Erin Isenberg MD , Maedeh Marzoughi BS , Pasithorn A. Suwanabol MD, MS
{"title":"When and how to adapt care in frail older adults","authors":"Erin Isenberg MD , Maedeh Marzoughi BS , Pasithorn A. Suwanabol MD, MS","doi":"10.1016/j.scrs.2024.101063","DOIUrl":"10.1016/j.scrs.2024.101063","url":null,"abstract":"<div><div>Adults ≥65 years of age comprise nearly 20 % of the U.S. population and over half of surgical patients. Older adults, particularly when frail, are at increased risk of adverse physical, cognitive, and functional changes after undergoing surgery. This manuscript highlights the importance of tailored care for frail older adults considering or undergoing colorectal surgery to optimize perioperative outcomes and recovery and better inform decision-making and promote goal-concordant care. We examine the challenges these patients face and outline evidence-based strategies for comprehensive preoperative assessment, perioperative management, and postoperative care to mitigate the risks associated with surgery and improve patient outcomes.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 4","pages":"Article 101063"},"PeriodicalIF":0.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ensuring goal-aligned care in a busy surgical practice","authors":"Jessica N. Cohan MD, MAS, FACS, FASCRS","doi":"10.1016/j.scrs.2024.101062","DOIUrl":"10.1016/j.scrs.2024.101062","url":null,"abstract":"<div><div>The US population is aging. Accordingly, older adults with multiple comorbidities and geriatric syndromes will present in increasing numbers for surgical consultation. Incorporating patient goals into surgical treatment decisions is recommended by a joint guideline from the American Geriatrics Society and American College of Surgeons, the American Society of Colon and Rectal Surgeons, the Geriatric Surgery Verification program, and the Institute for Healthcare Improvement as part of building Age-Friendly Health Systems, however uptake has been slow. The aim of this review is to provide a framework for how patient goals can be elicited and used in real-world surgical practices to achieve goal-aligned care.</div></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 4","pages":"Article 101062"},"PeriodicalIF":0.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah M. Kling MD, MPH , Simran Kripalani MD , Valeda Yong MD, MSEd , Juan Lucas Poggio MD
{"title":"The impact of federally legislated colon and rectal cancer screening programs and policy in the United States","authors":"Sarah M. Kling MD, MPH , Simran Kripalani MD , Valeda Yong MD, MSEd , Juan Lucas Poggio MD","doi":"10.1016/j.scrs.2024.101040","DOIUrl":"10.1016/j.scrs.2024.101040","url":null,"abstract":"<div><h3>Introduction</h3><p>Colorectal cancer (CRC) is the third leading cause of cancer deaths for men and women separately and the second leading cause of cancer deaths for men and women combined. CRC screening allows for cancer prevention, early treatment, or cure. Thus, screening can decrease the incidence and mortality of CRC. This supports the importance of making efforts to improve screening rates through public health programs and policy.</p></div><div><h3>Programs and Policy</h3><p>Government sponsored public health programs have been shown to be effective at increasing CRC screening rates at comparable costs across multiple regions and populations in the United States. Additionally, policy has been evolving to provide more comprehensive coverage of CRC screening tests.</p></div><div><h3>Conclusion</h3><p>Both public health programming and policy are important tools to increase CRC screening rates, with the ultimate goals of decreasing CRC incidence and mortality. CRC screening and its dissemination has been shown to be adoptable and cost effective, and should continue to be the focus of public health programming and policy efforts.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101040"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advanced practice providers: An evolution of scope of practice and clinical integration across the surgical healthcare landscape","authors":"Kelly M. Tyler M.D.","doi":"10.1016/j.scrs.2024.101039","DOIUrl":"10.1016/j.scrs.2024.101039","url":null,"abstract":"<div><p>Advanced practice providers (APPs) have become an integral part of surgical practice over the past 50 years. Understanding the clinical roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) provides insight into practice norms, collaborative opportunities, the nuances of APP independent practice trends, billing practices, and current practice challenges.</p><p>Exploring the history, education, and current practice environment of APPs allows a sophisticated understanding of their roles in the inpatient/facility and outpatient/office settings. This article explores the impact of APPs on access to care, and their role across the overall healthcare landscape in the United States particularly as government and healthcare continue to intersect.</p><p>The aim of this work is to provide the reader with a nuanced understanding of the factors influencing the current practice of APPs working in surgical fields in the United States and to foster an authentic appreciation of the existing complexities of APPs practicing in the field of surgery in the context of the current evolving national healthcare landscape.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101039"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdul S Hassan MD , David A Swift MD MPH , Courtney L Devin MD
{"title":"The effects of current health policy on social determinants of health, implications in colon and rectal surgery","authors":"Abdul S Hassan MD , David A Swift MD MPH , Courtney L Devin MD","doi":"10.1016/j.scrs.2024.101041","DOIUrl":"10.1016/j.scrs.2024.101041","url":null,"abstract":"<div><p>Despite decades of work on advancing outcomes in colon and rectal surgery, social determinants of health (SDOH) remain an unaddressed component in understanding these outcomes to ensure health equity. Consequently, there is evidence that SDOH have a negative impact on morbidity and mortality of those individuals with colorectal cancer and inflammatory bowel disease in comparison to their counterparts. We sought to elucidate the interplay between SDOH with the access and utilization of Medicaid and how best to improve patient care and outcomes through policy changes. Further education how to address SDOH is needed, as well as a continued push for policy makers to create legislation to improve these rampant inequities in medicine.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101041"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The importance of physician engagement in healthcare policy and advocacy","authors":"By Ross F. Goldberg MD","doi":"10.1016/j.scrs.2024.101043","DOIUrl":"10.1016/j.scrs.2024.101043","url":null,"abstract":"<div><p>Advocacy is a key component to a physician's practice; we advocate on behalf of our patients daily. As important as those efforts are, it is equally important that physicians are engaged in health care policy and advocacy on the state and federal level, where decisions are made that can directly impact a physician's ability to care for patients. This article summarizes the importance of physician engagement in these activities, looking at both the legislative and regulatory processes. It reviews how both interact with one another, and the impact it has on the patient-physician relationship. Finally, this article reviews ways in which physicians can easily get involved with advocacy, including providing resources available to assist those who never participated in these efforts before.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101043"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Consilience of healthcare legislation, complexity science & computational analysis","authors":"Don B. Colvin MD","doi":"10.1016/j.scrs.2024.101036","DOIUrl":"10.1016/j.scrs.2024.101036","url":null,"abstract":"<div><p>Our US Health Care System (HCS) has evolved from simple to complex and needs reform. Thus far, all legislative initiatives have failed to result in establishing a friendly, cost-effective, quality healthcare system. The question becomes, can Complexity Science (CS) and computational analytic platform modeling be used to help create better Health Care Policies (HCP) and reform our all too complex HCS? Modeling has been used in many diverse disciplines but has yet to be utilized in preemptive evaluation of major US legislative HCPs. Review of US Health Care Policy History (HCPH) viewed in the context of a Complex Adaptive System(CAS) reveals how, unanticipated historical events, politics, social, and personal leadership have tangentially shaped our US HCPs. Future construction of HCPs with the help of CS, and preemptive computational modeling (CM) techniques, will hopefully yield stronger conclusions in legislative HCP construction and advance our US HCS into one with dynamic resilience.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101036"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kurt S. Schultz MD , Michelle L. Hughes MD , Warqaa M. Akram MD, FACS , Anne K. Mongiu MD, PhD
{"title":"Artificial intelligence for the colorectal surgeon in 2024 – A narrative review of Prevalence, Policies, and (needed) Protections","authors":"Kurt S. Schultz MD , Michelle L. Hughes MD , Warqaa M. Akram MD, FACS , Anne K. Mongiu MD, PhD","doi":"10.1016/j.scrs.2024.101037","DOIUrl":"10.1016/j.scrs.2024.101037","url":null,"abstract":"<div><p>Artificial Intelligence (AI) touches innumerable aspects of our lives today. It plays our music, turns on our lights, answers our weather questions, and even helps navigate our cars safely down the road - to name but a few capabilities. Review of the literature shows that AI applications are rapidly infiltrating most aspects of healthcare. For the microcosm of colorectal surgery, AI can assist in specimen acquisition, pathologic and radiologic diagnosis, selection of treatment modality, pre/postoperative risk stratification, and more globally in surgeon education, grantsmanship, and claims assessment. However, with such power comes the risk of its abuse, and subsequent harm to patients (and providers). Understanding a brief history of AI and the hierarchy of the predominant forms with which we interact, allow us to better understand the nature of these risks and how we can apply ethical frameworks to better understand and mitigate/prevent them. Finally, considering President Biden's October 2023 executive order, we can evaluate how US policy addresses these concerns.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101037"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physician burnout and impact of policy","authors":"Sowmya Sharma MD , Jonathan S. Abelson MD","doi":"10.1016/j.scrs.2024.101042","DOIUrl":"10.1016/j.scrs.2024.101042","url":null,"abstract":"<div><p>Physician burnout, characterized by exhaustion, depersonalization and reduced satisfaction, is an important and increasingly discussed issue. It has an impact across all specialties, with highest rates among surgery, neurology and other high-demand specialties. Risk factors for this epidemic are diverse and are seen as early as medical school. The impact of burnout is being noted in various studies in both physician personal lives and well-being, and quality of patient care. It is clear that this is an issue that needs to be addressed, and mitigation strategies are important at individual, institution and government level to optimize patient care, maintain the physician work force and protect physician well being.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101042"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel Ekaireb MD , Anna Yap MD , Robert Kucejko MD MS MBA
{"title":"Vertical integration and market consolidation in healthcare: Policy drivers and impact on physicians and patient care","authors":"Rachel Ekaireb MD , Anna Yap MD , Robert Kucejko MD MS MBA","doi":"10.1016/j.scrs.2024.101038","DOIUrl":"10.1016/j.scrs.2024.101038","url":null,"abstract":"<div><p>As healthcare markets have become increasingly consolidated, the vertical integration of physician practices with hospital networks has drawn additional scrutiny. While vertical integration within healthcare was once predicted to improve efficiency and quality of healthcare delivery, empirical study has uncovered mixed results. In a review of existing literature, vertical integration has yielded inconsistent effects on health quality metrics, with modest improvements at best, but has consistently driven up prices. This article reviews economic theory and the real-world effects of vertical mergers within healthcare and discusses policies driving this trend. Given the impacts of vertical integration on healthcare outcomes, cost, patient choice and physician wellbeing, physicians should advocate for regulations that preserve sufficient competition in healthcare markets and diversity of practice settings.</p></div>","PeriodicalId":55956,"journal":{"name":"Seminars in Colon and Rectal Surgery","volume":"35 3","pages":"Article 101038"},"PeriodicalIF":0.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S104314892400037X/pdfft?md5=396abb7b9a537012cc159cc1f5bbea7b&pid=1-s2.0-S104314892400037X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}