Unmet needs in EGFR exon 20 insertion mutations in Central and Eastern Europe: reimbursement, diagnostic procedures, and treatment availability.

Lung cancer remains the leading cause of cancer-related deaths in Europe, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. NSCLC is a heterogeneous disease encompassing various oncogenic alterations. Among them, EGFR exon 20 insertion mutations, constituting 0.3-2.2% of NSCLC cases, rank as the third most common EGFR alteration after exon 19 deletions and the L858R point mutation in exon 21, also known as "typical" EGFR alterations. Recent advancements in understanding the molecular pathogenesis of NSCLC have led to significant breakthroughs in targeted therapies, revolutionizing treatment options for patients with specific genetic alterations.This article presents the outcomes of a Virtual Meeting conducted on the online platform (provided Within3©) from September 19 to October 30, 2022. The meeting focused on addressing the challenges in the diagnosis and treatment of NSCLC patients with EGFR exon 20 insertion mutations. The participants consisted of healthcare professionals from ten Central and Eastern European countries who shared their experiences and opinions on various aspects, including epidemiology, treatment options, and diagnostic approaches employed in their respective healthcare institutions. The discussions were facilitated through open-ended and multiple-choice questions.The primary objective of this article is to provide an overview of the identified challenges associated with the diagnosis and treatment of this heterogeneous disease, based on the assessments of the meeting participants. Among the major emerging challenges discussed, the reimbursement issues concerning next-generation sequencing (NGS), a recommended method in NSCLC molecular diagnosis, and the availability of approved targeted treatments to enhance patient outcomes were of paramount importance. Furthermore, fostering community awareness of lung cancer and promoting harmonized lung cancer care were identified as areas deserving greater attention. Notably, the rapidly evolving treatment landscape, particularly with NGS for NSCLC patients with genomic alterations like EGFR, ALK, RET, MET, NTRK, and ROS1, necessitates prioritizing the development of new drugs, even for the relatively smaller subgroup with exon 20 insertion mutations.

Strategies to manage cognitive dissonance when experiencing resistiveness to care in people living with dementia: A qualitative study.

AIMS: To explore the experiences of healthcare personnel when they face resistiveness to care in people living with dementia in nursing homes. DESIGN: The study has a qualitative explorative design. METHODS: Three focus group interviews were conducted in June 2019. A total of 16 nurses and other healthcare personnel employed in three different nursing homes participated. A semi-structured interview guide was used during the focus group interviews. Data were transcribed verbatim and analysed using an inductive qualitative content analysis. RESULTS: The analysis generated one overarching category-'Tension when facing resistiveness to care', which describes the discomfort healthcare personnel experienced when confronted with resistiveness to care in people with dementia-and two other categories: 'Attitude change' and 'Changing behaviour', which describes their strategies to reduce and/or manage the discomfort. Four subcategories-'Changing the mindset', Conceptual shift', Stepping back' and 'Not giving up'-described the actions taken by healthcare personnel to manage or reduce their cognitive dissonance. CONCLUSION: The strategies used to manage or reduce cognitive dissonance provide a new understanding of how healthcare personnel choose to approach resistiveness to care in people living with dementia. IMPACT: This study addresses cognitive dissonance, a discomfort experienced by healthcare personnel when facing resistiveness to care from people living with dementia. To reduce their dissonance, the participants employed several strategies, including coercive measures, when providing care. The theory of cognitive dissonance may help explain why healthcare personnel sometimes choose to employ coercive measures while providing care.

Twenty-five-year study of Nosema spp. in honey bees (Apis mellifera) in Serbia.

A total of 7386 samples of adult honey bees from different areas of Serbia (fifteen regions and 79 municipalities) were selected for light microscopy analysis for Nosema species during 1992-2017. A selection of honey bee samples from colonies positive for microsporidian spores during 2009-2011, 2015 and 2017 were then subjected to molecular diagnosis by multiplex PCR using specific primers for a region of the 16S rRNA gene of Nosema species. The prevalence of microsporidian spore-positive bee colonies ranged between 14.4% in 2013 and 65.4% in 1992. PCR results show that Nosema ceranae is not the only Nosema species to infect honey bees in Serbia. Mixed N. apis/N. ceranae infections were detected in the two honey bee samples examined by mPCR during 2017. The beekeeping management of disease prevention, such as replacement of combs and queens and hygienic handling of colonies are useful in the prevention of Nosema infection.

Epizootic features and control measures for lumpy skin disease in south-east Serbia in 2016.

Lumpy skin disease (LSD) is an infectious disease of cattle caused by virus of the Capripoxvirus genus (LSDV), family Poxviridae. Until 2015, it had not appeared in the Balkans. In June 2016, LSD spread throughout Serbia. This study analyses the first LSD occurrence, epizootic features, applied diagnostic procedures and control measures in five districts in south-east Serbia (Pcinja, Jablanica, Pirot, Toplica and Nisava). In total, there were 225 LSD outbreaks reported in Serbia, out of which 189 (84%) were located in the study area. The highest number of outbreaks was registered in Pcinja district (169), where LSD was first registered. The median distance and time between the nearest previous outbreak sites were calculated (4.32 km and 9 days). The median altitude of outbreak locations was 992 m with more than 90% above 500 m (p ≤ 0.001). The average herd morbidity rate in the study area was 13.6% and the herd mortality rate was recorded only in Pcinja (0.5%) and Jablanica (1.6%) districts. Samples taken from the cattle suspected to LSD were subjected to real time PCR analysis. Out of 233 samples tested for LSDV 132 (56.7%) were positive. The LSDV genome was identified in skin nodules (85.4%), blood (72.7%) and nasal swabs (62.5%). Phylogenetic analysis indicated that the LSDV strain circulating in Serbia fell within the cluster of field LSDV found worldwide. In response to the LSD epizootic, animal trade and movement were prohibited, complete stamping out, disinfection, disinsection and an entire bovine population vaccination using the homologous Neethling live attenuated vaccine (OBP, South Africa) were conducted. A month and a half after the completion of the vaccination campaign, the LSD epizootic was stopped, and no new cases have been reported since.