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1.
Otolaryngol Clin North Am ; 55(1): 145-151, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34823713

RESUMO

A perfect storm of events to include the COVID-19 global pandemic and technologic advances has led to the emergence of telemedicine in otolaryngology as a means to deliver remote clinical services to patients in their home and other clinical settings. There are benefits, such as increased safety and increased access to care, but also challenges, such as need for advanced technology and familiarity with computers. Telemedicine could play a greater role in otolaryngology in the future with advances in smartphone and endoscopic technology allowing for more detailed examination of patients.


Assuntos
COVID-19 , Otolaringologia , Telemedicina , Humanos , Recompensa , SARS-CoV-2
2.
J Nurs Care Qual ; 37(1): 47-53, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34224534

RESUMO

BACKGROUND: Influenza vaccinations are a preventive health quality measure. Home telehealth nursing staff interventions can reduce influenza disease burden and complications. PURPOSE: To improve seasonal flu vaccine rates using novel home telehealth clinical and technology interventions. METHODS: A pre- and postintervention concurrent cohort study for 513 outpatients was conducted. Interventions included automated 2-way patient messaging using remote monitoring equipment, a new note template to record vaccination status in the electronic health record, and flu vaccine patient education. RESULTS: Interventions resulted in vaccination rates of 70.4% for Veterans ages 19 to 65 years, and 81.7% for Veterans 66 years and older, exceeding national, regional, and local Veterans Administration targets. CONCLUSIONS: Two-way messaging and standardized documentation increased rates. Declinations persisted despite education. Reasons included fear of side effects, and rarely leaving home due to the COVID-19 pandemic. Nursing interventions can increase influenza vaccination quality measures for primary care home telehealth patients.


Assuntos
COVID-19 , Influenza Humana , Telemedicina , Adulto , Idoso , Estudos de Coortes , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pessoa de Meia-Idade , Pandemias , Indicadores de Qualidade em Assistência à Saúde , SARS-CoV-2 , Vacinação , Adulto Jovem
3.
J Public Health Manag Pract ; 28(1): 77-85, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34654021

RESUMO

CONTEXT: During the COVID-19 pandemic, demand for telehealth services increased to reduce disease exposure for patients and providers and to meet preexisting demand for physician services in health resource shortage areas. OBJECTIVE: To estimate self-reported telehealth availability, equipment for accessing telehealth, and telehealth usage among Medicare beneficiaries during the COVID-19 pandemic. DESIGN: We used data from the 2020 Medicare Current Beneficiary Survey (MCBS) COVID-19 Fall Supplement Public Use File to estimate the weighted percentages of beneficiaries who had (a) access to telehealth before or during COVID-19; (b) equipment for accessing telehealth; and (c) telehealth visits during COVID-19. We used logistic regression to examine sociodemographic factors associated with telehealth usage. PARTICIPANTS: Beneficiaries who participated in the MCBS COVID-19 Fall Supplements. RESULTS: During October and November 2020, telehealth appointments offered by providers were available to 63.8% (95% confidence interval [CI], 61.8-65.9) of Medicare beneficiaries who had accessed medical care by telephone or video. Among those, only 18.0% (95% CI, 16.1-19.9) had been offered telehealth before the pandemic. The majority of beneficiaries (92.2%; 95% CI, 91.2-93.1) had 1 or more types of equipment available for accessing telehealth, but only 44.9% (95% CI, 43.0-46.9) had had a telehealth visit since July 1, 2020. Older adults, minorities, those with a lower income, and non-English speakers had less availability of telehealth equipment. Patient characteristics were significantly (P < .05) associated with telehealth use, including age, sex, race/ethnicity, and equipment availability. CONCLUSION: Telehealth availability for Medicare beneficiaries increased substantially during the COVID-19 pandemic. Even with the improvement in telehealth offerings and use hastened by the pandemic, gaps in access and use still exist. Effectiveness and implementation research can find ways to close gaps in telehealth services between vulnerable and underrepresented populations and counterparts.


Assuntos
COVID-19 , Telemedicina , Idoso , Humanos , Medicare , Pandemias/prevenção & controle , SARS-CoV-2 , Estados Unidos
4.
Recurso na Internet em Inglês, Espanhol, Português | LIS - Localizador de Informação em Saúde | ID: lis-48554

RESUMO

A Organização Pan-Americana da Saúde (OPAS) lançou nesta sexta-feira (19) a “Pahola”, primeira profissional de saúde digital do mundo a se especializar em álcool e saúde, como parte de um esforço para ajudar os países da Região a reduzir as taxas crescentes do consumo nocivo do álcool.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Telemedicina/métodos , Organização Pan-Americana da Saúde , Inteligência Artificial
5.
J Telemed Telecare ; 27(10): 625-630, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726990

RESUMO

Telepalliative care services enable clinicians to provide essential palliation services to people with a life-limiting illness in or closer to home. This study aims to explore the costs, service activity and staff experiences resulting from the introduction of telehealth in a community palliative care service in Queensland, Australia. Pre- and post-activity and cost data from the 2016-2017 and 2019-2020 financial years were examined and staff members interviewed. Accounting for inflation and standard wage increases, the labour costs before and after the addition of telehealth were approximately equal. There were small variations in non-labour costs, but these were not directly attributable to the expansion of the telehealth services. Overall, the service activity increased by 189% for standard doctor and nurse consultations, due to the increased efficiency of telehealth compared to the previous outreach (travel) model. Thematic analysis of the staff interview data generated an overarching theme of Increased Job Satisfaction which staff attributed to the patient-centred nature of the telepalliative care service, the increased peer support and increased professional development. Compared with the traditional in-person service, the new telehealth-supported model resulted in equivalent costs, greater efficiency by allowing palliative care to reach more patients and improved staff job satisfaction.


Assuntos
Serviços de Saúde Comunitária , Cuidados Paliativos , Telemedicina , Austrália , Humanos , Satisfação no Emprego , Queensland
6.
J Telemed Telecare ; 27(10): 685-690, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726991

RESUMO

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases.We hypothesise that a model of care co-designed with stakeholders will address patients' needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service.The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.


Assuntos
Reabilitação Cardíaca , Infarto do Miocárdio , Serviços de Saúde Rural , Telemedicina , Austrália , Seguimentos , Humanos
7.
J Telemed Telecare ; 27(10): 667-673, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726994

RESUMO

We aimed to develop a telehealth peer support program for isolated dementia caregivers. This paper reports the co-design process by telehealth and the impact and experiences of participants. The Double Diamond model guided the co-design process, which has four phases, with participants reflecting on their caregiving experiences. Group meetings were recorded, notes compiled with inductive thematic analysis undertaken for phases one to three. Each phase findings were presented to the group for verification and refinement. Semi-structured interviews with participants were completed at the end of the project. Six dementia caregivers were recruited from dispersed locations with diverse characteristics. The process identified eight key topics to be included in a program to be delivered by telehealth. Participants reported the technology did not detract from the co-design and at times aided it, despite some technical problems. All reported high levels of group connectedness, feeling supported and transfer of knowledge and skills. One participant would have liked more understanding of the process. The group continued to meet without professional input for 2.5 years following the completion of the project. Telehealth can be a mechanism to support diverse populations in participating in co-design projects.


Assuntos
Aconselhamento , Demência , Grupo Associado , Apoio Social , Telemedicina , Cuidadores , Demência/terapia , Humanos
8.
J Telemed Telecare ; 27(10): 674-679, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726995

RESUMO

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.


Assuntos
Geriatria , Telemedicina , Idoso , Humanos , Encaminhamento e Consulta , Especialização , Vitória
9.
J Telemed Telecare ; 27(10): 609-614, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726998

RESUMO

This study describes and analyses the Medicare Benefits Schedule (MBS) activity and cost data for specialist consultations in Australia, as a result of the coronavirus disease 2019 (COVID-19) pandemic. To achieve this, activity and cost data for MBS specialist consultations conducted from March 2019 to February 2021 were analysed month-to-month. MBS data for in-person, videoconference and telephone consultations were compared before and after the introduction of COVID-19 MBS telehealth funding in March 2020. The total number of MBS specialist consultations claimed per month did not differ significantly before and after the onset of COVID-19 (p = 0.717), demonstrating telehealth substitution of in-person care. After the introduction of COVID-19 telehealth funding, the average number of monthly telehealth consultations increased (p < 0.0001), representing an average of 19% of monthly consultations. A higher proportion of consultations were provided by telephone when compared to services delivered by video. Patient-end services did not increase after the onset of COVID-19, signifying a divergence from the historical service delivery model. Overall, MBS costs for specialist consultations did not vary significantly after introducing COVID-19 telehealth funding (p = 0.589). Telehealth consultations dramatically increased during COVID-19 and patients continued to receive specialist care. After the onset of COVID-19, the cost per telehealth specialist consultation was reduced, resulting in increased cost efficiency to the MBS.


Assuntos
COVID-19 , Encaminhamento e Consulta , Telemedicina , Austrália , Humanos , Programas Nacionais de Saúde , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/tendências
10.
J Am Vet Med Assoc ; 259(10): 1140-1147, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34727081

RESUMO

OBJECTIVE: To gather and evaluate veterinarians' perspectives about the impacts of the COVID-19 pandemic on the use of veterinary telehealth and on cat owners' versus dog owners' attitudes toward transmission of the SARS-CoV-2 virus from their pets. SAMPLE: 93 respondent veterinarians (47 in primary care practice and 46 in specialty practice). PROCEDURES: An online survey was conducted between June 15 and July 15, 2020, and included 21 questions concerning demographics, use of telehealth before and after the onset of the pandemic (before March 15, 2020, and between March 15 and June 15, 2020, respectively), changes in caseloads, and perception of clients' concerns about potential for transmission of the SARS-CoV-2 virus from pets. Reported zip codes informed the collection of census data. RESULTS: The level of poverty was significantly lower in zip code areas for respondents who reported telehealth services were (vs were not) offered before the pandemic. The percentage of respondents who reported their practice offered telehealth services increased from 12% (11/93) before the pandemic to 38% (35/93) between March 15 and June 15, 2020. Although most respondents reported owner-expressed concerns over SARS-CoV-2 virus transmission from their pets, most also reported increased caseloads, seeing newly adopted pets, and few discussions of surrender of pets for reasons related to the SARS-CoV-2 virus. CONCLUSIONS AND CLINICAL RELEVANCE: Findings indicated that caseloads increased and telehealth services expanded during the pandemic but that there was no evidence of differences in respondent-reported owner concern for SARS-CoV-2 virus transmission from cats versus dogs.


Assuntos
COVID-19 , Doenças do Gato , Doenças do Cão , Telemedicina , Médicos Veterinários , Animais , Atitude , COVID-19/veterinária , Doenças do Gato/epidemiologia , Gatos , Doenças do Cão/epidemiologia , Cães , Humanos , Propriedade , Pandemias , Percepção , Animais de Estimação , SARS-CoV-2 , Inquéritos e Questionários
12.
Stud Health Technol Inform ; 285: 58-64, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34734852

RESUMO

In this ongoing fall of the year 2021, many disciplines are frightened by the Covid-19 situation. A generalized sense of Scientific and administrative impotence, - in keeping the pandemic under real control, - is felt widely in Society. In this Invited Lecture the author reminds us of the blows suffered, recalls pertinent elements present in our social organization, browses selected eHealth experiences and proposes an open agenda of actions to allow the eHealth to help the population segments better, and individuals as well.


Assuntos
COVID-19 , Telemedicina , Humanos , Pandemias
13.
Stud Health Technol Inform ; 285: 205-210, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34734875

RESUMO

The aim of this paper was to evaluate the effect of telemedical care of gestational diabetes mellitus (GDM) patients with the digital treatment pathway model DiabCare Tirol. METHODS: 27 courses of patients with GDM, who were telemonitored through the integrated care program DiabCare Tirol in a diabetes outpatient clinic in Tyrol, Austria during the COVID-19 pandemic in 2020, were analyzed. In addition, randomized controlled trials (RCTs) on telemedicine interventions for GDM were researched, and their results were used for comparison with this disease management method. The patient outcome analysis was used to examine the effects of the integrated care program involving telemonitoring support and compared them to the results of RCTs in which participants were randomly assigned to one of two groups, either mobile monitored or standard treatment group. RESULTS: The feasibility of the digital treatment pathway model was confirmed in practice, as the trend analysis of the 27 GDM patients involved showed significantly improved glycaemic control. Results of RCT studies tend to support the findings of DiabCare Tirol. CONCLUSION: Benefits of telemonitoring with integrated care to support conventional therapy cannot be dismissed, especially in times of the pandemic. Continuous outcome research with larger patient numbers will be necessary to confirm the effectiveness of telemonitoring in a regular care setting.


Assuntos
Diabetes Gestacional , Telemedicina , Áustria , COVID-19 , Diabetes Gestacional/terapia , Feminino , Humanos , Monitorização Fisiológica , Gravidez
14.
Stud Health Technol Inform ; 285: 239-244, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34734880

RESUMO

Mobile Health has been increasingly present in healthcare due to the wide availability of applications for smartphones, however, robust assessment methods must be considered, seeking to provide evidence for clinical practice and mHealth solutions. This research presents the assessment of applications aimed at detecting and preventing falls for the elderly, available for Android and IOS, through the Mobile App Rating Scale. Based on the results presented, it can be concluded that the fall detection and prevention applications for the elderly available for Android and IOS showed good quality after rigorous evaluation.


Assuntos
Acidentes por Quedas , Aplicativos Móveis , Telemedicina , Acidentes por Quedas/prevenção & controle , Idoso , Atenção à Saúde , Humanos , Smartphone
15.
BMC Health Serv Res ; 21(1): 1203, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740340

RESUMO

BACKGROUND: The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. METHODS: Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. RESULTS: The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. CONCLUSIONS: This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients' engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.


Assuntos
Pessoal de Saúde , Telemedicina , Comunicação , Humanos , Pesquisa Qualitativa , Tecnologia
16.
Crit Care Nurs Clin North Am ; 33(4): 459-470, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34742501

RESUMO

Telehealth in intensive care units (TeleICU) is the provision of critical care using audio-visual communication and health information systems across varying clinical and geographically dispersed settings. The optimal structure of a TeleICU team is one that leverages expert clinical knowledge to address the needs of critical care patients, regardless of hospital location or availability of an onsite intensivist. Information related to the optimal TeleICU team structure is lacking. This article examines the optimal TeleICU team composition, which is one that incorporates the use of an interdisciplinary approach, leverages technology, and is cognizant of varying geographic locations.


Assuntos
Unidades de Terapia Intensiva , Telemedicina , Cuidados Críticos , Hospitais , Humanos , Equipe de Assistência ao Paciente
17.
J Wound Care ; 30(11): 916-921, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34747216

RESUMO

OBJECTIVE: Lower extremity ulcers (LEUs) are associated with a decline in patients' quality of life (QoL). Better healthcare availability in remote regions, facilitated by telemedicine (TM), may improve patient wellbeing. The aim of this study was to compare the QoL of patients treated via synchronous video TM with that of patients treated with standard face-to-face (FTF) care. METHOD: The study was performed in a large health services provider in Israel (Maccabi Healthcare Services). TM was used in four remote locations; the FTF method was applied in two regional clinics. The treatment protocol was performed by a nurse and supervised by the regional physician in both treatment modes. A validated Wound-QoL questionnaire in Hebrew was used to assess patient outcomes. RESULTS: A total of 83 patients were treated via TM and 94 patients were treated FTF. The mean QoL for patients treated via TM was 0.546±0.249 compared with 0.507±0.238 for the FTF group. A similarity relating to outcomes in both treatment methods was demonstrated by a difference of 0.039 (95% confidence interval -0.33-0.111) and p=0.291. The probability of the difference being within the limits of the interval in a replicated study was 83.4%. The equivalence/non-inferiority was established within the accepted Δ=0.12 range. CONCLUSION: The results indicated no reduced QoL for patients with LEUs treated with telemedicine versus with standard FTF care. DECLARATION OF INTEREST: The authors have no conflicts of interest.


Assuntos
Úlcera da Perna , Telemedicina , Humanos , Úlcera da Perna/terapia , Extremidade Inferior , Qualidade de Vida , Úlcera
18.
Rev Med Chil ; 149(6): 928-933, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34751353

RESUMO

Recognizing the role of technology in the development of medicine and the impact of telecommunication advances, we reflect on the meaning and ethics of the use of Telemedicine, both in its general dimension for the use and distribution of knowledge, as well as in the delivery of health actions, scientific research, and data management. Teleconsultation is discussed in greater detail, analyzing its process and application, reviewing its possible advantages and disadvantages, from the point of view of providers and patients. We highlight the need to carry out an appropriate evaluation of each instance, from the point of view of both the patient and the professional who uses it. The importance of maintaining a doctor-patient relationship in agreement with the nature and practice of Medicine, respecting people's dignity, is emphasized. We mention the ethical conditions that must be bore in mind for the proper use of telemedicine. We discuss the eventual influence that this practice will have on the concept and practice of medical care, while suggesting the need to legislate on the matter.


Assuntos
Relações Médico-Paciente , Telemedicina , Humanos , Princípios Morais
19.
Medicine (Baltimore) ; 100(41): e27399, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731112

RESUMO

ABSTRACT: The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.


Assuntos
Assistência Ambulatorial/organização & administração , Visita a Consultório Médico/estatística & dados numéricos , Telemedicina/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , Prestação Integrada de Cuidados de Saúde/organização & administração , Humanos , Kentucky/epidemiologia , Pandemias , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , SARS-CoV-2
20.
J Med Syst ; 45(12): 108, 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34755231

RESUMO

Despite improved outcomes at pediatric trauma centers (PTC), 90% of injured children are not treated at PTCs. Telemedicine may play a role in ensuring patients are transferred to the appropriate level of care. We aimed to determine the level of interest in trauma telemedicine with our PTC among referring facilities. A survey was conducted with the trauma program directors of 45 hospitals in Utah, which consisted of four multiple choice questions designed to determine interest in pediatric trauma telemedicine support, projected frequency of use, anticipated uses of telemedicine, and perceived barriers to implementation. Forty-one directors (91%) responded. 88% of directors were interested in developing a pediatric trauma telemedicine network. 20% estimated their center would use telemedicine more than once a week, 17% once a week, 24% once a month, and 37% a few times a year. The most frequently cited uses of a telemedicine program were triage/transfer decisions and provider support. Inadequate volume and insufficient funding were the most common perceived barriers. These data show there is a strong interest amongst hospitals in our state in pediatric trauma telemedicine. Inadequate volume to warrant a program and insufficient facility funding remain concerns for development of a program.


Assuntos
Telemedicina , Criança , Humanos , Centros de Traumatologia , Triagem
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