Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 60-71).

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management July, 2014 / BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. South Africa has aligned itself with the MDGs. The Gauteng Department of Health and Social Development has also embraced the MDGs and decided to improve its maternal health services. It has decided to target Intra-partum period for interventions to improve maternal health because intra-partum period is associated with a high rate of perinatal death from intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000), as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This study was planned to systematically study the clinical procedure performed during the intra-partum period at the Heidelberg Hospital (a semi - rural district hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province). AIM: To describe the clinical procedures and factors related to these procedures and maternal and neonatal health outcomes for the mothers admitted and delivered in the Maternity unit at Heidelberg hospital during one year period (1st April 2010 to 31st March 2011) METHODOLOGY: The setting of this study was the Maternity unit of the Heidelberg Hospital. A cross sectional study design was used based on retrospective review of routinely collected data for 12 months (2010 April 1st to 2011 March 31st). No intervention was done as a part of this study. The study variables included different clinical procedures (such as normal vaginal delivery, assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean hysterectomy), socio-demographic profile of patients (such as age, gender, ethnicity, medical aid), clinical profile (such antenatal diseases, booking status, intra-partum complications, postpartum complications) and maternal and perinatal outcomes. RESULTS: The study found highest number of deliveries (78.6%) were normal vertex deliveries and a very few (1%) assisted and breech deliveries. The caesarean section rate was high (20.4%) as compared to the normal national target (12, 5%). Fetal distress and CPD was the main indications for caesarean section. The majority of women who delivered at Heidelberg Hospital maternity came from poor socio-economic class, mostly single, teenagers, and unemployed. They were the most vulnerable group in the Society. The majority of women were booked and referred from PHC clinic where they were booked for antenatal check-up. Pregnancy induced hypertension was the commonest obstetric problem encountered during antenatal period. Most women who delivered at Heidelberg hospital during the period were discharged without complications, no maternal deaths were reported. There were 8.1% preterm deliveries but a relatively high still birth rate which is of concern. CONCLUSION: The study was the first of its kind to be done at Heidelberg Hospital and the Sedibeng Health District. The study systematically analysed routinely collected data and identified high risk patients, who would require special attention. This study would hopefully assist the Hospital Management to realise the high rate of CS and to develop appropriate measures to reduce unnecessary C/S being done, and to strengthen referral systems. In addition, further study is necessary at clinic level in the sub-district to identify work-loads in the feeder clinics.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 63-65).

Esta tese consiste em uma análise da formação em obstetrícia durante a graduação em medicina, baseada em pesquisa etnográfica realizada em duas escolas conceituadas. Objetivou-se estudar o modo como se articulam a competência técnica e científica e o cuidado ou relação com a paciente no ensino teórico e prático da assistência ao parto. As técnicas utilizadas na coleta de dados foram: observação participante, entrevistas semi-estruturadas e, de modo complementar, a análise de livros-texto e protocolos assistenciais. O trabalho abrangeu uma caracterização das propostas curriculares e um exame da experiência dos alunos quanto ao ensino teórico e prático, incluindo sua supervisão nas diversas atividades assistenciais. Ênfase maior recai sobre o desenvolvimento de conhecimentos científicos na formação. Mesmo no internato ênfase é colocada na aprendizagem da construção e encenação de narrativas clínicas, privilegiando-se a transmissão oral do conhecimento e a memória em relação ao registro escrito e à consulta ao prontuário das pacientes. Pautado em parte por assim chamadas concepções \"clássicas\", que sustentam uma visão patológica da fisiologia do parto, o exercício da prática envolve condutas que têm sido questionadas a partir das evidencias científicas ou até abandonadas em outros contextos As decisões acerca das condutas ou tratamentos adotados não são compartilhadas com as mulheres atendidas que frequentemente não são consultadas ou sequer informadas à respeito. Por vezes juízos de valor também influenciam o julgamento clínico e a tomada de decisões médicas. Há poucos parâmetros para avaliar as atitudes dos alunos em sua interação com as pacientes. Nos serviços em que há maior interação entre alunos e pacientes, a supervisão é menor. Existem acordos informais entre os assistentes na divisão de plantões que se contrapõe aos organogramas formais dos serviços obstétricos vinculados as Faculdades de medicina pesquisadas. Esses acordos subordinam os objetivos institucionais da boa formação e assistência em obstetrícia aos interesses individuais e coletivos dos profissionais obstetras responsáveis pela supervisão do ensino. Componente do currículo oculto, esses acordos servem de modelo para outros envolvendo residentes e/ou alunos. Ao longo da formação dos estudantes de medicina, as interações entre os sujeitos em relação no exercício do ato médico contribuem de diversas maneiras para desqualificar a prática médica da obstetrícia como técnica moral-dependente. / This thesis consists of an analysis of obstetric training during medical school. It is based on ethnographic research undertaken at two acknowledged medical schools. The objective was to study how technical and scientific competence and care, that is, the relationship with the patient, are articulated in theoretical and practical training of birth assistance. The techniques employed in fieldwork were: participant observation, semi-structured interviews and, in a complementary form, the analysis of textbooks and assistance protocols. A characterization of the curriculum offered by the schools and an examination of students experience with respect to learning the theory and practice of obstetrics, including the supervision of the various activities involving obstetric assistance are discussed. Description and analysis of the scission between the development of technical and scientific competence in the educational process was undertaken. The implications of this scission for training in the practice of medicine as a moral dependent technique are discussed. Great emphasis is placed on the development of scientific knowledge during training. Even in the clinical years, emphasis is placed on learning to construct clinical narratives, placing priority on memory and the oral transmission of knowledge rather than written registration and consultation of patiente\'s charts. Learning and training is based in part on so-called \"classical\" concepts, which sustain a pathological approach to birthing. In training, this approach involves norms of conduct that have been questioned by scientific evidence and that have even been abandoned in other contexts. Obstetrical decisions involving conduct and training are not taken in conjunction with the women receiving assistance who frequently are not even consulted or informed of these decisions. Sometimes prejudices influence medical judgment and decision-making. There are few parameters to evaluate student attitudes in their interaction with patients. In the work stations where students interact more with patients there is less supervision. Informal arrangements between assistants with respect to rounds conflict with the formal schedules of the obstetric services associated to the medical schools where research was undertaken. These arrangements subordinate the institutional objectives of good medical practice and assistance to the individual and collective interests of the obstetricians responsible for supervising training. These arrangements are a component of the hidden curriculum and serve as a model for other arrangements involving residents and/or students. Throughout the obstetric training of medical students, interactions between the subjects involved in the medical act contribute in several ways to disqualify the medical practice of obstetrics as a morally-dependent technique.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Diss. Uppsala : Uppsala universitet, 2006.

Esta tese consiste em uma análise da formação em obstetrícia durante a graduação em medicina, baseada em pesquisa etnográfica realizada em duas escolas conceituadas. Objetivou-se estudar o modo como se articulam a competência técnica e científica e o cuidado ou relação com a paciente no ensino teórico e prático da assistência ao parto. As técnicas utilizadas na coleta de dados foram: observação participante, entrevistas semi-estruturadas e, de modo complementar, a análise de livros-texto e protocolos assistenciais. O trabalho abrangeu uma caracterização das propostas curriculares e um exame da experiência dos alunos quanto ao ensino teórico e prático, incluindo sua supervisão nas diversas atividades assistenciais. Ênfase maior recai sobre o desenvolvimento de conhecimentos científicos na formação. Mesmo no internato ênfase é colocada na aprendizagem da construção e encenação de narrativas clínicas, privilegiando-se a transmissão oral do conhecimento e a memória em relação ao registro escrito e à consulta ao prontuário das pacientes. Pautado em parte por assim chamadas concepções \"clássicas\", que sustentam uma visão patológica da fisiologia do parto, o exercício da prática envolve condutas que têm sido questionadas a partir das evidencias científicas ou até abandonadas em outros contextos As decisões acerca das condutas ou tratamentos adotados não são compartilhadas com as mulheres atendidas que frequentemente não são consultadas ou sequer informadas à respeito. Por vezes juízos de valor também influenciam o julgamento clínico e a tomada de decisões médicas. Há poucos parâmetros para avaliar as atitudes dos alunos em sua interação com as pacientes. Nos serviços em que há maior interação entre alunos e pacientes, a supervisão é menor. Existem acordos informais entre os assistentes na divisão de plantões que se contrapõe aos organogramas formais dos serviços obstétricos vinculados as Faculdades de medicina pesquisadas. Esses acordos subordinam os objetivos institucionais da boa formação e assistência em obstetrícia aos interesses individuais e coletivos dos profissionais obstetras responsáveis pela supervisão do ensino. Componente do currículo oculto, esses acordos servem de modelo para outros envolvendo residentes e/ou alunos. Ao longo da formação dos estudantes de medicina, as interações entre os sujeitos em relação no exercício do ato médico contribuem de diversas maneiras para desqualificar a prática médica da obstetrícia como técnica moral-dependente. / This thesis consists of an analysis of obstetric training during medical school. It is based on ethnographic research undertaken at two acknowledged medical schools. The objective was to study how technical and scientific competence and care, that is, the relationship with the patient, are articulated in theoretical and practical training of birth assistance. The techniques employed in fieldwork were: participant observation, semi-structured interviews and, in a complementary form, the analysis of textbooks and assistance protocols. A characterization of the curriculum offered by the schools and an examination of students experience with respect to learning the theory and practice of obstetrics, including the supervision of the various activities involving obstetric assistance are discussed. Description and analysis of the scission between the development of technical and scientific competence in the educational process was undertaken. The implications of this scission for training in the practice of medicine as a moral dependent technique are discussed. Great emphasis is placed on the development of scientific knowledge during training. Even in the clinical years, emphasis is placed on learning to construct clinical narratives, placing priority on memory and the oral transmission of knowledge rather than written registration and consultation of patiente\'s charts. Learning and training is based in part on so-called \"classical\" concepts, which sustain a pathological approach to birthing. In training, this approach involves norms of conduct that have been questioned by scientific evidence and that have even been abandoned in other contexts. Obstetrical decisions involving conduct and training are not taken in conjunction with the women receiving assistance who frequently are not even consulted or informed of these decisions. Sometimes prejudices influence medical judgment and decision-making. There are few parameters to evaluate student attitudes in their interaction with patients. In the work stations where students interact more with patients there is less supervision. Informal arrangements between assistants with respect to rounds conflict with the formal schedules of the obstetric services associated to the medical schools where research was undertaken. These arrangements subordinate the institutional objectives of good medical practice and assistance to the individual and collective interests of the obstetricians responsible for supervising training. These arrangements are a component of the hidden curriculum and serve as a model for other arrangements involving residents and/or students. Throughout the obstetric training of medical students, interactions between the subjects involved in the medical act contribute in several ways to disqualify the medical practice of obstetrics as a morally-dependent technique.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 4 uppsatser.