Clinical and pharmacological aspects of the use of morphine in advanced cancer.

The pharmacology of morphine has been studied with particular reference to its use in chronic dosage in patients with advanced cancer and to explore the hypothesis that one of its metabolites, mcxqphine-6-glucuronide, which is a highly potent analgesic in animal models, may play an important part in the analgesic action of morphine. In this work two different assays for morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) have been compared; radioimmunoassay (RIA) and high performance liquid chromatography (HPLC). Basic pharmacokinetic parameters for morphine and morphine-6- glucuronide have been established in healthy volunteers. Changes in both morphine and M6G plasma concentrations were found to reflect changes in scores for drowsiness, relaxation and dry mouth after oral and intravenous administration. In cancer patients receiving regular doses of oral morphine there was a mean absolute bioavailability of 34% which was not significantly different from that in healthy volunteers. No influence of impaired hepatic function due to metastases was seen on this or plasma clearance. A ratio of morphine:M6G of between 1:6 and 1:9 was found (compared to a ratio of 1:11 in healthy volunteers), and the ratio of mco:phine:M3G was 1:55. The pharmacology of controlled release morphine tablets (MST- Continus) has been investigated. No difference in bioavailability relative to aqueous morphine solution was found and when changing from oral morphine solution to MST no advantage in using a loading dose of aqueous morphine when initiating treatment with controlled release tablets was found. Morphine, M3G and M6G have been demonstrated in CSF, pleural fluid and ascitic fluid from cancer patients. Evidence for an enterohepatic circulation of morphine has been obtained by the demonstration of these substances in bile from cancer patiaits receiving regular morphine. Patterns of use of morphine in patients with cancer pain have been studied by both a retrospective review of drug use in a continuing care unit and a postal questionnaire to a cross section of medical practitioners

Invasive ants reduce abundance of small rainforest skinks

Invasive ants are among the world's most damaging invasive species, often directly or indirectly affecting native fauna. Insecticidal baits are the main method for suppressing or eradicating invasive ant populations, but their use must be considered against potential for unintended effects on native organisms. The invasive yellow crazy ant (Anoplolepis gracillipes) is widespread in the tropics, particularly on islands, where they have displaced a range of invertebrates. Effects of this ant on vertebrates, and in continental ecosystems generally, are less studied. We investigated the effects of yellow crazy ants and bait application on rainforest skinks and their invertebrate prey. We compared skink and skink prey abundance across four replicated rainforest site categories: high and low yellow crazy ant sites had both been baited but differed in yellow crazy ant activity; control sites had never had yellow crazy ants or been baited; and buffer sites had never had yellow crazy ants but had been baited. We recorded significantly lower abundance of two small skink species (Lygisaurus laevis and Saproscincus tetradactylus) in high yellow crazy ant sites compared to all other site categories. The differences persisted even after baiting reduced yellow crazy ant activity by 97.8% +/- 0.04% (mean +/- SD). A larger rainforest skink species (Carlia rubrigularis) was not negatively affected by yellow crazy ant invasion. Skink prey abundance was significantly lower in high yellow crazy ant sites compared to control sites and low yellow crazy ant sites, but not compared to buffer sites. These differences did not persist following baiting. We found no evidence that baiting negatively affects skinks or their invertebrate prey. Our data suggest that yellow crazy ants, but not the bait used to treat them, pose a direct threat to small rainforest skinks

Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.

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Patient experiences of brachytherapy for locally advanced cervical cancer: hearing the patient voice through qualitative interviews

Background Brachytherapy for gynaecological cancer is reported to cause pain, anxiety and distress with no clear guidance for optimising patient experiences. The aim of this study was to explore patient experiences of brachytherapy and views on improvements. Materials and Methods Semi-structured interviews were undertaken with patients who had received brachytherapy for locally advanced cervical cancer. Two cohorts were recruited: cohort one had recently had brachytherapy, cohort two were a year post brachytherapy. Four recruitment sites were selected, where brachytherapy is given in different ways, some with short day case procedures and others having one or two overnight stays with applicators in place. Consecutive patients were invited to interview. Participants were asked to retell their brachytherapy story, with views on their care and ideas for improvement. Interviews were audio-recorded, transcribed and data analysed following Braun and Clarke's method for reflexive thematic analysis.16 Results Thirty five interviews were conducted (20 in cohort one and 15 in cohort two). Participant's ages ranged from 28 to 87 years. The interview duration ranged from 22 to 78 minutes. Difficult and traumatic experiences were reported, including periods of severe pain and perceptions of poor care. However, some participants described positive experiences and what went well. Three themes were developed: 1) How I got through it 2) Unpleasantness, discomfort and the aftermath 3) Emotional consequences and trauma Some aspects of medium and long duration brachytherapy were found to be more problematic compared with short duration brachytherapy. Exploring experiences at one year post brachytherapy has provided insights into the long-lasting impact of brachytherapy experiences. Conclusion Hearing the patient voice has demonstrated that further work is needed to improve patient care in modern brachytherapy techniques using different regimes and durations, to minimise difficult and traumatic patient experiences. Study insights will inform future work to develop clinical care recommendations