Cedars-Sinai Medical Center
Department of Surgery
Edition: October 29, 2010
In This Issue:
Pharmacy Update Patient Classification and Surgery (Procedure) Scheduling Citizenship and Beyond
Furosemide, Bumetanide, Torsemide, Oh my!
As some of you may remember, torsemide (Demadex®) injection was discontinued in
2007 by Roche®. However, a generic company has recently started manufacturing this
product again and we are now able to purchase and dispense the medication. Since
intravenous furosemide is still not available (we currently have an automatic substitution
from furosemide IV to bumetanide IV) and bumetanide availability is not consistent, we
are hoping that torsemide injection can provide a reasonable therapeutic option for
some patients. Please consider using torsemide injection whenever possible. The
conversion between the three intravenous loop diuretics is: Bumetanide 1mg
IV=Furosemide 40mg IV=Torsemide 20mg IV
. Oral formulations of furosemide,
bumetanide, and torsemide continue to be available.
Epinephrine 0.1mg/ml 10ml syringes-AVAILABILITY UPDATE
We are happy to inform you that epinephrine 0.1mg/ml 10ml syringes are available from
the manufacturer! We are now in the process of purchasing and stocking all new
blue trays with the epinephrine 0.1mg/ml 10ml syringes instead of the epinephrine
1mg/ml 1ml concentrated ampules. Please note that although all new code blue trays
will have the epinephrine syringes, some already prepared code blue trays may still
contain the epinephrine concentrated ampules.
PATIENT CLASSIFICATION AND SURGERY (PROCEDURE) SCHEDULING
In August 2010, Cedars Sinai instituted new processes and procedures with new clinical
resources aimed at improving patient classification
of our surgery and procedure
Patient classification is a significant compliance issue for Medicare as well as MediCal and other insurance carriers. Over the past year, various governmental audit agencies have focused on the hospital community and this topic of patient classification. Hospitals are at great risk if found to be non-compliant with their regulations. In response to this ongoing oversight, Cedars Sinai has taken steps to further improve the proper identification of patient class. Ultimately, patients are classified as Inpatients or Outpatients for the purposes of billing and reporting. Within that overriding structure, procedure patients are scheduled as either “AM Admits” which is considered inpatient; “In-house” which is considered inpatient; or “outpatient procedure” which is outpatient in SIS and CSLink. As of the beginning of August, the option of “23 hour” was removed as it was not a true patient classification and confusing to users. Moreover, patients cannot be scheduled
as ‘observation’ but may become so after a procedure if they need to be evaluated for potential
inpatient admission and with an appropriate physician order. Case management has instituted a pre-review AND post-review of all scheduled procedures for the appropriate assignment of patient class. Additionally, specific ‘patient classification department guides’ were developed for non-OR procedural areas like the cath lab, interventional radiology and GI labs. Case managers are always available to assist with the proper determination of patient class. Please note, the distinction of patient class is very important to hospital compliance but does not change the care you need and desire to provide your patients. We appreciate your ongoing support of our endeavors in this area and welcome feedback on how we can further improve our process making it smoother for you and your patients.
CITIZENSHIP AND BEYOND
Wednesday, November 3, 2010 from 7:00am – 1:00pm
The Sanford Rosenbaum Lectureship in Vascular Surgery with Dr. Michael Conte
: Surgery Grant Rounds - "Critical Limb Ischemia: an Evidence Based
Approach to Limb Salvage in 2010?" in Harvey Morse 1-3
: Matrix Conference in Harvey Morse Auditorium 10:30 am
: Vascular Case Conference in Harvey Morse Auditorium 11:30 am
: Medicine/Surgery Grand Rounds - "Turning Veins into Arteries: What Have
we Learned about Vein Graft Disease?" in Harvey Morse Auditorium
_ Surgery Grand Rounds
Wednesday, November 10 at 7:00 am in Harvey Morse 1-3 “Fundamentals of Aortic Surgery”
with Ali Khoynezhad, MD
Publications and Presentations
V. Krishnan Ramanujan, Songyang Ren, Songyong Park, and Daniel L Farkas, (2010) Non-invasive, Contrast-enhanced Spectral Imaging of Breast Cancer Signatures
in Preclinical Animal Models In Vivo. J Cell Sci Therapy
Arkadiusz Gertych, Daniel L. Farkas, and Jian Tajbakhsh, (2010) Measuring topology
of low-intensity DNA methylation sites for high-throughput assessment of
epigenetic drug-induced effects in cancer cells. Exp Cell Res
. 2010 Nov
Philip K. Frykman, MD, PhD recently returned from the XXIII International Symposium
on Paediatric Surgical Research (ISPSR) annual congress in Tokyo, Japan on
September 12th – September 14th where he gave an oral presentation and a poster
The oral presentation was given on September 13th, titled "Do Primary Immune
Abnormalities Contribute to Hirschsprung-Associated Enterocolitis?
" The authors on the
presentation were: Philip K. Frykman, Zhi Cheng, Lifu Zhao, Deepti Dhall, Xiao Wang,
The poster presentation was given September 14th, titled "Preliminary Evaluation of a
New Compact High-Definition Video Microscope for Pediatric Surgery: Is it Time to
Throw Away the Loupes?"
The authors on the presentation were: Philip K. Frykman,
Andrew Freedman, Barry Duel, A. Trofimenko, George Berci.
Dr. Frykman presented a Special Lecture: Graduate Student Course in Medicine, on
September 15th at Jichi Medical University, Shimotsuke, Tochigi, Japan titled “Does the
Neural Crest Play a Role in Immune System Development? New Insights from
Hirschsprung Associated Enterocolitis
The Department of Surgery Congratulates Jian Tajbakhsh, PhD, Assistant Professor of
Surgery and head of the Translational Cytomics Group (TCG). His grant titled "Prostate
Cancer DNA Methylation Profiling by Advanced 3-D Imaging
", in conjunction with the
Louis Warshaw Prostate Cancer Center (CSMC) was funded in the amount of $725,138
by mechanisms supported by Congressionally Directed Medical Research Programs
(CDMRP)-Prostate Cancer Idea Development Award.
The Department of Surgery Congratulates Eric Ley, MD. His project titled “Utilize
previous experience with murine model for TBI to determine the effect of beta blockade
on TBI related cerebral perfusion, ischemia and immune dystfunction
.” was funded in
the amount of $50,000 by the American Assocatiation for the Surgery of Trauma.
Dr. Shirin Towfigh, MD, Director of Medical Student Education in the Department of
Surgery would like to acknowledge Dr. Marko Bukur, for teaching our interns Ventilator
Management" during Skills Lab, Sept 2, 2010.
Items for submission to Sutures may be sent to Meg Jenkins at The next SUTURES will be Wednesday, November 10, 2010.
Unique Active Ingredient in Drug Product Can Mean Patent Term Extension The U.S. Court of Appeals for the Federal Circuit recently affirmed two separate district court decisions finding that patents on newly approved pharmaceutical active ingredients are eligible for patent term extension under 35 U.S.C. § 156(a)(5)(A), to account for time lost during Food and Drug Administration (FDA) regula
Journal of the Neurological Sciences 264 (2008) 163 – 165Endovascular cooling in a patient with neuroleptic malignant syndromeJennifer Diedler a,⁎, Patricio Mellado a,b, Roland Veltkamp aa Department of Neurology, University of Heidelberg, Germanyb Department of Neurology, Pontificia Universidad Catolica de Chile, ChileReceived 11 April 2007; received in revised form 20 June 2007; accepte