Cedars-Sinai Medical Center

medical staff pulse newsletter

Text size: A A A
A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF July 9, 2010 Issue | Archived Issues

Pharmacy Focus

Pfizer withdraws Mylotarg® from market

On June 21, Pfizer announced the voluntary withdrawal of the drug Mylotarg® (gemtuzumab ozogamicin) from the U.S market. 

» Read more


Imaging Case of the Month for July

A 68-year-old female with dyspnea on exertion underwent a CT coronary angiogram as part of her workup. 

» Read more


Meetings and Events

Interdisciplinary Diabetes Conference, July 13

Argentina: Land of Pampas, Gauchos, Tango, Polo and Soccer, July 20

Sand N' Snore, July 16

» Read more

Hooray for Hollywood!

The Independence Day holiday weekend started with a bang – and a band – for 346 Cedars-Sinai physicians, their families and friends at the Hollywood Bowl.

» Read more

PEG Rarely Indicated for Palliative Care

New form can assist in evaluation

By Andrew Ippoliti, M.D., and Daniel Fink, M.D.
A gastrostomy tube is placed directly into the stomach to allow enteral nutrition without the discomfort, potential for dislodgement, and mechanical complications of a long-term nasogastric tube. With the development of flexible fiber optic endoscopy in the past few decades, percutaneous enterogastrostomy (PEG) has become the preferred technique for gastrostomy tube placement.

» Read more

House staff introduced to their new home

Eighty-eight residents and 65 fellows joined Cedars-Sinai’s house staff in June.

» Read more

Hooray for Hollywood!

The Independence Day holiday weekend started with a bang – and a band – for 346 Cedars-Sinai physicians, their families and friends at the Hollywood Bowl.

The "July 4th Fireworks Spectacular" kicked off with a rousing performance of patriotic standards including "America the Beautiful" and "Battle Hymn of the Republic" performed by the Los Angeles Philharmonic and the U.S. Air Force Band of the Golden West. Country superstar Vince Gill played a guest set of some of his fan favorites.

For the finale, the crowd "oohed" and "aahed" as 10 minutes of breathtaking fireworks perfectly choreographed to the marches of John Phillip Sousa shot into the sky. The gathering at the Hollywood Bowl is an annual tradition of the medical staff.

The event was organized by Marjorie Santore-Besson, director of System Affairs, and Erika Waring, executive assistant.

Lou Cohen, M.D., and his wife NikiSrinath Samudrala, M.D., and his family relax before the show.
Thomas Gordon, senior vice president of the Cedars-Sinai Medical Delivery Network, Jon Kobashigawa, M.D., director of the Heart Institute heart transplant program, Jignesh Patel, M.D., co-medical director of the Heart Transplant Program, and their families enjoy their festive box seats and box dinners at the Hollywood Bowl.Steven Piantadosi, M.D., director of the Samuel Oschin Comprehensive Cancer Institute, and Howard Sandler, M.D., chair of Radiation Oncology, relax and enjoy the pre-show festivities at the Hollywood Bowl.
Neurovascular Center director Michael Alexander, M.D., and his wife Joanne brought their family to the Hollywood Bowl to start their holiday weekend with wonderful music and eye-popping fireworks.Dr. and Mrs. Carey Strom recline in their box seats, waiting for the L.A. Phil to take to the stage.
Steven Galen, M.D., vice chief of staff, and Chris Ng, M.D., secretary of the medical staff, prepared for the show and long weekend.Chair of the Department of Pediatrics and director of the Division of Neonatology Charles Simmons, M.D., and his family get into the patriotic spirit at the Hollywood Bowl.
Andrew Schroeder, M.D., and his family pose for photos before the music begins.Food, flags and fireworks: This young man, Dr. Christine Walsh’s son, shows his Cedars-Sinai family how to get the holiday weekend started.

PEG Rarely Indicated for Palliative Care

New form can assist in evaluation

By Andrew Ippoliti, M.D., and Daniel Fink, M.D.
A gastrostomy tube is placed directly into the stomach to allow enteral nutrition without the discomfort, potential for dislodgement, and mechanical complications of a long-term nasogastric tube. With the development of flexible fiber optic endoscopy in the past few decades, percutaneous enterogastrostomy (PEG) has become the preferred technique for gastrostomy tube placement.

PEGs are frequently inserted in patients unable to swallow or swallow safely. Physicians and patient’s families often believe that enteral feeding via PEG prevents aspiration, maintains nutritional status, prevent decubitus ulcers and prolongs life. While no randomized trial has been done, the medical literature unfortunately shows that PEGs do not prevent aspiration, do not maintain nutritional status, do not prevent decubitus ulcers, and actually increase mortality.

PEGs are frequently inserted in elderly patients after disabling neurologic events, but PEG insertion is rarely if ever indicated as part of end of life care. The fluid and nutritional needs of a patient with advanced dementia are low, and may be met by peripheral intravenous hydration with glucose solutions. Extended care facilities will accept patients with nasogastric feeding tubes when there is limited life expectancy, although even these tubes are probably not indicated as part of end of life care.

Physicians should focus their discussions with families on patient preferences, goals and values. The lack of efficacy of PEGs in preventing complications or reducing mortality – indeed, the fact that PEGs increase mortality – should be explained to patients and families.

Members of the Center for Healthcare Ethics, Chaplaincy, and Palliative Care Services are available to assist in these discussions. References to literature regarding mortality rates in PEG patients may be obtained from the Division of Gastroenterology.

As part of efforts to improve patient care and reduce unnecessary utilization of PEGs, attending physicians and consulting gastroenterologists will be required to complete a PEG Evaluation Form before the procedure will be performed at Cedars-Sinai.

PEG Evaluation Form

Please send questions about the form or the appropriate criteria for PEG insertion to Dr. Ippoliti, director of Administration and Clinical Affairs for the Division of Digestive Diseases, at Andrew.Ippoliti@cshs.org.

House staff introduced to their new home

Eighty-eight residents and 65 fellows joined Cedars-Sinai's house staff in June.

The new physicians went through several hours of orientation, which covered everything from accessing the medical library to understanding medical center policies.

Senior librarian Bill Jacobs was on hand to provide information to the new residents.

Residents take a break during their orientation.