ELECTRONIC MEDICINE using recombinant DNA

1. 16 June 2011 ELECTRONIC MEDICINEusing recombinant DNA Professor Sir John Oluwole Ogunranti, KOJ (UK) Professor of Anatomy, University of Jos, Nigeria Visiting Professor of Anatomy Imperial College, London, UK British Knight Kentucky Colonel -USA Fellow of Civil Leadership- AustraliaMember, World Academy of Letters etc

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

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

4. ELECTRONIC MEDICINE Later the terminology changed to use of computers in the practice of Medicine

5. 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

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

7. 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.’

8. 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.”

9. ELECTRONIC MEDICINE Can be further defined as • 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

10. 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.

11. 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

12. 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

13. ELECTRONIC MEDICINE • eTreatment • ePrescription • eSurgery- e.g.  Da Vinci  robotics (telesurgery), keyhole surgery • eHealth testing

14. ELECTRONIC MEDICINE • It is divided into two broad categories • eLearning • ePractice

15. ELECTRONIC MEDICINE • Let us begin our learning ePractice by examining recombinant DNA technology in antenatal diagnosis of sickle cell disease

16. eDiagnosis of Sickle cell disease • Study • Examination

17. 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 BIOINFORMATICS • IN medicine the reasons are mainly in making diagnosis • of disease in the laboratory and they are of two main types • 5

18. 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.

19. 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

20. 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.

21. 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

22. ELECTRONIC MEDICINE • Electronic Procedures for Practice of Medicine • Electronic Surgery- e.g. Robotic Surgery • Telemedicine • Telesurgery • Electronic Imaging including electronic ultrasonics

23. 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.

24. 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

25. 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!!

26. 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

27. MEDICAL EDUCATIONproblems • THE GREATEST PROBLEM OF ALL IS • ROTE LEARNING

28. MEDICAL EDUCATION YALE ROBOT

29. MEDICAL EDUCATION • DISADVANTAGES OF THE YALE MODEL • IT was too expensive for ordinary medical school • It could not perform clinical investigations or indeed postmortems

30. 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

31. 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

32. 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

33. It took ten years to put up.

34. 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 ofinexpensiveness,networking, duplicabilityand multiple usability. Despite all the above, it is still able to provide integration.

35. It also has the following multimedia features which follow three senses and mimic the learning channels well • eVisual • eAuditory • eKinesthetic

36. eVisual

37. eVisual

38. eVisual

39. eAuditory

40. eKinesthetic Percutaneous transthoracic LIVER BIOPSY LIVER SURGERY

41. 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.

42. Teaching programs eDissector eEmbryology eHistology eHistory eVital signs eInspection ePalpation ePercussion eAuscultation eInvestigation eDiagnostics eOrgan integration Assessments eOSCE- long case-examination eOSCE- long case-tutorial eOSCE- long case-study eOSCE- short case-tutorial eOSCE- short case-study eOSCE- short case-examination eQuizzes for theoretical papers Saturday school DEMONSTRATIONS HUMAN ANATOMYMUSEUM

43. 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

44. 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 alsolinkedto various pages to refresh anatomical knowledge. All anatomicalstructuresare presented with a dissector to locate their depth.

45. Its multimedia facilities include VIDEO AUDIO ANIMATIONSwhich include flash, Java enabled, gif animation, and JPEG SEQUENCES STILL PICTURES The most widely used isanimationwhich mimics all known procedures and hence teaches. It uses the above to teach an evaluates clinical examination and medical procedures

46. 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.

47. 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)

48. 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 • eDoctorused 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

49. 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

50. 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 Museumon the internet that uses real cadavers for dissection