The Mount Sinai team that used an experimental treatment was led by interventional neuroradiologist Alejandro Berenstein, MD, and included Michelle Sorscher, RN, MSN, Clinical Program Manager, Neurosurgery.
When, in early 2017, the teacher of 14-year-old Shawn Svoboda called to say he was falling asleep in class, his mother wasn’t overly concerned, considering it typical teenage behavior.
However, when the teacher called a second time that same day to emphasize she thought this was something out of the ordinary, his mom requested that their pediatrician order a sleep study, as she had noticed subtle changes in Shawn, such as snoring, pulsating neck veins, muffled voice, clumsiness, and headaches, all of which she had chalked up to changes of puberty.
The results showed Shawn was suffering from central sleep apnea at the rate of 150 episodes per hour, and a brain MRI was immediately scheduled at their local hospital in Springfield, Massachusetts. The MRI showed an extensive, potentially lethal, arteriovenous (AV) fistula—an abnormal connection between an artery and a vein—at multiple sites in the brain, creating a complex tangle of blood vessels in the dura, or outer covering of the brain. Shawn was then referred for a genetics consult and a cardiology workup and met with a pediatric neurosurgeon in Connecticut.
After performing a brain angiogram, the neurosurgeon told Shawn’s parents that the condition was more extensive than originally believed and recommended that they take him to The Mount Sinai Hospital, to be seen by Alejandro Berenstein, MD, Professor of Neurosurgery, Radiology, and Pediatrics, at the Icahn School of Medicine at Mount Sinai, and Director of the Pediatric Cerebrovascular Program. Dr. Berenstein is a world-renowned interventional neuroradiologist who has vastly expanded the understanding and treatment of vascular abnormalities in the brain, pioneering the use of innovative substances to incrementally block off these abnormal blood vessels.
Without treatment, Dr. Berenstein says that Shawn was at risk for developing more neurological deficits, seizures, hemorrhage, or stroke. “He was a walking time bomb,” says his mom, Bonnie Kmon, RN, and an oncology certified nurse.
Typically, Dr. Berenstein would treat an AV fistula by injecting a standard medical-grade super glue—a lava-like embolism agent—through a catheter to seal the blood vessel, guided by real-time X-ray imaging.
Shawn’s situation was more complex: the extensive quantity needed would appear black in the X-ray, making it impossible for the surgical team to see what they were doing.
Dr. Berenstein was familiar with a different, liquid embolic super-glue substance being used outside of the United States called PHIL™ (Precipitating Hydrophobic Injectable Liquid), which is less dense and, using iodine, appears grey, instead of black, on an X-ray, making it possible to clearly see the areas being treated.
However, PHIL has not yet been approved by the U.S. Food and Drug Administration (FDA), so Dr. Berenstein and his team successfully petitioned the FDA to grant approval for a single patient compassionate use of PHIL, making Mount Sinai the first institution in the nation to use this agent. Dr. Berenstein was able to block off the abnormal blood vessels a few at a time.
The procedure had to be done in stages to allow the brain and heart to adjust to new blood-flow patterns. It took seven eight-hour procedures, over the course of more than a year, to complete treatment, and Shawn’s road to recovery was not an easy one. He developed blood clots in his brain on two separate occasions, had one grand mal seizure, and now needs to receive twice-daily injections of a blood thinner.
Amazingly, he has suffered no significant neurological deficits, his sleep apnea has completely resolved, he has better balance, is performing wonderfully in school, and no longer suffers from headaches. His genetics workup also showed that he suffers from PTEN Hamartoma Tumor Syndrome, which will require him to have continual yearly monitoring for other medical problems.
“Shawn’s recovery has been extraordinary,” says Dr. Berenstein. “Time will tell, but I expect this to be a permanent fix and I think he’ll continue to do very well.”
Shawn’s mom echoed his assessment, and is grateful, she says, to Dr. Berenstein and his “phenomenal” team of doctors and nurses who cared for Shawn throughout his journey.
Dr. Alejandro Berenstein receives financial compensation as a consultant for MicroVention, the manufacturer of the Precipitating Hydrophobic Injectable Liquid System (PHIL).
From left: moderator David Epstein, Director, Domestic Human Resources, Doctors Without Borders; with Mount Sinai’s Pamela Y. Abner, MPA, Vice President, Chief Administrative Officer, Office for Diversity and Inclusion; and Barbara Warren, PsyD, Director, LGBT Programs and Policies, who was a panelist at the event.
The Mount Sinai Health System recently hosted the National Diversity Council’s inaugural Tri-State Health Care Diversity Summit at the Corporate Services Center, which brought together nearly 100 health care administrators and diversity and inclusion professionals from across the region. The Council, a nonprofit organization that advances inclusiveness in the private, public, and nonprofit sectors, presented the Health System with a Health Care Diversity Excellence Award, recognizing Mount Sinai’s deep commitment to diversity and inclusion in the workplace and surrounding communities.
“This event provided a valuable forum for sharing and learning,” says Mary Koshy, MPA, Associate Director, Office for Diversity and Inclusion, Mount Sinai Health System. “The Council received such positive feedback that we were asked to host the event again next year.”
Showing respect and understanding for people of all backgrounds improves patient satisfaction—benefiting both patients’ well-being and a medical institution’s bottom line, panelists said. The keynote speaker, Mecca Santana, Senior Vice President of Diversity, Inclusion, and Community Engagement, Westchester Medical Center Health Network, said it was also important to consider diversity in mentoring, retention, and promotion of staff. “Diversity is being invited to the party,” she said. “Inclusion is being asked to dance.”
Students in the Nanotechnology course, from left: Ava Cardillo, Diven Duran, Daniel Musheev, and Kai Kumeno.
Parissa Tabrizian, MD, Professor of Surgery, center, gave a tour of operating rooms at The Mount Sinai Hospital to participants in “Saturday at Sinai.”
More than 120 high school, college, and graduate students aspiring to a broad range of careers in health participated this summer in internships and talent pipeline programs throughout the Mount Sinai Health System. Two units of the Office for Diversity and Inclusion (ODI)—Corporate Health System Affairs and the Center for Excellence in Youth Education (CEYE)—supported initiatives to provide opportunities in medicine, science, health administration, real estate, and technology to students from underrepresented backgrounds.
“The experience that I’ve had at Mount Sinai has helped me target what type of biomedical engineer I want to become in the future,” says Awa Bagayoko, who participated in CEYE’s Nanotechnology course. “The program also reaffirmed my interest in medicine.”
Israa Maarouf was an Information Technology intern.
This year marked the be.inning of a formal partnership between Mount Sinai and the New York City Department of Education (DOE) to off er internships to high school students in the departments led by Kumar Chatani, MBA, Executive Vice President and Chief Information Officer, Mount Sinai Health System; and Kenneth Holden, Senior Vice President, Real Estate Services & Facilities. “Twenty-six interns gained hands-on experiences in information technology; planning, design, and construction; engineering; and property management,” says Shana Dacon, MPH, MBA, Assistant Director, Office for Diversity and Inclusion. “We will continue to work with the DOE to expand opportunities for students during the academic year.”
Fourteen more students—from high school to graduate school—had internships in clinical departments, patient experience, population health, and diversity management, supported by ODI in partnership with organizations including America Needs You; the All Stars Project, Inc.; the Greater New York Hospital Association; the Institute for Diversity and Health Equity; and Prep for Prep.
This year, ODI also launched Lesbian, Gay, Bisexual, and Transgender Young Queer Urban Teens for Health (LGBT YQUTH) in Medicine—a talent pipeline program for careers in health care. In the program, ODI staff and members of the Icahn School of Medicine at Mount Sinai’s Stonewall Alliance student group gave informational talks to LGBT youth organizations throughout the city. “In June, we welcomed participants from the talks to the pilot ‘Saturday at Sinai’ event,” says Richard Cancio, MPH, Program Manager for LGBT Health Services, Mount Sinai Health System. The free event included interactive activities; a tour of The Mount Sinai Hospital; and a panel of public health researchers, nursing and medical students, and graduate school alumni.
CEYE student Awa Bagayoko toured Sinai BioDesign.
CEYE’s six-week summer internship programs attracted 73 high school students from across New York City. Students participated in the Fruit Fly Genomics or Nanotechnology research courses; the Clinical Internship program; or the Lloyd Sherman Scholars program.
CEYE’s research courses met daily, with students receiving lecture-based instruction coupled with activities in the Icahn School of Medicine’s teaching laboratories, where projects included studying the behavior of fruit flies kept in isolation, and exploring silver nanoparticles and their medical implications. Clinical Internship participants were matched with faculty and staff and shadowed them in jobs throughout The Mount Sinai Hospital. In the Lloyd Sherman Scholars program, first-year participants took a Biotechnology course, and second-year scholars were placed in mentored research labs. In another two-year program, 14 interns who worked in labs during the school year returned in the summer to continue their work, assisting in areas of study including ovarian cancer survival rates and engineered cardiac tissue. All of the research interns plan to submit their summer work to the upcoming New York City Science and Engineering Fair.
“My internship showed me how hands-on science is,” says Brandon Soto, a first-year Sherman Scholar. “It also showed me that there are a lot of problems in the world that can be solved with science.”
A virtual visit was demonstrated by Nicholas Genes, MD, PhD, Associate Professor of Emergency Medicine, and Natalya Sholomyansky, Director of IT Digital Health.
A new telehealth service, Mount Sinai Now, is available free to Mount Sinai Health System employees and their dependents who are covered by Mount Sinai’s Empire Blue Cross/Blue Shield plan. The service provides patients with urgent care from a board-certified physician, almost always a Mount Sinai clinician, via video conference. If there is an emergency, patients should call 911. But Mount Sinai Now, like other urgent care, can be a good choice for treating conditions such as allergies, colds and flu, nausea, rashes, and sprains, says Abraham L. Warshaw, MD, Senior Vice President, and Medical Director of Physician Access Services, Mount Sinai Health System.
The service, which is available 24 hours a day, is part of Mount Sinai’s mission to take the lead in telehealth and population health management. “The idea is giving the right care, in the right place, at the right time,” Dr. Warshaw says.
In a typical visit, a patient might wake up with a sore throat and nasal congestion. She logs into Mount Sinai Now, and within minutes the visit starts, with the patient communicating through FaceTime or another video tool. The physician asks about symptoms, consults the patient’s medical records, and conducts a virtual examination via webcam and monitor, for example evaluating the throat and tonsils, and demonstrating how to check for swollen lymph nodes. Finally, the physician might call in a prescription, or if the symptoms are ambiguous, recommend an appointment with a primary care physician or a specialist.
More than 1,300 staff have registered and 200 have been treated since Mount Sinai Now became available throughout the Health System in May. The team’s plan is to expand the service to other companies, unions, and the public once insurance models are in place. “Patients who use telehealth are saving money, saving travel time, and are able to continue their daytoday life without having to interrupt things or schedule an appointment that might be weeks away,” says Eric Cannan, Senior Director, Telehealth, Mount Sinai Health System.
To register for the free service, go to now.mountsinai.org or visit Google Play or the Apple App Store to download the Mount Sinai Now app.
The fifth episode of Mount Sinai Future You highlights “medical miracles” and shows the unique bond between a patient and her neurosurgeon, Joshua Bederson, MD, System Chair for the Department of Neurosurgery, who is also a sculptor. The painter from New Jersey discusses how recovering from brain surgery has affected her painting.
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 Five, also features:
Brian A. Coakley, MD, Assistant Professor of Pediatric Surgery, uses a new form of chemotherapy, rarely used in children, to help save a young boy’s life.
Kenneth Rosenzweig, MD, System Chair of Radiation Oncology, uses advanced radiation to allow a basketball legend to forgo surgery and make it her hall of fame induction.
A team of doctors led by Valentin Fuster, MD, Director of Mount Sinai Heart, sets out to promote better heart health worldwide in a new documentary called “The Resilient Heart,” which is available on Amazon Prime.
Jagat Narula, MD, PhD, MACC, Director of the Cardiovascular Imaging Program, studies ancient mummies to uncover the history of heart disease.
Sean P. Pinney, MD, Director of Advanced Heart Failure and Heart Transplantation, shares the emotional journey of one patient who ended up in the ER after giving birth.
The Mount Sinai Hospital has been named by U.S. News & World Report to its 2018-2019 “Best Hospitals” Honor Roll, a distinction awarded to 20 U.S. hospitals that deliver the highest quality of care across a range of specialties and for common procedures and conditions. Achieving a No. 18 ranking—out of the more than 4,500 hospitals that U.S. News evaluated—places The Mount Sinai Hospital among the very best in the nation. It was the third consecutive year the Hospital has been named to the Honor Roll.
Overall, U.S. News measured hospital performance in 16 specialties and 9 procedures and conditions. To be named to the Honor Roll, a hospital had to score high across many of these areas of care, excelling in complex, high-acuity cases, as well as performing significantly better than the national average for the more common inpatient procedures and conditions.
“This is an outstanding achievement, to be among a small group of hospitals recognized across the nation for providing the best possible care to our patients, year after year,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “We are extremely proud to be on the Honor Roll.”
New York Eye and Ear Infirmary of Mount Sinai was nationally ranked in two specialties: No. 11 in Ophthalmology and No. 44 in Ear, Nose & Throat—both gains over last year’s results. Mount Sinai Beth Israel, and Mount Sinai St. Luke’s/Mount Sinai West (considered one hospital for rankings purposes) were all ranked regionally.
Five specialty areas at The Mount Sinai Hospital were among the Top 20 in the nation:
Geriatrics, No. 3
Gastroenterology & GI Surgery, No. 9
Cardiology & Heart Surgery, No. 10
Nephrology, No. 14
Neurology & Neurosurgery, No. 17.
Also ranked are: Gynecology, No. 24; Diabetes & Endocrinology, No. 36; Ear, Nose & Throat, No. 37; Urology, No. 38; Orthopedics, No. 40; and Cancer, No. 47.
Additionally, U.S. News ranked four departments in the Health System as “high performing,” a category that represents the top 10 percent of all hospitals surveyed. They were Pulmonology and Rehabilitation at The Mount Sinai Hospital, and Nephrology and Neurology/Neurosurgery at Mount Sinai St. Luke’s/Mount Sinai West.
Rankings for the majority of the specialties that U.S. News evaluated were derived largely from multiple objective measures that assessed factors such as risk-adjusted survival and readmission rates, volume, patient experience, patient safety, and quality of nursing, among other care-related indicators. Also factored in were the responses from the three most recent years of an annual reputational survey of board certified physicians across the 16 specialties who were asked to give the names of up to five hospitals in their specialty that provide the best care to patients with serious conditions, without considering location or expense.
The seven procedures and conditions for which The Mount Sinai Hospital rated better than the national average were: abdominal aortic aneurysm repair, aortic valve surgery, heart bypass surgery, colon cancer surgery, lung cancer surgery, and treatment for heart failure and chronic obstructive pulmonary disease.
“An entrepreneurial spirit and an emphasis on innovation among our clinicians and researchers have allowed us to continue to accelerate the path of discovery and contribute to improved methods of diagnosing and treating human disease,” says Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System. “We expect our outstanding School of Medicine faculty to further build on these accomplishments.”
David L. Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, adds: “To be recognized as a Top 20 hospital, based on metrics focused on quality of care, and patient experience and safety, is a significant ref lection on the commitment by our physicians, nurses, and staff to excel every day.”
The Mount Sinai Hospital has been named by U.S. News & World Report to its 2018-2019 “Best Hospitals” Honor Roll, a distinction awarded to 20 U.S. hospitals that deliver the highest quality of care across a range of specialties and for common procedures and conditions. Achieving a No. 18 ranking—out of the more than 4,500 hospitals that U.S. News evaluated—places 
Rankings for the majority of the specialties that U.S. News evaluated were derived largely from multiple objective measures that assessed factors such as risk-adjusted survival and readmission rates, volume, patient experience, patient safety, and quality of nursing, among other care-related indicators. Also factored in were the responses from the three most recent years of an annual reputational survey of board certified physicians across the 16 specialties who were asked to give the names of up to five hospitals in their specialty that provide the best care to patients with serious conditions, without considering location or expense.