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Orton, M.-L., Andersson, Å., Wallin, L., Forsman, H. & Eldh, A. C. (2019). Nursing management matters for registered nurses with a PhD working in clinical practice. Journal of Nursing Management, 27(5), 955-962
Open this publication in new window or tab >>Nursing management matters for registered nurses with a PhD working in clinical practice
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2019 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 27, no 5, p. 955-962Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate what registered nurses (RNs) with a PhD working in clinical practice experience in terms of their role, function and work context.

BACKGROUND: Previous studies have shown that RNs with a graduate degree contribute to better and safer care for patients. However, little is known about what further academic schooling of RNs, at PhD level, means for clinical practice.

METHOD: Qualitative design, with semi-structured interviews and inductive content analysis.

RESULTS: The main areas of responsibilities for RNs with a PhD working in clinical practice were related to practice development and implementation of research results. In their work, they experienced barriers to the full use of their competence; the expectations and prerequisites of the organization were not clearly defined, and they often lacked a mandate to create conditions for quality improvement of nursing care.

CONCLUSIONS: RNs with a PhD can contribute to evidence-based practice (EBP), clinical training as well as the development of clinical research. Their roles and responsibilities need to be clarified and for this, they need support from managers.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should partner with RNs with a PhD to support the EBP process and help structure nursing practice in more efficient ways. 

Keywords
clinical practice, content analysis, doctoral degree, nursing care, qualitative
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29316 (URN)10.1111/jonm.12750 (DOI)30656787 (PubMedID)2-s2.0-85066033400 (Scopus ID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-08-23Bibliographically approved
Hälleberg Nyman, M., Forsman, H., Wallin, L., Ostaszkiewicz, J., Hommel, A. & Eldh, A. C. (2019). Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context. Journal of Evaluation In Clinical Practice, 25(2), 282-289
Open this publication in new window or tab >>Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context
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2019 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 2, p. 282-289Article in journal (Refereed) Published
Abstract [en]

RATIONALE, AIMS, AND OBJECTIVES:

The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

METHODS:

A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

RESULTS:

Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

CONCLUSION:

To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

Keywords
evidence-based practice; implementation; incontinence; older people; orthopaedics; research utilization
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26873 (URN)10.1111/jep.12879 (DOI)000461883800015 ()29411463 (PubMedID)2-s2.0-85063088977 (Scopus ID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2019-04-04Bibliographically approved
Seers, K., Rycroft-Malone, J., Cox, K., Crichton, N., Edwards, R. T., Eldh, A. C., . . . Wallin, L. (2018). Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation Science, 13(1), Article ID 137.
Open this publication in new window or tab >>Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework
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2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, no 1, article id 137Article in journal (Refereed) Published
Abstract [en]

Background

Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice.

Methods

A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention.

Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering.

Results

Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time.

Conclusions

This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.

Trial registration

Current Controlled Trials ISRCTN11598502. Date 4/2/10.

The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646.

Keywords
Facilitation, Implementation, PARIHS, Urinary incontinence, Context, Older people, RCT
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29011 (URN)10.1186/s13012-018-0831-9 (DOI)000450649900001 ()30442174 (PubMedID)2-s2.0-85056628999 (Scopus ID)
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2019-01-02Bibliographically approved
Eldh, A. C., Olai, L., Jönsson, B., Wallin, L., Denti, L. & Elf, M. (2018). Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study. Nordic journal of nursing research (2), 87-95
Open this publication in new window or tab >>Supporting first-line managers in implementing oral care guidelines in nursing homes – a pilot study
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, no 2, p. 87-95Article in journal (Refereed) Published
Abstract [en]

This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.

Keywords
context, frail older people, knowledge implementation, leadership, nursing home, oral care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26788 (URN)10.1177/2057158517713379 (DOI)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-06-08Bibliographically approved
Fredriksson, M., Halford, C., Eldh, A. C., Dahlström, T., Vengberg, S., Wallin, L. & Winblad, U. (2017). Are data from national quality registries used in quality improvement at Swedish hospital clinics?. International Journal for Quality in Health Care, 29(7), 909-915
Open this publication in new window or tab >>Are data from national quality registries used in quality improvement at Swedish hospital clinics?
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2017 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 29, no 7, p. 909-915Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden.

Design: Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level).

Setting and Participants: Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR).

Main Outcome Measure(s): Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation.

Results: Riksstroke data were reported as most extensively used at individual and unit levels (x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs (x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks (x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x̅ 10.32). In Riksstroke, the managers requested registry data more often (x̅ 15.17 of 20).

Conclusions: While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.

Keywords
audit < external quality assessment, cancers < disease categories, cardiovascular diseases < disease categories, care pathways/disease management < appropriate healthcare, endocrine disorders, hospital care < setting of care, incl. diabetes < disease categories, practice variations < appropriate healthcare, quality improvement < quality management
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26480 (URN)10.1093/intqhc/mzx132 (DOI)29077930 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-01-11Bibliographically approved
Eldh, A. C., Almost, J., DeCorby-Watson, K., Gifford, W., Harvey, G., Hasson, H., . . . Yost, J. (2017). Clinical interventions, implementation interventions, and the potential greyness in between - a discussion paper. BMC Health Services Research, 17(1), Article ID 16.
Open this publication in new window or tab >>Clinical interventions, implementation interventions, and the potential greyness in between - a discussion paper
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2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 16Article in journal (Refereed) Published
Abstract [en]

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between 'intervention' and 'implementation', yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is 'intervention' and what is 'implementation' in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.

Keywords
Concept; Implementation; Implementation Science; Intervention; Knowledge Translation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23767 (URN)10.1186/s12913-016-1958-5 (DOI)000391923400001 ()28061856 (PubMedID)
Available from: 2016-12-27 Created: 2016-12-27 Last updated: 2017-11-29Bibliographically approved
Eriksson, L., Bergström, A., Hoa, D. T., Nga, N. T. & Eldh, A. C. (2017). Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health. PLoS ONE, 12(8), Article ID e0182626.
Open this publication in new window or tab >>Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182626Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial.

METHODS: In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis.

RESULTS: To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital-prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking.

CONCLUSIONS: The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25778 (URN)10.1371/journal.pone.0182626 (DOI)000407548800028 ()28806744 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2017-11-29Bibliographically approved
Hälleberg Nyman, M., Forsman, H., Ostaszkiewicz, J., Hommel, A. & Eldh, A. C. (2017). Urinary incontinence and its management in patients aged 65 and older in orthopaedic care: what nursing and rehabilitation staff know and do. Journal of Clinical Nursing, 26(21-22), 3345-3353
Open this publication in new window or tab >>Urinary incontinence and its management in patients aged 65 and older in orthopaedic care: what nursing and rehabilitation staff know and do
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 21-22, p. 3345-3353Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES:

To describe what nursing and rehabilitation staff know and do with regards to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.

BACKGROUND:

Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent UI, there are indications that these guidelines are not applied in hospital care.

DESIGN:

A qualitative study with descriptive design was conducted in two orthopaedic units.

METHODS:

46 interviews and 36 observations of care were conducted from January to October 2014 and analysed with qualitative content analysis.

RESULTS:

Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.

CONCLUSIONS:

Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing UI.

RELEVANCE TO CLINICAL PRACTICE:

An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

Keywords
Evidence-based practice; hip surgery; knowledge implementation; older people; orthopaedic care; urinary incontinence
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23610 (URN)10.1111/jocn.13686 (DOI)000417389400010 ()27982485 (PubMedID)
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2017-12-29Bibliographically approved
van der Zijpp, T., Niessen, T., Eldh, A. C., Hawkes, C., McMullan, C., Mockford, C., . . . Seers, K. (2016). A bridge over turbulent waters: Illustrating the interaction between managerial leaders and facilitators when implementing research evidence. Worldviews on Evidence-Based Nursing, 13(1), 25-31
Open this publication in new window or tab >>A bridge over turbulent waters: Illustrating the interaction between managerial leaders and facilitators when implementing research evidence
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2016 (English)In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 1, p. 25-31Article in journal (Refereed) Published
Abstract [en]

Background: Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process.

Aims: To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people.

Methods: Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs.

Results: This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings.

Linking evidence to action: Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.

Keywords
evidence-based practice; long-term care; nursing practice; qualitative methodology; qualitative research; research methods; research utilisation; theory; work environment; working conditions
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-20560 (URN)10.1111/wvn.12138 (DOI)000370483100004 ()26788694 (PubMedID)
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2017-12-01Bibliographically approved
Tistad, M., Palmcrantz, S., Wallin, L., Ehrenberg, A., Olsson, C. B., Tomson, G., . . . Eldh, A. C. (2016). Developing leadership in managers to facilitate the implementation of national guideline recommendations: a process evaluation of feasibility and usefulness. International Journal of Health Policy and Management, 5(8), 477-486
Open this publication in new window or tab >>Developing leadership in managers to facilitate the implementation of national guideline recommendations: a process evaluation of feasibility and usefulness
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2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 8, p. 477-486Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22695 (URN)10.15171/ijhpm.2016.35 (DOI)27694661 (PubMedID)
Projects
PLIS - Primära Ledare Implementerar Strokeevidens
Funder
Vårdal Foundation
Available from: 2016-08-13 Created: 2016-08-13 Last updated: 2017-11-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7737-169X

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