This Says It All....

Monday, Sep. 01, 2008

In Wasilla, Pregnancy Was No Secret

By Nathan Thornburgh / WASILLA, ALASKA

So his name is Levi.

That's about the only thing I didn't know about Bristol Palin's pregnancy. The rest of the details I picked up almost without trying, while talking about other things with townsfolk — some who know the governor and her family well, some who don't. It was, more or less, an open secret. And everyone was saying the same thing: the governor's 17-year-old daughter is pregnant, the father is her boyfriend, and it's really nobody's business beyond that.

I happen to agree.

This tiny town wedged between the Chugach and Talkeetna mountain ranges has intrigued the whole country since John McCain's surprise Friday announcement that Wasilla's favorite daughter, Sarah Palin, would be his running mate. Sure, some of the interest was a prelude to attacks on Palin's readiness for national office. But Wasilla also offered a welcome chance to get specific about the geography of a politician. It's one of our most cherished myths, that a leader can come from somewhere and you can guess at their qualities not just by what they say, but by where they live.

Well, here's the deal: small towns have their own value systems, and in this situation those values are a lot more valid than the dispassionate, pushy inquisitiveness that political journalism encourages.

I just got off the phone with a longtime Wasilla resident. She had urged me to find time today to go up to Hatcher Pass — "the most beautiful place in the valley!" — when I mentioned that the story on Bristol's baby is now national news. Her voice slowed. "Oh," she said. "I'm so sorry. That's so unfair."

Wasilla seems at times to be utterly without guile. It's a large part of the town's charm, and it's exactly the quality that could make an unorthodox pick like Palin pay off. Don't get me wrong — she's a tough politician with sharp enough elbows on her own. But still, she appears to be more steeped in the values of her hometown than any politician I've ever come across.

Maybe that means Palin is a little too much Northern Exposure for America — after all, her father's good friend Curt Menard happily showed me a picture of the governor as a high schooler in 1981, in a root cellar with family and friends, helping skin and cube and cure a whole moose. It's enough to make you almost miss fake hunters like John Kerry and Mitt Romney.

People in Wasilla are Alaskan tough, so not only does a thing like teen pregnancy not seem like anyone's damn business, but it's also not seen as the calamity that so many people in the lower 48 states might think it is. This is dangerous country — it's not just the roughneck jobs on cable reality shows. It's real life here. I listened to the absolutely heartbreaking story of how the godfather of Track Palin, Sarah's oldest son, died in a small plane crash just minutes after having dropped off four kids. Another family invited me into their home and told their incredible story; with one son in Iraq, their other son was working on a conveyor line in Anchorage, got caught in the belt and had his head partially crushed. He lived to stand across the kitchen table from me and his parents, looking fully healed just three months later, grinning at his dumb luck and wondering what comes next in life. "It makes you realize that a thing like a little teenage pregnancy isn't such a big deal," his mom said. "Bristol — and lots of other girl like her out there — are going to be just fine."

If you haven't guessed yet, the people here are genuinely friendly. Even those in Palin's inner sanctum who have been told since Friday not to talk to reporters by McCain's media team are almost apologetic that they can't be neighborly and chat, since you came all this way to little Wasilla. And those who can talk, do. All weekend they had the decency not to pretend that they didn't know the governor's eldest daughter was pregnant. But they also expected decency in return, that I wouldn't be the kind of person to make sport out of a young girl's slip.

The fact is, regardless of what you will hear over the next few days, Bristol's pregnancy is not a legitimate political issue. Sarah Palin is a long-term member of a group called Feminists for Life, which is not opposed to birth control. So you probably can't tag her for consigning young people to unwanted pregnancies.

You can argue that it was ham-handed of the McCain campaign — they had to have known, right? — to somehow let this drop just a few days after the announcement. Pregnancy does show, and it does have a ticking clock. The story was going to come out eventually.

As for the idea — sure to be floated — that the avowedly antiabortion Palin might have pressured her poor daughter to ruin her life by carrying an unwanted baby to term, I wouldn't bet on it. The Palin family seems to share the same pro-life values going as far back as anyone here can remember, and it wouldn't be at all surprising if Bristol wore those values, however imperfectly, as her own. At least, that's what the town thinks. And Wasilla, above all, is pretty sensible.

A Glimpse into Beijing’s Fu Wai Hospital – Cardiovascular Program

Debra Alpha represents Trident Health Resources, Inc. and it is was with much appreciation and interest that Deb provided me a report of her observations in Fu Wai Hospital’s Cardiovascular Program when she was in Beijing recently. I asked her if I could post her notes at Trident’s blog as I think it would be information quite fascinating to Perfusionists. She agreed and the report is posted herein.

Please feel free to use the comment button for any questions or comments for Debra. Also, you may contact me directly via email.

Many thanks.

Ralph E. Jordan
CEO & President

Fu Wai Hospital in Beijing

I recently had the opportunity to visit a Cardiovascular program in Beijing. What a well maintained machine.

The hospital is 5 floors, 2 of which are CV OR's.

The day begins with the planned schedule reviewed by the perfusion director along with all participating surgeons and residence for the day.

All adult cases are on one floor and the pediatrics on another

The adult floor consists of 8 OR's and 3 separate rooms for the perfusion equipment and disposibles.

Each adults room will see a minimal of 4 cases/day and the 3 pedi rooms will see 4-5/day. These pedi cases are not ASD, VSD or PDA's (these are all done in the cath lab).

This is a teaching hospital as well.

Surgical techinques are not much diff than our US surg. These surg do not all have individual headlights the lighting is minimal at best.

Perfusion equipment:

Jostra and Cobe (Stockert and S3)

Oxygenators (Quadrox foe adults and Terumo RX for the pedis)

No CDI 500 $$$ just as we see in the states

Oxygen analyzer in every circuit

Cell Savers (autolog and the CAT)

Perfusion Disp:

They use what we have access to as well

This facility is as old as any dynasty in Chinese history

All toilets are IN THE FLOOR and toilet paper forget about it TAKE YOUR OWN or use the hands held sprayer.

All OR employees MUST shower before leaving the hospital

There is a room and locker for your shoes you will be wearing their croc type shoes for the rest of the day no socks needed or required. Anytime you pass from a sterile to a non sterile area you change shoes, yes these are shoes that have been wore by others doing the same thing, pick any pair that fits.

Patient rooms, small and most are 2 beds/room no such thing as a smoke free room

yes smoking is allowed in the hallways and lobby

My host Dr. Cun Long was most gracious. I shadowed 3 perf of 3 days.

All Chinese perf MUST be MD's before they train for perfusion and ALL (surg and perf) are equals in every way, they actually discuss the plan of care, WHAT....!!!

NONE OF US...NONE OF US would ever complain about our $$ or working conditions that we are so fortunate to have if this was our life.

Cars and houses are a luxury afforded to only about 10% of the population. Healthcare the same. The other 90% of the population will/may have to see their home to get surgery. This is their reality.

Transportation. bus or subway

Air quality... > 450 daily, mind you in the states anything over 100 we are warned to stay in our homes for health purposes.

Communication:

All surg and most doctors speak english, outside that forget it.

Will the Olympics be a success? Two weeks will tell. Cyclists and outdoor competitions will be a challenge. The sights in Beijing are truely amazing. Your health will be sacrificed during your visit. So a massage is a necessity to balance the day, $12/hour.

Onto Bangkok where I will be shadowing a CV surg as well.

More later

Deb

Important Recertification Information for Perfusionists

Visit Perfusion Community for details about perfusionist recertification (posted today in the Forum Section, which you can link to from the home page). There is an August 1st deadline which affects all certified perfusionists.

Regards,

Ralph E. Jordan
President & CEO

Sorry for the Confusion Today at Perfusion Community

My sincerest apology for the multiple emails which were sent to Perfusion Community members when we tested a new function of our emailing spooling on Tuesday, July 15, 2008. The problem has been corrected. Please be advised that those of you who received the emails, this was NOT a virus or spam sent to your email account and we’d like to allay any fears of that sort. However, we do recognize the inconvenience caused. Thank you for your understanding and your ongoing membership at Perfusioncommunity.com, where we are striving to bring you all the perfusion industry news and information. Although we did post the upcoming NFL Football Schedule, we received enough feedback from members that that is not information you’d like to see posted, and we will heed your wishes in the future. Again thank you for your indulgence in this matter and for your continued comments regarding this innovative website.

Ralph E. Jordan for Perfusioncommunity.com

On Hospitals and Hurricane Preparedness

Tampa Bay has been home for over 32 years now and although I live in the beautiful State of Florida, that doesn’t make me a weather expert. I can certainly attest to the beautiful sunsets and gulf breezes that make it a fine place to live. Known as “the Sunshine State,” the Tampa Bay area is also the lightning capital of the world, and clearly, a favored destination of Hurricanes. Because I’m a Floridian and also in the healthcare profession, I know that there are, indeed, some important implications for staff and patients in facilities in Florida, but also in the many other coastal states where hurricanes are likely to approach.

We’re early in the 2008 hurricane season, coming out of our first month, which began June first and runs until November. Because our waters aren’t quite warm enough yet (the catalyst for hurricane formation), we haven’t had great tropical activity. YET. But make no mistake—some experts are predicting a rather interesting and active season.

The Joint Commission on Healthcare makes patient safety an imperative in all accredited institutions. Hospitals are required to prepare for disasters involving everything from responding to acts of terror, plane crashes, and yes, hurricane catastrophes. As the epicenter of all things in emergencies, it’s crucial that medical facilities plan tightly and consider worst-case scenarios, keeping patient care the foremost in their plans. It doesn’t take going back very far in memory to bring to mind the news stories of hospitals overwhelmed by the devastation of Hurricane Katrina and several earlier storms (including some no-name storms) which shook up emergency rooms and drained staff resources.

Have you been through a disaster at your facility? Please feel free to comment.

I wanted to post a few website references for further information to those interested: The Joint Commission: http://www.jointcommission.org/ and Federal Emergency Management Agency (FEMA): http://www.fema.gov/ offer excellent resources for hospitals, as well as information for patients and consumers.

And finally, as another matter of interest, following are a list of this year’s Hurricane names. I see I’m not on the list...again...are you?

Arthur
Bertha
Cristobal
Dolly
Edouard
Fay
Gustav
Hanna
Ike
Josephine
Kyle
Laura
Marco
Nana
Omar
Paloma
Rene
Sally
Teddy
Vicky

Wilfred

Be safe and have a great summer. And if you need some last minute coverage don't forget to give us a call..We would be glad to help you. Thanks.

Ralph E. Jordan
President and CEO

Correspondence from an HCSG Employee

Apparently, things are greatly improved at HCSG, the company formerly known as Fresenius. I received an email last week from an HCSG employee who requested that I use this forum to to provide an update to my earlier blog post from last Fall (for reference click here).

The writer advised that HCSG never implemented a new payroll structure, one which was targeted to begin in March and was previously the subject of tension and concern among HCSG employees when it was announced. Although the writer did not like my terminology of “holding a week’s salary in arrears” to describe the payroll changes, there was no intent to mislead, as suggested. To the contrary, that blog post dated September 10^th speculated on the many reasons why a new payroll system might be initiated.

Here’s how the writer explained the reasoning behind HCSG’s proposed payroll changes:

“…they were not holding a week of employees salaries back due to financial problems, but rather they were trying to get all employees, exempt and non exempt, on the same payroll schedule…Basically, they ultimately decided to leave the payroll AS IS for the Exempt employees, and did not change the way in which Exempt employees are paid. However, I find it ironic that you never reported on this since you seem to have "insider" information….(and) as a CEO…it should be your responsibility to correct misinformation or (provide) any updated information since you were the one to put that information out there for all to see in the first place.”

We do our best to bring all matters of interest to our readers and industry news to the forefront as they become known to us. In our business, checking up on other companies internal affairs just isn’t a priority. Further, we’ve allowed this platform to be open to all contributors to add their commentary. At any time, it is welcomed for all to write in, even posts which are anonymously made are appreciated. We report news as it is shared and upon request, as well.

The writer also wanted it communicated here as to how HCSG employees are paid. Another excerpt from the email:

“You also alluded many times to the fact that HCSG/Formerly Fresenius does not pay its employees what they are worth. I will be the first to say that this was true and Fresenius was the worst when it came to merit increases. However…HCSG is trying hard to make things right and has restructured its compensation packages. HCSG restructured their salaries based on merit increases and…by creating three pay regions around the country…(reflective of) cost-of-living.

I am sure your confidential source of information MUST have told you about this, no?? Yet you fail to report on it, why? I think HCSG deserves some credit don't you? At least they are the first company to take employees concerns and complaints to heart and actually DO something about it unlike its predecessor(s). Yet you don't report on that....I am almost forced to wonder if unless the information is negative or juicy gossip which only serves to make Trident "look better" in the big picture, then would show up on your blog? Just my two cents for what it's worth.”

In this regard, please note that I mentioned in one of my earlier blog posts that I would wait a year to see what happens and gladly point out any positive news that had occurred. The fact that the writer felt that unless the information is negative or juicy that we would not comment on it, is a perception that is, quite simply, not in line with the Trident philosophy.

However, the point is, the writer’s two cents worth is worth a pound of gold. I appreciate the opportunity to respond and to assure readers that I was more concerned for the disappointment and outrage of some of our longtime friends and associates who came to us and asked for guidance and help. We didn’t report the facts because they were negative, but because what was going on at the time we received the information seemed to be unfair, unfeeling and was similar to the same shabby treatment that many of our friends had endured over the past several acquisitions.

I’m very happy to say that it seems that our friends and associates at HCSG have, apparently, a more enlightened and compassionate management. Did Trident’s initial expose’ have anything to do with this particular incident regarding the proposed payroll adjustment? I don’t know; I would rather doubt it, however.

But I do know this: it’s apparent that the NEW owners seem to be in tune with what is going on and are trying to be responsive to the needs of the employees. For that I congratulate all of you associated with HCSG and on your newfound good fortune.

It’s about time. And that’s my two cents worth.

I always appreciate comments posted herein or emailed to me privately. Keep ‘em coming.

Ralph E. Jordan
President and CEO

George Carlin and Tim Russert, Two Social Commentators Paralleled

“I recently went to a new doctor and noticed he was located in something called the Professional Building. I felt better right away.” ~ George Carlin

This week we’ve been talking about heart health and saying a fond farewell to great men of our time in history, who’ve made a difference in our lives. Adding to our tribute is legendary comedian George Carlin, who struggled with a heart condition since the 1970's, and, died of heart failure at the age of 71. Immediately I thought of the closeness in time between Tim Russert and George Carlin’s deaths--so alike in their cause of death, similar in other ways, too-- both being social commentators…Yet each so different in personality, decorum and philosophy.

Like his Mentor Lenny Bruce, Carlin is known for his irreverence, but still he had incredible insight into the human condition. His approach was without pretense or embellishments. He told it like he saw it and he was ever consistent. Carlin is best known for his spiel on the 7 words you can’t say on television, although his comedic routine on “stuff” was one of my favorites. George Carlin was a left-of-center spokesperson for Everyman. He was a tad twisted and quite irreverent, but maybe that’s why America adored him—for speaking out with great shock factor, fearlessly. He was featured on The Tonight Show 130 times. Seems we couldn’t ever get enough of him.

In contrast, Tim Russert had a vast following, as well, but Carlin wasn’t exactly the same style of communicator as Russert. Not in the least. George was cleverly unique. He not only made people laugh, but he made people think about what he might've meant. He was usually p.o.’ed about something, and I suppose in a lot of ways, his rants were a purge of human frustration and gave his fans a sense of comic relief.

As I think of his memory and I smile at all he’s ever said, I’m reminded of one of his humorous quotes about heaven, which seems so appropriate now… “Cloud nine gets all the publicity, but cloud eight actually is cheaper, less crowded, and has a better view.”

Let’s hope that Carlin is on Cloud 8, having a meaningful conversation with Tim Russert.

Ralph E. Jordan
President & CEO
Trident Health Resources, Inc.

Heart Health and Eulogy to a Friend: On the Passing of Tim Russert

Although I have few obsessions in life, there is one I can't seem to escape; I am an avowed news junky. Staying abreast of local, state, national and world news is a passion. My wife will tell you, I'm pretty hard pressed to do anything at home without talk shows in the background, or one eye glancing at cable TV except, of course, during the ACC/SEC football season in the Fall. After 40 years of marriage, my wonderfully patient wife still puts up with me.

Tim Russert, host of NBC’s, Meet the Press, was one of the finest political commentators of our time. I never met him but I did catch a flight from Washington National to La Guardia once and he was on the same flight. Even back then, in his early career he was boyish looking and seemed like an unmade bed in appearance. I enjoyed watching and listening to him. It is with a heavy heart we had to say goodbye to him last week. I wanted to mention something here on this blog and touch on some of the lessons learned in Russert’s life and, now, in his passing.

He was a man with an inspired work ethic. His career path was a pure blue collar American success story: He was a regular guy like so many across this great Country. But he was destined for great things in life, too. His early career was in politics. He landed a job as an NBC executive in the late 80's and in 1991, he became the host of Meet the Press, serving in that capacity for the longest time of anyone.

I was one of Russert’s biggest fans , like so many across this great Country, because we all could identify with his background and his love of family, his faith, good fortune and our favorite NFL football team.

He was a loyal cuss wasn't he? We know Russert died doing what he loved—some will say he died working and that would not do the man justice...he died where he was doing what he felt was the most good and he would be the last to call it work. But then, that is only an opinion from a fellow who has been accused of being a workaholic..which of course isn't so.. It wasn't until a while after he died that his cause of death was uncovered—media reports said a heart attack.

A Newsweek report today discussed the fact that Russert had an enlarged heart, which is not uncommon among middle-aged men (he was 58). His autopsy showed coronary blockage, as well....and we now know he was being treated for coronary artery heart disease.

As a person who has been involved in healthcare all my adult life, I can't help but notice that even in his passing Russert leaves the world with a message: it is noble to live life passionately and to love unconditionally your family and Country and what you do for a living...but you need to take care of your health as well. While it is our business in perfusion to help and assist those whose hearts are damaged, we know all too well that lifestyle management and healthy choices can lessen the likelihood of disease and early heart related deaths. And isn't it our hope for all to help to enhance life and its quality for ourselves and our patients?

Tim Russert was a true American Hero and a regular guy...who loved his family, his Irish heritage and Catholic Faith , his hometown, his Rolling Rock , Bruce and the E Street Band and his avocation. If it's Sunday's will never again be the same...What a Country...go Bills...fond fun memories.

Well, one thing for sure....the berries won't be as sweet nor the milk as cold...for awhile yet. Tim Russert—a fine man—we will miss you bud.

Ralph E. Jordan
President and CEO
Trident Health Resources, Inc.

Meeting Summary: 46th AmSect International Conference

Posted here is one of our manager's impressions of the 46th Annual AmSect International Conference held recently. I appreciate Greg Gagnon allowing me to share his report with readers. Trident Health Resources, Inc. sponsors and requires all of its employees to annually attend at least one regional or national perfusion-related conference. They are requested when they return to prepare and share their impressions of the meeting with their Trident colleagues.

Reader comments and any reflections from those who attend these perfusion-related conferences are most welcomed as posts to the comments section.

Ralph E. Jordan
CEO & President
__________________________

April 9-12, 2008
Greg Gagnon BS. C.C.P.

I was fortunate to be able to attend the 46^th Amsect International Conference Held at the Hilton Walt Disney Resort in Orlando Florida from April 9^th to April 12^th. This was the first Amsect meeting that I have attended in some time. I was happy to attend many of the conferences that I feel will directly affect my practice of perfusion.

On Wednesday April 9th^, the first lecture I chose to see was the Tandem Heart PTVA system. This ventricular assist device was an example of how perfusionists can be of help to patients in and out of the operating room. Several case reports were provided showing the Tandem Hearts ease of use and flexibility.

The main purpose for this device is to provide patients support in post cardiotomy shock. This particular device may also be used in the cath lab for support for patients undergoing PTCA and Valvuloplasty procedures. There were also examples given using the VAD for transport and as a Bridge to transport.

This device was totally percutaneous. This allows for not only CT surgeons also Interventional Cardiologists to take advantage of this pump for their patients. The pump uses a mini centrifugal pump that is about 2.5 inches in diameter. The pump is connected to the control box via a thin drive line which looked like a large I.V. pump. The system uses very little heparin that is used to keep the pump lubricated.

I thought this could be used in many settings; however the cost was pretty high. The system was very expensive. The disposables run about 20,000 dollars and last 2 years on the shelf. The company allows for one exchange of expired disposables once every four years.

Later, I attended the virtual OR sessions. On display were standard pump consoles that used mini circuits. One pump setup that caught my attention was provided by Jeffery Mowery BS CCP from University Hospitals of Cleveland – Case Medical Center. This pump setup used a Terumo Pump pack and an RX25 oxygenator. The priming volume for this setup was one liter.

On April 10^th, I chose to attend track one of the conference. This was billed as “Blood Management”.

Bradley Kulat, BA CCP LP from Children’s Memorial Hospital Chicago, IL presented “Optimizing Circuit Design Using a Remote Mounted Perfusion System”. His system used a remote pump head that was placed high up next to the cardiotomy with all the roller pumps in a “V” formation. They customized every circuit which allowed them to reduce blood usage by 65%, and priming volumes by 45%.

There were two presentations that followed that left me confused. The first was “Aprotinin is unnecessary in Redo coronary and Valve surgery” presented by Priya Sastry MD of Liverpool England.

She compared blood loss totals in patients undergoing redo CABG and Valve Surgery with and without Aprotinin and determined there to be little difference between the two. She did say that with redo MVR surgery a more detailed look was warranted to determine if there was any evidence that would show that Aprotinin was beneficial to patients.

This lecture seemed a bit out of place to me as Aprotinin is not available in the U.S.

The second lecture was presented by Michael Polis MD. He is a CT fellow from Liverpool England. His presentation was titled Haemofiltration on Bypass is potentially Associated with Cerebral Oedema: A Theoretical Analysis. I was very interested in this particular presentation because of my use of the Hemobag system which requires us to aggressively hemoconcentrate our patients.

I had hoped to hear more about hemoconcentrating and its effect on the brain, but this was only a theoretical analysis.

On Friday the 11^th I attended a lecture regarding “An in Vivo investigation of five Integral Cardiotomy Reservoirs for Gaseous Microemboli Activity During Venting”. This lecture I thought was very informative. Five oxygenators were compared for their handling of micro air bubbles being pulled in from the cardiotomy. The Terumo RX25 was superior in its handling of micro air.

All in all I thought the meeting was average. Many times it was very difficult to hear the responses of the lecturers during the question and answer phase. They would turn away from the microphone and speak directly to the moderator. I did enjoy the virtual operating room presentations. I felt that the minimal prime setups were very practical informative.

Perfusion Students: The Future of the Profession

TRIDENT RESPONDS BY EXPANDING PERFUSIONCOMMUNITY.COM

In the short time since Trident launched PerfusionCommunity.com, we have seen spikes of increased new membership and we thank our readers for telling one or two friends about us, and so forth. As many of you already know, features and enhancements continue to surprise and delight you each time you log on, with our latest feature being the CHAT functionality and PRIVATE INSTANT MESSAGING (IM). As membership to perfusion community.com is without cost, we hope to continue to attract new members, so please keep sharing the good word about perfusioncommunity.com.

One of the areas of focus for Trident is to support and assist the body of perfusionist students, who, of course, are the future for the profession. We need the energy and education and skills of these fine people to breathe new life into the field. The jobs for perfusionists, while competitive, are plentiful and we keep our job board updated weekly with the newest job opportunities. We want to aid in the exchange of news and information which will be helpful to students in their studies and future practice. As we grow, we want to include white papers and technical information… as such, we’ll even be recruiting some perfusionist presentations to include at perfusioncommunity.com as part of this education outreach.

Included is our lastest mailer/flyer designed for perfusion educators to share with their students.

A print-ready version can be uploaded to you at perfusion community.com at the DOCUMENTS link, or, we would be happy to mail you color printed brochures/ flyers.

We welcome all perfusion students to perfusioncommunity.com. Please share this information with your colleagues.

Regards,

Ralph E. Jordan
President and CEO
Trident Health Resources, Inc.

The Launch of Perfusioncommunity.com, Chat & IM Functionality and First Comments

I’m excited to provide this update about Trident’s launch of a new website to serve as an educational and networking resource to perfusionists. Now in its first month live online, 130+ users have already signed up at PerfusionCommunity.com, a new website developed by us specifically for cardiovascular professionals including perfusionists, educators, manufacturers, students, providers and other industry professionals. We came up with the idea based on a realization that a one-stop shop for the industry was needed to include a broad spectrum of information such as events, news, expert advice from community members, employment opportunities, and most of all an open forum of communication and exchange between members. Our vision includes a myriad of enhancements which are coming to life.

Perfusioncommunity.com added more features this week: A real-time chat room for members to communicate, which includes private instant messaging. The site allows members to meet around a virtual water cooler for discussion or public social exchange, where one can whisper (privately) to another member or have a separate conversation entirely from the water cooler in an instant message (IM) format. Perfusioncommunity.com’s layout and ease of use is supported by the latest technology, using Microsoft ASP.net browser-based internet Chat and instant messaging. There is no software required to be loaded.

Additional new enhancements are being explored as additions to Perfusioncommunity.com. We view the site as a work in progress and are responsive to the members’ wants and needs and we are getting rave reviews. We’ll continue to survey and solicit comments. In the future, we plan on having educational seminars and leadership lectures held in the moderated chat room.

Another thing I want to mention is that we’re still very early in establishing PerfusionCommunity.com’s presence. As such, we are offering web banner advertising at introductory prices which includes design, placement and quarterly traffic reporting to you. Contact me if you’d like a media kit containing details about our advertising programs.

Visit PerfusionCommunity.com daily for all the news of the industry (just click on the subject topics of interest at our home page, and all the latest news appear), and check out the message board updates, new calendar items and job postings.

JOIN TODAY!

Ralph E. Jordan
President and CEO
Trident Health Resources, Inc.

On Discerning Truth from Exaggeration & The Future Entry of Vivo RT To the Marketplace

What is this world coming to? I was thinking the other day about political campaigns and the continuum under which they operate in public display—from communicating subtle mistruths to the extreme of blatant exaggerations—all in an effort to posture, position and win. And the media loves it and the public must sort through it. Think about this. We must ask ourselves: What is important? What is authentic? Where does integrity lie? Regardless of political affiliation, can anyone possibly defend the ongoing disingenuousness which pervades recent news in the political arena?

Discernment is essential. We can draw a parallel from the political environment to the matter of “reputation” in many areas of life…be it of a political candidate, a product advertised, or even the stories told in social settings about “the big one caught” on our last fishing excursion. We must ask where is the line of distinction between exaggeration and truth?

Occasionally candidates make mistakes, sometimes the media reports wrong information, and oftentimes advertisers and fishermen embellish their stories to promote themselves or their capabilities. Perhaps some information is more than anyone really needs to know—things that are personal or private and have no place for public scrutiny. Once a story appears in print, a claim is advertised, or a fish tale is told, that story generally gets repeated, making it more and more believable. But again, ask…What’s true? What really happened?

I think many of us have a tendency to embellish what we accomplish and we minimize shortcomings or find an excuse as defense. It’s in the eyes and ears of the audience, the listeners, readers or the viewers to interpret and determine what is fact, what is deceptive, and what is intentionally meant to mislead. The Talmud is quoted, “If you add to the truth, you subtract from it.”

Even in Shakespeare’s, Othello, Protagonist Iago prides himself on honesty but is a man, in truth, who instead espouses that men serve their masters only to get what they can. Reputation is "oft got without merit, and lost without deserving" he said, and that the only thing that matters is what a person thinks of himself.

Yet where unethical practices have become widespread and entrenched, there remains for most of us, a simple task of responsibility-- the sense of honor and integrity. Enter the perfusionists… there is an acumen required: no room for error, no exaggerations or positioning. Rather, accuracy, authenticity and reality are foremost. Part of the fabric of the character of perfusionists is to exercise careful assessment and act with deliberation, without hesitation. It’s their reputation on the line!

Hence the philosophy of the design of a New Generation software product which will be available this summer EXCLUSIVELY through Trident Health Resources, Inc. :

Vivo RT is a paperless solution for continuous, real time data collection and management for cardiovascular procedures in today’s operating room.

Here’s what’s key:

The Vivo RT solution is a customizable platform leveraging the latest in state of the art Microsoft .Net CLR core development technologies.

The Vivo RT solution was designed from within Operating Room environments.

The Vivo RT solution efficiently and effectively records, charts and reports patient care data.

The Vivo RT solution is a powerful data discovery and harnessing tool for Patient Care analysis and clinical studies.

The Vivo RT solution is secure and HIPPA compliant.

The Vivo RT solution readily interfaces with electronic operating room equipment.

The Vivo RT solution is compatible with recognized Hospital Information Systems (HIS) and surgical databases for reliable record transfer.

The Vivo RT solution contains modules for Anesthesia, Autotransfusion, Nursing, Perfusion, Surgeon and Critical Care Units.

· No embellishments

· No exaggeration

· No stretching

And it will be available exclusively through Trident Health Resources.

Vivo RT is the latest technology which successfully exceeds first generation attempts at a patient care data management system. Stay tuned for future news about Vivo RT and Trident’s launch of this exceptional product.

I welcome your emails and comments regarding this announcement.

Ralph E. Jordan

President and CEO
Trident Health Resources, Inc.

San Diego Cardiothoracic Surgery Symposium

Trident Health Resources, Inc. sponsors and requires all of its employees to annually attend at least one regional or national perfusion-related conference. They are requested when they return to prepare and share their impressions of the meeting with their Trident colleagues.

Posted here is one of our manager's impressions of the Cardiothoracic Surgery Symposium held in San Diego this month. A thanks to Kris for a job well done.

When apropo we will post future summaries and we welcome reader comments and any reflections from those who attend these perfusion-related conferences.

Ralph E. Jordan
CEO & President

CREF 2008 Summary
by Kris Cleveland, CCP

The San Diego Cardiothoracic Surgery Symposium: Science and Techniques of Perfusion was held at the San Diego Marriott Hotel & Marina February 14-17, 2008. In their continuing goal to provide the very best educational experience, this years symposium topics were designed around suggestions made by the prior year’s attendees.

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The activity director Julie Swain MD along with the conference organizer Karen Morgan designed CREF 2008 to meet the specific educational needs of medical professionals involved with treating cardiac disease: anesthesiologists, biomedical technicians, cardiac surgeons, cardiologists, nurses, perfusionists, physician assistants, and technology researches and developers. They continue to provide timely talks on perfusion challenges and changes, but also added many others as well: cutting-edge cardiac care, blood and bleeding, and neurological and end-organ function.

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Past meeting attendees asked for more informal opportunities to learn about best perfusion practices in hospitals around the world. The CREF 2008 followed the American Academy of Cardiovascular Perfusionists (AACP) direction in offering Fireside Chat sessions on Friday afternoon and an International Panel of Perfusionists on Sunday morning. Fireside chats are moderated discussion groups giving participants a chance to discuss specific topics with course faculty and other attendees in an intimate, round-table setting. The International Panel discussed differences in perfusion practice and how & why each would respond to challenging cases.

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Last year’s overwhelming success with four different workshops was once again offered: Cerebral Monitoring, presented by Somanetics; Electronic Charting and Patient Management, presented by Terumo; Myocardial Protection, presented by Quest Medical; and Optimal Perfusion Circuit, presented by Sorin. The 45 minute workshops ran concurrently, and repeated after a 15 minute break, which allowed participants to attend two of the four workshops.

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Those who like to plan ahead should mark their calendars: the 29th Annual San Diego Cardiothoracic Surgery Symposium will be held February 12-15, 2009.

I should mention that daily parking charges for the San Diego Marriott are $20 per day. Right next door is the San Diego Convention Center which offers parking at $8 per day. This alternative is especially attractive for those of us wanting “more bang for their buck”. The daily room rate at the Marriott is $236 plus taxes; however there are many close-by alternative hotels that offer substantial savings. I stayed just down the road at the Sheraton and saved $200 for the three nights lodging.
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Thursday afternoon’s scientific agenda was entitled Perfusion: Challenges & Changes. Ian Sherer from Duke University Medical Center-Durham, NC provided insight into a potential role for the perfusionist in the application of isolated limb infusion, an evolving area of cancer therapy. Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hypothermia combined with chemotherapy agents, primarily Melphalan, has resulted in greater cytoxicity in laboratory studies which lead to the application of hyperthermia in clinical studies during the 1960’s. The effectiveness of this regional technique and the absence of any good systemic therapy has made hyperthermic isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma. Regional limb therapies, while palliative, improve the quality of life for patients and reduce the need for disfiguring and debilitating amputations. I would like to talk to anyone having clinical experience using HILP as there is a good chance we will be utilizing this technique soon at our hospital. My e mail address is: kcleveland@landmarkmedical.org
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Robert Groom from the Maine Medical Center-Portland, Maine once again provided his insight into Controversies in Perfusion: What Should We Do About Them? He defined a controversy as a disagreement that is typically prolonged, public, and heated. It is not surprising that there have been controversies in our field with regard to practices. Bob stressed the importance of evaluating the available evidence. Gathering data is important, but unless we can provide an analysis of this data and share it with others to provide positive change we are collecting worthless data. He quoted Anton Checkhov as saying “Knowledge is of no value unless you put it into practice.” Bob noted that there is a wide variation in how perfusion is practiced across the perfusion community. He posed these questions: Should we be concerned about this variation? What should we do when we encounter controversies in care? He feels that patients expect that what is done to them in the operating room will be based on the best knowledge that is available at the time of their surgery.

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Every heart center is capable of improving the care that it provides. 17 of the more notable controversies are: centrifugal blood pumps vs. roller pumps, normothermic vs. hypothermic CPB, high vs. low hematocrit, transfusion triggers, open vs. closed reservoirs, pulsatile vs. continuous flow, antegrade vs. retrograde cerebral perfusion, hollow fiber vs. silicone rubber membrane oxygenators, beating heart surgery vs. use of cardioplegic arrest, alpha Stat vs. pH Stat, cold storage vs. machine perfusion of donor organs, low flow hypothermic CPB vs. DHCA, low dose heparin vs. full anticoagulation, measurement of heparin levels vs. activated clotting time monitoring, 4:1 blood cardioplegia vs. all blood cardioplegia, cerebral oxygen saturation monitoring vs. pulse oxymetry, and point of care coagulation monitoring vs. standard laboratory coagulation tests.
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Friday morning’s topic Cutting edge Cardiac Care I began with George Despotis MD Washington University School of Medicine-St. Louis, MO speaking on transfusion-Related risks. We can rest assured that although our blood bank supply is safer than ever from what it is tested, the inherent risk of transfusion is great. Improvements in blood screening and administration techniques has led to a reduction in serious adverse events related to transfusion. However the literature is describing new l transfusion-related problems in addition to new potential pathogens. The three current, leading causes of transfusions related mortality include: TRALI, bacterial contamination of platelets units leading to sepsis and transfusion errors resulting in catastrophic hemolytic reactions secondary to ABO incompatibility. He stressed the importance re-iterated with the literature that we must cut down on giving blood products at all costs. Inappropriate use of blood and blood products can potentially lead to or aggravate blood shortages which may limit our ability to adequately manage our anemic and bleeding patients.
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Cardio-Aortic disease: Open vs. Percutaneous Procedures was given by Lars Svensson MD Cleveland Clinic Foundation-Cleveland, OH. His interests are minimal invasive valve surgeries, percutaneous cardiovascular surgery, and brain & spinal cord protection during cardiovascular surgery. They have found that homografts were no better than biological valves and have switched to inserting biological valves in younger patients. He went on to present a series of 388 aortic valve repair procedures. For the aortic valve, most of their patients have on pump minimally invasive repairs. Their high risk and inoperable patients have been managed with a percutaneous transcatheter valve from the femoral artery or transapically into the aortic annulus. They utilize a primed pump stand by for all their off pump valve procedures, and he feels that a pump is still needed for many of the patients.

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Terumo unveiled a new heater-cooler-HX2 Temperature Management System that will give the new Sorin Stockert Heater Cooler System 3T a run for the money. The HX2 supplies temperature controlled water to arterial and cardioplegia heat exchangers. Each temperature channel has a touch pad that precisely adjusts the mix of water flow between cooling and heating sources. The outlet water flow is 25 L/min at zero head and allows for a temperature set point control range from 1-42 degrees C. The Terumo HX2 is a much new and improved version of the old style Sarns heater cooler that is my old-time favorite. Dual and independent control of temperature is a nice improvement and will be on many perfusionists capitol expense budget wish list for next year. The only disadvantage over the Sorin 3T is that the Terumo Unit must utilize ice to cool below room temperature. The Sorin unit provides for cooling without ice during routine operation due to the strong performance of the compressor assembly. Wouldn’t it be nice to have one device that can do the work of two big & bulky C-subzero units? Yes!!!
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In conclusion, it is evident we as perfusionists must do our part to reduce CPB prime volume and avoid blood products if at all possible. The risk of blood and blood product transfusion is greater than ever and the literature is full of examples to follow. Data collected must be analyzed and put into a readable report that should then be passed along to the entire cardiac team. Together we can all make a difference in raising the standard of care that we provide as perfusionists.
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Kris J Cleveland, CCP Chief Perfusionist
Trident Health Resources, Inc.

The Continuing Saga of Stents Versus Heart Bypass Surgery....

An interesting study was in the news this week and thought I'd share a video version of it from MSNBC NEWS. Worth viewing!

Also, I've included links to the AP Article, Heart Bypass Better than Stents, Study Says as well as the Report from New England Journal of Medicine, Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease.

Ralph E. Jordan
CEO & President

A Few Thoughts about Growth: Organic versus Mergers & Acquisitions

Few companies in our industry can tout having 20 years under the same ownership, especially in today's global economy so rich in technology and fast-changing in leadership. Yet, TRIDENT HEALTH RESOURCES, INC. marches forward to celebrate its 20th anniversary this spring. We're abreast of the latest technological advancements and new business entrants in the marketplace—but we still recognize that some things never change. We've persevered long because our name and reputation are our capstone. It's a corporate philosophy based on patient-focused care, never forgetting this is a relationship-building business and that our employees are our greatest assets. These are the values which sustain us and remain constant, whether it is the year 1977, 2007 or 2037.

Our management philosophy is empowering. While we centralize the operations from our home office, we enfranchise and trust our chiefs and managers to make clinical decisions that best meet the customer's needs. We do not have layers upon layers of middle managers to dilute messages from the field. To the contrary, our people have a direct link to the office. The key to our success is we trust our staff and they, in turn, trust us. Trident is one of the few companies which has letters of recommendation not only from hospitals we serve, but also from our employees (link to testimonials). Our culture is unique, and one which has been fostered since the company's inception.

Most companies grow in size from mergers and acquisitions because it can be a short cut to growth. TRIDENT has grown organically in recent years based on reputation and its position in the marketplace as a leader in perfusion management services for long-term and locums assistance, as well as capital equipment and disposables management services. It's our goal to continue organic growth; that's another thing that won't change.

TRIDENT will, however, consider expanding by merger or acquisition in appropriate scenarios in which synergy is discovered with another company having a similar culture as ours.

Companies interested in furthering discussions may contact me directly for a private and confidential consultation.

Ralph E. Jordan
President & CEO

Auld Lang Syne & Some Thoughts about a Happy New Year

Does anyone know what Auld Lang Syne really means? And even if you don't, can you sing it? If your answer is the same as mine ("Not really" and "No"), why do we have such a difficult song as traditionally sung each New Year?

Let's reflect a moment… It's good stuff. Ah! There's a point here…

Auld Lang Syne means to acknowledge "times gone past" and the phrase has its roots in the 1700s in Scotland (I googled it.) I bring up Auld Lang Syne as topic to my first blog entry of the year for two reasons: (1) The past year was good at Trident Health Resources, Inc. (very good, actually) and I'm thankful for that. (2) Building on the past leads to greater success in the coming year.

There are new and exciting things forthcoming and I have a couple of announcements to make to the perfusion community at large. Within the next week Trident is launching its new state-of-the-art revamped interactive website. We've been at work long hours over the past few months for this—testing and fine-tuning the technology. We're expanding our internet presence to include educational resources, links to perfusion-related websites, access to our new database used by our team of professionals so that they have one entry point, etc. We're now also offering ad-banner opportunities to those who wish to participate to expand their reach for exposure within the industry.

But wait….there's more.

Coming Soon! Trident is hosting an online Perfusion Community designed to be a one-stop shop for perfusionists and professionals in the industry for the purpose of exchanging ideas and accessing important information. An official launch date for pefusioncommunity.com is near—very near—and we are diligently adding material to this interactive site as of this moment. Membership will be free and includes benefits such as individual blogs, chat functionality, and message exchanges in a forum of topical boards. A calendar will provide upcoming event information, and the latest news items, educational announcements and a comprehensive, international classified jobs section are among other items featured. Web banner advertising space will be available for sale, too.

I view the Perfusion Community to be work-in-progress which will be regularly enhanced and developed attuned to the wants and needs of its members. This, along with the new Trident website, is an exciting start to a new year. As such, it is with much enthusiasm I give thanks to the past, for it is from that which catapults us moving forward. Upon reflection and as is sung, "We'll take a cup o' kindness yet, for Auld Lang Syne."

Please check back and let us know what you think of our new website, tridenthealth.com and our other new site (coming soon!) perfusioncommunity.com. We appreciate your feedback.

The best to each of you in 2008!

Ralph E. Jordan
President & CEO

Merry Christmas & Happy Holidays!

May the Love of the Season enter into our homes and bring warmth into all of our hearts during this Time and remain with you and your family throughout 2007 and the coming New Year.

In warm appreciation of our association and for your loyalty, friendship and hard work during this past year, I extend to you my very best wishes for a Happy and Blessed Holiday Season.

Merry Christmas and Happy Holidays

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Ralph E. Jordan

President and CEO
Trident Health Resources, Inc.

Skepticism of a Skeptical Age...

In the spirit of the Holidays, I was reminded of a wondrous tale that seemingly parallels a response I made to a comment on my blog entry a little over two months ago. Perhaps you remember the true story... Eight-year-old Virginia O'Hanlon wrote a letter to the editor of New York Sun. The date was September 21, 1897 and a quick response was printed as an unsigned editorial...

"DEAR EDITOR: I am 8 years old. Some of my little friends say there is no Santa Claus. Papa says, 'If you see it in THE SUN it's so.’ Please tell me the truth; is there a Santa Claus? VIRGINIA O'HANLON"

And the Sun’s reply, in short...included these words...

"VIRGINIA, your little friends are wrong. They have been affected by the skepticism of a skeptical age. ....Yes, VIRGINIA, there is a Santa Claus. He exists as certainly as love and generosity and devotion exist, and you know that they abound and give to your life its highest beauty and joy. Alas! how dreary would be the world if there were no Santa Claus. It would be as dreary as if there were no VIRGINIAS." For complete text, click here.

In the spirit of the Holidays, I’d like to draw your attention to the fact that an anonymous comment was posted to my September 21, 2007 blog entry (Interestingly, the date is 110 years to the day of the publishing of Virginia’s letter)...

I didn’t believe the poster was who he said he was.

I was wrong.

I’ve been affected by the skepticism of a skeptical age. Yes, there is a Cliff Gardner...who blogged as “anonymous” herein!

To NOT believe? As the New York Sun editor said to Virginia... “Nobody can conceive or imagine all the wonders there are unseen and unseeable in the world.”

I stand corrected!

Happy Holidays to Each of You!

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Ralph E. Jordan

President and CEO
Trident Health Resources, Inc.