Unwholesome trauma care: a cautionary note.

BACKGROUND: Trauma care requires proper training on how to diagnose life and limb threatening conditions. The aim of this paper is to report an extreme case of unwholesome practice that drained the patient physically, emotionally and financially. METHODS: The medical record of the patient and relevant literature were reviewed. RESULT: A 25-year-old commercial motorcyclist (okada) presented with a huge discharging leg ulcer with exposed plate and necrotic distal half of the right tibia on the account of uninformed treatment he received from his primary physician and a traditional bonesetter spanning a period of five months. The foot was found to be grossly deformed and insensate. Below knee amputation was done as salvage. CONCLUSION: Our undergraduate curriculum should change to expose medical students more to basic trauma care. A designated body should regulate activities of traditional bonesetters. The practitioners should be made to undergo some form of training to recognize high-risk trauma patients and the need for early referral.

School behaviour and health status after central nervous system tumours in childhood.

This study was designed to assess the overall morbidity burden of survival from central nervous system (CNS) tumours and its impact on return to a normal lifestyle. School behaviour and health status of 27 children after treatment for CNS tumours, of 25 of their school-aged siblings, plus age- and sex-matched controls is reported. Spinetta school behaviour, Lansky play-performance and Health Utilities Index (mark II and III) assessments have been made. Patients had reduced mobility and increased pain levels. They demonstrated a reluctance to participate in organized physical activities. Impaired cognition, emotion and self-esteem were reported. They worried more than controls but attended school willingly, interacted normally with their peers and viewed the future confidently. Their siblings were reluctant to express openly concern for others or feelings of joy. Teachers were reliable proxies for most attributes, notable exceptions being speech and emotion. This is the first study to have assessed the school behaviour of a cohort solely composed of survivors of childhood CNS tumours. The good social reintegration is reassuring and likely to reflect a high level of psychosocial support. However, the results presented identify these young people as a 'special educational needs' group as defined by the 1981 and 1993 Education Acts.