First Person: Changing the Way We Respond to Errors Improves Patient Safety

Jun 28, 2022 | Community, Featured

Brian Radbill, MD, FACP, Chief Medical Officer, Mount Sinai Morningside, talks with Kim Keller and other staff about ways to develop a culture of safety.

Establishing a culture in which employees feel comfortable reporting safety events is one of the keys to achieving “zero harm” in health care because it allows hospitals to identify vulnerabilities in their care delivery systems.

Recently, a safety event in Tennessee that resulted in a nurse being convicted of criminally negligent homicide gained national attention for its criminalization of medical error. The verdict is expected to have a chilling effect on safety event reporting in hospitals across the nation that will ultimately make our health systems less safe.

Now is a crucial time for health care leaders to support front-line staff by promoting and properly implementing a system called Just Culture.

Brian Radbill, MD

Just Culture is a fair and just system of accountability that supports an organization’s values and reflects what we know about system design—systems are not perfect, and people make mistakes—when determining how we respond to a safety event. On the journey to “high reliability,” it is crucial that health care organizations develop a culture of safety and learning that respects and supports front-line staff.

Just Culture refers to a system used in a number of industries that is based on the principle that mistakes are generally the product of faulty organizational cultures, rather than the fault of one or more employees. The goal is to create an organization in which people report errors to help the organization learn from mistakes.

Historically, and even today, there is a perception that health care organizations remain overly punitive when responding to a safety event. Mount Sinai heard this from their own staff in the system-wide staff survey, Your Voice Counts.

Just Culture is not about creating a blame-free environment. It is about finding a fair balance where accountability is shared between the individual and the organization. The organization is responsible for designing and implementing safe systems and responding to safety events in a just manner. Individuals are accountable for the quality of their choices and for reporting errors or otherwise identifying system vulnerabilities.

Despite widespread recognition of the value of Just Culture, managers and leaders within health care often lack the necessary training to effectively and consistently respond to safety events in a manner consistent with Just Culture. In addition, most front-line staff have not been formally trained about Just Culture and are unaware of what it means to them.

To address these knowledge gaps and respond to concerns raised in the Your Voice Counts survey, leadership across the Mount Sinai Health System began working with David Marx, a pioneer in safety across several industries who is widely recognized as the “Father of Just Culture.” As part of that collaboration, Mount Sinai received training and educational materials to allow us to develop our own Just Culture “train-the-trainer” program. Originally intended as an in-person program, a virtual Just Culture training program was developed in response to the COVID-19 pandemic that allows participants to actively learn and engage with facilitators.

Recently, we began the first of several planned Just Culture Training for Managers programs within the Mount Sinai Health System. In order to make the program entertaining and leverage its online platform, the concept of the program is that participants are members of an at-home viewing audience watching a fictional morning talk show complete with hosts, guests, and even “commercial breaks.” Designated facilitators guide participants through a series of learning exercises in small breakout groups, culminating in their use of the Just Culture Company’s Just Culture Algorithm™ to work through two practice safety event cases.

In addition, after they have completed the half-day training, participants are instructed on how to educate staff about Just Culture within their unit or department. To strengthen the adoption of Just Culture, participants are invited to participate in monthly Zoom “lunch-and-learns” during which experts within the Health System discuss how to apply Just Culture in numerous industries.

Now more than ever, health systems need to work with front-line providers to create a culture of safety through a system of shared accountability. Just Culture training provides department heads, managers, nurse mangers, and other leaders with the tools to properly respond to a safety event to make our system of health care delivery safer. Through this training and associated education plan, the Mount Sinai Health System is committed to sustaining a workplace that ensures staff are treated fairly and patient safety remains at the center of everything we do.

For more information on Just Culture training at Mount Sinai, contact Shabona Akter, shabona.akter@mountsinai.org.

Brian Radbill, MD, Chief Medical Officer at Mount Sinai Morningside, is also a nephrologist who specializes in the treatment of chronic kidney disease. He earned his MD degree at Hahnemann University School of Medicine and trained as a resident and a fellow at the Icahn School of Medicine at Mount Sinai.

 

Computational Neuroscientist Opens Doors for New Ideas and Talent to Thrive

Jun 23, 2022 | Featured, Research

Computational Neuroscientist Opens Doors for New Ideas and Talent to Thrive

When Kanaka Rajan, PhD, an expert in neural networks, joined the Icahn School of Medicine at Mount Sinai in late 2018, it was the school’s way of investing in computational neuroscience. But since establishing her lab, she has achieved new heights not just in her area of study, but in paving roads for future diverse talents to enter what had been a rather homogenous field.

Dr. Rajan, an Assistant Professor of Neuroscience in The Friedman Brain Institute at Icahn Mount Sinai, was recently awarded the McKnight Scholar Award, a three-year honor that provides funding to early-career scientists, from the McKnight Foundation, a Minnesota-based organization that has supported work in arts and culture, neuroscience, and climate change.

“I am honored to be recognized by the McKnight Foundation this year. The announcement was such a pleasant surprise,” said Dr. Rajan. Awardees of such programs are not often pure theorists like herself, she said. But the less restricted nature of the funding will advance a new research direction her lab has taken on and will bring much needed exposure to a key problem in science: how does the brain work?

Growing the team

The Rajan lab builds recurrent neural networks—artificial networks of neural nodes or regions inspired by biological brains—toward two core goals. The first is to discover the pattern of cell activity and connectivity in the brain, especially in psychiatric disease models, using these networks. These include exploring how there might be unexpected similarities or differences across species.

One study in that vein was based on what Dr. Rajan calls “functional motifs”—brainwide neural maps that tracked motor dysfunction as a correlated passive coping mechanism, a trait associated with depression.

Larval zebrafish subjected to persistent stress were observed to shut down movement. By comparing computational models of the fish’s neural circuitry against what is known in similar studies in mice and humans, Dr. Rajan could extrapolate how multi-area brain communication and connectivity leads to behavior relevant to neuropsychiatric disease.

The second goal is studying the concept of generalized learning, in which skills learned for one task become applicable to other unrelated problems. This encompasses, among other things, how animals and people are able to multitask, and yet, unlike machines built with artificial intelligence, how people can fail to complete all or some of these tasks perfectly.

A recent breakthrough in generalized learning that Dr. Rajan is working on is getting recurrent neural networks to do “curriculum learning”—training them on designed syllabi of increasingly complex tasks.

The idea of curriculum learning is not new in psychology or cognitive neuroscience, in which animals learn through “shaping.” In a lab setting, animals can be shaped to perform a desired task through reinforcement, for example by rewarding successful completion of sequences of smaller tasks.

An illustrated look at Dr. Rajan’s work

Illustration credit: Jorge Cham

Using this method for recurrent neural networks was born partly out of recognition for how animals and children learn, and in part to address limitations of current training algorithms, Dr. Rajan said. She adds that her lab is among a handful to use curriculum learning in neuroscience, recognizing that understanding how people generalize requires understanding their full learning trajectory.

“It’s an exciting new chapter for this field and I’m hopeful the McKnight Scholar Award will help scale our efforts on this front,” Dr. Rajan said. Her team—comprising four postdoctoral researchers, some of whom are starting independent faculty positions later this year, and three graduate students—looks to add a few more members with the funding.

“This is a competitive field and city to hire scientists in,” she said. “Not only are we competing with other institutions; we’re also competing with industry, so it’s on us to make it an attractive proposition.”

But Dr. Rajan believes Mount Sinai offers something that other institutions or industry players might not: complete intellectual freedom.

“When I first arrived, I was told, ‘Welcome to the department. Let us know if you need anything,’ without any restrictions on my next steps,” Dr. Rajan recalled of her interactions with leadership in the Department of Neuroscience at Icahn Mount Sinai. “This was unlike previous institutions I had been at, where I had been gently nudged where I could or could not direct my research.”

Mapping new paths ahead

Just as Dr. Rajan felt she was given the opportunity to excel as a woman and person of color, she felt compelled to extend those opportunities to those who follow in her footsteps.

Dr. Rajan was allowed to tap her seed funding to start a pilot project in which she turned complex research papers into comic strips to get high school seniors and college students, especially those from disadvantaged communities, interested in joining the neuroscience field.

 

A peek at how Dr. Rajan makes complex research topics accessible to young students

Illustration credit: Jordan Collver

“There had been artificially high barriers to entry, like girls had been told they’re not good at math, or that AI and/or computational neuroscience are beyond their understanding,” Dr. Rajan said.

By turning complex ideas into jargon-free and engaging formats such as a comic strip, she hopes to help young students realize that they too can enter and flourish in such a technical field. A series of comic strips have been created and steps are underway to distribute them to schools in New York City and other cities.

“When I first started my lab, I had 116 applications to join my team. Guess how many were women?” Dr. Rajan asked. “Two. Computational neuroscience has a representation problem, and I want to fix what I can.” She continued, “I’ve taken small steps, but the ball rolled from Mount Sinai. Here, you see women really get to thrive.”

Answers to Your Questions About the COVID-19 Vaccines Just Authorized for Kids Six Months to Five Years Old

Updated on Jun 30, 2022 | COVID-19, Featured, Vaccines, Your Health

Parents of young kids finally have important news they have been waiting for: health authorities have authorized COVID-19 vaccines for kids six months to five years old.

This is welcome news for families and their younger children who have had to face the prospect of getting sick and have had to avoid many of their regular activities.

Federal health authorities have authorized the Moderna vaccine for children ages 6 months through 5 years, and the Pfizer-BioNTech vaccine for children ages 6 months through 4 years. The Pfizer vaccine requires three doses; the Moderna vaccine requires two doses. Pfizer’s vaccine was authorized for children ages 5 and over last November; the Moderna vaccine has now also been authorized for the  5-17 age group.

In this Q&A, Lindsey C. Douglas, MD, MSCR, a pediatrician at Mount Sinai Kravis Children’s Hospital, explains why parents should get their young kids vaccinated as soon as possible. Dr. Douglas is Medical Director, Children’s Quality and Safety, and Pediatric Hospital Medicine, and she is also Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai.

Why should I get the vaccine for my child six months to five years of age? What are the benefits and risks?

We’re really excited that the vaccine has been approved for children six months to five years of age, so now nearly all children can get vaccinated. The vaccine does, in fact, reduce the chances that a child will get COVID-19. Many people who have looked at the data believe the reduction doesn’t seem to be that much. But we know that the vaccine reduces the chance that a child will get severe COVID, and that is really important. Children are being hospitalized with COVID-19, and that is something we worry about. Also, the vaccine will help us truly get back to normal, with children being able to be around other children, around their grandparents, and reducing the risks of transmission in general. We hope this will get us back to where we were before the pandemic, so that we can all gather together and not be as worried about COVID-19.

Two vaccines are recommended. What are the differences and does it matter which vaccine I get?

We have some information about both of them. There were studies that were done for the authorization by the Food and Drug Administration, and the two vaccines seem to have similar efficacy. However, the doses are different, and the timing is different. There are three doses for the Pfizer vaccine and two doses for the Moderna vaccine. My recommendation is to get the one that’s easiest for you to get, the one that’s available at your pediatrician. The differences are probably not as important as the difference between having the vaccine and not having the vaccine. You can talk with your pediatrician if you have other questions.

Will children experience any side effects?

Side effects have been quite minimal, and they’re similar to other vaccines, which include soreness at the site of the shot, and some children experienced fevers and body aches. I like to think of these as proof that the vaccine is working, that your immune system is actually activated and working.

What can I do about these side effects?

You can give your young child acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). They can help with fever and muscle aches. Some medications, such as ibuprofen, work as anti-inflammatory medications, whereas acetaminophen does not. Some believe anti-inflammatory medications may also block the immune response. I have two children of my own who are between five and 11 and had the vaccine, and I tried to wait it out with them, so that they could have the most potent response. The symptoms typically last only about a day. If you need to use something, I suggest acetaminophen.

What does the data show about how effective the vaccine is?

The effectiveness of the vaccine was shown in how often a child would get COVID-19. But that’s not the only  thing that we worry about. The other thing that I worry about, as a pediatrician who takes care of hospitalized children, is preventing severe disease. There is not as much data on that, so it’s something that each parent should think about. Preventing severe disease in children is really important, and so is getting back to school and playgroups and all of the things that smaller children need for their development. Those to me are equally as important as not getting COVID-19 at all.

Are kids five and under at risk for serious disease?

People believe children don’t get COVID-19 as often or there are fewer cases of COVID-19 than in adults. That technically is true. More adults have been hospitalized. But there are children who have died from COVID-19. My opinion is this vaccine prevents both serious disease and hospitalization of a child, and that means it makes sense to get your child vaccinated.

Why is there no vaccine for kids under six months?

The studies for these vaccines were done in children over six months of age because the immune system is not fully formed in children under six months. We do start shots in infants as early as two months of age, but many vaccines can’t be given until kids are older, including the chickenpox shot. We tend to be much more careful with vaccines in children under six months of age.

If my child already had COVID-19, do they still need a vaccine?

Unfortunately, getting COVID-19 doesn’t prevent you from getting it again. I recommend that a child who has had COVID-19 be vaccinated. We know that vaccination is a strong way to prevent disease and prevent severe disease, and having some natural immunity from having the disease also provides some protection. The combination of the two is even better.

Is there anything else that patients and consumers should know?

The COVID-19 vaccines have been available for quite some time now. Kids under five are not that much different from those older than five. As a pediatrician, and as a parent myself, I’m thrilled that we can offer the vaccine to our most vulnerable and youngest children. This age group has been out of school the most of any age group because of not being eligible for the vaccine and not being able to wear masks easily. I urge parents to consider getting their children vaccinated today.

Read more from Mount Sinai about COVID-19

Rising Above the Health Toll of Racism

Updated on Jun 30, 2022 | Diversity and Inclusion, Featured, Your Health


Racism—both on a personal level and in overall society—negatively affects the mental and physical health of millions of people, according to the Centers for Disease Control and Prevention. These health issues, and some ways to rise above them, are addressed in this Q&A with Lynne D. Richardson, MD, Co-Director of the Institute for Health Equity Research at Mount Sinai, and Professor of Emergency Medicine, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai.

“Racism is a public health crisis that is damaging to all of us, regardless of race or ethnicity,” Dr. Richardson says. “We need to use all of the tools at our disposal to fight it, and to improve our own individual and our collective emotional and physical well-being.”

Lynne D. Richardson, MD

How does racism affect mental health?

That is a big question. The impacts of racism happen at various levels because, of course, racism happens at various levels. There is the experience of being personally discriminated against, whether that’s racial slurs or hate crimes or the experience of being followed in a store because you’re under suspicion that you’re going to steal because of the way you look. All of those sorts of macro and microaggressions really undermine your sense of self-confidence, your sense of self-esteem, and your sense of safety. It’s like having repeated traumas on your mental and emotional well-being.

There is a lot of evidence that racism of various kinds has a destructive impact on mental health, and there is a growing awareness of the importance of structural racism in that picture—this includes limited access to societal resources, like housing, food, job security, and health care. The persistent inequities in the way that those resources are distributed across our society have an impact on our mental health and well-being. It’s those persistent negative messages that you are not valued, that you are not protected. This is why we see huge disparities in conditions like depression. African Americans are much more likely to have more severe symptoms. They have a longer course of illness, and they experience greater levels of disability from depression compared to white patients. This is also why rates of youth suicide are exploding in the black community, with something like a 73 percent increase over the last decade of suicide attempts among young people of color. In terms of suicide death rates, the fastest growing segment are black children between the ages of five and 12. We are seeing the impact of racism and the harmful effects that it has on mental health reflected in this epidemic of suicide among black youth.

How does racism affect physical health?

Racism affects physical health in direct ways. Due to structural racism, you may be more likely to live in housing that is substandard, housing that has environmental toxins or irritants that directly impact your health. You are more likely to live in a neighborhood where there are higher levels of air pollution, where there are higher levels of violent crime. You are more likely to not get the health care that you need, and so you may have a higher burden of disease and more avoidable complications of illnesses like hypertension, diabetes, heart failure, or asthma. These effects are cumulative, and they directly impact the physical health of communities that are experiencing the effects of structural racism.

There is also a connection between mental health and physical health. We know that the assault on your mental health also affects your body. It affects your immune system and makes you more susceptible to disease. It affects your hormonal system and results in problems with your adrenal regulation. So the more we understand about how complex health disparities are and about all the things that create these differences in health between blacks and other groups, the more we understand how racism is often a root cause of many of these effects.

What are some ways to feel better?

I think it is important to not only talk about the negative ways in which racism impacts black people, but also to remember all of the strengths that have helped us to get to where we are today. I think that we have to pay attention, to take care of ourselves and take care of each other, especially given the recent impact of the COVID-19 pandemic. I think it is even more important that we lean on our strong social supports of families and friends. For many people, spirituality is a source of strength and comfort.

In addition, I think we have to try to directly address the inequities that are leading to these negative impacts on our mental and physical health. I have a colleague who talks about spreading hope, as a strategy to deal with what we are facing as we combat the effects of racism—and I love that image.

What are some ways to help?

I think all of us have an obligation to advocate for anti-racist policies, and that happens at every level. There are societal issues. There are policies and processes in every institution that we belong to. There are things that we can do, in every place we are, to try to understand how the structural inequities are embedded in our society, and to start to dismantle them. We need to do that where we work, where we go to school, where we worship. In every context, we all need to be doing this anti-racism work if we really want to make a difference and we really want to end these long-lasting, persistent effects of racism on communities of color.

What else should people know about racism and health?

There is a lot of discussion now about implicit bias. One of the things that is not widely understood about implicit bias, or unconscious bias, is that while it may happen at a subconscious level on the part of the person who has the bias, it has a very explicit impact on the person who is the recipient of the bias. There is often a sense that because this kind of bias is not intentional it’s not harmful, but it is very harmful, and it results in micro aggressions that do create repeated micro-traumas that erode our physical and mental health.

Therefore, I think everybody has individual work to do on themselves to understand the extent to which they have internalized the biases that are pervasive in our society. At the same time, we should work at a higher level collectively on our organizations and institutions and try to eliminate the structural racism that is persistent and pervasive throughout our institutions.

Learn more about the Mount Sinai's Institute for Health Equity Research

Crystal Party Virtual Tribute Spotlights Four Patients Saved by Mount Sinai’s Innovative Care

Updated on Jun 30, 2022 | Featured

Raghav Murthy, MD, shows a small plaque he got from the family of his patient who got a heart transplant when he was 7 months old. The plaque, which sits on his desk, reads “Thank you for saving my life with your compassion and extraordinary dedication to getting me my heart.” Says Dr. Murthy: “I smile at it every morning….It reminds me of what a difficult journey they had. But what a beautiful ending.”

For the 37th time, Mount Sinai’s annual Crystal Party proved to be more than just a fundraiser. Held as a virtual event for the second time since the onset of the COVID-19 pandemic, the event brought hundreds of viewers to a special video that debuted on Thursday, May 5. By celebrating the extraordinary achievements of the Mount Sinai Health System through a series of patient stories, the 30-minute short film showed the wide-ranging capabilities of Mount Sinai, demonstrating that no matter what the issue, “we find a way.”

“I want to start by thanking our staff for all they’ve done over the past two years,”  Kenneth L. Davis, MD, Chief Executive Officer of the Mount Sinai Health System, said in opening the event. “I know your work has been exhausting. As we continue to make progress with vaccines and treatments, I’m hopeful that we’re seeing the light at the end of the tunnel. The time you have given of yourselves is what has gotten us through the many challenging days we have endured as a community and a city.”

Dr. Davis noted that the help of donors was essential to Mount Sinai’s many accomplishments. “Thanks to your contributions, we’ve made extraordinary progress on several groundbreaking diagnostic tests and therapies that will be life-changing for patients. Over the past year alone,” Dr. Davis continued, “we’ve formed seven new companies, were granted 115 new patents, and filed another 357, an incredible number.” Moreover, “Our leading immunology group is testing a COVID-19 vaccine that will be able to adapt to new variants as they emerge.”

Dr. Davis also highlighted breakthroughs “in cancer, diabetes, and conditions that affect the brain and the heart,” pointing out discoveries such as uncovering blood biomarkers for early diagnosis of certain cancers, revealing how particular cells and genes affect Alzheimer’s disease, and developing an artificial pancreas to help diabetes patients manage their insulin intake.

Click here to watch the full video of the Crystal Party, including all of the patient stories.

Margaret Pastuszko, MBA, President and Chief Operating Officer of the Mount Sinai Health System, remarked on the world-class health care services provided by Mount Sinai—some of which can only be found here. “Our skilled physicians apply their deep knowledge and extensive training to solve the most complex health problems, bringing cutting-edge treatments into daily application,” said Ms. Pastuszko, “They are determined to find answers for their patients and their families and do so in a compassionate way. They have an unrelenting drive to find a way to heal all of our patients.”

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, continued on that theme, pointing out that outstanding outcomes for patients are achieved through the deep collaboration between Mount Sinai’s scientists and clinicians, calling them “the best and the brightest who are dedicated to solving the mysteries of disease, healing patients, and educating the next generation.”

David Miramontes and his doctor, Mark S. Courey, MD

Four patient stories vividly illustrated these opening remarks, starting with David Miramontes of San Antonio, Texas. Six months after marrying Christina, he went to see the doctor with what he thought was bronchitis. He soon learned that he had cancer between his vocal cords and his trachea. “And that’s when our jaws dropped, our hearts broke in half, and we started our journey,” he said. That journey soon led to Mount Sinai, the one place that offered to try to both remove the cancer and save his voice. As the Medical Director for the San Antonio Fire Department, he could not imagine life without a voice. “I couldn’t teach, I couldn’t see patients. It would literally kill me,” he said.

Mark S. Courey, MD, Professor of Otolaryngology-Head and Neck Surgery, Director of the Grabscheid Voice and Swallowing Center, Division Chief of Laryngology, and Vice Chair of Quality for the Department of Otolaryngology-Head and Neck Surgery at the Mount Sinai Health System, was not going to let that happen. There were no guarantees, however, as Dr. Courey knew from experience that it was complicated surgery.

The solution Dr. Courey arrived at was innovative and far beyond the standard of care. “ To reconstruct the bottom part of David’s voice box, we took a rib for its solid structure. But the rib is so large that if I put it into the voice box without a blood supply, it would die,” he explained in the video. “So, to prevent that, we take some vascularized tissue of the fascia from David’s thigh. In this particular area, the fascia has its own blood supply, and we can use the blood supply from the fascia to support the rib. I had been thinking about doing this for about 15 years.”

It was a stunning success. “My voice is actually better than expected,” Mr. Miramontes said. “I can talk to patients, even through a mask. I can work in the ER, I can work in the field. I actually have some range. I can go up and down and I can talk with pretty good volume.” Dr. Courey was dedicated to not only keeping his patient alive, but giving him his life back. And the one place he could do that is Mount Sinai: “I can do this here at Mount Sinai because I don’t like accepting the status quo. I am allowed the opportunity to think about new solutions to common problems or rare problems.”

Jayceon Serrano is joined by, from left, his mom, Raghav Murthy, MD, and Jaqueline Lamour, MD

Heart transplantation in an infant is also a rare thing, but that’s what Jayceon Serrano, who was born in early 2021 with dilated cardiomyopathy, needed. The disease was hidden for a while, but his heart grew to twice the normal size, and he was soon failing to thrive. He was admitted to the intensive care unit in severe heart failure.  At that point, “the best thing we can do for survival is to get him a new heart,” said Raghav Murthy, MD, DABS, FACS, Director of the Pediatric Heart Transplantation Program at the Mount Sinai Kravis Children’s Heart Center.

More than 100 people were involved in Jayceon’s care, providing more than just medical care for the four months it took for a heart to become available.

“As much as the focus is on the patient,” Samantha Corbin, LCSW, said, “how can I, as a social worker, support the parents to put their best foot forward and be that presence and support for their child?” Ms. Corbin met with Jayceon’s parents every day, helping them advocate for him and being their sounding board. Nurses provided essential support in addition to skilled care, as Janet Jimenez, RN, remembered: “If they needed a hug, we were there to provide that for them. If they needed to talk, we were there to provide that for them. You truly want the best for them as if they were your own family member.”

Mount Sinai is one of 50 to 75 pediatric heart transplantation programs in the country. But Jayceon was in the right place when it came time for his complex surgery. “The heart of newborn baby is the size of a strawberry,” Dr. Murthy noted, making the reconnection of the tiny blood vessels a delicate operation. While the transplant was a success, this will be a lifelong journey for Jayceon—but a hopeful one. As Jacqueline Lamour, MD, the Director of Pediatric Heart Failure and Transplantation in the Mount Sinai Kravis Children’s Heart Center, pointed out, Jayceon has “the potential to live an incredibly long time. As pediatricians, we follow children from birth through young adulthood, and he’s going to know me his whole life.”

Joshua Bederson, MD, and David Reichman

David Reichman was saved by Mount Sinai at a very different stage of life—after a brain abscess failed to resolve with antibiotics. In fact, the abscess began to enlarge, leading to dire situation: “The clock was ticking,” said Leslie Schlachter, PA, Clinical Director and Chief Physician Assistant in the Department of Neurosurgery at the Mount Sinai Health System. “There was a rapid decline, and we needed to get him to the operating room quickly, because every moment that passed was brain activity and brain tissue that we might not get back.”

Immediate brain surgery was necessary, and the outcome was not guaranteed as the abscess was very deep. But as he was rolled into surgery, the patient made his expectations very clear to Joshua B. Bederson, MD, the Leonard I. Malis, MD / Corinne and Joseph Graber Professor of Neurosurgery and Chair for the Department of Neurosurgery, Mount Sinai Health System. “I said, ‘If I can’t come out of this that I can dance with my daughter on my next birthday, I don’t want to come out.’ And I remember him saying, “You’re going to dance.’”

By combining multiple scans of Mr. Reichman’s brain, Dr. Bederson and his team created a 3D virtual reality environment that allowed them to precisely map an opening, a trajectory through the brain, and a pathway into the abscess that was safe. “There are so many ways in which we push boundaries in Mount Sinai in neurosurgery,” Dr. Bederson noted. “We are making strides now that we wouldn’t have thought possible even five to 10 years ago.”

Mr. Reichman was in the right place at the right time by coming to Mount Sinai. “His prognosis is excellent,” said Ms. Schlachter, “There should be no ill effects on the rest of his life, as if it never happened.” And two years later, he went to visit his daughter. “On my birthday, we danced right on the street. It was amazing, just an amazing thing. Tears were coming down my eyes because life was worthwhile.”

Robin Varghese, MD, and Benjamin Thomas

For Benjamin Thomas, a pastor, the pandemic proved very challenging. After contracting COVID-19, Mr.  Thomas “went through a very rough time—54 days on the ventilator. Over six weeks in a coma. Lost over 50 pounds. It was a very rough journey.” But no one at Mount Sinai gave up on him, least of all Robin Varghese, MD, Associate Professor of Cardiovascular Surgery, starting with a transfer from another institution. “He was admitted to a hospital in Long Island, and was going in the wrong direction. The family was losing hope, and the hospital was losing hope on his case. And that’s when they were trying to reach out to me to see if I could help in any way. The doctors told me if we don’t take Pastor Thomas this weekend, he’s going to die here. And that was a sign to me that I had to act.”

Dr. Varghese learned of all the good Mr. Thomas did in his church and community. His only child was preparing to graduate. “And I kept telling the team, ‘We got to get him to the graduation.’ We took care of him as best as we could, and he was quite sick for weeks. Even our team members and myself sometimes could not see the light at the end of the tunnel for him.”

One night, Dr. Varghese drove from his home in Connecticut to be at Mr. Thomas’s bed. “Being a man of faith myself, having very little hope left in me, I had just set a prayer and told God that I got to put it into his hands,” Dr. Varghese said, “But at Mount Sinai, we don’t give up. We fight till the end. As I was praying in the room, I just started thinking of his case more and more, and what could I do? I started to really just look at his case and go through the chart over and over again. I came up with a few different ideas, and we started to mobilize those over the next few days.”

Those ideas led to slow improvement, and Mr. Thomas eventually came off the ventilator and recovered further before leaving the hospital to go back to his family, his church, and his community. And he made it to his daughter’s graduation. Looking back, Dr. Varghese said, “We lost a lot of patients during the pandemic, but this is one that we saved, and changed a family.”

The video closed with remarks from the Co-Chairs of the Mount Sinai Boards of Trustees, James Tisch and Richard Friedman. “The three pillars of the Mount Sinai Health System are strong and sturdy,” Mr. Tisch said. “We provide outstanding patient care, we generate brilliant research, and we offer superb education for the next generation of physicians and scientists. But we can’t, and won’t stand still to maintain Mount Sinai’s high quality and sustain its extraordinary work. We need to invest.”

Mr. Friedman expressed pride in the people of Mount Sinai for their dedication, ingenuity, and skill and also thanked patients and their families for putting their faith in the institution. “Mount Sinai is now recognized as one of the nation’s very top academic medical centers,” he said, “As a Mount Sinai supporter, you deserve to have great pride in our achievements, because giving to Mount Sinai means you are helping to save lives. You are helping to drive important advances in science and medicine, your donations make it possible for Mount Sinai to find a way.”

Ms. Pastuszko thanked all the donors who helped the Crystal Party raise more than $2.5 million. “Mount Sinai’s groundbreaking research and outstanding clinical care could not be possible without your philanthropy and continued commitment. Your partnership and ongoing support of our clinical mission is truly inspirational.”

Read more Featured stories about Mount Sinai

Helen Mayberg, MD: Seizing Unexpected Opportunities at Every Turn

Jun 8, 2022 | Featured, Research

Helen Mayberg, MD: Seizing Unexpected Opportunities at Every Turn

Depression has long been considered a serious mental disorder caused by extreme stress or a chemical imbalance that is treated by psychotherapy or medication. That is, until Helen Mayberg, MD, Professor of Neurology, Neurosurgery, Psychiatry, and Neuroscience, and founding Director of the Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai, took a different approach.

“I am a neurologist, and neurologists map signs and symptoms to specific locations in the brain,” she said. She had always seen depression as a circuit disorder and the availability of brain imaging early in her training provided a method and strategy to study a psychiatric disorder as a neurological one. “That was a novel, if not heretical, idea at the time,” Dr. Mayberg said. “Now, it’s commonplace.”

For her body of work integrating imaging techniques to reveal mechanisms of depression, Dr. Mayberg was elected to the National Academy of Sciences (NAS) in May.

Dr. Mayberg considers her career to have taken an unconventional arc. She first trained clinically in neurology at Columbia University, then did a research fellowship in nuclear medicine and functional imaging at Johns Hopkins University. Prior to joining Icahn School of Medicine at Mount Sinai, Dr. Mayberg held a series of cross-disciplinary appointments in neurology, psychiatry, radiology, neurosurgery, and neuroscience at various institutions, including Johns Hopkins, University of Texas, University of Toronto, and Emory University.

Dr. Mayberg was elected to the National Academy of Sciences along with Yasmin Hurd, PhD, Ward-Coleman Chair of Translational Neuroscience and Director of the Addiction Institute of Mount Sinai. Read more about Dr. Hurd’s achievements here.

Over the last 35 years, she had used neuroimaging techniques to study abnormal brain circuits in depressed patients, explaining not just mood, motivation, cognitive, and motor feature characteristics of depression, but also providing a systematic strategy to understand how different treatments work and how to match a patient with an optimal treatment.

Forging partnerships, breaking frontiers

A milestone in her collaborative work came about when Dr. Mayberg discovered the critical role of Brodmann area 25 of the brain, a region of the prefrontal cortex, in negative mood in healthy individuals as well as how it was targeted when antidepressant treatments were successful for depression. The area is known to play a role in mood, appetite, and sleep, but its role in depression was unknown.

Following work on Brodmann area 25, Dr. Mayberg found that deep-brain stimulation—implanted electrodes that deliver electrical stimulation to precise brain locations to treat Parkinson’s disease and epilepsy—was a potential treatment for patients with treatment-resistant depression. Mapping studies she did in the 1990s led to her testing the new treatment in 2003, in which a majority of treated patients showed long-term recovery.

Every move to a new institution has been a scientific adventure with opportunity to work in a new environment with new colleagues, Dr. Mayberg said, but a constant has always been unexpected, exciting, and important new insights. “Creative disruption seems to best describe my trajectory,” she said.

Dr. Mayberg considers transdisciplinary collaboration as the philosophical anchor of her work, one that forms the overarching mission of the Nash Family Center for Advanced Circuit Therapeutics, which she founded in 2018. “The opportunity to fully realize this vision was the condition of my move to New York,” she said.

The Center brings neurology, psychiatry, neurosurgery, imaging, physiology, engineering, and behavioral health under the same roof. Researchers are working on circuit disorders, including Parkinson’s disease, depression, and obsessive-compulsive disorder, which can be treated with deep-brain stimulation, albeit in different brain targets.

“We all knew we needed to work together so that a discovery or new method developed for one disease could inform the others,” Dr. Mayberg said, “so we’re not reinventing the wheel each time.”

Continuing progress through collaborations

Technology innovations in the last several years have further advanced the deep-brain stimulation field, providing new opportunities for Dr. Mayberg and the investigators at the Center. With the capability to read electrophysiological signals in real-time via the stimulating electrodes, researchers at the Center are working on improving delivery of deep-brain stimulation, understanding what kind of patients are most appropriate and why the treatment works.

The Center is also interested in answering more basic questions, such as whether deep-brain stimulation repairs brain circuits or promotes brain plasticity. These studies are complemented by parallel work in animal models at The Friedman Brain Institute. “I consider my research ‘bedside to bench.’ I have always taken advantage of the work of basic neuroscientists, even if their methods cannot be fully applied to human patients,” Dr. Mayberg said.

“My work has had the same basic thread over the course of 35 years: what is the neurology of depression and how do we optimally treat it; not just generally, but in individual patients,” Dr. Mayberg said. “Mount Sinai is the ultimate place for this work, with a committed set of clinicians, scientists, and engineers who share this transdisciplinary vision.”

A closer look at Dr. Mayberg’s work

Dr. Eric Nestler

Eric Nestler, MD, PhD, Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, Dean for Academic Affairs of the Icahn School of Medicine at Mount Sinai, and Chief Scientific Officer for the Mount Sinai Health System, weighs in on what he found impressive about Dr. Mayberg’s research.

“Dr. Mayberg’s work is all translation since it’s all performed in humans,” said Dr. Nestler, “Even though her research has been tethered in basic neurobiology, thinking about how it intersects with patients is evident.”

Membership of the National Academy of Sciences—considered one of the highest honors for a scientist—comes through election by existing members only. Candidates’ entire bodies of work and contributions to the field are considered as part of the nomination process and their entries are voted on in April each year, with a maximum of 120 U.S. citizens and 30 non-citizens elected annually, according to NAS. There are currently approximately 2,400 U.S. members and 500 international members, of whom 190 have received Nobel prizes. Mount Sinai has six current faculty in the prestigious organization.

Dr. Mayberg had a longstanding track record in using brain imaging to study people with psychiatric disorders, but her breakthrough was using deep-brain stimulation to treat depression.

“What Helen did was extremely novel, especially because this was for a group of patients who had especially severe depression who did not respond to a wide range of existing treatments including electroconvulsive therapy, also known as ’shock’ therapy,” Dr. Nestler said.

The paper on using deep-brain stimulation for depression, published in Neuron in 2005, remains Dr. Mayberg’s most cited work. In her study, six patients with severe depression who had failed at least four different forms of treatment underwent the experimental stimulation procedure. All six saw improvement in clinical scores, with three achieving remission or near-remission that was sustained long term.

“It was a remarkable and brave study and she has since further developed its key findings and implications,” Dr. Nestler said.

Other notable publications from Dr. Mayberg included discovering areas of the brain that were involved in feelings of sadness, and how they exhibited dysfunction in returning to baseline state in people with depression. Dr. Mayberg considered that paper, published May 1999 in The American Journal of Psychiatry, one of her hardest to get published, but it ultimately led to her work with deep-brain stimulation.

“We recruited Dr. Mayberg because we had a great deal of confidence in her multidisciplinary approach,” Dr. Nestler said. “With the additional resources possible at Mount Sinai, she can take the program to the next level.”

Pin It on Pinterest