ABSTRACT
Background and Objectives:Healthcare information technology(HCIT) has potential in patient care as well as medical education, but is yet underutilized. With shortage of good clinical material, e-learning helps in supplementing a lecture/demonstration by an online tutorial. This ‘blended learning’ helps in meeting deficiencies of the exclusively traditional methods. Besides, with time constraints, there is a need for collaborative, on-line/web-based learning with a flexibility that would enable the students to learn at leisure. Methods: Seven faculty and 18 post-graduate students(residents) were exposed to the concept of clinical informatics at the BVUMC digital library, various features of Cerner Corporation’s academic education solution(AES), software from US-based company (from Bangalore). Faculty participants were trained in building clinical cases into the system, entering investigations, medications and allergy information. They were trained in usage of message centre -giving and answering assignments, accessing links to medical terminology and reference material. Students had a point-of-learning ability to access medical literature and interdisciplinary management of a clinical case. Cases were built up step by step, so students were encouraged to evaluate and opine on patient’s status and further management. Throughout the course, the system tracked and stored student performance. Results: The software was found to be effective ( significant changes in pre and post test scores). The mean scores out of 20, pre and post test were 12.389 and 14.333. Paired T test and Confidence intervals were used for statistical analysis. T-Value = -5.93 P-Value = < 0.0001, i.e there was a significant increase in the score. Of the students, 88.89% students felt that this experience motivated them for self-learning and that on-line case discussion should become a compulsory part of residents training programme. Of the faculty, 85.71% strongly felt the major advantages were 1)chronic cases-teaching, building a repository of rare cases 2)exposure of students to problem-solving and decision-making 3)flexibility of teaching sessions in terms of time. Conclusions: By adoption of an Electronic-Hospital-Records- cases fed in digital format, students can learn in a simulated environment with interdisciplinary team collaboration and integrated teaching. EMR and HCIT has the potential to revolutionize medical education.
ABSTRACT
Background: Actin cytoskeleton is involved in actin-based cell adhesion, cell motility, and matrix metalloproteinases(MMPs) MMP2, MMP9, MMP11 and MMP14 are responsible for cell invasion in breast cancer metastasis. The dietary intake of lignan from flax seed gets converted to enterolactone (EL) and enterodiol in the human system. Here we show that the enterolactone has a very significant anti-metastatic activity as demonstrated by its ability to inhibit adhesion and invasion and migration in MCF-7 and MDA MB231 cell lines. Materials and Methods: Migration inhibition assay, actin-based cell motility assay along with reverse transcriptase polymerase chain reaction (RT-PCR) for MMP2, MMP9, MMP11 and MMP14 genes were performed in MCF-7 and MDA MB 231 cell lines. Results: Enterolactone seems to inhibit actin-based cell motility as evidenced by confocal imaging and photo documentation of cell migration assay. The results are supported by the observation that the enterolactone in vitro significantly down-regulates the metastasis-related metalloproteinases MMP2, MMP9 and MMP14 gene expressions. No significant alteration in the MMP11 gene expression was found. Conclusions: Therefore we suggest that the anti-metastatic activity of EL is attributed to its ability to inhibit cell adhesion, cell invasion and cell motility. EL affects normal filopodia and lamellipodia structures, polymerization of actin filaments at their leading edges and thereby inhibits actin-based cell adhesion and cell motility. The process involves multiple force-generating mechanisms of actin filaments i.e. protrusion, traction, deadhesion and tail-retraction. By down-regulating the metastasis-related MMP2, MMP9 and MMP14 gene expressions, EL may be responsible for cell invasion step of metastasis.