array:23 [
  "pii" => "S2254887419301936"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2019.08.004"
  "estado" => "S300"
  "fechaPublicacion" => "2020-01-01"
  "aid" => "1723"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Rev Clin Esp. 2020;220:78-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256519302218"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2019.08.003"
      "estado" => "S300"
      "fechaPublicacion" => "2020-01-01"
      "aid" => "1723"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Rev Clin Esp. 2020;220:77-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 82
        "formatos" => array:2 [
          "HTML" => 48
          "PDF" => 34
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">CORRESPONDENCIA</span>"
        "titulo" => "V&#237;a cl&#237;nica para reducir la inserci&#243;n de sondas de alimentaci&#243;n en pacientes con demencia avanzada"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "77"
            "paginaFinal" => "78"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Clinical pathway to reduce feeding tube insertions in patients with advanced dementia"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "F&#46;J&#46; Mena-Mart&#237;n, M&#46;M&#46; Cobos-Siles, P&#46; Cubero-Morais, I&#46; Arroyo Jim&#233;nez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "F&#46;J&#46;"
                "apellidos" => "Mena-Mart&#237;n"
              ]
              1 => array:2 [
                "nombre" => "M&#46;M&#46;"
                "apellidos" => "Cobos-Siles"
              ]
              2 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Cubero-Morais"
              ]
              3 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Arroyo Jim&#233;nez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887419301936"
          "doi" => "10.1016/j.rceng.2019.08.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301936?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519302218?idApp=WRCEE"
      "url" => "/00142565/0000022000000001/v1_202001221235/S0014256519302218/v1_202001221235/es/main.assets"
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887419301791"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2019.07.005"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1711"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Rev Clin Esp. 2020;220:76-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
      "titulo" => "Metformin-induced lactic acidosis&#58; should we be more careful with renal dysfunction&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "76"
          "paginaFinal" => "77"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidosis l&#225;ctica por metformina&#58; &#191;debemos ser m&#225;s cautelosos con la disfunci&#243;n renal&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;L&#46; Blanco Taboada, J&#46; Castilla Y&#233;lamos, S&#46; Delgado Romero, J&#46;L&#46; Garc&#237;a Garmendia"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "A&#46;L&#46;"
              "apellidos" => "Blanco Taboada"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Castilla Y&#233;lamos"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Delgado Romero"
            ]
            3 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Garc&#237;a Garmendia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256519301961"
        "doi" => "10.1016/j.rce.2019.07.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301961?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301791?idApp=WRCEE"
    "url" => "/22548874/0000022000000001/v1_202002130124/S2254887419301791/v1_202002130124/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>"
    "titulo" => "Clinical pathway to reduce feeding tube insertions in patients with advanced dementia"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "78"
        "paginaFinal" => "79"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "F&#46;J&#46; Mena-Mart&#237;n, M&#46;M&#46; Cobos-Siles, P&#46; Cubero-Morais, I&#46; Arroyo Jim&#233;nez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "F&#46;J&#46;"
            "apellidos" => "Mena-Mart&#237;n"
            "email" => array:1 [
              0 => "fmenama@saludcastillayleon.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "M&#46;M&#46;"
            "apellidos" => "Cobos-Siles"
          ]
          2 => array:2 [
            "nombre" => "P&#46;"
            "apellidos" => "Cubero-Morais"
          ]
          3 => array:2 [
            "nombre" => "I&#46;"
            "apellidos" => "Arroyo Jim&#233;nez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario R&#237;o Hortega&#44; Valladolid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "V&#237;a cl&#237;nica para reducir la inserci&#243;n de sondas de alimentaci&#243;n en pacientes con demencia avanzada"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In our daily practice&#44; advanced dementia is still one of the main reasons for inserting a nasogastric or gastrostomy tube &#40;percutaneous endoscopic gastrostomy &#91;PEG&#93;&#41; for enteral nutrition &#40;EN&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; a 2009 Cochrane review revealed the lack of benefit of EN in these patients in terms of survival&#44; nutritional state and the prevalence of pressure ulcers and aspiration pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the last 10 years&#44; numerous scientific societies have published recommendations opposing this futile therapeutic measure&#44; in the context of initiatives such as <span class="elsevierStyleItalic">Choosing Wisely</span> in the United States and Canada&#44; the National Institute for Health and Care Excellence recommendations in the United Kingdom and the &#8220;Inadvisable Practices&#8221; in Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In June 2017&#44; our hospital launched a clinical pathway for reducing the insertion of feeding tubes in patients with advanced dementia&#44; an approach agreed upon by primary and specialized care&#46; To this end and on the initiative of the internal medicine department&#44; several clinical sessions were conducted with the most directly involved departments&#44; as well as another general hospital session&#44; all as part of the &#8220;Inadvisable Practices&#8221; recommendations promoted by the Spanish Ministry of Health&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We then retrospectively analyzed the discharge reports of all patients hospitalized at our center who were diagnosed with dementia &#40;472 in the second semester of 2015 and 452 for the same period in 2017&#41;&#46; We collected their demographic characteristics&#44; comorbidity and type of feeding at discharge &#40;oral&#44; nasogastric or gastrostomy&#41;&#46; We defined advanced dementia as stage 7 of the Global Deterioration Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patients with each type of EN for both periods and the significance levels with Fisher&#8217;s exact test&#44; showing the high degree of compliance with the recommendations indicated in the clinical pathway&#46; The high degree of multidisciplinary consensus in preparing these recommendations was the key element in achieving these results&#46; &#8220;Therapeutic inertia&#8221; in managing dysphagia in patients with advanced dementia has changed&#44; although it is possible that the decreased use of tubes in hospitals will entail an increase in the use of tubes in geriatric centers&#44; which would require the implementation of other strategies&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">According to the United Nations&#44; there were 24 million individuals with dementia worldwide in 2001&#59; by 2040&#44; the number is expected to increase to 81 million&#44; due in large measure to the increased life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the population 85 years or older&#44; almost 50&#37; present chronic cognitive impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> For many patients with advanced dementia&#44; feeding problems are the most common complication&#44; affecting more than 85&#37; of such patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> For their family members&#44; the decision to start enteral feeding is affected by complex bioethical issues&#44; although they are typically aware of the natural and irreversible disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A study on a cohort of institutionalized patients with advanced dementia estimated that 6-month mortality was 25&#37; and that mean survival was 1&#46;3 years&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> similar figures to that of other diseases with poor prognoses &#40;e&#46;g&#46;&#44; numerous cancers and functional class IV heart failure&#41;&#46; In this respect&#44; our role as health professionals should be to inform patients and their families as soon as possible as to the manifestations that will appear in the advanced phase of dementia and what the best scientific evidence recommends&#46; These recommendations should always be presented with the utmost respect for the previous instructions expressed by the patient or by their family acting as representatives&#46; In the US&#44; however&#44; 15&#37; of internists who treat this type of patient are unaware that inserting feeding tubes is associated with agitation&#44; 38&#37; are unaware of the scientific societies&#8217; recommendations on this subject&#44; and 63&#37; stated that the family requested inserting a PEG against the physician&#8217;s recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain&#44; the &#8220;Assistive Document for Decision Making in Managing Patients with Advanced Dementia&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> written in 2008 by the Andalusian Society of Internal Medicine&#44; recommended that&#44; given the lack of scientific evidence to justify EN for these patients&#44; healthcare practitioners should not promote the use of EN for these patients&#46; In the &#8220;Commitment for Quality by the Scientific Societies&#8221;&#44; the Spanish Society of Geriatric Medicine and the Spanish Society of Geriatrics and Gerontology have since 2016 included the recommendation to &#8220;<span class="elsevierStyleItalic">not indicate nasogastric or percutaneous gastrostomy tubes for patients with advanced phase dementia</span>&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> a recommendation that will surely be progressively implemented in clinical practice in the coming years&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mena-Mart&#237;n FJ&#44; Cobos-Siles MM&#44; Cubero-Morais P&#44; Arroyo Jim&#233;nez I&#46; V&#237;a cl&#237;nica para reducir la inserci&#243;n de sondas de alimentaci&#243;n en pacientes con demencia avanzada&#46; Rev Clin Esp&#46; 2020&#59;220&#58;77&#8211;78&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The data show the absolute number of patients&#44; with the percentage between parentheses&#46; The right column shows the level of statistical significance when comparing the percentages of the 2 study periods&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; EN&#44; enteral nutrition&#44; NGT&#44; nasogastric tube&#44; PEG&#44; percutaneous endoscopic gastrostomy&#46;</p>"
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results before the intervention&#58; Second semester of 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results after the intervention&#58; Second semester of 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients for whom EN by NGT was started during the hospitalization&#47;total number of discharges with dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;472 &#40;1&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;452 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;0031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients for whom EN by PEG was started during the hospitalization&#47;total number of discharges with dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;472 &#40;2&#46;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;452 &#40;0&#46;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with dementia for whom EN was started during the hospitalization&#47;total number of discharges with dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;472 &#40;3&#46;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;452 &#40;0&#46;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total number of patients with dementia and EN at discharge&#47;total number of discharges with dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#47;472 &#40;7&#46;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;452 &#40;3&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2237775.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hospital discharges of patients with dementia&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous feeding tubes in individuals with advanced dementia&#58; Are physicians &#8220;Choosing Wisely&#8221;&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Gieniusz"
                            1 => "L&#46; Sinvani"
                            2 => "A&#46; Kozikowski"
                            3 => "V&#46; Patel"
                            4 => "C&#46; Nouryan"
                            5 => "M&#46;S&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.15125"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2018"
                        "volumen" => "66"
                        "paginaInicial" => "64"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28975616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enteral tube feeding for older people with advanced dementia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Sampson"
                            1 => "B&#46; Candy"
                            2 => "L&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD007209.pub2"
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26884379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American geriatrics society feeding tubes in advanced dementia position statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12924"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "1590"
                        "paginaFinal" => "1593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25039796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Compromiso por la calidad de las sociedades cient&#237;ficas en Espa&#732;na &#91;consultado 25 Ago 2019&#93;&#46; Disponible en&#58; <a target="_blank" href="http://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/cal_sscc.htm">http&#58;&#47;&#47;www&#46;mscbs&#46;gob&#46;es&#47;organizacion&#47;sns&#47;planCalidadSNS&#47;cal&#95;sscc&#46;htm</a>&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Documento de ayuda a la toma de decisiones en el manejo de pacientes con demencia avanzada &#91;consultado 25 Ago 2019&#93;&#46; Disponible en&#58; <a target="_blank" href="https://sademi.com/documento-de-ayuda-a-latoma-de-decisiones-en-el-manejo-de-pacientes-con-demenciaavanzada/">https&#58;&#47;&#47;sademi&#46;com&#47;documento-de-ayuda-a-latoma-de-decisiones-en-el-manejo-de-pacientes-con-demenciaavanzada&#47;</a>&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Grupo de trabajo de la Gu&#237;a de Pr&#225;ctica Cl&#237;nica sobre la atenci&#243;n integral a las personas con enfermedad de Alzheimer y otras demencias&#46; Gu&#237;a de Pr&#225;ctica Cl&#237;nica sobre la atenci&#243;n integral a las personas con enfermedad de Alzheimer y otras demencias&#46; Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad&#44; Pol&#237;tica Social e Igualdad&#46; Ag&#232;ncia d&#180;Informaci&#243;&#44; Avaluaci&#243; i Qualitat en Salut de Catalu&#732;na&#59; 2010&#46; Gu&#237;as de Pr&#225;ctica Cl&#237;nica en el SNS&#58; AIAQS N&#250;m&#46; 2009&#47;07&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical course of advanced dementia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Mitchell"
                            1 => "J&#46;M&#46; Teno"
                            2 => "D&#46;K&#46; Kiely"
                            3 => "M&#46;L&#46; Shaffer"
                            4 => "R&#46;N&#46; Jones"
                            5 => "H&#46;G&#46; Prigerson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0902234"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1529"
                        "paginaFinal" => "1538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19828530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022000000001/v1_202002130124/S2254887419301936/v1_202002130124/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "71813"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Correspondence"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000001/v1_202002130124/S2254887419301936/v1_202002130124/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301936?idApp=WRCEE"
]
Share
Journal Information
Share
Share
Download PDF
More article options
Correspondence
Clinical pathway to reduce feeding tube insertions in patients with advanced dementia
Vía clínica para reducir la inserción de sondas de alimentación en pacientes con demencia avanzada
F.J. Mena-Martín
Corresponding author
fmenama@saludcastillayleon.es

Corresponding author.
, M.M. Cobos-Siles, P. Cubero-Morais, I. Arroyo Jiménez
Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain

Purchase article

For the purchase of this article it is necessary to fill in the following form:

Afganistan
Albania
Alemania
Andorra
Angola
Anguilla
Antartica
Antigua and barbuda
Antillas holandesas
Arabia saudita
Argelia
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgica
Belice
Benin
Bermudas/antillas britanicas
Bhutan
Bolivia
Bosnia y herzegowina
Botswana
Brasil
Brunei darussalam
Bulgaria
Burkina faso
Burundi
Cabo verde
Camboya
Camerun
Canada
Chad
Chile
China
Chipre
Colombia
Comoros
Corea
Costa rica
Cote d´ivoire
Croacia
Cuba
Dinamarca
Djibouti
Dominica
East timor
Ecuador
Egipto
El salvador
Emiratos arabes unidos
Eritrea
Escocia
Eslovaquia
Eslovenia
España
Estados federados de micronesia
Estados unidos
Estonia
Etiopia
Fiji
Filipinas
Finlandia
Francia
Gabon
Gambia
Georgia
Ghana
Gibraltar
Grecia
Grenada
Groenlandia
Guadalupe
Guam
Guatemala
Guayana britanica
Guinea
Guinea ecuatorial
Guinea francesa
Guinea-bissau
Haiti
Holanda
Honduras
Hong kong
Hungria
India
Indonesia
Irak
Iran
Irlanda
Isla bouvet
Isla cocos (keeling)
Isla cook
Isla mauricio
Isla navidad
Isla norfolk
Islandia
Islas caiman
Islas falkland (malvinas)
Islas faroe
Islas georgia del sur y sandwich
Islas heard and mc donald
Islas marshall
Islas northern mariana
Islas salomon
Islas svalbard and jan mayen
Islas turks and caicos
Islas united states minor outlyi
Islas virgenes (britanicas)
Islas virgenes (u.s.a.)
Islas wallis and futuna
Israel
Italia
Jamaica
Japon
Jordania
Kazakhstan
Kenia
Kiribati
Kuwait
Kyrgyzstan
Lesoto
Letonia
Libano
Liberia
Libia arab jamahiriya
Liechtenstein
Lituania
Luxemburgo
Macao
Macedonia
Madagascar
Malasia
Malawi
Maldives
Mali
Malta
Marruecos
Martinica
Mauritania
Mayotte
Mexico
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Niger
Nigeria
Niue
Noruega
Nueva caledonia
Nueva zelanda
Oman
Pakistan
Palau
Panama
Papua new guinea
Paraguay
Peru
Pitcairn
Polinesia francesa
Polonia
Portugal
Posesiones gran bretaña
Posesiones u.s.a.
Puerto rico
Qatar
Reino unido
Republica checa
Republica de africa central
Republica de cabo verde
Republica de congo
Republica de corea
Republica de moldova
Republica democratica de laos
Republica democratica del congo
Republica dominicana
Reunion
Ruanda
Rumania
Rusia
Sahara occidental
Saint kitts and nevis
Samoa
Samoa americana
San marino
San tomas y principe
San vincent and the grenadines
Santa lucia
Senegal
Serbia
Seychelles
Sierra leona
Singapur
Siria
Somalia
Sri lanka
St. helena
St. pierre and miquelon
Sudafrica
Sudan
Suecia
Suiza
Surinam
Swaziland
Tailandia
Taiwan republica de china
Tajikistan
Tanzania
Territorio de indias britanicas
Togo
Tokelau
Tonga
Trinidad and tobago
Tunisia
Turkmenistan
Turquia
Tuvalu
Ucrania
Uganda
Uruguay
Uzbekistan
Vanuatu
Vaticano
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbawe
Lebanon
Paises bajos
A coruña
Alava
Albacete
Alicante
Almeria
Asturias
Avila
Badajoz
Balears
Barcelona
Bizkaia
Burgos
Caceres
Cadiz
Cantabria
Castellon
Ceuta
Ciudad real
Cordoba
Cuenca
Girona
Granada
Guadalajara
Guipuzcoa
Huelva
Huesca
Jaen
La rioja
Las palmas
Leon
Lleida
Lugo
Madrid
Malaga
Melilla
Murcia
Navarra
Ourense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Tarragona
Tenerife
Teruel
Toledo
Valencia
Valladolid
Zamora
Zaragoza
-- Not applicable --
I accept to receive information about Elsevier's special products and promotions by email
I accept to receive information about products and special promotions from Elsevier partners by email
I have read and understand the Privacy Policy and Terms and conditions and agree to be bound by all of its terms.
* Required fields
In addition to temporary access to the article, it will be sent by email.
Customer Support
Phone
Calls from Spain
932 415 960
Calls from abroad
+34 932 415 960
Hours from 9 a.m. to 6 p.m. except the months of July and August, which will be from 9 am to 3 pm.
Idiomas
Revista Clínica Española (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?