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1.
Pol Arch Intern Med ; 129(9): 572-573, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31566586
3.
J Clin Ethics ; 30(3): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573971

RESUMO

Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.


Assuntos
Eticistas , Hospitais , Assistência Centrada no Paciente , Assistência à Saúde , Humanos , Assistência Centrada no Paciente/ética
5.
BMC Public Health ; 19(1): 1148, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522680

RESUMO

BACKGROUND: A clear understanding of the epidemiology of malaria and dengue co-infection is essential for informed decisions on appropriate control strategies for dengue and malaria. This systematic review synthesized evidence on the relationship of malaria and dengue co-infection and related it to alterations in platelet, hemoglobin, hematocrit, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels when compared to malaria mono-infection. METHODS: A systematic review in accordance with PRISMA guidelines was conducted. All published articles available in PubMed and Web of Science (ISI) databases before October 21, 2017 were recruited. All epidemiological studies except case reports on the prevalence or incidence of malaria and dengue co-infection among patients visiting hospitals with febrile illness were included. Studies that involved conference abstracts, protocols, systematic reviews, only mono-dengue or mono-malaria infections, and only animal or in vitro studies were excluded after screening the titles, abstracts, and body texts. Studies were additionally excluded after full text review when they lacked epidemiologic data on malaria and dengue co-infection. Two reviewers independently screened, reviewed, and assessed all the studies. Cochrane Q (Chi-square) and Moran's I2 were used to assess heterogeneity, and the funnel plot was used to examine publication bias. The summary odds ratio (OR) and 95% confidence intervals (CI) were estimated using a fixed-effects model. Thirteen cross-sectional and two retrospective studies were eligible to be included in the systematic review and meta-analysis. RESULTS: Out of the 2269 citations screened, 15 articles were eligible to be included in the systematic review and meta-analysis. The 15 studies involved 13,798 (10,373 cases with malaria and 3425 with dengue) patients in 9 countries. Thirteen studies compared the incidence and odds of Plasmodium sp. infection, five studies compared the odds of mean platelet, three studies compared Plasmodium parasite density, and four studies compared the odds of hemoglobin, hematocrit, AST, and ALT levels among co-infected groups and single-malaria-infected groups. CONCLUSIONS: This study showed that dengue and malaria co-infection was associated with decreased odds of malaria infection, malaria parasitemia, AST, and ALT levels when compared to malaria mono-infection. However, malaria and dengue co-infection was associated with increased odds of platelet and hemoglobin levels when compared to malaria mono-infection.


Assuntos
Coinfecção , Dengue , Malária , Animais , Coinfecção/epidemiologia , Estudos Transversais , Dengue/diagnóstico , Dengue/epidemiologia , Hematócrito , Hospitais , Humanos , Laboratórios , Malária/diagnóstico , Malária/epidemiologia , Razão de Chances , Parasitemia , Prevalência , Estudos Retrospectivos
7.
Pan Afr Med J ; 33: 89, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489067

RESUMO

Introduction: Mortality of adult patients who are on antiretroviral therapy (ART) is higher in low-income than in high-income countries. After the failure of standard first-line treatment, patients switch to second-line regimens. However, there are limited data about the outcome of patients after switching to a second-line regimen in the study area. This study aimed to measure the rate of mortality and its determinants among HIV patients on second-line ART regimens. Methods: Multicenter institution based retrospective follow up study was conducted among 1192 adult patients who started second-line ART between 2008 and 2016 in eight selected hospitals of Amhara region. Patients who started second-line treatment after the failure of first-line treatment were included. Patient medical records, registration books, and computer database were used to collect the data. Time to death after a switch to second-line ART was the primary outcome of interest. Cox proportional hazard model was fitted to identify determinant factors of mortality. Results: Among 1192 patients who were on second-line ART, 136 (11.4%) died with 3,157 person-years of follow up. Over the study period, the mortality rate was 4.33 per 100 person-years. Not taking isoniazid preventive therapy (IPT) (Adjusted Hazard Ratio (AHR): 6.6; 95% CI: 2.9, 15.0), did not make modification on second-line regimen (AHR: 4.4; 95% CI: 2.8, 6.8), poor clinical adherence (AHR: 2.5; 95% CI: 1.4, 4.5), functional status of bedridden (AHR: 2.7; 95% CI: 1.5, 4.8), and having attained a tertiary level of education (AHR: 0.4; 95% CI: 0.2, 0.8) were independent determinants of mortality. Conclusion: The incidence rate of mortality was high and most of the deaths occurred within 12 months after switching to second-line ART. Higher mortality among adult HIV-infected patients was associated with poor adherence, no formal education, not taking IPT, being bedridden at the time of the switch, and not modifying second-line treatment. Improving treatment adherence of patients by providing consistent adherence counseling, providing INH prophylaxis and monitoring patient's regimen more closely during the first twelve months after switch could decrease mortality of HIV patients on a second-line regimen.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Isoniazida/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Pessoas Acamadas/estatística & dados numéricos , Escolaridade , Etiópia/epidemiologia , Feminino , Seguimentos , Infecções por HIV/mortalidade , Hospitais , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
8.
Soins ; 64(838): 13-19, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31542112

RESUMO

The number of hospital-based clinical trials is resulting in the growing involvement of nurses. A cross-sectional study in five hospitals involving 60 nurses assessed the clinical research activities, the time allocated and the training level. The results suggest that identifying specific nursing time devoted to clinical research may influence the activities carried out. Improving the definition of these activities could facilitate their integration into nursing practice.


Assuntos
Ensaios Clínicos como Assunto/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/psicologia , Estudos Transversais , Hospitais , Humanos
9.
Isr Med Assoc J ; 21(8): 565-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474024

RESUMO

BACKGROUND: Global trends, such as the population aging, the increase of chronic morbidity, soaring costs of healthcare services, and work overload in hospitals raise the need to find innovative solutions for providing quality medical services. One solution adopted by healthcare systems around the world is "home hospitalization," that is, providing an array of necessary health services in the patient's home, instead of in the hospital department. The aim of this focus article is to explore the spread of home hospitalization worldwide and examine the challenges and pathways for its adoption and implementation. Many countries, including the United States, Canada, the United Kingdom, and Australia, operate home-based hospitalization programs. In Israel, the service is in its infancy, but in view of the extreme workload and the high mortality rate from infections in acute care hospitals, home hospitalization has recently gained public interest and political support, which may encourage its further development.


Assuntos
Serviços de Assistência Domiciliar , Hospitais , Austrália , Canadá , Humanos , Internacionalidade , Israel , Reino Unido , Estados Unidos
10.
Pan Afr Med J ; 33: 142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558940

RESUMO

Introduction: Hand injuries constitute a major proportion of trauma emergencies in developing countries. The hand establishes the individual in society, allowing them to meet social and economic responsibilities. Previously hand traumas accounted for 12% of major limb traumas in Addis Ababa, Ethiopia; but data on the specific types of tissue injuries and pattern of occurrence of these injuries over the years is limited. Methods: A retrospective study of sampled 178 patients with hand injury that presented to Yekatit 12 Hospital with hand injuries was done by reviewing the patient's medical records. Results: Hand trauma is the second commonest injury following burns that present to the Plastic and Reconstructive Surgery unit in Yekatit 12 hospital. It commonly occurs in males with ratio of 4:1. Average age of patients was 24.5 years. The right hand was more commonly injured than the left hand. Home and fall accidents were commonest cause of injury followed by machine injuries. Commonly occurring injuries were tendon injuries followed by fingertip injuries. The number of patients presenting to the hospital with hand injuries has doubled over the two year study period. Conclusion: The number of hand injury cases that presented to the hospital has doubled over the two years study period. Types of hand injuries presenting to the hospitals ranged from simple lacerations to deep tissue injuries requiring long duration of treatment and rehabilitation which has an impact on the productivity of the younger age group that was identified as the most at risk population.


Assuntos
Queimaduras/epidemiologia , Traumatismos da Mão/epidemiologia , Lacerações/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Etiópia , Feminino , Traumatismos dos Dedos/epidemiologia , Traumatismos da Mão/etiologia , Traumatismos da Mão/terapia , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Traumatismos dos Tendões/epidemiologia , Adulto Jovem
11.
Pan Afr Med J ; 33: 146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558943

RESUMO

Introduction: Infection due to multidrug-resistant microorganisms is a growing threat in healthcare settings. Acinetobacter species specifically A. baumannii is increasingly becoming resistant to most antimicrobial agents recommended for treatment. This study aimed to determine the antimicrobial susceptibility pattern of Acinetobacter species isolated from patients in Kenyatta National Hospital. Methods: We conducted a retrospective study based on VITEK 2 (BioMérieux) electronic records capturing identification and antimicrobial susceptibility of Acinetobacter isolates from patient samples analyzed between 2013 and 2015 at Kenyatta National Hospital microbiology laboratory. Generated data were analyzed using WHONET and SPSS. Results: A total of 590 Acinetobacter isolates were analyzed. 85% of the isolates tested were multi-drug resistant (MDR). Among the 590 isolates, 273 (46%) were from tracheal aspirates and 285 (48%) from the critical care unit. A. baumannii was the most frequently isolated species with high susceptibility to amikacin (77%) and poor susceptibility to ciprofloxacin (69-76%), tobramycin (37%) and meropenem (27%). Both A. lwoffii and A. haemolyticus had high susceptibility to amikacin (80-100%) and meropenem (75-100%). Conclusion: A. baumannii is resistant to commonly administered antibiotics. There is need for continuous antimicrobial resistance surveillance especially in health care facilities and strengthening of antibiotic stewardship programmes which will contribute to enhancement of infection control policies.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter/efeitos dos fármacos , Antibacterianos/farmacologia , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitais , Humanos , Quênia , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31522661

RESUMO

The Influenza Complications Alert Network (FluCAN) is a sentinel-hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2017 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data are also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2017 (the 2017 influenza season), 4,359 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 52% were elderly (≥65 years), 14% were children (<16 years), 6.5% were Aboriginal and Torres Strait Islander peoples, 1.6% were pregnant and 78% had chronic comorbidities. A significant proportion were due to influenza B (31%). Estimated vaccine coverage was 72% in the elderly (≥65 years), 50% in non-elderly adults with medical comorbidities and 24% in children (<16 years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 23% (95% CI: 7%, 36%). There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2017, with case numbers more than twice that reported in 2016.


Assuntos
Vírus da Influenza B/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos de Casos e Controles , Comorbidade , Feminino , Hospitalização , Hospitais , Humanos , Vírus da Influenza B/classificação , Vírus da Influenza B/genética , Influenza Humana/etnologia , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Gravidez , Vigilância de Evento Sentinela , Vacinação , Adulto Jovem
13.
Stud Health Technol Inform ; 267: 11-19, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483249

RESUMO

Radiology has a reputation for having a high affinity to innovation - particularly with regard to information technologies. Designed for supporting the peculiarities of radiological diagnostic workflows, Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) developed into widely used information systems in hospitals and form the basis for advancing the field towards automated image diagnostics. RIS and PACS can thus serve as meaningful indicators of how quickly IT innovations diffuse in secondary care settings - an issue that requires increased attention in research and health policy in the light of increasingly fast innovation cycles. We therefore conducted a retrospective longitudinal observational study to research the diffusion dynamics of RIS and PACS in German hospitals between 2005 and 2017. Based upon data points collected within the "IT Report Healthcare" and building on Rogers' Diffusion of Innovation (DOI) theory, we applied a novel methodological technique by fitting Bayesian Bass Diffusion Models on past adoption rates. The Bass models showed acceptable goodness of fit to the data and the results indicated similar growth rates of RIS and PACS implementations and suggest that market saturation is almost reached. Adoption rates of PACS showed a slightly higher coefficient of imitation (q = 0.25) compared to RIS (q = 0.11). However, the diffusion process expands over approximately two decades for both systems which points at the need for further research into how innovation diffusion can be accelerated effectively. Furthermore, the Bayesian approach to Bass modelling showed to have several advantages over the classical frequentists approaches and should encourage adoption and diffusion research to adapt similar techniques.


Assuntos
Teorema de Bayes , Sistemas de Informação em Radiologia , Radiologia , Hospitais , Estudos Retrospectivos
14.
Stud Health Technol Inform ; 267: 238-246, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483278

RESUMO

The German Emergency Department Data Registry (GEDD-registry, AKTIN) provides an infrastructure for collecting and querying up-to-date medical records in a distributed manner. Within this framework, a benchmark report on cross-institutional comparison using the program R is prepared using routine data of participating hospitals. Currently, 16 emergency departments (EDs) routinely transfer data of 1,200 to approximately 5,000 patients per month to a federated GEDD-registry datawarehouse. Using various packages in the R environment, hospitals receive a monthly visual report on their data among all participating hospitals. Graphical representations are implemented using column diagrams and box plots. Reports currently contain 25 tables and 40 graphs. Benchmark reports are created in R-Studio and exported using Portable Document Format, PDF. Quarterly expert meetings with the heads of participating EDs are currently performed for further improvements. Preparation of external benchmarking reports with R enables a detailed data presentation for participating hospitals and ED managers.


Assuntos
Benchmarking , Serviço Hospitalar de Emergência , Hospitais , Humanos , Sistema de Registros
15.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(3): 260-266, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31496157

RESUMO

OBJECTIVE: To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis. METHODS: Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (n=101) and out-of-hospital stroke (n=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis. RESULTS: Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, P<0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, P<0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, P<0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, P<0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, P<0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, P<0.05], compared with patients in primary stroke center. Age (OR=0.934, 95%CI: 0.882-0.989, P<0.05) and baseline National Institute of Health Stroke Scale score (OR=0.912, 95%CI: 0.855-0.973, P<0.01) were independent risk factors for prognosis of in-hospital stroke patients. CONCLUSIONS: In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Administração Intravenosa , Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Hospitais/estatística & dados numéricos , Humanos , Prognóstico , Terapia Trombolítica/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
16.
Pan Afr Med J ; 33: 120, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489098

RESUMO

Introduction: This study aimed to describe the epidemiological, clinical and evolutionary profile of patients treated for tuberculosis at the Regional Hospital of Maradi. Methods: We conducted a retrospective, descriptive and analytical study of data from the medical records of patients treated for tuberculosis from 1st January 2015 to 31st December 2017. Results: A total of 595 patients were followed (406 men, 68.24%, and 189 women, 31.76%) with a prevalence of 27,71%. The average age of patients was 42.3 ranging from 13 months to 85 years; 70.5% of these patients were from urban areas. Merchants represented 36.9% of the cases. Bacterial test was positive in 64.7% of cases. Functional signs included: coughing (99.5%), fever (79.5%), and chest pain. Pulmonary tuberculosis represented 78.7% of cases. Therapy was effective in 81.28% of cases. HIV prevalence was 13.6%, lethality 10.42% (40.4% of patients died from TB/HIV co-infection). Conclusion: Tuberculosis is a scourge in low-income countries, with 10.42% of deaths. HIV/AIDS infection has negatively contributed to these deaths during the study period. The search for comorbidities in any patient with tuberculosis should be systematic in order to improve their global management.


Assuntos
Antituberculosos/administração & dosagem , Infecções por HIV/epidemiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Níger/epidemiologia , Prevalência , Estudos Retrospectivos , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto Jovem
17.
Stud Health Technol Inform ; 264: 1849-1850, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438374

RESUMO

Patients' roles in preventing errors has been emphasized. Patients' and families' participation is one of the important strategies to improve patient safety. Therefore, it is necessary to educate patients and families who visit hospitals. Web-based educational programs can be useful tools to provide patient safety information easily and enhance patients' and families' knowledge. This study analyzed requirements for developing a web-based program for patient participation in patient safety.


Assuntos
Participação do Paciente , Segurança do Paciente , Hospitais , Humanos
18.
Stud Health Technol Inform ; 264: 1957, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438426

RESUMO

Malicious e-mails sent intentionally to institutions have caused an increase in data breaches. Measures against these methods must be taken by healthcare institutions to prevent leakage of sensitive personal medical information. As a form of training, we conducted a phishing simulation to gauge the response of the hospital staff to similar email attacks, and to raise awareness about information security protocols.


Assuntos
Correio Eletrônico , Hospitais
19.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(7): 818-822, 2019 Jul 28.
Artigo em Chinês | MEDLINE | ID: mdl-31413222

RESUMO

OBJECTIVE: To understand the development of medical social work in China, and provide reference and basis for promoting medical social work in the next stage.
 Methods: A random sampling method was used to survey and analyze the data from questionnaires distributed to hospitals at or above the second level in China.
 Results: Medical social work had been carried out in all parts of the country, but the development was not balanced with the establishment of specialized agencies accounting for about 7.9% of the total survey. Only 17.5% of the hospitals carried out medical social work as a routine work. The medical social work service mainly included volunteer operation and management, patient psychological counseling, and so on.
 Conclusion: The development of medical social work in hospitals in China is still in its infancy, and the regional development is not balanced. Lack of professionals, unclear responsibilities of medical social workers and low social identity of medical social work are the main factors restricting development.


Assuntos
Hospitais , Serviço Social , Grupo com Ancestrais do Continente Asiático , China , Humanos , Inquéritos e Questionários
20.
West Afr J Med ; 36(2): 112-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385595

RESUMO

BACKGROUND: Laboratory request forms serve as a medium for communication between clinicians managing medical cases and the pathologist. Improperly filled forms impairs the ability of pathologists to generate sound and valuable reports. This research focused on finding out the extent to which doctors in Federal Medical Centre, Umuahia properly fill laboratory request forms. METHODOLOGY: A total of 1,509 laboratory request forms directed to the electrolyte bench, already filled out by various doctors in the hospital between May and October, 2018 were retrospectively studied. The completeness of information supplied by requesting physician based on some parameters were analysed. RESULTS: In descending order, the most frequently provided data were as follows; name of patient, 1,509[100.0%]; gender,973[64.5%]; provisional diagnosis,866[57.4%]; age,639[42.4%]; hospital number,428[28.4%]; clinical summary,47[3.1%]. 26[2%] forms were completed in their entirety per the 6 variables assessed. CONCLUSION: Proper and adequate filling of laboratory request forms is very poor in this hospital. Therefore, continuous medical education on the need for adequate completion of request forms is absolutely necessary.


Assuntos
Serviços de Diagnóstico/estatística & dados numéricos , Controle de Formulários e Registros , Laboratórios Hospitalares , Médicos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Sistemas de Informação em Laboratório Clínico , Serviços de Laboratório Clínico , Testes Diagnósticos de Rotina/métodos , Hospitais , Humanos , Nigéria , Estudos Retrospectivos
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