Cedars-Sinai

Medical Staff Pulse Newsletter

Letter From Chief of Staff: Product Recall—Ranitidine

By Clement C. Yang, MD, Chief of Staff

Please be advised that the Food and Drug Administration (FDA) has issued product recalls for ranitidine manufactured by various companies due to the detection of trace amounts of an unexpected impurity. If you have questions or concerns regarding these recalls, review the FDA's Questions and Answers: NDMA Impurities in Ranitidine (Commonly Known As Zantac) page or ask your pharmacist.

» Read more

E-Cigarettes May Be More Harmful to Heart Health Than Tobacco

A new study from researchers at the Smidt Heart Institute shows that electronic nicotine delivery systems, including devices such as e-cigarettes, may be just as harmful to the heart, if not more, than traditional cigarettes. The findings were presented this week at the annual American Heart Association Scientific Sessions 2019.

» Read more

Study Highlights Best Options for Heart Patients

A study of thousands of patients with the most common form of heart disease shows that many are not receiving the best treatment to prevent future heart attacks and extend their lives. The study of patients with coronary artery disease, led by the Smidt Heart Institute Chair of Cardiac Surgery, Joanna Chikwe, was published in the Journal of the American College of Cardiology. Chikwe directed the study when she was with Mount Sinai Health System in New York.

» Read more

Core Labs Updating Reference Intervals Nov. 30

Beginning Nov. 30, the Core Laboratories within the Department of Pathology and Laboratory Medicine will begin using updated reference intervals and interpretive comments for a number of chemistry tests. The updates are necessary to bring the labs in line with current test-manufacturer reference intervals.

» Read more

New Physicians Welcomed at Reception

The medical staff held its first New Physician Welcome Reception at the Cedars-Sinai Accelerator on Tuesday, Nov. 12. The informal reception, which featured wine, beer and hors d'oeuvres, gave new medical staff members an opportunity to meet and network with other new physicians as well as staff leadership.

» Read more

Christmas Extravaganza Looking for Choral Singers

Get into the holiday spirit by singing in the Cedars-Sinai Christmas Chorus. The chorus will perform at this year's Christmas Extravaganza, planned for Thursday, Dec. 19, at noon in Harvey Morse Auditorium. All are welcome to sing in the chorus—no audition is necessary.

» Read more

Circle of Friends Honorees for October

COF-co

The Circle of Friends program honored 182 people in October. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Medical Library Offers Classes to Learn New Skills

The Cedars-Sinai Medical Library is offering a variety of classes in November and December. Classes are at noon in the Medical Library—Plaza Level, South Tower, Room 2815.

» Read more

CS-Link Tip: Marking Navigation Tabs as Important

If you have switched to Storyboard layout in CS-Link™, you have an option available to highlight navigation tabs so you can easily access the tabs you use most often. To use it, just select “Mark as important” from the pulldown menu after right-clicking on the tab you want to highlight.

» Read more

Letter From Chief of Staff: Product Recall—Ranitidine

By Clement C. Yang, MD, Chief of Staff

Please be advised that the Food and Drug Administration (FDA) has issued product recalls for ranitidine manufactured by various companies due to the detection of trace amounts of an unexpected impurity.

  • To date, no adverse events have been reported related to the presence of the impurity.
  • All medications affected by these recalls were pulled from the medical center inventory within 24 hours of receiving the recall notices.
  • We wanted to inform you of these recalls and provide information from the FDA in the event you wanted to discuss an alternative treatment with your patient(s).
  • Patients previously on ranitidine and requiring continued therapy should be converted to famotidine (Pepcid®) based on the following dose conversion. The Pharmacy and Therapeutics Committee has approved converting current inpatients to famotidine as of Nov. 14
    • For patients who cannot swallow whole tablets, pharmacists will change the route accordingly (e.g., per feeding tube) and include in Administration Instructions: "Famotidine tablet may be crushed and given via GT/NGT/Feeding tube."
    • For patients requiring famotidine doses that are not a standard tablet size, famotidine oral solution will be dispensed.

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E-Cigarettes May Be More Harmful to Heart Health Than Tobacco

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A new study from researchers at the Smidt Heart Institute shows e-cigarettes may be just as harmful to the heart as traditional cigarettes.

A new study from researchers at the Smidt Heart Institute shows that electronic nicotine delivery systems, including devices such as e-cigarettes, may be just as harmful to the heart, if not more, than traditional cigarettes. The findings were presented this week at the annual American Heart Association Scientific Sessions 2019.

"What makes e-cigarettes so harmful to the heart and lungs is not just nicotine," said senior author Florian Rader, MD, MSc, medical director of the Human Physiology Laboratory and assistant director of the Non-Invasive Laboratory at the Smidt Heart Institute. "It's the completely unknown bucket of manufactured products used to form vapors that is likely causing the most harm. This is what we believe is underlying the current public health problem."

These findings come at a crucial time, as reports of lung-related e-cigarette injuries are increasing, even while many distributors continue to claim that using e-cigarettes are safe and can help tobacco cigarette smokers kick the habit.

A recent study by the Food and Drug Administration found that 27.5% of high school students used e-cigarettes in 2019, compared to 20.8% in 2018. The same study also estimates 3.62 million middle and high school students were e-cigarette users in 2018.

In the Smidt Heart Institute study, the team of researchers compared healthy, young-adult smokers aged 18 to 38 who were regular users of e-cigarettes or tobacco cigarettes. The researchers then measured participants' blood flow to the heart muscle—focusing on a measure of coronary vascular function—before and after sessions of either e-cigarette use or cigarette smoking, while participants were at rest and also after they performed a handgrip exercise which simulates physiologic stress.

In smokers who used traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation and then decreased with subsequent stress. However, in smokers who used e-cigarettes, blood flow decreased after both inhalation at rest and also after handgrip stress.

"Our results suggest that e-cigarette use is associated with coronary vascular dysfunction at rest, even in the absence of physiologic stress," said Susan Cheng, MD, MPH, MMsc, director of Public Health Research at the Smidt Heart Institute and director of Cardiovascular Population Sciences at the Barbra Streisand Women's Heart Center. "These findings indicate the opposite of what e-cigarette and vaping marketing is saying about their safety profile."

The original concept and design of this study was initiated by the late Ronald G. Victor, MD, a foundational pioneer in cardiovascular physiology studies.

“We have known for decades that smoking increases your risk for heart attack and dying from heart disease," said Christine Albert, MD, MPH, founding chair of the newly established Department of Cardiology at the Smidt Heart Institute. "Now, with this study, we have compelling evidence suggesting that newer methods of electronic nicotine delivery may be equally, or potentially more, harmful to your heart as traditional cigarettes.”

Given that e-cigarettes represent a relatively new product on the market, Albert cautions users that there may be a number of unforeseen health effects.

To better understand the potentially dangerous consequences of e-cigarettes, Rader, Cheng and investigators in the Human Physiology Laboratory at the Smidt Heart Institute plan on studying the mechanisms underlying changes in heart and blood vessel flow seen in their work to-date, as well as the effects of e-cigarette use across a more diverse population of study participants including those with existing cardiovascular risk.

"What we are learning from our own research, along with the work of others, is that use of any electronic nicotine delivery system should be considered with a high degree of caution until more data can be gathered," said Rader.

Study Highlights Best Options for Heart Patients

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Cardiac surgeon Joanna Chikwe, center, performs a surgery. Photo courtesy of Mount Sinai Health System.

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Joanna Chikwe

A study of thousands of patients with the most common form of heart disease shows that many are not receiving the best treatment to prevent future heart attacks and extend their lives.

The study of patients with coronary artery disease, led by the Smidt Heart Institute Chair of Cardiac Surgery, Joanna Chikwe, was published in the Journal of the American College of Cardiology. Chikwe directed the study when she was with Mount Sinai Health System in New York.

"Our study highlights that thousands of coronary bypass patients may not be getting the best treatment option," said Chikwe, a professor of Medicine.

Coronary artery disease occurs when cholesterol builds up and blocks arteries. Untreated, this can lead to an unpleasant feeling of heaviness, tightness or pain in the chest, jaw or left arm, often during exercise. However, many patients have coronary disease with few or no symptoms, so it can be very difficult to recognize and treat. This is important because every day in the U.S., about 1,000 people die from coronary artery disease.

To treat advanced coronary disease, patients have several options:

  • Coronary bypass surgery—A cardiac surgeon attaches a healthy artery from the chest wall and usually a vein from the leg, to the heart, thereby diverting blood flow around the blocked arteries. Chikwe’s study shows that patients who received two arteries had better long-term results than those who got one artery and veins. This was especially true among patients who were younger than 70 years old.
  • Coronary stent—A cardiologist threads a catheter via a small puncture in the arm or the groin into the heart, allowing the insertion of a tiny metal frame called a stent into a blocked coronary artery to hold it open, thereby increasing blood flow. Although this is a less invasive option than traditional surgery, the benefits of stents are not as long-lasting as coronary bypass surgery.
  • Hybrid procedure—The newest option is a combination of robotic heart surgery and stents. This allows patients to enjoy the immediate benefits of a minimally invasive procedure, with the long-term benefits of surgery. In a hybrid procedure, patients receive one arterial bypass through a small incision. A few days later, the other blockages are treated with stents.

"For many patients, two arteries are often better than one," Chikwe said. "But many patients who need a double- or triple-bypass surgery prefer getting stents because they can go home the same day and feel better almost immediately. However, over the long term, having stents puts these patients at higher risk of dying or having a heart attack, especially if they are also diabetic."

Chikwe and her team of investigators surveyed all 42,714 coronary artery disease patients in New Jersey who had coronary bypass surgeries from 2005 to 2012. After excluding patients who underwent emergency surgery or had multiple diagnoses, the study found:

  • Of 26,124 patients who had coronary bypass surgery, only 3,647 or 14% had multiple arterial bypasses. The majority had a single arterial bypass. These findings mirror the rest of the U.S.
  • Patients who had multiple arterial bypasses were more likely to be alive 10 years after the procedure, and less likely to have had a heart attack than patients who only had a single arterial bypass and veins.

"We concluded that multiarterial bypass grafts are underused, especially in younger patients," Chikwe said. "Eighty-five percent of patients in the U.S. having coronary bypass surgery only get one artery combined with veins, and this study shows that the best treatment for many patients is multiarterial coronary bypass."

Said Eduardo Marbán, MD, PhD, a professor of Medicine and director of the Smidt Heart Institute, "With the recent addition of Dr. Chikwe to our leadership team, the Smidt Heart Institute is poised as never before to offer each patient highly-individualized, state-of-the-art treatment for their coronary artery disease."

Chikwe's advice for anyone diagnosed with coronary artery disease: Talk with your cardiologist and a cardiac surgeon to see if you would benefit from a multiarterial coronary bypass or a hybrid procedure.

"The hybrid procedure can give you the best of both worlds," Chikwe said. "It's the long-term benefit of an arterial bypass combined with minimally invasive stent placement that ensures a fast recovery."

 

Core Labs Updating Reference Intervals Nov. 30

Beginning Nov. 30, the Core Laboratories within the Department of Pathology and Laboratory Medicine will begin using updated reference intervals and interpretive comments for the chemistry tests listed in the PDF below.

Updated Ranges (PDF)  

The updates are necessary to bring the labs in line with current test-manufacturer reference intervals. In many cases, the ranges are further stratified by age and/or include additional interpretive comments that may be helpful.

If you have questions, contact Kimia Sobhani at kimiasobhani@cshs.org, or Anders Berg, PhD, at anders.berg@cshs.org.

New Physicians Welcomed at Reception

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Physicians gather for the first reception for new physicians at the Cedars-Sinai Accelerator earlier this week.

The medical staff held its first New Physician Welcome Reception at the Cedars-Sinai Accelerator on Tuesday, Nov. 12.

The informal reception, which featured wine, beer and hors d'oeuvres, gave new medical staff members an opportunity to meet and network with other new physicians as well as staff leadership.

New physicians also learned about physician wellness, medical affairs, and were provided tips for working in CS-Link™.

"Our new physicians appreciated the warm welcome and the opportunity to learn about Cedars-Sinai's history, mission and values," said Clement C. Yang, MD, chief of staff.

 

 

 

Christmas Extravaganza Looking for Choral Singers

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A Christmas choir sings at a previous holiday concert. 

Get into the holiday spirit by singing in the Cedars-Sinai Christmas Chorus.

The chorus will perform at this year's Christmas Extravaganza, planned for Thursday, Dec. 19, at noon in Harvey Morse Auditorium.

"Participating in the chorus brings a sense of community to a very large institution," said Gregory Eichelzer, MSN, RN, a clinical nurse educator who has participated in the annual Christmas event for eight years. "It's also a chance to share in the musical talents of so many employees."

All are welcome to sing in the chorus—no audition is necessary.

"If you are on the fence about joining, remember you won't know how incredible it is unless you try," added Eichelzer. "Spread the good holiday cheer and watch people's faces light up at the sound of the chorus. You won't regret it!"

For more information and to sign up, email Cathy O’Krent at catherine.o’krent@cshs.org.

 

 

Circle of Friends Honorees for October

The Circle of Friends program honored 182 people in October. 

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgment.

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

Ryan Abdul-Haqq, MD

Anthony Alamillo, RN

Farin F. Amersi, MD

Babak Azarbal, MD

C. Noel Bairey Merz, MD, FACC, FAHA

Jose J. Barajas

Anca M. Barbu, MD

Eli M. Baron, MD

Maya S. Benitez, MD

Yuri S. Benneth

Anat Ben-Shlomo, MD

Nicole C. Berndsen, NP

Behnoud Beroukhim, MD

Satinder J. Bhatia, MD

Rosenda L. Biares, CP

Weave H. Bishop, CNII

Keith L. Black, MD

Marion Black

Todd V. Brennan, MD

Earl W. Brien, MD

Rumailah E. Buenavente, CP

Matthew H. Bui, MD, PhD

Michele Burnison, MD

Stephanie Canola, RN

David H. Chang, MD

Johnny K. Chang, MD

Piyaporn Chantravat, RN

George E. Chaux, MD, FCCP

Aaron Chiang, MD

Regina N. Chung, RN

J. Louis Cohen, MD

Stephen T. Copen, MD

Rizza V. Cortes, CP

Bryan Croft

Rachelle B. Cruz, NP

Catherine M. Dang, MD, FACS

Dudley S. Danoff, MD, FACS

Mark M. Davidson, MD

Teresa M. Dean, MD

Robert W. Decker, MD

Stephen C. Deutsch, MD, FACP

Alice R. Dick, MD

Kathryn Distante, RN

Suhail Dohad, MD

Danielle S. Dondanville

Noam Z. Drazin, MD

Ashkan Ehdaie, MD

Karyn S. Eilber, MD

Mary El-Masry, MD

Fardad Esmailian, MD

Francis Y. Fah, RN

Edward J. Feldman, MD

David E. Fermelia, MD

Robert A. Figlin, MD, FACP

Charles A. Forscher, MD

Stephen J. Freedland, MD

Michelle L. Friedman, NP

Ryan G. Frost

Joni C. Fu, RN, BSN

Gerhard J. Fuchs, MD

Clark B. Fuller, MD

Srinivas Gaddam, MD

Diane Gean Gomez, CN

Dael Geft, MD

Sara Ghandehari, MD

Suzanne Gilberg Lenz, MD

Elie M. Gindi, MD, FACP

Richard N. Gold, MD

Sherry L. Goldman, RN, NP

Jun Gong, MD

Jeffrey S. Goodman, MD, FACP, FACC

Mark E. Granoff, MD

Abe Green, MD

Dayana Guillen

Brandy Habbary

Antoine Hage, MD

Michele A. Hamilton, MD

Michael D. Harris, MD

Arman Hekmati, MD

Earnestine C. Henderson

Jodi T. Hirata

Lalima A. Hoq, MD, MPH

Eva Huerta

Mariko L. Ishimori, MD

Gregg C. Itzko, RN, BSN

Stanley C. Jordan, MD

Mitchell Kamrava, MD

Sheila M. Kar, MD

Ronald P. Karlsberg, MD

David Y. Kawashiri, MD

Andrea D. Kepner

David M. Keys

Irene K. Kim, MD, FACS

Jason B. Kirk, MD

Keith L. Klein, MD

Michael A. Kropf, MD

Martyna O. Kulawiuk

Michael D. Lagrimas

Melissa R. Leaverton, RN

Caroline Lee, MD

Michael I. Lewis, MD

Andrew J. Li, MD

Milton T. Little, MD

Howard L. Liu, MD

Joanne Lutman, RN, OCN

Marc D. Makhani, MD

Rajendra Makkar, MD

Adam N. Mamelak, MD, FACS

Ana S. Martinez, CP

David N. Matsumura, MD

Philomena F. McAndrew, MD

Sonia Medina, CNA

Sharron L. Mee, MD, FACS

Richard J. Metz, MD, FACP

Alain C. Mita, MD

JoMarie E. Monzon-Duller, NP

Jaime D. Moriguchi, MD, FACC

Zuri Murrell, MD

Reiad Y. Najjar, MD

Yosef Y. Nasseri, MD

Ronald B. Natale, MD

Christopher S. Ng, MD

Nicholas N. Nissen, MD

Raena S. Olsen, DO

Katayoun Omrani, DDS

Adrian G. Ostrzega, MD

Asha Pathak, MD

Brad L. Penenberg, MD

Alice F. Peng, MD

Glenn B. Pfeffer, MD

Sareth Phal

Elinor Pullen, PA-C

Susan M. Rabizadeh, MD

Danny Ramzy, MD, PhD, FRCSC, FACC

Alexandre Rasouli, MD

James W. Rhee, MD

Aprillia L. Richards, RN

Bobbie J. Rimel, MD

Sonja L. Rosen, MD

Fred P. Rosenfelt, MD

Soraya A. Ross, MD

Stephen A. Sacks, MD

Wendy L. Sacks, MD

Bruce A. Samuels, MD, FACC

Myra A. San Andres, RN

Seema Satourian, MSW

Kevin S. Scher, MD, MBA

Wouter I. Schievink, MD

Bahman Shamloo, MD

Michael M. Shehata, MD

Randolph Sherman, MD

Allan W. Silberman, MD, PhD, FACS

Siddharth Singh, MD

Alvin Siu, MD

Tara D. Smith

Karyn M. Solky, MD

Daniel J. Stone, MD, MPH, MBA

Leslie M. Stricke, MD, FCCP

Nicholas R. Szumski, MD

Lillian Szydlo, MD

Steven W. Tabak, MD

Julleth M. Tejada, RN

Janessa Tiu, CN

Tsuyoshi Todo, MD

Stephanie A. Tran, MD

Alfredo Trento, MD, FACS

Alexander Tuchman, MD

Leticia O. Uy, RN, OCN

Teresa K. Vencill, NP, MSN

Nisha R. Verma, MD

Robert A. Vescio, MD

Andrei Vlad, BSc, RTT

Andrew S. Wachtel, MD, FCCP

Janet Wei, MD, FACC

Amy S. Weinberg, MD

Jason L. Weiner

Vidaflor A. Westlake, CP

Valerie Wong

Lewis Wyatt, Jr., MD

Evan M. Zahn, MD, FACC

Phillip C. Zakowski, MD

Christopher J. Zarembinski, MD

Medical Library Offers Classes to Learn New Skills

The Cedars-Sinai Medical Library is offering a variety of classes in November and December. Classes are at noon in the Medical Library—Plaza Level, South Tower, Room 2815.

EndNoteX9 for PC

Learn how to use this citation manager to organize your search results for manuscripts and grants. The half-hour class will meet Tuesday, Nov. 19, at noon.

Web of Science 

Learn how to search for highly cited or important papers on your topic. Analyze data by author or institution. Create an index to show publication influence. The half-hour class will meet Tuesday, Dec. 3, at noon.

Classes also are available by appointment. Call Caroline Marshall at ext. 3-2315 or RSVP to caroline.marshall@cshs.org.

CS-Link Tip: Marking Navigation Tabs as Important

If you haven’t switched to Storyboard layout in CS-Link™, you can now do so. At the bottom left of a patient encounter, click “Customize”, then “Move tabs to the top.” 

Now you have Storyboard. Your activity tabs are at the top, and in the same order as they were down the left side. You may want to make some of your tabs more obvious. You have an option available to highlight navigation tabs so you can easily access the most frequently used tabs.

While over a tab, right click, then select “Mark as important” from the pulldown menu. This feature is similar to the big tabs in the classic layout in that it expands the tab and now shows the name and an icon. You can make the tab even more obvious. If you right-click on the tab again after marking it as important, you can now hover over “Change the highlight color” to choose a color of your choice.

For more information and customization options, please see this job aid.

If you have further questions, feel free to contact us at groupeisphysicians@cshs.org.