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Wallin, Lars
Publications (10 of 35) Show all publications
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies, 90, 21-30
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

DESIGN: The study employed a qualitative descriptive approach.

SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Keywords
Evidence-based practice, Facilitation, Facilitators, Implementation, Knowledge translation, Leadership, Managers
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29100 (URN)10.1016/j.ijnurstu.2018.09.017 (DOI)30551080 (PubMedID)2-s2.0-85058064165 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-01-30Bibliographically approved
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
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 1365-2834Article in journal (Refereed) Epub ahead of print
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)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-01-21Bibliographically approved
Lind, S., Wallin, L., Furst, C. J. & Beck, I. (2019). The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings. Palliative & Supportive Care
Open this publication in new window or tab >>The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings
2019 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523Article in journal (Refereed) Epub ahead of print
Abstract [en]

ObjectiveImplementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings.MethodData were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed.ResultA total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS.Significance of resultsWe found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

Keywords
Acute care settings, Implementation, Integrated palliative care, Mixed-method, Outcome scale, Palliative care
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29748 (URN)10.1017/S1478951518001104 (DOI)2-s2.0-85062676075 (Scopus ID)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-03-25Bibliographically approved
Wikström, E., Dellenborg, L., Wallin, L., Gillespie, B. M. & Erichsen Andersson, A. (2019). The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action. American Journal of Infection Control, 47(3), 251-257
Open this publication in new window or tab >>The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action
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2019 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 47, no 3, p. 251-257Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques.

METHODS: This study was set in a large operating room suite in a Swedish university hospital. The theory-driven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis.

RESULTS: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process.

CONCLUSIONS: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

Keywords
Aseptic technique, Co-creation, Complex intervention, Contextual restructuring, Hand hygiene, Implementation process
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28915 (URN)10.1016/j.ajic.2018.08.024 (DOI)000459766900005 ()30449454 (PubMedID)2-s2.0-85056694740 (Scopus ID)
Available from: 2018-11-23 Created: 2018-11-23 Last updated: 2019-03-14Bibliographically approved
Rycroft-Malone, J., Seers, K., Eldh, A. C., Cox, K., Crichton, N., Harvey, G., . . . Wallin, L. (2018). A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. Implementation Science, 13(1), Article ID 138.
Open this publication in new window or tab >>A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar
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2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, no 1, article id 138Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice.

METHODS: This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing.

RESULTS: The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators' (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes.

CONCLUSION: The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature.

TRIAL REGISTRATION: Current controlled trials ISRCTN11598502 .

Keywords
Context, Facilitation, Implementation, Older people, PARIHS, Realist process evaluation, Urinary incontinence
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28905 (URN)10.1186/s13012-018-0811-0 (DOI)000450649900002 ()30442165 (PubMedID)2-s2.0-85056669640 (Scopus ID)
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-12-06Bibliographically approved
Erlandsson, K., Doraiswamy, S., Wallin, L. & Bogren, M. (2018). Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: a process evaluation of a mentorship programme. Nurse Education in Practice, 29, 212-218
Open this publication in new window or tab >>Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: a process evaluation of a mentorship programme
2018 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 29, p. 212-218Article in journal (Refereed) Published
Abstract [en]

When a midwifery diploma-level programme was introduced in 2010 in Bangladesh, only a few nursing faculty staff members had received midwifery diploma-level. The consequences were an inconsistency in interpretation and implementation of the midwifery curriculum in the midwifery programme. To ensure that midwifery faculty staff members were adequately prepared to deliver the national midwifery curriculum, a mentorship programme was developed. The aim of this study was to examine feasibility and adherence to a mentorship programme among 19 midwifery faculty staff members who were lecturing the three years midwifery diploma-level programme at ten institutes/colleges in Bangladesh. The mentorship programme was evaluated using a process evaluation framework: (implementation, context, mechanisms of impact and outcomes). An online and face-to-face blended mentorship programme delivered by Swedish midwifery faculty staff members was found to be feasible, and it motivated the faculty staff members in Bangladesh both to deliver the national midwifery diploma curriculum as well as to carry out supportive supervision for midwifery students in clinical placement. First, the Swedish midwifery faculty staff members visited Bangladesh and provided a two-days on-site visit prior to the initiation of the online part of the mentorship programme. The second on-site visit was five-days long and took place at the end of the programme, that being six to eight months from the first visit. Building on the faculty staff members' response to feasibility and adherence to the mentorship programme, the findings indicate opportunities for future scale-up to all institutes/collages providing midwifery education in Bangladesh. It has been proposed that a blended online and face-to-face mentorship programme may be a means to improving national midwifery programmes in countries where midwifery has only recently been introduced.

Keywords
Capacity building, Mentorship, Midwifery faculty staff members, Process evaluation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27269 (URN)10.1016/j.nepr.2018.02.006 (DOI)000429755000033 ()29448231 (PubMedID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-06-08Bibliographically approved
Björkelund, C., Svenningsson, I., Hange, D., Udo, C., Petersson, E.-L., Ariai, N., . . . Westman, J. (2018). Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial.. BMC Family Practice, 19(1), Article ID 28.
Open this publication in new window or tab >>Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial.
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2018 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, no 1, article id 28Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.

METHODS: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU).

OUTCOME MEASURES: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle.

RESULTS: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [- 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group.

CONCLUSIONS: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.

TRIAL REGISTRATION: Identifier: NCT02378272 . February 2, 2015. Retrospectively registered.

Keywords
Care manager, Collaborative care, Depression, Primary care, Quality-of- life, Sick-leave
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27207 (URN)10.1186/s12875-018-0711-z (DOI)000425172300001 ()29426288 (PubMedID)
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-03-01Bibliographically approved
Holst, A., Ginter, A., Björkelund, C., Hange, D., Petersson, E.-L., Svenningsson, I., . . . Svensson, M. (2018). Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study. BMJ Open, 8(11), Article ID e024741.
Open this publication in new window or tab >>Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 11, article id e024741Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.

DESIGN: Cost-effectiveness analysis.

SETTING: 23 PCCs in two Swedish regions.

PARTICIPANTS: Patients with depression (n=342).

MAIN OUTCOME MEASURES: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.

RESULTS: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.

DISCUSSION: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.

TRIAL REGISTRATION NUMBER: NCT02378272; Results.

Keywords
care manager, collaborative care, depression, health economic analysis, intervention, primary care
National Category
Health Sciences
Research subject
Health and Welfare, Care Manager - Vårdsamordnare som spindeln i nätet för patienter med depression i primärvården
Identifiers
urn:nbn:se:du-29216 (URN)10.1136/bmjopen-2018-024741 (DOI)30420353 (PubMedID)
Available from: 2018-12-28 Created: 2018-12-28 Last updated: 2018-12-28Bibliographically 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
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2018). From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries. In: : . Paper presented at Evidence Live Symposium, Oxford UK.
Open this publication in new window or tab >>From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29207 (URN)
Conference
Evidence Live Symposium, Oxford UK
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
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