Oxygen therapy: a clinical audit in an Internal Medicine Department
Read
11322
Timeswas read the article
2761
Total PDF
8561
Total HTML
Share statistics
array:20 [ "pii" => "X0873215915933115" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.11.005" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:101-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4154 "formatos" => array:3 [ "EPUB" => 264 "HTML" => 2988 "PDF" => 902 ] ] "itemSiguiente" => array:16 [ "pii" => "X0873215915933123" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.11.004" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:103-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4361 "formatos" => array:3 [ "EPUB" => 256 "HTML" => 3191 "PDF" => 914 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Solitary fibrous tumors of the pleura: not always a benign entity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "105" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n02-90393312fig1.jpg" "Alto" => 1636 "Ancho" => 1447 "Tamanyo" => 709967 ] ] "descripcion" => array:1 [ "en" => "(A) Chest X-ray showing a marked thoracic deformity; (B) chest X-ray showing a large retrosternal opacity; (C and D) chest CT showing a retrosternal lobulated mass at the right hemithorax with 10.2 × 3.7 cm." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Nascimento, T. Gomes, A. Fernandes, A. Afonso" "autores" => array:4 [ 0 => array:2 [ "Iniciales" => "L.M." "apellidos" => "Nascimento" ] 1 => array:2 [ "Iniciales" => "T." "apellidos" => "Gomes" ] 2 => array:2 [ "Iniciales" => "A." "apellidos" => "Fernandes" ] 3 => array:2 [ "Iniciales" => "A." "apellidos" => "Afonso" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915933123?idApp=UINPBA00004E" "url" => "/08732159/0000002100000002/v0_201604141148/X0873215915933123/v0_201604141148/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "X0873215915933107" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.09.008" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:99-101" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3689 "formatos" => array:3 [ "EPUB" => 256 "HTML" => 2472 "PDF" => 961 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Tuberculosis screening and compliance rate with guidelines among Northern Portuguese Hospitals prescribers of anti-TNF therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "101" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B.A. Ferreira, S. Ribeiro, J. Meireles, A. Correia, R. Duarte" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "B.A." "apellidos" => "Ferreira" ] 1 => array:2 [ "Iniciales" => "S." "apellidos" => "Ribeiro" ] 2 => array:2 [ "Iniciales" => "J." "apellidos" => "Meireles" ] 3 => array:2 [ "Iniciales" => "A." "apellidos" => "Correia" ] 4 => array:2 [ "Iniciales" => "R." "apellidos" => "Duarte" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915933107?idApp=UINPBA00004E" "url" => "/08732159/0000002100000002/v0_201604141148/X0873215915933107/v0_201604141148/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Oxygen therapy: a clinical audit in an Internal Medicine Department" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "101" "paginaFinal" => "103" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Nunes, J. Maia, J.P. Ferreira, J. Neves, I. Marques" "autores" => array:5 [ 0 => array:4 [ "Iniciales" => "S." "apellidos" => "Nunes" "email" => array:1 [ 0 => "sanpnunes@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "J." "apellidos" => "Maia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "J.P." "apellidos" => "Ferreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "J." "apellidos" => "Neves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "I." "apellidos" => "Marques" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Department of Internal Medicine, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. sanpnunes@gmail.com" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n02-90393311fig1.jpg" "Alto" => 2140 "Ancho" => 3244 "Tamanyo" => 654282 ] ] "descripcion" => array:1 [ "en" => "Comparison of results between the 2008 and the 2011 audits. (A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring." ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">Oxygen therapy, from prescription to administration, is still poorly handled,<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">, </span><a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">, </span><a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> and until the publication of “Guideline for emergency oxygen use in adult patients” by the British Thoracic Society<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> there were very little literature about oxygen therapy procedures.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">Recognizing the need to improve oxygen therapy procedures, the authors conducted an audit in 2008 to identify faulty practice and plan improvement measures. Three years later, a second audit was performed in order to evaluate those measures.</p><p class="elsevierStylePara">A taskforce consisting of physicians and nurses was set up in 2007 to evaluate OT practice in Internal Medicine wards of Hospital de Santo António, Oporto, Portugal. Based on the BTS guidelines, and according to NICE principles for best practice in clinical audit,<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> an audit was designed to evaluate the different aspects of OT: prescription, transcription, administration and monitoring.</p><p class="elsevierStylePara">The audit was performed in two of the four wards of the department between January 1st and March 31st 2008. All patients to whom oxygen was administered or prescribed were included in the audit, except those with non-invasive ventilation during daytime. Assessments were performed two days per week. No assessments were performed at weekends, on Mondays, public holidays or the day after holidays, nor of patients admitted to the ward in the previous 24 h, to ensure all prescriptions were performed/validated by ward physicians.</p><p class="elsevierStylePara">Information of the audit was obtained from clinical records, nurses’ software application or direct patient observation. Statistical analysis was performed using IBM SPSS v11.0.</p><p class="elsevierStylePara">Results of the first audit are published elsewhere.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> The main findings are summarized here and presented in <a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>A–D, in comparison with those of the second audit.</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n02-90393311fig1.jpg" alt="Comparison of results between the 2008 and the 2011 audits. (A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring."></img></p><p class="elsevierStylePara">Figure 1. Comparison of results between the 2008 and the 2011 audits. (A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring.</p><p class="elsevierStylePara">The authors considered that good practice was met whenever the rate of compliance was ≥90%. Based on this threshold, several criteria were identified as needing improvement. In relation to <span class="elsevierStyleItalic">prescription</span>, lack of a specific period of oxygen therapy institution and monitoring were the main problems. Prescription to target SatO<span class="elsevierStyleInf">2</span> range was observed in <50% of the patients. <span class="elsevierStyleItalic">Transcription</span> by nurses was incorrect in 26.8% of the patients. A significant number of patients on oxygen therapy had been correctly <span class="elsevierStyleItalic">administered</span> oxygen, but not during hygiene. In patients with acute hypercapnic respiratory failure, <span class="elsevierStyleItalic">monitoring</span> of oxygen administration was far from appropriate.</p><p class="elsevierStylePara">Several improvement measures were implemented: educational material was given to health professionals and patients; BTS guidelines were made accessible on all computers; training sessions were held in all wards of the department; an alert for hypercapnic respiratory failure was created on the prescription system; patients at risk of hypercapnic respiratory failure or in need of humidifiers were identified with bedside signs.</p><p class="elsevierStylePara">A re-audit was performed in all four wards between February 1st and April 31st 2011, using a similar methodology. Results were compared to those of the first audit; a separate comparison was also made between results in the wards audited in 2008 (A and D) and the corresponding ward in 2011 (Ward A – fusion of A and D).</p><p class="elsevierStylePara">This audit's results were better than those of other studies,<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> including one multicentric study on OT performed in 24 Portuguese hospitals,<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> where only prescription and administration were evaluated.</p><p class="elsevierStylePara">A significant increase of oxygen prescription to target SatO<span class="elsevierStyleInf">2</span> range was achieved (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>A). Prescription by “fixed dose” OT was residual in 2011. A correct target range was observed in <90%, an acceptable value since some patients may benefit from specifically tailored ranges.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a></p><p class="elsevierStylePara">There was a substantial improvement in the prescription of OT monitoring. There was also a clear improvement in the quality and accuracy of transcription (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>B). Use of humidifiers cannot be compared to 2008 given no clear guidelines, regarding their use had existed at the time. Very good results were observed in 2011, with scarce (17.5%) but appropriate use (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>C), in keeping with BTS guidelines.</p><p class="elsevierStylePara">There was no improvement in oxygen administration during hygiene (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>C). An improvement in arterial blood gas measurement before or in the first 12 h of OT was achieved (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>D). In patients with acute hypercapnic respiratory failure, monitoring is still far from appropriate (<a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>D).</p><p class="elsevierStylePara">This study confirms the value of clinical audits in improving quality of care. A combined strategy of education, protocol implementation, universal use of target SatO<span class="elsevierStyleInf">2</span> range<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> and software applications with safety alarms can improve OT in a hospital setting.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Acknowledgments</p><p class="elsevierStylePara">Besides the authors, the audit team included: Maria Barbosa, Cristiana Sousa, Sílvia Ramos, Paula Pereira, Joana Ramalho, Ana Oliveira Gomes, Carina Ribeiro, Joel Almeida, Margarida Carneiro, Bruno Pinto, Nelson Rocha, Alfredo Martins.</p><p class="elsevierStylePara">The authors would like to thank all other professionals from the Department of Internal Medicine who collaborated in data collection.</p><p class="elsevierStylePara">Corresponding author. sanpnunes@gmail.com</p>" "pdfFichero" => "320v21n02a90393311pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n02-90393311fig1.jpg" "Alto" => 2140 "Ancho" => 3244 "Tamanyo" => 654282 ] ] "descripcion" => array:1 [ "en" => "Comparison of results between the 2008 and the 2011 audits. (A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Comparison of results between the 2008 and the 2011 audits. (A) Oxygen prescription; (B) transcription by nurses; (C) oxygen administration by nurses (D) oxygen monitoring." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib9" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Guideline for emergency oxygen use in adult patients. Thorax. 2008; 63(Suppl. VI):vi1-vi68." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Guideline for emergency oxygen use in adult patients." "idioma" => "nl" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O’Driscoll BR" 1 => "Howard LS" 2 => "Davison AG." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2008.102947" "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2008" "volumen" => "63" "paginaInicial" => "vi1" "paginaFinal" => "vi68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18838559" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib10" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "ABC of oxygen: acute oxygen therapy. BMJ. 1998; 317:769-801." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "ABC of oxygen: acute oxygen therapy." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Bateman NT" 1 => "Leach RM." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ. " "fecha" => "1998" "volumen" => "317" "paginaInicial" => "769" "paginaFinal" => "801" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib11" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Principles for best practice in clinical audit. Oxford: Radcliffe Medical; 2002." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Principles for best practice in clinical audit." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Institute for Health and Care Excellence." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Principles for best practice in clinical audit." "fecha" => "2002" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib12" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "AARC clinical pratice guideline: oxygen therapy for adults in the acute care facility – 2002 revision & update. Respir Care. 2002; 47:717-20." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "AARC clinical pratice guideline: oxygen therapy for adults in the acute care facility – 2002 revision & update." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Kallstrom TJ" 1 => "American Association for Respiratory Care (AARC)." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Care. " "fecha" => "2002" "volumen" => "47" "paginaInicial" => "717" "paginaFinal" => "720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12078655" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib13" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Auditoria de oxigenoterapia em duas enfermarias de medicina. Rev Med Int. 2011; 18:129-36." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Auditoria de oxigenoterapia em duas enfermarias de medicina." "idioma" => "pt" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Neves J" 1 => "Sousa C" 2 => "Marques I" 3 => "Barbosa M" 4 => "Pereira P" 5 => "Ramos S" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Med Int. " "fecha" => "2011" "volumen" => "18" "paginaInicial" => "129" "paginaFinal" => "136" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib14" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Acute care: treatment with oxygen. Stud BMJ. 2004; 12:56-8." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Acute care: treatment with oxygen." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Cooper N." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Stud BMJ. " "fecha" => "2004" "volumen" => "12" "paginaInicial" => "56" "paginaFinal" => "58" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib15" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Oxygen therapy in adult medical care. BMJ. 2002; 32:1406-7." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Oxygen therapy in adult medical care." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Thomson AJ" 1 => "Webb DJ" 2 => "Maxwell S" 3 => "Grant IS." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ. " "fecha" => "2002" "volumen" => "32" "paginaInicial" => "1406" "paginaFinal" => "1407" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib16" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Oxygen therapy multicentric study – a nationwide audit to oxygen therapy procedures in internal medicine wards. Rev Port Pneumol. 2012; 18(2):80-5." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Oxygen therapy multicentric study – a nationwide audit to oxygen therapy procedures in internal medicine wards." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Neves JT" 1 => "Lobão MJ" 2 => "EMO Working Group." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppneu.2012.01.001" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol. " "fecha" => "2012" "volumen" => "18" "paginaInicial" => "80" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22280829" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002100000002/v0_201604141148/X0873215915933115/v0_201604141148/en/main.assets" "Apartado" => array:4 [ "identificador" => "50820" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002100000002/v0_201604141148/X0873215915933115/v0_201604141148/en/320v21n02a90393311pdf001.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915933115?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 5 | 27 |
| 2024 October | 115 | 30 | 145 |
| 2024 September | 123 | 27 | 150 |
| 2024 August | 165 | 40 | 205 |
| 2024 July | 163 | 46 | 209 |
| 2024 June | 132 | 45 | 177 |
| 2024 May | 121 | 28 | 149 |
| 2024 April | 132 | 35 | 167 |
| 2024 March | 138 | 30 | 168 |
| 2024 February | 127 | 26 | 153 |
| 2024 January | 128 | 37 | 165 |
| 2023 December | 91 | 29 | 120 |
| 2023 November | 93 | 31 | 124 |
| 2023 October | 78 | 36 | 114 |
| 2023 September | 85 | 33 | 118 |
| 2023 August | 76 | 27 | 103 |
| 2023 July | 116 | 26 | 142 |
| 2023 June | 74 | 30 | 104 |
| 2023 May | 111 | 31 | 142 |
| 2023 April | 91 | 16 | 107 |
| 2023 March | 160 | 28 | 188 |
| 2023 February | 101 | 24 | 125 |
| 2023 January | 71 | 13 | 84 |
| 2022 December | 71 | 25 | 96 |
| 2022 November | 120 | 44 | 164 |
| 2022 October | 89 | 34 | 123 |
| 2022 September | 99 | 30 | 129 |
| 2022 August | 96 | 37 | 133 |
| 2022 July | 75 | 49 | 124 |
| 2022 June | 60 | 40 | 100 |
| 2022 May | 74 | 52 | 126 |
| 2022 April | 70 | 39 | 109 |
| 2022 March | 79 | 47 | 126 |
| 2022 February | 59 | 55 | 114 |
| 2022 January | 72 | 40 | 112 |
| 2021 December | 56 | 42 | 98 |
| 2021 November | 92 | 42 | 134 |
| 2021 October | 71 | 57 | 128 |
| 2021 September | 69 | 41 | 110 |
| 2021 August | 108 | 35 | 143 |
| 2021 July | 65 | 18 | 83 |
| 2021 June | 76 | 25 | 101 |
| 2021 May | 150 | 38 | 188 |
| 2021 April | 202 | 89 | 291 |
| 2021 March | 133 | 40 | 173 |
| 2021 February | 102 | 26 | 128 |
| 2021 January | 73 | 20 | 93 |
| 2020 December | 67 | 19 | 86 |
| 2020 November | 76 | 22 | 98 |
| 2020 October | 104 | 34 | 138 |
| 2020 September | 102 | 30 | 132 |
| 2020 August | 69 | 20 | 89 |
| 2020 July | 101 | 24 | 125 |
| 2020 June | 91 | 28 | 119 |
| 2020 May | 85 | 23 | 108 |
| 2020 April | 79 | 9 | 88 |
| 2020 March | 88 | 9 | 97 |
| 2020 February | 71 | 19 | 90 |
| 2020 January | 84 | 24 | 108 |
| 2019 December | 64 | 16 | 80 |
| 2019 November | 88 | 15 | 103 |
| 2019 October | 76 | 24 | 100 |
| 2019 September | 103 | 24 | 127 |
| 2019 August | 149 | 23 | 172 |
| 2019 July | 123 | 18 | 141 |
| 2019 June | 140 | 24 | 164 |
| 2019 May | 143 | 17 | 160 |
| 2019 April | 147 | 34 | 181 |
| 2019 March | 168 | 12 | 180 |
| 2019 February | 121 | 16 | 137 |
| 2019 January | 83 | 34 | 117 |
| 2018 December | 44 | 10 | 54 |
| 2018 November | 10 | 2 | 12 |
| 2018 October | 14 | 11 | 25 |
| 2018 September | 17 | 11 | 28 |
| 2018 August | 30 | 28 | 58 |
| 2018 July | 32 | 22 | 54 |
| 2018 June | 28 | 9 | 37 |
| 2018 May | 46 | 15 | 61 |
| 2018 April | 50 | 27 | 77 |
| 2018 March | 59 | 11 | 70 |
| 2018 February | 31 | 4 | 35 |
| 2018 January | 39 | 12 | 51 |
| 2017 December | 55 | 15 | 70 |
| 2017 November | 22 | 11 | 33 |
| 2017 October | 14 | 11 | 25 |
| 2017 September | 20 | 8 | 28 |
| 2017 August | 35 | 9 | 44 |
| 2017 July | 22 | 15 | 37 |
| 2017 June | 27 | 12 | 39 |
| 2017 May | 40 | 9 | 49 |
| 2017 April | 23 | 3 | 26 |
| 2017 March | 25 | 4 | 29 |
| 2017 February | 19 | 4 | 23 |
| 2017 January | 11 | 4 | 15 |
| 2016 December | 17 | 3 | 20 |
| 2016 November | 8 | 1 | 9 |
| 2016 October | 5 | 9 | 14 |
| 2016 September | 3 | 2 | 5 |
| 2016 August | 7 | 4 | 11 |
| 2016 July | 3 | 8 | 11 |
| 2016 June | 7 | 0 | 7 |
| 2016 May | 2 | 0 | 2 |
| 2016 April | 23 | 2 | 25 |
| 2016 March | 36 | 16 | 52 |
| 2016 February | 49 | 26 | 75 |
| 2016 January | 49 | 10 | 59 |
| 2015 December | 52 | 13 | 65 |
| 2015 November | 49 | 19 | 68 |
| 2015 October | 44 | 14 | 58 |
| 2015 September | 29 | 18 | 47 |
| 2015 August | 40 | 8 | 48 |
| 2015 July | 25 | 10 | 35 |
| 2015 June | 32 | 12 | 44 |
| 2015 May | 46 | 29 | 75 |
| 2015 April | 113 | 64 | 177 |
| 2015 March | 113 | 70 | 183 |
Show all
