Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF February 9, 2018 | Archived Issues

Affiliation of Cedars-Sinai and Torrance Memorial Official

The proposed affiliation between Cedars-Sinai and Torrance Memorial—first announced last May—became official Feb. 1. The affiliation will focus on new opportunities for coordination of care and resources between the two organizations, and joint programs to provide access to more people for needed medical services.

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Cedars-Sinai Goes Red for Women's Heart Health

Women's Heart Day

The 13th annual Linda Joy Pollin Women's Heart Health Day recently attracted hundreds of healthcare professionals, employees and volunteers who made a collective red-themed fashion statement to help raise awareness about heart disease, the No. 1 killer of women in the U.S.

» Read more

New Guidelines for Assessing Head and Neck Cancers

Head and Neck Screening co

Cedars-Sinai investigators have developed a new, more accurate set of guidelines for assessing the severity of head and neck cancers and predicting patient survival. The new guidelines, outlined in a study recently published in the Journal of Clinical Oncology, center around counting the number of malignant lymph nodes found in each patient.

» Read more

Integrative Health Moves to New, Healing Space

1900_Integrative_Health_New_Space 150px

Cedars-Sinai Integrative Health will start welcoming patients to its new storefront space at 8820 Wilshire Blvd., Suite 110, beginning Feb. 12. The program combines conventional and alternative therapies to help achieve optimal health and healing.

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Stenting System Benefits Certain Stroke Patients

Alexander

A specialized stenting system used to open blocked arteries in the brain resulted in a low complication rate among a specific group of patients with stroke histories, according to a study led by Cedars-Sinai researchers.


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Triple Transplant Patient Defies Early Prognosis

Jim Stavis

When Jim Stavis was 17, he was told he'd be lucky to live past his 50th birthday. At that time, he was diagnosed with Type 1 diabetes. Doctors expected him to be plagued by kidney and heart disease, blindness and amputation before succumbing to diabetes at a young age. In December 2017, Stavis—who received three transplants at Cedars-Sinai—celebrated his 63rd birthday.

» Read more

FDA Issues Warning About Incorrect Dosing of Obeticholic Acid

The U.S. Food and Drug Administration (FDA) is warning that the liver disease medicine Ocaliva (obeticholic acid) has been incorrectly dosed daily instead of weekly in patients with moderate to severe primary biliary cholangitis, a rare chronic liver disease. Also, in an effort to foster safe use of the over-the counter anti-diarrhea drug loperamide, the FDA is working with manufacturers to use blister packs or other single dose packaging, and to limit the number of doses in a package.

» Read more

CS-Link Tip: Refilling Prescriptions

With CS-Link™, refilling prescriptions is simple. If you want to accept prescriptions, click on the "accept all" button. If you don't have the "accept all" button on your toolbar, you also can find it under "more." Also, it's easy to move the button to your toolbar.

» Read more

Affiliation of Cedars-Sinai and Torrance Memorial Official

Torrance Memorial

The proposed affiliation between Cedars-Sinai and Torrance Memorial—first announced last May—became official Feb. 1.

The affiliation will focus on new opportunities for coordination of care and resources between the two organizations, and joint programs to provide access to more people for needed medical services—as well as access to clinical trials and the latest developments in medical research.

Among the initial areas for collaboration are advanced treatments for cancer, heart disease and brain disorders. Cedars-Sinai specialists in these areas will work with Torrance Memorial physicians to provide clinical consultations for their patients and streamline patient access to clinical trials and new technologies.

Each organization will continue to have its own board of directors, its own hospital medical staff and related physician organizations, and its own employees. Each organization's president and CEO (Craig Leach at Torrance Memorial and Thomas M. Priselac at Cedars-Sinai) will continue to lead their respective entity. Both organizations now are affiliated under a new parent organization with a new board of directors, named Cedars-Sinai Health System. Priselac will serve as president and CEO of the parent entity, Cedars-Sinai Health System, in addition to continuing to serve as president and CEO of Cedars-Sinai.

Torrance Memorial includes the 470-bed Torrance Memorial Medical Center in addition to a multispecialty physician group (Torrance Memorial Physician Network), an independent physician association (Torrance Health IPA) and an Accountable Care Organization (Torrance Memorial Integrated Physicians), which collectively include more than 500 physicians. Torrance Memorial also has several outpatient centers located throughout the South Bay region.

Cedars-Sinai includes the 886-bed Cedars-Sinai Medical Center, the 145-bed Cedars-Sinai Marina Del Rey Hospital, a multispecialty physician network of 887 doctors (Cedars-Sinai Medical Network) and many primary care, urgent care and specialty care centers throughout the Los Angeles region. It also is a major research and education center, with more than 1,600 current research projects and 500 clinical trials, and trains 473 medical residents and fellows.

"This affiliation enables each institution to continue the unique relationships each has with the communities it serves, while providing a platform for a wide variety of collaborations to better serve the region," Leach said. "As a community-based provider, Torrance Memorial will now have access to the outstanding tertiary and quaternary clinical services and research at Cedars-Sinai, which will be a great benefit to the entire South Bay."

Priselac noted the opportunities for increasing community accessibility to healthcare with the affiliation.

"While both Torrance Memorial and Cedars-Sinai have strong track records for serving the region, the governance structure of the affiliation is designed to further enhance accessibility to care and the sharing of resources to benefit patients and the community," Priselac said.

Both organizations will continue their longstanding partnerships with local community organizations aimed at improving health.

Cedars-Sinai (founded in 1902) and Torrance Memorial (founded in 1925) are two of California's longest-serving nonprofit healthcare organizations. In the past several years, they have collaborated on a variety of projects, including the establishment of a Telestroke program to more quickly diagnose and treat stroke patients.

For more information regarding the affiliation between Cedars-Sinai and Torrance Memorial, view the Frequently Asked Questions.

Affiliation FAQs (PDF)  

Cedars-Sinai Goes Red for Women's Heart Health

The 2018 Wear Red group photo

The 13th annual Linda Joy Pollin Women's Heart Health Day recently attracted hundreds of healthcare professionals, employees and volunteers who made a collective red-themed fashion statement to help raise awareness about heart disease, the No. 1 killer of women in the U.S.

Denise Dador, health reporter for ABC 7 News, hosted the Feb. 2 event, which included blood pressure screenings, cardiac risk assessments and wellness stations for attendees. She also moderated a panel discussion with physicians about recent medical discoveries in women's heart health.

C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center, identified positive trends regarding women's heart health, but said much more needs to be done. Cardiovascular disease kills one woman approximately every 80 seconds in the U.S.

"We're on a pretty good roll, but is that good enough?" said Bairey Merz. "Women have a longer lifespan, and women tend to have these problems later on in life, so we still have a fair amount of work to do. In particular, we have to be working on these relatively young women because they're under the radar screen."

Florian Radar, MD, co-director of the Clinic for Hypertrophic Cardiomyopathy and Aortopathies, shared recent updates to high blood pressure guidelines. He noted that lower systolic blood pressure goals were likely to improve outcomes, especially in high-risk patients.

Chrisandra Shufelt, MD, associate director of the Barbra Streisand Women's Heart Center, presented on menopause updates and how hormone therapy affects the heart. Margareta Pisarska, MD, director of the Division of Reproductive Endocrinology and Infertility, stressed the importance of seeking care for fertility issues because they often point to underlying problems.

"Know that we're here for you, know that your Heart Institute and your Barbra Streisand Women's Heart Center are not only taking care of you. we're asking you to walk the walk and talk the talk," Bairey Merz said. "Know that we're strong advocates at our institutional level, our state level and our national level because we don't leave anything to chance."

To learn more about the services offered at the Barbra Streisand Women's Heart Center, visit the website.

New Guidelines for Assessing Head and Neck Cancers

Head and Neck Screening 480px

Allen S. Ho, MD

Cedars-Sinai investigators have developed a new, more accurate set of guidelines for assessing the severity of head and neck cancers and predicting patient survival.

The new guidelines, outlined in a study recently published in the Journal of Clinical Oncology, center around counting the number of malignant lymph nodes found in each patient.

"The greater the number of malignant lymph nodes, the less favorable the patients' chances of survival," said Allen S. Ho, MD, lead author of the study. Ho is director of the Head and Neck Program at the Samuel Oschin Comprehensive Cancer Institute. "This new approach could dramatically simplify staging systems."

For decades, doctors have determined the stage and predicted the progression of head and neck cancers based primarily on nodal size, location and how far the cancer has spread beyond the lymph nodes, but they have given less importance to the number of cancerous nodes. As a result, staging and treatment recommendations, based on current national guidelines, "are the same whether a patient has two or 20 positive lymph nodes," said Zachary S. Zumsteg, MD, assistant professor of Radiation Oncology at Cedars-Sinai and the study's senior author.

With the new system, based on the number of cancerous lymph nodes, patients are separated into similarly sized groups with distinct outcomes, Zumsteg said. "Our study demonstrated a better way to assess cancer severity, which will improve our ability to predict outcomes and give patients more personalized treatment."

The Cedars-Sinai study involved reviewing data of 14,554 U.S. patients identified in the National Cancer Database who were treated for squamous cell carcinoma of the oral cavity (mouth, gum and tongue) between 2004 and 2013.

The data showed that an increased risk of death was associated with each additional cancerous lymph node found. The investigators concluded that the number of cancerous lymph nodes is a predominant, independent factor associated with death in those patients. The study also identified an ultra-high-risk group of patients with five or more cancerous lymph nodes.

Head and neck cancers occur in the lips, tongue, gums, bottom of the mouth, throat, larynx, nasal cavity and salivary glands. About 63,000 people developed head and neck cancers in the U.S. in 2017. More than 13,000 deaths from those cancers occurred during that period, according to the American Society of Clinical Oncology.

"Although considering the number of cancerous lymph nodes in staging is a simple concept that many head and neck cancer specialists have assumed to be true for years, data has been limited until now," Zumsteg said. The study authors said they hope that, based on the new data, the number of positive nodes in staging now will be incorporated into clinical practice.

Research reported in this publication was supported in part by the National Institutes of Health under award number R01 CA188480-01A1, National Center for Advancing Translational Sciences under award numbers UL1TR000124 and UL1TR001881-01, the Donna and Jesse Garber Award for Cancer Research and the Health Network Foundation Service Excellence Award.

Disclosure: Zumsteg serves on the external advisory board of the Scripps Proton Therapy Center and has been a paid consultant for EMD Serono.

Integrative Health Moves to New, Healing Space

Cedars-Sinai Integrative Health will start welcoming patients to its new storefront space at 8820 Wilshire Blvd., Suite 110, beginning Feb. 12. The program combines conventional and alternative therapies to help achieve optimal health and healing.

Cedars-Sinai Integrative Health will start welcoming patients to its new storefront space at 8820 Wilshire Blvd., Suite 110, beginning Feb. 12.

It will be a particularly meaningful day for Integrative Health Medical Director Janet White, MD, as it marks a milestone in her medical career.

After two decades as a Cedars-Sinai internist, White started exploring other specialties that piqued her interest. Integrative medicine, which combines conventional and alternative therapies to help patients achieve optimal health and healing, was especially intriguing. Wanting to learn more, she attended an integrative medicine conference in November 2013.

"I walked out of that conference knowing integrative medicine was going to be my new focus. I didn't know how I was going to get there, but I knew somehow I was going to get there," said White.

Getting there involved White completing a fellowship at the University of Arizona Center for Integrative Medicine in 2016 and earning board certification from the American Board of Integrative Medicine. Cedars-Sinai Integrative Health was launched last year within White's existing internal medicine practice, with the goal of moving to a space dedicated to integrative medicine.

Spanning 4,600 square feet, the new space features nine exam rooms, a spacious multipurpose room, abundant natural light and calming colors. "Studies have shown that using colors and other elements found in nature, along with a lot of ambient light, creates an environment that contributes to healing and reduces stress," White said.

In addition to White, the Integrative Health team includes: Stephen Meeneghan, ND, LAc, a board-certified naturopathic physician and acupuncturist; Gloria Kamler, MA, a holistic educator and stress-relief expert; and Pam Tarlow, PharmD, a clinical pharmacist. A registered dietician also will be joining the Integrative Health staff.

"As an integrative medicine practitioner, I focus on the connection between the mind, body and spirit, and the need to keep those balanced in order to help people heal and to maintain optimal health. I now care for my patients in a holistic way and guide and motivate them to engage in health-promoting behaviors," said White.

"Given that integrative medicine centers on prevention and health optimization it can benefit almost anyone, but the most common conditions for which people seek integrative therapies are cancer, chronic pain, gastrointestinal disorders, depression, anxiety, stress, fatigue, fibromyalgia, sleep disorders, headache, diabetes, hypertension and heart disease," White said.

Therapies available through Integrative Health include: lifestyle counseling, Western herbal medicine, Chinese herbal medicine, biofeedback, pharmaceuticals, acupuncture, cupping, therapeutic massage, bio-identical hormone therapy and mindfulness-based stress reduction.

For patients who are under the care of a general practitioner or specialist, White emphasizes that the Integrative Health team coordinates closely with patients' other providers.

"We send their doctor a report and communicate directly about the patient's treatment and progress. Our therapies are intended to be integrated with whatever conventional care patients are receiving," White said.

Acupuncture services are provided by Meeneghan. "Acupuncture has been well studied in the treatment of acute and chronic pain, but it's also useful in the treatment of a wide variety of conditions such as nausea, fatigue, stroke, allergies, infertility, menstrual disorders, anxiety, depression and stress," said Meeneghan.

"I often use massage and cupping in my acupuncture treatments and also may prescribe Chinese herbs. In my naturopathic visits, I may prescribe herbal medicine, dietary supplements, specialized diets, stress-management techniques, bio-identical hormones, and, in some cases, pharmaceuticals," Meeneghan said.

Throughout February, Cedars-Sinai employees and employed physicians are being offered a 40 percent discount on their first acupuncture service.

Integrative Health also offers a free monthly, 90-minute introductory mindfulness-based stress reduction workshop. An all-day mindfulness workshop is being held on Feb. 10.

To register for the workshop or to schedule an appointment, contact Cedars-Sinai Integrative Health at 310-423-8200 or groupintegrativehealth@cshs.org.

Stenting System Benefits Certain Stroke Patients


Michael Alexander, MD

A specialized stenting system used to open blocked arteries in the brain resulted in a low complication rate among a specific group of patients with stroke histories, according to a study led by Cedars-Sinai researchers.

The Wingspan® Stent System Post-Market Surveillance Study (WEAVE™) examined patients with a narrowing of the arteries in the brain, called intracranial stenosis, resulting from a buildup and hardening of fatty deposits called cholesterol plaque. The condition can lead to strokes.

The trial demonstrated that stenting of brain arteries in these patients resulted in a complication rate of just 2.6 percent.

The results were presented last month at the International Stroke Conference in Los Angeles.

"These trial results have the potential to change how stroke patients are treated in the future," said Michael Alexander, MD, director of the Cedars-Sinai Neurovascular Center. "Using approved stents in the brain arteries may give new hope to patients suffering from stroke due to blockages from cholesterol plaque."

Alexander was the principal investigator for the national study. The research team included Shlee S. Song, MD, associate director of the Cedars-Sinai Stroke Center, as well as investigators from Mount Sinai Medical Center, Miami; Erlanger Medical Center, Chattanooga, Tennessee; Cottage Medical Center, Santa Barbara, Calif.; SSM Health System, St. Louis; and UC Irvine Health, Irvine, Calif.

The study tracked patients at 24 sites nationwide, including those at Cedars-Sinai. To be eligible, patients had to be between ages 22 and 80, have had two or more strokes, have significant narrowing of the arteries and have failed to respond to other forms of medical therapy.

Investigators found that of 152 patients with intracranial stenosis due to cholesterol plaque and treated with the Wingspan Stent System, just 2.6 percent experienced stroke or death within 72 hours of the procedure. Made by medical technology company Stryker, which sponsored the trial, the system has been approved by the U.S. Food and Drug Administration for use with patients who have intracranial atherosclerotic disease.

Disclosure: Alexander receives compensation from the company sponsoring the trial. This includes consulting fees and fees for speaking engagements.

Triple Transplant Patient Defies Early Prognosis


Doctors told Jim Stavis he wouldn't live past his 50th birthday. Today, the 63-year-old has written an autobiography about his triple transplant experience.

When Jim Stavis was 17, he was told he'd be lucky to live past his 50th birthday.

At that time, Stavis was diagnosed with Type 1 diabetes. Doctors expected him to be plagued by kidney and heart disease, blindness and amputation before succumbing to diabetes at a young age. While some of that prognosis turned out to be accurate, organ transplants have enabled Stavis to not only survive, but flourish.

In 2005, at age 50, Stavis received a heart and kidney transplant at Cedars-Sinai. He got a new pancreas a year later. In December 2017, Stavis celebrated his 63rd birthday.

"Having a birthday always makes you think about your mortality, and I'm kind of in overtime," he said.

Stavis began dealing with classic symptoms of diabetes in high school—frequent urination, excessive thirst and weight loss.

He followed his doctors' orders, which included two daily injections of insulin and testing his blood sugar levels. He adjusted what he ate and learned to be his own nutritionist.

"I hoped medical technology would offer me a cure one day, that all I needed was to live long enough," he said.

Despite his efforts, at 42, Stavis's heart briefly stopped and doctors performed an angioplasty to relieve an artery that was 95 percent blocked.

"That was my 'ah-ha' moment. Well, actually it was more of an 'oh-no' moment," he said.

Doctors told him time was running out, and there was nothing they could do.

"That was a dismal thing to hear from a cardiologist—basically, 'We did the best we could, and we're not sure how long it will last.'"

Stavis chose a new cardiologist, someone who understood the complexity of his case and focused on improving the four risk factors that were compromising his health—cholesterol, blood pressure, stress level, and blood sugar.

This kept him out of the operating room for six years, until his health took another downturn. He found himself in the hospital at age 49, confronted with congestive heart and kidney failure.

His cardiologist suggested transplants to replace the organs damaged by his diabetes and referred Stavis to Prediman Shah, MD, at Cedars-Sinai. Shah created a game plan for the three transplants.

"This was both scary and foreign to me," Stavis said. "Never in my wildest imagination would I imagine that having a transplant would be my ticket to good health."

"I wondered how this man was still standing," said Shah, director of Cedars-Sinai's Oppenheimer Atherosclerosis Research Center. "He needed a new heart, a new kidney and a new pancreas to cure his diabetes. When I mentioned the possibility of a triple organ transplant, Jim looked at me like I was crazy."

Stavis agreed to the bold idea, and Shah immediately put him on the waiting list for all three organs.

On Nov. 3, 2005, Stavis went into surgery, and 20 hours later he had a new heart and kidney.

Diabetes, however, was still a part of his daily life until October 2006, when he got a new pancreas.

"I couldn't remember having a functioning pancreas," said Stavis, who for decades had to inject himself with insulin.

"Of the three organs, this was the most liberating," he said.

Stavis finally was free of dealing with an insulin pump, testing his blood sugar levels and being overly conscious of his diet.

That Thanksgiving, for the first time in decades, Stavis had a slice of pumpkin pie.

"If I ever had a reason to be thankful, this is it," he said.

Since his transplants, Stavis has poured his energy into using his story to inspire others. He has produced a documentary called Source of Hope that raises awareness about organ donation. He also shares his story as an inspirational speaker.

For Stavis, his triple transplant was the start to a new life. Fourteen years ago, when his organs began failing, he didn't think he'd live to see 63.

"That felt like the beginning of the end," said Stavis. "But ultimately it put me on a path to getting my transplants at Cedars-Sinai."

From Shah to the transplant coordinator, Stavis said he truly felt everyone was pulling for him.

"The key for me, and as for any Cedars-Sinai patient, is that they focused on the aftercare of a transplant patient. You're their patient for life, and that's a good methodology," he said.

Stavis and Shah built such a bond that when Jim decided to write his autobiography, When Hope is Your Only Option, he asked Shah to write the foreword.

"Jim sent me a bunch of chapters and I read through them, and by the end I was in tears," said Shah. "It's beautifully written and really touches on his personal journey through some trying times, and how the role of a good family, a good team of doctors, hospitals, courage and the desire to get well helped him overcome it all."

Stavis talks with cardiologist Prediman Shah, MD.

Stavis is a grateful patient and supporter of the Campaign for Cedars-Sinai. Learn more about the Campaign.

FDA Issues Warning About Incorrect Dosing of Obeticholic Acid

The U.S. Food and Drug Administration (FDA) is warning that the liver disease medicine Ocaliva (obeticholic acid) has been incorrectly dosed daily instead of weekly in patients with moderate to severe primary biliary cholangitis (PBC), a rare chronic liver disease, increasing the risk of serious liver injury. To ensure correct dosing and reduce the risk of liver problems, FDA is clarifying the current recommendations for screening, dosing, monitoring, and managing PBC patients with moderate to severe liver disease taking Ocaliva.

The FDA website has more information.

FDA: Agency Seeks Packaging Limits for Anti-diarrhea Drug Loperamide

In an effort to foster safe use of the over-the-counter anti-diarrhea drug loperamide, the FDA is working with manufacturers to use blister packs or other single dose packaging and to limit the number of doses in a package. The agency continues to receive reports of serious heart problems and deaths linked to much higher than recommended doses of loperamide, primarily among people who are intentionally misusing or abusing the product. Loperamide is a safe drug when used as directed and helps control symptoms of diarrhea.

The FDA website has more information.

CS-Link Tip: Refilling Prescriptions

With CS-Link™, refilling prescriptions is simple. If you want to accept prescriptions, click on the "accept all" button.

If you don't have the "accept all" button on your toolbar, you also can find it under "more." However, it's easy to move the button to your toolbar.

The CS-Link™ website has more information.

Also, HealthStream offers physician efficiency training modules for continuing medical education credit. There are 22 modules that last 15 minutes each. They include topics such as "In Basket Quick Actions," "Smart Blocks in Progress Notes" and "SmartList Editor."

To take advantage, log into HealthStream and search the catalog using keywords: PET CME. Select the module you want to view, then click "Enroll."

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