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    "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&#46; In Aragon and Andalusia&#44; this rate reaches 50&#46;2&#37; and 59&#46;4&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the last 20 years and because of the aging of the population&#44; the age of patients hospitalized in internal medicine departments has increased between 8 and 19 years&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a> According to the minimum basic data set&#44; the mean age of patients in internal medicine departments in 2014 in Spain was 73&#46;98 years&#44; and up to 10&#46;06&#37; died during hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">4</span></a> In 2010&#44; approximately 3 of every 5 deaths that occurred in hospital occurred in internal medicine departments&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">5</span></a> Therefore&#44; care for individuals in their last days of life is one of the most common processes in internal medicine departments&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dying and death have been included in the standards of healthcare&#44; and the components for a good death have been identified&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">6&#44;7</span></a> Information&#44; dignity&#44; privacy&#44; pain control and spiritual and emotional support are some of these components&#46; Care for individuals in their last days of life requires a comprehensive assessment that enables clinicians to address all the physical&#44; emotional&#44; social-familial and spiritual needs that present in this stage&#46; In recent years&#44; laws have been enacted that protect the rights and guarantees of individuals to die with dignity&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8&#8211;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&#46; The secondary objectives were to determine whether there are differences in the care provided to patients with cancer and to those without cancer&#44; to terminal and nonterminal patients and in the practices between public and private hospitals&#46;</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 &#40;UDVIMI&#41; study was an observational&#44; cross-sectional&#44; retrospective and multicenter study in which 145 public and private hospitals participated &#40;143 in Spain and 2 in Argentina&#41;&#46; Each hospital included the first 10 patients who died in the internal medicine department starting on December 1&#44; 2015&#46; There were no exclusion criteria&#46;</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&#44; registering the data in their medical history&#44; using a clinical audit methodology&#46; The following data were collected&#58; type of hospital&#44; patient age&#44; sex&#44; institutionalization&#44; emergency department care and hospitalizations in the previous year&#44; the presence of polypathology&#44; Barthel index before the hospitalization&#44; number of drugs typically taken before the hospitalization&#44; symptoms of advanced disease&#44; terminal illness&#44; whether death was expected at admission&#44; patient&#39;s understanding of their vital prognosis&#44; their ability to make decisions&#44; whether advance directives or previous decisions had been made&#44; length of hospitalization at the time of death&#44; circumstances of the death&#44; use of palliative sedation and the provision of psychological and religious care&#46; The status of terminal illness was established subjectively by each researcher according to the data in the medical history&#46; The criterion for determining whether the death was expected was also subjectively determined by the researcher&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were defined as severely dependent if their Barthel score was &#60;60 points and as totally dependent if their score was &#60;20&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the Clinical Research Ethics Committee of Aragon &#40;PI 15&#47;0322&#41; and conducted in accordance with the Spanish law on the protection of personal data&#46;</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> &#40;&#37;&#41; and were compared with the chi-squared test&#46; The quantitative variables are presented as median &#40;interquartile range&#41; and were compared with the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; In all cases&#44; the level of significance was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46; The calculations were performed using the statistical program SPSS v22&#46;0&#46;</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 &#40;except for Alava&#44; Cuenca&#44; Melilla and Palencia&#41; participated in this study&#46; Two Argentine hospitals in Buenos Aires also participated&#46;</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&#44; 699 &#40;48&#46;3&#37;&#41; of whom were women&#44; with a median &#40;interquartile range&#41; age of 84 &#40;12&#41; years&#46; The patient characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the total patients&#44; 248 &#40;17&#46;1&#37;&#41; had cancer&#44; 1065 &#40;73&#46;6&#37;&#41; were polypathological&#44; 31&#46;3&#37; were severely dependent&#44; and 33&#46;0&#37; were totally dependent&#46; Only 8&#46;8&#37; of the patients had a Barthel index of 100&#46; During the previous year&#44; 710 &#40;49&#46;1&#37;&#41; patients had been treated in the emergency department of the hospital without being hospitalized&#44; with a median of 2 &#40;1&#8211;3&#41; visits&#46; A total of 788 &#40;54&#46;5&#37;&#41; patients had been admitted to a hospital in the previous year&#44; with a median of 2 &#40;1&#8211;3&#41; hospitalizations&#46; For 910 &#40;62&#46;9&#37;&#41; patients&#44; the death was expected at admission&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the total patients studied&#44; 1229 &#40;84&#46;9&#37;&#41; were included from public hospitals&#44; and 814 &#40;56&#46;2&#37;&#41; were included from general hospitals&#46; The patients from public hospitals consumed more drugs&#44; and those of the general hospitals were more frequently institutionalized&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Terminal patients</span><p id="par0065" class="elsevierStylePara elsevierViewall">At admission&#44; 751 &#40;51&#46;9&#37;&#41; patients were considered to be terminal&#44; but this fact was recorded in the medical history in only 61&#46;8&#37; of the cases&#46; There were no differences in the characteristics between the terminal and non-terminal patients&#46; Each patient had a median of 2 &#40;1&#8211;3&#41; symptoms of terminal illness&#46; The terminal illness was cancer in 237 &#40;32&#46;2&#37;&#41; patients&#44; neurological in 299 &#40;40&#46;7&#37;&#41;&#44; cardiac in 161 &#40;21&#46;9&#37;&#41;&#44; respiratory in 149 &#40;20&#46;3&#37;&#41;&#44; renal in 68 &#40;9&#46;3&#37;&#41;&#44; infectious in 39 &#40;5&#46;3&#37;&#41; and hepatic in 11 &#40;1&#46;5&#37;&#41;&#46; In 16 cases&#44; the type of terminal illness was not specified&#46; The terminal illness symptoms are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; For 92&#46;6&#37; of the terminal patients&#44; death was expected as the outcome at admission&#44; and 15&#37; died within the first 24<span class="elsevierStyleHsp" style=""></span>h&#46; The practices and circumstances of the patients&#8217; death are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; It is noteworthy that the medical records did not record important aspects such as whether the patient knew their prognosis &#40;37&#46;8&#37;&#41; or received psychological &#40;30&#46;5&#37;&#41; and religious care &#40;60&#46;5&#37;&#41;&#46;</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 &#40;32&#46;2&#37;&#41; patients&#44; the terminal illness was cancer&#46; There were no differences in age&#44; functionality &#40;measured by the Barthel index&#41; or in the consumption of drugs between the patients with cancer and those without&#46; The patients with nononcologic disease had been hospitalized more frequently in the previous year &#40;59&#46;5&#37; vs&#46; 50&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;025&#41;&#44; and their death was more frequently expected at admission &#40;93&#46;8&#37; vs&#46; 88&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; 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>&#46;</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&#39;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&#46; These circumstances also differed between the patients with cancer and those without cancer&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Patients who die in internal medicine departments are elderly&#46; In this study&#44; the median age was 84 years&#44; almost 10 years older than the mean age of patients hospitalized in internal medicine departments in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">3</span></a> Three of every 4 patients have polypathology&#44; 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&#46; Half of the patients have a terminal illness&#44; and in two-thirds of cases&#44; the death was expected at admission&#46; 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&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The end-of-life process has ethical&#44; medical-legal and judicial aspects that must be respected&#46;<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&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;20</span></a> The first of these refer to recognizing the dying process&#46; Dyspnea&#44; pain&#44; confusion and respiratory secretions are signs of imminent death&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a> In addition to the symptoms&#44; scales have been established to help identify patients at risk of death when admitted to the hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">22&#44;23</span></a> Other variables include age&#44; advanced chronic diseases&#44; previous hospitalizations&#44; hospitalization from an emergency department and the surprise question&#46; Our study patients frequently had these symptoms and characteristics&#46; The researchers recognized the risk of death at admission in most cases&#44; although&#44; retrospectively&#44; this could constitute an identification bias&#46; Although half of the patients could be considered in the terminal stage of their disease when admitted to the hospital&#44; this situation was only recorded in the medical history in 61&#37; of the cases&#46; This lack of record could influence the care provided to these patients&#44; because in emergency situations or in the absence of the patients&#8217; standard medical team situations can occur where futile treatments and&#47;or aggressive therapy are employed&#44; and efforts are not limited&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Once the risk of death has been recognized&#44; it is essential to inform the patient and their relatives of the situation and establish a therapeutic plan in keeping with this risk&#46; This right to information has been recognized by the Council of Europe and is covered by the law and professional associations&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8&#44;19&#44;24</span></a> Only 28&#37; of our terminal patients were competent to make decisions&#44; probably reflecting the considerable prevalence of occult cognitive impairment present in elderly patients in terminal condition&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a> Additionally&#44; less than 2&#37; of the patients had provided advance directives&#44; a slightly higher figure than that of the general Spanish population &#40;0&#46;53&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a> The record of directives was consulted in 10&#46;9&#37; of the patients&#46; It is therefore essential in most cases to inform the patient&#39;s family&#44; reach a consensus approach and make shared decisions to ensure that the patient&#39;s previously expressed expectations are met&#46; However&#44; the patients&#8217; perspectives and that of their relatives do not always agree&#46;<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&#8217; psychological&#44; spiritual and religious needs&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">19&#44;28</span></a> as established in Point 8 of the Declaration of Venice of the World Medical Association&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">29</span></a> In our study&#44; less than 15&#37; of the patients received religious care&#46; The same situation occurs with psychological care&#44; which is provided more to patients with cancer&#46; These patients&#8217; relatives also received more grief care&#46; In an audit conducted in England&#44; the discussion of the patients&#8217; spiritual needs was documented in only 21&#37; of cases&#59; the spiritual needs of the relatives were documented in only 25&#37;&#46;<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&#46;</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&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">8&#44;29&#44;31</span></a> In our study&#44; we only recorded the do-not-resuscitate orders&#44; which were documented in 3 of every 4 patients&#46; In the internal medicine departments in Spain&#44; the rate at which do-not-resuscitate orders are adopted depends on the type of hospital and unit and&#44; in recent years&#44; varied between 66&#37; and 76&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">32&#8211;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&#46;<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&#44; pain and confusion&#44; palliative sedation is indicated&#44; provided the patient has given their explicit or delegated consent&#46; In a Cochrane review that included 4167 adult terminal patients&#44; palliative sedation was employed in 27&#37; of the cases&#46; In our study&#44; sedation was prescribed for 57&#46;4&#37; of the terminal patients&#46; Other studies in Spain&#44;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">34&#44;37</span></a> Germany&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a> Austria&#44;<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&#44; and a study in Italy observed a use of 64&#37; in patients with cancer&#46;<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&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We observed a number of differences between the patients with cancer and those without cancer&#46; The patients with cancer were more aware of their prognosis and therefore probably received more psychological care&#44; died in individual rooms and were accompanied by their relatives&#44; who were provided more grief care&#46; 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&#46;</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&#44; reflecting a lack of protocolization in the process of care in the last days of life and of care after the death&#46; Improving these aspects is essential for achieving a good death for our patients&#46; A clinical trial has shown that the implementation of specific care programs can improve the wellbeing surrounding death for the elderly&#46;<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&#44; which is one of its strength&#46; The study does&#44; however&#44; have limitations&#46; Firstly&#44; this was a retrospective study&#44; although a number of authors have considered that the retrospective approach has advantages for studies on end-of-life care&#44; because it helps easily identify the patient cohort and allows researchers to study all patients and not just a random sample&#44; which enables the rapid development of indicators to assess the delivery of care&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a> Secondly&#44; 10 cases were collected from all hospitals without considering the number of beds or admissions&#44; which could mean that the value of the data from some of the hospitals could be underestimated or overestimated&#46; Nonetheless&#44; the wide representation of hospitals from all levels minimizes this limitation&#46; Lastly&#44; all data were collected from the medical records&#44; and it is very likely that some of the care was delivered but not recorded&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion&#44; there is an insufficient record of information regarding end-of-life care in medical records&#46; There are also differences in the care provided to patients with cancer and to those without cancer&#46; Protocols and good clinical practice standards need to be established and implemented in the care provided during the dying process&#44; especially for patients without cancer&#46;</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&#46;</p></span></span>"
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        "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&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; cross-sectional&#44; retrospective multicenter&#44; clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1&#44; 2015&#46; We collected demographic and clinical data and information regarding the circumstances and care at the time of death&#46;</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&#46; Of these&#44; 1065 &#40;74&#46;3&#37;&#41; were polypathological&#44; 751 &#40;51&#46;9&#37;&#41; were terminal and 248 &#40;17&#46;1&#37;&#41; had cancer&#46; For the terminal patients&#44; do-not-resuscitate orders were established for 539 &#40;73&#46;3&#37;&#41;&#44; and palliative sedation was performed for 422 &#40;57&#46;4&#37;&#41;&#46; There was no record as to whether psychological&#44; religious or grief care was provided in 32&#37;&#44; 64&#46;8&#37; and 44&#46;1&#37; of the terminal patients&#44; respectively&#46; The patients with cancer were more often competent to make decisions &#40;54&#46;4&#37; vs&#46; 15&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; knew their prognosis &#40;42&#46;6&#37; vs&#46; 8&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; received psychological care &#40;24&#46;9&#37; vs&#46; 8&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; died in an individual room &#40;64&#46;6&#37; vs&#46; 44&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and were accompanied &#40;81&#46;9&#37; vs&#46; 71&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46; Their relatives also more frequently received grief care &#40;15&#46;6&#37; vs&#46; 8&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;</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&#46; There are differences in the care provided to patients with cancer and to those without cancer&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "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&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal&#44; retrospectivo y multic&#233;ntrico de auditor&#237;a cl&#237;nica&#46; Cada hospital incluy&#243; los 10 primeros pacientes fallecidos en el servicio de medicina interna a partir del 1 de diciembre de 2015&#46; Se recogieron datos demogr&#225;ficos&#44; cl&#237;nicos y de circunstancias y cuidados en la muerte&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1&#46;447 pacientes&#44; con una mediana de edad de 84 a&#241;os&#46; Eran pluripatol&#243;gicos 1&#46;065 &#40;74&#44;3&#37;&#41;&#44; estaban en situaci&#243;n terminal 751 &#40;51&#44;9&#37;&#41; y ten&#237;an c&#225;ncer 248 &#40;17&#44;1&#37;&#41; pacientes&#46; En los pacientes terminales se estableci&#243; una orden de no reanimaci&#243;n en 539 &#40;73&#44;3&#37;&#41; y se realiz&#243; sedaci&#243;n paliativa en 422 &#40;57&#44;4&#37;&#41;&#46; No se registr&#243; si se proporcionaron cuidados psicol&#243;gicos&#44; religiosos o de atenci&#243;n al duelo en el 32&#44; 64&#44;8 y 44&#44;1&#37;&#44; respectivamente&#44; de los pacientes terminales&#46; Los pacientes con c&#225;ncer con m&#225;s frecuencia eran competentes para la toma de decisiones &#40;54&#44;4&#37; vs&#46; 15&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; conoc&#237;an su pron&#243;stico &#40;42&#44;6&#37; vs&#46; 8&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; recibieron cuidados psicol&#243;gicos &#40;24&#44;9&#37; vs&#46; 8&#44;6&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; fallecieron en una habitaci&#243;n individual &#40;64&#44;6&#37; vs&#46; 44&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y estuvieron acompa&#241;ados &#40;81&#44;9&#37; vs&#46; 71&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Adem&#225;s&#44; sus familiares recibieron con m&#225;s frecuencia atenci&#243;n al duelo &#40;15&#44;6&#37; vs&#46; 8&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</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 cl&#237;nicas de los cuidados al final de la vida&#46; Hay diferencias en los cuidados proporcionados a los pacientes con y sin c&#225;ncer&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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    ]
    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">The names of the UDVIMI study researchers are listed in <a class="elsevierStyleCrossRef" href="#sec0060">Appendix</a>&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; D&#237;ez-Manglano J&#44; Isasi de Isasmendi P&#233;rez S&#44; Rubio G&#243;mez M&#44; Formiga F&#44; S&#225;nchez Mu&#241;oz L&#193;&#44; Castiella Herrero J&#44; et al&#46; Cuidados en los &#250;ltimos d&#237;as de vida en los pacientes hospitalizados en medicina interna&#46; Rev Clin Esp&#46; 2019&#58;219&#58;107&#8211;115&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:3 [
            "apendice" => "<p id="par0135" class="elsevierStylePara elsevierViewall">Jes&#250;s D&#237;ez-Manglano&#44; Soledad Isasi de Isasmendi P&#233;rez&#44; Marta Rubio G&#243;mez&#44; Magdalena Mart&#237;n P&#233;rez&#44; Luis Felipe D&#237;ez Garc&#237;a&#44; Ignacio Vallejo Maroto&#44; Cristina Oca&#241;a Losada&#44; Pilar Giner Escobar&#44; Catalina D&#237;az P&#233;rez&#44; Javier Caballero Granado&#44; Resfa Mar&#237;a Garc&#237;a Font&#44; Francisco J&#46; J&#243;dar Lorente&#44; Gloria P&#233;rez V&#225;zquez&#44; Ana Bel&#233;n Ferro Exp&#243;sito&#44; Mar&#237;a Luisa Amaya Gonz&#225;lez&#44; Fernando Gamboa Anti&#241;olo&#44; &#193;lvaro Gonz&#225;lez Molina&#44; Mercedes G&#243;mez Hern&#225;ndez&#44; Marcos Guzm&#225;n Garc&#237;a&#44; Lola Ben&#237;tez Le&#243;n&#44; Lorena Montero Rivas&#44; Mar&#237;a Ruiz Mariscal&#44; Noelia G&#243;mez Aguirre&#44; Mar&#237;a Pilar Gonz&#225;lez Garc&#237;a&#44; Isabel Mart&#237;n Algora&#44; Mar&#237;a Carmen Bueno Castel&#44; Fernando Ruiz Laiglesia&#44; Esperanza Bejarano Tello&#44; Jos&#233; Luis Cabrerizo Garc&#237;a&#44; Nuria Guiral Fern&#225;ndez&#44; Luis Camera&#44; Carla Gauna&#44; Pedro Abad Requejo&#44; Roc&#237;o Mart&#237;nez Guti&#233;rrez&#44; Rebeca Fern&#225;ndez Regueiro&#44; Mar&#237;a Teresa S&#225;nchez Vidal&#44; Joaqu&#237;n Alfonso Mejido&#44; Enrique Garc&#237;a Car&#250;s&#44; Carmen Elena Calvo Rodr&#237;guez&#44; Paula Mart&#237;nez Garc&#237;a&#44; Sixto Ruiz Olivares&#44; Mar&#237;a Isabel Fullana Barcelo&#44; Carmen Gonz&#225;lez Arencibia&#44; Rosa Ros Vilamaj&#243;&#44; Mar&#237;a Jos&#233; Monedero Prieto&#44; Concepci&#243;n Gonz&#225;lez Becerra&#44; Sof&#237;a P&#233;rez&#44; Andrea Mart&#237;n Plata&#44; Raquel Portilla Chocarro&#44; Carlos Due&#241;as Guti&#233;rrez&#44; Francisco Estrada &#193;lvarez&#44; Sonia Pe&#241;a Balbuena&#44; Ra&#250;l Rodr&#237;guez Galindo&#44; Marta Mar&#237;a Cobos Siles&#44; Luis &#193;ngel S&#225;nchez Mu&#241;oz&#44; Ana Casta&#241;&#243;n L&#243;pez&#44; Celia Sanz Lobo&#44; Mar&#237;a Montserrat Chimeno Vi&#241;as&#44; Mar&#237;a &#193;ngeles Contreras Uriel&#44; Judit Gil Dom&#237;nguez&#44; Francisco Medrano Gonz&#225;lez&#44; Jos&#233; Manuel Mach&#237;n L&#225;zaro&#44; Jeffrey Magallanes Gamboa&#44; M&#243;nica Rodr&#237;guez Galdeano&#44; Joaqu&#237;n Castro Gim&#233;nez&#44; Jos&#233; Ram&#243;n Barber&#225; Farr&#233;&#44; Raquel N&#250;&#241;ez Arag&#243;n&#44; Ferr&#225;n Masan&#233;s Tor&#225;n&#44; Jos&#233; Barb&#233;&#44; Elena G&#252;ell Farr&#233;&#44; Olga Torres Bonafonte&#44; Ana Lozano Mi&#241;ana&#44; Desir&#233;e Moras Sarabia&#44; Rosa P&#233;rez&#44; Dolors Arnau i Fern&#225;ndez&#44; Francesc Formiga&#44; Javier Fern&#225;ndez Fern&#225;ndez&#44; Antoni Castro Salom&#243;&#44; Rami Qanneta&#44; Mar&#237;a Victoria Pardo Ortega&#44; Cristina Estrada D&#237;az&#44; Yasmina Monterroso Pintado&#44; Montserrat Garc&#237;a Cors&#44; Mar&#237;a Cruz Almendros Rivas&#44; Dolors Domingo Albin&#44; Jaume Roig Morera&#44; Nuria Galofr&#233; &#193;lvaro&#44; Aythami Toro Parodi&#44; Mario Loureiro S&#225;nchez&#44; Carla de la Guerra Acebal&#44; Javier Zubizarreta Garc&#237;a&#44; Iasone Benavente Claveras&#44; Juan Mart&#237; Cabanes&#44; Ignacio Sanz L&#225;zaro&#44; Jos&#233; Barquero Romero&#44; Leticia Nevado L&#243;pez-Alegr&#237;a&#44; Jos&#233; Carlos Ar&#233;valo Lorido&#44; Emilio Casariego Vales&#44; Ana Mar&#237;a Lorenzo Vizcaya&#44; Cristina Mac&#237;a Rodr&#237;guez&#44; Silvia P&#233;rez Fern&#225;ndez&#44; Pascual Sesma S&#225;nchez&#44; Mar&#237;a Dolores Jim&#233;nez-Beatty&#44; Laura Gonz&#225;lez V&#225;zquez&#44; &#193;ngel Brea Hernando&#44; Jes&#250;s Castiella Herrero&#44; Mar&#237;a Isabel Gonz&#225;lez Anglada&#44; Virginia M&#46; Gracia Lorenzo&#44; Alejandro P&#233;rez Mart&#237;n&#44; Gerardo Garc&#237;a Melc&#243;n&#44; Mar&#237;a G&#243;mez Ant&#250;nez&#44; Mar&#237;a Angustias Quesada Sim&#243;n&#44; Fuensanta Gil Gil&#44; Mar&#237;a Asenjo Mart&#237;nez&#44; Lourdes Mancebo Aragoneses&#44; Jorge Calder&#243;n Parra&#44; Mar&#237;a del Carmen Romero P&#233;rez&#44; Jos&#233; Curbelo Garc&#237;a&#44; Fernando Laguna Cuesta&#44; Mar&#237;a Eugenia Segovia Abad&#44; Mar&#237;a Fontecha Ortega&#44; Guillermina Lara Mart&#237;nez&#44; Ana Pinos Blanco&#44; Raquel Rodil Fraile&#44; Elisabel Mart&#237;nez Litago&#44; Aitziber Echeverr&#237;a Echeverr&#237;a&#44; Manuel Priego Valladares&#44; Carlos Trescoli Serrano&#44; Josep Vicente Mas&#44; &#211;scar Torregrosa Suau&#44; Eva Gil Tom&#225;s&#44; Rafael Castillo Rubio&#44; Jos&#233; Manuel Murcia Zaragoza&#44; Pilar Rom&#225;n S&#225;nchez&#44; Ana Garc&#237;a Herola&#44; Pedro Pablo Tenllado Doblas&#44; Julio C&#233;sar Bl&#225;zquez Encinar&#44; Enrique Castellano Vela&#44; N&#233;stor Carrizo&#44; Vicente Giner Galva&#241;&#44; Bernardino Manuel Roca Villanueva&#44; Francisco Pasquau Lia&#241;o&#44; Jos&#233; Mar&#237;a Pascual Izuel</p>"
            "etiqueta" => "Appendix&#46; 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
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        ]
        "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&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The data are presented as frequency &#40;percentage&#41; or median &#40;interquartile range&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
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                  <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">&nbsp;\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 &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1447&#41;&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1229&#41;&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>218&#41;&nbsp;\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>&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>814&#41;&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>633&#41;&nbsp;\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>&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;78&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;79&#8211;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;5 &#40;75&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;79&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;78&#8211;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;142&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">699 &#40;48&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">590 &#40;48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;587&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">405 &#40;49&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">294 &#40;46&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;211&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">343 &#40;23&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">282 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">217 &#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1065 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">903 &#40;74&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162 &#40;75&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;804&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">605 &#40;75&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">460 &#40;73&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;363&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">710 &#40;52&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">620 &#40;53&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">389 &#40;51&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">321 &#40;55&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;133&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">788 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">672 &#40;56&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;752&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">444 &#40;56&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">344 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;711&nbsp;\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 &#40;Barthel index&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;10&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;10&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;10&#8211;73&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;800&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;10&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;10&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;502&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;5&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;5&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;5&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;5&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;5&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;968&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">910 &#40;62&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">766 &#40;62&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144 &#40;66&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">507 &#40;62&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">403 &#40;63&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;595&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">751 &#40;51&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">636 &#40;51&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;52&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;785&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">406 &#40;49&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">345 &#40;54&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;081&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1263 &#40;88&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1072 &#40;88&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">191 &#40;88&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;968&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">706 &#40;88&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">557 &#40;88&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;731&nbsp;\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>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;3&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#8211;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5 &#40;3&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;661&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Data from 1404 patients&#46;</p>"
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            4 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Data from 1427 patients&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The data are presented as <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">There were no data on symptoms for 27 terminal patients&#46;</p>"
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                  <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">&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>724&#41;&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>233&#41;&nbsp;\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 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>491&#41;&nbsp;\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>&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">318 &#40;43&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;41&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">214 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;545&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;228&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">282 &#40;38&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;40&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182 &#40;37&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;338&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">351 &#40;47&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;44&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">242 &#40;49&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;242&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;19&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;528&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">217 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;30&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;460&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;414&nbsp;\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;18&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;427&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The data are presented as frequency &#40;percentage&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; CPR&#44; cardiopulmonary resuscitation&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>735&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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>&nbsp;\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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;185&nbsp;\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&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;020&nbsp;\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&#47;or relatives received psychological care&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;24&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;114&nbsp;\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&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">539 &#40;73&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">165 &#40;69&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">374 &#40;75&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;116&nbsp;\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&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">422 &#40;57&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;62&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">274 &#40;55&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;057&nbsp;\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&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">374 &#40;50&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;64&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">221 &#40;44&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A family member was present when the patient died&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">552 &#40;75&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">194 &#40;81&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">358 &#40;71&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\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&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Circumstances of death for the terminal patients&#46;</p>"
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    ]
    "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&#58; <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&#58;&#47;&#47;www&#46;saludinforma&#46;es&#47;portalsi&#47;documents&#47;10179&#47;848610&#47;Proceso&#95;Morir&#95;Aragoneses&#95;2015&#46;pdf&#47;483884a9-d10a-49a6-a818-60d37ef75576&#59;jsessionid&#61;EUkBF5-HDsj9t4kLkaPwBgzQ&#46;mov-saludinforma-01&#63;version&#61;1&#46;1</a> &#91;consultado 16 Feb 2018&#93;"
                  "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 => "Direcci&#243;n General de Calidad y Atenci&#243;n al Usuario"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2015"
                        "editorial" => "Gobierno de Arag&#243;n"
                        "editorialLocalizacion" => "Zaragoza"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "comentario" => "Disponible en&#58; <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&#58;&#47;&#47;www&#46;juntadeandalucia&#46;es&#47;salud&#47;export&#47;sites&#47;csalud&#47;galerias&#47;documentos&#47;c&#95;2&#95;c&#95;15&#95;muerte&#95;digna&#47;comoMuerenAndaluces&#47;comoMuerenAndalucesI&#46;pdf</a> &#91;consultado 16 Feb 2018&#93;"
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Sinopsis&#46; C&#243;mo mueren los andaluces I&#46; Informe sobre la aplicaci&#243;n y efectos de la ley 2&#47;2010 de derechos y garant&#237;as 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 Espa&#241;a&#58; una perspectiva de 20 a&#241;os"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Casademont"
                            1 => "E&#46; Francia"
                            2 => "O&#46; Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2012"
                        "volumen" => "138"
                        "paginaInicial" => "289"
                        "paginaFinal" => "292"
                      ]
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                ]
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            3 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ministerio de Sanidad&#44; Servicios Sociales e Igualdad&#46; Hospital Discharge Records in the National Health System&#46; CMBD &#91;consultado 16 Feb 2018&#93;&#46; Disponible en&#58; <a id="intr0020" class="elsevierStyleInterRef" href="https://www.msssi.gob.es/estadEstudios/estadisticas/cmbdhome.htm">https&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;estadEstudios&#47;estadisticas&#47;cmbdhome&#46;htm</a>"
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            ]
            4 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Disponible en&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="http://www.msssi.gob.es/estadEstudios/estadisticas/docs/Hospitalizacion_SNS_CMBD_Informe2010.pdf">http&#58;&#47;&#47;www&#46;msssi&#46;gob&#46;es&#47;estadEstudios&#47;estadisticas&#47;docs&#47;Hospitalizacion&#95;SNS&#95;CMBD&#95;Informe2010&#46;pdf</a> &#91;consultado 16 Feb 2018&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La hospitalizaci&#243;n en el Sistema Nacional de Salud CMBD &#8211; Registro de altas&#46; Informe resumen 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Instituto de Informaci&#243;n Sanitaria"
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                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "Ministerio de Sanidad&#44; Servicios Sociales e Igualdad"
                        "editorialLocalizacion" => "Madrid"
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              ]
            ]
            5 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A good death&#46; An important aim for health services and for all us"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Smith"
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                        ]
                      ]
                    ]
                  ]
                  "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"
                          ]
                        ]
                      ]
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                ]
              ]
            ]
            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&#58; the best is yet to come"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Debate of the Age Health&#44; 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&#47;2010&#44; de 8 de abril&#44; de derechos y garant&#237;as de la dignidad de la persona en el proceso de la muerte&#46; Bolet&#237;n Oficial de la Junta de Andaluc&#237;a&#44; 07&#47;05&#47;2010&#46; Disponible en&#58; <a id="intr0030" class="elsevierStyleInterRef" href="http://www.juntadeandalucia.es/boja/2010/88/1">http&#58;&#47;&#47;www&#46;juntadeandalucia&#46;es&#47;boja&#47;2010&#47;88&#47;1</a> &#91;consultado 16 Feb 2018&#93;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "9"
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