Biomedical subjects

L F Van Egeren

Publications and source records attributed to L F Van Egeren.

At least 19 recordsLinked to original sources

PubMed2000

Evidence-based guidelines for teaching patient-centered interviewing.

In a rare study of effectiveness of an interviewing method, we previously reported a randomized controlled trial demonstrating that training in a step-by-step patient-centered interviewing method improved residents' knowledge, attitudes, and skills and had a consistently positive effect on trained residents' patients. For those who wish to use this evidence-based patient-centered method as a template for their own teaching, we describe here for the first time our training program--and propose that the training can be adapted for students, physicians, nurse practitioners, physician assistants, and other new learners as well. Training was skills-oriented and experiential, fostered positive attitudes towards patient-centered interviewing, and used a learner-centered approach which paid special attention to the teacher-resident relationship and to the resident's self-awareness. Skills training was guided by a newly identified patient-centered interviewing method that described the step-by-step use of specific behaviors.

Attitude of Health Personnel↗

PubMed1998

The effectiveness of intensive training for residents in interviewing. A randomized, controlled study.

BACKGROUND: Interviewing and the physician-patient relationship are crucial elements of medical care, but residencies provide little formal instruction in these areas. OBJECTIVE: To determine the effects of a training program in interviewing on 1) residents' attitudes toward and skills in interviewing and 2) patients' physical and psychosocial well-being and satisfaction with care. DESIGN: Randomized, controlled study. SETTING: Two university-based primary care residencies. PARTICIPANTS: 63 primary care residents in postgraduate year 1. INTERVENTION: A 1-month, full-time rotation in interviewing and related psychosocial topics. MEASUREMENTS: Residents and their patients were assessed before and after the 1-month rotation. Questionnaires were used to assess residents' commitment to interviewing and psychosocial medicine, estimate of the importance of such care, and confidence in their ability to provide such care. Knowledge of interviewing and psychosocial medicine was assessed with a multiple-choice test. Audiotaped interviews with real patients and videotaped interviews with simulated patients were rated for specific interviewing behaviors. Patients' anxiety, depression, and social dysfunction; role limitations; somatic symptom status; and levels of satisfaction with medical visits were assessed by questionnaires and telephone interviews. RESULTS: Trained residents were superior to untrained residents in knowledge (difference in adjusted post-test mean scores, 15.7% [95% CI, 11% to 20%]); attitudes, such as confidence in psychological sensitivity (difference, 0.61 points on a 7-point scale [CI, 0.32 to 0.91 points]); somatization management (difference, 0.99 points [CI, 0.64 to 1.35 points]); interviewing of real patients (difference, 1.39 points on an 11-point scale [CI, 0.32 to 2.45 points]); and interviewing (data gathering) of simulated patients (difference, 2.67 points [CI, 1.77 to 3.56 points]). Mean differences between the study groups were consistently in the appropriate direction for patient satisfaction and patient well-being, but effect sizes were too small to be considered meaningful. CONCLUSION: An intensive 1-month training rotation in interviewing improved residents' knowledge about, attitudes toward, and skills in interviewing.

Attitude of Health Personnel↗

PubMed1995

Improving residents' confidence in using psychosocial skills.

OBJECTIVE: To evaluate an intensive training program's effects on residents' confidence in their ability in, anticipation of positive outcomes from, and personal commitment to psychosocial behaviors. DESIGN: Controlled randomized study. SETTING: A university- and community-based primary care residency training program. PARTICIPANTS: 26 first-year residents in internal medicine and family practice. INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills needed in primary care. MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from, and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization, and directive and nondirective facilitation of patient communication. RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p < 0.03 for all tests), anticipated more positive outcomes for emotional sensitivity (p = 0.05), managing somatization (p = 0.03), and nondirectively facilitating patient communication (p = 0.02), and were more strongly committed to being emotionally sensitive (p = 0.055) and managing somatization (p = 0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine than did the untrained residents (p < 0.001). CONCLUSIONS: Intensive psychosocial training improves residents' self-confidence in their ability regarding key psychosocial behaviors and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and personal commitment to some, but not all, psychosocial skills.

Clinical Competence↗

PubMed1995

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study.

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.

Clinical Competence↗

PubMed1991

Monitoring activity and blood pressure.

Body motion and blood pressure were monitored simultaneously for 24h in 82 healthy normotensive employees with sedentary jobs. Body movement frequency decreased from the level during work to the level at home in the evening and fell further when the subjects went to sleep. Approximately 25% of changes in blood pressure levels were explained by changes in gross body movement. The mean intrasubject correlation between pressure and motility was r = 0.52 (diastolic) and r = 0.51 (systolic). Simultaneous monitoring of blood pressure and human activity, using a behavioral diary to record the type of activity and an electronic motility monitor to record its intensity, can show how skeletal motor outflow affects the regulation of blood pressure in the normal circumstances of everyday life.

Activities of Daily Living↗

PubMed1988

A computer-assisted diary (CAD) for ambulatory blood pressure monitoring.

Methods for logging activities during ambulatory blood pressure monitoring are time consuming and poorly standardized. To overcome these problems we have developed a computer-assisted diary (CAD). The subject marks boxes on a computer-readable card to indicate the time, location, body position, activity, and mood associated with each blood pressure reading. Software implemented on a personal computer downloads the diary information from a card reader, checks its quality, scores the data, extracts quantitative critical features, and inserts the information into computer files ready for data analysis and clinical report writing. The diary system was tested on 24-hour blood pressure scans of 32 normotensive working adults. The results indicated that the automated diary system was accepted well and used accurately by the subjects. Activities and moods coded by the CAD system were systematically related to the level of systolic blood pressure. The method produced results that are similar to those of traditional diaries, with major time and cost savings resulting from computer automation. We have concluded that the computer-assisted diary is an effective way to monitor behavioral states during ambulatory blood pressure monitoring which merits further trial applications.

Activities of Daily Living↗

PubMed1988

Repeated measurements of ambulatory blood pressure.

Automated non-invasive recorders allow repeated measurement of blood pressure, 24 h a day; the question of how often to sample blood pressure remains unanswered. Interrupting the patients for a reading more often than necessary may elevate blood pressure or compromise patient cooperation. Thirty-two normotensive subjects were each monitored for 24 h at two measurement rates, one and four readings per h, on 2 work days, to determine whether the rates affected blood pressure and behaviour. The blood pressure level at home and at work and most behaviours were indistinguishable on the 2 monitoring days. The heart rate was slightly higher and subjects reported greater disruption of their daily routine on the four/h monitoring day. The results suggest that blood pressure can be read as often as four times an hour without falsely elevating blood pressure, inducing emotional distress or impairing cooperation with the monitoring procedure.

Adult↗

PubMed1983

Interpersonal and electrocardiographic responses of Type A's and Type B's in competitive socioeconomic games.

Forty-eight subjects classified as either Type A (coronary-prone) or Type B (coronary-resistant) exchanged points worth money with a computer-simulated opponent while an electrocardiogram was computer-monitored and scored. Type A's were more aggressive during the socioeconomic exchanges than were Type B's. The more aggressive a subject during the interactions the greater was the shift toward depression of the ST segment of the electrocardiogram. Despite the relationship between aggression and ST response, and the greater aggressiveness of Type A's during the interactions, Type A's and Type B's did not differ significantly in ST response.

Adult↗

PubMed1983

Electrocardiographic effects of social stress on coronary-prone (type A) individuals.

Subjects selected for possession of either the Type A (coronary-prone) or Type B (coronary-resistant) behavior pattern interacted with a computer, while appearing to interact with a partner, in a formal competitive game of social strategy. Type A subjects exhibited greater impatience than Type B subjects. Computer analysis of the electrocardiogram revealed that social stimulation elicited larger ventricular electrophysiological responses (ST segment depression, and reduction of T wave and R wave amplitudes) in Type A than in Type B subjects. Such changes are consistent with the assumption of greater cardiac sympathetic activity during the social interactions in the Type A subjects.

Arousal↗

PubMed1982

Competitive two-persons interactions of type-A and type-B individuals.

Forty subjects classified as either coronary-prone (Type A) or coronary-resistant (Type B) interacted in a mixed-motive game in pairs by pressing buttons which transmitted messages through a television screen while an electrocardiogram and digital blood volume pulse were computer monitored. Subjects could cooperate, compete, punish, reward, or withdraw during each interaction and could send 1 of 55 messages communicating feelings, requests, and intentions between interactions. Paired Type A's interacted more competitively and aggressively than paired Type B's. There were no significant differences between Type A's and Type B's in heart rate or digital vasomotor response during the interpersonal game. The behavioral results but not the physiological results confirm findings from an earlier experiment.

Arousal↗

PubMed1979

Cardiovascular changes during social competition in a mixed-motive game.

Male and female subjects played a mixed-motive game against a male confederate under either a 20% cooperative or an 80% cooperative strategy while cardiovascular responses were computer monitored. Females had larger heart rate responses than males during play against the competitive strategy, and the opposite was true during play against the cooperative strategy. Subjects who were more competitive during the game or who scored higher on a coronary-prone (Type A) behavior scale or who reported having an action orientation toward life stress tended to have larger heart rate responses during the game than the remaining subjects. The results draw attention to the importance of covert autonomic responses for understanding overt behavioral choices in mixed-motive games and to the potential utility of this behavioral model for studying the role of psychosocial factors in psychosomatic illnesses.

Competitive Behavior↗

PubMed1979

Social interactions, communications, and the coronary-prone behavior pattern: a psychophysiological study.

Sixty subjects classified as either Type A or Type B interacted in pairs by pressing buttons which transmitted messages through a television screen while the heart rate and digital blood volume pulse were computer-monitored. Partners could cooperate, compete, punish, reward, or withdraw on each interaction and could send 1 of 55 messages communicating feelings, requests, and behavioral intentions between interactions. Interactions and communications between Type A subjects were strikingly different from Type B subjects. Type A's were noticeably more aggressive competitive. Type A dyads also exhibited larger digital vasomotor responses than Type B dyads. When Type A subjects and Type B subjects interacted with each other, rather than with a same-type partner, the differences between them in behavior and vasomotor response largely disappeared.

Aggression↗

PubMed1978