The aims of intrapartal care are a healthy mother and child and a positive birth experience for the woman. The aims should be achieved using the least possible number of interventions that is compatible with safety. The overall aim of this thesis was to develop an instrument based on the WHO’s recommendations for care in normal birth, to describe documented intrapartal care in a pre- and post-test following a quality improvement program and to elucidate women’s perceptions of received intrapartal care. The Delphi method was used to develop the instrument. Birth records were scrutinized in the pre-test (n=212) as well in the post-test (n=240). Women’s (n=138) perceptions were collected with a questionnaire. An instrument with 69 questions and 24 follow-up questions was developed. The results from the pre-test showed that WHO’s recommendations were only partly followed. Intrapartal care for women at low-risk was similar to care for women at high-risk. Areas for improvement were identified and a quality improvement program was carried out during a two-year period. The post-test showed that the intrapartal care changed towards more adherence to WHO’s recommendations, especially for areas where guidelines were written and for women at low-risk. No statistically significant differences were found for the number of spontaneous vaginal deliveries, mother and child at low-risk after birth, active labour longer than 12 hours or second stage longer than one hour. The result from the women’s questionnaire showed that they to a great extent received care which encompassed practices that are demonstrably useful and should be encouraged. The women’s perceptions were that all received care was of great subjective importance. The instrument developed from WHO’s recommendations can be used to examine intrapartal care. Midwives should carry out a risk assessment on the woman’s arrival at the maternity unit and plan the care together with the woman and significant others. Midwives’ documentation needs to change to incorporate interpersonal aspects. Women’s faith in intrapartal care shows the importance of continuous education for midwives in evidence-based care for normal birth. National evidence-based guidelines for intrapartal care need to be developed. / Målet med förlossningsvården är en frisk mor och ett friskt barn samt en för kvinnan positiv upplevelse av förlossningen. Dessa mål skall eftersträvas med minsta möjliga ingrepp i förlossningens förlopp men med bibehållen säkerhet för mor och barn. Det övergripande syftet med denna avhandling var att, utifrån WHO:s rekommendationer avseende vård vid normal förlossning, utveckla ett instrument för att kartlägga barnmorskors dokumenterade förlossningsvård före och efter ett kvalitetsutvecklingsprogram samt belysa kvinnors uppfattningar av förlossningsvård. Instrumentutvecklingen genomfördes med Delfimetoden. Förlossningsjournaler granskades vid såväl föremätning (n= 212) som eftermätning (n=240). Kvinnors (n=138) uppfattningar insamlades med en enkät. Ett instrument omfattande 69 frågor och 24 uppföljningsfrågor utvecklades. Resultatet av föremätningen visar att WHO:s rekommendationer bara delvis följdes. Vården skilde sig i liten utsträckning för kvinnor med låg- respektive högrisk. Förbättringsområden identifierades och ett kvalitetsutvecklingsprogram genomfördes under en tvåårsperiod. Eftermätningen visar att vården förändrades i riktning mot WHO:s rekommendationer, särskilt för de områden där riktlinjer utvecklats samt för kvinnor i lågriskgruppen. Inga statistiskt signifikanta skillnader noterades beträffande antalet spontana förlossningar, antalet mödrar och barn som var lågrisk efter förlossningen, antalet aktiva förlossningar över 12 timmar och antalet förlossningar med utdrivningsskede över 1 timma. Enkätstudien till kvinnorna visar att de i stor utsträckning erhöll vård enligt den praxis som är bra och bör uppmuntras. Kvinnorna uppfattade genomgående att erhållen vård var av stor subjektiv betydelse. Instrumentet med utgångspunkt från WHO:s rekommendationer kan användas vid kartläggning av förlossningsvård. Barnmorskor bör göra en riskbedömning vid kvinnans ankomst till förlossningen och planera vården tillsammans med kvinnan och anhöriga utifrån denna. Barnmorskors dokumentation behöver förändras för att såväl omfatta medicinsk-tekniska som mellanmänskliga aspekter. Kvinnors tillit till förlossningsvården visar på vikten av att barnmorskor erhåller kontinuerlig fortbildning i evidensbaserad vård avseende normal förlossning. Evidensbaserade nationella riktlinjer för vård vid förlossning behöver utvecklas.

published_or_final_version / Housing Management / Master / Master of Housing Management

<p>In South Africa, it is estimated that approximately 70% of the population frequently make use of traditional medicinal plants for their health care needs. The use of Lessertia frutescens by the&nbsp / various cultural groups in South Africa dates back to the earlier civilizations and continues to be used today to treat a multitude of ailments. To get the best results from a medicinal plant, one&nbsp / &nbsp / would need to ensure that the crude material is of good quality through interventions like being properly grown, well dried and correctly processed. This would add a measure of quality&nbsp / assurance, which will contribute towards the safety and efficacy aspect of herbal medicine. The aim of this study was to investigate what impact a particular season of harvest and the time in&nbsp / storage would have on the flavonoid and triterpenoid marker levels of Lessertia frutescens. To achieve this, the following was investigated: (1) storage variation of Lessertia frutescens leaves&nbsp / by comparing the results obtained from the High Performance Liquid Chromatography (HPLC) analysis of the flavonoids and triterpenoids, (2) seasonal variation of Lessertia frutescens&nbsp / leaves by comparing the results obtained from the HPLC analysis of the flavonoids and triterpenoids, (3) leaf and stem variation of Lessertia frutescens by comparing the results obtained from HPLC analysis of the flavonoids and triterpenoids. The hypotheses were: (1) the stored sample would indicate the same level of the biomarkers for the flavonoids and triterpenoids, as that of&nbsp / the freshly prepared sample, (2) the sample that was harvested during the summer season would indicate higher levels of the biomarkers of&nbsp / flavonoids and triterpenoids than the other three&nbsp / seasons, (3) the leaf sample would indicate the same level of the biomarkers for the flavonoids and triterpenoids, as that of the stem sample. An Agilent 1200 series HPLC was used for the&nbsp / determination of the flavonoids sutherlandin A and sutherlandin D as well as the triterpenoids sutherlandioside B and sutherlandioside D. Results show that for both sutherlandin A (summer:&nbsp / 3.67 &plusmn / 2.88 mg/ml / storage: 4.07 &plusmn / 2.88 mg/ml) and D (summer: 4.10 &plusmn / 1.06 mg/ml / storage: 4.25 &plusmn / 1.06 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the storage&nbsp / amples. For both sutherlandioside B (summer: 3.01 &plusmn / 0.39 mg/ml / storage: 2.82 &plusmn / 0.39 mg/ml) and D (summer: 5.82 &plusmn / 0.42 mg/ml / storage: 4.66 &plusmn / 0.42 mg/ml) show significantly (P &lt / &nbsp / .0001)&nbsp / higher concentrations in the case of the fresh summer samples.For the seasonal comparison, results show that for sutherlandin A (summer: 3.67 &plusmn / 12.49 mg/ml / autumn: 4.75 &plusmn / &nbsp / 12.49 mg/ml / winter: 4.23 &plusmn / 12.49 mg/ml / spring: 6.56 &plusmn / 12.49 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the spring sample. For sutherlandin D (summer: 4.10&nbsp / &nbsp / 10.32 mg/ml / autumn: 6.37 &plusmn / 10.32 mg/ml / winter: 5.25 &plusmn / 10.32 mg/ml / spring / 6.08 &plusmn / 10.32 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the autumn sample. For both sutherlandioside B (summer: 3.01 &plusmn / 7.19 mg/ml / autumn: 2.15 &plusmn / 7.19 mg/ml / winter: 2.89 &plusmn / 7.19 mg/ml / spring: 1.47 &plusmn / 7.19 mg/ml) and D (summer: 5.82 &plusmn / 14.48 mg/ml / autumn: 3.33 &plusmn / 14.48 mg/ml / winter: 4.23 &plusmn / 14.48 mg/ml / spring: 2.50 &plusmn / 14.48 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the autumn sample. For the summer&nbsp / leaf/stem comparison, results show that for sutherlandin A (leaf: 3.67 &plusmn / 8.18 mg/ml / stem: 4.67 &plusmn / 8.18 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the stem&nbsp / sample. For the sutherlandin D (leaf: 4.10 &plusmn / 4.81 mg/ml / stem: 3.31 &plusmn / 4.81 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the case of the summer leaf sample. For both the&nbsp / sutherlandioside B (leaf: 3.01 &plusmn / 4.24 mg/ml / stem: 3.62 &plusmn / 4.24 mg/ml) and D (leaf: 5.82 &plusmn / 0.42 mg/ml / stem: 5.80 &plusmn / 0.42 mg/ml) show significantly (P &lt / 0.0001) higher concentrations in the&nbsp / case of the stem samples. Results demonstrate that the production of secondary metabolites are influenced by&nbsp / &nbsp / environmental factors like seasonal harvesting, as indicated by the variation in the chemical constituent composition of Lessertia frutescens depending on the season collected in. Moreover, the storage of Lessertia frutescens for a period of one year resulted in an&nbsp / increase of two of the four constituents being monitored. There was slight variations in the chemical constituents, depending on whether the leaf or stem material of Lessertia frutescens was being used. Finally, the type of chemical constituent being monitored was also important in the consideration of this study. Therefore, this study can be seen as a starting point to further&nbsp / &nbsp / investigations of these aspects, which are of clinical, pharmacological and economic</p>

Clinical immunohistochemistry (IHC) techniques are not yet fully standardized. In this project, a standardization method was developed and tested for proficiency testing (PT) in external quality assurance (EQA) and quality control (QC) in clinical IHC laboratories. The breast cancer markers estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) were used as a model system. Digital image analysis (IA) was used in conjunction with new calibrated and standardized cell line microarrays (CLMA). CLMAs built from nine formalin-fixed paraffin-embedded (FFPE) breast cancer cell lines were used for both QC controls and PT samples, instead of traditionally used FFPE tissues, in the standardization of breast cancer IHC. IA was used for measurement of IHC results, and compared to evaluation by the traditional expert-assessment method. Laboratory Score: Reference Score Ratio (LSRSR) was derived from Histo-Scores (HScores) determined by IA. HScores and LSRSRs were examined statistically and evaluated as histograms and boxplots to summarize and rank participant laboratory EQA results, in comparison to a reference sample or reference laboratories in two consecutive Canada-wide EQA runs. LSRSR-derived reference ranges were highly sensitive in evaluating laboratory EQA performance in PT as well as for monitoring of controls for QC. Laboratory on-slide tissue and cell-line IHC QA controls were assessed using IA and Levey Jennings QC charts. These charts were determined to be an excellent way to observe trending in laboratory IHC staining over time, particularly when cell line controls were used. This approach also reduced the time and labor costs for PT evaluation. Overall, cell line calibration controls were functionally equivalent or better than tissue-based controls in QC and PT mainly because of cell line biological homogeneity and sample availability. This study identified an optimal design for preparation of IHC cell line controls and PT samples for breast cancer markers. Optimal, intermediate staining cell line IHC controls were identified for all three breast cancer markers. Using IA with LSRSR and cell line samples is recommended for standardization of IHC methodology. This approach advances QA for diagnostic IHC and when implemented will improve patient care

MTech. in Business Administration (MBA) / Universities of technology and institutions of technology produce electrical engineering technicians and technologists who expect to be employed in the electrical engineering industry. One of the reasons for a shortage of skills is the perception that the engineering industry has concerns regarding the quality of qualified students from universities of technology, because graduates struggle to meet the expectations of the industry. The industry expects them to possess basic skills, which can be utilised immediately. Technological advancement is ongoing and appears that the curricula of tertiary institutions are not keeping abreast of changes. This study aims to establish the perception of the engineering industry of the quality of electrical engineering graduates leaving universities of technology in order to evaluate their employability. Universities of technology should regard industry as their main client, supplying firms with the type of product they need.

M. Tech. Business Administration / The city of Tshwane Emergency Services is the first in South Africa to be certified ISO 9001:2008 in 2013. This saw the department leading the course of quality management both in the city and throughout the country. As a service rendering undertaking their efficiency and effectiveness requires evaluation from a quality management perspective. The city seeks to roll-out certification throughout all city departments so as to enable a quality driven municipal entity. This study was conducted to identify the factors that affect adherence to ISO 9001:2008 within the city. The results of this study can be used by managers throughout the Emergency Services and related services around the world to evaluate the importance of the implementation of the management system. The study is descriptive and cross-sectional. A quantitative method was used to collect data and analyse it. A stratified random sampling techniques was used with sample size of n=121 on employees within the Emergency Services of the city of Tshwane. Frequency tables, pie-chart, histograms and tables were used to present and analyse the data collected. The study identified qualification, effective communication and proper record keeping (documentation) as key factors affecting adherence to ISO 9001:2008.

University in providing quality education needs to determine degree of fulfilment of customer needs. Therefore, the college needs to collect feedback on teaching evaluation by students in a systematic evaluation of teaching quality and its assurance. This thesis first looks at examining the current state of the problem in theory. The goal of the theoretical background of the problem is to provide a facilitator for further studying the problem in a particular situation. The output of the study is therefore an overview of the current state of problems in the Czech Republic and development opportunities. The next step is to map and description of current efforts in the system of the University of Economics, Prague. The work also carried out and evaluates own research among students of the faculty on student quality assessment of education. Work on the basis of these findings and analysis summarizes the recommendations in the issues under consideration, including proposals to modify the information system of the school. Another basis for these recommendations is the experiences of other universities. The main contribution is the proposal of the strategic map, which contains the structural elements of the problems embedded in the institution's strategic goals. The final recommendations of this work are a comprehensive summary of the steps necessary for the effective quality assurance of education in a school.

In this essay an analysis and classification is made of the roll of implementation swedish municipalities have regarding the national quality assurance policy in the school sector. In the light of international trends of decentralisation and the development of new quality assurance systems  the paper’s result classifies the municipalities as implementation roll number two according to Lundquist (1992) and his theory of implementation. The basis for this claim is given by the study of key actors in the municipal quality assurance work that shows that the implementation is made with a good understanding, with a loyal ambition but also with some shortcomings when it comes to the provision of necessary resources. Support for this is given by the case of municipality 2 that shows shortcomings regarding the number of employed, time, digital tools, knowledge and economic conditions. The same is shown in the case of municipality 1. Thus, the main conclusion of this essay is that the structural differences between the analyzed municipalities does not give rise to differences in the results of this study.

Quality assurance is increasingly becoming an important aspect of higher education institutions in developing countries, as expressed in the development of relevant policies, structures and systems at national and institutional levels. This thesis critically examines the nature of quality assurance policies and practices in selected universities in the Southern African Development Community (SADC), as well as the factors that shape these policies. Through a close examination of these policies and practices, the thesis explains why some universities realise better quality than others, even though they fall within the same geographical region and share relatively similar historical legacies. Although this study was largely qualitative, it did not preclude quantitative dimensions. Integrating the two approaches made it possible not only to triangulate data, but also to engage in multidimensional analysis of some of the phenomena under investigation. While debates in the literature locate quality assurance within internal and external discourses, this does not sufficiently explain the tensions that were observed amongst the various stakeholders within institutions, especially between management and academic staff. The manner in which institutional policies were developed, the role academic staff played in the process, and the reporting lines associated with institutional quality assurance arrangements, are reflected in staff perceptions on whether or not they regarded the policies as internal to the academic community and the extent to which they own the policies. The main contribution of this thesis to debates on quality assurance is its revelation of the complexities that arise in institutional policy making as a result of the highly differentiated nature of the academy. This aspect points at the need for institutions to pay particular care in adopting most appropriate strategies that privilege the organic development of policies within institutions. On the whole, institutions were mainly preoccupied with developing quality assurance policies and systems that are comparable to international standards, hence the heavy reliance on external/international expertise in doing so. Whilst this is not necessarily a iii bad thing, the quality assurance systems that were developed did not take into account the contextual peculiarities of the studied institutions. A direct consequence of this was the development of policies and mechanisms that are more concerned with standardisation of procedures than with enhancement of academic practice. Such quality assurance systems have not resulted in the self-improvement of institutions. The establishment of quality assurance policies and the putting in place of structures and procedures are necessary but not sufficient conditions for enhancing academic practice in universities.

ABSTRACT Aim: To assess the overall quality of child health services provided at primary health care facilities in the Johannesburg metropolitan area. Objectives: Primary Objective To evaluate the quality of clinical care provided by health care workers caring for children; including an assessment of the treatment of common childhood illnesses, counselling and health promotion. Secondary Objectives 1. To assess the quality of well baby services such as immunisation, growth promotion and developmental monitoring. 2. To assess the availability of drug supplies and equipment. 3. To assess the quality of record keeping. 4. To describe the infrastructure available at health facilities and the availability of services provided to children, including appropriate referral services. Design: This was a cross-sectional, observational study over a two-month period conducted at 16 primary health care facilities in the Johannesburg Metropolitan area; four community health centres (CHC) and 12 primary health care (PHC) clinics. A researcher-developed structured checklist, based on national guidelines and protocols was utilised. Results: A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting hours (mean [SD] of 135±72 minutes). Many routine examination procedures were poorly performed, with an appropriate diagnosis established in only 77% of consultations. Almost half of the children (46%) received antibiotics; their use was unwarranted in one-third of instances. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. The mother or sick child’s HIV status was seldom considered or investigated. At least a third of children requiring cotrimoxazole prophylaxis were not prescribed the antibiotic. Growth promotion and nutritional counselling at well child visits was generally inadequate with not one of 11 children requiring food supplementation receiving it. The majority of facilities were adequately equipped and well-stocked with drugs. A lack of capacity to manage children with chronic conditions (such as asthma), mental health problems and disabilities exists. Conclusion: The poor quality of care offered to children in the richest city in Africa is a sad indictment of the inability of health service providers in the city to meaningfully address children’s health needs. Nothing short of a deliberate and radical overhaul in the way that health care is organised for children, with clearly defined and monitored standard clinical practice routines, is likely to significantly change the status quo.