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Saving Lives Citywide With Innovative Stroke Treatment

Updated on Jun 30, 2022 | Featured, Patient Stories

Patient Dionne Garcia, shown at a follow-up visit six weeks after her stroke, with Johanna T. Fifi, MD, center, and Gal Yaniv, MD, PhD, a second-year neuroendovascular surgery fellow.

On Tuesday, May 1, Dionne Garcia, 72, who was in New York City from Peru visiting her daughter, began experiencing slurred speech and weakness on her left side, and was becoming increasingly unresponsive. EMS arrived at her daughter’s home in Astoria and immediately took her to Mount Sinai Queens, a primary stroke center. Her stroke severity was assessed at 22 on the National Institutes of Health Stroke Scale, indicating severe stroke. Within 15 minutes of her arrival at the hospital, her CT angiogram revealed a blockage of the right middle cerebral artery.

With stroke, each passing minute increases the likelihood of permanent brain damage, and urgent treatment was needed for Ms. Garcia. The Mount Sinai Queens Emergency Department contacted the Mount Sinai Comprehensive Stroke Center at The Mount Sinai Hospital. The Center’s Director, Stanley Tuhrim, MD, Professor and Vice Chair for Clinical Affairs in the Department of Neurology at the Icahn School of Medicine at Mount Sinai, immediately triaged the situation and identified the patient as having an emergent large vessel occlusion stroke (ELVO), one of the most devastating forms of stroke.

Dr. Tuhrim notified The Mount Sinai Hospital endovascular stroke team, led by Johanna T. Fifi, MD, Associate Professor of Neurosurgery, Neurology, and Radiology, and Associate Director of the Cerebrovascular Center for the Mount Sinai Health System. She, along with a neuroendovascular fellow and a radiologic technologist, quickly traveled to Mount Sinai Queens. There, they performed a minimally invasive endovascular thrombectomy to remove the blockage.

Doctors threaded a catheter through Ms. Garcia’s groin up to her brain, and used a combination of aspiration and stent-retriever techniques to completely open the blocked vessel. Within 24 hours of her procedure, Ms. Garcia showed no symptoms of stroke, and she was discharged to her daughter’s home less than a week later.

“Because of the recent advances in technology and the overwhelming evidence for thrombectomy, patients like Ms. Garcia are saved from a life of disability every day,” says Dr. Fifi, who is also Director of the Health System’s Endovascular Stroke Program.

In the past 12 months, the Mount Sinai Health System has performed nearly 200 endovascular thrombectomies, which are now considered the gold standard of stroke care for large-vessel occlusions detected within six hours of onset, and up to 24 hours for a subgroup of patients. The Mount Sinai Cerebrovascular Center has pioneered many of these endovascular techniques and approaches intended to speed up the assessment and treatment of stroke to eliminate or minimize brain damage.

To further address the time sensitivity, Mount Sinai created the innovative mobile interventional stroke team (MIST) approach, in which stroke specialists quickly travel—by taxi or subway—to the patient who has been brought to a Mount Sinai Health System primary stroke center.

The MIST strategy, which aims to minimize risks and the delays inherent in patient transfer, allows for parallel processing of patients who are prepared for the procedure, and in some cases are given the clot-busting drug tPA intravenously, simultaneously as the team is mobilized. In a study led by Dr. Fifi and published in the journal Stroke in December 2017, the MIST model of care had an onsetto-treatment time that was 79 minutes faster than transporting patients from a primary stroke center to a comprehensive stroke center for treatment.

Currently, The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Beth Israel are thrombectomy-capable. In October 2017, Mount Sinai Queens became the first center in the borough to provide thrombectomy procedures, and construction is ongoing to create, for early 2019, a fully thrombectomy-capable stroke center entirely designed to maximize speed and efficiency in diagnosing and treating all stroke.

J Mocco, MD, MS, Professor and Vice Chair of Neurosurgery, and Director of the Cerebrovascular Center at the Mount Sinai Health System; Dr. Fifi; and stroke team members also continue to advance innovative stroke treatments and technologies.

“The Mount Sinai stroke team has become an international leader in published research aimed at saving more stroke patients’ lives,” says Dr. Mocco. “We are addressing important questions and improving patient care at every stage of ELVO treatment, from initial evaluation, through acute treatment, to rehabilitation.” Among their efforts: they are testing an innovative device that may one day be used by 911 responders to detect and diagnose stroke and other brain disorders in the field; investigating artificial intelligence algorithms to speed up the detection and triage of stroke patients; and leading national trials investigating a number of other new devices for stroke.

“Only a few years ago, many major strokes were fatal, or patients were left with devastating effects. However, with rapidly developing technology and systems of care, Mount Sinai is changing the global conversation about stroke treatments,” says Joshua B. Bederson, MD, Professor and Chair of Neurosurgery at the Mount Sinai Health System. “While other hospitals in New York City focus on stroke diagnosis with ambulances that are outfitted with CT machines, our stroke-treatment team meets the incoming patient upon arrival at one of our Health System locations in Manhattan, Queens, and Brooklyn. Within minutes, the patient is diagnosed, and advanced endovascular treatment restores blood flow to the brain.”

Awards Recognize Mount Sinai’s Commitment to Quality Stroke Care

Updated on Jun 30, 2022 | Featured, Your Health

Six Mount Sinai Health System hospitals—Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai St. Luke’s, and Mount Sinai West—have received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award.

The award recognizes each hospital’s commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines that are based on the latest scientific evidence.

Each of these Mount Sinai Health System hospitals earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

“We are pleased to recognize so many Mount Sinai Health System hospitals for their commitment to stroke care,” says Eric E. Smith, MD, national chair of the Get With The Guidelines Steering Committee. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

2018 Commencement for New York Eye and Ear Infirmary of Mount Sinai

Updated on Jun 30, 2022 | Community, Featured

James C. Tsai, MD, MBA, President of the New York Eye and Ear Infirmary of Mount Sinai (middle row, center) with the graduating residents and fellows.

Faculty, family, and friends celebrated the accomplishments of 22 residents and fellows in Ophthalmology, Otolaryngology, and Plastic and Reconstructive Surgery recently at the 2018 Commencement of the New York Eye and Ear Infirmary of Mount Sinai (NYEE).

James C. Tsai, MD, MBA, President, New York Eye and Ear Infirmary of Mount Sinai, and Chair of Ophthalmology, Mount Sinai Health System, welcomed graduates and guests to the event, held on Thursday, June 21, at the Friends Meeting House near campus.

“For 198 years, NYEE has proudly served the patients of our community, educated physicians, and led global ophthalmology and otolaryngology advances. You have inspired us to become better teachers and re-energized our dedication to educate tomorrow’s leaders in specialty surgical care,” Dr. Tsai said. “Use your knowledge to aspire and inspire, innovate and reinvent as you realize your full potential.”

Four of the graduates were residents specializing in otolaryngology, and seven were residents in ophthalmology. The eye residents will now take fellowships at top-tier institutions, including NYEE, the University of Southern California Roski Eye Institute in Los Angeles, and Kaiser Permanente, as well as private practices in New York, New Jersey, Colorado, and Texas.

Eleven fellows completed training in surgical specialties, including cornea and refractive surgery, glaucoma, ocular immunology, vitreoretinal surgery, and aesthetic plastic surgery.

A Focus on Wellness at the 2018 Aspen Ideas Festival

Updated on Jun 30, 2022 | Featured, Insights

Kenneth L. Davis, MD, led a luncheon roundtable discussion on rising drug prices.

New models of care that keep people healthy—rather than intervening only when they are sick—were the focus of experts from the Mount Sinai Health System, which participated for the sixth time in the annual Aspen Ideas Festival. Presented by the Aspen Institute and The Atlantic magazine, the festival in Aspen, Colorado, which ran from Thursday, June 21, through Saturday, June 30, is a gathering place where thought leaders across many disciplines engage in an exchange of ideas.

“How do we keep people well? How do we keep people out of the emergency room? We think about this all the time,” Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System, said in “Health Systems of the Future,” a key panel discussion. “By moving away from the traditional fee-for-service model to population health care, we are better able to align incentives with clinical delivery. This result is keeping people healthy and out of the hospital.”

Next generation health care was discussed by, from left, Eric Schadt, PhD; Alan B. Copperman, MD; and Judy H. Cho, MD, in the panel “Saving Lives Through Genomics.”

Jesleen Ahluwalia, MD, Assistant Clinical Professor of Dermatology, screened festival participant Sam Abdelhamid.

Mount Sinai demonstrated its dedication to wellness and prevention by providing more than 1,300 attendees with complimentary screenings—the most ever at the festival. Dermatologists from the Kimberly and Eric J. Waldman Department of Dermatology performed 754 skin cancer screenings and identified 28 possible basal cell carcinomas, 15 possible squamous cell carcinomas, and 2 potential melanomas. Nurses from Mount Sinai Heart performed 635 blood pressure and cholesterol screenings.

The Health System also spread its message through social media, with its biggest audience ever. On Facebook, interviews with Mount Sinai experts at Aspen received more than 1 million views, compared with 92,000 in 2017, an increase that partly resulted from more precise targeting of viewers. And on Twitter, Mount Sinai was the festival’s third biggest “influencer,” with its content displayed more than 40 million times.

In a panel discussion led by Dr. Davis, experts from Mount Sinai elaborated on the promise and practice of precision medicine and genomics, especially in treating cancer. “We are able to conduct comprehensive molecular profiling of tumors to help guide treatment options,” said Eric Schadt, PhD, Dean for Precision Medicine, Icahn School of Medicine at Mount Sinai, and founder and Chief Executive Officer of Sema4, a patient-centered predictive health company spun out from Mount Sinai. “There is also the heritable side of your DNA—what you are born with and the risk that predisposes you for certain cancers. For example, the BRCA genes for breast cancer and ovarian cancer are increasingly seen as being important for men as they could impact the treatment for prostate cancer.”

Judy H. Cho, MD, Professor of Genetics and Genomic Sciences, and Medicine (Gastroenterology), Icahn School of Medicine, and Director of the Charles Bronfman Institute for Personalized Medicine at Mount Sinai, noted, “If you know your genome and you carry one of the high-risk mutations for colon cancer, the goal is to screen early and more effectively for colon cancer.” Inflammatory bowel disease and fatty liver disease also have a genetic component. “We think this understanding will allow us to diagnose patients earlier and treat more effectively, as well as identify drugs that will be most effective in patients,” Dr. Cho said.

Alan B. Copperman, MD, a leader in the treatment of infertility and Chief Medical Officer of Sema4, discussed breakthroughs in screening for couples using in vitro fertilization. Genomic sequencing is advancing so fast that over the next year or two, “We should be able to routinely test for all known diseases and even tiny rearrangements and deletions of DNA. This will move us forward in a way we could never have dreamed of in figuring out which embryo has the best chance of being a healthy baby,” Dr. Copperman said.

The microbiome—trillions of bacteria and fungi that live in the gut—was the subject of a popular talk by Ari Grinspan, MD, Assistant Professor of Medicine (Gastroenterology), Icahn School of Medicine, and Director of Gastrointestinal Microbial Therapeutics, Mount Sinai Health System. Dr. Grinspan said that for patients with persistent Clostridium difficile infections, fecal transplants are “incredibly effective,” curing 90 percent of cases. And he answered questions from a very engaged audience: Is taking probiotics good for you? It doesn’t hurt, and might help. How do you maintain a robust microbiome? “Eat fiber, fiber, fiber,” Dr. Grinspan said. “And exercise.”

Innovative models of care were outlined by, from left, Niyum Gandhi; Linda V. DeCherrie, MD; and Prabhjot Singh, MD, PhD, in the panel “Do or Die: It’s Time to Think Beyond the Hospital.”

In a second panel led by Dr. Davis, Mount Sinai experts discussed models that allow care to be delivered to its 3.8 million patients a year in more effective ways. “We must reimagine the financial model so that we can be rewarded for keeping people healthy,” said Niyum Gandhi, Executive Vice President and Chief Population Health Officer, Mount Sinai Health System.

Another innovation is Mount Sinai at Home, which encompasses programs that deliver home-based primary care, rehabilitation, hospital care, and palliative care. One of those programs, Hospitalization at Home, has resulted in shorter hospital stays and fewer readmissions and emergency department visits. “Though the model is successful, we still cannot do this widely because few insurance companies have been able to develop a payment model for services,” said Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine, and Clinical Director of Mount Sinai at Home.

“Addressing the social determinants of health is critical to reducing the cost of health care and improving the lives of our patients,” said Prabhjot Singh, MD, PhD, Director of the Arnhold Institute for Global Health, and Chair of Health System Design and Global Health, Icahn School of Medicine. “We need to find smart ways to recognize the food insecurity, housing, and transportation issues that our patients face, and then incorporate the right support as a seamless part of their care.”

All of these measures help Mount Sinai to control health costs, which are rising fast across the nation. “And they allow us to maintain our core values—to take care of everybody who comes to our door and still be an Honor Roll hospital and a leader in education and in research innovation,” Dr. Davis said.

Festival participants on the grounds of the Aspen Institute. Credit: CZ Photography

Could Dogs Serve as Hosts for the Next Flu Pandemic?

Updated on Jun 30, 2022 | Featured, Research

Study investigators Adolfo García-Sastre, PhD, left, and Guojun Wang, PhD, Postdoctoral Fellow

Dogs are becoming increasingly friendly hosts for a surprising array of influenza viruses, a situation that could pose a potential threat to humans. That is the finding of a new study from the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai, published June 5, 2018, in mBio.

The results were based on scientific evidence that dogs in southern China had the capacity to serve as “mixing vessels” for influenza viruses they receive from swine and birds—two animals considered to be the most common reservoirs of influenza viral genetic diversity.

“The more diversity we see in influenza viruses, the greater the chance they could jump from one host to another,” says the study’s lead author, Adolfo García-Sastre, PhD, Professor of Microbiology at the Icahn School of Medicine, and Director of the Global Health and Emerging Pathogens Institute. He is also Director of the Center for Research on Influenza Pathogenesis, one of five National Institutes of Health (NIH) Centers of Excellence for Influenza Research and Surveillance. The research took place in the Guangxi region of southern China, an area where diverse animal species are raised in proximity to one another and intermingle in live-animal markets.

In the study, researchers swabbed the noses of some 800 dogs that had all been brought to veterinarians or clinics in the region after showing respiratory symptoms consistent with canine influenza. The scientists sequenced the complete genomes of 16 influenza A viruses obtained from the dogs. All of these strains represented introductions of H1N1 swine influenza viruses circulating in pigs in Asia and Europe into these dogs.

They also found a set of three new viruses (H1N1r, H1N2r, and H3N2r) in which these swine-origin canine influenza viruses exchanged genes with previously identified avian-origin H3N2 canine influenza viruses.

Flu viruses have eight mini chromosomes and when two different strains infect the same cell they can exchange genetic segments, a process known as reassortment. All pandemic flu viruses that have been tracked have involved reassortment. The 2009 H1N1 swine-origin human influenza pandemic, for example, was a derivative of two different strains of swine influenza, one that had been circulating in Asia and Europe and the other in the Americas, particularly North America. That pandemic virus traced to a very small region in central Mexico, and was responsible for more than 17,000 deaths worldwide when it jumped from pigs into humans.

There is no known case of a human contracting a canine flu. Nor is it certain that the new strains of dog flu virus discovered in China would have that transmission capability. Still, as Dr. García-Sastre points out, the potential exists, especially in light of the frequent contact between pets and their owners. Moreover, the health risk increases for humans who have not previously been exposed to these viral strains and have not built an immunity to them.

Dr. García-Sastre does not predict a new pandemic, but he says there is a need for additional research and heightened vigilance by public health authorities around the world.

“We must start thinking about dogs as potential reservoirs for influenza viruses,” he says. “The more awareness we create, the more likely that countermeasures can be developed by countries to diminish the circulation of influenza virus in domestic animals.”

Melinda Lantz, MD, Assumes Leadership Role

Updated on Jun 30, 2022 | Featured, MSBI, Psychiatry

Melinda Lantz, MD

Members of the American Association of Geriatric Psychiatry (AAGP) have elected Mount Sinai Beth Israel physician Melinda Lantz, MD, to become the organization’s President. Dr. Lantz, Vice Chair, Chief of Geriatric Psychiatry, and Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, assumes her new role at a pivotal time.

Founded in 1978 to promote the well-being of older people through education, advocacy, and career development of psychiatrists, AAGP has embraced change. Its growing ranks now include nurses, physician assistants, and mental health professionals coping with a growing geriatric population.

Every day, an estimated 10,000 people reach age 65. Behavioral health problems affect 15 percent of older adults and up to 5 percent have serious mental illnesses, according to the federal Substance Abuse and Mental Health Services Administration. In 2013, more than 7,000 people age 65 or older died by suicide. Additionally, experts say direct health care costs associated with dementia in the elderly often equal or exceed the costs for heart disease and cancer.

In her role as President of AAGP, Dr. Lantz—a specialist in dementia care and geriatric mental illness—plans to address the need for additional recruitment and training by increasing interest in and availability of subspecialty fellowships in geriatric psychiatry. Boosting physician compensation for providing care to older adults with complex needs would also revitalize career opportunities.

Dr. Lantz would like to see an emphasis placed on empathy during training, a critical element for older patients who often cannot advocate for themselves. Elderly patients as a whole, she says, tend to like and respect doctors and welcome human contact.

Encouraging empathy in the treatment of patients “inspired me to be in the organization,” she says.

Too often, physicians lose empathy when they are stressed and have heavy workloads. “Everybody does better when they perceive empathy from physicians. One of the things that fellowships can do is help them get it back.”

After robust lobbying by the AAGP, the Centers for Medicare and Medicaid Services recently agreed to assign an insurance code to monitor the impact of geriatric psychiatry. “Getting that code suffix added was a major win,” says Dr. Lantz, who anticipates a favorable outcome once all of the factors are weighed. Tracking patients will show how geriatric psychiatry affects medical costs and resources.

Having spent billions of dollars researching dementia drugs with little success, many drugmakers have pulled back, according to Dr. Lantz. Today, she adds, “There are limited drug options for dementia in the pipeline. We need to focus on care and quality of life for those with dementia.”

An area that does show promise for helping in the treatment of geriatric psychiatry is technology. For elderly patients who are less mobile, telemedicine via videoconferencing can ease loneliness and increase access to care. Dr. Lantz says technology will also expand the scope of support to other health care providers who are located in communities where there are no specialists in geriatric psychiatry.

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