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Midwest Today, January 1997




By NEAL LAWRENCE/Senior Writer

Advances in medical knowledge are occurring so rapidly, it's hard for doctors to keep abreast of all the developments, let alone the lay public. To an extent greater than at any other time in human history, medical science is making some astonishing discoveries, that are changing the way illnesses are treated -- and prevented.

Some mysteries about the way the human body works have been unsolved for years. But now, pieces of the human puzzle are falling into place. With rates of heart disease and some forms of cancer declining, new hope for the efficacy of drugs to treat such catastrophic afflictions as AIDS, and increased awareness of the holistic basis for good health and longevity, life spans may indeed stretch telescopically into the new millennium.

It's not that funding for research is higher -- it isn't. Cutbacks in what the government allocates for medical research have occurred at every level. But some fortuitous discoveries have transformed modern medicine in the space of only a decade or two. Midwest doctors and research centers have played key roles in many of the advances.

It's impossible, of course, to list every discovery, every new approach to treating illness. But here are some highlights:


If, like many people, you never forget a face but are terrible with names, researchers now believe it's the "broker" in your brain that could be the culprit.

Broker is what scientists are calling a newly discovered brain function that, most of the time, enables us to dip into our enormous store of words and dredge up the correct one for a face or object.

Drs. Hanna and Antonio Damasio, renowned neuroscientists at the University of Iowa, say they've found there's a previously unsuspected middleman.

"We find evidence that you don't go from concepts to words nonstop," said Dr. Antonio Damasio recently. "There's an intermediary structure that helps you go from one to the other, like a diplomatic broker that is talking to both sides at the same time."

Moreover, he said, there may be as many brokers as there are categories of words.

Surprisingly, the areas of the brain that act as brokers, in effect as the brain's dictionary or thesaurus, aren't part of structures long considered the primary speech and language areas -- Broca's and Wernicke's areas.

Instead, they are scattered about the temporal lobe of the left hemisphere, said Damasio.

The fact that there are many brokers may explain bizarre cases of people with brain damage who can no longer name certain categories of words, like tools or animals, but have no trouble naming others. Damasio said the findings might someday help people who have difficulty thinking of certain words.


Using needle-sized instruments, surgeons can now remove gallbladders less painfully and with even less scarring than with another type of mini-surgery, according to a Cleveland doctor.

Using the new procedure, known as needlescopic surgery, doctors make three or four 1.7-millimeter incisions, compared with the five-millimeter to 15-millimeter incisions used with the older technique, called laparoscopic surgery.

With needlescopic surgery, there is much less pain in the upper abdomen since there are less wounds, and patients request fewer painkillers, said Dr. Michel Gagner of the Cleveland Clinic Foundation in Ohio, a pioneer of the new procedure.

Eventually, local anesthesia will replace general anesthesia for this procedure, which will be a drastic change in terms of cost and risk, he added.

The operation is going to lead to other types of surgery with needles, such as hernia operations, Gagner said. The new procedure also may be useful in head, neck and gynecologic surgeries.

The gallbladder is removed via instruments inserted through the belly button in both needlescopic and laparoscopic surgery.

Surgeons perform needlescopic surgery by inserting narrow guide tubes into the minute incisions and then passing tiny instruments through the tubes, while using a small television camera for guidance, according to Gagner.

They are then able to detach the gallbladder and remove it.


Researchers have found that a number of drugs are absorbed into the body more easily when taken with grapefruit juice, thus boosting their effectiveness.

Drug developers are racing to understand the process so they can use it to make their medicines more effective.

Patients who take calcium channel blockers for high blood pressure can triple their blood levels of the drug by taking their pills with grapefruit juice.

Other drugs react similarly, including the antihistamine terfenidine, known commercially as Seldane, and the sleeping pill Halcion. Experts say so far that they know of 13 drugs that increase in the blood when taken with grapefruit juice and predicted dozens more will show the same effect once studied.

A drug additive based on grapefruit juice could also allow transplant patients to take lower doses of cyclosporine, an expensive medication that keeps the body from rejecting foreign organs.

It could make some drugs practical when they would otherwise be difficult or impossible to administer. And it could make it easier for doctors to prescribe some medicines, such as calcium channel blockers, whose doses now have to be tailored to each patient.

But, cautions Paul Watkins of the General Clinical Research Center at the University of Michigan in Ann Arbor, "This is not a reason to change your habits and start taking your meds with grapefruit juice just yet."

Because it boosts blood levels of certain drugs, the juice may cause people to overdose inadvertently.


Blood-sucking leeches, a cure-all for everything from inflammations to meningitis until the 19th century, are being used again in modern medicine.

Doctors at Children's Hospital of Pittsburgh have been using leeches on post-operative patients who have undergone large skin grafts, reattachment of small digits such as fingers and toes and some plastic surgery procedures, according to Dr. Morey Moreland, chief of orthopedics at the hospital.

"It's been effective. It's an interesting use of a very old treatment," he said.

Old indeed. Leeches were first used at least as early as 200 B.C. and were considered cure-alls. "They were used for everything. Infections, colds, everything," Moreland noted.

Leeches aid in the healing process by keeping blood vessels from becoming clogged or engorged with blood, Moreland said. When a leech bites a human, it releases an agent from its mouth that prevents blood from coagulating. It also takes some blood from the affected area, preventing vessels from clogging.

Moreland explained the leech also releases an anaesthetic so the bite is not painful for the patient, who is sedated during the procedure.


Scottish doctors said recently they have produced synthetic diamonds with a new technique and used them in replacement hip joints that would last years longer than present replacements.

Dr. Philip John of Heriot-Watt University said his team produced sheets of synthetic diamonds using plasma techniques and simple chemicals.

The diamond sheets were used to cover the ball in ball-and-socket hip joint replacements, providing protection and reducing wear.

Hip replacements are one of the most common surgical operations in the West, because the joint easily gets worn out or affected by arthritis.


Cells from newborn babies' umbilical cords, long viewed as a waste product of birth, could help in the fight against leukemia, scientists have announced.

The stem cells, from which all blood cells grow, can be stored in a special blood bank that could be used as an alternative to bone marrow transplants.

Professor Jill Hows, director of the Cord Blood Program in London, told reporters, "Cord blood is an exciting new source of transplantable stem cells which may be used to cure patients with leukemia."

Cord blood transplants carry less risk of rejection and could help patients with rare tissue types.

With the mother's consent, the blood donation would be taken at hospital maternity units from the umbilical cord.


A pill that could reinvigorate the sex lives of millions of men has entered the final stages of trials, and is being offered to hundreds of British patients.

The drug, sildenafil, is aimed primarily at the estimated 10% of the male population who suffer serious problems of impotence, but early tests in healthy volunteers suggest it can also enhance normal erections.

It will give men the opportunity to avoid the misery of sexual failure by discreetly swallowing the pill about an hour before intercourse. The only other treatments for impotence currently available involve injections or the use of a suction pump.

Ian Osterloh, the Pfizer doctor coordinating the European section of the trial, said the drug only worked when men were receiving sexual stimulation; he would not comment on claims that it made normal erections bigger or longer-lasting, though test subjects say it does.

The drug was originally investigated as a possible treatment for heart problems. Although it had little effect on the cardiovascular system, male volunteers who took part in early tests reported that it had a pleasing and unexpected side effect.

Most men suffer occasional impotence and an estimated 5%, including some young adults in their early 20s, are so severely affected that they are never able to have sex. Few discuss it with their doctor, and the problem is compounded because many physicians see impotence as psychological or simply part of the aging process. Osterloh believes in-creasing numbers of doctors now believe it is indeed an organic problem.


Americans with high blood pressure can buy a new salt substitute that tastes like real salt, but they won't find it in grocery stores -- it's in pharmacies near the aspirin.

Cardia Salt Alternative is blurring the line between medicine and nutrition because it's eaten under a doctor's orders to fight disease. The new world of medical foods, one consumer advocate says, may be an expensive gimmick, but an emerging field that's attracting attention.

"This is where food is going in the next 20 years," said Scott Bass, a Georgetown University food policy professor and attorney. "It's a very hot topic."

For years, medical foods were considered the special mixes hospitals tube-fed the seriously ill, or those for people who physically can't digest regular foods. Some newborns, for example, are allergic to proteins and need special formula to survive.

Now food makers are branching out to healthier people. The idea is to harness foods' best benefits in the hopes they'll keep the slightly ill from getting worse.

Cardia's research convinced Dr. Jerome Cohen of St. Louis University to recommend it to patients.

"The data suggest strongly that this combination of sodium, potassium and magnesium influences blood pressure in a positive way," he said.

Indeed, the Food and Drug Administration issued regulations in October, that define a medical food as something vital for a patient to eat to mitigate disease. But salt substitutes won't qualify.

Regardless of what the FDA calls them, the industry sees a growing market for such foods as the population ages.

Experts envision an entire product line. Already tested is a new drink made from potatoes that hypertensive patients would swig before a meal to curb appetite, since losing weight helps control blood pressure.


Researchers have found a gene that for the first time can be directly linked to coronary artery disease and adult diabetes.

The gene targeted by the research is a mutant or changed form of one that tells the body how to make an enzyme that turns fats in the bloodstream into a source of energy.

In a study of 475 men and women, people carrying the mutant gene were 1.73 times more likely to have coronary arteries blocked by fatty deposits, Dr. Xing Li Wang and Drs. D.E. Wilcken and R.M. McCredia reported.

Carriers of the gene also were three times more likely to develop diabetes as adults.

The study opens wider the possibility of genetic testing to assess a person's risk profile more specifically, Wang said.


Combine all the money paid to doctors by Medicare for coronary artery bypasses, hip and knee repairs and replacements, hernia operations, breast and prostate surgery and the total is less than that spent for cataract removals alone. That's because recent advances in cataract treatment have made this type of outpatient surgery safe, effective and incredibly popular.

Typically using eye drop anesthesia instead of needles, an ophthalmologist peers through a microscope while delicately cutting a quarter-inch incision into the surface of a patient's eye. He carves open the layer of cloudy material that has clouded the previously crystalline lens behind the iris. Using an instrument that works like a tiny jackhammer, he pulverizes the cataract with hissing sound waves pulsing at 40,000 times a second as a hollow needle vacuums away the particles. Finally, the doctor inserts into the eye a new, plastic lens designed to provide 20/20 vision. The whole procedure generally takes 20 minutes, and with the new stitchless surgery (the wound is self-healing), an eye patch may not even be required.
The patient, who sees better immediately, is advised against strenuous physical exertion for awhile, and eye drops are prescribed to prevent infection and aid the healing process.

U.S. ophthalmologists performed 1.7 million cataract surgeries in 1991 on elderly patients, making it the surgery most commonly reimbursed by Medicare. But it's not just elderly persons who have cataracts; those who spend long hours in front of computer monitors are developing them as young as their teen years. Over-exposure to the sun is also a contributing factor.


A University of Minnesota scientist has developed what may become the first "magic bullet" treatment for prostate cancer, the second leading cause of cancer deaths in men.

Akhouri Sinha said that his delivery system -- designed to carry anti-cancer drugs exclusively to cancer cells -- has worked in laboratory experiments using animals.

"It could be used in humans within two or three years," said Sinha, a professor of genetics and cell biology at the University of Minnesota and the Minneapolis Veterans Affairs Medical Center.

He said the technique, if safe and effective, would avoid two of the major drawbacks of surgery and radiation: permanent damage to the nerves that control urine and sexual potency, and missing prostate cells that have spread to other parts of the body.

Other cancer specialists said that targeting techniques are being tested or used against some leukemia and lymphomas, which are relatively rare forms of cancer, and that research is underway to try to develop them against common cancers such as breast and colon.

In theory, Sinha said, his magic bullet should destroy both the entire prostate gland, which -- when cancerous -- usually is removed in surgery, and locate and destroy prostate cancer cells that have migrated elsewhere in the body. Most prostate cancer deaths are caused by cells that have invaded bone and bone marrow.

Prostate cancer accounts for 32% of all newly diagnosed cancers in men. It is now treated with surgery, radiation and sometimes hormones, chemotherapy and by what doctors call "watchful waiting."

With improved surgical techniques, the incontinence rate after surgery has dropped to under 5% and the impotency rate to 30 to 50%.


Doctors seeking a new treatment for congestive heart failure have come upon an unlikely candidate: human growth hormone.

A preliminary study raises the possibility that this genetically engineered protein makes the walls of the heart grow thicker so it will beat more strongly.

Researchers found it appears to work impressively on people with a common cause of heart failure called dilated cardiomyopathy. In this disease, the heart's main pumping chamber -- the left ventricle -- enlarges. But its walls do not grow thick enough to support its larger size.

As a result, the heart does not beat strongly enough to circulate the blood adequately. Swelling and shortness of breath are common symptoms.

Human growth hormone is a protein that was developed to help exceptionally short children grow taller.


Researchers at Children's Hospital of Pittsburgh have discovered that a group of drugs could help fight cancer in patients who are resistant to chemotherapy.

Enediynes currently are being used on an experimental basis on a group of ovarian cancer patients in New York state, and signs are promising that they could be used on a clinical basis in five to ten years.


The artificial flavors that spice up everything from cinnamon doughnuts to vanilla ice cream may help account for the dramatic decline in heart attack deaths among Americans in recent years.

That is because many of the most widely used synthetic flavorings contain chemicals called salicylates, which are related to the common aspirin tablets regularly prescribed to prevent blood clots in people with severe heart disease.

After a detailed study of the synthetic flavoring industry and the trends in cardiac mortality since the 1960s, government researchers said that the synthetic food additives may indeed play a protective role in curbing the death rate from heart disease.

Many risk factors like smoking and high-cholesterol diets have declined among Americans in recent years, more Americans are exercising, and better drugs have emerged to lower cholesterol levels and high blood pressure.

Treating heart disease itself has improved during the past few decades, the researchers agreed.

But it is hard to imagine that even all these factors combined can account for the dramatic drop in the death rate from coronary artery disease. So Dr. Lillian Ingster and Dr. Manning Feinleib decided to look for other sources of aspirin-like compounds in our foods.

They found plenty: vanilla ice cream, packaged cakes and cookies, liqueurs, puddings and almost every junk food on the market contain salicylates in one form or another. So do mouthwash, toothpaste and chewing gum -- and many natural foods and spices including apricots, oranges, raspberries, tomatoes, curry powder, hot paprika and thyme leaves.


A Chinese medical research center has revived an ancient imperial wine recipe using the healing properties of ants, the Economic Daily has reported.

The Nanjing Jinling Ant Research Healing Center in eastern Jiangsu province developed Chinese Ant-King Wine on the basis of an ancient recipe and modern discoveries concerning the medicinal qualities of ants, the newspaper said.

Apparently, the wine is effective in treating rheumatism, strengthening muscles and bones, boosting the immune system and preventing senility.


Two new studies find people are more likely to suffer heart attacks and life-threatening heart rhythm flare-ups during the Winter months than at any other time of the year.

Cardiac arrest -- what doctors call "sudden death" -- is an electrical foul up. The heart stops beating rhythmically, and circulation ceases.

Heart attacks kill 500,000 Americans annually, and 250,000 fatalities each year are called sudden death.

Some people who have survived serious heart rhythm problems have implanted devices known as defibrillators that sense these glitches and shock the heart back to normal beating.

These computerized devices record everything that goes wrong, so doctors know precisely when their patients have experienced heartbeat disruptions.

Researchers speculate that the effect of shorter days on the body's chemicals, such as light-sensitive melatonin, might somehow be involved. Cholesterol levels are also higher in the Winter. Blood pressure and even the blood's tendency to clot follow seasonal patterns.


Vitamin E can reduce the risk of a heart attack by a massive 75%, according to British researchers. The vitamin, which occurs naturally in oil-rich foods and is a staple part of the Mediterranean diet, was far more effective than current heart treatments like aspirin and cholesterol-lowering drugs.


Scientists have located the brain's stopwatch -- the spot that calculates whether you've got enough time to bolt across the street in front of a car or run to the bathroom during a commercial.

It's called the interval timer and its job is to keep track of the minutes and seconds that make up everyday life.

Unlike the body's other timekeeper -- the circadian clock, which keeps hormones, digestion, sleep and other functions running on a 24-hour cycle -- the interval clock measures much shorter times.

"Many gourmet cooks learn the specific duration for all the critical ingredients going into the dish," said Dr. Warren Meck of Duke University.

"They don't set up 20 egg timers on their kitchen counter. They learn to juggle in their heads different durations simultaneously."

Even non-gourmet cooks can boil an egg, brew coffee and make toast, all at the same time. That's because they have an interval timer.

The discovery of the interval clock has no practical uses for now. However, it may help scientist someday craft better treatments for Parkinson's patients and others who suffer damage in this part of the brain.


A Medical College of Wisconsin researcher thinks a cream that can smooth out facial wrinkles may also prevent the narrowing of coronary arteries in patients with heart disease. Joseph Miano, an assistant professor of physiology, is now testing this new wrinkle in the use of all-trans retinoic acid, the active ingredient in Retin-A and newly approved prescription Renova skin cream.

Miano is seeking to determine if it can prevent growth of smooth muscle cells that contribute to new plaque formations in arteries of patients who have undergone balloon angioplasty.

The rapid growth of the smooth muscle cells on the inside of heart arteries, thought to be due to damage from balloon angioplasty, is a major complication following the procedure, which is performed 300,000 times a year in the United States.

Retinoic acid is also being used experimentally in cancer patients because it is thought to inhibit the proliferation of cancer cells, Miano said. He is working with a Houston cancer researcher who has been using retinoic acid to treat 1,000 leukemia patients.


Melatonin, a supplement once found exclusively in health-food emporiums but now available at places like your local drugstore, continues to put a growing number of Americans, particularly aging and stressed-out baby boomers, to sleep.

The hormone -- whose long-term effects, if any, are unknown -- has been promoted as potentially a veritable elixir of life, capable of, among other things, retarding aging, boosting the immune system, fighting breast cancer, controlling cholesterol and combating epilepsy. Even the mere titles of such reports -- especially a best-seller called "The Melatonin Miracle: Nature's Age-Reversing, Disease-Fighting, Sex-Enhancing Hormone" -- have been enough to create a melatonin gold rush.

Sold in pill or lozenge form in doses that usually range from 1.5 to 5 milligrams, and costing seven to 20-cents apiece, is a synthetic version of a hormone secreted as darkness falls by the brain's pineal gland, which controls the sleep-wake cycle and internal clock. Less melatonin, however, is produced as people age. Studies suggest that when taken in low doses, melatonin is rather like taking a dose of darkness, prompting earlier onset of drowsiness and sleep. Many long-distance air travelers swear by it as a way to ease jet lag. (Taken at bedtime at a destination, it helps reset an out-of-whack biological clock.)


Researchers at the Medical College of Wisconsin are searching for growth factors that stimulate ailing hearts into growing their own new, unclogged blood vessels.

If the idea works, heart patients may not have to undergo costly heart-bypass surgery and other procedures, says David Warltier, professor of medicine at the Wauwatosa college.

Instead, heart patients would be treated by having growth factor genes attached to viruses sprayed directly into their heart arteries through a thin plastic tube, or just have the growth factor sprayed into the arteries.

Once heart cells are infected by the viruses carrying the genes, the genes would produce the growth factors causing the heart to grow new blood vessels called collaterals. Under usual circumstances, the growth of collaterals in the heart is triggered when tissue is denied blood, typically when the main arteries are blocked, Warltier said.

It is this natural process of collateral blood vessel growth that Warltier and David Harder, professor of physiology and director of the Cardiovascular Research Center at the Medical College, want to emulate and enhance.


Research now confirms what we thought all along: People with high levels of stress hormones are at a much greater risk of getting sick, said Dr. Ronald Glaser, an Ohio State virologist. If the hormone levels stay up longer than they should, there is a real risk of infectious disease, he said.

Glaser tested the effects of stress on the immune system by giving hepatitis vaccine shots to 48 students, including 23 medical students in the midst of final examinations. Blood tests showed the medical students had high levels of stress hormones.

Normally, a vaccination will cause the immune system to develop antibodies and white blood cells that will protect against a disease.

A month later, the students returned for booster shots and their blood again was tested. Glaser said those who had been under stress developed the least protection against hepatitis.

A natural "fight or flight" response that once gave ancient humans the speed and endurance to escape primitive dangers is triggered daily in many modern people, keeping their hormones at constant hyper-readiness, experts say. Stress and depression that send emergency hormones such as cortisol flowing into the bloodstream destroys appetite, cripples the immune system and in turns causes infections, shuts down processes that repair tissue, blocks sleep, helps cause brittle bones in women, and may even cause cancer. Viral infections, for instance, are now thought to cause liver cancer, leukemia and some forms of skin cancer.


Physicians have experimented with a technique to induce a small heart attack in patients to cure their heart problems.

The method involves injecting ethanol, or pure alcohol, into enlarged hearts to kill excess tissue, thereby reducing strain on the organ, they said.

The hope is that it will be a tool that physicians can use instead of surgery to help patients with enlarged hearts, or cardiomyopathy.

Robert Roberts, head of cardiology at Houston's Methodist Hospital, said several milliliters of alcohol can be injected into a specific region of the heart.


Despite years of discouragement, Gordon Nary, executive director of the International Association of Physicians in AIDS Care, says "this is such an extraordinary time of both discovery and hope.

"For many people today with HIV disease, there is a very good possibility...it'll be a chronic disease" instead of a quick killer.

New drugs, called protease inhibitors, don't cure the HIV virus that causes AIDS. But they attack it very differently than all other medicines and the two newest ones can almost eliminate virus lurking in patients blood.

The new drugs give patients unprecedented choices in battling HIV. More importantly, combining them with older medicines deals the virus a one-two punch that doctors hope -- although they haven't proved it yet -- will suppress HIV enough that patients can live with AIDS for decades, just as they control other chronic diseases like diabetes.

The headlines started last December when the Food and Drug Administration approved Hoffman LaRoche's saquinavir, the first but weak protease inhibitor, in a record 97 days.

That record quickly fell. On March 1, the FDA approved Abbott Laboratories' more powerful ritonavir in 72 days. Two weeks later, indinavir got the nod just 42 days after manufacturer Merck & Co. filed an FDA application.

Protease inhibitors weren't the only good news. Patients also got a new eye implant to prevent AIDS-related blindness, the FDA passed a better method to screen blood donations for HIV, and the first oral HIV.

AIDS patients until now had five choices: AZT, ddi, ddc, d4t and 3tc. All worked the same way, targeting an enzyme called reverse transcriptase that is important for HIV to reproduce. But the drugs helped only modestly, and HIV quickly mutates to resist them.

So scientists specially designed drugs to target a second enzyme, protease, that is vital to another key step in HIV's reproduction. When combined with older medicines, the two most powerful protease inhibitors can cause the amount of HIV floating in many patients' blood to plummet by up to 98%.

HIV still lurks elsewhere in the body, so the drugs are not a cure.

Still, the idea is that keeping patients' HIV blood levels low for years would postpone AIDS symptoms. To do that, three-drug cocktails of either ritonavir or indinavir plus two older medicines became the most recommended AIDS therapy.

But that recommendation could change within the year:

A fourth protease inhibitor, Agouron Inc.'s nelfinavir, is in final testing and expected to be approved by 1997. Roche is creating a stronger saquinavir, also expected soon, and three other protease inhibitors are in earlier testing.

Abbott and Roche are studying the effects of taking two protease inhibitors together, ritonavir plus saquinavir.

Doctors are beginning studies of a four-drug mixture.

And companies have lately begun testing two drugs, nevaripine and delvaripine, in a third new class of AIDS medicines.

Experts caution that getting new AIDS drugs to patients fast means they haven't been tested for very long. So no one knows how long the new protease inhibitors' effects will last or even which patients should opt for which drug.

Another serious drawback is the price of treatment. Treating HIV as a chronic disease could cost each patient $250,000 over a lifetime.


Strep throat might trigger some childhood cases of obsessive-compulsive disorder, suggesting penicillin could help some kids with the psychiatric condition, a researcher says.

People with obsessive-compulsive disorder, or OCD, have unwanted thoughts such as fear of contamination or impending harm, and often perform rituals like excessive handwashing or counting. They know the rituals are senseless, but they can't help themselves.

Nobody knows what percentage of childhood cases may be linked to strep throat, Swedo said. But the theory is that blood proteins called antibodies that are supposed to latch onto strep germs may trigger OCD by mistakenly attacking certain parts of the brain.


Today, many experts think stomach ulcers are caused by a bacterium, not by stress. As a result, doctors are no longer prescribing drugs that reduce stomach acid. Instead, many of them are putting ulcer sufferers on antibiotics. Some Italian researchers claim to be close to developing an anti-ulcer vaccine.


Instead of paper charts on clipboards, doctors and nurses are starting to carry pocket-sized computers to track patients' records in hospitals. The change to computers is expected to free time for more patient care and make information more easily accessible.

For each patient, for instance, a nurse must fill out a health assessment, write a nursing care plan and goals for the patient, transcribe doctors' orders, keep a 24-hour flow sheet, track medicine administration and more.

A computer like the Compaq Companion speeds the process by eliminating much of the record keeping. Nurses tap their notes on a keyboard, and information is quickly stored automatically on a network where other authorized nurses, technicians and doctors can retrieve it instantly.

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