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Andersson-Gäre, BoelORCID iD iconorcid.org/0000-0003-1176-8173
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Publications (10 of 46) Show all publications
Karltun, A., Sanne, J. M., Aase, K., Anderson, J. E., Fernandes, A., Fulop, N. J., . . . Andersson-Gäre, B. (2020). Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals. Health Policy, 124(2), 205-215
Open this publication in new window or tab >>Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals
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2020 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 124, no 2, p. 205-215Article in journal (Refereed) Published
Abstract [en]

The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems.

The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments.

There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Multilevel interaction, Healthcare management, Hospital management, Professionals’ action strategies, Knowledge management, Improvement science
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47326 (URN)10.1016/j.healthpol.2019.11.005 (DOI)000514023700010 ()31928857 (PubMedID)2-s2.0-85077715250 (Scopus ID)HOA HHJ 2020,HOA JTH 2020;HHJIMPROVEIS,JTHLogistikIS (Local ID)HOA HHJ 2020,HOA JTH 2020;HHJIMPROVEIS,JTHLogistikIS (Archive number)HOA HHJ 2020,HOA JTH 2020;HHJIMPROVEIS,JTHLogistikIS (OAI)
Funder
EU, FP7, Seventh Framework Programme, 241724
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-03-05Bibliographically approved
Norman, A.-C., Elg, M., Nordin, A., Andersson-Gäre, B. & Algurén, B. (2020). The role of professional logics in quality register use: a realist evaluation. BMC Health Services Research, 20, 1-11, Article ID 107.
Open this publication in new window or tab >>The role of professional logics in quality register use: a realist evaluation
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2020 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 20, p. 1-11, article id 107Article in journal (Refereed) Published
Abstract [en]

Background: Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement.

Methods: This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes.

Results: We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives.

Conclusions: We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Quality registers, Programme, Clinical practice, Professional logics, Realist evaluation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47780 (URN)10.1186/s12913-020-4944-x (DOI)000514610400002 ()32046710 (PubMedID)2-s2.0-85079338390 (Scopus ID)GOA HHJ 2020 (Local ID)GOA HHJ 2020 (Archive number)GOA HHJ 2020 (OAI)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-03-05Bibliographically approved
Roos Af Hjelmsäter, E., Ros, A., Andersson-Gäre, B. & Westrin, Å. (2019). Deficiencies in healthcare prior to suicide and actions to deal with them: A retrospective study of investigations after suicide in Swedish healthcare. BMJ Open, 9(12), Article ID e032290.
Open this publication in new window or tab >>Deficiencies in healthcare prior to suicide and actions to deal with them: A retrospective study of investigations after suicide in Swedish healthcare
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 12, article id e032290Article in journal (Refereed) Published
Abstract [en]

Objectives

The overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro-meso-macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority's decisions.

Design and setting

This is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.

Results

In 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in 'suicide risk assessment' and 'treatment'. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were 'education and competence', present in 52% of cases (n=227) and did not much correspond with identified deficiencies. Sixty-five per cent of the deficiencies and actions were at microlevel, while the remainders were at mesolevel. In 65% (n=284) of cases, the supervisory authority approved the investigation without further requirements.

Conclusions

The most common identified deficiencies were related to care in the immediate interface between patient and staff. Actions proposed to prevent new suicides were centred on single educational interventions without distinctive sustainable effects in the organisations and usually did not correspond with the identified deficiencies. Future research should examine if application of a framework based on knowledge of the suicide process, suicide prevention strategies and patient safety would enable more sophisticated investigations that could facilitate progress on suicide prevention. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
adult psychiatry, health & safety, quality in health care, risk management, suicide & self-harm
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47208 (URN)10.1136/bmjopen-2019-032290 (DOI)000512773400161 ()31831542 (PubMedID)2-s2.0-85076422244 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-03-05Bibliographically approved
Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., Käll, J., . . . Robert, G. (2019). Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol. BMJ Open, 9(7), Article ID e029723.
Open this publication in new window or tab >>Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e029723Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:

Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

METHODS AND ANALYSIS:

Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

ETHICS AND DISSEMINATION:

All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
case study, codesign, coproduction, healthcare, social care, adult, article, cultural factor, England, human, organization, physician, quantitative analysis, scientist, Sweden, wellbeing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-46421 (URN)10.1136/bmjopen-2019-029723 (DOI)000485269700101 ()31350253 (PubMedID)2-s2.0-85070675953 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01431
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-11Bibliographically approved
Robert, G., Kjellström, S., Areskoug Josefsson, K., Andersson-Gäre, B., Andersson, A.-C., Ockander, M., . . . Donetto, S. (2019). Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol). In: : . Paper presented at 14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK.
Open this publication in new window or tab >>Exploring, measuring and enhancing the co-production of health and wellbeing at the national, regional and local levels through comparative case studies in Sweden and England: The 'Samskapa' research programme (study protocol)
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45081 (URN)
Conference
14th ESA Conference, Europe and Beyond: Boundaries, Barriers and Belonging, 20-23 August 2019, Manchester, UK
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-06-25Bibliographically approved
Algurén, B., Nordin, A., Andersson-Gäre, B. & Peterson, A. (2019). In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time. Implementation Science, 14(1), Article ID 74.
Open this publication in new window or tab >>In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time
2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 74Article in journal (Refereed) Published
Abstract [en]

Background: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

Methods: Final reports of two QICs - one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

Results: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

Conclusions: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular. 

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Collaboratives, Data warehouses, Learning, Measurement skills, Quality improvement, Teams
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45508 (URN)10.1186/s13012-019-0926-y (DOI)000477011600001 ()31337394 (PubMedID)2-s2.0-85069773796 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-12Bibliographically approved
Pukk Härenstam, K., von Plessen, C. & Andersson-Gäre, B. (2019). Integrering, säkerhet och kvalitet – en självklarhet eller?. In: Synnöve Ödegård (Ed.), Säker vård - nya perspektiv på patientsäkerhet: (pp. 235-257). Stockholm: Liber
Open this publication in new window or tab >>Integrering, säkerhet och kvalitet – en självklarhet eller?
2019 (Swedish)In: Säker vård - nya perspektiv på patientsäkerhet / [ed] Synnöve Ödegård, Stockholm: Liber, 2019, p. 235-257Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2019
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47321 (URN)978-91-47-11300-2 (ISBN)
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-01-10Bibliographically approved
Nordal, E. B., Rypdal, V., Arnstad, E. D., Aalto, K. T., Berntson, L., Ekelund, M., . . . Andersson-Gäre, B. (2019). Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatric Rheumatology, 17(1), Article ID 44.
Open this publication in new window or tab >>Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study
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2019 (English)In: Pediatric Rheumatology, ISSN 1546-0096, E-ISSN 1546-0096, Vol. 17, no 1, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA).

Methods: Consecutive cases of JIA from defined geographical areas of Finland, Sweden and Norway with disease onset in 1997 to 2000 were followed for 8 years in a multi-center cohort study, aimed to be as close to population-based as possible. Clinical characteristics and information on school attendance and participation in physical education (PE) were registered.

Results: Participation in school and in PE was lowest initially and increased during the disease course. Eight years after disease onset 228/274 (83.2%) of the children reported no school absence due to JIA, while 16.8% reported absence during the last 2 months due to JIA. Full participation in PE was reported by 194/242 (80.2%), partly by 16.9%, and none by 2.9%. Lowest participation in PE was found among children with ERA and the undifferentiated categories. Absence in school and PE was associated with higher disease activity measures at the 8-year visit. School absence > 1 day at baseline predicted use of disease-modifying anti-rheumatic drugs, including biologics (DMARDs) (OR 1.2 (1.1-1.5)), and non-remission off medication (OR 1.4 (1.1-1.7) 8 years after disease onset.

Conclusion: School absence at baseline predicted adverse long-term outcome. In children and adolescents with JIA participation in school activities is mostly high after 8 years of disease. For the minority with low participation, special attention is warranted to promote their full potential of social interaction and improve long-term outcome.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Epidemiology, Juvenile idiopathic arthritis, Participation, Physical activity, Physical education, School
National Category
Rheumatology and Autoimmunity Pediatrics
Identifiers
urn:nbn:se:hj:diva-45410 (URN)10.1186/s12969-019-0341-6 (DOI)000475708400002 ()31307487 (PubMedID)2-s2.0-85069198105 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS,HHJARNIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS,HHJARNIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS,HHJARNIS (OAI)
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2020-01-20Bibliographically approved
Nyström, M. E., Karltun, J., Keller, C. & Andersson Gäre, B. (2018). Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects. Health Research Policy and Systems, 16, Article ID 46.
Open this publication in new window or tab >>Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects
2018 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 16, article id 46Article in journal (Refereed) Published
Abstract [en]

Background

Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers’ experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services.

Methods

Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis.

Results

Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or ‘student researchers’ were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner’s and researcher’s contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management.

Conclusions

Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Collaborative research, co-production, integrated knowledge translation, partnership research, quality improvement, healthcare, social services
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:hj:diva-39675 (URN)10.1186/s12961-018-0322-0 (DOI)000433968800001 ()29843735 (PubMedID)2-s2.0-85047814253 (Scopus ID)
Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2019-06-07Bibliographically approved
Andersson, A.-C., Melke, A., Andersson Gäre, B. & Golsäter, M. (2018). Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support. Quality Management in Health Care, 27(3), 172-177
Open this publication in new window or tab >>Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support
2018 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 27, no 3, p. 172-177Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
health care system, identification of children as relatives, incorporation of new regulations, interactive research, micro-level perspectives
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-41184 (URN)10.1097/QMH.0000000000000181 (DOI)000436873500010 ()29944630 (PubMedID)2-s2.0-85049356843 (Scopus ID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-1176-8173

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