Global Judgments Research Articles

Long-term results of the medical treatment of coronary artery disease.

The natural history of patients with ischemic heart disease varies widely depending upon the anatomic lesion and extent of left ventricular dysfunction. Several clinical variables may also be used to help determine the likelihood of long-term survival. Individuals with high-grade isolated disease of the left anterior descending coronary artery, without significant impairment of ventricular function, have little morbidity and mortality for the 2-year period after arteriography. At the other end of the spectrum, medically treated patients with stenosis of the left main coronary artery or three-vessel disease without such involvement have a reduced life expectancy compared with patients treated surgically. Global judgments on long-term results of the medical treatment of coronary artery disease are meaningless. Efforts should be made to delineate optimal treatment for various subgroups of patients under the broad rubric of ischemic heart disease.

A Rating Scale for Chemotherapy on Simple Acute Cystitis

In clinical evaluations of chemotherapy, operational rating scales for clinical states or their changes have usually been employed to integrate and summarize several symptoms or signs.This report describes an attempt to establish a rating scale for chemotherapy on simple acute cystitis. The data applied here were taken from a double blind study which was carried out lately to evaluate the efficacy of pivmecillinam including 216 cases with simple acute cystitis. For this study, subjective global judgement on the effect of chemotherapy was available together with data of four target symptoms: urinary frequency, pain during urination, WBC in sediment and bacterial count in urine.Statistical analyses on interrelationship revealed considerable high correlation between global judgement and individual changes in symptoms, strongly suggesting that global judgement could be validly explained by these symptoms. Since changes in symptoms correlated with each other, one of them, pain during urination, could be dropped without loss of statistical efficiency. In adopting the remaining three symptoms, the squared multiple correlation coefficient R2 was 0.835, the correlaton ratio in Hayashi's quantification theory η2 was 0.880, and WBC had the largest weight in the estimation. As the result of these analyses, a simple scale of scores 0-8 was tentatively established, which agreed satisfactorily with global judgement; the agreement ratio was 87.7%.

An Assessment Method of Clinical States in Bacterial Pneumonia

Patients with pneumonia have a variety of symptoms such as dyspnea, cyanosis, cough, rales, fever, chest pain, leukocytosis, increase of erythrocyte sedimentation rate, all of which do not appear, deteriorate or improve in a parallel manner. For making objective assessments in adequate and well controlled clinical investigations, it is favorable to use a rating scale which is well characterized both by the assessment criteria of the individual symptoms and by the investigation on the relationship between the various symptoms. Although some works on this subject have been done, the assessment method is not well established.In this paper, data on 72 cases with bacterial pneumonia being applied, assess ment criteria for chest X-ray films is discussed, and factor analytic approach is adopted to examine the basic structure of symptoms including findings on X-ray films. Three factors were extracted, each of which was characterized by a corresponding group of symptoms such as cyanosis, rales etc. for the first factor, cough and sputum for the second, fever and other general symptoms for the third. It was turned out that the first followed by the second symptom group showed speedy recovery, whereas improvement of the third group was clearly delayed; the disappearance ratio after two-week treatment was 78.6%, 81.8%, 13.9% in the first, second and third symptom group respectively. Correlation of subjective global judgement with these characteristic inclinations of each symptom group observed here was also investigated, and finally, a tentative rating scale for the assessment of chemotherapy on pneumonia is proposed.

On being sane in insane places

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment-the powerlessness, depersonalization, segregation, mortification, and self-labeling-seem undoubtedly countertherapeutic. I do not, even now, understand this problem well enough to perceive solutions. But two matters seem to have some promise. The first concerns the proliferation of community mental health facilities, of crisis intervention centers, of the human potential movement, and of behavior therapies that, for all of their own problems, tend to avoid psychiatric labels, to focus on specific problems and behaviors, and to retain the individual in a relatively non-pejorative environment. Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted. (The risk of distorted perceptions, it seems to me, is always present, since we are much more sensitive to an individual's behaviors and verbalizations than we are to the subtle contextual stimuli that often promote them. At issue here is a matter of magnitude. And, as I have shown, the magnitude of distortion is exceedingly high in the extreme context that is a psychiatric hospital.) The second matter that might prove promising speaks to the need to increase the sensitivity of mental health workers and researchers to the Catch 22 position of psychiatric patients. Simply reading materials in this area will be of help to some such workers and researchers. For others, directly experiencing the impact of psychiatric hospitalization will be of enormous use. Clearly, further research into the social psychology of such total institutions will both facilitate treatment and deepen understanding. I and the other pseudopatients in the psychiatric setting had distinctly negative reactions. We do not pretend to describe the subjective experiences of true patients. Theirs may be different from ours, particularly with the passage of time and the necessary process of adaptation to one's environment. But we can and do speak to the relatively more objective indices of treatment within the hospital. It could be a mistake, and a very unfortunate one, to consider that what happened to us derived from malice or stupidity on the part of the staff. Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent. Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves than to personal callousness. Their perceptions and behavior were controlled by the situation, rather than being motivated by a malicious disposition. In a more benign environment, one that was less attached to global diagnosis, their behaviors and judgments might have been more benign and effective.

Language attitudes: An analysis of teacher differences

Based upon a (Q‐type factor analysis, teachers were grouped according to their patterns of rating videotaped speech samples of Black, Anglo, and Mexican‐American children. As in prior research, ratings reflected global judgments of confidence‐eagerness and ethnicity‐nonstandardness. General corroboration xvas found among speech ratings, teachers’ stereotype ratings of different ethnic groups, and the teachers’ academic expectations of children representing such groups. Results held a number of implications regarding the linguistic attitudes of teachers.

Cue definition and residual judgment

A major problem in naturalistic studies is the defining of cues. The problem of cue definition leads to a consideration of the residual variance in modelling the judge. The part of judgment that cannot be modelled (i.e., the residual) is assumed to consist of cues not adequately defined and mis-specification of the integration function. The major question asked is whether the residual portion of judgment has functional value, i.e., does it add to the clinician's predictive efficiency. Cue definition is shown to be related to the “bootstrapping” phenomenon. The conditions where bootstrapping will work are delineated. The issue is shown to depend on the correlation of the residual and the criterion. Furthermore, psychological achievement is shown to be a weighted sum of the modelled and residual parts of judgment where the weight parameters are interpreted as “environmental complexity.” Two naturalistic studies are examined to investigate the residual contribution to achievement. It is shown that the residual enters into achievement most prominently in situations where the model of man is poor. Moreover, for certain cases one gets a reverse bootstrapping, i.e., the residual correlates higher with the criterion than either the model of the man or the global judgment. Further results are discussed and their implications noted.

Differentiation Matching in School Desegregation Workshops

The effectiveness of matching the conceptual structure of participants in educational training and psychotherapy experiences has been demonstrated in previous research. This paper describes an attempt to test the effectiveness of this model in a school desegregation workshop designed to promote a mandatory bussing proposal by a local school board. Differentiation matching had little effect on participants' global judgments of satisfaction with workshop goals but was significantly and inversely related to the decision to voluntarily bus a child, especially among blacks. Abstractness of topics discussed affected participant endorsement of workshop goals but did not affect bussing decision. The findings suggest that how such workshops are organized is dependent on whether the workshop success is to be evaluated on the basis of community public relations or actual decisions to bus children.

How ill is the patient at this time? Cues determining clinician's global judgments.

How ill is the patient at this time? Cues determining clinician's global judgments.

Growth hormone responses to administration of L-5-hydroxytryptophan (L-5-HTP) in manic-depressive psychoses.

SummaryFourteen hospitalized patients with manic‐depressive psychoses received L‐5‐hydroxy‐tryptophan (L‐5‐HTP), a serotonin precursor, which has been postulated as a potent antidepressive agent. Plasma human growth hormone (HGH) and glucose levels were measured at 30 minute intervals after oral administration of 200mg of L‐5‐HTP. Plasma cortisol levels prior to L‐5‐HTP administration were also measured.1. In five manic‐depressive (bipolar) patients, aged 17 to 60, each subject studied in manic state showed an adequate HGH response of more than 5.0ng/ml (maximum levels:17.7±7.1 ng/ml Mean± S.E.M., controls, aged 27 to 41:10.5±1.6 ng/ml), while those in depressive state failed to secrete HGH adequately (maximum levels ranged 1.4‐4.8 ng/ml) (p>0.05).2. Of five determinations from three endogenous depressive (unipolar) patients, aged 30 to 51, three showed adequate responses (maximum levels ranged 2.6–16.5 ng/ml). Nine out of 10 tests from six patients with protracted depressive symptoms prolonged for 2 to 6 years, aged 45 to 65, had deficient responses of HGH (maxi mum levels: 2.1±k0.5 ng/ml Mean±S.E.M., ranged 0.1–5.6 ng/ml) (p>0.01).3. Deficiency of pituitary HGH secretion appeared to correlate neither with the score of Hamilton's Depression Scale nor with the global judgement on the severity of the illness. Increments in the blood glucose levels after L‐5‐HTP administration were only mild ones, to which HGH insensitivity may be irrelevant. Morning plasma cortisol levels in depressives, ob served as high as those in manics, also may be unrelated.4. Treatment with 300 mg of L‐5HTP daily for two weeks proved to have no favorable clinical effects on four depressive patients, who were categorized as non‐responders of HGH.Because there is evidence suggesting pituitary hormone release related to brain bio‐genic amines, the deficient HGH responses to L‐5‐HTP in depressed patients may be due to a neurochemical defect hypothesized in the manic‐depressive psychoses. The HGH responses were most distinctly diminished in the protracted depressive patients, suggesting an endocrine hypofunction which may cause the fixation of the depressive symptoms.

The Comparison of Therapeutic Effects of FK-880 (Sulpiride) and Perphenazine in Schizophrenia by A Double-blind Controlled Study

The authors carried out a pilot study on therapeutic effectiveness of sulpiride mainly in the treatment of schizophrenia. The results of this study were already published (Journal of New Remedies & Clinics 22 ; 29, 1973). This paper presents the effect of sulpiride on schizophrenia by a double-blind controlled study compared with perphenazine, an established standard neuroleptic. The subjects enrolled were 64 hospitalized chronic schizophrenics, who were divided into two groups and daily given4-10 tablets of either sulpiride (100mg/Tab.) or perphenazine (3mg/Tab.) for a period of 6 weeks. During this period, 9 patients, 5 receiving sulpiride and 4 receiving perphenazine, dropped out. The global comparative judgement after the treatment for 6 weeks revealed statistically no significant difference in the therapeutic effects between both drug groups by a sequential analysis. The general improvement rating after the treatment for 6 weeks revealed that the slight or more improvement was observed in 44.4% of patients given sulpiride and 55.2% of patients given perphenazine, while the moderate or more improvement was observed in 29.6% and 13.8%, respectively. In patients suffering from schizophrenia for over 5 years, sulpiride showed significantly more favourable effect than perphenazine (P<0.05). This result suggests that sulpiride could be also favourably effective in the treatment of chronic schizophrenia. In the items of the three universities' rating scale, perphenazine made significantly higher improvement in hallucination than sulpiride (P<0.05) 4 and 6 weeks after initiation of the treatment. In the incidence of side effects, no significant difference was observed between the two groups. In the laboratory tests performed in all the patients no contributory abnormal findings were obtained.

A Double-Blind Controlled Trial of S-1530 in Patients with Insomnia

In a controlled double-blind study the hypnotic effect of S-1530 (5 mg q.d. for 7 consecutive nights) was investigated in comparison with that of nitrazepam (5mg) and a matching placebo in a series of 156 insomniac patients divided into three groups. Twenty-one eventually dropped out, then data were analyzed for evidence of hypnotic efficacy.By the Kruskal-Wallis H-test, there was no evidence of significant difference in effectiveness of drugs among the three groups according to global judgement by the physicians.The data were further assessed among the three groups by Discrimination Analysis (one of Multi-variate Analysis). No statistically significant difference was demonstrated among the three regimens in hypnotic efficacy of the initial dose, nor in promptness of effect, whereas both S-1530 and nitrazepam were significantly more effective than placebo on day 7 of medication with respect to induction and depth of sleep, number of awakenings before rising, dreaming, and feeling or mood on the following morning. It is suggested from the findings that the moode-levating and tranquilizing effects of S-1530, as well as nitrazepam, were beneficial at least partly in inducing and deepening sleep. The stochastical test, however, failed to reveal any significant difference in efficacy between S-1530 and nitrazepam. Nor was there significant difference among the three regimens with regard to incidence of side effects.

Expert measurement and mechanical combination

The expert can and should be used as a provider of input for a mechanical combining process since most studies show mechanical combination to be superior to clinical combination. However, even in expert measurement, the global judgment is itself a clinical combination of other judgmental components and as such it may not be as efficient as a mechanical combination of the components. The superiority of mechanically combining components as opposed to using the global judgment for predicting some external criterion is discussed. The use of components is extended to deal with multiple judges since specific judges may be differentially valid with respect to subsets of components for predicting the criterion. These ideas are illustrated by using the results of a study dealing with the prediction of survival on the basis of information contained in biopsies taken from patients having a certain type of cancer. Judgments were made by three highly trained pathologists. Implications and extensions for using expert measurement and mechanical combination are discussed.

Computer derived global judgments in psychiatry.

The authors describe a system in which factor scores obtained on a routine daily basis for each patient from computer scored nursing notes are subjected to sequential analysis to yield computer global decisions of significantly better, worse, or unchanged without special research techniques. The system's simplicity, objectivity, and enhanced reliability should make computer derived global decisions an attractive and extensively applicable technique in a wide variety of clinical and research settings.

Social dysfunction among psychiatric and non-psychiatric outpatients.

AbstractThere has been a need for a quantitative measure of social functioning in older subjects, in addition to the intuitive appraisal made possible by social work orientation. Our purpose was to determine, through the use of a newly developed scale, the dimensions and degrees of social dysfunction in schizophrenic and medical outpatients in a VA hospital. Three teams of two social workers interviewed 80 male subjects. One worker used the scale and another made only a global judgment or adjustment. Multivariate computer analysis showed that the ratings for emotional withdrawal, adaptive rigidity, lack of participation in the community, goallessness, and low self‐concept discriminated the two groups at beyond the .01 level. Total scores on the 21‐item scale correlated at r = .89 with the global judgments of adjustment made by social workers not using the scale.These results indicate validity for the scale, which measures dysfunction in personal, interpersonal, and performance areas. The findings also suggest that the scale—easily administered by social work practitioners—will lend itself to continuing research such as profiling samples of aging populations, or for teaching or diagnosis.

RELIABILITY OF READING OF THE COLLEGE BOARD ENGLISH COMPOSITION TEST, DECEMBER 19631

ABSTRACTIn December 1963, the College Board English Composition Test included a 20‐minute essay. Approximately 80,000 candidates wrote the examination, and the essays were read by 145 readers during the week following the administration. The purpose of this study was to assess the reliability of the reading.From the total group of papers, 25 were randomly selected, reproduced by hand, and given to 25 different readers on each of the five days of the reading period. The experimental papers were mixed in with the mass of other essays so that the readers did not know there was a study in process or which papers were the experimental ones.An analysis of variance procedure was used to assess the reliability of the judgments made by the readers. The reader reliability of the sum of two readings (the score used in reporting results) was .577, a figure that was consistent with those obtained in previous experimental investigations and indicated that there was no loss in reliability in moving from experimental reading of fewer than 1,000 papers to operational reading of more than 80,000 papers.Single judgment reliabilities were .41 on the average, but this average was reduced by the very low .26 that was found for readings made on the last day. It was concluded that this drop probably represented an “end effect” in which the readers relaxed their vigilance as they approached the end of the demanding reading period. Other evidence suggested that the readers were making global judgments, as directed.

Diagnostic Agreements among Psychiatrists and “Blind” Rorschach Raters or the Education of an Interdisciplinary Research Team

A special psychiatric rating form was constructed which would also be suitable for ratings made from Rorschach protocols only, called “blind” ratings, since the rater did not see the patient. Ratings were made independently by three psychiatrists but based on the same interview, while the Rorschach ratings were mace independently by two psychologists with special experience in Rorschach interpretation, If we define “agreement” arbitrarily as a correlation or chi square value at a better than .10 level of significance, there was agreement among the psychiatrists on almost a third of the scales, and consistency on one-fourth of the 59 scales. There was agreement among the Rorschach ratings on almost half of the scales. However, there was agreement between the psychiatric and Rorschach ratings on only 9 out of the 59 scales. These scales were concerned with: organization of thinking, pathognomic verbalizations, appropriateness of affect, anxiety, phobias, obsessions, direction of orientation (active or passive attitude), reality testing, and ego strength. It is noticeable that several of these items appear to call for global judgments about constructs for which precise definitions or simple diagnostic tests are lacking. No systematic individual differences among judges were found. The rating form contained 30 numerical and 29 categorical scales. There was a higher incidence of significant indices of agreement and consistency for the numerical than for the categorical scales.

EVALUATION OF COMBINED ANTIDEPRESSANT AND TRANQUILIZINGDRUG (AMITRIPTYLINE-PERPHENAZINE) IN THE TREATMENT OF HOSPITALIZED CHRONIC SCHIZOPHRENICPATIENTS.

Nineteen hospitalized, chronic female schizophrenics were treated with combined amitriptyline-perphenezine for a period of 12 weeks. Patients were evaluated initially and during the study in terms of standard rating scales, ward behavior, and global clinical judgment. Observations and test data indicate that the patients as a group showed improvement, and the combination of amitriptyline- perphenezine seems compatible. However, since this pilot study did not include a placebo control, no definite conclusion can be drawn at this time. The results are sufficiently encouraging to warrant controlled clinical trial.

Alternative Questionnaire Approaches to the Measurement of Influence in Organizations

Employees in a manufacturing company and in a set of auto dealerships were asked to make global judgments about the distribution of influence in their organizations; they were also asked about influence in specific decision areas. An index based on reports of influence in specific areas shows better reliability among non-supervisory respondents than does the global influence measure. There is, however, poor agreement across organizational levels (supervisory versus non-supervisory) in responses to either influence measure.Neither measure shows clear superiority as a predictor of employee morale.

A comparison of global and specific clinical judgments across several diagnostic categories.

A comparison of global and specific clinical judgments across several diagnostic categories.