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

Mott Transition in Quasi-One-Dimensional Systems

We report the application of the density-matrix renormalization group method to a spatially anisotropic two-dimensional Hubbard model at half-filling. We find a deconfinement transition induced by the transverse hopping parameter $t_y$ from an insulator to a metal. Therefore, if $t_y$ is fixed in the metallic phase, increasing the interaction $U$ leads to a metal-to-insulator transition at a finite critical $U$. This is in contrast to the weak-coupling Hartree-Fock theory which predicts a nesting induced antiferromagnetic insulator for any $U>0$.Comment: 4 pages, 3 figure

On the universality class of the Mott transition in two dimensions

We use the two-step density-matrix renormalization group method to elucidate the long-standing issue of the universality class of the Mott transition in the Hubbard model in two dimensions. We studied a spatially anisotropic two-dimensional Hubbard model with a non-perfectly nested Fermi surface at half-filling. We find that unlike the pure one-dimensional case where there is no metallic phase, the quasi one-dimensional modeldisplays a genuine metal-insulator transition at a finite value of the interaction. The critical exponent of the correlation length is found to be $\nu \approx 1.0$. This implies that the fermionic Mott transition, belongs to the universality class of the 2D Ising model. The Mott insulator is the 'ordered' phase whose order parameter is given by the density of singly occupied sites minus that of holes and doubly occupied sites.Comment: 9 pages, 8 figure

A Finite Size Scaling Study of Lattice Models in the three-dimensional Ising Universality Class

We simulate the spin-1/2 Ising model and the Blume-Capel model at various values of the parameter D on the simple cubic lattice. We perform a finite size scaling study of lattices of a linear size up to L=360 to obtain accurate estimates for critical exponents. We focus on values of D, where the amplitudes of leading corrections are small. Furthermore we employ improved observables that have a small amplitude of the leading correction. We obtain nu=0.63002(10), eta=0.03627(10) and omega=0.832(6). We compare our results with those obtained from previous Monte Carlo simulations and high temperature series expansions of lattice models, by using field theoretic methods and experiments.Comment: 25 pages, 6 figures, typos corrected, references added, conclusions extende

Patients' unvoiced agendas in general practice consultations.

Objective: To investigate patients' agendas before consultation and to assess which aspects of agendas are voiced in the consultation and the effects of unvoiced agendas on outcomes. Design: Qualitative study. Setting: 20 general practices in south east England and the West Midlands. Participants: 35 patients consulting 20 general practitioners in appointment and emergency surgeries. Results: Patients' agendas are complex and multifarious. Only four of 35 patients voiced all their agendas in consultation. Agenda items most commonly voiced were symptoms and requests for diagnoses and prescriptions. The most common unvoiced agenda items were: worries about possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context. Agenda items that were not raised in the consultation often led to specific problem outcomes (for example, major misunderstandings), unwanted prescriptions, non-use of prescriptions, and non-adherence to treatment. In all of the 14 consultations with problem outcomes at least one of the problems was related to an unvoiced agenda item. Conclusion: Patients have many needs and when these are not voiced they can not be addressed. Some of the poor outcomes in the case studies were related to unvoiced agenda items. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agenda

Misunderstandings in general practice prescribing decisions: a qualitative study

Objectives: To identify and describe misunderstandings between patients and doctors associated with prescribing decisions in general practice. Design: Qualitative study. Setting: 20 general practices in the West Midlands and south east England. Participants: 20 general practitioners and 35 consulting patients. Main outcome measures: Misunderstandings between patients and doctors that have potential or actual adverse consequences for taking medicine. Results: 14 categories of misunderstanding were identified relating to patient information unknown to the doctor, doctor information unknown to the patient, conflicting information, disagreement about attribution of side effects, failure of communication about doctor's decision, and relationship factors. All the misunderstandings were associated with lack of patients' participation in the consultation in terms of the voicing of expectations and preferences or the voicing of responses to doctors' decisions and actions. They were all associated with potential or actual adverse outcomes such as non-adherence to treatment. Many were based on inaccurate guesses and assumptions. In particular doctors seemed unaware of the relevance of patients' ideas about medicines for successful prescribing. Conclusions: Patients' participation in the consultation and the adverse consequences of lack of participation are important. The authors are developing an educational intervention that builds on these findings

Can the Heinrich ratio be used to predict harm from medication errors?

The purpose of this study was to establish whether, for medication errors, there exists a fixed Heinrich ratio between the number of incidents which did not result in harm, the number that caused minor harm, and the number that caused serious harm. If this were the case then it would be very useful in estimating any changes in harm following an intervention. Serious harm resulting from medication errors is relatively rare, so it can take a great deal of time and resource to detect a significant change. If the Heinrich ratio exists for medication errors, then it would be possible, and far easier, to measure the much more frequent number of incidents that did not result in harm and the extent to which they changed following an intervention; any reduction in harm could be extrapolated from this

Solving the puzzle of an unconventional phase transition for a 2d dimerized quantum Heisenberg model

Motivated by the indication of a new critical theory for the spin-1/2 Heisenberg model with a spatially staggered anisotropy on the square lattice as suggested in \cite{Wenzel08}, we re-investigate the phase transition of this model induced by dimerization using first principle Monte Carlo simulations. We focus on studying the finite-size scaling of $\rho_{s1} 2L$ and $\rho_{s2} 2L$, where $L$ stands for the spatial box size used in the simulations and $\rho_{si}$ with $i \in \{1,2\}$ is the spin-stiffness in the $i$-direction. Remarkably, while we do observe a large correction to scaling for the observable $\rho_{s1}2L$ as proposed in \cite{Fritz11}, the data for $\rho_{s2}2L$ exhibit a good scaling behavior without any indication of a large correction. As a consequence, we are able to obtain a numerical value for the critical exponent $\nu$ which is consistent with the known O(3) result with moderate computational effort. Specifically, the numerical value of $\nu$ we determine by fitting the data points of $\rho_{s2}2L$ to their expected scaling form is given by $\nu=0.7120(16)$, which agrees quantitatively with the most accurate known Monte Carlo O(3) result $\nu = 0.7112(5)$. Finally, while we can also obtain a result of $\nu$ from the observable second Binder ratio $Q_2$ which is consistent with $\nu=0.7112(5)$, the uncertainty of $\nu$ calculated from $Q_2$ is more than twice as large as that of $\nu$ determined from $\rho_{s2}2L$.Comment: 7 figures, 1 table; brief repor

Universal amplitude ratios in the 3D Ising Universality Class

We compute a number of universal amplitude ratios in the three-dimensional Ising universality class. To this end, we perform Monte Carlo simulations of the improved Blume-Capel model on the simple cubic lattice. For example, we obtain A_+/A_-=0.536(2) and C_+/C_-=4.713(7), where A_+- and C_+- are the amplitudes of the specific heat and the magnetic susceptibility, respectively. The subscripts + and - indicate the high and the low temperature phase, respectively. We compare our results with those obtained from previous Monte Carlo simulations, high and low temperature series expansions, field theoretic methods and experiments.Comment: 18 pages, two figures, typos corrected, discussion on finite size corrections extende