array:24 [
  "pii" => "S2254887419301250"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2019.04.004"
  "estado" => "S300"
  "fechaPublicacion" => "2020-01-01"
  "aid" => "1669"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "rev"
  "cita" => "Rev Clin Esp. 2020;220:49-56"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256519301109"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2019.04.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-01-01"
      "aid" => "1669"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "rev"
      "cita" => "Rev Clin Esp. 2020;220:49-56"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 132
        "formatos" => array:2 [
          "HTML" => 67
          "PDF" => 65
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "Ecograf&#237;a cl&#237;nica en el proceso de toma de decisiones en medicina"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "49"
            "paginaFinal" => "56"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Clinical ultrasonography in the decision-making process in medicine point-of-care ultrasound in clinical decision making"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1150
                "Ancho" => 2083
                "Tamanyo" => 116311
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Proceso de toma de decisiones en medicina&#46; El punto m&#225;s importante es la adquisici&#243;n de la informaci&#243;n que se basa en la historia cl&#237;nica &#40;anamnesis y exploraci&#243;n f&#237;sica cl&#225;sica&#41;&#46; Posteriormente el cl&#237;nico decide si es necesario solicitar pruebas complementarias adicionales para confirmar las sospechas diagn&#243;sticas&#44; interpreta toda la informaci&#243;n obtenida e idea un plan de acci&#243;n &#40;tratamiento&#41;&#46; Finalmente valora los resultados&#46; La ecograf&#237;a puede apoyar al m&#233;dico en todo el proceso ya que complementa la exploraci&#243;n f&#237;sica&#44; es en s&#237; una prueba complementaria y facilita la monitorizaci&#243;n y el seguimiento del enfermo&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "G&#46; Garc&#237;a de Casasola, I&#46; Casado L&#243;pez, J&#46; Torres-Macho"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Garc&#237;a de Casasola"
              ]
              1 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Casado L&#243;pez"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Torres-Macho"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887419301250"
          "doi" => "10.1016/j.rceng.2019.04.004"
          "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/S2254887419301250?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301109?idApp=WRCEE"
      "url" => "/00142565/0000022000000001/v1_202001221235/S0014256519301109/v1_202001221235/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887418301966"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2018.12.002"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1580"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "rev"
    "cita" => "Rev Clin Esp. 2020;220:57-68"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3
      "formatos" => array:2 [
        "HTML" => 1
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Update on postprandial hyperglycemia&#58; The pathophysiology&#44; prevalence&#44; consequences and implications of treating diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "57"
          "paginaFinal" => "68"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Actualizaci&#243;n sobre hiperglucemia posprandial&#58; fisiopatolog&#237;a&#44; prevalencia&#44; consecuencias e implicaciones para el tratamiento de la diabetes"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1248
              "Ancho" => 1495
              "Tamanyo" => 103237
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Relative contribution &#40;&#37;&#41; of baseline and postprandial hyperglycemia according to the HbA1c level&#46; Modified from Monnier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">3</span></a></p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46;J&#46; Pin&#233;s Corrales, V&#46; Bellido Casta&#241;eda, F&#46;J&#46; Ampudia-Blasco"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "P&#46;J&#46;"
              "apellidos" => "Pin&#233;s Corrales"
            ]
            1 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Bellido Casta&#241;eda"
            ]
            2 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Ampudia-Blasco"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256518302558"
        "doi" => "10.1016/j.rce.2018.06.015"
        "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/S0014256518302558?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301966?idApp=WRCEE"
    "url" => "/22548874/0000022000000001/v1_202002130124/S2254887418301966/v1_202002130124/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887419302152"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2019.06.010"
    "estado" => "S300"
    "fechaPublicacion" => "2020-01-01"
    "aid" => "1735"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2020;220:43-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
      "titulo" => "Iron and heart failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "43"
          "paginaFinal" => "48"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hierro e insuficiencia cardiaca"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1782
              "Ancho" => 2167
              "Tamanyo" => 167018
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Selection and identification of patients who would benefit the most from intravenous iron according to the meta-analysis by Anker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> Results related to readmissions for cardiovascular cause and mortality of patients with irony deficiency treated with intravenous iron&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; Ferrit&#44; ferritin &#40;expressed in ng&#47;mL&#41;&#59; TSAT&#44; transferrin saturation&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; de las Nieves L&#243;pez"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "de las Nieves L&#243;pez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256519302346"
        "doi" => "10.1016/j.rce.2019.06.011"
        "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/S0014256519302346?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302152?idApp=WRCEE"
    "url" => "/22548874/0000022000000001/v1_202002130124/S2254887419302152/v1_202002130124/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Clinical ultrasonography in the decision-making process in medicine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "49"
        "paginaFinal" => "56"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "G&#46; Garc&#237;a de Casasola, I&#46; Casado L&#243;pez, J&#46; Torres-Macho"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Garc&#237;a de Casasola"
            "email" => array:1 [
              0 => "ggcasasolaster@gmail.com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Casado L&#243;pez"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Torres-Macho"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Infanta Cristina&#44; Parla&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Medicina&#44; Facultad de Medicina&#44; Universidad Complutense de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Grupo de Trabajo de Ecograf&#237;a Cl&#237;nica&#44; Sociedad Espa&#241;ola de Medicina Interna&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ecograf&#237;a cl&#237;nica en el proceso de toma de decisiones en medicina"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2255
            "Ancho" => 2500
            "Tamanyo" => 228742
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary ultrasonography&#46; The technique is simple&#58; posterior&#44; anterior and lateral face sweeps of both lungs&#46; 1&#46; Normal lung&#58; characterized by the presence of A-lines&#46; 2&#46; Interstitial pattern&#58; characterized by the presence of B-lines&#46; 3&#46; Pulmonary condensation &#40;pneumonia&#41;&#46; 4&#46; Pleural effusion&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Significant technological advances in recent years have led to the development of high-quality&#44; relatively affordable ultrasound systems&#44; many of which are portable&#44; thereby enabling their widespread use&#46; Ultrasonography has therefore become an important imaging test in numerous medical specialties &#40;anesthesia&#44; intensive care&#44; dermatology&#44; rheumatology&#44; pediatrics&#44; nephrology&#44; neurology&#44; pneumology&#44; trauma&#44; urology&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the field of internal medicine and primary care&#44; the incorporation of ultrasonography in clinical practice is likely the most significant technological advance in the past century&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Concept of clinical ultrasonography</span><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical ultrasonography can be defined as an ultrasound examination performed by the physician directly responsible for the patient&#44; in other words&#44; by the physician who reviewed the medical history and who is most responsible for the patient&#39;s diagnostic and therapeutic process&#46; This situation represents an added value in terms of regulated examinations performed in the central departments &#40;e&#46;g&#46;&#44; radiology&#44; cardiology&#41; in which clinical information on the patient is limited&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In clinical ultrasonography&#44; it is essential that the examination be performed at the patient&#39;s bedside &#40;&#8220;point-of-care ultrasound&#8221;&#41;&#44; thereby avoiding displacing the patient to locations where the ultrasound is located&#44; as happens in the central departments&#46; This ability is an advantage for the patient&#44; especially if they are unstable&#46; Another relevant characteristic of clinical ultrasonography is that it can be repeated as often as the physician considers it necessary&#46; They can thereby monitor disease progression in numerous scenarios &#40;e&#46;g&#46;&#44; pulmonary congestion and pleural effusion in heart failure or in patients with volume overload&#44; ascites&#44; pericardial effusion&#44; pneumonic condensation&#44; etc&#46;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly&#44; one of the key elements of clinical ultrasonography is the selection&#44; within the complex world of ultrasonography&#44; of simple procedures and examinations that have high clinical cost-effectiveness &#40;utility&#41;&#46; Thus&#44; given the difficulties of assessing the abdomen with ultrasonography&#44; the characterization and diagnosis of hepatic and renal tumors can be truly complex and should be reserved for regulated ultrasonography in the central departments&#46; However&#44; detecting free fluid within the abdomen and diagnosing acute urine retention are easy procedures and are with the reach of any clinician with basic ultrasound training&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Decision-making process in medicine</span><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows a schematic of the diagnostic and decision-making process in medicine&#44; which is performed sequentially&#46; The first step is the most important and consists of collecting information regarding the patient&#46; To this end&#44; clinicians perform the anamnesis and physical examination&#46; Depending on the information obtained&#44; a number of diagnostic possibilities &#40;differential diagnosis&#41; are established and the likelihood of each &#40;pretest probability&#41; is mentally assigned&#46; In the second step&#44; the necessary complementary tests &#40;blood tests&#44; imaging studies&#44; endoscopies&#44; etc&#46;&#41; are chosen to confirm the suspected diagnosis&#46; The cost-effectiveness of complementary tests is directly linked to the diagnostic probability before performing the tests&#46; It is therefore essential to perform the first step &#40;collecting information regarding the patient&#41; as best as possible&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">After learning the results of the complementary tests&#44; clinicians interpret the available data&#44; establish the diagnosis and plan the most appropriate treatment&#46; They then monitor and follow-up the patient&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Unfortunately&#44; errors are often made during this process&#46; A number of studies have shown that 14&#37; of medical errors are related to incorrect diagnoses or the omission of the diagnosis&#44; generally due to an incomplete or deficient anamnesis and physical examination&#46; Obviously&#44; this type of error is potentially avoidable&#46; In the United States&#44; it is estimated that approximately 35&#44;000 patients die every year due to errors or omissions in the diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;3</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The classical physical examination and its limitations</span><p id="par0045" class="elsevierStylePara elsevierViewall">The classical physical examination&#44; based on the inspection&#44; palpation&#44; percussion and auscultation of various organs&#44; can be considered a diagnostic test whose accuracy varies significantly depending on the physician&#39;s ability and the patient&#39;s characteristics&#46; However&#44; due to enormous technological advances in recent decades&#44; practitioners&#8217; interest and expertise in performing physical examinations have declined substantially&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A hundred years ago&#44; most diseases were diagnosed based on the detection of certain signs and symptoms without any type of complementary test&#46; Currently&#44; the diagnosis of numerous processes rests mainly on laboratory and imaging tests&#46; Due to the increased availability and accessibility of these tests&#44; the physical examination has for many physicians been relegated to a secondary level&#46; Nevertheless&#44; there are many diseases &#40;cellulitis&#44; psoriasis&#44; amyotrophic lateral sclerosis&#44; Parkinson&#39;s disease&#44; Bell&#39;s palsy&#44; etc&#46;&#41; whose diagnosis is based exclusively on the classical physical examination&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the importance of the physical examination&#44; we need to be aware of its limitations&#46; Although the distance between the border of the liver and the costal margin can be palpated and measured&#44; this assessment has a poor correlation with increased liver size&#46; This situation is similar with the spleen&#46; It is relatively easy to palpate very large spleens &#40;&#62;20<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; but the sensitivity for detecting splenomegalies of 13&#8211;18<span class="elsevierStyleHsp" style=""></span>cm is very low &#40;clearly &#60;50&#37; in numerous series&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#8211;6</span></a> In terms of aorta abdominal aneurysms&#44; if their size is &#62;5<span class="elsevierStyleHsp" style=""></span>cm&#44; the sensitivity for detecting the aneurysm using palpation can reach 80&#37;&#59; however&#44; if its size is between 3 and 5<span class="elsevierStyleHsp" style=""></span>cm and especially if the patient has excess weight&#44; the effectiveness drops significantly&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a> The bladder can only be detected &#40;through percussion or palpation&#41; when it contains more than 500<span class="elsevierStyleHsp" style=""></span>mL of urine&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> When the ascites is &#60;1000<span class="elsevierStyleHsp" style=""></span>mL&#44; it is virtually impossible to detect it through the physical examination&#46; The sensitivity will significantly increase only if it exceeds 2000<span class="elsevierStyleHsp" style=""></span>mL&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">8</span></a> Estimating the central venous pressure by inspecting the jugular vein&#44; one of the paradigms of the cardiovascular physical examination&#44; is difficult to perform accurately in many patients&#44; even for expert clinicians&#44; for numerous reasons &#40;obesity&#44; short neck&#44; lack of cooperation&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">9</span></a> With regard to cardiac auscultation&#44; expert cardiologists can correctly identify 60&#37; of systolic murmurs but only 16&#37; of diastolic murmurs&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinical ultrasonography as a supplement to physical examinations</span><p id="par0060" class="elsevierStylePara elsevierViewall">Numerous studies have irrefutably shown that clinical ultrasonography improves the diagnostic yield of physical examinations&#44; Which is especially apparent in cardiovascular physical examinations&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">10&#44;11</span></a> In addition&#44; a long training period is not required for certain objectives&#46; Even medical students with basic ultrasonography training can substantially improve their diagnostic capacity compared with the physical examinations conducted by expert physicians&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">10&#44;12</span></a> Specifically&#44; ultrasonography has noteworthy reliability in diagnosing cardiac valve lesions&#44; estimating central venous pressure&#44; detecting pleural and pericardial effusion and free abdominal fluid and diagnosing splenomegaly and acute urine retention&#44; to name just a few examples&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical ultrasonography does not replace the classical physical examination but rather complements it&#46; For example&#44; pulmonary ultrasonography is an excellent tool for detecting interstitial lesions &#40;cardiogenic and noncardiogenic pulmonary edema&#44; pulmonary fibrosis&#41;&#44; alveolar consolidations &#40;pneumonia&#41;&#44; pneumothorax and pleural effusion&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">15&#8211;17</span></a> However&#44; pulmonary ultrasonography is unable to detect the presence of rhonchi and wheezing in a patient with asthma or chronic obstructive pulmonary disease&#46; In expert hands&#44; pulmonary ultrasonography can provide a diagnostic yield greater than even chest radiography for diagnosing pneumonia<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a>&#59; however&#44; an extensive swept of the lung fields needs to be performed to achieve this yield&#46; A prior pulmonary auscultation can direct clinicians toward choosing lung areas where the pulmonary consolidation is most likely to be detected and thus where to place the ultrasound probe&#46; In contrast&#44; an abnormal pulmonary auscultation&#44; as happens with the bases of many elderly patients&#44; can lead to the suspicion of underlying lung disease&#44; and pulmonary ultrasonography can help rule it out&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">It is apparent that echocardiography is clearly superior to cardiac auscultation for detecting cardiac valve lesions&#46; Nevertheless&#44; when middle to low-end portable scanners are employed or when the patient&#39;s window is deficient&#44; it can be difficult to observe significant valvular heart disease&#46; In contrast&#44; cardiac auscultation has more than acceptable sensitivity for detecting an aortic stricture or significant mitral regurgitation &#40;systolic murmurs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In short&#44; classical cardiac and pulmonary physical examinations are still of considerable usefulness even when ultrasonography equipment is available&#44; and when we have adequate training to use them properly&#46; Clinical ultrasonography &#40;insonation&#41; can help implement a more effective form of physical examination&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Multiorgan clinical ultrasonography</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Focused Assessment with Sonography in Trauma &#40;FAST&#41; protocol is a basic examination within the emergency ultrasonography setting and might have been the inspiration for clinical ultrasonography &#40;point-of-care ultrasound&#41; as it is currently understood&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The objective of the FAST protocol is to detect free fluid in the abdominal cavity in the context of abdominal trauma and has replaced diagnostic peritoneal flushing as the alternative method for abdominal computed tomography&#46; Since the 1970s&#44; several teams of surgeons in Germany and Japan have reported the ultrasound findings of patients with free peritoneal fluid&#46; In the mid 1990s&#44; the technique was protocolized and its use extended thanks to the availability of portable systems&#46; Shortly thereafter&#44; the subxiphoid plane was added to the 3 basic abdominal layers of the FAST protocol to visual the heart&#46; Slices in the posterior-inferior region of the chest were also added to rule out hemopericardium and hemothorax&#46; This addition led to the so-called extended FAST protocol &#40;eFAST&#41;&#46; The eFAST protocol is a form of multiorgan clinical ultrasonography because it assesses the heart&#44; lungs and abdomen&#44; although highly concisely and with highly specific objectives&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Both in emergency departments and intensive care units&#44; clinical ultrasonography should be performed quickly and limiting the examination to basic layers that help establish a diagnostic approach to specific medical problems&#44; especially when assessing gravely ill or unstable patients&#46; To diagnose certain symptoms and signs&#44; such as hypotension-shock and dyspnea&#44; ultrasonography needs to be performed on several organs and systems in a structured manner&#46; In recent years&#44; numerous protocols have been proposed &#40;RUSH&#44; RUSH-VTI&#44; SHoC&#44; BLUE&#44; FALLS&#44; FEEL&#44; FEER&#44; SEARCH 8Es&#44; LuCUS&#44; LCI&#44; FATE&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#8211;30</span></a> Most of these protocols are based on performing basic planes at the pulmonary&#44; cardiac and&#44; occasionally&#44; abdominal level &#40;especially when assessing the inferior vena cava and abdominal aorta&#41;&#46; Thanks to studies based on these protocols&#44; the use of multiorgan clinical ultrasonography has been widespread and popularized&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Interestingly&#44; multiorgan ultrasonography is an aspect of ultrasound that has no &#8220;owner&#8221; because it is outside the sphere of regulated ultrasounds that are performed in the central departments such as radiology and cardiology&#46; Pulmonary ultrasonography&#44; a fundamental technique in a number of the protocols mentioned earlier&#44; is not generally employed currently by a significant percentage of radiologists and cardiologists&#46; Multiorgan ultrasonography is a tool that is almost exclusively employed by physicians who require a comprehensive patient assessment &#40;internists&#44; family physicians&#44; intensivists&#44; emergency physicians&#44; geriatricians&#44; pediatricians&#44; nephrologists&#44; etc&#46;&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Systemization of multiorgan clinical ultrasonography in internal medicine</span><p id="par0100" class="elsevierStylePara elsevierViewall">One of the objectives of clinical ultrasonography is to supplement the classical physical examination to improve its cost-effectiveness&#46; Just as physical examinations are suitably regulated and standardized and should be performed systematically to assess all patients&#44; so should clinical ultrasonography&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There is currently no consensus specifying how systematic ultrasound examinations should be performed to supplement the classical physical examination&#46; Studies have very recently begun to assess the usefulness of standardized multiorgan clinical ultrasonography for patients who are not critically ill &#40;hemodynamically stable&#41;&#44; regardless of the reason for the consultation&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">31&#44;32</span></a> For patients with chest pain and fever&#44; a pulmonary ultrasound can be very useful &#40;after conducting an anamnesis and physical examination&#41; for determining whether there is a consolidation and the possibility of associated pleural effusion&#46; However&#44; it might be more efficient to complete the lung-focused ultrasonography with ultrasonography of other organs &#40;heart&#44; abdomen&#41; to detect other abnormalities &#40;significant heart disease&#44; abdominal aortic aneurysm&#44; acute urine retention&#44; etc&#46;&#41;&#44; which can also be clinically important&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We propose a multiorgan ultrasound examination with selected basic planes of the lungs&#44; heart and abdomen&#44; which should be performed at the same time as the anamnesis and physical examination&#46; The diagnostic yield of selected ultrasound images has been demonstrated in numerous studies&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Pulmonary ultrasonography</span><p id="par0115" class="elsevierStylePara elsevierViewall">Pulmonary ultrasonography is a simple technique and can be performed with any type of probe&#44; both high and low frequency&#46; As with the stethoscope in auscultation&#44; a sweep with the transducer should be performed on both lungs &#40;anterior&#44; lateral and posterior faces&#41;&#46; If the patient&#39;s clinical condition permits&#44; the examination should ideally be performed in the sitting position&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> Pulmonary ultrasonography is excellent for diagnosing pleural effusion&#44; condensation &#40;pneumonia&#44; tumors&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a> pneumothorax<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a> and interstitial disease &#40;heart failure&#44; pulmonary fibrosis&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">35</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">For patients with diffuse interstitial disease&#44; a full pulmonary sweep is often not required&#46; A craniocaudal examination of the posterior regions of both lungs might be sufficient&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Abdominal ultrasound</span><p id="par0125" class="elsevierStylePara elsevierViewall">Performing 6 essential planes is sufficient for basic abdominal ultrasonography&#46; The right and left coronal planes at the last costal arches and a transverse and a longitudinal slice of the pelvis constitute the layers of the FAST protocol&#46; The longitudinal slice in the epigastric region and transverse slice in the mesogastric region serve to visualize the inferior vena cava and aorta&#46; The right subcostal plane helps visualize the hepatic parenchyma&#44; gallbladder and bile duct&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows these abdominal planes&#44; the structures that are visualized and their clinical utility&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Cardiac ultrasonography</span><p id="par0130" class="elsevierStylePara elsevierViewall">To perform echocardiography&#44; we employ 4 basic planes&#58; subxiphoid&#44; parasternal long and short axes and apical 4 chamber&#46; The subxiphoid plane can be performed perfectly with the convex probe and can therefore be added to the abdomen slices&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows these layers&#44; the structures that are visualized and their clinical utility&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In selected patients&#44; the ultrasound examination of other structures might need to be completed&#46; Thus&#44; for example&#44; for a patient with suspected thromboembolism&#44; ultrasonography of the deep venous system of the legs is essential&#46; Carotid ultrasonography might also be necessary to assess the cardiovascular risk&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">With certain experience&#44; routine multiorgan pulmonary&#44; abdominal and cardiac ultrasonography can be performed in less than 15<span class="elsevierStyleHsp" style=""></span>min&#46; Supplementing the physical examination with ultrasonography can help improve the physician-patient relationship and generate increased patient and practitioner satisfaction&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> After the initial ultrasound study&#44; ultrasonography would only need to be repeated if abnormalities were detected that need monitoring &#40;e&#46;g&#46;&#44; pleural effusion&#44; ascites&#44; pulmonary condensation&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Multiorgan ultrasonography performed systematically on patients assessed in emergency departments has been shown to help diagnose significant medical problems in up to a third of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">31</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Clinical ultrasonography supplements but does not replace the classical physical examination and serves to improve the cost-effectiveness and reliability of physical examinations&#46; Ultrasonography can help recover and redefine the physical examination in a more complete and effective manner than the classical approach&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Clinical ultrasonography should be routinely integrated into the decision-making process in medicine&#44; given that&#44; in addition to supplementing the physical examination&#44; ultrasonography facilitates the diagnosis&#44; prognostic stratification&#44; monitoring and follow-up of patients&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">As with the standardized manner in which physical examinations are performed&#44; ultrasound studies should also be systematized as a supplement to the physical examination&#46; We propose a protocol that includes the multiorgan ultrasonography of the lungs&#44; heart and abdomen with selected basic layers whose diagnostic yield is widely demonstrated&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1306143"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1206269"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1306142"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1206268"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Concept of clinical ultrasonography"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Decision-making process in medicine"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "The classical physical examination and its limitations"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Clinical ultrasonography as a supplement to physical examinations"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Multiorgan clinical ultrasonography"
        ]
        8 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Systemization of multiorgan clinical ultrasonography in internal medicine"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Pulmonary ultrasonography"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Abdominal ultrasound"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Cardiac ultrasonography"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conclusions"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-04-02"
    "fechaAceptado" => "2019-04-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1206269"
          "palabras" => array:4 [
            0 => "Clinical ultrasonography"
            1 => "Echocardiography"
            2 => "Differential diagnosis"
            3 => "Prognosis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1206268"
          "palabras" => array:4 [
            0 => "Ecograf&#237;a cl&#237;nica"
            1 => "Ecocardioscopia"
            2 => "Diagn&#243;stico diferencial"
            3 => "Pron&#243;stico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical ultrasonography has undergone significant development in recent years due to its considerable usefulness and equipment miniaturization&#44; which have enabled its use at the point of care&#46; Clinical ultrasonography is a tool that supplements the classical anamnesis and physical examination&#44; thereby increasing the practitioner&#39;s diagnostic power&#46; This tool can be employed in numerous clinical scenarios and can be applied at all steps when making decisions about the patient&#46; In the hands of the general practitioner&#44; ultrasonography of the various areas of the body &#40;multiorgan ultrasonography&#41; optimizes not only the diagnostic capacity but also the prognostic stratification and monitoring of progress after treatment has been applied&#46; As with the systematic nature of conventional physical examinations&#44; we need to establish an ultrasound examination protocol that supplements the physical examination&#44; thereby redefining and boosting the classic examination&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a cl&#237;nica ha experimentado un importante desarrollo en los &#250;ltimos a&#241;os debido a su gran utilidad y a la miniaturizaci&#243;n de los equipos que han permitido llegar a la cabecera del enfermo&#46; Se trata de una herramienta que complementa la anamnesis y la exploraci&#243;n f&#237;sica tradicional aumentando la potencia diagn&#243;stica del profesional que la emplea en numerosos escenarios cl&#237;nicos y que puede ser aplicada en todos los pasos de la toma de decisiones sobre el paciente&#46; En manos de los generalistas&#44; la aplicaci&#243;n de los ultrasonidos en diferentes &#225;reas del cuerpo &#40;ecograf&#237;a multi&#243;rgano&#41; permite optimizar no solo la capacidad diagn&#243;stica&#44; sino la estratificaci&#243;n pron&#243;stica y el seguimiento evolutivo tras la aplicaci&#243;n de un tratamiento&#46; De la misma forma que existe una sistem&#225;tica de exploraci&#243;n f&#237;sica convencional&#44; se debe plantear el establecimiento de un protocolo de exploraci&#243;n ecogr&#225;fica que complemente a la primera y de esta forma poder redefinir y potenciar la exploraci&#243;n cl&#225;sica&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a de Casasola G&#44; Casado L&#243;pez I&#44; Torres-Macho J&#46; Ecograf&#237;a cl&#237;nica en el proceso de toma de decisiones en medicina&#46; Rev Esp Clin&#46; 2020&#59;220&#58;49&#8211;56&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1150
            "Ancho" => 2083
            "Tamanyo" => 112749
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Decision-making process in medicine&#46; The most important point is the acquisition of information based on the medical history &#40;classical anamnesis and physical examination&#41;&#46; The clinician then decides whether additional complementary tests need to be requested to confirm the suspected diagnosis&#44; interpreting all information received and forming a plan of action &#40;treatment&#41;&#46; Lastly&#44; the clinician assesses the results&#46; Ultrasonography can support physicians throughout the process because the technique supplements the physical examination&#44; is in itself a complementary test and facilitates patient monitoring and follow-up&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2255
            "Ancho" => 2500
            "Tamanyo" => 228742
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary ultrasonography&#46; The technique is simple&#58; posterior&#44; anterior and lateral face sweeps of both lungs&#46; 1&#46; Normal lung&#58; characterized by the presence of A-lines&#46; 2&#46; Interstitial pattern&#58; characterized by the presence of B-lines&#46; 3&#46; Pulmonary condensation &#40;pneumonia&#41;&#46; 4&#46; Pleural effusion&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2279
            "Ancho" => 3126
            "Tamanyo" => 435721
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Basic abdominal planes and their clinical usefulness&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 2212
            "Ancho" => 2919
            "Tamanyo" => 403246
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Basic cardiac planes and their clinical usefulness&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:35 [
            0 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Moore"
                            1 => "J&#46;A&#46; Copel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "364"
                        "paginaInicial" => "749"
                        "paginaFinal" => "757"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic errors and the bedside clinical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;W&#46; Clark"
                            1 => "A&#46; Derakhshan"
                            2 => "S&#46;V&#46; Desai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mcna.2017.12.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin North Am"
                        "fecha" => "2018"
                        "volumen" => "102"
                        "paginaInicial" => "453"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29650067"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inadequacies of physical examination as a cause of medical errors and adverse events&#58; a collection of vignettes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Verghese"
                            1 => "B&#46; Charlton"
                            2 => "J&#46;P&#46; Kassirer"
                            3 => "M&#46; Ramsey"
                            4 => "J&#46;P&#46; Ioannidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2015"
                        "volumen" => "128"
                        "paginaInicial" => "1322"
                        "paginaFinal" => "1324&#46;e3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based physical diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;R&#46; McGee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "Elsevier Saunders"
                        "editorialLocalizacion" => "Philadelphia"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Examiner dependence on physical diagnostic tests for the detection of splenomegaly&#58; a prospective study with multiple observers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;G&#46; Tamayo"
                            1 => "L&#46;S&#46; Rickman"
                            2 => "W&#46;C&#46; Mathews"
                            3 => "S&#46;C&#46; Fullerton"
                            4 => "A&#46;E&#46; Bartok"
                            5 => "J&#46;T&#46; Warner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/bf02599986"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gen Intern Med"
                        "fecha" => "1993"
                        "volumen" => "8"
                        "paginaInicial" => "69"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8441078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical diagnosis of splenomegaly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Yang"
                            1 => "L&#46;S&#46; Rickman"
                            2 => "S&#46;K&#46; Bosser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "West J Med"
                        "fecha" => "1991"
                        "volumen" => "155"
                        "paginaInicial" => "47"
                        "paginaFinal" => "52"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abdominal aortic aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Sakalihasan"
                            1 => "R&#46; Limet"
                            2 => "O&#46;D&#46; Defawe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)66459-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2005"
                        "volumen" => "365"
                        "paginaInicial" => "1577"
                        "paginaFinal" => "1589"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15866312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of clinical manoeuvres in detection of minimal ascites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;S&#46; Chongtham"
                            1 => "M&#46;M&#46; Singh"
                            2 => "S&#46;P&#46; Kalantri"
                            3 => "S&#46; Pathak"
                            4 => "A&#46;P&#46; Jain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Med Sci"
                        "fecha" => "1998"
                        "volumen" => "52"
                        "paginaInicial" => "514"
                        "paginaFinal" => "520"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10218296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical examination of venous pressure&#58; a critical review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;R&#46; McGee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-8703(98)70175-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "1998"
                        "volumen" => "136"
                        "paginaInicial" => "10"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9665212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Kobal"
                            1 => "L&#46; Trento"
                            2 => "S&#46; Baharami"
                            3 => "K&#46; Tolstrup"
                            4 => "T&#46;Z&#46; Naqvi"
                            5 => "B&#46; Cercek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2005.05.060"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1006"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16188532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy and efficacy of hand-held echocardiography in diagnosing valve disease&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Thomas"
                            1 => "N&#46; Flint"
                            2 => "S&#46; Setareh-Shenas"
                            3 => "F&#46; Rader"
                            4 => "S&#46;L&#46; Kobal"
                            5 => "R&#46;J&#46; Siegel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2018"
                        "volumen" => "131"
                        "paginaInicial" => "1155"
                        "paginaFinal" => "1160"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abdominal ultrasound and medical education"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Garcia de Casasola Sanchez"
                            1 => "J&#46; Torres Macho"
                            2 => "J&#46;M&#46; Casas Rojo"
                            3 => "P&#46; Cubo Romano"
                            4 => "J&#46;M&#46; Anton Santos"
                            5 => "V&#46; Villena Garrido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2013.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "131"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24168817"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac limited ultrasound examination techniques to augment the bedside cardiac physical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Kimura"
                            1 => "D&#46;J&#46; Shaw"
                            2 => "S&#46;A&#46; Amundson"
                            3 => "J&#46;N&#46; Phan"
                            4 => "D&#46;G&#46; Blanchard"
                            5 => "A&#46;N&#46; DeMaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7863/ultra.15.14.09002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "1683"
                        "paginaFinal" => "1690"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26269293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care cardiac ultrasound techniques in the physical examination&#58; better at the bedside"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Kimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/heartjnl-2016-309915"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2017"
                        "volumen" => "103"
                        "paginaInicial" => "987"
                        "paginaFinal" => "994"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28259843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung sonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Volpicelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7863/jum.2013.32.1.165"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "165"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23269722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46; Amatya"
                            1 => "J&#46; Rupp"
                            2 => "F&#46;M&#46; Russell"
                            3 => "J&#46; Saunders"
                            4 => "B&#46; Bales"
                            5 => "D&#46;R&#46; House"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12245-018-0170-2"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Emerg Med"
                        "fecha" => "2018"
                        "volumen" => "11"
                        "paginaInicial" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29527652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel approaches to ultrasonography of the lung and pleural space&#58; where are we now&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Lichtenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Breathe &#40;Sheff&#41;"
                        "fecha" => "2017"
                        "volumen" => "13"
                        "paginaInicial" => "100"
                        "paginaFinal" => "111"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Nazerian"
                            1 => "G&#46; Volpicelli"
                            2 => "S&#46; Vanni"
                            3 => "C&#46; Gigli"
                            4 => "L&#46; Betti"
                            5 => "M&#46; Bartolucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2015.01.035"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "620"
                        "paginaFinal" => "625"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time to add a fifth pillar to bedside physical examination&#58; inspection&#44; palpation&#44; percussion&#44; auscultation and insonation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Narula"
                            1 => "Y&#46; Chandrashekhar"
                            2 => "E&#46; Braunwald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamacardio.2018.0001"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Cardiol"
                        "fecha" => "2018"
                        "volumen" => "3"
                        "paginaInicial" => "346"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29490335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid Ultrasound in Shock &#40;RUSH&#41; velocity&#8211;time integral&#58; a proposal to expand the RUSH protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Blanco"
                            1 => "F&#46;M&#46; Aguiar"
                            2 => "M&#46; Blaivas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "1691"
                        "paginaFinal" => "1700"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RUSH exam&#58; Rapid Ultrasound in SHock in the evaluation of the critically lll"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Perera"
                            1 => "T&#46; Mailhot"
                            2 => "D&#46; Riley"
                            3 => "D&#46; Mandavia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.emc.2009.09.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med Clin North Am"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "29"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sonography in Hypotension and Cardiac Arrest &#40;SHoC&#41;&#58; rates of abnormal findings in undifferentiated hypotension and during cardiac arrest as a basis for consensus on a hierarchical point of care ultrasound protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Milne"
                            1 => "P&#46; Atkinson"
                            2 => "D&#46; Lewis"
                            3 => "J&#46; Fraser"
                            4 => "L&#46; Diegelmann"
                            5 => "P&#46; Olszynski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7759/cureus.564"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cureus"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "paginaInicial" => "e564"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27190729"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BLUE-protocol and FALLS-protocol&#58; two applications of lung ultrasound in the critically ill"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;A&#46; Lichtenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.14-1313"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2015"
                        "volumen" => "147"
                        "paginaInicial" => "1659"
                        "paginaFinal" => "1670"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26033127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SEARCH 8Es&#58; a novel point of care ultrasound protocol for patients with chest pain&#44; dyspnea or symptomatic hypotension in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;H&#46; Ahn"
                            1 => "J&#46; Jeon"
                            2 => "H&#46;C&#46; Toh"
                            3 => "V&#46;E&#46; Noble"
                            4 => "J&#46;S&#46; Kim"
                            5 => "Y&#46;S&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0174581"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2017"
                        "volumen" => "12"
                        "paginaInicial" => "e0174581"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28355246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosing acute heart failure in patients with undifferentiated dyspnea&#58; a lung and cardiac ultrasound &#40;LuCUS&#41; protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;M&#46; Russell"
                            1 => "R&#46;R&#46; Ehrman"
                            2 => "K&#46; Cosby"
                            3 => "A&#46; Ansari"
                            4 => "S&#46; Tseeng"
                            5 => "E&#46; Christain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/acem.12570"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "182"
                        "paginaFinal" => "191"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25641227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid evaluation by lung-cardiac-inferior vena cava &#40;LCI&#41; integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Kajimoto"
                            1 => "K&#46; Madeen"
                            2 => "T&#46; Nakayama"
                            3 => "H&#46; Tsudo"
                            4 => "T&#46; Kuroda"
                            5 => "T&#46; Abe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cardiovasc Ultrasound"
                        "fecha" => "2012"
                        "volumen" => "10"
                        "paginaInicial" => "49"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Nazerian"
                            1 => "S&#46; Vanni"
                            2 => "G&#46; Volpicelli"
                            3 => "C&#46; Gigli"
                            4 => "M&#46; Zanobetti"
                            5 => "M&#46; Bartolucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.13-1087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2014"
                        "volumen" => "145"
                        "paginaInicial" => "950"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Volpicelli"
                            1 => "A&#46; Lamorte"
                            2 => "M&#46; Tullio"
                            3 => "L&#46; Cardinale"
                            4 => "M&#46; Giraudo"
                            5 => "V&#46; Stefanone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-2919-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "1290"
                        "paginaFinal" => "1298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23584471"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative use of focus assessed transthoracic echocardiography &#40;FATE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;H&#46; Holm"
                            1 => "C&#46;A&#46; Frederiksen"
                            2 => "P&#46; Juhl-Olsen"
                            3 => "E&#46; Sloth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0b013e31826dd867"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2012"
                        "volumen" => "115"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23051882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point of care ultrasound&#58; a WFUMB position paper"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;F&#46; Dietrich"
                            1 => "A&#46; Goudie"
                            2 => "L&#46; Chiorean"
                            3 => "X&#46;W&#46; Cui"
                            4 => "O&#46;H&#46; Gilja"
                            5 => "Y&#46; Dong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ultrasmedbio.2016.06.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ultrasound Med Biol"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "49"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27472989"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasound findings in unselected patients in an emergency department &#8211; results from a prospective observational trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Weile"
                            1 => "C&#46;B&#46; Laursen"
                            2 => "C&#46;A&#46; Frederiksen"
                            3 => "O&#46; Graumann"
                            4 => "E&#46; Sloth"
                            5 => "H&#46; Kirkegaard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12873-018-0211-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Emerg Med"
                        "fecha" => "2018"
                        "volumen" => "18"
                        "paginaInicial" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30587153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PEARLS for an ultrasound physical and its routine use as part of the clinical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Wagner"
                            1 => "J&#46; Boughton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "South Med J"
                        "fecha" => "2018"
                        "volumen" => "111"
                        "paginaInicial" => "389"
                        "paginaFinal" => "394"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How I do it&#58; lung ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Gargani"
                            1 => "G&#46; Volpicelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1476-7120-12-25"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cardiovasc Ultrasound"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24993976"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A bedside ultrasound sign ruling out pneumothorax in the critically ill&#46; Lung sliding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Lichtenstein"
                            1 => "Y&#46; Menu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1995"
                        "volumen" => "108"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1348"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Real-time lung ultrasound for the diagnosis of alveolar consolidation and interstitial syndrome in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Volpicelli"
                            1 => "F&#46; Silva"
                            2 => "M&#46; Radeos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mej.0b013e3283101685"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "63"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20945542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022000000001/v1_202002130124/S2254887419301250/v1_202002130124/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48740"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022000000001/v1_202002130124/S2254887419301250/v1_202002130124/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301250?idApp=WRCEE"
]
Share
Journal Information
Share
Share
Download PDF
More article options
Review
Clinical ultrasonography in the decision-making process in medicine
Ecografía clínica en el proceso de toma de decisiones en medicina
G. García de Casasolaa,b,c,
Corresponding author
ggcasasolaster@gmail.com

Corresponding author.
, I. Casado Lópeza,b,c, J. Torres-Machoa,b,c
a Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Spain
b Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
c Grupo de Trabajo de Ecografía Clínica, Sociedad Española de Medicina Interna, 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?