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PubMedDate not supplied

Nurses' judgments of pain in term and preterm newborns.

OBJECTIVE: To examine neonatal intensive-care unit nurses' judgments of pain intensity in term and preterm newborns and to describe the cues used to assess the possible presence of pain in newborns. DESIGN: A combination of quantitative and qualitative approaches that included both parametric and nonparametric statistical procedures and a content analysis. SETTING: A large, university-affiliated, tertiary-care hospital in central Canada. PARTICIPANTS: Forty-five registered nurses employed in the neonatal intensive-care unit. INTERVENTIONS: Nurses viewed videotapes of term and preterm newborns and written vignettes. Visual analogue scales and open-ended questions were used. MAIN OUTCOME MEASURES: Pain intensity ratings of full-term and preterm newborns and the cues identified as indicative of pain in newborns. RESULTS: Nurses gave significantly higher pain intensity ratings to the full-term group than to the preterm group of newborns. Some differences were found in the cues identified by the nurses in assessing pain in term versus preterm newborns. CONCLUSIONS: Nurses' judgments of pain intensity in newborns are influenced by the vigor and richness of the newborn's behavior response. Neonatal nurses must be provided with continuing education that focuses upon recognition of the signs and symptoms of pain in newborns.

Adult↗
PubMed1983

Comparison of SASOC, a measure of dental aesthetics, with three orthodontic indices and orthodontist judgment.

Scores for three malocclusion indices (HLD, TPI and OI) and Orthodontist Judgment (OJ) were available for the 100 orthodontic study models utilized in the development of SASOC, the Social Acceptability Scale of Occlusal Conditions. The ability of SASOC to predict need for treatment using OJ as a standard was compared to the ability of HLD, TPI and OI to predict OJ's decisions. In addition, determinations of need for treatment of each of the 100 models using HLD, OI and OJ were compared to SASOC's rankings for the public's perceptions of aesthetic acceptability. Finally, the agreement of HLD, OI and OJ with each other in assessing need for treatment was compared. Results indicated: 1) that SASOC's, HLD's, TPI's and OI's "hit rate" in predicting OJ ranged between 73% and 81%; 2) HLD's, OI's and OJ's assessment of malocclusion paralleled lay perceptions of aesthetic acceptability (SASOC), and 3) there were differences of agreement among HLD, OI and OJ as to which cases had a definite need for treatment. There was more agreement on cases which did not have a definite need for treatment than on those which did. A tool which assesses only the aesthetic component of occlusal configurations was judged to be more suitable in the study of the social and psychological impact of malocclusion than indices and orthodontist judgment which include professional criteria as well as aesthetics in their assessments of malocclusion.

Adolescent↗
PubMedDate not supplied

A model to describe the relationship between knowledge, skill, and judgment in nursing practice.

This paper explores the relationship between knowledge, skill, and judgment and proposes a model to describe that relationship. Through illustration of the components and interrelationships within this model one can more clearly understand the nature of nursing work. Drawing on Benner's work on novice to expert, the model shows the interrelationship and the evolution of knowledge, skill, and judgment in a nurse's practice.

Clinical Competence↗
PubMedDate not supplied

Judgment strategies for coping with ambiguous clinical situations encountered in primary health care [corrected].

This naturalistic study identifies and describes strategies for clinical problem solving in situations of uncertainty, from observations of patient/family visits in a family health center. Judgment strategies were described for four types of uncertainty: information, diagnosis, treatment, and patient response that roughly correspond to the phases of assessment, planning, implementation, and evaluation of the clinical problem-solving process. The study contributes to increased understanding of the practical (experiential) knowledge involved in clinical judgment.

Adaptation, Psychological↗
PubMed1988

Auditory constraints on the perception of voice-onset time: the influence of lower tone frequency on judgments of tone-onset simultaneity.

The experiments reported employed nonspeech analogs of speech stimuli to examine the perceptual interaction between first-formant onset frequency and voice-onset time, acoustic cues to the voicing distinction in English initial stop consonants. The nonspeech stimuli comprised two pure tones varying in relative onset time, and listeners were asked to judge the simultaneity of tone onsets. These judgments were affected by the frequency of the lower tone in a manner that parallels the influence of first-formant onset frequency on voicing judgments. This effect was shown to occur regardless of prior learning and to be systematic over a wide range of lower tone frequencies including frequencies beyond the range of possible first-formant frequencies of speech, suggesting that the effect in speech is not attributable to (tacit) knowledge of production constraints, as some current theories suggest.

Auditory Pathways↗
PubMed1980

Assessment of fitness for surgical procedures and the variability of anaesthetists' judgments.

Ten anaesthetists were asked to make judgments on fitness for elective operation on data derived from 200 patients. The extent of their agreement was measured using a kappa statistic, and clusters of anaesthetists who agreed well with each other were identified. Using an alternative technique, the "true" fitness category of each patient was estimated using a maximum likelihood method which estimated the error involved in making judgments on limited amounts of information. It was possible to compare the performance of each anaesthetist against the consensus and to measure deviation on an "optimism--pessimism" continuum. A simple questionnaire predicted fitness for operation by all 10 anaesthetists in 96% of cases.

Anesthesia, General↗
PubMed1998

Judgment and decision making.

For many decades, research in judgment and decision making has examined behavioral violations of rational choice theory. In that framework, rationality is expressed as a single correct decision shared by experimenters and subjects that satisfies internal coherence within a set of preferences and beliefs. Outside of psychology, social scientists are now debating the need to modify rational choice theory with behavioral assumptions. Within psychology, researchers are debating assumptions about errors for many different definitions of rationality. Alternative frameworks are being proposed. These frameworks view decisions as more reasonable and adaptive that previously thought. For example, "rule following." Rule following, which occurs when a rule or norm is applied to a situation, often minimizes effort and provides satisfying solutions that are "good enough," though not necessarily the best. When rules are ambiguous, people look for reasons to guide their decisions. They may also let their emotions take charge. This chapter presents recent research on judgment and decision making from traditional and alternative frameworks.

Choice Behavior↗
PubMed1989

P-center judgments are generally insensitive to the instructions given.

The perceptual moment of occurrence of a syllable, its P-center, has frequently been examined by instructing subjects to adjust a series of speech sounds until they sounded isochronous. The present two experiments examined the effect of changing the instructions. In addition to the overall isochrony instructions, we asked subjects to align pairs of syllables so that the syllable onsets, vowel onsets, or syllable offsets sounded isochronous. In the first experiment, 3 of 4 subjects showed no difference among the first three instruction sets, and the changes introduced by the fourth went in the wrong direction. All subjects found it impossible to make alignments with respect to offsets. In the second experiment, vowel durations of two versions of some stimuli differed by 100 ms, to enhance the difference in syllable rhyme durations. Two subjects received the same instruction sets as in Experiment 1, and again found alignment with respect to offsets impossible. These subjects showed differences among the other instruction sets, although the direction and magnitude of the differences indicated that they had not succeeded in changing their timing criteria. The results indicate that P-center alignments are the syllable timing judgments that subjects most naturally make, and they may, indeed, be the only isochrony judgments that subjects can make reliably.

Analysis of Variance↗
PubMed2004

The cerebellum and English grammatical morphology: evidence from production, comprehension, and grammaticality judgments.

Three neuropsychological experiments on a group of 16 cerebellar patients and 16 age- and education-matched controls investigated the effects of damage to the cerebellum on English grammatical morphology across production, comprehension, and grammaticality judgment tasks. In Experiment 1, participants described a series of pictures previously used in studies of cortical aphasic patients. The cerebellar patients did not differ significantly from the controls in the total number of words produced or in the proportion of closed-class words. They did differ to a marginally significant extent in the production of required articles. In Experiment 2, participants identified the agent in a series of aurally presented sentences in which three agency cues (subject-verb agreement, word order, and noun animacy) were manipulated. The cerebellar patients were less affected than the controls were by the manipulation of subject-verb agreement to a marginally significant extent. In Experiment 3, participants performed a grammaticality judgment task on a series of aurally presented sentences. The cerebellar patients were significantly less able to discriminate grammatical and ungrammatical sentences than the controls were, particularly when the error was of subject-verb agreement as opposed to word order. The results suggest that damage to the cerebellum can result in subtle impairments in the use of grammatical morphology, and are discussed in light of hypothesized roles for the cerebellum in language.

Aged↗
PubMed1976

Assessment of sociolegal judgment of offenders.

While working with young male offenders the authors developed a scale to assess sociolegal judgment, i.e., the ability to evaluate the possible social and legal consequences of various choices of action in a given situation. They found that some inmates had committed crimes because of poor sociolegal judgment, whereas others understood the consequences of their actions but chose to act illegally despite this knowledge.

Connecticut↗
PubMed1987

Predictive validity of judgments of dangerousness in emergency civil commitment.

The authors investigated the predictive validity of judgments of dangerousness made in the context of emergency civil commitment. The medical charts of 101 consecutive patients involuntarily admitted to a university-based acute inpatient unit were reviewed for evidence of violence within the first 72 hours of hospitalization. More than two-thirds of the patients committed as a danger to others engaged in some type of violence, compared with fewer than one-third of other involuntary patients. The findings suggest that the emergency commitment situation permits judgments of dangerousness with a relatively high degree of short-term predictive validity.

Adult↗
PubMedDate not supplied

Screening for Depression in the Medically Ill: a comparison of self-report measures, clinician judgment, and DSM-IV diagnoses.

The performance of the self-report 10-item Depression in the Medically Ill scale was observed in 210 patients as part of clinical assessment by consultation-liaison psychiatry clinicians. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care were completed by the patient, and the clinicians made their judgment of the presence and severity of "clinical depression" and DSM-IV affective disorder diagnoses. Both the Depression in the Medically Ill scale and the Beck Depression Inventory for Primary Care detected 85% of patients with DSM-IV major depressive episode. The Depression in the Medically Ill scale was slightly superior to the Beck Depression Inventory for Primary Care in its relationship to clinicians' judgments of clinical depression caseness.

Adolescent↗
PubMedDate not supplied

Kindergarten risk factors, cognitive factors, and teacher judgments as predictors of early reading in Dutch.

This study focused on the predictive value of risk factors, cognitive factors, and teachers' judgments in a sample of 462 kindergartners for their early reading skills and reading failure at the beginning of Grade 1. With respect to risk factors, enrollment in speech-language therapy, history of dyslexia or speech-language problems in the family, and the role of gender were considered. None of these risk factors were significantly related to reading performance. Cognitive factors in this study included letter knowledge, rapid naming ability, and nonword repetition skills. Of these skills, letter knowledge seemed to have the highest correlation with reading. Kindergarten teachers' judgments, including a task assignment scale and teachers' predictions, demonstrated a significant relationship with reading. Finally, to judge whether these predictors could identify reading disabilities, the discriminatory power of all predictors was assessed and appeared to be insufficient. Implications for screening purposes are discussed.

Child↗
PubMed2005

Happiness as a belief system: individual differences and priming in emotion judgments.

Three studies involving 104 undergraduates sought to examine how an individual's level of life satisfaction organizes their knowledge concerning the self's emotions. Participants judged the self's positive and negative emotions within a computerized task. Key results sought to determine whether judging two positive emotions in a consecutive sequence speeds the second judgment--a pattern of priming that would suggest a tighter, more interconnected structure in semantic memory related to one's positive emotions. As expected, individual differences in life satisfaction predicted the magnitude of this priming effect (Studies 1 & 2), which appeared to be unique to judgments of the self's emotions (Study 3). The results indicate that happy, relative to less happy, individuals organize information concerning their positive emotions in a qualitatively different and tighter semantic manner.

Affect↗
PubMedDate not supplied

Withholding or starting antibiotic treatment in patients with dementia and pneumonia: prediction of mortality with physicians' judgment of illness severity and with specific prognostic models.

BACKGROUND: To help decision makers plan treatment, the authors assessed clinical predictors of mortality from nursing home-acquired pneumonia in patients with dementia. METHODS: Pneumonia patients treated without (n = 165) or with antibiotics (n = 541) were enrolled in a prospective cohort study in 61 nursing homes. RESULTS: In both groups, clinical judgment of illness severity was a strong predictor for 1-week mortality. Despite large differences in frailty and mortality (83% in untreated patients and 15% in treated patients), separate multivariable logistic models included similar specific predictors. DISCUSSION: Despite profound differences between the 2 independent groups, predictors for short-term mortality were largely similar. We found that, when combined with physicians' clinical judgment, 3 readily assessed predictors (respiratory rate, fluid intake, and eating dependency) helped predict mortality. Our results, if confirmed in an independent population, can help make decision making about antibiotic treatment of pneumonia in patients with dementia more evidence-based.

Aged↗
PubMed1982

Physicians' and patients' judgments of compliance with a hypertensive regimen.

This study examines an early decision point in the process of compliance. Thirty primary care physicians and thirty outpatients responded to a series of written scenarios. These scenarios systematically incorporated four factors thought to affect adherence to a hypertensive regimen--convenience, cost, severity, and support. Data were analyzed using multiple regression and multivariate analysis of variance. A mean R2 was obtained of 0.70 for physicians and 0.58 for patients. In making these judgments, physicians and patients placed similar emphasis on cost, convenience, and severity, but physicians placed greater emphasis on support. There was a significant difference between the judgments of physicians and patients (p less than 0.0001). Patients tended to be more optimistic than physicians regarding adherence and put more importance on severity of illness than on support. These findings are useful to the clinician concerned with compliance and demonstrate the potential of this paradigm for research in clinical reasoning.

Adult↗
PubMed1982

Two studies of good clinical judgment.

There is a continuing controversy about the quality of unaided clinical judgment. This paper reports two studies that show that experienced medical providers made accurate probability assessments and applied those assessments to patient care in a manner consistent with principles of optimal decision making. In the first study, experienced clinicians and physician assistants accurately judged the relative frequency of three cough-related diagnoses in an outpatient population, suggesting that their encounter with several "unrelated" diagnostic problems does not interfere with their ability to judge accurately the frequency of any single diagnostic problem. In the second study, a group of clinicians assessed the probability that each patient seen in an outpatient clinic had pneumonia. Physicians were more likely to assign a pneumonia diagnosis and to order a radiograph for patients with a greater assessed probability of pneumonia (p less than 0.05). Most of the physicians appeared to use cutoff probabilities or "thresholds" above which they acted as though the patient had the disease and below which they acted as though the patient did not have the disease, consistent with rational decision-making principles. However, the threshold probabilities being used were quite different from physician to physician, implying that the physicians managed the patient population in a nonuniform manner. Thus it may be desirable to supplement "good" clinical judgment with decision aids to ensure standardized medical care.

Bronchitis↗
PubMedDate not supplied

How convergence of research paradigms can improve research on diagnostic judgment.

The author's purpose is to urge the constructive convergence of two current judgment and decision-making research paradigms. He shows why the heuristics-and-biases approach and the lens-model approach should be placed in the context of two very different metatheories, the coherence metatheory and the correspondence metatheory. The differences between the two research paradigms thus become apparent; they speak to different problems and appeal to different criteria for evaluating performance. Bringing the two into a constructive relationship to one another, however, will not only double the store of knowledge regarding diagnostic judgment and decision making, but also enhance efforts to achieve a cumulative discipline. Isolating these research paradigms from one another--as is done now--stifles theoretical generality, fragments knowledge, and confuses medical decision makers. An example of how convergence can be achieved is provided.

Bias↗