array:23 [
  "pii" => "S0014256514002227"
  "issn" => "00142565"
  "doi" => "10.1016/j.rce.2014.05.008"
  "estado" => "S300"
  "fechaPublicacion" => "2014-08-01"
  "aid" => "971"
  "copyright" => "Elsevier España, S.L.. All rights reserved"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "edi"
  "cita" => "Rev Clin Esp. 2014;214:311-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 599
    "formatos" => array:2 [
      "HTML" => 393
      "PDF" => 206
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0014256514002276"
    "issn" => "00142565"
    "doi" => "10.1016/j.rce.2014.05.013"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "976"
    "copyright" => "Elsevier España, S.L."
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2014;214:313-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 828
      "formatos" => array:2 [
        "HTML" => 314
        "PDF" => 514
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Sarcopenia&#58; A condition in need for identification in different health care settings"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "313"
          "paginaFinal" => "314"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sarcopenia&#58; una condici&#243;n que debe identificarse en los diferentes &#225;mbitos asistenciales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#46;P&#46; Patel"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "H&#46;P&#46;"
              "apellidos" => "Patel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002276?idApp=WRCEE"
    "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002276/v1_201407221202/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0014256514002264"
    "issn" => "00142565"
    "doi" => "10.1016/j.rce.2014.05.012"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "975"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2014;214:309-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 848
      "formatos" => array:2 [
        "HTML" => 489
        "PDF" => 359
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Diagn&#243;stico de la fibrosis qu&#237;stica en el adulto"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "309"
          "paginaFinal" => "310"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Diagnostic of cystic fibrosis in adult"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; de Gracia, A&#46; &#193;lvarez Fern&#225;ndez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "de Gracia"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "&#193;lvarez Fern&#225;ndez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002264?idApp=WRCEE"
    "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002264/v1_201407221202/es/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Advance directives&#58; Better than nothing at all"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "311"
        "paginaFinal" => "312"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46;J&#46; Silveira"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "M&#46;J&#46;"
            "apellidos" => "Silveira"
            "email" => array:1 [
              0 => "mariajs&#64;med&#46;umich&#46;edu"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Research Scientist Center for Clinical Management Research&#44; Ann Arbor Veterans Administration Medical Center&#44; Michigan&#44; United States"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Internal Medicine&#44; University of Michigan&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Directivas m&#233;dicas por adelantado&#58; esta opci&#243;n mejor que ninguna"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Revista Cl&#237;nica Espa&#241;ola</span>&#44; Antolin et al&#46; have shown that despite having one of the highest advance directive completion rates in Spain&#44; patients in Catalonia rarely bring their advance directives to the hospital where they can be of use to their physicians&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the course of a decade&#44; only 130 advance directives were registered at the tertiary care center where the study was conducted&#46; The major limitation of the study is that we do not know how many people completed an advance directive and never registered it&#59; thus&#44; from this study we cannot determine what the true advance directive completion rate is in Catalonia&#46; Still&#44; the data raise two common concerns with regards to advance directives&#58; &#40;1&#41; people do not complete them and &#40;2&#41; advance directives are not shared with healthcare providers&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Indeed&#44; when similar studies from the 1990s showed that few Americans completed advance directives&#44; advance directives were unavailable to physicians when necessary&#44; few patients discussed the contents of their advance directives with their personal physician&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and few physicians asked patients about their advance directives&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> some argued that the US should forgo advance directives altogether&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fortunately&#44; advances over the years have led us to a place where these factors are no longer applicable in the US&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the United States&#44; we have seen the percentage of elderly community dwelling adults with an advance directive climb from 47&#37; in 2000 to 72&#37; in 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A number of legal&#44; financial&#44; and cultural factors are likely to explain the change&#46; First&#44; the United States has had a law in place since 1990 &#40;the Patient Self Determination Act<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#41; mandating that every hospital in the nation inform patients of their right to compose an advance directive&#46; Second&#44; physicians have found ways to be reimbursed by Medicare &#40;the nation&#39;s primary insurance for the aged&#41; for time spent in advance care planning&#46; Currently&#44; there is a bill under consideration by Congress to incentivize patients financially to complete advance directives&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Third&#44; as the Baby Boomer generation ages&#44; caregiving for demented elderly has become increasingly common and burdensome&#44; diminishing the specter around planning for death&#46; The term &#8220;advance directive&#8221; is familiar to most people&#44; especially those over age 60&#46; Lastly&#44; there is growing and convincing evidence of the benefits of advance directives<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and advance care planning&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">What we learned from our experience in the US is that low advance directive completion and documentation rates are not a marker of outright failure of the advance directive&#44; but rather a symptom of an inadequate process that needs amelioration&#46; Thus&#44; I believe the major implication of Antolin&#39;s study is that Catalonia needs a better process to systematically encourage patients to complete advance directives and ensure that completed advance directives are disseminated and readily discoverable when necessary&#46; There are communities that Catalonia can turn to for guidance&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">One such community is LaCrosse Wisconsin where a group of healthcare organizations worked in collaboration to develop and implement a system to&#58; &#40;1&#41; ask all adults to reflect on and discuss their future care in the event of a serious illness&#59; &#40;2&#41; ask all adults to document their preferences in writing&#59; &#40;3&#41; ensure that written care plans &#40;including advance directives&#41; are electronically stored&#44; transferred&#44; and retrieved wherever a patient gets care&#59; and &#40;4&#41; ensure that written care plans are reviewed and honored when necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Data suggest 85&#37; of decedent residents of LaCrosse have advance directive and 95&#37; of these advance directives are available through the electronic medical record at the time of death&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Among those with an advance directive&#44; 98&#37; receive care consistent with their preferences&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some might argue that even with a system like LaCrosse&#39;s in place&#44; Catalonia might never achieve the same rate of adoption of advance directives&#46; It is true that advance directives are an American invention and a product of a Western philosophy respecting personal autonomy above all else and valuing individual over social good&#46; The culture of Catalonia is different than the culture of the US&#46; Indeed&#44; when we examine the uptake of advance directives among ethnic minorities in the US &#40;including Latin-Americans&#41;&#44; rates of advance directive completion are very low&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> While there are some things we can do to make advance directives more appealing to diverse cultures&#44; there may be patients for whom an advance directive will never acceptable &#40;e&#46;g&#46; when they are superstitious about discussing death or when they believe in family-centered decision making over decision making by the patient alone&#41; and that should be okay&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even if we cannot get 100&#37; of the population to engage in advance care planning or to document their preferences in an advance directive&#44; we should still keep trying&#46; If not because it is the &#8220;right thing to do&#44;&#8221; then for one simple reason&#58; Advance directives come into effect when a patient loses decisional capacity and evidence shows that this happens more often than one would think&#46; Antolin et al&#46; found that among patients who completed advance directives in Catalonia&#44; over 30&#37; lost their decisional capacity before death&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the United States&#44; the number is closer to 60&#37; among community dwelling elderly&#46; As long as modern medicine continues to successfully prolong life without concurrently knowing how to preserve and protect decisional capacity&#44; decision making for patients who cannot speak for themselves will continue to challenge us&#46; While many families are able to step in for their incapacitated family members&#44; though that is not always the case&#44; and an advance directive will always be better than nothing at all&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and use of advanced directives in a tertiary hospital&#46; Period 2001&#8211;2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Antolin"
                            1 => "S&#46; Jimenez"
                            2 => "M&#46; Gonzalez"
                            3 => "E&#46; Gomez"
                            4 => "M&#46; Sanchez"
                            5 => "O&#46; Miro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "296"
                        "paginaFinal" => "302"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient preferences for communication with physicians about end-of-life decisions&#46; SUPPORT Investigators&#46; Study to Understand Prognoses and Preference for Outcomes and Risks of Treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Hofmann"
                            1 => "N&#46;S&#46; Wenger"
                            2 => "R&#46;B&#46; Davis"
                            3 => "J&#46; Teno"
                            4 => "A&#46;F&#46; Jr Connors"
                            5 => "N&#46; Desbiens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Intern Med"
                        "fecha" => "1997"
                        "volumen" => "127"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hope for the future&#58; achieving the original intent of advance directives&#46; The Hastings Center report&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;E&#46; Hickman"
                            1 => "B&#46;J&#46; Hammes"
                            2 => "A&#46;H&#46; Moss"
                            3 => "S&#46;W&#46; Tolle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2005 November&#8211;December"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enough &#8211; the failure of the living will"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Fagerlin"
                            1 => "C&#46;E&#46; Schneider"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hastings Cent Rep"
                        "fecha" => "2004"
                        "volumen" => "34"
                        "paginaInicial" => "30"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15156835"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advance directive completion by elderly Americans&#58; a decade of change"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Silveira"
                            1 => "W&#46; Wiitala"
                            2 => "J&#46; Piette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12736"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "706"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24697553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The patient self-determination act-on balance&#44; more help than hindrance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;L&#46; White"
                            1 => "J&#46;C&#46; Fletcher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "1991"
                        "volumen" => "266"
                        "paginaInicial" => "410"
                        "paginaFinal" => "412"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Coburn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2014"
                        "editorial" => "Senate"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advance directives and outcomes of surrogate decision making before death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Silveira"
                            1 => "S&#46;Y&#46; Kim"
                            2 => "K&#46;M&#46; Langa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0907901"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "1211"
                        "paginaFinal" => "1218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20357283"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of advance care planning on end of life care in elderly patients&#58; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;M&#46; Detering"
                            1 => "A&#46;D&#46; Hancock"
                            2 => "M&#46;C&#46; Reade"
                            3 => "W&#46; Silvester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "2010"
                        "volumen" => "340"
                        "paginaInicial" => "c1345"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparative&#44; retrospective&#44; observational study of the prevalence&#44; availability&#44; and specificity of advance care plans in a county that implemented an advance care planning microsystem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Hammes"
                            1 => "B&#46;L&#46; Rooney"
                            2 => "J&#46;D&#46; Gundrum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1532-5415.2010.02956.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2010"
                        "volumen" => "58"
                        "paginaInicial" => "1249"
                        "paginaFinal" => "1255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20649688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Death and end-of-life planning in one Midwestern community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;J&#46; Hammes"
                            1 => "B&#46;L&#46; Rooney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "383"
                        "paginaFinal" => "390"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of culture on end-of-life decision making"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Bullock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/15524256.2011.548048"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Soc Work End Life Palliat Care"
                        "fecha" => "2011"
                        "volumen" => "7"
                        "paginaInicial" => "83"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21391079"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1529943007002513"
                          "estado" => "S300"
                          "issn" => "15299430"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current research findings on end-of-life decision making among racially or ethnically diverse groups"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Kwak"
                            1 => "W&#46;E&#46; Haley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gerontologist"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "634"
                        "paginaFinal" => "641"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199398"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1020"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editoriales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002227?idApp=WRCEE"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Editorial
Advance directives: Better than nothing at all
Directivas médicas por adelantado: esta opción mejor que ninguna
M.J. Silveiraa,b
a Research Scientist Center for Clinical Management Research, Ann Arbor Veterans Administration Medical Center, Michigan, United States
b Department of Internal Medicine, University of Michigan, United States
Leído
759
Veces
se ha leído el artículo
361
Total PDF
398
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S0014256514002227"
  "issn" => "00142565"
  "doi" => "10.1016/j.rce.2014.05.008"
  "estado" => "S300"
  "fechaPublicacion" => "2014-08-01"
  "aid" => "971"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;. All rights reserved"
  "copyrightAnyo" => "2014"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "edi"
  "cita" => "Rev Clin Esp. 2014;214:311-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 599
    "formatos" => array:2 [
      "HTML" => 393
      "PDF" => 206
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0014256514002276"
    "issn" => "00142565"
    "doi" => "10.1016/j.rce.2014.05.013"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "976"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2014;214:313-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 828
      "formatos" => array:2 [
        "HTML" => 314
        "PDF" => 514
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Sarcopenia&#58; A condition in need for identification in different health care settings"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "313"
          "paginaFinal" => "314"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sarcopenia&#58; una condici&#243;n que debe identificarse en los diferentes &#225;mbitos asistenciales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#46;P&#46; Patel"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "H&#46;P&#46;"
              "apellidos" => "Patel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002276?idApp=WRCEE"
    "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002276/v1_201407221202/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0014256514002264"
    "issn" => "00142565"
    "doi" => "10.1016/j.rce.2014.05.012"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "975"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2014;214:309-10"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 848
      "formatos" => array:2 [
        "HTML" => 489
        "PDF" => 359
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Diagn&#243;stico de la fibrosis qu&#237;stica en el adulto"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "309"
          "paginaFinal" => "310"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Diagnostic of cystic fibrosis in adult"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; de Gracia, A&#46; &#193;lvarez Fern&#225;ndez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "de Gracia"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "&#193;lvarez Fern&#225;ndez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002264?idApp=WRCEE"
    "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002264/v1_201407221202/es/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Advance directives&#58; Better than nothing at all"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "311"
        "paginaFinal" => "312"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46;J&#46; Silveira"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "M&#46;J&#46;"
            "apellidos" => "Silveira"
            "email" => array:1 [
              0 => "mariajs&#64;med&#46;umich&#46;edu"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Research Scientist Center for Clinical Management Research&#44; Ann Arbor Veterans Administration Medical Center&#44; Michigan&#44; United States"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Internal Medicine&#44; University of Michigan&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Directivas m&#233;dicas por adelantado&#58; esta opci&#243;n mejor que ninguna"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Revista Cl&#237;nica Espa&#241;ola</span>&#44; Antolin et al&#46; have shown that despite having one of the highest advance directive completion rates in Spain&#44; patients in Catalonia rarely bring their advance directives to the hospital where they can be of use to their physicians&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the course of a decade&#44; only 130 advance directives were registered at the tertiary care center where the study was conducted&#46; The major limitation of the study is that we do not know how many people completed an advance directive and never registered it&#59; thus&#44; from this study we cannot determine what the true advance directive completion rate is in Catalonia&#46; Still&#44; the data raise two common concerns with regards to advance directives&#58; &#40;1&#41; people do not complete them and &#40;2&#41; advance directives are not shared with healthcare providers&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Indeed&#44; when similar studies from the 1990s showed that few Americans completed advance directives&#44; advance directives were unavailable to physicians when necessary&#44; few patients discussed the contents of their advance directives with their personal physician&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and few physicians asked patients about their advance directives&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> some argued that the US should forgo advance directives altogether&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fortunately&#44; advances over the years have led us to a place where these factors are no longer applicable in the US&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the United States&#44; we have seen the percentage of elderly community dwelling adults with an advance directive climb from 47&#37; in 2000 to 72&#37; in 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A number of legal&#44; financial&#44; and cultural factors are likely to explain the change&#46; First&#44; the United States has had a law in place since 1990 &#40;the Patient Self Determination Act<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#41; mandating that every hospital in the nation inform patients of their right to compose an advance directive&#46; Second&#44; physicians have found ways to be reimbursed by Medicare &#40;the nation&#39;s primary insurance for the aged&#41; for time spent in advance care planning&#46; Currently&#44; there is a bill under consideration by Congress to incentivize patients financially to complete advance directives&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Third&#44; as the Baby Boomer generation ages&#44; caregiving for demented elderly has become increasingly common and burdensome&#44; diminishing the specter around planning for death&#46; The term &#8220;advance directive&#8221; is familiar to most people&#44; especially those over age 60&#46; Lastly&#44; there is growing and convincing evidence of the benefits of advance directives<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and advance care planning&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">What we learned from our experience in the US is that low advance directive completion and documentation rates are not a marker of outright failure of the advance directive&#44; but rather a symptom of an inadequate process that needs amelioration&#46; Thus&#44; I believe the major implication of Antolin&#39;s study is that Catalonia needs a better process to systematically encourage patients to complete advance directives and ensure that completed advance directives are disseminated and readily discoverable when necessary&#46; There are communities that Catalonia can turn to for guidance&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">One such community is LaCrosse Wisconsin where a group of healthcare organizations worked in collaboration to develop and implement a system to&#58; &#40;1&#41; ask all adults to reflect on and discuss their future care in the event of a serious illness&#59; &#40;2&#41; ask all adults to document their preferences in writing&#59; &#40;3&#41; ensure that written care plans &#40;including advance directives&#41; are electronically stored&#44; transferred&#44; and retrieved wherever a patient gets care&#59; and &#40;4&#41; ensure that written care plans are reviewed and honored when necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Data suggest 85&#37; of decedent residents of LaCrosse have advance directive and 95&#37; of these advance directives are available through the electronic medical record at the time of death&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Among those with an advance directive&#44; 98&#37; receive care consistent with their preferences&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some might argue that even with a system like LaCrosse&#39;s in place&#44; Catalonia might never achieve the same rate of adoption of advance directives&#46; It is true that advance directives are an American invention and a product of a Western philosophy respecting personal autonomy above all else and valuing individual over social good&#46; The culture of Catalonia is different than the culture of the US&#46; Indeed&#44; when we examine the uptake of advance directives among ethnic minorities in the US &#40;including Latin-Americans&#41;&#44; rates of advance directive completion are very low&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> While there are some things we can do to make advance directives more appealing to diverse cultures&#44; there may be patients for whom an advance directive will never acceptable &#40;e&#46;g&#46; when they are superstitious about discussing death or when they believe in family-centered decision making over decision making by the patient alone&#41; and that should be okay&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even if we cannot get 100&#37; of the population to engage in advance care planning or to document their preferences in an advance directive&#44; we should still keep trying&#46; If not because it is the &#8220;right thing to do&#44;&#8221; then for one simple reason&#58; Advance directives come into effect when a patient loses decisional capacity and evidence shows that this happens more often than one would think&#46; Antolin et al&#46; found that among patients who completed advance directives in Catalonia&#44; over 30&#37; lost their decisional capacity before death&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the United States&#44; the number is closer to 60&#37; among community dwelling elderly&#46; As long as modern medicine continues to successfully prolong life without concurrently knowing how to preserve and protect decisional capacity&#44; decision making for patients who cannot speak for themselves will continue to challenge us&#46; While many families are able to step in for their incapacitated family members&#44; though that is not always the case&#44; and an advance directive will always be better than nothing at all&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:13 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and use of advanced directives in a tertiary hospital&#46; Period 2001&#8211;2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Antolin"
                            1 => "S&#46; Jimenez"
                            2 => "M&#46; Gonzalez"
                            3 => "E&#46; Gomez"
                            4 => "M&#46; Sanchez"
                            5 => "O&#46; Miro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "296"
                        "paginaFinal" => "302"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient preferences for communication with physicians about end-of-life decisions&#46; SUPPORT Investigators&#46; Study to Understand Prognoses and Preference for Outcomes and Risks of Treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Hofmann"
                            1 => "N&#46;S&#46; Wenger"
                            2 => "R&#46;B&#46; Davis"
                            3 => "J&#46; Teno"
                            4 => "A&#46;F&#46; Jr Connors"
                            5 => "N&#46; Desbiens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Intern Med"
                        "fecha" => "1997"
                        "volumen" => "127"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hope for the future&#58; achieving the original intent of advance directives&#46; The Hastings Center report&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;E&#46; Hickman"
                            1 => "B&#46;J&#46; Hammes"
                            2 => "A&#46;H&#46; Moss"
                            3 => "S&#46;W&#46; Tolle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2005 November&#8211;December"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enough &#8211; the failure of the living will"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Fagerlin"
                            1 => "C&#46;E&#46; Schneider"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hastings Cent Rep"
                        "fecha" => "2004"
                        "volumen" => "34"
                        "paginaInicial" => "30"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15156835"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advance directive completion by elderly Americans&#58; a decade of change"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Silveira"
                            1 => "W&#46; Wiitala"
                            2 => "J&#46; Piette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.12736"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2014"
                        "volumen" => "62"
                        "paginaInicial" => "706"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24697553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The patient self-determination act-on balance&#44; more help than hindrance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;L&#46; White"
                            1 => "J&#46;C&#46; Fletcher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "1991"
                        "volumen" => "266"
                        "paginaInicial" => "410"
                        "paginaFinal" => "412"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Coburn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2014"
                        "editorial" => "Senate"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advance directives and outcomes of surrogate decision making before death"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Silveira"
                            1 => "S&#46;Y&#46; Kim"
                            2 => "K&#46;M&#46; Langa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0907901"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "1211"
                        "paginaFinal" => "1218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20357283"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of advance care planning on end of life care in elderly patients&#58; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;M&#46; Detering"
                            1 => "A&#46;D&#46; Hancock"
                            2 => "M&#46;C&#46; Reade"
                            3 => "W&#46; Silvester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "2010"
                        "volumen" => "340"
                        "paginaInicial" => "c1345"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparative&#44; retrospective&#44; observational study of the prevalence&#44; availability&#44; and specificity of advance care plans in a county that implemented an advance care planning microsystem"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Hammes"
                            1 => "B&#46;L&#46; Rooney"
                            2 => "J&#46;D&#46; Gundrum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1532-5415.2010.02956.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2010"
                        "volumen" => "58"
                        "paginaInicial" => "1249"
                        "paginaFinal" => "1255"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20649688"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Death and end-of-life planning in one Midwestern community"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;J&#46; Hammes"
                            1 => "B&#46;L&#46; Rooney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "383"
                        "paginaFinal" => "390"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of culture on end-of-life decision making"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46; Bullock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/15524256.2011.548048"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Soc Work End Life Palliat Care"
                        "fecha" => "2011"
                        "volumen" => "7"
                        "paginaInicial" => "83"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21391079"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1529943007002513"
                          "estado" => "S300"
                          "issn" => "15299430"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current research findings on end-of-life decision making among racially or ethnically diverse groups"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Kwak"
                            1 => "W&#46;E&#46; Haley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gerontologist"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "634"
                        "paginaFinal" => "641"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199398"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1020"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editoriales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002227?idApp=WRCEE"
]
Información del artículo
ISSN: 00142565
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 0 1 1
2024 Octubre 0 6 6
2024 Septiembre 0 3 3
2024 Agosto 0 5 5
2024 Julio 0 5 5
2024 Junio 0 2 2
2024 Mayo 0 1 1
2024 Abril 0 2 2
2024 Marzo 0 5 5
2024 Febrero 0 1 1
2024 Enero 0 1 1
2023 Diciembre 0 2 2
2023 Noviembre 0 2 2
2023 Octubre 0 2 2
2023 Septiembre 0 1 1
2023 Agosto 0 6 6
2023 Julio 0 5 5
2023 Mayo 0 4 4
2023 Abril 0 1 1
2023 Marzo 5 4 9
2023 Febrero 0 1 1
2023 Enero 0 3 3
2022 Diciembre 0 1 1
2022 Noviembre 0 4 4
2022 Octubre 0 1 1
2022 Septiembre 0 3 3
2022 Agosto 0 3 3
2022 Julio 0 3 3
2022 Junio 0 2 2
2022 Mayo 0 6 6
2022 Abril 0 2 2
2022 Marzo 0 2 2
2022 Febrero 0 3 3
2022 Enero 0 2 2
2021 Diciembre 0 6 6
2021 Noviembre 0 1 1
2021 Octubre 0 4 4
2021 Septiembre 0 3 3
2021 Agosto 0 3 3
2021 Julio 0 6 6
2021 Junio 0 4 4
2021 Abril 0 2 2
2021 Marzo 0 5 5
2021 Febrero 0 1 1
2021 Enero 0 10 10
2020 Diciembre 0 2 2
2020 Noviembre 0 2 2
2020 Septiembre 0 1 1
2020 Agosto 0 1 1
2020 Julio 0 1 1
2020 Junio 0 1 1
2020 Abril 0 5 5
2020 Febrero 0 3 3
2019 Diciembre 0 2 2
2019 Agosto 0 8 8
2019 Julio 0 4 4
2019 Junio 1 11 12
2019 Mayo 0 12 12
2019 Abril 0 3 3
2019 Febrero 0 2 2
2019 Enero 0 1 1
2018 Noviembre 0 5 5
2018 Octubre 0 8 8
2018 Febrero 55 1 56
2018 Enero 18 3 21
2017 Diciembre 51 3 54
2017 Noviembre 18 4 22
2017 Octubre 16 6 22
2017 Septiembre 12 6 18
2017 Agosto 11 6 17
2017 Julio 9 4 13
2017 Junio 15 9 24
2017 Mayo 24 5 29
2017 Abril 10 4 14
2017 Marzo 7 2 9
2017 Febrero 15 2 17
2017 Enero 13 4 17
2016 Diciembre 22 29 51
2016 Noviembre 25 22 47
2016 Octubre 25 28 53
2016 Septiembre 14 4 18
2016 Agosto 29 3 32
2016 Julio 3 1 4
2016 Junio 0 2 2
2015 Diciembre 0 1 1
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Revista Clínica Española
es en

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

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