Attributions and inflammatory bowel disease: patients' perceptions of illness causes and the effects of these perceptions on relationships.
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Adult↗
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Results for “Perception”
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Women's perceptions of the safety of the pill: a survey in eight developing countries. Report of the perceptions of the pill survey group.
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Adolescent↗
[Changes of visual perception of moving objects in space and development of visual perception aptitude].
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Humans↗
Some perceptions and perceptives in dental science.
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Chlorhexidine↗
Masking and stimulus intensity effects on duplex perception: a confirmation of the dissociation between speech and nonspeech modes.
Using the phenomenon of duplex perception, previous researchers have shown that certain manipulations affect the perception of formant transitions as speech but not their perception as nonspeech "chirps," a dissociation that is consistent with the hypothesized distinction between speech and nonspeech modes of perception [Liberman et al., Percept. Psychophys. 30, 133-143 (1981); Mann and Liberman, Cognition 14, 211-235 (1983)]. The present study supports this interpretation of duplex perception by showing the existence of a "double dissociation" between the speech and chirp percepts. Five experiments compared the effects of stimulus onset asynchrony, backward masking, and transition intensity on the two sides of duplex percepts. It was found that certain manipulations penalize the chirp side but not the speech side, whereas other manipulations had the opposite effect of penalizing the speech side but not the chirp side. In addition, although effects on the speech side of duplex percepts have appeared to be much the same as in the case of normal (electronically fused) speech stimuli, the present study discovered that manipulations that impaired the chirp side of duplex percepts had considerably less effect on the perception of isolated chirps. Thus it would seem that duplex perception makes chirp perception more vulnerable to the effects of stimulus degradation. Several explanations of the data are discussed, among them, the view that speech perception may take precedence over other forms of auditory perception [Mattingly and Liberman, in Signals and Sense: Local and Global Order in Perceptual Maps, edited by G.M. Edelman, W.E. Gall, and W.M. Cowan (Wiley, New York, in press); Whalen and Liberman, Science 237, 169-171 (1987)].
Adult↗
Modeling changes in health perception following hip fracture.
BACKGROUND AND OBJECTIVE: Health perception is an important outcome associated with health-related quality of life. Various correlates of perceived health have been identified, but attempts at multivariate modeling have often failed to mirror the complex system of causal pathways surrounding this concept. The objective of this study was to develop a multivariate model to improve our understanding of how physical, social, and psychological factors interact to influence health perception following a hip fracture. METHODS: Patients were interviewed in-hospital during the week following the fracture to obtain information on in-hospital mental status and pre-fracture function, pre-fracture health perception, and pre-fracture social support. A follow-up interview was conducted by telephone to assess function, health perception, and social support 3 months post-fracture. Comorbidities and demographic information were obtained from medical records. RESULTS: This study included 222 hip fracture patients aged 65 + and fracturing a hip between 10 July 1996 and 30 August 1997. Our estimated model was theory-based, developed from existing research identifying the following correlates of health perception: physical function, comorbidities, socioeconomic status, social support, age, and prior health perception. In addition to these correlates, our model was unique in incorporating a variable to assess whether the gap between pre- and post-fracture functioning acted as a separate cause on post-fracture health perception. Initially, the fit between the data and the model was poor, however minor modifications to the model corrected this. While there was a good fit between the data and the estimated model, only about 25% of the variation in both pre- and post-fracture health perceptions were explained. The number of comorbidities and physical function were found to have the strongest influence on health perception. Post-fracture health perceptions were also improved by increased post-fracture social support, higher income/status, and higher pre-fracture health perception. The network of effects indicates that the causal sources of health perception may differ in the pre- and post-fracture periods. This suggests that the causal sources of health perception following major health changes may differ substantially from the causal sources of health perception operating during normal times. CONCLUSIONS: The findings suggest that interventions aimed at improving pre-fracture function and post-fracture social support could increase health perception following hip fracture. In interpreting our results, it is important to remember that while we attempted to adjust for measurement error in the analysis, the study may be limited due to the retrospective nature of the questions. Future research should focus on improving the model by including other components of the patient's emotional health.
Aged↗
From computing with numbers to computing with words. From manipulation of measurements to manipulation of perceptions.
Interest in issues relating to consciousness has grown markedly during the last several years. And yet, nobody can claim that consciousness is a well-understood concept that lends itself to precise analysis. It may be argued that, as a concept, consciousness is much too complex to fit into the conceptual structure of existing theories based on Aristotelian logic and probability theory. An approach suggested in this paper links consciousness to perceptions and perceptions to their descriptors in a natural language. In this way, those aspects of consciousness which relate to reasoning and concept formation are linked to what is referred to as the methodology of computing with words (CW). Computing, in its usual sense, is centered on manipulation of numbers and symbols. In contrast, computing with words, or CW for short, is a methodology in which the objects of computation are words and propositions drawn from a natural language (e.g., small, large, far, heavy, not very likely, the price of gas is low and declining, Berkeley is near San Francisco, it is very unlikely that there will be a significant increase in the price of oil in the near future, etc.). Computing with words is inspired by the remarkable human capability to perform a wide variety of physical and mental tasks without any measurements and any computations. Familiar examples of such tasks are parking a car, driving in heavy traffic, playing golf, riding a bicycle, understanding speech, and summarizing a story. Underlying this remarkable capability is the brain's crucial ability to manipulate perceptions--perceptions of distance, size, weight, color, speed, time, direction, force, number, truth, likelihood, and other characteristics of physical and mental objects. Manipulation of perceptions plays a key role in human recognition, decision and execution processes. As a methodology, computing with words provides a foundation for a computational theory of perceptions: a theory which may have an important bearing on how humans make--and machines might make--perception-based rational decisions in an environment of imprecision, uncertainty, and partial truth. A basic difference between perceptions and measurements is that, in general, measurements are crisp, whereas perceptions are fuzzy. One of the fundamental aims of science has been and continues to be that of progressing from perceptions to measurements. Pursuit of this aim has led to brilliant successes. We have sent men to the moon; we can build computers that are capable of performing billions of computations per second; we have constructed telescopes that can explore the far reaches of the universe; and we can date the age of rocks that are millions of years old. But alongside the brilliant successes stand conspicuous underachievements and outright failures. We cannot build robots that can move with the agility of animals or humans; we cannot automate driving in heavy traffic; we cannot translate from one language to another at the level of a human interpreter; we cannot create programs that can summarize non-trivial stories; our ability to model the behavior of economic systems leaves much to be desired; and we cannot build machines that can compete with children in the performance of a wide variety of physical and cognitive tasks. It may be argued that underlying the underachievements and failures is the unavailability of a methodology for reasoning and computing with perceptions rather than measurements. An outline of such a methodology--referred to as a computational theory of perceptions--is presented in this paper. The computational theory of perceptions (CTP) is based on the methodology of CW. In CTP, words play the role of labels of perceptions, and, more generally, perceptions are expressed as propositions in a natural language. CW-based techniques are employed to translate propositions expressed in a natural language into what is called the Generalized Constraint Language (GCL). In this language, the meaning of a proposition is expressed as a generalized constraint, X isr R, where X is the constrained variable, R is the constraining relation, and isr is a variable copula in which r is an indexing variable whose value defines the way in which R constrains X. Among the basic types of constraints are possibilistic, veristic, probabilistic, random set, Pawlak set, fuzzy graph, and usuality. The wide variety of constraints in GCL makes GCL a much more expressive language than the language of predicate logic. In CW, the initial and terminal data sets, IDS and TDS, are assumed to consist of propositions expressed in a natural language. These propositions are translated, respectively, into antecedent and consequent constraints. Consequent constraints are derived from antecedent constraints through the use of rules of constraint propagation. The principal constraint propagation rule is the generalized extension principle. (ABSTRACT TRUNCATED)
Consciousness↗
Relation of the perception of airway obstruction to the severity of asthma.
BACKGROUND: Patients with a poor perception of their symptoms of asthma seem to have an increased risk of an asthma attack. The influence of factors such as airway calibre, bronchial hyperresponsiveness, age and sex on the "perceptiveness" of a patient are poorly understood. It is of clinical importance to identify patients who are likely to have a poor perception of their symptoms. We have studied the perception of bronchoconstriction by asthmatic patients during a histamine provocation test and analysed the influence of bronchial obstruction, hyperresponsiveness, sex, and age. We were particularly interested to establish whether there was any difference in perception between subjects with a greater or lesser severity of asthma (expressed as bronchial obstruction, hyperresponsiveness). METHODS: One hundred and thirty four patients with allergic asthma underwent a histamine provocation test. The FEV1 was measured after each inhalation of histamine. Subjects were asked to rate subjective quantification of the sensation of breathlessness on a visual analogue scale (VAS). The relationship between changes in VAS values and the reduction in FEV1 as a percentage of the baseline value was analysed by determining the linear regression slope (alpha) between the two parameters and indicates the perception of airway obstruction. Multiple regression analysis was performed to investigate the effect of baseline FEV1, bronchial hyperresponsiveness, sex and age on the "perceptiveness" for bronchoconstriction. RESULTS: The median value of the slope alpha (indicating the perception of airway obstruction) was 0.91 (25-75th percentile: 0.48-1.45). Age and sex had no influence on the perception of bronchoconstriction. Both initial bronchial tone (baseline FEV1) and bronchial hyperresponsiveness (PC20) showed a significant correlation with the perception of bronchoconstriction. The regression coefficients for FEV1 and 2log PC20 in the multiple regression model were 0.20 and 0.10. Patients who had a low baseline FEV1 and/or a high bronchial responsiveness to histamine were more likely to show a low perceptiveness for bronchoconstriction during the challenge test. CONCLUSIONS: Low baseline FEV1 and high bronchial responsiveness are associated with a low degree of "perceptiveness" for bronchoconstriction. This suggests that patients with a more severe degree of asthma either show adaptation of "perceptiveness" for airway obstruction or that low perceptiveness leads to more severe asthma.
Adolescent↗
Stimulus intensity and fundamental frequency effects on duplex perception.
Duplex perception occurs when part of the acoustic signal is used for both a speech and a nonspeech percept. This phenomenon has been interpreted as evidence of a distinct system for speech perception that precedes other specialized systems of general auditory processing (such as auditory grouping, and perception of pitch, loudness, and timbre). This interpretation was investigated by using an intensity-dependent form of duplex perception with the acoustic pair /da/ and /ga/. The "base" portion of the stimulus, common to both, consisted of the first and second formants and the steady-state portion of the third formant (F3). The F3 transition (either a sinusoid or a true formant), which cued the difference between /da/ and /ga/, was varied in intensity and fundamental frequency (F0). For every subject, the level at which each type of F3 transition was barely audible in the context of the base, i.e., duplex perception threshold, was first established. Next, identification functions were obtained by varying the intensity of the F3 transition relative to each subject's duplex perception threshold. Results revealed that duplex perception thresholds decreased as the F0 of the F3 transition increasingly differed from the base. Also, identification functions showed that, as has been previously demonstrated, the F3 transition contributed to the speech percept over a wide range of intensities and fundamental frequencies. However, as F3 transition intensity increased well above duplex perception threshold, /ga/ identification decreased. Also, both /da/ and /ga/ identification progressively decreased as the F0 of the F3 transition increasingly differed from the base. Contrary to previous duplex perception reports, such findings indicate that both intensity and F0 information is available to the specialized speech perception system. Thus, the computations of the speech perception system and its relation to the general auditory processing systems need to be reexamined.
Adult↗
The use of patient perceptions in the evaluation of health-care delivery systems.
OBJECTIVES: Patient perceptions are increasingly used to measure quality of care in a diversity of health-care delivery settings. The goals of this article are to review the current use of patient perceptions and to review what is known about the sensitivity of patient perceptions for discerning variations in care across delivery systems. METHODS: This article first provides a rationale for using patient perceptions to evaluate delivery systems and reviews proposed frameworks for measuring perceptions. It then reviews illustrative studies that have used patient perceptions to compare delivery systems or that have examined associations between patient perceptions and other health-care indicators. RESULTS: Although the results of these studies suggest some general relations between patient perceptions and characteristics of delivery systems, findings are often inconsistent across individual studies. These inconsistencies may be related to several potential methodological limitations, including failure to account for the impact of patient mix, ceiling effects of patient responses, nonresponse bias, differences in data collection methods and timing of surveys, use of proxy respondents, and differences in survey instruments. CONCLUSIONS: The discussion concludes with five conceptual challenges and recommendations for further research: (1) to establish the sensitivity of patient perceptions for discerning differences across delivery systems; (2) to establish relations between alternative frameworks for measuring patient perceptions; (3) to standardize the measurement of patient perceptions; (4) to define optimal ways of presenting patient perceptions data to users; and (5) to broaden the "patient" populations in which perceptions of care have been measured.
Attitude to Health↗
Health perceptions of primary care patients and the influence on health care utilization.
This prospective study was conducted to determine the influence of primary care patients' health perceptions on their utilization of health care services. Patients' health perceptions were measured using the RAND Corporation's General Health Perceptions Questionnaire. Physicians provided scores of how they thought the patients perceived their health and of actual physical and emotional health. Utilization data (number of office visits, number of telephone calls to the physician, and ambulatory charges) were evaluated for a 12-month period after completion of the questionnaire. Of 208 patients, 62 (30%) patients with health perceptions scores less than 50 had greater degrees of anxiety (P less than .001), depression (P less than .001), health-related worry (P less than .001), and felt less able to resist illness (P less than .001) than patients with higher health perception scores. Analysis of covariance was used to control for differences in physical health among groups of patients with varying health perceptions. These analyses revealed that patients with low health perceptions made more office visits (P = .002), more telephone calls to the physician (P = .01), and had more office charges (P = .05) than patients with higher scores. Physicians accurately predicted the patients' health perceptions in 49% of the cases. In 37%, they thought patients would score their health perceptions higher than they did; in 14% they thought patients would score their health perceptions lower. Health perceptions are an important factor contributing to the use of health care by primary care patients, regardless of the patient's actual physical health. Persons with low health perceptions account for approximately 5% of office visits, a clinically important fraction, especially when compared to the 9% of office visits for hypertension, the most common disease treated in the medical office.
Adolescent↗
Perception of motion and position relative to the earth. An overview.
Results of the five experiments are consistent with the following generalizations. Canal-mediated turn perception (pitch, roll, or yaw) in earth-horizontal or earth-vertical plane, is suppressed in direct relationship to the magnitude of a linear acceleration vector lying in the plane of a responding canal when the magnitude of the linear vector is constant or increasing and when its direction is either fixed or rotating in the same direction as the concomitant canal signal. Canal-mediated turn perception (pitch, roll, or yaw) is not suppressed by a coplanar linear vector that is counterrotating relative to the canal signal. Change in perceived attitude (pitch, roll, or yaw) is very sluggish in the absence of concordant canal information; attitude change may not be an immediate otolith-mediated perceptual event but a slowly developing perception dependent upon cognitive appreciation of an immediate otolith angular position signal. Otolith phasic neural units, unreinforced by appropriate canal signals, may contribute more to a brief linear velocity component in perception than to rate of attitude change. Otolith-mediated attitude perception within a given earth-vertical plane can be distorted by strong coplanar angular velocity canal information. Once distorted, return to veridical attitude perception can be gradual because, in the absence of complimentary canal or visual information, recovery is dependent upon relatively slow cognitive appreciation of a prevailing otolith position signal. Several attractive hypotheses relating to the dynamics of attitude perception can only be tested by substantially more data on the dynamics of spatial orientation perception. Most of our objectives cannot be achieved without models that yield valid prediction of the dynamics of spatial orientation perception. All of the observations in these experiments were carried out in darkness, or, in the simulated catapult experiment, without external visual reference. Various forms of visual information will change the dynamics of spatial orientation perception. My discussion has been limited to consideration of the vestibular system, as though the canal and otolith systems completely controlled the dynamics of spatial orientation perceptions. Obviously other partners in the dynamics of postural control, including vision, proprioception, and expectation, must be included in this challenging field of research. Dedication to stereotyped ideas about objectivity in the 20th century has hindered advancement of knowledge on the dynamics of spatial orientation perception relative to rate of progress achieved by several scientists of the 18th and 19th centuries, who provided word pictures of perceived motions and tilts along with descriptions of the motions that engendered the pictures.(ABSTRACT TRUNCATED AT 400 WORDS)
Gravitation↗
Risk perception for developing diabetes: comparative risk judgments of physicians.
OBJECTIVE: To assess personal risk perceptions for developing diabetes among practicing physicians. RESEARCH DESIGN AND METHODS: Little is known about comparative risk perceptions concerning diabetes among medical experts. We administered the new Risk Perception Survey for Developing Diabetes to 535 nondiabetic physicians. The participants were 86% male, had a mean age of 49 years, and were 66% white and 24% Asian. Almost 37% were considered at higher risk for developing diabetes based on self-reported risk factors. Over 91% of respondents were either internal medicine or family medicine physicians. RESULTS: Of the four subscales, Comparative Disease Risk and Environmental Risk indicated moderate risk perceptions, whereas Personal Control scores indicated a robust sense of control over developing diabetes. Optimistic Bias scores showed a tendency toward participants' being optimistic that they were less likely to develop diabetes. Based on self-reported risk factor categories, a comparison of scores between physicians at higher risk (n = 196) and those at lower risk (n = 313) for developing diabetes showed greater comparative disease risk perception among the higher risk physicians (P < 0.01), as well as greater perception of diabetes risk (P < 0.001). Nearly 50% of higher risk physicians, however, reported an optimistic bias that they were less likely to develop diabetes than other people of their same age and sex. Women (n = 75) reported greater perception of environmental risks than men (P < 0.001). Asian respondents (n = 126) reported greater perception of environmental risk (P < 0.001) and greater worry about developing diabetes (P < 0.0001) than white respondents (n = 355). Regression analyses showed that scores for nondiabetes comparative disease risks (0.39) and level of optimistic bias (0.31) were predictive of diabetes risk perception (P < 0.0001). CONCLUSIONS: The data gathered on physicians' perception of their personal risk for developing diabetes and other comparative risk judgments provided an expert comparison for future analyses of at-risk or lay individuals' perceptions of diabetes risk. Effective communication of diabetes risk among physicians, patients, and the general public relies on knowledge of and sensitivity to group differences in these perceptions.
Air Pollution↗
[Relationships among self concept, perception of aging and physical aging].
Although everyone grows old, perception about the aging process and aging as measured physiologically vary widely. Perceptions of aging have psychologically influence on physical aging. This study was to examine the relationships between, self-concept, perception of aging, and physical aging in the elderly and to contribute to the theory development which may direct nursing intervention to promote well-being of the aged. Subjects were 70 women residents of a nursing home for the elderly in Seoul. Data collection was done from May 15 to June 15, 1988 using interview schedules and mechanical instruments. The instruments were selected items from the Health Self Concept Scale developed by Jacox and Stewart for self concept, and Secord and Jourad's Body Cathexis Scale and Osgood's Semantic Differential Scale for perception of aging. Physical aging was measured by mechanical instruments, inspection, questions, and palpation. The data were analysed for mean, t-test, ANOVA, and Pearson Correlation Coefficient using an S.P.S.S computerized program. The results of the analysis were as follows. 1. The mean level of self concept for the subject group was 16.97 (SD = +/- 6.17) in a range from 6-30. The mean level of perception of aging was 39.6. (SD = +/- 6.51) in a range from 13-65. The mean level of physical aging was 14.09 (SD = +/- 2.05) in a range from 8-40. 2. Relationships among self-concept, perception of aging, and physical aging. 1) There was a positive relationship between self-concept and perception of aging (r = 0.4461, p = 0.000). 2) There was a negative relationship between physical aging and perception of aging (r = -0.2975, p = 0.006). 3) There was a tendency toward a negative relationship between physical aging and self-concept, but not a significant relationship (r = -0.1033, p = 0.197). 3. 1) No general characteristic variables were related to self concept. 2) The general characteristic variable related to the level of perception of aging was religion (t = 4.17, p = 0.001). 3) The general characteristic variable related to the level of physical aging was age (F = 12.008, p = 0.000). There was a significant relationship between self-concept and perception of aging, and between physical aging and perception of aging. Therefore nursing intervention should focus on promoting a positive perception of aging and strengthening self-concept during the physical aging process.
Aged↗
Attention-biased multi-stable surface perception in three-dimensional structure-from-motion.
Retinal velocity distributions can lead to a percept of three-dimensional (3D) structure (structure-from-motion [SFM]). SFM stimuli are intrinsically ambiguous with regard to depth ordering. A classic example is the orthographic projection of a revolving transparent cylinder, which can be perceived as a 3D cylinder that rotates clockwise and counterclockwise alternately. Prevailing models attribute such bistable percepts to inhibitory connections between neurons that are tuned to opposite motion directions at equal binocular disparities. Cylinder stimuli can yield not only two but as many as four different percepts. Besides the well-documented clockwise and counterclockwise spinning transparent cylinders, observers can also perceive two transparent half-cylinders, either convex or concave, one in front of the other. Observers are able to bias the time during which a percept is present by attending to one or the other percept. We examined this phenomenon quantitatively and found that in standard SFM stimuli, the percept of two convex transparent half-cylinders can occur just as often as the percept of (counter-) clockwise spinning cylinders. So far, however, all interpretations of experimental (neurophysiological) data and all proposed mechanisms for SFM perception have focused solely on the two classical cylinder percepts. Prevailing models cannot explain the existence of the other two percepts. We suggest an alternative model to explain attention-biased multi-stable perception.
Attention↗
A survey of physicians' vaccine risk perception and immunization practices for subjects with immunological diseases.
Various publications have caused concern by implying that immunization may be linked to new cases or flare-ups of immunological diseases (IDs). In view of the resulting uncertainty, we studied physicians' vaccine risk perception and immunization practices for adults with IDs. A questionnaire was mailed to three groups of physicians in France: internal medicine specialists, general practitioners, and travel clinic physicians. Thirteen vaccines currently used for adults in France were studied. Risk perception was rated on a 10 cm visual analog scale (VAS). The distribution of the answers was compared between and within groups of physicians. Potential associations between risk perception and reported practices were investigated by multivariate analysis. In the three groups of physicians (n=762), the tetanus and Salk poliomyelitis vaccines had the lowest risk perception. The yellow fever, BCG and Sabin poliomyelitis vaccines were the least well perceived. The distribution of risk perception for these three live vaccines and the hepatitis B vaccine was uniform according to VAS grading. For the other vaccines studied, the distribution was skewed to the low-risk perception side of the VAS. Risk perception was greater for physicians who stated: (1) that certain IDs carried a high risk of adverse events following immunization; (2) that they sought the advice of the referent physician before immunization; (3) warned their patients of the risk of an ID flare-up after vaccination; (4) sought information about recent immunization in patients with a flare-up; and (5) had experience of the side effects of immunization in adults with ID. Risk perception was lower for physicians who said they updated immunizations, and for the internists. The worse the vaccine risk perception by physicians, the more uniform the distribution of perception, thus reflecting the disagreement of the scientific community about the risk of using such vaccines for adults with an ID. Risk perception and immunization practices were related in adults with ID. Understanding of decisions concerning immunization may help to improve immunization updating and prevent risk amplification when evidence is lacking.
Adult↗
Correlation between rCBF and speech perception in cochlear implant users.
OBJECTIVE: Although cochlear implants (CIs) have provided the opportunity for bilaterally deaf individuals to recover their hearing abilities, the speech perception performances of the CI users varies considerably. To elucidate the cortical mechanisms of processing speech signals coded by CIs, we evaluated the correlation between the brain activity during speech activation and speech perception in CI users by PET. METHODS: Fourteen postlingually deaf CI users were examined. CI used in the patients was a 22-channel system and its speech-coding strategy was the Nucleus spectral peak (SPEAK) strategy. To evaluate the speech perception performances, we examined vowel perception, consonant perception and speech tracking performances in the Japanese language. Regional cerebral blood flow (rCBF) was measured during no sound stimulation and speech sound stimulation. PET data of the silent condition was subtracted from that of speech stimulation to determine changes in rCBF. In the search for changes in rCBF in the areas for auditory processing, three regions of interest (ROI) were selected; primary auditory area, auditory association area and Broca's area. The correlation between the rCBF changes in the ROIs and the speech perception performances was analyzed using Pearson's correlation coefficient. RESULTS: The patient's speech perception performances ranged widely. Although there were no significant correlations between the speech perception and the rCBF increases in the primary auditory area and Broca's area, there were positive correlations in the auditory association area. In the left auditory association area, the correlation coefficient of the vowel perception performance was 0.546 (P <0.05) and that of the speech-tracking test was 0.657 (P < 0.05). Regarding the consonant perception performance, the correlation coefficient was 0.743 (P < 0.01). There was a positive correlation only between the consonant perception performance and the rCBF increase (R = 0.576, P < 0.05) in the right auditory association area. These correlations are stronger in the left hemisphere than in the right hemisphere. CONCLUSIONS: It is suggested that the improvement of the auditory processing of speech in CI users with SPEAK strategy is accompanied by the recruitment of more neurons in the auditory association areas. The adult auditory cortices may still have plasticity or
Adult↗
The impact of prehospital instant photography of motor vehicle crashes on receiving physician perception.
OBJECTIVES: The study was conducted to determine whether the use of prehospital instant photography of motor vehicle crashes (MVCs) by paramedics altered receiving physician (RP) perception of the magnitude of crash severity, as compared with verbal reports of vehicle damage. In addition, the study sought to determine whether altered RP perception resulted in any subsequent changes in emergency department (ED) management. METHODS: A prospective questionnaire and retrospective chart review were used at a Level I suburban trauma center receiving MVC patients from a single municipal paramedic agency. Patients injured in MVCs who required advanced life support (ALS) interventions and were subsequently evaluated by either surgical residents, emergency medicine residents, or attending emergency physicians in the ED were eligible for study enrollment. Instant photographs of interior and exterior vehicle damage were obtained by paramedics who then provided a verbal report of vehicle damage to the RP. Initially blinded from the photographs, the RP was then asked to rate the severity of the crash based on the verbal report and list planned interventions (laboratory tests, blood products, radiographs, and probable patient disposition). The RP was then shown the crash photographs and once again asked to rate the crash severity based on the addition of the photos and list changes in patient management based on any alterations in his or her perception. Hospital records were then examined to determine costs billed to patients and the length of hospital stay for those patients who were admitted. RESULTS: Instant photographs resulted in changes in physician perception in 47% (27 of 58) of the cases. Eighty-five percent of these physicians rated the MVC as more severe than the verbal report had indicated (p < 0.05 by multiple and logistic regression). The RPs who did alter their perceptions based upon the addition of MVC photos then changed their ED management in 59% (16 of 27) of the cases. Patients whose crash photographs altered RP perception of crash severity and who were subsequently released from the ED had average ED costs of $686, as compared with average ED charges of $595 for released patients whose crash photos did not alter physician perception of crash severity (p > 0.05 by Student's t-test). Inpatient charges and lengths of stay were also similar between the two groups for admitted patients: $21,363/14 days for the perception-change group and $24,726/8 days for the no-change-in-perception group (p > 0.05 for all comparisons). CONCLUSION: The augmentation of verbal paramedic reports with prehospital instant photographs frequently altered both physician perception of MVC severity and subsequent ED management of these trauma patients. However, cost to the patient and length of hospital stay were not significantly altered as a result of the change in physician perception.
Accidents, Traffic↗