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provocando frecuentes ingresos hospitalarios<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a>&#46; Tienen una elevada mortalidad y consumen muchos recursos sanitarios<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46; Hasta un 38&#37; de los pacientes ingresados en servicios de medicina interna son PP<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Si seguimos las gu&#237;as de pr&#225;ctica cl&#237;nica&#44; las recomendaciones para el tratamiento de los PP incluyen m&#250;ltiples medicamentos y medidas no farmacol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; En promedio&#44; los PP toman m&#225;s de ocho medicamentos al d&#237;a y un tercio de ellos toma m&#225;s de diez<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">7</span></a>&#46; Este elevado n&#250;mero de medicamentos aumenta la complejidad del r&#233;gimen medicamentoso&#44; y se ha comprobado que la mayor complejidad se asocia con menor adherencia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Habitualmente la complejidad terap&#233;utica se suele evaluar con el n&#250;mero de medicamentos que toma el paciente&#46; Sin embargo&#44; esta aproximaci&#243;n es incompleta&#46; Es conocido que no solo el n&#250;mero de f&#225;rmacos y el n&#250;mero de dosis diarias&#44; sino tambi&#233;n las instrucciones y las restricciones adicionales de administraci&#243;n&#44; as&#237; como la forma gal&#233;nica de los medicamentos&#44; pueden modificar la tasa de adherencia<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">9-12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se ha evaluado la complejidad terap&#233;utica en pacientes ancianos mayores de 65 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a> pero no espec&#237;ficamente en PP&#46; El objetivo de este estudio fue valorar la complejidad del r&#233;gimen terap&#233;utico en los PP ingresados en los servicios de medicina interna en el momento del alta hospitalaria y su relaci&#243;n con las diferentes categor&#237;as de enfermedad&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; prospectivo y multic&#233;ntrico con los pacientes reclutados en los servicios de medicina interna de cinco hospitales de Arag&#243;n&#58; uno comarcal&#44; dos de segundo nivel y dos de tercer nivel&#46; Se incluyeron pacientes hospitalizados entre marzo y junio en departamentos de medicina interna que cumpl&#237;an los criterios de PP seg&#250;n la definici&#243;n del Gobierno de Andaluc&#237;a<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a>&#46; Se excluyeron los reingresos y los pacientes que fallecieron durante el ingreso&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Datos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se recogieron las siguientes variables&#58; edad&#44; sexo&#44; vivir en domicilio o residencia asistida&#44; categor&#237;a diagn&#243;stica de pluripatolog&#237;a&#44; comorbilidad&#44; capacidad para realizar las actividades b&#225;sicas e instrumentales de la vida diaria&#44; estado cognitivo&#44; situaci&#243;n sociofamiliar&#44; n&#250;mero de ingresos en el a&#241;o previo&#44; aparici&#243;n de delirium en el ingreso previo&#44; necesidad de cuidador&#44; disponibilidad de cuidador y puntuaci&#243;n en el &#237;ndice PROFUND&#46; La comorbilidad se midi&#243; con el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">14</span></a>&#46; La capacidad para realizar las actividades b&#225;sicas de la vida diaria se midi&#243; con el &#237;ndice de Barthel&#44; que mide 10 actividades y punt&#250;a 0-100&#44; siendo menor la puntuaci&#243;n cuanto mayor es la discapacidad<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">15</span></a>&#46; La capacidad para realizar las actividades instrumentales de la vida diaria se midi&#243; con la escala de Lawton-Brody&#44; que incluye 8 actividades y punt&#250;a 0-8&#44; siendo menor la puntuaci&#243;n cuanto mayor es la discapacidad<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a>&#46; Se consider&#243; una persona como dependiente cuando la puntuaci&#243;n era inferior a 8 en mujeres o a 5 en varones&#46; El estado cognitivo se valor&#243; con el cuestionario mental breve de Pfeiffer&#44; que mide los errores en 10 cuestiones&#59; a mayor n&#250;mero de errores&#44; mayor deterioro cognitivo<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">17</span></a>&#46; La situaci&#243;n sociofamiliar se midi&#243; con la escala de Gij&#243;n&#44; que punt&#250;a 5-25&#59; a mayor puntuaci&#243;n&#44; mayor riesgo de problema social<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">18</span></a>&#46; El &#237;ndice PROFUND es un &#237;ndice para valorar la probabilidad de supervivencia al cabo de un a&#241;o en los PP e incluye dimensiones demogr&#225;ficas&#44; cl&#237;nicas&#44; anal&#237;ticas&#44; psicom&#233;tricas&#44; funcionales&#44; sociofamiliares y asistenciales<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">19</span></a>&#46; Punt&#250;a entre 0 y 30 puntos y establece 4 niveles de riesgo de muerte&#58; bajo &#40;0-2 puntos&#41;&#44; intermedio &#40;3-6 puntos&#41;&#44; alto &#40;7-10 puntos&#41; y muy alto &#40;11-30 puntos&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se consider&#243; que un paciente necesitaba cuidador cuando la puntuaci&#243;n en el &#237;ndice de Barthel era menor de 60 y&#47;o la puntuaci&#243;n en el cuestionario de Pfeiffer era superior a 3 errores&#46; Se consider&#243; polifarmacia el consumo de 5 o m&#225;s f&#225;rmacos diarios y polifarmacia extrema 10 o m&#225;s&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para evaluar la complejidad del r&#233;gimen de tratamiento farmacol&#243;gico se utiliz&#243; el <span class="elsevierStyleItalic">Medication Regimen Complexity Index</span> &#40;MRCI&#41;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">20</span></a>&#46; Es una herramienta de 65 &#237;tems que valora y cuantifica las caracter&#237;sticas que hacen complejo un r&#233;gimen terap&#233;utico&#44; m&#225;s all&#225; de solo tener en cuenta el n&#250;mero de medicamentos que toma un paciente&#46; El MRCI est&#225; dividido en 3 secciones&#46; La secci&#243;n<span class="elsevierStyleHsp" style=""></span>A hace referencia a la forma gal&#233;nica&#44; dando m&#225;s o menos puntuaci&#243;n en funci&#243;n de la dificultad de uso o toma del medicamento&#44; puntuando una sola vez por cada forma gal&#233;nica&#46; La secci&#243;n<span class="elsevierStyleHsp" style=""></span>B se refiere a la posolog&#237;a&#44; dando mayor puntuaci&#243;n cuantas m&#225;s veces al d&#237;a haya que tomar el medicamento y cuanto m&#225;s estricto sea el horario&#46; La secci&#243;n<span class="elsevierStyleHsp" style=""></span>C hace referencia y punt&#250;a en funci&#243;n de las instrucciones adicionales asociadas a la toma del medicamento&#46; La suma de las tres secciones es el valor final&#44; y cuanto m&#225;s alto sea&#44; m&#225;s complejo es el r&#233;gimen terap&#233;utico&#46; El c&#225;lculo del MRCI se hizo a partir de los datos recogidos en el informe de alta&#46; Es sabido que los pacientes con m&#250;ltiples enfermedades toman m&#250;ltiples f&#225;rmacos&#46; Por esta raz&#243;n se consider&#243; que el r&#233;gimen de medicaci&#243;n era complejo cuando la puntuaci&#243;n en el MRCI estaba en el cuarto cuartil&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; &#201;tico y de Investigaci&#243;n Cl&#237;nica de Arag&#243;n&#46; Todos los pacientes dieron su consentimiento informado por escrito&#46; En el caso de pacientes incapacitados&#44; fueron sus familiares directos los que proporcionaron este consentimiento&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se presentan como media &#40;desviaci&#243;n est&#225;ndar&#41; y las variables cualitativas como frecuencia absoluta &#40;porcentaje&#41;&#46; La comparaci&#243;n de variables cualitativas se ha realizado con el test de chi cuadrado y la de las variables cuantitativas con el test de la t de Student&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para estudiar la asociaci&#243;n de variables con la complejidad terap&#233;utica se ha construido un modelo de regresi&#243;n log&#237;stica incluyendo en el an&#225;lisis multivariante las variables que en el an&#225;lisis univariante estaban asociadas con una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#46; La bondad de ajuste del modelo de regresi&#243;n log&#237;stica se comprob&#243; con el test de Hosmer-Lemeshow&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En todos los casos el nivel de significaci&#243;n ha sido p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Caracter&#237;sticas de los pacientes</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 223 pacientes&#46; El diagrama de flujo de pacientes se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Las caracter&#237;sticas de los pacientes se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El n&#250;mero de categor&#237;as de pluripatolog&#237;a fue mayor en los pacientes con r&#233;gimen de medicaci&#243;n complejo&#46; La insuficiencia cardiaca y las enfermedades respiratorias fueron m&#225;s frecuentes en los pacientes con r&#233;gimen de medicaci&#243;n complejo y las enfermedades de sistema nervioso y la enfermedad arterial perif&#233;rica&#44; menos&#46; No hubo diferencias en la capacidad para realizar las actividades de la vida diaria&#44; el estado cognitivo y la situaci&#243;n sociofamiliar&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">R&#233;gimen de medicaci&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">El n&#250;mero medio de f&#225;rmacos prescritos fue 8&#44;4 &#40;3&#44;3&#41;&#46; Presentaban polifarmacia 198 &#40;88&#44;8&#37;&#41; pacientes y polifarmacia extrema 75 &#40;33&#44;6&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan las caracter&#237;sticas por paciente del r&#233;gimen terap&#233;utico&#46; La puntuaci&#243;n media en el MRCI fue 32&#44;0 &#40;15&#44;2&#41; y la puntuaci&#243;n por cuartiles 0-20&#44; 20&#44;5-30&#44; 30&#44;5-42&#44; 42&#44;5-80&#46; Las formas gal&#233;nicas m&#225;s frecuentes fueron las c&#225;psulas&#44; los inhaladores&#44; las inyecciones precargadas y los parches&#46; Aunque las frecuencias fijas de administraci&#243;n una&#44; dos o tres veces al d&#237;a fueron las m&#225;s frecuentes&#44; destaca que un 28&#44;7&#37; de los pacientes ten&#237;a que tomar medicamentos a d&#237;as alternos o con menos frecuencia&#46; Adem&#225;s&#44; 222 &#40;99&#44;6&#37;&#41; pacientes recibieron alguna instrucci&#243;n adicional&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Las puntuaciones medias de las secciones<span class="elsevierStyleHsp" style=""></span>A&#44; B&#44; C y total en el MCRI fueron 6&#44;1 &#40;4&#44;1&#41;&#44; 13&#44;2 &#40;5&#44;9&#41;&#44; 12&#44;7 &#40;6&#44;7&#41; y 32&#44;0 &#40;15&#44;2&#41;&#44; respectivamente&#46; Los pacientes con enfermedades respiratorias &#40;categor&#237;a<span class="elsevierStyleHsp" style=""></span>C&#41; tuvieron las puntuaciones m&#225;s altas&#58; 8&#44;4 &#40;4&#44;1&#41;&#44; 15&#44;2 &#40;6&#44;4&#41;&#44; 15&#44;4 &#40;7&#44;5&#41; y 39&#44;0 &#40;16&#44;5&#41;&#44; respectivamente&#44; y los pacientes con enfermedades neurol&#243;gicas &#40;categor&#237;a<span class="elsevierStyleHsp" style=""></span>E&#41; las m&#225;s bajas&#58; 5&#44;3 &#40;3&#44;7&#41;&#44; 11&#44;7 &#40;5&#44;3&#41;&#44; 10&#44;7 &#40;5&#44;6&#41; y 27&#44;7 &#40;13&#44;0&#41;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Factores asociados con la complejidad terap&#233;utica</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los factores relacionados con un r&#233;gimen terap&#233;utico m&#225;s complejo se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; En el an&#225;lisis multivariable las enfermedades respiratorias &#40;OR&#58; 4&#44;185&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 2&#44;015-8&#44;693&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron con una mayor complejidad y las enfermedades del sistema nervioso con d&#233;ficit mental permanente &#40;OR&#58; 0&#44;265&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;085-0&#44;828&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41; con una menor complejidad del r&#233;gimen medicamentoso&#46; El modelo mostr&#243; un buen ajuste &#40;test de Hosmer-Lemeshow p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;534&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los principales hallazgos de nuestro estudio fueron que los reg&#237;menes medicamentosos prescritos a los PP tras una hospitalizaci&#243;n fueron de gran complejidad&#44; y m&#225;s complejos en los pacientes con enfermedades respiratorias y menos en los pacientes con deterioro cognitivo&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La pluripatolog&#237;a es la coexistencia de dos o m&#225;s enfermedades cr&#243;nicas y se asocia con frecuencia a polifarmacia&#46; En el proyecto PROFUND&#44; un estudio multic&#233;ntrico espa&#241;ol&#44; los PP consum&#237;an una media de 8 f&#225;rmacos al d&#237;a<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">19</span></a>&#46; El estudio PLUPAR ya observ&#243; que en los PP la prevalencia de polifarmacia extrema era del 33&#37; y que la polifarmacia no se asoci&#243; con mayor supervivencia<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">4&#44;7</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En nuestro estudio se observ&#243; la relaci&#243;n ente el n&#250;mero de f&#225;rmacos y la complejidad terap&#233;utica&#46; Sin embargo&#44; la complejidad de un r&#233;gimen medicamentoso abarca m&#225;s aspectos que el simple n&#250;mero de medicamentos consumidos&#46; Aspectos como la forma gal&#233;nica&#44; la frecuencia de las dosis o la forma de preparar la medicaci&#243;n puede complicar la comprensi&#243;n y el seguimiento de las prescripciones&#46; En este estudio la complejidad media del r&#233;gimen medicamentoso medido con el MRCI fue de 32&#44; un valor que puede considerarse muy alto&#46; Algunos aspectos ilustran esta complejidad en nuestros PP&#46; Un 69&#37; de nuestros pacientes deben tomar alg&#250;n medicamento dos veces al d&#237;a&#44; un 33&#37; tres veces al d&#237;a y un 39&#37; en pautas alternantes&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Un estudio sueco reciente en ancianos mostr&#243; una puntuaci&#243;n media en el MRCI de 9&#44; m&#225;s de 3 veces inferior a la hallada por nosotros<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a>&#46; En un estudio multic&#233;ntrico en ancianos institucionalizados de Portugal la puntuaci&#243;n media fue 18&#44; mucho m&#225;s baja que en nuestro estudio<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a>&#46; Sin embargo&#44; en un estudio con poblaci&#243;n similar en Australia la puntuaci&#243;n mediana fue 43&#44; muy superior a la de nuestros pacientes<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a>&#46; Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a>&#44; en un estudio en atenci&#243;n primaria para determinar los niveles de alta y baja complejidad&#44; encontraron una mediana en el MRCI de 8&#44;5 y establecieron en &#8805;<span class="elsevierStyleHsp" style=""></span>15&#44;5-25&#44;4 los niveles de alta complejidad&#46; En nuestro estudio la mediana del MRCI fue casi 4 veces superior&#44; y aplicando estos niveles&#44; entre el 60&#44;5 y el 83&#44;9&#37; de los PP tienen reg&#237;menes de medicaci&#243;n muy complejos&#46; Si comparamos nuestros resultados con los del estudio de Mansur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a>&#44; realizado en pacientes agudos hospitalizados en Israel&#44; apenas existen diferencias en la complejidad &#40;puntuaci&#243;n media MRCI&#58; 30&#44;27&#41;&#44; aunque el n&#250;mero de f&#225;rmacos fue mayor en nuestro estudio &#40;8&#44;4 frente a 5&#44;9&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Wimmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a>&#44; en un estudio en ancianos&#44; informaron de una asociaci&#243;n de la complejidad del r&#233;gimen medicamentoso con la edad&#44; la comorbilidad&#44; el dolor&#44; el mejor estado cognitivo y el deterioro funcional&#46; Al igual que en otros estudios&#44; nosotros no hemos encontrado asociaci&#243;n con la edad<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a>&#46; Sin embargo&#44; la edad de los pacientes en nuestro estudio es entre 5 y 7<span class="elsevierStyleHsp" style=""></span>a&#241;os superior a la de los pacientes incluidos en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; L&#243;gicamente&#44; cuanto mayor es la comorbilidad mayor ser&#225; el n&#250;mero de f&#225;rmacos prescritos y la complejidad del r&#233;gimen terap&#233;utico&#46; Un estudio con cuatro cohortes de enfermos con una &#250;nica enfermedad &#8212;depresi&#243;n geri&#225;trica&#44; infecci&#243;n por HIV&#44; diabetes o hipertensi&#243;n&#8212; mostr&#243; valores de complejidad inferiores<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestro estudio la complejidad terap&#233;utica se asoci&#243; con algunas enfermedades&#44; como la insuficiencia cardiaca&#44; la enfermedad respiratoria cr&#243;nica&#44; la enfermedad arterial perif&#233;rica y el deterioro cognitivo&#44; que con frecuencia se asocian entre s&#237;&#46; Algunos estudios han evaluado la complejidad del r&#233;gimen de medicaci&#243;n en enfermedades cardiacas y respiratorias&#44; y todos han encontrado una alta complejidad<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">28-30</span></a>&#46; Las gu&#237;as de pr&#225;ctica cl&#237;nica para el tratamiento de la insuficiencia cardiaca y la enfermedad pulmonar obstructiva cr&#243;nica recomiendan utilizar m&#250;ltiples medicamentos&#46; Por lo tanto&#44; no es sorprendente que en nuestro estudio dichas enfermedades estuvieran asociadas con alta complejidad terap&#233;utica&#46; No hemos encontrado estudios previos sobre complejidad del r&#233;gimen de tratamiento en la enfermedad arterial perif&#233;rica&#46; Son pocos los estudios que han evaluado la relaci&#243;n entre complejidad del r&#233;gimen de la medicaci&#243;n y la funci&#243;n cognitiva&#44; y en ellos siempre se ha observado una asociaci&#243;n negativa<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">25&#44;31</span></a>&#44; tal y como ha ocurrido en nuestro estudio&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En estudios realizados en adultos y ancianos el principal factor causal de la complejidad del r&#233;gimen de medicaci&#243;n es la frecuencia de dosis&#44; que corresponde a la secci&#243;n<span class="elsevierStyleHsp" style=""></span>B del MRCI<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">21&#44;27</span></a>&#46; En nuestro estudio&#44; sin embargo&#44; el peso de las instrucciones adicionales &#40;12&#44;7 puntos&#41; en la puntuaci&#243;n final del MRCI fue equivalente al peso de la frecuencia de dosis &#40;13&#44;2 puntos&#41;&#46; Esto nos indica que&#44; en los PP&#44; seguir las instrucciones espec&#237;ficas en la toma de la medicaci&#243;n es un aspecto de gran importancia&#46; Resulta pues importante evaluar si los pacientes comprenden el plan de medicaci&#243;n&#46; Para ello se han desarrollado herramientas&#44; como el <span class="elsevierStyleItalic">Evaluation tool to test the handling of the medication plan</span><a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Las puntuaciones altas en el MRCI se han asociado con mayor mortalidad intrahospitalaria&#44; m&#225;s infecciones nosocomiales y m&#225;s &#250;lceras por presi&#243;n<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">33</span></a>&#46; Tambi&#233;n con los ingresos hospitalarios por efectos adversos de los medicamentos&#44; con una mayor mortalidad y con institucionalizaci&#243;n tras el alta hospitalaria<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">23&#44;34-37</span></a>&#46; La asociaci&#243;n entre la complejidad del r&#233;gimen de medicaci&#243;n y la adherencia al tratamiento tambi&#233;n ha sido estudiada<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a>&#46; Aunque un estudio en pacientes en hemodi&#225;lisis observ&#243; mayor adherencia en los reg&#237;menes complejos&#44; otros estudios en pacientes diab&#233;ticos&#44; hipertensos o con coinfecci&#243;n HIV&#47;virus hepatitis<span class="elsevierStyleHsp" style=""></span>C han observado lo contrario<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">38-41</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Presumiblemente&#44; la simplificaci&#243;n del r&#233;gimen de medicaci&#243;n se asociar&#225; con beneficios para el paciente y para el sistema sanitario&#46; En este sentido&#44; las revisiones de la medicaci&#243;n&#44; de sus indicaciones y de sus pautas son necesarias&#44; m&#225;s all&#225; de la simple reducci&#243;n en el n&#250;mero de medicamentos&#46; Se han realizado intervenciones aprovechando la hospitalizaci&#243;n&#44; con buenos resultados<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">42&#44;43</span></a>&#46; Estas intervenciones deben ir dirigidas a los m&#233;dicos del hospital y a los m&#233;dicos de atenci&#243;n primaria<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">44</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Este estudio tiene fortalezas y limitaciones&#46; Entre las primeras cabe destacar que&#44; hasta donde conocemos&#44; es el primer estudio que analiza la complejidad del r&#233;gimen terap&#233;utico en PP&#46; Aunque cabe esperar que los PP&#44; por su carga m&#243;rbida elevada&#44; consuman muchos f&#225;rmacos y con reg&#237;menes complejos&#44; hay que destacar que son pacientes que con frecuencia tienen deterioro cognitivo y funcional y dependen de otras personas para sus cuidados&#46; Por esta raz&#243;n el estudio de la complejidad terap&#233;utica es importante de cara a poder dise&#241;ar en el futuro estrategias educativas que ayuden tanto al paciente como a sus cuidadores a cumplir con las especificaciones del tratamiento&#46; Adem&#225;s&#44; se trata de un estudio multic&#233;ntrico&#44; lo que refuerza la validez de sus hallazgos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Sin embargo&#44; el estudio tambi&#233;n tiene limitaciones&#46; En primer lugar&#44; la inclusi&#243;n de pacientes se realiz&#243; en los meses de primavera&#46; Es posible que la inclusi&#243;n de pacientes en otros periodos del a&#241;o pueda modificar la complejidad de los reg&#237;menes terap&#233;uticos&#46; Sin embargo&#44; los PP presentan por definici&#243;n varias enfermedades cr&#243;nicas&#44; y las agudizaciones de dichas enfermedades que provocan hospitalizaci&#243;n tienen una menor estacionalidad y se producen durante todo el a&#241;o&#46; En segundo lugar&#44; los pacientes se han reclutado exclusivamente tras la hospitalizaci&#243;n en servicios de medicina interna&#46; Nuestros resultados&#44; por lo tanto no pueden extrapolarse a otros &#225;mbitos y otras circunstancias&#46; La complejidad del tratamiento podr&#237;a ser diferente en pacientes de atenci&#243;n primaria&#44; de otros servicios hospitalarios o reclutados desde consultas externas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En resumen&#44; los reg&#237;menes terap&#233;uticos en los PP son de gran complejidad&#44; y son recomendables estrategias que conduzcan a la mayor simplificaci&#243;n posible de los mismos junto con medidas educativas y de refuerzo que faciliten a los pacientes y a sus cuidadores el cumplimiento de sus especificaciones&#46; Las hospitalizaciones pueden ser un buen momento para estas intervenciones&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">Estudio confinanciado por los fondos Europeos de Desarrollo Regional&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaAceptado" => "2018-04-17"
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            0 => "Polypathological patients"
            1 => "Therapeutic complexity"
            2 => "Medication regimen complexity index"
            3 => "Polypharmacy"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la complejidad del r&#233;gimen terap&#233;utico en pacientes pluripatol&#243;gicos hospitalizados en servicios de medicina interna&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En un estudio observacional multic&#233;ntrico se incluyeron pacientes pluripatol&#243;gicos hospitalizados en servicios de medicina interna&#46; Se excluyeron los reingresos y los fallecidos&#46; Se recogieron datos de edad&#44; sexo&#44; residencia&#44; patolog&#237;a&#44; &#237;ndices de Charlson&#44; Barthel y Lawton-Brody&#44; cuestionario de Pfeiffer&#44; escala de Gij&#243;n&#44; n&#250;mero de ingresos en el a&#241;o previo&#44; delirium&#44; necesidad y disponibilidad de cuidador y puntuaci&#243;n en el &#237;ndice PROFUND&#46; Se calcul&#243; la complejidad terap&#233;utica con el <span class="elsevierStyleItalic">Medication Regimen Complexity Index</span> &#40;MRCI&#41;&#46; Se consider&#243; un r&#233;gimen terap&#233;utico complejo cuando la puntuaci&#243;n en el MRCI estaba en el cuarto cuartil&#46; Para determinar los factores asociados con la complejidad se construy&#243; un modelo de regresi&#243;n log&#237;stica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 233 pacientes pluripatol&#243;gicos&#59; el 52&#44;9&#37;&#44; mujeres&#59; edad media &#40;desviaci&#243;n est&#225;ndar&#41;&#58; 79&#44;8 &#40;8&#44;6&#41; a&#241;os&#46; El consumo medio de f&#225;rmacos fue 8&#44;4 &#40;3&#44;3&#41;&#46; La puntuaci&#243;n media &#40;desviaci&#243;n est&#225;ndar&#41; en el MRCI fue 30 &#40;15&#44;2&#41;&#46; La puntuaci&#243;n por cuartiles del MRCI fue 0-20&#44; 20&#44;5-30&#44; 30&#44;5-42&#44; 42&#44;5-80&#46; Las enfermedades respiratorias &#40;OR&#58; 4&#44;185&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 2&#44;015-8&#44;693&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron de forma independiente con mayor complejidad terap&#233;utica&#44; y las enfermedades neurol&#243;gicas con d&#233;ficit mental permanente &#40;OR&#59; 0&#44;265&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;085-0&#44;828&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41; se asocian con menor complejidad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los pacientes pluripatol&#243;gicos est&#225;n polimedicados y tienen reg&#237;menes terap&#233;uticos de medicaci&#243;n complejos&#46; Las enfermedades respiratorias determinan una mayor complejidad&#44; y el deterioro cognitivo&#44; una menor complejidad terap&#233;utica&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the complexity of the therapeutic regimen for polypathological patients hospitalised in internal medicine departments&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A multicentre observational study included polypathological patients hospitalised in internal medicine departments&#46; Patients who were readmitted or died were excluded&#46; Data were collected on age&#44; sex&#44; residence&#44; disease&#44; Charlson&#44; Barthel and Lawton-Brody indices&#44; Pfeiffer questionnaire&#44; Gij&#243;n scale&#44; number of hospitalisations in the previous year&#44; delirium&#44; need for and availability of caregivers and the PROFUND index score&#46; We calculated the therapeutic complexity with the Medication Regimen Complexity Index &#40;MRCI&#41;&#46; We considered a therapeutic regimen complex when the MRCI score was in the fourth quartile&#46; To determine the factors associated with complexity&#44; we constructed a logistic regression model&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We included 233 polypathological patients&#44; 52&#46;9&#37; of whom were women&#44; with a mean age of 79&#46;8 &#40;SD&#58; 8&#46;6&#41; years&#46; The mean number of drugs consumed was 8&#46;4 &#40;SD&#58; 3&#46;3&#41;&#46; The mean MRCI score was 30 &#40;SD&#58; 15&#46;2&#41;&#46; The MRCI score by quartiles was 0-20&#44; 20&#46;5-30&#44; 30&#46;5-42&#44; 42&#46;5-80&#46; The respiratory diseases &#40;OR&#58; 4&#46;185&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 2&#46;015-8&#46;693&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; were independently associated with increased therapeutic complexity&#44; and the neurological diseases with permanent mental deficiency &#40;OR&#58; 0&#46;265&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;085-0&#46;828&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41; were associated with less complexity&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients with comorbidities are polymedicated and have complex therapeutic drug regimens&#46; Respiratory diseases determine greater therapeutic complexity&#44; while cognitive impairment determines a lower therapeutic complexity&#46;</p></span>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>223&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sin complejidad terap&#233;utica<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Con complejidad terap&#233;utica<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Edad</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;8 &#40;8&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#44;2 &#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;8 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;330&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Sexo</span></td><td class="td" title="table-entry  " align="left" valign="top">0&#44;974&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Var&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;47&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mujer</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;53&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;52&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Vivienda</span></td><td class="td" title="table-entry  " align="left" valign="top">0&#44;876&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Domicilio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171 &#40;76&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130 &#40;77&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;76&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Residencia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;22&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;23&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Categor&#237;as de pluripatolog&#237;a</span></td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a A&#46; Enfermedades cardiacas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135 &#40;60&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;56&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;74&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>A1&#46; Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 &#40;44&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>A2&#46; Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;26&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;389&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a B&#46; Enfermedades autoinmunes&#47;renales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;33&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;34&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;458&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>B1&#46; Vasculitis y enfermedades autoinmunes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;566&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>B2&#46; Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;32&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a C&#46; Enfermedades respiratorias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;35&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;65&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a D&#46; Enfermedades digestivas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;094&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>D1&#46; Enfermedad inflamatoria intestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;566&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>D2&#46; Enfermedad hep&#225;tica cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a E&#46; Enfermedades del sistema nervioso</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;43&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 &#40;50&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E1&#46; Ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;21&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;24&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;12&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;067&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E2&#46; Enfermedad con d&#233;ficit motor permanente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;292&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>E3&#46; Enfermedad con d&#233;ficit mental permanente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;28&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a F&#46; Arteriopat&#237;a perif&#233;rica y diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;831&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>F1&#46; Enfermedad arterial perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>F2&#46; Diabetes con retinopat&#237;a o neuropat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a G&#46; Anemia y neoplasias</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;32&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;27&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;498&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>G1&#46; Anemia cr&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;18&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;964&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>G2&#46; Neoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;14&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;275&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a H&#46; Enfermedad osteoarticular cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;27&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">N&#250;mero de categor&#237;as</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;6 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;7 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Delirium durante el ingreso previo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;17&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">&#205;ndice de Charlson</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;2 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">&#205;ndice de Barthel</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;950&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">&#205;ndice de Lawton-Brody</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;0 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;0 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;0 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;935&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Cuestionario de Pfeiffer</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;3 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;7 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Escala sociofamiliar de Gij&#243;n</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;8 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;2 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Requiere cuidador</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121 &#40;54&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;50&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;565&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">N&#250;mero de f&#225;rmacos</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;5 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;2 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Ingresos en el a&#241;o previo</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;1 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;0 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;4 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;070&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">&#205;ndice PROFUND</span><span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;3 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;3 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;912&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes incluidos en el estudio</p>"
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
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            "rol" => "short"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Secci&#243;n A</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Secci&#243;n B</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Forma gal&#233;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frecuencia de administraci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C&#225;psulas&#47;tabletas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">222 &#40;99&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Una vez al d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">223 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gargarismos&#47;enjuag&#252;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Una vez al d&#237;a a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masticables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dos veces al d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154 &#40;69&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L&#237;quidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dos veces d&#237;a a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polvos&#47;gr&#225;nulos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;19&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tres veces al d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;33&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sprays&#47;tabletas sublinguales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tres veces d&#237;a a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cremas&#47;geles&#47;ung&#252;entos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuatro veces al d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vendajes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuatro veces d&#237;a a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tinturas&#47;soluciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 12 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;28&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pastas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 12 horas a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parches&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;26&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 8 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Esprays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 8 horas a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gotas&#47;crema&#47;ung&#252;ento auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 6 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gotas oculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 6 horas a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Geles&#47;ung&#252;entos oculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 4 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gotas&#47;crema&#47;ung&#252;ento nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 4 horas a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Espray nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 2 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accuhalers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cada 2 horas a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aerolizers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">De rescate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inhaladores con dosificador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No todos los d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;28&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nebulizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ox&#237;geno a demanda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ox&#237;geno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;21&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ox&#237;geno &#60;<span class="elsevierStyleHsp" style=""></span>16 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Turbuhalers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ox&#237;geno &#62;<span class="elsevierStyleHsp" style=""></span>16 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otros inhaladores de polvo seco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Di&#225;lisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Enemas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inyecciones precargadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 &#40;30&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inyecciones&#44; ampollas&#44; viales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pesarios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Analgesia controlada por el paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supositorios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">Cremas vaginales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1844038.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Secci&#243;n C</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Instrucciones adicionales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Romper o partir las pastillas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;39&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Disolver la pastilla o polvo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;25&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#225;s de una unidad de vez&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;28&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dosis variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tomar&#47;utilizar en momentos espec&#237;ficos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">163 &#40;73&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tomar con alimentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">220 &#40;98&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tomar con un l&#237;quido espec&#237;fico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tomar&#47;usar como se indica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">161 &#40;72&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pauta ascendente&#47;descendente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dosis alternas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;39&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                          "autores" => array:3 [
                            0 => "Y&#46; Zoellner"
                            1 => "M&#46;M&#46; Balp"
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                      "Revista" => array:6 [
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                        "volumen" => "3"
                        "paginaInicial" => "109"
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