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PubMed1978

Clinical judgment: an ethical issue.

In conclusion, the position of this paper maintains that clinical judgment is a viable, ethical issue of the highest order. Clinical judgment involves the personal orientation, the ethical framework of the one making the decision. Whatever judgment is ultimately made carries with it the burden of the maker's personal ethical approach to life, to the nature of man and finally his approach to the world at large. Clinical judgment is inseparable from ethics. It is further maintained that there must be more research into the areas of clinical judgment in relation to psychiatric nursing research. Clinical specialists, in particular, will be called on to make increasingly complex judgments. They must have a valid method to assist in the formulation, testing and analysis of their decisions. A model must be developed that assists the decision maker in: 1. Objectively identifying and specifying stimul; 2. Controlling and regulating the conditions of the judgment-making-process, intrinsic as well as extrinsic; and 3. Defining and standardizing the conditions of reporting.

Clinical Competence↗

PubMed1988

[Moral judgment and prediction of criminality. Comparative study of delinquents and non-delinquents].

A group of imprisoned criminals was compared to two groups of not-criminals with regard to five modes of judgment (profile of judgment) measured by Baruk's Tsedek test. The delinquents use more self-interest judgment, social judgment and absence of judgment that the whole of the not-delinquents (significantly different). They more often use the mode of moral judgment than the not-delinquents of the control group (general population) but less often than the not-delinquents of the comparative group (subjects of high educational level and religious for more than half of them). From the profile of judgment obtained for each group, a formula of prediction of tendency to crime was elaborated. It makes it possible to classify with rather good reliability the persons tested in the category of criminals or not-criminals.

Adolescent↗

PubMed1996

Experienced psychiatric nurses' clinical judgments in everyday practices.

The purpose of this study was to explore the characteristics of clinical judgment through uncovering the everyday practices of experienced psychiatric nurses. Participants were 13 nurses and 4 licensed assistant nurses who worked at a private mental hospital. The participants were interviewed and encouraged to describe their everyday practices and clinical judgment episode. The narrative texts were interpreted by the researcher in this study. As a result, the following characteristics emerged: 1) Clinical judgment embedded in everyday practices is based on the experienced nurse's expert ability of knowing the patient and grasping the patient's situation; 2) Clinical judgment is clinical wisdom, including intuition, based on the nurse's experience; 3) Clinical judgment in patient-nurse interactions is strongly affected by closeness/distance in the relationship. Clinical judgment is not context free, rather it is very situational; 4) When group consensus and the nursing care plan exert conformity pressure, the group consensus tends to obstruct the development of an individual nurse's judgment.

Clinical Competence↗

PubMed1998

Neural response during preference and memory judgments for subliminally presented stimuli: a functional neuroimaging study.

Preexposing subjects to visual stimuli is sufficient to establish a subsequent preference, even when previous exposure is subliminal, such that explicit recognition is at chance. This influence of previous exposure on preference judgments, known as the "mere exposure effect," is a form of unconscious memory. The present functional neuroimaging study examines the mechanism of this effect. Nine volunteer subjects were studied using functional imaging while making forced choice judgments about abstract stimuli on the basis of either preference or memory. Each judgment type was made under two conditions: under one condition one or the other stimulus had previously been presented subliminally, whereas under the second condition both stimuli were novel. Memory judgments were associated with activation of left frontopolar cortex and parietal areas, whereas preference judgments were associated with activation of medial prefrontal cortex and regions of occipital cortex. The modulation of preference by objective familiarity (implicit memory) was associated with right lateral frontal activation. Significant activation of hippocampal gyrus was seen in response to objective stimulus novelty, regardless of judgment type required. Our data thus demonstrate activations of a memory system independent of recollective experience. Dissociable activations within this system implicate a frontopolar involvement in explicit retrieval attempt and right lateral prefrontal cortex involvement in implicit memory expressed in preference judgments. Furthermore, the results suggest that hippocampal response to stimulus novelty can be independent of conscious reportability of familiarity.

Adult↗

PubMed1999

Are societal judgments being incorporated into the uncertainty factors used in toxicological risk assessment?

The aim of this paper is to show that the uncertainty factors used in toxic risk assessment to develop exposure standards do contain societal judgments as well as technical judgments. The process generally used today originated in the 1950s, when a deterministic approach to risk was the norm. Technical judgments are required concerning the nature and the quality of the evidence used in the risk assessment. Judgments taken are essentially cautious. This caution may not matter when measured exposure is significantly below the standard and may be accepted when exposure occurs only following an approval process based on "gate keeping." More sophisticated judgments are required when actual exposure may exceed this type of standard or when risk needs to be compared with benefit. These circumstances can occur with patient exposure to human medicines and with occupational exposure to chemicals. Under these circumstances more explicitly considered societal judgments concerning what constitute "broadly acceptable" and "tolerable" risk criteria, and hence what are appropriate uncertainty factors, are required. The outcomes of those societal judgments are likely to vary according to the circumstances surrounding the exposure and have led to smaller uncertainty factors being considered appropriate for occupational exposure, when compared with widespread public exposure.

Humans↗

PubMed2003

Interpretation and judgmental biases in social phobia.

Previous research demonstrated that social phobia is characterized by content-specific interpretation and judgmental biases. The present study investigated whether this interpretation bias occurs not only in ambiguous, but also in positive and negative social events, and whether social phobic patients (SPs) are more characterized by a judgmental bias in costs than in probability. Besides, we argued that the judgmental bias observed in former studies could also be attributed to accurate estimations of SPs (of, for example, stuttering). Therefore, we assessed judgmental bias by the ratings of probability and costs of a negative evaluation (e.g. 'people dislike me') and not, as in previous studies, of negative social events (e.g. 'stuttering'). SPs (n=228) and normal controls (n=33) were presented social and non-social events ranging from positive to profoundly negative. They ranked four different interpretations on likelihood to assess interpretation bias, and rated the profoundly negative interpretation on probability and cost to assess judgmental bias. SPs demonstrated content-specific interpretation and judgmental biases that also occurred in positive and negative social events. In contrast with expectations, SPs were characterized by a judgmental bias in both costs and probability.

Adult↗

PubMed2003

Cognitive estimation and affective judgments in alcoholic Korsakoff patients.

Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions ('size,' 'weight,' 'quantity,' and 'time') and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients' results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome.

Aged↗

PubMed2003

Expert judgment and occupational hygiene: application to aerosol speciation in the nickel primary production industry.

In many situations characterized by sparse data, occupational hygienists have used subjective judgments that are claimed to be derived from their experience and knowledge. While this practice is widespread, there has been no systematic study of 'expert judgment' or the 'art' of occupational hygiene. Indeed, there is a need to address the question of whether there is such a thing as 'expert opinion' in occupational hygiene that is broadly shared by practicing professionals. This research, employing 11 experts who estimate an exposure parameter (the percentages of four nickel species) in 12 workplaces in a nickel primary production industry, provides a large dataset from which useful inferences can be drawn about the quality of expert judgments and the variability among the experts. A well-designed questionnaire that provided succinct information about the processes and baseline data served to calibrate the experts. The Bayesian framework has been used in this work to develop posterior means and standard deviations of the percentages of the four nickel species in the 12 workplaces of interest in the company. These estimates of the nickel speciation are at least as precise as--and most of the time more precise than--those provided by the sparse measurement data. There was a very high degree of agreement among the experts. A majority of the experts agreed among themselves 92% of the time, while almost two-thirds agreed 73% of the time. This, coupled with the fact that the experts came from varied backgrounds, seems to suggest that there is indeed some broad body of specialized knowledge that the experts are drawing on to reach similar judgments. It also seems that one type of expert is not necessarily any better than any other kind, and expertise does not necessarily require intimate familiarity with the workplace. In this example, the expert judgment exercise has indeed enhanced the quality of our knowledge of the exposure 'fingerprints' for the nickel industry workplaces studied and the combination of expert judgment and sparse data is better than the sparse data alone. For occupational hygiene exposure assessment, our experience suggests that such expert judgment methods can provide a cost-effective means to improve and refine information about workplace hazards. However, more study is warranted for situations where the domain of the quantity of interest has a much wider range of values, e.g. actual exposure values.

Air Pollutants, Occupational↗

PubMed2003

Personality judgments in adolescents' families: the perceiver, the target, their relationship, and the family.

The present study investigated whether personality judgments involve different processes in a family setting than in a nonfamily setting. We used the Social Relations Model to distinguish the effects of perceiver, target, perceiver-target relationship, and family on personality judgments. Family members of families with adolescents judged their own and the other members' Big Five factors. Judgments were found to depend on the relevance of personality factors within the family setting: Agreeableness and Conscientiousness were judged most consistently. Large relationship variance indicated that parents adjust their judgments to the target family member; large perceiver variance indicated that adolescents judge family members' personalities rather similarly. However, a comparison of self- and other-judgments showed adolescents' judgments to be no more related to their self-perceptions than parents' judgments. We concluded that the relevance of personality factors may differ on specific tasks within a setting.

Adolescent↗

PubMed1998

Paramedic judgment of the need for trauma team activation for pediatric patients.

OBJECTIVE: To determine the value of paramedic judgment in determining the need for trauma team activation (TA) for pediatric blunt trauma patients. METHODS: A prospective, observational study was conducted at the ED of Children's Hospital Medical Center of Akron between July 12, 1996, and February 28, 1997, in cooperation with Akron Fire Department emergency medical technician-paramedics (EMT-Ps). The ED provides on-line and off-line medical control for pediatric transports. Patients with minor or no identifiable injuries are released at the scene with the instructions to see a physician. The remainder are transported to the ED. The decision for TTA is based on ED trauma protocols as well as emergency physician judgment of injury severity in combination with the judgment of the treating paramedic. During the study, EMT-Ps were asked (before physician input) whether, based solely on their judgment, a patient needed TTA. Patients 0-14 years old who were involved in motor vehicle crashes, bike crashes, or falls from a height of >10 feet were included in the study. TTA was defined as necessary if the patient was admitted to the intensive care unit (ICU) or operating room (OR) for nonorthopedic surgical procedures. Out-of-hospital, ED, and hospital records were reviewed. Coroners' records as well as medical records of all trauma admissions during the study period were reviewed to ensure that the patients released at the scene were not mistriaged. RESULTS: One hundred ninety-two patients met study criteria. Eighty-five patients (44%) were transported to the ED, of whom 12 had TTA. EMT-Ps requested TTA for 10 of these patients, and 2 patients had TTA per ED trauma protocol. Two of the patients who were judged by EMT-Ps to need TTA were admitted to the ICU/OR, and neither of the patients identified by ED trauma protocol to require TTA were admitted to the ICU/OR. Two initially stable patients who did not have TTA deteriorated after arrival to the ED. Both were admitted to the ICU. The sensitivity and specificity of paramedic judgment of the need for TTA for pediatric blunt trauma patients were 50% (95% CI 9.2-90.8) and 87.7% (95% CI 78.0-93.6), respectively. The positive and negative predictive values were 16.7% (95% CI 2.9-49.1) and 97.3% (95% CI 89.6-99.5). None of the patients released at the scene was mistriaged based on the review of the coroners' and trauma admission records. CONCLUSION: Results of this investigation indicate that a small percentage of pediatric blunt trauma patients require TTA. EMT-P judgment alone of the need for TTA for pediatric blunt trauma patients is not sufficiently sensitive to be of clinical use. The low sensitivity is explained by the deterioration in the clinical condition of 2 initially stable patients. The paramedic disposition decisions from the scene were always accurate. Nontransport by emergency medical services (EMS) may be acceptable in some uninjured pediatric trauma patients. Injured pediatric trauma patients who appear to be stable may deteriorate shortly after injury. However, if a pediatric patient appears injured, transport from the scene and examination by a trauma specialist are needed. Finally, the role of paramedic judgment must be further defined by larger studies with urban, rural, and suburban EMS systems before it can be used as a sole predictor of TTA.

Adolescent↗

PubMed2000

Judgment of duration in individuals with ataxia-telangiectasia.

Several clinical investigations with adults suggest that the cerebellum may be critical for judgment of explicit time intervals; however, little work has been done in populations with lesions of the cerebellum acquired during development. We evaluated 17 individuals with ataxia-telangiectasia (AT), an autosomal recessive disorder with on-set in early childhood characterized by diffuse, almost selective, degeneration of the cerebellar cortex, and 21 normal controls, matched for age. Because patients with AT have motor impairment, verbal IQ (VIQ) was used to estimate intelligence; VIQ was significantly lower in the group with AT (p < .0001). Participants were tested using a test of judgment of duration that has been found to be impaired in adults with cerebellar lesions and a contrasting auditory control task (not impaired in adults with cerebellar lesions) involving judgment of pitch. After statistically controlling for VIQ, the 2 groups did not differ significantly on judgment of pitch, but those with AT performed significantly worse than controls on judgment of duration (p = .01). Children and adolescents with AT show deficits in judgment of duration but not of pitch, suggesting that the cerebellum may be critical for judgment of explicit time intervals at all ages.

Adolescent↗

PubMed1983

Individual differences in distance estimation: comparison of judgments in the field with those from projected slides of the same scenes.

This study was designed to determine the comparative accuracy with which trained and untrained observers could judge distances to a target and to assess the correspondence of those judgments with other judgments, by the same observers, from photographic slides of the same target and scene at identical viewing distances. 9 experienced and 15 untrained observers estimated distances ranging from 600 to 1550 m in 50-m increments. Photographic slides were made of the target at each distance and, 1 mo. later, observers made the same judgments from the slides. It was found that averages of the group's judgments in the field very closely approximated true target distances. However, judgments of the individual observers were so erratic and inaccurate as to render questionable the interpretation of those averages. In addition, while the averages of the group indicated that judgments from two-dimensional slides could be substituted fro three-dimensional real-world judgments, detailed analysis of the individual observers' performances dramatically contradicted this conclusion.

Discrimination Learning↗

PubMed1999

Functional magnetic resonance imaging of neural activity related to orthographic, phonological, and lexico-semantic judgments of visually presented characters and words.

Functional magnetic resonance imaging was used to investigate neural activity during the judgment of visual stimuli in two groups of experiments using seven and five normal subjects. The subjects were given tasks designed differentially to involve orthographic (more generally, visual form), phonological, and lexico-semantic processes. These tasks included the judgments of whether a line was horizontal, whether a pseudocharacter or pseudocharacter string included a horizontal line, whether a Japanese katakana (phonogram) character or character string included a certain vowel, or whether a character string was meaningful (noun or verb) or meaningless. Neural activity related to the visual form process was commonly observed during judgments of both single real-characters and single pseudocharacters in lateral extrastriate visual cortex, the posterior ventral or medial occipito-temporal area, and the posterior inferior temporal area of both hemispheres. In contrast, left-lateralized activation was observed in the latter two areas during judgments of real- and pseudo-character strings. These results show that there is no katakana "word form center" whose activity is specific to real words. Activation related to the phonological process was observed, in Broca's area, the insula, the supramarginal gyrus, and the posterior superior temporal area, with greater activation in the left hemisphere. These activation foci for visual form and phonological processes of katakana also were reported for the English alphabet in previous studies. The present activation showed no additional areas for contrasts of noun judgment with other conditions and was similar between noun and verb judgment tasks, suggesting two possibilities: no strong semantic activation was produced, or the semantic process shared activation foci with the phonological process.

Adult↗

PubMed1975

Moral judgment and parental identification among children.

The relationship of moral judgment and parental identification was studied in 50 boys and 50 girls, all of whom were white, lower-middle-class children, aged 9 1/2 to 11 1/2 years. Two hypotheses were proposed: (1) that within each sex group, children with a higher-level parental identification attain a higher stage of moral judgment than children with a lower level of parental identification; and (2) that there are no sex differences in the stage of moral judgment attained by Ss from similar socioeconomic backgrounds. Ss were screened for socioeconomic status and age. Moral judgment was defined in terms of Piaget's "two moralities" of the child and measured by a structured interview that consisted of five subtests taken from Piaget. Parental identification was measured by means of a semantic space and differential technique, and Ss were grouped on the basis of low, medium and high levels of paternal and maternal identification. Results indicate that there are no significant sex differences in moral judgment. Within each sex group there is a clear positive relationship between high-level identification and a higher stage of moral judgment.

Age Factors↗

PubMed1994

Clinical judgment survey of mental-health professionals: I. An assessment of opinions, ratings, and knowledge.

A sample of mental health professionals listed in the National Register of Health Service Providers in Psychology was surveyed to examine attitudes with regard to the generalizability of findings from clinical judgment research, general beliefs and practices about clinical judgment, and knowledge of scholarly articles and books in the clinical judgment literature. Of the participants, 98.1% were doctoral-level psychologists engaged in clinical practice. Results suggested that participants consistently agreed that tasks used in studies of clinical judgment were not representative of the types of activities performed in their clinical practice. Respondents believed that the study of clinical judgment was important and that research could have meaningful implications for their clinical practice. Participants' knowledge of the judgment literature was significantly lower than expected.

Adult↗

PubMed1998

Independent judgment-linked and motor-linked forms of artificial grammar learning.

Three experiments investigated whether a motor-linked measure (string typing speed) and an judgment-linked measure (grammatical judgment of strings) accessed the same implicit learning mechanisms in the artificial grammar learning task. Participants first studied grammatical strings through observation or through responding to each letter by typing it and then performed typing and grammatical judgment tests. Grammatical judgment test performance was better after observation than after respond learning, whereas typing test performance on higher order relations was worse after observation than after respond learning (Experiment 1). Participants transferred grammatical knowledge across letter sets on the grammatical judgment test, but not on the typing test (Experiment 2). Typing speed did not differ for hits (grammatical strings classified by participants as grammatical) and misses (grammatical strings classified as nongrammatical, Experiment 3). These results are consistent with typing and grammatical judgment tests tapping independent mechanisms and indicate that implicit learning may consist of many different forms of learning rather than being a unitary learning mechanism.

Adolescent↗

PubMed1998

The mere exposure effect is differentially sensitive to different judgment tasks.

The mere exposure effect is the increase in positive affect that results from the repeated exposure to previously novel stimuli. We sought to determine if judgments other than affective preference could reliably produce a mere exposure effect for two-dimensional random shapes. In two experiments, we found that brighter and darker judgments did not differentiate target from distracter shapes, liking judgments led to target selection greater than chance, and disliking judgments led to distracter selection greater than chance. These results for brighter, darker, and liking judgments were obtained regardless of whether shape recognition was greater (Experiment 1) or not greater (Experiment 2) than chance. Effects of prior exposure to novel shapes were reliably observed only for affective judgment tasks. These results are inconsistent with general predictions made by the nonspecific activation hypothesis, but not the affective primacy or perceptual fluency hypotheses which were discussed in terms of cognitive neuroscience research.

Adolescent↗

PubMed1977

Enhancement of maturity of moral judgment by parent education.

Relationships between maturity of moral judgment of parents, role-taking opportunities in the home, roletaking ability in children and maturity of children's moral judgment were studied. A parent intervention program designed to increase role-taking opportunities in the home thought to lead to an increase in the maturity of moral judgment of children was utilized. Suggestive evidence for the claim that it is possible to accelerate rates of moral maturity of children through intervening indirectly to train their parents was found. Significant relationships were also found between maturity of moral judgment in children and role-taking AND OPPORTUNITIES FOR role-taking in the home. Maturity of moral judgment of parents was not found to be significantly related to maturity of moral judgment of their children.

Adult↗