Harvard Medical International Joins Partners HealthCare
Colocates with Partners International Medical Services

Partners International Medical Services (PIMS) is pleased to announce that our parent organization, Partners HealthCare, has reached an agreement with Harvard University to assume responsibility for the business operations and management of Harvard Medical International. The organization is now known as Partners Harvard Medical International (PHMI). As a subsidiary with close ties to Harvard Medical School, PHMI has played a significant role in the development of health care infrastructure and education in more than 30 countries since 1994.

A FORMIDABLE SYNERGY

"Partners is very pleased to have an opportunity to increase our involvement in the international health care arena by collaborating with a well-established organization that has an excellent reputation around the world," said Jay B. Pieper, MBA,Vice President, Partners HealthCare and President of Partners International Medical Services. "Uniting Harvard Medical School's reputation for medical education, PHMI's knowledge and experience in the global health care arena, and Partners extensive clinical resources creates a formidable synergy. This synergy will permit PHMI to take the international contributions and engagements of Partners faculty and institutions to a higher level."

In addition to developing greenfield schools to train health care professionals, and helping existing academic institutions to innovate and improve, PHMI also focuses on building sustainable models for clinical and operational excellence and designing strategies for workforce development in health care settings.

“We anticipate that in our new affiliation with Partners, we will be able to expand our mission to increase access to quality health care in countries across the world, while maintaining a vital academic partnership with Harvard Medical School and its affiliated institutions,” said Andrew A. Jeon, MD, MBA, President and CEO of PHMI.

PHMI now has the opportunity to build stronger relationships with key intellectual leaders within the Partners hospitals. These content experts in health care and education will add even greater depth to PHMI’s consulting teams, increasing PHMI’s capacity to develop and implement strategic programs.

“Working together and in parallel, PIMS and PHMI are well positioned to foster robust professional development and education opportunities in the Partners hospitals for visiting health care professionals, scientists, and leaders from abroad, while simultaneously increasing the number of opportunities for Partners faculty and clinicians to engage in activities overseas,” commented David M. Jones, Executive Director of PIMS.

As the leading integrated academic health care system in the US, each year Partners treats 1.5 million patients across the continuum of care and manages highly complex inter-hospital relationships. Through PIMS and PHMI, Partners HealthCare now has a greater opportunity to serve as a model for organizations around the world that are seeking to evolve into multi-faceted regional health care destinations supported by high-quality medical education, research and information technology.

COLOCATION WITH PARTNERS INTERNATIONAL MEDICAL SERVICES

As a component of the integration of PHMI into Partners HealthCare’s academic medical network, PHMI and PIMS have relocated their offices to a new shared space in Boston’s Back Bay.

The new address for both entities is:
131 Dartmouth Street, 5th Floor
Boston, Massachusetts 02116-5134
USA

Other contact details are as follows:

PIMS:
Telephone: +1 (617) 535-6550
Fax: +1 (617) 535-6551
Email: partnersinternational@partners.org
Website: www.partners.org/international

PHMI:
Telephone: +1 (617) 535-6400
Fax: +1 (617) 535-6410
Email: phmi@phmi.partners.org
Website: www.phmi.partners.org

Letter From the Executive Director

At Partners HealthCare, the air we breathe is always thick with medical innovation. Since 1934, fifteen Nobel laureates have trained or practiced at Partners-affiliated institutions. Every day, nearly 7,000 Partners physicians and scientists seek solutions to some of the world’s most complex clinical and scientific questions. We operate the largest hospital-based biomedical research enterprise in the United States, and the results we achieve are impressive: 400 new inventions per year are developed by Partners scholars, and a new US patent is issued to one of my colleagues approximately every 3 days.

While these specific medical milestones are always well documented and appropriately lauded, I think it’s fair to say that we are often less aware of our own institutional innovation per se. We tend to follow the scientific method, and focus on the measurable. Yet not every achievement lends itself to such clear calculus.

From an historical perspective, the recent addition of Harvard Medical International to Partners HealthCare could serve as the harbinger of a new era in the relationship between Harvard Medical School and its 18 affiliated hospitals and research institutions.

Since its founding in 1782 -- when medical education consisted merely of formal lectures for a semester or two, followed by an apprenticeship with a practicing physician -- Harvard Medical School has committed itself to educating future generations of physicians in the most advanced clinical methodologies known to humankind.

These days, a good deal of this work happens outside the hallowed halls of the school itself, as 10,000 faculty along with 7,600 resident physicians and postdoctoral fellows focus their attention on performing cutting edge translational research and providing advanced clinical care -- offsite at the School’s affiliated hospitals, divisions and research institutions.

Through Partners Harvard Medical International and Partners International Medical Services, the Medical School and all of its affiliated institutions may now draw upon a powerful multinational network of health professionals, policymakers and educators who all share a profound commitment to the advancement of global health. In an era of globalization and globalized medicine, our notions of “offsite” need some stretching. The knowledge exchange that could be leveraged within this emerging environment – which functions simultaneously as a global clinic, a supranational classroom, and a lab-without-walls -- offers unprecedented opportunity for current and future generations of faculty, medical students and patients alike.

Having just opened its doors in July 2008, the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital (BWH) is one of the most advanced cardiovascular care facilities in the world. Equipped with the latest, most advanced technology used in heart and vascular care, the Center is ushering in a whole new era for cardiovascular care and research.

With such superior technology, physicians, specialists, and nurses readily collaborate to implement innovative treatments. Among the advanced diagnostic technologies are:

• A computed tomography (CT) system that can take an image of the heart within one heartbeat, providing a more detailed image of the heart than ever before. The 320-slice CT system is one of only two available in the US.
  
  
• A scanner that combines imaging with data that enables physicians to better assess the degree of atherosclerosis in a patient. The hybrid 64-detector PET/CT scanner was one of the first available in the US.
  
  
• Imaging technology that enables physicians to scan the entire body in only a few seconds. The dual-source 64-slice CT uses two X-ray tubes and two detectors rotating around the patient three times a second reducing radiation exposure by half and enabling physicians to make faster, more precise decisions.
  
  
• A state-of-the-art scanner that allows physicians to see finer details and a better view of arteries, abnormalities and scarring. The 3 Tesla Magnetic Resonance Imaging (MRI) scanner is the premier cardiovascular MRI unit in the world.
  
  
• Imaging technology that is eight times faster than the traditional single proton emission computed tomography (SPECT) and enables patients to remain in an upright and more comfortable position. The new SPECT/CT imaging system provides faster results and added comfort for patients.

In addition to this state of the art diagnostic capability, the Center’s operating rooms integrate new technologies, enabling cardiovascular experts to pursue innovation in minimally invasive and non-invasive treatments. The Shapiro Cardiovascular Center houses 16 new state-of-the-art operating rooms – each able to accommodate next-generation, minimally invasive technology, including robotic surgery, image-guided and other advanced technologies. The new suites increase the total number of BWH operating rooms to 44 – along with a new and expanded recovery area.

The new ORs enable BWH to perform advanced hybrid therapies – combinations of catheter-based, conventional, and less invasive surgical procedures – and streamline care for patients who need multiple procedures as part of their treatment. Two hybrid operating rooms, which will open in the fall, also allow certain patients to have a same-day, one-stop process, such as a cardiac catheterization to check coronary arteries before planned valve surgeries or for performing a hybrid stent procedure and valve surgery.

The Center also advances treatment and discovery in the clinical and research fronts in the fight against heart disease. The Shapiro Center facilitates real integration among related disciplines and revolutionizes the way cardiovascular care is delivered. As all cardiovascular services are co-located in the Center, staff consult with a team of specialists, all under one roof, and collaborate to inform and improve patient care and recommend changes and enhancements to clinical practice. They bring what they learn from patients back into the research labs; then, through discovery and innovation, they will translate that research back to the patient, improving the clinical and surgical care of cardiac patients and changing the way patients with heart disease are cared for.

The Shapiro Center will be the first “green” hospital facility in New England; the construction of the 136-bed facility focuses on energy conservation and the use of earth-friendly construction materials. The building features large windows that allow more natural light; a roof painted white to deflect heat; rubber flooring, not vinyl, so there is no need to strip wax with toxic solvents; and a ventilation system designed to reduce the build up of latex allergens in ceiling spaces, among other environmental advances.

The Bermuda Hospitals Board has named Lawrence N. Shulman, MD, as clinical advisor for oncology. Dr. Shulman, who is chief medical officer and senior vice president of medical affairs of the Dana-Farber Cancer Institute, will be responsible for guiding the design and implementation of a new, multi-disciplinary model of cancer care in Bermuda.

Dr. Shulman’s appointment builds on a growing partnership between Partners International and the Bermuda Hospitals Board to improve the delivery of local care and to offer Bermudians the most advanced and innovative medical treatment overseas.

Visiting specialists from Dana-Farber, Brigham and Women’s Hospital and Massachusetts General Hospital will work collaboratively with their Bermudian hospital colleagues to develop state-of-the-art cancer treatment plans that will streamline and personalize the care provided on the island.

Dr. Shulman, who is an associate professor of medicine at Harvard Medical School, also is the director of Network Development for the Dana-Farber/Brigham and Women’s Cancer Center, where he has led the initiative to establish the first satellite oncology centers in the greater Boston area. He also has overseen clinical affiliations between Dana-Farber and health care facilities in six countries.

Contributors:
Douglas M. Dahl, MD; Donald S. Kaufman, MD; W. Scott McDougal, MD; Matthew R. Smith, MD, PhD; Anthony L. Zietman, MD

Key Points

• The five-year relative survival rate for all stages of prostate cancer combined has increased from 69% to nearly 100% over the past 25 years.
• With patients living longer, it has become increasingly important to define and prevent or mitigate long-term adverse effects of treatment.
• Investigations being conducted by Cancer Center researchers will help oncologists determine which patients would benefit from hormone therapy, and prevent unintended adverse effects.
• There have been no controlled studies showing that proton beam therapy is superior to high-dose, intensity-modulated radiation therapy or brachytherapy.
• Active surveillance is a reasonable alternative for appropriately selected patients.
• It is estimated that only 25% men who choose active surveillance ultimately undergo treatment.

A generation ago, approximately half of prostate cancer patients were diagnosed at a late stage, when treatment is often non curative. By contrast, in 2007, 90% of the estimated 219,000 prostate cancer patients in the United States were diagnosed with local or regional disease. Perhaps not surprisingly, the five-year relative survival rate for all stages of prostate cancer combined has increased significantly over the past 25 years — from 69% to nearly 100%.

This success is due, in large measure, to the earlier detection of the disease made possible by the widespread use of the prostate specific antigen (PSA) test. Advances in treatment, including intensity-modulated radiation therapy (IMRT), brachytherapy and androgen-deprivation therapy, have also played an important role. In addition, better surgical techniques have markedly reduced complications, including impotence and incontinence, while minimally invasive surgical procedures have reduced pain and recovery times, with no compromise in results.

Along with these positive changes come many new challenges, however. With patients now living longer, for example, it has become increasingly important to define long-term adverse effects of treatment and to identify strategies aimed at preventing or mitigating them.

Additionally, with more treatment options, it is now essential to compare new approaches, such as proton beam therapy (PBT), with standards of care in randomized trials. And with the increased early detection of prostate cancer, often a slow-growing disease that will never manifest clinically, it is critical to determine which patients should be closely monitored versus those needing more aggressive treatment.

Leadership Role in Survivorship
The Massachusetts General Hospital Cancer Center is ideally suited to address these challenges. One area in which the Cancer Center plays a national leadership role is prostate cancer survivorship.

It has long been recognized that hot flashes, fatigue and sexual dysfunction were side effects of androgen deprivation therapy, which is now used by one-third of the two million men with prostate cancer in the United States, either as part of primary treatment or as salvage therapy.

Cancer Center investigators published one of the first prospective clinical studies establishing that hormone therapy has other adverse physiologic effects, including osteoporosis and fractures, obesity, sarcopenia and metabolic changes. In a subsequent landmark paper, Cancer Center investigators demonstrated that hormone therapy is associated with a greater risk of diabetes and cardiovascular disease—both leading causes of mortality and morbidity in older men.

Currently, Cancer Center investigators are leading two large international clinical trials. One is focused on preventing fractures in men receiving hormone therapy. Another, being conducted in collaboration with the Mass General Diabetes Unit, will look at the effectiveness of intensive lifestyle intervention in the prevention of diabetes and reduction in cardiovascular risk. Cancer Center investigators also lead international studies to prevent bone metastases, which are one of the most serious consequences of prostate cancer among high-risk patients.

These and other investigations being conducted by Cancer Center researchers will improve clinical practice by helping oncologists determine which patients would benefit from hormone therapy, and to prevent unintended adverse effects among men who require it.

Proton Beam Studies Planned
Approximately one-third of prostate cancer patients undergo radiation therapy, either as primary therapy or an adjunct to surgical treatment. At the Cancer Center, roughly 400 prostate cancer patients a year are treated with radiation therapy.

Although the Cancer Center has a comprehensive proton beam therapy (PBT) center (the only one in the Northeast), the majority of patients receive IMRT or brachytherapy, since these have been shown in multiple clinical trials to be very effective therapies.

Despite an increase in proton beam centers across the nation, many of which are being heavily promoted to prostate cancer patients, there have been no controlled studies showing that PBT is superior to high-dose IMRT or brachytherapy in terms of either increased survival or reduced side effects.

The Cancer Center is conducting a detailed quality of life study involving patients undergoing PBT for prostate cancer, and plans to conduct a randomized trial that will compare side effects for patients undergoing IMRT and PBT. Until these studies are done, however, it is premature to advise that patients undergo this costly procedure.

Active Surveillance: A Reasonable Alternative
It is well-established that, in the PSA-era, many men diagnosed with prostate cancer, especially older men and/or those with comorbid conditions, will not die from their cancer.

Considering the major short- and long-term side effects of treatment, Cancer Center oncologists believe it is important and ethically responsible to offer active surveillance as a reasonable alternative to appropriately selected patients.

Based on evidence from studies conducted in the United Kingdom, Scandinavia, Canada and the United States (including Mass General), the Cancer Center team assumes that not all men with prostate cancer will require treatment and that the “test of time” is a useful tool to identify those who do. In fact, it is estimated that only one in four men who choose active surveillance will ultimately undergo treatment. It is important to note that active surveillance is not synonymous with a passive “wait and see” approach; rather, it involves a rectal exam and PSA test every three to six months and re-biopsies, as necessary.

While no one would suggest that the increased longevity for prostate cancer patients is anything but a positive development, managing prostate cancer is considerably more complex than it was even 20 years ago. Today, it requires a multidisciplinary team approach, an understanding of each patient’s unique situation and preexisting health conditions, and up-to-date knowledge of the issues that affect clinical decision-making.

Minimally Invasive Treatment
Today, many prostate cancer patients treated at the Massachusetts General Hospital Cancer Center who require surgery undergo laparoscopic prostatectomy which, among other advantages, significantly reduces recovery time.

Since the creation of its Laparoscopic Urology Program in 2001, the Massachusetts General Hospital Cancer Center has become a leader in the minimally invasive treatment of prostate cancer and other urologic malignancies. Today, the Cancer Center’s highly experienced surgeons perform up to 300 laparoscopic prostatectomies a year and train colleagues from around the world in this technique.

To view a webcast of a laparoscopic radical prostatectomy performed at MassGeneral, visit: massgeneral.org/webcast.

New Technique Improves Detection of Metastases
Nanoparticle-enhanced MRI, an innovation developed by a multidisciplinary team at Mass General, is now undergoing FDA evaluation for clinical use.

This new imaging tool more accurately detects lymph node metastases that are too small to be seen with conventional methods. This technique has increased the sensitivity of MRI screening of prostate cancer lymph node metastases from 45% to nearly 100%.

Mongan Named Most Powerful Physician

James J. Mongan, MD, President and CEO of Partners HealthCare, has been named the Most Powerful Physician Executive in health care by Modern Physician, a national health care newsweekly based in the US. Dr. Mongan was cited for his work in helping to improve the US Health Care system and expand coverage for the uninsured.

Yat-sen University Scholars Visit MGH

A group of 30 Chinese leaders - including hospital executives, government officials and MBA candidates affiliated with Yat-sen University – met with MGH President Peter Slavin, MD (front row, center left) and PIMS Executive Director David Jones (front row, center right) on May 27th. The group visited MGH as part of a multinational tour of health care systems in North America and Europe.

Charles Lee Receives Korean “Nobel Prize”

Charles Lee, PhD, a clinical cytogeneticist and an assistant professor at Brigham and Women’s Hospital (BWH) and Harvard Medical School, was awarded the 2008 Ho-Am Prize in Medicine on June 3 in Seoul. At 38, Lee was the youngest recipient of the award, which is considered the Korean equivalent of the Nobel Prize. Lee’s 2004 discovery of widespread structural genomic variation in humans has revolutionized human genetics. Because of his work, scientists have already associated some of these genetic variations with increased susceptibility to AIDS, autoimmune diseases and cancer.

American Nurses Association Bestows Highest Honor Upon MGH

The American Nurses Credentialing Center (ANCC) has formally re-designated MGH as a “Magnet” hospital through 2012. Magnet designation represents the highest available honor for nursing excellence. Fewer than 5 percent of the hospitals in the US are Magnet designated, and the renewed honor for MGH acknowledges the hospital’s continued high-quality patient care and innovations in professional nursing practice.

Jack Szostak Receives Heineken Prize For Biochemistry

Jack Szostak, PhD, an investigator at the Howard Hughes Medical Institute at Massachusetts General Hospital (MGH), has been awarded the 2008 Dr. HP Heineken Prize for biochemistry and biophysics. Presented by The Royal Netherlands Academy of Arts and Sciences, this award recognizes Szostak for “his highly original insights into the fundamental processes of life.” Szostak is known as one of the forefathers of today’s genetic research with ‘knockout mice’, genetically engineered mice in which one or more genes have been turned off.

SRM Delegation Visits MGH

As part of a 5-year partnership between PIMS and SRM University in Chennai, India, a delegation from SRM visited Boston to discuss clinical program development in cardiology. From left to right: David Jones, Executive Director, PIMS; Arvind Agnihotri, MD, MGH Cardiologist; Vinod Kochupallai, MD, Medical Director, SRM; A. Sirivasan, MD, Dean, SRM Medical School; Vinay Singhal, Market Advisor, PIMS; and Susie Driscoll, India Market Manager, PIMS.

Kazakh Observers at BWH

Having completed a 4-week training course in state-of-the art medical simulation techniques at Brigham and Women’s Hospital in Boston, Kazakh Trauma Surgeon Vladimir Kachalov, MD (far left) used his new skills to teach local paramedics Paul Farmer and Pamela Holmes. Dr. Kachalov returned to Kazakhstan on May 23rd to accept a position as a physician-instructor at the Clinical Educational Center.

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) 535-6550.

©2008. Partners HealthCare System, Inc.