Advances in Care

• Preventing Unnecessary C-Sections through Labor Induction Research

  On this episode of Advances in Care, host Erin Welsh and Dr. Moeun Son, OB/GYN and Maternal-Fetal Medicine Specialist at NewYork-Presbyterian and Weill Cornell Medicine, discuss Dr. Son’s perspective on treating patients who face a high-risk pregnancy and might need a caesarian delivery.Dr. Son explains that even though c-sections are a highly common and safe delivery option for many women, they’re not often not the top option in a woman’s birth plan, and don’t carry the same benefits as natural labor. She outlines the standard methods for labor induction to prevent the necessity of a c-section, which includes the administration of a synthetic form of the hormone oxytocin.Beyond her work with patients, Dr. Son is also passionate about researching alternative methods for labor induction and preventing unnecessary c-sections. She and her colleagues designed a study to promote natural oxytocin release through nipple stimulation – mimicking breastfeeding through the use of a hospital grade breast pump. The success of that treatment eventually led to the The Stimulation To Induce Mothers Study – or STIM Study. Today, it’s an ongoing trial that aims to compare the effectiveness of natural oxytocin versus synthetic oxytocin in helping women give birth vaginally.Dr. Son hopes that this research will broaden birthing options for women experiencing a high-risk pregnancy, and add more safe and effective treatment methods to the field of women’s health.***Dr. Moeun Son is board-certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. In her practice, she focuses on women with high-risk pregnancies, from pre-existing maternal conditions to babies with health anomalies. She is the principal investigator on many clinical research projects, including various randomized clinical trials. Dr. Son also serves as the Program Director of the MFM Fellowship Program at Weill CornellFor more information visit nyp.org/Advances

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• Innovating Shoulder Surgery through Tendon Transfers

  On this episode of Advances in Care, host Erin Welsh and Dr. Karan Dua, an orthopedic surgeon at NewYork-Presbyterian and Columbia, discuss novel approaches to shoulder surgery, including transferring donor tendons to the upper extremity with arthroscopic tools. Dr. Dua shares his passion developing personalized treatments that get to the root cause of a wide range of shoulder issues.Dr. Dua explains the importance of the scapula and what happens when its range of motion is abnormal, or out of alignment. He talks about his process for balancing the scapula to relieve pain in his patients, who are often young and suffering from pain due to injuries from work or sports.He also discusses the difference between shoulder replacement – a common treatment for patients with arthritis – and shoulder reanimation. Dr. Dua is skilled in shoulder reanimation, and describes how he performs tendon transfers to preserve a patient’s joints and allow them to restore movement of their shoulder. Using arthroscopic instruments, Dr. Dua collects a donor tendon either from another part of the patient’s body or from a cadaver, and replaces the injured tendon with a healthy one.Dr. Dua hopes to develop a robust scapula program at NewYork-Presbyterian and Columbia that offers targeted treatment for patients suffering from a range of upper extremity issues.***Dr. Karan Dua is an orthopedic surgeon specializing in the treatment of structures affecting the form and function of the entire arm. He is dual trained in hand, upper extremity, and microvascular surgery, and in shoulder and elbow surgery. He has an avid interest in open and arthroscopic tendon transfers of the shoulder, complex reconstructions after failed surgery, arthroscopic and minimally invasive techniques for nerve decompression including the brachial plexus and around the shoulder blade, and tendon transfers for scapular winging.For more information visit nyp.org/Advances

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• Exploring Psychedelics as the Next Wave of Psychiatric Innovation

  On this episode of Advances in Care, host Erin Welsh first hears from Dr. Richard Friedman, a clinical psychiatrist at NewYork-Presbyterian and Director of the Psychopharmacology Clinic at Weill Cornell Medicine. Using his background in psychopharmacology, Dr. Friedman distinguishes between psychedelics and standard antidepressants like SSRIs and SNRIs, explaining the various mechanisms in the brain that respond uniquely to psychedelic compounds. While both methods of treatment involve serotonin stimulation, psychedelics are the only known drug to shut off the brain’s Default Mode Network, which is the group of brain regions that are active when a person is not thinking about external stimuli. Dr. Friedman also identifies that the challenge of proving efficacy of psychedelic therapy lies in the question of how to design a clinical trial that gives patients a convincing placebo.To learn more about the challenges of trial design, Erin also speaks to Dr. David Hellerstein, a research psychiatrist at NewYork-Presbyterian and Columbia. Dr. Hellerstein contributed to a 2022 trial of synthetic psilocybin in patients with treatment resistant depression. He and his colleagues took a unique approach to dosing patients so that they could better understand the response rates of patients who use psychedelic therapy. The results of that trial underscore an emerging pattern in the field of psychiatry – that while psychedelic therapy has its risks, it’s also a promising alternative treatment for countless psychiatric disorders. Dr. Hellerstein also shares more about the future of clinical research on psychedelic therapies to potentially treat a range of mental health disorders.***Dr. Richard Friedman is a professor of clinical psychiatry and is actively involved in clinical research of mood disorders. In particular, he is involved in several ongoing randomized clinical trials of both approved and investigational drugs for the treatment of major depression, chronic depression, and dysthymia.Dr. David J. Hellerstein directs the Depression Evaluation Service at Columbia University Department of Psychiatry, which conducts studies on the medication and psychotherapy treatment of conditions including major depression, chronic depression, and bipolar disorder.For more information visit nyp.org/Advances

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• Detecting Parkinson’s Disease Sooner with Biomarker Research

  On this episode of Advances in Care, host Erin Welsh and Dr. Serge Przedborski, Chief of the Division of Movement Disorders at NewYork-Presbyterian and Columbia, discuss what happens in the brains of patients with Parkinson’s disease. Dr. Przedborski came to Columbia thirty two years ago and has spent that time researching why some neurons in the brain die while others live in people who suffer from the condition – and he’s learned a lot. With the help of the New York Brain Bank at Columbia, his lab has been able to map out what the neuronal patterns of death look like with the goal of using these brain maps to develop novel treatments that seek to address the progression of Parkinson’s rather than just treating the symptoms, which is how all current treatments work.Dr. Przedborksi also shares updates on new gene therapies that are being investigated across the institution to replace Deep Brain Stimulation – a common treatment for Parkinson’s where a wire is placed in the brain. While these gene therapy treatments are still invasive, the technology behind them is constantly improving and will likely lead to significant benefits to patients***Dr. Przedborski’s ongoing research aims at understanding the contributions of cell-autonomous and non cell-autonomous mechanisms to neurodegeneration using both toxic and genetic experimental models of Parkinson’s Disease and ALS. In keeping with this goal, how alterations in mitochondrial biology, especially of mitochondrial dynamics and mitophagy, provoke degeneration of specific subpopulations of neurons is one of the main areas of research in the Przedborski laboratory. To what extent and by which mechanisms do non-neuronal cells, like microglia and astrocytes, participate in the demise of neurons in neurodegenerative disorders, such as Parkinson’s and ALS, represent a second main line of research in this laboratory. These research efforts are supported by federal grants from both NIH and the DoD as well as by several private agencies such as the Parkinson's Disease Foundation and the Thomas Hartman Foundation.For more information visit nyp.org/Advances

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• Newborn Gene Sequencing: Expanding Early Detection of Treatable Diseases

  On this episode of Advances in Care, host Erin Welsh explores the story behind the GUARDIAN study, where thousands of newborn babies have been screened against rare disease by sequencing their genes, and looking  for more conditions than any of the current standard screening panels. First, she hears from Dr. Jordan Orange, Physician-in-Chief at Morgan Stanley Children’s Hospital at NewYork-Presbyterian and Columbia, about why genetic testing is a promising way of not only catching treatable rare diseases in infants, but also expanding health equity and medical resources to marginalized populations.Erin also hears from Dr. Josh Milner, a pediatric immunologist who treated a patient with a rare form of SCID, or severe combined immune deficiency, also known as bubble boy disease that was detected in the GUARDIAN screening panel. SCID is a disease that typically occurs in 1 of 50,000 babies. But GUARDIAN caught two cases within the first 10,000 babies involved in the program, indicating that the rate of the disease might be higher than expected, and that the most accurate way to detect is through genetic screening.Dr. Steven Lobritto, a pediatric gastroenterologist, also weighs in on how genetic screening can help identify Wilson’s disease, a copper storage disorder that causes liver damage when left unchecked. And Dr. Eric Silver, a pediatric electrophysiologist, discusses how the program detected a heart rhythm disorder called Long QT Syndrome for both a newborn baby and their father.Finally, Erin gets the big-picture takeaways from Dr. Orange, who reflects on what the results of GUARDIAN could mean for the future of newborn screening and health policy, and how he hopes to see genetic testing expand research and treatment of rare diseases.For more information visit nyp.org/Advances

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