Kerr L. White

The ecology of medical care

CURRENT discussions about medical care appear largely concerned with two questions: Is the burgeoning harvest of new knowledge fostered by immense public investment in medical research being delive...

Peer Review: Impact of a System Based on Billing Claims

Abstract To determine whether adjustment of billing claims made by a peer-review mechanism affects subsequent practice patterns, we examined the records of the San Joaquin Foundation for Medical Ca...

Primary medical care for families--organization and evaluation.

THE recent spate of reports on family medicine and family physicians documents the extent of public and professional concern with the problem of providing primary medical care for communities.1 2 3...

International comparisons of medical care utilization.

TO assess the influence of the organization and financing of health services on their utilization in general populations, it is desirable to choose contrasting regional or national systems. Before ...

Influence of emotional and physical stimuli on pressure in the isolated vein segment.

Generalized alterations in venous tone may shift large amounts of blood within the vascular system. Both physical and emotional stimuli are capable of affecting venous tone. The present report is a study in healthy males of the effects of certain of these factors on pressure (tone) in a peripheral vein segment isolated by means of specially designed, Plexiglas vein occluders. The emotional stimuli employed were the most effective of the group in increasing venous tone.

The incidence of psychogenic fever in a university hospital.

Abstract 1. 1. Previous limited studies of the incidence of psychogenic fever are reviewed. The charts of alternate first admissions to a university hospital were examined, and all patients with any possible organic or drug factors modifying their temperatures were excluded. 2. 2. The incidence of an initial temperature elevation of 0.8 ° F. or greater occurring immediately following first admission in patients without discernible cause for fever was found to be 3.6 per cent of all first admissions. The incidence of initial temperature elevation, as defined above, among all patients without discernible reason for fever was 27.2 per cent. The true incidence of this phenomenon is probably greater than 3.6 per cent and less than 27.2 per cent. 3. 3. The incidence on medicine and psychiatry was slightly higher i.e., 31.7 per cent and 29.9 per cent, respectively, and on the other services was lower, i.e., surgery, 21.4 per cent; obstetrics, 0.0 per cent and pediatrics, 17.9 per cent. The over-all proportion of first admissions to the hospital without discernible reasons for fever was 13.2 per cent, but on psychiatry this proportion was 47.2 per cent, and there were lower proportions on other services, i.e., medicine, 11.0 per cent, surgery, 9.2 per cent, obstetrics, 0.9 per cent, and pediatrics, 13.0 per cent. 4. 4. The incidence of an initial temperature elevation in patients without discernible reasons for fever among all first admissions to psychiatry was 14.4 per cent or four times greater than the incidence of this initial temperature elevation on all other services, i.e., medicine, 3.5 per cent, surgery 2.0 per cent, obstetrics, 0.0 per cent, pediatrics, 2.3 per cent, and for all first admissions, 3.6 per cent. Psychiatrists see more patients with an unexplained initial temperature elevation than do internists. 5. 5. The phenomenon of an initial unexplained temperature elevation is much more frequently observed in men in the age group 21 to 40 than in other population groups. 6. 6. The recognition of a characteristic spontaneous fall of temperature after a day or two in the hospital without evidence of organic disease or the administration of a drug should suggest the possibility that the patient has “psychogenic fever” and associated underlying emotional problems.

Behavioral Health: A Handbook of Health Enhancement and Disease Prevention

The Value of Preventive Medicine , edited by David Evered and Julie Whelan (Ciba Foundation Symposium 110, London, April 1984), 258 pp, with illus,

Technology and Health Care

35, London, Pitman Books Ltd, 1985. These two volumes represent long ( Behavioral Health ) and short ( The Value of Preventive Medicine ) versions of contemporary views on the relative efficacy, effectiveness, and costs of a wide variety of measures purported to promote health or ameliorate the ravages of age and disease. From their respective viewpoints, the collections cover about all that can plausibly be said on such subjects as cigarette smoking, diet, abuse of alcohol, safety, use of seat belts, exercise, weight control, rest and recreation, and their influence on psychological, physical, and social function. The long version has 146 contributors, largely from the behavioral sciences, in contrast to the short versions 25 contributors, largely epidemiologists and economists. Although their orientations differ, there is an overlap in the disciplines