transparente y sin necesidad de intervención del usuario. El objetivo de esta tesis es desarrollar algoritmos de decisión (Vertical Handover Decision Algorithms (VHDAs)) eficientes y escalables, optimizados para el contexto de las redes vehiculares. En ese sentido se ha propuesto, desarrollado y probado diferentes algoritmos de decisión basados en la infraestructura disponible en las actuales, y probablemente en las futuras, redes inalámbricas y redes vehiculares. Para ello se han combinado diferentes técnicas, métodos computacionales y modelos matemáticos, con el fin de garantizar una conectividad apropiada, y realizando el handover hacia las redes más adecuadas de manera a cumplir tanto con los requisitos de los usuarios como los requisitos de las aplicaciones. Con el fin de evaluar el contexto, se han utilizado diferentes herramientas para obtener información variada, como la disponibilidad de la red, el estado de la red, la geolocalización / Márquez Barja, JM. (2012). SCALABLE AND EFFICIENT VERTICAL HANDOVER DECISION ALGORITHMS IN VEHICULAR NETWORK CONTEXTS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/17869 / Palancia

The number of subscribers and use cases of mobile communication networks are expanding expeditiously with the evolution of technology. The available spectrum in lower frequency ranges does not meet the unprecedented increase in demand for user data throughput in mobile networks. Facing the problem of limited spectrum in traditional cellular bands that are below 6 GHz, Millimeter Wave (mmWave) frequency bands are being standardized for the 5th Generation (5G) mobile networks as a promising means for handling the unprecedented data traffic surge. Enabling higher carrier frequencies introduces new channel conditions. Propagating signals are exposed to higher diffraction loss and are highly susceptible to blockage caused by surrounding objects, which leads to rapid signal degradation and challenges user mobility. On the other hand, higher carrier frequencies enable the deployment of many small-sized antennas that are used for directional signal transmission, resulting in beamforming gain. In recent studies, a conditional handover procedure has been adopted for 5G networks to enhance user mobility robustness. Besides, contention-free random access procedure has been defined for beamformed systems aiming at minimizing the signaling and service interruption time caused by the random access procedure. An improper configuration of the mobility parameters, e.g., handover preparation and execution offsets, access beam selection threshold of random access procedure, leads User Equipments (UEs) to experience Handover Failures (HOFs) and Radio Link Failures (RLFs), and causes unnecessary signaling and inefficient resource utilization in the network. Each cell border has unique propagation characteristics and user mobility pattern, and, therefore, mobility parameters should be configured for each cell border individually. Moreover, mobility parameters should be updated for dynamic propagation environment (e.g., construction of buildings, seasonal changes in the vegetation) and for temporal mobility patterns. Considering the individual cell border configuration, temporal adaptation of the mobility parameters, and ultra-dense deployment, optimization of the conditional handover and random access parameters is a complex task that cannot be carried by human interaction. Therefore, an automatic optimization of the parameters is needed where the network collects statistics of the mobility events and adjusts the parameters autonomously. To investigate user mobility under these new propagation conditions, a proper model is needed that captures spatial and temporal characteristics of the channel in beamformed networks. Current channel models that have been developed for 5G networks are too detailed for the purpose of mobility simulations and lead to infeasible simulation time for most user mobility simulations. In this work, a simplified channel model is presented that captures the spatial and temporal characteristics of the 5G propagation channel and runs in feasible simulation time. To this end, the coherence time and path diversity originating from a fully fledged Geometry-based Stochastic Channel Model (GSCM) are analyzed and adopted in Jake’s channel model with reduced computational complexity. Furthermore, the deviation of multipath beamforming gain from single ray beamforming gain is analyzed and a regression curve is obtained to be used in the system-level simulations. In a typical system-level mobility simulator, the average downlink signal-to-interference and noise ratio (SINR) is used for RLF detection and throughput calculation. In addition to the channel model, models of desired and interfering signals are formulated first, by considering the impact of antenna beamforming, and a closed-form expression of average downlink SINR is derived by taking into account the user and beam scheduling probabilities. Then, an accurate approximation of the average downlink SINR with low computational complexity is presented, for 5G networks where the base station forms multiple beams. In addition, an SINR model is derived for both strict and opportunistic resource-fair scheduler, where the latter targets a higher utilization of radio resources when multiple beams are scheduled simultaneously. The mobility performance of conditional handover and contention-free random access are investigated by using the proposed channel and SINR models. Besides, a resource efficient random access procedure is proposed that aims at maximizing the utilization of contention-free random access resources. Moreover, simple, yet, effective decision tree-based supervised learning method is proposed to minimize the HOFs that are caused by the beam preparation phase of the random access procedure. Similarly, a decision-tree-based supervised learning method is proposed for automatic optimization of the conditional handover parameters. In addition, enhanced logging and emergency reporting methods are introduced first time in this study to mitigate the cell detection problems that are caused by rapid signal degradation. Results show that the optimum operation point of random access (in terms of minimizing the HOFs and maximizing the random access resource utilization) is achievable with the proposed learning algorithm for random access procedure in conditional handover. Results also show that the mobility performance of conditional handover is improved by automatic optimization of the handover parameters. In addition, the proposed enhanced logging and emergency reporting methods mitigate the mobility problems related with cell detection and further improve the mobility performance in combination with the decision-tree-based supervised learning methods.

The aim of this thesis is acquaintance with the EPS system of LTE and IMS subsystem. The thesis is aimed on analysis of the control procedures related to operations between the terminal and the packet core network of the fourth generation such as logging into the system, user authentication, change the viewing area, handover and disconnection from the network.

Das Ziel dieser Arbeit ist es, ein Handover-Verfahren für ein Siemens Handset zu entwickeln. Die Entwicklungsumgebung beruht auf den Wireless-LAN Standards 802.11 der IEEE (Institute of Electrical and Electronics Engineers). Dabei liegen die Schwerpunkte auf den Standardisierungen 802.11f und 802.11i, wobei sich eine neue Arbeitsgruppe (IEEE 802.11r) direkt mit dem Thema "Handover" beschäftigen wird. Das Handset soll selbständig die Verwaltung und Einleitung des Handovers übernehmen und lediglich insofern vom Access Point unterstützt werden, dass dieser als Informationssammler dient und somit Entscheidungshilfen geben kann.

No description available.

Abstrakt Bakgrund: Årligen uppstår vårdskador inom sjukvården till följd av kommunikationsbrister mellan personal. För att minska risken att dessa uppstår i samband med överrapportering har kommunikationsverktyg etablerats, ett av dessa är SBAR som står för situation, bakgrund, aktuell bedömning och rekommendation. Den postoperativa överrapporteringen anses vara ett kritiskt moment och införandet av ett standardiserat sätt att kommunicera på har visats sig reducera vårdskador och dödlighet, ge en förbättring av kvaliteten på rapporten med färre informationsmissar samt förbättrar lagarbetet. Syfte: Att beskriva intensivvårds- och anestesisjuksköterskors erfarenheter av postoperativ överrapportering med kommunikationsverktyget SBAR. Metod: En intervjustudie med kvalitativt deduktiv ansats genomfördes. Resultat: SBAR beskrevs som bästa praxis för postoperativ överrapportering samt som ett viktigt verktyg för att kunna garantera säker och effektiv kommunikation. SBAR ansågs ge en bra struktur och även skapa en gemensam förförståelse för postoperativ överrapportering. Deltagare beskrev dåligt lagarbete och undermålig arbetsmiljö som ytterligare hinder för patientsäker vård. Slutsats: Deltagare i studien hade goda erfarenheter av att använda SBAR och de tyckte att SBAR påverkade patientsäkerheten positivt, men önskade mer konsekvent användande av SBAR vid postoperativ överrapportering. / Abstract Background: Adverse events happen yearly within healthcare due to poor communication between health care personnel. To decrease the risk of these adverse events occurring during postoperative handover communication tools such as SBAR (situation, background, assessment, request) has been introduced. Postoperative handover is considered a critical moment during patient care and the introduction of a standardised way of communicating has shown to reduce adverse events and mortality, in addition to improving both the quality of the postoperative handover and the teamwork. Aim: To describe intensive care nurses’ and nurse anesthetists’ experiences of postoperative handover using the communication tool SBAR. Method: A qualitative interview study with a deductive approach was conducted.  Results: SBAR was described as best practice for postoperative handover and an important tool to ensure safe and effective communication. SBAR was thought to create a good structure and a shared mental model for postoperative handover. Participants described subpar teamwork and poor working conditions as further complications to providing safe care. Conclusion: Participants in the study had good experiences of using SBAR and thought it had a positive effect on patient safety but wished for a more consistent use of SBAR during postoperative handover.

Bakgrund: Bedsiderapportering är en överlämningsmetod som ämnar öka patientens delaktighet i omvårdnaden. Metoden har ett antal kliniska utmaningar kopplat till sekretessen och sjukhusets rutiner, men implementeringens vara eller icke vara beror till stor del på vårdpersonalens vanor, villighet och kompetens. Syfte: Att beskriva hur patienter upplever bedsiderapportering inom den somatiska slutenvården. Metod: Studien är en allmän litteraturstudie. Tio artiklar analyserades med tematisk analys. Åtta av artiklarna hade kvalitativ ansats och de två övriga hade mixed-method. Endast det kvalitativa innehållet i de två artiklarna med mixed-method inkluderades i resultatet. Resultat: Den tematiska analysen resulterade i två teman och sju subteman. Resultatet beskrivs utifrån teman: 1. Att känna sig delaktig och 2. Att känna sig respekterad. Bedsiderapporteringen gav patienterna en ökad känsla av delaktighet och trygghet. De föredrog att vara involverade i överrapporteringen då delaktighetens fördelar övervägde eventuella problem med sekretessen. Patienterna uppskattade att i första hand bli sedda som person och i andra hand som patient. Slutsatser: Trots att bedsiderapportering för patienterna genererade en ökad känsla av delaktighet och trygghet, skapade det för sjuksköterskorna en uppsättning nya utmaningar med omvårdnaden. Författarna till denna studie anser att det finns indikationer för behov av kompletterande forskning inom området, där de båda perspektiven undersöks och ställs mot varandra i relation till nyttan med bedsiderapportering. / Background: Bedside handover is a transfer method that seeks to increase the patient’s participation in the nursing care. The method has a number of clinical challenges in connection to confidentiality and hospital routines, but the implementations’ to be or not to be depends greatly on the nursing staff and their habits, willingness and competence. Aim: To describe how the patients experience bedside handover in somatic hospital wards. Method: The study is a literature study. Ten articles were analyzed with thematic analysis. Eight of the articles had a qualitative approach and the remaining two articles had a mixedmethod. Only the qualitative content from the two articles with mixed-method was included in the result. Results: The thematic analysis resulted in two themes and seven sub themes. The result is described departing from the following themes, 1. To feel involved and 2. To feel respected. The bedside handover gave patients an increased sense of participation and security. They preferred to be involved in the handover, as the benefits of participation outweighed any problems with confidentiality. The patients appreciated being seen firstly as a person and secondly as a patient. Conclusion: Even though bedside handover increased the feeling of participation and security for the patients, it created a set of new challenges for the nurses in the caring process. The authors of this study believe that there are indications of needs for complementary research in the field, where both perspectives are examined and put against each other in relation to the utility of bedside handover

The Use of a Standardized System of Communication to Change the Perception of Handoff Communication in a Psychiatric Setting by Alicia Renee' Plunkett MSN, Walden University 2007 MSHA, University of St. Francis, 2005 BSN, University of Memphis, 1995 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University December 2014 The Joint Commission's review of sentinel events indicated that communication errors were the cause of over 65% of the sentinel events occurring in healthcare. The nursing profession has the responsibility of providing 24-hour care in an acute care setting and nurses are thus the primary participants in the handoff communication process. The purpose of this project was to assess the nursing staff's perception of handoff and to create a process for handoff communication. The most common framework for correcting communication errors in the literature is the Situation, Background, Assessment, and Recommendation framework, which was used as a guide for developing a process and form for handoff in this facility. The "Clinical Handover Staff Survey" developed by O'Connell, MacDonald, and Kelly (2008) was modified for use in this study. This survey was distributed to nurses and mental health technicians in 2 acute care units within a standalone acute care psychiatric hospital (n = 140). The quantitative survey identified 3 common barriers to the process in this facility that included: (a) interruptions, (b) subjective terminology used to describe patients, and (c) the lack of confidence in the information presented. After the implementation of a new process and form, the staff members were resurveyed to measure their post implementation perceptions of the handoff process. In each of the 3 areas measured, the implementation of a new process and form allowed the facility to see changes in the staffs' perceptions of the handoff process. The changes seen in this facility further indicate the need for education, standardization, and a continued focus on improving and mastering the important task of handoff communication. Improving handoff communication prevents errors in patient care from occurring, therefore decreasing mortality and morbidity rates.

Bakgrund: Överrapportering mellan skiftbyten är en central roll för sjuksköterskan och en viktig del för vårdverksamheten. Dock är den traditionella överrapporteringen identifierad som ett möjligt område för felkommunikation och minskad patientdelaktighet. Bedside överrapportering kan öppna upp för en mer personcentrerad vård och öka delaktigheten för patienten.  Syfte: Att undersöka patientens upplevelser och erfarenheter vid bedside överrapportering. Metod: En litteraturöversikt innehållande tio kvalitativa artiklar. Artiklarna hämtades från PubMed och CINAHL och kvalitetsgranskades med hjälp av SBU:s granskningsmall för bedömning av studier med kvalitativ metodik. Artiklarna analyserades med Graneheim och Lundmans (2004) innehållsanalysmetod.  Resultat: Analysen resulterade i fyra domäner och fyra kategorier där resultatet presenterades. Patientens upplevelser och erfarenheter visade sig till stor del handla om önskan att vara delaktig i sin vård. Vissa patienter uttryckte önskan om delaktighet i större utsträckning än andra och många poängterade fördelar som att kunna korrigera felaktigheter, ställa frågor och tillägga missad information i anslutning till överrapporteringen. Kommunikationen mellan patient och sjuksköterska påpekades vara en viktig del. Förmedlandet av känslig information upplystes som en svårighet och bevarande av patientens integritet ansågs som betydelsefullt.     Slutsats: Patienters upplevelser och erfarenheter av bedside överrapportering visade sig till stor del främja patientdelaktigheten. En del patienter ansåg sig dock vilja vara involverad i en begränsad omfattning. Patienterna ansåg att överlämningen gav en mer personlig relation mellan till sjuksköterskan. Möjligheten att påverka informationsöverföringen ansågs vara positivt. Bevara patientens integritet vid hantering av känslig information ansågs som en svårighet och att patienter ibland ansåg att det var svårt att förstå sjuksköterskornas komplicerade språk. / Introduction: Shift reports between nurses is a central role for the nurses and an important part of health care. The traditional handover has however been identified as a possible source of miscommunication and reduced patient participation. Bedside shift reports can facilitate a more personalized care and increase patient participation. Objective: To examine patient experiences with bedside shift reports. Method: A literary study containing ten qualitative studies. The studies were identified through PubMed and CINAHL and reviewed using SBUs template “assessment of studies with a qualitative method”. The articles were analysed using Graneheim and Lundmans’ (2004) content analysis method. Results: The analysis resulted in four domains and four categories. The results showed that a big part of the patient’s experiences of bedside shift reports was that they wished to participate more in their care. Some patients had a bigger wish to participate than others and a lot of patients emphasized the benefits of bedside shift reports; how they could correct wrong information, ask questions, and add further information. The communication between patients and nurses was another important part of bedside shift reports. The mediation of sensitive information was pointed out as a difficulty, as well as the protection of the patient’s integrity. Conclusion: The patient’s experiences of bedside shift reports has shown increasing patient participation in their care. They said that the handover enabled a more personal relationship between the patient and the nurses, and that this resulted in a feeling of calmness and safety. The opportunity to influence the transfer of information and to correct wrong data or ask questions was a positive aspect of bedside shift reports. The handling of sensitive information was seen as a weakness of bedside shift reports. Patients also had difficulty understanding the nurses' complicated language.

Bakgrund: Bristande kommunikationen kan vara en stor anledning till patientsäkerhetsrisker, ofta uppstår bristerna i övergången mellan olika team och där en snabb och effektiv hantering är av största vikt såsom på intensivvårdsavdelningar. SBAR rekommenderas av SKR och studier har visat att användandet av SBAR ökar patientsäkerheten i vissa aspekter. Motiv: Inga studier har hittats som undersöker vilka faktorer som kan påverka intensivvårdssjuksköterskans möjligheter att rapportera enligt SBAR. Kunskap om detta kan leda till utvecklandet av metoder som kan förbättra möjligheten till korrekt SBAR rapportering. Syftet: Syftet med studien var att kartlägga om olika faktorer kan påverka om intensivvårdssjuksköterskor rapporterar korrekt enligt SBAR eller inte vid överrapportering. Metod: Metoden som användes var en kvantitativ observationsstudie. Observationerna skedde på två olika intensivvårdsavdelningar på ett medelstort sjukhus i Norrland. 31 intensivvårdssjuksköterskor deltog. Efter observationen fick studiedeltagaren svara på ett frågeformulär. Resultat: Resultatet visade inga statistiskt signifikanta skillnader eller samband vilket delvis kan förklaras av ett litet stickprov. Resultatet visade dock på medelstora effekter som tyder på att intensivvårdssjuksköterskor som rapporterat felaktigt enligt SBAR var äldre, hade arbetat en längre tid som sjuksköterskor och längre tid på arbetsplatsen samt att en korrekt SBAR rapportering hade fler störningar och en högre ljudnivå. Konklusion: En förbättrad följsamhet till SBAR skulle kunna minska samhällskostnader och vårdskador. Utbildningsinsatser i form av rollspel eller simulering skulle kunna öka kunskapen om SBAR. Kontinuerlig fortbildning behövs för att upprätthålla kompetensen, detta kan göras genom instruktionssjuksköterskor och användandet av lättillgängliga flödesscheman samt att rapportering bör ske där det är en låg ljudnivå / Background: Inadequate communication can be a considerable reason for patient safety risks. Mistakes in communication often happen in the transition between different teams and when efficient and fast management is of importance, such as in an ICU. The use of SBAR (Situation, Background, Assessment, Recommendation) is recommended by SKR and studies have shown that it can improve patient safety in some aspects. Motive: Knowledge about factors that can affect the intensive care nurses' possibilities to do a correct SBAR handover can help create methods that can increase the possibility of a correct SBAR handover. Aim: The aim of the study was to map out whether varied factors can affect intensive care nurses to do a correct handover accordingly to SBAR or not. Method: The method used was a quantitative observational study. The observations took place on two different intensive care units in a medium sized hospital in northern Sweden. 31 intensive care nurses participated in the study. The participants then answered a questionnaire after the observation. Result: The result did not show any significant differences or relationships. The result did, however, show midsized effects that could indicate that the intensive care nurses who fail to do a handover accordingly to SBAR tend to be older, had worked a longer time at the workplace and as a registered nurse. Correct SBAR handovers had a higher sound level and more interruptions. Conclusion: A better compliance with SBAR could reduce iatrogenic harm and societal costs. Educational efforts could help increase knowledge about SBAR, roleplay and simulations have shown a good effect when implementing SBAR. Continuous education to uphold knowledge is needed, it can be done with instructional nurses and flowcharts. During handovers, the sound level should be reduced.