Background: A Community of Practice (CoP) is a professional learning and development approach that facilitates knowledge sharing, skill enhancement, and collaboration among individuals within the same profession. It is typically structured around regular meetings focused on achieving a shared professional goal. Objective: This action research project aimed to develop and evaluate a virtual CoP based on Lave and Wenger’s situated learning theory. The initiative focused on enhancing research knowledge and skills among nurses working across various healthcare facilities in the United Arab Emirates (UAE). Methods: The project followed the four stages of action research: planning, implementation, observation, and reflection. A framework was designed and applied to guide the structure and activities of the virtual research CoP. Data collection took place between January 2023 and February 2024. Results: The findings demonstrated that participation in the CoP positively impacted members’ research knowledge, skills, and practice. The virtual CoP framework is recommended for use by nurses, other healthcare professionals, and practitioners in diverse fields requiring complex knowledge and skills. Key success factors include strong leadership, engaged participants, and effective use of video conferencing technology. Conclusion: The proposed CoP framework has proven to be beneficial and adaptable. It offers a practical model for ongoing professional learning and knowledge development, particularly in domains that demand complex competencies. Healthcare organizations, including those operating across multiple locations, can implement this model to support collaborative learning, knowledge creation, and the application of best practices across various communities and specialties.

Introduction: Nurses, a vast portion of the healthcare workforce, have made a low contribution to achieving healthcare organizational visions and strategies in producing research. The study aimed to identify the facilitators and barriers to research production among members of a community of practice (CoP). Method: This study utilized a descriptive qualitative research design, conducting a focus group discussion. Those members were provided with education, mentorship, and support over 12 months from January 2023 to January 2024. h a convenience sample of 21 members from the targeted CoP. Results: The online CoP provided members with several opportunities to compensate for any deficit in the existing individual, social, and organizational support system. However, the study highlighted several barriers to research among the community members, including individual factors, i.e., time limitations and lack of member’s knowledge and expertise, social factors, i.e., lack of collaboration among colleagues, and organizational factors, i.e., lack of organization and unit support, resources, and workload. Conclusion: The study revealed satisfactory progress in the members' research projects and recommended extending their learning and training period. The study suggests extending the members' education and training period, including psychological preparation, and providing them with additional skills such as persuasion, negotiation, and interpersonal skills to overcome existing research barriers. Moreover, further studies are required to assess the long-term impact, for example, after one or two years of the online CoP on members' research productivity. Further research to explore the facilitators and barriers of research production among CoP members in various contexts.

INTRODUCTION:Trastuzumab deruxtecan (T-DXd) is a HER2-directed antibody-drug conjugate indicated for the treatment of unresectable or metastatic HER2-positive breast cancer in patients who have received a prior anti-HER2-based regimen. T-DXd is also indicated for unresectable or metastatic HER2-low breast cancer, following prior chemotherapy in the metastatic setting or recurrent disease within six months of adjuvant chemotherapy. This study aims to evaluate the efficacy and safety of T-DXd in treating HER2-positive and HER2-low metastatic breast cancer (MBC) patients in a real-world clinical setting. In the T-DXd pivotal research, imaging assessments were conducted every six weeks with CT or MRI, but outside of a clinical trial setting, this frequent imaging is practically challenging due to resources and difficulty in reimbursing. In addition to clinical outcome assessments, we sought to review the incidence of pneumonitis in a real-world setting and to assess if the three-monthly response assessment scans would be sufficient to rule out asymptomatic pneumonitis. METHODS:A retrospective analysis was conducted on 100 patients diagnosed with HER2-positive (immunohistochemistry (IHC) 3+ or in situ hybridization (ISH) positive) or HER2-low (IHC 1+ or IHC 2+ and ISH negative) MBC treated with T-DXd at 5.4 mg/kg every 21 days, with standardized dose adjustments as required. Treatment was continued until disease progression or unacceptable toxicity. The median follow-up duration was 15 months. Responses were assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria, and toxicity was determined using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Data analysis was performed using SPSS IBM software version 26 (IBM Corp., Armonk, New York, NY, US). RESULTS:The median age of the patients was 47 years, ranging from 29 to 86 years, with the majority being younger than 65 and predominantly women. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 at baseline. Most patients were HER2-positive, while a smaller proportion were classified as HER2-low. A significant number of patients presented with visceral disease, while a smaller subset had brain metastases at the time of baseline evaluation. Nearly half of the patients were hormone receptor-positive (HR+), and more than half had a high Ki-67 index of over 20%. The majority of patients received T-DXd as a second- or third-line treatment. Clinical responses included partial response, complete response, and stable disease. Survival outcomes showed high overall survival rates at 12 and 24 months, with a median progression-free survival (PFS) of 24 months. Only one patient experienced grade 3 pneumonitis, suggesting that 12-weekly imaging assessments may be adequate for monitoring most patients. CONCLUSIONS:Our real-world experience confirms that the efficacy of T-DXd in UAE is consistent with published data from published phase 3 clinical trials. The incidence of clinical pulmonary toxicity is much lower than anticipated, and until further data is available, it may be reasonable to continue using the 12-weekly assessment scans to monitor patients for interstitial lung disease (ILD). Further studies are needed to determine the optimal imaging frequency for monitoring ILD.

Background: Journal clubs (JCs) are widely used to enhance nurses’ knowledge, promote evidence-based practice, and support professional development. However, in many clinical settings, JCs lack structured implementation and rigorous evaluation, especially in large, dispersed healthcare systems. Objective: To implement a structured journal club framework among nurses in a major healthcare organization and evaluate its effectiveness in improving knowledge, research engagement, and professional satisfaction. Methods: An action research design was conducted from September 2023 to June 2024 within Abu Dhabi Health Service Company (SEHA), the largest healthcare provider in the UAE. Eight JC meetings were held virtually. Attendance records showed that 551 nurses participated at least once, with a total attendance frequency of 827. For evaluation, 55 nurses who attended at least three meetings were invited to complete a mixed-methods survey, of whom 34 responded (62% response rate). Quantitative data were analyzed for reliability, validity, and correlation using Cronbach’s alpha, the Shapiro-Wilk test, and Kendall’s tau. Qualitative responses (n = 31) were thematically analyzed. Results: High internal reliability was demonstrated across all evaluation scales (Cronbach’s α = 0.96–0.98). Strong positive correlations were found between JC implementation, perceived benefits, and satisfaction (τ = 0.778–0.894, p<0.001). Participants reported high agreement with statements reflecting the success of the JC framework, its usefulness, and overall satisfaction (mean > 4.0 out of 5). Thematic analysis revealed three main themes: perceived benefits (e.g., improved article appraisal skills, knowledge updates, and research engagement), perceived limitations (e.g., virtual format and low discussion participation), and suggested improvements (e.g., unit-based and face-to-face sessions). Conclusion: The structured JC framework was positively received and perceived as beneficial by engaged participants. While limited by sample size and context, the study indicates potential value in continuing and expanding the initiative, particularly through unit-based adaptations and enhanced participation strategies.

Introduction: DLBCL is an aggressive B cell lymphoma. Despite increased understanding of the biology of the disease the treatment paradigm for front line therapy has not changed over the past twenty years (RCHOP or its variations) until recent approval of Polatuzumab vedotin-piiq for international prognostic Index (IPI) 2 or greater. Despite having been identified as one of the most common non-Hodgkin's lymphomas in the UAE, Data from the middle east countries regarding disease pattern, treatment paradigms and clinical outcome is lacking. This retrospective study aimed to analyze and generate data from a single institution public referral hospital from UAE. Methods: After approval from the Institutional review board (IRB), Patients aged 18 and older with DLBCL were included in this retrospective analysis from January 2022 till June 2024. Data was abstracted from the Electronic medical records (EMR) with regards to patient demographics, disease (biology, stage), treatment and outcomes. Results: We identified 41 patients during the study period who were seen with diagnosis of DLBCL. Median Age of patients at presentation was 48 years. Most of the patients were male (66%) with a Male to Female ratio of 1.93:1. Molecular subtype (Hans Algorithm) distinguished 8 patients (20%) with ABC type DLBCL, and 16 patients (39%) with GCB type DLBCL. Two patients had High grade B cell lymphoma Double/Triple Hit. Molecular subtype of 15 patients (36%) were not identified. Staging showed early stage (1-2) N= 9 (22%) while advanced stage disease was seen in 31 patients (78%). Data was not available for one patient. Risk Stratification with Revised International prognostic Index (R-IPI) showed Poor Risk group (IPI 3-5) 20, Good Risk 14, Very Good Risk 4. Score could not be calculated due to lack of data in 3 patients. Majority of the patients were treated with RCHOP n= 22 while others were treated with Pola RCHOP n=13. A cohort of the patient received other regimens (CHOP, CHOEP, DA REPOCH, R CODOX M/IVAC). Etoposide containing regimens were used in patients who had Hemophagocytic lymphohistocytic (HLH) presentation alongside the underlying DLBCL while patients with double hit Lymphoma's were treated with DA REPOCH of R CODOX M/R IVAC. 6 patients died of treatment or disease related complications before the end of induction therapy. With a median follow-up of 310 days (range 41-624 days), the Over all Response Rate (ORR) was 81% with Complete Remission (CR) 75% (N=25) while two patients had Partial Response (PR). Six patients failed induction therapy including the two patients with DH/TH Lymphoma. The remaining 8 patients were of those who expired or left prematurely against medical advice, so there is no recorded response to treatment. Conclusions The median age is approximately two decades younger than western literature. There were almost twice as many males than female patients, which is akin to the SEER results of rate of incidence per 100,000 in 2012-2016 of Non-Hodgkin's Lymphomas. Majority of the patients presented with advanced stage (78%), poor risk IPI disease (50%). Complete Remission (CR rate) of 75% is comparable to international published data. Disease free remission cannot be estimated due to short follow-up. Treatment options for DLBL DH/TH remains poor and novel therapeutic paradigm is needed.

The study aimed to investigate the effects of crises, specifically the COVID-19 pandemic, on customer satisfaction mediated by the offered marketing mix (7Ps) of the healthcare facilities of the United Arab Emirates. The study aimed to evaluate the effect of crises, specifically the COVID-19 pandemic, on the satisfaction of healthcare customers mediated by the marketing mix. Therefore, the authors adopted a cross-sectional, quantitative design to survey a sample of 146 healthcare customers and analysed data using smart PLS-SEM 3. The study identified one significant pathway, including the effect of the internal organisational factors through marketing mix on customer satisfaction. Therefore, the study confirmed the mediation role of the marketing mix and suggested modifying the marketing mix as a key strategy during crises.

Background/Aims The quality of nurses' work is integral to the success of healthcare systems. Job satisfaction and work engagement contribute to nurses' ability to be efficient and effective. The nature of their work means that nurses are likely to experience psychological distress, which might affect their job satisfaction and work engagement. This study aimed to examine the relationship between psychological distress experienced by nurses at work, job satisfaction and work engagement in the United Arab Emirates. Methods An online, cross-sectional, descriptive, correlational study was conducted from August–December 2022. Work engagement was assessed using the Utrecht Work Engagement Scale, while stress, anxiety and depression were measured using the Depression Anxiety and Stress Scales. Data analysis involved descriptive statistics, independent t-tests, one-way analysis of variance, Pearson correlation, Cronbach's alpha and multiple regression analysis, all performed using IBM SPSS version 27. Results The study recruited a total of 316 nurses. The mean job satisfaction score was 15.17±2.89 (moderately satisfied) and the mean work engagement score was 4.67±1.03 (highly engaged). A significant positive correlation was found between job satisfaction and work engagement. Prevalence rates for stress, anxiety, depression and insomnia were 11%, 35.5%, 31.6% and 49.4% respectively. Both job satisfaction and work engagement were negatively correlated with stress, anxiety, depression and insomnia. The regression model explained 57.2% of job satisfaction variance and 54.0% of work engagement variance. Conclusions This study highlights the importance of job satisfaction and work engagement in reducing psychological distress among nurses. Further interventions to enhance these factors may improve mental health outcomes in this population.

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.

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.

Background: The Phosphatidylinositol-4,5-bisphosphonate 3-kinase catalytic subunit alpha (PIK3CA) gene is mutated in about 30-40% of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2−) breast cancer (BC) patients. For HR+/HER2- advanced breast cancer patients with disease progression following endocrine-based therapy, the NCCN guideline recommends testing for PIK3CA mutations with tumour or liquid biopsy to identify suitable patients for targeted therapy with alpelisib, an oral α-specific PI3K inhibitor in combination with fulvestrant. The primary objective of this study was to evaluate the proportion and distribution of PIK3CA mutational landscape of HR+ve BC patients at the largest cancer centre in the United Arab Emirates (UAE). Material and methods: Retrospective review of consecutive HR+ve BC patients at Tawam Hospital for whom PIK3CA testing was requested. DNA was extracted from the samples and a targeted resequencing assay was used for mutation detection in exons 7, 9 and 20 of the PIK3CA gene. Sequencing was carried out using the Next Generation Sequencing platform Ion GeneStudio S5 Prime System with a detection limit of 2-5% of the mutant allelic content. Results: 124 patients with HR+ve BC were enrolled in the present study. The pathology samples were considered unsuitable/unsatisfactory in 18 cases. The median age was 51.5 years (range 31-90). All patients were female, 54% were post-menopausal and 49% presented with de-novo metastatic disease. Of the 106 eligible patients, PIK3CA mutations were detected in 33 (31%) patients, the most common being H1047R (45%) and E545K (30%) mutations in exons 20 and 9, respectively. Other less common mutations included C420R mutations (6%) in exon 7, E542 (6%) in exon 9 and H1047Y (3%) in exon 20. 9% of patients had more than one hotspot mutations, primarily in exons 9 and 20. Of the 12 HER2 +ve patients tested, 3 had PIK3CA mutations, most commonly the H1047R mutation in exon 20. Conclusion: The prevalence of PIK3CA mutations and the presence of most common hotspot mutations in exons 20 and 9 was consistent with prior published studies. The clinical relevance of PIK3CA mutations in HER2 +ve BC patients needs further assessment. Citation Format: Fathi Azribi, Mohammad Hourani, Sulaman Magdub, Aydah Alawadhi, Ali Yousif, Emad Dawoud, Khaled Al Qawasmeh, Mouza Al Ameri, Diaeddine Trad, Nouri Bennini, Mohamed Ahmed, Jawaher Ansari. PIK3CA mutation prevalence in hormone receptor positive breast cancer patients in United Arab Emirates [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-04.

ObjectiveThis 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. MethodsWe 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. ResultsOur 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. ConclusionOur 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.

Abstract 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.

Hypomethylating agent (HMA) and venetoclaxR as salvage therapy for Acute Myeloid Leukemia (AML) failing intensive induction therapy. A single center experience from United Arab Emirates. Introduction: Patients with AML who are younger and fit for therapy are treated with intensive chemotherapy. Complete remissions (CRs) range from 40-80% (Kantarjian, Blood vol. 116,22 (2010): 4422-9). Non-CR patients can be treated with salvage therapy as a bridge to Allogeneic hematopoietic cell transplant (AlloHCT). Salvage regimens have included high dose cytarabine based therapies (FLAG, MEC, HAM) which can be more toxic limiting the use of AlloHCT. Lower intensity and more targeted therapy could decrease toxicity with improved responses. We describe our experience with a low intensity regimen as salvage treatment after failure of intensive induction therapy and bridge to AlloHCT. Methods: This is a retrospective analysis of AML patients treated at Tawam Hospital, UAE from 01/2019 to 06/2022. Patient data was collected from the medical records including: demographics, hemogram at presentation, bone marrow biopsies, karyotyping, treatment and response. Results: Eighty patients were diagnosed with AML during this period. The median age was 45 years (range 16-95 years). Fifty-seven patients received therapy while twenty-three patients refused or were not eligible due to comorbidities and / or performance status. Intensive chemotherapy (infusional cytarabine and idarubicin 7+3 or FLAG) was used for thirty-three patients. The median age was 35 years (range 16 - 63 years). Cytogenetics (Metaphase Karyotyping and FISH): normal, n=7; good risk n=6 (inv 16 or t (8;21), growth failure n=5, poor risk n=10 (Complex = 3, Del 7 = 3, 11q abnormalities = 3, trans 6;9 =1) other n=5. Molecular testing for NPMI, FLT3, IDH1 and IDH2 was not available. Three patients died during induction and are excluded from analysis. Fifteen patients attained CR after 1 cycle of induction (50%). Twelve patients not in CR received outpatient, low intensity salvage therapy with HMA (5 azacitidine 75 mg/m2 daily x 7 days subcutaneously with Venetoclax 100 mg orally daily x 21 days along with antimicrobial prophylaxis with azoles in 28 days cycles). Bone marrow was repeated after the second cycle. The median number of cycles is 3 (range 1-9). Eight (67 %) achieved CR1. There were no treatment related deaths. This is comparable to our report of FLAG salvage therapy (Hassan IB. Int J Hematol. 2018 Oct;108(4):390-401). Four of the eight patients who achieved remission went for AlloHCT while one is awaiting AlloHCT. One patient is unable to go for HCT and is in remission after 9 cycles of therapy. Two patients after achieving CR relapsed and died of disease progression. With a median follow up of 123 days (range 33 -1107 days) five patients are alive and in remission, one has been lost to follow-up while the other six have died from progressive disease and complications. Conclusion. Low Intensity therapy with HMA and Venetoclax is a reasonable and effective alternative to intensive chemotherapy as first line salvage with minimal morbidity and zero treatment related mortality. Treatment was well tolerated and no patients required hospitalization for complications. This regimen is easily administered as an outpatient, serving as a bridge to AlloHCT

e23528 Background: Phyllodes tumors (PT) are rare fibroepithelial neoplasm that start in the connective tissue of the breast. PTs are classified by their histologic features into benign, borderline, and malignant. Malignant PTs account for about 1 in 4 PTs and are most likely to come back after treatment and metastasize. This study was conducted to investigate the incidence, clinical presentation, pathological characteristics, treatment and outcome of malignant PTs in the Abu Dhabi Health Services Company (SEHA) institutions in the United Arab Emirates. This will provide a better insight on factors that influences outcome in these patients. Methods: We retrospectively analyzed data of malignant PT treated at Tawam Hospital, Sheikh Khalifa Medical City and Sheikh Shakbout Medical City between 2000 and 2020. Information was obtained from the SEHA Cancer Registry and analyzed using excel software. Results: A total of 36 patients with malignant PT were identified. All were females. The median age at diagnosis was 38 (17-60). Median BMI at diagnosis was 27 (21-47). Out of the 36 patients, 3 were diagnosed during pregnancy, 16 (44%) had a history of fibroadenoma and 8 had a family history of first degree relative with breast cancer. Initial symptom at presentation was breast mass in 30 patients and fungating breast mass in 6 patients. Out of the 26 patients, 4 (11%) had tumor < 5 cm, 10 (28%) had tumor ≥5 cm and < 10 cm, 22 (61%) had tumor ≥10 cm, 2 patients had heterogenous tumor with component of invasive ductal carcinoma, no patient had metastatic ipsilateral axillary adenopathy at diagnosis and 5 (14%) presented with de-novo metastatic disease (4 in the lung and 1 in the contralateral breast as the first metastatic site). Of the 31 patients with non-metastatic disease at presentation, 17 underwent mastectomy, 14 underwent lumpectomy, 14 had axillary lymph node dissection, 8 had no axillary surgery, 9 had sentinel lymph node biopsy, 16 had adjuvant radiation therapy and 2 had adjuvant chemotherapy. Of the 31 patients, 13 patients developed locoregional recurrence of which 9 had positive margin on initial surgery and 4 had negative closet margin of ≤1 cm, 7 patients developed metastatic disease of which lung and/or the chest are the main sites. Of the total population to date, 7 patients passed away from the disease. Conclusions: Malignant PT patients are a unique population with limited characterization to date. Our study demonstrates the clinical and pathological characteristics and the treatment pattern of these patients. Further analysis is underway to assess risks associated with surgical and survival outcome of this disease.

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.

Research is a systematic approach to answering evolving inquiries and creating new knowledge critical for organizational development, competitiveness, and innovation. This study aimed to identify the determinants that affect employee individual research productivity. And to create a reliable and valid measurement tool to assist organizations in identifying employees who are ready to produce research. The authors conducted a comprehensive literature review about the topic, illustrated the relationship between the relevant variables in a model, and tested the tool quantitatively on a sample of 161 nurses at a tertiary hospital in the UAE. The analysis revealed that integration of self-efficacy and self-determination plays a critical role in individual research productivity in non-academic organizations. The study also came up with a reliable and valid tool.

Abstract Introduction: AML is a heterogenous group of hematological neoplasms with morphological, cytogenetic and molecular abnormalities resulting in maturation arrest of myeloid cell lines. This translates into clinical symptoms and signs resulting from neutropenia, anemia and thrombocytopenia. Although the knowledge of the underlying biology and molecular abnormalities has evolved tremendously, this has not been accompanied as quickly by translational changes in the early management of AML patients. The intensive induction therapy (combination of anthracycline and cytarabine) for young patients with good performance status has remained static since the first description in 1973 (Yates et al, Cancer Chemother Rep. 1973; 57(4):485-8). Older adults and patients with comorbidities had inferior treatment choices limited to hypomethylating (HMA) agents. The activity of Venetoclax R (Ven) with either HMA or Low dose Cytarabine (LDAC) has improved the outcome of patients who are not candidates for intensive induction therapy. In this report we describe our experience with HMA alone or the combination of HMA and Ven in patients not fit for intensive induction therapy in a real-world setting. Method: We conducted a retrospective chart review of AML patients diagnosed between January 2020 and July 2021. Data collected included patient demographics, karyotype, treatment and response to treatment. Older adults were defined as patients greater than 60 years of age. Patients with comorbidities (renal failure, active cardiac, pulmonary and hepatic disease) active opportunistic infections and poor performance status (ECOG >2) were also deemed not suitable for intensive induction therapy. Results: Alternative induction was given with HMA (5 Azacitidine) alone or in combination with Ven. HMA dose (75mg/m 2 was calculated over a period of 7 days and given during workdays of the week. Ven was given 100 mg (with CYP3A4 inhibitor) - 400 mg per day for 21 days. Patients were evaluated for treatment response after 2 - 4 cycles. Between January 2019 and June 2021, 66 patients were diagnosed with AML. The median age was 45 years (range 16-95years). Older adults (>60 years of age) have increased from < 10 % to 28 % (n=19) in the current cohort (Alam A et al Blood 2014; 124 (21). Treatment was as follows: Intensive induction n= 29, alternative induction n=19 and no therapy n=18 (refused treatment, age and poor performance status). The median age of patients given alternative induction was 55 years (range 26-80 years). Karyotype analysis showed good risk n=3, intermediate risk n= 9 poor risk n=3, metaphase failure n=4. Alternative induction reasons included age (n=9), co-morbidities (n=10) (Obesity, respiratory failure, cardiomyopathy, pulmonary embolism, renal failure, acute hepatitis, active infection (mucormycosis) and 2ndry AML). The response to HMA and Ven consisted of CR 60 % (9/15) with 4 patients ineligible for evaluation (2 early death (day + 3 and day + 8), the other 2 < 28 days post induction). The progression free survival is 149 days (range 41-517 days). 3 patients have relapsed after achieving complete remission. The median overall survival (OS) for the cohort is 120 days (range 3 to 517 days) while the median OS for non-responders is 103 days (range 3 to 375 days). Conclusion: The combination of HMA and Ven is an effective treatment modality in newly diagnosed patients with AML who are not eligible for intensive induction. The response to treatment has improved from < 10 % (HMA alone) to 60 % with HMA + Ven in an older cohort or those with comorbidities. The treatment is given in outpatient setting with increased patient satisfaction and minimal toxicities. However, this is complicated by increasing issues with access due to insurance coverage and co pay for Ven. Standardization of HMA and Ven with or without CYP3A4 inhibitors may improve the CR rates. Consolidation strategies in younger patients (especially good risk disease) who are other wise ineligible for intensive induction may improve progression free survival. Disclosures McCarthy: Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Juno: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees; Magenta Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bluebird: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Organizational psychology applies psychological theories to improve the physical and mental well-being of employees, increase productivity, and improve competitiveness. Accordingly, the authors adopted the interactional and transactional theories of stress to study the effect of the hospital accreditation stressors on the well-being status among nurses mediated by their coping mechanisms. Also, the study will evaluate the moderating effect of supervisory support on this relationship. To achieve these goals, the authors used a cross-sectional, causal, and quantitative methodology with a convenience sample of 416 nurses from several public hospitals from the emirate of Abu Dhabi. The study revealed an insignificant direct effect for accreditation stressors on the well-being status of the nurses. These effects were significant when mediated by the nurse's coping mechanisms. Furthermore, the study revealed insignificant moderation effects for supervisory support on the nurse's coping mechanisms. The outcome of this study could help supervisors and interested researchers fill the gaps related to accreditation stress.

Thalassemia is a group of complex haemoglobin disorders common in the Mediterranean countries, the Middle East and South East Asia 1 . Thalassemia is common in the United Arab Emirates (UAE) affecting indigenous population and the expatriates. The exact prevalence of thalassemia is not known. The management of thalassemia has improved significantly due to improvement in transfusion support and the management it9s complications. This has led to the improvement of the overall survival and most patients reaching their adulthood 2 . Despite this some die at young age mainly due to poor access to health care 2 , proper management and lack of compliance to chelation therapy which leads to the development of otherwise preventable complications 2 . Blood transfusion is the corner stone of the management of patient with thalassemia major and intermediate 3 . Blood transfusion improves the anemia and its symptoms but also suppress the resultant ineffective erythropoiesis. This is usually started once the patient has signs and symptoms of anemia and unable to compensate for the low haemoglobin 3 . The aim of blood transfusion is to maintain good quality of life and to prevent the skeletal abnormalities 2 . Although blood transfusion is essential in the management of patients with thalassemia, it will ultimately lead to iron overload. In addition there is excess of gastrointestinal iron absorption in these patients, secondary to the ineffective erythropoiesis 4 . To reduce the iron absorption the target is to maintain the pre-transfusion hemoglobin level between 9 and 10 g/dl. Iron overload is major cause of mortality and morbidity in patient9s thalassemia major and intermedia 5 . In this retrospective analysis we reviewed the ferritin levels over 1 year in 25 patients with thalassemia major or intermedia attending the adult hematology department at Tawam hospital The patients received regular blood transfusion once every three weeks. Of the 25 patients 16 were males and 9 were females. The age range was 15 years to 47 years. Nineteen patients had their chelation therapy changed during the year from Exjade (Deferasirox tablets for oral suspension) to Jadenu (Deferasirox tablets) which improved our patient9s compliance. The remaining 6 patients continued on Exjade. In addition to this 17 patients received additional Desferral infusion in connection with their blood transfusion. None of the patient was on subcutaneous desferral infusion. During our observation two patients were lost to follow up and one patient died. The medium ferritin level for our evaluable patients was at start of the review 2488 mcg/l, with a range between 609 mcg/l to 5147 mcg/l. The medium ferritin level at the end was 1691 mcg/l with a range between 470 mcg/l to 3731 mcg/l. Figure 1 one shows the ferritin value a start and end of the review for each patient. Our patients with the highest ferritin levels are despite repeated counselling not compliant with their medications. Despite significant improvement in the management of thalassemia patients, iron overload remain a challenge. The main problems to achieving full control over the iron overload are lack of compliance. Hopefully the newest oral formulation will increase the compliance and at least we have seen a decrease in the ferritin levels over the last year in most patients. References. 1 De Dreuzy E, Bhukhai K, Leboulch P, Payen E Current and future alternative therapies for Beta Thalassemia major. Biomedical Journal 39, 124-38 2 Modell, B., Khan, M., and Darlison, M. Survival in beta thalassaemia major in the UK: Data from the UK Thalassaemia Register. Lancet 355 [2000]: 2051-2052. 3 Rebulla P, Modell B. Transfusion requirements and effects in patients with thalassaemia major. Cooleycare Programme. Lancet 1991;337:277-80 4 Gardenghi S, Marongiu MF, Ramos P, et al. - Ineffective erythropoiesis in beta- thalassemia is characterized by increased iron absorption mediated by down- regulation of hepcidin and up-regulation of ferroportin. Blood 2007; 109:5027-35 5 Porter, J.B., and Davis, B.A. Monitoring chelation therapy to achieve optimal outcome in the treatment of thalassaemia. Best Practice u0026 Research: Clinical Haematology 15 [2002]: 329-368 6 Ayidinok Y, Kattamis A, Cappellini MD, et al. Deferasirox- Deferoxamine combination therapy reduces cardiac iron with rapid liver iron removal after 24 months in patients with severe transfusional iron overload (abstract). Haematologica 2014;99:229. Disclosures No relevant conflicts of interest to declare.