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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; we have witnessed the advent and establishment of polypathological patients in the practice of internal medicine&#46; The inversion of the population pyramid&#44; medical advances and social progress form the three pillars of this new patient profile&#44; which expends a considerable portion of our time and healthcare resources&#44; with still much more to come&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This expanding group typically shares the traits of frailty and high dependence&#44; an increasingly common situation in internal medicine&#46; These patients are elderly&#44; often live alone&#44; and many times require assistance for their daily activities&#46; Their needs grow the older they get&#44; as their loneliness deepens and as their polypathology progresses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is therefore a growing need to go beyond the clinical assessment and physical examination performed in daily practice and that is taught to internal medicine students&#46; These patients&#8217; frailty and thus their degree of dependence should form part of the clinical assessment&#44; given the percentage of polypathological patients treated in internal medicine&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study by Bernabeu-Wittel et al&#46; published in this issue of the journal highlights this problem&#46; As mentioned by the authors&#44; most polypathological patients have varying degrees of dependence&#44; which can be severe in more than 30&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> A healthcare intervention cannot be conducted&#44; either individually or as a whole&#44; for these patients without first conducting a frailty assessment&#46; The Barthel index &#40;BI&#41; is the most commonly used tool for this assessment&#44; but employing the index lengthens the time clinicians spend with patients in the initial clinical assessment&#46; The authors propose simplifying the previous screening using an abbreviated BI that facilitates and shortens the initial assessment&#46; To this end&#44; the authors designed a cross-sectional multicenter study that included more than 1600 patients &#40;most from hospitals with some outpatient representation and home hospitalization&#41;&#46; After performing a complete BI&#44; the authors identified those items with better positive and negative predictive values for obtaining a BI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90 points&#46; The item with the highest negative predictive value was the ability to feed and groom oneself&#46; The items with the highest positive predictive value were the ability to walk and go up and down stairs&#46; The authors proposed an algorithm for applying this simplified BI whose first question is&#44; &#8220;Can the patient go up and down stairs&#63;&#8221; If the patient is able to do so&#44; the BI is &#62;90&#44; and a full BI needs to be performed&#46; If the patient is unable to do so&#44; the next question is&#44; &#8220;Can the patient feed themselves&#63;&#8221; If they can&#44; the BI is between 60 and 89&#44; indicating the patient has moderate dependence and that a full BI needs to be performed&#46; If they unable to do so&#44; the BI is &#60;60&#44; indicating the patient has severe dependence&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors recognize that the lack of validation of the study&#39;s results with an independent patient cohort is one of the study&#39;s weaknesses&#46; There is also a disproportion between the number of hospitalized patients and outpatients in the sample&#46; The study&#39;s strengths are the participation of 37 hospital centers distributed throughout Spain and the considerable number of patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion&#44; this is an original study in its approach&#44; which achieves useful results if they can be validated&#46; Of course&#44; the authors are aiming in the right direction&#46; One has to look no further than the study&#39;s first table&#44; which shows the characteristics of this consecutively recruited patient cohort&#46; Here are just some of the data&#58; the number of comorbidities per patient was 4&#46;5&#44; 70&#37; had high blood pressure&#44; 35&#37; had atrial fibrillation&#44; the mean Charlson index was 4&#44; 47&#37; had a New York Heart Association classification of III-IV&#44; and 31&#37; had a BI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is the setting in which we work&#44; a scenario that could worsen&#46; Including information regarding frailty and dependence in the assessment of our patients in a global and practical manner appears to be essential&#46; On the other hand&#44; we increasingly need to work fast and in a variety of settings&#46; In our opinion&#44; the study by Bernabeu-Wittel et al&#46; is heading in that direction&#58; an abbreviated and fast BI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At this time&#44; 46&#37; of discharges from internal medicine departments are of patients 80 years or older&#44; and attendance in internal medicine departments increases as the population age group that requires the most treatment increases&#46; The latest RECALMIN report<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> recommends having specific information on the healthcare needs of patients older than 80 years admitted to internal medicine departments&#46; It is precisely these groups<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> that have specific requirements and for which the same hospitalization process can increase the patient&#39;s frailty and vulnerability and result in readmissions&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The latest RECALMIN survey showed that only 54&#37; of the departments stated having implemented a systematic care program for complex chronic patients&#44; which covered only 31&#37; of the Spanish population&#46; There is therefore a noticeable gap between the recommendations of the standards document for multiple-disease units<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and the strategy for approaching chronicity in the Spanish national health system&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is still much to do&#46; It is essential that we give frailty and dependence the place they deserve and include them definitively in our medical records&#44; assessments and documents&#46; A major step would be to progress toward their quick and reliable assessment&#46;</p></span>"
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                    0 => array:2 [
                      "titulo" => "Functional decline over one-year follow up in a multicenter cohort of polypathological patients&#58; a new approach to functional prognostication"
                      "autores" => array:1 [
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                          "autores" => array:6 [
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                            1 => "M&#46; Ollero-Baturone"
                            2 => "A&#46; Ruiz-Cantero"
                            3 => "L&#46; Moreno-Gavi&#241;o"
                            4 => "B&#46; Bar&#243;n-Franco"
                            5 => "A&#46; Fuertes"
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                        "tituloSerie" => "Int J Gerontol"
                        "fecha" => "2012"
                        "volumen" => "6"
                        "paginaInicial" => "68"
                        "paginaFinal" => "74"
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas cl&#237;nicas&#44; funcionales&#44; mentales y sociales de pacientes pluripatol&#243;gicos estudio prospectivo durante un a&#241;o en Atenci&#243;n Primaria"
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                            2 => "M&#46; Bernabeu-Wittel"
                            3 => "M&#46; Rinc&#243;n-G&#243;mez"
                            4 => "M&#46;A&#46; Ortiz-Camu&#241;ez"
                            5 => "S&#46; Garc&#237;a-Morillo"
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                        "paginaInicial" => "4"
                        "paginaFinal" => "11"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18221654"
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                            1 => "R&#46; Gomez-Huelgas"
                            2 => "J&#46; Diez-Manglano"
                            3 => "R&#46; Barba-Mart&#237;n"
                            4 => "J&#46; Carretero-Gomez"
                            5 => "A&#46; Maestre-Peir&#243;"
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Editorial
The importance of evaluating fragility and dependence
La importancia de evaluar la fragilidad y la dependencia
J. Marco Martíneza,
Corresponding author
javiermarco.z@gmail.com

Corresponding author.
, S. Plaza Cantelib
a Sección Medicina Perioperatoria, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Cuidados Paliativos, Hospital Severo Ochoa, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; we have witnessed the advent and establishment of polypathological patients in the practice of internal medicine&#46; The inversion of the population pyramid&#44; medical advances and social progress form the three pillars of this new patient profile&#44; which expends a considerable portion of our time and healthcare resources&#44; with still much more to come&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This expanding group typically shares the traits of frailty and high dependence&#44; an increasingly common situation in internal medicine&#46; These patients are elderly&#44; often live alone&#44; and many times require assistance for their daily activities&#46; Their needs grow the older they get&#44; as their loneliness deepens and as their polypathology progresses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is therefore a growing need to go beyond the clinical assessment and physical examination performed in daily practice and that is taught to internal medicine students&#46; These patients&#8217; frailty and thus their degree of dependence should form part of the clinical assessment&#44; given the percentage of polypathological patients treated in internal medicine&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study by Bernabeu-Wittel et al&#46; published in this issue of the journal highlights this problem&#46; As mentioned by the authors&#44; most polypathological patients have varying degrees of dependence&#44; which can be severe in more than 30&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> A healthcare intervention cannot be conducted&#44; either individually or as a whole&#44; for these patients without first conducting a frailty assessment&#46; The Barthel index &#40;BI&#41; is the most commonly used tool for this assessment&#44; but employing the index lengthens the time clinicians spend with patients in the initial clinical assessment&#46; The authors propose simplifying the previous screening using an abbreviated BI that facilitates and shortens the initial assessment&#46; To this end&#44; the authors designed a cross-sectional multicenter study that included more than 1600 patients &#40;most from hospitals with some outpatient representation and home hospitalization&#41;&#46; After performing a complete BI&#44; the authors identified those items with better positive and negative predictive values for obtaining a BI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90 points&#46; The item with the highest negative predictive value was the ability to feed and groom oneself&#46; The items with the highest positive predictive value were the ability to walk and go up and down stairs&#46; The authors proposed an algorithm for applying this simplified BI whose first question is&#44; &#8220;Can the patient go up and down stairs&#63;&#8221; If the patient is able to do so&#44; the BI is &#62;90&#44; and a full BI needs to be performed&#46; If the patient is unable to do so&#44; the next question is&#44; &#8220;Can the patient feed themselves&#63;&#8221; If they can&#44; the BI is between 60 and 89&#44; indicating the patient has moderate dependence and that a full BI needs to be performed&#46; If they unable to do so&#44; the BI is &#60;60&#44; indicating the patient has severe dependence&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors recognize that the lack of validation of the study&#39;s results with an independent patient cohort is one of the study&#39;s weaknesses&#46; There is also a disproportion between the number of hospitalized patients and outpatients in the sample&#46; The study&#39;s strengths are the participation of 37 hospital centers distributed throughout Spain and the considerable number of patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion&#44; this is an original study in its approach&#44; which achieves useful results if they can be validated&#46; Of course&#44; the authors are aiming in the right direction&#46; One has to look no further than the study&#39;s first table&#44; which shows the characteristics of this consecutively recruited patient cohort&#46; Here are just some of the data&#58; the number of comorbidities per patient was 4&#46;5&#44; 70&#37; had high blood pressure&#44; 35&#37; had atrial fibrillation&#44; the mean Charlson index was 4&#44; 47&#37; had a New York Heart Association classification of III-IV&#44; and 31&#37; had a BI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is the setting in which we work&#44; a scenario that could worsen&#46; Including information regarding frailty and dependence in the assessment of our patients in a global and practical manner appears to be essential&#46; On the other hand&#44; we increasingly need to work fast and in a variety of settings&#46; In our opinion&#44; the study by Bernabeu-Wittel et al&#46; is heading in that direction&#58; an abbreviated and fast BI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At this time&#44; 46&#37; of discharges from internal medicine departments are of patients 80 years or older&#44; and attendance in internal medicine departments increases as the population age group that requires the most treatment increases&#46; The latest RECALMIN report<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> recommends having specific information on the healthcare needs of patients older than 80 years admitted to internal medicine departments&#46; It is precisely these groups<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> that have specific requirements and for which the same hospitalization process can increase the patient&#39;s frailty and vulnerability and result in readmissions&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The latest RECALMIN survey showed that only 54&#37; of the departments stated having implemented a systematic care program for complex chronic patients&#44; which covered only 31&#37; of the Spanish population&#46; There is therefore a noticeable gap between the recommendations of the standards document for multiple-disease units<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and the strategy for approaching chronicity in the Spanish national health system&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is still much to do&#46; It is essential that we give frailty and dependence the place they deserve and include them definitively in our medical records&#44; assessments and documents&#46; A major step would be to progress toward their quick and reliable assessment&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Marco Mart&#237;nez J&#44; Plaza Canteli S&#46; La importancia de evaluar la fragilidad y la dependencia&#46; Rev Clin Esp&#46; 2019&#59;219&#58;449&#8211;450&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional decline over one-year follow up in a multicenter cohort of polypathological patients&#58; a new approach to functional prognostication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Bernabeu-Wittel"
                            1 => "M&#46; Ollero-Baturone"
                            2 => "A&#46; Ruiz-Cantero"
                            3 => "L&#46; Moreno-Gavi&#241;o"
                            4 => "B&#46; Bar&#243;n-Franco"
                            5 => "A&#46; Fuertes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Gerontol"
                        "fecha" => "2012"
                        "volumen" => "6"
                        "paginaInicial" => "68"
                        "paginaFinal" => "74"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas cl&#237;nicas&#44; funcionales&#44; mentales y sociales de pacientes pluripatol&#243;gicos estudio prospectivo durante un a&#241;o en Atenci&#243;n Primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Ram&#237;rez-Duque"
                            1 => "M&#46; Ollero-Baturone"
                            2 => "M&#46; Bernabeu-Wittel"
                            3 => "M&#46; Rinc&#243;n-G&#243;mez"
                            4 => "M&#46;A&#46; Ortiz-Camu&#241;ez"
                            5 => "S&#46; Garc&#237;a-Morillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1157/13115000"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2008"
                        "volumen" => "208"
                        "paginaInicial" => "4"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18221654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "RECALMIN&#46; Four years of growth of the internal medicine units of the Spanish National Health System &#40;2013&#8211;2016&#41; &#91;Article in English&#44; Spanish&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Zapatero-Gaviria"
                            1 => "R&#46; Gomez-Huelgas"
                            2 => "J&#46; Diez-Manglano"
                            3 => "R&#46; Barba-Mart&#237;n"
                            4 => "J&#46; Carretero-Gomez"
                            5 => "A&#46; Maestre-Peir&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2018.11.005"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2019"
                        "volumen" => "219"
                        "paginaInicial" => "171"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30808505"
                            "web" => "Medline"
                          ]
                        ]
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            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonagenarios en los servicios de Medicina Interna espa&#241;oles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; L&#225;zaro"
                            1 => "J&#46; Marco"
                            2 => "R&#46; Barba"
                            3 => "J&#46;M&#46; Ribera"
                            4 => "S&#46; Plaza"
                            5 => "A&#46; Zapatero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.regg.2012.02.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Geriatr Gerontol"
                        "fecha" => "2012"
                        "volumen" => "47"
                        "paginaInicial" => "193"
                        "paginaFinal" => "197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22884638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-hospital syndrome&#8212;an acquired transient condition of generalized risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;M&#46; Krumholz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "100"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehospitalizations among patients in the Medicare fee-forservice program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Jencks"
                            1 => "M&#46;V&#46; Williams"
                            2 => "E&#46;A&#46; Coleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0803563"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "1418"
                        "paginaFinal" => "1428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0091674916307953"
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                          "issn" => "00916749"
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0075"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Palanca I&#44; Medina J&#44; Elola FJ&#44; Bernal JL&#44; Paniagua JL&#44; Grupo de Expertos&#46; Unidad de Pacientes Pluripatol&#243;gicos&#46; Est&#225;ndares y Recomendaciones&#46; Agencia de Calidad del SNS&#46; Ministerio de Sanidad y Pol&#237;tica Social&#59; 2009&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estrategia para el Abordaje de la Cronicidad en el Sistema Nacional de Salud"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ferrer"
                            1 => "D&#46; Orozco"
                            2 => "P&#46; Rom&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2012"
                        "editorial" => "Ministerio de Sanidad&#44; Servicios Sociales e Igualdad"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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