LIVIVO - Search results -

Search results

Result 1 - 10 of total 13

Search options

Article ; Online: The effect of post-discharge oral nutritional supplements on outcomes after gastrointestinal surgery: A systematic review and meta-analysis

Rowley, Annabel / Adiamah, Alfred / Kushairi, Anisa / Lewis, Stephen J. / Lobo, Dileep N.

Clinical Nutrition. 2023 May 05,

2023

Abstract: Malnutrition is a risk-factor for adverse postoperative outcomes. This systematic review and meta-analysis evaluated the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery. The Medline ... ...

Abstract	Malnutrition is a risk-factor for adverse postoperative outcomes. This systematic review and meta-analysis evaluated the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery. The Medline and Embase databases were searched for randomised clinical trials in patients undergoing gastrointestinal surgery who had received ONS for at least two weeks after discharge from hospital. The primary endpoint was weight change. Secondary endpoints included quality of life, total lymphocyte count, total serum protein and serum albumin. Analysis was performed using RevMan5.4 software. Fourteen studies with 2480 participants (1249 ONS/1231 controls) were included. Pooling of results revealed that a reduction in postoperative weight loss in patients taking ONS, when compared with control: overall weighted mean difference (WMD) −1.69 kg, 95% CI −2.98 to −0.41, P = 0.01. Serum albumin concentration was increased in the ONS group: WMD = 1.06 g/L, 95% CI 0.04 to 2.07, P = 0.04. Haemoglobin was also increased: WMD = 2.91 g/L, 95% CI 0.58 to 5.25, P = 0.01. Total serum protein, total lymphocyte count, total cholesterol and quality of life did not differ between the groups. Patient compliance was relatively poor across the studies and there was variability in the composition of ONS, volume consumed and surgical procedures performed. There was a reduction in postoperative weight loss and an improvement in some biochemical parameters in patients receiving ONS after gastrointestinal surgery. Future RCTs with more consistent methodologies are needed to investigate the efficacy of ONS after discharge from hospital following gastrointestinal surgery.
Keywords	cholesterol ; clinical nutrition ; computer software ; gastrointestinal system ; hemoglobin ; hospitals ; lymphocyte count ; malnutrition ; meta-analysis ; patient compliance ; quality of life ; serum albumin ; surgery ; systematic review ; weight loss ; Post-discharge nutrition ; Oral nutritional supplements ; Postoperative outcomes ; Gastrointestinal surgery ; BWL ; CI ; EORTC ; ESPEN ; NICE ; ONS ; PRISMA ; RCT ; SI ; WMD
Language	English
Dates of publication	2023-0505
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Pre-press version ; Use and reproduction
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2023.04.028
Database	NAL-Catalogue (AGRICOLA)

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.A 1774: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

Details ▾

Article ; Online: Laparoscopic Cholecystectomy Versus Percutaneous Cholecystostomy: Suitability of APACHE-II Score, ASA Grade, and Tokyo Guidelines 18 Grade as Predictors of Outcome in Patients With Acute Cholecystitis.

Latif, Javed / Kushairi, Anisa / Thurley, Peter / Bhatti, Imran / Awan, Altaf

Surgical laparoscopy, endoscopy & percutaneous techniques

2022 Volume 32, Issue 3, Page(s) 342–349

Abstract: Introduction: Intervention options in acute cholecystitis (AC) include drainage (percutaneous/endoscopic) or surgery. Several scoring systems have been used to risk stratify acute surgical patients, but few have been validated. This study investigated ... ...

Abstract	Introduction: Intervention options in acute cholecystitis (AC) include drainage (percutaneous/endoscopic) or surgery. Several scoring systems have been used to risk stratify acute surgical patients, but few have been validated. This study investigated the suitability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, American Society of Anesthesiologist (ASA) grade, and Tokyo Guidelines 2018 (TG18) grade as predictors of outcome and assess laparoscopic cholecystectomy versus percutaneous cholecystostomy (PC) as treatment options in patients with AC. Materials and methods: Retrospective data was collected from patients that underwent acute inpatient cholecystectomy (index admission), urgent interval cholecystectomy (2 to 4 wk) and PC between 2016 and 2018. Data included baseline demographics, co-morbidities, ASA grade, APACHE-II score, TG18 grade, morbidity, and mortality. A P-value of <0.05 was statistically significant. Area under the receiver operating characteristic curve was calculated to compare accuracy of APACHE-II, ASA and TG18 in predicting morbidity. Results: A total of 344 consecutive patients (266 cholecystectomies and 84 PC) were included in the study. Significant difference in co-morbidities [median Charlson Co-Morbidity Index (CCI) 1 surgery and 4 cholecystostomy (PC) (P<0.05)], median APACHE-II score (3 surgery and 9 PC), median TG18 grade (1 surgery and 2 PC) and mortality rate [0% surgery and 7% cholecystostomy (PC)]. TG18 grade alone predicted postoperative/postprocedure morbidity (receiver operating characteristic; AUC=0.884; 95% confidence interval: 0.845-0.923; odds ratio: 4.38, 96% confidence interval, P<0.05). Discussion: Utilization of the TG18 grade have shown to be more accurate in risk stratifying and predicting outcomes in patients with AC and therefore may appropriately guide biliary intervention.PC can be utilized in a select group of septic and co-morbid patients (myocardial infarction <6 weeks, chest infection and acute cerebrovascular accident) unable to withstand surgical intervention or in those with complex biliary disease (Mirizzi Syndrome). In a proportion, PC drains sepsis to improve critical state of the patient enough to consider an interval cholecystectomy with satisfactory outcomes.
MeSH term(s)	APACHE ; Cholecystectomy, Laparoscopic/methods ; Cholecystitis, Acute/diagnosis ; Cholecystitis, Acute/etiology ; Cholecystitis, Acute/surgery ; Cholecystostomy/adverse effects ; Humans ; Retrospective Studies ; Tokyo ; Treatment Outcome
Language	English
Publishing date	2022-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/SLE.0000000000001048
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 3200: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: The effect of post-discharge oral nutritional supplements on outcomes after gastrointestinal surgery: A systematic review and meta-analysis.

Rowley, Annabel / Adiamah, Alfred / Kushairi, Anisa / Lewis, Stephen J / Lobo, Dileep N

Clinical nutrition (Edinburgh, Scotland)

2023 Volume 42, Issue 7, Page(s) 1189–1201

Abstract: Background: Malnutrition is a risk-factor for adverse postoperative outcomes. This systematic review and meta-analysis evaluated the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery.! ...

Abstract	Background: Malnutrition is a risk-factor for adverse postoperative outcomes. This systematic review and meta-analysis evaluated the impact of post-discharge oral nutritional supplements (ONS) on outcomes in patients undergoing gastrointestinal surgery. Methods: The Medline and Embase databases were searched for randomised clinical trials in patients undergoing gastrointestinal surgery who had received ONS for at least two weeks after discharge from hospital. The primary endpoint was weight change. Secondary endpoints included quality of life, total lymphocyte count, total serum protein and serum albumin. Analysis was performed using RevMan5.4 software. Results: Fourteen studies with 2480 participants (1249 ONS/1231 controls) were included. Pooling of results revealed that a reduction in postoperative weight loss in patients taking ONS, when compared with control: overall weighted mean difference (WMD) -1.69 kg, 95% CI -2.98 to -0.41, P = 0.01. Serum albumin concentration was increased in the ONS group: WMD = 1.06 g/L, 95% CI 0.04 to 2.07, P = 0.04. Haemoglobin was also increased: WMD = 2.91 g/L, 95% CI 0.58 to 5.25, P = 0.01. Total serum protein, total lymphocyte count, total cholesterol and quality of life did not differ between the groups. Patient compliance was relatively poor across the studies and there was variability in the composition of ONS, volume consumed and surgical procedures performed. Conclusions: There was a reduction in postoperative weight loss and an improvement in some biochemical parameters in patients receiving ONS after gastrointestinal surgery. Future RCTs with more consistent methodologies are needed to investigate the efficacy of ONS after discharge from hospital following gastrointestinal surgery.
MeSH term(s)	Humans ; Digestive System Surgical Procedures/adverse effects ; Patient Discharge ; Quality of Life ; Aftercare ; Malnutrition/prevention & control ; Serum Albumin ; Weight Loss ; Dietary Supplements
Chemical Substances	Serum Albumin
Language	English
Publishing date	2023-05-05
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2023.04.028
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.A 1774: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾

Article ; Online: Response to "A student's perspective on developing clinical reasoning (CR) skills".

Khin-Htun, Swe / Kushairi, Anisa

Medical teacher

2019 Volume 41, Issue 10, Page(s) 1206–1207

MeSH term(s)	Clinical Competence ; Humans ; Problem Solving ; Schools, Medical
Language	English
Publishing date	2019-04-21
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	424426-6
ISSN	1466-187X ; 0142-159X
ISSN (online)	1466-187X
ISSN	0142-159X
DOI	10.1080/0142159X.2019.1595368
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.B 2176: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾

Article ; Online: Twelve Tips for Developing Clinical Reasoning Skills in the Pre-Clinical and Clinical Stages of Medical School.

Khin-Htun, Swe / Kushairi, Anisa

Medical teacher

2018 Volume 41, Issue 9, Page(s) 1007–1011

Abstract: Clinical reasoning (CR) is a complex skill required in future clinicians. The best way to develop CR has not been fully elucidated in existing literature. Barriers to CR development include content, environmental, and teacher or expert physician factors. ...

Abstract	Clinical reasoning (CR) is a complex skill required in future clinicians. The best way to develop CR has not been fully elucidated in existing literature. Barriers to CR development include content, environmental, and teacher or expert physician factors. We have reviewed literature, interviewed medical students and teaching staff at the University of Nottingham, and evaluated our teaching delivery. We identified twelve strategies to combat barriers to CR learning at our university. The foundation for CR must be built early through lectures and case-based learning. We emphasize the irreplaceable nature of ward-based learning and add on methods of optimizing time on wards. Placement on acute wards with trained teaching staff to facilitate CR teaching was suggested. Ward time should be supplemented with symptom-focused teaching, patient workshops, simulation sessions, virtual case banks, and clinical skills practice. However, ward time is the utmost priority and must not be replaced.
MeSH term(s)	Clinical Competence ; Education, Medical, Undergraduate/methods ; Humans ; Interprofessional Relations ; Patient Simulation ; Physicians/psychology ; Problem Solving ; Schools, Medical ; Students, Medical/psychology ; Teaching
Language	English
Publishing date	2018-10-09
Publishing country	England
Document type	Journal Article
ZDB-ID	424426-6
ISSN	1466-187X ; 0142-159X
ISSN (online)	1466-187X
ISSN	0142-159X
DOI	10.1080/0142159X.2018.1502418
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.B 2176: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾

Article ; Online: Evaluating the Timely Assessment of Ill Patients (TAP) simulation course for medical students.

Khin-Htun, Swe Yin / Clegg, Rebecca / Kushairi, Anisa

BMJ simulation & technology enhanced learning

2020 Volume 6, Issue 3, Page(s) 180–181

Language	English
Publishing date	2020-04-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2799014-X
ISSN	2056-6697 ; 2056-6697
ISSN (online)	2056-6697
ISSN	2056-6697
DOI	10.1136/bmjstel-2019-000460
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: The Hydrocortisone vs Pasireotide in Reducing Pancreatic Surgery Complications Noninferiority Trial: Comparing Apples and Pears?

Adiamah, Alfred / Kushairi, Anisa / Gomez, Dhanwant

JAMA surgery

2020 Volume 155, Issue 10, Page(s) 994–995

MeSH term(s)	Humans ; Hydrocortisone ; Malus ; Pancreatic Fistula ; Pyrus ; Somatostatin/analogs & derivatives
Chemical Substances	Somatostatin (51110-01-1) ; pasireotide (98H1T17066) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2020-08-06
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2020.1998
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Uk I Zs.72: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Response to the Comment on "Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Chowdhury, Abeed H / Adiamah, Alfred / Kushairi, Anisa / Lobo, Dileep N

Annals of surgery

2020 Volume 274, Issue 6, Page(s) e676–e677

MeSH term(s)	Abdomen ; Adult ; Elective Surgical Procedures ; Humans ; Probiotics/therapeutic use ; Randomized Controlled Trials as Topic ; Synbiotics
Language	English
Publishing date	2020-02-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000003759
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Uk I Zs.35/1: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials.

Roslan, Farah / Kushairi, Anisa / Cappuyns, Laura / Daliya, Prita / Adiamah, Alfred

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2020 Volume 24, Issue 11, Page(s) 2643–2653

Abstract: Background: Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of ... ...

Abstract	Background: Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking. Methodology: A comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality. Results: Sixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD - 0.31, 95% CI - 0.36, - 0.26, p < 0.00001) and time to defecation (WMD - 0.47, 95% CI - 0.60, - 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality. Conclusion: The use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.
MeSH term(s)	Abdomen ; Adult ; Chewing Gum ; Colorectal Surgery ; Gastrointestinal Motility ; Humans ; Ileus/etiology ; Ileus/prevention & control ; Length of Stay ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control
Chemical Substances	Chewing Gum
Language	English
Publishing date	2020-02-26
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-019-04507-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 354: Show issues

Order via subito

Details ▾

Article ; Online: Hypertriglyceridaemia as a risk factor for critical care admission in acute pancreatitis: A prospective study.

Adiamah, Alfred / Kushairi, Anisa / Tumilty, Sue / Na, Yuuki / Crook, Martin / Brooks, Adam J / Lobo, Dileep N

Clinical nutrition ESPEN

2020 Volume 39, Page(s) 227–233

Abstract: Background and aims: Hypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. This study aimed to define the associations between hypertriglyceridaemia and clinical outcomes in patients admitted with acute pancreatitis.!# ...

Abstract	Background and aims: Hypertriglyceridaemia is both a primary cause of acute pancreatitis and an epiphenomenon. This study aimed to define the associations between hypertriglyceridaemia and clinical outcomes in patients admitted with acute pancreatitis. Methods: This single-centre prospective observational study included patients with a confirmed clinical, biochemical or radiological diagnosis of acute pancreatitis from August 2017 to September 2018. Baseline demographics, aetiology of pancreatitis, and fasting triglyceride concentrations were recorded and assessed against the surrogate markers of severity: admission to critical care, length of stay (LOS), readmission to hospital, and mortality. Results: In total, 304 patients with a mean ± SD age of 56.1 ± 19.7 years met the inclusion criteria. There were 217 (71.4%) patients with normotriglyceridaemia (<150 mg/dL or <1.7 mmol/L), 47 (15.5%) with mild hypertriglyceridaemia (150-199 mg/dL or 1.7-2.25 mmol/L) and 40 (13.2%) with moderate-to-severe hypertriglyceridaemia (≥200 mg/dL or >2.25 mmol/L). The underlying aetiologies of acute pancreatitis were gallstones (55%), alcohol (18%), idiopathic (15%), hypertriglyceridaemia (9%), iatrogenic (2%) and bile duct abnormalities (1%). Patients with hypertriglyceridaemia were younger than those with normotriglyceridaemia (p < 0.05). On multivariate regression, moderate-to-severe hypertriglyceridaemia (OR 5.66, 95% CI: 1.87 to 17.19, p = 0.002) and an elevated C-reactive protein concentration ≥120 mg/L (OR 1.00, 95% CI: 1.00-1.01, p = 0.040) were associated with admission to critical care. Moderate-to-severe hypertriglyceridaemia was also associated with an increased LOS (p = 0.002) but not readmission (p = 0.752) or mortality (p = 0.069). Conclusion: Moderate-to-severe hypertriglyceridaemia in all aetiological causes of acute pancreatitis was predictive of admission to critical care and prolonged LOS but not readmission or mortality.
MeSH term(s)	Acute Disease ; Adult ; Critical Care ; Humans ; Hypertriglyceridemia/complications ; Pancreatitis/diagnosis ; Pancreatitis/etiology ; Prospective Studies ; Risk Factors ; Young Adult
Language	English
Publishing date	2020-07-14
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	2405-4577
ISSN (online)	2405-4577
DOI	10.1016/j.clnesp.2020.06.008
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

Order via subito

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

Details ▾
- Full text online
- Order with fees

To top

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

Order via subito

Inter-library loan at ZB MED