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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
541

Auditoria e feedback : efeitos sobre a pratica obstetrica e os resultados da atenção a saude / Audit and feedback : effects on professional obstetrical practice and health care outcomes

Nascimento, Maria Laura Costa do, 1979- 12 August 2018 (has links)
Orientadores: Jose Guilherme Cecatti, Helaine Maria Besteti Pires Milanez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T04:53:54Z (GMT). No. of bitstreams: 1 Nascimento_MariaLauraCostado_M.pdf: 1430969 bytes, checksum: d6876f4a7fd820af8e7cd1d6109e0303 (MD5) Previous issue date: 2008 / Resumo: Introdução: Auditoria e Feedback, estratégia de intervenção na prática médica, sendo um resumo da atuação durante certo período, com posterior formulação de recomendações para a melhoria do serviço estudado. Sua efetividade ainda é incerta em Obstetrícia. Objetivo: Estudar o processo de Auditoria e Feedback em Obstetrícia e implementar o uso do material da Reproductive Health Library. Avaliar o possível efeito da intervenção sobre as taxas de parto por cesárea, com a utilização da classificação de Robson. Métodos: coleta prospectiva de dados sobre os seis parâmetros obstétricos selecionados segundo publicações baseadas em evidência, antes e depois de um período de intervenção, preparado após análise dos índices de prevalência de cada prática: episiotomia seletiva, cardiotocografia contínua durante o trabalho de parto em gestações de baixo risco, antibioticoprofilaxia no parto por cesárea, uterotônico no terceiro período do parto, indução de parto às 41 semanas em gestações de baixo risco e suporte contínuo durante o trabalho de parto. Realizado agrupamento de todos os partos segundo a classificação de Robson, em 10 grupos, levando em conta o antecedente obstétrico, tipo de gestação, curso do trabalho de parto e idade gestacional. Resultados: os dois períodos foram similares quanto às características obstétricas gerais. Com relação aos parâmetros selecionados, foi observada redução significativa do uso de episiotomia seletiva (RR 0.84 IC95% 0.73-0.97), embora o mesmo não tenha ocorrido entre as primigestas (p=0,315), aumento na presença de acompanhante durante o trabalho de parto (RR 1.42; 1.24-1.63) e adequação de uso de uterotônico (ocitocina 10UI) no terceiro período (p<0,0001). Segundo a classificação de Robson, não ocorreu alteração no índice global de partos cesárea nos dois períodos estudados (respectivamente 45.5% e 43.3%). Houve predomínio do Grupo 3 (multipara sem cesárea anterior, feto único, cefálico, de termo, trabalho de parto espontâneo) com índices de 28.5 e 26.8% respectivamente. O segundo mais prevalente foi o Grupo 1 (nulípara, feto único, cefálico, termo e trabalho de parto espontâneo), com 25.5 e 22.6% do total de partos, seguido pelo Grupo 5 (multípara com cesárea prévia, feto único, cefálico, gestação de termo), com taxas de 22.9 e 21.3% respectivamente. O Grupo 5 foi também responsável pela maior contribuição ao número total de cesáreas (36.4 e 34.6% nos dois períodos). Os Grupos 2 (nulípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto) e 4 (multípara, feto único, cefálico, de termo, em trabalho de parto induzido ou cesárea antes de trabalho de parto), embora tenham pouca contribuição ao número total de partos, demonstraram altos índices de cesárea dentro do seus grupos. O grupo 10, composto por prematuros, foi o quarto mais prevalente, também com altos índices de cesárea no seu grupo, porém com redução significativa entre os períodos pré e pós-intervenção (p=0.0058). Conclusão: o processo de Auditoria e feedback pode ser utilizado como mecanismo de implementação em obstetrícia, sobretudo quando a equipe é receptiva a mudanças. / Abstract: Background: Audit and feedback is a widely used strategy to improve professional practice and can be defined as any summary of clinical performance of health care over a period of time, which may include recommendations for clinical action. Its effectiveness is still uncertain in Obstetrics. Objectives: to assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to implement the use of RHL material as a routine in medical practice; to evaluate the effect of the intervention over the incidence of caesarean sections, according to the Robson's classification, in 10 groups. Methods: The study proposed has an audit and feedback design and was conducted in the obstetric Unit of the University of Campinas, Brazil, between the years 2007- 2008. It started by providing up to date estimates of prevalence rates of six audit standards underwritten by evidence-based recommendations: selective episiotomy; continuous electronic fetal monitoring during uncomplicated labour of low risk pregnant women; antibiotic prophylaxis for women undergoing caesarean section; use of oxytocin after delivery as one of the procedures of active management of third stage of labour; routine induction of labour at 41 weeks for uncomplicated pregnancies and continuous support for women during childbirth. The results were then analyzed and presented as feedback to clinical practice. Active information based on the WHO Reproductive Health Library (RHL) was prepared to remind important and reliable health care interventions during meetings with the whole maternity staff. After four months, the same practices were again measured and analyzed to compare data and assess if the intervention was effective. All caesarean sections were evaluated according to Robson's Classification to study a possible effect of the intervention on caesarean rates. Results: both periods studied showed equivalency in the total number of deliveries, vaginal and caesarean births, forceps and deliveries in nulliparous. Considering the obstetric practices evaluated, there was a significant reduction in selective episiotomy (RR 0.84 95%CI 0.73-0.97), but not in nulliparous (p=0.315); an increase in continuous support for women during childbirth (RR 1.42; 1.24-1.63). There was also a change in the institution protocol for the use of uterotonic (oxitocyn) during third stage of labor, with a shift to the WHO recommended dosage of 10UI (p<0.0001). There was no change observed in the use of continuous electronic fetal monitoring, routine induction of labour at 41 weeks for uncomplicated pregnancies and antibiotic prophylaxis in caesarean sections. Considering caesarean sections, there was no prevalence change after intervention. Robson's classification was applied and Group 3 (multiparous excluding previous CS, single, cephalic, =37 weeks, spontaneous labour) accounted for the largest proportion of deliveries, 28.5% and 26.8% in both periods. Group 1 (nulliparous, single, cephalic, =37 weeks, spontaneous labour) was the second largest one, with 25.5% and 22.6% respectively, while Group 5 (previous caesarean section, single, cephalic, =37 weeks) was the third, with percentages of 22.9% and 21.3% respectively. Group 5 also represented the most prevalent when considering only caesarean sections, accounting for 36.4% and 34.6% in both periods. Groups 2 (nulliparous, single, cephalic, =37 weeks, induction or CS before labour) and 4 (multiparous excluding previous CS, single, cephalic, =37 weeks, induction or CS before labour) had low contribution for the total number of deliveries, however they had higher rates of caesarean sections within each group. Group 10 (all single, cephalic, = 36 weeks, including previous CS) represented the fourth largest among all deliveries, with respectively 6.6% and 8.6%. Within its group, the rate of caesarean section was high, with a significant decrease from 70.5% to 42.6%, from pre to post intervention period (p=0.0058). Conclusion: Audit and feedback can be used as a successful implementation tool in obstetrics, especially when the medical staff is open and receptive to change. / Mestrado / Tocoginecologia / Mestre em Tocoginecologia
542

Ionização induzida por impacto de elétrons e fragmentação iônica de álcoois primários metanol e etanol

Pires, Wesley Augusto Dias 04 March 2016 (has links)
Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-05-16T12:36:25Z No. of bitstreams: 1 wesleyaugustodiaspires.pdf: 2433576 bytes, checksum: fedecc1b5c320d77bfd511976f14e396 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-05-22T14:31:18Z (GMT) No. of bitstreams: 1 wesleyaugustodiaspires.pdf: 2433576 bytes, checksum: fedecc1b5c320d77bfd511976f14e396 (MD5) / Made available in DSpace on 2018-05-22T14:31:18Z (GMT). No. of bitstreams: 1 wesleyaugustodiaspires.pdf: 2433576 bytes, checksum: fedecc1b5c320d77bfd511976f14e396 (MD5) Previous issue date: 2016-03-04 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A ionização induzida por impacto de elétrons e fragmentação iônica do metanol e do etanol foi investigada neste trabalho, utilizando um espectrômetro de massa quadrupolo HIDEN. Por se tratar da primeira vez que o espectrômetro foi utilizado no Laboratório de Espectroscopia Atômica e Molecular (LEAM) da UFJF, o trabalho se iniciou a com a caracterização do equipamento, para posterior aplicação nos estudos pretendidos. Nos estudos dos álcoois foram obtidos os espectros de massa e abundâncias relativas dos cátions gerados por impacto de elétrons com energia de 70 eV, onde registrou-se que o CH2O+H foi o cátion mais abundante para o metanol e o etanol. A seção de choque de ionização total (SCIT) para o metanol, bem como as seções de choque de ionização parcial (SCIP) para os cátions CH3O+H, CH3+, CH2+, CH2O+H, CO+H, CH2O+, CO+, C+, CH+, foram geradas para energias de impacto entre 10-100eV. Nossos resultados apresentam uma boa concordância com os valores teóricos e experimentais da literatura, para a maioria das massas formadas. Foram também registrados valores de SCIP para grupos de íons, para comparação com as medidas de Rejoub e cols., que reportaram dados com menor resolução ao registrado neste trabalho. Para o etanol, foram obtidas a SCIT e também, as SCIP para os cátions CH3CH2O+H, CH3CHO+H, CH3CHO+, C2H3O+, C2H2O+, C2HO+, CH3O+H, CH2O+H, CH2O+, C2H5+, CO+ ou C2H4+, C2H3+, C2H2+, C2H+, C2+, O2+ou CH4+, CH3+, CH2+, CH+ e C+. Ao nosso conhecimento, estas são as primeiras medidas de SCIP reportadas na literatura, para cada cátion individualmente. A única comparação possível foi com grupos de íons reportadas por Rejoub e cols. Finalmente, foram gerados os limiares de ionização do metanol e do etanol para os cátions formados. / The ionization and ion fragmentation of methanol and ethanol induced by electron impact were investigated in this work, using a HIDEN quadrupole mass spectrometer. Once, it is the first time that this spectrometer was used in the Atomic and Molecular Spectroscopy Laboratory (LEAM) at UFJF, the work began with the characterization of the apparatus, for subsequent application on the required studies. In studies of alcohols were obtained mass spectra and relative abundances of the cations generated by electron with energy impact of 70eV, where it was recorded that CH2O+H was the most abundant cation for methanol and for ethanol. The Total Ionization Cross Section (TICS) to methanol and the partial ionization cross sections (PICS) for the cations CH3O+H, CH3+, CH2+, CH2O+H, CO+H CH2O+, CO+, C+, CH+ were generated for electron impact energies of 10-100 eV. Our results are in good agreement with the theoretical and experimental values reported in literature, for most of the formed cations. It was also reported PICS values for ions groups for comparison with measurement of Rejoub et al., who reported data with lower resolution than was recorded in this work. For ethanol, was obtained TICS and also, PICS for the cations CH3CH2O+H, CH3CHO+H, CH3CHO+, C2H3O+, C2H2O+, C2HO+, CH3O+H, CH2O+H, CH2O+, C2H5+, CO+ or C2H4+, C2H3+, C2H2+, C2H+, C2+, O2+ or CH4+, CH3+, CH2+, CH+ and C+. To our knowledge, these are the first PICS measurement reported in the literature for each individual cation. The only possible comparison was with ion groups, reported by Rejoub et al. Finally, the ionization thresholds for methanol and ethanol for the formed cations were generated in this work.
543

Avaliação da dificuldade técnica e dor na inserção de sistema intrauterino liberador de levonorgestrel : Evaluation of pain and technical difficulties at insertion of the levonorgestrel-releasing intrauterine system / Evaluation of pain and technical difficulties at insertion of the levonorgestrel-releasing intrauterine system

Santos, Ana Raquel Gouvêa, 1980- 08 January 2012 (has links)
Orientador: Ilza Maria Urbano Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:58:08Z (GMT). No. of bitstreams: 1 Santos_AnaRaquelGouvea_M.pdf: 962766 bytes, checksum: e715593c7f98a14aacfd9c4d956e7c8d (MD5) Previous issue date: 2012 / Resumo: Introdução: A anticoncepção intrauterina é um método bastante eficiente, porém sub-utilizada. Uma das causas que diminuem seu uso são as dificuldades que o profissional enfrenta no momento da inserção bem como a dor que a paciente sente durante o procedimento. Recentemente o sistema intrauterino liberador de levonorgestrel (SIU-LNG) foi introduzido como uma nova opção de dispositivo intrauterino com características que ampliaram a indicação e uso do mesmo. A introdução do SIU-LNG retomou a discussão sobre seu uso em cada vez mais mulheres inclusive nas nunca engravidaram. Objetivo: Identificar e comparar as dificuldades técnicas na inserção do SIU-LNG e o grau de dor referida entre nuligestas e multíparas com e sem cesárea anterior. Métodos: Setenta e quatro mulheres que procuraram o serviço de planejamento familiar do CAISM/UNICAMP para primeira colocação de SIU - LNG como método anticoncepcional (MAC) foram incluídas no estudo, de Maio a Dezembro de 2011. As mulheres foram divididas em três grupos: 23 nuligestas, 28 multíparas com antecedente de cesárea e 23 sem antecedente de cesárea. Após serem submetidas à inserção do SIU-LNG foi pedido que classificassem a dor segundo a Escala Visual Analógica (EVA) de 0 (sem dor) a 10 (maior dor possível). No retorno, entre 45 e 60 dias após a inserção, foram questionadas novamente sobre a dor que sentiram no dia da inserção segundo o mesmo score. O profissional responsável pela inserção classificou a inserção em fácil, com dificuldade esperada, mais difícil que o esperado ou impossível de realizar inserção. O mesmo também classificou a causa da dificuldade encontrada em: estenose cervical, irregularidade da cavidade uterina, dor da paciente, reação vagal. Foi realizada uma análise de comparação de médias entre os três grupos sobre a dor e de características clínicas que poderiam estar associadas com a mesma. Grau de significância 5% com poder do teste de 80%. Resultados: Todas as mulheres referiram dor no momento da inserção. Não houve diferença nas médias de dor de acordo com paridade ou via de parto. Não houve diferença também quando classificamos a dor em leve, moderada ou severa. Apesar da dor, 93% das mulheres referiram que submeteriam-se novamente a inserção do SIU-LNG tanto no momento da inserção como um mês após. A média de dor referida após um mês foi semelhante entre os grupos e não foi significativamente menor do que imediatamente após a inserção. Nas nuligestas o tipo de dificuldade mais encontrada foi estenose cervical, nas multíparas com cesárea anterior foi irregularidade da cavidade uterina e nas multíparas sem cesárea anterior foi dor da paciente no momento da inserção. Não houve maior dificuldade de inserção em nenhum dos grupos. Não houve associação de algum dos tipos de dificuldade com maiores média de dor. Conclusões: Todas as mulheres independente da paridade ou via e parto referiram dor no momento da inserção do SIU-LNG. A dor não consistiu em um empecilho para a escolha do SIU-LNG. A principal causa de dificuldade variou de acordo com a paridade. A inserção do SIU-LNG é possível para todos os grupos de pacientes / Abstract: Background: Despite the high contraceptive effectiveness and non-contraceptive benefits there are still concerns of use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in nulligravida women. Objective: Evaluate ease of insertion and cause of difficulty by health proffessionals and women pain at insertion of the LNG-IUS in nulligravida women compared to parous women with and without cesarean section (C-section). Methods: Three groups were constituted: one with 23 nulligravida women, one with 28 parous women with previous cesarean and one with 23 parous women without previous C-section who received an LNG-IUS. The pain at insertion was evaluated immediately after insertion on the Visual Analogic Scale (VAS). On the second visit after one month women were asked again about the pain at insertion according to the VAS. The ease of insertion was evaluated as easy or difficult and was classified by the health professional according to cause (cervical stenosis, uterine irregularity, pain) after insertion. Results: Almost all patients reported pain at insertion, independent of parity and delivery. Despite reporting pain about 93% of the women would submit themselves to LNG-IUS insertion once again if necessary. In the followup control there was no diference, as well in the pain scores among the groups. In nulligravida the type of difficulty most common was cervical stenosis, in parous women with C-section was uterine cavity irregularity in parous women without C-section was pain. There was no association between type of difficulty and high pain scores. Conclusions: All women reported pain at insertion. Pain at insertion is not a problem for the use of the method among patients. Type of difficulty at insertion is related to parity. There was no difference in difficulty for any group / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde
544

Modélisation de structures spatiales déployées par des mètres ruban : vers un outil métier basé sur des modèles de poutre à section flexible et la méthode asymptotique numérique / Modeling of spatial structures deployed by tape springs : Towards a home-made modeling tool based on rod models with flexible cross sections and asymptotic nu- merical methods

Marone-Hitz, Pernelle 03 December 2014 (has links)
Les dimensions des satellites spatiaux tendent à croître fortement alors que le volume disponible dans la coiffe des lanceurs est limité. L'utilisation de structures déployables permet de résoudre cette contradiction. Afin de développer l'offre disponible, le département Recherche de Thales Alenia Space étudie les mètres rubans comme solution innovante de déploiement. La première structure envisagée est un télescope déployé par le déroulement de six mètres rubans assurant également le positionnement du miroir secondaire. D'autres structures déployables utilisant les propriétés des mètres rubans sont également en cours d'étude : mât, panneaux solaires, etc.Il convient alors de se doter d'outils de modélisation spécifiques pour modéliser les scénarios de déploiement et multiplier les configurations envisagées. Deux précédentes thèses ont conduit à l'élaboration de modèles énergétiques de poutre à section flexible, rendant compte du comportement plan des rubans ([Guinot2011]) puis de leur comportement tridimensionnel ([Picault2014]). Cette thèse présente différentes contributions autour de ces modèles de poutre à section flexible. Les hypothèses du modèle ont été améliorées. Le re-positionnement de la ligne de référence sur le barycentre des sections conduit à des résultats plus proches des scénarios physiques (apparition et disparition des plis sur le ruban). A ce jour, les hypothèses et les équations du modèle sont définitivement formalisées. Nous avons établi les équations locales 1D (équilibre, comportement) dans le cas des comportements tridimensionnels avec le souci de la plus grande généralité. Établir ensuite les équations dans des cas dérivés simplifiés (restriction aux comportements 2D, section faiblement courbée) nous a permis d'obtenir un certain nombre de solutions analytiques et les équations à implémenter dans l'outil métier.Nous avons développé sur le logiciel de continuation ManLab les premiers éléments d'un outil métier performant dédié à la modélisation des mètres rubans. Nous avons ainsi pu réaliser deux contributions principales :- Un outil généraliste, performant en temps de calcul, permettant d'étudier les systèmes différentiels 1D (BVP, Boundary Value Problems). Les équations locales des modèles de poutre à section flexible ont été implémentées dans cet outil, avec une discrétisation par interpolation polynomiale et collocation orthogonale.- Un élément fini spécifique pour les poutres à section flexible et son implémentation dans ManLab.Ces éléments ont permis de réaliser différentes simulations numériques conduisant à une meilleure compréhension du comportement des mètres rubans grâce aux diagrammes de bifurcation associés à plusieurs essais significatifs. / Dimensions of spatial satellites tend to grow bigger and bigger, whereas the volume in launchers remains very limited. Deployable structures must be used to meet this contradiction. To expand the offer of possible solutions, the Research Department of Thales Alenia Space is currently studying tape springs as an innovative deployment solution. The first structure to be considered is a telescope that is deployed by the uncoiling of six tape springs that also ensure the positioning of the secondary mirror. Other deployable structures that use the properties of tape springs are under investigation : mast, solar panels,...Specific modeling tools then appear compulsory to model deployment scenarios and multiply the tested configurations. Two previous PhD thesis lead to the development of energetic rod models with flexible cross-sections that account for planar ([Guinot2011])and three dimensional behavior of tape springs ([Picault2014]). This PhD thesis presents several contributions on these rod models with flexible cross-sections. The hypotheses of the model were improved. Re-positioning the reference rod line so that it passes through the sections' centroids leads to results that are closer to experimental scenarios (creation and disappearance of folds in the spring). The hypotheses and equations of the model are now definitively formalized.We have derived the 1D local equations in the three-dimensional behavior case in the most generalist way. Then, the derivation of the equations in simplified cases (restriction to 2D behavior, shallow cross-section) enabled us to obtain several analytic solutions and the equations to implement in the specific modeling tool.We have developed on the continuation software ManLab the first elements towards a home made, efficient modeling tool dedicated to the modeling of tape springs. Two main contributions can be listed :- A generalist tool, efficient in calculus times, to study 1D differential problems (BVP, Boundary Value Problems). The local equations of the rod models with flexible cross sections were implemented in this tool, with a discretization based on polynomial interpolation and orthogonal collocation.- A specific finite element for rods with flexible cross sections and its implementation in ManLab.These elements enabled us to perform several numerical simulations and have a better understanding of the behavior of tape springs thanks to full bifurcation diagrams obtained for significant tests.
545

Formgivningsförslag av ungdomsavdelningen på Eskilstuna stadsbibliotek

Gustafsson, Karin January 2008 (has links)
No description available.
546

Oljeläckage torkparti PM12 : Utvärdering av oljeläckage i torkparti PM12 / Evaluation of oil leakage in dryer section PM12

Folmerz, Mattias January 2017 (has links)
Stora Enso Kvarnsveden är ett pappersbruk lokaliserat vid Dalälven i Kvarnsveden. Bruket har för tillfället två producerande maskiner och detta arbete behandlar en av dem, vilken är PM12. På PM12 har man problem med oljeläckage i maskinens torkparti. Läckagen uppstår genom de lagerhus som finns för att bära upp torkpartiets valsar. I detta arbete har man undersökt vad läckagen beror på med fokus på dess lagertätningar. Syftet och målet med detta arbete har varit att utreda varför läckagen uppstår samt att generera koncept för att minska eller helt eliminera läckagen. Arbetet har innefattat diverse mätningar och utredningar för att komma till rätta med problemet. En litteraturstudie har genomförts för att identifiera felorsaker samt lösningar. Koncept har genererats utifrån studien samt de mätningar som utförts. Man har inte under arbetets gång helt kommit fram till vad läckagen beror på men man har kommit en bra bit på vägen. Förslag till fortsatt arbete har getts där det rekommenderas mer specifikt vilka typer av mätningar som bör genomföras samt de koncept man som bör bygga vidare på. / Stora Enso Kvarnsveden is a paper mill located at Dalälven in Kvarnsveden. The utility currently has two producing machines, and this study deals with one of them, which is PM12. At PM12 there is a problem with oil leaks in the machine's drying section. Leakage occurs through the bearing houses who are there to support the dryer's rollers. In this study, it has been investigated what the leakage is due to focusing on its bearing seals. The purpose of this study has been to investigate why leakage occurs and to generate concepts to reduce or eliminate leaks. The study has included various measurements and investigations to address the problem. A literature study has been conducted to identify causes and solutions. Concepts have been generated from the literature study as well as the measurements that have been taken. After this study it´s not fully realized why the leakage occurs, but it had come a long bit on the way. Proposals for continued work have been given, where it is recommended more specifically what kind of measurements that should be done and the concepts that should be further developed.
547

Approche d’évaluation systémique de la qualité de la césarienne au Bénin

Mongbo, Virginie 22 January 2018 (has links)
ABSTRACT Introduction Caesarean practice as a major obstetrical intervention is widely recognized as an effective way to reduce maternal and perinatal mortality when used in appropriate way. Its rate is still low in many sub-Saharan African countries where there is still a considerable inequality in the access to caesarean section. In these countries, the policy of free caesarean practice has been initiated to solve the problem of unequal access. However, this policy of gratuity alone is not enough to reduce maternal and perinatal mortality. Having contribuated significantly to the high rate of caesarean practice, its decrease in maternal and perinatal mortality is left to be desired. It is therefore necessary that the debate on caesarean takes place not only in terms of quantity, but also in terms of quality. However, the literature review has focused on the caesarean rate but not on its quality. Since 2009, Benin, like other sub-Saharan African countries, has been implementing the policy of free caesarean practice. This led to an increase in the rate of caesarean section, but the quality of the caesarean has not been sufficiently documented. The objective of this thesis is to contribute to a better knowledge and understanding of the quality of caesarean section (in terms of accessibility, availability of resources, compliance with clinical standards and results) in Benin and to make available to the Agency for the management of free Caesarean section some criteria for the summary assessment of the quality of caesarean section with a view for better improvement.Method This research work has been carried out in three phases, namely literature review on the criteria to assess the quality of caesarean section, a cross-sectional study and the proposal of evaluation chart of the quality of caesarean practice. 1. Literature review on the criteria to assess the quality of caesarean section aimed at identifying the different models and criteria available in the literature for the assessment of the quality of cesarean section. The research conducted in five electronic databases, in the gray literature and follow-up by quotations, targeted all available studies published in French or English on the evaluation of the quality of caesarean section. 2. The aim of the cross-sectional study was to study the quality of caesarean section in the hospitals of Benin using the model of "quality caesarean practice" found in the literature review. This model has been chosen because it gives a systemic view of caesarean. It organizes the criteria for the quality of caesarean section into four pillars also called the determinants of the quality of the caesarean practice. The first pillar, access to health services, includes the reference system, financial, geographical and temporal accessibility, the acceptability of health services. The other three pillars correspond respectively to diagnosis, technical procedure and post-surgery follow-up. The study was conducted from December 18, 2013 to February 8, 2014, in 12 hospitals performing caesarean operation and chosen by simple random selection, with one hospital in each of the 12 departments of Benin. In each hospital, the study targeted the hospital manager, the mothers who gave birth through caesarean during the data collection period and their accompanying persons. The hospital managers and mothers were selected in an exhaustive way and the accompanying persons, by a rational method. Data collection was done in each hospital by two midwives, under our supervision. These midwives were external to the hospital, recruited on the basis of their experience in data collection and their understanding of the local language. The data were collected using the obstetrical records, through observation, by semi-structured individual interviews and by questionnaire surveys. They were processed using the Epi info 3.5.1 software. The study structured in four phases related respectively to "the quality of caesarean section in Benin hospitals", "the accessibility to caesarean section", "the results of caesarean section for the mother and the baby" and "the opinion on caesarean section of those who have delivered". Phase 1 aimed at assessing the quality of caesarean section using the Dujardin et al. model of "quality caesarean section". The variables mainly focused on the four pillars of the said model. The quality of caesarean section was considered "good" if at least 70% of the criteria were met and "bad" if not.  The objective of Phase 2 was to measure the accessibility to caesarean section in terms of geographical and financial accessibility and the functionality of the obstetrical emergency referral system. Geographical accessibility was measured by the estimation of the distance between the residence of the parturient and the hospital. This distance was estimated using the database of the Institute of National Geography of Benin, supplemented if necessary by the sanitary map of the health zones. The maximum distance deemed to be "accessible" was set at 15 kilometers. As financial accessibility, we considered the average direct cost of caesarean section which is the sum of the medical and non-medical costs incurred during the stay and calculated from the bills, cashier receipts and declarations by the accompanying persons. The functionality of the referral system was assessed on the basis of the referral conditions of the obstetrical emergencies (filling out referral form, taking a venous approach, means of transport used, and accompaniment of a health agent). Phase 3 was about the description of morbidity and maternal and perinatal mortality and about the identification of the factors associated with post-caesarean stillbirth in the hospitals of Benin. The dependent variable was stillbirth at the end of the caesarean section, defined as any "baby born by caesarean section, without spontaneous respiratory or cardiac movement", as mentioned in the obstetrical records and surgical protocols. The independent variables were the socio-demographic and gyneco-obstetric characteristics of the mothers, the baby and the medical data. The description was made with the parameters of dispersion and of central tendency. The associated factors were identified through unvariable analysis and "step-by-step descending" multiple logistic regression, at the significance level of 5%.  Phase 4 aimed at documenting the opinion of the women who gave birth through caesarean practice in Benin. The qualitative data from the semi-structured interview were manually processed by thematic analysis. The themes were identified during the analysis and not from a pre-existing list. 3. The proposal for a caesarean section quality assessment chart aimed at developing operational criteria for the summary assessment of the quality of the caesarean section. The criteria were selected from the "quality caesarean section" model and submitted to the appreciation of the experts through a Delphi survey. Consensus is met for a criterion when at least 80% of the experts agree or strongly agree with this criterion.Results 1. Literature review on the criteria to assess the quality of caesarean section: It helped select 12 studies of which 75 criteria to assess the quality of caesarean section were identified. These criteria could be divided into two assessment models, namely the "Inputs, processes and results" model and that of "quality caesarean section" of Dujardin et al.2. Cross-sectional study: A total of 579 women, of median age of 26 (15; 50) years old, who underwent caesarean section, were included. The average rate of caesarean section was 37.6%, ranging from 23.4 to 53.3%. The caesarean sections were 80.7% performed in emergency. The results according to the different phases are as follows:  Phase 1: The entrance examination was complete in 12.6% of the parturients. Among the 144 parturients followed for delivery labor, partograph was used in 32.6%. The average response time was 124 minutes (2h 04 minutes), ranging from 5 to 918 minutes (15h 18 minutes). The caesarean sections were 48.0% performed for absolute maternal indications, 84.2% performed under spinal anesthesia. In 98.3% of the cases, the anesthetists were nurses or midwives. Caesarean section was found to be of poor quality, with an average quality score of 60.0 ± 10.0%.  Phase 2: The average distance between the place of residence of the mothers and the hospital was 20.2 ± 22.3 kilometers (km), varying from 8.6 to 37.7 km depending on the hospital. Among the parturients coming from the hospital area, 36.0% were living at more than 15 km. There were 63.0% of women who underwent a caesarean section who have been referred from a peripheral structure, of which 46.0% were carried by motorcycle and 21.8% by an ambulance. For about half of the parturients referred from a peripheral structure to the hospital, the referral conditions had not been documented. The referral form has been filled out 34.4%, the venous approach was taken in 28.5% and the referral was accompanied in 1.7% of the cases. The direct cost of caesarean section for the families ranged from 0 to 200,000 Francs of the Financial Community in Africa (CFAF), with an average of 36,782 ± 30,859 CFAF. It was higher in case of eclampsia, suppuration of the surgery wound/release of wire and in case of hospital stay over 3 days. Phase 3: There were 8.6% maternal complications, including haemorrhage, surgical wound suppuration, puerperal infection and anesthetic complications. Intra-hospital maternal mortality was 1.7 ‰ and perinatal mortality was 74.3 ‰. Stillbirth was 66 per 1,000 births. For 58% of these stillbirths, fetal heart sounds were negative during the entrance examination of the mother's admission to the hospital. The risk factors for stillbirth were the referral of the mother with obstetrical complications (p = 0.0011), general anesthesia (p = 0.0371), low birth weight (p = 0.0001) retroplacental hematoma (p = 0.0083) and umbilical cord prolapse (p = 0.0229). On the other hand, acute fetal distress (p = 0.0308) and anesthesia administered by a nurse or midwife (p = 0.0337) resulted in a lower risk of stillbirth.  Phase 4: The quality of care was deemed good by 93.9% of the women who gave birth, the main reason being the improvement in their health state (92.8%). The cost of caesarean section was considered affordable by 58.9% of the beneficiaries. However, 16.6% of them found it still high due to additional prescriptions and parallel expenses. Nearly half of the women who gave birth through caesarean section were reassured of the success of subsequent deliveries, whatever the mode. 3. Development of criteria for summary assessment of the quality of caesarean section: The Delphi survey was conducted in two rounds, with the participation of 15 experts in the first round and 10 in the second. Out of 16 criteria submitted to the experts, 12 were validated by consensus. Among the validated criteria, nine were related to the technical quality of the caesarean section, one to the referral of the parturient and two to the outcome of the caesarean section for the mother and the newborn. The criteria related to the technical quality of the caesarean section are all based on clinical recommendations from the World Health Organization (WHO) and the National Institute for Clinical Excellence (NICE).Conclusion The research work showed a low level of the quality of caesarean section in the twelve hospitals, regarding the four pillars of our assessment model. Beyond the technical quality of caesarean section, the model of "quality caesarean section" used assumes the importance of the accessibility of caesarean section and the continuity of obstetrical and neonatal emergency care from the health center to the referral hospital. These results can guide decision-making for the effective implementation of the principles of the free policy. Moreover, caesarean section quality assessment chart proposed in this thesis is an operationalized tool which will help the Free Caesarean Section Management Agency initiate the process of improving the quality of caesarean practice in Benin. In this way, we hope to contribute to the reinforcement of the policy of free caesarean section, with a view to reducing maternal and perinatal mortality in Benin. / IntroductionLa césarienne est une intervention obstétricale majeure largement reconnue comme un moyen efficace pour réduire la mortalité maternelle et périnatale, quand son utilisation est appropriée. Son taux est encore bas dans de nombreux pays d’Afrique sub-saharienne où persiste une grande inégalité d’accès à la césarienne. Dans ces pays, la politique de gratuité de la césarienne a été initiée pour résoudre le problème d’inégalité d’accès. Or, cette politique de gratuité, à elle seule, n’est pas suffisante pour réduire la mortalité maternelle et périnatale. En effet, elle a contribué à une augmentation du taux de césarienne mais sans une baisse significative de la mortalité maternelle et périnatale. Il est donc nécessaire que le débat sur la césarienne soit mené non seulement en termes de quantité, mais aussi en termes de qualité. Toutefois, la littérature abonde de publications sur le taux de césarienne mais très peu sur sa qualité. Le Bénin, à l’instar des autres pays d’Afrique subsaharienne, applique depuis 2009, la politique de gratuité de la césarienne. Il s’en est suivi un accroissement du taux de césarienne mais la qualité de ces césariennes n’a pas été suffisamment documentée. L’objectif de la présente thèse est de contribuer à une meilleure connaissance et compréhension de la qualité de la césarienne (en termes d’accessibilité, de disponibilité des ressources, de respect des normes cliniques et des résultats) au Bénin et de mettre à disposition de l’Agence de gestion de la gratuité de la césarienne, des critères d’évaluation sommaire de la qualité de la césarienne en vue de son amélioration.MéthodeLes travaux de la présente thèse se sont déroulés en trois phases à savoir :une revue de littérature sur les critères d’évaluation de la qualité de la césarienne, une étude transversale et la proposition d’une grille d’évaluation de la qualité de la césarienne.• La revue de littérature sur les critères d’évaluation de la qualité de la césarienne visait à recenser les différents modèles et critères disponibles dans la littérature pour l’évaluation de la qualité de la césarienne. La recherche effectuée dans cinq bases de données électroniques, dans la littérature grise et par suivi des citations, a ciblé toutes les études disponibles, publiées en français ou en anglais, ayant porté sur l’évaluation de la qualité de la césarienne. • L’étude transversale visait à étudier la qualité de la césarienne dans les hôpitaux du Bénin avec le modèle de la "césarienne de qualité", recensé dans la revue de littérature. Ce modèle a été retenu parce qu’il donne une vue systémique de la césarienne. Il organise les critères de qualité de la césarienne en quatre piliers appelés aussi déterminants de la qualité de la césarienne. Le premier pilier, l'accès aux services de santé regroupe le système de référence, l’accessibilité financière, géographique et temporelle, l'acceptabilité des services de santé. Les trois autres piliers correspondent respectivement au diagnostic, à l’acte technique et au suivi post-opératoire. L’étude a été réalisée du 18 décembre 2013 au 8 février 2014, dans 12 hôpitaux pratiquant la césarienne et sélectionnés par choix aléatoire simple, à raison d’un hôpital dans chacun des 12 départements que compte le Bénin. Dans chaque hôpital, l’étude a porté sur le gestionnaire de l’hôpital, les mères ayant accouché par césarienne au cours de la période de collecte des données et leurs accompagnants. Les gestionnaires et les mères ont été retenus de façon exhaustive et les accompagnants, par choix raisonné. La collecte des données a été assurée dans chaque hôpital par deux sages-femmes, sous notre supervision. Ces dernières étaient externes à l’hôpital, recrutées sur la base de leur expérience de collecte des données et de la compréhension de la langue du milieu. Les données ont été collectées par exploitation des dossiers obstétricaux, observation et par enquête par questionnaire. Elles ont été traitées à l’aide du logiciel Epi info 3.5.1. L’étude a été structurée en quatre volets portant respectivement sur "la qualité de la césarienne dans les hôpitaux du Bénin", "l’accessibilité de la césarienne", "les résultats de la césarienne pour la mère et le bébé" et "l’opinion des accouchées sur la césarienne".- Le volet 1 visait à évaluer la qualité de la césarienne avec le modèle de "césarienne de qualité" de Dujardin et al. Les variables portaient essentiellement sur les quatre piliers dudit modèle. La qualité de la césarienne a été jugée "bonne" si au moins 70% des critères étaient respectés et "mauvaise" dans le cas contraire.- Le volet 2 avait pour objectif de mesurer l’accessibilité à la césarienne en termes d’accessibilité géographique et financière et de la fonctionnalité du système de référence des urgences obstétricales. L’accessibilité géographique a été mesurée par l’estimation de la distance entre la résidence des parturientes et l’hôpital. Cette distance a été estimée à l’aide de la base de données de l’Institut Géographique National du Bénin, complétée en cas de besoin par la carte sanitaire des zones sanitaires. La distance maximale jugée comme "accessible" a été fixée à 15 kilomètres. Comme accessibilité financière, nous avons considéré le coût moyen direct de la césarienne qui est la somme des coûts médicaux et non-médicaux engagés pendant le séjour et calculés à partir des factures, reçus de caisse et déclarations des accompagnants. La fonctionnalité du système de référence a été appréciée sur la base des conditions de référence des urgences obstétricales (remplissage de fiche de référence, prise d’un abord veineux, moyens de transport utilisés, accompagnement par un personnel de santé).- Le volet 3 portait sur la description de la morbidité et de la mortalité maternelle et périnatale, ainsi qu’à l’identification des facteurs associés à la mortinaissance post-césarienne dans les hôpitaux du Bénin. La variable dépendante était la mortinaissance à l’issue de la césarienne, définie comme tout "bébé né par césarienne, sans mouvement respiratoire ou cardiaque spontané", tel que mentionné dans les dossiers obstétricaux et protocoles opératoires. Les variables indépendantes étaient les caractéristiques socio-démographiques et gynéco-obstétricales de la mère, celles du bébé et les données médicales. La description de l’échantillon a été faite avec les paramètres de tendance centrale et de dispersion. Les facteurs associés ont été identifiés par analyse univariée et régression logistique multiple "pas à pas descendante", au seuil de signification de 5%.- Le volet 4 visait à documenter l’opinion des accouchées sur la césarienne au Bénin. Les données qualitatives issues des questions ouvertes du questionnaire des accouchées ont été traitées manuellement par analyse thématique. Les thèmes ont été identifiés lors de l’analyse et non à partir d’une liste pré-existante.• La proposition d’une grille d’évaluation de la qualité de la césarienne visait à élaborer des critères opérationnels pour l’évaluation sommaire de la qualité de la césarienne. Des critères ont été sélectionnés à partir du modèle de "césarienne de qualité" et soumis à l’appréciation des experts, à travers une enquête Delphi. Le consensus est déclaré pour un critère lorsqu’au moins 80% des experts étaient d’accord ou tout à fait d’accord pour ce critère. Résultats• Revue de littérature sur les critères d’évaluation de la qualité de la césarienne :Elle a permis de sélectionner 12 études dont 75 critères d’évaluation de la qualité de la césarienne ont été recensés. Ces critères pouvaient se répartir en deux modèles d’évaluation à savoir le modèle "Intrants, processus et résultats" et celui de la "césarienne de qualité" de Dujardin et al. • Etude transversale :Au total 579 césarisées, d’âge médian de 26 (15 ;50) ans ont été incluses. Le taux moyen de césarienne était de 37,6%, variant de 23,4 à 53,3%. Les césariennes étaient à 80,7% réalisées en urgence. Les résultats selon les différents volets se présentent comme suit :- Volet 1 :L’examen d’entrée a été complet chez 12,6% des parturientes. Parmi les 144 parturientes suivies pour travail d’accouchement, le partogramme a été utilisé chez 32,6%. Le délai moyen d’intervention était de 124 minutes (soit 2h 04 minutes), variant entre 5 et 918 minutes (15h 18 minutes). Les césariennes étaient à 48,0% réalisées pour indications maternelles absolues, à 84,2% effectuées sous rachianesthésie. Dans 98,3% des cas, les anesthésistes étaient des infirmiers ou sages-femmes. La césarienne a été jugée de mauvaise qualité, avec un score moyen de qualité de 60,0±10,0%. - Volet 2 :La distance moyenne entre le lieu de résidence des mères et l’hôpital était de 20,2 ± 22,3 kilomètres (km), variant de 8,6 à 37,7 km selon les hôpitaux. Parmi les parturientes provenant de la zone de desserte des hôpitaux, 36,0% résidaient à plus de 15 km. Il y avait 63,0% de césarisées référées d’une structure périphérique, dont 46,0% transportées à motocyclette et 21,8%, en ambulance. Pour environ la moitié des parturientes référées d’une structure périphérique pour l’hôpital, les conditions de référence n’avaient pas été renseignées dans les dossiers. La fiche de référence a été remplie chez 34,4%, l’abord veineux était pris chez 28,5% et la référence a été accompagnée dans 1,7% des cas. Le coût direct de la césarienne pour les familles variait de 0 à 200 000 Francs de la Communauté Financière Africaine (F CFA), avec une moyenne de 36 782 ± 30 859 F CFA. Il était plus élevé en cas d’éclampsie, de suppuration de la plaie opératoire/lâchage de fil et en cas de durée d’hospitalisation supérieure à 3 jours.- Volet 3 :Il y avait 8,6% de complications maternelles, dont l’hémorragie, la suppuration de la plaie opératoire, l’infection puerpérale et les complications anesthésiques. La mortalité maternelle intra-hospitalière était de 1,7‰ et la périnatale, de 74,3‰. La mortinaissance était de 66 pour 1000 naissances. Pour 58% de ces mort-nés, les bruits du cœur fœtal étaient négatifs lors de l’examen d’entrée à l’admission de la mère à l’hôpital. Les facteurs de risque de la mortinaissance étaient la référence de la mère présentant des complications obstétricales (p = 0,0011), l’anesthésie générale (p = 0,0371), le petit poids de naissance (p = 0,0001), l’hématome rétro-placentaire (p = 0,0083) et la procidence du cordon ombilical (p = 0,0229). Par contre, la souffrance fœtale aigüe (p = 0,0308) et l’anesthésie administrée par un anesthésiste infirmier ou sage-femme (p = 0,0337) exposaient à un moindre risque de mortinaissance.- Volet 4 :La qualité des soins a été jugée bonne par 93,9% des accouchées, avec pour principale justification, l’amélioration de leur état de santé (92,8%). Le coût de la césarienne était considéré comme abordable par 58,9% des bénéficiaires. Toutefois, 16,6% d’entre eux l’ont trouvé encore élevé, à cause des ordonnances supplémentaires et des dépenses parallèles. Près de la moitié des accouchées par césariennes était rassurée du bon déroulement des accouchements subséquents, quel qu’en soit le mode.• Elaboration des critères d’évaluation sommaire de la qualité de la césarienne :L’enquête Delphi s’est déroulée en deux tours, avec la participation de 15 experts au premier tour et de 10 au deuxième. Sur 16 critères soumis à l’appréciation des experts, 12 ont été validés par consensus. Parmi les critères validés, neuf étaient relatifs à la qualité technique de la césarienne, un, à la référence de la parturiente et deux, à l’issue de césarienne pour la mère et le nouveau-né. Les critères relatifs à la qualité technique de la césarienne sont tous basés sur des recommandations cliniques de l’Organisation Mondiale de la Santé et de "The National Institute for Clinical Excellence". ConclusionLes travaux de la thèse ont montré un faible niveau de qualité de la césarienne dans les douze hôpitaux, concernant les quatre piliers du modèle d’évaluation. Au-delà de la qualité technique de la césarienne, le modèle de la "césarienne de qualité" utilisé montre l’importance de l’accessibilité de la césarienne et de la continuité des soins obstétricaux et néonataux d’urgence, depuis le centre de santé jusqu’à l’hôpital de référence. Ces résultats pourront orienter la prise de décision en vue de la mise en œuvre effective des principes de la politique de gratuité. Par ailleurs, la grille d’évaluation de la qualité de la césarienne proposée dans la présente thèse est un outil opérationnalisé qui permettra à l’Agence de gestion de la gratuité de la césarienne d’initier le processus d’amélioration de la qualité des césariennes au Bénin. Nous espérons ainsi contribuer au renforcement de la politique de gratuité de la césarienne, en vue de la réduction de la mortalité maternelle et périnatale au Bénin. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished
548

Lithic technologies of the Discovery Islands: materials, stone tool production, and communities of skilled practitioners

Abbott, Callum William Filan 26 April 2018 (has links)
This thesis explores the findings of a diachronic analysis of three lithic assemblages from Quadra Island, British Columbia. From this, insights flow about the genealogies of technological practice and communities of skilled practitioners who inhabited the study area throughout its deep history. I use qualitative and quantitative methods including macroscopic lithic analysis, thin section petrography, X-ray fluorescence spectrometry, and morphometrics to operationalize these theoretical foundations. This suite of complementary methods and theory weaves a narrative of technological change alongside simultaneous continuity for hundreds of generations of human life. I argue this is evidence of the dynamic, sophisticated, yet enduring knowledge and practice of the inhabitants of the Discovery Islands throughout their deep histories that persist in the present. / Graduate / 2019-04-16
549

RESPONSABILIDADE SOCIAL: UM ESTUDO DE CASO NA SOCIEDADE VICENTE PALLOTTI

Sporquio, Joao Roberto Durlo 18 August 2008 (has links)
The Social Responsibility has been amply discussed in the academic and business environment in the last times, and it can be defined as all and any action accomplished by the organizations that contributes to the improvement of the life quality of the society. It is a commitment of the organizations to the society, and it is expressed through attitudes that affect the community positively, contributing to its welfare and to the improvement of the life quality, as for the preservation of the environment. The present research aims to evidence the importance of the social responsibility in the current context, as well as verifying the actions developed by the Vicente Pallotti Society, in order to deepen the understanding on the exercise of the social responsibility adopted by this company and finally suggested actions of improvement. The method adopted is the study of cases, collects of data accomplished through direct observations and qualitative analysis of the available documents, which characterizes the present research as an exploratory research. For a better lay people understanding, the following study is divided in ten main items: introduction, containing the proposed theme, the definition of the problem and the objectives of the study; the bibliographical study about social responsibility, third section and philanthropy; the methods and procedures used to develop this study; the results of the work containing the accomplished actions for the Vicente Pallotti Society; and the final considerations. Through the accomplished study it was verified that the social responsibility is present in the company through several social, cultural and educational projects, consolidate through the commitment with the collaborators and the respect to the environment. / A Responsabilidade Social tem sido amplamente discutida nos meios acadêmicos e empresariais nos últimos tempos, como toda e qualquer ação realizada pelas organizações que contribua para a melhoria da qualidade de vida da sociedade. Trata-se de um compromisso das organizações para com a sociedade, sendo que o mesmo é expresso por meio de atitudes que afetam positivamente a comunidade, contribuindo para o seu bem estar e melhoria da qualidade de vida, assim como para a preservação do meio ambiente. O presente trabalho de pesquisa objetiva evidenciar a importância da responsabilidade social no contexto atual e dessa forma verificar as ações desenvolvidas pela Sociedade Vicente Pallotti, a fim de aprofundar o entendimento sobre o exercício da responsabilidade social adotado por esta empresa e por fim sugerir ações de melhorias. O método adotado é o estudo de caso, coleta de dados realizada através de observações diretas e análise qualitativa dos documentos disponibilizados, o que caracteriza a presente pesquisa como exploratória. Para melhor compreensão do leitor, o estudo que segue está dividido em cinco itens principais, sendo eles: introdução, contendo o tema proposto, a definição do problema e os objetivos do estudo; o referencial bibliográfico sobre responsabilidade social, terceiro setor e filantropia; os métodos e procedimentos utilizados para o desenvolvimento desse estudo; os resultados do trabalho contendo as ações realizadas pela Sociedade Vicente Pallotti; e as considerações finais. Através do estudo realizado verificou-se que a responsabilidade social encontra-se presente na empresa através de vários projetos sociais, culturais e educativos que se consolidam através do comprometimento com os colaboradores e respeito ao meio ambiente.
550

Separation mellan mor och barn efter kejsarsnitt : En intervjustudie om barnmorskors erfarenheter

Faria, Emma Karolina, Kjellström, Amanda Henrietta January 2018 (has links)
Syfte: Att beskriva barnmorskors erfarenheter av att hantera separation mellan mor och barn efter kejsarsnitt. Metod: En kvalitativ intervjustudie med tolv barnmorskor från två förlossningskliniker i Mellansverige genomfördes. Kvalitativ innehållsanalys användes som analysmetod. Resultat: Utifrån sex subkategorier framkom tre kategorier ur resultatet: Strävan efter att förebygga separation, omständigheter som kan påverka tiden för separation samt den professionella rollen i verksamheten. Barnmorskor strävade efter att undvika separation mellan mor och barn efter kejsarsnitt för att främja amning, anknytning och se familjen. Omständigheter som kunde påverka tiden för separation var barnmorskors arbetssituation på förlossningsavdelningen, förflyttningar samt brist på nedskrivna riktlinjer och rutiner. Konklusion: Det ses en tendens till förbättringsmöjligheter och ett behov av att utveckla tydligare riktlinjer kring hantering av separation mellan mor och barn efter kejsarsnitt. / Aim: To describe midwives’ experiences of handling separation between mother and infant after a Caesarean section. Method: A qualitative interview study was conducted with twelve midwives from two obstetric clinics in central Sweden. Qualitative content analysis was used as an analytical method. Results: Based on six subcategories, three categories emerged from the result: striving to prevent separation, circumstances that may affect the time of separation, and the professional role of the midwife. Midwives strived to avoid separation between mother and infant after a Caesarean section to promote breastfeeding, attachment, and to see the family. Circumstances that could affect the time for were the midwives' employment situation on the maternity ward, transport (of mother and infant), and lack of written guidelines and procedures. Conclusion: A tendency for improvement opportunities can be seen and a need to develop clearer guidelines on managing separation between mother and infant after a Caesarean section.

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