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PubMed1987

Computer modeling of clinical judgment.

Four main developments leading to computer modeling of clinical judgment are described in this paper. These include information processing psychology, clinical vs. statistical prediction studies, behavioral decision theory, and Bayesian decision analysis approaches. One clear catalyst in these developments has been the computer, which has been used as an information management tool rather than a data-processing device. Future directions of these efforts are delineated, and problems as well as prospects of computerizing clinical judgment are described.

Artificial Intelligence↗
PubMed1987

Contextual judgments of quality of life and adolescent cognitive development.

This research explored the relationship between adolescents' level of cognitive reasoning and their contextual judgments of the factors affecting quality of life. In comparison to adolescents at relatively lower levels of cognitive development, it was predicted that those who have achieved higher levels of cognitive reasoning would be: (1) more likely to identify social and interpersonal aspects of life as factors related to quality of life and (2) less likely to identify self issues. Subjects were 443 tenth-grade students from four Michigan school districts. The students were administered the Reasoning Level Test (RLT) and also asked to identify the aspects of their lives that they felt were the most and least satisfying at the moment. A median split was performed and each student was assigned to either a high or low cognitive-level group based upon his/her RLT score. The findings supported the above predictions, but more so in regard to negative than positive factors. The findings are also in line with cognitive-developmental theories of adolescence and indicate that cognitive structures and the specific nature of the factors perceived to influence one's life may mediate contextual judgments of these factors.

Adolescent↗
PubMed1984

Antisocial personality--diagnosis or moral judgment?

Antisocial personality is a problem-filled diagnosis. Even when diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) II manual, it was replete with value laden terminology. DSM III makes repeated criminal behavior central and includes a list of other behaviors that do not always truly imply an antisocial personality. In order to test the possibility that factors other than those listed in the manual may often influence the diagnosis, the prevalence of required characteristics in patients diagnosed antisocial personality was compared with the prevalence of required characteristics in another personality disorder, schizoid personality. The study involved a hospitalized Veteran's Administration (VA) population, employing DSM II criteria, which was used by the VA at that time. The difference was statistically highly significant. Examination of the case histories suggests that dislike of the patients or negative moral judgments about their actions frequently were involved in making a diagnosis of antisocial personality. It is therefore crucial that moral judgments not be disguised as scientific ones, and the meaning of an antisocial personality diagnosis as utilized by clinicians needs to be seriously questioned.

Adolescent↗
PubMed1980

Conceptual numerousness judgments by squirrel monkeys.

Two monkeys were reinforced for responding to the card which displayed fewer number of entities (three randomly selected sizes of filled circles) than the other card in any given pair. Area and brightness cues were controlled (at least for the successive numerousness discriminations), as were specific-pattern learning cues. Training proceeded in the order 2 versus 7 (2:7), 2:6, 2:5...2:3, 3:7, 3:6...3:4, etc., until it was judged that the monkeys were unlikely to attain the stringent criteria for discrimination. Both monkeys met criteria on the 7:8 discrimination, and one monkey met criteria on the 8:9 discrimination. It was concluded that the monkeys' numerousness judgments were made on a conceptual basis and that, among nonhuman animals, the evidence for such judgments appears to be limited to apes and monkeys.

Animals↗
PubMed1982

The use of microfiche in testing clinical judgment.

This paper reports an investigation of the use of microfiche to replace other more bulky clinical materials in testing clinical judgment. Twenty-three students were administered two versions of tests of clinical judgment (micro-fiche and nonmicrofiche) regarding the treatment of partial edentulism. Each student served as both experimental subject and control. Results indicated that under the conditions of testing used, students preferred the nonmicrofiche version of the test. However, there was no significant difference in time of administration or grades resulting from the microfiche medium. Whether the test was given first or fourth in a series of five made a difference in time to take the test (p less than .01), and in the grade received (p less than .01). Tests taken in the first position took more time to complete and resulted in a higher grade. The rate of agreement in grading between the first and second grading session was 70 percent.

Clinical Competence↗
PubMed1994

Identification of potentially avoidable pediatric hospital use: admitting physician judgment as a complement to utilization review.

OBJECTIVE: To determine, for acute general pediatric admissions, 1) the proportion of admissions that the admitting physician would identify as potentially avoidable; 2) services that might help reduce avoidable admissions; 3) potential savings in hospital days through eliminating avoidable admissions; 4) the role that social factors play in admission decisions; and 5) if admitting physician judgment provides a valuable complement to Utilization Review (UR) in identifying avoidable admissions. METHODS: A questionnaire was used to determine the proportion of 600 acute general pediatric admissions considered potentially avoidable by the admitting physician and to identify services required to prevent such admissions. Savings through eliminating potentially avoidable admissions and social factors influencing admission decisions were examined. Physicians' and UR assessments of necessity of inpatient care were compared. RESULTS: Admitting physicians judged 28% of admissions as potentially avoidable, citing alternative services for each avoidable admission. Eliminating all avoidable admissions would have reduced hospital days by 7.7%. Physicians identified 6% of admissions as social admissions, most commonly due to an overwhelmed family. UR identified 1% of potentially avoidable admissions as unnecessary. CONCLUSION: Incorporating admitting physician judgment may significantly improve current efforts to identify and reduce avoidable hospital use.

Acute Disease↗
PubMed1997

The impact of mood on information use in judgments of relationship satisfaction.

The hypothesis in Study 1 was that positive mood leads people to rely on both central and peripheral features of relationship quality when making global satisfaction judgments concerning their relationship with a spouse or partner, whereas sadness leads people to focus more exclusively on central features. For German university students, correlational analyses, within mood condition, of feature ratings with satisfaction judgments, both obtained following mood induction, revealed results consistent with the hypothesis. Study 2 again addressed the differential breadth of feature processing, by having a different group of German students categorize features of relationship quality after mood induction. As expected, participants in the positive mood condition used the fewest categories, whereas those in the neutral and sad mood conditions used the most categories.

Adult↗
PubMed1976

Short-term memory and equivalence judgments in normal and retarded readers.

Matched groups of normal and disabled readers were required to perform same/different judgments in which the interval between standard and comparison stimuli was either 0, 1, or 6 sec. Standard and comparison stimuli were either the same, different in element order, or different in actual elements present. Retarded readers performed as well as controls on same tasks in all 3 delay conditions. Difference tasks discriminated retarded readers on 1- and 6-sec conditions, but not on 0-sec conditions. Differences in order and gross element distinguished retarded from adequate readers equally well. The results are interpreted to indicate a deficit in short-term memory in retarded readers, but only for tasks requiring a difference judgment.

Attention↗
PubMed1998

The roles of cue and target familiarity in making feeling of knowing judgments.

This study evaluated the effects of cue and target familiarity on metacognitive judgments by using a retroactive interference paradigm. Subjects studied 12 pairs of unrelated words. The first 6 pairs formed an A-B list, and the next 6 formed an A-B list (both elements repeated), a C-B list (only the target repeated), an A-D list (only the cue repeated), or a C-D list (neither element repeated). Following study, the six critical cues were presented and subjects made predictions of knowing. Predictions were highest when both elements were repeated and equally low when only the cue, only the target, or neither element was repeated. A subsequent cued recall test showed that significant retroactive interference effects were apparent. The findings suggest that neither cue nor target familiarity alone sufficiently explains knowing judgments.

Cognition↗
PubMed1976

The effects of chlordesmethyldiazepam on behavioral performance and subjective judgment in normal subjects.

Eight normal subjects were tested on a battery of subjective and psychological tests 12 hours after a hypnotic dose of chlordesmethyldiazepam (1 or 2 mg), amylobarbitone sodium (100 mg), and a placebo. The tests included self-ratings of hypnotic effects and alertness; reactiontime, card-sorting, coding and cancellation tasks; arithmetic; and tapping. Before each task, test anxiety and performance expectation was self-rated; and after the task, judgment of performance was self-rated. Residual effects were definitely detectable after the 2-mg dose of benzodiazepine with both behavioral impairment and subjective hangover. Both the 1-mg dose and the barbiturate were almost devoid of such effects. Very few drug effects on test anxiety and performance judgment were discerned. Plasma concentrations of amylobarbitone were related to decreases in test anxiety and of chlordesmethyldiazepam with ratings of sleepiness.

Acoustic Stimulation↗
PubMed1998

Practice guidelines and the practice of medicine: is it the end of clinical judgment and expertise?

Clinical practice guidelines are an increasing part of efforts to improve the quality and reduce the cost of health care. They are recommendations for the evidence-based care of average patients, not rules for all patients. At best they are developed by panels representing a wide array of expertise and experience related to the clinical question, are based on comprehensive, critical review of scientific evidence, make clear how value judgments affect recommendations, and take into account all of the issues bearing on clinical decisions, such as effectiveness, risk, convenience, cost, cost-effectiveness, and the resources needed to carry out the recommendations. Physicians have a mixed opinion of guidelines, believing they are both useful summaries to improve the quality of care and potential tools to judge and control them. Although guidelines may point out the best research evidence to guide the care of average patients, they are not a substitute for clinical judgment, which should be applied to each individual patient.

Clinical Competence↗
PubMed1998

Tolerance and intolerance: children's and adolescents' judgments of dissenting beliefs, speech, persons, and conduct.

Tolerant and intolerant judgments of different types of dissent were examined. One hundred sixty participants (aged 7.3, 10.4, 13.6, and 20.1) made judgments about dissenting beliefs, speech, practices, and people engaged in those practices. Across all ages, participants were more tolerant (1) of the holding of dissenting beliefs than of their expression, (2) of the expression of beliefs than of the persons engaged in acts based on those beliefs, and (3) of the persons than of the acts. Tolerance of dissenting beliefs and speech increased with age. Although, at all ages, participants were intolerant of the practices, they were relatively more tolerant of practices grounded in cultural contexts. Participants were more tolerant of people espousing dissenting information than dissenting values. We concluded that tolerance and intolerance coexist at all ages and hinge on what individuals are asked to tolerate and on the sense in which they are asked to tolerate it.

Adolescent↗
PubMed1984

Clinical judgments in the decision to commit. Psychiatric discretion and the law.

Judicial decisions and statutory reforms point to a return to psychiatric discretion when clinical needs and patients' rights must be balanced. In seeking to commit patients, psychiatrists have been accused of contravening the legal rights of their patients by applying criteria other than those prescribed by law. This study examined the factors involved in the psychiatrists' decisions to seek commitment or to release 90 voluntarily hospitalized patients; we found psychiatrists' decisions to be appropriately correlated to legal criteria and legally relevant clinical and psychosocial factors. Interpersonal variables did not play a material role in the decision. Independent assessment of the patients' clinical status were consistent with clinicians' judgments of dangerousness. These findings indicate that this group of psychiatrists, faced with the decision to seek commitment, based their judgments on clinically relevant data rather than interpersonal factors and conformed to the dangerousness requirements of the commitment law.

Attitude of Health Personnel↗
PubMed2000

What is a binge? The influence of amount, duration, and loss of control criteria on judgments of binge eating.

OBJECTIVE: We investigated the influence of amount of food eaten, duration of eating episode, and loss of control in judgments of eating episodes as binges. METHOD: Participants rated the degree to which the eating behavior of a female actress qualified as a "binge" after observing eight videotaped vignettes in which the amount of food eaten, apparent duration of eating episode, and loss of control were varied. Binge ratings were stable across a test-retest interval of 3-4 weeks, there was minimal observer drift, and the experimental variables were independently perceived. RESULTS: A repeated measures analysis of variance (ANOVA) on binge ratings revealed significant main effects for quantity and loss of control, and a significant Quantity x Time interaction. DISCUSSION: The results are consistent with the definitional criteria of a binge, underscore the independence of loss of control, and highlight the importance of the violation of dietary standards in judgments of binges. Moreover, they illustrate the reliability and sensitivity of the methodology, and its potential for further investigations of binge eating.

Adolescent↗
PubMed1983

Anchoring and publicity effects in clinical judgment.

Extrapolation from the literature of social-cognitive bias suggested testing anchoring and publicity effects in clinicians' (N = 46) successive judgments of detailed interview notes, five per case. If anchoring occurs, Ss' estimates of a client's pathology and prognosis at the final judgment point would be related differentially to the time (early/late) that they had received salient, pathognomonic case material. The publicity effect would be a tendency toward more conservative estimates on the part of Ss who are asked to justify their ratings in writing. Results among an experienced sample of clinicians indicated significant anchoring in one case but not the other, which suggests a clinical bias to disregard pathognomonic data about a client who is seen initially as less disturbed. Public justification was related neither to Ss' ratings, to reported confidence in their ratings, nor differentially by case. Implications and limitations are suggested.

Adult↗
PubMed2002

Effects of mood and emotion on juror processing and judgments.

This study explored the influence of mood and emotion on mock-jurors' processing of testimonial inconsistencies, perceptions of witness credibility and offender culpability, and verdicts. Jurors' mood and testimonial consistency were manipulated using a simulated trial with a 2 (mood: sad/neutral) x 2 (testimonial consistency: consistent/inconsistent) between-groups design. Sad mood resulted in more accurate reporting of testimonial inconsistencies, a finding consistent with previous research indicating more substantive processing in association with sad mood. Direct relationships between veridicality and number of inconsistencies detected and mock-juror judgments were also observed. Although anger was not experimentally manipulated, the data suggest that trial circumstances which arouse anger in jurors may impair processing and also bias their judgments of witnesses and defendants. Possible directions for research on mood and emotion in the courtroom context are suggested.

Adolescent↗
PubMed2002

Effects of three types of potentially biasing information on symptom severity judgments for major depressive episode.

Two experiments examined the effects of potentially biasing information on judgments of symptom severity pertaining to the diagnosis of major depressive episode (MDE). In both experiments, clinicians viewed videotapes of two actor-simulated patients responding to questions from a standardized diagnostic interview. In Study 1, an expectancy effect was found for both patients such that prior information about a clear-cut history of depression resulted in lower rated severity of current symptoms. In addition, a halo effect was observed for one patient in Study 1 and both patients in Study 2: Clear-cut depressive nonverbal behavior (DNVB) resulted in greater rated severity for symptoms that should not have been affected (e.g., appetite/weight change, suicidal ideation). Clear-cut versus near-threshold information for the two essential criteria for MDE did not affect subsequent judgments in either study. Implications for diagnostic interviewing are discussed.

Adult↗
PubMed1980

The effects of race and social class on clinical judgment.

Asked 61 male clinical psychologists (21 blacks and 40 whites) to assess case histories that were presented to them to determine whether racial or social class biases could be detected. In order to avoid the apparent artificial results or weak interpretations of past research, only cases with concurrently validated diagnoses and 4-year follow-up were used. An equal number of positive and negative clinical outcomes were included. Diagnosis, disposition, and rated severity were studied. The following results were found: (1) diagnosis for all psychologists was guided by case characteristics, not bias; (2) severity was related strongly to diagnosis; (3) disposition followed judgments of severity and diagnosis, not bias. The question was raised whether clinical investigators may not have overdramatized bias in psychodiagnosis and clinical judgment.

Alcoholism↗