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Book: Verdauungssystem

Smith, Margaret E. / Morton, Dion G. / Tönjes, Sibylle

integrative Grundlagen und Fälle

(Organsysteme verstehen)

2017

Title translation	Systems of the body, the digestive system
Title variant	Organsysteme verstehen: Verdauungssystem
Author's details	Margaret E. Smith, Dion G. Morton ; Übersetzung der 2. englischen Auflage von Dr. Sibylle Tönjes
Series title	Organsysteme verstehen
Keywords	Verdauungskanal
Subject	Canalis alimentorius ; Verdauungstrakt ; Verdauungsorgan ; Verdauungsapparat ; Apparatus digestorius ; Verdauungssystem
Language	German
Size	X, 205 Seiten, Illustrationen
Edition	1. deutsche Auflage
Publisher	Elsevier
Publishing place	München
Publishing country	Germany
Document type	Book
HBZ-ID	HT019366122
ISBN	978-3-437-42994-1 ; 9783437173516 ; 3-437-42994-9 ; 3437173510
Database	Catalogue ZB MED Medicine, Health

In stock of ZB MED Cologne/Königswinter

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2017 A 1373	available for loan (reading room)	Lesesaal EG

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Article ; Online: Implementation of a batched stepped wedge trial evaluating a quality improvement intervention for surgical teams to reduce anastomotic leak after right colectomy.

Venn, Mary L / Knowles, Charles H / Li, Elizabeth / Glasbey, James / Morton, Dion G / Hooper, Richard

Trials

2023 Volume 24, Issue 1, Page(s) 329

Abstract: Background: Large-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe ... ...

Abstract	Background: Large-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe Anastomosis proGramme in CoLorectal SurgEry (EAGLE), intended to reduce anastomotic leak following right colectomy, and reflect on lessons learned about the implementation of quality improvement programmes on an international scale. Methods: Surgical units were recruited and randomised in batches to receive a hospital-level education intervention designed to reduce anastomotic leak, either before, during, or following data collection. All consecutive patients undergoing right colectomy were included. Online learning, patient risk stratification and an in-theatre checklist constituted the intervention. The study was powered to detect an absolute risk reduction of anastomotic leak from 8.1 to 5.6%. Statistical efficiency was optimised using an incomplete stepped wedge trial design and study batches analysed separately then meta-analysed to calculate the intervention effect. An established collaborative group helped nurture strong working relationships between units/countries and a prospectively designed process evaluation will enable evaluation of both the intervention and its implementation. Results: The batched trial design allowed sequential entry of clusters, targeted research training and proved to be robust to pandemic interruptions. Staggered start times in the incomplete stepped wedge design with long lead-in times can reduce motivation and engagement and require careful administration. Conclusion: EAGLE's robust but flexible study design allowed completion of the study across globally distributed geographical locations in spite of the pandemic. The primary outcome analysed in conjunction with the process evaluation will ensure a rich understanding of the intervention and the effects of the study design. Trial registration: National Institute of Health Research Clinical Research Network portfolio IRAS ID: 272,250. Health Research Authority approval 18 October 2019. Clinicaltrials: gov, identifier NCT04270721, protocol ID RG_19196.
MeSH term(s)	Humans ; Anastomotic Leak ; Colectomy/adverse effects ; Quality Improvement ; Research Design
Language	English
Publishing date	2023-05-15
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07318-9
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Article ; Online: Systematic review of preoperative and intraoperative colorectal Anastomotic Leak Prediction Scores (ALPS).

Venn, Mary L / Hooper, Richard L / Pampiglione, Tom / Morton, Dion G / Nepogodiev, Dmitri / Knowles, Charles H

BMJ open

2023 Volume 13, Issue 7, Page(s) e073085

Abstract: Objective: To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication ... ...

Abstract	Objective: To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication of colorectal surgery. Individualised leak risk could guide anastomosis and/or diverting stoma. Methods: Systematic search of Ovid MEDLINE and Embase databases, 30 October 2020, identified existing ALPS and validation studies. All records including >1 risk factor, used to develop new, or to validate existing models for preoperative or intraoperative use to predict colorectal AL, were selected. Data extraction followed CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies guidelines. Models were assessed for applicability for surgical decision-making and risk of bias using Prediction model Risk Of Bias ASsessment Tool. Results: 34 studies were identified containing 31 individual ALPS (12 colonic/colorectal, 19 rectal) and 6 papers with validation studies only. Development dataset patient populations were heterogeneous in terms of numbers, indication for surgery, urgency and stoma inclusion. Heterogeneity precluded meta-analysis. Definitions and timeframe for AL were available in only 22 and 11 ALPS, respectively. 26/31 studies used some form of multivariable logistic regression in their modelling. Models included 3-33 individual predictors. 27/31 studies reported model discrimination performance but just 18/31 reported calibration. 15/31 ALPS were reported with external validation, 9/31 with internal validation alone and 4 published without any validation. 27/31 ALPS and every validation study were scored high risk of bias in model analysis. Conclusions: Poor reporting practices and methodological shortcomings limit wider adoption of published ALPS. Several models appear to perform well in discriminating patients at highest AL risk but all raise concerns over risk of bias, and nearly all over wider applicability. Large-scale, precisely reported external validation studies are required. Prospero registration number: CRD42020164804.
MeSH term(s)	Humans ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/diagnosis ; Anastomotic Leak/etiology ; Colorectal Neoplasms/complications ; Risk Factors
Language	English
Publishing date	2023-07-18
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-073085
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Article ; Online: Global economic burden of unmet surgical need for appendicitis.

Reuter, Anna / Rogge, Lisa / Monahan, Mark / Kachapila, Mwayi / Morton, Dion G / Davies, Justine / Vollmer, Sebastian

The British journal of surgery

2022 Volume 109, Issue 10, Page(s) 995–1003

Abstract: Background: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis.: Methods: Data ... ...

Abstract	Background: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.
MeSH term(s)	Appendicitis/epidemiology ; Appendicitis/surgery ; Cost of Illness ; Financial Stress ; Health Care Costs ; Humans
Language	English
Publishing date	2022-08-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znac195
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Article ; Online: Erratum to "Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries" [

Kachapila, Mwayi / Monahan, Mark / Ademuyiwa, Adesoji O / Adinoyi, Yakubu Momohsani / Biccard, Bruce M / George, Christina / Ghosh, Dhruva N / Glasbey, James / Morton, Dion G / Osayomwanbo, Osaheni / Pearse, Rupert / Roberts, Tracy E / Suroy, Atul / Yakubu, Saidu Yusuf / Oppong, Raymond

BJA open

2024 Volume 9, Page(s) 100251

Abstract: This corrects the article DOI: 10.1016/j.bjao.2023.100207.]. ...

Abstract	[This corrects the article DOI: 10.1016/j.bjao.2023.100207.].
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Published Erratum
ISSN	2772-6096
ISSN (online)	2772-6096
DOI	10.1016/j.bjao.2023.100251
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Article ; Online: Erratum to 'Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries' [

BJA open

2024 Volume 10, Page(s) 100267

Abstract: This corrects the article DOI: 10.1016/j.bjao.2023.100207.]. ...

Abstract	[This corrects the article DOI: 10.1016/j.bjao.2023.100207.].
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Published Erratum
ISSN	2772-6096
ISSN (online)	2772-6096
DOI	10.1016/j.bjao.2024.100267
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Article ; Online: Fluid Optimisation in Emergency Laparotomy (FLO-ELA) Trial: study protocol for a multi-centre randomised trial of cardiac output-guided fluid therapy compared to usual care in patients undergoing major emergency gastrointestinal surgery.

Edwards, Mark R / Forbes, Gordon / Walker, Neil / Morton, Dion G / Mythen, Monty G / Murray, Dave / Anderson, Iain / Mihaylova, Borislava / Thomson, Ann / Taylor, Matt / Hollyman, Marianne / Phillips, Rachel / Young, Keith / Kahan, Brennan C / Pearse, Rupert M / Grocott, Michael P W

Trials

2023 Volume 24, Issue 1, Page(s) 313

Abstract: Introduction: Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve ... ...

Abstract	Introduction: Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve outcomes from surgery. Previous small trials of cardiac-output guided haemodynamic therapy algorithms in patients undergoing gastrointestinal surgery have suggested this intervention results in reduced complications and a modest reduction in mortality. However, this existing evidence is based mainly on elective (planned) surgery, with little evaluation in the emergency setting. There are fundamental clinical and pathophysiological differences between the planned and emergency surgical setting which may influence the effects of this intervention. A large definitive trial in emergency surgery is needed to confirm or refute the potential benefits observed in elective surgery and to inform widespread clinical practice. Methods: The FLO-ELA trial is a multi-centre, parallel-group, open, randomised controlled trial. 3138 patients aged 50 and over undergoing major emergency gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intra-venous fluid, or usual care without cardiac output monitoring. The trial intervention will be carried out during surgery and for up to 6 h postoperatively. The trial is funded through an efficient design call by the National Institute for Health and Care Research Health Technology Assessment (NIHR HTA) programme and uses existing routinely collected datasets for the majority of data collection. The primary outcome is the number of days alive and out of hospital within 90 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation. Participant recruitment started in September 2017 with a 1-year internal pilot phase and is ongoing at the time of publication. Discussion: This will be the largest contemporary randomised trial examining the effectiveness of perioperative cardiac output-guided haemodynamic therapy in patients undergoing major emergency gastrointestinal surgery. The multi-centre design and broad inclusion criteria support the external validity of the trial. Although the clinical teams delivering the trial interventions will not be blinded, significant trial outcome measures are objective and not subject to detection bias. Trial registration: ISRCTN 14729158. Registered on 02 May 2017.
MeSH term(s)	Aged ; Humans ; Middle Aged ; Cardiac Output ; Digestive System Surgical Procedures ; Fluid Therapy/methods ; Hemodynamics ; Laparotomy ; Multicenter Studies as Topic ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-05-06
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07275-3
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Article ; Online: Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden.

Monahan, Mark / Jowett, Susan / Pinkney, Thomas / Brocklehurst, Peter / Morton, Dion G / Abdali, Zainab / Roberts, Tracy E

PloS one

2020 Volume 15, Issue 6, Page(s) e0232960

Abstract: Background: Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly ... ...

Abstract	Background: Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe. Objective: The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs. Methods: A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template. Results: Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174-$29,610) and European countries ($21-$34,000). Huge study design heterogeneity was encountered across the two settings. Discussion: SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.
MeSH term(s)	Cost of Illness ; Developed Countries/economics ; Developing Countries/economics ; Global Health ; Health Expenditures ; Health Resources/economics ; Humans ; Incidence ; Income ; Length of Stay/statistics & numerical data ; Surgical Wound Infection/economics ; Surgical Wound Infection/epidemiology
Language	English
Publishing date	2020-06-04
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0232960
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Article ; Online: Preliminary model assessing the cost-effectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa.

Kachapila, Mwayi / Ademuyiwa, Adesoji O / Biccard, Bruce M / Ghosh, Dhruva N / Glasbey, James / Monahan, Mark / Moore, Rachel / Morton, Dion G / Oppong, Raymond / Pearse, Rupert / Roberts, Tracy E

PloS one

2021 Volume 16, Issue 8, Page(s) e0254698

Abstract: Background: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. ... ...

Abstract	Background: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. Methods: A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. Results: In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. Conclusions: Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.
MeSH term(s)	Abdomen/surgery ; COVID-19 ; Chlorhexidine/therapeutic use ; Cost-Benefit Analysis ; Humans ; Models, Theoretical ; Mouthwashes ; Pandemics ; Pneumonia/prevention & control ; Postoperative Complications/prevention & control ; Preoperative Care ; Prospective Studies ; South Africa
Chemical Substances	Mouthwashes ; Chlorhexidine (R4KO0DY52L)
Language	English
Publishing date	2021-08-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0254698
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Article ; Online: The molecular landscape of well differentiated retroperitoneal liposarcoma.

Tyler, Robert / Dilworth, Mark P / James, Jonathan / Blakeway, Daniel / Stockton, Joanne D / Morton, Dion G / Taniere, Phillipe / Gourevitch, David / Desai, Anant / Beggs, Andrew D

The Journal of pathology

2021 Volume 255, Issue 2, Page(s) 132–140

Abstract: Well differentiated liposarcoma (WD-LPS) is a relatively rare tumour, with fewer than 50 cases occurring per year in the UK. These tumours are both chemotherapy- and radiotherapy-resistant and present a significant treatment challenge requiring radical ... ...

Abstract	Well differentiated liposarcoma (WD-LPS) is a relatively rare tumour, with fewer than 50 cases occurring per year in the UK. These tumours are both chemotherapy- and radiotherapy-resistant and present a significant treatment challenge requiring radical surgery. Little is known of the molecular landscape of these tumours and no current targets for molecular therapy exist. We aimed to carry out a comprehensive molecular characterisation of WD-LPS via whole genome sequencing, RNA sequencing, and methylation array analysis. A recurrent mutation within exon 1 of FOXD4L3 was observed (chr9:70,918,189A>T; c.322A>T; p.Lys108Ter). Recurrent mutations were also observed in Wnt signalling, immunity, DNA repair, and hypoxia-associated genes. Recurrent amplification of HGMA2 was observed, although this was in fact part of a general amplification of the region around this gene. Recurrent gene fusions in HGMA2, SDHA, TSPAN31, and MDM2 were also observed as well as consistent rearrangements between chromosome 6 and chromosome 12. Our study has demonstrated a recurrent mutation within FOXD4L3, which shows evidence of interaction with the PAX pathway to promote tumourigenesis. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Forkhead Transcription Factors/genetics ; Humans ; Liposarcoma/genetics ; Male ; Middle Aged ; Mutation ; Retroperitoneal Neoplasms/genetics
Chemical Substances	FOXD4 protein, human ; Forkhead Transcription Factors
Language	English
Publishing date	2021-08-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3119-7
ISSN	1096-9896 ; 0022-3417
ISSN (online)	1096-9896
ISSN	0022-3417
DOI	10.1002/path.5749
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