The second episode of Mount Sinai Future You features a patient who suffered an intracerebral hemorrhage, one of the most devastating forms of stroke, and who shares his miraculous recovery after neurosurgeons saved his life using a new surgical technique called “SCUBA.” J Mocco, MD, MS, Director of the Cerebrovascular Center, and Christopher Kellner, MD, Director of the Intracerebral Hemorrhage Program, discuss the procedure.
Mount Sinai Future You, which highlights innovation at Mount Sinai, is being broadcast on CUNY TV, the non-commercial educational-access cable channel run by The City University of New York.
Mount Sinai Future You takes viewers behind the scenes as doctors at Mount Sinai Health System leverage innovative science to change patients’ lives every day. The series highlights preventative care and treatment models that will lead to better health and longer lives.
Mount Sinai Future You, Episode II, also features:
An interview with Roger Hajjar, MD, Arthur and Janet C. Ross Professor of Medicine, and Director of the Cardiovascular Research Center, about how gene therapy could one day treat heart disease.
Valentin Fuster, MD, PhD, Director of Mount Sinai Heart, and Samin Sharma, MD, Director of Clinical and Interventional Cardiology, give an elderly patient a second chance at life with a minimally invasive heart procedure.
Researchers from the Departments of Neuroscience and Rehabilitation Medicine discuss the most updated science and the importance of raising awareness of and knowledge about traumatic brain injuries and chronic traumatic encephalopathy (CTE) in women.
Rachel Yehuda, PhD, Director of the Traumatic Stress Studies Division, shares the latest research and clinical trials to treat post-traumatic stress disorder (PTSD). Janine Flory, PhD, Director of the PTSD Clinic at the Bronx VA Medical Center, provides insight on the link between traumatic brain injury and PTSD.
Hyunsuk Suh, MD, Assistant Professor of Surgery, is offering patients a scarless robotic surgery for thyroidectomies.
The parents of a toddler share their emotional journey after their son’s challenging start in life due to a heart defect.
New episodes of Mount Sinai Future You will run monthly, in the first week of each month, on Wednesdays at 9:30 pm, Thursdays at 6:30 am and 5 pm, and Saturdays at 11 am. They will cover newsworthy topics in medicine, as well as highlight new treatments, innovations, and preventive care for patients. The series is produced by Mount Sinai.
Here is where you can find this series:
Cable System
CUNY TV Channel
Spectrum
75
Cablevision
75
Optimum Brooklyn
75
RCN Cable
77
Verizon FiOS
30
*Some RCN digital cable and MMDS systems carry CUNY TV and/or NYC TV on different channel numbers. For example, some RCN systems in Manhattan and Queens carry CUNY TV on channel 24, 106 or 108. Please consult your cable provider directly to be sure.
David H. Adams, MD, after being named AATS President and receiving the Association’s Presidential chain.
David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and Cardiac Surgeon-in-Chief of the Mount Sinai Health System, was named President of the American Association for Thoracic Surgery (AATS) at its 98th annual meeting on Monday, April 30, in San Diego.
The AATS is an international organization of more than 1,300 of the world’s foremost cardiothoracic surgeons representing 41 countries, and publishes four official journals that advance its commitment to science, education, and research.
“Dr. Adams is an internationally recognized leader in the field of heart valve surgery and mitral valve reconstruction,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “That his achievements have been acknowledged by the most prominent organization in the field is a reflection on Dr. Adams and Mount Sinai’s commitment to advancing the treatment and study of heart disease.”
Additionally, Dr. Adams is President of the Mitral Foundation, a not-for-profit organization that promotes best practice standards in mitral valve disease, has co-authored the internationally acclaimed valve textbook, Carpentier’s Reconstructive Valve Surgery, and co-invented or invented several repair rings for mitral and tricuspid valve reconstruction that are used throughout the world. As the Program Director of The Mount Sinai Hospital’s Mitral Valve Repair Center—now one of the largest programs in the world caring for patients with mitral valve disease—Dr. Adams leads a team that has established national benchmarks for repair rates and excellent clinical outcomes.
The mitral valve controls blood flow between the collection chamber from the lungs (left atrium) and the pumping chamber (left ventricle), which is responsible for delivering the now-oxygenated blood to the body. Diseased mitral valve leaflets lead to either regurgitation or stenosis, altering normal blood flow patterns, and requiring repair or replacement. Dr. Adams and his team have pioneered reconstructive techniques that allow patients to keep their own living valve rather than undergo a valve replacement with a mechanical or animal valve.
According to the most recent New York State Department of Health Adult Cardiac Surgery 2013 – 2015 report, Dr. Adams is one of only four surgeons out of more than 230 to be recognized with a two-star safety rating, indicating superior clinical results in all index open heart cases. During this three-year period, Dr. Adams achieved a significantly higher safety level (0.52 percent) than the statewide average (2.25 percent).
“Becoming President of the American Association for Thoracic Surgery and receiving a two-star rating from New York State are really not my individual honors, but rather recognition of the extraordinary team of dedicated health care professionals whom I have the honor of working with every day in taking care of cardiovascular surgical patients at Mount Sinai,” says Dr. Adams.
The Department of Cardiovascular Surgery is currently participating in more than 20 clinical trials, several with a focus on exploring novel strategies that can treat mitral valve disease without opening the chest and placing the patient on a heart-lung machine. Dr. Adams was appointed the national co-Principal Investigator of the Medtronic Food and Drug Administration (FDA) pivotal APOLLO Trial, the first study in the United States to explore closed-chest, beating heart mitral valve replacement in patients who are at increased risk for conventional biological valve replacement.
The trial began in 2017 and will involve more than 40 clinical sites, including The Mount Sinai Hospital. Dr. Adams is also the co-Principal Investigator of the FDA Pivotal ReChord Trial that is exploring beating heart echo-guided valve repair for patients with mitral valve prolapse.
“This is the beginning of an important journey to establish truly less invasive approaches to treat patients with various types of mitral valve disease,” says Dr. Adams. “Investigators at The Mount Sinai Hospital are at the forefront of this research that we believe will revolutionize the treatment of patients in years to come.”
Dr. Adams is the co-inventor of the Edwards Lifesciences’ Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring, the Carpentier-Edwards Physio II ring, and the Medtronic Tri-Ad Adams Tricuspid Annuloplasty Ring. The Icahn School of Medicine at Mount Sinai receives royalties from Edwards Lifesciences and Medtronic in connection with the sale of these products. Dr. Adams and Mount Sinai do not receive any royalties when the devices are implanted in patients at Mount Sinai.
The Icahn School of Medicine at Mount Sinai has named Jonathan Ripp, MD, MPH, as Senior Associate Dean for Well-Being and Resilience, and Chief Wellness Officer. Dr. Ripp assumes the new post amid mounting challenges for medical professionals that include exhaustive clerical demands, increasingly burdensome documentation procedures, and numerous metric-driven requirements. Stressors such as these distract providers from the meaningful aspects of their jobs and make it harder for physicians to provide patients with the best possible care.
According to a December 2016 article in the Annals of Internal Medicine, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time filling out electronic health records and doing other administrative work. The study found they spent another 1 to 2 hours each night—after office hours—doing additional computer or clerical work.
“Our physicians and clinicians care for patients and families in need in an evolving health care system,” says Dr. Ripp. “They are driven in this pursuit to put the patient first, but often their own well-being suffers. We need to support their mission by improving the system-level factors that facilitate their purpose and provide them with the resources to promote well-being.”
Dr. Ripp has assumed a national leadership role in this endeavor. In April, he and colleagues from the Mayo Clinic and University of California San Francisco School of Medicine published a widely circulated “Charter on Physician Wellbeing” that appeared in the Journal of the American Medical Association.
David O. Barbe, MD, MHA, President of the American Medical Association (AMA), wrote, “Achieving national health goals depends on an energized, engaged, and resilient physician workforce. The AMA strongly supports the Charter and its declaration that the nation is best served by a health system that promotes professional fulfillment by allowing physicians to meet their patients’ needs for high-quality care.”
In his new role at Mount Sinai, Dr. Ripp will identify areas of excessive administrative and clinical burden that can be targets for intervention and workplace redesign efforts. He will also lead new initiatives that optimize physical and mental health.
“My role is to understand the local drivers of job burnout and to solve difficult problems,” he says. Initial initiatives will engage focus groups of faculty, students, and trainees and include gathering survey data on the drivers that erode well-being. He plans to identify a cohort of department-level faculty wellness champions who are eager to partner in implementing change.
Dr. Ripp—a faculty member in the Department of Medicine since 2004—has overseen the development of numerous wellness initiatives in Graduate Medical Education (GME) for the past two years. These include the expansion of mindfulness and reflection programs, codification of a policy that meets accreditation for well-being requirements, and the establishment of a GME-funded well-being grant program to decrease trainee work intensity and administrative burden. In addition to this work, he provides primary care to homebound New Yorkers through the Mount Sinai Visiting Doctors Program.
As Dr. Ripp pursues new programs within the Icahn School of Medicine and the Mount Sinai Health System, he also will continue his work on a national level. Over the course of their careers, physicians can expect to encounter patients who are dealing with extreme pain and suffering. Incorporating resilience-building strategies into medical training and education can provide physicians with the emotional awareness and support they need during these stressful encounters.
The development of clinician well-being initiatives will take a large effort, says Dr. Ripp, but the rewards for the nation’s doctors and patients are potentially huge.
At the first plenary session of the 98th Annual Meeting of the American Association for Thoracic Surgery in San Diego, Mount Sinai’s Joanna Chikwe, MD, Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, and David H. Adams, MD, presented a research study examining outcomes of patients undergoing coronary artery bypass grafting (CABG) surgery in the state of New Jersey, comparing results in patients treated on an arrested heart while on a heart-lung machine (on-pump) versus those approached on the beating heart (off-pump).
Dr. Chikwe, who is also the Cheng Endowed Professor and Chief of Cardiothoracic Surgery and Director of the Cardiovascular Institute at the State University of New York, Stony Brook, provided data aimed at resolving a four-decade-old debate regarding the optimal approach to perform CABG surgery.
The researchers compared outcomes 10 years after on-pump and off-pump surgery performed by high-volume surgeons in more than 20,000 patients.
“Our preliminary results found that outcomes with on-pump surgery were superior, with lower mortality, lower under-revascularization, and lower need for repeat revascularization after on-pump bypass surgery,” says Dr. Chikwe. Their paper has been provisionally accepted for publication in the Journal of the American College of Cardiology.
In March, Dr. Adams and Dr. Chikwe wrote an editorial in the Journal of the American College of Cardiology about the same topic, saying, “It is time for the debate to move on.”
Nursing assistants, trained as observers, monitor patients from a secure location.
A new Remote Patient Monitoring Program system, introduced in five units at The Mount Sinai Hospital as a pilot project in 2015, has expanded throughout the hospital and to Mount Sinai Queens, a unique technological effort to help nursing staff reduce falls among high-risk patients and keep them safe.
From left, Francine Fakih, MA, BSN, RN, with Michele Isaacs and Mario Geritano by the Remote Patient Monitoring device.
“Our entire nursing staff is trained in helping patients and caregivers learn safety measures to prevent falls, but some hospital patients who may try to get out of bed unsupervised remain prone to falling when they are weak, confused, or medicated,” says Francine Fakih, MA, BSN, RN, Deputy Chief Nursing Officer, The Mount Sinai Hospital, who oversees the program. “This new tool complements our existing patient-safety programs.” The Remote Patient Monitoring Program is being used in 19 units at The Mount Sinai Hospital and 6 units at Mount Sinai Queens.
The visual monitoring and two-way audio system consists of a camera and speaker that are mounted on a portable cart that is placed in the hospital room. The camera beams real-time video to computer screens that are monitored by trained nursing assistants observing from a secure hospital office. “This technology enhances the ability of our nursing unit teams to use all of their personnel more effectively, while safeguarding our most vulnerable patients,” says David L. Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens.
“When a patient is trying to get out of bed, the observer will use the speaker to redirect the individual,” explains Michele Isaacs, Program Coordinator, Surgical/Medical Specialties. Once the audio is activated, the patient and observer can continue talking. The observer can better determine the patient’s need and alert the nursing station to respond. In a real emergency, the observer can set off an alarm that summons immediate help. Staff can also redirect patients they observe trying to pull out their IVs.
The system—which meets all privacy policies and does not require the consent of the patient—does not record video and audio, and allows the observer to listen in only when the monitor is activated. It also has privacy settings, giving staff in the hospital room the ability to turn off the video and audio monitor during a physician visit and other private moments.
Says Mario Geritano, Project Manager, Program Management Office, Information Technology, Mount Sinai Health System, “We are using technology to provide additional support for our clinical team while allowing for a continuous, safe monitoring experience for our patients and families.”
Maria Brito, MD, Director of the Mount Sinai Thyroid Center at Union Square, and Terry F. Davies, MD, Co-Director.
The Mount Sinai Thyroid Center at Union Square is a valuable new resource for patients with thyroid disorders, as well as physicians seeking referrals for complex cases. The Center is unique in gathering a wide array of services in one ambulatory facility.
“This collaborative center includes Endocrinology, Endocrine Surgery, Head and Neck Surgery, Pathology, and Radiology,” says Director Maria Brito, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “I don’t think there is another thyroid center in Manhattan that has all of these services in one single building.” The Center is still expanding and will be joined by a Diabetes and Endocrine Center at Mount Sinai Union Square within the next year.
One goal of the Thyroid Center is to simplify care. “It is one-stop shopping, which is what we all want when we go to the doctor,” says the Center’s Co-Director, Terry F. Davies, MD, the Florence and Theodore Baumritter Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “If your physician says you need to see another specialist, it’s nice if he or she is in the next room. Y
ou can have your interview with the specialist and the surgeon; you can have a biopsy; you can have a sonogram; and you can have your blood tests, all in the same visit.”
New patients will be offered an appointment within 72 hours, Dr. Davies says, addressing a frequent complaint in medical care— having to wait weeks for an appointment.
Five endocrinologists and five surgeons are active in the Center, including leaders in their fields, Dr. Davies says, such as William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery at the Icahn School of Medicine; and Mark L. Urken, MD, Professor of Otolaryngology at the Icahn School of Medicine. For appropriate patients, “remote access” thyroidectomy can be offered, in which the thyroid is removed through incisions in the armpit or the mouth, leaving no visible scar on the neck. For certain patients with recurrent cysts, nodules, and some thyroid cancer recurrences, Dr. Brito and her colleague Michael A. Via, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine, offer a minimally invasive option, ethanol ablation, in which an alcohol solution is injected into these lesions, causing reabsorption or destruction.
Additionally, the Center is the national headquarters of the Thyroid, Head & Neck Cancer (THANC) Foundation, founded by Dr. Urken. The nation’s largest private funder of research for these cancers, THANC administers the Thyroid Cancer Care Collaborative, a data registry in which physicians can record important data about their thyroid cancer patients, enabling them to share clinical information with their patients as well as de-identified data with other physicians and researchers.
The Center’s physicians work closely with peers across the Mount Sinai Health System. For example, “we meet twice a month for the thyroid tumor board, in which surgeons and physicians discuss difficult cases,” says Dr. Davies, a leading physician-scientist in autoimmune thyroid disease who has been funded continuously for 35 years by the National Institutes of Health. Sharing knowledge among peers is a top priority of the Center, which is an important referral destination for primary care doctors seeking to consult with endocrinologists, and for endocrinologists seeking to collaborate with surgeons.
“We think this is definitely an appropriate place for second, third, or fourth opinions,” Dr. Brito says. “But it is very important for both primary care doctors and specialists to know that we expect to collaborate with them. They will not lose their patient to the Center, instead, they will gain a colleague.”
