Featured | Mount Sinai Today

Partnership Supports Veterans in Civilian Careers

Nov 5, 2019 | Community, Engagement, Featured

Roger Braman, RN, BSN, second from right, with veterans, from left, Anit Shrestha, Jonathan Duchnowski, and Kevin Lama.

The Mount Sinai Health System recently partnered with Workforce Opportunity Services (WOS), a leading nonprofit that is dedicated to recruiting, training, and placing underserved and veteran job seekers into long-lasting civilian careers. Through the organization’s WOS On Demand program, veterans Jonathan Duchnowski, Kevin Lama, and Anit Shrestha were recruited and placed in various roles within Mount Sinai’s Department of Information Technology (IT). Prior to joining this program, they struggled to find gainful employment opportunities as they transitioned from the military to civilian life.

“The Workforce program gives us a great opportunity to give back to those who have served in the military protecting our country,” says Roger Braman, RN, BSN, Senior IT Director of Infrastructure Project Management, who leads the partnership at Mount Sinai.

Using a scientifically based model derived from research conducted at Columbia University, the program recruits, educates, trains, and then places high-potential candidates at leading organizations around the world that are committed to diversifying their workforces. Key to the effort’s success, says Mr. Braman, is “the additional support and training that the candidates receive, both from the WOS program and Mount Sinai, to allow them to build on the valuable skills they learned in the military and help them to transition to the civilian workforce.”

For example, Mr. Duchnowski, who served in the military from 2000 to 2006 as a Nuclear Propulsion Plant Machinist’s Mate and Engineering Laboratory Technician, completed his BA in 2018 and was looking for work in health care or in a biological lab when he found a position at Mount Sinai through WOS. He says, “I was contacted by one of their team members who also happened to be a Marine. He explained what WOS was all about, and I was immediately hooked.”

Mr. Duchnowski, who currently works in Infrastructure Project Management as the Infrastructure Project Coordinator, spent three weeks in general business professional development, as well as in focused Project Management training modules as part of the WOS program to prepare him for the Mount Sinai job. “I wanted to work for an organization trying to heal and help people, and I always wanted to work with IT, as well, so this fits both of those desires,” Mr. Duchnowski says.

Mr. Braman says, “All of the participants are really motivated and eager to learn and have quickly been able to integrate themselves into the teams to which they have been assigned.”

Tele-ICU Brings Remote Teamwork to Intensive Care at Two Mount Sinai Hospitals

Nov 5, 2019 | Featured

Rohit R. Gupta, MD, center, with Critical Care fellows Alfred R. Schwab, MD, left, and Adewale Olayode, MD, consults remotely with Steven S. Chao, MD, Director of Critical Care at Mount Sinai Queens.

Intensive care unit (ICU) physicians at The Mount Sinai Hospital and Mount Sinai Queens are consulting remotely on complex cases with Tele-ICU, a service developed by the Mount Sinai Health System’s Institute for Critical Care Medicine and Clinical Innovation team.

Tele-ICU makes use of audio-visual technology and Epic Canto, a secure app that provides extensive, real-time electronic medical information. “This technology-enabled care allows the Mount Sinai Health System to provide specialized consult services to our ICU patients at Mount Sinai Queens and keep many patients in their own community and close to their loved ones, while supporting Mount Sinai Queens’ goal of treating patients with increasingly complex medical needs,” says Roopa Kohli-Seth, MD, Director, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai.

The Mount Sinai Hospital has more than 7,000 intensive care admissions a year in units for cardiac, cardiovascular, cardiothoracic, medical, neurosciences, surgical, and transplant care. They are staffed 24 hours a day with intensivists, board certified specialists in critical care. Mount Sinai Queens has an eight-bed intensive care unit, led by intensivists and ICU hospitalists.

When cases are particularly complex, Tele-ICU allows physicians at Mount Sinai Queens to compare notes with intensivists at The Mount Sinai Hospital. ICU physicians at both sites are equipped with monitors that show information from Epic, such as lab-test results and medical history. The physicians converse on tablets—similar to FaceTime but secure and encrypted—which can be turned toward patients to help visually assess their condition. The system makes communication and intervention easier, says Rohit R. Gupta, MD, Director of the Night Intensivist Coverage Service, Institute for Critical Care Medicine. “For example, if they are making adjustments to a patient’s ventilator at Mount Sinai Queens during the consult, we can see in real time what those changes are doing to his breathing pattern, to his oxygen numbers, to his blood pressure.”

Dr. Gupta described a case involving a woman who had ingested a toxic household chemical. She had seizures in the Emergency Department at Mount Sinai Queens and was taken to that hospital’s ICU, which contacted Dr. Gupta for a consultation at about 2 am. “Poisoning with this particular chemical is not very common,” Dr. Gupta says. “Fortunately we have experience with it, so we were able to discuss what to keep an eye out for.” The team was advised to avoid certain antibiotics that could predispose the patient to more seizures, and to carefully manage fluids because of the risk of kidney damage.

“These consults are reassuring for both sides,” Dr. Gupta says, since they make physicians at The Mount Sinai Hospital well aware of patients who might need to be transferred. In this case, the patient was stabilized and remained at Mount Sinai Queens, where she made a “very good recovery” in a few days, he says.

Physicians have used Tele-ICU about twice a week since it was launched in March 2019, says Cameron R. Hernandez, MD, Chief Medical Officer and Vice President for Medical Affairs, Mount Sinai Queens. “We have found that it’s nice to work in teams, to have that support when there is a difficult diagnosis that you don’t often see,” he says.

Telemedicine programs like Tele-ICU are gaining traction throughout the nation as a way to efficiently share the expertise of specialists with community hospitals or hospitals in underserved rural areas, says Patrick Healy, MBA, Associate Director of Clinical Innovation, Mount Sinai Health System, who was the project manager of the system. “There is so much value in seeing the patient remotely,” says Robbie Freeman, MSN, RN, Vice President of Clinical Innovation. “In the case of The Mount Sinai Hospital and Mount Sinai Queens, Tele-ICU provides a fuller picture of the patient’s condition, to make sure the right resources are in place at the right time.”

Top Honor for Renowned Physician for Transformational Research

Nov 5, 2019 | Community, Featured

David B. Sachar, MD, center, with event emcee Frank Sesno, Director of the School of Media and Public Affairs at George Washington University, and Meredith Asbury, Co-Chair of the Golden Goose Award, and Policy Officer at the Association of American Universities.

At the Library of Congress in Washington, D.C., on Tuesday, September 10, bipartisan Congressional supporters and representatives from science and higher education organizations saluted five scientists whose work has transformed the lives of countless millions of people.

Among the honorees was David B. Sachar, MD, Clinical Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Director Emeritus of the Dr. Henry D. Janowitz Division of Gastroenterology, whose seminal research into cholera—and the landmark clinical human trials that followed—is credited with saving approximately 50 million lives worldwide.

The honor they received, the Golden Goose Award, recognizes scientists whose federally funded work—which may have been considered silly, odd, or obscure when first conducted—has resulted in profound benefits to society. The effort is led by the American Association for the Advancement of Science.

Cholera is an acute bacterial infection in human intestines that causes an immediate loss of water and electrolytes, and without urgent treatment, results in death. At one time, diarrheal diseases like cholera were the leading cause of infant mortality in the world.

For Dr. Sachar, his work involved learning how to measure electrolyte transport across a frog skin in the laboratory and then adapting that technique for the first time to the measurement of intestinal activity in humans in Bangladesh in 1966. By studying patients with cholera, he additionally was able to illuminate the underlying physiological cause for the deadly diarrhea provoked by this disease. His work ultimately contributed to the development of a simple oral solution, known as oral rehydration therapy, which cut the fatality rate by 99 percent. Later, Dr. Sachar, a specialist in inflammatory bowel disease, joined Mount Sinai, where he was instrumental in laying the foundation for the current international classification of Crohn’s disease.

“Our work shows not only the amazing and often unpredictable medical and social benefits of basic research, but also exemplifies the principle that these benefits may not be fully realized until we take the science from the laboratory and carry it directly to where the disease is,” says Dr. Sachar.

At “Walk the Talk” Event, Delivering a Message of Lifelong Health

Nov 5, 2019 | Community, Featured

Valentin Fuster, MD, PhD, with students from the Icahn School of Medicine at Mount Sinai.

Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, was a special guest speaker during “Walk the Talk: The Health-for-All Challenge in the United States,” a recent event sponsored by the World Health Organization and Walk with a Doc, a nonprofit that promotes physical fitness and access to care.

The event, held on Sunday, September 22, in Central Park, included a four-mile run/walk, healthy snacks, blood pressure checks, and talks on public health. Dr. Fuster, a world leader in cardiology, delivered a message that he feels passionate about.

“Cardiovascular disease, unfortunately, is the No. 1 killer in the world,” Dr. Fuster said. “My advice is the following: First, be sure that elderly people take care of themselves, even if they feel well, and not wait until the next heart attack or stroke. No. 2, if you are a younger adult, take care of the seven risk factors—obesity, high blood pressure, high cholesterol, diabetes, smoking, poor diet, and lack of exercise. No. 3 to me is the most important: Infuse children—as young as age 3—with the idea that health is a priority. Education, education, education is the key.”

Pioneering Discoveries in Inflammatory Bowel Disease

Nov 5, 2019 | Featured, Gastroenterology, Research

Precise cell types that correlate with a patient’s resistance to the standard therapy for Crohn’s disease—anti-inflammatory drugs called TNF inhibitors—have been identified for the first time by researchers at the Icahn School of Medicine at Mount Sinai and published in the September 5, 2019, issue of Cell. TNF inhibitors are used in Crohn’s disease to stop inflammation, but as many as 30 percent of patients do not respond to this treatment and require surgical intervention within 10 years after diagnosis. The new discovery could open the door to identifying biomarkers and tailoring better therapeutic options for these patients.

At the same time, two studies in the September 26, 2019, issue of The New England Journal of Medicine validate effective therapies for patients with treatment-resistant ulcerative colitis (UC), a chronic inflammatory disease of the large intestine. Both of these studies were led by Bruce E. Sands, MD, the Dr. Burrill B. Crohn Professor of Medicine and Chief of the Dr. Henry D. Janowitz Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai.

The results of Dr. Sands’ first clinical trial validated ustekinumab as a UC therapy. In the phase lll clinical trial, Dr. Sands and his team tested more than 900 patients with moderate-to-severe UC who were unable to tolerate or had an inadequate response to TNF inhibitors. The results from this trial led the U.S. Food and Drug Administration in October to approve ustekinumab for adult patients with moderately to severely active ulcerative colitis. Ustekinumab had previously been approved for treating patients with Crohn’s disease.

The second study was the first ever head-to-head comparison of two biologic therapies for inflammatory bowel disease: vedolizumab and adalimumab. In total, 769 participants with moderate to severe UC were recruited for this randomized phase 3b study, with 383 patients receiving 300 mg of vedolizumab intravenously at weeks 0, 2, and 6, then every 8 weeks, and with subcutaneous placebo injections, and 386 receiving placebo intravenously and adalimumab subcutaneously (160 mg week 1, 80 mg week 2, and then 40 mg every 2 weeks).

Researchers found that patients who received vedolizumab achieved significantly higher week 52 clinical remission rates than patients who received adalimumab (31.3% versus 22.5%) and endoscopic improvement (39.7% versus 27.7%). The remission rates for both therapies were similar among the 20% of participants who had previous exposure to TNF inhibitors.

In the study in Cell, Mount Sinai researchers used single-cell RNA sequencing and CyTOF technology to examine inflamed and noninflamed small intestine tissue samples as soon as they were removed from Crohn’s disease patients. Looking at the lesions in real time on a single-cell level, the investigators identified the immune cells and the circulating blood cells and their interactions, and mapped a landscape of thousands of cells in the lesion.

“Single-cell profiling provides unprecedented information on the make-up of the disease,” says co-corresponding author Miriam Merad, MD, PhD, Director of the Precision Immunology Institute and the Human Immune Monitoring Center at the Icahn School of Medicine at Mount Sinai. “This type of analysis will help us understand why patients respond to or resist specific treatment and what else we could
be targeting.”

Co-corresponding author Judy H. Cho, MD, Director of The Charles Bronfman Institute for Personalized Medicine, and Ward-Coleman Professor of Translational Genetics and Medicine at the Icahn School of Medicine at Mount Sinai, says, “We designed this study in a way that defines inflammation with unprecedented precision using immunology and computational biology to get a better understanding of this disease.”

Computational biologist Ephraim Kenigsberg, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai, and co-corresponding author of the Cell study, says, “Single-cell analysis revealed different cellular signatures, and when we integrated this with larger data sets, including clinical trials, we were able to make our findings clinically relevant.”

Landmark Study on Aspirin for High-Risk Heart Patients Is Led by Mount Sinai

Oct 21, 2019 | Cardiology, Featured, Research

Roxana Mehran, MD, center, principal investigator of the TWILIGHT study, with leading collaborators in the study, from left, Annapoorna S. Kini, MD; Valentin Fuster, MD, PhD; Juan J. Badimon, PhD; George Dangas, MD, PhD; Usman Baber, MD, MS; and Samin K. Sharma, MD.

High-risk patients who have undergone a coronary stent procedure may not require long-term aspirin, according to a groundbreaking global study led by Roxana Mehran, MD, Director of the Center for Interventional Cardiovascular Research and Clinical Trials, Mount Sinai Heart, and the Mount Sinai Professor in Cardiovascular Clinical Research and Outcomes, Icahn School of Medicine at Mount Sinai.

“We showed that withdrawal of aspirin after three months in patients already on ticagrelor, a potent antiplatelet regimen, reduced bleeding significantly without the harm of increasing death or heart attacks,” says Dr. Mehran, global principal investigator of “Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention” (TWILIGHT), which was published in September 2019 in The New England Journal of Medicine.

Says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, “I am proud of our team for achieving such great success with our collaborators in the United States and around the world on this pioneering clinical trial.”

The study addresses long-standing questions about the treatment of high-risk patients after percutaneous coronary intervention (PCI), also known as angioplasty, which opens blocked arteries and restores normal blood flow to the heart. “The same patients who are at high risk for ischemic events—such as heart attack or stroke caused by blocked blood vessels—are also at high risk for bleeding events,” says Dr. Mehran. “You have to find the right balance in therapies, and it is not easily found.”

In the current standard of care, high-risk patients who have received a cardiac stent are advised to take dual-antiplatelet therapy (DAPT)—both aspirin and a drug from a class of strong antiplatelet medications called P2Y12 inhibitors, of which ticagrelor is one. These two medications prevent heart attack or stroke by reducing the risk of blood clots. DAPT combines two drugs with similar effects, Dr. Mehran says, like using both “a shotgun and slingshot” for self-defense. TWILIGHT examined the impact of taking ticagrelor alone versus ticagrelor plus aspirin on clinically relevant bleeding among high-risk patients.

Investigators enrolled 9,006 patients at 187 sites in the United States, Canada, Europe, and Asia. They were high risk, meaning they met criteria such as having long or complex lesions in coronary arteries, or disorders such as diabetes or chronic kidney disease. All patients had undergone PCI with at least one drug-eluting stent and were prescribed aspirin and ticagrelor. After a three-month course of DAPT, the 7,119 patients without major adverse events were randomized to take either DAPT or ticagrelor with a placebo for 12 months. Among patients who took DAPT, 7.1 percent had major bleeding, compared with 4 percent of those who took ticagrelor and a placebo, and there was no difference in the risk for heart attack, death, or stroke between the groups. “This simpler approach saved many bleeding events and preserved the benefit of the single potent blood thinner,” says Usman Baber, MD, MS, Assistant Professor of Medicine (Cardiology), Icahn School of Medicine, who was lead author of the study with Dr. Mehran, and Chair of the TWILIGHT Clinical Coordinating Center.

The results were corroborated by a sub-study led by Juan J. Badimon, PhD, Professor of Medicine (Cardiology), and Director of Atherothrombosis Research at Mount Sinai Heart. Using a tool he is renowned for developing, the Badimon Chamber, researchers measured the thrombogenicity or “stickiness” of the blood in a group of 42 TWILIGHT patients, testing samples taken before and after they completed the 12-month treatment. Like the clinical study, the study of blood samples found that withdrawing aspirin caused no additional clot formation.

“The findings are particularly important and have the potential to change PCI practice,” says a co-author of the TWILIGHT study, Samin K. Sharma, MD, Director of Clinical and Interventional Cardiology at The Mount Sinai Hospital, and Anandi Lal Sharma Professor of Medicine in Cardiology.

Dr. Mehran expressed profound gratitude to Mount Sinai, which was the global sponsoring organization of TWILIGHT. “This study gives you an idea of the things we are able to do as an institution,” she says, “bringing together all of our resources to answer important questions for physicians and enhance the outcome for patients.”

The drug ticagrelor is made by AstraZeneca, which provided Mount Sinai with an unrestricted grant to perform the investigator-initiated study. Dr. Mehran has received financial compensation as an advisory board member for AstraZeneca in the past, and she and Dr. Baber have received consulting fees from AstraZeneca in the past.

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