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PubMed1992

Medical knowledge for clinical problem solving: a structural analysis of clinical questions.

Despite technological advances that support wide-ranging access to and transfer of knowledge, practicing physicians continue to underutilize current biomedical literature. This paper explores the nature of clinically applicable medical knowledge through a structural analysis of clinical questions. The author analyzed a set of sixty questions, based on actual online search requests of practicing physicians, for stated and unstated needs, certainty levels, implicit and explicit assumptions, decision-making processes, and type of answer required. As a result, four states of information valuable in patient care were identified: prediagnostic assessment, diagnosis, treatment choice, and learning. These states are presented in frame-like structures that integrate declarative and procedural components of medical decision making. It is concluded that clinical problem solving requires a blend of declarative and procedural knowledge. The ratio depends, in part, upon the reasoning process underway at the time of the request. Procedural knowledge required for clinical problem solving may be absent from current biomedical journal literature or difficult to identify.

Decision Making↗
PubMedDate not supplied

[The capacity of dogs to solve problems by operating with the empirical dimensions of figures].

An investigation was made into the dogs capacity for operating with empirical dimensions of figures, i.e. the animal's capacity for solving problems based on the fact that out of two figures a volumetric bait can be placed only in a volumetric figure and not in a flat one. In experiments using two methods (single and multiple presentations of figures, each time of a new pair), the dogs were incapable of solving the problems. They were able, however, to elaborate in the course of learning a visual differentiation of a volumetric figure from a flat one, which implies the formation of a generalization of the volume cue as the only invariant in all the pairs of figures. The investigation into operation with empirical dimensions of figures as one of the objective parameters in estimating elementary reasoning activity of animals indicates that by this criterion dogs range in the philogenetic series by far lower than the previously studied marmoset monkeys and dolphins.

Animals↗
PubMed1975

Behavioral community psychology: training a community board to problem solve.

This study demonstrated the effect of training nine lower socio-economic adults participating as policy board members in a federally funded rural community project to make behaviorally defined statements to increase problem-solving behaviors in board meetings. A multiple-baseline design across subjects and skills was used to analyze the behavioral categories of: (1) stating the problem; (2) finding solutions to the problem, and (3) implementing the action to the solution. Problem-solving responses during board meetings increased for subjects following training and remained higher than baseline during follow-up.

Journal Article↗
PubMed1999

A problem-solving method for 'unprotocolised' therapy administration task in medicine.

This paper describes a problem-solving method for modelling the 'unprotocolised' treatment administration task in medicine. We argue that there are medical domains in which no well-established standard treatment protocols exist, and the physician has to decide on the therapy that is to be applied to each patient, in function of a set of therapeutic objectives to be fulfilled. For this reason, we propose the modelling of this type of task adapting the generic class of problem resolution methods for design task, labelled as Propose-Critique-Modify (PCM). In this paper, we are presenting a model of expertise which has been developed using the basic modelling components of the CommonKADS methodology.

Artificial Intelligence↗
PubMed1975

Approach to rapid problem solving in clinical medicine.

Problem-orientated flow charts have been developed to teach paramedical workers the skills of making diagnoses in outpatient clinics in Tanzania. The charts give high levels of repeatability, accuracy, and rapidity and their use may lead to improved standards of medical care.

Allied Health Personnel↗
PubMed2001

Distributing working memory resources during problem solving.

This study examines how problem solvers distribute working memory demands over internal and external resources. Participants recorded notes while performing an arithmetic task. They recorded a majority of intermediate results and labeled many of those results (e.g., "C = 10"). When more effort was required to take notes, participants recorded fewer results. Participants with a consistent goal structure recorded fewer results and with practice labeled fewer recorded results than those with varied goal structures. When notes were displayed in a consistent spatial arrangement participants labeled fewer recorded results than when notes appeared in varied locations. These findings indicate that individuals use explicit and implicit strategies for indexing intermediate results. The data support the view that individuals flexibly distribute working memory over internal and external resources in response to situational cost-benefit considerations.

Adult↗
PubMed2005

Arithmetic word-problem-solving in Huntington's disease.

The purpose of this study was to examine executive functioning in patients with Huntington's disease using an arithmetic word-problem-solving task including eight solvable problems of increasing complexity and four aberrant problems. Ten patients with Huntington's disease and 12 normal control subjects matched by age and education were tested. Patients with Huntington's disease performed the solvable problems significantly worse than the normal control subjects, but there was no difference in performance between the two groups in inhibiting aberrant problems. These results suggest that early Huntington's disease patients exhibit a precocious impairment in their ability to plan the resolution of complex arithmetic word problems without deficit in their ability to eliminate aberrant problems. This dissociation of performance fits with what we have found in such patients using script-sequencing tasks (Allain et al., 2004) and with neuropsychological data obtained by Watkins et al. (2000). These results are consistent with what is known about the neuropathological progression of Huntington's disease in which neuronal loss progresses in a dorso-to-ventral direction and with what was shown in patients with circumscribed frontal lobe damage. In these patients, impairments in planning solvable word problems were more frequent when lesions were in the lateral prefrontal regions.

Adult↗
PubMed2002

Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine.

The authors developed an instrument called the "Rehabilitation Problem-Solving Form" (RPS-Form), which allows health care professionals analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. In particular, the RPS-Form was designed to address the patients' perspectives and enhance their participation in the decision-making process. Because the RPS-Form is based on the International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, it could provide a common language for the description of human functioning and therefore facilitates multidisciplinary responsibility and coordination of interventions. The use of the RPS-Form in clinical practice is demonstrated by presenting an application case of a patient with a chronic pain syndrome.

Arthritis↗
PubMed1980

Dimensions underlying a hierarchically based assessment of social problem-solving.

The dimensions underlying a procedure designed to assess nine levels of social problem-solving among EMR learners were explored in relation to IQ and MA. Principal-factor solutions followed by oblimin rotations were performed on data collected from 120 EMR children (ages 9 to 14). Results yielded three hierarchical factors, two that were moderately related to IQ and MA and one that was independent of IQ and MA. Explanation of the findings was based on a consideration of the differences between divergent and convergent production abilities.

Factor Analysis, Statistical↗
PubMed2006

Studying primate learning in group contexts: Tests of social foraging, response to novelty, and cooperative problem solving.

Learning commonly refers to the modification of behavior through experience, whereby an animal gains information about stimulus-response contingencies from interacting with its physical environment. Social learning, on the other hand, occurs when the same information originates, not from the animal's personal experience, but from the actions of others. Socially biased learning is the 'collective outcome of interacting physical, social, and individual factors' [D. Fragaszy, E. Visalberghi, Learn. Behav. 32 (2004) 24-35.] (see p. 24). Mounting interest in animal social learning has brought with it certain innovations in animal testing procedures. Variants of the observer-demonstrator and cooperation paradigms, for instance, have been used widely in captive settings to examine the transmission or coordination of behavior, respectively, between two animals. Relatively few studies, however, have examined social learning in more complex group settings and even fewer have manipulated the social environment to empirically test the effect of group dynamics on problem solving. The present paper outlines procedures for group testing captive non-human primates, in spacious arenas, to evaluate the social modulation of learning and performance. These methods are illustrated in the context of (1) naturalistic social foraging problems, modeled after traditional visual discrimination paradigms, (2) response to novel objects and novel extractive foraging tasks, and (3) cooperative problem solving. Each example showcases the benefits of experimentally manipulating social context to compare an animal's performance in intact groups (or even pairs) against its performance under different social circumstances. Broader application of group testing procedures and manipulation of group composition promise to provide meaningful insight into socially biased learning.

Animals↗
PubMed1991

Assessment of children's social problem-solving skills in hypothetical and actual conflict situations.

This study compared the social problem-solving skills of 57 maladjusted and 57 well adjusted first and second graders in a series of hypothetical and actual provocations. All children were asked how they would react to four video-taped provocations involving same-age peers. They were also exposed to three provocations simulated by a peer-confederate; their verbal and nonverbal behaviors were videotaped. Multivariate analyses of variance indicated that, overall, maladjusted subjects displayed less assertiveness and more verbal and nonverbal aggressive responses to the actual provocations. Conversely, hypothetical situations yielded few between-group differences with respect to verbal strategies. The validity of hypothetical situations is questioned; the importance of actual situations for assessment and intervention purposes is stressed.

Aggression↗
PubMed1994

Verbal problem solving in high functioning autistic individuals.

The verbal problem-solving and abstract reasoning ability of 25 high-functioning autistic individuals ages 11 to 41 was compared with normal controls individually matched on age, gender, race, IQ, and educational level. The Twenty Questions Procedure was administered using a grid of 42 common objects. Time to complete the task, number of correct solutions, and number and type of questions asked were analyzed. Results indicated that controls were more often successful in achieving solutions, and in formulating constraint seeking questions that conceptually grouped, ordered, and sorted the objects. In contrast, the autistics relied primarily on guessing. Findings are consistent with prior studies reporting a core deficit in autism involving abstract reasoning ability.

Journal Article↗
PubMed2002

Dynamics and constraints in insight problem solving.

This article reports 2 experiments that investigated performance on a novel insight problem, the 8-coin problem. The authors hypothesized that participants would make certain initial moves (strategic moves) that seemed to make progress according to the problem instructions but that nonetheless would guarantee failure to solve the problem. Experiment 1 manipulated the starting state of the problem and showed that overall solution rates were lower when such strategic moves were available. Experiment 2 showed that failure to capitalize on visual hints about the correct first move was also associated with the availability of strategic moves. The results are interpreted in terms of an information-processing framework previously applied to the 9-dot problem. The authors argue that in addition to the operation of inappropriate constraints, a full account of insight problem solving must incorporate a dynamic that steers solution-seeking activity toward the constraints.

Attention↗
PubMed2001

The use of diagrams in analogical problem solving.

In four experiments, we examined the impact of perceptual properties on the effectiveness of diagrams in analogical problem solving, using variants of convergence diagrams as source analogues for the radiation problem. Static diagrams representing the initial problematic state (one large line directed at a target) and the final state for a convergence solution (multiple converging lines) were not accessed spontaneously but were often used successfully once a hint to consider the diagram had been provided. The inaccessibility of static diagrams was not alleviated by adding additional diagrams to represent intermediate states (Experiment 1), but spontaneous access was improved by augmenting static diagrams with a verbal statement of the convergence principle (Experiment 3). Spontaneous retrieval and noticing were increased markedly by animating displays representing converging forces and thereby encouraging encoding of the lines as indicating motion toward a target (Experiments 3 and 4). However, neither static nor animated diagrams were effective when the arrows were reversed to imply divergence rather than convergence (Experiment 2). The results indicate that when animation encourages the interpretation of a diagram as a helpful source analogue, it can greatly enhance analogical transfer.

Humans↗
PubMed2005

Better without (lateral) frontal cortex? Insight problems solved by frontal patients.

A recently proposed theory on frontal lobe functions claims that the prefrontal cortex, particularly its dorso-lateral aspect, is crucial in defining a set of responses suitable for a particular task, and biasing these for selection. This activity is carried out for virtually any kind of non-routine tasks, without distinction of content. The aim of this study is to test the prediction of Frith's 'sculpting the response space' hypothesis by means of an 'insight' problem-solving task, namely the matchstick arithmetic task. Starting from Knoblich et al.'s interpretation for the failure of healthy controls to solve the matchstick problem, and Frith's theory on the role of dorsolateral frontal cortex, we derived the counterintuitive prediction that patients with focal damage to the lateral frontal cortex should perform better than a group of healthy participants on this rather difficult task. We administered the matchstick task to 35 patients (aged 26-65 years) with a single focal brain lesion as determined by a CT or an MRI scan, and to 23 healthy participants (aged 34-62 years). The findings seemed in line with theoretical predictions. While only 43% of healthy participants could solve the most difficult matchstick problems ('type C'), 82% of lateral frontal patients did so (Fisher's exact test, P < 0.05). In conclusion, the combination of Frith's and Knoblich et al.'s theories was corroborated.

Adult↗
PubMed1992

[The application of the problem-solving method in a situation of surgical intervention; a case report].

This study used the problems solving method for directing nursing assistance to the hospitalized surgical patient. We present the elaborate instrument founded in the Bailey e Claus model which is analyzed and exemplified. The authors consider the available resources concluding that the proposed is possible to be established. They realize how necessary is in nursing all the taking decision process to reach the proposed objectives, toward the resolution of the patient problems.

Brazil↗
PubMedDate not supplied

Cognitive arithmetic and problem solving: a comparison of children with specific and general mathematics difficulties.

This study examined problem-solving and number-fact skills in two subgroups of third-grade children with mathematics difficulties (MD): MD-specific (n = 12) and MD-general (n = 12). The MD-specific group had difficulties in mathematics but not in reading, and the MD-general group had difficulties in reading as well as in mathematics. A comparison group of nonimpaired children (n = 24) also was included. The findings showed that on both story and number-fact problems, the MD-specific group performed worse than the nonimpaired group in timed conditions but not in untimed conditions. The MD-general group, on the other hand, performed worse than the nonimpaired group, regardless of whether tasks were timed or not. An analysis of children's strategies in untimed conditions showed that both the MD-specific and the MD-general groups relied more on backup strategies than the nonimpaired group. However, children in the MD-specific group executed backup strategies more skillfully than children in the MD-general group, allowing them to achieve parity with children in the nonimpaired group when tasks were not timed. The findings suggest that children with specific MD have circumscribed deficits associated with fact retrieval, whereas children with general MD have more basic delays associated with problem conceptualization and execution of calculation procedures.

Achievement↗