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1.
Zhonghua Nei Ke Za Zhi ; 58(10): 713-735, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31594170

RESUMO

National handbook for the prevention and control of diabetes in primary care (2019) is made for the use in combination with the national guidelines for the prevention and control of diabetes in primary care (2018). It provides detailed information and supplementary for the contents involved in the guidelines.


Assuntos
Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/normas , Humanos
2.
Zhonghua Zhong Liu Za Zhi ; 41(10): 728-733, 2019 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-31648493

RESUMO

The incidence of retroperitoneal tumor is low, and treatment is difficult.According to the recent updates of evidence-based medical evidence at home and abroad, the consensus on the standardized treatment of retroperitoneal tumors were discussed including examination and diagnosis , surgical treatment comprehensive treatment, nutrition, rehabilitation, and review and follow-up, etc.


Assuntos
Antineoplásicos/administração & dosagem , Consenso , Assistência à Saúde/normas , Guias de Prática Clínica como Assunto , Neoplasias Retroperitoneais/tratamento farmacológico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , China , Humanos , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/patologia
3.
Zhonghua Zhong Liu Za Zhi ; 41(10): 734-741, 2019 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-31648494

RESUMO

Microsatellite instability (MSI) which resulted from the deficiency of DNA mismatch repair (MMR), is an important clinical significance in the related solid tumors, such as colorectal cancer and endometrial cancer. There are several methods to detect MSI status, including immunohistochemistry for MMR protein, multiplex fluorescent polymerase chain reaction (PCR) for microsatellite site and MSI algorithm based on next generation sequencing (NGS). The consensus elaborates the definition and clinical significance of MSI as well as the advantages and disadvantages of the three detection methods. Through this expert consensus, we hope to promote the screening which based on MSI status in malignant tumors and improve the acknowledge of clinicians about various testing methods. Thereby, they could interpret the results more accurately and provide better clinical services to patients.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Colorretais/genética , Consenso , Assistência à Saúde/normas , Instabilidade de Microssatélites , Guias de Prática Clínica como Assunto , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , China , Neoplasias Colorretais/patologia , Reparo de Erro de Pareamento de DNA , Sequência de DNA Instável , Neoplasias do Endométrio , Feminino , Humanos , Imuno-Histoquímica , Repetições de Microssatélites , Microscopia de Fluorescência , Reação em Cadeia da Polimerase
4.
Urologe A ; 58(10): 1156-1164, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31501984

RESUMO

The aim of quality management in medicine must be to increase the safety of treatment, to optimize the treatment results, but also to confirm economic justifiability. Participation in multiagency quality assurance measures should create the possibility to assess the quality of the services offered compared with other service providers and to recognize and correct corresponding deficits. Comparative examinations and assessments should serve to improve the quality of the results. The benefits of quality management as an important approach to promoting patient safety should be made known to all stakeholders. Patient-oriented process optimization and patient satisfaction are the focus. Furthermore, quality management should help increase the satisfaction of everyone involved in the process.


Assuntos
Assistência à Saúde/normas , Legislação Médica , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Humanos , Responsabilidade Legal
6.
Implement Sci ; 14(1): 78, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399105

RESUMO

BACKGROUND: Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. METHODS: Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. RESULTS: Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). CONCLUSIONS: To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.


Assuntos
Assistência Ambulatorial/normas , Assistência à Saúde/normas , Ciência da Implementação , Modelos Organizacionais , Neurocirurgia/normas , Ortopedia/normas , Pacientes Ambulatoriais , Técnicas de Planejamento , Melhoria de Qualidade , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa Qualitativa , Queensland
8.
BMC Public Health ; 19(1): 1025, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366338

RESUMO

BACKGROUND: The mortality-to-incidence ratio (MIR) is a marker that reflects the clinical outcome of cancer treatment. MIR as a prognostic marker is more accessible when compared with long-term follow-up survival surveys. Theoretically, countries with good health care systems would have favorable outcomes for cancer; however, no report has yet demonstrated an association between gallbladder cancer MIR and the World's Health System ranking. METHODS: We used linear regression to analyze the correlation of MIRs with the World Health Organization (WHO) rankings and total expenditures on health/gross domestic product (e/GDP) in 57 countries selected according to the data quality. RESULTS: The results showed high crude rates of incidence/mortality but low MIR in more developed regions. Among continents, Europe had the highest crude rates of incidence/mortality, whereas the highest age-standardized rates (ASR) of incidence/mortality were in Asia. The MIR was lowest in North America and highest in Africa (0.40 and 1.00, respectively). Furthermore, favorable MIRs were correlated with good WHO rankings and high e/GDP (p = 0.01 and p = 0.030, respectively). CONCLUSIONS: The MIR variation for gallbladder cancer is therefore associated with the ranking of the health system and the expenditure on health.


Assuntos
Assistência à Saúde/normas , Neoplasias da Vesícula Biliar/epidemiologia , Saúde Global/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Neoplasias da Vesícula Biliar/mortalidade , Produto Interno Bruto/estatística & dados numéricos , Humanos , Incidência , Organização Mundial da Saúde
9.
Lancet ; 394(10199): 685-696, 2019 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-31448740

RESUMO

Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.


Assuntos
Isquemia Miocárdica/prevenção & controle , Prevenção Primária/métodos , Causalidade , Assistência à Saúde/normas , Exercício , Saúde Global , Dieta Saudável , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
10.
Expert Opin Drug Saf ; 18(10): 977-985, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31374180

RESUMO

Introduction: Fixed-dose combination (FDC) medicines contain more than one approved active pharmaceutical ingredient (API), are manufactured as a fixed-dose and packed in a single dosage form. FDCs have been drawing attention from the pharmaceutical industries because of the government's ban on 328 irrational FDCs in September 2018. The Drug Technical Advisory Board (DTAB) recommended that 'there is no therapeutic justification' for the active ingredients in the banned FDCs and accordingly these combinations 'may involve a risk to human beings'. Areas covered: The review illustrates the present status of FDCs, its regulatory framework, approvals in India and discusses the substantive cause behind the ban on FDCs in India. Expert opinion: The expert stress to establish a robust regulatory system for the approval of FDCs in India. The pharmaceutical industries should not perceive the ban against irrational FDCs as an impediment; rather, they should view as an opportunity to establish a stronger healthcare system. The current review is an eye-opener for the section of people who consider that the ban on FDCs is irrational. However, the ban on 328 FDCs may prove a landmark decision for the development of stronger healthcare policy in India.


Assuntos
Aprovação de Drogas , Combinação de Medicamentos , Política de Saúde , Tomada de Decisões , Assistência à Saúde/normas , Indústria Farmacêutica/legislação & jurisprudência , Humanos , Índia , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos
11.
J Nurs Adm ; 49(9): 447-453, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436744

RESUMO

OBJECTIVE: To identify and compare validated tools used to assess incivility in healthcare settings. BACKGROUND: Incivility in the workforce is associated with poor quality outcomes, increased employee turnover, and decreased job satisfaction. Validated tools are essential for accurate measurement of incivility. The aim of this study was to compare characteristics of validated tools for use in a busy clinical setting. METHODS: In a scoping review, English language research studies using incivility tools published in PubMed or CINAHL between March 1, 2013, and March 14, 2018, were assessed for sound psychometric properties and feasibility of use (eg, short, easy to administer). RESULTS: After screening 869 articles and full text review of 244, 5 identified tools met the criteria; the Short Negative Acts Questionnaire seemed best suited for use in a busy healthcare setting. CONCLUSION: Adoption of a standardized and validated incivility tool makes it possible to compare across clinical settings and track progress over time.


Assuntos
Assistência à Saúde/normas , Incivilidade/estatística & dados numéricos , Satisfação no Emprego , Psicometria/instrumentação , Local de Trabalho/psicologia , Local de Trabalho/normas , Humanos , Inquéritos e Questionários
13.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
14.
Rev Bras Enferm ; 72(3): 825-829, 2019 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269152

RESUMO

OBJECTIVE: To describe the experience in the implementation of the Humanitude Care Methodology (MCH) in the humanization of care for the elderly. METHODOLOGY: This is an experience report about the implementation of the MCH, in a Health Service in Portugal, with capacity for 30 elderly people, most of them having cognitive alterations. RESULTS: The implementation of the MCH has shown positive results in the humanization of care for the elderly, namely in the reduction of agitation behaviors and better acceptance of care. There was a change in organizational culture, more focused on the person and on the humanization of care. CONCLUSION: The results reflect the need to introduce innovative care methodologies in the training of health professionals, with a focus on interaction, for a professionalized relational care that dignifies the person cared for and the care giver.


Assuntos
Assistência à Saúde/normas , Geriatria/normas , Humanismo , Assistência à Saúde/métodos , Geriatria/métodos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Cultura Organizacional , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas
15.
Implement Sci ; 14(1): 70, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286964

RESUMO

BACKGROUND: Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations. METHODS: Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance. DISCUSSION: This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies.


Assuntos
Tomada de Decisões , Assistência à Saúde/normas , Fechamento de Instituições de Saúde/métodos , Administração de Serviços de Saúde , Autonomia Profissional , Qualidade da Assistência à Saúde/normas , Humanos , Entrevistas como Assunto , Modelos Teóricos , Política Organizacional , Formulação de Políticas , Suécia
16.
Implement Sci ; 14(1): 71, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288828

RESUMO

BACKGROUND: Evidence-based clinical practice guidelines (CPGs) are relevant sources for generating quality indicators (QIs). The objective of this study was to compare guideline-based QIs of German and international CPGs and their underlying methodological approaches. METHODS: We conducted systematic searches in the guideline databases of G-I-N (Guidelines International Network) and NGC (National Guideline Clearinghouse) between February and June 2017 to identify international CPGs matching the topics of German evidence-based CPGs (n = 35) that report QIs, which were identified in a preceding study. Additionally, we searched the websites of the particular CPG providers for separate documents with regard to QIs. We included evidence-based CPGs which report QIs. Reported QIs, the underlying guideline recommendations, and information on methods of development were extracted. The selection and extraction of CPGs were conducted by one reviewer and checked by another. For each matched pair of CPGs, we assessed whether the suggested QIs matched or were not directly comparable. RESULTS: Twenty-five international CPGs, originating from seven CPG providers in total, met the criteria for inclusion. They matched the topics of 18 German CPGs. This resulted in 30 CPG pairs for the comparison of QIs (some of the international CPGs matched the topic of more than one German CPG). We found 27 QI pairs with QIs "not different or slightly different", corresponding to 13% (27 of 212) of the QIs in German CPGs and 16% (27 of 166) in international CPGs. Only two QI pairs were judged to be "different/inconsistent". For 183 of 212 (86%) QIs from German CPGs and 137 of 166 (83%) QIs from international CPGs, no direct comparison could be made. An explicit link to one or more guideline recommendations was found for 136 of 152 (89%) QIs from German CPGs and 82 of 166 (49%) QIs from international CPGs. Some information on methods for the development of QIs existed for 12 of 18 (67%) German CPGs and 8 of 25 (32%) international CPGs. CONCLUSIONS: The majority of QIs in German and international CPGs were not comparable. Various reasons for this are conceivable. More transparent reporting of the underlying methods for generating guideline-based QIs is needed.


Assuntos
Assistência à Saúde/normas , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Bases de Dados Factuais , Alemanha , Humanos , Internacionalidade
18.
Urologe A ; 58(10): 1173-1178, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31359085

RESUMO

Patient safety is the basic quality of every medical treatment. Scientifically sound knowledge on the necessary structures of a safety management system and experience from effectively implementing those are aplenty. Yet, even 30 years after the first successful steps, it is still difficult for healthcare to implement a comprehensive, system-wide approach. Cultural changes at the level of attitudes and the consistent creation of the necessary structures might accelerate this transformation process.


Assuntos
Assistência à Saúde/normas , Segurança do Paciente , Qualidade da Assistência à Saúde , Gestão da Segurança , Urologia , Humanos , Erros Médicos
19.
Eur J Oncol Nurs ; 41: 24-32, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358254

RESUMO

PURPOSE: The administration of chemotherapy is a complex task which has many safety issues. Safe administration of chemotherapy by nurses should be evidence-based. The aim of this integrative review was to synthesise the evidence about education and practice requirements for safe administration of chemotherapy by nurses. METHOD: A systematic search of four databases identified 17 studies for inclusion in this review. Key words: Nurse, chemotherapy, cytotoxic drug, administration, safety, education. Data extracted from the studies included author, year, aims, design, sample, outcome measures and findings. After screening the articles, extracting study data and completing a summary table, critical appraisal of the studies was completed using the Mixed Methods Appraisal Tool (MMAT). RESULTS: All the studies focused on strategies to promote patient and nurse safety during nursing administration of chemotherapy. Content analysis identified five themes: governance, process safeguards, communication, interdisciplinary collaboration and education. Key strategies or interventions that increased patient and/or nurse safety identified were standardised computer-generated chemotherapy orders, barcodes, medication safety procedures, education and simulated learning. CONCLUSIONS: This review found low-level evidence exists about the education and safety requirements for nursing administration of chemotherapy. High-level research is needed to assist healthcare services to select evidence-based educational and safety strategies and provide appropriately resourced work environments to support the safe nursing administration of chemotherapy and deliver the best possible patient outcomes.


Assuntos
Assistência à Saúde/normas , Tratamento Farmacológico/normas , Recursos Humanos de Enfermagem no Hospital/educação , Enfermagem Oncológica/educação , Enfermagem Oncológica/normas , Segurança do Paciente/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Z Evid Fortbild Qual Gesundhwes ; 143: 8-14, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31153810

RESUMO

RATIONALE, AIMS AND OBJECTIVES: The hospital sector is under considerable pressure to change. On the one hand, demographic change plays an important role and, on the other hand, the rapid development of medicine and nursing care can be attributed to the pressure to change. The Lean Management concept, which originated in the automotive sector, represents a successful management method for meeting these growing challenges. The aim of this work therefore was to use interviews with experts from the healthcare sector to find out which leadership philosophy hospitals need in order to successfully implement the lean management approach in their organisational culture. METHODS: A semi-qualitative approach was chosen as a survey instrument for the present study of the expert interviews. The interview guideline was divided into four categories: hospital management, knowledge, practice and implementation. Four experts were interviewed for approx. 45minutes each. All four interviewees are male and hold intermediate- or top-level management positions in a hospital. The evaluation method used is based on the content analysis according to Mayring. RESULTS: In category 1, a high pressure for change was indicated. The reasons cited were different financing arrangements, changes in the framework and the unregulated flow of patients into the hospital. Managers in hospitals are not recruited for their management skills, but exclusively for their medical knowledge. Category 2 shows that managers in hospitals have never learned to lead or manage. The term 'Lean Management' is sometimes interpreted differently. In category 3, the interviewees cited different reasons for implementing the lean management approach. Among other things, they see the possibility of increasing quality for the patient, employee satisfaction and safety. In category 4, it was confirmed that employees and management play a key role in implementation. In a hospital, the 'patient-first' approach should be prioritised. CONCLUSION: A critical analysis of the results shows that implementing the lean management approach in a hospital will pose a major challenge. The functional, hierarchical structure as well as the understanding of leadership and the organizational culture are critical success factors.


Assuntos
Assistência à Saúde , Eficiência Organizacional , Administração Hospitalar , Áustria , Assistência à Saúde/métodos , Assistência à Saúde/normas , Alemanha , Administração de Serviços de Saúde , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
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