Base de dados : MEDLINE
Pesquisa : E01.789.600 [Categoria DeCS]
Referências encontradas : 2623 [refinar]
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[PMID]:28958363
[Au] Autor:Brooks SE; Peetz AB
[Ad] Endereço:Geriatric Trauma Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA; Pediatric Intensive Care Unit, Division of Trauma, Surgical Critical Care, Acute Care Surgery, Department of Surgery, John A. Griswold Trauma Center, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA. Electronic address: Steven.Brooks@ttuhsc.edu.
[Ti] Título:Evidence-Based Care of Geriatric Trauma Patients.
[So] Source:Surg Clin North Am;97(5):1157-1174, 2017 Oct.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The doubling of the geriatric population over the next 20 years will challenge the existing health care system. Optimal care of geriatric trauma patients will be of paramount importance to the health care discussion in America. These patients warrant special consideration because of altered anatomy, physiology, and the resultant decreased ability to tolerate the stresses imposed by traumatic insult. Despite increased risk for worsened outcomes, nearly half of all geriatric trauma patients will be cared for at nondesignated trauma centers. Effective communication is crucial in determining goals of care and arriving at what patients would consider a meaningful outcome.
[Mh] Termos MeSH primário: Ética Médica
Geriatria/métodos
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso/fisiologia
Prática Clínica Baseada em Evidências
Idoso Fragilizado
Avaliação Geriátrica
Seres Humanos
Futilidade Médica/ética
Traumatologia/ética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170930
[St] Status:MEDLINE


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[PMID]:28822393
[Au] Autor:Broman KK; Phillips SE; Ehrenfeld JM; Patel MB; Guillamondegui OM; Sharp KW; Pierce RA; Poulose BK; Holzman MD
[Ti] Título:Identifying Futile Interfacility Surgical Transfers.
[So] Source:Am Surg;83(8):866-870, 2017 Aug 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Surgeons perceive that some surgical transfers are futile, but the incidence and risk factors of futile transfer are not quantified. Identifying futile interfacility transfers could save cost and undue burdens to patients and families. We sought to describe the incidence and factors associated with futile transfers. We conducted a retrospective cohort study from 2009 to 2013 including patients transferred to a tertiary referral center for general or vascular surgical care. Futile transfers were defined as resulting in death or hospice discharge within 72 hours of transfer without operative, endoscopic, or radiologic intervention. One per cent of patient transfers were futile (27/1696). Characteristics of futile transfers included older age, higher comorbidity burden and illness severity, vascular surgery admission, Medicare insurance, and surgeon documentation of end-stage disease as a factor in initial decision-making. Among futile transfers, 82 per cent were designated as do not resuscitate (vs 9% of nonfutile, P < 0.01), and 59 per cent received a palliative care consult (vs 7%, P < 0.01). A small but salient proportion of transferred patients undergo deliberate care de-escalation and early death or hospice discharge without intervention. Efforts to identify such patients before transfer through improved communication between referring and accepting surgeons may mitigate burdens of transfer and facilitate more comfortable deaths in patients' local communities.
[Mh] Termos MeSH primário: Futilidade Médica
Transferência de Pacientes/estatística & dados numéricos
Procedimentos Cirúrgicos Operatórios
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170821
[St] Status:MEDLINE


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[PMID]:28792832
[Au] Autor:Griffith R
[Ad] Endereço:Senior Lecturer in Health Law at Swansea University.
[Ti] Título:The role of the courts in disagreements over the care of seriously ill babies.
[So] Source:Br J Nurs;26(15):894-895, 2017 Aug 10.
[Is] ISSN:0966-0461
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Richard Griffith, Senior Lecturer in Health Law at Swansea University, reviews how the courts assist in settling disputes over the care of seriously ill babies and describes the test used to inform decisions about their treatment.
[Mh] Termos MeSH primário: Criança Hospitalizada
Cuidados para Prolongar a Vida/legislação & jurisprudência
Futilidade Médica/legislação & jurisprudência
Assistência Terminal/legislação & jurisprudência
Terapias em Estudo
[Mh] Termos MeSH secundário: Seres Humanos
Lactente
Recém-Nascido
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170810
[St] Status:MEDLINE
[do] DOI:10.12968/bjon.2017.26.15.894


  4 / 2623 MEDLINE  
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[PMID]:28754353
[Au] Autor:Simon JR; Kraus C; Rosenberg M; Wang DH; Clayborne EP; Derse AR
[Ad] Endereço:Department of Medicine, Columbia University, New York, NY. Electronic address: JS1115@columbia.edu.
[Ti] Título:"Futile Care"-An Emergency Medicine Approach: Ethical and Legal Considerations.
[So] Source:Ann Emerg Med;70(5):707-713, 2017 Nov.
[Is] ISSN:1097-6760
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Futility often serves as a proposed reason for withholding or withdrawing medical treatment, even in the face of patient and family requests. Although there is substantial literature describing the meaning and use of futility, little of it is specific to emergency medicine. Furthermore, the literature does not provide a widely accepted definition of futility, and thus is difficult if not impossible to apply. Some argue that even a clear concept of futility would be inappropriate to use. This article will review the origins of and meanings suggested for futility, specific challenges such cases create in the emergency department (ED), and the relevant legal background. It will then propose an approach to cases of perceived futility that is applicable in the ED and does not rely on unilateral decisions to withhold treatment, but rather on avoiding and resolving the conflicts that lead to physicians' believing that patients are asking them to provide "futile" care.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica/ética
Medicina de Emergência/ética
Medicina de Emergência/legislação & jurisprudência
Ética Médica
Futilidade Médica/ética
Futilidade Médica/legislação & jurisprudência
[Mh] Termos MeSH secundário: Idoso
Serviço Hospitalar de Emergência/ética
Serviço Hospitalar de Emergência/legislação & jurisprudência
Feminino
Seres Humanos
Masculino
Meia-Idade
Médicos
Guias de Prática Clínica como Assunto/normas
Assistência Terminal/ética
Assistência Terminal/legislação & jurisprudência
Suspensão de Tratamento/ética
Suspensão de Tratamento/legislação & jurisprudência
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE


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[PMID]:28645428
[Au] Autor:van de Vrie R; van Meurs HS; Rutten MJ; Naaktgeboren CA; Opmeer BC; Gaarenstroom KN; van Gorp T; Ter Brugge HG; Hofhuis W; Schreuder HWR; Arts HJG; Zusterzeel PLM; Pijnenborg JMA; van Haaften M; Engelen MJA; Boss EA; Vos MC; Gerestein KG; Schutter EMJ; Kenter GG; Bossuyt PMM; Mol BW; Buist MR
[Ad] Endereço:Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
[Ti] Título:Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer.
[So] Source:Gynecol Oncol;146(3):449-456, 2017 Sep.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. METHODS: An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. RESULTS: We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. CONCLUSION: In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos de Citorredução/economia
Custos de Cuidados de Saúde
Laparoscopia/economia
Neoplasias Ovarianas/diagnóstico
Neoplasias Ovarianas/cirurgia
[Mh] Termos MeSH secundário: Quimioterapia Adjuvante/economia
Análise Custo-Benefício
Técnicas de Diagnóstico por Cirurgia/economia
Feminino
Seres Humanos
Futilidade Médica
Meia-Idade
Terapia Neoadjuvante/economia
Estadiamento de Neoplasias
Neoplasias Ovarianas/tratamento farmacológico
Neoplasias Ovarianas/patologia
Qualidade de Vida
Anos de Vida Ajustados por Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170625
[St] Status:MEDLINE


  6 / 2623 MEDLINE  
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[PMID]:28606979
[Au] Autor:Kyriakopoulos P; Fedyk M; Shamy M
[Ad] Endereço:Department of Medicine, University of Ottawa, Ottawa, Ont.
[Ti] Título:Translating futility.
[So] Source:CMAJ;189(23):E805-E806, 2017 06 12.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Futilidade Médica
[Mh] Termos MeSH secundário: Canadá
Tomada de Decisão Clínica
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.161354


  7 / 2623 MEDLINE  
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[PMID]:28541177
[Au] Autor:Dzeng E
[Ti] Título:When Teachable Moments Become Ethically Problematic.
[So] Source:Camb Q Healthc Ethics;26(3):491-494, 2017 Jul.
[Is] ISSN:1469-2147
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is frequently tension in medical education between teaching moments that provide skills and knowledge for medical trainees, and instrumentalizing patients for the purpose of teaching. In this commentary, I question the ethical acceptability of the practice of providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to dying patients who would be unlikely to survive resuscitation, as a teaching opportunity for medical trainees. This practice violates the principle of informed consent, as the patient agreed to resuscitation for the purpose of potentially prolonging life rather than to futile resuscitation as a teaching opportunity. Justifying futile resuscitation in order to practice normalizes deceptive and nonconsensual teaching cases in medical training. Condoning these behaviors as ethically acceptable trains physicians to believe that core ethical principles are relative and fluid to suit one's purpose. I argue that these practices are antithetical to the principles espoused by both medical ethics and physician professionalism.
[Mh] Termos MeSH primário: Suporte Vital Cardíaco Avançado/ética
Reanimação Cardiopulmonar/ética
Educação Médica/ética
Consentimento Livre e Esclarecido/ética
Futilidade Médica/ética
[Mh] Termos MeSH secundário: Suporte Vital Cardíaco Avançado/educação
Reanimação Cardiopulmonar/educação
Currículo
Ética Médica
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1017/S096318011600116X


  8 / 2623 MEDLINE  
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[PMID]:28473205
[Au] Autor:Essel KG; Bruegl A; Gershenson DM; Ramondetta LM; Naumann RW; Brown J
[Ad] Endereço:The University of Texas, Houston Health Sciences Center, Houston, TX, USA.
[Ti] Título:Salvage chemotherapy for gestational trophoblastic neoplasia: Utility or futility?
[So] Source:Gynecol Oncol;146(1):74-80, 2017 Jul.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN). METHODS: We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method. RESULTS: Of 68 identified patients, 38 required >2 chemotherapy regimens. Patients were treated for GTN (n=53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n=5); and for intermediate trophoblastic tumor (ITT) (n=10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0months, and median OS was not reached at median follow-up of 71.2months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8months, and median OS of 38.8months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1months, and median OS of 38.2months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD. CONCLUSIONS: Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Doença Trofoblástica Gestacional/tratamento farmacológico
Futilidade Médica
Terapia de Salvação/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Ciclofosfamida/administração & dosagem
Dactinomicina/administração & dosagem
Intervalo Livre de Doença
Etoposídeo/administração & dosagem
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Metotrexato/administração & dosagem
Meia-Idade
Gravidez
Estudos Retrospectivos
Fatores de Risco
Terapia de Salvação/utilização
Vincristina/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
1CC1JFE158 (Dactinomycin); 5J49Q6B70F (Vincristine); 6PLQ3CP4P3 (Etoposide); 8N3DW7272P (Cyclophosphamide); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE


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[PMID]:28473036
[Au] Autor:DeMartino ES; Wordingham SE; Stulak JM; Boilson BA; Fuechtmann KR; Singh N; Sulmasy DP; Pajaro OE; Mueller PS
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
[Ti] Título:Ethical Analysis of Withdrawing Total Artificial Heart Support.
[So] Source:Mayo Clin Proc;92(5):719-725, 2017 May.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. RESULTS: Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. CONCLUSION: It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support.
[Mh] Termos MeSH primário: Coração Artificial/ética
Cuidados para Prolongar a Vida/ética
Insuficiência de Múltiplos Órgãos/mortalidade
Suspensão de Tratamento/ética
[Mh] Termos MeSH secundário: Adulto
Diretivas Antecipadas/ética
Diretivas Antecipadas/estatística & dados numéricos
Idoso
Causas de Morte
Tomada de Decisões/ética
Análise Ética
Feminino
Coração Artificial/efeitos adversos
Coração Artificial/estatística & dados numéricos
Seres Humanos
Masculino
Futilidade Médica/ética
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos
Procurador
Estudos Retrospectivos
Análise de Sobrevida
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE


  10 / 2623 MEDLINE  
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[PMID]:28357824
[Au] Autor:Cooper PD; Smart DR
[Ad] Endereço:Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, GPO Box 1061L, Hobart, Tasmania 7001, Australia, david.cooper@dhhs.tas.gov.au.
[Ti] Título:Identifying and acting on inappropriate metadata: a critique of the Grattan Institute Report on questionable care in Australian hospitals.
[So] Source:Diving Hyperb Med;47(1):44-54, 2017 Mar.
[Is] ISSN:1833-3516
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: In an era of ever-increasing medical costs, the identification and prohibition of ineffective medical therapies is of considerable economic interest to healthcare funding bodies. Likewise, the avoidance of interventions with an unduly elevated clinical risk/benefit ratio would be similarly advantageous for patients. Regrettably, the identification of such therapies has proven problematic. A recent paper from the Grattan Institute in Australia (identifying five hospital procedures as having the potential for disinvestment on these grounds) serves as a timely illustration of the difficulties inherent in non-clinicians attempting to accurately recognize such interventions using non-clinical, indirect or poorly validated datasets. AIM: To evaluate the Grattan Institute report and associated publications, and determine the validity of their assertions regarding hyperbaric oxygen treatment (HBOT) utilisation in Australia. METHODS: Critical analysis of the HBOT metadata included in the Grattan Institute study was undertaken and compared against other publicly available Australian Government and independent data sources. The consistency, accuracy and reproducibility of data definitions and terminology across the various publications were appraised and the authors' methodology was reviewed. Reference sources were examined for relevance and temporal eligibility. RESULTS: Review of the Grattan publications demonstrated multiple problems, including (but not limited to): confusing patient-treatments with total patient numbers; incorrect identification of 'appropriate' vs. 'inappropriate' indications for HBOT; reliance upon a compromised primary dataset; lack of appropriate clinical input, muddled methodology and use of inapplicable references. These errors resulted in a more than seventy-fold over-estimation of the number of patients potentially treated inappropriately with HBOT in Australia that year. CONCLUSION: Numerous methodological flaws and factual errors have been identified in this Grattan Institute study. Its conclusions are not valid and a formal retraction is required.
[Mh] Termos MeSH primário: Acurácia dos Dados
Oxigenação Hiperbárica/normas
Futilidade Médica
Metadados/normas
[Mh] Termos MeSH secundário: Austrália
Bibliometria
Competência Clínica
Interpretação Estatística de Dados
Bases de Dados Factuais
Oxigenação Hiperbárica/classificação
Oxigenação Hiperbárica/economia
Oxigenação Hiperbárica/utilização
Admissão do Paciente/estatística & dados numéricos
Reprodutibilidade dos Testes
Tasmânia
Terminologia como Assunto
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170502
[Lr] Data última revisão:
170502
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170331
[St] Status:MEDLINE



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