sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY January 2018 | Archived Issues

Surgery Research at Cedars-Sinai

The research enterprise at the Department of Surgery has demonstrated remarkable growth over the last decade. In 2006, our department had negligible National Institutes of Health funding, and was ranked 104th in the nation. By 2016, we had increased to $5.8 million in funding and had a national rank of 18.

» Read more

Streamlining Without Cookie Cutters

President's Perspective

By Thomas M. Priselac, President and CEO

As part of our collective goal to make Cedars-Sinai care more affordable, many different departments have started re-examining how they do things. They’re finding opportunities to streamline processes, making things simpler and easier for our patients and each other, and in turn reducing unnecessary costs.

» Read more

Gender-Affirming Phalloplasty: A First for Cedars-Sinai

Significant challenges still face many transgender patients. Aside from discriminatory practices and a lack of constitutional protections, this circumstance has come to the forefront of societal awareness in recent years. A large number of transgender and gender-nonconforming patients suffer from a clinical diagnosis of gender dysphoria.

» Read more

Executives Begin New Duties in January

An executive at Cedars-Sinai for ten years, Jennifer Blaha has been promoted to vice president of Operations, while Clare T. Lee has been named the organization's vice president of Professional and Support Services.

» Read more

Breast Cancer Center Renovation Project to Begin

BREAST CENTER BUILDING

After nearly 20 years as a surgical center and home to Cedars-Sinai's Saul and Joyce Brandman Breast Center—A Project of Women's Guild, the building at 310 N. San Vicente Blvd. will begin the transformation into a fully dedicated breast cancer treatment facility at the end of this month. Surgeries will shift to the Medical Center and, in March, the Breast Center will relocate to an interim space as a complete renovation of the 310 Building commences.

» Read more

Stop the Bleed Class Teaches Lifesaving Skills

Stop the Bleed is a free class now offered by Cedars-Sinai for its employees and the general public. The program was originally created in wake of the mass shooting at Sandy Hook Elementary School in Newton, Connecticut, when it was learned that uncontrolled bleeding led to many deaths. The next class at Cedars-Sinai is slated for Wednesday, Feb. 7.

» Read more

Physician Is Hip to the Ways of Saber-Toothed Tigers

Klapper Saber-tooth Tiger research co

When the smilodon, or saber-toothed cat, roamed what is now Wilshire Boulevard more than 12,000 years ago, did the predator hunt alone or in packs? If hips don't lie, Robert Klapper, MD, co-director of the Joint Replacement Program at Cedars-Sinai, may have the answer to a long-debated question among paleontologists. Working with the La Brea Tar Pits and Museum, Klapper brought the best practices of medical diagnostics to bear on the saber-toothed cat in an effort to develop a clearer understanding of how the prehistoric animal lived.

» Read more

Drug-Free Workplace Rules Unaltered by Marijuana Law

With a new state law that now allows for the use of non-medical use of marijuana, Cedars-Sinai officials are reminding staff that the organization's longstanding policy of a drug- and alcohol-free workplace remains in effect. As of Jan. 1, Prop. 64, also known as the Adult Use of Marijuana Act (AUMA), allows the sale of non-medical marijuana through stores licensed by the state to individuals 21 years old and older.

» Read more

State-Mandated Workplace Violence Training to Begin

Under revised rules from the state’s Division of Occupational Safety and Health, all Cedars-Sinai employees will be required to have completed workplace violence training by April 1. Cedars-Sinai’s Environmental Health and Safety division is finalizing the learning modules, and employees should be receiving notifications regarding the training soon.

» Read more

New Cancer Gene Sequencing Panels

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The Molecular Pathology laboratory at Cedars-Sinai has developed a set of focused, DNA next-generation sequencing panels that can rapidly scan tissue samples for potentially treatable mutations in a variety of cancers. These panels are available to Cedars-Sinai physicians to help them design more effective therapies.

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FDA Issues New Safety Measures for Gadolinium-Based Contrast Agents

The U.S. Food and Drug Administration (FDA), is requiring a new class warning and other safety measures for all gadolinium-based contrast agents for magnetic resonance imaging because of concerns about gadolinium remaining in patients' bodies, including the brain, for months to years. The FDA also is removing its most prominent warning about asthma-related death from the drug labels of medicines that contain both an inhaled corticosteroids and long-acting beta agonists.

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FDA Requires Safety Label Change for Prescription Cough and Cold Medicines

The U.S. Food and Drug Administration is requiring safety labeling changes for prescription cough and cold medicines containing codeine or hydrocodone in an effort to limit the use of these products to adults. Extensive review has shown that the risks of the medicines outweigh their benefits in children younger than 18. The FDA also is asking healthcare professionals to be vigilant for signs of hypersensitivity or anaphylaxis in patients receiving Varubi (rolapitant) injectable emulsion.

» Read more

Core Labs Updating Test Methods

The Core laboratories in the Department of Pathology and Laboratory Medicine will update its Abbott chemistry test methods beginning Tuesday, Jan. 30. The new methods replace the former ones performed by Roche and Beckman. Please note new reference ranges (highlighted in yellow) and biases between methods.

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Biotin Interference with Immunoassays Can Alter Results

Patients who recently have taken biotin can exhibit false low or high results to a host of common tests, including thyroid tests, hormones, cardiac markers and others. The Core laboratories in the Department of Pathology and Laboratory Medicine, for the most part, do not use immunoassays that suffer from this potential interference. However, not all Cedars-Sinai patients have their samples run in our labs. As such, clinicians should be aware of the potential for biotin interference with immunoassays.

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Circle of Friends Honorees for December

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The Circle of Friends program honored 346 people in December. 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.

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CS-Link Tip: A Helpful Shortcut

Here's a helpful shortcut in CS-Link™ when calculating a patient's 10-year Atherosclerotic Cardiovascular Disease risk.

» Read more

Surgery Research at Cedars-Sinai

By Bruce Gewertz, MD
Surgeon-in-Chief, Chair of the Department of Surgery

The research enterprise at the Department of Surgery has demonstrated remarkable growth over the last decade. In 2006, our department had negligible National Institutes of Health (NIH) funding, and was ranked 104th in the nation. By 2016, we had increased to $5.8 million in funding and had a national rank of 18.

In 2018, we have at least $10.2 million in funding and should easily be in the top 10 of all academic departments of surgery. Surgery research funding has paralleled and contributed to the overall growth in the research portfolio of our institution. We now have more than $160 million of external research with a three-fold increase in NIH funding over the last 8 years.

This ascent clearly was aided by strong institutional investments that provided research space and infrastructure as well as the needed salary support for new investigators. With this help, we expanded the number of research faculty from four in 2006 to more than 35 scientists. Areas of particular strength include a remarkably strong group in cancer, especially genito-urinary disease (more than $2.5 million per year) and breast cancer. Our efforts in stem cell biology are likewise outstanding and have led to practical applications in a wide range of musculo-skeletal disorders.

As articulated by the executive committee and Michael Freeman, vice-chair for Research, the department has focused on translational research and fostered interdepartmental interactions with our scientific institutes. We have invested heavily in such collaborative efforts especially in our support of junior faculty. Importantly, we are consistently biased toward team science and an effort to eliminate "silos" in our intellectual pursuits. Scientific leaders in surgery have committed toward a non-hierarchical structure in their laboratories. This makes us an attractive place for bright and ambitious, young post-doctoral students and junior faculty. We also have seen substantial achievement from surgical residents in all fields who spend one to two years in our laboratories as part of their basic residencies.

Ironically, these achievements have been largely concentrated in basic and translational work. Given the extraordinary clinical volume of our main hospital and the expanding catchment of our new health system, clinical trials remains a great and largely untapped area for growth. Although we have seen a doubling of the number of clinical trials over the past five years from 20 to 52 active trials, there is still considerable opportunity. This is particularly true in cancer, where we report nearly twice as many cancer procedures and new diagnoses of malignancies as any other University Health Consortium (UHC) hospital in California. Realizing our potential in this area alone is one of our highest priorities in the continued evolution of the Samuel Oschin Comprehensive Cancer Institute. Collaborations of surgical clinical faculty such as Tim Daskivich, MD, and Jennifer Anger, MD, with the efforts of Brennan Spiegel, MD, director of Health Services Research, is another potential growth opportunity.

The next few years should be even more exciting based on our excellent track record and strong senior leadership in our laboratories. As our history indicates, the advantages we have are a strong commitment to research that makes a difference for patients, an orientation shared by the NIH and other important funding sources. We will look toward expanding the successes in cancer and stem cell biology while identifying other areas of growth.

Streamlining Without Cookie Cutters

By Thomas M. Priselac, President and CEO

As part of our collective goal to make Cedars-Sinai care more affordable, many different departments have started re-examining how they do things. They’re finding opportunities to streamline processes, making things simpler and easier for our patients and each other, and in turn reducing unnecessary costs.

Although each area has different challenges and specific solutions, we’re starting to see a common thread throughout the institution. Like many organizations, as we have grown over the past decade, we have developed a lot of one-off, customized processes and solutions in almost every part of the organization. Many of these have greatly increased the complexity and time it takes to get things done, without necessarily providing a significant benefit for patients—hindering our ability to be more streamlined and efficient.

As our departments now take a step back to examine their processes, they are finding that one of the greatest opportunities is to increase consistency and simplicity in how we do things, where appropriate. A few examples: assessing usage of OR instrument trays to reduce the number of unused instruments; optimizing patient flow in Medical Network primary care practices; and standardizing guidelines for use of inpatient telemetry beds.

Certainly, standardizing and simplifying processes, undertaken without a thoughtful approach, can go too far and turn well-intended ideas into a mindless cookie-cutter experience. And healthcare in particular is not a "one-size-fits-all" endeavor. So how do we keep a sense of balance as we seek to increase the ways we standardize and streamline our practices and procedures?

We need to listen carefully to each other as we engage in this examination of processes together. While there will be many opportunities for standardization, there also will be situations where this approach doesn’t optimize our work or the clinical care of our patients. We need to continue to examine all aspects of our processes before making decisions about what and where to streamline. In some cases, a customized process may turn out to be the best solution.

We also need to be open to tweaking processes after they have undergone initial change. What seems to work perfectly in theory usually has a few wrinkles to iron out after it has been piloted.

Cedars-Sinai’s "test of change" culture and our openness to continual adaptation will be great reference points as we work together to streamline and optimize, and look for opportunities where standardization makes sense for our patients and for each other.

Gender-Affirming Phalloplasty: A First for Cedars-Sinai

The urology and plastic surgery team that performed the first gender-affirming phalloplasty at Cedars-Sinai: (from left) urology resident Christopher Dru, MD; Maurice Garcia, MD, director of the Transgender Surgery and Health Program; Edward Ray, MD; and USC plastic surgery resident Erin Weber, MD.

By Edward Ray, MD

Significant challenges still face many transgender patients. Aside from discriminatory practices and a lack of constitutional protections, this circumstance has come to the forefront of societal awareness in recent years. A large number of transgender and gender-nonconforming patients suffer from a clinical diagnosis of gender dysphoria. This is a condition whose prevalence is not well known, but is now the most common diagnosis in the Diagnostic and Statistical Manual of Mental Disorders that prompts referral of transgender patients for gender-affirming surgery. This condition, previously labeled "gender identity disorder," is defined as a state of emotional and psychological distress experienced by an individual whose gender assigned at birth differs from their gender identity. Gender-noncomformity, including transgenderism, has a prevalence that may be as high as 0.6 percent, based on global population surveys.

In recent years, a certain degree of societal destigmatization has encouraged some of those who suffer from gender dysphoria to seek treatment including counseling, hormonal therapy and sometimes surgery. This has also brought to light the scale of this previously under-reported problem. In 2005, California passed the Insurance Gender Nondiscrimination Act, which prohibits medical insurance plans from discriminating against transgender people or denying access to "medically necessary procedures." According to recent legal interpretations, "medically necessary procedures" includes gender-affirming surgery for patients with gender dysphoria.

In 2016, Cedars-Sinai recruited Maurice Garcia, MD, a urologist specializing in gender-affirming surgery, to found and direct Cedars-Sinai's Transgender Surgery and Health Program. When asked about the challenges of starting the transgender program, Garcia replied that the most difficult part "was making a persuasive argument that the program was viable from a financial standpoint." Because there are so few centers offering gender-affirming surgery in the United States, Garcia said that it is not clear how effectively the Centers for Medicare & Medicaid Services (CMS) or private payers will be reimbursed for these services. In helping Cedars-Sinai understand how the medical center would recoup its costs, Garcia spent a great deal of time and energy formulating a business model to balance charges and predicted insurance payments. As the first, and still one of the only, MediCal physicians in the state to offer gender-affirming surgery, Garcia has mandated that the program continue to accept CMS insurance in the program.

In addition, Garcia is also a world-renowned researcher and prominent member of the World Professional Association for Transgender Health (WPATH), an organization of healthcare professionals that promotes an evidence-based and ethical approach to the treatment of gender-nonconforming patients. The Standards of Care, or simply "SOC," is a document written by and periodically updated by WPATH that synthesizes current evidence and professional consensus on a diverse range of health issues and medical controversies affecting this unique group. In light of the fact that many physicians and other health professionals know very little about gender-nonconformity, the SOC, which is available online in 16 languages, is a useful introduction and guide for all medical specialties.

Edward Ray, MD, a reconstructive plastic surgeon in the Department of Surgery who is fellowship-trained in microvascular surgery, and also a member of WPATH, has partnered with Garcia to perform phalloplasties for female-to-male transgender patients. In this procedure, skin and fat tissue flaps are harvested from other areas of the body (such as the forearm or thigh), fashioned into a neo-phallus, including a urethra. When a flap is harvested from a distant location, such as the forearm, it is then reattached to the body using microsurgical techniques. Nerves from the flap are coapted to nerves in the inguinal and genital area to provide sensation to the flap.

On June 26, 2017, Garcia and Ray performed Cedars-Sinai's first free radial forearm phalloplasty for a transgender patient. The team has had great success with this first patient, who recently underwent a second stage scrotoplasty as well as reattachment of the urethra to make the phallus functional for urination. A second patient who already had a neo-phallus made elsewhere underwent creation of a neo-urethra. In all, five phalloplasties have been performed so far, the goal is to do several per month.

Ray also performs chest surgery (subcutaneous mastectomy, breast reduction and breast reconstruction) for transgender patients. Garcia offers urogenital reconstruction options to both male-to-female and female-to-male transgender patients. Until this program was started, there was no well-established center in Southern California, and gender dysphoria patients referred for surgical treatments had to travel to San Francisco or out of state. Patients are traveling from all over California and abroad to seek the program's expertise.

"Feedback from all transgender and gender non-binary patients has been exceptional," said Garcia. "Patients consistently say to me and others on evaluations how well they were treated. I will say that patients often report that they were ‘surprised' to learn that we have this program, which tells me that we have to do a better job of messaging.

"[This] program reflects a long history of values that speak to a commitment to diversity and service to the underserved—including to historically socially marginalized populations," he added.

While the recent gender-affirming phalloplasty is a surgical first for Cedars-Sinai, it is also a first step and represents a commitment on the part of the medical center to bring life-changing gender-affirming surgery within reach of patients from Southern California and across the country.

Executives Begin New Duties in January

Jennifer Blaha

Clare T. Lee

An executive at Cedars-Sinai for ten years, Jennifer Blaha has been promoted to vice president of Operations, while Clare T. Lee has been named the organization's vice president of Professional and Support Services.

Blaha, who began her new duties Jan. 3, most recently served as executive director of the Department of Surgery, where she was instrumental in the successful launch of Orthopaedics as a separate department. In her capacity as executive director, Blaha was responsible for the clinical, operational, academic and business development activities. In addition, Blaha translated healthcare policy into sustainable care pathways for bundled payments, established the Boeing Center of Excellence relationship, successfully integrated the Kerlan-Jobe Institute research and education team and achieved strong patient, employee and faculty satisfaction scores.

Blaha also has extensive experience at Cedars-Sinai in surgery, orthopaedics, performance improvement, research and interventional services. She developed an impressive track record improving clinical quality, patient satisfaction and operational efficiency throughout the hospital with strategies that supported both safety and financial objectives.

In her new role as vice president, Blaha will work in close partnership with chairpersons and institute leaders, to oversee the administrative operations supporting the clinical and academic missions of the Department of Surgery, Department of Orthopaedics, Department of Neurosurgery, Department of Neurology, Department of Psychiatry, Comprehensive Transplant Center, Pain Center, Respiratory and Pulmonary Services. Her responsibilities will encompass directing and supporting quality, financial, service and performance-improvement activities in all areas of these departments as well as across Cedars-Sinai.

Lee, who began her new duties Jan. 15, is an exceptionally accomplished executive who brings with her extensive administrative experience and expertise in clinical support services.

Lee comes to Cedars-Sinai from Dignity Health's 342-bed Mercy General Hospital in Sacramento, Calif., where she served as the chief operating officer. In her role, Lee was the site executive responsible for all hospital operations including clinical, nursing, ancillary, quality, compliance, finance, facilities, operational efficiency and business development.

Lee helped integrate the system's strategic goals and led the development of patient, employee and physician satisfaction initiatives. She also served as the executive lead for the hospital's co-managed initiatives in orthopaedic and cardiovascular services.

Prior to her experience in Sacramento, Lee served as the vice president of operations at the Houston Methodist Hospital System's flagship 900-bed hospital located in the Texas Medical Center. During her 10 years in that role, she had numerous assignments including pharmacy services, laboratory services, all cancer programs, imaging, revenue cycle, cell and gene therapy, acute therapies, food/nutrition services, patient transportation, environmental services and valet parking.

In her new role at Cedars-Sinai, Lee will oversee Environmental Health and Safety, Hospitality Services, Plant Operations & Engineering, Pharmacy Services, Food/Nutrition Services, Pathology and Laboratory Medicine and Imaging.

Breast Cancer Center Renovation Project to Begin

The 310 Building will be transformed into a state-of-the-art breast cancer center after an upcoming renovation project. An artist's rendering shows the exterior view of the completed project.

The operating rooms at 310 N. San Vicente Blvd. will go dark Jan. 31. After 20 years as a surgical center, the building will begin the transformation into a fully dedicated breast cancer treatment facility housing the Saul and Joyce Brandman Breast Center—A Project of Women's Guild, commonly known around the medical center as the "310 Breast Center."

The first step in the transition is the permanent shift of surgeries to the Advanced Health Sciences Pavilion and the Medical Center, with some relocating to the 90210/Precision Ambulatory Surgery Center. The breast center will continue to operate at the 310 Building through March 7, then will reopen in a newly renovated interim space at 8670 Wilshire Blvd. on March 14. Breast center patients will have their mammograms at the interim location on Wilshire Boulevard, while community patients will go to the S. Mark Taper Foundation Imaging Center. All will be directed to the appropriate location when they make their appointments.

"This move represents a very exciting time for us," said Maria Mirabal, associate director of the breast center. "The breast center opened in 2000, so the fact that we're being given a new reality is exciting to a lot of people. It's going to be a stunning space—even the interim space is beautiful."

The renovation of the 310 Building is projected to take less than two years, and when complete will mark a radical transformation of a facility that has become home to a close-knit team focused on all aspects of care for breast cancer patients.

"The surgeons and staff who have worked at the 310 Building over the last two decades have built it into one of Cedars-Sinai's premier operating facilities," said Bryan Croft, senior vice president of Operations. "Our investment in the breast center is part of our ongoing commitment to provide our patients with excellent care in a welcoming, nurturing environment. It also represents our commitment to provide our dedicated staff with the state-of-the-art space and technology they need to do their jobs."

When the 310 Building, originally dubbed the 310 Surgery Center, opened in 1998, its prospects were met with skepticism by some who feared its location across Beverly Boulevard—and away from the main campus—would inconvenience patients and staff.

Those fears proved unfounded as the center quickly flourished into a hub for orthopaedic, pediatric, otolaryngology, plastic, vascular and general surgeries. More recently, it has housed breast and general outpatient surgeries along with gastrointestinal labs.

"There is great enthusiasm for this move," said Jan Decker, former director of Preoperative Services, who is overseeing the transition for the surgical teams. "We're working to make sure the experience remains seamless for both our staff and patients."

Since its founding, the team at the breast center has grown to more than 30 staff members, including seven surgeons, 14 patient service representatives, two clinical registered nurses and three nurse navigators—who serve as patient advocates providing resources and information to cancer patients.

The facility they will return to when the renovation is completed in 2019 will be very different from the space they shared with other specialties. Gone will be the operating rooms, which will be replaced by more exam rooms, imaging facilities and meeting spaces. The first floor of the three-story building will feature exam rooms, a boutique selling items to patients undergoing treatment, patient conference space and a garden space. Administrative offices will be housed on the second floor, and the top floor will be home to exam rooms, imaging and other primary patient care facilities.

The breast center's contact information will remain the same.

"We have made a concerted effort to include staff in the decisionmaking process from day one," said Mirabal. "They have provided invaluable support and input that have shaped how the clinic will flow, to ensure we maintain excellent customer service for our patients. We are all excited about what this new space will do to enhance the patient experience and our ability to provide high-quality care."

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A rendering of the entry view to reception is shown.

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The new center will feature open office space.

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The new center will have a boutique selling items to patients undergoing treatment.

Stop the Bleed Class Teaches Lifesaving Skills

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Navpreet Dhillon, MD, leads a demonstration in a recent “Stop the Bleed” class, which provides emergency training in treating severe wounds.

The person who is going to save your life is probably the person right next to you.

That’s a fact when it comes to emergency cases involving severe bleeding or hemorrhaging, which can be fatal within minutes, said Heidi Hotz, RN, Trauma Program manager in the Department of Surgery.

"Uncontrolled bleeding is the leading cause of preventable death from trauma," said Hotz. "Bystanders are likely to be first on the scene, and many lives would be saved if they knew how to control bleeding until help arrives."

Teaching those skills is precisely the purpose of Stop the Bleed (STB), a free class Cedars-Sinai recently launched for employees and the general public. Introduced by the Obama administration in 2015, STB was created after learning that uncontrolled bleeding led to many deaths in the December 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut.

Hotz points out that while STB skills might be most impactful in mass-casualty situations such as last October's Las Vegas shooting, these techniques are equally valuable in everyday accidents.

While law enforcement and other non-medical first responders were the initial focus of STB, there's since been a national call to reach as many civilians as possible. Now overseen by the American College of Surgeons Committee on Trauma, STB's objective is to make bleeding-control techniques as accessible to laypeople as training is for CPR.

"As a Level 1 trauma center, Cedars-Sinai is committed to educating the public and medical professionals about preventable injury, so we've been engaged with the Stop the Bleed initiative from the start," said Brett Dodd, RN, trauma education, injury prevention and outreach coordinator in the Department of Surgery.

That engagement has produced a two-and-a-half-hour class that provides educational information and hands-on training, including learning when and how to use a tourniquet to control life-threatening bleeding from a limb, and how to pack a wound and apply pressure to stem bleeding.

"This class is open to everyone and our goal is for all Cedars-Sinai employees—every department—to complete Stop the Bleed training," Dodd said. "This class educates and empowers people to not only save lives, but also to become advocates in their own communities about the importance of getting this training."

The Cedars-Sinai STB program has 25 instructors, but more are needed.

"With more instructors, we could equip more people with these lifesaving skills," said Hotz.

She notes that if you're certified as an athletic trainer, emergency medical technician, paramedic, physician's assistant, RN or MD, you can become an instructor after completing the class.

"If you have one of these certifications and want to be an instructor, sign up for a class and let us know you're interested when you arrive," Hotz added.

The next Stop the Bleed class is Wednesday, Feb. 7, 8–10:30 a.m. in the Education Conference Center, North Tower, Plaza Level, Room C. Registration is available online at Cedars-Sinai Stop the Bleed class.

For questions, email Brett Dodd at brett.dodd@cshs.org.

Physician Is Hip to the Ways of Saber-Toothed Tigers

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Robert Klapper, MD, co-director of the Joint Replacement Program, examines the results of a CT scan of a bone from a saber-toothed cat found near the La Brea Tar Pits.

When the smilodon, or saber-toothed cat, roamed what is now Wilshire Boulevard more than 12,000 years ago, did the predator hunt alone or in packs?

If hips don't lie, Robert Klapper, MD, co-director of the Joint Replacement Program at Cedars-Sinai, may have the answer to a long-debated question among paleontologists.

Working with the La Brea Tar Pits and Museum, Klapper brought the best practices of medical diagnostics to bear on the saber-toothed cat in an effort to develop a clearer understanding of how the prehistoric animal lived. He used Cedars-Sinai's most advanced CT scan machines to study the pelvis and femurs of the saber-toothed mammal, so named for its foot-long curving canine teeth.

"The most modern technology allowed these bones to speak to us, and they had a lot to say," Klapper said.

One bone specimen in particular had a lot to tell Klapper. Originally, scientists speculated the animal had died from infection. But Klapper's analysis revealed the animal had been born with dysplasia, an abnormal development of the hip joint.

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Jennifer Morales, a CT technologist at Cedars-Sinai, prepares a saber-toothed cat bone for a scan.

When Klapper and a team from the Department of Imaging examined the CT scan closely, they clearly could see a mismatch between the ball and socket, which over years caused distinctive spurs to develop. The finding meant that it was highly unlikely this animal could have survived on its own, said Klapper.

"The fact that there is even one of these animals that was able to survive into adulthood told us a tremendous amount," said Klapper. "If it had been limping since birth and it couldn't run fast enough to chase its prey, it had to have survived in packs.

"If it's a fact that this is how this animal was born," added Klapper, "then it's a fact that someone else had to feed it."

The project began 20 years ago, when Klapper went to the museum as tourist and stood face-to-face with 400 prehistoric wolf skulls. He saw something the average tourist would not.

"I realized I'm in a museum filled with bones, which is what I do for a living," Klapper said. "The exhibits are gorgeous, showing you the saber-toothed cat, the wooly mammoth and the dire wolf—all these prehistoric fossilized bones from the tar pits.

"Then I became obsessed with the questions: Where is the arthritis? Where are the fractures? Where are the abnormalities?"

The curator led the orthopaedic surgeon to a collection of abnormal saber-toothed cat bones, deep in the bowels of the museum. They have since been brought out into the light thanks to Klapper, researchers from the La Brea Tar Pits and Museum, and staff from the S. Mark Taper Foundation Imaging Center at Cedars-Sinai.

"I think it's awesome," said Jennifer Morales, CT technologist at Cedars-Sinai. "This happened years ago, and yet we still have the imaging today to reveal more things that we didn't know before."

Aisling Farrell, collections manager for the La Brea Tar Pits and Museum, has been working closely with Klapper for six months to coordinate the examination of these bones.

"I've known that we've needed to do this for ages," she said.

Klapper also will use the scans to create a prosthetic hip joint, which will help him treat dysplasia in human patients of similar size. (The saber-toothed cat was about the same size of a modern-day lion.) Klapper credits Barry D. Pressman, MD, professor and chair of the Department of Imaging, for providing his staff's expertise to the study.

"What if you're 7'1"? We don't have prostheses that fit that height," Klapper said. "We also don't have prostheses that fit someone small. What we're doing is taking a CT scan to build the anatomy and then a prosthesis."

Klapper will continue his studies in partnership with the La Brea Tar Pits and Museum.

"The La Brea Tar Pits are one of the crown jewel experiences that you can have in Los Angeles," Klapper said. "They predate everything, including man running around here; you have to go visit it."

To learn more about the saber-toothed cat, visit the La Brea Tar Pits and Museum website.

Drug-Free Workplace Rules Unaltered by Marijuana Law

With a new state law that now allows for the use of non-medical use of marijuana, Cedars-Sinai officials are reminding staff that the organization's longstanding policy of a drug- and alcohol-free workplace remains in effect.

As of Jan. 1, Prop. 64, also known as the Adult Use of Marijuana Act (AUMA), allows the sale of non-medical marijuana through stores licensed by the state to individuals 21 years old and older.

With so-called recreational marijuana now legal here, Andy Ortiz, senior vice president of Human Resources and Organization Development, said it was important that staff remember Cedars-Sinai's longstanding guidelines.

"While the law makes it acceptable to possess and use marijuana recreationally, the mere fact of this law does not create an exception to Cedars-Sinai's organization-wide drug-free and alcohol-free workplace policy and its non-smoking policy," he said. "The use of recreational marijuana is strictly prohibited within Cedars-Sinai Health System, including by employees, patients and visitors."

If you have any questions, please refer to Cedars-Sinai's Drug-Free and Alcohol-Free Workplace policy or contact your HR Business Partner. You also may contact Work & Life Matters.

State-Mandated Workplace Violence Training to Begin

Under revised rules from the state’s Division of Occupational Safety and Health (Cal/OSHA), all Cedars-Sinai employees will be required to have completed workplace violence training by April 1.

Cedars-Sinai’s Environmental Health and Safety division is finalizing the learning modules, and all employees should be receiving notifications regarding the training soon.

"Assuring that our employees are safe and well trained is one of the highest priorities here at Cedars-Sinai," said Andy Ortiz, senior vice president of Human Resources and Organization Development and Learning. "Meeting this Cal/OSHA mandate presents us with an opportunity to create a high-caliber program that meets that goal."

There will be four tiers of training, based on the amount of direct patient care contact an employee has:

  • All employees will be required to take a two-hour online course via Healthstream.
  • Employees in Imaging, Admissions, Food & Nutrition, Environmental Services and other low-risk occupations will receive an additional two-hour Healthstream training module.
  • Staff delivering bedside care, including RNs, CPs and LVNs, will be required to take a two-hour classroom training on non-violent crisis intervention and a prevention skills lab.
  • Higher-risk staff, including security officers, Emergency Department employees and mental health workers, will be required to take an additional full-day classroom session.

Department managers will notify their teams when the training sessions are ready. Sign-up for all sessions will be done via Healthstream.

"It’s vitally important that our employees sigh up promptly for the classes we have developed," said Donna Earley, director of Environmental Health and Safety. "Not only will they be better prepared in the unlikely event of a workplace incident, but we are required to have the entire workforce trained by April 1."

Andrea Ravard, a radiation physicist in the Environmental Health and Safety Division who designed the training program, said the training will cover four broad workplace violence categories: those involving an intimate partner, criminal behavior, interactions with patients and visitors and "lateral violence," or intra-staff conflict.

"A number of people have come through the Skills Lab," Ravard said, "RNs, CPs, ED staff, security and behavioral health, and they’re overall feeling is that they are grateful we have taken this approach to teach skills that make them more confident as caregivers."

The state has defined workplace violence to cover any threat or act of violence that occurs at a worksite, including a threat or act that has a high likelihood of resulting in injury, psychological trauma or stress, regardless of whether an employee sustains an injury.

Once in place, the workplace violence training will become an annual requirement for most staff members. For further information on the program, email GroupWPVPreventionTeam@cshs.org.

New Cancer Gene Sequencing Panels

focuspanels 270px

This chip is used in the new CS-Focus Panels to sequence base pairs of DNA.

The Molecular Pathology laboratory at Cedars-Sinai has developed a set of focused, DNA next-generation sequencing (NGS) panels that can rapidly scan tissue samples for potentially treatable mutations in a variety of cancers. These panels are available to Cedars-Sinai physicians to help them design more effective therapies.

Five panels, called CS-Focus Panels, have been developed for the rapid molecular diagnosis of lung cancer, colorectal cancer, gastrointestinal stromal tumors, melanoma and central nervous system tumors. These panels, which each contain from two to 10 of the most common cancer genes for each type of tumor, can be completed in days. They complement a larger, more comprehensive, cancer gene panel, which requires about two weeks to complete. This panel also is offered by the Molecular Pathology laboratory and other laboratories.

Although the CS-Focus Panels analyze only a handful of genes for each cancer type, these genes contain most of the mutations for which there are FDA-approved targeted drug therapies. The larger panel detects even more mutations, including some that might be relevant to off-label uses of an approved drug and clinical trials.

These special panels use NGS, a method that can quickly and quantitatively determine the sequences of hundreds of thousands of individual DNA molecules in a small-tissue biopsy. In a biopsy sample that contains both normal cells and cancer cells, both normal and mutant cancer gene sequences are detected.

David Engman, MD, PhD, professor and chair of the Department of Pathology and Laboratory Medicine, said his department has performed hundreds of CS-Focus Panels over the last several months with a high rate of success. "More than 70 percent of these panels have pointed to a specific therapy for our patients," he said.

The panels were developed by a team that included Jean Lopategui, MD, associate professor of Pathology and medical director of Molecular Pathology and Clinical Cytogenetics; James (Jianbo) Song, PhD, director of the Molecular Pathology Laboratory and associate director of the Cytogenomics Laboratory; and Andy Pao, technical manager and supervisor of the Molecular Pathology Laboratory at Cedars-Sinai.

To request this new service, physicians may call 310-423-5326.

FDA Issues New Safety Measures for Gadolinium-Based Contrast Agents

The U.S. Food and Drug Administration (FDA) is requiring a new class warning and other safety measures for all gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging because of concerns about gadolinium remaining in patients' bodies, including the brain, for months to years. Gadolinium retention has not been directly linked to adverse health effects in patients with normal kidney function, and the FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks.

The FDA website has more information.

FDA: Agency Removes Warning About Asthma-related Death

The FDA is removing its most prominent warning about asthma-related death from the drug labels of medicines that contain both inhaled corticosteroids (ICS) and long-acting beta agonists. A review of four large clinical-safety trials showed that treating asthma with long-acting beta agonists in combination with inhaled corticosteroids does not result in significantly more serious asthma-related side effects than treatment with ICS alone.

The FDA website has more information.

FDA Requires Safety Label Change for Prescription Cough and Cold Medicines

The U.S. Food and Drug Administration (FDA) is requiring safety labeling changes for prescription cough and cold medicines containing codeine or hydrocodone in an effort to limit the use of these products to adults. Extensive review has shown that the risks of the medicines outweigh their benefits in children younger than 18. Healthcare professionals should be aware that the FDA is changing the age range for which prescription opioid cough and cold medicines are indicated. These products will no longer be indicated for use in children, and their use in this age group is not recommended.

The FDA website has more information.

FDA: Agency Urges to Watch for Signs of Hypersensitivity with Varubi Injectable Emulsion

Healthcare professionals are asked to be vigilant for signs of hypersensitivity or anaphylaxis in patients receiving Varubi (rolapitant) injectable emulsion, both during and following its administration.

Anaphylaxis, anaphylactic shock and other serious hypersensitivity reactions have been reported in the post-marketing setting, some requiring hospitalization. Most reactions, however, have occurred within the first few minutes of administration.

The FDA website has more information.

Core Labs Updating Test Methods

The Core laboratories in the Department of Pathology and Laboratory Medicine will update its Abbott chemistry test methods beginning Tuesday, Jan. 30.

The new methods replace the former ones performed by Roche and Beckman. Please note new reference ranges (highlighted in yellow) and biases between methods.

If you have questions, contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org.

Abbott Chemistry Test Methods (PDF)  

Biotin Interference with Immunoassays Can Alter Results

Recent articles have highlighted the potential for biotin interference with clinical immunoassays. Biotin is a supplement that has grown in popularity in recent years as a health aid, particularly for hair and nail growth. Some patients are taking biotin in "mega" doses of 10,000 mg/day or more.

This trend becomes an issue with clinical immunoassays that take advantage of biotin-streptavidin binding to "capture" antibodies as part of their methodologies. Patients who have recently taken biotin can exhibit false low or high results to a host of common tests, including thyroid tests, hormones, cardiac markers and others. (Roche and Siemens immunoassays, in particular, frequently utilize biotin-streptavidin linking.)

The Core laboratories in the Department of Pathology and Laboratory Medicine, for the most part, do not use immunoassays that suffer from this potential interference (Roche assays are being discontinued). However, not all Cedars-Sinai patients have their samples run in our labs. As such, clinicians should be aware of the potential for biotin interference with immunoassays.

The U.S. Food and Drug Administration states that the available data is insufficient to support recommendations for safe testing using affected assays in patients taking high levels of biotin, including the length of time for adequate biotin clearance from the blood.

An article from Endocrine Practice discusses the issue in more detail.

If you have questions, contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org.

Circle of Friends Honorees for December

The Circle of Friends program honored 346 people in December.

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.

  • Sadeea Q. Abbasi
  • David E. Aftergood, MD
  • Michael J. Alexander, MD, FACS
  • Alison A. Almario, RN, BSN, OCN
  • Gloria M. Alvarado
  • Maria C. Alvarado
  • Michelle E. Amarillas, RN, CEN, MICN
  • Farin Amersi
  • Adeline R Amiana
  • Neel Anand, MD
  • Paula J. Anastasia
  • Arash Asher, MD
  • M. William Audeh
  • Laura G. Audell, MD, MS
  • Shirin Bagheri, MD
  • C. Noel Bairey Merz, MD, FACC, FAHA
  • Kiumars Bakshandeh, MD
  • Peyman Banooni, MD
  • Gladis A. Barravecchio
  • Donnabel Bartolo Wilson, CHAA
  • Benjamin Basseri, MD
  • Gary S. Bellack, MD, FACO
  • Brandon R. Benavidez
  • Peiman Berdjis, MD
  • Daniel S. Berman, MD
  • Satinder J. Bhatia
  • Keith L. Black
  • Noemy J. Boghossian
  • Kathryn H. Bornhurst, RN, BC, BSN, BA, CCTC
  • Earl W. Brien, MD
  • Philip G. Brooks, MD
  • Angela K. Brown, RN
  • Neil A. Buchbinder, MD, FACC
  • Matthew H. Bui, MD, PhD
  • Michael A. Bush, MD
  • Jonathan A. Cabin, MD
  • Merla O. Caermare, CP
  • Amanda R. Casanova
  • Ilana Cass, MD
  • Bojan Cercek, MD, PhD
  • David H. Chang
  • Kirk Y. Chang, MD
  • Piyaporn Chantravat, RN
  • Timothy Charlton
  • Connie Chein
  • Derek Cheng, MD
  • Wen Cheng, MD
  • Shara Chess
  • William W. Chow, MD
  • Andrew Chuang, MD
  • Alice P. Chung, MD, FACS
  • Geemee Chung, MD
  • Rex Chung, MD
  • Arnold C. Cinman, MD
  • Susan B. Clark, RN
  • Lawrence J. Cohen, MD
  • Myles J. Cohen, MD
  • Stephen R. Corday, MD
  • Alice C. Cruz, MD
  • Ramprasad C. Dandillaya
  • Catherine M. Dang, MD, FACS
  • Timothy Daskivich, MD
  • Alan Dauer, MD
  • Robert M. Davidson
  • Teresa M. Dean, MD
  • Robert W. Decker, MD
  • Premal J. Desai, MD
  • Stephen C. Deutsch, MD, FACP
  • Suhail Dohad, MD
  • Noam Z. Drazin, MD
  • J. Kevin Drury, MD, FRCPC, FACC
  • Julie A. Dunhill, MD
  • Cheryl L. Dunnett, MD
  • Yaron Elad, MD
  • Mary El-Masry, MD
  • Fardad Esmailian, MD
  • Richard Essner, MD, FACS
  • Amy J. Eutsler
  • Francis Y. Fah, RN
  • Edward J. Feldman, MD
  • Jack F. Felmann
  • David E. Fermelia
  • Robert A. Figlin
  • David M. Filsoof, MD
  • Jeremy S. Fine, MD
  • Carrie E. Fishman, RN, MN
  • Christopher R. Fitzgerald, MD
  • Charles A. Forscher, MD
  • John D. Friedman, MD
  • Stuart Friedman
  • Larry Froch, MD
  • Clark B. Fuller, MD
  • Michelle L. Gabbai
  • Ramin Gabbai
  • Srinivas Gaddam, MD
  • Larisa Gallo
  • Christine Mae Gamatero
  • Soniya Gandhi, MD
  • Dael Geft, MD
  • Ivor L. Geft, MD
  • Bruce L. Gewertz
  • Benjamin N. Gilmore, MD
  • Armando E. Giuliano
  • Richard N. Gold, MD
  • Neil J. Goldberg, MD
  • Michael A. Gonzalez
  • Nestor Gonzalez, MD
  • Jeffrey S. Goodman
  • Leland M. Green, MD
  • Vesna Grubic, RN, MSN, ANP-BC, MPH, CCTC
  • Emily Gustafson
  • Desiree Y. Guzman
  • Christina Y. Ha, MD
  • Antoine Hage, MD
  • Jennifer Hajj, RN
  • Behrooz Hakimian, MD
  • David S. Hallegua, MD, FACR
  • Solomon I. Hamburg, MD, PhD
  • Michele A. Hamilton
  • Julius P. Har, CP
  • John G. Harold
  • Michael D. Harris, MD
  • Bryna J. Harwood
  • Jeffrey S. Helfenstein, MD
  • Andrew E. Hendifar, MD, MPH
  • Gail K. Higa, RN, OCN
  • Allen S. Ho, MD
  • David M. Hoffman
  • Maaike Holman
  • Arash A. Horizon, MD, FACR
  • Carole H. Hurvitz, MD
  • Violeta B. Husain
  • Mariko L. Ishimori, MD
  • Marney Jakubowicz, LVN
  • Laith H. Jamil
  • Stanley C. Jordan, MD
  • David Y. Josephson
  • Neel R. Joshi, MD
  • Elaine S. Kamil, MD
  • Saibal Kar
  • Sheila M. Kar, MD
  • Sousan Karimi, MD
  • Beth Y. Karlan
  • Scott R. Karlan
  • Harold L. Karpman, MD
  • Sanjay Kaul, MD
  • David Kawashiri, MD
  • David Kayne
  • Ilan Kedan
  • Tami Kendra-Romito
  • Cynthia A. Kenner
  • Walter F. Kerwin, MD
  • Raj M. Khandwalla, MD
  • Chae Y. Kim, MD
  • Christine H. Kim, MD
  • Elizabeth M. Kim, MD
  • Hyung L. Kim
  • Irene Kim, MD, FACS
  • Terrence T. Kim, MD
  • Michelle M. Kittleson
  • Jon A. Kobashigawa, MD
  • Robert Koblin
  • Peter Koh, OD
  • Carrie F. Kohler
  • Gal Kotlov, RN
  • Stephanie Koven, MD
  • Evan P. Kransdorf, MD, PhD
  • Thomas J. Kremen, MD
  • Michael A. Kropf, MD
  • David A. Kulber, MD, FACS
  • Anna Belle R. Labrador, RN
  • Raymond Lackman
  • William G. Lang, MD
  • Nadia U. Lansing Paguio, RT (R) (M)
  • Zsofia Laszlo, NP
  • Letitia Lau, MD
  • Gary Leach
  • Madeline S. Lerman, RN, BSN
  • Ronald S. Leuchter, MD
  • Michael M. Levine, MD
  • Michael S. Levine
  • Eric J. Ley, MD
  • Andrew J. Li, MD
  • Aliza A. Lifshitz, MD
  • Michael C. Lill, MD, MB, BS, FRACP, FRCPA
  • Suwicha Limvorasak
  • Simon K. Lo, MD, FACP
  • Patrick D. Lyden, MD, FAAN, FAHA
  • Cheryle C. Maano Requejo, RN, BSN, OCN
  • Hooman Madyoon, MD
  • Shalini Mahajan, MD
  • Bartolome S. Mailom, RN
  • Fataneh Majlessipour, MD
  • Nyenti T. Makia
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD, FACS
  • Kalinda S. Marshall, CNII
  • Ana S. Martinez, CP
  • Guy S. Mayeda, MD
  • Peggy Mays
  • Philomena McAndrew, MD
  • Racheal M. McCabe
  • Jennifer McCay
  • Mary McCray
  • Portia D. McDuffie
  • Sharron L. Mee
  • Shahab Mehdizadeh, MD
  • Gil Y. Melmed
  • Shlomo Melmed, MD
  • Nicolas Melo, MD
  • Kimberly C. Mercado
  • Wynter P. Merideth
  • Tamar Meszaros, MD
  • Eric S. Millstein, MD
  • Margo Minissian
  • Amin J. Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Cyrus K. Mody, MD
  • Avinash M. Mondkar, MD
  • Pakavadee Mongkolsiri
  • Melvin T. Monsher, MD
  • Beth A. Moore, MD
  • Jaime D. Moriguchi, MD, FACC
  • Esther Morrison, RN
  • Audrey M. Moruzzi, MD
  • Kyle K. Mosqueda
  • Zuri Murrell, MD
  • Mary C. Nasmyth, MD
  • Anita N. Newman, MD, FACS
  • Christopher S. Ng
  • Tu Nguyen
  • Nicholas N. Nissen
  • Paul W. Noble, MD
  • Arshia M. Noori, MD
  • Arthur J. Ochoa, JD
  • Raena S. Olsen, DO
  • Joanne B. Ordono
  • Adrian G. Ostrzega, MD
  • Stephen J. Pandol, MD
  • Ronald L. Paquette, MD
  • Dorothy J. Park
  • Jignesh K. Patel, MD, PhD
  • Grace Pathomrit
  • Rema D. Pendon, RN
  • Brad Penenberg, MD
  • Alice Peng, MD
  • Tiffany G. Perry, MD
  • Glenn B. Pfeffer
  • Edward H. Phillips
  • Samuel J. Porter, MD
  • Edwin M. Posadas
  • Ana E. Prince
  • Dale Prokupek, MD
  • David S. Ramin, MD
  • Danny Ramzy, MD, PhD, FRCSC, FACC
  • Michelle M. Ranheim, RN
  • Jon Rasak
  • Alexandre Rasouli
  • Luisita F. Ravanera, RN
  • Chrystal M. Reed, MD, PhD
  • Ali Rezaie
  • Bobbie J. Rimel
  • Grace A. Romulo
  • Sonja L. Rosen, MD
  • Barry E. Rosenbloom
  • Fred P. Rosenfelt, MD
  • Soraya A. Ross, MD
  • Steven M. Rudd, MD
  • Jeremy D. Rudnick
  • Susan L. Rusnack, MD
  • Virginia Russell, MD
  • Colleen Ryan, MD
  • Stephen A. Sacks
  • Vivian L. Salle, RN
  • Farzin Samadi, MD
  • Cherry R. Sanchez, RN
  • Howard M. Sandler
  • Jay N. Schapira
  • Kevin S. Scher, MD, MBA
  • Wouter I. Schievink
  • C. Andrew Schroeder, MD, FCCP
  • Scott Serden, MD
  • Prediman K. Shah
  • Fay P. Shapiro
  • Melani P. Shaum
  • Omid A. Shaye, MD
  • Michael M. Shehata, MD
  • John L. Sherman, MD
  • Randolph Sherman, MD
  • Daniel Shouhed, MD
  • Nancy L. Sicotte, MD, FAAN
  • Robert J. Siegel
  • Allan W. Silberman
  • Charles F. Simmons, MD, FAAP
  • Americo A. Simonini
  • Richard Sokolov, MD
  • Andrew I. Spitzer, MD
  • Theodore N. Stein, MD
  • Jerrold H. Steiner
  • Daniel J. Stone, MD, MPH, MBA
  • Ronald Sue
  • Charles D. Swerdlow, MD
  • Steven N. Sykes, MD
  • Nicholas R. Szumski, MD
  • Lillian Szydlo, MD
  • Steven W. Tabak, MD
  • Siamak Tabib, MD
  • Charles B. Tano-an
  • Stephan R. Targan
  • David B. Thordarson, MD
  • Analisa Traba, RN
  • Alfredo Trento
  • Cheng M. Tsao
  • Conrad J. Tseng, MD
  • Amy Tu
  • Richard Tuli, MD, PhD
  • David M. Ulick, MD
  • Mark K. Urman, MD, FACC, FASE, FAHA
  • Eric A. Vasiliauskas, MD
  • Marina Vaysburd, MD
  • Angela W. Velleca, RN, BSN, CCTC
  • Supatanee Veradittakit
  • Robert A. Vescio, MD
  • Mark W. Vogel, MD
  • Olga Voroshilovsky
  • Andrew S. Wachtel, MD, FCCP
  • Evan S. Walgama, MD
  • Daniel J. Wallace
  • Christine S. Walsh
  • Xunzhang Wang, MD
  • Alan Waxman, MD
  • Amy S. Weinberg, MD
  • Alan Weinberger, MD
  • Jason L. Weiner
  • Jonathan M. Weiner, MD
  • Robert N. Wolfe, MD, FCCP
  • Philip A. Yalowitz
  • Clement C. Yang, MD
  • Michael C. Yang, MD
  • Payam R. Yashar, MD, FACC
  • Bonnie Yoo
  • Christopher Zarembinski, MD
  • Vida Z. Zhang, MD
  • Raymond Zimmer, MD
  • Millard H. Zisser
  • Zachary Zumsteg, MD

CS-Link Tip: A Helpful Shortcut

Consider this helpful shortcut when using CS-Link™. Suppose you are making a decision about treatment for a patient when you want to calculate their 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk.

One way to find out would be to use your smartphone to access the ASCVD risk calculator. Or you may know the link is listed under WebActivites, then click calculators, and finally get to the website while working in CS-Link™.

A more efficient approach would be to just type ".ascvd." As long as all components are present (blood pressure, a lipid panel are on file), the answer will appear. The system looks back two years for pertinent information.

Also, 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."

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