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Article ; Online: Martius flaps for low rectovaginal fistulae: a systematic review and proportional meta-analysis.

Swindon, Daisy / Izwan, Sara / Ng, Justin / Chan, Erick / Abbas, Naveed / Von Papen, Michael / Sahebally, Shaheel Mohammad

ANZ journal of surgery

2024

Abstract: Background: Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various others, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF ... ...

Abstract	Background: Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various others, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition. Methods: A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, whilst secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible. Results: Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF were included. The mean age of the study population was 42.4 (±15.7), years. There were 44 primary and 93 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45-98.46; I Conclusions: MF interposition appears to be more effective for primary than recurrent RVF. However, the poor quality of the data limits definitive conclusions being drawn and demands further assessment with randomized studies.
Language	English
Publishing date	2024-03-12
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18922
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Article ; Online: Incisional hernia following ileostomy closure: who's at risk? The Gold Coast experience.

Bloomfield, Ian / Dobson, Benjamin / Von Papen, Michael / Clark, David

ANZ journal of surgery

2021 Volume 92, Issue 1-2, Page(s) 146–150

Abstract: Background: Diverting ileostomy is utilized to protect high-risk anastomoses, though it is not shown to reduce the leak rate it may reduce the severe consequences of an anastamotic leak. In recent years mesh development has advanced to allow placement ... ...

Abstract	Background: Diverting ileostomy is utilized to protect high-risk anastomoses, though it is not shown to reduce the leak rate it may reduce the severe consequences of an anastamotic leak. In recent years mesh development has advanced to allow placement of meshes into potentially contaminated fields, such as an ostomy closure site. Method: A retrospective review of all ileostomy closure procedures in Gold Coast from 1st January 2011 until 31st December 2018 were included. Patient demographics and surgical outcomes and follow up reviewed to identify any cases of incisional hernia relating to ostomy closure. Results: A total of 193 patients were identified, after exclusions 171 were suitable for analysis within the study, a total of 25 incisional hernia detected radiologically or clinically. Two independent risk factors were identified BMI >30 and ASA 3-4. Both had significant association with development of incisional hernia with a 3- and 2-fold RR increase, respectively. This was also reflected in a subset analysis of BMI ranges demonstrating increased risk in the obese and severely obese group. Discussion: The high-risk group in our population was elevated BMI and ASA, these are the patients we would expect to benefit the most from targeted therapy to reduce the incidence of incisional hernia. Future studies to look at whether reducing BMI or prophylactic mesh placement are effective.
MeSH term(s)	Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Incisional Hernia/epidemiology ; Incisional Hernia/etiology ; Incisional Hernia/prevention & control ; Retrospective Studies ; Risk Factors ; Surgical Mesh/adverse effects
Language	English
Publishing date	2021-11-18
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17359
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Article ; Online: Lessons learnt from a rare case of splenic ectopic pregnancy.

Volante, Sonia N / Urquhart, Hamish / Math, Vanitha / Von Papen, Michael

ANZ journal of surgery

2020 Volume 90, Issue 12, Page(s) E225–E227

MeSH term(s)	Female ; Humans ; Pregnancy ; Pregnancy, Ectopic/diagnostic imaging ; Pregnancy, Ectopic/surgery ; Spleen
Language	English
Publishing date	2020-07-17
Publishing country	Australia
Document type	Case Reports ; Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.16021
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Article ; Online: Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation.

Rattray, Megan / Marshall, Andrea P / Desbrow, Ben / von Papen, Michael / Roberts, Shelley

BMC health services research

2021 Volume 21, Issue 1, Page(s) 514

Abstract: Background: A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and ... ...

Abstract	Background: A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery. Methods: A mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs' responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis. Results: The intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed. Conclusions: Approximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.
MeSH term(s)	Australia ; Humans ; Nutrition Therapy ; Nutritional Status ; Pilot Projects ; Translational Medical Research
Language	English
Publishing date	2021-05-27
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-021-06493-2
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Article ; Online: Omentoplasty to reduce anastomotic leak in colorectal surgery: a meta-analysis.

Sahebally, Shaheel Mohammad / Chan, Erick / Azmir, Alisha / Lu, Cu Tai / Doudle, Mark / Naik, Arun / Nolan, Gregory / Von Papen, Michael

ANZ journal of surgery

2022 Volume 92, Issue 7-8, Page(s) 1651–1657

Abstract: Background: Anastomotic leaks (AL) remain a devastating complication following intestinal anastomoses resulting in increased morbidity and mortality. Wrapping the anastomosis with omentum may be protective although data are conflicting. We performed a ... ...

Abstract	Background: Anastomotic leaks (AL) remain a devastating complication following intestinal anastomoses resulting in increased morbidity and mortality. Wrapping the anastomosis with omentum may be protective although data are conflicting. We performed a meta-analysis to assess the effect of omentoplasty on colorectal anastomoses. Methods: PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until August 2021. All randomized controlled trials (RCT) that reported on the use of omentoplasty in colon and rectal surgery were included. The primary outcome was rate of overall AL while secondary outcomes included clinical and radiological AL, overall reoperation and mortality. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Results: Four RCTs were included capturing 1067 patients. The mean (SD) age of the cohort was 61.5 (±14.8) years. On random effects analysis, omentoplasty reduced rate of overall (OR 0.43, 95% CI = 0.21-0.87, p = 0.02) and clinical AL (OR = 0.35, 95% CI = 0.15-0.81, p = 0.01). However, there was no difference in radiological AL (OR = 0.77, 95% CI = 0.40-1.47, p = 0.42), overall reoperations (OR 0.48, 95% CI = 0.18-1.32, p = 0.16) or mortality (OR 0.52, 95% CI = 0.12 to-2.18, p = 0.37). On sensitivity analysis, assessing rectal anastomoses only, the results for overall AL remained similar (OR 0.28, 95% CI = 0.12-0.61, p = 0.002). Conclusion: Although omentoplasty appears to reduce the rate of overall and clinical AL, the heterogeneity in the data prevents definitive recommendations from being made. Further well-designed trials are needed to investigate this technique.
MeSH term(s)	Aged ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery ; Colorectal Surgery ; Esophagectomy/adverse effects ; Humans ; Middle Aged ; Omentum/surgery
Language	English
Publishing date	2022-02-15
Publishing country	Australia
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17553
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Zs.A 180: Show issues

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Article ; Online: Phase-coherence classification: A new wavelet-based method to separate local field potentials into local (in)coherent and volume-conducted components.

von Papen, M / Dafsari, H S / Florin, E / Gerick, F / Timmermann, L / Saur, J

Journal of neuroscience methods

2017 Volume 291, Page(s) 198–212

Abstract: Background: Local field potentials (LFP) reflect the integrated electrophysiological activity of large neuron populations and may thus reflect the dynamics of spatially and functionally different networks.: New method: We introduce the wavelet-based ... ...

Abstract	Background: Local field potentials (LFP) reflect the integrated electrophysiological activity of large neuron populations and may thus reflect the dynamics of spatially and functionally different networks. New method: We introduce the wavelet-based phase-coherence classification (PCC), which separates LFP into volume-conducted, local incoherent and local coherent components. It allows to compute power spectral densities for each component associated with local or remote electrophysiological activity. Results: We use synthetic time series to estimate optimal parameters for the application to LFP from within the subthalamic nucleus of eight Parkinson patients. With PCC we identify multiple local tremor clusters and quantify the relative power of local and volume-conducted components. We analyze the electrophysiological response to an apomorphine injection during rest and hold. Here we show medication-induced significant decrease of incoherent activity in the low beta band and increase of coherent activity in the high beta band. On medication significant movement-induced changes occur in the high beta band of the local coherent signal. It increases during isometric hold tasks and decreases during phasic wrist movement. Comparison with existing methods: The power spectra of local PCC components is compared to bipolar recordings. In contrast to bipolar recordings PCC can distinguish local incoherent and coherent signals. We further compare our results with classification based on the imaginary part of coherency and the weighted phase lag index. Conclusions: The low and high beta band are more susceptible to medication- and movement-related changes reflected by incoherent and local coherent activity, respectively. PCC components may thus reflect functionally different networks.
MeSH term(s)	Aged ; Algorithms ; Apomorphine/pharmacology ; Beta Rhythm/drug effects ; Beta Rhythm/physiology ; Cohort Studies ; Deep Brain Stimulation ; Dopamine Agonists/pharmacology ; Female ; Humans ; Implantable Neurostimulators ; Male ; Middle Aged ; Motor Activity/physiology ; Neurons/drug effects ; Neurons/physiology ; Parkinson Disease/physiopathology ; Parkinson Disease/therapy ; Subthalamic Nucleus/drug effects ; Subthalamic Nucleus/physiopathology ; Synaptic Transmission/drug effects ; Synaptic Transmission/physiology ; Tremor/physiopathology ; Tremor/therapy ; Wavelet Analysis
Chemical Substances	Dopamine Agonists ; Apomorphine (N21FAR7B4S)
Language	English
Publishing date	2017-08-31
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	282721-9
ISSN	1872-678X ; 0165-0270
ISSN (online)	1872-678X
ISSN	0165-0270
DOI	10.1016/j.jneumeth.2017.08.021
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Article ; Online: Characterization of information processing in the subthalamic area of Parkinson's patients.

Weber, Immo / Florin, Esther / von Papen, Michael / Visser-Vandewalle, Veerle / Timmermann, Lars

NeuroImage

2020 Volume 209, Page(s) 116518

Abstract: Despite advances in symptomatic treatment options the pathomechanism of idiopathic Parkinson's disease (PD) remains poorly understood. Animal studies from recent years suggest pathological information processing in the basal ganglia network to be ... ...

Abstract	Despite advances in symptomatic treatment options the pathomechanism of idiopathic Parkinson's disease (PD) remains poorly understood. Animal studies from recent years suggest pathological information processing in the basal ganglia network to be responsible for major movement deficits observed in patients, which, according to the information lesion hypothesis, might also explain the mechanism of action of deep brain stimulation (DBS). Using novel measures from information theory we characterize the information content, storage and transfer of intraoperatively recorded local field potentials (LFP) from the subthalamic area of n = 19 PD patients undergoing surgery for implantation of electrodes for deep brain stimulation. In agreement with recent animal studies we demonstrate a significant positive correlation of subthalamic information content and movement deficits (ρ > 0.48). Analysis of information storage reveals a larger processing memory in the zona incerta (ZI) than in the subthalamic nucleus (STN). We discuss possible implications for the efficiency of high frequency DBS. Further, we estimate the information transfer between forearm muscles and ZI/STN. Here, we show that the bidirectional information flow with respect to the STN is larger compared to the ZI. In contrast to the STN, however, the bidirectional information flow in the ZI is modulated, namely increased, by movement. The results of our study may help to understand the mechanism of action of deep brain stimulation and further explain recent studies claiming efficiency of ZI stimulation for certain motor symptoms.
MeSH term(s)	Adult ; Aged ; Deep Brain Stimulation ; Electrocorticography ; Electrodes, Implanted ; Electromyography ; Electrophysiological Phenomena/physiology ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal/physiopathology ; Parkinson Disease/physiopathology ; Parkinson Disease/surgery ; Subthalamic Nucleus/physiopathology ; Subthalamic Nucleus/surgery ; Zona Incerta/physiopathology
Language	English
Publishing date	2020-01-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1147767-2
ISSN	1095-9572 ; 1053-8119
ISSN (online)	1095-9572
ISSN	1053-8119
DOI	10.1016/j.neuroimage.2020.116518
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Zs.A 3664: 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)
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Article ; Online: Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study.

Rattray, Megan / Desbrow, Ben / Marshall, Andrea P / von Papen, Michael / Roberts, Shelley

Nutrition (Burbank, Los Angeles County, Calif.)

2020 Volume 84, Page(s) 111015

Abstract: Objectives: Timely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation approach, designed to improve oral intake among postoperative ...

Abstract	Objectives: Timely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation approach, designed to improve oral intake among postoperative colorectal patients. Methods: A pre/post, mixed-methods pilot study was undertaken at a tertiary teaching hospital in Australia. Patients who had undergone elective colorectal surgery and were admitted to the ward where 10 nutrition-related strategies had been implemented were included. Quantitative data, including patient demographics, timing and type of nutrition consumed, and protein and energy intake were collected pre- and post-intervention via chart audits, direct observations, and verbal clarification. Qualitative data on patient (n = 18) responses to the intervention were collected through one-on-one, semistructured interviews and analyzed using inductive content analysis. Results: Sixty-four patients were observed (30 pre- and 34 post-intervention). Significant improvements were seen for the following outcomes (presented as median [interquartile range], pre- versus post-intervention): time (h) to first dietary intake (15.7 [7.4-22.5] versus 4.9 [3.7-14.2]); patient energy intakes (kJ) on day 1 (1719 [947-2200] versus 3530 [2192-5169]) and day 2 (2506 [1071-3749] versus 4144 [2987-5889]); and patient protein intake (g) on day 1 (3.3 [1.8-11.2] versus 30.3 [20-45]) and day 2 (10.8 [3.5-29.9] versus 39.6 [30.7-59]). Prescription of free fluids as first diet type increased from 13% to 79% pre- and post-intervention, respectively. There were no significant differences in time (h) to first solid dietary intake (86.1 [60.1-104] versus 69.2 [46.1-115.5]) and overall proportion of patients who met both their estimated energy and protein requirements while in hospital pre- and post-intervention (22 versus 37%). Patients reported positive experiences with the intervention. Conclusion: A multifaceted intervention developed using an integrated knowledge translation approach has the potential to improve oral intake in patients who undergo colorectal surgery. A larger-scale trial is required to confirm these findings and assess the effects of the intervention on clinical outcomes and costs.
MeSH term(s)	Australia ; Colorectal Surgery ; Eating ; Energy Intake ; Humans ; Nutritional Status ; Pilot Projects
Language	English
Publishing date	2020-09-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	639259-3
ISSN	1873-1244 ; 0899-9007
ISSN (online)	1873-1244
ISSN	0899-9007
DOI	10.1016/j.nut.2020.111015
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Article ; Online: On the Complexity of Resting State Spiking Activity in Monkey Motor Cortex.

Dąbrowska, Paulina Anna / Voges, Nicole / von Papen, Michael / Ito, Junji / Dahmen, David / Riehle, Alexa / Brochier, Thomas / Grün, Sonja

Cerebral cortex communications

2021 Volume 2, Issue 3, Page(s) tgab033

Abstract: Resting state has been established as a classical paradigm of brain activity studies, mostly based on large-scale measurements such as functional magnetic resonance imaging or magneto- and electroencephalography. This term typically refers to a ... ...

Abstract	Resting state has been established as a classical paradigm of brain activity studies, mostly based on large-scale measurements such as functional magnetic resonance imaging or magneto- and electroencephalography. This term typically refers to a behavioral state characterized by the absence of any task or stimuli. The corresponding neuronal activity is often called idle or ongoing. Numerous modeling studies on spiking neural networks claim to mimic such idle states, but compare their results with task- or stimulus-driven experiments, or to results from experiments with anesthetized subjects. Both approaches might lead to misleading conclusions. To provide a proper basis for comparing physiological and simulated network dynamics, we characterize simultaneously recorded single neurons' spiking activity in monkey motor cortex at rest and show the differences from spontaneous and task- or stimulus-induced movement conditions. We also distinguish between rest with open eyes and sleepy rest with eyes closed. The resting state with open eyes shows a significantly higher dimensionality, reduced firing rates, and less balance between population level excitation and inhibition than behavior-related states.
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article
ISSN	2632-7376
ISSN (online)	2632-7376
DOI	10.1093/texcom/tgab033
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Article ; Online: Incidence of Clostridioides difficile in patients post loop ileostomy reversal in an Australian tertiary hospital: a retrospective study.

Jordan, Stephanie / Hui, Nathan / Doudle, Mark / Von Papen, Michael / Naik, Arun / Lu, Cu Tai / Nolan, Gregory / Cooper, Michelle

ANZ journal of surgery

2021 Volume 92, Issue 3, Page(s) 403–408

Abstract: Introduction: The purpose of a loop ileostomy is to temporarily divert faeces away from a distal anastomosis, to reduce the consequences of anastomotic leak. This ultimately requires a second procedure to restore bowel continuity, which confers risk of ... ...

Abstract	Introduction: The purpose of a loop ileostomy is to temporarily divert faeces away from a distal anastomosis, to reduce the consequences of anastomotic leak. This ultimately requires a second procedure to restore bowel continuity, which confers risk of complications including the development of Clostridioides difficile infection (CDI). It is hypothesized that patients who undergo loop ileostomy reversal are at increased risk of CDI when compared with other patients undergoing elective colorectal surgical procedures, and that these patients also experience an increased length of stay (LOS). Methods: A retrospective cohort study was performed on all patients who underwent loop ileostomy reversal at the Gold Coast Hospital and Health Service between 1 January 2012 and 31 December 2019. Results: Two hundred and twenty-eight patients were identified. Eight tested positive for CDI on faecal PCR (3.51%), a higher incidence than that in patients who underwent an elective colorectal surgical procedure during the same period (0.83%) (RR = 4.23). Additionally, median LOS for ileostomy reversal patients was significantly increased in those who also had CDI when compared with those without CDI (11 versus 4 days; P = 0.0003). Conclusion: The study confirmed that the incidence of CDI was higher in those who underwent ileostomy reversal when compared with an otherwise comparable hospital population (elective colorectal surgery patients). Additionally, those patients who underwent ileostomy reversal and had CDI experienced an increased LOS which translates to increased cost to the healthcare system. Further investigation into pre-operative screening and prophylactic antibiotics should be considered as a measure to mitigate this post-operative complication.
MeSH term(s)	Australia/epidemiology ; Clostridioides ; Clostridioides difficile ; Clostridium Infections/complications ; Clostridium Infections/etiology ; Colorectal Neoplasms/complications ; Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Incidence ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Tertiary Care Centers
Language	English
Publishing date	2021-12-10
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17411
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