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  • 1.
    Edberg, Anna-Karin
    et al.
    Högskolan, Kristianstad.
    Ernsth Bravell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Kompetensen måste höjas på särskilda boenden för äldre2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 45, p. 1984-1986Article in journal (Other academic)
    Abstract [sv]

    Personer som bor och vårdas på särskilt boende (säbo) har omfattande omvårdnadsbehov och ofta nedsatt kognitiv funktion, de är ofta multisjuka och har många olika läkemedel samtidigt.

    Om en god vårdkvalitet ska kunna garanteras, måste kompetensen bland vårdpersonalen höjas, framför allt avseende specifik geriatrisk kompetens.

    En betydande andel av de äldre som bor och vårdas på säbo avlider också där, trots att förutsättningarna för att ge en god palliativ vård vid livets slut är begränsade.

  • 2.
    Ekman, Aimée
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health Science, HHJ. Research Platform of Social Work.
    Richt, Bengt
    Linköpings Universitet .
    Tonvikt på vikt tungt för de tyngsta2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 38, p. 1679-1680Article in journal (Other academic)
  • 3.
    Engström, Sven
    et al.
    Futurum, Region Jönköpings län.
    Arvidsson, Eva
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    André, Malin
    Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet.
    Borgquist, Lars
    Linköpings universitet.
    Så vill vi organisera vårdcentraler: 838 allmänläkares inställning – de flesta positiva till personlig patientlista om den är rimligt stor [How do we want to organize health centres? 838 Swedish general practitioners' attitudes to a personal patient list]2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, article id 21026Article in journal (Refereed)
    Abstract [en]

    In Swedish primary care patients are registered at health centres where different professions, such as general practitioners (GPs), nurses, assistant nurses, counsellors, physiotherapists, psychologists and biomedical analysts, work.

    In an international comparison personal physician continuity is low in Sweden. Several governmental inquiries propose that patients register with one GP or a care team. Do Swedish GPs want a personal patient list and how should this best be realised? A web survey was distributed to the members of the Swedish Union of General Practitioners and was answered by 838 GPs. 91% wanted a personal patient list if reasonably sized, the option to limit their list, and shared responsibility for the list with colleagues or a team. To be able to plan the working day themselves and designated time for collegial dialogue was considered essential for increased efficiency, well-being and reduced risk of patients harm due to their doctor’s knowledge gaps.

  • 4.
    Engström, Sven
    et al.
    Futurum, Jönköping.
    Borgquist, Lars
    Linköpings universitet.
    Nordvall, Dennis
    Qulturum, Region Jönköpings län.
    Albinsson, Gunnar
    Futurum, Jönköping.
    Arvidsson, Eva
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Jönköping.
    Hög personlig läkar­kontinuitet i primärvård förenad med färre besök på akutmottagning: En populationsbaserad studie i Jönköpings sjukvårdsregion2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 51-52Article in journal (Refereed)
    Abstract [en]

    Personal physician continuity in primary care associated with fewer emergency room visits

    Overloading of the emergency departments in hospitals is, in Sweden, a common problem that is often blamed on lack of access to primary care.  We have conducted a cross-sectional study comprising more than 40% of the 347 837  inhabitants of Region Jönköping with access to complete individual data on healthcare consumption, personal doctor continuity, socio-economics, and accessibility data for all of the region’s health centres. Individuals with high personal continuity at their own health centre had significantly fewer emergency room visits compared to those with the lowest continuity: for younger adults 55% and for elderly 34% fewer emergency room visits. Access to doctor consultations or to counselling nurses in primary care was not associated with a lower number of emergency room visits. Our results show the importance of personal doctor continuity also for the group of younger adults. 

  • 5.
    Engström, Sven
    et al.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Primärvårdens FoU-enhet, Futurum, Jönköping.
    Lindström, Kjell
    Ersättningsmodeller för vårdcentraler kan förbättras: ACG-systemet medför överdriven diagnosregistrering som kan göra patienter sjukare2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, no 17/18, p. 596-597Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Trots att det saknas vetenskapliga studier av hur ACG-systemet fungerar som ersättningssystem för vårdcentraler används det i 14 av 21 regioner.

    Alla dessa 14 regioner tillämpar relativ ACG-viktning, vilket skapar en tävling i registrering av diagnoser: den vårdcentral som inte ökar sina diagnosregistreringar i samma grad som övriga får en sjunkande ACG-vikt och därmed minskad ekonomisk ersättning.

    Vår granskning av över 4 500 journalanteckningar påvisade ett mycket stort antal icke relevanta diagnosregistreringar som konsumerat arbetstid och medför medicinska risker.

    Patienter, som i dag ofta läser sina journaler och ser alla sina diagnoser, riskerar att uppleva sig sjukare än de är.

  • 6. Fasth, A.
    et al.
    Andersson-Gäre, Boel
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Reumatiska sjukdomar hos barn viktigt specialområde: benmärgstransplantation ger ökat hopp för de svårast sjuka2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, no 24, p. 2968-2973Article in journal (Refereed)
    Abstract [en]

    Chronic inflammatory joint disorders can be viewed as a spectrum of disease presenting one set of characteristics during childhood and another in adulthood. Few of the disorders are specific for children of a specific age, even if some conditions might be very rare in certain age groups. Juvenile idiopathic arthritis is a new name suggested for pediatric chronic inflammatory joint disorders. Drug therapy is based on the same principles as for adults: an aggressive approach with NSAID-drugs and low dose methotrexate in combination with local steroid injections. New drugs like TNF-blockade and COX-2 inhibitors are almost untested in children, with the exception of etanercept which has been studied in children with polyarticular disease and proven to be very effective. For rare cases with very severe joint disease hematopoietic stem cell transplantation is under evaluation.

  • 7.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Edvinsson, J.
    Region Jönköpings län.
    Mellqvist, J.
    Region Jönköpings län.
    Ros, A.
    Region Jönköpings län.
    PIR – patientsäkerhet i realtid – lämpade sig väl under pandemin2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, no 48, p. 1587-1589Article in journal (Refereed)
    Abstract [en]

    The adaptation of the healthcare needed in the covid-19 pandemic poses challenges to patient safety. Proactive patient safety work must continue even under conditions such as a pandemic. Methods are needed that assess and support patient safety as the work is carried out. Patient safety in real time appears to be such a useful method in which patient record review to identify patient harm is combined with interviews with patients and healthcare staff. The method was used in wards and intensive care units (ICU) for covid-19 patients in Region Jönköping County. Patient harm was found in ICU care. Patients were overall satisfied with the care, and in the interviews with healthcare staff areas for improvement were identified. Valid indicators for patient record review to evaluate patient harm in covid-19 need to be developed. To judge if patient harm in care of a Covid-19 is avoidable or not is difficult since the level of knowledge and treatment principles in the disease develops very fast.

  • 8.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Mellqvist, Joanna
    Region Jönköpings län.
    Saric, Mikael
    Region Västernorrland.
    Proaktivt patientsäkerhetsarbete i den psykiatriska slutenvården [Proactive work with patient safety in psychiatry, Patient safety in Real time in Psychiatry]2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, no JulyArticle in journal (Refereed)
    Abstract [en]

    Traditionally, work with patient safety has mainly been focused on examining and learning from incidents retrospectively. Proactive methods to support and evaluate patient safety as work-as-done in real time are needed. Patient safety in Real time in Psychiatry (PiRiP), combining systematic reviews of inpatient records and interviews with inpatients and staff, can be such a method. We have evolved and tested this approach in psychiatric wards in Region Jönköping County and Region Västernorrland. We found that discussion and reflection with staff about the patients' views of care and treatment, observed strengths, risks and possibilities of improvement were of value to increase awareness and knowledge of how performance of daily work relates to patient safety. PiRiP adheres to the basic principles of patient safety as described in the national action plan for patient safety.

  • 9.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    A cultural shift is needed to improve patient safety: En kulturförändring behövs för att öka patientsäkerheten2023In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, no 7 AugustArticle in journal (Refereed)
    Abstract [en]

    In a recently published thesis, we propose a cultural shift in the assessment of suicide as an incident of severe patient harm, from a focus on errors and an often speculative avoidability, to healthcare's ability of risk management over time. Patient safety work needs to change in line with the development of knowledge in patient safety. This means a cultural change in the view of patient safety, with a clearer focus on healthcare's abilities in risk management and learning. Legislation and regulations regarding healthcare and the supervisory authority need to support this cultural change in assessment and investigations of patient harm.  A shift from a focus on errors and deviations to quality and positive outcomes of care, proactive patient safety work, risk management, patient safety culture and management commitment is needed.

  • 10.
    Gerdner, Arne
    et al.
    Runnagården, Örebro Läns Landsting.
    Bodin, Lennart
    Yrkesmedicinska enheten, Örebro Läns Landsting.
    Söderfeldt, Björn
    Socialmedicinsk avdelning, Örebro Läns Landsting.
    Minnesotamodellen på Runnagården - bakgrundsfaktorer och resultat1989In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 86, no 32-33, p. 2671-2674Article in journal (Refereed)
  • 11.
    Janson, S.
    et al.
    Barnrättsakademin, Örbero universitet.
    Andersson-Gäre, Boel
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Blennow, M.
    Södersjukhuset, Stockholm.
    Är barnen fortfarande osynliga vid familjevåld?2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 14, p. 1027-1028Article in journal (Other academic)
  • 12.
    Johansson, Yvonne A
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Tsevis, Theofanis
    Tema åldrande, Karolinska universitetssjukhuset.
    Bogdanovic, Nenad
    Tema åldrande, Karolinska universitetssjukhuset. Karolinska Institutet.
    Kenne Sarenmalm, Elisabeth
    Sahlgrenska akademin; FoU, Skaraborgs sjukhus.
    Delirium bör bedömas enhetligt och strukturerat i vården2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, article id 2018;115:E4IIArticle in journal (Other (popular science, discussion, etc.))
  • 13.
    Monwell, Bodil
    et al.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Blix, Olof
    Beroendemottagningen, Psykiatriska kliniken, Länssjukhuset Ryhov.
    Bülow, Per
    Psykiatriska kliniken, Länssjukhuset Ryhov.
    Gerdner, Arne
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Ämneslista som kognitivt stöd gav utförligare uppgifter om droganvändning: Jämförelse av två metoder för utredning av opioidberoende2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 48, p. 2178-2180Article in journal (Other academic)
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  • 14.
    Monwell, Bodil
    et al.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Johnson, Björn
    Malmö högskola.
    Gerdner, Arne
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Opiater eller opioider?: dags att städa bland begreppen2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 43, p. 1928-1929Article in journal (Other (popular science, discussion, etc.))
  • 15.
    Mårtensson, Jan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Linköpings universitet.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sexrådgivning viktig vid kardiovaskulär sjukdom: Återgång till sexuell aktivitet ett vanligt problem2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, article id CZH4Article in journal (Refereed)
    Abstract [sv]

    Frekvensen av erektil dysfunktion bland män och sexuell dysfunktion hos kvinnor med kardiovaskulär sjukdom är dubbelt så hög som i normalpopulationen. Återgång till sexuell aktivitet efter en kardiovaskulär händelse är ett vanligt problem, och information efterfrågas om hur sexuell aktivitet kan återupptas. Hälso- och sjukvårdspersonal inom hjärtområdet är medvetna om vikten av att diskutera sexuell funktion och aktivitet, men vet inte vilka specifika råd de ska ge. I en konsensusrapport från de amerikanska och europeiska hjärtförbunden AHA och ESC är därför avsikten att sammanfatta evidensen relaterad till sexuell rådgivning vid kardiovaskulär sjukdom och att vägleda läkare, sjuksköterskor, och annan hälsooch sjukvårdspersonal i praktiserandet av sexrådgivning.

    Download full text (pdf)
    Fulltext
  • 16.
    Nilsson, Sven E.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Anders Andersson: bortglömd medlem av Svenska akademien.2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 37, p. 2678-2679Article in journal (Other (popular science, discussion, etc.))
  • 17.
    Nilsson, Sven E.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Frida Kahlo suffered probably of post-polio syndrome.2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 46, p. 3696-3697Article in journal (Refereed)
  • 18.
    Nilsson, Sven E.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Pulserande elektromagnetiska fält och placebo gav samma effekt2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 32-33, p. 2167-2170Article in journal (Other (popular science, discussion, etc.))
  • 19.
    Nilsson, Sven E
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Dolby, J
    Ockander, Leif
    Åstrand, B
    Computer terminal in the physician's office to assist drug prescription1982In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 79, no 9, p. 760-762Article in journal (Refereed)
  • 20.
    Nilsson, Sven E.
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Nilsson, Martin S
    Nilsson , Erik D
    Nilsson, Peter M
    Långtidsöverlevnaden vid diabetes har successivt förbättrats: Lång sjukdomsduration kan ge information om protektiva möjligheter.2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 28-29, p. 2066-2070Article in journal (Refereed)
  • 21.
    Nordenström, Jörgen
    et al.
    Karolinska institutet.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Karolinska institutet.
    Bästa praxis - en nyckel till bättre vårdkvalitet och mer effektiv vård2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, p. 34-37, article id DWYWArticle in journal (Other academic)
    Abstract [sv]

    Medicinska paradigm har en tendens att samlas under mer eller mindre lättfattliga begrepp. De senaste decennierna har paradigmen »evidens« och »kvalitet« dominerat [1]. Paradigmet skiftar nu mot »värde«.

  • 22. Pedersen, Nancy
    et al.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Johansson, Boo
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Johansson, Kurt
    Viitanen, Matti
    Winblad, Bengt
    Gatz, Margaret
    Genetiska faktorer ligger ofta bakom Alzheimers sjukdom: Stor tvillingstudie skall klarlägga sambanden arv-miljö1998In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 95, no 22, p. 2585-2588Article in journal (Refereed)
  • 23.
    Rejler, Martin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Höglandssjukhuset, Eksjö, Sweden .
    Fabisch, Anna
    Qulturum, Region Jönköpings län, Sweden .
    Petersson, Christina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Henriks, Göran
    Qulturum, Region Jönköpings län, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ersätt kvalitetsregistren med förbättringsnätverk: Registerbaserade förbättringsnätverk bör ersätta nuvarande nationella kvalitetsregister2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 17, p. 760-762Article in journal (Other (popular science, discussion, etc.))
  • 24.
    Sundström, Gerdt
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Samuelsson, Gilis
    Dehlin, Ove
    Gustafsson, Lars
    Hagberg, Bo
    Nordlund, Ingvar
    Psykisk ohälsa bland äldre inte bara demens: Långsiktigt perspektiv viktigt inom omsorgen1991In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 10, p. 863-866Article in journal (Refereed)
  • 25.
    Thor, Johan
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Stockholm.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. Studies on Integrated Health and Welfare (SIHW). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättringskunskap behöver fortsatt tillämpas i vården [Improvement knowledge has been applied when changing health services - and continues to be needed]2023In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 120, article id 22154Article in journal (Refereed)
    Abstract [en]

    In 2002, Läkartidningen published a call to apply improvement knowledge in efforts to change health services. Looking back over the past 20 years, we highlight many scientifically documented examples of such application. Many efforts, often within »breakthrough collaboratives«, have included Swedish national quality registries, with documented health outcome improvements related to application of Improvement Knowledge. Applications have been evaluated through improvement science studies. A literature review documented 32 PhD theses addressing healthcare improvement published by Swedish universities. Increasingly, improvement knowledge definitions and applications include - and harness - the experiences and knowledge among patients and their families. To meet challenges in the future, all health care stakeholders will need to master and apply improvement knowledge.

  • 26.
    Wijma, Barbro
    et al.
    IKE, Linköpings universitet, Linköping - Genus och medicin Linköping, Sweden.
    Persson, Alma
    Linkopings universitet Tema Genus - Linkoping, Sweden Linkopings universitet Tema Genus - Linkoping, Sweden.
    Ockander, Marlene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Brüggemann, Jelmer
    Linköpings universitet - Institutionen för TEMA - Teknik och social förändring Linköping, Sweden.
    Kränkningar i vården är vanligt förekommande - viktigt med aktivt arbete mot att patienter kränks [Abuse in healthcare - lessons learned during two decades of research]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 3, p. 84-88Article in journal (Refereed)
    Abstract [en]

    Patients' experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.

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