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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the article by Díez-Manglano et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on the end-of-life care of patients hospitalized in internal medicine (IM) and would like to make a few comments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As indicated by the authors, 10% of patients hospitalized in IM die during the hospitalization; end-of-life care is therefore a critical part of our activities, and we should be experts in this process.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the article, the researchers recognized that 51.9% of the patients were terminal, a figure far from the 87% recorded by Vilá Santasuana et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> in a similar study. One of the study's limitations is that the authors used subjective criteria for this identification. Terminal status, defined as a vital prognosis shorter than 6 months, is extremely difficult to define in nononcologic patients, which can result in an underestimate of its recording in the study, both by the clinicians and researchers. Due to these difficulties, we prefer referring to such patients as having complex advanced disease with a limited life prognosis, for which there are defined objective criteria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Once these patients have been identified, a comprehensive approach needs to be conducted that establishes an appropriateness of diagnostic and therapeutic procedures to prevent therapeutic obstinacy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this respect, another of the study limitations is the scarce information regarding the decisions to limit the therapeutic effort (LTE), given that only the do-not-resuscitate orders are recorded. It would be of interest to record whether other LTE decisions were taken and when they were taken, given that if they were close to the end of life, they would lose some of their value.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although we should be experts in end-of-life care, the results of this and other studies<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> reflect the need to improve this aspect.</p></span>"
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