sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY February 2013 | Archived Issues

Sinus Center Leads with Quality-Assurance Program

Improving quality of care and being able to measure that improvement have become the main ingredients and universal themes in healthcare organizations. Quality and the awareness of its importance are the unifying concepts seen in numerous hospitalwide programs across the nation. Evidence-based medicine allows us to give growing attention to patient safety and quality of care. Recognizing and accepting this, the physicians at the Cedars-Sinai Sinus Center have become leaders in their quality-assurance program.

» Read more

Spine Center Starts Year with New Trial, Publications

The surgeons, specialists and researchers at the Cedars-Sinai Spine Center have started the year with a new trial and several recent publications.

» Read more

Washington Family Scholar Returns to Cedars-Sinai Four Years Later as Neurosurgical Resident

The first time Lindsey Ross worked in the Department of Neurosurgery at Cedars-Sinai, she was a medical school student and the 2008 recipient of the Pauletta and Denzel Washington Family Gifted Scholars Program in Neuroscience award. Now she is a doctor and first-year resident in Cedars-Sinai's Neurological Surgery Residency Program.

» Read more

Surgeons Asked to Review Use of CPT

Harry C. Sax, MD, MHCM, FACS, is asking Cedars-Sinai surgeons for help in focusing the role of Respiratory Therapy in patient care. There are specific patients who will benefit, notes Sax, senior physician liaison for Cedars-Sinai Medicine and executive vice chair of Surgery. We want to make sure that we deploy resources where they can do the most good.

» Read more

Orthopedic Surgeon Recognized for Dedication to Advancing Hip, Knee Surgery in Israel

Andrew I. Spitzer, MD, has traveled to Israel more than a dozen times over the past decade to perform his own brand of community service: Teaching surgeons the latest techniques for replacing hips and knees while treating many patients without charge.



» Read more

Neurosurgery Resident Wins Leadership Award from AMA Foundation

Debraj "Raj" Mukherjee, MD, MPH, a neurosurgery resident at Cedars-Sinai, has been named a recipient of the American Medical Association Foundation’s 2013 Leadership Award. The award provides medical students, residents, fellows and early-career physicians with training to develop their skills as future leaders in medicine and community affairs.



» Read more

Pediatricians Attend Surgery Conference

Pediatricians gathered Jan. 26 at the SLS Hotel in Beverly Hills to learn how to recognize signs and symptoms and know when to refer a patient to a pediatric surgeon. Cedars-Sinai and Children’s Hospital Los Angeles hosted the conference with expert physicians from both medical centers.

» Read more

Here Is Your Chance to Honor a Deserving Nurse!

Online nominations for the 2013 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are being accepted now through Monday, March 11.

» Read more

P&T Decisions, Notification of Injury Risk with Samsca

Pharmacy focus

The Pharmacy and Therapeutics Committee recently addressed an addition to the Cedars-Sinai formulary and a warning about methadone. In addition, the FDA is noting the risk of liver injury with the drug Samsca®.

» Read more

Circle of Friends Honorees for January

The Circle of Friends program honored 73 people in January. 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 those honored

Sinus Center Leads with Quality-Assurance Program

Improving quality of care and being able to measure that improvement have become the main ingredients and universal themes in healthcare organizations. Quality and the awareness of its importance are the unifying concepts seen in numerous hospital-wide programs across the nation. Evidence-based medicine allows us to give growing attention to patient safety and quality of care. Recognizing and accepting this, the physicians at the Cedars-Sinai Sinus Center have become leaders in their quality-assurance program.

The physicians of the Cedars-Sinai Sinus Center, under the direction of Medical Director Martin Hopp, MD, became pioneers in sinus surgery when they started implementing the "balloon sinuplasty" procedure for their patients (illustrated above). They were among the first physicians in the nation to do image-guided sinus surgery, and now have led the way for balloon sinuplasty. This tissue-saving procedure uses balloon catheters, inspired by those used for cardiac catheterization, to stretch open the nasal sinus ostium without any cutting. Convinced that their patients found this to have better results while being minimally invasive and tissue sparing, the center's physicians agreed that a quality-assurance program would be essential to measure success and patient outcomes.

Sinus Center physicians undertook a sinus surgery quality-assurance program using a proven quality-of-life instrument, the Sino Nasal Outcome Test (SNOT-22). The SNOT-22 is an evidence-based, validated instrument used to assess the severity of a patient's sinusitis symptoms. In our QA program, this form is given to patients before their sinus surgery, and is administered again at three, six and 12 months post-op. The 22-symptom checklist includes symptoms such as sneezing, ear pain and loss of smell or taste. The patient is asked to rank these 22 symptoms on a scale from 0 to 5. The data are collected, abstracted and analyzed by a biostatistician.

Multiple statistical tests are done on the outcome data to measure whether patients who undergo sinus surgery at Cedars-Sinai are improving. Our quality-assurance program has evaluated more than 400 consecutive patients. The data consistently demonstrate that the vast majority of our patients are statistically significantly better at three, six and 12 months after surgery. These results have established two important things for quality assurance:

  • We can test, demonstrate and measure the quality of surgical care received by patients of the Sinus Center by evidence-based medicine statistical analysis.
  • Our surgical outcomes testing shows that more than 89 percent of our patients are doing much better as long as one year after surgery. This is the leading long-term outcome among all institutions in the U.S.

Since these results were shown at national meetings, Yale-New Haven Hospital and the Mayo Clinic have adopted the same QA protocol. The Sinus Center is now working to expand this patient-centered QA instrument to include "appropriateness of surgery," focusing on the reasons for surgery, to further ensure our patients receive the best care possible.

Submitted by the Sinus Center in the Department of Surgery

Spine Center Starts Year with New Trial, Publications

The surgeons, specialists and researchers at the Cedars-Sinai Spine Center have started the year with a new trial and several recent publications.

Study on Electric Current Stimulation in Disc Repair

One of the holy grails of spine tissue engineering is intervertebral disc tissue injury repair. After several injection trials of growth factors or stem cells, Hyun Bae, MD, will head up new study on electric current stimulation (Biomet study) to repair small cracks in the disc and possibly regenerate it. This treatment is not invasive; it looks similar to the electrical bone stimulator).

Surgeons and medical specialists at the Spine Center will soon begin enrollment in this a multicenter trial approved by the Food and Drug Administration. To find out more information or refer patients, please contact Linda Kanim or Annie Sharabidze at (310) 248-7326 or the Spine Center at (310) 248-7300. (Investigators: Hyun W. Bae, MD (PI), Rick Delamarter, MD, Michael A. Kropf, MD, Timothy Davis, MD, Theodore Goldstein, MD, Howard Rosner, MD, Resa Oshiro, MD, Patrick Rhoten, MD, Roy Nini, MD, Avrom Gart, MD)

Study of Disc Replacement vs. ACDF

Cedars Sinai Spine Center surgeons Rick B. Delamarter, MD, Michael A. Kropf, MD, and Hyun W. Bae, MD, are conducting long-term follow-up of cervical spine patients who participated in a multicenter clinical trial (US-RCT IDE) study of artificial disc replacement versus anterior cervical discectomy and fusion (ACDF). The five-year, most recent results from this study were published in February 2013 in the journal Spine.

This trial includes patients' self-reported outcomes after ProDisc-C compared to ACDF through five years after surgery and demonstrates that the ProDisc-C continues to be a safe and effective surgical treatment for patients with disabling single-level cervical radiculopathy that is refractory to conservative treatment. This study provides level I data with baseline patient characteristics well balanced between the experimental and comparison treatment group and the excellent follow-up rates for ProDisc-C and ACDF (98 percent and 96 percent at two years, and 73 percent and 64 percent at five years).

For all patients, there was a statistically and clinically significant improvement at two and five years compared with pre-operative values (baseline). At five years, ProDisc-C patients had statistically significantly less neck pain intensity and frequency. All patients were satisfied (VAS satisfaction 10 cm) at five years, with ProDisc-C 86.56 and ACDF 82.74. There were no reports of device failures or implant migration with ProDisc-C. The ProDisc-C patients maintained motion at their index level.

At five years, the ProDisc-C patients had a statistically significantly lower rate of reoperation compared with ACDF patients (2.9 percent vs. 11.3 percent). At five years after surgery, ProDisc-C total disc replacement is a safe and effective treatment of single-level symptomatic cervical disc disease. Clinical outcomes were comparable with ACDF. ProDisc-C patients maintained motion at the index level and had significantly less neck pain intensity and frequency as well as a lower probability of secondary surgery. (Zigler JE, Delamarter RB, Murrey D, Spivak J, Janssen M: ProDisc-C and Anterior Cervical Discectomy and Fusion as Surgical Treatment for Single-Level Cervical Symptomatic Degenerative Disc Disease: Five-Year Results of a Food and Drug Administration Study. Spine (Phila Pa 1976). 2013 Feb 1;38(3):203-9. doi: 10.1097/BRS.0b013e318278eb38.; Delamarter RB , Zigler JE: Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial Spine 2013)

Evaluation of Disc Replacement Devices

Another ongoing, multicenter FDA-approved RCT study at the Spine Center is evaluating two total disc replacement devices, Freedom Disc (Axiomed) versus ProDisc-L (Synthes-DePuy), for patients who were treated for degenerative disc disease of the lumbar spine. Michael Kropf, Alexander Rasouli, Hyun Bae and Rick Delamarter have completed enrollment, surgeries and two-year follow-up on these patients.

Self-assessments of VAS back pain, VAS leg pain and ODI were significantly improved from preoperative levels over the follow-up period to 24 months (p<0.0001) for patients treated using either device (ADR-F and ADR-P). There was slightly greater earlier reduction in back pain, as measured by the VAS back pain scale, for patients treated with ADR-F compared to ADR-P (six weeks: 2.6 vs. 4.2, p< 0.03; three months: 2.3 vs 4.0; six months: 1.5 vs. 3.7). Similarly, there was 40 percent to 60 percent improvement in ODI scores for ADR-F-treated patients and 38 percent to 60 percent improvement reported by ADR-P-treated patients.

Improvements (preoperative to follow-up) were significant and maintained to 24 months (all comparisons p<0.0001 for both ADR-F and ADR-P); ADR-F patients reported statistically significantly less disability than ADR-P patients at six months (p<0.001). Motion was observed at the disc replacement level.

Follow-up out to five years has just started for these patients, and this longer-term follow-up will reveal if viscoelastic core motion characteristic of the ADR-F device will translate to decreased adjacent segment degeneration.

Study of the Use of Spinal Fusion

Rajaee SS, Bae HW, Kanim LEA, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37:67-76. To better understand the frequency of revision spinal fusion and primary spinal fusions performed annually in the U.S. our research group Rajaee, SS; Kanim, LEA; and Bae, H, performed an analysis and presented "The National Burden of Revision Spinal Fusion: A Focus on Patient Characteristics and Complications." The study related that the national trend in revision spinal fusion is increasing along with the frequency of fusion surgery, while adjusting for increases in the U.S. population.

This study presented a comparison of co-morbidities, inpatient complications and surgical factors in revision spinal fusion compared to primary fusion using a nationwide inpatient sample (NIS). It presented a retrospective comparative cohort analysis design for revision surgery versus primary spinal fusion from 2002 to 2009. Refusions represented 5.1 percent of the total number of annual fusions performed; the figure was 5.3 percent in 2002). From 2002 to 2009, primary fusions increased at a higher rate than refusions (56.4 percent vs 51.0 percent) (p<0.05). Length of stay and hospital charges were higher for refusion discharges (4.2 days vs. 3.8 days , p<0.0001; $91,909 vs. $87,161, p<0.0001).

In 2009, rhBMP-2 (Infuse) was used more in refusion cases than in primary cases (39.7 percent vs. 27.6 percent), while interbody devices were used less in refusion cases (41.7 percent vs. 56.4 percent) (p<0.05). In the multiple variable logistic regression model for all spinal fusions, depression (odds ratio, 1.53; p <0.0001), psychotic disorders (odds ratio, 1.49; p <0.0001), deficiency anemias (odds ratio, 1.35; p <0.0001) and smoking (odds ratio, 1.10; p < 0.01), occurred more frequently in revision spinal fusion discharges, adjusting for other variables.

In regard to complications, dural tears (odds ratio, 1.41; p<0.0001), surgical site infections (odds ratio, 3.40; p<0.0001) and wound dehiscence (odds ratio, 2.30; p<0.05) were more commonly reported in refusion discharges, adjusting for other variables. The most common primary diagnosis was ICD9 996.49 (mechanical complication of internal orthopedic device, implant and graft) for cervical, thoracic and lumbar refusion.

In summary, the study found that the national refusion rate has increased at a lower rate than primary fusions from 2002 to 2009. Length of stay and hospital charges were higher for refusions, while inpatient mortality was less. Co-morbidities of depression, psychotic disorders, tobacco use and deficiency anemias were more common in spinal refusion discharges compared to primary fusion discharges. Trans. Orthopaedics Research Society. 2013; 1654.

Work presented in January 2013 in the Orthopaedic Research Society (ORS 2013) included:

  • Bedi H (spine fellow at the Spine Center), Goomer R, Kanim LEA, Delamarter RB, Bae HW: "Novel Growth-Factor Loaded Controlled-Release Scaffolds Induce Dose-Dependent L4-L5 Spinal Fusion." Trans. Orthopaedic Research Society. 2013;38:1652
  • Melodie Metzger, PhD (Biomechanics-Spine Center), LEA Kanim, Li Zhao, PhD, Samuel T Robinson, Zorica Buser, PhD, Rick Delamarter, MD: "The Relationship Between Serum Vitamin D levels, Successful Fusion, and Fusion Strength: A Quantitative Analysis." Trans. Orthopaedics Research Society. 2013;0852
  • Buser, Z; Thang, C; Safai, Y; Kanim, L; Zhao, L; Delamarter, RB: Stem cell injection suppresses apoptosis in rat spinal cord injury model Trans. Orthopaedics Research Society. 2013; 0796

Projects ongoing by Spine Center research team:

  • Melodie Metzger, PhD, LEA Kanim, Li Zhao, PhD, Samuel T Robinson, Zorica Buser, PhD, Rick Delamarter, MD. "The Relationship Between Serum Vitamin D levels, Successful Fusion, and Fusion Strength: A Quantitative Analysis"
  • Samuel T Robinson, Rick B Delamarter, MD, Mark T Svet, Melodie F Metzger, PhD. "Does Sacral Geometry Affect Biomechanical Bahavior and Facet Forces after Total Disc Replacement at the Lumbosacral Junction?"
  • Samuel T Robinson, Mark T Svet, Melodie F Metzger, PhD. "Four-Point Bending in Flexion as a Method for Quantitatively Assessing Spinal Fusions."
  • Mark T Svet, Samuel T Robinson, Rick B Delamarter, MD, FL Acosta, DG Drazin, MD, Melodie F Metzger, PhD. "Biomechanical Analysis of the Effect of Different Instrumentation Techniques on Adjacent Level Stability After Long Segment Instrumentation of the Thoracic Spine."
  • Zorica Buser, PhD, Li Zhao, PhD, Yalda Safai, Linda E A Kanim, Rick B. Delamarter, MD, Alexander Rasouli, MD: "Inflammatory response after spinal cord injury in rats is modified by Enbrel."
  • Zorica Buser, PhD, Christopher Buser, PhD, Rick B. Delamarter, MD. "Differentiation of adipose stem cell constructs for intervertebral disc regeneration."
  • Hyun W. Bae, MD, assisted the team of Dmitriy Sheyn, PhD, Wafa Tawackoli, PhD, Deuk Soo Jun, MD, Young Do Koh, PhD, Xiaoyu Da, Susan Su, PhD, Zulma Gazit, PhD, Gadi Pelled, PhD, DMD, and Dan Gazit, PhD, DMD, for "Systemic treatment for multiple lumbar bone defects using combined human MSCs and PTH therapy."

Washington Family Scholar Returns to Cedars-Sinai Four Years Later as Neurosurgical Resident

Lindsey Ross, MD, with Greg deGuzman, BSN, CCRN, (above) and Eileen Dulce, BSN, RN (below).

The first time Lindsey Ross worked in the Department of Neurosurgery at Cedars-Sinai, she was a medical school student and the 2008 recipient of the Pauletta and Denzel Washington Family Gifted Scholars Program in Neuroscience award.

Now she is a doctor, having earned her medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. Again she is working with and learning from some of the most respected doctors and research scientists in the nation, this time as a first-year resident in Cedars-Sinai's Neurological Surgery Residency Program, designed to help new surgeons excel in the operating room, in the research laboratory and at the patient bedside by providing a well-rounded, wide-spectrum experience.

"One of the great things about Cedars-Sinai is that you can see it evolving in real time. I believe in Cedars-Sinai and the Neurosurgery Department; I see it being an even stronger force in the future, and I'm very excited to be part of it," says Ross, a Los Angeles native and the oldest of three children. She attended elementary school at The Center for Early Education in West Hollywood, blocks from the medical center.

Her interest in medicine was influenced by her parents – her mother is an obstetrician-gynecologist, her father an internist – and by family medical crises. Her mother was diagnosed with breast cancer when Ross was a senior in high school, and a brother had a neuroblastoma – a nerve tissue tumor – at birth. She says these crises profoundly affected her career path, as did another event that occurred while she was in the Washington Scholars program.

Scheduled to watch an early morning surgical case, Ross stayed home one evening when friends went out to a few favorite places in Hollywood. One friend, an excellent college athlete, was struck by a car driven by a drunk driver, suffering fractures of the neck and extremities and other serious injuries. He was rushed to Cedars-Sinai's Neuroscience Critical Care Unit, where he lay in a coma for more than two weeks.

"This was the first time I had seen somebody in a coma, and I was really fascinated by everything I learned," says Ross, who at that point in medical school had been exposed to more classroom instruction than patient contact. "I think that experience inspired me and I said, 'This is definitely what I would like to do.' It was amazing to see him wake up after two weeks, open his eyes, breathe on his own and move on to the rehab unit. He's not playing basketball like he was in college, but he is walking again, and he's still the same person I knew."

As a Washington scholar in 2008, Ross worked in the Maxine Dunitz Neurosurgical Institute laboratories of Julia Y. Ljubimova, MD, PhD, director of drug delivery and nanomedicine in the Department of Neurosurgery. Ljubimova's research is developing an innovative delivery system that uses a combination of drugs to target important mechanisms in cancer cells.

In her residency, which started on July 1, 2012, Ross was introduced to neurosurgery before entering rotations in neurocritical care and subspecialty areas of neurology. She says she was especially touched by encounters she had in the Neuro ICU.

"Every day, there would be family meetings where the residents would learn to talk with families about end-of-life matters and making challenging decisions for loved ones," she recalls. "The attending physician would usually be the leader in these discussions, and we would watch how they presented the information. Everyone has their own style, but it was interesting to see that it can still be emotionally painful to deliver bad news after 20 or 30 years of experience. I knew this profession would be mentally difficult, and I knew it would be physically difficult, but I probably didn't fully understand how emotionally difficult it is."

In February, Ross rotated back to neurosurgery, gradually taking a more hands-on, decision-making role, although still with the guidance of chief resident Sunil Jeswani, MD. She says she aspires to work in an academic setting to participate in research and contribute to the education of residents and medical students. And she has developed a strong interest in pediatric neurosurgical oncology.

"I'm a very upbeat and positive person, and even working with people who are the sickest of the sick with the most devastating diseases, I can find something positive. I think that helps make me an empathetic and relatable physician," she says. "Nobody knows how much time they have. That's not really determined by us. I think while we're here, we do the best we can with what God has given, and I think staying positive is an important part of healing."

The Neurosurgery Department, chaired by Keith L. Black, MD, the Ruth and Lawrence Harvey Chair in Neuroscience, started funding the Washington scholarships in 2004 to support students who demonstrated the desire, initiative and aptitude to make significant contributions in the sciences. Pauletta and Denzel Washington, strong advocates for the strength of family and the power of education, gladly lent their names and continue to take an active role in the program.

"One night when I left the hospital pretty late and it was dark outside, and I had come in that morning when it was dark, I thought, 'This is a complete dream come true,'" Ross recalls. "When my family once asked what my absolute dream position would be – what specialty – I said definitely Cedars-Sinai's Neurosurgery Department. At that point a few years ago, it seemed so far away and never obtainable. Now every time I leave the hospital really, really late, or it was a hard day, I look back on that and am just very happy. I feel very privileged and grateful to be in this position."

Surgeons Asked to Review Use of CPT

Harry C. Sax, MD, MHCM, FACS, is asking Cedars-Sinai surgeons for help in focusing the role of respiratory therapy in patient care. There are specific patients who will benefit, notes Sax, senior physician liaison for Cedars-Sinai Medicine and executive vice chair of Surgery. We want to make sure that we deploy resources where they can do the most good.

Chest physiotherapy, including percussion and postural drainage, is beneficial in a number of conditions: significant sputum production in patients needing assistance in clearing secretions; acute, segmental or lobar atelectasis caused by secretion retention; or cystic fibrosis, bronchiectasis and pulmonary abscess.

However, Cedars-Sinai data and chart review indicate that CPT is being routinely ordered postoperatively when literature suggests that there is no benefit. Specifically, simple atelectasis does not need CPT, and in fact, an Annals of Surgery article showed that CPT was associated with significantly more frequent and more severe atelectasis after cardiac surgery.  

Surgeons are asked to review their standing postoperative order sets to assure that we are ordering CPT in patients who will truly benefit. After review by various departmental PICs, including the Department of Surgery, we are recommending that CPT treatment should be discontinued after 24 hours if post-treatment outcome evaluation indicates the patient will not benefit further. Surgeons may receive calls from Respiratory Therapy confirming this assessment.

Chest Physiotherapy Recommendations - February 2013 (PDF)

Orthopedic Surgeon Recognized for Dedication to Advancing Hip, Knee Surgery in Israel

Andrew I. Spitzer, MD, has traveled to Israel more than a dozen times over the past decade to perform his own brand of community service: teaching surgeons the latest techniques for replacing hips and knees while treating many patients without charge.

That work has earned Spitzer, director of the Joint Replacement Program at the Cedars-Sinai Orthopaedic Center, a rare distinction. He is one of only a handful of American surgeons to be named an honorary member of the Israel Orthopaedic Association.

"It's the highlight of my professional career," Spitzer said. "It's nice to be recognized for what has come to be a passion of mine."

Spitzer got involved with the association in 2003, when he decided to put his surgical skills to use in hope of helping the Jewish state.

He took on surgical cases that would serve as teaching opportunities for residents and staff at hospitals in Jerusalem, Tel Aviv, Haifa and Beersheba, among other places. He began attending the association's annual meetings and delivered lectures to fellow orthopedists about his specialty, joint replacements for hips and knees.

"I wanted to contribute in some way to Israeli culture, to celebrate their yearning for knowledge," said Spitzer, who also is a member of the Cedars-Sinai/USC Dramatic Arts Dance Medicine Center. "I thought this was a great opportunity to make a contribution in a positive way."

Association leaders said Spitzer was a natural choice for induction into the organization. Spitzer received the award at the association's December meeting in Tel Aviv, where he delivered four lectures about innovations in hip and knee replacement surgery.

"Andrew is not only an excellent teacher and speaker but a real, true friend to Israel and Israeli orthopedics," said Steven Velkes, MD, the association's treasurer and chair of the Department of Orthopedic and Trauma Surgery at the Rabin Medical Center (Beilinson Campus) outside Tel Aviv.

At Cedars-Sinai, Spitzer serves as both surgeon and researcher, focusing on implant designs, blood management in total joint replacement, prevention of blood clots, and the nonoperative management of osteoarthritis of the hip and knee. He is board certified by the American Board of Orthopaedic Surgery and is a fellow of the American Academy of Orthopedic Surgeons.

Spitzer has written numerous articles for peer-reviewed publications, contributed chapters to textbooks on hip and knee replacement, and lectured extensively and presented scientific papers around the world. He also serves as a consultant reviewer to many of the major orthopedic journals, including the Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research.

He is a member of the American Association of Hip and Knee Surgeons, the Western Orthopaedic Association, the California Orthopaedic Association and the American Academy of Orthopaedic Surgeons.

Neurosurgery Resident Wins Leadership Award from AMA Foundation

Debraj "Raj" Mukherjee, MD, MPH, a neurosurgery resident at Cedars-Sinai, has been named a recipient of the American Medical Association Foundation’s 2013 Leadership Award.

The award provides medical students, residents, fellows and early-career physicians with training to develop their skills as future leaders in medicine and community affairs. Recipients are recognized for demonstrating outstanding leadership skills in advocacy, community service and education.

The four winners of the award will be honored at the foundation's annual Excellence in Medicine Awards ceremony Feb. 11 in Washington, D.C.

Mukherjee’s current research focuses on improving outcomes for pediatric and adult brain tumor patients through clinical trials as well as the development of novel nano-therapeutics for the treatment of brain tumors.

Pediatricians Attend Surgery Conference

From left: David Bliss, MD, Philip Frykman, MD, PhD, and Andrew Freedman, MD, at the conference.

Pediatricians gathered Jan. 26 at the SLS Hotel in Beverly Hills to learn how to recognize signs and symptoms and know when to refer a patient to a pediatric surgeon. Cedars-Sinai and Children’s Hospital Los Angeles hosted the conference with expert physicians from both medical centers. The topics covered were:

  • Common problems in the pediatrician’s office: head and neck, thoracic, hernias and testicular problems
  • Acute and chronic abdominal pain: How do they present; when do you refer?
  • Uncommon but serious medical problems: ingested foreign bodies, jaundice, lymphatic and vascular anomalies
  • Inflammatory bowel disease, constipation and bowel management

Featured speakers were:

  • Dean Anselmo, MD, surgeon, co-director of the Vascular Anomalies Center, CHLA
  • David Bliss, MD, surgeon, medical director of Pediatric Surgery, Cedars-Sinai
  • Marla Dubinsky, MD, director of the Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai
  • Philip Frykman, MD, PhD, associate director of Pediatric Surgery, Cedars-Sinai
  • Christopher Gayer, MD, PhD, pediatric surgeon, CHLA, assistant professor of Surgery, USC
  • Janet Kimble, RN, CPN, expertise in gastrostomy tubes and bowel management, Cedars-Sinai
  • Akemi Kawaguchi, MD, pediatric surgeon, CHLA, assistant professor of Clinical Surgery at the Keck School of Medicine at USC
  • Jaya Punati, MD, director of the Motility Program at Children’s Hospital and assistant professor of Gastroenterology and Nutrition at the Keck School of Medicine
  • Manuel B. Torres, MD, pediatric surgeon, CHLA, assistant professor of Clinical Surgery at the Keck School of Medicine
  • Kasper Wang, MD, FACS, FAAP, pediatric surgeon, CHLA, associate professor of surgery at the Keck School of Medicine (clinical scholar with tenure)

Here Is Your Chance to Honor a Deserving Nurse!

Online nominations for the 2013 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are being accepted now through Monday, March 11.

This annual award is given on behalf of the medical staff to a Cedars-Sinai nurse who exemplifies professionalism, clinical excellence and caring.

Click here to submit a nomination on the Intranet. Please fill out the form completely, as all fields are required except for the telephone information. Only medical staff members may submit a nomination.

The Excellence in Caring Award Medical Staff Selection Committee will conduct interviews of the top candidates and the recipient will be honored during Nurses Week in May.

If you submitted a nomination last year and would like your nominee to be considered for this year's award, please e-mail Chris Ng, MD, co-chair of the MD/RN Collaborative, at chris.ng@cshs.org or call him at (310) 423-4700.

P&T Decisions, Notification of Injury Risk with Samsca

Pharmacy focus

December decisions by the Pharmacy and Therapeutics Committee and pertinent agenda topics are summarized in the PDF linked below. Highlights include the addition of Rhophylac® to the forumlary, a black-box warning about methadone, and instructions regarding drug shortages.

P&T Update - Dec. 2012 (PDF)

FDA notes risk of liver injury with Samsca®

Drug maker Otsuka Pharmaceutical and the U.S. Food and Drug Administration have notified healthcare professionals of significant liver injury associated with the use of Samsca®.

In a double-blind, three-year, placebo-controlled trial in about 1,400 patients with autosomal dominant polycystic kidney disease (ADPKD) and its open-label extension trial, three patients treated with the drug developed significant increases in serum alanine aminotransferase (ALT) with concomitant, clinically significant increases in serum total bilirubin. In the trials, the maximum daily dose of Samsca administered (90 mg in the morning and 30 mg in the afternoon) was higher than the maximum 60 mg daily dose approved for the treatment of hyponatremia.

Most of the liver enzyme abnormalities were observed during the first 18 months of therapy. Following discontinuation of treatment, all three patients improved. An external panel of liver experts assessed these three cases as being either probably or highly likely to be caused by tolvaptan. These findings indicate that Samsca (tolvaptan) has the potential to cause irreversible and potentially fatal liver injury.

These data are not adequate to exclude the possibility that patients receiving Samsca for its indicated use of clinically significant hypervolemic and euvolemic hyponatremia are at a potential increased risk for irreversible and potentially fatal liver injury.

Samsca is a selective vasopressin V2-receptor antagonist indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia. Samsca is not approved for the treatment of ADPKD.

The FDA recommends that healthcare providers perform liver tests promptly in patients who report symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine or jaundice. If hepatic injury is suspected, Samsca should be promptly discontinued, appropriate treatment should be instituted, and investigations should be performed to determine probable cause.

Samsca should not be reinitiated in patients unless the cause for the observed liver injury is definitively established to be unrelated to treatment with Samsca.

Click here to read the MedWatch safety alert.

Circle of Friends Honorees for January

The Circle of Friends program honored 73 people in January.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Kristine Acorda (Baker), RN, BSN
  • Farin Amersi, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Johana E. Avalos
  • Irene K. Barnett, MD
  • Philip G. Brooks, MD
  • Eileen G. Brown, OCN, RN
  • Ilana Cass, MD
  • Elizabeth Cervantes
  • Jason S. Cohen, MD
  • Steven D. Colquhoun, MD
  • Stephen T. Copen, MD
  • Stephen R. Corday, MD
  • Daisy DaSilva, RN
  • Fardad Esmailian, MD
  • Margaret R. Farrell, RN, BSN
  • David E. Fermelia, MD
  • Morton H. Field, MD
  • Charles A. Forscher, MD
  • Arnold S. Friedman, MD
  • Gerhard J. Fuchs, MD
  • Clark B. Fuller, MD
  • Kristi M. Funk, MD
  • Armando E. Giuliano, MD
  • Richard N. Gold, MD
  • Travis L. Goul, LVN
  • Jeffrey R. Gramer, MD
  • Almar Guevarra, RN
  • Vincent Ha, DDS
  • Behrooz Hakimian, MD
  • Cynthia D. Hall, MD
  • Randy S. Harris, MD
  • Donald R. Henderson, MD, MPH
  • Theodric B. Hendrix, MD
  • Beth Y. Karlan, MD
  • Hyung L. Kim, MD
  • Terrence T. Kim, MD
  • Wesley A. King, III, MD
  • Jon A. Kobashigawa, MD
  • Megan S. Laib
  • Rachel M. Leon
  • Norman Lepor, MD
  • Roger L. Lerner, MD
  • John C. Liu, MD
  • Susan Lowenbraun, RN, BSN, OCN
  • Robert J. McKenna, Jr., MD
  • Roz Morgan, RN, MPA, CDE
  • Jaime Moriguchi, MD
  • Raphael D. Nach, MD
  • Reza Nazemi, MD
  • Ryan F. Osborne, MD
  • Resa Oshiro, MD
  • Surasak Phuphanich, MD
  • Edwin M. Posadas, MD
  • Paula Ruiz, PA-C
  • Cherry R. Sanchez, RN
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Michael M. Shehata, MD
  • John L. Sherman, MD
  • Randolph Sherman, MD
  • Allan W. Silberman, MD, PhD
  • Leslie Stricke, MD
  • Kamran Toluie, MD
  • Alfredo Trento, MD
  • Angela Velleca, RN, BSN, CCTC
  • Robert A. Vescio, MD
  • Mark W. Vogel, MD
  • Christine S. Walsh, MD
  • Xunzhang Wang, MD
  • Jonathan M. Weiner, MD
  • Edward M. Wolin, MD
  • Keyvan Yousefi, MD