Editorial
Areas for improvement in end-of-life care
Áreas de mejora en la asistencia al final de la vida
a Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Grupo de Trabajo de Bioética y Profesionalismo de Sociedad Española de Medicina Interna, Spain
b Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid. Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, Spain
Read
15
Timeswas read the article
6
Total PDF
9
Total HTML
Share statistics
array:24 [ "pii" => "S2254887421000503" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.06.011" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1887" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2021;221:341-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256520301788" "issn" => "00142565" "doi" => "10.1016/j.rce.2020.06.007" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1887" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2021;221:341-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Áreas de mejora en la asistencia al final de la vida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Areas for improvement in end-of-life care" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García Caballero, B. Herreros" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García Caballero" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Herreros" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887421000503" "doi" => "10.1016/j.rceng.2020.06.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000503?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301788?idApp=WRCEE" "url" => "/00142565/0000022100000006/v1_202106022027/S0014256520301788/v1_202106022027/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887421000485" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.03.005" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1825" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2021;221:343-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Hypertrophic cardiomyopathy: Beyond left ventricular hypertrophy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "344" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miocardiopatía hipertrófica: más allá de la hipertrofia ventricular izquierda" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Hernández Quiles, L.M. Beltrán Romero" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Hernández Quiles" ] 1 => array:2 [ "nombre" => "L.M." "apellidos" => "Beltrán Romero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520301028" "doi" => "10.1016/j.rce.2020.03.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301028?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000485?idApp=WRCEE" "url" => "/22548874/0000022100000006/v2_202106050640/S2254887421000485/v2_202106050640/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S225488742100059X" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.04.012" "estado" => "S300" "fechaPublicacion" => "2021-06-01" "aid" => "1858" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2021;221:331-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Statin adherence and health outcomes after st-elevation myocardial infarction: 1-year follow-up study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "340" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adherencia a estatinas y resultados en salud durante un año de seguimiento tras infarto agudo de miocardio con elevación del segmento ST" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 928 "Ancho" => 1675 "Tamanyo" => 70394 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cumulative incidence curves of cardiovascular mortality during the first year of follow-up.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Padilla López" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Padilla López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520301375" "doi" => "10.1016/j.rce.2020.04.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301375?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742100059X?idApp=WRCEE" "url" => "/22548874/0000022100000006/v2_202106050640/S225488742100059X/v2_202106050640/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Areas for improvement in end-of-life care" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "342" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. García Caballero, B. Herreros" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "García Caballero" "email" => array:1 [ 0 => "rebecagarciacaballero@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Herreros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid. Grupo de Trabajo de Bioética y Profesionalismo de Sociedad Española de Medicina Interna, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid. Instituto de Ética Clínica Francisco Vallés-Universidad Europea, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Áreas de mejora en la asistencia al final de la vida" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">End-of-life care has evolved in recent decades and now forms part of good clinical practice. Healthcare at the end of life has been institutionalized, professionalized, and medicalized and is now part of daily practice in internal medicine.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> This care for and palliation of terminal illness is no longer considered optional, rather it is an ethical and professional obligation. Just as it is obligatory to prescribe antibiotics for bacterial pneumonia, for patients at the end of life, initiating palliative measures is an unavoidable duty. For all patients, we must seek out the best option for their health, inform them, and request consent, whether it is pneumonia or the end of life.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The change that has taken place in end-of-life care in recent years has affected healthcare professionals, patients and their families, and society as a whole. This transition has been accompanied by confusion and has led to misunderstandings about what end-of-life care should be. Before, when terminal patients were deemed lost causes, they passed away in their homes surrounded by their loved ones, but endured enormous physical suffering. With the later medicalization and technicalization of death, patients then died in acute-care hospitals,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> where attempts were made to prolong life at all costs because medicine “could do everything.” In the journey towards palliation, physicians have had to learn to refocus the aims of medicine, to know and manage its limits, and to comprehensively care for patients in the final stage of life.</p><p id="par0015" class="elsevierStylePara elsevierViewall">However, this change has not been accompanied by adequate training for internal medicine physicians (some of the protagonists in end-of-life care) on palliative care, communication, and bioethics.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Internists have had to learn on the fly in their day-to-day about this complex area of knowledge. In a recent survey, only one out of every four internists know what limitation of therapeutic efforts was. Forty-three percent did not have training on palliative care, and more than 60% had anxiety when facing the planning of end-of-life care with patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This is why the Best Practices at the End of Life Guide by the Spanish and Portuguese Societies of Internal Medicine is so important.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This guide is an essential training document for clinicians who treat patients at the end of life, although it is not the first of its kind. Various scientific societies,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a> institutions,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> hospitals, and private groups<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> have established and published their indications. But compared to others, this guide has the advantage of having been created by means of a rigorous Delphi process which included 105 Spanish and Portuguese panelists (the majority of whom are physicians but which also includes lawyers, experts in bioethics, managers, politicians, and journalists), which lends great external validity to its recommendations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The guide proposes 37 recommendations with a high degree of consensus that are structured in different groups: patient identification; the patient’s knowledge, values, and preferences; information; the patient's needs; attention and care; palliative sedation; and care after death. In an attempt at synthesis, it explains the recommendations and contextualizes them legally. With all of this, it intends to improve the care and attention in patients' final last days and ensure a good death. For this to occur, it is necessary for professionals to speak the same language; this is possible through the guide, which is eminently clear. All of this is in addition to the fact that a consensus document on end-of-life care provides support to professionals and decreases the stress that these situations cause.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Like all guides, the document is oriented towards the majority of cases and situations. However, it is the clinicians who then have to know that treatment must be individualized to each patient and take into account their circumstances.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> As one of the principles of a good death, one of the recommendations states that patients should be accompanied by their caregivers and loved ones. During the SARS-CoV-2 crisis, this principle has not been able to be fully abided by, which has caused great emotional stress in patients, their loved ones (generating possible pathological grief), and professionals. However, this does not invalidate this recommendation: the guide provides guidance on how treatment should be for patients at the end of life, even if a specific patient or a certain circumstance does not allow all of its recommendations to be fully carried out.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The guide and its recommendations are useful both for experts in palliative care and for physicians who are less familiarized with managing patients at the end of life. During this epidemic, many physicians who were not used to treating patients in the final days of life have had to confront this. Managing and facing death has been an additional source of stress for them on top of the difficult situation they were already living through. This guide would have been of great help to all, experts and nonexperts alike.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The professionals who treat patients at the end of life know what their objectives are, how to achieve them, and, most of all, that these objectives are based on rigor.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Caballero R, Herreros B. Áreas de mejora en la asistencia al final de la vida. Rev Clin Esp. 2021;221:341–342.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Razones para decidir morir en el hospital o en el domicilio. Visión de los/las profesionales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.S. Lima-Rodríguez" 1 => "M.L.R. Asensio-Pérez" 2 => "J.C. Palomo-Lara" 3 => "E.B. Ramírez-López" 4 => "M. Lima-Serrano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2018.04.005" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2018" "volumen" => "32" "paginaInicial" => "362" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29793673" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortalidad esperable en Medicina Interna: ¿cómo son los últimos días de vida en los pacientes en los que la muerte es previsible?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Ameneiros-Lago" 1 => "C. Carballada-Rico" 2 => "J.A. Garrido-Sanjuán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Paliat" "fecha" => "2017" "volumen" => "24" "paginaInicial" => "63" "paginaFinal" => "71" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morir en casa con dignidad. Una posibilidad, si hay apoyo y cuidados de calidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Gervás" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gac Med Bilbao" "fecha" => "2011" "volumen" => "108" "paginaInicial" => "3" "paginaFinal" => "6" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical Ethics Education: Where Are We? Where Should We Be Going? A Review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.E. Eckles" 1 => "E.M. Meslin" 2 => "M. Gaffney" 3 => "P.R. Helft" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00001888-200512000-00020" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2005" "volumen" => "80" "paginaInicial" => "1143" "paginaFinal" => "1152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16306292" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Saben los internistas que es la limitación del esfuerzo terapéutico?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. García Caballero" 1 => "D. Real de Asúa" 2 => "L. García Olmos" 3 => "B. Herreros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2020.01.005" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2021" "volumen" => "221" "paginaInicial" => "274" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33998513" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Díez-Manglano" 1 => "L.Á Sánchez Muñoz" 2 => "R. García Fenoll" 3 => "E. Freire" 4 => "S. Isasi de Isasmendi Pérez" 5 => "A.H. Carneiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rceng.2020.04.009" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2021" "volumen" => "221" "paginaInicial" => "33" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33998477" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Cuidados al final de la vida. Manual SEOM de Cuidados Continuos. [Accessed 9 June 2020]. Available from: <a target="_blank" href="http://www.seom.org/seomcms/images/stories/recursos/sociosyprofs/documentacion/manuales/cuidCont/cuidadosContinuos493-531.pdf">http://www.seom.org/seomcms/images/stories/recursos/sociosyprofs/documentacion/manuales/cuidCont/cuidadosContinuos493-531.pdf</a>." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Guía de cuidados paliativos. Sociedad Española de Cuidados Paliativos. [Accessed 9 June 2020]. Available from: <a target="_blank" href="http://www.secpal.com/%5C%5CDocumentos%5CPaginas%5Cguiacp.pdf">http://www.secpal.com/%5C%5CDocumentos%5CPaginas%5Cguiacp.pdf</a>." ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Galindo Ocaña FJ, Hernández Quiles C, editors Manual de bolsillo de cuidados paliativos para enfermos oncológicos no oncológicos. Grünenthal. [Accessed 9 June 2020]. Available from: <a target="_blank" href="http://www.secpal.com/Documentos/Blog/Manual%20bolsillo%20cuidados%20paliativos%20ONLINE.pdf">http://www.secpal.com/Documentos/Blog/Manual%20bolsillo%20cuidados%20paliativos%20ONLINE.pdf</a>." ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Guía Práctica Clínica sobre Cuidados Paliativos. Vitoria-Gasteiz: Eusko Jaurlaritzaren Argitalpen Zerbitzu Nagusia; 2008. [Accessed 9 June 2020]. Available from: <a target="_blank" href="https://www.osakidetza.euskadi.eus/contenidos/informacion/osk_publicaciones/eu_argital/adjuntos/lehen/cuidadosPaliativos.pdf">https://www.osakidetza.euskadi.eus/contenidos/informacion/osk_publicaciones/eu_argital/adjuntos/lehen/cuidadosPaliativos.pdf</a>." ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones de tratamiento al final de la vida del paciente crítico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Monzón Marín" 1 => "I. Saralegui Reta" 2 => "R. Abizanda i Campos" 3 => "L. Cabré Pericas" 4 => "S. Iribarren Diarasarri" 5 => "M.C. Martín Delgado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0210-5691(08)70922-7" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "121" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18381017" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical ethics protocols in the clinical ethics committees of Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Herreros" 1 => "V.R. Ramnath" 2 => "L. Bishop" 3 => "E. Pintor" 4 => "M.D. Martín" 5 => "M.A. Sánchez-González" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/medethics-2012-100791" "Revista" => array:6 [ "tituloSerie" => "J Med Ethics" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "205" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23579231" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022100000006/v2_202106050640/S2254887421000503/v2_202106050640/en/main.assets" "Apartado" => array:4 [ "identificador" => "72714" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000006/v2_202106050640/S2254887421000503/v2_202106050640/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000503?idApp=WRCEE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 5 | 4 | 9 |
| 2021 July | 1 | 0 | 1 |
| 2021 June | 3 | 2 | 5 |
