Inhalation with bronchodilator combination effective in reducing length of hospital stay in children with pneumonia
Rahma Annisa, Nani Nurhaeni
, Dessie Wanda
Corresponding author
Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
Read
12101
Timeswas read the article
2486
Total PDF
9615
Total HTML
Share statistics
array:23 [ "pii" => "S1130862118300305" "issn" => "11308621" "doi" => "10.1016/S1130-8621(18)30030-5" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "70006" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Clin. 2018;28 Supl 1:23-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 335 "formatos" => array:3 [ "EPUB" => 37 "HTML" => 162 "PDF" => 136 ] ] "itemSiguiente" => array:18 [ "pii" => "S1130862118300317" "issn" => "11308621" "doi" => "10.1016/S1130-8621(18)30031-7" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "70007" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Clin. 2018;28 Supl 1:27-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 359 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 202 "PDF" => 102 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Arbi Care application increases preschool children’s hand-washing self-efficacy among preschool children" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "30" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => " Arbianingsih, Yossy Utario, Yeni Rustina, Tri Krianto, Dian Ayubi" "autores" => array:5 [ 0 => array:1 [ "apellidos" => "Arbianingsih" ] 1 => array:2 [ "nombre" => "Yossy" "apellidos" => "Utario" ] 2 => array:2 [ "nombre" => "Yeni" "apellidos" => "Rustina" ] 3 => array:2 [ "nombre" => "Tri" "apellidos" => "Krianto" ] 4 => array:2 [ "nombre" => "Dian" "apellidos" => "Ayubi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862118300317?idApp=UINPBA00004N" "url" => "/11308621/00000028000000S1/v4_201810090949/S1130862118300317/v4_201810090949/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130862118300299" "issn" => "11308621" "doi" => "10.1016/S1130-8621(18)30029-9" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "70005" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Enferm Clin. 2018;28 Supl 1:19-22" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1973 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 1520 "PDF" => 408 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "The combination of nebulization and chest physiotherapy improved respiratory status in children with pneumonia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "19" "paginaFinal" => "22" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nur Eni Lestari, Nani Nurhaeni, Siti Chodidjah" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nur Eni" "apellidos" => "Lestari" ] 1 => array:2 [ "nombre" => "Nani" "apellidos" => "Nurhaeni" ] 2 => array:2 [ "nombre" => "Siti" "apellidos" => "Chodidjah" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862118300299?idApp=UINPBA00004N" "url" => "/11308621/00000028000000S1/v4_201810090949/S1130862118300299/v4_201810090949/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Inhalation with bronchodilator combination effective in reducing length of hospital stay in children with pneumonia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "23" "paginaFinal" => "26" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rahma Annisa, Nani Nurhaeni, Dessie Wanda" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rahma" "apellidos" => "Annisa" ] 1 => array:4 [ "nombre" => "Nani" "apellidos" => "Nurhaeni" "email" => array:1 [ 0 => "nani-n@ui.ac.id" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Dessie" "apellidos" => "Wanda" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculty of Nursing, Universitas Indonesia, Depok, Indonesia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumonia still has a high rate of prevalence and remains one of the leading causes of deaths among toddlers worldwide, especially in developing countries. The World Health Organization (WHO) estimates that there are 156 million cases of pneumonia afflicting children under five years old annually. Pneumonia is responsible for 15% of deaths among children under five years old, accounting for 922 thousand deaths in 2015<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to a survey conducted by the Indonesian Health Ministry in 2013, the prevalence rate of pneumonia in all age groups throughout Indonesia increased from 2.1% in 2007 to 2.7% in 2013. In terms of age groups, children aged 1 to 4 years have the highest rate of pneumonia prevalence, at 18.5%<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Of all Indonesian provinces, West Nusa Tenggara Province has one of the highest pneumonia prevalence rates among children under five years old. It was estimated that in the province, as many as 54,220 children under five years old in 2014 were afflicted by pneumonia<a name="p2"></a> but that only 26,631 (49.12%) were treated by professional health workers<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the most troubling symptoms experienced by pneumonic children is respiratory tract blockage due to mucus accumulation. The respiratory tract can be cleared of mucus accumulation by performing various medical interventions, one of which is inhalation therapy. Inhalation therapy can help remove the airflow obstruction and reduce the mucus accumulation in the patient's respiratory tract<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. In spite of the fact that inhalation is performed on most patients, some medical professionals do not recommend it for the routine management of hospitalized children<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The use of various therapeutic interventions may influence a patient's length of hospital stay. Appropriate and effective treatment is necessary to avoid recurrent infections, which can prolong the patient's duration of treatment at the hospital and thus increase treatment costs<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. The purpose of this research project was to examine the correlation between inhalation therapy and length of hospital stay among pneumonic children under five years old.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study applied a descriptive-analytical research design and a cross-sectional approach. This study used secondary data which were obtained from the medical records of patients treated at the hospital within the one-year period from May 2015 to May 2016 and then written manually on the data forms. The respondents were selected using the consecutive sampling technique. The research sample consisted of 102 children under five years old who had been treated at the P3 Regional Hospital and had their treatment documented in the hospital's medical records. Our inclusion criteria were that (1) the patients were under five years old (aged 0 to 59 months) and (2) the patients were diagnosed with pneumonia and treated at the hospital. Our exclusion criterion was that the patients were treated at the hospital and diagnosed with pneumonia coupled with other infectious diseases, such as congenital heart disease or immunodeficiency disease. Samples were obtained using the consecutive sampling technique. The data were analyzed using the univariate and bivariate analyses with the Chi-square statistical test, which was performed using computer software. This research project was approved by the Ethics Committee of the Faculty of Nursing of Universitas Indonesia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">The characteristics of the respondents showed that most of this study participants were male (70 children, or 68.6%). Their median age was 11 months. The youngest was 1 month old, and the oldest was 59 months old. Fifty-six samples (54.9%) had leucocytes ≤ 14,000/mm<span class="elsevierStyleSup">3</span>. Most samples (71 children, or 69.6%) received second-line antibiotics, and the median oxygen therapy volume was 1 liter/minute. Twenty-one samples (20.6%) did not receive any inhalation therapy at all; 31 (30.4%) samples were treated with inhalation therapy using NaCl 0.9%, 24 samples (23.5%) were treated with inhalation therapy using β-agonist bronchodilator + NaCl 0.9%, and 26 samples (25.5%) were treated with inhalation therapy using a combination of β-agonist and anticholinergic bronchodilator + NaCl 0.9%. Fifty-six (54.9%) participants had a long treatment duration (> 5 days), whereas 46 (45.1%) participants underwent a short treatment duration. (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> demonstrated that the administration of inhalation therapy using a combination of β-agonist and anticholinergic bronchodilator + NaCl 0.9% resulted in shorter treatment durations (80.8% of cases) as compared to other types of inhalation therapy or the absence of inhalation therapy. This result proves that there is a significant correlation between the administration of inhalation therapy and the duration of treatment (<span class="elsevierStyleItalic">p</span> = 0.000).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The results of the bivariate analysis of the confounding and dependent variables showed correlations between the age, number of leucocytes, and the type of antibiotics prescribed (<span class="elsevierStyleItalic">p</span> < 0.05), while there was no significant correlation between the sex and oxygen therapy volume (<span class="elsevierStyleItalic">p</span> > 0.05).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pneumonic children in this study received different intervention treatments for the purpose of clearing their respiratory tracts of mucus deposits. The treatments consisted of inhalation therapy using NaCl 0.9% only, using β-agonist bronchodilator + NaCl 0.9%, and using a combination of β-agonist and anticholinergic bronchodilator + NaCl 0.9%, as well as treatments that did not involve any inhalation therapy at all. The results indicated that in general, children who received inhalation therapy had shorter treatment durations than those who did not receive inhalation therapy at all.<a name="p3"></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore, inhalation therapy can be considered as an effective medical intervention for respiratory tract diseases. This is due to the fact that by means of inhalation, medicines can enter directly into the patients’ respiratory tracts and reach their lungs more quickly than if they are distributed via other systemic circulation routes<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. The administration of respiratory tract medicines through inhalation therapy may reduce the necessary dosage and minimize potential side effects as compared to administration via other routes<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. Inhalation therapy can help prevent respiratory tract blockage, dilute pulmonary secretions, and release mucus accumulations from respiratory tracts<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this study, pneumonic children who received inhalation treatment received three different types of therapy. The results showed that children who received inhalation treatment coupled with a bronchodilator, either β-agonist or the combination of β-agonist and anticholinergic has shorter treatment durations than children who received inhalation therapy with normal saline at 0.9%.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Most of the pneumonic children in the age range of 2 to 12 months and 1 to 5 years experienced wheezing<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>. Wheezing occurs due to the constriction or blockage of the lower respiratory tract, which must be immediately treated with a fast-acting bronchodilator. In addition to fast-acting bronchodilator medicines, such as those belonging to the β-agonist group, some therapists also prescribe a combination of β-agonist and anticholinergic bronchodilator by means of inhalation<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The results of this study correspond to those published by the Scottish Intercollegiate Guidelines Network, which imply that inhalation therapy using a combination of β-agonist and anticholinergic bronchodilator results in a more significant bronchodilatation effect, faster recovery, and a shorter treatment duration<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>. It has been confirmed that the combination of β-agonist and anticholinergic bronchodilator can increase the bronchodilatation effect and that it is a simple combination therapy. In addition, this type of bronchodilator produces a more long-lasting effect and requires only 30 to 60 sixty minutes to reach its maximum effect<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In addition to inhalation therapy coupled with a combination of β-agonist and anticholinergic bronchodilator, inhalation therapy coupled with β-agonist bronchodilator also resulted in shorter treatment durations. This finding corresponded to previous study indicating that the administration of inhalation therapy coupled with β-agonist bronchodilator could decrease the severity of disease and shorten the duration of treatment at hospitals without causing any negative effects<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>. Another study also discovered that inhalation with salbutamol (another member of the β-agonist bronchodilator group) may reduce patients’ treatment duration and disease severity<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>. Furthermore, inhalation therapy using salbutamol (β-agonist bronchodilator) + NaCl 0.9% produced a higher bronchodilatation effect than that produced via inhalation therapy using salbutamol only<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>. Another research discovered that inhalation therapy using salbutamol (β-agonist bronchodilator) + NaCl 0.9% could increase the frequency of coughing and the volume of discharged sputum as compared to salbutamol inhalation only<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">β-agonists are a group of fast-acting bronchodilators whose mechanism includes the relaxation of smooth muscles in the respiratory tract. The addition of a β-agonist bronchodilator to an inhalation therapy can reduce asphyxia and improve patients’ quality of life<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>. Additionally, this group of bronchodilators can help dilute mucus, control the bronchoconstriction of the respiratory tract, and maximize mucociliary clearance<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In spite of the administration of inhalation therapy, some pneumonic cases in this research project resulted in longer treatment durations. This may happen when patients are at a very young age. Infants, especially those under six months old who suffered from respiratory tract edema and inflammation, were more prone to respiratory disorders because infants have smaller respiratory tract diameters, and this may extend the time required to treat their diseases<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>. Other factors that may affect to the duration of treatment of pneumonic children are the number of leucocytes and the type of antibiotics prescribed.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Innovations in the diagnosis and treatment of pneumonia are required to overcome this leading cause of death among children under five years old. Almost all deaths caused by pneumonia afflicting children can be prevented through more accurate diagnoses and appropriate treatments, as well as providing more skillful health workers in greater numbers<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Additionally, appropriate and effective therapy for pneumonic children can reduce their length of hospital stay, prevent nosocomial infections and thus shorten treatment duration, prevent recurrent infections in children, and reduce the costs of hospital treatment. Appropriate therapy also offers significant benefits to the hospital. It can reduce the costs of treatment and increase the hospital's reputation due to the patients’ and their families’ improved satisfaction with the quality of the service provided during the patients’ treatment at the hospital.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The results showed that pneumonic children who received inhalation therapy experienced shorter treatment durations than those who did not receive any inhalation therapy. Nurses, as professional health workers who take charge of patients during their treatment at hospitals, are expected to provide accurate explanations of their patients’ conditions so that the patients can receive appropriate and effective treatment for their health problems.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The limitations of this research include the researchers’ inability to perform a direct examination of the patients’ specific conditions during treatment due to the secondary data used in this study. Thus, the researchers were unable to generate a classification of each patient's pneumonic types.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The results of this study can be used to create guidelines for providing more effective health and nursing services, especially in the administration of respiratory tract clearance procedures. These results are also expected to serve as an example of evidence-based practice for the development of the science of nursing and as scientific proof that inhalation therapy offers significant benefits for the treatment of pneumonic children.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1092630" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1035502" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "xack371209" "titulo" => "Acknowledgement" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1035502" "palabras" => array:3 [ 0 => "Inhalation" 1 => "Length of hospital stay" 2 => "Pneumonia" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to examine the correlation between inhalation therapy and length of hospital stay in children under age of five with pneumonia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included 102 consecutive patients (secondary data) with pneumonia. The patients were divided depending on the type of therapy they received: Group I used inhalation therapy with bronchodilator β-agonist + NaCl 0,9%, Group II used inhalation therapy with bronchodilator β-agonist and anticholinergic + NaCl 0,9%, Group III used inhalation therapy with NaCl 0,9%, and Group IV used no inhalation therapy.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study results showed a significant correlation between the use of inhalation therapy and the length of hospital stay (p = 0.000) after being controlled age, leucocyte count, and the type of antibiotic therapy. However, there was no significant correlation between the use of inhalation therapy and the length of hospital stay in children under the age of five with pneumonia after sex and oxygen therapy being controlled.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Inhalation therapy with a combination of bronchodilator β-agonist and anticholinergic + NaCl 0.9% and with bronchodilator β-agonist + NaCl 0.9% are the two most effective treatments with which to reduce the length of hospital stay in toddlers with pneumonia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col">Length of hospital stay</th><th class="td" title="table-head " align="center" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Long</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Short</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">Total</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Administration of inhalation therapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Not treated with any type of inhalation therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>NaCl 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>β-agonist bronchodilator + NaCl 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Combination of β-agonist and anticholinergic bronchodilator + NaCl 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1868579.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Correlation between the Administration of inhalation therapy and the length of hospital stay for pneumonic children.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Barson WJ. Pneumonia in children: Epidemiology, pathogenesis, and etiology. 2015 [accessed 2015 Nov 16]. Available at: <a id="intr0005" class="elsevierStyleInterRef" href="http://www.uptodate.com/contents/pneumonia-in-children-epidemiology-pathogenesis-and-etiology">http://www.uptodate.com/contents/pneumonia-in-children-epidemiology-pathogenesis-and-etiology</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Pneumonia. 2015 [accessed 2015 Nov 17]. Available at: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.who.int/mediacentre/fact-sheets/fs331/en/">http://www.who.int/mediacentre/fact-sheets/fs331/en/</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Riset Kesehatan Dasar 2013" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Ministry of Health of Indonesia" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "Kemenkes RI" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Provincial Health Office of West Nusa Tenggara. Profil kesehatan Propinsi Jawa Tengah tahun 2014. Nusa Tenggara Barat: Dinas Kesehatan Propinsi Nusa Tenggara Barat; 2015." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi: 10.1186/s13063-015-0865-0" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventive nebulization of mucolytic agents and bronchodilating drugs in invasively ventilated intensive care unit patients (NEBULAE): Study protocol for a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Van der Hoeven" 1 => "J.M. Binnekade" 2 => "C.A.J.M. De Borgie" 3 => "F.H. Bosch" 4 => "H. Endeman" 5 => "J. Horn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13063-015-0865-0" "Revista" => array:5 [ "tituloSerie" => "Trials" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26329352" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi: 10.1016/j.pedneo.2015.04.014" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duration of hospitalization in Association with type of inhalation therapy used in the management of children with nonsevere, acute bronchiolitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Pinto" 1 => "J.L. Schairer" 2 => "A. Petrova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pedneo.2015.04.014" "Revista" => array:7 [ "tituloSerie" => "Pediatr Neonatol" "fecha" => "2016" "volumen" => "57" "paginaInicial" => "140" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26464183" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1590865813006956" "estado" => "S300" "issn" => "15908658" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower respiratory tract infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.L. Glover" 1 => "M.D. Reed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "The Mc-Graw Hill Companies, Inc" "editorialLocalizacion" => "USA" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nebulized therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Olveira" 1 => "A. Munoz" 2 => "A. Domenech" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.05.003" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2014" "volumen" => "50" "paginaInicial" => "535" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24997131" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatrics alergy asthma and immunology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Cantani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2008" "editorial" => "Springer Berlin Heidelberg" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi: 10.3126/jnps.v31i2.4642" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wheeze among pneumonia patients in Paediatrics Department of Patan Hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.R. Shrestha" 1 => "B. Yadhav" 2 => "S. Shresta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Journal of Nepal Paediatric Society" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "116" "paginaFinal" => "120" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mycoplasma pneumonia: Clinical features and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Kashyap" 1 => "M. Sarkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0970-2113.63611" "Revista" => array:6 [ "tituloSerie" => "Lung India." "fecha" => "2010" "volumen" => "27" "paginaInicial" => "75" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20616940" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Buku saku pelayanan kesehatan anak di rumah, sakit." "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "World Health, Organization" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "WHO Indonesia" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Doi: 10.1016/j. ejcdt.2012.10.023" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nebulized magnesium sulphate versus nebulized salbutamol in acute bronchial astma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.A. Abdelnabi" 1 => "M.M. Kamel" 2 => "A.E. Ali" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Egypt J Chest Dis Tuberc" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "29" "paginaFinal" => "34" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penyakit paru obstruktif kronik (PPOK): Pedoman diagnosis dan penatalaksanaan di, Indonesia." "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Perhimpunan Dokter Paru, Indonesia" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2003" "editorial" => "PDPI" "editorialLocalizacion" => "Jakarta" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi: 10.1016/j.annemergmed.2009.04.006" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based emergency medicine/systematic review abstract Is nebulized hypertonic saline solution an effective treatment for bronchiolitis in infants?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Chaundry" 1 => "R. Sinert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2009.04.006" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "120" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19464073" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "3% hypertonic saline vs normal saline nebulization in children with acute bronchiolitis. Critical appraisal of an article hypertonic 3% saline vs 0.9% saline nebulization for acute viral bronchiolitis: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.K. Yadav" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clinical Epidemiology and Global Health." "fecha" => "2014" "volumen" => "2" "paginaInicial" => "141" "paginaFinal" => "142" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nebulised salbutamol administered during sputum induction improves bronchoprotection in patients with asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Delvaux" 1 => "M. Henket" 2 => "L. Lau" 3 => "P. Kange" 4 => "P. Bartsch" 5 => "R. Djukanoviv" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax." "fecha" => "2004" "volumen" => "59" "paginaInicial" => "111" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14760148" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perbandingan efek salbutamol dengan salbutamol yang diencerkan dengan NaCl 0,9% pada pasien dewasa dengan asma akut sedang di RS Persahabatan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.S. Idrus" 1 => "F. Yunus" 2 => "S.L. Andarini" 3 => "A. Setiawati" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Jurnal Respirasi Indonesia." "fecha" => "2012" "volumen" => "32" "paginaInicial" => "167" "paginaFinal" => "177" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Labacs provide a simple convenient and effective COPD therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Amin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Majalah Kedokteran Respirasi." "fecha" => "2012" "volumen" => "3" "paginaInicial" => "61" "paginaFinal" => "68" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Zamani" 1 => "M. Movahhedi" 2 => "S.M. Nourbakhsh" 3 => "F. Ganji" 4 => "M.R. Kopaei" 5 => "M. Mobasheri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med J Islam Repub Iran." "fecha" => "2015" "volumen" => "29" "paginaInicial" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26478870" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "doi: 10.1016/S2214-109X(13)70117-7" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Innovations in pneumonia diagnosis and treatment: a call to action on world pneumonia day" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Ginsburg" 1 => "S. Sadruddin" 2 => "K.P. Klugman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2214-109X(13)70117-7" "Revista" => array:6 [ "tituloSerie" => "Lancet Glob Health" "fecha" => "2013" "volumen" => "1" "paginaInicial" => "e326" "paginaFinal" => "e327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25104591" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack371209" "titulo" => "Acknowledgement" "texto" => "<p id="par0110" class="elsevierStylePara elsevierViewall">We would like to extend our thanks to the Heads of the Medical Record Room and Children's Ward of the P3 Regional Hospital, West Lombok Regency, West Nusa Tenggara Province; the research assistants, and the Department of Research and Community Services, Universitas Indonesia.<a name="p4"></a></p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest for this study.</p></span>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11308621/00000028000000S1/v4_201810090949/S1130862118300305/v4_201810090949/en/main.assets" "Apartado" => array:4 [ "identificador" => "75447" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Part 1" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11308621/00000028000000S1/v4_201810090949/S1130862118300305/v4_201810090949/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862118300305?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 75 | 3 | 78 |
| 2024 October | 544 | 54 | 598 |
| 2024 September | 552 | 38 | 590 |
| 2024 August | 386 | 53 | 439 |
| 2024 July | 399 | 62 | 461 |
| 2024 June | 268 | 41 | 309 |
| 2024 May | 299 | 58 | 357 |
| 2024 April | 342 | 41 | 383 |
| 2024 March | 456 | 39 | 495 |
| 2024 February | 451 | 42 | 493 |
| 2024 January | 622 | 41 | 663 |
| 2023 December | 466 | 40 | 506 |
| 2023 November | 539 | 38 | 577 |
| 2023 October | 611 | 56 | 667 |
| 2023 September | 298 | 23 | 321 |
| 2023 August | 313 | 21 | 334 |
| 2023 July | 299 | 31 | 330 |
| 2023 June | 313 | 27 | 340 |
| 2023 May | 348 | 44 | 392 |
| 2023 April | 252 | 48 | 300 |
| 2023 March | 290 | 63 | 353 |
| 2023 February | 219 | 75 | 294 |
| 2023 January | 147 | 49 | 196 |
| 2022 December | 111 | 102 | 213 |
| 2022 November | 115 | 77 | 192 |
| 2022 October | 48 | 93 | 141 |
| 2022 September | 63 | 89 | 152 |
| 2022 August | 36 | 61 | 97 |
| 2022 July | 23 | 60 | 83 |
| 2022 June | 29 | 63 | 92 |
| 2022 May | 34 | 44 | 78 |
| 2022 April | 25 | 57 | 82 |
| 2022 March | 30 | 64 | 94 |
| 2022 February | 22 | 44 | 66 |
| 2022 January | 10 | 48 | 58 |
| 2021 December | 17 | 37 | 54 |
| 2021 November | 20 | 49 | 69 |
| 2021 October | 17 | 34 | 51 |
| 2021 September | 24 | 41 | 65 |
| 2021 August | 11 | 24 | 35 |
| 2021 July | 14 | 14 | 28 |
| 2021 June | 16 | 16 | 32 |
| 2021 May | 23 | 17 | 40 |
| 2021 April | 46 | 35 | 81 |
| 2021 March | 35 | 42 | 77 |
| 2021 February | 17 | 17 | 34 |
| 2021 January | 22 | 32 | 54 |
| 2020 December | 15 | 27 | 42 |
| 2020 November | 13 | 29 | 42 |
| 2020 October | 7 | 23 | 30 |
| 2020 September | 15 | 12 | 27 |
| 2020 August | 18 | 19 | 37 |
| 2020 July | 10 | 10 | 20 |
| 2020 June | 11 | 19 | 30 |
| 2020 May | 10 | 25 | 35 |
| 2020 April | 16 | 17 | 33 |
| 2020 March | 31 | 15 | 46 |
| 2020 February | 26 | 15 | 41 |
| 2020 January | 12 | 11 | 23 |
| 2019 December | 26 | 9 | 35 |
| 2019 November | 15 | 8 | 23 |
| 2019 October | 13 | 13 | 26 |
| 2019 September | 18 | 14 | 32 |
| 2019 August | 9 | 6 | 15 |
| 2019 July | 9 | 9 | 18 |
| 2019 June | 4 | 8 | 12 |
| 2019 May | 22 | 31 | 53 |
| 2019 April | 9 | 13 | 22 |
| 2019 March | 2 | 4 | 6 |
| 2018 December | 5 | 2 | 7 |
| 2018 November | 1 | 0 | 1 |
| 2018 April | 1 | 0 | 1 |
Show all
