metricas
covid
Buscar en
Clinics
Toda la web
Inicio Clinics Palliative care in the COVID-19 pandemic: Strategy of HCFMUSP
Journal Information

Statistics

Follow this link to access the full text of the article

Comments
Palliative care in the COVID-19 pandemic: Strategy of HCFMUSP
Ricardo Tavares de Carvalhoa, Douglas Henrique Crispimb, Ednalda Maria Franckb,
Corresponding author
ednalda.franck@hc.fm.usp.br

Corresponding authors.
, Daniel Battacini Dei Santib, Sergio Seiki Anaguskob, Márcio Veronesi Fukudab, Luciana Suelly Barros Cavalcanteb, Sumatra Melo da Costa Pereira Jalesb, Mônica Estuque Garcia de Queirozb, Eloisa Silva Dutra de Oliveira Bonfác,*
a Coordinator of Department of Palliative Care, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
b Department of Palliative Care, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
c Clinical Director of the Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
Read
1507
Times
was read the article
423
Total PDF
1084
Total HTML
Share statistics
 array:23 [
  "pii" => "S1807593222004999"
  "issn" => "18075932"
  "doi" => "10.1016/j.clinsp.2022.100050"
  "estado" => "S300"
  "fechaPublicacion" => "2022-01-01"
  "aid" => "100050"
  "copyright" => "HCFMUSP"
  "copyrightAnyo" => "2022"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Clinics. 2022;77C:"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1807593222028836"
    "issn" => "18075932"
    "doi" => "10.1016/j.clinsp.2022.100067"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "100067"
    "copyright" => "HCFMUSP"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Clinics. 2022;77C:"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Comments</span>"
      "titulo" => "Long COVID-19&#58; Rethinking mental health"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Miguel Gallegos, Nelson Portillo, Pablo Martino, Mauricio Cervigni"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Gallegos"
            ]
            1 => array:2 [
              "nombre" => "Nelson"
              "apellidos" => "Portillo"
            ]
            2 => array:2 [
              "nombre" => "Pablo"
              "apellidos" => "Martino"
            ]
            3 => array:2 [
              "nombre" => "Mauricio"
              "apellidos" => "Cervigni"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028836?idApp=UINPBA00004N"
    "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222028836/v3_202308251443/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1807593222004987"
    "issn" => "18075932"
    "doi" => "10.1016/j.clinsp.2022.100049"
    "estado" => "S300"
    "fechaPublicacion" => "2022-01-01"
    "aid" => "100049"
    "copyright" => "HCFMUSP"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Clinics. 2022;77C:"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Comments</span>"
      "titulo" => "Care coordination in pediatrics&#58; Experience of the outpatient clinic for Children with Special Health Care Needs &#40;CSHCN&#41;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Paula Scoleze Ferrer, Daleth Rodrigues Scaramuzzi, Maria L&#250;cia M&#46; Bourroul, Sandra M&#46;C&#46; Zuccolotto, Sandra J&#46;F&#46;E&#46; Grisi"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ana Paula Scoleze"
              "apellidos" => "Ferrer"
            ]
            1 => array:2 [
              "nombre" => "Daleth Rodrigues"
              "apellidos" => "Scaramuzzi"
            ]
            2 => array:2 [
              "nombre" => "Maria L&#250;cia M&#46;"
              "apellidos" => "Bourroul"
            ]
            3 => array:2 [
              "nombre" => "Sandra M&#46;C&#46;"
              "apellidos" => "Zuccolotto"
            ]
            4 => array:2 [
              "nombre" => "Sandra J&#46;F&#46;E&#46;"
              "apellidos" => "Grisi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222004987?idApp=UINPBA00004N"
    "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222004987/v3_202308251443/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Comments</span>"
    "titulo" => "Palliative care in the COVID-19 pandemic&#58; Strategy of HCFMUSP"
    "tieneTextoCompleto" => true
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Ricardo Tavares de Carvalho, Douglas Henrique Crispim, Ednalda Maria Franck, Daniel Battacini Dei Santi, Sergio Seiki Anagusko, M&#225;rcio Veronesi Fukuda, Luciana Suelly Barros Cavalcante, Sumatra Melo da Costa Pereira Jales, M&#244;nica Estuque Garcia de Queiroz, Eloisa Silva Dutra de Oliveira Bonf&#225;"
        "autores" => array:10 [
          0 => array:3 [
            "nombre" => "Ricardo Tavares de"
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Douglas Henrique"
            "apellidos" => "Crispim"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Ednalda Maria"
            "apellidos" => "Franck"
            "email" => array:1 [
              0 => "ednalda.franck@hc.fm.usp.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0001"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Daniel Battacini"
            "apellidos" => "Dei Santi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Sergio Seiki"
            "apellidos" => "Anagusko"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#225;rcio Veronesi"
            "apellidos" => "Fukuda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Luciana Suelly Barros"
            "apellidos" => "Cavalcante"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Sumatra Melo da Costa Pereira"
            "apellidos" => "Jales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "M&#244;nica Estuque Garcia de"
            "apellidos" => "Queiroz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Eloisa Silva Dutra de Oliveira"
            "apellidos" => "Bonf&#225;"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0001"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Coordinator of Department of Palliative Care&#44; Hospital das Cl&#237;nicas&#44; Universidade de S&#227;o Paulo&#44; Faculdade de Medicina&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0001"
          ]
          1 => array:3 [
            "entidad" => "Department of Palliative Care&#44; Hospital das Cl&#237;nicas&#44; Universidade de S&#227;o Paulo&#44; Faculdade de Medicina&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0002"
          ]
          2 => array:3 [
            "entidad" => "Clinical Director of the Hospital das Cl&#237;nicas&#44; Universidade de S&#227;o Paulo&#44; Faculdade de Medicina&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0003"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0001"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding authors&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3396
            "Ancho" => 2750
            "Tamanyo" => 583695
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Triage protocol for COVID-19 patients and Palliative Care needs&#46; <span class="elsevierStyleSup">a</span> Chronic Obstrutive Pulmonary Disease&#59; <span class="elsevierStyleSup">b</span> Heart Failure&#59; <span class="elsevierStyleSup">c</span> Karnofsky Performance Scale&#59; <span class="elsevierStyleSup">d</span> Clinical Dementia Rating&#59; <span class="elsevierStyleSup">e</span> Intensive Care Unit&#59; <span class="elsevierStyleSup">f</span> World Health Organization&#59; <span class="elsevierStyleSup">g</span> Consultant Group&#59; <span class="elsevierStyleSup">h</span> Mecanical Ventilation&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">In January 2020&#44; the Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo &#8210; HCFMUSP set up a Crisis Committee &#40;CC&#41; to organize the actions to fight the COVID-19 pandemic&#46; The focus was to organize itself to receive severely ill patients from the city of S&#227;o Paulo and the metropolitan region&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">On March 30<span class="elsevierStyleSup">th</span>&#44; the largest patient relocation operation in its history was unleashed&#44; with the objective of allocating the Central Institute &#40;CI&#41;&#44; with 900 beds&#44; exclusively for COVID-19 cases&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">From there&#44; an action plan was elaborated and submitted to the CC&#44; proposing specific actions of the Palliative Care Team &#40;PCT&#41; based on the World Health Organization &#40;WHO&#41; document&#44; which describes the role of Palliative Care &#40;PC&#41; in humanitarian crisis&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0005" class="elsevierStylePara elsevierViewall">Some actions were approved by the CC and are described below&#58;<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">a&#41;</span><p id="para0006" class="elsevierStylePara elsevierViewall">Triage Protocol</p></li></ul></p><p id="para0007" class="elsevierStylePara elsevierViewall">A triage protocol for patients who might need help from the PCT&#46; Three patient profiles were identified by colors<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> according to two main criteria&#58; the presence of terminal disease &#40;according to the SPICT-BR tool&#41;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> and clinical criteria that predict poor evolution facing an acute and potentially severe complication&#46; In this sense&#44; three profiles were defined&#58;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Red&#58; patients without terminality criteria and without general predictors of poor evolution according to the National Hospice Organization-NHO&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> It was oriented to consider calling the PCT for joint follow-up if there were factors of poor prognosis listed by the WHO&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Yellow&#58; patients with criteria for terminality but without predictors of bad evolution&#46; Call the PCT if have difficulties in symptom control&#44; communication with families&#44; discuss advance directives&#44; or need to make complex decisions&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Green&#58; Patients with terminality criteria and with clinical predictors of poor outcome &#40;death&#41;&#46; Call the PCT to transfer the patient to the PC Inpatient Unit &#40;PC-IU&#41;&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">The flowchart &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>&#41; also indicated the methodology for making complex decisions and ethical and legal rules in force in Brazil&#46;<a class="elsevierStyleCrossRefs" href="#bib0006"><span class="elsevierStyleSup">6-8</span></a><ul class="elsevierStyleList" id="celist0002"><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">a&#41;</span><p id="para0012" class="elsevierStylePara elsevierViewall">The &#8220;Hot Line&#8221;</p></li></ul></p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0013" class="elsevierStylePara elsevierViewall">A telephone was made available by the institution as a way to establish a communication channel with the PCT&#46; This enabled the CI care teams to receive quick help to solve doubts regarding the control of difficult symptoms&#44; aspects related to communication or interaction difficulties with the families&#44; as well as help for complex decisions from the PC technical&#44; ethical&#44; and legal point of view&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Also&#44; was possible to provide quick access to the vacancy&#39;s regulation center of the HCFMUSP&#44; speeding up the referral and admission process of cases indicated for the PC-IU&#46;<ul class="elsevierStyleList" id="celist0003"><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">a&#41;</span><p id="para0015" class="elsevierStylePara elsevierViewall">Communication</p></li></ul></p><p id="para0016" class="elsevierStylePara elsevierViewall">With a donation&#44; specifically made to enable this communication through telepresence&#44; it was possible to deploy 50 cell phones&#44; 40 tablets&#44; and 4G chips for all this equipment&#46; The action plan included the distribution&#44; to each CI unit&#44; of a tablet and a cell phone with the WhatsApp application&#44; for convenience&#44; already installed&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">A booklet was created with instructions and flowcharts involving the main communication modalities in this context&#58; notice of worsening of the clinical picture&#44; death news&#44; family meetings for shared decision making<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> besides virtual visits from the families to the patients&#46; A partnership was also made with technology companies from INOVAHC&#46; This also made possible a lending contract for three robots with remote control and steering for communication actions&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">In all this context&#44; the PC-IU organized the pilot actions&#44; developed the action plans&#44; and made possible the expansion of the communication project to the other CI&#46; This was done with the help of volunteers&#44; including FMUSP students&#44; trained to give access to the equipment to hospitalized patients&#46;</p><p id="para0019" class="elsevierStylePara elsevierViewall">The devices could also be used for family orientation at the time of hospital discharge&#46;<ul class="elsevierStyleList" id="celist0004"><li class="elsevierStyleListItem" id="celistitem0004"><span class="elsevierStyleLabel">a&#41;</span><p id="para0020" class="elsevierStylePara elsevierViewall">Palliative Care Inpatient Unit &#40;PC-IU&#41;</p></li></ul></p><p id="para0021" class="elsevierStylePara elsevierViewall">On 04&#47;08&#47;2020 the PC-IU was opened at CI specifically to care for patients who were assigned to the green group after triage protocol&#46; The PC-IU had 24 beds that were managed in such a way as to keep suspected and confirmed cases isolated separately&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The PC-IU operated with a local assistance team added to 2&#47;3 of the PCT&#44; medical and multi professional staff&#44; and residents besides volunteer doctors from other areas and hospitals&#44; with 24-h coverage&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Between 04&#47;08&#47;2020 and 07&#47;31&#47;2020&#44; 186 patients were admitted to the PC-IU&#44; with a median &#40;IQR&#41; age of 76 &#40;65&#8210;86&#41; years&#46; The overall rate of discharge or transfer to a non-COVID area after treatment during this period was 32&#37;&#44; of which 62&#37; had a confirmed diagnosis&#46; Symptoms in the end-of-life phase were palliated appropriately&#44; and palliative sedation therapy was used in 13&#37; of cases&#44; a rate consistent with the experience of literature in PC units&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0024" class="elsevierStylePara elsevierViewall">All patients had their advanced directives registered in their medical records and were not referred to the ICU&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">In parallel&#44; in the same period&#44; 310 inter-consultations were attended by the same team&#44; of which 65&#37; generated transference of the patient to the PC-IU within 72-h&#44; contributing to greater mobility of beds in critical areas&#46;<ul class="elsevierStyleList" id="celist0005"><li class="elsevierStyleListItem" id="celistitem0005"><span class="elsevierStyleLabel">a&#41;</span><p id="para0026" class="elsevierStylePara elsevierViewall">Post-death care and bereavement follow-up</p></li></ul></p><p id="para0027" class="elsevierStylePara elsevierViewall">A professional from the PCT was assigned to be part of the team that welcomed the families after the notification of death by telephone&#46; The families were instructed to go to the hospital to proceed with the legal issues related to the burial&#46; On this occasion&#44; they had the opportunity to be welcomed by a team assigned for this purpose&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">The families of patients who died in the PC-IU were screened for further outpatient follow-up based on markers indicating the possibility of complicated grief&#46; About 50&#37; of the triages performed led to a referral to the outpatient clinic&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">As final considerations&#44; the planning of strategic actions in PC in the context of the pandemic brought positive aspects that included the dissemination of the work and the perception of the teams about the importance of PC in this context&#46; This assistance brought visibility to the PCT and great interaction with the CI teams&#44; previously unaccustomed to this practice&#46; It is important to say that the PCT decided to share their experiences in PC-IU and with inter-consultations write a book about Palliative Care during the COVID-19 pandemic&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-03-15"
    "fechaAceptado" => "2022-05-06"
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3396
            "Ancho" => 2750
            "Tamanyo" => 583695
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Triage protocol for COVID-19 patients and Palliative Care needs&#46; <span class="elsevierStyleSup">a</span> Chronic Obstrutive Pulmonary Disease&#59; <span class="elsevierStyleSup">b</span> Heart Failure&#59; <span class="elsevierStyleSup">c</span> Karnofsky Performance Scale&#59; <span class="elsevierStyleSup">d</span> Clinical Dementia Rating&#59; <span class="elsevierStyleSup">e</span> Intensive Care Unit&#59; <span class="elsevierStyleSup">f</span> World Health Organization&#59; <span class="elsevierStyleSup">g</span> Consultant Group&#59; <span class="elsevierStyleSup">h</span> Mecanical Ventilation&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "&#91;1&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Integrating Palliative Care and Symptom Relief into the Response to Humanitarian Emergencies and Crisesa WHO Guide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "World Health Organization"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2018"
                        "editorial" => "Geneva&#58; World Health Organization"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;www&#46;who&#46;int&#47;publications&#47;i&#47;item&#47;9789241514460"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "&#91;2&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of manchester triage system&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "TRM Azeredo"
                            1 => "HM Guedes"
                            2 => "RAR Almeida"
                            3 => "TCM Chianca"
                            4 => "JCA&#46; Martins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ienj.2014.06.001"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int Emerg Nurs"
                        "fecha" => "2015"
                        "volumen" => "23"
                        "numero" => "2"
                        "paginaInicial" => "47"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25087059"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "&#91;3&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "University of Edinburgh&#46; Supportive and Palliative Care Indicators Tool&#46; SPICT-Br&#8482;&#46; &#40;Brazilian version&#41;&#44; 2016&#46; Available from&#58; <a target="_blank" href="https://www.spict.org.uk/the-spict/spict-br/">https&#58;&#47;&#47;www&#46;spict&#46;org&#46;uk&#47;the-spict&#47;spict-br&#47;</a> &#91;Last Accessed March 9th&#44; 2022&#93;&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0004"
              "etiqueta" => "&#91;4&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The NHO medical guidelines for non-cancer disease and local medical review policy&#58; hospice access for patients with diseases other than cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Stuart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Hosp J&#46;"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "numero" => "3-4"
                        "paginaInicial" => "139"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10839007"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "&#91;5&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "UN Inter-Agency Task Force on NCDs and Covid-19"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "World Health Organization"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2020"
                        "editorial" => "Geneva&#58; World Health Organization"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;www&#46;who&#46;int&#47;teams&#47;ncds&#47;Covid-19&#47;unitaf"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0006"
              "etiqueta" => "&#91;6&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brazil&#46; Conselho Federal de Medicina&#46; Resolu&#231;&#227;o CFM n&#176; 1&#46;805&#47;2006&#46; Available from&#58; <a target="_blank" href="https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2006/1805">https&#58;&#47;&#47;sistemas&#46;cfm&#46;org&#46;br&#47;normas&#47;visualizar&#47;resolucoes&#47;BR&#47;2006&#47;1805</a> &#91;Last Accessed March 9th&#44; 2022&#93;&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0007"
              "etiqueta" => "&#91;7&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brazil&#46; Conselho Federal de Medicina&#46; C&#243;digo de &#201;tica M&#233;dica&#46; Resolu&#231;&#227;o CFM n&#176; 2217&#47;2018&#44; modificada pelas Resolu&#231;&#245;es n&#176; 2&#46;222&#47;2018 e 2&#46;226&#47;2019&#46; Available from&#58; <a target="_blank" href="https://portal.cfm.org.br/images/PDF/cem2019.pdf">https&#58;&#47;&#47;portal&#46;cfm&#46;org&#46;br&#47;images&#47;PDF&#47;cem2019&#46;pdf</a> &#91;Last Accessed March 9th&#44; 2022&#93;&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "&#91;8&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brazil&#46; Conselho Federal de Medicina&#46; Resolu&#231;&#227;o CFM n&#176; 1995&#47;2012&#46; Available from&#58; <a target="_blank" href="https://sistemas.cfm.org.br/normas/visualizar/resolucoes/BR/2012/1995">https&#58;&#47;&#47;sistemas&#46;cfm&#46;org&#46;br&#47;normas&#47;visualizar&#47;resolucoes&#47;BR&#47;2012&#47;1995</a> &#91;Last Accessed March 9th&#44; 2022&#93;&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "&#91;9&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Crispim DH&#44; Silva MJP&#44; Cedotti W&#44; C&#226;mara M&#44; Gomes AS&#46; Comunica&#231;&#227;o dif&#237;cil e COVID-19&#58; recomenda&#231;&#245;es pr&#225;ticas para a comunica&#231;&#227;o e acolhimento em diferentes cen&#225;rios da pandemia&#46; 2020&#46; Available from&#58; <a target="_blank" href="https://ammg.org.br/wp-content/uploads/comunica%C3%A7%C3%A3o-COVID-19.pdf.pdf">https&#58;&#47;&#47;ammg&#46;org&#46;br&#47;wp-content&#47;uploads&#47;comunica&#37;C3&#37;A7&#37;C3&#37;A3o-COVID-19&#46;pdf&#46;pdf</a> &#91;Last Accessed March 9th&#44; 2022&#93;&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "&#91;10&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Palliative sedation in terminal cancer patients admitted to hospice or home care programs&#58; does the setting matter&#63; results from a National Multicenter Observational Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Caraceni"
                            1 => "R Speranza"
                            2 => "E Spoli"
                            3 => "CS Ambrose"
                            4 => "S Canestri"
                            5 => "M Marinari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pain Symptom Manag"
                        "fecha" => "2018"
                        "volumen" => "56"
                        "numero" => "1"
                        "paginaInicial" => "33"
                        "paginaFinal" => "43"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack684946"
        "titulo" => "Funding Sources Declaration"
        "texto" => "<p id="para0030" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18075932/000000770000000C/v3_202308251443/S1807593222004999/v3_202308251443/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "94926"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/18075932/000000770000000C/v3_202308251443/S1807593222004999/v3_202308251443/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222004999?idApp=UINPBA00004N"
]
Article information
ISSN: 18075932
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 0 5
2024 October 39 28 67
2024 September 51 20 71
2024 August 46 22 68
2024 July 38 15 53
2024 June 23 22 45
2024 May 37 15 52
2024 April 38 13 51
2024 March 52 11 63
2024 February 56 28 84
2024 January 55 20 75
2023 December 34 29 63
2023 November 73 53 126
2023 October 54 39 93
2023 September 45 28 73
2023 August 43 9 52
2023 July 51 25 76
2023 June 47 17 64
2023 May 71 3 74
2023 April 35 2 37
2023 March 119 10 129
2023 February 42 4 46
2023 January 14 8 22
2022 December 16 2 18
2022 November 0 0 0
Show all

Follow this link to access the full text of the article

es en pt

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

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

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos