array:24 [
  "pii" => "S2254887419301328"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2019.05.004"
  "estado" => "S300"
  "fechaPublicacion" => "2019-11-01"
  "aid" => "1678"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "edi"
  "cita" => "Rev Clin Esp. 2019;219:449-50"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256519301481"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2019.05.002"
      "estado" => "S300"
      "fechaPublicacion" => "2019-11-01"
      "aid" => "1678"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "edi"
      "cita" => "Rev Clin Esp. 2019;219:449-50"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 104
        "formatos" => array:2 [
          "HTML" => 62
          "PDF" => 42
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "La importancia de evaluar la fragilidad y la dependencia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "449"
            "paginaFinal" => "450"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The importance of evaluating fragility and dependence"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; Marco Mart&#237;nez, S&#46; Plaza Canteli"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Marco Mart&#237;nez"
              ]
              1 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Plaza Canteli"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887419301328"
          "doi" => "10.1016/j.rceng.2019.05.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301328?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301481?idApp=WRCEE"
      "url" => "/00142565/0000021900000008/v1_201910300637/S0014256519301481/v1_201910300637/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887419300797"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2019.03.013"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1636"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Rev Clin Esp. 2019;219:451-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinicopathological conference</span>"
      "titulo" => "Renal failure in a 23-year-old man with ulcerative colitis treated with 5-aminosalicylate"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "451"
          "paginaFinal" => "457"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Insuficiencia renal en un var&#243;n de 23 a&#241;os con colitis ulcerosa tratada con 5-aminosalicilato"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 571
              "Ancho" => 1286
              "Tamanyo" => 332732
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Renal biopsy&#46; &#40;A&#41; Interstitial edema and a labeled interstitial infiltrate &#40;hematoxylin and eosin&#44; original magnification 40&#215;&#41;&#46; &#40;B&#41; Inflammatory infiltrate consisting of lymphocytes and polymorphonuclear cells &#40;hematoxylin&#8211;eosin&#44; original increase 400&#215;&#41; &#40;red arrows&#41;&#46; This figure&#39;s colors can only be observed in the electronic version of this article&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#46;M&#46; Villafuerte Ledesma, J&#46;M&#46; Pe&#241;a Porta, C&#46;B&#46; Marta Casanova, R&#46; &#193;lvarez Lipe"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "H&#46;M&#46;"
              "apellidos" => "Villafuerte Ledesma"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Pe&#241;a Porta"
            ]
            2 => array:2 [
              "nombre" => "C&#46;B&#46;"
              "apellidos" => "Marta Casanova"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "&#193;lvarez Lipe"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256519300402"
        "doi" => "10.1016/j.rce.2018.12.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519300402?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300797?idApp=WRCEE"
    "url" => "/22548874/0000021900000008/v1_201910300730/S2254887419300797/v1_201910300730/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887419301663"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2019.08.001"
    "estado" => "S300"
    "fechaPublicacion" => "2019-11-01"
    "aid" => "1685"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2019;219:447-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Sarcopenia in internal medicine&#58; Time to act&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "447"
          "paginaFinal" => "448"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sarcopenia en medicina interna&#58; &#191;tiempo para la acci&#243;n&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Bernabeu-Wittel, J&#46; Garc&#237;a-Alegr&#237;a"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Bernabeu-Wittel"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Garc&#237;a-Alegr&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256519301559"
        "doi" => "10.1016/j.rce.2019.05.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301559?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301663?idApp=WRCEE"
    "url" => "/22548874/0000021900000008/v1_201910300730/S2254887419301663/v1_201910300730/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "The importance of evaluating fragility and dependence"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "449"
        "paginaFinal" => "450"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; Marco Mart&#237;nez, S&#46; Plaza Canteli"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "Marco Mart&#237;nez"
            "email" => array:1 [
              0 => "javiermarco.z@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Plaza Canteli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Secci&#243;n Medicina Perioperatoria&#44; Hospital Cl&#237;nico San Carlos&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Unidad de Cuidados Paliativos&#44; Hospital Severo Ochoa&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La importancia de evaluar la fragilidad y la dependencia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; we have witnessed the advent and establishment of polypathological patients in the practice of internal medicine&#46; The inversion of the population pyramid&#44; medical advances and social progress form the three pillars of this new patient profile&#44; which expends a considerable portion of our time and healthcare resources&#44; with still much more to come&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This expanding group typically shares the traits of frailty and high dependence&#44; an increasingly common situation in internal medicine&#46; These patients are elderly&#44; often live alone&#44; and many times require assistance for their daily activities&#46; Their needs grow the older they get&#44; as their loneliness deepens and as their polypathology progresses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is therefore a growing need to go beyond the clinical assessment and physical examination performed in daily practice and that is taught to internal medicine students&#46; These patients&#8217; frailty and thus their degree of dependence should form part of the clinical assessment&#44; given the percentage of polypathological patients treated in internal medicine&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study by Bernabeu-Wittel et al&#46; published in this issue of the journal highlights this problem&#46; As mentioned by the authors&#44; most polypathological patients have varying degrees of dependence&#44; which can be severe in more than 30&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> A healthcare intervention cannot be conducted&#44; either individually or as a whole&#44; for these patients without first conducting a frailty assessment&#46; The Barthel index &#40;BI&#41; is the most commonly used tool for this assessment&#44; but employing the index lengthens the time clinicians spend with patients in the initial clinical assessment&#46; The authors propose simplifying the previous screening using an abbreviated BI that facilitates and shortens the initial assessment&#46; To this end&#44; the authors designed a cross-sectional multicenter study that included more than 1600 patients &#40;most from hospitals with some outpatient representation and home hospitalization&#41;&#46; After performing a complete BI&#44; the authors identified those items with better positive and negative predictive values for obtaining a BI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90 points&#46; The item with the highest negative predictive value was the ability to feed and groom oneself&#46; The items with the highest positive predictive value were the ability to walk and go up and down stairs&#46; The authors proposed an algorithm for applying this simplified BI whose first question is&#44; &#8220;Can the patient go up and down stairs&#63;&#8221; If the patient is able to do so&#44; the BI is &#62;90&#44; and a full BI needs to be performed&#46; If the patient is unable to do so&#44; the next question is&#44; &#8220;Can the patient feed themselves&#63;&#8221; If they can&#44; the BI is between 60 and 89&#44; indicating the patient has moderate dependence and that a full BI needs to be performed&#46; If they unable to do so&#44; the BI is &#60;60&#44; indicating the patient has severe dependence&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors recognize that the lack of validation of the study&#39;s results with an independent patient cohort is one of the study&#39;s weaknesses&#46; There is also a disproportion between the number of hospitalized patients and outpatients in the sample&#46; The study&#39;s strengths are the participation of 37 hospital centers distributed throughout Spain and the considerable number of patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our opinion&#44; this is an original study in its approach&#44; which achieves useful results if they can be validated&#46; Of course&#44; the authors are aiming in the right direction&#46; One has to look no further than the study&#39;s first table&#44; which shows the characteristics of this consecutively recruited patient cohort&#46; Here are just some of the data&#58; the number of comorbidities per patient was 4&#46;5&#44; 70&#37; had high blood pressure&#44; 35&#37; had atrial fibrillation&#44; the mean Charlson index was 4&#44; 47&#37; had a New York Heart Association classification of III-IV&#44; and 31&#37; had a BI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is the setting in which we work&#44; a scenario that could worsen&#46; Including information regarding frailty and dependence in the assessment of our patients in a global and practical manner appears to be essential&#46; On the other hand&#44; we increasingly need to work fast and in a variety of settings&#46; In our opinion&#44; the study by Bernabeu-Wittel et al&#46; is heading in that direction&#58; an abbreviated and fast BI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">At this time&#44; 46&#37; of discharges from internal medicine departments are of patients 80 years or older&#44; and attendance in internal medicine departments increases as the population age group that requires the most treatment increases&#46; The latest RECALMIN report<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> recommends having specific information on the healthcare needs of patients older than 80 years admitted to internal medicine departments&#46; It is precisely these groups<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> that have specific requirements and for which the same hospitalization process can increase the patient&#39;s frailty and vulnerability and result in readmissions&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The latest RECALMIN survey showed that only 54&#37; of the departments stated having implemented a systematic care program for complex chronic patients&#44; which covered only 31&#37; of the Spanish population&#46; There is therefore a noticeable gap between the recommendations of the standards document for multiple-disease units<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and the strategy for approaching chronicity in the Spanish national health system&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There is still much to do&#46; It is essential that we give frailty and dependence the place they deserve and include them definitively in our medical records&#44; assessments and documents&#46; A major step would be to progress toward their quick and reliable assessment&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Marco Mart&#237;nez J&#44; Plaza Canteli S&#46; La importancia de evaluar la fragilidad y la dependencia&#46; Rev Clin Esp&#46; 2019&#59;219&#58;449&#8211;450&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional decline over one-year follow up in a multicenter cohort of polypathological patients&#58; a new approach to functional prognostication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Bernabeu-Wittel"
                            1 => "M&#46; Ollero-Baturone"
                            2 => "A&#46; Ruiz-Cantero"
                            3 => "L&#46; Moreno-Gavi&#241;o"
                            4 => "B&#46; Bar&#243;n-Franco"
                            5 => "A&#46; Fuertes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Gerontol"
                        "fecha" => "2012"
                        "volumen" => "6"
                        "paginaInicial" => "68"
                        "paginaFinal" => "74"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas cl&#237;nicas&#44; funcionales&#44; mentales y sociales de pacientes pluripatol&#243;gicos estudio prospectivo durante un a&#241;o en Atenci&#243;n Primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Ram&#237;rez-Duque"
                            1 => "M&#46; Ollero-Baturone"
                            2 => "M&#46; Bernabeu-Wittel"
                            3 => "M&#46; Rinc&#243;n-G&#243;mez"
                            4 => "M&#46;A&#46; Ortiz-Camu&#241;ez"
                            5 => "S&#46; Garc&#237;a-Morillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1157/13115000"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2008"
                        "volumen" => "208"
                        "paginaInicial" => "4"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18221654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "RECALMIN&#46; Four years of growth of the internal medicine units of the Spanish National Health System &#40;2013&#8211;2016&#41; &#91;Article in English&#44; Spanish&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Zapatero-Gaviria"
                            1 => "R&#46; Gomez-Huelgas"
                            2 => "J&#46; Diez-Manglano"
                            3 => "R&#46; Barba-Mart&#237;n"
                            4 => "J&#46; Carretero-Gomez"
                            5 => "A&#46; Maestre-Peir&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2018.11.005"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2019"
                        "volumen" => "219"
                        "paginaInicial" => "171"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30808505"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674911001849"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonagenarios en los servicios de Medicina Interna espa&#241;oles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; L&#225;zaro"
                            1 => "J&#46; Marco"
                            2 => "R&#46; Barba"
                            3 => "J&#46;M&#46; Ribera"
                            4 => "S&#46; Plaza"
                            5 => "A&#46; Zapatero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.regg.2012.02.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Geriatr Gerontol"
                        "fecha" => "2012"
                        "volumen" => "47"
                        "paginaInicial" => "193"
                        "paginaFinal" => "197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22884638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-hospital syndrome&#8212;an acquired transient condition of generalized risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;M&#46; Krumholz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "100"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehospitalizations among patients in the Medicare fee-forservice program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Jencks"
                            1 => "M&#46;V&#46; Williams"
                            2 => "E&#46;A&#46; Coleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0803563"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "1418"
                        "paginaFinal" => "1428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674916307953"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Palanca I&#44; Medina J&#44; Elola FJ&#44; Bernal JL&#44; Paniagua JL&#44; Grupo de Expertos&#46; Unidad de Pacientes Pluripatol&#243;gicos&#46; Est&#225;ndares y Recomendaciones&#46; Agencia de Calidad del SNS&#46; Ministerio de Sanidad y Pol&#237;tica Social&#59; 2009&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estrategia para el Abordaje de la Cronicidad en el Sistema Nacional de Salud"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ferrer"
                            1 => "D&#46; Orozco"
                            2 => "P&#46; Rom&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2012"
                        "editorial" => "Ministerio de Sanidad&#44; Servicios Sociales e Igualdad"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021900000008/v1_201910300730/S2254887419301328/v1_201910300730/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "72714"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000008/v1_201910300730/S2254887419301328/v1_201910300730/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301328?idApp=WRCEE"
]
Share
Journal Information
Share
Share
Download PDF
More article options
Editorial
The importance of evaluating fragility and dependence
La importancia de evaluar la fragilidad y la dependencia
J. Marco Martíneza,
Corresponding author
javiermarco.z@gmail.com

Corresponding author.
, S. Plaza Cantelib
a Sección Medicina Perioperatoria, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Cuidados Paliativos, Hospital Severo Ochoa, Madrid, Spain

Purchase article

For the purchase of this article it is necessary to fill in the following form:

Afganistan
Albania
Alemania
Andorra
Angola
Anguilla
Antartica
Antigua and barbuda
Antillas holandesas
Arabia saudita
Argelia
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgica
Belice
Benin
Bermudas/antillas britanicas
Bhutan
Bolivia
Bosnia y herzegowina
Botswana
Brasil
Brunei darussalam
Bulgaria
Burkina faso
Burundi
Cabo verde
Camboya
Camerun
Canada
Chad
Chile
China
Chipre
Colombia
Comoros
Corea
Costa rica
Cote d´ivoire
Croacia
Cuba
Dinamarca
Djibouti
Dominica
East timor
Ecuador
Egipto
El salvador
Emiratos arabes unidos
Eritrea
Escocia
Eslovaquia
Eslovenia
España
Estados federados de micronesia
Estados unidos
Estonia
Etiopia
Fiji
Filipinas
Finlandia
Francia
Gabon
Gambia
Georgia
Ghana
Gibraltar
Grecia
Grenada
Groenlandia
Guadalupe
Guam
Guatemala
Guayana britanica
Guinea
Guinea ecuatorial
Guinea francesa
Guinea-bissau
Haiti
Holanda
Honduras
Hong kong
Hungria
India
Indonesia
Irak
Iran
Irlanda
Isla bouvet
Isla cocos (keeling)
Isla cook
Isla mauricio
Isla navidad
Isla norfolk
Islandia
Islas caiman
Islas falkland (malvinas)
Islas faroe
Islas georgia del sur y sandwich
Islas heard and mc donald
Islas marshall
Islas northern mariana
Islas salomon
Islas svalbard and jan mayen
Islas turks and caicos
Islas united states minor outlyi
Islas virgenes (britanicas)
Islas virgenes (u.s.a.)
Islas wallis and futuna
Israel
Italia
Jamaica
Japon
Jordania
Kazakhstan
Kenia
Kiribati
Kuwait
Kyrgyzstan
Lesoto
Letonia
Libano
Liberia
Libia arab jamahiriya
Liechtenstein
Lituania
Luxemburgo
Macao
Macedonia
Madagascar
Malasia
Malawi
Maldives
Mali
Malta
Marruecos
Martinica
Mauritania
Mayotte
Mexico
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Niger
Nigeria
Niue
Noruega
Nueva caledonia
Nueva zelanda
Oman
Pakistan
Palau
Panama
Papua new guinea
Paraguay
Peru
Pitcairn
Polinesia francesa
Polonia
Portugal
Posesiones gran bretaña
Posesiones u.s.a.
Puerto rico
Qatar
Reino unido
Republica checa
Republica de africa central
Republica de cabo verde
Republica de congo
Republica de corea
Republica de moldova
Republica democratica de laos
Republica democratica del congo
Republica dominicana
Reunion
Ruanda
Rumania
Rusia
Sahara occidental
Saint kitts and nevis
Samoa
Samoa americana
San marino
San tomas y principe
San vincent and the grenadines
Santa lucia
Senegal
Serbia
Seychelles
Sierra leona
Singapur
Siria
Somalia
Sri lanka
St. helena
St. pierre and miquelon
Sudafrica
Sudan
Suecia
Suiza
Surinam
Swaziland
Tailandia
Taiwan republica de china
Tajikistan
Tanzania
Territorio de indias britanicas
Togo
Tokelau
Tonga
Trinidad and tobago
Tunisia
Turkmenistan
Turquia
Tuvalu
Ucrania
Uganda
Uruguay
Uzbekistan
Vanuatu
Vaticano
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbawe
Lebanon
Paises bajos
A coruña
Alava
Albacete
Alicante
Almeria
Asturias
Avila
Badajoz
Balears
Barcelona
Bizkaia
Burgos
Caceres
Cadiz
Cantabria
Castellon
Ceuta
Ciudad real
Cordoba
Cuenca
Girona
Granada
Guadalajara
Guipuzcoa
Huelva
Huesca
Jaen
La rioja
Las palmas
Leon
Lleida
Lugo
Madrid
Malaga
Melilla
Murcia
Navarra
Ourense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Tarragona
Tenerife
Teruel
Toledo
Valencia
Valladolid
Zamora
Zaragoza
-- Not applicable --
I accept to receive information about Elsevier's special products and promotions by email
I accept to receive information about products and special promotions from Elsevier partners by email
I have read and understand the Privacy Policy and Terms and conditions and agree to be bound by all of its terms.
* Required fields
In addition to temporary access to the article, it will be sent by email.
Customer Support
Phone
Calls from Spain
932 415 960
Calls from abroad
+34 932 415 960
Hours from 9 a.m. to 6 p.m. except the months of July and August, which will be from 9 am to 3 pm.
Idiomas
Revista Clínica Española (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?