sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY July 2015 | Archived Issues

P & T Approvals, FDA Warnings About Codeine-Containing Meds, NSAIDs, Proglycem

Pharmacy Focus

See highlights of the June meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has issued warnings about codeine-containing medicines in children, nonsteroidal anti-inflammatory drugs and Proglycem in infants.

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Mark Your Calendar


Grand Rounds

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


Surgery Scheduling

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

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Establishment of a New Orthopedic Academic Department

Message From the Chair

The Division of Orthopaedic Surgery has long been recognized for its high-quality care and treatment of musculoskeletal disorders and diseases. The Department of Surgery believes the program has the potential to achieve even a stronger academic reputation among specialists in the field with the addition of departmental status. Our recent proposal to form such a department was advanced through the Surgery Department and approved by the Medical Executive Committee; board approval is expected July 27, 2015.

» Read more

Joshi Wins 2015 Adashek Award

Neel R. Joshi, MD, has been named the 2015 winner of the Dr. Kenneth Adashek Surgical Excellence Award. The award was presented in June. The award comes with a $25,000 prize, which Joshi can use for educational or academic activity.


 

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Hydroxyurea-Induced Lower Extremity Ulcers on Rise?

By Romina Vincenti, DPM, and Karen Shum, DPM

On our service, we are seeing a rising trend of ulcers that may be associated with hydroxyurea therapy. These wounds take longer to heal compared to those in patients not undergoing hydroxyurea therapy, and they sometimes fail to heal.

» Read more

Notes, 'Fat Tab' Among CS-Link Updates

Several improvements were added recently to CS-Link™, including the ability to write notes via Haiku and Canto. Please note one change in particular: All order functions now are grouped into one "fat tab" called "Manage Orders."

» Read more

Doctors Deal With Rules on Patient Classification

Use of Two-Midnight Rule to Determine Status Can Be Confusing

Federal policy designed to clarify when patients in overnight hospital stays qualify as inpatients, outpatients or under observation is causing some confusion among Cedars-Sinai's medical staff, especially documenting "medical necessity" under the two-midnight rule.

» Read more

Circle of Friends Honorees for June

The Circle of Friends program honored 249 people in June. 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

Establishment of a New Orthopedic Academic Department

Message From the Chair

The Division of Orthopaedic Surgery has long been recognized for its high-quality care and treatment of musculoskeletal disorders and diseases. The strength of the program arises from a multidisciplinary team of experts that includes more than 80 orthopedic surgeons on the voluntary and full-time faculty, many of whom hold national positions of leadership.

In 2014, Cedars-Sinai was rated seventh nationally in the U.S. News & World Report list of top hospitals in orthopedics; it had the top orthopedic program on the West Coast. Importantly, Cedars-Sinai has the only orthopedics program in the top 10 that is not structured as an independent department. The Department of Surgery believes the program has the potential to achieve even a stronger academic reputation among specialists in the field with the addition of departmental status.

Our recent proposal to form such a department was advanced through the Surgery Department and approved by the Medical Executive Committee; board approval is expected July 27, 2015.

Given demographic trends, orthopedics is poised to be a top volume contributor over the next 10 years, with a projected inpatient growth rate of 15 percent and outpatient growth rate of 28 percent. While the Medicare population will continue to grow in orthopedics and the reimbursement for this segment will be heavily controlled by the government, the market trend to more outpatient procedures and the Orthopaedic Division's favorable outpatient payer mix set the foundation for strong financials in the coming years.

The academic component at Cedars-Sinai is still growing compared to the other Top 10 programs. The orthopedic residency was established in 2011 and currently has 20 Accreditation Council for Graduate Medical Education (ACGME) positions. In 2015, there were 555 applicants for the four yearly spots at Cedars-Sinai, representing a 42 percent increase in applications over four years. The quality of the applicants is outstanding, with more than 100 American Osteopathic Association graduates applying each year. The division has established 16 fellowships, 13 of which are ACGME positions. The Division of Orthopaedics currently has $2.4 million awarded for basic and translational research. This very respectable amount includes funds from the National Institutes of Health, the California Institute for Regenerative Medicine and other sources.

The prominence of Cedars-Sinai Orthopaedics has led to a number of other unique opportunities:

  • We have been contracted to provide orthopedic care to Boeing employees in the western United States. This was a highly competitive process and highlights our reputation for quality.
  • A recent affiliation with Kerlan-Jobe Orthopaedic Clinic and Santa Monica Orthopaedic and Sports Medicine Group through the Medical Network was another solid step in strengthening our reputation. Kerlan-Jobe and SMOG bring expertise and status in the professional sports world.
  • Cedars-Sinai, UCLA Health System and Select Medical Holdings will open a 138-bed rehabilitation hospital in Century City, reflecting the growing need for this specialty care and a key resource for the growing orthopedic market.

Creating an Orthopaedic Department at Cedars-Sinai will continue our reputational momentum and better position us to recruit the top clinical and research talent from across the country. Further, we can develop the academic components consistent with the strongest orthopedic group west of the Mississippi.

Please join me in congratulating the leadership of Orthopaedics, including Will Brien, MD, section chief, Robert Bernstein, MD, medical director of the Orthopaedic Center, and their colleagues, on this well-deserved change in structure.

Bruce L. Gewertz, MD
Surgeon-in-Chief
H and S Nichols Distinguished Chair in Surgery
Chair, Department of Surgery
Vice President, Interventional Services
Vice Dean, Academic Affairs

Joshi Wins 2015 Adashek Award

Neel R. Joshi, MD

Neel R. Joshi, MD, has been named the 2015 winner of the Dr. Kenneth Adashek Surgical Excellence Award. The award was presented in June.

The award comes with a $25,000 prize, which Joshi can use for educational or academic activity.

Joshi is a clinical assistant professor in the Cedars-Sinai Department of Surgery. His specialties are general surgery and surgical oncology.

The award provides vital resources to a surgeon who is within 10 years of fellowship completion and who exemplifies Adashek's outstanding personal and professional qualities, including surgical excellence, dedication to the field of surgery, exceptional interpersonal skills and complete integrity.

The award recognizes Adashek's significant accomplishments while highlighting Cedars-Sinai's emphasis on compassionate care for each patient. It is made possible by the generosity of Toni and Emmet Stephenson. The award is given annually to a surgeon on the staff at Cedars-Sinai.

Kenneth W. Adashek, MD, is an attending surgeon at the Cedars-Sinai Thyroid Cancer Center and the Saul and Joyce Brandman Breast Center. He is a former chair of the Cedars-Sinai Division of General Surgery and a former co-director of the breast center.

Neel R. Joshi, MD, was unable to attend the ceremony at which he was presented with the Dr. Kenneth Adashek Surgical Excellence Award. Click the image below to see his recorded message that was played at the ceremony.

Hydroxyurea-Induced Lower Extremity Ulcers on Rise?

By Romina Vincenti, DPM, and Karen Shum, DPM

On our service, we are seeing a rising trend of ulcers that may be associated with hydroxyurea therapy. These wounds take longer to heal compared to those in patients not undergoing hydroxyurea therapy, and they sometimes fail to heal.

Hydroxyurea is a chemotherapy agent used in patients with many hematologic disorders, including sickle cell anemia. The use of hydroxyurea has become popular due to its ability to work quickly, its mild side effects and quick patient recovery when blood counts drop too low. It has been shown that hydroxyurea can reduce white blood cell counts within one to two days. (1)

However, long-term treatment with hydroxyurea can result in painful leg ulcers. A case study by Sierex found that there was a 9 percent incidence of leg ulcers among patients taking long-term, high-dose hydroxyurea for myeloproliferative diseases. (2) The disruptive effects of hydroxyurea on DNA synthesis in the cell cycle causes damage to the basal keratinocytes and hindrance of collagen production, leading to skin breakdown.

Most commonly, these ulcers arise in the lower extremity, specifically the ankle malleolus, where there is more bony prominence. (3) Diagnosis is made by obtaining a thorough history and physical along with a review of the current medication list.

Treatment modalities including topical and systemic antibiotics, topical wound dressings, compression therapy and steroids have been implemented to promote wound healing. However, wound healing is seldom seen with these treatment modalities as long as patients remain on hydroxyurea. This indicates the importance of high clinical suspicion leading to accurate diagnosis of this drug-induced ulcer.

The first step of treatment is to contact the prescribing physician, often the hematologist or oncologist, to determine if hydroxyurea can be safely discontinued. In some rare cases, such as polycythemia vera, the medication may be the only life-saving treatment for this disease. Once hydroxyurea is discontinued, spontaneous resolution of these leg ulcers is often seen. (4)

Upon discontinuing the medication, local wound care should be implemented. It is generally advised against aggressive surgical debridement of these ulcers, as this may result in enlarged ulcer size. Leg edema may be treated with gentle compression therapy using multilayer compression bandages.

In conclusion, there is a clear association between hydroxyurea therapy and lower extremity ulcers. Poor response to traditional wound care therapy is typical of hydroxyurea-induced ulcers. Hydroxyurea causes cumulative toxicity on the basal layer of the epidermis in the skin, but this cytologic damage is reversible with cessation of the medication. Proper wound healing starts with coordinating with the prescribing physician to discontinue hydroxyurea or switch to an alternative drug agent.

References:

  1. Reichard KK, Larson RS, Rabinowitz I. Chronic myeloid leukemia. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means RT, eds., Wintrobe's Clinical Hematology, Philadelphia: Lippincott Williams and Wilkins; 2009; 12 (2); 2006-2030.
  2. Sirieix ME, Debure C, Baudot N, et al. Leg ulcers and hydroxyurea: forty-one cases. Arch Dermatol 1999; 135: 818-20.
  3. Dissemond J, et al. Leg ulcer in a patient associated with hydroxyurea therapy. International Journal of Dermatology 2006; 45: 158-160.
  4. Best PJ, Daoud MS, Pittelkow MR, Petitt RM. Hydroxyurea-induced leg ulceration in 14 patients. Ann Intern Med. 1998 Jan 1; 128(1):29-32.

Notes, 'Fat Tab' Among CS-Link Updates

Several improvements were added recently to CS-Link™, including the ability to write notes via Haiku and Canto.

Please note one change in particular: All order functions now are grouped into one "fat tab" called "Manage Orders." The current "Order Entry" function can be found within "Manage Orders" and will be along the right-hand column.

Also note that your ordering preference list will be accessed via the "+New" button. This change brings all ordering options onto one screen and serves to remind us to utilize the preferred "Modify" or "Discontinue" buttons for changes to existing orders, rather than using a nurse communication.

For more information about the improvements, including screen shots, see this PDF at CS-Link Central.

Inter-Facility Transfer Report — Psychotropic Meds

The Joint Commission (TJC) requires hospitals to obtain a Physician Certification Statement (PCS) when patients are transferred to skilled nursing facilities (SNFs) on psychotropic medications. In an effort to satisfy this requirement, a new documentation section has been added to the Inter-Facility Transfer Report navigator. The PCS is generated automatically and printed as part of the Inter-Facility Transfer Report for use by the receiving facility.

This improvement will:

  • Satisfy the TJC requirement to obtain a Physician Certification Statement prior to discharging patients to SNFs with psychotropic medications
  • Help in continuum of care when patients transferred to SNFs
  • Help ensure timely patient care with regard to ordering and dispensing of psychotropic medications at the receiving facility

Optimization of Clinical Swallow Evaluations

To encourage providers to use Clinical Swallow Evaluations when appropriate for patients, this feature incorporates a recommendation for a Clinical Swallow Evaluation prior to ordering a Video Swallow Study (VSS). This enhancement supports using needs assessment to drive clinical decision-making.

When physicians place an order for VSS and a patient does not have a Clinical Swallow Evaluation on file, an Alternative Alert will pop up asking if physicians would like to "Accept Alternative" recommended order or "Continue with Original Order."

This improvement will:

  • Support utilizing needs assessment to drive clinical decision-making prior to ordering a Video Swallow Study
  • Encourage providers to use Clinical Swallow Evaluations when appropriate for patients, providing clinicians with information regarding:
    • Whether the patient's dysphagia is oral or pharyngeal
    • Readiness for the radiologic study (patient must be alert and able to accept food in the mouth)
    • The oral reaction to various tastes, temperatures, and textures in the oral cavity
    • The presence of any swallowing apraxia or any abnormal oral reflexes such as a tonic bite
    • Postural and behavioral needs of the patient that must be addressed during the radiographic study

Optimal benefits from a VSS are dependent on stability of patient's medical status, behavior and cognitive level.

Clinical Overview Report

This report puts together frequently used reports in one Patient Summary report in order to make it easier to navigate and view patient data. The report is based on best practice experience at other hospitals.

This improvement will create one unified view of multiple reports, including team-based communication, patient flags and key clinical data.

Handoff/Rounding Tool

This piloting handoff tool will assist with team sign-outs and enable auto-generated rounding reports.

A new SignOut button will be added in the patient list toolbar for physicians to document a patient summary and a to-do list. This will automatically populate the SignOut report under the patient lists with the ability to print multiple patient reports per page.

This improvement will create a better handoff and rounding report for physicians.

Notes and Manage Orders — "Fat Tabs"

Notes and Manage Order buttons have changed to the "Fat Tab" format. Order Entry and Order Review no longer are available as standalone activity tabs.

The Manage Orders tab is now the primary screen for placing orders and access to Order Review. The ordering preference list is now found by clicking on "+New" button.

This improvement will:           

  • Provide visual distinction of the most commonly used physician activity tabs for inpatients
  • Assure utilization of the preferred Manage Orders activity

CHF: Patient Identification — Best Practice Advisory

In Med-Surg areas, nurses will now complete an assessment for certain patients who are at risk for congestive heart failure (CHF). If the nurse assesses that the patient potentially has CHF, and if the patient doesn't already have CHF on their problem list, physicians will see a Best Practice Advisory (BPA) that asks whether CHF should be added to the problem list.

If a patient has an order for a loop diuretic, an ejection fraction less than 40 percent, a BNP greater than 300 or documented shortness of breath, Med-Surg nurses will be required to complete a CHF assessment on the patient. Nurses will indicate that a patient potentially has CHF based on the criteria in a sidebar report.

If a Med-Surg nurse indicates that a patient potentially has CHF, physicians will see a BPA that asks whether it is appropriate to add CHF to the patient's problem list. If the patient has CHF, the physician should add it to the problem list by opening the Problem List activity from the BPA.

This improvement will:

  • Help identify patients with CHF so that nursing, pharmacy and nutrition staff can be notified to provide appropriate patient education
  • Help track patients with CHF, so that physicians can better manage care for these patients

VTE Prophylaxis Best Practice Advisory

If an adult patient has been admitted for more than 24 hours and if VTE prophylaxis has not yet been addressed, physicians will see a Best Practice Advisory (BPA) that prompts them to address prophylaxis.

A new BPA will display for physicians if they have not addressed VTE prophylaxis for an adult patient who has been admitted for 24 hours. VTE prophylaxis is considered "addressed" only with one or more of the following orders:

  • Mechanical prophylaxis
  • Pharmacological prophylaxis
  • Contraindication for both mechanical and pharmacological prophylaxis
  • Low risk for VTE; no prophylaxis needed

These orders can all be found in the VTE order set suggested by the BPA, and in the IP General Admission Order Set.

This improvement will help prevent VTE in at-risk patients.

Care Everywhere — Data Reconciliation

If there is outside data to reconcile, you will now see the hyperlinks within the Care Everywhere summary report in the following sections:

  • Allergies
  • Problem List
  • Medications

A second way to access the activity is to click the hyperlink that appears within the Allergy, Meds and Problem List activities.

These will appear only if there is data to reconcile in these activities.

The link display button has listed "Reconcile with Patient's Chart." Once the link has been selected, click Add or Discard to add the allergy, problem or medication to the Cedars-Sinai chart. Click Discard if you don't want to bring it in. These actions have no impact on the source organization.

When you choose to add a medication, there is the option to edit additional details about the med. The source organization automatically pulls into the Comments field. If we already have the medication in our system, it will ask if you want to discontinue the duplicate med.

For more information on this improvement, view this PDF at CS-Link Central.

Haiku/Canto Notes Entry

You will now see hyperlinks to document the following notes within Haiku/Canto Care:

  • Consult — Initial
  • Discharge Summaries
  • H&P
  • Operative Report
  • Post-Op (Brief Op Note)
  • Procedures
  • Progress Note — Doctor
  • Progress Notes (this is available in the ambulatory encounter context)

Click on the Note link to display and select a Note Type. Once identified, enter and sign the note.

Order Entry — Manage Orders

Inpatient physicians no longer have access to Order Entry activity. Physicians have to use Manage Orders activity to enter or place orders.

Diabetic Supplies Order-Set Enhancement

Names have been updated to familiar terms for supplies and medications under sections Meters/Test Strips/Lancets, Test Strips Only and Insulin Pens & Needles.

Meters/Test Strips/Lancets

  • Change from FreeStyle UniStik Lancet to FreeStyle Lancet
  • Change from FreeStyle Test Strip to FreeStyle Lite Test Strip

Test Strips Only

  • Change from FreeStyle Test Strip to FreeStyle Lite Test Strip

Insulin Pens & Needles

Additional options: BD AutoShield-DUO Safety Pen Needles 30G x 5mm

Miscellaneous (new section)

  • Glucose tablets
  • Glucagon Emergency Kit
  • Home Sharps Container

DME Order Enhancement

The DME order now has a new question option for specifying Hospital Bed. This new question has dropdown options of: Bed Cradle (18"-27"), Full Bed Rails, Full-Electric Hospital Bed, G-1 Alternating Pressure Pad and Pump, G-2 Low Air Loss Mattress, Half Bed Rails, Over Bed Table, Semi Electric Hospital Bed, and Trapeze.

This improvement will make it easier to order hospital beds for discharge.

Doctors Deal With Rules on Patient Classification

Use of Two-Midnight Rule to Determine Status Can Be Confusing

Federal policy designed to clarify when patients in overnight hospital stays qualify as inpatients, outpatients or under observation is causing some confusion among Cedars-Sinai's medical staff, especially documenting "medical necessity" under the two-midnight rule.

"We understand that this new policy may be yet another regulatory burden, but misclassification will ultimately lead to lapses in insurance coverage for patient care services, as well as denial of physician payments," said Chief of Staff Chris Ng, MD. "Fortunately, we have the support of our nursing and case management colleagues, and together we can solve questions of patient status in a timely manner."

The medical staff leadership is working to create simple solutions within CS-Link™, the medical center's secure online medical record, and through educational materials.

Two-Midnight Rule: Important Points to Consider

  • A midnight spent in the Emergency Department or in outpatient or observation status counts toward the two midnights needed to qualify for inpatient status.
  • A patient does not have to stay two midnights to qualify for inpatient status — the physician just has to have a reasonable expectation at the time of decision-making that the patient will require two or more midnights in the hospital.
  • The need for ongoing hospitalization cannot be based on social issues or delays in care.

Requirements to Satisfy Inpatient Status

  • A signed admit order
  • A history and physical with documentation of "reasonable expectation" supported by objective medical information
  • An appropriate discharge plan

The federal Centers for Medicare and Medicaid Services (CMS) established a two-midnight benchmark for physicians to use in determining patient status. CMS specifies that at the time of initial evaluation, if the physician expects the patient to require care that spans two midnights and orders admission based on that expectation, inpatient status is generally appropriate. Conversely, CMS specifies that for hospital stays in which the physician expects the patient to require care for less than two midnights, inpatient status is generally inappropriate.

However, patients who are to undergo procedures on Medicare's inpatient-only list must be classified as inpatient, regardless of their length of stay. Situations such as deaths or transfers also are exceptions to the two-midnight rule.

Otherwise, patients who are expected to need hospital care spanning just one midnight should have outpatient procedure or observation status.

For example:

  • If a physician is scheduling a cardiac pacemaker insertion and expects the patient to be discharged the same day or the next day, the physician should schedule the procedure as an outpatient procedure, as CMS does not recognize a pacemaker insertion as an inpatient procedure.
  • If a Medicare patient presents to the Emergency Department (ED) with a condition that requires an overnight stay in the hospital for further monitoring and evaluation, such as an asthma exacerbation, the physician would order observation status.
  • If a Medicare patient presents to the ED with a more severe condition that will require testing and monitoring for more than two midnights, the physician would order inpatient admission.
  • If a Medicare patient presents with a condition of undetermined severity, such as a gastrointestinal bleed or atypical chest pain, and it is difficult for the physician to determine how long the patient will stay upon initial presentation, the physician should place the patient in observation status. As new information becomes available suggesting a stay that spans a second midnight, the physician should later admit the patient as an inpatient.

In addition, there needs to be clear documentation and detailed analysis in patients' medical records to support inpatient status. "The rationale for the expected stay must be there," said Joe Kim, MD, medical director of Care Management. "Documentation by the physician in the initial history and physical, subsequent progress notes and the discharge summary must be sufficient to support that hospital services were reasonable and necessary."

It is important to keep in mind that the two-midnight rule does not affect what qualifies a stay in a skilled nursing facility (SNF) for Medicare coverage. For Medicare to cover an admission to a skilled nursing facility requires three days of hospital-based care under inpatient status. The three days begin when the inpatient order is written.

The medical record must clearly support that necessary services can be provided only in an acute-care hospital. Patients could be responsible for the entire cost of their SNF care if CMS determines their patient status is documented inaccurately.

"The quicker and more accurately we can classify these patients at the time of admission, the better the documentation is at the point of discharge," said Betty Johnson, RN, manager of Compliance and Revenue Integrity in the Cedars-Sinai Department of Patient Financial Services.

Johnson said it is critical that all members of the patient's care team work together to ensure appropriate and efficient coordination of care.

If you have questions, please ask a case manager, or contact Johnson at betty.johnson@cshs.org or Kim at joe.kim@cshs.org.

Circle of Friends Honorees for June

The Circle of Friends program honored 249 people in June.

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.

  • Kenneth Adashek, MD
  • Paul Y. Aguilar
  • Maryam Ahmadian, MSN, RN, NP
  • Anne L. Alayon, RN
  • Michael J. Alexander, MD
  • Howard N. Allen, MD
  • Daniel C. Allison, MD
  • Farin Amersi, MD
  • Neel A. Anand, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • Ronald M. Andiman, MD
  • Mario D. Angel
  • Stephanie L. Anger, RN
  • Pedrina Arguera
  • Arash Asher, MD
  • M. William Audeh, MD
  • Laura G. Audell, MD, MS
  • Babak Azarbal, MD
  • Michel Babajanian, MD
  • Robert H. Baloh, MD, PhD
  • Mark Bamberger, MD
  • Babak R. Bamshad, MD
  • Tina G. Ban, RN
  • Leon I. Bender, MD
  • Jason A. Berkley, DO
  • Satinder J. Bhatia, MD
  • Anton J. Bilchik, MD
  • Keith L. Black, MD
  • Vanessa Booker
  • Earl W. Brien, MD
  • William W. Brien, MD
  • Angela Brown, RN, CVN
  • Eileen G. Brown, OCN, RN
  • Neil A. Buchbinder, MD
  • Dana Burlingame, RN
  • Marlon C. Bustamante, BSN, PHN, RN
  • Allison H. Canavan, MD
  • Ilana Cass, MD
  • Bojan Cercek, MD, PhD
  • Michael L. Chaikin, MD
  • David H. Chang, MD
  • Kirk Y. Chang, MD
  • Yuming (Rose) Chang, RN, CGRN
  • Derek Cheng, MD
  • Wendy W. Cheng, MD
  • Elaina P. Chu, PA
  • Ray M. Chu, MD
  • Alice P. Chung, MD
  • Eugenio Cingolani, MD
  • Susan B. Clark, RN
  • Paul Cohart, MD
  • Katherine Cohen, RN
  • Martin Cooper, MD
  • Stephen R. Corday, MD
  • Lawrence S. Czer, MD
  • Ram C. Dandillaya, MD
  • Teresa M. Dean, MD
  • Robert W. Decker, MD
  • Premal J. Desai, MD
  • Stephen C. Deutsch, MD
  • Alice R. Dick, MD
  • Suhail Dohad, MD
  • Noam Z. Drazin, MD
  • J. Kevin Drury, MD
  • Cheryl L. Dunnett, MD
  • Karyn Eilber, MD
  • Joshua D. Ellenhorn, MD
  • Jonathan C. Ellis, MD
  • Richard Essner, MD
  • Moses J. Fallas, MD
  • Yvette B. Federizo, BSN, RN, OCN
  • Joel D. Feinstein, MD
  • Jack F, Felmann
  • Marion D. Ferguson, BSN, RN, CPON
  • Fozia Ferozali, MSN, EdD
  • Marshal P. Fichman, MD
  • Robert A. Figlin, MD
  • Stuart Friedman, MD
  • David M. Frisch, MD
  • Larry Froch, MD
  • Tiyana E. Garcia
  • Avrom Gart, MD
  • Eli Ginsburg, MD
  • Lisa Girard, RN
  • Armando E. Giuliano, MD
  • Julian A. Gold, MD
  • Neil J. Goldberg, MD
  • Richard E. Gould, MD
  • Stephen L. Graham, MD
  • Jon B. Greenfield, MD
  • Lloyd B. Greig, MD
  • Robert A. Gross, MD
  • Jennifer Hajj, RN
  • Behrooz Hakimian, MD
  • Michele A. Hamilton, MD
  • Genevieve A. Harlocker, RN
  • Arman Hekmati, MD
  • Donald R. Henderson, MD, MPH
  • Fernando P. Hernandez
  • Sonia M. Hernandez
  • Allen S. Ho, MD
  • David M. Hoffman, MD
  • Gabriel E. Hunt Jr., MD
  • Leonel A. Hunt, MD
  • Andrew F. Ippoliti, MD
  • Abraham Ishaaya, MD
  • Mariko L. Ishimori, MD
  • Michelle Israel, MD
  • Gail N. Jackson, MD
  • Patricia A. Jenkins, RN
  • Stanley C. Jordan, MD
  • David Y. Josephson, MD
  • Lauren N. Kaldjian, PT, DPT
  • Steven Kamara, MD
  • Saibal Kar, MD
  • Sousan Karimi, MD
  • Beth Y. Karlan, MD
  • Ronald P. Karlsberg, MD
  • Harold L. Karpman, MD
  • David Kawashiri, MD
  • Elizabeth M. Kim, MD
  • Hyung L. Kim, MD
  • Joan C. Kirschner, MSN, RN, ANP-BC
  • Michelle M. Kittleson, MD, PhD
  • Charles F. Kivowitz, MD
  • Dee Dee L. Klute-Evans, MSN, RN, CIC
  • Honore G. Kotler, NP
  • Stephanie Koven, MD
  • Amanda Kuehl, RN BSN
  • Megan S. Laib
  • Leslie S. Lane, RN
  • Rachel M. Leon
  • Madeline S. Lerman, BSN, RN
  • Keren Lerner, MD
  • Roger L. Lerner, MD
  • Ronald S. Leuchter, MD
  • Richard A. Lewis, MD
  • Aliza A. Lifshitz, MD
  • Michael C. Lill, MD
  • Debora Lindsay
  • Milton Little, MD
  • Gene C. Liu, MD
  • Ning-Ai Liu, MD, PhD
  • Simon K. Lo, MD
  • Patrick D. Lyden, MD
  • Dharshini Mahadevan
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD
  • Christine Manimtim, BSN, RN
  • Harumi O. Mankarios, RN, OCN
  • Cindy Margolis, RN
  • Annalissa C. Marquez
  • Philomena McAndrew, MD
  • Robert J. McKenna Jr., MD
  • Denisse Medina Lopez
  • Gil Y. Melmed, MD, MS
  • Amin Joseph Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Joel D. Mittleman, MD
  • Nancy Moldawer
  • Jaime D. Moriguchi, MD
  • Mary C. Nasmyth, MD
  • Ronald B. Natale, MD
  • Eve Makoff Newhart, MD
  • Alan C. Newman, DDS
  • David G. Ng, MD
  • Mei (Judy) Ng, LCSW
  • Nicholas N. Nissen, MD
  • Guy D. Paiement, MD
  • Dorothy J. Park, MD
  • Dale Pastel, PharmD
  • Michelle S. Pearl Davis, DO
  • Nichola L Pew, RN
  • Howard E. Pitchon, MD
  • Edwin M. Posadas, MD
  • Villa J. Powell
  • Lupita Rabago
  • Tania K. Ranasinghe, RN
  • Charlotte Roberts, RD, CDE
  • Eileen M. Rodriguez, MSN, RN
  • Kristina H. Rojas, MSN, RN
  • Stacey P. Rosenbaum, MD
  • Barry E. Rosenbloom, MD
  • Fred P. Rosenfelt, MD
  • Teresa Rowen, RN
  • Bruce A. Samuels, MD
  • Tanya M. Sanders, BSN, RN
  • Howard M. Sandler, MD, MS
  • Yeni Santizo, BSN, RN
  • Marilou Sarmiento, RN
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • Irwin Segal
  • Randolph Sherman, MD
  • Wende Sherman, RN, OCN
  • Dean Sherzai, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • Richard Sokolov, MD
  • Andrew Ira Spitzer, MD
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Jay J. Stein, MD
  • Theodore N. Stein, MD
  • Jerrold H. Steiner, MD
  • Sally A. Stewart
  • Colin Stokol, MD
  • Mabel A. Stringfellow
  • Kathryn Sunico, BSN, RN
  • Kazu Suzuki, DPM
  • Charles D. Swerdlow, MD
  • Nicholas R. Szumski, MD
  • Steven W. Tabak, MD
  • Michele Tagliati, MD
  • Michael D. Tajon
  • Heather Thompson, MS, CCC-SLP
  • David B. Thordarson, MD
  • Tram T. Tran, MD
  • Alfredo Trento, MD
  • Leo Treyzon, MD, MS
  • Mark P. Tuazon, RN
  • Doreen Tustison, RN-BC
  • Mark K. Urman, MD
  • Richard J. Van Allan, MD
  • Michael B. Van Scoy-Mosher, MD
  • Sharon Vancleave, RN
  • Angela Velleca, BSN, RN, CCTC
  • Swamy R. Venuturupalli, MD
  • Robert A. Vescio, MD
  • Tracy A. Vidal
  • Natasha Walker
  • Daniel J. Wallace, MD
  • Christine S. Walsh, MD
  • Arthur I. Waltuch, MD
  • Xunzhang Wang, MD
  • Alan Waxman, MD
  • Ariel E. Weber, BSN, RN, CCRN
  • Alan Weinberger, MD
  • Naomi Weiss, MA, CCC-SLP
  • Alexandra M. Wierzbicki, BSN, RN
  • Kenyetta Wilson
  • Deane L. Wolcott, MD
  • Edward M. Wolin, MD
  • Lisa Wong, RN
  • Paige Woodward, NP
  • Clement C. Yang, MD
  • Payam R. Yashar, MD
  • John S. Yu, MD
  • Tina Q. Yu
  • Hong Zhou, NP