CheckMate 141: 1‐Year Update and Subgroup Analysis of Nivolumab as First‐Line Therapy in Patients with Recurrent/Metastatic Head and Neck Cancer

Nivolumab significantly improved overall survival (OS) vs investigator's choice (IC) of chemotherapy at the primary analysis of randomized, open‐label, phase 3 CheckMate 141 in patients with recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN). Here, we report that OS benefit with nivolumab was maintained at a minimum follow‐up of 11.4 months. Further, OS benefit with nivolumab vs IC was also noted among patients who received first‐line treatment for R/M SCCHN after progressing on platinum therapy for locally advanced disease in the adjuvant or primary (i.e., with radiation) setting.     

Developing evidence‐based practice champions in the Maldives

Evidence‐based practice (EBP) is an approach that has gained recognition for facilitating the transfer of evidence into clinical practice. EBP champions is a strategy that can be adopted to encourage the uptake of EBP. This paper describes an action research project that was undertaken in Maldives. EBP champion model has been introduced in the Maldives early 2012 and aims to produce clinical leaders from variety of backgrounds who could implement EBP. This paper provides an extended discussion of the process that was undertaken to prepare EBP champions and their roles in implementing EBP.     

Case review: ED management of hypothermia in an elderly woman

This case study outlines the management of a profoundly hypothermic elderly patient. Tympanic temperature on arrival was 27.1 °C, and was accompanied by an altered state of consciousness. The circumstances surrounding this patient's presentation to the Emergency Department and subsequent clinical management are presented. The significance of hypothermia, secondary to a severe and overwhelming sepsis is examined including, pathophysiology changes that occur and invasive/non-invasive rewarming methods to correct hypothermia.     

Is there still a role for neoadjuvant chemotherapy in head and neck cancer?

After approximately 20 years of conflicting results from chemotherapy in randomized trials in advanced head and neck cancer, three meta-analyses reviewed its use. All three concluded that chemotherapy was associated with a statistically significant advantage in survival, but that this was low (4% absolute benefit at 2 and 5 years). The improvement in survival was mainly based on the more robust improvement obtained with the concomitant use of chemotherapy and radiotherapy. Induction chemotherapy, in particular, was not associated with any relevant survival advantage. This article reviews current indications for neoadjuvant chemotherapy in advanced head and neck cancer. Implications for current and future research are discussed.     

A complete remission with androgen-deprivation therapy in a recurrent androgen receptor-expressing adenocarcinoma of the parotid gland.

Salivary gland carcinomas (SGCs) account for 1–5% of allhead and neck cancers and include different histotypes. Salivarygland adenocarcinomas (SGA) represent 16% of parotid gland cancers[1]. Chemotherapy is delivered only with a palliative aim in metastaticand/or recurrent disease. The response rate ranges from 10%to 30% and complete remissions are anecdotal [2]. Immunoreactivity     

Observations and vital signs: ritual or vital for the monitoring of postoperative patients?

Patient surveillance during the postoperative period has traditionally consisted of the collection of routine and regulated vital signs, supported by observations of other aspects of a patient's recovery. The purpose of this research was to determine if the frequent collection of postoperative vital signs assisted in detecting postoperative complications in the first 24 hours after a patient has returned to the ward setting. The study involved: (1) a survey of policy documents; (2) observations of postoperative nursing care; and (3) an audit of medical records. Major findings revealed that vital signs are collected based on tradition and are collected routinely, and there may not be a relationship between vital-signs collection and the occurrence or detection of complications.     

The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies

Introduction:  The question of whether opioid analgesia should be given in patients with undifferentiated acute abdominal pain has been characterized by concerns about its efficacy and that signs used to determine accurate diagnosis may be masked by the drug. The objective of this review is to critically analyze pertinent pediatric randomized controlled studies considering this issue.
Methods:  A comprehensive literature search was conducted via Medline in October 2007, using the terms 'abdominal pain', 'physical examination', 'analgesics', 'opioid' and 'appendicitis'. Other articles were identified using the bibliographies of papers found through Medline; alternate databases were searched but did not reveal additional studies.
Results:  A total of four trials were identified, and their validity and applicability were reviewed. In all studies, randomization to the analgesia group was associated with significant reduction in pain; one study showing no greater effect with opioid than placebo. All studies used a 10 cm Visual Analogue Scale to assess pain. All studies were only sufficiently powered to consider the primary outcome of opioid efficacy in abdominal pain vs placebo rather than diagnostic accuracy, although they all reported on diagnostic accuracy. Meta-analysis of results for efficacy and accuracy was not possible due to the heterogeneity of study populations.
Conclusions:  A large, probably multi-centred trial is needed to answer with sufficient power the question of whether opioid analgesia impairs diagnostic accuracy in children with undifferentiated acute abdominal pain.