sutures newsletter

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

FDA Warns About Lenalidomide, Duloxetine Hydrochloride

Pharmacy Focus

The U.S. Food and Drug Administration has issued warnings about the cancer drug lenalidomide and the antidepressant duloxetine hydrochloride.

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Mark Your Calendar


Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

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Grand Rounds

Click here to view a schedule of all upcoming grand rounds.


Educational Schedule

Click the PDF link below to see the Department of Surgery's educational schedule.

Educational Schedule - November 2014 (PDF)


Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

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Pilot Allows Patients to See Progress Notes Online

Patients seen by one of 28 physicians participating in a new pilot called OpenNotes will be able to view their own progress notes in My CS-Link™. Faculty and private practice physicians are participating in the OpenNotes pilot, which went live Nov. 11.

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Colorectal Surgery Trials Challenge Dogma

By Karen Zaghiyan, MD, and Phillip Fleshner, MD

The Cedars-Sinai Division of Colorectal Surgery remains busy in the operating room while continuing to have its own fellowship program and to play an integral role in the educational program of the General Surgery Residency. On the research front, our group has been looking at our perioperative clinical decision-making more skeptically and evaluating our decisions with trials that challenge dogma regarding the preoperative and postoperative management of patients.

» Read more

Phillips Named Wilner Alumnus of the Year

Edward Phillips, MD, has been named the winner of the Howard I. Wilner, MD, Alumnus of the Year Award. The annual award, bestowed by the Cedars-Sinai Alumni Association, honors a physician's accomplishments and contributions to medicine. The award will be presented Wednesday, Dec. 3, at 6:30 p.m. in Harvey Morse Auditorium.
 

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General Surgery Residency Has New Program Coordinator

The Department of Surgery is pleased to announce that Berkelee Williams has joined our team as the General Surgery Residency program coordinator.

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Berci Chosen as 'Hero of Surgery'

George Berci, MD, has been named a "Hero in Surgery" by the American College of Surgeons. Berci, a pioneer of minimally invasive surgery, is a longtime faculty member in the Cedars-Sinai Department of Surgery. The Karl Storz Chair in Minimally Invasive Surgery was established in Berci's honor.

 

» Read more

Academic Urology Practice Ready to Keep Growing, Leading

By Hyung Kim, MD

In 2008, the Cedars-Sinai Academic Urology Practice (AUP) was formed to provide the highest level of urologic care to the Cedars-Sinai community. With a successful residency program and more than $5 million in active grants from the National Institutes of Health, AUP doctors are not simply reading about the latest breakthroughs but are actively involved in making them.

» Read more

New Award Named for Adashek

A cash award of $25,000 in honor of Kenneth Adashek, MD, (right) will be given annually to a surgeon on the staff of Cedars-Sinai. The award will provide recognition of Adashek's significant accomplishments, while highlighting Cedars-Sinai's emphasis on compassionate care for each patient.

 

» Read more

Circle of Friends Honorees for October

The Circle of Friends program honored 171 people in October. 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

Pilot Allows Patients to See Progress Notes Online

Patients seen by one of 28 physicians participating in a new pilot called OpenNotes will be able to view their own progress notes in My CS-Link™.

Faculty and private practice physicians are participating in the OpenNotes pilot, which went live Nov. 11. When their ambulatory care patients have an office visit during the six-month pilot period, a note from their visit may be accessible to them as part of the after-visit summary in My CS-Link, after it is completed and signed by the physician.

Only completed notes written after the go-live date will be available, and physicians will be able to hide specific notes if they wish. Following the conclusion of the pilot, patients and physicians will be surveyed to assess their perceptions of OpenNotes.

OpenNotes is a national initiative designed to improve patient engagement by providing patients with ready access to their medical information, such as their progress notes.

Health systems that have implemented OpenNotes have reported positive effects on patient engagement. A study funded by the Robert Wood Johnson Foundation and conducted by investigators at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center showed that 87 percent of patients read at least one of their notes, and more than 76 percent reported improvements in remembering their plan of care. Importantly, more than 60 percent reported better medication adherence.

"Patients want to have an open, honest dialogue with their physician, and that includes having real-time access to their medical records," said Sharon Isonaka, MD, vice president of Clinical Transformation at Cedars-Sinai.

"This level of positive patient response is consistent with national studies that demonstrate that improved patient engagement leads to better outcomes," Isonaka said. "Physician feedback has also been very favorable, and virtually every physician who participated in the initial OpenNotes study chose to continue offering it to their patients."

In addition to Cedars-Sinai, OpenNotes has been implemented at a number of health systems, including the Mayo Clinic, Cleveland Clinic, MD Anderson Cancer Center and Kaiser Permanente Northwest. Locally, UCLA Health System, Kaiser Permanente and Providence Health System are preparing to offer OpenNotes to their patients.

For more information, click the PDF link below for a physician FAQ on OpenNotes. You also can contact Isonaka at sharon.isonaka@cshs.org or visit myopennotes.org for videos and links to articles on OpenNotes.

OpenNotes FAQs For Physicians (PDF)

Previously in Sutures:

Pilot Project Will Let Some Patients View Progress Notes (October 2014)

Colorectal Surgery Trials Challenge Dogma

By Karen Zaghiyan, MD, and Phillip Fleshner, MD

No one can argue about the importance of the three pillars of surgical practice: clinical, education and research. The Cedars-Sinai Division of Colorectal Surgery remains busy in the operating room while continuing to have its own fellowship program and to play an integral role in the educational program of the General Surgery Residency.

On the research front, our group has been working hard to look at our perioperative clinical decision-making more skeptically and to evaluate our decisions with randomized, controlled trials that challenge dogma regarding the preoperative and postoperative management of patients undergoing colorectal surgery.

One of these pivotal studies, published in Annals of Surgery, examined the long-held dogma that stress-dose steroids were mandatory in steroid-treated patients undergoing major colorectal surgery. We embarked on a controlled trial to compare the safety of perioperative low-dose steroid against high-dose steroids in steroid-treated patients with inflammatory bowel disease undergoing major colorectal surgery.

Our data clearly demonstrated the safety of a low-dose perioperative corticosteroid regimen that did not increase the risk of hemodynamic instability. All patients taking steroids, or recently exposed to steroids, and undergoing major colorectal surgery should be managed with perioperative low-dose steroids.

A second study, also published in Annals of Surgery, challenged the practice of not feeding patients after elective colorectal surgery. Dietary management of the patient after intestinal surgery has been dictated by unsubstantiated surgical dogma. Traditionally, patients receive nothing by mouth until resolution of the postoperative ileus for fear that early postoperative feeding could lead to serious complications such as anastomotic breakdown, aspiration and wound separation.

This traditional view has been challenged extensively in recent literature showing that early clear-liquid feeding is safe and not associated with increased postoperative morbidity. What remained to be known is whether early intake of a solid diet confers the same benefits and is as safe as clear liquids for elective colorectal patients.

Our randomized, controlled trial of patient tolerance of either a clear-fluid or low-residue diet started on postoperative day 1 (POD 1) after elective colorectal surgery showed a statistically significant reduction in length of stay and better patient tolerance with early low-residue diet compared to early clear fluid. No detrimental effects of early low-residue diet were demonstrated with regard to postoperative morbidity, in particular reoperation for abdominal complications. These data suggest that surgeons should strongly consider adopting an early solid diet from POD 1 as part of standard practice for patients undergoing elective colorectal surgery.

On another front, our group has embarked on a randomized prospective study to evaluate the optimal timing of chemical venous prophylaxis after major colorectal surgery. The current chest and Surgical Care Improvement Project guidelines are vague, recommending that chemical venous prophylaxis start within 24 hours of major colorectal surgery. Thus, many surgeons wait until after surgery to begin prophylaxis due to concern for bleeding with preoperative prophylaxis.

On the other hand, postoperative prophylaxis leaves patients vulnerable for venous thromboembolism (VTE) during surgery, when the risk may be the highest. In our study, patients are randomized to preoperative prophylaxis (heparin 5,000 units subcutaneous given in the preoperative holding area) or postoperative prophylaxis (heparin 5,000 units subcutaneous started in the 24-hour postoperative period). All patients undergo a lower extremity venous duplex in the preoperative holding area before surgery, followed by a duplex immediately after surgery and on POD2.

Our study is ongoing, but the results of our planned interim analysis were presented this year at the American College of Surgeons. We found a statistically higher incidence of VTE occurring in the 48-hour postoperative period in patients managed with postoperative chemical prophylaxis (7 percent) compared with no VTE in patients randomized to preoperative prophylaxis.

Interestingly, there were fewer bleeding complications in patients managed with preoperative chemical prophylaxis. We also found a 3 percent incidence of preoperative deep vein thrombosis in patients walking in for elective colorectal surgery. These results may have serious implications both for our patients' well-being and with respect to hospital reimbursement in an era where hospitals may be penalized for perioperative VTE complications.

Thus, preoperative screening lower extremity venous duplex may prove to be worthwhile in patients scheduled for major colorectal surgery. While the study is ongoing, the results so far are striking, with potentially practice-changing findings.

Citations

"Trial Comparing Low Dose and High Dose Steroids in Patients Undergoing Colorectal Surgery," Cedars-Sinai Institutional Review Board no. Pro00022170

"Prospective Controlled Trial On Clear Feeds Versus Low Residue Diet After Surgery In Elective Colorectal Surgery Patients," Cedars-Sinai Institutional Review Board no. Pro00029966

Phillips Named Wilner Alumnus of the Year

Edward Phillips, MD, has been named the winner of the Howard I. Wilner, MD, Alumnus of the Year Award. The annual award, bestowed by the Cedars-Sinai Alumni Association, honors a physician's accomplishments and contributions to medicine.

The award will be presented Wednesday, Dec. 3, at 6:30 p.m. in Harvey Morse Auditorium. The event also will include a chamber concert by members of the American Youth Symphony, led by Alexander Treger. Admission is $10 for the general public and $5 for members of the medical staff, residents, members of the nursing staff, employees and volunteers.

A pioneer in minimally invasive surgery, Phillips is executive vice chair of the Cedars-Sinai Department of Surgery and chief of the Division of General Surgery. He is director of the Saul and Joyce Brandman Breast Center — A Project of Women's Guild, the Wasserman Breast Cancer Risk Reduction Program and the Weight Loss Center. He holds the Karl Storz Chair in Minimally Invasive Surgery in Honor of George Berci, MD.

Presentation of the Howard Wilner Alumnus of the Year Award - Dec. 3 (PDF)

General Surgery Residency Has New Program Coordinator

The Department of Surgery is pleased to announce that Berkelee Williams has joined our team as the General Surgery Residency program coordinator. She has more than five years of coordinating experience and comes to us from Columbia University in New York, where she managed the day-to-day activities, training needs and educational experience for medical students, residents and clinical fellows.

Our surgical residency program gives general surgical residents substantial surgical exposure preparing them for a career in general surgery, academic surgery and surgical fellowship training. Williams will work closely with Donald Dafoe, MD, program director, and Farin Amersi, MD, associate program director, as we continue to grow our program and promote our research activities.

Berci Chosen as 'Hero of Surgery'

George Berci, MD, has been named a "Hero in Surgery" by the American College of Surgeons. The distinction was announced at the organization's Clinical Congress on Oct. 28 in San Francisco. Video biographies were shown for Berci and the three other physicians so honored.

Berci, a pioneer of minimally invasive surgery, is a longtime faculty member in the Cedars-Sinai Department of Surgery. The Karl Storz Chair in Minimally Invasive Surgery was established in Berci's honor.

He was able to start a Multidisciplinary Surgical Endoscopy unit in 1974 at Cedars of Lebanon, a predecessor of Cedars-Sinai. The unit covered urology, gynecology, ear, nose and throat, and general surgery.

The college cited Berci's role in the launch of the Hopkins rod-lens system in endoscopy, which vastly improved the visual field for this procedure. Berci, concerned that surgeons could not see inside the common bile duct well enough to remove gallstones, began working on the system in 1959 with Harold Hopkins, a renowned physicist and professor of applied optics in London.

Berci went on to help pioneer other imaging and visualization advances, including colonoscopy, the college said. He established the GI Lab in 1975 at Cedars of Lebanon and later at Cedars-Sinai.

Academic Urology Practice Ready to Keep Growing, Leading

By Hyung Kim, MD

In 2008, the Cedars-Sinai Academic Urology Practice (AUP) was formed to provide the highest level of urologic care to the Cedars-Sinai community. AUP brought together urologists from the faculty practice and the Cedars-Sinai Medical Group. The group has fellowship-trained urologists who practice within all the subspecialties of urology, including urologic oncology, endourology, infertility, reconstructive urology and pediatric urology.

AUP provides tertiary-level care for the most complex urologic conditions. The program is proud to field world-class specialists recruited from throughout the country. Its members previously held faculty and leadership positions at UCLA, Roswell Park Cancer Institute and Memorial Sloan Kettering Cancer Center.

The next logical step for AUP was to start a residency program. Only nine months after turning in an application, the Urology Residency Program was approved by the Accreditation Council for Graduate Medical Education. Since then, two new medical school graduates have been added to the program each year. In July 2015, the program will have a full complement of 10 residents, and a year after that, it will graduate its first class of fully trained urologists.

The program receives approximately 250 applications each year for two positions. To complement the style of medical practice that residents experience at Cedars-Sinai, the training program is adding rotations at two Southern California county hospitals.

Research is an important component of any academic program. High-caliber research often requires money. Therefore, a useful measure of research activity is peer-reviewed grant funding. The urologists in AUP hold more than $5 million in active grants from the National Institutes of Health. Their projects range from translational laboratory research to innovative clinical trials.

AUP research brings the latest concepts, approaches and therapies to patients. AUP doctors are not simply reading about the latest breakthroughs but are actively involved in making them. In addition to the work led by the clinician-scientists, the urologists collaborate with top basic scientists. Within the past five years, Cedars-Sinai has recruited a team of highly accomplished researchers working on urologic diseases involving the tumor microenvironment, cellular metabolism and genetic changes.

In summary, the urology program is well positioned for continued growth and leadership. The program has recruited highly skilled clinicians. The Urology Residency Program is being established as one of the top training programs in the country. AUP remains actively engaged in innovative research that will continue to enhance patient care.

New Award Named for Adashek

Kenneth Adashek, MD

A cash award of $25,000 in honor of Kenneth Adashek, MD, will be given annually to a surgeon on the staff of Cedars-Sinai.

The Dr. Kenneth Adashek Surgical Excellence Award is made possible by the generosity of Toni and Emmet Stephenson. It is intended to provide vital resources to surgeons, within 10 years of fellowship completion, who exemplify and promulgate the outstanding personal and professional qualities of Adashek, including surgical excellence, dedication to the field of surgery, exceptional interpersonal skills and complete integrity. The award will provide recognition of Adashek's significant accomplishments, while highlighting Cedars-Sinai's emphasis on compassionate care for each patient.

A committee of three, co-chaired by Bruce Gewertz, MD, surgeon-in-chief and chair of the Department of Surgery, and Adashek, will select a finalist from a group of nominees. Adashek and Gewertz will name a third committee member to help select a finalist.

Nominees for this award will be selected from those excellent surgeons who best exhibit professionalism and compassionate, patient-centered care. The prize funds may be applied to educational or academic activity.

Nominations may be sent to johnny.thomas@cshs.org.

The recipient of the first Adashek award will be announced Dec. 1 and presented at the annual departmental holiday party.

Circle of Friends Honorees for October

The Circle of Friends program honored 171 people in October.

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.

  • Cheryl L. Abrazado, RN
  • Felicitas M. Acosta
  • Keith L. Agre, MD
  • Howard N. Allen, MD
  • Daniel C. Allison, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Bergit Arctander, BSN, RN, CN
  • M. William Audeh, MD
  • Jacqueline A. Avilez
  • Andrew R. Barquera
  • Jose E. Becerra-Flores
  • Valerie Betley
  • Donna M. Bias, BSN, RN
  • Keith L. Black, MD
  • Michael J. Blumenkrantz, MD
  • Earl W. Brien, MD
  • William W. Brien, MD
  • Eileen G. Brown, OCN, RN
  • Jovie O. Brown, RN
  • Matthew H. Bui, MD
  • Ilana Cass, MD
  • George Chaux, MD
  • Sant P. Chawla, MD
  • William W. Chow, MD
  • Geemee Chung, MD
  • J. Louis Cohen, MD
  • Stephen R. Corday, MD
  • Lawrence S. Czer, MD
  • Ruben C. Dadag
  • Shaun S. Daneshrad, MD
  • Catherine M. Dang, MD
  • Itai Danovitch, MD
  • Mark M. Davidson, MD
  • Jez A. Davidson Guito
  • Marietta A. De Jesus, RN
  • Robert W. Decker, MD
  • Maria L. Delioukina, MD
  • Ryan DellaMaggiora, MD
  • Alice R. Dick, MD
  • Thomas J. Diprima
  • Erika H. Douglass, RN
  • Noam Z. Drazin, MD
  • Julie A. Dunhill, MD
  • Pedram Enayati, MD
  • Fardad Esmailian, MD
  • Richard Essner, MD
  • Jeannifer W. Estrada, RN
  • Irina R. Eyfer
  • Mary Annalee C. Famas, BSN, RN
  • Edward J. Feldman, MD
  • Robert A. Figlin, MD
  • Eleni Fotiadis, RN
  • Joyce N. Fox, MD
  • Kathleen M. Freund, RN
  • Stuart Friedman, MD
  • David M. Frisch, MD
  • Ryan P. Galang, RN-BC
  • Ivor L. Geft, MD
  • Bruce L. Gewertz, MD
  • Armando E. Giuliano, MD
  • Sherry L. Goldman, RN, NP
  • Jeffrey S. Goodman, MD
  • Maria M. Gozip, RN
  • Steven B. Graff-Radford, DDS
  • Stephen L. Graham, MD
  • Jeffrey R. Gramer, MD
  • Leland M. Green, MD
  • Faina Gurfinkel
  • Andrew E. Hendifar, MD
  • Gail K. Higa, RN, OCN
  • David M. Hoffman, MD
  • Arash A. Horizon, MD
  • Antoinette Hubenette, MD
  • Joseph Isaacson, MD
  • Mariko L. Ishimori, MD
  • Laith H. Jamil, MD
  • J. Patrick Johnson, MD
  • David Y. Josephson, MD
  • Sheila Kar, MD
  • David Kawashiri, MD
  • Mehran J. Khorsandi, MD
  • Hyung L. Kim, MD
  • Michelle M. Kittleson, MD, PhD
  • Robert Klapper, MD
  • Jon A. Kobashigawa, MD
  • Michael A. Kropf, MD
  • David A. Kulber, MD
  • Erika E. Kurian, RN
  • Sandra M. Labat
  • Brenda N. Leano, BSN, RN, PCCN
  • Susie K. Lee, NP
  • Ella L. Leggett
  • Madeline S. Lerman, BSN, RN
  • Ronald S. Leuchter, MD
  • Andrew J. Li, MD
  • Michael C. Lill, MD
  • Julie Lim, RN
  • H. Gabriel Lipshutz, MD
  • Soledad Lopez-Ramirez
  • Mari A. Madsen, MD
  • Harumi O. Mankarios, RN, OCN
  • Ana R. Martinez
  • Edmund J. Martinez
  • Robert Maxwell, RN
  • Robert J. McKenna Jr., MD
  • Sharron L. Mee, MD
  • Andrea Meneses
  • Tamar Meszaros, MD
  • Stewart Middler, MD, PhD
  • Monica M. Mita, MD, MDSc
  • Rosina Mitchell-Lloyd, RN
  • Zuri Murrell, MD
  • Ronald B. Natale, MD
  • David G. Ng, MD
  • Roy D. Nini, MD
  • Nicholas N. Nissen, MD
  • Raena S. Olsen, DO
  • Rosalou Onate, RN
  • Sharon D. Ozorio
  • Guy D. Paiement, MD
  • Rhonda M. Parish
  • Monica R. Peterson, RN
  • Glenn B. Pfeffer, MD
  • Edward H. Phillips, MD
  • Tyler Pierson, MD
  • Mark Pimentel, MD
  • Mary M. Pittman, RN
  • Ralph T. Potkin, MD
  • Kristina C. Pulliam, BSN, RN
  • Joseph L. Robinson, MD
  • Warren L. Roston, MD
  • Tracy Salseth, ACNP-BC
  • Howard M. Sandler, MD, MS
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • C. Andrew Schroeder, MD
  • Scott Serden, MD
  • Aamir S. Shah, MD
  • Takahiro Shiota, MD
  • Allan W. Silberman, MD, PhD
  • R. Kendrick "Ken" Slate, MD
  • Andrew Ira Spitzer, MD
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Jerrold H. Steiner, MD
  • Sarah J. Stepien, MSN, RN, MPH, CMSRN
  • Kazu Suzuki, DPM
  • Alyssa Tennenbaum, RD, CDE, MBA
  • David B. Thordarson, MD
  • Tram T. Tran, MD
  • Alfredo Trento, MD
  • Gregory Tsushima, MD
  • Richard Tuli, MD, PhD
  • Franca Uchemefuna, RN
  • Ruby M. Unabia-Carino
  • Angela Velleca, BSN, RN, CCTC
  • Robert A. Vescio, MD
  • Rafael Villicana, MD
  • Olga Voroshilovsky, MD
  • Katherine D. Waite, RN
  • Abraham U. Waks, MD
  • Xunzhang Wang, MD
  • Michael H. Weisman, MD
  • Jeffrey C. Wertheimer, PhD
  • Donald A. Wiss, MD
  • Curtis D. Woodworth, RN
  • Veronica T. Wootton
  • Clement C. Yang, MD
  • Joey M. Yap, RN
  • Amara Yob, BSN, RN, OCN
  • Phillip C. Zakowski, MD
  • Christopher Zarembinski, MD