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  • 1.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Nygren, Mikaela
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Security.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    A new zero vision for Swedish patient safety - but how do we know that health care is becoming safer?2012Conference paper (Refereed)
  • 2.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Nygren, Mikaela
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Health and Developmental Care, Patient Security.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Patientsäkerhet svårt att uppnå, svårt att värdera: Landstingens patientsäkerhetsberättelser granskas och diskuteras2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 20-21, p. 1028-1031Article in journal (Refereed)
    Abstract [sv]

    Ansträngningarna för ökad patientsäkerhet i Sverige intensifierades 2011 i och med den nya patientsäkerhetslagen och den satsning som regeringen och SKL gjorde på prestationsbaserad ersättning till landstingen.

    Förväntningarna på ökad patientsäkerhet i Sverige är stora, men frågan är hur vi kan veta att vården blir säkrare.

    Med avstamp i ett ramverk – en vidareutveckling av Donabedians triad – och genom tillägg av en kontextuell komponent och komplettering med en lärandedimension belyses svårigheterna och möjligheterna vid utvärdering av patientsäkerhet.

    Ramverkets olika komponenter diskuteras med hänvisning till vad som redovisas i de patientsäkerhetsberättelser som landstingen har sammanställt för att beskriva sitt arbete med patientsäkerhet.

  • 3.
    Nygren, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Determinants of Patient Safety - Perceptions of Swedish Patient Safety Experts2012Conference paper (Other academic)
  • 4.
    Nygren, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Facilitators and barriers influencing patient safety in Swedish hospitals: a qualitative study of nurses' perceptions2014In: BMC nursing, ISSN 1472-6955, Vol. 13, no 23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sweden has undertaken many national, regional, and local initiatives to improve patient safety since the mid-2000s, but solid evidence of effectiveness for many solutions is often lacking. Nurses play a vital role in patient safety, constituting 71% of the workforce in Swedish health care. This interview study aimed to explore perceived facilitators and barriers influencing patient safety among nurses involved in the direct provision of care. Considering the importance of nurses with regard to patient safety, this knowledge could facilitate the development and implementation of better solutions.

    METHODS: A qualitative study with semi-structured individual interviews was carried out. The study population consisted of 12 registered nurses at general hospitals in Sweden. Data were analyzed using qualitative content analysis.

    RESULTS: The nurses identified 22 factors that influenced patient safety within seven categories: 'patient factors', 'individual staff factors', 'team factors', 'task and technology factors', 'work environment factors', 'organizational and management factors', and 'institutional context factors'. Twelve of the 22 factors functioned as both facilitators and barriers, six factors were perceived only as barriers, and four only as facilitators. There were no specific patterns showing that barriers or facilitators were more common in any category.

    CONCLUSION: A broad range of factors are important for patient safety according to registered nurses working in general hospitals in Sweden. The nurses identified facilitators and barriers to improved patient safety at multiple system levels, indicating that complex multifaceted initiatives are required to address patient safety issues. This study encourages further research to achieve a more explicit understanding of the problems and solutions to patient safety.

  • 5.
    Nygren, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rutberg, Hans
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed)
    Abstract [en]

    Background

    National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

    Methods

    The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

    Results

    The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

    Conclusion

    Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

  • 6.
    Ridelberg, Mikaela
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Towards safer care in Sweden?: Studies of influences on patient safety2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patient safety has progressed in 15 years from being a relatively insignificant issue to a position high on the agenda for health care providers, managers and policymakers as well as the general public. Sweden has seen increased national, regional and local patient safety efforts since 2011 when a new patient safety law was introduced and a four-year financial incentive plan was launched to encourage county councils to carry out specified measures and meet certain patient safety related criteria. However, little is known about what structures and processes contribute to improved patient safety outcomes and how the context influences the results.

    The overall aim of this thesis was to generate knowledge for improved understanding and explanation of influences on patient safety in the county councils in Sweden. To address this issue, five studies were con-ducted: interviews with nurses and infection control practitioners, surveys to patient safety officers and a document analysis of patient safety reports. Patient safety officers are healthcare professionals who hold key positions in their county council’s patient safety work. The findings from the studies were structured through a framework based on Donabedian’s triad (with a contextual element added) and applying a learning perspective, highlight areas that are potentially important to improve the patient safety in Swe-dish county councils.

    Study I showed that the conditions for the county councils’ patient safety work could be improved. Conducting root-cause analysis and attaining an organizational culture that encourages reporting and avoids blame were perceived to be of importance for improving patient safety. Study II showed that nurses perceived facilitators and barriers for improved pa-tient safety at several system levels. Study III revealed many different types of obstacles to effective surveillance of health care-associated infec-tions (HAIs), the majority belonging to the early stages of the surveillance process. Many of the obstacles described by the infection control practi-tioners restricted the use of results in efforts to reduce HAIs. Study IV of the Patient Safety Reports identified 14 different structure elements of patient safety work, 31 process elements and 23 outcome elements. These reports were perceived by patient safety officers to be useful for providing a structure for patient safety work in the county councils, for enhancing the focus on patient safety issues and for learning from the patient safety work that is undertaken. In Study V the patient safety officers rated efforts to reduce the use of antibiotics and improved communication be-tween health care practitioners and patients as most important for attaining current and future levels of patient safety in their county council. The patient safety officers also perceived that the most successful county councils regarding patient safety have good leadership support, a long-term commitment and a functional work organisation for patient safety work.

    Taken together, the five studies of this thesis demonstrate that patient safety is a multifaceted problem that requires multifaceted solutions. The findings point to an insufficient transition of assembled data and information into action and learning for improved patient safety.

  • 7.
    Ridelberg, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Landstingens och regionernas patientsäkerhetsberättelser: Systematisk sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige för åren 2010, 2011 och 20122014Report (Other academic)
    Abstract [sv]

    Sverige fick en ny patientsäkerhetslag 2011 (PSL 2010:659) i syfte att göra vården säkrare. Bland annat ställer lagen krav på att vårdgivare sammanställer en Patientsäkerhetsberättelse (PSB) årligen. Förra året gjordes en första granskning av de PSB som skrevs för år 2010 samt 2011. Uppdraget var att beskriva och jämföra innehållet från landstingens och regionernas PSB för verksamhetsåren 2010 och 2011 utifrån perspektiven struktur, process och resultat. För detta ändamål utarbetades en utvärderingsmodell som använ des i arbetet.

    Denna rapport bygger på den tidigare utarbetad e och testad e modell en och avser att ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård med utgångspunkt i de PSB som vårdgivarna har sammanställt för år 2012 samt att göra en jämförelse med innehållet i tidigare PSB. Analysen har gjorts med kvantitativ innehållsanalys.

    Granskningen visar att 2012 års PSB har högre täckningsgrad av variabler i jämförelse med 2010 och 2011. Resultatet visar att många variabler har tagits med i redovisningen men att det ibland inte är tydligt beskrivet vad som har gjorts eller vilka strukturer redovisningen faktiskt syftar på. Det är även tydligt att landstingen har haft vägledning av de grundläggande och prestationsbaserade krav som SKL haft uppställda för 2012 år s patientsäkerhetsarbete utifrån överenskommelsen med regeringen, vilket även framkom i 2011 års PSB.

    Av sammanlagt 5 2 undersökta patientsäkerhetsvariabler inom struktur (n=18 ), process (n=25) och resultat (n=9) som beskrivs fullständigt eller delvis i PSB år 2012, har olika landsting/regioner redovisat olika många möjliga variabler, med ett högsta värde av 44 av 52 och lägsta 28 av 5 2.

    Konceptet PSB är unikt internationellt sett och ger en god bild av hur man arbetar med patientsäkerhetsfrågor i landstingen/regionerna, men det finns också en utvecklingspotential. Vi bedömer att PSB i dagsläget inte riktigt håller måttet för att utöva myndighetstillsyn då det fortfarande kan vara svårt att få en tydlig bild av vad som faktiskt görs inom olika landsting/regioner. PSB har blivit mer informativa 2012 än tidigare år men saknar enhetlighet vad gäller rapporterade variabler och rapporterade resultatmått. Ytterligare utveckling av SKL:s mall skulle kunna underlätta landstingens arbete med att sammanställa PSB och förbättra förutsättningarna för jämförelser mellan landsting/regioner och över tid

  • 8.
    Ridelberg, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Using surveillance data to reduce healthcare–associated infection: a qualitative study in Sweden2015In: Journal of Infection Prevention, ISSN 1757-1774, Vol. 16, no 5, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Introduction: Healthcare-associated infection (HAI) surveillance data can be used to estimate the scope, spread and location of infections, monitor trends, evaluate preventive efforts, and improve practices, policy and facility planning. In Sweden, national point prevalence surveys (PPS) have been conducted twice yearly in all county councils since 2008.

    Aim: The aim of this study was to identify key obstacles concerning the HAI surveillance process.

    Methods: Twenty-two infection control practitioners (ICPs) from all county councils in Sweden were interviewed, using semi-structured interview guides. Data were analysed using qualitative content analysis.

    Results: Sixteen types of obstacles pertaining to four surveillance stages were identified. Most obstacles were associated with the first two stages, which meant that the latter stages of this process, i.e. the use of the results to reduce HAI, were underdeveloped. The ICPs observed scepticism towards both the PPS methodology itself and the quality of the HAI data collected in the PPS, which hinders HAI surveillance realising its full potential in Swedish healthcare.

  • 9.
    Ridelberg, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 98, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background

    There is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.

    Methods

    The study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.

    Results

    A total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.

    Conclusion

    Patient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils’ patient safety work, the PSRs are perceived as useful at various system levels.

  • 10.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nygren, Mikaela
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rutberg, Hans
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Strategier för säker och ännu säkrare vård: Enkätstudie om landstingens patientsäkerhetsarbete2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 45, p. 2024-2027Article in journal (Refereed)
    Abstract [sv]

    I en enkät till 216 personer med särskilt ansvar för patientsäkerhet har frågor ställts om vad som har haft betydelse och vad som kommer att ha betydelse för att uppnå en god patientsäkerhet i framtiden.

    Händelse- och riskanalyser ansågs ha varit mycket viktigt för att uppnå dagens patientsäkerhetsnivå, liksom rapportering av avvikelser och risker.

    Faktorer som ansågs mycket viktiga för att öka patientsäkerheten var främst organisationskultur, kommunikation och utbildning.

    Även förbättrad infektionskontroll och standardisering av rutiner samt bättre instruktioner och utbildning avseende medicinsk teknik var viktiga områden.

     

  • 11.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Ridelberg, Mikaela
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fyra år med patientsäkerhetsberättelsen: sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige 2010-20132015Report (Other academic)
    Abstract [sv]

    Sverige fick en ny patientsäkerhetslag 2011 i syfte att göra vården säkrare. I denna ingår att alla vårdgivare årligen ska ställ a samman en patientsäkerhetsberättelse (PSB) med början för verksamhetsåret 2010. PSB har nu skrivits för fjärde året i rad.

    Syftet med denna rapport är att utifrån innehållet i landstingens/regionernas PSB ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård, under de fyra år som PSB har sammanställts. Granskning en är dels en granskning av innehållet i 2013 års PS B men också en sammanfattning av utvecklingen av patientsäkerhetsarbetet under verksamhetsåren 2010 till 2013, så som det beskrivs i PSB:erna. Innehållet har analyserats utifrån perspektiven struktur, process och resultat och jämförelser har gjorts över tid och mellan olika landsting/regioner. Liknande granskningar har tidigare gjorts vid två tillfällen och analyserna bygger på en tidigare utarbetad och testad modell i de tidigare granskningarna av landstingens/ regionernas PSB.

    En tydlig utveckling har skett över åren, både vad gäller beskrivningarna av patientsäkerhetsarbetet och vilka områden och resultat man vill lyfta fram. Granskningen visar att landstingen/regionerna har haft vägledning av de grundläggande och prestations - baserade krav som funnits för patientsäkerhetsarbetet i den överenskommelse som träffats mellan staten och SKL. Man har också följt SKL:s mall för att skriva PSB. Detta har dock inte lett till någon större samstämmighet i vad som verkligen rapporteras utan har mer varit en likriktning av rapporternas struktur. M ånga variabler som tagits med i redovisningen beskrivs dessutom i ganska vaga ordalag. Överlag har standarden dock ökat och många PSB är innehållsrika och ger en bra översikt över hur patientsäkerhetsarbetet bedrivs och vad som återstår att göra.

    Jämfört med tidigare år har PSB 2013 fokuserat mer på resultat och egenkontroll. Tidigare berätta de man att man mäter och registrerar olika saker. Nu ange r man också resultat från de olika mätningarna i en högre grad. Vidare har ledningens roll för att höja säkerheten börjat uppmärksamma, även om många också påpekar att ansvaret för att bedriva en säker vård i slutändan ligger hos enskilda medarbetare.

    Av sammanlagt 6 2 undersökta patientsäkerhetsvariabler som ingått i den landstingsvis a jämförelsen 2013 har täckningsgraden i snitt varit 6 7 %. Motsvarande, sett över hela tidsspannet 2010 - 2013 , är 63 %. Landsting en/regionerna har redovisat olika stor andel av de undersökta variablerna, med en högsta andel p å 75 % för Östergötland, räknat som ett genomsnitt över de fyra åren. Skillnaderna mellan landstingen/regionerna är dock inte stora och drygt hälften (11 st.) har ett resultat över 65 %.

    Ett fåtal mer blygsamma resultat har uppmätts där en slentrianmässig rapportering förekommer och där den relevant a information en är sparsam. Detta kan tyda på att man inte ha r integrerat PSB:n som ett instrument i patientsäkerhetsarbetet, utan har andra medel för att skapa struktur och översikt över arbetet. D e allra flesta har dock sammanställt informativa och välstrukturerade rapporter. Mot bakgrund av den utveckling som skett av PSB:n , under en relativt kort tid, kan man förmoda att den kommer att fortsätta utvecklas i en pågående dynamisk process i många landsting/regioner och med tiden få en allt viktigare roll i arbetet för att åstadkomma en säkrare vård.

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