November 8, 2007 HPN to recognize “Supply Chain-Focused CEOs” Many industries outside of healthcare recognize and respect the value that effective and efficient supply chain management contributes to the top and bottom lines. Among healthcare providers, such recognition and support is growing, slowly but surely, from the top post in the executive suite. That’s why Healthcare Purchasing News launched its yearly search for “supply chain focused CEOs" three years ago. We wanted to locate forward-thinking men and women to share their insights with you, and you’ve helped us do that. In fact, we’ve profiled of 10 of them already since January 2005. Well, it’s that time of the year again – time to nominate noteworthy hospital presidents/CEOs for HPN’s fourth annual “S.U.R.E. Award for Supply Chain Focused CEOs” award. We’re looking to recognize chief executives who support, understand, recognize and empower the materials management department to do what needs to be done to achieve bottom-line savings and top-line revenue. We ask you, our dedicated readers, to recommend worthy candidates for recognition in our January 2008 edition by e-mailing us reasons how and why they deserve the spotlight – no more than a couple of paragraphs are needed for each of the four S.U.R.E. categories listed above that comprise the “SURE” acronym. For your nomination to qualify, please be sure to comply with the following rules: 1. Any nomination must be original and exclusive to HPN and not have been submitted, either original or edited, to any other publication or online media outlet currently or within the previous year. 2. GPO and distributor support is commendable, but we’re looking for internally driven details beyond GPO- and distributor-driven contributions. 3. Any nominated executive (or nominator) must be willing to share relevant basic financial details with our readers, including annual revenues, annual expenses and annual purchasing volume. Help us share the stories of these remarkable CEOs in our January 2008 edition so that the industry may learn from them and be inspired. Thanks in advance. E-mail us your nominations by Wednesday, November 14, to email@example.com. OHSU research suggests America may over-vaccinate A new study published in the New England Journal of Medicine this week by Oregon Health & Science University researchers suggests that timelines for vaccinating and revaccinating Americans against disease should possibly be reevaluated and adjusted. The study shows that in many cases, the established duration of protective immunity for many vaccines is greatly underestimated. This means that people are getting booster shots when their immunity levels most likely do not require it. “The goal of this study was to determine how long immunity could be maintained after infection or vaccination. We expected to see long-lived immunity following a viral infection and relatively short-lived immunity after vaccination, especially since this is the reasoning for requiring booster vaccinations. Surprisingly, we found that immunity following vaccination with tetanus and diphtheria was much more long-lived than anyone realized and that antibody responses following viral infections were essentially maintained for life,” explained Mark Slifka, Ph.D. Slifka serves as an associate scientist at the Vaccine and Gene Therapy Institute with joint appointments at the Oregon National Primate Research Center and the department of molecular microbiology and immunology in the OHSU School of Medicine. “We want to emphasize that proper vaccination is vital for protecting people against infectious disease. We also need to mention that over- vaccinating the population poses no health or safety concerns, it may just be unnecessary under certain circumstances. What our study found was that the lifespan of protective immunity for certain vaccines is much longer than previously thought. So what does this mean? Based on this data and other studies, we may want to consider adjusting some of our recommended vaccination schedules. Doing so may reduce the number of required shots that are administered each year in this country while at the same time help extend limited health care resources,” Dr. Slifka explained. To conduct the research, Slifka and his colleagues evaluated 630 blood samples from a total of 45 study participants. In the case of some participants, archived serum samples provided data going back as far as 26 years. Once gathered, the data was then analyzed to determine the level of immunity in each individual for measles, mumps, rubella, chickenpox (Varicella-zoster virus), mononucleosis (Epstein-Barr virus), tetanus and diphtheria over an extended period of time. Upon further examination, researchers found that antibody responses caused by viruses such as measles mumps, and rubella remained at protective levels for several decades and in most cases, for life. This is interesting because these three viruses were classically described as “childhood infections” because it was rare to be infected twice in a lifetime. The research also reconfirmed a previous finding by Slifka and his colleagues: that the duration of immunity after smallpox vaccination is much longer than previously thought. “Another example is the tetanus vaccine,” said Slifka. “Doctors are told that vaccination is effective for a period of 10 years, but after that, people should be revaccinated. Based on our studies and the work of others, once a person has received their primary series of vaccinations they are likely to be protected for at least three decades. Indeed, other countries such as Sweden have changed their vaccination policies and doctors are advised to offer tetanus revaccination only once every 30 years. Importantly, this has not resulted in any increase in the number of tetanus cases in Sweden and demonstrates first-hand that switching from the 10-year to 30-year policy is safe and effective. Taking this small step in vaccination scheduling could save hundreds of millions of dollars on healthcare here in the US.” Early research suggests a shot could replace blood pressure meds A hypertension vaccine could be an important alternative to conventional drug therapy because of patients’ inconsistent drug intake, if further research supports results from a small study testing the safety and tolerability of a vaccine. “Despite the fact that effective drugs are available, only about one out of four people has their blood pressure successfully controlled,” said Juerg Nussberger, M.D., professor of medicine at the University Hospital of the Canton of Vaud, in Lausanne, Switzerland, and lead author of the study reported at the American Heart Association’s Scientific Sessions 2007. “Many patients are apparently unable or unwilling to take pills every day for the rest of their lives. If we could add or substitute a vaccine that would need to be given just every few months, I think we could achieve better control of high blood pressure.” The vaccine targets angiotensin II, a molecule that constricts blood vessels and raises blood pressure. Angiotensin II is already the indirect target of several blood pressure medications. Angiotensin-converting enzyme (ACE) inhibitors (such as benazapril and enalapril) reduce the production of angiotensin II in the blood by slowing its conversion from angiotensin I. Angiotensin receptor blockers (ARBs, such as candesartan and losartan) prevent angiotensin II from acting on these receptors, thus preventing constriction of the blood vessels. “Instead, we take non-infectious particles with a virus shape and chemically couple them with angiotensin II so the body begins to vigorously attack angiotensin II,” said Martin Bachmann, Ph.D., senior co-author of the study and chief scientific officer at Cytos Biotechnology AG in Zurich, a company that creates vaccines to treat and prevent chronic diseases. After injections at zero, four and 12 weeks from the start of the study, patients who received the vaccine had a strong antibody response against angiotensin II, which was significantly higher in those receiving the higher dose. Blood pressure changes were evaluated at week 14. Compared with patients who received a placebo, those who were injected with 300ug of vaccine significantly reduced their daytime systolic blood pressure by 5.6 millimeters of mercury (mm Hg) and their diastolic blood pressure by 2.8 mm Hg. “Quite unexpectedly, our vaccine had the most striking effect early in the morning, the most dangerous time to have high blood pressure because it raises the risk of heart attack and stroke,” Bachmann said. In the 300ug group, the typical morning blood pressure surge was blunted between 5 a.m. and 8 a.m. After correcting for baseline blood pressure levels, the 8 a.m. blood pressure was lower by 25 mm Hg systolic and 13 mm Hg diastolic than in the placebo group. Most people take their blood pressure medications first thing in the morning, so medication levels are at their lowest during this early morning pressure rise. “Antibodies produced by the vaccine seem to function like a sponge,” Bachmann said. “The sponge empties out during the night when little angiotensin II is produced, so it is able to take up all the angiotensin II produced early in the morning.” Another potential advantage of the vaccine over ACE inhibitors and ARBs is that these medications result in a large increase in renin, an enzyme that is thought to cause inflammation and is implicated in kidney failure. Vaccination induced only a low increase in renin, Bachmann said. The next step in developing the vaccine is another small trial to determine whether a different injection regimen will create a larger antibody response and a greater reduction in blood pressure. Energy drinks may pose risks for people with high blood pressure, heart disease Downing an “energy drink” may boost blood pressure as well as energy, researchers said in a small study presented at the American Heart Association’s Scientific Sessions 2007. In the study, conducted by Wayne State University researchers, blood pressure and heart rate levels increased in healthy adults who drank two cans a day of a popular energy drink. While the increases didn’t reach dangerous levels in the healthy volunteers, the increases in blood pressure and heart rate could prove to be clinically significant in patients with heart disease or in those who consume energy drinks often, said James Kalus, Pharm.D., senior manager of Patient Care Services at Henry Ford Hospital in Detroit, MI, and a former Wayne State researcher who led the study. “Individuals with high blood pressure and heart disease should be advised to avoid these drinks.” Most energy drinks contain high levels of caffeine and taurine, an amino acid also found in protein-containing foods such as meats and fish. Both have had effects on heart function and blood pressure in some studies. In contrast, “sports drinks” in general contain various mixtures of water, sugars and salts alone, without chemicals aimed at increasing “energy” or alertness. The participants drank two cans of an energy drink that contained 80 milligrams of caffeine and 1,000 milligrams of taurine. Researchers then measured blood pressure, heart rate and ECG again at 30 minutes, one, two, three and four hours after consumption. This continued for the next five days, and then, on the seventh day, the researchers followed the same procedures used on the first day. Within four hours of energy drink consumption, maximum systolic blood increased by 7.9 percent on day one and 9.6 percent on day seven; diastolic blood increased by 7 percent and 7.8 percent, respectively, within two hours of energy drink consumption. Heart rate increased by 7.8 percent on day one and 11 percent on day seven. “This occurred while participants were sitting in chairs watching movies,” said Kalus. “The increases in heart rate and blood pressure weren’t enough for something to happen acutely, but a person on hypertension medication or who has cardiovascular disease may not respond as well. While energy drinks increase concentration and wakefulness, people with risk factors for heart disease could have a bad reaction. The subjects in this study were healthy with low blood pressure.” Kalus feels that the increases in blood pressure and heart rate may be due to the caffeine and taurine in the drinks. However, the energy drink used in the study had as much caffeine as one to two cups of coffee, and usually the effect of this amount of caffeine on blood pressure would be expected to wane over 2 or 3 days of regular intake. The researchers are unsure what effect exercise or the combination with alcohol has on a person who drinks energy drinks; however, some countries advise against using energy drinks to quench thirst while playing sports. Until further study, Kalus said people with high blood pressure or heart disease should avoid energy drinks because they could affect their blood pressure and may even alter the effectiveness of their medications. Providence Health & Services chooses WWT and AeroScout for wireless asset tracking solution World Wide Technology Inc. (WWT), a systems integrator that provides technology and supply chain solutions, and AeroScout, Inc., a provider of Wi-Fi-based Active RFID solutions, announced the addition of Providence Health & Services (PH&S) to their healthcare customer portfolio. WWT and AeroScout have partnered to configure, install, train and support a Wi-Fi-based asset tracking and location solution at Providence’s Centralia location. PH&S is a 27 hospital, 46,000 employee system which operates in Alaska, Washington, Montana, Oregon and California. “Eliminating the time and resources associated with searching for and managing assets, whether they are IT equipment, medical devices or even patients and caregivers, will reduce costs and improve operational efficiency The WWT and AeroScout solution delivers compelling value, especially because we can take advantage of our existing wireless infrastructure,” said Jody Albright, Western Washington CIO at PH&S. The wireless asset tracking and location solution utilizes innovative Active RFID technology from AeroScout to improve equipment management and utilization, increase safety and patient throughput. It also provides data for analysis and reporting to improve regulatory compliance and reduce expenses. The AeroScout deployment will utilize Providence’s existing IT infrastructure and network investments, including its medical grade wireless network designed by Motion Computing and powered by Cisco Systems. The first phase of the Centralia project will track networked devices, such as laptops and tablets with potential future phases addressing medical equipment, patients and staff while also incorporating Passive RFID components for greater inventory control capabilities. Fires during surgeries a bigger risk than thought During gallbladder surgery at North Shore Medical Center (Salem, MA) four years ago, a female patient became a victim of a little-known medical hazard: A flash fire ignited on her midsection. Her surgeon rubbed an alcohol-based cleaning solution on her abdomen after her surgery, wiped it clean, and then decided to remove a mole from her stomach with a hot cautery instrument. Blue flames immediately shot up from her midsection, “similar to a flambé,” the surgeon told state public health investigators. The surgeon and other operating room staff quickly patted down the flames and pulled off the sterile draping that also ignited, he said. But the patient suffered painful first- and second- degree burns, state investigators determined. Operating room fires have received less attention than other potential hazards such as wrong-site surgery, but fires have seriously injured and even killed patients. And new data show that they are more common than previously believed. Pennsylvania, which collects some of the most comprehensive statistics, has had 28 operating room fires a year for the past three years, 1 in about every 87,000 surgeries. The state’s data, released in September, suggest that nationally there may be hundreds of such fires out of roughly 50 million inpatient and outpatient surgeries annually, not the 50 to 100 previously estimated by patient safety organizations. The patient filed a lawsuit against her surgeon who denied allegations of malpractice in court papers. Last month, the patient and her lawyer filed a lawsuit against the surgeon’s malpractice insurer, Medical Liability Mutual Insurance Co. The hospital, which is not named in the lawsuit, said it disputes some of the patient’s allegations about the fire and her treatment afterward, as well as some of the findings of health officials. But hospital executives acknowledge the fire occurred and said they reported it to the state Department of Public Health. Several oversight groups, including the Department of Public Health and the Joint Commission, have published warnings about surgical fires and recommended preventive measures since the early 2000s. In the past year, several professional organizations, including the American Academy of Otolaryngology - Head and Neck Surgery, the Association of periOperative Registered Nurses, and the American Society of Anesthesiologists, have also launched educational efforts. Mark Bruley, vice president for accident and forensic investigation at the ECRI Institute in Pennsylvania, said these programs are beginning to decrease the number of accidents. Traditionally, anesthesiologists used highly flammable gases such as ether to put patients to sleep, and doctors and nurses were vigilant about preventing fires, Bruley said. But as doctors began using less flammable anesthetics in the 1980s, prevention efforts started to wane. At the same time, other fire hazards grew, including the use of 100 percent oxygen, which can leak into the air, increasing the combustibility of gauze and hair; alcohol-based skin cleansers; and advanced surgical tools such as lasers and electrocautery devices. According to ECRI, 44 percent of operating room fires occur during head, face, neck, or chest surgery, when electrical surgical tools are closest to the oxygen the patient is breathing. As with other types of surgical errors, poor communication between surgeons, nurses, and anesthesiologists can be the root of the problem. Operating room safety specialists recommend that doctors use less than 100 percent oxygen during head and neck surgery, that surgeons store hot instruments off the operating table when they are not in use, and that doctors wait two or three minutes until alcohol-based products have evaporated from the skin before using cautery tools. In this patient’s case, her surgeon told health investigators in 2003 that he applied an alcohol-based “skin prep” to her abdomen and chest before removing her gallbladder to help prevent postoperative infections. The substance is sticky, he said, so after he finished the operation, he applied an alcohol-based cleaner to remove it. He said he then remembered that he promised to remove a mole, so he grabbed the cautery device, and a flash fire occurred. According to the chief medical officer at North Shore, the fire led to more aggressive prevention policies, some of which were already in the works before the incident. (Boston Globe) To read the original article see: http://www.boston.com/news/local/articles/2007/11/07/fires_during_surgeries_a_bigger_risk_than_thought/?page=1 A sanitation crisis that’s no joke The nation with the greatest lead in potty technology is, no doubt, Japan. Toilets there aren’t just self-flushing; that’s Jurassic technology by Japan’s standards. The best detect you as you enter the bathroom, lifting their lids and firing up their seat-warmers. When finished, you have a choice of warm spritzes, “bidet” or “shower”, followed, if you like, by a drying blast of hot air. But it takes a wealthy nation, like Japan, to provide such luxury. Far more of the world gets along without even the fundamentals. According to the World Health Organization, 40 percent of the globe, or 2.6 billion people, have no access to hygienic toilets. They must use latrines, outhouses or buckets, or simply the bushes or rivers nearby. The World Toilet Summit, which just took place in New Delhi, is an attempt to improve that situation by drawing attention to the problem and pushing for better sanitation technologies. It is the brainchild of Jack Sim, a Singapore real estate mogul who grew up in poverty and remembers seeing children in his neighborhood shedding worms as they ran around diaperless. In 2001, he founded the World Toilet Organization, which has a blue toilet seat for its logo. Despite the silly name, he means serious business. Diarrhea kills 1.6 million children each year, more, even, than malaria, and the pollution of drinking water with waste is a principal cause. Also, about 160 million people have intestinal worms, which can cause malnutrition and anemia. Worms competing for the nutrition that their hosts eat can leave their victims too weak to farm or go to school and prone to other infections. Experts all agree that the two most important public health measures in the world, measures that saved more lives than either vaccines or antibiotics, were in place by the time of the Roman Empire: running water and toilets that carry feces safely away. But, because of the expense of pipes and plumbing, they have remained for over 2,000 years the province of the relatively rich of the world, even though measures that save far fewer lives, from cinchona bark for malaria to antiretrovirals for AIDS, have been hailed as godsends. Toilets get too little respect, Sim argues, openly wishing that someone with more celebrity than he has would take up the cause, because lack of adequate toilets threatens more children than, for example, global warming does. (The New York Times) See http://www.nytimes.com/2007/11/04/weekinreview/04basicA.html?ref=health for more.