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PubMed1987

Quantifying risk and accuracy in cancer risk assessment: the process and its role in risk management problem-solving.

A better understanding of chemical-induced cancer has led to appreciation of similarities to problems addressed by risk management of radiation-induced toxicity. Techniques developed for cancer risk assessment of toxic substances can be generalized to toxic agents. A recent problem-solving approach for risk management of toxic substances developed for the U.S. Department of Health and Human Services, and the role of risk assessment and how uncertainty should be treated within the context of this approach, is discussed. Finally, two different methods, research into the assumptions underlying risk assessment and the modification of risk assessment/risk management documents, are used to illustrate how the technique can be applied.

Humans↗
PubMed1977

Effect of perceptual processing strategies on problem solving of reflective and impulsive children.

Several studies employing the "20 questions" test reported that reflective children asked proportionally more constraint-seeking (CS) questions than did impulsive children. The finding was interpreted as supporting the generally accepted view that reflective children are more mature and more efficient problem solvers than impulsive children. Inexplicably, the reflectives' higher proportion of CS questions was not associated with fewer questions to solution, that is, with greater efficiency. The present study examined an alternative hypothesis that differences in performance of impulsive and reflective children on the "20 questions" test are due to individual differences in preferred perceptual processing strategy rather than in cognitive maturity of problem-solving strategy. Efficiency of performance of reflective and impulsive children was shown to be related to type of stimuli and experimental conditions employed, supporting a perceptual rather than cognitive-maturational interpretation.

Child↗
PubMed2000

Adolescent responses to depressive parental behaviors in problem-solving interactions: implications for depressive symptoms.

The purpose of this study was to explore the relations between child responses to interparental depressive behavior and subsequent child depressive symptomatology. Data were collected on 156 two-parent families. Families completed questionnaire data and participated in problem-solving interactions, which were coded using a microsocial observational system. Three potential child responses to interparental depressive behavior were examined: facilitative, aggressive, and depressive. Results indicated that for female adolescents the displays of facilitative and depressive behavior as well as the suppression of aggressive behavior in response to interparental depressive behavior were related to increases in depressive symptomatology. For males, on the other hand, the display of aggressive and depressive behavior in response to interparental depressive behavior was related to increases in depression. Results provide preliminary support both for the examination of child responses to conflictual marital behavior and for expanding the conceptualization of conflictual marital behaviors to include depressive as well as the more traditionally examined aggressive behaviors, in order to better understand the link between conflictual marital behavior and child depressive symptomatology.

Adolescent↗
PubMed1991

A problem-solving approach to group psychotherapy in the inpatient milieu.

Because of the trend toward a marked decrease in length of psychiatric hospitalization, clinicians need to improve the organization of the therapeutic milieu so that behavioral changes can be effected more rapidly. A university general psychiatric unit has adapted a problem-solving model that integrates groups and activities so that each one focuses on complementary behavioral objectives for each patient with the aim of effecting more rapid behavior change. The stages of the model are incorporated in a weekly sequence that begins with a goal-setting group. In a series of subsequent groups, each patient tries to develop and implement a solution to the problem identified that week. At the end of each week, patients participate in a goal review group, with feedback from staff and peers and self-reinforcement. The model can be used with a diverse patient population without interfering with each patient's individual psychotherapy or pharmacotherapy.

Adult↗
PubMed1991

Teaching epidemiology and biostatistics through interactive problem solving.

Medical education should prepare students for the reasoning and decision making that are required in a physician's clinical work. The disciplines of epidemiology and biostatistics, as combined in clinical epidemiology, lend themselves very well to this purpose. A lecture course in epidemiology and biostatistics was redesigned to emphasize interactive learning through problem-solving workshops in which students worked with actual data from two epidemiologic studies. A third workshop provided experience in the critical appraisal of an epidemiologic study from the current literature. Students respond favorably to these active learning experiences, which deal with relevant contemporary health problems. The concepts of clinical epidemiology should be integrated into clinical teaching in all stages of training.

Biometry↗
PubMed1976

Retention of learned temperature changes during problem solving.

In 2 studies (ns = 10, 9) college students were trained using biofeedback to lower or to raise finger temperature. Successful subjects were then asked to do distracting intellectual tasks, while simultaneously retaining the learned temperature changes. Results indicated that these changes could be maintained without detectable decreases in problem-solving efficiency in terms of either time or number of errors. These findings suggested that it might be possible for subjects to function efficiently outside the laboratory in their everyday activities while simultaneously exercising voluntary control over some autonomic processes.

Adult↗
PubMed2001

The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD.

Two family therapies were compared using teens with attention-deficit/hyperactivity disorder. Ninety-seven families were assigned to either 18 sessions of problem-solving communication training (PSCT) alone or behavior management training (BMT) for 9 sessions followed by PSCT for 9 sessions (BMT/PSCT). Both treatments demonstrated significant improvement in ratings of parent-teen conflicts at the midpoint but did not differ. By posttreatment, both produced improvement on ratings and observations but did not differ. Significantly more families dropped out of PSCT alone than out of BMT/PSCT. At most, 23% of families showed reliable change either by midpoint or by posttreatment, with no differences between therapies. Yet 31%-70% of families were normalized. Group-level change and normalization rates support treatment efficacy, whereas indices of reliable change are less impressive.

Adolescent↗
PubMed1995

Continuous quality improvement and school nurses' problem solving methods.

The concept of continuous quality improvement is already well known in industry. It is, however, potentially applicable to any organization that provides products or services (health care and education) to customers (students and their families, teachers, etc.). In the present situation of increasingly complex health care needs of many students, continuous quality improvement--which involves problem solving and management techniques to effect services--is a relevant concept in the school setting.

Humans↗
PubMed1990

A problem-solving approach to teaching electrochemical driving force to undergraduates.

The diversity of students in the typical undergraduate general physiology course demands consideration of several important education objectives: the instructor seeks to provide students with a sound understanding of basic physiological concepts, sharpen their analytical skills, and demonstrate how universal physicochemical laws determine function within living systems. These objectives converge in a problem-solving approach to electrochemical driving force and ion flux across biological membranes.

Electrochemistry↗
PubMed1984

Relapse coping and problem solving training following treatment for smoking.

Following an initial smoking program, 33 subjects were randomly assigned to one of four maintenance strategy conditions developed to investigate the Marlatt and Gordon cognitive-behavioral model of relapse. Two out of three components of the model were supported. Abstinent subjects given problem solving training did not show significant relapse while those given an attention placebo control did relapse significantly. Self-efficacy expectations predicted smoking rate up to 5-month follow-up. Contrary to expectations based on the Marlatt and Gordon model, subjects taught to cope with the guilt and sense of personal failure associated with a relapse episode showed considerable relapse.

Adaptation, Psychological↗
PubMed1991

Effects of conventional and problem-based medical curricula on problem solving.

This study examined the reasoning processes of beginning, intermediate, and senior students in two medical schools with different curricular formats. One school had a conventional curriculum (CC) where basic science was taught one and a half years before the clinical training, and the other had a problem-based learning curriculum (PBLC) where basic science was taught in the context of clinical problems and general problem-solving heuristics were specifically taught. The students were asked to give diagnostic explanations of a clinical case, both before and after being exposed to relevant basic science information. Two distinct modes of reasoning were identified, each reflecting a curriculum type. A predominantly "backward-directed" hypothetico-deductive mode of reasoning was found in the explanations of the PBLC students, and a "more forward-directed" pattern of reasoning was found in the explanations of the CC students. Students in the PBLC produced extensive elaborations using relevant biomedical information, which was relatively absent from the CC students' explanations. However, these elaborations were accompanied by a tendency to generate errors. These results have important implications regarding the strengths and weaknesses of the two types of curricula.

Canada↗
PubMed2005

The effect of peer collaboration on children's problem-solving ability.

BACKGROUND: A Vygotskian framework links cognitive change to collaborative interaction with a more competent partner whereas a Piagetian perspective supports the view that cognitive conflict arising from peer interaction leads to cognitive change. AIMS: The study investigated the effect of collaborative learning on children's problem-solving ability and whether differences in knowledge status or the use of explanatory language were contributing factors. SAMPLE: Participants were 100 Year 2 children (aged between 6 and 7 years), from schools in high socio-economic areas, who individually completed a pre- and post-test comprising a block sorting task. METHOD: During the experimental phase, children completed a card sorting activity, either individually or in same-gender dyads. The dyads consisted of same or different ability children who operated under either a 'talk' or 'no-talk' condition. RESULTS: It was found that children who collaborated collectively obtained a significantly higher number of correct sorts than children who worked individually. However, post-testing indicated that only those children of lower sorting ability who collaborated with higher sorting ability peers showed a significant improvement in sorting ability from pre-test scores. In addition, it was found that when analysis was limited to this particular group, only those children who were required to explain the sort for their partner to carry out improved significantly from pre- to post-test. CONCLUSION: It is suggested that perhaps the two theoretical positions are not as mutually exclusive as they are often portrayed. Implications of these findings for teachers and children's learning are also discussed.

Child↗
PubMed2004

Training residents in problem-solving treatment of depression: a pilot feasibility and impact study.

BACKGROUND AND OBJECTIVES: Primary care patients with depression may prefer or require a non-pharmacological treatment such as counseling. We investigated the feasibility of teaching family medicine residents an evidence-based brief counseling intervention for depression (Problem-solving Treatment of Depression for Primary Care [PST-PC]). METHODS: Eleven residents over 3 consecutive years were provided a brief training program in PST-PC. Residents were evaluated for skill acquisition, changes in self efficacy, intentions to improve their care for depression, and post-residency integration of PST-PC into their daily practice. RESULTS: Trainees met established criteria for competency to administer PST-PC. They improved to moderate-to-high levels of self efficacy for treating depression, including for their counseling skills, and in their intentions to improve their depression management. At up to 3 years post residency, 90% indicated they were using PST-PC, often in a modified form, and also for illnesses other than depression. They indicated they would recommend the training to new residents. CONCLUSIONS: The PST-PC training program evaluated in this study is feasible in residency training and appears to influence practice post residency. These findings warrant continued investigation of this training program with a larger sample of residents and evaluation of outcomes with depressed patients treated with PST-PC in real-world practice settings.

Clinical Competence↗
PubMed2000

Endovascular problem solving with intravascular stents.

BACKGROUND AND PURPOSE: Intravascular stents are being used with increasing frequency in interventional neuroradiology. They provide the potential to expand the therapeutic capabilities of the endovascular therapist and stand to revolutionize endovascular intervention within both the intracranial and extracranial vessels. We present our application of stent technology to further the understanding of endovascular rescue from procedural complications and the solving of complex clinical problems. METHODS: Three patients underwent unplanned placement of intravascular stents. In two patients a stent was used to provide stabilization of an irretrievable intravascular device; in the third patient a stent was used to provide a scaffolding for proximal external carotid sacrifice. RESULTS: Stent deployment was successful in all patients. The intravascular devices stabilized by stent placement included unraveled fragments of a Guglielmi detachable coil (GDC) and a partially deployed coronary stent. Proximal external carotid sacrifice was achieved with the aid of a stent in one patient to control hemorrhage from recurrence of laryngeal cancer. No periprocedural neurologic complications were encountered. Six-month follow-up angiography in one patient showed only minimal myointimal hyperplasia induced by stent-stabilized GDC fragments adjacent to the internal carotid vessel wall. CONCLUSION: Stents can be used to provide stabilization of irretrievable intravascular devices or as a scaffolding for proximal vessel sacrifice. These applications may allow endovascular rescue of procedural complications and solve unique clinical problems.

Aged↗
PubMed2005

Effects of aging on arithmetic problem-solving: an event-related brain potential study.

Younger and older participants were asked to indicate if 240 complex two-digit addition problems were smaller than 100 or not. Half of the problems were small-split problems (i.e., the proposed sums were 2% or 5% away from 100; e.g., 53 + 49) and half were large-split problems (i.e., proposed sums were 10% or 15% away from 100; 46 + 39). Behavioral and event-related potential (ERP) data revealed that (a) both groups showed a split effect on both reaction times and percent errors, (b) split effects were smaller for older than for younger adults in ERPs, and (c) the hemispheric asymmetry (left hemisphere advantage) reported for younger adults was reduced in older adults (age-related hemispheric asymmetry reduction). These results suggest that older adults tend to use only one strategy to solve all problems, whereas younger adults flexibly and adaptively use different strategies for small and large-split problems. Implications of these findings for our understanding of age-related similarities and differences in arithmetic problem-solving are discussed.

Adult↗
PubMed2006

Beyond compliance: environmental health problem solving, interagency collaboration, and risk assessment to prevent waterborne disease outbreaks.

A systems approach to environmental health problem solving was used to investigate two waterborne norovirus outbreaks in Wyoming and can serve in the development of improved prevention strategies. An interagency collaboration to prevent waterborne disease involving local, state, and federal partners was designed to coordinate response to outbreak investigations. Improved risk assessment and reporting procedures were also integrated to ensure better availability of necessary data. Public health entities should implement sustainable intersectoral interventions to prevent waterborne disease that not only improve regulatory compliance but also have a positive impact on community health outcomes. Collaborative preventive health and water system protection activities should receive priority attention for implementation in state and local jurisdictions.

Cooperative Behavior↗
PubMed2005

Problem-solving and decision-making preferences: no difference between complementary and alternative medicine users and non-users.

The objective of this study was to determine if complementary and alternative medicine (CAM) Users are more autonomous than Non-Users with respect to their preferred role in decision-making (measured by the problem-solving decision-making or PSDM scale). A survey was mailed in spring 2001 to a random sample of 696 men (selected from the Ontario Cancer Registry), aged 18 years or older and diagnosed with prostate cancer in the preceding 2 years. Less than 5% of the 489 (72.1% response rate) men (mean age 68.6 years) who responded to the PSDM question in our survey were classified as having an autonomous role preference, while almost 1/3 of the respondents reported using CAM for their prostate cancer. The majority of respondents were classified as preferring a shared role and a substantial minority was classified as preferring a passive role. There was no statistically significant difference between CAM users and non-users with respect to their preferred role. The hypothesis that CAM Users are more autonomous problem solvers and decision makers is not supported by these findings; however, the generalizability of our results is limited by the fact that we surveyed a relatively older male population only.

Aged↗