Can Ipilimumab restore immune response in advanced NSCLC after progression on anti-PD-1/PD-L1 agents?

Anti-PD-1/PD-L1 agents play a crucial part in the treatment of non-small cell cancer (NSCLC) demonstrating improved overall response rate (ORR) and overall survival (OS). Recent studies evaluating combination treatment with anti-PD-1 and anti-CTLA-4 suggests improved outcome but also increased toxicity. Evidence is scarce regarding subsequent treatment with immune checkpoint inhibitors (ICPI) after progression on anti-PD-1/PD-L1. A total of 15 patients were treated with a combination of anti-PD1 agent and ipilimumab after confirmed progression of disease on anti-PD1/PDL1 alone during 2017. Clinical data were retrieved retrospectively. Disease control rate (DCR) was defined as partial response (PR) or stable disease (SD). The overall DCR was 33.3% (n = 5); two patients with PR and three patients with SD, three of whom had prior documented disease control on anti-PD1. The immune-related adverse event (irAE) rate was 40% (n = 6); two patients had grade 3 AE and one patient died of pneumonitis. While the median time to progression was two months (range 0.5-16), four of the five patients with PR/SD experienced durable benefit for 8-16 months. This small retrospective cohort of heavily pretreated unselected patients suggests ipilimumab might reboost the immune response in patients with advanced NSCLC following progression of disease on anti-PD1 therapy, while delaying exposure to the higher toxicity rates associated with upfront combination therapy. This strategy should be explored prospectively.

Attitudes Among Nurses Toward the Integration of Complementary Medicine Into Supportive Cancer Care.

PURPOSE/OBJECTIVES: To explore the attitudes of nurses treating patients with cancer regarding the use of complementary and integrative medicine (CIM) therapies to reduce symptoms and improve quality of life (QOL). 
. DESIGN: Prospective and descriptive.
 
. SETTING: 12 hospital and community care settings in Israel. 
. SAMPLE: 973 nurses working in oncology and non-oncology departments.
. METHODS: A 26-item questionnaire was administered to a convenience sample of nurses treating patients with cancer. 
. MAIN RESEARCH VARIABLES: Interest in CIM integration and training in supportive cancer care.
. FINDINGS: Of the 973 nurses who completed the questionnaire, 934 expressed interest in integrating CIM into supportive cancer care. A logistic regression model indicated that nurses with a greater interest in integration tended to be older, believed that CIM improved patients' QOL, and had no structured postgraduate oncology training. Nurses who believed CIM to be beneficial for QOL-related outcomes were more likely to express interest in related training. The goals of such training include improving QOL-related outcomes, such as anxiety, insomnia, gastrointestinal symptoms, and pain. 
. CONCLUSIONS: Most nurses working with patients with cancer are interested in the integration of CIM into supportive cancer care. 
. IMPLICATIONS FOR NURSING: Most nurses would like to undergo training in CIM to supplement conventional care. CIM-trained integrative nurses can help promote the integration of patient-centered CIM therapies in supportive cancer care settings.

Levels and predictors of knowledge and attitudes regarding pain among Israeli baccalaureate nursing students and nurses pursuing specialty certification.

This paper presents the research conducted in 2003 by the Nursing Division of the Israeli Ministry of Health regarding the level of and predictors of pain knowledge and attitudes of Israeli nursing students and certifying nurses, in the context of the Division's educational policy. Cross-sectional descriptive in design, the research included first and fourth year baccalaureate students and nurses beginning and completing certification programs (N = 1149). Knowledge and attitudes, educational level, experience and success in pain care were examined via a questionnaire based on the McCaffery and Ferrell and Riddell and Fitche tools. Student's t-test, Pearson correlations and ANOVA were used for data analysis. Educational level was the strongest predictor of knowledge and attitudes among nursing students and certifying nurses, contributing most of the 42.8% explained variance. Small significant contributions were made by other variables. This indicates that formal education is a good vehicle for enhancing knowledge and attitudes.

Do new graduates of registered nursing programs in Israel perceive themselves as technically competent?

BACKGROUND: Technical competency of graduate nurses is a much sought after commodity by nurse managers in this age of limited human nursing resources. Clinical coursework in nursing school should provide the graduate with the core skills necessary to function safely and competently in a variety of clinical sites. METHODS: The research presented in this article examines the self-reported competency of 256 recent graduates of four different types of nursing programs in Israel, with respect to 53 technical skills. Information was collected via a structured questionnaire. RESULTS: Graduates generally perceive themselves as competent, although levels of competence varied for the different skills. Type of nursing program, opportunity for skill practice in nursing school, and employment in a healthcare facility were found to be related to competency. CONCLUSIONS: Suggestions for improvement in competency levels, such as the provision of more opportunities for practice, are offered based on the specific findings of this study and in light of previous research.

State involvement in professional nursing development in Israel: promotive or restrictive.

This article describes the role of the Israeli Ministry of Health's Nursing Division in regulating the development of the nursing profession and the nursing care provided. First, factors influencing professional nursing in Israel and the development of the Ministry of Health's Nursing Division are presented. Then, examples of the Nursing Division's influence on nursing practice, the process of statutory authorization used to facilitate this influence, and future Nursing Division initiatives are discussed. The article concludes by noting that, on balance, ministerial (governmental) involvement strengthens the nursing profession and the quality of nursing care provided, yet may also restrict nurses' private concerns.

When terror is routine: how Israeli nurses cope with multi-casualty terror.

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments.