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Åberg, A. C. & Ehrenberg, A. (2017). Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective.. Archives of gerontology and geriatrics (Print), 72, 113-120, Article ID S0167-4943(17)30237-6.
Open this publication in new window or tab >>Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective.
2017 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 113-120, article id S0167-4943(17)30237-6Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Geriatric assessment, Holistic view, Interview, Person-centred care, Qualitative research methods
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-60823 (URN)10.1016/j.archger.2017.06.002 (DOI)000408022200018 ()28623800 (PubMedID)2-s2.0-85020739840 (Scopus ID)
Available from: 2017-10-09 Created: 2017-10-09 Last updated: 2020-01-28Bibliographically approved
Göras, C., Maria, U., Nilsson, U. & Ehrenberg, A. (2017). Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey. BMJ Open, 7(9), Article ID e015607.
Open this publication in new window or tab >>Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015607Article, review/survey (Refereed) Published
Abstract [en]

Background: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors’ estimations of their staffs’ attitudes to patient safety.

Methods: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

Results: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors’ estimations of their staffs’ ratings of the safety climate cohered fairly well.

Conclusions: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-59446 (URN)10.1136/bmjopen-2016-015607 (DOI)000412650700060 ()28864690 (PubMedID)2-s2.0-85029118920 (Scopus ID)
Note

Funding Agency:

Centre for Clinical Research Dalarna

Available from: 2017-09-03 Created: 2017-09-03 Last updated: 2020-01-28Bibliographically approved
Källberg, A.-S., Ehrenberg, A., Florin, J., Östergren, J. & Göransson, K. E. (2017). Physicians' and nurses' perceptions of patient safety risks in the emergency department. International Emergency Nursing, 33, 14-19, Article ID S1755-599X(16)30114-8.
Open this publication in new window or tab >>Physicians' and nurses' perceptions of patient safety risks in the emergency department
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2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 14-19, article id S1755-599X(16)30114-8Article in journal (Refereed) Published
Abstract [en]

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Emergency service (hospital), Error, Interviews, Patient safety, Qualitative content analysis, Risk
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-61840 (URN)10.1016/j.ienj.2017.01.002 (DOI)000407530200003 ()28256336 (PubMedID)2-s2.0-85014054824 (Scopus ID)
Note

Funding agencies:

Centre for Clinical Research, Dalarna, Sweden CKFUU-337771 

Available from: 2017-10-22 Created: 2017-10-22 Last updated: 2020-01-28Bibliographically approved
Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C. B., Tomson, G., . . . Eldh, A. C. (2016). Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness. International Journal of Health Policy and Management, 5(8), 477-486
Open this publication in new window or tab >>Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness
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2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 8, p. 477-486Article in journal (Refereed) Published
Abstract [en]

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.

Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.

Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.

Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Place, publisher, year, edition, pages
Kerman University of Medical Sciences, 2016
Keywords
Evidence-Based Practice (EBP), Facilitation, Implementation, Leadership, Management, Stroke Rehabilitation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-51674 (URN)10.15171/ijhpm.2016.35 (DOI)000379825600005 ()
Available from: 2016-08-17 Created: 2016-08-17 Last updated: 2020-01-28Bibliographically approved
Berg, L. M., Florin, J., Ehrenberg, A., Östergren, J., Djärv, T. & Göransson, K. E. (2016). Reasons for interrupting colleagues during emergency department work: A qualitative study. International Emergency Nursing, 29, 21-26
Open this publication in new window or tab >>Reasons for interrupting colleagues during emergency department work: A qualitative study
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2016 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, p. 21-26Article in journal (Refereed) Published
Abstract [en]

Objective: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

Method: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

Results: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

Conclusion: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Interruption, Emergency care, Registered nurse, Physician, Clinicians, Work environment, Patient safety
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-53924 (URN)10.1016/j.ienj.2016.06.001 (DOI)000387779100005 ()27339485 (PubMedID)2-s2.0-84995900502 (Scopus ID)
Available from: 2016-12-13 Created: 2016-12-13 Last updated: 2020-01-28Bibliographically approved
Florin, J., Ehrenberg, A., Ehnfors, M. & Björvell, C. (2013). A comparison between the VIPS model and the ICF for expressing nursing content in the health care record. International Journal of Medical Informatics, 82(2), 108-17
Open this publication in new window or tab >>A comparison between the VIPS model and the ICF for expressing nursing content in the health care record
2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 2, p. 108-17Article in journal (Refereed) Published
Abstract [en]

Background: Multi-professional standardized terminologies are needed that cover common as well as profession-specific care content in order to obtain a full coverage and description of the contributions from different health professionals' perspectives in health care. Implementation of terminologies in clinical practice that do not cover professionals' needs for communication might jeopardize the quality of care.

Purpose: The aim of the study was to compare the structure and content of the Swedish VIPS model for nursing documentation and the international classification of function, disability and health (ICF).

Method: Mapping was performed between key words and prototypical examples for patient status in the VIPS model and terms in the ICF and its framework of domains, chapters and specific terms. The study had two phases. In the first phase 13 key words for patient status in the VIPS model and the 289 terms (prototypical examples) describing related content were mapped to comparable terms in the ICF. In phase two, 1424 terms on levels 2-4 in the ICF were mapped to the key words for patient status in the VIPS model.

Results: Differences in classification structures and content were found, with a more elaborated level of detail displayed in the ICF than in the VIPS model. A majority of terms could be mapped, but several essential nursing care concepts and perspectives identified in the VIPS model were missing in the ICF. Two-thirds of the content in the ICF could be mapped to the VIPS' key words for patient status; however, the remaining terms in the ICF, describing body structure and environmental factors, are not part of the VIPS model.

Conclusion: Despite that a majority of the nursing content in the VIPS model could be expressed by terms in the ICF, the ICF needs to be developed and expanded to be functional for nursing practice. The results have international relevance for global efforts to implement unifying multi-professional terminologies. In addition, our results underline the need for sufficient coverage and level of detail to support different professional perspectives in health care terminologies.

Place, publisher, year, edition, pages
Clare, Ireland: Elsevier, 2013
Keywords
Documentation, Classification, ICF, Mapping, Nursing, VIPS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-41315 (URN)10.1016/j.ijmedinf.2012.05.016 (DOI)000314116700005 ()22824196 (PubMedID)2-s2.0-84873060867 (Scopus ID)
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-28Bibliographically approved
Thoroddsen, A., Sigurjónsdóttir, G., Ehnfors, M. & Ehrenberg, A. (2013). Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record. Scandinavian Journal of Caring Sciences, 27(1), 84-91
Open this publication in new window or tab >>Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 84-91Article in journal (Refereed) Published
Abstract [en]

Aim: To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records.

Design and setting: A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers.

Participants: A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively.

Results: The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers.

Conclusions: The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2013
Keywords
Accuracy, completeness, comprehensiveness, documentation, patient record, pressure ulcer
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-41314 (URN)10.1111/j.1471-6712.2012.01004.x (DOI)000314819900013 ()22630335 (PubMedID)2-s2.0-84873437341 (Scopus ID)
Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2020-01-28Bibliographically approved
Fossum, M., Ehnfors, M., Svensson, E., Hansen, L. M. & Ehrenberg, A. (2013). Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. International Journal of Medical Informatics, 82(10), 911-921
Open this publication in new window or tab >>Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study
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2013 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 82, no 10, p. 911-921Article in journal (Refereed) Published
Abstract [en]

Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.

Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.

Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).

Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.

Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.

Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.

Keywords
Decision support system, Documentation, Intervention studies, Malnutrition, Nursing audit, Pressure ulcer
National Category
Medical and Health Sciences Probability Theory and Statistics
Research subject
Caring sciences; Statistics
Identifiers
urn:nbn:se:oru:diva-31983 (URN)10.1016/j.ijmedinf.2013.05.009 (DOI)000324312000002 ()
Available from: 2013-10-14 Created: 2013-10-14 Last updated: 2020-01-28Bibliographically approved
Göras, C., Wallentin, F. Y., Nilsson, U. & Ehrenberg, A. (2013). Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version). BMC Health Services Research, 13, Article ID 104.
Open this publication in new window or tab >>Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)
2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, article id 104Article in journal (Refereed) Published
Abstract [en]

Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ.

Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction.

Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Patient safety, Operating room, Safety climate, Psychometrics, Translation, Safety attitudes questionnaire
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-28904 (URN)10.1186/1472-6963-13-104 (DOI)000317113300001 ()23506044 (PubMedID)2-s2.0-84875072612 (Scopus ID)
Available from: 2013-05-06 Created: 2013-05-03 Last updated: 2020-01-28Bibliographically approved
Carlsson, E., Ehnfors, M., Eldh, A. C. & Ehrenberg, A. (2012). Accuracy and continuity in discharge information for patients with eating difficulties after stroke. Journal of Clinical Nursing, 21(1-2), 21-31
Open this publication in new window or tab >>Accuracy and continuity in discharge information for patients with eating difficulties after stroke
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 1-2, p. 21-31Article in journal (Refereed) Published
Abstract [en]

Aims: To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke.

Design: Prospective, descriptive.

Methods: The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics.

Results: Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities.

Conclusions: Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking.

Relevance to clinical practice: Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
continuity of care, eating difficulties, information transfer, nursing, record audit, stroke
National Category
Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-21638 (URN)10.1111/j.1365-2702.2010.03648.x (DOI)000297953700004 ()21564355 (PubMedID)2-s2.0-83355166869 (Scopus ID)
Note

Funding Agency:

Research Committee of Örebro County Council

Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2020-01-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3964-196X

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