1. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 1 1

2. Childhood Cancers – Cure Rates St. Jude Children’s Research Hospital 80% Survival Rates in Developed Countries 2

3. Childhood Cancers – Cure Rates 0-30% Rates in countries with limited resources 3

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5. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 5 International Visitors to St. Jude Dr. Georgette Chammas with International Visitors

6. Donations of Hospital Infrastructure Dr. Barrett Haik with a donation of a Retcam to Guatemala 6

7. www.Cure4Kids.org 7

8. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 8 Objectives of Cure4Kids Provide online education on catastrophic diseases in children to doctors, nurses, health care providers, patients and families. Provides for group communication tools for users of Cure4Kids anytime, anywhere. Provide assistance for Internet connectivity to partner sites.

9. Cure4Kids Global Usage Statistics 9

10. Cure4Kids Usage Statistics 10

11. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 11 519 United States 181 Brazil 105 Mexico 57 Venezuela 50 Chile 38 Russia 32 El Salvador 32 Lebanon 31 Peru 31 Colombia 29 Canada 28 Jordan 25 Argentina 22 China 21 Morocco 21 Spain 17 Japan 16 Guatemala 13 Ecuador 12 Romania 10 Costa Rica 10 United Kingdom 9 Honduras 8 Philippines 7 India 7 Paraguay 7 Netherlands 6 Panama 6 Ireland 6 Zimbabwe 5 Syria 5 Iran 5 Saudi Arabia 5 Qatar 5 Egypt 5 South Africa 5 Australia 4 Bolivia 4 Ukraine 4 Nicaragua 4 Italy 4 Uruguay 4 Singapore 4 Sweden 4 Iraq 3 Armenia 3 Germany 3 Hong Kong 3 Taiwan 3 France 3 Israel 3 Czech Republic 2 Malta 2 Albania 2 Dominican Republic 2 Cuba 2 Latvia 2 Croatia 2 Pakistan 1 Switzerland 1 Malaysia 1 Tunisia 1 Madagascar 1 Midway Islands 1 Bulgaria 1 Bangladesh 1 Norway 1 Kuwait 1 Haiti 1 Gibraltar 1 Rwanda 1 Trinidad and Tobago 1 Belarus 1 Micronesia 1 Nepal 1 Andorra 1 Slovakia 1 Thailand 1 Algeria 1 Portugal 1 Kyrgystan 1 Slovakia 1 Thailand 1 Algeria 1 Portugal 1 Kyrgystan 1550 Users from 82 Countries

12. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 12 Cure4Kids Online Content Clinical Case Discussions Online Lectures Digital Library Online Live Lectures

13. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 13

14. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 14

15. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 15

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17. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 17 Cure4Kids Online Seminars 120 Seminars available in 7 languages Online Quiz and Feedback forms Online Medical Education Credits (CME,CNE,CEU) Usage is widespread by all disciplines. Sometimes viewed and discussed as a group 17

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20. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 20 Cure4Kids Digital Library Medical Textbooks Medical Journals Medical Dictionaries Literature Databases Selected Web Links

21. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 21 Cure4Kids – Paper of the Month Journal Article of the Month Selected and reviewed by Dr. Raul C. Ribeiro St. Jude Children's Research Hospital

22. Live meeting using web conferencing 22

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24. International Online Conference Rabat, Morocco Casablanca, Morocco 24

25. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 25 Cure4Kids Conference Rooms 18 groups meet regularly on Cure4Kids Central America Morocco Lebanon Brazil Conference Room A – general meeting Emerging Global Collaboration Network

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27. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 27

28. 28 1 Historical Perspectives of Pediatric Oncology 2 Biological Basis of Pediatric and Adolescent Cancer 3 Assessments 4 Planning 5 Implementation 6 Oncologic Emergencies 7 Symptom Management and Supportive Care Cure4Kids Homepage >> Courses >> Pediatric Oncology Nursing Course 8 Infection Control 9 Pain Assessment and Pain Management 10 Survivorship and Late-effects of cancer 11 End-of-life and Palliative Care 12 Professional portfolio development 13 Individual disease Entity 14 Future Trends in Pediatric Oncology Nursing The goal of this course is to provide the participants (nurses) basic pediatric oncology nursing training. This course consists of on demand lectures, online papers, online live class discussions, and links to external educational resources.

29. 29 Cure4Kids Online Courses Online lectures Online readings Online testing Feedback forms Links to external web sites Live online class meetings

30. 30 Online Usage Statistics 30

31. Cure4Kids Items Accessed Per Month 31

32. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 32 Cure4Kids Usage Statistics Detailed usage statistics by Country Occupation

33. Telemedicine Dr. Francisco Pedrosa, IMIP/CEHOPE, Recife, Brazil 33

34. 34 Recife is located in Pernambuco in the Northeast of Brazil, one of the poorest areas of the country. Recife has 3 million inhabitants, of which 50% are children. Telemedicine

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36. 36 Telemedicine 36

37. 37 Telemedicine technology has been utilized at SJCRH to support the goals of the IOP in providing education and consultative expertise to medically under-served regions Telemedicine

38. 38 IMIP, a SJCRH partner hospital, was selected to develop the pilot IOP TELEMEDICINE program. Telemedicine

39. 39 Implemented on October 28, 1998 Aims: - reduce early mortality - reduce advanced stage disease at diagnosis - increased survival rate Telemedicine

40. 40 Training and education of health care providers Patient care (real time consultation) Implementation of advanced diagnostic techniques Continuing Education Telemedicine

41. 41 ISDN 6 Lines (BRI) Fiber optics 768 Kbps EMBRATEL IMIP St Jude Telemedicina 41

42. 42 Telemedicine 42

43. 43 Telemedicine Case discussions with direct viewing of physical findings: Radiology Pathology Surgery

44. 44 From St Jude to IMIP = 264 0 10 20 30 40 50 60 70 80 199819992000200120022003 3 38 37 45 69 72 Conferences Telemedicine

45. 45 From IMIP to St. Jude = 72 0 5 10 15 20 25 30 199819992000200120022003 8 28 20 9 4 3 Second Opinion Telemedicine

46. 46 3 38 37 45 69 72 8 28 20 9 4 3 0 10 20 30 40 50 60 70 80 1998 1999 2000 2001 2002 2003 SJCRH IMIP IMIP SJCRH Telemedicine

47. 47 n=91 29% ALL – 1980-90 Telemedicine 47

48. 48 ALL: 1997-2003 70±3% n=263 Telemedicine

49. 49 Telemedicine 0 50 100 19802003 % ALL 70 29 Survival

50. 50 Telemedicine NHL 1980-90 44±8% n=98 Cum Survival Years from Diagnosis

51. 51 NHL 1997-2003 84±3% n=66 Telemedicine 51

52. 52 Telemedicine 19802003 44 84 % NHL Survival

53. 53 Increased speed and accuracy of diagnosis with positive impact on patient care Close scrutiny of overall medical services and identification of areas requiring improvement (Pharmacy, Infection control, pathology) Benefits of Telemedicine Telemedicine

54. 54 Exposure of IMIP staff to current medical information and outstanding professional expertise without the need for travel Opportunities for collaborative publications Benefits of Telemedicine Telemedicine

55. 55 Reduced “sense of isolation and helplessness” and improved confidence level among IMIP staff Decreased patient referrals Benefits of Telemedicine Telemedicine

56. 56 A telemedicine program linking international partner hospitals is technically feasible, has a positive impact on patient care, promotes more rapid diagnoses, and may lead to earlier, improved treatment of children with cancer. Conclusions Telemedicine

57. 57 Telemedicine Our Team

58. Telemedicine Dr. Francisco Pedrosa, IMIP/CEHOPE, Recife, Brazil 58

59. Patient Education Using Storytelling Infection Control story – Dr. Miguela Caniza 59

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61. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 61 Cure4Kids - Feedback “Yesterday I registered on Cure4Kids and did not move from my computer for 10 hours. I said to my wife God Bless Danny Thomas! It is from my heart, and I extend it to his followers who continue his work” (Egypt)

62. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 62 Cure4Kids - Challenges Language Time Zones Levels of Expertise Cultural Differences Technology Financial Internet Accessibility Technical Support People

63. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 63 Physician Authors Raul Ribeiro, MD, Hematology/Oncology, St. Jude Judith Wilimas, MD, Hematology/Oncology, St. Jude Gaston Rivera, MD, Hematology/Oncology, St. Jude Miguela Caniza, MD, Infectious Diseases Bassem Razzouk, MD, Hematology/Oncology, St. Jude Monica Metzger, MD, Hematology/Oncology, St. Jude Scott Howard, MD, Hematology/Oncology, St. Jude Jesse Jenkins, MD, Anatomic Pathology Carlos Rodriguez Galindo, MD, Hematology/Oncology, St. Jude Ching-Hon Pui, MD, Hematology/Oncology, St. Jude Faculty and staff from St. Jude and other institutions.

64. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 64 Nurse Authors Ayda Nambayan, DSN Curriculum Developer, International Outreach Program. Georgette Chammas, EdD, Nursing Content Developer Nora Donahue, BSN, Nursing Content Developer Wren Kennedy, Certified Nurse Practitioner in Pediatric Oncology Pamela S. Hinds, RN, PhD, St. Jude Director of Nursing Research

65. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 65 Cure4Kids Team Raul Ribeiro, MD, Director, International Outreach Program Lynne Jordan Bowers, PhD, Associate Director, International Outreach Program Yuri Quintana, PhD – Education Director Ayda Nambayan, DSN, Curriculum Developer Richard O'Brien, Technologies Administrator Ana Shuler, Member Services and Live Events Coordinator, Aman Patel, Martin Norland, Cure4Kids Programming Team

66. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 66 Cure4Kids Multimedia Team Peter Bloom, Contract Multimedia Developer. Louis Kimery, Multimedia Developer. Adam Simpson, Contract Multimedia Developer Jorge Cruz, Cure4kids Multimedia Developer and Latin America online events coordinator Soumya Vandanam, Contract Multimedia Developer

67. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 67 Cure4Kids Admin Team Raisa Ioffe, Translation Coordinator and Content Facilitator Jamilah Howard, Contracts Accountant Adele Morton, Administrative Assistant II Alicia Rodriguez, Administrative Assistant II Wei Li, Administrative Support Gail Pond, Administrative Support

68. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 68 St. Jude Team St. Jude Biomedical Communications Internet Development Department Nursing Education Department Scientific Editing Department Clinical Research Department Information Technology Services Hartwell Center for Bioinformatics and Biotechnology Public Relations Volunteer Services ALSAC

69. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 69 Donors ALSAC Corporate Donors: Qwest Ingram-Micro

70. St. Jude International Outreach Program - www.cure4kids.org - Yuri.Quintana@stjude.org 70 Cure4Kids – Conclusions Motivated People Make it Happen Global medical education possible Great demand for high quality medical education Content is being used and discussed Online collaborations are increasing Cure4Kids is becoming an active global online community

71. Cure4Kids.org A hospital without walls 71

72. Cure4Kids - Global Knowledge Sharing www.Cure4Kids.org 72