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https://www.selleckchem.com/products/rbn-2397.html 9%-94.3%, P less then 0.05). Although well-being decreased over time (85.1%-81.5%, P = 0.01), this was seen globally with no difference between study arms [odds ratio (OR) 0.96 (0.74-1.25)]. Likewise, at the end of the study period, there was no association between flexible policy and duty-hour violations [OR 1.25 (0.95-1.61)] or satisfaction with duty hours [OR 0.80 (0.55-1.19)] compared to standard policy. Residents in flexible duty-hour programs reported significantly fewer lapses in continuity than standard policy residents, until all programs transitioned to flexibility by 2018. CONCLUSION Cumulative time under flexible duty-hour policies had no detrimental effects on duty-hour violations or resident well-being. After multiple years of flexibility, residents continue to report a high rate of satisfaction and positive effects on continuity of care.OBJECTIVE To examine the association between Textbook Outcome (TO)-a new composite quality measurement-and long-term survival in gastric cancer surgery. BACKGROUND Single-quality indicators do not sufficiently reflect the complex and multifaceted nature of perioperative care in patients with gastric adenocarcinoma. METHODS All patients undergoing gastrectomy for nonmetastatic gastric adenocarcinoma registered in the Population Registry of Esophageal and Stomach Tumours of Ontario (PRESTO) between 2004 and 2015 were included. TO was defined according to negative margins; >15 lymph nodes sampled; no severe complications; no re-interventions; no unplanned ICU admission; length of stay ≤21 days; no 30-day readmission; and no 30-day mortality. Three-year survival was estimated using the Kaplan-Meier method. A marginal multivariable Cox proportional-hazards model was used to estimate the association between achieving TO metrics and long-term survival. E-value methodology was used to assess for risk of residual confounding. RESULTS Of the 1836 patients included in this study,

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