Consenso GEDOS-SECOT sobre el proceso de atención a pacientes con artrosis de rodilla e indicación de artroplastia / GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty

Objetivo. Desarrollar recomendaciones sobre el proceso de evaluación y manejo del paciente con artrosis de rodilla e indicación de artroplastia basadas en la mejor evidencia científica disponible y la experiencia de un panel de expertos. Métodos. Se seleccionó un grupo multidisciplinar de 12 expertos que definieron: alcance, usuarios, apartados del documento, revisiones sistemáticas a realizar y a quienes se asignaron tareas. Se realizaron 3 revisiones sistemáticas en pacientes con indicación de artroplastia de rodilla sobre: 1) eficacia y seguridad de los protocolos de fast-track; 2) papel de las intervenciones cognitivo-conductuales en sujetos con catastrofismo, y 3) efecto del control del dolor agudo posquirúrgico en los resultados. Se realizaron 2 revisiones narrativas sobre la sensibilización central en este grupo y sobre la eficacia de la rehabilitación preoperatoria. Los expertos redactaron los apartados y generaron las recomendaciones. Estas recomendaciones se consensuaron mediante la metodología Delphi en un grupo multidisciplinar de 85 expertos. Se estableció también el nivel de evidencia de cada recomendación. Resultados. Se generaron 20 recomendaciones. Todas alcanzaron un nivel de acuerdo mayor del 80%. El mayor acuerdo se alcanzó en la necesidad de realizar informe de alta completo, en informar adecuadamente al paciente sobre el proceso y en seguir las recomendaciones de las guías clínicas disponibles. Conclusiones. Existe consenso entre los responsables del manejo de los pacientes con artrosis de rodilla e indicación de artroplastia en que es necesario protocolizar el proceso de sustitución articular, realizando una correcta evaluación y seguimiento del paciente, de forma integral y coordinada y con especial atención al procedimiento quirúrgico y al postoperatorio (AU)

Objective. To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. Methods. A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (I) efficacy and safety of fast-tracks; (II) efficacy and safety of cognitive interventions in patients with catastrophic pain, and (III) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. Results. A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. Conclusions. There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period (AU)

GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty. / Consenso GEDOS-SECOT sobre el proceso de atención a pacientes con artrosis de rodilla e indicación de artroplastia.

OBJECTIVE: To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS: A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS: A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS: There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.

Prospects for monitoring freshwater ecosystems towards the 2010 targets.

Human activities have severely affected the condition of freshwater ecosystems worldwide. Physical alteration, habitat loss, water withdrawal, pollution, overexploitation and the introduction of non-native species all contribute to the decline in freshwater species. Today, freshwater species are, in general, at higher risk of extinction than those in forests, grasslands and coastal ecosystems. For North America alone, the projected extinction rate for freshwater fauna is five times greater than that for terrestrial fauna--a rate comparable to the species loss in tropical rainforest. Because many of these extinctions go unseen, the level of assessment and knowledge of the status and trends of freshwater species are still very poor, with species going extinct before they are even taxonomically classified. Increasing human population growth and achieving the sustainable development targets set forth in 2002 will place even higher demands on the already stressed freshwater ecosystems, unless an integrated approach to managing water for people and ecosystems is implemented by a broad constituency. To inform and implement policies that support an integrated approach to water management, as well as to measure progress in halting the rapid decline in freshwater species, basin-level indicators describing the condition and threats to freshwater ecosystems and species are required. This paper discusses the extent and quality of data available on the number and size of populations of freshwater species, as well as the change in the extent and condition of natural freshwater habitats. The paper presents indicators that can be applied at multiple scales, highlighting the usefulness of using remote sensing and geographical information systems technologies to fill some of the existing information gaps. Finally, the paper includes an analysis of major data gaps and information needs with respect to freshwater species to measure progress towards the 2010 biodiversity targets.