Physician-reviewers' perceptions and judgments about quality of care.
(33/1353)
OBJECTIVE: Although Peer Review Organizations (PROs) and researchers rely on physicians to assess quality of care, little is known about what physicians think about when they judge quality. We sought to identify features of individual cases that are associated with physicians' judgments. DESIGN: Using 1994 Medicare data, we selected hospitalizations for 1134 beneficiaries in 42 acute care hospitals in California and Connecticut. The sample was enriched with 17 surgical and six medical complications identified using diagnosis and procedure codes. PRO physicians confirmed quality problems using a structured implicit chart review instrument and provided written open-ended comments about each case. We coded physicians' comments for factors presumed to influence judgments about quality. RESULTS: In crude and adjusted comparisons, reviewers questioned quality more frequently in cases with serious or fatal outcomes, technical mishaps and inadequate documentation. Among surgical (but not medical) patients, they were less likely to record poor quality among patients presenting with an acute illness. CONCLUSION: Factors other than the adequacy of key processes of care are associated with physician-reviewers' judgments about quality. (+info)
Feeling or features: different sensitivity to emotion in high-order visual cortex and amygdala.
(34/1353)
Emotionally loaded visual stimuli have shown increased activation in visual and cortex limbic areas. However, differences in visual features of such images could confound these findings. In order to manipulate valence of stimuli while keeping visual features largely unchanged, we took advantage of an "expressional transfiguration" (ET) effect of faces. In addition, we used repetition effects, which enabled us to test more incisively the impact of the ET effect. Using the ET manipulation, we have shown that the activation in lateral occipital complex (LOC) was unaffected by valence attributes, but produced significant modulation of fMR adaptation. Contrary to LOC, amygdala activation was increased by ET manipulation unrelated to the adaptation. A correlation between amygdala and LOC adaptation points to a possible modulatory role of the amygdala upon visual cortex short-term plasticity. (+info)
Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference.
(35/1353)
BACKGROUND: Checklists for peer review aim to guide referees when assessing the quality of papers, but little evidence exists on the extent to which referees agree when evaluating the same paper. The aim of this study was to investigate agreement on dimensions of a checklist between two referees when evaluating abstracts submitted for a primary care conference. METHODS: Anonymised abstracts were scored using a structured assessment comprising seven categories. Between one (poor) and four (excellent) marks were awarded for each category, giving a maximum possible score of 28 marks. Every abstract was assessed independently by two referees and agreement measured using intraclass correlation coefficients. Mean total scores of abstracts accepted and rejected for the meeting were compared using an unpaired t test. RESULTS: Of 52 abstracts, agreement between reviewers was greater for three components relating to study design (adjusted intraclass correlation coefficients 0.40 to 0.45) compared to four components relating to more subjective elements such as the importance of the study and likelihood of provoking discussion (0.01 to 0.25). Mean score for accepted abstracts was significantly greater than those that were rejected (17.4 versus 14.6, 95% CI for difference 1.3 to 4.1, p = 0.0003). CONCLUSIONS: The findings suggest that inclusion of subjective components in a review checklist may result in greater disagreement between reviewers. However in terms of overall quality scores, abstracts accepted for the meeting were rated significantly higher than those that were rejected. (+info)
The Perruche judgment and the "right not to be born".
(36/1353)
The French government has given in to public pressure and overturned a controversial legal ruling which recognised the right of a disabled child to seek damages. Most notably, the ruling, widely described as establishing a child's right "not to be born", had provoked "outrage" amongst groups defending the rights of the disabled and led to a ban on prenatal scans by French gynaecologists. Once again, only parents will be able to seek damages but some people think the ruling has been misinterpreted. (+info)
Qualitative research and the problem of judgement: lessons from interviewing fellow professionals.
(37/1353)
BACKGROUND: Qualitative research methods are recognized increasingly as valuable tools for primary care research, and add an extra dimension to quantitative work. OBJECTIVE: The aim of this study was to illustrate the benefits and problems attending the dual role of clinician/qualitative researcher. METHODS: As part of two studies employing semi-structured interviews of GPs in a North-West conurbation, about the topics of consultations on chronic low back pain and drug misuse in primary care, respondents' views on their interaction with a GP researcher were explored. RESULTS: Access to the GP by the interviewing GP was easier when the GP researcher was known to the respondent. Such prior knowledge, however, may then influence the content of the data and the manner in which the GP researcher is perceived. During the interview itself, where respondents recognized the researcher as a clinician, interviews were broader in scope and provided richer and more personal accounts of attitudes and behaviour in clinical practice. The GP was also identified as an expert and judge, not just of clinical decision making but also about moral judgements made by GPs in their work. This will impact on the data obtained at interview and must be taken into consideration when the data are interpreted and analysed. CONCLUSION: Qualitative research techniques increasingly are advocated as appropriate for research on and in general practice. The professional identity of the researcher plays an important part in constructing the kind of data obtained in such studies, and this must be made apparent in reporting and discussions of such qualitative work. (+info)
Facial attractiveness judgements reflect learning of parental age characteristics.
(38/1353)
Mate preferences are shaped by infant experience of parental characteristics in a wide variety of species. Similar processes in humans may lead to physical similarity between parents and mates, yet this possibility has received little attention. The age of parents is one salient physical characteristic that offspring may attend to. The current study used computer-graphic faces to examine how preferences for age in faces were influenced by parental age. We found that women born to 'old' parents (over 30) were less impressed by youth, and more attracted to age cues in male faces than women with 'young' parents (under 30). For men, preferences for female faces were influenced by their mother's age and not their father's age, but only for long-term relationships. These data indicate that judgements of facial attractiveness in humans reflect the learning of parental characteristics. (+info)
Selecting a cost-effective screening measure for the assessment of preschool social withdrawal.
(39/1353)
The utility of teacher judgment (rankings, ratings) and peer judgment (sociometric ratings) were studied as screening variables for preschool social withdrawal/responsiveness. Observational measures of preschoolers' interaction were used as the validation criterion based upon theoretical, empirical, and practical considerations related to development of a multipurpose behavioral assessment system. Results indicated that teacher rankings of students' verbal interaction frequencies (1) were most highly correlated to interaction rate in two preschool settings, (2) had test-retest reliability consistently above Rho = .80, and (3) were useful in that 77% of teachers using this procedure could identify their least socially responsive student within five rankings. The peer nomination sociometric rating was the least reliable measure at retest (Rho = .35) and showed consistently the lowest correlation with observational indices of interaction partner preferences, e.g., reciprocal rate (Rho = .29 to .39). The tendency for relationships among screening measures and the criterion to increase at retest suggested a training effect on screening accuracy. The use of teacher rankings in combination with observational measures to confirm selection accuracy and for monitoring treatment progress is discussed as a cost-effective behavioral assessment procedure for preschool social withdrawal/responsiveness. (+info)
Ratings of different olfactory judgements in schizophrenia.
(40/1353)
We assessed the influence of schizophrenia on different olfactory tasks. Forty patients with schizophrenia (20 males and 20 females) and 40 control subjects (20 males and 20 females) were tested. The experiment included two sessions. Initially, 12 odorants were presented at a rate of one per minute. The subjects were asked to rate intensity, pleasantness, familiarity and edibility for each odour using linear rating scales. The odorants were then presented a second time and the subjects were asked to identify them. The results showed that the scores for pleasantness, familiarity, edibility and identification but not intensity were disturbed in patients when compared with control subjects. Furthermore, the familiarity judgement of male patients was more often deficient than that of female patients and they rated odorants as being inedible when the women judged them as neutral. Considered together, these data show that our olfactory test may be used in patients with schizophrenia for evidencing various dysfunctions specific to different types of olfactory processing that represent steps in the odour name identification process. (+info)