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Ang FJL, Cheung YB, Gandhi M, Østbye T, Malhotra C, Malhotra R, Chow CCT, Chong PH, Amin Z, Tan TSZ, Tewani K, Buang SNH, Finkelstein EA. PRECIOUS demonstrated satisfactory measurement properties for assessing the quality of care for children with serious illnesses. J Clin Epidemiol 2024; 168:111286. [PMID: 38382889 DOI: 10.1016/j.jclinepi.2024.111286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To determine the measurement properties of PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS), a parent-reported measure of Quality of Care for seriously ill children across care settings and illness trajectories. STUDY DESIGN AND SETTING Parents self-administered baseline and 2-week follow-up surveys online. Exploratory Factor Analysis was used to determine PRECIOUS's factor structure and select items. Internal consistency was evaluated with Cronbach's α, test-retest reliability with intraclass correlation coefficients, and convergent validity with Spearman's correlations between PRECIOUS scales and subscales of Measure of Processes of Care and Quality of Children's Palliative Care Instrument. RESULTS Of 152 parents [108 (71%) mothers, 44 (29%) fathers] who completed the baseline survey, 123 (81%) completed follow-up. Exploratory Factor Analysis grouped PRECIOUS into five scales: collaborative and goal-concordant care (12 items), caregiver support and respectful care (15 items), access to financial and medical resources (five items), reducing caregiving stressors (nine items), and hospitalization-specific processes (four items). Root Mean Square Error of Approximation was 0.040 and Comparative Fit Index was 0.980. Cronbach's α ranged from 0.85 to 0.96. Intraclass correlation coefficients ranged from 0.72 to 0.86. Significant correlations with Measure of Processes of Care and Quality of Children's Palliative Care Instrument confirmed convergent validity. The original 56-item tool was reduced to 45 items. CONCLUSION PRECIOUS demonstrates satisfactory measurement properties for assessing Quality of Care for seriously ill children.
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Affiliation(s)
- Felicia Jia Ler Ang
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
| | - Yin Bun Cheung
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore; Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Finland
| | - Mihir Gandhi
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore; Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore; Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Finland; Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
| | - Truls Østbye
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, USA
| | - Chetna Malhotra
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Rahul Malhotra
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Cristelle Chu-Tian Chow
- Children's Complex and Home Care Services, KK Women's & Children's Hospital, Singapore, Singapore; Department of Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore
| | | | - Zubair Amin
- Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Teresa Shu Zhen Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Komal Tewani
- Women's Palliative Care Service, Perinatal Palliative Care, KK Women's & Children's Hospital, Singapore, Singapore; Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Siti Nur Hanim Buang
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore; Duke Department of Population Health Sciences, Duke University, Durham, USA
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Ang FJL, Gandhi M, Ostbye T, Malhotra C, Malhotra R, Chong PH, Amin Z, Chow CCT, Tan TSZ, Tewani K, Finkelstein EA. Development of the Parental Experience with Care for Children with Serious Illnesses (PRECIOUS) quality of care measure. BMC Palliat Care 2024; 23:66. [PMID: 38454420 PMCID: PMC10921687 DOI: 10.1186/s12904-024-01401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Parent-reported experience measures are part of pediatric Quality of Care (QoC) assessments. However, existing measures were not developed for use across multiple healthcare settings or throughout the illness trajectory of seriously ill children. Formative work involving in-depth interviews with parents of children with serious illnesses generated 66 draft items describing key QoC processes. Our present aim is to develop a comprehensive parent-reported experience measure of QoC for children with serious illnesses and evaluate its content validity and feasibility. METHODS For evaluating content validity, we conducted a three-round Delphi expert panel review with 24 multi-disciplinary experts. Next, we pre-tested the items and instructions with 12 parents via cognitive interviews to refine clarity and understandability. Finally, we pilot-tested the full measure with 30 parents using self-administered online surveys to finalize the structure and content. RESULTS The Delphi expert panel review reached consensus on 68 items. Pre-testing with parents of seriously ill children led to consolidation of some items. Pilot-testing supported feasibility of the measure, resulting in a comprehensive measure comprising 56 process assessment items, categorized under ten subthemes and four themes: (1) Professional qualities of healthcare workers, (2) Supporting parent-caregivers, (3) Collaborative and holistic care, and (4) Efficient healthcare structures and standards. We named this measure the PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS). CONCLUSIONS PRECIOUS is the first comprehensive measure and has the potential to standardize assessment of QoC for seriously ill children from parental perspectives. PRECIOUS allows for QoC process evaluation across contexts (such as geographic location or care setting), different healthcare workers, and over the illness trajectory for children suffering from a range of serious illnesses.
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Affiliation(s)
- Felicia Jia Ler Ang
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Mihir Gandhi
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Tampere Center for Child, Adolescent, and Maternal Health Research: Global Health Group, Tampere University, Tampere, Finland
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, USA
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Rahul Malhotra
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | | | - Zubair Amin
- Department of Neonatology, Khoo Tech Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cristelle Chu-Tian Chow
- Children's Complex and Home Care Services, KK Women's & Children's Hospital, Singapore, Singapore
| | - Teresa Shu Zhen Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Tech Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Komal Tewani
- Department of Gynaecological Oncology, KK Women's & Children's Hospital, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Duke Department of Population Health Sciences, Duke University, Durham, USA
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Tewani K, Singh R, Wendy CPY, Jia Huan H, Jayagobi P, Teo I. Understanding the experiences of mothers receiving perinatal palliative care: A qualitative study. Palliat Med 2023; 37:1379-1388. [PMID: 37132995 DOI: 10.1177/02692163231171182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Despite the diagnosis of life-limiting foetal conditions, some mothers choose to continue their pregnancies. The experiences of these individuals are relatively unknown, making it difficult for perinatal palliative services to be targeted towards their needs. AIM To examine maternal experiences in perinatal palliative care among those who choose to continue their pregnancies despite life-limiting foetal condition. DESIGN Qualitative, retrospective study involving semi-structured interviews. Braun & Clarke's reflexive thematic analyses using a constructionist-interpretive approach were conducted. SETTING/PARTICIPANTS A total of 15 adult women participants who decided to continue their pregnancies after learning of life-limiting foetal diagnoses were recruited from a Singaporean tertiary hospital. Interviews were conducted in-person or via video conferencing. RESULTS Seven themes were synthesized from the data: (1) Internal upheaval - 'World turns upside down'; (2) Role of religion and spirituality in hope of miracles; (3) Support from family and close friends; (4) Navigating a fragmented healthcare system; (5) Value added by the perinatal palliative service; (6) Goodbye and grieving and (7) No regrets and other personal reflections. CONCLUSIONS Continuing a pregnancy despite the diagnosis of a life-limiting foetal condition can be challenging for mothers. To better meet their needs during this difficult period, perinatal palliative care must be patient-centred, multidisciplinary and non-judgmental. Efforts must be made to streamline the healthcare delivery process.
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Affiliation(s)
- Komal Tewani
- Perinatal Palliative Care, Women's Palliative Care Service, Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ratna Singh
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
| | - Cheong Pei Yi Wendy
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
| | | | - Pooja Jayagobi
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Irene Teo
- Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Poh LW, Teo I, Tewani K, Tan HK, Yoon S, Sung SC. Understanding the needs of health care workers in Singapore during the COVID-19 outbreak: A qualitative analysis. Am J Infect Control 2022; 50:1133-1139. [PMID: 35700928 PMCID: PMC9188118 DOI: 10.1016/j.ajic.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A successful public health response during the COVID-19 pandemic pivots on the ability of health care workers (HCWs) to work through immense workplace-related physical and psychological pressures. OBJECTIVE The aim of current study was to explore support needs of HCWs during the COVID-19 outbreak in Singapore and to identify implications for practice and workplace policies. METHODS A descriptive qualitative approach was adopted in this study. HCWs from a major public health care cluster in Singapore (n = 612) responded to an open-ended question in an online survey. Results were analyzed using content analysis via an inductive approach. RESULTS Five main themes that borrows from Maslow's Hierarchy of Needs emerged from content analysis, with 17 categories under the themes. The 5 main themes are: physical needs, safety needs, love and belonging needs, esteem needs and self-actualization needs. CONCLUSIONS Findings from this study indicate that there were many unmet needs among HCWs during the COVID-19 pandemic. An overview of various need areas identified in this study may guide future research and development of interventions to mitigate the negative impact of disease outbreaks on HCWs.
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Affiliation(s)
- Li Wen Poh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Komal Tewani
- SingHealth Duke-NUS Supportive & Palliative Care Centre, Duke-NUS Medical School, Singapore; KK Gynaecological Cancer Centre, KK Women's and Children's Hospital, Singapore
| | - Hiang Khoon Tan
- Division of Surgery, Singapore General Hospital, Singapore; Division of Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Global Health Institute, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Sharon C Sung
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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Soo JEJ, Chan MY, Bte Adb Rashid NAB, Bte Mohamad Yusri LI, Wynn YY, Noda M, Tewani K. Medication chart review at end of life of paediatric palliative patients. J Paediatr Child Health 2022; 58:392-396. [PMID: 34553811 DOI: 10.1111/jpc.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/18/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to review the use of medications in a paediatric palliative care (PPC) population during the last two weeks of life. METHODS This is a retrospective observational cohort study that included 50 consecutive patients who were referred to KK Hospital PPC service from 2011 to 2015. Those who died after two weeks from discharge date were excluded. Medication charts were reviewed and relevant data were extracted. RESULTS The study population included 42 patients and consists predominantly oncological and neurological diagnoses. The median number of medications used was 11.5. Ninety-five percent (40 out of 42) of study population required analgesia where 81% (34 out of 42) were opioid. There was prevalent use of antibiotics (86% of study population, 36 out of 42). Less frequently used medications included steroids, sedatives, laxatives and antiemetics (48%, 52%, 48% and 38% of study population respectively). CONCLUSION Significant number of medications was used in PPC during the last two weeks of life. Apart from significant use of analgesia, there is also notable use of antibiotics. Future directions in education such as prescription of laxatives with opioid are proposed.
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Affiliation(s)
| | - Mei Yoke Chan
- KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Yi Yi Wynn
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Misa Noda
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Komal Tewani
- KK Women's and Children's Hospital, Singapore, Singapore
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Tewani K, Agarwal A, Wong WHM, Teo I, Tan HK, Wong WL, Ng KC. Anxiety and burnout among healthcare workers during the COVID-19 circuit breaker in a Women's and Children's Hospital in Singapore. Germs 2022; 12:137-141. [PMID: 35601938 PMCID: PMC9113681 DOI: 10.18683/germs.2022.13xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Komal Tewani
- FAMS, Department of Gynaecology Oncology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Akshita Agarwal
- MBBS, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Wei Han Melvin Wong
- BSc, Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, 168859, Singapore
| | - Irene Teo
- PhD, Department of Psychosocial Oncology, National Cancer Centre, 11 Hospital Cres Singapore, 169610, Singapore
| | - Hiang Khoon Tan
- FRCS (Ed), Division Surgery & Surgical Oncology, Singapore General Hospital and National Cancer Centre Singapore, 11 Hospital Cres, 169610, Singapore and Singhealth Duke - NUS Global Health Institute, 8 College Road, 169857, Singapore
| | - Wai Loong Wong
- MMED & FAMS, KK Gynaecological Cancer Centre, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899. Singapore
| | - Kee Chong Ng
- FAMS, Division of Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, Singapore
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Tewani K, Agarwal A, Wong WHM, Teo I, Tan HK, Wong WL, Ng KC. Anxiety and burnout among healthcare workers during the COVID-19 circuit breaker in a Women’s and Children’s Hospital in Singapore. Germs 2022. [DOI: 10.18683/germs.2022.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Teo I, Cheng GH, Tewani K. Relationship Satisfaction Mediates the Association Between Emotional Expressiveness and Depressive Symptoms Among Asian Women. Ann Acad Med Singap 2019; 48:396-402. [PMID: 32112064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Few studies in Asia have examined the association among depressive symptoms, relationship satisfaction, sexual dysfunction and emotional expressiveness. Examining the role of emotional expressiveness in the context of depression and relationships is important as it can be a point for therapeutic intervention. MATERIALS AND METHODS Guided by the Marital Discord Model of Depression and based on data from partnered women in Singapore (n = 193), we conducted a path analysis to examine the mediating role of relationship satisfaction and sexual dysfunction in the link between difficulty in emotional expression and depressive symptoms. RESULTS Controlling for age and health, lower relationship satisfaction (β = -0.213; P <0.001), higher sexual dysfunction (β = 0.139; P = 0.010) and greater difficulty in emotional expression (β = 0.908; P <0.001) were associated with increased depressive symptoms. Relationship satisfaction partially mediated the association between emotional expressiveness and depressive symptoms (indirect effect, 0.169; 95% confidence interval, 0.043‒0.379). CONCLUSION The findings suggest the importance of effective communication in mitigating relationship- and self-distress.
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Affiliation(s)
- Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Teo I, Cheung YB, Lim TYK, Namuduri RP, Long V, Tewani K. The relationship between symptom prevalence, body image, and quality of life in Asian gynecologic cancer patients. Psychooncology 2017; 27:69-74. [DOI: 10.1002/pon.4457] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/11/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Irene Teo
- Lien Centre for Palliative Care; Duke-NUS Medical School; Singapore
- Department of Psychosocial Oncology; National Cancer Centre Singapore; Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine; Duke-NUS Medical School; Singapore
- Center for Child Health Research; University of Tampere and Tampere University Hospital; Tampere Finland
| | | | | | | | - Komal Tewani
- Department of Gynaecology Oncology; KK Women's and Children's Hospital; Singapore
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Tewani K, Mulholland H, Gambles M, Lowe D, Husk J, Stewart K, Ellershaw J. THE USE OF MEDICATIONS IN THE LAST 24 HOURS OF LIFE IN THE ACUTE HOSPITAL SETTING—A DESCRIPTIVE COMPARISON OF CANCER AND NON CANCER PATIENTS USING DATA FROM THE NATIONAL CARE OF THE DYING AUDIT HOSPITALS—ENGLAND (NCDAH) 2013/14. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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