National Healthcare Quality Research Articles

Insurance and Structural Access Quality and Effects on AAA Mortality: A National Healthcare Quality and Disparities Report Analysis.

The National Health care Quality and Disparities Report (NHDQR) presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. This study aims to determine the significance of insurance quality and access to care on AAA repair outcomes. Data was obtained through the Agency for Health care Research and Quality database from 2016-2020. AAA repair mortality rates per 1000 persons, insurance quality, and structural access were compared between the 31 reportable U.S. states in which data was analyzed using linear regression models and ANOVA. Insurance quality and structural access groups were categorized as weak, average, and strong, based on NHDQR Reports measures. No association was found between access to care and AAA mortality at specific time points (2016 and 2020; P-value = .90 and .29 respectively) and when comparing states that showed improvement from 2016 to 2020 (weak categorization to strong; P value = .27). An association was found between private insurance quality and AAA repair mortality at baseline (2016; P-value = .022) and in those that showed improvement or worsening in private insurance quality over the study period (P-value = .042). Our findings suggest that there is no association between structural access quality and AAA mortality although an association exists between AAA mortality and private insurance quality.

Investigating the impact of a multicomponent positive participatory organisational intervention on burnout in New Zealand emergency department staff: a prospective, multisite, before and after, mixed methods study.

The well-being of healthcare workers (HCWs) is critical to providing excellent care. Recent evidence concerns the well-being of emergency department (ED) HCWs in New Zealand, with high levels of burnout found in a 2020 survey. This threat to providing high-quality acute care warrants improvement interventions. The causes of burnout are complex and multifactorial, the solutions are not straightforward. A prospective, multisite, before and after, mixed methods study assessing a multicomponent intervention, adaptable to local context, that targets three organisation levels (the individual, the group and the system levels) and meaningfully involves frontline HCWs may reduce HCW burnout and improve HCW well-being. Individual HCWs will choose from three individual-level psychological interventions and participate in those most appropriate for them. Local champions will decide which group-level intervention their ED will use. The system-level intervention will build capacity and capability for quality improvement (QI) with QI training and the establishment of a Quality Improvement Learning System. This system-level intervention has several important features that may ultimately empower HCWs to contribute to improving the quality of ED healthcare.We will enrol nine EDs, from which there will be at least 900 HCW participants. EDs will be enrolled in three waves from March 2023 to April 2024, with interventions taking place in each ED over 12 months.Methods of assessment will include baseline and repeat survey measures of burnout and well-being. Process evaluation at each ED will provide details of context, the intervention and the fidelity of the implementation. Ethics committee approval was provided, with locality approval at each site.Individual site feedback will be provided to each ED and executive leadership. Dissemination of findings will be through publication in peer-reviewed journals, presentation at national and international scientific meetings and through national healthcare quality bodies. Australia New Zealand Clinical Trials Registry (ACTRN12623000342617).

Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer.

Gastric cancer is one of the most common malignant tumors in the digestive system in China. Few comprehensive practice guidelines for early gastric cancer in China are currently available. Therefore, we created the Chinese national clinical practice guideline for the prevention, diagnosis, and treatment of early gastric cancer. This clinical practice guideline (CPG) was developed in accordance with the World Health Organization's recommended process and with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) in assessing evidence quality. We used the Evidence to Decision framework to formulate clinical recommendations to minimize bias and increase transparency in the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guidelines to ensure completeness and transparency of the CPG. This CPG contains 40 recommendations regarding the prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer based on available clinical studies and guidelines. We provide recommendations for the timing of Helicobacter pylori eradication, screening populations for early gastric cancer, indications for endoscopic resection and surgical gastrectomy, follow-up interval after treatment, and other recommendations. This CPG can lead to optimum care for patients and populations by providing up-to-date medical information. We intend this CPG for widespread adoption to increase the standard of prevention, screening, diagnosis, treatment, and follow-up of early gastric cancer; thereby, contributing to improving national health care and patient quality of life.

Characteristics of employment history and self-perceived barriers to healthcare access.

Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators. We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics. Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators. Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.

Clinical Performance Measures for Emergency Department Care for Adults With Intracranial Hemorrhage

Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage, emergency departments lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative. To develop the measure set, we convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure: internal quality improvement, benchmarking, or accountability, and examined data from Emergency Quality Network Stroke Initiative-participating EDs to consider the validity and feasibility of proposed measures for quality measurement and improvement applications. The initially conceived set included 14 measure concepts, of which 7 were selected for inclusion in the measure set after a review of data and further deliberation. Proposed measures include 2 for quality improvement, benchmarking, and accountability (Last 2 Recorded Systolic Blood Pressure Measurements Under 150 and Platelet Avoidance), 3 for quality improvement and benchmarking (Proportion of Patients on Oral Anticoagulants Receiving Hemostatic Medications, Median ED Length of Stay for admitted patients, and Median Length of Stay for transferred patients), and 2 for quality improvement only (Severity Assessment in the ED and Computed Tomography Angiography Performance). The proposed measure set warrants further development and validation to support broader implementation and advance national health care quality goals. Ultimately, applying these measures may help identify opportunities for improvement and focus quality improvement resources on evidence-based targets.

Implementation through translation: a qualitative case study of translation processes in the implementation of quality improvement collaboratives

BackgroundQuality improvement collaboratives (QICs) are used extensively to implement quality improvement in healthcare, and current research is demonstrating positive yet varying evidence. To interpret the effectiveness results, it is necessary to illuminate the dynamics of QIC implementation in specific contexts. Using Scandinavian institutionalist translation theory as a theoretical framework, this study aims to make two contributions. First, we provide insights into the dynamics of the translation processes inherent in QIC implementation. Second, we discuss the implications of the translation processes as experienced by participating actors.MethodsWe used empirical data from a qualitative case study investigating the implementation of QICs as an approach to quality improvement within a national Danish healthcare quality program. We included two diverse QICs to allow for exploration of the significance of organizational complexity for the translation processes. Data comprised qualitative interviews, participant observation and documentary material.ResultsTranslation was an inherent part of QIC implementation. Key actors at different organizational levels engaged in translation of their implementation roles, and the QIC content and methodology. They drew on different translation strategies and practices that mainly materialized as kinds of modification. The translations were motivated by deliberate, strategic, and pragmatic rationales, contingent on combinations of features of the actors’ organizational contexts, and the transformability and organizational complexity of the QICs. The findings point to a transformative power of translation, as different translations led to various regional and local QIC versions. Furthermore, the findings indicate that translation affects the outcomes of the implementation process and the QIC intervention. Translation may positively affect the institutionalization of the QICs and the creation of professional engagement and negatively influence the QIC effects.ConclusionThe findings extends the current research concerning the understanding of the dynamics of the translation processes embedded in the local implementation of QICs, and thus constitute a valuable contribution to a more sustainable and effective implementation of QICs in healthcare improvement. For researchers and practitioners, this highlights translation as an embedded part of the QIC implementation process, and encourages detailed attention to the implications of translation for both organizational institutionalization and realisation of the expected intervention outcomes.

Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Recipient of the 2022 National Healthcare Quality Award - Excellent Center Award Accountability in Quality Management: A Team with Innovation and Excellence of Quality Management

<p>高雄長庚紀念醫院品質管理中心以「創新品質與病人安全管理專業」運用「資訊智能資源整合」發展「卓越醫療品質特色」等成果，榮獲2022年第23屆國家醫療品質獎―卓越中心之殊榮。中心核心團隊發展專業特色如：「智能指標管理，做為高層決策之依據」、「建立病安通報系統，確保病人安全」、「研發醫病共享決策(Shared Decision Making, SDM)輔助工具，創立國際中文版翻譯」、「開發急性腎損傷(acute kidney injury, AKI)智能照護系統」、「營造優質病安文化」、「積極人才培育專業證照」等，引領全院進行跨領域專業多元合作，提供最高品質的醫療服務。榮獲「卓越中心」象徵本院為實現正向醫品病安文化價值，全方位提升醫療品質及病人安全成效之肯定，期望藉此經驗分享，引領同儕，追求更卓越的醫療品質。</p> <p> </p><p>The center of quality management, Kaohsiung Chang Gung Memorial Hospital has utilized its innovation and professionalism in quality and patient safety management to facilitate smart information and resource integration, achieving outstanding healthcare quality. In 2022, these achievements enabled the center to win the 23rd National Healthcare Quality Award in the Excellent Center category. The core management team of the center has developed the following professional features: smart index management for providing referential data to hospital executives when making decisions; establishing a patient safety report system to ensure the safety of all patients; developing the patient decision aids (PDAs) for shared decision making (SDM) and translating the international PDAs into Mandarin Chinese version; developing an acute kidney injury care system; fostering adequate patient safety culture; and promoting talent cultivation and professional certification. The center guides the entire hospital staff to participate in interdisciplinary collaboration to provide healthcare services of the highest quality. Winning the Excellent Center Award signifies approval of the efforts made by the hospital to promote positive healthcare culture and values through enhancing every aspect of healthcare quality and patient safety. By sharing its experience, the center hopes to play a leading role in the healthcare industry and help other institutions strive for excellent healthcare quality.</p> <p> </p>

Kaohsiung Municipal Siaogang Hospital, Recipient of the 2022 National Healthcare Quality Award - Distinguish Institution Award Improvement of Institutional Medical Quality and Culture

<p>小港醫院委由高雄醫學大學經營，已深耕南高雄地區24年，本院秉持「服務、品質、效率」的精神，以「全面品質管理」的概念，建構全院各科室醫療品質經營策略，積極營造院內品質改善風氣，培育單位醫品種子，建立激勵制度，鼓勵同仁的參與，並持續參加各類競賽，標竿學習他院且樹立典範。藉由實證醫學及擬真情境來輔助臨床作業，並結合創新醫療，提升醫療價值。</p> <p>醫療服務品質需要全院共同參與及推動，方能確保品質的卓越及精進，小港醫院秉持病人安全為第一及醫療品質提升為理念，深耕品質多年，努力給予民眾最優質的醫療品質及照護，盼成為最優質的「全人照護暨環境職業醫療特色醫院」。</p> <p> </p><p>Siaogang Hospital, which is under the management of Kaohsiung Medical University, has served southern Kaohsiung for 24 years. In the spirit of service, quality, and efficiency, Siaogang Hospital has established a healthcare quality management strategy based on comprehensive quality management to actively promote hospital-wide quality improvement and develop a cadre that is committed to the maintenance of healthcare quality. An incentive system has been established to encourage employee participation in competitions and in learning from other medical institutions and setting examples. Evidence-based medicine and high-fidelity simulation are introduced to support clinical operations, and these measures have also been integrated with innovative healthcare to create added value.</p> <p>The quality of healthcare services requires the joint effort of the entire hospital to improve and achieve excellence. For years, Siaogang Hospital has always strived to offer top-quality healthcare to the public in its quest to become a medical institution characterized by holistic care and environmental and occupational medicine.</p> <p> </p>

Kaohsiung Chang Gung Memorial Hospital, Recipient of the 2022 National Healthcare Quality Award - Distinguish Institution Award Pursuing Innovation and Excellence in Healthcare Quality: Emphasis on Quality Management and Error Free in Patient Safety

<p>高雄長庚紀念醫院創立於1986年，深耕南臺灣37年，從專業走向卓越，重視醫療品質；以王創辦人「要做就做最好的」為共同目標，自2003年開始參與財團法人醫院評鑑暨醫療品質策進會（以下簡稱醫策會）主辦「NHQA國家醫療品質獎」，19年期間屢獲佳績，2016年榮獲醫策會國家醫療品質獎頒發智慧醫療（Smart Hospital）全機構標章，近年連續獲得「醫品標竿獎」、「熱心分享獎」、「防疫貢獻獎」、「實證醫學類持續參與特別獎」、「主題類深耕品質獎」，更獲得3項「卓越中心」獎項，於2022年榮獲「特優機構」獎項。</p> <p>本院在院長、副院長、執行長等領導下，全員投入持續改善，整合教學、研究、辯論與知識轉譯等多元面向的發展，體現實證醫學於提升醫療品質之價值；透過高擬真情境訓練增強臨床知識、專業精神、決策能力和信心，確保病人的品質和安全；超前部署精進創新，打造屬於高雄長庚之專業品牌形象。追求品質永無止盡，需要實事求是、追根究柢，以展現卓越之價值與提供卓越的醫療服務。</p> <p> </p><p>Founded in 1986, the Kaohsiung Chang Gung Memorial Hospital has rooted its operation in Taiwan to pursue professionalism and excellence while focusing on healthcare quality over the past 37 years. The common goal set by Yung-Ching Wang, the founder of the Hospital, for all staff members is to complete every task to the best of their ability. The Hospital began participating in the National Healthcare Quality Award launched by the Joint Commission of Taiwan (JCT) in 2003 and has received multiple awards. Notably, the Hospital received the Smart Hospital Award - Whole Institution from JCT in 2016. It proceeded to win the Healthcare Benchmark Award, Experience Sharing Award, Pandemic Prevention Contribution Award, Special Award for Continual Participation in Evidencebased Medicine, and Special Theme Quality Awards consecutively in recent years, in addition to receiving three Excellent Center awards. In 2022, the Hospital won the Distinguish Institution Award. Under the leadership of the superintendent, deputy superintendent, and chief executive officer, all members of the Hospital continue to improve every aspect of its operation and ensure multifaceted development in the areas of medical education, research, debates, and knowledge translation, thereby highlighting the value of evidence-based medicine in improving healthcare quality. Hospital staff also participate in high-fidelity simulation to ensure patient care quality and safety by enhancing their clinical knowledge, professionalism, decision-making ability, and confidence. Relevant strategies have been deployed in advance to create a professional brand image for the Hospital, which continues to pursue outstanding healthcare quality, seek truth from facts, foster adequate values, and provide excellent healthcare services.</p> <p> </p>

Abstract WP49: Clinical Performance Measures For Emergency Department Care For Adults With Nontraumatic Intracranial Hemorrhage

Study Objective: Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage (ICH), Emergency Departments (EDs) lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative (E-QUAL). Methods: We convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure (internal quality improvement [QI], benchmarking, or accountability) and examined data from E-QUAL-participating EDs to consider the validity and feasibility of proposed measures. The initially conceived set included 14 measure concepts of which 7 were selected for inclusion in the measure set after review of data and further deliberation. To inform the process, we collected data from E-QUAL participating EDs. EDs used a web-based portal to submit data from chart reviews on patients with ICH during 2020-2021. Descriptive statistics characterize performance and identify variation. Results: Proposed measures include 2 for QI, benchmarking, and accountability, 3 for QI and benchmarking and 2 for QI only (Table). Of the E-QUAL participating EDs, 35 had sufficient case volume (≥25) and were included for review of preliminary performance data. Median annual ED volume was 44,000 (IQR 31,337-67,000) and 16 (48%) reported typically transferring patients with ICH. The Table includes available performance data. Conclusion: Application of these measures may identify opportunities for improvement and focus QI resources on evidence-based targets. The proposed measures warrant further development and validation to support broader implementation and advance national healthcare quality goals.

Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway.

The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.

Exploring heterogeneity in hospital length of stay post emergency abdominal surgery in Ireland: A quantile regression approach

Background Emergency Abdominal Surgery (EAS) refers to a range of complex intra-abdominal surgical procedures associated with high mortality risk and long length of hospital stay (LOS). LOS is often used as a proxy measure for hospital resource utilisation in hospital capacity management and planning. Our objective was to explore the heterogeneity in LOS among EAS patients admitted at publicly funded hospitals in Ireland. Methods We analysed national hospital inpatient data (2014 – 2022) for adults discharged following EAS. We used Quantile Regression (QR) methods to explore the heterogeneous effects along the LOS distribution between 10 th - 90 th percentiles. We compared QR with Ordinary Least Squares (OLS) estimates, and identified from which point in the LOS distribution heterogeneous effects were different from OLS estimates. Results From the National Healthcare Quality Reporting System (NHQRS) records for 15,408 EAS adult inpatient episodes were obtained for analysis. We observed significant (p < 0.001) heterogeneous effects across most quantiles of the LOS distribution. LOS was longer for patients with Charlson comorbidity indices of 4 or higher, American Society of Anaesthesiologists physical status scores of 2 and higher, admissions to critical care units, hospital readmissions within 30-days, discharges to nursing home and other hospital, and for patients treated in Model 4 hospitals. LOS was shorter for patients with a cancer diagnosis and patients who died during admission. Across these factors, statistically significant heterogeneous effects above OLS estimates were observed at the 70 th to the 90 th quantile. Conclusions The QR methods identified the presence of significant heterogeneity across the entire LOS distribution. Relative to OLS mean estimates, QR is a better method for identifying heterogeneous effects by exploring the entire LOS distribution. Our results highlight the importance of using appropriate methods for estimating skewed outcomes. This is important to provide valid and relevant empirical analysis to inform policy.

Racial differences in transfusion practices: Time to address structural racism

See article on page 1519–1526, in this issue

Reliability of data on percent consonants correct and its associated quality indicator in the Swedish cleft lip and palate registry.

Data in national health care quality registries must be valid and reliable in order to enable open comparisons of results. To assess the reliability of data on percent consonants correct (PCC) and its associated quality indicator ≥86% correct consonants in the Swedish quality registry for patients born with cleft lip and palate (CLP) registry. Six independent speech-language pathologists re-assessed the audio recordings of 96 five-year-olds with PCC data in the CLP registry. Target consonants of a single-word picture-naming test were phonetically transcribed, and PCC was calculated. The reliability of PCC data was assessed with the intraclass correlation coefficient (ICC). The reliability of the quality indicator ≥86% correct consonants was assessed with point-by-point percentage agreement and Cohen's kappa. Intra- and inter-judge agreement for PCC was excellent with ICCs above 0.9, and so was the agreement of data from the CLP registry and the six judges' re-assessments. The percentage agreement between all judges and the CLP registry for the quality indicator ≥86% correct consonants was poor (67%). However, in 88% of the cases, results from four judges and the CLP registry agreed, corresponding to good agreement. The mean of all kappa values for six judges and the CLP registry corresponded to good agreement (0.72). The results indicate the PCC data in the CLP registry and the quality indicator ≥86% correct consonants to be reliable. When differences in outcome between treatment centres are detected, the raw data collected should always be re-examined before drawing definitive conclusions.

Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)

Improving the standardized prevention rate of venous thromboembolism (VTE) is one of the national health care quality and safety improvement goals for 2022. The incidence of cancer-related VTE is significantly higher than that of non-cancer-related VTE, and there is currently a gap in domestic guidelines for perioperative VTE prevention in thoracic malignancies. China Embolism-thrombosis after Surgery of Thorax (ChEST) Study Group has taken the lead in formulating the guideline which adopts the Grading of Recommendation Assessment, Development Evaluation approach for evidence-based assessment and a content-oriented chapter structure. It is hoped by ChEST Study Group that the promulgation of this guideline will help improve the comprehensive knowledge of prevention and management of perioperative VTE in thoracic malignancies and further standardize the diagnosis and treatment of VTE among thoracic surgeons.

Trapeziectomy with or without a tendon-based adjunct: a registry-based study of 650 thumbs.

This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligament reconstruction and/or tendon interposition based on data in the Swedish national healthcare quality registry for hand surgery (HAKIR). Six-hundred and fifty thumbs were included, and 265 were assessed up to 12months after operation. There was significant and clinically relevant improvement in patient-reported measures (pain on load, pain on motion without load, pain at rest, stiffness, weakness, and ability to perform activities of daily living and the Quick Disabilities of the Arm, Shoulder and Hand score) and objective measures (strength and thumb mobility) at 3 and 12months for all procedures. The use of the abductor pollicis longus tendon had better improvement in some respects compared with the use of flexor carpi radialis or extensor carpi radialis tendons. However, overall, the use of a tendon adjuncts yielded no better outcomes than simple trapeziectomy.Level of evidence: III.

Proposal of modified textbook outcome for improving the quality of gastric cancer surgery: A single-center study.

270 Background: Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Since 2014, the national healthcare quality assessment has been implemented for gastric cancer in Korea, which has the highest incidence. The proportion of early gastric cancer through early detection is high in Korea, and gastric cancer surgery has a great influence on outcome index. The aim of this study is to find indicators that can improve Textbook outcome (TO) in patients undergoing gastric cancer surgery. Comparing with Western data, we intended to propose a modified TO (mTO). Methods: Using a prospective clinical database, we included consecutive cases of gastrectomy for primary gastric cancer between 2014 and 2016. TO was achieved when 10 original indicators proposed by the DUCA group were satisfied. We propose to adjust the index of the number of retrieved lymph nodes from 15 to 30 as the modified TO(mTO) indicator for improving the quality of gastrectomy. For comparison with Western data, we calculated TO, mTO and survival in stage I versus Stage II and III. Results: A total of 2,153 patients were included. TO was achieved in 80.1 percents by 10 original indicators. Most of the indicators showed more than 90 percents of TO satisfaction. Five-year survival was significantly different between the TO (90.0%) and non-TO (76.1%) groups ( P < 0.001). For 608 patients in stage II and III, TO was 72.9 percents, which was much higher than the Western publications. Five-year survival were 74.8 percents for the TO group and 56.8 percents for the non-TO group in stage II and III patients. We found that the number of metastatic lymph nodes increases as the stage increases and even the number of metastatic lymph nodes in stage IIIC exceeded 19. The modified textbook outcome (mTO) for stage II and III was 65.3 percents, and five–year survival was significantly different between mTO (74.0%) and mnon-TO (62.1%) groups ( P < 0.001). To prevent R1 resection and minimize the proportion of remnant total gastrectomy, we performed frozen study examinations of the proximal and distal margins as to ensure high oncological safety. Conclusions: Data from a high volume gastric cancer center showed the high textbook outcome rates. It suggests that the minimum number of lymph node retrievals should be at least 30, even in advanced gastric cancer, and routine intraoperative frozen study examination are necessary to increase R0 resection.

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Global and Russian Reproductive Care in the Context of Medical Tourism: Ethical, Social, Economic and Political Issues

Cross-border reproductive care is a complex issue of the modern world that also impacts the Russian Federation. The main reasons for engaging in cross-border reproductive care are various legal, social, cultural, economic and religious factors, as well as national healthcare quality. In many countries, reproduction involving third parties, i.e., their sperm, eggs and embryos, is prohibited by law. This is why gamete donation is one of the main causes of pursuing CBRC in a foreign country, with Russia holding leading positions in this industry. Current stage of healthcare development makes Russia a major surrogate tourism destination, due to its common European culture and improved public health standards. Besides, Russia, as a multiethnic state where all religions are represented, has the most liberal legislation concerning infertility treatment. Fertility tourists have the same rights as Russian citizens in terms of assisted reproduction procedures, including obtaining the birth certificate regardless of biological relation to the child.

Advancing racial and ethnic equity in science, medicine, and health: a call for papers

Advancing racial and ethnic equity in science, medicine, and health: a call for papers