An introduction to indigenous health and culture: the first tier of the Three Tiered Plan.

The objective of the present study was to prepare new doctors with an awareness of cultural and health issues to facilitate positive experiences with indigenous patients. The study incorporated the 1998 intern orientation programs in Queensland public hospitals. The study method included tier one of the Three Tiered Plan, which was implemented and audited. Indigenous liaison officers, directors of clinical training and medical education officers were surveyed prior to this implementation to determine whether any or similar initiatives had been carried out in previous years and/or were planned. Post-implementation feedback from interns was obtained by using questionnaires. Follow-up telephone interviews with the directors of clinical training, medical education officers and indigenous hospital liaison officers detailed the format and content of tier one at each hospital. The results indicate that this active intervention improved the implementation rate of tier one from nine of 19 (47%) Queensland public hospitals in 1997 to 17 (90%) in 1998. The 14 indigenous hospital liaison officers (100%) involved in the intervention perceived it as beneficial. Forty-three (67%) of interns who responded to the survey indicated they had encountered an indigenous patient within the last 2-4 months. The level of knowledge of indigenous health and culture self-reported by interns was between the categories 'enough to get by' and 'inadequate'. In conclusion, it appears that tier one has been successful and is to be a formal component of intern orientations in Queensland public hospitals. Further initiatives in indigenous health and culture targeting medical staff (i.e. tier two and tier three), are needed.

An aid to the management of pediatric trauma in peripheral centers--a proposal for a pediatric trauma board.

In 1986, 630,000 children under the age of 15 were living in Queensland. This accounted for 17% of Australia's pediatric population. That year there were 39 pediatric deaths in Queensland resulting from road traffic incidents. Another 408 injured children were admitted to hospital. Less than 20% of these children were treated in an accident and emergency (A&E) department staffed by a qualified pediatrician. Only 35% of the A&E departments were staffed by a qualified emergency physician. A Pediatric Trauma Board is proposed, which will lead to improvement in the care of injured or critically ill pediatric patients. This board is made of pre-marked whiteboard and includes normal pediatric values and replacement fluid flow charts; it is approximately three feet in height and six feet in width. The Board is aimed primarily at nonpediatric clinicians who may or may not be specifically trained or interested in emergency medicine. It provides quick, easy access to the normal values of vital signs for children of different ages and sizes. It enables accurate calculation of the fluid requirements for resuscitation and provides a means for following the response to this therapy. Drug doses per weight are provided. A copy of the board can be made on size A4 photostats for inclusion in the hospital chart as part of the admission notes.

Fractures of the accessory carpal bone in the horse.

The clinical signs and radiographic appearance of 19 cases of fracture of the accessory carpal bone of horses are described. In 17 cases the fractures were in the frontal plane and occurred palmar to the groove on the lateral aspect of the bone. In six cases radiographs taken six months to three years after the fracture occurred showed no evidence of bony union; nevertheless, these and five other horses for which follow-up information was available for up to seven years all became sound, and seven of them returned to competitive activity.