In this issue:

  Practi-Med programs in Japan and Dubai tackle full spectrum of health care issues

  Hygeia continues to lead at the cutting edge of care with implementation of PET/CT scan

  UAE neurologist is first to participate in Harvard-Dubai fellowship program

  HMI to collaborate with Hospital Management Italia on center of excellence for clinical nutrition

  Medical school in China looks to enhance research programs

  Leadership and curriculum design are focus of Singapore program

  HMI establishes operations in Dubai

The latest Specialty Practi-Med held in Dubai was attended by over 300 people.

Practi-Med programs in Japan and Dubai tackle full spectrum of health care issues
Practi-Med is in the news—again. This should come as no surprise to readers of HMI World who have been reading about this program since it was piloted in Brazil in 2000. Under the direction of Dr. Harvey Makadon, HMI vice president of health systems and director of international CME programs, Practi-Med has developed into one HMI’s most successful initiatives. HMI has recently held programs in Yokahama, Japan and Dubai, United Arab Emirates, and Practi-Med Dubai 2004, scheduled for December, will be the tenth time the course has been delivered.

“I am continually amazed at the energy and earnestness of our audiences. These physicians devour the medical literature that is available to them, and it’s gratifying to me to have the chance to discuss with them how to apply this knowledge to their practice,” said Makadon. “We have continued to receive positive reactions from health care professionals who are confronting a wide range of issues in primary care.”

A large part of Practi-Med’s success has been the depth of the faculty. Sixty faculty members have taken part, including 35 from Harvard Medical School. Dr. Beverly Woo, who practices internal medicine at Brigham & Women’s Hospital, served as course director for Practi-Med Dubai 2003 and Practi-Med Dubai 2004, and has spoken on issues such as obesity and disease prevention in Brazil, China, and the United Arab Emirates. She echoes many of the HMS faculty who have served as Practi-Med faculty when she says, “I look at each program as an opportunity to learn. Talking with health care providers in other countries and hearing about their top concerns enables me, after I return to Boston, to step back from my own practice and have a broader view of my own community.”

Dr. William Docken of Brigham and Women’s Hospital lectured on rheumatoid arthritis during a program focused on musculoskeletal health.

In September, more than 300 health care professionals gathered in Dubai for a Specialty Practi-Med program on musculoskeletal health and sports medicine. Dr. Charles H. Brown, Jr. of Brigham and Women’s Hospital led a multidisciplinary faculty that included six Gulf Region physicians.

Most recently, in October, the St. Luke’s Life Sciences Institute played host for the third annual Practi-Med program in Japan. Held in Yokahama and attended by over 300 physicians, the program addressed hypertension, HIV prevention, pregnancy, and osteoporosis. Makadon moderated a panel discussion on quality and evaluation. The night before the program began, Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine, gave a talk on publishing in the important medical publication.

Makadon and his cohorts hope to continue the success of Practi-Med in Dubai in December. This year, the three-day program will include a number of topics that have not previously been covered at Practi-Med, including emergency medicine, dermatology, headache diagnosis and treatment, and counseling patients with severe illnesses. The addition of these new topics isn’t accidental. “We work with the regional medical authorities to determine what topics are most relevant to the given audience—what do these health care providers need?” said Woo.

Practi-Med Dubai 2004 will also feature presentations on oncology, cardiology, health issues of mothers and children, infectious diseases, and common medical problems encountered in primary care practice like diabetes, stroke, depression, and irritable bowel syndrome. The program will be held December 5-7 in Dubai at the Jumeirah Beach Hotel. To learn more, visit the program website. HMI also makes sponsorship opportunities available to corporations and exhibitors that are interested in building relationships with practicing health care professionals. For more information, please email practi-med@hms.harvard.edu. Last year, more than 1,200 health care professionals and students from the Gulf Region gathered for Practi-Med Dubai 2003 to hear about advances in disease prevention, diagnosis, and treatment.

Hygeia continues to lead at the cutting edge of care with implementation of PET/CT scan
Hygeia Hospital in Athens, Greece continues to solidify its reputation for high-quality medical services. Truly ahead of the curve regionally in its use of cutting-edge technology, Hygeia is partnering with HMI to offer a series of conferences that introduce advances that are changing the way many diseases are diagnosed and treated. Earlier this year, Hygeia became the first hospital in Greece to implement gamma knife technology. Now the region’s leading private health care provider has introduced PET/CT scan technology. In October, Hygeia commemorated its latest step forward with a three-day conference on diagnostic imaging.

Dr. J. Anthony Parker, associate professor of radiology at Harvard Medical School and Beth Israel Deaconess Medical Center, delivered the main lecture on PET/CT scanning during the first day, and took part in a demonstration of Hygeia’s new PET/CT scan machine. Positron emission tomography (PET) and computerized tomography (CT) are standard imaging tools that allow clinicians to pinpoint the location of cancer within the body before making treatment recommendations. The highly sensitive PET scan picks up the metabolic signal of actively growing cancer cells in the body, and the CT scan provides a detailed picture of the internal anatomy that reveals the size and shape of abnormal cancerous growths. Alone, each test has its limitations but when the results of the scans are fused together they provide the most complete information on cancer location and metabolism. Unlike an x-ray or magnetic resonance imaging (MRI) that looks at the body’s structure and anatomy, the PET/CT scan looks at the body’s metabolic activity and yields important information about the body’s tissue. Because the PET/CT scan is able to discover changes in the body’s biochemical processes in their earliest stages, the technology is of significant value in detecting certain cancers, neurological conditions, and cardiac diseases.

“Hygeia Hospital sees the PET/CT scanner as the clinical tool to provide up-to-date imaging, especially for oncology patients,” said Parker.

The second day covered diagnostic imaging with respect to cardiology. Dr. Dennis V. Razis of Hygeia said, “The diagnosis of myocardial viability and coronary disease is achieved by non-invasive techniques using PET/CT, MRI, CT, echocardiograms, and SPECT.” On the final day of the conference, Parker and his Hygeia colleagues discussed research in molecular imaging that holds promise for further enhancing diagnostic capabilities.

UAE neurologist is first to participate in Harvard-Dubai fellowship program

Dr. Jacob Daniel

Dr. Jacob Daniel of Fujairah Hospital in the United Arab Emirates (UAE) has completed a month-long observership at Massachusetts General Hospital (MGH), the first physician to benefit from the establishment of the Harvard Medical School Dubai Center (HMSDC) postgraduate training program. The program, which was launched by Harvard Medical International and Dubai Healthcare City (DHCC) earlier this year, is designed to provide opportunities for physicians and scientists in the Gulf Region to advance their careers in medicine and biomedical research and as a resource for faculty development for the Dubai Healthcare City project. The program’s underlying objective is to identify and nurture leaders in academic medicine in order to expand the professional workforce and institutional resources of Dubai Healthcare City, and ultimately the region.

Daniel, a neurologist, worked in the Department of Neurology at MGH under the tutelage of Dr. Walter Koroshetz and Dr. Philip Kistler. His main objectives were to increase his knowledge of the advances in the management of stroke and in the applications of technology for the critical care of neurological patients. His observership included participating in daily morning rounds in the intensive care unit with members of the neurology care team, and attending weekly Grand Rounds, as well as stroke and critical care conferences. He also participated in a weekly “brain cutting” neuropathology conference.

“My aim is to improve the management of stroke at Fujairah Hospital, and possibly develop a dedicated stroke unit,” said Daniel, who since 1994 has been engaged as an internist and neurologist by the Ministry of Health in Fajairah, one of the seven autonomous sheikdoms (emirates) comprising the United Arab Emirates.

To learn more about postgraduate education opportunities offered by the Harvard Medical School Dubai Center, please visit the DHCC website and download the program brochure.

HMI to collaborate with Hospital Management Italia on center of excellence for clinical nutrition
Often overlooked in studies of the effectiveness of hospitals is the emphasis—or lack thereof—placed on nutrition. It is well known that nutrition plays a critical role in disease risk reduction and overall health promotion, an idea that continues to inspire interventions targeted at healthy as well as sick individuals. Yet in Italy a gap remains between management of nutritional information and implementation of healthy nutritional practice among care providers. HMI has teamed with Hospital Management Italia (HM Italia) to collaborate on the design of evidence-based guidelines and protocols in nutrition. These standardized tools will support nutritionists and physicians in Italian hospitals who are addressing pathologies in their effort to improve care delivery and hospital performance.

HM Italia partnered with HMI in 2003 with the goal of expanding upon its range of consultant services in administration, management, and clinical services and biomedical research. “This partnership and HMI’s involvement in the Italian health care sector comes at a time when the government of Italy is looking closely at ways to radically reform its health care system,” said Dr. Andrew Jeon, HMI executive vice president and chief operating officer.

Ing. Stefano Ali, chief executive officer of HM Italia, said that the project has begun in collaboration with INRAN (Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione). INRAN, a leading government-supported research organization led by its president Prof. Ferdinando Romano, carries out basic and applied research in the various areas of study in food science and human nutrition. For this project with HM Italia, Romano has assembled a team of senior scientists at IRNAN, including Prof. Amleto D’Amicis, Laura Rossi, and Doct. Phd Andrea Ghiselli.

“Currently, departments of clinical nutrition are not very common in Italian hospitals, and a centralized resource housing standardized protocols does not exist,” said Ali. “Our objective is to work with INRAN, with strategic advice from HMI, to establish an extranet that will link all of the hospitals in Italy and provide access to nutrition information.”

The Center of Excellence for Clinical Nutrition, which will be the first center of excellence to be developed in Italy, is a virtual center hosted in the southern Italy city of Catania, which has been sponsoring and supporting its development. Initially, HM Italia and INRAN will pilot the center’s IT platform with a small group of hospitals, and later expand access to all hospitals, targeting pharmaceutical companies as well. An expert team led by Prof. Alberto Savoldelli, project manager in several IT European Union Projects and Professor at the Business School of Politecnico di Milano, will implement the studies carried out by the INRAN scientists and the HMI / HMItalia advisors so that they will be available in an electronic format, in order for them to be adopted by physicians and nutritionists through a regular computer terminal in any part of Italy. Ali expects the nutrition protocols to be in place by August 2005, at which point a train-the-trainer program will be launched to create a cadre of professional experts that will lead other nutrition centers throughout Italy.

“The second phase of this project will focus on helping hospitals become better at using nutrition information to prevent disease and to really change practice in the Italian health care system,” said Ali.

Medical school in China looks to enhance research programs
In October, a faculty from HMI visited the campus of Xinjiang Medical University (XMU) for a series of workshops designed to help XMU develop models for research and medical education. The three-day program kicked off with the inauguration of XMU’s Cardiovascular Research Center (CRC).

HMI’s Dr. Tom Aretz, vice president of education, and Dr. Lynn Eckhert, director of academic programs, led a workshop on instituting a systems approach to research and medical education. Their discussions with XMU’s leadership covered research regulations, ethics, and infrastructure; the training of research technicians; and guidelines for conducting research on humans. They were joined by two members of the Harvard Medical School faculty whose experience in research settings provided a context for addressing XMU’s challenges as they further develop the CRC. Dr. Roger Hajjar, of the Cardiovascular Research Center at Massachusetts General Hospital (MGH), led discussions on general cardiovascular research and experimental transplantation. Dr. Steven Niemi, who directs the Center for Comparative Medicine at MGH, focused on developing successful animal research initiatives.

The HMI faculty and the leadership of XMU discussed how to continue and expand their collaboration in the area of research into cardiovascular disease and diabetes. “XMU has a unique opportunity to take advantage of the region’s multiple ethnic groups, which have different prevalences of Type 2 diabetes and hypertension. This special situation provides an excellent setting for research in population genetics and pharmacyogenetics,” said Aretz.

Going forward, XMU plans to explore the possibility of conducting gene therapy studies, as well as stem cell research. Hajjar has agreed to welcome scientists from XMU into his laboratory in Boston for further training. HMI and XMU are also looking ahead to 2005, when they plan to collaborate on a second workshop, this time focused on oncology research.

Leadership and curriculum design are focus of Singapore program

As part of its faculty development program, the National University of Singapore (NUS) Medical School invited Dr. Tom Aretz and Dr. Elizabeth Armstrong from HMI to conduct a medical education course for its medical teachers with four of its own faculty as co-facilitators. The course, held in Malaysia in October, brought together thirty educators from various disciplines, both clinical and non-clinical, and was designed to help NUS as it continues to introduce major curricular reforms.

The course focused on the curriculum development process, teaching and learning, assessment, educational management issues, and research in medical education. Aretz and Armstrong used case studies to create an interactive learning environment. A significant outcome from the program was the formulation of six organizational research projects that focus on curriculum reform initiatives. Professor Matthew Gwee of NUS said that the school is committed to implementing these projects and studying their impact within the next three months or so.

“The outcomes from these research projects can be expected to have important bearing on policy decisions and future directions for our medical school. Endowed with their newly acquired educational skills and with a ‘fire in the belly,’ many participants expressed a strong desire to be more actively engaged in the educational reform activities in our medical school,” said Gwee. “This reflects a positive behavioral change as a consequence of the new learning, and also provides clear testimony to the strong impact that Dr. Aretz and Dr. Armstrong have had on the course participants through their highly effective teaching style. It is our fervent hope that all participants will remain committed to further promoting and enhancing professionalism and excellence in medical education and also will continue to sustain their interests as a community of scholars in education actively engaged in the educational affairs of our medical school.”

The five-day program combined elements of the two annual programs offered by the Harvard Macy Institute, one of which focuses on leadership and creating change, the other designed to help health care professionals become better educators.

HMI establishes operations in Dubai

From left to right: Sarper H. Tanli, Arlene V. Asgard, Terry Motiuk, Richard Beadleston (seated), Andrew E. Barrer, and Anan Nathif.

In order to manage the growing complexity of the strategic collaboration between HMI and Dubai Healthcare City, HMI has built a team of industry veterans who will be based in Dubai and carry forward a number of initiatives. Richard Beadleston, MHA, as Chief of Operations, will head a seven-member team whose activities will cut across all aspects of the HMI-DHCC partnership, including the oversight of quality and licensing for DHCC tenants, continuing medical education, and clinical planning. This group will also form the core of the Center for Healthcare Planning and Quality (CPQ), the entity established by HMI and DHCC to provide health care systems development and medical education services to DHCC and the broader Gulf Region.

The other members of HMI’s landed Dubai team are:

• Arlene V. Asgard, RN, MSN, Director of Quality & Credentialing
• Andrew E. Barrer, PhD, Regional Director, HMI Gulf FZ, LLC
• Elizabeth Elwy, Manager, Postgraduate Medical Education Institute
• Terry Motiuk, DBA, CMA, CGA, Deputy Director of Operations
• Anan Nathif, Med, Manager, Continuing Medical Education
• Linda A. O’Connor, MA, Manager, Quality Improvement
• Sarper H. Tanli, MD, MHA, Director of Clinical Planning

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