sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY December 2012 | Archived Issues

New practices reduce surgical site infections after colorectal surgery

Surgical teams at Cedars-Sinai have reduced surgical site infections by more than 60 percent for patients who undergo colorectal procedures by introducing evidence-based protocols that are easy to follow and relatively low in cost.

» Read more

On the beaten path

By Harry  C. Sax, MD, MHCM, FACS
Professor and Vice Chair, Department of Surgery

Surgeons at Cedars-Sinai are involved in humanitarian work throughout the world. Although we often recount our cases as a measure of our experience, it is often when we get away from the hospital that we truly learn about those we serve. I have been returning to Hospital Sacre Coeur, in Milot, Haiti, on multiple occasions since the 2010 earthquake. For this issue of Sutures, I'd like to show you the area surrounding the hospital.

» Read more

Research Division sees marked increases in clinical trials, funding

In fiscal year 2007, the Research Division within the Department of Surgery was awarded almost $3 million in externally sponsored research funding, the bulk of which was contained in a few large federal projects. Five years later, the Research Division has increased its research funding three-fold, bringing in more than $9 million in fiscal year 2012.

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Transplant patient to highlight need for organ donation at Rose Parade

Kevin Riepl arrived at Cedars-Sinai in October 2010, suffering from sudden heart failure that left him fighting for his life. Surgeons swiftly installed a heart pump and later transplanted a new heart, saving his life and turning him into an unexpected ambassador for organ donation. Now the 38-year-old Winnetka man is preparing to represent Cedars-Sinai's Comprehensive Transplant Center on the 2013 Donate Life Rose Parade float on Jan. 1.

» Read more

Cedars-Sinai physician nominated by President Obama to National Cancer Advisory Board

Beth Y. Karlan, MD, director of the Women's Cancer Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, was appointed by President Barack Obama to the National Cancer Advisory Board, a committee that advises the U.S. National Cancer Institute.



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Presentations and publications

Click below to learn about recent presentations and publications by members of the Department of Surgery.

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Gangi wins Sports Spectacular fellowship

Alexandra Gangi, MD, has been named the winner of the 2013 Sports Spectacular Endowed Fellowship Award.

» Read more

FDA updates regarding Zofran, Chantix

Pharmacy focus

The 32 mg, single intravenous dose of the anti-nausea drug Zofran will no longer be marketed because of the potential for serious cardiac risks, according to the U.S. Food and Drug Administration. The FDA also issued an updated safety review on the risk of cardiovascular adverse events with Chantix.

» Read more

Circle of Friends honorees for November

The Circle of Friends program honored 137 people in November. 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.

» See the names of the honorees

New practices reduce surgical site infections after colorectal surgery

Surgical teams at Cedars-Sinai have reduced surgical site infections by more than 60 percent for patients who undergo colorectal procedures by introducing evidence-based protocols that are easy to follow and relatively low in cost.

Surgeons, nurses, operating room staff and patients all collaborated in a quality improvement project that measured surgical site infection rates from March 2011 to March 2012. Several new steps were introduced to guard against infections and these have now been expanded and standardized throughout the hospital.

“This work marks a significant step toward achieving Cedars-Sinai's goal of zero hospital-acquired infections,” said Rekha Murthy, MD, director of Hospital Epidemiology. “It represents the first of several projects to eliminate post-op infections.”

The new approach modified or optimized past practices:

  • Patients used chlorhexidine antiseptic solution to shower the evening and morning before surgery.
  • Surgical teams prepared operative sites with a sterile chlorhexidine and alcohol antiseptic solution prior to surgery. After surgery, patients were bathed with chlorhexidine wipes daily.
  • Antibiotics used immediately prior to surgery were standardized, allowing only those from a short list of appropriate alternatives. For operations lasting more than four hours, a second dose of antibiotics was administered to reduce infection risk.
  • Use of wound protectors was encouraged to reduce contamination of the skin while handling the intestines.
  • After completing the contaminated portion of colorectal procedures, members of surgical teams changed to new gowns and gloves, used new instruments and re-draped operative sites with sterile covers. This reduced contamination of the abdomen and skin during surgical closing procedures.
  • The technique of daily wound probing was broadly applied in some cases of wounds considered to be at high risk for infection. This involved a simple and inexpensive daily process using cotton-tipped applicators (Q-tips®) to release contaminated fluid trapped in wounds.

As a result of these steps and others, the rate of post-operative surgical site infections after colorectal surgeries dropped from a baseline of 15 percent to less than five percent within six months.

Doctors said the infection rate continued to decline after the initial rollout of the protocol, remaining well below five percent through July 2012, which is the most recent data available, Lower infection rates, they said, translate into fewer visits to the Emergency Department, fewer hospital readmissions and less need for subsequent operations.

Cedars-Sinai conducted its test as part of a larger national research project on surgical site infections piloted at seven large hospitals across the country, including Stanford University Medical Center and the Mayo Clinic. Under the collaborative, coordinated by The Joint Commission's Center for Transforming Healthcare, the hospitals each worked to develop a protocol to dramatically reduce surgical site infections among patients who underwent colorectal procedures.

Cedars-Sinai was among the hospitals that showed the best results, exceeding the goal for the hospitals to reduce infection rates by 50 percent and sustaining its success over a prolonged period.

“We are very pleased with the results we were able to achieve,” said Shirin Towfigh, MD, a faculty member in the Division of General Surgery and the Center for Minimally Invasive Surgery. “Our work illustrates that with institutional collaboration and low-cost changes in practice, surgeons can dramatically reduce their patients' surgical site infections.”

On the beaten path

By Harry C. Sax, MD, MHCM, FACS
Professor and Vice Chair, Department of Surgery

Surgeons at Cedars-Sinai are involved in humanitarian work throughout the world. Although we often recount our cases as a measure of our experience, it is often when we get away from the hospital that we truly learn about those we serve. I have been returning to Hospital Sacre Coeur, in Milot, Haiti, on multiple occasions since the 2010 earthquake. For this issue of Sutures, I'd like to show you the area surrounding the hospital. This is an excerpt from harryatsacrecoeur.blogspot.com/.

As a child in West Virginia and Ohio, I remember driving on National Pike, which was subsequently to become parts of Interstate 70. It followed a Native American trail several hundred years old. Post Road, from Boston to New York, now Route 1, was originally a trail, and with continued use, became a dirt road through the forests and along streams. Inns, post offices, and cities sprang up as human and vehicle traffic beat down any vegetation and created an enduring path. We speak of getting off the beaten trail, in an attempt to get away from society. Yet in Haiti and other less-developed countries, a trip along the beaten path reveals much about the people that live there and their interaction with geography and each other.

The road from Cap Haitien to Milot continues up the mountain, past San Souci to the Citadel. During the period of the war with the French, it served to move supplies inland, and gain strategic advantage. It has recently been paved, and the previous rattling ride from the airport is now 20 minutes, instead of an hour. About 300 yards before the entrance to the CRUDEM compound, a dirt road heads west and winds its way out of the valley, then back to Milot, well below the Palace. Its path reveals much about human nature.

Let's take a run and see what we can learn.

Turning left from the compound, we dodge tap taps, motorcycles and people walking to the hospital. A well marks the entrance to the path. Immediately, it becomes quiet. There are a few dwellings, and the banana trees, cocoa bushes, grapefruit and aloe grow to the edge. You can see perhaps 15 feet into the forest. A second path cuts to the right. I don't see where it's going, until a man with a machete and bunch of bananas emerges from the woods – that path led to economic support for his family.

About a half mile in, I see bags with USAID markings and a large pit near a river. Previously I would assume this was rice, but in fact it is limestone, which, when mixed with nearby water, forms plaster for homes. The road jogs back to the right and it is again quiet. A motorcycle overtakes me, and as I follow the dust cloud, it stops at a junction. There is a great deal of activity, and children begin to run with me. A new well, beautifully constructed after the cholera epidemic, draws local town folk and numerous homes are seen. A concrete bridge forges the river, yet in its shadow, women are doing laundry, the soap suds mixing with the shallow, muddy water.

We begin an uphill climb, and to the left, open-air stalls offer drinks, vegetables, cigarettes and canned goods. A grandmother sits on a stool as her granddaughter braids her hair. "Bon soir," they call out as they shake their heads at the concept of anybody running just for the sake of it. The road at this point is wide enough that a truck could get by, but soon it gets very rutted and I need to be careful to keep from twisting an ankle. As we move farther from water, dwellings again thin out, but there are areas of the forest that have been recently harvested. Piles of stone are in place for community use in building shelter.

The road comes to a T. To the right is the "short cut" to Cap; to the left the road to Milot. As is normal at crossroads of commerce, the Haitian equivalent of an ATM springs up (pictured at top). Trading dollars and gourds is big business.

As I climb above a ridge, the view back to the valley is spectacular, with the mountains behind. Few people are around.

Cresting the hill, I hear the noise of young men playing soccer, and the one flat area has become a makeshift field. The goals are sticks, and they play a tight game – goal width is about two ball diameters. I move to the side so as not to interrupt.

I must be getting closer to town as I start back down the hill. School children in their uniforms are walking up. A young man and his girlfriend hold hands. The homes now have rudimentary electricity, and the road is less dirt and more stone. It curves around a large tree that was never beaten down as a sapling.

The entry to the city is first heralded by the cellphone tower, then the river, and buildings tight together. People are everywhere, and there is a more frenetic feel. A left turn takes me past the music school, and I hear the sound of a band, but the location does jibe. A short block to the right is the main street to the hospital, and next to it, the cemetery. The road is packed as the funeral band, playing "Auld Lang Syne," marches past. Everyone is in their best clothes, and I feel embarrassed that I am sweating and in shorts. I stand well behind the masses, then when the procession passes, I turn to the left, and again compete with buses, vendors and the normal crowd by the hospital.

As things thin out, I am able to sprint the last 200 yards to finish the loop.

I sit outside to cool down. How often do we move through life, take the road prescribed by the GPS, and never notice the changes around us?

We often speak of standing on the shoulders of giants, yet as surgeons, perhaps we should also reflect that we are walking in the footsteps of those who first blazed the trail, and owe them thanks for beating out the path.

Research Division sees marked increases in clinical trials, funding

We’ve seen marked increases in the number of active clinical trials, research funding from nonfederal sources and a larger distribution of federal awards across our disciplines. Through targeted recruitments of accomplished investigators and strategic investments in our existing research portfolio, we’ve built on our funding successes each year.

Today, within the Department of Surgery, we have strong federally funded research programs in cancer biology, ophthalmology, regenerative medicine, general surgery, imaging and urological oncology. We also have a diverse portfolio of active clinical trials, including trials in cardiothoracic, orthopedics and bariatric surgery, as well as active trials in breast and pancreatic cancer.

One of the more unusual research projects is the Department of Defense OR360 project, which seeks to re-engineer teamwork and technology for 21st-century trauma care. A multidisciplinary team of trauma surgeons, Emergency Department staff, human factors specialists, and several experts on safety and human performance have been studying the processes of care delivery for trauma patients, to identify and address weaknesses in the current system. Worldwide, about 10 percent of patients are injured through a failure to deliver the appropriate care. By understanding the disruptions that occur in care and then examining their causes through detailed systems analysis, the team has been developing improved training, workspace layout, technology support and handoffs. Early results suggest a small but significant drop in coordination difficulties during the care of these often very sick patients.

Moving forward, we face a research-funding environment that will challenge the growth of our research programs. At the federal level, the National Institutes of Health research budget has essentially remained flat for the past five years, and all indications point to that trend continuing. When our applications are awarded, we’re seeing the awarded budgets cut immediately – sometimes by up to 20 percent – resulting in further financial strain to our research projects.

In response, we’re searching out alternate funding sources to support our research programs, be they disease-specific foundations, other federal agencies beyond the NIH, or partnerships with industry. We’ve also increased the number of research applications we’ve submitted to funding agencies, casting a larger net in hopes of more awards. We’ll continue to respond to the shifting research funding environment in hopes of continued success for the department.

Submitted by the Research Division in the Department of Surgery

Transplant patient to highlight need for organ donation at Rose Parade

Kevin Riepl arrived at Cedars-Sinai in October 2010, suffering from sudden heart failure that left him fighting for his life. Surgeons swiftly installed a heart pump and later transplanted a new heart, saving his life and turning him into an unexpected ambassador for organ donation.

Now the 38-year-old Winnetka man is preparing to represent Cedars-Sinai's Comprehensive Transplant Center on the 2013 Donate Life Rose Parade float on Jan. 1. With his wife, twin sons and parents watching from the grandstand, Riepl hopes his presence on the float will send a message about the importance of donating organs.

"It's the best gift anybody can ever give," he said.

Riepl's doctors say they are pleased with his recovery after seven surgeries over 2½ years, and that his new heart is stronger than ever. Riepl, they say, is an inspiration to other transplant patients.

"Kevin's case shows how important organ donation is, especially these days, when there are thousands of people on waiting lists," said Andrew S. Klein, MD, MBA, director of the Comprehensive Transplant Center and the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine.

David Chang, MD, and Kevin Riepl.

Before Riepl became sick, he was leading a happy life – writing music for video games, playing with his twin sons, working out at the gym near his home in the San Fernando Valley. Then in the fall of 2010, he started to feel fatigue, nausea and chest pain. Initially, he attributed the symptoms to a cold, but he continued to feel sicker and sicker. "I knew something wasn't right," he said.

One evening in October 2010, Riepl asked his wife to call 911. He was taken to the emergency room of a nearby community hospital. His organs were shutting down, and he stopped breathing for a short time.

Within hours, Riepl was airlifted to Cedars-Sinai, where he was placed on a heart bypass machine before surgeons installed a temporary heart pump known as a left ventricular assist device. It kept him alive while he awaited a new heart, which became available in July 2011.

The transplant turned out to be just the beginning of Riepl's road back to health. Soon after his transplant, doctors discovered a rare tumor on Riepl's adrenal gland that was affecting his blood pressure. He also has undergone several arm surgeries to repair damage from blood clots.

But today, with his heart condition under control, Riepl has returned to the gym and racquetball. And once again, he can horse around with his twins, now 5½ and in kindergarten.

"I feel great," he said, crediting his turnaround to the medical care he received at Cedars-Sinai. "Everyone was exceptional. I believe I received the best of best care a hospital could provide."

Riepl's doctors say they are delighted with his progress and moved by his unabashed spirit.

"I look forward to coming to work to see people like Kevin with passion for life," said Jon Kobashigawa, MD, (pictured with Riepl at left) director of Advanced Heart Disease, director of the Heart Transplant Program and associate director for Clinical Affairs at the Cedars-Sinai Heart Institute.

"That is rewarding in itself," added Kobashigawa, who holds the DSL/Thomas D. Gordon Chair in Heart Transplantation Medicine.

Cedars-Sinai surgeons perform more adult heart transplants than those at any other U.S. medical center. In 2011, surgeons performed heart transplants on 87 patients, and heart and lung transplants on two patients, making the Cedars-Sinai Heart Institute the leader among the 116 U.S. medical centers that performed adult heart transplants that year. The official statistics were compiled by the United Network for Organ Sharing, the nonprofit organization that manages the nation's transplant system.

Tracy Riepl said she is thankful her husband of nine years is a beneficiary of that success. She's thrilled to have him back at her side. The couple is planning a family vacation next summer to their childhood hometown in New Jersey. It will be the culmination of their medical journey, chronicled by Tracy Riepl on a family blog.

"It's like nothing ever happened," said Tracy, noting that her husband's sarcastic wit has returned. "He's the guy I fell in love with."

Pictured at top, from left: Kevin Riepl; Chris Brown, a financial management analyst at the Comprehensive Transplant Center; Mel Runyan, RN; and Jon Kobashigawa, MD.

Cedars-Sinai physician nominated by President Obama to National Cancer Advisory Board

Beth Y. Karlan, MD, director of the Women's Cancer Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, was appointed by President Barack Obama to the National Cancer Advisory Board, a committee that advises the U.S. National Cancer Institute.

She is one of six new appointees joining the 18-member panel, which, with the President's Cancer Panel, counsels the secretary of the U.S. Department of Health and Human Services, the NCI director and the president on issues related to the institute's activities, including reviewing and recommending grants and cooperative agreements.

"In addition to being a world-renowned scientist and surgeon, Dr. Karlan has been an instrumental voice advocating for greater public awareness, education and resources devoted to fighting cancer and saving lives," said Steven Piantadosi, MD, PhD, director of the Samuel Oschin Comprehensive Cancer Institute and the Phase One Foundation Chair. "Her impressive knowledge and dedication will be an asset to the National Cancer Advisory Board, and we congratulate her for this well-deserved honor."

Karlan serves as director of the division of gynecologic oncology in the Department of Obstetrics and Gynecology, director of the Gilda Radner Hereditary Cancer Program and the Board of Governors Chair in Gynecologic Oncology. She has written more than 200 peer-reviewed articles, and serves as editor-in-chief of Gynecologic Oncology. As president of the Society of Gynecologic Oncologists, she testified before Congress in support of the Gynecologic Cancer Education and Awareness Act of 2005, a milestone law providing millions of dollars to better inform the public about gynecologic cancers.

Her research, which has been funded by the National Institutes of Health, the American Cancer Society and the Department of Defense, focuses on discovery of ovarian cancer specific biomarkers to aid in early detection and as targets for molecular therapies, as well as studies on inherited cancer susceptibility – especially the clinical impact of mutations in the BRCA1 and BRCA2 genes in ovarian cancer.

"Dr. Karlan has been a leader in the charge to defeat women's cancers, and to save women's lives through increased education and awareness," said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and Helping Hand of Los Angeles Chair in Obstetrics and Gynecology. "Her appointment reinforces Cedars-Sinai's role as an outstanding institution devoted to clinical care and research that benefits women."

President Obama announced his selections for the board this month.

"I am grateful these accomplished men and women have agreed to join this Administration, and I'm confident they will serve ably in these important roles. I look forward to working with them in the coming months and years," the president said in a White House statement.

Presentations and publications

Oral presentations related to abstracts by Cedars-Sinai Spine Center physicians at the North American Spine Society's 27th Annual Meeting, held Oct. 24-27 in Dallas:

  • Spivak J.M., Delamarter R.B., Murrey D.B., Zigler J.E., Janssen M.E., Goldstein J.A.: Adjacent Level Radiographic Degenerative Changes Following Single-Level Artificial Disc Replacement or ACDF at Five- to Seven-Year Follow-Up.
  • Delamarter R.B., Zigler J.E., Murrey D.B., Janssen M.E., Spivak J.M.: Seven-Year Reoperation Rates: Results of a Prospective Randomized Clinical Trial: Cervical Total Disc Replacement Versus Fusion.
  • Delamarter R.B., Zigler J.E.: Does Two-Level 360-Degree Lumbar Spinal Fusion Improve Long-Term Clinical Outcomes After Failure of Conservative Treatment in Patients with Functionally Disabling Two-Level Degenerative Lumbar Disc Disease? Results of Five-Year Follow-Up in Fifty-Two Randomized Postoperative Patients.
  • Kropf M.A., Bedi H., Kanim L.E.A., Kim J., Rasouli A., Bae H.W., Delamarter R.B.: Disc Replacement for Treatment of Degenerative Disc Disease: Analysis of One Site Participating in the USA-FDA trial of Freedom Disc vs. ProDisc-L.
  • Sheyn D., Bae H.W., Oh A., Tawackoli W., Gazit D., Gazit Z.: Resident Stem Cells of the Nucleus Pulposus are Affected by Tissue Degeneration.
  • Davis R.J., Araghi A., Bae H.W., Hisey M.S., Nunley P.D.: Investigational Device Exemption Trial of Cervical Arthroplasty for Treatment of Degenerative Disc Disease at Two Levels: 24-Month Results of 330 Subjects.
  • Davis R.J., Araghi A., Bae H.W., Hisey M.S., Nunley P.D.: Comparison of Outcomes After Treatment of Cervical Degenerative Disc Disease at One or Two Levels with Total Disc Replacement.
  • Jawahar A., Nunley P.D., Araghi A., Bae H.W., Davis R.J., Hisey M.J., Jackson R.J.: Number of Levels Involved at Index Surgery Significantly Affects the Outcomes After Anterior Cervical Discectomy and Fusion: Analysis of Data from a Multicenter Prospective Randomized Controlled Trial.
  • Davis R.J., Araghi A., Bae H.W., Hisey M.S., Nunley P.D.: Comparison of Complication Rates Associated with Two-Level Cervical Arthroplasty Versus Two-Level Anterior Cervical Discectomy and Fusion.

Gerhard J. Fuchs, MD, FACS, vice chair of Surgery, gave presentations at the University of Indiana meeting of the International Kidney Stone Institute Oct. 18-19 in Indianapolis and at the National Brazilian Endourology meeting Nov. 14-17 in Rio de Janeiro:

At the IKSI meeting:

  • Fuchs G.: Expanding indications for flexible URS. IKSI Advanced Stone Workshop
  • Fuchs G.: Moderator Live Surgery: Ureteroscopy. IKSI Advanced Stone Workshop

At the National Brazilian Endourology meeting:

  • Fuchs G.: Roundtable Treatment of Staghorn Stones; panelist.
  • Fuchs G.: Roundtable Treatment of Ureteral Stones; panelist.
  • Fuchs G.: Complications of ureteroscopy.
  • Fuchs G.: Complications of Endourology: Bleeding and extravasation with Percutaneous Stone Surgery.
  • Fuchs G.: State-of-the Art Lecture: Treatment of upper tract transitional tumors with endoscopic surgery.
  • Fuchs G.: Treatment of choice for renal pelvic stones > 1.5 cm: the role of RIRS.

Book chapter:

  • Jian Tajbakhsh, PhD, and Arkadiusz Gertych, PhD, "3-D Quantitative DNA Methylation Imaging for Chromatin Texture Analysis in Pharmacoepigenomics and Toxicoepigenomics." In "Epigenomics: From Chromatin Biology to Therapeutics," K. Appasani, editor. Cambridge University Press, Cambridge, United Kingdom. Available since August 2012. The book, with contributions from experts in epigenetics, constitutes the first of its kind to publish ideas and strategies about the new concept of chromatin-based therapies in modern biomedicine, depicted with cutting-edge technologies from academia and leading companies.

Accepted article:

  • “Thromboprophylaxis and major oncologic surgery performed with epidural analgesia.” Daniel Shouhed, MD, Farin Amersi, MD, Thomas Sibert, BsC, Karen Sibert, MD, Emad Hemaya, MD, Allan W. Silberman, MD,PhD. Archives of Surgery, September 17, 2012, Online

Gangi wins Sports Spectacular fellowship

Alexandra Gangi, MD, has been named the winner of the 2013 Sports Spectacular Endowed Fellowship Award. The $1,000 award will be used to fund Gangi's training.

FDA updates regarding Zofran, Chantix

Pharmacy focus

32 mg, single IV dose of Zofran no longer marketed

The 32 mg, single intravenous dose of the anti-nausea drug Zofran (ondansetron hydrochloride) will no longer be marketed because of the potential for serious cardiac risks, according to the U.S. Food and Drug Administration.

This dose of Zofran had been used to prevent chemotherapy-induced nausea and vomiting. A previous FDA announcement issued on June 29, 2012, communicated that the 32 mg, single IV dose should be avoided due to the risk of a specific type of irregular heart rhythm called QT interval prolongation, which can lead to Torsades de Pointes, an abnormal, potentially fatal heart rhythm.

These products likely will be removed from the market through early 2013, according to the FDA. The agency does not anticipate that removal of the 32 mg intravenous dose of ondansetron currently sold as pre-mixed injections will contribute to a drug shortage of IV ondansetron, as the 32 mg dose makes up a very small percentage of the current market

The FDA continues to recommend the intravenous regimen of 0.15 mg/kg administered every four hours for three doses to prevent chemotherapy-induced nausea and vomiting. Oral dosing of the drug remains effective for the prevention of chemotherapy-induced nausea and vomiting. At this time, there is not enough information available for FDA to recommend an alternative single IV dose regimen.

Click here to read the complete MedWatch Safety Alert.

Updated safety review on the risk of cardiovascular adverse events with Chantix

The FDA is informing the public about the results of a large, combined analysis, called a meta-analysis, of clinical trials that compared patients who received the smoking-cessation drug Chantix (varenicline) to patients who received a placebo, an inactive treatment. A higher occurrence of major adverse cardiovascular events – a combined outcome of cardiovascular-related death, nonfatal heart attack and nonfatal stroke – was observed in patients using Chantix compared to those using a placebo. These events were uncommon in both the Chantix and placebo groups, and the increased risk was not statistically significant, which means it is uncertain whether the excess risk for the Chantix group was due to the drug or due to chance.

Healthcare professionals are advised to weigh the risks of Chantix against the benefits of its use. It is important to note that Chantix is effective in helping patients to quit smoking and abstain from it for as long as one year. The health benefits of quitting smoking are immediate and substantial.

Click here to read the MedWatch alert, including links to the FDA Drug Safety Communication.

Circle of Friends honorees for November

The Circle of Friends program honored 137 people in November.

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.

  • Margarito G. Aguirre
  • Nelli A. Akopyan, RN
  • Farin Amersi, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • M. William Audeh, MD
  • David E. Baires
  • Tina G. Ban, RN
  • Leon I. Bender, MD
  • Sherry Brandon, MFA
  • Nathaniel D. Bravo
  • Earl W. Brien, MD
  • Philip G. Brooks, MD
  • Rhommel R. Canuto, RT (R) (CV)
  • James L. Caplan, MD
  • Bojan Cercek, MD, PhD
  • Ray M. Chu, MD
  • Alice P. Chung, MD
  • Kristen Cisneros
  • Hart C. Cohen, MD
  • Steven D. Colquhoun, MD
  • Jessica Contreras
  • Martin Cooper, MD
  • Stephen T. Copen, MD
  • Stephen R. Corday, MD
  • Annette M. Davis, RN-MS, CCRN
  • Pamela Davis, MD
  • Robert W. Decker, MD
  • Rick B. Delamarter, MD
  • Naomi Drucker, RN
  • J. Kevin Drury, MD
  • Marla C. Dubinsky, MD
  • Cheryl L. Dunnett, MD
  • Phillip R. Fleshner, MD
  • Charles Forscher, MD
  • Marc L. Friedman, MD
  • Stuart Friedman, MD
  • David M. Frisch, MD
  • Clark Fuller, MD
  • Erwin Peter Gabor, MD
  • Avrom Gart, MD
  • Armando E. Giuliano, MD
  • Marianito Gloriani
  • Richard N. Gold, MD
  • Sherry L. Goldman, RN, NP
  • Richard F. Gordon
  • Mark E. Granoff, MD
  • Diana M. Griffin, RN, LVN
  • Ruchi Gupta
  • Erroll L. Hackner, MD
  • Antoine Hage, MD
  • David S. Hallegua, MD
  • Michele A. Hamilton, MD
  • Jeremy R. Herman, MD
  • David M. Hoffman, MD
  • Gary H. Hoffman, MD
  • Stuart Holden, MD
  • Arash A. Horizon, MD
  • Leonel Hunt, MD
  • Asma Hussaini, MS, PA-C
  • Peter Julien, MD
  • Deborah B. Kallick
  • Kamran Kalpari, MD
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Scott R. Karlan, MD
  • Manreet Kaur, MD
  • David Kawashiri, MD
  • Walter F. Kerwin, MD
  • Mehran J. Khorsandi, MD
  • Ali Khoynezhad, MD
  • Jon A. Kobashigawa, MD
  • Jerry Koontz
  • Michael A. Kropf, MD
  • Rachel M. Leon
  • Ronald S. Leuchter, MD
  • Manresa A. Levera
  • Michael C. Lill, MD, BS
  • Arthur E. Lipper, MD
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • Trent O. Martin, RN
  • Siobhan McCourt, RN-BC, BSN
  • Robert J. McKenna, Jr., MD
  • Puja K. Mehta, MD
  • Stephanie A. Meyer
  • Stewart Middler, MD, PhD
  • Becky J. Miller, MD
  • Ronald B. Natale, MD
  • Christopher S. Ng, MD
  • David G. Ng, MD
  • Robert Nisenbaum, MD
  • Nicholas N. Nissen, MD
  • Victor M. Nolasco, RN
  • Anna G. Nothdurft, RN
  • Jennifer E. Oberhofer, RT (R) (VI)
  • Asako B. Oshiro
  • Guy D. Paiement, MD
  • Raul V. Paramo
  • Robert S. Pashman, MD
  • Jignesh K. Patel, MD, PhD
  • Michele Pelot, MD
  • Edward H. Phillips, MD
  • Mark Pimentel, MD
  • Robert Richter, MD
  • Laura J. Riggs, RN
  • Angel Rocha
  • Howard L. Rosner, MD
  • Gregorio B. Rue, RN
  • Stephen A. Sacks, MD
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Danica J. Schulte, MD
  • Michael M. Shehata, MD
  • Randolph Sherman, MD
  • Allan W. Silberman, MD, PhD
  • R. Kendrick "Ken" Slate, MD
  • Cheryl Smith
  • Karyn Morse Solky, MD
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Jerrold H. Steiner, MD
  • Steve C. Sun, MD
  • Gary A. Swadling
  • Nicholas R. Szumski, MD
  • Priscilla C. Tanedo, RN
  • Connie Tejero
  • David B. Thordarson, MD
  • Michael Tom, CV, FAVIR
  • Alfredo Trento, MD
  • Hannah T. Tualla, RN, MSN, NP-C
  • Michael B. Van Scoy-Mosher, MD
  • Eric Vasiliauskas, MD
  • Robert A. Vescio, MD
  • Romina Vincenti, DPM
  • Olga Voroshilovsky, MD
  • Ashley M. Wachsman, MD
  • Andrew Wachtel, MD
  • Alan Weinberger, MD