Seminars in Colon and Rectal Surgery最新文献

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IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2025-03-01 Epub Date: 2025-02-08 DOI: 10.1016/j.scrs.2025.101084

Alexis D. Desir MD, Emina H. Huang MD

Returning to the operating room after birth-related leave presents significant challenges for female surgeons, who are often navigating the demands of parenthood alongside rigorous work schedules. This manuscript explores the multifaceted hurdles faced by these surgeons, including physical, mental, financial, and professional impacts. The physically demanding nature of surgery, coupled with hormonal changes, breastfeeding challenges, and sleep deprivation, exacerbates the difficulties of postpartum recovery. Additionally, female surgeons are at higher risk for postpartum depression and anxiety, which can hinder their performance in the operating room. Professionally, trainees may face changes in relationships with co-residents, potential delays in graduation, and evolving career priorities as they balance surgical training with family responsibilities. The manuscript emphasizes the need for flexible, supportive environments in surgical programs to better accommodate new mothers. By recognizing these challenges and adopting policies that prioritize wellness, the surgical community can help ensure that female surgeons successfully reintegrate into their careers without compromising their health or professional development.

对于女外科医生来说，在产假结束后重返手术室是一个巨大的挑战，她们往往要在严格的工作安排之外应对为人父母的要求。本文探讨了这些外科医生所面临的多方面障碍，包括身体、精神、经济和专业影响。手术对体力的要求，加上荷尔蒙的变化、母乳喂养的挑战和睡眠剥夺，加剧了产后恢复的困难。此外，女性外科医生患产后抑郁和焦虑的风险更高，这可能会影响她们在手术室的表现。在专业上，受训者可能会面临与实习医师关系的变化，毕业的潜在延迟，以及在平衡外科培训与家庭责任时不断变化的职业优先级。该手稿强调需要灵活的，支持性的手术方案环境，以更好地适应新妈妈。通过认识到这些挑战并采取优先考虑健康的政策，外科社区可以帮助确保女性外科医生成功地重新融入她们的职业生涯，而不会损害她们的健康或专业发展。

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引用次数: 0

A wellness resource guide for residents and fellows 住院医师和研究员健康资源指南

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2025-03-01 Epub Date: 2025-02-08 DOI: 10.1016/j.scrs.2025.101083

Vanessa A. Hortian DO, MS, LAc

Surgical training requires resilience and grit, as well as sacrifice. Each stage of training presents a set of unique challenges. Studies have shown that training is associated with burnout, attrition, and even cases of suicide. This article describes training-associated challenges that can lead to burnout and attrition and provides a resource guide to aid in maintaining well-being and humanity while navigating the journey of surgical training.

外科训练需要适应力和勇气，以及牺牲精神。训练的每个阶段都有一系列独特的挑战。研究表明，训练与倦怠、减员甚至自杀有关。本文描述了与培训相关的挑战，这些挑战可能导致倦怠和损耗，并提供了一个资源指南，以帮助在外科培训的过程中保持健康和人性。

引用次数: 0

The joys of a surgical career and beyond 外科手术生涯的乐趣以及其他

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2025-03-01 Epub Date: 2025-02-08 DOI: 10.1016/j.scrs.2025.101087

Patricia Roberts MD, FACS, FASCRS

In 2017, my Presidential address to the American Society of Colon and Rectal Surgeons was titled “the joys of a surgical career.” The address examined the continuum of a long surgical career, and particularly the four stages including the initial education and training to become a colon and rectal surgeon, early career, mid career and late career. This paper builds on that address and specifically looks at ways to continue to thrive and to find joy in the clinical practice of surgery and beyond.

2017年，我在美国结肠直肠外科学会发表的总统演讲题为“外科手术生涯的乐趣”。演讲考察了长期外科手术生涯的连续性，特别是四个阶段，包括成为结肠和直肠外科医生的最初教育和培训，职业生涯早期，职业生涯中期和职业生涯晚期。本文以该地址为基础，特别着眼于如何继续茁壮成长，并在外科及其他临床实践中找到快乐。

引用次数: 0

What it takes to be a surgeon today 今天的外科医生

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2025-03-01 Epub Date: 2025-02-08 DOI: 10.1016/j.scrs.2025.101080

Celine Soriano MD., Terrah Paul Olson MD

A long career in surgery requires prioritizing surgeon well-being. Burnout is prevalent in surgery, and is tied to job dissatisfaction, mental illness, and adverse patient outcomes. Individual and institutional factors, such as protection of identity, boundary setting, supportive workplace culture and communities, and creative re-structuring of work models can alleviate burnout and optimize surgeon wellness. This can allow surgeons today to thrive in the profession and enjoy life outside of it.

长期从事外科手术需要优先考虑外科医生的福祉。职业倦怠在外科手术中很普遍，并与工作不满意、精神疾病和不良的患者结果有关。个人和机构因素，如身份保护、边界设置、支持性的工作场所文化和社区，以及创造性地重构工作模式，可以减轻职业倦怠，优化外科医生的健康。这可以让今天的外科医生在这个行业中茁壮成长，并享受它之外的生活。

引用次数: 0

Coaching as a resource for the modern surgeon 教练是现代外科医生的资源

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2025-03-01 Epub Date: 2025-02-08 DOI: 10.1016/j.scrs.2025.101086

Sharon L. Stein MD

Surgical coaching is becoming more prevalent over the last ten years. The practice of surgical coaching is widely variant, from technical coaching to developmental and remedial coaching. However, the premise behind coaching remains the same, to continue to foster the growth and development of news skills for the surgeon. This chapter reviews some of the data on coaching, as well as information on types of coaching. It also reviews some of the cultural biases that limit the acceptance of coaching by surgeons.

近十年来，手术指导越来越普遍。手术指导的做法多种多样，有技术指导，也有发展和补救指导。然而，指导背后的前提始终不变，即继续促进外科医生新闻技能的增长和发展。本章回顾了一些有关教练的数据以及教练类型的信息。本章还回顾了限制外科医生接受辅导的一些文化偏见。

引用次数: 0

Identifying and optimizing psychosocial frailty in surgical practice 在外科实践中识别和优化社会心理脆弱性

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1016/j.scrs.2024.101061

Kurt S. Schultz MD, Caroline E. Richburg MD, Emily Y. Park MD, Ira L. Leeds MD MBA ScM

Psychosocial frailty is under-screened for and under-treated in patients undergoing surgery, even though patients with psychosocial frailty are at increased risk for postoperative complications. Numerous approaches exist to identifying psychosocial frailty in the preoperative period, ranging from neighborhood-level indices to patient-level, patient-reported data. Presurgical optimization of psychosocial frailty has returned mixed results, focusing primarily on psychological well-being with limited attention paid to addressing a patient's social risk profile. Mediators and moderators of psychosocial frailty in surgical outcomes must be further elucidated before investigators can appropriately trial psychosocial optimization programs that benefit patients. In recent years, new policies and system-level changes have incentivized screening for psychosocial frailty, and additional reimbursement strategies should be formulated to address frailty in the preoperative period in a feasible, sustainable, and cost-effective manner.

尽管心理社会功能虚弱的患者术后出现并发症的风险会增加，但对手术患者的心理社会功能虚弱筛查和治疗却不足。目前有许多方法可用于识别术前的心理社会脆弱性，从邻里层面的指数到患者层面的患者报告数据，不一而足。手术前优化心理社会脆弱性的结果不一，主要集中在心理健康方面，而对患者的社会风险概况关注有限。必须进一步阐明社会心理脆弱对手术结果的中介和调节因素，研究人员才能适当地试用有益于患者的社会心理优化方案。近年来，新政策和系统层面的变化激励了社会心理虚弱的筛查，应制定更多的报销策略，以可行、可持续和具有成本效益的方式解决术前阶段的虚弱问题。

引用次数: 0

Improving surgical outcomes for older adults with adoption of technological advances in comprehensive geriatric assessment 采用先进技术进行老年综合评估，改善老年人的手术效果

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1016/j.scrs.2024.101060

Sydney F Tan MD, Benjamin Cher MD, Julia R Berian MD, MS

Frailty is a well-recognized predictor of poor surgical outcomes for older adults, yet effective measurements and interventions remain limited. Technological advances offer an opportunity to address this gap and improve surgical care for older adults. This paper reviews the background of frailty and comprehensive geriatric assessments in surgery, and how technological innovations can advance frailty measurement and intervention in surgical settings. We review two broad areas of technological advancement as applied to frailty in surgery: (1) Innovation in the use of electronic health records (EHR) using Artificial Intelligence (AI) and Machine Learning (ML), and (2) Novel uses for wearable sensors and mobile health (mHealth) applications. We explore the integration of AI and ML with EHR systems, which can surpass traditional comorbidity indices by providing comprehensive health assessments and enhancing prediction models. Innovations like the electronic Frailty Index (eFI) show promise in expanding the reach of frailty assessments and facilitating real-time screening. Additionally, wearable devices and mobile health (mHealth) applications offer new ways to monitor and improve physical activity, nutrition, and psychological well-being, supporting perioperative rehabilitation. While these technologies present challenges, such as the need for infrastructure, training, and data interoperability, they offer promising strategies to facilitate the assessment and management of frailty among surgical patients. Continued research and tailored implementation strategies will be essential to fully realize the potential of these advancements in improving surgical outcomes for frail older adults.

衰弱是公认的老年人手术效果不佳的预测因素，但有效的测量和干预措施仍然有限。技术进步为弥补这一不足、改善老年人外科护理提供了机会。本文回顾了虚弱的背景和外科手术中的老年综合评估，以及技术创新如何推进外科手术中的虚弱测量和干预。我们回顾了应用于外科虚弱的两大技术进步领域：(1) 使用人工智能（AI）和机器学习（ML）的电子健康记录（EHR）的使用创新，以及 (2) 可穿戴传感器和移动医疗（mHealth）应用的新用途。我们探索将人工智能和 ML 与电子病历系统集成，通过提供全面的健康评估和增强预测模型，超越传统的合并症指数。电子虚弱指数（eFI）等创新技术有望扩大虚弱评估的覆盖范围并促进实时筛查。此外，可穿戴设备和移动医疗（mHealth）应用为监测和改善体力活动、营养和心理健康提供了新的方法，为围术期康复提供了支持。虽然这些技术存在一些挑战，如需要基础设施、培训和数据互操作性，但它们为促进手术患者体弱状况的评估和管理提供了前景广阔的策略。要想充分发挥这些先进技术在改善体弱老年人手术效果方面的潜力，就必须继续开展研究并制定有针对性的实施策略。

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引用次数: 0

Utilizing a defined multiphase, multispecialty perioperative pathway to achieve functional recovery after surgery 利用确定的多阶段、多专科围手术期路径实现术后功能恢复

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1016/j.scrs.2024.101064

Federica Greco MD , Isacco Montroni MD, PhD

This article emphasizes the need for a personalized approach in managing older cancer patients, highlighting the importance of a multidisciplinary team that tailors treatment to the patient's specific health conditions and goals. The objective is to balance positive oncological outcomes with the restoration of independence, reduction of disabilities and enhancement of quality of life. Functional recovery is central to treatment decisions as disability can impact cancer patients more than the prognosis itself. The paper stresses the value of frailty screening tools, nutritional assessment and physical evaluation which help predict postoperative outcomes and guide clinical management. It advocates for comprehensive preoperative evaluations, including geriatric assessments, to prevent both undertreatment and overtreatment. Multimodal prehabilitation can improve postoperative outcomes, reduce healthcare costs, and help older patients remain engaged in society. The article concludes by recommending a patient-centered, individualized approach to optimize functional recovery and alleviate the economic burden on healthcare systems.

这篇文章强调，在管理老年癌症患者时需要采取个性化的方法，突出了多学科团队根据患者的具体健康状况和目标进行治疗的重要性。目标是在积极的肿瘤治疗效果与恢复独立、减少残疾和提高生活质量之间取得平衡。功能恢复是治疗决策的核心，因为残疾比预后本身对癌症患者的影响更大。论文强调了虚弱筛查工具、营养评估和身体评估的价值，它们有助于预测术后结果并指导临床管理。论文提倡进行全面的术前评估，包括老年评估，以防止治疗不足和治疗过度。多模式术前康复可改善术后效果，降低医疗成本，并帮助老年患者继续参与社会活动。文章最后建议采用以患者为中心的个性化方法，以优化功能恢复并减轻医疗系统的经济负担。

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引用次数: 0

Pearls for counseling older adults on the indications for stopping colon cancer screening 向老年人提供有关停止结肠癌筛查指征的指导原则

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1016/j.scrs.2024.101065

Josh Sommovilla MD

Colorectal cancer remains a leading cause of mortality, making effective screening procedures like colonoscopy essential in reducing associated risks. The cessation of colorectal cancer screening in older adults presents complex challenges, particularly as guidelines recommend screening initiation at age 45 and emphasize individualized decision-making for older populations. Key considerations include balancing procedural risks, cancer risk, overall health prognosis, and patient preferences. The risks associated with colonoscopy are especially pertinent for older patients with comorbidities, necessitating the use of prognostic tools like ePrognosis and the Charlson Comorbidity Index to inform screening decisions. High-risk individuals may experience increased anxiety about cancer, complicating the decision-making process, as many have historically relied on regular surveillance. Perspectives from both physicians and patients reveal significant uncertainty regarding screening cessation, highlighting the importance of patient involvement in these discussions. Effective communication strategies are crucial, advocating for recommendations that align with patients' broader health goals rather than focusing solely on age-related actuarial data. Ultimately, navigating the intricacies of colorectal cancer screening cessation in older adults requires a patient-centered approach that minimizes risks while respecting individual values and health goals.

结肠直肠癌仍然是导致死亡的主要原因，因此结肠镜检查等有效的筛查程序对于降低相关风险至关重要。停止对老年人进行结直肠癌筛查是一项复杂的挑战，尤其是指南建议在 45 岁开始筛查，并强调老年人群的个性化决策。主要考虑因素包括平衡手术风险、癌症风险、整体健康预后和患者偏好。结肠镜检查的相关风险对于有合并症的老年患者尤为重要，因此有必要使用预后工具（如 ePrognosis 和 Charlson 合并症指数）为筛查决策提供依据。高危人群对癌症的焦虑可能会增加，从而使决策过程复杂化，因为许多人历来依赖于定期监测。从医生和患者的角度来看，他们对停止筛查都有很大的不确定性，这凸显了患者参与这些讨论的重要性。有效的沟通策略至关重要，应倡导与患者更广泛的健康目标相一致的建议，而不是仅仅关注与年龄相关的精算数据。最终，要驾驭老年人停止大肠癌筛查的复杂性，需要采取以患者为中心的方法，在尊重个人价值观和健康目标的同时最大限度地降低风险。

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引用次数: 0

When and how to adapt care in frail older adults 何时以及如何调整对体弱老年人的护理

IF 0.4 Q4 SURGERY

Seminars in Colon and Rectal Surgery

Pub Date : 2024-12-01 Epub Date: 2024-11-06 DOI: 10.1016/j.scrs.2024.101063

Erin Isenberg MD , Maedeh Marzoughi BS , Pasithorn A. Suwanabol MD, MS

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.

年龄≥65 岁的成年人占美国人口的近 20%，占外科手术患者的一半以上。老年人，尤其是体弱的老年人，在接受手术后身体、认知和功能发生不良变化的风险会增加。本手稿强调了为考虑或正在接受结直肠手术的体弱老年人提供量身定制的护理的重要性，以优化围手术期的效果和恢复，更好地为决策提供信息并促进目标一致的护理。我们研究了这些患者面临的挑战，并概述了以证据为基础的综合术前评估、围手术期管理和术后护理策略，以降低手术相关风险并改善患者预后。

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

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Seminars in Colon and Rectal Surgery

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