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Cancer Cell Mar 2024Atezolizumab (anti-PD-L1), combined with carboplatin and etoposide (CE), is now a standard of care for extensive-stage small-cell lung cancer (ES-SCLC). A clearer...
Atezolizumab (anti-PD-L1), combined with carboplatin and etoposide (CE), is now a standard of care for extensive-stage small-cell lung cancer (ES-SCLC). A clearer understanding of therapeutically relevant SCLC subsets could identify rational combination strategies and improve outcomes. We conduct transcriptomic analyses and non-negative matrix factorization on 271 pre-treatment patient tumor samples from IMpower133 and identify four subsets with general concordance to previously reported SCLC subtypes (SCLC-A, -N, -P, and -I). Deeper investigation into the immune heterogeneity uncovers two subsets with differing neuroendocrine (NE) versus non-neuroendocrine (non-NE) phenotypes, demonstrating immune cell infiltration hallmarks. The NE tumors with low tumor-associated macrophage (TAM) but high T-effector signals demonstrate longer overall survival with PD-L1 blockade and CE versus CE alone than non-NE tumors with high TAM and high T-effector signal. Our study offers a clinically relevant approach to discriminate SCLC patients likely benefitting most from immunotherapies and highlights the complex mechanisms underlying immunotherapy responses.
Topics: Humans; Lung Neoplasms; Immune Checkpoint Inhibitors; Small Cell Lung Carcinoma; Carboplatin; Etoposide; Immunotherapy
PubMed: 38366589
DOI: 10.1016/j.ccell.2024.01.010 -
Blood Cancer Discovery Nov 2023In the past year, three new bispecific antibodies have received accelerated FDA approval for the treatment of relapsed/refractory multiple myeloma. In this article, we... (Review)
Review
In the past year, three new bispecific antibodies have received accelerated FDA approval for the treatment of relapsed/refractory multiple myeloma. In this article, we review the available data for these three agents, teclistamab, elranatamab, and talquetamab, and discuss practical considerations for their use in clinical settings while the medical community awaits randomized phase III clinical trial datasets comparing them to standard-of-care regimens.
Topics: Humans; Multiple Myeloma; Antibodies, Bispecific; Embarrassment; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37824758
DOI: 10.1158/2643-3230.BCD-23-0176 -
Psychodynamic Psychiatry Dec 2023The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective...
The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.
Topics: Humans; Suicide; Shame; Guilt; Emotions; Grief
PubMed: 38047673
DOI: 10.1521/pdps.2023.51.4.381 -
Nederlands Tijdschrift Voor Geneeskunde Jun 2024Eating disorders, such as anorexia, bulimia and binge eating disorder, are a common mental health problem, but are even so easily missed in the medical field. Patients... (Review)
Review
Eating disorders, such as anorexia, bulimia and binge eating disorder, are a common mental health problem, but are even so easily missed in the medical field. Patients experience a lot of shame to come up with their eating problem. Doctors tend to forget asking for eating pattern and purging when a patient has a normal weight or is obese. A third of the obese population experience binges. A relatively new diagnose is ARFID (avoidant restrictive food intake disorder). Patients are not scared to gain weight, but have nutritional deficits because of not being able to eat, forgetting to eat or eating only a couple of products. Motivating patients to seek treatment is challenging. Understanding their struggles, knowing the complications and what to examine is important. The article gives an overview how to diagnose and examine eating disorders and when and where to refer to.
Topics: Humans; Feeding and Eating Disorders; Obesity
PubMed: 38864170
DOI: No ID Found -
Nursing Philosophy : An International... Jul 2024Communication is an integral part of nursing practice-with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through...
Communication is an integral part of nursing practice-with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the 'other', language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing silence to speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly.
Topics: Humans; Communication
PubMed: 38739851
DOI: 10.1111/nup.12481 -
Clinical Ethics Jun 2024This paper is particularly concerned with shame, sometimes considered the 'master emotion', and its possible role in affecting the consent process, specifically where...
This paper is particularly concerned with shame, sometimes considered the 'master emotion', and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity.
PubMed: 38778880
DOI: 10.1177/14777509231218203 -
JAMA Dec 2023
Topics: Emotions; Grief; Guilt; Shame
PubMed: 37948060
DOI: 10.1001/jama.2023.23193