sutures newsletter

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

Cedars-Sinai Team Performs More Than 100 Operations During Guatemala Mission

When the team from Cedars-Sinai arrived at the small town of Joyabaj, Guatemala, on April 21, the only medical facility was a single labor-and-delivery room in an otherwise empty building. A day later, the group of 85 volunteers had created a small hospital from the equipment they brought with them, complete with an operating room, a recovery room, and a clinic to see and treat patients.

» Read more

Trauma Centers and Trauma Systems Save Lives

By Ali Salim, MD

As trauma continues to be the leading cause of death among children and adults under the age of 45, the Trauma Program at Cedars-Sinai provides the infrastructure necessary to resuscitate, stabilize, support, recover and rehabilitate the most critically injured patients in our community.

» Read more

Cedars-Sinai Researchers Identify Genes Contributing to Corneal Blindness

Keratoconus is a disease of the eye in which the cornea progressively thins, resulting in mixed myopic astigmatism. Approximately 20 percent of patients become legally blind and require corneal transplantation, making it one of the most common causes for corneal transplantation in young adults worldwide.

» Read more

Service Line Director Promoted to Vice President

Joan August, MS, service line director for the Department of Surgery, has been promoted to the position of service line vice president effective July 1. August has been a member of the leadership team at Cedars-Sinai for more than 15 years.



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Changes Announced for OR Management Team

Cedars-Sinai's main operating room manager will take on that role in the Advanced Health Sciences Pavilion, and an education program coordinator has been promoted to take her place. Also, the OR/Anesthesia/Surgery Center Service Line has a new health system manager.

» Read more

Circle of Friends Honorees for April

See the names of those honored

The Circle of Friends program honored 113 people in April. 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.

» Read more

Patient-Care Simulations Help Prepare for AHSP Opening

In preparation for its official opening, the 11-story Advanced Health Sciences Pavilion experienced a series of simulations last week to evaluate, among other things, operational flow in the new space.

» Read more

Cedars-Sinai Team Performs More Than 100 Operations During Guatemala Mission

Guatemala 1 480px

For many residents, a visit from Cedars-Sinai medical professionals marks their only access to healthcare all year. This year's mission was to Joyabaj, Guatemala.

When the team from Cedars-Sinai arrived at the small town of Joyabaj, Guatemala, on April 21, the only medical facility was a single labor-and-delivery room in an otherwise empty building. A day later, the group of 85 volunteers had created a small hospital from the equipment they brought with them, complete with an operating room, a recovery room, and a clinic to see and treat patients.

"It was like a MASH unit," said Gary Hoffman, MD, an attending surgeon in the Division of Colorectal Surgery. "One day there's nothing there, and the next we're performing surgery."

Remarkable, but also business as usual for the annual medical mission – one of 11 such visits organized by HELPS International each year. A nonprofit organization, HELPS oversees volunteer work throughout impoverished areas of Latin America.

This year's mission took place in Joyabaj, a town of about 9,500, located in the highlands in central Guatemala. For many of the residents, most of them indigenous, the Cedars-Sinai visit is their only access to medical care all year.

Babak Larian, MD, division chief of Otolaryngology, serves as director of the Cedars-Sinai HELPS mission. A participant in the missions since 2003, he said he feels a special responsibility to his Guatemalan patients, who have so little access to medical care.

Hoffman was so moved by the experience that he changed his Memorial Day travel plans and flew to Dallas with Larian, Olivia Marroquin, their team leader, and Hoffman's son, Jordan Hoffman, MD, a second-year surgical resident at Emory University. There, they attended the annual HELPS International review meeting. All of the volunteer team leaders from across the nation were in attendance.

Father and son volunteered and will be leading a second, yearly Los Angeles/Cedars-Sinai team mission to Guatemala. That team's first trip will begin Oct. 18, 2014.

"My response to this was immediate and profound," said Hoffman, "and by leading a second team to an underserved area of the globe, Jordan will begin his career with a dedication to service, and I will be able to cap my career in the same way. It is right on so many levels."

Hoffman continued, "Let's see how many medical,  surgical, dental, nursing and staffing volunteers we can pull into this. I hope that everyone will answer the call, or at least answer my phone calls."

For Hoffman, a first-time participant in the mission, now in its 13th year, the experience was eye-opening in a number of ways. He was struck by the extreme need of the people, and their open-hearted gratitude. He also had the rare opportunity to see his son and Alexandra Gangi, MD, a Cedars-Sinai surgical resident PGY 4, at work in challenging circumstances.

"Watching Jordan and Alex work with the patients, seeing their level of skill, competence and their compassion, buoyed my confidence that we are turning out excellent doctors who are equipped for the challenges of our profession," Hoffman said.

"The entire trip was so well organized," he added. "I give all of the credit to Babak (Larian) and Olivia Marroquin for having organized this remarkable mission. The patients were the recipients of a real humanitarian effort."

Challenge was the order of the day. During the five days of the mission, the medical team, which traveled for 36 hours to reach its destination, saw 933 patients and performed 101 operations, said Marroquin, a surgical endoscopy tech at Cedars-Sinai. A native of Guatemala who moved to the U.S. in 1970, Marroquin has been the organizing force behind the mission since its inception.

The medical team started work at 7 a.m. and often finished at 1 or 2 a.m. the next day. Mission participants paid their own travel expenses and used personal time to be there. Operations included cleft palate repairs, gall bladder removal, hysterectomies, head-and-neck cancer operations, repairs of hand deformities and, to the joy of the participants, the birth of two healthy babies.

Susan Whang, RN, who works in the OR, joined the mission for the first time after hearing about it from her colleagues for several years.

"It was a great experience – I have never worked as hard as I did there, and it's the most rewarding experience I have ever had," Whang said. "I saw things I have never seen in practice – a fibroid as big as two basketballs – and when you see the need, you know you'll go back."

All formality and hierarchy were wiped away, and everyone, from surgeons and nurses to translators and clerical staff, worked as equals. Talk to almost anyone who has taken part in a mission and they say the same thing – this is medicine at its most profoundly satisfying.

"We in the U.S. are so fortunate; we rarely even see the kinds of cases that are routine in the Guatemala mission," Larian said. "And so we work 18-hour days – I literally have to force people to stop and get some rest, because all of us want to help as much as we can."

Trauma Centers and Trauma Systems Save Lives

By Ali Salim, MD
Director of Trauma Services
Program Director of the General Surgery Residency Educational Program

As trauma continues to be the leading cause of death among children and adults under the age of 45, the Trauma Program at Cedars-Sinai provides the infrastructure necessary to resuscitate, stabilize, support, recover and rehabilitate the most critically injured patients in our community. As one of only four Level 1 trauma centers in the County of Los Angeles (covering a population of nearly 10 million), our program was recently reverified by the American College of Surgeons.

Besides caring for some of the sickest patients at Cedars-Sinai, the Trauma Program provides leadership in injury prevention programs, research, education, community outreach and trauma system planning. This past year we welcomed two young trauma surgeons — Nicolas Melo, MD, and Matthew Bloom, MD — to join our nationally recognized trauma faculty: Daniel R. Margulies, MD, Eric J. Ley, MD, Rex Chung, MD, and Marko Bukur, MD. Their addition has brought a welcome enthusiasm to our group.

Education and research continue to be priorities of our program. In the past three years, our trauma surgeons have produced more than 55 trauma-related peer-reviewed publications. This research is presented in many trauma professional forums nationally. Our trauma surgeons have more than 50 trauma-related research projects underway. Our research has focused on trauma outcomes, disease management, organ donation and traumatic brain injury. Besides this mostly clinical research, Eric J. Ley, MD, has a productive basic science lab focusing on the mechanism behind the beneficial effects of certain therapeutics such as beta blockers on severe traumatic brain injury.

Our trauma surgeons continue to represent Cedars-Sinai nationally and internationally as invited guest lecturers at many trauma conferences. We offer continuing medical education through forums such as trauma surgery grand rounds, Advanced Trauma Life Support®, Advanced Trauma Care for Nurses, weekly case conferences and Journal Clubs.

The success of our program depends on the outstanding administrative support led by our Trauma Program Manager Heidi Hotz, RN, and her exceptional team. Their tireless effort, commitment and hard work ensure we have the resources necessary to maintain our prestigious Level 1 trauma center status.

Aside from our trauma surgeons, our Trauma Program is guided by the following team:

  • Heidi A. Hotz, RN, Trauma Program manager
  • Mario Trizzino, Trauma registrar
  • Debbie Flores, RN, Trauma registrar
  • Amelia (Molly) Teas, RN, Trauma registrar
  • Terri-Anne Mauricio, RN, Trauma performance improvement coordinator
  • Donovan Stewart, RN, Trauma educator, injury prevention and outreach coordinator
  • Janice Polk, Trauma management assistant

Cedars-Sinai Researchers Identify Genes Contributing to Corneal Blindness

Keratoconus is a disease of the eye in which the cornea progressively thins, resulting in mixed myopic astigmatism. Approximately 20 percent of patients become legally blind and require corneal transplantation, making it one of the most common causes for corneal transplantation in young adults worldwide.

Funded by the National Eye Institutes of Health for the past 20 years, Yaron S. Rabinowitz, MD (pictured at right), corneal transplant surgeon, director of Ophthalmology Research at Cedars-Sinai and a member of the Department of Surgery, has been the leading researcher in the world on keratoconus focusing on unraveling the genes that may contribute to the development of this disease and devising techniques for early detection using sophisticated computer modeling and optical coherence tomography. His review article on keratoconus published in 1998 is the most quoted article on the subject in the medical literature and according to Google Scholar has been cited by his peers approximately 1,000 times.

His group, in collaboration with the Medical Genetics group at Cedars-Sinai, has made several significant discoveries this year that might provide clues as to the underlying mechanisms causing the disease. In a genomewide association study of patients with keratoconus, his group discovered an association with the RAPGAB gene suggesting a defect in the control of the development of the eye. This finding was published in the journal Human Molecular Genetics (reference 1 below).

Illustrations show a normal cornea and the corneal thinning caused by keratoconus.

In its advanced stages, keratoconus can cause scarring on the cornea.

Two additional publications in the journal Investigative Ophthalmology & Visual Science (reference 2 and reference 3 below) describe their discoveries as it relates to the collagen fibers that span the cornea. One article suggests that there is a defect in the cross links between the collagen fibers resulting in weakening and bulging of the cornea, while the other article suggests that there is a defect in collagen 5A, which controls collagen assembly of the fibers in the cornea, thereby weakening the cornea and resulting in the development of keratoconus.

In January of this year, in collaboration with an Australian research group and a consortium of roughly 50 centers worldwide, Rabinowitz's group identified several gene loci that are associated with regulating central corneal thickness. These findings were published in the journal Nature Genetics (reference 4 below).

In collaboration with the Cedars-Sinai Regenerative Medicine Institute, Rabinowitz and his collaborators are developing stem cells from the corneal stroma and using a disease-modeling approach. They hope to learn more about the role of genes in the early and late development of keratoconus. It is hoped that these new findings will lead to further translational discoveries, which may allow for a medical cure for keratoconus and thus obviate the need for future corneal transplantation.

References

1. Li X, Bykhovskaya Y, Haritunians T, Siscovick D, Aldave A, Szczotka-Flynn L, Iyengar SK, Rotter JI, Taylor KD, Rabinowitz YS. "A genomewide association study identifies a potential novel gene locus for keratoconus, one of the commonest causes for corneal transplantation in developed countries." Human Molecular Genetics, 2012 Jan 15;21(2):421-9

2. Li X, Bykhovskaya Y, Haritunians T, Siscovick D, Aldave A, Szczotka-Flynn L, Iyengar SK, Rotter JI, Taylor KD, Rabinowitz YS. "Genetic association of COL5A1 variants in keratoconus patients suggests a complex connection between corneal thinning and keratoconus." Invest. Ophthalmol. Vis. Sci., 2013 March 19, 10.1167/iovs.13-11601

3. Bykhovskaya Y, Li X, Epifantseva I, Haritunians T, Siscovick D, Aldave A, Szczotka-Flynn L, Iyengar SK, Taylor KD, Rotter JI, Rabinowitz YS. "Variation in the lysyl oxidase (LOX) gene is associated with keratoconus in family-based and case-control studies." Invest. Ophthalmol. Vis. Sci., 2012 Jun 28;53(7):4152-7

4. Lu Y, Vitart V, Burdon KP, Khor CC, Bykhovskaya Y, Hauser MA, Rabinowitz YS, Pfeiffer N, Mackey DA, Craig JE, Macgregor S, Wong TY. "Genome-wide association analyses identify multiple loci associated with central corneal thickness and keratoconus." Nature Genetics, 2013 Feb;45(2):155-63

Service Line Director Promoted to Vice President

Joan August, MS, service line director for the Department of Surgery, has been promoted to the position of service line vice president effective July 1.

The promotion was announced by Mark Gavens, senior vice president for Clinical Care Services and chief operating officer, and Shlomo Melmed, MD, senior vice president for Academic Affairs and dean of the medical faculty.

August has been a member of the leadership team at Cedars-Sinai for more than 15 years. She joined the organization in 1996 as director of Rehabilitation and Post-Acute Care Services, including Home Care, Hospice, Home Infusion and Skilled Nursing. In 2001, she became service line director of Women's Health, Pediatrics and Medical Genetics. She moved to her current position in 2006.

Gavens and Melmed praised August's relationships with physicians and staff, fiscal management and strategic planning. Among her recent accomplishments are the expansion of the Spine, Orthopaedic and Breast Centers, the development of a number of the surgical Centers of Excellence, engagement of physicians in Cedars-Sinai Medicine "Best Practices," and implementing the redesign of the Ambulatory Clinics.

As vice president, August will work closely with chairs and institute leaders to oversee the administrative operations supporting the clinical and academic missions of the Department of Medicine, the Samuel Oschin Comprehensive Cancer Institute, Radiation Oncology, Women's Health Services, Children's Services, Respiratory and Pulmonary Services, Gastroenterology and the Emergency Department.

Her responsibilities will include leading and supporting quality, service and performance improvement in these areas as well as across the medical center.

Changes Announced for OR Management Team

Cedars-Sinai's main operating room manager will take on that role in the Advanced Health Sciences Pavilion, and an education program coordinator has been promoted to take her place. Also, the OR/Anesthesia/Surgery Center Service Line has a new health system manager.

Kyung Jun, RN, MSN, CNOR, current manager for the main OR, will be manager of the new Sue and Bill Gross Surgery and Procedure Center. She will have oversight of the pre-op, OR, and PACU areas in the Pavilion. Kyung has been with Cedars Sinai for more than 26 years, with 13-plus years in education and management. She has managed the main OR for seven years.

Joan Dawson, RN-BC, CNOR, MSN/ED, NEA-BC, has been promoted to main OR manager. On an interim basis, she is also covering the role of CNIV of operations for 6OR. Joan joined Cedars-Sinai as a clinical nurse III for 8OR in 1998. In 2005, she transitioned to the CNIV educator role for the OR, and in 2011 she was promoted to an education program coordinator.

In addition, Magnolia "Coco" Dea has been promoted to health system manager within the OR/Anesthesia/Surgery Center Service Line. She will have primary oversight of daily operations of the service line surgical system and materials. Coco joined Cedars-Sinai in 1999, and her responsibilities have grown from new product coordinator, to surgical system application coordinator to perioperative/materials management coordinator. She has led application performance improvement initiatives that greatly improved efficiencies and has been pivotal in reducing surgery supply costs.

The changes were announced by Jan M. Decker, RN, director of OR/Anesthesia/Surgery Center Services.

Circle of Friends Honorees for April

The Circle of Friends program honored 113 people in April.

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.

  • Krystianne Nigel Abrenica, RN
  • Kenneth Adashek, MD
  • Michael J. Alexander, MD
  • Michelle Amarillas, RN, CEN, MICN
  • Neel A. Anand, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Ashley N. Atmospera, RN
  • Mark J. Ault, MD
  • C. Noel Bairey Merz, MD
  • Irene K. Barnett, MD
  • Eli Baron, MD
  • Diana Barrientos
  • Valerie Betley
  • Keith L. Black, MD
  • Selvyn B. Bleifer, MD
  • Philip G. Brooks, MD
  • Neil A. Buchbinder, MD
  • James L. Caplan, MD
  • Kirk Y. Chang, MD
  • Cheryl G. Charles, MD
  • Sumeet S. Chugh, MD
  • Arnold C. Cinman, MD
  • Susan B. Clark, RN
  • Stephen R. Corday, MD
  • Maria Victoria Cordero
  • Donna V. Costales
  • Moise Danielpour, MD
  • Robert W. Decker, MD
  • Doniel Drazin, MD
  • Cheryl L. Dunnett, MD
  • Noliza V. Escarza
  • Richard Essner, MD
  • Robert A. Figlin, MD
  • Phillip R. Fleshner, MD
  • Lashawn Ford
  • Lorraine Fox
  • Tara L. Funari, MS, CGC
  • Eli Ginsburg, MD
  • Richard N. Gold, MD
  • Sherry L. Goldman, RN, NP
  • Karina Y. Gonzalez
  • Mark O. Goodarzi, MD
  • Lloyd B. Greig, MD
  • Andrew E. Hendifar, MD
  • Fernando P. Hernandez
  • Teresa M. Huang, RN, MSN, FNP
  • Gabriel E. Hunt, Jr., MD
  • Stanley C. Jordan, MD
  • Colleen C. Juban, RN
  • Saibal Kar, MD
  • Hyelim Kim, RN
  • Wesley A. King, III, MD
  • Jon A. Kobashigawa, MD
  • Jerry L. Koontz
  • Deborah Krakow, MD
  • Lyle D. Kurtz, MD
  • Stuart H. Kuschner, MD
  • Dominique LaPage, RN
  • Norman E. Lepor, MD
  • Keren Lerner, MD
  • Ronald S. Leuchter, MD
  • Michael C. Lill, MD
  • David Logan
  • Laila C. Madi, RN
  • Adam N. Mamelak, MD
  • Adeline M. Marcelo, RN, BC, BSN
  • M. Marcel Maya, MD
  • Imee M. Mayo-Mendez, RN, BSN, CMSRN
  • Robert J. McKenna, Jr., MD
  • Leslie Memsic, MD
  • Peggy B. Miles, MD
  • Youram Nassir, MD
  • Ronald B. Natale, MD
  • Ricardo Navas, MD
  • Kenith K. Paresa, MD
  • Glenn B. Pfeffer, MD
  • Edward H. Phillips, Jr., MD
  • Surasak Phuphanich, MD
  • Frances L. Pleski
  • Edwin M. Posadas, MD
  • Irving Posalski, MD
  • Geraldine L. Rice, RN, ASN, AC-BC
  • Sepehr Rokhsar, MD
  • Fred P. Rosenfelt, MD
  • Jeremy D. Rudnick, MD
  • Rahnana Sachs, MD
  • Howard M. Sandler, MD, MS
  • Malek Sayegh
  • Jessica L. Schneider, MD
  • C. Andrew Schroeder, MD
  • Prediman K. Shah, MD
  • Robert J. Siegel, MD
  • Thomas P. Sokol, MD
  • Marilyn A. Solsky, MD
  • Andrew Ira Spitzer, MD
  • Daniel J. Stone, MD, MPH, MBA
  • Joseph Sugerman, MD
  • Lillian Szydlo, MD
  • Michael Tahery, MD
  • Timothy Tattu, RN, BSN
  • Alfredo Trento, MD
  • Gregory Tsushima, MD
  • Hannah T. Tualla, RN, MSN, NP-C
  • David M. Ulick, MD
  • Michael B. Van Scoy-Mosher, MD
  • Gregoria Vicente
  • Irina Vinogradova, RN, BSN, PHN
  • Talya Waldman, MSN, WHNP-BC, NCMP
  • Xunzhang Wang, MD
  • George Weinberger, MD
  • Michael H. Weisman, MD
  • Edward M. Wolin, MD
  • Philip A. Yalowitz, MD

Patient-Care Simulations Help Prepare for AHSP Opening

Pictured above and at bottom: Bill Hucks of consulting company NBBJ (left) keeps watch on the players during a patient-care simulation last week in the Advanced Health Sciences Pavilion.

In preparation for its official opening, the 11-story Advanced Health Sciences Pavilion experienced a series of tests last week to evaluate, among other things, operational flow in the new space.

The simulations, which incorporated patient care and emergencies, took place Wednesday, Thursday and Friday within various areas, including the Heart Institute, neurosciences and the Anesthesia Pre-Procedure Evaluation Center.

Terry Huang of NBBJ (in back) watches over a simulation.

Participants meet before the simulations begin.

The goal of the simulations was not only to evaluate operational flow but also to make staff members more familiar with the new facility, said Robert Cull, executive project director in Facilities Planning, Design and Construction.

The registration process and patient experience also were major parts of the scenarios. And during the emergency "code" simulations, members of Cedars-Sinai’s security team were heavily involved, Cull said.

"We ran through some much-scripted scenarios so that we could evaluate how well staff handled the new space, how patients might react, and how well the building itself would support those scenarios," Cull said. "We also have some services, or procedures, that are new to us in the Advanced Health Sciences Pavilion and needed to evaluate those as well."

To create the scenarios, actors and actresses were hired to portray patients, Cull said. Members of Cedars-Sinai’s Volunteer Services Department acted as family members.

After the simulations, the volunteers were asked to provide feedback on the operation, said Camille Camello-Zendejas, volunteer coordinator at Cedars-Sinai.

"From their observations, the care was great and the responsiveness was spot-on," she said about the volunteers' assessments of the Pavilion’s overall operation during the live simulations.

Cull said the simulations went "very well" and that the staff demonstrated a high level of preparedness.

Designed with a patient-centered focus, and to foster collaborations between scientists and clinicians, the AHSP is being opened in phases. Research labs occupy the eighth and ninth levels of the building and have moved into their new space, including the Regenerative Medicine Institute on the eighth level. The Heart Institute and neurosciences, which includes the departments of Neurosurgery and Neurology, will begin moving into the Pavilion on the third and sixth levels.

The Pavilion also features the 50,000-square-foot, state-of-the-art Sue and Bill Gross Surgery and Procedure Center on the fifth level, which will serve as the home for outpatient and a.m.-admit orthopedics patients. In addition to eight general surgical rooms, it will feature two interventional radiology rooms and two cardiac cath labs.