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Complexities of Genetic Screening and Testing in Hereditary Colorectal Cancer
It is becoming increasingly important to identify patients at risk for hereditary colorectal cancer (CRC) given the opportunity to impact medical management and reduce morbidity and mortality among patients and their family members once inherited CRC predisposition is confirmed. Methods by which patients are identified are evolving as genetic testing costs have plummeted, resulting in many more genetic screening and testing options. Opportunities and challenges with newer approaches to genetic testing and screening for hereditary CRC are reviewed along with benefits and limitations of each approach. (Source: Seminars in Co...
Source: Seminars in Colon and Rectal Surgery - July 15, 2018 Category: Gastroenterology Authors: Deborah L. Cragun, Joy Kechik, Tuya Pal Source Type: research

Management of small bowel and pouch neoplasia in hereditary colorectal syndromes
Small bowel neoplasia remains an important, yet commonly overlooked, disease process in patients with familial colorectal cancer syndromes. The aim of this paper is to summarize the incidence and management of small bowel neoplasia in the more common syndromes, and outline recommendations for management and surveillance. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 15, 2018 Category: Gastroenterology Authors: Tarik Sammour BHB, Craig A. Messick MD Source Type: research

Hamartomatous polyposis syndromes: diagnosis and management
Hamartomatous polyps of the gastrointestinal tract are one of the major clinical features for several hereditary syndromes. Juvenile polyposis syndrome, Peutz-Jeghers syndrome, and PTEN hamartoma syndrome are inherited in an autosomal dominant fashion and predispose to formation of such polyps, especially in the colon and rectum. These polyps can lead to increased colorectal cancer risk and therefore should be managed with appropriate surveillance and treatment. In this article, the presentation, colorectal surveillance, and management of the three major hereditary hamartomatous syndromes is discussed. (Source: Seminars in...
Source: Seminars in Colon and Rectal Surgery - July 15, 2018 Category: Gastroenterology Authors: Molly M. Ford Source Type: research

Cancer prevention in hereditary colorectal cancer syndromes: Chemoprevention and lifestyle changes
Lynch Syndrome (LS) and familial adenomatous polyposis (FAP) represent the most prevalent inherited colorectal cancer syndromes. The key to reducing morbidity and mortality in affected individuals is prevention, and there is interest in chemopreventive agents that can either delay or prevent the need for procedural or surgical interventions. Sulindac is supported as a chemopreventive agent for the reduction of colorectal and duodenal polyps, as well as desmoids, in FAP. Aspirin has shown benefit in reducing polyp burden in LS. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 15, 2018 Category: Gastroenterology Authors: Rebeccah Baucom, Katerina Wells Source Type: research

Introduction to Seminars Edition
Our understanding of hereditary colorectal cancer syndromes continues to evolve as our understanding of new genes and patient risk grows. However, there are already many quality publications looking at the current understanding of the more “basic” aspects of hereditary colorectal cancer syndromes and their management. In this issue of Seminars, we endeavor to dig deeper and focus more on the difficult and complex aspects of the topic. Gaining a better understanding of these “complexities” allows us to provide enhanced specialt y care and expertise in a challenging discipline. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 3, 2018 Category: Gastroenterology Authors: Molly Ford, Paul Wise Source Type: research

Management of Desmoid Disease
Desmoid disease results when the wnt signaling pathway in fibroblasts is constantly active. It is characterized by enlarging tumors and sclerosing sheets of tissue. In patients with familial adenomatous polyposis (FAP) this can happen in the abdomen, the abdominal wall and in extra-abdominal sites. This review describes the clinical sequelae of desmoid disease in patients with FAP and their management. While abdominal wall desmoids cause symptoms due to their increasing size and prominence, they can be resected with a recurrence rate of about 30%. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - July 2, 2018 Category: Gastroenterology Authors: James Church Source Type: research

Editorial Board
(Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 10, 2018 Category: Gastroenterology Source Type: research

A Job Well Done
Seminars in Colon and Rectal Surgery has been lovingly cared for by David J. Schoetz, Jr., MD since 1995. During his tenure as Editor-in-Chief, the journal enjoyed great popularity. Seminars served as a voice of thoughtful reflection in an era increasingly entranced with the immediate. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - March 7, 2018 Category: Gastroenterology Authors: Thomas E. Read Source Type: research

Envisioning Value-Based Reimbursement
Seminars in Colon and Rectal Surgery has been lovingly cared for by David J. Schoetz, Jr. MD since 1995. During his tenure as Editor-in-Chief, the journal enjoyed great popularity. Seminars served as a voice of thoughtful reflection in an era increasingly entranced with the immediate. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - March 7, 2018 Category: Gastroenterology Authors: Thomas E. Read Source Type: research

The hospital-acquired condition reduction program for colorectal surgery: Current initiatives and implications for the future
The 2010 Patient Protection and Affordable Care Act (PPACA)1 sought to reform healthcare in the United States through a myriad of initiatives that included expanding health insurance accessibility, mandating coverage, revising and expanding a multitude of government programs, and incentivizing improved quality and value in healthcare delivery.2 One initiative aimed at containing costs and improving patient outcomes is the Hospital-Acquired Condition Reduction Program (HACRP). Like the Hospital Readmission Reduction Program (HRRP), the goal of this program is to stratify hospitals based on their outcomes, in this case a com...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Richard S. Hoehn, Ian M. Paquette Source Type: research

Bundled care payment models
In response to rising national healthcare spending, the Medicare program has proposed episode-based payments models as an alternative to the traditional fee-for-service program. A “bundled payment” is a single reimbursement provided for all aspects of care for a single diagnosis or procedure. This reimbursement model is argued to improve care delivery by accomplishing the following goals: (1) Improve coordination between hospital and physicians as well as between differen t care teams. (2) Improve efficiency of care thereby reducing spending. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Arielle E. Kanters, Chad Ellimoottil Source Type: research

Assessing quality in payment reform initiatives
Rising healthcare costs and increasing evidence of variation in quality of healthcare have spurred payment reform initiatives that tie reimbursement to the quality of care provided. Success in these initiatives will require identification of valid and reliable measures of quality and rigorous evaluation of the effects of payment reform implementation on these quality metrics. Despite the support and investment in quality improvement through payment reform, results of these improvement initiatives have been mixed. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Anne-Lise D. D ’Angelo, Elise H. Lawson Source Type: research

Private payer value initiatives: The Michigan Model
The recent national emphasis on improving value in healthcare delivery has placed increasing responsibility for health care value improvement on individual hospitals through financial incentives. Private Payer Initiatives are partnerships between providers and hospitals with payers that are intended to improve quality and value of health care. Blue Cross Blue Shield of Michigan has been a pioneer in the development and financial support of “The Michigan Model.” The Michigan Model is a is a longstanding multifaceted initiative that has successfully improved quality of healthcare delivery throughout the state through the...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Sarah P. Shubeck, Scott E. Regenbogen Source Type: research

The value of patient-reported outcomes in colon and rectal surgery
Quality in surgery is often assessed in terms of perioperative complications, such as surgical site infections and readmissions. Although patients are the ultimate end-users of surgical care, the impact of surgical care on aspects of health that are most important to them, such as functional status, is rarely assessed. Value is in the eye of the beholder. Patient-reported outcomes provide patients a voice in the assessment of their care quality, and brings greater accountability into the assessment of value. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: Jason B. Liu, Julia R. Berian, Larissa K. Temple Source Type: research

Public reporting of surgical outcomes
As a result of pressures from patients, payers, and providers, mechanisms that measure and publicly report surgical outcomes have emerged rapidly over the last two decades. This growing movement is the result of an increasing demand for transparency and accountability. Processes that generate these outcomes reports, however, are challenged by issues related to accuracy and bias. Furthermore, the impact of reports on behaviors within the healthcare marketplace is complicated. In order to better understand the current state and future of public reporting within the United States, a brief review of the history of this movemen...
Source: Seminars in Colon and Rectal Surgery - February 2, 2018 Category: Gastroenterology Authors: David A. Etzioni Source Type: research