Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF May 6, 2016 | Archived Issues

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 2016 (PDF)  


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to submit your milestones and comments.

Pilot Program Helps Decrease Antibiotic Overuse

A recent Cedars-Sinai initiative is already showing promise in combating a rising global health threat — drug-resistant infections, largely due to overuse of antibiotics. In four pilot programs, the Antimicrobial Stewardship team's two-pronged approach has led to a 35 percent drop in antibiotic therapies.

» Read more

VP of Research Appointed, Starts in June

Nicole Leonard

Nicole Leonard has been appointed vice president of Research. She assumes her post June 6. At Cedars-Sinai, Leonard will oversee a host of teams that will include Sponsored Research and Funds Administration, Comparative Medicine, Research Facilities, Research Compliance and Quality Improvement.


» Read more

Kroener, Lange Win Clinical Fellows Award

Clinical Fellows Award

Two physicians striving to solve medical conundrums at opposite ends of the human lifespan have won this year's Cedars-Sinai Clinical Fellows Award for Excellence in Research. The award, which carries a $3,000 prize, is designed to encourage clinical and laboratory-based translational research by clinical fellows. The winners were Lindsay Kroener, MD, and David Lange, MD.

» Read more

CS-Link Tip: Add Documentation to an Encounter

cs-link logo

You need to add documentation to an encounter in CS-Link. You can look up the patient by name, go to chart review and search encounters. Then simply right-click on the encounter you want to edit.

» Read more

Centralized Monitoring Center Expands Space, Care

Centralized monitoring center

The Centralized Monitoring Center is expanding in size and capability. The inpatient and observation cardiac monitoring center will move on May 10 to Saperstein, Mezzanine level, room M10. The new space will be able to monitor the heart rhythms of an additional 66 patients and up to a maximum of 352 patients.

» Read more

Summer Is Coming, and So Are Fireworks

Hollywood Bowl

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the legendary band Chicago. The event on Sunday, July 3, is open to Cedars-Sinai physicians and their immediate family members.

» Read more

Changes in Warnings, Labels for Aripiprazole, Metformin, Fluconazole, Brintellix

Pharmacy Focus

The U.S. Food and Drug Administration issued a warning regarding reports of impulse-control issues with the use of aripiprazole. Also, the FDA has revised the labeling for metformin and is evaluating a study that shows there is a possible increased risk of miscarriage with the use of oral fluconazole. And the agency has approved the name change of the antidepressant Brintellix to Trintellix.

» Read more

Pilot Program Helps Decrease Antibiotic Overuse

A recent Cedars-Sinai initiative is already showing promise in combating a rising global health threat — drug-resistant infections, largely due to overuse of antibiotics.

The Antimicrobial Stewardship team is seeing initial success in its "Get Smart About Antibiotics" campaign to ensure antibiotics are used effectively at the hospital. The team's plan features best practice alerts in CS-Link and emphasizes delivering "the right antibiotic for the right patient at the right time."

In four pilot programs launched in December, the team has asked healthcare providers to reassess the need for continuing antibiotics for three days or more. If further antibiotic treatment is warranted, providers must be able to justify its use.

Another important part of the pilots involves the widening use of rapid diagnostic testing with timely physician notification. In less than two hours, test results can help determine how antibiotic treatments should be modified to meet the individual needs of the patient. This compares favorably to traditional methods where two or three days were required for results.

So far, the pilots have seen antibiotic therapies decrease by as much as 35 percent, exceeding the original goals.

"This is a big win," said Rehka Murthy, MD, medical director of the Department of Hospital Epidemiology. "It reflects a lot of work and coordination between prescribers, pharmacists, laboratory staff and other caregivers. Our focus is on getting the right antibiotic quickly to our patients; often, that involves stopping or narrowing antibiotics, but in many instances it includes escalating therapy when appropriate."

With the positive results, the team is considering expanding the program hospitalwide next year.

For more information on how to safely use antibiotics, visit the website of the Centers for Disease Control and Prevention.

VP of Research Appointed, Starts in June

Nicole Leonard

Nicole Leonard

Nicole Leonard has been appointed vice president of Research. She assumes her post June 6.

At Cedars-Sinai, Leonard will oversee a host of teams that will include Sponsored Research and Funds Administration, Comparative Medicine, Research Facilities, Research Compliance and Quality Improvement.

Leonard brings more than 15 years of leadership experience in research administration to Cedars-Sinai. Most recently, she served as director of Research Administration at The Johns Hopkins School of Medicine, where the research portfolio exceeds $700 million. At Johns Hopkins, she also directed the Medical Devices Portfolio for the Office of Technology Transfer.

Leonard earned her law degree at the University of North Carolina School of Law and her master's in business administration at the Johns Hopkins Carey Business School. She is a member of the Maryland State Bar and the American Bar Association in addition to being an active presenter to the Society of Research Administrators.

Kroener, Lange Win Clinical Fellows Award

CFA

Cedars-Sinai leaders with finalists for the 2016 Clinical Fellows Award for Excellence in Research (from left): Leon Fine, MD, vice dean of Research and Graduate Research Education and chair of the Department of Biomedical Sciences; Mariko Ishimori, MD, associate site director for the Clinical and Translational Science Institute; finalists David Lange, MD, Lindsay Kroener, MD, Angelica Nangit, MD, and Snehalkumar Patel, MD; and Shlomo Melmed, MB ChB, executive vice president, Academic Affairs, and dean of the medical faculty.

Two physicians striving to solve medical conundrums at opposite ends of the human lifespan have won this year's Cedars-Sinai Clinical Fellows Award for Excellence in Research. The award, which carries a $3,000 prize, is designed to encourage clinical and laboratory-based translational research by clinical fellows.

In her winning study, Lindsay Kroener, MD, discovered a new role for the so-called GATA3 protein, which was already known to be crucial in the placenta's development during pregnancy. She demonstrated that GATA3 also helps the embryo attach to the uterus, a process known as placentation, during pregnancy and that this protein is regulated by the female hormone estrogen.

Kroener

Award winner Lindsay Kroener, MD, presented her study on pregnancy.

Kroener's discovery is important because it may help explain why pregnancies that result from in vitro fertilization have higher rates of problems linked to abnormal placentation. These problems include low birth weight and preeclampsia, a serious hypertensive condition in pregnancy that often leads to preterm delivery and can trigger convulsions in the mother if untreated. Kroener found that fresh cycles of in vitro fertilization changed the hormonal environment of the uterus, negatively affecting GATA3.

The other Clinical Fellows Award winner, David Lange, MD, focused on a medical crisis that tends to occur late in life: heart attack. He studied the emergency dispatch of specialists to Cedars-Sinai to treat a type of heart attack known as STEMI (ST-elevation myocardial infarction), which can happen when a coronary artery is entirely blocked. The specialists' goal is to administer life-saving coronary angioplasty to restore blood flow within 90 minutes.

In reviewing more than 1,300 STEMI dispatches, Lange found that nearly two-thirds of them were so-called "false activations," in which the patient was not actually suffering from a STEMI The most common source of the error was an electrocardiogram, the initial diagnostic test for STEMI, which Lange described as an "imperfect tool." On an electrocardiogram, a variety of heart conditions can mimic STEMI, he explained.

Lange

Award winner David Lange, MD, presented his study on heart attacks.

Lange is a member of the Cedars-Sinai Clinical Scholars Program, and the foundation work for his project was supported by the Eigler-Whiting-Mann Grant from that program.

Kroener and Lange, along with two other award finalists, presented their abstracts April 27 to an audience and a panel of Cedars-Sinai researchers in Harvey Morse Auditorium, who chose the winners. The other finalists were Angelica Nangit, MD, who presented "Causes and Predictors of Thirty Day Hospital Readmissions in Systemic Lupus Erythematosus," and Snehalkumar Patel, MD, who presented "Next Generation Sequencing: A Novel Approach to Distinguish Multifocal Primary Lung Adenocarcinomas from Intrapulmonary Metastases."

The awards program, established in 2012, is supported by the Cedars-Sinai site of the UCLA Clinical and Translational Science Institute (CTSI), which includes three other partner institutions. Eighteen fellows applied for the award.

"We noticed a lot of high-quality applications this year and hope to continue the trend in the coming year," said Mariko Ishimori, MD, the associate CTSI site director and an assistant professor of Medicine. "Our finalists were chosen from a very competitive pool. We hope this award program encourages fellows in training to consider research careers."

For more information about the Clinical Fellows Award, contact Jonathan Hackmeyer, CTSI management assistant, at 310-423-8965.

Research reported in this publication was supported by the National Institutes of Health under award number R01HD074368. The IRB numbers for human subjects in research referenced in this article are 06806, 08600 and 36746.

CS-Link Tip: Add Documentation to an Encounter

You need to add documentation to an encounter in CS-Link. You can look up the patient by name, go to chart review and search encounters. Then simply right-click on the encounter you want to edit.

You will get a drop down list that will allow you to edit or addend the encounter. You do not need to go back to that date's schedule — just right click.

Learn to be more efficient by attending a Physician Efficiency Training (PET) session. To meeting your scheduling needs, they are offered in the morning, at noon, or at 5 p.m. These sessions are hands on and take place in Cafeteria Conference Room C. Here's the schedule.

If you have questions, email groupeisphysicians@cshs.org.

Centralized Monitoring Center Expands Space, Care

Centralized Monitoring Ctr

The Centralized Monitor Center will celebrate its recent expansion with a ribbon-cutting ceremony May 9.

The Centralized Monitoring Center is expanding in size and capability.

The inpatient and observation cardiac monitoring center, currently located off 5 Northwest, will move on May 10 to Saperstein, Mezzanine level, room M10.

The new space will be able to monitor the heart rhythms of an additional 66 patients and up to a maximum of 352 patients. The expansion will allow for coverage of the medical center's North and South towers, 3 Saperstein and the Medical Observation Unit, and it will permit future growth, if needed, of up to a total of 528 patients.

"The move will allow the Centralized Monitoring Center to expand its services and respond to future needs of the health system," said Giancarlo Lyle-Edrosolo, DNP, NE-BC, CNL, CCRN-CMC, nurse manager of 3 Saperstein.

Since being established in 2011, the monitoring center has improved patient safety with its cardiac monitoring capabilities. The implementation of telemetry monitoring on individual units enables nurses and clinical partners to watch for life-threatening arrhythmias. As a result, patients are placed in the unit specific to their diagnosis instead of being limited to cardiac observation.

The new monitoring center has eight new monitoring stations in addition to new software. The latest software has greater access to information needed to make critical decisions, better clinical support tools, stronger technology security and faster hardware. Ten clinical partners will also be added to the monitoring center's roster, allowing greater focus on fewer patients.

"It is remarkable how the new space addresses every concern or need of the old space," said David Karcher, CNS, MSN, RN-BC, nurse manager of 5 North.

Rabbi Jason Weiner will celebrate the new space with a ribbon cutting and spiritual ceremony on Monday, May 9, at 8 a.m. in the new monitoring center.

Summer Is Coming, and So Are Fireworks

Celebrate Independence Day at the Hollywood Bowl with fireworks and music by the legendary band Chicago.

Also performing will be the Hollywood Bowl Orchestra.

The event on Sunday, July 3, is open to Cedars-Sinai physicians and their immediate family members. Cost is $135 per adult and $65 per child 3-11 years of age.

Parking passes also are available.

To reserve a place for either event, contact Cheryl Verne at 310-423-2681 or cheryl.verne@cshs.org.

A photo from the 2015 celebration at the Hollywood Bowl

Changes in Warnings, Labels for Aripiprazole, Metformin, Fluconazole, Brintellix

Pharmacy Focus

The U.S. Food and Drug Administration issued a warning regarding reports of impulse-control issues with the use of aripiprazole. Also, the FDA has revised the labeling for metformin and is evaluating a study that shows there is a possible increased risk of miscarriage with the use of oral fluconazole. And the agency has approved the name change of the antidepressant Brintellix to Trintellix.

FDA: Impulse-Control Problems Possible With Aripiprazole

The FDA issued a warning regarding reports of impulse-control issues (urges to binge eat, shop, gamble and have sex) with the use of the antipsychotic aripiprazole. These uncontrollable urges were reported to have stopped when the medicine was discontinued or the dose was reduced.

The FDA is recommending that healthcare providers alert patients and caregivers of these potential effects. Prescribers should consider reducing the dose or stopping the medication if patients develop these compulsive behaviors.

The FDA website has more information.

FDA Revises Metformin Warnings for Patients With Reduced Kidney Function

The FDA has revised the labeling for metformin regarding patients with impaired renal function.

The FDA concluded, from its review of studies published in the medical literature, that metformin can be used safely in patients with mild impairment in kidney function and in some patients with moderate impairment in kidney function. FDA is requiring changes to the metformin labeling to reflect this new information and provide specific recommendations on the drug's use in patients with mild to moderate kidney impairment.

The FDA website has more information.

FDA Evaluating Use of Oral Fluconazole in Pregnancy

The FDA is evaluating a study that shows there is a possible increased risk of miscarriage with the use of oral fluconazole (Diflucan) for yeast infections.

Until FDA's review is complete and more is understood about this study and other available data, FDA advises cautious prescribing of oral fluconazole in pregnancy.

The FDA website has more information.

Brintellix Changes Name to Trintellix to Avoid Confusion With Brilinta

The FDA has approved the name change of the antidepressant Brintellix to Trintellix to avoid confusion with Brilinta (ticagrelor). Prescribers are advised to include generic names to avoid confusion in the interim. Trintellix tablets will look the same as the previously named Brintellix tablets but will have a new NDC number.

The FDA website has more information.