De opdracht van de Landbouwhogeschool

Rede, Wageningen 6 september 198

Veranderende ruimteclaims voor natuurtypen : consequenties van demografische en culturele scenario's in beleidsvarianten

De vraag naar recreatie in kaart, aan de hand van gegevens rond: veranderende bevolkingssamenstelling; wensen voor inrichting van gebieden; waardering van het landschap; natuurbeleving. Onderzoek door LEI en Alterra in opdracht van Natuurplanburea

Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis

Pathophysiology and treatment of rheumatic disease

Onderzoek beschikbaarheid glasaal bij RWZI's t.b.v. herstel aalstand en uitzet binnenvisserij

Uit een literatuurstudie blijkt dat het zeer aannemelijk is dat RWZI-effluent een aantrekkende werking heeft op glasaal. In de maanden april en mei 2013 heeft Visserij Service Nederland bij vier lozingspunten van effluent van rioolwaterzuiveringen verspreid door Nederland onderzoeken uitgevoerd naar de aanwezigheid en vangbaarheid van glasaal. De doelstelling van het project is het ontwikkelen van een methode voor het economisch rendabel vangen van glasaal bij RWZI's, wat ten goede komt aan het herstel van de aalstand en de visserij in de Nederlandse binnenwateren

Combining agro-ecological functions in grass-clover mixtures

Grass-clover mixtures show many benefits for sustainable agriculture. In the Netherlands, organic farmers often work together in a so-called partner farm concept, with the aim to close nutrient cycles on a regional level. In this system, arable farms grow one-year grass-clover leys, as fodder for a livestock farm, in exchange for, e.g., manure. This practice could also be used in the transition of conventional farms towards a more circular regenerative and nature inclusive agriculture. In the current experiment we assessed the effect of a range of grass (Lolium perenne: Lp, Lolium multiflorum: Lm) and clover (Trifolium pratense: Tp and Trifolium repens: Tr) monocultures and mixtures on both below- and aboveground parameters in light of benefits for livestock and arable farms, and biodiversity. The grass monocultures showed good weed suppression, high root density, and especially Lp had a positive effect on soil structure. Clover, on the other hand, showed high herbage dry matter yield (particularly Tp) and Nitrogen (N) yield, and Tr showed high digestibility. Moreover, clover had a positive effect on the soil mineral N, and earthworm abundance tended to be higher in the clover monocultures. When (some of) the four species were combined in grass-clover mixtures, they combined the positive effects of the species and often even outperformed the (best) monocultures. We concluded that grass-clover mixtures increased agro-ecological functions

Global cost of postoperative ileus following abdominal surgery: meta-analysis

Published: 23 June 2023Background: Following abdominal surgery, postoperative ileus is a common complication significantly increasing patient morbidity and cost of hospital admission. This is the first systematic review aimed at determining the average global hospital cost per patient associated with postoperative ileus. Methods: A systematic search of electronic databases was performed from January 2000 to March 2023. Studies included compared patients undergoing abdominal surgery who developed postoperative ileus to those who did not, focusing on costing data. The primary outcome was the total cost of inpatient stay. Risk of bias was assessed using the Newcastle–Ottawa assessment tool. Summary meta-analysis was performed. Results: Of the 2071 studies identified, 88 papers were assessed for full eligibility. The systematic review included nine studies (2005– 2022), investigating 1 860 889 patients undergoing general, colorectal, gynaecological and urological surgery. These studies showed significant variations in the definition of postoperative ileus. Six studies were eligible for meta-analysis showing an increase of €8233 (95 per cent c.i. (5176 to 11 290), P < 0.0001, I² = 95.5 per cent) per patient with postoperative ileus resulting in a 66.3 per cent increase in total hospital costs (95 per cent c.i. (34.8 to 97.9), P < 0.0001, I² = 98.4 per cent). However, there was significant bias between studies. Five colorectal-surgery-specific studies showed an increase of €7242 (95 per cent c.i. (4502 to 9983), P < 0.0001, I² = 86.0 per cent) per patient with postoperative ileus resulting in a 57.3 per cent increase in total hospital costs (95 per cent c.i. (36.3 to 78.3), P < 0.0001, I² = 85.7 per cent). Conclusion: The global financial burden of postoperative ileus following abdominal surgery is significant. While further multicentre data using a uniform postoperative ileus definition would be useful, reducing the incidence and impact of postoperative ileus are a priority to mitigate healthcare-related costs, and improve patient outcomes.Luke Traeger, Michalis Koullouros, Sergei Bedrikovetski, Hidde M. Kroon, James W. Moore and Tarik Sammou

Cost of postoperative ileus following colorectal surgery: a cost analysis in the Australian public hospital setting

Aim: Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital. Methods: A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI-2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30-day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed. Results: Of the 415 patients included, 34.9% (n = 145) developed POI. POI was more prevalent in males, smokers, previous intra-abdominal surgery, and converted laparoscopic surgery (p < 0.05). POI was associated with increased length of stay (8 vs. 5 days, p < 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p = 0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p < 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p < 0.05). Conclusion: In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.Luke Traeger, Michalis Koullouros, Sergei Bedrikovetski, Hidde M. Kroon, Michelle L. Thomas, James W. Moore, Tarik Sammou

Safety and efficacy of laxatives after major abdominal surgery: systematic review and meta-analysis

Background: Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend laxatives to reduce the duration of POI, but evidence is unclear. This systematic review aimed to assess the safety and efficacy of laxative use after major abdominal surgery. Methods: Ovid MEDLINE, Embase, Cochrane Library and PubMed databases were searched from inception to May 2019 to identify eligible RCTs focused on elective open or minimally invasive major abdominal surgery. The primary outcome was time taken to passage of stool. Secondary outcomes were time taken to tolerance of diet, time taken to flatus, length of hospital stay, postoperative complications and readmission to hospital. Results: Five RCTs with a total of 416 patients were included. Laxatives reduced the time to passage of stool (mean difference (MD) −0⋅83 (95 per cent c.i. −1⋅39 to −0⋅26) days; P = 0⋅004), but there was significant heterogeneity between studies for this outcome measure. There was no difference in time to passage of flatus (MD −0⋅17 (−0⋅59 to 0⋅25) days; P = 0⋅432), time to tolerance of diet (MD −0⋅01 (−0⋅12 to 0⋅10) days; P = 0⋅865) or length of hospital stay (MD 0⋅01(−1⋅36 to 1⋅38) days; P = 0⋅992). There were insufficient data available on postoperative complications for meta-analysis. Conclusion: Routine postoperative laxative use after major abdominal surgery may result in earlier passage of stool but does not influence other postoperative recovery parameters. Better data are required for postoperative complications and validated outcome measures.N. N. Dudi-Venkata, W. Seow, H. M. Kroon, S. Bedrikovetski, J. W. Moore, M. L. Thomas, and T. Sammou