Workplace Resilience Program Targets Health Care Worker Well-Being

Updated on May 11, 2023 | Featured, Psychiatry

What do resilient people do when times get tough? Researchers at Mount Sinai, including Dennis Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs of the Mount Sinai Health System, have a long history of exploring that question.

So when the COVID-19 pandemic arrived in New York City early in 2020, Dr. Charney gathered together Mount Sinai experts in trauma and resilience, who recognized almost immediately what lay ahead. They saw that their staff was at risk for stress-related conditions from the mounting crisis—and they didn’t wait to react.

By early that summer, the Center for Stress, Resilience, and Personal Growth (CSRPG) opened its doors, directed by Deborah B. Marin, MD, the George and Marion Blumenthal Professor of Psychiatry.  Over its first few years, the Center has become a firmly established resource available to all Mount Sinai staff, faculty, students, and trainees.

When developing the program, the Center’s leadership, including Vanshdeep Sharma, MD, Craig L. Katz, MD, and Jonathan DePierro, PhD, drew on their collective expertise managing the behavioral health impact of the September 11, 2001, attacks in emergency responders.

“We had existing services that predated this Center, but there was a clear need as the pandemic raged on to have an on-the-ground resource led by mental health professionals,” says Dr. DePierro, the Center’s Associate Director and an Associate Professor of Psychiatry at Icahn Mount Sinai.

The Center was designed to provide evidence-based services to increase resilience and support the psychological well-being of the people who make the Health System function. Three years later, it remains a valuable and effective resource for the Mount Sinai community, and a model for other health systems.

Treating Health Care Provider Stress

Dr. DePierro and his colleagues at the Center set out to create a program that would support staff with mental health needs while also offering preventive measures to reduce the risk of stress-related conditions. Their dedicated team includes clinical social workers, psychologists, psychiatrists, and support staff. Together, that team supports the 43,000 people who work within the Mount Sinai system, including health care workers, administrative and support staff, medical students, and trainees.

Jonathan DePierro, PhD

One of the Center’s earliest offerings was an immediate way to connect to support. “Anyone employed at Mount Sinai can call to be evaluated over the phone and referred for behavioral health care as needed,” Dr. DePierro says.

While some in-person services are available, telehealth options are also available for behavioral health services. That makes care more easily accessible for those who need it—and helps them feel more comfortable seeking services in the place where they work. “We take many efforts to ensure we’re protecting confidentiality,” Dr. DePierro adds. The Center’s faculty practice is led by Clinical Director Ashley Doukas, PhD.

While providers at the Center often help people manage work stress and burnout, their concerns don’t have to be job-related. “We started in the midst of the pandemic, but people are presenting with stress from all sorts of things: exhaustion, relationship problems, sleep problems, depression, anxiety,” he adds. “We take care of you first as a person, and second as a health care provider.”

Boosting Resilience Through Prevention

Treatment is only part of the Center’s scope. The Center’s leadership team also drew from the deep well of scientific literature on resilience to develop training materials that would help employees weather the storm of stress.

Based on that science, the team developed a series of resilience training curricula to give people the tools and skills to manage stress in healthy ways. Since 2020, they’ve led almost 400 resilience workshops with the Mount Sinai community. Those workshops are tailored to the needs and cultures of a given group. Nurses, for instance, may have different needs and stressors than hospital security staff or medical students. “One important lesson to take away from this is that there is not a one-sized-fits-all approach,” DePierro says.

The workshops are customized for each population, but they share a common goal: “They provide the tools people need to manage the ups and downs they deal with on a daily basis,” Dr. DePierro says. Scarlett Ho, PhD, Director of Education, is responsible for the ongoing expansion and evolution of the resilience workshops.

Tools that can boost resilience in the face of stress and trauma include:

  • Social support
  • Remaining optimistic
  • Facing fears rather than withdrawing from them
  • Physical exercise
  • Having a role model or mentor
  • Thinking flexibly about challenges
  • Avoiding negative self-talk

Much of the evidence in support of these strategies is described in detail in the forthcoming third edition of the book Resilience: The Science of Mastering Life’s Greatest Challenges, by Drs. Charney, DePierro, and the late Yale University psychiatrist Steven M. Southwick, MD.

An Investment in Health Care Provider Well-Being

The Center continues to grow and expand its offerings. In 2021, the team shared its resilience training program with the broader New York City community, partnering with faith-based organizations in Harlem, the Bronx, Brooklyn, and Queens.

“In 2022, we trained community health advisors and pastors in nine organizations to teach workshops to their congregations, reaching over 1,000 community members,” Dr. DePierro says. This work built on more than a decade of community-based partnerships fostered by Dr. Marin and health care chaplain Zorina Costello, DMin, Director of Community Engagement for the Center and the Center for Spirituality and Health at Mount Sinai.

In 2022, the Center and Mount Sinai’s Office of Well-Being and Resilience jointly received a $2.1 million Health Workforce Resiliency grant from the Health Resources and Services Administration to further develop the resilience training and tools. In collaboration with partners in digital health, including the Hasso Plattner Institute for Digital Health at Mount Sinai, the Center’s leadership also created an app called Wellness Hub. Available to Mount Sinai’s health care workers, the self-guided digital health platform allows users to screen themselves for stress and provides activities to boost resilience.

Staff of the Center for Stress, Resilience, and Personal Growth at Mount Sinai

The Center’s team is collecting data to evaluate the efficacy of their workshops and the app. So far, feedback has been positive. Surveys from workshop participants suggest that following the training, people feel better prepared to manage stressors from their jobs and their personal lives. “They have a better sense that they can bounce back from life’s challenges,” Dr. DePierro says.

As the team collects more data about program outcomes, they are considering packaging the material for other health systems to use to boost resilience among staff. In the meantime, Dr. DePierro says he’s happy to share his knowledge with other health system leaders who want to take steps to invest in the mental health and well-being of their providers.

“We’re exceptionally lucky that Mount Sinai has had the vision to invest in this resource at a time it was badly needed,” he says. But even as the pandemic eases, that investment is paying dividends, he adds. “We’re baked into the system now, and we’re not going anywhere.”

Mount Sinai Doctors-787 Eleventh Avenue Provides Comprehensive Breast, Spine, and Imaging Services

Updated on May 11, 2023 | Community, Featured

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Mount Sinai Doctors-787 Eleventh Avenue is a new outpatient center designed to provide comprehensive, convenient care for breast and spine patients, and imaging services.

The Center welcomes new and existing patients to a relaxing, beautifully designed facility. Home to Mount Sinai’s outstanding multidisciplinary team of surgeons, specialists, and medical support staff, the new facility allows patients to experience Mount Sinai expertise in a convenient, state-of-the art facility.

“This space was designed to emphasize collaboration across disciplines in caring for our patients,” said Lisa Mazie, Chief Administrative Officer, Mount Sinai West. “Breast Surgeons and staff work in partnership with radiologists and technical imaging specialists to coordinate cohesive care. Orthopedic and neurosurgical spine surgeons and interventional physiatrists work together in one practice with their own EOS low-dose X-ray, plain film standing X-ray, and fluoroscopy within their space.  We want to provide patients one location with varying modalities of care and expertise to meet their health care needs.”

Samuel K. Cho, MD, right, and a patient

At the same time, the facility’s design, from the artwork on the walls to the lighting and furniture, seeks to create a soothing environment for patients.

“The new location will be home to an expanding array of breast imaging services including the most advanced mammography, ultrasound, and MRI available,” said Laurie Margolies, MD, FACR, FSBI, Vice Chair for Breast Imaging, Mount Sinai Health System, and Professor, Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai.

“Patient-centered care is at the heart of everything we do,” said Stephanie Bernik, MD, FACS, Chief of Breast Service at Mount Sinai West and Associate Professor, Surgery at Icahn Mount Sinai. “This state-of-the-art facility is thoughtfully designed with patients’ needs in mind, is easy to access, and will allow more people to benefit from Mount Sinai’s world-class surgeons, radiologists, and support staff.”

Stephanie Bernik, MD, FACS, right, speaks with a patient.

Mount Sinai Spine at Mount Sinai Doctors offers a fully integrated collaboration among providers in orthopedic surgery, neurosurgery, and physiatry/pain management to provide the highest quality, comprehensive spine care.

“We have created a seamless structure that is able to provide whatever treatment and care a patient needs, regardless of spinal condition,” Jeremy M. Steinberger, MD, Director, Minimally Invasive Spine Surgery, Mount Sinai Health System, and Assistant Professor, Neurosurgery, and Orthopedics, at the Icahn Mount Sinai.

“Our doctors at the new Mount Sinai West Spine Center offer a full complement of comprehensive spine services that meet your needs using the latest minimally invasive techniques in our state-of-art facility,” said Samuel K. Cho, MD, Chief of Spine Surgery, Mount Sinai West, and Professor, Orthopedics, and Neurosurgery at the Icahn Mount Sinai. “Whether you are a teenager with scoliosis or an adult suffering with disc herniation, we are here to help you.”

For spine patients, EOS, a low-dose alternative to X-rays and CT scans, is available. EOS provides 3D, weight-bearing images that enable physicians to get the most accurate view of the spine and lower limbs in a natural standing position.

Get more information or to book an appointment with a specialist

Thinking About Becoming a Neuroscientist Someday? Start Here—at Mount Sinai’s Brain Fair for Schoolchildren

May 9, 2023 | Community, Featured

It was a most amazing field trip for nearly 600 elementary, middle, and high school students who participated in the recent 11th Annual Brain Fair on the campus of the Icahn School of Medicine at Mount Sinai, eager for a day of learning and fun.

The event, which was also open to Mount Sinai staff and the community, was held during Brain Awareness Week, a global campaign launched by The Dana Alliance for Brain Initiatives to foster public enthusiasm and support for brain science. Mentoring in Neuroscience Discovery at Mount Sinai (MiNDS) co-sponsored the Brain Fair with The Friedman Brain Institute and the Center for Excellence in Youth Education (CEYE).

Angelica Minier-Toribio, a fifth-year Neuroscience PhD student and MiNDS volunteer, was ready for the throngs—among them was Jordan, a fifth-grader at CEYE partner school PS 171 Patrick Henry. He stopped by her booth, curious to learn how the brain sends electrical impulses to muscles and controls movement.

Fifth-grade student Jordan, with classmate Julian looking on, gets a lesson from Angelica Minier-Toribio on how the brain sends electrical impulses to muscles and controls movement.

Ms. Minier-Toribio placed two electrodes on Jordan’s arm and three on herself, and asked, “Do you feel anything?” as she used a battery-powered device to record electrical impulses from her own arm muscle, which she amplified and gently directed to his arm muscle. Jordan could feel—and see—his fingers and hand move involuntarily. He recounted after the demonstration that his arm and fingers “felt tingling” and that he saw how “electricity can control your muscles.”

MiNDS, a program that was launched by PhD neuroscience students at Mount Sinai’s Graduate School of Biomedical Sciences, aims to make neuroscience education more engaging and accessible to the public. Denise Croote, PhD, who was active in MiNDS as a neuroscience graduate student, is now its faculty supervisor. The CEYE, directed by Kenya Townsend, has been in existence for nearly 50 years, hosting both school-year and summer programs for youth from racial and ethnic backgrounds that are underrepresented in medicine and science.

Adding to the excitement—this was the first in-person Brain Fair in the three years since the COVID-19 pandemic first ravaged New York City. Appearing at the event were Eric J. Nestler, MD, PhD, and Paul J. Kenny, PhD. Dr. Nestler is Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, and Dean for Academic Affairs at Icahn Mount Sinai, and Chief Scientific Officer of the Mount Sinai Health System. Dr. Kenny is Ward-Coleman Professor and Chair of the Nash Family Department of Neuroscience and Director of the Mount Sinai Drug Discovery Institute.

The Friedman Brain Institute hosted additional activities around Brain Awareness Week. Among them:

  • The Art of the Brain, an annual exhibition of photographs, paintings, illustrations, and videos that celebrate the beauty of the brain and nervous system as seen through the eyes of some of the world’s leading researchers. Veronica Szarejko, the Director of Art of the Brain and the exhibition’s curator, says faculty, trainees, and staff from 14 departments and institutes across Mount Sinai submitted 52 works.

The Art of the Brain celebrates the beauty of brain science.

The virtual exhibition, launched on March 22, is available to Wednesday, May 31. Over the years, the exhibition has received world-wide acclaim for showcasing how science—and art—are revealed as researchers study the brain. Take a museum-style tour of the exhibition.

  • Stories of Brain and Beyond, a special Mount Sinai storytelling event in which five scientists shared true, personal stories of their scientific paths. Created through a collaboration between The Friedman Brain Institute and The Story Collider, and spearheaded by neuroscience postdoctoral fellow Aya Osman, PhD, and Abha Karki Rajbhandari, PhD, Assistant Professor of Psychiatry, and Neuroscience, this event was performed live, on-stage, at Caveat, a New York City performance space. From the tragic to the hilarious, the storytellers explored the deeply human side of science.

Scientists shared personal stories of their scientific paths during a live event at Caveat, a New York City performance space.

At the Brain Fair, 100 volunteers, which included 60 MiNDS members, 28 CEYE high school students, and 12 Neuroscience faculty were on hand to interact with the students. The volunteers were stationed at more than 20 booths that offered unique learning experiences. Visitors were able to see real specimens of a healthy—and diseased—human brain; stop by an “Ask an Expert” booth; learn about balance and optical illusions, taste and smell, and hand-eye coordination; and walk through a giant inflatable model of the brain, an immersive and educational experience.

A popular activity for the schoolchildren was the hands-on opportunity to remove a “brain tumor” using the same technology that Mount Sinai brain surgeons rely on in their operating rooms—the 3D robotic exoscope. This is a device that has a high-definition digital camera system and magnifies the brain’s neural and vascular structures, allowing neurosurgeons to remove tumors with greater precision.

Fatima uses the Synaptive Medical Modus V, a 3D robotic digital exoscope, assisted by Evelyn Richardson, Senior Clinical Applications Specialist, Synaptive Medical.

Fatima, also a fifth-grader at PS 171 Patrick Henry, was one of many eager students who stopped by. With a neurosurgery operating room team member guiding her, Fatima put on the same 3D glasses used by Mount Sinai neurosurgeons as she attempted to delicately remove, under high magnification, a tiny strawberry seed—”the tumor”—from a fresh strawberry. Her classmates, also wearing 3D glasses, stood around and watched as she carefully, and successfully, completed the task. One of her teachers who was looking on said with delight: “Fatima is a brain surgeon now!”

Not yet—but the Brain Fair certainly opened up the possibility for Fatima and the others to consider eventual careers in neuroscience.

Scroll through this slideshow for more photos.

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AI Spotlight: Forecasting ICU Patient States for Improved Outcomes

May 8, 2023 | Featured, Research

AI Spotlight: Forecasting ICU Patient States for Improved Outcomes

Girish Nadkarni, MD, MPH, and Faris Gulamali

Artificial intelligence (AI) and machine learning (ML) have seen increasing use in health care, from guiding clinicians in diagnosis to helping them decide the best course of treatment. However, AI still has much unrealized potential in various health care settings.

Mount Sinai researchers are exploring bringing AI into intensive care, and developed Spatial Resolved Temporal Networks (SpaRTeN), a model to assess high-frequency patient data and generate representations of their state in real time.

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The work was presented at the Time Series Representation Learning for Health workshop on Friday, May 5, hosted by the International Conference for Learned Representations, a premier gathering dedicated to machine learning.

Hear from Girish Nadkarni, MD, MPH, Irene and Dr. Arthur Fishberg Professor of Medicine at the Icahn School of Medicine at Mount Sinai and the leader of the SpaRTeN research, and Faris Gulamali, medical student at Icahn Mount Sinai and member of the Augmented Intelligence in Medicine and Science lab, on what lay behind creating the model and what it could achieve for patients.

What was the motivation for your study?

A growing amount of research is indicating the need to redefine critical illness by biological state rather than a non-specific illness syndrome. Advances in genomics, data science, and machine learning have generated evidence of different underlying etiologies for common ICU syndromes. As a result, patients with the exact same diagnosis can have entirely different outcomes.

What are the implications?

In the ICU, representations of a patient can be used to guide personalized treatments based on personalized diagnoses rather than generic treatments with empirical diagnoses.

What are the limitations of the study?

In this study, we only looked at using one type of data at a time in real time. For example, we looked primarily at measures of intracranial pressure. However, the ICU has many types of data being output simultaneously. Future work hopes to integrate all the different types of data such as electrocardiograms, blood pressure, and imaging to improve patient representations.

How might these findings be put to use?

These patient representations are being combined with data on medications and procedures to determine how to optimize patient treatment based on underlying state rather than common illness syndromes.

What is your plan for following up on this study?

In this study, we focused primarily on creating the algorithm and showing that it works for the case of intracranial hypertension. In future studies, we would like to integrate multiple data modalities such as imaging, electrocardiograms, and blood pressure as well as intervention-based data such as medications and procedures to determine precise empirical interventions that lead to improvements in short-term and long-term patient outcomes.

Learn more about how Mount Sinai researchers and clinicians are leveraging machine learning to improve patient lives

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For 24th Year, Mount Sinai Receives Top Safety Rating for Cardiac Catheterization

Updated on Apr 14, 2023 | Cardiology, Featured

Annapoorna S. Kini, MD, left, and Samin K. Sharma, MD.

For the 24th consecutive year, The Mount Sinai Hospital’s Cardiac Catheterization Laboratory or its interventionalists have received the highest two-star safety rating from the New York State Department of Health (NYSDOH) for percutaneous coronary interventions (PCI), also known as angioplasty. PCI—one of the most common procedures for patients with coronary artery disease—opens blocked arteries and restores normal blood flow to the heart.

In a highlight of the report, Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory at The Mount Sinai Hospital, received the two-star rating for significantly lower 30-day risk adjusted mortality for PCI in all cases and in non-emergency cases. She was the only interventionalist in the state to receive this rating in both categories, while performing 2,844 procedures in the latest period reported, December 1, 2016, to November 30, 2019.

“This NYSDOH report is again a testament to the top quality work being done in The Mount Sinai Hospital Cardiac Catheterization Laboratory by the dedicated interventionalists, making it No. 1 in the nation in volume and quality,” says Samin K. Sharma, MD, Director of the Mount Sinai Cardiovascular Clinical Institute, and Senior Vice President of Operations and Quality for Mount Sinai Heart.

Mount Sinai’s exceptional ratings appeared in the latest NYSDOH report, released in April 2023, on the risk factors associated with PCI at 65 hospitals across New York State. The NYSDOH began publishing PCI safety ratings in 1995, in reports designed to help patients make better decisions about their care based upon a statistical review of each hospital’s data.

“Despite taking on some of the most challenging referrals, our Cath Lab has received the double-star rating again. I believe that our efforts as educators and investigators—in our conferences, live cases, publications, educational applications, and clinical trials—bring us to the forefront of the field,” says Dr. Kini, the Zena and Michael A. Wiener Professor of Medicine.  “We are looking forward, toward the horizon, and are always seeking the best practices and proven methods to provide our patients with the best outcomes.”

During the three-year period, The Mount Sinai Hospital had a risk-adjusted PCI mortality rate of 0.85 percent for all of its cases—emergency and nonemergency—significantly lower than the statewide average of 1.22 percent, while performing the largest number of procedures (10,347). For nonemergency cases, Mount Sinai’s PCI mortality rate was 0.50 percent, compared with the statewide average of 0.79 percent

 

Read more about The Mount Sinai Hospital’s Cardiac Catheterization Laboratory

Mount Sinai Neuroradiologist Collaborates on New Opera About a Long-Ago Pandemic

Updated on Apr 13, 2023 | Featured

Jarrett Porter and Joyce El-Khoury in the Odyssey Opera performance of Awakenings. Photo by Kathy Wittman

The COVID-19 pandemic is the most significant public health crisis of our time. However, from 1916 to 1927, there was another pandemic that shaped and ended lives—encephalitis lethargica, or sleeping sickness, which afflicted more than one million people worldwide, causing 500,000 deaths. Of those who recovered, many were left in a catatonic state, speechless and motionless. Most of these patients were warehoused in mental health or hospital facilities, with no ability or means to treat them successfully.

The story of three of these patients in the Bronx, and their physician, Oliver Sacks, MD, is the subject of an opera by a Mount Sinai neuroradiologist, Aryeh Lev Stollman, MD, and his composer husband, Tobias Picker. Awakenings made its debut in June 2022 at the Opera Theatre of St. Louis and its East Coast premiere in Boston in February 2023 with Odyssey Opera in a limited run at the Huntington Theatre. The opera was recently featured in The New Yorker and The New York Times.

Oliver Sacks, a neurologist, was struck by the similarities between encephalitis lethargica and Parkinson’s disease. He advocated to hospital management that L-dopa, an experimental drug used to treat Parkinson’s, might be an effective way to treat these patients. He was given permission to treat one patient as a test. The patient, Leonard, made a spectacular recovery, and Dr. Sacks gained authorization to treat many more patients. Unfortunately, the effects did not last, and most patients relapsed into their former trance-like state.

Dr. Sacks wrote a book, Awakenings, in 1973, detailing the cases of 20 patients. Dr. Stollman and his husband became friends with Dr. Sacks after being introduced at a dinner party in Manhattan in 1993. Mr. Picker had Tourette syndrome as a child, and over the course of his friendship with Dr. Sacks, was helped by him, both in accepting his condition and learning to live with it. Dr. Sacks noticed that Mr. Picker, who wrote the music, was relieved of his symptoms while playing piano, which Dr. Sacks wrote about in his book describing the therapeutic effects of music, Musicophilia.

Dr. Stollman, who is also an award-winning novelist, wrote the libretto for Awakenings. “We based the story on Dr. Sacks’ book, but because he wrote about 20 separate patients, we chose three main patients and created their interaction with each other and Dr. Sacks,” Dr. Stollman says. “Dr. Sacks realized that his book wasn’t just a collection of case histories, but rose to the level of allegory or myth. It’s symbolic of our own lives and what we go through. Even if we’re not afflicted like these patients, we have our own awakenings and then have to return to everyday life. So we framed this story in the myth of Sleeping Beauty, and Dr. Sacks is the prince who awakens our characters. However, Sleeping Beauty doesn’t have to go back to sleep, but these patients do.”

In the opera, as Leonard responds to his treatment and awakens, he sings:

It’s a lovely feeling!

A lovely feeling.
To walk. To talk.

I have watched you every night and every day for years.
How many years have I been imprisoned in that chair?
I could only live in books,
And live through other people’s lives.
It’s a lovely feeling.
A lovely feeling!
I am reborn.

“The opera was ready to premiere in June 2020 when the pandemic struck,” Dr. Stollman says. “Every opera company closed, and Awakenings had to be delayed. Perhaps audiences can now understand a little better and can relate through their own experience, coming out of this pandemic.”

Tobias Picker, left, and Aryeh Stollman, MD, at their wedding at the U.S. Supreme Court in Washington, D.C. Photo by Jon Fleming

In the opera, Dr. Sacks has an awakening of his own, coming to an awareness of his own identity as a gay man. But he feels he is not ready to fully embrace that fact, singing, “I am no longer the man I was / But I have not truly awakened yet.” “When Dr. Sacks came out, it took him a long time, but he wanted to do that before he died,” Dr. Stollman says. “In the end, he was a proud gay man. And we were fortunate to be his friend.”

While Dr. Sacks’ book was also the basis for a film starring Robin Williams and Robert De Niro, the opera written by Dr. Stollman and Mr. Picker is a fresh and original take on the story, enriched by their personal friendship.

As a neuroradiologist, Dr. Stollman reads CT scans and MRIs for neurological diseases and disorders of the spine. “My background in medicine certainly helped in writing the story, but I think writing and medicine are both life-affirming pursuits. As a doctor, you have an intense engagement with life. You can learn more about a patient in a few minutes than perhaps their closest friends know about them. And writing reflects the more intense and emotional aspects of our lives. They’re not that different, in some ways.”

Dr. Stollman has written several novels, including The Far Euphrates, which won the Lambda Literary Award and has been translated into German, Dutch, Italian, Portuguese, and Hebrew. His second novel, The Illuminated Soul, won the Harold U. Ribalow Prize for Jewish literature from Hadassah Magazine.

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