Life and times of an urban surgeon, circa 1990.

After considering some of the successes and failures of the Canadian Association of General Surgeons as they relate to the nonacademic surgeon, the author describes in detail the practice of one nonacademic urban surgeon to provide a historical record and a guide to the educational needs of such surgeons. He compares academic and nonacademic surgical practice, emphasizing the perhaps unrecognized benefits of the latter. Future change in nonurban general surgical practice is postulated.

Repeated dosing of Uniphyl tablets under fed and fasting conditions: comparison of serum theophylline levels, pulmonary function, and asthma symptoms.

In order to determine the effects of repeated administration under fed and fasting conditions on the bioavailability and clinical efficacy of Uniphyl tablets, 22 adult asthmatics took the drug immediately following their evening meal for seven consecutive days and under fasting conditions for an additional seven consecutive days. For each patient, the daily theophylline dose remained constant throughout the study. Peak and trough serum theophylline concentrations (STC), spirometry, asthma symptoms, side effects and use of beta-agonist inhalers were recorded daily at 0730 and 1900 hours.

Potential cost-avoidance with oral extended-release morphine sulfate tablets versus morphine sulfate solution.

The costs of acquiring, preparing, and administering morphine sulfate extended-release tablets and morphine sulfate solution were compared. Pharmacists at an acute-care community hospital timed the pharmacy and nursing components of the process of preparing and administering single doses of morphine sulfate extended-release tablets 60 mg and morphine sulfate solution 5 mg/mL. The labor cost of each step was determined by multiplying the mean time required to perform the task by the median of the wage scale for the person performing it.

Cost considerations of analgesic therapy: an analysis of the effects of dosing frequency and route of administration.

Using work sampling methodologies, we compared both acquisition and administration costs of equivalent daily doses of controlled-release morphine tablets and morphine sulphate solution. A total cost for each drug therapy was derived by summing: (i) the acquisition cost of the medication, (ii) the cost of drug administration supplies, (iii) the cost of pharmacy time required for packaging and distribution of doses to nursing units, (iv) the cost of nursing time required to administer the medication, (v) the cost of nursing time required to complete the requisite narcotic records. Acquisition costs for controlled-release morphine tablets, morphine sulphate solution and ancillary materials required for dosing were those actually paid by the hospital pharmacy at the time of the study.

The role of theophyllines in a preventive approach for subjects with both mild and severe asthma.

Theophyllines continue to have a definite place in asthma therapy. With careful attention to therapeutic serum theophylline concentrations they are effective to improve spirometry and prevent symptoms. Theophyllines provide an additional benefit when prescribed with beta 2 agonists, and oral or inhaled steroids.

Analgesic response to single and multiple doses of controlled-release morphine tablets and morphine oral solution in cancer patients.

Immediate-release oral morphine, given every four hours in individually titrated doses, is effective in the control of severe cancer pain. To evaluate the analgesic efficacy of a controlled-release morphine sulfate preparation, MS Contin tablets (MSC, Purdue Frederick, Toronto, Ontario, Canada), after a single dose and under steady-state conditions, the authors compared MSC administered every 12 hours with morphine oral solution (MOS) administered every 4 hours in 17 adult cancer patients with chronic severe pain. In the single-dose evaluation, in which the patients were randomly assigned to receive MSC or MOS, there were no significant differences in analgesic efficacy or requirement for supplemental morphine between the two treatments.

Control of severe pain with sustained-release morphine tablets v. oral morphine solution.

Recently a sustained-release morphine sulfate tablet (MS Contin [MSC]) was introduced in Canada. In a randomized double-blind crossover trial we compared MSC given every 12 hours with a morphine sulfate solution (MSS) given every 4 hours to 17 patients suffering from chronic severe pain. After titration of the morphine dosage to optimize the analgesic effect, each patient received 10 days of therapy with either MSC or MSS, then 10 days of therapy with an equal daily dose of the other formulation.

The clinical significance of food-induced changes in the absorption of theophylline from Uniphyl tablets.

To determine the effects of food on the absorption of theophylline from Uniphyl tablets (a once-daily sustained-release theophylline formulation), we performed a crossover evaluation in 20 adults with asthma. After 5 days of continuous dosing (at 6 PM), all patients received their regular Uniphyl dose under specified fasting conditions, and serum theophylline concentrations were measured sequentially during the following 24 hours. The patients' next Uniphyl dose was administered immediately after ingestion of a standardized high-fat meal, and theophylline concentrations were again measured during 24 hours.

Review of the North American experience with evening administration of Uniphyl tablets, a once-daily theophylline preparation, in the treatment of nocturnal asthma.

Increasing awareness of the exaggerated circadian rhythm in bronchomotor tone that causes most asthmatic patients to have increased respiratory symptoms in the early morning has resulted in a search for dosing strategies that will provide maximal bronchodilatory activity at the time of reduced bronchial patency. The purpose of this paper is to review briefly the published data on the North American experience with evening administration of the once-daily theophylline preparation, Uniphyl tablets. An increasing body of data demonstrates that this regimen produces peak concentrations of theophylline in the blood during the early morning hours, the time of maximal benefit for patients with nocturnal asthma.