Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Dec. 16, 2011 Issue | Archived Issues

Physician News

Keith Black, M.D., was honored by the Cedars-Sinai Alumni Association, and John Harold, M.D., was named president-elect of the American College of Cardiology.

» Read more


Meetings and Events


Pharmacy Focus

Carisoprodol to Become Schedule IV Drug on Jan. 11, 2012

Due to the potential for abuse of carisoprodol, the Drug Enforcement Administration (DEA) made the decision to designate carisoprodol (SOMA) as a Schedule IV controlled substance.

» Read more


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - December 2011 (PDF)


Grand Rounds

Click here to view upcoming Grand Rounds.

MEC "Morning After" Report

Highlights of the Medical Executive Committee meeting on Dec. 5 include important announcements regarding medical staff re-credentialing and CS-Link™ training for physicians.

» Read more

Only 77 Days before CS-Link Go-Live on March 2!

Physicians will begin using CS-Link™ to enter and manage orders and use clinical documentation tools

Please register for CS-Link training to ensure you get the dates and times that best accommodate your schedule. Registration for training is available now through Sunday, Jan. 15, 2012.

» Read more

An Eye to a Cure

C-S researchers look for novel ways to prevent corneal blindness from diabetes and other diseases of the eye

It’s a well-known fact there’s no cure for diabetes. Likewise, diseases of the eyes caused by diabetes are not curable.

» Read more

Mengele Survivor Reminds Researchers of Importance of Informed Consent

Eva Kor is no scientist. But as a survivor of Nazi Dr. Josef Mengele’s brutal medical experiments on twins in the Auschwitz concentration camp during World War II, she has much to say about research ethics.

» Read more

Circle of Friends Honorees for November

The Circle of Friends program honored 82 people in November, including 52 physicians. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

FDA Approved

Transfusion Medicine successfully passes FDA inspection

The Rita and Taft Schreiber Division of Transfusion Medicine in the Department of Pathology and Laboratory Medicine recently underwent routine inspection by the FDA and no deficiencies were cited.

» Read more

Rifaximin Safest Among Recommended IBS Treatments, Study Finds

Among the most commonly used treatments for irritable bowel syndrome - which affects as many as 20 percent of the U.S. population - a targeted antibiotic, rifaximin, was shown to be the safest in a new study by Cedars-Sinai researchers. 

» Read more

Inpatient Specialists Are at Your Bedside, Around the Clock

When adult Medical Group patients need to be hospitalized at Cedars-Sinai Medical Center, they get expert care from a team of internal medicine specialists with specific expertise in hospital care. 

» Read more

MEC "Morning After" Report

Highlights of the Medical Executive Committee meeting on Dec. 5 include important announcements regarding medical staff re-credentialing and CS-Link™ training for physicians.

New Re-credentialing Process:

The Medical Staff Services Department has adopted a new workflow process for re-credentialing.

  • All courtesy reminders regarding reappointment will be sent via email only.
  • Your reappointment application will be sent by mail until mid-2012; however, you will not receive any additional paper notices regarding the processing of your application.
  • To maintain Medical Staff membership and privileges, you must have an active California State License, DEA Registration and NP/PA certification (if applicable). We will send courtesy reminders thirty (30) days and two (2) days before one of these expires. Be forewarned that your membership and privileges will be automatically suspended at 5p.m. on the day prior to the expiration date.

CS-Link™ Update: 

1. Physicians can sign up for training now. As promised, all members of the Medical Staff who complete 8 hours of mandated training will receive:

  • $1,000 honorarium*
  • 8 hours of CME credit* (*prorated for those who have less training mandated)

2. There is a new website to provide CS-Link updates. It’s called CS-Link Central and it’s accessible inside and outside the Cedars-Sinai firewall at www.cslinkcentral.org.

3. There will be a series of ‘Sneak Peaks’ to expose physicians to new workflows in CS-Link.

  • Most are one-hour sessions with food.
  • Each session will highlight specific areas where CS-Link will impact your inpatient practice.
  • You are invited to attend at any time (before or after training).

4. Updates will be sent out regularly via CS-Link News.

Revised Proctoring Protocol - The MEC approved a revised Proctoring Protocol. This clarifies our current policies and makes one small change to broaden the pool of available proctors. Several MEC members asked to have the entire proctoring process revamped. This is being planned for mid-2012.

Proctoring Protocol Version 4 (PDF)

Closure of Department of Psychiatry - There was a long discussion about the recent decision to restructure psychiatry services. Over the next few months, Cedars-Sinai will be eliminating inpatient and outpatient services for patients with a primary psychiatric diagnosis. Cedars-Sinai President and CEO Tom Priselac reassured the MEC that the hospital plans to maintain (and strengthen if necessary) the psychiatry services provided (1.) to patients in the Emergency Room, (2.) to inpatients hospitalized for non-psychiatric primary diagnoses (via our Psychiatric Consultation and Liaison service), and (3.) to support outpatient programs that have an essential psychiatric component (Transplantation is one example).

Secretary and Treasurer for 2012: The MEC elected the following physicians for the offices of Secretary & Treasurer for 2012:

  • David Kulber, M.D. - Secretary

  • Christopher Ng, M.D. - Treasurer

Allied Health Professional Rules & Regulations - The MEC approved revisions to the following sections of the AHP Rules and Regulations.

  • Article Articles I, II, III, IV, V, VI, VII, and IX

    • Changing wording of "Clinical Privileges/Scope of Service" to Clinical privileges

    • Changing PPD to TST

    • Changing "Renewal of Privileges" to Reappointment

    • Removing student categories

Revised Medically Inappropriate Policy - The MEC approved the revised Medically Inappropriate Policy submitted from the Bioethics Committee.

New Members of the Medical Staff: 

  • Jonathan P. Jacobs, M.D. - General Internal Medicine

  • Mamo Nakamura M.D. - Cardiology

  • Constance J. Ornelas, D.P.M. - Podiatric Surgery

  • Helen Phan, M.D. - Pediatrics

  • Henrietta Stancz-Szeder, M.D. - OB/Gyn

Only 77 Days before CS-Link Go-Live on March 2!

Physicians will begin using CS-Link™ to enter and manage orders and use clinical documentation tools

Sign up for CS-Link Training

Please register for CS-Link training to ensure you get the dates and times that best accommodate your schedule. Registration for training is available now through Sunday, Jan. 15, 2012. As a reminder, CS-Link training begins January 16.

For your convenience, there are two ways to sign up for training:

  1. Call 310-423-2828 (option 7) any time of the day to speak to a registration staff member who will schedule you for training.

  2. Complete the Training Registration Form online at www.cslinkcentral.org. The information will be sent to the registration staff who will schedule you for training.

Once scheduled, you will receive an e-mail confirming the date, time and location of your CS-Link training.

CS-Link E-Learning Modules Available

Complete the CS-Link eLearning modules so that you’re familiar with CS-Link functionality before you attend your instructor-led training. The following modules are available at www.cslinkcentral.org.

  • Introduction to CS-Link
  • Navigators
  • Notes
  • Order Sets/Orders
  • Inbasket

Get a Sneak Peek

Get a sneak peek of the CS-Link system. Hour-long sessions are being offered that will highlight specific areas where CS-Link will impact your inpatient practice. Space is limited. Contact Lisa Feinstein at lisa.feinstein@cshs.org to reserve your seat!

DATE

TIME

LOCATION

December 27

Dinner 5:30-6:30pm

Harvey Morse Room 6

December 29

Lunch 12-1pm

Harvey Morse Rooms 4-5


CS-Link Central

Check out the new website specifically designed for medical staff at www.cslinkcentral.org. The website will be your source for CS-Link training, support and information.

An Eye to a Cure

C-S researchers look for novel ways to prevent corneal blindness from diabetes and other diseases of the eye

It's a well-known fact there's no cure for diabetes. Likewise, diseases of the eyes caused by diabetes are not curable .Often, they can lead to blindness. In diabetes the most common cause of blindness is due to retinal disease, but the cornea can also be affected.

Eye experts at Cedars-Sinai's Regenerative Medicine Institute and Department of Surgery are currently developing novel ways to prevent corneal blindness in diabetic patients through gene therapy and stem cells.

"We are developing a powerful research niche here," said Clive Svendsen, Ph.D., director of the Cedars-Sinai Regenerative Medicine Institute. "One major research focus of the Eye Program deals with corneal damage that occurs in individuals diagnosed with diabetes."

"Surgery has a longstanding commitment to ophthalmology and, in partnership with the Regenerative Medicine Institute, we are developing a world class Eye Program that will inevitably lead to exciting new clinical therapies in the future," said Bruce Gewertz, M.D., Chair of the Department of Surgery and Vice Dean of Academic Affairs.

Led by Alexander Ljubimov, Ph.D., the Eye Program has some of the nation's top scientists and clinicians including Yaron Rabinowitz, M.D., Homayon Ghiasi,Ph.D., and Shaomei Wang, M.D., Ph.D.

Ljubimov and his collaborators, Svendsen and Rabinowitz, were awarded a $3 million grant this spring from the National Eye Institute to develop gene therapy in corneal stem cells to alleviate damage to corneas that can cause vision loss. "It's a great example of how the Regenerative Medicine Institute is bringing together teams of researchers to tackle difficult medical issues with federal funding right here at Cedars-Sinai," says Svendsen.

Diabetes damages the eye's retina and eventually causes blindness. It also strikes the cornea - the clear, dome-shaped surface that covers the front of the eye. In healthy patients, the cornea's stem cells constantly regenerate. But, in diabetics, these cells become dysfunctional and prone to poor wound healing, a condition known as diabetic keratopathy.

Ljubimov said 43 percent of people with Type I diabetes and 60 percent of people with Type II diabetes will lose some vision within five years of the disease's onset, mainly due to diabetic retinopathy.

He said diabetics' corneal stem cells become abnormal because their corneas may stop producing certain proteins that enable normal functioning of corneal stem cells.

"Our goal is to do gene therapy on defective stem cells, restore them so that they function properly and then put them back into the patient. The patient will then have a much better possibility of having normal corneas," Ljubimov said. "This is only for patients with severe disease. If people have borderline disease,or the disease doesn't require drastic measures, then they can betreated with standard symptomatic therapy."

Rabinowitz leads his own corneal research projects looking at genetic defects in individuals with keratoconus. Keratoconus is a condition, in which the cornea assumes a conical shape and can lead to progressive loss of vision over time. It is the commonest cause for corneal transplants in Western developed countries.

"The purpose of identifying gene defects is that if we can determine the root cause then we may be able to develop a therapy to stop the progression and prevent the need for a cornea transplant," he said. Rabinowitz's research has been funded by the National Institutes of Health for the past 18 years. Recently his lab, in collaboration with the Medical Genetics Group at Cedars-Sinai, identified a gene locus for keratoconus. This work was published in the prestigious journal Human Molecular Genetics in November 2011.

In another study, Rabinowitz, Svendsen,and Ljubimov, together with Dhruv Sareen, PhD, who directs the Regenerative Medicine Institute Induced Pluripotent Stem Cell Core Facility, are isolating functional stem cells from adult post-mortem human corneas. The hope is to generate new lines of cells that can be expanded and then made into corneal tissue.

"This is for people with extreme disease of the cornea who may become blind, but do not qualify for transplants because their corneal stem cells are depleted. Corneal stem cells could also potentially be used to treat patients with keratoconus, who have thin corneas due to ‘programmed cell death.' Stem cells could be used as cell replacement therapy to thicken the cornea. In this way, stem cells and genetics can work together to treat a disease; genetics to retard the disease and stem cells to replace lost cells," said Rabinowitz, who is a leading corneal expert.

The institute also recently recruited Wang, who is a world expert intreating animal models of retinal diseases such as macular degeneration with stem cells. Macular degeneration is a leading cause of blindness in the aging population for which there is no cure. An estimated 30% of individuals over age 70 in the U.S. have some degree of macular degeneration. Wang leads a group that can perform complex retinal surgeries and detect how stem cells may bring back sight in rats with retinal degeneration. Hopefully, one day her work can be taken a step further and used in treatment for patients affected with age related macular degeneration. Her laboratory uses both fetal human stem cells produced by Svendsen and various sources of adult stem cells.

"These are very exciting times for regenerative medicine and eye diseases. We hope to develop the research to a point where we can bring therapies back to the patients with the help of the Department of Surgery," said Svendsen.

Mengele Survivor Reminds Researchers of Importance of Informed Consent

Eva Kor is no scientist. But as a survivor of Nazi Dr. Josef Mengele's brutal medical experiments on twins in the Auschwitz concentration camp during World War II, she has much to say about research ethics.

Speaking before a crowd that filled Cedars-Sinai's Harvey Morse Auditorium for an IRB Grand Rounds series lecture on Nov. 11, Kor cautioned researchers who use human subjects.

Cedars-Sinai "You have been trained to use good judgment and clear logic," she said. "But you cannot forget that you are dealing with human beings. The moment you forget and cross that narrow line, you are headed in the direction of the Dr. Mengeles."

In her speech, titled "The Importance of Informed Consent," the Romanian-born founder of the CANDLES Holocaust Museum and Education Center in Terre Haute, Ind., gave a harrowing account of her experiences as "a human guinea pig" who nearly died at the hand of the infamous "Angel of Death."

Mengele, who helped choose prisoners for execution at the camp in Nazi-occupied Poland, was blamed for the deaths of thousands, including many of the estimated 1,500 sets of Jewish and Roma ("Gypsy") twins, mostly children, whom he selected for pseudoscientific experiments.

Kor and her sister, Miriam, then 10, were two of the twins who survived. After arriving in Auschwitz by cattle-car train in 1944 and being separated from their mother, father and two older sisters - whom they never saw again - they huddled in "filthy bunk beds, crawling with lice and rats," Kor recalled.

Several times a week, she said, she was injected with unidentified substances and stripped naked while her body parts were measured.

"We were reduced to the lowest form of existence - just a mass of living, breathing cells,'" Kor said.

After falling ill with a high fever, Kor received a bedside visit from Mengele and four other doctors at the camp's hospital.

"Dr. Mengele said, laughing sarcastically, 'Too bad. She's so young. She has only two weeks to live,' " Kor recalled.

But she defied predictions and recovered. The twins' ordeal ended, shortly before their 11th birthdays, in January 1945 when Soviet troops liberated Auschwitz. Kor later made her way to Israel and the U.S., where she settled in Terre Haute after marrying Michael Kor, an American tourist she had met.

In recent decades, she has devoted her life to locating other survivors of Mengele's twins experiments and educating people about the Holocaust. In 1984, Kor founded an organization known as CANDLES, which stands for "Children of Auschwitz Nazi Deadly Lab Experiments Survivors." In 1995, she opened the Holocaust museum.

In her speech last month,Kor urged scientists to apply the following test to human trials:

"Just ask yourself: Would I want to be treated this way if I was one of the research subjects? And if the answer is 'no,' you are going in the wrong direction, and you are doing the wrong thing."

Audience member Stuart G. Finder, Ph.D., director of the Center for Healthcare Ethics at Cedars-Sinai, said Kor's speech provided an important reminder that a research subject is not just a "data generator."

"She reminds us to pay close attention to our shared humanity," Finder said, "and as such, to remember, even in research, that our core commitment is to take care of others."

Circle of Friends Honorees for November

The Circle of Friends program honored 82 people in November, including the 52 physicians listed below.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • M. William Audeh, MD

  • Michael C. Lill, MD

  • Keith Black, MD

  • Raj Makkar, MD

  • Neil A. Buchbinder, MD

  • Robert McKenna, Jr., MD

  • Christiane Michelle Burnison, MD

  • Amin Joseph Mirhadi, MD

  • James L. Caplan, MD

  • Leon Morgenstern, MD

  • David Cossman, MD

  • Jaime Moriguchi, MD

  • Catherine M. Dang, MD

  • Lisa E. Nguyen, MD, MPH

  • Suhail Dohad, MD

  • Charles E. Niesen, MD

  • Michael Engelberg, MD

  • Nicholas Nissen, MD

  • Joel D. Feinstein, MD

  • Mark Pimentel, MD

  • Aaron G. Filler, MD, PhD

  • Jeffrey Rapp, MD

  • Charles Forscher, MD

  • Patrick R. Rhoten, MD

  • Rodney Gabriel, MD

  • Barry Rosenbloom, MD

  • Steven S. Galen, MD

  • Stephen A. Sacks, MD

  • Ivor L. Geft, MD

  • Srinath Samudrala, MD

  • Armando E. Giuliano, MD

  • Gregory Sarna, MD

  • Richard E. Gould, MD

  • Randolph Sherman, MD

  • Jon B. Greenfield, MD

  • Jerrold H. Steiner, MD

  • Gabriel Hunt, Jr., MD

  • Michele Tagliati, MD

  • Beth Y. Karlan, MD

  • Amir H. Tahernia, MD

  • Mitchell Karlan, MD

  • Gregory Tsushima, MD

  • Asher Kimchi, MD

  • Taz E. Varkey, MD

  • Babak Larian, MD

  • Marina Vaysburd, MD

  • Letitia Lau, MD

  • Matthew T. Wilson, MD

  • Gary Leach, MD

  • Philip A. Yalowitz, MD

  • Ronald Leuchter, MD

  • John Yu, MD

FDA Approved

Transfusion Medicine successfully passes FDA inspection

The Rita and Taft Schreiber Division of Transfusion Medicine in the Department of Pathology and Laboratory Medicine recently underwent routine inspection by the FDA and no deficiencies were cited.

The FDA conducts unscheduled biennial inspections of all blood inspections to determine compliance with FDA regulations that are intended to ensure the safety of blood components used for transfusion.

"Dr. Ellen Klapper, Ihab Abumuhor and the entire management and quality assurance team in Transfusion Medicine deserves recognition and heartiest congratulations for their commitment to excellence and adherence to the highest quality and patient safety standards,"said Mahul B. Amin, M.D., professor and chair of the Department of Pathology & Laboratory Medicine.

Rifaximin Safest Among Recommended IBS Treatments, Study Finds

Among the most commonly used treatments for irritable bowel syndrome - which affects as many as 20 percent of the U.S. population - a targeted antibiotic, rifaximin, was shown to be the safest in a new study by Cedars-Sinai researchers. The study analyzed 26 large-scale clinical trials.

"For patients who suffer from irritable bowel syndrome, historically effective treatment options have been very scarce," said Mark Pimentel, MD, director of the G.I. Motility Program at Cedars-Sinai Medical Center and a lead author on the study. "Unfortunately, many of the treatments approved for IBS cause intolerable complications for many patients. This underscores the need for us to continue to seek new therapies for this disease, which dramatically harms quality of life for millions of people."

The study examined drug interventions for IBS deemed to be of merit by a task force of the group. The study compared the therapies based on "number needed to harm statistics" from large clinical trials. In evaluating a drug's effectiveness, two common measures are the number needed to treat (the average number of patients who must take a therapy before one is treated successfully) and the number needed to harm (how many patients must be treated before the adverse effects of a therapy are bad enough that one patient drops the medication).

The study looked at the most common and highly rated treatments for the condition. Three of these treatments are for diarrhea-predominant IBS: tricyclic antidepressants; alosetron - a drug that slows movement of stool in the gut; and rifaximin, an antibiotic absorbed only in the gut. The difference among these drugs was striking. For tricyclic inhibitors, the number needed to harm was 18.3, while the number needed to harm for alosetron was 19.4. For rifaximin, the number needed to harm was 8,971.

The study also found that for every 2.3 and 2.6 patients who benefitted from tricyclic inhibitors and alosetron respectively, one patient was harmed by the study medication and had to withdraw. For rifaximin, this number was 897.

"This further validates previous research we've done on rifaximin as a safe and effective treatment for IBS," Pimentel said. "Now, not only have our previous clinical studies shown that this selectively absorbed antibioticis the first treatment for IBS patients in which patients continue to have relief from their symptoms after stopping the drug - compared to other available treatments for the condition, it statistically has caused fewer adverse side effects."

In an article published earlier this year in the New England Journal of Medicine, the ground-breaking therapy developed at Cedars-Sinai found through two double-blind trials that patients who suffered from diarrhea prominent IBS reported relief from bloating, less abdominal pain and improved stool consistency for up to 10 weeks. While the concept of bacteria playing a key role in IBS was controversial when first unveiled a decade ago, this research confirms that bacteria in the gut trigger the symptoms of the chronic condition, affecting an estimated 30 million people in the United States.

Rifaximin is marketed by Salix Pharmaceuticals Inc. Pimentel discovered the use of rifaximin for IBS, and Cedars-Sinai holds patent rights to this discovery and has licensed rights to the invention to Salix. Pimentel is a consultant to Salix Inc. and serves on its scientific advisory board.

Inpatient Specialists Are at Your Bedside, Around the Clock

Cedars-Sinai

When adult Medical Group patients need to be hospitalized at Cedars-Sinai Medical Center, they get expert care from a team of internal medicine specialists with specific expertise in hospital care. Also called hospitalists, these physicians are located in the hospital to allow around-the-clock care and physician access for patients. The hospitalists and their care team stay in close communication with patients and their physicians to ensure coordination of care in the hospital and a smooth transition after hospitalization.

Who will care for me in the hospital?

Your Medical Group physician works with the hospitalists associated with the Inpatient Specialty Program (ISP) to provide 24-hour care, seven days a week when you are hospitalized at Cedars-Sinai.

The ISP hospitalists are interviewed and hired based on criteria that include clinical excellence, interpersonal skills (warmth, compassion and communication) and work ethic.

In addition to the inpatient specialists, the ISP care team also includes nurse practitioners, care managers and administrative support staff. Working closely with the hospitalists, the care managers act as your liaison and help with care coordination and communication. They coordinate scheduling of tests and procedures, answer questions and ensure there are no unnecessary delays in your hospital care.

How are my primary physician and other specialists involved?

Rest assured the ISP team manages your care in partnership and close communication with your primary care physician and specialists. They are kept thoroughly updated throughout your hospital stay and have access to your medical record electronically so they can check on your status at any time. As well, your hospitalist has access to your medical history through your electronic medical record.

Why do I need a hospitalist?

Hospitalists don't have an outside office to run, so they are always available in the hospital when you need them, regardless of the time of night or day. They have a close working relationship with hospital staff and an intimate understanding of hospital processes that enables them to get things done efficiently and effectively for you. They have a great deal of experience managing acute inpatient illness, so you can feel confident you are getting the quality medical care you need.

When you're ready to be discharged, your hospitalist will discuss further treatment needs with your primary care physician. Your care manager will help arrange your follow-up care and assist with any home care or medical equipment needs you may have. At that point, you will be placed back into the care of your primary care physician and specialists for your ongoing medical needs.

(Pictured above: The Cedars-Sinai Inpatient Specialty Program (ISP) team includes 19 hospitalists, two nurse practitioners, eight care managers and their manager, plus three administrative support staff. Bradley T. Rosen, MD, MBA, is the ISP medical director. They provide care for hospitalized Medical Group patients 24/7.)