There is emerging evidence that the performance of risk assessment instruments is weaker when used for clinical decision‐making than for research purposes. For instance, research has found lower agreement between evaluators when the risk assessments are conducted during routine practice. We examined the field interrater reliability of the Short‐Term Assessment of Risk and Treatability: Adolescent Version (START:AV). Clinicians in a Dutch secure youth care facility completed START:AV assessments as part of the treatment routine. Consistent with previous literature, interrater reliability of the items and total scores was lower than previously reported in non‐field studies. Nevertheless, moderate to good interrater reliability was found for final risk judgments on most adverse outcomes. Field studies provide insights into the actual performance of structured risk assessment in real‐world settings, exposing factors that affect reliability. This information is relevant for those who wish to implement structured risk assessment with a level of reliability that is defensible considering the high stakes.
All experience/knowledge comes from three sources: (1) perception, (2) the past (consolidated perception in memory, or mediated by "technology": stories, writing, photo, etc.), or (3) judgment/argument based on perception and past (analogy). There is something special going on with our 'judgments '. Our judgements are not only fooled on the basis of perceptual traces created in our brain, as shown in perceptual illusions when we see or hear things that are not actually shown, it also seems that our two hemispheres judge differently. Optimization through analysis and numerical insight may not be the best strategy, certainly not when judging in the context of forecasting. And that while all our knowledge can again be traced back to three sources, perception, past (consolidated perception) and judgment.
MULTIFILE
PURPOSE: The Nasality Severity Index 2.0 (NSI 2.0) forms a new, multiparametric approach in the identification of hypernasality. The present study aimed to investigate the correlation between the NSI 2.0 scores and the perceptual assessment of hypernasality. METHOD: Speech samples of 35 patients, representing a range of nasality from normal to severely hypernasal, were rated by four expert speech-language pathologists using visual analogue scaling (VAS) judging the degree of hypernasality, audible nasal airflow (ANA) and speech intelligibility. Inter- and intra-listener reliability was verified using intraclass correlation coefficients. Correlations between NSI 2.0 scores and its parameters (i.e. nasalance score of an oral text and vowel /u/, voice low tone to high tone ratio of the vowel /i/) and the degree of hypernasality were determined using Pearson correlation coefficients. Multiple linear regression analysis was used to investigate the possible influence of ANA and speech intelligibility on the NSI 2.0 scores. RESULTS: Overall good to excellent inter- and intra-listener reliability was found for the perceptual ratings. A moderate, but significant negative correlation between NSI 2.0 scores and perceived hypernasality (r=-0.64) was found, in which a more negative NSI 2.0 score indicates the presence of more severe hypernasality. No significant influence of ANA or intelligibility on the NSI 2.0 was observed based on the regression analysis. CONCLUSION: Because the NSI 2.0 correlates significantly with perceived hypernasality, it provides an easy-to-interpret severity score of hypernasality which will facilitate the evaluation of therapy outcomes, communication to the patient and other clinicians, and decisions for treatment planning, based on a multiparametric approach. However, research is still necessary to further explore the instrumental correlates of perceived hypernasality. LEARNING OUTCOMES: The reader will be able to (1) describe and discuss current issues and influencing variables regarding perceptual ratings of hypernasality; (2) describe and discuss the relationship between the Nasality Severity Index 2.0, a new multiparametric approach to hypernasality, and perceptual judgments of hypernasality based on visual analogue scale ratings; (3) compare these results with the correlations based on a single parameter approach and (4) describe and discuss the possible influence of audible nasal airflow and speech intelligibility on the NSI 2.0 scores.
