Les médecines complémentaires sont nombreuses et variées, leur recours est largement répandu et en hausse. Selon les pratiques, les données d’évaluation sont plus ou moins riches, mais il y a peu de conclusions consensuelles quant à leur efficacité, même en cas de littérature abondante. Nous commencerons par un état des lieux de l’adéquation des méthodes conventionnelles utilisées pour l’évaluation du médicament, à savoir de l’essai contrôlé randomisé (ECR) et des méta-analyses, pour l’évaluation des médecines complémentaires.A travers trois applications pratiques, nous réfléchirons ensuite à l’apport d’autres méthodes, moins reconnues à ce jour dans le champ de l’evidence based medecine mais pouvant apporter d’autres éclairages. En particulier, nous discuterons de l’intérêt des méthodes mixtes, des études qualitatives et de l’exploitation des grandes bases de données médico-administratives. Nous réaliserons une revue mixte sur l’évaluation de l’hypnose pour le travail et l’accouchement, une étude qualitative sur l’expérience du qi gong par des patientes hospitalisées pour anorexie mentale sévère, et nous étudierons le potentiel d’exploitation du Système National d'Information Inter Régimes de l'Assurance Maladie (SNIIRAM) pour évaluer les médecines complémentaires. Les deux premiers axes nous amèneront à questionner le choix des critères de jugement et des instruments de mesure utilisés dans les ECR et nous inciteront à accorder davantage de place et de légitimité à la perspective du patient. Plus largement, cela nous invitera à remettre en cause la suprématie traditionnellement accordée aux études quantitatives pour la remplacer par une vision non hiérarchique mais synergique des approches qualitatives et quantitatives. Le troisième axe nous permettra d’identifier les limites actuelles à l’exploitation du SNIIRAM pour l’évaluation des médecines complémentaires, à la fois sur le plan technique et sur le plan de la représentativité. Nous proposerons des mesures concrètes pour rendre possible et pertinente son exploitation dans le champ de l'évaluation des médecines complémentaires.Enfin, dans la discussion générale, nous tiendrons compte du fait que l’évaluation des médecines complémentaires n’a pas pour but d’autoriser ou non une mise sur le marché. Ainsi, contrairement à l'évaluation des médicaments, l'évaluation des médecines complémentaires ne s'inscrit pas toujours dans une visée de prise de décision. Nous soulignerons l’importance de tenir compte de la visée (visée de connaissance ou visée de décision) dans l’élaboration d’une stratégie de recherche et nous proposerons deux stratégies différentes en nous appuyant sur la littérature et les résultats issus de nos trois exemples d'application. Concernant la stratégie de recherche à visée de prise de décision, nous montrerons l’importance des étapes de définition de l’intervention, d’identification des critères de jugement pertinents, et d’optimisation de l’intervention, avant la réalisation d’essais pragmatiques visant à évaluer l’efficacité en vie réelle. Nous verrons comment la volonté d’évaluer ces pratiques nous renvoie à des défis en terme de réglementation et nous soulignerons par ailleurs la nécessité d’évaluer la sécurité de ces pratiques en développant des systèmes de surveillance adaptés. / Complementary medicines are numerous and varied, their use is widespread and increasing.Quality and quantity of evaluation data depend on the type of complementary medicines, but there are few consensual conclusions about their effectiveness, even in the case of abundant literature. We will start with an inventory of the adequacy of the conventional methods used for drug evaluation, namely randomized controlled trials (RCT) and meta-analyzes, for the evaluation of complementary medicines. Through three practical applications, we will then consider the contribution of other methods, less recognized to date in the field of evidence-based medicine but potentially contributive to shed light on other perspectives. In particular, we will discuss the advantages of mixed methods, qualitative studies and the exploitation of large health administrative databases. We will conduct a mixed-method review of the assessment of hypnosis for labor and childbirth, a qualitative study on the experience of qi gong by patients hospitalized for severe anorexia nervosa and we will study the potential of the French national health insurance database (SNIIRAM) to evaluate complementary medicines. The first two axis will lead us to question the choice of outcomes and measurement tools used in RCTs and to value and legitimate the patient's perspective. More broadly, it will invite us to question the hierarchical vision of qualitative and quantitative research that traditionally attributes supremacy to quantitative studies. It will encourage us to replace it with a synergistic vision of qualitative and quantitative approaches. The third axis will enable us to identify the current limits to the use of SNIIRAM for the evaluation of complementary medicines, both technically and in terms of representativeness. We will propose concrete measures to make its exploitation possible and relevant in the field of evaluation of complementary medicines.Finally, in the general discussion, we shall take account of the fact that the evaluation of complementary medicines is not part of a marketing authorization process. Thus, contrary to drug evaluation, complementary medicines evaluation does not always imply decision making. We will emphasize the importance of considering the aim (aim of knowledge or aim of decision) in the development of a research strategy. We will propose two different strategies based on the literature and the results from our three examples. Concerning the research strategy aimed at decision-making, we will show the importance of defining the intervention, identifying the relevant outcomes, and optimizing the intervention first, before carrying out pragmatic clinical trials to evaluate its effectiveness. We will discuss the regulatory challenges complementary medicine evaluation confronts us to, and stress the need to assess the safety of these practices by developing appropriate monitoring systems.

Bakgrund: Covid-19 är en luftburen infektionssjukdom med hög smittorisk som främst överförs via droppsmitta. Nationella samt internationella försiktighetsåtgärder har framtagits i syfte att minska smittspridningen av viruset. Folkhälsomyndigheten har skärpt rekommendationerna för gravida samtidigt som omprioriteringar görs inom hälso- och sjukvården. Syfte: Syftet med denna studie var att undersöka barnmorskors erfarenheter av att arbeta i patientnära vård under virusutbrottet covid-19. Metod: Studien var en tvärsnittsstudie med kvantitativ ansats. Datainsamling har gjorts via en webbenkät som besvarats anonymt. Resultat: Av de 159 respondenter som svarat på studien upplevde majoriteten en ökad stress samt en oro att bli smittad av covid-19 och föra smittan vidare. En femtedel av barnmorskorna upplevde ett nedsatt psykiskt välbefinnande. Slutsats: Riktlinjer på nationell nivå för simulering, skyddsutrustning och tydlig information för barnmorskor kring arbetet i patientnära vård under covid-19 efterfrågas. Detta i syfte att skapa trygghet i arbetet, att inte bli smittade eller föra smittan vidare. / Background: Covid-19 is a highly contagious airborne infectious disease which primarily spreads via droplets when throat or nasal secretions are released into the air. Precautions have been implemented worldwide with the intent to minimize the spread of the disease. The Public Health Agency of Sweden has implemented new and improved recommendations. Purpose: The aim for this study was to investigate the midwife’s firsthand experiences working intimately with patients during the outbreak of the covid-19 pandemic. Method: The study was a cross- sectional study with a quantitative method. The data was gathered throughout anonymous online questionnaires answered by midwives in Sweden. Result: Of the 159 respondents in the study, the majority reported an increased level of stress and anxiety related to becoming ill or transferring the virus to others. One in five respondents experienced a decrease in mental wellbeing. Conclusion: National guidelines for midwives regarding practice simulations, protective gear and comprehensive information concerning the work in near proximity to the patient was desired. Midwives called for this to ensure a safe working environment, and to avoid transferring the virus to their colleagues and patients.

<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>

Efter en kartläggning som Socialstyrelsen utfört över hälso- och sjukvårdens nyttjande avArtificiell Intelligens (AI), har det konstaterats att det finns utrymme och potential för ett mereffektivt användande av tekniken. Men trots att potential och fördelar med AI presenteras,möter branschen motgångar och utmaningar vid införandet av tekniken. I rapportenpresenteras några av de utmaningar som kan uppstå vid arbetet med att införa AI-teknik inomhälso- och sjukvården samt varför de förväntade effekterna inte uppnås. Studien har utgåttfrån en kvalitativ forskningsansats i syfte att genomföra empirisk datainsamling genomsemistrukturerade intervjuer och det insamlade materialet har bearbetats utifrån en tematiskanalys. Därefter presenteras och sammankopplas resultatet med tidigare forskning ochlitteratur för att avslutningsvis presentera bakomliggande anledningar till utmaningar vidimplementering av AI inom hälso- och sjukvården. / The National Board of Health and Welfare (Socialstyrelsen) has mapped in which extent thehealthcare is using Artificial Intelligence (AI) and it’s been established that there is potentialfor a more efficient use of the technology. But despite the potential and benefits that AI couldentail, the Healthcare industry faces setbacks and challenges with implementing thetechnology. This paper presents some of the challenges that may arise in the process ofintroducing AI technology to healthcare and also why the expected effects are not achieved.The study is based on a qualitative research approach, with the aim of conducting empiricaldata collection through semi-structured interviews. The collected material was then processedbased on a thematic analysis. The results are then presented and linked to previous researchand literature, in order to finally present the underlying reasons for challenges withimplementing AI in healthcare.

Situation of families in which a child with spinal muscular atrophy was born, is the topic of this thesis. This rare genetic disease affects neuromuscular system of children and shortens their lives. In most severe cases the failure of respiratory functions comes in the first year of child's life. This thesis is focused on support that Czech system of social and medical services provides to families with this disease. Next, it looks into needs of these families and examine the extent to which the system is able to saturate them. Very important point in this research is also families' perception of quality of care. The research was implemented with use of qualitative methods, mostly by semi-structured interviews which followed families' journey through the system of social and medical services. Then there is a comparison of experience of families with theories, policy and other normative framework and suggestion of steps that should be taken to improve families' satisfaction with services they receive concerning the child's disease. Key words: spinal muscular atrophy, rare diseases, patient's autonomy, patient- centered care, patient journey, quality of care.

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This study explored the needs and challenges faced by diabetics and healthcare personnel in the context of diabetes consultations in Sweden, with the aim of identifying improvements for Clinical Decision Support Systems (CDSS). Given the global prevalence of diabetes, understanding the use and implications of CDSS in patient consultations is crucial. This research aimed to fill that knowledge gap by exploring ways to improve CDSS, considering the needs of both diabetics and healthcare workers. A qualitative approach was used, including 12 interviews, 1 observation, and 6 document reviews. A thematic analysis revealed four key themes which highlighted various challenges and needs, experienced from both diabetics and healthcare personnel. The underlying causes of these challenges were linked to recent technological advancements and the increase in available data points. This results infrustration, suboptimal care outcomes, and an increased reliance on alternative solutions by both parties. The DeLone and McLean IS Success Model was used to identify potential technological solutions and provides a clear recommendation on what needs to be improved for future solutions. The findings contribute significantly to understanding the utilization of CDSS in diabetes care and associated challenges. The study is particularly relevant for healthcare personnel, diabetics, policymakers, entrepreneurs, and scholars interested in healthcare information systems. Future studies should focus on generalizing these findings by exploring other healthcare systems and to what extent this findings are applicable for type 2 diabetics, as well as practically exploring how new systems can address the identified needs in this study. Ultimately, this study contributes to the potential for improved care and quality of life for diabetics. / Denna studie utforskade behov och utmaningar som diabetiker och sjukvårdspersonal står inför i samband med diabeteskonsultationer i Sverige, med målet att identifiera förbättringar för kliniska beslutsstödssystem (CDSS). Med tanke på diabetes globala prevalens, är det avgörande att förstå användningen och implikationerna av CDSS i patientkonsultationer. Denna forskning syftade till att fylla detta kunskapsgap genom att utforska möjligheter att förbättra CDSS, med hänsyn till både diabetikers och vårdgivares behov. Kvalitativa metoder användes, inklusive intervjuer, observationer och dokumentgranskningar. En tematisk analys identifierade fyra nyckelteman som belyste flera utmaningar och behov från både diabetiker och sjukvårdspersonal. De underliggande orsakerna till dessa utmaningar var kopplade till tekniska utveckling och ökningen av tillgängliga datapunkter. Detta resulterade i frustration, suboptimala vårdresultat och en ökad användning av alternativa lösningar från båda parter. DeLone och McLean IS Success Model användes för att översätta behoven till tekniska krav för potentiella framtida lösningar. Studiens resultat bidrar till förståelsen av användningen av CDSS inom diabetesvård och relaterade utmaningar. Studien är särskilt relevant för sjukvårdspersonal, diabetiker, politiker, entreprenörer och forskare som är intresserade av hälso- och sjukvårdsinformationssystem. Framtida studier bör fokusera på att generalisera dessa resultat genom att undersöka andra sjukvårdssystem och i samband med typ 2 diabetes, samt utforska hur mer praktiskt utveckling av nya system kan gå till för möta de identifierade behoven i denna studie. Slutligen bidrar denna studie till potentialen för förbättrad vård och livskvalitet för diabetiker.

Bakgrund   Allmänsjuksköterskor kommer ofta i kontakt med personer med venösa bensår. Behandling och vård av dessa personer sker ofta inom primärvård, öppenvård eller hemsjukvård, men även på vårdavdelningar och andra sjukvårdsinstanser. Venösa bensår är en följd av underliggande kronisk venös insufficiens. Det är därför stor risk att såren återkommer efter läkning och behandlingen måste därför i många fall bli livslång. Trots detta finns få studier som fokuserar på personers upplevelser av behandling och vård vid venösa bensår.   Syfte  Syftet är att beskriva personers upplevelser av behandling och vård vid venösa bensår. Metod  För att sammanfatta den forskning som i dagsläget finns kring ämnet har en litteraturöversikt gjorts. Sökningar har utförts i de vetenskapliga databaserna Pub Med och CINAHL och 16 artiklar identifierades. Dessa har kvalitetsgranskats genom Sophiahemmet Högskolas bedömningsinstrument. Resultat Litteraturöversiktens tre huvudkategorier, förhoppning och uppgivenhet, att leva ett begränsat liv och att inte bli sedd som person berättar om upplevelser som många personer med venösa bensår har av behandling och vård. Personer upplever att behandling och vård på något sätt begränsar eller påverkar dem. Vårdens kontinuitet, god kommunikation, och relationen till sjuksköterskan är av betydelse för upplevelsen av behandling och vård. Det finns brister i individanpassningen av behandling och vård som påverkar personer med venösa bensårs förtroende för vården. Många personer uppger en ovisshet som gör det svårt att hantera behandlingen psykologiskt. En stark önskan om läkning av de venösa bensåren är gemensamt för många studiedeltagare. Slutsats Det fattas specifik forskning om personers upplevelser. Sjuksköterskor som behandlar personer med venösa bensår saknar kunskaper om deras tillstånd och rekommenderad behandling. I denna litteraturöversikt framkommer ett behov av att skifta fokus från läkning av det venösa bensåret till personens livskvalitet. Sjuksköterskor behöver mer kunskaper om venösa bensår och en större förståelse för den livssituation som många personer med venösa bensår befinner sig i. Ökad nivå av personcentrering i behandling och vård av personer med venösa bensår bör därför eftersträvas, och förutsättningar måste skapas för sjuksköterskor att kunna erbjuda den specialiserade och kvalitativa vård som krävs. / Background Registered nurses frequently come into contact with persons living with venous leg ulcers, as these wounds are primarily treated and cared for by nurses. Persons with venous leg ulcers often experience underlying chronic venous insufficiency, which is the main cause of venous leg ulcers. This means that even once healed venous leg ulcers are likely to reoccur, and treatment is often life-long. In spite of this, very few studies and research projects focus on the person’s experiences of their ailment in relation to the treatment they receive. Aim To highlight persons’ experiences related to the treatment and care of venous ulcers.  Method To summarize the research knowledge of this subject, a review of current literature was undertaken. Searches have been conducted in several online-based databases. Through the databases PubMed and CINAHL 16 articles were identified and then analyzed. Results Many persons with venous leg ulcers feel that treatment and care affects or impedes them in some way. Three core categories were identified as signifying for the result: hopefulness and uncertainty, an impaired life, and not being viewed as a person. Continuity of care, quality of communication, and the nurse-patient relationship are all key contributors to the experiences of treatment and care that persons with venous leg ulcers describe. The result implies that treatment and care of persons with venous leg ulcers is not satisfyingly individualized, which reduces the level of confidence that these persons feel for their healthcare providers. Persons with venous leg ulcers report that experiences of uncertainty make the treatment hard to handle psychologically. A strong desire for permanent healing is shared by persons with venous leg ulcers.  Conclusions There is a shortage of specific research aimed at the experiences of persons with venous leg ulcers of aspects relating to their treatment and care. Many nurses lack vital knowledge regarding the treatment and care of these individuals. In this review a need for a shift of focus is perceived, from simply the healing of the venous leg ulcer, into also considering the quality of life of persons with venous leg ulcers. Nurses are in need of more knowledge of the condition, and more insight into the lives of persons with venous leg ulcers. A person-centred approach should therefore be sought, and conditions must be provided for nurses to expand their knowledge and be able to offer a more specialized and qualitative level of treatment and care.

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No description available.