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[PMID]:28470797
[Au] Autor:O'Kane GM; Ryan É; McVeigh TP; Creavin B; Hyland JM; O'Donoghue DP; Keegan D; Geraghty R; Flannery D; Nolan C; Donovan E; Mehigan BJ; McCormick P; Muldoon C; Farrell M; Shields C; Mulligan N; Kennedy MJ; Green AJ; Winter DC; MacMathuna P; Sheahan K; Gallagher DJ
[Ad] Endereço:St. James's Hospital, Dublin 8, Ireland.
[Ti] Título:Screening for mismatch repair deficiency in colorectal cancer: data from three academic medical centers.
[So] Source:Cancer Med;6(6):1465-1472, 2017 Jun.
[Is] ISSN:2045-7634
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Reflex immunohistochemistry (rIHC) for mismatch repair (MMR) protein expression can be used as a screening tool to detect Lynch Syndrome (LS). Increasingly the mismatch repair-deficient (dMMR) phenotype has therapeutic implications. We investigated the pattern and consequence of testing for dMMR in three Irish Cancer Centres (CCs). CRC databases were analyzed from January 2005-December 2013. CC1 performs IHC upon physician request, CC2 implemented rIHC in November 2008, and CC3 has been performing rIHC since 2004. The number of eligible patients referred to clinical genetic services (CGS), and the number of LS patients per center was determined. 3906 patients were included over a 9-year period. dMMR CRCs were found in 32/153 (21%) of patients at CC1 and 55/536 (10%) at CC2, accounting for 3% and 5% of the CRC population, respectively. At CC3, 182/1737 patients (10%) had dMMR CRCs (P < 0.001). Additional testing for the BRAF V600E mutation, was performed in 49 patients at CC3 prior to CGS referral, of which 29 were positive and considered sporadic CRC. Referrals to CGS were made in 66%, 33%, and 30% of eligible patients at CC1, CC2, and CC3, respectively. LS accounted for CRC in eight patients (0.8%) at CC1, eight patients (0.7%) at CC2, and 20 patients (1.2%) at CC3. Cascade testing of patients with dMMR CRC was not completed in 56%. Universal screening increases the detection of dMMR tumors and LS kindreds. Successful implementation of this approach requires adequate resources for appropriate downstream management of these patients.
[Mh] Termos MeSH primário: Neoplasias Colorretais/genética
Reparo de Erro de Pareamento de DNA
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Seres Humanos
Imuno-Histoquímica
Meia-Idade
Mutação
Fenótipo
Proteínas Proto-Oncogênicas B-raf/genética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
EC 2.7.11.1 (BRAF protein, human); EC 2.7.11.1 (Proto-Oncogene Proteins B-raf)
[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:170505
[St] Status:MEDLINE
[do] DOI:10.1002/cam4.1025


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[PMID]:28453824
[Au] Autor:Tricarico P; Castriotta L; Battistella C; Bellomo F; Cattani G; Grillone L; Degan S; De Corti D; Brusaferro S
[Ad] Endereço:Dipartimento di Scienze Mediche e Biologiche (Department of Medical and Biological Sciences), Università degli Studi di Udine (University of Udine), Piazzale Kolbe 4, 33100 Udine, Italy.
[Ti] Título:Professional attitudes toward incident reporting: can we measure and compare improvements in patient safety culture?
[So] Source:Int J Qual Health Care;29(2):243-249, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: To establish categories of professionals' attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators. Design: The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed. Setting: A 1000-bed Italian academic hospital. Participants: Staff of the hospital (over 3200 professionals). Interventions: None. Main outcome measures: NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions. Results: The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42-0.46) among doctors and 0.40 (95% CI: 0.39-0.41) among nurses. Between 2010 and 2015, only the doctors' reporting rate increased significantly (P = 0.04), from 0.29 (95% CI: 0.25-0.34) to 0.67 (95% CI: 0.60-0.73). Patient complaints decreased from 384 to 224 (P < 0.001) and work accidents decreased from 296 to 235 (P = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31-1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11-2.87). Conclusions: Because the doctors' reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Segurança do Paciente
Gestão de Riscos/tendências
Gestão da Segurança/tendências
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Acidentes de Trabalho/estatística & dados numéricos
Feminino
Seres Humanos
Itália
Masculino
Corpo Clínico Hospitalar/psicologia
Readmissão do Paciente/estatística & dados numéricos
Satisfação do Paciente/estatística & dados numéricos
Autorrelato
[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/mzx004


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[PMID]:29466590
[Au] Autor:Tseng P; Kaplan RS; Richman BD; Shah MA; Schulman KA
[Ad] Endereço:Duke University School of Medicine, Durham, North Carolina.
[Ti] Título:Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.
[So] Source:JAMA;319(7):691-697, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective: To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants: This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures: Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures: Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results: Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance: In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/economia
Custos de Cuidados de Saúde/estatística & dados numéricos
Seguro Saúde/organização & administração
Administração da Prática Médica/economia
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/organização & administração
Custos e Análise de Custo
Seguro Saúde/economia
Sistemas Computadorizados de Registros Médicos/economia
Modelos Organizacionais
Análise e Desempenho de Tarefas
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19148


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[PMID]:29424974
[Au] Autor:Fahy K; Hermann M
[Ti] Título:Case Study #6: Enterprise Information Management at Children's Health System of Texas. Updating Organizational Policies and Procedures for Information Governance.
[So] Source:J AHIMA;88(6):46-7, 2017 06.
[Is] ISSN:1060-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Governança Clínica
Gestão da Informação em Saúde/organização & administração
Hospitais Pediátricos
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Seres Humanos
Modelos Organizacionais
Estudos de Casos Organizacionais
Política Organizacional
Texas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:180210
[St] Status:MEDLINE


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[PMID]:29406676
[Au] Autor:Downing K; Taylor C
[Ti] Título:HIM Students Help Build an Innovative Path to Information Governance.
[So] Source:J AHIMA;88(2):36-9, 2017 02.
[Is] ISSN:1060-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos
Educação Profissionalizante
Gestão da Informação em Saúde/educação
[Mh] Termos MeSH secundário: Currículo
Seres Humanos
Modelos Organizacionais
Estudos de Casos Organizacionais
Inovação Organizacional
Competência Profissional
Washington
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE


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[PMID]:29368483
[Au] Autor:Ahmed R; Davitt J; Rayyan Y
[Ti] Título:Using Capsule Endoscopy at an Academic Teaching Hospital in West Virginia: A Descriptive Analysis of our 7 year Experience and Determination of Diagnostic Yield for Obscure Gastrointestinal Bleeding.
[So] Source:W V Med J;112(5):54-8, 2016 Sep-Oct.
[Is] ISSN:0043-3284
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: The aim of our study was to describe, analyze, and evaluate results of wireless capsule endoscopy (CE) as an imaging modality for various indications. Methods: We conducted a retrospective chart review study of all CE studies performed between January 1, 2007 and June 30, 2014 at Marshall University. The study included 272 patients between the ages of 21-85 years old. Results: The most common finding in our study was a normal study (57.7%) followed by small bowel erosions (14.3%), neoplasms (11.4%), Arteriovenous malformations (10.7%), inflammatory bowel disease (2.6%), and nonspecific findings (3.3%). Discussion: 90/209 patients who had indications for IDA, melena, or heme-positive stools demonstrated positive findings by CE; our diagnostic yield for obscure GI bleeding was therefore 43.1%.
[Mh] Termos MeSH primário: Endoscopia por Cápsula
Hemorragia Gastrointestinal/diagnóstico
Hospitais Universitários
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Idoso
Idoso de 80 Anos ou mais
Endoscopia por Cápsula/métodos
Diagnóstico Diferencial
Feminino
Seres Humanos
Enteropatias/diagnóstico
Neoplasias do Jejuno/diagnóstico
Masculino
Meia-Idade
Valor Preditivo dos Testes
Reprodutibilidade dos Testes
Estudos Retrospectivos
Sensibilidade e Especificidade
West Virginia
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE


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[PMID]:29461353
[Au] Autor:Moreno JV; Girard AS; Foad W
[Ad] Endereço:Author Affiliations: Director of Professional Development and Clinical Education (Dr Moreno), Center of Professional Excellence and Inquiry, Stanford Children's Health/Lucille Packard Children's Hospital, Menlo Park; and Magnet Program Director (Dr Girard) and Associate Chief Nursing Officer (Ms Foad), Patient Care Services, Stanford Health Care, Stanford, California.
[Ti] Título:Realigning Shared Governance With Magnet® and the Organization's Operating System to Achieve Clinical Excellence.
[So] Source:J Nurs Adm;48(3):160-167, 2018 Mar.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In 2012, an academic medical center successfully overhauled a 15-year-old shared governance to align 6 house-wide and 30 unit-based councils with the new Magnet Recognition Program® and the organization's operating system, using the processes of LEAN methodology. The redesign improved cross-council communication structures, facilitated effective shared decision-making processes, increased staff engagement, and improved clinical outcomes. The innovative structural and process elements of the new model are replicable in other health institutions.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/organização & administração
Tomada de Decisões Gerenciais
Recursos Humanos de Enfermagem no Hospital/organização & administração
Gestão da Qualidade Total/organização & administração
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/normas
Tomada de Decisões
Seres Humanos
Relações Interprofissionais
Liderança
Recursos Humanos de Enfermagem no Hospital/psicologia
Recursos Humanos de Enfermagem no Hospital/normas
Estudos de Casos Organizacionais
Inovação Organizacional
Melhoria de Qualidade/organização & administração
Melhoria de Qualidade/normas
Gestão da Qualidade Total/normas
Engajamento no Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000591


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[PMID]:29377847
[Au] Autor:Maurer M; Canacari E; Eng K; Foley J; Phelan C; Sulmonte K; Wandel J
[Ad] Endereço:Author Affiliations: Senior Vice President for Patient Care Services and Chief Nursing Officer (Ms Maurer), Associate Chief Nurses (Mss Canacari, Foley, Phelan, and Sulmonte), and Program Director (Ms Wandel), Beth Israel Deaconess Medical Center, Boston; and Business Transformation Advisor (Ms Eng), Lynn Community Health Center, Lynn, Massachusetts.
[Ti] Título:Building a Culture of Continuous Improvement and Employee Engagement Using a Daily Management System Part 1: Overview.
[So] Source:J Nurs Adm;48(3):127-131, 2018 Mar.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or workflow and to address them on a daily basis. Through DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 1 describes the background and organizing framework of the program.
[Mh] Termos MeSH primário: Cultura Organizacional
Administração de Recursos Humanos em Hospitais/normas
Melhoria de Qualidade/organização & administração
Engajamento no Trabalho
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/organização & administração
Boston
Seres Humanos
Estudos de Casos Organizacionais
Administração de Recursos Humanos em Hospitais/métodos
Melhoria de Qualidade/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000593


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[PMID]:27773453
[Au] Autor:Liu Y; Vela M; Rudakevych T; Wigfield C; Garrity E; Saunders MR
[Ad] Endereço:Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
[Ti] Título:Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis.
[So] Source:J Heart Lung Transplant;36(3):264-271, 2017 Mar.
[Is] ISSN:1557-3117
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patient's transplant-eligible diagnosis and waitlist registration. METHODS: We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV ] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests. RESULTS: Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist. CONCLUSIONS: Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.
[Mh] Termos MeSH primário: Fibrose Cística/cirurgia
Transplante de Pulmão/métodos
Fibrose Pulmonar/cirurgia
Encaminhamento e Consulta/estatística & dados numéricos
Listas de Espera
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Estudos de Coortes
Comorbidade
Fibrose Cística/diagnóstico
Fibrose Cística/mortalidade
Feminino
Rejeição de Enxerto
Sobrevivência de Enxerto
Seres Humanos
Cobertura do Seguro
Estimativa de Kaplan-Meier
Transplante de Pulmão/mortalidade
Masculino
Meia-Idade
Seleção de Pacientes
Fibrose Pulmonar/diagnóstico
Fibrose Pulmonar/mortalidade
Testes de Função Respiratória
Estudos Retrospectivos
Medição de Risco
Índice de Gravidade de Doença
Estatísticas não Paramétricas
Análise de Sobrevida
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29194297
[Au] Autor:Kavanagh JM; Szweda C
[Ad] Endereço:About the Authors Joan M. Kavanagh, MSN, RN, NEA-BC, is the associate chief nurse of nursing education and professional development, Cleveland Clinic Foundation, Cleveland, Ohio. Christine Szweda, MS, BSN, RN, is the senior director, operations of nursing education and professional development, Cleveland Clinic Foundation. For more information, contact Joan Kavanagh at kavanaj@ccf.org.
[Ti] Título:A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning.
[So] Source:Nurs Educ Perspect;38(2):57-62, 2017 Mar/Apr.
[Is] ISSN:1536-5026
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: The aim of the study was to assess entry-level competency and practice readiness of newly graduated nurses. BACKGROUND: Literature on success of new graduates focuses primarily on National Council of State Boards of Nursing Licensure Examination (NCLEX-RN) pass rates, creating a false and incomplete picture of practice readiness. METHOD: Posthire and prestart Performance-Based Development System assessments were administered to more than 5,000 newly graduated nurses at a large midwestern academic medical center between July 2010 and July 2015. RESULTS: Aggregate baseline data indicate that only 23 percent of newly graduated nurses demonstrate entry-level competencies and practice readiness. CONCLUSION: New data suggest that we are losing ground in the quest for entry-level competency. Graduates often are underprepared to operate in the complex field of professional practice where increased patient acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing programs, have exacerbated a crisis in competency.
[Mh] Termos MeSH primário: Competência Clínica
Tomada de Decisão Clínica
Emprego
Ética em Enfermagem
Pensamento
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Seres Humanos
Ohio
Segurança do Paciente
Resolução de Problemas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1097/01.NEP.0000000000000112



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