Tracy L. Veach

A novel stress and coping workplace program reduces illness and healthcare utilization.

Objective The purpose of this study was to determine if a novel workplace stress management program, delivered either face-to-face or by self-help, would reduce illness and health services utilization among participants. Methods Five hundred one volunteers were randomly allocated to one of three groups: full intervention, which received assessment and personalized self-study feedback and was offered six face-to-face, small-group sessions; partial intervention, a self-help group that received assessment and personalized feedback by mail; and a wait-list control group. All participants completed questionnaires for stress, anxiety, and coping at the start of the study and 6 and 12 months later. Health reports were completed at 0, 3, 6, 9, and 12 months. A subsample of subjects who subscribed to a single health maintenance organization provided objectively recorded doctor visit data across the study year. Results All three groups reported significant improvement in their stress, anxiety, and coping across the year. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. Objectively measured physician visits showed a large (34%) reduction in healthcare utilization for full intervention subjects in the HMO subsample. Conclusions These results indicated that a work-site program that focuses on stress, anxiety, and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization.

Web-Based Learning Versus Standardized Patients For Teaching Clinical Diagnosis: A Randomized, Controlled, Crossover Trial

Background: Little evidence exists to guide the selection of methods for teaching clinical diagnosis. Purpose: To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students. Methods: Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost. Results: Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p =. 17) and Headache checklist (56% vs. 63%; p =. 07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p =. 006), but not the Headache SOAP note (69% vs. 67%; p =. 85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at

Boolean Search Experience and Abilities of Medical Students and Practicing Physicians

2,190 for the SP format and

Prevalence of Substance Abuse and Smoking in a University Family Practice Setting

2,250 for the WB format. Ongoing costs per case per student were estimated to be

Effects of prior information and initial attitude on susceptibility to emotional appeals

45 for the SP format and

Personality correlates of accurate time perception.

30 for the WB format. Conclusions: WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.

A pluralistic explanation of choice shifts on the risk dimension.

Background: Little is known about physician ability to utilize Boolean search skills to access information. Purpose: Determine the proficiency of medical students and practicing physicians to identify efficient Boolean phrases. Methods: Experiential survey and multiple-choice questions administered to 49 4th-year medical students and 42 practicing physicians. Subjects identified the best answer or correctly ranked 3 Boolean search phrase options. Results: Practicing physicians identified the single best query phrase significantly more often than did medical students (85.7% vs. 75.0%, p < 0.001), and both groups had significantly more difficulty correctly rank-ordering the queries (students, 75% vs. 54%, p < 0.001; practitioners, 85.7% vs. 57.1%, p <. 04). Only recent MEDLINE use was an independent predictor of accuracy in both groups. Conclusion: Students and physicians demonstrated deficiencies in identifying optimal Boolean phrases. Although formal instruction has not demonstrated clear improvement in skills, more creative teaching of Boolean search techniques should be undertaken and tested.

The stress and coping inventory: an educational and research instrument

Abstract This study examined the prevalence and use patterns of alcohol, nicotine, and other drugs in a university ambulatory clinic. A total of 149 patients sampled during a 3-month period was asked to fill out a self-report questionnaire regarding substance use. The questionnaire included the CAGE, the AUDIT, and the T-ACE instruments. Subjects had a mean age of 35 years, were 84% Caucasian, 60% unemployed, and 80% female. Based on CAGE and T-ACE scores, 13 and 25% of the subjects would be screened for possible alcoholism, respectively. The AUDIT revealed a prevalence rate of between 15 and 31% for early problematic drinking. Forty-six percent of the sample reported current use of nicotine. There is a definite overlap between nicotine and other substance use, with smokers representing 60 and 61% of those positively screened by the CAGE and the AUDIT, respectively. Other drug use was highest for marijuana (8.7%), followed by cocaine (4.7%). These prevalence rates validate the need to provide substance ab...

Blackjack and the Risky Shift

In order to examine variables that mediate susceptibility to emotional appeals, 80 Ss received a positive or negative appeal concerning a little-known country. In addition, one-half of the Ss also received neutral information about the attitude object prior to the appeal. Results of a 2 by 2 by 2 analysis of variance (Positive Appeal vs Negative Appeal by Prior Information vs No Prior Information by Favorable Initial Attitude vs Unfavorable Initial Attitude) showed two significant interactions. First, negative appeals effected more change among Ss with initially favorable attitudes (p <.01), and second, the presence of prior information increased the effectiveness of negative but decreased the effectiveness of positive appeals (p <.05). The findings suggest that positive and negative appeals may identify separate processes of change, but that communicator credibility should be examined in further studies.

Effectiveness of an intensive stress intervention workshop for senior managers

The relationship between four Myers-Briggs personality indices and accuracy of autokinetic time perception was examined for 41 undergraduate Ss. Accurate perceivers scored significantly higher on the personality measures of extraversion and perceiving than inaccurate perceivers.