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1.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192934

RESUMO

INTRODUCCIÓN: ¿cómo seguir trabajando la orientación y participación comunitaria en Atención Primaria durante la pandemia por COVID-19?. OBJETIVOS Y MÉTODOS: observar, describir, reflexionar y documentar aspectos relativos a la atención comunitaria en el momento actual de pandemia por COVID-19 en los equipos de Atención Primaria (EAP) de Aragón. Estudio exploratorio-descriptivo observacional transversal con enfoque cualitativo, con dos fases. 1ª: recopilación de experiencias comunitarias y localización de informantes clave. 2ª: descripción de acciones comunitarias. Análisis descriptivo y tipo DAFO. RESULTADOS: se detectaron 47 iniciativas. Participaron 11 expertas y 54 informantes clave. El 66,6% consideró el rol de los EAP como consultores/colaboradores. El 64,9% de las iniciativas contempló la diversidad. El 49,1% no sabía si valoraron diferencias por género. Destacaron la importancia de lo comunitario para superar la crisis y la cooperación y coordinación con la comunidad e instituciones locales. DISCUSIÓN: protocolos con orientación biomédica, miedo e incertidumbre por la COVID-19 dificultaron el desarrollo de iniciativas comunitarias; frente a esto, fue clave la trayectoria comunitaria previa de los EAP, el trabajo en equipo, con especial relevancia el de las trabajadoras sociales, y su motivación. La participación del EAP como colaborador refuerza la importancia del liderazgo compartido. Son necesarios espacios colaborativos, apoyo institucional y coordinación intersectorial. CONCLUSIÓN: durante la pandemia, las comunidades deben ser parte de la respuesta; la orientación comunitaria de los EAP es clave. Es preciso visibilizar, acompañar y reforzar el trabajo comunitario y estimular la coordinación con Salud Pública


INTRODUCTION: How to continue working on community guidance and participation in Primary Care during the COVID-19 pandemic?. OJECTIVES AND METHODS: To observe, report, reflect and document autonomous community experiences of Aragonese Primary Care Teams (PCT) during the COVID-19 pandemic. A two-phase exploratory-descriptive observational, cross-sectional study with a qualitative approach. Phase 1: compilation of experiences in community health and location of key informants. Phase 2: description of community actions. Descriptive and SWOT analysis. RESULTS: A total of 47 initiatives were detected; 11 experts and 54 key informants took part. A total of 66.6% considered the role of the PCT as consultants or collaborators; 64.9% of initiatives considered diversity. A total of 49.1% did not know whether they evaluated differences by sex. They highlighted the importance of the community to overcome the crisis, and cooperation and coordination with community and local institutions. DISCUSSION: Protocols with biomedical guidance, fear and uncertainty due to COVID-19 hindered development of community initiatives. In light of this, the previous community trajectory of PCTs, teamwork with special relevance of social workers and their motivation were fundamental. PCT involvement as a partner strengthens the importance of shared leadership. Collaborative spaces, institutional support and intersectoral coordination are all necessary. CONCLUSION: During the pandemic, communities must be part of the response; PCT community guidance is essential. Visibility, working alongside and strengthening community work and stimulating public health coordination are all necessary requirements


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Serviço Social/organização & administração , Assistência ao Paciente/tendências , Serviços de Saúde Comunitária/organização & administração , Participação da Comunidade/tendências , Pandemias/estatística & dados numéricos , Estudos Transversais , Pesquisa sobre Serviços de Saúde/tendências
4.
J Alzheimers Dis ; 77(4): 1805-1813, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986671

RESUMO

BACKGROUND: The COVID-19 pandemic has brought great disruption to health systems worldwide. This affected ongoing clinical research, particularly among those most vulnerable to the pandemic, like dementia patients. Fundació ACE is a research center and memory clinic based in Barcelona, Spain, one of the hardest-hit countries. OBJECTIVE: To describe the ad-hoc strategic plan developed to cope with this crisis and to share its outcomes. METHODS: We describe participants' clinical and demographic features. Additionally, we explain our strategic plan aimed at minimizing the impact on clinical trial research activities, which included SARS-CoV-2 RT-PCR and IgG serological tests to all participants and personnel. The outcomes of the plan are described in terms of observed safety events and drop-outs during the study period. RESULTS: A total of 130 patients were participating in 16 active clinical trials in Fundació ACE when the lockdown was established. During the confinement, we performed 1018 calls to the participants, which led to identify adverse events in 26 and COVID-19 symptoms in 6. A total of 83 patients (64%) could restart on-site visits as early as May 11, 2020. All SARS-CoV-2 RT-PCR diagnostic tests performed before on-site visits were negative and only three IgG serological tests were positive. Throughout the study period, we only observed one drop-out, due to an adverse event unrelated to COVID-19. DISCUSSION: The plan implemented by Fundació ACE was able to preserve safety and integrity of ongoing clinical trials. We must use the lessons learned from the pandemic and design crisis-proof protocols for clinical trials.


Assuntos
Doença de Alzheimer/terapia , Ensaios Clínicos como Assunto , Infecções por Coronavirus , Pandemias , Assistência ao Paciente , Pneumonia Viral , Idoso , Instituições de Assistência Ambulatorial , Betacoronavirus , Técnicas de Laboratório Clínico , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Espanha/epidemiologia , Telemedicina/métodos , Terapias em Estudo/métodos
5.
J Alzheimers Dis ; 77(2): 539-541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925073

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic has substantially affected patients with dementia and their caregivers. However, we found not all Alzheimer's disease (AD) patients were afraid of COVID-19 infection. Therefore, we investigated the association between rate of awareness of COVID-19 and depressive tendency in AD. 126 consecutive outpatients with AD were enrolled in this study from May 25, on the day when the declaration of emergency was lifted in Japan, through June 30, 2020. In addition to routine psychological tests, the participants were asked the following two questions: "Do you know COVID-19?" and "Why are you wearing a face mask?". Moderate to severe AD patients were found to have a low COVID-19 recognition rate and did not fully understand why they were wearing face masks. In addition, because they did not understand the seriousness of the COVID-19 outbreak, their Geriatric Depression Scale scores were also substantially lower. These results may appear to simply indicate that people with severe dementia are unaware of current events. However, these results provide insights into how to care for patients with dementia and how to allocate the time and support of our limited staff during the COVID-19 outbreak.


Assuntos
Doença de Alzheimer , Conscientização , Infecções por Coronavirus , Competência Mental , Pandemias , Assistência ao Paciente , Pneumonia Viral , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Doença de Alzheimer/virologia , Betacoronavirus , Cuidadores/psicologia , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Sistemas de Apoio Psicossocial , Índice de Gravidade de Doença
6.
Internist (Berl) ; 61(9): 912-921, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32809034

RESUMO

Since the early 2000s, legislators have allowed the establishment of medical care centers to supplement and increase the flexibility of medical cooperation models. Several legal changes in subsequent years were unable to prevent that, contrary to the original intention, almost 90% of the newly founded facilities were established in urban cores and medium-sized centers; that concentration processes and monopolization were encouraged; and that the freedom of choice for patients was restricted. In order to counter the risk of undermining the free exercise of the medical profession and the dictates of economics over patient-oriented medicine in the outpatient sector, corporations, scientific societies, and professional associations are demanding more transparency and narrower limits for non-physician capital investors. There are currently more than 3000 medical care centers in Germany employing around 20,000 physicians, many of whom are internal medicine specialists. Regionally networked medical care center structures combine the advantages of optimized patient care with the growing desire of the younger generation of physicians for flexible working conditions within employment. With increasing acceptance on the part of the medical profession, networked medical care centers are able to create local structures for the expansion of modern intersectoral care and, at the same time, can be available for outpatient specialist training in internal medicine.


Assuntos
Medicina Interna/tendências , Pacientes Ambulatoriais , Assistência ao Paciente/tendências , Médicos , Assistência à Saúde , Alemanha , Hospitais , Humanos
7.
Ophthalmologe ; 117(9): 892-904, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32845384

RESUMO

BACKGROUND: Survey by the commission for cross-sectoral ophthalmology, as a joint commission of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) on the effects of the SARS-CoV­2 pandemic on ophthalmological patient care in Germany. METHODS: Online-based survey. RESULTS: A total of 1190 questionnaires were (partly) answered. With respect to outpatient care and consultations from 15 March to 15 April 2020, a total of 69 (5.8%) participants indicated unlimited, 756 (63.5%) reduced and 330 (27.7%) emergency care only, independent of the type of institution. Outpatient surgery was restricted to emergency surgery in 68% of clinics, 42.0% of inpatient wards, 45.0% of surgical medical care centers and group practices and 33.0% of private practices. Inpatient procedures were limited to emergency care in 75.0% of inpatient wards and in 71.0% of clinics. With the exception of endophthalmitis (+8.2%), the number of urgent indications and emergencies declined: retinal detachment (-34.8%), perforating eyeball injuries (-7.3%), acute glaucoma (-17.8%), central retinal artery occlusion and anterior ischemic optic neuropathy (-31.0%), others (-30.9%), penetrating keratoplasty and amniotic membrane transplantation (-59.1%). Institutional or professional policy requirements (76.0%) and appointment cancellation by patients (84.0%) were the most common reasons for limitations in ophthalmic patient care. CONCLUSION: The initial phase of the pandemic was characterized by a massive reduction in non-urgent conservative and surgical treatment that affected all areas of ophthalmology. Due to intensive care capacities required for COVID-19 patients, inpatient treatment was largely restricted to emergencies. Treatment of ophthalmological patients, including ocular emergencies and urgent treatment, was maintained across all sectors with a (considerable) decrease in the number of cases even in these groups.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Oftalmologia/tendências , Assistência ao Paciente/tendências , Pneumonia Viral/epidemiologia , Betacoronavirus , Alemanha/epidemiologia , Humanos , Pandemias
8.
J Am Coll Cardiol ; 76(11): 1318-1324, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32828614

RESUMO

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients. OBJECTIVES: This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol on the treatment and prognosis of STEMI patients in China. METHODS: Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients. RESULTS: The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center's modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable. CONCLUSIONS: There were reductions in STEMI patients' access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.


Assuntos
Infecções por Coronavirus , Controle de Infecções , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST , Terapia Trombolítica , Betacoronavirus , China/epidemiologia , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/métodos , Terapia Trombolítica/estatística & dados numéricos
9.
Am J Health Syst Pharm ; 77(22): 1874-1884, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32710774

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for health systems around the world. We describe our approach to adapting the pharmacy leadership structure to address critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy. SUMMARY: Yale New Haven Health deployed a system incident management command structure to effectively respond to the COVID-19 crisis. System pharmacy services adopted a similar framework to enable efficient communication and quick decision-making in key domains, including drug procurement and policy. By refining a model to project health-system medication needs, we were able to anticipate challenges and devise alternative treatment algorithms. By leveraging big data and creating a system knowledge base, we were able to consolidate reporting and coordinate efforts to ensure system success. Various procurement strategies were employed to ensure adequate supply, including frequent communication with our wholesaler, sourcing direct from suppliers, outsourcing of sterile products compounding to registered 503B outsourcing facilities, and acquisition of active pharmaceutical ingredients for compounding of essential medications. Strategic positioning of pharmacists within the health system's incident command response teams and rapid adaption of drug use policy governance fueled accelerated response and nimble implementation. Communication was streamlined and executed via multiple outlets to reach a broad audience across the health system. CONCLUSION: With medication shortages posing a threat to patient care, dynamic pharmacy leadership proved essential to providing patient care at the height of the COVID-19 pandemic. System alignment and the rapid adaption of the existing framework for drug shortage management and medication use policy were crucial to success in crisis response.


Assuntos
Infecções por Coronavirus , Formulários de Hospitais como Assunto/normas , Liderança , Pandemias , Assistência ao Paciente/tendências , Preparações Farmacêuticas/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Farmácia/tendências , Pneumonia Viral , Centros Médicos Acadêmicos , Connecticut , Formulários Farmacêuticos como Assunto , Humanos , Comunicação Interdisciplinar , Sistemas de Medicação no Hospital , Farmacêuticos
10.
Curr Opin Anaesthesiol ; 33(4): 589-593, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32618686

RESUMO

PURPOSE OF REVIEW: The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. RECENT FINDINGS: Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation. SUMMARY: Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/estatística & dados numéricos , Anestésicos/efeitos adversos , Assistência ao Paciente/métodos , Fatores Etários , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anestesia/métodos , Anestesia/tendências , Anestesiologistas , Anestésicos/farmacologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Assistência ao Paciente/tendências , Segurança do Paciente
14.
J Parkinsons Dis ; 10(3): 893-897, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538870

RESUMO

The COVID-19 pandemic has driven rapid, widespread adoption of telemedicine. The distribution of clinicians, long travel distances, and disability all limit access to care, especially for persons with Parkinson's disease. Telemedicine is not a panacea for all of these challenges but does offer advantages. These advantages can be summarized as the 5 C's: accessible care, increased convenience, enhanced comfort, greater confidentiality to patients and families, and now reduced risk of contagion. Telemedicine also has its limitations, including the inability to perform parts of the physical examination and inequitable access to the Internet and related technologies. Future models will deliver care to patients from a diverse set of specialties. These will include mental health specialists, physiotherapists, neurosurgeons, speech-language therapists, dieticians, social workers, and exercise coaches. Along with these new care models, digital therapeutics, defined as treatments delivered through software programs, are emerging. Telemedicine is now being introduced as a bridge to restart clinical trials and will increasingly become a normal part of future research studies. From this pandemic will be a wealth of new telemedicine approaches which will fundamentally change and improve care as well as research for individuals with Parkinson's disease.


Assuntos
Betacoronavirus , Confidencialidade/tendências , Infecções por Coronavirus/epidemiologia , Doença de Parkinson/epidemiologia , Assistência ao Paciente/tendências , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Previsões , Humanos , Pandemias , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Assistência ao Paciente/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Telemedicina/métodos
16.
Ned Tijdschr Geneeskd ; 1642020 04 30.
Artigo em Holandês | MEDLINE | ID: mdl-32395956

RESUMO

No more shaking hands and keeping your distance to flatten the corona epidemic. The forced distance between doctor and patient in times of corona makes us realize the value of touch in healthcare. The temporary austerity of contacts offers a scope for reflection on the small things that make the difference between care and healing.


Assuntos
Infecções por Coronavirus , Relações Interpessoais , Pandemias , Assistência ao Paciente/psicologia , Relações Médico-Paciente , Pneumonia Viral , Isolamento Social/psicologia , Tato , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Humanos , Pandemias/prevenção & controle , Assistência ao Paciente/tendências , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Percepção do Tato
19.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376727

RESUMO

BACKGROUND AND OBJECTIVES: Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve inpatient asthma care but mainly in studies at large, tertiary children's hospitals. It remains unclear if these effects are generalizable across diverse hospital settings. Our objective was to improve inpatient asthma care by implementing pathways in a diverse, national sample of hospitals. METHODS: We used a learning collaborative model. Pathway implementation strategies included local champions, external facilitators and/or mentors, educational seminars, quality improvement methods, and audit and feedback. Outcomes included length of stay (LOS) (primary), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits (balancing). Hospitals reviewed a sample of up to 20 charts per month of children ages 2 to 17 years who were admitted with a primary diagnosis of asthma (12 months before and 15 months after implementation). Analyses were done by using multilevel regression models with an interrupted time series approach, adjusting for patient characteristics. RESULTS: Eighty-five hospitals enrolled (40 children's and 45 community); 68 (80%) completed the study (n = 12 013 admissions). Pathways were associated with increases in early administration of metered-dose inhalers (odds ratio: 1.18; 95% confidence interval [CI]: 1.14-1.22) and referral to smoking cessation resources (odds ratio: 1.93; 95% CI: 1.27-2.91) but no statistically significant changes in other outcomes, including LOS (rate ratio: 1.00; 95% CI: 0.96-1.06). Most hospitals (65%) improved in at least 1 outcome. CONCLUSIONS: Pathways did not significantly impact LOS but did improve quality of asthma care for children in a diverse, national group of hospitals.


Assuntos
Asma/epidemiologia , Asma/terapia , Hospitalização/tendências , Inaladores Dosimetrados/tendências , Assistência ao Paciente/tendências , Adolescente , Asma/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Inaladores Dosimetrados/normas , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Estados Unidos/epidemiologia
20.
J Am Acad Orthop Surg ; 28(11): e477-e486, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-142633

RESUMO

The COVID-19 pandemic has necessitated modifications to pediatric orthopaedic practice to protect patients, families, and healthcare workers and to minimize viral transmission. It is critical to balance the benefits of alterations to current practice to reduce the chances of COVID-19 infection, with the potential long-term impact on patients. Early experiences of the pandemic from orthopaedic surgeons in China, Singapore, and Italy have provided the opportunity to take proactive and preventive measures to protect all involved in pediatric orthopaedic care. These guidelines, based on expert opinion and best available evidence, provide a framework for the management of pediatric orthopaedic patients during the COVID-19 pandemic. General principles include limiting procedures to urgent cases such as traumatic injuries and deferring outpatient visits during the acute phase of the pandemic. Nonsurgical methods should be considered where possible. For patients with developmental or chronic orthopaedic conditions, it may be possible to delay treatment for 2 to 4 months without substantial detrimental long-term impact.


Assuntos
Infecções por Coronavirus , Procedimentos Ortopédicos/tendências , Pandemias/prevenção & controle , Pneumonia Viral , Guias de Prática Clínica como Assunto , Ferimentos e Lesões/cirurgia , Adolescente , Criança , Pré-Escolar , China , Feminino , Saúde Global , Humanos , Itália , Masculino , Assistência ao Paciente/tendências , Pediatria , Gestão da Segurança , Singapura
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