sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2017 | Archived Issues

Changes in Senior Leadership Structure

Cedars-Sinai is pleased to announce several changes in its senior leadership structure. These appointments will help the organization efficiently address the expanding geography and scope of Cedars-Sinai’s programs and services, and the important work of integrating clinical care across these sites.

» Read more

President's Perspective on Efficiency

Presidents-Perspective-logo-callout

By Thomas M. Priselac, President and CEO

I'd like to share some thoughts on the broader topic of affordability and efficiency, their place in Cedars-Sinai's mission, and the opportunities and challenges they present for everyone who works or practices here.

» Read more

U.S. News Best Hospitals 2017-18

Cedars-Sinai Medical Center is ranked nationally in 12 specialties and has been named to the "Honor Roll" in the just-released U.S. News & World Report's "Best Hospitals 2017-18." The medical center was ranked #11 of more than 4,500 hospitals in the nation, placing it among a select group of Honor Roll hospitals.

» Read more

Leadership Program Graduates Class

The Cedars-Sinai Leadership in Healthcare Improvement Program graduated its inaugural cohort of residents and fellows in July. The six-month program is designed to develop the ability to lead sustainable and rigorous improvement initiatives in healthcare.

» Read more

Two Minutes With …

This question-and-answer feature will help you get to know some of the faculty in the Cedars-Sinai Department of Surgery. This month's installment features Jennifer Anger, MD.


» Read more

Study Examines Lung Cancer Among Nonsmoking Women

A new study examines the biology of non-small-cell lung cancer (NSCLC) and new therapeutic molecular targets, focusing on the pathogenesis of non-smoker female NSCLC patients. Harmik J. Soukiasian, MD, director of Division of Thoracic Surgery at Cedars-Sinai, contributed to the study.

» Read more

Deadly Bacteria Could Reduce Organ Rejection

Jordan co

An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai. The study, published in the New England Journal of Medicine, found treating patients with the drug IdeS® before transplantation significantly reduced, and in most cases eliminated, donor-specific antibodies that can cause rejection or failure of new organs.

» Read more

Circle of Friends Honorees for July

CoF

The Circle of Friends program honored 85 people in July. 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

Librarian Brings Wit and Intellect to Her Work

Librarian Janet Wulf co

For decades, Janet Wulf's inquisitive energy, intellectual curiosity and wry sense of humor have made her an indispensable fixture in the Medical Library. The recent winner of a Cedars-Sinai President's Award is best known for her exhibits that include ones on Civil War medicine, patent medicine bottles and objects removed from human airways.

» Read more

Research Helps Predict Outcomes After Liver Transplant

A routinely used hospital tool can predict which liver transplant recipients are more likely to do poorly after surgery, according to a study led by Cedars-Sinai. The findings could help doctors identify which patients should receive physical therapy or other interventions to improve their recovery.

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Using Young Stem Cells to Rejuvenate Old Hearts

Cardiac stem cell infusions could someday help reverse the aging process in the human heart, making older ones behave younger, according to a new study from the Cedars-Sinai Heart Institute. "Our previous lab studies and human clinical trials have shown promise in treating heart failure using cardiac stem cell infusions," said Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute and the primary investigator of the study. "Now we find that these specialized stem cells could turn out to reverse problems associated with aging of the heart."

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Are You a Veteran? Let Us Know

Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

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CS-Link Tip: Avoiding Clicks and Scrolling

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Extra clicks and endless scrolling are a waste of time and unnecessary when you know how to navigate CS-Link™. Instead of scrolling or hunting for a wild card (***) or a list, use the F2 key instead and it will direct you there.

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Changes in Senior Leadership Structure

By Mark Gavens, John Jenrette, MD, Shlomo Melmed, MD, and Ed Prunchunas

One of the reasons for Cedars-Sinai’s success over the years is our ability to continually adapt our organizational structure to effectively address changes in the health care environment. As part of that endeavor, we are pleased to announce several changes in our senior leadership structure. These appointments will help us efficiently address the expanding geography and scope of Cedars-Sinai’s programs and services, and the important work of integrating clinical care across these sites.

Bryan Croft will be assuming a broader role in leading day-to-day operations of Cedars-Sinai Medical Center as Senior Vice President for Operations. In this new role, he will assume operational responsibility for all service line and clinical support services. Reporting to Bryan will be Vice President for Service Line Operations Joan August, as well as the successor to Bryan’s former position of Vice President for Service Line Operations and the successor to Vice President for Clinical Support Services Jeff Deeter. Bryan is beginning those two recruitments immediately. He will continue to report jointly to Mark Gavens and Shlomo Melmed, MD. Bryan joined Cedars-Sinai in 2010 as Vice President for Service Line Operations after serving in operating capacities at Methodist Hospital in Texas and Queen’s Medical Center in Hawaii. He has been instrumental in advancing our operations agenda and developing clinical programs and services, working closely with our chairs and medical staff leadership.

Reflecting the increasingly important responsibility of delivering high-quality nursing care to our patients and the development and support of the professional practice of nursing at Cedars-Sinai Medical Center, our ambulatory care clinics, the Medical Network and Marina Del Rey Hospital, the Chief Nursing Officer/Health System Chief Nursing Executive position is being advanced from a Vice President to a Senior Vice President. This will apply to the incumbent, Linda Burnes Bolton, RN, PhD, FAAN, as well as her successor. The position will continue to report to Mark Gavens. As you know, Linda announced her retirement from the position last year, and will become our Chief Health Equity Officer upon the recruitment of her successor.

With the ongoing major expansion of the Medical Network, the role and responsibilities of its Chief Operating Officer have grown significantly. As a result, Jill Martin is being promoted to Senior Vice President. She will continue to report to John Jenrette, MD. Over the past few years, the operations of the Medical Network have added 10 new physician practices, created three joint venture outpatient surgery centers and opened four new primary care sites and two new urgent care centers. Since joining Cedars-Sinai in 1997, Jill has been a key member of its leadership team, helping to guide its growth, steward its resources and integrate its operations with the rest of Cedars-Sinai.

As a result of Ed Prunchunas taking on additional responsibilities in the last few years, David Wrigley’s role is being expanded to include not only his current responsibilities, but to encompass all of the Medical Center’s financial operations. Reflecting this change, he is being promoted to Senior Vice President for Finance. Patricia Kittell, Vice President for Patient Financial Services, will report to David. David joined Cedars-Sinai as Vice President for Finance in 2014, after serving in leadership positions at Presence Health (the largest Catholic health system in Illinois) and at the accounting firm KPMG. At Cedars-Sinai, he has had significant involvement in the acquisition of Marina del Rey Hospital and the 6500 Wilshire building, and the proposed Torrance Memorial affiliation.

Please join us in thanking these leaders for their past and future contributions to Cedars-Sinai, and congratulating them on their new roles.

President's Perspective on Efficiency

By Thomas M. Priselac
President and CEO

In June, I wrote to you about the three imperatives for Cedars-Sinai as we pursue our vision as one of the nation's leading healthcare organizations:

  • Retain our absolute commitment to quality
  • Make our services more geographically and virtually accessible to patients and consumers
  • Fulfill our obligation to make healthcare affordable through operational and clinical efficiency work

While I focused at that time on our FY18 budget planning, today I'd like to share some thoughts on the broader topic of affordability and efficiency, their place in Cedars-Sinai's mission, and the opportunities and challenges they present for everyone who works or practices here. I'll be focusing more on how we approach this challenge together rather than trying to prescribe specific solutions. As we've learned from successfully tackling complex issues in the past, specific solutions are much more effective and meaningful when they come from a process that involves each of you.

If you ask just about anyone what differentiates Cedars-Sinai, almost all will reference our quality. Thanks to your extraordinary commitment, expertise and relentless dedication, we continually set new standards for the nation, and, most importantly, improve the lives of our patients. A focus on quality is definitely palpable at Cedars-Sinai — it's part of our mission, part of our DNA.

Now, our focus is to raise operational and clinical efficiency to the same level as quality. Put simply, our collective challenge is to deliver the highest quality, appropriate care in an efficient, affordable manner.

The imperative to optimize our operational and clinical efficiency is not only a business issue; it is also our institutional obligation to do so.

As a business issue, the very nature of our patient care, education, research and community benefit mission creates a cost structure here at Cedars-Sinai that is higher than community hospitals and other lower-cost settings. If we are to fulfill our mission in an increasingly price-sensitive world, we must do all we can to assure we are as operationally and clinically efficient as possible, in everything we do.

More importantly, if we are advocates for a healthcare system that is truly accessible to all Americans, we have an institutional obligation to optimize our efficiency and affordability.

Increasing our efficiency does not mean infringing on our quality. In fact, over the past several years, our clinical efficiency efforts have improved the quality of care. We have done so by avoiding unnecessary admissions through better care in the outpatient setting, reducing inpatient length-of-stay and reducing unnecessary or ineffective tests and procedures.

Efficiency requires an ongoing focus on keeping things as simple and streamlined as possible (for our patients and for each other), and continually examining our priorities and processes.

This aspect of efficiency will not only benefit our patients but will also benefit each of us. If we identify opportunities to simplify our internal processes, it can increase the job satisfaction of our physicians and staff, enabling them to spend time on what they enjoy most about their work.

Our approach to operational and clinical efficiency should be grounded in the following principles:

Everyone's got a piece of this.
This will not be a top-down push. The challenge is big enough, and the urgency great enough, that it will require the involvement, discipline and innovation of everyone at Cedars-Sinai. Good ideas can come from anywhere in the institution. Operational efficiency improvements are not limited to clinical areas, they can and should occur in all parts of the institution, including academics and support services. As we have done in the past with other issues, we will look together at best practices (operational and clinical), marketplace aspects, and, most importantly, tap the innovative minds of everyone at Cedars-Sinai.

This is not a campaign, it's about who we are.
Our work to continually enhance our efficiency and affordability, like our work to continually enhance our quality of care, is not a one-off, short-term initiative. This won't be solved just by one or a small number of solutions. This is a systemwide issue that demands our collective wisdom and energy. There will likely be thousands of ways to increase efficiency — some large, some small — and it is the collection of all of these efforts that will enable us to achieve our goals together.

Be open to thinking differently.
To make meaningful improvements in efficiency to serve the community, we can't limit our thinking to business-as-usual. We should be willing to question long-held assumptions. Even if it eventually turns out in some cases that these assumptions remain valid, everyone should feel free and secure to raise questions. Healthcare has changed significantly over the years; many processes and perspectives that were best practices in the past may need updating, replacement or even elimination.

An open and supportive approach.
Although it's often easier to point out opportunities for increased efficiency in other departments, each of us should focus first on the area we know best: our own. This is not to say that there aren't major opportunities you may identify in other areas along with your own, given the interconnectedness of healthcare and our institution. And nothing is off limits. But it is crucial that everyone approach this in a constructive, open and supportive manner — no finger-pointing allowed!

The Operational Efficiency Council, led by Mark Gavens, will coordinate our efforts throughout the institution. Over the coming months, you will begin to see a variety of tools, two-way communications and other information-sharing to enable each of you to participate in a coordinated effort. Until then, please share any ideas you may have on increasing efficiency through your respective management structures. Equally important, our clinical efficiency efforts, led by Dr. Scott Weingarten, will continue their successful work and expand their efforts throughout the institution.

Many years ago, Cedars-Sinai set a lofty goal of providing the highest quality care. This was a challenging goal, as it involved many moving parts and every department. Because of the people who work and practice here, we were not only able to become a national quality leader; it is now embedded in our culture. I am confident that together we are up to the challenge of providing care that is not only of the highest quality but delivered in an affordable, efficient manner for the people we serve.

See past President's Perspective columns on the intranet.

U.S. News Best Hospitals 2017-18

From Thomas M. Priselac, President and CEO

Cedars-Sinai Medical Center is ranked nationally in 12 specialties and has been named to the "Honor Roll" in the just-released U.S. News & World Report's "Best Hospitals 2017-18."

The medical center was ranked #11 of more than 4,500 hospitals in the nation, placing it among a select group of Honor Roll hospitals.

The rankings are based on a variety of measures, including patient outcomes, patient safety, technology and reputation (based on surveying physicians). Each year, U.S. News makes changes in its rankings methodology; among the changes this year is a risk adjustment based on socioeconomic status.

As with all of the accolades and honors Cedars-Sinai receives, we can be very proud of our performance. It is important, however, to keep "hospital scorecards" like this and others in perspective. Currently, there are limits and methodological flaws in such rankings, and we should not let them distract any of us from our most important work — providing the highest-quality, efficient, affordable, patient-centered care possible.

At Cedars-Sinai, we have rigorous metrics in place to continually assess our quality, efficiency and effectiveness in patient care, research, education and community benefit. We will continue to use these metrics both to assess our performance and to help identify opportunities for continual improvement.

With that balanced perspective in mind, the U.S. News rankings are one of many ways of recognizing the outstanding work that goes on daily at Cedars-Sinai. Below are the 12 specialties for which Cedars-Sinai was ranked nationally:

  • Cancer (#47)
  • Cardiology and Heart Surgery (#4)
  • Diabetes and Endocrinology (#18)
  • Ear, Nose and Throat (#26)
  • Gastroenterology and GI surgery (#4)
  • Geriatrics (#21)
  • Gynecology (#28)
  • Nephrology (#15)
  • Neurology & Neurosurgery (#14)
  • Orthopedics (#10)
  • Pulmonology (#20)
  • Urology (#12)

The quality of care and compassion that all of our patients receive are the result of the commitment every one of you brings to work each day. On behalf of our patients and community, thank you for being at Cedars-Sinai.

Leadership Program Graduates Class

Participants in the Cedars-Sinai Leadership in Healthcare Improvement Program (from right): Bruce Gewertz, MD, chair of the Department of Surgery; Christos Colovos, MD, PhD; Tom Feng, MD; Halley Vora, MD; Pratik Mehta, MD; Navpreet Dhillon, MD; and James Tatum, MD.

The Cedars-Sinai Leadership in Healthcare Improvement Program graduated its inaugural cohort of residents and fellows in July. The six-month program is designed to develop the ability to lead sustainable and rigorous improvement initiatives in healthcare.

Participants included four general surgery residents: Christos Colovos, MD, PhD; Pratik Mehta, MD; Navpreet Dhillon, MD; and Halley Vora, MD; two urology residents: Tom Feng, MD, and Devin Patel, MD; and surgical and critical care fellow James Tatum, MD.

Program participants learned about a range of leadership and quality improvement topics during dinner sessions at the OR 360 space.

Harry Sax, MD, explored the pros and cons of narcissistic leadership through a personality assessment and a body language quiz on emotional intelligence.

Human factors research scientist Douglas Wiegmann, PhD, discussed the Swiss cheese model of accident causation and how to use a structured classification tool to identify unsafe conditions that can lead to human error.

Eric Ley, MD, reviewed the Formula One pit-stop model, along with other team strategies and tools to enhance performance and patient safety.

Quality improvement specialist Sarah Francis taught participants a range of Lean and Six Sigma process improvement tools and provided hands-on project feedback and support.

During one of the evening sessions, participants visited the Sterile Processing Department to observe a process in action and identify contributing factors that could lead to delays in sterilizing surgical instruments.

In addition to the evening sessions, participants worked on three improvement projects:

  • Tatum and Dhillon focused on improving communication during multidisciplinary rounds in the Surgical Intensive Care Unit. They investigated the adverse effect that numerous computers on wheels within the rounding group had on team formation and effective group communication.
  • Vora and Mehta aimed to reduce the number of surgical instruments in trays by eliminating unused instruments and consolidating trays.
  • Feng, Patel and Colovos worked on improving surgical robot utilization and efficiency.

The next Leadership in Healthcare Improvement Program will begin in September.

Two Minutes With …

Jennifer T. Anger, MD

This question-and-answer feature will help you get to know some of the faculty in the Cedars-Sinai Department of Surgery.

Jennifer T. Anger, MD, MPH

Where did you grow up?

I grew up in Manhattan Beach, California. I trained in urology at Cornell University in New York City, and planned to stay there as faculty after graduation. However, while visiting home on vacation, I met a New Yorker in Hermosa Beach. This New Yorker, Lowell, became my husband and brought me back to my hometown, where I live today.

Why did you decide to specialize in urology, urogynecology?

I was inspired by the dedication of my urology professors at the University of Southern California. I also realized that there was a real need for more women doctors in urology. In fact, I was the second woman to graduate from the urology residency program at Cornell. Even today, only 8 percent of urologists are women, despite women comprising 30 percent of patients seeking urologic care. During my residency, I developed interest in urologic trauma and reconstruction, which led me to pursue a fellowship in this subspecialty with George Webster, MD, at Duke University. I trained in both female and male incontinence, female pelvic organ prolapse and male urethral reconstruction.

Today, urologists receive fellowship training in either male urethral reconstruction or female pelvic medicine and reconstructive surgery (FPMRS), also called female urology or urogynecology. My partner, Karyn Eilber, MD, and I came to Cedars-Sinai in 2010 to build a program in the field of FPMRS. I am thrilled that, after recruiting our third partner, A. Lenore Ackerman, MD, in 2016, we are now in the process of applying for our own ACGME-accredited fellowship.

What is the most rewarding aspect of our job?

Surgical success is the most rewarding aspect of my job. It is incredibly gratifying when a patient with urinary incontinence who, after years of suffering, tells me, "You changed my life." Also rewarding is a career that balances clinical work, research, and teaching residents and medical students. Every day is different from the next.

What is the funniest thing a patient has ever said to you?

Recently, I removed a man's testicle, which had ruptured in a motorcycle accident. Before his surgery, I wrote "yes" on his left inguinal area, which is routine protocol to assure correct-sided surgery. He was an artistic man with a great sense of humor, and had my "yes" permanently tattooed on his groin!

What did your parent(s) always tell you that you now have to admit was correct?

My mother, who is a retired high school principal, once said that it is not always necessary to win arguments. Sometimes, it is best to say, "You might be right." I have found this to be very useful in life and negotiating.

If you could spend the day doing one thing, what would it be?

There is nothing like spending a day at the beach with my family. My children have very distinct interests, yet they all like to boogie board. I could boogie board with them all day long. Taking children out of the picture and speaking more selfishly, I love to travel with my husband. Although we don't get to travel together often, we went to Israel, had the opportunity to go to Italy together twice, and last year we made a vacation out of a urology meeting in Japan. We are "foodies," and love to try new places together. I keep snapping my fingers and hoping I will be in Kyoto eating green tea soft serve ice cream.

And speaking even more selfishly, if I had a day to myself and nobody cared where I was, I would catch up on writing papers, and grants, then spend the rest of my free time in a Zumba class!

Study Examines Lung Cancer Among Nonsmoking Women

Harmik J. Soukiasian, MD

A new study examines the biology of non-small-cell lung cancer (NSCLC) and new therapeutic molecular targets, focusing on the pathogenesis of non-smoker female NSCLC patients. Harmik J. Soukiasian, MD, director of Division of Thoracic Surgery at Cedars-Sinai, contributed to the study, which was published in Cancer Biology & Therapy earlier this year.

While most lung cancers are a result of smoking, approximately 25 percent of lung cancer cases worldwide are not attributable to tobacco use. Notably, more than half of the lung cancer cases in women occur in nonsmokers.

Among NSCLC cases, cigarette smokers have a greater association with squamous cell carcinoma than adenocarcinoma, which is more common in nonsmokers. These findings imply that specific molecular and pathological features may associate with lung adenocarcinoma arising in non-smoker female patients.

Current status of research and treatment for non small cell lung cancer in never smoking females (PDF)

Deadly Bacteria Could Reduce Organ Rejection

Stanley C. Jordan, MD

An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

The study, published in the New England Journal of Medicine, found treating patients with the drug IdeS® before transplantation significantly reduced, and in most cases eliminated, donor-specific antibodies that can cause rejection or failure of new organs. These antibodies represent an often impenetrable immunologic barrier to transplantation.

IdeS is derived from an enzyme in the bacteria Streptococcus pyogenes, which causes disorders ranging from sore throats to life-threatening infections.

Stanley C. Jordan, MD, medical director of the Kidney Transplant Program at Cedars-Sinai, said the enzyme is the only one that can completely remove organ-rejecting antibodies and allow kidney transplantation to take place. He noted that one hour after infusion of the enzyme, antibodies declined drastically.

"We found that IdeS could immediately cut patient antibodies in half, making them powerless to attack and injure a newly transplanted kidney," said Jordan, the study’s lead author and professor of Medicine. "We can put a new kidney in a patient without it being rejected."

All people have human leukocyte antigens (HLA), proteins that are key to the immune system’s defense against bacteria, viruses and other potentially harmful invaders. Patients develop antibodies to foreign HLA due to failed organ transplants, transfusions or pregnancy.

These antibodies persist over a patient’s lifetime, causing the body to perceive a newly donated organ as a threat and then attack it. This response prevents patients from having a successful kidney transplant, and they often remain on dialysis for years with diminished quality and length of life.

The study of IdeS involved two coordinated investigations, with a total of 25 patients treated in the U.S. and Sweden. Twenty-four of the patients were transplanted successfully after receiving the investigational therapy.

The special enzyme is produced by Hansa Medical of Sweden.

"IdeS could change the way we treat antibody rejections overall," said Jordan, who also directs the Human Leukocyte Antigen and Transplant Immunology Laboratory at Cedars-Sinai. "We think this approach to preventing organ rejection has the potential to offer significant benefits to those in need of heart, lung, liver and bone marrow transplants."

Nearly 128,000 people in the U.S. are waiting for organ transplants, according to the Organ Procurement and Transplantation Network, with more than 105,000 needing new kidneys. Many of them wait years for an organ to become available, only to have their bodies' immune systems attack it.

"We need larger studies to confirm the promising results of this unique approach to removing patient antibodies that threaten newly transplanted organs," Jordan said. "And we want to investigate any long-term impact IdeS therapy may have on overall antibody production in patients."

Research reported in this study was supported by Hansa Medical of Sweden.

Disclosure: Jordan reports receiving fees from Hansa for medical and scientific consultation.

DOI: 10.1056/NEJMoa1612567

Circle of Friends Honorees for July

The Circle of Friends program honored 85 people in July.

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.

See more information about the program and a list of past honorees.

  • David E. Aftergood, MD
  • Annie Aivazian, RN
  • Ria Aldanese, BSN, RN
  • Thais Aliabadi, MD
  • Carrie M. Allen, LCSW, ACM
  • Angel S. Amador, CP
  • Paula J. Anastasia, MN, RN, AOCN
  • Babak R. Bamshad, MD
  • Terry Barnes
  • Eli M. Baron, MD
  • Sameer K. Berry, MD
  • Philip G. Brooks, MD
  • Neil A. Buchbinder, MD, FACC
  • Brendan J. Carroll, MD
  • Ilana Cass, MD
  • Kirk Y. Chang, MD
  • George Chaux, MD, FCCP
  • Ray M. Chu, MD
  • Susan A. Creel
  • Ana Maricel D. Cruz, RN, ANCC
  • Cynthia N. De Guzman
  • Pedro G. Delgado
  • Premal J. Desai, MD
  • Jeremy A. Falk, MD
  • David M. Filsoof, MD
  • Charles A. Forscher, MD
  • Srinivas Gaddam, MD
  • Bruce L. Gewertz, MD
  • Sara Ghandehari, MD
  • Jaime H. Goldberg
  • Sherry L. Goldman, RN, NP
  • Keith Gurtzweiler, MSN, RN, PHN
  • Paul B. Hackmeyer, MD
  • Bryna J. Harwood, MD
  • Carlos H. Hernandez, CP
  • Jamie Holzmann, LCSW
  • Joseph Isaacson, MD
  • Laith H. Jamil, MD
  • Calvin Johnson, MD
  • Neel R. Joshi, MD
  • Saibal Kar, MD
  • Tina Kiani
  • Dennis H. Kim, MD
  • Evan P. Kransdorf, MD, PhD
  • Yong-Jian Lin, MD
  • Marisol Luna, RN
  • Rajendra Makkar, MD
  • Harumi O. Mankarios, RN, OCN
  • Karizza T. McAlexander, RN
  • Heather L. Mcarthur, MD, MPH
  • Sharron L. Mee, MD, FACS
  • Dorothy T. Melvin
  • Tamar Meszaros, MD
  • Becky J. Miller, MD
  • Alain C. Mita, MD
  • Charles N. Moon, MD
  • Reiad Najjar, MD
  • Ronald B. Natale, MD
  • Farshid Nejad, DPM
  • Nicholas N. Nissen, MD
  • Felicia T. Patterson
  • Aaron M. Perlmutter, MD
  • Edward H. Phillips, MD, FACS
  • Kate Pivoriunas, RN
  • Edwin M. Posadas, MD
  • Lina Quintanilla
  • Alexandre Rasouli, MD
  • Erin L. Reeve, MD
  • Fred P. Rosenfelt, MD
  • Marikit V. Santiago, BSN, RN
  • Jay N. Schapira, MD, FACP, FAHA, FCCP, FACC
  • Allan W. Silberman, MD
  • Rose M. Solomon, RN
  • Megan M. Thomas
  • Alfredo Trento, MD, FACS
  • Leo Treyzon, MD, MS
  • Mark K. Urman, MD, FACC, FASE, FAHA
  • Michael B. Van Scoy-Mosher, MD
  • Robert A. Vescio, MD
  • Andrei Vlad, BS, RTT
  • Andrew S. Wachtel, MD, FCCP
  • Jonathan M. Weiner, MD
  • Robert N. Wolfe, MD, FCCP
  • Marcos Yohannes, RN
  • Christopher Zarembinski, MD

Librarian Brings Wit and Intellect to Her Work

Janet Wulf, a recent President's Award winner, has worked at Cedars-Sinai for more than four decades, most of those in the Medical Library.

"Objects Removed From Human Airways" was the title of one of Janet Wulf's previous exhibits in the Medical Library. The objects included:

  • Meat impacted in esophagus
  • Fishbone in larynx
  • Pin in trachea
  • Chicken bone in esophagus
  • Safety pin in esophagus
  • Bone in right bronchus
  • Peanut in bronchus
  • Sandbur in right bronchus
  • Bone; forceps tip in esophagus
  • Rabbit thigh in esophagus
  • Penny in esophagus
  • Nickel in esophagus
  • Potato in trachea
  • Jigsaw puzzle piece in esophagus
  • Corn kernel in right bronchus
  • Dog tag in esophagus
  • Open safety pin in esophagus
  • Glass bead in right main esophagus
  • Eggshell in larynx
  • Nickel in esophagus
  • Quarter in esophagus
  • Screw in right main bronchus
  • Sewing machine bobbin in esophagus
  • Whistle in esophagus
  • Upholstery tack in left bronchus
  • Nutshell in larynx

(This list was compiled in commemoration of Barney M. Kully, MD, 1896-1975.)

Even for a medical center, Janet Wulf's desk is a bit unusual.

Between a Hewlett-Packard printer and bottle of green aloe Purell is a glass replica of a life-size human head. On top of the transparent cranium sits a spongy gray brain, the size of a child's fist. Within arm's reach of the desk is a small model of a human body and its acupuncture points.

"I bought the head at Ross [Dress for Less]," said Wulf, an administrative services associate in the Medical Library who has worked at Cedars-Sinai for 42 years. "I got the brain from a vendor."

The scavenged items, like so many strange and exotic earlier ones, will only temporarily reside on her desk, which functions more as a runway to the library's main display case near the front entrance. The collection, which also will feature vintage pill boxes and a 1972 research paper entitled "The Headache in History, Literature, and Legend," are all earmarked for an upcoming exhibit on the headache.

Her desk and its multivaried contents merely reflect the bright and curious mind that has curated it for decades. With an inquisitive energy and a wry sense of humor, Wulf has established herself as an indispensable fixture in the Medical Library. Staging the library's popular exhibits are just the start of her duties, which also include purchashing, cataloguing, circulation, event planning and organizing an ongoing lecture series featuring authors affiliated with Cedars-Sinai.

"She's a driving force for the library," said Janet Hobbs, the library's manager. "She's just super creative and very interested in politcs, history and music. She's been an invaluable way for us to engage with our users in different and meaningful ways."

On any given day, this Cedars-Sinai President's Award winner engages in a host of traditional library duties. They include everything from answering questions at the reference desk, registering new library patrons and cataloging the facility's 25,000 bound books to helping a medical student hunt down obscure references in one of the library's 22,000 electronic medical journals.

When Wulf arrived in 1975, just one year before the first patient was admitted to the newly formed medical center created by the merging of Cedars of Lebanon and Mount Sinai Hospital, she didn't start out in the library.

At that time, jobs for new college graduates were hard to come by and the hospital needed phone operators as it transitioned from the switchboard phones to a modern-day telecommunications system. So Wulf — armed with an English degree from California State University, Northridge — applied for the job and was hired.

"People were asking for stuff like, 'Can I speak to the epidemiologist?' And I'd go, 'What?'" she laughed. "So I had to learn — while running on my feet — all the medical terminology."

She later worked in admissions before landing in the Medical Library in the late 1980s. Back then, card catalogues were still used and copies were made with a mimeograph machine.

Wulf found these vintage containers for headache remedies to use in an upcoming exhibit.

"The correction fluid smell would make you dizzy," she said. "It was awful and messy. I had gloves and a lab coat and ink flying. It was terrible."

But for a sense of what makes Wulf tick, library patrons need look no further than the display case just inside the library entrance. About six times a year, she and her colleagues set up a new exhibit to showcase the library's archives. And it's Wulf's quirky sensibilities that typically flavor what patrons see, read and learn from them.

She fondly recalled a display on western frontier medicine, which included her own cowboy and horse models, a Stetson hat, an advertisement for snake oil remedies and a wanted poster. To invoke a bit more wild west realism, she drizzled fake blood left over from Halloween on some rags she slung over the side of an old tin bowl.

"I sort of have an interesting sense of humor," she said with a smile.

Few library visitors who observed her "Foreign Objects Removed from Human Airways" exhibit would disagree. Other topics she's helped bring to life include Civil War medicine, healthcare ethics, patent medicine bottles and a history of Cedars-Sinai.

That historical look at the medical center showcased commemorative keys to the hospital next to prehistoric bones excavated during hospital construction and a collection of maps of the facility dating back to 1938.

To give it a splash of color and fun, Wulf threw in a bright Mount Sinai Hospital brochure featuring a yellow convertible, circa 1954. Nearby, she displayed a hospital café menu from 1962 that advertised a 10-cent cup of coffee and a 75-cent hamburger.

"The prices were just so ridiculous," said Wulf whose interests outside of work includes horses and classic Hollywood cinema. "But I hope when people come away from that exhibit or any others, they leave with a sense of enlightened interest."

While many of the items on display come from the library's collection that's stored in boxes on its shelves, some of it comes from Wulf's own stash of vintage books and assorted knickknacks she enjoys collecting.

While recently antiquing with her sister, Wulf found some vintage tins and bottles that held analgesia medications for headaches. That served as the inspiration for the upcoming exhibit on the history of the headache.

"The history of medicine … is just fascinating," she said. "It's is one of my favorite topics here in the library."

Wulf sits before a table of material earmarked for an upcoming library display.

Research Helps Predict Outcomes After Liver Transplant

A routinely used hospital tool can predict which liver transplant recipients are more likely to do poorly after surgery, according to a study led by Cedars-Sinai. The findings could help doctors identify which patients should receive physical therapy or other interventions to improve their recovery.

The multicenter study, led by principal investigator Vinay Sundaram, MD, uncovered an important new use for a nursing assessment known as the Braden Scale, which is performed for all hospitalized patients as required by Medicare and Medicaid. The Braden Scale aims to evaluate whether newly admitted patients need extra care to avoid developing or worsening pressure ulcers, or bedsores.

Vinay Sundaram, MD

The scale rates patients based on their activity level, mobility, nutrition and other measures of frailty. A low score is associated with greater frailty and increased risk of bedsores.

The investigators reviewed 341 medical records of liver transplant patients at Cedars-Sinai and the Oregon Health and Science University in Portland. They found that liver transplant patients with lower Braden Scale scores were more likely to be nonambulatory at discharge, discharged to a rehabilitation facility and have longer hospital stays compared with transplant patients with higher scores.

The study, published in the journal Liver Transplantation, addresses a pressing clinical need, according to Sundaram, assistant medical director of Liver Transplantation at Cedars-Sinai.

"With medical advances in recent decades, liver transplant patients are living longer than ever," Sundaram said. "So doctors are rightly turning their attention to improving quality of life.

"The problem is that we have no good way to measure how well these patients will do. Our findings provide a way to achieve that so that we can take preventive action."

Specifically, the investigators suggested that patients with low Braden Scale scores be put on supervised exercise programs soon after their transplants.

"These programs could improve physical functioning and, ultimately, quality of life," Sundaram said. Future research with a larger sample, he added, is needed to evaluate whether the Braden Score can help predict overall survival of liver transplant patients.

More than 7,000 liver transplants are performed annually in the U.S. for end-stage liver disease that may be caused by conditions such as hepatitis C virus infection, alcoholic liver disease, nonalcoholic fatty liver disease and genetic disorders. The three-year survival rate for these patients after transplantation averages about 86 percent, according to the American Liver Foundation.

"More than 15,000 people are now on the waiting list for liver transplants, and there simply are not enough donated organs to go around," said Andrew Klein, MD, MBA, director of the Cedars-Sinai Comprehensive Transplant Center.

"Research like this helps us give every patient the best chance for a successful, long-term recovery."

The Liver Transplantation study was a collaboration between Cedars-Sinai and the Oregon Health and Science University. The senior author was Barry Schlansky, MD, assistant professor of Medicine at the Oregon Health and Science University.

Using Young Stem Cells to Rejuvenate Old Hearts


Telomeres, stained in purple, are caps that protect our chromosomes from damage. They get shorter with age but, in rats used in the study, grew longer after an infusion of stem cells from younger rats.

Cardiac stem cell infusions could someday help reverse the aging process in the human heart, making older ones behave younger, according to a new study from the Cedars-Sinai Heart Institute.

"Our previous lab studies and human clinical trials have shown promise in treating heart failure using cardiac stem cell infusions," said Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute and the primary investigator of the study. "Now we find that these specialized stem cells could turn out to reverse problems associated with aging of the heart."

The study was published Aug. 14 by the European Heart Journal.

In the study, investigators injected cardiosphere-derived cells, a specific type of stem cell known as CDCs, from newborn laboratory rats into the hearts of rats with an average age of 22 months, which is considered aged. Other laboratory rats from the same age group were assigned to receive placebo treatment, saline injections instead of stem cells. Both groups of aged rats were compared to a group of young rats with an average age of 4 months.

Baseline heart function was measured in all rats, using echocardiograms, treadmill stress tests and blood analysis. The older rats underwent an additional round of testing one month after receiving cardiosphere-derived cells that came from young rats.

Eduardo Marbán, MD, PhD

"The way the cells work to reverse aging is fascinating," said Marbán, professor of Medicine. "They secrete tiny vesicles that are chock-full of signaling molecules such as RNA and proteins. The vesicles from young cells appear to contain all the needed instructions to turn back the clock."

Results of those tests show lab rats that received the cardiosphere-derived cells:

  • Experienced improved heart function
  • Demonstrated longer heart cell telomeres, compound structures located at the ends of chromosomes that shrink with age
  • Improved their exercise capacity by an average of approximately 20 percent
  • Regrew hair faster than rats that didn't receive the cells

"This study didn't measure whether receiving the cardiosphere-derived cells extended lifespans, so we have a lot more work to do," said Lilian Grigorian-Shamagian, MD, PhD, co-primary investigator and the first author of the study. "We have much to study, including whether CDCs need to come from a young donor to have the same rejuvenating effects and whether the extracellular vesicles are able to reproduce all the rejuvenating effects we detect with CDCs."

Lilian Grigorian-Shamagian, MD, PhD

Since Marbán's team completed the world's first cardiac stem cell infusion in 2009, the Cedars-Sinai Heart Institute has made significant contributions to decoding and understanding how cardiac stem cells regenerate damaged heart muscle. The team is studying the use of stem cells to treat patients with Duchenne muscular dystrophy as well as patients with heart failure with preserved ejection fraction, a condition that affects more than 50 percent of all heart failure patients.

General support for Marbán's laboratory is provided by the National Institutes of Health. The CDCs, manufactured by Capricor Inc. (NASDAQ: CAPR) as its product CAP-1002, have been used in other human clinical trials.

The process to grow cardiac-derived stem cells was developed by Marbán when he was on the faculty of Johns Hopkins University and further developed at Cedars-Sinai. Capricor has licensed the process from Johns Hopkins and from Cedars-Sinai for clinical and commercial development. Capricor has licensed additional intellectual property from Cedars-Sinai and the University of Rome. Cedars-Sinai and Marbán have financial interests in Capricor.

Are You a Veteran? Let Us Know

Were you in the military, or do you know a co-worker who was? For Veterans Day, The Bridge wants to honor Cedars-Sinai's military veterans. Please email thebridge@cshs.org to let us know when and in which branch you served, and any notable details about your service. Also, please include your current position at Cedars-Sinai.

CS-Link Tip: Avoiding Clicks and Scrolling

Extra clicks and endless scrolling are a waste of time and unnecessary when you know how to navigate CS-Link™.

Instead of scrolling or hunting for a wild card (***) or a list, use the F2 key instead and it will direct you there. If you use a Mac and the F2 key doesn't work, go to system preferences and choose "keyboard." In the keyboard screen, choose "use F1, F2 keys" as standard function keys.

Here's another tip about entering a SmartPhrase. If you don't want a carriage return, hit the space bar instead of return. Many of us instinctively hit enter or return, and then have to backspace.

HealthStream offers physician efficiency training modules for continuing medical education credit. There are 22 modules that last 15 minutes each. They include topics such as "In Basket Quick Actions," "Smart Blocks in Progress Notes" and "SmartList Editor."

To take advantage, log into HealthStream and search the catalog using keywords: PET CME. Select the module you want to view, then click "Enroll."

CSLink tip- Physician Efficiency Training

If you have questions, contact groupeisphysicians@cshs.org.