Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Jan. 18, 2013 | Archived Issues

FDA lowers recommended dose of zolpidem products

Pharmacy focus

The U.S. Food and Drug Administration is notifying the public of new information about zolpidem, a widely prescribed insomnia drug. FDA recommends that the bedtime dose be lowered because new data show that blood levels in some patients may be high enough the morning after use to impair activities that require alertness, including driving.

» Read more


Meetings and events


Grand rounds

Click here to view upcoming grand rounds.


Upcoming CME conferences

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

Medical Staff CME Newsletter - January 2013 (PDF)

Medical staff gets new officers

The Cedars-Sinai medical staff has new officers, who took their positions at the beginning of the year.

» Read more

Harvey Morse Auditorium gets clinician workstations

Clinical workstations have been installed near Conference Rooms 1, 2 and 3 in Harvey Morse Auditorium. The workstations will provide Cedars-Sinai clinicians an opportunity to answer patient care needs while attending meetings in the conference center.

» Read more

Changes coming for Infectious Diseases

As the healthcare environment continues to present challenges to integrated health systems, Cedars-Sinai faces difficult decisions regarding organizational structure and staffing. One of these decisions involves the Division of Infectious Diseases in the Department of Medicine. Starting in July, the outpatient and inpatient Infectious Diseases services of the Department of Medicine will be staffed primarily by private attending medical staff members of the Division of Infectious Diseases, instead of full-time faculty infectious disease physicians. The division's clinical and educational programs – including those serving people with HIV and AIDS, as well as the resident and fellowship training programs – will continue.

» Read more

More doctors, hospitals partner to coordinate care for people with Medicare

Cedars-Sinai has been selected as one of 106 new Accountable Care Organizations in Medicare, ensuring as many as 4 million Medicare beneficiaries across the United States now have access to high-quality, coordinated care, Health and Human Services Secretary Kathleen Sebelius announced Jan. 10.

» Read more

Here comes the flu

C-S sees spike in flu cases; new visitor precautions put into place

Cedars-Sinai is experiencing an increase in flu cases, and California public health officials warn that the flu epidemic that has already hit hard in other areas of the nation is headed our way. "The number of positive influenza cases confirmed at Cedars-Sinai has increased substantially in the past two weeks," says Rekha Murthy, MD, director of Hospital Epidemiology at Cedars-Sinai. "We are admitting five to six patients per day with influenza diagnosis and three to four positive for other respiratory viruses."

» Read more

Re-entry program gives doctors a chance to return to medicine

Sandy Kaushal, MD, graduated medical school in 2002 and became a pediatrician. But six years later, pregnant with her second child, she decided to take a break from medicine. Kaushal said it was a family decision for her to stay home and be there for her children while they were babies. This year, with both her children in school, Kaushal was ready to return to medicine. But returning to the profession is not as simple as rehanging the shingle.

» Read more

Prominent bone cancer surgeons join Orthopaedic Center

Two of Southern California's best-known orthopedic oncologists have joined Cedars-Sinai, enhancing a surgical team that treats some of the most complex and difficult types of cancer. Lawrence R. Menendez, MD, and Daniel C. Allison, MD, FACS, MBA, have partnered with Earl Warren Brien, MD, director of musculoskeletal tumor service at the Cedars-Sinai Orthopaedic Center, to form one of the preeminent orthopedic oncology practices in the western U.S.

» Read more

The baby was a surprise, the teamwork an inspiration

It was Friday night when things started to go wrong for a 25-year-old woman in the Antelope Valley. Her family said she appeared confused, but she insisted nothing was wrong. The next morning, she was worse, and by the time an ambulance raced her to a local hospital, she had lost consciousness. Medical tests delivered a series of shocks to the woman's family – her systolic blood pressure was a life-threatening 200-plus, and her high blood pressure had caused a brain bleed. And unbeknownst to her mother and sister, the young woman was 30 weeks pregnant.

» Read more

Ideas sought for Great Debates topic

The Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition committee is soliciting suggestions for a topic for this annual spring event. The debate will convene for its 10th year at 8 a.m. Thursday, April 18, 2013, in ECC A-C.

» Read more

Ordinary heart cells become 'biological pacemakers' with injection of a single gene

Cedars-Sinai Heart Institute researchers have reprogrammed ordinary heart cells to become exact replicas of highly specialized pacemaker cells by injecting a single gene (Tbx18) — a major step forward in the decade-long search for a biological therapy to correct erratic and failing heartbeats.

» Read more

Medical staff gets new officers

The Cedars-Sinai medical staff has new officers, who took their positions at the beginning of the year. They are:

Steven S. Galen, MD, 
Chief of Staff

Christopher S. Ng, MD, 
Vice Chief of Staff

Peggy Miles, MD, 
Medical Staff Secretary

Alan Klein, MD,
Medical Staff Treasurer

Harvey Morse Auditorium gets clinician workstations

Clinical workstations have been installed near Conference Rooms 1, 2 and 3 in Harvey Morse Auditorium. The workstations will provide Cedars-Sinai clinicians an opportunity to answer patient care needs while attending meetings in the conference center.

Paul Silka, MD, chief medical information officer, said the clinical workstations are in response to a request by medical staff leadership following installation of CS-Link™, Cedars-Sinai's electronic medical records system. The medical staff wanted a convenient way to access CS-Link while attending educational conferences or meetings in the auditorium, Silka said.

Chief of Staff Steven Galen, MD, said the clinical workstations allow physicians to complete patient orders without having to rely on telephones, which can disrupt work flow.

The clinical workstations, each of which includes a computer and a telephone, are available so all clinicians can briefly step away from meetings to provide patient care. These workstations are among the nearly 1,000 clinical workstations added in the past year to allow for the best possible information system access for physicians, nurses, and other members of the Clinical Care Services Team.

George Carion, director of Voice and Data Networks, and his EIS staff were instrumental in the design and installation of the workstations, Silka said.

Above, from left: George Carion, director of Voice and Data Networks, Chief of Staff Steven S. Galen, MD, and Vice Chief of Staff Christopher S. Ng, MD, with the workstations in Harvey Morse Auditorium. Below, Ng and Galen use a workstation computer.

Changes coming for Infectious Diseases

As the healthcare environment continues to present challenges to integrated health systems, Cedars-Sinai faces difficult decisions regarding organizational structure and staffing. One of these decisions involves the Division of Infectious Diseases in the Department of Medicine. Starting in July, the outpatient and inpatient Infectious Diseases services of the Department of Medicine will be staffed primarily by private attending medical staff members of the Division of Infectious Diseases, instead of full-time faculty infectious disease physicians. The division's clinical and educational programs – including those serving people with HIV and AIDS, as well as the resident and fellowship training programs – will continue.

"The full-time faculty and staff in Infectious Diseases have done an outstanding job over the years, so this is a hard change for everyone," said Zab Mosenifar, MD, executive vice-chair of the Department of Medicine. "I would particularly like to acknowledge the leadership of Dr. W. David Hardy, and thank him and Drs. Paula Gaut and Yoko Miyasaki for their many contributions to Cedars-Sinai. We wish them all the best as they pursue the next chapters in their exemplary professional careers."

Dr. Miyasaki will continue her research in the Department of Biomedical Sciences. The two other Infectious Diseases faculty, Rekha Murthy, MD, and Jonathan Grein, MD, and their staff will remain in their current positions in Hospital Epidemiology as well as members of the Division.

Cedars-Sinai is fortunate to have a number of outstanding infectious disease specialists on its medical staff, so this transition is expected to go smoothly.

Phillip Zakowski, MD, a longtime private attending physician in Infectious Diseases who has won numerous Golden Apple Awards for teaching, has agreed to serve as the coordinator for the Infectious Diseases Fellowship Training Program. Sam Alkasspooles, MD, will continue to serve as clinical chief of Infectious Diseases. Zab Mosenifar, MD, will be the Department of Medicine's liaison to ensure that all Infectious Diseases programs transition smoothly and effectively.

Questions about this transition can be addressed to Dr. Mosenifar at mosenifarz@cshs.org.

More doctors, hospitals partner to coordinate care for people with Medicare

Cedars-Sinai has been selected as one of 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries across the United States now have access to high-quality, coordinated care, Health and Human Services (HHS) Secretary Kathleen Sebelius announced Jan. 10.

Doctors and healthcare providers can establish Accountable Care Organizations in order to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. Accountable Care Organizations share with Medicare any savings generated from lowering the growth in healthcare costs, while meeting standards for quality of care.

"Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare," said Secretary Sebelius. "Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve."

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative are up to $940 million over four years.

The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.

The group announced Jan . 10 also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.

Also Jan. 10, HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.

Additional information about the Advance Payment Model is available at http://www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.

The next application period for organizations that wish to participate in the Shared Savings Program beginning in January 2014 is summer 2013. More information about the Shared Savings Program is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/

For a list of the 106 new ACOs announced Jan. 10, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html

Here comes the flu

C-S sees spike in flu cases; new visitor precautions put into place

Cedars-Sinai is experiencing an increase in flu cases, and California public health officials warn that the flu epidemic that has already hit hard in other areas of the nation is headed our way.

"The number of positive influenza cases confirmed at Cedars-Sinai has increased substantially in the past two weeks," says Rekha Murthy, MD, director of Hospital Epidemiology at Cedars-Sinai. "We are admitting five to six patients per day with influenza diagnosis and three to four positive for other respiratory viruses."

To help prevent the spread of infection and protect our patients, all Cedars-Sinai employees and members of the medical staff are strongly urged to get vaccinated if they have not already done so. This year's vaccine is particularly effective – an estimated 90 percent of all the flu strains circulating in the nation are included in the current vaccine, according to the CDC.

Cedars-Sinai medical staff, including attending physicians, can receive a free vaccination at Employee Health Services, located on the second floor of the Spielberg Building, from 7 a.m. to 4 p.m., Monday through Friday. No appointment is necessary. Flu shot clinics are also being scheduled on campus; watch for further announcements about dates and locations.

Physicians are advised to take note that a number of precautions have been put into place this week to minimize the spread of influenza-like illness at the medical center. These include:

  • Screening visitors with symptoms of influenza-like illness as they arrive (fever and any of the following: cough, shortness of breath, difficulty breathing, muscle aches, sore throat) and keeping them from visiting patients.
  • Pre-emptively place patients with influenza-like illness on Droplet Precautions (employees, medical staff and volunteers must sanitize hands and wear a surgical mask when entering these rooms).
  • In ambulatory care areas such as the ED, provide a disposable surgical mask for patients with influenza-like illness and separate from others where possible.
  • Reminding employees, patients and visitors to observe proper hand hygiene and respiratory/cough etiquette (cough and sneeze into your elbow or a tissue).
  • Urging staff with influenza-like illness to stay home until symptoms subside (usually five to seven days from onset) or absence of fever for 24 hours.

Re-entry program gives doctors a chance to return to medicine

Sandy Kaushal, MD, graduated medical school in 2002 and became a pediatrician. But six years later, pregnant with her second child, she decided to take a break from medicine.

Kaushal said it was a family decision for her to stay home and be there for her children while they were babies.

This year, with both her children in school, Kaushal was ready to return to medicine. But returning to the profession is not as simple as rehanging the shingle. Doctors, like Kaushal, who want to rejoin hospitals, are finding credentialing committees have toughened the standards for re-entry.

Cedars-Sinai is one of only a handful of hospitals in the country with a re-entry program. The program is for doctors who have left the practice of medicine for more than two years for nondisciplinary reasons, have not seen any patients during that time, and want to get back into medicine. The program was structured by Leo Gordon, MD. He said half of the people who've gone through the program are women.

"The women left to start families, and after approximately six years, when their children are in school, they want to return to the practice of medicine," Gordon said. Others who've gone through the program are doctors who left because of illnesses, doctors who left to start businesses and doctors who retired and want to come back.

According to a New York Times article that highlights Cedars-Sinai's re-entry program, studies have shown twice as many doctors now take time off as compared to a decade ago.

At Cedars-Sinai, those who join the program usually spend three months at the medical center in their respective fields, and they partake in all educational activities in that department. They go on rounds, do presentations and keep a detailed log of all cases they are watching. At the end of the three months, they have a rigorous exit interview to assess their clinical competence in the areas to which they have been exposed.

So far, 14 doctors have gone through the program, and all have received staff jobs. The medical center is getting about five calls a month from doctors interested in re-entry.

The rules for re-entering the medical profession vary from state to state, some requiring a written exam, others a re-entry program, and in many cases it's entirely up to the hospital. Kaushal was able to find a job at a California hospital, but the credentialing committee wouldn't accept her without a re-entry program. So she enrolled in the re-entry program at Cedars-Sinai.

Kaushal said the program was tailor made for her. She rounded with other doctors in the Maxine Dunitz Children's Health Center as part of the team, participated in patient discussions, and was involved in patient care. She said having a re-entry program was "a wonderful experience, good for my self-confidence and made me feel ready to go back to work."

Charles Simmons, MD, chair of the Department of Pediatrics and the Ruth and Harry Roman Chair in Neonatology, said the program is a win-win for the medical profession. "It enables doctors to make choices that perhaps weren't available years ago, and with a growing shortage of physicians, it helps hospitals bring competent physicians back into the field."

Prominent bone cancer surgeons join Orthopaedic Center

New cancer surgeons add expertise to treat metastatic bone disease and other complex conditions

Two of Southern California's best-known orthopedic oncologists have joined Cedars-Sinai, enhancing a surgical team that treats some of the most complex and difficult types of cancer.

Lawrence R. Menendez, MD

Daniel C. Allison, MD, FACS, MBA

Earl Warren Brien, MD

Lawrence R. Menendez, MD, and Daniel C. Allison, MD, FACS, MBA, have partnered with Earl Warren Brien, MD, director of musculoskeletal tumor service at the Cedars-Sinai Orthopaedic Center, to form one of the preeminent orthopedic oncology practices in the western U.S.

The surgeons specialize in metastatic bone disease, sarcoma cancers of the bone and soft tissue, invasive skin cancers and melanomas, and complex tumor-like conditions that other hospitals are unable to handle.

"With the joining of these new physicians to the already outstanding program established by Earl Brien, Cedars-Sinai can continue to make meaningful contributions to the treatment of these disorders," said Bruce Gewertz, MD, chair of the Department of Surgery and the H & S Nichols Chair in Surgery.

Menendez and Allison came from USC, where they held leadership positions in orthopedic oncology.

At USC, Menendez served as chief of the Metastatic Bone Clinic, the Multidisciplinary Sarcoma Center and the Center for Orthopaedic Oncology.

His research focuses largely on musculoskeletal tumors. In addition to authoring a book on musculoskeletal tumors for the American Academy of Orthopaedic Surgeons, he co-authored two book chapters, 34 peer-reviewed journal articles and numerous abstracts and presentations.

Menendez is a member of the Los Angeles Surgical Society, the Western Orthopaedic Association, the American Medical Association, the American Academy of Orthopaedic Surgeons, the Musculoskeletal Tumor Society, the American College of Surgeons and the Society of Surgical Oncology.

"We've come to Cedars-Sinai to build something special and important in the field of orthopedic oncology," Menendez said. "This is the place to be if you're an orthopedic oncologist."

Before joining Cedars-Sinai, Allison was assistant chief of the USC Center for Orthopaedic Oncology at the USC Norris Cancer Hospital. He has expertise in musculoskeletal oncology, joint reconstruction and anterior hip replacement. Allison has published extensively in peer reviewed journals and co-authored two book chapters relating to orthopedic surgery, and he has presented numerous papers and abstracts about orthopedic conditions.

"This is a valuable opportunity to become the preeminent center for orthopedic oncology in the western U.S.," said Allison, who is a fellow of the American College of Surgeons and the American Academy of Orthopedic Surgeons, as well as a member of the Musculoskeletal Tumor Society and the California Orthopedic Association.

Menendez and Allison combine forces with Brien, the co-director of Orthopedic Oncology who has published numerous articles, written book chapters and lectured internationally on these subjects. Brien is a diplomate of the National Board of Medical Examiners and the American Board of Orthopaedic Surgery. He also is a member of numerous professional societies, including the American Orthopaedic Association and the Association of Bone and Joint Surgeons.

"This team will offer a level of expertise and specialized care that patients will find few other places," Brien said. "We treat some of the most challenging cases."

The baby was a surprise, the teamwork an inspiration

It was Friday night when things started to go wrong for a 25-year-old woman in the Antelope Valley. Her family said she appeared confused, but she insisted nothing was wrong. The next morning, she was worse, and by the time an ambulance raced her to a local hospital, she had lost consciousness.

Medical tests delivered a series of shocks to the woman's family – her systolic blood pressure was a life-threatening 200-plus, and her high blood pressure had caused a brain bleed. And unbeknownst to her mother and sister, the young woman was 30 weeks pregnant.

"That's when we got the call," said Asma Moheet, MD, a neurocritical care intensivist in the Department of Neurology at Cedars-Sinai. "With the baby in danger, she had to be moved."

When the air ambulance left for Cedars-Sinai, the woman had been outfitted with a heart monitor and a fetal monitor, she was on a ventilator, and her local doctors had drilled a hole in her skull to relieve intracranial pressure. At the Cedars-Sinai helipad, she was met by nurses and doctors from the neurology department, the Neuro ICU, the NICU, the high-risk OB team, and hospital security.

"She went from the helipad straight to the CT scanner, with everyone from the different departments working together as a single team," Moheet said. "She was unconscious and close to comatose, and we didn't even stop at the ICU."

Thanks to advance phone calls by the Neuro ICU's Kimberly Alva, NP, the team at the CT scanner was ready and waiting. The test revealed a very large hemorrhage, which went beyond her brain tissue and into the fluid-filled spaces of her skull.

A drain was placed into her brain, and an experimental drug was used to clear out the hemorrhage. This sort of life-saving drainage procedure, funded through a grant from the National Institutes of Health, is available only in selected Comprehensive Stroke Centers in the United States.

"One thing we knew was that if the mom didn't survive, the baby wouldn't survive either," Alva said. "We knew we had to quickly determine how critical the situation was, and then make a clinical decision based on that."

Moheet, along with the OB team, determined that the mother was stable enough to survive a Cesarean section to deliver the baby. The woman was rushed to OR 8, where the high-risk OB team successfully delivered a girl. John Williams, MD, was the attending physician at the C-section and participated in the patient's care at the medical center.

"The baby came out very well for only 30 weeks, and she went straight to the NICU," said labor and delivery nurse Scout Hebinck, RN. "Once we got the baby delivered and the mother was stable, we took her up to Saperstein for more treatment."

Hebinck, who has worked eight of her 18 years as an RN at Cedars-Sinai, said even as the emergency played out, she was aware of the remarkable teamwork that was saving two lives.

"Everyone worked together, NICU, Neuro ICU, OB, the anesthesia team, all communicating, all working for the best outcome for the mother and the baby," she said. "Without everyone working the way they did, it couldn't have gone so well."

"I've been a nurse for 12 years, and I can say from working other places – this kind of teamwork, it's something that would only happen at Cedars-Sinai," said Hussein Dakhlallah, RN. "It was very fulfilling, that they both survived, and it's because of the care the teams here gave them."

Ideas sought for Great Debates topic

The Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition committee is soliciting suggestions for a topic for this annual spring event.

The debate will convene for its 10th year at 8 a.m. Thursday, April 18, 2013, in ECC A-C. Topics must be timely and must be of interest to the many departments and sections within the medical center.

Submit suggestions to Leo A. Gordon, MD, FACS, coordinator, Great Debates in Clinical Medicine, Leo.Gordon@cshs.org.

The 2012 debate focused on the influence of technology on the traditional doctor-patient relationship.

Ordinary heart cells become 'biological pacemakers' with injection of a single gene

Researchers at the Cedars-Sinai Heart Institute have reprogrammed ordinary heart cells to become exact replicas of highly specialized pacemaker cells by injecting a single gene (Tbx18) — a major step forward in the decade-long search for a biological therapy to correct erratic and failing heartbeats.

The advance was published in the Jan. 8 issue of Nature Biotechnology and also is available on the journal's website.

"Although we and others have created primitive biological pacemakers before, this study is the first to show that a single gene can direct the conversion of heart muscle cells to genuine pacemaker cells. The new cells generated electrical impulses spontaneously and were indistinguishable from native pacemaker cells," said Hee Cheol Cho, PhD, a Heart Institute research scientist.

Pacemaker cells generate electrical activity that spreads to other heart cells in an orderly pattern to create rhythmic muscle contractions. If these cells go awry, the heart pumps erratically at best; patients healthy enough to undergo surgery often look to an electronic pacemaker as the only option for survival.

The heartbeat originates in the sinoatrial node (SAN) of the heart's right upper chamber, where pacemaker cells are clustered. Of the heart's 10 billion cells, fewer than 10,000 are pacemaker cells, often referred to as SAN cells. Once reprogrammed by the Tbx18 gene, the newly created pacemaker cells — "induced SAN cells" or iSAN cells — had all key features of native pacemakers and maintained their SAN-like characteristics even after the effects of the Tbx18 gene had faded.

But the Cedars-Sinai researchers, employing a virus engineered to carry a single gene (Tbx18) that plays a key role in embryonic pacemaker cell development, directly reprogrammed heart muscle cells (cardiomyocytes) to specialized pacemaker cells. The new cells took on the distinctive features and function of native pacemaker cells, both in lab cell reprogramming and in guinea pig studies.

Previous efforts to generate new pacemaker cells resulted in heart muscle cells that could beat on their own. Still, the modified cells were closer to ordinary muscle cells than to pacemaker cells. Other approaches employed embryonic stem cells to derive pacemaker cells. But the risk of contaminating cancerous cells is a persistent hurdle to realizing a therapeutic potential with the embryonic stem cell-based approach. The new work, with astonishing simplicity, creates pacemaker cells that closely resemble the native ones free from the risk of cancer.

For his work on biological pacemaker technology, Cho, the article's last author, recently won the Louis N. and Arnold M. Katz Basic Research Prize, a prestigious young investigator award of the American Heart Association.

"This is the culmination of 10 years of work in our laboratory to build a biological pacemaker as an alternative to electronic pacing devices," said Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute and Mark S. Siegel Family Professor, a pioneer in cardiac stem cell research. A clinical trial of Marbán's stem cell therapy for heart attack patients recently found the experimental treatment helped damaged hearts regrow healthy muscle.

If subsequent research confirms and supports findings of the pacemaker cell studies, the researchers said they believe therapy might be administered by injecting Tbx18 into a patient's heart or by creating pacemaker cells in the laboratory and transplanting them into the heart. But additional studies of safety and effectiveness must be conducted before human clinical trials could begin.

The study was supported by the Cedars-Sinai Board of Governors Heart Stem Cell Center, the Heart Rhythm Society, the Heart and Stroke Foundation of Canada, the American Heart Association, the National Heart, Lung, and Blood Institute, and the Mark S. Siegel Family Professorship. The authors report that they have no conflicts of interest.