Developing a protocol for the use of telenursing in community health in Australia

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client's home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients' responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved.

Evaluation of a pilot telemedicine network for accident and emergency work

A pilot accident and emergency. teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately pound1.5 million has been made available by the government to develop a national system for Scotland.

Superstring: A scalable service discovery protocol for the wide-area pervasive environment

Arguably, the world has become one large pervasive computing environment. Our planet is growing a digital skin of a wide array of sensors, hand-held computers, mobile phones, laptops, web services and publicly accessible web-cams. Often, these devices and services are deployed in groups, forming small communities of interacting devices. Service discovery protocols allow processes executing on each device to discover services offered by other devices within the community. These communities can be linked together to form a wide-area pervasive environment, allowing processes in one p u p tu interact with services in another. However, the costs of communication and the protocols by which this communication is mediated in the wide-area differ from those of intra-group, or local-area, communication. Communication is an expensive operation for small, battery powered devices, but it is less expensive for servem and workstations, which have a constant power supply and 81'e connected to high bandwidth networks. This paper introduces Superstring, a peer to-peer service discovery protocol optimised fur use in the wide-area. Its goals are to minimise computation and memory overhead in the face of large numbers of resources. It achieves this memory and computation scalability by distributing the storage cost of service descriptions and the computation cost of queries over multiple resolvers.