The immediate and short-term impact of COVID 19 infections on nurses in a UAE hospital.

BACKGROUND/AIMS: Nurses were on the front line against the COVID 19 pandemic, fighting to save human lives. Many nurses sacrificed their well-being and social life to win the battle. In consequence, many nurses have been infected with the virus around the Globe. This study aims to determine the immediate and short-term physical, psychological, and social impact of COVID 19 infection on nurses and midwives retrospectively. On the other hand, it aims to find the effect of COVID 19 stigma on the self-esteem of the infected nurses. METHODS: To achieve this goal, the authors used an exploratory, mixed-method design with a sample of nurses and midwives working in a tertiary hospital in UAE who has been infected with the COVID 19 virus and recovered. The authors have used the qualitative results to explain and interpret the findings of the quantitative findings. The data were collected through distributing the quantitative survey to participants and then it was followed by conducting semi-structured interviews. RESULTS: The careful exploration of the experiences of nurses infected with the COVID 19 virus suggested a simple model that manages the patients in hospitals and at homes, including improving self-efficacy and patient coping, providing the basic nursing skills to patients and families, providing continuous psychological support, and providing high standards of health care. CONCLUSION: The new suggested model will maintain a positive status of wellbeing amongst infected patients during the infection time and in 3-6 months after the infection.

Comparison of perceptions of unmet supportive care needs between cancer patients and their oncologists.

PURPOSE: The prevalence of cancer in the Middle East is increasing and predicted to nearly double by 2030. In the United Arab Emirates (UAE), cancer ranks as the third leading cause of death. Yet, there are limited data describing the needs of cancer patients in the region. The purpose of this study is to compare cancer patients' reports of unmet supportive care needs with the perceptions of their oncologists. METHODS: A cross-sectional survey of cancer patients and their oncologists, using an Arabic translation of the short form of the Supportive Care Needs Survey (SCNS-SF34), was conducted at a major oncology center in the UAE between December 2014 and March 2017. Descriptive statistics and McNemar test were calculated to determine differences in unmet need responses between oncologists and patients. RESULTS: Nine physicians (100%) and 210 of 268 (78.3%) patients completed the questionnaire. Oncologists accurately assessed the level of unmet physical needs of their patients, but significantly underestimated unmet psychological supportive care needs of the patients. Male patients expressed significantly lower (p < 0.05) physical and psychological unmet needs, compared to female patients. CONCLUSION: Our findings reveal a general concordance between physician and patient perspectives of unmet supportive care needs. This is reassuring as physician perceptions impact the care patients receive. We present multifaceted supportive care strategies for oncology patients in the region.

Breaking New Ground in Palliative Care: Examining the Impact of Al Ain - Palliative Care Outreach Program on Patients With Advanced Cancer in the United Arab Emirates.

Introduction This study aimed to evaluate the effectiveness of the Palliative Outreach Program in improving the quality of palliative care for patients with advanced cancer in a Tertiary Hospital in the Al Ain region of the United Arab Emirates (UAE). Methods & Material One hundred patients who met the inclusion criteria were included in the study and administered the patient version of the Consumer Quality (CQ) Index Palliative Care Instrument to assess their perception of the quality of care they received. The demographics, diagnosis, and questionnaire responses were analyzed to determine the effectiveness of the Palliative Outreach Program. Results A total of one hundred patients met the criteria for the study. Most patients were above 50, female, female, Non-Emiratis, and had high school certificates. The top three cancer diagnoses were breast (22%), lung (15%), and head & neck (13%). The patients reported high levels of support from their caregivers regarding physical, psychological, and spiritual well-being, as well as information and expertise. The mean scores for most variables were favorable, except for information (mean = 2.9540, SD= 0.25082) and general appreciation (mean = 6.7150, sd = 0.82344). Overall, the patients rated the care they received positively, with high mean scores for physical/psychological well-being (mean = 3.4950, SD = 0.28668), autonomy (mean = 3.7667, SD= 0.28623), privacy (mean = 3.6490, SD = 0.23159), and spiritual well-being (mean =3.7500, SD = 0.54356). The patients would recommend their caregivers to others in similar situations. Discussion The findings demonstrate that the Palliative Outreach Program effectively improves the quality of palliative care for patients with advanced cancer in the UAE. The CQ Index Palliative Care Instrument proved a novel method for assessing palliative care quality from patients' perspectives. However, there is room for improvement in providing more favorable information and general appreciation outcomes. Caregivers should focus on all areas to enhance their physical/psychological well-being, autonomy, privacy, spiritual well-being, expertise, and general appreciation of their patients. Conclusion In conclusion, the Palliative Outreach Program is an effective intervention to improve the quality of palliative care for patients with advanced cancer in the UAE. The patients reported high levels of support from their caregivers in all aspects of care, except for information and general appreciation. These findings provide valuable insights into the effectiveness of palliative care interventions and highlight the need for continued efforts to improve the quality of care for patients with advanced cancer.

Integrating Artificial Intelligence Into Radiation Oncology: Can Humans Spot AI?

Introduction Artificial intelligence (AI) is transforming healthcare, particularly in radiation oncology. AI-based contouring tools like Limbus are designed to delineate Organs at Risk (OAR) and Target Volumes quickly. This study evaluates the accuracy and efficiency of AI contouring compared to human radiation oncologists and the ability of professionals to differentiate between AI-generated and human-generated contours. Methods At a recent AI conference in Abu Dhabi, a blind comparative analysis was performed to assess AI's performance in radiation oncology. Participants included four human radiation oncologists and the Limbus® AI software. They contoured specific regions from CT scans of a breast cancer patient. The audience, consisting of healthcare professionals and AI experts, was challenged to identify the AI-generated contours. The exercise was repeated twice to observe any learning effects. Time taken for contouring and audience identification accuracy were recorded. Results Initially, only 28% of the audience correctly identified the AI contours, which slightly increased to 31% in the second attempt. This indicated a difficulty in distinguishing between AI and human expertise. The AI completed contouring in up to 60 seconds, significantly faster than the human average of 8 minutes. Discussion The results indicate that AI can perform radiation contouring comparably to human oncologists but much faster. The challenge faced by professionals in identifying AI versus human contours highlights AI's advanced capabilities in medical tasks. Conclusion AI shows promise in enhancing radiation oncology workflow by reducing contouring time without quality compromise. Further research is needed to confirm AI contouring's clinical efficacy and its integration into routine practice.

Understanding the Radiation Dose Variability in Nasopharyngeal Cancer: An Organs-at-Risk Approach.

Objective This study aims to thoroughly assess the radiation dose distribution to critical organs in patients with nasopharyngeal carcinoma, focusing on the correlation between the radiation dosages for the various organs at risk (OARs) in nasopharyngeal cancer patients. Methods We meticulously analysed a dataset comprising 38 nasopharyngeal carcinoma patients, focusing on radiation dosages measured in Gray (Gy) and volumetric data in cubic centimetres (cc) of critical organs, including the lens, brainstem, spinal cord, optic nerve, optic chiasm, and cochlea. A detailed exploratory data analysis approach encompassed univariate, bivariate, and multivariate techniques. Results Our analysis revealed several key findings. The mean and median values across various dose measurements were closely aligned, indicating symmetrical distributions with minimal skewness. The histograms further corroborated this, showing evenly distributed dose values across different anatomical regions. The correlation matrix highlighted varying degrees of interrelationships between the doses, with some showing strong correlations while others exhibited minimal or no correlation. The 3D scatter plot provided a view of the multi-dimensional dose relationships, with a specific focus on the spinal cord, lens, and brainstem doses. The bivariate scatter plots revealed symmetrical distributions between the right and left lens doses and more complex relationships involving the brainstem and spinal cord, illustrating the intricacies of dose distribution in radiation therapy. Conclusion Our findings reveal distinct radiation exposure patterns to OARs of nasopharyngeal carcinoma. This research emphasises the need for tailored radiation therapy planning to achieve optimal clinical outcomes while safeguarding vital organs.

High incidence of microsatellite instability and loss of heterozygosity in three loci in breast cancer patients receiving chemotherapy: a prospective study.

BACKGROUND: The aim of the study was to evaluate potential chemotherapy-induced microsatellite instability, loss of heterozygosity, loss of expression in mismatch repair proteins and associations with clinical findings in breast cancer patients, especially resistance to chemotherapy and/or development of other tumors in the four years following chemotherapy treatment. METHODS: A comprehensive study of chemotherapy-related effects with a follow-up period of 48 months post treatment was conducted. A total of 369 peripheral blood samples were collected from 123 de novo breast cancer patients. Microsatellite instability and loss of heterozygosity in five commonly used marker loci (including Tp53-Alu of the tumor suppressor gene TP53) were analyzed in blood samples. Sampling was conducted on three occasions; 4-5 weeks prior to the first chemotherapy session (pre-treatment), to serve as a baseline, followed by two consecutive draws at 12 weeks intervals from the first collection. Mismatch repair protein expression was evaluated in cancer tissues using immunohistochemistry for three mismatch-repair related proteins. RESULTS: A total of 70.7% of the patients showed microsatellite instability for at least one locus, including 18.6% marked as high-positive and 52.1% as low-positive; 35.8% showed loss of heterozygosity in addition to microsatellite instability, while 29.3% exhibited microsatellite stability. The following incidence rates for microsatellite instability and loss of heterozygosity were detected: 39.1% positive for Tp53-Alu, 31.1% for locus Mfd41, and 25.3% for locus Mfd28. A higher occurrence of loss of heterozygosity was noted with alleles 399 and 404 of Tp53-Alu. The mismatch repair protein expression analysis showed that the chemotherapy caused a loss of 29.3% in hMLH1 expression, and 18.7% and 25.2% loss in hMSH2 and P53 expression, respectively. A strong correlation between low or deficient hMSH2 protein expression and occurrence of mismatch repair/loss of heterozygosity events in Mfd41, Tp53-Alu, and Mfd28 was evident. A significant association between mismatch repair/loss of heterozygosity and incidence of secondary tumors was also established. CONCLUSION: Our results suggest that microsatellite instability, loss of heterozygosity, and deficiency in mismatch repair may serve as early prognostic factors for potential chemotherapy-related side effects in breast cancer patients.

Rare case of chemotherapy-refractory metastatic vaginal squamous cell carcinoma with complete response to concurrent pembrolizumab and radiotherapy- case report and literature review.

Primary vaginal cancer is a rare malignancy with a lack of international guidelines and supporting clinical trial evidence to guide decision making. Historical results have shown poor outcomes with chemotherapy for stage IVB vaginal squamous cell carcinoma (SCC). The evolving role of checkpoint inhibitors in rare gynaecological cancers prompted us to investigate the role of pembrolizumab in this setting. The efficacy of pembrolizumab in vaginal SCC has never been investigated in any clinical trial. There is established data to support the use of concurrent chemoradiotherapy in gynaecological cancers, however, the data for concurrent use of immunotherapy and radiotherapy is still lacking but is the subject of several clinical trials. We herein present the first reported case of chemotherapy refractory vaginal SCC with complete response to pembrolizumab and concurrent pelvic radiotherapy. We also present wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as a rare but new immune related adverse event.

Supportive care needs of multicultural patients with cancer in the United Arab Emirates.

Despite the high prevalence of cancer in the Middle East, there is limited published data reporting the needs of cancer patients in this region of the world. The purpose of this study is to assess the unmet supportive care needs of oncology patients in the United Arab Emirates (UAE). From December 2014 to December 2016, a cross-sectional survey of cancer patients was conducted at a large tertiary care hospital and an oncology referral centre in the UAE, using a validated Arabic translation of the supportive care needs survey--short form (SCNS-SF34-A), assessing cancer-specific perceived needs across five domains: psychological, health system information, patient care and support, physical and daily living and sexuality. Chi-square test and Pearson's correlation coefficient were used to assess the association between variables. Participant responses were tabulated as mean ± standard error of the mean (SEM). The response rate was 78% (210/268). Five of the 10 items from the psychological domain constituted the 10 most prevalent unmet moderate or high needs, followed by physical and daily living needs (3.04 ± 0.029, p < 0.001), health system information (3.03 ± 0.02, p < 0.001), patient care and support (2.95 ± 0.24, p < 0.001), with low sexuality needs (1.79 ± 0.08, p < 0.001). Women had significantly higher psychological unmet needs. Cultural differences were noted only in the health system information domain. Improvements in mental health services, development of multidisciplinary cancer care teams, introduction of cancer support groups and fully engaging women in all treatment decisions are feasible and easy to implement interventions that can significantly improve the care and wellbeing of oncology patients in the UAE.

Impact of Oncotype†DX testing on adjuvant treatment decisions in patients with early breast cancer: a single-center study in the United Arab Emirates.

AIM: To evaluate the distribution of the Oncotype DX Recurrence Score (a validated prognostic/predictive tool in early-stage estrogen-receptor positive [ER+] breast cancer) and its impact on adjuvant treatment decisions in the United Arab Emirates. METHODS: A retrospective analysis of a single-center cohort. RESULTS: The analysis included 47 node-negative ER+ breast cancer patients with low-to-intermediate risk according to the St. Gallen criteria. The mean (SD) Recurrence Score result was 17.7 (8.0); 25 (53.2%), 19 (40.4%) and 3 (6.4%) patients had low, intermediate and high Recurrence Score results, respectively. Recurrence Score risk categories were concordant with risk groups according to the St. Gallen criteria in 23 patients (48.9%). Before testing, 24 patients (51.1%) were recommended endocrine therapy alone and 23 patients (48.9%) were recommended chemoendocrine therapy. After testing, 13 patients (27.7%; 95% confidence interval 16.3-42.4%) had a treatment change (from pretesting recommendation to posttesting actual treatment), and chemotherapy use decreased overall (from 48.9 to 25.5%; P = 0.0023, McNemar's test), and particularly in the low Recurrence Score category (from 56.0 to 8.0%; P = 0.0005, McNemar's test). After testing, the proportions of patients with chemoendocrine therapy recommendations differed significantly across the Recurrence Score categories (8.0, 36.8 and 100% in the low, intermediate and high Recurrence Score categories, respectively; P = 0.0012, Fisher's exact test). With an average follow-up of 31.2 months (range: 17-51), no locoregional/systemic relapses were observed. CONCLUSION: This first decision impact study in a Middle Eastern country showed the significant effect of Oncotype DX testing on clinical practice, further demonstrating the consistent impact of such testing worldwide.