In the check-out line: Safe counts for surgical sponges

Brian Stewart's background is in the investment industry, including investments in medical device companies. To help in his due diligence, he would often reach out to friends, family and outside consultants with clinical backgrounds. Much of that dialogue would result in clinicians sharing their thoughts on issues they often faced in their daily practice. This is where he first became aware of the issue of retained surgical sponges, their frequency and the real economic and human costs. Brian's father, a surgeon, added additional perspective by sharing the realities of the operating room and the typical usage of sponges in surgery. From a number of previous investments Brian had made, he was relatively familiar with various forms of automatic identification, including simple barcodes, two-dimensional codes and RFID technologies. Thinking out loud to his father as they stood together in a line at a grocery store, watching a woman quickly scan each item in their cart and hand them a detailed receipt of each item, he pondered "Why not use a technology of some sort to help nurses count more accurately?" That was the beginning of the company they co-founded, SurgiCount Medical.

Brian and his father worked for years to develop a cost effective, safe solution. Finally they found something that worked well, from the garment industry – it uses iron-on thermal transfer labels. So a bar code on a piece of plastic is basically melted onto the sponge, placing a unique identifier on each sponge. When used with a small handheld scanner, the solution helps increase the accuracy of sponge counts, in that each sponge can only be counting IN once and OUT once. This addresses the underlying issue in the vast majority of retained sponge cases, false "correct" counts. That is still the core of the product that the company Brian is CEO of today (Patient Safety Technologies, which acquired SurgiCount back in 2005) offers, called the SurgiCount Safety-Sponge. That has proven to help eliminate retained sponges and the costs associated with them for those using it, which includes over 65 hospitals, including five of US News and World Report’s 2010-11 Honor Roll Hospitals.

Now, in the February 2011 issue of the Joint Commission Journal on Quality and Patient Safety, there's an article about a multi-year study, the largest ever done on retained foreign objects, in which the Mayo Clinic examines the occurrence rates of retained sponges and profiles the success that Mayo had by implementing the Safety-Sponge System there. Before implementation, Mayo was averaging a retained sponge every 64 days (about one in 8,000 operations). Eighteen months after implementing the Safety-Sponge System and using over 1.8 million Safety-Sponges in more than 87,000 cases, they have not had a single retained sponge. In addition to the usage at Mayo, over 32 million Safety-Sponges have been successfully used in more than 1.6 million operations.

Read a story on a http://www.PatientSafetyBlog.com/2007/01/they-dont-count-non-surgical-towels.html">retained object.

Thanks to Brian Stewart for our phone interview for this blog post and to Stephanie Pavol.

He lost a $25,000 bet: Chewing tobacco addiction

Red Sox Manager Terry Francona was seen in last night's World Series baseball game spitting five times and what clearly looked like brown tobacco juice emerged three times. He knows he has a problem: he lost a $25,000 bet that he could kick his habit by the end of the season. Francona appeared to switch to gum last night.

Watching Francona's toxic brown spit should spur Major League Baseball into a vigorous campaign against chewing tobacco. Joe Garagiola, who has spoken to major leaguers and amateur players about the risks of chewing tobacco, said yesterday that Francona's parents had asked him to talk to their son about his addiction. Garagiola said his message is that chewing tobacco is addictive, causes oral cancer and can cost you your life. "If I were to talk to Terry, I'd tell him to think seriously after the World Series about getting help," he said. "I know a good place, like the Mayo Clinic in Rochester, Minnesota."

Advice to nervous members of Red Sox Nation: Chew sugarless gum for the tension, and warn your tobacco-chewing friends about the dangers.

Read another of our baseball stories, or read Richard Sandomir’s source story in today’s New York Times.

Three days later, he was fine: Adverse Drug Reaction - Avandia

[Translation appears below]
A 70-year-old man with hypertension and chronic renal insufficiency presented with dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Metformin had been replaced with rosiglitazone, 4 mg/d, 1 month previously. The patient had no history of congestive heart failure. Physical examination revealed tachypnea and bilateral lower extremity edema. Chest radiography showed cardiomegaly with bilateral basilar infiltrates. Transthoracic echocardiography revealed left ventricular hypertrophy and diastolic dysfunction but normal LVEF. The serum digoxin level was slightly increased at 2.3 ng/mL. Serum creatinine values did not change. Rosiglitazone was discontinued, and intravenous furosemide was administered. Metoprolol, digoxin, minoxidil, and verapamil were replaced with losartan and felodipine. After 3 days, the patient was asymptomatic.

Translation: A 70-year-old man with high blood pressure and bad kidneys came to the hospital because he had a distinctive kind of rapid and labored breathing. Examination and test results showed he had an enlarged heart, and feet swollen with fluid. He had started taking Avandia a month earlier. Though he had no congestive heart failure before the Avandia, it looked like he was getting it, or another serious heart problem. In the hospital, doctors took him off Avandia. Three days later, he was fine.

He was one of millions of patients taking the highly profitable drug.

Two days ago, researchers published an article in the prestigious New England Journal of Medicine that reviewed 40 earlier studies on the subject, and discovered that users of Avandia (thiazolidinedione) got 40% more heart attacks than other diabetic patients who were not taking it.

In one of these studies, quoted above, Dr. Asra Kermani and his co-authors “conclude that thiazolidinediones can cause pulmonary edema or exacerbate heart failure. Thiazolidinediones should be used with caution or avoided in patients with left ventricular dysfunction or chronic renal insufficiency.”

Advice to people with diabetes: Discuss with your doctor what to do. There may well be alternative drugs, not to mention other alternatives like exercise, diet, etc.

Read another of our adverse drug reaction stories, or read Stephanie Saul’s story in Tuesday’s New York Times.