Featuring e-prescribing, CCHIT Certified(SM) e-MDs Solution Series v6.1 provides for secure and direct submission of new prescriptions, and can receive refill requests from pharmacies electronically. Patient portal allows timely communication between practices and their patients, speeding up workflow. Software features multiparty faxing through sophisticated fax server, and enhanced workflow automation that offers improved health summary, templating, and advanced case management.

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e-MDs Solution Series(TM) 6.1 Adds Valuable Features

AUSTIN, Texas, March 1 /- e-MDs, a leading provider of electronic health record and practice management software, announced today that it has completed its latest release of the award winning e-MDs Solution Series(TM). The CCHIT Certified(SM) Solution Series 6.1 delivers new highly requested features while enhancing many of the functionalities that make it the standard for affordable and integrated EHR and practice management software solutions.

“e-MDs Solution Series 6.1 continues our tradition of providing an integrated, easy-to-use solution, while adding exciting new features like e-prescribing, a patient portal PHR, more tools to help with quality compliance, improved enterprise faxing, and even more automation of office workflow and tasking to assist physicians in providing better care and simplifying their practices,” said Dr. David Winn, CEO of e-MDs.
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e-MDs Solution Series 6.1 includes the following new features and enhancements:

e-Prescribing through SureScripts[R]: Provides secure, fast and direct

submission of new prescriptions and the ability to receive refill

requests from pharmacies electronically, saving valuable staff time on

the phone or fax machine.

Patient Portal: Facilitates secure and timely communication between

practices and their patients, speeding up workflow and freeing up staff

and patients from repeated phone calls.

Easier Multi-Party Faxing: A more sophisticated fax server featuring a

more robust faxing interface that eases faxing to multiple parties.

Enhanced Workflow Automation: Improved health summary, better templating,

advanced case management, automated tasking and even more reporting

options help physicians’ practices become more productive.

About e-MDs

e-MDs is a leading developer of healthcare software solutions headquartered in Austin, Texas. e-MDs Solution Series(TM) is the standard for affordable and integrated EHR and PRACTICE MANAGEMENT software solutions, including clinical, financial, and document management modules designed to automate medical practice processes and chart management. Designed by physicians to improve care, reduce errors and simplify business so that time spent with patients is time billed and coded properly. With e-MDs, medical practices can visit, code and bill with a single application. For more information on e-MDs and the Solution Series, visit http://www.e-mds.com/ .

How far can strategic planning extend? How far can competitive advantage stretch? The correct answer is: pretty far. Healthcare organizations (HCOs) that have embraced information technology generally have done so across the board, with motivation that exceeds the noble–albeit typical–goals of providing quality patient care and maintaining financial health.

DeKalb Medical Center in DeKalb County, Ga., part of metropolitan Atlanta, is such a healthcare system. Senior management there wants the organization to be perceived locally and by employees as the kind of employer that qualified personnel work at, stay at and support with loyalty and performance. IT helps it succeed.

DeKalb Medical Center maintains what some HCOs would call a liberal policy when it comes to personal Internet use by employees. Every workstation in the enterprise, including PCs in public areas such as waiting rooms, connects to the Internet. DeKalb Medical Center considers it an employee benefit that employees are allowed to use enterprise PCs and access the Internet for personal interest, and wants to sustain that benefit as part of its retention and recruitment strategy. In return, the organization asks employees for moderation, judgment and propriety–and gets it.

The Internet as a Risk
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When Information Security Administrator Sharon Finney arrived at DeKalb Medical Center in August 2003, the HCO was knee-deep in finalizing compliance with HIPAA regulations and taking steps to identify where, when and by whom patient health information might be transmitted. The Internet was instantly identified as a formidable risk.

“We allow employees to access the Internet for personal use, as long as they are diligent and judicious,” says Finney. “We leave it to management of various departments to regulate. With that kind of policy, the organization needs the ability to monitor utilization, enforce policy, and report to and work with departmental managers if problems appear.” Early on, its capabilities in that arena were limited.

Initially, DeKalb Medical Center didn’t know what was moving across its Internet circuit. It didn’t know if protected health information was being transmitted; it didn’t know if files were being shared appropriately; it didn’t know if employees were buying shoes via home shopping networks.

Although the healthcare organization has more than 60 IT staff, the technical services personnel who support infrastructure and networking–and would have been responsible for in-house development of monitoring capability-numbered only seven, so the organization looked outward for help.

“We needed to buy a tool to help us monitor, filter, assess and, if necessary, control Internet usage,” says Finney. DeKalb Medical Center managers evaluated at least four products for the job and finally selected Vericept Healthcare Compliance and Vericept Filter for HIPAA compliance from Colorado-based Vericept. Finney says these were the only tools at the time they found that had all the necessary rules already embedded and would function, right out of the box, in a way the HCO wanted, but would also allow for subsequent customization.

Cost was another factor that helped ink the deal for Vericept. Because the technology was a new one for the organization, it wanted vendor support throughout implementation, and found Vericept included that support in what DeKalb Medical Center considered a competitive price. “They were very willing to work with us from a budgetary perspective,” says Finney.

Look and Learn

How does an organization that values diversity and wants to continue providing Internet access for employees nevertheless monitor, manage and control, and also prevent overuse or abuse?

The healthcare organization began by using its out-of-the-box solution for two months to monitor and learn. Finney says that while the organization didn’t see the inappropriate transmittal of any identifiable patient health information, what it did see enlightened management.

“Initially, we saw a considerable amount of pop-up adware and even spyware on desktops, causing an extreme (excessive) amount of Internet traffic. We also learned that employees were listening to the radio via Internet, which chewed up our bandwidth.” Equally important, she says, a number of employees weren’t Internet-saw, T and would enter substantial personal information on unsecured Web sites. They were unaware of how unprotected their data was, and they entered personal data via their keyboards as if they were sitting in a bank talking with a bank officer.

DeKalb Medical Center management initiated departmental meetings, and up to three times each month, Finney made security presentations at those meetings, describing the new system, monitoring capabilities, and appropriate types and levels of personal usage within the organization. She also described how individuals could safeguard their own data in personal Internet use.

The organization’s master plan was to use the Vericept products’ default settings with no modifications for 60 days while managers monitored and analyzed, and then to be able to customize the software for the HCO’s individual use.

As Doctor (Maj.) Steve Messier pushes through what was shaping up to be an 80-hour work week, his face looks understandably tired. But despite the long hours, the neonatology fellow at Wilford Hall Medical Center’s Neonatal Intensive Care Unit never fails to forget the needs of the premature babies surrounding him.

“You always have to keep in the back of your mind that even when things are going OK for them, something could go really wrong at any minute,” said Dr. Messier.

When things do go wrong, the unit’s talented hands, warm hearts and state-of-the-art equipment take fast action.

The normal gestation period for infants is 40 weeks, with births prior to 37 weeks considered premature. The survival rate for babies born between 27 and 30 weeks is 95 percent, but those rates drop with every decreased week of gestation. The NICU has helped children born as early as 23 weeks survive, but despite superb care that keeps preemie survival rates at WHMC on par with leading U.S. hospitals, sometimes a baby’s organs simply have not matured enough to function as would a healthy, full-term baby.

The NICU is a special place where the best technology has to offer unites with the best human beings have to offer–kindness, compassion and character.
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Equipment and emotions

One of the more remarkable technological capabilities the NICU offers is the Department of Defense’s only Extra-Corporeal Membrane Oxygenation machine, which provides life-saving heart-lung bypass. When combined with the airlift abilities of the Air Force, the NICU is uniquely qualified to save babies virtually anywhere in the world. In fact, that help goes well beyond the military family, extending to foreign families in remote locations. With the help of aircrews, they have saved the lives of children from as far off as Okinawa, Japan.

To date, more than 150 patients have been ECMO treated by the unit, 62 of them needing ECMO transport. Predicted survival rates of children without ECMO transport are at less than 20 percent, but when Airmen from this unit step in, those rates rocket to greater than 70 percent.

Technology is only part of what nurtures these babies to good health. As 1st Lt. Carla Sutton prepares to clean Gavin White’s tracheotomy tube, she caresses the soft wisps of hair on his head. His round rosy face reflects nothing but bliss as her gentle touch comforts him. Sometimes it seems as if the best medicine is a loving touch.

Gavin was born at only 28 weeks and suffers from a narrow airway, which will likely require the breathing tube and a ventilator for at least his first year. At two months old, he weighs well more than 4 pounds, a weight that looks almost hefty in a room of cribs with babies that sometimes weigh less than a can of Coke.

Gavin’s parents, Tech. Sgts. Marsha and Jeremiah White, glow with pride over their little boy as they watch him get bigger and healthier. The task of caring for children with such serious medical problems is one that requires eternal vigilance, and the Whites are grateful to have such a great staff watching over their baby.

Peace of mind

At a time when hundreds of thousands of military members are focusing on defeating enemies at home and abroad, the NICU goes to great lengths to ensure military families have piece of mind when their children or wives are at great risk of dying during or following birth.

That task–providing night and day care for an average of 17 “preemies”–is one that requires a gifted staff of more than 60 dedicated doctors, nurses and respiratory therapists, as well as many others. The staff enlists the help of parents as much as possible, allowing them to take their child’s temperature, change diapers or clean their mouths that often have tubes leading to their bellies and lungs. Parents yearning to touch their babies relish the responsibilities.

Victoria Sanford, 20, whose husband Brandon is a K-9 handler at Malmstrom Air Force Base, Mont., visits their baby girl Annissa at least three times a day. Annissa was born 11 weeks early and weighed only one pound, three ounces. Her weight has more than doubled after 51 days of loving care in the NICU.

The constant worry and stress over their baby’s health takes a toll on parents as they ride an emotional roller coaster. Experiencing feelings of helplessness when they learn of their child’s illnesses, parents find comfort knowing when such crises occur, this is the place to be.

“I will never stop worrying about her,” said Mrs. Sanford, “but I am so glad she’s here.”

Priceless Rewards

Though the staff normally wears blue scrubs, you’re reminded most of them are Airmen and Soldiers when you see the camouflaged battle dress uniforms clash with the peaceful setting where life is preserved and nurtured. As Nurse Michelle Barragan inserts a needle into the foot of a baby boy, he sobs and waives his tiny hands in the air.

“I’m sorry sweetie,” said the 34-year nurse, struggling to find a tiny vein. “It’s not without emotion, but you know the baby is going to get better because of it. We just give them a cuddle and blow them a kiss.”

Caption: SCRAPPING HIS SCRUBS: Famed cancer surgeon LaSalle D. Leffall Jr., M.D., is greeted by physicians, residents and staff of the Howard University Hospital in Washington, D.C., after he performed a marathon round of seven surgeries on his final day of surgery after more than 50 years. Leffall, also an author, lecturer, and educator, has taught more than 5,000 medical students who have graduated from the Howard University College of Medicine. He has also helped train more than 250 general surgery residents since 1962. A graduate of Howard’s College of Medicine, Leffall ranked first in his 1952 class and is currently the Charles R. Drew Professor of Surgery, a designation he received in 1992, which is the first endowed chair in Howard’s surgery department. During his illustrious career, Leffall, a native of Tallahassee, FL, has received several accolades, including honorary degrees from 11 institutions, and was the first Black president of many organizations, including the American Cancer Society and the Society of Surgical Oncology. Although the internationally-known physician is stepping down from his post, he will work in the hospital’s department of surgery along with his successor, Wayne Frederick, M.D., and will continue to teach at Howard. He and his wife, Ruthie, have one son.

Women always stop Latressa Fulton on the street to compliment her on her style. Her fashion trademark; interesting accessories that transform her classic wool pantsuits and jersey wrap dresses into unique looks. We asked the twentysomething medical-research coordinator and graduate student how she puts it all together.

Style influences: “My mother and godmother thought gloves should be worn to church, and that jeans were for hard labor only. Women in my family always dress. This has definitely affected my sensibility.”

Signature look: “I’m a girlie girl at heart. I don’t feel dressed unless I’m in heels. I love to accent basics with unusual color, texture or patterns, so my look is never predictable.”

Wardrobe staples: “Black suits, high-heeled leather boots, colorful blouses, pencil skirts, round-toe pumps. Also a good-looking bag to hold everything from school papers to makeup.”
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On her wish list: “A purple coat and tall white boots-sounds outrageous, I know. I probably won’t wear them together.”

Favorite places to shop: “I live in Loehmann’s and Banana Republic, and buy almost everything on sale. I pick up accessories when I travel. I’m still wearing jewelry I found years ago in Edinburgh, Barcelona, Cairo, Florence and Paris.”

Kenneth Cole leather tote with brass links, $298, (800) KEN-COLE.

[ILLUSTRATION OMITTED]

Liza Shtromberg rosewood bangle, $130, lizashtromberg.com.

[ILLUSTRATION OMITTED]

Fossil two-tone bracelet watch, $75, fossil.com.

[ILLUSTRATION OMITTED]

Miss Sixty wool coat, $549, Miss Sixty stores nationwide.

[ILLUSTRATION OMITTED]

Happy David for Bijux.com earrings, $65, bijux.com.

[ILLUSTRATION OMITTED]

New York & Company blouse, $37, (800) 853-2920.

[ILLUSTRATION OMITTED]

Ann Taylor wool crepe skirt, $98, (800) DIALANN.

[ILLUSTRATION OMITTED]

Aldo leather pumps, $150, aldoshoes.com.

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Moment by moment, a movie captures the action as a group of immune cells scrambles to counter an invasion of tuberculosis bacteria. Rushing to the site of infected lung tissue, the cells build a complex sphere of active immune cells, dead immune cells, lung tissue, and trapped bacteria. Remarkably, no lung tissue or bacterium was harmed in the making of this film.

Instead, each immune cell is a computer simulation, programmed to fight virtual tuberculosis bacteria on a square of simulated lung tissue. In their computer-generated environment, these warrior cells spontaneously build a structure similar to the granulomas that medical researchers have noted in human lungs fighting tuberculosis.

The simulation, created by Denise Kirschner of the University of Michigan in Ann Arbor, is an example of an emerging technique called agent-based modeling. This new tool in the world of medical research relies on computing power instead of tissues and test tubes. A growing cadre of researchers, including Kirschner, predicts that agent-based modeling will usher in a broadened understanding of complex interactions within the human body.

The agents in the models are individual players–immune cells in the tuberculosis example. Each player is programmed with rules that govern its behavior. Computer-savvy researchers then set the agents free to cooperate with, compete with, or kill each other. Meanwhile, the agents must navigate the surrounding environment, whose properties can vary over space and time.
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Scientists can manipulate disease progression within the models by changing the agents or their environment and then watching what happens. As opposed to traditional, biologically based in vivo or in vitro experiments, these computer trials are dubbed “in silico.” The results can suggest biological experiments to test the models’ findings and may eventually lead to new medical treatments.

Even simple rules assigned to agents can give rise to surprisingly complex behaviors. When many independent agents interact, they create phenomena–such as the granulomas–that can’t necessarily be predicted by breaking down the system into its separate components, says complex-systems specialist John Holland of the University of Michigan.

You’ve got to study the interactions as well as the parts,” Holland says.

In-silico modeling differs from traditional mathematical modeling, which uses differential equations to understand how molecules or cells behave in an averaged, continuous way. Instead, the agents of in-silico modeling make independent decisions in response to situations that they encounter. As a result, unusual activity of even a small number of cells can change the entire system’s behavior.

Computers can now calculate thousands of interactions with ease, says Alan Perelson of Los Alamos National Laboratory in New Mexico. “Agent-based modeling has only come into its own with the arrival of really powerful computers sitting on people’s desktops, within the last 10 or 15 years,” he notes.

Pioneered for economics and population-dynamics studies (SN: 11/23/96, p. 332; www.sciencenews.org/pages/ sn_arc99/4_10_99/mathland.htm), agent-based modeling has only recently plumbed the inner workings of the human body, Perelson adds. That’s partly because new imaging and genetic techniques are providing crucial data on which agents’ rules can be based.

“Agent-based modeling represents a new frontier with respect to how we do science,” says surgeon Gary An of Cook County Hospital in Chicago. “In medicine in particular, all the diseases that we’re now dealing with are complex problems: sepsis, cancer, AIDS. All these things are disorders of the system as a whole.”

INFLAMMATION SIMULATION An, whom Kirschner calls an in-silico “groundbreaker,” got into agent-based modeling to help people survive traumatic injuries and major infections.

A leading cause of death for patients in intensive care units, An explains, is a syndrome called systemic inflammatory response syndrome/multiple organ failure (SIRS/MOF), also termed sepsis when it occurs in response to an infection. In this syndrome, the body’s inflammatory response rages out of control after a severe injury or bacterial infection. Excessive inflammation can kill a patient by attacking and shutting down vital organs. More commonly, the runaway inflammation paralyzes the rest of the immune response, and the patient then dies of secondary infections.

During the 1990s, researchers performed clinical experiments in an attempt to develop drugs that dampen an overwhelming inflammatory response to injury, An notes. Only one drug, activated protein C, appeared to help patients with SIRS/MOF. An suggests that trials of other drugs failed because they were planned using data representing individual components of the inflammatory response rather than the interactions of the immune system as a whole.

An says, “It’s kind of a Humpty Dumpty syndrome, where after you break the system apart, you can’t put it back together.”

R864

2004-013530

0-7637-2759-8

The medical record as a forensic resource.

Quinn, Campion.

Jones & Bartlett, [c]2005
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277 p.

$47.95 (pa)

Quinn, a physician with expertise in both writing and reviewing medical records, explains what a medical record is, what it should contain, how to acquire, review, and report on the content, and how to extract relevant information for forensic investigations. He also addresses the nature of personal injury and malpractice cases, and the admissibility of the medical chart as evidence. Material is in detailed question-and-answer format with many examples and checklists. The book will be of use to those in the legal field and to health care professionals such as legal nurse consultants.

Dates in Medicine. A chronological record of medical progress over three millennia Ed Anton Sebastian

Parthenon Publishing, 35 [pounds sterling], pp 435 ISBN 1 85070 095

Rating: 0

Quite apart from the Millennium Dome, our daft obsession with a date containing three zeros has a lot to answer for–including these two books, which have been “inspired” by the millennium. The Medical Millennium consists of 1000 names in alphabetical order from Peter of Abano (1250-1316) to Yvunge Zotterman (1898-1982), who wrote an autobiography called Touch, Tickle and Pain. For each name, dates of birth and death are given, followed by a potted biography of 20-30 words. Having to find 1000 names has led to there being some unlikely people included, and the book would have been much better with fewer names and longer entries. However, most of the entries are sensibly written, and there seem to be few mistakes–apart from James Harvey for William Harvey in the foreword, which was presumably just a slip of the pen.

Neither of these books can possibly give any sense of historical change if read through from beginning to end. They can be judged only as works of reference. If you want a very brief guide to the great and the good in medicine, Lee’s book will do.
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Sebastian’s book (which, in spite of the subtitle, starts in 8000 BC) is another matter. It contains about 6000 entries, each of about 30 words, arranged in chronological order. You would think that the compiler of this enormous list would have entered people by the year or years in which their observation or discovery was made. Instead, most are entered simply by their date of birth. Semmelweis, for instance, is associated with 1847, the year when he introduced antisepsis by chlorine washings to prevent puerperal fever. Here, the sole entry for Semmelweis comes at his date of birth, 1818, where he is incorrectly said to have introduced asepsis when “doctors washed their hands” Lister introduced surgical antisepsis in the 1860s, but you will find nothing about him or his work unless you know that he was born in 1827. If you had made an important medical discovery in 1970 when you were 40 years old, would you have been surprised to see that this was entered in 1930? I would, and Sir David Weatherall may well be surprised to find himself included in this chronology in 1933, when he was born.

This system means that it is impossible to scan any historical period to learn what was going on in medicine. To make matters worse, the system is inconsistent. Edward Jenner is entered at 1796, the year when he first performed vaccination. Waksman, who discovered streptomycin, is entered at 1952, when he received the Nobel prize. William Harvey is entered three times–once for his date of birth and twice more for the dates of publication of his two famous treatises, leading to repetition. Alexander Fleming appears twice–once for his date of birth 1881 and again with the discovery of penicillin, which is given as 1928 in one entry and 1929 in the other.

Any reference work such as a chronology must be easy to use and as accurate as possible. This book is not only extremely difficult to use but contains many errors and anachronisms as well as trivial entries. What, for example, is one to make of an entry in 1647 recording the birth of Denis Papin, who apparently invented a steam digester to dissolve bones, or Gustav Michaelis (born 1798), who “described the diamond-shaped area over the aspect of the pelvis bounded by the dimples of the posterior iliac spines”? Most of the errors might be considered minor, but there are enough to destroy confidence. A pneumonectomy was not performed in 1951 on King George IV. Wrong king. It was the Royal College of Surgeons of London, not England, that was founded in 1800, and not, as given here, in 1799. The Royal College of Obstetricians and Gynaecologists is entered at 1937, when it received its Royal Charter, but the date when it was founded (1929) is not included. The first endowed chair in anaesthesiology in the world was not at Harvard in 1941 but at Oxford in 1936. This is only a small sample of errors, but the eccentric and inconsistent way in which this chronology was constructed means it cannot be recommended.

Ratings are on a 4 star scale, 4=excellent

Irvine Loudon medical historian, Wantage

The BMJ Bookshop will endeavour to obtain any books reviewed here. To order contact the BMJ Bookshop, BMA House, Tavistock Square, London WC1H 9JR. Tel: 020 7383 6244, Fax: 020 7383 6455 email: orders@bmjbookshop.com Online: bmjbookshop.com (Prices and availability subject to change by publishers.)

TORONTO — Ontario Superior Court Justice John Ferrier ordered the Ontario government to continue paying for treatment for two children diagnosed with Autism Spectrum Disorder. He said the delay in treatment between now and an expected court decision next fall “could result in irreversible losses” for the two boys.

Judge Ferrier ordered the payment of treatment for the two boys despite a Supreme Court landmark decision issued last fall and known as Auton. In that decision, the Court refused to order the British Columbia government to provide treatment for a child with autism, saying the province has the right to determine which health care programs it will provide.

However, in his judgement, Justice Ferrier said despite the Supreme Court’s argument regarding the provision of health services and “notwithstanding Auton, serious issues remain which should be determined at a trial, whether the benefit claimed is medical in nature or a question of access to education,” as the lawyers for the two boys had argued.

His order also remains in effect until at least the fall, when it is expected that a ruling will be made in a major treatment for autism case known as Wynberg, which involves the question ot whether it is constitutional for the province to eliminate funding for treatment for children with autism once they turn six years of age.
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Unlike the Supreme Court, Justice Ferrier praised the treatment for autism, saying if the “ABA treatment is reduced or withdrawn, they will experience significant harm.”

The Bettencourt case, like the several other cases currently before the courts, was caused when funding for treatment for autism, called Intensive Behavioural Intervention or Applied Behavioural Analysis, was stopped because the twin boys had reached the age of six years.

When the treatment for the boys was cut off, the Bettencourts tried to continue the costly treatment by paying for it themselves, including mortgaging their home, but have since run into financial hardship. As well, there was an unsuccessful attempt to integrate the twins into the public school system, but both boys were unable to continue attending the school either wholly or partially because the school system was unprepared to deal with their special requirements and treatment needs.

The judge noted that both boys had made significant gains under the treatment, and stressed that the public school had neither the resources nor the training to allow the boys to learn in the school, but with treatment the boys are able to learn.

It’s bad enough to be a patient in a hospital. What’s worse, according to a team of British researchers, is that a substantial minority of medical patients is legally incompetent to make decisions about their treatment, yet their physicians often overlook this limitation.

Over an 18-month period, about one-third of a predominantly elderly group of people treated at a London hospital for at least 2 days exhibited an inability to understand the treatment decisions that they faced, say psychiatrist Matthew Hotopf of the Institute of Psychiatry in London and his colleagues. Yet physicians taking care of these patients rated only a small number of them as mentally incapacitated.

“More should be done to protect the interests of … the high proportion of medical patients who are treated without being able to give valid consent,” the investigators conclude.

In particular, physicians need to assess and document mental capacity in elderly patients facing critical health decisions, in Hotopf’s view. Such choices include a patient’s acceptance of placement in a nursing home and whether he or she wants physicians to withhold treatment under certain circumstances.
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The new study appears in the Oct. 16 Lancet.

Hotopf’s team considered 302 patients consecutively admitted mainly for acute heart, lung, or neurological disorders. None of them suffered from a progressive brain condition, such as Alzheimer’s disease.

Of the patients, 72 exhibited cognitive problems too severe to join the study. Another 71 refused to participate or were unable to speak English.

Researchers conducted standardized interviews with the remaining 159 patients to determine their medical-decision-making capacities. Interviews focused on the extent to which a person understood his or her disorder and its treatment, knowledge of how a treatment would affect his or her life, and the ability to compare alternative medical choices before picking an option.

Decision-making incapacity characterized 50 patients, or 31 percent of those interviewed. Only 12 patients, however, were rated by treating clinicians as unable to make informed decisions.

Of the 109 patients that the researchers characterized as mentally competent, none was tagged by doctors as mentally incapacitated.

Psychiatric disorders were rare in both groups.

The most troubling result, Hotopf contends, was the tendency of incapacitated persons to trust in physicians who failed to recognize or address those patients’ decision-making deficiencies.

The new findings don’t apply to all medical patients. For instance, an earlier study using the same standardized interviews with 82 people being treated for chronic ischemic heart disease in three U.S. hospitals found that nearly all of them possessed decision-making competence. That study, directed by Paul S. Appelbaum and Thomas Grisso, both of the University of Massachusetts Medical School in Worcester, included mainly middle-aged patients rather than elderly ones.

Further research needs to examine whether researchers, clinicians, and families, given the same interview information, agree on patients’ competency, remarks geriatric physician Jason H.T. Karlawish of the University of Pennsylvania in Philadelphia.

STATS

1 in 3

Proportion of accurately ill patients at a British hospital rated as unable to make informed treatment decisions