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PubMed1994

Estimating neonatal mortality risk: an analysis of clinicians' judgments.

BACKGROUND: Clinicians' estimates of mortality risk in the neonatal intensive care unit (NICU) have implications for patient triage, transfer, initiation and termination of life support, and allocation of medical resources. The accuracy of these judgments has not been studied, nor the differences between nurses and attending physicians. OBJECTIVES: 1) evaluate the accuracy of subjective judgments of NICU unit mortality risk, 2) identify the key components of clinician judgments, 3) compare accuracy between attending physicians and nurses, and 4) examine the utility of combining an objectively computed risk and clinician judgments to improve predictions. METHODS: We obtained estimates of mortality risk on 544 admissions to two NICUs on the day of admission from the attending physician and primary nurse. These were compared with an objective computed mortality risk based on birth weight and the Score for Neonatal Acute Physiology (SNAP) using a linear judgment analysis model, as well as with actual outcomes. RESULTS: Physicians and nurses had good discriminating power with actual mortality rates ranging from 0% among low risk patients to 67% among those with the highest mortality estimates. Physicians had a tendency to overestimate mortality risk. Clinicians base their estimates on the same factors and similar judgment weights as the empiric mortality risk model (22% birth weight, 62% illness severity (SNAP), 13% low Apgar, and 3% for intrauterine growth restriction). Clinicians place additional emphasis on therapeutic as well as physiologic factors. When the computed risk and physician judgment were combined, both made significant contributions in a logistic mortality risk model. CONCLUSIONS: Clinician judgments of mortality risk are fairly accurate and similar to an objective illness severity index. This simple method provides insight into clinical decision making and has important applications in improving direct patient care, appropriate allocation of medical resources, and medical training.

Clinical Competence↗

PubMed2002

The anterior frontomedian cortex and evaluative judgment: an fMRI study.

This study investigated the neuronal basis of evaluative judgment. Judgments can be defined as the assessment of an external or internal stimulus on an internal scale and they are fundamental for decision-making and other cognitive processes. Evaluative judgments (I like George W. Bush: yes/no) are a special type of judgment, in which the internal scale is related to the person's value system (preferences, norms, aesthetic values, etc.). We used functional magnetic resonance imaging to examine brain activation during the performance of evaluative judgments as opposed to episodic and semantic memory retrieval. Evaluative judgment produced significant activation in the anterior frontomedian cortex (BA 10/9), the inferior precuneus (BA 23/31), and the left inferior prefrontal cortex (BA 45/47). The results show a functional dissociation between the activations in the anterior frontomedian cortex and in the inferior precuneus. The latter was mainly activated by episodic retrieval processes, supporting its function as a multimodal association area that integrates the different aspects of retrieved and newly presented information. In contrast, the anterior frontomedian cortex was mainly involved in evaluative judgments, supporting its role in self-referential processes and in the self-initiation of cognitive processes.

Adult↗

PubMed1991

A model of clinical judgment processes in psychiatric nursing.

This study addressed judgment processes in psychiatric nursing by analyzing reported use of clinical cues cited as being relevant in the process of making a nursing judgment. Using an exploratory, qualitative approach, data were collected by interviewing 15 subjects who provided 36 in-depth interviews upon completion of an intake interview. Comparative content analysis was used to determine the underlying structure in subject reports. A model depicting judgment processes is presented and discussed. Results suggest that although judgments were highly context-dependent, all subjects assessed data labeled as universals in the psychiatric nursing assessment: suicidality, depression, drug and alcohol use, and patient functional abilities. Similarities among subjects were noted in that presenting behaviors were most salient, a categorization process occurs within the judgment process, and patients are included in the judgment process. Finally, nursing judgments uncovered an action orientation rather than a labeling function.

Adult↗

PubMed1987

Person memory and judgments: the impact of information that one is told to disregard.

Subjects read a series of behaviors with instructions to form an impression of the person who performed them. In some conditions, subjects were told after reading the behaviors that an administrative error had been made and that certain ones should be disregarded. If the behaviors that subjects were told to disregard were descriptively unrelated to the other behaviors in the series, their influence on trait judgments was greatest when they were presented last. If the behaviors to be disregarded were descriptively inconsistent with the remaining behaviors, their influence was greatest when they were first in the series but subjects were not told to ignore them until after the remaining ones were presented. If the to-be-disregarded behaviors implied the same trait as the remaining ones, they had an influence on trait judgments in both of these conditions. All of these effects were consistently greater when the trait implied by the behaviors to be disregarded was favorable. In fact, when behaviors implied an unfavorable trait, instructions to disregard them often led the behaviors to have a contrast effect on trait judgments. Subjects appeared to base their judgments on implications of the cognitive representations they formed of the person at the time information was first presented. They then adjusted these subjective judgments at the time they reported them to compensate for the influence they perceived the to-be-disregarded information to have, making relatively greater adjustments when this information was unfavorable than when it was favorable. An additional experiment provided further evidence of adjustment processes, but it indicated that subjects also base their judgments on a partial review of the information they have received. A general model of person memory and judgment proposed by Wyer and Unverzagt (1985) provided a satisfactory account of the results of these studies.

Attention↗

PubMed1988

Consensus in personality judgments at zero acquaintance.

This research focused on the target effect on a perceiver's judgments of personality when the perceiver and the target are unacquainted. The perceiver was given no opportunity to interact with the target, a condition we refer to as zero acquaintance. We reasoned that in order to make personality judgments, perceivers would use the information available to them (physical appearance). Consensus in personality judgments would result, then, from shared stereotypes about particular physical appearance characteristics. Results from three separate studies with 259 subjects supported this hypothesis. On two of the five dimensions (extraversion and conscientiousness) on which subjects rated each other, a significant proportion of variance was due to the stimulus target. Consensus on judgments of extraversion appears to have been largely mediated by judgments of physical attractiveness. Across the three studies there was also evidence that the consensus in judgments on these two dimensions had some validity, in that they correlated with self-judgments on those two dimensions.

Beauty↗

PubMed1995

Mood and judgment: the affect infusion model (AIM).

Evidence for the role of affective states in social judgments is reviewed, and a new integrative theory, the affect infusion model (AIM), is proposed as a comprehensive explanation of these effects. The AIM, based on a multiprocess approach to social judgments, identifies 4 alternative judgmental strategies: (a) direct access, (b) motivated, (c) heuristic, and (d) substantive processing. The model predicts that the degree of affect infusion into judgments varies along a processing continuum, such that judgments requiring heuristic or substantive processing are more likely to be infused by affect than are direct access or motivated judgments. The role of target, judge, and situational variables in recruiting high- or low-infusion judgmental strategies is considered, and empirical support for the model is reviewed. The relationship between the AIM and other affect-cognition theories is discussed, and implications for future research are outlined.

Affect↗

PubMed2006

The influence of improper sets of information on judgment: how irrelevant information can bias judged probability.

This article introduces 2 new sources of bias in probability judgment, discrimination failure and inhibition failure, which are conceptualized as arising from an interaction between error prone memory processes and a support theory like comparison process. Both sources of bias stem from the influence of irrelevant information on participants' probability judgments, but they postulate different mechanisms for how irrelevant information affects judgment. The authors used an adaptation of the proactive interference (PI) and release from PI paradigm to test the effect of irrelevant information on judgment. The results of 2 experiments support the discrimination failure account of the effect of PI on probability judgment. In addition, the authors show that 2 commonly used measures of judgment accuracy, absolute and relative accuracy, can be dissociated. The results have broad implications for theories of judgment.

Analysis of Variance↗

PubMed2005

Aging and conditional probability judgments: a global matching approach.

Age differences in bias in conditional probability judgments were investigated based on predictions derived from the Minerva-Decision Making model (M. R. P. Dougherty, C. F. Gettys, & E. E. Ogden, 1999), a global matching model of likelihood judgment. In this study, 248 younger and older adults completed frequency judgment and conditional probability judgment tasks. Age differences in the frequency judgment task are interpreted as an age-related deficit in memory encoding. Older adults' stronger biases in the probability judgment task point to age differences in criterion setting. Age-related biases were eliminated when age groups were equated on memory encoding by means of study time manipulation. The authors conclude that older adults' stronger judgment biases are a function of memory impairment.

Adolescent↗

PubMed2006

Olympic medals as fruits of comparison? Assimilation and contrast in sequential performance judgments.

The authors investigated the evaluative consequences of sequential performance judgments. Recent social comparison research has suggested that performance judgments may be influenced by judgments about a preceding performance. Specifically, performance judgments may be assimilated to judgments of the preceding performance if judges focus on similarities between the two. If judges focus on differences, however, contrast may ensue. The authors examined sequential performance judgments, using data gathered from the 2004 Olympic Games as well as data gathered in the laboratory with students or experienced gymnastics judges as participants. Sequential performance judgments were influenced by previously judged performances, and the direction of this influence depended on the degree of perceived similarity between the successive performances.

Achievement↗

PubMed2005

Comparison of clinician judgments and measurements of swallow response time: a preliminary report.

Practicing clinicians frequently offer judgments about aspects of swallowing physiology rather than performing actual measurements. Little is known about the accuracy of those judgments. The purpose of this preliminary study was to explore agreement of clinicians' judgments of pharyngeal swallow response time (PSRT) with temporal measurements of PSRT. In preparation for a larger study, PSRT was measured from the first 3 ml liquid bolus swallow that appeared in each of 20 videofluorographic swallowing evaluations. The same 20 swallows were then shown to 3 clinicians who were instructed to subjectively rate PSRT. The reliability of the PSRT measurements was strong (r > .95). Intrajudge and interjudge agreement was better than chance in all but 1 interjudge comparison. Percentage agreement between clinicians' judgments and the measurements, when the measurements were categorized as either not delayed or delayed, ranged from 60% to 95%. Chi-square and Phi statistics comparing the outcomes of clinicians' ratings with the measurement outcomes were significant, supporting the agreement of the judgments with the measurements. Although the results of tests of agreement were found to be acceptable, clinician experience and training remain important issues whenever clinical judgments are involved. Larger studies are needed to establish the accuracy and importance of clinicians' judgments of PSRT and observations of swallowing physiology.

Adult↗

PubMed1997

Consistency of physician judgments of capacity to consent in mild Alzheimer's disease.

OBJECTIVE: To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults. DESIGN: Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment. SETTING: University medical center. PARTICIPANTS: Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology. MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression. RESULTS: Competency judgements of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 (P < .0001) and differed significantly (P < .0001) from the physician group kappa of .14 (P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgements for the AD group (chi 2 = 63.8, P < .0001) but not for the control group (chi 2 = 4.1, P = 1.00). Within the Ad group, pairwise analyses revealed significant judgment disagreement (P < .01) for seven of the 10 physician pairs.

Aged↗

PubMed1990

Gradient effects of fundamental frequency on stop consonant voicing judgments.

The post-stop-release rise or fall of fundamental frequency (F0) is known to affect voicing judgments of syllables with ambiguous voice onset times (VOTs). In 1986, Silverman claimed that the critical factor was not direction of F0 change but rather its direction relative to the intonational contour. He further claimed that only F0s that start above and fall to the contour have an effect proportional to the size of the frequency change; F0s that rise to the contour by different amounts were claimed to be equivalent. In our first experiment, we examined the effect on voicing judgments of five onset F0s preceding a single, flat contour. Only falling F0s were differentiated in the first set of judgments, but after increased exposure to the syllables, even F0s below the contour differentially affected the voicing judgment. In a second experiment, the contour of the final part of the syllable was flat, rising or falling. F0 contour affected the judgments, as did onset F0s, but the two factors did not interact, indicating that the onset values were not being judged by reference to the contours. However, the contour which was predicted to result in more voiceless judgments also ended at a higher F0 in the vowel, and another effect of voicing is that the F0 is higher throughout the vowel after voiceless stops. In a third experiment, F0 contours were created to contrast contour and mean F0. The effect of the F0 during the vocalic segment appeared to be attributable to the average F0 rather than the contour. In all three experiments, the F0 onset values contributed to the voicing judgment whether they were above or below the putative intonation contour. The contribution of the lower F0s, while significant, was not as great as that of the higher F0s, which argues for a noncategorical contribution of intonation.

Cues↗

PubMed2003

Effects of the Ebbinghaus illusion on different behaviors: one- and two-handed grasping; one- and two-handed manual estimation; metric and comparative judgment.

Many studies have suggested that visually-guided action is largely immune to the effects of several pictorial illusions that strongly influence perceptual judgments. The judgments in these experiments, however, have usually involved comparisons of multiple elements within a display, whereas the visually-guided actions have typically involved a pincer grip directed to only one display element. The three experiments presented here assess the influence of this confound on the perception versus action illusion dissociation. In general, the studies suggest (a) that the confound affects perceptual judgment but not grasping or manual estimation, and (b) that difficult visuomotor tasks are more affected by the Ebbinghaus illusion than easier tasks. In Experiment 1, participants reached for or made judgments about plastic disks placed in the center of the Ebbinghaus illusion display. Some participants reached for or made judgments about only the disk on the right, whereas others reached for or judged both disks simultaneously. A large effect of the illusion was found for grasping and comparative judgment, but not for manual estimation or metric judgment. In Experiment 2, the disks were elevated slightly to make gripping the targets easier, and the effects of the illusion on grasping were greatly reduced. For Experiment 3, participants performed the manual estimation task while the hands were placed in view, on the surface of the table, and the effects of the illusion were significantly increased. Taken together, the experiments indicate that task difficulty and hand visibility affect whether a task will be influenced by pictorial illusions or not. One- and two-handed grasping seem to be affected approximately equally.

Behavior↗

PubMed2006

A heuristics approach to understanding cancer risk perception: contributions from judgment and decision-making research.

BACKGROUND: The likelihood judgments that people make about their risks for cancer have important implications. At the individual level, risk estimates guide protective actions, such as cancer screening. However, at the extremes, exaggerated risk judgments can also lead to anxiety that degrades quality of life or to aggressive self-protective actions that are unwarranted given the objective risks. At the policy level, risk judgments may serve as an indicator of societal perceptions of the "war" against cancer. Using risk judgments, the public expresses its belief about whether we are winning. PURPOSE: We present theoretical perspectives from judgment and decision making, illustrate how they can explain some of the existing empirical findings in the cancer risk literature, and describe additional predictions that have not yet been tested. CONCLUSIONS: Overall, we suggest that theories from the judgment and decision-making perspective offer a potentially powerful view for understanding and improving risk judgments for cancer and other diseases.

Attitude to Health↗

PubMed2001

Lighting position and judgments of distance of shadow-casting objects.

Participants recruited on the web performed in two experiments in which they viewed eight pictures of the same two rods in the exact same positions with shadows generated by a light source located at eight positions around the rods. In Exp. 1, participants judged how much shadows projected to the front, back, and sides of the rods facilitated the correct perception of the actual distance of the rods relative to each other. In Exp. 1 (n: 52), frontal lighting facilitated judgments more than lighting from the rear, but frontal and side lighting did not differ in facilitative effects. In Exp. 2 (n: 72), judgments of rods depicted with shadows were relative to a judgment of the rods depicted without shadows (raw scores were the value of the judgment of the shadowless rods subtracted from the value of the judgment of each of the eight sets of rods). Again, frontal lighting was more facilitative than rear lighting and frontal lighting did not differ from side lighting. However, when the average of each participant's backlighting judgments was compared with his judgment of the shadowless rods, shadows generated by backlighting were more facilitative than none.

Distance Perception↗

PubMed1999

Judgments of perceptual groups: reliability and sensitivity to stimulus transformation.

The reliability of subjects' judgments of the groups present in dot patterns and the sensitivity of those judgments to stimulus transformation were assessed. The subjects indicated the groups that they saw within random dot patterns, and each judgment was compared with those of other subjects and with their own judgments for related presentations. Within subjects, each pattern appeared in an initial presentation, an identical repetition, and a transformed state (a rotation or a change in scale). Within-subjects judgments were more reliable than between-subjects judgments. An interpretation of within-subjects results was made in relation to predictions made by a formal algorithm of grouping by proximity (the CODE algorithm), which assumes that grouping by proximity is invariant over transformations such as rotations or changes in scale. A slight cost to transforming the patterns was found. The implications for CODE and for using grouping judgments as data are discussed.

Humans↗

PubMed1999

Intersensory conflict between vision and touch: the response modality dominates when precise, attention-riveting judgments are required.

In four experiments, reducing lenses were used to minify vision and generate intersensory size conflicts between vision and touch. Subjects made size judgments, using either visual matching or haptic matching. In visual matching, the subjects chose from a set of visible squares that progressively increased in size. In haptic matching, the subjects selected matches from an array of tangible wooden squares. In Experiment 1, it was found that neither sense dominated when subjects exposed to an intersensory discrepancy made their size estimates by using either visual matching or haptic matching. Size judgments were nearly indentical for conflict subjects making visual or haptic matches. Thus, matching modality did not matter in Experiment 1. In Experiment 2, it was found that subjects were influenced by the sight of their hands, which led to increases in the magnitude of their size judgments. Sight of the hands produced more accurate judgments, with subjects being better able to compensate for the illusory effects of the reducing lens. In two additional experiments, it was found that when more precise judgments were required and subjects had to generate their own size estimates, the response modality dominated. Thus, vision dominated in Experiment 3, where size judgments derived from viewing a metric ruler, whereas touch dominated in Experiment 4, where subjects made size estimates with a pincers posture of their hands. It is suggested that matching procedures are inadequate for assessing intersensory dominance relations. These results qualify the position (Hershberger & Misceo, 1996) that the modality of size estimates influences the resolution of intersensory conflicts. Only when required to self-generate more precise judgments did subjects rely on one sense, either vision or touch. Thus, task and attentional requirements influence dominance relations, and vision does not invariably prevail over touch.

Adult↗

PubMed1999

Examination of judgments of drunkenness, binge drinking, and drunk-driving tendencies in teens with and without a family history of alcohol abuse.

BACKGROUND: The present study examined judgment processes of individuals with and without a family history of alcohol abuse. Despite the alarming statistics involving alcohol-related consequences in this population, very little is known about what judgment processes they use or how beneficial these processes are at preventing intoxication and alcohol-related consequences. METHODS: Participants were 270 individuals, 16-18 years old, screened on the basis of the history of family alcohol abuse. Individuals were asked to (1) make judgments of drunkenness in relation to the legal limits in response to factorially manipulated external cues on number of drinks, time taken to consume, and type of beverage, using the methodology of Jaccard and Turrisi (1987), and (2) answer several questions regarding their alcohol-related behaviors. RESULTS: Our results indicated that individuals with a positive family history of alcohol abuse were more likely to make judgmental errors and underestimate their drunkenness relative to individuals without a positive family history of alcohol abuse. Moreover, the errors in judgments were more pronounced in situations involving moderate to heavy alcohol consumption. Finally, family history was found to moderate the relationship between underestimation errors and drinking, and drinking and driving tendencies. For individuals with a positive family history of alcohol abuse, the more they tended to underestimate their drunkenness, the more likely they were to binge drink and drive after drinking. CONCLUSIONS: The findings suggest that judgmental errors tend to be an important process variable in the relationship between family history and alcohol-related behavioral tendencies. The findings are discussed with respect to potential behavioral antecedents (e.g., student binge drinking) and development of prevention programs geared toward training students to make more accurate judgments, using external cues.

Adolescent↗