Hope News

VOLUME 1, NUMBER 7 February 13, 2006

JCAHO confirms City of Hope accreditation

by Darrin S. Joy The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) issued a formal letter of accreditation to City of Hope on Jan. 20, 2006. The letter follows the Joint Commissions survey of City of Hope in September 2005 and confirms the institutions compliance with JCAHO standards for delivery of patient care. JCAHO surveyors employed a new methodology known as the tracer method during the September visit. This method offers a new opportunity for JCAHO to work in partnership with City of Hope to identify areas for improvement in our delivery of patient care, said Steve Hartranft, vice president of Quality Improvement and Patient Safety for City of Hope. Along with confirming the institutions existing high standards of patient care and supporting services, the survey identified some requirements for improvement. Since survey results have been received, several teams of City of Hope staff have created and implemented process improvements. The letter indicated that JCAHO reviewed and accepted these improvements.
Julius Shulman and Juergen Nogai

Darrin S. Joy

Quest for a Donor During a Feb. 6 interview at City of Hope, patient Christine Pechera (center) told KABC-TVs medical producer Denise Dador (right) about her search for a bone marrow match. Pechera, who has lymphoma, also described the need for more Filipino donors in the national registry. She directed those interested in registering to her Web site at www.christinepechera.com. Filmed in City of Hopes Japanese Garden, the segment aired Feb. 7 during the 5 p.m. news hour.

Nursing recruitment and retention remain top priorities for hospital

by Steve Kirk

he countrys nursing shortage continues even as the nations baby boomers and nursing workforce grow older, and the need for health care expands. Although nursing colleges and universities around the nation are working to increase enrollment levels to meet the rising need for nursing care, demand is outstripping supply. The United States is 10 percent short of the nurses it needs, according to Hospitals and Health Network magazine. In California, the problem is even more serious, with vacancy rates at health care organizations in the state approaching 13 percent. Despite such statistics, recruitment at City of Hope was marked by a nearly 20 percent increase in nursing staff for the one-year period ending February 2006, according to Larry Kidd, R.N., vice president of Patient Care Services and chief nurse executive. During the past year, 100 new nurses have been hired, bringing City of Hopes total number to approximately 500, including staff nurses, nurse practitioners, research coordinators, case managers, clinical nurse specialists and nurse researchers. Kidd credits the employee referral program, an effective

advertising campaign and City of Hopes longstanding reputation as a great place to work for the success in recent hiring. In addition to our status as a leading research hospital, attracting nurses to City of Hope is made easier by the institutions favorable working conditions, Kidd said. These include low patient-to-nurse ratios, flexible work schedules, better educational opportunities than many places, including up to three months of on-the-job training, and an extensive array of support staff for nursing teams, such as attendants, clerks, therapists, transporters and pharmacies in every unit. These factors also may account for City of Hopes retention rate. The figure is better than that of many institutions, with a turnover rate of 7 percent annually, significantly lower than the statewide average of 16.4 percent. Low nurse-to-patient ratios help attract and retain staff. City of Hope employs about one registered nurse for every four patients in its medical oncology/hematology nursing units. In other areas, the pediatric ratio is approximately 1-to-3, and the intensive care unit ratio is about 1-to-2. Using an acuity tool, nursing staff provides additional support when needed by evaluating patient needs for ongoing patient care. If required,
See Nursing page 3

Helford Clinical Research Hospital at City of Hope

All City of Hope employees are to be commended for their commitment in meeting and exceeding JCAHOs standards, said James Miser, M.D., chief executive officer and chief medical officer, City of Hope National Medical Center. A special thank you goes to those who worked diligently on the required changes and enhancements to our processes. Pointing to JCAHOs new system of unannounced inspections, Hartranft
See JCAHO page 3

Drug to give patients options

Inhaled insulin tested at City of Hope approved for market
by Alicia Di Rado With the help of City of Hope physician Wei Feng and her colleagues, millions of people with diabetes can now take a breather and get their medication at the same time. On Jan. 27, the United States Food and Drug Administration approved the first-ever inhaled insulin, called Exubera, for adults with type 1 or 2 diabetes. But what is now a welcome alternative to injection was once just an experimental insulin delivery method in testing at City of Hope.
Markie Ramirez

Feng led a three-year trial at the Leslie and Susan Gonda (Goldshmied) Diabetes and Genetic Research Center from 2000 to 2003, evaluating the delivery method among patients with type 1 diabetes. Nationwide, Exubera, a Pfizer Inc. product, was tested in about 2,500 adults with type 1 and 2 diabetes. The inhaler delivers a puff of insulin as a dry powder directly to the lungs, organs rich with potential for drug delivery. If all the lungs tiny alveoli were unfolded, the lungs would have nearly the surface area of a tennis court; and at about one-half micron thick, the lungs lining forms one of the bodys thinnest epithelial barriers. Ive thought all along that this is a good product; not necessarily for type 1 as much as for
See Inhaled insulin page 4

Generous supporter remembers CITI project with $1.5 million gift

by Lisa Lyons Thanks to a generous bequest from the estate of Marcelle S. Schwartz, the planned CITI (Cancer Immunotherapeutics & Tumor Immunology) research center has received a $1.5 million gift. In recognition, the centers entryway will be named the Marcelle S. Schwartz Entry Plaza.

Im excited about inhaled insulin getting out to those with Wei Feng diabetes, said Feng, principal investigator for the inhaled insulin trial at City of Hope. It does give us more alternatives to treat patients; you can individually tailor it to patients needs.

An artists rendering depicts the striking architecture of the planned CITI building.

ANF names COH nurse scholar, funds survey about complementary and alternative medicine
by Beth Hill The American Nurses Foundation (ANF) recently named City of Hope Research Specialist Teresa Rojas-Cooley, R.N., B.S.N., in the Department of Nursing Research & Education, a Dorothy Reilly/ANF Scholar. Consequently, RojasCooley received a $5,000 American Nurses Foundation grant to fund a project called Complementary and Alternative Medicine (CAM): American Nurses Knowledge. The results of Rojas-Cooleys study will reveal information on the knowledge and attitudes of nurses toward CAM therapies, such as Reiki, therapeutic touch and aromatherapy. The National Cancer Institutes Office of Cancer Complementary and Alternative Medicine defines complementary and alternative medicine as any medical system, practice or product that is not considered standard care. One example of a complementary therapy is aromatherapy, Rojas-Cooley said. According to the National Cancer Institute, aromatherapy the therapeutic use of essential oils from flowers, herbs or trees can improve a persons physical, emotional and spiritual well-being. Cancer patients sometimes use aromatherapy to help alleviate the stress and anxiety brought on by conventional treatment. They look to other treatments, such as massage or acupuncture, to complement standard medical treatments. Their ultimate goal is to improve their health and quality of life.
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Schwartz, a breast cancer survivor, began supporting City of Hope as a direct-mail donor. While not sizable, her donations were consistent and formed the basis of a relationship with the institution that steadily grew over the years. Senior Gift Planning Officer Sandee Zschomler first spoke with Schwartz and her sister, Ruth Cordish, in 2000. During those conversations, the sisters mentioned their desire to include City of Hope in their estate plans. The two expressed an interest in cancer research and Beckman Research Institute, so Zschomler encouraged them to come to campus for a tour. Due to a number of medical and personal obstacles, however, Schwartz was unable to visit the campus before her death in 2004. When Cordish called Zschomler to tell her of Schwartzs passing and that she had a $100,000 gift for City of Hope, Zschomler mentioned the CITI program and the planned research center. Cordish was intrigued enough
See Schwartz page 3

Other well-known and respected U.S. cancer centers using CAM to treat patients include Dana-Farber/Harvard Cancer Center in Boston, UCLA Collaborative Centers for Integrative Medicine in Los Angeles, and the University of Texas M.D. Anderson Cancer Center in Austin, Texas. Rojas-Cooleys new study will follow up a similar project she led last year, which focused on the knowledge and attitudes of direct-care oncology nurses toward complementary and alternative medicine. The results showed that oncology nurses in direct patient care did not know much about complementary or alternative medicine but were very interested in learning more if it helped their patients, Teresa Rojas-Cooley Rojas-Cooley says. Many nurses are uncomfortable bringing up the subject if patients seem to know more about it than they do, and the problem is magnified when the nurses are unable to discuss complementary therapies because of negative reactions by their health-care-provider colleagues to their out-ofthe-box thinking.
Markie Ramirez

hopes to receive responses in the spring, prepare an assessment of their learning needs and publish the results by next year. She expects the study to show that nurses must be educated to assist their patients in making informed judgments for complementary and alternative medicine and therapies. Rojas-Cooley has held various positions at City of Hope for the past eight years. She currently attends California State University, Fullerton, and the University of California, Irvine, studying to become a family nurse practitioner. The Dorothy Reilly/ANF Scholarship was named for Dorothy Reilly, an internationally known nurse, educator and scholar.
FEBRUARY 13, 2006

In the new study, researchers will mail a survey to a random sample of 3,000 registered nurses practicing in the United States. Rojas-Cooley

Jorge Hernandez tackles cancer

City of Hope patient wins state Spirit of Sport award
by Kevin Koga Two years ago, Jorge Hernandez, then a sophomore and a varsity football player at El Monte High School in the San Gabriel Valley, received very difficult news. He was diagnosed with Hodgkins lymphoma. However, two months ago, in full remission from his disease following treatment at City of Hope Cancer Center, he was awarded the prestigious California Interscholastic Federation (CIF) Spirit of Sport Award. The award recognizes excellence in scholastic activities, community service and leadership. According to CIF Executive Director Marie M. Ishida, the award is presented to student athletes who have demonstrated great sportsmanship, the purest form of competition. Recipients understand that a positive attitude and teamwork should exist throughout sports, and they realize that winning at all costs is not really winning. The same spirit they show in athletics carries over into all aspects of life. Last year, while receiving treatment, Hernandez was regularly on the sidelines cheering for his team. Then last April, his physician, Cancer Center Associate Director Smita Bhatia, M.D., M.P.H., gave him the news he was awaiting. He was cleared to rejoin the team for his senior season. Last fall, the linebacker was third on his team in tackles, with 75. Today, he competes for his schools varsity wrestling team; he has also participated in track and field. Through his treatment, Hernandez remained involved in the schools Academy Program and
Amy Cantrell

Schwartz: Bequethes to CITI

Continued from page 2

to ask for more information, so a personalized proposal was presented to her. Cordish then called to say she might have a lead on a significantly larger donation for CITI. The lead turned out to be Schwartzs estate, which had set aside funds in trust for a number of charitable foundations. However, Cordish was so impressed with the CITI proposal and the programs stated aim of revolutionizing the standard approach to cancer research and treatment that she decided to give the entire $1.5 million to City of Hope.

City of Hope patient Jorge Hernandez gives the Hookem Horns sign with Texas Coach Mack Brown.

maintains a 3.5 grade-point average. He has previously received his schools Perfect Attendance and Scholar-Athlete Awards and, last year, he received the City of El Monte Leadership Award, which was presented by the towns mayor. Hernandez is using his experience as a cancer survivor positively, mentoring junior high school age cancer patients at City of Hope. I want kids to have the opportunity to talk to someone their age about their diseases and treatments, said Hernandez. A few days before the Bowl Coalition Series Championship Game held at the Rose Bowl, Hernandez and several City of Hope pediatric patients spent time talking with head coach of the National Champion University of Texas Longhorns, Mack Brown, and Rose Bowl Most Valuable Player Vince Young, as well as USC Head Coach Pete Carroll and USC All-Americans Reggie Bush and Matt Leinert. Both coaches told Hernandez that they were inspired by his story.

When it came to selecting an appropriate recognition for Schwartz, Zschomler and Cordish both felt that the entry plaza to the planned $60 million research building would be an ideal spot for a visual testament to Schwartzs philanthropic legacy. What is so amazing to me about this bequest is the rapid progression from a modest direct mail donor, to a $100,000 gift, then to a donation of $1.5 million, said Zschomler. It really showed me that even the smallest gift, if properly nurtured, can grow into a major gift when the time is right.

JCAHO: Verifies COHs quality

Continued from page 1

cautioned City of Hope staff to remain vigilant about future surveys. It is important to remember that under JCAHOs new process, a spontaneous visit is possible at any time. This calls for us to remain vigilant in maintaining our high standards of patient care and compliance with the Joint Commissions standards. An independent, not-for-profit organization, the Joint Commission is the nations predominant standards-setting and accrediting body in health care.

Nursing: Medical Center focuses on recruiting and retaining nursing staff

Continued from page 1

ratios may be adjusted in any area and nurses may carry even fewer patients. Despite the number of new hires and relatively low turnover, the need for more nurses remains strong. The vacancy rate at City of Hope now stands at 12 percent annually, created by the addition of many new positions. Staffing needs for Helford Clinical Research Hospital at City of Hope, for example, are extensive. We are near capacity during the weekdays, even after opening up additional beds in East Unit A (formerly Wing V), Kidd said. We now have a staffed available bed capacity of 154, and will incrementally open more as we are able to recruit and train additional nurses. Contributing to the future demand is the maturity of City of Hopes own nursing staff, reflecting a national trend. About 62 percent of the institutions nurses are between 40 and 60 years old; the typical City of Hope nurse is 46. While we have been able to attract a significant number of nurses, most have just graduated from nursing school or have entered into nursing as a second career, so the need to retain our experienced staff members for both staffing and training is great, he added. Therefore, one of the goals of the nursing leadership team in coming months is to make further strides in nurses working conditions at City of Hope, including addressing the needs of the more experienced nurses that have been here for many years.
FEBRUARY 13, 2006

Its not only about recruitment, but also retention. Kidd said a number of opportunities for improvement exist that, when in place, will make working at City of Hope even better for all nursing staff. Including such professionals on more committees and involving them in decision-making, assessing nurses satisfaction with their work environment and addressing their concerns quickly, and engaging them in the development and design of educational programs will help.

Markie Ramirez

Nurses Kathy Ilagan (left) and Holly Bengtson confer about a patient.

Regarding day-to-day operations, improving on-the-job communications with advanced technology will keep City of Hope among the best places to work. Currently, some nurses are visiting other hospitals to learn about wireless communications devices to identify the best ones to pilot at City of Hope, Kidd said. Our nurses will also have input into the selection of a computerized information system, or CIS.
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Calendar of Events
Monday, Feb. 13
4 to 5 p.m. Platt 3 Conference Room Seminar. DNA Repair and Cancer: A Model for Estimating the Role of Genetic Variation in Risk of Common Disease Following Exposure, Harvey Mohrenweiser, UC Irvine Info: Saundra Hilton, ext. 62737

Inhaled insulin: Approved for use

Continued from page 2

Monday, Feb. 20
11 a.m. to noon Cooper Auditorium Seminar. Estrogen-related Receptors as Key Regulators of Cardiac and Skeletal Muscle Energetics: Implications for Metabolic Disease, Janice M. Huss, Washington University School of Medicine Info: Eileen Sepulveda, ext. 62833

Thursday, March 2
5:45 to 8:20 p.m. Visitor Center *CME Dinner Meeting. Advances in the Surgical and Systemic Treatments of Advanced Bladder Cancer, Timothy Wilson and Przemyslaw Twardowski, COH Info: ext. 65622

type 2, Feng said. As she explained, people with type 1 diabetes need to fine-tune their insulin delivery. Injected insulin may be delivered in doses as precise as a half-unit, while inhaled insulin is provided in one-unit doses at the smallest. Type 1 diabetes patients suffering from needlephobia, however, may benefit, she said, and our type 1 patients who used the inhaled insulin were happy with their glycemic control. The inhaled insulin might be helpful for type 1 patients as a replacement for short-acting insulin taken with meals, she added. However, patients with lung problems should not use the inhaler. Physicians have had a hard time getting many people with diabetes to meet their blood-sugar control goals, but this medication may help, Feng noted. Insulin has shown effectiveness in controlling diabetes, yet it has been a barrier for some of the diabetic patients to administrate injected medication, she said. Inhaled insulin has showed equal effectiveness in controlling blood glucose as a regular insulin dose, but with improved quality of life.

Thursday, Feb. 16
9 to 10 a.m. Library Conference Room Seminar. Regulating Homologous Recombinases in Meiosis and Beyond, Hideo Tsubouchi, Yale University Info: Devina Caggiano, ext. 63344 6 to 7:30 p.m. Platt Conference Center Ask the Experts Lecture. What You Need to Know About Prostate Cancer Info and reservations: ext. 65669

Tuesday, Feb. 21
6:30 to 8:30 p.m. Helford Hospital Main Lobby Hands-on-Harps Concert and Workshop Info: Jeanne Lawrence, ext. 63971 *City of Hope National Medical Center is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. City of Hope designates the above activities for 1.0 hour Category 1 Credit each toward the AMA Physicians Recognition Award, unless otherwise noted.

Wednesday, March 1
Noon to 1 p.m. Needleman 1 Conference Room *CME Seminar. Peripheral Neuropathy in the Oncology Patient, Harry Openshaw, COH Info: ext. 65622

Deadline for calendar submissions is noon on the Tuesday preceding publication. Three weeks advance notice is recommended. Timely submission does not guarantee items will be printed. Send calendar items to HopeNews@coh.org or fax to Lorena Avila, Communications, at 626-930-5363. Submissions must include day, date, time, title, speaker first and last names and affiliation (if applicable), location and contact information (contact name, phone and/or e-mail).

COH in the News

The San Jose Mercury News featured Barry M. Forman, M.D., Ph.D., in a Feb. 7 article about testing for performance-enhancing drugs at the Winter Olympics. KABC-TV featured City of Hope patient Christine Pechera in a Feb. 7 segment about her search for a bone marrow match and the need for more Filipino donors in the national registry. The Feb. 4 Pasadena Star-News, San Gabriel Valley Tribune and Whittier Daily News showcased City of Hopes mural in the Visitor Center as an example of the 1930s New Deal legacy in California and the San Gabriel Valley. The San Gabriel Valley Tribune featured a photo of the mural. The Inland Valley Daily Bulletin featured City of Hope pediatric patient Nicole Schulz in a Feb. 1 article about a blood drive organized for her benefit.
That about covers it Articles by City of Hope investigators recently made the covers of two scientific journals. The cover of the Jan. 1 issue of Clinical Cancer Research featured an article and laboratory image by Richard Jove, Ph.D., associate director of the Cancer Center, about Stat3 activation in breast cancer. Meanwhile, a review article co-authored by Don Diamond, Ph.D., director of the Laboratory of Vaccine Research, about CMV vaccination appeared on the cover of the Jan. issue of Trends in Molecular Medicine.

Next Issue: February 20

Darrin S. Joy, Steve Kirk
Co-editors

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