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ORIGINAL ARTICLE01-10-2024
Childbirth dynamics in the riverside region of the Brazilian Amazon from the perspective of geospatialization
Revista Brasileira de Enfermagem. 2024;77:e20240038
Abstract
ORIGINAL ARTICLEChildbirth dynamics in the riverside region of the Brazilian Amazon from the perspective of geospatialization
Revista Brasileira de Enfermagem. 2024;77:e20240038
DOI 10.1590/0034-7167-2024-0038
Views0See moreABSTRACT
Objective:
to analyze the spatial-temporal pattern of childbirths and flow of postpartum women assisted at a regional reference maternity hospital.
Methods:
ecological study of 4,081 childbirths, between September 2018 and December 2021, at a public maternity hospital in the Baixo Tocantins region, Pará, Brazil. With data collected from five sources, a geographic database was constructed, and spatial analysis was used with Kernel density interpolator. Maps were generated using QGis/3.5 and TerraView/4.3, calculating chi-square (p<0.05).
Results:
the highest concentrations of normal and cesarean childbirths were observed in Barcarena (n=2,558/62.68%), Abaetetuba (n=750/18.38%), Moju (n=363/8.89%) and Igarapé-Miri (n=219/5.37%). Among the municipalities in the region, ten had obstetric beds, totaling 210 beds. In this scenario, postpartum women traveled up to 288 km to reach the maternity hospital.
Conclusions:
long distances between certain municipalities of residence and maternity hospital, and low supply of obstetric beds, were identified as risk factors for unfavorable obstetric outcomes.
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REVIEW01-10-2024
Nurses’ practical contributions to improving healthy and sustainable public spaces: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20240023
Abstract
REVIEWNurses’ practical contributions to improving healthy and sustainable public spaces: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20240023
DOI 10.1590/0034-7167-2024-0023
Views0ABSTRACT
Objective:
to identify knowledge production about nurses’ contributions to improving healthy and sustainable public spaces.
Methods:
an integrative review carried out in February 2023 in electronic databases. Studies that answered the research question and that were available in full, in Portuguese, English and Spanish, were included.
Results:
a total of five articles were selected. The findings highlighted the importance of educational projects in the training of local managers and community autonomy; citizen participation and health promotion as ways to implement Sustainable Development Goal 11; nurses as facilitators of collective care; new health practices and modes of producing subjectivity; and use of public transportation, bicycles and/or walking in these spaces.
Final considerations:
there is a clear need for greater incentives from local governments to develop effective sustainability strategies that are led by nurses and the community.
Keywords:AttitudesCommunity HealthHealth KnowledgeHealthy Lifestyle, NursesNursesPracticeSustainable DevelopmentSee more -
ORIGINAL ARTICLE01-10-2024
Pain management in hospitalized infants: recommendations for achieving the Sustainable Development Goals
Revista Brasileira de Enfermagem. 2024;77:e20230421
Abstract
ORIGINAL ARTICLEPain management in hospitalized infants: recommendations for achieving the Sustainable Development Goals
Revista Brasileira de Enfermagem. 2024;77:e20230421
DOI 10.1590/0034-7167-2023-0421
Views1See moreABSTRACT
Objective:
to assess pain management in infants in a Neonatal Intensive Care Unit (NICU) and discuss its articulation with the Sustainable Development Goals, with a focus on promoting neonatal well-being.
Method:
a documentary study, retrospective in nature and quantitative approach, conducted in a NICU of a public hospital in Paraná, Brazil, between January and July 2022, with 386 medical records of infants, hospitalized for more than 24 hours, between 2019 and 2021. Data were subjected to descriptive and inferential analysis, considering p-value<0.05 as a statistical difference. National ethical guidelines were respected.
Results:
all infants underwent at least one painful procedure, but only 13.7% had documented pain. Pharmacological interventions, such as fentanyl (25.9%), and non-pharmacological interventions, such as breastfeeding encouragement (86%) were used. Only 2.8% were reassessed.
Conclusion:
there was a devaluation of neonatal pain management that may perpetuate neonatal well-being and sustainable development.
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LETTER TO THE EDITOR01-10-2024
Adherence to COVID-19 vaccination during the pandemic and fake news: Correspondence
Revista Brasileira de Enfermagem. 2024;77:e202477Suppl101c
Abstract
LETTER TO THE EDITORAdherence to COVID-19 vaccination during the pandemic and fake news: Correspondence
Revista Brasileira de Enfermagem. 2024;77:e202477Suppl101c
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LETTER TO THE EDITOR01-10-2024
Adherence to COVID-19 vaccination during the pandemic and fake news: Correspondence
Revista Brasileira de Enfermagem. 2024;77:e202477Suppl101c
Abstract
LETTER TO THE EDITORAdherence to COVID-19 vaccination during the pandemic and fake news: Correspondence
Revista Brasileira de Enfermagem. 2024;77:e202477Suppl101c
DOI 10.1590/0034-7167.202477Suppl101c
Views0Dear Dr Dulce Aparecida BarbosaEditor in Chief of the Revista Brasileira de Enfermagem[…]See more -
ORIGINAL ARTICLE01-10-2024
Clinical and epidemiological characteristics and outcomes of patients affected by COVID-19 in the Intensive Care Unit
Revista Brasileira de Enfermagem. 2024;77:e20230527
Abstract
ORIGINAL ARTICLEClinical and epidemiological characteristics and outcomes of patients affected by COVID-19 in the Intensive Care Unit
Revista Brasileira de Enfermagem. 2024;77:e20230527
DOI 10.1590/0034-7167-2023-0527
Views0See moreABSTRACT
Objective:
To understand the clinical and epidemiological characteristics, outcomes, and nursing care of adult patients affected by COVID-19 in the Intensive Care Unit.
Methods:
This is a quantitative, retrospective, and descriptive study. The study participants were clinical and epidemiological statistical reports. Variables analyzed included age, gender, race, comorbidities, signs and symptoms, length of hospital stay, use of mechanical ventilation, medications, infections, monitoring, invasive devices, positioning, diet, comfort, and clinical outcomes.
Results:
The majority of individuals were men, of white race, with a mean age of 63 years, hypertensive, diabetic, and obese. The average length of hospital stay was 16 days. Most required invasive mechanical ventilation, vasopressor drugs, sedoanalgesia, and neuromuscular blockers.
Conclusion:
Nursing care is related to monitoring, ventilation, medication administration, installation of devices, prone positioning, diet administration, and providing comfort.
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ORIGINAL ARTICLE01-10-2024
Morbidity and factors associated with frailty in post-COVID-19 elderly patients attended at a reference center
Revista Brasileira de Enfermagem. 2024;77:e20230454
Abstract
ORIGINAL ARTICLEMorbidity and factors associated with frailty in post-COVID-19 elderly patients attended at a reference center
Revista Brasileira de Enfermagem. 2024;77:e20230454
DOI 10.1590/0034-7167-2023-0454
Views0See moreABSTRACT
Objective:
To assess the morbidity profile and identify factors associated with frailty syndrome in post-COVID-19 elderly patients treated at the only Reference Center for Elderly Health Care in northern Minas Gerais.
Methods:
This is a case series study, utilizing the Clinical-Functional Vulnerability Index-20 (CFVI-20) and Comprehensive Geriatric Assessment (CGA) to characterize and evaluate the health condition of the group. To define the variables associated with frailty, a multivariate analysis was conducted.
Results:
The study included 204 elderly individuals, with a predominance of females (63.7%). The variables associated with frailty were cognitive impairment (OR: 2.95; 95% CI: 1.12-7.80; p=0.029), the presence of five or more comorbidities (OR: 11.55; 95% CI: 2.22-60.01; p=0.004), and impairment in instrumental activities of daily living (OR: 41.97; 95% CI: 5.47-321.93; p<0.001).
Conclusions:
The results of this study highlight the need for a well-established and prepared coordination of integrated care to meet the demands of the post-COVID-19 elderly population.
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ORIGINAL ARTICLE01-10-2024
Nursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
Abstract
ORIGINAL ARTICLENursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
DOI 10.1590/0034-7167-20230254
Views0See moreABSTRACT
Objective:
To characterize nursing care management strategies for addressing the COVID-19 pandemic.
Method:
A descriptive, qualitative study conducted with 22 nurse professionals at a University Hospital in Southern Brazil. Data collection through interviews in June and August 2021, analyzed according to Bardin’s Content Analysis and the theoretical framework of complex thinking.
Results:
The identified strategies were organized into four categories: Reorganization of health services; People management and emergency admission; Multiprofessional articulation; and Bedside nursing care.
Final Considerations:
Professional performance revealed a complex interplay between leadership and care management practices, even in the face of working condition restrictions, and were understood as crucial in the pandemic scenario.
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Nursing care by telehealth: what is the influence of distance on communication?
Revista Brasileira de Enfermagem. 2017;70(5):928-934
Abstract
Nursing care by telehealth: what is the influence of distance on communication?
Revista Brasileira de Enfermagem. 2017;70(5):928-934
DOI 10.1590/0034-7167-2016-0142
Views0See moreABSTRACT
Objective:
Evaluate the perception of nurses regarding interpersonal communication while providing care via telehealth.
Method:
Qualitative research realized with seven nurses working in telehealth in Brazil, the sample was determined by data saturation. A questionnaire with open questions was applied and then content analysis of the dialogues was conducted, focusing on thematic analysis.
Results:
Four categories emerged from the dialogues: Understanding the importance of communication; the interpersonal relationship interfering with communication; Communicating via technology; and Learning the communication process.
Final considerations:
The perception of nurses working in telehealth in Brazil is that technology has facilitated their professional practice; however, in relation to the communication process, they believe it is harder to communicate by telehealth, mainly due to difficulty in perceiving nonverbal signals. To overcome these difficulties, they agreed that interpersonal communication is a skill that must be acquired during their professional training.
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Neoliberalist influences on nursing hospital work process and organization
Revista Brasileira de Enfermagem. 2017;70(5):912-919
Abstract
Neoliberalist influences on nursing hospital work process and organization
Revista Brasileira de Enfermagem. 2017;70(5):912-919
DOI 10.1590/0034-7167-2016-0092
Views0See moreABSTRACT
Objectives:
To describe and analyze the influence of the neoliberal economic and political model on the nursing hospital work process and organization.
Method:
Qualitative descriptive research, having as its scenery a university hospital. The subjects were 34 nursing workers. The data collection took place from March to July 2013, through semi-structured interview. The data treatment technique used was content analysis, which brought up the following category: working conditions precariousness and its consequences to the hospital work process and organization in the neoliberal context.
Results:
The consequences of neoliberalism on hospital work process and organization were highlighted, being observed physical structure, human resources and material inadequacies that harms the assistance quality. In addition to wage decrease that cause the need of second jobs and work overload.
Final considerations:
There is a significant influence of the neoliberal model on hospital work, resulting on working conditions precariousness.
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Nursing team’s conceptions about the families of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(5):904-911
Abstract
Nursing team’s conceptions about the families of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(5):904-911
DOI 10.1590/0034-7167-2016-0233
Views0See moreABSTRACT
Objectives:
to describe nursing team care and discuss the nursing team’s conception of companion families of hospitalized children. The study was based on the theoretical framework of Collière’s theory of nursing care identity.
Method:
this was a qualitative study with 14 members of a nursing team, conducted through an unstructured group interview. Thematic data analysis was employed.
Results:
habitual and repair care was delegated to families, regardless of the child’s clinical condition.
Final considerations:
the team’s official discourse about the families of hospitalized children, as recommended by the literature, refers to the family’s alterity and participation in care provision, with sights on discharge and defending family participation as beneficial to children. In practice, however, the nursing staff makes concessions about the presence of chaperoning families and delegates care.
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Innovation in nursing health care practice: expansion of access in primary health care
Revista Brasileira de Enfermagem. 2017;70(5):898-903
Abstract
Innovation in nursing health care practice: expansion of access in primary health care
Revista Brasileira de Enfermagem. 2017;70(5):898-903
DOI 10.1590/0034-7167-2016-0131
Views0ABSTRACT
Objective:
analyze the reorganization of the health care practice of nurses as an innovative strategy for expansion of access in primary care.
Method:
qualitative and quantitative study, which interviewed 32 management and care nurses and collected documentary data from public reports of production of nursing consultations from 2010 to 2014, in a municipality in southern Brazil. Data processing for textual analysis was performed by IRAMUTEQ software; for simple descriptive statistical analysis, the program Excel 2013 was used.
Results:
in the innovative care practice class, associated with awareness of change, related to implementation of the FHS, its challenges and advantages, the following subclasses were identified: reorganization of schedules, nursing consultation, physical restructuring of BHUs, and shared consultation.
Final considerations:
the need to expand access to and valorization of care practice encourages the development of innovative strategies. The protagonism of care needs to be discussed in the various spaces so that each professional carry out the respective role with competence and efficacy.
Keywords:Access to Health ServicesHealth Care Practice ManagementNursingOrganizational InnovationPrimary Health CareSee more -
O trabalho em Enfermagem e a construção de uma sociedade democrática
Revista Brasileira de Enfermagem. 2017;70(5):896-897
Abstract
O trabalho em Enfermagem e a construção de uma sociedade democrática
Revista Brasileira de Enfermagem. 2017;70(5):896-897
DOI 10.1590/0034-7167.2017700501
Views0No Brasil, o trabalho em enfermagem é realizado por expressivo contingente de trabalhadores, que, de acordo com o último levantamento realizado pela Associação Brasileira de Enfermagem, somava 1.856.683 profissionais, em sua maioria mulheres, distribuído em três categorias profissionais: Enfermeiros, Técnicos e Auxiliares de Enfermagem que atuam na rede pública e privada de saúde. Com baixos […]See more -
The Nursing work and the construction of a democratic society
Revista Brasileira de Enfermagem. 2017;70(5):896-897
Abstract
The Nursing work and the construction of a democratic society
Revista Brasileira de Enfermagem. 2017;70(5):896-897
DOI 10.1590/0034-7167.2017700501
Views0In Brazil, the Nursing work is performed by an expressive contingent of workers, which – according to the last survey by the Brazilian Nursing Association – comprised 1,856,683 professionals, mostly women, distributed into three professional categories: Nurses, Nursing Technicians and Nursing Assistants, who work in public and private health care networks. With salaries lower than […]See more -
Trascendencia, historicidad y temporalidad del ser adulto mayor: reflexión enfermera en Heidegger
Revista Brasileira de Enfermagem. 2017;70(4):891-895
Abstract
Trascendencia, historicidad y temporalidad del ser adulto mayor: reflexión enfermera en Heidegger
Revista Brasileira de Enfermagem. 2017;70(4):891-895
DOI 10.1590/0034-7167-2016-0275
Views0See moreRESUMEN
El objetivo es reflexionar en la historicidad y temporalidad como caminos para la trascendencia del ser adulto mayor, basado en los conceptos fenomenológicos de Martín Heiddeger. Se llevó a cabo una revisión de los conceptos de trascendencia, historicidad y temporalidad en la obra de Martín Heidegger, realizando su integración en la perspectiva de enfermería al adulto mayor. La trascendencia del ser adulto mayor es factible accediendo a la temporalidad del mismo en el camino de su historicidad para llegar a la comprensión de sí a la que ha llegado: trascendiendo, que no es sino un proceso del mismo ser. El ser es el tiempo en sí mismo existiendo en el mundo, existencia dada por el encuentro del pasado (haber sido), presente y futuro (devenir), mismo encuentro que determina la historicidad del ser. El encuentro se ha consumado y el ser es trascendencia, como punto supremo la comprensión del ser mismo.
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Workers of CEASA: factors associated with fatigue and work ability
Revista Brasileira de Enfermagem. 2015;68(3):460-466
Abstract
Workers of CEASA: factors associated with fatigue and work ability
Revista Brasileira de Enfermagem. 2015;68(3):460-466
DOI 10.1590/0034-7167.2015680312i
Views0See moreABSTRACT
Objective:
to investigate the socio-demographic characteristics, lifestyle and health conditions related to fatigue and the work ability.
Method:
a cross-sectional study was conducted in 2011 and the sample was composed by 90 workers from the supply center of Campinas. Three questionnaires were used: Fatigue; Work ability index; and socio-demographic characteristics.
Results:
in the univariate regression analysis, the variables associated with work ability were: education, use of medicine, stress, pain in the last six months and pain in the last week. In univariate regression analysis the variables associated with fatigue were: education, stress, sleepiness, pain in the last six months, pain in the last week and health problems.
Conclusion:
these results indicate the need for health promotion program implementation among these workers.
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Nursing Terminology defines domestic violence against children and adolescents
Revista Brasileira de Enfermagem. 2015;68(3):452-459
Abstract
Nursing Terminology defines domestic violence against children and adolescents
Revista Brasileira de Enfermagem. 2015;68(3):452-459
DOI 10.1590/0034-7167.2015680311i
Views0See moreABSTRACT
Objective:
Identifi cation of terminology relating to nursing practices aimed at children and adolescents at risk of domestic violence.
Methods:
bibliographic descriptive research which selected 40 articles from the Virtual Health Library on domestic violence against children and adolescents, its manifestations, causes, and consequences, in association with nursing procedures for its confrontation and prevention, and which also identifi ed terminology via computer tools.
Results:
17,365 terms that, after standardization and uniformity procedures, resulted in a listing of 915 terms.
Conclusion:
The terminology selected focused on the individual biopsychic nexus and the historic manifestation of this phenomenon was partially identifi ed in terms that appear less frequently in these articles, thereby explaining the contradiction between the formal identifi cation logic of such terminology and the dialectic logic that recognizes the historic reasons for, and dynamicity of, such phenomena.
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RESEARCH06-01-2015
Instrumento para avaliação de estilo de vida sedentário em pacientes com hipertensão
Revista Brasileira de Enfermagem. 2015;68(3):445-451
Abstract
RESEARCHInstrumento para avaliação de estilo de vida sedentário em pacientes com hipertensão
Revista Brasileira de Enfermagem. 2015;68(3):445-451
DOI 10.1590/0034-7167.2015680310i
Views0See moreRESUMEN
Objetivo:
este artículo describe la precisión diagnóstica del International Physical Activity Questionnaire en la identifi cación del diagnóstico enfermero Estilo de vida sedentario.
Método:
un estudio de precisión diagnóstica se desarrolló con 240 individuos con hipertensión arterial establecida. El análisis de precisión diagnóstica se basó en medidas de sensibilidad, especifi cidad, valores predictivos, razones de verosimilitud, efi ciencia, odds ratio diagnóstica, índice de Youden y área bajo la curva característica receptor-operador.
Resultados:
diferencias estadísticas entre los sexos se observaron para las actividades intensidad moderada y la actividad física total. La edad se correlacionó negativamente con la actividad de intensidad moderada y la actividad física total.
Conclusión:
el análisis del área bajo la curva característica receptor-operador para las actividades de intensidad moderada, de caminar, y la actividad física total mostró que el International Physical Activity Questionnaire presenta moderada capacidad para clasificar correctamente los sujetos con y sin el estilo de vida sedentario.
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Instrument for evaluation of sedentary lifestyle in patients with high blood pressure
Revista Brasileira de Enfermagem. 2015;68(3):445-451
Abstract
Instrument for evaluation of sedentary lifestyle in patients with high blood pressure
Revista Brasileira de Enfermagem. 2015;68(3):445-451
DOI 10.1590/0034-7167.2015680310i
Views0See moreABSTRACT
Objective:
this article describes the diagnostic accuracy of the International Physical Activity Questionnaire to identify the nursing diagnosis of sedentary lifestyle.
Method:
a diagnostic accuracy study was developed with 240 individuals with established high blood pressure. The analysis of diagnostic accuracy was based on measures of sensitivity, specifi city, predictive values, likelihood ratios, effi ciency, diagnostic odds ratio, Youden index, and area under the receiver-operating characteristic curve.
Results:
statistical differences between genders were observed for activities of moderate intensity and for total physical activity. Age was negatively correlated with activities of moderate intensity and total physical activity.
Conclusion:
the analysis of area under the receiver-operating characteristic curve for moderate intensity activities, walking, and total physical activity showed that the International Physical Activity Questionnaire present moderate capacity to correctly classify individuals with and without sedentary lifestyle.
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Potentialities and weaknesses in the care network of people with HIV/AIDS
Revista Brasileira de Enfermagem. 2015;68(3):438-444
Abstract
Potentialities and weaknesses in the care network of people with HIV/AIDS
Revista Brasileira de Enfermagem. 2015;68(3):438-444
DOI 10.1590/0034-7167.2015680309i
Views0See moreABSTRACT
Objective:
to understand the strengths and weaknesses in the care network of people with HIV/AIDS in a referral center in the state of Santa Catarina-SC.
Method:
participants were eight subjects and their care network, totaling 18 participants. Data were collected through interviews and examined by content analysis, theoretically supported by symbolic interaction.
Results:
the analysis resulted in the following categories: The network offering care to people with acquired immunodefi ciency syndrome, and Facing Barriers in care, which refl ect the strengths and weaknesses in the care network. The fi rst depicts the provision of emotional and humanized care, and the second a restricted network formed by health professionals and a family member.
Conclusion:
the professional care network is important, despite the increased number of assistances in a physical structure and amount of professionals who no longer meet the growing demand.
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AIDS epidemic in the triple frontier: subsidies for professional practice
Revista Brasileira de Enfermagem. 2015;68(3):429-437
Abstract
AIDS epidemic in the triple frontier: subsidies for professional practice
Revista Brasileira de Enfermagem. 2015;68(3):429-437
DOI 10.1590/0034-7167.2015680308i
Views0See moreABSTRACT
Objective:
to analyze the AIDS epidemic trend from 1988 to 2012, in a tri-border area.
Method:
Ecological time-series study with data from the Department of informatics from the Brazilian Unifi ed Health System (SUS).
Results:
A total of 1427 cases of AIDS were registered, and 82.1% were aged 20-49 years and 56% in males. The relationship man/woman went from 9/1 to 1/1 and increased the number of cases among individuals with more years of education, also, people aged more than 50 years old the age group from 20 to 34 years old. The most common exposure category was heterosexual, significantly higher among women; on the other hand, drug injection use was associated with male gender.
Conclusion:
seeking to embrace the changes in the epidemiological scenario of AIDS, nursing professionals should implement intervention strategies for people identified as the most vulnerable to HIV infection.
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The Informal Caregiver Burden Assessment Questionnaire: validation for Brazil
Revista Brasileira de Enfermagem. 2015;68(3):421-428
Abstract
The Informal Caregiver Burden Assessment Questionnaire: validation for Brazil
Revista Brasileira de Enfermagem. 2015;68(3):421-428
DOI 10.1590/0034-7167.2015680307i
Views0See moreABSTRACT
Objectives:
to analyze the dimensionality, convergent construct validity and internal consistency of the Informal Caregiver Burden Assessment Questionnaire (QASCI) after its semantic adaptation to Brazil.
Method:
this methodological study was developed with 132 informal caregivers of elders who are dependent of help for basic or instrumental activities of daily living, in a capital city in Northeast Brazil. Quality of life measures related to health, anxiety and depression were used in the analysis of the convergent construct validity of the QASCI.
Results:
the results of the instrument construct validation evidenced statistically signifi cant correlations with the three measures. The confi rmatory factor analysis evidenced good adjustment of the theoretical model of seven factors (domains) of the version used in the group studied. Cronbach’s alpha for the scale total was 0.92.
Conclusion:
the Brazilian version of the QASCI was considered to be valid and reliable for assessing the burden of informal elder caregivers.
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Study of billing audits in a teaching hospital
Revista Brasileira de Enfermagem. 2015;68(3):414-420
Abstract
Study of billing audits in a teaching hospital
Revista Brasileira de Enfermagem. 2015;68(3):414-420
DOI 10.1590/0034-7167.2015680306i
Views0See moreABSTRACT
Objectives:
to determine which component items of hospital bills, examined by nurse auditors, were adjusted the most during pre-analysis; to identify the impact upon revenue caused by the adjustments to bills analyzed by physician and nurse auditors; and to identify disallowances related to items checked by the audit team.
Method:
quantitative, exploratory, descriptive, singlecase study.
Results:
after analysis of 2,613 bills, it was found that the item most included by nurses was gas (90.5%) and the most excluded was inpatient drugs (41.2%). Hemodynamics materials, gases and equipment had the greatest impact on upward adjustments. Downward adjustments were the result of improper entries on bills and did not generate revenue losses. Of total disallowances, 52.24% were related to the pre-analysis of nurses and 47.76% to that of physicians.
Conclusion:
this study of the pre-analysis process provides input that enhances knowledge about hospital bill audits.
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