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  1 / 66829 MEDLINE  
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[PMID]:29505537
[Au] Autor:Chan FK; Hsu CC; Lin HJ; Wang JJ; Su SB; Huang CC; Weng SF
[Ad] Endereço:Department of Emergency Medicine, Kuo General Hospital.
[Ti] Título:Physicians as well as nonphysician health care professionals in Taiwan have higher risk for lumbar herniated intervertebral disc than general population.
[So] Source:Medicine (Baltimore);97(1):e9561, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Physicians in Taiwan have long working hours and are at risk for inappropriate posture when handling patients, which may contribute to lumbar herniated intervertebral disc (L-HIVD). This study was conducted to delineate this issue, which is still unknown. This nationwide population-based cohort study was based on Taiwan National Health Insurance Research Database. We identified 25,428 physicians, 32,316 nonphysician health care professionals (HCPs), and an identical number of age- and sex-matched individuals from the general population. All individuals who had L-HIVD before 2007 were excluded. We compared the L-HIVD risk between physicians and general population, nonphysician HCPs and general population, and physicians and nonphysician HCPs by tracing their medical histories between 2007 and 2011. A comparison among physician specialties was also performed. Physicians and nonphysician HCPs had higher L-HIVD risk than the general population [odds ratio (OR): 1.149; 95% confidence interval (CI): 1.011-1.307 and OR: 1.220; 95% CI: 1.080-1.378, respectively]. Physicians did not have higher L-HIVD risk than nonphysician HCPs [adjusted OR (AOR): 0.912; 95% CI: 0.795-1.046]. Physician specialties of orthopedics and obstetrics and gynecology had a trend of higher L-HIVD risk than other specialties (AOR: 1.538; 95% CI: 0.805-2.939, and AOR: 1.306; 95% CI: 0.967-1.764, respectively). Physicians as well as nonphysician health care professionals in Taiwan have higher L-HIVD risk than the general population, which could be attributed to a probable role of long working hours. This result provides an important reference for the government to promote occupational health in health care professionals; however, further studies are warranted for the underlying mechanisms.
[Mh] Termos MeSH primário: Pessoal Técnico de Saúde/estatística & dados numéricos
Deslocamento do Disco Intervertebral/epidemiologia
Vértebras Lombares
Exposição Ocupacional/efeitos adversos
Médicos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Deslocamento do Disco Intervertebral/etiologia
Masculino
Meia-Idade
Risco
Taiwan/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009561


  2 / 66829 MEDLINE  
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[PMID]:29447291
[Au] Autor:Tanuseputro P; Beach S; Chalifoux M; Wodchis WP; Hsu AT; Seow H; Manuel DG
[Ad] Endereço:Bruyère Research Institute, Ottawa, Ontario, Canada.
[Ti] Título:Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study.
[So] Source:PLoS One;13(2):e0191322, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While most individuals wish to die at home, the reality is that most will die in hospital. AIM: To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. DESIGN: Observational retrospective cohort study, examining location of death and health care in the last year of life. SETTING/PARTICIPANTS: Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754). RESULTS: More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51). CONCLUSION: Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.
[Mh] Termos MeSH primário: Hospitais/utilização
Visita Domiciliar/utilização
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Canadá
Estudos de Coortes
Morte
Feminino
Serviços de Assistência Domiciliar/tendências
Serviços de Assistência Domiciliar/utilização
Cuidados Paliativos na Terminalidade da Vida/tendências
Hospitalização/tendências
Hospitais/tendências
Seres Humanos
Masculino
Razão de Chances
Cuidados Paliativos
Médicos
Qualidade de Vida
Estudos Retrospectivos
Assistência Terminal/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191322


  3 / 66829 MEDLINE  
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[PMID]:29437652
[Au] Autor:Davis J
[Ad] Endereço:Whittington Hospital, London, UK.
[Ti] Título:Most UK doctors support assisted dying, a new poll shows: the BMA's opposition does not represent members.
[So] Source:BMJ;360:k301, 2018 02 07.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Médicos/psicologia
Sociedades Médicas
Suicídio Assistido
[Mh] Termos MeSH secundário: Dissidências e Disputas
Seres Humanos
Inquéritos e Questionários
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k301


  4 / 66829 MEDLINE  
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[PMID]:29446903
[Au] Autor:Baker SS
[Ti] Título:President's Page: Be Grateful.
[So] Source:J Okla State Med Assoc;109(6):177-8, 2016 Jun.
[Is] ISSN:0030-1876
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Satisfação no Emprego
Médicos
[Mh] Termos MeSH secundário: Seres Humanos
Equilíbrio Trabalho-Vida
Carga de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE


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[PMID]:29441974
[Au] Autor:Gudienè V
[Ti] Título:The medical treatment of Maria, Dowager Empress of the Russian Empire: an analysis of her prescription book from 1807 and 1808.
[So] Source:Pharmazie;71(11):670-679, 2016 Nov 02.
[Is] ISSN:0031-7144
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:This study analyzes the medicines that were used to treat the Dowager Russian Empress Maria, widow of Tsar Paul I, and describes the doctors who cared for her health in 1807 and 1808. The source for this research was the imperial court pharmacy prescription book 1807-1811. Hypotheses about the diseases and medical problems of the Empress and how treatment for her differed according to circumstances, particularly after the loss of her granddaughter Princess Elizabeth, have been made based on the prescriptions recorded in the book. The content of the prescriptions suggests that the Empress suffered from gastrointestinal tract disorders, skin and eye diseases, neuralgic pains and insomnia. Foreign physicians educated in European universities worked at the imperial court and implemented European medical traditions. They took high positions in the administration and the medical education system, and gradually spread their experience and modern knowledge to Tsarist Russian society.
[Mh] Termos MeSH primário: Prescrições de Medicamentos/história
Tratamento Farmacológico/história
[Mh] Termos MeSH secundário: Livros
Quimioterapia Combinada
História do Século XIX
Farmácias
Médicos
Federação Russa
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1691/ph.2016.6067


  6 / 66829 MEDLINE  
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[PMID]:28460596
[Au] Autor:Cerrone SA; Adelman P; Akbar S; Yacht AC; Fornari A
[Ad] Endereço:a Internal Medicine , Northwell Health , Manhasset , NY , USA.
[Ti] Título:Using Objective Structured Teaching Encounters (OSTEs) to prepare chief residents to be emotionally intelligent leaders.
[So] Source:Med Educ Online;22(1):1320186, 2017.
[Is] ISSN:1087-2981
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chief Residents must lead, manage and mentor a diverse and often large group of residents, however there is a lack of formal leadership training throughout graduate medical education. OBJECTIVE: Development of a 3-part Chief Resident (CR) Program focused on leading, managing and mentoring. DESIGN: Each participant completes an Emotional Intelligence (EI) Inventory prior to the day-long event. Participants receive their EI scores at the beginning of the program, which features interactive sessions on leadership, management, and feedback skills. The program then reinforces the application of their new knowledge about EI through a four station OSTE (Observed Structured Teaching Encounter). CRs practice feedback and coaching skills in a simulated environment where they need to provide the context of formative feedback to a standardized resident. RESULTS: The aggregated mean pre-session EI score for all participants was 76.9 (an ideal score is >85). An independent-samples t-test compared the CRs' leadership and feedback performance on their first and second OSTE performance within a single afternoon session. There was a significant difference between the first OSTE performance (M = 47.92, SD = 7.8) and the second OSTE performance (M = 51.22, SD = 6.9); t (68) = 1.99, p = 0.006. These results suggest that participating in multiple OSTEs positively reinforces the core interpersonal and communication skills discussed in the didactic and practiced in the interactive portions of the program. CONCLUSION: The low mean pre-session EI score achieved by our participants supports the idea that CRs enter their new roles with a level of EI that can be enhanced. CRs had an overall positive reaction to EI and its application to the core skills addressed in the program, highlighting the fact that similar programs could be used to train early career physicians to be more skilled and comfortable with leading, managing and mentoring. ABBREVIATIONS: CR: Chief resident; EI: Emotional intelligence; GME: Graduate medical education; OSTE: Objective structured teaching encounter.
[Mh] Termos MeSH primário: Educação de Pós-Graduação em Medicina/métodos
Inteligência Emocional
Internato e Residência/métodos
Liderança
Médicos/psicologia
[Mh] Termos MeSH secundário: Competência Clínica
Currículo
Avaliação Educacional
Seres Humanos
Mentores
Ensino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1080/10872981.2017.1320186


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[PMID]:28747292
[Au] Autor:Emmert M; Sauter L; Jablonski L; Sander U; Taheri-Zadeh F
[Ad] Endereço:Institute of Management, School of Business and Economics, Health Services Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany.
[Ti] Título:Do Physicians Respond to Web-Based Patient Ratings? An Analysis of Physicians' Responses to More Than One Million Web-Based Ratings Over a Six-Year Period.
[So] Source:J Med Internet Res;19(7):e275, 2017 Jul 26.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Physician-rating websites (PRWs) may lead to quality improvements in case they enable and establish a peer-to-peer communication between patients and physicians. Yet, we know little about whether and how physicians respond on the Web to patient ratings. OBJECTIVE: The objective of this study was to describe trends in physicians' Web-based responses to patient ratings over time, to identify what physician characteristics influence Web-based responses, and to examine the topics physicians are likely to respond to. METHODS: We analyzed physician responses to more than 1 million patient ratings displayed on the German PRW, jameda, from 2010 to 2015. Quantitative analysis contained chi-square analyses and the Mann-Whitney U test. Quantitative content techniques were applied to determine the topics physicians respond to based on a randomly selected sample of 600 Web-based ratings and corresponding physician responses. RESULTS: Overall, physicians responded to 1.58% (16,640/1,052,347) of all Web-based ratings, with an increasing trend over time from 0.70% (157/22,355) in 2010 to 1.88% (6377/339,919) in 2015. Web-based ratings that were responded to had significantly worse rating results than ratings that were not responded to (2.15 vs 1.74, P<.001). Physicians who respond on the Web to patient ratings differ significantly from nonresponders regarding several characteristics such as gender and patient recommendation results (P<.001 each). Regarding scaled-survey rating elements, physicians were most likely to respond to the waiting time within the practice (19.4%, 99/509) and the time spent with the patient (18.3%, 110/600). Almost one-third of topics in narrative comments were answered by the physicians (30.66%, 382/1246). CONCLUSIONS: So far, only a minority of physicians have taken the chance to respond on the Web to patient ratings. This is likely because of (1) the low awareness of PRWs among physicians, (2) the fact that only a few PRWs enable physicians to respond on the Web to patient ratings, and (3) the lack of an active moderator to establish peer-to-peer communication. PRW providers should foster more frequent communication between the patient and the physician and encourage physicians to respond on the Web to patient ratings. Further research is needed to learn more about the motivation of physicians to respond or not respond to Web-based patient ratings.
[Mh] Termos MeSH primário: Internet/utilização
Médicos/normas
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Relações Médico-Paciente
Melhoria de Qualidade
Inquéritos e Questionários
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.7538


  8 / 66829 MEDLINE  
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[PMID]:28461285
[Au] Autor:Rothenfluh F; Schulz PJ
[Ad] Endereço:Institute of Communication and Health, Department of Communication Sciences, Università della Svizzera italiana, Lugano, Switzerland.
[Ti] Título:Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives.
[So] Source:J Med Internet Res;19(5):e127, 2017 May 01.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. OBJECTIVE: To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. METHODS: In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. RESULTS: In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes of care were also judged to be very important, but both parties agreed that they would not be evaluable by health care consumers. CONCLUSIONS: Health care consumers in Switzerland show a high appraisal of the importance of physician-approved criteria for assessing health care performance and a moderate self-perception of how capable they are of assessing the quality and performance of a physician. This study supports that health care consumers are differentiating between aspects they perceive they would be able to evaluate after a visit to a physician (such as attributes of structure and the interpersonal skills of a doctor), and others that lay beyond their ability to make an accurate judgment about (such as technical skills of a physician and outcome of care).
[Mh] Termos MeSH primário: Informática Aplicada à Saúde dos Consumidores
Assistência à Saúde/normas
Internet
Satisfação do Paciente/estatística & dados numéricos
Médicos/normas
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Autoimagem
Habilidades Sociais
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.6875


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[PMID]:28453827
[Au] Autor:Gagliardi AR; Lehoux P; Ducey A; Easty A; Ross S; Bell CM; Trbovich P; Takata J; Urbach DR
[Ad] Endereço:Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
[Ti] Título:Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.
[So] Source:Int J Qual Health Care;29(2):276-282, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions. Design: Qualitative interviews using a basic descriptive approach. Setting: Canada. Participants: Practicing cardiovascular and orthopaedic physicians. Main outcome measures: Level, processes and determinants of PE in medical device discussions and decisions. Results: Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice. Conclusions: This study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.
[Mh] Termos MeSH primário: Tomada de Decisões
Participação do Paciente/métodos
Médicos/psicologia
Próteses e Implantes
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Canadá
Cardiologistas/psicologia
Seres Humanos
Cirugiões Ortopédicos/psicologia
Relações Médico-Paciente
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzx013


  10 / 66829 MEDLINE  
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[PMID]:29480851
[Au] Autor:Primdahl SC; Weile J; Clemmesen L; Madsen KR; Subhi Y; Petersen P; Graumann O
[Ad] Endereço:Department of Emergency Medicine, Regional Hospital West Jutland, Herning.
[Ti] Título:Validation of the Peripheral Ultrasound-guided Vascular Access Rating Scale.
[So] Source:Medicine (Baltimore);97(2):e9576, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Evidence-based standards in proficiency are needed for ultrasound-guided peripheral intravenous access. In this study, we explored the validity of the Peripheral Ultrasound-Guided Vascular Access (P-UGVA) Rating Scale.We recruited 3 groups of physicians (5 novices, 5 intermediates, and 5 experts) of increasing proficiency in peripheral ultrasound-guided intravenous access. All participants performed 3 peripheral ultrasound-guided intravenous accesses on three different patients. Performance was video-recorded by 3 cameras and the ultrasound image. Synchronized and anonymized split-screen film clips were rated using the P-UGVA rating scale by 2 assessors, which also assessed overall performance on a 1-5 Likert-scale. Evidence of validity was explored using the contemporary validity framework by Messick (content, response process, internal structure, relations to other variables, and consequences).Content and response process was ensured in the development of the rating scale and validity study. Internal consistency of the P-UGVA rating scale was excellent and sufficient high for certification purposes (Cronbach's alpha = 0.91). Proficiency groups were successfully discriminated by the UPGIVA rating scale (P = .029, one-way ANOVA), and the P-UGVA rating scale scores also correlated strongly with the overall performance evaluations (rho = 0.87, P < .001, Pearson correlation). We calculated a pass/fail score of 29, which lead to a theoretical false positive rate of 26.5% and false negative rate of 8.5%.We present validity evidence for the P-UGVA rating scale and an evidence-based standard in proficiency for ultrasound-guided peripheral intravenous access.
[Mh] Termos MeSH primário: Ultrassonografia de Intervenção
[Mh] Termos MeSH secundário: Análise de Variância
Competência Clínica
Medicina Baseada em Evidências
Seres Humanos
Médicos
Estudos Prospectivos
Ultrassonografia de Intervenção/métodos
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009576



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