Opera House Rag

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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

Phosphorus Use Efficiency and Fertilizers: future opportunities for improvements

The continued supply of phosphate fertilizers that underpin global food production is an imminent crisis. The rock phosphate deposits on which the world depends are not only finite, but some are contaminated, and many are located in geopolitically unstable areas, meaning that fundamental changes will have to take place in order to maintain food production for a growing global population. No single solution exists, but a combination of approaches to phosphorus management is required not only to extend the lifespan of the remaining non-renewable rock phosphate reserves, but to result in a more efficient, sustainable phosphorus cycle. Solutions include improving the efficiency of fertilizer applications to agricultural land, alongside a better understanding of phosphorus cycling in soil-plant systems, and the interactions between soil physics, chemistry and biology, coupled with plant traits. Opportunities exist for the development of plants that can access different forms of soil phosphorus (e.g., organic phosphorus) and that use internal phosphorus more efficiently. The development of different sources of phosphorus fertilizers are inevitably required given the finite nature of the rock phosphate supplies. Clear opportunities exist, and it is now important that a concerted effort to make advances in phosphorus use efficiency is prioritized

The uptake of selenium by perennial ryegrass in soils of different organic matter contents receiving sheep excreta

Background and Aims The intake of selenium, an essential element for animals and humans, in ruminants is largely determined by selenium concentration in ingested forages, which take up selenium mainly from soil. Ruminant excreta is a common source of organic fertilizer, which provides both nutrients and organic matter. This study aims to unentangle the unclear effect of applying different types of ruminant excreta in soils of different organic matter contents on selenium uptake by forage. Methods Perennial ryegrass (Lolium perenne) was grown in soils of different organic matter contents. Urine and/or feces collected from sheep fed with organic or inorganic mineral supplements, including selenium, were applied to the soils. The selenium in the collected samples were analyzed using ICP-MS. The associated biogeochemical reactions were scrutinized by wet chemistry. Results The application of urine and/or feces resulted in either the same or lower selenium concentrations in perennial ryegrass. The excreta type did not affect total selenium accumulation in grass grown in low organic matter soil, whereas in high organic matter soil, feces resulted in significantly lower total selenium accumulation than urine, which was attributed to a possible interaction of selenium sorption in soil and microbial reduction of Se. Conclusion This one-time excreta application did not increase, but further decrease in some treatments, selenium concentration and accumulation in the perennial ryegrass. Consequently, to increase ruminant selenium intake, supplementing selenium directly to animals is more recommended than applying animal manure to soil, which might drive selenium reduction and decrease selenium uptake by grass

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 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

The effect of soil type on yield and micronutrient content of pasture species

The use of multispecies swards on livestock farms is growing due to the wide range of benefits they bring, such as improved biomass yield and animal performance. Preferential uptake of micronutrients by some plant species means the inclusion of legumes and forbs in grass-dominated pasture swards could improve micronutrient provision to livestock via careful species selection. However, although soil properties affect plant micronutrient concentrations, it is unknown whether choosing ‘best-performing’ species, in terms of their micronutrient content, needs to be soil-specific or whether the recommendations can be more generic. To address this question, we carried out an experiment with 15 common grass, forb and legume species grown on four soils for five weeks in a controlled environment. The soils were chosen to have contrasting properties such as texture, organic matter content and micronutrient concentrations. The effect of soil pH was tested on two soils (pH 5.4 and 7.4) chosen to minimise other confounding variables. Yield was significantly affected by soil properties and there was a significant interaction with botanical group but not species within a botanical group (grass, forb or legume). There were differences between botanical groups and between species in both their micronutrient concentrations and total uptake. Micronutrient herbage concentrations often, but not always, reflected soil micronutrient concentrations. There were soil-botanical group interactions for micronutrient concentration and uptake by plants, but the interaction between plant species (within a botanical group) and soil was significant only for forbs, and predominantly occurred when considering micronutrient uptake rather than concentration. Generally, plants had higher yields and micronutrient contents at pH 5.4 than 7.4. Forbs tended to have higher concentrations of micronutrients than other botanical groups and the effect of soil on micronutrient uptake was only significant for forbs

The Mineral Composition of Wild Type and Cultivated Varieties of Pasture Species

Mineral deficiencies in livestock are often prevented by using prophylactic supplementation, which is imprecise and inefficient. Instead, the trend for increased species diversity in swards is an opportunity to improve mineral concentrations in the basal diet. Currently there are limited data on the mineral concentrations of different species and botanical groups, particularly for I and Se, which are among the most deficient minerals in livestock diets. We grew 21 pasture species, including some cultivar/wild type comparisons, of grasses, legumes and forbs, as single species stands in a pot study in a standard growth medium. Herbage concentrations of Co, Cu, I, Mn, Se, Zn, S, Mo and Fe showed no consistent differences between the wild and cultivated types. There were significant differences between botanical groups for many minerals tested. Forbs were highest in I and Se, grasses in Mn, and legumes in Cu, Co, Zn and Fe. Comparing species concentrations to recommended livestock intakes, the forbs Achillea millefolium, Cichorium intybus and Plantago lanceolate, and the legumes Medicago lupulina, Trifolium hybridum, and Lotus corniculatus, appear good sources of Co, Cu, I, Se and Zn. Further work is required to ensure these results are consistent in multispecies mixtures, in different soil types, and in field trials

The role of ruminant urine and faeces in the recycling of nutrients by forages

This study addresses the effect of using animal excreta on the nutritional content of forages, focusingon macro- and micro-element concentrations (nitrogen; N, phosphorus; P, sulphur; S, copper; Cu,zinc; Zn, manganese; Mn, selenium; Se) from animal feed to excreta, soil, and plants. Data were collected from pot and field trials using separate applications of sheep or cattle urine and faeces. Key findings indicate that soil organic carbon (SOC) and the type of excreta significantly influences nutrient uptake by forages, with varied responses among the seven elements defined above. Although urine contributes fewer micronutrients compared to faeces (as applied at a natural volume/mass basis, respectively), it notably improves forage yield and micronutrient accumulation, thus potentially delivering positive consequences at the farm level regarding economic performance and soil fertility when swards upon clayey soil types receive said urine in temperate agro-climatic regions (i.e., South West England in the current context). In contrast, faeces application in isolation hinders Se and Mn uptake, once again potentially delivering unintended consequences such as micronutrient deficiencies in areas of high faeces deposition. As it is unlikely that (b)ovine grazing fields will receive either urine or faeces in isolation, we also explored combined applications of both excreta types which demonstrates synergistic effects on N, Cu, and Zn uptake, with either synergistic or dilution effects being observed for P and S, depending largely on SOC levels. Additionally, interactions between excreta types can result in dilution or antagonistic effects on Mn and Se uptake. Notably, high SOC combined with faeces reduces Mn and Se in forages, raising concerns for grazed ruminant systems under certain biotic situations, e.g., due to insufficient soil Se levels typically observed in UK pastures for livestock growth. These findings underscore the importance of considering SOC and excreta nutritional composition when designing forage management to optimize nutrient uptake. It should be noted that these findings have potential ramifications for broader studies of sustainable agriculture through system-scale analyses, as the granularity of results reported herein elucidate gaps in knowledge which could affect, both positively and negatively, the interpretation of model-based environmental impact assessments of cattle and sheep production (e.g., in the case of increased yields [beneficial] or the requirement of additional synthetic supplementation [detrimental])