Title Medical Workshop (Day1)
Chair S Shimizu (Kyushu University/JP)
Ho-Seong Han (Seoul National University Bundang Hospital, Korea)
Objective Our goal is to establish a medical network with high-quality moving image on a broadband Internet in all Asia-Pacific regions. In order to expand our WG, it is essential for both medical and engineering people to get together on site and discuss our next strategy. At the same time, we will demonstrate our new and developing systems to our members.
Target Audience Medical doctors/Co-medicals /Engineers/Researchers
Expected No. of Participants 50
Session Chair & Speakers

Medical WG day-1: 2007.1.24 (Wed): version 2.0

9:00-10:30 (Local time) Session 1: Activity report
Chairperson: S Shimizu (Kyushu University/JP)
1. Asia-Pacific Gastric Cancer Conference

Lim Sew Hoo,
Senior Manager, Center for Instructional Technology NUS. http://www.cit.nus.edu.sg/.
Provide technical support for the deployment of webcast and video conferencing services.

The aim of this presentation is to share the lesson learned in providing technical support to facilitate the following activities during the 1st Asia-Pacific Gastric Cancer Conference organized by NUS.

  • 4 parties DVTS linkup -- Korea, Japan, Taiwan and Singapore (conference venue and operating theatre) with live demonstration of Laparoscopic Gastrectomy from Korea.
  • Transmission of Endoscopic Submucosal Dissection and Endoscopic Ultrasound images from hospital operation theatre to conference site using IP linkup.
  • OT and scope images can also be transmitted through the DVTS linkup to Japan.
2. Links between RCH, Melbourne and NHP, Hanoi (remote presentation)

Garry L Warne garry.warne@rch.org.au,
Director, Royal Childrenfs Hospital International, Royal Childrenfs Hospital, Melbourne, Victoria Australia.

Speaker Biography: Professor Garry Warne is Director of Royal Childrenfs Hospital International, a department established by the Royal Childrenfs Hospital Melbourne in 1998, and Senior Endocrinologist. He graduated from the Faculty of Medicine, University of Melbourne in 1968. He was awarded the gFor The Peoplefs Healthh medal by the Vietnamese Ministry of Health in 2005 and the Royal Childrenfs Hospital Gold Medal in 2006.

RCHM and NHP Hanoi have enjoyed a close cooperation since 1995. The main activities have been in education and training, research capacity building, and two consultancies related to an extensive hospital redevelopment project and a new master plan of staff training. Train the trainer programs have been conducted for medical, nursing and infection control staff. In addition there have been numerous staff visits of both long and short duration in both directions. Annual Conferences sponsored by RCHI have been held at NHP for about the last 8 years, attracting audiences of 300+. Following the installation of a dedicated cable to NHP in preparation for the launch of VINAREN last year, we conducted a live videoconference between Melbourne and Hanoi as a demonstration for the launch. We then used the link for weekly videoconferences between members of the project team responsible for writing the master plan of staff training. Nursing project teams from both centres held videoconferences to plan for the commencement of a 6-month nurse training course. In preparation for the first paediatric bone marrow transplant in Vietnam, oncology and infection control staff from both centres held a videoconference to check arrangements for the transplant before the Melbourne team left for Hanoi. At the Annual Scientific Conference in November, a live interview between an Adolescent Health specialist in Hanoi and a Vietnamese teenager and his mother in Melbourne, was used as a demonstration before an audience of over 300 paediatricians from Vietnam, Laos and Cambodia.
Key Words: Child health, medical education, project planning, scientific conference
3. Asia BB project  


Kenji Kawai
engineer in NTT Communications Corporation, Japan.

Speaker Biography: Kenji Kawai took part in designing, construction, and operation of the network for a project called "The Advanced Information Technology Collaboration Experiments for Creating International Info-Communication Hub", which was carried out by the Ministry of Public Management, Home Affairs, Posts and Telecommunications in Japan. He participated in thie project mainly in 2003 which was the first year of this project. Since 2004, he has been involved in operation of JGN2, which is mainly a layer-2 testbed network originated in Japan and extended to Thailand, Singapore, and USA, and is run by the National Institute of Information and Communications Technology in Japan. He is in charge of managing JGN2 Network Operations Center.

We, NTT Communications, have been carrying out the joint telemedicine experiment between Kyushu University in Japan and Chulalongkorn University in Thailand, starting from the year of 2006.
This experiment aims at the implementation and spread of the international telemedicine technology for the broadband telecommunication era, and its main themes are the tele-mentoring for endoscopic surgery, and remote diagnosis.
In the tele-mentoring project, the goal is the international contribution by spreading the advanced medical diagnostic technology in the Asian region, and we are working to realize training to acquire skills by establishing the medical teleinstruction environment based on the latest video transmitting technology.
It is obvious that remote diagnosis requires high-resolution and real-time images, and consequently, very wide network bandwidth. However, the cost and quality of network are in a trade-off relation, therefore, there should be a guideline to determine the quality of the image that fits the level of diagnosis, and we are working to contribute to realizing future remote diagnosis.by defining the relationship between the image qualities and types of diagnosis with the parameters of encoding method and bandwidth of real-time remote diagnosis.
4. Telesurgery Study Group in Asia (HS Han/KR)
5. Australian telemedicine project

Colin Carati,
School of Medicine, Faculty of health Sciences,
Flinders University, South Australia Speaker Biography: Assoc Prof Colin Carati is Associate Dean (Support Services) in the School of Medicine, Flinders University, and is involved in with the Universityfs Advanced Computing and Networking initiatives, including TeleHealth. He is the Australian representative for APANfs Medical Working Group.

There has been a significant amount of activity in eTeleHealthf between Australia and its Asia Pacific neighbours in 2006, as detailed in this session. This led to the suggestion amongst the Australian collaborators that an Australian Network for TeleHealth should be established to facilitate the use of advanced IT networks for research, education and delivery of Medicine and Health related activities within and beyond Australia. This network has no formal structure or funding as yet, but it already has contributors from most regions of Australia, and aims to serve as an eexchangef for connecting people and projects through the use of high and medium bandwidth networks. Key members of the network and their activities will be outlined in this presentation.
6. AQUA (Nakashima/ JP)

Naoki Nakashima, MD PhD
Department of Medical Informatics
Kyushu University Hospital, Fukuoka, Japan

We have conducted many teleconferences and events in this Asia-Pacific broad-banded telemedical network since February 2003. A lot of medical staffs in varieties of fields and engineering researchers have united their strength to develop the network. APAN-medical WG was formally approved in APAN-Taipei in August 2005. AQUA is a management center of APAN-medical WG. Main contents have been cutting-edge surgical techniques especially focusing on endoscopic surgery. Finally, we could enjoy the perfected series of telesurgery in the meeting of Endoscope & Laparoscope Surgeons of Asia (ELSA) in Seoul in October 2006. Besides continuing telesurgical contents, we have decided to employ the other medical contents in the network, like as emergent infectious diseases, healthcare/life style diseases, and medical ethical problem in transplantation, so on. In this APAN-Manila, we will focus on the problems and possible strategies about the bird influenza in the Asia-Pacific area and the world. We expect this network contributes to (1) standardize medical process and techniques in the Asia-Pacific area, (2) make a collaboration community gathering medical and engineering researchers, and (3) promote cultural and personal exchange among the Asia-Pacific area.

7. New members; Introduction of institution and its activity
Mie University (Sakurai/JP)

Shinobu SAKURAI, R.N., P.H.N., M.N.
Professor Dep. Community Nursing, Mie University, Faculty of medicine, School of Nursing,
Professor, Mie University's Center for International Education and Research (CIER)

I am very glad that it can participate in medical group this time in APAN Manila. Mie University is continuing activity from the beginning time of APAN started. Mie are located at the center in Japan, the other hands, it is going across prefectural geographical feature north from south. By the geographical character, especially the southern part of Mie has very many remote districts and depopulated areas, and is the area where the dissatisfaction of the residents to serious shortage of medical resources and services. We try to investigate and deal with this situation, however we can not find out better way for community. I want to consider support of health service to the community using the Internet etc. of a remote area from now on.
As you know, Japan is an earthquake-prone country, it is said that the probability of Mie for the earthquake of a bigger scale than the Great Hanshin Earthquake to happen over 20 years is very high. Therefore, we try to report our university activity on disaster mitigation and organizing comprehensive science research department which we are performing beyond faculties as international center of Mie University.

Sangra (Hina/India)
8. Homepage update (Torata)
9. Next APAN in Xian
-Endoscopic activity from Kyoto (Tanaka/JP)
-Nursing project (Sakurai, Kita)
10:30-11:00 Coffee break  
11:00-12:30 Session 2: ELSA review
Chairperson: SG Kim (ANF/KR)
-Meeting overview (HS Han/KR)
-Network overview (SG Kim/KR)
-Report from each station
-Lotte venue (Tora, Anbai, Yamauchi, -Hattori/JP)
-Bundang (JungHun Lee/KR): remote
-Taichung (Kochi /TW)
-Kyushu U (Kuwahara/JP)
-Tsinghua U (Bao/CN)
-Hong Kong(Patrick,Edmond/HK): remote
-Iwate (Kyoritu/JP)
-Flinders (Colin/AU)
12:30-14:00 Lunch  
14:00-17:30 Teleconference of bird influenza
Chairpersons: Naoki Nakashima (Kyushu U, JP)
Pisuth Paiboonrat (Hydro and Agro Informatics Institute, TH)
Moderators and discussants at each station
14:30-15:30: Presentations and discussion-1
14:30-14:40: Bird Flu research in China (local presentation) Speaker: Junacai Ma (Inst of Microbiology, Chinese Academy of Science)
14:40-14:50: Bird Flu research in Malaysia (local presentation)Speaker: Suhaimi Napis (UPM, Malaysia)
14:50-15:00: Ontology of Bird Flu (local presentation) Speaker: Asanee Krawtrakul (Kasetsart University, Thailand)
15:00-15:10: One from MAFFIN, Japan (local presentation)
15:10-15:10: Effects of episodic variations in web-based avian influenza education: Influence of fear appeal and humor on self-efficacy, comprehension, retention, and behavior change Speaker: Youngsung Lee and Paul Kim (Stanford U) (by DVTS)
1) Youngsung Lee
Youngsung Lee, a graduate of Seoul National University with a M.D. has focused his Ph.D. studies on medical policy and administration. His research interests include associating medical information and IT together; currently, he is closely working with SUMMIT (Stanford University Medical Media and Information Technologies) collaborating the education contents of the U.S. and the medical information of Korea utilizing the internet2 infrastructure. His research interests expand to educating the public with health information using easy comprehensible animations. He has focused on developing contents of AIDS, hand washing, avian flu and additionally promoted bio-microscopic photography exhibitions on amusing pictures from medical and science fields to enhance publicfs interest of medical contents.  He has been the director of the Korean Academy of Medical Sciences and is currently the director of MedRIC (Medical Research Information Center) and a board member of the Korean Society of Medical Informatics.

2) Paul Kim4




As the Chief Technology Officer for Stanford University School of Education, he is responsible to provide leadership in all aspects of academic and innovative technology.  He received his Ph.D. in Educational Technology from University of Southern California and has been collaborating with educational research and development institutes such as U.S. Satellite Laboratories, Medical Research & Information Center, and Korea Educational Research and Information Service.  He has served as Vice President for Vatterott College, MO and Chairman of the Board for Intercultural Institute of California. He has taught EDUC392 - Enterprising Higher Education in the Digital Age, EDUC391- Web-Based Technologies for Learning, EDUC480 & 490 Directed Studies with topics such as Private Post-Secondary Education, Digital Portfolios, and Concept-Map-based Assessment. His recent publication topics include gPerspectives on a Visual-map-based Electronic Portfolio System,h gEffects of 3D Virtual Reality of Plate Tectonics on Fifth Grade Studentsf Achievement and Attitude Toward Science.  His recent presentations include "Assessment through Digital Portfolios", EDUCAUSE, October, 2005, "Development of Large-Scale Stereo 3D Image DB Network for Medical Education Using KOREN", Korean Association for Educational Information & Media, September, 2005. "Enterprising Higher Education with ICT", APEC (Asia Pacific Economic Cooperation) Education Forum, September, 2005.
Abstract:In order to provide empirical evidence on the role of episodic variations in a web-based avian influenza education programs for mass education and ultimately help young children to learn and develop healthy behaviors against AI and all types of influenza, web-based AI education programs with episodic variations (i.e., fear and humor) have been developed and examined with 183 5th grade elementary students. A quasi-experimental design was employed to find potential differential effects on context-specific self-efficacy (i.e., AI literacy and preventive measures against AI), comprehension, retention, and behavior. The study results support that the fear appealed AI web-based education program was more effective than the humor based program in positively influencing self-efficacy and educating the students about avian influenza. However, neither program lead students to a significant retention or self-reported behavior change.
16:00-17:30: Presentations and discussion-2
16:00-16:10: Mahomed Patel (ANU) (by DVTS)

Dr Mahomed Patel
MBBCh (South Africa), FRACP, FAFPHM
Current Position: Senior Lecturer
Contact Details: (Building 62, ANU map)
National Centre for Epidemiology and Population Health
The Australian National University
Canberra, ACT, 0200 Australia

T: +61 2 6125 5619
F: +61 2 6125 0740
E: Mahomed.Patel@anu.edu.au

Our centre has a particular interest in capacity building at the national and regional levels to strengthen the surveillance and control
of communicable diseases. In the context of this meeting, our focus has been on preparedness for pandemic influenza. Reference will be made to two simulation exercises, and to our research on strengthening preparedness among general practitioners. (1) Exercise Cumpston, held in October 2006, was Australia's largest ever health simulation exercise, and tested Australia's readiness to address a potential pandemic outbreak. The exercise was monitored by international health experts, most of whom were from Asian countries. (2) The APEC Pandemic Response Exercise 2006, held on 7-8 June 2006, was a desk-top simulation exercise led and funded by Australia, with Singapore co-facilitating. This Exercise tested regional responses and communication networks, and included a recommendation to establish regional communication networks and a regional communication plan to deal with an influenza pandemic or other major disasters. (3) International experience (e.g. with SARS and influenza) shows general practice planning for pandemics lags behind public health planning. Our research findings will be relevant for primary health care preparedness in many other countries.
Selected Recent Publications
Patel M. A century of meningococcal disease: development and the changing ecology of an accidental pathogen. Med J Aust 2006 (in press).
Tiong A, Patel M, Gardiner J, et al. Health issues in newly arrived African refugees attending general practice clinics in Melbourne. Med J Aust 2006 (in press).
Condon R, Patel MS. Response of the Western Pacific Regional Office. In: SARS. How a global epidemic was stopped. Western Pacific Regional Office. p56-66. WHO 2006.
Patel M, Lee C. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. The Cochrane Library. Chichester , UK : John Wiley & Sons, Ltd, 2004.
Greig JE, Patel MS, Clements MC, Taylor NK. Control strategies for Q fever based on results of Q fever pre-vaccination screening in Victoria, 1988 to 2001. Australia and New Zealand Journal of Public Health 2005;29:53-57
Samaan G, Patel MS, Olowokure B, Roces C, Oshitani H. Rumor Surveillance and Avian Influenza H5N1. Emerging Infectious Disease 2005;11:463-465
Samaan G, Patel M, Spencer J, Roberts L. Border screening for SARS in Australia : what has been learnt? Med JAust 2004;180(5):220-223.

16:10-16:20: Clinical manifestations and laboratory findings of eleven patients with Avian Influenza A/H5N1 pneumonia in National Hospital of Peadiatrics- Vietnam Speaker: Nguyen Thanh Liem (National Hosp of Pediatrics(VN)) (by DVTS)
Text Box:


Nguyen Thanh Liem ,M.D.,Ph.D.(nipliem@hotmail.com), Luong Thi San M.D., Ngo Thi Thi Ph.D, Le Phuc Phat Ph.D
National Hosp of Pediatrics, Hanoi, Vietnam

Nguyen Thanh Liem is a Professor of Pediatric surgery. He has been the Director of National Hospital of Peadiatrics since 1998. He is also the Chairman of Vietnamese Pediatric Surgery Association. Currently, Prof Nguyen Thanh Liem is a team leader of researching Avian Influenza A/H5N1 in Vietnam in oder to get the better of management and prevention.

Abstract: Human infection with Avian Influenza A/H5N1 virus was reported in Hong Kong in 1997. Recently, there are some outbreaks of Avian Influenza A/H5N1 in poultry throughout Asia. In Vietnam, the first human infection with H5N1 was found in January 2004. We describe the clinical presentation and some epidemiologic findings among 11 patients with H5N1 admitted the National Hospital of Peadiatrics. Finding: Patients ranged from 1 to 12 years of age ( mean 6,7 years). It often occurred in winter and spring from December to April. Seven of them had a clear contact history with poultry. There was one family that mother and daughter died due to Avian Influenza A/H5N1. Patients often presented with fever, respiratory failure and significant leucopenia (82%; 100% and 82% respectively). The lessions in CXR were often bilateral diffused infiltrates and air bronchograms. Raised liver enzymes, renal failure and thrombocytopenia were the factors associated with severe disease. Eight patients died and three patients recovered. Conclusion: Avian Influenza A/H5N1 infection characterized by fever, respiratory symtoms, leucopenia and rapid progression in CXR. It is highly mortality in children. There was no clear evidence of human to human transmission.
16:20-16:30: Tetsu Yamashiro (Nagasaki U) (by DVTS)
16:30-16:40: Jiang GU (Peking U) (by DVTS)
16:40-16:50: 2004 to 2006 Bird flu situation in Thailand Speaker: Yong Poovorawan MD (Chulalongkorn U) (by DVTS)
Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Presenter: Yong Poovorawan MD  
Head, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Abstract: The 2004-2006 outbreaks of highly pathogenic avian influenza (HPAI) subtype H5N1 virus in Thailand as the cause of a major epidemic with potentially vast repercussions on economics, public health and society at large. Not only has this avian influenza virus infected poultry but also proven highly pathogenic and fatal to mammalian species including humans felines and canine. In 4 periods of the outbreaks in Thailand H5N1 influenza virus can cause 17 from 25 human deaths. A case of H5N1 human infected, virus could be isolated from human plasma on day 10 after symptoms developed. Raising the concern of the necessity to carefully handle and transport serum or plasma samples suspected to be infected with H5N1 avian influenza. Because viable virus has been detected in blood samples, handling, transportation, and testing of blood samples should be performed in a biosafety containment laboratory to prevent the spread of the virus to healthcare and laboratory workers. In feline and canine, transmission to these species has been observed by intake raw infected chickens or avian carcasses. As in the biggest tiger zoo in Thailand, 147 tigers out of a population of 441 died or had to be euthanized. In addition, the probable tiger-to-tiger transmission was reported after stop feeding raw chickens carcasses. At the same period another feline, domestic cat, was also found to be infected by eating a pigeon carcass. The first evidence of HPAI infection in domestic dog in Thailand was also reported. Based on information provided by its owner, the animal had eaten a duck carcass in the AI affected area before developing the disease. All tiger cat and dog can be demonstrated that HPAI H5N1 virus caused severe pneumonia and confirmed by immunohistochemistry and multiplex RT-PCR.
It was necessary to have tools for improving diagnostic procedures, studying chronology and molecular changes associated with the emergence of a highly pathogenic influenza virus, developing therapeutic methods and a vaccine. As a consequence the study of 8 gene segments of H5N1 viral genome through phylogenetic analysis was carried out to compare the different H5N1 strains from various times and places throughout Asia. The data of H5N1 influenza virus in Thailand between the year of 2004-2006 can be differentiated into 3 groups: the first group is the 2004 H5N1 virus which were near to Vietnam and Malaysia; the second group is the 2005 H5N1 virus and the last is the 2006 H5N1 virus which were near both 2004 and 2005 H5N1 virus in Thailand and 2005/06 H5N1 virus from Laos and South Eastern of China. The imperative point from the sequence analysis were the cleavage site of HPAI virus, the hemagglutinin receptor binding site, the genotype of nucleoprotein gene, the codon deletion of amino acid in neuraminidase (NA) and nonstructural (NS) gene, the amantadine resistance in matrix (M2) gene, the Oseltamivir resistance in neuraminidase gene, a single amino acid substitution at the position 627 in the polymerase basic protein 2 (PB2). This data draws a comprehensive picture encompassing epidemiology, inter-species transmission and genetic characterization of this highly virulent virus.
Moreover, in laboratory diagnostic techniques, rapid method to detect H5N1 virus were developed by using real-time PCR with multiplex probes, H5N1 Oseltamivir-resistance detection by real-time PCR using two high sensitivity labeled TaqMan probes and method for conventional PCR, furthermore, developed the method for discrimination between HPAI and LPAI H5 virus by using SYBR Green I with melting curve analysis. We believe that the outbreak of H5N1 is unlikely to be the last in the near future. We have to prepare and take preventive measures for a pandemic by extensive influenza surveillance, vaccine development and production, antiviral therapy and influenza related research.
16:50-17:00: Avian influenza in Indonesia Speaker: Hadiarto Mangunnegoro (U of Indonesia) (by DVTS)
2 Hadiarto Mangunnegoro
Dept. of Respiratory Medicine Faculty of Medicine University of Indonesia
Persahabatan Hospital, Jakarta, Indonesia
Abstract: Since 2003, H5N1 outbreaks in poultry have occurred throughout Indonesia. Indonesiafs first human H5N1 case was confirmed in July 2005. Seventy four cases and seven clusters were noted among H5N1 cases through December 2006 with age ranging from 1 to 67 years, mean age is 20 years.
The H5N1 viruses isolated from humans in Indonesia are genotype Z and belong to class 2, similar to H5N1 avian viruses found from poultry. There is no evidence of genetic reassortment with human or pig influenza viruses. Based on serosurvey carried out on 928 subjects regarded as high risk persons (poultry farmers, chicken sellers etc) none of them proven positive to antibody titer against H5N1which means AI virus is not easy to infect human being.
From 74 cases confirmed to date (December 4, 2006) in Indonesia, 57 (77%) had been fatal. High percentage (46%) of fatal cases have occurred in clusters (7 clusters), most cluster cases had direct or indirect poultry exposure, all cluster cases were blood related, however human to human transmission still unproven.
Clinically, case fatality is very high 77%, they have short illness with mean time from onset to death: 8.5 days (range 2-18). Time between onset and notification = 5 days, time between notification and lab results: available within 3 days for 70% of cases. Fatal cases hospitalized late in illness before oseltamivir treatment is administered and die shortly after hospitalization
Clinical presentation is similar to H5N1 cases in other countries mostly showing high fever, short of breath and cough, leucopenia and thrombocytopenia. All patients with fatal disease presented with fever, bilateral pneumonia, ARDS and or multi organ failure.
Currently Indonesia is in WHO pandemic alert phase 3: Primarily animal infection, some human infections. Clusters due to self limited human-to-human transmission does NOT change phase 3 to 4. In response to this pre pandemic influenza, the government has already set up The National Strategic Plan on Avian Flu Control and Influenza Pandemic Preparedness.
However, there are still a lot of unanswered questions regarding H5N1 human cases in Indonesia such as why are there more clusters in Indonesia than other countries? Why is the case fatality so high? What is the different between fatal cases and surviving cases? When the pandemic will occur? Will Indonesia be the place country for pandemic?

*Medical WG dinner
After the first day sessions, we will have a medical WG dinner, which is done by Dutch style. The time & place as well as individual charge will be announced later.

Remarks(including Special arrangements if Any) We will have two live demonstrations among multiple stations. We would like to have enough time for preparation or rehearsals at the same room, such as the night before or a few days before the event. Necessary equipments may include multi-point teleconference system, microphones, and several high-quality monitors.

Last Updated 24 Jan 2007