Share
array:24 [ "pii" => "S2254887418301346" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.08.004" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1550" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:107-15" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9 "formatos" => array:2 [ "HTML" => 4 "PDF" => 5 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S001425651830198X" "issn" => "00142565" "doi" => "10.1016/j.rce.2018.06.010" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1550" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:107-15" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 172 "formatos" => array:2 [ "HTML" => 86 "PDF" => 86 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "115" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "End-of-life care for patients hospitalised in internal medicine departments" ] ] "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" => 1353 "Ancho" => 1949 "Tamanyo" => 178367 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Circunstancias en los últimos días de vida de los pacientes terminales fallecidos en servicios de medicina interna.</p>" ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "J. Díez-Manglano, S. Isasi de Isasmendi Pérez, M. Rubio Gómez, F. Formiga, L.Á. Sánchez Muñoz, J. Castiella Herrero, E. Casariego Vales, O.H. Torres Bonafonte" "autores" => array:9 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Díez-Manglano" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Isasi de Isasmendi Pérez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Rubio Gómez" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Formiga" ] 4 => array:2 [ "nombre" => "L.Á." "apellidos" => "Sánchez Muñoz" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Castiella Herrero" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Casariego Vales" ] 7 => array:2 [ "nombre" => "O.H." "apellidos" => "Torres Bonafonte" ] 8 => array:1 [ "colaborador" => "y los investigadores del estudio UDVIMI, del Grupo de Paciente Pluripatológico y Edad Avanzada de la Sociedad Española de Medicina Interna" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Investigadores del estudio UDVIMI" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887418301346" "doi" => "10.1016/j.rceng.2018.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301346?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651830198X?idApp=WRCEE" "url" => "/00142565/0000021900000003/v1_201903280610/S001425651830198X/v1_201903280610/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887418301425" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.10.002" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1559" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2019;219:116-23" "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">Original article</span>" "titulo" => "Evolution of the antibiotic-resistance of microorganisms causing urinary tract infections: A 4-year epidemiological surveillance study in a hospital population" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "123" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de la resistencia a antibióticos de microorganismos causantes de infecciones del tracto urinario: un estudio de vigilancia epidemiológica de 4 años en población hospitalaria" ] ] "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" => 4074 "Ancho" => 2343 "Tamanyo" => 646879 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Activity (in %) of the various antibiotics on the all microorganisms isolated in urine samples during 2013–2016.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Sánchez-García, A. Sorlózano-Puerto, J.M. Navarro-Marí, J. Gutiérrez Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Sánchez-García" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Sorlózano-Puerto" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Navarro-Marí" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Gutiérrez Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518302340" "doi" => "10.1016/j.rce.2018.07.005" "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/S0014256518302340?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301425?idApp=WRCEE" "url" => "/22548874/0000021900000003/v1_201903280618/S2254887418301425/v1_201903280618/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2254887419300451" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.01.011" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1623" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2019;219:145-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Internists and death in the hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "145" "paginaFinal" => "146" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los internistas y la muerte en el hospital" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Plaza Canteli, J. Marco Martínez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Plaza Canteli" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Marco Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519300207" "doi" => "10.1016/j.rce.2019.01.002" "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/S0014256519300207?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300451?idApp=WRCEE" "url" => "/22548874/0000021900000003/v1_201903280618/S2254887419300451/v1_201903280618/en/main.assets" ] ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "End-of-life care for patients hospitalized in internal medicine departments" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Díez-Manglano, S. Isasi de Isasmendi Pérez, M. Rubio Gómez, F. Formiga, L.Á. Sánchez Muñoz, J. Castiella Herrero, E. Casariego Vales, O.H. Torres Bonafonte" "autores" => array:9 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Díez-Manglano" "email" => array:1 [ 0 => "jdiez@aragon.es" ] "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">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Isasi de Isasmendi Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Rubio Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Formiga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "L.Á." "apellidos" => "Sánchez Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Castiella Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 6 => array:3 [ "nombre" => "E." "apellidos" => "Casariego Vales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 7 => array:3 [ "nombre" => "O.H." "apellidos" => "Torres Bonafonte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 8 => array:2 [ "colaborador" => "the researchers of the UDVIMI study, researchers of the Pluripathologic and Advanced Age Group of the Spanish Society of Internal Medicine" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Unidad de Pacientes Pluripatológicos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Investigación en Comorbilidad y Pluripatología de Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "061 Aragón, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Idibell, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad de Pacientes Pluripatológicos, Servicio de Medicina Interna, Hospital Clínico Universitario, Valladolid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Unidad de Servicio de Medicina Interna, Fundación Hospital de Calahorra, Calahorra, La Rioja, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna" ] ] "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" => 1353 "Ancho" => 1999 "Tamanyo" => 170379 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Circumstances in the last days of life of terminal patients who died in internal medicine departments.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Changes in family structures and social customs have had a major influence on the current situation in which most non-violent deaths occur in hospitals. In Aragon and Andalusia, this rate reaches 50.2% and 59.4%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the last 20 years and because of the aging of the population, the age of patients hospitalized in internal medicine departments has increased between 8 and 19 years.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a> According to the minimum basic data set, the mean age of patients in internal medicine departments in 2014 in Spain was 73.98 years, and up to 10.06% died during hospitalization.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">4</span></a> In 2010, approximately 3 of every 5 deaths that occurred in hospital occurred in internal medicine departments.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">5</span></a> Therefore, care for individuals in their last days of life is one of the most common processes in internal medicine departments.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dying and death have been included in the standards of healthcare, and the components for a good death have been identified.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">6,7</span></a> Information, dignity, privacy, pain control and spiritual and emotional support are some of these components. Care for individuals in their last days of life requires a comprehensive assessment that enables clinicians to address all the physical, emotional, social-familial and spiritual needs that present in this stage. In recent years, laws have been enacted that protect the rights and guarantees of individuals to die with dignity.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8–17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The main objective of this study was to describe the practices and circumstances in the care of patients hospitalized in internal medicine departments during their last days of life. The secondary objectives were to determine whether there are differences in the care provided to patients with cancer and to those without cancer, to terminal and nonterminal patients and in the practices between public and private hospitals.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The Last Days of Life in Internal Medicine (UDVIMI) study was an observational, cross-sectional, retrospective and multicenter study in which 145 public and private hospitals participated (143 in Spain and 2 in Argentina). Each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. There were no exclusion criteria.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data</span><p id="par0030" class="elsevierStylePara elsevierViewall">An online survey was completed for each patient, registering the data in their medical history, using a clinical audit methodology. The following data were collected: type of hospital, patient age, sex, institutionalization, emergency department care and hospitalizations in the previous year, the presence of polypathology, Barthel index before the hospitalization, number of drugs typically taken before the hospitalization, symptoms of advanced disease, terminal illness, whether death was expected at admission, patient's understanding of their vital prognosis, their ability to make decisions, whether advance directives or previous decisions had been made, length of hospitalization at the time of death, circumstances of the death, use of palliative sedation and the provision of psychological and religious care. The status of terminal illness was established subjectively by each researcher according to the data in the medical history. The criterion for determining whether the death was expected was also subjectively determined by the researcher.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were defined as severely dependent if their Barthel score was <60 points and as totally dependent if their score was <20.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the Clinical Research Ethics Committee of Aragon (PI 15/0322) and conducted in accordance with the Spanish law on the protection of personal data.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistics</span><p id="par0045" class="elsevierStylePara elsevierViewall">The qualitative variables are presented as <span class="elsevierStyleItalic">n</span> (%) and were compared with the chi-squared test. The quantitative variables are presented as median (interquartile range) and were compared with the Mann–Whitney <span class="elsevierStyleItalic">U</span> test. In all cases, the level of significance was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05. The calculations were performed using the statistical program SPSS v22.0.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Hospitals from all Spanish provinces (except for Alava, Cuenca, Melilla and Palencia) participated in this study. Two Argentine hospitals in Buenos Aires also participated.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient characteristics</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study included 1447 patients, 699 (48.3%) of whom were women, with a median (interquartile range) age of 84 (12) years. The patient characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Of the total patients, 248 (17.1%) had cancer, 1065 (73.6%) were polypathological, 31.3% were severely dependent, and 33.0% were totally dependent. Only 8.8% of the patients had a Barthel index of 100. During the previous year, 710 (49.1%) patients had been treated in the emergency department of the hospital without being hospitalized, with a median of 2 (1–3) visits. A total of 788 (54.5%) patients had been admitted to a hospital in the previous year, with a median of 2 (1–3) hospitalizations. For 910 (62.9%) patients, the death was expected at admission.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the total patients studied, 1229 (84.9%) were included from public hospitals, and 814 (56.2%) were included from general hospitals. The patients from public hospitals consumed more drugs, and those of the general hospitals were more frequently institutionalized.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Terminal patients</span><p id="par0065" class="elsevierStylePara elsevierViewall">At admission, 751 (51.9%) patients were considered to be terminal, but this fact was recorded in the medical history in only 61.8% of the cases. There were no differences in the characteristics between the terminal and non-terminal patients. Each patient had a median of 2 (1–3) symptoms of terminal illness. The terminal illness was cancer in 237 (32.2%) patients, neurological in 299 (40.7%), cardiac in 161 (21.9%), respiratory in 149 (20.3%), renal in 68 (9.3%), infectious in 39 (5.3%) and hepatic in 11 (1.5%). In 16 cases, the type of terminal illness was not specified. The terminal illness symptoms are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. For 92.6% of the terminal patients, death was expected as the outcome at admission, and 15% died within the first 24<span class="elsevierStyleHsp" style=""></span>h. The practices and circumstances of the patients’ death are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. It is noteworthy that the medical records did not record important aspects such as whether the patient knew their prognosis (37.8%) or received psychological (30.5%) and religious care (60.5%).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Differences between terminal patients with cancer and those without cancer</span><p id="par0070" class="elsevierStylePara elsevierViewall">For 237 (32.2%) patients, the terminal illness was cancer. There were no differences in age, functionality (measured by the Barthel index) or in the consumption of drugs between the patients with cancer and those without. The patients with nononcologic disease had been hospitalized more frequently in the previous year (59.5% vs. 50.6%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.025), and their death was more frequently expected at admission (93.8% vs. 88.6%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.015). The practices and circumstances in the last days of life of terminal patients with cancer and those without cancer are listed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Our study's main finding was that there was an insufficient record in the medical history of the circumstances during the last days of life of patients hospitalized in internal medicine departments. These circumstances also differed between the patients with cancer and those without cancer.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Patients who die in internal medicine departments are elderly. In this study, the median age was 84 years, almost 10 years older than the mean age of patients hospitalized in internal medicine departments in Spain.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a> Three of every 4 patients have polypathology, 9 of every 10 have disability and half are admitted to hospital and have gone to the emergency department without being admitted in the previous year. Half of the patients have a terminal illness, and in two-thirds of cases, the death was expected at admission. We can therefore state that the care provided to patients in their last days of life and at the time of death is a frequent process in internal medicine departments and should follow certain quality standards.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The end-of-life process has ethical, medical-legal and judicial aspects that must be respected.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">18</span></a> Recommendations and priorities have been established in the care of patients who are expected to die.<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19,20</span></a> The first of these refer to recognizing the dying process. Dyspnea, pain, confusion and respiratory secretions are signs of imminent death.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a> In addition to the symptoms, scales have been established to help identify patients at risk of death when admitted to the hospital.<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">22,23</span></a> Other variables include age, advanced chronic diseases, previous hospitalizations, hospitalization from an emergency department and the surprise question. Our study patients frequently had these symptoms and characteristics. The researchers recognized the risk of death at admission in most cases, although, retrospectively, this could constitute an identification bias. Although half of the patients could be considered in the terminal stage of their disease when admitted to the hospital, this situation was only recorded in the medical history in 61% of the cases. This lack of record could influence the care provided to these patients, because in emergency situations or in the absence of the patients’ standard medical team situations can occur where futile treatments and/or aggressive therapy are employed, and efforts are not limited.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Once the risk of death has been recognized, it is essential to inform the patient and their relatives of the situation and establish a therapeutic plan in keeping with this risk. This right to information has been recognized by the Council of Europe and is covered by the law and professional associations.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8,19,24</span></a> Only 28% of our terminal patients were competent to make decisions, probably reflecting the considerable prevalence of occult cognitive impairment present in elderly patients in terminal condition.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a> Additionally, less than 2% of the patients had provided advance directives, a slightly higher figure than that of the general Spanish population (0.53%).<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a> The record of directives was consulted in 10.9% of the patients. It is therefore essential in most cases to inform the patient's family, reach a consensus approach and make shared decisions to ensure that the patient's previously expressed expectations are met. However, the patients’ perspectives and that of their relatives do not always agree.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Another important aspect is to address the patients’ psychological, spiritual and religious needs,<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19,28</span></a> as established in Point 8 of the Declaration of Venice of the World Medical Association.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">29</span></a> In our study, less than 15% of the patients received religious care. The same situation occurs with psychological care, which is provided more to patients with cancer. These patients’ relatives also received more grief care. In an audit conducted in England, the discussion of the patients’ spiritual needs was documented in only 21% of cases; the spiritual needs of the relatives were documented in only 25%.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">30</span></a> This situation indicates that the non-physical aspects of death are not sufficiently approached.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The limitation of therapeutic effort and the withdrawal or non-initiation of futile treatments are covered in deontology and the law.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8,29,31</span></a> In our study, we only recorded the do-not-resuscitate orders, which were documented in 3 of every 4 patients. In the internal medicine departments in Spain, the rate at which do-not-resuscitate orders are adopted depends on the type of hospital and unit and, in recent years, varied between 66% and 76% of patients.<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">32–34</span></a> This rate is lower than that of studies with patients hospitalized in US Veteran Affairs facilities<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">35</span></a> and with patients with cancer in Korea.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">36</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">When patients in their last moments of life have uncontrollable symptoms such as dyspnea, pain and confusion, palliative sedation is indicated, provided the patient has given their explicit or delegated consent. In a Cochrane review that included 4167 adult terminal patients, palliative sedation was employed in 27% of the cases. In our study, sedation was prescribed for 57.4% of the terminal patients. Other studies in Spain,<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">34,37</span></a> Germany,<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a> Austria,<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">39</span></a> the Netherlands<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">40</span></a> and China<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">41</span></a> have found a much lower use, and a study in Italy observed a use of 64% in patients with cancer.<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">42</span></a> These differences could be due to a previous inadequate control of symptoms or to greater sensitivity of internists in relieving end-of-life suffering.</p><p id="par0110" class="elsevierStylePara elsevierViewall">We observed a number of differences between the patients with cancer and those without cancer. The patients with cancer were more aware of their prognosis and therefore probably received more psychological care, died in individual rooms and were accompanied by their relatives, who were provided more grief care. This situation could be attributed to the difficulty in establishing a prognosis in chronic nononcologic diseases and therefore to the fact that establishing care plans for the last days of life are performed less often and later.</p><p id="par0115" class="elsevierStylePara elsevierViewall">An important finding of our study is the significant lack of recording of the dying process in the medical history, reflecting a lack of protocolization in the process of care in the last days of life and of care after the death. Improving these aspects is essential for achieving a good death for our patients. A clinical trial has shown that the implementation of specific care programs can improve the wellbeing surrounding death for the elderly.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">43</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Our study was multicenter and had considerable nationwide representativeness, which is one of its strength. The study does, however, have limitations. Firstly, this was a retrospective study, although a number of authors have considered that the retrospective approach has advantages for studies on end-of-life care, because it helps easily identify the patient cohort and allows researchers to study all patients and not just a random sample, which enables the rapid development of indicators to assess the delivery of care.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> Secondly, 10 cases were collected from all hospitals without considering the number of beds or admissions, which could mean that the value of the data from some of the hospitals could be underestimated or overestimated. Nonetheless, the wide representation of hospitals from all levels minimizes this limitation. Lastly, all data were collected from the medical records, and it is very likely that some of the care was delivered but not recorded.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion, there is an insufficient record of information regarding end-of-life care in medical records. There are also differences in the care provided to patients with cancer and to those without cancer. Protocols and good clinical practice standards need to be established and implemented in the care provided during the dying process, especially for patients without cancer.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1171497" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1095895" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1171496" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1095894" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistics" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Terminal patients" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Differences between terminal patients with cancer and those without cancer" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-26" "fechaAceptado" => "2018-06-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1095895" "palabras" => array:5 [ 0 => "End-of-life care" 1 => "Terminal disease" 2 => "In-hospital dying" 3 => "Do-not-resuscitate order" 4 => "Palliative sedation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1095894" "palabras" => array:5 [ 0 => "Cuidados al final de la vida" 1 => "Enfermedad terminal" 2 => "Muerte en el hospital" 3 => "Orden de no reanimar" 4 => "Sedación paliativa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the care provided at the end of life for patients who die in internal medicine departments.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational, cross-sectional, retrospective multicenter, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 1447 patients with a median age of 84 years. Of these, 1065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), knew their prognosis (42.6% vs. 8.6%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), received psychological care (24.9% vs. 8.6%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), died in an individual room (64.6% vs. 44.4%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) and were accompanied (81.9% vs. 71.9%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.002).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los cuidados proporcionados al final de la vida en los pacientes fallecidos en servicios de medicina interna.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, transversal, retrospectivo y multicéntrico de auditoría clínica. Cada hospital incluyó los 10 primeros pacientes fallecidos en el servicio de medicina interna a partir del 1 de diciembre de 2015. Se recogieron datos demográficos, clínicos y de circunstancias y cuidados en la muerte.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1.447 pacientes, con una mediana de edad de 84 años. Eran pluripatológicos 1.065 (74,3%), estaban en situación terminal 751 (51,9%) y tenían cáncer 248 (17,1%) pacientes. En los pacientes terminales se estableció una orden de no reanimación en 539 (73,3%) y se realizó sedación paliativa en 422 (57,4%). No se registró si se proporcionaron cuidados psicológicos, religiosos o de atención al duelo en el 32, 64,8 y 44,1%, respectivamente, de los pacientes terminales. Los pacientes con cáncer con más frecuencia eran competentes para la toma de decisiones (54,4% vs. 15,5%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), conocían su pronóstico (42,6% vs. 8,6%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), recibieron cuidados psicológicos (24,9% vs. 8,6%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), fallecieron en una habitación individual (64,6% vs. 44,4%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001) y estuvieron acompañados (81,9% vs. 71,9%; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003). Además, sus familiares recibieron con más frecuencia atención al duelo (15,6% vs. 8,2%; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hay un registro insuficiente en las historias clínicas de los cuidados al final de la vida. Hay diferencias en los cuidados proporcionados a los pacientes con y sin cáncer.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">The names of the UDVIMI study researchers are listed in <a class="elsevierStyleCrossRef" href="#sec0060">Appendix</a>.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: Díez-Manglano J, Isasi de Isasmendi Pérez S, Rubio Gómez M, Formiga F, Sánchez Muñoz LÁ, Castiella Herrero J, et al. Cuidados en los últimos días de vida en los pacientes hospitalizados en medicina interna. Rev Clin Esp. 2019:219:107–115.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall">Jesús Díez-Manglano, Soledad Isasi de Isasmendi Pérez, Marta Rubio Gómez, Magdalena Martín Pérez, Luis Felipe Díez García, Ignacio Vallejo Maroto, Cristina Ocaña Losada, Pilar Giner Escobar, Catalina Díaz Pérez, Javier Caballero Granado, Resfa María García Font, Francisco J. Jódar Lorente, Gloria Pérez Vázquez, Ana Belén Ferro Expósito, María Luisa Amaya González, Fernando Gamboa Antiñolo, Álvaro González Molina, Mercedes Gómez Hernández, Marcos Guzmán García, Lola Benítez León, Lorena Montero Rivas, María Ruiz Mariscal, Noelia Gómez Aguirre, María Pilar González García, Isabel Martín Algora, María Carmen Bueno Castel, Fernando Ruiz Laiglesia, Esperanza Bejarano Tello, José Luis Cabrerizo García, Nuria Guiral Fernández, Luis Camera, Carla Gauna, Pedro Abad Requejo, Rocío Martínez Gutiérrez, Rebeca Fernández Regueiro, María Teresa Sánchez Vidal, Joaquín Alfonso Mejido, Enrique García Carús, Carmen Elena Calvo Rodríguez, Paula Martínez García, Sixto Ruiz Olivares, María Isabel Fullana Barcelo, Carmen González Arencibia, Rosa Ros Vilamajó, María José Monedero Prieto, Concepción González Becerra, Sofía Pérez, Andrea Martín Plata, Raquel Portilla Chocarro, Carlos Dueñas Gutiérrez, Francisco Estrada Álvarez, Sonia Peña Balbuena, Raúl Rodríguez Galindo, Marta María Cobos Siles, Luis Ángel Sánchez Muñoz, Ana Castañón López, Celia Sanz Lobo, María Montserrat Chimeno Viñas, María Ángeles Contreras Uriel, Judit Gil Domínguez, Francisco Medrano González, José Manuel Machín Lázaro, Jeffrey Magallanes Gamboa, Mónica Rodríguez Galdeano, Joaquín Castro Giménez, José Ramón Barberá Farré, Raquel Núñez Aragón, Ferrán Masanés Torán, José Barbé, Elena Güell Farré, Olga Torres Bonafonte, Ana Lozano Miñana, Desirée Moras Sarabia, Rosa Pérez, Dolors Arnau i Fernández, Francesc Formiga, Javier Fernández Fernández, Antoni Castro Salomó, Rami Qanneta, María Victoria Pardo Ortega, Cristina Estrada Díaz, Yasmina Monterroso Pintado, Montserrat García Cors, María Cruz Almendros Rivas, Dolors Domingo Albin, Jaume Roig Morera, Nuria Galofré Álvaro, Aythami Toro Parodi, Mario Loureiro Sánchez, Carla de la Guerra Acebal, Javier Zubizarreta García, Iasone Benavente Claveras, Juan Martí Cabanes, Ignacio Sanz Lázaro, José Barquero Romero, Leticia Nevado López-Alegría, José Carlos Arévalo Lorido, Emilio Casariego Vales, Ana María Lorenzo Vizcaya, Cristina Macía Rodríguez, Silvia Pérez Fernández, Pascual Sesma Sánchez, María Dolores Jiménez-Beatty, Laura González Vázquez, Ángel Brea Hernando, Jesús Castiella Herrero, María Isabel González Anglada, Virginia M. Gracia Lorenzo, Alejandro Pérez Martín, Gerardo García Melcón, María Gómez Antúnez, María Angustias Quesada Simón, Fuensanta Gil Gil, María Asenjo Martínez, Lourdes Mancebo Aragoneses, Jorge Calderón Parra, María del Carmen Romero Pérez, José Curbelo García, Fernando Laguna Cuesta, María Eugenia Segovia Abad, María Fontecha Ortega, Guillermina Lara Martínez, Ana Pinos Blanco, Raquel Rodil Fraile, Elisabel Martínez Litago, Aitziber Echeverría Echeverría, Manuel Priego Valladares, Carlos Trescoli Serrano, Josep Vicente Mas, Óscar Torregrosa Suau, Eva Gil Tomás, Rafael Castillo Rubio, José Manuel Murcia Zaragoza, Pilar Román Sánchez, Ana García Herola, Pedro Pablo Tenllado Doblas, Julio César Blázquez Encinar, Enrique Castellano Vela, Néstor Carrizo, Vicente Giner Galvañ, Bernardino Manuel Roca Villanueva, Francisco Pasquau Liaño, José María Pascual Izuel</p>" "etiqueta" => "Appendix. List of researchers of the UDVIMI study" "identificador" => "sec0060" ] ] ] ] "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" => 1353 "Ancho" => 1999 "Tamanyo" => 170379 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Circumstances in the last days of life of terminal patients who died in internal medicine departments.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The data are presented as frequency (percentage) or median (interquartile range).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1447) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Public hospital (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1229) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Private hospital (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>218) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">General hospital (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>814) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other hospital (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>633) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (78–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (79–89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.5 (75–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (79–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (78–89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.142 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">699 (48.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">590 (48.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.587 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">405 (49.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">294 (46.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.211 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Institutionalized \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">343 (23.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">282 (22.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.095 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217 (26.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (19.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polypathological patient<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1065 (74.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">903 (74.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162 (75.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.804 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">605 (75.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">460 (73.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.363 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Treated in the emergency department without hospitalization in the last year<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">710 (52.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">620 (53.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (51.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.738 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">389 (51.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">321 (55.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admitted to hospital in the last year<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">788 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">672 (56.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.752 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">444 (56.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">344 (55.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.711 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Functionality (Barthel index)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (10–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (10–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (10–73.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (10–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (10–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.502 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typically consumed drugs<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.030 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.968 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death expected at admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">910 (62.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">766 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (66.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">507 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">403 (63.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.595 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient is considered terminal at admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">751 (51.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">636 (51.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (52.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.785 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">406 (49.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">345 (54.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.081 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Had symptoms of terminal illness<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1263 (88.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1072 (88.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">191 (88.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.968 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">706 (88.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">557 (88.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.731 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of hospital stay until death<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.646 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5 (3–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.661 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999318.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Median (interquartile range).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Data from 1433 patients.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Data from 1342 patients.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Data from 1404 patients.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Data from 1427 patients.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients included in the study.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The data are presented as <span class="elsevierStyleItalic">n</span> (%).</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">There were no data on symptoms for 27 terminal patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>724) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Oncologic (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>233) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nononcologic (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>491) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anorexia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">318 (43.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (41.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">214 (43.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.545 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pressure ulcers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (15.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.228 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bed-ridden \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">282 (38.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (40.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182 (37.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.338 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyspnea at rest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">351 (47.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104 (44.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">242 (49.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.242 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cachexia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (21.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (19.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.528 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (27.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 (30.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.460 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (20.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.414 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dysphagia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (18.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (20.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (17.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.427 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999317.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Terminal illness symptoms.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The data are presented as frequency (percentage).</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>: CPR, cardiopulmonary resuscitation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>735) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients with cancer (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>237) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients without cancer (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>498) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient was competent for making decisions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (54.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient knows their situation and vital prognosis. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (19.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (42.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient has advance directives. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.185 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The advance directives record was consulted. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (14.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient and/or relatives received psychological care. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (24.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient and/or relatives received religious care. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.114 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do-not-resuscitate orders were recorded in the medical history. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">539 (73.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">165 (69.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">374 (75.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.116 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palliative sedation was performed. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">422 (57.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 (62.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">274 (55.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.057 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The patient died in the individual room. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">374 (50.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">153 (64.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">221 (44.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A family member was present when the patient died. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">552 (75.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">194 (81.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">358 (71.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grief care was provided. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999319.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Circumstances of death for the terminal patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib0225" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://www.saludinforma.es/portalsi/documents/10179/848610/Proceso_Morir_Aragoneses_2015.pdf/483884a9-d10a-49a6-a818-60d37ef75576;jsessionid=EUkBF5-HDsj9t4kLkaPwBgzQ.mov-saludinforma-01?version=1.1">https://www.saludinforma.es/portalsi/documents/10179/848610/Proceso_Morir_Aragoneses_2015.pdf/483884a9-d10a-49a6-a818-60d37ef75576;jsessionid=EUkBF5-HDsj9t4kLkaPwBgzQ.mov-saludinforma-01?version=1.1</a> [consultado 16 Feb 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Los aragoneses ante el proceso de morir" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Dirección General de Calidad y Atención al Usuario" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2015" "editorial" => "Gobierno de Aragón" "editorialLocalizacion" => "Zaragoza" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0230" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="http://www.juntadeandalucia.es/salud/export/sites/csalud/galerias/documentos/c_2_c_15_muerte_digna/comoMuerenAndaluces/comoMuerenAndalucesI.pdf">http://www.juntadeandalucia.es/salud/export/sites/csalud/galerias/documentos/c_2_c_15_muerte_digna/comoMuerenAndaluces/comoMuerenAndalucesI.pdf</a> [consultado 16 Feb 2018]" "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Sinopsis. Cómo mueren los andaluces I. Informe sobre la aplicación y efectos de la ley 2/2010 de derechos y garantías de la dignidad de las personas en el proceso de la muerte" "serieFecha" => "2012" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0235" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La edad de los pacientes atendidos en los servicios de medicina interna en España: una perspectiva de 20 años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Casademont" 1 => "E. Francia" 2 => "O. Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "138" "paginaInicial" => "289" "paginaFinal" => "292" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0240" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Servicios Sociales e Igualdad. Hospital Discharge Records in the National Health System. CMBD [consultado 16 Feb 2018]. Disponible en: <a id="intr0020" class="elsevierStyleInterRef" href="https://www.msssi.gob.es/estadEstudios/estadisticas/cmbdhome.htm">https://www.msssi.gob.es/estadEstudios/estadisticas/cmbdhome.htm</a>" ] ] ] 4 => array:3 [ "identificador" => "bib0245" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="http://www.msssi.gob.es/estadEstudios/estadisticas/docs/Hospitalizacion_SNS_CMBD_Informe2010.pdf">http://www.msssi.gob.es/estadEstudios/estadisticas/docs/Hospitalizacion_SNS_CMBD_Informe2010.pdf</a> [consultado 16 Feb 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La hospitalización en el Sistema Nacional de Salud CMBD – Registro de altas. Informe resumen 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Instituto de Información Sanitaria" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "editorial" => "Ministerio de Sanidad, Servicios Sociales e Igualdad" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0250" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A good death. An important aim for health services and for all us" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2000" "volumen" => "320" "paginaInicial" => "129" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10634711" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0255" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The future of health and care of older people: the best is yet to come" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Debate of the Age Health, Care Study Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1999" "editorial" => "Age Concern" "editorialLocalizacion" => "London" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0260" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 2/2010, de 8 de abril, de derechos y garantías de la dignidad de la persona en el proceso de la muerte. Boletín Oficial de la Junta de Andalucía, 07/05/2010. Disponible en: <a id="intr0030" class="elsevierStyleInterRef" href="http://www.juntadeandalucia.es/boja/2010/88/1">http://www.juntadeandalucia.es/boja/2010/88/1</a> [consultado 16 Feb 2018]" ] ] ] 8 => array:3 [ "identificador" => "bib0265" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley foral 8/2011, de 24 de marzo, de derechos y garantías de la dignidad de la persona en el proceso de la muerte. Boletín Oficial de Navarra, 04/04/2011. Disponible en: <a id="intr0035" class="elsevierStyleInterRef" href="http://www.lexnavarra.navarra.es/detalle.asp?r=12315">http://www.lexnavarra.navarra.es/detalle.asp?r=12315</a> [consultado 16 Feb 2018]" ] ] ] 9 => array:3 [ "identificador" => "bib0270" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 10/2011, de 24 de marzo, de derechos y garantías de la dignidad de la persona en el proceso de morir y de la muerte. Boletín Oficial de Aragón, 07/04/2011. Disponible en: <a id="intr0040" class="elsevierStyleInterRef" href="http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VERDOC%26BASE=BOLE%26PIECE=BOLE%26DOCS=1-37%26DOCR=2%26SEC=FIRMA%26RNG=200%26SEPARADOR=%26%26PUBL=20110407">http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VERDOC&BASE=BOLE&PIECE=BOLE&DOCS=1-37&DOCR=2&SEC=FIRMA&RNG=200&SEPARADOR=&&PUBL=20110407</a> [consultado 16 Feb 2018]" ] ] ] 10 => array:3 [ "identificador" => "bib0275" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 1/2015, de 9 de febrero, de derechos y garantías de la dignidad de la persona ante el proceso final de su vida. Boletín Oficial de Canarias, 13 febrero 2015. Disponible en: <a id="intr0045" class="elsevierStyleInterRef" href="http://www.gobiernodecanarias.org/boc/2015/030/001.html">http://www.gobiernodecanarias.org/boc/2015/030/001.html</a> [consultado 16 Feb 2018]" ] ] ] 11 => array:3 [ "identificador" => "bib0280" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 4/2015, de 23 de marzo, de derechos y garantías de la persona en el proceso de morir. Butlletí Oficial de les Illes Balears, 28 marzo 2015. Disponible en: <a id="intr0050" class="elsevierStyleInterRef" href="http://www.caib.es/eboibfront/ES/2015/10270/561786/ley-4-2015-de-23-de-marzo-de-derechos-y-garantias-">http://www.caib.es/eboibfront/ES/2015/10270/561786/ley-4-2015-de-23-de-marzo-de-derechos-y-garantias-</a> [consultado 16 Feb 2018]" ] ] ] 12 => array:3 [ "identificador" => "bib0285" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 5/2015, de 26 de junio, de derechos y garantías de la dignidad de las personas enfermas terminales. Diario Oficial de Galicia, 16 julio 2015. Disponible en: <a id="intr0055" class="elsevierStyleInterRef" href="https://www.xunta.gal/dog/Publicados/2015/20150716/AnuncioC3B0-020715-0003_es.html">https://www.xunta.gal/dog/Publicados/2015/20150716/AnuncioC3B0-020715-0003_es.html</a> [consultado 16 Feb 2018]" ] ] ] 13 => array:3 [ "identificador" => "bib0290" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 11/2016, de 8 de julio, de garantía de los derechos y de la dignidad de las personas en el proceso final de su vida. Boletín Oficial del País Vasco, 14 julio 2016. Disponible en: <a id="intr0060" class="elsevierStyleInterRef" href="http://www.euskadi.eus/gobierno-vasco/-/ley/ley-112016-de-8-de-julio-de-garantia-de-los-derechos-y-de-la-dignidad-de-las-personas-en-el-proceso-final-de-su-vida/">http://www.euskadi.eus/gobierno-vasco/-/ley/ley-112016-de-8-de-julio-de-garantia-de-los-derechos-y-de-la-dignidad-de-las-personas-en-el-proceso-final-de-su-vida/</a> [consultado 16 Feb 2018]" ] ] ] 14 => array:3 [ "identificador" => "bib0295" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 4/2017, de 9 de marzo, de derechos y garantías de las personas en el proceso de morir. Boletín Oficial de la Comunidad de Madrid, 22 marzo 2017. Disponible en: <a id="intr0065" class="elsevierStyleInterRef" href="https://www.bocm.es/boletin-completo/bocm-20170322/69/i.-comunidad-de-madrid/a%29-disposiciones-generales/presidencia-de-la-comunidad">https://www.bocm.es/boletin-completo/bocm-20170322/69/i.-comunidad-de-madrid/a%29-disposiciones-generales/presidencia-de-la-comunidad</a> [consultado 16 Feb 2018]" ] ] ] 15 => array:3 [ "identificador" => "bib0300" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Asamblea Parlamentaria del Consejo Europa. Declaración Protección de los derechos humanos y la dignidad de los enfermos terminales y moribundos, 25 junio 1999. Disponible en: <a id="intr0070" class="elsevierStyleInterRef" href="http://www.aeu.es/UserFiles/ConsejoEuropaDignidadEnfermosTerminales.pdf">www.aeu.es/UserFiles/ConsejoEuropaDignidadEnfermosTerminales.pdf</a> [consultado 23 Feb 2018]" ] ] ] 16 => array:3 [ "identificador" => "bib0305" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 26742. Ley sobre derechos del paciente, historia clínica y consentimiento informado. Derechos del paciente en su relación con los profesionales e instituciones de la salud. Derechos esenciales en la relación entre el paciente y el o los profesionales de la salud. Muerte digna. Modificación de la ley 26529. Boletín Oficial de la República de Argentina. Disponible en: <a id="intr0075" class="elsevierStyleInterRef" href="https://www.boletinoficial.gob.ar/">https://www.boletinoficial.gob.ar/#!DetalleNorma/70105/20120524</a> [consultado 15 Mar 2018]" ] ] ] 17 => array:3 [ "identificador" => "bib0310" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspectos éticos, médico-legales y jurídicos del proceso del final de la vida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Arimany-Manso" 1 => "F. Torralba" 2 => "M. Gómez-Sancho" 3 => "E.L. Gómez-Durán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2017" "volumen" => "149" "paginaInicial" => "217" "paginaFinal" => "222" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0315" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "One chance to get it right. Improving people's experience of care in the last few days and hours of life. Leadership Alliance for the care of dying people; 2014. Disponible en: <a id="intr0080" class="elsevierStyleInterRef" href="http://www.wales.pallcare.info/files/One_chance_to_get_it_right.pdf">www.wales.pallcare.info/files/One_chance_to_get_it_right.pdf</a> [consultado 23 Feb 2018]" ] ] ] 19 => array:3 [ "identificador" => "bib0320" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The quality of care provided to hospitalized patients at the end of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Walling" 1 => "S.M. Asch" 2 => "K.A. Lorenz" 3 => "C.P. Roth" 4 => "T. Barry" 5 => "K.L. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinternmed.2010.175" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2010" "volumen" => "170" "paginaInicial" => "1057" "paginaFinal" => "1063" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20585072" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0325" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of the prevalence of signs of impeding death and symptoms in the last 2 weeks of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.A. Kehl" 1 => "J.A. Kowalkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Hospit Palliat Med" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "601" "paginaFinal" => "616" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0330" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of a tool for defining and identifying the dying patient in hospital criteria for screening and triaging to appropriate alternative care (CriSTAL)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Cardona-Morrel" 1 => "K. Hillman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjspcare-2014-000770" "Revista" => array:7 [ "tituloSerie" => "BMJ Support Palliat Care" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "78" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25613983" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S009167491600186X" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0335" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Just ask: discussing goals of care with patients in hospital with serious illness" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the Canadian researchers at the end of life network (CARENET)" "etal" => false "autores" => array:3 [ 0 => "J.J. You" 1 => "R.A. Fowler" 2 => "D.K. Heyland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "CMAJ" "fecha" => "2014" "volumen" => "186" "paginaInicial" => "425" "paginaFinal" => "432" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0340" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0085" href="http://www.cgcom.es/sites/default/files/declaracion_atencion_medica_final_vida.pdf">www.cgcom.es/sites/default/files/declaracion_atencion_medica_final_vida.pdf</a> [consultado 23 Feb 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Declaración sobre La atención médica al final de la vida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Consejo General de Colegios Oficiales de Médicos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2009" "editorial" => "Organización Médica Colegial de España" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0345" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Undetected cognitive impairment and decision-making capacity in patients receiving hospice care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.Z. Burton" 1 => "E.W. Twamley" 2 => "L.C. Lee" 3 => "B.W. Palmer" 4 => "D.V. Jeste" 5 => "L.B. Dunn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/JGP.0b013e3182436987" "Revista" => array:6 [ "tituloSerie" => "Am J Geriatr Psychiatry" "fecha" => "2012" "volumen" => "20" "paginaInicial" => "306" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22322907" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0350" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Servicios Sociales e Igualdad. Registro Nacional de Instrucciones Previas. Disponible en: <a id="intr0090" class="elsevierStyleInterRef" href="https://www.msssi.gob.es/ciudadanos/rnip/home.htm">https://www.msssi.gob.es/ciudadanos/rnip/home.htm</a> [consultado 15 Mar 2018]" ] ] ] 26 => array:3 [ "identificador" => "bib0355" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET)" "etal" => true "autores" => array:6 [ 0 => "J.J. You" 1 => "P. Dodek" 2 => "F. Lamontagne" 3 => "J. Downar" 4 => "T. Sinuff" 5 => "X. Jinag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.140673" "Revista" => array:7 [ "tituloSerie" => "CMAJ" "fecha" => "2014" "volumen" => "186" "paginaInicial" => "E679" "paginaFinal" => "E687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25367427" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S009167491730218X" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0360" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The Economist Intelligence Unit. The 2015 quality of death index. Ranking palliative care across the world. Disponible en: <a id="intr0095" class="elsevierStyleInterRef" href="https://www.eiuperspectives.economist.com/sites/default/files/2015%20EIU%20Quality%20of%20Death%20Index%20Oct%2029%20FINAL.pdf">https://www.eiuperspectives.economist.com/sites/default/files/2015%20EIU%20Quality%20of%20Death%20Index%20Oct%2029%20FINAL.pdf</a> [consultado 15 Mar 2018]" ] ] ] 28 => array:3 [ "identificador" => "bib0365" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Asociación Médica Mundial. Declaración de Venecia sobre la enfermedad terminal. Disponible en: <a id="intr0100" class="elsevierStyleInterRef" href="https://www.wma.net/es/policies-post/declaracion-de-venecia-de-la-amm-sobre-la-enfermedad-terminal/">https://www.wma.net/es/policies-post/declaracion-de-venecia-de-la-amm-sobre-la-enfermedad-terminal/</a> [consultado 15 Mar 2019]" ] ] ] 29 => array:3 [ "identificador" => "bib0370" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Royal College of Physicians. National care of the dying audit of hospitals. Disponible en: <a id="intr0105" class="elsevierStyleInterRef" href="https://www.rcplondon.ac.uk/projects/outputs/national-care-dying-audit-hospitals">https://www.rcplondon.ac.uk/projects/outputs/national-care-dying-audit-hospitals</a> [consultado 15 Mar 2018]" ] ] ] 30 => array:3 [ "identificador" => "bib0375" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consejo General de Colegios Oficiales de Médicos. Código de Deontología Médica. Disponible en: <a id="intr0110" class="elsevierStyleInterRef" href="https://www.cgcom.es/sites/default/files/codigo_deontologia_medica.pdf">https://www.cgcom.es/sites/default/files/codigo_deontologia_medica.pdf</a> [consultado 15 Mar 2018]" ] ] ] 31 => array:3 [ "identificador" => "bib0380" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las órdenes de no reanimar. Historia y situación actual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ruiz-Garcia" 1 => "I. Canal-Fontcuberta" 2 => "M. Martínez-Sellés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "316" "paginaFinal" => "320" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0385" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortalidad esperable en medicina interna: ¿cómo son los últimos días de vida en los pacientes en los que la muerte es previsible?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Ameneiros-Lago" 1 => "C. Carballada-Rico" 2 => "J.A. Garrido-Sanjuán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Paliat" "fecha" => "2017" "volumen" => "24" "paginaInicial" => "63" "paginaFinal" => "71" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0390" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limitación del esfuerzo terapéutico en pacientes hospitalizados en servicios de medicina interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. García Caballero" 1 => "B. Herreros" 2 => "D. Real de Asúa" 3 => "S. Gámez" 4 => "G. Vega" 5 => "L. García Olmos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2017.10.001" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2018" "volumen" => "218" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29137700" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0395" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of end-of-life care provided to patients with different serious illnesses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.W. Wachterman" 1 => "C. Pilver" 2 => "D. Smith" 3 => "M. Ersek" 4 => "S.R. Lipsitz" 5 => "N.L. Keating" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamainternmed.2016.1200" "Revista" => array:6 [ "tituloSerie" => "JAMA Intern Med" "fecha" => "2016" "volumen" => "176" "paginaInicial" => "1095" "paginaFinal" => "1102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27367547" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0400" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between end-of-life care and the time interval between provision of a do-not-resuscitate consent and death in cancer patients in Korea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.K. Baek" 1 => "H.J. Chang" 2 => "J.M. Buyn" 3 => "J.J. Han" 4 => "D.S. Heo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4143/crt.2016.073" "Revista" => array:6 [ "tituloSerie" => "Cancer Res Treat" "fecha" => "2017" "volumen" => "49" "paginaInicial" => "502" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27586675" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0405" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuestra experiencia en sedación paliativa como opción terapéutica en pacientes en situación clínica de últimos días" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Carmona-Espinazo" 1 => "F. Sánchez-Prieto" 2 => "J.B. López-Sáez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Legal" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "93" "paginaFinal" => "97" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0410" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative Sedierung auf einer universitären Palliativstation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Hopprich" 1 => "L.D. Günther" 2 => "R. Laufenberg-Feldmann" 3 => "U. Reinholz" 4 => "M. Weber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0041-106460" "Revista" => array:6 [ "tituloSerie" => "Dtsch Med Wochenschr" "fecha" => "2016" "volumen" => "141" "paginaInicial" => "e60" "paginaFinal" => "e66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27078251" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0415" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sedation at the end of life — a nation-wide study in palliative care units in Austria" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the AUPACS (Austrian Palliative Care Study) Group" "etal" => true "autores" => array:6 [ 0 => "S. Schur" 1 => "D. Weixler" 2 => "C. Gabl" 3 => "G. Kreye" 4 => "R. Likar" 5 => "E.K. Msel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12904-016-0121-8" "Revista" => array:5 [ "tituloSerie" => "BMC Palliat Care" "fecha" => "2016" "volumen" => "15" "paginaInicial" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27180238" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0420" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient-related determinants of the administration of continuous palliative sedation in hospices and palliative care units: a prospective, multicenter, observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.H. Van Deijck" 1 => "J.G. Hasselaar" 2 => "S.C. Verhagen" 3 => "K.C. Vissers" 4 => "R.T. Koopmans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpainsymman.2015.12.327" "Revista" => array:7 [ "tituloSerie" => "J Pain Symptom Manage" "fecha" => "2016" "volumen" => "51" "paginaInicial" => "882" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26921495" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2213219815005206" "estado" => "S300" "issn" => "22132198" ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0425" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative sedation for terminally ill cancer patients in a tertiary cancer center in Shanghai, China" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "X. Gu" 1 => "W. Cheng" 2 => "M. Chen" 3 => "M. Liu" 4 => "Z. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12904-015-0002-6" "Revista" => array:5 [ "tituloSerie" => "BMC Palliat Care" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25810691" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0430" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative sedation at the end of life at a tertiary cancer center" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Caraceni" 1 => "E. Zecca" 2 => "C. Martini" 3 => "G. Gorni" 4 => "T. Campa" 5 => "C. Brunelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Support Care Cancer" "fecha" => "2012" "volumen" => "20" "paginaInicial" => "1299" "paginaFinal" => "1307" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0435" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving comfort around dying in elderly people: a cluster randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Beernaert" 1 => "T. Smets" 2 => "J. Cohen" 3 => "R. Verhofstede" 4 => "M. Constantini" 5 => "K. Eecloo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(17)31265-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "390" "paginaInicial" => "125" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28526493" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0440" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Looking back from death: the value of retrospective studies of end-of-life care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.C. Earle" 1 => "J.Z. Ayanian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2005.03.9388" "Revista" => array:7 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "838" "paginaFinal" => "840" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484691" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2213260015000314" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000003/v1_201903280618/S2254887418301346/v1_201903280618/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000003/v1_201903280618/S2254887418301346/v1_201903280618/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301346?idApp=WRCEE" ]
