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Limitation of therapeutic effort in emergency departments: A shared decision
Limitación del esfuerzo terapéutico desde los servicios de urgencias: una decisión compartida
A. Juan Pastor
Institut Català de la Salut, Barcelona, Spain
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Torrente Jiménez, M.A. Villarino Marzo, S. Herranz Martínez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Torrente Jiménez" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Villarino Marzo" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Herranz Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518300511" "doi" => "10.1016/j.rce.2018.02.002" "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/S0014256518300511?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488741830033X?idApp=WRCEE" "url" => "/22548874/0000021800000005/v1_201805300413/S225488741830033X/v1_201805300413/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "Limitation of therapeutic effort in emergency departments: A shared decision" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "266" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "A. Juan Pastor" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Juan Pastor" "email" => array:1 [ 0 => "a.juanpastor@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Institut Català de la Salut, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Limitación del esfuerzo terapéutico desde los servicios de urgencias: una decisión compartida" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Having read the interesting article by García Caballero et al. entitled “Limitation of therapeutic effort in patients hospitalized in departments of internal medicine”, which, among other data, reveals the delay in starting palliative measures, I wish to comment on the option, in selected cases, of starting these measures in the emergency department. Considering that most patients who are admitted to internal medicine departments are hospitalized in urgent situations, this could improve the care for the patients described in the article. The special care conditions of emergency departments and their organization do not facilitate this approach. Observational units<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> would therefore be the most appropriate setting for the joint assessment of this type of patient by the emergency department staff and internal medicine specialists responsible for the hospital units. In recent years, Spanish emergency departments have made a special effort to generate and assess evidence on the predictors of mortality for various diseases and in introducing geriatric assessment scales into clinical practice.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a> These efforts show the interest of practitioners in predicting mortality and in properly addressing geriatric patients. There has been progress in collaborative work among various specialties, in addition to internal medicine (which treats patients who are potential candidates for limitation of therapeutic effort), such as oncology, hematology, and intensive medicine and practitioners assigned to emergency departments. These collaborations could help prevent the start of measures shown to be ineffective, which extend unnecessary suffering and that result in a delay in implementing palliative measures.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Juan Pastor A. Limitación del esfuerzo terapéutico desde los servicios de urgencias: una decisión compartida. Rev Clin Esp. 2018;218:266–266.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Innovación en Medicina de Urgencias y Emergencias: cinco aspectos organizativos que podrían cambiar nuestra práctica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.F. Lobón" 1 => "P. 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