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ORIGINAL ARTICLE
Sepsis and COVID-19: outcomes in young adults in intensive care
- Talita Andrade Santos
, - José Edilson de Oliveira ,
- Cassiane Dezoti da Fonseca ,
- Dulce Aparecida Barbosa ,
- Angélica Gonçalves da Silva Belasco , [ … ],
- Carla Roberta Monteiro Miura
12-04-2023
Abstract
ORIGINAL ARTICLESepsis and COVID-19: outcomes in young adults in intensive care
Revista Brasileira de Enfermagem. 2023;76(6):e20230037
12-04-2023DOI 10.1590/0034-7167-2023-0037
- Talita Andrade Santos ,
- José Edilson de Oliveira ,
- Cassiane Dezoti da Fonseca ,
- Dulce Aparecida Barbosa ,
- Angélica Gonçalves da Silva Belasco ,
- Carla Roberta Monteiro Miura
Views0See moreABSTRACT
Objective:
to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables.
Methods:
a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records.
Results:
sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis.
Conclusions:
there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.
- Talita Andrade Santos
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ORIGINAL ARTICLE
Changes in body composition of burn patients during the phases of response to trauma
- Andressa Maranhão de Arruda ,
- Patrícia Calado Ferreira Pinheiro Gadelha ,
- Bruna Lúcia de Mendonça Soares ,
- Catiana Coelho Cabral Dowsley ,
- Maria da Conceição Chaves de Lemos , [ … ],
- Ana Célia Oliveira dos Santos
12-04-2023
Abstract
ORIGINAL ARTICLEChanges in body composition of burn patients during the phases of response to trauma
Revista Brasileira de Enfermagem. 2023;76(6):e20230039
12-04-2023DOI 10.1590/0034-7167-2023-0039
- Andressa Maranhão de Arruda ,
- Patrícia Calado Ferreira Pinheiro Gadelha ,
- Bruna Lúcia de Mendonça Soares ,
- Catiana Coelho Cabral Dowsley ,
- Maria da Conceição Chaves de Lemos ,
- Ana Célia Oliveira dos Santos
Views0See moreABSTRACT
Objective:
To assess the changes in body composition of burn patients through electrical bioimpedance in the phases of response to trauma.
Methods:
a longitudinal observational study, carried out from October 2019 to March 2020. Sociodemographic, clinical, epidemiological, anthropometric and body composition data were collected. Statistical analysis was performed with SPSS, considering a significance of 5%. The comparison between variables was performed using the paired Student’s t test.
Results:
the sample consisted of 58 adult burn patients, with a mean age of 38.2±12.5 years. The mean body surface area (BSA) with burns was 10.8±7.3%. Nutritional assessment demonstrated a depletion of body weight, Body Mass Index, fat-free mass and muscle mass in the phases of response to trauma (p<0.005).
Conclusion:
metabolic alterations in the different phases of the metabolic response to trauma led to a depletion of the nutritional status of burn patients of both sexes during hospitalization.
- Andressa Maranhão de Arruda
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ORIGINAL ARTICLE
Clinical simulation scenarios for the planning and management of infusion therapy by nurses
- Mariana de Jesus Meszaros ,
- Angélica Olivetto de Almeida ,
- Ruana Luiz Ferreira da Silva ,
- Aline Helena Appoloni Eduardo ,
- Maria Helena de Melo Lima , [ … ],
- Ana Railka de Souza Oliveira-Kumakura
12-04-2023
Abstract
ORIGINAL ARTICLEClinical simulation scenarios for the planning and management of infusion therapy by nurses
Revista Brasileira de Enfermagem. 2023;76(6):e20230019
12-04-2023DOI 10.1590/0034-7167-2023-0019
- Mariana de Jesus Meszaros ,
- Angélica Olivetto de Almeida ,
- Ruana Luiz Ferreira da Silva ,
- Aline Helena Appoloni Eduardo ,
- Maria Helena de Melo Lima ,
- Ana Railka de Souza Oliveira-Kumakura
Views0ABSTRACT
Objective:
to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses.
Methods:
methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74.
Conclusion:
two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.
Keywords:Educational MeasurementNursing EducationPatient Care PlanningSimulation TrainingVascular Access DevicesSee more - Mariana de Jesus Meszaros
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ORIGINAL ARTICLE
Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
- Ademir Jones Antunes Dorneles ,
- Graziele de Lima Dalmolin ,
- Edison Luiz Devos Barlem ,
- Rosemary Silva da Silveira ,
- Rafaela Andolhe , [ … ],
- Valdecir Zavarese da Costa
12-04-2023
Abstract
ORIGINAL ARTICLEBurnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
12-04-2023DOI 10.1590/0034-7167-2022-0684
- Ademir Jones Antunes Dorneles ,
- Graziele de Lima Dalmolin ,
- Edison Luiz Devos Barlem ,
- Rosemary Silva da Silveira ,
- Rafaela Andolhe ,
- Silviamar Camponogara ,
- Tânia Solange Bosi de Souza Magnago ,
- Valdecir Zavarese da Costa
Views0See moreABSTRACT
Objectives:
to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units.
Methods:
mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used.
Results:
the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit.
Conclusions:
there was an association between burnout and ethical climate and elements of the work organization.
- Ademir Jones Antunes Dorneles
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Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
- Vitória Pessoa Nogueira ,
- Marília Alves Furtado ,
- Vera Lúcia Mendes de Paula Pessoa ,
- Viviane Magalhães Pereira
12-04-2023
Abstract
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
12-04-2023DOI 10.1590/0034-7167-2022-0759
- Vitória Pessoa Nogueira ,
- Marília Alves Furtado ,
- Vera Lúcia Mendes de Paula Pessoa ,
- Viviane Magalhães Pereira
Views0See moreABSTRACT
Objectives:
to reflect on the ethical dilemmas involved in the care of patients at the end of their lives.
Methods:
this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari.
Results:
discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient’s autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care.
Final Considerations:
issues related to being, stemming from one’s reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.
- Vitória Pessoa Nogueira
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The ethics of nursing care for transgender people
Revista Brasileira de Enfermagem. 2023;76:e20220797
12-04-2023
Abstract
The ethics of nursing care for transgender people
Revista Brasileira de Enfermagem. 2023;76:e20220797
12-04-2023DOI 10.1590/0034-7167-2022-0797
Views0See moreABSTRACT
Objectives:
to discuss ethical aspects in nursing care for transgender people.
Methods:
reflective study based on the dilemmas that emerges in nursing care for transgender people. The report was structured around the four bioethical principles.
Results:
health care for trans people is complex, transversal to many devices and specialties and longitudinal in time, that is why it requires coordinated action. There is an ethical framework in which the nursing care must be observed in the care of this group.
Final Considerations:
the nurse as a health worker can assume several general lines in the care of transgender patients. So, complementary training should be provided not only to professionals, but also to students of nursing and other health sciences.
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EDITORIAL
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
12-04-2023
Abstract
EDITORIALChronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
12-04-2023DOI 10.1590/0034-7167.202376suppl301
Views0The relationship between chronicity and work has been a growing concern in contemporary society. As the number of chronic illnesses increases around the world, it is critical to understand how these conditions impact workers’ health(). In this editorial, we will explore the impacts of chronicity on workers’ health, highlighting data from the Global Burden of […]See more -
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
12-04-2023
Abstract
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
12-04-2023DOI 10.1590/0034-7167-2023-0126
Views0See moreABSTRACT
Objectives:
to reflect on the impacts of the General Personal Data Protection Law on Nursing practice.
Methods:
reflection article, through the intentional collection of materials relating to the topic.
Results:
legislation regulates confidentiality, processing and data sharing, requiring institutional protection measures. The nursing team is responsible for acting preventively, both in care and in the management role, in order to avoid the misuse of the patient’s personal data. The law allows academic research to be carried out as long as the purpose is clear, data collection occurs with an explicit purpose and data is anonymized.
Final Considerations:
although the General Personal Data Protection Law requires greater care in relation to data processing, it is established on precepts of good faith and respect for the rights of the individual, concepts aligned with the nursing code of ethics.
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ORIGINAL ARTICLE
Tuberculosis: health care and surveillance in prisons
- Manuela Filter Allgayer ,
- Karine Zenatti Ely ,
- Graziela Hamann de Freitas ,
- Andréia Rosane de Moura Valim ,
- Roxana Isabel Cardozo Gonzales , [ … ],
- Lia Gonçalves Possuelo
09-16-2019
Abstract
ORIGINAL ARTICLETuberculosis: health care and surveillance in prisons
Revista Brasileira de Enfermagem. 2019;72(5):1304-1310
09-16-2019DOI 10.1590/0034-7167-2018-0260
- Manuela Filter Allgayer ,
- Karine Zenatti Ely ,
- Graziela Hamann de Freitas ,
- Andréia Rosane de Moura Valim ,
- Roxana Isabel Cardozo Gonzales ,
- Suzane Beatriz Frantz Krug ,
- Lia Gonçalves Possuelo
Views0ABSTRACT
Objective:
To identify tuberculosis-related health care and surveillance actions in Prison Health Units.
Method:
Cross-sectional study, of quantitative, exploratory and descriptive character. We visited 13 Teams of Prison Health, and nurses and technicians were interviewed regarding epidemiological surveillance instruments, physical structure and materials.
Results:
Search for respiratory symptoms in admission was reported by 6 (46.2%) of the teams, and the smear microscopy was the most requested test. The Logbook of Respiratory Symptoms and the Logbook for Monitoring Tuberculosis Cases were used in 7 (53.8%) institutions. Two of them (15.4%) had a location for sputum collection and 1 (7.7%) had a radiographer. The Directly Observed Therapy was reported in 7 (53.8%) units.
Conclusion:
Health care actions related to the search for respiratory symptoms and Directly Observed Therapy should be expanded, as well as surveillance actions and recording in official documents of the National Tuberculosis Control Program.
Keywords:Cross-Sectional StudiesDelivery of Health CarePrisonsPublic Health SurveillanceTuberculosisSee more
- Manuela Filter Allgayer
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ORIGINAL ARTICLE
Patient safety incidents identified by the caregivers of hospitalized children
- Letícia Maria Hoffmann ,
- Wiliam Wegner ,
- Cecilia Biasibetti ,
- Merianny de Ávila Peres ,
- Luiza Maria Gerhardt , [ … ],
- Márcia Koja Breigeiron
06-27-2019
Abstract
ORIGINAL ARTICLEPatient safety incidents identified by the caregivers of hospitalized children
Revista Brasileira de Enfermagem. 2019;72(3):707-714
06-27-2019DOI 10.1590/0034-7167-2018-0484
- Letícia Maria Hoffmann ,
- Wiliam Wegner ,
- Cecilia Biasibetti ,
- Merianny de Ávila Peres ,
- Luiza Maria Gerhardt ,
- Márcia Koja Breigeiron
Views0See moreABSTRACT
Objective:
to analyze patient safety incidents identified by caregivers of hospitalized children.
Method:
a qualitative, exploratory-descriptive study was carried out with 40 caregivers of children hospitalized in three hospital institutions in the city of Porto Alegre, Rio Grande do Sul State, Brazil, from April to December 2016. Semi-structured, recorded and transcribed interviews were carried out in their entirety, submitted to a thematic analysis using the NVivo 11.0 software.
Results:
reports related to falls, infant feeding, patient/caregiver identification, medication process, communication, hand hygiene and hygiene of the hospital environment, spread of diseases, relations between caregivers and professionals and care processes/procedures were all cited.
Final considerations:
communication and the relations among caregivers and professionals are the main contributory factors for patient safety incidents, interfering with the quality of care. The participation of caregivers and engagement in child care may be strategies to be developed to promote a safety culture.
- Letícia Maria Hoffmann
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ORIGINAL ARTICLE
Maternal and child health care: adequacy index in public health services
- Flávia Françoso Genovesi ,
- Márcia Aparecida dos Santos Silva Canario ,
- Christine Bacarat de Godoy ,
- Sandra Mara Maciel ,
- Alexandrina Aparecida Maciel Cardelli , [ … ],
- Rosângela Aparecida Pimenta Ferrari
07-31-2020
Abstract
ORIGINAL ARTICLEMaternal and child health care: adequacy index in public health services
Revista Brasileira de Enfermagem. 2020;73:e20170757
07-31-2020DOI 10.1590/0034-7167-2017-0757
- Flávia Françoso Genovesi ,
- Márcia Aparecida dos Santos Silva Canario ,
- Christine Bacarat de Godoy ,
- Sandra Mara Maciel ,
- Alexandrina Aparecida Maciel Cardelli ,
- Rosângela Aparecida Pimenta Ferrari
Views0See moreABSTRACT
Objectives:
to analyze the adequacy of maternal and child-care in prenatal care, childbirth and the puerperal period, in the public health service.
Methods:
longitudinal study carried out in a city in Paraná with 357 puerperal women in a public maternity ward, outpatient clinic for immediate puerperal return and home visit 42 days postpartum. Four care domains were grouped (1 – Prenatal, 2 – Maternity, 3 – Immediate puerperal return, 4 – Late puerperal return). Mean, median, standard deviation and coefficient of variance were calculated considering adequate assistance when ≥ 70%; and inadequate, inferior.
Results:
lowest suitability average in Domain 3 (39.37%) and highest for Domain 4 (74.82%); median of 50.00% at 3 and 76.90% at 4. The largest standard deviation, in Domain 3 (25.18%); and high coefficient of variance for 1 and 3.
Conclusions:
in maternal and child follow-up, rates close to adequate in maternity care and higher in late puerperal return, meanwhile prenatal and immediate puerperal return were below the recommended in the health care network.
- Flávia Françoso Genovesi
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ORIGINAL ARTICLE
Temporal trend of leprosy in a region of high endemicity in the Brazilian Northeast
- Thayza Miranda Pereira ,
- Lucilane Maria Sales da Silva ,
- Maria Socorro de Araújo Dias ,
- Lorena Dias Monteiro ,
- Maria Rocineide Ferreira da Silva , [ … ],
- Olga Maria de Alencar
09-16-2019
Abstract
ORIGINAL ARTICLETemporal trend of leprosy in a region of high endemicity in the Brazilian Northeast
Revista Brasileira de Enfermagem. 2019;72(5):1356-1362
09-16-2019DOI 10.1590/0034-7167-2018-0682
- Thayza Miranda Pereira ,
- Lucilane Maria Sales da Silva ,
- Maria Socorro de Araújo Dias ,
- Lorena Dias Monteiro ,
- Maria Rocineide Ferreira da Silva ,
- Olga Maria de Alencar
Views0See moreABSTRACT
Objective:
to analyze the temporal trend and epidemiological patterns of leprosy indicators in Sobral, a municipality countryside of the state of Ceará, from 2001 to 2016.
Method:
a time series study based on data from the Department of Informatics of the Unified Health System. The time trend analysis was performed using the join point regression model.
Results:
There were 2,220 new cases of leprosy in Sobral from 2001 to 2016. Of these, 158 (7.2%) in children younger than 15 years of age, the proportion of new male cases was 52.8% (1,162), cases with grade 2 were 7.0% (156), and proportion of cases diagnosed by contact examination 5.7% (126).
Final considerations:
leprosy remains hyperendemic in adults and children, demonstrating the character of neglected disease. Analysis of the temporal trend allowed to verify that the instability in the detection coefficients, reflect operational problems in the organization of the services
- Thayza Miranda Pereira
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ORIGINAL ARTICLE
Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities
- Andrea Bernardes ,
- Carmen Silvia Gabriel ,
- Greta G. Cummings ,
- Ariane Cristina Barboza Zanetti ,
- Alexandre Bevilacqua Leoneti , [ … ],
- Vanessa Gomes Maziero
09-30-2020
Abstract
ORIGINAL ARTICLEOrganizational culture, authentic leadership and quality improvement in Canadian healthcare facilities
Revista Brasileira de Enfermagem. 2020;73:e20190732
09-30-2020DOI 10.1590/0034-7167-2019-0732
- Andrea Bernardes ,
- Carmen Silvia Gabriel ,
- Greta G. Cummings ,
- Ariane Cristina Barboza Zanetti ,
- Alexandre Bevilacqua Leoneti ,
- Graziela Caldana ,
- Vanessa Gomes Maziero
Views0See moreABSTRACT
Objective:
To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities.
Method:
Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman’s correlation coefficient and Chi-squared test (p<0.05).
Results:
Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices.
Conclusion:
This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.
- Andrea Bernardes
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COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention
- Vinicius Batista Santos ,
- Daniele Cristina Bosco Aprile ,
- Camila Takáo Lopes ,
- Juliana de Lima Lopes ,
- Mônica Antar Gamba , [ … ],
- Tânia Arena Moreira Domingues
04-14-2021
Abstract
COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention
Revista Brasileira de Enfermagem. 2021;74:e20201185
04-14-2021DOI 10.1590/0034-7167-2020-1185
- Vinicius Batista Santos ,
- Daniele Cristina Bosco Aprile ,
- Camila Takáo Lopes ,
- Juliana de Lima Lopes ,
- Mônica Antar Gamba ,
- Karina Aparecida Lopes da Costa ,
- Tânia Arena Moreira Domingues
Views0See moreABSTRACT
Objective:
to perform the content and face validation of a checklist and a banner on pressure injury prevention in patients in prone position.
Method:
this is a methodological study of content and face validation with 26 nurses with specialization. Professionals assessed the checklist and the banner in relation to clarity, theoretical relevance, practical relevance, relation of the figures to the text and font size. The Content Validity Index was calculated for each item, considering one with a value equal to or greater than 0.8 as valid.
Results:
all the actions described in the checklist and in the banner had a Content Validity Index greater than 0.80, with standardization of verbal time and esthetic adjustments in the banner’s layout, as suggested.
Conclusions:
the checklist and the banner were validated and can be used in clinical practice to facilitate pressure injury preventions in patients in prone position.
- Vinicius Batista Santos
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Production and validation of educational technology on nursing care for syphilis prevention
- Policardo Gonçalves da Silva ,
- Luana Matos Silva Araújo ,
- César Augusto Sangaletti Terçariol ,
- Camilla Borges Lopes Souza ,
- Raquel Dully Andrade , [ … ],
- Soraia Assad Nasbine Rabeh
03-19-2021
Abstract
Production and validation of educational technology on nursing care for syphilis prevention
Revista Brasileira de Enfermagem. 2021;74:e20190694
03-19-2021DOI 10.1590/0034-7167-2019-0694
- Policardo Gonçalves da Silva ,
- Luana Matos Silva Araújo ,
- César Augusto Sangaletti Terçariol ,
- Camilla Borges Lopes Souza ,
- Raquel Dully Andrade ,
- Renata Karina Reis ,
- Soraia Assad Nasbine Rabeh
Views0See moreABSTRACT
Objectives:
Validate script and storyboard of a video for educational intervention on nursing care for the prevention and management of syphilis.
Methods:
Methodological design study, with quantitative analysis approach. The content and appearance of the educational video script and storyboard was validated by a committee of experts on the subject and video. They were considered validated from the agreement of 78%, calculated by means of the Content Validity Index.
Results:
There were suggestions, which were analyzed; and, where relevant, the script and storyboard were changed. The degree of agreement among the expert judges on the subject obtained a Content Validity Index (CVI) of 100%, while, with the technical experts in video, all the questions in the educational material obtained the percentage above the recommended minimum of 78%.
Conclusion:
The validated video is an important technological production and could be used in the context of health care.
- Policardo Gonçalves da Silva
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REVIEW
Singular therapeutic project in mental health: an integrative review
Revista Brasileira de Enfermagem. 2020;73(2):e20180508
03-09-2020
Abstract
REVIEWSingular therapeutic project in mental health: an integrative review
Revista Brasileira de Enfermagem. 2020;73(2):e20180508
03-09-2020DOI 10.1590/0034-7167-2018-0508
Views0ABSTRACT
Objectives:
to analyze the Singular Therapeutic Projects’ characteristics in mental health care used to assist the subject with psychological distress.
Methods:
it is an Integrative Literature Review study conducted in July 2017. The following databases used to collect the data were LILACS, MEDLINE and BDENF. After applying the inclusion and exclusion criteria, 12 articles were selected.
Results:
there was divergence between what was recommended by the Ministry of Health for PTS elaboration with that described in the studies analyzed. Emphasis is placed on the low participation and co-responsibility between team/user in PTS elaboration, excessive referrals to specialized mental health services, fragmentation of knowledge within the multidisciplinary team, and difficulty sharing and discussing information about cases.
Final considerations:
it is pointed out the need to adapt PTS elaboration, and its respective steps, to the needs of each individual.
Keywords:Integrality in HealthMental HealthMental Health ServicesPatient Care PlanningPrimary Health CareSee more
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