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1.
Res Gerontol Nurs ; : 1-13, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33492402

RESUMO

The purpose of the current study was to investigate the predictive properties of five definitions of a frailty risk score (FRS) and three comorbidity indices using data from electronic health records (EHRs) of hospitalized adults aged ≥50 years for 3-day, 7-day, and 30-day readmission, and to identify an optimal model for a FRS and comorbidity combination. Retrospective analysis of the EHR dataset was performed, and multivariable logistic regression and area under the curve (AUC) were used to examine readmission for frailty and comorbidity. The sample (N = 55,778) was mostly female (53%), non-Hispanic White (73%), married (53%), and on Medicare (55%). Mean FRSs ranged from 1.3 (SD = 1.5) to 4.3 (SD = 2.1). FRS and comorbidity were independently associated with readmission. Predictive accuracy for FRS and comorbidity combinations ranged from AUC of 0.75 to 0.77 (30-day readmission) to 0.84 to 0.85 (3-day readmission). FRS and comorbidity combinations performed similarly well, whereas comorbidity was always independently associated with readmission. FRS measures were more associated with 30-day readmission than 7-day and 3-day readmission. [Research in Gerontological Nursing, xx(x), xx-xx.].

3.
Dysphagia ; 35(5): 787-797, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31811381

RESUMO

Frail patients may have heightened risk of dysphagia, a potentially modifiable health factor. Our aim is to examine whether the relationship between dysphagia and adverse health outcomes differs by frailty conditions among inpatients ≥ 50 years of age. Medical or surgical hospitalizations among patients ≥ 50 years of age in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2014 through the first three quarters of 2015 were included. Adverse outcomes included length of stay (LOS), hospital costs, in-hospital mortality, discharge status, and medical complications. Dysphagia was determined by ICD-9-CM codes. Frailty was defined as (a) ≥ 1 condition in the10-item Johns Hopkins Adjusted Clinical Groups (ACG) frailty measure and a frailty index for the (b) ACG and (c) a 19-item Frailty Risk Score (FRS) categorized as non-frail, pre-frail, and frail. Weighted generalized linear models for complex survey designs using generalized estimating equations were performed. Of 6,230,114 unweighted hospitalizations, 4.0% had a dysphagia diagnosis. Dysphagia presented in 3.1% and 11.0% of non-frail and frail hospitalizations using the binary ACG (p < 0.001) and in 2.9%, 7.9%, and 16.0% of non-frail, pre-frail, and frail hospitalizations using the indexed FRS (p < 0.001). Dysphagia was associated with greater LOS, higher total costs, increased non-routine discharges, and more medical complications among both frail and non-frail patients using the three frailty definitions. Dysphagia was associated with adverse outcomes in both frail and non-frail medical or surgical hospitalizations. Dysphagia management is an important consideration for providers seeking to reduce risk in vulnerable populations.

4.
J Nurs Educ ; 58(10): 607-610, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573652

RESUMO

BACKGROUND: Faculty who teach gerontological nursing are challenged to deliver competency-based baccalaureate nursing education. Because our courses are divided into multiple sections and taught by a variety of faculty, the need for a peer-reviewed, curated repository of gerontological learning materials was conceived. METHOD: Syllabi for prelicensure and RN-to-baccalaureate nursing (BSN) degree gerontological courses were reviewed. Stufflebeam's Content, Input, Process and Product (CIPP) model of program evaluation provided a framework to guide the process of identifying existing resources and gaps in eLearning materials. Using the Learning Object Review Instrument, faculty determined the relevance and applicability of eLearning materials. RESULTS: A crosswalk between the syllabi and the American Association of Colleges of Nursing-recommended geriatric nursing competencies was completed to evaluate eLearning materials identified as valuable. Consensus was reached, and content was placed in the learning management system. CONCLUSION: This project can serve as a model for other course faculty and faculty in other specialty areas to enhance the curriculum by providing readily available, multifaceted instructional resources. [J Nurs Educ. 2019;58(10):607-610.].


Assuntos
Educação Baseada em Competências/organização & administração , Currículo , Bacharelado em Enfermagem/organização & administração , Enfermagem Geriátrica/educação , Docentes de Enfermagem/psicologia , Humanos , Aprendizagem , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Revisão por Pares , Estudantes de Enfermagem/psicologia
5.
JAMIA Open ; 2(1): 205-214, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31984354

RESUMO

Objective: We sought to assess the current state of risk prediction and segmentation models (RPSM) that focus on whole populations. Materials: Academic literature databases (ie MEDLINE, Embase, Cochrane Library, PROSPERO, and CINAHL), environmental scan, and Google search engine. Methods: We conducted a critical review of the literature focused on RPSMs predicting hospitalizations, emergency department visits, or health care costs. Results: We identified 35 distinct RPSMs among 37 different journal articles (n = 31), websites (n = 4), and abstracts (n = 2). Most RPSMs (57%) defined their population as health plan enrollees while fewer RPSMs (26%) included an age-defined population (26%) and/or geographic boundary (26%). Most RPSMs (51%) focused on predicting hospital admissions, followed by costs (43%) and emergency department visits (31%), with some models predicting more than one outcome. The most common predictors were age, gender, and diagnostic codes included in 82%, 77%, and 69% of models, respectively. Discussion: Our critical review of existing RPSMs has identified a lack of comprehensive models that integrate data from multiple sources for application to whole populations. Highly depending on diagnostic codes to define high-risk populations overlooks the functional, social, and behavioral factors that are of great significance to health. Conclusion: More emphasis on including nonbilling data and providing holistic perspectives of individuals is needed in RPSMs. Nursing-generated data could be beneficial in addressing this gap, as they are structured, frequently generated, and tend to focus on key health status elements like functional status and social/behavioral determinants of health.

7.
J Psychosoc Nurs Ment Health Serv ; 56(7): 20-29, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29975396

RESUMO

Frailty is a syndrome of impaired homeostasis and poor response to stressors leading to adverse health outcomes. The aim of the current study was to explore lay perspectives about frailty among African American adults. Thirteen men and women participated in two focus groups. Content analysis yielded six themes: (a) Physical Impairment With Loss of Independence; (b) Can Happen to Anyone, At Any Age, At Any Time; (c) Mind-Body Connection; (d) Affects All Aspects of Life; (e) Positive Attitude and Prayer Guard Against Frailty; and (f) Be In Tune and Stay Connected. Findings suggest psychological and social factors, including a positive attitude and spirituality, are linked to physical function and well-being in aging and are influential in frailty. Culturally tailored interventions that focus not only on promoting physical function but also address psychological, social, and spiritual domains may foster the resilience needed to prevent or alleviate frailty in African American individuals. [Journal of Psychosocial Nursing and Mental Health Services, 56(7), 20-29.].


Assuntos
Afro-Americanos/psicologia , Fragilidade , Apoio Social , Espiritualidade , Idoso , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Inquéritos e Questionários
8.
J Psychosoc Nurs Ment Health Serv ; 56(7): 46-55, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-29975398

RESUMO

The purpose of the current study was to explore resilience in senior-level baccalaureate nursing students. Twenty-seven participants completed an online questionnaire assessing three stressors that pertained to marriage or divorce, death or loss of family members or close friends, and extreme financial hardship in the past 1 year. Resilience was measured using the 25-item Connor-Davidson Resilience Scale (CD-RISC-25) and one open-ended question about the experience of resilience. Mean CD-RISC-25 score was 73.26 (SD = 10.7; range = 45 to 96); only 33.3% of the sample was considered resilient (score >80). Qualitative data described academic stressors and support resources for resilience. Study findings underscore the relevance of resilience in nursing students. Nurse educators must help nursing students develop resilience to better prepare them for academic success and ensure a smooth transition into their professional nursing role. [Journal of Psychosocial Nursing and Mental Health Services, 56(7), 46-55.].


Assuntos
Bacharelado em Enfermagem/métodos , Psicometria , Resiliência Psicológica , Estresse Psicológico/psicologia , Estudantes de Enfermagem/psicologia , Adulto , Competência Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
9.
J Clin Nurs ; 27(19-20): 3510-3521, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29777549

RESUMO

BACKGROUND: Research indicates that diabetes mellitus (DM) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM; however, there is limited research in hospitalised older adults. OBJECTIVES: To determine the extent of frailty in hospitalised older adults with and without DM using a 16-item Frailty Risk Score (FRS) and assess the role of frailty in predicting 30-day rehospitalisation, discharge to an institution and in-hospital mortality. METHODS: The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data. The sample was older adults hospitalised on medicine units. Logistic regression was performed for 30-day rehospitalisation and discharge location. Cox proportional hazards regression was used to analyse time to in-hospital death and weighted using propensity scores. RESULTS: Of 278 hospitalised older adults, 49% had DM, and the mean FRS was not significantly different by DM status (9.6 vs. 9.1, p = 0.07). For 30-day rehospitalisation, increased FRS was associated with significantly increased odds of rehospitalisation (AOR = 1.24, 95% CI [1.01, 1.51], p = 0.04). Although 81% were admitted from home, 57% were discharged home and 43% to an institution. An increased FRS was associated with increased odds of discharge to an institution (AOR = 1.48, 95% CI [1.26, 1.74], p < 0.001). The FRS was not significantly associated with increased risk of in-hospital death (p = 0.17), but DM was associated with a 484% increase in the instantaneous risk of death (AHR = 5.84, 95% CI [1.71, 19.9], p = 0.005). CONCLUSION: Diabetes mellitus and frailty were highly prevalent; the mean FRS was not significantly different by DM status. Although increased frailty was significantly associated with rehospitalisation and discharge to an institution, only DM was significantly associated with in-hospital mortality. RELEVANCE TO CLINICAL PRACTICE: Frailty assessment may augment clinical assessment and facilitate tailoring care and determining optimal outcomes in patients with and without DM.


Assuntos
Complicações do Diabetes/complicações , Fragilidade/complicações , Fragilidade/diagnóstico , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Complicações do Diabetes/mortalidade , Registros Eletrônicos de Saúde , Feminino , Idoso Fragilizado , Fragilidade/mortalidade , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Alta do Paciente , Prevalência , Estudos Retrospectivos , Fatores de Risco
10.
Biol Res Nurs ; 19(2): 213-228, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27913742

RESUMO

INTRODUCTION: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS: The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS: The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION: Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.


Assuntos
Registros Eletrônicos de Saúde , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/métodos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sudeste dos Estados Unidos , Centros de Atenção Terciária/estatística & dados numéricos
12.
Res Gerontol Nurs ; 5(1): 64-76, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21702425

RESUMO

Poor understanding of factors influencing integration of new practices into long-term care (LTC) hinders timely implementation of evidence-based practices (EBPs). Using the Diffusion of Innovations (DOI) framework, a new instrument measuring staff perceptions of an EBP was developed as part of a DOI-LTC measurement battery and tested in a cross-sectional survey of North Carolina LTC nursing personnel. Valid questionnaires were received from 95 licensed nurses and 102 certified nursing assistants (CNAs). Internal consistency reliability for five of seven subscales was acceptable (Cronbach's alpha coefficient = 0.77 to 0.95). Perception of innovation attributes was associated with intention to adopt the new practice (Spearman rho correlation: licensed nurses = 0.41 to 0.68, p < 0.0001; CNAs = 0.26 to 0.54, p = 0.05 to <0.0001). The DOI-LTC measurement battery represents a promising new approach to studying implementation of EBPs in LTC. Future work should examine its responsiveness to interventions that facilitate implementation of EBPs in LTC.


Assuntos
Difusão de Inovações , Casas de Saúde , Estudos Transversais , Assistência de Longa Duração , North Carolina , Enfermeiras e Enfermeiros , Inquéritos e Questionários , Recursos Humanos
13.
J Prof Nurs ; 27(4): 202-14, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21767817

RESUMO

Nursing faculty members are responsible for assuring competence and safety in the preparation of prelicensure students who are preparing to deliver care in diverse settings. The growing complexity of care and the rapid expansion of knowledge have challenged the adequacy of traditional educational approaches. Proposed solutions have encouraged closer integration of classroom and clinical teaching. This article describes an integrated instructional approach to developing clinical leadership competencies in a cohort of accelerated, second-degree, baccalaureate nursing students. Fifty-six students completed an intensive clinical experience in long-term care settings in which they used evidence on improving care for persons with heart failure to practice the principles of delegation and supervision with nursing staff. The pre- and postassessments indicated improvement in heart failure knowledge and increased readiness for delegation and supervision of certified nursing assistants. As one component of the learning experience, the students completed reflection journals. The entries in the students' journals revealed five themes: (a) low leadership self-efficacy, (b) managing the credibility gap, (c) flexibility in communication strategies, (d) RN accountability in delegation and supervision, and (e) knowledge dissemination with diverse nursing staff. Students and faculty judged the learning experience to be successful and supported the experience for future cohorts of students. This report is one example of how innovative learning experiences could be developed to increase the "real-world" aspects of clinical care within a multidisciplinary team context for the entry-level learner.


Assuntos
Educação em Enfermagem/organização & administração , Liderança , Inovação Organizacional , Estudantes de Enfermagem , Modelos Educacionais
15.
Nurse Educ Pract ; 10(4): 243-8, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20100666

RESUMO

Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients' conditions, complex care environments, and limited advanced clinical training of nursing staff. To translate key elements of heart failure guidelines into practice in a nursing home, the Connected Learning Model was developed based on the diffusion of innovations framework. An advanced practice nurse in geriatrics fostered greater interaction and collaboration among key administrative, medical, and nursing staff to promote awareness of heart failure guidelines and to translate key practices from those guidelines into the nursing home setting. Direct care staff skills for early recognition and reporting of signs and symptoms of acute heart failure were enhanced through a learner-centered educational program which included classroom and unit-based instruction and bedside clinical teaching. The Connected Learning Model is a promising method to mobilize advanced nursing expertise to bridge research/practice gaps through implementation of clinical practice guidelines that are systematically adapted to accommodate diverse health care contexts.


Assuntos
Difusão de Inovações , Educação em Enfermagem/métodos , Enfermagem Baseada em Evidências/educação , Enfermagem Geriátrica/educação , Fidelidade a Diretrizes , Insuficiência Cardíaca/enfermagem , Humanos , Casas de Saúde/organização & administração , Casas de Saúde/normas , Guias de Prática Clínica como Assunto , Aprendizagem Baseada em Problemas
16.
Online J Issues Nurs ; 15(2)2010 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-25006330

RESUMO

This study is a qualitative, descriptive study of how registered nurses (RNs) (N=33) in leadership roles in institutionalized long-term care settings delegate care, including their strategies and processes for delegating care, and their perceptions of barriers to effective delegation and potential benefits of delegation. Findings indicate two key approaches to delegation, including the "follow the job description" approach, emphasizing adherence to facility-level roles and job descriptions, and the "consider the scope of practice" approach, emphasizing consideration of multiple aspects of scope of practice and licensure, and the context of care. While the former resulted in more clarity and certainty for the RN, the latter facilitated a focus on quality of resident care outcomes as linked to the delegation process. Barriers to effective delegation were comparable among RNs using either approach to delegation, and almost all RNs could describe benefits of delegation for long-term care.

17.
ANS Adv Nurs Sci ; 32(4): 307-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19934837

RESUMO

Despite improvements in many aspects of health, African American women experience early onset of disease and disability and increased mortality because of health disparities. African American women experience stress and health disadvantages because of the interaction and multiplicative effects of race, gender, class, and age. Sojourner Syndrome is an illustrative and symbolic representation that describes the multiple roles and social identities of African American women on the basis of historical referents and adaptive behaviors that fostered survival and resilience under oppressive circumstances. Adaptive behaviors also precipitated health risks due to chronic active coping. Weathering describes the cumulative health impact of persistent stress and chronic active coping that contributes to early health deterioration and increased morbidity, disability, and mortality in African American women. An emancipatory knowing nursing perspective provides a viewpoint from which to examine social injustices that create conditions for the excessive health burdens experienced by African American women and to frame nursing actions that create opportunities to promote health and eliminate health disparities.


Assuntos
Afro-Americanos/etnologia , Identidade de Gênero , Disparidades nos Níveis de Saúde , Papel do Profissional de Enfermagem , Estresse Psicológico/etnologia , Mulheres/psicologia , Adaptação Psicológica , Afro-Americanos/estatística & dados numéricos , Feminino , Promoção da Saúde , Humanos , Pesquisa em Enfermagem/organização & administração , Defesa do Paciente , Preconceito , Projetos de Pesquisa , Resiliência Psicológica , Autoimagem , Classe Social , Identificação Social , Justiça Social , Estresse Psicológico/complicações , Estresse Psicológico/prevenção & controle , Estados Unidos/epidemiologia , Saúde da Mulher
18.
J Gerontol Nurs ; 35(4): 26-33; quiz 34-5, 2009 04.
Artigo em Inglês | MEDLINE | ID: mdl-19452736

RESUMO

Evidence-based practice holds tremendous potential to optimize care outcomes for older adults, yet many nurses are ill prepared to identify, interpret, and apply the best evidence to their practice. The Geriatric Nursing Innovations through Education (GNIE) Institute is a 39-contact-hour, hybrid distance learning continuing education model designed to strengthen RNs'clinical knowledge, leadership skills, and capacity for implementing evidence-based geriatric care. The GNIE Institute combines reflective, learner-centered instructional approaches with a practicum during which evidence-based guidelines are implemented.The experiences of 128 RNs suggest that the GNIE Institute supports the implementation of a variety of best practices, including management of acute pain, dehydration, delirium, oral hygiene, urinary incontinence, and falls prevention. Participant feedback has shown low initial awareness of practice guidelines but high satisfaction with their use. The GNIE Institute thus represents a viable model for building the capacity of practicing RNs to implement evidence-based approaches to the care of geriatric syndromes across the care continuum.


Assuntos
Enfermagem Baseada em Evidências/educação , Geriatria/educação , Educação a Distância , Internet
19.
J Am Geriatr Soc ; 56(6): 1080-6, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18410318

RESUMO

OBJECTIVES: To determine whether satisfaction of on-site nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN: Longitudinal quality improvement study. SETTING: Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center. PARTICIPANTS: Eighteen registered nurses. INTERVENTION: Communicating Health Assessments by Telephone (Project CHAT), a program of individualized training sessions and decision support tools to aid LTC nurses with symptom assessment and communication of health information over the telephone. MEASUREMENTS: Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT). RESULTS: The nurses' average satisfaction scores increased on several items, including those that assessed whether the nurse was pretty sure what pieces of information the physician was going to ask for (P=.04), felt that the amount of patient information the physician asked for seemed reasonable (P=.03), felt prepared to answer the questions the physician asked (P=.01), and felt that the process of gathering patient information for the physician was easy (P=.01). The percentage of calls that resulted in immediate evaluation by a physician (on-site or in the emergency department) increased from 2.0% in the period before Project CHAT to 8.6% in the period after Project CHAT (P=.01). CONCLUSION: Nurses' satisfaction with several aspects of after-hours telephone medicine improved after an inexpensive, education-based intervention in one LTC facility. Further research is needed to determine how similar interventions might affect other quality measures, including patient outcomes.


Assuntos
Plantão Médico , Casas de Saúde , Relações Médico-Enfermeiro , Garantia da Qualidade dos Cuidados de Saúde , Desenvolvimento de Pessoal , Atitude do Pessoal de Saúde , Grupos Focais , Humanos , Assistência de Longa Duração , Estudos Longitudinais , Telefone , Estados Unidos , United States Department of Veterans Affairs , Recursos Humanos
20.
J Am Geriatr Soc ; 55(12): 1989-94, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18081673

RESUMO

OBJECTIVES: To describe after-hours telephone calls from nurses in long-term care (LTC) facilities to doctors in a geriatric medicine training program. DESIGN: Evaluation of 1,928 after-hours calls from LTC facilities over a 10-month period in 2005/06. SETTING: Geriatrics fellowship program and three affiliated LTC facilities. PARTICIPANTS: Eight geriatrics fellows and 40 medicine interns. MEASUREMENTS: Data were collected on call characteristics (such as reason for call and call outcome) and physician attitudes about the call, scored using a 5-point Likert scale. RESULTS: Clinical problems were the focus of 70.4% of the calls. The range of clinical problems was broad; most common reasons for calls were falls (n=377), pain (n=138), and agitation (n=100). The majority of calls resulted in medical intervention, including new medications or treatments (43.4%), diagnostic tests (10.2%), or more-extensive medical evaluation in the emergency department (9.1%) or by an on-site physician (2.4%). Overall, physician trainees had favorable attitudes about most after-hours calls, although medicine interns taking calls had a less-favorable impression and felt less prepared to manage them. CONCLUSION: After-hours telephone calls from LTC facilities are common, reflect the heterogeneity of geriatric health concerns, and typically result in intervention. As the LTC population grows, more study is needed on telephone care and optimal strategies for training physicians in this important aspect of LTC.


Assuntos
Plantão Médico/estatística & dados numéricos , Geriatria/educação , Assistência de Longa Duração , Telefone , Atitude do Pessoal de Saúde , Coleta de Dados/métodos , Bolsas de Estudo , Geriatria/organização & administração , Humanos , Internato e Residência , Modelos Logísticos
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