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PubMed1989

Some scientific judgments in the assessment of the risk of environmental contaminants.

The assessment of risk due to environmental contaminants depends, in part, on scientific data. When such data are incomplete, as is usually the case, assumptions based on scientific judgments are made to analyze the consequences. Specifically, when health related data needed to assess the risk posed by environmental contaminants are missing or incomplete, it becomes necessary to make assumptions using scientific judgment to estimate the risk. Different scientists can and do make different assumptions, and the resulting differences in opinion can result in controversy. The present discussion presents a few of the consensus judgments of the Science Advisory Board (SAB) of the U.S. Environmental Protection Agency concerning the health effects and risk for such environmental contaminants as 1,2-dichloroethylene, dichloromethane, para-dichlorobenzene, polychlorinated biphenyls, perchloroethylene, and xylene, as well as the implications of the more likely cancer mechanisms, the exposure routes, and pharmacokinetics to the risk assessment process. In some of these examples, the scientific data have been developed to the extent that specific judgments by groups such as the SAB can result in greater confidence that one is correct in the assessment of risk. Because of the uncertainties in current scientific knowledge for many environmental contaminants, judgments differ and there is no right or wrong opinion.

Animals↗
PubMed2006

A systematic review of factors affecting the judgments produced by formal consensus development methods in health care.

OBJECTIVES: Formal consensus development methods are ways of obtaining and synthesising views of experts, opinion leaders and other stakeholders, and are increasingly being used to develop clinical practice guidelines. Our objective was to examine the impact that the characteristics of individual participants, groups and the consensus process have on the judgments produced by formal consensus development methods in health care. METHODS: Studies were identified from an earlier methodological review and a search of five bibliographic databases for the period January 1996 to December 2004. Studies were eligible if they involved formal consensus development methods and reported differences in judgments between groups or participants. For studies comparing two or more groups overall percentage agreement, the kappa coefficient and the odds ratio for differences in judgments were calculated. RESULTS: There were 22 studies comparing the impact of the characteristics of individual participants within groups and 30 studies comparing the results produced by two or more groups. Practitioners who perform a procedure tend to emphasise the appropriateness of the procedure compared with non-performing practitioners, and individuals from groups that were subject to performance criteria are more critical of those criteria than individuals from other groups. There was no clear pattern for the differences in judgments produced by participants and groups from different countries. CONCLUSIONS: Except for participant specialty there is little general evidence for how the characteristics of participants and groups influence the judgments produced in formal consensus development methods. Multi-specialty groups are preferable to single-specialty groups because of their potential for taking account of a wider range of opinions.

Consensus↗
PubMed2002

Prognostic judgments and triage decisions for patients with acute congestive heart failure.

STUDY OBJECTIVES: To determine how well triage physicians judge the probability of death or severe complications that require treatment only available in an ICU to maintain life for patients with acute congestive heart failure (CHF). DESIGN: Prospective cohort study. SETTING: An urban university hospital, a Veteran's Administration hospital, and a community hospital. PATIENTS OR PARTICIPANTS: Patients were those visiting the emergency department (ED) with acute CHF, excluding those who already required a treatment only available in an ICU to maintain life, and those with possible or definite myocardial infarction. Physician participants were those caring for the patients in the ED. MEASUREMENTS AND RESULTS: We performed chart reviews to ascertain whether each patient died or had severe complications develop by 4 days. We collected judgments of the probability of this outcome from the physicians taking care of the study patients in the ED. The prevalence of death or severe complications was 43 per 1,032 patients (4.2%). The mean +/- SD of physicians' judgments of the probability of this outcome was 32.1 +/- 28.4%. A calibration curve that stratified these judgments by decile demonstrated that physicians consistently overestimated this probability (p < 0.01). Physicians' judgments were only moderately good at discriminating which patients would have the outcome (receiver operating characteristic curve area, 0.715). Patients admitted to an ICU received the highest average predicted probability (56.4%), followed by those admitted to a telemetry unit (34.1%), to a regular hospital ward (29.8%), and those sent home (17.9%.) CONCLUSIONS: Physicians drastically overestimated the probability of a severe complication that would require critical care for patients with acute CHF who were candidates for ICU admission. Their judgments of this probability were associated with their triage decisions, as they should be according to several guidelines for ICU triage. Overestimation of the probability of severe complications may have lead to overutilization of scarce critical care resources. Current critical care triage guidelines should be revised to take this difficulty into account, and better predictive models for patients potentially requiring critical care should be developed.

Acute Disease↗
PubMed2002

Physicians' judgments of survival after medical management and mortality risk reduction due to revascularization procedures for patients with coronary artery disease.

STUDY OBJECTIVE: s: To assess the accuracy of physicians' judgments of survival probability for medically managed patients with coronary artery disease (CAD), and of the absolute risk reduction of mortality due to coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for such patients; and relationships among these judgments and the physicians' propensity to perform revascularization. DESIGN: Two surveys (for three-vessel or two-vessel CAD) for patients presenting with stable CAD, currently managed medically, and without other life-limiting problems. SETTING: Multiple educational conferences, 1996-1997. PARTICIPANTS: Conference attendees. MEASUREMENTS AND RESULTS: Main outcomes were proportions of patients for whom the physicians would recommend revascularization (CABG for three-vessel CAD, CABG or PTCA for two-vessel CAD), and judgments of the proportions of medically managed patients who would be alive after 5 years, 7 years, and 11 years, and of absolute risk reduction of mortality due to CABG (or PTCA for two-vessel CAD). At least one half of the participants judged the survival rate of medically managed patients with three-vessel or two-vessel CAD to be less than the lowest rates supported by the best available evidence. More than one fourth judged the absolute risk reduction due to CABG to be higher than the highest values based on such evidence. Physicians' propensity to perform revascularization correlated inversely with their judgments of survival given medical management, and with their judgments of absolute risk reduction due to revascularization. CONCLUSIONS: Physicians may overuse revascularization because of excessive pessimism about survival of medically managed patients, and excessive optimism about the survival benefits of revascularization.

Angioplasty, Balloon, Coronary↗
PubMed1992

Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality.

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.87 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.

Adolescent↗
PubMed2002

Perceptual judgment of voice pitch during pitch-matching tasks.

This study investigated the perceptual judgment of voice pitch. 24 individuals were assigned to two groups to assess whether there is a difference in perceptual judgment of voice pitch during pitch-matching tasks. Group I, Naïve listeners, had no previous experience in anatomy, physiology, or voice pitch-evaluation methods. Group II, Experienced listeners, were master's level speech-language pathologists having completed academic training in evaluation of voice. Both groups listened to identical stimuli, which required matching audiotaped voice-pitch samples of a male and female voice to a note on an electronic keyboard. The experiment included two tasks. The first task assessed pitch range, which required matching of the lowest and highest voice pitch of both a male and female speaker singing /a/ to a note on a keyboard. The second task assessed habitual pitch, which required matching of the voice pitch of a word spoken by a male and female speaker to a note on a keyboard. A one-way analysis of variance indicated a significant difference between groups occurred for only one of four conditions measured, perceptual judgment of the female pitch range. No differences between groups were found in the perceptual judgments of the male pitch range or during perceptual judgment of the female or male habitual pitch, suggesting that the skill possessed by speech-language pathology students is no different from that of inexperienced listeners.

Adolescent↗
PubMed1985

Hearing aid quality judgments in reverberant and nonreverberant environments using a magnitude estimation procedure.

Speech discrimination performance utilizing CID W-22 word lists and patient preferences for hearing aids were investigated. Preference judgments were made using the magnitude estimation procedure. 10 experienced hearing aid users served as subjects. Results revealed that speech discrimination using CID W-22 words was unable to differentiate among hearing aids which possessed similar electroacoustic characteristics. In contrast, the magnitude estimation quality judgment procedure was quite effective and reliable at differentiating among the hearing aids. Further, the magnitude estimation quality judgment procedure is able to provide numerous preference judgments about each hearing aid in a relatively short time. In addition, the magnitude estimation procedure has a major advantage over the paired-comparison quality judgment procedure in that the patient is able to actually wear the hearing aid during the magnitude estimation procedure.

Adult↗
PubMed2004

Judgments of duration, figure-ground contrast, and size for words and nonwords.

Does the word-superiority effect on letter discrimination result in a word-superiority effect on duration judgments? We examined this question in five experiments. In the first four experiments, we have demonstrated that (1) words shown for 32-80 msec were judged as presented longer than non-words shown for the same duration; (2) this word-superiority effect persists if the stimuli are shown for an objective duration of up to 250 msec; and (3) these effects can be extended to judgments of figure-ground contrast and letter size. These findings extend existing data on effects of processing fluency on perceptual judgments. In Experiment 5, we found that duration judgments were higher for words than for pronounceable nonwords, and duration judgments were higher for pronounceable non-words than for nonpronounceable nonwords. We discuss the implications of this finding for the discrepancy-attribution hypothesis.

Attention↗
PubMed1987

Use of explicit criteria and implicit judgments in a drug-use review program.

The degree of agreement between implicit and explicit judgments made by a pharmacist in a drug-use review program in an ambulatory-care setting was studied. During a six-month period in 1980, all prescriptions for a group of 19 drugs were reviewed for appropriateness of indication, dosage, and length of therapy by a pharmacist using implicit judgment. The same prescriptions were then reevaluated according to explicit criteria that had been approved by the prescribing physicians. A sample of prescriptions that did not meet either implicit or explicit criteria for use was subjected to review by a committee of four physicians to validate whether these prescriptions were indeed inappropriate. Of the 935 prescriptions evaluated, 36.8% were judged inappropriate by the explicit criteria and 23.5% were judged inappropriate by implicit judgment. The explicit and implicit approaches yielded concordant results for 95.5% of the observations. The proportion of true deviations as validated by the review committee was estimated at 80% for the implicit method and 74.4% for the explicit method. The implicit judgments of a pharmacist appear to be as effective as explicit drug-use criteria for identifying inappropriate prescribing in a drug-use review program. These judgments could be used to increase the efficiency of a drug-use review program when explicit criteria are not available.

Drug Utilization↗
PubMed1993

Physician judgment in clinical settings: methodological influences and cognitive performance.

Understanding the quality of physicians' intuitive judgments is essential in determining the appropriate use of their judgments in medical decision-making (vis-a-vis analytical or actuarial approaches). As part of this process, the quality of physicians' predictions must be assessed because prediction is fundamental to common clinical tasks: determining diagnosis, prognosis, and therapy; establishing monitoring intervals; performing screening and preventive maneuvers. Critical evaluation of predictive capabilities requires an assessment of the components of the prediction process: the data available for prediction, the method used for prediction, and the accuracy of prediction. Although variation in and uncertainty about the underlying data elements are often acknowledged as a source of inaccurate predictions, prediction also can be confounded by both methodological and cognitive limitations. During the past two decades, numerous factors have been recognized that may bias test characteristics (sensitivity and specificity). These same factors may also produce bias in intuitive judgments. The use of cognitive processes to simplify judgment tasks (e.g., the availability and representativeness heuristics) and the presence of certain biases in the judgment process (e.g., ego, regret) may present obstacles to accurate estimation of probabilities by physicians. Limitations on the intuitive use of information (cognitive biases) have been demonstrated in both medical and nonmedical decision-making settings. Recent studies have led to a deepening understanding of the advantages and disadvantages of intuitive and analytical approaches to decision making. Here, many aspects of the basis for this understanding are reviewed.

Chemistry, Clinical↗
PubMed1993

The role of gender-related information and self-endorsement of traits in preadolescents' inferences and judgments.

The major purpose of this study was to examine the effects of a target child's gender typicality on different aspects of preadolescents' inferences and judgments. The secondary purpose of the study was to investigate the relation between children's self-endorsement of traits and their inferences and judgments. Fifth and sixth graders were shown a video film, portraying a child playing either a gender-appropriate game with members of the same sex or a gender-inappropriate game with members of the other sex. In addition, subjects completed an adapted version of the BSRI and were categorized into sex-typed, androgynous, and undifferentiated subjects. Subjects made a number of different types of judgments and inferences about the target, including inferences about traits, popularity, choice of gift and name, and willingness to engage in activities with the target. All types of inferences and judgments were affected by the variations in the targets' gender-related behaviors, whereas self-endorsement of traits was not related to the inferences and judgments. The results suggest that the gender typicality of the target behavior is salient to preadolescents, regardless of their sex-role orientation.

Adolescent↗
PubMed2002

Developing professional judgment.

The concept of professional judgment is considered, including its theoretical foundations, how it is developed, and how it may be assessed. Professionals are asked to engage in complex and unpredictable tasks on society's behalf, and in doing so must exercise their discretion, making judgments--decide what is "best" in the particular situation rather than what is "right" in some absolute sense. Inevitably, some of these judgments lead to "error," which is endemic to professional practice. This challenges some current ideologies in health care regarding the primacy of evidence-based practice and the application of protocols. At the foundation of professional judgment is a form of knowledge--called practical wisdom--which is not formally taught and learnt but is acquired largely through experience and informal conversations with respected peers. Wisdom develops through "the critical reconstruction of practice," including deliberation, which is distinguished from mere reflection. Professionals need to engage in the appreciation of their practice--not just to understand what informs their own practice but to consider critically the contestable issues endemic to practicing as a professional.

Decision Making↗
PubMed2006

Affective judgment and beneficial decision making: ventromedial prefrontal activity correlates with performance in the Iowa Gambling Task.

Damasio proposes in his somatic marker theory that not only cognitive but also affective components are critical for decision making. Since affective judgment requires an interplay between affective and cognitive components, it might be considered a key process in decision making that has been linked to neural activity in ventromedial prefrontal cortex (VMPFC). Using functional magnetic resonance imaging (fMRI), we examined the relationship between VMPFC, emotionally (unexpected)- and cognitively (expected)-accentuated affective judgment, and beneficial decision making (Iowa Gambling Task; IGT) in healthy subjects. Neuronal activity in the VMPFC during unexpected affective judgment significantly correlated with both global and final performance in the IGT task. These findings suggest that the degree to which subjects recruit the VMPFC during affective judgment is related to beneficial performance in decision making in gambling.

Adult↗
PubMed2005

Influence of tonal and temporal expectations on chord processing and on completion judgments of chord sequences.

Pitch and time are two principal form-bearing dimensions in Western tonal music. Research on melody perception has shown that listeners develop expectations about "What" note is coming next and "When" in time it will occur. Our study used sequences of chords (i.e., simultaneously sounding notes) to investigate the influence of these expectations on chord processing (Experiments 1 and 4) and subjective judgments of completion (Experiments 2 and 3). Both tasks showed an influence of tonal relations and temporal regularities: expected events occurring at the expected moment were processed faster and led to higher completion judgments. However, pitch and time dimensions interacted only for completion judgments. The present outcome suggests that for chord perception the influence of pitch and time might depend on the required processing: with a more global judgment favoring interactive influences in contrast to a task focusing on local chord processing.

Auditory Perception↗
PubMed2006

The moral judgment of juvenile delinquents: a meta-analysis.

A meta-analysis of 50 studies was conducted to investigate whether juvenile delinquents use lower levels of moral judgment than their nondelinquent age-mates and, if so, what factors may influence or moderate the developmental delay. The results show a lower stage of moral judgment for juvenile delinquents (d=.76). Effect sizes were large for comparisons involving male offenders, late adolescents, delinquents with low intelligence, and incarcerated delinquents. The largest effect sizes were found for period of incarceration and comparisons involving juvenile delinquents with psychopathic disorder. Production instead of recognition measures, dilemma-free assessment methods, and non-blind scoring procedures yielded relatively large effect sizes, whereas effect sizes were medium for comparisons involving delinquents with average intelligence, non-incarcerated delinquents, female offenders, as well as early and middle adolescents. Psychopathic disorder and institutionalization were identified as unique moderators of the link between moral judgment and juvenile delinquency. It is concluded that developmentally delayed moral judgment is strongly associated with juvenile delinquency, even after controlling for socioeconomic status, gender, age and intelligence.

Adolescent↗
PubMed1988

Assessing judgment.

There is currently no satisfactory way to assess judgment and yet the clinician is frequently confronted with this responsibility. The author reviews the judgment and decision-making literature, proposes a model for testing judgment, applies this model to patients in a medical setting, and makes the model operational for empirical study. He emphasizes that to assess judgment one needs to evaluate the process of how the individual deals with uncertainty and then goes on to express a preference. The author develops his model by assessing how the individual appraises the challenge, surveys the alternatives, weighs the alternatives, deliberates about selection, and finally makes a commitment to a preference.

Adult↗
PubMed2004

Actor-observer differences in realism in confidence and frequency judgments.

Taking a social psychological approach to metacognitive judgments, this study analyzed the difference in realism (validity) in confidence and frequency judgments (i.e., estimates of overall accuracy) between one's own and another person's answers to general knowledge questions. Experiment 1 showed that when judging their own answers, compared with another's answers, the participants exhibited higher overconfidence, better ability to discriminate correct from incorrect answers, lower accuracy, and lower confidence. However, the overconfidence effect could be attributable to the lowest level of confidence. Furthermore, when heeding additional information about another's answers the participants showed higher confidence and better discrimination ability. The overconfidence effect of Experiment 1 was not found in Experiment 2. However, the results of Experiment 2 were consistent with Experiment 1 in terms of discrimination ability, confidence, and accuracy. Finally, in both experiments the participants gave lower frequency judgments of their own overall accuracy compared with their frequency judgments of another person's overall accuracy.

Adult↗
PubMed2005

The San Francisco Syncope Rule vs physician judgment and decision making.

OBJECTIVE: To compare a clinical decision rule (San Francisco Syncope Rule [SFSR]) and physician decision making when predicting serious outcomes in patients with syncope. METHODS: In a prospective cohort study, physicians evaluated patients presenting with syncope and predicted the chance (0%-100%) of the patient developing a predefined serious outcome. They were then observed to determine their decision to admit the patient. All patients were followed up to determine whether they had a serious outcome within 7 days of their emergency department visit. Analyses included sensitivity and specificity to predict serious outcomes for low-risk patients and comparison of areas under the receiver operating characteristic curve for the decision rule, physician judgment, and admission decisions. RESULTS: During the study period, there were 684 visits for syncope with 79 visits resulting in serious outcomes. The area under the receiver operating characteristic curve was 0.92 (95% confidence interval [CI], 0.88-0.95) for the SFSR compared with physician judgment 0.89 (95% CI, 0.85-0.93) and physician decision making 0.83 (95% CI, 0.81-0.87). Physicians admitted 28% of patients in a low-risk group, with a median length of stay of 1 day (interquartile range, 1-2.5 days). The SFSR had the potential to absolutely decrease admissions by 10% in this low-risk group and still predict all serious outcomes. CONCLUSIONS: Physician judgment is good when predicting which patients with syncope will develop serious outcomes, but contrary to their judgment, physicians still admit a large number of low-risk patients. The SFSR performs better than current physician performance and has great potential to aid physician decision making.

Clinical Competence↗