Seminars in Colon and Rectal Surgery最新文献

Introduction

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.

Programs and Policy

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.

Conclusion

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Nowadays, endoscopy has achieved amazing results in the treatment of benign and malignant pathologies, but it has yet to establish itself fully in the sense of an operative endoscopy. It is commonly believed that traditional endoscopy has reached its limits due to the intrinsic characteristics of existing platforms. Numerous robotic endoluminal platforms have been developed to overcome limitations in recent years. Existing robotic endoluminal platforms can be divided into three categories: fully robotic flexible endoscopic, robotic add-on systems, and traditional surgery-based platforms. These platforms are incredible pieces of technology, but in reality, they can only be considered a bridge to a genuinely robotic surgical system. Nowadays, both gastroenterologists and surgeons perform endoscopic procedures all over the world. We believe these platforms, leading to increased manipulation possibilities, may require an increasingly excellent knowledge of surgical techniques to develop their potential fully. Surgeons' unique training and experience push surgeons to take the lead in endoscopic operations over gastroenterologists due to the potential advantages in surgical precision and patient outcomes. However, gastroenterologists deeply understand gastrointestinal disorders and a collaborative effort between them and surgeons can lead to an efficient approach to endoscopic surgery.

Patients with large colorectal polyps or mucosal neoplasms not amenable to standard polypectomy have traditionally undergone colon resection. However, minimally invasive surgical techniques have gained popularity over the past two decades. Transanal approaches such as transanal endoscopic microsurgery and transanal minimally invasive surgery have enabled surgeons to treat mucosal neoplasms located in the rectum. Later on, robotic surgery was incorporated into the transanal approach. Meanwhile, there was no such treatment option for more proximal colonic neoplasms then, and endoscopic mucosal resection and endoscopic submucosal dissection emerged in Japan to provide resection in treating such proximal lesions. Nowadays, all procedures performed in a hollow organ integrating standard surgical (dissection, resection, suturing, homeostasis) and oncological principles (en-bloc resection, clean surgical margins) are merged under endoluminal surgery. Within the scope of this review, we aimed to elaborate an overview of the role of endoluminal surgery in daily colorectal surgery practice while focusing on endoscopic procedures.