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Bremer, Anders, DocentORCID iD iconorcid.org/0000-0001-7865-3480
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Publications (10 of 85) Show all publications
Olander, A., Magnusson, C., Sundler, A. J., Bremer, A., Andersson, H., Herlitz, J., . . . Andersson Hagiwara, M. (2023). Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study. Prehospital and Disaster Medicine, 38(2), 160-167
Open this publication in new window or tab >>Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study
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2023 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 38, no 2, p. 160-167Article in journal (Refereed) Published
Abstract [en]

Introduction: The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. 

Study Objective: The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. 

Methods: A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. 

Results: A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. 

Conclusions: As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.

Keywords
ambulance clinician, ambulance service, glucose, lactate, sepsis
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29443 (URN)10.1017/s1049023x23000110 (DOI)000929336400001 ()2-s2.0-85150666227 (Scopus ID)
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2024-02-01Bibliographically approved
Högstedt, Å., Thuccani, M., Carlstrom, E., Claesson, A., Bremer, A., Ravn-Fischer, A., . . . Lundgren, P. (2022). Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1)
Open this publication in new window or tab >>Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests
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2022 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, no 1Article in journal (Refereed) Published
Abstract [en]

Background: There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. Methods: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. Results: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). Conclusion: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.

Keywords
Volunteer, Lay volunteer, Lay responder, OHCA, Bystander, CPR, AED, Motivation, Self-determination theory, CARDIOPULMONARY-RESUSCITATION, TRAINED VOLUNTEERS, COMMUNITY, SURVIVAL, WORLD, RATES, LIFE
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hb:diva-27718 (URN)10.1186/s13049-022-01009-1 (DOI)000772810500001 ()2-s2.0-85127067302 (Scopus ID)
Note

Times Cited in Web of Science Core Collection: 0 Total Times Cited: 0 Cited Reference Count: 41

Available from: 2022-04-04 Created: 2022-04-04 Last updated: 2024-01-17Bibliographically approved
Olander, A., Sundler, A. J., Andersson, H., Andersson Hagiwara, M. & Bremer, A. (2022). Lived experiences of the onset of sepsis. In: The 4th International NCCS & EACS Conference April 27th – 28th 2022 at Mälardalen University, Sweden: . Paper presented at The 4th International NCCS & EACS Conference, April 27 – 28, 2022..
Open this publication in new window or tab >>Lived experiences of the onset of sepsis
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2022 (English)In: The 4th International NCCS & EACS Conference April 27th – 28th 2022 at Mälardalen University, Sweden, 2022Conference paper, Poster (with or without abstract) (Refereed)
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-29106 (URN)
Conference
The 4th International NCCS & EACS Conference, April 27 – 28, 2022.
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2023-03-30Bibliographically approved
Svensson, A., Bremer, A., Rantala, A., Andersson, H., Devenish, S., Williams, J. & Holmberg, M. (2021). Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: A Delphi study. International Journal of Older People Nursing
Open this publication in new window or tab >>Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: A Delphi study
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2021 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743Article in journal (Refereed) Published
Abstract [en]

Objective

The proportion of older people is increasing and reflects in the demand on ambulance services (AS). Patients can be more vulnerable and increasingly dependent, especially when their decision-making ability is impaired. Self-determination in older people has a positive relation to quality of life and can raise ethical conflicts in AS. Hence, the aim of this study was to empirically explore attitudes among Swedish ambulance clinicians (ACs) regarding older patients’ self-determination in cases where patients have impaired decision-making ability, and who are in urgent need of care.

Materials and methods

An explorative design was adopted. A Delphi technique was used, comprising four rounds, involving a group (N = 31) of prehospital emergency nurses (n = 14), registered nurses (n = 10) and emergency medical technicians (n = 7). Focus group conversations (Round 1) and questionnaires (Rounds 2–4) generated data. Round 1 was analysed using manifest content analysis, which ultimately resulted in the creation of discrete items. Each item was rated with a five-point Likert scale together with free-text answers. Consensus (≥70%) was calculated by trichotomising the Likert scale.

Results

Round 1 identified 108 items which were divided into four categories: (1) attitudes regarding the patient (n = 35), (2) attitudes regarding the patient relationship (n = 8), (3) attitudes regarding oneself and one's colleagues (n = 45), and (4) attitudes regarding other involved factors (n = 20). In Rounds 2–4, one item was identified in the free text from Round 2, generating a total of 109 items. After four rounds, 72 items (62%) reached consensus.

Conclusions

The findings highlight the complexity of ACs’ attitudes towards older patients’ self-determination. The respect of older patients’ self-determination is challenged by the patient, other healthcare personnel, significant others and/or colleagues. The study provided a unique opportunity to explore self-determination and shared decision-making. AS have to provide continued ethical training, for example to increase the use of simulation-based training or moral case deliberations in order to strengthen the ACs’ moral abilities within their professional practice.

Implications for practice

Ambulance services must develop opportunities to provide continued training within this topic. One option would be to increase the use of simulation-based training, focusing on ethical aspects of the care. Another option might be to facilitate moral case deliberations to strengthen the ACs’ abilities to manage these issues while being able to share experiences with peers. These types of interventions should illuminate the importance of the topic for the individual AC, which, in turn, may strengthen and develop the caring abilities within an integrated care team.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
ambulance clinicians, decision-making ability, ethics, older patients, patient autonomy, prehospital emergency nurses, self-determination
National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-26369 (URN)10.1111/opn.12423 (DOI)000694940200001 ()2-s2.0-85114687386 (Scopus ID)
Available from: 2021-09-13 Created: 2021-09-13 Last updated: 2021-10-21Bibliographically approved
Olander, A., Bremer, A., Sundler, A. J., Andersson Hagiwara, M. & Andersson, H. (2021). Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study. BMC Emergency Medicine, 21(45)
Open this publication in new window or tab >>Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study
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2021 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 21, no 45Article in journal (Refereed) Published
Abstract [en]

Background: The initial care of patients with sepsis is commonly performed by ambulance clinicians (ACs). Earlyidentification, care and treatment are vital for patients with sepsis to avoid adverse outcomes. However, knowledgeabout how patients with sepsis are assessed in ambulance services (AS) by AC is limited. Therefore, the aim of thisstudy was to explore the meaning of ACs’ lived experiences in assessing patients suspected of having sepsis.

Methods: A descriptive design with a qualitative approach was used. Fourteen ACs from three Swedish ambulanceorganizations participated in dyadic and individual semistructured interviews. A thematic analysis based ondescriptive phenomenology was performed.

Results: AC experiences were grouped into four themes: (1) being influenced by previous experience; (2) searchingfor clues to the severity of the patient’s condition; (3) feeling confident when signs and symptoms were obvious;and (4) needing health-care professionals for support and consultation.

Conclusions: This study indicates that several factors are important to assessments. ACs needed to engage in anongoing search for information, discuss the cases with colleagues and reconsider the assessment throughout theentire ambulance mission. A reflective and open stance based on professional knowledge could contribute torecognizing patients with sepsis.

National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-25290 (URN)10.1186/s12873-021-00440-4 (DOI)000638592600001 ()33836665 (PubMedID)2-s2.0-8510414228 (Scopus ID)
Available from: 2021-04-09 Created: 2021-04-09 Last updated: 2022-11-25Bibliographically approved
Falchenberg, Å., Andersson, U., Wireklint Sundström, B., Bremer, A. & Andersson, H. (2021). Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study. Nordic journal of nursing research, 0(0)
Open this publication in new window or tab >>Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study
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2021 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 0, no 0Article in journal (Refereed) Published
Abstract [en]

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

Keywords
emergency medical services, evidence-based practice, nursing assessment, practice guideline
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-25338 (URN)10.1177/20571585211006980 (DOI)2-s2.0-85132279411 (Scopus ID)
Available from: 2021-04-22 Created: 2021-04-22 Last updated: 2024-02-01
Bremer, A., Årestedt, K., Rosengren, E., Carlsson, J. & Sandboge, S. (2021). Do-not-attempt-resuscitation orders: attitudes, perceptions and practices of Swedish physicians and nurses. BMC Medical Ethics, 22(1), Article ID 34.
Open this publication in new window or tab >>Do-not-attempt-resuscitation orders: attitudes, perceptions and practices of Swedish physicians and nurses
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2021 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 22, no 1, article id 34Article in journal (Refereed) Published
Abstract [en]

Background: The values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt-resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation.

Methods: This was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional hospitals and one county hospital.

Results: 210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the discussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made.

Conclusions: Swedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions. © 2021, The Author(s).

Place, publisher, year, edition, pages
Springer Nature, 2021
Keywords
Attitudes, Autonomy, Cardiac arrest, DNAR order, Informed consent, Nurses, Physicians
National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-25892 (URN)10.1186/s12910-021-00604-8 (DOI)000635104400001 ()2-s2.0-85103573871 (Scopus ID)
Available from: 2021-07-12 Created: 2021-07-12 Last updated: 2021-10-21
Bremer, A. & Holmberg, M. (2020). Ethical conflicts in patient relationships: Experiences of ambulance nursing students. Nursing Ethics, 27(4), 946-959
Open this publication in new window or tab >>Ethical conflicts in patient relationships: Experiences of ambulance nursing students
2020 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 27, no 4, p. 946-959Article in journal (Refereed) Published
Abstract [en]

Background: Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts. Aim: To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies. Research design: An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses. Participants: The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university. Ethical consideration: The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study. Findings: The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient’s narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient’s decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient’s best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care. Discussion: Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient’s best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient’s communication and decision-making ability, the views of third parties, and the need for prioritisation. Conclusion: The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient’s best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient’s decision-making ability.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Ambulance service, clinical studies, ethical conflicts, nursing students, patient relationship, thematic analysis
National Category
Health Sciences
Identifiers
urn:nbn:se:hb:diva-24855 (URN)10.1177/0969733020911077 (DOI)000527762800001 ()2-s2.0-85083046399 (Scopus ID)
Available from: 2021-01-21 Created: 2021-01-21 Last updated: 2021-10-21Bibliographically approved
Bremer, A., Andersson Hagiwara, M., Tavares, W., Paakkonen, H., Nyström, P. & Andersson, H. (2020). Translation and further validation of a global rating scale for the assessmentof clinical competence in prehospital emergency care. Nurse Education in Practice, 47, Article ID 102841.
Open this publication in new window or tab >>Translation and further validation of a global rating scale for the assessmentof clinical competence in prehospital emergency care
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2020 (English)In: Nurse Education in Practice, Vol. 47, article id 102841Article in journal (Refereed) Published
Abstract [en]

Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions.The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contributevalidity evidence and instrument usefulness in training results and clinical competence assessments of studentsundergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The studyincluded translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturallyadapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated usingeight experts. IRR tests were performed with five registered nurses working as university lecturers, and with sixclinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment.Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI foritems and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreementin the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supportingits use in measuring clinical competence among students undergoing training to become ambulancenurses and paramedics.

Keywords
Ambulance nurses Clinical competence, Educational measurement, Global rating scale
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-23674 (URN)10.1016/j.nepr.2020.102841 (DOI)000573643200010 ()2-s2.0-85088963452 (Scopus ID)
Available from: 2020-08-07 Created: 2020-08-07 Last updated: 2022-01-20Bibliographically approved
Jonasson, L.-L., Sandman, L. & Bremer, A. (2019). Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training. Journal of Healthcare Leadership, 11(63-74)
Open this publication in new window or tab >>Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training
2019 (English)In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed) Published
Abstract [en]

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

Keywords
manager, ethical responsibility, municipal, older person, thematic analysis
National Category
Other Medical Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15232 (URN)10.2147/JHL.S199167 (DOI)000471092500001 ()2-s2.0-85070204322 (Scopus ID)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2020-01-31Bibliographically approved
Organisations
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7865-3480

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