POISONING OBSERVATION AND ASSESSMENT

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Observational assessment taxonomy ispossible (Leat& Nichols, 2000), it add into the value of therapist or physician those came across situations to assess patients with observational assessment and itproved useful (Pelgrim, Kramer, Mokkink, Van den Elsen, Grol& Van der Vleuten, 2011).
Anything that can harm life by inhaling, intake, injecting, and ingesting and absorbing can be a kind of poisoning; various substances could cause toxicity (Lynn and Christopher, 2016).
Frequently observed symptoms of poisoning include nausea , vomiting , burns on the lips, blister or rashes on the skin, around the mouth , ulcers, low blood pressure, hyper ventilation, burning, palpitation, breathlessness, hypothermia , rapid heart beat, restlessness , palpitations , breathing problems , irritation in trachea or larynx or esophagus.
Ala, Vahdati, Moosavi&Sadeghi (2011) studied the role of demography regarding poisoning.It was found that medical doctors use BZD for poisoning , employed used opioids and alcoholf or poisoning as compared with unemployed, moreover males commit suicide with opioids and alcohol as compared with female those use other means.The researchers also provided useful information about age, gender, occupation and level of education.It was also found that preventable accidental poisoning still play a significant role in child morbidity (Sahin, Carman &Dinleyici, 2011).Moreover the age groups affected by poisoning fall between the age group of 11-30 years of age (Chirasirisap, Ussanawarong, Tassaneeyakul, Reungsritrakool, Prasitwatanaseree, Sripanyawit,... &Patitas, 1992).
The importance of correct and prompt diagnosis in ailment management is known (Lee, Goren, Zou, Odell, Russell, Araiza, &Luo 2016).Objectivity in psychologicalassessment is historical (Gillham, 2001) and has contributed positively towards treatment efficiency (John 2003).A study revealed that the more objective the diagnosis would be the more feasible it would be to practice psychiatry (Pies, 2007).Therefore, objectivity is a known psychological preference for assessment (Hart & Goldstein1986;Groth-Marnat 2009;Anastasi 1954) and psychiatry (Pies, 2007).Moreoveradvancement in clinical psychology is a continuous need (Valle &Klimo, 2014).Furthermore,field of assessmentis improving day by day (Greene2011).In that context the shift of attention towards the healthcare provider and clients 'interaction' for better health outcomes (von Thiele 2016) is now a focused area.Hull (1937) rated observed facts about adaptive behavior important for behavior assessment.Anobservational study for poisoning cases for demographic analysis (Thapa, Lama, Karki&Khadka, 2008) found it useful for assessment.
The present study therefore was planned to explore that is it possible with a systematic objective observation to assess, label and diagnose different type of poisoning cases during initial interaction for prompt and improved intervention that may be useful for the areas where advanced medical facilities lack?

Sample and Description
All the poisoning cases those reported to the poisoning ward of a selected government

Method and Procedure
The 6 months unobtrusive study was conducted to make possible descriptive and narrative pictures of self, accidental and pretended poisoning behaviors.The assumption was based on the fact that for intrinsic motives/reasons the difference due to poising category could be observable or could occur in overt behaviors of the poisoning patients?
The study was conducted in three phases.In the first phase (STS) was developed in which the possible "poisonous behaviors" in focused categories were described.Expert opinion was also sought during development.In the second phase research assistants were hired for 24 hours duties on the ward counters in the selected poisoning ward.All the three research assistants were familiarized with the nature of study and were apprised about the handling and filling of (STS).Demos and practicing sessions were conducted to fully equip the assistants to meet the requirements of the job .After confirmation that the hired persons had achieved the requisite skills the third phase of study was started in which research assistants were assigned to complete (STS) for six months in the ward as trained.
Riphah Research Ethics Committee approved the study.For verbal inform consent, following instructions were delivered to the research assistants before the conduct."Watch each admission in the ward on first entrance.Fill in (STS) columns with complete details of first exposure.Do not leave any column blank and in case some other behavior/s takes place that were not mentioned in (STS) than record it/these as a separate note.After recording the response when you (researcher) found that the patient is settled than approach the patient.If patient in not in senses approach caregiver of the patient for the permission to retain the (STS) recorded response for research purpose.Show the recorded response to the patient or caregiver.Get the permission for inclusion, if patient or caregiver accord approval then include (STS) in the records otherwise delete and count the mentioned number in the study as deleted.During the entire study the data collectors followed the instructions in letter and spirit and a verbal informed consent for each case was acquired.
A few glimpses of details filled in the (STS) were.
• Mode of entrance in poisoning unit as: walking, walking with help, wheel chair, use stature and a few other details.
• Appearance including height, weight, any peculiar feature, hair, dress and a few more.
• Facial Expressions including color of the face, sweating, oral secretions and some more.
• Social interaction and mode details.
• Other signs like breathing, eye movement, and heart rate and a few others.
After the completion of third phase the data gathered by experts was compared with provisional medical diagnosis and final medical diagnosis records of all the casesto assess the comparability of (STS)with already in practice diagnosis methods.

Results
Among total 360 studied poisoning patients 35, 9.7% were of pretended poisoning, 236, 65.6% wereself-poisoning and 89, 24.7% wereaccidental poisoning.The patterns on (STS) were found closely similar to final medical diagnosis as compared with provisional medical diagnosis.The occurrence of particular behaviors in particular poisoning category (Figure -A)/, (

Conclusion/ Discussion
Diagnosing patterns of three types of poisoning behaviors pretended, self and accidental bysystematic objective observation with (STS) method is possible.For cross cultural applications fresh studies catering for various cultural needs are recommended to test (STS) method utility for quickpoisoning type diagnosis.(STS)however application even in similar cultural context may not be practiced without caution and required medical assistance.The studysuccessfully highlights the importance of systematic observation in clinical assessment.Importance of observational methods emerged in high emergency cases for diagnosis/ assessment.It could be utilized in the areas where less advanced diagnostic facilities necessary for modern diagnosis are available.It is easy, could be used without much expertize and even by a nonprofessional.The proposed method in the study could be utilized in other emergencies situations if developed in similar way, the study thereby, brought in a possibility for objective evaluation/ assessment/diagnosis in medical situations in the developing world to cater for less modern medical facilities available there.Lynn S McCarty yz and Christopher J Borgertz y LSARE (2016) ALL CURRENT ECOTOXICITY TEST RESULTS CONFOUNDED BY DESIGN AND IMPLEMENTATI ON ISSUES?Integrated Environmental Assessment and Management 12( 2) Meel, B. L. (2011).Aluminium phosphide (tank pill) poisoning in the Transkei region of South Africa: a case report.Medicine, Science and the Law, 51(2), 116-118.Müller, D., &Desel, H. (2013).Common causes of poisoning: etiology, diagnosis and treatment.DeutschesÄrzteblatt International, 110(41), 690.Mutlu, M., Cansu, A., Karakas, T., Kalyoncu, M., &Erduran, E. (2010).Pattern of pediatric poisoning in the east Karadeniz region between 2002 and 2006: increased suicide poisoning.Human & experimental toxicology, 29(2), 131-136.Ostapenko, Y. N., Matveev, S. B., Gassimova, Z. M., &Khonelidze, R. S. (2001).Epidemiology and medical aid at acute poisoning in Russia.Przegladlekarski, 58(4), 293-296.Paumgartten, Francisco J.R.. (1993).Risk assessment for chemical substances: the link ://dx.doi.org/10.1590/S0102-311X1993000400004Patil, A., Peddawad, R., Verma, V. C. S., & Gandhi, H. (2014).Profile of acute poisoning cases treated in a tertiary care hospital: a Study in Navi Mumbai.Asia Pacific Journal of Medical Toxicology, 3(1), 36-40.Paumgartten, Francisco J.R.. (1993).Risk assessment for chemical substances: the link between toxicology and public health.Cadernos de SaúdePública, 9(4), 439-447.https://dx.doi.org/10.1590/S0102-311X1993000400004a-Was walking b-Walking with support c-On wheelchair d-On stature e-Resisting to the attendant to be admitted in hospital 2-First contact with the ward: a-Looked toward attendant b-Looked toward Nurse/Doctor c-Was Semi conscious d-Unconscious e-Didn't make any response 3-Nurse Patient Interaction Found: a-Realistic b-Confused c-Convincing d-Social e-Pretending 4-Appearance: a-Good looking b-Informal dressing c-Reflecting a dirty look d-Was half naked e-Completely naked 5-Hair style: a-Stylish b-Partially set c-Unusual d-Dirty with dust e-Dirty with secretion 6-Vomiting and oral secretions: a-Vomitingb-Nauseac-Watery fluidd-Thick oral secretione-Bloody secretion from mouth and nose 7-Seeking help: a-Crying b-Weeping c-Noise excessively d-Calling names e-Laughing 8-Observable behavior: a-Extremely fearful b-Trembling c-Death feelings d-Was sticking to the attendant e-Cool and calm 9-In case of Female: a-Makeup exceptional b-Usual healthy look c-Unusual d-No makeup eNote: This column shall be filled when the diagnosis shall finally be finalized (Please mark A---for Self Poisoning, B----for accidental Poisoning and C---for pretended, after the final diagnostic findings are finalized) Large number of cases 161 out of 360 waited formal discharge from the ward by their doctors but about 70 cases left without informing and 89 shifted to other wards relating to their complications.40 cases expired.
A huge number of patients were illiterate 107 (29.7%), 51 (14.1%) were under metric, (20.3%) were matriculates and intermediate.Only 30 (8.3%) were graduates whereas only (1.7%) were highly qualified.13(3.6%)cases were having no history of education.A large number of participants were unemployed 144 out of 360, 100 out of 360 were students , were employed , 01 was handicapped and 13 were with no history.Most of cases were referred by parents and a few by others.
The running records of all poisoning patients' behaviors those admitted in the selected ward were recorded on a Structured Taxonomy Sheet (STS) (Appendices-A) by expert observers for six months.(STS) recorded observations later were compared with initial provisional medical diagnosis of the patients in the emergency and after it with final medical diagnosis.It was assumed that (STS) records could indicate differences between poisoning type behaviors close to medical diagnosis now in practice as a quick diagnostic measure for quick intervention and subsequent pre-cautionary measures?