Clinical peer mentoring: partnering BSN seniors and sophomores on a dedicated education unit.

PubMed

Harmer, Bonnie McKay; Huffman, Jaime; Johnson, Barbara

2011-01-01

The authors describe a clinical peer mentoring (CPM) program that partnered 16 pairs of senior (mentors) and sophomore (novices) BSN students to provide patient care on a dedicated education unit at a VA Medical Center. Situated learning theory and Tanner's Clinical Judgment Model provided frameworks for CPM implementation. Survey findings suggested novices and mentors perceived improvements in self-confidence, prioritization, time management, clinical judgment, and evidence-based practice use. Many mentors spontaneously expressed an interest in becoming a preceptor or nurse educator. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Script Concordance Test: a new tool assessing clinical judgement in neurology.

PubMed

Lubarsky, Stuart; Chalk, Colin; Kazitani, Driss; Gagnon, Robert; Charlin, Bernard

2009-05-01

Clinical judgment, the ability to make appropriate decisions in uncertain situations, is central to neurological practice, but objective measures of clinical judgment in neurology trainees are lacking. The Script Concordance Test (SCT), based on script theory from cognitive psychology, uses authentic clinical scenarios to compare a trainee's judgment skills with those of experts. The SCT has been validated in several medical disciplines, but has not been investigated in neurology. We developed an Internet-based neurology SCT (NSCT) comprising 24 clinical scenarios with three to four questions each. The scenarios were designed to reflect the uncertainty of real-life clinical encounters in adult neurology. The questions explored aspects of the scenario in which several responses might be acceptable; trainees were asked to judge which response they considered to be best. Forty-one PGY1-PGY5 neurology residents and eight medical students from three North American neurology programs (McGill, Calgary, and Mayo Clinic) completed the NSCT. The responses of trainees to each question were compared with the aggregate responses of an expert panel of 16 attending neurologists. The NSCT demonstrated good reliability (Cronbach alpha = 0.79). Neurology residents scored higher than medical students and lower than attending neurologists, supporting the test's construct validity. Furthermore, NSCT scores discriminated between senior (PGY3-5) and junior residents (PGY1-2). Our NSCT is a practical and reliable instrument, and our findings support its construct validity for assessing judgment in neurology trainees. The NSCT has potentially widespread applications as an evaluation tool, both in neurology training and for licensing examinations.

Impact of computer-based treatment planning software on clinical judgment of dental students for planning prosthodontic rehabilitation

PubMed Central

Deshpande, Saee; Chahande, Jayashree

2014-01-01

Purpose Successful prosthodontic rehabilitation involves making many interrelated clinical decisions which have an impact on each other. Self-directed computer-based training has been shown to be a very useful tool to develop synthetic and analytical problem-solving skills among students. Thus, a computer-based case study and treatment planning (CSTP) software program was developed which would allow students to work through the process of comprehensive, multidisciplinary treatment planning for patients in a structured and logical manner. The present study was aimed at assessing the effect of this CSTP software on the clinical judgment of dental students while planning prosthodontic rehabilitation and to assess the students’ perceptions about using the program for its intended use. Methods A CSTP software program was developed and validated. The impact of this program on the clinical decision making skills of dental graduates was evaluated by real life patient encounters, using a modified and validated mini-CEX. Students’ perceptions about the program were obtained by a pre-validated feedback questionnaire. Results The faculty assessment scores of clinical judgment improved significantly after the use of this program. The majority of students felt it was an informative, useful, and innovative way of learning and they strongly felt that they had learnt the logical progression of planning, the insight into decision making, and the need for flexibility in treatment planning after using this program. Conclusion CSTP software was well received by the students. There was significant improvement in students’ clinical judgment after using this program. It should thus be envisaged fundamentally as an adjunct to conventional teaching techniques to improve students’ decision making skills and confidence. PMID:25170288

Enhancing Critical Thinking Via a Clinical Scholar Approach.

PubMed

Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M

2017-11-01

Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.

Perception versus reality: a comparative study of the clinical judgment skills of nurses during a simulated activity.

PubMed

Fenske, Cynthia L; Harris, Margaret A; Aebersold, Michelle L; Hartman, Laurie S

2013-09-01

This study was conducted to determine how closely nurses' perceptions of their clinical judgment abilities matched their demonstrated clinical judgment skills during a simulation. Seventy-four registered nurses participated in a simulation using a video format. After the simulation, the nurses self-assessed their performance using the Lasater Clinical Judgment Rubric. This rubric was then used to rate the nurses' actual performance in the simulation activity. The study results showed a significant discrepancy between nurses' perceptions of their own clinical judgment abilities and their demonstrated clinical judgment skills. Age and length of nursing experience enhanced the difference between the findings of self-assessment and actual performance. Younger nurses and those with 1 year or less of nursing experience were significantly more likely to have self-assessed their abilities at a much higher level compared with their actual skills. Copyright 2013, SLACK Incorporated.

Nursing student stories on learning how to think like a nurse.

PubMed

Di Vito-Thomas, Pam

2005-01-01

The ability to think critically, improve clinical systems, and decrease errors in clinical judgments are ever the vision of nursing practice. The author describes the thinking processes of nursing students as they make clinical judgments and the most important teaching/learning strategies that help develop their clinical judgment.

Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant.

PubMed

Balekian, Alex A; Silvestri, Gerard A; Simkovich, Suzanne M; Mestaz, Peter J; Sanders, Gillian D; Daniel, Jamie; Porcel, Jackie; Gould, Michael K

2013-12-01

Management of pulmonary nodules depends critically on the probability of malignancy. Models to estimate probability have been developed and validated, but most clinicians rely on judgment. The aim of this study was to compare the accuracy of clinical judgment with that of two prediction models. Physician participants reviewed up to five clinical vignettes, selected at random from a larger pool of 35 vignettes, all based on actual patients with lung nodules of known final diagnosis. Vignettes included clinical information and a representative slice from computed tomography. Clinicians estimated the probability of malignancy for each vignette. To examine agreement with models, we calculated intraclass correlation coefficients (ICC) and kappa statistics. To examine accuracy, we compared areas under the receiver operator characteristic curve (AUC). Thirty-six participants completed 179 vignettes, 47% of which described patients with malignant nodules. Agreement between participants and models was fair for the Mayo Clinic model (ICC, 0.37; 95% confidence interval [CI], 0.23-0.50) and moderate for the Veterans Affairs model (ICC, 0.46; 95% CI, 0.34-0.57). There was no difference in accuracy between participants (AUC, 0.70; 95% CI, 0.62-0.77) and the Mayo Clinic model (AUC, 0.71; 95% CI, 0.62-0.80; P = 0.90) or the Veterans Affairs model (AUC, 0.72; 95% CI, 0.64-0.80; P = 0.54). In this vignette-based study, clinical judgment and models appeared to have similar accuracy for lung nodule characterization, but agreement between judgment and the models was modest, suggesting that qualitative and quantitative approaches may provide complementary information.

Comparison of Decision Assist and Clinical Judgment of Experts for Prediction of Lifesaving Interventions

DTIC Science & Technology

2015-03-01

min of pulse oximeter photopletysmograph waveforms and extracted features to predict LSIs. We compared this with clinical judgment of LSIs by...Curve (AUROC). We obtained clinical judgment of need for LSI from 405 expert clinicians in135 trauma patients. The pulse oximeter algorithm...15 min of pulse oximeter waveforms predicts the need for LSIs during initial trauma resuscitation as accurately as judgment of expert trauma

Adolescent Judgments and Reasoning about the Failure to Include Peers with Social Disabilities

ERIC Educational Resources Information Center

Bottema-Beutel, Kristen; Li, Zhushan

2015-01-01

Adolescents with autism spectrum disorder often do not have access to crucial peer social activities. This study examines how typically developing adolescents evaluate decisions not to include a peer based on disability status, and the justifications they apply to these decisions. A clinical interview methodology was used to elicit judgments and…

Current status of clinical education in paramedic programs: a descriptive research project.

PubMed

Grubbs, K C

1997-01-01

Development of competence in exercising therapeutic judgment skills represents the goal of clinical education. Time (clock hours) is not a valid predictor of attainment of competence in paramedic clinical education. Quantity of patient contact experiences facilitates development of judgment skills, and offers a valid measure of progress toward competence. This project uses national survey data from accredited programs to describe the availability and accessibility of patient contact experiences within paramedic clinical education. Data from this local program supplements the national survey results. The components of clinical judgment are enumerated, and strategies to teach and evaluate clinical judgment skills are discussed.

Clinical judgment, moral anxiety, and the limits of psychiatry.

PubMed

Murray, Bradley

2017-12-01

It is common for clinicians working in psychiatry and related clinical disciplines to be called on to make diagnostic clinical judgments concerning moral anxiety, which is a kind of anxiety that is closely bound up with decisions individuals face as moral agents. To make such a judgment, it is necessary to make a moral judgment. Although it has been common to acknowledge that there are ways in which moral and clinical judgment interact, this type of interaction has remained unacknowledged. This raises questions as to the nature and limits of psychiatry-particularly concerning the extent to which psychiatric discourse ought to incorporate moral discourse, and the role of the clinician as an expert in identifying problematic anxiety.

Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis.

PubMed

Victor-Chmil, Joyce

2013-01-01

Concepts of critical thinking, clinical reasoning, and clinical judgment are often used interchangeably. However, they are not one and the same, and understanding subtle difference among them is important. Following a review of the literature for definitions and uses of the terms, the author provides a summary focused on similarities and differences in the processes of critical thinking, clinical reasoning, and clinical judgment and notes suggested methods of measuring each.

Implementing psychophysiology in clinical assessments of adolescent social anxiety: use of rater judgments based on graphical representations of psychophysiology.

PubMed

De Los Reyes, Andres; Augenstein, Tara M; Aldao, Amelia; Thomas, Sarah A; Daruwala, Samantha; Kline, Kathryn; Regan, Timothy

2015-01-01

Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.

Do clinicians decide relying primarily on Bayesians principles or on Gestalt perception? Some pearls and pitfalls of Gestalt perception in medicine.

PubMed

Cervellin, Gianfranco; Borghi, Loris; Lippi, Giuseppe

2014-08-01

Clinical judgment is a foundation of medical practice and lies at the heart of a physician's knowledge, expertise and skill. Although clinical judgment is an active part of all medical fields, thus including diagnosis and therapy, communication and decision making, it is still poorly defined. It can be considered a synthesis of intuition (mainly based on Gestalt principles) and an analytical approach. Gestalt perception finds its rationale in the evidence that perception of any given object or experience exhibits intrinsic qualities that cannot be completely reduced to visual, auditory, tactile, olfactory, or gustatory components. Thus, perceptions are not constructed in a "bottom-up" fashion from such elements, but are instead globally perceived, in a more "top-down" fashion. Gestalt perception, if cautiously and carefully combined with structured (techno)logical tools, would permit one to defoliate the often too-many-branches built diagnostic trees, and help physicians to better develop their competency. On the other hand, the practice of evidence-based medicine lies in the integration of individual clinical expertise and judgment with the best available external clinical evidence from systematic research. This article is aimed at providing some general concepts about Gestalt perception, and to discuss some aspects of clinical practice potentially influenced by this approach.

Clinical Ethics Consultants are not “Ethics” Experts—But They do Have Expertise 1

PubMed Central

Rasmussen, Lisa M.

2016-01-01

The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena” (1988, 8). PMID:27302970

[Clinical judgment is a schema. Conceptual proposals and training perspectives.

PubMed

Nagels, Marc

2017-06-01

Clinical judgment is a critical concept for the development of nursing and nursing education. Its theoretical origins are multiple and its definition is not yet consensus. The analysis of the scientific and professional literature shows heterogeneous and dispersed points of views, notably on the role of intuition, on its cognitive and metacognitive dimensions, and on its proximity to other concepts. Between professional stakes and epistemological constructions, clinical judgment is still an emerging concept.To overcome the obstacle and contribute to the theoretical effort, we will argue that clinical judgment must be analyzed as a schema. It presents all the characteristics : diagnosis and information necessary for reasoning, rational decision-making process, metacognitive control and evaluation of decision-making. Perspectives then open to better understand the nursing activity.In conclusion, recommendations for developing clinical judgment in training will be presented.

Gaming as an Educational Strategy to Enhance Clinical Judgment and Knowledge Retention

ERIC Educational Resources Information Center

Lane, Jodie

2011-01-01

Classroom lecture methods in nursing education are falling short of providing long-term retention of knowledge and do not enhance problem solving skills or clinical judgment at the bedside. This problem impacts the health care recipients because applied knowledge and an enhanced skill set can provide nurses with confident clinical judgment to…

Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

PubMed

Marson, D C; Earnst, K S; Jamil, F; Bartolucci, A; Harrell, L E

2000-08-01

To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. A university medical center. Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

On assessing the quality of physicians' clinical judgment: the search for outcome variables.

PubMed

Wainer, Howard; Mee, Janet

2004-12-01

A primary question that must be resolved in the development of tasks to assess the quality of physicians' clinical judgment is, "What is the outcome variable?" One natural choice would seem to be the correctness of the clinical decision. In this article, we use data on the diagnosis of urinary tract infections among young girls to illustrate why, in many clinical situations, this is not a useful variable. We propose instead a judgment weighted by the relative costs of an error. This variable has the disadvantage of requiring expert judgment for scoring, but the advantage of measuring the construct of interest.

Clinical nursing informatics. Developing tools for knowledge workers.

PubMed

Ozbolt, J G; Graves, J R

1993-06-01

Current research in clinical nursing informatics is proceeding along three important dimensions: (1) identifying and defining nursing's language and structuring its data; (2) understanding clinical judgment and how computer-based systems can facilitate and not replace it; and (3) discovering how well-designed systems can transform nursing practice. A number of efforts are underway to find and use language that accurately represents nursing and that can be incorporated into computer-based information systems. These efforts add to understanding nursing problems, interventions, and outcomes, and provide the elements for databases from which nursing's costs and effectiveness can be studied. Research on clinical judgment focuses on how nurses (perhaps with different levels of expertise) assess patient needs, set goals, and plan and deliver care, as well as how computer-based systems can be developed to aid these cognitive processes. Finally, investigators are studying not only how computers can help nurses with the mechanics and logistics of processing information but also and more importantly how access to informatics tools changes nursing care.

Clinical Interview Assessment of Financial Capacity in Older Adults with Mild Cognitive Impairment and Alzheimer’s Disease

PubMed Central

Marson, Daniel C.; Martin, Roy C.; Wadley, Virginia; Griffith, H. Randall; Snyder, Scott; Goode, Patricia S.; Kinney, F. Cleveland; Nicholas, Anthony P.; Steele, Terri; Anderson, Britt; Zamrini, Edward; Raman, Rema; Bartolucci, Alfred; Harrell, Lindy E.

2009-01-01

Objectives To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a clinician interview approach. Design Cross-sectional. Setting Tertiary care medical center. Participants Healthy older adults (N=75), patients with amnestic MCI (N=58), mild AD (N=97), and moderate AD (N=31). Measurements The investigators and five study physicians developed a conceptually based, semi-structured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity. Results Study physicians made a total of over 11,000 capacity judgments across the study sample (N=261). Very good inter-rater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95 percent of physician judgments for older controls were rated as capable, as compared to only 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD. Conclusion Financial capacity in cognitively impaired older adults can be reliably evaluated by physicians using a relatively brief, semi-structured clinical interview. Financial capacity shows mild impairment in MCI, emerging global impairment in mild AD, and advanced global impairment in moderate AD. MCI patients and their families should proactively engage in financial and legal planning given these patients’ risk of developing AD and accelerated loss of financial abilities. PMID:19453308

Development of a Self-Management Theory-Guided Discharge Intervention for Parents of Hospitalized Children.

PubMed

Sawin, Kathleen J; Weiss, Marianne E; Johnson, Norah; Gralton, Karen; Malin, Shelly; Klingbeil, Carol; Lerret, Stacee M; Thompson, Jamie J; Zimmanck, Kim; Kaul, Molly; Schiffman, Rachel F

2017-03-01

Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention. © 2017 Sigma Theta Tau International.

The ADA's practice parameters.

PubMed

Ellek, Donalda M

2005-01-01

The ADA parameters of care have served the needs of practicing dentists for fifteen years. Their purpose is to describe a range of treatment options that dentists will want to consider, in combination with particular clinical conditions and patient preferences. These options have been developed based on available evidence and a consensus of professional judgment. The ADA has exercised concern that parameters not be used, out of the context of individual professional judgment, for policy purposes.

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective.

PubMed

Cipoli, Daniel E; Martinez, Edson Z; Castro, Margaret de; Moreira, Ayrton C

2012-12-01

To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS.

Application of a Judgment Model toward Measurement of Clinical Judgment in Senior Nursing Students

ERIC Educational Resources Information Center

Pongmarutai, Tiwaporn

2010-01-01

Clinical judgment, defined as "the application of the nurse's knowledge and experience in making decisions about client care" (The National Council of State Boards of Nursing, 2005, p. 2), has been recognized as a vital and essential skill for healthcare providers when caring for clients. Undisputedly, nurses represent the largest…

Futility and the varieties of medical judgment.

PubMed

Sulmasy, D P

1997-01-01

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the "circumspect" view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine-an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.

A framework to support preceptors' evaluation and development of new nurses' clinical judgment.

PubMed

Nielsen, Ann; Lasater, Kathie; Stock, Mary

2016-07-01

In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nurses' Judgment as They Care for Persons Who Exhibit Impaired Judgment: A Phenomenonological Study.

ERIC Educational Resources Information Center

Doona, Mary Ellen

1995-01-01

A study looked at the process by which psychiatric nurses (n=6) make judgments as they care for people with impaired judgment. Results revealed an overarching theme--judgment as personal responsibility--and four major themes: closeness to clinical data, critical reflection, respect for one's knowledge and ignorance, and the existential nature of…

Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.

PubMed

Fawaz, Mirna A; Hamdan-Mansour, Ayman M

2016-11-01

High-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students. The purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students. A post-test, quasi-experimental design was used. Two private universities in Lebanon were targeted to implement the intervention. A convenience sample of 56 nursing students from two private universities in Lebanon were recruited. Data were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires. Nursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t=5.23, p<0.001) and motivation for academic achievement (t=-6.71, p<0.001). The intervention group had a higher mean score of clinical judgment (29.5, SD=5.4) than the control group (22.1, SD=5.7) and, similarly, students had higher mean scores of motivation (198.6, SD=10.5) in the intervention group than in the control group (161.6, SD=20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda =0.77, F=1.09, p=0.374). There is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing risk of reoffending in adolescents who have committed a sexual offense: the accuracy of clinical judgments after completion of risk assessment instruments.

PubMed

Elkovitch, Natasha; Viljoen, Jodi L; Scalora, Mario J; Ullman, Daniel

2008-01-01

As courts often rely on clinicians when differentiating between sexually abusive youth at a low versus high risk of reoffense, understanding factors that contribute to accuracy in assessment of risk is imperative. The present study built on existing research by examining (1) the accuracy of clinical judgments of risk made after completing risk assessment instruments, (2) whether instrument-informed clinical judgments made with a high degree of confidence are associated with greater accuracy, and (3) the risk assessment instruments and subscales most predictive of clinical judgments. Raters assessed each youth's (n = 166) risk of reoffending after completing the SAVRY and J-SOAP-II. Raters were not able to predict detected cases of either sexual recidivism or nonsexual violent recidivism above chance, and a high degree of rater confidence was not associated with higher levels of accuracy. Total scores on the J-SOAP-II were predictive of instrument-informed clinical judgments of sexual risk, and total scores on the SAVRY of nonsexual risk.

The tacit dimension of clinical judgment.

PubMed Central

Goldman, G. M.

1990-01-01

Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered. PMID:2356625

Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels.

PubMed

Formby, Craig; Payne, JoAnne; Yang, Xin; Wu, Delphanie; Parton, Jason M

2017-02-01

This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable , and loud, but OK (tolerable) sound inputs for the individual listener.

Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

PubMed Central

Formby, Craig; Payne, JoAnne; Yang, Xin; Wu, Delphanie; Parton, Jason M.

2017-01-01

This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable, and loud, but OK (tolerable) sound inputs for the individual listener. PMID:28286363

Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

PubMed Central

Brehaut, Jamie C; Poses, Roy; Shojania, Kaveh G; Lott, Alison; Man-Son-Hing, Malcolm; Bassin, Elise; Grimshaw, Jeremy

2007-01-01

Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1) prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2) initiation of anticoagulation for patients with atrial fibrillation (AF), where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2) to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes) for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be able to identify which variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey), and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey), for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete. Discussion This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments. PMID:17555586

Can physician examiners overcome their first impression when examinee performance changes?

PubMed

Wood, Timothy J; Pugh, Debra; Touchie, Claire; Chan, James; Humphrey-Murto, Susan

2018-03-20

There is an increasing focus on factors that influence the variability of rater-based judgments. First impressions are one such factor. First impressions are judgments about people that are made quickly and are based on little information. Under some circumstances, these judgments can be predictive of subsequent decisions. A concern for both examinees and test administrators is whether the relationship remains stable when the performance of the examinee changes. That is, once a first impression is formed, to what degree will an examiner be willing to modify it? The purpose of this study is to determine the degree that first impressions influence final ratings when the performance of examinees changes within the context of an objective structured clinical examination (OSCE). Physician examiners (n = 29) viewed seven videos of examinees (i.e., actors) performing a physical exam on a single OSCE station. They rated the examinees' clinical abilities on a six-point global rating scale after 60 s (first impression or FIGR). They then observed the examinee for the remainder of the station and provided a final global rating (GRS). For three of the videos, the examinees' performance remained consistent throughout the videos. For two videos, examinee performance changed from initially strong to weak and for two videos, performance changed from initially weak to strong. The mean FIGR rating for the Consistent condition (M = 4.80) and the Strong to Weak condition (M = 4.87) were higher compared to their respective GRS ratings (M = 3.93, M = 2.73) with a greater decline for the Strong to Weak condition. The mean FIGR rating for the Weak to Strong condition was lower (3.60) than the corresponding mean GRS (4.81). This pattern of findings suggests that raters were willing to change their judgments based on examinee performance. Future work should explore the impact of making a first impression judgment explicit versus implicit and the role of context on the relationship between a first impression and a subsequent judgment.

Clinicians’ Personal Theories of Developmental Disorders Explain Their Judgments of Effectiveness of Interventions

PubMed Central

de Kwaadsteniet, Leontien; Hagmayer, York

2017-01-01

Evidence-based psychotherapy requires clinicians to consider theories of psychopathology and evidence about effectiveness, and their experience when choosing interventions. Research on clinical decision making indicates that clinicians’ theories of disorders might be personal and inform judgments and choices beyond current scientific theory and evidence. We asked 20 child therapists to draw models of how they believed that biological, psychological, environmental, and behavioral factors interact to cause and maintain four common developmental disorders. They were also asked to judge the effectiveness of interventions recommended in the literature. Therapists showed only fair agreement about the factors and a slight to fair agreement about the causal relations between these, and just fair agreement about interventions’ effectiveness. Despite these disagreements, we could predict effectiveness judgments from therapists’ personal theories, which indicates that clinicians use personal theories in decision making. We discuss the implications of these findings for evidence-based practice. PMID:29527408

Physiotherapy Student Clinical Examinations: The Influence of Subjective Judgments on Observational Assessment.

ERIC Educational Resources Information Center

Alexander, Helen A.

1996-01-01

A study investigated the role of subjective assessment in the evaluation of physiotherapy students in clinical programs. Clinical teachers, visiting lecturers, and students recorded perceptions of daily events and interactions in journals. Analysis suggests that assessors make subjective judgments about students that influence grades, and…

Learning to think like a nurse: stories from new nurse graduates.

PubMed

Etheridge, Sharon A

2007-01-01

One aim of nursing education is to help students learn to be beginning practitioners, which includes making clinical judgments that ensure patient safety. Clinical judgments often determine how quickly nurses detect a life-threatening complication, how soon patients leave the hospital, or how quickly patients learn to take care of themselves. However, current research shows that new graduates do not perform well when making clinical judgments, despite having graduated from accredited schools of nursing and passing the NCLEX examination. This descriptive, qualitative study examined the perceptions of recent nursing graduates about learning to make clinical judgments. Graduates with baccalaureate degrees in nursing were interviewed three times in 9 months to determine their perceptions of how they learned to think like nurses. The results of this study should be useful in identifying strategies to help new graduates make the transition from students to registered nurses.

Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

PubMed

Earnst, K S; Marson, D C; Harrell, L E

2000-08-01

To investigate measures of patient cognitive abilities as predictors of physician judgments of medical treatment consent capacity (competency) in patients with Alzheimer's disease (AD). Predictor models of legal standards (LS) and personal competency judgments were developed for each study physician using independent neuropsychological test measures and logistic regression analyses. A university medical center. Five physicians with experience assessing the competency of AD patients were recruited to make competency judgments of videotaped vignettes from 10 older controls and 21 patients with AD (10 with mild and 11 with moderate dementia). The 31 patient and control videotapes of performance on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI) were rated by the five physicians. The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Each study physician viewed each vignette videotape individually, made judgments of competent or incompetent under each of the LS, and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis and neuropsychological test performance. Stepwise logistic regression was conducted to identify cognitive predictors of each physician's LS and personal competency judgments for Vignette A using the full sample (n = 31). Classification logistic regression analysis was used to determine how well these cognitive predictor models classified each physician's competency judgments for Vignette A. These classification models were then cross-validated using physician's Vignette B judgments. Cognitive predictor models for Vignette A competency judgments differed across individual physicians, and were related to difficulty of LS and to incompetency outcome rates across LS for AD patients. Measures of semantic knowledge and receptive language predicted judgments under less difficult LS of evidencing a treatment choice (LS1) and making the reasonable treatment choice (LS2). Measures of semantic knowledge, short-term verbal recall, and simple reasoning ability predicted judgments under more difficult and clinically relevant LS of appreciating consequences of a treatment choice (LS3), providing rational reasons for a treatment choice (LS4), and understanding the treatment situation and choices (LSS). Cognitive models for physicians' personal competency judgments were virtually identical to their respective models for LS5 judgments. For AD patients, shortterm memory predictors were associated with high incompetency outcome rates (over 70%), a simple reasoning measure was associated with moderately high incompetency outcome rates (60-70%), and a semantic knowledge measure was associated with lower incompetency outcome rates (30-60%). Overall, single predictor models were relatively robust, correctly classifying an average of 83% of physician judgments for Vignette A and 80% of judgments for Vignette B. Multiple cognitive functions predicted physicians' LS and personal competency judgments. Declines in semantic knowledge, short-term verbal recall, and simple reasoning ability predicted physicians' judgments on the three most difficult and clinically most relevant LS (LS3-LS5), as well as their personal competency judgments. Our findings suggest that clinical assessment of competency should include evaluation of semantic knowledge, verbal recall, and simple reasoning abilities.

Original research in pathology: judgment, or evidence-based medicine?

PubMed

Crawford, James M

2007-02-01

Pathology is both a medical specialty and an investigative scientific discipline, concerned with understanding the essential nature of human disease. Ultimately, pathology is accountable as well, as measured by the accuracy of our diagnoses and the resultant patient care outcomes. As such, we must consider the evidence base underlying our practices. Within the realm of Laboratory Medicine, extensive attention has been given to testing accuracy and precision. Critical examination of the evidence base supporting the clinical use of specific laboratory tests or technologies is a separate endeavor, to which specific attention must be given. In the case of anatomic pathology and more specifically surgical pathology, the expertise required to render a diagnosis is derived foremost from experience, both personal and literature-based. In the first instance, knowledge of the linkage between one's own diagnoses and individual patient outcomes is required, to validate the role of one's own interpretations in the clinical course of patients. Experience comes from seeing this linkage first hand, from which hopefully comes wisdom and, ultimately, good clinical judgment. In the second instance, reading the literature and learning from experts is required. Only a minority of the relevant literature is published in pathology journals to which one may subscribe. A substantial portion of major papers relevant to the practice of anatomic pathology are published in collateral clinical specialty journals devoted to specific disease areas or organs. Active effort is therefore required to seek out the literature beyond the domain of pathology journals. In examining the published literature, the essential question then becomes: Does the practice of anatomic pathology fulfill the tenets of 'evidence-based medicine' (EBM)? If the pinnacle of EBM is 'systematic review of randomized clinical trials, with or without meta-analysis', then anatomic pathology falls far short. Our published literature is largely observational in nature, with reports of case series (with or without statistical analysis) constituting the majority of our 'evidence base'. Moreover, anatomic pathology is subject to 'interobserver variation', and potentially to 'error'. Taken further, individual interpretation of tissue samples is not an objective endeavor, and it is not easy to fulfill the role of a 'gold standard'. Both for rendering of an overall interpretation, and for providing the semi-quantitative and quantitative numerical 'scores' which support evidence-based clinical treatment algorithms, the Pathologist has to exercise a high level of interpretive judgment. Nevertheless, the contribution of anatomic pathology to 'EBM' is remarkably strong. To the extent that our judgmental interpretations become data, our tissue interpretations become the arbiters of patient care management decisions. In a more global sense, we support highly successful cancer screening programs, and play critical roles in the multidisciplinary management of complex patients. The true error is for the clinical practitioners of 'EBM' to forget the contribution to the supporting evidence base of the physicians that are Anatomic Pathologists. Finally, the academic productivity of pathology faculty who operate in the clinical realm must be considered. A survey of six North American academic pathology departments reveals that 26% of all papers published in 2005 came from 'unfunded' clinical faculty. While it is likely that their academic productivity is lower than that of 'funded' research faculty, the contribution of clinical faculty to the knowledge base for the practice of modern medicine, and to the academic reputation of the department, must not be overlooked. The ability of clinical faculty in academic departments of pathology to pursue original scholarship must be supported if our specialty is to retain its preeminence as an investigative scientific discipline in the age of EBM.

Effects of LifeSkills Training on Medical Students' Performance in Dealing with Complex Clinical Cases

ERIC Educational Resources Information Center

Campo, Ana E.; Williams, Virginia; Williams, Redford B.; Segundo, Marisol A.; Lydston, David; Weiss, Stephen M.'

2008-01-01

Objective: Sound clinical judgment is the cornerstone of medical practice and begins early during medical education. The authors consider the effect of personality characteristics (hostility, anger, cynicism) on clinical judgment and whether a brief intervention can affect this process. Methods: Two sophomore medical classes (experimental,…

The Relationship of Critical-Thinking Skills and the Clinical-Judgment Skills of Baccalaureate Nursing Students.

ERIC Educational Resources Information Center

Bowles, Kathleen

2000-01-01

Nursing graduates (n=65) completed a critical thinking instrument and clinical decision-making scale. The critical thinking subscales of inference and inductive reasoning were positively correlated to clinical judgment. A significant relationship was found between critical thinking score and grade point average in nursing. (SK)

Probative value of absolute and relative judgments in eyewitness identification.

PubMed

Clark, Steven E; Erickson, Michael A; Breneman, Jesse

2011-10-01

It is well-accepted that eyewitness identification decisions based on relative judgments are less accurate than identification decisions based on absolute judgments. However, the theoretical foundation for this view has not been established. In this study relative and absolute judgments were compared through simulations of the WITNESS model (Clark, Appl Cogn Psychol 17:629-654, 2003) to address the question: Do suspect identifications based on absolute judgments have higher probative value than suspect identifications based on relative judgments? Simulations of the WITNESS model showed a consistent advantage for absolute judgments over relative judgments for suspect-matched lineups. However, simulations of same-foils lineups showed a complex interaction based on the accuracy of memory and the similarity relationships among lineup members.

Factors Influencing Mini-CEX Rater Judgments and Their Practical Implications: A Systematic Literature Review.

PubMed

Lee, Victor; Brain, Keira; Martin, Jenepher

2017-06-01

At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors. The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study. Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation). The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.

Pillars of judgment: how memory abilities affect performance in rule-based and exemplar-based judgments.

PubMed

Hoffmann, Janina A; von Helversen, Bettina; Rieskamp, Jörg

2014-12-01

Making accurate judgments is an essential skill in everyday life. Although how different memory abilities relate to categorization and judgment processes has been hotly debated, the question is far from resolved. We contribute to the solution by investigating how individual differences in memory abilities affect judgment performance in 2 tasks that induced rule-based or exemplar-based judgment strategies. In a study with 279 participants, we investigated how working memory and episodic memory affect judgment accuracy and strategy use. As predicted, participants switched strategies between tasks. Furthermore, structural equation modeling showed that the ability to solve rule-based tasks was predicted by working memory, whereas episodic memory predicted judgment accuracy in the exemplar-based task. Last, the probability of choosing an exemplar-based strategy was related to better episodic memory, but strategy selection was unrelated to working memory capacity. In sum, our results suggest that different memory abilities are essential for successfully adopting different judgment strategies. PsycINFO Database Record (c) 2014 APA, all rights reserved.

The Practicum Script Concordance Test: An Online Continuing Professional Development Format to Foster Reflection on Clinical Practice

ERIC Educational Resources Information Center

Hornos, Eduardo H.; Pleguezuelos, Eduardo M.; Brailovsky, Carlos A.; Harillo, Leandro D.; Dory, Valerie; Charlin, Bernard

2013-01-01

Introduction: Judgment in the face of uncertainty is an important dimension of expertise and clinical competence. However, it is challenging to conceive continuing professional development (CPD) initiatives aimed at helping physicians enhance their clinical judgment skills in ill-defined situations. We present an online script concordance-based…

Medicine and the call for a moral epistemology, part II: constructing a synthesis of values.

PubMed

Tauber, Alfred I

2008-01-01

The demands and needs of an individual patient require diverse value judgments to interpret and apply clinical data. Indeed, objective assessment takes on particular meaning in the context of the social and existential status of the patient, and thereby a complex calculus of values determines therapeutic goals. I have previously formulated how this moral thread of care becomes woven into the epistemological project as a "moral epistemology." Having argued its ethical justification elsewhere, I offer another perspective here: clinical choices employ diverse values directed at an array of goals, some of which are derived from a universal clinical science and others from the particular physiological, psychological, and social needs of the patient. Integrating these diverse elements that determine clinical care requires a complex synthesis of facts and judgments from several domains. This constructivist process relies on clinical facts, as well as on personal judgments and subjective assessments in an ongoing negotiation between patient and doctor. A philosophy of medicine must account for the conceptual basis of this process by identifying and addressing the judgments that govern the complex synthesis of these various elements.

Do social utility judgments influence attentional processing?

PubMed

Shore, Danielle M; Heerey, Erin A

2013-10-01

Research shows that social judgments influence decision-making in social environments. For example, judgments about an interaction partners' trustworthiness affect a variety of social behaviors and decisions. One mechanism by which social judgments may influence social decisions is by biasing the automatic allocation of attention toward certain social partners, thereby shaping the information people acquire. Using an attentional blink paradigm, we investigate how trustworthiness judgments alter the allocation of attention to social stimuli in a set of two experiments. The first experiment investigates trustworthiness judgments based solely on a social partner's facial appearance. The second experiment examines the effect of trustworthiness judgments based on experienced behavior. In the first, strong appearance-based judgments (positive and negative) enhanced stimulus recognizability but did not alter the size of the attentional blink, suggesting that appearance-based social judgments enhance face memory but do not affect pre-attentive processing. However, in the second experiment, in which judgments were based on behavioral experience rather than appearance, positive judgments enhanced pre-attentive processing of trustworthy faces. This suggests that a stimulus's potential benefits, rather than its disadvantages, shape the automatic distribution of attentional resources. These results have implications for understanding how appearance- and behavior-based social cues shape attention distribution in social environments. Copyright © 2013 Elsevier B.V. All rights reserved.

Modelling category goodness judgments in children with residual sound errors.

PubMed

Dugan, Sarah Hamilton; Silbert, Noah; McAllister, Tara; Preston, Jonathan L; Sotto, Carolyn; Boyce, Suzanne E

2018-05-24

This study investigates category goodness judgments of /r/ in adults and children with and without residual speech errors (RSEs) using natural speech stimuli. Thirty adults, 38 children with RSE (ages 7-16) and 35 age-matched typically developing (TD) children provided category goodness judgments on whole words, recorded from 27 child speakers, with /r/ in various phonetic environments. The salient acoustic property of /r/ - the lowered third formant (F3) - was normalized in two ways. A logistic mixed-effect model quantified the relationships between listeners' responses and the third formant frequency, vowel context and clinical group status. Goodness judgments from the adult group showed a statistically significant interaction with the F3 parameter when compared to both child groups (p < 0.001) using both normalization methods. The RSE group did not differ significantly from the TD group in judgments of /r/. All listeners were significantly more likely to judge /r/ as correct in a front-vowel context. Our results suggest that normalized /r/ F3 is a statistically significant predictor of category goodness judgments for both adults and children, but children do not appear to make adult-like judgments. Category goodness judgments do not have a clear relationship with /r/ production abilities in children with RSE. These findings may have implications for clinical activities that include category goodness judgments in natural speech, especially for recorded productions.

Learning to think like a nurse: the development of clinical judgment in nursing students.

PubMed

Ashley, Jane; Stamp, Kelly

2014-09-01

The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study. Copyright 2014, SLACK Incorporated.

Advances in the assessment and prediction of interpersonal violence.

PubMed

Mills, Jeremy F

2005-02-01

This article underscores the weakness of clinical judgment as a mechanism for prediction with examples from other areas in the psychological literature. Clinical judgment has as its Achilles'heel the reliance on a person to incorporate multiple pieces of information while overcoming human judgment errors--a feat insurmountable thus far. The actuarial approach to risk assessment has overcome many of the weaknesses of clinical judgment and has been shown to be a much superior method. Nonetheless, the static/historical nature of the risk factors associated with most actuarial approaches is limiting. Advances in risk prediction will be found in part in the development of dynamic actuarial instruments that will measure both static/historical and changeable risk factors. The dynamic risk factors can be reevaluated on an ongoing basis, and it is proposed that the level of change in dynamic factors necessary to represent a significant change in overall risk will be an interactive function with static risk factors.

Deciphering the use and predictive value of "emergency medical services provider judgment" in out-of-hospital trauma triage: a multisite, mixed methods assessment.

PubMed

Newgard, Craig D; Kampp, Michael; Nelson, Maria; Holmes, James F; Zive, Dana; Rea, Thomas; Bulger, Eileen M; Liao, Michael; Sherck, John; Hsia, Renee Y; Wang, N Ewen; Fleischman, Ross J; Barton, Erik D; Daya, Mohamud; Heineman, John; Kuppermann, Nathan

2012-05-01

"Emergency medical services (EMS) provider judgment" was recently added as a field triage criterion to the national guidelines, yet its predictive value and real world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in five regions across the Western United States from 2006 to 2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for Injury Severity Score ≥ 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio of Injury Severity Score ≥ 16 for EMS provider judgment was 1.23 (95% confidence interval, 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Among this multisite cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, independently associated with serious injury, and useful in identifying high-risk patients missed by other criteria. However, there was variability in predictive value between sites.

Proportionate Responses to Life Events Influence Clinicians’ Judgments Of Psychological Abnormality

PubMed Central

Kim, Nancy S.; Paulus, Daniel J.; Gonzalez, Jeffrey S.; Khalife, Danielle

2012-01-01

Psychological abnormality is a fundamental concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person’s current behaviors? The appropriate role of life-event context in assessment has long been the subject of intense debate and scrutiny among clinical theorists, yet relatively little is known about clinicians’ own judgments in practice. We propose a proportionate-response hypothesis, such that judgments of abnormality are influenced by whether the behaviors are a disproportionate response to past events, rendering them difficult to understand or explain. We presented licensed, practicing clinical psychologists (N=77) with vignettes describing hypothetical people’s behaviors (disordered, mildly distressed, or unaffected) that had been preceded by either traumatic or mildly distressing events. Experts’ judgments of abnormality were strongly and systematically influenced by the degree of mismatch between the past event and current behaviors in strength and valence, such that the greater the mismatch, the more abnormal the person seemed. A separate, additional group of clinical psychologists (N=20) further confirmed that the greater the degree of mismatch, the greater the perceived difficulty in understanding the patient. These findings held true across clinicians of different theoretical orientations and in disorders for which these patterns of judgments ran contrary to formal recommendations in the DSM-IV-TR (APA, 2000). The rationality of these effects and implications for clinical decision science are discussed. PMID:22142425

Clinical judgment research on economic topics: Role of congruence of tasks in clinical practice.

PubMed

Huttin, Christine C

2017-01-01

This paper discusses what can ensure the performance of judgment studies with an information design that integrates economics of medical systems, in the context of digitalization of healthcare. It is part of a series of 5 methodological papers on statistical procedures and problems to implement judgment research designs and decision models, especially to address cost of care, and ways to measure conversation on cost of care between physicians and patients, with unstructured data such as economic narratives to complement billing and financial information (e.g. cost cognitive cues in conjoint or reversed conjoint designs). The paper discusses how congruence of tasks can increase the reliability of data. It uses some results of two Meta reviews of judgment studies in different fields of applications: psychology, business, medical sciences and education. It compares tests for congruence in judgment studies and efficiency tests in econometric studies.

Medical Students' Development of Ethical Judgment - Exploring the Learners' Perspectives using a mixed methods approach.

PubMed

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students' perspectives on their development in ethical judgment has received less attention. Better insights in the learners' experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient's parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant's preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants' responses changed overtime. Accepting parents' autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents' decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students.

Medical Students’ Development of Ethical Judgment – Exploring the Learners’ Perspectives using a mixed methods approach

PubMed Central

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W.

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students’ perspectives on their development in ethical judgment has received less attention. Better insights in the learners’ experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient’s parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant’s preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants’ responses changed overtime. Accepting parents’ autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents’ decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students. PMID:27990470

Suicide in Children Younger than Age Fourteen: Clinical Judgment and Assessment Issues.

ERIC Educational Resources Information Center

Wise, Amy J.; Spengler, Paul M.

1997-01-01

Discusses the importance of accurate information about childhood suicide to prevent clinical judgment errors. Describes available methods for evaluating suicide risk in children. Looks at myths and misconceptions surrounding childhood suicide; risk factors, such as family dysfunction and distress; and evaluation techniques, such as interviews and…

Simulation and the Development of Clinical Judgment: A Quantitative Study

ERIC Educational Resources Information Center

Holland, Susan

2015-01-01

The purpose of this quantitative pretest posttest quasi-experimental research study was to explore the effect of the NESD on clinical judgment in associate degree nursing students and compare the differences between groups when the Nursing Education Simulation Design (NESD) guided simulation in order to identify educational strategies promoting…

The Validity of Computer Audits of Simulated Cases Records.

ERIC Educational Resources Information Center

Rippey, Robert M.; And Others

This paper describes the implementation of a computer-based approach to scoring open-ended problem lists constructed to evaluate student and practitioner clinical judgment from real or simulated records. Based on 62 previously administered and scored problem lists, the program was written in BASIC for a Heathkit H11A computer (equivalent to DEC…

Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

ERIC Educational Resources Information Center

Stapleton, Drue; Hawkins, Andrew

2015-01-01

Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

Assessing severity of patients with community-acquired pneumonia.

PubMed

Pereira, Jose Manuel; Paiva, Jose Artur; Rello, Jordi

2012-06-01

Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. Based on 30 day mortality, several prediction rules have been proposed to aid clinicians in deciding on the appropriate site of care. In spite of being well validated, their sensitivity and specificity vary, which limits their widespread use. The utility of biomarkers to overcome this problem has been investigated. At this moment, their full clinical value remains undetermined, and no single biomarker is consistently ideal for assessing CAP severity. Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Key factors in children's competence to consent to clinical research.

PubMed

Hein, Irma M; Troost, Pieter W; Lindeboom, Robert; Benninga, Marc A; Zwaan, C Michel; van Goudoever, Johannes B; Lindauer, Ramón J L

2015-10-24

Although law is established on a strong presumption that persons younger than a certain age are not competent to consent, statutory age limits for asking children's consent to clinical research differ widely internationally. From a clinical perspective, competence is assumed to involve many factors including the developmental stage, the influence of parents and peers, and life experience. We examined potential determining factors for children's competence to consent to clinical research and to what extent they explain the variation in competence judgments. From January 1, 2012 through January 1, 2014, pediatric patients aged 6 to 18 years, eligible for clinical research studies were enrolled prospectively at various in- and outpatient pediatric departments. Children's competence to consent was assessed by MacArthur Competence Assessment Tool for Clinical Research. Potential determining child variables included age, gender, intelligence, disease experience, ethnicity and socio-economic status (SES). We used logistic regression analysis and change in explained variance in competence judgments to quantify the contribution of a child variable to the total explained variance. Contextual factors included risk and complexity of the decision to participate, parental competence judgment and the child's or parents decision to participate. Out of 209 eligible patients, 161 were included (mean age, 10.6 years, 47.2 % male). Age, SES, intelligence, ethnicity, complexity, parental competence judgment and trial participation were univariately associated with competence (P < 0.05). Total explained variance in competence judgments was 71.5 %. Only age and intelligence significantly and independently explained the variance in competence judgments, explaining 56.6 % and 12.7 % of the total variance respectively. SES, male gender, disease experience and ethnicity each explained less than 1 % of the variance in competence judgments. Contextual factors together explained an extra 2.8 % (P > 0.05). Age is the factor that explaines most of to the variance in children's competence to consent, followed by intelligence. Experience with disease did not affect competence in this study, nor did other variables. Development and use of a standardized instrument for assessing children's competence to consent in drug trials: Are legally established age limits valid?, NTR3918.

Beyond "utilitarianism": maximizing the clinical impact of moral judgment research.

PubMed

Rosas, Alejandro; Koenigs, Michael

2014-01-01

The use of hypothetical moral dilemmas--which pit utilitarian considerations of welfare maximization against emotionally aversive "personal" harms--has become a widespread approach for studying the neuropsychological correlates of moral judgment in healthy subjects, as well as in clinical populations with social, cognitive, and affective deficits. In this article, we propose that a refinement of the standard stimulus set could provide an opportunity to more precisely identify the psychological factors underlying performance on this task, and thereby enhance the utility of this paradigm for clinical research. To test this proposal, we performed a re-analysis of previously published moral judgment data from two clinical populations: neurological patients with prefrontal brain damage and psychopathic criminals. The results provide intriguing preliminary support for further development of this assessment paradigm.

Neuropsychological Correlates of Capacity Determinations in Alzheimer’s Disease: Implications for Assessment

PubMed Central

Palmer, Barton W.; Ryan, Kerry A.; Kim, H. Myra; Karlawish, Jason H.; Appelbaum, Paul S.; Kim, Scott Y. H.

2011-01-01

Objectives To explore the neuropsychological correlates of the capacity to consent to research and to appoint a research proxy among persons with Alzheimer’s disease. Design, Setting, and Participants Interview study of 77 persons with Alzheimer’s disease recruited through an Alzheimer’s disease research center and a memory disorder clinic. Measurements The capacity to consent to two research scenarios (a drug randomized clinical trial and a neurosurgical clinical trial) and the capacity to appoint a research proxy were determined by five experienced consultation psychiatrists who rendered categorical judgments based on videotaped interviews of the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) and the Capacity to Appoint a Proxy Assessment (CAPA). Mattis Dementia Rating Scale-2 (DRS-2) was used to assess neuropsychological functioning. Results The capacity to appoint a proxy and to consent to the drug randomized clinical trial, as determined by a majority or greater opinion of the 5-psychiatrist panel, were predicted by Conceptualization and Initiation/Perseveration subscales whereas the capacity to consent to a neurosurgical randomized clinical trial was predicted by the Memory subscale. Furthermore, the more lenient individual psychiatrists’ judgments were predicted by the Conceptualization subscale whereas the stricter psychiatrists’ judgments were predicted by the Memory subscale. Conclusions How experienced psychiatrists view Alzheimer’s patients’ capacity for consenting to research and for appointing a proxy may be related to the patients’ conceptualization and memory functioning. More explicit and standardized guidance on the role of short term memory in capacity determinations may be useful. PMID:23498384

Diagnosing Flu

MedlinePlus

... your symptoms and their clinical judgment. Will my health care provider test me for flu if I have flu-like ... with flu symptoms are not tested because the test results usually do not change how you are treated. Your health care provider may diagnose you with flu based on ...

Deliberation's blindsight: how cognitive load can improve judgments.

PubMed

Hoffmann, Janina A; von Helversen, Bettina; Rieskamp, Jörg

2013-06-01

Multitasking poses a major challenge in modern work environments by putting the worker under cognitive load. Performance decrements often occur when people are under high cognitive load because they switch to less demanding--and often less accurate--cognitive strategies. Although cognitive load disturbs performance over a wide range of tasks, it may also carry benefits. In the experiments reported here, we showed that judgment performance can increase under cognitive load. Participants solved a multiple-cue judgment task in which high performance could be achieved by using a similarity-based judgment strategy but not by using a more demanding rule-based judgment strategy. Accordingly, cognitive load induced a shift to a similarity-based judgment strategy, which consequently led to more accurate judgments. By contrast, shifting to a similarity-based strategy harmed judgments in a task best solved by using a rule-based strategy. These results show how important it is to consider the cognitive strategies people rely on to understand how people perform in demanding work environments.

Effects of Age Expectations on Oncology Social Workers' Clinical Judgment

ERIC Educational Resources Information Center

Conlon, Annemarie; Choi, Namkee G.

2014-01-01

Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent's age…

Neural substrates of similarity and rule-based strategies in judgment

PubMed Central

von Helversen, Bettina; Karlsson, Linnea; Rasch, Björn; Rieskamp, Jörg

2014-01-01

Making accurate judgments is a core human competence and a prerequisite for success in many areas of life. Plenty of evidence exists that people can employ different judgment strategies to solve identical judgment problems. In categorization, it has been demonstrated that similarity-based and rule-based strategies are associated with activity in different brain regions. Building on this research, the present work tests whether solving two identical judgment problems recruits different neural substrates depending on people's judgment strategies. Combining cognitive modeling of judgment strategies at the behavioral level with functional magnetic resonance imaging (fMRI), we compare brain activity when using two archetypal judgment strategies: a similarity-based exemplar strategy and a rule-based heuristic strategy. Using an exemplar-based strategy should recruit areas involved in long-term memory processes to a larger extent than a heuristic strategy. In contrast, using a heuristic strategy should recruit areas involved in the application of rules to a larger extent than an exemplar-based strategy. Largely consistent with our hypotheses, we found that using an exemplar-based strategy led to relatively higher BOLD activity in the anterior prefrontal and inferior parietal cortex, presumably related to retrieval and selective attention processes. In contrast, using a heuristic strategy led to relatively higher activity in areas in the dorsolateral prefrontal and the temporal-parietal cortex associated with cognitive control and information integration. Thus, even when people solve identical judgment problems, different neural substrates can be recruited depending on the judgment strategy involved. PMID:25360099

Children's Facial Trustworthiness Judgments: Agreement and Relationship with Facial Attractiveness.

PubMed

Ma, Fengling; Xu, Fen; Luo, Xianming

2016-01-01

This study examined developmental changes in children's abilities to make trustworthiness judgments based on faces and the relationship between a child's perception of trustworthiness and facial attractiveness. One hundred and one 8-, 10-, and 12-year-olds, along with 37 undergraduates, were asked to judge the trustworthiness of 200 faces. Next, they issued facial attractiveness judgments. The results indicated that children made consistent trustworthiness and attractiveness judgments based on facial appearance, but with-adult and within-age agreement levels of facial judgments increased with age. Additionally, the agreement levels of judgments made by girls were higher than those by boys. Furthermore, the relationship between trustworthiness and attractiveness judgments increased with age, and the relationship between two judgments made by girls was closer than those by boys. These findings suggest that face-based trait judgment ability develops throughout childhood and that, like adults, children may use facial attractiveness as a heuristic cue that signals a stranger's trustworthiness.

Clinical Intuition in Family Medicine: More Than First Impressions

PubMed Central

Woolley, Amanda; Kostopoulou, Olga

2013-01-01

PURPOSE The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician’s mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine. METHODS Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) participants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judgments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types. RESULTS Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ = 0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do. CONCLUSIONS Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the different types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed. PMID:23319507

Clinical intuition in family medicine: more than first impressions.

PubMed

Woolley, Amanda; Kostopoulou, Olga

2013-01-01

The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician's mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine. Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) participants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judgments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types. Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ = 0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do. Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the different types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed.

Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment

PubMed Central

Benjamin, Daniel K.; Stoll, Barbara J.; Gantz, Marie G.; Walsh, Michele C.; Sanchez, Pablo J.; Das, Abhik; Shankaran, Seetha; Higgins, Rosemary D.; Auten, Kathy J.; Miller, Nancy A.; Walsh, Thomas J.; Laptook, Abbot R.; Carlo, Waldemar A.; Kennedy, Kathleen A.; Finer, Neil N.; Duara, Shahnaz; Schibler, Kurt; Chapman, Rachel L.; Van Meurs, Krisa P.; Frantz, Ivan D.; Phelps, Dale L.; Poindexter, Brenda B.; Bell, Edward F.; O’Shea, T. Michael; Watterberg, Kristi L.; Goldberg, Ronald N.

2011-01-01

OBJECTIVE Invasive candidiasis is a leading cause of infection-related morbidity and mortality in extremely low-birth-weight (<1000 g) infants. We quantify risk factors predicting infection in high-risk premature infants and compare clinical judgment with a prediction model of invasive candidiasis. METHODS The study involved a prospective observational cohort of infants <1000 g birth weight at 19 centers of the NICHD Neonatal Research Network. At each sepsis evaluation, clinical information was recorded, cultures obtained, and clinicians prospectively recorded their estimate of the probability of invasive candidiasis. Two models were generated with invasive candidiasis as their outcome: 1) potentially modifiable risk factors and 2) a clinical model at time of blood culture to predict candidiasis. RESULTS Invasive candidiasis occurred in 137/1515 (9.0%) infants and was documented by positive culture from ≥ 1 of these sources: blood (n=96), cerebrospinal fluid (n=9), urine obtained by catheterization (n=52), or other sterile body fluid (n=10). Mortality was not different from infants who had positive blood culture compared to those with isolated positive urine culture. Incidence varied from 2–28% at the 13 centers enrolling ≥ 50 infants. Potentially modifiable risk factors (model 1) included central catheter, broad-spectrum antibiotics (e.g., third-generation cephalosporins), intravenous lipid emulsion, endotracheal tube, and antenatal antibiotics. The clinical prediction model (model 2) had an area under the receiver operating characteristic curve of 0.79, and was superior to clinician judgment (0.70) in predicting subsequent invasive candidiasis. Performance of clinical judgment did not vary significantly with level of training. CONCLUSION Prior antibiotics, presence of a central catheter, endotracheal tube, and center were strongly associated with invasive candidiasis. Modeling was more accurate in predicting invasive candidiasis than clinical judgment. PMID:20876174

Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.

PubMed

Gorton, Karen L; Hayes, Janice

2014-03-01

The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.

14 CFR 67.313 - General medical condition.

Code of Federal Regulations, 2014 CFR

2014-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.213 - General medical condition.

Code of Federal Regulations, 2012 CFR

2012-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.313 - General medical condition.

Code of Federal Regulations, 2012 CFR

2012-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.313 - General medical condition.

Code of Federal Regulations, 2011 CFR

2011-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.113 - General medical condition.

Code of Federal Regulations, 2012 CFR

2012-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.113 - General medical condition.

Code of Federal Regulations, 2014 CFR

2014-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.113 - General medical condition.

Code of Federal Regulations, 2011 CFR

2011-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.213 - General medical condition.

Code of Federal Regulations, 2014 CFR

2014-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.113 - General medical condition.

Code of Federal Regulations, 2013 CFR

2013-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.313 - General medical condition.

Code of Federal Regulations, 2013 CFR

2013-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.213 - General medical condition.

Code of Federal Regulations, 2013 CFR

2013-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

14 CFR 67.213 - General medical condition.

Code of Federal Regulations, 2011 CFR

2011-01-01

... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

Medical Problem-Solving: A Critique of the Literature.

ERIC Educational Resources Information Center

McGuire, Christine H.

1985-01-01

Prescriptive, decision-analysis of medical problem-solving has been based on decision theory that involves calculation and manipulation of complex probability and utility values to arrive at optimal decisions that will maximize patient benefits. The studies offer a methodology for improving clinical judgment. (Author/MLW)

Recollection-Based Prospective Metamemory Judgments Are More Accurate than Those Based on Confidence: Judgments of Remembering and Knowing (JORKS)

ERIC Educational Resources Information Center

McCabe, David P.; Soderstrom, Nicholas C.

2011-01-01

Five experiments were conducted to examine whether the nature of the information that is monitored during prospective metamemory judgments affected the relative accuracy of those judgments. We compared item-by-item judgments of learning (JOLs), which involved participants determining how confident they were that they would remember studied items,…

The Influence of Framing on Clinicians’ Judgments of the Biological Basis of Behaviors

PubMed Central

Kim, Nancy S.; Ahn, Woo-kyoung; Johnson, Samuel G. B.; Knobe, Joshua

2015-01-01

Practicing clinicians frequently think about behaviors both abstractly (i.e., in terms of symptoms, as in the DSM-5; APA, 2013) and concretely (i.e., in terms of individual clients, as in DSM-5 Clinical Cases; Barnhill, 2013). Does abstract/concrete framing influence clinical judgments about behaviors? Seventy-four practicing mental health clinicians were presented with hallmark symptoms of six disorders framed abstractly versus concretely, and provided ratings of their biological and psychological bases (Experiment 1) and the likely efficacy of medication and psychotherapy in alleviating them (Experiment 2). Clinicians perceived behavioral symptoms in the abstract to be more biologically and less psychologically based than when concretely described, and medication was viewed as more effective for abstractly than concretely described symptoms. These findings suggest one possible basis for miscommunication and misalignment of views between primarily research-oriented and primarily practice-oriented clinicians; furthermore, clinicians may accept new neuroscience research more strongly in the abstract than for individual clients. PMID:26651348

Comparison of ethical judgments exhibited by clients and ethics consultants in Japan.

PubMed

Nagao, Noriko; Kadooka, Yasuhiro; Asai, Atsushi

2014-03-04

Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of "uncertain decisional capacity," and 23 cases (38.3%) of "withholding of decision-making." A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants' reasoning was based on "patient's preference was ambiguous," "validity of family as a surrogate," "estimation of patient preference," and "patient's best interest," whereas the CEC client's reasoning was based on "consistent family preference was shown/not shown" and "appropriate therapeutic methods to manage patient safety." Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic.

The development of intention-based morality: The influence of intention salience and recency, negligence, and outcome on children's and adults' judgments.

PubMed

Nobes, Gavin; Panagiotaki, Georgia; Engelhardt, Paul E

2017-10-01

Two experiments were conducted to investigate the influences on 4-8 year-olds' and adults' moral judgments. In both, participants were told stories from previous studies that had indicated that children's judgments are largely outcome-based. Building on recent research in which one change to these studies' methods resulted in substantially more intention-based judgment, in Experiment 1 (N = 75) the salience and recency of intention information were increased, and in Experiment 2 (N = 99) carefulness information (i.e., the absence of negligence) was also added. In both experiments even the youngest children's judgments were primarily intention-based, and in Experiment 2 punishment judgments were similar to adults' from 5-6 years. Comparisons of data across studies and experiments indicated that both changes increased the proportion of intention-based punishment judgments-but not acceptability judgments-across age-groups. These findings challenge and help to explain those of much previous research, according to which children's judgments are primarily outcome-based. However, younger participants continued to judge according to outcome more than older participants. This might indicate that young children are more influenced by outcomes than are adults, but other possible explanations are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Individual and Joint Expert Judgments as Reference Standards in Artifact Detection

PubMed Central

Verduijn, Marion; Peek, Niels; de Keizer, Nicolette F.; van Lieshout, Erik-Jan; de Pont, Anne-Cornelie J.M.; Schultz, Marcus J.; de Jonge, Evert; de Mol, Bas A.J.M.

2008-01-01

Objective To investigate the agreement among clinical experts in their judgments of monitoring data with respect to artifacts, and to examine the effect of reference standards that consist of individual and joint expert judgments on the performance of artifact filters. Design Individual judgments of four physicians, a majority vote judgment, and a consensus judgment were obtained for 30 time series of three monitoring variables: mean arterial blood pressure (ABPm), central venous pressure (CVP), and heart rate (HR). The individual and joint judgments were used to tune three existing automated filtering methods and to evaluate the performance of the resulting filters. Measurements The interrater agreement was calculated in terms of positive specific agreement (PSA). The performance of the artifact filters was quantified in terms of sensitivity and positive predictive value (PPV). Results PSA values between 0.33 and 0.85 were observed among clinical experts in their selection of artifacts, with relatively high values for CVP data. Artifact filters developed using judgments of individual experts were found to moderately generalize to new time series and other experts; sensitivity values ranged from 0.40 to 0.60 for ABPm and HR filters (PPV: 0.57–0.84), and from 0.63 to 0.80 for CVP filters (PPV: 0.71–0.86). A higher performance value for the filters was found for the three variable types when joint judgments were used for tuning the filtering methods. Conclusion Given the disagreement among experts in their individual judgment of monitoring data with respect to artifacts, the use of joint reference standards obtained from multiple experts is recommended for development of automatic artifact filters. PMID:18096912

The Effect of Learning Styles, Critical Thinking Disposition, and Critical Thinking on Clinical Judgment in Senior Baccalaureate Nursing Students during Human Patient Simulation

ERIC Educational Resources Information Center

McCormick, Kiyan

2014-01-01

Simulated learning experiences using high-fidelity human patient simulators (HPS) are increasingly being integrated into baccalaureate nursing programs. Thus, the purpose of this study was to examine relationships among learning style, critical thinking disposition, critical thinking, and clinical judgment during high-fidelity human patient…

Effects of Client Bisexuality on Clinical Judgment: When Is Bias Most Likely to Occur?

ERIC Educational Resources Information Center

Mohr, Jonathan J.; Weiner, Jennifer L.; Chopp, Regina M.; Wong, Stephanie J.

2009-01-01

In this study, the authors investigated whether psychotherapist bias related to client bisexuality is most likely to occur with respect to judgments about stereotype-relevant clinical issues. Participants were 108 psychotherapists who read a fictitious intake report about a male client who was portrayed as heterosexual, gay, or bisexual. Client…

Time Keeps on Ticking: The Experience of Clinical Judgment

ERIC Educational Resources Information Center

Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

2009-01-01

The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

Smelling is Telling: Human Olfactory Cues Influence Social Judgments in Semi-Realistic Interactions.

PubMed

Gaby, Jessica M; Zayas, Vivian

2017-06-01

How does a person's smell affect others' impressions of them? Most body odor research asks perceivers to make social judgments based on armpit sweat without perfume or deodorant, presented on t-shirts. Yet, in real life, perceivers encounter fragranced body odor, on whole bodies. Our "raters" wore blindfolds and earplugs and repeatedly smelled same-sex "donors" in live interactions. In one condition, donors wore their normal deodorant and perfume ("diplomatic" odor) while in the other condition, donors were asked to avoid all outside fragrance influences ("natural" odor). We assessed the reliability of social judgments based on such live interactions, and the relationships between live judgments and traditional t-shirt based judgments, and between natural- and diplomatic odor-based judgments. Raters' repeated live social judgments (e.g., friendliness, likeability) were highly consistent for both diplomatic and natural odor, and converged with judgments based on t-shirts. However, social judgments based on natural odor did not consistently predict social judgments based on diplomatic odor, suggesting that natural and diplomatic body odor may convey different types of social information. Our results provide evidence that individuals can perceive reliable, meaningful social olfactory signals from whole bodies, at social distances, regardless of the presence or absence of perfume. Importantly, however, the social value of these signals is modified by the addition of exogenous fragrances. Further, our focus on judgments in same-sex dyads suggests that these olfactory cues hold social value in non-mating contexts. We suggest that future research employ more ecologically relevant methods. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Haunted by a doppelgänger: irrelevant facial similarity affects rule-based judgments.

PubMed

von Helversen, Bettina; Herzog, Stefan M; Rieskamp, Jörg

2014-01-01

Judging other people is a common and important task. Every day professionals make decisions that affect the lives of other people when they diagnose medical conditions, grant parole, or hire new employees. To prevent discrimination, professional standards require that decision makers render accurate and unbiased judgments solely based on relevant information. Facial similarity to previously encountered persons can be a potential source of bias. Psychological research suggests that people only rely on similarity-based judgment strategies if the provided information does not allow them to make accurate rule-based judgments. Our study shows, however, that facial similarity to previously encountered persons influences judgment even in situations in which relevant information is available for making accurate rule-based judgments and where similarity is irrelevant for the task and relying on similarity is detrimental. In two experiments in an employment context we show that applicants who looked similar to high-performing former employees were judged as more suitable than applicants who looked similar to low-performing former employees. This similarity effect was found despite the fact that the participants used the relevant résumé information about the applicants by following a rule-based judgment strategy. These findings suggest that similarity-based and rule-based processes simultaneously underlie human judgment.

Heuristic reasoning and cognitive biases: Are they hindrances to judgments and decision making in orthodontics?

PubMed

Hicks, E Preston; Kluemper, G Thomas

2011-03-01

Studies show that our brains use 2 modes of reasoning: heuristic (intuitive, automatic, implicit processing) and analytic (deliberate, rule-based, explicit processing). The use of intuition often dominates problem solving when innovative, creative thinking is required. Under conditions of uncertainty, we default to an even greater reliance on the heuristic processing. In health care settings and other such environments of increased importance, this mode becomes problematic. Since choice heuristics are quickly constructed from fragments of memory, they are often biased by prior evaluations of and preferences for the alternatives being considered. Therefore, a rigorous and systematic decision process notwithstanding, clinical judgments under uncertainty are often flawed by a number of unwitting biases. Clinical orthodontics is as vulnerable to this fundamental failing in the decision-making process as any other health care discipline. Several of the more common cognitive biases relevant to clinical orthodontics are discussed in this article. By raising awareness of these sources of cognitive errors in our clinical decision making, our intent was to equip the clinician to take corrective action to avoid them. Our secondary goal was to expose this important area of empirical research and encourage those with expertise in the cognitive sciences to explore, through further research, the possible relevance and impact of cognitive heuristics and biases on the accuracy of orthodontic judgments and decision making. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Children's Facial Trustworthiness Judgments: Agreement and Relationship with Facial Attractiveness

PubMed Central

Ma, Fengling; Xu, Fen; Luo, Xianming

2016-01-01

This study examined developmental changes in children's abilities to make trustworthiness judgments based on faces and the relationship between a child's perception of trustworthiness and facial attractiveness. One hundred and one 8-, 10-, and 12-year-olds, along with 37 undergraduates, were asked to judge the trustworthiness of 200 faces. Next, they issued facial attractiveness judgments. The results indicated that children made consistent trustworthiness and attractiveness judgments based on facial appearance, but with-adult and within-age agreement levels of facial judgments increased with age. Additionally, the agreement levels of judgments made by girls were higher than those by boys. Furthermore, the relationship between trustworthiness and attractiveness judgments increased with age, and the relationship between two judgments made by girls was closer than those by boys. These findings suggest that face-based trait judgment ability develops throughout childhood and that, like adults, children may use facial attractiveness as a heuristic cue that signals a stranger's trustworthiness. PMID:27148111

42 CFR 418.22 - Certification of terminal illness.

Code of Federal Regulations, 2010 CFR

2010-10-01

... certification of terminal illness for each of the periods listed in § 418.21, even if a single election... certification. Certification will be based on the physician's or medical director's clinical judgment regarding... certification or recertification form, in addition to the physician's signature on the certification or...

Professional identity as a resource for talk: exploring the mentor-student relationship.

PubMed

Shakespeare, Pam; Webb, Christine

2008-12-01

This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre-registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice-Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre-registration nursing students is not only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence.

Golden Section Relations in Interpersonal Judgment

ERIC Educational Resources Information Center

Benjafield, John; Green, T. R. G.

1978-01-01

A model of the organization of interpersonal judgments, based on the hypothesis that people tend to organize their judgments in Golden Section ratios, was presented. A theory of the process of interpersonal judgment, based on the notion that people judge acquaintances using a Fibonacci-like decision rule, was then developed. A computer simulation…

Assessment of the Impact of Integrated Simulation on Critical Thinking and Clinical Judgment in Nursing Instruction

ERIC Educational Resources Information Center

Meyer, Rita Allen

2012-01-01

The purpose of this study was to explore the effects of using simulation and didactic instruction on critical thinking and clinical judgment with student nurses enrolled in a fall semester medical-surgical class. Specifically, it was of interest to compare the performance of these fall semester nursing students with the performance of nursing…

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

PubMed

Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students.

PubMed

Cazzell, Mary; Anderson, Mindi

2016-01-01

The study examined the impact of critical thinking (CT) on clinical judgment (CJ) during a pediatric Objective Structured Clinical Evaluation (OSCE) with 160 pre-licensure nursing students. Educators are called to transform teaching strategies to develop CJ but confusion exists over definitions. A descriptive correlational design was used to examine demographics and Tower of Hanoi (TOH) and Health Science Reasoning Test (HSRT) scores. CJ was measured by scores on the Lasater Clinical Judgment Rubric (LCJR) from videotaped OSCEs. Participants were: 86 percent female, 42 percent Caucasian, median 23 years, with 49 percent having health care experience. Students averaged seven moves over minimum on the TOH. Average scores were: HSRT 25/38 and LCJR 31/44. Statistically significant predictors of CJ were gender, ethnicity, HSRT deduction, and analysis; 11 CT variables accounted for 17 percent of LCJR scores. Educators need to utilize/develop innovative teaching strategies addressing CJ predictors.

The Clinical Assessment in the Legal Field: An Empirical Study of Bias and Limitations in Forensic Expertise

PubMed Central

Iudici, Antonio; Salvini, Alessandro; Faccio, Elena; Castelnuovo, Gianluca

2015-01-01

According to the literature, psychological assessment in forensic contexts is one of the most controversial application areas for clinical psychology. This paper presents a review of systematic judgment errors in the forensic field. Forty-six psychological reports written by psychologists, court consultants, have been analyzed with content analysis to identify typical judgment errors related to the following areas: (a) distortions in the attribution of causality, (b) inferential errors, and (c) epistemological inconsistencies. Results indicated that systematic errors of judgment, usually referred also as “the man in the street,” are widely present in the forensic evaluations of specialist consultants. Clinical and practical implications are taken into account. This article could lead to significant benefits for clinical psychologists who want to deal with this sensitive issue and are interested in improving the quality of their contribution to the justice system. PMID:26648892

SCIENTIFIC AND SOCIAL VALUE JUDGMENTS FOR ORPHAN DRUGS IN HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Nicod, Elena; Kanavos, Panos

2016-01-01

We explore how broader aspects of a treatment's value and the impact of the condition on patients not captured by routine health technology assessment (HTA) methods using clinical and economic evidence, defined as "other considerations," may influence HTA processes in different settings. Countries included were England, Scotland, Sweden, and France. Data sources were the publicly available reports on HTA recommendations. Ten drugs with European Medicines Agency orphan designation and appraised in England were selected. Qualitative thematic analysis was used to systematically identify and code all "other considerations" based on a previously developed methodological framework, which also coded whether it was provided by stakeholders, and how it influenced the decision. A classification framework of scientific and social value judgments was developed and used throughout the study. A total of 125 "other considerations" were identified and grouped into ten subcategories based on the information provided. Eighteen to 100 percent of these, depending on the agency, were put forward as one of the main reasons for the final decision potentially contributing to accepting a higher incremental cost-effectiveness ratio or uncertain evidence. Some of these were nonquantified or nonelicited and pertained to the assessor's judgment. A taxonomy of these value judgments was created to be used in future cases. Results also contributed to better defining the determinants of social value and improving accountability for reasonableness. The systematic identification of the scientific and social value judgments enables to better understanding the dimensions of value, which can be used to improve their transparency and consistent use across decisions and settings.

Trust based obligations of the state and physician‐researchers to patient‐subjects

PubMed Central

Miller, P B; Weijer, C

2006-01-01

When may a physician enroll a patient in clinical research? An adequate answer to this question requires clarification of trust‐based obligations of the state and the physician‐researcher respectively to the patient‐subject. The state relies on the voluntarism of patient‐subjects to advance the public interest in science. Accordingly, it is obligated to protect the agent‐neutral interests of patient‐subjects through promulgating standards that secure these interests. Component analysis is the only comprehensive and systematic specification of regulatory standards for benefit‐harm evaluation by research ethics committees (RECs). Clinical equipoise, a standard in component analysis, ensures the treatment arms of a randomised control trial are consistent with competent medical care. It thus serves to protect agent‐neutral welfare interests of the patient‐subject. But REC review occurs prior to enrolment, highlighting the independent responsibility of the physician‐researcher to protect the agent‐relative welfare interests of the patient‐subject. In a novel interpretation of the duty of care, we argue for a “clinical judgment principle” which requires the physician‐researcher to exercise judgment in the interests of the patient‐subject taking into account evidence on treatments and the patient‐subject‘s circumstances. PMID:16943338

Instructional Storytelling: Application of the Clinical Judgment Model in Nursing.

PubMed

Timbrell, Jessica

2017-05-01

Little is known about the teaching and learning implications of instructional storytelling (IST) in nursing education or its potential connection to nursing theory. The literature establishes storytelling as a powerful teaching-learning method in the educational, business, humanities, and health sectors, but little exploration exists that is specific to nursing. An example of a story demonstrating application of the domains of Tanner's clinical judgment model links storytelling with learning outcomes appropriate for the novice nursing student. Application of Tanner's clinical judgment model offers consistency of learning experience while preserving the creativity inherent in IST. Further research into student learning outcomes achievement using IST is warranted as a step toward establishing best practices with IST in nursing education. [J Nurs Educ. 2017;56(5):305-308.]. Copyright 2017, SLACK Incorporated.

Reflections on Self-Reflection: Contemplating Flawed Self-Judgments in the Clinic, Classroom, and Office Cubicle.

PubMed

Dunning, David; Heath, Chip; Suls, Jerry M

2018-03-01

We reflect back on our 2004 monograph reviewing the implications of faulty self-judgment for health, education, and the workplace. The review proved popular, no doubt because the importance of accurate self-assessment is best reflected in just how broad the literature is that touches on this topic. We discuss opportunities and challenges to be found in the future study of self-judgment accuracy and error, and suggest that designing interventions aimed at improving self-judgments may prove to be a worthwhile but complex and nuanced task.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2016 OUTPATIENT GLUCOSE MONITORING CONSENSUS STATEMENT.

PubMed

Bailey, Timothy S; Grunberger, George; Bode, Bruce W; Handelsman, Yehuda; Hirsch, Irl B; Jovanovič, Lois; Roberts, Victor Lawrence; Rodbard, David; Tamborlane, William V; Walsh, John

2016-02-01

This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

Effects of Age of Transgressor, Damage, and Type of Presentation on Kindergarten Children's Moral Judgments

ERIC Educational Resources Information Center

Rybash, John M.; And Others

1975-01-01

This study used both verbal and videotape presentation techniques to assess the role of cognitive conflict in children's moral judgments. The results indicated that the children presented problems via videotape based their moral judgments on intentions, while verbal presentation increased the number of moral judgments based on damage. (JMB)

Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism

PubMed Central

Torralva, Teresa; Rattazzi, Alexia; Marenco, Victoria; Roca, María; Manes, Facundo

2013-01-01

Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people’s thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition. PMID:22689217

Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism.

PubMed

Gleichgerrcht, Ezequiel; Torralva, Teresa; Rattazzi, Alexia; Marenco, Victoria; Roca, María; Manes, Facundo

2013-10-01

Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people's thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition.

Laterality judgments in people with low back pain--A cross-sectional observational and test-retest reliability study.

PubMed

Linder, Martin; Michaelson, Peter; Röijezon, Ulrik

2016-02-01

Disruption of cortical representation, or body schema, has been indicated as a factor in the persistence and recurrence of low back pain (LBP). This has been observed through impaired laterality judgment ability and it has been suggested that this ability is affected in a spatial rather than anatomical manner. We compared laterality judgment performance of foot and trunk movements between people with LBP with or without leg pain and healthy controls, and investigated associations between test performance and pain. We also assessed the test-retest reliability of the Recognise Online™ software when used in a clinical and a home setting. Cross-sectional observational and test-retest study. Thirty individuals with LBP and 30 healthy controls performed judgment tests of foot and trunk laterality once supervised in a clinic and twice at home. No statistically significant group differences were found. LBP intensity was negatively related to trunk laterality accuracy (p = 0.019). Intraclass correlation values ranged from 0.51 to 0.91. Reaction time improved significantly between test occasions while accuracy did not. Laterality judgments were not impaired in subjects with LBP compared to controls. Further research may clarify the relationship between pain mechanisms in LBP and laterality judgment ability. Reliability values were mostly acceptable, with wide and low confidence intervals, suggesting test-retest reliability for Recognise Online™ could be questioned in this trial. A significant learning effect was observed which should be considered in clinical and research application of the test. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mindfulness in occupational therapy education.

PubMed

Gura, Shira Taylor

2010-07-01

ABSTRACT The purpose of this paper is to explore the value of mindfulness and its role in occupational therapy education. The plethora of research on mindfulness-based stress reduction programs has shown consistent and positive results to enhance quality of life in clinical and nonclinical populations. Offering students the opportunities to learn and experience mindfulness could lead to enhanced self-awareness and care, focus and empathy, and a decrease of client judgment enhancing the success of clinical interventions.

A Quantitative Methodology to Examine the Development of Moral Judgment

ERIC Educational Resources Information Center

Buchanan, James P.; Thompson, Spencer K.

1973-01-01

Unlike Piaget's clinical procedure, the experiment's methodology allowed substantiation of the ability of children to simultaneously weigh damage and intent information when making a moral judgment. Other advantages of this quantitative methodology are also presented. (Authors)

Similar Task Features Shape Judgment and Categorization Processes

ERIC Educational Resources Information Center

Hoffmann, Janina A.; von Helversen, Bettina; Rieskamp, Jörg

2016-01-01

The distinction between similarity-based and rule-based strategies has instigated a large body of research in categorization and judgment. Within both domains, the task characteristics guiding strategy shifts are increasingly well documented. Across domains, past research has observed shifts from rule-based strategies in judgment to…

The influence of intention, outcome and question-wording on children's and adults' moral judgments.

PubMed

Nobes, Gavin; Panagiotaki, Georgia; Bartholomew, Kimberley J

2016-12-01

The influence of intention and outcome information on moral judgments was investigated by telling children aged 4-8yearsandadults (N=169) stories involving accidental harms (positive intention, negative outcome) or attempted harms (negative intention, positive outcome) from two studies (Helwig, Zelazo, & Wilson, 2001; Zelazo, Helwig, & Lau, 1996). When the original acceptability (wrongness) question was asked, the original findings were closely replicated: children's and adults' acceptability judgments were based almost exclusively on outcome, and children's punishment judgments were also primarily outcome-based. However, when this question was rephrased, 4-5-year-olds' judgments were approximately equally influenced by intention and outcome, and from 5-6years they were based considerably more on intention than outcome. These findings indicate that, for methodological reasons, children's (and adults') ability to make intention-based judgment has often been substantially underestimated. Copyright © 2016 Elsevier B.V. All rights reserved.

Professional Norms versus Managerialism in Campus Mental Health Centers: The Experiences of Eight Clinicians

ERIC Educational Resources Information Center

Jodoin, Elizabeth C.; Ayers, David F.

2013-01-01

The purpose of this qualitative study was to understand better how, if at all, eight campus-based mental health clinicians experienced and negotiated managerialist practices, and with what outcomes. It was found that managerialism was experienced as challenges to professional ethics, clinical judgment, and challenges related to professional role…

CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM--2015 EXECUTIVE SUMMARY.

PubMed

Garber, Alan J; Abrahamson, Martin Julian; Barzilay, Joshua I; Blonde, Lawrence; Bloomgarden, Zachary T; Bush, Michael A; Dagogo-Jack, Samuel; Davidson, Michael B; Einhorn, Daniel; Garber, Jeffrey R; Garvey, W Timothy; Grunberger, George; Handelsman, Yehuda; Hirsch, Irl B; Jellinger, Paul S; McGill, Janet B; Mechanick, Jeffrey I; Rosenblit, Paul David; Umpierrez, Guillermo E

2015-12-01

This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON TESTING FOR AUTONOMIC AND SOMATIC NERVE DYSFUNCTION.

PubMed

Vinik, Aaron I; Camacho, Pauline M; Davidson, Jaime A; Handelsman, Yehuda; Lando, Howard M; Leddy, Anne L; Reddy, Sethu K; Cook, Richard; Spallone, Vicenza; Tesfaye, Solomon; Ziegler, Dan

2017-12-01

This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF TESTOSTERONE AND CARDIOVASCULAR RISK.

PubMed

Goodman, Neil; Guay, Andre; Dandona, Paresh; Dhindsa, Sandeep; Faiman, Charles; Cunningham, Glenn R

2015-09-01

This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

Judgments about Judgments: The Dissociation of Consideration Price and Transaction Commitment Judgments

ERIC Educational Resources Information Center

Janiszewski, Chris; Lichtenstein, Donald R.; Belyavsky, Julia

2008-01-01

There are many contexts in which people make judgments about prior judgments. For example, Internet shopping bots (e.g., NexTag.com) allow consumers to search for products and, if the price is too high, list a price at which they would consider making the purchase (i.e., base judgment). If the price drops to this level, the vendor generates an…

Cognitive error as the most frequent contributory factor in cases of medical injury: a study on verdict's judgment among closed claims in Japan.

PubMed

Tokuda, Yasuharu; Kishida, Naoki; Konishi, Ryota; Koizumi, Shunzo

2011-03-01

Cognitive errors in the course of clinical decision-making are prevalent in many cases of medical injury. We used information on verdict's judgment from closed claims files to determine the important cognitive factors associated with cases of medical injury. Data were collected from claims closed between 2001 to 2005 at district courts in Tokyo and Osaka, Japan. In each case, we recorded all the contributory cognitive, systemic, and patient-related factors judged in the verdicts to be causally related to the medical injury. We also analyzed the association between cognitive factors and cases involving paid compensation using a multivariable logistic regression model. Among 274 cases (mean age 49 years old; 45% women), there were 122 (45%) deaths and 67 (24%) major injuries (incomplete recovery within a year). In 103 cases (38%), the verdicts ordered hospitals to pay compensation (median; 8,000,000 Japanese Yen). An error in judgment (199/274, 73%) and failure of vigilance (177/274, 65%) were the most prevalent causative cognitive factors, and error in judgment was also significantly associated with paid compensation (odds ratio, 1.9; 95% confidence interval [CI], 1.0-3.4). Systemic causative factors including poor teamwork (11/274, 4%) and technology failure (5/274, 2%) were less common. The closed claims analysis based on verdict's judgment showed that cognitive errors were common in cases of medical injury, with an error in judgment being most prevalent and closely associated with compensation payment. Reduction of this type of error is required to produce safer healthcare. 2010 Society of Hospital Medicine.

Comparison of ethical judgments exhibited by clients and ethics consultants in Japan

PubMed Central

2014-01-01

Background Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. Methods The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. Results As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of “uncertain decisional capacity,” and 23 cases (38.3%) of “withholding of decision-making.” A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants’ reasoning was based on “patient’s preference was ambiguous,” “validity of family as a surrogate,” “estimation of patient preference,” and “patient’s best interest,” whereas the CEC client’s reasoning was based on “consistent family preference was shown/not shown” and “appropriate therapeutic methods to manage patient safety.” Conclusion Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic. PMID:24592932

The Reliability and Predictive Validity of the Stalking Risk Profile.

PubMed

McEwan, Troy E; Shea, Daniel E; Daffern, Michael; MacKenzie, Rachel D; Ogloff, James R P; Mullen, Paul E

2018-03-01

This study assessed the reliability and validity of the Stalking Risk Profile (SRP), a structured measure for assessing stalking risks. The SRP was administered at the point of assessment or retrospectively from file review for 241 adult stalkers (91% male) referred to a community-based forensic mental health service. Interrater reliability was high for stalker type, and moderate-to-substantial for risk judgments and domain scores. Evidence for predictive validity and discrimination between stalking recidivists and nonrecidivists for risk judgments depended on follow-up duration. Discrimination was moderate (area under the curve = 0.66-0.68) and positive and negative predictive values good over the full follow-up period ( Mdn = 170.43 weeks). At 6 months, discrimination was better than chance only for judgments related to stalking of new victims (area under the curve = 0.75); however, high-risk stalkers still reoffended against their original victim(s) 2 to 4 times as often as low-risk stalkers. Implications for the clinical utility and refinement of the SRP are discussed.

Damage to the ventromedial prefrontal cortex is associated with impairments in both spontaneous and deliberative moral judgments

PubMed Central

Cameron, C. Daryl; Reber, Justin; Spring, Victoria L.; Tranel, Daniel

2018-01-01

Implicit moral evaluations—spontaneous, unintentional judgments about the moral status of actions or persons—are thought to play a pivotal role in moral experience, suggesting a need for research to model these moral evaluations in clinical populations. Prior research reveals that the ventromedial prefrontal cortex (vmPFC) is a critical area underpinning affect and morality, and patients with vmPFC lesions show abnormalities in moral judgment and moral behavior. We use indirect measurement and multinomial modeling to understand differences in implicit moral evaluations among patients with vmPFC lesions. Our model quantifies multiple processes of moral judgment: implicit moral evaluations in response to distracting moral transgressions (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Compared to individuals with non-vmPFC brain damage and neurologically healthy comparisons, patients with vmPFC lesions showed a dual deficit in processes of moral judgment. First, patients with vmPFC lesions showed reduced Unintentional Judgment about moral transgressions, but not about non-moral negative affective distracters. Second, patients with vmPFC lesions showed reduced Intentional Judgment about target actions. These findings highlight the utility of a formal modeling approach in moral psychology, revealing a dual deficit in multiple component processes of moral judgment among patients with vmPFC lesions. PMID:29382558

Damage to the ventromedial prefrontal cortex is associated with impairments in both spontaneous and deliberative moral judgments.

PubMed

Cameron, C Daryl; Reber, Justin; Spring, Victoria L; Tranel, Daniel

2018-03-01

Implicit moral evaluations-spontaneous, unintentional judgments about the moral status of actions or persons-are thought to play a pivotal role in moral experience, suggesting a need for research to model these moral evaluations in clinical populations. Prior research reveals that the ventromedial prefrontal cortex (vmPFC) is a critical area underpinning affect and morality, and patients with vmPFC lesions show abnormalities in moral judgment and moral behavior. We use indirect measurement and multinomial modeling to understand differences in implicit moral evaluations among patients with vmPFC lesions. Our model quantifies multiple processes of moral judgment: implicit moral evaluations in response to distracting moral transgressions (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Compared to individuals with non-vmPFC brain damage and neurologically healthy comparisons, patients with vmPFC lesions showed a dual deficit in processes of moral judgment. First, patients with vmPFC lesions showed reduced Unintentional Judgment about moral transgressions, but not about non-moral negative affective distracters. Second, patients with vmPFC lesions showed reduced Intentional Judgment about target actions. These findings highlight the utility of a formal modeling approach in moral psychology, revealing a dual deficit in multiple component processes of moral judgment among patients with vmPFC lesions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Gifted Education Quarterly, 1998.

ERIC Educational Resources Information Center

Fisher, Maurice, Ed.

1998-01-01

These four issues of "Gifted Education Quarterly" include the following articles: (1) "Using Test Results To Support Clinical Judgment" (Linda Kreger Silverman), which discusses some of the difficulties in obtaining accurate indications of a child's level of giftedness and the importance of using professional judgment in…

Clinical versus actuarial judgment.

PubMed

Dawes, R M; Faust, D; Meehl, P E

1989-03-31

Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department

PubMed Central

Balamuth, Fran; Alpern, Elizabeth R.; Grundmeier, Robert W.; Chilutti, Marianne; Weiss, Scott L.; Fitzgerald, Julie C.; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

2015-01-01

Objectives To compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). Methods This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Results Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159, and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% CI = 72.1% to 73.4%) and specificity 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity 92.1% (95% CI = 91.7% to 92.4%), and specificity 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment vs. algorithmic alert were 40.3% vs. 2.5% and 99.88 % vs. 99.96%, respectively. Conclusions The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. PMID:26474032

Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department.

PubMed

Balamuth, Fran; Alpern, Elizabeth R; Grundmeier, Robert W; Chilutti, Marianne; Weiss, Scott L; Fitzgerald, Julie C; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

2015-11-01

The objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively. The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. © 2015 by the Society for Academic Emergency Medicine.

Determining dangerousness in sexually violent predator evaluations: cognitive-experiential self-theory and juror judgments of expert testimony.

PubMed

Lieberman, Joel D; Krauss, Daniel A; Kyger, Mariel; Lehoux, Maribeth

2007-01-01

Past research examining the effects of expert testimony on the future dangerousness of a defendant in death penalty sentencing found that jurors are more influenced by less scientific clinical expert testimony and tend to devalue scientific actuarial testimony. This study was designed to determine whether these findings extend to civil commitment trials for sexual offenders and to test a theoretical rationale for this effect. In addition, we investigated the influence of a recently developed innovation in risk assessment procedures, Guided Professional Judgment (GPJ) instruments. Consistent with a cognitive-experiential self-theory based explanation, mock jurors motivated to process information in an experiential condition were more influenced by clinical testimony, while mock jurors in a rational mode were more influenced by actuarial testimony. Participants responded to clinical and GPJ testimony in a similar manner. However, participants' gender exerted important interactive effects on dangerousness decisions, with male jurors showing the predicted effect while females did not. The policy implications of these findings are discussed. 2007 John Wiley & Sons, Ltd

Intuitive and Deliberate Judgments Are Based on Common Principles

ERIC Educational Resources Information Center

Kruglanski, Arie W.; Gigerenzer, Gerd

2011-01-01

A popular distinction in cognitive and social psychology has been between "intuitive" and "deliberate" judgments. This juxtaposition has aligned in dual-process theories of reasoning associative, unconscious, effortless, heuristic, and suboptimal processes (assumed to foster intuitive judgments) versus rule-based, conscious, effortful, analytic,…

Psychiatric mental health evidence-based practice.

PubMed

Rice, Michael J

2008-05-01

This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.

Detecting fast, online reasoning processes in clinical decision making.

PubMed

Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

2014-06-01

In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed.

The development of intention-based sociomoral judgment and distribution behavior from a third-party stance.

PubMed

Li, Jing; Tomasello, Michael

2018-03-01

The current study investigated children's intention-based sociomoral judgments and distribution behavior from a third-party stance. An actor puppet showed either positive or negative intention toward a target puppet, which had previously performed a prosocial or antisocial action toward others (i.e., children witnessed various types of indirect reciprocity). Children (3- and 5-year-olds) were asked to make sociomoral judgments and to distribute resources to the actor puppet. Results showed that 5-year-olds were more likely than 3-year-olds to be influenced by intention when they made their judgment and distributed resources. The target's previous actions affected only 5-year-olds' intent-based social preference. These results suggest that children's judgments about intent-based indirect reciprocity develop from ages 3 to 5 years. Copyright © 2017 Elsevier Inc. All rights reserved.

Adolescent judgments and reasoning about the failure to include peers with social disabilities.

PubMed

Bottema-Beutel, Kristen; Li, Zhushan

2015-06-01

Adolescents with autism spectrum disorder often do not have access to crucial peer social activities. This study examines how typically developing adolescents evaluate decisions not to include a peer based on disability status, and the justifications they apply to these decisions. A clinical interview methodology was used to elicit judgments and justifications across four contexts. We found adolescents are more likely to judge the failure to include as acceptable in personal as compared to public contexts. Using logistic regression, we found that adolescents are more likely to provide moral justifications as to why failure to include is acceptable in a classroom as compared to home, lab group, and soccer practice contexts. Implications for intervention are also discussed.

When fast logic meets slow belief: Evidence for a parallel-processing model of belief bias.

PubMed

Trippas, Dries; Thompson, Valerie A; Handley, Simon J

2017-05-01

Two experiments pitted the default-interventionist account of belief bias against a parallel-processing model. According to the former, belief bias occurs because a fast, belief-based evaluation of the conclusion pre-empts a working-memory demanding logical analysis. In contrast, according to the latter both belief-based and logic-based responding occur in parallel. Participants were given deductive reasoning problems of variable complexity and instructed to decide whether the conclusion was valid on half the trials or to decide whether the conclusion was believable on the other half. When belief and logic conflict, the default-interventionist view predicts that it should take less time to respond on the basis of belief than logic, and that the believability of a conclusion should interfere with judgments of validity, but not the reverse. The parallel-processing view predicts that beliefs should interfere with logic judgments only if the processing required to evaluate the logical structure exceeds that required to evaluate the knowledge necessary to make a belief-based judgment, and vice versa otherwise. Consistent with this latter view, for the simplest reasoning problems (modus ponens), judgments of belief resulted in lower accuracy than judgments of validity, and believability interfered more with judgments of validity than the converse. For problems of moderate complexity (modus tollens and single-model syllogisms), the interference was symmetrical, in that validity interfered with belief judgments to the same degree that believability interfered with validity judgments. For the most complex (three-term multiple-model syllogisms), conclusion believability interfered more with judgments of validity than vice versa, in spite of the significant interference from conclusion validity on judgments of belief.

On the relativity of athletic performance: a comparison perspective on performance judgments in sports.

PubMed

Damisch, Lysann; Mussweiler, Thomas

2009-01-01

Identifying the best performance at a specific point in time constitutes the central purpose of all competitive sports. In many sports, this decision is based on subjective performance judgments. In the present chapter, we consider how these judgments are formed by emphasizing the relative nature of person judgments and athletic performance judgments in particular. Specifically, we argue that athletic judgments are influenced by comparisons with prior performances thereby leading to similar judgmental consequences as have been observed in other comparison domains (e.g., social comparison). Particularly, we demonstrate that performance judgments are assimilated to judgments of the preceding performance if judges focus on similarities between the two. If judges focus on differences, however, contrast ensues. Strategies for preventing or correcting this judgmental bias are discussed.

Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students.

PubMed

Bravo, Adrian J; Pearson, Matthew R; Kelley, Michelle L

2018-02-01

Previous research on trait mindfulness facets using person-centered analyses (e.g., latent profile analysis [LPA]) has identified four distinct mindfulness profiles among college students: a high mindfulness group (high on all facets of the Five-Factor Mindfulness Questionnaire [FFMQ]), a judgmentally observing group (highest on observing, but low on non-judging of inner experience and acting with awareness), a non-judgmentally aware group (high on non-judging of inner experience and acting with awareness, but very low on observing), and a low mindfulness group (low on all facets of the FFMQ). In the present study, we used LPA to identify distinct mindfulness profiles in a community based sample of U.S. military personnel (majority veterans; n = 407) and non-military college students ( n = 310) and compare these profiles on symptoms of psychological health outcomes (e.g., suicidality, PTSD, anxiety, rumination) and percentage of participants exceeding clinically significant cut-offs for depressive symptoms, substance use, and alcohol use. In the subsample of college students, we replicated previous research and found four distinct mindfulness profiles; however, in the military subsample we found three distinct mindfulness profiles (a combined low mindfulness/judgmentally observing class). In both subsamples, we found that the most adaptive profile was the "high mindfulness" profile (i.e., demonstrated the lowest scores on all psychological symptoms and the lowest probability of exceeding clinical cut-offs). Based on these findings, we purport that the comprehensive examination of an individual's mindfulness profile could help clinicians tailor interventions/treatments that capitalize on individual's specific strengths and work to address their specific deficits.

'Utilitarian' judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good.

PubMed

Kahane, Guy; Everett, Jim A C; Earp, Brian D; Farias, Miguel; Savulescu, Julian

2015-01-01

A growing body of research has focused on so-called 'utilitarian' judgments in moral dilemmas in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. However, the relation between such 'utilitarian' judgments and genuine utilitarian impartial concern for the greater good remains unclear. Across four studies, we investigated the relationship between 'utilitarian' judgment in such sacrificial dilemmas and a range of traits, attitudes, judgments and behaviors that either reflect or reject an impartial concern for the greater good of all. In Study 1, we found that rates of 'utilitarian' judgment were associated with a broadly immoral outlook concerning clear ethical transgressions in a business context, as well as with sub-clinical psychopathy. In Study 2, we found that 'utilitarian' judgment was associated with greater endorsement of rational egoism, less donation of money to a charity, and less identification with the whole of humanity, a core feature of classical utilitarianism. In Studies 3 and 4, we found no association between 'utilitarian' judgments in sacrificial dilemmas and characteristic utilitarian judgments relating to assistance to distant people in need, self-sacrifice and impartiality, even when the utilitarian justification for these judgments was made explicit and unequivocal. This lack of association remained even when we controlled for the antisocial element in 'utilitarian' judgment. Taken together, these results suggest that there is very little relation between sacrificial judgments in the hypothetical dilemmas that dominate current research, and a genuine utilitarian approach to ethics. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

‘Utilitarian’ judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good

PubMed Central

Kahane, Guy; Everett, Jim A.C.; Earp, Brian D.; Farias, Miguel; Savulescu, Julian

2015-01-01

A growing body of research has focused on so-called ‘utilitarian’ judgments in moral dilemmas in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. However, the relation between such ‘utilitarian’ judgments and genuine utilitarian impartial concern for the greater good remains unclear. Across four studies, we investigated the relationship between ‘utilitarian’ judgment in such sacrificial dilemmas and a range of traits, attitudes, judgments and behaviors that either reflect or reject an impartial concern for the greater good of all. In Study 1, we found that rates of ‘utilitarian’ judgment were associated with a broadly immoral outlook concerning clear ethical transgressions in a business context, as well as with sub-clinical psychopathy. In Study 2, we found that ‘utilitarian’ judgment was associated with greater endorsement of rational egoism, less donation of money to a charity, and less identification with the whole of humanity, a core feature of classical utilitarianism. In Studies 3 and 4, we found no association between ‘utilitarian’ judgments in sacrificial dilemmas and characteristic utilitarian judgments relating to assistance to distant people in need, self-sacrifice and impartiality, even when the utilitarian justification for these judgments was made explicit and unequivocal. This lack of association remained even when we controlled for the antisocial element in ‘utilitarian’ judgment. Taken together, these results suggest that there is very little relation between sacrificial judgments in the hypothetical dilemmas that dominate current research, and a genuine utilitarian approach to ethics. PMID:25460392

The role of sexual abuse on functional neuroimaging markers associated with major depressive disorder.

PubMed

Skokauskas, Norbert; Carballedo, Angela; Fagan, Andrew; Frodl, Thomas

2015-10-01

Victims of child sexual abuse can develop depression and other mental health conditions that follow them well into adulthood. This study aimed to clarify the role of sexual abuse (SA) on functional imaging markers associated with MDD. Thirty-seven patients with MDD only; and 13 patients with both MDD and SA and 43 healthy controls performed emotional attention shifting tasks during fMRI session. Clinical diagnoses were made by consultant psychiatrists based on the DSM-IV-TR criteria and diagnoses were confirmed using SCID-I. Magnetic resonance images were obtained with a Philips Achieva 3 Tesla MRI scanner. Short form childhood trauma questionnaire, Hamilton Rating Scale for Depression and Beck's Depression Inventory were also employed. Data were analysed with Statistical Parametric Mapping 8 (SPM8). Using the contrast judgment of emotion minus judgment of geometry following emotional neutral stimuli, patients with MDD showed significantly reduced activation in comparison to healthy controls in the area of the right fusiform gyrus. With the contrast judgment of emotion minus judgment of geometry following emotional negative stimuli, participants with MDD and SA showed significantly higher activation in the area of the left inferior parietal lobe in comparison to participants with MDD without SA. The history of sexual abuse affects functional neuroimaging markers associated with major depressive disorder.

Intuitive and deliberate judgments are based on common principles.

PubMed

Kruglanski, Arie W; Gigerenzer, Gerd

2011-01-01

A popular distinction in cognitive and social psychology has been between intuitive and deliberate judgments. This juxtaposition has aligned in dual-process theories of reasoning associative, unconscious, effortless, heuristic, and suboptimal processes (assumed to foster intuitive judgments) versus rule-based, conscious, effortful, analytic, and rational processes (assumed to characterize deliberate judgments). In contrast, we provide convergent arguments and evidence for a unified theoretical approach to both intuitive and deliberative judgments. Both are rule-based, and in fact, the very same rules can underlie both intuitive and deliberate judgments. The important open question is that of rule selection, and we propose a 2-step process in which the task itself and the individual's memory constrain the set of applicable rules, whereas the individual's processing potential and the (perceived) ecological rationality of the rule for the task guide the final selection from that set. Deliberate judgments are not generally more accurate than intuitive judgments; in both cases, accuracy depends on the match between rule and environment: the rules' ecological rationality. Heuristics that are less effortful and in which parts of the information are ignored can be more accurate than cognitive strategies that have more information and computation. The proposed framework adumbrates a unified approach that specifies the critical dimensions on which judgmental situations may vary and the environmental conditions under which rules can be expected to be successful.

Soldier Decision-Making for Allocation of Intelligence, Surveillance, and Reconnaissance Assets

DTIC Science & Technology

2014-06-01

Judgments; also called Algoritmic or Statistical Judgements Computer Science , Psychology, and Statistics Actuarial or algorithmic...Jan. 2011. [17] R. M. Dawes, D. Faust, and P. E. Meehl, “Clinical versus Actuarial Judgment,” Science , vol. 243, no. 4899, pp. 1668–1674, 1989. [18...School of Computer Science

Case study method and problem-based learning: utilizing the pedagogical model of progressive complexity in nursing education.

PubMed

McMahon, Michelle A; Christopher, Kimberly A

2011-08-19

As the complexity of health care delivery continues to increase, educators are challenged to determine educational best practices to prepare BSN students for the ambiguous clinical practice setting. Integrative, active, and student-centered curricular methods are encouraged to foster student ability to use clinical judgment for problem solving and informed clinical decision making. The proposed pedagogical model of progressive complexity in nursing education suggests gradually introducing students to complex and multi-contextual clinical scenarios through the utilization of case studies and problem-based learning activities, with the intention to transition nursing students into autonomous learners and well-prepared practitioners at the culmination of a nursing program. Exemplar curricular activities are suggested to potentiate student development of a transferable problem solving skill set and a flexible knowledge base to better prepare students for practice in future novel clinical experiences, which is a mutual goal for both educators and students.

False dichotomies: EBM, clinical freedom, and the art of medicine.

PubMed

Parker, M

2005-06-01

According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by critiques of EBM's reductionism and uniformity, its problematic application to individual patients, and its alleged denial of the continuing need for clinical interpretation, insight, and judgment. Most of these attacks on EBM and defences of clinical freedom fail. They are based on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action. Evidence based medicine is a necessary condition for clinical freedom, not a threat to it, and EBM is not something to be balanced with either clinical experience or patient preferences. The art and science of medicine are more conceptually and practically connected than the defenders of clinical freedom, whatever they conceive that to be, are willing to admit.

Clinimetrics and clinical psychometrics: macro- and micro-analysis.

PubMed

Tomba, Elena; Bech, Per

2012-01-01

Clinimetrics was introduced three decades ago to specify the domain of clinical markers in clinical medicine (indexes or rating scales). In this perspective, clinical validity is the platform for selecting the various indexes or rating scales (macro-analysis). Psychometric validation of these indexes or rating scales is the measuring aspect (micro-analysis). Clinical judgment analysis by experienced psychiatrists is included in the macro-analysis and the item response theory models are especially preferred in the micro-analysis when using the total score as a sufficient statistic. Clinical assessment tools covering severity of illness scales, prognostic measures, issues of co-morbidity, longitudinal assessments, recovery, stressors, lifestyle, psychological well-being, and illness behavior have been identified. The constructive dialogue in clinimetrics between clinical judgment and psychometric validation procedures is outlined for generating developments of clinical practice in psychiatry. Copyright © 2012 S. Karger AG, Basel.

Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection.

PubMed

Saad, Toni C

2017-04-24

In her paper 'Cosmetic surgery and conscientious objection', Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy's meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Computer-based personality judgments are more accurate than those made by humans

PubMed Central

Youyou, Wu; Kosinski, Michal; Stillwell, David

2015-01-01

Judging others’ personalities is an essential skill in successful social living, as personality is a key driver behind people’s interactions, behaviors, and emotions. Although accurate personality judgments stem from social-cognitive skills, developments in machine learning show that computer models can also make valid judgments. This study compares the accuracy of human and computer-based personality judgments, using a sample of 86,220 volunteers who completed a 100-item personality questionnaire. We show that (i) computer predictions based on a generic digital footprint (Facebook Likes) are more accurate (r = 0.56) than those made by the participants’ Facebook friends using a personality questionnaire (r = 0.49); (ii) computer models show higher interjudge agreement; and (iii) computer personality judgments have higher external validity when predicting life outcomes such as substance use, political attitudes, and physical health; for some outcomes, they even outperform the self-rated personality scores. Computers outpacing humans in personality judgment presents significant opportunities and challenges in the areas of psychological assessment, marketing, and privacy. PMID:25583507

Computer-based personality judgments are more accurate than those made by humans.

PubMed

Youyou, Wu; Kosinski, Michal; Stillwell, David

2015-01-27

Judging others' personalities is an essential skill in successful social living, as personality is a key driver behind people's interactions, behaviors, and emotions. Although accurate personality judgments stem from social-cognitive skills, developments in machine learning show that computer models can also make valid judgments. This study compares the accuracy of human and computer-based personality judgments, using a sample of 86,220 volunteers who completed a 100-item personality questionnaire. We show that (i) computer predictions based on a generic digital footprint (Facebook Likes) are more accurate (r = 0.56) than those made by the participants' Facebook friends using a personality questionnaire (r = 0.49); (ii) computer models show higher interjudge agreement; and (iii) computer personality judgments have higher external validity when predicting life outcomes such as substance use, political attitudes, and physical health; for some outcomes, they even outperform the self-rated personality scores. Computers outpacing humans in personality judgment presents significant opportunities and challenges in the areas of psychological assessment, marketing, and privacy.

Subjective Confidence in Perceptual Judgments: A Test of the Self-Consistency Model

ERIC Educational Resources Information Center

Koriat, Asher

2011-01-01

Two questions about subjective confidence in perceptual judgments are examined: the bases for these judgments and the reasons for their accuracy. Confidence in perceptual judgments has been claimed to rest on qualitatively different processes than confidence in memory tasks. However, predictions from a self-consistency model (SCM), which had been…

Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives.

PubMed

Tait, Raymond C; Chibnall, John T; House, Kylie; Biehl, Joann

2016-07-01

While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Functional assessment of the elderly. A comparison of standard instruments with clinical judgment.

PubMed

Pinholt, E M; Kroenke, K; Hanley, J F; Kussman, M J; Twyman, P L; Carpenter, J L

1987-03-01

Using specific instruments and scales to measure mental status, nutritional state, visual acuity, gait, and activities of daily living, we studied 79 medical inpatients aged 70 years or older. We then interviewed the patients' primary physicians and nurses and asked them to rate their patients. The prevalence of functional impairment was high: 25 (32%) of the 79 patients were mentally impaired, 31 (39%) were malnourished, 18 (23%) were visually impaired, 31 (39%) had impaired gait, and 23 (29%) had problems with continence. Although clinicians recognized severe impairments, the sensitivity of their clinical judgment was poor in detecting moderate impairment in four categories: mental status sensitivity was 28% (5/18); nutrition, 54% (14/26); vision, 27% (4/15); and continence, 42% (5/12). With clinical judgment alone, physicians and nurses correctly identify severe impairment, but the more prevalent moderate impairments in mental status, nutrition, vision, and continence are poorly recognized. Comprehensive functional assessment instruments can detect these moderate impairments, which may be remediable through early intervention.

A Psychological Model for Aggregating Judgments of Magnitude

NASA Astrophysics Data System (ADS)

Merkle, Edgar C.; Steyvers, Mark

In this paper, we develop and illustrate a psychologically-motivated model for aggregating judgments of magnitude across experts. The model assumes that experts' judgments are perturbed from the truth by both systematic biases and random error, and it provides aggregated estimates that are implicitly based on the application of nonlinear weights to individual judgments. The model is also easily extended to situations where experts report multiple quantile judgments. We apply the model to expert judgments concerning flange leaks in a chemical plant, illustrating its use and comparing it to baseline measures.

The influence of first impressions on subsequent ratings within an OSCE station.

PubMed

Wood, Timothy J; Chan, James; Humphrey-Murto, Susan; Pugh, Debra; Touchie, Claire

2017-10-01

Competency-based assessment is placing increasing emphasis on the direct observation of learners. For this process to produce valid results, it is important that raters provide quality judgments that are accurate. Unfortunately, the quality of these judgments is variable and the roles of factors that influence the accuracy of those judgments are not clearly understood. One such factor is first impressions: that is, judgments about people we do not know, made quickly and based on very little information. This study explores the influence of first impressions in an OSCE. Specifically, the purpose is to begin to examine the accuracy of a first impression and its influence on subsequent ratings. We created six videotapes of history-taking performance. Each video was scripted from a real performance by six examinee residents within a single OSCE station. Each performance was re-enacted with six different actors playing the role of the examinees and one actor playing the role of the patient and videotaped. A total of 23 raters (i.e., physician examiners) reviewed each video and were asked to make a global judgment of the examinee's clinical abilities after 60 s (First Impression GR) by providing a rating on a six-point global rating scale and then to rate their confidence in the accuracy of that judgment by providing a rating on a five-point rating scale (Confidence GR). After making these ratings, raters then watched the remainder of the examinee's performance and made another global rating of performance (Final GR) before moving on to the next video. First impression ratings of ability varied across examinees and were moderately correlated to expert ratings (r = .59, 95% CI [-.13, .90]). There were significant differences in mean ratings for three examinees. Correlations ranged from .05 to .56 but were only significant for three examinees. Rater confidence in their first impression was not related to the likelihood of a rater changing their rating between the first impression and a subsequent rating. The findings suggest that first impressions could play a role in explaining variability in judgments, but their importance was determined by the videotaped performance of the examinees. More work is needed to clarify conditions that support or discourage the use of first impressions.

Consistency of Angoff-Based Standard-Setting Judgments: Are Item Judgments and Passing Scores Replicable across Different Panels of Experts?

ERIC Educational Resources Information Center

Tannenbaum, Richard J.; Kannan, Priya

2015-01-01

Angoff-based standard setting is widely used, especially for high-stakes licensure assessments. Nonetheless, some critics have claimed that the judgment task is too cognitively complex for panelists, whereas others have explicitly challenged the consistency in (replicability of) standard-setting outcomes. Evidence of consistency in item judgments…

A conceptual model for generating and validating in-session clinical judgments

PubMed Central

Jacinto, Sofia B.; Lewis, Cara C.; Braga, João N.; Scott, Kelli

2016-01-01

Objective Little attention has been paid to the nuanced and complex decisions made in the clinical session context and how these decisions influence therapy effectiveness. Despite decades of research on the dual-processing systems, it remains unclear when and how intuitive and analytical reasoning influence the direction of the clinical session. Method This paper puts forth a testable conceptual model, guided by an interdisciplinary integration of the literature, that posits that the clinical session context moderates the use of intuitive versus analytical reasoning. Results A synthesis of studies examining professional best practices in clinical decision-making, empirical evidence from clinical judgment research, and the application of decision science theories indicate that intuitive and analytical reasoning may have profoundly different impacts on clinical practice and outcomes. Conclusions The proposed model is discussed with respect to its implications for clinical practice and future research. PMID:27088962

Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report.

PubMed

Balslev, Thomas; Rasmussen, Astrid Bruun; Skajaa, Torjus; Nielsen, Jens Peter; Muijtjens, Arno; De Grave, Willem; Van Merriënboer, Jeroen

2014-12-11

Abstract Morning reports offer opportunities for intensive work-based learning. In this controlled study, we measured learning processes and outcomes with the report of paediatric emergency room patients. Twelve specialists and 12 residents were randomised into four groups and discussed the same two paediatric cases. The groups differed in their presentation modality (verbal only vs. verbal + text) and the use of buzz groups (with vs. without). The verbal interactions were analysed for clinical reasoning processes. Perceptions of learning and judgment of learning were reported in a questionnaire. Diagnostic accuracy was assessed by a 20-item multiple-choice test. Combined bimodal presentation and buzz groups increased the odds ratio of clinical reasoning to occur in the discussion of cases by a factor of 1.90 (p = 0.013), indicating superior reasoning for buzz groups working with bimodal materials. For specialists, a positive effect of bimodal presentation was found on perceptions of learning (p < 0.05), and for residents, a positive effect of buzz groups was found on judgment of learning (p < 0.005). A positive effect of bimodal presentation on diagnostic accuracy was noted in the specialists (p < 0.05). Combined bimodal presentation and buzz group discussion of emergency cases improves clinicians' clinical reasoning and learning.

Development of cognitive processing and judgments of knowledge in medical students: Analysis of progress test results.

PubMed

Cecilio-Fernandes, Dario; Kerdijk, Wouter; Jaarsma, A D Debbie C; Tio, René A

2016-11-01

Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students' cognitive processing, and awareness of their knowledge during medical school. Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom's taxonomy: "simple questions" requiring lower and "vignette questions" requiring higher-order cognitive processing. Subsequently, we compared students' performance and awareness of their knowledge in 2008 to that in 2011 for each question type. Students' performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students' judgment of knowledge decreased over time. The progress test is a useful tool to assess students' cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.

Provider judgments of patients in pain: seeking symptom certainty.

PubMed

Tait, Raymond C; Chibnall, John T; Kalauokalani, Donna

2009-01-01

Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment. This review examines the pain assessment literature from a social cognition perspective that emphasizes interpersonal and situational factors that can influence judgments. Consistent with that model, it organizes research findings into three broad domains that have been shown to systematically influence assessments of pain, involving patient, provider, and situational factors. A causal model for pain judgment is proposed, and its implications for clinical research and practice are explored. In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.

Latent Fairness in Adults’ Relationship-Based Moral Judgments

PubMed Central

Hao, Jian; Liu, Yanchun; Li, Jiafeng

2015-01-01

Can adults make fair moral judgments when individuals with whom they have different relationships are involved? The present study explored the fairness of adults’ relationship-based moral judgments in two respects by performing three experiments involving 999 participants. In Experiment 1, 65 adults were asked to decide whether to harm a specific person to save five strangers in the footbridge and trolley dilemmas in a within-subject design. The lone potential victim was a relative, a best friend, a person they disliked, a criminal or a stranger. Adults’ genetic relatedness to, familiarity with and affective relatedness to the lone potential victims varied. The results indicated that adults made different moral judgments involving the lone potential victims with whom they had different relationships. In Experiment 2, 306 adults responded to the footbridge and trolley dilemmas involving five types of lone potential victims in a within-subject design, and the extent to which they were familiar with and affectively related to the lone potential victim was measured. The results generally replicated those of Experiment 1. In addition, for close individuals, adults’ moral judgments were less deontological relative to their familiarity with or positive affect toward these individuals. For individuals they were not close to, adults made deontological choices to a larger extent relative to their unfamiliarity with or negative affect toward these individuals. Moreover, for familiar individuals, the extent to which adults made deontological moral judgments more closely approximated the extent to which they were familiar with the individual. The adults’ deontological moral judgments involving unfamiliar individuals more closely approximated their affective relatedness to the individuals. In Experiment 3, 628 adults were asked to make moral judgments with the type of lone potential victim as the between-subject variable. The results generally replicated those of the previous two experiments. Therefore, the present study shows that, in addition to apparent unfairness, latent fairness exists in adults’ relationship-based moral judgments. Moral judgments involving individuals with whom adults have different relationships have different cognitive and affective bases. PMID:26696935

Rethinking Heat Injury in the SOF Multipurpose Canine: A Critical Review.

PubMed

Baker, Janice L; Hollier, Paul J; Miller, Laura; Lacy, Ward A

2012-01-01

Heat injury is a significant concern of the Special Operations Forces Multipurpose Canine (SOF MPC). The unique athletic abilities and working environment of the SOF MPC differ from that of companion dogs or even conventional military working dogs. This should be considered in the prevention, diagnosis, and treatment of heat injury of the SOF MPC. A critical review of the literature on canine heat injury as it pertains to working dogs demonstrates limited scientific evidence on best practices for immediate clinical management of heat injury in SOF MPCs. A majority of management guidelines for heat injury in veterinary reference books and journals are based on review articles or professional opinion of the author vs. evidence from original research. In addition, guidelines are written primarily for companion animal populations vs. SOF MPCs and focus on measures to be undertaken in a clinical setting vs. point of injury. The phenomenon of ?circular referencing? is also prevalent in the heat injury literature. Current guidelines supported by review articles and textbooks often provide no citation or cite other review articles for clinical standards such as normal temperature ranges, treatment methods, and recurrence of heat injury. This ?circular referencing? phenomenon misrepresents anecdotal evidence and professional opinion as scientifically validated, reinforcing concepts and recommendations that are not truly supported by the evidence. Further study is needed to fully understand heat injury in SOF MPCs and how this applies to prevention, diagnosis and treatment guidelines. In order to provide SOF canine programs with best clinical advice and care, SOF Veterinarians must make clinical judgments based on evaluation of the most accurate and valid information possible. Clinical guidelines are fluid and should be reviewed regularly for relevance to the defined population in question. Clinical Guidelines should also be utilized as guiding principles in conjunction with clinical judgment vs. dictate a clinical protocol. SOF veterinarians as the veterinary support asset to SOF MPC programs should be clinically competent as well as versed in evidence based medicine practices to provide the cutting edge clinical support that is required to keep SOF MPCs operating in modern warfare environments. 2012.

Can model-free reinforcement learning explain deontological moral judgments?

PubMed

Ayars, Alisabeth

2016-05-01

Dual-systems frameworks propose that moral judgments are derived from both an immediate emotional response, and controlled/rational cognition. Recently Cushman (2013) proposed a new dual-system theory based on model-free and model-based reinforcement learning. Model-free learning attaches values to actions based on their history of reward and punishment, and explains some deontological, non-utilitarian judgments. Model-based learning involves the construction of a causal model of the world and allows for far-sighted planning; this form of learning fits well with utilitarian considerations that seek to maximize certain kinds of outcomes. I present three concerns regarding the use of model-free reinforcement learning to explain deontological moral judgment. First, many actions that humans find aversive from model-free learning are not judged to be morally wrong. Moral judgment must require something in addition to model-free learning. Second, there is a dearth of evidence for central predictions of the reinforcement account-e.g., that people with different reinforcement histories will, all else equal, make different moral judgments. Finally, to account for the effect of intention within the framework requires certain assumptions which lack support. These challenges are reasonable foci for future empirical/theoretical work on the model-free/model-based framework. Copyright © 2016 Elsevier B.V. All rights reserved.

Aspiration in children and adolescents with neurogenic dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing.

PubMed

Beer, Sabrina; Hartlieb, Till; Müller, Arnd; Granel, Michael; Staudt, Martin

2014-12-01

A total of 30 children and adolescents with dysphagia due to various chronic neurological disorders were assessed for their risk of aspiration. This assessment was performed clinically by experienced speech and swallowing therapists, and verified thereafter by fiberoptic endoscopy. We found the clinical judgment to be correct in only 70% (for aspiration of saliva), 55% (of puree), and 67% (of thin liquids). We conclude that, because of this unacceptably high error rate of clinical assessment, a fiberoptic evaluation of swallowing is a necessary diagnostic step both for the planning of therapy and for the development of feeding strategies in children and adolescents with neurogenic dysphagia. Georg Thieme Verlag KG Stuttgart · New York.

Individual differences in moral judgment competence influence neural correlates of socio-normative judgments

PubMed Central

Wartenburger, Isabell; Mériau, Katja; Scheibe, Christina; Goodenough, Oliver R.; Villringer, Arno; van der Meer, Elke; Heekeren, Hauke R.

2008-01-01

To investigate how individual differences in moral judgment competence are reflected in the human brain, we used event-related functional magnetic resonance imaging, while 23 participants made either socio-normative or grammatical judgments. Participants with lower moral judgment competence recruited the left ventromedial prefrontal cortex and the left posterior superior temporal sulcus more than participants with greater competence in this domain when identifying social norm violations. Moreover, moral judgment competence scores were inversely correlated with activity in the right dorsolateral prefrontal cortex (DLPFC) during socio-normative relative to grammatical judgments. Greater activity in right DLPFC in participants with lower moral judgment competence indicates increased recruitment of rule-based knowledge and its controlled application during socio-normative judgments. These data support current models of the neurocognition of morality according to which both emotional and cognitive components play an important role. PMID:19015093

The Memory State Heuristic: A Formal Model Based on Repeated Recognition Judgments

ERIC Educational Resources Information Center

Castela, Marta; Erdfelder, Edgar

2017-01-01

The recognition heuristic (RH) theory predicts that, in comparative judgment tasks, if one object is recognized and the other is not, the recognized one is chosen. The memory-state heuristic (MSH) extends the RH by assuming that choices are not affected by recognition judgments per se, but by the memory states underlying these judgments (i.e.,…

Changes in Emotional-Social Intelligence, Caring, Leadership and Moral Judgment during Health Science Education Programs

ERIC Educational Resources Information Center

Larin, Helene; Benson, Gerry; Wessel, Jean; Martin, Lynn; Ploeg, Jenny

2014-01-01

In addition to having academic knowledge and clinical skills, health professionals need to be caring, ethical practitioners able to understand the emotional concerns of their patients and to effect change. The purpose of this study was to determine whether emotional-social intelligence, caring, leadership and moral judgment of health science…

Neural evidence for "intuitive prosecution": the use of mental state information for negative moral verdicts.

PubMed

Young, Liane; Scholz, Jonathan; Saxe, Rebecca

2011-01-01

Moral judgment depends critically on theory of mind (ToM), reasoning about mental states such as beliefs and intentions. People assign blame for failed attempts to harm and offer forgiveness in the case of accidents. Here we use fMRI to investigate the role of ToM in moral judgment of harmful vs. helpful actions. Is ToM deployed differently for judgments of blame vs. praise? Participants evaluated agents who produced a harmful, helpful, or neutral outcome, based on a harmful, helpful, or neutral intention; participants made blame and praise judgments. In the right temporo-parietal junction (right TPJ), and, to a lesser extent, the left TPJ and medial prefrontal cortex, the neural response reflected an interaction between belief and outcome factors, for both blame and praise judgments: The response in these regions was highest when participants delivered a negative moral judgment, i.e., assigned blame or withheld praise, based solely on the agent's intent (attempted harm, accidental help). These results show enhanced attention to mental states for negative moral verdicts based exclusively on mental state information.

Neural bases of motivated reasoning: an FMRI study of emotional constraints on partisan political judgment in the 2004 U.S. Presidential election.

PubMed

Westen, Drew; Blagov, Pavel S; Harenski, Keith; Kilts, Clint; Hamann, Stephan

2006-11-01

Research on political judgment and decision-making has converged with decades of research in clinical and social psychology suggesting the ubiquity of emotion-biased motivated reasoning. Motivated reasoning is a form of implicit emotion regulation in which the brain converges on judgments that minimize negative and maximize positive affect states associated with threat to or attainment of motives. To what extent motivated reasoning engages neural circuits involved in "cold" reasoning and conscious emotion regulation (e.g., suppression) is, however, unknown. We used functional neuroimaging to study the neural responses of 30 committed partisans during the U.S. Presidential election of 2004. We presented subjects with reasoning tasks involving judgments about information threatening to their own candidate, the opposing candidate, or neutral control targets. Motivated reasoning was associated with activations of the ventromedial prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex, insular cortex, and lateral orbital cortex. As predicted, motivated reasoning was not associated with neural activity in regions previously linked to cold reasoning tasks and conscious (explicit) emotion regulation. The findings provide the first neuroimaging evidence for phenomena variously described as motivated reasoning, implicit emotion regulation, and psychological defense. They suggest that motivated reasoning is qualitatively distinct from reasoning when people do not have a strong emotional stake in the conclusions reached.

Not that neglected! Base rates influence related and unrelated judgments.

PubMed

Białek, Michał

2017-06-01

It is claimed that people are unable (or unwilling) to incorporate prior probabilities into posterior assessments, such as their estimation of the likelihood of a person with characteristics typical of an engineer actually being an engineer given that they are drawn from a sample including a very small number of engineers. This paper shows that base rates are incorporated in classifications (Experiment 1) and, moreover, that base rates also affect unrelated judgments, such as how well a provided description of a person fits a stereotypical engineer (Experiment 2). Finally, Experiment 3 shows that individuals who make both types of assessments - though using base rates to the same extent in the former judgments - are able to decrease the extent to which they incorporate base rates in the latter judgments. Copyright © 2017 Elsevier B.V. All rights reserved.

The Science of Climate Change

DOE Office of Scientific and Technical Information (OSTI.GOV)

Makundi, Willy R.

2002-09-20

What constitutes 'dangerous anthropogenic interference' is a value judgment arrived at through a socio-political process, taking issues like equity and sustainability into account. Science provides key information needed to arrive at an informed judgment. However, that judgment is primarily a political one, and not a purely scientific decision. Such judgments are based on risk assessment, and lead to risk management choices by decision makers, about actions and policies.

The Utility of the Frailty Index in Clinical Decision Making.

PubMed

Khatry, K; Peel, N M; Gray, L C; Hubbard, R E

2018-01-01

Using clinical vignettes, this study aimed to determine if a measure of patient frailty would impact management decisions made by geriatricians regarding commonly encountered clinical situations. Electronic surveys consisting of three vignettes derived from cases commonly seen in an acute inpatient ward were distributed to geriatricians. Vignettes included patients being considered for intensive care treatment, rehabilitation, or coronary artery bypass surgery. A frailty index was generated through Comprehensive electronic Geriatric Assessment. For each vignette, respondents were asked to make a recommendation for management, based on either a brief or detailed amount of clinical information and to reconsider their decision after the addition of the frailty index. The study suggests that quantification of frailty might aid the clinical judgment now employed daily to proceed with usual care, or to modify it based on the vulnerability of the person to whom it is aimed.

Dissociable Temporo-Parietal Memory Networks Revealed by Functional Connectivity during Episodic Retrieval

PubMed Central

Hirose, Satoshi; Kimura, Hiroko M.; Jimura, Koji; Kunimatsu, Akira; Abe, Osamu; Ohtomo, Kuni; Miyashita, Yasushi; Konishi, Seiki

2013-01-01

Episodic memory retrieval most often recruits multiple separate processes that are thought to involve different temporal regions. Previous studies suggest dissociable regions in the left lateral parietal cortex that are associated with the retrieval processes. Moreover, studies using resting-state functional connectivity (RSFC) have provided evidence for the temporo-parietal memory networks that may support the retrieval processes. In this functional MRI study, we tested functional significance of the memory networks by examining functional connectivity of brain activity during episodic retrieval in the temporal and parietal regions of the memory networks. Recency judgments, judgments of the temporal order of past events, can be achieved by at least two retrieval processes, relational and item-based. Neuroimaging results revealed several temporal and parietal activations associated with relational/item-based recency judgments. Significant RSFC was observed between one parahippocampal region and one left lateral parietal region associated with relational recency judgments, and between four lateral temporal regions and another left lateral parietal region associated with item-based recency judgments. Functional connectivity during task was found to be significant between the parahippocampal region and the parietal region in the RSFC network associated with relational recency judgments. However, out of the four tempo-parietal RSFC networks associated with item-based recency judgments, only one of them (between the left posterior lateral temporal region and the left lateral parietal region) showed significant functional connectivity during task. These results highlight the contrasting roles of the parahippocampal and the lateral temporal regions in recency judgments, and suggest that only a part of the tempo-parietal RSFC networks are recruited to support particular retrieval processes. PMID:24009657

Throwing the baby out with the bath water: is it time for clinical judgment to supplement actuarial risk assessment?

PubMed

Abbott, Brian R

2011-01-01

The assessment of the potential for sexual violence is one of three prongs that must be met to satisfy the requirements for civil confinement of dangerous sex offenders in the 21 U.S. jurisdictions that have these laws. In a recent issue of The Journal, Sreenivasan et al. argued that, because of a host of methodological problems, actuarial risk assessment methods in general and the Static-99 and its progeny in particular are insufficient for accurate assessment of risk for dangerous sex offenders. They propose using a combination of clinical judgment with actuarial science as a solution. This analysis and review of Sreenivasan et al. reveals and corrects flaws in the arguments they employed to support their position and shows how the combination of actuarial science with clinical judgment is more error prone than the actuarial approach only, and cannot be forensically defended in court. Recommendations on reporting Static-99R data in expert testimony are provided, taking into account the limitations of the instrument.

Race, Color-Blind Racial Attitudes, and Judgments About Mental Health: A Shifting Standards Perspective

ERIC Educational Resources Information Center

Gushue, George V.

2004-01-01

A fictitious counseling center intake report was given to a sample of 158 White graduate students in counseling and clinical psychology to examine the impact of reported client race (Black or White) on perceptions of clients' symptom severity. As predicted by the shifting standards model of social judgment (M. Biernat, M. Manis, & T. E. Nelson,…

Pelvic inflammatory disease and sepsis.

PubMed

Dulin, Judy D; Akers, Mary C

2003-03-01

Pelvic inflammatory disease affects approximately 1 million women per year in the United States alone and has a variety of causative organisms. Because the diagnosis of PID is based on clinical judgment, health care providers need to be guided by the CDC recommendations for diagnosing and treating PID. Because presenting symptoms are often vague, the health care provider should assess female patients for risky behaviors that may lead to PID and should use screening data when making clinical judgments and differential diagnoses. Whenever possible, female patients with PID should be treated as outpatients. If diagnosis and treatment are not performed in a timely manner, PID may cause sepsis, septic shock, and even death. Even if they survive, as many as 15% to 20% of these women experience long-term sequelae of PID, such as ectopic pregnancy, tubo-ovarian abscess, infertility, dyspareunia, and chronic pelvic pain. The best treatments for PID are interventions that lead to prevention and early detection. The critical care nurse has an important role in recognizing the variables that may lead to PID-related sepsis and in encouraging health-seeking and health-maintenance behaviors among women with these diagnoses.

The Development of Intention-Based Morality: The Influence of Intention Salience and Recency, Negligence, and Outcome on Children's and Adults' Judgments

ERIC Educational Resources Information Center

Nobes, Gavin; Panagiotaki, Georgia; Engelhardt, Paul E.

2017-01-01

Two experiments were conducted to investigate the influences on 4-8 year-olds' and adults' moral judgments. In both, participants were told stories from previous studies that had indicated that children's judgments are largely outcome-based. Building on recent research in which one change to these studies' methods resulted in substantially more…

[Role of the orbitofrontal cortex in moral judgment].

PubMed

Mimura, Masaru

2010-11-01

The neural substrates of moral judgments have recently been advocated to consist of widely distributed brain networks including the orbitofrontal cortex (OFC), anterior temporal lobe and superior temporal gyrus. Moral judgments could be regarded as a conflict between the top-down rational/logical processes and the bottom-up irrational/emotional processes. Individuals with OFC damage are usually difficult to inhibit emotionally-driven outrages, thereby demonstrating severe impairment of moral judgments despite their well-preserved moral knowledge. Individuals with OFC damage frequently present with anti-social less moral behaviors. However, clinical observation indicates that some OFC patients may show "hypermoral" tendency in the sense that they are too strict to overlook other person's offense. Two representative cases with OFC damage were reported, both presented with extreme rage against others' offensive behaviors. To further elucidate the "hypermorality" of OFC patients, an experiment was performed in which patients with OFC damage and healthy control participants were asked to determine punishments for other's fictitious crimes that varied in perpetrator responsibility and crime severity. Individuals with OFC damage punished more strictly than healthy controls those persons for mitigating circumstances. The results are consistent with clinical observation of OFC patients' highly rigid and inflexible behaviors against third person's offense.

Connecting Inquiry and Values in Science Education. An Approach Based on John Dewey's Philosophy

NASA Astrophysics Data System (ADS)

Lee, Eun Ah; Brown, Matthew J.

2018-03-01

Conducting scientific inquiry is expected to help students make informed decisions; however, how exactly it can help is rarely explained in science education standards. According to classroom studies, inquiry that students conduct in science classes seems to have little effect on their decision-making. Predetermined values play a large role in students' decision-making, but students do not explore these values or evaluate whether they are appropriate to the particular issue they are deciding, and they often ignore relevant scientific information. We explore how to connect inquiry and values, and how this connection can contribute to informed decision-making based on John Dewey's philosophy. Dewey argues that scientific inquiry should include value judgments and that conducting inquiry can improve the ability to make good value judgments. Value judgment is essential to informed, rational decision-making, and Dewey's ideas can explain how conducting inquiry can contribute to make an informed decision through value judgment. According to Dewey, each value judgment during inquiry is a practical judgment guiding action, and students can improve their value judgments by evaluating their actions during scientific inquiry. Thus, we suggest that students need an opportunity to explore values through scientific inquiry and that practicing value judgment will help informed decision-makings.

Behavioral-Based Predictors of Workplace Violence in the Army STARRS

DTIC Science & Technology

2014-10-01

Dawes RM, Faust D, Meehl PE. Clinical versus actuarial judgment. Science . 1989;243(4899): 1668-1674. 46. Grove WM, Zald DH, Lebow BS, Snitz BE, Nelson...develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target...generate an actuarial post- hospitalization suicide risk algorithm. Previous research has revealed that actuarial suicide prediction is much more

Uncovering clinical knowledge and caring practices.

PubMed

Feldman, M E

1993-06-01

Narrative storytelling is a means by which knowledge embedded in nursing practice is uncovered and examined. Benner uses this method to study and explore skill acquisition and experience-based knowledge in nursing practice. By sharing these stories, knowledge that is unique to the experienced clinician is preserved and extended. The narrative presented here describes the expert coaching, discretionary judgment, and skilled involvement in the care of a patient in the PACU.

When ignorance is no excuse: Different roles for intent across moral domains.

PubMed

Young, Liane; Saxe, Rebecca

2011-08-01

A key factor in legal and moral judgments is intent. Intent differentiates, for instance, murder from manslaughter. Is this true for all moral judgments? People deliver moral judgments of many kinds of actions, including harmful actions (e.g., assault) and purity violations (e.g., incest, consuming taboo substances). We show that intent is a key factor for moral judgments of harm, but less of a factor for purity violations. Based on the agent's innocent intent, participants judged accidental harms less morally wrong than accidental incest; based on the agent's guilty intent, participants judged failed attempts to harm more morally wrong than failed attempts to commit incest. These patterns were specific to moral judgments versus judgments of the agent's control, knowledge, or intent, the action's overall emotional salience, or participants' ratings of disgust. The current results therefore reveal distinct cognitive signatures of distinct moral domains, and may inform the distinct functional roles of moral norms. Copyright © 2011 Elsevier B.V. All rights reserved.

Is HIV/AIDS a consequence or divine judgment? Implications for faith-based social services. A Nigerian faith-based university's study.

PubMed

Olaore, Israel B; Olaore, Augusta Y

2014-01-01

A contemporary reading of Romans 1:27 was disguised as a saying by Paul Benjamin, AD 58 and administered to 275 randomly selected members of a private Christian university community in south western Nigeria in West Africa. Participants were asked to respond to a two-item questionnaire on their perception of the cause of HIV/AIDS either as a judgment from God or consequence of individual lifestyle choices. The apparent consensus drifted in the direction of God as the culprit handing down his judgment to perpetrators of evil who engage in the homosexual lifestyle. The goal of this paper was to examine the implications of a judgmental stance on addressing the psychosocial needs of Persons Living with HIV/AIDS in religious environments. It also explores how service providers in faith-based environments can work around the Judgment versus Consequence tussle in providing non-discriminatory services to persons diagnosed with HIV/AIDS.

Is HIV/AIDS a consequence or divine judgment? Implications for faith-based social services. A Nigerian faith-based university's study

PubMed Central

Olaore, Israel B.; Olaore, Augusta Y.

2014-01-01

Abstract A contemporary reading of Romans 1:27 was disguised as a saying by Paul Benjamin, AD 58 and administered to 275 randomly selected members of a private Christian university community in south western Nigeria in West Africa. Participants were asked to respond to a two-item questionnaire on their perception of the cause of HIV/AIDS either as a judgment from God or consequence of individual lifestyle choices. The apparent consensus drifted in the direction of God as the culprit handing down his judgment to perpetrators of evil who engage in the homosexual lifestyle. The goal of this paper was to examine the implications of a judgmental stance on addressing the psychosocial needs of Persons Living with HIV/AIDS in religious environments. It also explores how service providers in faith-based environments can work around the Judgment versus Consequence tussle in providing non-discriminatory services to persons diagnosed with HIV/AIDS. PMID:24820240

The neural basis of intuitive and counterintuitive moral judgment.

PubMed

Kahane, Guy; Wiech, Katja; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

2012-04-01

Neuroimaging studies on moral decision-making have thus far largely focused on differences between moral judgments with opposing utilitarian (well-being maximizing) and deontological (duty-based) content. However, these studies have investigated moral dilemmas involving extreme situations, and did not control for two distinct dimensions of moral judgment: whether or not it is intuitive (immediately compelling to most people) and whether it is utilitarian or deontological in content. By contrasting dilemmas where utilitarian judgments are counterintuitive with dilemmas in which they are intuitive, we were able to use functional magnetic resonance imaging to identify the neural correlates of intuitive and counterintuitive judgments across a range of moral situations. Irrespective of content (utilitarian/deontological), counterintuitive moral judgments were associated with greater difficulty and with activation in the rostral anterior cingulate cortex, suggesting that such judgments may involve emotional conflict; intuitive judgments were linked to activation in the visual and premotor cortex. In addition, we obtained evidence that neural differences in moral judgment in such dilemmas are largely due to whether they are intuitive and not, as previously assumed, to differences between utilitarian and deontological judgments. Our findings therefore do not support theories that have generally associated utilitarian and deontological judgments with distinct neural systems.

The neural basis of intuitive and counterintuitive moral judgment

PubMed Central

Wiech, Katja; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

2012-01-01

Neuroimaging studies on moral decision-making have thus far largely focused on differences between moral judgments with opposing utilitarian (well-being maximizing) and deontological (duty-based) content. However, these studies have investigated moral dilemmas involving extreme situations, and did not control for two distinct dimensions of moral judgment: whether or not it is intuitive (immediately compelling to most people) and whether it is utilitarian or deontological in content. By contrasting dilemmas where utilitarian judgments are counterintuitive with dilemmas in which they are intuitive, we were able to use functional magnetic resonance imaging to identify the neural correlates of intuitive and counterintuitive judgments across a range of moral situations. Irrespective of content (utilitarian/deontological), counterintuitive moral judgments were associated with greater difficulty and with activation in the rostral anterior cingulate cortex, suggesting that such judgments may involve emotional conflict; intuitive judgments were linked to activation in the visual and premotor cortex. In addition, we obtained evidence that neural differences in moral judgment in such dilemmas are largely due to whether they are intuitive and not, as previously assumed, to differences between utilitarian and deontological judgments. Our findings therefore do not support theories that have generally associated utilitarian and deontological judgments with distinct neural systems. PMID:21421730

Clinical judgement and the medical profession

PubMed Central

Kienle, Gunver S; Kiene, Helmut

2011-01-01

Objectives Clinical judgment is a central element of the medical profession, essential for the performance of the doctor, and potentially generating information also for other clinicians and for scientists and health care managers. The recently renewed interest in clinical judgement is primarily engaged with its role in communication, diagnosis and decision making. Beyond this issue, the present article highlights the interrelations between clinical judgement, therapy assessment and medical professionalism. Methods Literature review and theory development. Results The article presents different methodological approaches to causality assessment in clinical studies and in clinical judgement, and offers criteria for clinical single case causality. The article outlines models of medical professionalism such as technical rationality and practice epistemology, and characterizes features of professional expertise such as tacit knowledge, reflection in action, and gestalt cognition. Conclusions Consequences of a methodological and logistical advancement of clinical judgment are discussed, both in regard to medical progress and to the renewel of the cognitive basis of the medical profession. PMID:20973873

Plausibility Judgments in Conceptual Change and Epistemic Cognition

ERIC Educational Resources Information Center

Lombardi, Doug; Nussbaum, E. Michael; Sinatra, Gale M.

2016-01-01

Plausibility judgments rarely have been addressed empirically in conceptual change research. Recent research, however, suggests that these judgments may be pivotal to conceptual change about certain topics where a gap exists between what scientists and laypersons find plausible. Based on a philosophical and empirical foundation, this article…

Disgust sensitivity is primarily associated with purity-based moral judgments.

PubMed

Wagemans, Fieke M A; Brandt, Mark J; Zeelenberg, Marcel

2018-03-01

Individual differences in disgust sensitivity are associated with a range of judgments and attitudes related to the moral domain. Some perspectives suggest that the association between disgust sensitivity and moral judgments will be equally strong across all moral domains (i.e., purity, authority, loyalty, care, fairness, and liberty). Other perspectives predict that disgust sensitivity is primarily associated with judgments of specific moral domains (e.g., primarily purity). However, no study has systematically tested if disgust sensitivity is associated with moral judgments of the purity domain specifically, more generally to moral judgments of the binding moral domains, or to moral judgments of all of the moral domains equally. Across 5 studies (total N = 1,104), we find consistent evidence for the notion that disgust sensitivity relates more strongly to moral condemnation of purity-based transgressions (meta-analytic r = .40) than to moral condemnation of transgressions of any of the other domains (range meta-analytic rs: .07-.27). Our findings are in line with predictions from Moral Foundations Theory, which predicts that personality characteristics like disgust sensitivity make people more sensitive to a certain set of moral issues. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Medical Decision Making for Patients Without Proxies: The Effect of Personal Experience in the Deliberative Process.

PubMed

Robichaud, Allyson L

2015-01-01

The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent--or informed refusal--is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Use of expert judgment elicitation to estimate seismic vulnerability of selected building types

USGS Publications Warehouse

Jaiswal, K.S.; Aspinall, W.; Perkins, D.; Wald, D.; Porter, K.A.

2012-01-01

Pooling engineering input on earthquake building vulnerability through an expert judgment elicitation process requires careful deliberation. This article provides an overview of expert judgment procedures including the Delphi approach and the Cooke performance-based method to estimate the seismic vulnerability of a building category.

Application of evidence-based dentistry: from research to clinical periodontal practice.

PubMed

Kwok, Vivien; Caton, Jack G; Polson, Alan M; Hunter, Paul G

2012-06-01

Dentists need to make daily decisions regarding patient care, and these decisions should essentially be scientifically sound. Evidence-based dentistry is meant to empower clinicians to provide the most contemporary treatment. The benefits of applying the evidence-based method in clinical practice include application of the most updated treatment and stronger reasoning to justify the treatment. A vast amount of information is readily accessible with today's digital technology, and a standardized search protocol can be developed to ensure that a literature search is valid, specific and repeatable. It involves developing a preset question (population, intervention, comparison and outcome; PICO) and search protocol. It is usually used academically to perform commissioned reviews, but it can also be applied to answer simple clinical queries. The scientific evidence thus obtained can then be considered along with patient preferences and values, clinical patient circumstances and the practitioner's experience and judgment in order to make the treatment decision. This paper describes how clinicians can incorporate evidence-based methods into patient care and presents a clinical example to illustrate the process. © 2012 John Wiley & Sons A/S.

The Impact of Autism Spectrum Disorder and Alexithymia on Judgments of Moral Acceptability

PubMed Central

2015-01-01

One’s own emotional response toward a hypothetical action can influence judgments of its moral acceptability. Some individuals with autism spectrum disorder (ASD) exhibit atypical emotional processing, and moral judgments. Research suggests, however, that emotional deficits in ASD are due to co-occurring alexithymia, meaning atypical moral judgments in ASD may be due to alexithymia also. Individuals with and without ASD (matched for alexithymia) judged the moral acceptability of emotion-evoking statements and identified the emotion evoked. Moral acceptability judgments were predicted by alexithymia. Crucially, however, this relationship held only for individuals without ASD. While ASD diagnostic status did not directly predict either judgment, those with ASD did not base their moral acceptability judgments on emotional information. Findings are consistent with evidence demonstrating that decision-making is less subject to emotional biases in those with ASD. PMID:26375827

Decision tool for clients with medical issues: a framework for identifying driving risk and potential to return to driving.

PubMed

Dickerson, Anne E; Bédard, Michel

2014-04-01

This paper offers occupational therapy generalists and specialists a new framework by which to consider clinical evaluation data and an older adult's driving risk and potential to resume this previously learned skill. Based on Michon's model describing the hierarchy of driving levels, clinical questions identify the factors that may affect a client's fitness to drive. The first part is intended to support clinical judgment of whether a client needs a driving evaluation by a driver rehabilitation specialist. The second part offers a framework to organize clinical data that are already known and determine what other evaluation information is justified and necessary to make a driving recommendation. Methods and rational for use are discussed.

Usefulness of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) in differentiating congestive heart failure from noncardiac cause of acute dyspnea in elderly patients with a normal left ventricular ejection fraction and permanent, nonvalvular atrial fibrillation: insights from a prospective, monocenter study.

PubMed

Arques, Stephane; Roux, Emmanuel; Sbragia, Pascal; Pieri, Bertrand; Gelisse, Richard; Luccioni, Roger; Ambrosi, Pierre

2007-05-01

The incremental role of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown. To investigate the usefulness of bedside tissue Doppler echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation. Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission. By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy. Bedside tissue Doppler echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.

The role of assessment in competency-based medical education.

PubMed

Holmboe, Eric S; Sherbino, Jonathan; Long, Donlin M; Swing, Susan R; Frank, Jason R

2010-01-01

Competency-based medical education (CBME), by definition, necessitates a robust and multifaceted assessment system. Assessment and the judgments or evaluations that arise from it are important at the level of the trainee, the program, and the public. When designing an assessment system for CBME, medical education leaders must attend to the context of the multiple settings where clinical training occurs. CBME further requires assessment processes that are more continuous and frequent, criterion-based, developmental, work-based where possible, use assessment methods and tools that meet minimum requirements for quality, use both quantitative and qualitative measures and methods, and involve the wisdom of group process in making judgments about trainee progress. Like all changes in medical education, CBME is a work in progress. Given the importance of assessment and evaluation for CBME, the medical education community will need more collaborative research to address several major challenges in assessment, including "best practices" in the context of systems and institutional culture and how to best to train faculty to be better evaluators. Finally, we must remember that expertise, not competence, is the ultimate goal. CBME does not end with graduation from a training program, but should represent a career that includes ongoing assessment.

Development and validation of Dutch version of Lasater Clinical Judgment Rubric in hospital practice: An instrument design study.

PubMed

Vreugdenhil, Jettie; Spek, Bea

2018-03-01

Clinical reasoning in patient care is a skill that cannot be observed directly. So far, no reliable, valid instrument exists for the assessment of nursing students' clinical reasoning skills in hospital practice. Lasater's clinical judgment rubric (LCJR), based on Tanner's model "Thinking like a nurse" has been tested, mainly in academic simulation settings. The aim is to develop a Dutch version of the LCJR (D-LCJR) and to test its psychometric properties when used in a hospital traineeship context. A mixed-model approach was used to develop and to validate the instrument. Ten dedicated educational units in a university hospital. A well-mixed group of 52 nursing students, nurse coaches and nurse educators. A Delphi panel developed the D-LCJR. Students' clinical reasoning skills were assessed "live" by nurse coaches, nurse educators and students who rated themselves. The psychometric properties tested during the assessment process are reliability, reproducibility, content validity and construct validity by testing two hypothesis: 1) a positive correlation between assessed and self-reported sum scores (convergent validity) and 2) a linear relation between experience and sum score (clinical validity). The obtained D-LCJR was found to be internally consistent, Cronbach's alpha 0.93. The rubric is also reproducible with intraclass correlations between 0.69 and 0.78. Experts judged it to be content valid. The two hypothesis were both tested significant, supporting evidence for construct validity. The translated and modified LCJR, is a promising tool for the evaluation of nursing students' development in clinical reasoning in hospital traineeships, by students, nurse coaches and nurse educators. More evidence on construct validity is necessary, in particular for students at the end of their hospital traineeship. Based on our research, the D-LCJR applied in hospital traineeships is a usable and reliable tool. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of antiviral treatment in the management of seasonal influenza A: point-of-care rapid test versus clinical judgment.

PubMed

Nshimyumukiza, Léon; Douville, Xavier; Fournier, Diane; Duplantie, Julie; Daher, Rana K; Charlebois, Isabelle; Longtin, Jean; Papenburg, Jesse; Guay, Maryse; Boissinot, Maurice; Bergeron, Michel G; Boudreau, Denis; Gagné, Christian; Rousseau, François; Reinharz, Daniel

2016-03-01

A point-of-care rapid test (POCRT) may help early and targeted use of antiviral drugs for the management of influenza A infection. (i) To determine whether antiviral treatment based on a POCRT for influenza A is cost-effective and, (ii) to determine the thresholds of key test parameters (sensitivity, specificity and cost) at which a POCRT based-strategy appears to be cost effective. An hybrid « susceptible, infected, recovered (SIR) » compartmental transmission and Markov decision analytic model was used to simulate the cost-effectiveness of antiviral treatment based on a POCRT for influenza A in the social perspective. Data input parameters used were retrieved from peer-review published studies and government databases. The outcome considered was the incremental cost per life-year saved for one seasonal influenza season. In the base-case analysis, the antiviral treatment based on POCRT saves 2 lives/100,000 person-years and costs $7600 less than the empirical antiviral treatment based on clinical judgment alone, which demonstrates that the POCRT-based strategy is dominant. In one and two way-sensitivity analyses, results were sensitive to the POCRT accuracy and cost, to the vaccination coverage as well as to the prevalence of influenza A. In probabilistic sensitivity analyses, the POCRT strategy is cost-effective in 66% of cases, for a commonly accepted threshold of $50,000 per life-year saved. The influenza antiviral treatment based on POCRT could be cost-effective in specific conditions of performance, price and disease prevalence. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

The Influence of Judgment Calls on Meta-Analytic Findings.

PubMed

Tarrahi, Farid; Eisend, Martin

2016-01-01

Previous research has suggested that judgment calls (i.e., methodological choices made in the process of conducting a meta-analysis) have a strong influence on meta-analytic findings and question their robustness. However, prior research applies case study comparison or reanalysis of a few meta-analyses with a focus on a few selected judgment calls. These studies neglect the fact that different judgment calls are related to each other and simultaneously influence the outcomes of a meta-analysis, and that meta-analytic findings can vary due to non-judgment call differences between meta-analyses (e.g., variations of effects over time). The current study analyzes the influence of 13 judgment calls in 176 meta-analyses in marketing research by applying a multivariate, multilevel meta-meta-analysis. The analysis considers simultaneous influences from different judgment calls on meta-analytic effect sizes and controls for alternative explanations based on non-judgment call differences between meta-analyses. The findings suggest that judgment calls have only a minor influence on meta-analytic findings, whereas non-judgment call differences between meta-analyses are more likely to explain differences in meta-analytic findings. The findings support the robustness of meta-analytic results and conclusions.

Neural Correlates of Explicit Social Judgments on Vocal Stimuli

PubMed Central

Hensel, Lukas; Bzdok, Danilo; Müller, Veronika I.; Zilles, Karl; Eickhoff, Simon B.

2015-01-01

Functional neuroimaging research on the neural basis of social evaluation has traditionally focused on face perception paradigms. Thus, little is known about the neurobiology of social evaluation processes based on auditory cues, such as voices. To investigate the top-down effects of social trait judgments on voices, hemodynamic responses of 44 healthy participants were measured during social trait (trustworthiness [TR] and attractiveness [AT]), emotional (happiness, HA), and cognitive (age, AG) voice judgments. Relative to HA and AG judgments, TR and AT judgments both engaged the bilateral inferior parietal cortex (IPC; area PGa) and the dorsomedial prefrontal cortex (dmPFC) extending into the perigenual anterior cingulate cortex. This dmPFC activation overlapped with previously reported areas specifically involved in social judgments on ‘faces.’ Moreover, social trait judgments were expected to share neural correlates with emotional HA and cognitive AG judgments. Comparison of effects pertaining to social, social–emotional, and social–cognitive appraisal processes revealed a dissociation of the left IPC into 3 functional subregions assigned to distinct cytoarchitectonic subdivisions. In total, the dmPFC is proposed to assume a central role in social attribution processes across sensory qualities. In social judgments on voices, IPC activity shifts from rostral processing of more emotional judgment facets to caudal processing of more cognitive judgment facets. PMID:24243619

Teaching evidence-based practice at the University of Texas Health Science Center at San Antonio dental school.

PubMed

Rugh, John D; Hendricson, William D; Glass, Birgit J; Hatch, John P; Deahl, S Thomas; Guest, Gary; Ongkiko, Richard; Gureckis, Kevin; Jones, Archie A; Rose, William F; Gakunga, Peter; Stark, Debra; Steffensen, Bjorn

2011-02-01

The overarching goal of the Evidence-Based Practice Program at San Antonio is to provide our graduates with life-long learning skills that will enable them to keep up-to-date and equip them with the best possible patient care skills during their 30-40 years of practice. Students are taught to (1) ask focused clinical questions, (2) search the biomedical research literature (PubMed) for the most recent and highest level of evidence, (3) critically evaluate the evidence, and (4) make clinical judgments about the applicability of the evidence for their patients. Students must demonstrate competency with these "just-in-time" learning skills through writing concise one-page Critically Appraised Topics (CATs) on focused clinical questions. The school has established an online searchable library of these Critically Appraised Topics. This library provides students and faculty with rapid, up-to-date evidence-based answers to clinical questions. The long-range plan is to make this online library available to practitioners and the public.

More than Just Beliefs: Experience and Beliefs Jointly Contribute to Volume Effects on Metacognitive Judgments

ERIC Educational Resources Information Center

Frank, David J.; Kuhlmann, Beatrice G.

2017-01-01

Experience-based cues, such as perceptual fluency, have long been thought to influence metacognitive judgments (Kelley & Jacoby, 1996; Koriat, 1997). Studies found that manipulations of perceptual fluency via changes in font and volume alter Judgments of Learning (JOLs) without influencing memory performance (Rhodes & Castel, 2008, 2009).…

6- And 8-Year-Olds' Performance Evaluations: Do They Differ between Self And Unknown Others?

ERIC Educational Resources Information Center

Destan, Nesrin; Spiess, Manuela A.; de Bruin, Anique; van Loon, Mariëtte; Roebers, Claudia M.

2017-01-01

The current study investigated kindergarteners and second graders' ability to monitor and evaluate their own and a virtual peer's performance in a paired-associate learning task. Participants provided confidence judgments (CJs) for their own responses and performance-based judgments (judgments provided "after" receiving feedback on their…

Judgments about Forces in Described Interactions between Objects

ERIC Educational Resources Information Center

White, Peter A.

2011-01-01

In 4 experiments, participants made judgments about forces exerted and resistances put up by objects involved in described interactions. Two competing hypotheses were tested: (1) that judgments are derived from the same knowledge base that is thought to be the source of perceptual impressions of forces that occur with visual stimuli, and (2) that…

Brief Contemplation as a Factor in the Accuracy of Perceptual Judgments.

ERIC Educational Resources Information Center

Rollman, Steven A.; Gabbard-Alley, Anne

A study investigated the importance of brief contemplation as a factor in the accuracy of judgments about other people, based on their nonverbal appearance. The following questions were addressed: (1) Are observers who are given time to contemplate the significance of nonverbal cues more accurate in their perceptual judgments than observers who…

Improving epistemological beliefs and moral judgment through an STS-based science ethics education program.

PubMed

Han, Hyemin; Jeong, Changwoo

2014-03-01

This study develops a Science-Technology-Society (STS)-based science ethics education program for high school students majoring in or planning to major in science and engineering. Our education program includes the fields of philosophy, history, sociology and ethics of science and technology, and other STS-related theories. We expected our STS-based science ethics education program to promote students' epistemological beliefs and moral judgment development. These psychological constructs are needed to properly solve complicated moral and social dilemmas in the fields of science and engineering. We applied this program to a group of Korean high school science students gifted in science and engineering. To measure the effects of this program, we used an essay-based qualitative measurement. The results indicate that there was significant development in both epistemological beliefs and moral judgment. In closing, we briefly discuss the need to develop epistemological beliefs and moral judgment using an STS-based science ethics education program.

Neural substrates of embodied natural beauty and social endowed beauty: An fMRI study.

PubMed

Zhang, Wei; He, Xianyou; Lai, Siyan; Wan, Juan; Lai, Shuxian; Zhao, Xueru; Li, Darong

2017-08-02

What are the neural mechanisms underlying beauty based on objective parameters and beauty based on subjective social construction? This study scanned participants with fMRI while they performed aesthetic judgments on concrete pictographs and abstract oracle bone scripts. Behavioral results showed both pictographs and oracle bone scripts were judged to be more beautiful when they referred to beautiful objects and positive social meanings, respectively. Imaging results revealed regions associated with perceptual, cognitive, emotional and reward processing were commonly activated both in beautiful judgments of pictographs and oracle bone scripts. Moreover, stronger activations of orbitofrontal cortex (OFC) and motor-related areas were found in beautiful judgments of pictographs, whereas beautiful judgments of oracle bone scripts were associated with putamen activity, implying stronger aesthetic experience and embodied approaching for beauty were elicited by the pictographs. In contrast, only visual processing areas were activated in the judgments of ugly pictographs and negative oracle bone scripts. Results provide evidence that the sense of beauty is triggered by two processes: one based on the objective parameters of stimuli (embodied natural beauty) and the other based on the subjective social construction (social endowed beauty).

The impact of autism spectrum disorder and alexithymia on judgments of moral acceptability.

PubMed

Brewer, Rebecca; Marsh, Abigail A; Catmur, Caroline; Cardinale, Elise M; Stoycos, Sarah; Cook, Richard; Bird, Geoffrey

2015-08-01

One's own emotional response toward a hypothetical action can influence judgments of its moral acceptability. Some individuals with autism spectrum disorder (ASD) exhibit atypical emotional processing, and moral judgments. Research suggests, however, that emotional deficits in ASD are due to co-occurring alexithymia, meaning atypical moral judgments in ASD may be due to alexithymia also. Individuals with and without ASD (matched for alexithymia) judged the moral acceptability of emotion-evoking statements and identified the emotion evoked. Moral acceptability judgments were predicted by alexithymia. Crucially, however, this relationship held only for individuals without ASD. While ASD diagnostic status did not directly predict either judgment, those with ASD did not base their moral acceptability judgments on emotional information. Findings are consistent with evidence demonstrating that decision-making is less subject to emotional biases in those with ASD. (c) 2015 APA, all rights reserved).

THE ROLE OF AFFECTIVE EXPERIENCE IN WORK MOTIVATION

PubMed Central

SEO, MYEONG-GU; BARRETT, LISA FELDMAN; BARTUNEK, JEAN M.

2005-01-01

Based on psychological and neurobiological theories of core affective experience, we identify a set of direct and indirect paths through which affective feelings at work affect three dimensions of behavioral outcomes: direction, intensity, and persistence. First, affective experience may influence these behavioral outcomes indirectly by affecting goal level and goal commitment, as well as three key judgment components of work motivation: expectancy judgments, utility judgments, and progress judgments. Second, affective experience may also affect these behavioral outcomes directly. We discuss implications of our model. PMID:16871321

FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

PubMed

Bui, Thanh C; Krieger, Heather A; Blumenthal-Barby, Jennifer S

2015-10-01

This study aimed to assess physicians' susceptibility to framing effects in clinical judgment and decision making. A survey was administered online to 159 general internists in the United States. Participants were randomized into two groups, in which clinical scenarios varied in their framings: frequency vs percentage, with cost information vs without, female patient vs male patient, and mortality vs survival. Results showed that physicians' recommendations for patients in hypothetical scenarios were significantly different when the predicted probability of the outcomes was presented in frequency versus percentage form and when it was presented in mortality rate vs survival rate of the same magnitude. Physicians' recommendations were not different for other framing effects.

Detecting Abnormal Word Utterances in Children With Autism Spectrum Disorders: Machine-Learning-Based Voice Analysis Versus Speech Therapists.

PubMed

Nakai, Yasushi; Takiguchi, Tetsuya; Matsui, Gakuyo; Yamaoka, Noriko; Takada, Satoshi

2017-10-01

Abnormal prosody is often evident in the voice intonations of individuals with autism spectrum disorders. We compared a machine-learning-based voice analysis with human hearing judgments made by 10 speech therapists for classifying children with autism spectrum disorders ( n = 30) and typical development ( n = 51). Using stimuli limited to single-word utterances, machine-learning-based voice analysis was superior to speech therapist judgments. There was a significantly higher true-positive than false-negative rate for machine-learning-based voice analysis but not for speech therapists. Results are discussed in terms of some artificiality of clinician judgments based on single-word utterances, and the objectivity machine-learning-based voice analysis adds to judging abnormal prosody.

Use of the Progressive Aphasia Severity Scale (PASS) in monitoring speech and language status in PPA

PubMed Central

Sapolsky, Daisy; Domoto-Reilly, Kimiko; Dickerson, Bradford C.

2014-01-01

Background Primary progressive aphasia (PPA) is a devastating neurodegenerative syndrome involving the gradual development of aphasia, slowly impairing the patient’s ability to communicate. Pharmaceutical treatments do not currently exist and intervention often focuses on speech-language behavioral therapies, although further investigation is warranted to determine how best to harness functional benefits. Efforts to develop pharmaceutical and behavioral treatments have been hindered by a lack of standardized methods to monitor disease progression and treatment efficacy. Aims Here we describe our current approach to monitoring progression of PPA, including the development and applications of a novel clinical instrument for this purpose, the Progressive Aphasia Severity Scale (PASS). We also outline some of the issues related to initial evaluation and longitudinal monitoring of PPA. Methods & Procedures In our clinical and research practice we perform initial and follow-up assessments of PPA patients using a multi-faceted approach. In addition to standardized assessment measures, we use the PASS to rate presence and severity of symptoms across distinct domains of speech, language, and functional and pragmatic aspects of communication. Ratings are made using the clinician’s best judgment, integrating information from patient test performance in the office as well as a companion’s description of routine daily functioning. Outcomes & Results Monitoring symptom characteristics and severity with the PASS can assist in developing behavioral therapies, planning treatment goals, and counseling patients and families on clinical status and prognosis. The PASS also has potential to advance the implementation of PPA clinical trials. Conclusions PPA patients display heterogeneous language profiles that change over time given the progressive nature of the disease. The monitoring of symptom progression is therefore crucial to ensure that proposed treatments are appropriate at any given stage, including speech-language therapy and potentially pharmaceutical treatments once these become available. Because of the discrepancy that can exist between a patient’s daily functioning and standardized test performance, we believe a comprehensive assessment and monitoring battery must include performance-based instruments, interviews with the patient and partner, questionnaires about functioning in daily life, and measures of clinician judgment. We hope that our clinician judgment-based rating scale described here will be a valuable addition to the PPA assessment and monitoring battery. PMID:25419031

A novel magnetic resonance imaging segmentation technique for determining diffuse intrinsic pontine glioma tumor volume.

PubMed

Singh, Ranjodh; Zhou, Zhiping; Tisnado, Jamie; Haque, Sofia; Peck, Kyung K; Young, Robert J; Tsiouris, Apostolos John; Thakur, Sunitha B; Souweidane, Mark M

2016-11-01

OBJECTIVE Accurately determining diffuse intrinsic pontine glioma (DIPG) tumor volume is clinically important. The aims of the current study were to 1) measure DIPG volumes using methods that require different degrees of subjective judgment; and 2) evaluate interobserver agreement of measurements made using these methods. METHODS Eight patients from a Phase I clinical trial testing convection-enhanced delivery (CED) of a therapeutic antibody were included in the study. Pre-CED, post-radiation therapy axial T2-weighted images were analyzed using 2 methods requiring high degrees of subjective judgment (picture archiving and communication system [PACS] polygon and Volume Viewer auto-contour methods) and 1 method requiring a low degree of subjective judgment (k-means clustering segmentation) to determine tumor volumes. Lin's concordance correlation coefficients (CCCs) were calculated to assess interobserver agreement. RESULTS The CCCs of measurements made by 2 observers with the PACS polygon and the Volume Viewer auto-contour methods were 0.9465 (lower 1-sided 95% confidence limit 0.8472) and 0.7514 (lower 1-sided 95% confidence limit 0.3143), respectively. Both were considered poor agreement. The CCC of measurements made using k-means clustering segmentation was 0.9938 (lower 1-sided 95% confidence limit 0.9772), which was considered substantial strength of agreement. CONCLUSIONS The poor interobserver agreement of PACS polygon and Volume Viewer auto-contour methods highlighted the difficulty in consistently measuring DIPG tumor volumes using methods requiring high degrees of subjective judgment. k-means clustering segmentation, which requires a low degree of subjective judgment, showed better interobserver agreement and produced tumor volumes with delineated borders.

Cold or Calculating? Reduced Activity in the Subgenual Cingulate Cortex Reflects Decreased Emotional Aversion to Harming in Counterintuitive Utilitarian Judgment

ERIC Educational Resources Information Center

Wiech, Katja; Kahane, Guy; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

2013-01-01

Recent research on moral decision-making has suggested that many common moral judgments are based on immediate intuitions. However, some individuals arrive at highly counterintuitive utilitarian conclusions about when it is permissible to harm other individuals. Such utilitarian judgments have been attributed to effortful reasoning that has…

The Influence of Negligence, Intention, and Outcome on Children's Moral Judgments

ERIC Educational Resources Information Center

Nobes, Gavin; Panagiotaki, Georgia.; Pawson, Chris

2009-01-01

Piaget (1932) and subsequent researchers have reported that young children's moral judgments are based more on the outcomes of actions than on the agents' intentions. The current study investigated whether negligence might also influence these judgments and explain children's apparent focus on outcome. Children (3-8 years of age) and adults (N =…

Children's Moral Judgments and Moral Emotions Following Exclusion of Children with Disabilities: Relations with Inclusive Education, Age, and Contact Intensity

ERIC Educational Resources Information Center

Gasser, Luciano; Malti, Tina; Buholzer, Alois

2013-01-01

We investigated relations between children's moral judgments and moral emotions following disability-based exclusion and inclusive education, age, and contact intensity. Nine- and 12-year-old Swiss children (N = 351) from inclusive and noninclusive classrooms provided moral judgments and moral emotion attributions following six vignettes about…

Teacher Judgments and Pupils' Causal Explanations: Social Valorization of Effort-Based Explanations in School Context

ERIC Educational Resources Information Center

Matteucci, Maria Cristina; Tomasetto, Carlo; Selleri, Patrizia; Carugati, Felice

2008-01-01

Achievement evaluation in school contexts may be considered as a kind of social judgment, which is affected by social and moral determinants since it is not merely an estimation of pupils' accomplishment (Dompnier, Pansu, & Bressoux, 2006; Weiner, 2003). Teachers' judgments have been investigated starting from the analysis of two theoretical…

Are You Sure the Library Is That Way? Metacognitive Monitoring of Spatial Judgments

ERIC Educational Resources Information Center

Stevens, Christopher A.; Carlson, Richard A.

2016-01-01

Many studies have examined how people recall the locations of objects in spatial layouts. However, little is known about how people monitor the accuracy of judgments based on those memories. The goal of the present experiments was to examine the effect of reference frame characteristics on metacognitive accuracy for spatial judgments. Reference…

The Influence of First Impressions on Subsequent Ratings within an OSCE Station

ERIC Educational Resources Information Center

Wood, Timothy J.; Chan, James; Humphrey-Murto, Susan; Pugh, Debra; Touchie, Claire

2017-01-01

Competency-based assessment is placing increasing emphasis on the direct observation of learners. For this process to produce valid results, it is important that raters provide quality judgments that are accurate. Unfortunately, the quality of these judgments is variable and the roles of factors that influence the accuracy of those judgments are…

Clinical errors and therapist discomfort with client disclosure of troublesome pornography use: Implications for clinical practice and error reduction.

PubMed

Walters, Nathan T; Spengler, Paul M

2016-09-01

Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment. The present paper explores clinician examples of judgment errors that may result from feelings of discomfort, and specifically from client use of pornography. Issues of potential bias, bias management techniques, and therapeutic implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Relative Success of Recognition-Based Inference in Multichoice Decisions

ERIC Educational Resources Information Center

McCloy, Rachel; Beaman, C. Philip; Smith, Philip T.

2008-01-01

The utility of an "ecologically rational" recognition-based decision rule in multichoice decision problems is analyzed, varying the type of judgment required (greater or lesser). The maximum size and range of a counterintuitive advantage associated with recognition-based judgment (the "less-is-more effect") is identified for a range of cue…

Models based on value and probability in health improve shared decision making.

PubMed

Ortendahl, Monica

2008-10-01

Diagnostic reasoning and treatment decisions are a key competence of doctors. A model based on values and probability provides a conceptual framework for clinical judgments and decisions, and also facilitates the integration of clinical and biomedical knowledge into a diagnostic decision. Both value and probability are usually estimated values in clinical decision making. Therefore, model assumptions and parameter estimates should be continually assessed against data, and models should be revised accordingly. Introducing parameter estimates for both value and probability, which usually pertain in clinical work, gives the model labelled subjective expected utility. Estimated values and probabilities are involved sequentially for every step in the decision-making process. Introducing decision-analytic modelling gives a more complete picture of variables that influence the decisions carried out by the doctor and the patient. A model revised for perceived values and probabilities by both the doctor and the patient could be used as a tool for engaging in a mutual and shared decision-making process in clinical work.

Is moral beauty different from facial beauty? Evidence from an fMRI study.

PubMed

Wang, Tingting; Mo, Lei; Mo, Ce; Tan, Li Hai; Cant, Jonathan S; Zhong, Luojin; Cupchik, Gerald

2015-06-01

Is moral beauty different from facial beauty? Two functional magnetic resonance imaging experiments were performed to answer this question. Experiment 1 investigated the network of moral aesthetic judgments and facial aesthetic judgments. Participants performed aesthetic judgments and gender judgments on both faces and scenes containing moral acts. The conjunction analysis of the contrasts 'facial aesthetic judgment > facial gender judgment' and 'scene moral aesthetic judgment > scene gender judgment' identified the common involvement of the orbitofrontal cortex (OFC), inferior temporal gyrus and medial superior frontal gyrus, suggesting that both types of aesthetic judgments are based on the orchestration of perceptual, emotional and cognitive components. Experiment 2 examined the network of facial beauty and moral beauty during implicit perception. Participants performed a non-aesthetic judgment task on both faces (beautiful vs common) and scenes (containing morally beautiful vs neutral information). We observed that facial beauty (beautiful faces > common faces) involved both the cortical reward region OFC and the subcortical reward region putamen, whereas moral beauty (moral beauty scenes > moral neutral scenes) only involved the OFC. Moreover, compared with facial beauty, moral beauty spanned a larger-scale cortical network, indicating more advanced and complex cerebral representations characterizing moral beauty. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Thinking about thinking: implications for patient safety.

PubMed

Montgomery, Kathryn

2009-01-01

Clinical medicine, a learned, rational, science-using practice, is labelled a science even though physicians have the good sense not to practise it that way. Rather than thinking like scientists - or how we think scientists think - physicians are engaged in analogical, interpretive reasoning that resembles Aristotle's phronesis, or practical reasoning, more closely than episteme, or scientific reasoning. In medicine, phronesis is clinical judgment; and while it depends on both a fund of information and extensive experience, somehow it is not quite teachable. This practical, clinical rationality relies on case narrative for teaching and learning about illness and disease, for recording and communicating about patient care and, inevitably, for thinking about and remembering the details, as well as the overarching rules of practice. At the same time, "anecdotal" remains the most pejorative word in medicine, and the tension between the justifiable caution this disdain expresses and the pervasive narrative structure of medical knowledge is characteristic of clinical knowing generally: a tug-of-war between apparent irreconcilables that can be settled only by an appeal to the circumstances of the clinical situation. Practical rationality in the clinical encounter is characterized by a productive circulation between the particular details of the patient's presentation and general information about disease stored as a taxonomy of cases. Evidence-based medicine can improve this negotiation between general knowledge and the patient's particulars, but it cannot replace it. In a scientific era, clinical judgment remains the quintessential intellectual strength of the clinician. Why, then, do we not teach the epistemology of medicine? Understanding the mis-description of physicians' thinking - and the accompanying claim that medicine is, in itself, a science - could mitigate the misplaced perfectionism that makes mistakes in medicine personal and unthinkable.

Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment.

PubMed

Peláez-Ballestas, Ingris; Hernández Cuevas, Claudia; Burgos-Vargas, Rubén; Hernández Roque, Lizandra; Terán, Leobardo; Espinoza, Jesús; Esquivel-Valerio, Jorge A; Goycochea-Robles, María Victoria; Aceves, Francisco J; Bernard, Ana Guilaisne; Ventura, Lucio; Shumsky, Clara; Hernández Garduño, Adolfo; Vázquez-Mellado, Janitzia

2010-08-01

Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists. This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined. We studied 549 patients (96% men), mean age 50 +/- 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised >or= 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004). Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.

Automatic and controlled components of judgment and decision making.

PubMed

Ferreira, Mario B; Garcia-Marques, Leonel; Sherman, Steven J; Sherman, Jeffrey W

2006-11-01

The categorization of inductive reasoning into largely automatic processes (heuristic reasoning) and controlled analytical processes (rule-based reasoning) put forward by dual-process approaches of judgment under uncertainty (e.g., K. E. Stanovich & R. F. West, 2000) has been primarily a matter of assumption with a scarcity of direct empirical findings supporting it. The present authors use the process dissociation procedure (L. L. Jacoby, 1991) to provide convergent evidence validating a dual-process perspective to judgment under uncertainty based on the independent contributions of heuristic and rule-based reasoning. Process dissociations based on experimental manipulation of variables were derived from the most relevant theoretical properties typically used to contrast the two forms of reasoning. These include processing goals (Experiment 1), cognitive resources (Experiment 2), priming (Experiment 3), and formal training (Experiment 4); the results consistently support the author's perspective. They conclude that judgment under uncertainty is neither an automatic nor a controlled process but that it reflects both processes, with each making independent contributions.

COMFORT scale: a reliable and valid method to measure the amount of stress of ventilated preterm infants.

PubMed

Wielenga, J M; De Vos, R; de Leeuw, R; De Haan, R J

2004-01-01

Assessment of clinimetric properties and diagnostic quality of a stress measurement scale (COMFORT scale). Sample of an open population. Neonatology department (Neonatal Intensive Care Unit), Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands. One clinical expert and 9 observers observed ventilated premature born babies simultaneously. Criterion validity was assessed by correlating the COMFORT scale with the clinical judgment regarding the amount of stress. Interobserver reliability was assessed on the clinical judgment as well as on the COMFORT scale. Diagnostic qualities were evaluated with a ROC curve. On 19 ventilated prematurely born babies (mean gestational age 30 weeks, mean birth weight 1385 gm), one clinical expert and 9 observers made 30 paired observations. The criterion validity of the COMFORT scale was good (Pearson's r of 0.84). The interobserver reliability of the clinical judgment was very good (weighted Kappa 0.84). The interobserver reliability of each item varied from good to almost perfect (weighted Kappa of 0.64 for muscle tone to 1.00 on heart rate). The reliability of the total COMFORT scale score was satisfying (intra-class correlation coefficient of 0.94). The diagnostic quality of the COMFORT scale was excellent, at a cut-off point of 20 the sensitivity was 100 percent, the specificity was 77 percent, and the area under the curve (AUC) of 0.95. In this first evaluation, the COMFORT scale appears to be a valid and reliable measurement tool to assess the stress of ventilated prematurely born babies.

Reverse correlating trustworthy faces in young and older adults

PubMed Central

Éthier-Majcher, Catherine; Joubert, Sven; Gosselin, Frédéric

2013-01-01

Little is known about how older persons determine if someone deserves their trust or not based on their facial appearance, a process referred to as “facial trustworthiness.”In the past few years, Todorov and colleagues have argued that, in young adults, trustworthiness judgments are an extension of emotional judgments, and therefore, that trust judgments are made based on a continuum between anger and happiness (Todorov, 2008; Engell et al., 2010). Evidence from the literature on emotion processing suggest that older adults tend to be less efficient than younger adults in the recognition of negative facial expressions (Calder et al., 2003; Firestone et al., 2007; Ruffman et al., 2008; Chaby and Narme, 2009). Based on Todorov';s theory and the fact that older adults seem to be less efficient than younger adults in identifying emotional expressions, one could expect that older individuals would have different representations of trustworthy faces and that they would use different cues than younger adults in order to make such judgments. We verified this hypothesis using a variation of Mangini and Biederman's (2004) reverse correlation method in order to test and compare classification images resulting from trustworthiness (in the context of money investment), from happiness, and from anger judgments in two groups of participants: young adults and older healthy adults. Our results show that for elderly participants, both happy and angry representations are correlated with trustworthiness judgments. However, in young adults, trustworthiness judgments are mainly correlated with happiness representations. These results suggest that young and older adults differ in their way of judging trustworthiness. PMID:24046755

The implications of using Hemoglobin A1C for diagnosing Diabetes Mellitus

PubMed Central

Malkani, Samir; Mordes, John P

2011-01-01

Until 2010 the diagnosis of diabetes mellitus was based solely on glucose concentration, but American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives. PMID:21531226

Contrasting cue-density effects in causal and prediction judgments.

PubMed

Vadillo, Miguel A; Musca, Serban C; Blanco, Fernando; Matute, Helena

2011-02-01

Many theories of contingency learning assume (either explicitly or implicitly) that predicting whether an outcome will occur should be easier than making a causal judgment. Previous research suggests that outcome predictions would depart from normative standards less often than causal judgments, which is consistent with the idea that the latter are based on more numerous and complex processes. However, only indirect evidence exists for this view. The experiment presented here specifically addresses this issue by allowing for a fair comparison of causal judgments and outcome predictions, both collected at the same stage with identical rating scales. Cue density, a parameter known to affect judgments, is manipulated in a contingency learning paradigm. The results show that, if anything, the cue-density bias is stronger in outcome predictions than in causal judgments. These results contradict key assumptions of many influential theories of contingency learning.

The Reliability Estimation for the Open Function of Cabin Door Affected by the Imprecise Judgment Corresponding to Distribution Hypothesis

NASA Astrophysics Data System (ADS)

Yu, Z. P.; Yue, Z. F.; Liu, W.

2018-05-01

With the development of artificial intelligence, more and more reliability experts have noticed the roles of subjective information in the reliability design of complex system. Therefore, based on the certain numbers of experiment data and expert judgments, we have divided the reliability estimation based on distribution hypothesis into cognition process and reliability calculation. Consequently, for an illustration of this modification, we have taken the information fusion based on intuitional fuzzy belief functions as the diagnosis model of cognition process, and finished the reliability estimation for the open function of cabin door affected by the imprecise judgment corresponding to distribution hypothesis.

Quantum-Secret-Sharing Scheme Based on Local Distinguishability of Orthogonal Seven-Qudit Entangled States

NASA Astrophysics Data System (ADS)

Liu, Cheng-Ji; Li, Zhi-Hui; Bai, Chen-Ming; Si, Meng-Meng

2018-02-01

The concept of judgment space was proposed by Wang et al. (Phys. Rev. A 95, 022320, 2017), which was used to study some important properties of quantum entangled states based on local distinguishability. In this study, we construct 15 kinds of seven-qudit quantum entangled states in the sense of permutation, calculate their judgment space and propose a distinguishability rule to make the judgment space more clearly. Based on this rule, we study the local distinguishability of the 15 kinds of seven-qudit quantum entangled states and then propose a ( k, n) threshold quantum secret sharing scheme. Finally, we analyze the security of the scheme.

Validation of consensus panel diagnosis in dementia.

PubMed

Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

2010-12-01

The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

Grammar Clinical Marker Yields Substantial Heritability for Language Impairments in 16-Year-Old Twins.

PubMed

Dale, Philip S; Rice, Mabel L; Rimfeld, Kaili; Hayiou-Thomas, Marianna E

2018-01-22

There is a need for well-defined language phenotypes suitable for adolescents in twin studies and other large-scale research projects. Rice, Hoffman, and Wexler (2009) have developed a grammatical judgment measure as a clinical marker of language impairment, which has an extended developmental range to adolescence. We conducted the first twin analysis, along with associated phenotypic analyses of validity, of an abridged, 20-item version of this grammatical judgment measure (GJ-20), based on telephone administration using prerecorded stimuli to 405 pairs of 16-year-olds (148 monozygotic and 257 dizygotic) drawn from the Twins Early Development Study (Haworth, Davis, & Plomin, 2012). The distribution of scores is markedly skewed negatively, as expected for a potential clinical marker. Low performance on GJ-20 is associated with lower maternal education, reported learning disability (age 7 years), and low scores on language tests administered via the Twins Early Development Study (age 16 years) as well as General Certificate of Secondary Education English and Math examination performance (age 16 years). Liability threshold estimates for the genetic influence on low performance on GJ-20 are substantial, ranging from 36% with a lowest 10% criterion to 74% for a lowest 5% criterion. The heritability of GJ-20 scores, especially at more extreme cutoffs, along with the score distribution and association with other indicators of language impairments, provides additional evidence for the potential value of this measure as a clinical marker of specific language impairment.

The Development of Intention-Based Moral Judgments in Three- and Four-Year-Old Children.

ERIC Educational Resources Information Center

Moran, James D., III; O'Brien, Gayle

The developmental sequence of preschool children's moral judgments, and their emphasis on intentions versus property damage was investigated. Eight moral judgment stories with drawings were read to twelve 3 1/2- and twelve 4 1/2-year-old children (mean ages = 46.6 and 54.0 months, respectively). The stories included either positive or negative…

The Effect of Attribute Order on Judgment in Chinese and English

ERIC Educational Resources Information Center

Tavassoli, Nader T.; Lee, Yih Hwai

2004-01-01

The authors found that the order of attribute presentation had a stronger effect on judgment in English than in Chinese. In Experiment 1, with a sample of 102 female and 63 male bilingual Singaporeans, the authors found that participants' memory-based judgments showed a stronger primacy effect in English than in Chinese that was mediated by recall…

Effects of Categorical Labels on Similarity Judgments: A Critical Analysis of Similarity-Based Approaches

ERIC Educational Resources Information Center

Noles, Nicholaus S.; Gelman, Susan A.

2012-01-01

Our goal in the present study was to evaluate the claim that category labels affect children's judgments of visual similarity. We presented preschool children with discriminable and identical sets of animal pictures and asked them to make perceptual judgments in the presence or absence of labels. Our findings indicate that children who are asked…

[The diagnostic and the exclusion scores for pulmonary embolism].

PubMed

Junod, A

2015-05-27

Several clinical scores for the diagnosis of pulmonary embolism (PE) have been published. The most popular ones are the Wells score and the revised Geneva score; simplified versions exist for these two scores; they have been validated. Both scores have common properties, but there is a major difference for the Wells score, namely the inclusion of a feature based on clinical judgment. These two scores in combination with D-dimers measurement have been used to rule out PE. An important improvement in this process has recently taken place with the use of an adjustable, age-dependent threshold for DD for patients over 50 years.

Clinical methods for the assessment of the effects of environmental stress on fish health

USGS Publications Warehouse

Wedemeyer, Gary A.; Yasutake, William T.

1977-01-01

Clinical methods are presented for biological monitoring of hatchery and native fish populations to assess the effects of environmental stress on fish health. The choice of methods is based on the experience of the authors and the judgment of colleagues at fishery laboratories of the U.S. Fish and Wildlife Service. Detailed analysis methods, together with guidelines for sample collection and for the interpretation of results, are given for tests on blood (cell counts, chloride, cholesterol, clotting time, cortisol, glucose, hematocrit, hemoglobin, lactic acid, methemoglobin, osmolality, and total protein); water (ammonia and nitrite content); and liver and muscle (glycogen content).

In person versus Computer Screening for Intimate Partner Violence Among Pregnant Patients

PubMed Central

Dado, Diane; Schussler, Sara; Hawker, Lynn; Holland, Cynthia L.; Burke, Jessica G.; Cluss, Patricia A.

2012-01-01

Objective To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women’s assessment of the screening methods. Methods We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Results Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. Conclusion Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. Practice Implications Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer. PMID:22770815

In person versus computer screening for intimate partner violence among pregnant patients.

PubMed

Chang, Judy C; Dado, Diane; Schussler, Sara; Hawker, Lynn; Holland, Cynthia L; Burke, Jessica G; Cluss, Patricia A

2012-09-01

To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women's assessment of the screening methods. We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A continuous dual-process model of remember/know judgments.

PubMed

Wixted, John T; Mickes, Laura

2010-10-01

The dual-process theory of recognition memory holds that recognition decisions can be based on recollection or familiarity, and the remember/know procedure is widely used to investigate those 2 processes. Dual-process theory in general and the remember/know procedure in particular have been challenged by an alternative strength-based interpretation based on signal-detection theory, which holds that remember judgments simply reflect stronger memories than do know judgments. Although supported by a considerable body of research, the signal-detection account is difficult to reconcile with G. Mandler's (1980) classic "butcher-on-the-bus" phenomenon (i.e., strong, familiarity-based recognition). In this article, a new signal-detection model is proposed that does not deny either the validity of dual-process theory or the possibility that remember/know judgments can-when used in the right way-help to distinguish between memories that are largely recollection based from those that are largely familiarity based. It does, however, agree with all prior signal-detection-based critiques of the remember/know procedure, which hold that, as it is ordinarily used, the procedure mainly distinguishes strong memories from weak memories (not recollection from familiarity).

Elbow Room for Best Practice? Montgomery, Patients' values, and Balanced Decision-Making in Person-Centred Clinical Care.

PubMed

Herring, Jonathan; Fulford, Kmw; Dunn, Michael; Handa, Ashoki

2017-11-01

The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor. This model reflects recent developments in both law and medicine and is widely regarded (by the General Medical Council and others) as representing best practice in contemporary person-centred medicine. So understood, we suggest, the shift marked by Montgomery in the basis of duty of care is a shift in underpinning values: it is a shift from the clinician's interpretation about what would be best for patients to the values of (to what is significant or matters from the perspective of) the particular patient concerned in the decision in question. But the values of the particular patient do not thereby become paramount. The Montgomery test of duty of care requires the values of the particular patient to be balanced alongside the values of a reasonable person in the patient's position. We illustrate some of the practical challenges arising from the balance of considerations required by Montgomery with examples from surgical care. These examples show the extent to which Montgomery, in mirroring the realities of clinical decision-making, provides elbowroom for best practice in person-centred clinical care. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Clinical Threat Assessment of the Lone-Actor Terrorist.

PubMed

Meloy, J Reid; Genzman, Jacqueline

2016-12-01

The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for the assessment of individuals who present a concern for lone-actor terrorism. It consists of eight proximal warning behaviors and 10 distal characteristics. Previous research has demonstrated its interrater reliability and some concurrent and postdictive validity. In this article, TRAP-18 is retrospectively applied to the case of US Army psychiatrist and jihadist Malik Nidal Hasan, who committed a mass murder at Fort Hood, Texas in 2009. The strengths and limitations of TRAP-18 as a structured professional judgment instrument for mental health clinicians are discussed, and clinical risk management suggestions are made. Copyright © 2016 Elsevier Inc. All rights reserved.

Children's moral judgments and moral emotions following exclusion of children with disabilities: relations with inclusive education, age, and contact intensity.

PubMed

Gasser, Luciano; Malti, Tina; Buholzer, Alois

2013-03-01

We investigated relations between children's moral judgments and moral emotions following disability-based exclusion and inclusive education, age, and contact intensity. Nine- and 12-year-old Swiss children (N=351) from inclusive and noninclusive classrooms provided moral judgments and moral emotion attributions following six vignettes about social exclusion of children with disabilities. Children also reported on their level of sympathy towards children with disabilities and their contact intensity with children with disabilities. Overall, children condemned disability-based exclusion, attributed few positive emotions to excluder targets, and expressed high sympathy for children with disabilities, independent of age and educational setting. However, younger children from inclusive classrooms exhibited more moral judgments and moral emotions than younger children from noninclusive classrooms. Moreover, children who expressed high sympathy towards children with disabilities were more likely to report frequent contact with children with disabilities. The findings extend existing research on social exclusion by examining disability-based exclusion and are discussed with respect to developmental research on social and moral judgments and emotions following children's inclusion and exclusion decisions. Copyright © 2012 Elsevier Ltd. All rights reserved.

The role of emotions for moral judgments depends on the type of emotion and moral scenario.

PubMed

Ugazio, Giuseppe; Lamm, Claus; Singer, Tania

2012-06-01

Emotions seem to play a critical role in moral judgment. However, the way in which emotions exert their influence on moral judgments is still poorly understood. This study proposes a novel theoretical approach suggesting that emotions influence moral judgments based on their motivational dimension. We tested the effects of two types of induced emotions with equal valence but with different motivational implications (anger and disgust), and four types of moral scenarios (disgust-related, impersonal, personal, and beliefs) on moral judgments. We hypothesized and found that approach motivation associated with anger would make moral judgments more permissible, while disgust, associated with withdrawal motivation, would make them less permissible. Moreover, these effects varied as a function of the type of scenario: the induced emotions only affected moral judgments concerning impersonal and personal scenarios, while we observed no effects for the other scenarios. These findings suggest that emotions can play an important role in moral judgment, but that their specific effects depend upon the type of emotion induced. Furthermore, induced emotion effects were more prevalent for moral decisions in personal and impersonal scenarios, possibly because these require the performance of an action rather than making an abstract judgment. We conclude that the effects of induced emotions on moral judgments can be predicted by taking their motivational dimension into account. This finding has important implications for moral psychology, as it points toward a previously overlooked mechanism linking emotions to moral judgments.

Comparing Usual Care With a Warfarin Initiation Protocol After Mechanical Heart Valve Replacement.

PubMed

Roberts, Gregory; Razooqi, Rasha; Quinn, Stephen

2017-03-01

The immediate postoperative warfarin sensitivity for patients receiving heart valve prostheses is increased. Established warfarin initiation protocols may lack clinical applicability, resulting in dosing based on clinical judgment. To compare current practice for warfarin initiation with a known warfarin initiation protocol, with doses proportionally reduced to account for the increased postoperative sensitivity. We compared the Mechanical Heart Valve Warfarin Initiation Protocol (Protocol group) with current practice (clinical judgment-Empirical group) for patients receiving mechanical heart valves in an observational before-and-after format. End points were the time to achieve a stable therapeutic international normalized ratio (INR), doses held in the first 6 days, and overanticoagulation in the first 6 days. The Protocol group (n = 37) achieved a stable INR more rapidly than the Empirical group (n = 77; median times 5.1 and 8.7 days, respectively; P = 0.002). Multivariable analysis indicated that the Protocol group (hazard ratio [HR] = 2.22; P = 0.005) and men (HR = 1.76; P = 0.043) more rapidly achieved a stable therapeutic INR. Age, serum albumin, amiodarone, presence of severe heart failure, and surgery type had no impact. Protocol patients had fewer doses held (1.1% vs 10.1%, P < 0.001) and no difference in overanticoagulation (2.7% vs 9.1%, P = 0.27). The Mechanical Heart Valve Warfarin Initiation Protocol provided a reliable approach to initiating warfarin in patients receiving mechanical aortic or mitral valves.

Workplace-Based Assessment: Raters' Performance Theories and Constructs

ERIC Educational Resources Information Center

Govaerts, M. J. B.; Van de Wiel, M. W. J.; Schuwirth, L. W. T.; Van der Vleuten, C. P. M.; Muijtjens, A. M. M.

2013-01-01

Weaknesses in the nature of rater judgments are generally considered to compromise the utility of workplace-based assessment (WBA). In order to gain insight into the underpinnings of rater behaviours, we investigated how raters form impressions of and make judgments on trainee performance. Using theoretical frameworks of social cognition and…

40 CFR 1065.659 - Removed water correction.

Code of Federal Regulations, 2011 CFR

2011-07-01

... know that saturated water vapor conditions exist. Use good engineering judgment to measure the... absolute pressure based on an alarm set point, a pressure regulator set point, or good engineering judgment... from raw exhaust, you may determine the amount of water based on intake-air humidity, plus a chemical...

40 CFR 1065.659 - Removed water correction.

Code of Federal Regulations, 2010 CFR

2010-07-01

... know that saturated water vapor conditions exist. Use good engineering judgment to measure the... absolute pressure based on an alarm set point, a pressure regulator set point, or good engineering judgment... from raw exhaust, you may determine the amount of water based on intake-air humidity, plus a chemical...

An analysis of ratings: A guide to RMRATE

Treesearch

Thomas C. Brown; Terry C. Daniel; Herbert W. Schroeder; Glen E. Brink

1990-01-01

This report describes RMRATE, a computer program for analyzing rating judgments. RMRATE scales ratings using several scaling procedures, and compares the resulting scale values. The scaling procedures include the median and simple mean, standardized values, scale values based on Thurstone's Law of Categorical Judgment, and regression-based values. RMRATE also...

Explaining the forgetting bias effect on value judgments: The influence of memory for a past test.

PubMed

Rhodes, Matthew G; Witherby, Amber E; Castel, Alan D; Murayama, Kou

2017-04-01

People often feel that information that was forgotten is less important than remembered information. Prior work has shown that participants assign higher importance to remembered information while undervaluing forgotten information. The current study examined two possible accounts of this finding. In three experiments, participants studied lists of words in which each word was randomly assigned a point value denoting the value of remembering the word. Following the presentation of each list participants engaged in a free recall test. After the presentation of all lists participants were shown each of the words they had studied and asked to recall the point value that was initially paired with each word. Experiment 1 tested a fluency-based account by presenting items for value judgments in a low-fluency or high-fluency format. Experiment 2 examined whether value judgments reflect attributions based on the familiarity of an item when value judgments are made. Finally, in Experiment 3, we evaluated whether participants believe that forgotten words are less important by having them judge whether an item was initially recalled or forgotten prior to making a value judgment. Manipulating the fluency of an item presented for judgment had no influence on value ratings (Experiment 1) and familiarity exerted a limited influence on value judgments (Experiment 2). More importantly, participants' value judgments appeared to reflect a theory that remembered information is more valuable than forgotten information (Experiment 3). Overall, the present work suggests that individuals may apply a theory about remembering and forgetting to retrospectively assess the value of information.

Action, Not Rhetoric, Needed to Reverse the Opioid Overdose Epidemic.

PubMed

Davis, Corey; Green, Traci; Beletsky, Leo

2017-03-01

Despite shifts in rhetoric and some positive movement, Americans with the disease of addiction are still often stigmatized, criminalized, and denied access to evidencebased care. Dramatically reducing the number of lives unnecessarily lost to overdose requires an evidence-based, equity-focused, well-funded, and coordinated response. We present in this brief article evidence-based and promising practices for improving and refocusing the response to this simmering public health crisis. Topics covered include improving clinical decision-making, improving access to non-judgmental evidence-based treatment, investing in comprehensive public health approaches to problematic drug use, and changing the way law enforcement actors interact with people who use drugs.

How Judgments Change Following Comparison of Current and Prior Information

PubMed Central

Albarracin, Dolores; Wallace, Harry M.; Hart, William; Brown, Rick D.

2013-01-01

Although much observed judgment change is superficial and occurs without considering prior information, other forms of change also occur. Comparison between prior and new information about an issue may trigger change by influencing either or both the perceived strength and direction of the new information. In four experiments, participants formed and reported initial judgments of a policy based on favorable written information about it. Later, these participants read a second passage containing strong favorable or unfavorable information on the policy. Compared to control conditions, subtle and direct prompts to compare the initial and new information led to more judgment change in the direction of a second passage perceived to be strong. Mediation analyses indicated that comparison yielded greater perceived strength of the second passage, which in turn correlated positively with judgment change. Moreover, self-reports of comparison mediated the judgment change resulting from comparison prompts. PMID:23599557

Elevated moral condemnation of third-party violations in multiple sclerosis patients.

PubMed

Patil, Indrajeet; Young, Liane; Sinay, Vladimiro; Gleichgerrcht, Ezequiel

2017-06-01

Recent research has demonstrated impairments in social cognition associated with multiple sclerosis (MS). The present work asks whether these impairments are associated with atypical moral judgment. Specifically, we assessed whether MS patients are able to integrate information about intentions and outcomes for moral judgment (i.e., appropriateness and punishment judgments) in the case of third-party acts. We found a complex pattern of moral judgments in MS patients: although their moral judgments were comparable to controls' for specific types of acts (e.g., accidental or intentional harms), they nevertheless judged behaviors to be less appropriate and endorsed more severe punishment across the board, and they were also more likely to report that others' responses would be congruent with theirs. Further analyses suggested that elevated levels of externally oriented cognition in MS (due to co-occurring alexithymia) explain these effects. Additionally, we found that the distinction between appropriateness and punishment judgments, whereby harmful outcomes influence punishment judgments to a greater extent than appropriateness judgments, was preserved in MS despite the observed disruptions in the affective and motivational components of empathy. The current results inform the two-process model for intent-based moral judgments as well as possible strategies for improving the quality of life in MS patients.

Comparison of Trained Clinician Ratings with Expert Ratings of Aspiration on Videofluoroscopic Images from a Randomized Clinical Trial

PubMed Central

Hind, Jacqueline A.; Gensler, Gary; Brandt, Diane K.; Miller Gardner, Patricia J.; Blumenthal, Loreen; Gramigna, Gary D.; Kosek, Steven; Lundy, Donna; McGarvey-Toler, Susan; Rockafellow, Susan; Sullivan, Paula A.; Villa, Marybell; Gill, Gary D.; Lindblad, Anne S.; Logemann, Jeri A.; Robbins, JoAnne

2009-01-01

Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that inter-judge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin down posture with thin-liquids and thickened liquids (nectar-thick and honey-thick consistencies) in a head neutral posture. The subject population included patients with Parkinson’s disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all К > .86) and variable accuracy (range 69%–76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale. PMID:18953607

A novel magnetic resonance imaging segmentation technique for determining diffuse intrinsic pontine glioma tumor volume

PubMed Central

Singh, Ranjodh; Zhou, Zhiping; Tisnado, Jamie; Haque, Sofia; Peck, Kyung K.; Young, Robert J.; Tsiouris, Apostolos John; Thakur, Sunitha B.; Souweidane, Mark M.

2017-01-01

OBJECTIVE Accurately determining diffuse intrinsic pontine glioma (DIPG) tumor volume is clinically important. The aims of the current study were to 1) measure DIPG volumes using methods that require different degrees of subjective judgment; and 2) evaluate interobserver agreement of measurements made using these methods. METHODS Eight patients from a Phase I clinical trial testing convection-enhanced delivery (CED) of a therapeutic antibody were included in the study. Pre-CED, post–radiation therapy axial T2-weighted images were analyzed using 2 methods requiring high degrees of subjective judgment (picture archiving and communication system [PACS] polygon and Volume Viewer auto-contour methods) and 1 method requiring a low degree of subjective judgment (k-means clustering segmentation) to determine tumor volumes. Lin’s concordance correlation coefficients (CCCs) were calculated to assess interobserver agreement. RESULTS The CCCs of measurements made by 2 observers with the PACS polygon and the Volume Viewer auto-contour methods were 0.9465 (lower 1-sided 95% confidence limit 0.8472) and 0.7514 (lower 1-sided 95% confidence limit 0.3143), respectively. Both were considered poor agreement. The CCC of measurements made using k-means clustering segmentation was 0.9938 (lower 1-sided 95% confidence limit 0.9772), which was considered substantial strength of agreement. CONCLUSIONS The poor interobserver agreement of PACS polygon and Volume Viewer auto-contour methods high-lighted the difficulty in consistently measuring DIPG tumor volumes using methods requiring high degrees of subjective judgment. k-means clustering segmentation, which requires a low degree of subjective judgment, showed better interob-server agreement and produced tumor volumes with delineated borders. PMID:27391980

Caregivers' concerns about judgment and safety of patients with brain injury: a preliminary investigation.

PubMed

Kreutzer, Jeffrey S; Livingston, Lee A; Everley, Rachel S; Gary, Kelli W; Arango-Lasprilla, Juan Carlos; Powell, Victoria D; Marwitz, Jennifer H

2009-08-01

To identify caregivers' most common concerns about the judgment and safety of patients with brain injury in home and community environments. To quantify caregivers' stress levels and their level of comfort leaving patients at home unsupervised and examine the interrelationships between caregivers' safety and judgment ratings, stress levels, and levels of comfort leaving patients unattended. Retrospective, cross-sectional design. Outpatient brain injury neuropsychology clinic at a university medical center. A convenience sample of 121 caregivers of traumatic brain injury survivors at least 1 month postinjury and 18 years of age or older. Scores in 9 domains from the Judgment and Safety Screening Inventory; ratings of stress levels and levels of comfort leaving patients at home unattended derived from the General Health and History Questionnaire. Caregivers' most common judgment and safety-related concerns were in the Travel and Financial domains, with many reflecting patients' memory deficits. Heightened caregiver stress levels were prevalent. Higher levels of concern about judgment and safety were associated with higher stress levels and concerns about leaving patients unattended. Consistent with research on patients with other types of neurological disorders, concerns about driving and financial management among caregivers are prevalent. Additional research is needed to identify the most cost-effective methods of evaluating patients and enabling them to function at their highest level in the community.

Magnesium replacement therapy.

PubMed

DiPalma, J R

1990-07-01

Magnesium is involved as a cofactor in many vital enzymatic reactions. It is also important in the maintenance of membrane electric potential. Diagnosis of magnesium disturbances must often be based on clinical judgment. Hypomagnesemia is frequently associated with hypokalemia and hypocalcemia; hypermagnesemia most often occurs in patients with acute or chronic renal failure. Hypomagnesemia presents as neuromuscular, central nervous system and cardiac abnormalities. Inadequate dietary intake of magnesium occurs in alcoholism, catabolic states and gastrointestinal diseases. Intravenous administration of magnesium can cause neuromuscular paralysis and cardiac arrhythmias.

Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

PubMed

Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

2018-02-27

Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley & Sons, Ltd.

Measuring the Confidence of 8th Grade Taiwanese Students' Knowledge of Acids and Bases

ERIC Educational Resources Information Center

Jack, Brady Michael; Liu, Chia-Ju; Chiu, Houn-Lin; Tsai, Chun-Yen

2012-01-01

The present study investigated whether gender differences were present on the confidence judgments made by 8th grade Taiwanese students on the accuracy of their responses to acid-base test items. A total of 147 (76 male, 71 female) students provided item-specific confidence judgments during a test of their knowledge of acids and bases. Using the…

The practice of evidence-based medicine involves the care of whole persons.

PubMed

Richardson, W Scott

2017-04-01

In this issue of the Journal, Dr. Fava posits that evidence-based medicine (EBM) was bound to fail. I share some of the concerns he expresses, yet I see more reasons for optimism. Having been on rounds with both Drs. Engel and Sackett, I reckon they would have agreed more than they disagreed. Their central teaching was the compassionate and well-informed care of sick persons. The model that emerged from these rounds was that patient care could be both person-centered and evidence-based, that clinical judgment was essential to both, and the decisions could and should be shared. Both clinicians and patients can bring knowledge from several sources into the shared decision making process in the clinical encounter, including evidence from clinical care research. I thank Dr. Fava for expressing legitimate doubts and providing useful criticism, yet I am cautiously optimistic that the model of EBM described here is robust enough to meet the challenges and is not doomed to fail. Copyright © 2017 Elsevier Inc. All rights reserved.

Healthcare justice and human rights in perinatal medicine.

PubMed

Chervenak, Frank A; McCullough, Laurence B

2016-06-01

This article describes an approach to ethics of perinatal medicine in which "women and children first" plays a central role, based on the concept of healthcare justice. Healthcare justice requires that all patients receive clinical management based on their clinical needs, which are defined by deliberative (evidence-based, rigorous, transparent, and accountable) clinical judgment. All patients in perinatal medicine includes pregnant, fetal, and neonatal patients. Healthcare justice also protects the informed consent process, which is intended to empower the exercise of patient autonomy in the decision-making process about patient care. In the context of healthcare justice, the informed consent process should not be influenced by ethically irrelevant factors. Healthcare justice should be understood as a basis for the human rights to healthcare and to participate in decisions about one's healthcare. Healthcare justice in perinatal medicine creates an essential role for the perinatologist to be an effective advocate for pregnant, fetal, and neonatal patients, i.e., for "women and children first." Copyright © 2016 Elsevier Inc. All rights reserved.

[Clinical research XXIII. From clinical judgment to meta-analyses].

PubMed

Rivas-Ruiz, Rodolfo; Castelán-Martínez, Osvaldo D; Pérez-Rodríguez, Marcela; Palacios-Cruz, Lino; Noyola-Castillo, Maura E; Talavera, Juan O

2014-01-01

Systematic reviews (SR) are studies made in order to ask clinical questions based on original articles. Meta-analysis (MTA) is the mathematical analysis of SR. These analyses are divided in two groups, those which evaluate the measured results of quantitative variables (for example, the body mass index -BMI-) and those which evaluate qualitative variables (for example, if a patient is alive or dead, or if he is healing or not). Quantitative variables generally use the mean difference analysis and qualitative variables can be performed using several calculations: odds ratio (OR), relative risk (RR), absolute risk reduction (ARR) and hazard ratio (HR). These analyses are represented through forest plots which allow the evaluation of each individual study, as well as the heterogeneity between studies and the overall effect of the intervention. These analyses are mainly based on Student's t test and chi-squared. To take appropriate decisions based on the MTA, it is important to understand the characteristics of statistical methods in order to avoid misinterpretations.

Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning.

PubMed

Chiffi, Daniele; Zanotti, Renzo

2017-10-01

Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. © 2016 John Wiley & Sons, Ltd.

Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards.

PubMed

Milisen, Koen; Coussement, Joke; Flamaing, Johan; Vlaeyen, Ellen; Schwendimann, René; Dejaeger, Eddy; Surmont, Kurt; Boonen, Steven

2012-06-01

To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls. Prospective multicenter study. Six Belgian hospitals. Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Hospital-Acquired Pneumonia in Patients Undergoing Coronary Artery Bypass Graft; Comparison of the Center for Disease Control Clinical Criteria With Physicians’ Judgment

PubMed Central

Baghban, Mahboubeh; Paknejad, Omalbanin; Yousefshahi, Fardin; Gohari Moghadam, Keivan; Bina, Payvand; Samimi Sadeh, Saghar

2014-01-01

Background: Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients. Objectives: This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG. Patients and Methods: This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient’s records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis. Results: Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians’ clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians’ clinical judgment to establish the diagnosis. Conclusions: Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients’ course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated. PMID:25289379

Hospital-acquired pneumonia in patients undergoing coronary artery bypass graft; comparison of the center for disease control clinical criteria with physicians' judgment.

PubMed

Baghban, Mahboubeh; Paknejad, Omalbanin; Yousefshahi, Fardin; Gohari Moghadam, Keivan; Bina, Payvand; Samimi Sadeh, Saghar

2014-08-01

Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients. This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG. This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient's records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis. Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians' clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians' clinical judgment to establish the diagnosis. Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients' course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated.

Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

PubMed

Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B

2015-09-01

An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to describe the treatment's intended benefit as an effect on a clearly identified aspect of how a patient feels or functions. This aspect must have importance to the patient and be part of the patient's typical life. This meaningful health aspect can be measured directly or measured indirectly when it is impractical to evaluate it directly or when it is difficult to measure. For indirect measurement, a concept of interest (COI) can be identified. The COI must be related to how a patient feels or functions. Procedures are then developed to measure the COI. The relationship of these measurements with how a patient feels or functions in the intended setting and manner of use of the COA (the context of use) could then be defined. A COA has identifiable attributes or characteristics that affect the measurement properties of the COA when used in endpoints. One of these features is whether judgment can influence the measurement, and if so, whose judgment. This attribute defines four categories of COAs: patient reported outcomes, clinician reported outcomes, observer reported outcomes, and performance outcomes. A full description as well as explanation of other important COA features is included in this report. The information in this report should aid in the development, refinement, and standardization of COAs, and, ultimately, improve their measurement properties. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Aspirin in Older Adults: Need for Wider Utilization in Secondary Prevention and Individual Clinical Judgments in Primary Prevention.

PubMed

Sehgal, Mandi; Wood, Sarah K; Ouslander, Joseph G; Hennekens, Charles H

2017-11-01

In the treatment or secondary prevention of cardiovascular disease (CVD), there is general consensus that the absolute benefits of aspirin far outweigh the absolute risks. Despite evidence from randomized trials and their meta-analyses, older adults, defined as aged 65 years or older, are less likely to be prescribed aspirin than their middle-aged counterparts. In primary prevention, the optimal utilization of aspirin is widely debated. There is insufficient randomized evidence among apparently healthy participants at moderate to high risk of a first CVD event, so general guidelines seem premature. Among older adults, randomized data are even more sparse but trials are ongoing. Further, older adults commonly take multiple medications due to comorbidities, which may increase deleterious interactions and side effects. Older adults have higher risks of occlusive events as well as bleeding. All these considerations support the need for individual clinical judgments in prescribing aspirin in the context of therapeutic lifestyle changes and other adjunctive drug therapies. These include statins for lipids and usually multiple drugs to achieve control of high blood pressure. As regards aspirin, the clinician should weigh the absolute benefit on occlusion against the absolute risk of bleeding. These issues should be considered with each patient to facilitate an informed and person-centered individual clinical judgment. The use of aspirin in primary prevention is particularly attractive because the drug is generally over the counter and, for developing countries where CVD is becoming the leading cause of death, is extremely inexpensive. The more widespread use of aspirin in older adults with prior CVD will confer net benefits to risks and even larger net benefits to costs in the United States as well as other developed and developing countries. In primary prevention among older adults, individual clinical judgments should be made by the health-care professional and each of his or her patients.

Reconciling intuitive physics and Newtonian mechanics for colliding objects.

PubMed

Sanborn, Adam N; Mansinghka, Vikash K; Griffiths, Thomas L

2013-04-01

People have strong intuitions about the influence objects exert upon one another when they collide. Because people's judgments appear to deviate from Newtonian mechanics, psychologists have suggested that people depend on a variety of task-specific heuristics. This leaves open the question of how these heuristics could be chosen, and how to integrate them into a unified model that can explain human judgments across a wide range of physical reasoning tasks. We propose an alternative framework, in which people's judgments are based on optimal statistical inference over a Newtonian physical model that incorporates sensory noise and intrinsic uncertainty about the physical properties of the objects being viewed. This noisy Newton framework can be applied to a multitude of judgments, with people's answers determined by the uncertainty they have for physical variables and the constraints of Newtonian mechanics. We investigate a range of effects in mass judgments that have been taken as strong evidence for heuristic use and show that they are well explained by the interplay between Newtonian constraints and sensory uncertainty. We also consider an extended model that handles causality judgments, and obtain good quantitative agreement with human judgments across tasks that involve different judgment types with a single consistent set of parameters.

The road to heaven is paved with effort: Perceived effort amplifies moral judgment.

PubMed

Bigman, Yochanan E; Tamir, Maya

2016-12-01

If good intentions pave the road to hell, what paves the road to heaven? We propose that moral judgments are based, in part, on the degree of effort exerted in performing the immoral or moral act. Because effort can serve as an index of goal importance, greater effort in performing immoral acts would lead to more negative judgments, whereas greater effort in performing moral acts would lead to more positive judgments. In support of these ideas, we found that perceived effort intensified judgments of both immoral (Studies 1-2) and moral (Studies 2-7) agents. The effect of effort on judgment was independent of the outcome (Study 3) and of perceptions of the outcome extremity (Study 6). Furthermore, the effect of effort on judgment was mediated by perceived goal importance (Studies 4-6), even when controlling for perceived intentions (Studies 5-6). Finally, we demonstrate that perceived effort can influence actual behavior, such as the assignment of monetary rewards (Study 7). We discuss the possible implications of effort as a causal motivational factor in moral judgment and social retribution. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The ABC of moral development: an attachment approach to moral judgment

PubMed Central

Govrin, Aner

2014-01-01

As with other cognitive faculties, the etiology of moral judgment and its connection to early development is complex. Because research is limited, the causative and contributory factors to the development of moral judgment in preverbal infants are unclear. However, evidence is emerging from studies within both infant research and moral psychology that may contribute to our understanding of the early development of moral judgments. Though its finding are preliminary, this proposed paradigm synthesizes these findings to generate an overarching, model of the process that appears to contribute to the development of moral judgment in the first year of life. I will propose that through early interactions with the caregiver, the child acquires an internal representation of a system of rules that determine how right/wrong judgments are to be construed, used, and understood. By breaking moral situations down into their defining features, the attachment model of moral judgment outlines a framework for a universal moral faculty based on a universal, innate, deep structure that appears uniformly in the structure of almost all moral judgments regardless of their content. The implications of the model for our understanding of innateness, universal morality, and the representations of moral situations are discussed. PMID:24478739

Is moral beauty different from facial beauty? Evidence from an fMRI study

PubMed Central

Wang, Tingting; Mo, Ce; Tan, Li Hai; Cant, Jonathan S.; Zhong, Luojin; Cupchik, Gerald

2015-01-01

Is moral beauty different from facial beauty? Two functional magnetic resonance imaging experiments were performed to answer this question. Experiment 1 investigated the network of moral aesthetic judgments and facial aesthetic judgments. Participants performed aesthetic judgments and gender judgments on both faces and scenes containing moral acts. The conjunction analysis of the contrasts ‘facial aesthetic judgment > facial gender judgment’ and ‘scene moral aesthetic judgment > scene gender judgment’ identified the common involvement of the orbitofrontal cortex (OFC), inferior temporal gyrus and medial superior frontal gyrus, suggesting that both types of aesthetic judgments are based on the orchestration of perceptual, emotional and cognitive components. Experiment 2 examined the network of facial beauty and moral beauty during implicit perception. Participants performed a non-aesthetic judgment task on both faces (beautiful vs common) and scenes (containing morally beautiful vs neutral information). We observed that facial beauty (beautiful faces > common faces) involved both the cortical reward region OFC and the subcortical reward region putamen, whereas moral beauty (moral beauty scenes > moral neutral scenes) only involved the OFC. Moreover, compared with facial beauty, moral beauty spanned a larger-scale cortical network, indicating more advanced and complex cerebral representations characterizing moral beauty. PMID:25298010

At the heart of morality lies neuro-visceral integration: lower cardiac vagal tone predicts utilitarian moral judgment

PubMed Central

Kappes, Andreas; Rho, Yeojin; Van Bavel, Jay J.

2016-01-01

To not harm others is widely considered the most basic element of human morality. The aversion to harm others can be either rooted in the outcomes of an action (utilitarianism) or reactions to the action itself (deontology). We speculated that the human moral judgments rely on the integration of neural computations of harm and visceral reactions. The present research examined whether utilitarian or deontological aspects of moral judgment are associated with cardiac vagal tone, a physiological proxy for neuro-visceral integration. We investigated the relationship between cardiac vagal tone and moral judgment by using a mix of moral dilemmas, mathematical modeling and psychophysiological measures. An index of bipolar deontology-utilitarianism was correlated with resting heart rate variability (HRV)—an index of cardiac vagal tone—such that more utilitarian judgments were associated with lower HRV. Follow-up analyses using process dissociation, which independently quantifies utilitarian and deontological moral inclinations, provided further evidence that utilitarian (but not deontological) judgments were associated with lower HRV. Our results suggest that the functional integration of neural and visceral systems during moral judgments can restrict outcome-based, utilitarian moral preferences. Implications for theories of moral judgment are discussed. PMID:27317926

From aggregation to interpretation: how assessors judge complex data in a competency-based portfolio.

PubMed

Oudkerk Pool, Andrea; Govaerts, Marjan J B; Jaarsma, Debbie A D C; Driessen, Erik W

2018-05-01

While portfolios are increasingly used to assess competence, the validity of such portfolio-based assessments has hitherto remained unconfirmed. The purpose of the present research is therefore to further our understanding of how assessors form judgments when interpreting the complex data included in a competency-based portfolio. Eighteen assessors appraised one of three competency-based mock portfolios while thinking aloud, before taking part in semi-structured interviews. A thematic analysis of the think-aloud protocols and interviews revealed that assessors reached judgments through a 3-phase cyclical cognitive process of acquiring, organizing, and integrating evidence. Upon conclusion of the first cycle, assessors reviewed the remaining portfolio evidence to look for confirming or disconfirming evidence. Assessors were inclined to stick to their initial judgments even when confronted with seemingly disconfirming evidence. Although assessors reached similar final (pass-fail) judgments of students' professional competence, they differed in their information-processing approaches and the reasoning behind their judgments. Differences sprung from assessors' divergent assessment beliefs, performance theories, and inferences about the student. Assessment beliefs refer to assessors' opinions about what kind of evidence gives the most valuable and trustworthy information about the student's competence, whereas assessors' performance theories concern their conceptualizations of what constitutes professional competence and competent performance. Even when using the same pieces of information, assessors furthermore differed with respect to inferences about the student as a person as well as a (future) professional. Our findings support the notion that assessors' reasoning in judgment and decision-making varies and is guided by their mental models of performance assessment, potentially impacting feedback and the credibility of decisions. Our findings also lend further credence to the assertion that portfolios should be judged by multiple assessors who should, moreover, thoroughly substantiate their judgments. Finally, it is suggested that portfolios be designed in such a way that they facilitate the selection of and navigation through the portfolio evidence.

Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.

PubMed

Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

2014-09-01

Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease

PubMed Central

Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

2014-01-01

Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions – the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1–13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols. PMID:25077519

The Effects of High- and Low-Anxiety Training on the Anticipation Judgments of Elite Performers.

PubMed

Alder, David; Ford, Paul R; Causer, Joe; Williams, A Mark

2016-02-01

We examined the effects of high- versus low-anxiety conditions during video-based training of anticipation judgments using international-level badminton players facing serves and the transfer to high-anxiety and field-based conditions. Players were assigned to a high-anxiety training (HA), low-anxiety training (LA) or control group (CON) in a pretraining-posttest design. In the pre- and posttest, players anticipated serves from video and on court under high- and low-anxiety conditions. In the video-based high-anxiety pretest, anticipation response accuracy was lower and final fixations shorter when compared with the low-anxiety pretest. In the low-anxiety posttest, HA and LA demonstrated greater accuracy of judgments and longer final fixations compared with pretest and CON. In the high-anxiety posttest, HA maintained accuracy when compared with the low-anxiety posttest, whereas LA had lower accuracy. In the on-court posttest, the training groups demonstrated greater accuracy of judgments compared with the pretest and CON.

Assessing Perceptions of Interpersonal Behavior with a Video-Based Situational Judgment Test

ERIC Educational Resources Information Center

Golubovich, Juliya; Seybert, Jacob; Martin-Raugh, Michelle; Naemi, Bobby; Vega, Ronald P.; Roberts, Richard D.

2017-01-01

Accurate appraisal of others' behavior is critical for the production of skilled interpersonal behavior. We used an ecologically valid methodology, a video-based situational judgment test with true-false items, to assess the accuracy with which students (N = 947) perceive the interpersonal behavior of actors involved in workplace situations.…

Social Judgments and Emotion Attributions about Exclusion in Switzerland

ERIC Educational Resources Information Center

Malti, Tina; Killen, Melanie; Gasser, Luciano

2012-01-01

Adolescents' social judgments and emotion attributions about exclusion in three contexts, nationality, gender, and personality, were measured in a sample of 12- and 15-year-old Swiss and non-Swiss adolescents (N = 247). Overall, adolescents judged exclusion based on nationality as less acceptable than exclusion based on gender or personality.…

Similarities and differences in Chinese and Caucasian adults' use of facial cues for trustworthiness judgments.

PubMed

Xu, Fen; Wu, Dingcheng; Toriyama, Rie; Ma, Fengling; Itakura, Shoji; Lee, Kang

2012-01-01

All cultural groups in the world place paramount value on interpersonal trust. Existing research suggests that although accurate judgments of another's trustworthiness require extensive interactions with the person, we often make trustworthiness judgments based on facial cues on the first encounter. However, little is known about what facial cues are used for such judgments and what the bases are on which individuals make their trustworthiness judgments. In the present study, we tested the hypothesis that individuals may use facial attractiveness cues as a "shortcut" for judging another's trustworthiness due to the lack of other more informative and in-depth information about trustworthiness. Using data-driven statistical models of 3D Caucasian faces, we compared facial cues used for judging the trustworthiness of Caucasian faces by Caucasian participants who were highly experienced with Caucasian faces, and the facial cues used by Chinese participants who were unfamiliar with Caucasian faces. We found that Chinese and Caucasian participants used similar facial cues to judge trustworthiness. Also, both Chinese and Caucasian participants used almost identical facial cues for judging trustworthiness and attractiveness. The results suggest that without opportunities to interact with another person extensively, we use the less racially specific and more universal attractiveness cues as a "shortcut" for trustworthiness judgments.

Prevalence of chronic widespread pain and fibromyalgia syndrome: a Korean hospital-based study.

PubMed

Kim, Cheolhwan; Kim, Hyejin; Kim, Jongkwan

2012-11-01

This study was conducted to estimate the point prevalence of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) in a primary care center of a hospital in Korea. CWP was defined as pain lasting more than 3 months involving all the classified pain sites (axial, left and right, above and below waist). FMS was diagnosed by the American College of Rheumatology (ACR) criteria and also by clinical judgment of a physician. All 1,077 subjects were classified into three groups as no chronic pain (NCP), chronic regional pain (CRP), and CWP. CRP was defined as chronic pain with the exception of CWP. The point prevalence of CWP was 6.5% (95% confidence interval (CI) 0.2-12.8) and the point prevalence of FMS was 1.7% (95% CI 0.0-4.9) by ACR criteria and 2.3% (95% CI 0.0-6.1) by clinical judgment, respectively. We also analyzed the differential demographic characteristics among patients with NCP, CRP, and CWP. When compared to NCP, CWP was significantly associated with the female gender after adjusting for other variables (odds ratio 4.2; 95% CI 1.4-12.4, P = 0.009). Compared to NCP, CWP patients had lower levels of education (P = 0.018), a lower likelihood of a professional occupation (P = 0.014), infrequent alcohol intake (P = 0.014) and a lower proportion of current smokers (P = 0.003) based on a univariable analysis. In this Korean hospital-based study, CWP patients were common and had different demographic characteristics and life habits from NCP.

[Dispositional mindfulness modulates automatic transference of disgust into moral judgment].

PubMed

Sato, Atsushi; Sugiura, Yoshinori

2014-02-01

Previous studies showed that incidental feelings of disgust could make moral judgments more severe. In the present study, we investigated whether individual differences in mindfulness modulated automatic transference of disgust into moral judgment. Undergraduates were divided into high- and low-mindfulness groups based on the mean score on each subscale of the Five Facet Mindfulness Questionnaire (FFMQ). Participants were asked to write about a disgusting experience or an emotionally neutral experience, and then to evaluate moral (impersonal vs. high-conflict personal) and non-moral scenarios. The results showed that the disgust induction made moral judgments more severe for the low "acting with awareness" participants, whereas it did not influence the moral judgments of the high "acting with awareness" participants irrespective of type of moral dilemma. The other facets of the FFMQ did not modulate the effect of disgust on moral judgment. These findings suggest that being present prevents automatic transference of disgust into moral judgment even when prepotent emotions elicited by the thought of killing one person to save several others and utilitarian reasoning conflict.

Liberating reason from the passions: overriding intuitionist moral judgments through emotion reappraisal.

PubMed

Feinberg, Matthew; Willer, Robb; Antonenko, Olga; John, Oliver P

2012-07-01

A classic problem in moral psychology concerns whether and when moral judgments are driven by intuition versus deliberate reasoning. In this investigation, we explored the role of reappraisal, an emotion-regulation strategy that involves construing an emotion-eliciting situation in a way that diminishes the intensity of the emotional experience. We hypothesized that although emotional reactions evoke initial moral intuitions, reappraisal weakens the influence of these intuitions, leading to more deliberative moral judgments. Three studies of moral judgments in emotionally evocative, disgust-eliciting moral dilemmas supported our hypothesis. A greater tendency to reappraise was related to fewer intuition-based judgments (Study 1). Content analysis of open-ended descriptions of moral-reasoning processes revealed that reappraisal was associated with longer time spent in deliberation and with fewer intuitionist moral judgments (Study 2). Finally, in comparison with participants who simply watched an emotion-inducing film, participants who had been instructed to reappraise their reactions while watching the film subsequently reported less intense emotional reactions to moral dilemmas, and these dampened reactions led, in turn, to fewer intuitionist moral judgments (Study 3).

Analysis of nutrition judgments using the Nutrition Facts Panel.

PubMed

González-Vallejo, Claudia; Lavins, Bethany D; Carter, Kristina A

2016-10-01

Consumers' judgments and choices of the nutritional value of food products (cereals and snacks) were studied as a function of using information in the Nutrition Facts Panel (NFP, National Labeling and Education Act, 1990). Brunswik's lens model (Brunswik, 1955; Cooksey, 1996; Hammond, 1955; Stewart, 1988) served as the theoretical and analytical tool for examining the judgment process. Lens model analysis was further enriched with the criticality of predictors' technique developed by Azen, Budescu, & Reiser (2001). Judgment accuracy was defined as correspondence between consumers' judgments and the nutritional quality index, NuVal(®), obtained from an expert system. The study also examined several individual level variables (e.g., age, gender, BMI, educational level, health status, health beliefs, etc.) as predictors of lens model indices that measure judgment consistency, judgment accuracy, and knowledge of the environment. Results showed varying levels of consistency and accuracy depending on the food product, but generally the median values of the lens model statistics were moderate. Judgment consistency was higher for more educated individuals; judgment accuracy was predicted from a combination of person level characteristics, and individuals who reported having regular meals had models that were in greater agreement with the expert's model. Lens model methodology is a useful tool for understanding how individuals perceive the nutrition in foods based on the NFP label. Lens model judgment indices were generally low, highlighting that the benefits of the complex NFP label may be more modest than what has been previously assumed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementation science: a role for parallel dual processing models of reasoning?

PubMed Central

Sladek, Ruth M; Phillips, Paddy A; Bond, Malcolm J

2006-01-01

Background A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. Discussion Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. Summary It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice. PMID:16725023

Implementation science: a role for parallel dual processing models of reasoning?

PubMed

Sladek, Ruth M; Phillips, Paddy A; Bond, Malcolm J

2006-05-25

A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.

Finding the right match: Mindfulness training may potentiate the therapeutic effect of non-judgment of inner experience on smoking cessation

PubMed Central

Schuman-Olivier, Zev D.; Hoeppner, Bettina B.; Evins, A. Eden; Brewer, Judson

2014-01-01

Mindfulness Training (MT) is an emerging therapeutic modality for addictive disorders. Non-judgment of inner experience, a component of mindfulness, may influence addiction treatment response. To test whether this component influences smoking cessation, tobacco smokers (n=85) in a randomized control trial of MT vs. Freedom from Smoking (FFS), a standard cognitive-behaviorally-oriented treatment, were divided into split-half subgroups based on baseline Five Facet Mindfulness Questionnaire non-judgment subscale. Smokers who rarely judge inner experience (non-judgment > 30.5) smoked less during follow-up when randomized to MT (3.9 cigs/d) vs. FFS (11.1 cigs/d), p <0.01. Measuring trait non-judgment may help personalize treatment assignments, improving outcomes. PMID:24611853

On the Wrong Track: Process and Content in Moral Psychology

PubMed Central

Kahane, Guy

2012-01-01

According to Joshua Greene's influential dual process model of moral judgment, different modes of processing are associated with distinct moral outputs: automatic processing with deontological judgment, and controlled processing with utilitarian judgment. This article aims to clarify and assess Greene's model. I argue that the proposed tie between process and content is based on a misinterpretation of the evidence, and that the supposed evidence for controlled processing in utilitarian judgment is actually likely to reflect, not ‘utilitarian reasoning’, but a form of moral deliberation which, ironically, is actually in serious tension with a utilitarian outlook. This alternative account is further supported by the results of a neuroimaging study showing that intuitive and counterintuitive judgments have similar neural correlates whether or not their content is utilitarian or deontological. PMID:23335831

Clinic expert information extraction based on domain model and block importance model.

PubMed

Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng

2015-11-01

To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method. Copyright © 2015 Elsevier Ltd. All rights reserved.

From dental science to clinical practice: Knowledge translation and evidence-based dentistry principles.

PubMed

Afrashtehfar, Kelvin I; Assery, Mansour K

2017-07-01

It has been claimed that in order to decrease the gap between what we know and what we do, research findings must be translated from knowledge to action. Such practices better enable dentists to make evidence-based decisions instead of personal ideas and judgments. To this end, this literature review aims to revisit the concepts of knowledge translation and evidence-based dentistry (EBD) and depict their role and influence within dental education. It addresses some possible strategies to facilitate knowledge translation (KT), encourage dental students to use EBD principles, and to encourage dental educators to create an environment in which students become self-directed learners. It concludes with a call to develop up-to-date and efficient online platforms that could grant dentists better access to EBD sources in order to more efficiently translate research evidence into the clinic.

Nurses' reported thinking during medication administration.

PubMed

Eisenhauer, Laurel A; Hurley, Ann C; Dolan, Nancy

2007-01-01

To document nurses' reported thinking processes during medication administration before and after implementation of point-of-care technology. Semistructured interviews and real-time tape recordings were used to document the thinking processes of 40 nurses practicing in inpatient care units in a large tertiary care teaching hospital in the northeastern US. Content analysis resulted in identification of 10 descriptive categories of nurses' thinking: communication, dose-time, checking, assessment, evaluation, teaching, side effects, work arounds, anticipating problem solving, and drug administration. Situations requiring judgment in dosage, timing, or selection of specific medications (e.g., pain management, titration of antihypertensives) provided the most explicit data about nurses' use of critical thinking and clinical judgment. A key element was nurses' constant professional vigilance to ensure that patients received their appropriate medications. Nurses' thinking processes extended beyond rules and procedures and were based on patient data and interdisciplinary professional knowledge to provide safe and effective care. Identification of thinking processes can help nurses to explain the professional expertise inherent in medication administration beyond the technical application of the "5 rights."

Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia.

PubMed

Yeung, Jeffrey C; Fung, Kevin; Davis, Eric; Rai, Sunita K; Day, Adam M B; Dzioba, Agnieszka; Bornbaum, Catherine; Doyle, Philip C

2015-03-01

Adductor spasmodic dysphonia (AdSD) is a voice disorder characterized by variable symptom severity and voice disability. Those with the disorder experience a wide spectrum of symptom severity over time, resulting in varied degrees of perceived voice disability. This study investigated the longitudinal variability of AdSD, with a focus on auditory-perceptual judgments of a dimension termed laryngeal overpressure (LO) and patient self-assessments of voice-related quality of life (V-RQOL). Longitudinal, correlational study. Ten adults with AdSD were followed over three time periods. At each, both voice samples and self-ratings of V-RQOL were gathered prior to their scheduled Botox injection. Voice recordings subsequently were perceptually evaluated by eight listeners for LO using a visual analog scale. LO ratings for all-voiced and Rainbow Passage sentence stimuli were found to be highly correlated. However, only the LO ratings obtained from judgments of AV stimuli were found to correlate moderately with self-ratings of voice disability for both the physical functioning and social-emotional subscores, as well as the total V-RQOL score. Based on perceptual judgments, LO appears to provide a reliable means of quantifying the severity of voice abnormalities in AdSD. Variability in self-ratings of the V-RQOL suggest that perceived disability related to AdSD should be actively monitored. Further, auditory-perceptual judgments may provide an accurate index of the potential impact of the disorder on the speaker. Similarly, LO was supported as a simple clinical measure that serves as a reliable index of voice change over time. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Monitoring Hospitalized Adult Patients for Opioid-Induced Sedation and Respiratory Depression.

PubMed

Jungquist, Carla R; Smith, Kirsten; Nicely, Kelly L Wiltse; Polomano, Rosemary C

2017-03-01

: Opioid analgesics are commonly administered to hospitalized patients to treat acute pain, but these drugs put patients at risk for serious adverse events, such as unintended advancing sedation, respiratory depression, and death. Nurses play an important role in keeping patients safe by making clinical decisions about the frequency and intensity with which patients receiving IV and epidural opioids should be monitored. To make sound clinical judgments, nurses must be aware of the factors that place patients at elevated risk for adverse opioid-related effects and know how to screen and assess patients for these risks. The authors review the literature on unintended advancing sedation and respiratory depression associated with opioid administration and present evidence-based recommendations for clinical decision making and patient monitoring, using both nursing assessments and electronic technologies.

Interpreting Laboratory Tests in Infection: Making Sense of Biomarkers in Sepsis and Systemic Inflammatory Response Syndrome for Intensive Care Unit Patients.

PubMed

Martin, Jennifer B; Badeaux, Jennifer E

2017-03-01

Sepsis and severe sepsis are leading causes of death in the United States and the most common causes of death among critically ill patients in noncoronary intensive care units. Diagnosis of infection and sepsis is a subjective clinical judgment based on the criteria for systemic inflammatory reaction, which is highly sensitive, not specific, and often misleading in intensively treated patients. Biomarkers are emerging as adjuncts to traditional diagnostic measures. No biomarkers have sufficient specificity or sensitivity to be routinely used in clinical practice, but they can aid in the diagnosis and treatment of infection versus inflammation. Copyright © 2016 Elsevier Inc. All rights reserved.

I know I've seen you before: Distinguishing recent-single-exposure-based familiarity from pre-existing familiarity

PubMed Central

Gimbel, Sarah I.; Brewer, James B.; Maril, Anat

2018-01-01

This study examines how individuals differentiate recent-single-exposure-based familiarity from pre-existing familiarity. If these are two distinct cognitive processes, are they supported by the same neural bases? This study examines how recent-single-exposure-based familiarity and multiple-previous-exposure-based familiarity are supported and represented in the brain using functional MRI. In a novel approach, we first behaviorally show that subjects can divide retrieval of items in pre-existing memory into judgments of recollection and familiarity. Then, using functional magnetic resonance imaging, we examine the differences in blood oxygen level dependent activity and regional connectivity during judgments of recent-single-exposure-based and pre-existing familiarity. Judgments of these two types of familiarity showed distinct regions of activation in a whole-brain analysis, in medial temporal lobe (MTL) substructures, and in MTL substructure functional-correlations with other brain regions. Specifically, within the MTL, perirhinal cortex showed increased activation during recent-single-exposure-based familiarity while parahippocampal cortex showed increased activation during judgments of pre-existing familiarity. We find that recent-single-exposure-based and pre-existing familiarity are represented as distinct neural processes in the brain; this is supported by differing patterns of brain activation and regional correlations. This spatially distinct regional brain involvement suggests that the two separate experiences of familiarity, recent-exposure-based familiarity and pre-existing familiarity, may be cognitively distinct. PMID:28073651

Ambient lighting: setting international standards for the viewing of softcopy chest images

NASA Astrophysics Data System (ADS)

McEntee, Mark F.; Ryan, John; Evanoff, Micheal G.; Keeling, Aoife; Chakraborty, Dev; Manning, David; Brennan, Patrick C.

2007-03-01

Clinical radiological judgments are increasingly being made on softcopy LCD monitors. These monitors are found throughout the hospital environment in radiological reading rooms, outpatient clinics and wards. This means that ambient lighting where clinical judgments from images are made can vary widely. Inappropriate ambient lighting has several deleterious effects: monitor reflections reduce contrast; veiling glare adds brightness; dynamic range and detectability of low contrast objects is limited. Radiological images displayed on LCDs are more sensitive to the impact of inappropriate ambient lighting and with these devices problems described above are often more evident. The current work aims to provide data on optimum ambient lighting, based on lesions within chest images. The data provided may be used for the establishment of workable ambient lighting standards. Ambient lighting at 30cms from the monitor was set at 480 Lux (office lighting) 100 Lux (WHO recommendations), 40 Lux and <10 Lux. All monitors were calibrated to DICOM part 14 GSDF. Sixty radiologists were presented with 30 chest images, 15 images having simulated nodular lesions of varying subtlety and size. Lesions were positioned in accordance with typical clinical presentation and were validated radiologically. Each image was presented for 30 seconds and viewers were asked to identify and score any visualized lesion from 1-4 to indicate confidence level of detection. At the end of the session, sensitivity and specificity were calculated. Analysis of the data suggests that visualization of chest lesions is affected by inappropriate lighting with chest radiologists demonstrating greater ambient lighting dependency. JAFROC analyses are currently being performed.

Basic self-knowledge and transparency.

PubMed

Borgoni, Cristina

2018-01-01

Cogito -like judgments, a term coined by Burge (1988), comprise thoughts such as, I am now thinking , I [hereby] judge that Los Angeles is at the same latitude as North Africa, or I [hereby] intend to go to the opera tonight. It is widely accepted that we form cogito -like judgments in an authoritative and not merely empirical manner. We have privileged self-knowledge of the mental state that is self-ascribed in a cogito -like judgment. Thus, models of self-knowledge that aim to explain privileged self-knowledge should have the resources to explain the special self-knowledge involved in cogito judgments. My objective in this paper is to examine whether a transparency model of self-knowledge (i.e., models based on Evans ' 1982 remarks) can provide such an explanation: granted that cogito judgments are paradigmatic cases of privileged self-knowledge, does the transparency procedure explain why this is so? The paper advances a negative answer, arguing that the transparency procedure cannot generate the type of thought constitutive of cogito judgments.

Dissociation between judgments and outcome-expectancy measures in covariation learning: a signal detection theory approach.

PubMed

Perales, José C; Catena, Andrés; Shanks, David R; González, José A

2005-09-01

A number of studies using trial-by-trial learning tasks have shown that judgments of covariation between a cue c and an outcome o deviate from normative metrics. Parameters based on trial-by-trial predictions were estimated from signal detection theory (SDT) in a standard causal learning task. Results showed that manipulations of P(c) when contingency (deltaP) was held constant did not affect participants' ability to predict the appearance of the outcome (d') but had a significant effect on response criterion (c) and numerical causal judgments. The association between criterion c and judgment was further demonstrated in 2 experiments in which the criterion was directly manipulated by linking payoffs to the predictive responses made by learners. In all cases, the more liberal the criterion c was, the higher judgments were. The results imply that the mechanisms underlying the elaboration of judgments and those involved in the elaboration of predictive responses are partially dissociable.

At the heart of morality lies neuro-visceral integration: lower cardiac vagal tone predicts utilitarian moral judgment.

PubMed

Park, Gewnhi; Kappes, Andreas; Rho, Yeojin; Van Bavel, Jay J

2016-10-01

To not harm others is widely considered the most basic element of human morality. The aversion to harm others can be either rooted in the outcomes of an action (utilitarianism) or reactions to the action itself (deontology). We speculated that the human moral judgments rely on the integration of neural computations of harm and visceral reactions. The present research examined whether utilitarian or deontological aspects of moral judgment are associated with cardiac vagal tone, a physiological proxy for neuro-visceral integration. We investigated the relationship between cardiac vagal tone and moral judgment by using a mix of moral dilemmas, mathematical modeling and psychophysiological measures. An index of bipolar deontology-utilitarianism was correlated with resting heart rate variability (HRV)-an index of cardiac vagal tone-such that more utilitarian judgments were associated with lower HRV. Follow-up analyses using process dissociation, which independently quantifies utilitarian and deontological moral inclinations, provided further evidence that utilitarian (but not deontological) judgments were associated with lower HRV. Our results suggest that the functional integration of neural and visceral systems during moral judgments can restrict outcome-based, utilitarian moral preferences. Implications for theories of moral judgment are discussed. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Exploring the role of first impressions in rater-based assessments.

PubMed

Wood, Timothy J

2014-08-01

Medical education relies heavily on assessment formats that require raters to assess the competence and skills of learners. Unfortunately, there are often inconsistencies and variability in the scores raters assign. To ensure the scores from these assessment tools have validity, it is important to understand the underlying cognitive processes that raters use when judging the abilities of their learners. The goal of this paper, therefore, is to contribute to a better understanding of the cognitive processes used by raters. Representative findings from the social judgment and decision making, cognitive psychology, and educational measurement literature will be used to enlighten the underpinnings of these rater-based assessments. Of particular interest is the impact judgments referred to as first impressions (or thin slices) have on rater-based assessments. These are judgments about people made very quickly and based on very little information. A narrative review will provide a synthesis of research in these three literatures (social judgment and decision making, educational psychology, and cognitive psychology) and will focus on the underlying cognitive processes, the accuracy and the impact of first impressions on rater-based assessments. The application of these findings to the types of rater-based assessments used in medical education will then be reviewed. Gaps in understanding will be identified and suggested directions for future research studies will be discussed.

Age-related changes to spectral voice characteristics affect judgments of prosodic, segmental, and talker attributes for child and adult speech.

PubMed

Dilley, Laura C; Wieland, Elizabeth A; Gamache, Jessica L; McAuley, J Devin; Redford, Melissa A

2013-02-01

As children mature, changes in voice spectral characteristics co-vary with changes in speech, language, and behavior. In this study, spectral characteristics were manipulated to alter the perceived ages of talkers' voices while leaving critical acoustic-prosodic correlates intact, to determine whether perceived age differences were associated with differences in judgments of prosodic, segmental, and talker attributes. Speech was modified by lowering formants and fundamental frequency, for 5-year-old children's utterances, or raising them, for adult caregivers' utterances. Next, participants differing in awareness of the manipulation (Experiment 1A) or amount of speech-language training (Experiment 1B) made judgments of prosodic, segmental, and talker attributes. Experiment 2 investigated the effects of spectral modification on intelligibility. Finally, in Experiment 3, trained analysts used formal prosody coding to assess prosodic characteristics of spectrally modified and unmodified speech. Differences in perceived age were associated with differences in ratings of speech rate, fluency, intelligibility, likeability, anxiety, cognitive impairment, and speech-language disorder/delay; effects of training and awareness of the manipulation on ratings were limited. There were no significant effects of the manipulation on intelligibility or formally coded prosody judgments. Age-related voice characteristics can greatly affect judgments of speech and talker characteristics, raising cautionary notes for developmental research and clinical work.

General practitioners' judgment of their elderly patients' cognitive status.

PubMed

Pentzek, Michael; Fuchs, Angela; Wiese, Birgitt; Cvetanovska-Pllashniku, Gabriela; Haller, Franziska; Maier, Wolfgang; Riedel-Heller, Steffi G; Angermeyer, Matthias C; Bickel, Horst; Mösch, Edelgard; Weyerer, Siegfried; Werle, Jochen; van den Bussche, Hendrik; Eisele, Marion; Kaduszkiewicz, Hanna

2009-12-01

General practitioners (GP) play an important role in detecting cognitive impairment among their patients. To explore factors associated with GPs' judgment of their elderly patients' cognitive status. Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers. 138 GPs, 3,181 patients (80.13 +/- 3.61 years, 65.23% female). General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs' judgment of "cognitively impaired" vs. "cognitively unimpaired." Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35-4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13-1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35-12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08-1.22) were more likely to be rated as "cognitively impaired" by their GPs. The associations between GPs' assessments of cognitive impairment and their familiarity with their patients and patients' mobility, hearing, and morbidity provide important insights into how GPs make their judgments.

The role of social comparison in social judgments of dental appearance: An experimental study.

PubMed

Al-Kharboush, Ghada H; Asimakopoulou, Koula; AlJabaa, AlJazi H; Newton, J Tim

2017-06-01

The objective of this study was to examine the influence of social comparison on social judgments of dental malalignment in a sample of females. In a Repeated measures design, N=218 female participants of which N=128 were orthodontic patients (mean age 31.4) and N=90 controls (mean age 26.1) rated their satisfaction with their facial appearance after viewing stereotypically beautiful images of faces (experimental condition) or houses (neutral condition). After 4-6 weeks participants returned to view an image of a female with severe crowding and were asked to make judgments of social competence (SC), intellectual ability (IA), psychological adjustment (PA) and attractiveness (A). The comparison of social judgments between high comparers (High SocComp) and low comparers (Low SocComp) was not statistically significant; (SC (t (204)=0.30, p=0.76), IA (t (204)=0.14, p=0.89) PA (t (204)=0.004, p=0.996), A (t(204)=1.26, (p=0.209). However, dentally induced social judgments (DISJ) was statistically significant in the clinical sample than the non-clinical sample SC (t (204)=0.784, p=0.434), IA (t (204)=0.2.15, p=0.033) PA (t (204)=-0.003, p=0.997) A (t (204)=1.58, p=0.116). Social comparison has little impact on DISJ. However, there are differences in DISJs between individuals who seek treatment for their malocclusion versus the nonclinical population; the reason for this is unclear but does not appear to be the result of adoption of societal standards of beauty and instead suggests individual ranking of important 'beauty areas' may play a role. This paper uses social comparison theory to investigate the basis of judgments in regards to dental appearance. The findings of this research may help to identify individuals who are more susceptible to societal pressures towards non-ideal dentitions. This will help clinicians become more aware of the patient's comparison orientation, which seems to have an impact on satisfaction with treatment outcomes. This study may form the foundation for future behaviour studies seeking to alleviate the negative effects of social comparison. Copyright © 2017 Elsevier Ltd. All rights reserved.

Insight in psychosis: Standards, science, ethics and value judgment.

PubMed

Jacob, K S

2017-06-01

The clinical assessment of insight solely employs biomedical perspectives and criteria to the complete exclusion of context and culture and to the disregard of values and value judgments. The aim of this discussion article is to examine recent research from India on insight and explanatory models in psychosis and re-examine the framework of assessment, diagnosis and management of insight and explanatory models. Recent research from India on insight in psychosis and explanatory models is reviewed. Recent research, which has used longitudinal data and adjusted for pretreatment variables, suggests that insight and explanatory models of illness at baseline do not predict course, outcome and treatment response in schizophrenia, which seem to be dependent on the severity and quality of the psychosis. It supports the view that people with psychosis simultaneously hold multiple and contradictory explanatory models of illness, which change over time and with the trajectory of the illness. It suggests that insight, like all explanatory models, is a narrative of the person's reality and a coping strategy to handle with the varied impact of the illness. This article argues that the assessment of insight necessarily involves value entailments, commitments and consequences. It supports a need for a broad-based approach to assess awareness, attribution and action related to mental illness and to acknowledge the role of values and value judgment in the evaluation of insight in psychosis.

Pursuing Improvement in Clinical Reasoning: Development of the Clinical Coaching Interactions Inventory.

PubMed

Jessee, Mary Ann; Tanner, Christine A

2016-09-01

Clinical coaching has been identified as a signature pedagogy in nursing education. Recent findings indicate that clinical coaching interactions in the clinical learning environment fail to engage students in the higher order thinking skills believed to promote clinical reasoning. The Clinical Coaching Interactions Inventory (CCII) was based on evidence of supervisor questioning techniques, the Tanner clinical judgment model, Bloom's Taxonomy, and simulation evaluation tools. Content validity was established with expert assessment, student testing for clarity, and calculation of scale-content validity index/average (S-CVI/Ave). Reliability was established with Kuder-Richardson Formula 20 (KR-20). CVI (S-CVI/Ave) was .91, and KR-20 was .70. The CCII identified differences in clinical coaching behaviors in university faculty supervisors and staff nurse preceptor supervisors. The CCII advances the measurement of clinical coaching interactions from qualitative to quantitative. Ultimately, results from use of this inventory may facilitate the design of prelicensure clinical coaching strategies that promote the improvement of students' clinical reasoning skill. [J Nurs Educ. 2016;55(9):495-504.]. Copyright 2016, SLACK Incorporated.

Judgments of Omitted BE and DO in Questions as Extended Finiteness Clinical Markers of SLI to Fifteen Years: A Study of Growth and Asymptote

PubMed Central

Rice, Mabel L; Hoffman, Lesa; Wexler, Ken

2009-01-01

Purpose Clinical grammar markers are needed for children with SLI older than 8 years. This study followed children studied earlier on sentences with omitted finiteness to determine if affected children continue to perform at low levels and to examine possible predictors of low performance. This is the first longitudinal report of grammaticality judgments of questions. Method Three groups of children participated: 20 SLI, 20 age controls and 18 language-matched controls, followed from ages 6–15 years. An experimental grammaticality judgment task was administered with BE copula/auxiliary and DO auxiliary in Wh- and Yes/No questions for 9 times of measurement. Predictors were indices of vocabulary, nonverbal intelligence, and maternal education. Results Growth curve analyses show that the affected group performed below the younger controls at each time of measurement, for each variable. Growth analyses show linear and quadratic effects for both groups across variables, with the exception of BE acquisition which was flat for both groups. The control children reached ceiling levels; the affected children reached a lower asymptote. Conclusions The results suggest an on-going maturational lag in finiteness marking for affected children with promise as a clinical marker for language impairment in school-aged and adolescent children and probably adults as well. PMID:19786705

Prognostic value of resident clinical performance ratings.

PubMed

Williams, Reed G; Dunnington, Gary L

2004-10-01

This study investigated the concurrent and predictive validity of end-of-rotation (EOR) clinical performance ratings. Surgeon EOR ratings of residents were collected and compared with end-of-year (EOY) progress decisions and to EOR and EOY confidential judgments of resident ability to provide patient care without direct supervision. Eighty percent to 85% of EOR ratings were Excellent or Very Good. Five percent or fewer were Fair or Poor. Almost all residents receiving Excellent or Very Good EOR ratings also received positive EOR judgments about ability to provide patient care without direct supervision. Residents rated Fair or Poor received negative EOR judgments about ability to provide patient care without direct supervision. As the cumulative percent of Good, Fair, and Poor EOR ratings increased, the number of residents promoted without stipulations at the end of the year decreased and the percentage of faculty members who judged the residents capable of providing effective patient care without direct supervision at the end of the year declined. All residents receiving 40% or more EOR ratings below Very Good had stipulations associated with their promotion. Despite use of descriptive anchors on the scale, clinical performance ratings have no direct meaning. Their meaning needs to be established in the same manner as is done in setting normal values for diagnostic tests, ie, by establishing the relationship between EOR ratings and practice outcomes.

Sociocultural Influences on Moral Judgments: East–West, Male–Female, and Young–Old

PubMed Central

Arutyunova, Karina R.; Alexandrov, Yuri I.; Hauser, Marc D.

2016-01-01

Gender, age, and culturally specific beliefs are often considered relevant to observed variation in social interactions. At present, however, the scientific literature is mixed with respect to the significance of these factors in guiding moral judgments. In this study, we explore the role of each of these factors in moral judgment by presenting the results of a web-based study of Eastern (i.e., Russia) and Western (i.e., USA, UK, Canada) subjects, male and female, and young and old. Participants (n = 659) responded to hypothetical moral scenarios describing situations where sacrificing one life resulted in saving five others. Though men and women from both types of cultures judged (1) harms caused by action as less permissible than harms caused by omission, (2) means-based harms as less permissible than side-effects, and (3) harms caused by contact as less permissible than by non-contact, men in both cultures delivered more utilitarian judgments (save the five, sacrifice one) than women. Moreover, men from Western cultures were more utilitarian than Russian men, with no differences observed for women. In both cultures, older participants delivered less utilitarian judgments than younger participants. These results suggest that certain core principles may mediate moral judgments across different societies, implying some degree of universality, while also allowing a limited range of variation due to sociocultural factors. PMID:27656155

The logic-bias effect: The role of effortful processing in the resolution of belief-logic conflict.

PubMed

Howarth, Stephanie; Handley, Simon J; Walsh, Clare

2016-02-01

According to the default interventionist dual-process account of reasoning, belief-based responses to reasoning tasks are based on Type 1 processes generated by default, which must be inhibited in order to produce an effortful, Type 2 output based on the validity of an argument. However, recent research has indicated that reasoning on the basis of beliefs may not be as fast and automatic as this account claims. In three experiments, we presented participants with a reasoning task that was to be completed while they were generating random numbers (RNG). We used the novel methodology introduced by Handley, Newstead & Trippas (Journal of Experimental Psychology: Learning, Memory, and Cognition, 37, 28-43, 2011), which required participants to make judgments based upon either the validity of a conditional argument or the believability of its conclusion. The results showed that belief-based judgments produced lower rates of accuracy overall and were influenced to a greater extent than validity judgments by the presence of a conflict between belief and logic for both simple and complex arguments. These findings were replicated in Experiment 3, in which we controlled for switching demands in a blocked design. Across all three experiments, we found a main effect of RNG, implying that both instructional sets require some effortful processing. However, in the blocked design RNG had its greatest impact on logic judgments, suggesting that distinct executive resources may be required for each type of judgment. We discuss the implications of our findings for the default interventionist account and offer a parallel competitive model as an alternative interpretation for our findings.

20 CFR 656.5 - Schedule A.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

20 CFR 656.5 - Schedule A.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

20 CFR 656.5 - Schedule A.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

20 CFR 656.5 - Schedule A.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

Creating a test blueprint for a progress testing program: A paired-comparisons approach.

PubMed

von Bergmann, HsingChi; Childs, Ruth A

2018-03-01

Creating a new testing program requires the development of a test blueprint that will determine how the items on each test form are distributed across possible content areas and practice domains. To achieve validity, categories of a blueprint are typically based on the judgments of content experts. How experts judgments are elicited and combined is important to the quality of resulting test blueprints. Content experts in dentistry participated in a day-long faculty-wide workshop to discuss, refine, and confirm the categories and their relative weights. After reaching agreement on categories and their definitions, experts judged the relative importance between category pairs, registering their judgments anonymously using iClicker, an audience response system. Judgments were combined in two ways: a simple calculation that could be performed during the workshop and a multidimensional scaling of the judgments performed later. Content experts were able to produce a set of relative weights using this approach. The multidimensional scaling yielded a three-dimensional model with the potential to provide deeper insights into the basis of the experts' judgments. The approach developed and demonstrated in this study can be applied across academic disciplines to elicit and combine content experts judgments for the development of test blueprints.

Weak encoding of faces predicts socially influenced judgments of facial attractiveness.

PubMed

Schnuerch, Robert; Koppehele-Gossel, Judith; Gibbons, Henning

2015-01-01

Conforming to the majority can be seen as a heuristic type of judgment, as it allows the individual to easily choose the most accurate or most socially acceptable type of behavior. People who process the currently to-be-judged items in a superficial, heuristic way should tend to conform to group judgment more than people processing these items in a systematic and elaborate way. We investigated this hypothesis using electroencephalography (EEG), analyzing whether the strength of neural encoding of faces was related to the tendency to adopt a group's evaluative judgments regarding these faces. As expected, we found that the amplitude of the N170, a specific neural correlate of face encoding, was inversely related to conformity across participants: The weaker the faces were encoded, the more the majority response regarding the faces' attractiveness was adopted instead of relying on the actual qualities of the faces. Applying neurophysiological methodology, we thus provide support for previous claims, based on behavioral data and theorizing, that social conformity is a heuristic type of judgment. We propose that weak encoding of judgment-relevant information is a typical, possibly even necessary, precursor of socially adjusted judgments, irrespective of one's current motivational goal (i.e., to be accurate or accepted).

Safety behaviors and judgmental biases in social anxiety disorder.

PubMed

Taylor, Charles T; Alden, Lynn E

2010-03-01

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD. 2009 Elsevier Ltd. All rights reserved.

The Development of Adaptive Decision Making: Recognition-Based Inference in Children and Adolescents

ERIC Educational Resources Information Center

Horn, Sebastian S.; Ruggeri, Azzurra; Pachur, Thorsten

2016-01-01

Judgments about objects in the world are often based on probabilistic information (or cues). A frugal judgment strategy that utilizes memory (i.e., the ability to discriminate between known and unknown objects) as a cue for inference is the recognition heuristic (RH). The usefulness of the RH depends on the structure of the environment,…

Judging Drawing Abilities of Hong Kong Chinese Gifted Students: Could Nonexperts Make Expert-Like Judgments?

ERIC Educational Resources Information Center

Chan, David W.; Chan, Lai-kwan; Chau, Amethyst

2009-01-01

Two drawings based on tasks originally used in Clark's Drawing Abilities Test from each of 297 Chinese students were first evaluated independently by two Chinese visual artists as below average, average, and above average in drawing abilities. Based on these judges' verbalization to make explicit their implicit criteria for judgments, a set of…

The Effects of Judgment-Based Stratum Classifications on the Efficiency of Stratum Scored CATs.

ERIC Educational Resources Information Center

Finney, Sara J.; Smith, Russell W.; Wise, Steven L.

Two operational item pools were used to investigate the performance of stratum computerized adaptive tests (CATs) when items were assigned to strata based on empirical estimates of item difficulty or human judgments of item difficulty. Items from the first data set consisted of 54 5-option multiple choice items from a form of the ACT mathematics…

Contrasting Semantic versus Inhibitory Processing in the Angular Gyrus: An fMRI Study.

PubMed

Lewis, Gwyneth A; Poeppel, David; Murphy, Gregory L

2018-06-06

Recent studies of semantic memory have focused on dissociating the neural bases of two foundational components of human thought: taxonomic categories, which group similar objects like dogs and seals based on features, and thematic categories, which group dissimilar objects like dogs and leashes based on events. While there is emerging consensus that taxonomic concepts are represented in the anterior temporal lobe, there is disagreement over whether thematic concepts are represented in the angular gyrus (AG). We previously found AG sensitivity to both kinds of concepts; however, some accounts suggest that such activity reflects inhibition of irrelevant information rather than thematic activation. To test these possibilities, an fMRI experiment investigated both types of conceptual relations in the AG during two semantic judgment tasks. Each task trained participants to give negative responses (inhibition) or positive responses (activation) to word pairs based on taxonomic and thematic criteria of relatedness. Results showed AG engagement during both negative judgments and thematic judgments, but not during positive judgments about taxonomic pairs. Together, the results suggest that activity in the AG reflects functions that include both thematic (but not taxonomic) processing and inhibiting irrelevant semantic information.

What's fair is fair--or is it? Value differences underlying public views about social justice.

PubMed

Rasinski, K A

1987-07-01

Individual differences in judgments of the fairness of various sociopolitical phenomena were examined in three surveys. Scales measuring two value dimensions thought to underlie the meaning of fairness were constructed, and survey respondents endorsing these different values were compared on their evaluation of the procedural and distributive fairness of political objects. Those endorsing the value of proportionality, hypothesized by equity theorists to underlie fairness judgments, judged equity-based public policies to be fairer than equality-based policies and judged that Ronald Reagan would be a fairer president than Walter Mondale. These people also emphasized the procedural aspects of government when judging government fairness. Respondents endorsing the value of egalitarianism, hypothesized by developmental theorists and some political philosophers to underlie fairness judgments, judged equality-based public policies to be fairer than equity-based policies and judged that Mondale would be a fairer president than Reagan. These people emphasized the distributive aspects of government when judging government fairness. Results support the naive moral philosopher image of the individual as judge of political objects (Tyler, 1984a). Political fairness judgments are ideological responses and are subject to the influence of the value structure of the judge (Tetlock, 1986).

Integration of Intention and Outcome for Moral Judgment in Frontotemporal Dementia: Brain Structural Signatures.

PubMed

Baez, Sandra; Kanske, Philipp; Matallana, Diana; Montañes, Patricia; Reyes, Pablo; Slachevsky, Andrea; Matus, Cristian; Vigliecca, Nora Silvana; Torralva, Teresa; Manes, Facundo; Ibanez, Agustin

2016-01-01

Moral judgment has been proposed to rely on a distributed brain network. This function is impaired in behavioral variant frontotemporal dementia (bvFTD), a condition involving damage to some regions of this network. However, no studies have investigated moral judgment in bvFTD via structural neuroimaging. We compared the performance of 21 bvFTD patients and 19 controls on a moral judgment task involving scenarios that discriminate between the contributions of intentions and outcomes. Voxel-based morphometry was used to assess (a) the atrophy pattern in bvFTD patients, (b) associations between gray matter (GM) volume and moral judgments, and (c) structural differences between bvFTD subgroups (patients with relatively preserved moral judgment and patients with severer moral judgment impairments). Patients judged attempted harm as more permissible and accidental harm as less permissible than controls. The groups' performance on accidental harm was associated with GM volume in the precuneus. In controls, it was al- so associated with the ventromedial prefrontal cortex (VMPFC). Also, both groups' performance on attempted harm was associated with GM volume in the temporoparietal junction. Patients exhibiting worse performance displayed smaller GM volumes in the precuneus and temporal pole. Results suggest that moral judgment abnormalities in bvFTD are associated with impaired integration of intentions and outcomes, which depends on an extended brain network. In bvFTD, moral judgment seems to critically depend on areas beyond the VMPFC. © 2016 S. Karger AG, Basel.

How to explain receptivity to conjunction-fallacy inhibition training: evidence from the Iowa gambling task.

PubMed

Cassotti, Mathieu; Moutier, Sylvain

2010-04-01

Intuitive predictions and judgments under conditions of uncertainty are often mediated by judgment heuristics that sometimes lead to biases. Using the classical conjunction bias example, the present study examines the relationship between receptivity to metacognitive executive training and emotion-based learning ability indexed by Iowa Gambling Task (IGT) performance. After completing a computerised version of the IGT, participants were trained to avoid conjunction bias on a frequency judgment task derived from the works of Tversky and Kahneman. Pre- and post-test performances were assessed via another probability judgment task. Results clearly showed that participants who produced a biased answer despite the experimental training (individual patterns of the biased --> biased type) mainly had less emotion-based learning ability in IGT. Better emotion-based learning ability was observed in participants whose response pattern was biased --> logical. These findings argue in favour of the capacity of the human mind/brain to overcome reasoning bias when trained under executive programming conditions and as a function of emotional warning sensitivity. Copyright 2009 Elsevier Inc. All rights reserved.

Comparing moral judgments of patients with frontotemporal dementia and frontal stroke.

PubMed

Baez, Sandra; Couto, Blas; Torralva, Teresa; Sposato, Luciano A; Huepe, David; Montañes, Patricia; Reyes, Pablo; Matallana, Diana; Vigliecca, Nora S; Slachevsky, Andrea; Manes, Facundo; Ibanez, Agustin

2014-09-01

Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions. Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

COMPREHENSIVE EVALUATIVE TECHNIQUES FOR THE CHILD WITH A CLEFT PALATE.

ERIC Educational Resources Information Center

BENSEN, JACK F.; WHITE, FRAZER D.

A MULTIDISCIPLINARY APPROACH TO CHILDREN WITH CLEFT PALATES IS DESCRIBED. THE SOUTH FLORIDA CLEFT PALATE CLINIC, REPRESENTING NINE PROFESSIONAL SPECIALTIES, MEETS WEEKLY TO SEE SIX OR SEVEN CASES. SPEECH PERFORMANCE IS RECORDED ON SIX DIAGNOSTIC, DATA COLLECTING FORMS WHICH PROVIDE A BASIS FOR RECORDING CLINICAL JUDGMENTS. PROGNOSIS AND…

Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain.

PubMed

Román-Cereto, Montserrat; García-Mayor, Silvia; Kaknani-Uttumchandani, Shakira; García-Gámez, Marina; León-Campos, Alvaro; Fernández-Ordóñez, Eloisa; Ruiz-García, Maria Luisa; Martí-García, C; López-Leiva, Inmaculada; Lasater, Kathie; Morales-Asencio, José Miguel

2018-05-01

The clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. To obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. Cultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Málaga (Spain). A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium-fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. 152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92-0.95) (p = 0.0001) and Cronbach's alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a χ 2 /df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000-0.066). The rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Aesthetics by Numbers: Links between Perceived Texture Qualities and Computed Visual Texture Properties.

PubMed

Jacobs, Richard H A H; Haak, Koen V; Thumfart, Stefan; Renken, Remco; Henson, Brian; Cornelissen, Frans W

2016-01-01

Our world is filled with texture. For the human visual system, this is an important source of information for assessing environmental and material properties. Indeed-and presumably for this reason-the human visual system has regions dedicated to processing textures. Despite their abundance and apparent relevance, only recently the relationships between texture features and high-level judgments have captured the interest of mainstream science, despite long-standing indications for such relationships. In this study, we explore such relationships, as these might be used to predict perceived texture qualities. This is relevant, not only from a psychological/neuroscience perspective, but also for more applied fields such as design, architecture, and the visual arts. In two separate experiments, observers judged various qualities of visual textures such as beauty, roughness, naturalness, elegance, and complexity. Based on factor analysis, we find that in both experiments, ~75% of the variability in the judgments could be explained by a two-dimensional space, with axes that are closely aligned to the beauty and roughness judgments. That a two-dimensional judgment space suffices to capture most of the variability in the perceived texture qualities suggests that observers use a relatively limited set of internal scales on which to base various judgments, including aesthetic ones. Finally, for both of these judgments, we determined the relationship with a large number of texture features computed for each of the texture stimuli. We find that the presence of lower spatial frequencies, oblique orientations, higher intensity variation, higher saturation, and redness correlates with higher beauty ratings. Features that captured image intensity and uniformity correlated with roughness ratings. Therefore, a number of computational texture features are predictive of these judgments. This suggests that perceived texture qualities-including the aesthetic appreciation-are sufficiently universal to be predicted-with reasonable accuracy-based on the computed feature content of the textures.

Aesthetics by Numbers: Links between Perceived Texture Qualities and Computed Visual Texture Properties

PubMed Central

Jacobs, Richard H. A. H.; Haak, Koen V.; Thumfart, Stefan; Renken, Remco; Henson, Brian; Cornelissen, Frans W.

2016-01-01

Our world is filled with texture. For the human visual system, this is an important source of information for assessing environmental and material properties. Indeed—and presumably for this reason—the human visual system has regions dedicated to processing textures. Despite their abundance and apparent relevance, only recently the relationships between texture features and high-level judgments have captured the interest of mainstream science, despite long-standing indications for such relationships. In this study, we explore such relationships, as these might be used to predict perceived texture qualities. This is relevant, not only from a psychological/neuroscience perspective, but also for more applied fields such as design, architecture, and the visual arts. In two separate experiments, observers judged various qualities of visual textures such as beauty, roughness, naturalness, elegance, and complexity. Based on factor analysis, we find that in both experiments, ~75% of the variability in the judgments could be explained by a two-dimensional space, with axes that are closely aligned to the beauty and roughness judgments. That a two-dimensional judgment space suffices to capture most of the variability in the perceived texture qualities suggests that observers use a relatively limited set of internal scales on which to base various judgments, including aesthetic ones. Finally, for both of these judgments, we determined the relationship with a large number of texture features computed for each of the texture stimuli. We find that the presence of lower spatial frequencies, oblique orientations, higher intensity variation, higher saturation, and redness correlates with higher beauty ratings. Features that captured image intensity and uniformity correlated with roughness ratings. Therefore, a number of computational texture features are predictive of these judgments. This suggests that perceived texture qualities—including the aesthetic appreciation—are sufficiently universal to be predicted—with reasonable accuracy—based on the computed feature content of the textures. PMID:27493628

Fractional flow reserve-guided revascularization: practical implications of a diagnostic gray zone and measurement variability on clinical decisions.

PubMed

Petraco, Ricardo; Sen, Sayan; Nijjer, Sukhjinder; Echavarria-Pinto, Mauro; Escaned, Javier; Francis, Darrel P; Davies, Justin E

2013-03-01

This study sought to evaluate the effects of fractional flow reserve (FFR) measurement variability on FFR-guided treatment strategy. Current appropriateness guidelines recommend the utilization of FFR to guide coronary revascularization based on a fixed cut-off of 0.8. This rigid approach does not take into account the intrinsic biological variability of a single FFR result and the clinical judgment of experienced interventional cardiologists. [corrected]. FFR reproducibility data from the landmark Deferral Versus Performance of PTCA in Patients Without Documented Ischemia (DEFER) trial was analyzed (two repeated FFR measurements in the same lesion, 10 min apart) and the standard deviation of the difference (SDD) between repeated measurements was calculated. The measurement certainty (probability that the FFR-guided revascularization strategy will not change if the test is repeated 10 min later) was subsequently established across the whole range of FFR values, from 0.2 to 1. Outside the [0.75 to 0.85] FFR range, measurement certainty of a single FFR result is >95%. However, closer to its cut-off, certainty falls to less than 80% within 0.77 to 0.83, reaching a nadir of 50% around 0.8. In clinical practice, that means that each time a single FFR value falls between 0.75 and 0.85, there is a chance that the FFR-derived revascularization recommendation will change if the measurement is repeated 10 min later, with this chance increasing the closer the FFR result is to 0.8. A measurement FFR gray-zone is found between 0.75 and 0.85]. Therefore, clinicians should make revascularization decisions based on broadened clinical judgment when a single FFR result falls within this uncertainty zone, particularly between 0.77 and 0.83, when measurement certainty falls to less than 80%. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Accuracy in inference of nursing diagnoses in heart failure patients.

PubMed

Pereira, Juliana de Melo Vellozo; Cavalcanti, Ana Carla Dantas; Lopes, Marcos Venícios de Oliveira; da Silva, Valéria Gonçalves; de Souza, Rosana Oliveira; Gonçalves, Ludmila Cuzatis

2015-01-01

Heart failure (HF) is a common cause of hospitalization and requires accuracy in clinical judgment and appropriate nursing diagnoses. to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients. descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating efficacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected. the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identified by the nursing evaluators. the search for improving diagnostic accuracy reaffirms the need for continuous and specific training to improve the diagnosis capability of nurses. the training allowed the exercise of clinical judgment and better accuracy of nurses.

Influence of Learning Style and Learning Flexibility on Clinical Judgment of Prelicensure Nursing Students within a Human Patient Computer Simulation Environment

ERIC Educational Resources Information Center

Robison, Elizabeth Sharon

2012-01-01

Nursing education is experiencing a transition in how students are exposed to clinical situations. Technology, specifically human patient computer simulation, is replacing human exposure in clinical education (Nehring, 2010b). Kaakinen and Arwood (2009) discuss the need to apply learning theories to instructional designs involving simulation for…

Clinical Significance of Human Herpesvirus 6 Positivity on the FilmArray Meningitis/Encephalitis Multiplex PCR Panel.

PubMed

Green, Daniel A; Pereira, Marcus; Miko, Benjamin; Radmard, Sara; Whittier, Susan; Thakur, Kiran

2018-04-09

A review of 15 patients who tested positive for HHV-6 on the FilmArray Meningitis/Encephalitis (M/E) panel revealed that the majority were unlikely to have HHV-6 encephalitis. Interpreting HHV-6 positive results on the M/E panel requires careful clinical judgment, as this finding may be clinically insignificant for many patients.

Clinical extracts of biomedical literature for patient-centered problem solving.

PubMed Central

Florance, V

1996-01-01

This paper reports on a four-part qualitative research project aimed at designing an online document surrogate tailored to the needs of physicians seeking biomedical literature for use in clinical problem solving. The clinical extract, designed in collaboration with three practicing physicians, combines traditional elements of the MEDLINE record (e.g., title, author, source, abstract) with new elements (e.g., table captions, text headings, case profiles) suggested by the physicians. Specifications for the prototype clinical extract were developed through a series of relevance-scoring exercises and semi-structured interviews. For six clinical questions, three physicians assessed the applicability of selected articles and their document surrogates, articulating relevance criteria and reasons for their judgments. A prototype clinical extract based on their suggestions was developed, tested, evaluated, and revised. The final version includes content and format aids to make the extract easy to use. The goals, methods, and outcomes of the research study are summarized, and a template of the final design is provided. PMID:8883986

Experiencing Physical Pain Leads to More Sympathetic Moral Judgments

PubMed Central

Xiao, Qianguo; Zhu, Yi; Luo, Wen-bo

2015-01-01

Previous studies have shown that observing another’s pain can evoke other-oriented emotions, which instigate empathic concern for another’s needs. It is not clear whether experiencing first-hand physical pain may also evoke other-oriented emotion and thus influence people’s moral judgment. Based on the embodied simulation literature and neuroimaging evidence, the present research tested the idea that participants who experienced physical pain would be more sympathetic in their moral judgments. Study 1 showed that ice-induced physical pain facilitated higher self-assessments of empathy, which motivated participants to be more sympathetic in their moral judgments. Study 2 confirmed findings in study 1 and also showed that State Perspective Taking subscale of the State Empathy Scale mediated the effects of physical pain on moral judgment. These results provide support for embodied view of morality and for the view that pain can serve a positive psychosocial function. PMID:26465603

The effect of attribute order on judgment in Chinese and English.

PubMed

Tavassoli, Nader T; Lee, Yih Hwai

2004-12-01

The authors found that the order of attribute presentation had a stronger effect on judgment in English than in Chinese. In Experiment 1, with a sample of 102 female and 63 male bilingual Singaporeans, the authors found that participants' memory-based judgments showed a stronger primacy effect in English than in Chinese that was mediated by recall from long-term memory. In contrast, participants' online (immediate) judgments showed a primacy effect in both languages that was unmediated by recall from short-term memory. In Experiment 2, with a sample of 67 female and 53 male bilingual Singaporeans, the authors found that participants' online judgments were more influenced by the attribute order of a previously seen competitive advertisement in English than in Chinese. A cross-cultural field study in Mainland China and the United Kingdom provided external validity for the experimental results. copyright (c) 2004 APA, all rights reserved.

The Influence of Effortful Thought and Cognitive Proficiencies on the Conjunction Fallacy: Implications for Dual-Process Theories of Reasoning and Judgment.

PubMed

Scherer, Laura D; Yates, J Frank; Baker, S Glenn; Valentine, Kathrene D

2017-06-01

Human judgment often violates normative standards, and virtually no judgment error has received as much attention as the conjunction fallacy. Judgment errors have historically served as evidence for dual-process theories of reasoning, insofar as these errors are assumed to arise from reliance on a fast and intuitive mental process, and are corrected via effortful deliberative reasoning. In the present research, three experiments tested the notion that conjunction errors are reduced by effortful thought. Predictions based on three different dual-process theory perspectives were tested: lax monitoring, override failure, and the Tripartite Model. Results indicated that participants higher in numeracy were less likely to make conjunction errors, but this association only emerged when participants engaged in two-sided reasoning, as opposed to one-sided or no reasoning. Confidence was higher for incorrect as opposed to correct judgments, suggesting that participants were unaware of their errors.

Experiencing Physical Pain Leads to More Sympathetic Moral Judgments.

PubMed

Xiao, Qianguo; Zhu, Yi; Luo, Wen-Bo

2015-01-01

Previous studies have shown that observing another's pain can evoke other-oriented emotions, which instigate empathic concern for another's needs. It is not clear whether experiencing first-hand physical pain may also evoke other-oriented emotion and thus influence people's moral judgment. Based on the embodied simulation literature and neuroimaging evidence, the present research tested the idea that participants who experienced physical pain would be more sympathetic in their moral judgments. Study 1 showed that ice-induced physical pain facilitated higher self-assessments of empathy, which motivated participants to be more sympathetic in their moral judgments. Study 2 confirmed findings in study 1 and also showed that State Perspective Taking subscale of the State Empathy Scale mediated the effects of physical pain on moral judgment. These results provide support for embodied view of morality and for the view that pain can serve a positive psychosocial function.

When do people rely on affective and cognitive feelings in judgment? A review.

PubMed

Greifeneder, Rainer; Bless, Herbert; Pham, Michel Tuan

2011-05-01

Although people have been shown to rely on feelings to make judgments, the conditions that moderate this reliance have not been systematically reviewed and conceptually integrated. This article addresses this gap by jointly reviewing moderators of the reliance on both subtle affective feelings and cognitive feelings of ease-of-retrieval. The review revealed that moderators of the reliance on affective and cognitive feelings are remarkably similar and can be grouped into five major categories: (a) the salience of the feelings, (b) the representativeness of the feelings for the target, (c) the relevance of the feelings to the judgment, (d) the evaluative malleability of the judgment, and (e) the level of processing intensity. Based on the reviewed evidence, it is concluded that the use of feelings as information is a frequent event and a generally sensible judgmental strategy rather than a constant source of error. Avenues for future research are discussed.

I know I've seen you before: Distinguishing recent-single-exposure-based familiarity from pre-existing familiarity.

PubMed

Gimbel, Sarah I; Brewer, James B; Maril, Anat

2017-03-01

This study examines how individuals differentiate recent-single-exposure-based familiarity from pre-existing familiarity. If these are two distinct cognitive processes, are they supported by the same neural bases? This study examines how recent-single-exposure-based familiarity and multiple-previous-exposure-based familiarity are supported and represented in the brain using functional MRI. In a novel approach, we first behaviorally show that subjects can divide retrieval of items in pre-existing memory into judgments of recollection and familiarity. Then, using functional magnetic resonance imaging, we examine the differences in blood oxygen level dependent activity and regional connectivity during judgments of recent-single-exposure-based and pre-existing familiarity. Judgments of these two types of familiarity showed distinct regions of activation in a whole-brain analysis, in medial temporal lobe (MTL) substructures, and in MTL substructure functional-correlations with other brain regions. Specifically, within the MTL, perirhinal cortex showed increased activation during recent-single-exposure-based familiarity while parahippocampal cortex showed increased activation during judgments of pre-existing familiarity. We find that recent-single-exposure-based and pre-existing familiarity are represented as distinct neural processes in the brain; this is supported by differing patterns of brain activation and regional correlations. This spatially distinct regional brain involvement suggests that the two separate experiences of familiarity, recent-exposure-based familiarity and pre-existing familiarity, may be cognitively distinct. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical evaluation of a novel population-based regression analysis for detecting glaucomatous visual field progression.

PubMed

Kovalska, M P; Bürki, E; Schoetzau, A; Orguel, S F; Orguel, S; Grieshaber, M C

2011-04-01

The distinction of real progression from test variability in visual field (VF) series may be based on clinical judgment, on trend analysis based on follow-up of test parameters over time, or on identification of a significant change related to the mean of baseline exams (event analysis). The aim of this study was to compare a new population-based method (Octopus field analysis, OFA) with classic regression analyses and clinical judgment for detecting glaucomatous VF changes. 240 VF series of 240 patients with at least 9 consecutive examinations available were included into this study. They were independently classified by two experienced investigators. The results of such a classification served as a reference for comparison for the following statistical tests: (a) t-test global, (b) r-test global, (c) regression analysis of 10 VF clusters and (d) point-wise linear regression analysis. 32.5 % of the VF series were classified as progressive by the investigators. The sensitivity and specificity were 89.7 % and 92.0 % for r-test, and 73.1 % and 93.8 % for the t-test, respectively. In the point-wise linear regression analysis, the specificity was comparable (89.5 % versus 92 %), but the sensitivity was clearly lower than in the r-test (22.4 % versus 89.7 %) at a significance level of p = 0.01. A regression analysis for the 10 VF clusters showed a markedly higher sensitivity for the r-test (37.7 %) than the t-test (14.1 %) at a similar specificity (88.3 % versus 93.8 %) for a significant trend (p = 0.005). In regard to the cluster distribution, the paracentral clusters and the superior nasal hemifield progressed most frequently. The population-based regression analysis seems to be superior to the trend analysis in detecting VF progression in glaucoma, and may eliminate the drawbacks of the event analysis. Further, it may assist the clinician in the evaluation of VF series and may allow better visualization of the correlation between function and structure owing to VF clusters. © Georg Thieme Verlag KG Stuttgart · New York.

[Study on Information Extraction of Clinic Expert Information from Hospital Portals].

PubMed

Zhang, Yuanpeng; Dong, Jiancheng; Qian, Danmin; Geng, Xingyun; Wu, Huiqun; Wang, Li

2015-12-01

Clinic expert information provides important references for residents in need of hospital care. Usually, such information is hidden in the deep web and cannot be directly indexed by search engines. To extract clinic expert information from the deep web, the first challenge is to make a judgment on forms. This paper proposes a novel method based on a domain model, which is a tree structure constructed by the attributes of search interfaces. With this model, search interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from the returned web pages indexed by search interfaces. To filter the noise information on a web page, a block importance model is proposed. The experiment results indicated that the domain model yielded a precision 10.83% higher than that of the rule-based method, whereas the block importance model yielded an F₁ measure 10.5% higher than that of the XPath method.

Critical thinking of student nurses during clinical accompaniment.

PubMed

Uys, B Y; Meyer, S M

2005-08-01

The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators' perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts 'critical thinking' and 'facilitation' were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.

Grey Comprehensive Evaluation of Biomass Power Generation Project Based on Group Judgement

NASA Astrophysics Data System (ADS)

Xia, Huicong; Niu, Dongxiao

2017-06-01

The comprehensive evaluation of benefit is an important task needed to be carried out at all stages of biomass power generation projects. This paper proposed an improved grey comprehensive evaluation method based on triangle whiten function. To improve the objectivity of weight calculation result of only reference comparison judgment method, this paper introduced group judgment to the weighting process. In the process of grey comprehensive evaluation, this paper invited a number of experts to estimate the benefit level of projects, and optimized the basic estimations based on the minimum variance principle to improve the accuracy of evaluation result. Taking a biomass power generation project as an example, the grey comprehensive evaluation result showed that the benefit level of this project was good. This example demonstrates the feasibility of grey comprehensive evaluation method based on group judgment for benefit evaluation of biomass power generation project.

In a Year, Memory Will Benefit from Learning, Tomorrow It Won't: Distance and Construal Level Effects on the Basis of Metamemory Judgments

ERIC Educational Resources Information Center

Halamish, Vered; Nussinson, Ravit; Ben-Ari, Liat

2013-01-01

Metamemory judgments may rely on 2 bases of information: subjective experience and abstract theories about memory. On the basis of construal level theory, we predicted that psychological distance and construal level (i.e., concrete vs. abstract thinking) would have a qualitative impact on the relative reliance on these 2 bases: When considering…

Investigation of the effects of color on judgments of sweetness using a taste adaptation method.

PubMed

Hidaka, Souta; Shimoda, Kazumasa

2014-01-01

It has been reported that color can affect the judgment of taste. For example, a dark red color enhances the subjective intensity of sweetness. However, the underlying mechanisms of the effect of color on taste have not been fully investigated; in particular, it remains unclear whether the effect is based on cognitive/decisional or perceptual processes. Here, we investigated the effect of color on sweetness judgments using a taste adaptation method. A sweet solution whose color was subjectively congruent with sweetness was judged as sweeter than an uncolored sweet solution both before and after adaptation to an uncolored sweet solution. In contrast, subjective judgment of sweetness for uncolored sweet solutions did not differ between the conditions following adaptation to a colored sweet solution and following adaptation to an uncolored one. Color affected sweetness judgment when the target solution was colored, but the colored sweet solution did not modulate the magnitude of taste adaptation. Therefore, it is concluded that the effect of color on the judgment of taste would occur mainly in cognitive/decisional domains.

On Consistency Test Method of Expert Opinion in Ecological Security Assessment

PubMed Central

Wang, Lihong

2017-01-01

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert’s individual judgment level, ability and the consistency of the expert’s overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment. PMID:28869570

On Consistency Test Method of Expert Opinion in Ecological Security Assessment.

PubMed

Gong, Zaiwu; Wang, Lihong

2017-09-04

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert's individual judgment level, ability and the consistency of the expert's overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment.

Heuristics can produce surprisingly rational probability estimates: Comment on Costello and Watts (2014).

PubMed

Nilsson, Håkan; Juslin, Peter; Winman, Anders

2016-01-01

Costello and Watts (2014) present a model assuming that people's knowledge of probabilities adheres to probability theory, but that their probability judgments are perturbed by a random noise in the retrieval from memory. Predictions for the relationships between probability judgments for constituent events and their disjunctions and conjunctions, as well as for sums of such judgments were derived from probability theory. Costello and Watts (2014) report behavioral data showing that subjective probability judgments accord with these predictions. Based on the finding that subjective probability judgments follow probability theory, Costello and Watts (2014) conclude that the results imply that people's probability judgments embody the rules of probability theory and thereby refute theories of heuristic processing. Here, we demonstrate the invalidity of this conclusion by showing that all of the tested predictions follow straightforwardly from an account assuming heuristic probability integration (Nilsson, Winman, Juslin, & Hansson, 2009). We end with a discussion of a number of previous findings that harmonize very poorly with the predictions by the model suggested by Costello and Watts (2014). (c) 2015 APA, all rights reserved).

Changing the personality of a face: Perceived Big Two and Big Five personality factors modeled in real photographs.

PubMed

Walker, Mirella; Vetter, Thomas

2016-04-01

General, spontaneous evaluations of strangers based on their faces have been shown to reflect judgments of these persons' intention and ability to harm. These evaluations can be mapped onto a 2D space defined by the dimensions trustworthiness (intention) and dominance (ability). Here we go beyond general evaluations and focus on more specific personality judgments derived from the Big Two and Big Five personality concepts. In particular, we investigate whether Big Two/Big Five personality judgments can be mapped onto the 2D space defined by the dimensions trustworthiness and dominance. Results indicate that judgments of the Big Two personality dimensions almost perfectly map onto the 2D space. In contrast, at least 3 of the Big Five dimensions (i.e., neuroticism, extraversion, and conscientiousness) go beyond the 2D space, indicating that additional dimensions are necessary to describe more specific face-based personality judgments accurately. Building on this evidence, we model the Big Two/Big Five personality dimensions in real facial photographs. Results from 2 validation studies show that the Big Two/Big Five are perceived reliably across different samples of faces and participants. Moreover, results reveal that participants differentiate reliably between the different Big Two/Big Five dimensions. Importantly, this high level of agreement and differentiation in personality judgments from faces likely creates a subjective reality which may have serious consequences for those being perceived-notably, these consequences ensue because the subjective reality is socially shared, irrespective of the judgments' validity. The methodological approach introduced here might prove useful in various psychological disciplines. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Is being mindful associated with reduced risk for internally-motivated drinking and alcohol use among undergraduates?

PubMed

Reynolds, Ashley; Keough, Matthew T; O'Connor, Roisin M

2015-03-01

Mindfulness encompasses four core skills: observing, describing, acting with awareness, and accepting without judgment; which aim to increase one's awareness, tolerance, and acceptance of internal experiences (Baer et al., 2004). Despite promising clinical results that mindfulness reduces alcohol craving and relapse, complementary etiological research is underdeveloped. Theory suggests that those who are motivated to drink to change internal states (reduce negative/increase positive affect) are at risk for elevated alcohol use. The ability to accept one's affective state should preclude internally-motivated drinking, and thus, elevated alcohol use. The purpose of this study was to parse out which mindfulness skills are central to alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking (drinking for coping and enhancement motives) and alcohol use. Students (N=76) completed self-report measures of past month alcohol use and four motives for drinking: to cope, for enhancement, to conform, and for social reasons. Partially supporting our hypotheses, accepting without judgment was negatively associated with drinking for coping motives, but was unassociated with drinking for enhancement motives. Interestingly, acceptance without judgment was negatively associated with drinking for conformity motives (to reduce social rejection). Unexpectedly, acting with awareness, but not accepting without judgment, was a negative predictor of alcohol use. Our findings suggest that interventions aimed at reducing coping- and conformity-motivated drinking and alcohol use by young adults may benefit from incorporating mindfulness skills training (i.e., accepting without judgment; acting with awareness). Copyright © 2014 Elsevier Ltd. All rights reserved.

Apprentices' Learning of Occupationally Informed Practical Judgment

ERIC Educational Resources Information Center

Chan, Selena

2015-01-01

Learning to become trade workers requires developing the ability to make practical workplace-based judgments, often centred around difficult to articulate trade "know-how" or tacit knowledge. Apprentices learn discipline specific ways of doing, thinking, feeling and being from experts, peers and through interactions with occupational…

Morality, Reason and Feeling.

ERIC Educational Resources Information Center

Bailey, Charles

1980-01-01

This paper argues that morality is essentially a matter of rational reflection and judgment and has little to do with feelings or affections. The notions of reason and justification are analyzed. Four types of feelings are defined and shown to provide inadequate bases for moral judgment. (Author/SJL)

Sight over sound in the judgment of music performance.

PubMed

Tsay, Chia-Jung

2013-09-03

Social judgments are made on the basis of both visual and auditory information, with consequential implications for our decisions. To examine the impact of visual information on expert judgment and its predictive validity for performance outcomes, this set of seven experiments in the domain of music offers a conservative test of the relative influence of vision versus audition. People consistently report that sound is the most important source of information in evaluating performance in music. However, the findings demonstrate that people actually depend primarily on visual information when making judgments about music performance. People reliably select the actual winners of live music competitions based on silent video recordings, but neither musical novices nor professional musicians were able to identify the winners based on sound recordings or recordings with both video and sound. The results highlight our natural, automatic, and nonconscious dependence on visual cues. The dominance of visual information emerges to the degree that it is overweighted relative to auditory information, even when sound is consciously valued as the core domain content.

Sight over sound in the judgment of music performance

PubMed Central

Tsay, Chia-Jung

2013-01-01

Social judgments are made on the basis of both visual and auditory information, with consequential implications for our decisions. To examine the impact of visual information on expert judgment and its predictive validity for performance outcomes, this set of seven experiments in the domain of music offers a conservative test of the relative influence of vision versus audition. People consistently report that sound is the most important source of information in evaluating performance in music. However, the findings demonstrate that people actually depend primarily on visual information when making judgments about music performance. People reliably select the actual winners of live music competitions based on silent video recordings, but neither musical novices nor professional musicians were able to identify the winners based on sound recordings or recordings with both video and sound. The results highlight our natural, automatic, and nonconscious dependence on visual cues. The dominance of visual information emerges to the degree that it is overweighted relative to auditory information, even when sound is consciously valued as the core domain content. PMID:23959902

Eight-week ledipasvir/sofosbuvir in non-cirrhotic, treatment-naïve hepatitis C genotype-1 patients with hepatitis C virus-RNA < 6 million: Single center, real world effectiveness and safety.

PubMed

Latt, Nyan L; Yanny, Beshoy T; Gharibian, Derenik; Gevorkyan, Rita; Sahota, Amandeep K

2017-07-14

To evaluate sustained viral response (SVR) of 8-wk ledipasvir/sofosbuvir therapy among non-cirrhotic, genotype-1 hepatitis C virus (HCV) patients with RNA < 6 million IU/mL. We performed a retrospective cohort study to examine SVR rates, predictors of treatment failure and safety analysis of 8-wk ledipasvir/sofosbuvir (LDV/SOF) therapy among non-cirrhotic, genotype 1 HCV patients with viral load < 6 million IU/mL. Primary outcome was an achievement of SVR at 12 wk after treatment. Secondary outcomes were identifying predictors of treatment failure and adverse events during treatment. Total 736 patients: 55% males, 51% Caucasians and 65% were genotype 1a. Non-cirrhotic state of 53% was determined by clinical judgment (imaging, AST, platelet count) and 47% had documented liver fibrosis testing (biopsy, vibration-controlled transient elastography, serum biomarkers). Overall SVR12 was 96%. No difference in SVR12 was seen between patients whose non-cirrhotic state was determined by clinical judgment and patients who had fibrosis testing. Age groups, gender, ethnicity and genotype 1 subtype did not predict SVR. Non-cirrhotic state determined by clinical judgment based on simple, non-invasive tests were not associated with lower SVR [OR = 1.02, 95%CI: 0.48-2.17, P = 0.962]. The AUROC for hepatitis C RNA viral load was 0.734 ( P < 0.001, 95%CI: 0.66-0.82). HCV RNA 2.2 million IU/mL was identified as the cutoff value with sensitivity 73% and specificity 64%. HCV RNA < 2.2 million IU/mL was associated with significantly higher SVR 98% with OR = 0.22 (95%CI: 0.1-0.49, P < 0.001) compared to SVR 92% in HCV RNA ≥ 2.2 million IU/mL. No death or morbidities were reported. Our outcomes validate safety and effectiveness of 8-wk LDV/SOF therapy in non-cirrhotic, untreated HCV genotype 1 patients with HCV RNA < 6 million IU/mL.

Eight-week ledipasvir/sofosbuvir in non-cirrhotic, treatment-naïve hepatitis C genotype-1 patients with hepatitis C virus-RNA < 6 million: Single center, real world effectiveness and safety

PubMed Central

Latt, Nyan L; Yanny, Beshoy T; Gharibian, Derenik; Gevorkyan, Rita; Sahota, Amandeep K

2017-01-01

AIM To evaluate sustained viral response (SVR) of 8-wk ledipasvir/sofosbuvir therapy among non-cirrhotic, genotype-1 hepatitis C virus (HCV) patients with RNA < 6 million IU/mL. METHODS We performed a retrospective cohort study to examine SVR rates, predictors of treatment failure and safety analysis of 8-wk ledipasvir/sofosbuvir (LDV/SOF) therapy among non-cirrhotic, genotype 1 HCV patients with viral load < 6 million IU/mL. Primary outcome was an achievement of SVR at 12 wk after treatment. Secondary outcomes were identifying predictors of treatment failure and adverse events during treatment. RESULTS Total 736 patients: 55% males, 51% Caucasians and 65% were genotype 1a. Non-cirrhotic state of 53% was determined by clinical judgment (imaging, AST, platelet count) and 47% had documented liver fibrosis testing (biopsy, vibration-controlled transient elastography, serum biomarkers). Overall SVR12 was 96%. No difference in SVR12 was seen between patients whose non-cirrhotic state was determined by clinical judgment and patients who had fibrosis testing. Age groups, gender, ethnicity and genotype 1 subtype did not predict SVR. Non-cirrhotic state determined by clinical judgment based on simple, non-invasive tests were not associated with lower SVR [OR = 1.02, 95%CI: 0.48-2.17, P = 0.962]. The AUROC for hepatitis C RNA viral load was 0.734 (P < 0.001, 95%CI: 0.66-0.82). HCV RNA 2.2 million IU/mL was identified as the cutoff value with sensitivity 73% and specificity 64%. HCV RNA < 2.2 million IU/mL was associated with significantly higher SVR 98% with OR = 0.22 (95%CI: 0.1-0.49, P < 0.001) compared to SVR 92% in HCV RNA ≥ 2.2 million IU/mL. No death or morbidities were reported. CONCLUSION Our outcomes validate safety and effectiveness of 8-wk LDV/SOF therapy in non-cirrhotic, untreated HCV genotype 1 patients with HCV RNA < 6 million IU/mL. PMID:28765697

Pointing towards visuospatial patterns in short-term memory: differential effects on familiarity- and recollection-based judgments.

PubMed

Rossi-Arnaud, Clelia; Spataro, Pietro; Marques, Valeria R S; Longobardi, Emiddia

2015-03-01

Previous studies have indicated that pointing toward to-be-remembered visuospatial patterns enhances short-term memory (STM) when the presentation of pointing and no-pointing trials is mixed (Chum et al., 2007; Dodd & Shumborski, 2009; Rossi-Arnaud et al., 2012). By contrast, when presentation is blocked, pointing has inhibitory effects on memory (Dodd & Shumborski, 2009; Rossi-Arnaud et al., 2012). In the present study, we demonstrated that pointing has different effects on short-term recollection- and familiarity-based judgments, depending on the length of the visuospatial patterns (5- vs. 7-item arrays) and the interval between the encoding and test phases (2 vs. 5 s). More specifically, pointing decreased the accuracy of recollection-based judgments for 5-item arrays, but not for 7-item arrays (this negative effect did not interact with interval length). In contrast, pointing facilitated familiarity-based judgments when the interval between the study and test phases was 5 s, but not when it was 2 s (this positive effect did not interact with pattern length). We proposed that the negative effects might be accounted for by the simultaneous recruitment of attention resources in the planning and execution of pointing movements. As a consequence, executive resources are diverted from the primary memory task, resulting in a less efficient use of attention-demanding retrieval strategies, like chunking. By contrast, the positive effects on familiarity judgments might reflect the unitization of the to-be-remembered items into a single shape. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

The processing of linear perspective and binocular information for action and perception.

PubMed

Bruggeman, Hugo; Yonas, Albert; Konczak, Jürgen

2007-04-08

To investigate the processing of linear perspective and binocular information for action and for the perceptual judgment of depth, we presented viewers with an actual Ames trapezoidal window. The display, when presented perpendicular to the line of sight, provided perspective information for a rectangular window slanted in depth, while binocular information specified a planar surface in the fronto-parallel plane. We compared pointing towards the display-edges with perceptual judgment of their positions in depth as the display orientation was varied under monocular and binocular view. On monocular trials, pointing and depth judgment were based on the perspective information and failed to respond accurately to changes in display orientation because pictorial information did not vary sufficiently to specify the small differences in orientation. For binocular trials, pointing was based on binocular information and precisely matched the changes in display orientation whereas depth judgment was short of such adjustment and based upon both binocular and perspective-specified slant information. The finding, that on binocular trials pointing was considerably less responsive to the illusion than perceptual judgment, supports an account of two separate processing streams in the human visual system, a ventral pathway involved in object recognition and a dorsal pathway that produces visual information for the control of actions. Previously, similar differences between perception and action were explained by an alternate explanation, that is, viewers selectively attend to different parts of a display in the two tasks. The finding that under monocular view participants responded to perspective information in both the action and the perception task rules out the attention-based argument.

Multimodal Analgesia in Breast Surgical Procedures: Technical and Pharmacological Considerations for Liposomal Bupivacaine Use

PubMed Central

Newman, Martin I.; Seeley, Neil; Hutchins, Jacob; Smith, Kevin L.; Mena, Gabriel; Selber, Jesse C.; Saint-Cyr, Michel H.; Gadsden, Jeffrey C.

2017-01-01

Enhanced recovery after surgery is a multidisciplinary perioperative clinical pathway that uses evidence-based interventions to improve the patient experience as well as increase satisfaction, reduce costs, mitigate the surgical stress response, accelerate functional recovery, and decrease perioperative complications. One of the most important elements of enhanced recovery pathways is multimodal pain management. Herein, aspects relating to multimodal analgesia following breast surgical procedures are discussed with the understanding that treatment decisions should be individualized and guided by sound clinical judgment. A review of liposomal bupivacaine, a prolonged-release formulation of bupivacaine, in the management of postoperative pain following breast surgical procedures is presented, and technical guidance regarding optimal administration of liposomal bupivacaine is provided. PMID:29062649

The Psychometric Properties of the Kentucky Inventory of Mindfulness Skills in Clinical Populations

ERIC Educational Resources Information Center

Baum, Corinna; Kuyken, Willem; Bohus, Martin; Heidenreich, Thomas; Michalak, Johannes; Steil, Regina

2010-01-01

The Kentucky Inventory of Mindfulness Skills (KIMS) is a well-validated multidimensional questionnaire measuring dimensions of mindfulness on four scales: Observing, Describing, Act With Awareness, and Accept Without Judgment. Even though the KIMS has been used in several clinical studies no information is available about the psychometric…

Should I Pack My Umbrella? Clinical versus Statistical Prediction of Mental Health Decisions

ERIC Educational Resources Information Center

Aegisdottir, Stefania; Spengler, Paul M.; White, Michael J.

2006-01-01

In this rejoinder, the authors respond to the insightful commentary of Strohmer and Arm, Chwalisz, and Hilton, Harris, and Rice about the meta-analysis on statistical versus clinical prediction techniques for mental health judgments. The authors address issues including the availability of statistical prediction techniques for real-life psychology…

Identification of Clinical Markers of Specific Language Impairment in Adults

ERIC Educational Resources Information Center

Poll, Gerard H.; Betz, Stacy K.; Miller, Carol A.

2010-01-01

Purpose: To investigate the usefulness of 3 tasks known to be effective diagnostic clinical markers of specific language impairment (SLI) in children: (a) nonword repetition, (b) sentence repetition, and (c) grammaticality judgments of finiteness marking. Method: Two groups of young adults, 13 with SLI and 18 with typical language, completed 3…

Proportionate Responses to Life Events Influence Clinicians' Judgments of Psychological Abnormality

ERIC Educational Resources Information Center

Kim, Nancy S.; Paulus, Daniel J.; Gonzalez, Jeffrey S.; Khalife, Danielle

2012-01-01

Psychological abnormality is a fundamental concept in the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-IV-TR"; American Psychiatric Association, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person's current behaviors? The appropriate…

Unraveling the Contributions of the Diencephalon to Recognition Memory: A Review

ERIC Educational Resources Information Center

Aggleton, John P.; Dumont, Julie R.; Warburton, Elizabeth Clea

2011-01-01

Both clinical investigations and studies with animals reveal nuclei within the diencephalon that are vital for recognition memory (the judgment of prior occurrence). This review seeks to identify these nuclei and to consider why they might be important for recognition memory. Despite the lack of clinical cases with circumscribed pathology within…

Understanding the Cranial Nerves: Evaluation of a Self-Paced Online Module in Optometric Education

ERIC Educational Resources Information Center

Taylor, Daniel Arnett

2016-01-01

Among the faculty of Southern College of Optometry in Memphis, Tennessee, it is perceived that optometry students often enter their clinical assignments with poor clinical judgment. To address this, "Understanding the Cranial Nerves"--an online-self paced instructional intervention of approximately two hours' duration--was developed. In…

The Development of the Simulation Thinking Rubric

ERIC Educational Resources Information Center

Doolen, Jessica

2012-01-01

High fidelity simulation has become a widespread and costly learning strategy in nursing education because it can fill the gap left by a shortage of clinical sites. In addition, high fidelity simulation is an active learning strategy that is thought to increase higher order thinking such as clinical reasoning and judgment skills in nursing…

Age-related changes to spectral voice characteristics affect judgments of prosodic, segmental, and talker attributes for child and adult speech

PubMed Central

Dilley, Laura C.; Wieland, Elizabeth A.; Gamache, Jessica L.; McAuley, J. Devin; Redford, Melissa A.

2013-01-01

Purpose As children mature, changes in voice spectral characteristics covary with changes in speech, language, and behavior. Spectral characteristics were manipulated to alter the perceived ages of talkers’ voices while leaving critical acoustic-prosodic correlates intact, to determine whether perceived age differences were associated with differences in judgments of prosodic, segmental, and talker attributes. Method Speech was modified by lowering formants and fundamental frequency, for 5-year-old children’s utterances, or raising them, for adult caregivers’ utterances. Next, participants differing in awareness of the manipulation (Exp. 1a) or amount of speech-language training (Exp. 1b) made judgments of prosodic, segmental, and talker attributes. Exp. 2 investigated the effects of spectral modification on intelligibility. Finally, in Exp. 3 trained analysts used formal prosody coding to assess prosodic characteristics of spectrally-modified and unmodified speech. Results Differences in perceived age were associated with differences in ratings of speech rate, fluency, intelligibility, likeability, anxiety, cognitive impairment, and speech-language disorder/delay; effects of training and awareness of the manipulation on ratings were limited. There were no significant effects of the manipulation on intelligibility or formally coded prosody judgments. Conclusions Age-related voice characteristics can greatly affect judgments of speech and talker characteristics, raising cautionary notes for developmental research and clinical work. PMID:23275414

An empirical test of competing theories of hazard-related trust: the case of GM food.

PubMed

Allum, Nick

2007-08-01

Few scholars doubt the importance of trust in explaining variation in public perception of technological risk. Relatively little, however, is known about the particular types of judgments that people use in granting or withholding trust. This article presents findings from an empirical study that explores several dimensions of trust relevant for citizens' judgments of scientists involved in the development of GM food. The relationship between particular dimensions of trust and perceptions of GM food risk is also explored, using structural equation modeling. Results suggest that trust judgments based on the perception of shared values are most important in relation to GM food risk, but that judgments about scientists' technical competence are also important.

Clinic Design as Placebo—Using Design to Promote Healing and Support Treatments

PubMed Central

Schuster, Kai

2017-01-01

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person’s judgments and behavior with a particular focus on health related issues, a quantitative survey (N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength. PMID:29120378

Clinic Design as Placebo-Using Design to Promote Healing and Support Treatments.

PubMed

Rehn, Jonas; Schuster, Kai

2017-11-09

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person's judgments and behavior with a particular focus on health related issues, a quantitative survey ( N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength.

Utility of an abbreviated version of the stanford-binet intelligence scales (5th ed.) in estimating 'full scale' IQ for young children with autism spectrum disorder.

PubMed

Twomey, Conal; O'Connell, Helen; Lillis, Mary; Tarpey, Sarah Louise; O'Reilly, Gary

2018-03-01

The fifth edition of the Stanford-Binet Intelligence scales allows 'full scale' IQ (FSIQ) to be estimated using an abridged version of the test-the abbreviated battery IQ (ABIQ). Set within a public early intervention team service, the current cross-sectional study investigated the utility of the ABIQ in estimating FSIQ for 40 children with autism spectrum disorder (ASD) aged 3-5 years. A strong ABIQ-FSIQ association was yielded (r = 0.89; r 2  = 0.808) and the ABIQ did not over-estimate mean FSIQ above a clinically-relevant threshold; however, clinically significant over-estimation occurred in 17.5% of individual cases. While the findings provide support for the utility of the ABIQ in estimating FSIQ for young children with ASD, caution relating to the over-estimation of FSIQ is warranted. Careful clinical judgment-ideally based on examination of previous cognitive assessment results (if available), thorough interactional observations, and close multi-disciplinary consultation-is necessary to determine the applicability of the ABIQ to individual cases. Autism Res 2018, 11: 503-508. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. We investigated the utility of a shortened version of the Stanford-Binet Intelligence Scales in estimating IQ for 40 young children with autism spectrum disorder (ASD). The findings provide qualified support for the instrument: acceptably accurate IQ estimation was achieved for most cases; but not so for a sizeable minority (17.5%). Careful clinical judgment is necessary to determine the applicability of the ABIQ to individual cases. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Norm Acquisition, Rational Judgment and Moral Particularism

ERIC Educational Resources Information Center

Westphal, Kenneth R.

2012-01-01

Moral particularism, defined as the view that moral judgment does not require moral principles, has become prominent both in moral philosophy and in philosophy of education. This article re-examines Nussbaum's case for particularism, based on Sophocles' "Antigone", because her stress on sensitive appreciation of circumstantial specifics is…

Changing Resistant Audience Attitudes Using Social Judgment Theory's "Anchor" Point Perspectives

ERIC Educational Resources Information Center

Ramos Salazar, Leslie

2017-01-01

Courses: Public Speaking, Business and Professional Communication, Persuasion, or any other skill-based oral communication course. Objectives: Students will practice the development and demonstration of persuasive arguments in this single-class social judgment theory activity to improve their ability to change resistant audience attitudes.

Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

PubMed Central

das Virgens, Cláudio Marcelo Bittencourt; Lemos Jr, Laudenor; Noya-Rabelo, Márcia; Carvalhal, Manuela Campelo; Cerqueira Junior, Antônio Maurício dos Santos; Lopes, Fernanda Oliveira de Andrade; de Sá, Nicole Cruz; Suerdieck, Jéssica Gonzalez; de Souza, Thiago Menezes Barbosa; Correia, Vitor Calixto de Almeida; Sodré, Gabriella Sant'Ana; da Silva, André Barcelos; Alexandre, Felipe Kalil Beirão; Ferreira, Felipe Rodrigues Marques; Correia, Luís Cláudio Lemos

2017-01-01

AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain. METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure. RESULTS In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt’s numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37). CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting. PMID:28400920

Understanding barriers to evidence-based assessment: Clinician attitudes toward standardized assessment tools

PubMed Central

Jensen-Doss, Amanda; Hawley, Kristin M.

2010-01-01

In an era of evidence-based practice, why are clinicians not typically engaged in evidence-based assessment? To begin to understand this issue, a national multidisciplinary survey was conducted to examine clinician attitudes toward standardized assessment tools. 1442 child clinicians provided opinions about the psychometric qualities of these tools, their benefit over clinical judgment alone, and their practicality. Doctoral-level clinicians and psychologists expressed more positive ratings in all three domains than master’s-level clinicians and non-psychologists respectively, although only the disciplinary differences remained significant when predictors were examined simultaneously. All three attitude scales were predictive of standardized assessment tool use, although practical concerns were the strongest and only independent predictor of use. PMID:21058134

Genetics Home Reference: GRN-related frontotemporal dementia

MedlinePlus

... temporal lobes . The frontal lobes are involved in reasoning, planning, judgment, and problem-solving, while the temporal ... MND. Phenotype variability in progranulin mutation carriers: a clinical, neuropsychological, imaging and genetic study. Brain. 2008 Mar; ...

Memory Loss: When to Seek Help

MedlinePlus

... a set of symptoms, including impairment in memory, reasoning, judgment, language and other thinking skills. Dementia usually ... et al. Mild cognitive impairment: Epidemiology, pathology and clinical assessment. http://www.uptodate.com/home. Accessed March ...

The doctor as businessman: the changing politics of a cultural icon.

PubMed

Stone, D A

1997-04-01

From just after the Civil War, when medicine began to professionalize, until the late 1970s, doctors and policy makers believed that clinical judgment should not be influenced by the financial interests of doctors. Physicians were highly entrepreneurial, and organized medicine fought to preserve their entrepreneurial interests, but the moral norm that justified their autonomy from state regulation was a strict separation of clinical judgment and pecuniary interests. Under managed care, the old norm is reversed. A good doctor takes financial considerations into account in making clinical decisions. Theoretically, doctors should consider measures of cost to society, but in practice, the payment systems of managed care plans induce doctors to consider the impact of each clinical decision on their own income. Because doctors share the risks of insuring patients with managed care plans, they have the same incentives as insurers to avoid patients who are expensively sick. The new cultural image of doctors as entrepreneurs masks their considerable loss of clinical autonomy under managed care. It also serves to persuade doctors to accept managed care arrangements and to persuade insurance consumers and patients to accept reduced benefits from employers and the government.

Evaluating faces on trustworthiness: an extension of systems for recognition of emotions signaling approach/avoidance behaviors.

PubMed

Todorov, Alexander

2008-03-01

People routinely make various trait judgments from facial appearance, and such judgments affect important social outcomes. These judgments are highly correlated with each other, reflecting the fact that valence evaluation permeates trait judgments from faces. Trustworthiness judgments best approximate this evaluation, consistent with evidence about the involvement of the amygdala in the implicit evaluation of face trustworthiness. Based on computer modeling and behavioral experiments, I argue that face evaluation is an extension of functionally adaptive systems for understanding the communicative meaning of emotional expressions. Specifically, in the absence of diagnostic emotional cues, trustworthiness judgments are an attempt to infer behavioral intentions signaling approach/avoidance behaviors. Correspondingly, these judgments are derived from facial features that resemble emotional expressions signaling such behaviors: happiness and anger for the positive and negative ends of the trustworthiness continuum, respectively. The emotion overgeneralization hypothesis can explain highly efficient but not necessarily accurate trait judgments from faces, a pattern that appears puzzling from an evolutionary point of view and also generates novel predictions about brain responses to faces. Specifically, this hypothesis predicts a nonlinear response in the amygdala to face trustworthiness, confirmed in functional magnetic resonance imaging (fMRI) studies, and dissociations between processing of facial identity and face evaluation, confirmed in studies with developmental prosopagnosics. I conclude with some methodological implications for the study of face evaluation, focusing on the advantages of formally modeling representation of faces on social dimensions.

5 CFR 838.103 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Court Orders § 838.103 Definitions. In this part (except subpart J)— Child abuse creditor means an individual who applies for benefits under CSRS or FERS based on a child abuse judgment enforcement order. Child abuse judgment enforcement order means a court or administrative order requiring OPM to pay a...

ICT Student Teachers' Judgments and Justifications about Ethical Issues

ERIC Educational Resources Information Center

Alakurt, Turgay; Bardakci, Salih; Keser, Hafize

2012-01-01

In this study, Turkish ICT student teachers' judgments and justifications in four scenarios involving ICT-related ethical problems were investigated. Scenarios were designed based on Mason's (1986) four ethical issues: privacy, accuracy, property and accessibility. The study was carried out in the fall of 2010. We used the critical incidents…

Strategies for Teaching Students to Think Critically: A Meta-Analysis

ERIC Educational Resources Information Center

Abrami, Philip C.; Bernard, Robert M.; Borokhovski, Eugene; Waddington, David I.; Wade, C. Anne; Persson, Tonje

2015-01-01

Critical thinking (CT) is purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference, as well as explanations of the considerations on which that judgment is based. This article summarizes the available empirical evidence on the impact of instruction on the development and enhancement of critical…

5 CFR 838.103 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Court Orders § 838.103 Definitions. In this part (except subpart J)— Child abuse creditor means an individual who applies for benefits under CSRS or FERS based on a child abuse judgment enforcement order. Child abuse judgment enforcement order means a court or administrative order requiring OPM to pay a...

5 CFR 838.103 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Court Orders § 838.103 Definitions. In this part (except subpart J)— Child abuse creditor means an individual who applies for benefits under CSRS or FERS based on a child abuse judgment enforcement order. Child abuse judgment enforcement order means a court or administrative order requiring OPM to pay a...

5 CFR 838.103 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Court Orders § 838.103 Definitions. In this part (except subpart J)— Child abuse creditor means an individual who applies for benefits under CSRS or FERS based on a child abuse judgment enforcement order. Child abuse judgment enforcement order means a court or administrative order requiring OPM to pay a...

5 CFR 838.103 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Court Orders § 838.103 Definitions. In this part (except subpart J)— Child abuse creditor means an individual who applies for benefits under CSRS or FERS based on a child abuse judgment enforcement order. Child abuse judgment enforcement order means a court or administrative order requiring OPM to pay a...

The Two Sides of Beauty: Laterality and the Duality of Facial Attractiveness

ERIC Educational Resources Information Center

Franklin, Robert G., Jr.; Adams, Reginald B., Jr.

2010-01-01

We hypothesized that facial attractiveness represents a dual judgment, a combination of reward-based, sexual processes, and aesthetic, cognitive processes. Herein we describe a study that demonstrates that sexual and nonsexual processes both contribute to attractiveness judgments and that these processes can be dissociated. Female participants…

Teacher Judgment, Student Motivation, and the Mediating Effect of Attributions

ERIC Educational Resources Information Center

Zhou, Ji; Urhahne, Detlef

2013-01-01

Based on Weiner's attributional theory of intrapersonal motivation, the mediating effect of attributions between teacher judgment and student motivation was examined. In two studies, 144 German and 272 Chinese fourth-grade elementary school students were tested on their mathematical achievement, causal ascriptions for success and failure,…

College Students' Judgment of Others Based on Described Eating Pattern

ERIC Educational Resources Information Center

Pearson, Rebecca; Young, Michael

2008-01-01

Background: The literature available on attitudes toward eating patterns and people choosing various foods suggests the possible importance of "moral" judgments and desirable personality characteristics associated with the described eating patterns. Purpose: This study was designed to replicate and extend a 1993 study of college students'…

Asymmetries in Predictive and Diagnostic Reasoning

ERIC Educational Resources Information Center

Fernbach, Philip M.; Darlow, Adam; Sloman, Steven A.

2011-01-01

In this article, we address the apparent discrepancy between causal Bayes net theories of cognition, which posit that judgments of uncertainty are generated from causal beliefs in a way that respects the norms of probability, and evidence that probability judgments based on causal beliefs are systematically in error. One purported source of bias…

Are Examiners' Judgments in OSCE-Style Assessments Influenced by Contrast Effects?

PubMed

Yeates, Peter; Moreau, Marc; Eva, Kevin

2015-07-01

Laboratory studies have shown that performance assessment judgments can be biased by "contrast effects." Assessors' scores become more positive, for example, when the assessed performance is preceded by relatively weak candidates. The authors queried whether this effect occurs in real, high-stakes performance assessments despite increased formality and behavioral descriptors. Data were obtained for the 2011 United Kingdom Foundational Programme clinical assessment and the 2008 University of Alberta Multiple Mini Interview. Candidate scores were compared with scores for immediately preceding candidates and progressively distant candidates. In addition, average scores for the preceding three candidates were calculated. Relationships between these variables were examined using linear regression. Negative relationships were observed between index scores and both immediately preceding and recent scores for all exam formats. Relationships were greater between index scores and the average of the three preceding scores. These effects persisted even when examiners had judged several performances, explaining up to 11% of observed variance on some occasions. These findings suggest that contrast effects do influence examiner judgments in high-stakes performance-based assessments. Although the observed effect was smaller than observed in experimentally controlled laboratory studies, this is to be expected given that real-world data lessen the strength of the intervention by virtue of less distinct differences between candidates. Although it is possible that the format of circuital exams reduces examiners' susceptibility to these influences, the finding of a persistent effect after examiners had judged several candidates suggests that the potential influence on candidate scores should not be ignored.

Incorporating uncertainty into medical decision making: an approach to unexpected test results.

PubMed

Bianchi, Matt T; Alexander, Brian M; Cash, Sydney S

2009-01-01

The utility of diagnostic tests derives from the ability to translate the population concepts of sensitivity and specificity into information that will be useful for the individual patient: the predictive value of the result. As the array of available diagnostic testing broadens, there is a temptation to de-emphasize history and physical findings and defer to the objective rigor of technology. However, diagnostic test interpretation is not always straightforward. One significant barrier to routine use of probability-based test interpretation is the uncertainty inherent in pretest probability estimation, the critical first step of Bayesian reasoning. The context in which this uncertainty presents the greatest challenge is when test results oppose clinical judgment. It is this situation when decision support would be most helpful. The authors propose a simple graphical approach that incorporates uncertainty in pretest probability and has specific application to the interpretation of unexpected results. This method quantitatively demonstrates how uncertainty in disease probability may be amplified when test results are unexpected (opposing clinical judgment), even for tests with high sensitivity and specificity. The authors provide a simple nomogram for determining whether an unexpected test result suggests that one should "switch diagnostic sides.'' This graphical framework overcomes the limitation of pretest probability uncertainty in Bayesian analysis and guides decision making when it is most challenging: interpretation of unexpected test results.

Quality of clinical brain tumor MR spectra judged by humans and machine learning tools.

PubMed

Kyathanahally, Sreenath P; Mocioiu, Victor; Pedrosa de Barros, Nuno; Slotboom, Johannes; Wright, Alan J; Julià-Sapé, Margarida; Arús, Carles; Kreis, Roland

2018-05-01

To investigate and compare human judgment and machine learning tools for quality assessment of clinical MR spectra of brain tumors. A very large set of 2574 single voxel spectra with short and long echo time from the eTUMOUR and INTERPRET databases were used for this analysis. Original human quality ratings from these studies as well as new human guidelines were used to train different machine learning algorithms for automatic quality control (AQC) based on various feature extraction methods and classification tools. The performance was compared with variance in human judgment. AQC built using the RUSBoost classifier that combats imbalanced training data performed best. When furnished with a large range of spectral and derived features where the most crucial ones had been selected by the TreeBagger algorithm it showed better specificity (98%) in judging spectra from an independent test-set than previously published methods. Optimal performance was reached with a virtual three-class ranking system. Our results suggest that feature space should be relatively large for the case of MR tumor spectra and that three-class labels may be beneficial for AQC. The best AQC algorithm showed a performance in rejecting spectra that was comparable to that of a panel of human expert spectroscopists. Magn Reson Med 79:2500-2510, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

Implementations of clinical functional magnetic resonance imaging using character-based paradigms for the prediction of Chinese language dominance.

PubMed

Liu, Ho-Ling; Wu, Chien-Te; Chen, Jian-Chuan; Hsu, Yuan-Yu; Wai, Yau-Yau; Wan, Yung-Liang

2003-01-01

Recently, functional MRI (fMRI) using word generation (WG) tasks has been shown to be effective for mapping the Chinese language-related brain areas. In clinical applications, however, patients' performance cannot be easily monitored during WG tasks. In this study, we evaluated the feasibility of a word choice (WC) paradigm in the clinical setting and compared the results with those from WG tasks. Intrasubject comparisons of fMRI with both WG and WC paradigms were performed on six normal human subjects and two tumor patients. Subject responses in the WC paradigm, based on semantic judgments, were recorded. Activation strength, extent, and laterality were evaluated and compared. Our results showed that fMRI with the WC paradigm evoked weaker neuronal activation than that with the WG paradigm in Chinese language-related brain areas. It was sufficient to reveal language laterality for clinical use, however. In addition, it resulted in less nonlanguage-specific brain activation. Results from the patient data demonstrated strong evidence for the necessity of incorporating response monitoring during fMRI studies, which suggested that fMRI with the WC paradigm is more appropriate to be implemented for the prediction of Chinese language dominance in clinical environments.

Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians.

PubMed

Qaseem, Amir; McLean, Robert M; Starkey, Melissa; Forciea, Mary Ann

2017-01-03

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the diagnosis of gout. This guideline is based on a systematic review of published studies on gout diagnosis, identified using several databases, from database inception to February 2016. Evaluated outcomes included the accuracy of the test results; intermediate outcomes (results of laboratory and radiographic tests, such as serum urate and synovial fluid crystal analysis and radiographic or ultrasonography changes); clinical decision making (additional testing and pharmacologic or dietary management); short-term clinical (patient-centered) outcomes, such as pain and joint swelling and tenderness; and adverse effects of the tests. This guideline grades the evidence and recommendations by using the ACP grading system, which is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes adults with joint inflammation suspected to be gout. ACP recommends that clinicians use synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible acute gout. (Grade: weak recommendation, low-quality evidence).

Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism.

PubMed

Patil, Indrajeet; Melsbach, Jens; Hennig-Fast, Kristina; Silani, Giorgia

2016-03-29

This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics' hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations.

Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism

PubMed Central

Patil, Indrajeet; Melsbach, Jens; Hennig-Fast, Kristina; Silani, Giorgia

2016-01-01

This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics’ hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations. PMID:27020307

Image acquisition context: procedure description attributes for clinically relevant indexing and selective retrieval of biomedical images.

PubMed

Bidgood, W D; Bray, B; Brown, N; Mori, A R; Spackman, K A; Golichowski, A; Jones, R H; Korman, L; Dove, B; Hildebrand, L; Berg, M

1999-01-01

To support clinically relevant indexing of biomedical images and image-related information based on the attributes of image acquisition procedures and the judgments (observations) expressed by observers in the process of image interpretation. The authors introduce the notion of "image acquisition context," the set of attributes that describe image acquisition procedures, and present a standards-based strategy for utilizing the attributes of image acquisition context as indexing and retrieval keys for digital image libraries. The authors' indexing strategy is based on an interdependent message/terminology architecture that combines the Digital Imaging and Communication in Medicine (DICOM) standard, the SNOMED (Systematized Nomenclature of Human and Veterinary Medicine) vocabulary, and the SNOMED DICOM microglossary. The SNOMED DICOM microglossary provides context-dependent mapping of terminology to DICOM data elements. The capability of embedding standard coded descriptors in DICOM image headers and image-interpretation reports improves the potential for selective retrieval of image-related information. This favorably affects information management in digital libraries.

Validating the proposed diagnostic and statistical manual of mental disorders, 5th edition, severity indicator for personality disorder.

PubMed

Morey, Leslie C; Bender, Donna S; Skodol, Andrew E

2013-09-01

The authors sought to determine whether a 5-point global rating of personality dysfunction on the Level of Personality Functioning Scale proposed as a severity index for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), would be related to DSM-IV personality disorder diagnosis as well as to other key clinical judgments. Data were collected from a national sample of 337 mental health clinicians who provided complete diagnostic information relevant to DSM-IV and proposed DSM-5 personality disorder diagnoses, as well as demographic information and other clinical judgments, on one of their patients. Of the 337 patients described, 248 met criteria for 1 of the 10 specific DSM-IV personality disorders. A "moderate" or greater rating of impairment in personality functioning on the Level Scale demonstrated 84.6% sensitivity and 72.7% specificity for identifying patients meeting criteria for a specific DSM-IV personality disorder. The Level of Personality Functioning Scale had significant and substantial validity correlations with other measures of personality pathology and with clinical judgments regarding functioning, risk, prognosis, and optimal treatment intensity. Furthermore, the single-item Level of Personality Functioning rating was viewed as being as clinically useful as the 10 DSM-IV categories for treatment planning and patient description and was a better predictor of clinician ratings of broad psychosocial functioning than were the 10 DSM-IV categories combined. These results confirm hypotheses that the single-item Level of Personality Functioning Scale rating provides an indication of severity of personality pathology that predicts both assignment of personality disorder diagnosis and clinician appraisals of functioning, risk, prognosis, and needed treatment intensity.

Psychopathic traits linked to alterations in neural activity during personality judgments of self and others.

PubMed

Deming, Philip; Philippi, Carissa L; Wolf, Richard C; Dargis, Monika; Kiehl, Kent A; Koenigs, Michael

2018-01-01

Psychopathic individuals are notorious for their grandiose sense of self-worth and disregard for the welfare of others. One potential psychological mechanism underlying these traits is the relative consideration of "self" versus "others". Here we used task-based functional magnetic resonance imaging (fMRI) to identify neural responses during personality trait judgments about oneself and a familiar other in a sample of adult male incarcerated offenders ( n  = 57). Neural activity was regressed on two clusters of psychopathic traits: Factor 1 (e.g., egocentricity and lack of empathy) and Factor 2 (e.g., impulsivity and irresponsibility). Contrary to our hypotheses, Factor 1 scores were not significantly related to neural activity during self- or other-judgments. However, Factor 2 traits were associated with diminished activation to self-judgments, in relation to other-judgments, in bilateral posterior cingulate cortex and right temporoparietal junction. These findings highlight cortical regions associated with a dimension of social-affective cognition that may underlie psychopathic individuals' impulsive traits.

The spatial frequencies influence the aesthetic judgment of buildings transculturally.

PubMed

Vannucci, Manila; Gori, Simone; Kojima, Haruyuki

2014-01-01

Recent evidence has shown that buildings designed to be high-ranking, according to the Western architectural decorum, have more impact on the minds of their beholders than low-ranking buildings. Here we investigated whether and how the aesthetic judgment for high- and low-ranking buildings was affected by differences in cultural expertise and by power spectrum differences. A group of Italian and Japanese participants performed aesthetic judgment tasks, with line drawings of high- and low-ranking buildings and with their random-phase versions (an image with the exact power spectrum of the original one but non-recognizable anymore). Irrespective of cultural expertise, high-ranking buildings and their relative random-phase versions received higher aesthetic judgments than low-ranking buildings and their random-phase versions. These findings indicate that high- and low-ranking buildings are differentiated for their aesthetic value and they show that low-level visual processes influence the aesthetic judgment based on differences in the stimuli power spectrum, irrespective of the influence of cultural expertise.

Public judgments of information in a diazepam patient package insert.

PubMed

Fisher, S; Mansbridge, B; Lankford, D A

1982-06-01

As part of a larger study of the effects of giving patients written take-home information with prescription medications, a "patient package insert" (PPI) for diazepam was prepared based on content determined by "experts." This report compares the experts' judgments of what information should be included with judgments obtained from the public. Information judged to be most important for inclusion in a PPI was identified by having subjects sort cards containing facts about diazepam. Subjects who had previously used diazepam were no different in their judgments than inexperienced subjects. In general, there was a high degree of concordance between public and expert judgments and also a remarkably strong consensus across very different demographic samples. In those few instances of disagreement, the public attached even greater importance to warnings and "bad news" about diazepam than to information providing reassurances, benign general education, and "good news." To what extent patients would effectively use this information--whether conveyed by PPIs or alternative educational routes--must await empirical evaluation.

Event-related potential evidence of accessing gender stereotypes to aid source monitoring.

PubMed

Leynes, P Andrew; Crawford, Jarret T; Radebaugh, Anne M; Taranto, Elizabeth

2013-01-23

Source memory for the speaker's voice (male or female) was investigated when semantic knowledge (gender stereotypes) could and could not inform the episodic source judgment while event-related potentials (ERPs) were recorded. Source accuracy was greater and response times were faster when stereotypes could predict the speaker's voice at test. Recollection supported source judgments in both conditions as indicated by significant parietal "old/new" ERP effects (500-800ms). Prototypical late ERP effects (the right frontal "old/new" effect and the late posterior negativity, LPN) were evident when source judgment was based solely on episodic memory. However, these two late ERP effects were diminished and a novel, frontal-negative ERP with left-central topography was observed when stereotypes aided source judgments. This pattern of ERP activity likely reflects activation of left frontal or left temporal lobes when semantic knowledge, in the form of a gender stereotype, is accessed to inform the episodic source judgment. Copyright © 2012 Elsevier B.V. All rights reserved.

The effect of analytic and experiential modes of thought on moral judgment.

PubMed

Kvaran, Trevor; Nichols, Shaun; Sanfey, Alan

2013-01-01

According to dual-process theories, moral judgments are the result of two competing processes: a fast, automatic, affect-driven process and a slow, deliberative, reason-based process. Accordingly, these models make clear and testable predictions about the influence of each system. Although a small number of studies have attempted to examine each process independently in the context of moral judgment, no study has yet tried to experimentally manipulate both processes within a single study. In this chapter, a well-established "mode-of-thought" priming technique was used to place participants in either an experiential/emotional or analytic mode while completing a task in which participants provide judgments about a series of moral dilemmas. We predicted that individuals primed analytically would make more utilitarian responses than control participants, while emotional priming would lead to less utilitarian responses. Support was found for both of these predictions. Implications of these findings for dual-process theories of moral judgment will be discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

Where is the "meta" in animal metacognition?

PubMed

Kornell, Nate

2014-05-01

Apes, dolphins, and some monkeys seem to have metacognitive abilities: They can accurately evaluate the likelihood that their response in cognitive task was (or will be) correct. These certainty judgments are seen as significant because they imply that animals can evaluate internal cognitive states, which may entail meaningful self-reflection. But little research has investigated what is being reflected upon: Researchers have assumed that when animals make metacognitive judgments they evaluate internal memory strength. Yet decades of research have demonstrated that humans cannot directly evaluate internal memory strength. Instead, they make certainty judgments by drawing inferences from cues they can evaluate, such as familiarity and ease of processing. It seems likely that animals do the same, but this hypothesis has not been tested. I suggest two strategies for investigating the internal cues that underlie animal metacognitive judgments. It is possible that animals, like humans, are capable of making certainty judgments based on internal cues without awareness or meaningful self-reflection. ©2014 APA, all rights reserved.

Can the Knobe Effect Be Explained Away? Methodological Controversies in the Study of the Relationship Between Intentionality and Morality.

PubMed

Cova, Florian; Lantian, Anthony; Boudesseul, Jordane

2016-10-01

Based on the "Knobe Effect," Knobe has argued that moral evaluations can influence intentionality judgments. However, two methodological objections have been raised against this claim: first, that participants' answers do not accurately reflect what they think and, second, that the Knobe Effect can be fully explained by non-moral factors, such as the agent's desires or beliefs. In this article, we discuss these two methodological objections to the existence of the Knobe Effect and provide new evidence that moral evaluations can shape intentionality judgments. First, Study 1 shows that standard measures of intentionality do not overestimate participants' intentionality judgments. Second, Studies 2 and 3 suggest that participants' moral evaluations still mediate the impact of positive versus negative side-effects on judgments about intentional action, even when taking into account a whole range of non-moral factors. Results suggest that moral evaluations play an irreducible role in shaping our judgments about intentional action. © 2016 by the Society for Personality and Social Psychology, Inc.

Judging arrival times of incoming traffic vehicles is not a prerequisite for safely crossing an intersection: Differential effects of vehicle size and type in passive judgment and active driving tasks.

PubMed

Mathieu, Julie; Bootsma, Reinoud J; Berthelon, Catherine; Montagne, Gilles

2017-02-01

Using a fixed-base driving simulator we compared the effects of the size and type of traffic vehicles (i.e., normal-sized or double-sized cars or motorcycles) approaching an intersection in two different tasks. In the perceptual judgment task, passively moving participants estimated when a traffic vehicle would reach the intersection for actual arrival times (ATs) of 1, 2, or 3s. In line with earlier findings, ATs were generally underestimated, the more so the longer the actual AT. Results revealed that vehicle size affected judgments in particular for the larger actual ATs (2 and 3s), with double-sized vehicles then being judged as arriving earlier than normal-sized vehicles. Vehicle type, on the other hand, affected judgments at the smaller actual ATs (1 and 2s), with cars then being judged as arriving earlier than motorcycles. In the behavioral task participants actively drove the simulator to cross the intersection by passing through a gap in a train of traffic. Analyses of the speed variations observed during the active intersection-crossing task revealed that the size and type of vehicles in the traffic train did not affect driving behavior in the same way as in the AT judgment task. First, effects were considerably smaller, affecting driving behavior only marginally. Second, effects were opposite to expectations based on AT judgments: driver approach speeds were smaller (rather than larger) when confronted with double-sized vehicles as compared to their normal-sized counterparts and when confronted with cars as compared to motorcycles. Finally, the temporality of the effects was different on the two tasks: vehicle size affected driver approach speed in the final stages of approach rather than early on, while vehicle type affected driver approach speed early on rather than later. Overall, we conclude that the active control of approach to the intersection is not based on successive judgments of traffic vehicle arrival times. These results thereby question the general belief that arrival time estimates are crucial for safe interaction with traffic. Copyright © 2016 Elsevier B.V. All rights reserved.

The influence of causal connections between symptoms on the diagnosis of mental disorders: evidence from online and offline measures.

PubMed

Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio; González-Martín, Estrella

2014-09-01

An experiment conducted with students and experienced clinicians demonstrated very fast and online causal reasoning in the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. The experiment also demonstrated that clinicians' causal reasoning is triggered by information that is directly related to the causal structure that explains the symptoms, such as their temporal sequence. The use of causal theories was measured through explicit, verbal diagnostic judgments and through the online registration of participants' reading times of clinical reports. To detect both online and offline causal reasoning, the consistency of clinical reports was manipulated. This manipulation was made by varying the temporal order in which different symptoms developed in hypothetical clients, and by providing explicit information about causal connections between symptoms. The temporal order of symptoms affected the clinicians' but not the students' reading times. However, offline diagnostic judgments in both groups were influenced by the consistency manipulation. Overall, our results suggest that clinicians engage in fast and online causal reasoning processes when dealing with diagnostic information concerning mental disorders, and that both clinicians and students engage in causal reasoning in diagnostic judgment tasks. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Genetics Home Reference: autosomal dominant nocturnal frontal lobe epilepsy

MedlinePlus

... brain are involved in many critical functions, including reasoning, planning, judgment, and problem-solving. It is unclear ... E, Montagna P. Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain. ...

Stable aesthetic standards delusion: changing 'artistic quality' by elaboration.

PubMed

Carbon, Claus-Christian; Hesslinger, Vera M

2014-01-01

The present study challenges the notion that judgments of artistic quality are based on stable aesthetic standards. We propose that such standards are a delusion and that judgments of artistic quality are the combined result of exposure, elaboration, and discourse. We ran two experiments using elaboration tasks based on the repeated evaluation technique in which different versions of the Mona Lisa had to be elaborated deeply. During the initial task either the version known from the Louvre or an alternative version owned by the Prado was elaborated; during the second task both versions were elaborated in a comparative fashion. After both tasks multiple blends of the two versions had to be evaluated concerning several aesthetic key variables. Judgments of artistic quality of the blends were significantly different depending on the initially elaborated version of the Mona Lisa, indicating experience-based aesthetic processing, which contradicts the notion of stable aesthetic standards.

Can I trust you? Negative affective priming influences social judgments in schizophrenia

PubMed Central

Hooker, Christine I.; Tully, Laura M.; Verosky, Sara C.; Fisher, Melissa; Holland, Christine; Vinogradov, Sophia

2010-01-01

Successful social interactions rely on the ability to make accurate judgments based on social cues as well as the ability to control the influence of internal or external affective information on those judgments. Prior research suggests that individuals with schizophrenia misinterpret social stimuli and this misinterpretation contributes to impaired social functioning. We tested the hypothesis that for people with schizophrenia social judgments are abnormally influenced by affective information. 23 schizophrenia and 35 healthy control participants rated the trustworthiness of faces following the presentation of neutral, negative (threat-related), or positive affective primes. Results showed that all participants rated faces as less trustworthy following negative affective primes compared to faces that followed neutral or positive primes. Importantly, this effect was significantly more pronounced for schizophrenia participants, suggesting that schizophrenia may be characterised by an exaggerated influence of negative affective information on social judgment. Furthermore, the extent that the negative affective prime influenced trustworthiness judgments was significantly associated with patients’ severity of positive symptoms, particularly feelings of persecution. These findings suggest that for people with schizophrenia negative affective information contributes to an interpretive bias, consistent with paranoid ideation, when judging the trustworthiness of others. This bias may contribute to social impairments in schizophrenia. PMID:20919787

Using Relative Position and Temporal Judgments to Assess the Effects of Texture and Field of View on Spatial Awareness for Synthetic Vision Systems Displays

NASA Technical Reports Server (NTRS)

Bolton, Matthew L.; Bass, Ellen J.; Comstock, James R., Jr.

2006-01-01

Synthetic Vision Systems (SVS) depict computer generated views of terrain surrounding an aircraft. In the assessment of textures and field of view (FOV) for SVS, no studies have directly measured the 3 levels of spatial awareness: identification of terrain, its relative spatial location, and its relative temporal location. This work introduced spatial awareness measures and used them to evaluate texture and FOV in SVS displays. Eighteen pilots made 4 judgments (relative angle, distance, height, and abeam time) regarding the location of terrain points displayed in 112 5-second, non-interactive simulations of a SVS heads down display. Texture produced significant main effects and trends for the magnitude of error in the relative distance, angle, and abeam time judgments. FOV was significant for the directional magnitude of error in the relative distance, angle, and height judgments. Pilots also provided subjective terrain awareness ratings that were compared with the judgment based measures. The study found that elevation fishnet, photo fishnet, and photo elevation fishnet textures best supported spatial awareness for both the judgments and the subjective awareness measures.

The Influence of Context on Residents' Evaluations: Effects of Priming on Clinical Judgment and Affect

ERIC Educational Resources Information Center

Teunissen, P. W.; Stapel, D. A.; Scheele, F.; Scherpbier, A. J. J. A.; Boor, K.; van Diemen-Steenvoorde, J. A. A. M.; van der Vleuten, C. P. M.

2009-01-01

Different lines of research have suggested that context is important in acting and learning in the clinical workplace. It is not clear how contextual information influences residents' constructions of the situations in which they participate. The category accessibility paradigm from social psychology appears to offer an interesting perspective for…

Clinical Judgment in Science: Reply

ERIC Educational Resources Information Center

Westen, Drew; Weinberger, Joel

2005-01-01

This paper presents replies to comments published by M. S. Schulz and R. J. Waldinger, J. M. Wood and M. T. Nezworski, and H. N. Garb and W. M. Grove on the original article by D. Westen and J. Weinberger. Schulz and Waldinger (2005) make the important point that just as researchers can capitalize on the knowledge of experienced clinical observers…

Grammar Clinical Marker Yields Substantial Heritability for Language Impairments in 16-Year-Old Twins

ERIC Educational Resources Information Center

Dale, Philip S.; Rice, Mabel L.; Rimfeld, Kaili; Hayiou-Thomas, Marianna E.

2018-01-01

Purpose: There is a need for well-defined language phenotypes suitable for adolescents in twin studies and other large-scale research projects. Rice, Hoffman, and Wexler (2009) have developed a grammatical judgment measure as a clinical marker of language impairment, which has an extended developmental range to adolescence. Method: We conducted…

Abdominal shotgun trauma: A case report

PubMed Central

Toutouzas, Konstantinos G; Larentzakis, Andreas; Drimousis, Panagiotis; Riga, Maria; Theodorou, Dimitrios; Katsaragakis, Stylianos

2008-01-01

Introduction One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. Case presentation We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. Conclusion The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills. PMID:18625076

Los Angeles Free Clinic [and]"Adolescent Health Care Programs That Work."

ERIC Educational Resources Information Center

Rainwater, Mary; De Caprio, Chris

The first paper describes The Los Angeles Free Clinic and its services, which are specifically designed to respond to the needs of low-income and homeless youth within the community. The paper describes a free-of-charge, free-of-judgment comprehensive response system that exists because of collaboration with other health facilities such as…

Assessing experience in the deliberate practice of running using a fuzzy decision-support system

PubMed Central

Roveri, Maria Isabel; Manoel, Edison de Jesus; Onodera, Andrea Naomi; Ortega, Neli R. S.; Tessutti, Vitor Daniel; Vilela, Emerson; Evêncio, Nelson

2017-01-01

The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches’ knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p<0.001) and also with five other expert running coaches (r>0.86, p<0.001). From the expert’s knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency) and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings. PMID:28817655

Diminished Medial Prefrontal Activity behind Autistic Social Judgments of Incongruent Information

PubMed Central

Watanabe, Takamitsu; Yahata, Noriaki; Abe, Osamu; Kuwabara, Hitoshi; Inoue, Hideyuki; Takano, Yosuke; Iwashiro, Norichika; Natsubori, Tatsunobu; Aoki, Yuta; Takao, Hidemasa; Sasaki, Hiroki; Gonoi, Wataru; Murakami, Mizuho; Katsura, Masaki; Kunimatsu, Akira; Kawakubo, Yuki; Matsuzaki, Hideo; Tsuchiya, Kenji J.; Kato, Nobumasa; Kano, Yukiko; Miyashita, Yasushi; Kasai, Kiyoto; Yamasue, Hidenori

2012-01-01

Individuals with autism spectrum disorders (ASD) tend to make inadequate social judgments, particularly when the nonverbal and verbal emotional expressions of other people are incongruent. Although previous behavioral studies have suggested that ASD individuals have difficulty in using nonverbal cues when presented with incongruent verbal-nonverbal information, the neural mechanisms underlying this symptom of ASD remain unclear. In the present functional magnetic resonance imaging study, we compared brain activity in 15 non-medicated adult males with high-functioning ASD to that of 17 age-, parental-background-, socioeconomic-, and intelligence-quotient-matched typically-developed (TD) male participants. Brain activity was measured while each participant made friend or foe judgments of realistic movies in which professional actors spoke with conflicting nonverbal facial expressions and voice prosody. We found that the ASD group made significantly less judgments primarily based on the nonverbal information than the TD group, and they exhibited significantly less brain activity in the right inferior frontal gyrus, bilateral anterior insula, anterior cingulate cortex/ventral medial prefrontal cortex (ACC/vmPFC), and dorsal medial prefrontal cortex (dmPFC) than the TD group. Among these five regions, the ACC/vmPFC and dmPFC were most involved in nonverbal-information-biased judgments in the TD group. Furthermore, the degree of decrease of the brain activity in these two brain regions predicted the severity of autistic communication deficits. The findings indicate that diminished activity in the ACC/vmPFC and dmPFC underlies the impaired abilities of individuals with ASD to use nonverbal content when making judgments regarding other people based on incongruent social information. PMID:22745788

Reasoning, cognitive control, and moral intuition

PubMed Central

Patterson, Richard; Rothstein, Jared; Barbey, Aron K.

2012-01-01

Recent Social Intuitionist work suggests that moral judgments are intuitive (not based on conscious deliberation or any significant chain of inference), and that the reasons we produce to explain or justify our judgments and actions are for the most part post hoc rationalizations rather than the actual source of those judgments. This is consistent with work on judgment and explanation in other domains, and it correctly challenges one-sidedly rationalistic accounts. We suggest that in fact reasoning has a great deal of influence on moral judgments and on intuitive judgments in general. This influence is not apparent from study of judgments simply in their immediate context, but it is crucial for the question of how cognition can help us avoid deleterious effects and enhance potentially beneficial effects of affect on judgment, action, and cognition itself. We begin with established work on several reactive strategies for cognitive control of affect (e.g., suppression, reappraisal), then give special attention to more complex sorts of conflict (“extended deliberation”) involving multiple interacting factors, both affective and reflective. These situations are especially difficult to study in a controlled way, but we propose some possible experimental approaches. We then review proactive strategies for control, including avoidance of temptation and mindfulness meditation (Froeliger et al., 2012, this issue). We give special attention to the role of slow or “cool” cognitive processes (e.g., deliberation, planning, and executive control) in the inculcation of long-term dispositions, traits, intuitions, skills, or habits. The latter are critical because they in turn give rise to a great many of our fast, intuitive judgments. The reasoning processes involved here are distinct from post hoc rationalizations and have a very real impact on countless intuitive judgments in concrete situations. This calls for a substantial enlargement of research on cognitive control, drawing on work in developmental psychology, automatization, educational theory, and other fields. PMID:23264763

Why some women have an optimistic or a pessimistic bias about their breast cancer risk: experiences, heuristics, and knowledge of risk factors.

PubMed

Katapodi, Maria C; Dodd, Marylin J; Facione, Noreen C; Humphreys, Janice C; Lee, Kathryn A

2010-01-01

Perceived risk to a health problem is formed by inferential rules called heuristics and by comparative judgments that assess how one's risk compares to the risk of others. The purpose of this cross-sectional, community-based survey was to examine how experiences with breast cancer, knowledge of risk factors, and specific heuristics inform risk judgments for oneself, for friends/peers, and comparative judgments for breast cancer (risk friends/peers - risk self). We recruited an English-speaking, multicultural (57% nonwhite) sample of 184 middle-aged (47 + or - 12 years old), well-educated women. Fifty percent of participants perceived that their breast cancer risk was the same as the risk of their friends/peers; 10% were pessimistic (risk friends/peers - risk self < 0), whereas 40% were optimistic (risk friends/peers - risk self > 0). Family history of breast cancer and worry informed risk judgments for oneself. The availability and cultural heuristics specific for black women informed risk judgments for friends/peers. Knowledge of risk factors and interactions of knowledge with the availability, representativeness, and simulation heuristics informed comparative judgments (risk friends/peers - risk self). We discuss cognitive mechanisms with which experiences, knowledge, and heuristics influence comparative breast cancer risk judgments. Risk communication interventions should assess knowledge deficits, contextual variables, and specific heuristics that activate differential information processing mechanisms.

Reappraising Abstract Paintings after Exposure to Background Information

PubMed Central

Park, Seongmin A.; Yun, Kyongsik; Jeong, Jaeseung

2015-01-01

Can knowledge help viewers when they appreciate an artwork? Experts’ judgments of the aesthetic value of a painting often differ from the estimates of naïve viewers, and this phenomenon is especially pronounced in the aesthetic judgment of abstract paintings. We compared the changes in aesthetic judgments of naïve viewers while they were progressively exposed to five pieces of background information. The participants were asked to report their aesthetic judgments of a given painting after each piece of information was presented. We found that commentaries by the artist and a critic significantly increased the subjective aesthetic ratings. Does knowledge enable experts to attend to the visual features in a painting and to link it to the evaluative conventions, thus potentially causing different aesthetic judgments? To investigate whether a specific pattern of attention is essential for the knowledge-based appreciation, we tracked the eye movements of subjects while viewing a painting with a commentary by the artist and with a commentary by a critic. We observed that critics’ commentaries directed the viewers’ attention to the visual components that were highly relevant to the presented commentary. However, attention to specific features of a painting was not necessary for increasing the subjective aesthetic judgment when the artists’ commentary was presented. Our results suggest that at least two different cognitive mechanisms may be involved in knowledge- guided aesthetic judgments while viewers reappraise a painting. PMID:25945789

Building a successful trauma practice in a community setting.

PubMed

Althausen, Peter L

2011-12-01

The development of a busy community-based trauma practice is a multifaceted endeavor that requires good clinical judgment, business acumen, interpersonal skills, and negotiation tactics. Private practice is a world in which perfect outcomes are expected and efficiency is paramount. Successful operative outcomes are dependent on solid clinical training, good preoperative planning, and communication with mentors when necessary. Private practitioners must display confidence, polite behavior, and promptness. Maintaining availability for consultation from emergency room physicians, private practice physicians, and local orthopaedic surgeons is a powerful marketing tool. Orthopaedic trauma surgery has been shown to be a profitable field for hospitals and private practitioners. However, physician success depends on a sound understanding of hospital finance, marketing skills, and knowledge of billing and coding. As the financial pressures of medical care increase, hospital negotiation will be paramount, and private practitioners must combine clinical and business skills to provide good patient care while maintaining independence and financial security.

Will the future of knowledge work automation transform personalized medicine?

PubMed

Naik, Gauri; Bhide, Sanika S

2014-09-01

Today, we live in a world of 'information overload' which demands high level of knowledge-based work. However, advances in computer hardware and software have opened possibilities to automate 'routine cognitive tasks' for knowledge processing. Engineering intelligent software systems that can process large data sets using unstructured commands and subtle judgments and have the ability to learn 'on the fly' are a significant step towards automation of knowledge work. The applications of this technology for high throughput genomic analysis, database updating, reporting clinically significant variants, and diagnostic imaging purposes are explored using case studies.

Making the Right Choices: Ethical Judgments among Educational Leaders

ERIC Educational Resources Information Center

Eyal, Ori; Berkovich, Izhak; Schwartz, Talya

2011-01-01

Purpose: Scholars have adopted a multiple ethical paradigms approach in an attempt to better understand the bases upon which everyday ethical dilemmas are resolved by educational leaders. The aim of this study is to examine the ethical considerations in ethical judgments of aspiring principals. Design/methodology/approach: To examine the ethical…

Social Utility versus Social Desirability of Students' Attributional Self-Presentation Strategies

ERIC Educational Resources Information Center

Matteucci, Maria Cristina

2014-01-01

Research on impression management has shown that students can manage their social images by providing attributional self-presentation strategies (ASPSs). Based on the distinction between social desirability judgments and social utility judgments, two studies were conducted to examine the students' understanding of the impact of ASPSs both on…

How to Explain Receptivity to Conjunction-Fallacy Inhibition Training: Evidence from the Iowa Gambling Task

ERIC Educational Resources Information Center

Cassotti, Mathieu; Moutier, Sylvain

2010-01-01

Intuitive predictions and judgments under conditions of uncertainty are often mediated by judgment heuristics that sometimes lead to biases. Using the classical conjunction bias example, the present study examines the relationship between receptivity to metacognitive executive training and emotion-based learning ability indexed by Iowa Gambling…

One-Reason Decision Making Unveiled: A Measurement Model of the Recognition Heuristic

ERIC Educational Resources Information Center

Hilbig, Benjamin E.; Erdfelder, Edgar; Pohl, Rudiger F.

2010-01-01

The fast-and-frugal recognition heuristic (RH) theory provides a precise process description of comparative judgments. It claims that, in suitable domains, judgments between pairs of objects are based on recognition alone, whereas further knowledge is ignored. However, due to the confound between recognition and further knowledge, previous…

40 CFR 1065.546 - Validation of minimum dilution ratio for PM batch sampling.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the raw exhaust flow rate based on the measured intake air molar flow rate and the chemical balance..., fuel rate measurements, and fuel properties, consistent with good engineering judgment. (b) Determine...) and dilute exhaust corrected for any removed water. (c) Use good engineering judgment to develop your...

Thinking about memories for everyday and shocking events: do people use ease-of-retrieval cues in memory judgments?

PubMed

Echterhoff, Gerald; Hirst, William

2006-06-01

Extant research shows that people use retrieval ease, a feeling-based cue, to judge how well they remember life periods. Extending this approach, we investigated the role of retrieval ease in memory judgments for single events. In Experiment 1, participants who were asked to recall many memories of an everyday event (New Year's Eve) rated retrieval as more difficult and judged their memory as worse than did participants asked to recall only a few memories. In Experiment 2, this ease-of-retrieval effect was found to interact with the shocking character of the remembered event: There was no effect when the event was highly shocking (i.e., learning about the attacks of September 11, 2001), whereas an effect was found when the event was experienced as less shocking (due either to increased distance to "9/11" or to the nonshocking nature of the event itself). Memory vividness accounted for additional variance in memory judgments, indicating an independent contribution of content-based cues in judgments of event memories.

Clinical reasoning: concept analysis.

PubMed

Simmons, Barbara

2010-05-01

This paper is a report of a concept analysis of clinical reasoning in nursing. Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, 'clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.

Integrative moral judgment: dissociating the roles of the amygdala and ventromedial prefrontal cortex.

PubMed

Shenhav, Amitai; Greene, Joshua D

2014-03-26

A decade's research highlights a critical dissociation between automatic and controlled influences on moral judgment, which is subserved by distinct neural structures. Specifically, negative automatic emotional responses to prototypically harmful actions (e.g., pushing someone off of a footbridge) compete with controlled responses favoring the best consequences (e.g., saving five lives instead of one). It is unknown how such competitions are resolved to yield "all things considered" judgments. Here, we examine such integrative moral judgments. Drawing on insights from research on self-interested, value-based decision-making in humans and animals, we test a theory concerning the respective contributions of the amygdala and ventromedial prefrontal cortex (vmPFC) to moral judgment. Participants undergoing fMRI responded to moral dilemmas, separately evaluating options for their utility (Which does the most good?), emotional aversiveness (Which feels worse?), and overall moral acceptability. Behavioral data indicate that emotional aversiveness and utility jointly predict "all things considered" integrative judgments. Amygdala response tracks the emotional aversiveness of harmful utilitarian actions and overall disapproval of such actions. During such integrative moral judgments, the vmPFC is preferentially engaged relative to utilitarian and emotional assessments. Amygdala-vmPFC connectivity varies with the role played by emotional input in the task, being the lowest for pure utilitarian assessments and the highest for pure emotional assessments. These findings, which parallel those of research on self-interested economic decision-making, support the hypothesis that the amygdala provides an affective assessment of the action in question, whereas the vmPFC integrates that signal with a utilitarian assessment of expected outcomes to yield "all things considered" moral judgments.

Accuracy and consensus in judgments of trustworthiness from faces: behavioral and neural correlates.

PubMed

Rule, Nicholas O; Krendl, Anne C; Ivcevic, Zorana; Ambady, Nalini

2013-03-01

Perceivers' inferences about individuals based on their faces often show high interrater consensus and can even accurately predict behavior in some domains. Here we investigated the consensus and accuracy of judgments of trustworthiness. In Study 1, we showed that the type of photo judged makes a significant difference for whether an individual is judged as trustworthy. In Study 2, we found that inferences of trustworthiness made from the faces of corporate criminals did not differ from inferences made from the faces of noncriminal executives. In Study 3, we found that judgments of trustworthiness did not differ between the faces of military criminals and the faces of military heroes. In Study 4, we tempted undergraduates to cheat on a test. Although we found that judgments of intelligence from the students' faces were related to students' scores on the test and that judgments of students' extraversion were correlated with self-reported extraversion, there was no relationship between judgments of trustworthiness from the students' faces and students' cheating behavior. Finally, in Study 5, we examined the neural correlates of the accuracy of judgments of trustworthiness from faces. Replicating previous research, we found that perceptions of trustworthiness from the faces in Study 4 corresponded to participants' amygdala response. However, we found no relationship between the amygdala response and the targets' actual cheating behavior. These data suggest that judgments of trustworthiness may not be accurate but, rather, reflect subjective impressions for which people show high agreement. PsycINFO Database Record (c) 2013 APA, all rights reserved

Social trait judgment and affect recognition from static faces and video vignettes in schizophrenia

PubMed Central

McIntosh, Lindsey G.; Park, Sohee

2014-01-01

Social impairment is a core feature of schizophrenia, present from the pre-morbid stage and predictive of outcome, but the etiology of this deficit remains poorly understood. Successful and adaptive social interactions depend on one’s ability to make rapid and accurate judgments about others in real time. Our surprising ability to form accurate first impressions from brief exposures, known as “thin slices” of behavior has been studied very extensively in healthy participants. We sought to examine affect and social trait judgment from thin slices of static or video stimuli in order to investigate the ability of schizophrenic individuals to form reliable social impressions of others. 21 individuals with schizophrenia (SZ) and 20 matched healthy participants (HC) were asked to identify emotions and social traits for actors in standardized face stimuli as well as brief video clips. Sound was removed from videos to remove all verbal cues. Clinical symptoms in SZ and delusional ideation in both groups were measured. Results showed a general impairment in affect recognition for both types of stimuli in SZ. However, the two groups did not differ in the judgments of trustworthiness, approachability, attractiveness, and intelligence. Interestingly, in SZ, the severity of positive symptoms was correlated with higher ratings of attractiveness, trustworthiness, and approachability. Finally, increased delusional ideation in SZ was associated with a tendency to rate others as more trustworthy, while the opposite was true for HC. These findings suggest that complex social judgments in SZ are affected by symptomatology. PMID:25037526

Review of the refeeding syndrome.

PubMed

Kraft, Michael D; Btaiche, Imad F; Sacks, Gordon S

2005-12-01

Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment.

Perception of local three-dimensional shape.

PubMed

Phillips, F; Todd, J T

1996-08-01

The authors present a series of 4 experiments designed to test the ability to perceive local shape information. Observers were presented with various smoothly varying 3-dimensional surfaces where they reported shape index and sign of Gaussian curvature at several probe locations. Results show that observers are poor at making judgments based on these local measures, especially when the region surrounding the local point is restricted or manipulated to make it noncoherent. Shape index judgments required at least 2 degrees of context surrounding the probe location, and performance on sign of Gaussian curvature judgments deteriorated as the contextual information was restricted as well.

Why do ineffective treatments seem helpful? A brief review.

PubMed

Hartman, Steve E

2009-10-12

After any therapy, when symptoms improve, healthcare providers (and patients) are tempted to award credit to treatment. Over time, a particular treatment can seem so undeniably helpful that scientific verification of efficacy is judged an inconvenient waste of time and resources. Unfortunately, practitioners' accumulated, day-to-day, informal impressions of diagnostic reliability and clinical efficacy are of limited value. To help clarify why even treatments entirely lacking in direct effect can seem helpful, I will explain why real signs and symptoms often improve, independent of treatment. Then, I will detail quirks of human perception, interpretation, and memory that often make symptoms seem improved, when they are not. I conclude that healthcare will grow to full potential only when judgments of clinical efficacy routinely are based in properly scientific, placebo-controlled, outcome analysis.

[The diagnostic scores for deep venous thrombosis].

PubMed

Junod, A

2015-08-26

Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan).

Building metamemorial knowledge over time: insights from eye tracking about the bases of feeling-of-knowing and confidence judgments.

PubMed

Chua, Elizabeth F; Solinger, Lisa A

2015-01-01

Metamemory processes depend on different factors across the learning and memory time-scale. In the laboratory, subjects are often asked to make prospective feeling-of-knowing (FOK) judgments about target retrievability, or are asked to make retrospective confidence judgments (RCJs) about the retrieved target. We examined distinct and shared contributors to metamemory judgments, and how they were built over time. Eye movements were monitored during a face-scene associative memory task. At test, participants viewed a studied scene, then rated their FOK that they would remember the associated face. This was followed by a forced choice recognition test and RCJs. FOK judgments were less accurate than RCJ judgments, showing that the addition of mnemonic experience can increase metacognitive accuracy over time. However, there was also evidence that the given FOK rating influenced RCJs. Turning to eye movements, initial analyses showed that higher cue fluency was related to both higher FOKs and higher RCJs. However, further analyses revealed that the effects of the scene cue on RCJs were mediated by FOKs. Turning to the target, increased viewing time and faster viewing of the correct associate related to higher FOKs, consistent with the idea that target accessibility is a basis of FOKs. In contrast, the amount of viewing directed to the chosen face, regardless of whether it was correct, predicted higher RCJs, suggesting that choice experience is a significant contributor RCJs. We also examined covariates of the change in RCJ rating from the FOK rating, and showed that increased and faster viewing of the chosen face predicted raising one's confidence above one's FOK. Taken together these results suggest that metamemory judgments should not be thought of only as distinct subjective experiences, but complex processes that interact and evolve as new psychological bases for subjective experience become available.

Brain regions involved in the retrieval of spatial and episodic details associated with a familiar environment: an fMRI study.

PubMed

Hirshhorn, Marnie; Grady, Cheryl; Rosenbaum, R Shayna; Winocur, Gordon; Moscovitch, Morris

2012-11-01

Functional magnetic resonance imaging (fMRI) was used to compare brain activity during the retrieval of coarse- and fine-grained spatial details and episodic details associated with a familiar environment. Long-time Toronto residents compared pairs of landmarks based on their absolute geographic locations (requiring either coarse or fine discriminations) or based on previous visits to those landmarks (requiring episodic details). An ROI analysis of the hippocampus showed that all three conditions activated the hippocampus bilaterally. Fine-grained spatial judgments recruited an additional region of the right posterior hippocampus, while episodic judgments recruited an additional region of the right anterior hippocampus, and a more extensive region along the length of the left hippocampus. To examine whole-brain patterns of activity, Partial Least Squares (PLS) analysis was used to identify sets of brain regions whose activity covaried with the three conditions. All three comparison judgments recruited the default mode network including the posterior cingulate/retrosplenial cortex, middle frontal gyrus, hippocampus, and precuneus. Fine-grained spatial judgments also recruited additional regions of the precuneus, parahippocampal cortex and the supramarginal gyrus. Episodic judgments recruited the posterior cingulate and medial frontal lobes as well as the angular gyrus. These results are discussed in terms of their implications for theories of hippocampal function and spatial and episodic memory. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice.

PubMed

Elzakkers, Isis F F M; Danner, Unna N; Grisso, Thomas; Hoek, Hans W; van Elburg, Annemarie A

Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m 2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research. Copyright © 2018 Elsevier Ltd. All rights reserved.

What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities

PubMed Central

Moretti, Anna; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

2016-01-01

Background and objectives Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. Methods A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Results Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. Conclusions The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the access to research opportunity are needed; the perception about clinical activity and the overall judgment of the programs are quite satisfactory. PMID:27403529

What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities.

PubMed

Moretti, Anna; Ghidini, Michele; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

2016-01-01

Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the access to research opportunity are needed; the perception about clinical activity and the overall judgment of the programs are quite satisfactory.

Multispectral imaging burn wound tissue classification system: a comparison of test accuracies between several common machine learning algorithms

NASA Astrophysics Data System (ADS)

Squiers, John J.; Li, Weizhi; King, Darlene R.; Mo, Weirong; Zhang, Xu; Lu, Yang; Sellke, Eric W.; Fan, Wensheng; DiMaio, J. Michael; Thatcher, Jeffrey E.

2016-03-01

The clinical judgment of expert burn surgeons is currently the standard on which diagnostic and therapeutic decisionmaking regarding burn injuries is based. Multispectral imaging (MSI) has the potential to increase the accuracy of burn depth assessment and the intraoperative identification of viable wound bed during surgical debridement of burn injuries. A highly accurate classification model must be developed using machine-learning techniques in order to translate MSI data into clinically-relevant information. An animal burn model was developed to build an MSI training database and to study the burn tissue classification ability of several models trained via common machine-learning algorithms. The algorithms tested, from least to most complex, were: K-nearest neighbors (KNN), decision tree (DT), linear discriminant analysis (LDA), weighted linear discriminant analysis (W-LDA), quadratic discriminant analysis (QDA), ensemble linear discriminant analysis (EN-LDA), ensemble K-nearest neighbors (EN-KNN), and ensemble decision tree (EN-DT). After the ground-truth database of six tissue types (healthy skin, wound bed, blood, hyperemia, partial injury, full injury) was generated by histopathological analysis, we used 10-fold cross validation to compare the algorithms' performances based on their accuracies in classifying data against the ground truth, and each algorithm was tested 100 times. The mean test accuracy of the algorithms were KNN 68.3%, DT 61.5%, LDA 70.5%, W-LDA 68.1%, QDA 68.9%, EN-LDA 56.8%, EN-KNN 49.7%, and EN-DT 36.5%. LDA had the highest test accuracy, reflecting the bias-variance tradeoff over the range of complexities inherent to the algorithms tested. Several algorithms were able to match the current standard in burn tissue classification, the clinical judgment of expert burn surgeons. These results will guide further development of an MSI burn tissue classification system. Given that there are few surgeons and facilities specializing in burn care, this technology may improve the standard of burn care for patients without access to specialized facilities.

Temporal Precision of Neuronal Information in a Rapid Perceptual Judgment

PubMed Central

Ghose, Geoffrey M.; Harrison, Ian T.

2009-01-01

In many situations, such as pedestrians crossing a busy street or prey evading predators, rapid decisions based on limited perceptual information are critical for survival. The brevity of these perceptual judgments constrains how neuronal signals are integrated or pooled over time because the underlying sequence of processes, from sensation to perceptual evaluation to motor planning and execution, all occur within several hundred milliseconds. Because most previous physiological studies of these processes have relied on tasks requiring considerably longer temporal integration, the neuronal basis of such rapid decisions remains largely unexplored. In this study, we examine the temporal precision of neuronal activity associated with a rapid perceptual judgment. We find that the activity of individual neurons over tens of milliseconds can reliably convey information about sensory events and was well correlated with the animals' judgments. There was a strong correlation between sensory reliability and the correlation with behavioral choice, suggesting that rapid decisions were preferentially based on the most reliable sensory signals. We also find that a simple model in which the responses of a small number of individual neurons (<5) are summed can completely explain behavioral performance. These results suggest that neuronal circuits are sufficiently precise to allow for cognitive decisions to be based on small numbers of action potentials from highly reliable neurons. PMID:19109454

Temporal precision of neuronal information in a rapid perceptual judgment.

PubMed

Ghose, Geoffrey M; Harrison, Ian T

2009-03-01

In many situations, such as pedestrians crossing a busy street or prey evading predators, rapid decisions based on limited perceptual information are critical for survival. The brevity of these perceptual judgments constrains how neuronal signals are integrated or pooled over time because the underlying sequence of processes, from sensation to perceptual evaluation to motor planning and execution, all occur within several hundred milliseconds. Because most previous physiological studies of these processes have relied on tasks requiring considerably longer temporal integration, the neuronal basis of such rapid decisions remains largely unexplored. In this study, we examine the temporal precision of neuronal activity associated with a rapid perceptual judgment. We find that the activity of individual neurons over tens of milliseconds can reliably convey information about sensory events and was well correlated with the animals' judgments. There was a strong correlation between sensory reliability and the correlation with behavioral choice, suggesting that rapid decisions were preferentially based on the most reliable sensory signals. We also find that a simple model in which the responses of a small number of individual neurons (<5) are summed can completely explain behavioral performance. These results suggest that neuronal circuits are sufficiently precise to allow for cognitive decisions to be based on small numbers of action potentials from highly reliable neurons.

The neural bases of cognitive conflict and control in moral judgment.

PubMed

Greene, Joshua D; Nystrom, Leigh E; Engell, Andrew D; Darley, John M; Cohen, Jonathan D

2004-10-14

Traditional theories of moral psychology emphasize reasoning and "higher cognition," while more recent work emphasizes the role of emotion. The present fMRI data support a theory of moral judgment according to which both "cognitive" and emotional processes play crucial and sometimes mutually competitive roles. The present results indicate that brain regions associated with abstract reasoning and cognitive control (including dorsolateral prefrontal cortex and anterior cingulate cortex) are recruited to resolve difficult personal moral dilemmas in which utilitarian values require "personal" moral violations, violations that have previously been associated with increased activity in emotion-related brain regions. Several regions of frontal and parietal cortex predict intertrial differences in moral judgment behavior, exhibiting greater activity for utilitarian judgments. We speculate that the controversy surrounding utilitarian moral philosophy reflects an underlying tension between competing subsystems in the brain.

Culture and Negotiator Cognition: Judgment Accuracy and Negotiation Processes in Individualistic and Collectivistic Cultures.

PubMed

Gelfand; Christakopoulou

1999-09-01

In this paper, we argue that judgment biases in negotiation are perpetuated by underlying cultural values and ideals, and therefore, certain judgment biases will be more prevalent in certain cultural contexts. Based on theory in cultural psychology (Markus & Kitayama, 1991; Triandis, 1989), we considered the notion that fixed pie error, a judgment bias in which negotiators fail to accurately understand their counterparts' interests (Pruitt & Lewis, 1975; Thompson & Hastie, 1990), would be more prevalent at the end of negotiations in the United States, an individualistic culture, than Greece, a collectivistic culture. The results of a 2-week computer-mediated intercultural negotiation experiment, which took place between American students in Illinois and Greek students in Athens, supported this view. Theoretical implications of culture and cognition in negotiation are also discussed. Copyright 1999 Academic Press.

Atherectomy for calcified coronary lesions: When and how?

PubMed

Karatasakis, Aris; Brilakis, Emmanouil S

2016-03-01

Percutaneous coronary intervention of heavily calcified lesions can be challenging. Although the ROTAXUS trial did not demonstrate long-term clinical benefit with routine rotational atherectomy, atherectomy remains an indispensable tool to achieve acute procedural success. Until new data becomes available determining when and how to optimally use coronary atherectomy depends heavily on personal experience and clinical judgment. © 2016 Wiley Periodicals, Inc.

Non-Patient-Based Clinical Licensure Examination for Dentistry in Minnesota: Significance of Decision and Description of Process.

PubMed

Mills, Eric A

2016-06-01

In recent years in the United States, there has been heightened interest in offering clinical licensure examination (CLE) alternatives to the live patient-based method in dentistry. Fueled by ethical concerns of faculty members at the University of Minnesota School of Dentistry, the state of Minnesota's Board of Dentistry approved a motion in 2009 to provide two CLE options to the school's future predoctoral graduates: a patient-based one, administered by the Central Regional Dental Testing Service, and a non-patient-based one administered by the National Dental Examining Board of Canada (NDEB). The validity of the NDEB written exam and objective structured clinical exam (OSCE) has been verified in a multi-year study. Via five-option, one-best-answer, multiple-choice questions in the written exam and extended match questions with up to 15 answer options in the station-based OSCE, competent candidates are distinguished from those who are incompetent in their didactic knowledge and clinical critical thinking and judgment across all dental disciplines. The action had the additional effects of furthering participation of Minnesota Board of Dentistry members in the University of Minnesota School of Dentistry's competency-based curriculum, of involving the school's faculty in NDEB item development workshops, and, beginning in 2018, of no longer permitting the patient-based CLE option on site. The aim of this article is to describe how this change came about and its effects.

[Fool's gold standards in language screening. Sensitivity and specificity of the Hessian child language screening test (Kindersprachscreening, KiSS)].

PubMed

Neumann, K; Holler-Zittlau, I; van Minnen, S; Sick, U; Zaretsky, Y; Euler, H A

2011-01-01

The German Kindersprachscreening (KiSS) is a universal speech and language screening test for large-scale identification of Hessian kindergarten children requiring special educational language training or clinical speech/language therapy. To calculate the procedural screening validity, 257 children (aged 4.0 to 4.5 years) were tested using KiSS and four language tests (Reynell Development Language Scales III, Patholinguistische Diagnostik, PLAKSS, AWST-R). The majority or consensus judgements of three speech-language professionals, based on the language test results, served as a reference criterion. The base (fail) rates of the professionals were either self-determined or preset based on known prevalence rates. Screening validity was higher for preset than for self-determined base rates due to higher inter-judge agreement. The confusion matrices of the overall index classification of the KiSS (speech-language abnormalities with educational or clinical needs) with the fixed base rate expert judgement about language impairment, including fluency or voice disorders, yielded a sensitivity of 88% and a specificity of 78%, for just language impairment 84% and 75%, respectively. Specificities for disorders requiring clinical diagnostics in the KiSS (language impairment alone or combined with fluency/voice disorders) related to the test-based consensus expert judgment was about 93%. Sensitivities were unsatisfactory because the differentiation between educational and clinical needs requires improvement. Since the judgement concordances between the speech-language professionals was only moderate, the development of a comprehensive German reference test for speech and language disorders with evidence-based algorithmic decision rules rather than subjective clinical judgement is advocated.

Chinese Adolescents' Reasoning about Democratic and Authority-Based Decision Making in Peer, Family, and School Contexts.

ERIC Educational Resources Information Center

Helwig, Charles C.; Arnold, Mary Louise; Tan, Dingliang; Boyd, Dwight

2003-01-01

This study explored judgments and reasoning of Chinese 13- to 18-year-olds regarding making decisions involving children in peer, family, and school contexts. Findings indicated that judgments and reasoning about decision-making varied by social context and by the decision under consideration. Evaluations of procedures became more differentiated…

The Validity of Interpersonal Skills Assessment via Situational Judgment Tests for Predicting Academic Success and Job Performance

ERIC Educational Resources Information Center

Lievens, Filip; Sackett, Paul R.

2012-01-01

This study provides conceptual and empirical arguments why an assessment of applicants' procedural knowledge about interpersonal behavior via a video-based situational judgment test might be valid for academic and postacademic success criteria. Four cohorts of medical students (N = 723) were followed from admission to employment. Procedural…

Students' Approaches to the Evaluation of Digital Information: Insights from Their Trust Judgments

ERIC Educational Resources Information Center

Johnson, Frances; Sbaffi, Laura; Rowley, Jennifer

2016-01-01

This study contributes to an understanding of the role of experience in the evaluation phase of the information search process. A questionnaire-based survey collected data from 1st and 3rd-year undergraduate students regarding the factors that influence their judgment of the trustworthiness of online health information. Exploratory and…

Some Memories Are Odder than Others: Judgments of Episodic Oddity Violate Known Decision Rules

ERIC Educational Resources Information Center

O'Connor, Akira R.; Guhl, Emily N.; Cox, Justin C.; Dobbins, Ian G.

2011-01-01

Current decision models of recognition memory are based almost entirely on one paradigm, single item old/new judgments accompanied by confidence ratings. This task results in receiver operating characteristics (ROCs) that are well fit by both signal-detection and dual-process models. Here we examine an entirely new recognition task, the judgment…

Psychometric Analysis of a Measure of Socio-Emotional Development in Adolescents

ERIC Educational Resources Information Center

Sandell, Rolf; Kimber, Birgitta; Andersson, Marie; Elg, Mattias; Fharm, Linus; Gustafsson, Niklas; Soderbaum, Wendela

2012-01-01

This is a psychometric analysis of an instrument to assess the socio-emotional development of school students, How I Feel (HIF), developed as a situational judgment test, with scoring based on expert judgments. The HIF test was administered in grades 4-9, 1999-2005. Internal consistency, retest reliability, and year-to-year stability were…

Delphi in Criminal Justice Policy: A Case Study on Judgmental Forecasting

ERIC Educational Resources Information Center

Loyens, Kim; Maesschalck, Jeroen; Bouckaert, Geert

2011-01-01

This article provides an in-depth case study analysis of a pilot project organized by the section "Strategic Analysis" of the Belgian Federal Police. Using the Delphi method, which is a judgmental forecasting technique, a panel of experts was questioned about future developments of crime, based on their expertise in criminal or social…

Exposure Influences Expressive Timing Judgments in Music

ERIC Educational Resources Information Center

Honing, Henkjan; Ladinig, Olivia

2009-01-01

This study is concerned with the question whether, and to what extent, listeners' previous exposure to music in everyday life, and expertise as a result of formal musical training, play a role in making expressive timing judgments in music. This was investigated by using a Web-based listening experiment in which listeners with a wide range of…

Children and Adults Use Gender and Age Stereotypes in Ownership Judgments

ERIC Educational Resources Information Center

Malcolm, Sarah; Defeyter, Margaret A.; Friedman, Ori

2014-01-01

In everyday life, we are often faced with the problem of judging who owns an object. The current experiments show that children and adults base ownership judgments on group stereotypes, which relate kinds of people to kinds of objects. Moreover, the experiments show that reliance on stereotypes can override another means by which people make…

The Contact Principle and Utilitarian Moral Judgments in Young Children

ERIC Educational Resources Information Center

Pellizzoni, Sandra; Siegal, Michael; Surian, Luca

2010-01-01

In three experiments involving 207 preschoolers and 28 adults, we investigated the extent to which young children base moral judgments of actions aimed to protect others on utilitarian principles. When asked to judge the rightness of intervening to hurt one person in order to save five others, the large majority of children aged 3 to 5 years…

Teaching Old Dogs New Tricks: Using Cognitive Feedback to Improve Physicians' Diagnostic Judgments on Simulated Cases.

ERIC Educational Resources Information Center

Wigton, Robert S.; And Others

1990-01-01

An educational intervention was effective in improving the judgment of experienced student-health physicians (N=11) in predicting positive culture in simulated patients with pharyngitis. The intervention was three parts: an initial one-hour lecture; three sessions with computer-based cognitive feedback; and monthly reports of the percentage of…

The underlying number-space mapping among kindergarteners and its relation with early numerical abilities.

PubMed

Chan, Winnie Wai Lan; Wong, Terry Tin-Yau

2016-08-01

People map numbers onto space. The well-replicated SNARC (spatial-numerical association of response codes) effect indicates that people have a left-sided bias when responding to small numbers and a right-sided bias when responding to large numbers. This study examined whether such spatial codes were tagged to the ordinal or magnitude information of numbers among kindergarteners and whether it was related to early numerical abilities. Based on the traditional magnitude judgment task, we developed two variant tasks-namely the month judgment task and dot judgment task-to elicit ordinal and magnitude processing of numbers, respectively. Results showed that kindergarteners oriented small numbers toward the left side and large numbers toward the right side when processing the ordinal information of numbers in the month judgment task but not when processing the magnitude information in the number judgment task and dot judgment task, suggesting that the left-to-right spatial bias was probably tagged to the ordinal but not magnitude property of numbers. Moreover, the strength of the SNARC effect was not related to early numerical abilities. These findings have important implications for the early spatial representation of numbers and its role in numerical performance among kindergarteners. Copyright © 2016 Elsevier Inc. All rights reserved.

Cold or calculating? Reduced activity in the subgenual cingulate cortex reflects decreased emotional aversion to harming in counterintuitive utilitarian judgment

PubMed Central

Wiech, Katja; Kahane, Guy; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

2013-01-01

Recent research on moral decision-making has suggested that many common moral judgments are based on immediate intuitions. However, some individuals arrive at highly counterintuitive utilitarian conclusions about when it is permissible to harm other individuals. Such utilitarian judgments have been attributed to effortful reasoning that has overcome our natural emotional aversion to harming others. Recent studies, however, suggest that such utilitarian judgments might also result from a decreased aversion to harming others, due to a deficit in empathic concern and social emotion. The present study investigated the neural basis of such indifference to harming using functional neuroimaging during engagement in moral dilemmas. A tendency to counterintuitive utilitarian judgment was associated both with ‘psychoticism’, a trait associated with a lack of empathic concern and antisocial tendencies, and with ‘need for cognition’, a trait reflecting preference for effortful cognition. Importantly, only psychoticism was also negatively correlated with activation in the subgenual cingulate cortex (SCC), a brain area implicated in empathic concern and social emotions such as guilt, during counterintuitive utilitarian judgments. Our findings suggest that when individuals reach highly counterintuitive utilitarian conclusions, this need not reflect greater engagement in explicit moral deliberation. It may rather reflect a lack of empathic concern, and diminished aversion to harming others. PMID:23280149

Content validation: clarity/relevance, reliability and internal consistency of enunciative signs of language acquisition.

PubMed

Crestani, Anelise Henrich; Moraes, Anaelena Bragança de; Souza, Ana Paula Ramos de

2017-08-10

To analyze the results of the validation of building enunciative signs of language acquisition for children aged 3 to 12 months. The signs were built based on mechanisms of language acquisition in an enunciative perspective and on clinical experience with language disorders. The signs were submitted to judgment of clarity and relevance by a sample of six experts, doctors in linguistic in with knowledge of psycholinguistics and language clinic. In the validation of reliability, two judges/evaluators helped to implement the instruments in videos of 20% of the total sample of mother-infant dyads using the inter-evaluator method. The method known as internal consistency was applied to the total sample, which consisted of 94 mother-infant dyads to the contents of the Phase 1 (3-6 months) and 61 mother-infant dyads to the contents of Phase 2 (7 to 12 months). The data were collected through the analysis of mother-infant interaction based on filming of dyads and application of the parameters to be validated according to the child's age. Data were organized in a spreadsheet and then converted to computer applications for statistical analysis. The judgments of clarity/relevance indicated no modifications to be made in the instruments. The reliability test showed an almost perfect agreement between judges (0.8 ≤ Kappa ≥ 1.0); only the item 2 of Phase 1 showed substantial agreement (0.6 ≤ Kappa ≥ 0.79). The internal consistency for Phase 1 had alpha = 0.84, and Phase 2, alpha = 0.74. This demonstrates the reliability of the instruments. The results suggest adequacy as to content validity of the instruments created for both age groups, demonstrating the relevance of the content of enunciative signs of language acquisition.

Achieving World Class: An Independent Review of the Design Plans for the Walter Reed National Military Medical Center and the Fort Belvoir Community Hospital

DTIC Science & Technology

2009-05-01

class medical facility. Based on a review of relevant reports and other literature, the HSAS’s collective experience and judgment, and extensive...analyses of the demand for PACU services and of the experience and skills of PACU staff relative to the skills needed to properly care for other...class medical facility. Based on a review of relevant reports and other literature, the Subcommittee’s collective experience and judgment, and

Information quantity and quality affect the realistic accuracy of personality judgment.

PubMed

Letzring, Tera D; Wells, Shannon M; Funder, David C

2006-07-01

Triads of unacquainted college students interacted in 1 of 5 experimental conditions that manipulated information quantity (amount of information) and information quality (relevance of information to personality), and they then made judgments of each others' personalities. To determine accuracy, the authors compared the ratings of each judge to a broad-based accuracy criterion composed of personality ratings from 3 types of knowledgeable informants (the self, real-life acquaintances, and clinician-interviewers). Results supported the hypothesis that information quantity and quality would be positively related to objective knowledge about the targets and realistic accuracy. Interjudge consensus and self-other agreement followed a similar pattern. These findings are consistent with expectations based on models of the process of accurate judgment (D. C. Funder, 1995, 1999) and consensus (D. A. Kenny, 1994). Copyright 2006 APA, all rights reserved.

Spatial modelling of landscape aesthetic potential in urban-rural fringes.

PubMed

Sahraoui, Yohan; Clauzel, Céline; Foltête, Jean-Christophe

2016-10-01

The aesthetic potential of landscape has to be modelled to provide tools for land-use planning. This involves identifying landscape attributes and revealing individuals' landscape preferences. Landscape aesthetic judgments of individuals (n = 1420) were studied by means of a photo-based survey. A set of landscape visibility metrics was created to measure landscape composition and configuration in each photograph using spatial data. These metrics were used as explanatory variables in multiple linear regressions to explain aesthetic judgments. We demonstrate that landscape aesthetic judgments may be synthesized in three consensus groups. The statistical results obtained show that landscape visibility metrics have good explanatory power. Ultimately, we propose a spatial modelling of landscape aesthetic potential based on these results combined with systematic computation of visibility metrics. Copyright © 2016 Elsevier Ltd. All rights reserved.

Habitual Cognitive Reappraisal Was Negatively Related to Perceived Immorality in the Harm and Fairness Domains

PubMed Central

Li, Zhongquan; Wu, Xiaoyuan; Zhang, Lisong; Zhang, Ziyuan

2017-01-01

Emotion plays an important role in moral judgment, and people always use emotion regulation strategies to modulate emotion, consciously or unconsciously. Previous studies had investigated only the relationship between emotion regulation strategies and moral judgment in the Harm domain, and revealed divergent results. Based on Moral Foundations Theory, the present study extended the investigation into moral judgment in all five moral domains and used a set of standardized moral vignettes. Two hundred and six college students filled in the Emotion Regulation Questionnaire and completed emotional ratings and moral judgment on moral vignettes from Moral Foundations Vignettes. Correlation analysis indicated that habitual cognitive reappraisal was negatively related to immorality rating in Harm, Fairness, and Loyalty domains. Regression analysis revealed that after controlling the effect of other variables, cognitive reappraisal negatively predicted immorality ratings in the Harm and Fairness domains. Further mediation analysis showed that emotional valence only partially explained the association between cognitive reappraisal and moral judgment in Harm area. Some other factors beyond emotional valence were suggested for future studies. PMID:29075229

Can cognitive psychological research on reasoning enhance the discussion around moral judgments?

PubMed

Bialek, Michal; Terbeck, Sylvia

2016-08-01

In this article we will demonstrate how cognitive psychological research on reasoning and decision making could enhance discussions and theories of moral judgments. In the first part, we will present recent dual-process models of moral judgments and describe selected studies which support these approaches. However, we will also present data that contradict the model predictions, suggesting that approaches to moral judgment might be more complex. In the second part, we will show how cognitive psychological research on reasoning might be helpful in understanding moral judgments. Specifically, we will highlight approaches addressing the interaction between intuition and reflection. Our data suggest that a sequential model of engaging in deliberation might have to be revised. Therefore, we will present an approach based on Signal Detection Theory and on intuitive conflict detection. We predict that individuals arrive at the moral decisions by comparing potential action outcomes (e.g., harm caused and utilitarian gain) simultaneously. The response criterion can be influenced by intuitive processes, such as heuristic moral value processing, or considerations of harm caused.

Habitual Cognitive Reappraisal Was Negatively Related to Perceived Immorality in the Harm and Fairness Domains.

PubMed

Li, Zhongquan; Wu, Xiaoyuan; Zhang, Lisong; Zhang, Ziyuan

2017-01-01

Emotion plays an important role in moral judgment, and people always use emotion regulation strategies to modulate emotion, consciously or unconsciously. Previous studies had investigated only the relationship between emotion regulation strategies and moral judgment in the Harm domain, and revealed divergent results. Based on Moral Foundations Theory, the present study extended the investigation into moral judgment in all five moral domains and used a set of standardized moral vignettes. Two hundred and six college students filled in the Emotion Regulation Questionnaire and completed emotional ratings and moral judgment on moral vignettes from Moral Foundations Vignettes. Correlation analysis indicated that habitual cognitive reappraisal was negatively related to immorality rating in Harm, Fairness, and Loyalty domains. Regression analysis revealed that after controlling the effect of other variables, cognitive reappraisal negatively predicted immorality ratings in the Harm and Fairness domains. Further mediation analysis showed that emotional valence only partially explained the association between cognitive reappraisal and moral judgment in Harm area. Some other factors beyond emotional valence were suggested for future studies.

The prescriber as moralist: values in the antidepressant debate.

PubMed

Scheurich, Neil

2006-01-01

The past decade has seen a growing debate about the expanding use of psychotropic medications. Of particular concern are current antidepressants, as well as hypothetical "mood brighteners" that could modify affect and behavior in people heretofore classified as being within the normal range. This paper argues that objections to such pharmacologic applications are based on appeals to cultural values--authenticity, diversity, inwardness, and stoicism among others--that are viewed as being under increasing threat in contemporary American culture. Critiques of mood brighteners, like critiques of technological, consumer-driven culture, repudiate the ideals of shallow satisfaction and of the self as commodity. The decision to prescribe or not to prescribe a psychotropic medication in any given case is based on cultural values as well as clinical judgment.

[In the beginning was a relationship].

PubMed

Vanbelle, Guido

2008-01-01

Judgment and actions based on scientific evidence are modified by the unique caregiver-patient relationship. Caregivers relying exclusively upon "rational" decisions in line with evidence-based clinical recommendations avoid their relational responsibility. The "noble" purpose illustrates that decisions to treat can be at the same time pointless and valuable. Dia (through) - logue (knowledge) makes it possible to go beyond informed consent, which holds caregivers responsible for providing information and patients for the decision to treat. Finally, where healing is no longer achievable and autonomy dies away, compassion rather than therapeutic tenacity might be the answer. These examples are explained corresponding to the philosophical ideas of respectively Emmanuel Levinas en Roger Burgraeve (noble purpose), Martin Buber (dialogical thinking) and Daniel C. Dennett (autonomy loss).

Short-term prediction of threatening and violent behaviour in an Acute Psychiatric Intensive Care Unit based on patient and environment characteristics.

PubMed

Vaaler, Arne E; Iversen, Valentina C; Morken, Gunnar; Fløvig, John C; Palmstierna, Tom; Linaker, Olav M

2011-03-18

The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance. In 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU). Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Brøset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R). A multiple logistic regression analysis with SOAS-R as outcome variable was performed. The global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression. The use of segregation reduced the number of SOAS-R incidents. In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents. Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients. NCT00184119/NCT00184132.

Short-term prediction of threatening and violent behaviour in an Acute Psychiatric Intensive Care Unit based on patient and environment characteristics

PubMed Central

2011-01-01

Background The aims of the present study were to investigate clinically relevant patient and environment-related predictive factors for threats and violent incidents the first three days in a PICU population based on evaluations done at admittance. Methods In 2000 and 2001 all 118 consecutive patients were assessed at admittance to a Psychiatric Intensive Care Unit (PICU). Patient-related conditions as actuarial data from present admission, global clinical evaluations by physician at admittance and clinical nurses first day, a single rating with an observer rated scale scoring behaviours that predict short-term violence in psychiatric inpatients (The Brøset Violence Checklist (BVC)) at admittance, and environment-related conditions as use of segregation or not were related to the outcome measure Staff Observation Aggression Scale-Revised (SOAS-R). A multiple logistic regression analysis with SOAS-R as outcome variable was performed. Results The global clinical evaluations and the BVC were effective and more suitable than actuarial data in predicting short-term aggression. The use of segregation reduced the number of SOAS-R incidents. Conclusions In a naturalistic group of patients in a PICU segregation of patients lowers the number of aggressive and threatening incidents. Prediction should be based on clinical global judgment, and instruments designed to predict short-term aggression in psychiatric inpatients. Trial registrations NCT00184119/NCT00184132 PMID:21418581

Examination of clinical and cognitive insight in acute schizophrenia patients.

PubMed

Greenberger, Cheryl; Serper, Mark R

2010-07-01

Lack of insight or awareness of illness is a hallmark feature of schizophrenic illness and has become an increasingly important area of investigation. Although clinical insight focuses on awareness of illness factors, the concept of cognitive insight focuses on the cognitive processes involved in correcting erroneous judgments and certainty about mistaken judgments. The present study was aimed at further investigating the clinical utility and the statistical coherence of the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004) in acute schizoaffective and schizophrenia (SZ) patients. The present study examined the internal consistency of the scale, as well as its discriminative and predictive validity relative to a well-established traditional measure of clinical insight in a sample of 50 DSM-IV diagnosed SZ patients, presenting for acute inpatient treatment. The BCIS was found to be an internally consistent and a coherent measure of cognitive insight. The BCIS was unassociated with clinical insight, indicating the 2 constructs share little empirical overlap. Cognitive insight was found to be inversely associated with patients' severity of autistic preoccupation symptoms such that those individuals with more cognitive insight, exhibited fewer autistic/cognitive symptoms. Patients' clinical insight, however, was found to be inversely associated specifically with patients' severity of depression. Additionally, clinical insight was also found to be more impaired in patients residing in nursing home environments relative to their counterparts living in less restrictive settings when outside the hospital. Results are discussed in terms of the relationship between clinical and cognitive insight constructs to SZ symptom domains.

Developmental frontal lobe imaging in moral judgment: Arthur Benton's enduring influence 60 years later.

PubMed

Eslinger, Paul J; Robinson-Long, Melissa; Realmuto, Jennifer; Moll, Jorge; deOliveira-Souza, Ricardo; Tovar-Moll, Fernanda; Wang, Jianli; Yang, Qing X

2009-02-01

Early prefrontal cortex damage has been associated with developmental deficits in social adaptation, moral behavior, and empathy that alter the maturation of social cognition and social emotions. The seminal case of Ackerly and Benton (1948) continues to provide the most striking clinical example of prefrontal-related neurodevelopmental impairments, with more recent case reports confirming and elaborating these influential observations. This study investigated the prefrontal hypothesis of moral decision making in healthy, typically developing children and adolescents (10-17 years of age) using functional magnetic resonance imaging (fMRI). Participants judged the actions in age-appropriate moral vignettes as right or wrong, and results were contrasted to a nonsocial/nonmoral baseline condition requiring similar right versus wrong judgments. Results confirmed a predominant cluster of activity in the most rostral-medial (frontal polar) prefrontal region across moral judgment conditions, along with left lateroposterior orbitofrontal/ventrolateral prefrontal, left temporoparietal junction, midline thalamus and globus pallidus, and bilateral inferior occipital clusters. Trials entailing ambiguous moral situations activated considerably more prefrontal and parietal regions than did routine moral situations, suggesting the need for more neurocognitive resources. While age regression analysis identified a few regions of greater or lesser activity with age, the frontal polar activations did not change with age. Findings confirm a significant role for anterior-medial prefrontal cortex in the typical development and maturation of moral decision making, consistent with clinical lesion case descriptions.