Beyond clinical trials: real-world impact of immunotherapy on NSCLC in Jordan.

Background: This study aims to evaluate real-world (rw) outcomes of immunotherapy (IO) for advanced stage NSCLC at King Hussein Cancer Center (KHCC) in Jordan. Methods: Advanced stage NSCLC patients who received IO at KHCC between 2017 and 2022 were included. The data were retrospectively collected. PFS and OS were estimated for patients with ECOG performance status (ECOG PS) 0-1. Cox regression analyzed predictors of OS in first-line (1L) IO, regardless of performance status. Results: The total number of patients included was 244. Out of those, 160 (65%), 67 (28%), and 17 (7%) patients received IO as 1L, second-line (2L), or third-line or beyond (3L or beyond), respectively. The median age for all patients was 59 years. Male were 88%, and 77% were smokers. The median follow-up time was 12.5 months. The median PFS and OS for 1L IO were 7 [95% CI 5.8 - 10.3] and 11.8 [95% CI 8.8 - 14.4], months, respectively. In the first 3 months after starting 1L IO, 34/160 (21%) patients had died. For those who survived beyond 3 months after starting 1L IO, the median PFS and OS were 11.3 [95% CI 8.3 - 16.5] and 15.4 [95% CI 13.2 - 21] months, respectively. In the Cox regression model of 1L IO patients with any performance status, ECOG PS 2 was predictive of worse OS compared to ECOG PS 0-1 (p= 0.005). Conclusion: This real-world study of advanced-stage NSCLC patients treated with immunotherapy at KHCC reveals outcomes that fall short of those anticipated from clinical trials. The inclusion of Middle Eastern patients in lung cancer trials is essential to ensure adequate representation of various ethnicities in clinical research.

Social cognitive elements of mental illness stigma among healthcare professionals currently working in general hospitals: A cross-sectional study from Jordan.

AIM: To assess the social cognitive elements of the stigma of mental illness (knowledge, attitudes and behaviours) among healthcare professionals (HCPs) in Jordan. DESIGN: A cross-sectional descriptive design. METHODS: A total of 206 HCPs were conveniently recruited from general hospitals in Jordan. The mental attitude, knowledge and intended behaviours scales were used to measure stigma elements. RESULTS: Participants reported a moderate level of knowledge, a moderate negative attitude and a moderate or not greater interest to deal with people with mental health illnesses. The bivariate correlation revealed a negative significant correlation between HCPs' knowledge and attitude, indicating that HCPs with more knowledge significantly have more positive attitude (lower average score) towards those suffering from the illness. A more significant correlation was found between HCPs' knowledge and behaviour. The HCPs who had more knowledge were holding more interest and willingness towards dealing with persons with mental illness. PATIENT OR PUBLIC CONTRIBUTION: Negative attitudes among HCPs demand awareness programmes pertaining to the stigma of mental illness to afford higher standards of practice for patients with mental problems.

Delayed Anaphylaxis to Intravenous Colistin in a Critically Ill Cancer Patient: A Case Report.

Introduction: Anaphylaxis is an acute, life-threatening, multi-system syndrome that has been reported with a wide range of medications. Though anaphylaxis usually has a rapid onset, we describe a patient who developed anaphylaxis to intravenous colistin after 28 days of daily administration. Case presentation: A 20 years-old Caucasian male patient, with a history of relapsed acute myeloid leukemia, was transferred from the medical floor to our intensive care unit with septic shock. The source of infection was presumed to be a recto-cecal abscess and arm cellulitis. Cultures were positive for extended spectrum beta-lactamase (ESBL) and carbapenem-resistant enterobacteriaceae (CRE) Escherichia coli. for which he was receiving broad spectrum antibiotics, as well as intravenous colistin, started about 4 weeks earlier. On day 2 of ICU admission, and during the administration of colistin, the patient experienced an anaphylactic reaction. He developed hypotension requiring the initiation of norepinephrine, shortness of breath, hypoxia, tachycardia, and tachypnea. The reaction was resolved after supportive therapy but it was thought to be related to septic shock and therefore the patient continued on colistin the following day. The patient tolerated colistin for the next 3 days before developing another similar, but more severe, reaction. Colistin was discontinued and the symptoms resolved following supportive therapy. Conclusion: This case highlights the importance of being aware of delayed serious reactions that may occur several weeks after initiation of drug therapy. In addition, successful re-initiation may not necessarily rule out the recurrence of such reactions and therefore close monitoring is crucial.

Compassion fatigue and substance use among nurses.

AIM: This study aimed to detect if there were differences in compassion fatigue (CF) among nurses based on substance use and demographic variables of gender, marital status, type of health institution and income. BACKGROUND: Compassion fatigue is considered an outcome of poorly handled stressful situations in which nurses may respond with self-harming behaviours like substance use. Evidence in this area is critically lacking. METHODS: This study used a descriptive design to survey differences in CF of 282 nurses. The participants completed a demographic survey and indicated whether they consume any of the following substances on a frequent basis: cigarettes, sleeping pills, power drinks, anti-depressant drugs, anti-anxiety drugs, coffee, analgesics, amphetamines and alcohol. Compassion Fatigue scores were surveyed using CF self-test 66 items developed by Stamm and Figely (Compassion satisfaction and fatigue test. http://www.isu.edu/~bhstamm/tests.htm, 1996). RESULTS: There were significant differences in CF scores in favour of nurses who used cigarettes, sleeping pills, power drinks, anti-depressants and anti-anxiety drugs. While no significant differences in CF were found between nurses who used coffee, analgesics, amphetamines and alcohol, significant differences in nurses' CF were found in relation to type of institution, gender and marital status. But nurses' income did not bring differences to CF scores. CONCLUSION: Nurses who might be lacking resilience cope negatively with CF using maladaptive negative behaviours such as substance use. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management should be aware of the substance use drive among nurses and build organizational solutions to overcome compassion fatigue and potential substance use problems.