Partners International Helps Northern Ireland Launch Connected Health Initiative
Partners International and Northern Ireland’s Department of Health, Social Services and Public Safety launched a new international collaboration on January 25. Designed to improve the quality of health and social services in Northern Ireland, the collaboration will focus initially on strategic consulting, bilateral educational exchange, and clinical program development in the areas of tele-stroke, tele-radiology and remote monitoring of chronic disease.
As a critical component of the collaboration, Partners International has also agreed to assist Northern Ireland with strategic planning for the European Centre for Connected Health, a major initiative that aims to introduce ascendant technology into the local health care system and establish Northern Ireland as a regional hub within Europe’s emerging connected health economy.
With an expectation that the number of residents over 85 years of age will double by 2028, Northern Ireland’s current health care infrastructure runs the risk of being overwhelmed by patients with heart disease, diabetes and other chronic conditions. By collaborating with Partners HealthCare, a pioneering leader in the development of telehealth and technology-enabled remote care programs, Northern Ireland plans to provide remote monitoring to 5,000 patients within three years. In addition to increasing efficiency and reducing costs, this achievement would comprise “one of the largest [programs] of this nature in Europe,” according to Northern Ireland’s Health Minister, Michael McGimpsey.
Describing the significance of the collaboration, Andrew McCormick, Northern Ireland’s Permanent Secretary at the Department of Health, Social Services and Public Safety said, “The alliance between the Department and Partners HealthCare is an important step in ensuring that Northern Ireland is at the forefront in developing and implementing new technology and innovative working practices that will deliver high quality and accessible health and social care for patients in Northern Ireland.
“The relationship will give Northern Ireland access to leading edge developments in health care…It will also allow professionals working in health care and life bioscience here to share their knowledge and experience with their American counterparts.” Among other activities, the new European Centre for Connected Health is expected to launch a state-of-the-art digital picture archiving and communication system, which will abolish outdated film x-rays and allow reports to be shared electronically between hospitals and physicians’ offices.
Commenting on Northern Ireland’s 3-year, £46 million commitment to integrating technology into health care delivery and patient care, Joseph L. Ternullo, Associate Director of the Partners HealthCare Center for Connected Health, remarked, “The Northern Ireland leaders are to be commended for their vision and resolve. This is a very bold and exciting step toward improved patient outcomes. Partners HealthCare is delighted to collaborate on this important initiative.”
Letter From the Executive Director
For the past ten years, Partners International has served as a gateway for overseas patients, governments and medical professionals seeking relationships with the Partners community. Helping patients from foreign countries receive the most advanced medical treatment available has always been – and continues to be – a core mandate for Partners International. More recently, the Program’s evolution has been marked by significant milestones not only in the number and origin of patients who are treated in Boston, but also by the ways in which Partners’ clinicians and administrators share their experiences, knowledge and resources with colleagues across the global medical community.
Through our collaboration with governments, health care providers, and private sector entities, Partners International harnesses the talent and dedication of individuals across the Partners system to improve the health of people in underserved countries. From initial facility design to training and operations development, Partners International provides our clients with the knowledge and infrastructure they need to upgrade their local health care systems. These initiatives often establish new standards for quality in international health care.
Continuing medical education is another important aspect of our mission. In order to meet the demand for knowledge about best practices in medicine, particularly in developing economies, Partners International frequently draws upon experts within the Partners network to conduct live webcasts, on-line symposia, custom videoconferences, visiting physician programs and continuing medical education courses. We are indebted to our colleagues at all levels of the organization who have brought us this far and who will lead us in the exciting times ahead.
In an era of globalization, delivering the best medicine, whether in Boston, Beirut, Bangalore or Bangkok, increasingly requires the collective brainpower of leading clinicians and scientists from throughout the world. Partners International is committed to playing an active role at a time in which solving the most pressing health care problems requires us to look beyond traditional borders — whether they are professional, institutional, or geographic.
As Partners International celebrates both the conclusion of our first decade and the opportunities that lie ahead, we look forward to working with all of you in the advancement of global health.
Partners International Advances Medical Simulation In Kazakhstan
Partners International and senior officials in Kazakhstan recently announced plans to establish a state-of-the-art medical simulation training center in the new capital city of Astana. The simulation center – which will combine high fidelity human patient simulators, sophisticated micro-computer human physiology simulators and a laboratory for advanced skills training – will create real-time case scenarios that are applicable to anesthesia, critical care, trauma, emergency medicine and pre-hospital care. When it becomes operational in June of 2008, the center is expected to be the first facility of its kind among all the former Soviet Republics.
“By collaborating with Partners HealthCare’s Harvard-affiliated hospitals, Astana will train a new generation of clinicians to the highest standards in modern medicine and will gain access to the very latest medical technologies. We look forward to taking the quality of health care in Astana to the next level,” said Askar Mamin, Mayor of Astana.
Astana’s new medical simulation center will be capable of training physicians, nurses, police, firefighters and hotel personnel to respond to a full spectrum of patient emergencies, as well as bioterrorism or chemical warfare incidents. Depending upon the simulation scenario, students will be trained to perform intravenous cannulation, phlebotomy, medication administration, airway maintenance, intubation, fiberoptic procedures, needle or surgical cricothyrotomy, needle chest decompression, chest tube insertion, CPR, cardiac defibrillation, or Foley catheterization, among other procedures.
Occupying over 7,000 square feet in one of Astana’s newest outpatient clinics, the new simulation center is expected to train over 100 physicians within the first year.
“Kazakhstan has experienced enormous growth and rapid economic expansion in recent years,” commented Temirlan Karibekov, MD, Director of Astana’s Department of Health, which initially established the affiliation with Partners. “If we are to join the fifty most developed countries in the world, our health care system must meet international standards. We have an excellent opportunity to collaborate with Partners in employing new technology that will eventually improve the quality of health care for all the people of Kazakhstan.”
The new medical simulation center is the cornerstone project within a 5-year framework agreement between the City of Astana and Partners International. Other initiatives within the framework include annual site visits in Astana conducted by Partners experts, as well as a preceptorship program for Kazakh health care professionals at the Partners hospitals in Boston.
Among the first Kazakh physicians to participate in the 4-week preceptorship program was trauma surgeon Vladimir Kachalov, MD, who arrived in Boston on March 30th. Reflecting on his training experience with Tobias D. Barker, MD and Charles Pozner, MD at Brigham and Women’s Hospital, Dr. Kachalov said, “It’s very exciting to train at a teaching hospital that is affiliated with Harvard Medical School, the most highly rated medical school in the world. Offering simulation training to physicians yields significant benefits for patients: fewer medical mistakes and better outcomes, particularly in emergency situations. I believe that simulation training is essential for all health care providers in Kazakhstan.”
Researchers from Brigham and Women’s Hospital (BWH), for the first time, using new DNA sequencing technology, can identify the unique genetic mutations of a cancerous tumor of an individual patient. This new, more rapid and efficient approach may dramatically improve therapeutic decisions for cancer patients.
The researchers obtained the genetic sequences of all of the expressed genes in tumors from four patients with mesothelioma, an asbestos caused cancer of the lung. Three to four novel genetic mutations were found in each tumor, none of which had been implicated in cancer in previous studies. Each tumor had a unique mutation profile, similar to having a unique fingerprint. The research results are published in the February 25, 2008 issue of the Proceedings of the National Academy of Sciences.
The findings confirmed the accuracy of advanced new sequencing technology to identify the patient-specific genetic mutations in surgically removed tumor tissue and suggest that this approach could become a new standard for discovery of tumor mutations that underlie cancer. This approach points the way to individualized analysis of patient tumors thereby encouraging discoveries that have tremendous potential to highly refine individual patient care and guide therapy.
The BWH group developed new methods to preserve and select the optimal tissue from newly harvested tumors, and software tools to manage the billions of DNA sequence data points and discovered the important cancer causing genetic changes. This newly developed pipeline could be used to identify the genetic mutations in a given patient within a relatively short time frame, from a several weeks to just a few months.
BWH surgeons analyzed tissue from four malignant pleural mesothelioma tumors, one lung cancer specimen and from normal lung tissue. Approximately 266 megabases of cDNA were sequenced per patient using technology in collaboration with 454 Life Science Inc. All expressed genes were sequenced without any preconceived notion as to which may be more or less important. Analysis of the billions of DNA sequence data points was enabled by software developed in collaboration with the National Center for Genome Resources in Santa Fe, NM. The computer programs were designed to assemble the data and compare it among the patients and with public DNA and RNA databases to determine candidate mutations, which were validated by independent methods. In the four mesothelioma tumors 15 novel mutations of multiple types were discovered and each mesothelioma tumor had a unique mutation profile. None of the mutated genes has ever been implicated in mesothelioma.
“We found that each tumor had its own unique genetic mutation, sort of like its own fingerprint,” said David J. Sugarbaker, Chief, Division of Thoracic Surgery at BWH, lead author of the study and a pioneer in mesothelioma research. “One truly encouraging aspect of our findings is after spending a year and a half to develop the methodology and software for the pipeline, new tumors can be analyzed over the course of about a month. Knowing which genes are mutated opens the door to better understanding and the discovery of more targeted and effective patient-specific treatments in real time.”
He added, “Technical advances are rapidly changing the way we can do mesothelioma research and advance personalized medicine at the clinical level. This step forward is akin to mainframe computers giving way to the desk top PC revolution. Ultimately, every patient’s tumor will be directly sequenced to determine its mutations and optimal treatment just as we now identify the cause of an infection before selecting the best antibiotic to treat it.”
Contributors
Nabeel Bardeesy, PhD, David P. Ryan, MD, Carlos Fernandez-del-Castillo, MD, Sarah P. Thayer, MD, PhD, Cristina R. A. Ferrone, MD, Andrew L. Warshaw, MD, Theodore S. Hong, MD
Comparing proton beam therapy (PBT) and photons (intensity modulated radiation therapy, or IMRT) for pancreatic cancer: IMRT (image on left) produces a more diffuse dose distribution, exposing more of the body cavity and organs to radiation. PBT (image on right) focuses more of the therapeutic radiation dose (25 Gy) on the tumor and the immediate surrounding area.
This year, 232,000 people across the globe will be diagnosed with pancreatic cancer, and 227,000 will die of the disease, making it the eighth leading cause of cancer deaths among men and women in the world. Because it is an aggressive malignancy typically asymptomatic in its early stages and metastatic by the time it is diagnosed, pancreatic cancer has a poor prognosis. Median survival among the approximately 15-20% of patients with resectable disease approaches just 17 months, for example, and is only four to six months for those whose cancer has metastasized, generally to the liver and lungs.
High surgical volume – improved outcomes
Surgery is the mainstay of treatment for pancreatic cancer. Surgical volume is highly correlated with improved outcomes, including reduced morbidity and mortality. Providing surgical treatment for nearly 200 pancreatic cancer patients annually, the Massachusetts General Hospital Cancer Center performs the largest number of pancreatic resections in the Northeast. Massachusetts General’s high volume, coupled with the availability of a dedicated pancreas surgical team and a multidisciplinary clinic that provides comprehensive care for these patients, translates to significantly lower mortality and morbidity. For patients whose tumors are resectable, most undergo the Whipple procedure, a complex operation in which the head of the pancreas and sections of adjacent organs are removed. Today at the Cancer Center, the mortality rate for the Whipple procedure is just 1.5% compared to 14% nationwide. Moreover, the average time patients spend in the hospital is fewer than eight days, versus about three weeks nationally—and patients rarely require blood transfusions or intensive care.
Massachusetts General Hospital Cancer Center has long focused on the challenge of pancreatic cancer, leading the way in clinical care and research. In 1983, for example, the hospital established a pancreatic research laboratory to investigate the molecular basis of pancreatic adenocarcinoma—the most common form of pancreatic cancer, accounting for 95% of all cases.
Massachusetts General Hospital’s radiation oncologists were the first to use intraoperative radiation therapy (IORT) for unresectable tumors. Today, the hospital is one of only a few in the world, and the only one in New England, to offer electronbeam IORT, which published studies have shown can lead to significant improvements in survival.
Recently, the Cancer Center became the first and only hospital in the country to treat pancreatic cancer with proton-beam adiotherapy. In an ongoing clinical trial, resectable patients receive a one-week, preoperative course of proton-beam therapy instead of the standard six-week regimen following surgery. In contrast to photon radiation, protons offer superior dose distribution and no exit dose beyond the distal edge of the tumor, which avoids or limits radiation to normal tissues.
At the Cancer Center, proton-beam radiotherapy is currently delivered in conjunction with capecitabine, a drug that increases sensitivity of cancer cells to radiation. In future research, proton-beam radiotherapy will be combined with emerging experimental compounds designed to further heighten cancer cells’ radiosensitivity.
The Cancer Center also pioneered the use of CT, laparoscopy and peritoneal cytology to better define appropriate treatment pathways. Endoscopic ultrasound (EUS) has now been added to that repertoire of diagnostic and treatment planning options.
The most recent Medicare data on pancreatic surgery shows consistently lower mortality rates at centers performing a higher volume of pancreatic surgery procedures, such as the Massachusetts General Hospital Cancer Center.
Basic research advances understanding
Scientists at the Cancer Center are shedding new light on the causes of pancreatic cancer. Recent studies have confirmed that the disease can arise from precancerous tissues known as pancreatic intraepithelial neoplasias (PanINs). Mouse models have shown that PanIN formation in the pancreatic ductal epithelia can be triggered by mutations in the K-ras gene, a common oncogene. The growth of K-ras-induced PanINs can then be accelerated by inactivation of the tumor-suppressor gene, CDKN2A. These findings provide a model with which to study new diagnostic methods and therapies.
Novel imaging studies being conducted at the Cancer Center are focusing on specific gene variations that affect pancreatic tumor biology and the response to therapy. These efforts have begun to identify cell surface markers that reveal specific cancer subtypes, such as those induced by mutations in a gene called Smad4, that have a particularly poor prognosis. These studies may someday make it possible to diagnose pancreatic cancer noninvasively using tests that predict metastatic potential based on the tumor’s unique genetic features.
Related studies underway at the Cancer Center using cultured cell lines are investigating how gene variations affect drug response. This research could lead to the ability to tailor drug therapies to patients’ specific genetic signatures, resulting in more targeted, effective therapies.
Mouse models are also being developed to grow human tumor cells obtained from surgical resection. Compared to culturing cancer cells in vitro, this method allows tumor cells to grow in a mammalian system, where they interact with blood vessels and non-malignant cells. This novel pre-clinical mouse modeling of human disease is a unique system to test new drug targets. One such target under investigation is the developmental signaling pathway, Hedgehog. In prior research, Cancer Center scientists found that Hedgehog is inappropriately activated in the initiation and maintenance of pancreatic cancer. Upcoming experiments will evaluate what effect blocking Hedgehog will have on tumors.
A leader in GI endoscopy
Through its Advanced Endoscopy Service, the Cancer Center has become a national leader in the use of endoscopic ultrasound (EUS) for patients with pancreatic malignancies. More than a tool for high-resolution imaging, EUS can also be used to extract pancreatic cells for a variety of purposes, including diagnosis and treatment planning.
Recent studies have shown that compared to other endoscopic techniques for extracting tumor cells (namely endoscopic retrograde cholangiopancreatography, or ERCP), EUS provides higher-quality material at greater volumes. EUS can also be used to assess pancreatic cystic tumors that can be cured with surgery, but have the potential to progress to adenocarcinoma. Cancer Center GI endoscopists have pioneered the use of endoscopy to obtain cyst fluid for analysis, a procedure that aids in diagnosis and helps clinicians determine which patients require surgery.
Endoscopic tools are also being used to treat cystic tumors with ethanol, which can eradicate cells from cysts before they have the potential to become malignant. To advance this technique, mouse models of intraductal papillary mucinous neoplasms, which are common human cystic tumors, have been developed for ethanol-ablation research. These models will be used to reveal the mechanisms of the biological response to ethanol ablation, as well as events that underlie tumor recurrence after treatment.
The Massachusetts General Hospital Cancer Center offers a unique combination of multidisciplinary, state-of-the-art clinical care; cutting-edge basic and clinical research; and vitally important patient-support services to further improve outcomes for patients with pancreatic cancer. This, coupled with a realistic but positive approach to treatment, is making significant strides against a challenging disease.
Selected References
Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg 2007; 245(5); 777-783. Hollenbeck KB, et al. Volume-based referral for cancer surgery: Informing the debate. J Clin Oncol 2007; 25 (1): 91-96. Kozak KR, Kachnic LA, Adams J, Crowley EM, Alexander BM, Mamon HJ, Fernández-del-Castillo C, Ryan DP, et al. Dosimetric feasibility of hypofractionated proton radiotherapy for neoadjuvant pancreatic cancer treatment. Int J Radiat Oncol Biol Phys 2007 Jun 1 [Epub ahead of print]. Salvia R, Fernández-del-Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Warshaw AL. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Annal Surg 2004; 239:679-687. Kotwall CA, Maxwell JG, Brinker CC, Koch GG, Covington DL. National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients. Ann Surg Oncol. 2002 Nov; 9(9):826-7.
The Global Clinic 2008
Health Care Management for Physician Executives
Boston Fairmont Copley Plaza Hotel, June 26 - 28, 2008
Leaders from industry, government and academia will gather in Boston next June to discuss best practices in international corporate medical and occupational health programs at Partners International’s 2008 Global Clinic Conference. Led by faculty from Harvard Medical School, the conference will address strategies to improve workforce health and promote productivity while meeting new business challenges brought on by globalization.
Course highlights for Global Clinic 2008 include:
• Update in Infectious Disease and Public Health Risks
• Advances in Clinical Medicine and Leading Edge Science
• Corporate Case Studies in All-Hazards Management
• Strategies to Promote Workforce Health and Productivity
• Bomb and Blast Injury Management
• Metabolic Syndrome Prevalence and Impact in the Workplace
• Clinical Application of Genome Mapping
• Continuity of Care and Linking Delivery Systems
• Ambulatory Practice of the Future
• Impact of Workplace Clinics on Employee Health
To register or view additional course information online, please visit: www.cme.hms.harvard.edu/courses/theglobalclinic
The 2008 Partners delegation was led by Jay B. Pieper (standing), President of Partners International Medical Services and Vice President of Partners HealthCare. Seated at left is Samir Bouri, Regional Vice President, Middle East and Europe, WorldCare. |
James H. Thrall, MD, Professor of Radiology at Harvard Medical School and Radiologist-in-Chief at the Massachusetts General Hospital, delivered the keynote address for the Imaging and Diagnostics Congress. |
2008 Arab Health Exhibition and Congress
Partners International Medical Services was pleased to participate in the 2008 Arab Health Exhibition and Congress, which was held January 28 - 31 in Dubai. Drawing an annual audience of over 50,000 people from 65 countries, Arab Health is the largest medical trade show and conference in the Middle East. Partners International is a leading participant each year, providing speakers with expertise from a variety of medical specialties as well as health care administration.
Center for the Integration of Medicine and Innovative Technology
Partners-based CIMIT (Center for the Integration of Medicine and Innovative Technology), a consortium of Boston-area teaching hospitals and engineering schools, is pleased to announce the launch of its first international affiliate in Manchester, UK. Known as MIMIT (Manchester: Integrating Medicine and Innovative Technology), the new affiliate will foster interdisciplinary collaboration among researchers from the University of Manchester, Central Manchester and Manchester Children’s Hospitals NHS Trust, Salford Royal NHS Foundation Trusts, Christie Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, Manchester Mental Health and Social Care Trust, and Salford Primary Care Trust.
From left to right: Feng Feng, MD, Associate Professor and Vice Director of Radiology Research, Peking Union Medical College Hospital; Youwei Xian, Chairman, Qinghe Hospital; David M. Jones, Executive Director, Partners International Medical Services; Timothy E. Guiney, MD, Medical Advisor, Partners International Medical Services; Chao Luo, Vice President, Shenhua Group Beijing Guohua Electric Power Corporation; Geoffrey S. Young, MD, Radiologist, Brigham and Women’s Hospital; Weiwei Li, General Manager, Qinghe Hospital. |
Qinghe Hospital Co., Ltd. Delegation visits Partners HealthCare
A delegation from Qinghe Hospital Co., Ltd., a private company owned by China’s leading electrical utility, visited Partners HealthCare in March to explore possibilities for collaborating on a new 800-bed hospital which is scheduled to open in Beijing’s “University District” next year. Areas under discussion include: clinical program design, system development, management training and bi-lateral educational exchange, as well as a “Partners Premiere” affiliation, which would provide personal health guidance and 24/7 travel-related medical services to Chinese executives.
Executive Director |
Medical Editors Timothy Guiney, MD Gilbert H. Mudge, MD |
Executive Editor Elizabeth A. Nolan |
| Corporate Manager of International Business Development Edwin J. McCarthy |
Design Jackrabbit Design |
The Global Health Update is published by Partners International Medical Services, a division of Partners HealthCare System, Inc. Partners International develops opportunities for Partners staff to contribute to the improvement of health care around the world.
This publication provides medical news. It is not intended to provide medical advice, which should always be obtained directly from a physician. To subscribe, request additional copies or make comments, please contact us via email at partersinternational@partners.org or by phone at +1 (617) 724-6420.
©2008. Partners HealthCare System, Inc.