The multiple organizational factors impacting on a merger as well as those processes being impacted on throughout the merger process will be examined. First, the issue of constant and lucid communication and its importance throughout the merger and acquisition (M&A) process will be addressed. Second, an examination of the current corporate culture and its effects on employees when two companies merge is analyzed, while illuminating the realities of the new culture. An exploration of change in general is examined, as well as the reaction of employees (resistance) to these changes. Next, the article addresses the critical issue of stress, which is an M&A outcome within the new and uncertain environment. The article concludes with the process of managing and strategy throughout the phases. Furthermore, the five major sections (communications, corporate culture, change, stress, and managing/strategy) are sub‐divided into three sub‐sections: pre‐merger; during the merger; post‐merger.

SummaryConsecutive patients undergoing knee arthroplasty or tibial osteotomy at four participating hospitals received either enoxaparin, 30 mg subcutaneously every 12 h (n = 66) or an identicalappearing placebo (n = 65). All study medications started the morning after the operation and were continued up to a maximum of 14 days. Patients underwent surveillance with 125I-fibrinogen leg scanning and impedance plethysmography. Bilateral contrast venography was performed routinely at Day 14 or at time of discharge, if sooner. Deep vein thrombosis was detected by venography in 35 of 54 patients (65%) in the placebo group and in 8 of 41 patients in the enoxaparin group (19%), a risk reduction of 71%, P <0.0001. For the entire study group, deep vein thrombosis was detected by either venography of non-invasive tests in 37 of 64 patients (58%) in the placebo group and in 11 of 65 patients (17%) in the enoxaparin group, a risk reduction of 71%, P <0.0001. Proximal vein thrombosis was found in 19% of the placebo patients and in none of the enoxaparin patients, a risk reduction of 100%, P <0.001. Bleeding complications occurred in 5 of 65 patients (8%) in the placebo group and in 4 of 66 patients (6%) in the enoxaparin group, P = 0.71. There were no differences in the amount of blood loss, minimum hemoglobin levels and number of units of packed red cells given between the two treatment groups. We conclude that a fixed dose regimen of enoxaparin, started post-operatively, is an effective and safe regimen for reducing the frequency of deep vein thrombosis after major knee surgery.

Recombinant activated factor VII (rFVIIa) was found to be effective and safe in treating 24 bleeding episodes and to prevent bleeding during one bilateral herniorrhaphy in four children with Glanzmann thrombasthenia. One of the patients had alloantibodies to platelet membrane glycoprotein (GP) IIb/IIIa and was refractory to platelet transfusion. rFVIIa was administered at 89 to 116 μg/kg per injection every 2 hours, in association with antifibrinolytic drugs. Bleeding stopped in all cases, but platelet transfusion was required in one. Two bleeding episodes recurred 36 and 63 hours after discontinuation of rFVIIa, but were successfully treated with additional doses. No adverse effects of rFVIIa were observed. Although the number of patients is small, our study suggests that rFVIIa may be an alternative to platelet transfusions in patients with a severe congenital thrombocytopathy.

1. It has been shown that factor V accelerates the rate of conversion of prothrombin into thrombin by activated factor X, and that this activity does not depend on the presence of phospholipid. 2. Although the mechanism by which factor V increases the rate of reaction is not clear, it seems unlikely that it is converted into an enzyme. 3. The rate of conversion of prothrombin by purified activated factor X and factor V was increased threefold in the presence of phospholipid, and it is suggested that the lipid acts by adsorbing the proteins on its surface and hence increasing the local concentration of the reactants.