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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF May 25, 2012 Issue | Archived Issues

Training the CS-Link trainers to help others with new improvements

Chief CS-Link™ Super-user Shaun Miller, MD, is bringing all of his physician super-users up to speed on some new improvements so that they can provide the necessary training to others.

» Read more

P&T decisions, micafungin formulary addition

Pharmacy focus

April P&T decisions and pertinent agenda topics are summarized in the PDF linked below. Highlights include: drug shortages update, 2012 priority black box warnings and dabigatran safety updates.

P&T Update - April 2012 (PDF)

» Read more

Cedars-Sinai successfully implants its first total artificial heart

Michelle Johnson has helped make Cedars-Sinai history. Over a six-hour operation in mid-January, surgeons removed the 39-year-old San Diego woman's failing heart and implanted an FDA-approved artificial one made of polyurethane, carbon and titanium.

» Read more

Medical staff honors 8 South nurse

Monette De Leon, BSN, RN, received the Maggie Stempson-Carter, RN, Excellence in Caring Award. De Leon received an unprecedented nine nominations this year for the medical staff's highest nursing honor.


» Read more

Circle of Friends honorees for April

The Circle of Friends program honored 127 people in April. 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

What vitamin D test to order?

During the past decade, there has been an explosion in the number of articles written about vitamin D and its importance in the maintenance of normal bone and muscle function. Vitamin D deficiency has been associated with osteopenia, osteoporosis, bone pain, as well as muscle weakness and aches and increased risk of falls.

» Read more

Last day to RSVP for Hollywood Bowl tickets

Medical staff members and their families are invited to take part in two Cedars-Sinai summer traditions: Independence Day at the Hollywood Bowl and Sand N' Snore at the Jonathan Beach Club. To reserve your seat at the Bowl, call (310) 423-2681 today.

» Read more

Enlisting viruses for a good cause

After enduring eons of suffering inflicted by viruses, humans are harnessing these infective agents to do good, not evil. That's the mission of the new Viral Vector Core at Cedars-Sinai Medical Center's Regenerative Medicine Institute.

» Read more

Delivering on a beautiful renovation for new moms

With new upgrades that give the Labor and Delivery unit a spa-like feel, mothers will be giving birth at Cedars-Sinai in more comfort than ever. The first of four phases of renovations for Labor and Delivery are complete after eight months of construction.


» Read more

What do you know about organ donation?

Cedars-Sinai's Organ Donor Council is conducting a brief 18-question survey of all employees to evaluate individual knowledge, perceptions and beliefs regarding organ donation. Please take a few minutes to participate: www.zoomerang.com/Survey/WEB22FHFS966SR

» Read more

Training the CS-Link trainers to help others with new improvements

Chief CS-Link™ Super-user Shaun Miller, MD, is bringing all of his physician super-users up to speed on some new improvements so that they can provide the necessary training to others.

"We have created new training aids that give physicians updated guidance on two important areas: the optimized dictation/transcription/edit/sign workflow and best practices for the use of nursing communication orders," said Miller, pictured at right.

These training updates can be found at www.cslinkcentral.org/index.php/how-to/training-updates/.

Miller encourages medical staff who would like personalized training to visit the Physician Resource Center in Room 2806 on the Plaza Level of the South Tower.

"When physicians understand the dictation/transcription workflow, it will make them much more efficient," Miller said.

Regarding nurse communication orders, Miller said, "physicians need to use these appropriately. Orders for medications cannot be placed there because pharmacy will not see them." He added that proper use of the CS-Link tools will enhance patient safety.

P&T decisions, micafungin formulary addition

Pharmacy focus

April P&T decisions and pertinent agenda topics are summarized in the PDF linked below. Highlights include: drug shortages update, 2012 priority black box warnings and dabigatran safety updates.

P&T Update - April 2012 (PDF)

Micafungin (Mycamine®) formulary addition

Also at its April meeting, the Pharmacy and Therapeutics Committee voted to follow the Antimicrobial Use Review and Stewardship Committee's recommendation to add micafungin (Mycamine®) to the Cedars-Sinai formulary. The same restriction criteria that exist for caspofungin (Cancidas®) will apply to micafungin and micafungin will replace caspofungin as the sole echinocandin antifungal agent at Cedars-Sinai.

Effective Tuesday, May 29, 2012, micafungin may be ordered in CS-Link™. The prescriber must specify an indication to ensure compliance with micafungin restriction criteria.Note: The dose of micafungin is 100mg IV daily. No loading dose is indicated with micafungin and no dose adjustments are necessary for either hepatic or renal insufficiency. Exception: esophageal candidiasis, where micafungin dose is 150 mg IVPB daily.

All existing orders for caspofungin will be continued until treatment course is completed. All new orders of caspofungin will be automatically substituted to micafungin effective May 29.

For questions regarding the micafungin formulary addition, please call ext. 3-5352.

Cedars-Sinai successfully implants its first total artificial heart

Michelle Johnson has helped make Cedars-Sinai history.

Over a six-hour operation in mid-January, surgeons removed the 39-year-old San Diego woman's failing heart and implanted an FDA-approved artificial one made of polyurethane, carbon and titanium. Manufactured by SynCardia Systems, the 5.6-ounce device gives patients with end-stage biventricular failure such as Johnson a new lease on life. She was discharged from Cedars-Sinai in mid-March, her new heart pumping a steady 130 beats per minute.

"I'm looking forward to taking my son to Legoland for his 7th birthday and just spending time with my family," she said.

Previously, patients like Johnson couldn't leave the hospital - they had to be tethered to "Big Blue," a 418-pound machine that powers an artificial heart. But she is part of a group of patients in an FDA study testing a 13.5 pound, backpack-sized pneumatic machine and batteries. The so-called "freedom portable driver" connects to the artificial heart via two external tubes. The small machine gives recipients full mobility, allowing them to go about their daily lives as they wait for a donor heart - the kind that doesn't need batteries.

"They can't run marathons or swim, but the quality of life is pretty good," said Jaime Moriguchi, MD, medical director of the Mechanical Circulatory Support Program in the Cedars-Sinai Heart Institute.

The surgery went smoothly, said one of her surgeons, Fardad Esmailian, MD, surgical director of Cedars-Sinai's Heart Transplantation and Ventricular Assist Device Program. Cedars-Sinai is one of only 60 medical centers worldwide certified to perform artificial-heart implants.

"Everything went extremely well from a technical standpoint," Esmailian said. "If we find the right candidates, we will do more."  

The medical center's first artificial heart implant was one year in the making. Dozens of medical personnel were trained to deal with the device and its pneumatic machines. That included emergency first responders such as local paramedics and fire departments, who were trained not to perform CPR or an EKG on artificial-heart recipients such as Johnson.

In addition, a core team that included cardiologists, surgeons and nurse practitioners traveled to SynCardia's headquarters in Tucson, Ariz., to see how the device is made, perform surgery simulations, and receive other training.

"We worked out all the kinks, so we were well prepared," said Lawrence Czer, MD, medical director of the Heart Transplant Program and transplantation cardiology at the Heart Institute. "This was a team effort and everyone pulled together. Now, many more patients can be helped."

Johnson is one of the lucky ones. Diagnosed with idiopathic cardiomyopathy in her late 20s, her condition gradually deteriorated so much that she underwent a human-heart transplant at Cedars-Sinai in December 2010.

At first, all went well. She exercised at the gym, ferried her kids to school and work, and took classes for an associate's degree in social work at San Diego City College.

But after nine months, her body began rejecting the heart. This is not an uncommon occurrence - nearly 25 percent of heart transplant recipients show signs of rejection within a year of transplant. However, powerful immunosuppressant drugs and other therapy such as plasmapharesis did not improve Johnson's condition.

The artificial heart was her only option. The man-made heart, which pumps up to 9.5 liters of blood a minute, does not require immunosuppressants. And unlike donor hearts, the device has no risk of rejection since it's made out of biocompatible materials.

"You can't reject plastic or titanium" Moriguchi said and "We anticipate that she will become a more suitable candidate for a second heart transplantation once her antibody levels have been reduced."

Pictured from top: (l-r) Fardad Esmailian, MD, Rotch Delos Santos, RN, patient Michelle Johnson and Jaime Moriguchi, MD; Johnson visits with her caregivers in the Saperstein Critical Care Tower.

 At left: After being discharged, Johnson pushes the backpack-sized pneumatic machine that is connected to her artificial heart.

Medical staff honors 8 South nurse

Monette De Leon, BSN, RN, received the Maggie Stempson-Carter, RN, Excellence in Caring Award. De Leon received an unprecedented nine nominations this year for the medical staff's highest nursing honor. She had been nominated 12 times over the past three years.

Her nominators wrote:

  • "Monette is an excellent nurse. She takes exceptional care of the patients. She is extremely empathic and always goes above and beyond what she is asked to do. She is one of the most dedicated nurses that I have ever had the pleasure to work with."
  • "Monette is one of the best nurses I have ever worked with. She is not only compassionate, but smart – almost better than some of the newer doctors! I have no hesitation recommending her."
  • "Highly regarded for her expertise and caring attitude. One of the best and conscientious nurses."
  • "Monette is a fantastic nurse. Her smiling disposition is a joy to see up on 8 South. Patients and doctors love her dearly."

The Maggie Stempson-Carter award is given each year on behalf of the medical staff to a Cedars-Sinai nurse who exemplifies professionalism, clinical excellence and caring. Originally known as the Excellence in Caring Award, it was renamed in 2005 in honor of the late Maggie Stempson-Carter, RN, who received the award in 2004. The recipient is selected by the Excellence in Caring Award Medical Staff Selection Committee.

Shown above: Allan Silberman, MD, Monette De Leon, BSN, RN, and Chris Ng, MD

Circle of Friends honorees for April

The Circle of Friends program honored 127 people in April.

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.

  • Kenneth Adashek, MD
  • Phillip L. Levine, MD
  • Sonu S. Ahluwalia, MD
  • Andrew J. Li, MD
  • Carolyn Alexander, MD
  • Simon K. Lo, MD
  • Rebecca Allegretto, RN
  • Reymundo Lozano, MD
  • Farin Amersi, MD
  • Rajendra Makkar, MD
  • Jacqueline Avilez
  • Adam N. Mamelak, MD
  • Lilia G. Ayap
  • Susan Marble
  • Hyun Bae, MD
  • Robert McKenna, Jr., MD
  • C. Noel Bairey-Merz, MD
  • Peggy B. Miles, MD
  • Scott Bengtson
  • Melanie A. Miller, RN, CSPDM
  • Keith Black, MD
  • Amin Joseph Mirhadi, MD
  • Neil A. Buchbinder, MD
  • Jaime Moriguchi, MD
  • Mathew H. Bui, MD
  • Arpine Nahabedian, RN, MPH
  • Miguel Burch, MD
  • Ronald B. Natale, MD
  • Paula Carruthers, MD
  • Nicholas Nissen, MD
  • Carolina P. Caso, RN, BSN, CPON
  • Robert S. Pashman, MD
  • Christopher Chang, MD, PhD
  • Alice Peng, MD
  • Cheryl G. Charles, MD
  • Farrokh F. Poordad, MD
  • Kim Coleman
  • Edwin Posadas, MD
  • Lawrence S. Czer, MD
  • Jana Posalski, MD
  • Taneill N. Dear, RN
  • Michelle Quandt, RN
  • Robert W. Decker, MD
  • David Ramin, MD
  • Rick B. Delamarter, MD
  • Alexandre Rasouli, MD
  • Stephen C. Deutsch, MD
  • Allison E. Rotter, MSW
  • Suhail Dohad, MD
  • Tania Rubin
  • Noam Z. Drazin, MD
  • Carmelita Runyan, RN
  • Marla C. Dubinsky, MD
  • Brian Salus, RN
  • Macdonaldson During
  • Gregory Sarna, MD
  • Robert A. Figlin, MD
  • Jay Schapira, MD
  • Charles Forscher, MD
  • Prediman K. Shah, MD
  • Maria Garcia
  • Khawar M. Siddique, MD
  • Bruce L. Gewertz, MD
  • Allan W. Silberman, MD, PhD
  • Eli Ginsburg, MD
  • Charles F. Simmons, MD
  • Armando E. Giuliano, MD
  • Janice Singleton
  • Eskedar F. Gobeze, RN, BSN
  • R. Kendrick "Ken" Slate, MD
  • Karina Gonzalez
  • Meir Jonathon Solnik, MD
  • Leo Gordon, MD
  • Andrew Ira Spitzer, MD
  • Richard E. Gould, MD
  • Lucille I. Supall
  • Steven B. Graff-Radford, DDS
  • Alyssa Tennenbaum, RD, CDE, MBA
  • Violette G. Gray, MD
  • Lauren Timpe, RN
  • John G. Harold, MD, MACC, MACP
  • Analisa Traba, RN
  • Arman Hekmati, MD
  • Tram T. Tran, MD
  • Jeremy Herman, MD
  • Alfredo Trento, MD
  • Stuart Holden, MD
  • Leo Treyzon, MD, MS
  • Robert Huizenga, MD
  • Timothy Tsui, MD
  • Laith H. Jamil, MD
  • Minerva Tumaru-Fong, RN
  • J. Patrick Johnson, MD
  • Michael B. Van Scoy-Mosher, MD
  • Sheila Kar, MD
  • Eric Vasiliauskas, MD
  • Beth Y. Karlan, MD
  • Marina Vaysburd, MD
  • Harold L. Karpman, MD
  • Andrew Wachtel, MD
  • Robert M. Kass, MD
  • Willis Wagner, MD
  • David Kawashiri, MD
  • Daniel J. Wallace, MD
  • Ilan Kedan, MD, MPH
  • Michael H. Weisman, MD
  • Michelle M. Kittleson, MD, PhD
  • Ashely Willetts, RN
  • Jon A. Kobashigawa, MD
  • Reed Wilson, MD
  • Brian Kong, MD
  • Robert N. Wolfe, MD
  • Robert H. Kraus, MD
  • Edward Wolin, MD
  • Marcella D. Kurtzman, RN, OCN
  • Clement C. Yang, MD
  • Stuart H. Kuschner, MD
  • Michael C. Yang, MD
  • Anna Belle R. Labrador, RN
  • Rachel Zabner, MD
  • Ethel Lai
  • Albert Zager, MD
  • David Leibman
 
  • Norman Lepor, MD
 
  • Linda Lesley
 

What vitamin D test to order?

During the past decade, there has been an explosion in the number of articles written about vitamin D and its importance in the maintenance of normal bone and muscle function. Vitamin D deficiency has been associated with osteopenia, osteoporosis, bone pain, as well as muscle weakness and aches and increased risk of falls. Although a cause-and-effect relationship has not been established, low blood levels of vitamin D have also been associated with an increased risk of cardiovascular disease, autoimmune diseases, some cancers and depression. The two sources of vitamin D are sunlight and nutrition. When skin is exposed to ultraviolet light, vitamin D3 (cholecalciferol) is synthesized. Nutritional sources of vitamin D3 include fatty fish such as salmon, mackerel and herring fish liver oils and egg yolks. Vitamin D2 (ergocalciferol) is present in yeast and plants. For many of us, dietary and sunlight sources of vitamin D are inadequate to provide sufficient quantities of vitamin D to maintain optimal health.

Click here to read about test changes in the Core Laboratory.

Vitamin D made in the skin or ingested in the diet is converted to 25-hydroxy vitamin D [25(OH)D] in the liver and to 1,25 dihydroxy-vitamin D [1,25(OH)2D (calcitrol)] in the kidney. 1,25(OH)2D is the most active metabolite of vitamin D and is responsible for increasing calcium and phosphorus absorption from the intestine, promotion of bone osteoid mineralization, stimulation of proximal tubular phosphate reabsorption and maintenance of calcium reabsorption by the kidneys and decreasing parathyroid hormone synthesis and secretion. Vitamin D deficiency is found in individuals who use sunscreen, hats and long sleeve shirts, people who are housebound, and individuals with gastrointestinal problems such as Crohn’s disease and post-bariatric surgery which cause malabsorption of lipids. Hispanic and African Americans are also at higher risk than caucasians, because of the effect of skin pigmentation from melanin. Vitamin D toxicity is rare and generally found in individuals consuming more than 10,000 IU per day of exogenous vitamin D.

25(OH)D is the main circulating form of vitamin D with a half-life of two to three weeks. Serum quantities are measured in ng/ml.In contrast, 1,25(OH)2D has a half-life of about four hours and serum concentrations are measured in pg/ml, which is a thousand times less than 25(OH)D. Most importantly, however, serum concentration of 1,25(OH)2D are often normal or elevated in the presence of vitamin D deficiency. Therefore, 1,25(OH)2D should not be used to asses vitamin D levels and the only appropriate marker to assess vitamin D status is 25(OH)D.

Although a number of publications have debated the actual cutoff values for diagnosing vitamin D deficiency, data supports levels of 25(OH)D less than 20 ng/ml to be considered a deficiency, between 21-29 ng/ml vitamin D insufficiency, and levels greater than 30 ng/ml vitamin D sufficiency. Serum concentrations of greater than 150 ng/ml are indicative of vitamin D intoxication.

Low levels of 1,25(OH)2D may be seen in severe vitamin D deficiency, renal osteodystrophy or renal failure. However, 25(OH)D remains the appropriate test and will detect the deficiency. Low 1,25(OH)2D levels also may be seen in the setting of pseudohyperparathyroidism and hypoparathyroidism, where measurement of parathyroid hormone along with serum calcium is better tests. High levels of1,25(OH)2D are found with 1,25(OH)2D intoxication and hyperparathyroidism.

When should 1,25(OH)2D levels be ordered?

There are very few indications for measurements of 1,25(OH)2D levels. These include:

  • Hypercalcemia with a low parathyroid hormone. The initial test to evaluate hypercalcemia should be a measurement of parathyroid hormone. If it is elevated in the presence of elevated serum calcium, the diagnosis of hyperparathyroidism is made. If the parathyroid hormone level is suppressed, the elevated calcium may be due to production of parathyroid hormone-related protein from a tumor, local production of osteolytic factors from metastatic disease to the bone, or the production of 1,25(OH)2D from granulomatous diseases, some lymphomas and rare leukemias.
  • Tumor induced osteomalacia (oncogenic osteomalacia) (rare) is associated with a very low phosphate and low 1,25(OH)2D level.
  • Hereditary phosphate-losing disorders are also rare and may be associated with abnormalities in 1,25(OH)2D.
  • Renal insufficiency is associated with both low serum 25(OH)D and low serum 1,25(OH)2D concentrations, with high normal or elevated serum phosphate and low serum calcium. Again, 25(OH)D is the appropriate test to evaluate vitamin D status with kidney disease.
  • The very rare vitamin D-dependent rickets type 1, also known as pseudo-vitamin D deficient rickets, is associated with a combination of normal or low serum 25(OH)D and low 1,25(OH)2D with a low serum phosphorus.

Analysis of vitamin D ordering patterns at Cedars-Sinai

A review of 176 patients who had 1,25(OH)2D levels ordered over a three-month period showed that 3.4 percent had an indication for the measurements (hypercalcemia with a suppressed parathyroid hormone) and an additional 3.4 percent had marginal indications, primarily related to renal disease.Thus, at the most 6.8 percent of the 1,25(OH)2D levels ordered could be justified.

Recommendations

Screening for vitamin D deficiency should be carried out with measurements of serum 25(OH)D levels only. 1,25(OH)2D will be removed from the ordering panels on CS-Link™, but can be ordered specifically at the request of the attending physician.

Article prepared by: Holli M. Mason, MD, associate director, Transfusion Medicine, medical director, Core Laboratory; Hossein Sadrzadeh, PhD, scientific director, Core Laboratory; and Glenn D. Braunstein, MD, vice president, Clinical Innovation.

Last day to RSVP for Hollywood Bowl tickets

Medical staff members and their families are invited to take part in two Cedars-Sinai summer traditions: Independence Day at the Hollywood Bowl and Sand N’ Snore at the Jonathan Beach Club.

Celebrate Independence Day at the Bowl

Celebrate our country's Independence Day with rousing patriotic music and the familiar tunes of special guest Barry Manilow at the Hollywood Bowl on Tuesday, July 3.

Tickets are $125 per adult and $60 per child under age 12. Parking passes also are available: valet at $35 or lower terrace at $17.

Call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681 to reserve your tickets before Friday, May 25.

Click here to see photos and story from last year.

Save your spot at Sand N' Snore

It's not too early to dig out the tent and camping gear for this year's Sand N' Snore. The dinner, sleepover and breakfast starts on Friday, July 20, at the Jonathan Beach Club in Santa Monica. Those who don't want to sleep on the sand are welcome to enjoy dinner and the evening with colleagues and their families.

There's a limit of one tent per physician. Tickets for the whole event are $60 per adult and $40 for each child 12 and younger. Tickets for Friday's dinner only are $45 per adult and $20 for each child 12 and younger.

Call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681 to reserve your spot.

Click here to see photos and story from last year.

Enlisting viruses for a good cause

After enduring eons of suffering inflicted by viruses, humans are harnessing these infective agents to do good, not evil. That's the mission of the new Viral Vector Core at Cedars-Sinai Medical Center's Regenerative Medicine Institute.

Directed by Vaithi Arumugaswami, MVSc, PhD, at left, this facility uses viruses as couriers, or vectors, to ferry experimental genes into living cells for basic research and development of potential therapies. This process takes advantage of viruses' ability to invade cells and turn them into factories that produce more viruses.

Launched in October 2011, with its newly arrived director and support staff, the facility is poised for further expansion.

"The demand is high," said Arumugaswami, who works with more than a dozen principal investigators at the medical center. Among the disorders they are studying are amyotrophic lateral sclerosis ("Lou Gehrig's disease"), Huntington's disease, multiple sclerosis, diabetes, cancer and hepatitis C.

Viral vectors are created by removing genes from a virus and inserting experimental genes to replace them. This "package" is then inserted into a cell, which generates more viruses carrying the new genes. These altered viruses are collected, purified and concentrated into precise doses.

Researchers use these viruses to study how genes may induce tumors or suppress them, help cells fight off infections or effect other changes. They also may engineer genes to use in treatments.

"The Viral Vector Core is essential for so many of the scientists working at Cedars-Sinai," said Clive Svendsen, PhD, director of the Regenerative Medicine Institute. "Vaithi is an outstanding virologist and one of our newest recruits to the department. We are lucky that he has devoted so much time to launching this new venture."

In his own research, Arumugaswami focuses on hepatitis C, a widespread, serious viral liver disease that may lurk for years in a human body before causing symptoms. He is trying to modify the genes of this virus to make it less pathogenic so that it can form the basis of a vaccine. In another line of attack, working with mouse models, he is engineering liver stem cells with hepatitis C virus-resistant factors to facilitate regeneration of hepatitis C damaged livers.

The Viral Vector Core can provide "ready-to-use," preclinical-grade vectors with a range of capabilities, including fluorescent markers, or custom engineer them to an investigator's specifications. On request, Arumugaswami will also consult with researchers to help them determine the best viruses to use. Although the facility works mainly with vectors derived from lentiviruses, adeno-associated viruses and adenoviruses, it will also consider special requests for other vectors.

For more information, email vectorcore@csmc.edu or visit the Viral Vector Core's Internet page.

Pictured at top: In this view of mammalian cells infected with a human virus, the virus genetic materials, in red, are visualized by fluorescent microscopy; the cell nuclei are shown in blue.

Delivering on a beautiful renovation for new moms

With new upgrades that give the Labor and Delivery unit a spa-like feel, mothers will be giving birth at Cedars-Sinai in more comfort than ever.

The first of four phases of renovations for Labor and Delivery are complete after eight months of construction. This phase includes four spacious new labor and delivery rooms, a new operating room geared toward meeting the needs of women having twins, triplets or other multiple births, as well as new workspaces for staff.

"Welcoming a new baby into the family is such an important time in the lives of our patients," said Marle Shelton-Hoff, the Labor and Deliver and Maternal Fetal Care Unit nurse manager. "These new rooms not only provide a beautiful and comfortable environment for them, but also provide better accessibility for our nurses to care for patients."

Spacious bathrooms accompany each room, and two of them include large tubs for the comfort of laboring mothers. Recessed lighting, wood floors, soft green tones and tile offer a spa-like feel to the renovated areas.

Employees also will benefit from the upgrades, with larger work areas for nursing staff, an additional restroom for employees, an office for CN IV nurses and new room for the anesthesiologists who tend to the unit around the clock.

Patients will now be greeted from a large, curved reception counter - rather than the smaller window currently in use.

Employees got their first glimpse of the renovations during an unveiling party on Tuesday from 5 p.m. to 9 p.m.

Patients will not be occupying these rooms until licensing is completed in a few months, Shelton-Hoff said. These renovations include converting the small intake rooms to additional labor and delivery suites, as well as expanding some of the staff areas.

What do you know about organ donation?

Cedars-Sinai's Organ Donor Council is conducting a brief 18-question survey of all employees to evaluate individual knowledge, perceptions and beliefs regarding organ donation. Please take a few minutes to participate: www.zoomerang.com/Survey/WEB22FHFS966SR

Your assistance will help researchers design strategies to increase donation, there by benefitting all those waiting for life-saving organs.

Cedars-Sinai understands the increasing need for organs for waiting transplant recipients. More than 900 people await life-saving heart, lung, liver, kidney and pancreas transplants at Cedars Sinai's Comprehensive Transplant Center. Despite the desperate need, there appears to be a lack of awareness and suitable donors.

The council is working with Ali Salim, MD, Darren Malinoski, MD, and Danielle Schulman, MPH, on this effort.