Base de dados : MEDLINE
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[PMID]:29281665
[Au] Autor:Bergmeir C; Bilgrami I; Bain C; Webb GI; Orosz J; Pilcher D
[Ad] Endereço:Faculty of Information Technology, Monash University, Clayton, Australia.
[Ti] Título:Designing a more efficient, effective and safe Medical Emergency Team (MET) service using data analysis.
[So] Source:PLoS One;12(12):e0188688, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Hospitals have seen a rise in Medical Emergency Team (MET) reviews. We hypothesised that the commonest MET calls result in similar treatments. Our aim was to design a pre-emptive management algorithm that allowed direct institution of treatment to patients without having to wait for attendance of the MET team and to model its potential impact on MET call incidence and patient outcomes. METHODS: Data was extracted for all MET calls from the hospital database. Association rule data mining techniques were used to identify the most common combinations of MET call causes, outcomes and therapies. RESULTS: There were 13,656 MET calls during the 34-month study period in 7936 patients. The most common MET call was for hypotension [31%, (2459/7936)]. These MET calls were strongly associated with the immediate administration of intra-venous fluid (70% [1714/2459] v 13% [739/5477] p<0.001), unless the patient was located on a respiratory ward (adjusted OR 0.41 [95%CI 0.25-0.67] p<0.001), had a cardiac cause for admission (adjusted OR 0.61 [95%CI 0.50-0.75] p<0.001) or was under the care of the heart failure team (adjusted OR 0.29 [95%CI 0.19-0.42] p<0.001). Modelling the effect of a pre-emptive management algorithm for immediate fluid administration without MET activation on data from a test period of 24 months following the study period, suggested it would lead to a 68.7% (2541/3697) reduction in MET calls for hypotension and a 19.6% (2541/12938) reduction in total METs without adverse effects on patients. CONCLUSION: Routinely collected data and analytic techniques can be used to develop a pre-emptive management algorithm to administer intravenous fluid therapy to a specific group of hypotensive patients without the need to initiate a MET call. This could both lead to earlier treatment for the patient and less total MET calls.
[Mh] Termos MeSH primário: Eficiência Organizacional
Serviço Hospitalar de Emergência/organização & administração
Equipe de Respostas Rápidas de Hospitais/organização & administração
Segurança do Paciente
[Mh] Termos MeSH secundário: Algoritmos
Interpretação Estatística de Dados
Doença/classificação
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188688


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[PMID]:28866971
[Au] Autor:Flabouris A; Mesecke M
[Ad] Endereço:Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. arthas.flabouris@sa.gov.au.
[Ti] Título:Rapid response team calls that overlap in time: incidence, consequences and patient outcomes.
[So] Source:Crit Care Resusc;19(3):214-221, 2017 Sep.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate overlap rapid response team (RRT) calls, factors associated with overlap calls, and their impact on RRT call times and patient outcomes. DESIGN AND SETTING: Review of prospectively collected, linked clinical and administrative datasets, at a public adult tertiary hospital during July 2013 to May 2016. RESULTS: There were 11 669 RRT calls to 7223 patients, of which 10 868 calls (93.1%) were to inpatients. The median number of daily calls was 12 (interquartile range [IQR], 9-15 calls; range, 2-29 calls). The median number of daily calls per 1000 hospital admissions was 56.3 (IQR, 41.3- 78.9 calls/1000 admissions; range, 8.3-231.5 calls/1000 admissions), and the median proportion of the day spent at RRT calls was 22.8% (IQR, 16.9%-30.5%). In total, 4575 (39.2%) calls overlapped. Overlap calls, compared with non-overlap calls, had similar patient characteristics, but a longer response time (4 min v 3 min; P < 0.001) and scene time (20 min v 34 min; P < 0.001). The daily number of calls correlated with the number of overnight-stay hospital admissions (r = 0.104; P = 0.001), but not with the total number of hospital admissions (r = -0.035; P = 0.258). The number of overlap calls correlated with the number of RRT calls (r = 0.786; P < 0.001), and also correlated with the proportion of the day spent at RRT calls (r = 0.762; P < 0.001). Overlap calls, compared with non-overlap calls, were more likely to result in an ICU admission (484 calls [11.2%] v 571 calls [8.7%]; P < 0.001). In contrast, efferent limb failure (815 calls [17.8%] v 1195 calls [16.8%]; P = 0.389) and hospital mortality (496 calls [19.3%] v 781 calls [19.6%]; P = 0.823) was similar for overlap and nonoverlap calls, respectively. CONCLUSIONS: Overlap RRT calls are common and influenced by overall RRT and hospital activity. They are more likely to be associated with longer response and scene times and unanticipated ICU admissions.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Equipe de Respostas Rápidas de Hospitais
Unidades de Terapia Intensiva
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Bases de Dados Factuais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28859061
[Au] Autor:Peek KN; Gillham M
[Ad] Endereço:Auckland District Health Board, Auckland.
[Ti] Título:Is the New Zealand Early Warning Score useful following cardiac surgery?
[So] Source:N Z Med J;130(1461):9-14, 2017 Sep 01.
[Is] ISSN:1175-8716
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:AIMS: The rate of medical emergency team (MET) calling among post-cardiac surgery patients is unknown. We set out to determine what the call frequency would be if MET activation occurred in every instance that the early warning score (EWS) breached our local threshold, what the outcome was for these patients and what the calling rate might be if the proposed New Zealand EWS (NZEWS) system was implemented with 100% adherence. METHODS: The clinical records of 400 consecutive post-cardiac surgery patients were examined. The number of times a patient's EWS reached the threshold which mandated a call to the MET was determined, as was the actual rate of calling, the occurrence of inpatient death and re-admission to the intensive care unit (ICU). The rate of calling was then determined using the NZEWS, and with a routine modification to the heart rate score. RESULTS: There were 73 occasions (MET events) where the EWS reached the MET calling threshold. The MET was only called twice. There were no inpatient deaths and 12 ICU re-admissions in the study cohort. Nine ICU re-admissions were preceded by a MET event, two by cardiac arrest and one had neither. Re-scoring with NZEWS yielded 53 events. Eight of the 12 ICU admissions were preceded by a NZEWS event. CONCLUSIONS: The rate of MET triggering EWS in patients post-cardiac surgery is high at 182/1,000 admissions. Using NZEWS could reduce the MET calling rate without significant risk to patient safety.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos
Serviço Hospitalar de Emergência/normas
Equipe de Respostas Rápidas de Hospitais/normas
Complicações Pós-Operatórias/diagnóstico
[Mh] Termos MeSH secundário: Bases de Dados Factuais
Feminino
Parada Cardíaca/epidemiologia
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Nova Zelândia
Admissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE


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[PMID]:28622215
[Au] Autor:Amacher SA; Schumacher C; Legeret C; Tschan F; Semmer NK; Marsch S; Hunziker S
[Ad] Endereço:1Department of Intensive Care Medicine, Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.2Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.3Department of Psychology, University of Neuchatel, Neuchatel, Switzerland.4Department of Psychology, University of Bern, Bern, Switzerland.5Medical Faculty, University of Basel, Basel, Switzerland.
[Ti] Título:Influence of Gender on the Performance of Cardiopulmonary Rescue Teams: A Randomized, Prospective Simulator Study.
[So] Source:Crit Care Med;45(7):1184-1191, 2017 Jul.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Little is known about the influence of gender on resuscitation performance which may improve future education in resuscitation. The aim of this study was to compare female and male rescuers in regard to cardiopulmonary resuscitation and leadership performance. DESIGN: Prospective, randomized simulator study. SETTING: High-fidelity patient simulator center of the medical ICU, University Hospitals Basel (Switzerland). SUBJECTS: Two hundred sixteen volunteer medical students (108 females and 108 males) of two Swiss universities in teams of three. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed data on the group and the individual level separately. The primary outcome on the group level was the hands-on time within the first 180 seconds after the onset of the cardiac arrest. Compared with male-only teams, female-only teams showed less hands-on time (mean ± SD) (87 ± 41 vs 109 ± 33 s; p = 0.037) and a longer delay before the start of chest compressions (109 ± 77 vs 70 ± 56 s; p = 0.038). Additionally, female-only teams showed a lower leadership performance in different domains and fewer unsolicited cardiopulmonary resuscitation measures compared with male-only teams. On the individual level, which was assessed in mixed teams only, female gender was associated with a lower number of secure leadership statements (3 ± 2 vs 5 ± 3; p = 0.027). Results were confirmed in regression analysis adjusted for team composition. CONCLUSIONS: We found important gender differences, with female rescuers showing inferior cardiopulmonary resuscitation performance, which can partially be explained by fewer unsolicited cardiopulmonary resuscitation measures and inferior female leadership. Future education of rescuers should take gender differences into account.
[Mh] Termos MeSH primário: Reanimação Cardiopulmonar/estatística & dados numéricos
Equipe de Respostas Rápidas de Hospitais/organização & administração
Estudantes de Medicina/estatística & dados numéricos
[Mh] Termos MeSH secundário: Competência Clínica
Feminino
Hospitais Universitários
Seres Humanos
Internato e Residência
Liderança
Masculino
Manequins
Equipe de Assistência ao Paciente/organização & administração
Estudos Prospectivos
Fatores Sexuais
Treinamento por Simulação
Suíça
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170617
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002375


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[PMID]:28434554
[Au] Autor:Fehr JJ; McBride ME; Boulet JR; Murray DJ
[Ad] Endereço:Anesthesiology & Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: fehrj@wustl.edu.
[Ti] Título:The Simulation-Based Assessment of Pediatric Rapid Response Teams.
[So] Source:J Pediatr;188:258-262.e1, 2017 Sep.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To create scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners. STUDY DESIGN: A set of 10 simulated scenarios was designed for the training and assessment of pediatric RRTs. Pediatric RRTs, comprising a pediatric intensive care unit (PICU) registered nurse and respiratory therapist, led by a PICU intensivist-in-training or a pediatric nurse practitioner, managed 7 simulated acutely decompensating patients. Two raters evaluated the scenario performances and psychometric analyses of the scenarios were performed. RESULTS: The teams readily managed scenarios such as supraventricular tachycardia and opioid overdose but had difficulty with more complicated scenarios such as aortic coarctation or head injury. The management of any particular scenario was reasonably predictive of overall team performance. The teams led by the PICU intensivists-in-training outperformed the teams led by the pediatric nurse practitioners. CONCLUSIONS: Simulation provides a method for RRTs to develop decision-making skills in managing decompensating pediatric patients. The multiple scenario assessment provided a moderately reliable team score. The greater scores achieved by PICU intensivist-in-training-led teams provides some evidence to support the validity of the assessment.
[Mh] Termos MeSH primário: Competência Clínica
Equipe de Respostas Rápidas de Hospitais
[Mh] Termos MeSH secundário: Adulto
Cuidados Críticos
Docentes de Medicina
Feminino
Seres Humanos
Masculino
Meia-Idade
Missouri
Profissionais de Enfermagem
Recursos Humanos de Enfermagem no Hospital
Pediatria
Terapia Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170425
[St] Status:MEDLINE


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[PMID]:28346260
[Au] Autor:Kim Y; Lee DS; Min H; Choi YY; Lee EY; Song I; Park JS; Cho YJ; Jo YH; Yoon HI; Lee JH; Lee CT; Do SH; Lee YJ
[Ad] Endereço:1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 4Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 5Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
[Ti] Título:Effectiveness Analysis of a Part-Time Rapid Response System During Operation Versus Nonoperation.
[So] Source:Crit Care Med;45(6):e592-e599, 2017 Jun.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To evaluate the effect of a part-time rapid response system on the occurrence rate of cardiopulmonary arrest by comparing the times of rapid response system operation versus nonoperation. DESIGN: Retrospective cohort study. SETTING: A 1,360-bed tertiary care hospital. PATIENTS: Adult patients admitted to the general ward were screened. Data were collected over 36 months from rapid response system implementation (October 2012 to September 2015) and more than 45 months before rapid response system implementation (January 2009 to September 2012). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The rapid response system operates from 7 AM to 10 PM on weekdays and from 7 AM to 12 PM on Saturdays. Primary outcomes were the difference of cardiopulmonary arrest incidence between pre-rapid response system and post-rapid response system periods and whether the rapid response system operating time affects the cardiopulmonary arrest incidence. The overall cardiopulmonary arrest incidence (per 1,000 admissions) was 1.43. Although the number of admissions per month and case-mix index were increased (3,555.18 vs 4,564.72, p < 0.001; 1.09 vs 1.13, p = 0.001, respectively), the cardiopulmonary arrest incidence was significantly decreased after rapid response system (1.60 vs 1.23; p = 0.021), and mortality (%) was unchanged (1.38 vs 1.33; p = 0.322). After rapid response system implementation, the cardiopulmonary arrest incidence significantly decreased by 40% during rapid response system operating times (0.82 vs 0.49/1,000 admissions; p = 0.001) but remained similar during rapid response system nonoperating times (0.77 vs 0.73/1,000 admissions; p = 0.729). CONCLUSIONS: The implementation of a part-time rapid response system reduced the cardiopulmonary arrest incidence based on the reduction of cardiopulmonary arrest during rapid response system operating times. Further analysis of the cost effectiveness of part-time rapid response system is needed.
[Mh] Termos MeSH primário: Parada Cardíaca/epidemiologia
Parada Cardíaca/terapia
Equipe de Respostas Rápidas de Hospitais/organização & administração
Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos
Quartos de Pacientes/organização & administração
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Parada Cardíaca/mortalidade
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Centros de Atenção Terciária
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170328
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002314


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[PMID]:28277773
[Au] Autor:Hartin J; Walker J
[Ad] Endereço:Senior Nurse, Patient Emergency Response and Resuscitation Team (PERRT); Co-Chair Talking DNACPR Project Management Board, PERRT office, University College Hospital, London NW1 2BU.
[Ti] Título:Rapid response systems supporting end of life care: time for a new approach.
[So] Source:Br J Hosp Med (Lond);78(3):160-164, 2017 Mar 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Rapid response systems have been implemented worldwide to support management of deteriorating patients outwith critical care units, and are increasingly required to support end of life care. These challenges require a new approach to supporting staff involved in do not attempt cardiopulmonary resuscitation decisions.
[Mh] Termos MeSH primário: Comunicação
Parada Cardíaca/terapia
Equipe de Respostas Rápidas de Hospitais
Assistência Terminal
[Mh] Termos MeSH secundário: Reanimação Cardiopulmonar
Seres Humanos
Ordens quanto à Conduta (Ética Médica)
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.3.160


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[PMID]:28277768
[Au] Autor:Patel S; Gillon SA; Jones DA
[Ad] Endereço:ST1 Radiology Registrar, Radiology Department, Guys Hospital, London SE1 9RT.
[Ti] Título:Rapid response systems: recognition and rescue of the deteriorating hospital patient.
[So] Source:Br J Hosp Med (Lond);78(3):143-148, 2017 Mar 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The last 25 years have witnessed significant change in the approach to the deteriorating patient. This article reviews and discusses the merits and drawbacks of the various systems used across the world.
[Mh] Termos MeSH primário: Estado Terminal/terapia
Diagnóstico Precoce
Intervenção Médica Precoce
Equipe de Respostas Rápidas de Hospitais
[Mh] Termos MeSH secundário: Progressão da Doença
Medicina Baseada em Evidências
Falha da Terapia de Resgate
Parada Cardíaca
Frequência Cardíaca
Seres Humanos
Taxa Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.3.143


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[PMID]:28277762
[Au] Autor:Gooneratne M; Walker D
[Ad] Endereço:Consultant, Anaesthetist, The Royal London Hospital, London E1 1BB.
[Ti] Título:Rapid response systems and the deteriorating patient.
[So] Source:Br J Hosp Med (Lond);78(3):124-125, 2017 Mar 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Equipe de Respostas Rápidas de Hospitais
Assistência Terminal
[Mh] Termos MeSH secundário: Progressão da Doença
Diagnóstico Precoce
Intervenção Médica Precoce
Seres Humanos
[Pt] Tipo de publicação:EDITORIAL; INTRODUCTORY JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.3.124


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[PMID]:28277760
[Au] Autor:Hogan H; Carver C; Zipfel R; Hutchings A; Welch J; Harrison D; Black N
[Ad] Endereço:Clinical Senior Lecturer, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH.
[Ti] Título:Effectiveness of ways to improve detection and rescue of deteriorating patients.
[So] Source:Br J Hosp Med (Lond);78(3):150-159, 2017 Mar 02.
[Is] ISSN:1750-8460
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A number of interventions has been introduced to improve recognition of and response to deterioration, but evidence for improved outcomes is mixed. Future evaluations need better articulation of intervention components and outcomes, longer run-in times and consideration of the interplay between concurrent interventions.
[Mh] Termos MeSH primário: Estado Terminal/terapia
Equipe de Respostas Rápidas de Hospitais
Corpo Clínico Hospitalar/educação
Recursos Humanos de Enfermagem no Hospital/educação
Transferência da Responsabilidade pelo Paciente/normas
Sinais Vitais
[Mh] Termos MeSH secundário: Diagnóstico Precoce
Intervenção Médica Precoce
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.12968/hmed.2017.78.3.150



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