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Hospital workers are highly mobile; they are constantly changing location to perform their daily work, which includes visiting patients, locating resources, such as medical records, or consulting with other specialists. The information required by these specialists is highly dependent on their location. Access to a patient's laboratory results might be more relevant when the physician is near the patient's bed and not elsewhere. We describe a location-aware medical information system that was developed to provide access to resources such as patient's records or the location of a medical specialist, based on the user's location. The system is based on a handheld computer which includes a trained backpropagation neural-network used to estimate the user's location and a client to access information from the hospital information system that is relevant to the user's current location.

ObjectiveTo assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults.DesignUnblinded, randomized, controlled trial.SettingInsured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.ParticipantsPatients were aged over 60 years with a frailty index score higher than 0.14.InterventionAfter screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.MeasurementsThe primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.ResultsThe framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group.Conclusion:An intervention based on NV+AB seems to have a positive effect on frailty scores.

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