For which patients is attending a pre-operative education session most important in a total hip and knee replacement ERAS pathway?

Objectives: Optimising the psychological status of patients’ pre-surgery through education is recommended by the Enhanced Recovery after Surgery (ERAS) Society. However, despite this; the majority of the current evidence base does not confirm that preoperative education reduces length of stay in total hip or knee replacement pathways. The aim of this study is to compare length of stay between patients who attended an education class prior to elective total hip or knee replacement surgery, compared to those who did no

A preoperative education class reduces length of stay for total knee replacement patients identified at risk of an extended length of stay

Abstract: Objective: To establish whether attendance at an education class prior to total hip or knee replacement surgery as part of an enhanced recovery after surgery pathway could decrease length of hospital stay. Methods: A single-site, retrospective cohort study comparing length of stay in hospital for patients who attended and did not attend an education class prior to hip or knee replacement surgery. Patients were stratified into 3 groups according to the predicted likelihood of an extended inpatient hospital stay using the Risk Assessment Predictor Tool. Results: Mean length of stay reduced by 0.37 days for patients who received hip replacement (n = 590) (95% confidence interval (95% CI) –0.74, –0.01, p = 0.05) and by 0.77 days for patients who underwent knee replacement (n = 643) (95% CI –1.23, –0.31, p = 0.001) following attendance at a preoperative education class. Patients undergoing knee replacement who were considered at high risk of an extended hospital stay stayed, on average, 2.59 days less in hospital after attending the class (mean length of stay: 4.52 (standard deviation (SD) 1.26) vs 7.11 (SD 4.18) days (95% CI –4.62, –0.54, p < 0.02). Conclusion: This study supports the inclusion of a preoperative education session in this context for both hip and knee replacement procedures, and indicates that this may be most beneficial for patients undergoing knee replacement who are at risk of an extended length of stay. Lay Abstract: The aim of this study was to compare length of stay in hospital between patients who attended an education class prior to elective total hip or knee replacement surgery, and those who did not attend. A further aim was to establish which patients would benefit most from a preoperative education class, using the Risk Assessment Predictor Tool. The study showed that patients who attended the class spent 0.38 days less in hospital following hip replacement, and 0.77 days less following knee replacement surgery. Patients undergoing knee replacement who were considered at high risk of an extended hospital stay spent, on average, 2.58 days less in hospital after attending the class. These results support the inclusion of a preoperative education class in this context for both hip and knee replacement procedures, and indicate that this may be most beneficial for patients undergoing knee replacement

Attendance to a Preoperative Education Session as part of an Enhanced Recovery Pathway for Total Hip and Knee Replacement

Objectives: Optimising the psychological status of patients’ pre-surgery through education is recommended by the Enhanced Recovery after Surgery (ERAS) Society. However, despite this; the majority of the current evidence base does not confirm that pre-operative education reduces length of stay in total hip or knee replacement pathways. The aim of this study is to compare length of stay between patients who attended an education class prior to elective total hip or knee replacement surgery, compared to those who did not. Methods: This is a single site, retrospective cohort study comparing length of stay in hospital for patients who attended and did not attend an education class prior to hip or knee replacement surgery on an ERAS pathway. Data were accessed through the hospital’s online administrative system. Patients were excluded if they were readmitted to hospital following discharge. Data were also recorded on the patient’s risk of needing extended inpatient rehabilitation through the Risk Assessment Predictor Tool (RAPT). Results: Mean length of stay reduced by 0.38 days for patients (n=1233) who underwent hip replacement (n=590) (p <0.0016) and by 0.77 days for patients who underwent knee replacement (n=643) (p<0.0001) following attendance to a one hour preoperative education class as part of an ERAS pathway. Patients undergoing knee replacement who were considered at high risk of extended inpatient rehabilitation on the RAPT score, stayed on average 2.58 days less in hospital after attending the education class (mean length of stay 4.52 ± 1.26 days versus 7.1 ± 4.18 days (p <0.02)). There were no significant differences in mean length of stay between patients undergoing hip replacement who did and did not attend their preoperative education class when data were categorised into level of risk. Conclusion: This study highlights that the inclusion of a preoperative education session to ERAS pathways may be most beneficial for patients undergoing knee replacement, and who are identified pre-operatively as being at high risk of long length of stay using the RAPT score. Therefore, the pre-operative characterisation and identification of which patients may require specific educational and psychological support is recommended

A Survey of Experimental Research on Contests, All-Pay Auctions and Tournaments

Many economic, political and social environments can be described as contests in which agents exert costly efforts while competing over the distribution of a scarce resource. These environments have been studied using Tullock contests, all-pay auctions and rankorder tournaments. This survey provides a review of experimental research on these three canonical contests. First, we review studies investigating the basic structure of contests, including the contest success function, number of players and prizes, spillovers and externalities, heterogeneity, and incomplete information. Second, we discuss dynamic contests and multi-battle contests. Then we review research on sabotage, feedback, bias, collusion, alliances, and contests between groups, as well as real-effort and field experiments. Finally, we discuss applications of contests to the study of legal systems, political competition, war, conflict avoidance, sales, and charities, and suggest directions for future research. (author's abstract

Ascorbic acid in the gonads of North Sea dab (Limanda limanda) during the reproductive cycle.

Total ascorbic acid was measured in the gonads of North Sea dab (Limanda limanda) throughout one reproductive cycle. In the ovaries, the concentration of ascorbate began to increase during the resting period in summer and reached maximum values of 400 μg .g fresh weight (fw)-1 at the onset of ovary maturation in fall. Concentrations declined rapidly towards the spawning period in spring and reached the lowest values of 80-100 μg .g fw-1. The maximum deposition of ascorbate in the ovaries amounted to 2.5 mg .organ-1 and occurred in late winter, corresponding to the beginning of the spawning period. In the testes, ascorbate concentrations were lower than in the ovaries, reaching a maximum of 170 μg .g fw-1 in early fall. The lowest values of 20-60 μg .g fw-1 appeared in winter and spring. In the testes the highest deposition of ascorbate amounted to 110 μg .organ-1 and appeared at the beginning of maturation. The sexual differences and seasonal variations are discussed in relation to the reproductive biology of dab. </jats:p

measurement of swimming performance of wild Atlantic salmon (

Swimming capabilities and in situ measurement of muscle activity from adult Atlantic salmon (Salmo salar) at two seasonal temperatures were measured using radio transmitted electromyogram (EMG) signals. Forced sustained levels of activity and critical swimming speeds were determined and correlated to radio transmitted EMG signals using a modified Blazka swim speed chamber. There were no differences in swimming performance levels between tagged and untagged individuals. At 18 °C, sustained activity and critical swimming speeds were approximately 70% and 20% higher than at 12 °C, respectively. No differences in burst activity were observed at these temperatures. EMGs recorded from salmon during ascent of an artificial flume at cold temperatures revealed that overall muscle activity is greater than that observed for critical swimming speeds. This implies that white muscle may be recruited at this temperature. However, in contrast, most activity at 18 °C is below that observed during critical swimming speed. Moreover, salmon required almost twice as long to traverse the flume at 18 °C than at 12 °C. Together, our data demonstrates that salmon may recruit white muscle fibres and incur an oxygen debt at colder temperature as a strategy for ascending velocity obstructions at a quicker rate