What it takes to implement and maintain successful supplier-managed inventory programs.

Besieged by global competition and rapid technology changes, manufacturers subsequently have increased pressures on their suppliers to deliver product in less than traditional lead-times. In order to accomplish this goal, the proper selection of suppliers and inventory management programs is paramount. This article will focus on the selection of suppliers, what it takes to make the programs successful, and the most popular types of supplier-managed inventory programs in today's high-technology marketplace.

Suppression of silent ischemia by metoprolol without alteration of morning increase of platelet aggregability in patients with stable coronary artery disease.

To determine the effect of metoprolol on silent ischemia and platelet aggregability, 10 patients with coronary artery disease were studied with a randomized, double-blind, placebo-controlled, crossover trial. Patients were treated with metoprolol (200 mg b.i.d.) or placebo for 1 week and then received the alternate therapy. Two days before the end of each treatment period, platelet aggregability was studied for 24 hours, and a 48-hour ambulatory electrocardiogram was obtained. Compared with placebo, metoprolol significantly decreased the total number (from 26 to 4, p less than 0.1) and duration (from 735 to 84 minutes, p less than 0.01) of silent ischemic episodes. This decrease was accompanied by a decrease in the mean blood pressure (from 127/81 to 118/71 mm Hg, p less than 0.01) and the mean heart rate (from 70 to 54 beats/min, p less than 0.01). The incidence of silent ischemic episodes in the morning was significantly higher in untreated patients than in treated patients. The few episodes observed during metoprolol treatment occurred at the same time as the peak incidence observed during placebo treatment. During placebo treatment, platelet aggregability increased from 6:00 to 9:00 AM as reflected by a decrease in the threshold concentrations of ADP and epinephrine required to induce biphasic platelet aggregation (from 4.8 +/- 0.8 to 2.6 +/- 0.4 microM, p less than 0.02; and from 7.3 +/- 2.3 to 1.8 +/- 0.9 microM, respectively, p less than 0.02). Metoprolol did not alter the basal level nor blunt the morning increase of platelet aggregability.(ABSTRACT TRUNCATED AT 250 WORDS)

Asymptomatic coronary artery disease.

Asymptomatic coronary artery disease (ACAD) is a significant diagnosis that is documented in the current cardiology literature. This syndrome is characterized by myocardial ischemia without the typical anginal pain. Diagnosis must be specific, with the use of objective evidence of ischemic changes provided by ambulatory monitoring or exercise stress testing. It is the purpose of this article to review the current literature for the prognosis, the population at risk, and the recommended therapies for these patients. ACAD appears to occur in three different types of individuals. A type 1 person is totally asymptomatic, has no history of angina, myocardial infarction, or congestive heart failure, and demonstrates myocardial ischemia. The type 2 patient with ACAD is in the postmyocardial infarction period and demonstrates asymptomatic myocardial ischemia. The type 3 patient with ACAD is one who experiences myocardial ischemia both with and without pain. Nursing needs to provide support and guidance for the ACAD patient and family. Common nursing diagnoses have been outlined to assist in planning the care of this patient population.