sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY May 2014 | Archived Issues

A Pause for Patient Safety

New Process Succeeds in Tests, Will Expand Housewide

Sometimes, the best solution is the simplest one. To help prevent the accidental removal of patient tubes and lines, a simple, three-step process, Pause-Clear-Go, has proven so successful that it is being rolled out across the medical center.

» Read more

Morgenstern Debaters to Tackle Robotics

Robotics in medicine is the subject of this year's Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition. Kicking off the first Cedars-Sinai Founders Day, the debate will convene for its 11th year on Friday, June 6, at 8 a.m. in Harvey Morse Auditorium.



» Read more

Switch to ICD-10 Delayed; Preparation Continues

Cedars-Sinai will continue preparing to switch to ICD-10, although the U.S. government has delayed implementation of the coding system for a year. A federal law that took effect April 1 pushes the compliance date for ICD-10 to Oct. 1, 2015. The deadline had been Oct. 1 of this year.

» Read more

Summaries of Symposium Speakers' Research

Speaking at the Craig A. Lipkin, MD, Resident Research Symposium at Cedars-Sinai were Michael Choi, MD, Heidi Reich, MD, and Ryan Spurrier, MD. The symposium took place May 28 in ECC B-C. Click the "Read more" to see summaries of the residents' current and recent research.

» Read more

New Parking Rates for Patients, Visitors

Cedars-Sinai will implement new patient and visitor parking rates effective May 1. In keeping with prevailing parking rates in this area, Cedars-Sinai will no longer provide free parking, and the daily cost of validated self-parking will be increased from $4 to a maximum of $5.

» Read more

Champions for the Most Vulnerable Hearts

The Guerin Family Congenital Heart Program repairs disorders in children's hearts while reducing the need for open-heart surgery. The program helps give patients of all ages a chance at a normal life.
 

» Read more

Trauma Program Posts on Cedars-Sinai Facebook Page

As a Level I trauma hospital, Cedars-Sinai is a leader in providing the highest level of care for injured patients. To help prevent injuries, the medical center's Trauma Program has taken to social media. The program has begun posting messages about the issue on the Cedars-Sinai Facebook page.

» Read more

Recognition for Klein, Singer

Physician News

Andrew S. Klein MD, MBA, is being honored for a lifetime of achievement in the field of liver transplantation by the Los Angeles chapter of the American Liver Foundation, and Matthew Singer, MD, has been named a winner of the Excellence in Teaching with Humanism Residents and Fellows Award from the David Geffen School of Medicine at UCLA.

» Read more

Circle of Friends Honorees for April

The Circle of Friends program honored 180 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.

» Read more

FDA Airs Risks of Corticosteroids, Blood Thinners, Lunesta

Pharmacy Focus

The U.S. Food and Drug Administration is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis and death. In addition, the FDA has released a study comparing the risks of the blood thinners Pradaxa® and warfarin, and has said the insomnia drug Lunesta® can impair next-day alertness.

» Read more

A Pause for Patient Safety

New Process Succeeds in Tests, Will Expand Housewide

Sometimes, the best solution is the simplest one. To help prevent the accidental removal of patient tubes and lines, a simple, three-step process, Pause-Clear-Go, has proven so successful that it is being rolled out across the medical center.

"After surgery, patients have so many lines and drains in them that it's easy to overlook one during transport," said Christine Chuey, RN, CN III. "In 3 OR, we were experiencing numerous incidents of lines and drains that were almost pulled out but were caught at the last minute. We decided to find a way to prevent these near misses in the O.R."

Components of Pause-Clear-Go

  • Pause — the primary care provider calls out "Pause," and everyone stops
  • Clear — the assisting care provider calls out "Lines … Drains … Airway" and the primary care provider answers "All clear"
  • Go — either the primary care provider or assisting provider calls out "Go" to signal that the patient is safe to reposition, turn or transfer

The Medical Intensive Care Unit (MICU) team on 7 Saperstein was experiencing the same problem, which can result in unintended consequences not only for patients, but for their families and care providers. When lines are accidentally pulled out, it can interrupt treatment, cause complications and create distrust between patients and healthcare teams.

The issue simultaneously attracted the attention of two separate unit-based safety project teams: SCORE (Safe Care in the O.R. Every time) and Normalized Deviation.

SCORE is a grass-roots effort that enables front-line surgical staff and physicians to address safety concerns in the O.R. SCORE team leaders include Bruce Gewertz, MD, chair of Surgery and vice president of Interventional Services, Julian Gold, MD, co-chair of Anesthesiology, Bryan Croft, vice president of Service Line Operations, and Jan Decker, RN, director of O.R./Anesthesiology/Surgery Center.

The Normalized Deviation team, led by Neil Romanoff, MD, vice president of Medical Affairs and associate chief medical officer, addresses the small, continuously occurring defects that eventually become "normalized" as part of daily routine.

"In the ICU, the problem with lines usually occurs during repositioning of the patient, because critically ill patients have so many lines attached to them," said Adolfo Famas, RN, assistant nurse manager on 7 Saperstein. "We had an average of one pulled line each month that was related to the repositioning, turning and transferring of patients. Although that may sound like a small number, it's important to us that we ensure it never happens to a single patient."

To address the issue, the SCORE and Normalized Deviation teams began testing the Pause-Clear-Go time-out system prior to moving any patient.

"Following implementation, O.R. staff members have reported a decreased near-miss rate from 64 percent to 28 percent," said Ann Gilligan, RN, MSN-BC, assistant nurse manager in the O.R. "In addition, the MICU has not experienced a single incident since September 2013. As we continue to implement this system housewide, we anticipate that the number of near misses will decline even further."

Morgenstern Debaters to Tackle Robotics

Heidi Reich, MD

Ryan Spurrier, MD

Robotics in medicine is the subject of this year's Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition.

The debate will convene for its 11th year on Friday, June 6, at 8 a.m. in Harvey Morse Auditorium. The topic will be "Robotics — Medicine or Marketing? Progress or Promotion?" Heidi Reich, MD, will argue that robotics is a medical advance. Ryan Spurrier, MD, will argue that robotics is medical marketing.

The debate will anchor the inaugural Cedars-Sinai Founders Day (see story below).

For more information about the debate, contact Leo Gordon, MD, at leo.gordon@cshs.org.

To see coverage of last year's debate, click here.


Cedars-Sinai's First Founders Day

The daylong Founders Day celebration on Friday, June 6, will commemorate the opening of Cedars-Sinai in its current location on June 6, 1976.

The 11th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition will kick off the day at 8 a.m. At noon, there will be a presentation on the history of Cedars-Sinai. Both events will take place in Harvey Morse Auditorium.

Making its debut on Founders Day will be the preview of an exhibit tracing the growth of Cedars-Sinai from its first days as the Kaspare Cohn Hospital — founded in 1902 — to today's medical center. The exhibit, a project of the Cedars-Sinai Historical Conservancy, will be in the hallway outside the Medical Library.

Switch to ICD-10 Delayed; Preparation Continues

Cedars-Sinai will continue preparing to switch to ICD-10, although the U.S. government has delayed implementation of the coding system for a year.

A federal law that took effect April 1 pushes the compliance date for ICD-10 to Oct. 1, 2015. The deadline had been Oct. 1 of this year.

The new compliance date for the ICD-10 coding system is Oct. 1, 2015.

The training that Cedars-Sinai physicians and employees have undergone in preparing for ICD-10 is still valid. The education modules already assigned will remain available in HealthStream for completion or review. Any coursework completed will be recorded and will not need to be taken again. No new education modules are anticipated before April 2015.

The medical staff training sessions occurring in April and May 2014 will proceed as scheduled. These sessions will focus on improvement of documentation and will include an overview of enhancements when CS-Link™ is upgraded June 7. All other peer-to-peer sessions will resume after January 2015.

The ICD-10-CM (Clinical Modification) training for physician office coders will proceed as scheduled in August.

Cedars-Sinai is awaiting further guidance from the federal Centers for Medicare and Medicaid Services regarding the delay.

The switch to ICD-10 is mandated by the federal Department of Health and Human Services. The change will result in an increase from about 17,000 codes in ICD-9 to more than 140,000 in ICD-10.

For more information and updates regarding ICD-10 activity at Cedars-Sinai, visit the ICD-10 Project page on the Intranet or the ICD-10 Implementation page at CS-Link Central.

Previously in Medical Staff Pulse:

New Intranet Section Gives Healthcare Coding Tips (Dec. 20, 2013)

Physicians and Office Staff — Not Just Coders — Need to Prepare for ICD-10 (Sept. 27, 2013)

Summaries of Symposium Speakers' Research

Speaking at the Craig A. Lipkin, MD, Resident Research Symposium at Cedars-Sinai were Michael Choi, MD, Heidi Reich, MD, and Ryan Spurrier, MD. The symposium, part of the Surgery Grand Rounds series, took place May 28 in ECC B-C.

Here are summaries of the residents' current and recent research.

Choi: BRCA Mutations and FOXC1

Michael Choi, MD, working under the guidance of Farin Amersi, MD, and Allan Silberman, MD, PhD, presented his abstract "Analysis of Factors Affecting Outcome in De-Differentiated and Well-Differentiated Retroperitoneal Liposarcomas" at the 2014 Society of Surgical Oncology Cancer Symposium in March. He also had his abstract "The Clinicopathologic Significance of FOXC1 in BRCA-Mutant Breast Cancer" accepted for presentation at the 2014 American Society of Clinical Oncology annual meeting in May.

Choi is working in the Cedars-Sinai Women's Cancer Program laboratory with Xiaojiang Cui, PhD, investigating the association between BRCA 1 and BRCA 2 gene mutations and the related breast cancer transcription factor FOXC1. His clinical research focuses on the prognostic role of FOXC1 in determining the likelihood of recurrence and survival in patients with hereditary breast cancers. The research ultimately will help guide physicians in their clinical decision-making.

He also is examining the significance of the basal molecular phenotype and breast cancer stem cells in trastuzumab resistance for Her2-positive breast cancers under the direction of Alice Chung, MD, and Cui.

Michael Choi, MD, (second from right) presented his poster titled "Analysis of Factors Affecting Outcome in De-Differentiated and Well-Differentiated Retroperitoneal Liposarcomas" at the 2014 Society of Surgical Oncology Cancer Symposium in Phoenix.

Reich: Stem Cells and the Heart

Heidi J. Reich, MD, working in the lab of Eduardo Marbán, MD, PhD, in the Cedars-Sinai Heart Institute, has been participating in clinical trials using stem cells derived from normal, healthy allogeneic human heart tissue delivered through the coronary arteries in patients with myocardial infarction or advanced heart failure. The paradigm to date uses single dosing, but multiple doses may achieve greater benefit, if there are no immune complications.

Heart disease remains the leading cause of death in the U.S. and worldwide. Despite improvements in care for patients with advanced heart failure, mortality within five years of diagnosis remains at 50 percent. Members of the lab are increasingly optimistic that stem-cell therapy will dramatically change this dismal picture by affording a treatment option that can potentially reverse, and maybe one day cure, advanced heart disease.

Reich is studying the immune response to repeat dosing of allogeneic cardiac stem cells. Whether stem cells are immunologically inert or could lead to sensitization has important clinical implications: Rejection or sensitization could reduce the benefit of allogeneic stem-cell therapy, lead to myocarditis or limit future consideration for heart transplantation. Conversely, stem cells that evade the immune system completely can be tumorigenic.

Previous studies in the Marbán lab were encouraging: No detrimental immune response was apparent after single-dose allogeneic cardiac stem-cell therapy. To better characterize the immune response and ensure patient safety, lab members are taking a closer look by giving repeat doses of allogeneic cardiac stem cells and measuring the humoral and cellular immune response in a rat model of myocardial infarction.

Repeat dosing has been found to significantly improve left ventricular ejection fraction on transthoracic echo, and the lab's characterization of the immune response is ongoing.

Spurrier: Engineering Tissue to Treat Gastrointestinal and Liver Failure

Ryan G. Spurrier, MD, completed his postdoctoral research fellowship at Children's Hospital Los Angeles in the Department of Developmental Biology and Regenerative Medicine under the mentorship of Tracy Grikscheit, MD. Spurrier's research focuses on treating gastrointestinal and liver failure through tissue engineering, in which healthy tissues are regenerated from a patient's own stem cells for replacement of a defective or absent organ by auto-transplantation. To further investigate the mechanism of this regeneration, he has worked extensively with transgenic mouse strains and fluorescent cell labeling to study the interactions between mesenchymal and epithelial cells that comprise the intestinal stem cell niche.

Spurrier also has adapted the technique of vitrification to the field of gastrointestinal tissue engineering. Vitrification is a phenomenon wherein supercooled liquid is able to transition almost instantaneously into a solid, glasslike state, allowing for the long-term preservation of living cells. Spurrier demonstrated that vitrified cells can be reanimated and then used to create tissue-engineered small intestine. This cell preservation strategy could expand the reach of tissue-engineered therapies to patients who are too ill to undergo auto-transplantation at the time of tissue resection or who require transfer to a medical center capable of such interventions.

Spurrier also has been active in clinical and basic/translational research regarding cholestatic liver failure, which often affects children with short bowel syndrome requiring total parenteral nutrition (TPN). In collaboration with pediatric gastroenterologist Russell Merritt, MD, he helped carry out the second-largest clinical trial of fish-oil-based TPN in the U.S.

This pilot study demonstrated impressive results, with reversal of cholestasis in more than 90 percent of patients. In the laboratory, Spurrier collaborated with Kasper Wang, MD, to generate the first reported instance of tissue-engineered liver from human stem cells. Furthermore, he applied his vitrification technique to cryopreserve human liver progenitor cells and subsequently thaw these to generate tissue-engineered liver.

Most recently, Spurrier generated human tissue-engineered esophagus. While other researchers have described seeding of tubularized polymers with epithelium alone, growth of full-thickness human tissue-engineered esophagus had not been demonstrated. However, by isolating stem cells from fresh esophagectomy specimens and implanting them into immune-deficient murine hosts, Spurrier was able to regenerate full-thickness esophageal epithelium with supporting muscularis and nerve.

Furthermore, these multicellular isolates were able to proliferate in vitro, where they organized to form a neuromuscular network that enveloped the esophageal epithelium and demonstrated peristaltic contraction, which highlights the functional potential of tissue-engineered gastrointestinal tissues.

Spurrier has presented his research at the Clinical Congress of the American College of Surgeons, the Academic Surgical Congress, Digestive Disease Week, the Southern California chapter of the American College of Surgeons and the Federation of American Societies for Experimental Biology. He also has published in the Journal of Pediatric Surgery and the Journal of Clinical Gastroenterology and Hepatology.

His other ongoing projects include characterizing the microbiome of tissue-engineered intestine and human subjects. He is completing his General Surgery residency at Cedars-Sinai and plans to pursue fellowship training in Pediatric Surgery.

New Parking Rates for Patients, Visitors

Cedars-Sinai will implement new patient and visitor parking rates effective May 1. In keeping with prevailing parking rates in this area, Cedars-Sinai will no longer provide free parking, and the daily cost of validated self-parking will be increased from $4 to a maximum of $5.

The daily maximum for nonvalidated self-parking will be set at $10 for all medical center parking lots. This represents a cost savings of $5 from the previous maximum rate of $15 that was charged in some Cedars-Sinai lots.

Effective May 1, the new patient and visitor parking rates will be:

  • $10 daily maximum for nonvalidated self-parking in parking lots P1, P2, P3, P4, P5, P6 and Mark Goodson Building
  • $5 daily maximum for validated self-parking in lots P1, P2, P3, P4, P5, P6 and Mark Goodson Building (validations are available only for outpatient visits and the first and last day of admissions)
  • $25 for a packet of 10 tickets for patients with multiple clinic visits (transplant, rehab, cancer, etc.)
  • $30 for a one-week pass in lots P1, P2 and P4
  • $50 for a two-week pass in lots P1, P2 and P4
  • $100 for a one-month pass in lots P1, P2 and P4

Valet parking is available in lots P3 and P4 and at the S. Mark Taper Foundation Imaging Center for an additional $5. Gratuities are not accepted.

For additional information, please contact the Parking Office at 310-423-5535.

Champions for the Most Vulnerable Hearts

Evan Zahn, MD, co-director of the Cedars-Sinai Guerin Family Congenital Heart Program, is a recognized international authority on minimally invasive techniques to repair structural disorders in children’s hearts.

Guerin Family Congenital Heart Program Helps Give Patients of All Ages a Chance at a Normal Life

Frances Jones thought she knew everything about the care and feeding of babies. While awaiting the birth of their fourth child last summer, Jones and her husband, Marcus, felt relaxed and confident. After all, they were experienced at juggling the needs, rivalries and scraped knees of their 12-, 7- and 4-year-olds.

But, following a routine ultrasound when Frances was 23 weeks into her pregnancy, doctors told the Joneses their new son, Bryce, would be born with a heart defect called tetralogy of Fallot.

"We were in shock for hours," Jones said. "Neither of our families has heart disease or anything remotely like that, so it really scared us. We didn't know what to do."

"It's very humbling to know that there are doctors out there who really treat children as though they were their own," said Frances Jones. With her and Bryce are Alistair Phillips, MD, co-director of the Guerin Family Congenital Heart Program, (left) and Shreya Sheth, MD, a pediatrician with the program.

Fortunately, Jones' team of doctors at her community hospital had a plan. Step 1: Put Jones on bed rest so her baby could be born as close to full term as possible. Step 2: Put the Guerin Family Congenital Heart Program in the Cedars-Sinai Heart Institute and Department of Pediatrics on standby in case the baby's condition worsened.

At first, Bryce did fine when he was born in August at just 32 weeks' gestation, although he weighed barely 3 pounds. But Bryce's underlying heart disease began causing episodes where he wasn't getting enough blood flow to his lungs. His pediatric cardiologist realized that Bryce needed a procedure to improve pulmonary blood flow.

"We work closely with community hospitals and pediatric cardiologists throughout Southern California to provide the highest level of personalized care for the most vulnerable babies," said Evan Zahn, MD, a recognized international authority on minimally invasive techniques to repair structural disorders in children's hearts. "With the most advanced treatments from the moment of diagnosis, including advances in nonsurgical techniques, we can be a lifesaving resource to give these babies the best chance for a normal, healthy life."

Zahn co-directs the Guerin Family Congenital Heart Program with pediatric cardiothoracic surgeon Alistair Phillips, MD, known for developing novel treatment approaches that reduce the need for multiple open-heart surgeries. Their patients range in age from infancy through adulthood, because even after Zahn and Phillips treat newborns' cardiac emergencies, most born with structural heart disease require specialized care throughout their lives.

Bryce's diagnosis, tetralogy of Fallot, is a condition characterized by four structural heart defects that prevent sufficient oxygen from reaching the blood. Infants and children with that condition usually have blue-tinged skin due to oxygen deficiency.

These "blue babies" were the first congenital heart patients treated surgically in the 1940s. However, it wasn't until the 1960s that a permanent surgical correction was developed. Today, most of these children will receive surgical correction within the first year of life. Yet for babies like Bryce who are premature and tiny, there are very few options to improve pulmonary blood flow.

"Traditional approaches for very small babies that are premature can be performed but are very high-risk procedures," Phillips said. "These babies are very fragile and are at increased risk of having organ dysfunction, notably brain injury and kidney injury, especially if cardiopulmonary bypass is needed."

Bryce was transferred to Cedars-Sinai under the care of Zahn and Phillips, each of whom played a significant role in developing and performing a minimally invasive procedure. "We made a 1-centimeter incision in the baby's lower chest. Through that, we were able to get access to the heart, and we were able to put a stent into place and increase blood flow to the lungs," Phillips said.

Bryce Jones was born with a heart defect called tetralogy of Fallot. The news frightened his parents, Frances and Marcus. But once Frances Jones met the doctors at Cedars-Sinai, "I knew they had Bryce's best interests in their own hearts," she said.

"The advantage to the hybrid procedure is that the baby would not have to recuperate from open-heart surgery, we avoid the need for cardiopulmonary bypass, and it could be done through a small incision that will be part of the larger incision when he has his full repair," Zahn said. "He could therefore grow bigger and stronger; his other organs will be more mature and unlikely to be injured."

Giving approval for the procedure, believed to be the first of its kind in Southern California, was tough on the Joneses. "We were petrified — there's no other word for it," Frances Jones said, "but once I met Dr. Zahn and Dr. Phillips, I knew they had Bryce's best interests in their own hearts. I knew we had to go forward."

Two days after the procedure, baby Bryce was discharged from Cedars-Sinai and transferred back to his community hospital in the San Fernando Valley, the same hospital where the doctors and the nurses recognized the need for an intervention. Within a week, Bryce was home in Santa Clarita and his siblings were fighting over who could hold him. By the time he was 2 months old, Bryce tipped the scales at close to 7 pounds, took in 5 ounces of milk every four hours and, it seemed to his mother, smiled constantly.

Throughout his life, Bryce will require focused care. To accommodate the healthcare needs of growing patients like Bryce, the Guerin Family Congenital Heart Program provides treatment to patients of all ages with structural heart disease.

"It's very humbling to know that there are doctors out there who really treat children as though they were their own," Jones said. "I think of Dr. Zahn and Dr. Phillips every day when I tell my 12-year-old that he needs to study hard so he can be a cardiologist like them."

Trauma Program Posts on Cedars-Sinai Facebook Page

As a Level I trauma hospital, Cedars-Sinai is a leader in providing the highest level of care for injured patients. To help prevent injuries, the medical center's Trauma Program has taken to social media.

The program has begun posting messages about the issue on the Cedars-Sinai Facebook page. The first message was posted May 1 for National Trauma Awareness Month, and the Trauma Program will continue posting once a month. Follow the injury-prevention messages by liking the Cedars-Sinai page.

The services of the Trauma Program range from prevention to rehabilitation. The American College of Surgeons requires all trauma hospitals, including Cedars-Sinai, to participate in injury-prevention activities.

Effective communication with the community on the prevention of injury is one of many roles for the injury prevention coordinator. In addition to social media, these efforts can occur in collaboration with emergency medical services personnel, police departments, and local, regional and national coalitions.

Recognition for Klein, Singer

Physician News

Klein Honored for Work in Liver Disease, Transplantation

Andrew S. Klein MD, MBA, director of the Cedars-Sinai Comprehensive Transplant Center, is being honored for a lifetime of achievement in the field of liver transplantation by the Los Angeles chapter of the American Liver Foundation.

"This is a wonderful opportunity to bring attention to someone who has had such a profound impact on patients and their families in our community," said Taly Fantini, executive director of the Greater Los Angeles Division of the American Liver Foundation. "We want to honor Dr. Klein with our Healthcare Visionary award for his pioneering work in the field of liver transplantation and hepotobiliary surgery and for tirelessly promoting awareness and education about liver disease."

As a surgeon and medical researcher, Klein, the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine, has written extensively about liver disease, transplantation and immunobiology and has helped establish rules and guidelines for the nation's transplant system.

"The remarkable thing about Andrew Klein is that his wonderful achievements are not confined to the clinic or the operating room or the laboratory," said Shlomo Melmed, MD, senior vice president and dean at Cedars-Sinai and the Helene A. and Philip E. Hixon Chair in Investigative Medicine. "He has also played a key leadership role in the national transplant arena by spearheading development of national policies for equitable allocation of the precious supply of available donor organs."

Klein is a former chair of the United Network of Organ Sharing Liver and Intestinal Transplantation Committee, as well as a member of the governing board of the American Association for the Study of Liver Diseases.

The American Liver Foundation is dedicated to the prevention and treatment of liver disease and to education and advocacy for patients. Klein was honored May 4 at the foundation's eighth annual gala in Santa Monica.


Singer Wins Award From Geffen Medical Students

Matthew Singer, MD, a resident in the Department of Surgery, has been named a winner of the Excellence in Teaching with Humanism Residents and Fellows Award from the David Geffen School of Medicine at UCLA.

This award, created and presented by the Geffen School's medical student body, recognizes residents and fellows who exhibit exemplary behavior toward medical students and other members of the healthcare team. Winners of the award serve as exceptional mentors and are recognized for their ongoing contributions to the clinical training of the school's medical students.

"Dr. Singer is a fantastic role model for how residents should treat and mentor medical students," one student said. "He provided us with every possible opportunity for hands-on experiences."

The 11 winners of the 2014 award were chosen from among more than 150 nominations.

Singer received the award May 28.

Circle of Friends Honorees for April

The Circle of Friends program honored 180 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.

  • Felicitas M. Acosta
  • Michael J. Alexander, MD
  • Daniel C. Allison, MD
  • Farin Amersi, MD
  • Neel A. Anand, MD
  • Justin Andersen, RN
  • Ellen Anifantis, LCSW
  • Regina Astilla, RN, BSN
  • M. William Audeh, MD
  • Paul C. Azer, MD
  • Esther Baik, MD
  • C. Noel Bairey Merz, MD
  • Nathan J. Ball, RN
  • David Barcay, MD
  • Eli Baron, MD
  • Andrew R. Barquera
  • Felina M. Bayron, RN
  • Leon I. Bender, MD
  • Daniel S. Berman, MD
  • Page A. Bertolotti, RN, BSN, OCN
  • Satinder J. Bhatia, MD
  • Anton J. Bilchik, MD
  • Keith L. Black, MD
  • Derek Boardman, RN
  • William W. Brien, MD
  • Neil A. Buchbinder, MD
  • Mathew H. Bui, MD
  • Bonnie J. Campbell, LCSW
  • Ilana Cass, MD
  • Christopher Chang, MD, PhD
  • David H. Chang, MD
  • Kirk Y. Chang, MD
  • Cheryl G. Charles, MD
  • George Chaux, MD
  • Henry H. Chen, MD
  • Derek Cheng, MD
  • Alice P. Chung, MD
  • Jason S. Cohen, MD
  • Steven D. Colquhoun, MD
  • Stephen R. Corday, MD
  • Barbara H. Cowen, MSW
  • Katrina G. Creencia, RN
  • Adrian Cruz, RN
  • Jamie S. Dahbura, RN, BC, BSN
  • Angela C. David, RN
  • Annette M. Davis, RN-MS, CCRN
  • Bernadette "Sylvia" C. De La Rosa, RN
  • Theodore P. De La Torre
  • Graciela Dela Cruz, RN
  • Eloisa S. Delacruz, RN
  • Rick B. Delamarter, MD
  • Kristian A. Drilon
  • J. Kevin Drury, MD
  • Karyn Eilber, MD
  • Lynne Emma, RN, MPH
  • David E. Fermelia, MD
  • James S. Fishkin, MD
  • Phillip R. Fleshner, MD
  • Charles Fong
  • Charles A. Forscher, MD
  • Larry Froch, MD
  • Tara L. Funari, MS, CGC
  • Donna Gallik, MD
  • Joseph C. Giaconi, MD
  • Armando E. Giuliano, MD
  • Eskedar F. Gobeze, RN, BSN
  • Richard N. Gold, MD
  • Sherry L. Goldman, RN, NP
  • Lisa M. Goldstein, RN
  • Ora K. Gordon, MD
  • Steven B. Graff-Radford, DDS
  • Lloyd B. Greig, MD
  • Xiomara Guzman
  • Michele A. Hamilton, MD
  • Michael D. Harris, MD
  • Andrew E. Hendifar, MD
  • David M. Hoffman, MD
  • Stuart Holden, MD
  • Jethro L. Hu, MD
  • Antoinette Hubenette, MD
  • Andrew F. Ippoliti, MD
  • Jay L. Jordan, MD
  • David Y. Josephson, MD
  • Neel R. Joshi, MD
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Mitchell Karlan, MD*
  • Ronald P. Karlsberg, MD
  • David Kawashiri, MD
  • Ilan Kedan, MD, MPH
  • Ali Khoynezhad, MD, PhD
  • Terrence T. Kim, MD
  • Asher Kimchi, MD
  • Sheldon Kishineff, MD
  • Michelle M. Kittleson, MD, PhD
  • Robert Klapper, MD
  • Claude Jean Langevin, MD, DMD
  • Sheryl Lewin, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Simon K. Lo, MD
  • Dorothy L. Lowery
  • Patrick D. Lyden, MD
  • Barak Maguen, MD
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • Neel K. Mann, MD
  • Eduardo Marban, MD, PhD
  • Philomena McAndrew, MD
  • Robert J. McKenna Jr., MD
  • Farhad Melamed, MD
  • Stewart Middler, MD, PhD
  • Peggy B. Miles, MD
  • Rolito A. Mintac
  • Monica M. Mita, MD, MDSc
  • Jaime D. Moriguchi, MD
  • Esther Morrison, RN
  • Zahra Mostafavi-Jahanshahi, RT (R) (CT) (PET)
  • Rebecca Naor, PA-C
  • Youram Nassir, MD
  • Ronald B. Natale, MD
  • Nicholas N. Nissen, MD
  • Adrian G. Ostrzega, MD
  • Chirag G. Patil, MD
  • Brad Penenberg, MD
  • Edward H. Phillips Jr., MD
  • Mark Pimentel, MD
  • Linda Piponniau, RN, BSN
  • Charles Pollick, MD
  • Danny Ramzy, MD, PhD
  • Jacqueline Recinos
  • John F. Reinisch, MD
  • Hector Rodriguez, MD, PhD, MPH
  • Sepehr Rokhsar, MD
  • Nita K. Rubin, RN, BSN
  • Jeremy D. Rudnick, MD
  • Wendy L. Sacks, MD
  • Justin D. Saliman, MD
  • Vivian L. Salle, RN
  • Enrique Sanchez
  • Howard M. Sandler, MD, MS
  • Nicholas L. Schenck, MD
  • Wouter I. Schievink, MD
  • Nicole D. Schneider, MD
  • Christine Scholar Kang, RN
  • Payam Shadi, MD
  • Michael M. Shehata, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • Silvia E. Sinanan
  • Andrew Ira Spitzer, MD
  • Herbert Stein, MD
  • Jay J. Stein, MD
  • Daniel J. Stone, MD, MPH, MBA
  • Gary M. Tearston, MD
  • Hilda A. Torres
  • Alfredo Trento, MD
  • Elizabeth Rose Tria
  • Richard Tuli, MD, PhD
  • Dimitrios Tzachanis, MD, PhD
  • Leticia O. Uy, RN, OCN
  • Sharon Vancleave, RN
  • Eric Vasiliauskas, MD
  • Robert A. Vescio, MD
  • Ghazal Vessal, PharmD
  • Olga Voroshilovsky, MD
  • Daniel J. Wallace, MD
  • Christine S. Walsh, MD
  • Chiung "Cindy" Wang
  • Alan Waxman, MD
  • Ariel E. Weber, RN, BSN, CCRN
  • Alan Weinberger, MD
  • Michael H. Weisman, MD
  • Joanna L. Wilson, RN-BC, OCN
  • Edward M. Wolin, MD
  • LaChalle D. Woodley
  • Clement C. Yang, MD
  • Shelby Young
  • Keyvan Yousefi, MD
  • Salpy Zetlian, PharmD

* Deceased

FDA Airs Risks of Corticosteroids, Blood Thinners, Lunesta

Pharmacy Focus

The U.S. Food and Drug Administration is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis and death. In addition, the FDA has released a study comparing the risks of the blood thinners Pradaxa® and warfarin, and has said the insomnia drug Lunesta® can impair next-day alertness.

Corticosteroid injections are given to treat neck and back pain, and radiating pain in the arms and legs. The effectiveness and safety of epidural administration of corticosteroids have not been established, and the FDA has not approved corticosteroids for this use. 

The agency is requiring the addition of a warning to the drug labels of injectable corticosteroids to describe these risks.

For more information, click here.

Pradaxa: Lower Risk of Stroke and Death, Higher Risk of GI Bleeding Than Warfarin

The U.S. Food and Drug Administration recently completed a study in Medicare patients comparing Pradaxa® (dabigatran) to warfarin for risk of ischemic or clot-related stroke, bleeding in the brain, major gastrointestinal bleeding, myocardial infarction (MI) and death.

The new study included information from more than 134,000 Medicare patients 65 or older, and found that among new users of blood-thinning drugs, Pradaxa was associated with a lower risk of clot-related strokes, bleeding in the brain and death, than warfarin.

The study also found an increased risk of major gastrointestinal bleeding with use of Pradaxa as compared to warfarin. The MI risk was similar for the two drugs.

For more information, click here.

Lunesta Can Impair Next-Day Alertness, FDA Warns

The FDA has notified health professionals and their medical care organizations of a new warning that the insomnia drug Lunesta® (eszopiclone) can cause next-day impairment of driving and other activities that require alertness.

The agency recommends decreasing the starting dose of Lunesta to 1 mg at bedtime. Women and men are equally susceptible to impairment from Lunesta, so the recommended starting dose of 1 mg is the same for both.

The FDA approved changes to the Lunesta prescribing information and the patient medication guide to include these new recommendations. The drug labels for generic eszopiclone products also will be updated.

For more information, click here.