Parish Nurse classes sponsored by our educational partners. - Parish Nurse Perspectives

United States, By State

Alabama

Mobile (On-line), Spring Hill College of Nursing,

Carol Harrison, 251-380-4492

Alaska

Anchorage Northwest Parish Nurse Ministries

at Providence Alaska Medical Center

Linda Shepard, 907-261-5053

Arizona

Scottsdale Beatitudes Center DOAR Nurse

and Health Ministries Network

Barbara Sage, 602-274-5022

California

Fullerton Evangelical Free Church of America,

Paula Lilja, 281-532-3060

Oakland Samuel Merritt College, July 11-14,

2008, Joan Bard, 510-869-6511

Florida

Boca Raton (On-line) Florida Atlantic University,

Susan Dyess, 561-297-3236

Orlando Florida Hospital, Center of Health

Ministry, Candace Huber, 407-303-7153

Venice Lee Memorial Health System, June 1-6,

2008. Rita Horvath, 239-432-3182

Georgia

Atlanta Gwinnett Hospital System, June 15-20,

2008, Linda Hughes, 678-312-2423

Hawaii

Kailua Castle Medical Center

Sue Pignataro, 808-263-0136

Idaho

Boise St. Alphonsus Regional Medical Center,

November 6-9, 2008

Sr. Mary Alice Quintana, 208-367-6494

Illinois

Oak Brook Lewis University, May 5-9, 2008 or

Oct/Nov '08

Kathie Blanchfield, 708-448-9429

Quincy Blessing-Rieman College of Nursing

Sheila Capp, 217-228-5520

Rock Island Trinity Medical Center

Mary Slutz, 309-779-5122

Springfield St. John's Hospital

Kathleen Cross, 217-757-6620

Indiana

Evansville (On-line) USI School of Nursing,

Victoria Pigott, 877-874-4584

Ferdinand USI School of Nursing

Peggy Graul, 800-467-8600

Lafayette Greater Lafayette PN Development

Center, May 19, August, November, 2008

Susan Buchanan, 765-477-6150

Indianapolis Clarian Health Partners

Congregational Health Ministries

Cyndi Alte, 317-962-9330

Morgantown National Episcopal Health Ministries,

Inc., May 25-30, 2008

Diane Beyer, 317-253-1277

Valparaiso Valparaiso University

Janelle Fleck, 219-464-5289

Kansas

Wichita Spiritual Life Center, Kansas Parish

Nurse Ministry, July 13-19, 2008

JoVeta Wescott, 316-686-0111

Kentucky

Louisville (On-line) Bellarmine University

Margaret Miller, 502-452-8413

Paducah Lourdes & Western Baptist Hospitals

Carol Bradford, 270-217-9949

Louisiana

Monroe (On-line) University of Louisiana at

Monroe School of Nursing. Linda E. Sabin,

318-342-1517

New Orleans McFarland Institute

Congregational Wellness Program

Rebecca Harris-Smith, 504-593-2320

Maine

Biddeford St. Joseph's Hospital

Pamela Deres, 603-225-4888

Massachusetts

Fall River Saint Anne's Hospital, Congregational

Health Ministry PN Program

Kathleen Emerson, 508-674-5600, ext. 2064

Maryland

Baltimore Lutheran Intercity Network Coalition

Diane Kretzschmar, 443-777-7931

Takoma Park Columbia Union College

Bernice DeShay, 301-891-4157

Michigan

Clinton Township Henry Ford Macomb

Hospital, Mary Ann Stockwell, 586-263-2117

Grand Rapids Calvin College, Dept. of Nursing

Bethany Gordon, 616-526-7076

Kalamazoo, MI

Borgess Health, Paula White, 269-343-1396

Minnesota

Minneapolis United Theological

Seminary, Vicki Gustafson, 612-872-7400

Moorhead Concordia College

Jean Bokinskie, 218-299-3893

Missouri

Kansas City St. Luke's Hospital

Nancy Wagner, 816-932-3504

St. Louis International Parish Nurse Resource

Center, Spring and Fall Classes 314-918-2559

St. Louis (On-line with Nebraska Methodist

College) International Parish Nurse Resource

Center, Barbara Wehling, 314-918-2591

St. Louis (On-line) St. Louis University School

of Nursing, Sally Lehnert, 314-977-8919

Springfield St. John's Hospital

Mary Hansen, 417-820-2770

Montana

Helena Carroll College, The Parish Nurse

Center, Cynthia Gustafson, 406-447-4367

Nebraska

Omaha Alegent Health, Ronnette Sailors,

402-898-8350

Omaha (On-line with IPNRC) Nebraska Methodist

College, Susan Ward, 402-354-7063

New York

Buffalo Catholic Charities, 716-856-4494 ext.

3003

Buffalo/East Aurora Trocaire College & PN

Ministries of New York, Ann Marie MacIsaac,

716-566-1163

Troy Seton Health--St. Mary's Hospital

Angela Sheehan, 518-268-6062

North Carolina

Asheville (On-line) Supplemental Modules

Hospice Care Corp., Spring, Summer & Fall

Semesters, Robin Shepherd, 304-376-0546

Boiling Springs Gardner-Webb University

Shirley Toney, 704-406-4366 ext. 4360

Charlotte Queens University of Charlotte

Joan McGill, 704-337-2295

North Dakota

Fargo Concordia College, Parish Nurse

Center, May 5-9, 2008

Jean Bokinskie, 218-299-3893

Ohio

Cedarville Cedarville University, May 18-23,

2008, Judi Shrubsole, 937-766-7725

Kettering Kettering Health Network, Chris Van-Denburgh,

937-395-8021

Norwalk Congregational Nurse Project of NW

Ohio, Sept. 30, Oct. 7, 14, 21, 28, 2008.

Mary Jane Fulcher, 419-262-1462

Rocky River Fairview Hospital Wellness Center,

May 29-30, June 5-6, and 19-20, 2008.

Gayle Donahue, 216-476-7324

Toledo Congregational Nurse Project of NW

Ohio, Oct. 7, 14, 21, 28 & Nov. 4, 2008

Mary Jane Fulcher, 419-262-1462

Oklahoma

Guthrie Catholic Charities, May 15-17 & June

5-7, 2008, Marilyn Seiler, 405-523-3006

Guymon Catholic Charities, March 13-15, April

17-19, Marilyn Seiler, 405-523-3006

Oklahoma City Catholic Charities

Marilyn Seiler, 405-523-3006

Oregon

Albany Northwest Parish Nurse Ministries

Linn-Benton Community College

Rachel Hagfeldt, 541-812-4701

Portland Northwest Parish Nurse Ministries

Concordia University, June 9-14, 2008

Debbie Waring, 503-413-2341

Pennsylvania

Lewisburg Diakon Lutheran Social Ministries,

Debbie Best, 570-320-0520

Pittsburgh Mercy Parish/Congregational Nurse

& Health Ministry Program, June 15-21, 2008

Joyce Schumm, 412-232-5815

South Carolina

Charleston Medical University of S. Carolina,

College of Nursing, Parish Nurse Program

Ann Hollerbach, 843-792-4624

South Dakota

Mitchell, SD (On-line) Dakota Wesleyan

University, Gloria Thompson, 605-995-2889

Sioux Falls Augustana College, June 16-20,

2008, Mary Auterman, 605-274-4929

Tennessee

Newport Tennessee Wesleyan College

Lisa Kirkland or Gail Lambert, 865-777-5100

Texas

Abilene Rural Nurse Resource, Inc., St. Paul

United Methodist Church, April 30-May 3, 2008

Sharon Hinton, 806-983-8096

Austin Evangelical Free Church of America

Paula Lilja, 281-532-3060

Beaumont Memorial Hermann Baptist Hospital

Rebekah Seymour, 409-212-5648

Dallas/Fort Worth Dallas/Fort Worth Faith and

Health Collaborative, Debbie Sieder,

214-947-2476

San Antonio University of the Incarnate Word

Jean Deliganis, 210-224-7122

Slaton MHW Nursing Consultation and Health

Ministry of NW Texas, Mercy Center

Margaret Hiett Williams, 432-270-2144

Virginia

Harrisonburg (On-line) Eastern Mennonite

University, Tammy Kiser, 540-879-2638

Lowesville Women's Missionary Union of

Virginia, Rachel Cobb, 804-915-5000

Roanoke Jefferson College of Health Sciences

Linda Rickabaugh, 540-985-8297

Winchester Shenandoah University

540-665-5505

Washington

Bellingham Puget Sound Health Ministries, St.

Joseph Hospital, Donna Gustin, 360-715-6408

Seattle Puget Sound Health Ministries, Seattle

Pacific University, July 13-16, July 21-23, 2008

Emily Hitchens, 206-281-2964 (option 2)

Tacoma NW Parish Nurse Ministries, Pacific

Lutheran University, April 22-24, May 21-22,

2008, Terry Bennett, 253-535-7683

West Virginia

Arthurdale (On-line) Hospice Care Corp/West

Virginia Univ., Robin Shepherd, 304-864-0884

Wheeling Wheeling Jesuit University, Alma

Cunningham, 888-434-6237 ext. 369

Wisconsin

LaCrosse Viterbo University, PN Ministry Center,

Silvana Richardson, 608-796-3670

Madison, Edgewood College

Karen Stremihis, 608-663-2270

Milwaukee, Marquette University & Covenant

Healthcare, Patrice Olin, 414-550-8519

Wyoming

Cheyenne Wyoming Health Council with the

Parish Nurse Center, Carroll College, Helena,

MT, Call Carol Peterson, 307-632-3640

Canada

Toronto, Ontario (and other sites)

InterChurch Health Ministries

Location: Emmanuel College

Karen Marks, 416-225-7231

Coordinator's Preparation

Fort Myers, FL

Lee Memorial Health System, Parish Nurse

Program, Rita Horvath, 239-336-6721

St. Louis, MO

International Parish Nurse Resource Center,

314-918-2559

Portland, OR

Northwest PN Ministries, University of Portland

Debbie Waring, 503-413-2341

Winchester, VA

Shenandoah University, Oct. 8-12, 2008

Parish nurse classes sponsored by our educational partners.(Calendar) - Parish Nurse Perspectives

United States, By State

Alabama

Mobile (On-line), Spring Hill College of Nursing, Aug. 25-Nov. 14, 2008, Carol Harrison, 251-380-4492

Alaska

Anchorage Northwest Parish Nurse Ministries at Providence Alaska Medical Center Linda Shepard, 907-261-5053

Arizona

Scottsdale Beatitudes Center DOAR Nurse and Health Ministries Network Barbara Sage, 602-274-5022

California

Fullerton Evangelical Free Church of America, Paula Lilja, 281-532-3060

Oakland Samuel Merritt College Joan Bard, 510-869-6511

Delaware

Newark Christiana Care Health System Community Health Outreach and Education, LaVaida Owens-White, 302-765-4557

Florida

Boca Raton (On-line) 8/23-12/12, Florida Atlantic University, Susan Dyess, 561-297-3236

Orlando Florida Hospital Parish Nurse Inst., Oct. 17-24, Candace Huber, 407-303-7153

Tampa Baycare Health Systems, April 20-24, October 12-16, 2009, Barbara Mosser, 813310-7725

Venice Lee Memorial Health System Rita Horvath, 239-432-3182

Georgia

Atlanta Gwinnett Hospital System Linda Hughes, 678-312-2423

Hawaii

Kailua Castle Medical Center Sue Pignataro, 808-263-0136

Idaho

Boise St. Alphonsus Regional Medical Center November 6-9, 2008 Sr. Mary Alice Quintana, 208-367-6494

Illinois

Oak Brook Lewis University, Oct. 21, 28, Nov. 4, 11, 18, 2008 OR May 4-8, 2009. Janice Smith, 630-752-0776

Quincy Blessing-Rieman College of Nursing Sheila Capp, 217-228-5520

Rock Island Trinity Medical Center Pamela Griffith, 309-779-5120

Springfield St. John's Hospital Kathleen Cross, 217-757-6620

Iowa

Bettendorf Genesis VNA and Hospice, Sept. 12, 13, 26, 27, and Oct. 11, 2008. Cinda Hathaway, 563-421-2423.

Indiana

Evansville (On-line) USI School of Nursing, Sept. 22-Nov. 3, Victoria Pigott, 877-874-4584

Ferdinand USI School of Nursing, Sept. 24-28 Peggy Graul, 800-467-8600

West Lafayette Greater Lafayette PN Development Center, Oct. 17, 18, Nov. 7, 8, 15, 2008 Susan Buchanan, 765-477-6150

Indianapolis Clarian Health Partners Congregational Health Ministries Cyndi Alte, 317-962-9330

Morgantown National Episcopal Health Ministries, Diane Beyer, 317-253-1277

Valparaiso Valparaiso University Janelle Fleck, 219-464-5289

Kansas

Wichita Spiritual Life Center, Kansas Parish Nurse Ministry, July 13-19, 2008 JoVeta Wescott, 316-686-0111

Kentucky

Crab Orchard Ephraim McDowell Regional Medical Center, Aug. 22, 23, Sept. 19, 20, 2008. Terry Casey 859-239-1619

Paducah Lourdes & Western Baptist Hospitals Carol Bradford, 270-217-9949

Louisiana

Monroe (On-line) University of Louisiana at Monroe School of Nursing. Linda E. Sabin, 318-342-1517

New Orleans McFarland Institute Congregational Wellness Program Rebecca Harris-Smith, 504-593-2320

Maine

Biddeford St. Joseph's Hospital Pamela Deres, 603-225-4888

Massachusetts

Fall River Saint Anne's Hospital, Congregational Health Ministry PN Program (14 classes) Kathleen Emerson, 508-674-5600, ext. 2064

Maryland

Baltimore Lutheran Intercity Network Coalition Nov. 13, 20, Dec. 4, 11, 13, 2008. Diane Kretzschmar, 443-777-7931

Buckeystown National Episcopal Health Ministries. Oct. 5-10. Diane Beyer, 317-253-1277

Takoma Park Columbia Union College Bernice DeShay, 301-891-4157

Michigan

Clinton Township Henry Ford Macomb Hospital, Mary Ann Stockwell, 586-263-2117

Grand Rapids Calvin College College of Nursing, Sept. 19-20, Oct. 17-18, Nov. 14-15, 2008, Bethany Gordon, 616-526-7076

Kalamazoo Borgess Health Paula White, 269-343-1396

Minnesota

Alexandria Concordia College, PN Center, Oct. 27-31, Jean Bokinskie, 218-299-3893.

Minneapolis United Theological Seminary, Vicki Gustafson, 612-872-7400

St. Paul Concordia College, PN Center, Mar. 913, 2009, Jean Bokinskie, 218-299-3893

Missouri

Kansas City St. Luke's Hospital, Sept. 3, 10, Dec. 18, Nancy Wagner, 816-932-3504

Kirksville Missouri School for Religion, IPNRC. Oct. 14-18, Krystal Jacobs, 573-635-1187.

St. Louis IPNRC, Nov. 3-7, 2008 or Apr. 27-May 1, 2009. Maureen Daniels, 314-918-2559

St. Louis (On-line with Nebraska Methodist College) International Parish Nurse Resource Center, Barbara Wehling, 314-918-2591

St. Louis (On-line) St. Louis University School of Nursing, Sally Lehnert, 314-977-8919

Springfield St. John's Hospital Mary Hansen, 417-820-2770

Montana

Helena Carroll College, The Parish Nurse Center, Cynthia Gustafson, 406-447-4367

Nebraska

Omaha Alegent Health, Ronnette Sailors, 402-898-8350

Omaha (On-line with IPNRC) Nebraska Methodist College, Sept. 29-Dec. 1, Susan Ward, 402-354-7063

New York

Buffalo Catholic Charities, 716-856-4494 ext. 3003

Buffalo/East Aurora Trocaire College & PN Ministries of New York, Ann Marie MacIsaac, 716-566-1163

Troy Seton Health--St. Mary's Hospital Angela Sheehan, 518-268-6062

North Carolina

Asheville (On-line) Supplemental Modules Hospice Care Corp., Spring, Summer & Fall Semesters, Robin Shepherd, 304-376-0546

Boiling Springs Gardner-Webb University Shirley Toney, 704-406-4366 ext. 4360

Charlotte Queens University of Charlotte, Sept. 6, 20, Oct. 4, 18, Nov. 1, 15, 2008 Joan McGill, 704-337-2295

North Dakota

Fargo Concordia College, Parish Nurse Center, Jean Bokinskie, 218-299-3893

Ohio

Cedarville Cedarville University, Judi Shrubsole, 937-766-7725

Kettering Kettering Health Network, Chris Van-Denburgh, 937-395-8021

Norwalk Congregational Nurse Project of NW Ohio, Sept. 30, Oct. 7, 14, 21, 28, 2008. Mary Jane Fulcher, 419-262-1462

Rocky River Fairview Hospital Wellness Center, Gayle Donahue, 216-476-7324

Toledo Congregational Nurse Project of NW Ohio, Sept. 30, Oct. 7, 14, 21, 28, 2008 Mary Jane Fulcher, 419-262-1462

Oklahoma

Broken Arrow Catholic Charities, Sept. 18-20, Oct. 2-4, Marilyn Seiler, 405-523-3006

Oklahoma City Catholic Charities, Jan. 15, 16, 17, 29, 30, 31 OR May 14-16, June 4, 2009 Marilyn Seiler, 405-523-3006

Oregon

Albany Northwest Parish Nurse Ministries Linn-Benton Community College Rachel Hagfeldt, 541-812-4701

Portland Northwest Parish Nurse Ministries Debbie Waring, 503-413-2341

Pennsylvania

Lewisburg Diakon Lutheran Social Ministries, Debbie Best, 570-320-0520

Pittsburgh Mercy Parish/Cngl. Nurse & Health Ministry, Joyce Schumm, 412-232-5815

South Carolina

Charleston Medical University of S. Carolina, College of Nursing, Parish Nurse Program Ann Hollerbach, 843-792-4624

South Dakota Mitchell, SD (On-line) Dakota Wesleyan University, Gloria Thompson, 605-995-2889

Sioux Falls Augustana College Mary Auterman, 605-274-4929

Tennessee

Newport Tennessee Wesleyan College, Oct. 23-26, 2008, Lisa Kirkland, 865-777-5113

Texas

Amarillo Rural Nurse Resource, July 24, 25, 31, and Aug. 1, Sharon Hinton, 806-983-8096

Beaumont Memorial Hermann Baptist Hospital Rebekah Seymour, 409-212-5648

Dallas Baylor University, Aug-October, 2008 Linda Garner, 214-820-4185.

Dallas/Fort Worth Dallas/Fort Worth Faith and Health Collaborative, Debbie Sieder, 214-947-2476

San Antonio University of the Incarnate Word Jean Deliganis, 210-224-7122

Slaton MHW Nursing Consultation and Health Ministry of NW Texas, Mercy Center Margaret Hiett Williams, 432-270-2144

Virginia

Glen Allen Bon Secours Richmond Heatlh System, Inc., Yolonda Thompson, 804-627-5565

Harrisonburg (On-line) Eastern Mennonite University, Tammy Kiser, 540-879-2638

Lowesville Women's Missionary Union of Virginia, Rachel Cobb, 804-915-5000

Roanoke Jefferson College of Health Sciences Linda Rickabaugh, 540-985-8297

Winchester Shenandoah University, Oct. 8-11, 2008, Martha Erbach, 540-665-5505

Washington

Bellingham Puget Sound Health Ministries, St. Joseph Hospital, Donna Gustin, 360-715-6408

Seattle Puget Sound Health Ministries, Seattle Pacific University, July 13-16, July 21-23, 2008 Emily Hitchens, 206-281-2964 (option 2)

Tacoma NW Parish Nurse Ministries, Pacific Lutheran University, Terry Bennett, 253-535-7683

West Virginia

Arthurdale (On-line) Hospice Care Corp/West Virginia Univ., Robin Shepherd, 304-864-0884

Wheeling Wheeling Jesuit University, Alma Cunningham, 888-434-6237 ext. 369

Wisconsin

LaCrosse Viterbo University, PN Ministry Center, Oct. 26, 27, 28, and 29, 2008 OR April 3, 4, 17, 18, 24, and 25, 2009, Silvana Richardson, 608-796-3670

Madison, Edgewood College Karen Stremihis, 608-663-2270

Milwaukee, Marquette University & Covenant Healthcare, Patrice Olin, 414-550-8519

Wyoming

Cheyenne Wyoming Health Council with the Parish Nurse Center, Carroll College, Helena, MT, Call Carol Peterson, 307-632-3640

Canada

Toronto, Ontario (and other sites) InterChurch Health Ministries Location: Emmanuel College Oct. 18, 25, Nov. 1, 8, 15, 22, 2008 Karen Marks, 416-225-7231

Coordinator's Preparation

Fort Myers, FL

Lee Memorial Health System, Parish Nurse Program, Rita Horvath, 239-336-6721

St. Louis, MO

International Parish Nurse Resource Center, March 10-13, 2009, 314-918-2559

Portland, OR

Northwest PN Ministries, University of Portland Debbie Waring, 503-413-2341

Winchester, VA

PEOPLE.(Executive and administrative hirings in the health care industry) - Modern Healthcare

Presidents, CEOs

* Scott Beacham has been named president of the Utica-Watertown division at Excellus Health Plan, Syracuse, N.Y. He will continue as president of the Central New York division.

Administrators

* Robert Krenitsky has been named chief administrative officer of Blue Cross and Blue Shield of Central New York, Syracuse. He will continue as vice president of information technology.

* Scott Ziskin has been named administrator and executive vice president of Jewish Nursing Home of Western Massachusetts, Longmeadow. He had been administrator of Salmon Brook Center, Glastonbury, Conn.

CFOs, CIOs, COOs

* Nancy Hellyer has been named executive vice president and chief operations officer of Alexian Brothers Medical Center, Elk Grove Village, Ill. She had been president and chief executive officer of LaGrange (Ill.) Memorial Hospital.

* David Yeager has been named chief financial officer at Saint Joseph Hospital, Omaha, Neb. He had been regional director of finance for Orange County at Tenet HealthSystems, San Diego.

VPs, associates, assistants

* David Budke has been named senior vice president of operations at Physicians Surgical Care, Houston. He had been senior vice president at Mariner Post-Acute Network, Houston.

* Robert Bycer has been named vice president of medical group administration at Fletcher Allen Health Care, Burlington, Vt. He had been chief operating officer of Medical Faculty Associates at George Washington University Medical Center, Washington.

* Rick Faulise has been named senior vice president of claims operations at Physicians Health Services, Shelton, Conn. He had been vice president of claims management.

* Kathy Longworth-Gentry has been named senior vice president of customer service and the provider call unit at Physicians Health Services, Shelton, Conn. She had been senior vice president of commercial customer service at First Union National Bank, Charlotte, N.C.

* Dawn Sorenson has been named vice president of value management and education at Methodist Hospitals of Dallas. She had been manager of management and leadership development at North Memorial Health Care, Robbinsdale, Minn.

* Nancy Whitelaw has been named vice president of research and demonstrations at the National Council on the Aging, Washington. She had been program director at the Center for Health Services Research at Henry Ford Health System, Detroit.

Kids missing out on sleep face serious health risks. - Omaha World-Herald (Omaha, NE)

Byline: Julie Anderson

Mar. 11--If you snooze, you don't lose -- especially if you're a kid.

Kids need their sleep. Sleep deprivation can affect children's overall health, school performance and behavior.

To help meet a growing demand, Children's Hospital is expanding its sleep-related services, a move that will include construction of a freestanding sleep center by the end of 2007. The hospital also will double, from two to four, the number of beds for sleep studies used to diagnose sleep disorders.

The move coincides with expansions of sleep study capacity at a number of hospitals in the Omaha and Lincoln areas, driven by a growing awareness of sleep disorders and the problems they can cause.

Many children, according to the National Sleep Foundation, aren't getting required amounts of nightly sleep.

Dr. Hari Bandla, director of the Children's sleep disorders program, said parents may not be aware of how much sleep kids need. A variety of social and cultural factors -- from too much late-night computer and cell phone time to early school start times -- also may keep them from getting it.

Sleep deprivation is more common among teenagers than in preschool children, he said. As they enter puberty, their biological sleep patterns shift toward later times for sleeping and waking.

Most often, children can make up for lost sleep on weekends. But if they're involved in a lot of activities, they may not get that chance. Sleep deprivation also can make teens vulnerable to accidents, namely by falling asleep behind the wheel.

'Everyone should be aware of these things because it's really a public health problem,' said Bandla, who joined Children's in January. He is one of a few pediatric board certified sleep specialists in the United States.

Bandla recommended that parents set limits for teens when it comes to computers and other electronic gadgets and that gadgets be kept out of bedrooms. Computer time should be kept to early evening because exposure to the light from the computer screen inhibits onset of sleep.

Parents also should make sure kids don't overload with activities on weekends so they have time to catch up on sleep, he said. One to two hours of extra sleep a day is best on weekends. More than four can compromise nighttime sleep during the week.

Sleep disturbances, he said, typically can be classified as behavioral or medical. Behavioral sleep problems are more common among the preschool set, from ages 1 to 5, and typically can be addressed by adjusting sleep routines and behaviors.

The medical category includes sleep apnea. Tissues of the upper airway relax and block the airway. The sleeper rouses, begins breathing again and drifts back to sleep.

In adults as well as children, the condition can have serious health consequences, including cardiovascular disease. In very young children, it can lead to a failure to gain weight.

In children, the most common cause of snoring and sleep apnea is enlarged tonsils and adenoids, Bandla said. Nearly 10 percent of children snore. Of those, about 2 percent have sleep apnea. But just as the condition is linked to obesity in adults, that connection also is increasingly showing up in children.

In addition to more sleep study beds, the hospital's expansion of sleep services will include assembling a team that includes an ear, nose and throat specialist; nutritionists; and home health care services. That approach also will help with the treatment of children with developmental disabilities, who have a high prevalence of sleep disorders.

Other area hospitals have increased their sleep services. Alegent Health has 22 beds at four hospitals, up from 10 beds at two hospitals in 2005 and sees patients as young as 5. BryanLGH Medical Center West in Lincoln, which also sees children, has increased from six to 11 beds.

Creighton University Medical Center has doubled its beds from two to four. Methodist Health System is planning to go from two beds to six, and the Nebraska Medical Center has four beds.

Copyright (c) 2007, Omaha World-Herald, Neb.

Distributed by McClatchy-Tribune Business

News.

Contracts Update.(Contracts of health care information technology companies) - Health Data Management

The Contracts Update section includes announcements of contracts that health care information technology companies have signed with customers in recent weeks. Contract news can be sent to Health Data Management by electronic mail to: rebecca.kelly-schuerenbergsourcemedia.com.

A4Health Systems

Emergency department information system

Athens (Ga.) Regional Medical Center

Allscripts Healthcare Solutions

Electronic medical records system

University Physicians Healthcare, Tucson, Ariz.

Amicore Inc.

Electronic medical records system

Waterbury (Conn.) Health Access Program

Captiva Software Corp.

Document capture software

Lahey Clinic Medical Center, Burlington, Mass.

Companion Technologies

Claims software

Concho County Hospital, Eden, Texas

North Runnels Hospital, Winter, Texas

COPAN Systems

Disaster recovery system

Baptist Memorial Health Care, Memphis, Tenn.

Courian Corp.

Identity management software

The Health Alliance of Greater Cincinnati

Craneware Inc.

Revenue cycle software

VHA Inc., Irving, Texas

DeJarnette Research Systems Inc.

Medical imaging interface software

Inova Fairfax Hospital, Falls Church, Va.

Morristown (N.J.) Memorial Hospital

Eclipsys Corp.

Clinical information system

Community General Hospital, Syracuse, N.Y.

New York Hospital Queens, Flushing, N.Y.

EMC Corp.

Network storage technology

Providence (Ore.) Health System

FormFast Inc.

Document automation software

Baptist Memorial Healthcare System, Memphis, Tenn.

Hays (Kan.) Regional Medical Center

Memorial Medical Center of Las Cruces, N.M.

Northfield (Minn.) Hospital

Physicians Hospital, El Paso, Texas

Rochester (N.Y.) General Hospital

Galvanon Inc.

Patient self-service kiosks

University of Pittsburgh Medical

Center

Health Care Software Inc.

Health care information system

Gulf States Health Services Inc., New Orleans

IDX Systems Corp.

Health care information system

PeaceHealth, Bellevue, Wash.

Stanford (Calif.) Hospital & Clinics

IM-Age Software Inc.

Security software

The Methodist Hospital System, Houston

Kryptiq Corp.

Clinical messaging technology

Inland Northwest Health Services, Spokane, Wash.

McKesson Corp.

Health care information system

WestCare Health System, Sylva, N.C.

MEDai Inc.

Cost prediction software

State of Florida Agency for Health Care

Administration, Tallahassee

Medical Present Value Inc.

Contract modeling system

Cedar Valley Medical Specialists, Waterloo, Iowa

UCI University Physicians & Surgeons, Irvine, Calif.

UConn Medical Group, Hartford

Mediware Information Systems

Transfusion information system

Yale-New Haven (Conn.) Hospital

MedSeek

Web-based consumer portal technology

Martin's Point Health Care, Portland, Maine

Mary Greeley Medical Center, Ames, Iowa

Parkview (Ind.) Health System

Russell Medical Center, Alexander City, Ala.

St. Vincent's Catholic Medical Center, Jamaica, N.Y.

Virginia Mason Medical Center, Seattle

Misys Healthcare Systems

Home care information system

Metropolitan Jewish Health System, Brooklyn, N.Y.

Laboratory information systems

University of South Alabama Health System, Mobile

Nightingale Informatix Corp.

Practice management and electronic medical records systems

Mount Sinai Hospital, Toronto

Optio Software

Medical records automation software

Wray (Colo.) Community Hospital

Picis

Perioperative information system

University of Texas M.D. Anderson Cancer Center, Houston

Plexis Healthcare Systems Inc.

Claims administration software

Clear Choice Health Plans, Bend, Ore.

Weyco Inc., Okemos, Mich.

Premier Healthcare Informatics

Performance improvement software

Spectrum Health System, Grand Rapids, Mich.

Provation Medical Inc.

Documentation and coding compliance software

Trinity Mother Frances Health System, Tyler, Texas

QuadraMed Corp.

Pharmacy information system

St. Claire Regional Medical Center, Morehead, Ky.

Quest Diagnostics Inc.

Electronic medical records system

The Health Alliance of Greater Cincinnati

Radiologix Inc.

Integrated radiology information system and picture archiving and communication system

Ide Imaging Partners, Rochester, N.Y.

Mid Rockland Imaging Partners, New City, N.Y.

RelayHealth Corp.

Web-based doctor-patient communication services

Hill Physicians Medical Group, San Ramon, Calif.

Research Triangle Software

E-mail application

Lahey Clinic, Burlington, Mass.

Secure Computing Corp.

Security software

Kindred Healthcare Inc., Louisville, Ky.

Surgical Information Systems

Surgical information system

Medcenter One, Bismarck, N.D.

Talisma Corp.

Customer relationship management system

Midlands Choice, Omaha, Neb.

TheraDoc Inc.

Clinical decision support software

VA Salt Lake City Healthcare System

VIASANT

Service request management system

Northwestern Memorial Hospital, Chicago

VISICU Inc.

Intensive care unit monitoring software

MaineHealth, Portland

XactiMed

Revenue cycle software

Jefferson Health System Inc., Radnor, Pa.

Montgomery Hospital Medical Center, Norristown, Pa.

Zix Corp.

Secure e-mail services

Charlotte (N.C.) Radiology

Langlade Memorial Hospital, Antigo, Wis.

Northeast Georgia Health System, Gainesville

Zynx Health Inc.

Evidence-based medical content

MemorialCare Health System, Aneheim, Calif.

Salem (Ore.) Hospital Regional Health Services

Contracts Update.(signed by health care information technology companies with customers) - Health Data Management

The Contracts Update section includes announcements of contracts that health care information technology companies have signed with customers in recent weeks. Contract news can be sent to Health Data Management by e-mail to: rebecca.kelly-schuerenbergsourcemedia.com

Agfa

Clinical nursing module application

Sampson Regional Medical Center,

Clinton, N.C.

Api Software Inc.

Payroll and staffing systems

Evergreen Healthcare, Kirkland, Wash.

Arrendale Associates Inc.

Integrated dictation system

Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

Brocade

Storage area network technology

New York-Presbyterian Hospital

Carefx Corp.

Single-sign-on software

Alegent Health, Omaha, Neb.

Inova Health System, Falls Church, Va.

CPU Medical Management Systems Inc.

Practice management software

MAG Mutual Healthcare Solutions Inc.,

Atlanta

eClinicalWorks

Integrated electronic medical records/ practice management system

Community Care Network of Virginia Inc., Alexandria

Eclipsys Corp.

Clinical information system

SUNY Downstate Medical Center's

University Hospital of Brooklyn, N.Y.

EHealth Global

Technologies Inc.

Medical records and imaging collection services

Penn State Milton Hershey (Pa.) Medical Center

Encentuate

Single-sign-on software

Children's Hospital Boston

First Consulting Group

I.T. outsourcing services

New York Blood Center

First DataBank

Medication database software

Beth Israel Deaconess Medical Center, Boston

Freedom Profit Recovery Inc.

Document output services

INTEGRIS Health, Oklahoma City

Henry Schein Medical Systems

Electronic medical records software

Ohio Valley Surgeons, St. Clairsville, Ohio

Sport Medicine and Rehabilitation, Forest Hills, N.Y.

Integrated practice management and electronic medical records software

Beaver (Pa.) Valley Urology

HTP Inc.

Administrative and clinical data exchange software

HealthLink RHIO, Dayton, Ohio

iDashboards

Data visualization software

Affinity Health System, Menasha, Wis.

Initiate Systems Inc.

Master patient index software

Providence (Ore.) Health System

InteGreat

Electronic medical records system

Great Falls (Mont.) Clinic

InterSystems Corp.

Integration software

Long Island (N.Y.) Patient Information eXchange

Pathology Medical Services and Nebraska LabLinc, Lincoln

JJWild

Disaster system implementation and services

Huntington Hospital, Pasadena, Calif.

Keane Inc.

Revenue cycle management system

NorthBay Healthcare, Fairfield, N.C.

Kryptiq Corp.

Contract management software

Regence, Portland, Ore.

Language Access Network Inc.

Video interpretation services

Mercy Hospital, Miami

LingoLogix

Coding and translation software

Johns Hopkins Health System Corp., Baltimore

McKesson Corp.

Home care information system

Intermountain Healthcare, Salt Lake City

Medical Present Value Inc.

Financial software

Conemaugh Health Initiatives, Johnstown, Pa.

Mediware Information Systems

Transfusion/donor blood management system

Arkansas Heart Hospital, Little Rock

Lennox Hill Hospital, New York

Louisiana Heart Hospital, Lacombe

Nassau (N.Y.) University Medical Center

Medsphere Systems Corp.

Electronic medical records system

Memorial Hospital of Sweetwater County, Rock Springs, Wyo.

Meru Networks

Wireless local area network technology

Sun Health, Phoenix, Ariz.

Microsoft Corp.

Integration software

New York-Presbyterian Hospital

Navicure

Revenue cycle management system

Methodist Medical Group, Peoria, Ill.

Orthocrat

Orthopedic surgical planning system

Fletcher Allen Health Care of

Burlington, Vt.

Picis Inc.

Emergency department information system

Saints Memorial Medical Center,

Lowell, Mass.

Surgical department information system

Burdette Tomlin Memorial Hospital,

Cape May Court House, N.J.

Radianse Inc.

Radio frequency identification-based tracking software

Providence Health Center, Waco, Texas

SDS

Medical records conversion services

Bon Secours Richmond (Va.) Health System

ShiftWise

Staffing technology

Resurrection Health Care, Chicago

SRS Software Inc.

Chart management software

OrthoMaryland, Baltimore

Wellogic

Health care information exchange systems

AtlantiCare, Atlantic City, N.J.

Wyngate Technologies

Transfusion management system

Caldwell Memorial Hospital, Lenoir, N.C.*

ECRI Institute Announces Winner of Third Annual Health Devices Achievement Award - US Fed News Service, Including US State News

The Emergency Care Research Institute issued the following news release:

ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, has granted Children's Hospital of Omaha in Omaha, Nebraska the third annual Health Devices Achievement Award for excellence in health technology management. The Health Devices Achievement Award recognizes an outstanding initiative undertaken by an ECRI Institute member healthcare facility that improves patient safety, reduces costs, or otherwise facilitates better strategic management of health technology.

The application submitted by Children's Hospital of Omaha, Nebraska, is a superb example of how steadfast commitment to improving operational performance can lead to enhanced procedures and patient care. The application, 'See-through' Process: Improving Effectiveness, Efficiency and Patient Safety Related to Chest and Abdominal x-rays in a Pediatric Intensive Care Unit, describes a priority improvement focus for the hospital that aimed to reduce unnecessary x-ray exposures and decrease errors in x-ray order entry. By implementing evidence-based indicators within their x-ray order process, Children's Hospital reduced the number of x-rays for pediatric patients, decreased order changes, and reduced radiology technician time spent on follow-up and modification--thereby streamlining and re-prioritizing the x-ray order process to enhance patient care.

This teaching institution's residents have also greatly benefitted from the initiative by receiving concrete direction when ordering radiology tests.

In judging this submission, ECRI Institute staff and members of the Health Devices Group's external advisory board were particularly impressed by the joint impact on patient safety and the efficiency of operations for the hospital's pediatric intensive care patients.

'One of the goals for this award is to give us a way to honor our member hospitals' commitment to technology management by achieving high standards of safety, quality, and cost-effectiveness in healthcare,' says James P. Keller, Jr., vice president, health technology evaluation and safety, ECRI Institute. 'This project helped to significantly decrease unnecessary x-rays in a patient population where it is so important to minimize radiation dose while allowing clinical staff to spend more time on the high-quality care patients need. Children's Hospital of Omaha should be commended for its fine work on this project.'

'We are absolutely thrilled to have been selected for this award,' said Mel Hall, performance improvement and patient safety manager, Children's Hospital, Omaha, Nebraska. 'The acknowledgment helps to underscore our continuous effort to improve patient care through our quality and safety initiatives. I am delighted that this project has improved internal processes and most importantly, the level of care we provide to our patients.'

The winner will be featured in ECRI Institute's Health Devices journal and on the ECRI Institute Web site. A formal presentation will also be made by ECRI Institute staff at Children's Hospital later this year.

This year's finalists are Beaumont Commercialization of Center Royal Oak, Michigan; Hamilton Health Sciences of Ontario, Canada; Memorial Sloane-Kettering Cancer Center of New York, New York; The Methodist Hospital System of Houston, Texas; and Virtua Health of Gibbsboro, New Jersey. To learn more about this year's finalists, visit www.ecri.org/Health_Devices_Finalists08.

ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research to healthcare to uncover the best approaches to improving patient care. As a pioneer in this science for 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. ECRI Institute is designated a Collaborating Center of the World Health Organization and an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality. For more information, please visit www.ecri.org.

About Children's Hospital of Omaha, Nebraska

Proudly serving children since 1948, Children's Hospital is the only full-service, pediatric health care center in Nebraska. Located in Omaha, it provides expertise in more than 30 pediatric specialty services to children and families across a five-state region and beyond. The 151-bed, non-profit hospital houses the only dedicated pediatric emergency department in the region and offers 24-hour, in-house services by pediatric critical care specialists. Children's Hospital has achieved the Magnet designation for nursing excellence and is an InfoWorld 100 award winner for innovation in information technology. A pediatric affiliation established between Children's Hospital and the University of Nebraska Medical Center (UNMC) College of Medicine supports enhancements in pediatric education, research and clinical care. Children's Hospital is also the primary teaching site for the family practice and joint pediatric residency programs at Creighton University and UNMC. For more information on Children's Hospital, visit www.ChildrensOmaha.org.

For more information, contact ECRI Institute by telephone at (610) 825-6000, ext. 5891; by e-mail at communications@ecri.org; by fax at (610) 834-1275; by mail at 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA; or by visiting www.ecri.org.Contact: Kristen Campbell, +1-610/825-6000, ext. 5377, kcampbell@ecri.org

TNS mv45-jf78-080905-1814656 18MASHJofrey

Parish nurse classes sponsored by our educational partners.(Directory) - Parish Nurse Perspectives

United States, By State

Alabama

Mobile (On-line), Spring Hill College of Nursing, Cathy Whelton, 251-633-1578

Alaska

Anchorage Northwest Parish Nurse Ministries at Providence Alaska Medical Center Linda Shepard, 907-261-5053

Arizona

Scottsdale Beatitudes Center DOAR Nurse and Health Ministries Network Barbara Sage, 602-274-5022

California

Burlingame Samuel Merritt University June 7-10, 2009, Joan Bard, 510-869-6511

Fullerton Evangelical Free Church of America, Paula Lilja, 281-532-3060

Florida

Boca Raton (On-line) Florida Atlantic University, Susan Dyess, 561-297-3236

Fort Myers Lee Memorial Health System, May 26-30 and June 1-3, 2009 Rita Horvath, 239-432-3182

Orlando Florida Hospital, Center for Community Health Ministry/Parish Nurse Institute, Oct. 16-23, 2009 Candace Huber, 407-303-7153

Tampa BayCare Health Systems, St. Joseph's Hospital, Oct. 12-16, 2009 Susie Prescott, 813-757-8006

Georgia

Atlanta Gwinnett Hospital System, June 14-19, 2009, Linda Hughes, 678-312-2423

Hawaii

Kailua Castle Medical Center Sue Pignataro, 808-263-0136

Idaho

Boise St. Alphonsus Regional Medical Center, Sr. Mary Alice Quintana, 208-367-6494

Illinois

Oak Brook Lewis University, May 4-8, 2009 Kathie Blanchfield, 708-448-9429

Rock Island Trinity Medical Center Pamela Griffith, 309-779-5120

Quincy Blessing-Rieman College of Nursing Sheila Capp, 217-228-5520

Springfield St. John's Hospital Kathleen Cross, 217-757-6620

Indiana

Evansville (On-line) USI School of Nursing, Victoria Pigott, 877-874-4584

Ferdinand USI School of Nursing Peggy Graul, 800-467-8600

Lafayette Greater Lafayette PN Development April 3, 4, 24, and 25, 2009 Susan Buchanan, 765-477-6150

Indianapolis Clarian Health Partners Cyndi Alte, 317-962-9330

Morgantown National Episcopal Health Ministries, Inc., Diane Beyer, 317-253-1277

Valparaiso Valparaiso University Janelle Fleck, 219-464-5289

Kansas

Wichita Spiritual Life Center, Kansas Parish Nurse Ministry, JoVeta Wescott, 316-686-0111

Kentucky Louisville(On-line) Bellarmine University Margaret Miller, 502-452-8413

Paducah Lourdes & Western Baptist Hospitals Carol Bradford, 270-217-9949

Louisiana

Monroe (On-line) University of Louisiana at Monroe School of Nursing. Linda E. Sabin, 318-342-1517

New Orleans McFarland Institute Congregational Wellness Program Rebecca Harris-Smith, 504-593-2320

Maine

Biddeford St. Joseph's Hospital Pamela Deres, 603-225-4888

Massachusetts

Fall River Saint Anne's Hospital, Congregational Health Ministry PN Program Kathleen Emerson, 508-674-5600, ext. 2064

Maryland

Baltimore Lutheran Intercity Network Coalition Diane Kretzschmar, 443-777-7931

Takoma Park Washington Adventist Hospital July 25-30, 2009, Katia Reinert, 301-891-6102

Michigan

Clinton Township Henry Ford Macomb Hospital, Mary Ann Stockwell, 586-263-2117

Grand Rapids Calvin College, Dept. of Nursing Bethany Gordon, 616-526-7076

Kalamazoo, MI Borgess Health, June 5-6, July 10-11, and August 14-15, 2009 Paula White, 269-343-1396

St. Joseph Kettering Health Network, Aug. 9-15, 2009, Chris VenDenburgh, 937-395-8021

Minnesota

Minneapolis United Theological Seminary, Vicki Gustafson, 612-872-7400

Moorhead Concordia College Jean Bokinskie, 218-299-3893

St. Paul Luther Seminary, Mar. 9-13, 2009 Jean Bokinskie, 218-399-3893

Missouri

Kansas City St. Luke's Hospital Nancy Wagner, 816-932-3504

Liberty Liberty Hospital, May 18-21, 2009 Joyce Bouyear, 816-792-7085

St. Louis International Parish Nurse Resource Center, April 27-May 1 OR Oct. 19-23, 2009 Maureen Daniels, 314-918-2632

St. Louis (On-line) St. Louis University School of Nursing, Sally Lehnert, 314-977-8919

Springfield St. John's Hospital Mary Hansen, 417-820-2770

Montana

Helena Carroll College, Parish Nurse Center, May 14-17, 2009 Cynthia Gustafson, 406-447-4367

Nebraska

Omaha Alegent Health, Ronnette Sailors, 402-898-8350

Omaha (On-line) Nebraska Methodist College, Susan Ward, 402-354-7063

New York

Buffalo Trocaire College, Parish Nurse Ministries of NY, Ann Marie MacIsaac 716-566-1163

Troy Seton Health-St. Mary's Hospital Angela Sheehan, 518-268-6062

Vestal Lourdes Hospice, April 23, 24, 25, & May 14, 16, and 23, 2009 Kathy Medovich, 607-321-2633

North Carolina

Asheville (On-line) Hospice Care Corp. Robin Shepherd, 304-376-0546

Boiling Springs Gardner-Webb University Shirley Toney, 704-406-4366 ext. 4360

Charlotte Queens University of Charlotte Joan McGill, 704-337-2295

Concord CMC Northeast, Parish Nursing & Health Ministry, May 12-16, 2009, Pam Hurley, 704-403-4009

North Dakota

Fargo Concordia College, Parish Nurse Center, May 18-22, 2009 Jean Bokinskie, 218-299-3893

Ohio

Cedarville Cedarville University Judi Shrubsole, 937-766-7725

Kettering Kettering Health Network, Chris VanDenburgh, 937-395-8021

Norwalk Congregational Nurse Project of NW Ohio, Mary Jane Fulcher, 419-262-1462

Rocky River Fairview Hospital Wellness Center, Gayle Donahue, 216-476-7324

Toledo Congregational Nurse Project of NW Ohio, Mary Jane Fulcher, 419-262-1462

Oklahoma

Oklahoma City Catholic Charities May 14-16, June 4-6, 2009 Marilyn Seiler, 405-523-3006

Oregon

Albany Northwest Parish Nurse Ministries Linn-Benton Community College Rachel Hagfeldt, 541-812-4701

Portland Northwest Parish Nurse Ministries Providence, St. Vincent Medical Center April 28, 29 and May 5-7, 2009 OR Concordia University, June 8-12, 2009 Debbie Waring, 503-413-2341

Pennsylvania

Immaculata Immaculata University, Sr. Paula Jameson, IHM, 610-647-4400

Lewisburg Diakon Lutheran Social Ministries April 4, May 2, June 6, Sept. 19, Oct. 3, Nov. 7, and Dec. 5, 2009 at Upper Susquahanna Synod, ELCA; OR Apr. 11, May 9, June 13, Sept. 12, Oct. 10, Nov. 14, Dec. 12, 2009, Highland Presbyterian Church, Debbie Best, 570-320-0520

Pittsburgh Mercy Parish/Congregational Nurse & Health Ministry Program, June 15-20, 2009 Joyce Schumm, 412-232-5815

South Carolina

Charleston Medical University of S. Carolina, College of Nursing, Parish Nurse Program, Ann Hollerbach, 843-792-4624

South Dakota

Mitchell, SD (On-line) Dakota Wesleyan University, Gloria Thompson, 605-995-2889

Sioux Falls Augustana College, June 15-19, 2009, Mary Auterman, 605-274-4929

Tennessee

Newport Tennessee Wesleyan College Lisa Kirkland or Gail Lambert, 865-777-5100

Texas

Abilene Rural Nurse Resource, Inc., St. Paul United Methodist Church Sharon Hinton, 806-983-8096

Austin Evangelical Free Church of America Paula Lilja, 281-532-3060

Beaumont Memorial Hermann Baptist Hospital, Rebekah Seymour, 409-212-5648

Dallas/Fort Worth Dallas/Fort Worth Faith and Health Collaborative, Debbie Sieder, 214-947-2476

Midland MHW Nursing Consultation and Health Ministry of NW Texas Margaret Williams, 432-270-2144

San Angelo MHW Nursing Consultation and Health Ministry of NW Texas, Apr. 5-8, 2009 Margaret Williams, 432-270-2144

San Antonio University of the Incarnate Word Jean Deliganis, 210-224-7122

Slaton MHW Nursing Consultation and Health Ministry of NW Texas, Mercy Center Margaret Hiett Williams, 432-270-2144

Virginia

Harrisonburg (On-line) Eastern Mennonite University, Tammy Kiser, 540-879-2638

Lowesville Women's Missionary Union of Virginia, Rachel Cobb, 804-915-5000

Roanoke Jefferson College of Health Sciences Linda Rickabaugh, 540-985-8297

Winchester Shenandoah University Vickie Morley, 540-535-3565

Washington

Bellingham, Donna Gustin, 360-305-1795

West Virginia

Arthurdale (On-line) Hospice Care Corp/West Virginia Univ., Robin Shepherd, 304-864-0884

Wheeling Wheeling Jesuit University, Alma Cunningham, 888-434-6237 ext. 369

Wisconsin

LaCrosse Viterbo University, Parish Nurse Ministry Center, Apr. 3-4, 17-18, 24-25, 2009 Silvana Richardson, 608-796-3670

Madison, Edgewood College Karen Stremihis, 608-663-2270

Milwaukee, Marquette University & Covenant Healthcare, Patrice Olin, 414-550-8519

Wyoming

Cheyenne Wyoming Health Council with the Parish Nurse Center, Carroll College, Helena, MT, Call Carol Peterson, 307-632-3640

Canada

Toronto, Ontario (and other sites) InterChurch Health Ministries, at Emmanuel College, Oct. 17, 24, 31, Nov. 7, 14, 21, 2009. Karen Marks, 416-225-7231

Coordinator's Preparation

Fort Myers, FL Lee Memorial Health System, Parish Nurse Program, Rita Horvath, 239-336-6721

St. Louis, MO International Parish Nurse Resource Center, 314-918-2559

Portland, OR Northwest PN Ministries, University of Portland Debbie Waring, 503-413-2341

PUBLICATION LISTS 'FRIENDLY' HOSPITALS.(NEWS) - The Cincinnati Post (Cincinnati, OH)

Byline: Associated Press

WINDBER, Pa. -- The smell of antiseptics, bright fluorescent lights and plain furnishings are hospital stereotypes that don't apply to Windber Medical Center.

Patients at this 102-bed hospital enjoy bedside lamps, original artwork, fresh flowers and aromatherapy, along with live entertainment, helpful workers and room service.

''They just spoil you here,'' said patient Mary McGuire, 79, of Johnstown.

Attention to detail - like fresh-baked bread and in-room massages - is earning national attention for the hospital about 65 miles southeast of Pittsburgh. The July/August issue of AARP's Modern Maturity magazine lists Windber Medical Center and 14 other institutions as America's most friendly hospitals.

''When I entered this field, I found that everywhere I looked, I asked, 'Why did they run it like that?' '' said Windber President F. Nicholas Jacobs, who became the head of the hospital four years ago. ''We wanted to create a place were you don't have to leave your dignity behind at the door.''

Windber Medical, an affiliate of the Conemaugh Health System, is a full-service hospital located in a town of 4,500 people. It has been the center of town and the biggest employer since it opened in 1906, when Windber was a coal-company town, said medical center spokeswoman Lesa Skotnicki.

Its hospice, health club, research institute and medical arts building attract patients from as far away as Baltimore. It even offers cooking, yoga and other classes.

Windber started out about four years ago to become a ''patient-centered'' hospital.

It started with liberalized visiting hours. Family members can visit as long as they want, and can bring the family dog. Patients also have full access to their charts and can wear their own pajamas, for example.

Windber became affiliated in 1998 with Planetree, a nonprofit organization that helps hospitals brainstorm new ways to provide and improve care.

Many of the hospitals on Modern Maturity magazine's ''most friendly'' list are Planetree affiliates, said Margaret Guroff, the magazine's features editor.

Each hospital on the list was selected for details that make patients feel more comfortable and empowered, Guroff said.

Text of fax box follows:

The top 15

AARP's Modern Maturity magazine featured the following institutions as ''Hospitals With Heart:''

Bergan Mercy Medical Center, Omaha, Neb.

Bronson Methodist Hospital, Kalamazoo, Mich.

Children's Hospital and Health Center, San Diego

Griffin Hospital, Derby, Conn.

Highline Community Hospital, Burien, Wash.

Barbara Ann Karmanos Cancer Institute, Detroit

Longmont United Hospital, Longmont, Colo.

Mid-Columbia Medical Center, The Dalles, Ore.

Midwestern Regional Medical Center, Zion, Ill.

North Hawaii Community Hospital, Kamuela, Hawaii.

St. Charles Medical Center, Bend, Ore.

Shawano Medical Center, Shawano, Wis.

Warren Memorial Hospital, Front Royal, Va.

Windber Medical Center, Windber, Pa.

Parish nurse classes sponsored by our educational partners. - Parish Nurse Perspectives

Eastern Time Zone

Jacksonville, FL

University of North Florida

Pam Marsden, 904-308-7558

Orlando, FL

Florida Hospital, Center of Health Ministry

March 16-23, 2007 OR Sept. 21-28, 2007

Candace Huber, 407-303-7153

Venice, FL

Lee Memorial Health System

May 20-25, 2007

Rita Horvath, 239-336-6721

Evansville, IN

Univ. of Southern Indiana School of Nursing

On-line starting March 12 or Sept. 24, 2007

Victoria Pigott, 812-465-1148

Indianapolis, IN

Clarian Health Partners

Pat Thorlton, 317-962-3412

Morgantown, IN

National Episcopal Health Ministries at

The Waycross Center

Diane Beyer, 317-253-1277, ext. 34

Valparaiso, IN

Valparaiso University

Janelle Fleck, 219-464-5289

Monroe, LA (Call for dates for on-line class)

University of Louisiana at Monroe School of

Nursing, March 2-3, April 13-14 & May 18-29

Linda E. Sabin, 318-342-1517

Fall River, MA

Saint Anne's Hospital

Sept-May 2007-2008 (2x month), Call

Kathleen Emerson, 508-674-5600, ext. 2064

Clinton Township, MI

St. Joseph's Healthcare FCN Network

March 2-3 and 23-24, 2007

Mary Ann Stockwell, 586-263-2117

Grand Rapids, MI

Calvin College, Dept. of Nursing

Bethany Gordon, 616-957-6012

Kalamazoo, MI

Bogress Health

June 22-23, July 20-21 and Aug. 10-11

Paula White, 269-343-1396

Saginaw, MI

Saginaw Valley State University

May 11, 18, and June 1, 2007

Vickie Jaskiewicz, 989-964-2732

Boiling Springs, NC

Gardner-Webb University

Shirley Toney, 704-406-4366 (4360)

Concord, NC

IPNRC, Northeast Medical Center

April 17-21, 2007

Pam Hurley, 704-783-4009

Buffalo, NY

July 14, 21, 28, Aug. 11, 18, 24-25, 2007

OR Sept. 8, 15, 22, Oct. 13, 20, 26-27, 2007

Catholic Charities.

Rosemary Walter, 716-856-4494, Ext. 3003

East Aurora, NY

Trocaire College and Parish Nurse Institute

of West New York

Ann Marie MacIssac, 716-566-1163

Latham, NY

Seton Health--St. Mary's Hospital

Fran Zoske, 518-268-6062

Charlotte, NC

Queens University of Charlotte

Joan McGill, 704-337-2295

Cleveland, OH

Fairview Hospital

Gayle Donahue, 216-476-7324

Toledo, OH

Congregational Nurse Project of NW Ohio

Mary Jane Fulcher, 419-262-1462

Aston, PA

IPNRC, Neuman College, June 4-9, 2007

Allison Jones, 610-358-4580

Pittsburgh, PA

Waynesburg College Dept. of Nursing

June 24-30, 2007

Joyce Schumm, 412-232-5815

Charleston, SC

Medical University of South Carolina, College of Nursing, Parish Nurse Program

Ann Hollerbach, 843-792-4624

Harrisonburg, VA

Eastern Mennonite University

May 7-June 15 (on-line)

Tammy Kiser, 540-746-6336

Lowesville, VA

Women's Missionary Union of Virginia

Rachel Cobb, 804-915-5000

Roanoke, VA

Jefferson College of Health Sciences

Linda Rickabaugh

540-985-8297

Winchester, VA

Shenandoah University

Martha Erbach

540-665-5505

Arthurdale, WV

Hospice Care Corp/West Virginia University

On-line classes, May 7-August 17, 2007

Robin Shepherd, 304-864-0884

Charleston, WV

Wheeling Jesuit University

May 17-20, 2007 and August 2-5, 2007

Alma Cunningham, 888-434-6237 x 369

Central Time Zone

Huntsville, AL

Huntsville Association for Pastoral Care

Melinda Lawson, 256-824-2462

Carbondale, IL

IPNRC at Southern Illinois Healthcare

March 1-3, 23-24, 2007

Yvonne Whitfield, 618-457-5200, ext. 67830

Oakbrook, IL

Lewis University College of Nursing

May 7-11, 2007 (9 am-5 pm)

Janice Smith, 630-752-0776

Quincy, IL

Blessing-Rieman College of Nursing

Carol Ann Moseley, (217) 223-8400

Rock Island, IL

Trinity Medical Center

Mary Slutz, 309-779-5122

Springfield, IL

St. John's Hospital

Brenda Heaton, 217-544-6464 ext. 47798

Urbana, IL

Community Parish Nurse Program, UIC College of Nursing

Faith Roberts

217-326-2683

Waterloo, IA

Allen College, On-line course

Anna Weepie, 319-226-2037

Wichita, KS

Newman University, Kansas PN Ministry

Feb. 23-24, Mar. 9-10, 23-25, 2007 OR

August 12-18, 2007

JoVeta Wescott

316-686-0111

Louisville, KY

Bellarmine University

March 3, April 14, 2007, remainder on-line

Margaret Miller, 502-452-8413

Paducah, KY

Lourdes & Western Baptist Hospitals

Mar. 12, 19, 26, 31, Apr. 2, 9, 16, 21, 2007

Carol Bradford, 270-217-1407

Duluth, MN

Concordia College, Parish Nurse Center

Jean Bokinskie, 218-299-3893

Minneapolis, MN

Concordia College, Parish Nurse Center

March 12-16, 2007

Jean Bokinskie, 218-299-3893

Minneapolis, MN

United Theological Seminary, Dates TBA

Vicki Gustafson, 612-872-7400

Kansas City, MO

St. Luke's Hospital and UMKC

Nancy Wagner, 816-935-3504

St. Louis, MO

International Parish Nurse Resource Center

March 26-30, 2007

Alvyne Rethemeyer, 314-918-2557

St. Louis, MO

St. Louis University School of Nursing

On-line course, Fall & Spring Semesters

Sally Lehnert, 314-977-8919

Springfield, MO

St. John's Hospital, March 2007 (eves/Sats)

Mary Hansen, 417-820-2770

Omaha, NE

Alegent Health

February 23-24, March 23-24, April 21, 2007

Ronette Sailors, 402-898-8350

Omaha, NE

Nebraska Methodist College

On-line course, call for next class

Susan Ward, 402-354-7063

Fargo, ND

Concordia College, Parish Nurse Center

April 23-27, 2007

Jean Bokinskie, 218-299-3893

Guthrie, OK

Oklahoma Parish Nurse Network, Catholic Charities

Andrea West, 405-364-8228

Sioux Falls, SD

Augustana College

June 18-22, 2007

Mary Auterman, 605-274-4929

Newport, TN

Tennessee Wesleyan College

Gail Lambert, 865-777-5104

Beaumont, TX

Memorial Hermann Baptist Hospital

Feb. 16-17, Feb. 23-25, 2007

Rebekah Seymour, 409-212-5648

Dallas, TX

Baylor University School of Nursing

Linda Garner, 214-820-4185

Flower Mound, TX

Dallas/Ft. Worth Faith & Health Collaborative

Debbie Seider, 214-947-2476

San Antonio, TX

University of the Incarnate Word

Jean Deliganis, 210-224-7122

Madison, WI

Edgewood College, Dates TBA

Karen Stremihis, 608-663-2270

Milwaukee, WI

Marquette Univ. & Covenant Healthcare

February 9, 10, 13, 20, 27 and

March 6, 13, 20, 27, 31, and

August 3-9, 2007

Patrice Olin, 414-550-8519

Mountain Time Zone--US

Scottsdale, AZ

Beatitudes Center DOAR Nurse & Health

Ministries Network

February 25-27 and March 25-27, 2007

Barbara Sage, 602-274-5022

Helena, MT

Carroll College, The Parish Nurse Center

Cynthia Gustafson, 406-447-4367

Pacific, Aleutian Time Zones

Anchorage, AK

Northwest Parish Nurse Ministries at

Providence Alaska Medical Center

Linda Shepard, 907-261-5053

Oakland, CA

Samuel Merritt College

July 13-16, 2007

Joan A. Bard, 510-869-8620

Kailua, HI

Puget Sound Parish Nurse and Health

Ministries, March 5-9, 2007

Sue Pignataro, 808-263-0136

Bend, OR

Northwest Parish Nurse Ministries

Central Oregon Community College

Lyn Bogie, 541-383-6861

Hillsboro, OR

Northwest PN Ministries, Portland

Community College, & Tuality Healthcare

Maria Michalczyk, 503-731-6627

Medford, OR

Puget Sound Parish Nurse and Health Ministries, May 14-20, 2007

Kathy Mahannah, 541-472-8235

Bellingham, WA

Puget Sound PN and Health Ministries

St. Joseph Hospital

Donna Gustin, 360-715-6408

Olympia, WA

Northwest Parish Nurse Ministries at Pacific

Lutheran University

Terry Bennett, 253-535-7683

Seattle, WA

Puget Sound Parish Nurse & Health

Ministries (at Seattle University)

Aileen MacLaren Loranger

206-363-1197

Canada

Toronto, Ontario (and other sites)

InterChurch Health Ministries

Location: Emmanuel College

Valerie Jenkins, 888-433-9422

Coordinator's Preparation

Fort Myers, FL

Lee Memorial Health System Parish Nurse

Program

Rita Horvath, 239-336-6721

St. Louis, MO

International Parish Nurse Resource Center

March 13-16, 2007

Alvyne Rethemeyer, 314-918-2557

Winchester, VA

Shenandoah University

Martha Erbach, 540-665-5505

Parish Nurse classes sponsored by our educational partners.(Directory) - Parish Nurse Perspectives

United States, By State

Anchorage, AK Northwest Parish Nurse Ministries at Providence Alaska Medical Center Linda Shepard, 907-261-5053

Mobile, AL Spring Hill College of Nursing August 20-November 9, 2007 Carol Harrison, 251-380-4492

Scottsdale, AZ Beatitudes Center DOAR Nurse & Health Ministries Network Barbara Sage, 602-274-5022

Oakland, CA Samuel Merritt College July 13-16, 2007 Joan A. Bard, 510-869-8620

Jacksonville, FL University of North Florida Pam Marsden, 904-308-7558

Orlando, FL Florida Hospital, Center of Health Ministry Sept. 21-28, 2007 Candace Huber, 407-303-7153

Venice, FL Lee Memorial Health System May 20-25, 2007 Rita Horvath, 239-336-6721

Atlanta, GA Gwinnett Medical Center and GA Baptist College of Nursing of Mercer University June 10-15, 2007 Linda Hughes, 678-442-2423

Waterloo, IA Allen College, On-line course Anna Weepie, 319-226-2037

Oak Brook, IL Lewis University College of Nursing Nov. 5, 12, 19, 26, Dec. 3, 2007 OR May 5-9, 2008 Kathie Blanchfield, 708-448-9429

Rock Island, IL Trinity Medical Center Mary Slutz, 309-779-5122

Evansville, IN Univ. of Southern Indiana School of Nursing On-line starting September 24, 2007 Victoria Pigott, 812-465-1148

Valparaiso, IN Valparaiso University Janelle Fleck, 219-464-5289

Wichita, KS Newman University, Kansas PN Ministry August 12-18, 2007 JoVeta Wescott 316-686-0111

Louisville, KY Bellarmine University March 3, April 14, 2007, remainder on-line Margaret Miller, 502-452-8413

Paducah, KY Lourdes & Western Baptist Hospitals Carol Bradford, 270-217-9949

Monroe, LA (Call for dates for on-line class) University of Louisiana at Monroe School of Nursing, Linda E. Sabin, 318-342-1517

New Orleans, LA, McFarland Institute Congregational Wellness Program June 22, 23, July 6, 7, 20 and 21, 2007 Rebecca Harris-Smith, 504-593-2320

Falls River, MA Saint Anne's Hospital Sept-May 2007-2008 (2x month) Kathleen Emerson, 508-674-5600, ext. 2064

Biddeford, ME St. Joseph's Hospital November 12-18, 2007 Pamela Deres, 603-225-4888

Grand Rapids, MI Calvin College, Dept. of Nursing Sept. 14-15, Oct. 19-20, Nov. 16-17, 2007 Bethany Gordon, 616-957-6012

Kalamazoo, MI Borgess Health June 22-23, July 20-21 and Aug. 10-11 Paula White, 269-343-1396

Saginaw, MI Saginaw Valley State University May 11, 18, and June 1, 2007 Vickie Jaskiewicz, 989-964-2732

Alexandria, MN with Concordia College October 29-November 2, 2007 Jean Bokinskie, 218-299-3893

Duluth, MN Concordia College, Parish Nurse Center Jean Bokinskie, 218-299-3893

Minneapolis, MN United Theological Seminary Vicki Gustafson, 612-872-7400

Kansas City, MO St. Luke's Hospital Nancy Wagner, 816-935-3504

St. Louis, MO International Parish Nurse Resource Center November 5-9, 2007 Alvyne Rethemeyer, 314-918-2557

St. Louis, MO St. Louis University School of Nursing On-line course, Fall & Spring Semesters Sally Lehnert, 314-977-8919

Sikeston, MO with IPNRC October 9-13, 2007 Krystal Jacobs, 573-635-1187

Springfield, MO St. John's Hospital Mary Hansen, 417-820-2770

Helena, MT Carroll College, The Parish Nurse Center Cynthia Gustafson, 406-447-4367 Omaha, NE

Alegent Health Oct. 5-6, Nov. 2-3, Dec. 1, 2007 Ronette Sailors, 402-898-8350

Omaha, NE Nebraska Methodist College On-line course starting January 14, 2008 Pam Mills, 402-354-7100

Buffalo, NY at Catholic Charities July 14, 21, 28, August 11, 18, 24-25, 2007 Sept. 8, 15, 22, Oct. 13, 20, 26-27, 2007 Rosemary Walter, 716-856-4494, Ext. 3003

East Aurora, NY Trocaire College and Parish Nurse Institute of West New York Ann Marie MacIssac, 716-566-1163

Troy, NY Seton Health--St. Mary's Hospital Fran Zoske, 518-268-6062

Boiling Springs, NC Gardner-Webb University Shirley Toney, 704-406-4366 (4360)

Charlotte, NC Queens University of Charlotte Joan McGill, 704-337-2295

Fargo, ND Concordia College, Parish Nurse Center Jean Bokinskie, 218-299-3893

Cleveland, OH Fairview Hospital Gayle Donahue, 216-476-7324

Toledo, OH Congregational Nurse Project of NW Ohio Mary Jane Fulcher, 419-262-1462

Guthrie, OK Oklahoma Parish Nurse Network, Catholic Charities Andrea West, 405-364-8228

Albany, OR Northwest Parish Nurse Ministries September 20-22, October 2, 2007 Rachel Hagfeldt, 541-812-4701

Hillsboro, OR Northwest Parish Nurse Ministries Tuality Healthcare October 18-19, and November 1-3, 2007 Debbie Waring, 503-413-2341

Medford, OR Asante Health System, May 14-20, 2007 Kathy Mahannah, 541-472-7235

Aston, PA IPNRC, Neuman College, June 4-9, 2007 Allison Jones, 610-358-4580

Pittsburgh, PA Waynesburg College Dept. of Nursing June 24-30, 2007 Joyce Schumm, 412-232-5815

Charleston, SC Medical University of South Carolina, College of Nursing, Parish Nurse Program Ann Hollerbach, 843-792-4624

Sioux Falls, SD Augustana College June 18-22, 2007 Mary Auterman, 605-274-4929

Newport, TN Tennessee Wesleyan College Gail Lambert, 865-777-5104

Beaumont, TX Memorial Hermann Baptist Hospital Feb. 1-2, 8-10, 2008 Rebekah Seymour, 409-212-5648

Dallas/Forth Worth, TX Dallas/Ft. Worth Faith & Health Collaborative June 17-22, 2007 Debbie Sieder, 214-947-2476

Flower Mound, TX Dallas/Ft. Worth Faith & Health Collaborative Debbie Seider, 214-947-2476

San Antonio, TX University of the Incarnate Word Jean Deliganis, 210-224-7122

Harrisonburg, VA Eastern Mennonite University May 7-June 15 (on-line) Tammy Kiser, 540-432-4186

Lowesville, VA Women's Missionary Union of Virginia Rachel Cobb, 804-915-5000

Roanoke, VA Jefferson College of Health Sciences Linda Rickabaugh 540-985-8297

Winchester, VA Shenandoah University Martha Erbach 540-665-5505

Bellingham, WA Puget Sound PN and Health Ministries St. Joseph Hospital Donna Gustin, 360-715-6408

Kirkland, WA Puget Sound Health Ministries July 8-15, 2007 Carol Story, 425-339-8034

Olympia, WA Northwest Parish Nurse Ministries at Pacific Lutheran University Terry Bennett, 253-535-7683

Seattle, WA Puget Sound Parish Nurse & Health Ministries (at Seattle University) Aileen MacLaren Loranger 206-363-1197

Arthurdale, WV Hospice Care Corp/West Virginia University On-line classes, May 7-August 17, 2007 Supplemental, May 21-August 10, 2007 Robin Shepherd, 304-864-0884

Charleston, WV Wheeling Jesuit University May 17-20, 2007 and August 2-5, 2007 Alma Cunningham, 888-434-6237 x 369

Madison, WI Edgewood College, Dates TBA Karen Stremihis, 608-663-2270

Milwaukee, WI Marquette Univ. & Covenant Healthcare August 3-9, 2007 Patrice Olin, 414-550-8519

Casper, WY (First United Methdoist Church) Carroll College, Parish Nurse Center May 14-17, 2007 Cynthia Gustafson, 406-447-5494

Canada

Toronto, Ontario (and other sites) InterChurch Health Ministries Location: Emmanuel College Karen Marks, 416-225-7231

Coordinator's Preparation

Fort Myers, FL Lee Memorial Health System Parish Nurse Program Rita Horvath, 239-336-6721

St. Louis, MO International Parish Nurse Resource Center Alvyne Rethemeyer, 314-918-2557

Portland, OR Northwest Parish Nurse Ministries at the University of Portland July 22-24, 2007 Debbie Waring, 503-413-2341

Winchester, VA Shenandoah University October 17-20, 2007 Martha Erbach, 540-665-5505

SMASH. (abolish the veterans hospitals) - The Washington Monthly

Don't fix those deadly veterans hospitals. Abolish them.

What was a nice former beauty queen doing in a place like this? A room where shell-shocked, quadriplegic patients languished unfed for three days, swimming in feces and tied to their beds? Where uncertified doctors accidentally killed some vets with faulty CPR treatment and subjected others to blood-tainted needles and bacterially infected gloves? She was making a segment of 'PrimeTime.' And after Diane Sawyer and her pen-sized camera got through with America's veterans hospitals, only one logical conclusion could be drawn: Old soldiers may never die, but the VA keeps trying.

Add to those memorable TV images the revelations of Ron Kovic and the film Article 99, and you've got the average American's mental picture of the average American veterans hospital: half infirmary, half inferno. And this popular image isn't off base; it's just incomplete. The root problem with Veterans Administration hospitals doesn't lend itself to video treatment: It's how much American citizens are paying for this substandard care. Thanks to unnecessary testing, overly long stays, mind-boggling logistics, and way too many empty beds, caring for the average VA hospital patient now costs nearly twice what it would at the average community hospital. And who's paying for that waste? You are, to the tune of hundreds of millions of dollars.

If figures like that don't move you, consider James Williams' story: When the 25-year-old Nebraskan needed a kidney stone removed last year, he might have driven to Omaha's Methodist Hospital, a top-flight private institution where he could have gotten a simple lithotripsy as an outpatient for about $5,000. But Williams, a veteran of the Air Force, qualified for free treatment by the VA. So instead he was directed to fly 500 miles via commercial jet (at taxpayer expense) from Omaha to Milwaukee, the nearest vets' facility capable of performing lithotripsy. Unfortunately, Williams first had to wait three months for a slot to open in Milwaukee, so the folks at the Omaha veterans hospital decided to insert a silicon catheter into his kidney (at risk of infection) until the Milwaukee hospital was ready to admit him. After the lithotripsy, Williams had to check back into the Omaha VA to have the catheter removed. Done? Not quite. Williams has since learned he has another stone. He'll likely be forced to retrace the same medical odyssey this summer.

Hedged vets

The Sununuesque habit of airbusing vets across the country for routine procedures may seem trivial compared to the billions spent on health care annually, but replay that type of wasteful spending a dozen different ways at dozens of VA hospitals around the nation, and the bill adds up. Today, the VA spends nearly $14 billion a year to care for a mere 3 million eligible vets.

Why are we paying Connoisseur Class prices for a third-rate medical system? Thanks goes to a Congress unwilling to say no to the 5-million strong veterans' lobby, which is quick to invoke Normandy, Inchon, or Khe Sahn whenever the question of over-spending arises. Of course, as a result of Ronald Reagan's means-testing enactment, many heroes of these battles don't actually get to use the VA system-its patients include only veterans poor enough to qualify (those with an annual income of less than $18,000) or those injured while serving. And many who do use it might jump at the chance to get free care elsewhere. Nevertheless, to the veterans' lobby and the congressmen who serve it, overhauling the system seems a betrayal of a sacred contract made in the wake of World War I: In return for serving their country, veterans should have their own hospital system to meet their needs.

Certainly, all Americans should be accorded affordable, quality health care, and until we create a universal system that works, we should make especially sure our former soldiers' health needs are met. But by clinging to a bureaucratic arrangement that's about as up-to-date as leech therapy, the VA isn't just wasting money, it's hurting the very constituency it's supposed to help. If we really want to help America's needy vets, we need an entirely new approach to providing good, free health care-an approach that would replace the VA hospital system with our underused, more efficient community hospitals.

The VA will tell you that it provides an important service to veterans, but what it won't volunteer is how few veterans use its hospital system. In fiscal year 1990, nearly one third of VA hospital beds were empty. As veterans' groups are quick to point out, the number of old and sick vets is likely to increase during the next few years, as more and more World War II veterans reach their seventies. Even so, the overall veteran population has been declining rapidly since 1980.

This shrinkage and the slew of empty beds don't leave much opportunity for economies of scale-even if the VA were interested in economy. But thanks to the peculiarities of the federal budget process, the 60,000 administrators employed by the VA have little incentive to be worried about savings. In fact, too much financial worry would put those same bureaucrats out of a job.

The OMB appropriates the VA health care budget on an annual basis, not allowing financing for the future-a setup that gives the VA a powerful incentive to spend all of its appropriated funds before the fiscal year runs out. The great fear of any bureaucrat is that by saving the federal government's money this year, he'll get a correspondingly smaller outlay in the next budget cycle. So a smart administrator-one who doesn't want to lose jobs or future funds-attempts to run through all the money he's got. The result? Once a VA gets hold of a patient, the impetus is to keep him as long and as expensively as possible, even when there's no medical rationale for doing so.

Here's how it works. Let's say you're a 25-year-old vet with a bone spur in your big toe. VA protocol requires that a gamut of tests be administered to all patients scheduled for surgery, allowing no adjustment of its policy for each type of patient. So you go through the same chest x-ray, EKG, physical, and blood and urine exams as the 70-year-old cigarette smoker in for a bypass. After waiting about two months for the tests to be processed, you'll have to check into the hospital for your relatively simple operation not once (as would be the case in a community hospital) but two or three times-each time for more unneeded exams or 'precautionary' procedures. And each time, nurses and staff are paid to put you through this diagnostic rigmarole.

Thanks to budget-extenders like these, the average expense per admission at VA hospitals in 1990 tallied $7,164, compared to the $4,947 average at community hospitals. And while, according to a Washington Monthly analysis, Medicare pays community hospitals approximately $3,000 for a gall-bladder removal and allows five and a half days to complete it, the average VA hospital cost for the same procedure is nearly $6,000 at an eight-day stay. Prostate removal? Community hospitals are forced to operate for the less than $3,000 that Medicare will give them and keep patients for an average of just under five days. The VA takes nearly seven days at a cost of $4,600.

Of course, the VA might tell you that its figures are inflated because the vets who turn to it are generally older and sicker than the average hospital patient. And some are. But even if they aren't, the hospitals won't send them home in a hurry. A 1985 General Accounting Office (GAO) study reported that with better management VA hospitals could have cut inpatient days by 43 percent. 'The VA is the only hospital system in the country where the average length of stay is measured in seasons, not days,' says a private health care consultant.

What allows this type of waste to proliferate is simple: the absence of a disciplined regulatory system for VA care. While the Medicare bureaucracy has its problems Oust ask any of the thousands of doctors who have enough Medicare paperwork to repaper their waiting rooms), the VA could learn a lesson from Medicare rules that prevent superfluous spending on items like extra overnight stays or useless exams. While a recently established VA hospital reimbursement system will pay each hospital a fixed amount depending on the type of care given to a patient, the procedures and costs are audited by no outside entity. 'The VA won't accept any requirements for accountability,' laments a former Senate veterans affairs committee staffer.

Of course, the real irony is the low quality of much of that overpriced care. To their credit, VA hospitals have been leaders in treating spinal cord injuries, initiating innovative programs to address alcohol and drug abuse, and caring for the elderly. Moreover, the system boasts a number of excellent hospitals, most of them affiliated with top medical schools, such as the Brockton-West Roxbury VA Medical Center, which has ties to Harvard's program, and the UCLA-linked West Los Angeles VA Medical Center. But, as has been documented by several recent studies, the care at the average VA hospital tends to be well below average.

So well below, in fact, that just this past November, a congressional investigator discovered incompetence and neglect at each of the six veterans hospitals she examined-failings she determined in several cases to have been the primary cause of a patient's death. In her testimony before a House subcommittee, she spoke of finding 'nurses who] allowed patients with life-threatening illness to languish for hours, even days, without monitoring.' The worst case involved a Cheyenne, Wyoming, patient whose bladder cancer, a normally curable illness, metastasized while he waited 45 days for the hospital to settle a contract dispute with its urologist. When someone finally noticed that the patient had lost 30 pounds and the cancer had spread, they shipped him to the Denver VA hospital, where he soon died.

Semper fiasco

In many ways, the care and cost problems of the VA system only mirror those that beset American health care as a whole, from lack of fiscal and medical accountability to poorly trained staff. But the VA system, with its limited number of hospitals and its manageable clientele, could be reformed into a model of first-rate health care provision. Unfortunately, nearly every major effort to change the way the veterans do their medical business has been dead on arrival, thanks to the troika that guards veterans' interests: the VA, the veterans' lobby, and Congress.

The VA's motivation to thwart reform isn't tough to plumb. A full 90 percent of the VA's staff is involved in running its medical system, thus any talk of radical change in the health-care process directly threatens the VA's main source of power, not to mention a huge chunk of its budget. And while bureaucratic self-protection is nothing new to government, the VA's intransigence is backed by one of the most formidable phalanxes in American politics: the American Legion, the Veterans of Foreign Wars, the Disabled American Veterans, and other smaller groups that comprise the veterans' lobby.

The lobby's leaders boast of being able to deliver more than a million letters to Congress on any given issue, and they don't take lightly any serious attempts to change their health care system. Consider what happened in February, when the VA agreed to join with the Department of Health and Human Services in a pilot program allowing non-vets to use VA hospitals in rural Virginia and Alabama, where hospitals are few in number. The veterans' lobby threw a fit, arguing that such a move would shut veterans out of their own hospitals, even after a VA spokesman had told them that opening the vacancy-heavy facilities to non-vets would have 'no impact' on veterans in the two states and would perhaps enhance service there.

After the Senate voted 91 to 3 to block the program, VA secretary Edward Derwinski terminated the plan, fearing the vet lobby. 'I decided, hell, I have a chance of getting rolled over or getting off the road,' he told The Washington Post, adding that the Senate felt the same pressure in this, an election year. 'Privately, everyone was saying, A great idea, but I can't vote for it.' '

Why not? Because when lobby leaders invoke the American flag, it's hard to say no. Just listen to what one vet lobbyist, Mario Raimondi of the New York State Veterans of Foreign Wars, had to say about the common-sense plan: 'This proposal is a tragic error and a shameful display of unconcern for the American veterans and their continued need for medical assistance.'

But it's not just the lobby that Congress has to worry about, says a Senate staffer who handles veterans affairs. 'The average citizen sees the hospital system and the cemeteries as the only two tangible reminders of our commitment to take care of those who have been in the military.'

VACANCIES

Of course, after so much media documentation, even diehard congressional loyalists admit that some VAs aren't taking proper care of those military men. While some call for butterfly stitches and cash infusions, what the VA really needs is major surgery-a health care voucher system that essentially eliminates the VA hospital system, turning the most viable of its hospital facilities over to community hospitals. That would help solve two American health care crises at once: the excess of hospital beds nationwide (American community hospitals are only two thirds full) and the extremely expensive upkeep of our special facilities for vets.

Without the need to staff and maintain its own facilities, the VA could shift hundreds of millions of dollars to direct medical expenses. This approach would preserve the best of the current system-free health care for veterans in need-and eliminate the worst: the bureaucracy that has stymied the VA's ability to provide adequate care at reasonable costs.

While some of the VA hospitals would be closed under such a plan (do Boston and Chicago really need four VA units when their community hospitals are one-quarter to one-third empty?), others would be converted to community hospitals, which could serve non-veterans as well as vets, just like the pilot program in the South that was deep-sixed this winter. If the voucher system alone is too expensive for our nation to bear, the government could provide a buy-in option for nonentitled vets and thus ensure care to a much greater number of veterans.

Mind you, it's not just economists who think a plan like this might work. 'There's no real medical or financial reason why the VA ought to have its own system of hospitals,' says Dr. Steve Koukol, former surgery resident at West Virginia's Morgantown Veterans Hospital. 'It would be better for veterans and more economically effective if we threw the system out and used vouchers.' But when the subject of vouchers comes up, VA loyalists tend to note their hospitals' skill in dealing with vet-specifics. In addition to experience tending to maladies commonly afflicting veterans (battle wounds, depression, alcoholism and drug addiction, and illnesses common to older men), VA hospitals are continually lauded by medical administrators for maintaining a vet-friendly environment. But can't community hospitals employ staff skilled at veterans' care? Besides, any urban trauma center today is, sadly enough, experienced at treating gunshot wounds.

Community leaders in Baltimore argued along these lines when a localized version of the voucher plan nearly took shape back in 1982. As the city planned to tear down and replace one of the three area veterans hospitals, the Maryland Hospital Association suggested that instead of erecting a new facility, veterans should be provided with vouchers to use at community hospitals-after all, the city already had more than 2,600 empty beds. For the government and taxpayers, the plan would have meant tens of millions of dollars saved by not constructing a new unit. For the veterans themselves, it would've meant more efficient care. But to the nation's veterans' organizations, it meant heresy. Fearing a backlash at the polls, not one member of Congress was willing to propose the necessary legislation to make the plan fly, even though the empty beds in Baltimore were costing an estimated $122,000 each annually to maintain. The new $118 million Baltimore VA Medical Center will open this spring.

The ultimate irony of this is that the average poor vet in Baltimore, or Omaha or Little Rock or Tacoma, probably doesn't have the same kind of allegiance to the VA hospital as he does to the notion of good health care. 'I wouldn't have any objection to going to a regular hospital,' says James Williams, the Omaha resident shipped 500 miles for his kidney stone treatment. 'If I have that choice, I'll take it.' But these vets-the ones with firsthand experience in the dilapidated VA system-aren't the ones being heard when it comes time to talk of VA reform. 'The quality of care in the VA hospitals is, on the whole, better than that in community hospitals,' boasts Dr. Earl Brown, a former Veterans Affairs health-care administrator and staunch defender of the status quo. But does he go to a VA hospital? No,' he concedes. 'The care there is not exactly the most . . . expedient.'

Evaluation of the BiliChek Being Used on Hyperbilirubinemic Newborns Undergoing Home Phototherapy - Archives of Pathology & Laboratory Medicine

* Context.-Newborns are often screened prior to discharge for hyperbilirubinemia. Transcutaneous bilirubin analyzers, such as the BiliChek, are promoted as screening tools, but it is unclear whether they also function well as monitoring devices. Newborns on home phototherapy require frequent determinations of serum bilirubin levels to monitor therapy effects. A transcutaneous bilirubin analyzer would be helpful to limit blood draws and enhance staff efficiency. We evaluated the accuracy of the BiliChek analyzer in this setting.

Objective.-Is the BiliChek sufficiently accurate to monitor the effectiveness of home phototherapy and establish when to terminate therapy?

Design.-Paired serum bilirubin results and results from the BiliChek were obtained from newborns on home phototherapy during daily home health care visits.

Results.-The BiliChek demonstrates a negative bias (mean bias, -1.71 mg/dL; 95% confidence interval, -1.89 to -1.52 mg/dL) compared with serum bilirubin values. This bias worsens as the serum bilirubin level rises. If a value of 14 mg/dL or less obtained using the BiliChek had been used as the cutoff for termination of phototherapy, 45% of newborns would have had therapy terminated prematurely. If, knowing the negative bias of the BiliChek, the cutoff for termination of therapy was set at less than or equal to 11 mg/dL, then 29% of newborns would have had therapy terminated prematurely.

Conclusions.-The values obtained using the BiliChek, compared to serum bilirubin values, have a negative bias that worsens at the higher bilirubin levels expected in newborns at home on phototherapy. The BiliChek does not provide sufficient accuracy to be utilized to monitor newborns on home phototherapy or to ascertain when to discontinue such therapy.

(Arch Pathol Lab Med. 2008;132:684-689)

Hyperbilirubinemia, with the potential risk of kernicterus, has recently gained attention as new cases of this preventable disorder were reported in the early 2000s.1 Guidelines for the management of hyperbilirubinemic newborns have been established by the American Academy of Pediatrics.2,3 In our community, many of these newborns are discharged to receive home phototherapy and require measurement of bilirubin levels to monitor the effects of therapy and to ascertain when to terminate treatment. The serum bilirubin level at which to terminate home therapy is not provided in guidelines, but for patients readmitted to the hospital and treated for hyperbilirubinemia, the recommendation is to discontinue phototherapy once the serum bilirubin level falls below 13 to 14 mg/dL.2 Most of our clinicians use 12 to 14 mg/dL, along with a general evaluation of the newborn's status.

The BiliChek (Respironics, Marietta, Ga) is a device that measures bilirubin transcutaneously. Demonstrated to be useful to screen for hyperbilirubinemia in newborn nurseries, 4-8 it is also claimed by the company to be accurate enough to use as a monitoring device in newborns undergoing phototherapy.8 As newborns on home therapy may require several days of treatment, a method of measuring bilirubin that does not entail a venous or heel puncture and that can give instant results would be very useful. We evaluated the BiliChek in this population to ascertain whether it was sufficiently accurate to allow for monitoring of patients and determining when to terminate therapy.

MATERIALS AND METHODS

The BiliChek devices were acquired (on a trial basis) by Children's Hospital Home Health Care Services (Omaha, Neb) in March 2006. Training of home health care nurses and respiratory therapists was performed. It consisted of a 2-day session of hands-on training by the manufacturer's representative and observational training at the Methodist Hospital Newborn Nursery (Omaha, Neb) teaching site to observe technicians performing a bilirubin level test with the BiliChek on newborns on the day of their discharge. Methodist Nursery has been using the BiliChek device for more than 2 years as a screening tool. A check-off sheet was used to evaluate all trainees in the operational steps of the BiliChek device (including error codes, battery removal, criteria when not to use device), as well as the step-by-step process of using the device. This was followed by hands-on training with the device and testing on each other. After all trainees were checked off as competent in the use of the device, a 2-month trial to determine variability among staff was performed to identify any retraining needs.

Three devices were obtained (1 device was replaced due to performance failure-a broken piece of plastic).

Home health care nurses and respiratory therapists were assigned to visit hyperbilirubinemic newborns for whom phototherapy was ordered by their physicians on their first day at home, and to draw a blood sample for serum bilirubin measurement, perform a bilirubin level test using the BiliChek, set up phototherapy (either a Wallaby III system and/or PEP unit [an Ultra BiliLight device]), and weigh and evaluate the newborn. Only newborns on the Wallaby system were tested with the BiliChek. All newborns were tested on the forehead. Specimens for serum bilirubin testing were transported to Children's Hospital for processing. The clinician returned each subsequent day to evaluate the newborn, weigh the newborn, draw a blood sample for serum bilirubin testing, and obtain a BiliChek bilirubin level. Each newborn received a daily serum bilirubin test for 1 to 4 days on average. When the serum bilirubin value was approximately 12 to 14 mg/dL, and the newborn was doing well clinically, the phototherapy was terminated by the ordering physician. Upon discontinuation of home phototherapy by the physician (based upon the serum bilirubin result), the clinician would return to the patient's home to remove the phototherapy equipment.

Specimens for serum bilirubin testing were collected in microtainers that protected the specimens from light. Upon arrival in the laboratory, the specimens were spun and analyzed on a Fusion 5,1 (Vitros/Ektachem; Ortho-Clinical Diagnostics), using a 10-�L sample drop volume on the dry slide technology. Both the unconjugated (Bu) and conjugated (Bc) bilirubin were measured from the same slide. The test reaction is an end point colorimetric, dual-wavelength reaction that employs the unique spectral characteristics of Bu and Bc, with readings at both 400 and 460 nm. Results are reported in milligrams per deciliter. Per routine, quality control is run daily and monitored for deviations from the expected range. Calibrations are performed at least every 6 months or whenever deemed necessary due to implementation of a new lot number, after certain service procedures, or in the event of unacceptable quality control deviation.

The data collected listed each patient's identification number, which BiliChek device was used, which staff member performed the BiliChek test, the hours of age of the newborn, the serum bilirubin level, and the bilirubin level obtained using the Bili- Chek. Allowing for a several-month learning curve, only data obtained since June 1, 2006 were used. EP Method Validator was the program used to obtain statistical values. Bias plots and Deming regression were utilized to compare the 2 methods.9

RESULTS

Two hundred nine newborns were included in the study. Only very rarely would a newborn have a significant increase in bilirubin levels after arriving home; most were already at or near their peak bilirubin level, and most of the values demonstrated a daily decline. Rarely would a newborn have a mild increase in bilirubin after several days of therapy. The newborns were greater than 34 weeks' gestation. Underlying risk factors for hyperbilirubinemia were unknown, as was racial distribution. Most of the newborns were breast-fed, but these data were not collected and many received various amounts of fluid and formula supplementation. The average age of the newborns at the time of the first home visit was 94.6 hours (median, 90.5 hours; range, 39.9-530.4 hours).

The data were subjected to Grubbs analysis for outliers. Some differences between the bilirubin levels obtained using the BiliChek and the serum bilirubin levels appeared extreme (up to 8.9 mg/dL), but there was a continuous range of differences and therefore these apparent extreme differences could not be dismissed as outliers.

A difference plot using all data points (N = 477) demonstrated that the BiliChek has a mean bias of -1.71 mg/ dL (95% confidence interval [CI], -1.89 to -1.52 mg/dL) compared with the serum bilirubin level (Figure 1). Deming regression analysis demonstrated a slope of 1.204 (95% CI, 1.083-1.324) with the intercept -4.83 (95% CI, -6.67 to -3.00) (Figure 2). The correlation coefficient (r) was 0.662.

According to its product literature,8 Respironics performed correlation studies of the BiliChek on newborns with bilirubin levels that were relatively low compared with the newborns we evaluated. Only 3.3% of the newborns in the Respironics studies had bilirubin values greater than 14 mg/dL, and only 11.8% of these newborns had values greater that 12 mg/dL. Other studies found in the literature also evaluated data on serum bilirubin values that were predominantly 13 to 15 mg/dL or less.4-6 In an article by Bhutani et al,4 the range of bilirubin values was 0.2 to 18.2 mg/dL, but only 1.1% of the values were greater than 15 mg/dL and only 21.7% were greater than 10 mg/dL. The exception is the article by Engle et al,7 in which populations had elevated levels, with 31% of Hispanic newborns and 9% of non-Hispanic white newborns having values greater than 15 mg/dL. Our population was similar to that of Engle et al in this respect. To evaluate whether the level of bilirubin affected the accuracy of the BiliChek, we evaluated bias plots for serum bilirubin levels less than 12.9 mg/dL, from 13 to 14.9 mg/dL, and greater than 15 mg/dL. We observed that at levels less than 12.9 mg/dL (n = 66; 14% of all values), the bias was less at -0.897 mg/dL (95% CI, -1.26 to -0.534 mg/dL). At levels between 13 and 14.9 mg/dL (n = 137; 29.3% of all values), the bias was -1.41 mg/dL (95% CI, -1.74 to -1.08 mg/dL). At levels greater than 15 mg/dL (n = 268; 56.7% of all values), the bias was -1.99 mg/dL (95% CI, -2.24 to -1.74 mg/dL). Thus, we observed a significant worsening of negative bias as serum bilirubin levels rose (Figure 3).

One of our goals was to ascertain whether the BiliChek was accurate enough to be used to monitor and terminate phototherapy. Home health care staff proposed the following algorithm and question. On day 1, both a serum and a BiliChek bilirubin value would be obtained. If the newborn was older than 96 hours of age, and if there had been at least 2 declining bilirubin levels via BiliChek, could the final decision to withdraw phototherapy be made based on a subsequent further decrease in the BiliChek bilirubin level alone, without having to repeat a serum bilirubin? This would mean fewer venipunctures or capillary draws for serum bilirubin levels. The staff also would be able to finalize care of the patient in a single visit, removing the equipment during the same visit at which they obtained the final bilirubin level using the BiliChek. This would improve efficiency by eliminating delivery of a specimen for serum bilirubin determination to the laboratory, awaiting the results, contacting the physician, and then returning to the home to remove equipment.

We therefore evaluated the third consecutive decreasing serum bilirubin values versus the BiliChek bilirubin levels (n = 79) and found that the bias of the BiliChek was -1.78 mg/dL (95% CI, -2.18 to -1.39 mg/dL). For study purposes, we chose a bilirubin level of 14 mg/dL or less as the decision point to terminate phototherapy. If we had chosen to terminate phototherapy when the bilirubin level obtained using the BiliChek was 14 mg/dL or less (n = 62), 45% of the newborns would have had phototherapy terminated before their serum bilirubin values were less than or equal to 14 mg/dL. Most would have had serum bilirubin values in the 14 to 15 mg/dL range, but some were in the 16 mg/dL range, with rarely a newborn having a serum bilirubin value as high as 17.5 mg/dL. Also, by using a BiliChek bilirubin level cutoff of 14 mg/dL, 12% of newborns (n = 17) would have continued to receive unnecessary therapy.

In an attempt to correct for the fact that the BiliChek has a negative bias, we re-evaluated the data based on a lower cutoff value, a BiliChek bilirubin level of 11 mg/dL or less (n = 24). Using this decision point, 29% of the newborns would have had therapy terminated before their serum bilirubin levels were less than 14 mg/dL, while 33% (n = 55) would have received 1 or 2 days of unnecessary therapy (Figure 4).

In an attempt to rule out user error, the first 2 months of data were evaluated. The overall bias (n = 89) was -1.39 mg/dL (CI, -1.77 to -1.01 mg/dL). The distribution of serum bilirubin levels was comparable to the overall distribution in the post training period data (21.3% less than 12.9 mg/dL, 29.2% between 13 and 14.9 mg/dL, and 49.5% greater than 15 mg/dL). This bias (-1.39 mg/dL) is somewhat better compared with that obtained when the training period data are eliminated (-1.71 mg/dL), possibly secondary to fewer data points.

We then analyzed the data beginning after the training period by user, to look for single user error that might account for the negative bias identified. There was no pattern evident when we compared the number of times a clinician used the BiliChek with the average serum bilirubin versus the BiliChek bilirubin difference. In other words, familiarity with the BiliChek did not lessen the bias (Figure 5).

Finally, we evaluated the impact of age of the newborn on the results obtained using the BiliChek. The BiliChek literature8 states that the instrument is designed to evaluate newborns from 0 to 20 days of age. Our age span was from 1.6 to 13.7 days (with a single outlier at 22.8 days with a difference of -1.9 mg/dL; not included in the data for Figure 6). The bias did not change based on the newborn's age (Figure 6).

COMMENT

The BiliChek is a device designed for screening newborns for hyperbilirubinemia. The BiliChek product literature8 indicates a bias of /- 1.5 mg/dL. There are numerous studies4-7 that evaluate the BiliChek as a screening device. During screening, most bilirubin levels are relatively low, within the range in which (based on our data) the BiliChek demonstrates improved accuracy compared to higher bilirubin levels. This permits establishment of BiliChek bilirubin cutoff values beyond which obtaining a serum level is prompted for further evaluation of the newborn.

Utilizing an analyzer for a completely different purpose than intended (screening vs monitoring) opens the door for great discrepancies in its performance.10 However, the literature for BiliChek also indicates8 that the device is accurate enough to use for monitoring newborns receiving phototherapy. The BiliChek study obtained a correlation factor (r) of 0.87 to 92; no bias plot or data are provided. Of interest, however, of the patients on phototherapy who were monitored by the BiliChek manufacturer,8 only 3.3% had bilirubin levels greater than 14 mg/dL.

Only a few other studies have evaluated the BiliChek as a monitoring device. One is the study by Engle et al,7 who evaluated newborns on phototherapy. As in our study, they had newborns with elevated bilirubins, most expected to be at least 15 mg/dL. They also uncovered a significant negative bias that limited the ability of the BiliChek to be utilized as a monitoring tool. Both Hispanic newborns (31%) and non-Hispanic white newborns (9%) in their study had serum bilirubins greater than 15 mg/dL; they report a similar bias irrespective of race. While we cannot confirm that race does not play a role in this bias because we do not have race data on our newborn population, we suspect that there is a nonlinear bias that worsens as bilirubin levels increase.

In addition, all studies identified to date were performed in newborn nurseries or outpatient pediatric clinics. 3-8 No studies evaluating the device in the home health care setting could be found. The home health care setting is a very different environment with many more opportunities for preanalytic error than in the newborn nursery. It is possible that this setting and the resultant error are contributing to the bias we are observing.

Although we initially considered user error as a potential confounder of our data, review of the data indicates no correlation between familiarity with the BiliChek and the bias obtained.

Potential problems with this study are several. First, the home health care environment itself, with other children, distractions, etc, may have contributed to our bias. Second, our comparison method was the Fusion 5,1 analyzer, and this could have been inaccurate, although based on quality control data and other monitors, we could identify no aberrations. Third, we do not know the racial distribution of our patients. Finally, we did not evaluate the precision of the BiliChek in this study.

CONCLUSIONS

It would be very useful to have a transcutaneous, point-of- care method to measure bilirubin in the newborn at home on phototherapy and to monitor treatment. However, in this setting, newborns have expectedly high bilirubin levels. Our data show that the negative bias of the BiliChek worsens as the bilirubin level increases. The BiliChek does not offer adequate accuracy to allow it to be used to monitor newborns on home phototherapy or to ascertain when to discontinue therapy.

[Reference]

References

1. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Kernicterus threatens healthy newborns. Sentinel Event Alert 2001;18(18):1-2. Available at: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/ sea=18.htm. Accessed September 30, 2007.

2. Subcommittee on Hyperbilirubinemia, American Academy of Pediatrics, Clinical Practice Guidelines. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.

3. Stanley IP, Chung M, Kulig J, et al; and Subcommittee on Hyperbilirubinemia. Evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004;114:e130-e153.

4. Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000; 106(2):E17.

5. Dominguez T, Bukovitz M, Swartz H, Buckellew M. Implementation of the new transcutaneous bilirubinometer, BiliChek�, in the maternity ward and pediatric outpatient clinic. The Society of Armed Forces Medical Laboratory Scientists (SAFMLS) Society Scope. Summer 2005;8-11. Available at: http://www.safmls. org/Scopes/Scope%20-%202005%20Summer.pdf. Accessed September 30, 2007.

6. Rubaltelli FF, Gourley GR, Loskamp N, et al. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device. Pediatrics. 2001;107:1264- 1271.

7. Engle WD, Jackson GL, Sendelbach D, Manning D, Frawley WH. Assessment of a transcutaneous device in the evaluation of neonatal hyperbilirubinemia in a primarily Hispanic population. Pediatrics. 2002;110:61-67.

8. BiliChek Noninvasive Bilirubin Analyzer, User Instruction Manual, Respironics, Inc.

9. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307-310.

10. Schumacher RC. Transcutaneous bilirubinometry and diagnostic tests: ''the right job for the tool.'' Pediatrics. 2002;110:407-408.

[Author Affiliation]

Christine A. Reyes, MD; Donald R. Stednitz, BA, RRT-NPS, AE-C; Carol Hahn, MT(ASCP); Kelly D. Mutchie, PharmD; Steven R. McCullough, MT(ASCP); Kent Kronberg, MD

Accepted for publication October 12, 2007.

From the Department of Pathology (Dr Reyes, Ms Hahn, and Mr McCullough), Children's Home Health Care (Mr Stednitz and Dr Mutchie), and Children's Physicians Eagle Run (Dr Kronberg), Children's Hospital, Omaha, Neb.

The authors have no relevant financial interest in the products or companies described in this article.