MODELLING AN ENHANCED REMOTE PATIENT MEDICAL MONITORING SYSTEM IN NIGERIAN HOSPITALS

ABSTRACT

With the advancement of wireless technologies, wireless sensor networks can greatly expand our ability to monitor and track the conditions of patients in the healthcare area. Remote Medical Monitoring is one of the components of telemedicine capable of monitoring the vital signs of patients in a remote location and sending the results directly to a monitoring station. Ambulatory unobtrusive monitoring of the vital signs of the elderly and chronically ill patients is very crucial in helping to save their lives. The manual medical monitoring done in the Nigerian hospitals has a lot of challenges ranging from faulty instruments, negligence of duty on the part of the nurses left to do this monitoring , absence of doctors on call from their offices and so on. This thesis simulates the readings of the blood pressure and the pulse rate of patients based on the known causes of the high and low blood pressure and pulse rate respectively with a data structure that includes, age, health status, smoking habits, alcohol intake etc. The simulation is done with an application called the Mobile Health Information Management System that runs on a simulated mobile phone. The blood pressure and the pulse rate of the patient is simulated every 25 seconds and sent directly to the server where it enters an M/M/1 queuing model that operates on First In First Out (FIFO) basis, where it performs analyses on the data and keeps the packets of data in the queue as they arrive from where it sends it to the mobile user log file. In the server, there is another application software called the Integrated Hospital Information Management System which performs other hospital functions and contains the hospital database as well as the electronic medical records. The packets of data sent to the server are encrypted using the symmetric key encryption algorithm to prevent the records from unauthorised access. The patient id is generated and encrypted together with the patient’s medical records using a software called the Simulated Patient Data Software(SPDS) and can only be decrypted in the server using the encryption key only by authorised users. A survey type questionnaire and a face to face interview was conducted on the nurses and the patients of the Central Hospital Warri and a weighted average was used for the analysis. The Structured Systems Analysis and Design Method (SSADM), the Object Oriented Analysis and Design Method (OOADM) and prototyping were deployed to study, design and implement this simulation model. The software was developed in Java because of its web based features and its portability. The result of this research effort is the unobtrusive monitoring, evaluation and intelligent medical emergency detection of the blood pressure and pulse rate of patients in Nigerian hospitals and the notification of the medical personnel for immediate medical intervention. By this, continuous monitoring of these vital signs can be performed without interfering with the patients’ everyday activities or restricting their movement while protecting their medical records. This has the capacity of saving many lives of patients in our Nigerian hospitals that could have otherwise been lost. This thesis has heralded the ascendance of a functional telemedicine application in Nigeria.

CHAPTER 1

INTRODUCTION

1. Background of the Study

With the advancement of wireless technologies, wireless sensor networks can greatly expand our ability to monitor and track conditions of patients in the healthcare area. High performance and fault tolerant wireless devices can now be employed to eliminate medical errors,   reduce workload and increase the efficiency of hospital staff, and improve the comfort of patients. Thus, there has been increased interest among research groups in developing wireless recording and monitoring for real-time physiological parameters (e.g. Electrocardiogram (ECG), Electroencephalography (EEG), Electrooculography (EOG), Electromyography (EMG) Neural, Blood Flow, Blood Pressure, Pulse Rate etc.) from a patient’s body in medical environments . Existing wireless data collection systems use standards such as ZigBee (IEEE 802.15.4) or Bluetooth (IEEE 802.15.1). A Wireless Body Area Network (WBAN) based on a low cost wireless sensor network technology could greatly benefit patient monitoring    systems    in    hospitals,    residential    and    work     environments (Poon & Zhang, 2006).

A WBAN system allows easy internetworking with other devices and networks, thus offering health care worker easy access to patient’s critical and non-critical data. One of the main advantages of a WBAN is to monitor patients remotely using an intranet or the Internet. A WBAN could be seen as a special purpose wireless sensor network with a number of additional system design requirements. A WBAN is mostly likely to incorporate wearable and implantable node operating in two different frequencies. An implantable node is most likely to operate at 400 MHz using the Medical Implant Communications Service (MICS) medical band whereas the wearable node could operate in some other band.

Many patients can benefit from continuous monitoring as a part of a diagnostic procedure, optimal maintenance of a chronic condition or during supervised recovery from an acute disease or surgical procedure (Park & Jayaraman, 2003).

A Personal Area Network (PAN) or Body Area Network (BAN) can be achieved by integrating a vital sign monitoring sensor into a user’s clothing. This monitoring system is suitable for patients suffering from very chronic diseases such as stroke, diabetes, hypertension, etc because many of them will be practically immobile and therefore stationed in one place due to the seriousness of their ailment and in such a situation, there is need for a continuous unobtrusive monitoring of these vital signs. However, Body Area Network is unsuitable for lengthy, continuous monitoring, particularly during normal activity, intensive training or computer-assisted rehabilitation. Recent technology advances in wireless networking, micro-fabrication, and integration of physical sensors, embedded microcontrollers and radio interfaces on a single chip, promise a new generation of wireless sensors suitable for many applications. However, the existing telemetric devices either use wireless communication channels exclusively to transfer digitized data from sensors to the monitoring station, or use standard high-level wireless protocols such as Bluetooth or ZigBee to transfer the data to the monitoring devices. Simple, accurate means of monitoring daily activities outside of the laboratory are not available at the present, only estimates can be obtained from questionnaires, measures of heart rate, video assessment, and use of pedometers or accelerometers. Finally, records from individual monitoring sessions can be integrated into research databases that would provide support for data mining and knowledge discovery relevant to specific conditions and patient categories (Istepanian et al., 2004).

Increased system processing power allows sophisticated real-time data processing from the data acquired from the sensors. The results obtained from the systems can support biofeedback and generation of warnings. The use of biofeedback techniques has gained increased attention among researchers in the field of physical medicine and tele-rehabilitation. Intensive practice schedules have been shown to be important for

recovery of motor function. Unfortunately, an aggressive approach to rehabilitation involving extensive therapist-supervised motor training is not a realistic expectation in today’s health care system where individuals are typically seen as outpatients about twice a week for no longer than 30–45 min. Results from the Wireless Body Area Network (WBAN) technology and biofeedback systems appear to be a valid alternative, as they reduce the extensive time to set-up a patient before each session and require limited time involvement of physicians and therapists. Furthermore, WBAN technology could potentially address a second factor that hinders enthusiasm for rehabilitation, namely the fact that setting up a patient for the procedure is rather time-consuming. This is because tethered sensors need to be positioned on the subject, attached to the equipment, and a software application needs to be started before each session. WBAN technology allows sensors that will be positioned on the subject for prolonged periods, therefore eliminating the need to position them for every training session. Instead, a personal server such as a Personal Digital Assistant (PDA) can almost instantly initiate a new training session whenever the subject is ready and willing to exercise. In addition to home rehabilitation, this setting also may be beneficial in the clinical setting, where precious time of physicians and therapists could be saved. Moreover, the system can issue timely warnings or alarms to the patient, or to a specialized medical response service in the event of significant deviations of the norm or medical emergencies. However, as for all systems, regular, routine maintenance (verifying configuration and thresholds) by a specialist is required (Martin et al., 2000).

Typical examples of possible applications include stroke rehabilitation, physical rehabilitation after hip or knee surgeries, myocardial infarction rehabilitation, and traumatic brain injury rehabilitation. The assessment of the effectiveness of rehabilitation procedures has been limited to the laboratory setting; relatively little is known about rehabilitation in real-life situations. Miniature, wireless, Body Area Network (BAN) technology offers a tremendous opportunity to address this issue.

Several models of multiparametric monitors are networkable, i.e., they can send their output to a Central Intensive care Unit (CICU) monitoring station, where a single staff member can observe and respond to several bedside monitors simultaneously. Ambulatory telemetry can also be achieved by portable, battery-operated models which are carried by the patient and which transmit their data via a wireless data connection.

Persons requiring critical care; patients who have undergone surgery or persons with chronic ailments require continuous health monitoring and real-time feedback for immediate action in emergency situations. The patients would be subjected to discomfort and inconvenience due to prolonged hospitalization. Frequent visits to hospitals may also be required for follow up treatment and care. Use of Body Sensor Network can provide an alternative solution for remote monitoring of patients residing in the comfort of the homes. Patients can move about and follow their daily routine without the necessity of being confined to their beds. Data obtained over a long period of time in the patient’s natural environment would offer the doctors a better insight into the patient’s health condition and such data can be analyzed to arrive at the correct diagnosis and provide the right care (Park & Jayaraman, 2003).

Communication of health related information between sensors in BSN and the remote medical server has to be strictly private and confidential to protect patient privacy The sensor data sent using Internet and wireless transmission is prone to different types of attack such as eavesdropping, sending false values or replay of previous data. Medical professionals have to be certain that the data are not tampered in transit or at a point of origin as proper diagnosis requires accurate data.

The Internet of Things (IoT) which is the network of physical devices, vehicles, buildings and other items—embedded with electronics, software, sensors, actuators, and network connectivity enable these objects to collect and exchange data. In 2013 the Global Standards Initiative on Internet of Things (IoT-GSI) defined the IoT as “the infrastructure of the information society.” The IoT allows objects to be sensed and controlled remotely across existing network infrastructure, creating opportunities

for more direct integration of the physical world into computer-based systems, and resulting in improved efficiency, accuracy and economic benefit; when IoT is augmented with sensors and actuators, the technology becomes an instance of the more general class of cyber-physical systems, which also encompasses technologies such as smart grids, smart homes, intelligent transportation and smart cities. Each thing is uniquely identifiable through its embedded computing system but is able to interoperate within the existing Internet infrastructure.

In the internet of things (IoT), devices gather and share information directly with each other and the cloud, making it possible to collect, record and analyze new data streams faster and more accurately. That suggests all sorts of interesting possibilities across a range of industries: cars that sense wear and tear and self-schedule maintenance or trains that dynamically calculate and report projected arrival times to waiting passengers.

The internet of things (IoT) plays a significant role in healthcare applications where it can be used to manage chronic diseases and store patients’ medical records. Internet of things in remote medical monitoring offers great promise to patients because it can be used to monitor, track and store patients’ medical records in the cloud for easy access.

Remote medical monitoring of patients requires monitoring the physiological state of patients with acute or chronic conditions or chronic disease states which predominantly derive decided prognosis advantages from intensive condition tracking. More particularly, the invention is directed to a condition monitoring system which includes one or more remote modular testing units and a central station. The remote units include physiological parameter testing modules to acquire data from one or possibly many patients and communicate with a central station typically capable of interfacing with a large number of patient-operated units or clinician-operated units testing many patients. The central station, in turn, may interface and communicate with any number of other devices as by networking. Parameters checked may include but are not limited to blood pressure, pulse rate, blood oxygen saturation, weight, blood glucose, temperature, prothrombin (clotting) time and pulmonary function,

including respiratory rate and depth. Other functions, such as ECG (electrocardiograph) traces and infant breathing monitoring for detection of SIDS (sudden      infant      death      syndrome)      onset      are      also      contemplated (Park & Jayaraman, 2003)

A remote monitoring system operates with an instruction set to provide automated administration of health care to a patient. In a preferred embodiment of the invention a central monitoring station receives data from a plurality of patients connected with vital sign monitoring sensors which enter the queuing model from where the results are analysed and kept in the server. The doctor can view the server from anywhere to see the results of the patients’ vital signs. A particular patient’s graph can also be viewed by the doctor to see the progression of the patient’s vital signs readings. Medical procedures are then administered to the patient and results taken as data. The data is made available to the central monitor so that proper medical interpretation is enabled. A number of novel steps in the programming of the system are taken to assure that the right patient is being monitored, that the patient is being tested properly and that the system is being monitored appropriately.

Body network sensors have become wearable computing results from placing computers and sensors on the body to create a body area network (BAN) that can sense, process, and report on some set of the wearer’s attributes. Proactive computing and wearable computing working in tandem let computers fade into the woodwork, enriching quality of life and engendering independence.

1.2              Statement of the Problem

In a typical Nigerian hospital, the vital signs of patients are only checked by nurses on duty. The nurses check these vital signs two times a day and because the vital signs fluctuate throughout the day, a patient who was checked a while ago may have the vital signs deteriorate terribly after some time. The nurse having recorded the readings for that particular patient will not get to know except when the vital signs are checked again in the evening. This results in the avoidable death of the patients most of the time. Therefore, there is the need to have these patients (especially those suffering

from chronic diseases) monitored remotely and continuosly so that at every point in time, the readings of the different vital signs are taken and sent to a central location and anytime the reading becomes abnormal, the central location notifies the medical personnel immediately so that they can swing into action. This project is designed to have a continuous unobtrusive monitoring of the vital signs, have a real time medical interpretation and prescription and this will drastically reduce the mortality rate in Nigerian hospitals.

1.3              Objectives of the Study

The objective of this thesis is to develop a remote medical monitoring system that when fully deployed, will be capable of:

1. Simulating and monitoring the vital signs (such as blood pressure, and pulse rate) of patients with very chronic diseases like diabetes, hypertension, stroke, etc, based on known causes of abnormal blood pressure and pulse rate and send the results to the central location.
   1. Utilizing a Wireless Application Protocol (WAP) which can run on a Personal Digital Assistant (PDA), or smart phone based on the simulated data.
   1. Utilizing supplementary software in the server which collects these vital signs from a queuing model, analyse them, make predictions and recommendations and the doctor can view the patients’ records from anywhere and at anytime.
   1. Storing such records as archived documents for future reference by medical experts. These stored records can also be used in data mining.
   1. Producing report on medical failures and events which can be used for decision making by medical experts in their absence from the hospital.
   1. Ensuring that the data being transferred are adequately secured as they move between the patient and the medical personnel.

1.4              Significance of the Study

Many sick people in Nigeria today are in the remote areas where adequate health facility is not readily available. Some of these sick people do not necessarily need to be in the hospital environment in order to get treated.

Most of the time, some of these patients die due to lack of adequate care when these deaths can be avoidable. Part of the reason people die in hospitals is latency between ward visits, absence of medical personnel in critical situations for people who are sick of chronic diseases and no health care facilities for people in the remote areas. These avoidable deaths need to be stopped by deploying a technology that is dynamic and responsive to stimuli in the hospital rooms.

If this is not done, more Nigerians will die when such deaths are expected to be avoidable.

Loss of Nigerian citizens through causes that can be prevented is detestable. Any effort made to avert these avoidable deaths is to be lauded. This project if implemented will assist in saving many lives that would have been lost and will also extend health care services to people in the rural areas. It is for this reason that this dissertation is very significant.

1.5              Scope of the Study

1. This thesis is limited to the blood pressure and pulse rate monitoring which are two of the major vital signs of humans. There is also a particular interest in patients suffering from chronic diseases like diabetes, hypertension and stroke.
   1. This thesis produced a prototype Remote Medical Monitoring system using Central Hospital Warri as a case study. It is expected that this prototype when deployed in any other hospital with little or no amendment whether the hospital is a private or public one will be able to achieve similar results.

1.6              Limitations of the Study

The limitations of this thesis are as follows:

1. It was difficult getting a blood pressure and pulse rate monitoring device which can monitor the blood pressure and pulse rate and which can send the result to a mobile phone using Bluetooth. To overcome this limitation, the readings of the blood pressure and the pulse rate were simulated using a computer program.
   1. During the feasibility study, the nurses at the Central Hospital were not very supportive in divulging information about how the system work initially but after much persuasion, the nurses became friendly and volunteered reasonable information.

Remote Medical Monitoring is a new area in Nigeria, so it was not easy getting materials especially during the literature review.

1.7              Definition of Terms

1. Blood pressure

Blood pressure (BP) is a force exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum (systolic) and a minimum (diastolic) pressure (Klabunde, 2005). The mean BP, due to pumping by the heart and resistance in blood vessels, decreases as the circulating blood moves away from the heart through arteries. It has its greatest decrease in the small arteries and arterioles, and continues to decrease as the blood moves through the capillaries and back to the heart through veins. Gravity, valves in veins, and pumping from contraction of skeletal muscles, are some other influences on BP at various places in the body.

The term blood pressure usually refers to the pressure measured at a person’s upper arm. It is measured on the inside of an elbow at the brachial artery, which is the upper arm’s major blood vessel that carries blood away from the heart. A person’s BP is usually expressed in terms of the systolic pressure and diastolic pressure, for example 120/80, where 120 is the systolic pressure and 80 is the diastolic pressure.

ii.            Bluetooth

Bluetooth is a proprietary open wireless protocol for exchanging data over short distances (using short length radio waves) from fixed and mobile devices, creating personal area networks (PANs). It was originally conceived as a wireless alternative to RS-232 data cables (Stallings, 2005). It can connect several devices, overcoming problems of synchronization.

iii.            Body Area Network

WBAN or BAN, short for (Wireless) Body Area Network, consists of a set of mobile and compact intercommunicating sensors, either wearable or implanted into the human body, which monitor vital body parameters and movements.

These devices, communicating through wireless technologies, transmit data from the body to a home base station, from where the data can be forwarded to a hospital, clinic or elsewhere, real-time (Charles & Jeffrey, 2004).

iv.            Data Hub

In data communications, a hub is a place of convergence where data arrives from one or more directions and is forwarded out in one or more other directions. A hub usually includes a switch of some kind. (And a product that is called a “switch” could usually be considered a hub as well.) The distinction seems to be that the hub is the place where data comes together and the switch is what determines how and where data is forwarded from the place where data comes together.

v.            Electrocardiography

Electrocardiography (ECG or EKG from Greek: kardia, meaning heart) is a transthoracic (across the thorax or chest) interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the surface of the skin and recorded by a device external to the body. The recording produced by this noninvasive procedure is termed an electrocardiogram (ECG or EKG).

An ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker (Van Mieghem et al., 2004).

Most ECGs are performed for diagnostic or research purposes on human hearts, but may also be performed on animals, usually for diagnosis of heart abnormalities or research.

vi.            Electroencephalography (EEG)

Electroencephalography (EEG) is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain. In clinical contexts, EEG refers to the recording of the brain’s spontaneous electrical activity over a short period of time, usually 20–40 minutes, as recorded from multiple electrodes placed on the scalp. Diagnostic applications generally focus on the spectral content of EEG, that is, the type of neural oscillations that can be observed in EEG signals. In neurology, the main diagnostic application of EEG is in the case of epilepsy, as epileptic activity can create clear abnormalities on a standard EEG study. A secondary clinical use of EEG is in the diagnosis of coma, encephalopathies, and brain death. A third clinical use of EEG is for studies of sleep and sleep disorders where recordings are typically done for one full night,

sometimes more. EEG used to be a first-line method for the diagnosis of tumors, stroke and other focal brain disorders, but this use has decreased with the advent of anatomical imaging techniques with high (<1 mm) spatial resolution such as MRI and CT. Despite limited spatial resolution, EEG continues to be a valuable tool for research and diagnosis, especially when millisecond-range temporal resolution (not possible with CT or MRI) is required (Niedermeyer & Da Silva, 2004).

vii.            Electromyography (EMG)

Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, recruitment order or to analyze the biomechanics of human or animal movement (Kamen, 2004).

viii.            Electrooculography (EOG/E.O.G.)

Electrooculography (EOG/E.O.G.) is a technique for measuring the resting potential of the retina. The resulting signal is called the electrooculogram. The main applications are in ophthalmological diagnosis and in recording eye movements. Unlike the electroretinogram, the EOG does not represent the response to individual visual stimuli (Brown et al., 2006).

Eye movement measurements: Usually, pairs of electrodes are placed either above and below the eye or to the left and right of the eye. If the eye is moved from the center position towards one electrode, this electrode “sees” the positive side of the retina and the opposite electrode “sees” the negative side of the retina. Consequently, a potential difference occurs between the electrodes.

Assuming that the resting potential is constant, the recorded potential is a measure for the eye position.

ix.            General Packet Radio Service (GPRS)

General packet radio service (GPRS) is a packet oriented mobile data service on the second generation (2G) and third generation (3G) cellular communication systems global system for mobile communications (GSM). The service is available to users in over 200 countries worldwide. GPRS was originally standardized by European Telecommunications Standards Institute (ETSI) in response to the earlier CDPD and i-mode packet switched cellular technologies. It is now maintained by the 3rd Generation Partnership Project (3GPP).

x.            Global Positioning System (GPS)

The Global Positioning System (GPS) is a space-based global navigation satellite system that provides reliable location and time information in all weather and at all times and anywhere on or near the Earth when and where there is an unobstructed line of sight to four or more GPS satellites. It is maintained by the United States government and is freely accessible by anyone with a GPS receiver (Hoffmann-Wellenhof et al., 1994).

GPS consists of three parts: the space segment, the control segment, and the user segment. The U.S. Air Force develops, maintains, and operates the space and control segments. GPS satellites broadcast signals from space, which each GPS receiver uses to calculate its three-dimensional location (latitude, longitude, and altitude) plus the current time (Kaplan, 1996).

xi.            Pager

A pager is a small telecommunications device that receives (and, in some cases, transmits) alert signals and/or short messages. This type of device is convenient for people expecting telephone calls, but who are not near a telephone set to make or return calls immediately.

A typical one-way pager fits easily in a shirt pocket; some are as small as a wristwatch. A miniature, short-range wireless receiver captures a message, usually accompanied by a beep. (This is why the device is also known as a beeper). The simplest one-way pagers display the return-call telephone number of the person who sent the message. Alternatively, a code can be displayed that indicates which of several designated parties is requesting a return phone call. Sophisticated one-way pagers can display short text messages.

xii.            Personal Area Network

A personal area network (PAN) is a computer network used for communication among computer devices, including telephones and personal digital assistants, in proximity to an individual’s body. The devices may or may not belong to the person in question. The reach of a PAN is typically a few meters. PANs can be used for communication among the personal devices themselves (intrapersonal communication), or for connecting to a higher level network and the Internet (an uplink).

Personal area networks may be wired with computer buses such as USB and FireWire. A wireless personal area network (WPAN) can also be made possible with network technologies such as Infrared Data Association (IrDA), Bluetooth, Ultra-wide Band (UWB), Z-Wave and ZigBee (Charles & Jeffrey, 2004).

xiii.            Personal Digital Assistant

A personal digital assistant (PDA), also known as a palmtop computer, is a mobile device which functions as a Personal information manager and connects to the internet. The PDA has an electronic visual display enabling it to include

a web browser, but some newer models also have audio capabilities, enabling them to be used as mobile phones or portable media players (Viken, 2009). Many PDAs can access the internet, intranets or extranets via Wi-Fi, or Wireless Wide Area Networks (WWANs). Many PDAs employ touch screen technology.

xiv.            Pulse

The pulse is the physical expansion of the artery. Its rate is usually measured either at the wrist or the ankle and is recorded as beats per minute. The pulse commonly taken is the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at the opposite of the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse varies with age (Lauralee, 2006). A newborn or infant can have a heart rate of about 130-150 beats per minute. A toddler’s heart will beat about 100-120 times per minute, an older child’s heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere between 50 and 80 beats per minute.

xv.            Pulse oximetry

Pulse oximetry (or ~ oxymetry in the UK) is a non-invasive method allowing the monitoring of the oxygenation of a patient’s haemoglobin (Mower et al., 1997).

A sensor is placed on a thin part of the patient’s anatomy, usually a fingertip or earlobe, or in the case of a neonate, across a foot, and a light containing both red and infrared wavelengths is passed from one side to the other. Changing absorbance of each of the two wavelengths is measured, allowing determination of the absorbances due to the pulsing arterial blood alone,

excluding venous blood, skin, bone, muscle, fat, and (in most cases) fingernail polish. Based upon the ratio of changing absorbance of the red and infrared light caused by the difference in color between oxygen-bound (bright red) and oxygen unbound (dark red or blue, in severe cases) blood haemoglobin, a measure of oxygenation (the per cent of haemoglobin molecules bound with oxygen molecules) can be made (Mower et al., 1998).

xvi.            Radio

Radio is the transmission of signals by modulation of electromagnetic waves with frequencies below those of visible light. Electromagnetic radiation travels by means of oscillating electromagnetic fields that pass through the air and the vacuum of space. Information is carried by systematically changing (modulating) some property of the radiated waves, such as amplitude, frequency, phase, or pulse width. When radio waves pass an electrical conductor, the oscillating fields induce an alternating current in the conductor (Clint & Gervelis, 2003). This can be detected and transformed into sound or other signals that carry information.

xvii.             Respiratory rate

Varies with age, but the normal reference range for an adult is 12-20 breaths/minute The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value (Tortora & Anagnostakos, 1990).

xviii.             Satellite link

A satellite modem is not the only device needed to establish a communication channel. Other equipment that are essential for creating a satellite link include satellite antennas and frequency converters.

Data to be transmitted are transferred to a modem from Data terminal equipment (e.g. a computer). The modem usually has Intermediate frequency

(IF) output (that is, 50-200 MHz), however, sometimes the signal is modulated directly to L-band. In most cases frequency has to be converted using an up converter before amplification and transmission.

xix.            Satellite modem

A satellite modem or sat modem is a modem used to establish data transfers using a communications satellite as a relay.

There is a wide range of satellite modems from cheap devices for home internet access to expensive multifunctional equipment for enterprise use.

A “modem” stands for “modulator-demodulator”. A satellite modem’s main function is to transform an input bitstream to a radio signal and vice versa. There are some devices that include only a demodulator (and no modulator, thus only allowing data to be downloaded by satellite) that are also referred to as “satellite modems”. These devices are used in satellite Internet access (in this case uploaded data is transferred through a conventional Public Switched Telephone Network (PSTN) modem or an Asymetric Digital Subscriber Line (ADSL) modem).

xx.            Temperature

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions (Chang, 2004).

Temperature can be recorded in order to establish a baseline for the individual’s normal temperature for the site and measuring conditions. The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38.5°C or sustained temp > 38°C), or elevated significantly above the individuals normal temperature.

xxi.            The pill box

The ‘pill box’ helps keep track of the patient’s medication by sending a signal to his or her mobile phone every time a pill is removed. If a patient forgets to take medication or is taking too many pills, he or she is sent a reminder via mobile phone to follow the prescribed doses.

xxii.             The Weighted Average

A weighted average is an average that takes into account the proportional relevance of each component rather than treating each component equally.

It is an average in which each quantity to be averaged is assigned a weight. The weightings determine the relative importance of each quantity on the average (James, 2006). Weightings are the equivalent of having that many like items with the same value are involved in the average.

xxiii.             The wristband blood-pressure monitoring device

The wristband blood-pressure monitoring device can also check other vital signs such as heart rate, and is activated by simply pressing a button. Blood- pressure readings, for example, are gathered from one or more sensors via a Bluetooth short-range radio connection. Once transmitted, secure access ensures only authorised medical personnel see the patient’s data. If an unusual reading comes through, either a reminder can be sent to the patient to take his or her medication or a new prescription can be made, depending on the doctor’s diagnosis.

xxiv.             Transmission Control Protocol

The Transmission Control Protocol (TCP) is one of the core protocols of the Internet Protocol Suite. TCP is one of the two original components of the suite (the other being Internet Protocol, or IP), so the entire suite is commonly referred to as TCP/IP (Comer, 2006). Whereas IP handles lower-level transmissions from computer to computer as a message makes its way across

the Internet, TCP operates at a higher level, concerned only with the two end systems, for example a Web browser and a Web server.

xxv.            Very Small Aperture Terminal (VSAT)

A Very Small Aperture Terminal (VSAT), is a two-way satellite ground station or a stabilized maritime VSAT antenna with a dish antenna that is smaller than 3 meters. The majority of VSAT antennas range from 75 cm to 1.2 m. Data rates typically range from 56 Kbit/s up to 4 Mbit/s. VSATs access satellites in geosynchronous orbit to relay data from small remote earth stations (terminals) to other terminals (in mesh configurations) or master earth station “hubs” (in star configurations).

xxvi.             Vital signs

Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording Body temperature, Pulse rate (or heart rate), Blood pressure, and Respiratory rate, but may also include other measurements. Vital signs often vary by age.

The equipment needed are: a thermometer, a sphygmomanometer, and a watch. Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse (Gao, 2005).

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