sutures newsletter

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

Stay tuned, the fun is just starting

Message from the chair

The Cedars-Sinai Department of Surgery enjoyed remarkable success in the most recent academic year.


» Read more

Pediatric surgery has strong roots, future at Cedars-Sinai

Cedars-Sinai's pediatric surgeons have played key roles at the local, regional and national levels. It's been that way since Stephen Gans, MD, helped transform a fledgling group of child-caring surgeons into the American Pediatric Surgical Association and then developed the Journal of Pediatric Surgery.  

» Read more

Annual Meeting of the Medical Staff is Oct. 22

Join us for a free lunch, some special awards and humor (supposedly)

The annual meeting will be held on Monday, Oct. 22, from 11:30 a.m. to 1:30 p.m. in Harvey Morse Auditorium.

» Read more

Liver transplant program earns LA County's highest one-year success rate

One-year liver transplant survival rate better than national average, data show

In 2011, 90 percent of Cedars-Sinai liver transplant patients reached the one-year post-surgery milestone, giving the Cedars-Sinai Comprehensive Transplant Center the highest one-year liver transplant survival rate in Los Angeles County.

» Read more

Featured publication

Leon Morgenstern, MD, FACS, the first chair of the combined Cedars-Sinai Department of Surgery, continues to inspire us. His most recent publication in the Journal of the American College of Surgeons, was published this month.



» Read more

CS-Link enhancements coming in early November

For those of you who have been waiting for better or additional CS-Link™ features, you’ll be happy to know that the latest upgraded version of CS-Link will be installed to production in the early hours of Sunday, Nov. 4. You will not, however, see a significant amount of changes to your day-to-day workflows or screens.

» Read more

Circle of Friends honorees for September

The Circle of Friends program honored more than 200 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

PubMed, EndNote Web among Medical Library class offerings

Courses scheduled through December

Cedars-Sinai's Medical Library is offering a variety of classes through December. Library staff also is available to schedule specific times for individual or group sessions if the times listed are not convenient.

» Read more

Out-of-this-world medical challenges

Anemia, vertigo, atrophied muscles, lowered cardiac output and reduced bone mass. Symptoms of a very sick patient? On Earth, perhaps. But in space, it's pretty normal. For help with these conditions, astronauts turn to experts such as Gregg A. Bendrick, MD, chief medical officer and senior flight surgeon for NASA Dryden Flight Research Center at California's Edwards Air Force Base in the Mojave Desert.

» Read more

Pantoprazole as preferred PPI, change from Gamunexto Gammaked

Pharmacy focus

Pantoprazole (Protonix®) is now the preferred proton pump inhibitor and Gammaked® is being dispensed in place of Gamunex®.

» Read more

Stay tuned, the fun is just starting

Message from the chair

The Cedars-Sinai Department of Surgery enjoyed remarkable success in the most recent academic year.

Research funding currently equals $9 million with the majority of grants coming from federal sources (National Institutes of Health or Department of Defense). This is a three-fold increase from 2006. The number of surgical procedures matched last year’s all-time high. In certain programs such as adult heart transplant, we are the largest program in the world. In many of our other programs including orthopedics, spine surgery, thoracic surgery and minimally invasive general surgery, we are the largest in our state. Our largest residency program, general surgery, received a record 650 applications for our four categorical slots; this represents nearly 40 percent of all U.S. medical students applying in this field.

In short, there are many reasons to be confident that our unique balance of full-time and private attendings will continue to advance us in both academic and clinical activities.

That said, we must acknowledge that we cannot expect to be unaffected by the tumult surrounding healthcare issues. These include, but are not limited to, changes in the financing of care for those currently uninsured and major alterations in the funding of Medicare and other government programs.

Less openly discussed, but equally critical,are the predicted reductions in reimbursement for post-graduate education and a likely 8-10 percent reduction in the NIH budget. Should these cuts come to pass, both would adversely impact academic medical centers such as ours.

The production of physicians by medical schools has increased dramatically in the last decade with a number of new schools opening every year. Unfortunately, the number of post-graduate residency slots has not kept pace. This has created a substantial imbalance especially in surgical specialties such as general surgery in which severe shortages are already evident especially in rural areas. While we are justifiably proud of our superb residency programs in general surgery and cardiothoracic surgery and the newly created urology and orthopedic programs, the growth in the number of residents has not matched the increased number of procedures we perform at Cedars-Sinai (currently exceeding 30,000 per year) and the severity of illness of our more than 900 daily hospitalized patients (with nearly 20 percent of them in critical care units).If such reductions in funding materialize, expansion of these programs to meet the nation’s needs will be problematic.

Undoubtedly, there is a path to continued excellence and growth, but it will require innovation as well as perseverance. We need to foster positive behaviors such as prudent utilization of clinical resources and enhanced collaboration in translational research endeavors. Philanthropy by grateful patients and research funding from industrial partners will likely be an even more important source of support and needs to be a focus for all of us.

Without question, our goals of increasing the value of our clinical and research missions are worth the effort. The momentum gained by our institution and department will be maintained. In the upcoming months, we will be reaching out to all our constituencies to gather your ideas on adapting to our changing environment and to support you in your initiatives.

Research Funding Graph

Pediatric surgery has strong roots, future at Cedars-Sinai

Cedars-Sinai's pediatric surgeons have played key roles at the local, regional and national levels. It's been that way since Stephen Gans, MD, helped transform a fledgling group of child-caring surgeons into the American Pediatric Surgical Association and then developed the Journal of Pediatric Surgery.  

David W. Bliss, MD, FACS, FAAP,joined Cedars-Sinai as the director of the Division of Pediatric Surgery in early 2011.While clinical care will always be the group's focus, it also is now exploring ways to contribute to pediatric surgical science.

Hirschsprung’s disease model

Frykman 90pxPhilip Frykman, MD, PhD, (pictured left) associate director of Pediatric Surgery, is one of a select group of international physicians working on a basic science model of Hirschsprung’s disease (congenital megacolon) as well as a registry of patients with Hirschsprung’s enterocolitis.

Frykman’s work, which is funded by the National Institutes of Health, holds promise to identify new methods of treatment and discern risk factors for complications of the disease.

Evidence-based techniques

Bliss 90pxBliss (pictured right) brings an interest in using evidence-based techniques to define optimal care in Pediatric Surgery. His work includes studies of neonates with posterolateral diaphragmatic hernia, head-injured children and appendicitis.

In the past, hypercapnea was considered anathema in children with diaphragmatic hernia because of the perceived risk of recurrent, life-threatening pulmonary hypertension. Bliss’ work demonstrated that infants tolerate arterial CO2 concentrations above 120 torr and pH levels as low as 6.9 without clinically detectable complications.

He recently submitted for publication data demonstrating that only 7 percent of children undergoing a head CT for closed head injury will have findings on a subsequent scan that lead to a surgical intervention – thus suggesting that serial CT examinations are neither cost-effective nor clinically useful in these circumstances.

Since the advent of endoscopic surgical techniques, patients, families, referring physicians, and surgeons have rapidly accepted the "superiority" of these methods. While it seems intuitively obvious that these "minimally invasive" procedures should be less painful, have faster recoveries, shorter length of stays, and lower complication rates, the actual data to support these assertions has been in short supply.

Bliss recently completed the largest prospective, randomized, blinded trial of laparoscopic versus open appendectomy in children. While the findings are currently under peer review, the analysis suggests that the laparoscopic approach is faster and has fewer infectious complications but is no different than open operation with regard to pain medication requirements or length of stay.

To learn more about the clinical or research activities of the Division of Pediatric Surgery at Cedars-Sinai, please call the office at (310) 423-6235 or email Bliss at blissd@cshs.org.

Submitted by the Division of Pediatric Surgery in the Department of Surgery.

Annual Meeting of the Medical Staff is Oct. 22

Join us for a free lunch, some special awards and humor (supposedly)

The annual meeting will be held on Monday, Oct. 22, from 11:30 a.m. to 1:30 p.m. in Harvey Morse Auditorium.

Highlights include reports from the chief of staff and medical center leadership as well as the presentation of the Chief of Staff Award and the 2012 Pioneer in Medicine Award.

Liver transplant program earns LA County's highest one-year success rate

One-year liver transplant survival rate better than national average, data show

In 2011, 90 percent of Cedars-Sinai liver transplant patients reached the one-year post-surgery milestone, giving the Cedars-Sinai Comprehensive Transplant Center the highest one-year liver transplant survival rate in Los Angeles County.

The data also show that the survival rate for Cedars-Sinai liver transplant patients exceeds the national average of 88.5 percent. The statistics are compiled by the Scientific Registry of Transplant Recipients, a nonprofit organization administered by the Minneapolis Medical Research Foundation, which designs and carries out rigorous scientific analyses of data for the transplant community.

"Our program is focused on giving our patients, many of whom are among the most severely ill, the best chance for a new start in life," said Steven Colquhoun, MD, director of Liver Transplantation. "That focus is why our survival rates consistently, over several years, have out-performed the national average. Achieving a 90 percent one-year survival rate is wonderful but our goal is to give our patients a 100 percent survival rate."

Andrew S. Klein, MD, MBA, liver surgeon, director of the Cedars-Sinai Comprehensive Transplant Center and the Esther and Mark Schulman Chair of Surgery and Transplant Medicine, said, "Cedars-Sinai has made transplantation medicine an institutional priority. The collaborative efforts of more than 300 doctors, scientists and staff within our Comprehensive Transplant Center have saved lives and improved the quality of life for a rapidly growing number of patients. As a physician, every time I witness a patient regain health after receiving a new heart, liver, kidney, pancreas or lung, I know how fortunate I am to be part of this transformative process."

Throughout the U.S., there are more than 100,000 people on the National Organ Transplant Waiting List, according to the United Network for Organ Sharing, the nonprofit agency that oversees the national organ transplant system. More than 400 Cedars-Sinai patients are on the waiting list for a liver and more than 20,000 patients are listed at California transplant centers. Because there are insufficient donated organs to meet the need, 18 people die each day in the U.S. while awaiting organ transplants; a new name is added to the national waiting list every 13 minutes.

"Organs for transplantation are such a precious resource that it is imperative that all of us – doctors and patients – do everything possible to maximize transplant success," Klein said.

Featured publication

Morgenstern 90pxLeon Morgenstern, MD, FACS, the first chair of the combined Cedars-Sinai Department of Surgery, continues to inspire us. His most recent publication in the Journal of the American College of Surgeons, was published this month. The Clamp, the Stomach, and the Spleen Jules-Emile Pean (1830-1898) (PDF)

Our admiration and congratulations for a career of scholarship that has extended for seven decades.

We encourage you to submit your recent publications for inclusion in Sutures. Please email links and information to sutures@cshs.org.

CS-Link enhancements coming in early November

For those of you who have been waiting for better or additional CS-Link features, you’ll be happy to know that the latest upgraded version of CS-Link will be installed to production in the early hours of Sunday, Nov. 4. You will not, however, see a significant amount of changes to your day-to-day workflows or screens.

Following are just a few of the enhancements that you can look forward to:

  • Frequently placed orders saved and recommended in Order Entry
  • View and edit notes in the sidebar while reviewing other patient information
  • More easily identify prior-to-admission medications requiring review
  • Streamlined transcription authentication process

The CS-Link upgrade will require minimal training. However, so that you know what to expect, we encourage you to stop by the Physician Resource Center (Room 2806 on the Plaza Level of the South Tower) so that a Physician Super User can quickly show you the enhancements. You can view e-Learning modules by going to www.cslinkcentral.org.

The CS-Link changes that will appear the day of the upgrade will lay the foundation for future system enhancements. For example, over the next few months, these foundational changes will support ICD-10 modifications, as well as the upcoming implementation of the Perioperative (Optime) and Radiology (Radiant) applications. The CS-Link team will continue to work closely with physicians, nursing and other clinical and business operations areas to implement these optimization opportunities.

As part of the upgrade process, you will not be able to create new SmartPhrases or edit current SmartPhases starting Tuesday, Oct. 30, through Sunday, Nov. 4. If you attempt to do so, you will get an error message. You will, however, be able to use your current SmartPhrases during this time period.

Finally, this upgrade will require a downtime coordinated to accommodate the daylight saving time change. CS-Link, users will need to log off of the system for approximately four hours beginning at 1 a.m. (PDT) on Nov. 4 and follow downtime procedures.

For more details about what to expect with the CS-Link upgrade, go to www.cslinkcentral.org and click on the Upgrade tab.

Circle of Friends honorees for September

The Circle of Friends program honored more than 200 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.

  • Stephanie Abad
  • Ali Khoynezhad, MD, PhD
  • Bessie Adams
  • Hyung L. Kim, MD
  • Kenneth Adashek, MD
  • Ellen B. Klapper, MD
  • Keith L. Agre, MD
  • Robert Klapper, MD
  • Alexandriah N. Alas, MD
  • Jon A. Kobashigawa, MD
  • Felipe S. Amador
  • Brent A. Kohler, RN
  • Farin Amersi, MD
  • Jerry L. Koontz
  • Mahul B. Amin, MD
  • David A. Kulber, MD
  • Kapil K. Anand, MD
  • Lia B. Labrant, MD
  • Paula J. Anastasia, RN, MN, AOCN
  • Cecilia K. Lam
  • Carlos Anaya, MD
  • Babak Larian, MD
  • Jennifer T. Anger, MD, MPH
  • Gary Leach, MD
  • M. William Audeh, MD
  • Mario R. Leal
  • Babak Azarbal, MD
  • Ronald S. Leuchter, MD
  • Traci V. Babcock, RN, MSN, ACNP-BC
  • Andrew J. Li, MD
  • Sam Bakshian, MD
  • Michael C. Lill, MD
  • Irene K. Barnett, MD
  • Stephen W. Lim, MD
  • Rachel Barroso, RN
  • Howard L. Liu, MD
  • Cynthia Barter, RNC
  • Simon K. Lo, MD
  • Aron B. Bick, MD
  • Victoria C. Lopez, RN
  • Anton J. Bilchik, MD
  • Patrick D. Lyden, MD
  • Steven H. Black, CN
  • Hooman Madyoon, MD
  • Keith L. Black, MD
  • Rajendra Makkar, MD
  • Swaraj Bose, MD
  • Lilian Manier
  • Glenn D. Braunstein, MD
  • David N. Matsumura, MD
  • Barry J. Brock, MD
  • Philomena McAndrew, MD
  • Eileen G. Brown, RN, OCN
  • Siobhan McCourt, RN
  • Neil A. Buchbinder, MD
  • Robert J. McKenna Jr., MD
  • Matthew H. Bui, MD
  • Diane B. McWhorter
  • Maria M. Cananea, RN
  • Joel D. Mittleman, MD
  • Jamia C. Carr
  • Patricia A. Moore
  • Ilana Cass, MD
  • Jaime D. Moriguchi, MD
  • Kirk Y. Chang, MD
  • Karyn L. Morse, MD
  • David H. Chang, MD
  • Charisse A. Murakami, RN
  • George Chaux, MD
  • Arpine Nahabedian
  • Marina V. Chavez, RN
  • Ronald B. Natale, MD
  • Connie Chein, MD
  • Christopher S. Ng, MD
  • Ray M. Chu, MD
  • Nicholas N. Nissen, MD
  • Andrew Chuang, MD
  • Andrea Pack, RN
  • Sumeet S. Chugh, MD
  • Karen P. Page, RN
  • Alice P. Chung, MD
  • Jignesh K. Patel, MD, PhD
  • Hart C. Cohen, MD
  • Brad Penenberg, MD
  • Stephen T. Copen, MD
  • Christina A. Penfield, MD, MPH
  • Stephen R. Corday, MD
  • Brian Perri, MD, DO
  • Barbara H. Cowen, MSW
  • Daniel N. Phillips, LCSW, MSW
  • Alice C. Cruz, MD
  • Edward H. Phillips, MD
  • Scott A. Cunneen, MD
  • Joanne Pileggi, RN, MSN, NE-BC
  • Nicola P. D'Attellis, MD
  • Lawrence D. Platt, MD
  • Moise Danielpour, MD
  • Edwin M. Posadas, MD
  • Laura O. Daniels, RN, BC, BSN
  • Dolores C. Ramirez
  • Annette M. Davis, RN-MS, CC, RN
  • Danny Ramzy, MD, PhD
  • Dorshey M. Dean
  • Alexandre Rasouli, MD
  • Anne J. Dela Cruz, RN, BSN
  • Nina Redl
  • Noam Z. Drazin, MD
  • Jenna Renella
  • Sherry Duarte, RN, BC, BSN
  • Patrick R. Rhoten, MD
  • Marla C. Dubinsky, MD
  • Harvey S. Richmond, MD
  • Montessa L. Edwards, MD
  • Marsha Ricks, RN
  • Michael Engelberg, MD
  • Richard V. Riggs, MD
  • Loren J. Ennis, RN, CRN
  • Deborah K. Rothwell, BS, RRTR
  • Shervin Eshaghian, MD
  • Regina M. Rozenblat, CN
  • Fardad Esmailian, MD
  • Stephen A. Sacks, MD
  • Amanda B. Espinoza, RN
  • Mossi S. Salibian, MD
  • Iris Estupinian
  • Rosa O. Sanabria
  • Fozia Ferozali, MSN, EdD
  • Ma. Lorelie V. Sanosa, RN
  • Mary Fox, RN, MPH
  • Gregory P. Sarna, MD
  • Gerhard J. Fuchs, MD
  • David N. Sayah, MD
  • Erwin P. Gabor, MD
  • Jay N. Schapira, MD
  • Steven S. Galen, MD
  • Wouter I. Schievink, MD
  • Donna Gallik, MD
  • Prediman K. Shah, MD
  • Angelina C. Gamboa, RN
  • Michael M. Shehata, MD
  • Eli S. Gang, MD
  • Robert J. Siegel, MD
  • Avrom Gart, MD
  • Allan W. Silberman, MD, PhD
  • Ivor L. Geft, MD
  • Paul A. Silka, MD
  • Alexander Gershman, MD
  • Americo Simonini, MD
  • Armando E. Giuliano, MD
  • R. Kendrick Slate, MD
  • Richard N. Gold, MD
  • Della M. Smith
  • Ora K. Gordon, MD
  • Della M. Smith
  • Steven B. Graff-Radford, DDS
  • Americo Simonini, MD
  • Rafael O. Grefaldeo
  • R. Kendrick Slate, MD
  • Leonardo M. Guinto Jr.
  • Della M. Smith
  • Victor Gura, MD
  • Michael J. Soffer, MD
  • Xiomara Guzman
  • Thomas P. Sokol, MD
  • Antoine Hage, MD
  • Shlee S. Song, MD
  • Behrooz Hakimian, MD
  • Joyce R. Spalding, RN
  • Michele A. Hamilton, MD
  • Andrew I. Spitzer, MD
  • John G. Harold, MD
  • Jasminka Stegic, MS, ANP-BC, CC, RN
  • Arman Hekmati, MD
  • Jerrold H. Steiner, MD
  • Jeremy R. Herman, MD
  • Leslie Stricke, MD
  • Martha J. Hibbitt
  • Joseph Sugerman, MD
  • Solange D. Hildreth
  • Lillian Szydlo, MD
  • Daniel K. Hoh, MD
  • Steven W. Tabak, MD
  • Gabriel E. Hunt Jr., MD
  • Michele Tagliati, MD
  • Darlene B. Husain, RN, BSN
  • Lauren L. Timpe, RN
  • Omar Hussain, MD
  • Shirin Towfigh, MD
  • Asma Hussaini, MS, PA-C
  • Tram T. Tran, MD
  • Mariko L. Ishimori, MD
  • Alfredo Trento, MD
  • Ifeoma S. Izuchukwu, MD
  • Cherry Lou E. Trono, RN
  • Laith H. Jamil, MD
  • Richard Van Allen, MD
  • Leslie S. Johnson, MA, OTR/L
  • Robert A. Vescio, MD
  • Carole Jordan-Harris, MD
  • Billy O. Villao
  • Marshall L. Kadner, MD
  • Xunzhang Wang, MD
  • Stephanie M. Kagimoto
  • Alan Weinberger, MD
  • Saibal Kar, MD
  • Rabbi Jason L. Weiner
  • Beth Y. Karlan, MD
  • Jonathan M. Weiner, MD
  • Ronald P. Karlsberg, MD
  • Janet White, MD
  •  Manreet Kaur, MD
  • Ashley Willetts
  • David Kawashiri, MD
  • Edward M. Wolin, MD
  •  Manreet Kaur, MD
  •  Isa Wright, RN, BSN
  • David Kawashiri, MD
  • Leslie A. Yadao, BSN, CMS, RN
  •  Ilan Kedan, MD
  • Philip A. Yalowitz, MD
  •  Walter F. Kerwin, MD
  • Clement C. Yang, MD

 

  • John S. Yu, MD

 

  • Mae Zakhour, MD

PubMed, EndNote Web among Medical Library class offerings

Courses scheduled through December

Library 170pxCedars-Sinai's Medical Library is offering a variety of classes through December. Library staff also is available to schedule specific times for individual or group sessions if the times listed are not convenient.

On-site and on your desktop: learn to use the Cedars-Sinai Medical Library (drop-in class)

Learn how to take advantage of the Cedars-Sinai Medical Library online databases, electronic journals and books, as well as a variety of services via our website.

  • When: Monday, Wednesday, Friday
    Time: 11 a.m.-noon OR 2 p.m.-3 p.m.
  • Location: Medical Library, South Tower, Plaza Level, Room 2815
  • Contact:caroline.marshall@cshs.org

PubMed class (registration required)

Learn to search like an expert. Get more control over your results with MeSH Subject Headings, subheadings and limits. Learn to refine your search for more precision or broaden the search for results that are more comprehensive. Learn to save your references and searches, email them or send them to Endnote Web. Registration required, on a first come, first served basis as space is limited.

  • Date: Tuesday, Oct. 23, Nov. 13 OR Dec. 11
  • Time: 2 p.m.-3 p.m.
  • Location: Medical Library, South Tower, Plaza Level, Room 2815
  • Contact: caroline.marshall@cshs.org

ENDNOTE WEB class (registration required)

Need help managing and organizing your references. EndNote Web (not desktop) is a web-based reference manager offered by the Medical Library that allows you to; collect, organize and manage references and insert them in MS WORD using Cite and Write. Registration required, on a first come, first served basis as space is limited.

  • When: Thursday, Oct.18, Oct. 25, Nov. 1OR Dec.6
  • Time: 2 p.m.-3 p.m.
  • Location: Medical Library, South Tower, Plaza Level, Room 2815
  • Email: caroline.marshall@cshs.org

CINAHL, OVID Medline Instruction courses are by appointment only.

Medical Library Classes (PDF)

Out-of-this-world medical challenges



Anemia, vertigo, atrophied muscles, lowered cardiac output and reduced bone mass. Symptoms of a very sick patient? On Earth, perhaps. But in space, it's pretty normal. For help with these conditions, astronauts turn to experts such as Gregg A. Bendrick, MD, chief medical officer and senior flight surgeon for NASA Dryden Flight Research Center at California's Edwards Air Force Base in the Mojave Desert.

In a Sept. 20 lecture in Harvey Morse Auditorium, sponsored by the Cedars-Sinai Alumni Association, Bendrick described the "tremendous physiological assaults" that humans endure while exploring the universe, as well as the sometimes stormy "marriage" between astronauts and the flight surgeons (the military's term for flight medicine physicians) who work with them. His lecture was followed by a screening of the 1995 movie "Apollo 13," which portrays the medical and technical challenges that plagued the aborted 1970 lunar mission.

In the early days of the U.S. space program, when some flight surgeons came to view astronauts as research subjects and "completely forgot that they were human," their relationship deteriorated, Bendrick said. Project Mercury astronaut Walter Schirra once described the rigorous array of physical and psychological exams that astronauts underwent as "an embarrassment, a degrading experience."

Overall, though, physicians and space pilots build a bond like a family relationship, said Bendrick, who coordinated medical crews for five space shuttle landings at Edwards. Astronauts, he said in an interview after his lecture, are physically gifted, very intelligent and accustomed to dealing with high risk.

"You don't tell the astronauts what to do," he said. "You clarify the risks, not only for them, but for their families and the program."

Fortunately, many physical changes associated with space travel are temporary. Traceable to microgravity, commonly called weightlessness, such effects tend to gradually dissipate after return to Earth. Aboard the International Space Station, astronauts rely on special equipment, such as treadmills rigged to simulate the pull of gravity, to help counter effects of prolonged weightlessness.

"Space travel has shown us the amazing resiliency of the human body," said Bendrick, a U.S. Air Force veteran who is board-certified in aerospace medicine.

But some medical issues may be longer term. Astronauts, especially at higher altitudes, are exposed to levels of ionizing radiation that exceed federal safety standards, Bendrick said Such exposures may raise their risks of developing cataracts or even cancer, he explained.

Rapid bone loss is another troublesome issue. While in space, people may lose up to 2 percent of their bone mass each month, which could pose a significant obstacle to future interplanetary trips requiring long journeys.

As it turns out, though, one of the greatest medical challenges for space travelers may be mental health, Bendrick said. To help reduce the stress of lengthy deployments, NASA offers regular private family conferences, in which astronauts visit with their Earth-bound families through video conferencing.

In introducing Bendrick at the alumni presentation, the group's events director, Yzhar Charuzi, MD, noted that the retired U.S. space shuttle Endeavour, riding atop a modified Boeing 747, would make a celebrated flyover in Southern California the next day. Endeavour later will be exhibited at the California Science Center in Los Angeles. Although NASA ended the space shuttle program last year, it is developing plans to return U.S. astronauts to space in the future.

Photos: Gregg A. Bendrick, MD, chief medical officer and senior flight surgeon for NASA Dryden Flight Research Center at California's Edwards Air Force Base, discussing the history of flight surgeons, their stormy "marriage" with astronauts and the medical challenges of space exploration at a lecture sponsored by the Cedars-Sinai Alumni Association.

Pantoprazole as preferred PPI, change from Gamunexto Gammaked

Pharmacy focus

Pantoprazole (Protonix®) as Preferred PPI

On June 5, Cedars-Sinai's Pharmacy and Therapeutics Committee approved pantoprazole (Protonix®) as the preferred proton pump inhibitor. Starting Wednesday, Sept. 26, new orders for PO and IV PPIs are automatically being substituted to pantoprazole per medical center-approved automatic substitutions.

  • Pantoprazole adult dosing:
    • 40mg PO or IVP daily
    • IV Infusion: 80mg IVPB bolus, then 8mg/hr continuous infusion
  • Automatic substitutions:
    • Autosub from esomeprazole to pantoprazole
      • Esomeprazole 40 mg IVP TO 40 mg IV push at same interval
      • Esomeprazole 80 mg IVPB bolus then 8 mg/hr continuous infusion TO 80 mg IVPB bolus then 8 mg/hr continuous infusion
      • Esomeprazole 40 mg PO TO 40mg PO or as solution via enteral tube at same interval
      • Esomeprazole 40 mg via enteral tube TO 40mg solution via enteral tube at same interval
    • Autosub from lansoprazole to pantoprazole
      • Lansoprazole 30 mg IVPB TO 40 mg IV push at same interval
      • Lansoprazole 60 mg IVPB bolus then 6 mg/hr cont infusion TO 80 mg IVPB bolus then 8 mg/hr continuous infusion
      • Lansoprazole 30 mg PO TO 40 mg PO at same interval
      • Lansoprazole 30 mg suspension via enteral tube TO 40mg solution via enteral tube at same interval
    • Autosub from omeprazole to pantoprazole
      • Omeprazole 10-. 20- or 40mg PO TO 40mg PO or via enteral tube
    • Pantoprazole 40mg IV TO pantoprazole 40mg PO or via enteral tube at same interval
    • Dexlanzoprazole 30- and 60mg PO TO pantoprazole 40mg PO or via enteral tube at same interval
    • Rabeprazole 20mg PO TO pantoprazole 40mg PO or via enteral tube at same interval

NOTE: Pantoprazole tablets may not be crushed. For patients requiring NG/GT administration, please select the suspension option to assure that the appropriate formulation is dispensed. Lansoprazole suspension will continue to be available for pediatric patients only.

Change from Gamunex® to Gammaked® IVIG brand name product

Starting Wednesday, Sept. 26, the Department of Pharmacy Services began dispensing Gammaked® in place of Gamunex®. Gammaked is identical to Gamunex, but is being sold by a different manufacturer under the brand name of Gammaked. The CS-Link™ order panel has been updated to include the Gammaked brand name product as the non-sucrose based product for NON-ESRD patients or patients prior to renal transplant. Infusion guidelines will remain unchanged.

Please see the following PDF:  B2B. Gammaked vs Gammunex-C Comparison 05.12 (PDF)

Pharmacy and Therapeutics Committee approvals

Cedars-Sinai's P&T Committee released approvals from its August meeting. Please see the following PDF:  Pharmacy and Therapeutics Committee Approvals - August 2012 (PDF)