Sensitivity and Specificity of the Comfort Scale to Assess Pain in Ventilated Critically Ill Adult Patients in Intensive Care Unit

Background: Pain is a common phenomenon experienced by ventilated and critically ill adult patients. It is urgent to measure the pain among these patients since they are unable to report their pain verbally. Comfort Scale is one of the instruments used to measure pain in adult patients. The scale is used to measure pain among children patients with fairly high sensitivity and specificity.Purpose: This study aimed to examine the sensitivity and specificity of the Comfort Scale to measure pain in the ventilated critically ill adult patients in the ICU.Methods: This study employed a cross-sectional design with 66 ventilated adult patients in the ICUs of two hospitals in Semarang. The pain assessment was administered to the patients in 2 duplo periods by two observers comparing with the Comfort Scale and Critical Care Pain Observational Tool (CPOT) as a gold standard instrument during the pre and post positioning procedures. The data were analyzed using the receiver operating curve (ROC).Result: The results showed that in the pre-positioning procedure, the Comfort Scale had the sensitivity value of 69% and the specificity value of 81%. Meanwhile, in the post-positioning procedure, the values were decreasing (the sensitivity of 45%, the specificity of 67%). This indicated that the sensitivity value of the comfort scale decreased and could be interpreted that the ability of the instrument to detect pain remained low. Meanwhile, the decrease of the specificity value of the instrument between the pre and post administration was not far different, so it could be interpreted that the instrument can correctly identify the patient without pain.Conclusion: The Comfort Scale had a lower value of sensitivity and specificity in the post-positioning than that in the pre-positioning procedure. It is recommended that further studies should focus on the relationship between sedation and pain by using instruments of pain studies for adult patients (CPOT). Additionally, the hospital policy makers, that is Pain Task Force is expected to give education and training through workshops and seminars about the nurse skills in pain management on critical areas as part of the multidisciplinary team

Specificity distinction

This paper is concerned with semantic noun phrase typology, focusing on the question of how to draw fine-grained distinctions necessary for an accurate account of natural language phenomena. In the extensive literature on this topic, the most commonly encountered parameters of classification concern the semantic type of the denotation of the noun phrase, the familiarity or novelty of its referent, the quantificational/nonquantificational distinction (connected to the weak/strong dichotomy), as well as, more recently, the question of whether the noun phrase is choice-functional or not (see Reinhart 1997, Winter 1997, Kratzer 1998, Matthewson 1999). In the discussion that follows I will attempt to make the following general points: (i) phenomena involving the behavior of noun phrases both within and across languages point to the need of establishing further distinctions that are too fine-grained to be caught in the net of these typologies; (ii) some of the relevant distinctions can be captured in terms of conditions on assignment functions; (iii) distribution and scopal peculiarities of noun phrases may result from constraints they impose on the way variables they introduce are to be assigned values. Section 2 reviews the typology of definite noun phrases introduced in Farkas 2000 and the way it provides support for the general points above. Section 3 examines some of the problems raised by recognizing the rich variety of 'indefinite' noun phrases found in natural language and by attempting to capture their distribution and interpretation. Common to the typologies discussed in the two sections is the issue of marking different types of variation in the interpretation of a noun phrase. In the light of this discussion, specificity turns out to be an epiphenomenon connected to a family of distinctions that are marked differently in different languages

On object specificity

[W]e have demonstrated that the object specificity follows from the same principle as the subject specificity under the EMH. Furthermore, the semantic discrepancy between the realis and irrealis object shift constructions turns out to be a subcase of the more general indicative-modal asymmetry. Although our analysis presented here is nothing but conclusive, it does suggest that the EMH is a potent candidate for explaining the indicative-modal asymmetry, as well as for building a general theory of the specificity effects in question

Specificity in Personality Measurement

Born, M.P.H. [Promotor]Vries, R.E. de [Copromotor

Inhibitor specificity of amine oxidase

Although at the present time it appears clear that amine oxidase oxidation of adrenalin, or other o-diphenolic pressor amines such as were studied by Richter (6), does not play a significant physiological role, it is equally clear that the inactivation of aliphatic amines, phenethylamine and probably 4-hydroxyphenethylamine (tyramine), does predominantly take place by amine oxidase oxidation. In view of the evidence from the experiments of Ewins and Laidlaw (8) and a later study by Guggenheim and Löffler (9), such amine oxidations chiefly occur in the liver. In the present studies, an attempt was made to value quantitatively the inhibition of some of these particular type compounds by certain types of amines which are not themselves oxidized by the enzyme system (see Alles and Heegaard (10))

Pattern specificity of contrast adaptation.

Contrast adaptation is specific to precisely localised edges, so that adapting to a flickering photograph makes one less sensitive to that same photograph, but not to similar photographs. When two low-contrast photos, A and B, are transparently superimposed, then adapting to a flickering high-contrast B leaves no net afterimage, but it makes B disappear from the A+B picture, which now simply looks like A

Substrate specificity of amine oxidase

The tyramine oxidase activity of liver extracts found by Hare (1), the aliphatic amine oxidase activity of brain, kidney, and liver extracts observed by Pugh and Quastel (2), and the adrenalin oxidase activity of similar extracts noted by Blaschko, Richter, and Schlossman (3) were brought under a common enzyme view-point by the latter authors. They were able to show (4) that extracts of brain, instestine, kindey, and liver from a number of mammals or representatives of the birds, reptiles, amphibians, and fishes all acted to absorb oxygen in the presence of several amine substrates. Hare (1) had shown that tyramine and phenethylamine form ammonia in the course of such oxidations, and Richter (5) showed that an ethylamino and a dimethylamino compound, as well as a number of methylamino and amino compounds, all yield the corresponding alkyl-amines or ammonia in the enzymic oxidation. The conslusion that the demonstrated variey of such enzymic activity can be acribed to the presence of a single type pf amine oxidase was dependent in large part on observations that the relative activities of a preparation from one source on a series of substrates bear some relation to the relative activities exhibited by a preparation from another source. Further evidence depended on the action of certain amines as inihibitors and apparent competition between substrates when two oxidizable substrates are present in the system. The degree to which relative activities of different enzyme preparations were constant in a series of substrates was not good in the data reported, and the fact that Hare (1) had not been able to note activity of the liver preparations she used upon adrenalin as the substrate appeared to require special explanations