We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in England

In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital

Influence of Islam on smoking among Muslims

Smoking prevalence is generally high among Muslims. An awareness of their religious beliefs and rulings might increase the effectiveness of antismoking campaign

Methodological reflections on the evaluation of the implementation and adoption of national electronic health record systems

Copyright @ 2012, International Journal of Integrated Care (IJIC). This work is licensed under a (http://creativecommons.org/licenses/by/3.0) Creative Commons Attribution 3.0 Unported License.Introduction/purpose of presentation: Far-reaching policy commitments to information technology-centered transformations of healthcare systems have now been made in many countries. There is as yet little empirical evidence to justify such decisions, hence the need for rigorous independent evaluation of current implementation efforts. Such evaluations however pose a number of important challenges. This presentation has been designed as a part of a Panel based on our experience of evaluating the National Health Service’s (NHS) implementation of electronic health records (EHR) systems in hospitals throughout England. We discuss the methodological challenges encountered in planning and undertaking an evaluation of a program of this scale and reflect on why and how we adapted our evaluation approach—both conceptually and methodologically—in response to these challenges. Study design/population studied: Critical reflections on a multi-disciplinary and multi-facet independent evaluation of a national program to implement electronic health record systems into 12 ‘early wave’ NHS hospitals in England. Findings: Our initial plan was to employ a mixed methods longitudinal ‘before-during-after’ study design. We however found this unsustainable in the light of fluxes in policy, contractual issues and over-optimistic schedules for EHR deployments. More importantly, this research design failed adequately to address the core of multi-faceted evolving EHRs as understood by key stakeholders and as worked out in their distinct work settings. Thus conventional outcomes-centric evaluations may not easily scale-up when evaluating transformational programs and may indeed prove misleading. New assumptions concerning the implementation process of EHR need to be developed that recognize the constantly changing milieu of policy, product, projects and professions that are inherent to such national implementations. The approaches we subsequently developed substitute the positivist view that EHR initiatives are self-evident and self-contained interventions, which are amenable to traditional quantitative evaluations, to one that focuses on how they are understood by various stakeholders and made to work in specific contexts. These assumptions recast the role of evaluation towards an approach that explores and interprets processes of socio-technical change that surround EHR implementation and adoption as seen by multiple stakeholders. Conclusions and policy implications: There is likely to be an increase in politically-driven national programs of reform of healthcare based on information and communication technologies. Programs on such a scale are inherently complex with extended temporalities and extensive and dynamic sets of stakeholders. They are, in short, different and pose new evaluation challenges that previously formulated evaluation methods for health information systems cannot easily address. This calls for methodological innovation amongst research teams and their supporting bodies. We argue that evaluation of such system-wide transformation programs are likely to demand both breadth and depth of experience within a multidisciplinary research team, constant questioning of what is and what can be evaluated and how, and a particular way of working that emphasizes continuous dialogue and reflexivity. Making this transition is essential to enable evaluations that can usefully inform policy-making. Health policy experts urgently need to reassess the evaluation strategies they employ as they come to address national policies for system-wide transformation based on new electronic health infrastructures

Nearing Extremal Intersecting Giants and New Decoupled Sectors in N = 4 SYM

We study near-horizon limits of near-extremal charged black hole solutions to five-dimensional $U(1)^3$ gauged supergravity carrying two charges, extending the recent work of Balasubramanian et.al. We show that there are two near-horizon decoupling limits for the near-extremal black holes, one corresponding to the near-BPS case and the other for the far from BPS case. Both of these limits are only defined on the 10d IIB uplift of the 5d black holes, resulting in a decoupled geometry with a six-dimensional part (conformal to) a rotating BTZ X $S^3$. We study various aspects of these decoupling limits both from the gravity side and the dual field theory side. For the latter we argue that there should be two different, but equivalent, dual gauge theory descriptions, one in terms of the 2d CFT's dual to the rotating BTZ and the other as certain large R-charge sectors of d=4,N =4 U(N) SYM theory. We discuss new BMN-type sectors of the N=4 SYM in the $N\to\infty$ limit in which the engineering dimensions scale as $N^{3/2}$ (for the near-BPS case) and as $N^2$ (for the far from BPS case).Comment: 44 pages, references added, minor change

Tensor model and dynamical generation of commutative nonassociative fuzzy spaces

Rank-three tensor model may be regarded as theory of dynamical fuzzy spaces, because a fuzzy space is defined by a three-index coefficient of the product between functions on it, f_a*f_b=C_ab^cf_c. In this paper, this previous proposal is applied to dynamical generation of commutative nonassociative fuzzy spaces. It is numerically shown that fuzzy flat torus and fuzzy spheres of various dimensions are classical solutions of the rank-three tensor model. Since these solutions are obtained for the same coupling constants of the tensor model, the cosmological constant and the dimensions are not fundamental but can be regarded as dynamical quantities. The symmetry of the model under the general linear transformation can be identified with a fuzzy analog of the general coordinate transformation symmetry in general relativity. This symmetry of the tensor model is broken at the classical solutions. This feature may make the model to be a concrete finite setting for applying the old idea of obtaining gravity as Nambu-Goldstone fields of the spontaneous breaking of the local translational symmetry.Comment: Adding discussions on effective geometry, a note added, four references added, other minor changes, 27 pages, 17 figure

Hepatic encephalopathy: a critical current review.

Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of cirrhosis and/or porto-systemic shunting. The clinical symptoms are widely variable, extending from subtle impairment in mental state to coma. The utility of categorizing the severity of HE accurately and efficiently serves not only to provide practical functional information about the current clinical status of the patient but also gives valuable prognostic information. In the past 20-30 years, there has been rapid progress in understanding the pathophysiological basis of HE; however, the lack of direct correlation between pathogenic factors and the severity of HE make it difficult to select appropriate therapy for HE patients. In this review, we will discuss the classification system and its limitations, the neuropsychometric assessments and their challenges, as well as the present knowledge on the pathophysiological mechanisms. Despite the many prevalent hypotheses around the pathogenesis of the disease, most treatments focus on targeting and lowering the accumulation of ammonia as well as inflammation. However, treatment of minimal HE remains a huge unmet need and a big concerted effort is needed to better define this condition to allow the development of new therapies. We review the currently available therapies and future approaches to treat HE as well as the scientific and clinical data that support their effectiveness

Temperature-induced pair correlations in clusters and nuclei

The pair correlations in mesoscopic systems such as $nm$-size superconducting clusters and nuclei are studied at finite temperature for the canonical ensemble of fermions in model spaces with a fixed particle number: i) a degenerate spherical shell (strong coupling limit), ii) an equidistantly spaced deformed shell (weak coupling limit). It is shown that after the destruction of the pair correlations at T=0 by a strong magnetic field or rapid rotation, heating can bring them back. This phenomenon is a consequence of the fixed number of fermions in the canonical ensemble