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Walløe S, Bogh SB, Birkeland SF, Pedersen LK, Lykkebo AW, Andersen LLT, Frederiksen-Møller B, Morsø L. Correction: Using complaints from obstetric care for improving women's birth experiences - a cross sectional study. BMC Pregnancy Childbirth 2024; 24:97. [PMID: 38297230 PMCID: PMC10832192 DOI: 10.1186/s12884-024-06291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Affiliation(s)
- Sisse Walløe
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark.
- The Research and Implementation Unit PROgrez, Physio- and Occupational Therapy Unit, Naestved-Slagelse- Ringsted Hospitals, Faelledvej 2c, Slagelse, 4200, Denmark.
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark.
| | - Søren Bie Bogh
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 15, 2, Odense C, 5000, Denmark
| | - Lone Kjeld Pedersen
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Gynecological Obstetric Unit D, Odense University Hospital, Kløvervaenget 5, Odense C, 5000, Denmark
| | | | | | - Britta Frederiksen-Møller
- Women's Health and Labour, Hospital of Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, 6200, Denmark
| | - Lars Morsø
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
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Walløe S, Bogh SB, Birkeland SF, Pedersen LK, Lykkebo AW, Andersen LLT, Frederiksen-Møller B, Morsø L. Using complaints from obstetric care for improving women's birth experiences - a cross sectional study. BMC Pregnancy Childbirth 2023; 23:705. [PMID: 37789282 PMCID: PMC10546670 DOI: 10.1186/s12884-023-06022-5] [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: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services. MATERIALS AND METHODS We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study. RESULTS Complaints regarding obstetric care differed from women's complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims. CONCLUSION Systematic complaint analysis acknowledged women's experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.
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Affiliation(s)
- Sisse Walløe
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark.
- The Research and Implementation Unit PROgrez, Physio- and Occupational Therapy Unit, Naestved-Slagelse- Ringsted Hospitals, Faelledvej 2c, Slagelse, 4200, Denmark.
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark.
| | - Søren Bie Bogh
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 15, 2, Odense C, 5000, Denmark
| | - Lone Kjeld Pedersen
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Gynecological Obstetric Unit D, Odense University Hospital, Kløvervaenget 5, Odense C, 5000, Denmark
| | | | | | - Britta Frederiksen-Møller
- Women's Health and Labour, Hospital of Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, 6200, Denmark
| | - Lars Morsø
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
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Bie Bogh S, Fryd Birkeland S, Maj-Britt Hansen S, Alexandrovna Tchijevitch O, Hallas J, Morsø L. Harnessing patient complaints to systematically monitoring healthcare concerns through disproportionality analysis. Int J Qual Health Care 2023; 35:mzad062. [PMID: 37556110 DOI: 10.1093/intqhc/mzad062] [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: 04/24/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
Staff observations are the most common source of data for driving improvements in care. However, the patient perspective should also be considered, and healthcare complaints offer concrete details that health organizations might otherwise overlook and that can highlight areas for learning and improvement in the healthcare system. However, because of the diverse nature of patient complaints, systematic analyses can be challenging. This study aimed to identify and prioritize areas for improvement using a data-driven approach to analysing patient complaints. The Danish version of the Healthcare Complaints Analysis Tool was used to categorize the content of complaint letters. All complaints managed by the national complaints authority, compensation claims to the Patient Compensation Association, and locally managed complaints that were filed directly at Odense University Hospital from 2017 to 2021 were included. Proportional reporting ratios (PRRs) were used to measure and display the top five signals of disproportionality and rank them by excess complaints at the hospital level and when divided into department types. The study included 6366 complaints containing 13 156 problems (on average, 2.1 problems mentioned per complaint letter). Surgical departments had the highest number of complaints (3818), followed by medical (1059), service (439), and emergency departments (239). Signal 1 of disproportionality, relating to quality problems during ward procedures, had the highest excess reporting of 1043 complaints at the hospital level and a PRR of 1.61 and was present in all department types. Signal 2, relating to safety problems during the examination and diagnosis stage, had an excess reporting of 699 problems and a PRR of 1.86 and was also present in all department types. Signal 3, relating to institutional problems during admission, had the highest PRR of 3.54 and was found in most department types. Signals 4 and 5, relating to environmental problems during ward procedures and care on the ward, respectively, had PRRs of 1.5 and 1.84 and were present in most department types. The study found that analysing patient complaints can identify potential areas for hospital improvement. The study identified recurring issues in multiple departments, including quality problems during ward procedures, safety problems during the examination, institutional problems during admission, and environmental problems on the ward. The study highlights disproportionality analysis of complaints as a valuable tool to monitor patient concerns systematically.
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Affiliation(s)
- Søren Bie Bogh
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
| | - Søren Fryd Birkeland
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
- Department of Regional Health Research, Faculty of Health Science, Forensic Mental Health Research Unit Middelfart (RFM), University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense 5000, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, Middelfart 5500, Denmark
| | - Sebrina Maj-Britt Hansen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Olga Alexandrovna Tchijevitch
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Denmark
| | - Lars Morsø
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, Odense, Syddanmark 5000, Denmark
- Odense University Hospital, Region of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Denmark
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Morsø L, Birkeland SF, Walløe S, Grøn PS, Rexbye H, Bogh SBB. Does systematic analysis of patient complaints and compensation cases at hospitals provide useful information to guide quality improvement? Experience from Denmark. BMJ Open Qual 2023; 12:bmjoq-2022-002101. [PMID: 36796865 PMCID: PMC9936271 DOI: 10.1136/bmjoq-2022-002101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Patient complaints and compensation cases are analysed individually and do not allow for organisational learning. Systematic information on complaint patterns needs evidence-based measures. The Healthcare Complaints Analysis Tool (HCAT) can systematically code and analyse complaints and compensation claims, but whether this information is useful for quality improvement is underexplored. We aim to explore if and how HCAT information is perceived useful to inform healthcare quality gaps. METHODS To explore the HCAT's usefulness for quality improvement purposes, we used an iterative process. We accessed all complaints relating to a large university hospital. Trained HCAT raters systematically coded all cases, using the Danish version of HCAT. INTERVENTION The intervention had four phases: (1) coding of cases, (2) education, (3) selection of HCAT analyses for dissemination, (4) 'dashboard' development and delivery of targeted HCAT reports. To study the interventions and phases, we used quantitative and qualitative approaches. The coding patterns were descriptively displayed on department and hospital level. The educational programme was monitored using passing rates, coding reliability checks and rater feedback. Online interviews recorded dissemination feedback. We used a phenomenological approach with thematised quotations from the interviews to analyse the usefulness of the information from cases coded. RESULTS We coded 5217 complaint cases (11 056 complaint points). The average case coding time was 8.5 min (95% CI 8.2 to 8.7). All four raters passed the online test with >80% correct answers. Using rater feedback, we handled 25 cases of doubt. None affected the HCAT structure or categories. Interviews verified the usefulness of analyses after expert group dissemination. Three themes were important: 'overview of complaints', 'learning from complaints' and 'listening to the patients'. Stakeholders perceived the 'dashboard' development as highly relevant. CONCLUSION Through the development process with several adjustments, stakeholders found the systematic approach useful for quality improvement. The hospital management evaluated the approach as promising and decided to test the approach in clinical practice.
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Affiliation(s)
- Lars Morsø
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sisse Walløe
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Helle Rexbye
- Clinical Development, Odense University Hospital, Odense, Denmark
| | - Søren Bie Bie Bogh
- OPEN Research Unit, Odense Universitetshospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Linkhorst T, Birkeland SF, Gildberg FA, Mainz J, Torp-Pedersen C, Bøggild H. Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions. Int J Law Psychiatry 2022; 85:101838. [PMID: 36208564 DOI: 10.1016/j.ijlp.2022.101838] [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] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. METHODS For coercive episodes reported to the national administrative register for the period 2011-16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. RESULTS Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. CONCLUSION The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.
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Affiliation(s)
- Thea Linkhorst
- Odense University Hospital, Region of Southern Denmark, 5000 Odense, Denmark; Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark
| | | | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark; Department of Psychiatry, Middelfart, Mental Health Services, Region of Southern Denmark, 5500 Middelfart, Denmark.
| | - Jan Mainz
- Department of Psychiatry, North Denmark Region, 9000 Aalborg, Denmark; Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, 9000 Aalborg, Denmark; Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel; DaCHE, University of Southern Denmark, 5000 Odense, Denmark.
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Cardiology, Nordsjællands Hospital, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, E, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, 9000 Aalborg, Denmark.
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Birkeland SF. Health Care Complaints and Professional Legal Responsibility - A Cross-Country Comparative Review. Eur J Health Law 2022; 30:297-321. [PMID: 37582532 DOI: 10.1163/15718093-bja10100] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/05/2022] [Indexed: 08/17/2023]
Abstract
One approach to stimulating patient safety and health care quality is through holding health care professionals legally responsible for their performance. Law and health care variation across countries, however, makes it difficult to get an overview and make comparisons of the personal legal responsibility of health care providers. This article describes health care professional liability and complaint measures in some European countries (UK, The Netherlands, Sweden and Denmark) and US. Countries all have established a public authority to assess complaints about health professional performance and opportunities for economic compensation. The assessment of health professional legal responsibility generally relies on comparisons to supposedly "objective" standards predominantly dictated by the health profession. In line with the aim of ensuring acceptable care for all, health ethics principles on justice, respect for patients' autonomy, and the duty to do good and prevent harm may provide an attractive supplement in the description of legal responsibility in the health professions.
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Affiliation(s)
- Søren Fryd Birkeland
- Department of Clinical Research, OPEN, Open Patient data Explorative Network, University of Southern Denmark 1318 J. B. Winsløws Vej 9a, 3. Floor,DK-5000 Odense C Denmark
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Abstract
OBJECTIVE The study aim was to test the intra-assessor and interassessor reliability of the Healthcare Complaints Analysis Tool (HCAT) for categorising the information in the claim letters in a sample of Danish patient compensation claims. DESIGN, SETTING AND PARTICIPANTS We used a random sample of 140 compensation cases completed by the Danish Patient Compensation Association that were filed in the field of acute medicine at Danish hospitals from 2007 to 2018. Four assessors were trained in using the HCAT manual before assessing the claim letters independently. MAIN OUTCOME MEASURES Intra-assessor and interassessor reliability was tested at domain, problem category and subcategory levels of the HCAT. We also investigated the reliability of ratings on the level of harm and of the descriptive details contained in the claim letters. RESULTS The HCAT was reliable for identifying problem categories, with reliability scores ranging from 0.55 to 0.99. Reliability was lower when coding the 'severity' of the problem. Interassessor reliability was generally lower than intra-assessor reliability. The categories of 'quality' and 'safety' were the least reliable of the seven HCAT problem categories. Reliability at the subcategory level was generally satisfactory, with only a few subcategories having poor reliability. Reliability was at least moderate when coding the stage of care, the complainant and the staff group involved. However, the coding of 'level of harm' was found to be unreliable (intrareliability 0.06; inter-reliability 0.29). CONCLUSION Overall, HCAT was found to be a reliable tool for categorising problem types in patient compensation claims.
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Affiliation(s)
| | | | | | | | - Kim Mikkelsen
- Patient Injury Prevention and Learning, Patient Insurance Association, Copenhagen, Denmark
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Birkeland SF, Gerdes LU, Tomsen DV, Andersen HB, Plessen CV. [Medication reconciliation]. Ugeskr Laeger 2018; 180:V12170918. [PMID: 30037387] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of medicines reconciliation (MR) is to avoid medication errors through the complete and accurate transfer of information on patients' medicines during health care sector transitions. We review the rapidly expanding literature on MR showing a need for consensus on taxonomy and research into efficient ways to implement MR. Further, we describe quality improvement initiatives on MR in Denmark and challenge the, in our view, one-sided focus on information technology in MR.
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Abstract
By means of a case vignette, this study explores the clinical intersection between paranoid personality disorder and other schizophrenia-spectrum illness. Even though the patient described had paramount signs of a paranoid personality disorder and was diagnosed as such, psychopathological symptoms extended considerably beyond the common concept and diagnostic criteria of the disorder. Management strategies included psychopharmacological and non-pharmacological interventions, yet psychosocial functioning permanently appeared defective. While there is a persistent need for an opportunity to distinguish the characteristic syndromal pattern of paranoid personality attributes, the case exemplifies the challenges associated with classifying some largely suspicious and distrustful eccentrics within the schizophrenia spectrum.
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Affiliation(s)
- Søren Fryd Birkeland
- Department of Psychiatry, Svendborg Hospital, Vaengevej 22, DK-5772, Kvaerndrup, Denmark
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Birkeland SF, Jarbøl DE. Danish medical doctor reprimanded for treatment of a four week-old child following reporting from the National Board of Health. Eur J Health Law 2013; 20:97-105. [PMID: 23544323 DOI: 10.1163/15718093-12341256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- S F Birkeland
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
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Fryd Birkeland S. Paranoid Personality Disorder and Sociodemography: a 25-year Study of First Admissions to a Danish General Psychiatric Hospital. Nordic Psychology 2012. [DOI: 10.1027/1901-2276/a000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Birkeland SF. [The concept of insanity and the sanitary authority's complaints commission]. Ugeskr Laeger 2005; 167:147-8. [PMID: 15697122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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