B Sang | PubMed Health

PubMed2002

[New Level III opioids of the World Health Organization].

PURPOSE: The new opioids and the new galenic forms, now available in France, require an update in practitioners' knowledge. The purpose of the present study is to help those prescribing select the appropriate opioid and its galenic form for pain relief. CURRENT KNOWLEDGE AND KEY POINTS: Presentation of pharmacological properties of opioids (mechanisms, pharmacokinetics and pharmacovigilance). Presentation of indications, modes of prescription and use of main opioids for pain (especially cancer pain). Examples for calculating required drug dosage depending on the clinical situation and the route of administration. Symptomatic treatments of the main undesirable side effects of the opioids, and actions to be taken in the event of accidental overdose. FUTURE PROSPECTS AND PROJECTS: Oral morphine is the treatment first recommended for nociceptive pain insufficiently relieved by WHO level I and II analgesics. The new immediate-release galenic forms allow morphine titration and the treatment of breakthrough pain. Transmucosal fentanyl, soon available in France, is recommended for breakthrough pain in patients already under opioid treatment: it gives more rapid relied starting after only 5 minutes and it only acts for a short time. Transdermal fentanyl is indicated for stable cancer pain. It is particularly suitable when oral and injectable morphine routes are not available, or for patients with severe constipation. Hydromorphone is the first opioid recommended in France for severe cancer pain when morphine resistance exists or uncontrolled side effects are present (opioid rotation). The new opioids and the new galenic forms widen the range of therapeutic possibilities. Their use is well codified for cancer pain and must still undergo clinical trials for chronic non-cancer pain. When correctly indicated, opioid selection provides a considerable advance in pain management.

Administration, Oral↗

PubMed2001

Avalanches in a Bose-Einstein condensate.

Collisional avalanches are identified to be responsible for an 8-fold increase of the initial loss rate of a large (87)Rb condensate. We show that the collisional opacity of an ultracold gas exhibits a critical value. When exceeded, losses due to inelastic collisions are substantially enhanced. Under these circumstances, reaching the hydrodynamic regime in conventional Bose-Einstein condensation experiments is highly questionable.

Journal Article↗

PubMed1999

Service user movement. The customer is sometimes right.

Patients' groups and service user organisations have grown enormously in the past 20 years. The NHS is beginning to take the principle of patients managing their own conditions seriously. Sustained service user involvement in the planning of local services is still some way off.

Community Health Planning↗

PubMed1997

Making local pay helpful--Part 2: Using action research to address the challenge.

Second part of an item featuring action research with four different trusts to investigate factors relating to the implementation of the local pay policy. Describes methodologies used, such as clinical team diagnosis and cognitive mapping. Looks at the way forward, listing critical factors in ensuring successful implementation.

Efficiency, Organizational↗

PubMed1997

Making local pay helpful--Part 1: Surfacing the hidden challenge.

Reports on a project which looked into the impact of "local pay" on four different types of Trust. Notes that all four were working towards ameliorating the perceived threat of local pay. Reports the use of various methodological approaches such as semi-structured interviews and a team diagnostic exercise and comes up with numerous findings.

Efficiency, Organizational↗