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.

‘Scarless’ Thyroid Surgery Wins a Patient’s Gratitude

Updated on Jun 30, 2022 | Featured, Patient Stories

Sarah Bird during a follow-up visit with Hyunsuk Suh, MD.

 

Sarah Bird, a 27-year-old accounting supervisor, had a “very rough” month about a year ago. She went to Mount Sinai Union Square to check out a lump on her neck that she had first spotted in a photograph. During follow-up visits, an ultrasound scan and biopsy of her thyroid found a nodule the size of a golf ball, and she was advised to have it removed.

“I went from not even knowing I had this condition to being told, ‘You have to have surgery pretty quickly,’” she says.

Ms. Bird was worried about a long recuperation after surgery. And because she is fair-skinned and prone to thick, raised keloid scars, she also worried that she would have “this huge worm across my throat for the rest of my life.”

But those fears were put to rest by Hyunsuk Suh, MD, who used an advanced robotic procedure to remove the nodule. Ms. Bird says she is “just so thankful” that she was referred to Dr. Suh, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, who in 2015 was the first in the United States to perform robotic bilateral axillo-breast approach (BABA), a “scarless” technique in which part or all of the thyroid is removed through four small incisions to the breasts and axilla (underarms). Mount Sinai is still one of only a few health systems in the nation to perform the procedure.

Dr. Suh also was the first in the nation to use robotic BABA to perform a radical modified neck dissection—removing a patient’s metastatic thyroid cancer and neck lymph nodes. Radical modified neck dissection typically requires an incision of about 10 centimeters, but the BABA technique uses four very small incisions, from 8 to 12 millimeters, making it unique among thyroidectomy approaches.

Dr. Suh, who earned his medical degree at the Johns Hopkins School of Medicine, trained with the physicians who developed the BABA procedure at Seoul National University in South Korea. When that six-month fellowship ended in 2015, he came to the Mount Sinai Health System, where he works closely with his mentor William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery, Icahn School of Medicine at Mount Sinai.

Robotic surgery is common in other specialties, such as urology and gynecology, Dr. Suh says, but it is an innovation in his field. “As surgeons we take great joy in learning new skills, new approaches, and new techniques,” he says, “and being in a place like Mount Sinai where there is an abundance of research and interests and innovations—that is very special.”

The BABA technique is as safe and effective as conventional thyroid surgery, Dr. Suh says, but some patients still prefer conventional surgery, which is typically performed through the front of the neck.

“Some people are apprehensive and fearful of something that is new. That is a natural response,” Dr. Suh says.“You have to explain to the patient how you were trained, and what the surgery entails, and what it means to do robotic surgery. Some people think you push a button and a robot comes out of a closet!”

Hyunsuk Suh, MD, was first in the nation to perform the advanced robotic procedure known as BABA.

Thyroid surgery—whether conventional or robotic—is usually ambulatory, meaning that patients are discharged after a few hours of observation. So Dr. Suh calls patients at home for a few days to check in. “Otherwise,” he says, “it is possible to lose the connection to the patient—being able to follow up on their symptoms and listen to their concerns.”

During Ms. Bird’s surgery, in March 2017, Dr. Suh removed the left lobe of the thyroid, including a benign four-centimeter nodule. Ms. Bird went home that day, and Dr. Suh called soon after.

“That was great,” she says. “I’ve never had a doctor who calls you at home and asks you how you’re doing.”

After some initial hoarseness and pain, Ms. Bird recovered quickly and was left with scars in her armpits that she says are “pretty much nonexistent.” In April 2017, she ran the SHAPE Women’s Half Marathon in 2 hours, 24 minutes. “It was my slowest half marathon ever,” Ms. Bird says. “But at least I finished, and it was very cool to be able to say, ‘You know, I had surgery a month ago, and I was down and out for a week, and now here I am crossing the finish line.’”

Two Mount Sinai Hospitals Work as One to Save a Life

Updated on Jun 30, 2022 | Featured, Patient Stories

Amit Pawale, MD

When 24-year-old Andrea Giraldo arrived in New York City from Miami to ring in 2018 with friends in the East Village, she had no idea how gravely ill she would soon become.

Her ordeal began with terrible leg pain, which sent Ms. Giraldo to a New York City hospital that is not affiliated with the Mount Sinai Health System. There, she was treated for blood clots in her leg vein and sent home. But later that night in her friend’s apartment, she had trouble breathing and collapsed.

The Emergency Medical Services ambulance took her to Mount Sinai Beth Israel (MSBI). Now unconscious, with very low blood pressure and a low blood-oxygen level, Ms. Giraldo was placed on a breathing machine. A CAT scan revealed that she had large life-threatening clots in her lung arteries. She received clot-busting medication (tPA) with no effect.

MSBI physicians contacted Amit Pawale, MD, Assistant Professor of Cardiovascular Surgery at The Mount Sinai Hospital, and a team of ECMO (Extracorporeal Membrane Oxygenation) specialists led by Dr. Pawale was dispatched immediately. They placed Ms. Giraldo on an ECMO machine, which supported her heart and lungs and prevented imminent cardiac arrest. ECMO works by draining blood from a patient’s vein and pumping it to an artificial lung or oxygenator that adds oxygen, removes carbon dioxide, and sends it back to the patient.

Her blood pressure and oxygen level normalized, and Ms. Giraldo was transported to The Mount Sinai Hospital on ECMO support. Dr. Pawale and his team performed open heart surgery, removed large blood clots from her arteries, and discontinued ECMO support. Vascular surgeons implanted an intravascular filter to prevent future clots from reaching her heart.

Four weeks after her surgery, Ms. Giraldo returned home to Miami, where she gradually resumed her work and daily activities. “I’m so glad I ended up at Mount Sinai,” Ms. Giraldo says. “I got the best care. The nurses were amazing, and Dr. Pawale literally saved my life.”

Dr. Pawale attributes Ms. Giraldo’s excellent outcome to exceptional teamwork throughout the Mount Sinai Health System: the Pulmonary Embolism Response Team, and the doctors, nurses, and technicians in the Cardiothoracic Surgery Intensive Care Unit.

 

The ECMO machine was used to help provide Andrea Giraldo with life-sustaining support.