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Eriksson, Kerstin
Publications (10 of 12) Show all publications
Wikström, L., Nilsson, M. & Eriksson, K. (2020). The association of patients' daily summarized self-rated “real-time” pain scores with physical recovery after major surgery – A repeated measurement design. Nursing Open, 7(1), 307-318
Open this publication in new window or tab >>The association of patients' daily summarized self-rated “real-time” pain scores with physical recovery after major surgery – A repeated measurement design
2020 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 7, no 1, p. 307-318Article in journal (Refereed) Published
Abstract [en]

Aim:

To determine the associations of patients' documented self-rated pain with self-rated early postoperative physical recovery.

Design:

Observational with repeated measures.

Methods:

General and orthopaedic inpatients (N = 479) were during the period 2012–2015 screened for pain. Individual daily median pain scores at rest and during activity were based on 4–9 self-ratings on postoperative days 1 and 2, using the Numeric Rating Scale. Nine items reflecting physical recovery from the “Postoperative Recovery Profile” were used in a questionnaire.

Results:

Associations between median pain scores on postoperative day 1 and physical recovery (fatigue, sleeping difficulties, bladder function, mobilization, muscle weakness and personal hygiene) the same day were found. Additionally, associations were found between median pain scores on day 1 and physical recovery (fatigue, sleeping difficulties, mobilization and muscle weakness) on day 2.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
numeric rating scale, nurse, nursing, pain, pain assessment, postoperative care, recovery, repeated measures
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-46871 (URN)10.1002/nop2.392 (DOI)000493717500001 ()2-s2.0-85074769403 (Scopus ID)GOA HHJ 2020 (Local ID)GOA HHJ 2020 (Archive number)GOA HHJ 2020 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 598311Medical Research Council of Southeast Sweden (FORSS), 376851
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-12-18Bibliographically approved
Eriksson, K., Årestedt, K., Broström, A. & Wikström, L. (2019). Nausea intensity as a reflector of early physical recovery after surgery. Journal of Advanced Nursing, 75(5), 989-999
Open this publication in new window or tab >>Nausea intensity as a reflector of early physical recovery after surgery
2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 5, p. 989-999Article in journal (Refereed) Published
Abstract [en]

Aim: To compare different levels of self-rated average nausea intensity with early physical recovery and determine if nausea can reflect recovery in patients undergoing general or orthopaedic surgery.

Background: Nausea has been found to influence postoperative physical recovery. Despite the incidence of nausea in postoperative care, there is a knowledge gap about the possibility of using average nausea intensity to reflect recovery, motivating further investigation.

Design: An observational design with repeated measures.

Methods: General and orthopaedic patients answered a questionnaire (October 2012–January 2015) about nausea and impact on recovery on postoperative days 1 (N = 479) and 2 (N = 441). Questions about average nausea intensity at rest and during activity were answered based on the Numeric Rating Scale (NRS) (0–10). Impact on recovery was evaluated using three dimensions from the postoperative recovery profile tool.

Results: About one-fifth of the patients reported nausea intensity as moderate to severe on days 1 and 2. Nausea intensity was associated with eight of nine aspects of recovery on postoperative day 1. Nausea intensity on day 1 also reflected four of nine aspects of recovery on day 2. About reflecting physical recovery, the association was strongest between nausea intensity and appetite changes.

Conclusions: As postoperative nausea is common, regular assessments by healthcare professionals are needed. Assessment of nausea is of importance since it reflects physical recovery. This also shows the importance of treating nausea without delay. Using the NRS to measure nausea intensity is a simple method that is easy to use in clinic. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
nausea, numeric rating scale, nursing, physical recovery, postoperative care
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-42336 (URN)10.1111/jan.13893 (DOI)000465107000008 ()30375009 (PubMedID)2-s2.0-85057897106 (Scopus ID)PP HHJ 2019 embargo 12 (Local ID)PP HHJ 2019 embargo 12 (Archive number)PP HHJ 2019 embargo 12 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 598311Medical Research Council of Southeast Sweden (FORSS), 376851
Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2019-05-27Bibliographically approved
Wikström, L., Nilsson, M., Broström, A. & Eriksson, K. (2019). Patients’ self-reported nausea: Validation of the Numerical Rating Scale and of a daily summary of repeated Numerical Rating Scale scores. Journal of Clinical Nursing, 28(5-6), 959-968
Open this publication in new window or tab >>Patients’ self-reported nausea: Validation of the Numerical Rating Scale and of a daily summary of repeated Numerical Rating Scale scores
2019 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 5-6, p. 959-968Article in journal (Refereed) Published
Abstract [en]

Aim and objectives: To validate the Numeric Rating Scale (NRS) for postoperative nausea assessments, and determine whether a central tendency, median, based on patients’ self-rated nausea is a clinically applicable daily measure to describe patients’ nausea after major surgery.

Background: Postoperative nausea causes major discomfort, risks for complications and prolonged hospital stays. The NRS is recommended for the assessment of pain but is little explored for assessing nausea.

Design: A repeated measure design was carried out on patients who had undergone major surgery in three Swedish hospitals.

Methods: Nonparametric statistical methods were used to analyse (a) associations between the NRS and a verbal scale (no, mild, moderate and severe) and (b) to analyse associations between Measure 1 (nausea scores postoperative Day 1) and Measure 2 (retrospective nausea scores at rest and during activity, postoperative Day 2). Reporting of this research adheres to the Strobe Guidelines.

Results: The mean age of the 479 patients (44% women) in the sample was 65 years (range, 22–93 years). Self-assessed nausea scores from the NRS and the verbal scale correlated well (rS pearman= 0.79). Correlation between nausea at rest and nausea during activity was rS pearman= 0.81. The calculated median scores (Measure 1) showed only moderate correlations with retrospective nausea scores (Measure 2); 4–9 ratings, rS pearman= 0.41; 6–9 ratings, rS pearman= 0.54.

Conclusions: Numeric Rating Scale scores showed strong associations with a verbal scale; therefore, the NRS seems to be a valid tool to measure nausea intensity. The quality of daily summarised median nausea scores needs to be further explored before clinical use.

Relevance to clinical practice: The use of the NRS in assessments of nausea in postoperative care will facilitate communication between patients and health care professionals regarding nausea intensity. When documenting nausea, it seems unnecessary to distinguish nausea at rest from nausea during activity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
assessment, nausea, Numeric Rating Scale, postoperative, validation
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-42100 (URN)10.1111/jocn.14705 (DOI)000458362400024 ()30357970 (PubMedID)2-s2.0-85056162192 (Scopus ID)PP HHJ 2019 embargo 12 (Local ID)PP HHJ 2019 embargo 12 (Archive number)PP HHJ 2019 embargo 12 (OAI)
Available from: 2018-11-21 Created: 2018-11-21 Last updated: 2019-03-12Bibliographically approved
Eriksson, K., Wikström, L., Broström, A. & Pakpour, A. H. (2019). Predictors for Early Physical Recovery for General and Orthopedic Patients after Major Surgery: Structural Equational Model Analyses. Pain Management Nursing
Open this publication in new window or tab >>Predictors for Early Physical Recovery for General and Orthopedic Patients after Major Surgery: Structural Equational Model Analyses
2019 (English)In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background:

Attention to factors that may affect patients’ ability to experience enhanced recovery after surgery is essential in planning for postoperative care.

Aims:

To create models of predefined pre,- peri-, and postoperative variables in order to analyze their impact on patients’ physical recovery on postoperative days 1 and 2 after major orthopedic and general surgery.

Design:

An exploratory design with repeated measures was used, including 479 patients who had undergone orthopedic (289) or general surgery (190) at three hospitals.

Methods:

Pain, nausea, and level of physical ability were measured preoperatively and on postoperative days 1 and 2 by using the Numerical Rating Scale and items from the Postoperative Recovery Profile. Structural equation modeling was used to explore the impact of the predefined variables on patients’ physical recovery.

Results:

The orthopedic group contained significantly more women and significantly more patients with pain and opioid use. Although the models showed good fit, “traditional” preoperative (pain, nausea, physical abilities, chronic pain, opioid use) and perioperative variables (anesthesia, length of surgery) constituted few (orthopedic) or no (general surgery) predictive properties for physical recovery. Postoperative average pain intensity, average nausea intensity, and physical ability explained physical recovery on day 1, and physical recovery on day 1 predicted physical recovery on day 2.

Conclusions:

“Traditional” predictors had little effect on patients’ postoperative physical recovery, while associations with common postoperative symptoms were shown. Further research is needed to explore additional variables affecting early physical recovery and to understand how soon patients are physically ready to return home. 

National Category
Physiotherapy
Identifiers
urn:nbn:se:hj:diva-46987 (URN)10.1016/j.pmn.2019.10.001 (DOI)2-s2.0-85075379398 (Scopus ID);HHJADULTIS, HHJÖvrigtIS (Local ID);HHJADULTIS, HHJÖvrigtIS (Archive number);HHJADULTIS, HHJÖvrigtIS (OAI)
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-05
Eriksson, K., Wikström, L., Fridlund, B., Årestedt, K. & Broström, A. (2017). Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery - A quantitative study with repeated measures. Journal of Advanced Nursing, 73(11), 2664-2675
Open this publication in new window or tab >>Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery - A quantitative study with repeated measures
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2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2664-2675Article in journal (Refereed) Published
Abstract [en]

Aim: To compare different levels of self-rated pain and determine if they predict anticipated early physical recovery in patients undergoing general and orthopaedic surgery.

Background: Previous research has indicated that average self-rated pain reflects patients' ability to recover the same day. However, there is a knowledge gap about the feasibility of using average pain ratings to predict patients' physical recovery for the next day.

Design: Descriptive, quantitative repeated measures.

Methods: General and orthopaedic inpatients (n = 479) completed a questionnaire (October 2012-January 2015) about pain and recovery. Average pain intensity at rest and during activity was based on the Numeric Rating Scale and divided into three levels (0-3, 4-6, 7-10). Three out of five dimensions from the tool "Postoperative Recovery Profile" were used. Because few suffered severe pain, general and orthopaedic patients were analysed together.

Results: Binary logistic regression analysis showed that average pain intensity postoperative day 1 significantly predicted the impact on recovery day 2, except nausea, gastrointestinal function and bladder function when pain at rest and also nausea, appetite changes, and bladder function when pain during activity. High pain ratings (NRS 7-10) demonstrated to be a better predictor for recovery compared with moderate ratings (NRS 4-6), day 2, as it significantly predicted more items in recovery.

Conclusion: Pain intensity reflected general and orthopaedic patients' physical recovery postoperative day 1 and predicted recovery for day 2. By monitoring patients' pain and impact on recovery, patients' need for support becomes visible which is valuable during hospital stays.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Assessment, Nurse-patient interaction, Nurse-patient relationships, Pain, Postoperative care, Quantitative approaches
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35340 (URN)10.1111/jan.13331 (DOI)000418363000018 ()28475240 (PubMedID)2-s2.0-85020059107 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS), 376851Futurum - Academy for Health and Care, Jönköping County Council, Sweden, 598311
Note

Part of doctoral thesis in its submitted form.

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-11-21Bibliographically approved
Eriksson, K. (2017). Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective. (Doctoral dissertation). Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.

Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.

Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.

Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).

Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. p. 77
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 080
Keywords
pain assessment, pain intensity, pain scale, physichal recovery, postoperative care
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35346 (URN)978-91-85835-79-9 (ISBN)
Public defence
2017-05-10, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-20 Created: 2017-04-10 Last updated: 2017-04-12Bibliographically approved
Wikström, L., Eriksson, K., Fridlund, B., Nilsson, M., Årestedt, K. & Broström, A. (2017). The clinical applicability of a daily summary of patients’ self-reported postoperative pain - a repeated measure analysis. Journal of Clinical Nursing, 26(23-24), 4675-4684
Open this publication in new window or tab >>The clinical applicability of a daily summary of patients’ self-reported postoperative pain - a repeated measure analysis
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4675-4684Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVES:

(I) to determine if a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (II) and to determine the number of self-ratings required for the calculation of this measure.

BACKGROUND:

Perioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored.

DESIGN:

A repeated measure design was carried out at three Swedish country hospitals.

METHODS:

Associations between the measures were analysed with non-parametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1.

RESULTS:

The sample, 190 general- and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. 44% had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 4-9 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, versus retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant.

CONCLUSIONS:

The median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments.

RELEVANCE TO CLINICAL PRACTICE:

The documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health-related consequences.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
documentation; numerical rating scale; pain; repeated measures; self-rated
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35350 (URN)10.1111/jocn.13818 (DOI)000416319600080 ()28334471 (PubMedID)2-s2.0-85019551916 (Scopus ID)
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2018-05-22Bibliographically approved
Wikström, L., Eriksson, K., Fridlund, B., Årestedt, K. & Broström, A. (2016). Healthcare professionals’ descriptions of care experiences and actions when assessing postoperative pain – a critical incident technique analysis. Scandinavian Journal of Caring Sciences, 30(4), 802-812
Open this publication in new window or tab >>Healthcare professionals’ descriptions of care experiences and actions when assessing postoperative pain – a critical incident technique analysis
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2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 802-812Article in journal (Refereed) Published
Abstract [en]

Background

Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

Objectives

The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

Methods

An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

Findings

In pain assessments, patient-related facilitators were patients’ verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients’ pain manifestations and adapting to patients’ communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

Conclusions

Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals’ dissimilar responsibilities when collecting patients’ and relatives’ perspectives on current pain.

Keywords
collaboration; critical incident technique; healthcare professionals; postoperative pain assessment
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-28942 (URN)10.1111/scs.12308 (DOI)000389453000019 ()26709955 (PubMedID)2-s2.0-84952837637 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2018-11-21Bibliographically approved
Eriksson, K., Wikström, L., Fridlund, B., Årestedt, K. & Broström, A. (2016). Patients’ experiences and actions when describing pain after surgery – A critical incident technique analysis. International Journal of Nursing Studies, 56, 27-36
Open this publication in new window or tab >>Patients’ experiences and actions when describing pain after surgery – A critical incident technique analysis
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2016 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, p. 27-36Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Pain is a common postoperative symptom, and length of hospital stay after surgery is short which highlights the importance of pain assessments. Experiences of assessing pain are mainly described from the perspective of nurses. In postoperative care, enrolled nurses and physicians also assess pain. It is therefore important to take note of their experiences to improve postoperative pain assessments.

OBJECTIVES:

The aim of this study was, through considering critical incidents, to describe care experiences and actions taken by healthcare professionals when assessing postoperative pain.

METHODS:

An explorative design employing critical incidents technique analysis was used. A total of 24 strategically selected enrolled nurses, nurses and physicians employed at orthopaedic or general surgery wards in four Swedish hospitals were interviewed. The intention was to reach variation in age, sex, profession and professional experience.

FINDINGS:

In pain assessments, patient-related facilitators were patients' verbal and emotional expressions including pain ratings, while lack of consistency with observed behaviours was a barrier. Clinical competence, continuity in care and time were healthcare-related facilitators. The actions healthcare professionals took were gathering facts about patients' pain manifestations and adapting to patients' communication abilities. Patient observations, either passive or active were used to confirm or detect pain. Collaboration between healthcare professionals, including consultations with pain experts, social workers and relatives, strengthened understanding of pain.

CONCLUSIONS:

Communication skills and working conditions have an impact on performance of pain assessment. Patient comfort without compromising safety is reached by including healthcare professionals' dissimilar responsibilities when collecting patients' and relatives' perspectives on current pain.

Keywords
collaboration; critical incident technique; healthcare professionals; postoperative pain assessment
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-28940 (URN)10.1016/j.ijnurstu.2015.12.008 (DOI)000371844700004 ()26709955 (PubMedID)2-s2.0-84953216205 (Scopus ID)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenMedical Research Council of Southeast Sweden (FORSS)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2018-11-21Bibliographically approved
Wikström, L., Eriksson, K., Årestedt, K., Fridlund, B. & Broström, A. (2014). Healthcare professionals' perceptions of the use of pain scales in postoperative pain assessments. Applied Nursing Research, 27(1), 53-58
Open this publication in new window or tab >>Healthcare professionals' perceptions of the use of pain scales in postoperative pain assessments
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2014 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 27, no 1, p. 53-58Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-25837 (URN)10.1016/j.apnr.2013.11.001 (DOI)000331019400007 ()24387871 (PubMedID)2-s2.0-84892976157 (Scopus ID)
Available from: 2015-02-04 Created: 2015-02-04 Last updated: 2017-12-05Bibliographically approved
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