Masters Degrees (Health Systems and Public Health)

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Browsing Masters Degrees (Health Systems and Public Health) by Author "Burman, Francois"

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    A retrospective review of the most common safety concerns encountered at a range of international recompression facilities when applying the Risk Assessment Guide for Recompression Chambers over a period of 13 years
    (Stellenbosch : Stellenbosch University, 2014-04) Burman, Francois; Meintjes, Willem Albertus Jacobus; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
    ENGLISH ABSTRACT: Diving medical doctors frequently make use of Hyperbaric Facilities without fully realising their legal and ethical responsibilities towards the safety of their patients and their staff. Few have specific training in the technical or operational aspects of these facilities; this deficiency is exacerbated when these are established in remote areas. The potential dangers are real and the results can be devastating. Most current regulatory, manufacturing, safety and operational guidance documents are not flexible enough to be applied universally, nor do they offer practical guidance on the recognition and the mitigation of the unique and relevant hazards at a given facility. The goal of integrated safety is rarely achieved. The Risk Assessment Guide (RAG) was developed by the investigator as a tool to qualify the actual safety status of a hyperbaric facility and to offer guidance on how to improve and maintain it. Although the RAG has been subject to extensive peer review and field implementation over the past 13 years, it has not been subject to scientific validation. Therefore, the objective of this thesis was to do so by (1) retrospectively reviewing the most common safety concerns affecting facility status as identified by the RAG; (2) using the data derived from the analysis to produce a predictive model of likely safety status for un-assessed facilities; and (3) consolidating the results in the form of specific recommendations to improve and maintain safety status. Data collected from a consistent application of the RAG over a period of 13 years, covering 105 applicable facilities, was analysed to determine the common safety concerns, particularly those affecting safety status by means of a consolidated Risk Assessment Score (RAS). The RAS values permitted comparisons between the facilities assessed. The various factors associated with a higher RAS were determined by means of a multivariate regression. Thereupon, the most significant determinant factors were built into a predictive model for the likely safety status of an un-assessed facility. Finally, the most common safety concerns were identified and summarised so that medical practitioners are empowered to determine, improve and maintain the safety status of a given facility. The conclusions of this project are that: (1) the RAG is an appropriate tool to assess facilities for risk elements relevant to their safety status while simultaneously filling the knowledge gaps to equip medical practitioners and staff to improve and maintain safety; (2) reliable predictions on unknown facilities can be made to provide medical practitioners with the necessary information on whether a given facility is appropriate for patient referral; and (3) the RAG is a suitable benchmark for determining hyperbaric facility safety; the review of its application has provided objective data that will permit the formulation of future safety guidelines based on empirical rather than arbitrary information.