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Fredrikson, Mats
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Publications (10 of 107) Show all publications
Larsen, R., Bäckström, D., Fredrikson, M., Steinvall, I., Rolf, G. & Sjöberg, F. (2019). Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), Article ID 24.
Open this publication in new window or tab >>Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study
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2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and riskadjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

Methods: All hospital admissions for injury in Sweden during the period 2001–2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0–14, 15–50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women.

Results: Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0–14 years OR 0.56 (95% CI 0.25 to 1.25), 15–50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)).

Conclusion: In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Risk-adjusted mortality; ICISS; Trauma; injury; Nationwide; Epidemiological
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-155087 (URN)10.1186/s13049-019-0597-3 (DOI)000461309000001 ()30871611 (PubMedID)
Note

Funding agencies: Linkoping University, Linkoping, Sweden; Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns

Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-04-17Bibliographically approved
Nordwall, M., Fredrikson, M., Ludvigsson, J. & Arnqvist, H. (2019). Impact of Age of Onset, Puberty, and Glycemic Control Followed From Diagnosis on Incidence of Retinopathy in Type 1 Diabetes: The VISS Study. Diabetes Care, 42(4), 609-616
Open this publication in new window or tab >>Impact of Age of Onset, Puberty, and Glycemic Control Followed From Diagnosis on Incidence of Retinopathy in Type 1 Diabetes: The VISS Study
2019 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 4, p. 609-616Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate sex, age at diabetes onset, puberty, and HbA1c, with subjects followed from diabetes diagnosis and during different time periods, as risk factors for developing diabetic simplex and proliferative retinopathy.

RESEARCH DESIGN AND METHODS In a population-based observational study, HbA1c for 451 patients diagnosed with diabetes before 35 years of age during 1983–1987 in southeast Sweden was followed for up to 18–24 years from diagnosis. Long-term mean weighted HbA1c(wHbA1c) was calculated. Retinopathy was evaluated by fundus photography and analyzed in relation to wHbA1c levels.

RESULTS Lower wHbA1c, diabetes onset ≤5 years of age, and diabetes onset before puberty, but not sex, were associated with longer time to appearance of simplex retinopathy. Proliferative retinopathy was associated only with wHbA1c. The time to first appearance of any retinopathy decreased with increasing wHbA1c. Lower wHbA1c after ≤5 years’ diabetes duration was associated with later onset of simplex retinopathy but not proliferative retinopathy. With time, most patients developed simplex retinopathy, except for those of the category wHbA1c≤50 mmol/mol (6.7%), for which 20 of 36 patients were without any retinopathy at the end of the follow-up in contrast to none of 49 with wHbA1c >80 mmol/mol (9.5%).

CONCLUSIONS Onset at ≤5 years of age and lower wHbA1c the first 5 years after diagnosis are associated with longer duration before development of simplex retinopathy. There is a strong positive association between long-term mean HbA1c measured from diagnosis and up to 20 years and appearance of both simplex and proliferative retinopathy.

Place, publisher, year, edition, pages
Arlington, VA, United States: American Diabetes Association, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-155907 (URN)10.2337/dc18-1950 (DOI)000461816500027 ()30705061 (PubMedID)2-s2.0-85063626496 (Scopus ID)
Note

Funding Agencies|Barndiabetesfonden (the Swedish Child Diabetes Foundation); Forskningsradet i Sydostra Sverige (FORSS) (the Research Council of Southeast Sweden)

Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-17Bibliographically approved
de Geer, L., Oscarsson Tibblin, A., Fredrikson, M. & Walther, S. M. (2019). No association with cardiac death after sepsis: A nationwide observational cohort study. Acta Anaesthesiologica Scandinavica, 63(3), 344-351
Open this publication in new window or tab >>No association with cardiac death after sepsis: A nationwide observational cohort study
2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 3, p. 344-351Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences and implications for patients remain unclear. The aim of this study was to investigate cardiac outcome in sepsis by assessing causes of death up to 2 years after treatment in an Intensive Care Unit (ICU) in a nationwide register-based cohort collected from the Swedish Intensive Care Registry.

METHODS: A cohort of 13 669 sepsis and septic shock ICU patients from 2008 to 2014 was collected together with a non-septic control group, matched regarding age, sex and severity of illness (n = 6582), and all without preceding severe cardiac disease. For a large proportion of the severe sepsis and septic shock patients (n = 7087), no matches were found. Information on causes of death up to 2 years after ICU admission was sought in the Swedish National Board of Health and Welfare's Cause of Death Registry.

RESULTS: Intensive Care Unit mortality was nearly identical in a matched comparison of sepsis patients to controls (24% in both groups) but higher in more severely ill sepsis patients for whom no matches were found (33% vs 24%, P < 0.001). There was no association of sepsis to cardiac deaths in the first month (OR 1.03, 95%CI 0.87 to 1.20, P = 0.76) nor up to 2 years after ICU admission (OR 1.01, 95%CI 0.82 to 1.25, P = 0.94) in an adjusted between-group comparison.

CONCLUSIONS: There was no association with an increased risk of death related to cardiac disease in patients with severe sepsis or septic shock when compared to other ICU patients with similar severity of illness.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154455 (URN)10.1111/aas.13280 (DOI)000458335800009 ()30318583 (PubMedID)2-s2.0-85054923116 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-03-04Bibliographically approved
Abdelrahman, I., Steinvall, I., Fredrikson, M., Sjöberg, F. & Elmasry, M. (2019). Use of the burn intervention score to calculate the charges of the care of burns. Burns, 45(2), 303-309
Open this publication in new window or tab >>Use of the burn intervention score to calculate the charges of the care of burns
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 303-309Article in journal (Refereed) Published
Abstract [en]

Background To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. Methods All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. Results Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. Conclusion Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Burns;Charges;Intervention score;Costs;Payments
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-153636 (URN)10.1016/j.burns.2018.12.007 (DOI)000461044900004 ()
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2019-04-01
Pompermaier, L., Elmasry, M., Abdelrahman, I., Fredrikson, M., Sjöberg, F. & Steinvall, I. (2018). Are there any differences in the provided burn care between men and women? A retrospective study. Burns & Trauma, 6, Article ID 22.
Open this publication in new window or tab >>Are there any differences in the provided burn care between men and women? A retrospective study
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2018 (English)In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed) Published
Abstract [en]

Background

Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.

Methods

All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.

Results

A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).

Conclusion

We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Burn care; Intervention score; Sex; Trauma model; Workload
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150365 (URN)10.1186/s41038-018-0125-0 (DOI)000442159400001 ()30123802 (PubMedID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-04-18Bibliographically approved
Larsson Viksten, J., Engerström, L., Steinvall, I., Samuelsson, A., Fredrikson, M., Walther, S. & Sjöberg, F. (2018). Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.. Acta Paediatrica
Open this publication in new window or tab >>Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates.
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: This study described the basic characteristics of children aged 0-16 years who were treated in intensive care units (ICUs) and paediatric ICUs (PICUs), compared their outcomes and examined any causes of death.

METHODS: This was a retrospective cohort study of admissions to 74 ICUs and three PICUs in Sweden that were recorded in the Swedish Intensive Care Registry from January 1, 2008 to December 31, 2012.

RESULTS: We retrieved data on 12 756 children who were admitted 17 003 times. The case mix differed between the ICUs, which were mainly admissions for injuries, accidents and observation, and PICUs, which were mainly admissions for malformations, genetic abnormalities and respiratory problems (p < 0.001). The median stays in the ICUs and PICUs were 1.4 and 3.5 days (p < 0.001), respectively. The respective crude mortality rates were 1.1% and 2.0, and the Paediatric Index of Mortality version 2 standardised mortality ratios were 0.43 and 0.50. None of these differences were significant. Most deaths were within 24 hours: About 57% in the ICUs, mainly from brain anomalies, and 13% in the PICUs, mainly from circulatory problems.

CONCLUSION: Sweden had a low mortality rate in both ICUs and PICUs and the children admitted to these two types of unit differed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
Child mortality, Demographics, Intensive care unit, Length of stay, Paediatric intensive care unit
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154075 (URN)10.1111/apa.14708 (DOI)30582755 (PubMedID)
Funder
Region Östergötland
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-03-03
Bäckström, D., Larsen, R., Steinvall, I., Fredrikson, M., Gedeborg, R. & Sjöberg, F. (2018). Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing. European Journal of Trauma and Emergency Surgery, 44(4), 589-596
Open this publication in new window or tab >>Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing
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2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 589-596Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999-2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

METHOD: CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999-2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

RESULTS: The incidence of prehospital death decreased significantly (coefficient -0.22, r (2) = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r (2) = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18-64 years) decreased significantly (coefficient -0.40, r (2) = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient -0.34, r (2) = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r (2) = 0.84; p < 0.001) and poisoning (coefficient 0.13, r (2) = 0.69; p < 0.001).

CONCLUSION: The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Elderly, Injury, Mortality, Prehospital, Trauma, Working age
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-142763 (URN)10.1007/s00068-017-0827-1 (DOI)000440981100014 ()28825159 (PubMedID)2-s2.0-85027836250 (Scopus ID)
Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2019-02-11Bibliographically approved
Larsen, R., Bäckström, D., Fredrikson, M., Steinvall, I., Gedeborg, R. & Sjöberg, F. (2018). Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 24.
Open this publication in new window or tab >>Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients.less thanbr /greater thanMethods: All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS).less thanbr /greater thanResults: Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient - 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p less than 0.0001, coefficient - 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period.less thanbr /greater thanDiscussion: Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care.less thanbr /greater thanConclusions: The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.

National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-146965 (URN)10.1186/s13049-018-0485-2 (DOI)000429285700002 ()29615089 (PubMedID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2019-02-11
Abdelrahman, I., Elmasry, M., Fredrikson, M. & Steinvall, I. (2018). Validation of the burn intervention score in a National Burn Centre. Burns (5), 1159-1166
Open this publication in new window or tab >>Validation of the burn intervention score in a National Burn Centre
2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, no 5, p. 1159-1166Article in journal (Refereed) Published
Abstract [en]

The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).

We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.

We retrieved 22 301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p < 0.001) and daily (model R2 0.61, p < 0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p < 0.001).

To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Burn intervention score; Validation; Workload
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145311 (URN)10.1016/j.burns.2018.02.001 (DOI)000436791900014 ()29475745 (PubMedID)2-s2.0-85042192631 (Scopus ID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-07-23Bibliographically approved
Abdelrahman, I., Elmasry, M., Olofsson, P., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2017). Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.. PLoS ONE, 12(3), Article ID e0174579.
Open this publication in new window or tab >>Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, article id e0174579Article in journal (Refereed) Published
Abstract [en]

Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.less thanbr /greater thanResults: Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, pless than0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (pless than0.001, R2 0.51).less thanbr /greater thanConclusion: Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

Place, publisher, year, edition, pages
Public Library of Science, 2017
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136275 (URN)10.1371/journal.pone.0174579 (DOI)000399175000022 ()
Note

Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2017-11-29
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