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[PMID]:28598918
[Au] Autor:Prielipp RC; Weinkauf JL; Esser TM; Thomas BJ; Warner MA
[Ad] Endereço:From the *University of Minnesota Medical School, Minneapolis, Minnesota; †Preferred Physicians Medical, Overland Park, Kansas; and ‡Mayo Clinic, Rochester, Minnesota.
[Ti] Título:Falls From the O.R. or Procedure Table.
[So] Source:Anesth Analg;125(3):846-851, 2017 Sep.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Patient safety secured by constant vigilance remains a primary responsibility of every anesthesia professional. Although significant attention has been focused on patient falls occurring before and after surgery, a potentially catastrophic complication is when patients fall off an operating room or procedure table during anesthesia care. Because such events are (fortunately) uncommon, and because very little information is published in our literature, we queried 2 independent closed claims databases (the American Society of Anesthesiologists Closed Claims Project and the secure records of a private, anesthesia specialty-specific liability insurer) for information. We acquired documentation of patient events where a fall occurred during anesthesia care, noting the surrounding conditions of the provider, the patient, and the environment at the time of the event. We identified 21 claims (1.2% of cases) from the American Society of Anesthesiologists Closed Claims Project, while information from a private liability insurer identified falls in only 0.07% of cases. The percentage of these patients under general, regional, or monitored anesthesia care anesthesia was 71.5%, 19.5%, and 9.5%, respectively. To educate personnel about these uncommon events, we summarized this cohort with illustrative examples in a series of mini-case reports, noting that both inpatients and outpatients undergoing a broad array of procedures with various anesthetic techniques within and outside operating rooms may be vulnerable to patient falls. Based on detailed reports, we created 2 supplementary videos to further illuminate some of the unique mechanisms by which these events and their resulting injuries occur. When such information was available, we also noted the associated liability costs of defending and settling malpractice claims associated with these events. Our goal is to inform anesthesia and perioperative personnel about the common patient, provider, and environmental risk factors that appear to contribute to these mishaps, and suggest key strategies to mitigate the risks.
[Mh] Termos MeSH primário: Acidentes por Quedas
Anestesia/efeitos adversos
Salas Cirúrgicas/normas
Mesas Cirúrgicas/normas
Segurança do Paciente/normas
Papel do Médico
[Mh] Termos MeSH secundário: Acidentes por Quedas/prevenção & controle
Adulto
Idoso
Bases de Dados Factuais
Evolução Fatal
Feminino
Seres Humanos
Responsabilidade Legal
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170610
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002125


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[PMID]:28087159
[Au] Autor:Molenaers B; Driesen R; Molenaers G; Corten K
[Ad] Endereço:Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium; Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
[Ti] Título:The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table.
[So] Source:J Arthroplasty;32(5):1553-1559, 2017 May.
[Is] ISSN:1532-8406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures. METHODS: We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17). RESULTS: The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97). CONCLUSION: Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation.
[Mh] Termos MeSH primário: Acetábulo/cirurgia
Artroplastia de Quadril/efeitos adversos
Artroplastia de Quadril/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Fêmur/cirurgia
Seguimentos
Luxação do Quadril/etiologia
Luxação do Quadril/prevenção & controle
Seres Humanos
Instabilidade Articular/etiologia
Instabilidade Articular/prevenção & controle
Masculino
Meia-Idade
Mesas Cirúrgicas
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170427
[Lr] Data última revisão:
170427
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170115
[St] Status:MEDLINE


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[PMID]:27555132
[Au] Autor:McAllister RK; Booth RT; Bittenbinder TM
[Ad] Endereço:Department of Anesthesiology, Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, TX, USA. Electronic address: rmcallister@sw.org.
[Ti] Título:Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.
[So] Source:J Clin Anesth;33:47-50, 2016 Sep.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure.
[Mh] Termos MeSH primário: Obesidade Mórbida/cirurgia
Mesas Cirúrgicas
[Mh] Termos MeSH secundário: Acidentes por Quedas
Adulto
Falha de Equipamento
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170227
[Lr] Data última revisão:
170227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160825
[St] Status:MEDLINE


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[PMID]:27290944
[Au] Autor:Aust H; Koehler S; Kuehnert M; Wiesmann T
[Ad] Endereço:Department of Anaesthesiology and Intensive Care, Philipps-University of Marburg UKGM StO. Marburg, Baldingerstrasse D-35033 Marburg, Germany. Electronic address: aust@staff.uni-marburg.de.
[Ti] Título:Guideline-recommended 15° left lateral table tilt during cesarean section in regional anesthesia-practical aspects: An observational study.
[So] Source:J Clin Anesth;32:47-53, 2016 Aug.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Left lateral table tilt of 15° to 30° is recommended for cesarean section, although little is known about the practical problems of its implementation. This study examines these issues from the perspective of anesthesiologists, obstetricians, theater nurses, and patients. Initially, the tilt was set by visual estimation in 100 women and checked by inclinometer afterwards. STUDY DESIGN: Observational survey. PATIENTS: One hundred women undergoing primary cesarean section. INTERVENTION: The anesthesiologist's initial estimated tilt setting was documented, then patient comfort and obstetrician's needs were assessed at 15°, and the tilt was adjusted accordingly. Problems were identified, and possible solutions were introduced. The effects of our solutions were reevaluated after 12months. RESULTS: Despite appropriate training, too little tilt was achieved in most cases. Even with objective inclinometry, complaints by patients, obstetricians, and theater nurses made physicians reluctant to press for 15° tilt. Better compliance was achieved by the introduction of a 2-step tilt procedure, side bar mounting, and inclinometry. After 12months, 96% of anesthesiologists were using the inclinometer to set at least 10°. Most observed an improvement in patient care. CONCLUSION: Implementation of 10° to 15° tilt requires objective inclinometry. It allows tilt adjustment to be made by interdisciplinary staff in greater confidence that patient comfort and surgical conditions will not be impaired. Strategies to reduce discomfort are presented in this article.
[Mh] Termos MeSH primário: Anestesia por Condução
Anestesia Obstétrica
Cesárea
Mesas Cirúrgicas
Posicionamento do Paciente/métodos
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Feminino
Seres Humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170303
[Lr] Data última revisão:
170303
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160614
[St] Status:MEDLINE


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[PMID]:27236322
[Au] Autor:Morelli L; Palmeri M; Guadagni S; Di Franco G; Moglia A; Ferrari V; Cariello C; Buccianti P; Simoncini T; Zirafa C; Melfi F; Di Candio G; Mosca F
[Ad] Endereço:General Surgery Unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Via Paradisa 2, Pisa, 56124, Italy. luca.morelli@unipi.it.
[Ti] Título:Use of a new integrated table motion for the da Vinci Xi in colorectal surgery.
[So] Source:Int J Colorectal Dis;31(9):1671-3, 2016 Sep.
[Is] ISSN:1432-1262
[Cp] País de publicação:Germany
[La] Idioma:eng
[Mh] Termos MeSH primário: Cirurgia Colorretal
Mesas Cirúrgicas
Robótica
[Mh] Termos MeSH secundário: Seres Humanos
Duração da Cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170403
[Lr] Data última revisão:
170403
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160530
[St] Status:MEDLINE
[do] DOI:10.1007/s00384-016-2609-3


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[PMID]:27129907
[Au] Autor:Sahin E; Songür M; Kalem M; Zehir S; Aksekili MA; Keser S; Bayar A
[Ad] Endereço:Bülent Ecevit University, Faculty of Medicine, Department of Orthopedics& Traumatology, Zonguldak, Turkey. Electronic address: dr_erc_sah@yahoo.com.tr.
[Ti] Título:Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial.
[So] Source:Injury;47(7):1547-54, 2016 Jul.
[Is] ISSN:1879-0267
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. DESIGN: Prospective, randomized, two-center trial. MATERIALS AND METHODS: 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. RESULTS: No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0±1.6min in MT group, 29.0±2.4min in TT group) (p<0.05). In terms of total anaesthesia time (Preparation+surgery) approximately 6min of difference was observed in favor of MT group (72.8±14.0min for MT and 78.6±6.5min for TT, [p<0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p<0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. CONCLUSIONS: Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. LEVEL OF EVIDENCE: Level II.
[Mh] Termos MeSH primário: Fixação Intramedular de Fraturas
Fraturas do Quadril/cirurgia
Mesas Cirúrgicas
Complicações Pós-Operatórias/cirurgia
Tração/instrumentação
[Mh] Termos MeSH secundário: Idoso
Feminino
Seguimentos
Fixação Intramedular de Fraturas/instrumentação
Fixação Intramedular de Fraturas/métodos
Fraturas do Quadril/epidemiologia
Seres Humanos
Masculino
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Estudos Prospectivos
Decúbito Dorsal
Tração/métodos
Resultado do Tratamento
Turquia/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160501
[St] Status:MEDLINE


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[PMID]:26948383
[Au] Autor:Rodríguez-Hornillo M; de la Riva MC; Ojeda R
[Ad] Endereço:Servicio de Aseguramiento y Riesgos, Responsabilidad Patrimonial, Servicio Andaluz de Salud, Sevilla, España. Electronic address: manuel.rodriguez.hornillo.sspa@juntadeandalucia.es.
[Ti] Título:Brachial neuritis or Parsonage-Turner syndrome: A problem of liability. A presentation of 3 cases.
[Ti] Título:Neuritis braquial o síndrome de Parsonage-Turner: un problema de responsabilidad. A propósito de 3 casos..
[So] Source:Rev Esp Anestesiol Reanim;63(7):427-30, 2016 Aug-Sep.
[Is] ISSN:2340-3284
[Cp] País de publicação:Spain
[La] Idioma:eng; spa
[Ab] Resumo:Neuralgic amyotrophy, brachial neuritis or Parsonage-Turner syndrome is a rare neuromuscular involvement of unknown aetiology. When it onsets in connection with a health care act, such as childbirth or surgery, a malpractice argument is often used as a cause of adverse outcome, usually due to an incorrect position of the patient on the operating table, a circumstance which directly involves the anesthesia area. Three cases are presented of Parsonage-Turner syndrome following very different surgery, with different results as regards prognosis. A review and discussion of bibliography is presented on the possibility that such circumstances are the subject of malpractice claims. Special emphasis is placed on the most currently accepted aetiopathogenic theories, and the relationship of this syndrome with the surgical act as a determining medico-legal aspect. Valuation parameters are proposed.
[Mh] Termos MeSH primário: Neurite do Plexo Braquial
[Mh] Termos MeSH secundário: Seres Humanos
Imperícia
Mesas Cirúrgicas
Prognóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160308
[St] Status:MEDLINE


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[PMID]:26844853
[Au] Autor:Quint U; Benen T
[Ad] Endereço:Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm.
[Ti] Título:[Possible Instrument Contamination in the Operating Room During Implantation of Knee and Hip Arthroplasty].
[Ti] Título:Mögliche Instrumentenkontamination im Operationssaal während der Implantation von Hüft- und Kniegelenkendoprothesen..
[So] Source:Z Orthop Unfall;154(2):157-62, 2016 Apr.
[Is] ISSN:1864-6743
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Integrated ventilation systems with low turbulence displacement flow (TAV) are generally legally required in the architectural structure of operating theatres. However, it seems that the instruments laid out on sterile covered tables do not have the best possible protection from bacteria. Within an operating theatre, different bacteria counts are possible on the instruments. This prospective controlled study was conducted to demonstrate the influence of instrument tables with integrated horizontal flow on contamination with pathogens in comparison with conventional tables. In an operating theatre (OT) with a ceiling legally appropriate for TAV (2.40 m × 1.20 m), microbiological samples were placed on a table with integrated TAV flow (n = 100) and on a conventional instrument table (n = 100). The routine qualification of the OT was on an ongoing basis and was in accordance with DIN 1946-4: 1999 standards (in accordance with DIN measurement of recovery time 1946-4: 12-2008). This corresponds to the OT of the room class Ib. The results show significant differences between the two tables. The bacteria count and the percentage of contamination were many times higher on the conventional table. It is important to understand that the instruments are not completely protected against contamination after opening the pack and during the operation. Remedial measures are possible to optimise the sterility the instrument table.
[Mh] Termos MeSH primário: Microbiologia do Ar
Contaminação de Equipamentos/prevenção & controle
Prótese Articular/microbiologia
Mesas Cirúrgicas/microbiologia
Instrumentos Cirúrgicos/microbiologia
Ventilação/instrumentação
[Mh] Termos MeSH secundário: Desenho de Equipamento
Análise de Falha de Equipamento
Alemanha
Prótese de Quadril/microbiologia
Prótese do Joelho/microbiologia
Salas Cirúrgicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170111
[Lr] Data última revisão:
170111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160205
[St] Status:MEDLINE
[do] DOI:10.1055/s-0035-1568194


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[PMID]:26726099
[Au] Autor:Niane MM; Kinkpé CV; Daffé M; Sarr L; Gueye AB; Sané AD; Séye SI
[Ad] Endereço:Faculty of medicine, université de Thiès, Thiès ex 10(e) Raoim, Thiès, Senegal. Electronic address: mniane@yahoo.fr.
[Ti] Título:Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.
[So] Source:Orthop Traumatol Surg Res;102(1):81-5, 2016 Feb.
[Is] ISSN:1877-0568
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. HYPOTHESES: Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? MATERIAL AND METHODS: This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. RESULTS: The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. DISCUSSION: The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. LEVEL OF PROOF: IV, retrospective treatment study.
[Mh] Termos MeSH primário: Osteotomia/métodos
Escorregamento das Epífises Proximais do Fêmur/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Feminino
Fêmur/diagnóstico por imagem
Fêmur/cirurgia
Fluoroscopia
Seguimentos
Seres Humanos
Masculino
Mesas Cirúrgicas
Equipamentos Ortopédicos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1610
[Cu] Atualização por classe:170103
[Lr] Data última revisão:
170103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160105
[St] Status:MEDLINE


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[PMID]:26589462
[Au] Autor:Fischer EJ; Mayrand K; Ten Eyck RP
[Ad] Endereço:Department of Emergency Medicine, Boonshoft School of Medicine at Wright State University, Dayton, OH.
[Ti] Título:Effect of a backboard on compression depth during cardiac arrest in the ED: a simulation study.
[So] Source:Am J Emerg Med;34(2):274-7, 2016 Feb.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RESEARCH PURPOSE: We evaluated the impact of a backboard on chest compression depth during cardiac arrest practice sessions conducted using a high-fidelity mannequin on a standard emergency department stretcher. METHODS: Forty-three health care trainees completed cardiac resuscitation simulations requiring 2 minutes of uninterrupted chest compressions. Twenty-one were randomly allocated to the intervention group in which a backboard was concealed by placement between the stretcher mattress and a top sheet and, 22 were allocated to the control group in which no backboard was placed. The mannequin software automatically recorded mean chest compression depth in 10-second intervals for the 2 minutes of compressions. RESULTS: The backboard group achieved a mean compression depth of 41.2 mm (95% confidence interval, 37.8-44.6). The no-backboard group's mean compression depth was 41.4 mm (95% confidence interval, 38.7-44.2). Most subjects in both groups did not achieve the 50-mm compression depth threshold recommended by the American Heart Association. CONCLUSIONS: Use of a backboard as an adjunct during cardiopulmonary resuscitation of a simulated patient lying on a standard emergency department stretcher did not improve the mean chest compression depth achieved by advanced life support rescuers. Most rescuers did not achieve the minimum compression depth of 50 mm recommended by the American Heart Association.
[Mh] Termos MeSH primário: Força Compressiva
Parada Cardíaca/terapia
Massagem Cardíaca/métodos
Manequins
Mesas Cirúrgicas
[Mh] Termos MeSH secundário: Serviço Hospitalar de Emergência
Desenho de Equipamento
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160213
[Lr] Data última revisão:
160213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151122
[St] Status:MEDLINE



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