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Pesquisa : N03.219.521.576.130 [Categoria DeCS]
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[PMID]:29206980
[Au] Autor:Sutcliffe TJ
[Ad] Endereço:The Arc of the United States, Washington.
[Ti] Título:Social Security's Disability Hearings Backlog: A National Crisis.
[So] Source:Health Soc Work;41(4):215-217, 2016 Nov 20.
[Is] ISSN:0360-7283
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Avaliação da Deficiência
Pessoas com Deficiência
Definição da Elegibilidade
Previdência Social
[Mh] Termos MeSH secundário: Seres Humanos
Benefícios do Seguro
Política
Política Pública
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:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/hsw/hlw044


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[PMID]:29360311
[Au] Autor:Raduege TJ; Thomson Reuters Accelus..
[Ti] Título:Benefits and Services.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-59, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Benefícios do Seguro
Medicaid/organização & administração
[Mh] Termos MeSH secundário: Orçamentos
Administração de Caso
Criança
Serviços de Saúde da Criança
Serviços de Saúde Comunitária
Serviços de Saúde Bucal
Serviços de Planejamento Familiar
Governo Federal
Infecções por HIV
Serviços de Assistência Domiciliar
Seres Humanos
Cobertura do Seguro
Seguro de Serviços Farmacêuticos
Assistência de Longa Duração
Serviços de Saúde Materna
Serviços de Saúde Mental
Terapia Ocupacional
Patient Protection and Affordable Care Act
Modalidades de Fisioterapia
Governo Estadual
Telemedicina
Abandono do Uso de Tabaco
Transporte de Pacientes
Estados Unidos
Transtornos da Visão/terapia
Serviços de Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29360303
[Au] Autor:Karberg J; Thomson Reuters Accelus.
[Ti] Título:Mandated Benefits.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-19, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Benefícios do Seguro
Seguro Saúde/organização & administração
[Mh] Termos MeSH secundário: Governo Federal
Seres Humanos
Cobertura do Seguro
Reembolso de Seguro de Saúde
Seguro de Serviços Farmacêuticos
Medicaid
Medicare
Serviços de Saúde Mental
Patient Protection and Affordable Care Act
Governo Estadual
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29345890
[Au] Autor:Willink A; Shoen C; Davis K
[Ad] Endereço:Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health.
[Ti] Título:How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.
[So] Source:Issue Brief (Commonw Fund);2018:1-12, 2018 Jan 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Findings and Conclusions: Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.
[Mh] Termos MeSH primário: Transtornos da Audição/economia
Benefícios do Seguro/economia
Cobertura do Seguro/organização & administração
Seguro Odontológico/economia
Medicare/economia
Transtornos da Visão/economia
[Mh] Termos MeSH secundário: Custo Compartilhado de Seguro
Serviços de Saúde Bucal/economia
Transtornos da Audição/terapia
Seres Humanos
Renda
Estados Unidos
Transtornos da Visão/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE


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[PMID]:28464814
[Au] Autor:Busch SH; Mcginty EE; Stuart EA; Huskamp HA; Gibson TB; Goldman HH; Barry CL
[Ad] Endereço:Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-8034, USA. Susan.busch@yale.edu.
[Ti] Título:Was federal parity associated with changes in Out-of-network mental health care use and spending?
[So] Source:BMC Health Serv Res;17(1):315, 2017 05 02.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act is to eliminate differences in insurance coverage between behavioral health and general medical care. The law requires out-of-network mental health benefits be equivalent to out-of-network medical/surgical benefits. Insurers were concerned this provision would lead to unsustainable increases in out-of-network related expenditures. We examined whether federal parity implementation was associated with significant increases in out-of-network mental health care use and spending. METHODS: We conducted an interrupted time series analysis using health insurance claims from self-insured employers (2007-2012). We examined changes in the probability of using out-of-network mental health services and, conditional on out-of-network mental health service use, changes in the number of outpatient out-of-network mental health visits and total out-of-network mental health spending associated with the implementation of federal parity in 2010. RESULTS: From 2007 to 2012, the proportion of individuals receiving any out-of-network mental health services each month declined dramatically from 18 to 12%, with a one-time drop of 3 percentage points at parity implementation (p < .01). Among out-of-network mental health service users, there was an increase in the number of visits per month (.12 visits; p < .01) and total spending per month ($49; p < .01) at parity implementation. Although there was a one-time increase in spending at parity implementation, this increase was accompanied by an attenuation of a trend toward increased spending growth, such that spending was back to original predictions by the end of our study period. CONCLUSIONS: Despite concerns expressed by the health insurance industry when federal parity was enacted, out-of-network mental health spending did not substantially increase after parity implementation. In addition, use of out-of-network mental health services appears to have contracted rather than expanded, suggesting insurers may have implemented other policies to curb out-of-network use, such as increasing access to in-network providers.
[Mh] Termos MeSH primário: Gastos em Saúde/estatística & dados numéricos
Benefícios do Seguro
Cobertura do Seguro/legislação & jurisprudência
Seguro Saúde/utilização
Serviços de Saúde Mental/utilização
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Seguradoras
Seguro Saúde/economia
Seguro Saúde/legislação & jurisprudência
Análise de Séries Temporais Interrompida
Masculino
Serviços de Saúde Mental/economia
Meia-Idade
Probabilidade
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2261-9


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[PMID]:29232071
[Au] Autor:Employee Benefits Security Administration, Department of Labor.
[Ti] Título:Claims Procedure for Plans Providing Disability Benefits; 90-Day Delay of Applicability Date. Final rule; delay of applicability date.
[So] Source:Fed Regist;82(228):56560-6, 2017 Nov 29.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This document delays for ninety (90) days--through April 1, 2018--the applicability of a final rule amending the claims procedure requirements applicable to ERISA-covered employee benefit plans that provide disability benefits (Final Rule). The Final Rule was published in the Federal Register on December 19, 2016, became effective on January 18, 2017, and was scheduled to become applicable on January 1, 2018. The delay announced in this document is necessary to enable the Department of Labor to carefully consider comments and data as part of its effort, pursuant to Executive Order 13777, to examine regulatory alternatives that meet its objectives of ensuring the full and fair review of disability benefit claims while not imposing unnecessary costs and adverse consequences.
[Mh] Termos MeSH primário: Benefícios do Seguro/legislação & jurisprudência
Revisão da Utilização de Seguros/legislação & jurisprudência
Seguro por Invalidez/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:27776013
[Au] Autor:Friedman EE; Duffus WA
[Ad] Endereço:Office of Health Equity, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
[Ti] Título:Chronic health conditions in Medicare beneficiaries 65 years and older with HIV infection.
[So] Source:AIDS;30(16):2529-2536, 2016 Oct 23.
[Is] ISSN:1473-5571
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/HIV+) at least 65 years old and compare their chronic disease prevalence with beneficiaries without HIV. DESIGN: National fee-for-service Medicare claims data (parts A and B) from 2006 to 2009 were used to create a retrospective cohort of beneficiaries at least 65 years old. METHODS: Beneficiaries with an inpatient or skilled nursing facility claim, or outpatient claims with HIV diagnosis codes were considered HIV+. HIV+ beneficiaries were compared with uninfected beneficiaries on demographic factors and on the prevalence of hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, and diabetes. Odds ratios (OR), 95% confidence intervals (CIs), and P values were calculated. Adjustment variables included age, sex, race/ethnicity, end stage renal disease (ESRD), and dual Medicare-Medicaid enrollment. Chronic conditions were examined individually and as an index from zero to all five conditions. RESULTS: Of 29 060 418 eligible beneficiaries, 24 735 (0.09%) were HIV+. HIV+ beneficiaries were more likely to be Hispanic, African-American, male, and younger (P > 0.0001) and were 1.5-2.1 times as likely to have a chronic disease [diabetes (adjusted OR) 1.51, 95% CI (1.47, 1.55): rheumatoid arthritis/osteoarthritis 2.14, 95% CI (2.08, 2.19)], and 2.4-7 times as likely to have 1-5 comorbid chronic conditions [1 condition (adjusted OR) 2.38, 95% CI (2.21, 2.57): 5 conditions 7.07, 95% CI (6.61, 7.56)]. CONCLUSION: Our results show that PLWHIV at least 65 years old are at higher risk of comorbidities than other fee-for-service Medicare beneficiaries. This finding has implications for the cost and health management of PLWHIV 65 years and older.
[Mh] Termos MeSH primário: Doença Crônica/epidemiologia
Comorbidade
Infecções por HIV/complicações
Benefícios do Seguro
Medicare
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Saúde
Seres Humanos
Masculino
Prevalência
Estudos Retrospectivos
Medição de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29227444
[Au] Autor:Zhou C; Yu NN; Losby JL
[Ad] Endereço:Health Care Cost Institute, Washington, DC.
[Ti] Título:The Association Between Local Economic Conditions and Opioid Prescriptions Among Disabled Medicare Beneficiaries.
[So] Source:Med Care;56(1):62-68, 2018 Jan.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This paper concerns public health crises today-the problem of opioid prescription access and related abuse. Inspired by Case and Deaton's seminal work on increasing mortality among white Americans with lower education, this paper explores the relationship between opioid prescribing and local economic factors. OBJECTIVE: We examined the association between county-level socioeconomic factors (median household income, unemployment rate, Gini index) and opioid prescribing. SUBJECTS: We used the complete 2014 Medicare enrollment and part D drug prescription data from the Center for Medicare and Medicaid Services to study opioid prescriptions of disabled Medicare beneficiaries without record of cancer treatment, palliative care, or end-of-life care. MEASURES AND RESEARCH DESIGN: We summarized the demographic and geographic variation, and investigated how the local economic environment, measured by county median household income, unemployment rate, Gini index, and urban-rural classification correlated with various measures of individual opioid prescriptions. Measures included number of filled opioid prescriptions, total days' supply, average morphine milligram equivalent (MME)/day, and annual total MME dosage. To assess the robustness of the results, we controlled for individual and other county characteristics, used multiple estimation methods including linear least squares, logistic regression, and Tobit regression. RESULTS AND CONCLUSIONS: Lower county median household income, higher unemployment rates, and less income inequality were consistently associated with more and higher MME opioid prescriptions among disabled Medicare beneficiaries. Geographically, we found that the urban-rural divide was not gradual and that beneficiaries in large central metro counties were less likely to have an opioid prescription than those living in other areas.
[Mh] Termos MeSH primário: Analgésicos Opioides/economia
Pessoas com Deficiência/estatística & dados numéricos
Prescrições de Medicamentos/economia
Benefícios do Seguro/economia
Medicare Part D/economia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Renda
Masculino
Meia-Idade
Análise de Regressão
Fatores Socioeconômicos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000841


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[PMID]:29176368
[Au] Autor:Koroukian SM; Basu J; Schiltz NK; Navale S; Bakaki PM; Warner DF; Dor A; Given CW; Stange KC
[Ad] Endereço:Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University.
[Ti] Título:Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011.
[So] Source:Med Care;56(1):39-46, 2018 Jan.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204). SUBJECTS: HRS participants who were also enrolled in Medicare. MEASURES: Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. RESULTS: The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059). CONCLUSIONS: Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.
[Mh] Termos MeSH primário: Planos de Pagamento por Serviço Prestado/estatística & dados numéricos
Benefícios do Seguro/estatística & dados numéricos
Programas de Assistência Gerenciada/estatística & dados numéricos
Medicare/estatística & dados numéricos
Avaliação de Resultados da Assistência ao Paciente
[Mh] Termos MeSH secundário: Idoso
Autoavaliação Diagnóstica
Feminino
Seres Humanos
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000847


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[PMID]:28541791
[Au] Autor:Olszewski AJ; Dusetzina SB; Eaton CB; Davidoff AJ; Trivedi AN
[Ad] Endereço:Adam J. Olszewski, Charles B. Eaton, and Amal N. Trivedi, Alpert Medical School of Brown University; Adam J. Olszewski, Rhode Island Hospital; Charles B. Eaton, Brown University School of Public Health; Amal N. Trivedi, Providence Veterans Affairs Medical Center and Brown University School of Public
[Ti] Título:Subsidies for Oral Chemotherapy and Use of Immunomodulatory Drugs Among Medicare Beneficiaries With Myeloma.
[So] Source:J Clin Oncol;35(29):3306-3314, 2017 Oct 10.
[Is] ISSN:1527-7755
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose The low-income subsidy (LIS) substantially lowers out-of-pocket costs for qualifying Medicare Part D beneficiaries who receive orally administered chemotherapy. We examined the association of LIS with the use of novel oral immunomodulatory drugs (IMiDs; lenalidomide and thalidomide) among beneficiaries with myeloma, who can receive either orally administered or parenteral (bortezomib-based) therapy. Methods Using SEER-Medicare data, we identified Part D beneficiaries diagnosed with myeloma in 2007 to 2011. In multivariable models adjusted for sociodemographic and clinical characteristics, we analyzed associations between the LIS and use of IMiD-based therapy, delays between IMiD refills, and select health outcomes during the first year of therapy. Results Among 3,038 beneficiaries, 41% received first-line IMiDs. Median out-of-pocket cost for the first IMiD prescription was $3,178 for LIS nonrecipients and $3 for LIS recipients, whereas the respective median costs for the first year of therapy were $5,623 and $6, respectively. Receipt of the LIS was associated with a 32% higher (95% CI, 16% to 47%) probability of receiving IMiDs among beneficiaries age 75 to 84 years and a significantly lower risk of delays between refills in all age groups (adjusted relative risk, 0.54; 95% CI, 0.32 to 0.92). Duration of therapy did not significantly differ between LIS recipients and nonrecipients (median, 7.6 months). Patients treated with IMiDs had significantly fewer emergency department visits and hospitalizations compared with patients receiving bortezomib (without IMiDs), but 1-year overall survival and cumulative Medicare costs were similar. Conclusion Medicare beneficiaries with myeloma who do not receive LISs face a substantial financial barrier to accessing orally administered anticancer therapy, warranting urgent attention from policymakers. Limiting out-of-pocket costs for expensive anticancer drugs like the IMiDs may improve access to oral therapy for patients with myeloma.
[Mh] Termos MeSH primário: Antineoplásicos/administração & dosagem
Antineoplásicos/economia
Custos de Medicamentos
Gastos em Saúde
Fatores Imunológicos/administração & dosagem
Fatores Imunológicos/economia
Benefícios do Seguro/economia
Medicare Part D/economia
Mieloma Múltiplo/tratamento farmacológico
Mieloma Múltiplo/economia
Avaliação de Processos (Cuidados de Saúde)/economia
[Mh] Termos MeSH secundário: Administração Oral
Demandas Administrativas em Assistência à Saúde
Idoso
Idoso de 80 Anos ou mais
Bortezomib/administração & dosagem
Bortezomib/economia
Bases de Dados Factuais
Esquema de Medicação
Definição da Elegibilidade/economia
Feminino
Acesso aos Serviços de Saúde/economia
Disparidades em Assistência à Saúde/economia
Seres Humanos
Masculino
Modelos Econômicos
Mieloma Múltiplo/diagnóstico
Programa de SEER
Talidomida/administração & dosagem
Talidomida/análogos & derivados
Talidomida/economia
Fatores de Tempo
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Immunologic Factors); 4Z8R6ORS6L (Thalidomide); 69G8BD63PP (Bortezomib); F0P408N6V4 (lenalidomide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1200/JCO.2017.72.2447



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