Partial-birth abortion: should moral judgment prevail over medical judgment?
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Abortion, Induced↗
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Results for “Judgment”
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[A new terminal judgment method for family planning: indistinct comprehensive judgment].
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Asia↗
Does judgment for nurse require judgment for hospital? Case in point: Eversole v. Oklahoma Hosp. Founders (818 P. 2d. 456--OK (1991)).
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Accidental Falls↗
[Practicable judgments on characteristics of public health on a population level. 2. Diagnosis as a judgment on health].
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Diagnosis↗
Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.
OBJECTIVES: To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. DESIGN: Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. SETTING: A university medical center. PARTICIPANTS: Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. MEASUREMENTS: The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. RESULTS: As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). CONCLUSIONS: Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.
Alzheimer Disease↗
Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.
OBJECTIVES: To investigate measures of patient cognitive abilities as predictors of physician judgments of medical treatment consent capacity (competency) in patients with Alzheimer's disease (AD). DESIGN: Predictor models of legal standards (LS) and personal competency judgments were developed for each study physician using independent neuropsychological test measures and logistic regression analyses. SETTING: A university medical center. PARTICIPANTS: Five physicians with experience assessing the competency of AD patients were recruited to make competency judgments of videotaped vignettes from 10 older controls and 21 patients with AD (10 with mild and 11 with moderate dementia). MEASUREMENTS: The 31 patient and control videotapes of performance on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI) were rated by the five physicians. The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Each study physician viewed each vignette videotape individually, made judgments of competent or incompetent under each of the LS, and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis and neuropsychological test performance. Stepwise logistic regression was conducted to identify cognitive predictors of each physician's LS and personal competency judgments for Vignette A using the full sample (n = 31). Classification logistic regression analysis was used to determine how well these cognitive predictor models classified each physician's competency judgments for Vignette A. These classification models were then cross-validated using physician's Vignette B judgments. RESULTS: Cognitive predictor models for Vignette A competency judgments differed across individual physicians, and were related to difficulty of LS and to incompetency outcome rates across LS for AD patients. Measures of semantic knowledge and receptive language predicted judgments under less difficult LS of evidencing a treatment choice (LS1) and making the reasonable treatment choice (LS2). Measures of semantic knowledge, short-term verbal recall, and simple reasoning ability predicted judgments under more difficult and clinically relevant LS of appreciating consequences of a treatment choice (LS3), providing rational reasons for a treatment choice (LS4), and understanding the treatment situation and choices (LSS). Cognitive models for physicians' personal competency judgments were virtually identical to their respective models for LS5 judgments. For AD patients, shortterm memory predictors were associated with high incompetency outcome rates (over 70%), a simple reasoning measure was associated with moderately high incompetency outcome rates (60-70%), and a semantic knowledge measure was associated with lower incompetency outcome rates (30-60%). Overall, single predictor models were relatively robust, correctly classifying an average of 83% of physician judgments for Vignette A and 80% of judgments for Vignette B. CONCLUSIONS: Multiple cognitive functions predicted physicians' LS and personal competency judgments. Declines in semantic knowledge, short-term verbal recall, and simple reasoning ability predicted physicians' judgments on the three most difficult and clinically most relevant LS (LS3-LS5), as well as their personal competency judgments. Our findings suggest that clinical assessment of competency should include evaluation of semantic knowledge, verbal recall, and simple reasoning abilities.
Alzheimer Disease↗
Functional neuroanatomy of different olfactory judgments.
Humans routinely make judgments about olfactory stimuli. However, few studies have examined the functional neuroanatomy underlying the cognitive operations involved in such judgments. In order to delineate this functional anatomy, we asked 12 normal subjects to perform different judgments about olfactory stimuli while regional cerebral blood flow (rCBF) was measured with PET. In separate conditions, subjects made judgments about the presence (odor detection), intensity, hedonicity, familiarity, or edibility of different odorants. An auditory task served as a control condition. All five olfactory tasks induced rCBF increases in the right orbitofrontal cortex (OFC), but right OFC activity was highest during familiarity judgments and lowest during the detection task. Left OFC activity increased significantly during hedonic and familiarity judgments, but not during other odor judgments. Left OFC activity was significantly higher during hedonicity judgments than during familiarity or other olfactory judgments. These data demonstrate that aspects of odor processing in the OFC are lateralized depending on the type of olfactory task. They support a model of parallel processing in the left and right OFC in which the relative level of activation depends on whether the judgment involves odor recognition or emotion. Primary visual areas also demonstrated a differential involvement in olfactory processing depending on the type of olfactory task: significant rCBF increases were observed in hedonic and edibility judgments, whereas no significant rCBF increases were found in the other three judgments. These data indicate that judgments of hedonicity and edibility engage circuits involved in visual processing, but detection, intensity, and familiarity judgments do not.
Adult↗
Duration, distance, and speed judgments of two moving objects by 4- to 11-year olds.
Four- to 11-year-old children (N = 133) made duration, distance, and speed judgments on a Piagetian task where two cars ran on two parallel tracks. Special effort was made to make duration judgment tasks and distance judgment tasks comparable. Among younger children, difficulties of duration judgments and distance judgments were approximately the same. Additionally, temporal attributes had nearly the same effects on duration judgments as spatial attributes had on distance judgments, and spatial attributes had nearly the same effects on duration judgments as temporal attributes had on distance judgments. Among older children, distance judgments were easier than duration judgments, and the above-mentioned symmetry in effects of temporal and spatial attributes decreased somewhat. Temporal and spatial attributes affected speed judgments equally, across age groups.
Acceleration↗
Brain correlates of aesthetic judgment of beauty.
Functional MRI was used to investigate the neural correlates of aesthetic judgments of beauty of geometrical shapes. Participants performed evaluative aesthetic judgments (beautiful or not?) and descriptive symmetry judgments (symmetric or not?) on the same stimulus material. Symmetry was employed because aesthetic judgments are known to be often guided by criteria of symmetry. Novel, abstract graphic patterns were presented to minimize influences of attitudes or memory-related processes and to test effects of stimulus symmetry and complexity. Behavioral results confirmed the influence of stimulus symmetry and complexity on aesthetic judgments. Direct contrasts showed specific activations for aesthetic judgments in the frontomedian cortex (BA 9/10), bilateral prefrontal BA 45/47, and posterior cingulate, left temporal pole, and the temporoparietal junction. In contrast, symmetry judgments elicited specific activations in parietal and premotor areas subserving spatial processing. Interestingly, beautiful judgments enhanced BOLD signals not only in the frontomedian cortex, but also in the left intraparietal sulcus of the symmetry network. Moreover, stimulus complexity caused differential effects for each of the two judgment types. Findings indicate aesthetic judgments of beauty to rely on a network partially overlapping with that underlying evaluative judgments on social and moral cues and substantiate the significance of symmetry and complexity for our judgment of beauty.
Adult↗
Cognitive models that predict physician judgments of capacity to consent in mild Alzheimer's disease.
OBJECTIVE: To identify cognitive measures that predict consent capacity of normal and demented older adults as judged by experienced physicians. This study is a companion to the physician competency judgment research reported in this issue. DESIGN: Predictor models for competency judgments of individual physicians were developed using independent patient neuropsychological test measures and discriminant function analyses (DFA). SETTING: University medical center. PARTICIPANTS: Subjects were 16 normal older controls and 29 patients with mild AD (MMSE > or = 20). Five experienced medical center physicians were recruited as competency decision-makers. MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Interview subjects were also independently administered (off videotape) a battery of neuropsychological measures theoretically and empirically linked to competency function. Study physicians blinded to subject diagnosis and neuropsychological test performance individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent to treatment. Stepwise DFA identified neuropsychological predictors of each physician's competency judgments for the full sample (N = 45). Classification DFAs determined how accurately these predictor models classified competency outcomes assigned by the individual physician. RESULTS: Cognitive models differed across individual physicians and were related to stringency of judgments for AD patients. Under stepwise DFA, delayed verbal recall (R2 = .57, P < .0001) predicted judgments of Physician 1 (incompetency rate of 90% for AD patients), short term verbal recall (R2 = .43, P < .0001) predicted judgments of Physician 2 (incompetency rate of 52%), phonemic word fluency (R2 = .27, P < .001) predicted judgments of Physician 3 (incompetency rate of 24%), and visuomotor tracking/sequencing (R2 = .31, P < .001) predicted judgments of Physician 4 (incompetency rate of 14%). (No predictor model was available for Physician 5 as this physician found all subjects to be competent). These single predictor solutions correctly classified 93%, 87%, 87%, and 96% of cases for Physicians 1-4, respectively. Use of two predictor solutions achieved successful classification rates between 98% and 100%. CONCLUSIONS: We identified two cognitive models of consent capacity as judged by physicians: (1) verbal recall and (2) simple executive function. The verbal recall model predicted judgments of physicians likely to find mild AD patients incompetent, whereas the executive function model predicted judgments of physicians likely to find mild AD patients competent. Assessment of verbal recall and simple executive functions may provide important information in the clinical evaluation of capacity to consent to treatment.
Aged↗
Measuring the fit between human judgments and automated alerting algorithms: a study of collision detection.
Methodologies for assessing human judgment in complex domains are important for the design of both displays that inform judgment and automated systems that suggest judgments. This paper uses the n-system lens model to evaluate the impact of displays on human judgment and to explicitly assess the similarity between human judgments and a set of potential judgment algorithms for use in automated systems. First, the need for and concepts underlying judgment analysis are outlined. Then the n-system lens model and its parameters are formally described. This model is then used to examine a previously conducted study of aircraft collision detection that had been analyzed using standard analysis of variance methods. Our analysis found the same main effects as did the earlier analysis. However, n-system lens model analysis was able to provide greater insight into the information relied upon for judgments and the impact of displays on judgment. Additionally, the analysis was able to identify attributes of human judgments that were--and were not--similar to judgments produced by automated systems. Potential applications of this research include automated aid design and operator training.
Accident Prevention↗
Influence of speaker gender on listener judgments of tracheoesophageal speech.
The objectives of this prospective and exploratory study are to determine: (1) naïve listener preference for gender in tracheoesophageal (TE) speech when speech severity is controlled; (2) the accuracy of identifying TE speaker gender; (3) the effects of gender identification on judgments of speech acceptability (ACC) and naturalness (NAT); and (4) the acoustic basis of ACC and NAT judgments. Six male and six female adult TE speakers were matched for speech severity. Twenty naïve listeners made auditory-perceptual judgments of speech samples in three listening sessions. First, listeners performed preference judgments using a paired comparison paradigm. Second, listeners made judgments of speaker gender, speech ACC, and NAT using rating scales. Last, listeners made ACC and NAT judgments when speaker gender was provided coincidentally. Duration, frequency, and spectral measures were performed. No significant differences were found for preference of male or female speakers. All male speakers were accurately identified, but only two of six female speakers were accurately identified. Significant interactions were found between gender and listening condition (gender known) for NAT and ACC judgments. Males were judged more natural when gender was known; female speakers were judged less natural and less acceptable when gender was known. Regression analyses revealed that judgments of female speakers were best predicted with duration measures when gender was unknown, but with spectral measures when gender was known; judgments of males were best predicted with spectral measures. Naïve listeners have difficulty identifying the gender of female TE speakers. Listeners show no preference for speaker gender, but when gender is known, female speakers are least acceptable and natural. The nature of the perceptual task may affect the acoustic basis of listener judgments.
Adult↗
Do different metamemory judgments tap the same underlying aspects of memory?
We compared the predictions from several kinds of metamemory judgments (on the same set of items), both in terms of their predictive accuracy and in terms of the commonality of predictions. Undergraduates made judgments about the ease with which they could learn each item in a list (ease-of-learning judgments); then they learned every item, either to a minimal criterion of learning or with overlearning, and made judgments about how well they knew each item (judgments of knowing); finally, they returned 4 weeks later for a retention session and made feeling-of-knowing judgments on every time they could not recall, after which a recognition test assessed predictive accuracy. Ease-of-learning judgments had the least predictive accuracy. Surprisingly, however, the recognition of nonrecalled items was predicted equally well by judgments of knowing (made 4 weeks earlier) as by feeling-of-knowing judgments (made immediately prior to recognition). Moreover, those two kinds of judgments were only weakly correlated with each other, which implies that they do not tap memory in the same way.
Attention↗
Relative and absolute duration judgments under prospective and retrospective paradigms.
A dual-process contingency model of short duration judgment is proposed and tested. The first process, or P(t), is a timer that uses cognitive capacity to keep track of units of time. If capacity is directed toward other tasks, P(t) will record fewer units and produce lower time judgments than when capacity is not directed toward other tasks. This timing process is most likely to affect performance when people know in advance (prospective judgments) that time judgments will be required and when absolute, rather than relative, judgments are made. The second process, or P(m), which is used for retrospective and relative judgments, judges duration on the basis of the number of remembered high priority events (HPEs) occurring during the interval. When this process is used, time judgments increase with the amount of HPEs that can be retrieved at the moment of judgment. Two experiments are reported. Tactual stimuli were presented, and nontemporal information processing load (simple or complex stimuli), type of judgment (absolute or relative), and judgment paradigm (prospective or retrospective) were manipulated. The results obtained support the proposed dual-process contingency model.
Adult↗
Descriptive and evaluative judgment processes: behavioral and electrophysiological indices of processing symmetry and aesthetics.
Descriptive symmetry and evaluative aesthetic judgment processes were compared using identical stimuli in both judgment tasks. Electrophysiological activity was recorded while participants judged novel formal graphic patterns in a trial-by-trial cuing setting using binary responses (symmetric, not symmetric; beautiful, not beautiful). Judgment analyses of a Phase 1 test and main experiment performance resulted in individual models, as well as group models, of the participants' judgment systems. Symmetry showed a strong positive correlation with beautiful judgments and was the most important cue. Descriptive judgments were performed faster than evaluative judgments. The ERPs revealed a phasic, early frontal negativity for the not-beautiful judgments. A sustained posterior negativity was observed in the symmetric condition. All conditions showed late positive potentials (LPPs). Evaluative judgment LPPs revealed a more pronounced right lateralization. It is argued that the present aesthetic judgments engage a two-stage process consisting of early, anterior frontomedian impression formation after 300 msec and right-hemisphere evaluative categorization around 600 msec after onset of the graphic patterns.
Adult↗
Use of expert judgment in exposure assessment. Part I. Characterization of personal exposure to benzene.
This paper presents the results of the first phase of a study, conducted as an element of the National Human Exposure Assessment Survey (NHEXAS), to demonstrate the use of expert subjective judgment elicitation techniques to characterize the magnitude of and uncertainty in environmental exposure to benzene. In decisions about the value of exposure research or of regulatory controls, the characterization of uncertainty can play an influential role. Classical methods for characterizing uncertainty may be sufficient when adequate amounts of relevant data are available. Frequently, however, data are neither abundant nor directly relevant, making it necessary to rely to varying degrees on subjective judgment. Since the 1950s, methods to elicit and quantify subjective judgments have been explored but have rarely been applied to the field of environmental exposure assessment. In this phase of the project, seven experts in benzene exposure assessment were selected through a peer nomination process, participated in a 2-day workshop, and were interviewed individually to elicit their judgments about the distributions of residential ambient, residential indoor, and personal air benzene concentrations (6-day integrated average) experienced by both the non-smoking, non-occupationally exposed target and study populations of the US EPA Region V pilot study. Specifically, each expert was asked to characterize, in probabilistic form, the arithmetic means and the 90th percentiles of these distributions. This paper presents the experts' judgments about the concentrations of benzene encountered by the target population. The experts' judgments about levels of benzene in personal air were demonstrative of patterns observed in the judgments about the other distributions. They were in closest agreement about their predictions of the mean; with one exception, their best estimates of the mean fell within 7-11 microg/m(3) although they exhibited striking differences in the degree of uncertainty expressed. Their estimates of the 90th percentile were more varied with the best estimates ranging from 12 to 26 microg/m(3) for all but one expert. However, their predictions of the 90th percentile were far more uncertain. The paper demonstrates that coherent subjective judgments can be elicited from exposure assessment scientists and critically examines the challenges and potential benefits of a subjective judgment approach. The results of the second phase of the project, in which measurements from the NHEXAS field study in Region V are used to calibrate the experts' judgments about the benzene exposures in the study population, will be presented in a second paper.
Benzene↗
[Methodology of retrospective chart review to detect adverse events: the reliability of physician judgment].
PURPOSE: To establish a scientific basis for promoting patient safety, basic information related to the incidence of adverse events (AEs) is needed. In studies in several other countries, trained nurses screened for potential AEs using explicit criteria in the first stage, and physicians reviewed selected charts in the second stage. To assure the accuracy of retrospective chart review, it is important to verify the reliability of AE judgments by physician reviewers. The purpose of this study was to test this reliability of judgment of AEs (their presence, causation of healthcare management and preventability) by three physician reviewers. METHODS: This study used 100 selected charts of non-psychiatric inpatients in an acute care hospital. Three physicians independently assessed AEs and discussed their judgments with the physician who created the manual for judging AEs. We considered judgments of the AEs agreed on by the four physicians to be final AE judgments and compared the reliability of each measure related to AE judgments among the physician reviewers using the kappa statistic. RESULTS: The number of AE cases each physician reviewer judged ranged from 18 to 27. Agreement on the presence of an AE ranged from 83.0% to 90.0% (kappa=0.52-0.70). Ultimately, AEs were judged to have occurred in 16 cases while 7 cases were deferred. The agreement on the presence of an AE between the physician's and the final judgment ranged from 86.0% to 96.8% (kappa = 0.56-0.88). However, agreement on the causation of healthcare management and preventability between the physician's and the final judgment was not in the acceptable range. CONCLUSION: The reliability of each physician's judgments regarding the presence of an AE was satisfactory. However, the reliability of judgments related to the causation of health care management and preventability was not necessarily satisfactory. Therefore, it is considered important to judge causation and preventability based on discussion with clinical experts in the relevant field.
Adolescent↗
Living wills and substituted judgments: a critical analysis.
In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the "power of attorney"), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The ever more common aversion of best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit.
Decision Making↗