sutures newsletter

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

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.


Education Schedule

Click the PDF links below to see the Department of Surgery's education schedule.

Education Schedule - May 2015 (PDF)


Surgery Scheduling

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

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New Preoperative Pain Program Benefits Patients

By Karl Wittnebel, MD, MPH

In October 2014 we began to identify Cedars-Sinai Spine Center patients on high doses of opiates and treat them before surgery to reduce their opiate intake. This Preoperative Pain Program uses interdisciplinary methodology, involving medical management, psychiatric care, pain psychology, physical and occupational therapy and pharmacy services.

» Read more

Trauma Center Focuses on Injury Prevention

Injury is the most under-recognized public health problem facing the nation today. Unintentional injury is the leading cause of death of those between ages 1 and 45 and the fifth-leading cause of death across all ages in the U.S. The most challenging aspect of this large burden of injury is that it is largely preventable. Cedars-Sinai's trauma center is focused on the most effective approach to prevent injuries.

» Read more

Reich Wins Rubenstein Prize

Surgery resident Heidi Reich, MD, is a winner of the 2015 Paul Rubenstein, MD, Prize for Excellence in Resident Research. The prize was awarded May 20, after presentations by Reich and the three other finalists.


 

» Read more

Debaters to Tackle Fee-for-Service Medicine

The future of fee-for-service medicine will be the topic of this year's Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition. The debate will convene for its 12th year on Friday, June 5, at 8 a.m. in Harvey Morse Auditorium. The topic will be "Fee-for-Service Medicine — Will it Survive?"

 

» Read more

Gewertz Delivers Arizona Commencement Speech

Bruce Gewertz, MD, surgeon-in-chief and chair of the Department of Surgery, gave the keynote commencement address May 14 at the University of Arizona College of Medicine in Tucson.


 

» Read more

Residents Receive Fellowship Matches

This year's fellowship matches for Cedars-Sinai surgical residents have been announced.

» Read more

Mini-Symposium Considers the Aging Physician

The eighth Mini-Symposium in Clinical Surgery convened April 30 to analyze the topic "The Aging Physician." These mini-symposiums, sponsored by the Cedars-Sinai Department of Surgery, involve brief analyses of central problems in clinical medicine from four perspectives.

» Read more

Circle of Friends Honorees for April

The Circle of Friends program honored 215 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

New Preoperative Pain Program Benefits Patients

By Karl Wittnebel, MD, MPH

In October 2014 we began to identify Cedars-Sinai Spine Center patients on high doses of opiates and treat them before surgery to reduce their opiate intake. This Preoperative Pain Program uses interdisciplinary methodology, involving medical management, psychiatric care, pain psychology, physical and occupational therapy and pharmacy services.

These services are all co-located within the Spine Center to provide both patient convenience and opportunities for ad lib team collaboration among providers. We see the patients twice per week, ideally for six to eight weeks, depending upon their initial intake of medication. Our targets are individualized to some degree, but overall, we hope to reduce daily opiate intake to below the equivalent of 80mg of morphine per day.

Among patients who enroll in the program and participate, we have had success reducing opiate doses without undue suffering. We track patient-reported outcomes with the PROMIS-29 tool using an iPad interface developed by Spine Center staff, and the data for each patient is then uploaded to a Research Electronic Data Capture (REDCap) database.

Though not yet available in CS-Link™, this data provides excellent longitudinal tracking of pain levels, how much pain interferes with daily activities, and co-variates such as depression and anxiety, in a response format that is generally easily managed by each patient during a clinic visit. This tool also is used at follow-up visits after surgery to track post-surgical functional status.

The effort has not been without its challenges. Our main issues have included changing the workflow of surgery scheduling to permit time for this program to work, the sensitive and complex nature of opiate medication use, and the geographic referral pattern of the Spine Center itself.

For instance, it may not be feasible for a scoliosis patient requiring a T10-pelvis fusion to travel from Bakersfield twice per week to participate in our program. Similarly, some patients are hesitant to enroll due to anxiety about changing long-established methods of coping with pain, and this is counterbalanced against the need for safe intraoperative and postoperative care.

We have, however, been pleasantly surprised by the number of patients who look forward to the opportunity to reduce their medication intake and relish the chance to participate in the program. Many have been taking high doses of medication for years, and have simply not been encouraged or able to find any provider with a plan to help them achieve this goal.

The main reasons for creating the Preoperative Pain Program were to avoid cancellations at the time of surgery, to improve postoperative pain control and to avoid undue complications such as extended intubation or care in an intensive care unit, extended length of stay or respiratory failure requiring reintubation. During the course of the program, participants have largely been able to avoid these adverse outcomes, while patients not participating have continued to experience them. Our total numbers remain modest, however, and data collection continues for what remains a pilot effort.

Though the Preoperative Pain Program has not formally been expanded to include nonspine patients, we routinely field consults from anesthesiologists and surgeons on a variety of preoperative patients and are always willing to assist in whatever way we can to provide perspective on pain medication use and other comorbidities such as depression and anxiety that can complicate care at the time of surgery. Please feel free to contact us with questions at 310-423-8886.

Trauma Center Focuses on Injury Prevention

Injury is the most under-recognized public health problem facing the nation today. Unintentional injury is the leading cause of death of those between ages 1 and 45 and the fifth-leading cause of death across all ages in the U.S. The most challenging aspect of this large burden of injury is that it is largely preventable.

Cedars-Sinai's trauma center is focused on the most effective approach to prevent injuries and prioritizes its efforts based on our local epidemiologic data. Cedars-Sinai, along with other trauma centers across the nation, collaborates with injury-prevention experts and resources within the community.

For example, in May, National Trauma Awareness Month celebrates its 27th anniversary with the campaign slogan "3D Trauma Prevention." The campaign is focusing on contributors to motor vehicle crashes, including drugs and alcohol, distraction and drowsiness. Cedars-Sinai has been dedicated to supporting this educational prevention message ever since President Ronald Reagan signed the declaration declaring May as National Trauma Awareness Month in 1988.

Part of every effective injury-prevention effort is a focus on proximate causes. The Cedars-Sinai trauma center uses the screening, brief, intervention and referral process to screen for alcohol in trauma patients. This tool provides a mechanism to identify problem drinkers and has the capability to provide intervention or referral for patients identified as problem drinkers.

Cedars-Sinai is part of the Hospital and Morgue Program, a collaboration with Los Angeles County Superior Court and the Office of the Coroner. The goal of this program is to reduce recidivism among its participants, who have been convicted of driving under the influence of alcohol or drugs.

The program consists of three components:

  • An interactive lecture at Cedars-Sinai by an experienced trauma nurse
  • A visit to the Coroner's Office; the visit consists of a tour, case presentations and an interactive lecture from a guest speaker
  • A 500-word essay in which participants describe the impact they have felt by participating in this program

Each year the American Trauma Society, in collaboration with the Society of Trauma Nurses and other professional organizations, highlights injury-prevention topics such as risks of falls, distracted driving, drunk driving and sports injuries.

Reich Wins Rubenstein Prize

Surgery resident Heidi Reich, MD, is a winner of the 2015 Paul Rubenstein, MD, Prize for Excellence in Resident Research. The prize was awarded May 20, after presentations by Reich and the three other finalists.

The title of Reich's presentation was "Repeat Dosing of Allogeneic Cardiosphere-Derived Cells After Myocardial Infarction in Immunocompetent Rats."

This year's other Rubenstein winner is Christopher Vanichsarn, MD, a resident in the Department of Medicine.

Named for the first director of Medical Education at Cedars-Sinai, the competitive prize recognizes outstanding research by residents. It is sponsored by the Burns and Allen Research Institute and the Cedars-Sinai Clinical and Translational Research Center, a partner in the UCLA Clinical and Translational Science Institute.

Debaters to Tackle Fee-for-Service Medicine

Derek Serna-Gallegos, MD

Monica Jain, MD

The future of fee-for-service medicine will be the topic of this year's Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition.

The debate will convene for its 12th year on Friday, June 5, at 8 a.m. in Harvey Morse Auditorium. The topic will be "Fee-for-Service Medicine — Will it Survive?"

Derek Serna-Gallegos, MD, will argue that it will survive. Monica Jain, MD, will argue that it won't.

The debate will be part of Cedars-Sinai's second annual Founders Day (see story below).

For more information about this annual event, contact Leo Gordon, MD, at leo.gordon@cshs.org.

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


Cedars-Sinai History Goes Pop for Founders Day

What does Cedars-Sinai have to do with pop culture? Come to the second annual Founders Day Celebration and you'll get an answer. A lot of answers, actually, when organizers of the yearly celebration of the medical center's founding invite attendees to compete in a game show.

The 50-minute celebration will take place Friday, June 5, at noon in Harvey Morse Auditorium. Box lunches will be provided.

The game show, a three-part quiz about the many instances in which Cedars-Sinai has appeared in pop culture over the years, is open to everyone. Audience members at the celebration can participate via the electronic voting tools they will find on their seats. The winners of the preliminary rounds of the quiz will compete in a playoff, and yes, there will be prizes.

Other Founders Day events:

  • 8 a.m., Harvey Morse Auditorium: Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition. The topic is "Fee-for-Service Medicine — Will It Survive?"
  • 11 a.m. and 1 p.m., Historical Conservancy exhibit: Docent-led tours of the exhibit. Meet at the beginning of the exhibit, near the Plaza Café.

Gewertz Delivers Arizona Commencement Speech

Bruce Gewertz, MD, surgeon-in-chief and chair of the Department of Surgery, gave the keynote commencement address May 14 at the University of Arizona College of Medicine in Tucson.

A video of Gewertz's speech, "Leadership Is the Best Medicine," can be seen at the university's website. His introduction begins around 24 minutes into the video, and his talk begins just after the 26-minute mark.

Click the PDF link below to see his prepared remarks.

Dr Gewertz Arizona Commencement Address (PDF)

Residents Receive Fellowship Matches

This year's fellowship matches for Cedars-Sinai surgical residents have been announced. They are:

  • Seth Felder, MD – Colorectal Surgery, University of Minnesota
  • Alexandra Gangi, MD – Surgical Oncology, Moffit Cancer Center
  • Silvia Kurtovic, MD – Plastic Surgery, Duke University
  • Scott Short, MD – Pediatric Surgery, University of Utah
  • Matthew Singer, MD – Trauma, University of Arizona

Mini-Symposium Considers the Aging Physician

The eighth Mini-Symposium in Clinical Surgery convened April 30 to analyze the topic "The Aging Physician."

David Cossman,
MD

Hart Cohen, MD

Lauren Polak, Esq.

Randy Sherman, MD

These mini-symposiums, sponsored by the Cedars-Sinai Department of Surgery, involve brief analyses of central problems in clinical medicine from four perspectives.

At the April 30 event, David Cossman, MD, director of Vascular Trauma in the Division of Vascular Surgery, shared his thoughts on surgeons entering the later stages of a surgical career.

Hart Cohen, MD, of the Department of Neurology, outlined the specific problems a neurologist faces when analyzing an aging physician.

The legal and credentialing aspects of an aging medical staff were analyzed by Lauren Polak, associate legal counsel in Legal Affairs and legal adviser to the medical staff.

The hour ended with remarks by Randy Sherman, MD, vice chair of the Department of Surgery. A surgeon and a pilot, Sherman reviewed the methods of measuring competencies in these two professions.

A question-and-answer segment followed the presentations.

The event will be available soon on video. For a video copy or for video access to this mini-symposium, please contact Leo Gordon, MD, at leo.gordon@cshs.org.

Circle of Friends Honorees for April

The Circle of Friends program honored 215 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.

  • Mona Akhlaghi, BSN, RN
  • Joselito B. Alba
  • Farin Amersi, MD
  • Paula J. Anastasia Davis, RN, MN, AOCN
  • John B. Andrews, MD
  • Gary R. Appel, RN, PCCN
  • Francisco A. Arabia, MD
  • Caden Austin, RN
  • Pamela Priscilla Babila, BSN, RN
  • C. Noel Bairey Merz, MD
  • Babak R. Bamshad, MD
  • Eli Baron, MD
  • Stephanie Beaton
  • Leon I. Bender, MD
  • Page A. Bertolotti, BSN, RN, OCN
  • Keith L. Black, MD
  • Michael J. Blumenkrantz, MD
  • Vivien S. Bonert, MD
  • Arletta R. Boone
  • Maria Belinda Brant, BSN, RN-BC, CCTC
  • Sonia Castillo
  • Michael L. Chaikin, MD
  • Cheryl G. Charles, MD
  • George Chaux, MD
  • Derek Cheng, MD
  • Sumeet S. Chugh, MD
  • Stephen R. Corday, MD
  • Alice C. Cruz, MD
  • Angelica R. Cuellar, LVN
  • Josephine Cunanan
  • M. Alicia Curiel
  • Robert M. Davidson, MD
  • Robert W. Decker, MD
  • Maria L. Delioukina, MD
  • Jose A. Diaz
  • Alice R. Dick, MD
  • Deanna L. Dilibero, PharmD
  • Jack Ditlove, MD
  • Christy J. Dobbie, RN
  • Ma. Charisma Joy Dondonay
  • Robert J. Dowhy
  • Naomi Drucker, RN
  • J. Kevin Drury, MD
  • Julie A. Dunhill, MD
  • Joseph E. Ebinger, MD
  • Marianne S. Ebrahim, MD
  • Robert W. Eitches, MD
  • Shervin Eshaghian, MD
  • Richard Essner, MD
  • Edward J. Feldman, MD
  • James S. Fishkin, MD
  • Charles A. Forscher, MD
  • Stuart Friedman, MD
  • David M. Frisch, MD
  • Larry Froch, MD
  • Rodney A. Gabriel, MD
  • Ryan P. Galang, RN-BC
  • Elayne K. Garber, MD
  • Francine J. Gates
  • Armando E. Giuliano, MD
  • Richard N. Gold, MD
  • Neil J. Goldberg, MD
  • Theodore B. Goldstein, MD
  • Martin N. Gordon, MD
  • Steven B. Graff-Radford, DDS
  • Stephen L. Graham, MD
  • Jeffrey R. Gramer, MD
  • Violette G. Gray, MD
  • Sarah C. Greene, MD
  • Kapil Gupta, MD
  • David S. Hallegua, MD
  • Solomon I. Hamburg, MD
  • Michele A. Hamilton, MD
  • John G. Harold, MD
  • Michael D. Harris, MD
  • Timothy D. Henry, MD
  • Ryan M. Hodges, RN
  • David M. Hoffman, MD
  • Mackenzie S. Hoffmann, BSN, RN
  • Gabriel E. Hunt Jr., MD
  • Leonel A. Hunt, MD
  • Andrew F. Ippoliti, MD
  • Laith H. Jamil, MD
  • J. Patrick Johnson, MD
  • Neel R. Joshi, MD
  • Stephanie M. Kagimoto
  • Joseph Kahwaji, MD
  • Gena Julia Kangleon, RN
  • Saibal Kar, MD
  • Beth Y. Karlan, MD
  • Scott R. Karlan, MD
  • Ilan Kedan, MD, MPH
  • Raj Khandwalla, MD
  • Stephanie Khouw, MSN, AGNP-BC
  • Ali Khoynezhad, MD, PhD
  • Howard H. Kim, MD
  • Asher Kimchi, MD
  • Charles F. Kivowitz, MD
  • Jon A. Kobashigawa, MD
  • Kevin Koomalsingh, MD
  • Michael A. Kropf, MD
  • David A. Kulber, MD
  • Marie Kristine A. Lacar, RN
  • Michael L. Langberg, MD
  • Gary E. Leach, MD
  • Mario R. Leal
  • Betty P. Lee, MD
  • Keren Lerner, MD
  • Michael M. Levine, MD
  • Andrew J. Li, MD
  • Jamie Libo, RN
  • Michael C. Lill, MD
  • Simon K. Lo, MD
  • Patrick D. Lyden, MD
  • Hooman Madyoon, MD
  • Rajendra Makkar, MD
  • Josephine T. Maleon
  • Glenn A. Marshak, MD
  • Lucy Mathew, NP
  • Ruchi Mathur, MD
  • Paula McAllister, MD
  • Philomena McAndrew, MD
  • Janet McCready, RN
  • Robert J. McKenna Jr., MD
  • Leslie Memsic, MD
  • Kiarash Michel, MD
  • Stewart Middler, MD, PhD
  • Sarah Miller, BSN, RN
  • Eric S. Millstein, MD
  • Margo Minissian, MSN, RN, NP, ACNP-BC, CLS-BC, CNS
  • Mike Mirahmadi, MD
  • Joel D. Mittleman, MD
  • Charles N. Moon, MD
  • Florence G. Moreno, CNA
  • Jaime D. Moriguchi, MD
  • Esther Morrison, RN
  • Youram Nassir, MD
  • Ronald B. Natale, MD
  • Nicholas N. Nissen, MD
  • Edward Kazuhisa Nomoto, MD
  • Jignesh K. Patel, MD, PhD
  • Rajan M. Patel, MD
  • Chirag G. Patil, MD
  • Edward H. Phillips, MD
  • Mark Pimentel, MD
  • Terry E. Podell, MD
  • Stephen C. Rabin, MD
  • Alexandre Rasouli, MD
  • Shahram F. Ravan, MD
  • Bella Reznik
  • R. L. Patrick Rhoten, MD
  • Robert Richter, MD
  • Charlotte Roberts, RD, CDE
  • Barry E. Rosenbloom, MD
  • Fred P. Rosenfelt, MD
  • Jeremy D. Rudnick, MD
  • Ruth "Virginia" Russell, MD
  • Wendy L. Sacks, MD
  • Jeanne M. Safford, RN
  • Allen I. Salick, MD
  • Ashley M. Samaniego, RN
  • Anna L. Sanchez, RN
  • Gregory P. Sarna, MD
  • Jay N. Schapira, MD
  • C. Andrew Schroeder, MD
  • Laurence Seigler, MD
  • Cigal T. Shaham, MD
  • Melanie Sheeter
  • Michael M. Shehata, MD
  • Larisa B. Shekhtman, RN
  • John L. Sherman, MD
  • David Q. Shih, MD
  • Takahiro Shiota, MD
  • Robert J. Siegel, MD
  • Allan W. Silberman, MD, PhD
  • David S. Silver, MD
  • Stuart L. Silverman, MD
  • Charles F. Simmons, MD
  • Steven M. Simons, MD
  • R. Kendrick "Ken" Slate, MD
  • Lynette Smith
  • Karyn Morse Solky, MD
  • Andrew Ira Spitzer, MD
  • Jasminka Stegic, MS, ANP-BC, CCRN
  • Daniel J. Stone, MD, MPH, MBA
  • Eric R. Sue, MD
  • Steven Sykes, MD
  • Steven W. Tabak, MD
  • Michele Tagliati, MD
  • Stephan R. Targan, MD
  • Mihaela D. Te Winkel, ACNP-BC, MSN
  • David B. Thordarson, MD
  • Hitoshi "Tommy" Tomizawa, MD, MPH
  • Shirin Towfigh, MD
  • Katie D. Tran, BSN, RN, PCCN
  • Tram T. Tran, MD
  • Alfredo Trento, MD
  • Richard Tuli, MD, PhD
  • Dimitrios Tzachanis, MD, PhD
  • Michael B. Van Scoy-Mosher, MD
  • Robert A. Vescio, MD
  • Lloyd Villacorta
  • Gloria Villasenor
  • Daniel J. Wallace, MD
  • Christine S. Walsh, MD
  • Xunzhang Wang, MD
  • Janet Y. White, MD
  • Nicole Williams, RN
  • Veronica T. Wootton
  • Philip A. Yalowitz, MD
  • Payam R. Yashar, MD
  • Roxanne Yongvanich, RN
  • Run Yu, MD
  • Jason Zimmerman, RN
  • Nancy A. Zimmerman