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1.
J Surg Res ; 262: 240-243, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549329

RESUMO

As the SARS-COV-2 pandemic created the need for social distancing and the implementation of nonessential travel bans, residency and fellowship programs have moved toward a web-based virtual process for applicant interviews. As part of the Society of Asian Academic Surgeons 5th Annual Meeting, an expert panel was convened to provide guidance for prospective applicants who are new to the process. This article provides perspectives from applicants who have successfully navigated the surgical subspecialty fellowship process, as well as program leadership who have held virtual interviews.


Assuntos
/prevenção & controle , Cirurgia Geral/educação , Internato e Residência/organização & administração , Seleção de Pessoal/métodos , Comunicação por Videoconferência/organização & administração , /epidemiologia , Certificação/organização & administração , Certificação/normas , Docentes/psicologia , Docentes/normas , Bolsas de Estudo/organização & administração , Bolsas de Estudo/normas , Humanos , Internato e Residência/normas , Liderança , Pandemias/prevenção & controle , Seleção de Pessoal/organização & administração , Seleção de Pessoal/normas , Conselhos de Especialidade Profissional , Cirurgiões/psicologia , Cirurgiões/normas
2.
BMC Surg ; 21(1): 54, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482805

RESUMO

BACKGROUND: Surgeons are likely to get progressively fatigued during the course of a normal workday. The objective of this study was to evaluate the impact of surgeon work duration prior to performing distal pancreatectomy (DP) on the perioperative outcome, especially frequency of grade II or higher grade postoperative complications. METHODS: Patients undergoing DP for all causes were divided into two groups according to surgeon work hours prior to performing DP: group A (less than 5 h) and group B (5-10 h). Propensity score matching (PSM) analysis (1:1) were performed to balance the baseline characteristics between the two groups. Intraoperative complications were compared between the two groups. Postoperative complications and their severity were followed up for 60 days and mortality for 90 days. The study was powdered to identify a 15% difference in the incidence of grade II or higher grade complications. RESULTS: By using PSM analysis, the patients in group A (N = 202) and group B (N = 202) were well matched regarding demographics, comorbidities, operative technique, pancreatic texture and pathology. There was no significant difference in the incidence of grade II or higher grade complications between the two groups. There was no difference in clinically relevant postoperative pancreatic fistula, percutaneous drainage, readmission, reoperation, or morality. Group B was associated with a higher incidence of intraoperative organ injury, which could be managed successfully during the operation. CONCLUSION: The retrospective study demonstrated that the surgeon work duration did not significantly affect the clinical outcome of DP.


Assuntos
Fadiga/complicações , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas , Cirurgiões , Desempenho Profissional/normas , Idoso , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia/normas , Pancreatopatias/cirurgia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Cirurgiões/normas , Fatores de Tempo , Resultado do Tratamento , Carga de Trabalho
4.
Plast Reconstr Surg ; 147(1): 231-238, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370071

RESUMO

BACKGROUND: Non-board-certified plastic surgeons performing cosmetic procedures and advertising as plastic surgeons may have an adverse effect on a patient's understanding of their practitioner's medical training and patient safety. The authors aim to assess (1) the impact of city size and locations and (2) the impact of health care transparency acts on the ratio of board-certified and non-American Board of Plastic Surgeons physicians. METHODS: The authors performed a systematic Google search for the term "plastic surgeon [city name]" to simulate a patient search of online providers. Comparisons of board certification status between the top hits for each city were made. Data gathered included city population, regional location, practice setting, and states with the passage of truth-in-advertising laws. RESULTS: One thousand six hundred seventy-seven unique practitioners were extracted. Of these, 1289 practitioners (76.9 percent) were American Board of Plastic Surgery-certified plastic surgeons. When comparing states with truth-in-advertising laws and states without such laws, the authors found no significant differences in board-certification rates among "plastic surgery" practitioners (88.9 percent versus 92.0 percent; p = 0.170). There was a significant difference between board-certified "plastic surgeons" versus out-of-scope practitioners on Google search between large, medium, and small cities (100 percent versus 92.9 percent versus 86.5; p < 0.001). CONCLUSIONS: Non-board-certified providers tend to localize to smaller cities. Truth-in-advertising laws have not yet had an impact on the way a number of non-American Board of Plastic Surgery-certified practitioners market themselves. There may be room to expand the scope of truth-in-advertising laws to the online world and to smaller cities.


Assuntos
Publicidade/estatística & dados numéricos , Marketing de Serviços de Saúde/estatística & dados numéricos , Conselhos de Especialidade Profissional/normas , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/normas , Publicidade/legislação & jurisprudência , Certificação/estatística & dados numéricos , Cidades/estatística & dados numéricos , Simulação por Computador , Técnicas Cosméticas/estatística & dados numéricos , Estudos Transversais , Humanos , Internet/legislação & jurisprudência , Internet/estatística & dados numéricos , Marketing de Serviços de Saúde/legislação & jurisprudência , Segurança do Paciente , Cirurgiões/legislação & jurisprudência , Cirurgiões/normas , Cirurgia Plástica/estatística & dados numéricos , Estados Unidos
5.
Plast Reconstr Surg ; 147(1): 239-247, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370072

RESUMO

SUMMARY: The current status of the plastic surgeon in the medical liability spectrum and ways to avoid litigation are explored by using pooled national data from the Medical Professional Liability Association, private information from Applied Medico-Legal Solutions RRG, and a detailed literature search. The medical liability system in the United States costs $55.6 billion, or 2.4 percent of total health care spending. Plastic surgery accounts for 3.31 percent of reported claims and 3.16 percent of paid claims. Total payments for plastic surgeons represent 1.75 percent of the total paid for all specialties. Malpractice awards are relatively light for plastic surgeons. Nevertheless, they still have a 15 percent chance per year of being sued. However, 93 percent of cases will close with a dismissal or a settlement, and only 7 percent will go to trial. Of these, the plastic surgeon will prevail in 79 percent. Most importantly, 75 percent of all cases will result in no payment. To minimize the chances of a lawsuit, plastic surgeons should maintain excellent communication with their patients and participate in shared decision-making. They should take a leadership role and buy in to the performance of perioperative checklists, embrace patient education, and actively participate in Maintenance of Certification. They should be transparent in their dealings with patients by preoperatively declaring their policies on revisions, refunds, complications, and payments. Plastic surgeons must maintain complete and accurate medical records and participate in hospital-based programs of prophylaxis. They should be aware that postoperative infection is the single costliest adverse outcome and proactively deal with it.


Assuntos
Responsabilidade Legal/economia , Erros Médicos/prevenção & controle , Complicações Pós-Operatórias/economia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Cirurgia Plástica/economia , Lista de Checagem/normas , Comunicação , Tomada de Decisão Compartilhada , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/normas , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Educação de Pacientes como Assunto/legislação & jurisprudência , Educação de Pacientes como Assunto/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/economia , Cirurgiões/legislação & jurisprudência , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/normas , Cirurgia Plástica/estatística & dados numéricos , Estados Unidos
6.
Nurs Res ; 70(1): 58-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649391

RESUMO

BACKGROUND: Preventable clinician communication errors are the most frequent root cause of surgical adverse events. Effective communication among surgical team members is an important overall indicator of clinical nursing excellence and is crucial to promote patient safety and reduce healthcare risk. OBJECTIVE: The purpose of this publication is to describe our research protocol, which will comprehensively investigate surgical team communication and surgical team structure. There are two overall study objectives: (a) to characterize the network factors that influence perioperative clinician communication and (b) to identify how team structure shapes communication effectiveness. Specifically, we will study the association among clinician relationships, surgical team familiarity, surgical team size, and communication effectiveness. METHODS: We will use an exploratory, prospective, cross-sectional, network-centric approach using social network analysis to determine how interdependent clinician relationships influence surgical communication patterns. Targeting an 80% response rate, we will use total population sampling to recruit all clinicians (nurses, surgeons, anesthetists, surgical technologists, students, residents) who directly provide surgical care in the operating room at a large military medical center. We will administer an electronic survey to surgical teams at the end of the surgical day to elicit clinician communication assessments and relational preferences. From the survey questions, we will develop six relational networks (interaction, close working relationship, socialization, advice seeking, advice giving, speaking up/voice) and three models that represent communication effectiveness for each participant and team. We will use various statistical methods to characterize the network factors that shape operating room clinician communication and identify how team structure shapes communication effectiveness. RESULTS: This study will start enrolling participants in 2020. DISCUSSION: We are among the first to comprehensively investigate operating room communication using social network analysis. The results of this study will provide valuable insight into nurse collaboration and communication in interprofessional teams, enable a thoughtful analysis of surgical staffing and perioperative team building, and inform future-targeted interventions to improve operating room communication weaknesses.


Assuntos
Comunicação , Relações Interprofissionais , Militares/psicologia , Equipe de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , Cirurgiões/psicologia , Cirurgiões/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos
7.
Curr Oncol ; 27(5): e501-e511, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33173390

RESUMO

Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.


Assuntos
Infecções por Coronavirus/complicações , Hepatectomia/estatística & dados numéricos , Controle de Infecções/métodos , Neoplasias Hepáticas/cirurgia , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Cirurgiões/normas , Tempo para o Tratamento/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Neoplasias Hepáticas/virologia , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
8.
Can J Surg ; 63(5): E460-E467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107814

RESUMO

BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols use evidence-based perioperative practices that reduce morbidity and length of stay and improve patient satisfaction. ERAS is considered standard of care; however, utilization remains low and substantial practice variation exists. The aim of this study was to pragmatically characterize variation in colorectal surgery practice and identify predictors of ERAS utilization. METHODS: A survey of general surgeons identified using the Ontario College of Physicians and Surgeons database was conducted. Information on basic demographic characteristics, utilization of ERAS and predictors of ERAS implementation was collected. Nine ERAS behaviours were analyzed. Multivariable analysis was used to determine effects of demographic, hospital and surgeon covariates on ERAS utilization. RESULTS: Seven hundred and ninety-seven general surgeons were invited to participate in the survey, and 235 general surgeons representing 84 Ontario hospitals responded (30% response rate). Surgeons practising in academic settings and in large community hospitals represented 30% and 47% of the respondents, respectively. A total of 20% of the respondents used all 9 ERAS behaviours consistently. Rates of diet advancement on postoperative day 0, intravenous fluid restriction and having catheter and line procedures were significantly higher among respondents who adhered to ERAS protocols than among those who did not (74% v. 54%, p = 0.004; 92% v. 80%, p = 0.01; and 91% v. 41%, p < 0.001, respectively). Respondents from academic settings reported practising nearly 1 more ERAS behaviour than those from small community hospitals (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.42 to 1.31, p < 0.001). Multivariable analysis demonstrated that colorectal fellowship training or exposure to ERAS during training did not significantly affect ERAS behaviour utilization (OR 0.32, 95% CI -0.31 to 0.94, p = 0.16; OR 0.28, 95% CI -0.26 to 0.82, p = 0.16, respectively). CONCLUSION: Substantial practice variation in colorectal surgery still exists. Individual ERAS principles are commonly followed; however, ERAS behaviours are not widely formalized into hospital protocols.


Assuntos
Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada/normas , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Reto/cirurgia , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Protocolos Clínicos/normas , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Comunitários/normas , Hospitais Comunitários/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Padrões de Prática Médica/normas , Padrão de Cuidado , Cirurgiões/normas , Inquéritos e Questionários/estatística & dados numéricos
9.
Can J Surg ; 63(5): E391-E392, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32856888

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care delivery and has resulted in a backlog of patients needing surgery. There is a lack of experience and guidance in dealing with this increased demand on an already overburdened health care system. We created an online tool (www.covidbacklog.com) that helps surgeons explore how resource allocation within their group will affect wait times for patients. After inputting a handful of readily available variables, the computer program generates a forecast of how long it will take to see the backlog of patients. This information could be used to allow surgical groups to run simulations to explore different resource allocation strategies in order to help prevent downstream consequences of delayed patient care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Cirurgia Geral/organização & administração , Pneumonia Viral/epidemiologia , Cirurgiões/normas , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão
10.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
14.
Surgery ; 168(3): 404-407, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32624225

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center, a regional safety-net hospital, the Department of Surgery created a dedicated coronavirus disease 2019 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in coronavirus disease 2019 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams. METHODS: Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment. Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated surgeon-led team would perform invasive bedside procedures expeditiously and with few complications. RESULTS: From March 30, 2020 to April 30, 2020, there were 1,196 coronavirus disease 2019 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax. CONCLUSION: Procedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be redirected to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Provedores de Redes de Segurança/organização & administração , Cirurgiões/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Pneumonia Viral/transmissão , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
18.
Rev Col Bras Cir ; 47: e20202549, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578820

RESUMO

Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Humanos , Músculos Laríngeos/cirurgia , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/normas , Gestão de Riscos/normas , Cirurgiões/normas , Traqueostomia/normas
19.
Rev Col Bras Cir ; 47: e20202570, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578822

RESUMO

During the current COVID-19 pandemic, the surgical community faces the possible risk of infection of health care professionals involved in the surgical procedure. This leaves to concerns and questions referred to the most adequate surgical approach at this moment. With the objective of guiding surgeons, and based in many different protocols published until now, the Brazilian College of surgeons brings recommendations about this subject. The aim of this technical note is, trough a compilaton of publications and recommendations from Scientific Societies of Surgery worldwide, to provide guidelines regarding laparoscopic access during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Laparoscopia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sociedades Médicas/normas , Cirurgiões/normas , Betacoronavirus , Brasil , Infecções por Coronavirus/transmissão , Humanos , Salas Cirúrgicas/normas , Equipamento de Proteção Individual , Pneumonia Viral/transmissão , Pneumoperitônio Artificial/normas , Triagem/normas
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