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PubMed1989

The relation of medical problem solving and therapeutic errors to disease categories.

Review of 146 internal medicine cases at Emerson Hospital in Concord, Massachusetts, revealed significant variations in the patterns of physician error and medical problem solving for five diseases: recurrent congestive heart failure, transient ischemic attacks, recurrent cerebrovascular accidents, upper gastrointestinal hemorrhage, and acute bacterial pneumonia. Reviewers used general criteria to identify quality issues, which were separated into six error categories: insufficient data acquisition, inadequate hypothesis generation, inattention to or misinterpretation of cues, inappropriate or mismanaged therapy, delayed or missed diagnoses, and delayed treatment. The most common errors were inadequate hypothesis generation (38%) and inattention to or misinterpretation of cues (32%). Inappropriate or mismanaged therapy was found in 21% of cases.

Clinical Competence↗
PubMed2003

Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research.

Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and "how-to" questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

Community Health Planning↗
PubMed1987

A model for ethical problem solving in medicine, with practical applications.

Despite the dramatic increase over recent years in the research and teaching of medical ethics, there exists no theoretical framework within which to conceptualize ethical problems in medicine, to say nothing of solutions to these problems. The model proposed here attempts to fill this void by developing a conceptual understanding of the nature of moral dilemmas that can be applied to both theoretical and practical problems in medicine. Practical applications are demonstrated in three areas: personal ethical problem solving, hospital ethics committees, and the teaching of medical ethics. Suggestions are offered for the extension of these and other applications of the model, a model proposed as a foundation to be built upon through further research and daily experiences in a world of conflicting values.

Bioethical Issues↗
PubMed1994

Problem-solving therapy in the treatment of unexplained physical symptoms in primary care: a preliminary study.

We describe a pilot study of a simple psychological treatment based on reattribution techniques and problem-solving. The treatment was administered to a consecutive series of patients (N = 11) presenting in primary care with unexplained physical symptoms. The findings suggest that the treatment is both feasible and acceptable. Finally we suggest selection criteria for those patients who may benefit from the treatment. This needs further evaluation in a randomized, controlled trial.

Adolescent↗
PubMed1984

The influence of a supportive, problem-solving, group intervention on the health status of students with great recent life change.

A small randomized trial was conducted with college students to test the efficacy of a supportive, problem-solving group intervention for reducing morbidity following accumulation of numerous life changes. The two intervention groups reported declines in number of illness episodes and number of disability days over the two semesters of study; one of the intervention groups also reported a decrease in number of days on which illness was experienced. The control group did significantly worse on these measures than the intervention groups.

Clinical Trials as Topic↗
PubMed1985

Two approaches to family therapy with alcoholics: problem-solving and systemic therapy.

A significant proportion of the alcohol population continues to function within intact families. Two comparative family therapy approaches are described that have been used in treating alcoholics and their families. Problem-solving therapy focuses directly on the drinking and attempts to modify this through the active participation of family members. The Milan systemic approach aims to alter the family system's functioning and so effect change in the problem drinker.

Adult↗
PubMed2001

An investigation of the psychological characteristics of stalkers: empathy, problem-solving, attachment and borderline personality features.

This study examined the psychological characteristics of a sample of self-reported stalkers in comparison with a control group, on measures of empathy, problem-solving skills, attachment, and borderline personality features. Stalkers were identified by their endorsement of specific behavioral items, consistent with a widely adopted definition of stalking, denoting behaviors that: (a) are repeatedly directed toward an identified target; (b) are intrusive and unwanted; and (c) evoke fear in the victim. Stalkers scored significantly higher than controls on measures of insecure attachment and borderline personality features, suggesting that the stalking group demonstrates a general pattern of inadequate interpersonal attachment, has limited abilities to form and maintain appropriate relationships, is emotionally labile and unstable, and experiences ambivalence regarding their interpersonal relationships. Treatment implications are discussed herein.

Adolescent↗
PubMed1995

Poor interpersonal problem solving as a mechanism of stress generation in depression among adolescent women.

The authors examined C. Hammen's (1991) model of stress generation in depression and the role of interpersonal problem-solving strategies (IPS) in the stress generation process in a longitudinal sample of 140 young women who entered the study at ages 17-18. Structural equation modeling was used to test a model in which IPS and subsequent interpersonal stress mediated the relationship between initial and later depressive symptoms. Results supported the main prediction of the stress generation model: Interpersonal stress mediated the relationship between initial and later depressive symptoms. In addition, IPS predicted interpersonal stress. However, no association was found between depressive symptoms and IPS. An alternative model in which IPS moderated the relationship between stress and depressive symptoms was tested; it was not supported.

Adolescent↗
PubMed1997

Visuospatial dysfunction and problem solving in Parkinson's disease.

Individuals with Parkinson's disease (PD) perform deficiently on Raven's Coloured Progressive Matrices (RCPM), in contrast to their relatively good performance on many other problem-solving tasks. The question is raised as to whether a visuospatial deficit may account for poor RCPM performance in PD. The authors analyzed RCPM results in 50 nondemented participants with PD and 39 age-matched healthy control participants. The PD group made significantly more errors than the control group on all RCPM subtests, including the subtest that mainly assessed visuospatial function (RCPM-A). For the PD group, the composite score of other visuospatial tests, but not the composite scores of tests of executive function or verbal memory, significantly predicted performance on the RCPM-A. Visuospatial impairment in PD may arise from dysfunction of the basal ganglia-thalamocortical circuit that also includes the dorsolateral prefrontal cortex and, importantly, the posterior parietal lobes.

Aged↗
PubMed1983

Psychoanalysis and the science of problem-solving man: an appreciation of Popper's philosophy and a response to Will (1980).

Popper's philosophy has been often misrepresented in the debate about the scientific status of psychoanalysis by pseudo-Popperians who use the idea of falsifiability without rejecting positivism and inductive logic. The debate itself is misconceived because it is based on the outdated positivist assumption that what is not science is not important. Partially submerged by this, however, is a very important debate about method. The issues are clearly focused by what is here called "Hill's problem', that of finding a common framework in which the contributions of organic, psychodynamic and social psychiatry can be discusses and applied to clinical problem solving. Will's paper brings out many fundamental problems. This reply discussed misapprehended aspects of Popper's world view and introduces his plural interactionalist metaphysical research programme. It demonstrates the close similarity of Popper's view of science which Lorenz calls 'hypothetical realism' with Bhaskar's 'transcendental realism' which Will advocates for psychoanalysis. The differences hinge on concepts of explanation and the methods of theory testing. It is here argued that Popper's view is better fitted for the task Will proposes. The resemblance of 'hypothetical realism' to the clinical tradition further demonstrates its applicability to Hill's problem.

Humans↗
PubMedDate not supplied

Overt and covert verbal problem-solving strategies: developmental trends in use, awareness, and relations with task performance in children aged 5 to 17.

Age-related changes in children's use, self report, and awareness of verbal problem-solving strategies (private speech) and strategy effectiveness were explored with a large (N = 2,156) cross-sectional sample of children aged 5 to 17. Children's verbal strategies moved from overt, to partially covert, to fully covert forms with age. Self-reports of verbal strategy use were accurate yet incomplete. Awareness of children's use of verbal strategies was low and increased with age. Although verbal strategies were associated with competence among the youngest children, self-talk was unrelated to task performance for older children, suggesting considerable persistence over time of a relatively ineffective strategy. Awareness was not a prerequisite for children's verbal strategy use but was positively associated with strategy effectiveness among those who talked.

Adolescent↗
PubMed2001

Engineering for problem solving in future: eco-social market economy and eco-social tech.

The paper differentiates approaches in technology (end-of-pipe, cleaner production, industrial ecology, zero emission and eco-social-tech) and compares them in respect to the problem solving capacity on the ecological as well as social dimension by showing the eco-impact reduction and job creation. Eco-social-tech represents the approach with highest problem solution as it is based on "eco-social market economy", which will the replace free market economy. The deep background of these innovations is "ecosophy", the wisdom of nature, which serves as guideline for eco-restructuring the world.

Biotechnology↗
PubMed2000

External and Internal Instantiation of Abstract Information Facilitates Transfer in Insight Problem Solving.

Four studies were conducted to examine how instantiation of abstract statements facilitates solutions to insight problems. The first two experiments explored the effects of external instantiation (adding a concrete example to the abstract source information) on transfer. Providing an example along with the abstract source statement fostered transfer of analogous solutions. Moreover, adding a complete concrete instantiation to an abstract statement produced greater transfer than adding only specific items to illustrate the abstract terms. The second two experiments examined the effects of internal instantiation (encouraging learners to generate their own concrete examples of the abstract information) on transfer. This factor, too, facilitated problem solving. Generating examples to instantiate the abstract statement yielded even better transfer than simply informing participants of the relationship between the abstract statements and the target problems. These findings suggest that both external and internal instantiation facilitate transfer by promoting mental processes associated with implementing the source analogs. Copyright 2000 Academic Press.

Journal Article↗
PubMed1995

Use of social information in the problem solving of orangutans (Pongo pygmaeus) and human children (Homo sapiens).

Fourteen juvenile and adult orangutans and 24 3- and 4-year-old children participated in 4 studies on imitative learning in a problem-solving situation. In all studies a simple to operate apparatus was used, but its internal mechanism was hidden from subjects to prevent individual learning. In the 1st study, orangutans observed a human demonstrator perform 1 of 4 actions on the apparatus and obtain a reward; they subsequently showed no signs of imitative learning. Similar results were obtained in a 2nd study in which orangutan demonstrators were used. Similar results were also obtained in a 3rd study in which a human encouraged imitation from an orangutan that had previously been taught to mimic arbitrary human actions. In a 4th study, human 3- and 4-year-old children learned the task by means of imitation.

Animals↗
PubMed1995

A problem solving intervention for caregivers of cancer patients.

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Adaptation, Psychological↗
PubMedDate not supplied

Quality problem-solving, decision-making, type theory, and case managers.

Temperament theory can serve as a tool to improve the case manager's effectiveness. This knowledge identifies strengths and liabilities that can enhance individual and group problem-solving, decision making and team productivity. This article will examine components of decision making, temperament or personality theory, and describe major types. Part II will discuss the implications of typewatching for case managers and others with whom they interact with respect to time management, negotiation, and team building. off

Case Management↗
PubMed1996

Problem-solving treatment: evidence for effectiveness and feasibility in primary care.

OBJECTIVE: There is a need for psychological treatments for psychiatric disorders in primary care. The purpose of this article is to review studies of problem-solving treatment (PST). PST is a brief psychological treatment for emotional symptoms in primary care patients. METHOD: A series of different studies of primary care patients in Oxford are reviewed. RESULTS: In primary care, PST is effective for patients with major depression and for patients with more broadly defined emotional disorders. PST can be effectively delivered in primary care settings by psychiatrists, general practitioners, or nurses. PST may be more expensive than primary care practitioners' usual treatment in terms of direct costs. However, PST might result in greater savings if indirect costs are also considered. CONCLUSIONS: PST is a feasible, brief, effective treatment for mental disorders of mild to moderate severity in primary care. Replication studies and further research on combination treatments, long-term outcomes, and indirect costs are indicated.

Amitriptyline↗