Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Oct. 29, 2010 Issue | Archived Issues

P&T Committee Approvals

Pharmacy Focus

Formulary review of asenapine (Saphris®) and several physician guidelines, including methotrexate for ectopic pregnancy, were among the items addressed by Cedars-Sinai’s Pharmacy and Therapeutics Committee at its August 2010 meeting.

For more information, call Cedars-Sinai’s Drug Information Center at (310) 423-3784.

Pharmacy and Therapeutics Committee August 2010


Physician News

Margie A. Morgan, Ph.D.

Rick B. Delamarter, M.D.

Hyun Bae, M.D.

» Read more


Meetings and Events

The Jewish World of Broadway
Nov. 4

The Great American Stickup
Nov. 5

Advances in Multi-Specialty Aesthetic and Reconstructive Plastic Surgery Symposium and Bernard G. Sarnat, M.D., Lectureship
Nov. 6-7

Run for Her
Nov. 14

» Read more

2010 Influenza Screening and Testing

Hospital Epidemiology has created the following guidelines when for influenza screening, testing and isolation precautions.

» Read more

CS-Link™ Inpatient Phase 2 Now Live

On Oct. 23, Cedars-Sinai went live with Inpatient Phase 2 of the CS-Link™ implementation. It was an extraordinary effort by Cedars-Sinai nurses, physicians and other clinical care staff to prepare for this event. » Read more

Daniel Berman, M.D., Named Pioneer in Medicine

Daniel S. Berman, M.D., a founding father of nuclear cardiology, received the 2010 Pioneer in Medicine award. The honor was announced at the Annual Meeting of the Medical Staff on Monday, Oct. 18.


» Read more

Mark Noah, M.D., Receives Chief of Staff Award

Mark Noah, M.D., does much more at Cedars-Sinai than run the medical center’s expansive resident training program. Last week, he accepted the 2010 Chief of Staff Award for his efforts.



» Read more

2 Minutes With Gerhard Fuchs, M.D.

Dr. Fuchs is director of the Minimally Invasive Urology Program, vice chair of the Department of Surgery and a urologist at the Urology Center at Cedars-Sinai. Since 1977, he has served on the Advisory Board of Cedars-Sinai's Endoscopic Surgery Training and Research Center.


» Read more

Printing an Inpatient Detailed Transfer Medication List

Web/VS Tip of the Week

Printing of an inpatient detailed Transfer Medication List is available in Web/VS. To view or print the medication list, simply take the following steps:

» Read more

Imaging Case of the Month for October

Make your diagnosis

History: A 32-year-old male recently diagnosed with HIV presented to the emergency room with lethargy, agitation and right-sided weakness. CT scan of the brain without intravenous contrast showed multiple bilateral low attenuation white matter lesions within the cerebral hemispheres.

» Read more

2010 Influenza Screening and Testing

Patients in medical settings with influenza-like respiratory illness should be screened using the following criteria:

  • Fever (>38.0oC or >100.4oF)

AND one or more of the following:

  • Cough
  • Shortness of breath
  • Difficulty breathing
  • Muscle aches
  • Sore throat

If the patient meets the above criteria:

  • In ambulatory settings and Emergency Department, immediately place a surgical mask on the patient.
  • If possible, separate the patient from others or place the patient in a private room.
  • If admitted, it is not necessary to place the patient in a negative pressure room.

 

Isolation Precautions

Call Hospital Epidemiology at (310) 423-5574 with questions.

  • Healthcare workers evaluating suspected cases should use the “Droplet Isolation” precautions currently recommended by the CDC as follows:
    • Hand hygiene – Wash hands (soap and water or alcohol-based hand rub) before entering and upon leaving the patient room
    • Masks* – Wear a disposable surgical mask upon entering room
      * Wear an N-95 respirator mask with face shield or powered air purifying respirator (PAPR) when performing aerosol-inducing procedures such as sputum induction, intubation, extubation or bronchoscopy.
  • Follow standard precautions (as with all patients):
    • Gloves – Wear disposable gloves gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated
    • Gowns – Wear disposable gown if soiling of clothes with a patient’s respiratory secretions is anticipated

Laboratory Testing

Contact Microbiology (Dr. Morgan or Dr. Nichols) at (310) 423-4777 with questions.

CSMC laboratory influenza testing protocol:

  • Submit a nasal (upper nasal) or nasopharyngeal (NP) swab placed in Universal Transport media. For pediatric patients, nasal washing specimens are appropriate.
    • Submit specimens to the Microbiology lab (7th floor)
    • Testing sensitivity is highly dependent on the quality of specimen collection
  • PCR is the test of choice for all adult and pediatric inpatients suspected of having influenza. Order “Influenza PCR” – turn-around time is ~24 hours (weekend times may vary).

Influenza Screening and Testing

CS-Link™ Inpatient Phase 2 Now Live

On Oct. 23, Cedars-Sinai went live with Inpatient Phase 2 of the CS-Link™ implementation.

It was an extraordinary effort by Cedars-Sinai nurses, physicians and other clinical care staff to prepare for this event. The CS-Link project team did an excellent job translating clinicians’ needs into an electronic medical record system that meets our future technology needs. This has been a particularly challenging transition for nurses and, to date, their adoption of CS-Link has been remarkable.

Medical staff leadership thanks all the physicians for their patience during the go-live period with special thanks extended to the CS-Link Physician Champions for their dedication to supporting other doctors and nurses.

The champions assisted with project planning and communication during events such as rounding with WOWs (Workstations on Wheels), meet-and-greets, CS-Link project meetings and hallway conversations. All of these efforts helped to make the IP2 go-live a success.

Medical staff members interested in becoming a CS-Link Champion should contact Steve Galen, M.D., or Marty Hopp, M.D., co-chairs of the CS-Link Physician Advisory Committee. Increasing physician participation will improve subsequent physician implementations.

The IP2 Go-Live Medical Staff Resource Center in room 2806 will remain open through Sunday, Nov. 7. Please stop by or call the MD Support Hotline at ext. 3-2828 for answers to your questions about CS-Link and Web/VS. CS-Link Physician Champions and members of the physician support staff are available to assist you.


CS-Link Physician Champion David Palestrant, M.D., promotes the use of CS-Link while rounding in the Neuro ICU. He has been a rapid and early adopter of CS-Link in his unit.

Daniel Berman, M.D., Named Pioneer in Medicine

Daniel S. Berman, M.D., a founding father of nuclear cardiology, received the 2010 Pioneer in Medicine award.

The honor was announced at the Annual Meeting of the Medical Staff on Monday, Oct. 18.

Dr. Berman was recruited by the medical center 33 years ago to serve as director of Nuclear Cardiology. He quickly recognized the importance of “multimodality cardiac imaging” – the use of various technologies to establish an accurate picture of the heart and its function. As a result, Nuclear Medicine merged in 1981 with Radiology to form the Department of Imaging. The former Division of Nuclear Cardiology is now called Cardiac Imaging, and it includes nuclear cardiology, cardiac CT and cardiac MRI. Dr. Berman now serves as chief of cardiac imaging at the Cedars-Sinai Heart Institute and S. Mark Taper Foundation Imaging Center.

Dr. Berman and his team have created much of the imaging software in use today. He also established the largest and most extensively studied patient database in the field of cardiac imaging.

“Thirty-five years ago, he predicted the pathway that nuclear cardiology would take,” said John D. Friedman, M.D., chief of Outpatient Cardiac Imaging, as he introduced Dr. Berman at the meeting.

Dr. Friedman presented the award with Steven Galen, M.D., vice chief of staff and chair of the Pioneer in Medicine selection committee. Since 1981, the award has been presented to members of Cedars-Sinai’s medical staff who met numerous criteria and have made clinical and research contributions recognized at Cedars-Sinai and in the national or international medical communities.

 

Prediman K. Shah, M.D., right, director of both the Division of Cardiology and Oppenheimer Atherosclerosis Research Center, congratulates Dr. Berman.

 

Mark Noah, M.D., Receives Chief of Staff Award

Mark Noah, M.D., does much more at Cedars-Sinai than run the medical center’s expansive resident training program.

During the past year, he has been a leader in two hospital-wide projects – the implementation of CS-Link™ and hand hygiene compliance.

Last week, Dr. Noah, the medical director of Graduate and Continuing Medical Education and director of Cedars-Sinai’s Medicine Residency Training Program, was honored for all his efforts.

He accepted the 2010 Chief of Staff Award at the Annual Meeting of the Medical Staff on Monday, Oct. 18.

“The Medical Executive Committee identified four major projects to focus on this year – and Mark tacked two of them,” said Chief of Staff Scott Karlan, M.D. ”We all owe Mark a debt of gratitude for representing the medical staff and taking a leading role in both the CS-Link and hand-hygiene projects.”

Friends and colleagues congratulate Dr. Noah, at left, on receiving the 2010 Chief of Staff Award.

2 Minutes With Gerhard Fuchs, M.D.

Dr. Fuchs is director of the Minimally Invasive Urology Program, vice chair of the Department of Surgery and a urologist at the Urology Center at Cedars-Sinai. Since 1977, he has served on the Advisory Board of Cedars-Sinai's Endoscopic Surgery Training and Research Center.

If you were not a physician, what would you be?

I would go back to university to study Roman history, Latin and medieval history, and to teach. I’d spend part of the year in Europe, probably Rome, since the history of the papacy is best studied locally

What drew you to your specialty?

During medical school, I did clerkships and got a good cross section of surgical specialties: closed, open, minimally invasive, diagnostic ultrasound. I was able to experience many different surgical techniques in what was then a small field.

If you could choose again, would you choose the same one or another?

This one – I would do it all over again.

What is the funniest thing a patient has ever said to you?

When I had my moustache, I was treating a Swedish lady who didn’t speak English. A family member was translating for her. She kept looking at me, and looking, and looking. Finally, she smiled and said, “Magnum P.I.!”

What do you do to relax?

Family, reading, history, philosophy, languages and, of course, soccer. I once spent four weeks in a monastery studying. It was unusual to have cause to use Latin for real. Playing soccer with Benedictine monks is also interesting. They have to raise their robes to hit the ball.

Is there something or someplace you have never seen that you would like to see in the near future?

I have been to a fair number of places, but I would like to climb Mount Kilimanjaro.

What did your mother always tell you that you now have to admit was correct?

My mother was a politician. She said that you do your best, but don’t burn the candle at both ends. She also said that there is nothing wrong with being more than what you seem.

When you have an hour of free time, what do you like to do?

15 minutes – nap. 5 minutes — play with my dog. She’s an Entlebucher, which is a mountain dog. When we have guests and they stray away from the group, she brings them back. The rest is for family.

Dr. Fuchs can be reached at gerhard.fuchs@cshs.org.

Printing an Inpatient Detailed Transfer Medication List

Web/VS Tip of the Week

Printing of an inpatient detailed Transfer Medication List is available in Web/VS. To view or print the medication list, simply take the following steps:

  1. Log into Web/VS and select the patient that is currently an inpatient
  2. Click on the "CS-Link Active Medication List" link located in the "Recent Results" listing
  3. Click the "Transfer Med List" button located at the bottom of the screen
  4. Click the “Print” hyperlink at the top right of the window

For questions, comments or suggestions, please contact the Web/VS Support Team at (310) 423-2828 or via e-mail at mdsupport@cshs.org. You can also click on the "Contact Us" button in Web/VS (located in the blue shaded area on the bottom left side of the screen).

Imaging Case of the Month for October

Make your diagnosis

Submitted by Michael Witkosky and E. James Tourje, M.D., of the S. Mark Taper Foundation Imaging Center.

History:

A 32-year-old male recently diagnosed with HIV presented to the emergency room with lethargy, agitation and right-sided weakness. CT scan of the brain without intravenous contrast showed multiple bilateral low attenuation white matter lesions within the cerebral hemispheres.

Subsequent MRI is shown below:

 

Question: Which answer best describes the findings?

  1. Multiple asymmetric white matter lesions with FLAIR hyperintensity and peripheral enhancement (ADEM)
  2. Predilection for periventricular white matter
  3. Scattered asymmetric white matter lesions without enhancement
  4. Multi-focal grey matter/white matter lesions in the cortical/subcortical, basal ganglia, and thalamic portions of the brain

Click here to access the Imaging Case of the Month site and continue with your diagnosis. 

We welcome your feedback. Please send your questions and comments to Marcel Maya, M.D., at marcel.maya@cshs.org.