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PubMed1987

Drunks, livers, and values. Should social value judgments enter into liver transplant decisions?

The idea that social value judgments should enter into the distribution of scarce resources has been debated for many years. The question of transplanting livers into alcoholic patients, even if they do not constitute a technically worse group than do nonalcoholics, is used to examine this issue. The paper concludes that (a) "social worth," as a criterion for distribution of scarce resources, is morally precluded in allocations directly involving the patient-physician relationship; (b) social worth criteria may be useful in macroallocation decisions prior to resorting to a lottery approach or to a market approach; (c) social worth criteria may be more legitimately applied when it comes to transplanting organs than in the distribution of other resources. Social worth criteria constitute an expression of communal value and are prone to the evolution of communal sensitivities and to growth.

Alcoholism↗
PubMed1986

Comparison of Tonar II, pressure-flow, and listener judgments of hypernasality in the assessment of velopharyngeal function.

The purpose of the present investigation was to study the interrelationships among Tonar II, pressure-flow, and listener judgments of hypernasality in a consecutive series of patients. The subjects employed were 124 children and adults seen for evaluation at the University of North Carolina Oral-Facial and Communicative Disorders Program. The results indicated that nasalance scores and clinical ratings of hypernasality change systematically among patients as a function of their pressure-flow categorization. A discussion is presented concerning the impact that differential use of information from these assessment techniques can have upon patient management.

Adolescent↗
PubMed1987

Interactive computer graphics: a new technology to improve judgment in rhinoplasty.

A teaching system has been developed that employs interactive computer graphics to simulate the surgical experience of rhinoplasty, allowing the surgeon to experiment within a model of nasal behavior. The ability to experiment without risk and to safely learn the laws governing nasal behavior should augment the development of surgical judgment in rhinoplasty.

Computer Graphics↗
PubMed1987

Problem size and mentally retarded children's judgment of commutativity.

The effects of problem size on judgments of commutativity by 51 moderately and mildly mentally retarded students were investigated. The task required subjects to judge whether commuted addition problems (e.g., 5 + 2 and 2 + 5) and noncommuted problems (e.g., 5 + 3 and 5 + 0) would have the same or different sum. Small problems had addends of five or less; large problems had at least one addend greater than five. The subjects' responses to the commutativity task were highly consistent across the two problem sizes. Results indicated that many retarded students who are given computational practice recognize the general principle that addend order does not affect the sum.

Adolescent↗
PubMed1986

Quality-of-life judgments, treatment decisions, and medical ethics.

Treatment of the elderly should rest on criteria that are morally different from those applied to the rest of the population. These criteria depend on perceptions about life and the quality of life that the elderly are more likely to hold than younger citizens. Six treatment axioms are proposed for avoiding subjective and often capricious quality-of-life judgments about the care of the elderly. These axioms rest on an explication of the moral difference between the elderly and the rest of the population.

Aged↗
PubMed1985

Differential diagnosis and the competing-hypotheses heuristic. A practical approach to judgment under uncertainty and Bayesian probability.

Evaluating the same diagnostic information across the plausible competing diagnoses is a practical strategy (ie, heuristic) to guide decision making in the face of uncertainty. The prevalence of use of this competing-hypotheses heuristic by 89 first-year house officers was examined in three simulated patient cases. Results indicated that only a minority (24%) of the house officers selected optimal diagnostic information consistent with this Bayesian heuristic across all three cases. Almost all (97%) of the house officers selecting optimal diagnostic information were able to identify the most probable diagnosis specified by Bayes' theorem, while only a chance number (53%) of house officers selecting nonoptimal information were able to identify the most probable diagnosis. The competing-hypotheses heuristic is discussed within the context of diagnostic problem-solving models derived from the literature on medical decision making and clinicopathological conference case records. It is suggested that the heuristic, which does not necessitate any mathematical calculations, may be useful as a complement to clinical judgment.

Bayes Theorem↗
PubMed1984

Physicians' judgments about estrogen replacement therapy for menopausal women.

A study was undertaken to determine how physicians decide when to prescribe estrogen. Twenty-five gynecologists and 25 family physicians responded to case histories and a questionnaire regarding estrogen administration. There was no difference in mean probability of prescribing, 0.42 for gynecologists and 0.40 for family physicians. Endometrial cancer risk and vasomotor symptom severity were significant factors in prescribing judgments; osteoporosis risk and current treatment status were not. In linear regression analysis the constant, not factor weights, were significantly related to each physician's overall likelihood of prescribing and to the individual's self-characterization as prescriber or nonprescriber. Most physicians indicated that estrogen reduces fracture risk, and that progestin reduces cancer risk. Physicians' responses to cases were not consistent with these stated beliefs about estrogen effects.

Estrogens↗
PubMed1982

Judgments of EMR students toward their peers: effects of label and academic competence.

To test the relative potency of a clinical label and behavioral competence on the judgments of EMR students, we asked special-class students to evaluate a target child (labeled "mentally retarded" or "regular" student) who performed competently or incompetently on an academic task, controlling sex of target. The EMR students rated the target child in a manner similar to that of nonretarded raters. They responded most negatively to the incompetent retarded target child, while expressing positive affect toward the other three target children, in ascending order: the incompetent nonlabeled, competent retarded, and competent nonlabeled child. For these subjects competence was valued highly and more potently determined their expressed attitude than did the assigned label.

Adolescent↗
PubMed1982

The role of decision skills and medical knowledge in the clinical judgment of surgical residents.

Five surgical management problems amenable to solution by decision analysis were developed to test the decision-making skills, or surgical judgment, of residents in three university-based surgical training programs. Incorporated within the problems were indicators of textbook knowledge, basic computational ability and the ability to integrate probabilistic information in a logical decision-making process. Seventy-two residents representing 65% of those in the 5-year programs participated. Correct answers were determined by 50 senior surgeons and independently supported by the surgical literature and decision analyses. The percentage of correct surgical decisions averaged 72 +/- 3% until after the chief residency year, when it rose to 87 +/- 6%. Among the residents still in training, correct clinical decisions were associated with more accurate estimates of textbook information. The clinical recommendations of senior surgeons were consistent with the solutions of the problems by formal decision analysis in 92 +/- 2% of cases; the clinical recommendations of residents were consistent in 77 +/- 2% of cases. Decision analyses with appropriate use of textbook information could improve the accuracy of the residents' clinical recommendations. Decision analysis without accurate information resulted in inferior decision making for one of the management problems. Decision analysis can supplement, but not replace, the acquisition of scientific knowledge in the education of surgical residents.

Academic Medical Centers↗
PubMed1982

[Age-matched normal values of regional cerebral blood flow measurements by 133Xe inhalation and production of judgment image: as to initial slope index computed by Fourier analysis].

In order to investigate an influence of advancing age on regional cerebral blood [flow](rCBF), 125 measurements of rCBF were made by 133Xe inhalation method in 90 normal subjects without cerebral symptoms and risk factors of atherothrombotic stroke including hypertension, diabetes mellitus, and hyperlipidemia. There were 46 male and 44 female aged 19 to 80 years old (mean 42.5). The measurements were carried out in a quiet, semi-darkened room with the subjects at rest and eye closed. 133Xe inhalation system (Meditronic-Novo Diagnostic Systems, Inhalation Cerebrograph, Denmark) consists of 32 scintillation detectors, the lateral part of each hemisphere being covered by 16 detectors placed in parallel. One pair of the detectors is mounted in place over the brain stem and cerebellar region. Relationship of age and rCBF computed as the initial slope index (ISI) by Fourier analysis was investigated with both correlation and regression analyses, and age-matched normal values were calculated. End-tidal partial pressure for carbon dioxide (PECO2) was recorded from the face mask during the measurements along with the mean arterial blood pressure (MABP). ISI values were not corrected for changes in PECO2. PECO2 and MABP did not differ significantly among the normal subjects. There were no significant differences in the hemispheric mean ISI values between the right and left hemispheres. Mean brain ISI values showed significant negative correlation with advancing age (r = -0.67, p less than 0.001), and regression line was Y = -0.30X + 67.8. Ninety five per-cent confidence interval of the regression line was +/- 11.8. Regional ISI values also showed significant negative correlations with advancing age in the whole brain (p less than 0.001). There were no significant differences in the correlation coefficients obtained from parallel regions between the right and left hemispheres. The regional reduction of ISI values with advancing age was significantly greater in the regional distribution of the middle cerebral arteries bilaterally, compared with regions in the distribution of either the anterior cerebral, the posterior cerebral, or vertebrobasilar arteries (p less than 0.05). Regional hemispheric percent value of frontal lobe was greater than that of either parietal, temporal, occipital lobe, or brain stem and cerebellar region in the whole age. But, this hyperfrontal distribution became gradually obscured with advancing age, because reduction of ISI values with aging was significantly greater in the frontal than in other regions. It is concluded that measured rCBF of a patient have to be compared with age-matched normal values of mean brain and each region. Judgment image was produced with dividing patient value by 95% confidence limit of age-matched normal value. According to this image, regions in which rCBF significantly decrease or increase can be easily evaluated.

Adult↗
PubMedDate not supplied

The effects of informative and non-informative speech on the judgment of most comfortable listening level.

Fifteen normal-hearing males and fifteen normal-hearing females were presented with a portion of speech played in a forward and a backward direction. The speech was presented in an ascending manner, and the subjects were asked to make comfortable listening judgments. Results indicated that most comfortable listening level is independent of the direction of the speech stimulus and thus independent of information content. Results also showed that sex of the listener plays an unimportant role in most comfortable listening level. Overall, the results indicated that most comfortable listening level results from clinical populations will be little influenced by the listener's ability to understand the stimulus message and thus little influenced by the degree of reduction to speech discrimination ability.

Adult↗
PubMed1995

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: III. Clinical features affecting experts' therapeutic recommendations in anxiety disorders.

Our objective was to assemble expert clinical experience and judgment in the treatment of anxiety and related disorders in a systematic, quantitative manner. This article reports on some clinical features apart from diagnosis that may affect choice of strategy in the pharmacotherapy of anxiety disorders. A panel of internationally recognized experts in treating anxiety and depression was constituted by multistage peer nomination. Ninety percent (66 of 73) completed an extensive questionnaire. This report focuses on the expert panel's responses to questions on therapeutic options, based on multi-part case vignettes of several anxiety disorders presenting clinical variations within the same diagnosis. In the presence of higher levels of functional impairment, the experts more often recommended formal psychosocial procedures for adjustment disorder; medication for agoraphobia, social phobia, obsessive-compulsive disorder, and adjustment disorder; and polypharmacy for agoraphobia. Their therapeutic recommendations were not materially affected by chronicity in the case of panic disorder. Under the condition of heavy use of alcohol in the case of generalized anxiety disorder, the experts avoided benzodiazepines in favor of various other medications. In the presence of a serious cardiac conduction defect in the case of obsessive-compulsive disorder, they less often recommended medication. Those who did recommend medication changed their preference from tricyclic antidepressants (clomipramine) to selective serotonin reuptake inhibitors. Under the condition of a more severe precipitating event in the case of adjustment disorder, the experts were more likely to recommend both formal psychosocial intervention and medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A commentary on the NRC report "Science and judgment in risk assessment".

This article provides a brief overview of the report "Science and Judgment in Risk Assessment," prepared by a Committee of the National Research Council/National Academy of Science in response to a U.S. Environmental Protection Agency request mandated by the Clean Air Act Amendments of 1990 (CAAA-1990). The report critiques EPA's current approaches for characterizing human cancer risks from exposure to chemicals and offers recommendations for the conduct of future cancer risk assessments, especially those required in implementing the CAAA-1990 provisions which are concerned with hazardous air pollutants. The report offers specific recommendations that address the role of default options, data needs, methods and models, uncertainty, variability, and the aggregation of data. A cross-cutting theme of the report is the use of an iterative approach in which screening assessments with limited data and, of necessity, default options used in the absence of specific scientific data may be performed initially followed by subsequent assessments, as needed, in which increasing amounts of data are developed and incorporated. In some instances, the specific data on a given chemical or pollutant source will replace conservative default options used in earlier assignments. The report includes two authored appendices that address issues related to the use of default options and their replacement by specific scientific information. One appendix by Finkel advocates a principle of "plausible conservatism" for choosing and altering default options and in making cancer risk estimates. A second appendix by McClellan and North advocates the full use of scientific information in the risk assessment process. This article gives major attention to the key aspects of the NRC/NAS report, especially those dealing with the use and replacement of default options. The default options and the extent to which the options are replaced with specific science have major impact on the final quantitation of cancer risk for exposure to chemicals.

Air Pollution↗
PubMedDate not supplied

[Course on industrial medicine in graduate education of medicine and surgery at the University of Modena. Critical analysis of the judgment of students of the academic year 1993-1994].

Assessment of teaching activity based on the judgment of students can provide useful information which can be used to revise and improve the courses. In the academic year 1993-1994 the course of "Occupational Medicine" was assessed in the Medical School of the University of Modena. Fifty-six out of 62 medical students participated in the study. An anonymous questionnaire was administered to obtain information on usefulness, clarity (presentation and visual aids quality), cultural and professional interest. Each student was requested to assess these aspects on a 5-point scale ranging from 1 (poor) to 5 (very good). The results show that some lectures ("Occupational History", "Allergic respiratory diseases") were considered more useful and more interesting from a professional point of view. No difference was found among the lectures with respect to clarity, which was considered as "good". Clarity depends mostly on the quality of the visual aids. The students suggested that 80% of the program should be covered during the course.

Curriculum↗
PubMed1994

[Cognitive and emotional feeling states and controllability: effects on judgment contents and processing style].

Reviews summarizing experiments on the interaction of emotional and cognitive processes generally conclude that moods or feelings influence memory, decision-making, and learning processes. The congruency effects observed concern the content or quality of cognition involved as well as the style of information processing. This experiment aimed to further differentiate the conditions of the congruency effects. Therefore, with a 3-factorial design, the influence of (1) positive and negative feelings, (2) a detached and vivid mode of experiencing, and (3) cognitive control on two aspects of probability estimates concerning future events were investigated. 194 female and male subjects (M = 22.58, SD = 4.85 years of age) participated. The feeling states were induced by an autobiographical recollection procedure, and the modality and control conditions were manipulated by means of instructions. 3-way interactions for the content and style of judgments as dependent variables support the expected mood-congruency effects. Three factors quality these effects. First, the mood-congruity effect as described in the literature can be interpreted as being composed of two different parts, a strong emotional and a weak cognitive mood-congruency effect, the latter being an artifact, if real emotion-cognition relationships are concerned. Second, the influence of feelings on information processing style can only be replicated under conditions of "hot" cognition, and so is a truly emotional phenomenon. Third, the interactions of mood, control, and modality point towards different control strategies being implicit in various feeling states. Positive mood is ruled by "compensation" control, whereas negative mood states are governed by "congruency" control if future life events are evaluated.

Adolescent↗
PubMed1994

Structured text representations and relevance judgments: an exploratory study.

This paper presents results of an exploratory study on using a structured text and query model for analyzing relevance judgments made by users on retrieved texts The structured model moves beyond keyword based text representation and retrieval. In particular it allows texts and queries to be represented by concepts embedded within the structural framework of complex objects. These objects preserves important text-based links between the selected concepts. The current study reveals a tendency for user judged relevance potential to decrease as the structure-based similarity between query and text decreases. This indicates that the structure-based retrieval model has the potential to conduct more precise retrieval than keyword based models. This supports our overall research goal of developing and investigating the structured retrieval model.

Information Storage and Retrieval↗
PubMed1994

Improving intensive care unit discharge decisions: supplementing physician judgment with predictions of next day risk for life support.

OBJECTIVE: To develop predictive equations, estimating the probability that an individual intensive care unit (ICU) patient will receive life support within the next 24 hrs. DESIGN: Prospective, multicenter, inception cohort study. SETTING: Forty-two ICUs in 40 U.S. hospitals, including 26 that were randomly selected and 14 volunteer hospitals, primarily university or large tertiary care centers. PATIENTS: A consecutive sample of 17,440 ICU admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A series of multivariate equations were developed to create daily estimates of probability of life support in the next 24 hrs. These equations used demographic, physiologic, and treatment information obtained at the time of ICU admission and during the first 7 ICU days. The most important determinants of next day risk for life support were the current day's therapy and Acute Physiology Score of the Acute Physiology and Chronic Health Evaluation (APACHE) III score. Other predictor variables included diagnosis, age, chronic health status, emergency surgery, previous day Acute Physiology Score, and hospital stay and location before ICU admission. The cross-validated ICU day 1, 2, and 3 predictive equations had receiver operating characteristic areas of 0.90. Survival, ICU readmission rate, and the number and type of therapies received by patients predicted at < 10% risk for active treatment suggest that discharge of patients meeting these criteria to an intermediate care unit or hospital ward could reduce ICU bed demand without compromising patient safety. CONCLUSIONS: Accurate, objective predictions of next day risk for life support can be developed, using readily available patient information. Supplementing physician judgment with these objective risk assessments deserves evaluation for the role of these assessments in enhancing patient safety and improving ICU resource utilization.

Adolescent↗
PubMed1993

Reliability of psychiatric and psychological diagnoses of mental retardation severity: judgments under naturally occurring conditions.

The reliability of diagnoses of mental retardation severity was examined through the comparison of psychiatric and psychological case reports found in client records. For a sample of 126 dually diagnosed clients, overall chance-corrected agreement was .47, ranging from .38 (for diagnoses of moderate mental retardation) to .55 (for diagnoses of borderline mental retardation). Results showed that the analysis of naturally occurring variation in diagnostic practices (including variability in professional judgment and assessment methods) may offer a more realistic appraisal of the reliability of diagnostic decisions in professional practice situations than do studies in which important sources of diagnostic error are controlled.

Adolescent↗