ELECTRONIC MEDICINEusing recombinant DNA

Professor Sir John Oluwole Ogunranti, KOJ (UK)

Professor of Anatomy, University of Jos, NigeriaVisiting Professor of AnatomyImperial College, London, UK

British KnightKentucky Colonel -USAFellow of Civil Leadership- AustraliaMember, World Academy of Lettersetc

16 June 2011

ELECTRONIC MEDICINE

That branch of Medicine which deals with the use of computers and information technology in the learning and practice of medicine

ELECTRONIC MEDICINE

It was first used as terminology for the placement of latest medical information on internet by the website- Electronic Medicine

ELECTRONIC MEDICINE

Later the terminology changed to use of computers in the practice of Medicine

ELECTRONIC MEDICINE

I am happy to say that we are one of the first to use this terminology in Medical Education

Firstly at Ilorin when I gave a lecture to medical students at the University in 2006

Later in 2008 at Imperial College St Mary’s Hospital, London, UK and

In 2010 at the University Ibadan Workshop on Electronic Medicine

ELECTRONIC MEDICINE

The prolegomena of the program was aired on NTA Network Voyage of Discovery 5 times in 2005 sponsored by the NUC

ELECTRONIC MEDICINE

In 2010 University of California Irvine said of Electronic Medicine in the USA ‘As part of its new iMedEd Initiative, the medical school has developed a comprehensive, iPad-based curriculum, reinventing how medicine is taught in the 21st century and becoming the first in the nation to offer entering students a completely digital, interactive learning environment.’

ELECTRONIC MEDICINE

“We are committed to using evolving technology to benefit the education of our medical students,” says Dr. Ralph V. Clayman, dean of the School of Medicine. “It is our firm belief that a digitally based curriculum will be the wave of the future, and UCI seeks to be a leader in the innovative presentation of information to students.”

ELECTRONIC MEDICINE

The application of electronic means or gadget to medical education and/or practice of Medicine

Electronic refers to ICT ICT means telephony, personal

computer and cybernetics

Can be further defined as

ELECTRONIC MEDICINE

Why electronic Medicine?Because the world is going that direction

Because it is cheaper on the long run, just as in Electronic Banking, for the developing world.

ELECTRONIC MEDICINE Compare with Electronic Banking · Obtain money anywhere in the world ·  Do banking transactions anywhere in the world ·   Use mobile phones, internet etc for banking

ELECTRONIC MEDICINE eMedicine ·         Access to case notes anywhere in the world ·         Access to consultant’s diagnosis and treatment

anywhere in the world ·         Case notes – known as eMR (electronic

medical records) in digital format ·         Emedicine gadgets such as electronic labor

monitoring, eEEG, eECG, eETG, etc ·         eDiagnostic programmes -free and available           Telemedicine

ELECTRONIC MEDICINE

eTreatment ePrescription eSurgery- e.g.  Da Vinci  robotics

(telesurgery), keyhole surgery eHealth testing

ELECTRONIC MEDICINE It is divided into two broad categories

eLearning ePractice

ELECTRONIC MEDICINE

Let us begin our learning ePractice by examining recombinant DNA technology in antenatal diagnosis of sickle cell disease

eDiagnosis of Sickle cell disease

Study Examination

RECOMBINANT DNA

Why do we sequence genes. The following can be given as reasons why we sequence genes.To learn how to synthesize genes. For example, if the nucleotide base sequence of a gene is known, then they can be put together to synthesize the gene in vitro. Such information can be placed in computer data banks and this can be access by anyone who may need the information for various recombinant DNA reasons. This is the subject and concern of BIOINFORMATICSIN medicine the reasons are mainly in making diagnosis of disease in the laboratory and they are of two main types

5

 

rDNA– Diagnoses involving sequences of DNA. This

is – recognized as Southern blot.3

– Diagnoses involving sequences of RNA. This is

– recognized as Northern blot.4

Combination of the above techniques on microscopic slides- this is known as in situ hybridization histochemistry.

rDNA Table1: Human genes which have been assigned by cell hybrid analysis and /or in situ hybridization. Genes Chromosomal location Immunoglobulin        α chain 2p12 Collagen, type 1 α 2 7q21 α- interferon 9p21 β-Interferon 9p21 β- Globin 11p15 Insulin 11p15 γ-Interferon

rDNA 12q24 Immunoglobulin       Heavy chains 14q32 α Globin 16p12 Collagen, type 1 α 1 17q21 Growth hormone 17q22 Immunoglobulin       λ  light chain 22q11   Table 3. Hybridisation also to interphase nucleus can be used to study the functional organisation of

particular sequences. It is possible to use the technique to detect DNAs  that are present in only  a very small subset of cells. Such DNAs might never be detected because of dilution of other DNAs of no interest.

ELECTRONIC MEDICINE

. Other forms of Electronic Practice This has a modest list. Electronic Medical Records. All members

of the health profession take part actively Medical Records: This is the most useful of

all the areas of electronic practice in modern times

 

ELECTRONIC MEDICINE

Electronic Procedures for Practice of Medicine

Electronic Surgery- e.g. Robotic Surgery Telemedicine Telesurgery Electronic Imaging including electronic

ultrasonics

MEDICAL EDUCATION 4.1. Definition: What is medical

education? The organised system that provides

teaching and learning in the subject of Medicine which trains would be medical doctors.

Medical doctors practice on the sick with the aim of curing them or on the healthy with the aim of preventing illness.

MEDICAL EDUCATIONproblems

Loss of cadaveric dissection replaced by models

Embryology is a total failure; how can you learn what you can never see?

Histology is dead; the dead tissues ensure that Loss of pre qualification practice Inability to design educational methods for

assessing skill acquisition etc

MEDICAL EDUCATIONproblems

Poverty or indeed absence of much needed subject integration

Anatomy and surgery have parted ways. In the past a good surgeon was one who had mastered his anatomy and was also an anatomist. Today surgeons struggle with their anatomy and anatomists are nowhere to be found!!

MEDICAL EDUCATIONproblems

We are not training doctors at all but book wormers who later train themselves

We are not interested in integration of medical subjects

We have no means of evaluating the much needed skills for entry into the world of practice

MEDICAL EDUCATIONproblems

THE GREATEST PROBLEM OF ALL IS ROTE LEARNING

MEDICAL EDUCATION

YALE ROBOT

MEDICAL EDUCATION

DISADVANTAGES OF THE YALE MODEL

IT was too expensive for ordinary medical school

It could not perform clinical investigations or indeed postmortems

MEDICAL EDUCATION

It was too unwieldy and cannot be duplicated or networked and can have only a few students at a time

YALE MODEL THEREFORE COSTED MORE THAN IT COULD DELIVER ALBEIT VERY SOPHISTICATED GADGET AND USEFUL

MEDICAL EDUCATION For this modern age no other medium can provide all the

above and change medical education or indeed any other, for good except the electronic one

This can be distributed via the internet It can be distributed via the intranet It can be distributed via local network, wireless

transmissions, mobile phones and even copied and disseminated widely

It is interactive It can be texted It can hypertexted

An alternative which we feel fulfill all the criteria of a good medium for medical education today placed free to use at the Electronic School of Medicine on the world wide web can be found

@

www.oluwoleogunranti.com

It took ten years to put up.

This model of electronic medicine for medical education can examine a patient, order investigations and perform postmortems without any gadgetry except a virtual screen and manipulating mouse and keyboards. It can therefore easily fulfill the criteria of inexpensiveness, networking, duplicability and multiple usability. Despite all the above, it is still able to provide integration.

It also has the following multimedia features which follow three senses and mimic the learning channels well

eVisualeAuditoryeKinesthetic

eVisual

eVisual

eVisual

eAuditory

eKinesthetic

Percutaneous transthoracicLIVER BIOPSY

LIVER SURGERY

It has Temporal and spatial attributes IT can reduce leaning time- at least time

to acquire skill and provide pluralistic spatial features to augment learning. It is superior to other learning methods

because it REDUCES rather than

INCREASES learning time.

Teaching programs eDissector eEmbryology eHistology eHistory eVital signs eInspection ePalpation ePercussion eAuscultation eInvestigation eDiagnostics eOrgan integration

Assessments eOSCE- long case-examinatio

n

eOSCE- long case-tutorial eOSCE- long case-study eOSCE- short case-tutorial eOSCE- short case-study eOSCE- short case-examinatio

n eQuizzes for theoretical

papers Saturday school

DEMONSTRATIONS

HUMAN ANATOMYMUSEUM

This school teaches medicine via stupendously rich multimedia facilities with a modicum of text which is of course hypertexted.

Its URL is

http://www.oluwoleogunranti.com

Anatomy is exempt from text scarcity for it provides a powerful tool for checking and consulting the language of medicine. It is therefore useful just like pharmocopeia in drugs. It is also linked to various pages to refresh anatomical knowledge. All anatomical structures are presented with a dissector to locate their depth.

Its multimedia facilities includeVIDEOAUDIO

ANIMATIONS which include flash, Java enabled, gif animation, and JPEG SEQUENCES

STILL PICTURES The most widely used is animation which

mimics all known procedures and hence teaches.

It uses the above to teach an evaluates clinical examination and medical procedures

One of the uses of animation is to simplify understanding. Hence those areas of medical education which are not easy to understand can be animated- e.g. countercurrent exchange mechanism in kidney physiology.

In this school two programs are paramount

Electronic laboratories consist of all laboratories in Medicine (anatomy physiology, biochemistry, surgery, ophthalmology etc). They can be used for revision shortly before a professional examination so as to refresh the memory of the candidate and help him to pass his examination. Because practical in most medical schools carry higher marks, it is easy to pass the examination after this revision.

Electronic objective structured clinical assessment (eOSCE)

Other programs which are more complex in nature are available at this school and they include

eMidwife which is used to study extensively the art of baby delivery, including complicated ones

eSurgeon used to study the processes involved in surgery

eDoctor used to study clinical features in 100 common clinical conditions

eSubjects (20) used to study both theory and practice of all medical subjects useful for repeat examinations etc

Electronic search remains the best of the services provided in electronic media using search engines.

This school provides search engines for all vital information and you can search the entire website in just one click. The search leads to dictionary information on all aspects of Medicine provided with, again, a modicum of text but a plethora of multimedia; JUST IDEAL FOR STUDENT FAST REVISION

The information on the school has been widely disseminated to all medical schools in the world through their respective Deans by REAL posters and real mail.

The website is available on the world wide web and free, including access to the only Human anatomy Museum on the internet that uses real cadavers for dissection

Although still a growing website, its integration of all medical subjects is stupendously flamboyant to capture a learning environment that is capable of taking care of learning theory.

Its learning environment take into consideration artistic temperaments and hence provides pluralistic environments for learning.

It has exotic features such as Tropical medicine and high technology medicine for the two most far apart modalities of health practice in the world.

In a world where time is money, it is totally unnecessary for a person to spend 10 years or more in order to specialize. With a capture of the essence of procedures via Electronic Medicine at least skill acquisition can be curtailed considerably while allowing time for theoretical learning.

This school is free

IT DOES NOT COST A THING

WEBSITE STATISTICS

Electronic medicine Limitations

While eMedicine as defined in this paper has many features to support and recommend it, it is essential that we spell out its limitations.

It is amenable only to two out of the five senses and the third for touch is limited in its scope. Hence it is to be used all the time as adjunct to the real and not just on its own!

Electronic medicine senses

Taste- no longer useful to doctors Smell- still slightly useful but of no

purpose in electronic medicine Touch- can be useful in tenderness but

useless in consistency unless with some electronic dexterity

Vision – just as good if not better Auditory- just as good if not better

Electronic medicine limitations

ESM presently uses Java and that is not peculiar to it. Some other virtual programs use JAVA on internet which is not enabled in modern Windows operating systems. This is strong limitation to most users but can be circumvented. We need JAVA for two things– The very fine discriminatory audio localization– The encryptment of multimedia facilities

MEDICAL EDUCATIONWEBSITE ENGINES

MEDICAL EDUCATION

ELECTRONIC PATIENT PROBLEM

END

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