South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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In this article, I explore the South African 2003 National School Health Policy (NSHP) and the revised 2012 Integrated School Health Policy (ISHP). I examine whether the shortcomings in the development, content and implementation of the 2003 NSHP, and the context in which it was implemented, have been addressed adequately in the 2012 ISHP. The shortcomings include poorly structured relationships among key policy actors; an absent policy translation process resulting in insufficient understanding and prioritisation of school health by district and facility managers; and poor support and training of nurses. ⋯ The comparison of the 2003 and 2012 policies is guided by the policy analysis framework of the Walt and Gilson policy triangle, which considers the policy context, process of policy development, policy actors and the policy content as key dimensions to successful policy development and implementation. I draw on an evaluation of a six-year implementation period (2003 - 2009) of the 2003 NSHP, which revealed the implementation challenges with the related explanatory factors. I provide lessons from the evaluation of the 2003 NSHP, highlight the policy changes in the new 2012 ISHP and finally highlight key opportunities, and remaining challenges, for the implementation of the new 2012 ISHP.
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Comparative Study
The South African Vascular Surgical Cardiac Risk Index (SAVS-CRI): a prospective observational study.
Recent evidence suggests that application of the Revised Cardiac Risk Index (RCRI) for peri-operative cardiovascular risk stratification in vascular surgery patients may be inappropriate, necessitating the development of risk indices specific to vascular surgery patients. ⋯ The RCRI is not appropriate for peri-operative cardiovascular risk stratification in vascular surgery patients. The SAVS-CRI may be preferable for risk stratification in South African vascular surgery patients, although independent validation is required.
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Comparative Study
The versatility of median sternotomy in general paediatric surgery.
While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. ⋯ This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.
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Globally, 90% of road traffic crash (RTC) deaths occur in low- and middle-income countries. ⋯ Our results demonstrate a high incidence of RTCs associated with a high injury score and significant morbidity. Most crashes were associated with a number of high-risk behaviours.
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The 2-year internship period for medical graduates began in South Africa in 2005 and has never been formally evaluated. ⋯ The 2-year internship has provided the basis for independent medical practice in DHs. However, certain critical skill gaps need urgent attention, particularly in obstetrics and anaesthesia. Areas of weakness in ENT, urology, ophthalmology and dermatology could be addressed by including these specialities as a compulsory rotation in surgery, medicine or family medicine during internship training.