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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF June 7, 2013 | Archived Issues

P&T Committee Adds Medical-Grade Honey to Formulary

Pharmacy Focus

April's actions by the Pharmacy and Therapeutics Committee include the addition of medical-grade honey to the formulary. Also, the U.S. Food and Drug Administration is advising healthcare professionals against using magnesium sulfate injections for more than five to seven days to stop pre-term labor in pregnant women.

» 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.

CME Newsletter - May 2013 (PDF)

Cedars-Sinai Will Hold First PhD Graduation on June 11

Arthur Rubenstein, MB BCh, Will Deliver Commencement Address

Take a look around the Cedars-Sinai campus, and some of the biggest changes of the past year are easy to see. Ask Leon G. Fine, MD, what the biggest advance at Cedars-Sinai has been in the last year, and he points to one that isn't as visible.

» Read more

CS-Link Tip: Editable SmartLinks

This week's CS-Link™ Tip comes from Lisa Masson, MD, associate medical director of Ambulatory Clinical Systems, EIS. She spent the last two weeks as staff of the Faculty Inpatient Service and reminds us that a review of the basics is good for all physicians from time to time.

» Read more

Unit Closures Continue as Part of Nurse Call System Replacement; 7SW Set to Close This Weekend

As part of our ongoing efforts to improve the health, safety and satisfaction of our patients, Cedars-Sinai is replacing its current nurse call system with the Responder 5 Nurse Call System. The new system expands nurses' ability to monitor a variety of parameters and provides tools for real-time reporting and extractable data.

» Read more

Longtime Emergency Co-Chair Retiring - But Not From Patients

After serving as co-chair of the Emergency Department at Cedars-Sinai for 26 years, during which he oversaw the expansion of the department and helped lead it into the digital age, James Loftus, MD, is stepping down from his administrative duties. He will remain on the Cedars-Sinai medical staff, however, and will continue his favorite part of working in the ED – seeing patients.

» Read more

July Is Coming, and So Are Fireworks, Sand 'N' Snore

July has a couple of treats in store for medical staff members and their families. The first of them is less than a month away.



» Read more

Kabbalat Shabbat Services Start This Today

Beginning June 7, a weekly celebration of the Sabbath will be held at 3 p.m. in the Chapel. The Kabbalat Shabbat service (literally, "welcoming the Sabbath") will be 15 minutes of songs, psalms, prayer and Torah reflections.

» Read more

Cedars-Sinai Team Performs More Than 100 Operations During Guatemala Mission

When the team from Cedars-Sinai arrived at the small town of Joyabaj, Guatemala, the only medical facility was a single labor-and-delivery room in an otherwise empty building. A day later, the group of 85 volunteers had created a small hospital from the equipment they brought with them, complete with an operating room, a recovery room, and a clinic to see and treat patients.

» Read more

Innovator of Heart Valve Repair Receives Cedars-Sinai Heart Institute's Corday Prize in Heart Research

Cedars-Sinai Heart Institute has honored the physician widely known as  the leading pioneer in modern mitral heart valve repair, Alain Carpentier, MD, PhD, with the second annual Eliot Corday, MD, International Prize in Heart Research.

» Read more

Outpatient Pharmacy to Open in Pavilion

The Advanced Health Sciences Pavilion's Outpatient Pharmacy will open next month on the Plaza Level. The pharmacy's state-of-the-art technology will enable pharmacists to spend more time counseling patients and supporting their medication management needs.

» Read more

Cedars-Sinai Will Hold First PhD Graduation on June 11

Ahmed Ibrahim, left, and Morgan Clond are two of the students in the graduate program in Biomedical Sciences and Translational Medicine. Clond will graduate June 11.

Arthur Rubenstein, MB BCh, Will Deliver Commencement Address

Take a look around the Cedars-Sinai campus, and some of the biggest changes of the past year are easy to see. For example, the gleaming Advanced Health Sciences Pavilion poised to open its doors, the medical center buildings with fresh coats of paint, new landscaping and art sprucing up the campus.

Ask Leon G. Fine, MD, what the biggest advance at Cedars-Sinai has been in the last year, and he points to one that isn't as visible.

"What is the fundamental difference this year compared to last? Today, we are not only a world-class medical and research center, but we are also a degree-granting institution. Up to now, we have had growing and significant research initiatives, producing some incredibly important and interesting scientific discoveries. But, we were a research community without students," said Fine, vice dean of Research and Research Graduate Education, and chair of Biomedical Sciences.

Commencement Ceremony

The inaugural commencement of the Graduate Program in Biomedical Sciences and Translational Medicine will be held Tuesday, June 11, at 4 p.m. in Harvey Morse Auditorium. A reception will follow.

Arthur Rubenstein, MB BCh, a distinguished leader in American medicine whose research was key to understanding the natural history of diabetes, will speak at the ceremony.

RSVP to commencement@cshs.org.

The graduate program in Biomedical Sciences and Translational Medicine will celebrate its first graduating class at commencement ceremonies on June 11 in Harvey Morse Auditorium. Shlomo Melmed, senior vice president of Academic Affairs and dean of the Medical Faculty, announced that Arthur Rubenstein, MB BCh, professor and emeritus dean of the University of Pennsylvania Perelman School of Medicine, will deliver the commencement address. Rubenstein, a distinguished leader in American medicine, is a member of the Institute of Medicine and a past chair of the American Board of Internal Medicine. He was a pioneer in unraveling the role of disrupted insulin secretion and the developing natural history of diabetes. He developed the first accurate way to measure insulin secretion leading to a subsequent translational platform for over 40 years of diabetes research discovery.

The addition of graduate students has injected a new vibrancy and excitement into the Cedars-Sinai academic community. The graduates, the first to earn doctorates from Cedars-Sinai, will be clutching diplomas from a fully accredited program. The Western Association of Schools and Colleges granted accreditation to the program in July 2012 – a tribute to how much was accomplished while maintaining the highest levels of quality.

Shabnam Ziaee (left) and Morgan Clond are students in the graduate program in Biomedical Sciences and Translational Medicine.

"There is virtually no record of a program getting accredited before a graduation," Fine said. "This speaks volumes about how much our program was able to accomplish quickly."

The program offers a doctorate in Biomedical Science and Translational Medicine, with mentoring from both researchers and clinicians to produce graduates who are committed to applying basic science discovery that directly affects patients.

"When you look at graduate programs on a national level, there is a huge divide between basic science and clinical medicine," said David Underhill, PhD, director of the graduate program. "Our program bridges that issue, because we have the infrastructure to make that divide disappear."

The program has attracted a diverse student population, with about a quarter of students from under-represented minority groups. They are also diverse in their backgrounds and career plans. Many plan to continue research careers, others plan to pursue medical degrees. A number of students are MDs who wanted to go into research – and Underhill and Fine said they hope more physicians will do the same.

"We want students to gain a broad knowledge and understanding of biological science, and how that relates to medicine," Fine said. "We also want to be responsive to the scientific interests of our students."

Among the students in the graduate program in Biomedical Sciences and Translational Medicine are Candy Bedoya (left) and Ahmed Ibrahim.

No matter which scientific discipline most interests students, the program's main goal is to instill an understanding of how basic science research relates to treatment and the pathophysiology of disease. The faculty and mentors include both physicians who diagnose and treat diseases, as well as scientists who delve into the underlying mechanisms of disease.

"It's not enough to simply have a complete understanding of the science," Fine said. "Our students have clinical exposure. We expect them to think and talk about the clinical issues related to the scientific concepts. Though we spend significant time in the laboratory, our focus remains on what these discoveries mean for real-world patients."

Students complete several laboratory rotations, including pairing them with clinical mentors. They familiarize themselves with laboratories and research of their choosing, and they observe patient care and clinical research. During the first year of study, students participate in structured workshops, seminars and journal clubs. During their second year, they choose a doctoral committee and complete a proposal for their dissertation research. In the final year, students complete their research, write their dissertation and defend it, and they meet regularly with their committees, and continue workshop and journal club activities.

CS-Link Tip: Editable SmartLinks

This week's CS-Link™ Tip comes from Lisa Masson, MD, associate medical director of Ambulatory Clinical Systems, EIS. She spent the last two weeks as staff of the Faculty Inpatient Service and reminds us that a review of the basics is good for all physicians from time to time.

She notes that an important basic tool is making a SmartLink (highlighted green in a CS-Link template note) editable. By moving the cursor over the SmartLink and right-clicking, a user can then add free text to the field in the position where the link was. This is helpful if you wish to add additional detail to structured data captured elsewhere in the chart.

One caveat: Once the SmartLink is made editable, it will no longer refresh itself when used elsewhere. (For instance, if you edit the medication list to show a unique detail or remove an irrelevant item).

Click here to go to CS-Link Central and see screen shots for this tip (click on link and scroll down to bottom of the page).

Unit Closures Continue as Part of Nurse Call System Replacement; 7SW Set to Close This Weekend

As part of our ongoing efforts to improve the health, safety and satisfaction of our patients, Cedars-Sinai is replacing its current nurse call system with the Responder 5 Nurse Call System. The new system expands nurses' ability to monitor a variety of parameters and provides tools for real-time reporting and extractable data.

To allow for installation of the new system, units are being closed on a rotating basis for 14 days. The next unit scheduled for closure is 7 Southwest. As a result, 7SW rehab patients will be moved to available beds in 7 Southeast on Saturday, June 8. Patients who would routinely be admitted or transferred to 7SE on or after June 6 will be moved to available medical/surgical beds on other units.

Relocation back to 7SW is anticipated to take place Friday afternoon, June 21, pending inspection and permission to reopen.

Units expected to have the Responder 5 system installed this calendar year also include:

  • July 2013 – 7NE and 7NW
  • August 2013 – 8NE and 8NW
  • September 2013 – 4SE and 4SW
  • October 2013 – 8SE and 8SW

If you have any questions regarding these unit closures, please contact Vice President and Chief Nursing Officer Linda Burnes Bolton, DrPH, RN, FAAN, at 310-423-5191 or burnesbolton@cshs.org, or Peachy Hain, RN, director of Medical, Surgical and Rehabilitation Nursing, at 310-423-6747 or peachy.hain@cshs.org.

Longtime Emergency Co-Chair Retiring - But Not From Patients

For James Loftus, MD, the plan, back when he was starting out, was retirement by age 55. Thirteen years after that birthday, he's finally following through. Sort of.

After serving as co-chair of the Emergency Department at Cedars-Sinai for 26 years, during which he oversaw the expansion of the department and helped lead it into the digital age, Loftus is stepping down from his administrative duties. He will remain on the Cedars-Sinai medical staff, however, and will continue his favorite part of working in the ED – seeing patients.

"It's like when you meet the right person, you just know," Loftus said of his decision to give up his post as co-chair. "This is the right time to step down from my administrative duties, and I just knew that. Now, it's time to be with my family."

Loftus' journey to his leadership at the ED began at the University of Tennessee Medical School, where he graduated with honors and won the President's Medal. He then moved to Los Angeles for a one-year internship at UCLA, followed by two years working for the U.S. Public Health Service, first at a hospital on the Navajo reservation near Shiprock, N.M., and later in Phoenix.

"I loved that work, loved the people and the country," Loftus said. "There were medicine men there who had as much say as I did when taking care of people, working with chants and doing sand paintings on the floor."

In 1973, Loftus returned to California, where he completed a two-year residency, again at UCLA. Although he planned to specialize in pulmonology or rheumatology, he first did a stint in an emergency department in San Gabriel.

"Almost immediately, I said, 'This is it, this is my place, this is my personality,'" he recalled. "I recently found an old schedule – my first shift in the ED was Dec, 12, 1976."

Colleagues were unanimous and unstinting in their praise of Loftus, calling him an excellent doctor and a gifted administrator.

"He's been very collaborative and trustworthy," said Joel Geiderman, MD, co-director of the ED since June 1993. "We've had a good working relationship, and complement each other in this partnership."

Loftus helps center the staff of the ED, a challenging department known for its fast pace, Geiderman said.

Geiderman also hailed Loftus as an early adopter of computerized record keeping, including a precursor to CS-Link™ in the late 1990s.

"The ED was the first department at Cedars-Sinai to automate the physician order entry system, which is an important legacy," Geiderman said.

Another legacy is the bond patients feel with Loftus, said Sam Torbati, MD, vice chair of the ED who will take on the role of co-chair in July.

"His patients love him," Torbati said. "And that's probably not something he'd be willing to tell you, as he's extremely modest."

Loftus is drawn to both the challenge of medicine and to the people he treats, Torbati said.

"He's not only a great clinician, but he also has a gift for being able to bond with his patients," Torbati said. "His patients know that he has a deep interest in them outside of the disease that brought them to the ED and that he cares about them as individuals."

Among Loftus' other attributes are his deep knowledge about the medical center, and his ties and connections to so many staff members.

"He knows everyone in the hospital," said Gayla Nielsen, RN, PhD, who serves as administrative director of the Emergency Department. "He brings a lot of wisdom to the role and, because of his breadth of experience, is able to process the most complicated situations in a way that is calm, thoughtful and tailored to meet the highest-quality outcome."

Nielsen said she, like the rest of the ED staff, is happy Loftus isn't retiring completely.

"He reassures us he's not going away, he's just giving up the co-chair position," she said.

Loftus estimates he spends 60 percent of his time in Emergency on administrative tasks, the rest on clinical work. Taking a step back from the administrative side will give him more time to spend with patients and with his greatest love of all, his family.

"My kids – Jimmy is 13 and Katie is 11 – are at a point where they need me around more," Loftus said. "One of the advantages of having kids when you're older is that you've done the work of building your career and you now have more time to spend with them."

That means attending his son's baseball games and watching his daughter dance and play soccer. And at the medical center, he'll be able to focus on his first love in medicine – the people he treats.

"Being a physician is one of the most rewarding careers you can have," Loftus said. "You get to meet and help so many different people, hear their stories and make a difference in their lives. I still get tremendous satisfaction out of it, and look forward to this new phase in my career."

Leadership Changes in Department of Emergency Medicine (PDF)

July Is Coming, and So Are Fireworks, Sand 'N' Snore

July has a couple of treats in store for medical staff members and their families. The first of them is less than a month away.

Hollywood Bowl Fireworks – July 3

Celebrate Independence Day with fireworks and music by the Hollywood Bowl Orchestra and special guest Josh Groban. The event on Wednesday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $125 per adult and $60 per child younger than 12. To reserve tickets, call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681.

>> See coverage of last year's event.

A snapshot from last year's Hollywood Bowl event

Sand 'N' Snore – July 19

The dinner, sleepover and breakfast starts Friday, July 19, 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 $65 per adult and $40 for each child under age 12. Tickets for Friday's dinner only are $50 per adult and $20 for each child younger than 12. Call Cheryl Verne (in the office of Marjorie Santore Besson) at (310) 423-2681 to reserve your spot.

>> See coverage of last year's event.

A scene from last year's Sand 'N' Snore

Kabbalat Shabbat Services Start This Today

Beginning June 7, a weekly celebration of the Sabbath will be held at 3 p.m. in the Chapel. The Kabbalat Shabbat service (literally, "welcoming the Sabbath") will be 15 minutes of songs, psalms, prayer and Torah reflections. Challah and grape juice will be served.

The Kabbalat Shabbat, the medical center's first-ever weekly Jewish prayer service, is a milestone, said Rabbi Jason Weiner, senior rabbi and manager of the medical center's Spiritual Care Department. Because a minyan – a quorum of 10 Jewish adults – is required for the Shabbat service, which begins at sunset each Friday, the services have not been held in the past, Weiner explained. But this “Shabbat on the Go” Kabbalat Shabbat service will take place before sunset, and with any number of celebrants.

"This is 15 minutes in the afternoon, so people can briefly get away from their desks and come to the Chapel, which is centrally located," Weiner said. "As the day starts to lean into sunset and Shabbat gets closer, everyone is invited to come and join others celebrating and preparing for Shabbat."

Cedars-Sinai Team Performs More Than 100 Operations During Guatemala Mission

Guatemala 1 480px

For many residents, a visit from Cedars-Sinai medical professionals marks their only access to healthcare all year. This year's mission was to Joyabaj, Guatemala.

When the team from Cedars-Sinai arrived at the small town of Joyabaj, Guatemala, on April 21, the only medical facility was a single labor-and-delivery room in an otherwise empty building. A day later, the group of 85 volunteers had created a small hospital from the equipment they brought with them, complete with an operating room, a recovery room, and a clinic to see and treat patients.

"It was like a MASH unit," said Gary Hoffman, MD, an attending surgeon in the Division of Colorectal Surgery. "One day there's nothing there, and the next we're performing surgery."

Remarkable, but also business as usual for the annual medical mission – one of 11 such visits organized by HELPS International each year. A nonprofit organization, HELPS oversees volunteer work throughout impoverished areas of Latin America.

This year's mission took place in Joyabaj, a town of about 9,500, located in the highlands in central Guatemala. For many of the residents, most of them indigenous, the Cedars-Sinai visit is their only access to medical care all year.

Babak Larian, MD, division chief of Otolaryngology, serves as director of the Cedars-Sinai HELPS mission. A participant in the missions since 2003, he said he feels a special responsibility to his Guatemalan patients, who have so little access to medical care.

Hoffman was so moved by the experience that he changed his Memorial Day travel plans and flew to Dallas with Larian, Olivia Marroquin, their team leader, and Hoffman's son, Jordan Hoffman, MD, a second-year surgical resident at Emory University. There, they attended the annual HELPS International review meeting. All of the volunteer team leaders from across the nation were in attendance.

Father and son volunteered and will be leading a second, yearly Los Angeles/Cedars-Sinai team mission to Guatemala. That team's first trip will begin Oct. 18, 2014.

"My response to this was immediate and profound," said Hoffman, "and by leading a second team to an underserved area of the globe, Jordan will begin his career with a dedication to service, and I will be able to cap my career in the same way. It is right on so many levels."

Hoffman continued, "Let's see how many medical,  surgical, dental, nursing and staffing volunteers we can pull into this. I hope that everyone will answer the call, or at least answer my phone calls."

For Hoffman, a first-time participant in the mission, now in its 13th year, the experience was eye-opening in a number of ways. He was struck by the extreme need of the people, and their open-hearted gratitude. He also had the rare opportunity to see his son and Alexandra Gangi, MD, a Cedars-Sinai surgical resident PGY 4, at work in challenging circumstances.

"Watching Jordan and Alex work with the patients, seeing their level of skill, competence and their compassion, buoyed my confidence that we are turning out excellent doctors who are equipped for the challenges of our profession," Hoffman said.

"The entire trip was so well organized," he added. "I give all of the credit to Babak (Larian) and Olivia Marroquin for having organized this remarkable mission. The patients were the recipients of a real humanitarian effort."

Challenge was the order of the day. During the five days of the mission, the medical team, which traveled for 36 hours to reach its destination, saw 933 patients and performed 101 operations, said Marroquin, a surgical endoscopy tech at Cedars-Sinai. A native of Guatemala who moved to the U.S. in 1970, Marroquin has been the organizing force behind the mission since its inception.

The medical team started work at 7 a.m. and often finished at 1 or 2 a.m. the next day. Mission participants paid their own travel expenses and used personal time to be there. Operations included cleft palate repairs, gall bladder removal, hysterectomies, head-and-neck cancer operations, repairs of hand deformities and, to the joy of the participants, the birth of two healthy babies.

Susan Whang, RN, who works in the OR, joined the mission for the first time after hearing about it from her colleagues for several years.

"It was a great experience – I have never worked as hard as I did there, and it's the most rewarding experience I have ever had," Whang said. "I saw things I have never seen in practice – a fibroid as big as two basketballs – and when you see the need, you know you'll go back."

All formality and hierarchy were wiped away, and everyone, from surgeons and nurses to translators and clerical staff, worked as equals. Talk to almost anyone who has taken part in a mission and they say the same thing – this is medicine at its most profoundly satisfying.

"We in the U.S. are so fortunate; we rarely even see the kinds of cases that are routine in the Guatemala mission," Larian said. "And so we work 18-hour days – I literally have to force people to stop and get some rest, because all of us want to help as much as we can."

Innovator of Heart Valve Repair Receives Cedars-Sinai Heart Institute's Corday Prize in Heart Research

Cedars-Sinai Heart Institute has honored the physician widely known as the leading pioneer in modern mitral heart valve repair, Alain Carpentier, MD, PhD, with the second annual Eliot Corday, MD, International Prize in Heart Research. The Cedars-Sinai Heart Institute established the Corday Prize to recognize physicians and scientists conducting groundbreaking research, or individuals who significantly advance the practice of heart medicine.

Carpentier is a leading surgeon, researcher and professor, and 2007 recipient of the prestigious Albert Lasker Award for Clinical Medical Research. Carpentier is credited with taking valves from pigs and using them in humans, thus reducing or eliminating the need for patients to take blood thinners for the rest of their lives, as required for artificial valve patients.

Carpentier serves as president of Académie des Sciences at the Institut de France and is an emeritus professor at the University Paris-Descartes and adjunct professor at Mount Sinai Medical School in New York.

"Carpentier's contributions to cardiology can be felt by patients worldwide," said Eduardo Marbán, MD, PhD,director of the Cedars-Sinai Heart Institute and Mark S. Siegel Family Professor. "At Cedars-Sinai, where were have performed more minimally invasive heart valve procedures than any other U.S. medical center, we rely on Carpentier's pioneering work every day. Dr. Carpentier's legacy and commitment to heart health inspires all of us to continue working toward improving outcomes for patients with highly complex and challenging cardiac conditions."

The Corday Prize is named for the late Eliot Corday, MD, a distinguished cardiologist who was an attending physician with Cedars-Sinai, a member of its board of directors and chief of Cardiology for 11 years. Corday was an influential scientist, clinician and educator who helped to pioneer invasive cardiology. He collaborated on research that led to modern stress testing and nuclear cardiology. His interests in sudden cardiac death and ischemic – or silent – heart disease contributed to the development of coronary intensive care units. Corday’s leadership had global impact, as he championed increased federal funding for medical research and the sharing of American cardiovascular expertise worldwide. He served as president of the American College of Cardiology and in a consultant capacity at high levels of the United States government.

The Corday Prize is funded by a gift from Brindell Gottlieb and her late husband, Milton. The Gottlieb family has longstanding ties with both Cedars-Sinai and the Corday family.

Outpatient Pharmacy to Open in Pavilion

Pharmacy supervisor Julie Ly stocks the pharmacy at the Advanced Health Sciences Pavilion.

The Advanced Health Sciences Pavilion's Outpatient Pharmacy will open next month on the Plaza Level.

"The AHSP Pharmacy has state-of-the-art technology including bar code scanning and automated storage and retrieval of prescriptions to ensure accuracy and support timely processing of patient and employee prescriptions," said Melsen Kwong, PharmD, pharmacy manager.

Pharmacy supervisor Christine Manukyan (back) helps pharmacy tech IV Peter Do stock medication in the AHSP Pharmacy. Below, they look over a computer display in the pharmacy.

Advanced Health Sciences Pavilion Pharmacy Hours

  • Open: 7:30 a.m.-6 p.m. Monday through Friday
  • Closed: Saturday, Sunday and holidays

This technology will enable pharmacists to spend more time counseling patients and supporting their medication management needs. As more becomes known about diseases and treatments, patients are often prescribed complex medication regimens. The pharmacist can help patients understand their medications, how they work and how to take them appropriately, Kwong said. Sometimes, something as simple as taking medication with food rather than water can significantly lessen the effect of the medication. Having an accurate medication list is also essential to ensure optimal treatment of diseases and conditions and to prevent adverse events.

"This pharmacy is the newest addition to the current three outpatient pharmacies. It will serve the medication needs of patients whether they are in the clinics or in the hospital and need prescriptions to take home," Kwong said. "The AHSP pharmacy will also provide prescriptions for Cedars-Sinai employees."

In addition to the Plaza Level location, an OR pharmacy satellite is centrally located on the 5th floor of the Pavilion, Kwong said. The OR pharmacist is available to assist the OR, PACU, and Procedural Areas with patient-specific medication needs, whether it is providing dosing recommendations or helping nurses optimize medication administration. In addition, the pharmacist will serve as a member of the critical care response team in emergencies.

Pharmacy services in the new building were created with the goal of being available to play an integral role in the health care team to provide the best possible patient care.