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Longitudinal training models for entrusting students with independent patient care?

Objective: The participation of students from both undergraduate medical education (UGME) and postgraduate medical education (PGME) in independent patient care contributes to the development of knowledge, skills and the professional identity of students. A continuing collaboration between students and their preceptor might contribute to opportunities for students to independently provide patient care. In this systematic review, we aim to evaluate whether longitudinal training models facilitate the independent practice of students and what characteristics of longitudinal training models contribute to this process. Method: This systematic review was performed according to the PRISMA guidelines. In May 2020, we performed a search in three databases. Articles evaluating the impact of longitudinal training models on the independent practice of students from both UGME and PGME programmes were eligible for the study. A total of 68 articles were included in the study. Quality of the included studies was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).Results: Both UGME and PGME students in longitudinal training models are more frequently allowed to provide patient care independently when compared with their block model peers, and they also feel better prepared for independent practice at the end of their training programme. Several factors related to longitudinal training models stimulate opportunities for students to work independently. The most important factors in this process are the longitudinal relationships with preceptors and with the health care team. Conclusion: Due to the ongoing collaboration between students and their preceptor, they develop an intensive and supportive mutual relationship, allowing for the development of a safe learning environment. As a result, the professional development of students is fostered, and students gradually become part of the health care team, allowing them the opportunity to engage in independent patient care.

Building and building systems energy prediction models to enhance energy flexibility control

The built environment requires energy-flexible buildings to reduce energy peak loads and to maximize the use of (decentralized) renewable energy sources. The challenge is to arrive at smart control strategies that respond to the increasing variations in both the energy demand as well as the variable energy supply. This enables grid integration in existing energy networks with limited capacity and maximises use of decentralized sustainable generation. Buildings can play a key role in the optimization of the grid capacity by applying demand-side management control. To adjust the grid energy demand profile of a building without compromising the user requirements, the building should acquire some energy flexibility capacity. The main ambition of the Brains for Buildings Work Package 2 is to develop smart control strategies that use the operational flexibility of non-residential buildings to minimize energy costs, reduce emissions and avoid spikes in power network load, without compromising comfort levels. To realise this ambition the following key components will be developed within the B4B WP2: (A) Development of open-source HVAC and electric services models, (B) development of energy demand prediction models and (C) development of flexibility management control models. This report describes the developed first two key components, (A) and (B). This report presents different prediction models covering various building components. The models are from three different types: white box models, grey-box models, and black-box models. Each model developed is presented in a different chapter. The chapters start with the goal of the prediction model, followed by the description of the model and the results obtained when applied to a case study. The models developed are two approaches based on white box models (1) White box models based on Modelica libraries for energy prediction of a building and its components and (2) Hybrid predictive digital twin based on white box building models to predict the dynamic energy response of the building and its components. (3) Using CO₂ monitoring data to derive either ventilation flow rate or occupancy. (4) Prediction of the heating demand of a building. (5) Feedforward neural network model to predict the building energy usage and its uncertainty. (6) Prediction of PV solar production. The first model aims to predict the energy use and energy production pattern of different building configurations with open-source software, OpenModelica, and open-source libraries, IBPSA libraries. The white-box model simulation results are used to produce design and control advice for increasing the building energy flexibility. The use of the libraries for making a model has first been tested in a simple residential unit, and now is being tested in a non-residential unit, the Haagse Hogeschool building. The lessons learned show that it is possible to model a building by making use of a combination of libraries, however the development of the model is very time consuming. The test also highlighted the need for defining standard scenarios to test the energy flexibility and the need for a practical visualization if the simulation results are to be used to give advice about potential increase of the energy flexibility. The goal of the hybrid model, which is based on a white based model for the building and systems and a data driven model for user behaviour, is to predict the energy demand and energy supply of a building. The model's application focuses on the use case of the TNO building at Stieltjesweg in Delft during a summer period, with a specific emphasis on cooling demand. Preliminary analysis shows that the monitoring results of the building behaviour is in line with the simulation results. Currently, development is in progress to improve the model predictions by including the solar shading from surrounding buildings, models of automatic shading devices, and model calibration including the energy use of the chiller. The goal of the third model is to derive recent and current ventilation flow rate over time based on monitoring data on CO₂ concentration and occupancy, as well as deriving recent and current occupancy over time, based on monitoring data on CO₂ concentration and ventilation flow rate. The grey-box model used is based on the GEKKO python tool. The model was tested with the data of 6 Windesheim University of Applied Sciences office rooms. The model had low precision deriving the ventilation flow rate, especially at low CO2 concentration rates. The model had a good precision deriving occupancy from CO₂ concentration and ventilation flow rate. Further research is needed to determine if these findings apply in different situations, such as meeting spaces and classrooms. The goal of the fourth chapter is to compare the working of a simplified white box model and black-box model to predict the heating energy use of a building. The aim is to integrate these prediction models in the energy management system of SME buildings. The two models have been tested with data from a residential unit since at the time of the analysis the data of a SME building was not available. The prediction models developed have a low accuracy and in their current form cannot be integrated in an energy management system. In general, black-box model prediction obtained a higher accuracy than the white box model. The goal of the fifth model is to predict the energy use in a building using a black-box model and measure the uncertainty in the prediction. The black-box model is based on a feed-forward neural network. The model has been tested with the data of two buildings: educational and commercial buildings. The strength of the model is in the ensemble prediction and the realization that uncertainty is intrinsically present in the data as an absolute deviation. Using a rolling window technique, the model can predict energy use and uncertainty, incorporating possible building-use changes. The testing in two different cases demonstrates the applicability of the model for different types of buildings. The goal of the sixth and last model developed is to predict the energy production of PV panels in a building with the use of a black-box model. The choice for developing the model of the PV panels is based on the analysis of the main contributors of the peak energy demand and peak energy delivery in the case of the DWA office building. On a fault free test set, the model meets the requirements for a calibrated model according to the FEMP and ASHRAE criteria for the error metrics. According to the IPMVP criteria the model should be improved further. The results of the performance metrics agree in range with values as found in literature. For accurate peak prediction a year of training data is recommended in the given approach without lagged variables. This report presents the results and lessons learned from implementing white-box, grey-box and black-box models to predict energy use and energy production of buildings or of variables directly related to them. Each of the models has its advantages and disadvantages. Further research in this line is needed to develop the potential of this approach.

Social Robots for Elderly Care

Referral decisions and its predictors related to orthopaedic care

Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81– 0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient’s diagnosis and the period (p < 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.

Do You Care for Robots That Care?

Abstract: Background: There has been a rapid increase in the population of senior citizens in many countries. The shortage of caregivers is becoming a pressing concern. Robots are being deployed in an attempt to fill this gap and reduce the workload of caregivers. This study explores how healthcare robots are perceived by trainee care professionals. Methods: A total of 2365 students at different vocational levels completed a questionnaire, rating ethical statements regarding beneficence, maleficence, justice, autonomy, utility, and use intentions with regard to three different types of robots (assistive, monitoring, and companion) along with six control variables: gender, age, school year, technical skills, interest in technology, and enjoying working with computers.

eHealth education in primary care practice : part 3

eHealth education should be integrated into vocational training and continuous professional development programmes. In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided