scholarly journals Probable Pain on the Pain Assessment in Impaired Cognition (PAIC15) Instrument: Assessing Sensitivity and Specificity of Cut-Offs against Three Standards

2021 ◽  
Vol 11 (7) ◽  
pp. 869
Author(s):  
Jenny T. van der Steen ◽  
Andrew Westzaan ◽  
Kimberley Hanemaayer ◽  
Muhamad Muhamad ◽  
Margot W. M. de Waal ◽  
...  

Observational pain scales can help to identify pain in persons with dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) covers 15 items that indicate pain, but it is unclear how probable pain is, for each summed score (range 0–45). We aimed to determine sensitivity and specificity of cut-offs for probable pain on the PAIC15 against three standards: (1) self-report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut-off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with re-assessment after 2 months in 137 residents. The area under the ROC curve was excellent against the PAINAD cut-off (≥0.8) but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, PAIC15 scores of 3 and higher represent possible pain for screening in practice, with sensitivity and specificity against self-report in the 0.5 to 0.7 range. While sensitivity for screening in practice may be too low, a cut-off of 4 is reasonable to indicate probable pain in research.

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 166-166
Author(s):  
Jenny van der Steen ◽  
Margot de Waal ◽  
Wilco Achterberg

Abstract Observational pain scales can help identify pain in persons with impaired cognition including dementia who may have difficulty expressing pain verbally. The Pain Assessment in Impaired Cognition-15 (PAIC15) observational pain scale covers 15 important items that are indicative of pain, but it is unclear how likely pain is for persons with each summed score (theoretical range 0-45). The goal of our study was to determine sensitivity and specificity of cut offs for probable pain on the PAIC15 against three possible standards. We determined cut offs against (1) self report when able, (2) the established Pain Assessment in Advanced Dementia (PAINAD) cut off of 2, and (3) observer’s overall estimate based on a series of systematic observations. We used data of 238 nursing home residents with dementia who were observed by their physician in training or nursing staff in the context of an evidence-based medicine (EBM) training study, with 137 residents assessed twice. The area under the ROC curve was excellent against the PAINAD cut off (□ 0.8) at both assessments, but acceptable or less than acceptable for the other two standards. Across standards and criteria for optimal sensitivity and specificity, cut offs at the PAIC15 could be 3 or 4. Guided by self report we recommend PAIC15 scores of 3 and higher to represent probable pain with sensitivity and specificity in the 0.5 to 0.7 range.


2019 ◽  
Vol 9 (6) ◽  
pp. 559-567
Author(s):  
Mohammad Rababa ◽  
Sami Al-Rawashdeh

Aim: This study aims to examine the associations of pain assessment scope, nurses’ certainty, patient outcomes, and cognitive and verbal characteristics of nursing home (NH) residents. Methods: This study used a descriptive correlational design and a convenience sample of 78 NH residents with dementia. Results: There are significant associations between the severity of dementia and the ability to self report symptoms in NH residents and nurses’ certainty of pain. Also, pain assessment scope does not mediate the relationship between nurses’ certainty and patient outcomes. Conclusion: Pain assessment in NH residents with dementia is very challenging for nurses due to multiple complex factors. Improved understanding of pain assessment in those residents and how it relates to certainty of pain and patient outcomes are crucial.


Author(s):  
INDAH SRI WAHYUNINGSIH

Critically ill adult patients with a ventilator in intensive care often receive treatment that causes pain. Pain is a symptom that often occurs in critically ill adult patients with ventilator and it is very individual. Pain assessment in critically ill patients with the ventilator is needed because of the patient unable to self-report of pain. Pain assessments critically ill adult patients have been developed. However, there is no valid and reliable instrument to assess pain. The objectives of the literature review are to identify the instruments of pain assessment in patients with ventilator. The method of literature was performed through seeking publication of articles in MEDLINE, Google Search, PubMed, and Proquest with keywords pain assessment, tool, critical care, adult, critically ill, unconscious and ventilator. Literatures were undertaken from 2000-2015 with a cross-sectional study design, before and after studies and observational study. The results of the study according to the characteristics of the research was found five pain assessment instruments, they were NVPS, P.A.I.N, Comfort scale, BPS and CPOT. The validity and reliability CPOT is highest among others. All instruments had been measured its validity and reliability, but it had never tested its sensitivity and specificity. So, more researches should be conducted related to the sensitivity and specificity of all the instruments of pain in critically ill adult patients with a ventilator.�Keywords : Pain assessment, critically ill, adult, ventilator.


Author(s):  
Regina M. Fink ◽  
Rose A. Gates ◽  
Robert K. Montgomery

Pain is multifactorial and affects the whole person and family caregivers, and multiple barriers to pain assessment exist. Patients should be screened for pain on admission to a hospital, clinic, nursing home, hospice, or home care agency. If pain or discomfort is reported, a comprehensive pain assessment should be performed at regular intervals, whenever there is a change in the pain, and after any modifications in the pain management plan. The patient’s self-report of pain is the gold standard, even for those patients who are nonverbal or cognitively impaired. Multiple pain scales are available for use in nonverbal or cognitively impaired patients or residents; these should be used in combination with clinical observation and information from healthcare professionals and family caregivers.


2013 ◽  
Vol 4 (2) ◽  
pp. 114 ◽  
Author(s):  
Kirk Roth ◽  
D. Robert Siemens

Introduction: Evidence-based medicine (EBM) is the conscientious,explicit, and judicious use of the current best evidence in decision-making for the care of patients. Teaching best evidence practicein residency should include both formal or freestanding content,as well as integration into clinical scenarios and patient care.We sought to assess the attitudes, experience and knowledge ofEBM in urology residency training across Canada.Methods: An anonymous, cross-sectional, self-report questionnairewas completed by a convenience sample of 29 residents,including all chief urology residents in English-speaking programsacross Canada. The survey included both open-ended and closedendedquestions designed to assess familiarity and attitudes towardsEBM and potential barriers to developing EBM skills in a surgicaltraining program. Questions were formatted to determine the understandingof statistical and analytical concepts, as well as familiarityof available EBM resources. Descriptive and correlative statisticswere used to analyze the responses.Results: The response rate was 100%. An overwhelming majorityof residents felt that EBM is an important component of the urologyresidency and journal club was the most common vehiclefor discussing best evidence concepts. However, there was significantvariation in the presence of freestanding, formal curriculaacross programs, with only 28% of residents signifying thatthey received any formal training in their program. The apparentlevel of understanding of important EBM terminology and resourcesappears to be limited. The most frequently stated barriers to incorporatingEBM curricula into urology training were time constraintsand a perceived lack of expert educators.Conclusion: This self-report survey of urology chief residents identifiedthe overwhelming acceptance of the importance of EBM intheir training. Although best evidence practices appears to beaddressed in journal clubs and in real-life clinical experiences,the obvious lack of familiarity and understanding of EBM contentand resources would suggest a need for redoubling efforts to ensureappropriate exposure and instruction in our training programs.Introduction : La médecine factuelle vise l’utilisation consciencieuse,explicite et judicieuse des meilleures données actuellesdans le processus décisionnel concernant les soins aux patients.L’enseignement de cette approche factuelle aux étudiants en résidencedoit inclure du contenu officiel et indépendant, ainsi quedes exercices d’intégration dans des scénarios cliniques et despratiques de soins. Nous avons tenté d’évaluer les attitudes, l’expérienceet les connaissances vis-à-vis la médecine factuelle dansles programmes de résidence en urologie au Canada.Méthodologie : Un questionnaire anonyme d’auto-évaluation glo -bale a été rempli par un échantillon de commodité comprenant29 résidents, y compris tous les chefs-résidents des programmesd’urologie des universités anglophones du Canada. Le sondagecomprenait des questions ouvertes et fermées visant à évaluer leniveau de familiarité et les attitudes vis-à-vis la médecine factuelleet les obstacles pouvant nuire au développement de compétencesen médecine factuelle dans un programme de formation en chirurgie.Les questions étaient formulées de manière à permettre de déterminerle niveau de compréhension des concepts statistiques etanalytiques, ainsi que le niveau de familiarité avec les ressourcesexistantes de la médecine factuelle. Les réponses ont été analyséesà l’aide de méthodes statistiques descriptives et corrélatives.Résultats : Le taux de réponse obtenu était de 100 %. Une majoritéécrasante de résidents croyait que la médecine factuelle était unecomposante cruciale de leur formation en urologie et que l’examenen groupe d’articles publiés (Journal Club) représentait le moyenle plus fréquent de discuter des concepts de la médecine factuelle.Néanmoins, on a noté une variation significative dans la présencede contenu indépendant et officiel dans les différents programmes;en effet, seulement 28 % des résidents ont indiqué recevoir uneformation officielle dans le cadre de leurs études. Le niveau appa -rent de compréhension des principaux termes et ressources liés àla médecine factuelle semble limité. Les obstacles les plus souventmentionnés à l’intégration d’un contenu sur la médecine factuelledans la formation en urologie étaient les contraintes de temps etun manque perçu d’éducateurs bien versés sur le sujet.Conclusion : Ce sondage mené auprès de chefs-résidents en urologiea permis de montrer que ces derniers valorisent grandementle rôle de la médecine factuelle dans leur formation. Même si lespratiques factuelles semblent être abordées dans les groupes d’exa -men d’articles et les expériences cliniques réelles, le manque évidentde familiarité et de compréhension des concepts et desressources liés à la médecine factuelle porte à croire qu’il fautredoubler les efforts afin de s’assurer que les résidents soientThe status of evidence-based medicine education in urology residencyKirk Roth MD; D. Robert Siemens MD, FRCSC suffisamment exposés à cette approche et reçoivent la formation requise pendant leur résidence.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 527-528
Author(s):  
Lauren Starr ◽  
Kristin Corey Magan

Abstract There are 5.8 million people with Alzheimer’s dementia in the United States—81% are 75 years or older. Although half of persons with dementia regularly experience pain, their pain is underrecognized and undertreated, partly because clinicians experience challenges assessing pain in persons with dementia who cannot self-report. Evidence suggests clinician empathy is involved in pain assessment and treatment. Conceptual models guiding Alzheimer’s research are lacking in the literature. To create an interdisciplinary, evidence-based model for understanding clinical empathy’s relationship with the assessment and treatment of pain in persons with advanced dementia, we conducted a literature review of relevant manuscripts from 2000-2019 across disciplines and countries, emphasizing dementia studies and research conducted in the last decade. After performing quality appraisal using the Oxford Centre for Evidence-based Medicine’s levels of evidence, we synthesized findings from 38 qualifying studies and developed a new conceptual model driven by observation of behaviors indicating pain in persons with dementia unable to self-report. The model represents the cognitive, affective, ethical, and behavioral components of clinical empathy involved in assessing and treating pain, relevant patient outcomes, and contextual factors influencing empathy and outcomes; and provides a framework for testing clinical empathy interventions to improve adverse outcomes in persons with advanced dementia. Understanding the relationship between clinician empathy and the assessment/treatment of pain in persons with dementia may improve care quality and help reduce pain behaviors in this population. This model may be used to inform pain research in persons with dementia and develop clinical interventions and clinician education programs.


Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.


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