Introduction Pediatric delirium assessment is complicated by variations in baseline language and cognitive skills, regression of skills during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders (DSM) delirium criterion. Objective To develop a standardized approach to pediatric delirium assessment by psychiatrists. Methods A multidisciplinary group of clinicians used DSM criterion as the foundation for the Vanderbilt Assessment for Delirium in Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the delirium criterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validity by the American Academy of Child and Adolescent Psychiatry (AACAP) Delirium Special Interest Group (SIG). Results The AACAP-Delirium SIG determined that the VADIC demonstrated high content validity. The VADIC 1) preserved the core DSM delirium criterion; 2) appropriately paired interactive assessments with key criterion based on development, and 3) addressed confounders for delirium. A cohort of 300-patients with a median age of 20 months was assessed for delirium using the VADIC. Delirium prevalence was 47%. Conclusion The VADIC provides a comprehensive framework to standardize pediatric delirium assessment by psychiatrists. The need for consistency in both delirium education and diagnosis is highlighted given the high prevalence of pediatric delirium.
Our systematic review of existing literature highlights that provider's age, sex, experience, specialty, and the interplay between provider and patient characteristics are important variables in pain management. However, generalizations relating to these findings are limited by the heterogeneity of the studies and the paucity of literature in this field.
Background- Unnatural deaths place a significant burden on society. The sociodemographic characteristics of these deaths in Bihar is not well-documented in the literature. The goal of the current study was to add to knowledge so that these deaths could be stopped or reduced. Material and Method- A retrospective autopsy analysis of one-year unnatural deaths (421 cases) was done at the Department of Forensic Medicine and Toxicology, Nalanda Medical College & Hospital, Patna & Madhubani Medical College & Hospital, Madhubani, Bihar. RTA was the most common cause of unnatural deaths (126/421 i.e., 29.9%). It was followed by violence death (84/421 i.e., 19.9%), poisoning (74/421 i.e., 17.6%), hanging (34/421 i.e., 8.1%), burn (32/421 i.e., 7.6%), drowning (27/421 i.e., 6.4%), strangulation (20/421 i.e., 4.8%) and others (electrocution, lightning, fall- 24/421 i.e., 5.7%). Victims of most unnatural deaths were male except in burn and strangulation cases (3.5% vs 4.1% & 2.1% vs 2.6%). Cases of unnatural deaths were seen to be higher in younger and working age groups (226/421 i.e., 53.4%) in both males and females in the age group of 16-40 years. There was a slight increase in unnatural deaths in the summer season (40%). Suicide was the most common cause of unnatural deaths (140/421 i.e., 33.2%), followed by RTA (126/421 i.e., 29.9%), homicide (104/421 i.e., 24.7%), and other causes (drowning, electrocution, etc.– 51/421 i.e., 12.2%). Male to female death ratio in suicide, homicide and RTA was 1.7 (88/52), 4.8 (86/18), and 8.6 (113/13) respectively. Conclusion- Unnatural death is one of the indicators of the level of social and mental health. Many studies showed different results regarding different modes of unnatural death. These deaths can be minimized by public awareness, skilled drivers, better road conditions and health system, female education and their social empowerment, sincere effort to solve unemployment, strict rules of law, and regulation on the selling of agrochemicals and other poisons.
Bihar is relatively a backward state of India where deaths due to chest injuries in road traffic accidents are very common. Deaths due to chest injuries could be more preventable and treatable than head injuries due to road traffic accidents. OBJECTIVEThe main objective of our study is to give emphasis on various aspect of deaths due to chest trauma in road traffic accidents, so that policies could be made by lawmakers to prevent these deaths and also to enrich the knowledge of clinicians about various reasons of death of traffic chest trauma victims. MATERIAL AND METHODThis is a prospective study, consists of 201 fatal chest trauma cases due to road traffic accident, brought for medico-legal autopsies to the mortuary of NMCH, Patna, between August 2011 and July 2013. The data were analysed in tabular form and percentage method. RESULTSThe study revealed that most of the traffic fatal chest trauma cases were pedestrians (67.2%), male (92%) and were of productive age group of life (37% between 31 and 45 years' age group). Majority of the accidents took place on highways (62.7%) in winter season (29.35%) and victims died on spot (72.5%). Shock and Haemorrhage (84.5%) was the most common cause of death, while fatal chest injuries generally combined with abdominal injuries (51.3%) also. Liver (50%) and Spleen (28.3%) were also injured in some victims. Contusions (42.7%), Rib fracture (61.2%) and Haemothorax (89%) were the other common findings in fatal chest trauma victims due to Road Traffic Accident (RTA). CONCLUSIONSOn the basis of this study, we can highlight various aspects of deaths due to chest trauma in road traffic accidents and accordingly the need to deploy the "Quick response teams" on highways and "Hi-Tech Trauma Centre" at district head-quarters can be justified to reduce the mortality in such cases.
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