Response to: anastomotic leaks after colon cancer resections: does the individual surgeon matter?

: Legitimate nutrition assumes a significant role in preventing diseases and, in this way, nutritional interventions establish vital strategies in the area of public health. Nutrigenomics centres on the different genes and diet in an individual and how an individual’s genes influence the reaction to bioactive foodstuff. It targets considering the genetic and epigenetic interactions with nutrients to lead to a phenotypic alteration and consequently to metabolism, differentiation, or even apoptosis. Nutrigenomics and lifestyle factors play a vital role in health management and represent an exceptional prospect for the improvement of personalized diets to the individual at risk of developing diseases like cancer. Concerning cancer as a multifactorial genetic ailment, several aspects need to be investigated and analysed. Various perspectives should be researched and examined regarding the development and prognosis of breast and colon cancer. Malignant growth occurrence is anticipated to upsurge in the impending days, and an effective anticipatory strategy is required. The effect of dietary components, basically studied by nutrigenomics, looks at gene expression and molecular mechanisms. It also interrelates bioactive compounds and nutrients because of different 'omics' innovations. Several preclinical investigations demonstrate the pertinent role of nutrigenomics in breast and colon cancer, and change of dietary propensities is conceivably a successful methodology for reducing cancer risk. The connection between the genomic profile of patients with breast or colon cancer and their supplement intake, it is conceivable to imagine an idea of personalized medicine, including nutrition and medicinal services.

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Shared care in surgery: Practical considerations for surgical leaders

Healthcare Management Forum ◽

10.1177/0840470420952485 ◽

2020 ◽

pp. 084047042095248

Author(s):

Morgann Reid ◽

Alex Lee ◽

David R. Urbach ◽

Craig Kuziemsky ◽

Morad Hameed ◽

...

Keyword(s):

Clinical Care ◽

Surgical Care ◽

Shared Care ◽

Clinical Integration ◽

Integration Model ◽

Surgical Access ◽

Disease Site ◽

Individual Surgeon ◽

Professional Isolation ◽

The Individual

The recent COVID-19 pandemic has highlighted limitations in current healthcare systems and needed strategies to increase surgical access. This article presents a team-based integration model that embraces intra-disciplinary collaboration in shared clinical care, professional development, and administrative processes to address this surge in demand for surgical care. Implementing this model will require communicating the rationale for and benefits of shared care, while shifting patient trust to a team of providers. For the individual surgeon, advantages of clinical integration through shared care include decreased burnout and professional isolation, and more efficient transitions into and out of practice. Advantages to the system include greater surgeon availability, streamlined disease site wait lists, and promotion of system efficiency through a centralized distribution of clinical resources. We present a framework to stimulate national dialogue around shared care that will ultimately help overcome system bottlenecks for surgical patients and provide support for health professionals.

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Up Close and Personal: A Statewide Collaborative's Effort to Get Individual Surgeon Quality Improvement Data to the Practitioner

The American Surgeon ◽

10.1177/000313481608200310 ◽

2016 ◽

Vol 82 (3) ◽

pp. 192-198

Author(s):

Brian J. Daley ◽

William Cecil ◽

Joseph B. Cofer ◽

P. Chris Clarke ◽

Oscar Guillamondegui ◽

...

Keyword(s):

Quality Improvement ◽

Best Practice ◽

Quality Improvement Program ◽

Surgical Morbidity ◽

Improvement Program ◽

Surgical Quality ◽

Prolonged Intubation ◽

Personal A ◽

Individual Surgeon ◽

The Individual

Ranking of surgeons and hospitals focuses on procedure volume and hospitality. The National Surgical Quality Improvement Program provides vetted outcomes of surgical quality and therefore can direct improvement. Our statewide collaborative's analysis creates personalized surgeon data to drive quality improvement. Statewide National Surgical Quality Improvement Program data generated specific measures from 103,656 general/vascular cases and identified individual surgeon's outcome of occurrences and length of procedure. We assumed a normal distribution and called the top 2.5 per cent as exemplars and the bottom 2.5 per cent as outliers. For length of operation, a standard duration was calculated, and identified outliers as longer than the 95th percentile of the upper confidence interval/procedure. Since 2009, sharing best practice reduced statewide mortality rate by 31.5 per cent and postoperative morbidity by 33.3 per cent. For length of surgery, long outliers have more complications (urinary tract infection, organ space/surgical site infection, sepsis, septic shock, prolonged intubation, pneumonia, deep venous thrombosis, deep incisional infection, and wound disruption). No significant trends in surgeon performance were seen over 24 months. A statewide collaborative has resulted in substantial risk-adjusted reductions in surgical morbidity and mortality. These results of the individual surgeon demonstrate best practices are shared, a proven tool for improvement in our collaborative.

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Intravesical Tension-Free Vaginal Tape Removal: Is There a Single Solution?

ISRN Urology ◽

10.5402/2011/343850 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Rhana H. Zakri ◽

Amit K. Patel ◽

Babbin S. John ◽

Nitin C. Shrotri

Keyword(s):

Urinary Incontinence ◽

Full Range ◽

Common Interest ◽

Optimal Management ◽

Number Of Patients ◽

Single Solution ◽

Individual Surgeon ◽

History Of ◽

The Individual ◽

The Ideal

Stress urinary incontinence (SUI) affects 10–20% of women in the general population. Surgery for stress incontinence has been performed on women for over a century, but with the advent of new urogynaecological sling procedures for its management, urological surgeons are having to deal with an increasing number of patients presenting with associated complications. With no clarity on the full range of possible complications or certain consensus on their optimal management, the ideal treatment remains a decision for the individual surgeon. In view of this, we felt it of common interest to review the literature for the history of sling procedures, present commonly arising complications, and seek to answer the question in the title.

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The influence of the individual surgeon and of the type of vagotomy upon the insulin test after vagotomy

Gut ◽

10.1136/gut.12.12.963 ◽

1971 ◽

Vol 12 (12) ◽

pp. 963-967 ◽

Cited By ~ 36

Author(s):

D. Johnston ◽

J. C. Goligher

Keyword(s):

Individual Surgeon ◽

Insulin Test ◽

The Individual

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Knockdown by MSH2 and EPCAM siRNA suppress Wnt/β-Catenin Pathway in HCT116 Cell Line

10.21203/rs.3.rs-274862/v1 ◽

2021 ◽

Author(s):

Wan Khairunnisa Wan Juhari ◽

Khairul Bariah Ahmad Amin Noordin ◽

Wan Faiziah Wan Abdul Rahman ◽

Andee Dzulkarnaen Zakaria ◽

Wan Muhammad Mokhzani Wan Muhammad Mokhter ◽

...

Keyword(s):

Colon Cancer ◽

Protein Expression ◽

Cancer Cells ◽

Cell Line ◽

Tumour Progression ◽

Quantitative Polymerase Chain Reaction ◽

Hct116 Cell ◽

Cell Group ◽

Mrna And Protein Expression ◽

The Individual

Abstract Purpose: Small interfering RNA (siRNA) has the potential as a therapeutic approach against selective pathways in colorectal cancer. EPCAM, a transmembrane glycoprotein mediating cell adhesion, was known to be involved in suppressing Wnt/β-catenin pathway, an important pathway for tumour progression in colon cancer cells. EPCAM deletions caused a transcriptional read-through that may silence its neighbouring gene, MSH2. This study aimed to investigate the effect of co-siRNA targeted genes, MSH2 and EPCAM, in colon cancer cell line, HCT116, and their effect in regulating the Wnt/β-catenin pathway. Methods: Pre-designed siRNA of MSH2 and EPCAM were transfected into HCT116 cells. The cells were divided into six group of treatments: untreated cell group, cells treated with negative control siRNA, MSH2-siRNA treated cells, EPCAM-siRNA treated cells, cells treated with both EPCAM and MSH2-siRNA, and cells treated with transfection reagent (mock control). The mRNA and protein expression following the individual and combined siRNA treatments were assessed by quantitative polymerase chain reaction and Western blot. Results: The mRNA and protein expression levels of MSH2, EPCAM and β-catenin were reduced in the individual MSH2 and EPCAM-siRNA treated samples as compared to the untreated sample. Further reduction of mRNA and protein expressions for MSH2, EPCAM and β-catenin were identified in combined siRNA treatments. Conclusion: Reduction of β-catenin expression by simultaneous silencing of MSH2 and EPCAM suggested that these genes may play a role in supressing the Wnt/β-catenin pathway in cancer cells.

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The Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to Undescended Testes and Hypospadias

PEDIATRICS ◽

10.1542/peds.56.3.479 ◽

1975 ◽

Vol 56 (3) ◽

pp. 479-483

Author(s):

Panayotis Kelalis ◽

Raymond Bunge ◽

Martin Barkin ◽

Alan D. Perlmutter ◽

David B. Friedman ◽

...

Keyword(s):

Elective Surgery ◽

Optimal Time ◽

First Year ◽

Timing Of Operation ◽

Undescended Testes ◽

The Third ◽

Individual Surgeon ◽

The Subject ◽

The Individual ◽

First Year Of Life

Psychologic considerations suggest that the optimal time for elective surgery on the genitalia is either the first 6 months of life or sometime during the fourth year. In the child with cryptorchidism, physiologic considerations are of paramount importance and the timing of treatment should be based on these considerations. Despite the conflicting views on the subject, there is suggestive evidence that early orchiopexy—during the first year of life or soon afterwards—may be the most optimal time for orchiopexy, but further investigation would be necessary to confirm this. Currently, timing of operation is based more on psychologic rather than physiologic factors (although both are taken into account), and should remain unchanged until further evidence accumulates. The Committee feels that the later the orchiopexy after age 6, the more likely germinal epithelial failure will occur. However, it should be pointed out that 5 or 6 has not proven to represent optimal age in respect to germinal function but only the latest recommended age for orchiopexy. In patients with hypospadias, technical considerations have the greatest bearing on timing, but, depending on the individual surgeon, the precise timing varies. The period after the third birthday is preferred by the majority; this certainly is consistent with psychologic considerations unless the correction of chordee justifies a separate cedure, which then should be corrected by age 2.

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Variation between hospitals in outcomes following cardiac surgery in the UK

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0029 ◽

2019 ◽

Vol 101 (5) ◽

pp. 333-341 ◽

Cited By ~ 1

Author(s):

G Soppa ◽

P Theodoropoulos ◽

R Bilkhu ◽

DA Harrison ◽

R Alam ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Complications ◽

Patient Outcomes ◽

Demographic Data ◽

Cardiothoracic Surgery ◽

Hospital Level ◽

Negative Finding ◽

Individual Surgeon ◽

The Individual ◽

The Uk

Introduction We examine the influence of variations in provision of cardiac surgery in the UK at hospital level on patient outcomes and also to assess whether there is an inequality of access and delivery of healthcare. Cardiothoracic surgery has pioneered the reporting of surgeon-specific outcomes, which other specialties have followed. We set out to identify factors other than the individual surgeon, which can affect outcomes and enable other surgical specialties to adopt a similar model. Materials and methods A retrospective analysis of prospectively collected data of patient and hospital level factors between 2013 and 2016 from 16 cardiac surgical units in the UK were analysed through the Society for Cardiothoracic Surgery of Great Britain and Ireland and the Royal College of Surgeons Research Collaborative. Patient demographic data, risks factors, postoperative complications and in-hospital mortality, as well as hospital-level factors such as number of beds and operating theatres, were collected. Correlation between outcome measures was assessed using Pearson’s correlation coefficient. Associations between hospital-level factors and outcomes were assessed using univariable and multivariable regression models. Results Of 50,871 patients (60.5% of UK caseload), 25% were older than 75 years and 29% were female. There was considerable variation between units in patient comorbidities, bed distribution and staffing. All hospitals had dedicated cardiothoracic intensive care beds and consultants. Median survival was 97.9% (range 96.3–98.6%). Postoperative complications included re-sternotomy for bleeding (median 4.8%; range 3.5–6.9%) and mediastinitis (0.4%; 0.1–1.0%), transient ischaemic attack/cerebrovascular accident (1.7%; range 0.3–3.0%), haemofiltration (3.7%; range 0.8–6.8%), intra-aortic balloon pump use (3.3%; range 0.4–7.4%), tracheostomy (1.6%; range 1.3–2.6%) and laparotomy (0.3%; range 0.2–0.6%). There was variation in outcomes between hospitals. Univariable analysis showed a small number of positive associations between hospital-level factors and outcomes but none remained significant in multivariable models. Conclusions Variations among hospital level factors exists in both delivery of, and outcomes, following cardiac surgery in the UK. However, there was no clear association between these factors and patient outcomes. This negative finding could be explained by differences in outcome definition, differences in risk factors between centres that are not captured by standard risk stratification scores or individual surgeon/team performance.

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Article Commentary: Retained Intra-abdominal Surgical Instruments: Time to Use Nascent Technology?

The American Surgeon ◽

10.1177/000313480707301101 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1083-1085 ◽

Cited By ~ 5

Author(s):

Seth Berkowitz ◽

Harry Marshall ◽

Anthony Charles

Keyword(s):

Healthcare System ◽

Foreign Bodies ◽

Surgical Care ◽

Surgical Instruments ◽

Individual Surgeon ◽

The Individual ◽

Complication Of Surgery

Retention of surgical instruments is a possible complication of surgery; moreover, its occurrence has typically been used to denote poor surgical care on the part of the individual surgeon and the healthcare system. In the literature, it is not surprising that instances of retained foreign bodies are underreported to minimize exposure to possible litigation.

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