Browsing by Author ","

Now showing 1 - 3 of 3
  • No Thumbnail Available
    Item
    Open Access
    Making Unusual suspects - girls in gangs: a critical reflections on the ethics of cross-cultural filmmaking
    (2023) Lamotte, Sophie; ,
    This research explores questions of ethics in cross-cultural documentary filmmaking in relation to making of the film “Unusual suspects: girls in gangs”. The film depicts the livedexperiences of three women who are or were involved in gangs and follows a police unit commander in her duties in fighting gang-related crime. The making of the film was characterised by cultural differences because I, the film maker, am a foreigner entering an arguably less privileged field with participants who could be considered vulnerable - both in terms of their socio-economic status and their safety. The mode of the documentary is observational, with elements of the participatory, based on encounters with the ‘Other' androoted in a desire to shine a light on a largely hidden issue that affects a lot of women in South Africa, and the Cape Flats specifically. The film's production prompted continual engagement with ethical questions. In this explication, which accompanies the film, I analyse my own practises and offer a set of suggestions based on my experience for making a documentary film with the intent of acknowledging one's positionality and overtly addressing issues of power differentials between the filmmaker and the people she represents.
  • No Thumbnail Available
    Item
    Open Access
    One-year retrospective analysis of red cell concentrate requisition and utilization practices at Regional and District hospitals with no blood bank on-site, Metro West Cape Town, South Africa: A multicentre descriptive study
    (2023) Chiu, Chian-Jia; ,
    Introduction: The usage of red cell concentrate (RCC) is an essential part of patient blood management (PBM). While a substantial amount of literature describes RCC usage at tertiary institutions, very few exists in the setting of regional or district hospitals with no blood bank on-site (H-NBBOS). Addressing this shortfall in countries with a strained health economy, such as South Africa, is imperative. This scarcity of resources also renders the intervention studies needed to improve blood utilisation and PBM particularly difficult. Material and Methods: A 12-month retrospective and comparative study investigating RCC usage across a hospital with a blood bank on-site (H-BBOS) or H-NBBOS and the various specialities, in Metro West Cape Town, South Africa. We proposed a set of new blood utilisation indices: individualised crossmatch-to-transfusion ratio (iCTR) and individualised transfusion-to-crossmatch ratio (iTCR), over and above conventional indices, to comprehensively ascertain the efficiency of both RCC crossmatching and transfusion practices through individualised cases. Regression analyses were performed to provide recommendations for a cost-effective intervention study to improve future PBM. Results: Apart from wastage ratio (3.74%) of H-NBBOS, all other overall blood utilisation indices for both H-BBOS and H-NBBOS were in accordance with international benchmarks. The overall crossmatch-to-transfusion ratio (CTR) of 1.19 in H-NBBOS indicated greater crossmatching efficiency than the H-BBOS (1.31). The superior efficiency of H-NBBOS was substantiated via statistical inference of our proposed individualised patient indices of iCTR and iTCR (p<0.05). Regression analyses of the various specialities revealed that Surgery and Obstetrics/Gynaecology of both H-NBBOS and the H-BBOS had the least efficient blood utilisation practices and higher chances of wastage. Conclusions: The conventional overall CTR showed that H-NBBOS were considerably more efficient than the H-BBOS. However, only a marginal difference was detected through the analysis of our proposed iCTR (p<0.05). There was a more distinctive difference in transfusion practices, with H-NBBOS transfusing proportionately more than the BBOS hospital. This advocates the importance of also investigating the utilisation efficiency from a transfusion perspective. A cost-effective intervention study focused on Surgery and Obstetrics/Gynaecology departments, particularly in H-NBBOS, is recommended to improve future blood utilisation practices in South Africa. In addition, our proposed indices enabled comprehensible and insightful interrogation of both crossmatching and transfusing practices. The individualisation of efficiency indices also permitted further objective statistical inferences. Therefore, we propose the incorporation of these indices in future blood utilisation analyses.
  • No Thumbnail Available
    Item
    Open Access
    The design, development, and validation of an accessible high flow nasal oxygen solution with patient scoring outputs
    (2024) Reabow, Brandon; ,
    Introduction Acute respiratory failure patients are admitted to healthcare units to treat hypoxemic symptoms. High Flow Nasal Oxygen (HFNO) device are medical oxygen therapy devices, with its use emerging through the COVID-19 pandemic and ongoing to treat congenital diseases, to effectively treat poor patient vitals and oxygenate patients. Clinical settings such as the general ward, for which HFNO is suitable, is left to be managed with manual patient monitoring means. Continuous monitoring methods are generally not accessible to these settings. With no high flow devices targeting means to provide this option without sophisticated medical devices, patient care may be limited. Therefore, this study aimed to develop an HFNO device that interfaced with predicate patient vital sign sensors that provided medical professionals with the Respiratory Rate and Oxygenation (ROX) patient score. The score has been validated to aid in early detection of patient deterioration and informing clinicians on treatment prognosis, improving patient care. Materials & Method A standalone HFNO device was designed with subsystems that are characteristic of the common treatment components of HFNO, which included the Oxygen Regulator and Mixer Unit, the Humidification and Heating Unit, and the Patient Airway Device. Additionally, a Patient Vitals Acquisition Unit for acquiring patient vitals was incorporated into the system architecture. The subsystem designs were based on requirements ad specifications informed by the World Health Organisation (WHO) clinical guidance and ISO 8601-2-90:2021 safety and performance requirements. An iterative and fast prototyping approach was adopted, with a Failure Modes and Effects Analysis for assessing risks in safety and failure in performances, to produce design and development outcomes for each unit and the integrated overall device. The study progressed through various processes of verification and validation. The outcomes were verified based on meeting the technical specifications outlined and conducted in the Medical Devices Laboratory (MDL) at the University of Cape Town (UCT) under simulated compressed air inputs. The system was fully integrated and validated by testing the accuracy of oxygen settings guided by ISO 80601-2-90:2021 and interfacing with all peripherals within the clinical setting, simulated within the Groote Schuur Clinical Skills department. The HFNO device with patient vitals were connected to medical oxygen source and the Simman patient simulator to demonstrate the intended use and feasibility within the relevant context. Results and Observations All units were manufactured successfully and tested for essential performance and integral safety. Initial tests with simulated compressed air supply showed flow rate outputs of up to 70 l/min with sufficient automated flow rate control and manual oxygen concentration settings of 21-100%. The humidification unit provided permissible humidification loads of up to 100%RH, and 37°C gas heating which reduced humidification loads to 48%RH at 60 l/min. The patient airway device fit the Laerdal Patient Airway Management trainer effectively. The patient vitals sensors provided respiratory rate capture of 3 to 90 breaths per minute, and the pulse oximetry data connectivity to the system. The maximum error in oxygen flow rates greater than 30 l/min was - 5.69 l/min for 30% FiO2. Maximum errors of +3.2% FiO2 were shown for flow rates less than 15 l/min and greater than 30 l/min. The respiratory rate and pulse oximetry measurements were used to produce the ROX and modified ROX scores in real-time within the clinical setting for simulated patients for unsuccessful and successful treatment pathways. Conclusions A preliminary HFNO solution was developed and performed well amongst performance criteria of commonly used products. The solution was produced affordably within a research and development context and on a basis of materials only. The automatic access to respiratory rate, a good basis for predicted outcomes illustrated the benefit of the system. Ultimately, the results and the solution had implications for improving HFNO within resource-poor settings.