A Priority-based Fair Queuing (PFQ) Model for Wireless Healthcare System

Healthcare is a very active research area, primarily due to the increase in the elderly population that leads to increasing number of emergency situations that require urgent actions. In recent years some of wireless networked medical devices were equipped with different sensors to measure and report on vital signs of patient remotely. The most important sensors are Heart Beat Rate (ECG), Pressure and Glucose sensors. However, the strict requirements and real-time nature of medical applications dictate the extreme importance and need for appropriate Quality of Service (QoS), fast and accurate delivery of a patient’s measurements in reliable e-Health ecosystem. As the elderly age and older adult population is increasing (65 years and above) due to the advancement in medicine and medical care in the last two decades; high QoS and reliable e-health ecosystem has become a major challenge in Healthcare especially for patients who require continuous monitoring and attention. Nevertheless, predictions have indicated that elderly population will be approximately 2 billion in developing countries by 2050 where availability of medical staff shall be unable to cope with this growth and emergency cases that need immediate intervention. On the other side, limitations in communication networks capacity, congestions and the humongous increase of devices, applications and IOT using the available communication networks add extra layer of challenges on E-health ecosystem such as time constraints, quality of measurements and signals reaching healthcare centres. Hence this research has tackled the delay and jitter parameters in E-health M2M wireless communication and succeeded in reducing them in comparison to current available models. The novelty of this research has succeeded in developing a new Priority Queuing model ‘’Priority Based-Fair Queuing’’ (PFQ) where a new priority level and concept of ‘’Patient’s Health Record’’ (PHR) has been developed and integrated with the Priority Parameters (PP) values of each sensor to add a second level of priority. The results and data analysis performed on the PFQ model under different scenarios simulating real M2M E-health environment have revealed that the PFQ has outperformed the results obtained from simulating the widely used current models such as First in First Out (FIFO) and Weight Fair Queuing (WFQ). PFQ model has improved transmission of ECG sensor data by decreasing delay and jitter in emergency cases by 83.32% and 75.88% respectively in comparison to FIFO and 46.65% and 60.13% with respect to WFQ model. Similarly, in pressure sensor the improvements were 82.41% and 71.5% and 68.43% and 73.36% in comparison to FIFO and WFQ respectively. Data transmission were also improved in the Glucose sensor by 80.85% and 64.7% and 92.1% and 83.17% in comparison to FIFO and WFQ respectively. However, non-emergency cases data transmission using PFQ model was negatively impacted and scored higher rates than FIFO and WFQ since PFQ tends to give higher priority to emergency cases. Thus, a derivative from the PFQ model has been developed to create a new version namely “Priority Based-Fair Queuing-Tolerated Delay” (PFQ-TD) to balance the data transmission between emergency and non-emergency cases where tolerated delay in emergency cases has been considered. PFQ-TD has succeeded in balancing fairly this issue and reducing the total average delay and jitter of emergency and non-emergency cases in all sensors and keep them within the acceptable allowable standards. PFQ-TD has improved the overall average delay and jitter in emergency and non-emergency cases among all sensors by 41% and 84% respectively in comparison to PFQ model

In-situ simulation: A different approach to patient safety through immersive training

Simulation is becoming more and more popular in the field of healthcare education. The main concern for some faculty is knowing how to organise simulation training sessions when there is no simulation centre as they are not yet widely available and their cost is often prohibitive. In medical education, the pedagogic objectives are mainly aimed at improving the quality of care as well as patient safety. To that effect, a mobile training approach whereby simulation-based education is done at the point of care, outside simulation centres, is particularly appropriate. It is usually called “in-situ simulation”. This is an approach that allows training of care providers as a team in their normal working environment. It is particularly useful to observe human factors and train team members in a context that is their real working environment. This immersive training approach can be relatively low cost and enables to identify strengths and weaknesses of a healthcare system. This article reminds readers of the principle of « context specific learning » that is needed for the good implementation of simulation-based education in healthcare while highlighting the advantages, obstacles, and challenges to the development of in-situ simulation in hospitals. The objective is to make clinical simulation accessible to all clinicians for the best interests of the patient.Peer reviewe

Virtual reality simulation for the optimization of endovascular procedures : current perspectives

Endovascular technologies are rapidly evolving, often - requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR) simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls. The latest developments in this field include the use of fully immersive simulated hybrid angiosuites to train whole endovascular teams in crisis resource management and novel technologies that enable practitioners to build VR simulations based on patient-specific anatomy. As our understanding of the skills, both technical and nontechnical, required for optimal endovascular performance improves, the requisite tools for objective assessment of these skills are being developed and will further enable the use of VR simulation in the training and assessment of endovascular interventionalists and their entire teams. Simulation training that allows deliberate practice without danger to patients may be key to bridging the gap between new endovascular technology and improved patient outcomes

Knowledge and Skills of Emergency Care During Disaster for Community Health Volunteers: a Literature Review

Background: Nowadays, disaster preparedness and responses are essential for everyone to be involved since the disaster becomes increasing. The Community Health Volunteers (CHVs) in particular are the key partners required adequately prepared in emergency care during disaster event. Purpose: The study aims to examine the essential knowledge and skills of emergency care during natural disaster for CHVs. Method: The reviews published during 2000 and 2011 searching from PubMed, Science Direct, CINAHL, ProQuest Medical Library were conducted. Result: Twenty-four articles and documents related to community-based disaster preparedness programs were intensively reviewed. Based on the review, six components of knowledge and skills for emergency care in natural disaster for CHVs are required including 1) early warning, 2) disaster triage, 3) first aid, 4) search and rescue, 5) logistic and communication, and 6) team organizations. Conclusion: There was a few studies focusing on the emergency care in disaster management and some factors related to knowledge and skills were shown. It is therefore recommended that the current CHVs' knowledge and skills should be explored in order to assist people in their community following disaster event when professional responders are not immediately available to help

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Does Telemedical Support of First Responders Improve Guideline Adherence in an Offshore Emergency Scenario? A Simulator-Based Prospective Study

OBJECTIVE: To investigate, in a simulator-based prospective study, whether telemedical support improves quality of emergency first response (performance) by medical non-professionals to being non-inferior to medical professionals. SETTING: In a simulated offshore wind power plant, duos (teams) of offshore engineers and teams of paramedics conducted the primary survey of a simulated patient. PARTICIPANTS: 38 offshore engineers and 34 paramedics were recruited by the general email invitation. INTERVENTION: Teams (randomised by lot) were supported by transmission technology and a remote emergency physician in Berlin. OUTCOME MEASURES: From video recordings, performance (17 item checklist) and required time (up to 15 min) were quantified by expert rating for analysis. Differences were analysed using two-sided exact Mann-Whitney U tests for independent measures, non-inferiority was analysed using Schuirmann one-sided test. The significance level of 5 % was Holm-Bonferroni adjusted in each family of pairwise comparisons. RESULTS: Nine teams of engineers with, nine without, nine teams of paramedics with and eight without support completed the task. Two experts quantified endpoints, insights into rater dependence were gained. Supported engineers outperformed unsupported engineers (p<0.01), insufficient evidence was found for paramedics (p=0.11). Without support, paramedics outperformed engineers (p<0.01). Supported engineers' performance was non-inferior (at one item margin) to that by unsupported paramedics (p=0.03). Supported groups were slower than unsupported groups (p<0.01). CONCLUSIONS: First response to medical emergencies in offshore wind farms with substantially delayed professional care may be improved by telemedical support. Future work should test our result during additional scenarios and explore interdisciplinary and ecosystem aspects of this support. TRIAL REGISTRATION NUMBER: DRKS0001437

Improving Emergency Response in the Outpatient Clinic Setting

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. Weaknesses in the emergency response system in the community-based outpatient clinic setting were identified. Results: Several tools were utilized including a fish bone diagram and the 5-Whys tool. Two root causes were identified. The first is that clinic staff does not have a working knowledge with specifics regarding the emergency response process. The second is that the existing emergency response checklist document is visually confusing and duties are not in sequence. Discussion and Implications for the CNL: Weaknesses in the emergency response system will be discussed. Knowledge and experience from inpatient care will be translated to the outpatient clinic setting. The role of the CNL in designing an effective emergency response system will be discussed with the proposal of several plans of action