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1.
Gesundheitswesen ; 82(1): 14-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31962367

RESUMO

AIM: The aims of this study were to create a scale for measuring the sedating and activating effects of drugs and to analyse if the total value of this scale correlates significantly with falls requiring medical treatment in dementia patients. Furthermore, prescription of drugs in nursing homes included in the PRISCUS-List, Anticholinergic Cognitive Burden List (ACB-List) and usage of psychotropic drugs were investigated. METHOD: This is a data analysis of a randomized controlled trial which tested the effects of a non-pharmacological multimodal activation therapy (MAKS®) in 139 patients with degenerative dementia in 5 nursing homes. At the beginning of the study, all prescribed drugs were rated on a five-tier scale by 2 pharmacologists based on the drugs' sedating or activating effects. The scale ranged from severely activating (+2) to severely sedating (- 2). The "central nervous system (CNS) depressant score" of each patient was calculated by summing up the scale value of all the medications they were taking. The correlation between CNS-depressant score and falls resulting in injuries within an observation period of 12 months was investigated by binary logistic regression analysis. RESULTS: Nearly 30% of the nursing home residents received drugs listed in the PRISCUS-list, 50% received drugs on the ACB-List, 55% took psychotropic drugs and 66% received at least 5 drugs. Sedating drugs were prescribed to 62% of patients. During the observation period, 36 out of 139 nursing home residents suffered falls and medical treatment was necessary. In multivariate analysis, the CNS-depressant score was associated significantly (p=0.045) with falls with resulting injuries. Increased sedation resulted in a higher number of fall incidents. CONCLUSIONS: The CNS-depressant score is a useful tool to describe the degree of sedation. Due to the significant association between sedation and falls resulting in injuries, the sedating medication of people suffering from dementia should be minimised as much as possible to reduce the risk of undesirable side effects.


Assuntos
Acidentes por Quedas , Demência , Hipnóticos e Sedativos , Psicotrópicos , Acidentes por Quedas/estatística & dados numéricos , Antagonistas Colinérgicos , Demência/tratamento farmacológico , Alemanha , Humanos , Hipnóticos e Sedativos/efeitos adversos , Casas de Saúde , Psicotrópicos/efeitos adversos
2.
Hu Li Za Zhi ; 67(1): 25-32, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960394

RESUMO

With Taiwan now an "aged society", home safety for older individuals has become a very important issue. The purpose of establishing early warning systems in homes and/or communities is to generate and disseminate meaningful warning information to medical institutions or rescue units in a timely manner so that they may take timely and appropriate action. The main purpose of this paper is to introduce the current application of information and communication technology (ICT, especially the Internet of Things and artificial intelligence) in early warning systems for home and community care. Two approaches to developing these systems are introduced: instant detection and prevention monitoring. Instant detection facilitates fall detection and personnel tracking, while the focus of prevention monitoring is on preventing falls and physiological status monitoring. The challenges faced by in incorporating ICT into these early monitoring systems are discussed as well.


Assuntos
Serviços de Assistência Domiciliar , Tecnologia da Informação , Monitorização Fisiológica/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Inteligência Artificial , Humanos , Taiwan
3.
Medicine (Baltimore) ; 99(4): e18998, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977916

RESUMO

The causes for falls in the elderly are varied, and visual spatial neglect could be 1 contributing factor. Further, the presence of a carotid artery plaque, especially on the right side, might influence the visual spatial attention of the elderly.Our aim was to identify the intrinsic association between carotid plaques and lateralization of spatial attention in the elderly. Further, we sought to understand and potentially prevent the consequences of unilateral spatial neglect such as injury from falls.Participants aged 64 to 93 years were divided into a group with carotid artery plaque(s) of the right side or both sides (BOTH, n = 38; and 9/ 38 were right side only) and a group without right-side carotid artery plaque(s) (LEFT, n = 53). Participants were asked to perform a line bisection task and undergo doppler ultrasonography examinations.Contrary to expectations, compared to LEFT, the mean index and net scores of the line bisection errors in BOTH were significantly less leftward, but the mean diameter of the right-side common carotid artery in BOTH was significantly larger.Our results indicate that the presence of carotid plaque(s) might be linked to increased risk of falls in the elderly. The attenuated spatial neglect in participants with right-side carotid artery plaque(s) might be due to compensatory carotid artery dilatation.


Assuntos
Acidentes por Quedas , Estenose das Carótidas/complicações , Transtornos da Percepção/complicações , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/patologia , Artéria Carótida Interna/patologia , Estudos de Casos e Controles , Circulação Cerebrovascular/fisiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Fatores de Risco
4.
Isr Med Assoc J ; 22(1): 64-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927809

RESUMO

BACKGROUND: Falling from a height accounts for 14.1% of all hospital admissions for traumatic injury. In 5% of cases, the injury is severe or critical, and in 1.5%, it is fatal. The dangers of falling have been recognized since time immemorial. Indeed, the Bible instructs us to build a parapet around the roof of our home so that, "…you may not bring the guilt of bloodshed on your house if someone falls from it" (Deuteronomy 22:8). This commandment highlights the relatively simple and practical means by which we can prevent falls. It is also one of a series of ethical laws that are presented to help us understand and obey the larger Biblical precepts of loving one's neighbor and guarding the sanctity of life. The concept teaches us that it is the responsibility of all individuals to be cognizant of others and to avoid harming people through negligence or carelessness. The aim of this article is to explain the commandment to build a parapet in the context of the risk of falling from a height and to expand on its wider implications. The present work was prompted in part by the alarming increase in fatal and near-fatal accidents in Israel in two particular populations.


Assuntos
Acidentes por Quedas/prevenção & controle , Arquitetura de Instituições de Saúde , Códigos de Obras/legislação & jurisprudência , Arquitetura de Instituições de Saúde/legislação & jurisprudência , Humanos , Israel , Judaísmo
6.
Ann R Coll Surg Engl ; 102(1): e4-e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509003

RESUMO

Thoracoabdominal hernia following blunt trauma is extremely rare. Abdominal viscera are more likely to herniate into the thorax if there is traumatic diaphragmatic rupture. We report the case of a patient presenting with a traumatic thoracoabdominal hernia containing part of the right lobe of the liver and the hepatic flexure of the colon. The hernia migrated cranially, to protrude through a seventh intercostal defect despite the diaphragm remaining fully intact. The need for early multispecialty (thoracic and hepatobiliary) surgical repair is highlighted, with improvements in surgical outcome for a complex trauma case by using a novel chest-wall reconstruction technique.


Assuntos
Hérnia Diafragmática Traumática/cirurgia , Herniorrafia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes por Quedas , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia
7.
J Forensic Sci ; 65(1): 255-258, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31411743

RESUMO

The horizontal displacement of the human body resulting from fatal fall from a height is an important variable commonly used to inversely determine the cause or identify other forensic aspects of the fall. When examining the horizontal displacement, the wind effect is generally ignored. This technical note reports analytical modeling of the falling process, utilizing previous measurements of wind force acting on the human body, for determining the functional relationship between the wind speed and the horizontal displacement in the falling process. The result reveals that it does not take extremely rare wind conditions to cause a considerable shift of the human body, highlighting the importance to consider wind as a factor in investigations of fatal falls.


Assuntos
Acidentes por Quedas , Ciências Forenses/métodos , Modelos Biológicos , Modelos Estatísticos , Vento , Fenômenos Biofísicos , Estatura , Índice de Massa Corporal , Feminino , Humanos , Masculino
8.
J Forensic Sci ; 65(1): 193-195, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31433492

RESUMO

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.


Assuntos
Lesões Encefálicas/mortalidade , Base do Crânio/lesões , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Abuso Físico/estatística & dados numéricos , Distribuição por Sexo , Base do Crânio/patologia , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
9.
J Nurs Adm ; 50(1): 45-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31809456

RESUMO

OBJECTIVE: To examine if increasing the percentage of nurses with bachelor degrees (BSNs) and/or certified nurses leads to improved patient outcomes, specifically the number of reported falls. BACKGROUND: Research suggests a link between higher levels of education and expertise and positive patient outcomes, including falls. The Institute of Medicine recommends an increase in BSN nurses. METHODS: This was a retrospective cross-sectional cohort analysis using data from the National Database of Nursing Quality Indicators from 2010 to 2016 from multiple medical centers in Central and Southern Illinois. RESULTS: With every 1-unit increase in the percentage of BSN nurses or certified nurses, a reduction in total patient falls per 1000 patient-days can be expected in the amount of 0.02 to 0.04 and 0.01 to 0.03, respectively, all else held constant. CONCLUSIONS: Improvements to patient outcomes may be optimized with increased percentages of nurses with bachelor degrees and/or certifications.


Assuntos
Acidentes por Quedas , Certificação , Competência Clínica , Recursos Humanos de Enfermagem no Hospital , Estudos de Coortes , Estudos Transversais , Escolaridade , Humanos , Estudos Retrospectivos , Gestão da Segurança
10.
Praxis (Bern 1994) ; 108(16): 1065-1071, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31822226

RESUMO

The Older the Hiker, the More Severe the Injury - a Retrospective Analysis of Mountain Hiking Accidents in the Swiss Alps from 2009 to 2018 Abstract. Hiking is a regular activity of the elderly, however, the question of a relationship between age and the severity of a mountaineering accident is still unanswered. A total of 10 185 hikers was analyzed between the years 2009 and 2018. For every mountain accident, the NACA score was available allowing to conduct regression analysis between age and NACA scores. The results show that elderly hikers had higher NACA scores compared to younger ones, implying more severe events in the elderly. The tendency of more severe mountain accidents can be attributed to several reasons. Especially emphasized should be falls that are probably favoured by the age-dependent decrease of postural stability, turning a fall into a downfall, predisposing more severe events.


Assuntos
Acidentes por Quedas , Montanhismo , Esportes , Adulto , Fatores Etários , Idoso , Humanos , Pessoa de Meia-Idade , Montanhismo/lesões , Estudos Retrospectivos , Suíça
11.
Sud Med Ekspert ; 62(6): 32-35, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825330

RESUMO

The interpretation of symptoms of multiple injuries caused by fall from height in case of postmortem examination with the aim to establish facts of causing traumas is onerous, especially in diagnosing mechanisms of various injury formations. The objective of the study was to elaborate expert diagnostic criteria to determine mechanisms of fractures of long tubular bones caused by fall from height on the basis of the analysis of fracture morphology and information technologies. The prognostic models have been developed, which make it possible to prognosticate mechanisms of fractures basing on the elaborated expert diagnostic criteria of fractures of long tubular bones in case of catatrauma. The morphologic criteria of fractures with the use of linear regression analysis make it possible to distinguish reliably different variants of the body landing and height of fall ranges.


Assuntos
Acidentes por Quedas , Fraturas Ósseas , Traumatismo Múltiplo , Autopsia , Humanos
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 90-98, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825396

RESUMO

AIM: To study the geriatric status of patients with osteoarthritis (OA) older than 60 years depending on the severity of frailty. MATERIAL AND METHODS: The study included 201 patients with OA (mean age 75.84±8.09 years). The patients were divided into 3 groups: patients without frailty, patients with prefrailty and patients with frailty. Along with clinical examination, the risk of falls, pain intensity, the Charlson comorbidity index and the number of geriatric syndromes were calculated. RESULTS AND CONCLUSION: With the increase of frailty, the number of patients experiencing difficulties in movement increases. The physical activity of the patients gradually reduces with the appearance of prefrailty and significantly reduces in OA. At the same time, there is the increase in dependence on outside help, the decrease in IADL and walking speed. The most common geriatric syndromes in patients with OA are sensory deficits, chronic pain syndrome and falls. The neuropathic component of pain is diagnosed in every tenth patient with OA without frailty and in every third patient with OA and frailty. In light of results obtained in the study, the authors suggest detailed recommendations for treatment of patients.


Assuntos
Fragilidade , Osteoartrite , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Dor , Síndrome
14.
Isr Med Assoc J ; 12(21): 773-778, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814338

RESUMO

BACKGROUND: Falls are a common complication in persons with stroke (PwS). Reliable assessment of balance responses to unexpected loss of balance has the potential to identify risk for falls. OBJECTIVES: To examine inter-observer reliability of balance responses to unannounced surface perturbations in PwS and to explore the concurrent validity of a balance recovery assessment protocol. METHODS: Two observers evaluated balance recovery strategies and fall threshold (a fall into a harness system) in 15 PwS and 15 healthy adults who were exposed to forward, backward, right, and left unannounced surface translations in six increasing intensities while standing. RESULTS: Observer agreement was 100% for the fall threshold. Kappa coefficients for step strategies were 0.960-0.988 in PwS and 0.886-0.938 in healthy adults, 0.905-0.988 for arm reactions in PwS and 0.754-0.926 in healthy adults. Significant correlations were found between fall threshold and Berg Balance Scale (r = 0.691), 6-minute walk test (r = 0.599), and fall efficacy scale-international (r= -0.581). CONCLUSIONS: A trained examiner can reliably classify reactive balance responses to surface perturbations. The high frequency of falls observed in PwS highlights the importance of assessing reactive balance responses to different directions and intensities of surface translations.


Assuntos
Acidentes por Quedas/prevenção & controle , Exame Neurológico/métodos , Equilíbrio Postural , Posição Ortostática , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Medição de Risco/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Teste de Caminhada/métodos
15.
Isr Med Assoc J ; 12(21): 812-816, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814345

RESUMO

BACKGROUND: The effect of repeated intravenous amantadine (IVAM) in advanced Parkinsonism has not been studied in depth. OBJECTIVES: To report the experience of our medical center with repeated IVAM infusions in patients with advanced Parkinsonism. METHODS: Thirty patients with advanced Parkinsonism of various etiologies were enrolled in an open-label retrospective study. All patients were treated with IVAM infusions in a neurological daycare center. Treatment was initiated with a loading dose of 200/400 mg per day for 5 days followed by a once-daily maintenance dose of 200/400 mg every 1 to 3 weeks. Patients and their caregivers participated in a structured interview and independently completed a clinical global impression of changes scale questionnaire on various motor and non-motor symptoms. RESULTS: Patient mean age was 73.3 ± 9.7 years, average disease duration was 6.2 ± 5.7 years, and mean Hoehn and Yahr score was 3.2 ± 0.84. Mean duration of the IVAM treatment was 15.1 ± 11.6 months. An improvement in general function was reported by 91% of the patients and 89% of the caregivers. Most of the patients reported improvement in tremor and rigidity, as well as in gait stability, freezing of gait, and reduced falls. The treatment was safe with few side effects. CONCLUSIONS: Our data suggest that repeated IVAM infusions could be an effective treatment against various motor symptoms and for improvement of mobility in patients with advanced Parkinsonism. Further randomized clinical trials with a larger sample size using objective measures are warranted to validate our results.


Assuntos
Acidentes por Quedas/prevenção & controle , Amantadina , Destreza Motora/efeitos dos fármacos , Doença de Parkinson , Recuperação de Função Fisiológica/efeitos dos fármacos , Idoso , Amantadina/administração & dosagem , Amantadina/efeitos adversos , Progressão da Doença , Dopaminérgicos/administração & dosagem , Dopaminérgicos/efeitos adversos , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
16.
Ceska Gynekol ; 84(4): 289-292, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31818112

RESUMO

OBJECTIVE: The aim of this work is to present a case of traumatic bladder rupture in a patient with total uterine prolapse. Additionally, we provide a brief description of this issue. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague; Departement of Radiology, 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague. RESULTS: We present a case report of a patient with a total uterine prolapse that has been examined for a lower abdominal pain, hematuria and difficulties with urination. The problems arose suddenly after the fall on the ground. These symptoms are typical for bladder rupture, but other more frequent causes have to be ruled out. CT scan showed a contrast agent leak from the bladder. The patient was indicated for surgical revision and suture of the bladder wall. CONCLUSION: Separately, rupture of the bladder occurs rarely. Most often, this injury is part of a wider trauma - especially after car crashes. However, our case report suggests that this option should be considered.


Assuntos
Acidentes por Quedas , Doenças da Bexiga Urinária , Bexiga Urinária , Prolapso Uterino , Feminino , Humanos , Gravidez , Ruptura , Doenças da Bexiga Urinária/etiologia
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1363-1368, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838805

RESUMO

Objective: To analyze and compare the disease burden of falls in Chinese population aged 0-19, in 1990 and 2017. Methods: Indicators including number of deaths, mortality rates, years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted of life years (DALY), on falls, were gathered from the Global Burden of Disease (GBD) 2017 and used to describe the disease burden and corresponding parameters on falls, between 1990 and 2017, in China. Results: In 2017, number of death, YLLs, YLDs, DALYs caused by falls were 5 321, 0.43 million person years, 0.14 million person years and 0.57 million person years respectively, among aged 0-19 group. Rates on standardized mortality, YLLs, YLDs and DALYs on falls were 1.76/100 000, 141.49/100 000, 46.99/100 000, and 188.48/100 000, respectively. The burden of falls decreased with the increase of age. Compared with 1990, disease burden of falls decreased in all age groups, both in male and female, with more seen in the lower age groups. Compared with 1990, the number of deaths, rates on YLLs, YLDs and DALYs caused by falls decreased by 65.08%, 46.63%, 47.38% and 36.33% respectively, in 2017. However, the YLDs rate increased by 73.31% between 1990 and 2017. The ratio of YLLs to DALYs decreased from 90.84% in 1990 to 75.07% in 2017, with a proportion as 17.36%. Conclusion: Compared with 1990, although the disease burden of falls among aged 0-19 group showed a decreasing trend, falls still caused serious disease burden for the aged 0-19 group. Research that targeting prevention on falls, should be continued.


Assuntos
Acidentes por Quedas , Pessoas com Deficiência/estatística & dados numéricos , Mortalidade Prematura , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Feminino , Carga Global da Doença , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem
19.
Medicine (Baltimore) ; 98(52): e18429, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876721

RESUMO

RATIONALE: Galeazzi fractures are uncommon, and are less common in children than in adults. Galeazzi-equivalent fractures, a variant of the classic Galeazzi fractures, mostly occur in children or adolescents. Galeazzi equivalent fractures may commonly accompany distal radial fractures or injury of the epiphyseal plate of the distal ulna. PATIENT CONCERNS: A 13-year-old man visited our emergency department after stumbling over a rock. Manual reduction and splinting was already done in a nearby medical center. Plain radiographs revealed fractures in the distal radius and fracture of the ulnar epiphyseal plate. DIAGNOSIS: Plain radiographs showed Galeazzi-equivalent fracture. The result of primary closed reduction was not enough and there was still displacement of fracture. INTERVENTIONS: Anatomical reduction of distal radius was fixed with a plate and screws, and K-wires were inserted percutaneously for reduction and fixation of ulnar fracture. OUTCOMES: Complete bone union was achieved and normal range of motion is shown 2 years postoperatively. The patient is able to perform daily activities and sport activities without any signs of ulnar growth arrest. LESSONS: Open reduction is required in patients with malalignment, failure to reduce the DRUJ or maintain its reduction, or older ages which are hard to expect sufficient bone remodeling.


Assuntos
Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Traumatismos do Punho/cirurgia , Acidentes por Quedas , Adolescente , Humanos , Masculino , Redução Aberta/métodos , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/patologia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/patologia
20.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(11): 1260-1269, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31748451

RESUMO

We analyzed 197 fall incidents in the questionnaire survey about the incident that occurred in Department of Radiology. In the past paper about the patient safety, there is no report that evaluated incident data directly. The purpose of this paper is to analyze the factor of the medical incidents using statistical technique scientifically. In this paper, we do not suggest concrete precaution. At first, we found the number of patients (each gender, modality, generation) in the five facilities of the coworker of one week. We found an incident rate from this patient total number, and we normalized data. As a result, we were able to do each risk evaluation because a risk ratio and relative risk degree was found. And, we were able to identify modality and the generation with the significant difference using the testing for differences in population rate. By our analyses, we revealed the chapter which must strengthen safety management.


Assuntos
Acidentes por Quedas , Segurança do Paciente , Radiologia , Humanos , Gestão de Riscos , Gestão da Segurança
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