Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Oct. 11, 2013 | Archived Issues

Meetings and Events


Hydroxyethyl Starch Solutions Removed From Formulary

Pharmacy Focus

Due to the risks associated with the use of hydroxyethyl starch (HES) solutions, and the availability of safer and equally efficacious alternatives, the Pharmacy and Therapeutics Committee has approved the removal of Hespan from the formulary.

» Read more


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 - October 2013 (PDF)

MEC Morning After Report

See highlights of the Oct. 7 meeting of the Medical Executive Committee.

» Read more

Annual Meeting of Medical Staff Is Oct. 21

The annual meeting of the medical staff is scheduled for Monday, Oct. 21, from 11:30 a.m.-1:30 p.m. in Harvey Morse Auditorium.

» Read more

CS-Link Tip: Frequent Medication Management

Physicians might need medications available at the bedside for a procedure. In the Comments section, they should say, "Have Available at Bedside" and can further communicate their intentions to the nurses by adding, for example, "I plan to be there at 3 p.m. to insert a trach."

» Read more

New Cancer Genome Sequencing Offers Physicians Ability to Tailor Treatments

A new DNA sequencing test that scans 50 genes for 2,800 cancer-related mutations – thus offering oncologists greater precision in the selection of treatment options – is now available at Cedars-Sinai.

» Read more

Learn About the Next Medical Mission to Guatemala on Oct. 20

Would you like to participate in a medical mission in Guatemala? A team of volunteers is planning to aid residents of the Central American country May 18-26, 2014. Those interested in learning more about this opportunity are invited to an informational meeting at 10 a.m. Sunday, Oct. 20, in ECC-C.

» Read more

How the Medical Library Affects Patient Care

As clinicians work to integrate the best evidence into clinical decision making to improve patient care, the library's role increases exponentially in terms of providing consultative services coupled with the latest technology to effectively retrieve, filter and organize the increasing body of relevant literature for medical staff members.

» Read more

Flu Shots Now Offered at Off-Campus Locations

Be sure to protect yourself and our patients from getting the flu this year. Cedars-Sinai is offering free flu shots for employees, volunteers and members of the medical staff now through Dec. 30.

» Read more

Circle of Friends Honorees for September

The Circle of Friends program honored 164 people in September. 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

Most Who Qualify for Lifesaving Heart Treatment Do Not Receive It

A new study of patients who died of sudden cardiac arrest shows the majority who qualified to receive potentially lifesaving treatment did not receive it.

» Read more

MEC Morning After Report

Highlights of the Oct. 7 meeting of the Medical Executive Committee are summarized in the PDF link below.

Morning After Report - October 2013 (PDF)

Annual Meeting of Medical Staff Is Oct. 21

The annual meeting of the medical staff is scheduled for Monday, Oct. 21, from 11:30 a.m.-1:30 p.m. in Harvey Morse Auditorium.

Agenda items include the chief of staff report, CEO report and executive update, the Chief of Staff Award, and the 2013 Pioneer in Medicine Award.

Annual Meeting of the Medical Staff - Oct. 21 (PDF)

CS-Link Tip: Frequent Medication Management

This week's tip comes from Dani Hackner, MD.

Physicians might need medications available at the bedside for a procedure. They should order the medications as they usually would.

In the Comments section, they should say, "Have Available at Bedside" and can further communicate their intentions to the nurses by adding, for example, "I plan to be there at 3 p.m. to insert a trach."

This is NOT a case for Nursing Communication Orders. Nursing Communication Orders Should NOT be used for medications.

Click here for more CS-Link training updates for physicians.

New Cancer Genome Sequencing Offers Physicians Ability to Tailor Treatments

A new DNA sequencing test that scans 50 genes for 2,800 cancer-related mutations – thus offering oncologists greater precision in the selection of treatment options – is now available at Cedars-Sinai.

The next-generation sequencing cancer panel was launched at Cedars-Sinai and is performed on DNA that has been extracted from formalin-fixed, paraffin-embedded tumor tissue, said Jean Lopategui, MD, medical director of Molecular Pathology and Clinical Cytogenetics and director of the Molecular Genetics Pathology Fellowship.

The test, which has a turnaround time of five weeks, essentially creates a genetic fingerprint of the cancer and will identify the tumors that are likely to respond to existing or developing targeted therapies.

The test uses advanced semiconductor technology. For more information, click here. Photo from Ion Torrent.

"In this novel paradigm, we identify the mutation and then see if there's an FDA-approved drug that is applicable specifically to the mutation," Lopategui said. For instance, in non-small cell lung cancer, about 20 percent of tumors presently fall under this category, he said.

If the test shows that the patient's lung tumor is among the 80 percent that do not presently have an FDA-approved treatment that matches the mutation, the scope of the test makes it possible to scan for other mutations. The detailed results can then allow doctors to search for an appropriate clinical trial, and thus match a patient to an alternative avenue of treatment.

"This is where next generation sequencing is so helpful," Lopategui said. "We can scan for multiple mutations in a single test."

Next generation sequencing offers hope to identify precise molecular pathway-based treatment targets to patients with tumors that have fewer traditional treatment options. It complements traditional cancer classification (i.e., by their location in the body, by tumor size, or by how far the disease has progressed) by providing the genetic signature that itself provides the additional information to help guide therapy. The 50-gene test advances the cancer science beyond single-gene testing and moves it in the direction of characterizing the entire exome and genome.

In alignment with the institutional vision of Precision Medicine and under the leadership of Mahul Amin, MD, chair of the department of Pathology and Laboratory Medicine, exhaustive validation of this deep sequencing assay began in March 2013 in Cedars-Sinai's CAP/CLIA-certified Molecular Pathology laboratory. The test uses advanced semiconductor technology for next generation sequencing.

Under the supervision of Raju Pillai, MD, director of Pathology Bioinformatics, the data generated is then analyzed by sophisticated bioinformatics softwares that identify mutations. Specific targeted therapies are then searched in available databases for optimal drug selection. Although it has been released nationally, availability of the test is limited.

"Cedars-Sinai is one of less than 25 academic centers in the entire country that is offering it," Lopategui said. "This is a cutting-edge test that is emerging from research and just now going into clinical use." We anticipate this test to become a novel standard of care paradigm to expand therapeutic options for oncologists and their patients by providing the genetically based evidence to tailor treatments.

This strategy in the fight against cancer will also open great opportunities for novel treatments at the Samuel Oschin Comprehensive Cancer Institute. This approach has already been shown to result in a higher response rate and a longer survival time in cancer patients.

Learn About the Next Medical Mission to Guatemala on Oct. 20

A photo from the 2013 mission

Would you like to participate in a medical mission in Guatemala? A team of volunteers is planning to aid residents of the Central American country May 18-26, 2014.

Those interested in learning more about this opportunity are invited to an informational meeting Sunday, Oct. 20, at 10 a.m. in ECC-C.

The annual mission is arranged by HELPS International, a nonprofit organization that supports volunteer work in Guatemala. People with both clinical and administrative experience are welcome, as are friends and family members.

This past spring, nearly 100 volunteers – the majority from Cedars-Sinai – took part in the mission. The team helped more than 1,000 patients.

For more information, please contact Olivia Marroquin at olivia.marroquin@cshs.org, Jim Laur at james.laur@cshs.org, or Babak Larian, MD, at larianb@yahoo.com.

Click here to read about the 2013 mission.

How the Medical Library Affects Patient Care

As clinicians work to integrate the best evidence into decision making to improve patient care, the library's role increases greatly in terms of providing consultative services coupled with the latest technology to retrieve, filter and organize the increasing body of relevant literature for medical staff members.

A recent article in the Journal of the American Medical Association, "The Evolving Role and Value of Libraries and Librarians in Health Care," discusses the value of librarians in this information revolution. The article, co-authored by a physician and a librarian, describes the results of a survey of 118 hospitals that highlights how medical staffs handled patient care more effectively because of information provided by the library.

At Cedars-Sinai, a customer service survey done by the Medical Library staff supports the findings from JAMA. The survey, carried out in April 2013, shows that respondents do change patient care based on information provided by the Medical Library. Respondents included physicians, nurses, researchers, students and other employees of the medical center.

Changes reported were mostly associated with medication or dosage (16 percent), reduction in length of stay (12 percent), diagnosis (35 percent), treatment advice to a patient (38 percent) and procedure or practice (46 percent).

As healthcare evolves, the health science library evolves alongside it, adapting to its users' information needs, and it continues to provide high-quality information to support patient care.

Flu Shots Now Offered at Off-Campus Locations

Be sure to protect yourself and our patients from getting the flu this year. Cedars-Sinai is offering free flu shots for employees, volunteers and members of the medical staff now through Dec. 30.

Please note the following dates, times and locations for upcoming clinics:

  • Oct. 11 – 9 a.m.-2 p.m. on South Plaza Level Terrace, north side
  • Oct. 11 – 8 a.m.-3:30 p.m. in the Mark Goodson Building conference room 102
  • Oct. 11 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3
  • Oct. 14 – 7:30 a.m.-11 a.m. and 11:45 a.m.-2:45 p.m. in Thalians West 135
  • Oct. 14 – 8-11:30 a.m. in the Mark Goodson Building Pain Center flex room
  • Oct. 14 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3
  • Oct. 15 – 7:30 a.m.-11 a.m. and 11:45 a.m.-2:45 p.m. in Thalians West 135
  • Oct. 15 – 8:30 a.m.-3 p.m. at Torrance
  • Oct. 15 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3
  • Oct. 16 – 7:30 a.m.-2:45 p.m. in room A605B, on the lower level of the South Tower
  • Oct. 16 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3
  • Oct. 17 – 7:30 a.m.-11 a.m. and 11:45 a.m.-2:45 p.m. in Thalians West 135
  • Oct. 17 – 8:30 a.m.-2:30 p.m. at 6500 Wilshire Blvd., first floor conference room
  • Oct. 17 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3
  • Oct. 18 – 9 a.m.-2 p.m. on South Plaza Level Terrace, north side
  • Oct. 18 – 8:30 a.m.-2:30 p.m. at 6500 Wilshire Blvd., first floor conference room
  • Oct. 18 – 4-7 p.m. and 7:45-9:45 p.m. in AHSP PEC 3

For more information, or to schedule an appointment for a flu vaccination, please call Employee Health Services at ext. 3-3322.

Circle of Friends Honorees for September

The Circle of Friends program honored 164 people in September.

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.

  • Kristine Acorda (Baker), RN, MSN, ANP-BC, CCTC
  • Michael J. Alexander, MD
  • Felipe S. Amador
  • Farin Amersi, MD
  • Neel A. Anand, MD
  • Mohammad A. Ansari, MD
  • Goar Babakhanyan
  • C. Noel Bairey Merz, MD
  • Lea C. Banton, RN
  • Eli Baron, MD
  • Jana Baumgarten, MD
  • Sushma Bhadauria, MD
  • Selvyn B. Bleifer, MD
  • Glenn D. Braunstein, MD
  • Barry J. Brock, MD
  • Eileen G. Brown, OCN, RN
  • Neil A. Buchbinder, MD
  • Mathew H. Bui, MD
  • John D. Carmichael, MD
  • Ilana Cass, MD
  • David H. Chang, MD
  • Kirk Y. Chang, MD
  • Ray M. Chu, MD
  • Sumeet S. Chugh, MD
  • Alice P. Chung, MD
  • Geemee Chung, MD
  • Susan B. Clark, RN
  • Myles J. Cohen, MD
  • Lori R. Compton, NP
  • Chelsea L. Converse
  • Stephen T. Copen, MD
  • Stephen R. Corday, MD
  • Lawrence S. Czer, MD
  • Moise Danielpour, MD
  • Dudley S. Danoff, MD
  • Robert W. Decker, MD
  • Noam Z. Drazin, MD
  • J. Kevin Drury, MD
  • Marla C. Dubinsky, MD
  • April Jane Dulla-Herrera, RN, BC, BSN
  • Darryl M. Eddy, RN, BC, BSN
  • Jeannifer W. Estrada, RN
  • Sharon Fawcett, RN
  • Charles A. Forscher, MD
  • Stuart Friedman, MD
  • Larry Froch, MD
  • Gerhard J. Fuchs, MD
  • Eli S. Gang, MD
  • Avrom Gart, MD
  • Ivor L. Geft, MD
  • David H. Geller, MD, PhD
  • Sara Ghandehari, MD
  • Armando E. Giuliano, MD
  • David B. Golden, MD
  • Steven B. Graff-Radford, DDS
  • Solomon I. Hamburg, MD
  • John G. Harold, MD
  • Michael D. Harris, MD
  • Theresa C. Henderson, MD
  • Andrew E. Hendifar, MD
  • Jeremy R. Herman, MD
  • David M. Hoffman, MD
  • Gabriel E. Hunt Jr., MD
  • Charlotte Y. Jammott, LVN
  • Karmen Javanizadeh, PA
  • David Y. Josephson, MD
  • Neel R. Joshi, MD
  • Kamran Kalpari, MD
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Ronald P. Karlsberg, MD
  • Harold L. Karpman, MD
  • Albert M. Katz, MD
  • David Kawashiri, MD
  • Ilan Kedan, MD, MPH
  • Ooana A. Khan, MD
  • Puja Khanna, MD
  • Mehran J. Khorsandi, MD
  • Hyung L. Kim, MD
  • Michelle M. Kittleson, MD, PhD
  • Keith L. Klein, MD
  • Jon A. Kobashigawa, MD
  • Michael A. Kropf, MD
  • Claude Jean Langevin, MD, DMD
  • Caroline Lee, MD
  • Madeline S. Lerman, RN, BSN
  • Phillip L. Levine, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Simon K. Lo, MD
  • Ezra Maguen, MD
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • William J. Mandel, MD
  • Robert J. McKenna Jr., MD
  • Gil Y. Melmed, MD, MS
  • Anne Meyer, MD
  • Stewart Middler, MD, PhD
  • Amin Joseph Mirhadi, MD
  • Cyrus Mody, MD
  • Mercedes Moran
  • Lastenia Carmen Moreno Esquer
  • Jaime D. Moriguchi, MD
  • Myra R. Morris, RN
  • Wendy Munayco
  • Anthony Nesburn, MD
  • Nicholas N. Nissen, MD
  • Mark S. Noah, MD
  • Sara Oliva, RN, BSN, OCN
  • Guy D. Paiement, MD
  • Arlene Parker, RNC, MS
  • Brad Penenberg, MD
  • Mark Pimentel, MD
  • Linda Piponniau, RN, BSN
  • Jana Posalski, MD
  • Ralph T. Potkin, MD
  • Debra L. Potyk, RN
  • Kristina C. Pulliam, RN
  • Stephen Rabin, MD
  • Florian Rader, MD
  • David S. Ramin, MD
  • Victor Ramirez
  • Jeffrey Rapp, MD
  • Richard M. Ress, MD
  • Bella Reznik
  • Jaime E. Richardson, RN
  • Robert Richter, MD
  • Richard V. Riggs, MD
  • Sepehr Rokhsar, MD
  • Barry E. Rosenbloom, MD
  • Jeremy D. Rudnick, MD
  • Ruth "Virginia" Russell, MD
  • Ynez Sabio, RN, BSN
  • Stephen A. Sacks, MD
  • Mina Sadeghi
  • Vivian L. Salle, RN
  • Bruce A. Samuels, MD
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • Arie R. Schwartz, MD
  • Prediman K. Shah, MD
  • Alan E. Shapiro, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • Andrew Ira Spitzer, MD
  • Daniel J. Stone, MD, MPH, MBA
  • Steven W. Tabak, MD
  • Mark Tarshis, BSN, RN, PHN
  • David B. Thordarson, MD
  • Alfredo Trento, MD
  • Yesenia I. Urquilla Corvera, RN
  • Marina Vaysburd, MD
  • Angela Velleca, RN, BSN, CCTC
  • Robert A. Vescio, MD
  • Norma J. Viveros, RN, BSN
  • Andrew S. Wachtel, MD
  • Robert N. Wolfe, MD
  • Edward M. Wolin, MD
  • Lauren N. Wood, MD
  • Howard Wynne, MD
  • Evan M. Zahn, MD
  • Phillip C. Zakowski, MD
  • Christopher Zarembinski, MD

Most Who Qualify for Lifesaving Heart Treatment Do Not Receive It

A new study of patients who died of sudden cardiac arrest shows the majority who qualified to receive potentially lifesaving treatment did not receive it.

Researchers led by Sumeet Chugh, MD (pictured at right), associate director of the Cedars-Sinai Heart Institute, examined medical records of 2,093 patients who died of sudden cardiac arrest and found that only 488 patients, or about 20 percent, were medically evaluated to see if they met the criteria to receive an implantable cardiac defibrillator, which can shock a stopped heart into beating. Of those 488 patients, 92 were eligible to receive this treatment. Further analysis showed that just 12 patients of those who were eligible received a defibrillator.

"That tells us that even people who meet the guidelines, for some reason, are not getting this therapy," said Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. "The data show that most people aren't screened for sudden cardiac arrest, but even when they are eligible, they still are not getting proper treatment."

The analysis of data from the Oregon Sudden Unexpected Death Study is published online by Circulation, the medical journal of the American Heart Association, and is scheduled to appear in the printed edition of the publication dated Oct.15.   

"The purpose of guidelines is to deploy treatments in the right people," Chugh said. "It's not a question of more defibrillators or fewer, but a question of providing defibrillators to the patients who need it the most."  

Guidelines are standards of treatment established by a consensus of medical experts. Additionally, the U.S. Centers for Medicare & Medicaid Services establishes criteria for which patients qualify for certain interventions, such as defibrillator implantation.  

Currently, the guidelines call for patients to receive defibrillators if their heart's ejection fraction, a measure of the heart's ability to pump blood, is less than 35 percent. Of the 448 patients who did receive proper screening for sudden cardiac arrest, 304 — nearly 68 percent — were ineligible for a defibrillator because their ejection fraction was too high.  

"The pumping function of the heart has to be weak to meet the defibrillator guidelines," Chugh said. "Most of the people in our study don't have a low ejection fraction, but they still died of sudden cardiac arrest, which leads me to suggest that we need to take another look at the guidelines."  

Although the general public often uses the terms "sudden cardiac arrest" and "heart attack" interchangeably, they are different medical conditions.

A heart attack is caused when there is a blockage, such as a blood clot, in one or more arteries of the heart, preventing the heart from receiving enough blood, resulting in damage to the heart muscle.  

Sudden cardiac arrest, which accounts for half of all deaths caused by heart disease, is triggered by an electrical malfunction in the heart that causes an irregular heartbeat, called arrhythmia. Arrhythmia causes a disruption in the flow of blood to other organs throughout the body. Without treatment, the patient can die in seconds.  

Chugh said more analysis is needed to determine why patients with low ejection fractions did not receive implantable defibrillators.

"Perhaps they had other health problems that drove the decision-making process, or possibly many didn't have health insurance or access to care," Chugh said. "It could be a variety of reasons."