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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The aim of the study in this issue of the <span class="elsevierStyleItalic">Journal</span> by Amado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> of the Cardiology Department of Faro Hospital was to compare their experience of patient referrals for cardiac surgery between January 1&#44; 2008 and September 30&#44; 2014&#44; divided into two groups&#58; those referred between January 1&#44; 2008 and August 1&#44; 2011 &#40;43 months&#59; 557 patients&#41; and those referred between August 1&#44; 2011 and September 30&#44; 2014 &#40;37 months&#59; 307 patients&#41;&#46; The division into two time periods was prompted by changes to referral protocols issued by the Regional Health Authorities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although it is not specifically stated in the article&#44; it appears that patients were preferentially referred to a particular hospital in Lisbon during the first period and to a different one during the second period&#46; For reasons that are not explained&#44; the number of patients referred in each period is not proportional to the length of the period&#44; but this may be due to a broadening of the referral network in the more recent period&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The demographic and clinical characteristics of the two patient groups were similar but the mean waiting time increased from 10&#46;6&#177;18&#46;5 days in the first period to 55&#46;7&#177;79&#46;9 days in the second&#44; which led to a significant difference in morbidity&#44; as reflected in hospitalizations &#40;0&#46;4&#37; and 9&#46;1&#37;&#44; respectively&#41; and mortality &#40;0&#37; and 2&#46;3&#37;&#41; while awaiting surgery&#46; However&#44; waiting times in urgent cases were not dissimilar &#40;2&#46;1 vs&#46; 3&#46;0 days&#41;&#44; and there appears to have been no significant difference between the groups in surgical results or follow-up after surgery in this study population&#44; even though some authors have shown that longer waiting times are often associated with worsening clinical status and hence worse surgical outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">These findings are hardly surprising&#59; increased mortality and morbidity while awaiting cardiac or other surgery is a well-known problem that has been widely discussed in the medical literature<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and has prompted considerable efforts everywhere to shorten waiting lists and times&#46; Most national and international guidelines on myocardial revascularization now recommend a maximum wait of two weeks for urgent cases and six weeks for elective cases&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; classifying cases as urgent or elective is a highly subjective process&#46; Malaisrie et al&#46;&#44; of Northwestern Memorial Hospital&#44; Chicago&#44; found that prolonged waiting time for aortic valve replacement &#40;AVR&#41; was associated with greater mortality &#40;3&#46;7&#37; and 11&#46;6&#37; at one and six months&#8217; wait&#44; respectively&#41; than AVR operative mortality&#44; although waiting time was not associated with poor operative outcomes after AVR&#46; They recommended that patients should receive AVR on a semi-urgent&#44; not elective&#44; basis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Portuguese Societies of Cardiology and of Cardiothoracic and Vascular Surgery recently formed a joint working group with the aim of implementing such recommendations in Portugal&#44; and the group presented a document at the last Portuguese Congress of Cardiology recommending the same waiting times as mentioned above&#46; However&#44; the waiting times during the second period analyzed by the Faro group were far longer&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The problem is not restricted to Portugal&#59; it is found everywhere&#44; even in more developed countries&#44; some of which have even longer mean waiting times than in this country&#46; Some years ago&#44; this issue was the subject of heated political debate in Spain&#44; which resulted in a substantial reduction in waiting times for cardiac surgery&#46; It should be noted that cardiac surgery is the best surgical specialty in Portugal in terms of the size and length of waiting lists&#44; although this does not mean that we cannot do much better&#46; It may be that the harmful effects of lengthy waiting times are more evident in this specialty than in others&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The organizational models of the country&#39;s cardiothoracic surgery departments vary &#40;that of Coimbra University Hospitals is well known&#41;&#44; as do the reasons for the length of their waiting lists&#44; but this is not the place to analyze them&#46; I would only say that in my opinion some of the difficulties could easily be overcome&#44; not only by enlisting the help of national and regional health authorities&#44; but also by addressing certain organizational aspects that are the sole responsibility of the departments themselves&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The comparative study by our colleagues in Faro has certain limitations&#44; the most important of which is the fact that the two cardiothoracic surgery centers to which most patients were referred&#44; one private and one public&#44; have completely different characteristics&#46; Obviously&#44; private facilities cannot afford the luxury of long waiting lists and are therefore organized differently&#46; This then raises the question as to why all patients should not benefit from such a service&#44; but this is not what happens in Portugal&#44; and I do not know if it would be possible&#46; Indeed&#44; the cardiology department of Faro Hospital was in a privileged position in this respect for a long time&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition&#44; one point that appears to have been neglected by the joint working group of the two medical societies involved is the time between the onset of a patient&#39;s symptoms and an appointment with their family physician&#44; and from then to a cardiology consultation and then to a definitive diagnosis&#44; all of which must be taken into account in terms of waiting times for surgery&#46; This point was also not mentioned by our colleagues in Faro&#46; Without going into details&#44; it does not seem reasonable to me that this should be left out of the equation&#44; assuming that their wait times are comparable to most other cardiology departments&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Unfortunately&#44; the authors did not even attempt to answer the question they themselves posed in the article&#39;s title&#44; as to whether &#8220;&#8230; financial considerations come at a cost&#8221;&#44; probably due to the lack of data&#46; Apparently&#44; the decision to change the referral system for patients in Faro was made &#8220;for economic reasons&#44; in an attempt to reduce national health system costs&#8221;&#44; implying that the amounts being paid to the private hospital exceeded the prices set for national health service-funded services&#46; We are therefore left wondering whether increased hospitalizations cancel out or even produce the opposite effect of what was intended&#44; even before taking into consideration the impact of waiting times on the personal finances of individual patients&#44; which has repercussions for the country&#39;s economy in general&#44; not to mention the effect on mortality&#44; which cannot be quantified in financial terms&#46; That would be a study well worth doing&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In Canada&#44; Sampalis et al&#46; demonstrated that compared to baseline scores&#44; patients who waited longer for coronary artery bypass grafting &#40;CABG&#41; had significantly reduced physical functioning&#44; vitality&#44; social functioning&#44; general health and mental health&#59; they also found that longer waits before CABG were associated with an increased likelihood of not returning to work after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; one issue that is often ignored in any discussion is the impact of social inequality on waiting times&#46; Petrelli et al&#46; reported that in Italy the conditional probabilities of undergoing surgery were lower among people with low and middle education levels than for more highly educated people after adjustment for gender&#44; age&#44; comorbidities and time on the waiting list&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Pell et al&#46; came to similar conclusions in the UK&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It is therefore essential that Portugal&#39;s cardiologists and cardiothoracic surgeons work together to establish referral protocols based on the capacity and availability of surgical departments rather than on bureaucratically defined rules&#44; a practice that in fact already exists based on individual personal relationships&#46; It is not as if this were against the law&#44; and it should be taken into account in the directives issued by both central and regional health authorities&#46; I admit I have met little resistance in this respect&#44; least of all from patients whose main concern is to have their cardiac problems treated as quickly as possible&#44; irrespective of where this is done&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is thus incomprehensible to limit patient referrals to facilities that already have longer than recommended waiting lists rather than referring them to one with a shorter or no waiting list&#46; It also restricts patients&#8217; freedom to choose the center that can best respond to their needs and which may also lead to better outcomes&#46; Portugal is too small a country for such inequalities in health care and the national health service must be able to respond appropriately and promptly to its patients&#8217; needs&#46; However&#44; if this is deemed impossible&#44; then let us use private health facilities&#44; negotiating financial terms that the system can support&#46;</p></span>"
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The economics and costs of patient referral protocols for cardiac surgery
A economia e os custos das redes de referenciação de doentes para cirurgia cardíaca
Manuel Antunes
Centro de Cirurgia Cardiotorácica, CHU, Coimbra, Portugal
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    "titulo" => "The economics and costs of patient referral protocols for cardiac surgery"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The aim of the study in this issue of the <span class="elsevierStyleItalic">Journal</span> by Amado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> of the Cardiology Department of Faro Hospital was to compare their experience of patient referrals for cardiac surgery between January 1&#44; 2008 and September 30&#44; 2014&#44; divided into two groups&#58; those referred between January 1&#44; 2008 and August 1&#44; 2011 &#40;43 months&#59; 557 patients&#41; and those referred between August 1&#44; 2011 and September 30&#44; 2014 &#40;37 months&#59; 307 patients&#41;&#46; The division into two time periods was prompted by changes to referral protocols issued by the Regional Health Authorities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although it is not specifically stated in the article&#44; it appears that patients were preferentially referred to a particular hospital in Lisbon during the first period and to a different one during the second period&#46; For reasons that are not explained&#44; the number of patients referred in each period is not proportional to the length of the period&#44; but this may be due to a broadening of the referral network in the more recent period&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The demographic and clinical characteristics of the two patient groups were similar but the mean waiting time increased from 10&#46;6&#177;18&#46;5 days in the first period to 55&#46;7&#177;79&#46;9 days in the second&#44; which led to a significant difference in morbidity&#44; as reflected in hospitalizations &#40;0&#46;4&#37; and 9&#46;1&#37;&#44; respectively&#41; and mortality &#40;0&#37; and 2&#46;3&#37;&#41; while awaiting surgery&#46; However&#44; waiting times in urgent cases were not dissimilar &#40;2&#46;1 vs&#46; 3&#46;0 days&#41;&#44; and there appears to have been no significant difference between the groups in surgical results or follow-up after surgery in this study population&#44; even though some authors have shown that longer waiting times are often associated with worsening clinical status and hence worse surgical outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">These findings are hardly surprising&#59; increased mortality and morbidity while awaiting cardiac or other surgery is a well-known problem that has been widely discussed in the medical literature<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and has prompted considerable efforts everywhere to shorten waiting lists and times&#46; Most national and international guidelines on myocardial revascularization now recommend a maximum wait of two weeks for urgent cases and six weeks for elective cases&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; classifying cases as urgent or elective is a highly subjective process&#46; Malaisrie et al&#46;&#44; of Northwestern Memorial Hospital&#44; Chicago&#44; found that prolonged waiting time for aortic valve replacement &#40;AVR&#41; was associated with greater mortality &#40;3&#46;7&#37; and 11&#46;6&#37; at one and six months&#8217; wait&#44; respectively&#41; than AVR operative mortality&#44; although waiting time was not associated with poor operative outcomes after AVR&#46; They recommended that patients should receive AVR on a semi-urgent&#44; not elective&#44; basis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Portuguese Societies of Cardiology and of Cardiothoracic and Vascular Surgery recently formed a joint working group with the aim of implementing such recommendations in Portugal&#44; and the group presented a document at the last Portuguese Congress of Cardiology recommending the same waiting times as mentioned above&#46; However&#44; the waiting times during the second period analyzed by the Faro group were far longer&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The problem is not restricted to Portugal&#59; it is found everywhere&#44; even in more developed countries&#44; some of which have even longer mean waiting times than in this country&#46; Some years ago&#44; this issue was the subject of heated political debate in Spain&#44; which resulted in a substantial reduction in waiting times for cardiac surgery&#46; It should be noted that cardiac surgery is the best surgical specialty in Portugal in terms of the size and length of waiting lists&#44; although this does not mean that we cannot do much better&#46; It may be that the harmful effects of lengthy waiting times are more evident in this specialty than in others&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The organizational models of the country&#39;s cardiothoracic surgery departments vary &#40;that of Coimbra University Hospitals is well known&#41;&#44; as do the reasons for the length of their waiting lists&#44; but this is not the place to analyze them&#46; I would only say that in my opinion some of the difficulties could easily be overcome&#44; not only by enlisting the help of national and regional health authorities&#44; but also by addressing certain organizational aspects that are the sole responsibility of the departments themselves&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The comparative study by our colleagues in Faro has certain limitations&#44; the most important of which is the fact that the two cardiothoracic surgery centers to which most patients were referred&#44; one private and one public&#44; have completely different characteristics&#46; Obviously&#44; private facilities cannot afford the luxury of long waiting lists and are therefore organized differently&#46; This then raises the question as to why all patients should not benefit from such a service&#44; but this is not what happens in Portugal&#44; and I do not know if it would be possible&#46; Indeed&#44; the cardiology department of Faro Hospital was in a privileged position in this respect for a long time&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition&#44; one point that appears to have been neglected by the joint working group of the two medical societies involved is the time between the onset of a patient&#39;s symptoms and an appointment with their family physician&#44; and from then to a cardiology consultation and then to a definitive diagnosis&#44; all of which must be taken into account in terms of waiting times for surgery&#46; This point was also not mentioned by our colleagues in Faro&#46; Without going into details&#44; it does not seem reasonable to me that this should be left out of the equation&#44; assuming that their wait times are comparable to most other cardiology departments&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Unfortunately&#44; the authors did not even attempt to answer the question they themselves posed in the article&#39;s title&#44; as to whether &#8220;&#8230; financial considerations come at a cost&#8221;&#44; probably due to the lack of data&#46; Apparently&#44; the decision to change the referral system for patients in Faro was made &#8220;for economic reasons&#44; in an attempt to reduce national health system costs&#8221;&#44; implying that the amounts being paid to the private hospital exceeded the prices set for national health service-funded services&#46; We are therefore left wondering whether increased hospitalizations cancel out or even produce the opposite effect of what was intended&#44; even before taking into consideration the impact of waiting times on the personal finances of individual patients&#44; which has repercussions for the country&#39;s economy in general&#44; not to mention the effect on mortality&#44; which cannot be quantified in financial terms&#46; That would be a study well worth doing&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In Canada&#44; Sampalis et al&#46; demonstrated that compared to baseline scores&#44; patients who waited longer for coronary artery bypass grafting &#40;CABG&#41; had significantly reduced physical functioning&#44; vitality&#44; social functioning&#44; general health and mental health&#59; they also found that longer waits before CABG were associated with an increased likelihood of not returning to work after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; one issue that is often ignored in any discussion is the impact of social inequality on waiting times&#46; Petrelli et al&#46; reported that in Italy the conditional probabilities of undergoing surgery were lower among people with low and middle education levels than for more highly educated people after adjustment for gender&#44; age&#44; comorbidities and time on the waiting list&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Pell et al&#46; came to similar conclusions in the UK&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It is therefore essential that Portugal&#39;s cardiologists and cardiothoracic surgeons work together to establish referral protocols based on the capacity and availability of surgical departments rather than on bureaucratically defined rules&#44; a practice that in fact already exists based on individual personal relationships&#46; It is not as if this were against the law&#44; and it should be taken into account in the directives issued by both central and regional health authorities&#46; I admit I have met little resistance in this respect&#44; least of all from patients whose main concern is to have their cardiac problems treated as quickly as possible&#44; irrespective of where this is done&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is thus incomprehensible to limit patient referrals to facilities that already have longer than recommended waiting lists rather than referring them to one with a shorter or no waiting list&#46; It also restricts patients&#8217; freedom to choose the center that can best respond to their needs and which may also lead to better outcomes&#46; Portugal is too small a country for such inequalities in health care and the national health service must be able to respond appropriately and promptly to its patients&#8217; needs&#46; However&#44; if this is deemed impossible&#44; then let us use private health facilities&#44; negotiating financial terms that the system can support&#46;</p></span>"
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Altera&#231;&#227;o nas redes de referencia&#231;&#227;o de doentes para cirurgia cardiotor&#225;cica&#58; as raz&#245;es econ&#243;micas ser&#227;o destitu&#237;das de custos&#63;"
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                            2 => "D&#46; Silva"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2631811"
                            "web" => "Medline"
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                  ]
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              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of preoperative symptoms on postoperative survival in severe aortic stenosis&#58; Implications for the timing of surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Pi&#233;rard"
                            1 => "C&#46; Meester"
                            2 => "S&#46; Seldrum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "97"
                        "paginaInicial" => "806"
                        "paginaFinal" => "810"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The occurrence of adverse events in relation to time after registration for coronary artery bypass surgery&#58; a population-based observational study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Sobolev"
                            1 => "G&#46; Fradet"
                            2 => "L&#46; Kuramoto"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1749-8090-8-74"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiothorac Surg"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23577641"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 ESC&#47;EACTS Guidelines on myocardial revascularization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Windecker"
                            1 => "P&#46; Kolh"
                            2 => "F&#46; Alfonso"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "paginaInicial" => "2544"
                        "paginaFinal" => "2640"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality while waiting for aortic valve replacement"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;C&#46; Malaisrie"
                            1 => "E&#46; McDonald"
                            2 => "J&#46; Kruse"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2014.06.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2014"
                        "volumen" => "98"
                        "paginaInicial" => "1564"
                        "paginaFinal" => "1570"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240781"
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                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Sampalis"
                            1 => "S&#46; Boukas"
                            2 => "M&#46; Liberman"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2001"
                        "volumen" => "165"
                        "paginaInicial" => "429"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11531051"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
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              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Socioeconomic differences in waiting times for elective surgery&#58; a population-based retrospective study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "G&#46; de Luca"
                            2 => "T&#46; Landriscina"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6963-12-268"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "268"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22909260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "Effect of socioeconomic deprivation on waiting time for cardiac surgery&#58; retrospective cohort study"
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                          "autores" => array:3 [
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                        "tituloSerie" => "BMJ"
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                        "paginaFinal" => "19"
                        "link" => array:1 [
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Revista Portuguesa de Cardiologia (English edition)
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