On this episode of Advances in Care, we return to the high-intensity environment of New York City’s emergency departments with Dr. Angela Mills and Dr. Brenna Farmer. Host Erin Welsh hears from these leaders at NewYork-Presbyterian about how they are implementing innovative strategies to meet the challenges of the behavioral health emergencies epidemic.

Dr. Brenna Farmer, chief of emergency medicine at NewYork-Presbyterian Brooklyn Methodist, and Dr. Angela Mills, chief of emergency medicine at NewYork-Presbyterian and Columbia, bring us inside the emergency departments they lead to explain the challenges that their staff face in meeting the needs of severely decompensated patients. From disruptions in the flow of care, to potentially violent outbursts, their teams navigate these issues against the backdrop of an already complex operational environment.

Dr. Farmer tells us how she has implemented an innovative protocol called BERT– the Behavioral Health Response Team– in the Brooklyn Methodist Emergency Department, which is rolling out across the NewYork-Presbyterian system. BERT allows ED teams to better address  behavioral health patients, leading to more robust support for staff, and quicker, more comprehensive patient care overall, including connecting them to much needed outpatient resources. Finally, Dr. Farmer and Dr. Mills share additional strategies they employ to support their own well-being– and that of their medical teams– as they face difficult cases, plus their personal reasons for working in this unique field.

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Dr. Angela M. Mills is a nationally recognized leader and expert in emergency medicine. She serves as the inaugural chair of the newly designated Department of Emergency Medicine at Columbia University Irving Medical Center and chief of Emergency Medicine Services at NewYork-Presbyterian. 

Dr. Brenna M. Farmer is Chief of Emergency Medicine at NewYork-Presbyterian Brooklyn Methodist Hospital and vice chair for the Department of Emergency Medicine at Weill Cornell Medicine. She is also an assistant associate professor of clinical emergency medicine at Weill Cornell Medicine. Dr. Farmer is a nationally recognized medical toxicology expert and frequent keynote speaker on quality improvement, patient safety, and medication safety.

For more information visit nyp.org/Advances.

On this episode of Advances in Care, host Erin Welsh hears from two emergency department chiefs at NewYork-Presbyterian about how they optimize operations in their uniquely high-intensity, high-volume EDs.

Dr. Angela Mills, chief of emergency medicine at NewYork-Presbyterian and Columbia, and Dr. Brenna Farmer, chief of emergency medicine at NewYork-Presbyterian Brooklyn Methodist, both lead large medical teams in high-volume, New York City emergency departments. They discuss what makes New York City such a unique environment for emergency care, from its massive population and cultural complexity, to the severity and array of traumas that can come through the ED doors each day. Then, they share stories behind the life-saving care they provide, and explain why the collaborative spirit and excitement of the emergency room keeps them coming back to work every day.

Dr. Mills and Dr. Farmer also describe some of the ways that they continuously optimize operations in their departments, including addressing language barriers and providing specialized care for patients with complex cardiac needs. Their goal is to ensure that their staff can navigate the organized intensity of the emergency medicine environment without missing a beat.

In our next episode, Dr. Mills and Dr. Farmer return to discuss how their departments are piloting innovative strategies to address the growing behavioral health epidemic that is affecting EDs across the country.

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Dr. Angela M. Mills is a nationally recognized leader and expert in emergency medicine. She serves as the inaugural chair of the newly designated Department of Emergency Medicine at Columbia University Irving Medical Center and chief of Emergency Medicine Services at NewYork-Presbyterian. 

Dr. Brenna M. Farmer is Chief of Emergency Medicine at NewYork-Presbyterian Brooklyn Methodist Hospital and vice chair for the Department of Emergency Medicine at Weill Cornell Medicine. She is also an associate professor of clinical emergency medicine at Weill Cornell Medicine. Dr. Farmer is a nationally recognized medical toxicology expert and frequent keynote speaker on quality improvement, patient safety, and medication safety.

For more information visit nyp.org/Advances.

When her own experience with a complicated pregnancy reignited an interest in medicine and science, Dr. Lauren Osborne left her career in publishing to pursue medical school. Now a reproductive psychiatrist, Dr. Osborne leads the way in researching the connection between immune system dysregulation, stress reactivity, and the role of allopregnanolone in mood and anxiety disorders, particularly in pregnant and postpartum women. In this episode from the Advances In Care archives, she discusses how her expansive research is getting us one step closer to decoding perinatal mood disorders, and she calls for increased training in reproductive psychiatry to help OBGYNs better treat their patients.

Since this episode aired Dr. Osborne and her colleagues have taken their research on perinatal mood disorders one step further. They conducted the first comprehensive study of the metabolic pathway of the hormone progesterone to pinpoint alterations that could predict which women are at a higher risk of postpartum depression, or PD. They are hopeful that their findings will lead to the development of a blood test that could be used during pregnancy to predict PD and identify which patients may benefit from prophylactic treatment.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh speaks with Dr. Zev Williams, Chief of the Division of Reproductive Endocrinology and Fertility at NewYork-Presbyterian and Columbia and Director of the Columbia University Fertility Center. Recently, Dr. Williams and a team of researchers and clinicians used artificial intelligence to develop a system called STAR, or Sperm Track and Recovery, which combines advanced imaging with innovations in microfluidic chip technology to more accurately identify and capture sperm in samples from patients with azoospermia – a condition that often leaves men with untraceable numbers of sperm in their semen.

Dr. Williams explains that some azoospermia patients might have two or three sperm cells as opposed to the typical two or three million and having human researchers looking for those cells under a microscope is painstaking and rarely leads to success. Inspired by the AI-powered technology that astrophysicists use to find stars, Dr. Williams and his colleagues set out to build a tool that could help embryologists not only find those few sperm in a field of cell debris, but also collect them gently for future fertilization in an expedited manner.

The effort took five years of research and development, along with a collaborative bench-to-bedside research approach that Dr. Williams says is unique to the Columbia University Fertility Center. But the work paid off, resulting in a successful pregnancy and a promising example of how AI will continue to transform reproductive medicine.

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Dr. Zev Williams is the Wendy D. Havens Associate Professor of Women's Health at Columbia and the Chief of the Division of Reproductive Endocrinology and Infertility at NewYork-Presbyterian Columbia University Irving Medical Center. As a physician scientist, Dr. Williams' focus has been on helping those suffering from recurrent pregnancy loss and infertility and developing novel technologies and treatments to improve patient success.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh hears from Dr. Meghna Trivedi, an oncologist at NewYork-Presbyterian and Columbia, who is spearheading new research to assess cancer patients’ risk of developing chemotherapy induced peripheral neuropathy–an all too common side effect of cancer treatment.

Dr. Trivedi describes a study that she and her team undertook to identify and assess patient risk for developing a specific type of chemotherapy-induced neuropathy called TIPN, which is caused by taxanes, a commonly used chemotherapy drug. Based on this SWOG trial, known as S1714, physicians are better able to monitor at-risk patients for these side effects and adjust their treatment regimens accordingly.

Then, Dr. Trivedi explains how her team–also led by Dr. Daniel Hertz, PharmD, PhD at the University of Michigan–was recently awarded a prestigious R37 grant to identify a biomarker for TIPN.  This study, which she co-leads with Dr. Daniel Hertz, PharmD, PhD at the University of Michigan, will help doctors understand the mechanisms for why TIPN develops in the first place, and will be a critical step forward in creating targeted therapies to treat this disease before it starts.

Finally, Dr. Trivedi dives into the clinical trials her team is currently conducting to identify new therapeutic approaches to address and prevent the effects of neuropathy, such as cryotherapy.

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Dr. Meghna Trivedi, is a medical oncologist at NewYork-Presbyterian and co-leads the Hereditary Breast and Ovarian Cancer Program at Columbia’s Herbert Irving Comprehensive Cancer Center, a comprehensive, multi-disciplinary initiative aimed at screening, preventing, diagnosing, and treating hereditary breast and ovarian cancer. This innovative program brings together the resources of a world-renowned academic institution, including cutting-edge genomic testing, clinical trials, and experts in hereditary cancers across different specialties. Dr. Trivedi’s research and care expertise also includes cancer genetics and genomics, precision medicine, and chemotherapy induced peripheral neuropathy. She is the principal investigator on several clinical trials, and has authored numerous publications in leading peer-reviewed journals.

To learn more about the SWOG trial visit swog.org/clinical-trials/s1714

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh hears from Dr. Juan P. Rocca, a transplant surgeon at NewYork-Presbyterian and Weill Cornell Medicine, who recently led the first fully robotic liver transplant in New York.

Dr. Rocca details the recent developments in robotic surgery at Weill Cornell Medicine’s Division of Liver Transplantation and Hepatobiliary Surgery, including an ongoing push to advance from laparoscopic and open surgical methods, and now to robotics. He explains why the robotic approach is optimal for complex liver surgeries, and discusses how he and his team have been training to make robotic living donor hepatectomies a standard in their department.

Then, Dr. Rocca breaks down the process of the liver transplant operation that became the first fully robotic execution in New York. He describes the most critical steps of the procedure, how it felt to achieve this milestone, and the example that he hopes to set for other institutions beyond NewYork-Presbyterian and Weill Cornell Medicine.

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Dr. Juan Rocca is the Surgical Director of the Weill Cornell Liver Cancer Program and an attending surgeon in the Division of Liver Transplantation and Hepatobiliary Surgery at NewYork-Presbyterian and Weill Cornell Medicine. He was an early adopter of laparoscopic techniques for major hepatectomy and later transitioned to robotic surgery for complex liver procedures in patients with chronic liver disease. At Weill Cornell Medicine, he led the development of a comprehensive robotic liver surgery program, encompassing liver cancer resections, living liver donation, and the state's first fully robotic liver transplant

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh and Dr. Joel Gabre, a gastroenterologist at NewYork-Presbyterian and Columbia who specializes in cancer care, discuss the ongoing rise in colorectal cancer rates among younger individuals. Dr. Gabre lays out trends observed by the medical community in colorectal cancer rates, including the increasing likelihood by birth cohort for patients to develop this disease. He also talks about the main differences in colorectal cancer for patients from these different cohorts, most notably the location where cancers are likely to develop in the colon.

Dr. Gabre also shares some of the leading hypotheses for why colon cancer rates are rising in younger people, and that clinicians and researchers are focused on searching for answers to improve prevention and treatment options. He gets into the importance of the western diet in developing these forms of cancer and shares details about his team’s recent findings regarding changes at the cellular level that could be contributing to the accelerated growth of these cancers.

Finally, Dr. Gabre speaks to his personal experiences as a gastroenterologist who has seen first hand the rise in colon cancer rates among his patients. He shares a story of what motivated him to begin researching the cellular mechanisms driving colorectal cancer in young people, with the hope of finding a solution.

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Dr. Joel Gabre is a gastroenterologist and GI cancer genetics specialist interested in studying diseases of the upper GI tract with particular focus on the esophagus. He completed his undergraduate degree at Johns Hopkins University in biophysics, medical degree at the University of Maryland, internal medicine residency at the University of Cincinnati, and gastroenterology fellowship and post-doctoral research fellowship at the University of Pennsylvania, where he was chief GI fellow. He currently serves as Assistant Professor of Medicine at Columbia University Irving Medical Center in the Division of Digestive and Liver Diseases and as a member of the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian and Columbia.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh talks to Dr. David Majure, a cardiologist and heart failure specialist at NewYork-Presbyterian and Weill Cornell Medicine. Together they discuss the rapid rise in GLP-1 research over the past few years, indicating new applications for these therapies to help a wide variety of patients. They explore how GLP-1s work on a molecular level, and how using them to treat diabetes revealed other potential cardiovascular benefits.

Dr. Majure highlights several  recent studies that explore the effects of semaglutide and tirzepatide on patients with heart failure, particularly those with preserved ejection fraction. This new research demonstrates that GLP-1s can be an effective treatment beyond diabetes, helping with weight management and cardiovascular disease. Dr. Majure breaks down what effects doctors can expect to see in patients who are prescribed GLP-1s, including the difference in outcomes between semaglutide and tirzepatide. He also notes the potential risk factors, cautioning that while these medications are effective, the focus in addressing heart disease should always remain on prevention.

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Dr. David Majure is the Medical Director of the Heart Transplant Service at NewYork-Presbyterian and Weill Cornell Medicine. He specializes in the care of patients with heart failure, patients requiring or who have a heart transplant or ventricular assist device (LVAD), and patients with pulmonary hypertension. He has contributed extensively to research and has served as principal investigator in multiple clinical trials, exploring all aspects of advanced heart failure. Dr. Majure has been recognized as a Castle Connolly Top Doctor since 2020.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh and cardiologist Dr. Diala Steitieh discuss the current landscape of care for hypertrophic cardiomyopathy — or HCM — the most common genetic heart disorder. Dr. Steitieh outlines the advantages of genetic screenings for patients who have HCM, along with the symptoms and risks if the condition is left undiagnosed or unmanaged.

She expands on the importance of understanding obstructive vs. non-obstructive conditions and the importance of making a precise diagnosis to get a clear sense of each patient’s severity. Dr. Steitieh and her team recently implemented a new approach to their diagnostic imaging protocol called goal-directed Valsalva. With this emerging tool in the landscape of cardiology, they are able to get a better sense of an obstruction impacting blood flow, and ultimately offer a wider variety of treatment options.

Beyond diagnosis, Dr. Steitieh also shares her excitement about updates to the management of HCM, including recently approved drugs and new guidelines regarding sports & exercise. She and her team at Weill Cornell Medicine are in the process of becoming a designated Hypertrophic Cardiomyopathy Association Center of Excellence, a development that Dr. Steitieh hopes will improve access to care for patients in New York and beyond.

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Dr. Diala Steitieh is an Assistant Professor of Clinical Medicine, and the Director of the Hypertrophic Cardiomyopathy program in the Division of Cardiology at Weill Cornell Medical College and New York Presbyterian Hospital. She has a background in sports cardiology and also cares for patients with a wide array of cardiovascular diseases, including coronary disease and valvular heart disease. Dr. Steitieh also serves as an attending physician on the inpatient services at NewYork-Presbyterian Hospital, including the intensive care unit and cardiac units.

For more information visit nyp.org/Advances

On this episode of Advances in Care, host Erin Welsh talks to Dr. Andrew Goldstone and Dr. David Kalfa, pediatric cardiac surgeons at NewYork-Presbyterian and Columbia, about their groundbreaking heart transplant that saved the lives of three separate children. It was the first time doctors at NewYork-Presbyterian Morgan Stanley Children’s Hospital performed a split-root domino partial heart transplant. In this procedure, one child was transplanted with a new heart and their original heart was used to donate living pulmonary and aortic valves to two separate recipients in need.

Dr. Goldstone, Dr. Kalfa and the rest of the team at NewYork-Presbyterian and Columbia had previous experience with a handful of domino partial heart transplants where one patient is transplanted with a new heart and another receives a valve from the explanted heart. Those experiences helped prepare for the split-root domino, which took nearly 24 hours of extremely coordinated care. In addition to their efforts to increase the number of domino heart transplants being done, physician-researchers at the institution are leading new studies that are  also helping improve living valve procurement and storage, allowing more children to receive heart valves that will grow with them and require less surgeries.

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Dr. Andrew Goldstone is the Surgical Director of Heart Transplant and Mechanical Circulatory Support and Director of the Valve Transplant Program at Columbia and NewYork-Presbyterian. He has been recognized nationally and internationally for his clinical and basic science research.  In the lab, he focuses on mechanisms underlying collateral artery formation and cardiac regeneration. His long-term goal is to continue adding high-level evidence to better inform the surgical treatment of pediatric and adult cardiovascular disease.

Dr. David Kalfa is a Board-certified cardiothoracic surgeon with a subspecialization in pediatric cardiac surgery. He is also a researcher focusing in the field of growing heart valves and growth accommodating heart valves.

For more information visit nyp.org/Advances