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Evidence of the impact of public reporting of health care performance on quality improvement is not yet sufficient for definitive conclusions to be drawn, despite the important policy implications. This study explored the association of public reporting of performance indicators of long-term care facilities in Canada with performance trends. We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, whereas the other 8 are not publicly reported, between the fiscal years 2011–2012 and 2018–2019. Data from 1,087 long-term care facilities were included. Improving trends were observed among publicly reported indicators more often than among indicators that were not publicly reported. Our analysis also suggests that the association between publication of data and improvement is stronger among indicators for which there was no improvement prior to publication and among the worst performing facilities.

Mental health conditions are common among medical students. While stigma contributes to low rates of help-seeking, little programming exists to address stigma.In 2015, the authors developed a mental health initiative (MHI) to combat stigma at the Pritzker School of Medicine featuring 3 elements: (1) Mental Health Panel, an annual first-year event where faculty/peers share mental health stories; (2) Pritzker, I Screwed Up, an annual all-school event where faculty/peers share experiences with failure; and (3) Humans of Pritzker, a social media initiative featuring students' mental health posts. Postevent surveys and the 2021-2022 MHI survey assessed student satisfaction and impact on stigma and help-seeking behaviors. Student Counseling Services utilization rates for medical and nonmedical students were compared for academic years 2014-2015 vs 2018-2019 and 2020-2021 to account for the pandemic's impact on mental health care utilization.The MHI survey response rate was 61% (261/430). Respondents were distributed across class-years. Most were female (57%, 150/261). The majority agreed they could speak about mental health without judgment from peers (78%, 203/259) and faculty (57%, 149/260). Most (62%, 161/260) utilized mental health services during medical school. Of these, 41% (66/161) agreed that MHI programming contributed to their decision to seek care. On the 2021-2022 Mental Health Panel and Pritzker, I Screwed Up evaluations, almost all agreed that faculty/peers sharing experiences destigmatized mental illness (99%, 78/79) and making mistakes (96%, 152/159). Student Counseling Services utilization increased from 8% (32/389) for 2014-2015 to 19% (75/394) for 2018-2019 and 33% (136/406) for 2020-2021 for medical students, compared with 19% (2,248/12,138) to 21% (3,024/14,293) and 22% (3,285/15,004) for nonmedical students.Faculty and peers sharing mental health stories may help reduce stigma and increase help-seeking in medical students. Future work should explore the longitudinal impact of programming and disseminating similar initiatives at other institutions.

End-stage kidney disease (ESKD) is a global burden that reflects each country's unique condition. We used the National Health Insurance Research Database (NHIRD) of Taiwan to decipher changes in the mortality and international survival rates and to determine the effectiveness of the pre-end-stage renal disease care program (pre-ESRD care program) to guide future health policies for ESKD.We conducted a retrospective cohort analysis of the NHIRD data along with records from the catastrophic illness certificate program of ESKD patients from 2010 to 2018.From 2010 to 2018, the annual dialysis-related mortality rate in Taiwan increased from 10.6 to 11.8 deaths per hundred patient-years. The mortality rate for patients below 40 years appears to be decreasing, reflecting the improved quality of care for ESKD patients. Patients above 75 years showed increasing mortality, indicating the prolonged survival and aging of the ESKD population. Patients undergoing dialysis who participated in the pre-ESRD care program had a higher post-dialysis initiation life expectancy than those who did not participate. Among the program enrollees, the post-dialysis initiation life expectancy was higher in patients who had participated for more than one year. Taiwan has one of the highest ESKD patient survival rates globally.From 2010 to 2018, the reduced mortality in young patients and aging of the ESKD population might indicate that the quality of care in Taiwan for ESKD has improved. Furthermore, a better survival rate after dialysis initiation was observed in the pre-ESRD care program participants.

Aims Examine relationships between the systemic exposure of acalabrutinib, a highly selective, next-generation Bruton tyrosine kinase inhibitor, and its active metabolite (ACP-5862) vs. efficacy and safety responses in patients with B-cell malignancies who received acalabrutinib as monotherapy or in combination with obinutuzumab. Methods For exposure-efficacy analyses, patients with untreated chronic lymphocytic leukaemia were assessed for best overall response, progression-free survival and tumour regression. For exposure-safety analyses, incidences of grade ≥2 adverse events (AEs), grade ≥3 AEs and grade ≥2 events of clinical interest were assessed in patients with B-cell malignancies. Acalabrutinib and ACP-5862 pharmacokinetic (PK) parameter estimates were obtained from population PK modelling. Exposure calculations were based on study dosing regimens. Total active moieties were calculated to account for contributions of ACP-5862 to overall efficacy/safety. Results A total of 573 patients were included (exposure-efficacy analyses, n = 274; exposure-safety analyses, n = 573). Most patients (93%) received acalabrutinib 100 mg twice daily. Median total active area under the concentration-time curve (AUC24h,ss ) and total active maximal concentration at steady-state (Cmax,ss ) were similar for patients who received acalabrutinib as monotherapy or in combination with obinutuzumab, and for responders and nonresponders. No relationship was observed between AUC24h,ss /Cmax,ss and progression-free survival or tumour regression. Acalabrutinib AUC24h,ss and Cmax,ss were generally comparable across groups regardless of AE incidence. Conclusion No clinically meaningful correlations between acalabrutinib PK exposure and efficacy and safety outcomes were observed. These data support the fixed acalabrutinib dose of 100 mg twice daily in the treatment of patients with B-cell malignancies.