Merck & Co., Inc. announced today that Darryle D. Schoepp, Ph.D. has been named senior vice president and franchise head, Neuroscience, Merck Research Laboratories (MRL). Dr. Schoepp assumes his new role on March 5th and will report to Peter S. Kim, Ph.D., president, MRL.

“Darryle Schoepp is among the world’s most outstanding drug discovery scientists, and we are delighted to have a leader of his stature join the MRL team,” Dr. Kim said. “The depth and breadth of his expertise across neuroscience research will greatly enhance the franchise-based research strategy that we have been implementing within MRL.”

Dr. Schoepp, 51, comes to MRL after 20 years in neuroscience discovery research at Eli Lilly and Company, where for the past three years he has served as vice president and overall global head of neuroscience research and early clinical investigation. In that role, he formulated the company’s neuroscience strategy and expanded the research emphasis in Alzheimer’s and Parkinson’s diseases and pain. He and his team were responsible for delivering a number of highly novel drug candidates now in clinical development.

At Merck, Dr. Schoepp will have overall responsibility for scientific direction across the drug discovery and development process for neuroscience, including Merck’s priority research areas of Alzheimer’s disease, pain and sleep disorders. He will be based at the Merck facility in Upper Gwynedd, PA.

“I join Peter Kim in expressing how pleased we are that a scientist of Dr. Schoepp’s distinction is joining the MRL team in this key leadership role,” said Richard T. Clark, chief executive officer and president, Merck. “I am confident that Dr. Schoepp will make outstanding contributions to neuroscience research and play a role in continuing Merck’s proud history of developing innovative new medicines that improve health and the quality of lives around the world.”

Dr. Schoepp received his bachelor’s degree in Pharmacy from North Dakota State University and his doctoral degree in Pharmacology and Toxicology from West Virginia University. He conducted postdoctoral research in Pharmacology and Toxicology at the University of Kansas.

He is recognized for having made major contributions in the investigation of the excitatory amino acid neurotransmitter glutamate in disease pathophysiology, pharmacology and therapeutics. He led early and current efforts to discover agents that act at the receptor level to activate, antagonize, or allosterically modulate excitatory amino acid neuronal transmission. With his colleagues at Lilly, Dr. Schoepp discovered many novel compounds that entered clinical development for the management of pain, migraine, epilepsy, anxiety, schizophrenia and neurodegenerative diseases. Most recently, his research has been focused on discovery of receptor agonists, antagonists and modulators in studying the role of glutamate regulation in psychiatric illnesses.

In 2002, Dr. Schoepp was honored with the Pharmacia / American Society for Experimental Therapeutics (ASPET) Award for Experimental Therapeutics for his research on the experimental therapeutics of metabotropic glutamate receptors. He has organized and participated in numerous international meetings and symposia, published extensively in peer-reviewed journals and is the inventor of multiple patents in the glutamate area.

He serves on the Basic Pharmacology Executive Committee of the Pharmaceutical Manufacturers Foundation, on the Board of Publication Trustees for ASPET and as Executive Editor for the journal Neuropharmacology. He is a member of the American College of Neuropsychopharmacology (ACNP).

About Merck

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit www.merck.com.

Forward-Looking Statement

This press release contains “forward-looking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management’s current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the many uncertainties that affect Merck’s business, particularly those mentioned in the cautionary statements in Item 1 of Merck’s Form 10-K for the year ended Dec. 31, 2006, and in its periodic reports on Form 10-Q and Form 8-K, which the Company incorporates by reference.

By Ellen Tomson, Pioneer Press, St. Paul, Minn.

Mar. 3–On the judge’s left on Friday sat the mothers, grieving for sons who will never again tear through snacks, build ramps for bikes and ‘boards, lose and lend clothes to friends, grin while holding fish, fall from tree limbs or yell the words mothers wait up for late at night: “Mom, I’m home.”

And on the judge’s right: a teenage girl who got drunk on vodka while driving their sons and another girl in circuits around a lake in White Bear Township. She slammed her purple Ford Escort into a cottonwood tree and survived to tattoo the names of the mothers’ two dead sons and the date they died on her right ankle, which was broken — her only injury — in the crash. She’s a girl with a tumultuous family history who began drinking alcohol at 12 and, by the time she reached high school, sometimes added marijuana, methamphetamine and cocaine into the mix.

On both sides of the Ramsey County courtroom, the mothers and fathers, siblings, grandparents and friends sobbed, hugged and held papers they would read from with shaking hands.

Judge Robert Awsumb noted the “very difficult situation” and then, in an effort to create the potential for a “productive life” from the tragic circumstances, he sentenced Heather Ann Tucci, 18, to two years in the county jail and 23 years of probation, instead of sending her to a state prison.

Awsumb told Tucci her age weighed heavily in his decision and said he was “in favor of being able to supervise, of having my grip on you.”

The judge said he wanted to see her “regain at some point a productive life — which Joseph Shafer and Joseph Renner will not be able to enjoy.”

Janice Barker, a Ramsey County assistant attorney, urged Awsumb to send Tucci to prison for up to the 48 months the state allows on each count. After the crash, referring to the two boys who died after getting into her car, Tucci wrote on her MySpace.com page, “Both of them knew what they were getting in to.”

Barker said Tucci has consistently made statements beginning, “I’m responsible, but …”

But Awsumb told Tucci, “I do believe you feel remorse for your friends.”

He ordered Tucci to pay $5,404 to the family of Shafer, 18, of White Bear Township, and $316 to the family of Renner, 19, of White Bear Lake. Renner died at the crash site, and Shafer died at the hospital.

Tucci also will pay a still-undetermined amount in restitution to Samantha Ziebell, 18, of Vadnais Heights, who survived with injuries and underwent several surgeries, and she was ordered to pay $950 to the Minnesota crime victims restitution board, as well as $250 in fines and court costs.

The judge told Tucci she will not be allowed to participate in any release programs during her first year in the workhouse. But during her second year there, she will be eligible for work-release, education, chemical dependency treatment, counseling and other programs. During her years of probation, she must abstain from drug and alcohol use, submit to random drug and alcohol testing, undergo psychological and mental health evaluations, finish her high school education or obtain a GED, and maintain full-time employment.

The judge required Tucci to write a letter to him every year on Aug. 19, the anniversary of the accident, outlining activities she undertakes to “give back” to her community and efforts she makes to maintain sobriety and her plans for community service and sobriety for the coming year. He ordered that copies of her letters be sent to the victims’ families.

The court session opened with impact statements from Shafer’s and Renner’s extended families and friends. The judge and others in the courtroom viewed a video set to music that included images of Shannon Shafer talking about her son and photographs that illustrated his life and personality. The images showed he was active — biking and boarding on water, land and snow. Many pictures showed him with his family, all smiling, and a few were taken after he died. In one, family and friends, wearing blue Superman T-shirts, carried his casket.

“We were given a son we lived our lives for,” his mother said.

Renner’s mother sobbed as she showed an album of family photographs to the judge and spoke of the pain she has suffered since the night her son died.

“How could I be asleep when my son is dying? How could I?” she said she asked herself before telling her husband, “I can’t do this. I cannot do this. I cannot do my son’s death.”

Ellen Tomson can be reached at [email protected] or 651-228-5455.

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Copyright (c) 2007, Pioneer Press, St. Paul, Minn.

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

A California woman found out she was pregnant only 48 hours before she gave birth to a healthy full-term baby boy.

April Barnum, who is very overweight, thought she was suffering from a stomach ache when she went to a hospital emergency room, the Orange County Register reported. Doctors saw the fetus on an X-ray and sent Barnum to University of California-Irvine Medical Center.

Walter Scott Edwards III was delivered by Caesarian section.

Barnum and her fiance, Walter Edwards II, are happy about their son but not very well prepared. The couple had adopted four dogs.

I was blowing money on dogs, Edwards said. You need the money most when you’re having a baby.

Friends and relatives have stepped up with a crib and other necessary items.

Doctors said Barnum’s weight was responsible for her not realizing she was pregnant. She also had a gastric bypass operation seven years ago that did not bring her down to a normal weight.

NORTH HAVEN, Conn., March 2 /PRNewswire/ — BlueCare Family Plan, the Medicaid (HUSKY) health plan from Anthem Blue Cross and Blue Shield in Connecticut, announces a month-long calendar of charitable giving to statewide organizations – all striving to better serve Connecticut’s low income families. The local organizations with which Anthem Blue Cross and Blue Shield in Connecticut is collaborating include the New Haven Diaper Bank, New Haven; the Foundation for Children, Hartford; Maternal and Infant Outreach Program (MIOP), Hartford; and St. Mary’s Hospital Children’s Health Center, Waterbury. These community organizations cumulatively will receive more than $100,000 from BlueCare Family Plan, as well as a sizeable donation of disposable diapers to the New Haven Diaper Bank that the health insurer’s employees will donate to help the state’s poor.

“The BlueCare Family Plan team is delighted to work closely with organizations throughout the state who are equally devoted to quality and affordable health care for all children,” said Scott Markovich, regional vice president of State Sponsored Business for Anthem Blue Cross and Blue Shield in Connecticut. “Our calendar of community giving marks the start of several new wellness initiatives we’ll be introducing to our BlueCare Family Plan members in the months ahead with the theme, ‘Growing up healthy, growing up Anthem.’ The programs are aimed at giving children a healthy start, from pre-delivery right through young adulthood,” Markovich explained.

March 5 Donation: The Foundation for Children, Hartford, http://www.reachoutandread.org/

The Foundation for Children, the non-profit arm of the Connecticut Chapter of the American Academy of Pediatrics, is expanding the number of statewide Reach Out and Read sites as a way to promote pediatric literacy, a cornerstone of early language development and learning. Toward that goal, the BlueCare Family Plan will donate $50,000 to enable this foundation to provide 18,000 books to sites where, “children living in poverty might never get a book to call their own were it not for Anthem’s concern and generous donation,” said executive director Jillian G. Wood.

Wood alludes to new research demonstrating that participating in Reach Out and Read is linked to a notable increase in the frequency in how often parents read to their children, as well as improved early language skills. BlueCare Family Plan’s donation will enable the Foundation to purchase age-appropriate books that will be distributed through a network of pediatric providers to children who attend their preventive well care visits and screenings.

A check presentation ceremony with Anthem’s BlueCare Family Plan representatives to the Connecticut Chapter of the American Academy of Pediatrics will be held at 10:00 a.m. at the Charter Oak Health Center at Connecticut Children’s Medical Center (CCMC), Washington Street, Hartford.

March 7 Donation at 1:00 p.m.: New Haven Diaper Bank, New Haven, http://www.newhavendiaperbank.org/

At monthly costs of more than $100.00 per bottom, keeping a baby in dry, clean diapers is costly. For the state’s poor, it can be downright impossible. Infrequent diaper changing increases the risk of many health problems. Also, infants crying non-stop from being in soiled diapers are at greater risk for abuse. For these reasons, Anthem’s BlueCare Family Plan will donate more than $30,000 to the New Haven Diaper Bank. That will enable the New Haven Diaper Bank to buy a six-month supply of disposable diapers – approximately 250,000 to 300,000 diapers – for children from newborn through approximately age three. In addition, Anthem’s employees will donate a sizeable supply of disposable diapers that they collected during a December holiday drive held at the company’s North Haven campus.

“The New Haven Diaper Bank distributes about 50,000 disposable diapers a month,” said Joanne Goldblum, executive director of the New Haven Diaper Bank. “Anthem’s BlueCare Family Plan recognizes that these are not luxury items,” she added. “They are essentials for children living in poverty. With no federal or state supported source of free or reduced-cost diapers, New Haven children are struggling every day and Anthem’s generous donation will help alleviate their suffering.”

March 9 Donation: Maternal and Infant Outreach Program (MIOP), Hartford

The Maternal and Infant Outreach Program of the Hartford Health and Human Services Department works to ensure that pregnant mothers in Hartford receive early and adequate prenatal care and are healthy throughout their pregnancies. MIOP also provides essentials for disadvantaged children and their families. In support of these efforts, BlueCare Family Plan will donate $10,000 to MIOP to purchase items of top priority to families, including breast pumps, children’s clothing, basinets and bedding, as well as infant car seats, which are required for parents to have before their newborns can be released from the hospital.

“Besides offering essential care items, health education, emotional support and case management, MIOP workers search every day to find resources to meet babies’ basic needs,” said Leticia Marulanda, public health manager, Maternal and Child Health Division of the Department of Health and Human Services in Hartford. “We’re enormously grateful to Anthem’s BlueCare Family Plan for this generous support.”

March 12 Donation: Children’s Health Center (CHC) in Waterbury operated by the Franklin Medical Group, an affiliate of St. Mary’s Hospital

The Regional Medical Home Support Center for Children and Youth with Special Health Care Needs at Saint Mary’s Hospital Children’s Health Center has been recognized by the Connecticut Legislature, state child advocacy groups and national quality organizations as a leader and best practice in the care of children and youth with special health care needs. This special population of children has become a national focus of health care quality improvement. With Litchfield County Pediatrics in Torrington and the Medicine/Pediatrics Residency Training Program operated jointly by Yale-New Haven Hospital and Saint Mary’s Hospital in Waterbury, the CHC has participated in Reach Out and Read to cultivate early literacy and school readiness, but reports that funding is increasingly becoming more challenging to acquire.

Later this month, the BlueCare Family Plan will donate $10,000 to help this organization sustain Reach Out and Read in northwest Connecticut.

Anthem Blue Cross and Blue Shield in Connecticut is a subsidiary of WellPoint, Inc. WellPoint, Inc. subsidiaries serve more than two million Medicaid managed care members in 14 states. Enrolled Medicaid managed care members have access to a wide network of health care professionals as well as health management programs that are accredited and nationally recognized in several states.

About BlueCare Family Plan:

BlueCare Family Plan, the Medicaid (HUSKY) program of Anthem Blue Cross and Blue Shield in Connecticut, is the state’s largest health benefits insurer serving more than 134,000 Connecticut HUSKY members, through more than 1,500 participating primary care providers. BlueCare Family Plan, a community-based model, is designed to break down social, financial and other barriers traditionally faced by Medicaid recipients. In 1995, 11 Medicaid Managed Care plans operated in Connecticut; today there are four, with virtually every hospital in the state participating in the state-sponsored program.

Anthem Blue Cross and Blue Shield in Connecticut

CONTACT: Karin A. Nobile, Director of Corporate Communications of AnthemBlue Cross and Blue Shield in Connecticut, +1-203-985-7187

Web site: http://www.reachoutandread.org/http://www.newhavendiaperbank.org/

By King, Rosemarie B; Hartke, Robert J; Denby, Florence

Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes. This pilot study, guided by a coping model, examined the efficacy and durability of a caregiver problem-solving intervention (CPSI) on CG and stroke survivor outcomes. Additional aims included assessment of feasibility issues and reliability and sensitivity of the study measures. The nonrandom sample of 15 stroke CGs was matched on depression and demographics with a comparison group. The CPSI started during acute rehabilitation and continued through 2 months after discharge. Parametric and nonparametric tests were used to assess achievement of the aims. CG depression, anxiety, preparedness, and survivor motor function improved significantly in the intervention group over time. Burden, life changes, and taking care of CG’s own needs did not change significantly. CPSI group CG depression significantly improved compared with the matched group. The improvement in outcomes for the CPSI group supports further testing of the intervention with a large sample.

KEY WORDS

caregivers

function

problem solving

stroke

Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes (King & Shade- Zeldow, 1995; Kotila, Numminen, Waltimo, & Kaste, 1998). Intervention studies that targeted emotional distress have resulted in modest success and rarely included positive outcomes, survivor function, or the durability of treatment effects. Therefore, a pilot study was designed to assess the efficacy and short-term durability of a caregiver problem-solving intervention (CPSI) on positive and negative CG outcomes and survivor function. The aims of the study were to assess the efficacy of the CPSI on CG depression, preparedness, anxiety, life change, burden, healthy caregiving, and survivor motor function immediately after intervention and 2 months later; to assess the feasibility of recruiting 65% of eligible CGs and retaining 75% of participants in the study; to assess the feasibility of achieving treatment helpfulness ratings in 80% of participants; and to assess the reliability and sensitivity of the study measures. The hypothesis was that the severity and rate of depression in CPSI participants immediately after intervention will be lower than those in a matched comparison group, who received usual care.

The crisis of physical illness model was used to guide the study (Moos & Tsu, 1977) (Figure 1). In this stress and coping model, the influence of contextual factors (person, illness, and environmental characteristics) on adaptation outcomes, such as depression, is mediated by coping process variables (appraisal of the situation, coping strategies). The intervention was guided by social problem- solving theory (D’Zurilla, 1986) and cognitive-behavioral theory (CBT; Beck, Rush, Shaw, & Emery, 1979) and targeted coping process factors to affect outcomes.

Background and Significance

Stroke CGs initiate their role at the time of the survivor’s maximum disability, with great uncertainty about the future (King & Shade-Zeldow, 1995). The multiple problems and needs reported by CGs include preparation for caregiving, enhancing the survivor’s function (e.g., dealing with difficult behaviors and emotions), and sustaining the self and family (e.g., dealing with the CG’s own emotions and other responsibilities) (Hartke & King, 2002; King & Semik, 2006; Periard & Ames, 1993).

Reports of high rates of depression, anxiety, and burden are common during acute and chronic caregiving (Anderson, Lin to, & Stewart- Wynne, 1995; Dennis, O’Rourke, Lewis, Sharpe, & Warlow, 1998; King, Carlson, Shade-Zeldow, Bares, & Roth, 2001; Schulz, Tompkins, & Rau, 1988). CG depression and anxiety rates as high as 42% and 44%, respectively, have been reported during the first year after stroke (Anderson et al., 1995; Kotila et al., 1998). The impact of CG distress is apparent in findings of a relationship between negative CG outcomes, such as anxiety, and unfavorable survivor outcomes (Dennis et al., 1998). Reports of positive outcomes, such as closer relationships and improved health, are less common (Bakas & Champion, 1999; King, & Shade-Zeldow, 1995) and have not been examined in intervention studies.

Research findings on coping process variables indicate that they may be important targets for interventions. For instance, negative appraisal of the situation, concerns about caregiving, and avoidance coping have been positively related to depressive symptoms or perception of negative life changes in stroke CGs (Bakas & Champion, 1999; King et al., 2001; Schulz et al., 1988).

With few exceptions, a recent review of stroke CG intervention literature indicated disappointing treatment results (Visser-Meily, van Heugten, Post, Schepers, & Lindeman, 2005). The studies often lacked a theoretical base and standardized protocols, used limited treatment intensity and focus, and provided no follow-up. However, two problem-solving intervention studies initiated early and targeting CG emotional and physical health or family functioning and survivor adjustment had strong designs and were effective (Evans, Matlock, Bishop, Stranahan, & Pederson, 1988; Grant, Elliott, Weaver, Bartolucci, & Giger, 2002). Another counseling intervention resulted in improvement in family functioning and stroke survivor function but not in depression and anxiety (Clark, Rubenach, & Winsor, 2003). Two studies reported significant mental health treatment effects, favoring treatment groups over control groups. However, interpretation of the findings and ability to replicate these studies were limited by the lack of baseline group comparisons or the use of unstructured interventions and wide variability in treatment frequency (Dennis, O’Rourke, Slattery, Staniforth, & Warlow, 1997; Mant, Carter, Wade, & Winner, 1998). Another study that used a CBT group intervention resulted in stabilization of burden and significantly greater competence in treatment participants, compared to greater burden and lower competence in control subjects (Hartke & King, 2003). The effects for depression and loneliness were not significant.

The proposed problem-solving intervention is based on D’Zurilla’s (1986) model of social problem-solving therapy (PS). PS influences outcomes by promoting a positive view of problems as normal and manageable, increasing awareness of emotional responses to problems, and improving problem-solving skills. PS has been used effectively to treat depression in CGs and community samples (Grant et al., 2002; Lynch, Tamburrino, & Nagel, 1997).

Findings from CG and community studies of depression treatment provided support for the development of the pilot study to assess the efficacy of PS on the short-term durability of CG and stroke survivor outcomes. The current study contributed to the research on management of CG distress by using a structured intervention that was guided by a strong theoretical foundation.

Methods

A single-group repeated-measures design was used to examine the feasibility and efficacy of a PS intervention to promote adaptation in stroke CGs. In addition, depression and functional status findings were compared with a historical matched CG and survivor group. Participants met the following inclusion criteria: age ≥50, primary CG for a stroke survivor in acute rehabilitation, living with the survivor, English speaking, accessible by telephone, not in active psychotherapy or a support group, and a score of 210 on the depression scale. The setting was a free-standing rehabilitation hospital. CGs were identified by a research nurse on the stroke service. The nurse contacted family members and verified their role as primary CG.

Procedures

The study was approved by the university institutional review board. Depression risk was assessed after informed consent was obtained. The nurse offered a list of resources to CGs who were interested but not eligible. Assessment data for the CPSI group were collected by a research assistant at the following times: baseline (preintervention, T1), postintervention (8-10 weeks after discharge, T2), and 2 months later (16-18 weeks after discharge, T3). Data for the matched adaptation study group were available for baseline and 8- 12 weeks after discharge (T2).

Sample

Twenty-eight CGs consented to participate. Three of them did not meet the screening criteria, so 25 were enrolled. Fifteen of 25 CGs (60%) completed the intervention; 14 completed the final assessment. Reasons for attrition included death of stroke survivor, extreme distress that prevented participation, change in CG, CG too busy, or inability to reach the CG. No significant differences were found in demographic or survivor illness variables between consenting CGs who dropped out or were not eligible and those who completed the study. Table 1 contains demographic statistics for the CPSI and matched adaptation groups. The majority of CGs were female, white, in a spousal relationship with the survivor (spouses and unmarried domestic partners), approximately 63 years of age, and a high school graduate. The majority were caring for survivors who had experienced a first stroke (93%). With \the exception of education, which was significantly higher in the CPSI group (p

Intervention

The CPSI 10-session intervention combined PS (problem orientation and problem-solving skills) and CBT (relaxation training, reframing negative thoughts). Examples of additional content include information and tips on stress management, self-care, resources, behavior management, and risk factors for recurrent stroke. CGs received a manual that contained the content for each session and included exercises to tailor the content to each CG. In addition, they received a copy of a stress management booklet that reinforced the course content.

A brief introductory meeting and two or three in-person sessions were conducted during the survivor’s hospitalization. The remaining seven or eight weekly postdischarge sessions were conducted primarily by telephone. One CG requested in-person contacts while her husband was in outpatient therapy at the hospital, and another received four in-person sessions because of difficulty participating by telephone. Sessions were 45-60 min long. Participants identified their most difficult problems with the counselor and developed plans to solve them using the PS steps. They were asked to complete home assignments, such as applying PS to problems, rating their mood, and practicing relaxation. The counselors were flexible in fitting the sessions into the lives of busy CGs, often rescheduling sessions and holding sessions late in the evening and on weekends.

Comparison Group

The comparison (matched adaptation study) group consisted of 15 of 136 CGs who participated in a descriptive, longitudinal study of stroke CGs and their stroke survivors (King et al., 2001). They were matched with the CPSI sample on baseline Center for Epidemiologic Studies Depression scale (CES-D) scores, gender, age, race, and caregiving relationship. The measures used in both studies, depression and functional status, were compared between the groups. The matched group had received usual care.

Integrity of the Intervention

Two nurses experienced in family caregiving delivered the intervention. The co-principal investigator, a clinical psychologist, met with the nurses biweekly to discuss cases. A record of intervention components was completed after each session to ensure that the treatment structure was maintained. Counselor training included learning PS techniques and relaxation methods and ways to manage negative thoughts. With the exception of two CGs, who participated in 9 meetings instead of 10 to accommodate their schedules, CGs completed 10 sessions. The content of two chapters was combined into one meeting for participants who received fewer meetings.

Analysis

Clinical efficacy was assessed by using the McNemar test to compare depression rates (scores ≥16) between T1, T2, and T3 in the CPSI group and between T1 and T2 in the matched group. 12 Depression rates were compared between the two groups using the chi- square test. Repeated-measures ANOVAs followed by paired t tests were used to compare scores in the CPSI group over three times. Change in mean scores in the matched group was assessed using paired t tests. Independent t tests were used to examine differences in depression severity and survivor motor function between groups at T2. Feasibility issues were examined using frequencies to compare recruitment, retention, and credibility of the intervention with the study goals. Because of the small sample, a liberal value of p

Variables and Measures

The level of helpfulness of the intervention components was assessed using an investigator-generated measure. One item asked whether participation in the study was helpful. Other items included rating the helpfulness of each session. Responses for the session items ranged from 0 (not helpful) to 3 (very helpful).

Coping Variables

Burden was measured using the difficulty subscale of the 15-item Caregiving Burden Scale (Carey, Oberst, McCubbin, & Hughes, 1991). The difficulty subscale has evidence of internal consistency reliability and validity (Bakas, Austin, Jessup, Williams, & Oberst, 2004; Carey et al., 1991). The response set ranges from 1 (not difficult) to 5 (extremely difficult). Responses are summed to yield a difficulty score. The potential range of scores is 15-75. Higher scores reflect greater perceived difficulty with tasks. Alpha coefficients in the current study ranged from .65 to .84.

Appraisal of ability to cope was assessed using the Preparation for Caregiving Scale (PCS; Archbold, Stewart, Greenlick, & Harvath, 1990) and the Caregiver Competence and Confidence Scale (CCCS) from the Healthy Caregiving Scale (Edelman & Fulton, 1997). The PCS assesses perceptions of preparedness to manage CG tasks and stresses. The 8-item scale has five response options: 0 (not at all prepared) to 4 (very well prepared). The responses are summed and averaged to yield a potential range of scores from 0 to 4. Evidence of internal consistency reliability and construct validity has been reported (Archbold et al). Alphas in the current study ranged from .70 to .85. The CCCS is a new 6-item scale, with responses ranging from 1 (not at all) to 5 (very much), that measures caregiving confidence. The summed score can range from 6 to 30, with higher scores indicating greater confidence. Psychometric testing demonstrated an alpha of .84 and significant correlation with a measure of subjective burden (Edelman & Fulton, 1997). This scale was not analyzed further in this study because of strong correlations (r = .70 to .79) with the PCS, which has been used in other stroke CG studies and provided stronger published psychometric support.

Outcomes

Depression was measured using the CES-D, which has established reliability and validity (Radloff, 1977). The CES-D measures the frequency of 20 depressive symptoms experienced during the past week on a scale of 0 (none) to 3 (5 to 7 days). The possible range of scores is 0-60, with higher scores representing greater symptom severity. A score of 16 is the cutoff for depression. Alpha coefficients ranged from .77 to .81 in this study.

Anxiety was measured using the 5-item Tension Anxiety subscale of the Profile of Moods Scale short form (McNair, Lorr, & Droppleman, 1992). The 30-item total scale, comprising six subscales, uses a 5- point response set of 0 (not at all) to 4 (extremely) to respond to descriptors of feelings. The possible range of scores for anxiety is 0-20, with higher scores representing greater anxiety. Construct and concurrent validity and internal consistency ((alpha) = .86 to .88) have been demonstrated (McNair et al.). Alphas ranged from .63 to .88 in the current study.

Perception of life changes was measured using the Bakas Caregiving Outcomes Scale, which measures changes in social functioning, subjective well-being, and somatic health (Bakas & Champion, 1999). The 15 items, with a 7-point response scale of 1 (changed for the worst) to 7 (changed for the best), are summed for an overall score that reflects the extent of negative and positive life change. The possible range of scores is 15-105, with higher scores reflecting more positive life change. Alpha coefficients ((alpha) = .77 to .90) and content and construct validity were strong (Bakas & Champion). Alphas in this study ranged from .66 to .77.

Healthy caregiving was measured using two scales from the Healthy Caregiving Scale (Edelman & Fulton, 1997). The Caregiver Cares for Own Needs Scale is a 3-item scale that assesses perceptions about health self-care using a 5-point response set from 1 (strongly disagree) to 5 (strongly agree). The potential range of scores is 3- 15; lower scores indicate greater attention to the CG’s own needs. Internal consistency reliability has been reported to be .85; alphas ranged from .82 to .94 in the current study. The 4-item Makes Time for Self Scale used a 5-point response set, 1 (almost never) to 5 (almost always), with higher scores representing perceptions of making more time for self. The Makes Time for Self Scale was reported to have an alpha of .88. A low T1 alpha (.55) in this study precluded further analysis of the measure.

Stroke Survivor Functional Status

The CGs completed the Functional Independence Measure (FIM; Uniform Management Service, 1993). The FIM measures severity of disability using an 18-item, 7-point scale ranging from 1 (maximum dependence) to 7 (independent function). The scale consists of a 13- item motor scale and a 5-item cognitive scale. The possible ranges of scores are 13-91 and 5-35, respectively, for the motor and cognitive scales; higher scores reflect greater independence. Adequate internal consistency has been reported for motor and cognitive scales for stroke survivors (Hartke & King, 2003). In this study, alpha coefficients for cognitive and motor scales ranged from .91 to .99. Only the motor scale was used in between-group comparisons because the cognitive scale was not collected in the matched group study.

Results

The CPSI resulted in significant improvement over three times for depression, F(2, 26) = 13.74, p .10. Effect sizes ranged from d = .16 (burden) to 1.33 (preparedness). Table 2 shows descriptive statistics and p values for change over time and group differences.

The hypothesis that the severity and rate of depression will be lower in the CPSI group after intervention compared with the matched group, assessed at 2 months after discharge, was supported. Independent t tests \indicated that the T2 CES-D severity score was significantly lower for the CPSI group, t(28) = 2.42, p .05, and T2, r = -.05, n = 30, n >.05; or for the matched group only at T1 and T2, r = -.08, n = 15, n >.05; r = .27, n = 15, n >.05, respectively. In the matched sample, the relationship converted over time from negative to positive, such that greater education was related to greater depression.

A significant reduction was found in the CPSI depression rate, from 53% to 13% and 21% at T2 and T3, respectively (McNemar, p .10. Cognitive function for the CPSI survivors improved significantly over three times F(2, 12) = 8.04, p

Among the scales that did not change significantly, the life change mean scores changed in the expected direction from negative to slightly positive. Both burden and taking care of own needs worsened over time. The Caregiver Burden Scale may not have been appropriate for use during hospitalization. The T1 means for 14 of 15 items were less than 2 (not difficult). Items with the lowest T1 means included medical and nursing treatments, personal care, and watching for and reporting the patient’s symptoms. The only item with a mean score in the slightly difficult range was managing behavior problems.

Both the recruitment and retention rates were lower than expected. Of 63 probably eligible CGs, only 44% consented to participate. Of 25 participants, 15 (60%) participated through T2 (postintervention assessment) and 14 (56%) completed T3.

All intervention components were rated as somewhat to very helpful by 92% of the CGs. Whereas the depression and coping with stress sessions received the highest percentages of very helpful ratings (73% and 80%, respectively), stroke risk factors received the least very helpful ratings (53%). Yet three CGs viewed the risk factor information as most helpful. The median score for all sessions was 3.0 (very helpful). In response to the question “Overall, did you find it helpful to participate in the study,” 93% of the caregivers reported that the intervention was helpful. A 76- year-old male CG indicated that the program was not helpful because “It didn’t fit for me. I’m kind of bull headed; I just do what I have to do as it comes.” Four participants indicated that the amount of time needed for the postdischarge sessions was problematic. When asked what was most helpful, 80% of participants identified learning how to relax and cope with stress; 50% stated that analyzing problems was most helpful. The sum of these ratings is more than 100% because several CGs rated two topics as most helpful. A CG stated that the program “was a gift that helped [her] feel more secure and confident” as a CG. Another CG recommended that we make the program “mandatory” for the self-esteem, moral support, and help it gave.

Internal consistency reliability was adequate ((alpha) >.70), with few exceptions, (T2 burden, .65, and life change, .66; T1 anxiety, .63; and T1 time for self, .55). In addition, the measures were sensitive to change over time.

Discussion

Similar to the findings reported by Evans et al. (1988) and Grant et al. (2002), significant improvements were found for most outcomes. Unlike other intervention studies, this study examined the intervention effect on both percentage depressed and depression severity. Change in percentage depressed is important because it indicates that CGs at risk for clinical depression benefit from the intervention. Compared with the matched adaptation group, the CPSI CGs experienced a greater reduction in depressive symptoms and a lower rate of depression. The CPSI CGs reported significantly greater education than the adaptation group. In the current study, level of education was not related significantly to depression at T1 or T2. Other investigators have reported both a negative relationship between education and depression in CGs of older adults with disabilities (Clark, 2002) and no significant relationship between CG depression and education or socioeconomic status, a proxy for education (Grant, Bartolucci, Elliot, & Newman Giger, 2000; King et al., 2001). The nonequivalence between groups is a concern because it is not known how CGs who do not have a high school education would respond to the intervention or whether they would participate. Randomization to group is necessary to avoid such differences between groups.

Other clinically important findings are the significant improvements in anxiety, perception of preparedness, and stroke survivor motor function. Decreased anxiety may be clinically significant, not only because of benefits to the CG but also because anxiety has been related to stroke survivor emotions (Dennis et al., 1998). The baseline anxiety score indicates greater anxiety than in reports of people with chronic obstructive lung disease, older adults, and adult and college samples (Kapella, Larson, Patel, Covey, & Berry, 2006; McNair et al., 1992; Nyenhuis, Yamamoto, Luchetta, Terrien, & Parmentier, 1999). After the intervention, the T2 and T3 scores were equal to or lower than those of these samples. Improved preparedness for caregiving after a problem-solving treatment also was reported by Grant et al. (2002). Feeling better prepared for suddenly becoming a CG may help to reduce the reports of unmet needs. Motor function improved significantly in both groups between T1 and T2, with no difference between groups in T2 scores. FIM cognition improved significantly in the CPSI group in each time interval. Unfortunately, differences in measurement of cognition in the groups precluded comparisons between groups. A larger study that includes a randomized, concurrent comparison group and accounts for factors such as continued therapy, stroke severity, and comorbidity is needed to test the CPSI effects on function.

The success of the CPSI in achieving moderate to strong effect sizes for several outcomes may be related to the use of a structured treatment that allowed tailoring of content to the individual CG’s needs. Schulz et al. (2003) recently recommended this approach to achieve clinically important outcomes. The maintenance of gains in most outcomes for 2 months after the intervention ended is encouraging, but a longer follow-up is needed to test durability effectively.

The change in burden was not significant. The short follow-up interval may have precluded finding a benefit on burden because CGs were still adjusting to their new roles and were adding new responsibilities beyond those acquired during hospitalization. Although the T3 follow-up showed a slight decrease from T2 in the expected direction, it is unknown whether this was the beginning of a trend toward lower burden. Using the same measure Bakas et al. (2004) recently reported higher levels of burden in CGs who had been caregiving an average of 18 months, compared with our postintervention findings (M = 30.3 vs. 22.6). With the exception of the study by Grant et al. (2002), for which scores were not provided, the burden measure has been used only with outpatient samples. If this measure is used in intervention studies, careful thought should be given to the study design and hypothesis because many tasks are not pertinent during the survivor’s hospitalization. Therefore, it is difficult to effect positive change between baseline and the subsequent data collection time. Future studies should examine durability of treatment effects on burden during an extended follow-up. Although the life change scores showed improvement in the expected direction, the change was not significant. There are no reports of Bakas Caregiving Outcomes Scale findings in studies of new CGs, so comparisons are not possible. The ability to view changes after a stroke as positive may take a longer period of adjustment than provided in this study. Scores for the outcome “taking care of their own needs” worsened for CGs by T2 and remained worse 2 months later. The intervention may have increased sensitivity to their needs without sufficient time for participants to feel confident in meeting them.

The improvements in CG preparedness and emotional well-being may reduce the distress and unmet needs that occur during the early phase of caregiving. The potential benefit to stroke survivor function is important because it can reduce CG burden and has potential to improve the survivor’s quality of life. Quality of life and other survivor outcomes, such as depression, changes in the dyadic relationship, and family functioning, could be examined in future studies that target stroke survivor benefits from a CG intervention. To date, stroke CG intervention studies that include survivor outcomes are uncommon (Clark et al., 2003; Dennis et al., 1997; Evans et al., 1988).

Although attrition was high, this is not unusual in stroke CG studies (King et al., 2001; Rodgers et al., 1999; Teel, Duncan, & MinLai, 2001; Wright, Hickey, Buckwaiter, Hendrix, & Kelechi, 1999). Unlike Alzhei\mer’s CGs, these CGs are faced with a sudden crisis, resulting in destabilize tion in their ways of functioning and the acquisition of multiple new responsibilities (Moos & Tsu, 1977). The crisis and the vulnerability of survivors to mortality and morbidity may increase attrition. In the current study, several CGs who completed the intervention experienced stressful events, such as the deaths of a stroke survivor (n = 1) or a best friend (n = 1) and one or more hospitalizations of the stroke survivor (n = 4). These CGs completed the intervention despite the added stressors, but similar stressors may have contributed to distress and attrition. These events were reported anecdotally in the current study, so the relationship between such events and attrition and outcomes could not be assessed. Such events should be monitored and controlled statistically in future intervention studies to increase validity. It is also possible that the time commitment required to participate became too great during this difficult time. High attrition may be an unavoidable risk that adds to the complexity of stroke CG intervention studies during the first months of caregiving.

With one exception, the participants found the intervention helpful. Median ratings for all session topics were in the very helpful range. However, the differences in ratings of topics, such as stroke risk factors, highlight the need to tailor information and counseling to the needs of the CG. The CGs’ comments about time constraints must be considered in future interventions. Their comments indicated that scheduling sessions was problematic after discharge when the demands on their time increased.

For the most part, the study measures had adequate psychometrics, were sensitive to change, and could be considered for inclusion in future studies.

The findings must be viewed cautiously because of the small sample size, high attrition rate, use of a nonrandomized sample, and short duration of follow-up. Despite the limitations, the strength of improvement in CG outcomes holds promise for future testing of the intervention.

Implications for Practice

The hospitalization period and first months after discharge have been reported to be the most difficult for CGs (King & Semik, 2006). Aspects of the intervention, which targeted this time period, can readily be applied in practice. Nurses see the CG more often than other professionals during hospitalization and can play an important role in promoting their adjustment during this time and during clinic visits. They can assess the CG’s concerns and how effective he or she is in managing them, watch for evidence of negative thinking, attend to responses during teaching, and make referrals to assist in building skills (e.g., stress management and relaxation training or counseling) to reduce distress during the early stage of coping with caregiving.

Future Studies

Findings support the effectiveness of the CPSI intervention in a small sample of stroke CGs. Practice in solving difficult problems and teaching relaxation techniques and methods to reduce negative think-. ing facilitated development of these skills for participants. These skills may have contributed to the durability of findings for the outcomes. The high ratings given to content such as problem solving, relaxation, stress management, and reducing negative thinking support the inclusion of such techniques in future studies to manage CG stress. Future studies with large samples and long-term follow-up to determine durability of the intervention are necessary. The cycle of chronic depression seen in stroke CGs may be broken through a tailored, early, multicomponent intervention that arms the CG with skills to manage stress and prevent chronic negative outcomes.

Conclusions

Despite the limitations, results suggest that a problem-solving intervention can help both CGs and stroke survivors adapt to a stroke in the family. The treatment was accessible to CGs, including those in rural communities, and was cost-effective because the telephone intervention eliminates the need for travel by participants and counselors. Such interventions may be even more important in the current environment of ever shorter lengths of stay for inpatient rehabilitation.

Acknowledgments

This work was supported by the Buehler Center on Aging and the Ralph and Marian C. FaIk Research Trust (Rosemarie B. King, PI). We wish to thank the caregivers who graciously gave of their time and energy to participate in this study. We also thank Maria Bergman, PhD, and Patrick Semik, BA, for their assistance with this study.

Quality of life and other survivor outcomes, such as depression, changes in the dyadic relationship, and family functioning, could be examined in future studies that target. stroke survivor benefits from a CG intervention.

References

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King, R. B., & Semik, P. E. (2006). Difficult times, service use, and needs during the first two years of stroke caregiving. Journal of Gerontological Nursing, 32(4), 37-44.

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Visser-Meily, A., van Heugten, C., Post, M., Schepers, V., & Lindeman, E. (2005). Intervention studies for caregivers of stroke survivors: A critical review. Patient Education and Counseling, 56, 257-267.

Wright, L. K., Hickey, J. V., Buckwalter, K. C., Hendrix, S. A., & Kelechi, T. (1999). Emotional and physical health of spouse caregivers of persons with Alzheimer’s disease and stroke. Journal of Advanced Nursing, 30(3), 552-563.

Rosemarie B. King, PhD RN * Robert J. Hartke, PhD MPH * Florence Denby, MS CRRN

About the Authors

Rosemarie B. King, PhD RN, is a research associate professor at the Northwestern University Feinberg School of Medicine and adjunct senior research associate at the Rehabilitation Institute of Chicago. Address correspondence to her at 345 E. Superior Street, Chicago, IL 60611, or [email protected].

Robert J. Hartke, PhD MPH, is a staff psychologist at the Rehabilitation Institute of Chicago and an assistant professor at the Northwestern University Feinberg School of Medicine.

Florence Denby, MS CRRN, is a nurse practitioner at the Stroke Rehabilitation Center, Rehabilitation Institute of Chicago, and an instructor at Northwestern University Feinberg School of Medicine.

Copyright Association of Rehabilitation Nurses Mar/Apr 2007

(c) 2007 Rehabilitation Nursing. Provided by ProQuest Information and Learning. All rights Reserved.

MedLink International, Inc. (OTCBB: MLKNA) (FRANKFURT: WM6B), an Electronic Health Record provider based in Islandia, NY, announced that Mr. Ray Vuono, Chief Executive Officer of MedLink, presented to the Suffolk County Legislature Health and Human Services Committee on March 1, 2007 in Hauppauge, NY.

Mr. Vuono touched on some of the following issues during his presentation to the committee including:

 --  98,000 deaths per year due to ineffective Health Data Sharing. --  $75 - $250 billion per year wasted on costly duplicate testing and     unnecessary hospitalization. --  Natural Disaster recovery plan (Hurricane Katrina), the importance of     a comprehensive plan as Long Island is the 3rd most likely location in the     U.S. mainland to be hit by a major hurricane after Louisiana and Florida. --  The benefits of a fully retrievable patient record encompassing all     health interactions across disparate networks.      

There have been steps taken on a government level recently in the state of New York such as New York State Governor George Pataki recently announcing the availability of $52,875,000 in grant funding to advance Healthcare IT on a regional level and New York City Mayor Bloomberg announcing $20,000,000 in funds for NY physicians to adopt EHRs. These announcements have emphasized the importance of interoperable Healthcare IT and Mr. Vuono made the suggestion that Suffolk County seek to acquire some of these funds for the constituents of Suffolk County, and seek to create an EHR infrastructure for disaster recovery and laid out some of the following potential initiatives:

 --  The centralization of Electronic Health Records with a county wide     initiative --  Allow for Secure Integration of both Public and Private Facilities to     share and access via the use of Electronic Health Records. --  Initiate programs for both mandatory and voluntary participation in     the consolidation of health data both on a facility and individual patient     basis. --  Building an integrated health information infrastructure allowing     clinicians access to critical health care information when treatment     decisions are being made. --  Using health information technology to give consumers more access and     involvement in health decisions. --  Expanding capacity for public health monitoring, quality of care     measurement, and bringing research advances more quickly into medical     practice.      

About Medlink International, Inc:

The business of MedLink International, Inc. (OTCBB: MLKNA) (FRANKFURT: WM6B) is carried out through its flagship product, the MedLink VPN in conjunction with its proprietary MedLink EHR software. The MedLink Virtual Private Network allows subscribing doctors to securely communicate with other physicians and remotely access and retrieve patient records, lab results, X-Rays, CAT Scans and other Personal Health Information (PHI). The MedLink VPN incorporates several third party applications and the company has developed a state of the art Healthcare IT infrastructure on the MedLink VPN. The company also offers other products and services such as Medical Coding & Recovery, MedLink Scheduler, MedLink Billing, Secure Health Mail, Remote PACS, Health IT infrastructure and networking, document management, video conferencing and Optical Memory Cards for personal health records (PHR). The company has developed unique partnerships in the medical community and it utilizes those partnerships to market its products and services. The company website is www.medlinkus.com.

 Contact: MedLink International, Inc. Jameson Rose (631) 342-8800 [email protected]

SOURCE: MedLink International, Inc.

By Flanagan, Jane; Melillo, Karen Devereaux; Abdallah, Lisa; Remington, Ruth

Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

KEY WORDS

assessment

electrolytes

nutrition

Nurses in rehabilitation settings face multiple challenges, including caring for patients with increasingly complex problems. Laboratory values can provide critical information regarding the patient’s condition, but interpreting the findings can be overwhelming. Common problems experienced by adults in the rehabilitation setting include dehydration, fluid overload, bleeding disorders, malnutrition, infection, and drug toxicities. Therefore, the most critical laboratory values that most often reflect serious problems in the adult will be considered in light of these potential health problems. Several important points to remember with regard to laboratory values are outlined in Figure 1.

Laboratory Values

Nurses working in rehabilitation settings care for patients who experience a number of problems, such as traumatic brain injury, major cardiac events, fractures, burns, elective orthopedic surgeries, and many other conditions. Because of advances in healthcare, people are living longer and overall healthier lives. With this improved life expectancy, patients in the rehabilitation setting may not only be older but have increasingly complex medical histories. For example, an older patient may be recovering from a stroke and also have underlying medical problems such as diabetes and heart disease necessitating chronic medical management.

For the nurse in the rehabilitation setting, small changes in a person’s physical condition, especially in the older adult, may warrant notifying a physician. Subtle changes such as confusion, loss of appetite, and alterations in elimination are not normal for the older population and instead serve as cues of a new problem or a change in an underlying chronic disease. Age-related physiological changes can also affect some laboratory values and must be recognized (Amelia, 2004; Clark & Halm, 2003).

Some general considerations for interpreting and reporting laboratory values are highlighted in Figures 2 and 3.

Sodium and Potassium: Two Important Electrolytes

Two critically important electrolyte values are sodium (Na) and potassium (K). Working together on the cellular level as the sodium- potassium pump, these values are integral to the overall water balance of the body. Regulation of potassium is through the kidneys and of sodium through the adrenal glands. It therefore stands to reason that problems with either organs, such as Cushing’s disease or chronic renal failure, will cause disturbances in the fluid and electrolyte balance in the body (Kraft, Btaiche, Sacks, & Kudsk,2005).

When considering laboratory values of patients in the rehabilitation setting, it is important to remember that a person with a history of medical problems is more prone to and more sensitive to changes in fluid and electrolyte balance. These include problems of the cardiac, respiratory, endocrine, orthopedic, vascular, gastrointestinal, and urinary systems. Often underlying medical conditions directly correspond to problems with fluid and electrolyte balance; however, problems can also arise as a result of a side effect of medical management (Kraft et al., 2005). An example of a condition causing fluid and electrolyte disturbance is congestive heart failure, which can cause a fluid overload in the body through a poorly functioning heart, as occurs with mitral valve regurgitation. Likewise, the medical management of this problem, which may include drugs such as digoxin and furosemide, may also cause dehydration and lower the potassium level.

The nurse in a rehabilitation setting should always be concerned about sodium and potassium levels. Any changes in a person’s clinical condition, in association with a variation in electrolyte values above or below the normal parameter, should be reported to the doctor immediately.

The Complete Blood Cell Count

The complete blood cell count (CBC) can provide information about the patient’s general health and concerns such as excessive bleeding, hydration status, infection, and anemia. The major components of whole blood are erythrocytes or red blood cells (RBCs), leukocytes or white blood cells (WBCs), and platelets (PLTs).

The RBC count is made up of hemoglobin (Hb) and reticulocytes, which are immature RBCs. Th Hb is a measure of the iron-rich protein that carries oxygen in the blood. Often reported with the Hb is the hematocrit (Hct), a measure of the percentage of blood volume that is composed of RBCs (George-Gay & Parker, 2003).

Decreases in any component of the RBC can represent rapid blood loss as a result of hemolysis or destruction of the blood cell, sometimes caused by medications, or of decreased cell production, as in anemia. In the next section fluid volume overload and dehydration are discussed in detail, but it is important to note that the Hct can be falsely low because of hemodilution when a person has fluid volume overload and can be falsely elevated when a person is dehydrated because of hemoconcentration (George-Gay & Parker, 2003). Correction of the underlying problem will provide a more accurate Hct result. The nurse should assess for and report findings related to recent changes in a person’s medical or surgical history, skin color (pallor, jaundice), pruritus, blood pressure, pulse rate and respirations, intake and output, weight, and Hct.

Fluid Overload

When a patient’s serum sodium level is low, it is known as hyponatremia. Although often asymptomatic initially, the patient may eventually complain of a headache, nausea and vomiting, and generalized malaise and muscle weakness. Most importantly in the rehabilitation setting, the nurse may observe confusion, a symptom that is often attributed to hospitalization, medications, and old age (Amelia, 2004). Therefore, in this setting hyponatremia often is overlooked. Daily weights, intake and output, jugular ” vein pressure, respiration, skin appearance, mental status, and blood pressure are helpful in evaluating hyponatremia.

Hyponatremia is complex and can be the result of several underlying conditions. There are three types of hyponatremia: hypovolemic, normovolemic, and hypervolemic. Less commonly in the adult population, normovolemic hyponatremia can be a result of syndrome of inappropriate antidiuretic hormone, or psychogenic polydipsia, a syndrome in which there is excessive water intake. Hypovolemic hyponatremia is defined as true volume depletion and is caused by excessive fluid loss through sweating, burns, diuretics, vomiting, and diarrhea. The third and most common type of hyponatremia is hypervolemic (Kugler & Hustead, 2000).

Hypervolemic hyponatremia occurs when there is retention of water in the body and low serum sodium. Hypervolemia can be caused by several underlying chronic medical conditions, such as diabetes, kidney disease, hypothyroidism, and cardiac and liver failure, and as a result of some medications such as first-generation sulfonylureas and diuretics (Kugler & Hustead, 2000). Assessment findings in hypervolemic hyponatremia include changes in mental status, restlessness, anxiety, decreased urine output, weight gain, edema in the dependent extremities, increased blood pressure, jugular vein distention, dyspnea and orthopnea, and, on auscultation, abnormal lung sounds such as crackles. In addition to a low sodium count, laboratory findings include a low Hb and Hct.

Treatment may vary, depending on the cause, but often diuretics help alleviate the imbalance (Kugler & Hustead, 2000). Other considerations in the treatment plan for hyponatremia include careful monitoring of vital signs, daily weightlifting, intake and output measurement, and assessment of signs and symptoms of hypernatremia.

The normal changes associated with aging can make assessment related to hydration status more challenging (Amelia, 2004; Larson, 2003). Skin turgor can be altered by decreased elasticity and therefore may not be an accurate indicator of dehydration. Mental status changes can be the result of other underlying conditions, including infection or preexisting dementia. Certain medications may alter the mucosa of the mouth, causing dryness. Physical symptoms such as nocturia, psychological symptoms associated with depression, and the decreased thirst and desire for fluids (and food) common in older adults can all present challenges to the nurse’s assessment (Larson). An initial assessment of the person with frequent reassessment can enable the nurse to detect changes early.

Dehydration

There are three types of hypernatremia: hypovolemic, normovo\lemic, and hypervolemic. Hypervolemic hypernatremia is less common and can occur as a result of less common chronic medical conditions such as Cushing’s disease or as a result of excessive salt intake. Excessive intake of hypertonic fluids via tube feedings or intravenous fluids may also result in hypervolemic hypernatremia in the rehabilitation setting (Kugler & Hustead, 2000).

Hypovolemic hypernatremia is the more commonly seen condition and is the result of dehydration or inadequate fluid replacement in combination with free water loss (Amelia, 2004; Kugler & Hustead, 2000). Hypovolemic hypernatremia occurs when there is a deficient water intake. This is usually the result of an impaired thirst mechanism or a lack of access to adequate fluid intake, two common problems among older adults (Kugler & Hustead). Free water loss can occur with fever, sweating, diarrhea, and hyperventilation.

In a patient experiencing dehydration, the nurse may observe a change in mental status including irritability initially and later, confusion, lethargy, weakness, fatigue, dizziness, weight loss (3% or greater), decreased urine output, increased urine concentration, poor skin turgor, dry skin and mucous membranes, and thirst. Muscle cramping may occur initially, followed by hyperreflexia, increased pulse rate, and decreased jugular venous pressure and blood pressure. In addition to elevated serum sodium, the patient may have elevated Hb and Hct (Clark & Baldwin, 2004; Foreman, Mion, Trygstad, & Fletcher, 2003; Larson, 2003). Treatment includes intravenous infusion of 0.9% sodium chloride or normal saline (which is the normal concentration of sodium chloride in the blood plasma) and monitoring of intake, output, vital signs, and daily weight (Kugler & Hustead, 2000).

Hypokalemia: Causes and Treatment

Normal potassium (K) levels can vary depending on the laboratory, and as with all electrolytes, little variation from the norm is acceptable and should be reported immediately to the healthcare provider. This is particularly true in patients who have been or are being treated for cardiac disease, renal disease, diabetes, Cushing’s disease, gastrointestinal disturbances necessitating suctioning, or problems with diarrhea.

Vomiting, diarrhea, suctioning (gastrointestinal), diuretics, and insulin can all cause hypokalemia. The patient experiencing hypokalemia may complain of muscle weakness. Potassium is vital to cardiac functioning, and therefore fluctuations such as a flattening of the T wave and later ST depression are reflected in the electrocardiogram. If this technology is unavailable, there are other symptoms to note, such as a decrease in both blood pressure and bowel sounds (Fishbach, 2004).

If the patient is on digoxin, it is important to note that kidney function diminishes with age, and as a result there may be a decreased ability to clear digoxin from the body. In addition, a person who is on digoxin may often be on diuretics, which may cause further depletion of potassium even if the person is taking potassium supplements (Harrington, 2005). These two situations may result in digoxin toxicity, which is evidenced by such signs and symptoms as nausea, vomiting, visual changes, blurred vision, anorexia, palpitations, and, in older adults, mental status changes. It is therefore particularly important to monitor both digoxin and potassium levels carefully and frequently, especially if drugs are newly initiated or if the person has concurrent kidney disease.

Treatment for hypokalemia is through supplementation, usually given orally in the rehabilitation setting, but it may need to be given intravenously in severe cases. Orally, potassium may be given in pill or diluted liquid form. Intravenously, it must always be diluted and never infused rapidly. It is infused at a rate of no more than 10-20 mEq/hr for intermittent potassium dosing. Higher infusion rates are reserved for more critical situations, and when this occurs, the patient may need to be transferred to a hospital because continuous cardiac monitoring is recommended. In these cases and at these dosages it is also recommended that potassium be given by central line to minimize phlebitis (Kraft, Btaiche, Sacks, & Kudsk, 2005). It is extremely important to remember that the patient must have urinary output of 20-30 cc per hour before being given any type of potassium supplementation.

Hyperkalemia: Causes and Treatment

Burns, necrotizing tissue, Addison’s disease, hypoxia, acidosis, overuse of salt substitutes, and potassium replacement can cause hyperkalemia (National Institutes of Health, 2005). The patient experiencing hyperkalemia may complain of numbness and tingling in hands and feet along with diarrhea, and the nurse caring for the person may note a slowed pulse rate or bradycardia, an irregular rhythm confirmed by electrocardiogram, and signs such as apathy, confusion, and hyperactive bowel sounds. Untreated hyperkalemia can result in cardiac arrest.

Before reporting or treating an abnormal potassium value, it is essential to determine whether the sample was drawn adequately. Because potassium is mostly intracellular, it is released into serum when the cell wall is broken, which can result even from difficulty obtaining the specimen. This can result in hemolysis, causing a falsely elevated level. The laboratory should be called to verify the adequacy of the sample. If the serum level is elevated, the treatment of hyperkalemia initially involves Kayexalate enemas (Harrington, 2005). If the condition is severe or the person does not respond quickly enough, intravenous insulin and glucose may be necessary; the insulin binds to the potassium, thus decreasing the concentration in the blood. Glucose is given to stabilize the blood sugar *” level. These treatments often necessitate transfer to an acute care facility.

Nutritional Concerns

Considered part of liver function tests, prealbumin is an important laboratory value in the adult because it provides a window into nutritional status. Malnutrition is a multifaceted problem and can be the result of limited income, social isolation, decreased appetite, chronic illness, depression, and physiological changes (DiMaria-Ghalili & Amelia, 2005).

During hospitalization, and even in the rehabilitation setting, dietary intake can be poor. This places the patient at risk for low protein intake, which can delay wound healing and can be associated with skin breakdown, infection, and an increased risk of morbidity. It is essential for nurses to know how to screen for and when to report nutrition concerns (DiMaria-Ghalili & Amelia, 2005; Lawrence & Amelia, 2004; Stechmiller, 2003). Prealbumin is the preferred laboratory test to screen for nutrition problems. It is not affected by hydration status, but it is low in patients with malignant conditions and temporarily in the postoperative period or when inflammation is present. Prealbumin levels of 5.0 mg/dl or less indicate poor prognosis, and additional treatments including intravenous hyperalimentation may be needed (Beck, 2002; Stechmiller, 2003). Nutritional screening by nursing in the rehabilitation setting is essential, and several good tools for nurses are available, such as those provided by the Hartford Institute for Geriatric Nursing (Lawrence & Amelia, 2004). All nutritional concerns should be conveyed to the physician and a nutritionist for appropriate intervention.

Medications, Dehydration, Malnutrition, and the Aging Kidney

Blood urea nitrogen (BUN) and creatinine are laboratory values usually considered together and provide the nurse with a picture of the filtering function of the kidneys and the degree of bodily hydration. The normal range for BUN is 7-20 mg/dl, and for creatinine it is 0.6-1.2 mg/dl. The ratio of BUN to creatinine normally is 20:1 (Larson, 2003). Increases in the BUN and creatinine are caused by dehydration (too little water in the tissues), any condition that decreases blood flow to the kidneys, blood in the intestinal tract, or a large meal of cooked meat. Malnutrition, kidney diseases, liver disease, and sickle cell anemia cause increases in the BUN and creatinine.

With decreases in muscle mass as a person ages, creatinine production slows, as does the ability to excrete creatinine; therefore, a creatinine level in an older adult that is within the normal laboratory range may actually reveal impairment. Because lean body mass declines with aging, the total production of creatinine also declines, and as a result static measurements may overestimate renal function in older adults. Therefore, creatinine clearance provides a more accurate picture of renal function, which is important when one is considering hydration status and the potential for drug toxicity (Melillo, 1993). One formula commonly used to estimate creatinine clearance based on serum creatinine is the Cockcroft-Gault equation: creatinine clearance (ml/min) = {[140 (-) age (years)] (x) weight (kg)}/[72 (x) serum creatinine concentration (mg/dl)]. For women, multiply the result by 0.85 (Larson, 2003).

Hypotension in itself can be a precipitating factor for diminished renal function, but it can also be a symptom of dehydration, along with poor skin turgor, low urine output, and complaints of thirst. However, thirst often tends to be diminished in older adults. It has been suggested that skin turgor assessment in the older adult should be tested on the inner aspect of the thigh or over the sternum (Larson, 2003). Dehydration is treated with fluid replacement starting with oral rehydration and advancing to intravenous treatments as indicated. Assessing skin turgor and measuring intake, output, vital signs, and daily weights will determine effectiveness of the plan. Because a common presentation in older adults with dehydration is altered mental status and lethargy, improvement in energy and mental status would also indicate effectiveness of the plan (Beer\s & Berkow, 2000).

Two common medications that can cause altered renal function are angiotensin-converting enzyme inhibitors and nonsteroidal antiinflammatory drugs. Lithium and some antibiotics and cardiac antiarrhythmic medications can also be detrimental to kidney function; therefore, creatinine clearance must be monitored in these situations as well (Larson, 2003).

Drug Toxicity

Drug levels in the rehabilitation setting are obtained for several reasons: when a drug is newly prescribed and it is necessary to know whether the therapeutic range has been reached, when an underlying medical condition may place the person at risk for toxicity, and when one drug may potentiate the action of another. The latter can be a common problem among older adults because of polypharmacy (Fishbach, 2004). In general, drug levels are drawn when the drug has a narrow therapeutic range or when the person has preexisting medical conditions such as renal failure or age-related changes such as decreased renal or liver function that may alter the drug level.

Some commonly used medications necessitating routine drug level measurements include anticonvulsants, antibiotics, antiarrhythmics, bronchodilators, and cardiotonics, all of which have narrow therapeutic ranges. Therapeutic drug levels can be monitored for many other drugs if toxicity is suspected. The frequency of testing depends on the medication itself, its potential for toxicity, underlying preexisting medical conditions, and changes in a person’s medical condition, appearance, signs, and symptoms; more frequent testing may be needed when the desired therapeutic response is not achieved (Fishbach, 2004). Any drug level below or above the therapeutic range should be reported immediately, along with changes in mental status, vision or hearing disturbances, weight changes, gastrointestinal distress, or changes in vital signs.

Liver function tests (LFTs) are a group of blood tests that measure substances in the blood that indicate how well the liver is working. LFTs include alanine transaminase, aspartate transaminase, alkaline phosphatase (ALP), gamma-glutamyl transpeptidase, total and direct bilirubin and albumin, and total protein. The liver produces bilirubin, and elevations of this value and the ALP usually are associated with blockages in the bile duct, such as gallstones, but can be associated with rumors or chronic alcoholism (National Institutes of Health, 2005).

The rehabilitation nurse should be concerned with liver disorders such as hepatitis or cirrhosis and with illicit drug use and overconsumption of alcohol, which are sometimes overlooked in older adults (Masters, 2003). In older adults the ALP may be slightly elevated, yet overall LFTs may be unchanged. Newly elevated LFTs warrant further assessment of the skin and sciera of the eyes to determine whether jaundice is present. Other assessment criteria should include checking for pruritus and increases in abdominal girth. The presence or absence of these findings should be reported along with elevated LFT results.

Treatment varies greatly depending on the causative agent and may include anything from discontinuation of the liver toxic substance, to surgery to remove a blockage, to palliative care to ease the suffering. The toxic substance may include an infectious agent, a prescribed drug, or substance abuse.

Bleeding Problems and Anticoagulation

Blood clots are a risk after many surgeries, trauma, or recovery periods necessitating prolonged inactivity. To reduce the incidence of such complications prophylactic anticoagulation therapy is used. This entails frequent monitoring of the platelets, prothrombin time (PT), or international normalized ratio (INR). With anticoagulation therapy, the therapeutic range rather than a normal value is the goal (Warkentin & Greinacher, 2004). For example, a person can have a normal PT or INR but not be in therapeutic range if he or she is on warfarin. Some situations necessitating prophylactic anticoagulation therapy are obesity and cardiac or orthopedic surgery. Each of these situations warrants a different therapeutic range for the INR or PT.

Heparin is no longer a preferred agent for prophylactic therapy because of the risk of heparin-induced thrombocytopenia, which can cause deep vein thrombosis, pulmonary embolism, myocardial infarction, skin necrosis, end organ damage, and death. Instead, low molecular weight heparin or warfarin sodium is used for prophylactic anticoagulation therapy (Warkentin & Greinacher, 2004).

All patients on warfarin or low molecular weight heparin should have frequent monitoring as follows. All results should be reported to the medical group managing prophylactic therapy as soon as they are obtained (Warkentin & Greinacher, 2004).

* Low molecular weight heparin: at least every-other-day platelet count monitoring until day 14, or until low molecular weight heparin is stopped.

* Warfarin: PT or INR daily until therapeutic range is achieved, then two or three times per week, then once per month during treatment (Hirsh, Fuster, Ansell, & Halperin, 2003).

It is important to note that the platelets, PT, and INR are measures of clotting, which depends on vitamin K and protein made by the liver. Liver cell damage and bile flow obstruction can interfere with proper blood clotting.

Along with calcium, vitamin K, and fibrinogen, platelets aid in blood dotting. A normal platelet count is approximately 150,00- 400,000, and platelet counts less than this can be considered thrombocytopenia. When platelets drop below 30,000, it is critical because the person’s ability to clot or heal after injury is seriously compromised (George-Gay & Parker, 2003). Although there are several blood disorders that result in thrombocytopenia, it is more commonly the result of certain medications, such as chemotherapy, and autoimmune disorders such as lupus. Any low platelet count should be reported along with the previous result of a platelet count (if known) and symptoms of bleeding difficulties such as petechiae (painless, round, reddened pinpoints on the skin), ecchymosis (purple, blue, or yellow-green bruises), nosebleeds, malaise, fatigue and general weakness, temperature, and abnormal vital signs.

Rarely, people can have problems with elevated platelet production, which can be a benign condition occurring in the absence of other medical problems or a result of a blood disorder. With elevated platelet production, two seemingly opposite conditions are possible (Fishbach, 2004). Despite the elevated production of platelets, bleeding can occur because the platelets may lack adhesive properties, or as a result of an elevated number of platelets, adhesions may occur and result in a vascular clot. The latter situation is urgent and may warrant transfer to an acute care facility. Any symptoms associated with emboli should be reported immediately. These include chest pain, shortness of breath, changes in vital signs, confusion, and calf area irritation, swelling, redness, or tenderness.

Infection

The WBC is the measure of white blood cells in the whole blood. There are five types of WBCs, which together are known as the differential: neutrophils, eosinophils, monocytes, lymphocytes, and basophils. In general, WBC elevations are an indication of infection, but confusion may be the only presenting symptom initially (Foreman et al., 2003). A low WBC can indicate some types of cancers or blood disorders. Therefore, increases or decreases should be reported to the provider immediately, along with changes in the person’s general condition, respiratory status, skin, body temperature, other vital signs, aches, night sweats, gastrointestinal distress, urine output, weakness, or generalized malaise.

The urinalysis is a routine test used to screen for myriad health problems. A positive urinalysis may be significant for problems such as infection, diabetes, renal failure, fever, vomiting, excessive sweating, dehydration, poor nutrition, anorexia, cirrhosis, hepatitis, gallstones, liver tumors, and hyperthyroidism (National Institutes of Health, 2005).

In some situations, such as diabetes, a patient may have a positive chemical urinalysis, and ketones or glucose may be present (Haas, 2005). It is therefore important to know the patient’s history, but typically any variation from a normal urinalysis warrants reporting to the primary provider, who may initiate treatment or perform additional testing. Along with reporting the positive urinalysis, the nurse should record the patient’s self- report of overall health, past medical history, and current medications and assess the patient’s appearance, temperature, vital signs, intake, output, and any odors or complaints such as urinary frequency and burning.

A urine culture and sensitivity may be ordered in conjunction with the urinalysis. It is important that this sample be obtained as cleanly as possible; if a catheter is in place, a sterile specimen can be obtained. Institutions and manufacturers of specimen kits will provide instructions for sample collection, and they should be followed closely. The tests are sent to bacteriology laboratories, and results usually take several days. The results will report the presence of specific bacteria and indicate the antibiotics to which the strain is sensitive or resistant. Similarly, other specimens such as blood, sputum, and stool may be obtained for bacteriology, with findings reported in the same manner as urine culture and sensitivity.

Conclusions

In the rehabilitation setting, laboratory values can provide the nurse with critical information about the health status of their patients. Seldom will the findings alone provide the whole picture. Because of age-related changes, symptoms in older adults may not be the same as those in a younger person. For example, a change in mental status may be the only warning of an infection or dehydration. It is therefore important to \assess the patient frequently and be able to readily detect changes in the usual pattern. The nurse must also know when and what to report to the primary provider.

Small and subtle changes keenly observed make the difference in early diagnosis and treatment of health problems in the rehabilitation setting. The nurse’s knowledge of the patient and the patient’s history, medications, and unique variations is essential to providing optimal care.

Case Study

Mrs. R is an 84-year-old woman admitted to the rehabilitation setting after a 3-week stay at an acute care hospital. Her admitting diagnosis is traumatic brain injury and fractured left hip after a fall at home. Until this event, she had been living at home with her husband and was healthy, with only a history of atrial fibrillation. She now presents with confusion. The following laboratory findings are important for you to know about.

* CBC: Elevations in the WBC could be a sign of infection.

* Electrolytes and creatinine clearance: These provide information about hydration status, which could be altered and lead to confusion.

* Platelets, PT, and INR: If she is on anticoagulation, this will provide information about whether Mrs. R’s drug level is in therapeutic range. This is particularly important because of her fracture history, traumatic brain injury, and atrial fibrillation history. All three conditions place her at risk for a blood clot, and a presenting sign can be increased confusion.

* Urinalysis, culture, and sensitivity: Even though she is not known to be a diabetic, she could have unknown diabetes, be newly diagnosed while hospitalized, or develop diabetes caused by medications such as prednisone. Also, she may have a urinary tract infection, which would be noted on a culture and sensitivity.

* Have any drug levels been drawn? If the patient is on antibiotics, it indicates a history of infection (that may or may not be improving). Confusion can be a sign of infection.

* Prealbumin level: This will provide a window on her nutritional status, and poor nutrition can contribute to confusion.

* LFT: An elevated LFT may indicate an underlying alcohol or drug dependency problem.

Other considerations in the treatment plan for hyponatremia include careful monitoring of vital signs, daily weightlifting, intake and output measurement, and assessment of signs and symptoms of hypernatremia.

Hypotension in itself can be a precipitating factor for diminished renal function, but it can also be a symptom of dehydration, along with poor skin turgor, low urine output, and complaints of thirst.

References

Amelia, E. (2004). Presentation of illness in older adults: If you think you know what you are looking for, think again. American Journal of Nursing, 104(10), 40-51.

Beck, F. (2002). Prealbumin: A marker for nutritional evaluation. American Family Physician, 65(8), 1575-1578.

Beers, M. H., & Berkow, R. (Eds.). (2000). The Merck manual of geriatrics (3rd ed.). Whitehouse Station, NJ: Merck Research Laboratories.

Clark, A., & Baldwin, K. (2004). Best practices of older adults: Highlights and summary from the preconference. NACNS National Conference, March 10 2004, San Antonio, Texas. Clinical Nurse Specialist, 18(6), 288-299.

Clark, B., & Halm, M. (2003). Postprocedural acute confusion in the elderly: Assessment tools can minimize this common condition. American Journal of Nursing, 103(5), 64UU-64AA3.

DiMaria-Ghalili, R., & Amelia, E. (2005). Nutrition in older adults: Intervention and assessment can help curb the growing threat of malnutrition. American Journal of Nursing, 305(3), 40-51.

Fishbach, F. (2004). A manual of laboratory & diagnostic tests (6th ed.). Philadelphia: Lippincott.

Foreman, M. D., Mion, L. C., Trygstad, L., & Fletcher, K. (2003). Delirium: Strategies for assessing and treating. In M. Mezey, T. Fulmer, I. Abraham, & D. A. Zwicker (Eds.), Geriatric nursing protocols for best practice (2nd ed., pp. 116-140). New York: Springer.

George-Gay, B. & Parker, K. (2003). Understanding the complete blood count with differential. Journal of Perianesthesia Nursing, 18, 96-114.

Haas, L. (2005). Management of diabetes mellitus medications in the nursing home. Drugs & Aging, 22(3), 209-218.

Harrington, L. (2005). Potassium protocols: In search of evidence. Clinical Nurse Specialist, 19(3), 137-141.

Hirsh, J., Fuster, V., Ansell, J., & Halperin, J. L. (2003). American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. AHA/ ACC scientific statement. Circulation, 107, 1692-1711.

Kraft, M. D., Btaiche, I. F., Sacks, G. S., & Kudsk, K. A. (2005). Treatment of electrolyte disorders in adult patients in the intensive care unit. American Journal of Health System Pharmacy, 62, 1663-1682.

Kugler, J., & Hustead, T. (2000). Hyponatremia and hypernatremia in the elderly. American Family Physician, 6(12), 3623-3647.

Larson, K. (2003). Fluid balance in the elderly: Assessment and intervention-important role in community health and home care nursing. Geriatric Nursing, 24(5), 306-309.

Lawrence, J., & Amelia, E. (2004). Assessing nutrition in older adults. Retrieved July 15, 2005, from www.hartfordign. org/ resources/education/tryThis.html.

Masters, J. (2003). Moderate alcohol consumption and unappreciated risk for alcohol-related harm among ethnically diverse, urban-dwelling elders. Geriatric Nursing, 24(3), 155-161.

Melillo, K. D. (1993). Interpretation of laboratory values in older adults. The Nurse Practitioner: The American Journal of Primary Health Care, 18(7), 59-67.

National Institutes of Health. (2005). Medline Plus medical encyclopedia of the United States National Library of National Institutes of Health. Retrieved July 6, 2005, from www.nlm. nih.gov/ medlineplus/encyclopedia.html.

Stechmiller, J. (2003). Early nutrition screening of older adults: Review and nutritional support. Journal of Infusion Nursing, 26(3), 170-177.

Warkentin, T, & Greinacher, A. (2004). Heparin-induced thrombocytopenia: Recognition, treatment, and prevention. Chest, 126, 311-337.

Jane Flanagan, PhD APRN BC * Karen Devereaux Melillo, PhD APRN BC FAANP * Lisa Abdallah, PhD RN * Ruth Remington, PhD APRN BC

About the Authors

Jane Flanagan, PhD APRN BC, is an assistant professor at Connell School of Nursing, Boston College. Address correspondence to her at 140 Commonwealth Avenue, Chestnut Hill, MA 02467, or [email protected].

Karen Devereaux Melillo, PhD APRN BC FAANP, is a professor and chair at the Department of Nursing School of Health and Environment, University of Massachusetts, Lowell, MA.

Lisa Abdallah, PhD RN, is an assistant professor at the Department of Nursing School of Health and Environment, University of Massachusetts, Lowell, MA.

Ruth Remington, PhD APRN BC, is an assistant professor at the Department of Nursing School of Health and Environment, University of Massachusetts, Lowell, MA.

Copyright Association of Rehabilitation Nurses Mar/Apr 2007

(c) 2007 Rehabilitation Nursing. Provided by ProQuest Information and Learning. All rights Reserved.

By Anonymous

DETOX DOESN’T HAVE TO BE A DIFFICULT OR PUNISHING EXPERIENCE. LIGHTEN YOUR BODY’S TOXIC LOAD WITH A FEW GENTLE CHANGES THAT PROMISE INNER AND OUTER RADIANCE

Our Short piece on Kat James (“TheTruth About Kat lames,” February, p. 68)-passionate natural health expert and well-known author of the newly rereleased book The Truth About Beauty-left us craving more details, particularly concerning her gentle approach to detox. From juicing to fasting to herbal cleanses and colonies, lames shares her personal detox regimen in this question-and-answer format, and reveals the best way to cleanse your body and improve nagging health issues using natural products.

Q: You say that your first experience with detox not only changed your life, but may have also saved it. Please explain how.

A: The first half of my life was my “toxic accumulation” period. I grew up on processed foods, soda and the occasional salad from a salad bar (complete with artificial bacon bits, orange-dyed cheese and hydrogenated croutons). I developed an eating disorder at age 13, which progressed to bulimia by high school.

By age 24, along with horrible rashes, bladder infections, and increasing heart palpitations and mood swings, came a scarier symptom: I started to pass undigested material. A doctor said my liver was inflamed (sky-high enzymes, but no viral hepatitis). Amazingly, he made no nutritional recommendations, but was quick to prescribe an immuno-suppressive drug that was notorious for causing side effects. That was the day I stepped into a health food store. I set out to learn about alternatives.

A few months of reading, a few blood tests and a few bottles of milk thistle, fish oil and alpha-lipoic acid Liter, my liver enzymes returned to normal, which shocked both my doctor and me. But the real revelation for me was the unexpected positive changes in my digestion, skin (rashes and painfully dry skin were gone) and improved mood. Suddenly I was a believer in nutrition-this also helped put me on the road to freedom from my eating disorder.

Q: What is the role of detox in beauty?

A: I learned personally that detox, and its counterpart, nourishment, are the dynamic duo that creates vitality-the harmonious, effortless radiance nature intended everyone to achieve.

But when most of us think of beauty, we think of the countless products on our bathroom shelves that we’ve been convinced are necessary to achieve acceptable personal hygiene and grooming. Detox strives for the ultimate hygiene-the pursuit of a thriving inner ecology that makes us glow without makeup. I’m living proof that fixing that internal ecology can turn back the clock and give us far greater beauty rewards than any makeup tricks or skin-care regimen ever can.

Most of us were born with near-perfect body ecology, but things like too much sugar, chlorinated water, air pollution, prescription drugs and even the synthetic grooming products present constant challenges to our internal balance. Until they’re addressed, we can expect a steady onslaught of consequences ranging from blemishes, bloating, under-eye circles, itchy scalp and weight gain to deeper health issues, such as fatigue, depression and autoimmune syndromes.

Halting continued toxic assaults is part of the solution. Detox is pan of the recovery.

Q: Do you recommend seasonal cleanses?

A: I think people just starting out might find a seasonal detox ideal. For most people, it can take several years to phase out challenging foods and vices. You may have to go through several evolutions before reaching a point at which you no longer want to return to your old, toxic lifestyle habits. Seasonal cleanses can then become a way to focus your efforts.

For me detox is not seasonal, but rather a way of life and a way of caring for myself on autopilot-both defensively and assertively- year-round. Once you come to desire the very choices that rejuvenate you and have phased out most of the toxic assaults you can control, there is little or no conscious effort required in continuing the process. I would never have thought that to be possible, and I affectionately call the state “beauty nirvana.”

Q: Are you a fan of harsh fasting therapies?

A: Some experts advocate fasting and some do not. I was overweight and insulin-resistant. For people with these issues (who now comprise at least two-thirds of our country!), fasting can be a problem.

Restricting food intake or skipping meals can worsen unstable blood sugar issues and even lead to bingeing. However, a small percentage of people who do not have blood sugar or weight issues (typically people who didn’t consume much soda or white flour growing up), can usually fast and/or do all-day “juice” fasts (drinking fruit and vegetable juices only) without harm.

Q: What do you think about cleansing programs?

A: I think everyone should get informed about liver, gallbladder and other cleanses, and educate themselves with the teachings of detox pioneers Bernard Jensen (author of Dr. Jensen’s Guide to Diet and Detoxification and many other books) and Elson Haas (author of several books, including The New Detox Diet). Your gut (literally), will tell you where to go from there.

It was from Brenda Watson, CT, author of Gut Solutions and other books, that I learned about the seven channels of elimination and the proper order for detox. (Hint: keep a clean colon, no matter what!)

I use cleansing products myself because I live in New York City, a toxic big city, but I avoid products with harsh ingredients, such as those containing the laxative herb senna.

Q: What are the benefits of detox?

A: If you have been consuming a lot of sugar, then generally speaking, your face could look “de-puffed” one or two mornings after getting off sugar (inflammation goes way down).

Other benefits: Energy dips start to disappear soon thereafter, though there are about three days of craving sugar, which can be greatly reduced by incorporating blood sugar-stabilizing supplements. [Editor’s note: To help you detox from sugar, look for a combination formula designed to balance blood sugar at the health food store.]

In a few days, abdominal bloating decreases as yeast and gut fermentation from processed flours and sugar are halted. In a week, cravings are all but gone and this affects your shape and mood dramatically. Within the month, skin looks healthier, eyes are clearer and weight loss is substantial. Best of all, no fasting, or even calorie deprivation, is required to achieve these results.

3 SHORTCUTS TO DETOX (THAT YOU CAN DO EVERY DAY!)

At her Total Transformation retreats (for schedule, see informedbeauty.com), James helps people detoxify their systems. In addition to the exploration of effective nontoxic beauty and personal care practices, the following three steps represent the most critical elements of James’ regimen:

1 Get the sugar out. Weaning off sugar is central to her approach. This not only starves yeast in the gut, which improves body ecology, it is the fastest step toward conquering cravings and weight issues, and achieving younger-looking, healthier skin.

2 Eat nourishing foods. She serves lots of organic greens and berries, as well as hempseed (an amazing grain substitute rich in omega fats), nuts, and grass-fed or wild meats and fish.

3 Cleanse naturally. She also incorporates her daily Beauty Detox Elixir, which is a whole juice rather than a conventional sugary juice, and therefore free of added sugar and preservatives (see p.49 for recipe). Certain detox products can help, especially in the beginning. James recommends the following nutritional supplements for cleansing and energizing the body:

* CleanseSmart by Renew Life-helps support the body’s key channels of elimination.

* 4Fiber by Genesis Today-a nutritive fiber that helps provide blood sugar support and offers a source of probiotics for intestinal/ gut health.

* LiverCare by Himalaya-a powerful liver detoxification formula that does not contain milk thistle but rather a blend of cleansing Ayurvedic herbs.

* PectaSol by Source Naturals (or another manufacturer)-this is one of the ony forms of modified citrus pectin shown to be effective at removing mercury and other heavy metals from the body, says James.

DO YOU NEED TO DETOX?

Some signs that your body is full of toxins include:

* Blemishes, eczema, psoriasis, hives

* Bloating, water retention

* Under-eye circles

* Itchy scalp, as well as itchy skin, eyes, ears

* Weight gain

* Fatigue and disturbed sleep

* Depression, foggy thinking, anxiety, poor memory

* Autoimmune diseases

* Bloodshot eyes, swollen or inflamed eyelids

* Constipation or diarrhea, belching or gas and/or heartburn and indigestion

* Uncontrollable food cravings

* Aching or painful joints

* Headaches or migraines

kat’s beauty detox elixir Makes 2 10-0z. servings

Made from 100% whole juice, this elixir is an uncommonly tasty way to detoxify and reveal vibrant skin. For best results, use a heavy-duty blender or juicer. You want to retain as much fiber from the fruits and vegetables as possible. Fiber-rich foods are particularly ideal for diabetics or those with blood sugar issues, as they help maintain blood sugar levels.

1 cups cold water or aloe juice (aloe juice helps digestion and regularity)

1/3 cup of fresh parsley (alkalizing and detoxifying)

cup of fresh dark greens, such as arugula, kale or watercress (rich in detoxifying chlorophyll and enzy\mes)

11-inch wedge of cabbage (helps heal the stomach lining)

1-inch piece of ginger, peeled (for enhanced circulation and digestion)

lemon, scrubbed hut not peeled (alkalizing and tastes great; peel is rich in bioflavanoids, which make the fruit’s vitamin C more effective)

small beet (for its blood-cleansing properties)

Pinch of cayenne or -inch slice of small jalapeno pepper (a digestive aid that tastes great, reduces pain and even compulsive behaviors)

2 tsp. xylitol or packet “de-bittered” stevia (these natural sweeteners smooth out the taste and have their own health benefits)

Bonus: Add a sprig of fresh herbs, such as cilantro (a great heavy metal detoxifier), rosemary or thyme, for added cleansing and antioxidant effects

Combine ingredients in machine (reserve cup of water or aloe juice) and run for 15 seconds on a medium speed and then on high for another 15 seconds. Taste and add remaining water, sweetener and a handful of ice cubes, if desired. Process on high until the mixture is very thin-it will thicken quickly once the fiber expands and absorbs liquid,

PER SERVING: 101 CAL; 3C PROT;

Above, author Kat lames talks about detox at one of her Total Transformation retreats.

Copyright Active Interest Media Mar 2007

(c) 2007 Better Nutrition. Provided by ProQuest Information and Learning. All rights Reserved.

MINNEAPOLIS, Feb. 28 /PRNewswire/ — Cardiocom Multi-Disease Management, a leader in innovative telehealth solutions for chronic disease management, today launched its new enterprise level Omnivisor Pro Telemonitoring Patient Management System that will assist physicians, hospitals, health plans, home health agencies and disease management companies to operate more cost- effectively by enabling improved management of clinical data transmitted daily from the patient’s home. Cardiocom will showcase its newest hardware and software system at the American Medical Group Association’s 2007 Annual Conference at Booth #307.

The Omnivisor Pro System connects patients and their health care professionals. It enables the nurse to coordinate care and assist the treating physician by quickly and concisely supplying real-time data about an at-risk patient. The flexible suite of Cardiocom telemonitoring devices, including Telescale(TM), Commander and AutoLink(TM), interact with the Omnivisor Pro System to provide daily remote monitoring of patients’ vital signs and symptoms. Data is transmitted via a standard telephone line or using the optional Commander Cellular connection. Clinicians can then assess what interventions are required to change medications and/or treatment plans and coach the patient in self-management skills.

Omnivisor Pro is an ASP.NET(R) browser-based system built on Microsoft(R) technologies, utilizing the .NET(R) 2.0 Framework and SQL Server(TM) 2000. This allows for universal access by Cardiocom’s clients via intranet or a dedicated connection, as well as high performance and scalability to manage very large patient populations. The single point of deployment feature provides low IT maintenance and minimal down time. Omnivisor Pro can be installed at the client site in about a day.

“The Omnivisor Pro System brings the next generation in enterprise level remote patient monitoring and more cost-effective solutions to our customers,” said Daniel Cosentino, Cardiocom President. “In developing Omnivisor Pro we focused on creating a comprehensive system that improves clinical staff to patient ratios, delivers advanced patient management features and provides a flexible platform for tighter integration with clients.”

The Omnivisor Pro System uses branching clinical algorithms to automatically identify each day’s “exception” patients with symptoms outside the individual parameters set by the patient’s physician. Cardiocom’s “management by exception” approach allows the case manager to focus time on patients who need the most immediate assistance. This distinctive technology can reduce staffing ratios and free nurses for other patient care responsibilities. The System also provides succinct, actionable reports that display current objective and subjective health data for the clinician.

About Cardiocom LLC

Cardiocom ( http://www.cardiocom.com/ ) is an award-winning leader in innovative patient telemonitoring and disease management solutions. Founded in 1997, Cardiocom develops, manufactures and markets its own telehealth devices for congestive heart failure, diabetes, hypertension, obesity, COPD, severe asthma, and ESRD. GlucoCom(TM) ( http://www.glucocom.com/ ), a division of Cardiocom offering blood glucose monitoring products, was added to the product line in 2006. Cardiocom’s clients include some of the most respected health plans, hospitals, physician groups, home health groups and disease management vendors in the nation. Through these established relationships, Cardiocom improves the lives of thousands of people each day.

   Contact:   Jodie Root, Vice President, Sales & Marketing, Cardiocom   888-243-8881 or [email protected]  

Cardiocom Multi-Disease Management

CONTACT: Jodie Root, Vice President, Sales & Marketing, Cardiocom,+1-888-243-8881, [email protected] ; Product Inquiries, +1-952-361-6467

Web site: http://www.cardiocom.net/

Privately held U.S. HealthWorks, the nation’s second largest operator of outpatient occupational health and urgent care centers, today announced the appointment of David Lamm as Chief Financial Officer (CFO) effective today.

Mr. Lamm replaces Robert DiProva, Senior Vice President of Finance and Administration, who steps down today. Mr. DiProva has been at U.S. HealthWorks since August 2002 and led the Finance Department since November 2003, playing a key role in supporting the balance sheet restructuring in 2004 and 2005, the dramatic improvements to the Company’s performance and in the acquisition of the Company by a new ownership group in December 2006.

“Bob has been a key member of our management team,” said Daniel D. Crowley, Chief Executive Officer of U.S. HealthWorks. “We have enjoyed working with him immensely, we appreciate his consistently valuable contributions to the organization and we wish him all the best in his future endeavors.”

Mr. Crowley continued: “David Lamm will be a strong addition to our management team. He comes to U.S. HealthWorks from Kaiser Permanente, where he was National Vice President of Patient Billing Services and prior to that Vice President and Controller of Kaiser’s California Division. During the 1990s, he was CFO of two publicly traded technology companies and Vice President, Finance of the Information Technologies Division of McKesson Corporation. Prior to that he was a Vice President, Finance, for a subsidiary of American Airlines and an auditor for a major accounting firm.

“We intend to grow the business rapidly, and Finance and Operations will be working together to identify and evaluate potential acquisitions,” said Mr. Crowley. “One of David’s first tasks at U.S. HealthWorks will be to evaluate options for relocating the Company’s headquarters to California, while maintaining a regional operations center in Alpharetta. With more than half of the Company’s business is in California, we believe performance can be enhanced by having the Finance Department near our California Operations and Billing Center.”

U.S. HealthWorks was founded in 1995 and is a leading national operator of occupational health and urgent care centers specializing in injury care, early return-to-work programs, injury prevention and wellness programs. Operating 114 medical centers in 13 states with more than 2,000 employees and approximately 350 affiliated physicians, U.S. HealthWorks centers serve more than 10,000 patients each day. For more information, visit www.ushealthworks.com.

The New York Otolaryngology Group (NYOG), recognized as one of the nation’s leading otolaryngology practices, announced today that Dr. Jamie Koufman, a preeminent surgeon and academician specializing in voice disorders, has joined its medical practice to oversee its newly formed Voice Institute of New York.

Dr. Koufman, one of the first full-time academic surgical laryngologists, has pioneered laser surgery of the vocal cords, performed in her office without incisions or anesthesia. She has treated well-known CEOs, broadcasters, and performers, including Doug Gray, the lead singer of the Marshall Tucker Band, who last year publicly thanked Dr. Koufman at a concert for restoring his voice after his vocal cords were damaged.

Dr. Koufman, previously a professor of otolaryngology at the Wake Forest University School of Medicine, was the founder and director of the voice center there. She also identified the disorder and coined the term “silent reflux,” a condition in which people suffer from gastric reflux symptoms in the upper throat and larynx (voice box), without esophageal symptoms such as heartburn. She has patented a diagnostic saliva test for the detection of gastric reflux that has been licensed by Bayer HealthCare’s Diagnostics Division.

Reflux is a major cause of incessant throat clearing and other throat disorders. Reflux also is a cause of sinusitis, but the condition is frequently undiagnosed, often resulting in unnecessary surgery or other medical procedures. Acid reflux can also cause sleep disorders, another NYOG treatment specialty.

“Our practice has long focused on ensuring that our patients receive the most advanced medical care and minimally invasive procedures,” said NYOG co-founder Dr. Scott Gold, who along with NYOG co-founder Dr. Robert Pincus, has repeatedly been ranked by New York Magazine and Castle Connelly Medical Ltd. as New York’s top sinus doctors. “Dr. Koufman’s ability to perform what until recently was a major surgical procedure as an in-office treatment where the patient can return to work right away is truly a medical breakthrough. Dr. Koufman’s extensive research and treatment of acid reflux will further enhance our ability to diagnose and treat this rapidly growing disease, which also is known to cause esophageal cancer.”

In addition to her directorship at the Voice Institute of New York, Dr. Koufman is currently Adjunct Clinical Professor of Surgery (Otolaryngology) at the George Washington School of Medicine and Adjunct Clinical Professor of Otolaryngology at Drexel University. She earned her medical degree from Boston University School of Medicine. She was chief resident at the time she completed the residency program in otolaryngology (head and neck surgery) jointly sponsored by Tufts University and Boston University School of Medicine.

Dr. Koufman has received numerous national honors and awards in recognition of her contributions to the field of laryngology, including recently a Presidential Citation for Contributions to the Field of Laryngology from the American Laryngological Association. A frequent lecturer, Dr. Koufman has written six books and contributed to more than three dozen others. She has also authored over 100 peer-reviewed scientific journal articles that relate to reflux and voice disorders.

The Voice Institute of New York is located at 9 West 67th Street (CPW). The main phone number is 212-884-8277.

About The Voice Institute of New York

The Voice Institute of New York is one of the most comprehensive voice centers in the United States, providing medical services for people with voice problems and other disorders of the larynx. Specialized clinical services are available for professional voice users (singers, actors, etc.) and others with vocal overuse syndromes, recurrent laryngitis, spasmodic dysphonia, vocal cord paralysis, the aging voice, cancer of the vocal cord, scarred vocal cords, and benign vocal cord growths, such as nodules, polyps, cysts, granulomas, and papillomas. The Institute’s director, Dr. Jamie Koufman, has been America’s leading clinician and researcher in the field of laryngology and the voice for more than 25 years. For more information, please visit www.voiceinstituteny.com.

About The New York Otolaryngology Group

Founded in 1993 by Drs. Scott Gold and Robert Pincus, the NYOG is among the nation’s leading diagnostic and treatment centers for otolaryngology-related illnesses. Areas of expertise include sinus, head and neck, plastic surgery, sleep apnea, and hearing and balance. All Otolaryngology Group physicians are board certified and adhere to a comprehensive disease management approach; they are affiliated with most of New York’s major teaching hospitals and medical schools. For more information, please visit www.newyorksinuscenter.com.

The five member health systems of the Catholic Contracting Group (CCG) within Premier Purchasing Partners realized savings of more than $70 million in 2006, driving improved operating margins across the group. Compared to competitor Catholic GPO members, Premier’s CCG members experienced consistently higher operating margins; nearly 3 percent versus other Catholics’ operating margins of less than 2 percent.

“This program is not just about attaining incremental economic benefit, although this is very important,” said Ron Brady, vice president, materiel management, Bon Secours Health System, Inc., Marriottsville, Md.

“As Catholic-based ministries, we share a common vision to reach out and into the communities we serve with a holistic approach to care and meeting needs,” he said. The Catholic Contracting Group within Premier allows us to realize other important strategic supply chain priorities such as creating contracting portfolios that are both environmentally responsible and appropriately diverse.”

The Catholic Contracting Group was formed in August 2005 to combine the collective strength of the Catholic members of Premier Purchasing Partners to identify and implement additional supply chain savings.

CCG consistently performs at better supply chain ratios than industry statistics. CCG member Catholic Healthcare West, for example, has improved its supply chain expense as a percent of total operating expense from 16.47 percent in 1999 to 14.88 percent in 2006. That compares to Moody’s survey averages of 18.25 percent and Healthcare Financial Management Association (HFMA) averages of 21.7 percent.

Members are Bon Secours Health System; Catholic Healthcare Partners of Cincinnati; Catholic Healthcare West of San Francisco; PeaceHealth of Bellevue, Wash.; and SSM Health Care of St. Louis. The non-profit healthcare organizations represent about 110 acute care hospitals with 18,500 staffed patient beds.

About Premier, 2006 Malcolm Baldrige National Quality Award recipient

Serving 1,700 hospitals and more than 43,000 other healthcare sites, Premier Inc. is the largest healthcare alliance in the United States dedicated to improving patient outcomes while safely reducing the cost of care. Owned by not-for-profit hospitals, Premier operates the nation’s largest healthcare purchasing network, the most comprehensive repository of hospital clinical and financial information and one of the largest policy-holder owned, hospital professional liability risk-retention groups in healthcare. Headquartered in San Diego, Premier has offices in Charlotte, N.C. and Washington. For more information, visit www.premierinc.com.

Through a new staffing strategy and the advanced automation of its ClairVia™ staffing software, Beaufort Memorial Hospital has gained more effective, centralized control over its nursing resources, reduced open shifts and improved employee satisfaction.

Beaufort Memorial, a non-profit, 197-bed community hospital with approximately 1,200 staff members, had long relied on paper-based staff scheduling that was handled on a floor-by-floor basis. Each department director was responsible for his or her department’s schedule and staffing needs list.

“Many of our internal float nurses, what we refer to as “HOP” nurses, would go to each floor to examine each needs list and sign up only for those assignments and floors they preferred to work,” explains Scott Huska, clinical staffing coordinator at Beaufort Memorial. “The nursing supervisor was always in the position of scrambling to fill open assignments on a shift-by-shift basis, with few options other than agency and overtime.”

A key change occurred when the hospital required all full-time nurses to commit to regular, four-week schedules coordinated centrally by Huska. A tiered reward system, which gave the most pay to HOP nurses who most adhered to their schedules, was put into effect.

“It was clear that we needed more scheduling consistency and stability in our nursing units, which would not only save money but improve quality of care,” says Huska. “And we needed the right software system, ClairVia, to support this strategy.”

Once ClairVia was implemented in all six of Beaufort Memorial’s nursing departments, covering approximately 400 hospital nurses, the organization had the ability to manage its nurses centrally, and pinpoint its staffing needs in advance, and from a single perspective.

“By scheduling employees in ClairVia weeks ahead of time, I can proactively select the most appropriate, highest quality and cost-efficient employees to work,” says Huska. “And since nurses are rewarded to fulfill their regular schedule commitments, the hospital has fewer open shifts and has dramatically reduced reliance on agency resources and overtime.

“Today, in fact, we have virtually no agency costs, and we’ve significantly reduced our bonus pay,” he reports. “We only pay a bonus for a shift if it is within 24 hours of the actual need, and only then if the need was critical.”

Improved employee communication and interaction

While the new scheduling strategy was not welcomed initially by some nurses at Beaufort, Huska says the hospital’s nurses have quickly embraced the ClairVia system, particularly its Web-based self-service functionality.

Through ClairVia’s customizable, personalized Web portals, Beaufort Memorial nurses can view their and colleagues’ schedules, participate in online shift requests and sign-ups, and receive and submit important updates and messages.

“Our nurses really take advantage of ClairVia’s self-service Web access,” Huska emphasizes, “because they love being proactive in establishing their schedules. They want to access their schedules from their homes and see how schedules are coming together. If they notice that they may be working short on a shift, they will actively recruit other nurses to work that shift. They’re very involved in the scheduling process, and ClairVia helps them stay involved.”

This high level of flexibility, convenience and communication has helped boost employee satisfaction, Huska says. In results from the hospital’s latest employee survey, HOP nurse satisfaction rose to 3.94 out of a perfect score of 4.

“There’s a strong link between the nurses’ use of ClairVia and their workplace satisfaction,” Huska asserts. “It’s evident to me in my day-to-day interaction with the nursing staff. They are very engaged in the process. That has increased our level of communication, and has made the entire scheduling process more flexible and satisfying.”

About Beaufort Memorial Hospital

Beaufort Memorial Hospital is a non-profit community hospital located in Beaufort, S.C. Affiliated with Duke University Health System in heart and cancer care, Beaufort Memorial has become one of the leading health care providers in the region. The 197-bed hospital is served by approximately 1,200 employees and more than 150 board-certified specialists.

Opened as a community hospital in 1944, Beaufort Memorial is fully accredited by the Joint Commission of Healthcare Organizations (JCAHO).

In addition, the hospital was recently recognized as being one of the best healthcare providers for clinical outcomes. It received five-star ratings within Orthopedics, Pulmonary Services and Gastrointestinal Services, according to a comprehensive study released by HealthGrades, the nation’s leading healthcare ratings company. As part of its ninth annual Hospital Quality in America Study, HealthGrades independently analyzed more than 5,000 hospitals in all 50 states and the District of Columbia for its 2007 ratings, assessing their clinical outcomes and quality.

For more information, go to www.bmhsc.org.

About AtStaff

AtStaff develops demand management and staff management software that enables healthcare organizations to improve healthcare quality and patient safety, increase profitability, and enhance staff recruitment and retention. Hospital enterprise-wide solutions and physician scheduling systems from AtStaff serve more than 1,200 healthcare organizations, medical facilities, nursing departments and group practices.

AtStaff’s newest software is ClairVia Demand Manager™, an outcomes-driven, demand management solution. Its science-based, patient tracking technology enables healthcare organizations to monitor and measure patient demand and maintain the correct mix of clinical staffing for patient demand requirements. ClairVia Demand Manager has the most advanced predictive capabilities on the market, using event-driven Patient Progress Patterns to predict clinical workload demands and constantly refine the accuracy of those projections. Hospitals using ClairVia are able to build a reputation for superior patient safety, better patient experience and clinician satisfaction, while optimizing both their clinical and financial outcomes.

More information is available at www.clairvia.com.

* Patent Pending

eClinicalWorks™, a market leader in unified EMR/PM systems, today announced that Memorial Hermann Health Network Providers (MHHNP), the largest independent physician organization of its kind in Texas, has selected eClinicalWorks unified electronic medical records (EMR) and practice management (PM) solution to streamline practice operations, facilitate collaborative disease management initiatives, and accelerate adoption of evidence-based clinical practice protocols among 1300 physicians throughout southeast Texas. MHHNP will also be one of the first organizations to use eClinicalWorks Electronic Health eXchange (eEHX) to create a community health record to engage MHHNP physicians and their patients in more effective medical management. E-prescribing along with an interface between eClinicalWorks and the hospital network will further automate MHHNP-affiliated physicians in their efforts to foster better, more efficient care in both the inpatient and ambulatory settings.

“Memorial Hermann prides itself for the most innovative solutions for improving the quality of patient care,” said Dr. Richard Blakely, Chief Medical Officer of Memorial Hermann Health Network Providers. “Our physicians are convinced that eClinicalWorks is the ideal solution for our doctors because of the intuitive nature of the product, its inherent connectivity supporting our clinical integration strategy, and the outstanding record of customer support provided by eClinicalWorks to its customers.”

The newly released eEHX is comprised of both the Patient Portal and its physician counterpart, eClinicalWorks Physician Portal, a secure means for providers to securely share facets of patient care, including electronic referrals, patient record summary, lab results and registry reporting. This reduces phone calls and data entry errors while increasing the privacy of patient information. The lack of printed paper means that patient information goes directly from physician to physician, without interruption. Also, advanced registry reporting functionality within eClinicalWorks EMR/PM will aid the groups in analyzing and reporting on management of chronic care, a component in pay-for-performance initiatives.

“As payers increase their pay-for-performance criteria and tighten restrictions, it is vital to have increased automation and documentation between locations,” said Scott Fenn, Chief Executive Officer of Memorial Hermann Health Network Providers. “The advanced reporting capabilities in eClinicalWorks and the ease at which it automates any type of clinical location are critical to our wide network of healthcare providers who are collaborating in a clinically integrated practice environment.”

MHHNP chose eClinicalWorks unified EMR/PM system and eEHX to streamline the clinical processes between practice locations and promote patient safety while reducing costs. The Patient Portal is a secure means for doctors and patients to communicate aspects of their care including appointments, lab results and statements. MHHNP is also utilizing e-prescribing, providing a direct link between the practice and the computer at the pharmacy (not the fax machine), establishing a two-way electronic connection.

“Memorial Hermann is the first in southeast Texas to commit to this level of clinical integration,” said Girish Kumar Navani, president of eClinicalWorks. “Using eClinicalWorks EMR/PM with our Electronic Health eXchange will help organizations like MHHNP improve operations and communication throughout its providers’ extended practices. Our network will also permit pay-for-performance initiatives, which aim to improve the value of healthcare by paying providers based on quality and cost measures.”

Founded in 1982, Memorial Hermann Health Network Providers (MHHNP) is the largest independent physician organization of its kind in Texas, with leadership strength unsurpassed in today’s healthcare industry. It is affiliated with the Memorial Hermann Healthcare System.

eClinicalWorks’ EMR solution enables MHHNP to manage patient flow, immediately access patient records in-house or remotely, electronically communicate with the referring physicians and securely send consult notes and clinical data. Users can easily access and review complete patient histories, past visits, current medications, allergies, labs and charts. Integrated with EMR is eClinicalWorks Practice Management, designed to instantly streamline the medical billing process.

About the Memorial Hermann Healthcare System

An integrated health system, the Memorial Hermann Healthcare System is known for world-class clinical expertise, patient-centered care, leading edge technology, and innovation. The system, with its exceptional medical staff and 17,000 employees, serves southeast Texas and the greater Houston community. Memorial Hermann’s 16 hospitals include three hospitals in the Texas Medical Center, two long-term care facilities, three heart institute locations and eight suburban hospitals. The system also operates numerous imaging, sports medicine and rehabilitation, and surgery centers, a Wellness Center, a chemical dependency treatment center, a home health agency, a retirement community and a nursing home. It is also the official healthcare provider for the Houston Rockets, Comets and Aeros, Rice University and the University of Houston. The system operates 24 physical therapy centers across the Greater Houston area. To learn more, visit www.memorialhermann.org or call 713-222-CARE.

About eClinicalWorks

eClinicalWorksTM is a privately-held leader in the unified electronic medical record (EMR) and practice management (PM) market. The company’s EMR/PM solutions are proven for every market segment: large practice groups, including Massachusetts eHealth Collaborative (MAeHC) and Electronic Health Records of Rhode Island (EHRRI), as well as medium, small and solo practices regardless of specialty. The company enjoys high profitability with a five-year compounded growth

rate of more than 100 percent year-to-year. With an established customer base of more than 2,200 customers across all 50 states, eClinicalWorks has been awarded multiple top industry honors including Best in KLAS in 2006, 2005 and 2004, a top solution by TEPR for four consecutive years and the 5-STAR rated EMR solution by AC Group for three years. Based in Westborough, Mass., eClinicalWorks has additional offices in Alpharetta, Ga. More information on eClinicalWorks can be found at www.eclinicalworks.com or by calling (866) 888-MY-CW.

eClinicalWorks is a trademark of eClinicalWorks, LLC. All other trademarks or service marks contained herein are the property of their respective owners.

OAKBROOK TERRACE, Ill., Feb. 26 /PRNewswire/ — Chicago Piano Superstore has opened a new 21,000 sq. ft. showroom in Downers Grove, IL. On March 2, 3, and 4, 2007, guests and performers will be on hand for the various Grand Opening events. Henry Z. Steinway, 91, will join Roger Williams in hosting guests from 6 PM to 7:30 PM on Friday, March 2, 2007. Also on Friday will be performances by Roger Williams and the recent winners of the Steinway Piano Competition and other special guests including Chicago’s own Rosemary Bailey, product specialist for the Roland Corporation. Chicago Piano Superstore displays more than 200 pianos and organs, offering one of the largest selections of keyboard instruments in the US. It is also home to the largest selection of classical and theatre organs in the Midwest.

The showroom has separate rooms devoted to particular manufacturers, including Steinway Pianos and Allen Organs. It also houses a performance space with flexible seating and superior acoustical design for musical events and recitals. The organ showroom even includes a replication of chamber and the ability to replicate the acoustics of many different spaces.

Schmitt Music of Minneapolis (also the owner of Wells Music in Colorado) and Jordan Kitt’s Music of College Park, Maryland became the new owners of the predecessor of Chicago Piano Superstore in April, 2005. Schmitt Music was established in 1896 and operates 26 stores in 10 states. Tom Wennblom, from Wells Music in Denver was chosen as the General Manager of the Chicago operation. Jordan Kitt’s Music was founded in 1912. In addition to the new Chicago location, Kitt’s operates 11 keyboard stores in 6 east coast metropolitan markets, including Washington, DC, Baltimore and Atlanta. Both companies are family owned and enjoy a long standing reputation for quality merchandise and service. In the past 100 years each has won every top award for excellence in the music industry.

Frank Mazurco, Executive VP of Sales & Marketing for Steinway Piano and Steve Markowitz, President of Allen Organ Co. will be joined by the executive management of several other manufacturers attending the 3-day opening event. Several limited edition Steinway pianos including the Henry Z. Steinway and the Roger Williams Gold Piano will be on display. A separate showroom of Allen Organs will also be on display with special performances planned throughout the event. Special guest, Felix Hell will perform on the Allen Classical Organ on Sunday March 4. Mr. Hell is world-renowned and has performed all over the world. Now 21, Mr. Hell has the distinction of being the youngest Organ Major to receive a Bachelor of Music from the world famous Curtis Institute of Music in Philadelphia in 2004 at age 19.

Lee Maloney, Manager of Organ sales and service at the new location also serves as the house organist at the Chicago Theatre. The Chicago Piano Superstore is located at 1205A Butterfield Rd. in Downers Grove, IL. 60515. (Frontage Rd. just south of Butterfield Rd./ west of Highland Ave. Enter off of Highland, just south of Butterfield or off of Butterfield, just west of Highland). Phone # 630-512-9200. Web address: http://www.chicagopianosuperstore.com/ .

Chicago Piano Superstore

CONTACT: Lee Maloney, Manager, Organ Sales, Chicago Piano Superstore,+1-815-693-9510, or [email protected]

Web site: http://www.chicagopianosuperstore.com/

Mimi’s Cafe, the restaurant chain known for upscale family dining, introduces an affordable, all-inclusive kid’s menu to provide more meal options for children and parents. Meals include an entr©e, side dish, beverage and dessert for $3.99 to $4.59. With four new items, including kid-friendly meals, healthy-choice options and fun activities on the menu, Mimi’s Cafe is helping families have enjoyable dining experiences at breakfast, lunch and dinner.

The kid’s menu, dubbed the “Gazette,” is available for guests 12 and under and is packed with colorful, fun activities that are entertaining and educational. Games include a crossword puzzle, maze, matching activity and much more. Following are items featured on the kid’s menu:

Breakfast: new Chocolate Chip Pancakes, Mimi Mouse Pancakes and Scrambled Eggs & Bacon

Lunch/Dinner (served after 11 a.m.):

— Traditional choices: new Pepperoni Pizzadillas, new PB&J Soldiers, Chicken Fingers, Mimi Burger, Mini Corn Dogs, Mac & Cheese and Grilled Cheese

— Healthier choices: Turkey Dinner, Spaghetti (plain, buttered or with marinara) and Soup & Salad

Side Dishes: Zero Grams Trans Fat Fries, new Applesauce, Fresh Vegetables, Mashed Potatoes and Fresh Fruit

Beverages: Whole or Non Fat Milk, Chocolate Milk, Lemonade, Orange Juice, Hi-C® Fruit Punch, Coke, Diet Coke, Sprite and Root Beer

Dessert: Mimi’s Oreo® Dirt Cup

“We are dedicated to helping families have the best dining experience possible; therefore, offering kid’s meals that can be part of a well-balanced diet for a reasonable price is a top priority,” said Russ Bendel, President and CEO of Mimi’s Cafe. “I’m proud that our new menu has many delicious items which appeal to children and contain important nutrients that they need like calcium, iron and vitamin C.”

Each year, Mimi’s Cafe honors more than 1.5 million students who have demonstrated excellence both inside and outside the classroom with Certificates of Achievement. The chain also rewards children for athletic achievement through the Wooden Nickel Program. These certificates and real wooden nickels can be used to redeem a free kid’s meal at any Mimi’s Cafe location.

For more information, visit www.mimiscafe.com.

About Mimi’s Cafe

Mimi’s Cafe is a collection of upscale family dining restaurants with 108 locations in 19 states. The publicly traded company (NASDAQ:BOBE) is known and loved for its full breakfast, lunch and dinner menus with high-quality, eclectic cuisine, unparalleled service and tastefully appointed d©cor.

For more information, to schedule an interview, or to request photography, please contact Christy Flanagan of Morgan Marketing & Public Relations LLC: (949) 261-2216 or [email protected].

The Down Syndrome Research and Treatment Foundation (DSRTF), a leading funder of Down syndrome cognition research, announced their fundraising target of $2 million for 2007 during the inaugural meeting of its Scientific Advisory Board (SAB). Citing the importance of advances made quietly during the past five years, DSRTF is challenging the medical research community to review both the science and the inaccurate positioning of the Down syndrome disorder.

“In establishing and convening the SAB, an effort spearheaded by DSRTF Board of Directors member Pat White, M.D., the Foundation has taken a further step towards achieving the goal of engaging and galvanizing the public, medical community, and scientists with a changed perception regarding the merit and significant potential of Down syndrome cognition research,” said Patricia O’Brien-White, co-founder of DSRTF. “Cognition research — the study of information processing by the brain, including learning and memory, and associated disorders — presents a different side of Down syndrome: the as yet untapped capacity of the individual with Down syndrome to achieve cognitive abilities beyond what anyone ever expected. This research will dispel any impressions that it is futile to expect people with Down syndrome to lead independent lives.”

DSRTF sought to assemble a group of high caliber scientists with areas of expertise relevant, but in some cases not yet applied, to the study of Down syndrome, based on the Foundations’ conclusion that interdisciplinary approaches are essential to accelerate research and ultimately provide meaningful therapies. The DSRTF SAB members’ areas of expertise encompass the fields of Down syndrome research, neuroscience, including Alzheimer’s disease research, molecular cell physiology and metabolism, genetics/genomics, and drug discovery. DSRTF SAB members include a Nobel laureate, Lasker Medical Research Award winners, and members of the National Academy of Sciences and Institute of Medicine; current members are listed below:

 --  William Cohen, M.D.  Children's Hospital of Pittsburgh. --  David Cox, M.D., Ph.D.  Perlegen Sciences, Inc. --  Ron Evans, Ph.D.  Salk Institute for Biological Studies and  Howard     Hughes Medical Institute. --  Michael Harpold, Ph.D. EnkephaSys, Inc. --  Eric Kandel, M.D.  College of Physicians and Surgeons, Columbia     University and Howard Hughes Medical Institute. --  Leslie Leinwand, PH.D.  University of Colorado. --  Lynn Nadel, Ph.D.  University of Arizona. --  Roger Reeves Ph.D.  Johns Hopkins School of Medicine.      

Dr. Bill Cohen, Director of the DS Clinic at the Children’s Hospital of Pittsburgh for 17 years, is a leader in addressing the medical and social needs of the DS population. Dr. Cohen stated, “Parents of children with Down syndrome are told that there are no therapeutic interventions available to improve cognition and memory skills for a child with Down syndrome. The conversation usually ends there.” Dr. Cohen further stressed that mobilization, involving parents, physicians, funding agencies, and researchers, is a critical issue and necessary to overcome research and therapeutic nihilism.

Today, DSRTF is pressing to build increased awareness among parents and biomedical researchers that recent studies suggest there may be various ways to intervene. In fact, over the past year, three independent research approaches, using mice with an extra copy of a similar chromosome to chromosome 21 in humans, demonstrated in these “DS model” mice the ability to significantly rescue specific brain structural and functional abnormalities which are closely related to cognition in Down syndrome. The timing of these findings suggests that a major impact on Down syndrome is achievable within the next ten years. It was clear to the DSRTF SAB members who met in San Francisco earlier this month that now is the time to infuse resources and funding to build and accelerate cognition research.

The SAB will play an important role in DSRTF’s grant-making efforts by making recommendations concerning the research areas that could be enhanced through DSRTF funding. They already have acknowledged the important need for bold new initiatives, including the development of a comprehensive Down syndrome patient registry and tissue/DNA bank for detailed genotype-phenotype analyses and correlations. “Such a resource, if made available to the entire research community, would make it possible to expedite the process of identifying and moving potential therapeutic targets all the way through drug development and associated clinical studies,” said Dr. Michael Harpold, SAB Chair and member of the DSRTF Board of Directors. Dr. Harpold further stated, “Based on our SAB meeting discussions it is clear that there are many additional promising research areas with the potential for significant impact in Down syndrome and that more support and funding will be key to realizing this potential. DSRTF is making a real difference and it will be critical to sustain and increase its research support initiatives.”

“It was impressive to see the enthusiasm and commitment that each of the SAB members brought to this endeavor. The latest research is exciting and the newly added focus and perspectives being contributed by this prestigious group of scientists as DSRTF SAB members are important indicators of the promise this work holds,” said O’Brien-White. Dr. David Cox, SAB member from Perlegen Sciences, concluded, “We have the technology, now is the time to fulfill the dream.”

About DSRTF

The Down Syndrome Research and Treatment Foundation (DSRTF), based in Palo Alto, California, is a national non-profit organization dedicated to supporting medical research for treatments that will improve cognition in individuals with Down syndrome. DSRTF was founded in 2003 by a small group of leading venture capitalists, who are parents of children with Down syndrome. They recognized that the availability of new scientific tools and techniques, stemming from the human genome project, presented an unprecedented opportunity to develop a deeper understanding of the biology of Down syndrome.

 Contact: Down Syndrome Research and Treatment Foundation (DSRTF) Patricia O'Brien-White [email protected] (650) 868-1447  755 Pagemill Road, Suite A200 Palo Alto, CA 94304 (510) 421-4201 www.dsrtf.org

SOURCE: Down Syndrome Research and Treatment Foundation

Healthcare information technology (HIT) is transforming the healthcare industry and Siemens Medical Solutions (www.usa.siemens.com/healthcareit) is leading the way with Soarian® healthcare process management solutions such as its Soarian Clinical and Financial suites. Using Soarian, Siemens customers are rethinking, redefining, and reinventing processes with an industry-leading workflow engine that simultaneously pushes multiple tasks to multiple people — across care settings, departments, and disciplines — so information is available when and where it’s needed.

According to a recent report by the Gartner Group, the No. 1 business priority for chief information officers (CIOs) globally is Business Process Management: linking business goals with IT-enabled process improvements. Furthermore, healthcare CIOs plan to make the investments needed to put these improvements within reach. According to Health Data Management’s 2006 CIO Survey, 77 percent of the CIOs who participated in the survey said that they expect their organizations’ IT budgets to increase in 2007. When asked why, they cited the need for better access to information, an increase in the quality of care, and a reduction in medical errors.

At its core, healthcare is a team-based business with each player fulfilling his or her specific role. This calls for extensive communication and coordination, which until now was a manual task. Coordination of care is performed through personal communication, phone calls, and maintaining paper records — making it prone to delays, omissions, and errors, especially when many team members are involved.

As the new-generation Siemens HIT solution, Soarian software’s core differentiator is its use of a powerful workflow engine that facilitates and tracks technology-driven “workflows” designed to help our customers increase efficiency, improve on patient safety initiatives, and achieve desired clinical and financial outcomes — while supporting key quality and regulatory initiatives. Siemens has pioneered the use of workflow technology in the healthcare sector. With the quest for safe, efficient, and superior patient care at the heart of every healthcare organization, Soarian helps facilitate more informed decision-making and more efficient business practices. To reach its goals, Siemens is collaborating with customers to:

Design efficient healthcare processes using a proven process modeling environment,

Automate the transfer of information with an industry-leading workflow engine,

Monitor processes seamlessly with embedded analytics for Business Activity Monitoring built into the system, and

Deliver the benefits of healthcare process management throughout an organization with the capabilities provided by Service-Oriented Architecture.

All four — process modeling, workflow engine, business activity monitoring, and service-oriented architecture — are essential for effective healthcare process management and only Soarian contains them all.

“Information technology is transforming healthcare, providing greater transparency and establishing quality-of-care benchmarks that evolve into industry standards,” explained Janet Dillione, president, Health Services, Siemens Medical Solutions Healthcare IT Division. “Our goal is to help our customers optimize healthcare outcomes and increase efficiency by establishing consistent healthcare process management that drives clinical and financial success.”

With an influx of new and expanding customer engagements for Soarian, Siemens is helping an increasing number of healthcare institutions move toward greater adoption of HIT to increase workflow efficiency and help providers focus on patient safety initiatives, improve the patient healthcare experience, and advance healthcare outcomes. St. Luke’s Health System, Idaho’s largest healthcare provider, recently chose Soarian solutions to assist with clinical documentation for its Children’s and Heart Hospitals. In addition to purchasing Soarian Clinicals, St. Luke’s has purchased and plans to implement Soarian solutions including Critical Care, Cardiology and Scheduling, as well as Siemens Decision Support and Contract Management solutions, and components of the syngo® Suite, Siemens integrated RIS/PACS solution, which connects seamlessly with the clinical and administrative cycles addressed by Soarian.

“Following the merger of St. Luke’s Regional Medical Center and Magic Valley Regional Medical Center, my team and I were asked to evaluate a go-forward healthcare IT strategy for the newly formed health system,” explained Sheryl Bell, director, Information Technology, St. Luke’s Health System. “Upon evaluating the status of our current health information systems and best-of-breed IT efforts, we recognized that integration needed to be a primary goal of our organization. We have experienced benefits from Siemens technologies and felt that Soarian was the strongest solution to help us move in a new direction toward true enterprise-wide integration, especially due to its unique workflow engine.”

Today, nearly 150 Soarian implementations are occurring around the world. Soarian-driven workflows are being deployed globally to support key quality and regulatory initiatives such as those defined by Centers for Medicare and Medicaid Services (CMS), the Joint Commission (JC) Core Measures, the six key objectives of the Institute for Healthcare Improvement’s (IHI) 100,000 Lives Campaign, and providers’ own internal quality measures. Currently, more than 50 Soarian-enabled workflows are live across the Siemens customer base, demonstrating the ability to seamlessly connect clinical, operational, and financial processes in support of patient-centered care. Examples include workflows to:

Identify patients at risk for deep vein thrombosis (DVT),

Better manage patients on heparin therapy,

Better manage bed utilization,

Identify early and manage patients with isolation-requiring infections,

Deliver evidence-based care to Acute Myocardial Infarction (AMI), chronic heart failure (CHF), Diabetes and Community-Acquired Pneumonia patients,

Reduce risk of negative drug interactions by reconciling medications on transfer patients,

Coordinate care of IV site management, according to hospital best practice guidelines, and

Better manage patients at risk for falling in the hospital.

According to the Centers for Disease Control (CDC), infections, such as Methicillin Resistant Staphylcoccus Aureus (MRSA) and other drug-resistant infections, acquired in hospitals kill some 90,000 patients a year and cost the healthcare system $4.5 billion. At The Chester County Hospital (TCCH), West Chester, Pa., it was found that four percent of adult patients entering the hospital have a history of MRSA, accounting for eight percent of patient days. Before TCCH began using Soarian, the hospital estimated that nursing was unaware of a patient’s positive history of MRSA status up to 25 percent of the time. Since TCCH went live on a Soarian-enabled infection control/isolation workflow, nursing now receives notification on 100 percent of all known MRSA patients.

The Soarian-enabled infection control/isolation workflow has had a positive impact on TCCH’s ability to more quickly and effectively treat patients, while better managing bed utilization. Early identification of patients with infections that require isolation, and fast implementation of an isolation protocol, has reduced the risk of additional patients and staff being exposed, decreased inappropriate patient bed assignment, and improved detection of negative screens to expedite removal of a patient from a high-cost isolation bed.

For its ground-breaking use of healthcare process management technology, TCCH was recently named the 2006 Gold Winner for the North American Global Excellence in Business Process Management and Workflow Award, acknowledging the positive impact on both clinical and business outcomes that the hospital has achieved through HIT, specifically in the areas of bed management and infection control.

“We realized that healthcare process management was one of the keys to the survival of a healthcare system in the 21st century,” Ray Hess, vice president, Information Management, TCCH. “The Chester County Hospital system upholds the fundamental principles of medicine — the desire to make people well, and to do so in the safest, most effective way possible.”

About Siemens Medical Solutions

Siemens Medical Solutions of Siemens AG (NYSE:SI) is one of the world’s largest suppliers to the healthcare industry. The company is known for bringing together innovative medical technologies, healthcare information systems, management consulting, and support services, to help customers achieve tangible, sustainable, clinical and financial outcomes. Recent acquisitions in the area of in-vitro diagnostics — such as Diagnostic Products Corporation and Bayer Diagnostics — mark a significant milestone for Siemens as it becomes the first full service diagnostics company. Employing more than 41,000 people worldwide and operating in over 130 countries, Siemens Medical Solutions reported sales of 8.23 billion EUR, orders of 9.33 billion EUR and group profit of 1.06 billion EUR for fiscal 2006 (Sept. 30). Further information can be found by visiting www.siemens.com/medical.

DALLAS, Feb. 22 /PRNewswire/ — The American Heart Association and Lippincott Williams & Wilkins, part of Wolters Kluwer Health, announce the launch of a new consumer magazine, Heart Insight, for heart patients, their families and caregivers.

The first AHA consumer magazine that focuses exclusively on managing and preventing cardiovascular disease and related conditions, such as stroke and obesity, Heart Insight will provide readers with the most up-to-date, authoritative and practical advice.

“Heart Insight may look like other health and nutrition magazines, but it has something the others don’t have and that is the full resources and credibility of the American Heart Association,” said Patrick O’Gara, M.D., F.A.H.A., the magazine’s Editorial Board Chair, who is Director of Clinical Cardiology at Brigham & Women’s Hospital in Boston.

Heart Insight will be published four times a year, with the first issue available later this month. Copies will be distributed free of charge to 10,000 cardiologists’ offices and other healthcare providers who are involved in patient care. Each doctor’s office will receive 50 copies of each issue.

Patients will also be able to order their own free subscriptions to the magazine for home delivery, either by filling out a subscription card or by visiting http://www.heartinsight.com/. Several thousand patients have already signed up for individual subscriptions even before the first issue was published, after a pilot issue was distributed at the American Heart Association’s annual Scientific Sessions meeting in November 2006.

“Providing accurate and timely information to help reduce death and disability from cardiovascular disease and stroke is essential to our mission,” said the association’s president, Raymond Gibbons, M.D., F.A.C.C. “Heart Insight will supplement our existing patient education programs and Web sites to deliver reliable health and lifestyle information directly to the people who need it most — patients, families and caregivers affected by these diseases.”

“Heart Insight is very close to my heart because of my own family history of high blood pressure and high cholesterol,” said Ruth Papazian, the magazine’s editor. “I’ve also dealt with the effects of these conditions, having been a caregiver to help a parent recover from a stroke.”

“Heart Insight will offer practical advice on managing or avoiding heart disease, along with realistic goals against which to measure progress,” she added. “We’re hoping readers will find Heart Insight appealing and engaging. The writing is lively, the tone is upbeat and the design is as attractive and glossy as any consumer health magazine on the newsstand.”

Heart Insight is being published in partnership with Lippincott Williams & Wilkins, which also publishes the American Heart Association’s six scientific journals: Circulation; Circulation Research; Arteriosclerosis, Thrombosis and Vascular Biology; Hypertension; and Stroke.

Perhaps most important, Heart Insight will give patients hope, inspiration and encouragement by featuring articles about, and by, people who have first-hand experience dealing with cardiovascular conditions, either as patients or caregivers.

About the American Heart Association

Founded in 1924, the American Heart Association today is the nation’s oldest and largest voluntary health organization dedicated to reducing disability and death from diseases of the heart and stroke. These diseases, America’s No. 1 and No. 3 killers, and all other cardiovascular diseases claim over 870,000 lives a year. In fiscal year 2005-06 the association invested over $543 million in research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives. To learn more, call 1-800-AHA-USA1 or visit americanheart.org.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (http://www.lww.com/) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information for professionals and students in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company with annual revenues (2005) of euro 3.4 billion and approximately 18,400 employees worldwide. Visit http://www.wolterskluwer.com/.

American Heart Association

CONTACT: Carrie Thacker, Director of Corporate and Media Communicationsof American Heart Association, +1-214-706-1665, [email protected]; orRobert Dekker, Director of Communications of Wolters Kluwer Health,+1-610-234-4533, [email protected]

Web site: http://www.americanheart.org/http://www.lww.com/http://www.wolterskluwer.com/http://www.heartinsight.com/

CHADDS FORD, Pa., Feb. 22 /PRNewswire-FirstCall/ — The country’s largest workplace health care provider, CHD Meridian Healthcare (an I-trax company, Amex: DMX), has published encouraging research demonstrating that a new technique it has developed resulted in a three-fold improvement in enrollment into a corporate-sponsored disease management program. The results of the research demonstrated an encouraging 76 percent enrollment rate, which compares to the typical rate of about 25 percent using conventional enrollment methods.

According to the study, “Disease Management Engagement Rates: Leveraging the Trusted Clinician,” published in the February issue of Disease Management, enrollment rates in workplace disease management programs can be improved by involving a familiar and trusted clinician in the recruiting process, as opposed to relying solely on the anonymous telephone callers typically used in disease management programs. Disease Management is a peer-reviewed journal published by the Disease Management Association of America (http://www.liebertpub.com/)

The study involved nearly 2,000 Goodyear Tire & Rubber Co.* employees, dependents and retirees who were identified and invited to participate in disease management programs to better control their diabetes, hypertension and coronary artery disease. They were selected to participate based on data demonstrating dramatic opportunities to improve their health and medical condition statuses.

The group, approached through established, trusted primary care clinicians delivering care at the workplace, were contacted and enrolled at significantly higher rates than those approached through the traditional “cold-call” process.

“At Goodyear, we recognize the fact that good health among our associates translates into greater efficiency, productivity and reduced cost,” noted Dr. Bruce Sherman, Goodyear’s global medical director. “That’s why we are continually looking for new and better ways to encourage our more than 75,000 associates around the world to take an active interest in their and their families’ health. By utilizing our worksite primary health care and pharmacy services to integrate other programs such as disease management, we can get key information disseminated and really make a difference in the scale and scope of these tactical programs.”

CHD Meridian Healthcare found that enrollment in the Goodyear program particularly spiked (79 percent) when patients were approached to participate during a regularly scheduled visit with a familiar clinician at their worksite health center.

“These results are fascinating and provide evidence that ‘high touch’ methods for recruitment to care management programs can be worth the investment. This added benefit also dovetails with the growing interest by large employers in on-site medical centers,” said Helen Darling, President, National Business Group on Health.

“Coordinating the ‘trusted clinicians in the workplace’ with remote telephonic nurse coaches – aligning caregivers into a single, integrated delivery model – will bring us closer to realizing the potential value of population health management which includes healthier employees, reduced health care costs, increased productivity and reduced absenteeism,” the study authors concluded.

“Our company is committed to doing the research necessary to methodically demonstrate the value of workplace health and productivity solutions,” said Dr. Ray Fabius, President of CHD Meridian Healthcare and a co-author of the study. “The results of this study are directly relevant to all types of employee health management and wellness programs.”

CHD Meridian Healthcare has plans for additional studies to evaluate the clinical, financial and utilization outcomes of the patients in disease management programs facilitated by a trusted clinician versus those in conventional programs.

Authors of the study include CHD Meridian Healthcare employees Sharon G. Frazee, Ph.D., Vice President, Health Informatics; Patricia Kirkpatrick, R.N., Vice President Integrated Care; and Dr. Fabius.

For more on disease management go to: http://www.dmaa.org/dm_definition.asp

About CHD Meridian Healthcare

CHD Meridian Healthcare, an I-trax company, is the leading provider of integrated workplace health and productivity management solutions. Serving nearly 100 clients at over 215 locations nationwide, CHD Meridian Healthcare offers on-site health centers, which deliver primary care, acute care, corporate health, occupational health and pharmacy care management services as well as integrated disease management, wellness and lifestyle management programs. CHD Meridian Healthcare provides a comprehensive solution utilizing telephonic and e-health tools to enhance the trusted relationship established by its clinicians at the worksite.

CHD Meridian Healthcare is focused on helping companies achieve employer of choice status, making the workplace safe, improving the quality of care and the productivity of the workforce while mitigating healthcare costs. Managing employer-sponsored health centers for over 40 years, some of CHD Meridian Healthcare’s clients include: BMW, Blue Ridge Paper, Coors Brewing Company, Coushatta Casino Resort, DENSO Manufacturing Michigan, Deutsche Bank, Eastman Chemical, Fieldale Farms, Horizon Blue Cross Blue Shield of New Jersey, Lowe’s, Toyota, UnumProvident and US Steel. For more information, visit http://www.chdmeridian.com/.

About Goodyear

Goodyear is one of the world’s largest tire companies. The company manufactures tires, engineered rubber products and chemicals in more than 90 facilities in 28 countries around the world. Goodyear employs more than 75,000 people worldwide.

*Although Goodyear is not identified in the study as the worksite explored, it was the sole organization involved in this study.

   Contacts:   Peter Hotz   CHD Meridian Healthcare   (610) 459-2405 x126   [email protected]    Michelle Sawatka-Fernandez   Edelman   (212) 704-4544   [email protected]  

I-trax, Inc.

CONTACT: Peter Hotz of CHD Meridian Healthcare, +1-610-459-2405 x126,[email protected], or Michelle Sawatka-Fernandez of Edelman,+1-212-704-4544, [email protected]

Web site: http://www.i-trax.com/http://www.dmaa.org/dm_definition.asphttp://www.chdmeridian.com/

PHILADELPHIA, Pennsylvania, February 21 /PRNewswire-FirstCall/ — Elsevier , the world’s leading scientific, technical and medical publisher has announced that its journal, Nanomedicine: Nanotechnology, Biology and Medicine has been selected for inclusion in MEDLINE(R). Maintained by the U.S. National Library of Medicine(R), MEDLINE (Medical Literature Analysis and Retrieval System Online) is the premier bibliographic database containing approximately 13 million references to journal articles in life sciences with a concentration on biomedicine.

Nanomedicine: NBM Editor-in-Chief, Chiming Wei, MD, PhD, Department of Surgery, Johns Hopkins University School of Medicine, commented, “The entire Editorial Board and I are extremely pleased that Nanomedicine: NBM is being added to the MEDLINE journal collection so soon after its launch in March 2005 in recognition of its scientific merit and contribution to the field. Inclusion in this prominent database will help investigators throughout the world more easily locate articles published in Nanomedicine: NBM.

Nanomedicine: Nanotechnology, Biology and Medicine (http://www.nanomedjournal.org/), the Official Journal of the American Academy of Nanomedicine (AANM), is an international, peer-reviewed journal published quarterly. Nanomedicine: NBM publishes basic, clinical and engineering research in the innovative field of nanomedicine. Article categories include diagnostic, experimental, clinical, engineering, pharmacological and basic nanomedicine. Nanomedicine: NBM provides the latest information in this rapidly developing field, covering both research advancements and clinical applications. The Journal publishes original clinical and investigative studies, state-of-the-art papers, reports on new equipment and techniques, review articles and more.

Nanomedicine, an offshoot of nanotechnology, refers to highly specific medical intervention at the molecular scale for curing disease or repairing damaged tissues, such as bone, muscle or nerve. A nanometer is one-billionth of a meter, too small to be seen with a conventional lab microscope. It is at this size scale – about 100 nanometers or less – that biological molecules and structures inside living cells operate.

The National Library of Medicine MEDLINE selection process is managed by an advisory committee, the Literature Selection Technical Review Committee, composed of authorities knowledgeable in the field of biomedicine, such as physicians, researchers, educators, editors, health science librarians and historians, to review and recommend the journal titles NLM should index. With inclusion in MEDLINE, citations, abstracts and indexing terms for articles published in Nanomedicine: NBM will be available online in the U.S. and throughout the world back to Volume 1/Issue 1. MEDLINE is searchable for free using PubMed at http://pubmed.gov/.

Elsevier, a world-leading medical and scientific publisher, brings the full support of its global organization to the journal. It is recognized for its numerous long-standing and successful society-publishing partnerships, as well as excellence in all aspects of the publishing process. ScienceDirect (http://www.sciencedirect.com/), Elsevier’s world-class electronic platform with over 16 million users, provides online access to the full text of Nanomedicine: NBM to institutional subscribers. Members of the affiliated society and individual subscribers are able to access the journal via http://www.nanomedjournal.org/.

ABOUT THE AMERICAN ACADEMY OF NANOMEDICINE

The American Academy of Nanomedicine (http://www.aananomed.org/) is a forum to exchange ideas, communicate new findings and encourage collaboration among the diverse disciplines represented in Nanomedicine. Membership in AANM includes a subscription to Nanomedicine: Nanotechnology, Biology, and Medicine.

ABOUT ELSEVIER

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier’s 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (http://www.sciencedirect.com/), MD Consult ( http://www.mdconsult.com/), Scopus (http://www.info.scopus.com/), bibliographic databases and online reference works.

Elsevier (http://www.elsevier.com/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (http://www.reedelsevier.com/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier’s ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Elsevier

CONTACT: Contact: Jami E. Walker, Associate Publisher, Nanomedicine:NBM, +1-(314)-579-3342, [email protected]. William Deutsch, Marketing,Nanomedicine: NBM, +1-(215)-239-3651, [email protected]

By Edie Grossfield, Post-Bulletin, Rochester, Minn.

Feb. 20–A boy wakes up with a fever and an upset stomach — and the scrambling begins. Can Dad or Mom to stay home from work? Can a friend or family member watch the sick child? What happens if his condition worsens during the day?

Mayo Clinic employees, however, are less likely to grapple with such questions, thanks to Children’s R&R, a free ill-child care center that’s in its 18th year.

Instead of avoid missing work, Mayo employees can bring their sick children to the center to be cared for by trained patient-care assistants and two pediatric registered nurses.

“It allows me to stay employed, basically,” said Ruth Paulson, a registered nurse at Mayo Clinic.

She took her 5-year-old son Michael to Children’s R&R last week.

“He got that stomach virus that’s been going around,” Paulson said.

Operating on the first and second floors of Mayo’s Colonial Building, Children’s R&R is the largest center of its kind in the country, said Director Lynnelle Campeau. It cares for an average of 30 sick children each day and has 9,800 preregistered children.

The center’s capacity is three infants, six toddlers, eight preschoolers and 31 school-age kids — a total of 48 children. It’s been running to near capacity since the beginning of February.

The center groups children by age, with a bed for every child. To help keep their minds off of being sick, the center has age-appropriate books and toys, TVs and VCRs and staff members who care for and play with the kids. Menus are selected for each child based on his or her condition.

Paulson can request a nurse practitioner to see her sons while they’re staying at Children’s R&R. If they need a prescribed medication, it can be filled and started while they’re still at the center.

“It gives me peace of mind,” she said.

The center, which is open from 6 a.m. to 6 p.m. weekdays, begins taking calls for the following day’s care at 1 p.m. the preceding day. But most calls come early in the morning, before the workday begins.

“So, it’s a busy, busy phone every morning, especially this time of year,” Campeau said.

—–

To see more of the Post-Bulletin, or to subscribe to the newspaper, go to http://www.postbulletin.com.

Copyright (c) 2007, Post-Bulletin, Rochester, Minn.

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

The TriZetto Group Inc. (NASDAQ: TZIX) today announced a distribution alliance with AmeriScript to provide TriZetto’s benefit administrator customers with discounted access to AmeriScript’s pharmacy benefit management (PBM) program. TriZetto is integrating AmeriScript’s PBM services with its line of QicLink™-based health benefit administration software, hosting services, and business services. The alliance supports TriZetto’s strategy of establishing key partnerships that enhance the risk management capabilities of benefit administrators.

As pharmacy costs continue to consume an escalating portion of each healthcare dollar, the rise in prescription drug usage and spending has forced many employer groups to reduce pharmacy coverage and increase member coinsurance rates. TriZetto joined forces with AmeriScript to offer benefit administrators highly competitive pricing for their employer clients, who will be able to better manage expenses in this critical area.

“TriZetto is very pleased to provide our clients with a prescription drug management program that can deliver some of the lowest drug costs in the industry,” said Joseph Manheim, senior vice president of Benefits Administration for TriZetto. “The AmeriScript relationship further expands our ability to support benefit administrators with the critical tools that can help them gain a competitive advantage in the retail healthcare market.”

TriZetto’s QicLink customers will benefit from exclusive, fully-integrated access to AmeriScript’s prescription benefit management services, which include over 50,000 retail pharmacies and mail order services, as well as robust data analysis tools and cost management services.

“TriZetto has an intimate knowledge of the payer industry, and we really step inside our customers’ businesses to identify their information technology needs,” continued Manheim. “To provide our customers with comprehensive solutions, we partner with leaders in their particular niche, whose software and services complement ours and can provide high value to our customers. The AmeriScript partnership is one way we can help benefit administrators enhance their critical revenue growth.”

“By securing deep discounts from drug manufacturers and pharmacies, AmeriScript offers a highly competitive PBM service that can directly translate into savings for employer groups,” said John Baker, R.Ph., vice president of AmeriScript. “Equipped with these deep discounts and robust analytic functionality, our team is well positioned to respond to the needs of employers dealing with the escalation of the cost of pharmacy benefits. TriZetto’s excellent reputation in healthcare payer technology combined with AmeriScript’s high-tech analytic capabilities gives employers a powerful weapon in the fight to lower healthcare costs. Providing our quality solutions to TriZetto’s benefits administrator clients can positively impact the cost of prescription drug care for the many employer groups who administer their benefit plans through the QicLink system.”

“We are very excited about partnering with the TriZetto team,” said Paul Glover, CEO of Interplan Health Group, AmeriScript’s parent company. “TriZetto and AmeriScript’s joining forces will significantly benefit our mutual clients with a truly innovative service. Capturing meaningful data and applying state-of-the-art analytics will have a profound effect on guiding consumers to better health and more cost effective healthcare decisions.”

TriZetto provides a full complement of benefit administration technology and transaction services that clients can use to improve operational effectiveness, while maintaining the flexibility to adapt to a rapidly changing healthcare environment. Partnering with AmeriScript supports and further enhances this mission.

About AmeriScript

AmeriScript is dedicated to providing solutions for the escalating cost of prescription programs and positively affecting outcomes. AmeriScript’s pharmacy benefit management plans are designed to meet the individual needs of the client, not to provide a “one size fits all” approach, effectively providing solutions to high drug costs for self-funded employers and union groups. AmeriScript is a wholly owned subsidiary of Interplan Health Group (IHG), a health service company serving more than 1.5 million members. IHG provides a broad array of managed care offerings, including direct PPO networks in nineteen states, the national PPO network of Superien™, workers’ compensation programs, medical management, out-of-network solutions. AmeriScript can be reached at (800) 681-6912 or www.ameriscript.com.

About TriZetto

With its technology touching nearly half of the U.S. insured population, TriZetto is distinctly focused on accelerating the ability of healthcare payers to lead the industry’s transformation to consumer-retail healthcare. The company provides premier information technology solutions that enhance its customers’ revenue growth, increase their administrative efficiency and improve the cost and quality of care for their members. Healthcare payers include national and regional health insurance plans, and benefits administrators that provide transaction services to self-insured employer groups. The company’s payer-focused information technology offerings include enterprise and component software, hosting and business process outsourcing services, and consulting. Headquartered in Newport Beach, Calif., TriZetto can be reached at 949-719-2200 or at www.trizetto.com.

Important Notice Regarding Forward-Looking Statements

This press release contains forward-looking statements that involve risks and uncertainties. The forward-looking statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. These forward-looking statements may include statements about future revenue, profits, cash flows and financial results, the market for TriZetto’s services, future service offerings, industry trends, client and partner relationships, TriZetto’s operational capabilities, future financial structure, uses of cash or proposed transactions. Actual results may differ materially from those stated in any forward-looking statements based on a number of factors, including the effectiveness of TriZetto’s implementation of its business plan, the market’s acceptance of TriZetto’s new and existing products and services, the timing of new bookings, risks associated with management of growth, reliance on third parties to supply key components of TriZetto’s services, attraction and retention of employees, variability of quarterly operating results, competitive factors, risks associated with acquisitions, changes in demand for third party products or solutions which form the basis of TriZetto’s service and product offerings, financial stability of our customers, the ability of TriZetto to meet its contractual obligations to customers, including service level and disaster recovery commitments, changes in government laws and regulations and risks associated with rapidly changing technology, as well as the other risks identified in TriZetto’s SEC filings, including, but not limited to, its annual report on Form 10-K and quarterly reports on Form 10-Q, copies of which may be obtained by contacting TriZetto’s Investor Relations department at 949-719-2225 or at TriZetto’s web site at www.trizetto.com. All information in this release is as of February, 20, 2007. TriZetto undertakes no duty to update any forward-looking statement to conform the statement to actual results or changes in the company’s expectations.

ARLINGTON, Va., Feb. 20 /PRNewswire-FirstCall/ — FBR Capital Markets Corporation, the principal subsidiary of Friedman, Billings, Ramsey Group, Inc. , today announced that Thomas A. Crowley Jr., David Moskowitz, RPh., Jeffrey R. Swarz, Ph.D. and Ryan T. Stewart have joined the firm’s healthcare investment banking group. These additions broaden FBR’s healthcare platform and continue the expansion of its investment banking team.

“Tom, David, Jeff and Ryan’s combined expertise spanning virtually every segment of the healthcare industry will be a tremendous asset to FBR’s capital markets franchise,” said FBR Capital Markets President and Chief Operating Officer Richard J. Hendrix. “These appointments demonstrate our commitment to achieving success in each of our industry groups and to placing talented and knowledgeable individuals within those groups in order to achieve that goal.”

Thomas Crowley joins FBR as Managing Director and comes from Aircast LLC, a leading global orthopedic company where he served as Chief Executive Officer for the last four years. Mr. Crowley has also held general management and senior level roles with healthcare firms including Hoffman-La Roche Inc.; Bayer; and Becton, Dickinson and Company. He has worked closely with venture capital and private equity portfolio companies and has served on the boards of for-profit and not-for-profit organizations. Mr. Crowley earned an M.S. from the Columbia University School of Business and graduated from the U.S. Army Command and General Staff College.

David Moskowitz has been with FBR since 2001. Prior to his role as Managing Director of Healthcare Investment Banking, Mr. Moskowitz was Group Head of FBR’s healthcare research, where he provided coverage of the large-cap pharmaceutical industry and select specialty pharmaceutical companies. Before joining FBR, Mr. Moskowitz worked for UBS Warburg and Standard and Poor’s. Prior to entering the financial services industry, Mr. Moskowitz practiced as a registered pharmacist. He received an M.B.A. in Finance and Pharmaceutical Industry Studies from Fairleigh Dickinson University.

Jeffrey Swarz joins the firm as Managing Director and brings 20 years of experience in product development and marketing, equity analysis, capital raising, and investment analysis for companies in various segments of the healthcare industry. Prior to joining FBR, Mr. Swarz was a managing director at Life Sciences Group where he was responsible for corporate finance, mergers and acquisitions, and private financing. Before that, he was a partner at EGS Healthcare Capital Partners, a healthcare private equity fund investing in biotechnology, specialty pharmaceuticals, and medical device companies. As an equity analyst in biotechnology research at Credit Suisse First Boston and Goldman Sachs, Mr. Swarz was rated among the top 10 biotechnology analysts on Wall Street for 1988-1999. He was a National Institutes of Health Research Fellow in Neurovirology, completed a Postdoctoral Fellowship from Johns Hopkins School of Medicine’s Department of Neurology and earned a Ph.D. in Neuroscience from the University of Rochester.

Ryan Stewart joins as Senior Vice President and comes from UnitedHealth Group, where he was Vice President of Strategy and Business Development. Mr. Stewart brings more than 14 years of experience in the healthcare industry, with an emphasis on healthcare information technology, disease management, managed care and pharmaceutical services. Prior to UnitedHealth Group, Mr. Stewart was a managing director at Piper Jaffray & Co. and Director and Senior Healthcare Equity Research Analyst at SunTrust Robinson Humphrey. Mr. Stewart also founded and ran a venture-backed healthcare software company, was in healthcare consulting with Arthur Andersen and in business development with Horizon Blue Cross Blue Shield of New Jersey.

Friedman, Billings, Ramsey Group, Inc. provides investment banking*, institutional brokerage*, asset management, and private wealth services through its operating subsidiaries and invests in mortgage-related assets and merchant banking opportunities. FBR focuses capital and financial expertise on eight industry sectors: consumer, diversified industrials, energy and natural resources, financial institutions, healthcare, insurance, real estate, and technology, media and telecommunications. FBR is headquartered in the Washington, D.C. metropolitan area with offices in Arlington, VA, Boston, Dallas, Houston, Irvine, London, New York, Phoenix and San Francisco. Friedman, Billings, Ramsey Group, Inc. is the parent company of First NLC Financial Services, Inc., a non-conforming residential mortgage originator headquartered in Deerfield Beach, Florida. For more information, see http://www.fbr.com/.

*Friedman, Billings, Ramsey & Co., Inc.

Friedman, Billings, Ramsey Group, Inc.

CONTACT: Lauren M. Burk of Friedman, Billings, Ramsey Group, Inc.,+1-703-469-1004, [email protected]

Web site: http://www.fbr.com/

Sonora Medical Systems, Inc., a majority-owned subsidiary of Misonix, Inc. (NASDAQ: MSON), has entered into a joint development agreement with Medical Diagnostic Technologies (“MDT”) to bring to market a novel and sophisticated test device designed to troubleshoot diagnostic ultrasound systems. The companies will collaborate on a product to be marketed as FirstAssist, and is expected to be commercially available in the United States during the summer of 2007.

Sonora, of Longmont, Colorado, is a leading supplier of after-market products, services and test equipment to the medical imaging market. Medical Diagnostic Technologies of Las Vegas, Nevada, is a leader in the development of computer aided detection (“CAD”) products. The companies will jointly develop a product to test all imaging and Doppler modalities of an ultrasound system and analyze signals displayed on the ultrasound monitor for various operational characteristics claimed by original equipment manufacturers (“OEMs”) in their published system specifications. FirstAssist will connect to ultrasound systems in the same receptacle in which probes are normally inserted and will have the capability of interfacing with laptop computers, enabling more user-friendly maintenance and accurate in-service system testing.

FirstAssist will serve as complementary product to Sonora’s ultrasound probe-testing device FirstCall, which is currently used by more than 100 major hospitals nationwide. FirstCall tests probes independently of the ultrasound system, while FirstAssist will test the ultrasound system independently of the probe. The FirstAssist device supports intuitive processing as it will connect and test the ultrasound system as if the probe that delivers ultrasonic energy were actually connected and in service.

“Sonora has for years led the industry in developing and commercializing electro-acoustic test devices designed to test the performance of, and troubleshoot, advanced diagnostic ultrasound systems,” said G. Wayne Moore, President and CEO of Sonora. “This new product will obviate the need for hospitals to rely upon the ultrasound OEM for after warranty service contracts, thereby providing a substantial cost savings annually for hospitals and clinics. The combination of Sonora’s hardware design and the sophisticated image processing algorithms developed by MDT will set a new standard in ultrasound quality control and really empower hospital biomedical engineers to troubleshoot and repair even the most technologically intense ultrasound system.”

“Sonora has an impressive track record of technical innovation and achievement,” continued Mr. Moore. “Among other products, Sonora has developed and commercialized the first ever electro-acoustic ultrasound test device, the FirstCall, opening an entirely new market segment in diagnostic ultrasound. Since its market inception just five years ago, the FirstCall has received five US Patents with three additional patents pending. Along with the FirstCall, Sonora recently introduced another breakthrough product, the Nickel, a hand-held device that directly tests all the major modes of operation of any commercial ultrasound system.

“With a mission to continuously develop new products that support improved performance and efficiency for the medical imaging market, Sonora was recently recognized among the industry’s brightest in Medical Imaging Magazine’s 2006 Readers’ Choice Awards. In the 11th annual Medical Imaging Readers’ Choice Awards, the leading trade magazine’s readers voiced their opinions on who is providing unbeatable equipment, software, and services to the health care industry. Sonora ranked among the highest within the Dealer/Distributor and Remanufacturer/Rebuilder group. This is the third consecutive year that Sonora has been named to the list.”

James Benson of MDT noted, “Having created CAD for the early detection of prostate cancer as well as other important clinical applications, it was a natural extension to direct our technology into the rapidly growing area of ultrasound quality control and service. We are excited to work on the development of this product with Sonora, the recognized world leader in the field of ultrasound test equipment.”

About Sonora Medical Systems, Inc.:

Sonora Medical Systems is an ISO-9000 certified and FDA registered provider of high quality products and services to the diagnostic ultrasound and MRI markets. Its products and services are marketed on a direct basis to healthcare providers, dealers and service organizations in North America, and both directly and through distribution partners in non-U.S. markets. Customers include large and small hospitals, stand-alone imaging centers, clinics, Independent Service Organizations (ISOs) and Original Equipment Manufacturers (OEMs). Located in Longmont, Colorado, Sonora is a subsidiary of Misonix, Inc. (NASDAQ: MSON). Additional information on Sonora is available at its Web site at www.4sonora.com.

About Misonix:

Misonix, Inc. (NASDAQ: MSON) designs, develops, manufactures, and markets medical, scientific, and industrial ultrasonic equipment, laboratory safety equipment, and air pollution control products. Misonix’s ultrasonic platform is the basis for several innovative medical technologies. Misonix has a minority equity position in Focus Surgery, Inc. which uses high intensity focused ultrasound technology to destroy deep-seated cancerous tissues without affecting surrounding healthy tissue. Addressing a combined market estimated to be in excess of $3 billion annually, Misonix’s proprietary ultrasonic medical devices are used for wound debridement, cosmetic surgery, neurosurgery, laparoscopic surgery, and other surgical and medical applications. Additional information is available on the Company’s Web site at www.misonix.com.

With the exception of historical information contained in this press release, content herein may contain “forward looking statements” that are made pursuant to the Safe Harbor Provisions of the Private Securities Litigation Reform Act of 1995. These statements are based on management’s current expectations and are subject to uncertainty and changes in circumstances. Investors are cautioned that forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from the statements made. These factors include general economic conditions, delays and risks associated with the performance of contracts, uncertainties as a result of research and development, potential acquisitions, consumer and industry acceptance, litigation and/or court proceedings, including the timing and monetary requirements of such activities, regulatory risks including approval of pending and/or contemplated 510(k) filings, the ability to achieve and maintain profitability in the Company’s business lines, and other factors discussed in the Company’s Annual Report on Form 10-K, subsequent Quarterly Reports on Form 10-Q and Current Reports on Form 8-K.

American Medical Alert Corp. (NASDAQ: AMAC), a provider of healthcare communication services and advanced home health monitoring technologies, announced today the launch of Walgreens Ready Response™ Medical Alert System with Walgreen Co. (NYSE: WAG)(NASDAQ: WAG), the nation’s largest drugstore chain.

Walgreens Ready Response™ system was developed exclusively for Walgreen Co. by American Medical Alert Corp. to support family caregivers and their aging loved ones who are seeking creative solutions to maintain independent living at home. Using AMAC’s flagship personal response system technology, Walgreens Ready Response™ Medical Alert system will be monitored by AMAC’s Response Center to provide round-the-clock response services. Additionally, the offering will include a dedicated bathroom activator to enhance the ability to summon assistance from the area in the home where many falls occur.

“This system is an important addition to the services we offer for seniors and their caregivers that go beyond the traditional pharmacy offering,” said Don Huonker, Vice President of Pharmacy Services for Walgreens. “It’s another way of helping people live independently for as long as possible.”

Under this exclusive relationship, the Walgreens Ready Response™ Medical Alert system will be offered at Walgreens stores in selected markets and on a national scale through Walgreens Web site at www.walgreens.com/readyresponse.

Frederic Siegel, Executive Vice President of AMAC, said, “We are pleased to be selected by Walgreen as its technology provider in this initiative. With Walgreens national brand recognition in the retail health sector coupled with AMAC’s 25 years experience in medical alert system manufacturing and 24/7 monitoring services, we believe that Walgreens Ready Response™ Medical Alert System will become an integral solution for caregivers to help their loved ones remain independent at home. More than 30 percent of individuals over 65 will experience a fall or other emergency in their home each year, and this service provides instant access to emergency assistance, improving the chance of recovery and return to independent living.”

Added Jack Rhian, AMAC’s Chief Executive Officer, “We are extremely pleased to support Walgreen in providing this valuable service. Through its national pharmacy network and loyal customer base, Walgreen expects to build consumer awareness about this vital health monitoring device and make it simple for caregivers and seniors to obtain the service.”

Pricing & Availability

Walgreens Ready Response™ Medical Alert System is available for $34.95 (U.S.) per month and a one time activation fee of $34.95 (U.S.) The system includes a two-way voice console unit, personal help activator, bathroom activator, telephone and power cord and monitoring services. There are no long-term contracts required. Consumers may obtain the system through select Walgreen locations and on online at www.walgreens.com/readyresponse.

About Walgreen Co.

Walgreen Co. is the nation’s largest drugstore chain with fiscal 2006 sales of $47.4 billion. The company operates 5,611 stores in 48 states and Puerto Rico, including 76 Happy Harry’s stores in Delaware and surrounding states. Walgreens also provides additional services to pharmacy patients and prescription drug and medical plans through Walgreens Health Services, its managed care division, which includes Walgreens Health Initiatives Inc. (a pharmacy benefits manager), Walgreens Mail Service Inc., Walgreens Home Care Inc. and Walgreens Specialty Pharmacy.

About American Medical Alert Corp.

AMAC is a healthcare communications company dedicated to the provision of support services to the healthcare community. AMAC’s product and service portfolio includes Personal Emergency Response Systems (PERS) and emergency response monitoring, electronic medication reminder devices, disease management monitoring appliances and healthcare communication solutions services. AMAC operates eight communication centers under local trade names: HLINK OnCall, Long Island City, NY, North Shore TAS, Port Jefferson, NY, Live Message America, Audubon, NJ, ACT Teleservice, Newington, CT and Springfield, MA, MD OnCall, Cranston RI and Capitol Medical Bureau Rockville, MD, American MediConnect and Phone Screen Chicago, IL to support the delivery of high quality, healthcare communications.

This press release contains forward-looking statements that involve a number of risks and uncertainties. Forward-looking statements may be identified by the use of forward-looking terminology such as “may,””will,””expect,””believe,””estimate,””anticipate,””continue,” or similar terms, variations of those terms or the negative of those terms. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are set forth in AMAC’s filings with the Securities and Exchange Commission (SEC), including AMAC’s Annual Report on Form 10-K, AMAC’s Quarterly Reports on Forms 10-Q, and other filings and releases. These include uncertainties relating to government regulation, technological changes, costs relating to ongoing FCC remediation efforts, our expansion plans, our contract with the City of New York and product liability risks.

SHELTON, Conn., Feb. 20 /PRNewswire/ — Veterinary hospitals and pet owners in the Shelton, Connecticut, area now have a convenient and advanced new resource for the medical and surgical treatment of animals.

Shoreline Animal Emergency Clinic, which has provided emergency coverage to area hospitals on off hours and holidays for over 20 years, announces the opening of its state-of-the-art new Shoreline Veterinary Referral and Emergency Center in Shelton, conveniently located at 895 Bridgeport Avenue, just off Exit 11 of Route 8.

Together with the Veterinary Referral and Emergency Center of Norwalk, the new facility will offer coverage 24 hours a day, 7 days a week. “In addition to our more accessible new location, our expanded hours will offer greater convenience for referring veterinarians and their clients,” said Larry Berkwitt, DVM, DACVIM, chief of staff of the new center. “Pets will no longer need to be picked up before eight a.m., allowing veterinarians and their clients more time to make treatment and transfer decisions.”

Shoreline offers internal medicine and ultrasound services by Dr. Berkwitt and Dr. Michelle Cieplucha, who will be available for referrals on an emergency or appointment basis, Monday through Friday. Surgical emergency services will be covered on a 24/7 basis until April by the doctors at the VREC of Norwalk and the Cheshire Veterinary Hospital.

By April, the new facility will offer comprehensive referral services, including internal medicine, surgery, neurology, radiology, critical care and cardiology.

For more information, contact the Shoreline Veterinary Referral and Emergency Center at 203.929.8600.

Shoreline Animal Emergency Clinic

CONTACT: Kay Wyler, +1-203-854-9960

By REBECCA HOWARD

A RECENT U.S. study has confirmed what men have instinctively known for centuries – that an hourglass figure complete with a tiny waist and curvaceous hips is seriously sexy.

According to the University of Texas, the formula for a perfect figure – and one guaranteed to turn the heads of the opposite sex – involves dividing your waist by your hip measurement (this needs to include your bottom).

Anything below 0.8 is considered a healthy result, but the smaller your waist to hip ratio (WHR), the more sexually alluring your figure. For example, the classic pinup dimensions of 36-24-36 gives a WHR of 0.66.

So, science may have come up with a solution for sure-fire sex appeal, but why is a small WHR so alluring to men?

‘It’s all down to the male’s unconscious assessment of a female’s sexual and reproductive capabilities – it’s a primeval response,’ says study author, Professor Devendra Singh.

‘The classic hourglass figure tells a man three important things at a glance: first, the woman is not already pregnant; second, a narrow waist shows that she is of reproductive age; and third, she is healthy and free from disease.’ Hardly the most romantic of reasons, but a tiny waist, it seems, is every woman’s secret weapon in the seduction stakes and one that fashion has helped us maximise for several centuries.

The corset dates back 3,000 years and has been worn to devastating effect by femme fatales ranging from showgirls to superstars.

Today, minuscule midriffs are championed by Dita Von Teese (hers measures just 161/2 in in a corset) and the Pussycat Dolls, and make a regular appearance on the red carpet and the catwalk. Just look at Alexander McQueen’s Spring/Summer show, all ponyskin corsets and waist-nipping jackets, and the body-bandaging Herve Leger number actress Emily Blunt wore to the Golden Globes.

In a world of emaciated models and celebrities, this look champions femininity and sex appeal and is a million miles away from La La Land’s size zeros. Posh may have a 23in waist, but she’s no poster girl for this trend, proving skeletal can never be mistaken for sexy.

As the adage goes, men do like a little something to grab hold of, and thanks to Lifestyle’s six-step plan, you can create killer curves in all the right places.

The exercise The pose CELEBRITY trainer David Kirsch recommends seated twists combined with a medicine ball for extra waist- slimming resistance.

Sit down with your legs bent, feet flat on the floor in front of you.

Holding the medicine ball in both hands, rock backwards slightly to engage your stomach muscles as you lift your feet off the floor.

Holding the ball out in front of you, elbows slightly bent, rotate your shoulders round and twist from the waist from left to right, feeling your abdominal muscles working at the front and sides of your stomach.

Swivel left and right 15 times, rest and repeat twice more. Perform this exercise on alternate days for a slimmer, trimmer midriff.

The treatment ARASYS stimulates circulation by using pulsating waves to contract and tone muscles, and claims it can help to reduce that unsightly overhang by up to 9in after a single session.

From Pounds 25, each 17-minute treatment is the equivalent of performing 300 sit-ups and can help boost your natural metabolic rate to burn off stored fat.

A two-week course of treatments will soon help sculpt a curvier silhouette.

For Arasys salons nationwide, tel: 01202 299 228.

DESKBOUND jobs, weak muscles and ageing all contribute to poor posture that can leave your figure looking squat and dumpy, especially around your middle.

‘Essentially, if you stoop and haven’t got the muscle tone to hold your posture properly, your ribcage drops down towards your pelvis, meaning your waist disappears,’ says body- conditioning expert Marja Putkisto. To help realign and lengthen your trunk, Marja recommends the Bow Stretch.

Start by standing side on to a wall, your feet together. Lift the arm nearest the wall, bend your elbow and lean your arm against the wall, The product The diet tip your fingers pointing down to the floor. Create a bow shape by tilting your rib cage to the right, increasing the space between your lowest left rib and your hipbone.

Hold the position and breathe in deeply allowing your diaphragm to rise inside your ribcage, while pulling your abdominals back towards your spine.

Pause, and at the end of the exhalation, pull your navel in more and squeeze your buttocks to pull up your pelvic floor muscles.

Repeat three times before switching to the other side.

TACKLE unsightly bulges with Bliss Fat Girl Slim, Pounds 35, available at www.blisslondon.co.uk.

This rub-in cream, laced with caffeine, comes with a special applicator, helping to break up fat cells under the skin, leaving your stomach and hips smooth and more streamlined.

The makers claims that in three weeks, you’ll have a firmer, leanerlooking waist.

INCREASE the amount of fresh food, fruit and vegetables you eat to boost your fibre intake.

Fibre helps keep your digestive system working efficiently, cleaning the digestive wall to ensure food is quickly and effectively digested.

Food that stays undigested in your system longer than 24 hours will release gases that leave you looking permanently bloated. Be sure to incorporate plenty of the following into your diet: APPLES to increase your fibre content.

NON-FAT, plain yoghurt to increase your friendly bacteria.

GRAPEFRUIT, because it’s high in B vitamins, good for any weightloss programme.

SAUERKRAUT, which keeps your bowels moving.

BROCCOLI, which provides many nutrients for your hormones to produce enzymes.

Finally, take time to chew your food. It’s not just about what you eat, but also how you eat it, and smaller fragments of food are easier for your system to break down.

The fashion fix GOOD underpinnings can make all the difference to your torso.

It’s a touch Bridget Jones and definitely better concealed under clothes than displayed au naturel, but the Spanx Hide Sleek Hi- Rise Body Smoother, Pounds 45, starts just below your bra line and extends down to mid-thigh, flattening out the bulging bits in between and creating a cinched waist.

If this sounds a bit extreme and seriously unsexy, try Agent Provocateur’s Waspie, Pounds 98. Front fastening and made from duchess satin, the luxurious outer shell conceals steel spiral boning for ultimate control.

Alternatively, diehard fashionistas should opt for the 3.1 Philip Lim belt, Pounds 120. This elasticated waist-cincher has two leather panels at the front joined by a linking brass buckle, ensuring you achieve the hourglass shape of the season.

(c) 2007 Daily Mail; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.

By Diedtra Henderson, The Boston Globe

Feb. 19–WASHINGTON — For patients suffering from a severe form of Crohn’s disease, a remedy already on the shelf to treat other maladies and a brand-new drug could offer new hope.

Within days, Illinois-based Abbott Laboratories expects to win federal approval to sell its drug, Humira, currently used to treat rheumatoid arthritis, psoriatic arthritis, and a disease that causes arthritis of the spine, to combat the intestinal disorder.

The new use could produce up to about $500 million in annual revenue for a drug that is produced at Abbott’s facility in Worcester.

Some 600,000 North Americans suffer from Crohn’s, a chronic, inflammatory disease of the gastrointestinal tract.

The ailment is marked by debilitating flares that trigger diarrhea, cramping, loss of appetite, and weight loss.

It’s a “wonder disease,” jokes Judi Walk, of Needham, “because you’re always wondering why you’re sick. You can be fabulous one morning and sick as a dog that night,” said Walk, 63, who has struggled with Crohn’s symptoms since she was a teenager.

“When you have a flare-up, you’re basically knocked into bed,” Walk said. “A serious flare-up can stop your life.”

Dr. Adam S. Cheifetz, who treats patients with Crohn’s, said only two-thirds respond to Centocor Inc.’s Remicade , the first biologic treatment approved by the Food and Drug Administration for adults with moderate to severe Crohn’s. Even those who do respond can build resistance to Remicade over time.

“The biggest difference this is going to make is for those people who had been doing well on Remicade, and then lost their response. That was a problem group of patients,” said Cheifetz, clinical director of the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center. “For those patients we would normally put on Remicade, now we have two drugs to choose from.”

In clinical trials, 21 percent of patients who had stopped responding to Remicade were coaxed into remission by week four on Humira, compared with 7 percent who achieved remission on a placebo. Those results were impressive enough for the FDA to speed its handling of the drug — trimming the review from 10 months to six months and indicating that an approval decision could come by the end of February.

Because the FDA has already approved Humira for other uses, doctors and patients would be able to purchase it immediately after FDA approval, for roughly $600 per syringe wholesale, or $16,000 per year, according to Abbott spokeswoman Elizabeth Shea.

People with Crohn’s are often diagnosed between the ages of 15 and 30, a “young and active patient population,” said Shea, who added that Humira’s other selling point for people who plan their lives around trips to the bathroom is the ease of being able to self-administer the drug at home.

Cowen and Co. analysts factored that into their projection that Humira would become a $4.3 billion worldwide seller by 2010 and the dominant injectable Crohn’s drug in the United States, besting UCB Pharma’s once-monthly Cimzia , an experimental drug that is also expected to receive FDA approval this year.

For patients like Lauren Whelihan , a 25-year-old who was home-schooled because she was too sick to attend high school, the new drugs are a godsend. Whelihan already has had two surgeries that removed much of her large intestine. For now, Remicade works, and the Westfield State College student is in her longest remission ever.

But Whelihan is already planning for a future when Remicade might not work. “It never hurts to have more options with a disease like this,” she said.

A third possible option for Crohn’s patients is Biogen Idec’s multiple sclerosis therapy Tysabri.

Tysabri was greeted with excitement because of its ability to keep Crohn’s patients in remission in clinical trials, and because it works by a different mechanism than the other drugs.

The multiple sclerosis remedy was pulled from the market after being linked to a rare brain infection. But regulators have allowed renewed sales and, on Dec. 15, Biogen Idec said it was seeking FDA approval to sell the drug as a treatment for moderately to severely active Crohn’s disease.

Jennifer M. Chao , a senior biotechnology analyst at Deutsche Bank , however, maintains a forecast of no revenue from its future use as a Crohn’s therapy.

“Tysabri is much more of a long shot, at this point,” Cheifetz agreed.

—–

To see more of The Boston Globe, or to subscribe to the newspaper, go to http://www.boston.com/globe.

Copyright (c) 2007, The Boston Globe

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Dan Vierria, The Sacramento Bee, Calif.

Feb. 18–Pat yourself on the deltoids. Nice job dropping pounds and building muscle. You look terrific.

In honor of your dedication and hard work, we’ve plucked a few lighthearted, offbeat health and fitness stories. Sip a fruit smoothie and enjoy.

Uplifting experiences

The American Society of Plastic Surgeons cites a 283 percent increase in butt lifts between 2000 and 2005. The procedure has become a hot one for both men and women.

Lifts, or fat grafting, uses a patient’s body fat to resculpt rear ends affected by age or genetics. The Brazilian Butt Lift is the signature (and patented) butt augmentation procedure of Beverly Hills plastic surgeon Dr. Anthony Griffin.

Griffin, of ABC’s “Extreme Makeover” and a featured guest on other broadcast and cable channels, says the derrières of Beyonce and Jennifer Lopez are what butt augmentation patients seek. Extracting fat from around the patient’s waist, Griffin relocates it to the buttocks, sculpting a full, rounded rear end.

On his Web site, www.griffinmd.com, the result is described as “a round, curvaceous, thong-worthy butt.”

Skin gym

Response for the first Naked Sunday, a day for nude workouts at a gym in the Netherlands, has been mixed, according to Patrick de Man, owner of Fitworld gym in Heteren.

He says a couple of his members suggested Naked Sunday, but a survey of all members found most prefer wearing clothes while on the gym floor. And most had questions about sanitation.

The membership was assured by de Man that nude exercisers would be required to place disposable seat covers on exercise bikes and use towels on weight machines. Plus, as always, machines would be cleaned and disinfected on a daily basis.

His first Naked Sunday will be March 4.

Misguided message?

The Oakland-based National Association to Advance Fat Acceptance is demanding that billboards targeting childhood obesity in Massachusetts be removed.

The group also wants the MetroWest Community Health Care Foundation of Framingham, Mass., to cease all radio, TV and print ads because, the NAAFA claims, they “promote fear and hatred of larger bodies and body obsession in children, ultimately leading to eating disorders.”

MetroWest explained that the campaign targets adults, not kids. But NAAFA countered with, “Billboards depicting fat kids are extraordinarily harmful to the very kids they are supposedly trying to help. Fat children are already the targets of merciless bullying. This campaign simply gives the bullies permission to do more of the same.”

The NAAFA folks support healthy eating habits but believe the overweight should accept their bodies and love every pound.

—–

Copyright (c) 2007, The Sacramento Bee, Calif.

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By David Blackburn, Messenger-Inquirer, Owensboro, Ky.

Feb. 17–Aerobics was born in 1968 but grew up in the winter of 1981-82.

America wanted the infant MTV when it was still showing music videos like the one with “Grease” good girl Olivia Newton-John in a gym purring “Let’s Get Physical.”

The song, No. 1 from November 1981 to January 1982, and video didn’t just make headbands, tights and leg warmers fashionable.

They and the 1982 release of Jane Fonda’s workout tape created an aerobics explosion.

Twenty-five years later, group cardiovascular exercise has evolved beyond the term “aerobics,” a type of music, even the intent.

There are water and dance aerobics; martial arts-based exercises; and trunk muscles-centered yoga and Pilates classes.

They are done to jazz, techno, hip-hop, salsa and myriad combinations of those and other types of music.

What they have in common is interval training — combining heart-pumping, heavy-breathing movement with muscle-shaping strength training.

Doctors, sports therapists and physiologists say raising and lowering the heart rate strengthens and conditions heart muscles, said longtime fitness instructor Nancy Mollett.

“I think through studies … they have determined interval training is the best training for the heart,” said Mollett, 53, finance director at the Owensboro Family YMCA.

Mollett started teaching aerobics in 1988 but first took an aerobics class in 1985 while trying to lose the weight gained from having her second child.

She loved the classes but “it was just grueling,” Mollett said.

Classes followed Jane Fonda’s up-tempo, “no-pain, no-gain” mantra, got the heart rate way up there and left it there while trying to firm up tummies, thighs, rear ends and arms.

“Women wanted more than just weights. They wanted to get up and move around,” said Jan Young, Mollett’s mentor. Young is a longtime instructor and is considered the local aerobics guru.

Local instructors weren’t trained or certified, and the dancelike moves were rigid and tough to learn, said Young, 51, then Owensboro Catholic High School’s dance team choreographer.

“It was not about form,” the Apollo High School guidance counselor said. “It was more about being creative and sweating and pushing them to the limit.”

It was also about a look that included headband, brightly colored tights and leg warmers.

“The outfit was the thing,” Young said, laughing.

What aerobics was NOT about back then was comfort.

The high-impact workouts were sometimes done on unforgiving hardwood, tile or carpet-covered concrete floors that left exercisers sore.

Jane Noble, 65, of Halifax Drive, a former five-pack-a-day smoker, started taking aerobics after a 1984 throat cancer scare. She quit after two years because of knee and hip pain.

Patsy Shelton, 58, of Fern Hill Drive, also a former smoker, and Noble found they preferred the lower-impact classes.

“It wasn’t as hard on me. It seemed like it was easier on my body,” Shelton said after they finished Young’s recent Saturday morning classes.

“You could target your muscles,” Noble said.

Both women said they have learned about the different muscle groups and enjoy the variety of the workouts.

Back in the day, they said, routines were almost always the same, and each instructor had favorite areas of the body they liked to work on.

From the time the music begins, Jan Young’s feet never stop bouncing on the wood floor of the aerobics room during her aerobics class at the Owensboro Medical Health System HealthPark.

Now, it changes up and they have someone to teach them the proper techniques, which Young emphasizes frequently.

“You know what her nickname is?” Noble said, sweating through a set of partial squats with dumbbells. ” ‘G.I. Jane.’ She’s like a drill sergeant.”

“Technique is everything,” said Young, who walks through class adjusting students’ forms. An instructor’s role “is not to go into a class to stay fit. We’re supposed to be professionals.”

Young even teaches the proper way to walk — head up, arms in a controlled swing at 90-degree angles and hands unclenched.

Young also teaches not to stomp the boxes during step aerobics, which became popular in the mid-1980s and attracted male students when aerobics no longer looked like dancing, she said.

“I tell them, ‘We are not cows; we are women,’ ” she said.

Instructors also should encourage students to mix up their workouts, adding bicycling or running, Mollett said.

“I always encourage people, and still do, to cross train so they don’t burn out,” said Mollett, who augments her own workouts with light running.

Noble, who sometimes takes water aerobics, hates working out on machines.

Aerobics “is all I’ve ever done,” she said. “I need the commitment and motivation from other people. It makes it fun.”

“There is a very strong social aspect to it,” said Jaime Ford, YMCA fitness director who schedules its many types of group exercise programs.

“I think it’s popular because you always have an instructor. You’ve got that accountability,” Ford said. “Somebody’s going to miss you if you’re not there.”

There also are strong bonds between students and with instructors, said Ford, who once taught a workout class for mothers and infants.

“They are very loyal to their instructors,” Ford said. “It’s kind of like your hairdresser. You go with what works.”

For Noble and Shelton, that has meant aerobics and several of its evolutions.

“It helps me forget about work. I forget about all I do at the office,” said Noble, who owns a travel agency.

Shelton, who remembers doing step aerobics on handmade wooden boxes instead of molded plastic shells, takes classes even while on vacation.

“I feel good when I leave. I feel like I’ve done something,” Shelton said.

—–

Copyright (c) 2007, Messenger-Inquirer, Owensboro, Ky.

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

By Travis E. Poling, San Antonio Express-News

Feb. 16–Two hospitals of the Baptist Health System have new presidents at the helm.

San Antonio native Matt Stone was promoted from chief operating officer of Northeast Baptist Hospital to president.

And John “Jack” Cleary will move to San Antonio from Jackson, Miss., next week to head North Central Baptist.

Stone, a certified public accountant, joined the system in 2001 as a financial analyst after holding several other positions in the health care industry.

Despite his financial background, Stone said he found he enjoyed dealing with the doctors, patients and employees as much as he liked the analysis.

“It’s one of those things that you find out you’re pretty good at,” Stone said. “I was known as the accountant that would talk to you.” Stone, a graduate of the University of Texas at San Antonio, worked in the restaurant and building industries before switching to health care. He worked at Christus Santa Rosa Health Corp. and health insurers Blue Cross/Blue Shield of Texas, PCA Health and Humana Health Plans of Texas.

Northeast Baptist now has 310 beds and 1,000 employees after a recently completed $80 million expansion. Stone replaces Bruce Buchanan, who left to head a hospital in Phoenix owned by Baptist parent company Vanguard Health Systems.

“The team (at Northeast Baptist) has really rallied around Matt,” said Baptist Health System CEO Trip Pilgrim. Doctors and employees “have all expressed their confidence in his knowledge, experience and leadership abilities.” Cleary starts his job at North Central Baptist in the Stone Oak area Monday.

Most recently, he served as president and CEO of the two-hospital River Oaks Health System in Jackson. Cleary also held positions with Singing River Hospital System in Gautier, Miss.

Cleary is a 26-year veteran of the Air Force, retiring as a colonel. As a Medical Services Corps officer, he made countless visits to San Antonio on Air Force business — to Randolph AFB and the former Brooks AFB. The offer to move here to work with Baptist, Cleary said, was an easy sell.

He said he wants to work with physicians to attract more patients to North Central Baptist, which recently underwent an $85 million expansion. Competitor Methodist Healthcare System is building a hospital in the same part of town.

Previous North Central Baptist President Dominic Dominguez left to go to Methodist Metropolitan Hospital downtown.

—–

To see more of the San Antonio Express-News, or to subscribe to the newspaper, go to http://www.mysanantonio.com.

Copyright (c) 2007, San Antonio Express-News

Distributed by McClatchy-Tribune Business News.

For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

NEW YORK, Feb. 16 /PRNewswire/ — IdeaSphere Inc. (ISI), a global health and wellness company specializing in vitamins, minerals, and other nutritional products, entered into a Stock Purchase Agreement on August 24, 2006 with Boehringer Ingelheim GmbH (BI), of Ingelheim, Germany, to acquire BI’s nutritional supplement company Pharmaton SA, based in Lugano, Switzerland.

Following this morning’s announcement by BI that it was terminating the August 24 Stock Purchase Agreement, Mark Fox, President and COO of ISI stated, “We are disappointed that the parties were not able to reach agreement at this time to complete the Pharmaton transaction.” Mr. Fox added, “We have very much enjoyed working with our Pharmaton colleagues over the past year, and we still believe that the alliance between the Pharmaton and ISI platforms of nutritional products is the right answer for the global consumer.”

“IdeaSphere remains committed to providing consumers with the highest quality nutritional products, and we are very excited about the opportunities to expand the reach of our house of brands in 2007, both domestically and internationally,” said Fox.

About IdeaSphere, Inc

IdeaSphere is an innovative global company focused on delivering healthy lifestyle solutions to a broad spectrum of individuals. With more than 1,000 consumer-focused, science-based, content-driven nutrition products across a range of innovative formulations, IdeaSphere is an emerging leader in the health and wellness sector. IdeaSphere is committed to incorporating the latest medical discoveries and meticulously researched ingredients into trusted and time-tested products. The Company’s portfolio of global brands includes Twinlab(R), which includes the Fuel Line of sports and nutritional supplements; Metabolife(R); Ultra Harvest(R), a premium food-based line of vitamins and minerals; Nature’s Herbs(R); Alvita(R) Teas; Rebus Publishing(R); and Dr. Weil(TM) supplements. For more information, visit http://www.ideasphereinc.com/.

IdeaSphere Inc.

CONTACT: Glenn Silver, +1-646-437-4851, or [email protected], or UlyseeHuling, +1-646-437-4865, or [email protected], both for IdeaSphere Inc.

Web site: http://www.ideasphereinc.com/

By JENNY HOPE

EATING watercress every day could help protect against cancer, say researchers.

The vegetable reduces damage to DNA in cells, according to a British trial.

Some nutritionists claim higher intakes of ‘superfoods’ including cruciferous vegetables such as watercress and broccoli can improve the body’s defences against cancer.

But specialists in the disease have sounded a note of caution, warning that consumers are being misled into thinking that superfoods will prevent them contracting cancer, rather than reducing the risk.

Karol Sikora, professor of cancer medicine at Imperial College London, said: ‘ I don’t think people will seriously convert to eating 85g of the stuff each day. That’s an awful lot of watercress! You might even turn green.’ The research, which was published yesterday in the American Journal of Clinical Nutrition, involved 30 men and 30 women. Half the group were smokers.

They ate 85g of watercress a day for eight weeks the equivalent of a bag of pre-prepared salad in addition to their regular diet.

Blood tests were taken at the start and end of the trial, which was carried out by researchers from the University of Ulster.

The tests showed a 23 per cent reduction in DNA damage to white blood cells which is regarded as a marker for susceptibility to cancer among the watercress eaters. When the same cells were exposed to damaging free radicals, scientists observed a 10 per cent cut in damage compared with cells of those eating a normal diet.

They also found a rise of up to 100 per cent in levels of antioxidants, chemicals which help cells defend themselves against damage.

The research, which was funded by British watercress suppliers, found smokers gained most from a watercress-rich diet probably because the habit depletes antioxidants.

Professor Ian Rowland, who led the study, said the results were ‘highly significant’ because they were found in a real life situation.

Most previous research in the area has been conducted in test tubes or in animals, using chemicals derived from cruciferous vegetables.

He said benefits were slightly reduced for those eating cooked watercress such as actress Elizabeth Hurley, who has been known to drink seven cups of watercress soup a day.

But Professor Sikora said the findings of the study were ‘grossly overstated’.

He added: ‘We know that fruits and vegetables all do affect DNA damage, hence the five-a- day strategy to prevent cancer.

‘There is absolutely nothing special about watercress. Much better to look holistically at your diet and ensure that there’s plenty of fruit and vegetables, fibre and as little fat as possible.’ Dr Anthea Martin, of Cancer Research UK, said: ‘While the results of this study are interesting, it involved a relatively small number of people. Larger studies are needed to determine whether the effects of watercress on cells seen by the researchers translate into a decreased risk of developing cancer.’ The charity is funding a study of 500,000 people across ten countries looking at the effect of foods on cancer risk.

[email protected]

UPPSALA, Sweden, February 16 /PRNewswire/ — Radi Medical Systems, a manufacturer of innovative devices in interventional cardiology, announced today that the Center for Medicare and Medicaid Services (CMS) has approved increases in reimbursements for procedures used to measure myocardial Fractional Flow Reserve (FFRmyo). CMS has more than doubled reimbursement for procedures used in measuring FFRmyo in multiple artery disease.

Clinical studies have shown that FFRmyo can be used to accurately assess the functional significance of coronary lesions. Comparative studies have shown that cost savings can be obtained by routinely utilizing FFRmyo to assist in identifying the culprit stenosis.

“CMS continues to see the value in physicians assessing the extent of a patient’s coronary artery disease, particularly, those patients with multi-vessel disease, and then using this vital information to determine the most effective therapy for that particular patient,” said Jim Archetto, COO, Radi Medical Systems Inc.

The adjustments to the reimbursement codes for FFRmyo that took effect January 1, 2007 are as follows:

Ambulatory Patient Classification (APC)

– APC group 0670, entitled ‘Level II Intravascular and Intracardiac Ultrasound and Flow Reserve’ has a national average payment rate of $1984.52, an increase of $273.30.

– APC group 0416, entitled ‘Level I Intravascular and Intracardiac Ultrasound and Flow Reserve’ has a national average payment rate of $2000.61, an increase of $1021.87.

Current Procedural Terminology (CPT)

– CPT Codes 93571 and 93572 have increased approximately 7.4% to $99.29 and 6.8% to $77.31, respectively.

APC group 416 and CPT code 93572 are utilized when more then one vessel is interrogated to measure FFRmyo.

Radi’s physiology measurement platform is the only system on the market that provides measurement of pressure (FFR) thermodilution derived flow (CFR) and intravascular temperature, using a single PressureWire(R) and one instrument. The new generation of intravascular assessment products includes the PressureWire(R) Certus coronary guide wire and the RadiAnalyzer(R) Xpress, a mobile, diagnostic computer designed to record and display information based on the input from the PressureWire(R).

About Radi Medical Systems:

Radi Medical Systems AB develops, manufactures and sells medical devices designed to improve patient care. Our pioneering work within the field of interventional cardiology has resulted in market-leading intravascular sensors and hemostasis management devices. We continue to work closely with medical practitioners to refine techniques and find new uses for our devices, as well as provide unrivaled education and support. Based in Uppsala, Sweden, Radi Medical Systems was founded in 1988. Today we employ more than 320 people globally with representation in 42 countries.

All CPT Codes are Copyright 2006, American Medical Association

Radi Medical Systems AB

CONTACT: For more information, contact: Melinda Perjons, Radi MedicalSystems, AB, Palmbladsgatan 10, SE – 754-50 Uppsala, +46-018-16-2018,[email protected], Jason Rudy, Director, US Marketing, Radi MedicalSystems, Inc, 200 Research Drive, Wilmington, MA 01887-4432, +1-877-337-7234,[email protected]

Research and Markets (http://www.researchandmarkets.com/reports/c50633) announces the addition of Frost & Sullivan’s new report U.S Hospital Information Systems (HIS) Markets to their offering.

This Research analyzes market trends in the United States hospital information systems market since 2002, forecasts future changes in market measurements through 2012, and discusses specific challenges facing industry participants and strategic recommendations targeted to overcome these challenges. The hospital information systems market was sub-segmented into non-clinical and clinical information systems and further subsegmented into stand-alone and integrated information systems.

Key Topics Covered inside Report:

1 EXECUTIVE SUMMARY

2 U.S. HOSPITAL INFORMATION SYSTEMS (HIS) MARKET OVERVIEW

3 U.S. NON-CLINICAL HIS MARKET

4 U.S. CLINICAL HIS MARKET

5 APPENDIX

Increasing Need to Reduce Errors Generate Growth in the Hospital Information Systems Market

Due to the increasing need to reduce errors, cut costs, and improve the delivery of services, hospitals are investing in robust information technology to better patient safety and healthcare. It is also imperative for hospitals to periodically upgrade their systems to effectively reduce errors, and improve the efficiency of the service. This coupled with the need to provide cost-efficient services is essentially increasing hospital information systems (HIS) adoption rates.

The U.S. HIS market is likely to further expand with increasing demand for integrated versions of HIS and customized solutions for individual departments such as clinical laboratory, radiology, pharmacy, and high acuity care areas of the hospital. “As stand-alone systems are customized to meet the specific needs of these particular departments, they offer solutions such that the entire process of the particular department is taken care of, thereby shaping the direction of the information flow in the hospital,” explains the analyst of this research service. “Technological improvements are likely to provide complete backward integration, which would improve customization and provide new opportunities.”

Expert Installation and Stand-alone HIS Help Save Cost and Time of Installation

Although return on investment is high, many hospitals find HIS implementation expensive. Moreover, installation of the hospital-wide enterprise system can require about 36 months, adding to the cost of implementation significantly. As HIS solutions present several issues that are to be dealt with at various stages, it is essential to hire experts for the installation. As they are better equipped to deal with the complicated process that stretches across many departments, they can help save valuable time. Many vendors are offering solutions that are targeted at selected regions of the hospital. Stand-alone systems typically require lesser amount of time for installation, provide a certain level of connectivity, and offer limited functionalities. Many hospitals prefer to adopt this model, as the cost and time of implementation better suit their plans.

However, stand-alone solutions that work well in small hospitals and restricted departments, quite often, are incapable of scaling up to a larger set up. Hence they become redundant and have to be either replaced or abandoned. The familiarity with systems, which already exist in the hospital and the effort required to embrace a newer system cause resistance to change. Physicians, nurses, and other hospital staff need to be properly educated to adopt the new system. “The industry needs to evolve a standard that would provide a uniform set of services, and have the same installing processes,” cites the analyst. “This could be achieved through a consensual approach or through acquisitions and mergers.”

For more information visit http://www.researchandmarkets.com/reports/c50633

By Ji, B; Liu, J; Liu, M; Feng, Z; Et al

Aim. The aim of this investigation is to evaluate the effect of enriched with potassium-magnesium aspartate cold-blood cardioplegia on early reperfusion injury and postoperative arrhythmias in patients with ischemic heart disease undergoing coronary artery bypass grafting (CABG), using measurements of cardiac troponin I (CTnI), hemodynamic indexes and clinical parameters. Methods. Forty patients with three-vessel coronary artery disease (CAO) and stable angina, receiving firsttime elective CABG, were randomly divided into 2 groups: patients in control group (C group n=20) received routine institutional cold blood cardioplegia (4 C) concentration of Mg2+4 mmol/L, Ca2+1.2 mmol/L and K+ 24mmol/L during myocardial arrest Patients in P group (n=20) received modified cold blood cardioplegia enriched with potassium-magnesium aspartate and maintained concentration of Mg2+10 mmol/L, Ca2+1.2 mmol/L and K+20mmol/L in the final blood cardioplegia solution. Clinical outcomes were observed during operation and postoperatively. Serial venous blood samples for CTnI were obtained before induction, after cardiopulmonary bypass (CPB), and postoperative 6, 24, and 72 hours. Hemodynamic indexes were obtained before and after bypass by the radial catheter and SwanGanz catheter.

Results. In both groups, there were no differences regarding preoperative parameters. There were no cardiac related deaths in either group. The time required to achieve cardioplegic arrest after cardioplegia administration was significantly shorter in P group (47.516.3 s) than in C group (62.517.6 s) (P

KEY WORDS: Potassium – Magnesium aspartate – Coronary artery bypass grafting – Myocardial infarction – Troponin.

Cardioplegia is a very important component during cardiopulmonary bypass (CPB) surgery, not only supplying a bloodless field for the surgeon, but also decreasing myocardial injury from ischemia/ reperfusion. Instead of crystalloid cardioplegia, cold blood cardioplegia was regarded as a clinical practice in 1994 in our hospital for adult patients and provided benefits over cold crystalloid cardioplegia1. Over 30 000 open-heart operations were performed with cold blood cardioplegia from 1994-2005. However, mortality and morbidity related to myocardial ischemia/reperfusion injury remained. Significant evidence now exists that the primary mediators of reversible and irreversible myocardial ischemia/ reperfusion injury include intracellular Ca2+ overload during ischemia and reperfusion, and oxidative stress induced by reactive oxygen species (ROS) generated at the onset of reperfusion2-4. The molecule nitric oxide (NO) can also interact with ROS to generate various reactive nitrogen species that appear capable of both contributing to and reducing injury5,6. In addition, metabolic alterations occurring during ischemia can contribute directly and indirectly to Ca^sup 2+^ overload and ROS formation. An understanding of intracellular events that occur secondary to ischemia and reperfusion injury stimulated a search for modifying our cardioplegic solution, in an attempt to improve myocardial recovery postoperative.

Potassium-magnesium aspartate is composed of magnesium aspartate 140 mg (equivalent a 11.8 mg Mg^sup 2+^), potassium aspartate 158 mg (equivalent to 36.2 K^sup +^) and can be effective in stimulating myocardial metabolism, and producing an anti-arrhythmic effect7. In addition, it is well known that magnesium is a natural blocker of the L-type calcium channels and therefore prevents the rise in intracellular calcium during ischemia;8,9 thus, it is likely to reduce energy demands and preserve intracellular metabolites. There are, therefore, strong theoretical reasons to support the addition of magnesium to this cardioprotective strategy. Magnesium also has been widely used in the management of reperfusion-induced ventricular arrhythmias10. In addition, some investigations have shown that metabolic supplementation with aspartate in the cardioplegic solution improves tolerance of normal hearts to global ischemia at normothermia or hypothermia. Possible mechanisms are prevention of ischemia-induced depletion of tricarboxylic acid cycle intermediates and stimulation of the malate-aspartate shuttle11.

The purpose of this study is to investigate whether enriched potassium-magnesium aspartate in the cold blood cardioplegia solution could reduce myocardial injury and prevent postoperative arrhythmias when compared with simple cold blood cardioplegia.

Material and methods

Patient selection and cardioplegia preparation

Our hospital and local ethical community approved the study. Forty consecutive patients who underwent first-time elective coronary artery bypass grafting (CABG) under CPB were enrolled in the present study: 28 men and 12 women, and their ages at operation ranged from 47 to 68 years with a mean of 57.67.5 years. All patients gave their informed consent for the study. The patients were prospectively randomized into one of two groups according to cardioplegic solution used for intraoperative myocardial protection. Randomization was performed by the method described by Altman and Bland12. Control group (C group n=20) received routine institutional cold blood cardioplegia (4 C), which has been used in our hospital since 1994. The cardioplegia formula consists of K+ 20 mmol/L, Mg^sup 2+^ 4 mmol/L, Ca^sup 2+^ 1.2 mmol/L, procaine 0.9 mmol/L, pH 6.9, osmoality 340 mOsm/L. The potassium-magnesium aspartate group (P group n=20) received modified cold blood cardioplegia enriched with 90 mL potassium-magnesium aspartate and concentration of Mg^sup 2+^ maintained at 10 mmol/L and K+ 20 mmol/L in the cardioplegic solution. Preoperative patient characteristics are shown in Table I. All were patients having three-vessel coronary artery disease without valve disease, receiving first time CABG. Excluded were patients with an ejection fraction (EF) below 0.30, recent myocardial infarction (

Operation method

All patients were operated on by the same group in our hospital including the surgeon, anesthesiologist and perfusionist.

Table I. – Preoperative patient characteristics.

ANESTHESIA

The patients were placed in the supine position and anesthesia was induced by the intravenouos administration of fentanyl citrate and vecuroniumbromide, maintained with intravenously administered propofol and inhalation of isofurane. The left radial artery and the right internal jugular vein were catheterized for hemodynamic monitoring. The electrocardiogram and temperature were also monitored. All patients received a high-dose anti-fibrinolytic treatment with aprotinin (5 million KIU).

CARDIOPULMONARY BYPASS

The Stockert-II heart-lung machine (Germany) with roller pump and Medtronic membrane oxygenator Affinity (USA) was used. Continuous non-pulsatile CPB was adjusted at a flow rate of 2.8-3 L/min/kg at 30 C. Mean arterial pressure was maintained 65100mmHg.

SURGICAL PROCEDURE

Following mid-sternotomy and left internal mammary artery (LIMA) preparation, CPB was started under full heparinization (4 mg/kg heparin). The two groups had cardioplegia arrest maintained by two kinds of cold (4 C) blood cardioplegic solutions that were reinfused intermittently every 30 minutes. The route of delivery was exclusively antegrade. The initial dose of cardioplegia was 15 ml/ kg of body weight, and each subsequent dose was half of the initial dose. The a-stat method was used for pH management during hypothermie CPB. When surgical procedures were finished, CPB was stopped. When patient hemodynamics were stable, heparin was neutralized by an infusion of 1 mg protamine sulfate/100 IU of heparin administration.

Laboratory assay

Plasma level marker of myocardial damage (CTnI) was obtained from serial venous blood samples before induction, after CPB, and postoperatively 6, 12, 24, and 72 hours. CTnI concentrations were measured by a specific immunoenzymometric assay developed and has been described in our previous study13.

Electrocardiographic changes

A 12-lead electrocardiogram was recorded 2 hours preoperatively, postoperatively and then daily postoperatively. The electrocardiographic diagnosis criteria for perioperative myocardial infarction (PMI) were new Q-waves more than 0.04 ms or a reduction in R-waves more than 25% in at least two leads.

Statistical analysis

Statistical analysis was performed with SPSS (9.0 version) statistical software. One-way analysis variance (ANOVA) was performed to test the effect of the type of cardioplegia and time on CTnI concentration. Two-way analysis of covari\ance with repeated measures was performed to test the effect of the different type of cardioplegia on CTnI concentrations. Statistical significance accepted at a P

Results

Preoperative and intraoperative data

The major preoperative variables were similar in the two groups (Table I). There were no significant differences between the mean values of age, sex ratio, New York Heart Association (NYHA) classification, body surface area (BSA) and EF.

Operative data

There was no significant difference between the two groups in CPB time, clamp time, graft number, total amount of cardioplegic solution and lowest temperature during bypass. The time required to achieve cardioplegic arrest after starting initial cardioplegia administration was significantly shorter in P group (47.516.3 s, P

Postoperative data

There were no operative deaths (to one month postoperatively) in both groups. Eight patients in C group and one patient in P group (P

Table II. – Operative data and postoperative data.

Leakage of CTnI

CTnI level were similar in both groups before induction. But increased in both groups postoperatively 6 hours. In P group, leakage of CTnI was reduced after CPB. Differences in CTnI concentration between two groups could be inspected at 6 and 12 hours postoperatively (P

Changes of electrocardiograpby

One patient in C group developed new Q waves on the EGG postoperatively. In P group ST segment changes were present in one patient postoperatively (in P group). These data did not show any statistical significance.

Discussion

This study demonstrated that cold-blood cardioplegia solution enriched with potassium-magnesium aspartate decreased early reperfusion injury and preventing postoperative arrhythmias in patients with ischemic heart disease undergoing CABG.

Figure 1.-Cardiac troponin (CTnI) concentration time courses in P group and C group. Data are presented as means standard deviation. Th figure shows that CTnI concentrations are significantly lower in P group than in C group at 6 hours and 12 hours (* = P≤.05).

Mg^sup 2+^ has been reported to afford myocardial contractile protection, particularly in patients with acute myocardial infarction. Potential mechanisms for this protection include a reduction in oxygen demand, an improvement of collateral blood supply, and membrane stabilization. Although there is growing evidence to suggest that the administration of Mg^sup 2+^ to patients undergoing CABG and to patients after myocardial infarction is beneficial, the concentration of Mg^sup 2+^ in cardioplegic solutions remains controversial. Hearse et al.14 have shown that a cardioplegic solution with 16 mmol/L of Mg^sup 2+^ and 1.2 mmol/L Ca^sup 2+^ provided significant postischemic ventricular protection. St. Thomas solution includes 16 mmol/L of magnesium-dichloride. In our previous study, magnesium supplementation could generate the detrimental effects of blood cardioplegia by using a relatively high concentration of magnesium (14-16 mmol/L)15. Caputo16 proposed intermittent antegrade warm blood cardioplegia containing 1.25-2.5 mmol/L of Mg^sup 2+^, and Tyers solution has 1.5 mmol/L of magnesium. Miyoshi et al. have demonstrated that the optimal magnesium concentration is between 2.4 and 4.8 mmol/L for the prevention of reperfusion arrhythmias in isolated rat hearts17. In Yoshitaka’s study, 2 mmol/L of magnesium in the minimally-diluted blood cardioplegia provided more effective myocardial protection than the standard 4:1-diluted blood cardioplegia18.

Potassium-magnesium aspartate supplied not only sufficient Mg^sup 2+^. In addition, although the mechanism of action of aspartate in the ischmie myocardium was not addressed in this study, some studies find that aspartate improved functional recovery by augmenting myocardial energy production mainly during early post-ischemic reperfusion. Replacing extracellular magnesium by enriching cardiologie solutions has been shown to decrease the incidence of postoperative arrhythmias, as well as improve myocardial protection by a variety of pathways19-21. The most important of these is probably magnesium’s ability to modulate intracellular calcium levels by inhibiting calcium entry across the cellular membrane, as well as displacing calcium from the binding sites of the sarcolemmal membrane14,19,22. This prevents mitochondrial calcium uptake, which can lead to uncoupling of oxidative phosphorylation with a decrease in ATP production. Post-ischemic calcium entry is further limited because magnesium prevents an influx of sodium, which during reperfusion is exchanged for calcium. Supplemental magnesium can also facilitate asystole at lower potassium concentrations10. This is important because high potassium concentrations can damage vascular endothelial cells directly, as well as enhance endothelial and myocyte calcium entry.

Conclusions

Although the present study has methodical limitations and there remain several issues to be examined, cold blood cardioplegia enriched with potassiummagnesium aspartate is beneficial on reducing reperfusion injury. It could be a reliable and effective technique for intra-operative myocardial protection.

References

1. Yao R, An J. Advances in myocardial protection. Int J Anesthesiol 1999;3:2-4.

2. Bolli R, Maiban E. Molecular and cellular mechanisms of myocardial stunning. Physiol Rev 1999;79:609-34.

3. Park JL, Lucchesi BR. Mechanisms of myocardial reperfusion injury. Ann Thorac Surg 1999;68:1905-12.

4. Piper HM, Garcia-Dorado D. Prime causes of rapid cardiomyocyte death during reperfusion. Ann Thorac Surg 1999;68:1913-9.

5. Beckman JS, Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol 1996 271:01424-37.

6. Droge W. Free radicals in the physiological control of cell function. Physiol Rev 2002;82:47-95.

7. Kuhn P, Oberthaler G, Oswald J. Anti-arrhythmia effectiveness of potassium-magnesium-aspartate infusion. Wien Med Wochenschr 1991;141:64-5.

8. Ataka K, Chen D, McCully J, Levitsky S, Feinberg H. Magnesium cardioplegia prevents accumulation of cytosolic calcium in the ischemic myocardium. J Mol Cell Cardiol 1993;25:1387-90.

9. Dichtl A, Vierling W. Inhibition by magnesium of calcium inward current in heart ventricular muscle. Eur J Pharmacol 1991;204:243-8.

10. Jensen BM, Alstrup P, Klitgard NA. Magnesium substitution and postoperative arrhythmias in patients undergoing coronary artery bypass grafting. Scand Cardiovasc J 1997;31:265-9.

11. Rosenfeldt FL, Korchazhkina OV, Richards SM, Fisher JL, Tong S, Pisarenko OI. Aspartate improves recovery of the recently infarcted rat heart after cardioplegic arrest. Eur J Cardiothorac Surg 1998;14:185-90.

12. Altman DG, Bland JM. How to randomize. BMJ 1999:319:703-4.

13. Ji B, Liu M, Lu F, Liu J, Wang G, Feng Z et al. Warm induction cardioplegia and reperfusion dose influence the occurrence of the post CABG TnI level. Interact CardioVasc Thorac Surg 2006;5:67-70.

14. Hearse DJ, Stewart DA, Braimbridge MV. Myocardial protection during ischemic cardiac arrest: the importance of magnesium in cardioplegic infusates. J Thorac Cardiovasc Surg 1978;75:877-85.

15. Ji B, Feng Z, Liu J Long C. Myocardial protection related to magnesium content of cold blood hyperkalemic cardioplegic solutions in CABG. J Extra Corpor Technol 2002;34:107-10.

16. Caputo M, Bryan AJ, Calafiore AM, Suleiman MS, Angelini GD. Intermittent antegrade hyperkalaemic warm blood caridoplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 1998;14:596-601.

17. Miyoshi K, Taniguchi M, Seki S, Mochizuki S. Effects of magnesium and its mechanism on the incidence of reperfusion arrhythmias following severe ischemia in isolated rat hearts. Cardiovasc Drugs Ther 2000;14:625-33.

18. Hayashi Y, Ohtani M, Sawa Y, Hiraishi T, Akedo H, Kobayashi Y et al. Minimally-diluted blood cardioplegia supplemented with potassium and magnesium for combination of ‘initial, continuous and intermittent bolus’ administration. Circ J 2004;68:467-72.

19. McCully JD, Levitsky S. Mechanisms of in vitro cardioprotective action of magnesium on the aging myocardium. Magnes Res 1997;10:157-68.

20. Lareau S, Boyle AJ, Stewart LC, Deslauriers R, Hendry P, Keon WJ et al. The role of magnesium in myocardial preservation. Magnes Res 1995:8:85-97.

21. Sha Kerinia T, Ali IM, Sullivan JA. Magnesium in cardioplegia: is it necessary? Can J Surg 1996;39:397-400.

22. Kronen M, Boiling KS, Alien BS, Rahman S, Wang T, Halldorsson A et al. The relationship between calcium and magnesium in pediatric myocardial protection. J Thorac Cardiovasc Surg 1997;114:1010-9.

B. JI 1-2, J. LIU1, M. LIU3, Z. FENG1, G. WANG3, F. LU4, C. LONG1

1 Department of Cardiopulmonary Bypass,

Cardiovascular Institute and Fuwai Hospital,

Beijing, China

2 Department of Pediatrics, Hershey Medical Center, Penn

State College of Medicine, USA

3 Department of Anesthesiology, Cardiovascular Institute

and Fuwai Hospital, Beijing, China

4 Department of Cardiac Surgery Cardiovascular Institute

and Fuwai Hospital, Beijing, Ch\ina

Address reprint requests to: Ji, MD., Pediatrics Cardiology, Penn State College of Medicine, Department of Pediatrics-085, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850, USA. E- mail: [email protected]

Copyright Edizioni Minerva Medica Dec 2006

(c) 2006 Journal of Cardiovascular Surgery. Provided by ProQuest Information and Learning. All rights Reserved.

The Nevada Economic Development Advisory Board (NEDAB) welcomes Emil Frei, M.D. to Nevada and endorses the inaugural Dr. Emil Frei III Symposium, to be held March 2 and 3 in Las Vegas. The symposium, a Certified Continuing Medical Education Program, will provide training for community-based medical oncologists, hematologists, fellows, primary care physicians and internists, based on the latest research regarding leukemias and lymphomas.

One of the world’s leading oncologists and a pioneer in chemotherapy and medical research, Dr. Frei is now a Nevada resident and his symposium is expected to draw hundreds of medical professionals to the state. Nevada Governor Jim Gibbons has proclaimed March 3, 2007 as a day in honor of Dr. Emil Frei. He has also recently received commendations or proclamations from:

 --  Senator Harry Reid --  Senator John Ensign --  Congresswoman Shelley Berkley --  Congressman Jon Porter --  Congressman Dean Heller --  Nevada Governor Jim Gibbons --  State Senator Barbara Cegavske on behalf of the Nevada Legislature --  Commissioner Rory Reid on behalf of Clark County --  Councilwoman Lois Tarkanian on behalf of the City of Las Vegas      

Dr. Frei will be honored for his lifetime of achievement in the field of medicine at the opening reception on Friday evening, at which several of these awards will be presented.

The Dr. Emil Frei III Symposium may prove a watershed in Nevada’s growth, both from a medical as well as a general business perspective. The symposium comes at a time when the state is debating major funding for a health initiative that is unlike what is found in most other states. Currently in Nevada, as in most other states, the various medical programs offered by the state’s colleges, community colleges, and universities are not linked to one another. This leads to a “silo effect” in which institutions are unaware what is going on outside their own immediate environment. They also compete against one another for staff, space, and funding.

Dr. Frei believes that an integrated university-based system fosters innovation by combining fundamental scientific research with clinical practice. “You need a cluster of physician scientists and basic scientists who will interact with each other to provide the necessary depth and breadth to be at the forefront of a given disease,” he said.

Nevada university system Chancellor Jim Rogers hopes to change all that by creating an integrated Health Sciences System unifying the various programs offered around the state. Governor Jim Gibbons has already pledged $110 million towards construction costs, but operating costs are still a giant question mark. As Rogers told the Las Vegas Sun in a January 26 interview, “There is no sense building a building if we can’t put people in it.”

Dr. Frei supports Rogers’ belief that this approach will help produce more doctors and nurses, expand and enrich community outreach and education programs, improve research and ultimately improve patient care. This is especially important in a state that already suffers from one of the worst doctor/patient ratios in the U.S. According to the Department of Health & Human Services, Nevada ranks 45th in terms of number of physicians per capita, 48th for dentists and 49th for registered nurses. This dismal ratio affects not only citizens, but also businesses, both those resident in the state and those considering coming here.

Dr. Frei sees the Health Science System as critical to Nevada’s economic development. Besides the major economic impact of the system itself, a better health care system makes Nevada more competitive for population growth and corporate growth and helps to create a more productive workforce. It also keeps patient care dollars within the state.

The legislature is debating an initial amount of nearly $200 million, but its support for any amount will be based in part on private contributions and public demand to support the effort. This is where Dr. Frei’s Symposium may be a catalyst, by helping raise awareness of the need and both public and private support of the initiative. Dr. Frei is very familiar with the challenges of funding and growing health care institutions, having been instrumental in obtaining both private and public funding for operating expenses at M. D. Anderson and for major new facility construction at Dana-Farber Cancer Institute.

Dr. Frei is also in strong support of the new Lou Ruvo Brain Institute (LRBI), which broke ground February 9 on its new outpatient treatment and clinical research institute. The institute will focus on the research and treatment of Alzheimer’s, Huntington’s, Parkinson’s, ALS and memory disorders.

“Living with Parkinson’s disease myself, I have a strong personal interest in the innovative work being done at LRBI,” said Frei. “I am committed to working with Rogers, Ruvo, and the leaders of other Nevada organizations to help bring world-class medical personnel to Nevada.”

Dr. Frei is also working with NEDAB as chair of the Life Sciences Screening Committee. In this role, he is helping to identify and screen companies in the healthcare, pharmaceutical and related industries that are qualified for, and could benefit from, participation in the capital markets. Dr. James Eells, an internist practicing in Las Vegas for more than 15 years, is assisting him in this effort.

“NEDAB is pleased to welcome Dr. Frei to Nevada and to endorse this symposium,” said Mark Daigle, CEO of Colonial Bank’s Nevada Region and Co-chair of NEDAB. “We hope to help bring more events like this to our state as we support the growth of a burgeoning life sciences industry in Nevada.”

For more information or to register for the symposium or the opening reception, please visit http://www.DrEmilFreiIIISymposium.com or contact Christina Goodman at (702) 436-4220, x102 or via email at [email protected].

About Emil Frei III, M.D.

Dr. Emil Frei III is one of the world’s leading oncologists, a pioneer of chemotherapy and a leader in medical research, clinical practice and education. His distinguished career includes 40 years in top leadership positions. He served as Chief of Medicine at National Cancer Institute, Associate Scientific Director at M.D. Anderson, and Director and Physician-in-Chief at the Dana-Farber Cancer Institute (formerly Sidney Farber Cancer Institute). He continues as Physician-in-Chief, Emeritus, at Dana-Farber.

He has been a major contributor to the successful application of chemotherapy, particularly the use of chemotherapeutic agents in combination for acute leukemia in children and in Hodgkin’s disease and chemotherapy following surgical removal of the primary tumor in patients with the more common tumors including breast cancer and osteosarcoma. He produced major therapeutic advances in head and neck cancers. He has been particularly effective in applying the sciences of pharmacology, toxicology, clinical trial design and cytokinetics. Tens of thousands of patients have been cured by these treatments.

His contributions have been acknowledged by numerous awards including the Albert Lasker Award, the Kettering Prize from the General Motors Cancer Research Foundation and most recently the Inaugural Lifetime Achievement Award from the American Association for Cancer Research.

Dr. Frei’s career in medicine began in 1948 after participating in the country’s V-12 program of the Navy. He served in both WW II and the Korean War as a general physician including time on the battlefield. He then served at the National Institutes of Health (NIH) in the National Cancer Institute division as Chief of Medicine and was principal investigator in the leukemia research program.

He developed a reputation as a great institutional leader, particularly for his ability to secure funding and manage growing organizations. At M.D. Anderson in the late 1960s, he was instrumental in obtaining $1 million a year in operating funds from NIH for the development of cancer research programs. At the Farber Cancer Institute in the 1970s, he helped obtain a gift of $7 million from Charles A. Dana as seed money for partial construction of the institute’s new permanent facility, and with the help of Massachusetts Senator Edward W. Brooke III, he was able to obtain the additional $10 million from NIH to complete construction.

He has been an industry leader, serving as past president of American Association for Cancer Research (AACR), American Society of Clinical Oncology (ASCO) and Cancer and Leukemia Group B (CALGB) clinical research group. He has also served on the advisory or director boards of numerous companies and non-profit organizations, including Adherex Technologies, Angstrom, CaP Cure, Celator Pharmaceuticals, DIAD Research, Immunogen, Vion Pharmaceuticals, Aid for Cancer Research, Cancer Research Institute, Journal of Clinical Oncology and the New England Journal of Medicine.

Dr. Frei has been a leader in medical education, serving as Professor of Medicine at The University of Texas from 1965-1972 and at Harvard Medical School from 1972-1996. He holds the chair of the Richard and Susan Smith Distinguished Professor of Medicine at Harvard, established through a $3 million gift from philanthropists Michael Milken, Marvin Davis and Edward Bennett Williams to fund oncology research.

He has directed the education of over 300 oncologists, many of whom have become today’s top leaders and researchers, and has lectured to thousands. Together with Dr. James Holland, Dr. Frei co-authored the first text in medical oncology, “Cancer Medicine,” the seventh edition of which is primary standard text of the field.

Dr. Frei has made Las Vegas his home with his family since 2004 and already

has close ties to the community. He serves on the chapter board of the Southern Nevada Leukemia & Lymphoma Society. He also previously worked with current Nevada Cancer Institute Director Nicholas Vogelzang, M.D., on the CALGB clinical research group, of which Dr. Frei was Chairman at the time. Dr. Frei also chairs the Life Sciences Screening Committee for the Nevada Economic Development Advisory Board (NEDAB).

He lives next door to his stepson and daughter-in-law, Stephen and Kathryn Brock, and their four children. Kathryn Brock was born and raised in Las Vegas and her grandfather, Frank Scott, was one of the first economic development visionaries for the city. Stephen Brock is founder and CEO of Public Company Management Corporation and former President of the Nevada Business Journal.

Retired from full-time practice, Dr. Frei now lectures, writes and offers consulting services in areas including grant applications and reviews, clinical trials, industry collaboration and management advice.

For more information, visit http://www.Emil-Frei-III-MD.org.

About Nevada Economic Development Advisory Board (NEDAB)

NEDAB is a council of prominent businesspeople and legislators who share a vision of diversified economic growth through capital marketing participation and assist in making that vision a reality. NEDAB believes that Nevada has the potential to become the premier destination in the U.S. for small business issuers looking to enter the capital markets; that Nevada corporations across a variety of industries can benefit from participating in the capital markets as a way to build long-term shareholder value, provide access to capital, increase visibility and improve business practices to meet the standards of being a public company; and that an increased number of Nevada corporations successfully entering and sustaining participation in the capital markets will create diversified economic growth, increase the number of companies that physically relocate to Nevada, create new jobs and increase revenue for the state.

Activities of NEDAB include:

 --  Outreach to other economic development groups, legislators,     regulators, business owners, and business and industry leaders. --  Educational Programs for companies seeking to learn about capital     markets and the advantages of domiciling in Nevada as a private or public     company. --  Policy Research and Recommendations to make Nevada even more     attractive as a home for companies wanting to participate in capital     markets. --  Locally based Industry Screening Committees to help identify and     screen companies that are good candidates for participation in the public     markets.      

NEDAB is in the process of expanding to its target of 10 members. Current members include:

 --  Mark Daigle, NEDAB Co-Chairman and President and CEO of Colonial Bank     N.A.'s Nevada operations. --  Paul Henry, Esq., President and CEO of Henry & Associates, LLC --  Robert Uithoven, President of J3 Strategies and Manager for Jim     Gibbons' successful 2006 gubernatorial campaign.      

Advisors to NEDAB include:

 --  Bob Beers, State Senator District 6 & PCMC Nevada Client Audit     Coordinator --  Tim Carlson, CEO, Powered by Renewables and Former Executive Director,     Nevada Development Authority & Nevada Commission on Economic Development      

NEDAB is a program of Public Company Management Corporation (PCMC), which is publicly traded on the OTC Bulletin Board under the symbol “PUBC” (OTCBB: PUBC). For more information about NEDAB visit http://www.Nevada-EDAB.com. For more information about PCMC visit http://www.PublicCompanyManagement.com.

Safe Harbor

This press release contains or may contain forward-looking statements such as statements regarding the number of people who may attend the Dr. Emil Frei III Symposium, the symposium’s contribution to economic development in Nevada, the funding for, or creation or benefits of, a Health Sciences System as well as beliefs held by NEDAB and economic development in Nevada. NEDAB assumes no obligation to update these forward-looking statements to reflect actual results, changes in risks, uncertainties or assumptions underlying or affecting such statements, or for prospective events that may have a retroactive effect.

 Contact: Robert Uithoven NEDAB Spokesperson Phone: (775) 762-8550 Contact via http://www.marketwire.com/mw/emailprcntct?id=1DACF866087B0F09 http://www.Nevada-EDAB.com

SOURCE: Public Company Management Corporation

SANTA BARBARA, Calif., Feb. 15 /PRNewswire/ — A study funded by the Defense Advanced Research Projects Agency (DARPA) and recently released by researchers at Appalachian State University showed that the natural, plant-based flavonoid antioxidant quercetin reduced illness and helped maintain mental performance in physically-stressed test subjects. The clinical study was double-blind and placebo-controlled, and involved 40 test subjects who were subjected to extreme physical stress situations during a five week period.

Quercetin is the first plant compound proven in a controlled clinical trial to reduce susceptibility to viral illnesses. Participants in the Appalachian State University study ingested 1,000 milligrams of pure QU995 quercetin daily, combined with niacin and vitamin C to help the body absorb the substance more efficiently. In comparison, the average American eating a normal, healthy diet including fruits and vegetables consumes about 25-50 milligrams of quercetin a day.

QU995, niacin and vitamin C are the same active ingredients contained in New Sun Nutrition’s FRS(R) health drink. By drinking three cans of FRS daily, individuals can consume the same amount of QU995 that was administered in the Appalachian State University study.

QU995 is the highest grade of quercetin commercially available and New Sun Nutrition has reached an exclusive agreement with Quercegen Pharma of Newton, MA to use QU995 (high quality quercetin that is more than 99.5% pure) in its FRS Health Drink. FRS’ patented formula synergistically combines quercetin and other antioxidants (green tea catechins) with vitamins B, C, E and metabolic enhancers to provide a sustained, healthy energy boost and long-term antioxidant health protection as well as improve the absorption of the antioxidant in the bloodstream for more effective results.

“Quercetin is an incredibly exciting natural antioxidant and scientific evidence is clear that at high purity it successfully combats a number of health issues,” said Richard Lamb, chief executive officer at New Sun Nutrition and healthy energy snack industry veteran who co-founded The Balance Bar Company in 1992. “We have been advocating the benefits of higher consumption of quercetin and other flavonoid antioxidants for several years, and it’s rewarding to see that this new study demonstrates an increased level of support for the consumption of high-grade quercetin combined with key vitamins as a way to protect the body from the harmful effects of physical stress.”

“This double-blind, randomized, placebo-controlled study has delivered ground breaking results that have clearly shown that highly purified quercetin, a natural plant compound, can prevent viral illness,” said Dr. David Nieman, a professor in Appalachian State University’s Department of Health, Leisure and Exercise Science who led the study. “The future of healthy beverages is clearly to combine quercetin with other advanced supplements.”

“The results of the DARPA-funded Appalachian State study reinforce what we’ve learned about the beneficial effects of quercetin from previous physical endurance tests performed at Pepperdine University,” said Marcus Elliot, M.D., a Harvard-trained physician and world leader in sports performance who serves as the head of New Sun Nutrition’s Scientific Advisory Board. “It’s important to note that the body’s physiological response to stress is the same, whether induced by extreme physical activity, or a highly stressful week at the office, so quercetin offers significant health benefits to elite athletes as well as the average hard working professional.”

Where to Buy FRS

FRS ready-to-drink cans are currently available at select grocery, convenience and health food stores in West Coast markets including Santa Barbara, San Diego and Seattle. A list of retailers is available online at http://www.frs.com/. FRS ready-to-drink formula is available in All Natural and Low Calorie versions. The all natural flavors (Orange and Lemon Lime) are sweetened with organic evaporated cane juices and contain no added preservatives, additives or coloring. The low calorie line (Wild Berry, Orange and new Peach Mango) has only 25 calories per can. FRS is also available in liquid concentrate, powder, ready-to-drink and chew forms. All forms of FRS are available online at http://www.frs.com/.

The Scientists Behind FRS

FRS is the result of years of research and development by leading scientists including Dr. Mitsunori Ono, Ph.D., world-renowned phytochemical expert and Visiting Professor at Harvard Medical School’s Beth Israel Deaconess Medical Center and Thomas Lines, a pioneer in flavonoid research.

About New Sun Nutrition

New Sun Nutrition, founded in 2004, is a developer and distributor of nutritional supplements, healthy snacks and beverages that is pioneering the development of flavonoid antioxidant health solutions to improve consumer health and wellness. The company’s patented and proprietary formulas synergistically combine nature’s most potent plant nutrients with other healthy ingredients to provide both immediate and long-term health benefits.

The company’s product portfolio includes FRS(R) antioxidant health drink, a scientifically formulated supplement designed to boost energy, enhance performance and neutralize free radicals before they can cause cellular damage. FRS, which stands for the scientific term Free Radical Scavenger, contains a patented combination of flavonoids, essential vitamins and metabolic enhancers. The flavonoids are quercetin, an antioxidant typically found in the skins of apples, onions and red grapes, as well as catechins extracted from green tea.

The New Sun Nutrition management and advisory team is comprised of nutrition and beverage industry leaders, renowned scientists, medical doctors and specialists in the fields of sports performance, disease prevention, and drug development.

For more information on New Sun Nutrition’s products, log on to http://www.frs.com/.

New Sun Nutrition

CONTACT: Taffy Spencer, +1-310-854-8151, [email protected], orSallie Olmsted, +1-310-854-8124, [email protected], both of Rogers &Cowan for New Sun Nutrition

Web site: http://www.frs.com/

Robeks Corporation, a premium, made-to-order fruit smoothie franchise chain, today introduces its latest innovation — a convenient line of daily-use packets of Robeks’ popular all-natural dietary supplements and nutritional boosts to mark the March arrival of National Nutrition Month(R). Initially, the product line will be launched with Powerbek(TM), a natural energy booster for adults to increase endurance, stamina and vitality, and Immunibek(R), an adult support formula to strengthen the immune system. Beginning mid-March 2007, both daily-use packets will be available in all 107 Robeks locations and at its e-store at www.robeks.com.

Robeks’ new daily-use supplement line provides multiple capsules, equal to one daily serving size, in an attractively packaged, affordable and convenient daily-use packet. As dietary supplements, it is recommended that adults take one to three capsules as needed with a maximum of six Powerbek capsules per day and three Immunibek capsules a day. New trial-size packets are designed to provide health-conscious consumers with a fast, easy and affordable way to sample Robeks’ proprietary line of premium-quality nutritional boosts and dietary supplements.

Trial-size packets of Powerbek(TM) and Immunibek(R) will be introduced for the first time to the public at the 2007 Los Angeles Marathon. Robeks has been named the “Official Fruit Smoothie of the LA Marathon,” and will sample an estimated 60,000 packets of the new daily-use size Powerbek(TM) to all LA Marathon participants and visitors at the Quality of Life Expo, March 2-3, 2007.

Americans continue to demonstrate a commitment to live healthfully. Now, consumers can walk into a Robeks location, order their favorite, blended-to-order smoothie (which always includes a choice of one high-quality boost as an added benefit) and walk out with daily-use nutritional packets to be used later that day or evening. This flexibility gives consumers yet another opportunity to make healthier choices that fit their active lifestyles.

Powerbek(TM) is Robeks’ proprietary, all-natural energy booster that increases endurance, stamina and vitality, and can help boost sustainable energy during athletic workouts. This powerful formula contains a unique and complex blend of natural energizing herbs, stress-modulating B-complex vitamins and supporting minerals. Proven herbal energizers, such as Korean and American Panax ginseng, Brazilian guarana and eleuthero root, promote enhanced energy and vitality. Supporting herbs and nutrients provide balance and synergy to increase the formula’s effectiveness.

Immunibek(R) is Robeks’ proprietary, premium-quality immunotonic support formula that contains a unique combination of herbs, vitamins, and minerals to provide strong support for the immune system. Immunibek is formulated with premium-quality echinacea and fortified with vitamin C and zinc. The formula delivers optimal benefits when used for short periods of time (weeks) and when the immune system is most challenged such as during cold and flu season and while traveling.

About Robeks’ Commitment to Health

Robeks’ mission is to serve the public with fresh and healthy alternatives to fast food, which includes a full line of nutritional boosts and dietary supplements. These products have been developed with the company’s nutritional consultant, Dr. Edward M. Lieskovan, president and chief executive officer of Performance Research Laboratories, Chief Scientist for Nutritional Research Group, and Adjunct Assistant Professor of Clinical Pharmacy at the University of Southern California’s School of Pharmacy. As an authority in the nutritional and pharmaceutical fields, Dr. Lieskovan consults with Robeks to formulate new products that maximize health benefits for guests.

Since its early days, Robeks has offered a complete line of premium-quality nutritional products. Guests may visit any store and customize their smoothie order with a wide range of boosts in scoop portion: Cardiobek(TM) offers a cardiovascular support formula with red grape seed extract; Robeks’ Creatine optimizes workout performance; Fiberbek(R) reduces cholesterol and promotes healthy digestion; Immunibek(R) as mentioned above; Intellibek(R) aids memory and concentration with ginkgo biloba; Kidbek(TM) offers essential support for growing kids; Powerbek(TM) as mentioned above; Robeks’ Soy Protein delivers six grams of vegetarian protein; Trimbek(R) offers chromium and thermogenic herbs to increase metabolism and burn fat; Vitabek(R) delivers 100% DV of 20 vitamins and minerals; and Robeks’ Whey Protein provides five grams of high-performance protein. Alternatively, guests may meet their individual wellness goals with the purchase of larger size containers of all Robeks dietary supplements, convenient for home use.

About Robeks

Since opening the first Robeks Juice store in 1996, the Company has always been passionate about promoting the essential role of good nutrition and its importance in helping people maintain active and healthy lifestyles. Robeks’ goal is to make eating a healthier meal both quick and easy by offering a great-tasting selection of premium-quality, made-to-order fruit smoothies and squeezed-fresh fruit and vegetable juices, healthy snacks, as well as gourmet sandwiches, wraps and salads (in most locations). Currently, Robeks serves its guests at 107 franchise locations in 15 states and the District of Columbia. Robeks was named one of the top ten new franchises for 2006 by Entrepreneur(R) in their 27th Annual Franchise 500(R). For store locations, franchise or product information, please visit www.robeks.com.

 --  Digital images available on request --  Interviews with Robeks executives on request      

 Media Contacts:  West Coast: Carolyn Smith 626.744.0711 [email protected]  East Coast: Chuck Casto 617.314.4358 [email protected]

SOURCE: Robeks Corporation

Health Hero Network, a leading innovator of technology solutions for chronic care management, launched today Health Buddy(R) TV, a new product which will deliver the company’s proven Health Buddy(R) System to patients through an interactive television connection. Health Hero Network’s international partner Sananet B.V. will market the Health Buddy TV product in the Netherlands. Meavita, a Dutch homecare organization, is the first Health Buddy TV customer.

The Health Buddy System provides coaching, monitoring and education for patients managing their chronic conditions at home. The addition of the television offering extends the family of successful Health Buddy Appliance patient interfaces. Health Buddy TV will allow patients in the Netherlands the flexibility of accessing their health management programs through their television using their remote control and a set top box. Dutch health care professionals can access data transmitted from the patient at home using web-based decision support tools included in the Health Buddy System.

“Health Buddy TV demonstrates the innovation that has made Health Hero Network the clear leader in creating products that bring peace of mind to patients with chronic conditions, their family members and others who love and care for them,” said Steve Brown, Founder and CEO of Health Hero Network. “Meavita’s endorsement of our approach further proves the widespread need for a more effective model of care for people with chronic conditions, and their launch in the Netherlands will accelerate our delivery of technology and services to more partners and customers around the world.”

Meavita will use the product to monitor and educate Diabetes patients across the Netherlands using their TVFoon service. The Meavita service offerings will include delivery of the Health Buddy System in one of their broadband channels, “Meavita Thuis.”

“The strength of Health Hero Network’s health management programs has been proven with our current customers,” said Jan Ramaekers, Sananet CEO. “We are accelerating the market in the Netherlands by expanding into platform independent options such as Health Buddy TV, for patients who want choices in accessing their health management programs.”

About Sananet

Sananet B.V. offers healthcare technology solutions, including products and services, to enable professionals and patients to use sophisticated information and communication technology (ICT) for eHealth. Sananet enables healthcare professionals to link care providers with each other and patient data regardless of time or place, helping to provide efficient relations between different care partners and patients. The simplified communication facilitated by Sananet results in increased quality of care. Sananet’s services include consultancy, network capacity, training and solutions support. http://www.sananet.nl/

About Health Hero Network

Based in Redwood City, Health Hero Network develops and markets the Health Buddy System for health improvement. The Health Buddy System serves as the interface between patients at home and care providers, facilitating education and monitoring of patients with chronic conditions. The System includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy System improves the quality of patient care. Health Hero Network’s systems are protected by 57 issued US patents. http://www.healthhero.com

 Media Contacts: Rocky Shaw Health Hero Network, Inc. 650-779-9146 Contact via http://www.marketwire.com/mw/emailprcntct?id=AB7839BED8752B7D  

SOURCE: Health Hero Network

LOUISVILLE, Colo., Feb. 15 /PRNewswire/ — The hospitals rated the nation’s best by U.S. News & World Report are committed to quality patient care. Three of the top five, and more than a third of the 14 who made the list, have something else in common. They use the innovative non-invasive Arctic Sun(R) Temperature Management device to chill critically ill patients, potentially reducing brain damage.

The Mayo Clinic, the Cleveland Clinic, and the Massachusetts General Hospital — ranked numbers 2-4, respectively — are employing the first non- invasive, sophisticated patient cooling system from Medivance that quickly and easily controls, monitors and precisely maintains core body temperature in a therapeutic range. Other top-rated hospitals using the Arctic Sun to improve patient outcomes include New York-Presbyterian University Hospitals of Columbia and Cornell, and Stanford Hospital. Others are evaluating the promising new technology.

“We know that high fevers decrease the chance of good neurological outcomes, says Igor Ougorets, MD, Director of Neuroscience ICU at Weill-Cornell Medical College. “There is ample data from retrospective studies to warrant therapeutic temperature management to save brain tissue, and logistically, it’s easier for a physician to have a nurse apply Arctic Sun pads and begin cooling appropriate patients immediately,” he says.

Four of the top five neurology programs and three of the top five heart programs employ the Arctic Sun’s highly efficient, non-invasive therapeutic cooling technology.

A growing body of clinical research demonstrates that mild hypothermia and fever reduction have potential protective effects for victims of cardiac arrest, stroke, brain injury, trauma, high fevers and other critical conditions. The updated American Heart Association CPR guidelines call for inducing therapeutic hypothermia after cardiac arrest for some resuscitated patients.

About Medivance’s Arctic Sun

The non-invasive Arctic Sun Temperature Management System precisely monitors and maintains core body temperature in a therapeutic range, between 33 and 37 degrees Celsius (approximately 91.4 and 98.6 degrees Fahrenheit) with the potential to minimize damage to the heart and brain. The Arctic Sun has received 510 (k) FDA clearance in the U.S., the European Union’s CE Mark, and marketing approval in Japan. Medivance develops and manufactures non-invasive, proprietary therapeutic temperature management solutions. More information at http://www.medivance.com/.

Medivance

CONTACT: Edna Kaplan of KOGS Communication, m: +1-617-974-8659, [email protected], for Medivance

Web site: http://www.medivance.com/

By Dee Dixon, The Beaumont Enterprise, Texas

Feb. 12–When people think about the segregation blacks endured before integration, what might come to mind are schools, water fountains and buses. But people might not think about hospitals, which were not immune to segregation practices.

When Baptist Hospital of Southeast Texas opened its new $1.3 million, 137-bed facility at College and 11th Street in 1949, it had a separate section for black patients.

Back then hospitals, like schools and water fountains, were separate for blacks and whites. When the hospital opened, it was nicknamed “The City of Healing” and billed as an all-inclusive hospital. “But this hospital must not open its doors to some, close them to others … there must be money for the care of all who need it,” according to the author of an August 1949 Beaumont Journal article. On the first floor of the four-story hospital was a unit for blacks. It was described in the article as being as “beautifully equipped as those for the white on the upper floors, both private, semi-private and four-bed rooms and maternity delivery rooms.”

May Guillory, who in September will have worked in the hospital’s laundry department 50 years, said when she talks to younger people about how the hospital was segregated they find it hard to believe. “Back then that’s just the way we were. The blacks just stayed to themselves and the whites just stayed to themselves,” Guillory said. “You passed each other and went on with your business.” She had all four of her children at Baptist Hospital. Back then, black patients immediately checked into the “negro ward” regardless of their medical condition.

Blacks rarely came off the floor. It was mostly pregnant women who were taken to the second floor to deliver their babies, but they were immediately returned to the “negro ward.” Their husbands or other family members were not allowed to accompany them to the second floor. “The doctor came downstairs and told my husband what I had, and that the mother and the baby were doing all right,” Guillory said. “It was so much different than what they do now. You have to live it to know exactly what it was like.”

She said the hospital’s dining area and coffee shop even were segregated, and blacks had to eat in the back and order their coffee from a window outside the shop.

Sarah Thomas, 68, was 13 when she first went into the “negro ward” at the back of Baptist. Her aunt had a massive stroke and watching the black nurses tend to her sparked her desire to become a nurse. After graduating from Prairie View A& M University, she returned to Beaumont and landed a job at Martin de Porres, where blacks were treated on the third floor of the hospital.

“Everything was treated on the floor … medical patients, pediatrics. It made for crowded conditions,” said Thomas, who added that sometimes patients had to be placed in the hallways.

She explained other differences.

In white hospitals, men and women were treated in separate wings. In the black hospital, because of space it was not uncommon for male patients to be treated near women.

At Martin de Porres, nurses had to deliver babies because doctors wouldn’t make it in time when they were called in, Thomas said. “Sometimes they didn’t even come,” she said. She later went on to become the first black nurse for Mobil Oil in 1963, where she worked for 25 years.

Dr. Frank Giglio, an obstetrician and gynecologist, had a private practice but would see patients or send patients to area hospitals. “Black patients couldn’t go to St. Elizabeth. You took them to Baptist to deliver them,” Giglio said.

He said the nuns tried to encourage blacks to go to Martin de Porres to deliver their babies or for any other medical treatment they needed. However, often black mothers didn’t have prenatal care, and when they were in labor they went to the nearest hospital.

While there was a separate wing for black patients, if they required facilities on another floor they did receive that care, Giglio said. “If they were in ICU they would move to the same ICU as the white people,” he said. “They had access to everything. It’s just they were segregated in the hospital.”

The situation became controversial on New Year’s Day when the first baby born was celebrated and inundated with gifts. “They only gave it to the first white baby born, and we objected to that. They said the black merchants had to give it to the first black baby,” Giglio said. “It seems strange now, but all the schools in the city were segregated and everything else was segregated.” He said while the hospital was segregated, patients were treated equally. Doris Price Nealy, one of the first black professors at Lamar University and a director of the associate nursing program, said nurses sometimes had to endure prejudice on the job. While doing her clinical studies as a student, the blacks were not addressed with courtesy titles like their white counterparts.

“It was so degrading. That is how they distinguished the black nurses from the white nurses. It was subtle stuff,” she said. In her hometown of Teague in the 1940s, Price Nealy remembers how black women were reluctant to go to the hospital. Instead, they had midwives who would come to their home to deliver their babies. At the hospital, the black babies weren’t kept in the nursery with the white babies but were kept in the room with their mom, Nealy said. “Now it’s called rooming in, but back then it was called separatism,” she said.

While there were segregated wings, Southeast Texas also had black-only hospitals and ones opened by black doctors for the black community. Three brothers, Drs. Maxie C., Ed and Curtis Sprott, opened the Sprott Hospital Clinic on the city’s south end to treat black patients. The clinic created an opportunity for black doctors to practice medicine in the city.

Hotel Dieu was a hospital started in 1897 by Catholic nuns in the Charlton-Pollard neighborhood. In the 1940s, the Martin de Perres hospital was built to treat black patients.

In 1958, the Jefferson County commissioners went on record in favor of having black patients at the county tuberculosis hospital. By 1965, the facility was closing and 16 black patients had to be relocated.

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