All-Female Team Leads Live-Case Demonstration

May 8, 2018 | Featured

From left: Sarah Lamothe, BSN, RN-BC; Surbhi Chamaria, MD; Yuliya Vengrenyuk, PhD, Assistant Professor of Medicine (Cardiology); Annapoorna S. Kini, MD; Haydee Garcia, MSN, ACNP-BC; Asma Khaliq, MD; and Jennifer Del Campo, MSN, FNP-C. All but Ms. Garcia and Ms. Del Campo participated in the live-case demonstration.

It was an historic moment at a cardiology conference when Mount Sinai’s Annapoorna S. Kini, MD, led an all-female team for the first time in a live-case demonstration.

The demonstration was beamed from The Mount Sinai Hospital to an audience attending the CRT 2018 meeting, a leading interventional cardiology conference that took place in March in Washington, D.C.

The team consisted of female cardiologists, nurses, and technicians from The Mount Sinai Hospital’s Cardiac Catheterization Laboratory with participation from female fellows Surbhi Chamaria, MD, and Asma Khaliq, MD. They performed a complex percutaneous coronary intervention with stent procedure on an elderly high-risk patient.

The panel discussing the case live was also all-female, and included Mount Sinai’s Roxana Mehran, MD, Professor of Medicine (Cardiology) and Director of Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Wiener Cardiovascular Institute.

Says Dr. Kini: “The entire Mount Sinai Cath Lab team was excited and proud of this achievement. Our goal was to encourage every female cardiologist to be optimistic and confident in this male-dominated field. It was a true demonstration that if we work hard and push our boundaries, we can achieve great heights in the field we love.”

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Mount Sinai at Home Coordinates and Innovates Home-Based Care

May 8, 2018 | Featured, Your Health

Mount Sinai at Home leaders, from left, Operations Director Alexander Mandl; Albert L. Siu, MD; and Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine.

The Mount Sinai Health System recently launched Mount Sinai at Home, an innovative enterprise with two key components: a service line of programs across the Health System that care for patients in their own homes, and a research arm, the Institute for Care Innovations at Home.

“Mount Sinai at Home’s programs will align closely with the Health System’s population health strategies and advance our capacity to serve communities beyond our hospitals,” says Director Albert L. Siu, MD, Professor and Chair Emeritus of Geriatrics and Palliative Medicine. Treating patients in familiar and convenient environments can improve communication, coordination, and continuity of care, and reduce the risk of admission and readmission.

“This all started with Mount Sinai Visiting Doctors, which was founded in 1995 and gave us an opportunity to create the Mobile Acute Care Team (MACT),” Dr. Siu says. “When MACT started out in 2014, it was just Hospitalization at Home, but very quickly our teams found more ways to support our patients and our Health System, so we created services such as Rehabilitation at Home for care after hospitalization.” MACT, which was founded with a $9.6 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services, has been a success, treating 750 patients so far. Its name presented a challenge, Dr. Siu says, since “MACT was not particularly descriptive from the point of view of patients.” As all of its home-based programs grew, the Health System saw a need to coordinate them and to find a new, unified name.

The result is Mount Sinai at Home, which is also headed by Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, who was Director of Mount Sinai Visiting Doctors and Clinical Director of MACT; and Operations Director Alexander Mandl. Mount Sinai at Home will provide “operational, financial, legal, logistical, and clinical” support for home-based care across the Health System, Mr. Mandl says. Its clinical programs are:

  • Mount Sinai Visiting Doctors, providing primary care for homebound patients, who are usually very frail and elderly;
  • Pediatric Visiting Doctors and Complex Care Program, for young patients, such as children with chronic illnesses or infants who have just left neonatal intensive care;
  • Hospitalization at Home, for patients with a condition that might otherwise call for hospitalization, such as acute pneumonia; and
  • Rehabilitation at Home, for patients who need care that might otherwise be provided at an inpatient rehabilitation center.

In March 2017, Frederick Ballen became the 500th patient of the Mobile Acute Care Team—now part of Mount Sinai at Home. He was treated at his home in Manhattan by Caitlin Pelan, RN, left, and Joanna Jimenez-Mejia, NP.

These programs will continue to function in collaboration with the Departments of Medicine, Geriatrics and Palliative Medicine, and Pediatrics. Over time, other efforts and collaborations may be added, such as a palliative care program that is now part of a clinical trial led by R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine. In the program, a team of nurses, community health workers, social workers, nurse practitioners, and physicians provide care and support to seriously ill patients at home. “If it is successful, we hope to keep this as a clinical program,” Dr. DeCherrie says. Another study led by Dr. Morrison, on the cost-effectiveness of palliative care, was recently published in the Journal of the American Medical Association Internal Medicine.

Mount Sinai at Home also created a payment model for Hospitalization at Home that in September became the first to be approved by Medicare’s Physician-Focused Payment Model Technical Advisory Committee. “When it is implemented, it will be a model that hospitals around the country can use,” Dr. DeCherrie says.

The Mount Sinai Health System has long been a leader in palliative care, geriatrics, and health care at home. “We already have the largest academic house-call program in the country—Visiting Doctors—and our Hospitalization at Home program is already the largest in the country,” Dr. DeCherrie says. “To put it all together under one service line, that is very different and very new.”

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Palliative Care Cuts Hospital Costs, Large Study Finds

May 8, 2018 | Featured, Research

R. Sean Morrison, MD

Palliative care, which focuses on improving quality of life and reducing suffering for people with serious illness and their families, is associated with shorter hospital stays and lower costs, according to a study published in April 2018 in the Journal of the American Medical Association Internal Medicine. The study—the largest of its kind—was conducted by the National Palliative Care Research Center at the Icahn School of Medicine at Mount Sinai and Trinity College Dublin.

The investigation pooled data from six prior studies involving more than 130,000 adults admitted to hospitals in the United States between 2001 and 2015; of these patients, 3.6 percent received a palliative care consultation in addition to their other hospital care. It found that when palliative care was added to patients’ routine care, hospitals saved an average of $4,251 per stay for cancer patients and $2,105 for those with non-cancer diagnoses. The savings were greatest for patients with the highest number of co-existing illnesses.

Unlike hospice care, palliative care can be provided early in the course of illness, along with life-prolonging therapies. Palliative care has seen a steady rise during the past 30 years, but research suggests that there is much room for growth, says study coauthor R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine.

“The potential to reduce the suffering of millions of Americans is enormous,” Dr. Morrison says. “This study proves that better care can go hand in hand with a better bottom line.”

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Mount Sinai Adolescent Health Center Hosts Conference on Violence Against Children

May 8, 2018 | Featured, Patient Stories, Research

“When a young person is traumatized, it sets the stage for a life that is more difficult.” Dennis S. Charney, MD

“Is anything more important than ending violence against children and adolescents?”

That rhetorical question was posed by 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, in his opening remarks at a recent conference sponsored by the Mount Sinai Adolescent Health Center and the World Childhood Foundation USA. “When a young person is traumatized,” said Dr. Charney, a renowned expert in the neurobiology and treatment of mood and anxiety disorders, “it sets the stage for a life that is more difficult.”

The conference, “Ending Violence Against Children: Developing a Roadmap to a Healthy Childhood and Adolescence,” was held Thursday, March 22, and Friday, March 23, in Stern Auditorium, and kicked off the 50th anniversary of the Mount Sinai Adolescent Health Center, a unique New York City-based program that delivers comprehensive medical and mental health services and prevention education to people ages 10 to 22.

More than 70 percent of the young people who come to the Adolescent Health Center have a history of trauma, according to conference co-director Angela Diaz, MD, PhD, MPH, Director of the Mount Sinai Adolescent Health Center and the Jean C. and James W. Crystal Professor of Pediatrics, and Professor of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai.

“Young people are our present and our future,” said Dr. Diaz. “Together, we can create a model for ending violence against children.”

Sixty experts served on panel discussions that included research into the long-term consequences of early childhood abuse and neglect, the economic impact of violence in childhood, and ways to safeguard the mental health of children and adolescents. Panel participants covered topics such as abuse prevention, support for survivors, the role of the justice system, and ways to find innovative solutions.

David Finkelhor, PhD

Rachel Lloyd, Founder and President of Girls Educational and Mentoring Service (GEMS), participated in a panel discussion on helping victims of sexual trafficking. “Poverty is the baseline for almost every child who ends up being sexually trafficked,” she said. “Sexual trafficking is a matter of demand and supply, but it’s driven by sexual abuse at home, poverty, domestic violence, and running away from Child Protective Services.”

The audience was comprised of hundreds of clinicians, researchers, policymakers, philanthropists, and youth advocates, who came together to identify solutions to defend children’s rights and promote better living conditions for children. Joanna Rubinstein, DDS, PhD, President and Chief Executive Officer, World Childhood Foundation USA, also served as co-director of the conference.

David Finkelhor, PhD, Director, Crimes against Children Research Center, University of New Hampshire, delivered the conference’s keynote address, and proposed the creation of a common field of study to examine the full scope of violence against children, including bullying and peer victimization, as well as abuse by adults and how the risk of violence changes over the course of development.

“Children suffer five times more violence than adults,” he said. “Why are they so vulnerable? They are small, dependent, inexperienced. Kids don’t choose their families, schools, or neighborhoods.”

Dr. Diaz and Dr. Rubinstein concluded the conference with a call to action that would include addressing barriers to identifying victims and integrating a “trauma-informed” approach into programs that interact with children and youth. “This is the beginning of a movement,” Dr. Diaz said.

Angela Diaz, MD, PhD, MPH

 

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Introducing Mount Sinai Future You, a New Television Series

May 2, 2018 | Featured, Future You, Patient Stories, Research


A new television series called 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.

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.

In its first 30-minute episode, Mount Sinai Future You highlights:

  • Dennis Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, who discusses the anniversary of the Icahn School of Medicine, a leader in medical breakthroughs since 1968, and shares his own story of resilience after recovering from a traumatic event.
  • Breakthroughs in operating room technologies, such as augmented reality, simulation, and 3D printing, by surgeons and researchers in the Department of Neurosurgery.
  • The science of addiction, with Eric Nestler, MD, PhD, Dean for Academic and Scientific Affairs and Director of The Friedman Brain Institute, who is researching addiction and depression, and Yasmin Hurd, PhD, Ward-Coleman Chair of Translational Neuroscience and Director of the Addiction Institute at Mount Sinai, who is investigating how a component of the marijuana plant may aid in treatment of opioid addiction.
  • How vaccines developed in the lab of Joshua Brody, MD, Assistant Professor of Medicine (Hematology and Medical Oncology), are targeting cancer cells.
  • Douglas Dieterich, MD, Professor of Medicine (Liver Diseases), and a patient of his, who relate their shared journey with hepatitis C.

A Promising New Approach to Treat Stroke Patients

Updated on Jun 30, 2022 | Featured, Research

J Mocco, MD, MS

In recent years, there has been dramatic progress in the treatment of stroke—with significant contributions made by Icahn School of Medicine at Mount Sinai researchers— especially in the development of endovascular therapy that quickly and safely removes the stroke-causing blood clots that form in an artery that supplies blood to the brain.

In January, at the International Stroke Conference 2018 in Los Angeles, Mount Sinai researchers unveiled preliminary clinical trial data that further advance the effectiveness of a new clot-aspiration treatment as a first-line approach for retrieving and removing these blood clots from arteries.

The findings, which were presented by J Mocco, MD, MS, Professor of Neurosurgery, and Vice Chair of Neurosurgery and Director of the Cerebrovascular Center at the Mount Sinai Health System, showed that using, as a first-line approach, a clot-aspiration system that acts like a “vacuum” to retrieve and remove the clot was not inferior to using a stent, the current standard of care. Over the years, research conducted by Dr. Mocco was instrumental in developing both approaches.

“Our data strongly demonstrate that the two approaches are clinically equivalent, meaning that patients do just as well when you start with aspiration, or clot suction, as when you start with a stent retriever to trap and pull out the clot,” says Dr. Mocco, who designed the still-to-be-published study in collaboration with two leading stroke experts from other institutions. “Ours is the first trial designed to compare patient functional outcomes between these treatment approaches.”

Both the aspiration and stent retriever techniques are initiated by inserting a guide catheter into the femoral artery in the groin and moving it up into the brain under image guidance. The aspiration approach involves passing a specialized aspiration catheter through the guide catheter, the first step in a system that allows the clot to be suctioned from the artery. The stent retriever approach involves introducing a stent retriever, which resembles a tiny wire cage, through the guide catheter and moving it to the clot, where it opens up and traps the clot. The stent that contains the clot is then removed through the guide catheter.

Specifically, the study enrolled 270 stroke patients at 15 centers into a prospective, multicenter, randomized trial to assess how functional they were after treatment using either a large-diameter aspiration catheter system, made by Penumbra, Inc., or a stent retriever, as a first approach. To compare clinical outcomes, researchers used the modified Rankin Scale for neurologic activity, (mRS), a standard measurement of the degree of disability or dependence in the daily activities of people who have had a stroke. The scale runs from 0 (no symptoms at all) to 6 (death).

The data showed that 52 percent of patients treated with Penumbra’s aspiration system achieved the primary endpoint of functional independence (mRS 0-2) at 90 days compared with 49 percent of patients treated with stent retrievers.

“This study is very exciting because it shows that there are other ways to open the arteries that are just as effective and perhaps may be even faster, safer, and less expensive,” says Dr. Mocco.

 The clinical trial was funded by Penumbra, Inc., but was conducted independently by Dr. Mocco and his collaborators, who also handled all data analysis. Dr. Mocco does not have a financial interest with Penumbra. Dr. Mocco serves as a consultant and has equity in companies that develop and manufacture devices for the treatment of neurologic diseases and is a manager for Neurotechnology Investors.