Clinical Issues in the Assessment of Competency.

The evaluation of a patient's competency to consent to treatment, regardless of the test of competency used, can be substantially affected by a number of clinical factors. The authors point out that, in assessing competency, the clinician must consider 1) psychodynamic elements of the patient's personality, 2) the accuracy of the historical information conveyed by the patient, 3) the accuracy and completeness of the information disclosed to the patient, 4) the stability of the patient's mental status over time, and 5) the effect of the setting in which consent is obtained. Inattention to these factors can lead to errors in assessment of competency that can have important implications for patient care. Reprinted from Am J Psychiatry 1981; 138:1462-1467, with permission from American Psychiatric Association Publishing. Copyright © 1981.

The Classification of Violence Risk.

(Reprinted with permission from Behav. Sci. Law 24: 721-730, 2006).

PrepLink: a novel web-based tool for healthcare emergency planning and response.

Effective planning and response to bioterrorism or other disasters, natural or manmade, requires timely and effective communication as well as situational awareness. During a catastrophic event, decision makers--including first responders, hospital workers, and command center emergency workers--will have a short time to make crucial decisions. Preparing to receive and treat patients, especially when there are mass casualties, requires immediate access to large amounts of integrated health data from disparate sources. This article describes PrepLink, a novel comprehensive web-based healthcare-related all-hazards electronic disaster management system. Over the past 3 years, PrepLink has been developed and tested at the University of Pittsburgh Medical Center in partnership with the Pennsylvania National Guard. It can be deployed in multiple sites across a region or state or more broadly. The system includes pages for public awareness about planning for and responding to disasters, as well as secure, password-protected private pages that can be used by many types of emergency and healthcare personnel who are involved in such events. Timely information related to public health, safety, planning, preparation, and response can be accessed from both sets of pages. The system permits rapid communication and sharing of team plans across disparate locations; it stores multiple key documents and contains asset inventories, a GIS, patient tracking, and a command-and-control module. Each function is directly related to providing healthcare treatment for victims. PrepLink's comprehensive and user friendly approach to health-related disaster management holds promise for future progress in this challenging arena.

The relationship between the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center--a profile in synergy.

In the synergistic evolution of their research, educational, and clinical programs, the University of Pittsburgh (Pitt) School of Medicine (SOM) and the University of Pittsburgh Medical Center (UPMC) have followed one core principle: What is good for one is good for both. The collaboration is underpinned by UPMC's commitment to its community mission, including support for the academic and research objectives of the SOM. UPMC's conceptual origin was fostered by its experience with Western Psychiatric Institute and Clinic in the 1970s. Over time, UPMC acquired other hospitals through merger and negotiation and, by 2008, had grown into a $7 billion global health enterprise. From the outset, the senior leaders of both UPMC and Pitt committed to collaborative decision making on all key issues. Under this coordinated decision-making model, UPMC oversees all clinical activity, including that from a consolidated physicians' practice plan. Pitt remains the guardian of all academic priorities, particularly faculty-based research. UPMC's steady financial success underpins the model. A series of interrelated agreements formally defines the relationship between Pitt and UPMC, including shared board seats and UPMC's committed ongoing financial support of the SOM. In addition, the two institutions have jointly made research growth a priority. The payoff from this dynamic has been a steadily growing Pitt research portfolio; enhanced growth, visibility, and stature for UPMC, the SOM, and Pitt as a whole; and the sustained success of UPMC's clinical enterprise, which now has an international scope. Given the current stagnation in the National Institutes of Health budget, the Pitt-UPMC experience may be instructive to other academic health centers.

The classification of violence risk.

The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.