National Priorities for Perioperative Research in South Africa

BACKGROUND:Perioperative research is currently unco-ordinated in South Africa (SA); with no clear research agenda.OBJECTIVE:To determine the top ten national research priorities for perioperative research in SA.METHODS:A Delphi technique was used to establish consensus on the top ten research priorities.RESULTS:The top ten research priorities were as follows: (i) establishment of a national database of (a) critical care outcomes; and (b) critical care resources; (ii) a randomised controlled trial of preoperative B-type natriuretic peptide-guided medical therapy to decrease major adverse cardiac events following non-cardiac surgery; (iii) a national prospective observational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a stepped-wedge trial of an enhanced recovery after surgery programme for (a) surgery; (b) obstetrics; (c) emergency surgery; and (d) trauma surgery; (vi) a stepped-wedge trial of a surgical safety checklist on patient outcomes in SA; (vii) a prospective observational study of perioperative outcomes after surgery in district general hospitals in SA; (viii) short-course interventions to improve anaesthetic skills in rural doctors; (ix) studies of the efficacy of simulation training to improve (a) patient outcomes; (b) team dynamics; and (c) leadership; and (x) development and validation of a risk stratification tool for SA surgery based on the South African Surgical Outcomes Study (SASOS) data.CONCLUSIONS:These research priorities provide the structure for an intermediate-term research agenda

Barriers to Self-Management of Diabetes : a Qualitative Study among Low-Income Minority Diabetics

Objectives : Diabetes self-management is a key element in the overall management of diabetes. Identifying barriers to disease self-management is a critical step in achieving optimal health outcomes. Our goal was to explore patients' perceptions about barriers to self-management of diabetes that could possibly help explain poor health outcomes among minority patients. Study design : Four focus groups were conducted among 31 predominately African-American patients with diabetes who were enrolled in the Baltimore Cardiovascular Partnership Study; a NIH-funded multi-year prospective partnership study. The topic guide consisted of a series of open-ended questions about knowledge of current health status; medication use; continuity of care; blood glucose level and nutrition. Results : The focus groups confirmed that previously reported barriers to self-management persisted; and identified new concerns that could be associated with poor health outcomes among minority patients with diabetes. Attitudes; perceptions and behaviours surrounding diabetes and self-management of the condition did vary across individuals; however; the variation appeared to reflect the individual's knowledge and opinions rather than patient's age; gender or culture. The primary barrier to diabetes self-management resulted from lack of knowledge of target blood glucose level and blood pressure. Several participants found some of the health information quite confusing. Conclusions : Diabetes is a major public health concern and the lack of awareness of target blood glucose level and blood pressure further complicates the problem. The limited health literacy seen in this study could help explain several of the barriers to self-management. The barriers to self-management identified in this qualitative study are amenable to intervention that could improve health outcomes