Advances in Care

On this episode of Advances in Care, Erin Welsh is joined by Dr. Leonardo Lopez, a psychiatrist at NewYork-Presbyterian and vice chair for inpatient services in the Department of Psychiatry at Weill Cornell Medicine. Dr. Lopez and his team are at the forefront of electroconvulsive therapy (ECT), and have built one of the largest programs of its kind in the country dedicated to treating severe psychiatric illness through this revolutionary method. Though it is one of the most effective therapies available for certain psychiatric conditions like treatment resistant depression and schizophrenia, ECT isn’t widely adopted or accessible. However, Dr. Lopez hopes to change that. In the episode, he describes the history of this treatment, how it has evolved since its inception to become one of the safest procedures done under general anesthesia, and the dramatic response rates. 

 

ECT works by restructuring neurotransmitter release and promoting neuronal growth. Patients with conditions like psychotic depression and catatonia can sometimes see upwards of 90-95% response rates. To illustrate the power of ECT, Dr. Lopez shares the story of a pediatric patient who was referred to his team after being diagnosed with catatonia caused by another condition. Although the other condition was treated, the catatonia persisted until she was entirely dependent and non-verbal. Following a 6-week ECT treatment plan, the catatonia resolved completely and the patient was able to return to a normal life. 

 

The treatment is less than 5 minutes and administered while patients are under general anesthesia and muscle relaxants, resulting in some of the fastest-acting psychiatric treatment for certain conditions, with minimal side effects. Dr. Lopez hopes that as ECT becomes increasingly destigmatized and sees continued treatment success, there will be more access across the country to this transformative and life-saving therapy. 

 

 

Chapters:

 

[00:00 – 5:12] Efficacy of Electroconvulsive Therapy 

Dr. Leonardo Lopez describes a potentially fatal syndrome called catatonia and the remarkable results of electroconvulsive therapy (ECT) in catatonia and other psychiatric conditions. 

 

[5:12 – 10:17] Electroconvulsive Therapy to Treat Severe Catatonia 

Dr. Lopez recounts a recent case of a pediatric patient with catatonia whose syndrome resolved completely after receiving electroconvulsive therapy (ECT), and why ECT should not be considered a treatment of last resort. 

 

[10:17 - 13:05] Destigmatizing the Treatment

Dr. Lopez talks about how ECT has been stigmatized by media portrayals despite modern advancements in application. 

 

[13:05 - 15:26] Expanding Access to ECT

Dr. Lopez shares his role in developing NewYork-Presbyterian’s ECT program and his hopes for increased access in the future. 

 

[15:26 – 15:55] Credits

 

***

Dr. Leonardo Lopez is a psychiatrist and clinical leader who serves as Vice Chair for Inpatient Services in the Department of Psychiatry at Weill Cornell Medicine. In this role, he partners closely with leadership at NewYork-Presbyterian to oversee the development, implementation, and ongoing management of inpatient psychiatry services, including electroconvulsive therapy (ECT), across multiple sites, including Weill Cornell Medical Center, Westchester Behavioral Health, and Brooklyn Methodist Hospital, while also collaborating with Gracie Square Hospital to integrate clinical services and advance system-wide behavioral health policies and practices. In these roles, he oversees large-scale inpatient services caring for New York’s most vulnerable populations, including specialized units for co-occurring disorders and patients in Department of Corrections custody, while also expanding access to advanced treatments like ECT and intravenous ketamine for treatment-resistant depression and other disorders.

 

For more information visit nyp.org/Advances

On this episode of Advances in Care, Dr. Steven Lobritto, pediatric medical director for liver transplant at NewYork-Presbyterian and Columbia, joins host Erin Welsh to tell the story of a high-risk pediatric liver transplant that he and his team performed to save the life of a two month old baby, after the center where the baby was originally treated deemed her inoperable. 

Dr. Lobritto describes how NewYork-Presbyterian and Columbia has been building their liver transplant center since 1998, allowing them to push forward innovative, and life-saving, surgical strategies, like living donor and partial liver transplants, in order to increase the odds of survival for pediatric patients on the organ waitlist.

Children under one year of age have the highest mortality rates while waiting for a transplantable organ. In the case of this infant, the optimal treatment required surgical expertise in partial liver transplant due to her uniquely small size. Dr. Lobritto explains how he and his team coordinated with the patient’s initial care team across the country to prepare the critically ill, 11-pound baby to fly to New York, and the intricacies of the surgical procedure.

Dr. Lobritto also explains his involvement with the STARZL Network, a consortium of hospitals that share protocols, best practices, and learnings to address knowledge and training gaps in pediatric organ transplantation. He advocates for partial liver transplantation to be universally taught as a requirement of surgical training, to increase access to organs and save the lives of more young patients.

Chapters:

[00:00 - 5:58] NewYork-Presbyterian and Columbia’s Liver Transplant Center 

Dr. Lobritto describes the strengths of the NewYork-Presbyterian and Columbia Liver Transplant Center, including the cutting edge techniques that allowed them to coordinate a partial liver transplant in a critically ill baby. 

[5:58 - 8:12] A Specialized Transport to New York

Dr. Lobritto outlines the challenges of transporting the baby, who needed a mobile ICU team for life-support to travel to New York City. 

[8:12 - 12:50] Multidisciplinary Collaboration 

Dr. Lobritto shares the considerations that went into preparing for the baby’s complex surgery and how they adapted care when a complication arose. 

[12:10 - 14:41] The STARZL Network

Dr. Lobritto discusses his work with the STARZL Network, which strives to increase access to pediatric organ transplant. 

[14:41 - 15: 31] Credits

***

Dr. Steven Lobritto is a distinguished pediatric gastroenterologist and a professor of pediatrics and medicine at Columbia University Irving Medical Center (CUIMC). He has been instrumental in the development of the Pediatric Liver Transplantation Program at NewYork-Presbyterian/Columbia and is the Medical Director of the program. Dr. Lobritto has trained many leading physicians in transplant hepatology and has contributed significantly to pediatric liver transplantation through his research and clinical care. His expertise in pediatric gastroenterology and liver transplantation has made him a respected figure in the medical community.

For more information visit nyp.org/Advances

On this episode of Advances in Care, Erin Welsh is joined by Dr. Howard Fine, a neuro-oncologist at NewYork-Presbyterian and director of the Brain Tumor Center at Weill Cornell Medicine, to explore his pioneering research on glioblastoma, the most common and aggressive form of brain cancer.

Glioblastoma has long resisted meaningful therapeutic progress. When Dr. Fine began working in this field, the median survival after diagnosis was just 12-13 months. Forty years later, there’s been little progress made to meaningfully extend life for glioblastoma patients, despite concerted research efforts. Unlike many other cancers, glioblastoma cells diffusely infiltrate the brain, making complete surgical removal and targeted chemotherapy extremely difficult, thus limiting the effectiveness of traditional cancer treatment approaches.

Dr. Fine’s work aims to fundamentally change how glioblastoma is studied and treated.

His lab is bioengineering human embryonic stem cells to form cerebral organoids - also called mini brains - which exhibit similar characteristics to a human brain. Through a platform they’ve created called GLICO, his team can develop genetically matched, patient-specific models that incorporate a patient’s own immune cells and glioma stem cells, allowing researchers to screen various drug therapies and map how an individual patient’s glioma might progress. 

By combining these personalized glioblastoma models with artificial intelligence and machine learning, Dr. Fine’s goal is to build a future care model where clinicians can identify patient-specific therapies and test treatments before they reach the bedside, ultimately transforming glioblastoma into a more manageable disease.

Chapters:

[00:00 - 07:13] Past Research and Treatment for Glioblastoma

Dr. Fine and Erin discuss his history in researching and treating glioblastoma. 

[07:13-10:54] Reframing Glioblastoma 

Dr. Fine explains how glioblastoma differs from other types of cancers and why traditional approaches haven’t improved outcomes. 

[10:54-14:46] GLICO and Glioblastoma Cerebral Organoids 

Dr. Fine describes the GLICO platform he’s pioneering, and how advancements in cerebral organoids open new pathways for treatment strategies. 

[14:46-18:34] Shifting the Paradigm

Dr. Fine shares his research goals to accommodate this new biological understanding of glioblastoma and how it could transform the condition into a manageable disease and improve survivorship. 

[18:35-18:59] Credits

***

Howard A. Fine, M.D., is the founding Director of the Brain Tumor Center at NewYork-Presbyterian/Weill Cornell Medicine and Associate Director for Translational Research at the Sandra and Edward Meyer Cancer Center. Over his career, he has built multidisciplinary brain tumor programs at leading institutions including the National Institutes of Health and Dana-Farber Cancer Institute/Harvard Medical School. He has cared for nearly 20,000 patients with brain and spinal cord tumors, led more than 100 clinical trials, and authored over 250 publications. His laboratory has operated continuously for more than two decades, focusing on the genetic and molecular drivers of brain tumors.

Today, his research centers on developing patient-specific tumor models, creating genetically precise replicas of individual brain tumors to better predict disease behavior and enable real-time drug screening tailored to each patient. At WCM, he leads a multidisciplinary team dedicated to delivering highly personalized neuro-oncology treatment plans.

For more information visit nyp.org/Advances

Erin Welsh is joined by Dr. Jennifer Haythe, director of the Adult Pulmonary Hypertension Center and Cardio-Obstetrics programs at NewYork-Presbyterian and Columbia, to discuss the prevalence of high-risk pregnancies due to heart disease and the multi-disciplinary efforts required for optimal patient care. 

Many women in the US are having children at a later age than in the past, and with that comes an increased occurrence of certain conditions that create risk for heart disease during, or after, pregnancy. In fact, cardiovascular disease is the leading cause of maternal mortality in the US, with pulmonary hypertension and peripartum cardiomyopathy posing significantly high risks. Dr. Haythe discusses how coordinated, multi-disciplinary care is crucial in treating these vulnerable patients, and how the cardio-obstetrics program at Columbia is approaching care to allow women, many of whom have been told they could never give birth, achieve safe and successful pregnancies. Dr. Haythe also talks about the latest cutting edge research for cardiac conditions in pregnancy and her program’s involvement in the ReBIRTH study, a national, multi-center, randomized placebo controlled trial examining the use of bromocriptine as a course of treatment for pregnant patients with peripartum cardiomyopathy - a study that could potentially introduce a new paradigm in high-risk pregnancy care. 

Chapters:

[00:00 - 5:49] Columbia’s Multidisciplinary Cardio-Obstetrics Program

Dr. Haythe and Erin discuss how the multidisciplinary cardio-obstetrics program at Columbia and the growing population of pregnant patients with heart disease.

[05:49 - 10:28 ] Navigating Cardiovascular Complications 

Dr. Haythe and Erin talk about the risks of pulmonary hypertension and other cardiovascular complications in pregnant patients, including during the post-partum period, and also highlights new research that may help change the course of treatment. 

[10:28 - 14:08] A Rewarding Patient Story

Dr. Haythe tells a story of a pregnant patient with pulmonary hypertension who delivered successfully, demonstrating how the program effectively managed her care. 

[14:08 - 17:12 ] Vision For the Future

Dr. Haythe shares her experience as part of the New York City Maternal Mortality Review Board, a committee formed to review maternal deaths and determine how to minimize the risk of recurrence going forward. 

[17:12 - 18:04] Credits

***

Jennifer Haythe, MD, is the Director of the Adult Pulmonary Hypertension Center, and the Cardio-Obstetrics program at Columbia. She is currently the Irene and Sidney B. Silverman Associate Professor of Cardiology, Center for Advanced Cardiac Care at Columbia, and Co-Director of The Columbia Women’s Heart Center.

Dr. Haythe specializes in pulmonary hypertension, cardio-obstetrics, heart failure, HFPEF, and cardiovascular disease in women.

For more information visit 

nyp.org/Advances

On this episode of Advances in Care, Erin Welsh and Dr. Jeffrey Greenfield, pediatric neurosurgeon at NewYork-Presbyterian and director of the Chiari CARE program at Weill Cornell Medicine, discuss a rare condition called Chiari malformation. 

Typically diagnosed by MRI, Chiari malformation is classified when part of the cerebellum descends into the upper spinal canal. Though some of the most severe types of Chiari malformation can be diagnosed during pregnancy, the most common type may present asymptomatically until adolescence or adulthood, with symptoms that are often misdiagnosed as other disorders. To address the unmet need for proper diagnosis and management of this condition, Dr. Greenfield created the Chiari CARE program–a multidisciplinary approach involving neurology, pain management, neuropsychology, radiology, and more–to help provide full-spectrum care to patients. A key factor of the Chiari CARE program is its emphasis on transitional care, which includes both treating patients who come in as pediatrics throughout their adulthood as well as those who are diagnosed later in life. 

But Dr. Greenfield’s vision extends to the future. Having just treated the program’s thousandth surgical patient, his team is amassing and analyzing outcomes data and using machine learning to refine predictions for which future patients would be good candidates for surgery or require other treatment methods that will enhance overall quality of life. 

Chapters:

[00:00 - 4:12] Chiari CARE

Dr. Greenfield and Erin discuss a rare congenital brain condition called Chiari malformation, and highlight Dr. Greenfield’s Chiari CARE program at NewYork-Presbyterian and Weill Cornell Medicine.  

[4:12 - 8:35] The Importance of Transitional Care 

Dr. Greenfield expands on the importance of transitional care for patients with congenital neurological conditions like Chiari malformation. 

[8:35 - 11:51] Determining the Right Approach 

Dr. Greenfield explains how he and his team determine whether their patients need surgery or not, and the challenges of diagnosing and treating Chiari malformation in adults. 

[11:51 - 14:31] Harnessing Data to Advance Research

Dr. Greenfield describes how his team is utilizing the MRI scans from over a thousand patients to develop models that could predict who may be a good candidate for surgery or other treatment avenues. 

[14:31 - 18:35] Advancing Diagnostics 

Dr. Greenfield shares his vision for an improved coordinated care model for patients newly diagnosed with Chiari malformation. 

[18:35 - 19:20] Credits 

***

Jeffrey Greenfield, MD, PhD is a board-certified neurosurgeon who specializes in pediatric neurosurgery. In addition he sees certain adult patients with congenital neurosurgical conditions. Compassionate clinical care, research, and education are all central to his philosophy as a neurosurgeon and physician. His clinical expertise includes Chiari malformation, all forms of tethered spinal cord, pediatric brain tumors and congenital neurosurgery into adulthood. 

As creator and director of the Chiari CARE program, Dr. Greenfield has developed an international reputation caring for children and adults with Chiari malformation, tethered cord, syringomyelia, and other associated conditions such as craniocervical instability, CSF leaks, and hydrocephalus as part of a large multidisciplinary team.

For more information visit 

nyp.org/Advances