Brain metastases treatment in 23 Neurosurgery and Oncology clinics in São Paulo

Terrible service, absurd delay at reception of more than 40 minutes. Unprepared employees with no information on service protocols. Both for scheduling by phone and in person. I scheduled an MRI and confirmed the information before making the call and when I arrived to be seen on the second attempt (as the first time I was unable to be seen because the exam was 2 hours late) the attendant gave me completely different information, stating that I would need to change the order on behalf of the council, and I confirmed it with the telephone attendant twice regarding the council. Anyway, on top of that, I agreed to take the exam because I was urgently required, but it was 1h30 late, which ended up being a little longer. The hospital used to be excellent, but it has lost its quality, I don't recommend it.

Terrible in terms of hospitalization... I arrived at the hospital with my daughter with blood in her stool... I was well looked after in the ER and, after carrying out the tests, the doctor informed me that hospitalization would be necessary. We were directed to the infirmary and here I have been ever since. I was admitted to the hospital on 11/27/23 at 7:58 pm. I signed the authorization for hospitalization on 11/28/23 at 01:48 and now it is 15:50 on 11/28/23 and we are still here in the infirmary... They should warn you before admitting you about all this! A lack of respect. My daughter has been on a stretcher for 14 hours and I was sitting in a chair for hours and after a lot of complaining, they put an armchair...

DON’T HAVE CHILDREN IN THIS PLACE😡😡 Worst experience possible, we signed a maternity plan at this unit, everything was wonderful when presented, I thought it would be a good place for my wife and daughter. My wife went into labor so we went to the hospital. Arriving at the location, my wife went to the service. There was no room available, so we did the whole process by pushing our bags around the hospital. I asked the receptionist who informed me that this is quite common at the place, as it happens every day and so I asked someone from management (both rude) and said that I would only have a room around 9 am and at that time it was around midnight. night and a half. Of course it didn't happen, he only got to the room around 2:30 pm. In short, my wife had our daughter, I continued through the hospital pushing suitcases, all of this was nothing close to what my wife went through. THEY SIMPLY LEFT MY WIFE FOR 5 HOURS IN THE RECOVERY ROOM ALONE WITH THE BABY AFTER A RACHI BECAUSE THERE WAS NO ROOM I CAN'T GET OUT OF MY HEAD HER CRYING TELLING ME Several women passed through the recovery room and went to their rooms, and they remained there with no one to help. We arrived at our room after much insistence and were poorly attended to by the staff while my wife went through what she went through. INHUMANE HOSPITAL WITH TERRIBLE ADMINISTRATIVE STAFF NOTE: Nurse GABI was incredible in providing care at all times In other words, look for another place for such an incredible moment in life.

Terrible phone service. It took me more than 45 minutes for the first person to speak on the phone, adding up to more than 5 calls (as several dropped) and a lot of time listening to "little music". Whatsapp service is also non-existent. It is very difficult to have information about recovering patients, regrettable.

Lack of empathy with patients on the part of reception. We arrived at 4pm, as my husband had a procedure scheduled for 6pm, and according to the instructions received in advance via WhatsApp, we would have to be at the hospital 2 hours before the time given by the doctor to carry out the administrative procedures, the time being documented by the surgeon at 6pm. An attendant asked to wait, as they would call by name. At 6:05 pm we went to question the delay in being seen, and were informed that the surgery was scheduled for 9 pm and that it was not a priority. Therefore, my first experience at the hospital was unpleasant until they showed no interest or concern for the time we were waiting. I cannot direct the complaint to the attendant in question as they do not have identification on their uniform.

Night nurse Robson, totally unprepared, passed, my wife underwent a procedure in this hospital and was very poorly treated by this professional, even he and nurse Renata were just making fun and laughing at my wife. Total disregard. I would never recommend this rubbish.

This hospital is terrible!!!! I had an ear problem last month and I went to this hospital that charged me for a consultation without first telling me that they did NOT have an ENT doctor available who could help me (even after having gone through the screening), and now even having spoken to the ombudsman, they claim that I was notified, which is an absurd lie. What I take away from this is that in addition to having terrible service and incompetent nurses, they also lie. Don't go to Santa Paula, they won't solve your problem, and then they will claim that “you were too stunned to understand” which is an absurd lack of empathy and humanity for a hospital to say something like that.

Second time this week I spent this week in the emergency room of this hospital, because the medicines prescribed by the doctors are not relieving my pain, I have flu-like symptoms. I haven't slept almost at all this week and today in particular, I stayed up all night feeling a lot of pain. It is not possible that I will have to go to the emergency room for the third time. If I go, it won't be in this hospital. Update: I went to the emergency room for the third time this week, but in another hospital, I was howling in pain, I knew something was wrong, as I was feeling very ill and didn't get better with any prescribed medication. I was diagnosed with sinusitis in another hospital, I remember that the last doctor at this hospital said it was nothing serious and didn't even give me an antibiotic and said it was influenza. They gave me nausea dosage in the amount for a child and not for an adult and in a greater number of hours. I no longer trust this hospital and will not return again.

Good afternoon everybody. My 18 year old daughter was hospitalized on 10/06 with teratomas on her ovary. A huge scare, because we went to the emergency room with suspected kidney stones. We were very scared and very worried, but I would like to record here the excellent and extremely humanized care provided by everyone, without exception, at the hospital. My daughter had recently turned 18 and so I couldn't sleep with her in the hospital, imagine my despair and worry? So, in addition to never being hospitalized, she had to be alone. But, all (without exception) the nurses, receptionists, doctors, were very careful, loving, attentive and caring. I would really like to remember everyone's name (and I recommend that the hospital look at the days of this shift to really recognize these professionals from 10/05 to 11:20 pm to 10/08), but I was very nervous, but, I remember Carol, Kelly, Luana (in the emergency room), Dr Manoel and the team that successfully performed the surgery to remove the teratomas on my daughter. Those whose names I don't remember (especially a nurse who attended to us in the early hours of 10/06 who was so loving), please forgive me, they are no less important in my gratitude, as I said to some of you, for For me, it is not simply a profession but rather a gift of caring for others. I couldn't spend 24 hours with my daughter in the 3 days she was there, but I'm sure that God chose all the people who took care of her correctly. Congratulations to the hospital, which recognizes its team and always values ​​the people who work there. I also mention the cleanliness of the hospital and the rooms, which are cleaned constantly. My daughter continues to recover very well. I am grateful for Dr. Manoel's assertive clarifications, which left us calm and confident as my daughter continued. I noticed that all medications, all procedures that were performed, were calmly explained to her, eye to eye, realizing whether she was understanding or not. Thank you all very much, may God bless you always.

After waiting for 2 hours, our daughter was called to help and, to my surprise, they didn't allow the father to go up, they let the mother go up alone with a 10-month-old baby and three bags. Lack of space, lack of planning, lack of training or lack of humanism? Unfortunate...

Terrible hospitalization, few employees, they make the patient do the work, you need to call or ask for sheets, pillowcases, bath towels via QRCOD, I asked for a bathtub so I could bathe my baby, it took more than an hour to arrive, the employee who brings it the bathtub cannot bring towels, the patient needs to use the hospital system to request towels, sheets, pillowcases, hygiene items... and 1 item at a time, in an order you cannot, for example, request sheets, towels and blanket, you have to order one item at a time for the companion and the patient. I am the companion responsible for my 5 month old baby, I also have the flu, I requested hot water to make tea at 10 pm and they told me that the kitchen in a HOSPITAL does not work at night, I have never seen this, an emergency room, a patient in hospitalization and not having hot water. They serve 3 meals a day, breakfast at 7:00 am, lunch at 1:00 pm and dinner at 7:00 pm, during these intervals if you want to order something via app, you cannot go down to reception to receive it, no one at reception can go up to bring your food and no staff can look at your child who is hospitalized for you to go down to reception for 3 minutes to receive the food, you are forced to go hungry or buy it at the hospital cafe. My rating for hospitalization is terrible, if I need it again I won't come back here, good accommodation but the system is terrible service, not even a public hospital is that bad.

Super-fast screening and registration. Examination and medication expedited. However, when they send us to that little room to go back to the doctor, you forget about life because it seems like they will never see you. And it's not the first time. Today I ordered to cancel and left. I arrived before 8pm, it was around 7:30pm, everything would have ended quickly, if it weren't for the wait to see the doctor again. They should monitor these doctors who keep the door closed with no one inside, while mothers and fathers are waiting for a report. It is, at the very least, a lack of empathy and respect for the health of little ones. Now with these traumas, I probably won't take it anymore. If I need it again, I will go to São Luiz. But, I congratulate Dr Daigo, who once, when I was being seen by him and needed to return, as soon as he saw me, he immediately called me and immediately released us, since there was no one else in the waiting room. Super attentive, agile and helpful.

I have never been ignored in a hospital, not even in the same unit, but this time it was different. I was seen by the doctor Raphael Augusto Travernard Neves de Oliveira CRM 119677, he asked about my symptoms, I explained that last year I had a migraine attack for 2 months (I was even admitted to the same hospital, in addition to undergoing several tests), finally I was diagnosed with anxiety and chronic sinusitis due to low immunity. After I explained my entire case, according to the doctor and my clinical condition in his eyes, I was “just having a cold”. I didn't agree, and asked us to do the tomography, detailing that I had done the last tomography in less than 2 months, as it was exactly the same. I left there with a prescription for antibiotics, 2 types of corticosteroids, painkillers and nasal wash, as I had a cyst preventing drainage. But to the doctor it was just a cold. DETAIL: the doctor always laughed when I said that my pain was a grade 7.

On 10/23/2023 I was admitted to the hospital to have my cesarean section, so far everything was fine, everything was perfect with the service. However, my newborn was born with a lingual frenulum and no one from the medical team informed me about this. For me, A VERY SERIOUS MISTAKE, especially because the test in maternity is the law. I had a lot of difficulty breastfeeding even with a full breast in the hospital and no pediatric doctor gave me any guidance. One of the nurses told me that the pediatrician on duty was asking me for permission to take the formula, as the right-handed man was showing low blood sugar levels and NOBODY... gave me this very IMPORTANT information and obviously I didn't accept it, as my chest was sore. so full. I was discharged on Thursday 10/26 and only found out about the frenulum on 10/30 when I went to a private pediatrician, by which time my son had already lost a lot of weight. Since 10/30 I've been fighting with my little one, where he needed surgery on the lingual frenulum and only now after almost 20 days did my son start eating properly. I was extremely disappointed with this and even with the information that my son was born at 37 weeks, and the correct one was 39s and 2 d. Unfortunately, I am very hurt and disappointed with the negligence of the professional who was supposed to inform me of this very important information. The rest, such as the nursing team, cleaning and food, were all wonderful.

Great service, I was hospitalized for 3 days and received very good service from all the employees, especially Isaac, the kitchen and Fran from nursing. I recommend!

Hospital Paulistano is excellent, incredible professionals from reception to departure, delicious food, I was very well assisted by neurosurgeon Dr Adil Bachir and Dr Rodrigo during my anterior and posterior lumbar arthrodesis surgery, on the L4, L5 and S1 vertebrae, almost 8 hours, doctors on duty, very human and attentive, wonderful nursing technicians, excellent nurses, excellent and committed physiotherapists, it was an immense joy 1 day after the surgery to get up from the bed and walk around, without any support. My mother waited for my surgery in a room, fully assisted by the staff and nurses, thank you in advance for so much effort and care. Congratulations to everyone involved. The only negative point is the shower, which doesn't heat up very much.

Today I had it at the oncology outpatient unit with an appointment more than 30 days ago. When I got there I found out that it was no longer scheduled. Because my plan, which was Amil, changed on 11/01/23 to Bradesco and they simply didn't send me a confirmation email. In other words, lack of respect and I missed two appointments, one with the oncologist and another with the general surgery team (which has already been rescheduled 4 times since September) Today I was rescheduled for 11/24 by the oncologist and the general surgery team oncology on 12/11. I complained to customer service. What I heard was . I'm sorry ma'am, let's find out what happened. Very inhumane towards cancer patients. And on June 14th of this year, during my first surgery, they lost all my exams from the surgical center back to the room. What I heard from the Surgical Center Manager... I trust my team... This has never happened... In other words, I'm the one who fights behind the exams to continue the treatment. I had to go to the Lavosier and Tecnolab laboratories to request a duplicate of the image exams.

I had knee surgery on 6/24. The service was all polite. They always ask you to arrive two hours before surgery completely fasting. Before the surgery I spent time with nursing, with an anesthesiologist and with my doctor. All facilities clean and well organized.

Our treatment with Alvorada was good up to a certain point, Doctors were cordial and treatment was decent. Our problem starts with some of the Administration staff that failed to inform us of the costs, and a Week after my partners X-ray exams the hospital decides to charge us extra, failing to properly explain the reason for the extra charges. It was also disappointing the lack of instruction from the admnistrative team, I felt like all it was needed from them was collecting the "payment". I understand hospital is a Business, but I still feel disappointed that my Mother was charged extra instead of my Partner and I - Let alone the charge came a week late with little explanation. We felt scammed

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Had an infection in the year with moderate to high pain. Excellent and quick service. Dr Vanessa was sweet, efficient and professional. Thank you.

I want to thank the entire team who were with me throughout my hospitalization, who welcomed me with so much affection and dedication. This team knew how to help me when I was really bad, they held my hand, and always gave me words of comfort. Unparalleled empathy. Congratulations to everyone and I ask that God gives double everything you gave to us. Kiss in the heart 🥰 I don't remember everyone's name, but it ranged from doctors, nurses day and night, to other sectors, physiotherapists, kitchen maids and cleaning assistants.

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It could be 5! BUT IT'S BEEN A MONTH SINCE MY SON'S RESULTS HAVE NOT BEEN OUT. I DID IT BY REFERRAL FROM THE HEALTH CENTER! THEY SAY THE DOCTOR HAS NOT DONE THE REPORT YET! ONE MONTH? MY SON NEEDS THIS REPORT TO BE ABLE TO GO TO NEURO FOR A DIAGNOSIS. ONE STAR FOR LACK OF RESPECT! Did it in October and so far nothing! I call! I send an SMS. TERRIBLE ABOUT THE DELAY IN THE REPORT RESULTS!

Saturday, November 25th, I was at GRAAC to have an MRI of the lumbar sacral spine, referred by the UBS, I was well received at the reception, attended to at the time the MRI was scheduled, attentive nurse and exam technician; bathrooms and very clean facilities, and after leaving with exam in hand, to my surprise, I even received a snack kit

Very good hospital. service ten. Congratulations to everyone who works at this hospital. very polite staff who care about the lives of patients and respect their companions and relatives 👏👏👏👏👏👏

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Excellent

I am completely outraged and frustrated with the service provided by Hospital São Camilo at the Ipiranga Unit in recent months. I had the misfortune of needing to go to the hospital a few times in a short period of time, and every time I went I had a terrible experience. But I'm going to focus on the day before yesterday, which was the last straw, and my cup of patience overflowed. The day before yesterday (11/21) I went to the hospital at 11:05 pm, with a severe migraine, nausea and weakness. When I went through the triage, they didn't even check my temperature, my blood pressure was high (14/9) and as the nurse said “it must be nothing, it could be because of your pain”. So far I agree, it could be because of the pain or my pain could be because of the pressure. I received a GREEN bracelet! Taking into account that the hospital follows the Manchester protocol, because of my absurd pain (those who have migraines know what I'm talking about) and because of my high blood pressure, I shouldn't have to wait for care for 2 hours (which is what says the Manchester protocol for the color GREEN). But they gave me this bracelet, and several people passed in front of me, it took more than 2 hours to wait to speak to the doctor, that's why I showed my indignation at the delay, because if I had remained quiet I would have waited another 2 hours. And the reception says that other people passed in front of me because they were other doctors, or it was orthopedics, or a general surgeon or Covid. And they also reiterated “you already and next time, the doctor was collecting the returns” IN other words, more people passed in front of me who were being discharged from the hospital, and yet were already medicated. Therefore, I was forgotten at reception with the pain they call N°10! And everyone knows that the more irritated a person gets, the worse the pain and the worse the pressure. So seeing my despair, where I was almost fainting from the pain, the receptionist asked me to go to the triage to re-evaluate my condition. Arriving at the screening, the blessed one looks at my face and says “Well?” I explain that the reception asked to reevaluate me and he responds “How? The reception?" I said “yes, the reception, the girl who is there at the tables”, and he replied “Really the reception?” I said yes!" and I pointed to the person, then he looked like he wasn't happy and checked my blood pressure again, it was still 14/9! After that I had to wait another 30 minutes until I was called, the receptionist was already desperate too, calling the hospital and informing them that I was feeling ill. Everyone passed by me, and did NOTHING! I was called to the doctor's room at 1:11 am, they made me wait more than 2 hours for an appointment, which according to the Manchester protocol should have been attended to with an ORANGE bracelet, and within 10 minutes. I can and I feel entitled to say that it was a failure to provide help, as my clinical condition was delicate, and the screening data and my face did not deny this, quite the contrary, they affirmed it. In a hospital like São Camilo, where I have been treated since I was 7 years old, when it still had the pediatrics area, you have left a LOT to be desired. You are a PRIVATE hospital, in case you forgot, if you are “short of professionals” hire more professionals. FOLLOW the protocol that YOU yourselves say you follow. Why a person almost fainting from pain, WITH ALL SURE IN THE WORLD, is not a green bracelet. And if it's too much to follow a WORLDWIDE protocol, STOP using and deceiving the people who will be served. Don't give me speeches about “we were without doctors”, “the four doctors who were attending were from other areas”, “your high blood pressure must be nothing”, “can I give you medicine X?”, “they are taking care of cases more serious than yours”, “the doctors were just going through the returns” because I'm TIRED of your lame excuses. I prefer you to take the time you would spend responding to me and review your services and professionals, why I felt neglected and in a hospital that for me was an example.

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I loved Google

Huge hospital with many specialties, including non-invasive cardiology, urology, oncology, orthopedics, among others. It is well located in the city of São Paulo, close to Vergueiro station. There are two other hospitals close by, including the BP hospital.

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I have been here several times, but today seems to be the time that this hospital's ER is the least prepared. Having passed through covid season peak now the hospital seems not being able to cope with the current influenza surge. The expected waiting time for a clinic evaluation, not considering possible needed exams or medications is of 4 hours! Seems that there is no medical staff at all right now. However the nursing and administrative staff are whatever possible. Hope somehow they can cope better with this seasonal flu...

I was at the Oswaldo Cruz Vergueiro unit on 11/24/23 at 8 pm. The service was for my mother and it was reasonable, however I witnessed the arrival of a girl with an injury to her head. The family in panic with the girl on their lap. The security guard and triage nurse were so quick that I didn't even see where they came from. The medical team was also quick and I saw the stabilized girl being taken to the upper floors. Of all this, what caused surprise was the apathy of the receptionists. They didn't help at all. Not even the family seeing the issue of documents to open the file. Even the nurse on duty was irritated with the receptionists. There was a lack of empathy, there was a lack of humanity in the service. Reception grade zero. Security and medical team, grade 1000

This hospital it’s unclean and the service are very bad we was waiting over 8 hours just to see the doctor

Hospital increasingly abandoned. Bad mood from reception to service floor. Doctor, thank God, he treats me well. Dr Alexander. So abandoned that there's no one to even pick up the token... 🤦🏻 (3rd floor) Sadly.

It is an excellent hospital, well located and with a wonderful team. We are always very well attended to, they give us quick solutions with zero bureaucracy. I have been a patient for 4 years and the service is always of the same standard. Whenever I feel something or go straight to this hospital 🏥. It has a restaurant, cafes, 24-hour bank and valet.

Considered top level. The prompt service leaves a lot to be desired. I passed on 25/Nov/23. In pain, the medical team only did a urine test. When the doctor came to talk, she had to consult a urologist with my request for medication, as I was in pain. In short, an US or CT scan would solve the problem and be accurate. But I had to go to another hospital to find out. BP Mirante for emergency care is too weak.

IS A PREMIUM?!?! JOKE!! Yesterday I was in the ER and I was outraged by the lack of structure and commitment to the patient. Only 1 attendant to open a form, 1 person doing the triage, 2 doctors attending all Emergency Rooms, patients being placed in common chairs to be medicated, only 1 nursing assistant to apply all the patients' medications and mismatched information. I thought that the fact that Mirante has premium service would never be served in this way. The doctor who attended to me prescribed the same medications I was taking at home, did he think I liked going to the ER for a walk? While I was in the medication room, I asked the person responsible for the PS, and nurse Bruna came to assist me. I informed him what was happening and he immediately took action. He transferred my care to a surgeon to analyze me, transferred me to a private place to receive the new prescribed medications, in short, he did everything possible to make my impression change. The problem is that I wouldn't have needed to complain to receive the service that should have been offered. I was extremely disappointed with BP Mirante, as it was not what I expected for this service.

It is an excellent hospital, well located and with a wonderful team. We are always very well attended to, they give us quick solutions with zero bureaucracy. I have been a patient for 4 years and the service is always of the same standard. Whenever I feel something or go straight to this hospital 🏥. It has a restaurant, cafes, 24-hour bank and valet.

Considered top level. The prompt service leaves a lot to be desired. I passed on 25/Nov/23. In pain, the medical team only did a urine test. When the doctor came to talk, she had to consult a urologist with my request for medication, as I was in pain. In short, an US or CT scan would solve the problem and be accurate. But I had to go to another hospital to find out. BP Mirante for emergency care is too weak.

IS A PREMIUM?!?! JOKE!! Yesterday I was in the ER and I was outraged by the lack of structure and commitment to the patient. Only 1 attendant to open a form, 1 person doing the triage, 2 doctors attending all Emergency Rooms, patients being placed in common chairs to be medicated, only 1 nursing assistant to apply all the patients' medications and mismatched information. I thought that the fact that Mirante has premium service would never be served in this way. The doctor who attended to me prescribed the same medications I was taking at home, did he think I liked going to the ER for a walk? While I was in the medication room, I asked the person responsible for the PS, and nurse Bruna came to assist me. I informed him what was happening and he immediately took action. He transferred my care to a surgeon to analyze me, transferred me to a private place to receive the new prescribed medications, in short, he did everything possible to make my impression change. The problem is that I wouldn't have needed to complain to receive the service that should have been offered. I was extremely disappointed with BP Mirante, as it was not what I expected for this service.

Clean and sophisticated hospital, sympathic and skilled people and doctors English speaking doctors Very good experience Recommend 100%

Don't go there if you don't have a brazilian plan, they will force you to pay for unnecessary insurance that is 3x the normal price.

Stellar. professional, humaine, attentive, caring and loving. My mother was admitted 3 times and used the hospital almost daily after discharged. From the valet parking to the doctors, cleaning to nursing staff, everyone was efficient albeit friendly.

The structure of the building is good, but the service is lacking. In the office building there is no air conditioning and it is 35ºC hot. It is absurd that a private hospital environment does not have a decent structure to serve its clients!

I underwent a total thyroidectomy surgery on 08/17 and I was very well taken care of, from the time I arrived until I left (08/18). I would like to thank the entire team of Dr. Reginaldo Fujita, all the nurses and doctors in the recovery sector and all the nurses, physiotherapists and other employees in the hospitalization sector, for their love, care and patience. The structure of the hospital is wonderful (bedroom, operating room, recovery room)!!! My only complaint is about parking…..absurdly expensive. My mother paid 122.00 to stay 1 day with me!

I had septum surgery at this hospital and it went smoothly. Nurse Roberto took care of me with care. I stayed in room 509 where everything was organized and clean. Dr. Moacir's surgical team is very careful.

Being in the medical field for 40 years world wide Absolutely the Best Hospital overall I have ever visited! Facilities A+ Staff A+ Communication A+ Value A+

Excellent. Both our daughters were born here and care was absolutely great. Thanks. :)

Excellent in every measure. Was admitted for an emergency surgery and they diagnosed other ailments that needed emergency care. All the staff at the hospital are the best trained and competent I've seen. I owe my life to them.

I'm amazed by the outstanding service we're receiving here, from the entire staff and doctors at every stage. Despite its simplicity, hygiene is a top priority everywhere, and both doctors and nurses have displayed not only humility but also a profound understanding of their fields. They have been readily available to explain all the details that might be important for our peace of mind, with patience and zero condescendence. The interior design of the entrance is exceptional and is worth a quick visit, even if you're not here to use the hospital facilities.

I'm amazed by the outstanding service we're receiving here, from the entire staff and doctors at every stage. Despite its simplicity, hygiene is a top priority everywhere, and both doctors and nurses have displayed not only humility but also a profound understanding of their fields. They have been readily available to explain all the details that might be important for our peace of mind, with patience and zero condescendence. The interior design of the entrance is exceptional and is worth a quick visit, even if you're not here to use the hospital facilities.

One of the best hospitals even been in, from the reception to the surgery room. Very well organized, punctual, super clean rooms, respectful staff, and great doctors. They have well preserved the mission of Santa Catarina, since 548 A.D.