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
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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.

Pediatric Perfusionist Needed Immediately for Canadian Market

Looking for an experienced Pediatric Perfusionist for a 1-year assignment in Canada. Great location. Great salary.

Please call the office for information. 1-800-888-8408.

Thank you.

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

Mail from Everywhere Regarding The Company Formerly Known as Fresenius

I apologize for not posting this update to the Trident Blog much earlier, but even at this late date, Trident is still wading through and responding to numerous faxes and emails received from our blog discussion post about the new company's policy to hold salaries in arrears.

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The responses we have received have paralleled the sentiment behind Trident’s inital impression. Thank you to those of you who have agreed to share the contents of your correspondence reflecting your feelings of dismay, discouragement and in some cases, even anger. To many we’ve heard from, it’s not even the money that’s being held as a point of contention (although that certainly is a factor), it's the fact that a major decision regarding salaries seemingly took place without regard, care or consideration to the many long-time employees who have endured much over these constant mergers and buy-outs.

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Whether a new payroll system of payment is initiated based on cash flow considerations or State-regulated legalities, or simply as the means to assuage a department’s workload, the reason of company “convenience” to change an important payroll policy (although legal in many states) speaks volumes about a corporate philosophy. What is evident from the correspondence we received, the communication to the field was poorly handled and was deja vu all over again (as Yogi Berra so eloquently once stated).

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The perception of cold and impersonal management is not new and was the hallmark of past owners perpetuated by these kinds of management decisions that disregard the needs of the front line. Clearly that’s what happened, or else why did the new venture group retreat and offer to postpone the payroll adjustment until March 2008, even offering an improved repayment program to employees of need (for their own paycheck), if not to acquiesce to the pressures of "exempt associates"? The overwhelming response that we have received seems to indicate that many of the rank and file continue to question management decisions.

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A management team which sways from a firm decision under pressure exposes the soft-underbelly of weakness...of having acted hastily, needing to then back-peddle to make a correction in a flawed decision. It happens in some organizations and history shows us, such handiwork can destroy credibility instantly.

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We are touched by the stories of those who’ve contacted us. With permission, a few of the quotes that we have received follow:

• "We are very confused about what we have heard and do not know what to make of it, since we have no details."
• "The funny thing is the people in charge are all new...they never worked for Fresenius or Edwards or Baxter....all new benefit people, as well. So no one can blame it on Fresenius this time. It's all the fault of the new management. I am not a happy employee and I am personally tired of all the mergers and changes in policies every few years....I am tired of the lack of competitive pay. I was optimistic that the new management might make the necessary changes, but I'm not impressed with what I have seen so far, and they haven't been in charge that long. And now...this."
• "Many of the old upper management people were laid off, so in many ways we have a new company...I have been through three mergers and having been with this company for over 12 years, I am not impressed. This acquisition has been nothing short of disorganized and virtually no information has been forthcoming. We got a letter telling us who our 401k, health, and dental will be with, but no details or info on costs. We just got info on the 401k package last week, but nothing else. .... It is a disaster, if you ask me."
• "It was sold in May, although our benefits are still covered through Fresenius until the beginning of October. Now, I can say that this organization has not been very organized in getting out information to us in a timely fashion. Our benefits are due to switch over on October 7th and we still have not received our benefits package. Hello??? And they have no phone number designated for us to call in and ask questions, including benefits questions, so a few of us are very irritated and unhappy with the way things are going in that regard."

Upon review of these comments above, it's clear that communication is the essential factor to good employer/employee relations and it seems from the comments we received that it was somewhat lacking in the new venture company's payroll policy change. The responses that we received were more about a lack of communication than anything else and that this problem seems to have been persistent throughout the three mergers, etc. It was Trident's intention in blogging about this to bring forward shared information for the good of all, however, some comments to us expressed concern that maybe we were too heavy-handed in our message.

For example, several individuals expressed the following:

• "It was inappropriate to prematurely post that information before you were certain that all Fresenius/HCSG employees were notified."
• "...not exactly a professional thing to do, especially if it involves speculation." (Trident's Response: Note: which it did not)
• "You never know when information you post will be disproved and make it appear that you are just spreading propoganda. Like I said, I don't believe this was your intention...just be careful."

We thank all of you who responded to our blog post of 9-10-07 . I appreciate all of your comments and your points of view. Please keep writing and we will attempt to be as responsible as we know how to post factual information that benefits the entire Perfusion Community. Trident views our niche industry like family and wants to keep communication open and positive, addressing any concerns as they arise.

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Perfusionists have historically aspired to the highest standards regarding the Profession and the care of the patient. Shouldn't they also hold their management to the same standards that they aspire for themselves? Because if they can't find it in the environment that they're in, they will eventually seek alternatives with other companies which aspire to that same excellence.

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As always, we welcome your comments and if given permission, will post on this blog.

Never settle!

Sincerely,

Ralph E. Jordan
President and CEO

Trident Health Resources, Inc.

Industry Update and the Latest on the Company Formerly Known as Fresenius

Because our industry is relationship driven, like family—news travels quickly. Any change in the infrastructure of key players in the perfusion business has implications to all. As Trident’s leader of a fine team comprised of many good people, it’s important to me to convey accurately and swiftly any concerning reports of unusual activity. As such, today, I sent a memo to our employees, copied herein, in response to the company formerly known as Fresenius and their plans to freeze a week of their employees’ salary. What does it all mean?

9-10-2007

A surprise is forthcoming to our dear friends employed by the old Fresenius Perfusion Unit that was most recently sold to a venture capital group out of Nashville (mentioned in an earlier blog post) It seems the transition from old Fresenius to the new organization has run into a few roadblocks...but this snag is a doozie and one that reeks of a possible severe cash crunch.

The first week of October completes the formal transition to the new venture capital group. I’ve confirmed that the new owners of the beleaguered perfusion service company are greeting their new employees with a dose of reality, believed to be symptomatic of a cash flow problem, but hopefully, not a sign of things to come. Every employee in the new corporation will have one full week of pay held...the 1st week of October, paid back upon separation from the company. It is understood that the terms of this unprecedented salary take-back includes a clause that reads if there is a hardship to the employee, the company will loan the week’s pay to be paid back in November. I question how loaning someone their own well deserved pay is a sincere attempt to assuage a hardship.

Further, if there is a true cash shortage in any company for whatever reason, such information should be honestly and forthrightly told to the deserving loyal employees. Not giving a reason, as I understand was the case, is a pretty bold and arrogant statement about the ethical platform on which a company stands.

I certainly share the feelings of loss for our friends from the old Fresenius still employed under the new venture capital group. They will be rightly and deservedly upset, if not down-right angry, when they hear about this latest shortfall, which affects their pocketbook. This decision is an insult to their stellar professional careers.

As a Trident employee, step up and let your friends know that they have a friend in Trident. We'd be glad to listen to anyone who would like to get in touch with us, realizing that offering condolences at this time won’t exactly change things. However, perhaps there are other alternatives to alleviate their collective dilemma. Please reach out. Listen. There will be much anger because of this situation. I believe the PerfList message board will be blazing with comments of disgust and despair. Trident will listen and try to offer solutions to those groups of clinicians feeling the brunt of this unfortunate managerial decision.

Like many of their ilk, these venture capital types are interested in one thing—a return on their investment. Historically, venture capital managers have sought the usual 40% return. Such a return won't be achieved in this business by these folks given the latest management decision to sequester funds. The most important stakeholders in any business, but especially ours, are the staff.

Despite the dire circumstances described above, Trident employees should know: this is an excellent business to be in...we have celebrated 19 straight yrs of successful, profitable business with happy and productive perfusionists who are our most important asset. We don't skimp on salaries or benefits, staffing needs, vacation relief and annual meetings (which are a requirement for all of our folks). I can affirm with confidence, as well, that there are quite a few other contract companies out there which do a good job and protect and value their people, just as Trident does.

Thank you for your constancy and great work efforts. We are proud of our association with you. Let us know how we can help you all.

Best Regards,

Ralph E. Jordan

President and CEO
Trident Health Resources, Inc.

Staffing Update at Trident Health Resources

Trident Health Resources has been fortunate in recent weeks to have hired some strong , experienced new perfusionists to our team. While we are still recruiting (see our website, Employment page, for specific needs), we are saddened to announce the departure of a fine Elite Travel member who also headed up our Q.A. function at Trident.

Ms. Rebekah Trittipoe will continue to work as a consultant to the organization, however she will be launching two perfusion-related business endeavors. Enabled by her recently completed MEd in e-Learning Technology and Design, the first is an online educational venue that will provide ABCP Category I CEUs for completing various educational learning units. The associated website is http://www.perfusioneducationonline.com/ . The second venture is a continuation of her perfusion quality consulting business, launched initially in 2003. Rebekah will be providing a variety of perfusion quality and risk assessment services to her clients. At present, the website which is still under development can be found at http://www.r-gconsulting.com/ . However, in the near future, the company information can be found simply at http://www.perfusionquality.com/ . Rebekah may be contacted at (434) 238-2118.

Rebekah, all of us at Trident will miss you and we extend to you good wishes on your new venture. We are very proud of the association with you over the many years you helped us.

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Ralph E. Jordan

President and CEO

Trident Health Resources to Begin Immediate Hiring Spree

Why is Trident Health Resources, Inc. in the process of hiring a dozen or so exceptional and certified professionals across the country? While the success of this strategy will become clearer over the next 12 to 18 months, it's a sign of good times and ample opportunity. All bets are that business will increase and new markets will emerge.

A Message from

Ralph E. Jordan...

As Trident’s President and CEO, I want to convey the enormity of the company's positioning for growth beginning right now and moving full steam ahead through the rest of the year and into 2008. What we need now are experienced, certified perfusionists who can help fill the spaces where new business is flowing from various parts of the country.

• Specifically, we need an additional 5 Full-time Experienced Travelers NOW for our Elite-Traveling Team.

• We also need an additional 8 Full-time Perfusionists on our team for new long-term accounts.

By the end of 2007, I believe we’ll still have plenty of room for organic growth via new company business and through mergers and acquisitions. We are exploring opportunities and finding them to be plentiful. Our future is bright and as our current team members can attest to, " the GREATEST ASSET of our company is our people."

RUN DON'T WALK to the nearest fax machine or your computer's email to submit your resume and references to apply.

To visit the employment page at the Trident Website. CLICK THIS LINK.

Response to a Fresenius Field Manager

We received an email response to my May 16th Post from a dedicated field manager working for Fresenius. With respect to his desire to remain anonymous and given permission to post it, I wanted to share this with the rest of you because it gives good insight from a person who cares about his company and staff--and who is obviously loyal to his company.

What follows is the total message and my comments indicated in blue.

Comments: On your blog, you wrote: "My guess is that SCSG will eventually spin off all or parts of the newly acquired perfusion business and concentrate in the renal sector of their new venture." Has it not occurred to you that perhaps Fresenius would have made certain to include stipulations that effectively prevent this group from competing directly with them in any Dialysis-related businesses going forward? Making a guess like the one you made is at the very least uninformed.

I’m sure that Fresenius corporate (FMC) has laid out many stipulations regarding competing in dialysis-related businesses. It’s apparent that the Pharmacy and the IT units of the new company (SCSG) have a close business relationship with FMC. That's my point, although I qualify my statement to say it's a calculated guess, not one uninformed. The newly formed company that has acquired the old Fresenius Perfusion Unit has a strong background in the renal marketplace, and that’s where their comfort zone is.

Some very good Corporations like Baxter, Edwards Lifesciences, and even Fresenius, have attempted to make a success out of this Perfusion book of business. Apparently, their attempts have failed. Doing the same thing over and over again and expecting different results is the definition of insanity. One thing's for sure... SCSG has some smart business people and I'm sure that they're goal and results-oriented. I am sure everyone, including their managers, will be held accountable for the loss or gain of accounts in their respective territories. If this new Group cannot make a go of this perfusion business, they're not going to hold onto it. That's not uninformed or a wild guess--that's just good common business sense.

I realize you have your biases, and I have mine. Comments by either party that could be construed to be inflammatory and/or disruptive to the perfusion community should be avoided. This community is too small to have someone with a forum to be making comments such as; asking for condolences to be extended to the staff of the newly formed company. The simple fact that there is a change could possibly be a distraction to some staff to perhaps lose focus, therefore these statements are, in my opinion, unprofessional.

I appreciate and respect your opinion. Over the past several years, the Perf List, which is known throughout the perfusion community, has published a myriad of comments (both negative and positive) regarding this company and other contract companies. Respectfully, I am in variance with you that the comments in this blog could be disruptive to the perfusion community in general. As for being unprofessional, I would say that my comments were more pragmatic and rational than unprofessional.

As someone that has actually sat down and talked with these six accomplished health care officers, I see a very different picture. I see a group of people that turned a 70-something million Renal Care Group into a 1.6 Billion company, which they sold, and they did it in less than 10 years. An extremely large part of their success was due to stressing patient care above all other aspects of running a health-care-related business.

Any group of executives which takes a $70 million company and runs those revenues to $1.6 billion in 10 years is to be commended, and I can assure you that stressing patient care above all other aspects, is but one of the many attributes associated with Renal Care Group's success. As you know, they did not grow the company organically, but by a concise merger and acquisition strategy. And they grew it for one reason: to make money and to sell it for a huge profit--which I presume they did.

For the first time in a long time, the perfusionists, autotransfusionists, as well as the other technicians and staff, are under the leadership of a private group of proven-to-be-successful leaders in the health care field. A group of leaders that are quick to point out top-notch quality patient care is the focus about which revolves any and every decision of the new company. That focus is much clearer without having to satisfy shareholders.

I find it interesting what you indicate--that it's the first time in a long time that your leadership is competent and successful and that they have indicated to you that every corporate decision is based on quality patient care. But certainly you're not saying that having shareholders is a detriment to the growth of a company? It seems when one's on the inside, there's a human tendency to look at the world through myopic, rose-colored glasses. When some companies falter, the management sometimes inexplicably blames the shareholders--a tired old excuse for non performance. When they succeed who do they credit? That dog don't hunt anymore. This new bunch is going to go after accountability. That's not a guess, either.

Consequently, I do not share your dour mood about the future of the company, nor do I see this change requiring condolences to the staff. In fact, I see the opposite: this is a long-overdue, welcome chance for the staff to have ready-access to the Leadership Team, a team that is stressing patient care above all other concerns, with the resultant benefits to the staff, which icludes getting the top notch support needed to provide the very best patient care.

Dour or sour, I am not. Please understand the sentiment of my memorandum was upbeat. I'm sure that many of your colleagues are thankful for--as you say--the chance to have ready access to the leadership team.

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I think Trident and this newly formed company will better serve the patients entrusted to our care, as well better serve our respective staff, by competing with one another based upon patient care results. Not by making an uninformed "guess" about the future intentions of this accomplished health care team, nor by resorting to language such as requesting "condolences" to be extended to the competitor's staff.

Trident welcomes any and all competition based on a multitude of things, including the care of the patient. We have had a patient care philosophy that has permeated our entire company for many, many years. Trident has been growing steadily because of our good reputation and our care for the patient, as have so many other contract groups across the country these past five years. Our strongest asset is our people. We've never given false promises. We've not cut salaries to make our bottom line look better or to drive out senior perfusionists because their salaries were too high. We respect the opinion of the individual, without threatening his livelihood. We treat our client-hospitals with respect. We allow our folks to take their vacations, by supporting their efforts and we bring in replacement personnel so as not to jeopardize patient care. We never stick one perfusionist in one solitary account most of the time without relief. We know what patient focused care is and we know how to treat our people. That is why this year we celebrate our 19th consecutive year of successful growth.

Further, we send congratulations to our staff; we don't offer condolences--because there's no need for condolences. If you saw the resumes that come across my desk from disgruntled employees and former employees and the horror stories that they tell about how they've been treated, you would send condolences. I would bet on it.

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This isn't akin to democrats and republicans wrestling over political power, it's about perfusion providers taking care of patients. From my standpoint, regardless of any changes that may occur to you or any other competitor, you can expect to never see nor hear me communicate anything that could possibly contribute to ANY staff to become unfocused and risk taking their attention off of the patient care target. Although I may at times be disappointed, I expect the same professionalism from my competitors.

I think you may have confused definitions of professionalism with plain talking/rational-thinking. However, if I have written in the Blog anything to offend, it was not my intent.

I applaud and appreciate your comments and encourage you to continue a vigorous debate in an honest and open fashion. We wish you every good luck and perhaps, a year from now, I can send you our congratulations.

Reply in Blue by Ralph E. Jordan, CEO & President, Trident Health Resources, Inc.