Internal medicine curriculum reform.
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Biomedical subjects
Publications and source records attributed to J A Margolis.
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Age differences were examined in 4 aspects of visual mental imagery, namely, image generation, maintenance, scanning, and rotation. The results suggested that one or more distinct processes are used to carry out each aspect of imagery, and that this is true for 5-year-olds, 8-year-olds, 14-year-olds, and adults. There was no evidence that younger children have fewer processing components, which become differentiated into more specialized subsystems over age. In addition, the results suggested that younger children are relatively poor at scanning, rotating, and generating objects in images, but are relatively good at maintaining images.
Physicians' Current Procedural Terminology (CPT) is the system most commonly recognized by third-party payers for describing medical services in numerical codes for subsequent reimbursement. Adequate description of psychiatric services using CPT codes is an ongoing challenge. Psychiatrists have responded to the demands of third-party payers and peer review organizations for documentation and accountability by billing for specific services rather than by designating all care as psychotherapy. The authors present guidelines for using CPT codes to describe inpatient and outpatient psychiatric services and consultation. They also discuss continuing controversies, including regional diversity in the interpretation of codes by third-party payers, the risks of "gaming" the coding process, and the use of CPT codes by non-physician providers and the consequent mixing of data on service charges.
The authors describe a nine-year collaboration between the American Psychiatric Association and CHAMPUS to ensure quality psychiatric treatment in residential treatment centers ( RTCs ). After discussing the development of RTCs and the effects of early peer review, the authors detail the development of the APA/ CHAMPUS peer review project. During the first five months of the project the reviewers found that RTC care under CHAMPUS was usually necessary and of adequate quality; however, the reviewers found limited medical presence and insufficient documentation at some centers. The authors endorse continued review by the APA/ CHAMPUS peer review project to ensure the appropriate utilization of RTC care.
A man thought to have a dissecting aortic aneurysm was found to have an oat cell carcinoma encasing the thoracic aorta and great vessels. This is the first reported association of pseudoaneurysm with an oat cell carcinoma and is only the third case of a tumor presenting as a pseudoaneurysm. False-positive or false-negative results of aortography, echocardiography, and thoracic CT scanning point out the shortcomings of modern, sophisticated laboratory and radiographic procedures.
The author describes his role as the only child psychiatrist member of a psychiatric peer review committee in a medical care foundation. In addition to working with hist colleagues on general review and health-policy matters, he also handled issues related to the special needs of children and helped to get third-party benefit packages altered to better suit the treatment needs of children. He offers recommendations to those interested in joining a peer review committee and emphasizes the need for child psychiatrists to work together not only with general psychiatrists but also with pediatricians, psychologists, and social workers to see that high-quality care is available and provided.
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