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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Nowadays&#44; clinical ultrasonography has become an indispensable tool in general practitioners&#8217; daily practice&#44; providing significant added value in the management of patients in a wide variety of clinical settings&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This technique can be routinely integrated into clinical protocols based on patients&#8217; symptoms or signs and is notable for its versatility and ability to provide real-time&#44; detailed information directly at the patient&#8217;s bedside&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given the rise in use of clinical ultrasound&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> a need was identified for basic recommendations for its effective incorporation into the different branches of medical care&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This consensus document seeks to address fundamental issues&#44; such as a definition of the concept&#44; an outline of essential indications&#44; and the skills required for ultrasound practice according to the different care settings&#46; In addition&#44; it aims to promote standardization and progress in the implementation of ultrasound in order to ensure the quality&#44; systematic use of this diagnostic tool&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The list of recommendations provided is flexible and may be updated to reflect evolving scientific evidence&#44; technological advances&#44; widespread adoption in a specialty&#44; and cost-effectiveness&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The Ultrasound Working Groups of the Spanish Society of Internal Medicine &#40;SEMI&#41;&#59; Spanish Society of Anesthesiology&#44; Resuscitation&#44; and Pain Therapy &#40;SEDAR&#41;&#59; Spanish Society of Geriatrics and Gerontology &#40;SEGG&#41;&#59; Spanish Society of Primary Care Physicians &#40;SEMERGEN&#41;&#59; Spanish Society of Emergency Medicine &#40;SEMES&#41;&#59; Spanish Society of Family and Community Medicine &#40;SEMFyC&#41;&#59; and Spanish Society of General and Family Physicians &#40;SEMG&#41; bring together professionals with extensive experience in the development and promotion of point-of-care multiorgan ultrasound&#46; Several members of these groups held an online meeting via Zoom Meetings&#174; on November 30&#44; 2023&#46; They proposed the need to develop a consensus document to standardize the practical application of clinical ultrasound based on the latest scientific evidence identified through a MEDLINE literature search&#46; The document would also have representation from national experts with experience and knowledge regarding ultrasound from each of the respective societies&#44; valuing the selection of professionals with experience managing ultrasound units&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A group of 28 experts was selected&#44; including the ultrasound coordinators from each of the societies&#58; SEMI &#40;YTC&#41;&#44; SEDAR &#40;MV&#41;&#44; SEMERGEN &#40;MMB&#41;&#44; SEMFYC &#40;ISB&#41;&#44; SEGG &#40;JSR&#41;&#44; SEMG &#40;JSS&#41;&#44; SEMES &#40;TVV&#41;&#46; In addition&#44; advisory members or members from each working group chosen at the discretion of each coordinator were included&#58; SEMI &#40;GGC&#44; JTM&#44; LBR&#41;&#44; SEDAR &#40;AGD&#44; AH&#44; JMM&#41;&#44; SEMERGEN &#40;OMV&#44; EMP&#44; ERU&#44; ASG&#41;&#44; SEMFYC &#40;JSA&#44; RAR&#44; ACC&#41;&#44; SEGG &#40;PRP&#41;&#44; SEMG &#40;ARG&#44; MMR&#44; KFG&#44; IAG&#41;&#44; SEMES &#40;JAV&#44; IGS&#44; RCL&#41;&#46; Each working group had the respective endorsement of the society they represent&#46; The meeting was facilitated by the SEMI coordinator &#40;YTC&#41;&#44; who has experience and postdoctoral training on education and research in clinical ultrasonography&#46; This first meeting addressed the document&#8217;s objectives&#44; members&#8217; roles and responsibilities&#44; the methods to be followed&#44; the literature search&#44; and a timetable with dates for meetings&#46; In addition&#44; a previously published consensus document template &#40;YTC&#41; was presented as an example&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">After an initial vote &#40;December 4&#44; 2023&#41;&#44; it was decided to tailor the indications for ultrasound according to the clinical scenario &#40;symptoms or syndromes&#41; common to each setting listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> &#40;in-hospital&#47;out-of-hospital emergency and critical care&#44; primary care and outpatient hospital setting&#44; hospitalization&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">In order to synthesize the available evidence on clinical ultrasound&#44; a narrative literature review was conducted in the MEDLINE database using the terms&#58; &#8220;Point-of-Care Ultrasonography&#44;&#8221; &#8220;Clinical Ultrasonography&#44;&#8221; and &#8220;Bedside Ultrasonography&#46;&#8221; Articles published in Spanish or English in the last 30 years were selected&#46; This process culminated in an initial draft that included 129 proposals divided into categories that included concepts and definitions as well as practical applications of clinical ultrasonography in different medical contexts and care settings&#44; such as the emergency setting&#44; the primary care and outpatient hospital setting&#44; and the hospital setting&#46; Then&#44; a hierarchy of importance was assigned to each statement&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">These statements were then carefully reviewed by working group members so they could contribute their experience and make the appropriate adjustments&#46; New recommendations were incorporated and those considered unfeasible within the different professional settings of the health system were discarded&#46; The final result was a compendium of 238 statements&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">At a second meeting&#44; held using Zoom Meetings&#174; on February 12&#44; 2024 and facilitated by YTC&#44; a first round of online voting was conducted using the Google Forms&#174; tool&#46; A validated Likert scale was used &#40;1 &#8211; strongly disagree&#44; 5 &#8211; neutral&#44; and 9 &#8211; strongly agree&#41;&#46; All voting was conducted in a confidential manner and included all initial participants&#46; The method classified the statements so that participants could express their degree of agreement with each statement&#46; Then&#44; they were classified according to the level of consensus reached&#46; The following degrees of consensus were defined&#58; &#8220;consensus&#8221; &#40;average &#8805;7 and deviation &#8804;1 of 2 points from the average&#41;&#44; &#8220;near consensus&#8221; &#40;average &#8805;6&#46;5 and deviation &#8804;2 of 2 points from the average&#41;&#44; or &#8220;no consensus&#8221; &#40;average &#60;6&#46;5 or deviation &#8805;3 of 2 points from the average&#41;&#46; In the first round of voting&#44; full consensus was reached on 51 statements&#44; near consensus on 35&#44; and no consensus on 152&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The statements that did not reach consensus were reviewed at a third meeting&#44; where it was decided whether they should be changed or eliminated from the document&#46; During the third meeting&#44; held on March 20&#44; 2024&#44; the 187 statements that had previously failed to reach consensus were re-examined&#46; Eighteen were eliminated and changes were made based on the comments and notes gathered in the previous meetings in order to reflect all perspectives and the multidisciplinary consensus of the different professional profiles involved&#46; In a second round of voting&#44; 169 statements were evaluated with the participation of all members&#46; Consensus was reached on 107&#44; two statements were unified into one&#44; and near consensus was reached on 58&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Given the importance of these statements&#44; it was decided to convene a fourth meeting on April 25&#44; 2024&#44; where the wording of these statements was revised and improved&#46; In the third and final round of voting&#44; with the participation of all members&#44; the statements that reached near consensus were re-examined and consensus was reached on 28 after the vote&#46; As a result of this process&#44; a final list of 189 statements was compiled and included in Appendix <a class="elsevierStyleCrossRef" href="#sec0095">A</a> &#40;additional material&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">This consensus highlights the importance of the 189 statements listed in Appendix <a class="elsevierStyleCrossRef" href="#sec0095">A</a> &#40;additional material&#41; as fundamental to the effective incorporation of ultrasonography into clinical practice&#46; It recognizes the value of ultrasonography throughout the entire care process&#8212;from diagnosis to prognostic evolution&#8212;in improving patient care&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The recommendations aim to unify the criteria for use and promote the creation of a theoretical and practical educational program on ultrasonography that includes these contents&#46; The objective is to make the program accessible to as many professionals as possible from different specialties&#44; facilitating the rapid application of knowledge acquired in the clinical setting and ensuring the skill and quality of the ultrasound procedures performed&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The most relevant points of the consensus document are listed below&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">A&#41; Concepts and practice</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Statements 1 to 5</span><p id="par0075" class="elsevierStylePara elsevierViewall">Clinical ultrasonography is defined as the systematic use of ultrasound as part of the physical examination &#40;along with inspection&#44; palpation&#44; percussion&#44; and auscultation&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in addition to being a tool that facilitates the diagnosis&#44; prognostic stratification&#44; monitoring&#44; and follow-up of individuals treated&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Clinical ultrasonography should be routinely integrated into the care process and decision-making&#44; given its versatility and ability to provide detailed&#44; real-time information at the patient&#8217;s bedside&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Performed&#44; interpreted&#44; and incorporated into the care process by appropriately trained and skilled professionals attending to the patient&#44; it is a value-added skill that is fundamental in healthcare practice&#46; It significantly improves physicians&#8217; diagnostic capabilities&#44; allowing for quicker and more accurate assessments without the need to transfer patients to other departments&#46; It is relatively harmless and widely available&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Its scope of application continues to expand to different specialties and diverse clinical situations&#44; contributing to better patient care and health outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;5</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">B&#41; Emergency department setting&#58; in-hospital&#44; out-of-hospital&#44; and critical care</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Statements 6 to 76</span><p id="par0095" class="elsevierStylePara elsevierViewall">Clinical ultrasonography in the emergency department has seen significant advances in its use in both in-hospital and out-of-hospital departments&#44; where patients with acute and acute-on-chronic diseases are attended to&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The use of point-of-care ultrasound seeks to facilitate the diagnosis and management of urgent&#44; emergency&#44; or critical conditions including &#40;but not limited to&#41; patients with severe trauma and polytrauma&#44; during cardiopulmonary resuscitation&#44; and as a guide in various procedures&#46; It also facilitates monitoring the progress and treatment of multiple diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;10</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">During cardiopulmonary resuscitation&#44; cardiac ultrasound is crucial for identifying patterns that indicate possible treatable causes of pulseless cardiac arrest&#44; such as cardiac tamponade&#44; and can provide guidance on ventricular failure patterns&#46; It is suggested to integrate ultrasound into the CPR algorithm with protocols that do not interfere with compressions&#46; In airway management&#44; ultrasound helps assess intubation and facilitates critical procedures such as cricothyroidotomy&#46; After return of circulation&#44; multiorgan ultrasound is crucial for patient management&#44; aiding in ultrasound-guided procedures such as pericardiocentesis or thoracentesis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Ultrasound allows for rapidly identifying the causes of different types of shock&#8212;hypovolemic&#44; cardiogenic&#44; obstructive&#44; and distributive&#8212;using markers such as the velocity time integral &#40;VTI&#41;&#44; obtained via spectral Doppler&#44; to estimate systolic volume&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;12</span></a> It also helps determine the origin of chest pain associated with cardiac problems&#44; myocardial infarction or aortic valve disease&#44; and respiratory or gastrointestinal conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In addition&#44; it is useful in providing guidance on possible causes of dyspnea&#44; including pneumonia&#44; pulmonary edema&#44; pleural effusion&#44; atelectasis&#44; pulmonary consolidations&#44; thromboembolic disease&#44; and pneumothorax&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The E-FAST protocol can be used in patients with polytrauma&#44; allowing for detecting free fluid and air in the pleural space as well as screening to identify solid organ injuries&#44; which is crucial for rapid patient management&#46; In patients with polytrauma&#44; cardiac ultrasound assesses thoracic trauma by identifying effusions and tamponade and guides critical procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In cases of abdominal pain&#44; ultrasound can identify appendicitis&#44; cholecystitis&#44; bowel obstructions&#44; abdominal aortic aneurysm&#44; rectus sheath hematoma&#44; diverticulitis&#44; acute pancreatitis&#44; and ovarian or uterine disorders in women&#44; among other causes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It can also help in the diagnosis of infections such as urinary tract infections&#44; gastroenteritis&#44; and other bacterial or viral respiratory conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;15&#44;16</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition&#44; ultrasound is essential for the evaluation of cardiovascular problems such as hypertensive emergencies&#44; aortic dissections or aneurysms&#44; arrhythmias&#44; heart failure&#44; stroke&#44; and amaurosis fugax&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> It also allows for assessing the urinary bladder to diagnose acute urinary retention and for verifying the correct placement of bladder catheters&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Finally&#44; ultrasound guides the conduct of emergency procedures including thoracentesis&#44; chest drains&#44; pericardiocentesis&#44; central line placement&#44; orotracheal intubation&#44; cricothyrotomy&#44; paracentesis&#44; arthrocentesis&#44; drainage of collections&#44; nerve blocks&#44; and lumbar puncture&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">C&#41; Primary care and outpatient hospital setting</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Statements 77 to 155</span><p id="par0130" class="elsevierStylePara elsevierViewall">Clinical ultrasound is essential at the first level of care because of its ability to rule out or confirm conditions that may require a specific treatment or referral to a second level of care&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This makes it possible to establish the most appropriate pathway for the patient &#40;normal&#44; priority&#44; or hospital emergency&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Abdominal ultrasound is useful for evaluating the morphology and size of the main abdominal organs and is useful in the characterization of hepatosplenomegaly and cirrhosis&#46; It allows for characterizing diffuse and focal hepatic lesions &#40;hepatic steatosis and SOLs&#41; and intrahepatic and extrahepatic biliary tract and gallbladder conditions &#40;cholelithiasis&#44; cholecystitis&#41;&#46; Doppler mode can be useful for characterizing the velocities and flows that help in the diagnosis of portal hypertension&#46; It is fundamental for studying abdominal pain and in the presence of abnormal analytical findings&#59; ultrasound is a useful tool that can help in the diagnostic algorithm&#46; It detects the existence of free abdominal fluid and&#44; supported by other findings&#44; can orient to its characterization as ascitic fluid or other physiological fluids&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">It can assess the pancreas and allow for characterizing focal and diffuse lesions as well as large vessels and the diseases related to them&#44; such as nutcracker syndrome&#46; Ultrasound is also valuable in assessing the retroperitoneum&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Finally&#44; it adds value in the diagnosis of intestinal conditions such as diverticulitis&#44; appendicitis&#44; or bowel obstruction and is used to monitor benign lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The contribution of ultrasound in the assessment of abdominal pain originating in the abdominal wall also merits mention&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Cervical spine ultrasound is effective for characterizing palpable masses in the neck&#44; determining whether they are solid or cystic&#44; and assessing their size and relationship to nearby structures&#46; It can also be used to visualize thyroid nodules&#44; thyroid and parathyroid gland abnormalities&#44; and adenopathy&#46; Ultrasound guides procedures such as biopsies of cervical spine masses or lymph nodes and drainage of fluid collections&#44; improving accuracy and minimizing risks&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In cases of cough&#44; fever&#44; or dyspnea with possible pulmonary involvement&#44; ultrasound facilitates the ruling out and monitoring of acute and chronic respiratory diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> It is also crucial in monitoring heart failure&#44; providing valuable details on cardiac anatomy and function as well as pulmonary and systemic congestion&#44; which is essential for clinical decision making&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Ultrasound is effective in the initial evaluation of constitutional syndrome or fever of unknown origin as well as in the detection of nephrological-urological diseases&#46; It allows for observing the shape and size of the kidneys&#44; dilatation of the urinary tract&#44; kidney stones&#44; and abnormalities in the bladder and prostate&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">It is essential in the initial evaluation of joint pain in order to determine the cause&#44; such as degenerative or inflammatory causes&#44; and direct appropriate treatment&#44; avoiding unnecessary referrals and facilitating the identification of arthritis and tendinitis&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">In gynecology&#44; although vaginal ultrasound offers higher resolution&#44; abdominal-pelvic ultrasound can be useful in the first level of care for decision making in certain clinical scenarios&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> It is also the recommended initial technique in scrotal pain to differentiate between intratesticular masses&#59; extratesticular masses&#59; and conditions such as hydrocele&#44; varicocele&#44; testicular torsion&#44; and tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Ultrasound is also increasingly being used in pediatrics as the initial imaging technique for common childhood diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In addition&#44; technological advances and the miniaturization of equipment have allowed for incorporating it into home care&#44; significantly improving the detailed&#44; continuous evaluation of patients without compromising comfort or safety&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Finally&#44; ultrasound guides procedures such as paracentesis in cases of ascites&#44; thoracentesis in pleural effusion&#44; biopsies of superficial masses or adenopathies&#44; and other procedures such as drains and infiltrations&#44; improving the precision and safety of these interventions&#44; which is especially valuable in home care&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">D&#41; Hospitalization</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statements 156 to 189</span><p id="par0190" class="elsevierStylePara elsevierViewall">Clinical ultrasound is systematically integrated into the physical examination in this care setting&#44; accompanying traditional techniques such as inspection&#44; palpation&#44; percussion&#44; and auscultation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> It functions not only as an additional tool that enriches the diagnosis and prognostic stratification&#44; but also as a means of monitoring and guiding procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;28</span></a> In hospitalized patients&#44; it is crucial when distinguishing normal anatomy and function from pathology&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Its main applications include assessing exacerbations of heart failure that require specialized treatment adjustments<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as well as the management of pulmonary diseases and other respiratory conditions such as pneumonia&#44; acute bronchitis&#44; and certain cases of asthma and&#47;or chronic obstructive pulmonary disease exacerbations&#46; In addition&#44; it is fundamental in the diagnosis of complicated urinary tract infections&#44; especially in older adults or patients with multiple health conditions who may require intravenous treatment and constant monitoring&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;28</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Ultrasound is useful in evaluating blood volume status&#44; especially in patients with chronic diseases or older adults with inadequate intake&#46; It also plays a vital role in the diagnosis and management of acute pulmonary embolism as well as in the assessment of body composition&#44; including the distribution of adipose tissue and muscle mass&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">This tool is especially valuable for assessing agitated or delirious patients&#44; quickly and noninvasively identifying treatable pathological conditions that may have triggered the episode&#46; It should be considered as a tool to support the physical examination and within a broader clinical context that includes formal cognitive assessments and screening tests&#44; e&#46;g&#46;&#44; the Confusion Assessment Method &#40;CAM&#41; and&#47;or the 4AT&#44; among other relevant tests&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In addition&#44; ultrasound is essential in critical situations such as cardiac arrest and advanced life support&#44; identifying reversible causes and guiding therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Likewise&#44; it improves precision and safety in guided procedures such as paracentesis in cases of ascites&#44; thoracentesis for pleural effusion&#44; arthrocentesis&#44; aspiration punctures&#44; biopsies of superficial masses or adenopathies&#44; and in drainage and infiltrations&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It is of particularly high value in home care&#44; improving the quality and safety of the care provided&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">This consensus document provides a detailed analysis of the multiple indications and competencies of clinical ultrasound in various medical situations&#46; This report aims to provide a comprehensive guide that serves to standardize and facilitate the integration of this essential diagnostic technique into daily clinical practice&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">This study has certain limitations&#46; Primarily&#44; the recent expansion of ultrasound use outside the emergency department has influenced the studies examined&#59; they mainly involve critically ill patients&#46; This underscores the urgency of fostering collaborative research in other clinical fields&#46; In addition&#44; although the participating experts have a broad command of ultrasound&#44; their individual expertise does not necessarily cover all areas included in this consensus&#46; However&#44; this &#8220;weakness&#8221; is simultaneously an advantage&#44; since the synergy created among different specialists from different areas of care has enriched this report with a wide range of perspectives&#46; Finally&#44; it is important to mention that some statements are based on subjective observations based on clinical experience and are not yet supported by formal studies&#46; Therefore&#44; it is essential to continuously evaluate and update these recommendations as new scientific evidence emerges&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Significant advances in the field of clinical ultrasound are expected in the coming years&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Technological innovations are aimed at improving its efficiency&#44; accessibility&#44; and diagnostic accuracy&#46; The reduction in size of ultrasound devices will increase their portability&#44; making this healthcare advance available in a wider variety of clinical and remote settings&#46; Advances in software&#44; including the integration of artificial intelligence &#40;AI&#41; tools&#44; promise to simplify image acquisition and interpretation&#44; resulting in faster&#44; more accurate diagnoses and expanding the number of healthcare professionals who can use it&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> AI in particular is expected to transform ultrasound by providing real-time analysis and guidance&#44; improving diagnostic accuracy for both novice and experienced users&#46; All this will be complemented by the development of tele-ultrasound tools&#44; which will allow for remote consultations and expert advice&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0230" class="elsevierStylePara elsevierViewall">The medical societies that endorse this consensus unanimously emphasize the importance of integrating clinical ultrasound into all areas of medical care without exception&#46; Clear guidelines have been established in this document in order to achieve this goal&#44; outlining the main indications for the use of ultrasound in different clinical contexts&#46; These guidelines not only serve as a framework for clinical practice&#44; education&#44; and research&#44; but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence&#46; The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in daily healthcare practice&#44; thus improving the quality of the service provided in its various possible applications&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethics committee approval</span><p id="par0235" class="elsevierStylePara elsevierViewall">This is a consensus article&#46; The ethics committee of the La Paz University Hospital has confirmed that ethical approval is not required&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">During the preparation of this article&#44; artificial intelligence tools &#40;ChatGPT-4&#41; were used to make specific grammatical and stylistic corrections&#46; No additional supporting features were used&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0245" class="elsevierStylePara elsevierViewall">This research has not received specific grants from agencies in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data availability statement</span><p id="par0255" class="elsevierStylePara elsevierViewall">The scientific content of the document is the sole responsibility of the authors&#46; The authors confirm that the data supporting this study&#8217;s findings are available from the corresponding author upon reasonable request&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Point-of-Care Ultrasound has significantly evolved&#44; establishing itself as an essential tool in daily medical practice&#44; especially in various clinical contexts&#46; This consensus document&#44; supported by several Spanish medical societies&#44; proposes guidelines for the effective integration of ultrasound in healthcare&#44; promoting its standardization and ensuring the quality and systematic application of this technique&#46; The working groups&#44; composed of experts from different specialties&#44; conducted a comprehensive review of the literature in MEDLINE and extensively discussed recommendations to formulate a coherent and practical set of guidelines for different application areas&#58; hospital and out-of-hospital emergencies and critical care&#44; primary care&#44; and outpatient hospital care&#44; hospitalization&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The methodology included virtual meetings and confidential voting to reach a consensus on the relevant recommendations&#46; Ultrasound was highlighted as fundamental in the initial approach to various pathologies&#44; such as abdominal&#44; thoracic&#44; and musculoskeletal issues&#44; facilitating quick and accurate diagnoses&#44; and reducing the need for unnecessary referrals&#46; Furthermore&#44; this technique has proven valuable in emergencies and critical care&#44; guiding procedures and enhancing the safety and efficiency of clinical interventions&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These guidelines not only serve as a framework for clinical practice&#44; education&#44; and research but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence&#46; The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in the daily practice of healthcare&#44; thus improving the quality of the services provided in its various possible applications&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a cl&#237;nica ha evolucionado significativamente&#44; consolid&#225;ndose como una herramienta esencial en la pr&#225;ctica m&#233;dica diaria&#44; especialmente en m&#250;ltiples contextos cl&#237;nicos&#46; Este documento de consenso&#44; apoyado por diversas sociedades m&#233;dicas espa&#241;olas&#44; propone directrices para la integraci&#243;n efectiva de la ecograf&#237;a en la atenci&#243;n m&#233;dica&#44; promoviendo su estandarizaci&#243;n y garantizando la calidad y la aplicaci&#243;n sistem&#225;tica de esta t&#233;cnica&#46; Los grupos de trabajo&#44; compuestos por expertos de distintas especialidades&#44; realizaron una revisi&#243;n exhaustiva de la literatura en MEDLINE y discutieron extensamente las recomendaciones para formular un conjunto coherente y pr&#225;ctico de indicaciones seg&#250;n los distintos &#225;mbitos de aplicaci&#243;n&#58; urgencias hospitalarias&#47;extrahospitalarias y cuidados cr&#237;ticos&#44; atenci&#243;n primaria y nivel hospitalario ambulatorio&#44; hospitalizaci&#243;n&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La metodolog&#237;a incluy&#243; reuniones virtuales y votaciones confidenciales para alcanzar un consenso sobre las recomendaciones pertinentes&#46; La ecograf&#237;a se destac&#243; como fundamental en la primera aproximaci&#243;n a diversas patolog&#237;as&#44; como problemas abdominales&#44; tor&#225;cicos&#44; y musculoesquel&#233;ticos&#44; facilitando diagn&#243;sticos r&#225;pidos y precisos&#44; y reduciendo la necesidad de derivaciones innecesarias&#46; Asimismo&#44; esta t&#233;cnica ha demostrado ser valiosa en urgencias y cuidados cr&#237;ticos&#44; guiando procedimientos y mejorando la seguridad y eficiencia de las intervenciones cl&#237;nicas&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estas directrices no solo sirven como un marco para la pr&#225;ctica cl&#237;nica&#44; la educaci&#243;n y la investigaci&#243;n&#44; sino que tambi&#233;n buscan asegurar que los profesionales est&#233;n debidamente capacitados y que las evaluaciones ecogr&#225;ficas se realicen con un est&#225;ndar de excelencia&#46; El prop&#243;sito de estas recomendaciones es homogenizar y facilitar la adopci&#243;n de esta herramienta cl&#237;nica en el d&#237;a a d&#237;a de la atenci&#243;n m&#233;dica&#44; mejorando as&#237; la calidad del servicio prestado en sus diversas aplicaciones posibles&#46;</p></span>"
      ]
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      0 => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0265" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0095"
          ]
          1 => array:4 [
            "etiqueta" => "Appendix C"
            "titulo" => "List of contributors to the consensus document"
            "identificador" => "sec0100"
            "apendiceSeccion" => array:7 [
              0 => array:3 [
                "apendice" => "<p id="par0270" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0275" class="elsevierStylePara elsevierViewall">Yale Tung-Chen &#40;group coordinator&#41;&#46; Internal Medicine Department&#44; La Paz University Hospital&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0280" class="elsevierStylePara elsevierViewall">Luis Beltr&#225;n Romero&#46; Internal Medicine Department&#44; Virgen Macarena University Hospital&#44; Seville&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0285" class="elsevierStylePara elsevierViewall">Juan Torres Macho&#46; Internal Medicine Department&#44; University Hospital of Getafe&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0290" class="elsevierStylePara elsevierViewall">Gonzalo Garc&#237;a de Casasola S&#225;nchez&#46; Emergency Department&#44; Alcorc&#243;n Foundation University Hospital&#44; Madrid&#44; Spain</p></li></ul></p>"
                "titulo" => "SEMI Working Group on Clinical Ultrasound"
                "identificador" => "sec0105"
              ]
              1 => array:3 [
                "apendice" => "<p id="par0295" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0300" class="elsevierStylePara elsevierViewall">Ignacio Manuel &#40;group coordinator&#41;&#46; P&#237;o XII Health Center&#44; Ciudad Real&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0305" class="elsevierStylePara elsevierViewall">Jorge Short Apellaniz&#46; Emergency Department&#44; Jim&#233;nez D&#237;az Foundation University Hospital&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0310" class="elsevierStylePara elsevierViewall">Rafael Alonso Roca&#46; Mar B&#225;ltico Health Center&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0315" class="elsevierStylePara elsevierViewall">Antonio Calvo Cebri&#225;n&#46; Robledo de Chavela Health Center&#44; Madrid&#44; Spain</p></li></ul></p>"
                "titulo" => "SEMFYC Working Group on Ultrasound"
                "identificador" => "sec0110"
              ]
              2 => array:3 [
                "apendice" => "<p id="par0320" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0325" class="elsevierStylePara elsevierViewall">Tom&#225;s Vill&#233;n Villegas &#40;group coordinator&#41;&#46; Department of Medicine&#44; Francisco de Vitoria University&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0330" class="elsevierStylePara elsevierViewall">Jos&#233; Ram&#243;n Alonso Viladot&#46; Emergency Department&#44; Cl&#237;nic Hospital&#44; Barcelona&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">11</span><p id="par0335" class="elsevierStylePara elsevierViewall">Ricardo Campo Linares&#46; Emergency Department&#44; Santa B&#225;rbara Hospital&#44; Puertollano&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">12</span><p id="par0340" class="elsevierStylePara elsevierViewall">Iv&#225;n Garc&#237;a Su&#225;rez&#46; Emergency Department&#44; San Agust&#237;n University Hospital&#44; Avil&#233;s&#44; Spain</p></li></ul></p>"
                "titulo" => "SEMES Working Group on Ultrasound"
                "identificador" => "sec0115"
              ]
              3 => array:3 [
                "apendice" => "<p id="par0345" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">13</span><p id="par0350" class="elsevierStylePara elsevierViewall">Martin F&#46; Marchese Ratti &#40;deputy coordinator of the group&#41;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">14</span><p id="par0355" class="elsevierStylePara elsevierViewall">Jos&#233; Carlos S&#225;nchez S&#225;nchez &#40;manager of the group&#8217;s ultrasound area&#41;&#46; Radiodiagnosis Unit&#44; Poniente Hospital&#44; Almeria&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">15</span><p id="par0360" class="elsevierStylePara elsevierViewall">Irene Arnanz Gonz&#225;lez</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">16</span><p id="par0365" class="elsevierStylePara elsevierViewall">Keith Albert Foo Gil</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">17</span><p id="par0370" class="elsevierStylePara elsevierViewall">Alberto Romero Gal&#225;n</p></li></ul></p>"
                "titulo" => "SEMG Working Group on Knowledge in Ultrasound"
                "identificador" => "sec0120"
              ]
              4 => array:3 [
                "apendice" => "<p id="par0375" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">18</span><p id="par0380" class="elsevierStylePara elsevierViewall">Marc Vives &#40;group coordinator&#41;&#46; Department of Anesthesiology and Resuscitation&#44; University Clinic of Navarre&#44; Pamplona&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">19</span><p id="par0385" class="elsevierStylePara elsevierViewall">Ariel Duilio Gonz&#225;lez Delgado&#46; Department of Anesthesiology and Resuscitation&#44; University Clinic of Navarre&#44; Pamplona&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">20</span><p id="par0390" class="elsevierStylePara elsevierViewall">Alberto Hern&#225;ndez Mart&#237;nez&#46; Department of Anesthesiology and Resuscitation&#44; Bellvitge University Hospital&#44; Barcelona&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">21</span><p id="par0395" class="elsevierStylePara elsevierViewall">Jordi Mercadal Mercadal&#46; Department of Anesthesiology&#44; Resuscitation&#44; and Pain Management&#46; Hospital Cl&#237;nic de Barcelona&#44; Spain</p></li></ul></p>"
                "titulo" => "SEDAR Working Group on Ultrasound"
                "identificador" => "sec0125"
              ]
              5 => array:3 [
                "apendice" => "<p id="par0400" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">22</span><p id="par0405" class="elsevierStylePara elsevierViewall">Mar&#237;a Esther Montes Belloso &#40;group coordinator&#41;&#46; Isabel II Health Center&#44; Parla&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">23</span><p id="par0410" class="elsevierStylePara elsevierViewall">Olga Mart&#237;nez Vill&#233;n &#40;group member&#41; Gandhi Health Center&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">24</span><p id="par0415" class="elsevierStylePara elsevierViewall">Esther Minguela Puras &#40;group member&#41;&#46; Valle de la Oliva Health Center&#46; Majadahonda&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">25</span><p id="par0420" class="elsevierStylePara elsevierViewall">Ecatherine Rodr&#237;guez Urteaga &#40;group member&#41;&#46; Dos de Mayo Health Center&#44; M&#243;stoles&#44; Madrid&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">26</span><p id="par0425" class="elsevierStylePara elsevierViewall">Ana Segura Grau&#46; Medical Management of the Diagnostic Ultrasound Center&#46; Head of the General Ultrasound Unit of the San Francisco de As&#237;s Hospital in Madrid&#44; Spain</p></li></ul></p>"
                "titulo" => "SEMERGEN Working Group on Ultrasound"
                "identificador" => "sec0130"
              ]
              6 => array:3 [
                "apendice" => "<p id="par0430" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">27</span><p id="par0435" class="elsevierStylePara elsevierViewall">Jos&#233; Luis S&#225;nchez Rodr&#237;guez &#40;group coordinator&#41;&#46; Geriatrics Department&#44; Sta Creu de Jes&#250;s Hospital - Tortosa&#44; Tarragona&#44; Spain</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">28</span><p id="par0440" class="elsevierStylePara elsevierViewall">Paola Pastora Reinoso P&#225;rraga&#46; Geriatrics Department&#44; La Paz University Hospital&#44; Madrid&#44; Espa&#241;a</p></li></ul></p>"
                "titulo" => "SEGG Working Group on Ultrasound"
                "identificador" => "sec0135"
              ]
            ]
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dimension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Statements&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">1</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Concepts and practice</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">1 to 5</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Emergency department setting&#58; in-hospital&#44; out-of-hospital&#44; and critical care</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">6 to 76</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiac arrest and advanced life support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 to 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnosis and management of shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 to 17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 to 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 to 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma and injuries&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 to 32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 to 42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43 to 53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiovascular problems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 to 64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urinary bladder assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contribution in the diagnosis of testicular masses and scrotal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 to 73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ocular assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Procedures guide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">3</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Primary care and outpatient hospital setting</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">77 to 155</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastrointestinal problems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 to 83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute and chronic respiratory diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 to 85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow-up on heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 to 91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of constitutional syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 to 99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever of unknown origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 to 103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Musculoskeletal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 to 108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of Cervical Spine Disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 to 111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of Nephrological-Urological Disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112 to 118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gynecological problems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 to 124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contribution in the diagnosis of testicular masses and scrotal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125 to 132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ocular ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 to 137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiac ultrasound &#40;or echocardioscopy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 to 143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Utility in pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 to 152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Home Care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guidance for procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">4</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Hospitalization</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">156 to 189</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 to 160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lung Disease and other Respiratory Conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">161 to 163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complicated Urinary Tract Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 to 166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of blood volume status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167 to 170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonary Embolism &#40;PE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171 to 175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of Body Composition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Assessment of an agitated or delirious patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177 to 183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiac arrest and advanced life support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184 to 187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Guidance for procedures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      "titulo" => "References"
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                      "titulo" => "Point-of-care ultrasonography"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JL D&#237;az-G&#243;mez"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1916062"
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                        "volumen" => "385"
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                      "titulo" => "Usefulness of multi-organ point-of-care ultrasound as a complement to the decision-making process in internal medicine"
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                          "etal" => true
                          "autores" => array:6 [
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                            3 => "D&#46; Luordo-Tedesco"
                            4 => "A&#46; Mata-Mart&#237;nez"
                            5 => "J&#46;M&#46; Casas-Rojo"
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                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Med"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mapping the ultrasound landscape to define point-of-care ultrasound and diagnostic ultrasound&#58; a proposal from the society of radiologists in ultrasound and ACR commission on ultrasound"
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                  "contribucion" => array:1 [
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                      "titulo" => "Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine&#58; recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine &#40;GTECO-SEMI&#41;"
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                            3 => "L&#46; Beltr&#225;n Romero"
                            4 => "M&#46; Bernab&#233;u Wittel"
                            5 => "L&#46;S&#46; Briongos Figuero"
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                      "doi" => "10.1016/j.rceng.2023.12.006"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine&#58; Consensus document of the Spanish Society of Anesthesia &#40;SEDAR&#41;&#44; Spanish Society of Internal Medicine &#40;SEMI&#41; and Spanish Society of Emergency Medicine &#40;SEMES&#41;"
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                          "etal" => true
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                            1 => "A&#46; Hern&#225;ndez"
                            2 => "A&#46;D&#46; Gonz&#225;lez"
                            3 => "J&#46; Torres"
                            4 => "P&#46; Cuesta"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Competencias b&#225;sicas de la ecograf&#237;a cl&#237;nica en los servicios de urgencias y emergencias"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Vill&#233;n Villegas"
                            1 => "R&#46; Campo Linares"
                            2 => "J&#46;R&#46; Alonso Viladot"
                            3 => "R&#46; Mart&#237;nez Mas"
                            4 => "M&#46;J&#46; Luque Hern&#225;ndez"
                            5 => "M&#46; Ruiz Dur&#225;n"
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                      "Revista" => array:5 [
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              "etiqueta" => "7"
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                      "titulo" => "Point-of-care ultrasound stewardship"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Shokoohi"
                            1 => "N&#46;M&#46; Duggan"
                            2 => "S&#46; Adhikari"
                            3 => "L&#46;A&#46; Selame"
                            4 => "R&#46; Amini"
                            5 => "M&#46; Blaivas"
                          ]
                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Emerg Physicians Open"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Point-of-care and clinical ultrasound guidelines in medicine"
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                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1016/j.annemergmed.2016.08.457"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "2017"
                        "volumen" => "69"
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Consensus Document
Uncorrected Proof. Available online 11 October 2024
Executive summary of the consensus document on point-of-care ultrasound implementation: Recommendations from the Clinical Ultrasound Working Groups of SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC, and SEMG
Resumen ejecutivo del documento de consenso sobre la realización de la ecografía clínica: recomendaciones desde los Grupos de Trabajo de Ecografía Clínica de la SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC Y SEMG
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Y. Tung-Chen
Corresponding author
yale.tung@salud.madrid.org

Corresponding author.
, en representación de los 28 colaboradores de los grupos de trabajo SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC y SEMG que aparecen en el anexo II de este artÍculo
Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
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Table 1. Dimensions and applications considered for statements included in the consensus.
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Abstract

Point-of-Care Ultrasound has significantly evolved, establishing itself as an essential tool in daily medical practice, especially in various clinical contexts. This consensus document, supported by several Spanish medical societies, proposes guidelines for the effective integration of ultrasound in healthcare, promoting its standardization and ensuring the quality and systematic application of this technique. The working groups, composed of experts from different specialties, conducted a comprehensive review of the literature in MEDLINE and extensively discussed recommendations to formulate a coherent and practical set of guidelines for different application areas: hospital and out-of-hospital emergencies and critical care, primary care, and outpatient hospital care, hospitalization.

The methodology included virtual meetings and confidential voting to reach a consensus on the relevant recommendations. Ultrasound was highlighted as fundamental in the initial approach to various pathologies, such as abdominal, thoracic, and musculoskeletal issues, facilitating quick and accurate diagnoses, and reducing the need for unnecessary referrals. Furthermore, this technique has proven valuable in emergencies and critical care, guiding procedures and enhancing the safety and efficiency of clinical interventions.

These guidelines not only serve as a framework for clinical practice, education, and research but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence. The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in the daily practice of healthcare, thus improving the quality of the services provided in its various possible applications.

Keywords:
Point-of-care ultrasound
Emergency ultrasound
Healthcare quality assessment
Medical education
Resumen

La ecografía clínica ha evolucionado significativamente, consolidándose como una herramienta esencial en la práctica médica diaria, especialmente en múltiples contextos clínicos. Este documento de consenso, apoyado por diversas sociedades médicas españolas, propone directrices para la integración efectiva de la ecografía en la atención médica, promoviendo su estandarización y garantizando la calidad y la aplicación sistemática de esta técnica. Los grupos de trabajo, compuestos por expertos de distintas especialidades, realizaron una revisión exhaustiva de la literatura en MEDLINE y discutieron extensamente las recomendaciones para formular un conjunto coherente y práctico de indicaciones según los distintos ámbitos de aplicación: urgencias hospitalarias/extrahospitalarias y cuidados críticos, atención primaria y nivel hospitalario ambulatorio, hospitalización.

La metodología incluyó reuniones virtuales y votaciones confidenciales para alcanzar un consenso sobre las recomendaciones pertinentes. La ecografía se destacó como fundamental en la primera aproximación a diversas patologías, como problemas abdominales, torácicos, y musculoesqueléticos, facilitando diagnósticos rápidos y precisos, y reduciendo la necesidad de derivaciones innecesarias. Asimismo, esta técnica ha demostrado ser valiosa en urgencias y cuidados críticos, guiando procedimientos y mejorando la seguridad y eficiencia de las intervenciones clínicas.

Estas directrices no solo sirven como un marco para la práctica clínica, la educación y la investigación, sino que también buscan asegurar que los profesionales estén debidamente capacitados y que las evaluaciones ecográficas se realicen con un estándar de excelencia. El propósito de estas recomendaciones es homogenizar y facilitar la adopción de esta herramienta clínica en el día a día de la atención médica, mejorando así la calidad del servicio prestado en sus diversas aplicaciones posibles.

Palabras clave:
Ecografía en el punto de atención
Ecografía de urgencias
Control de calidad en salud
Educación médica

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