Engineering-Medicine

Principles and Applications of Engineering in Medicine

Lawrence S. Chan, William C. Tang

• Publisher: CRC Press
• Year: 2019
• Print ISBN:
  9780367779801
• eBook ISBN:
  9781351012256
• Topic: Medicine
• Subtopic: Biotechnology in Medicine

This transformative textbook, first of its kind to incorporate engineering principles into medical education and practice, will be a useful tool for physicians, medical students, biomedical engineers, biomedical engineering students, and healthcare executives. The central approach of the proposed textbook is to provide principles of engineering as applied to medicine and guide the medical students and physicians in achieving the goal of solving medical problems by engineering principles and methodologies. For the medical students and physicians, this proposed textbook will train them to "think like an engineer and act as a physician". The textbook contains a variety of teaching techniques including class lectures, small group discussions, group projects, and individual projects, with the goals of not just helping students and professionals to understand the principles and methods of engineering, but also guiding students and professionals to develop real-life solutions. For the biomedical engineers and biomedical engineering students, this proposed textbook will give them a large framework and global perspective of how engineering principles could positively impact real-life medicine. To the healthcare executives, the goal of this book is to provide them general guidance and specific examples of applying engineering principles in implementing solution-oriented methodology to their healthcare enterprises. Overall goals of this book are to help improve the overall quality and efficiency of healthcare delivery and outcomes.

1

Engineering-Medicine An Introduction

Lawrence S. Chan

QUOTABLE QUOTES

“Be innovative, challenge the status quo, think out of the box, and make a difference!”

Dr. Victor Dzau, President, the Institute of Medicine (Dzau 2015)

“Whatever we succeed in doing is a transformation of something we have failed to do.”

Paul Valery, French Poet (FORBES 2017a)

“History is a race between education and catastrophe.”

Hebert G. Wells, English Writer (FORBES 2017b)

“New Year’s Day. A fresh start. A new chapter in life waiting to be written. New questions to be asked, embraced, and loved. Answers to be discovered and then lived in this transformative year of delight and self-discovery.”

Sarah Ban Breathnach, American Author (BRAINY 2017)

“Engineers can help realize the vision of high-quality, precision, and quantitative medicine while also reducing health care costs. Just as the revolution in medicine created by the advent of molecular biology in the past century, engineering will be the new driving force for the progress of medical research and education in this century and beyond.”

Engineering as a new frontier for translational medicine (Chien et al. 2015)

Learning Objectives

The learning objectives of this chapter are to pave the foundation for the rationale of engineering-medicine education and to set the logical foundation for engineering-medicine.

After completing this chapter, the students should:

• Understand the current healthcare and medical education status in the US.

• Understand the rationale for fulfilling the triple aim of better care, better health and lower cost called by Institute of Medicine.

• Understand similar educational goals between engineering and medicine.

• Understand ways engineering education may enhance future physicians’ efficiency.

• Understand the potentials of engineering-medicine may improve the overall healthcare deliver.

• Understand the global picture of how engineering was, is, and will be enhancing the quality of healthcare.

• Understand pathways that engineering-medicine may be implemented.

The Current State of US Healthcare and Medical Education

The health of healthcare in the US is presently being assessed in a major way. The current US healthcare faces two major challenges in that while the cost is very high its overall outcome is not excellent. In its 2014 report, the Organization for Economic Co-operation and Development (OECD) informed us that healthcare expenditure of the US costs 16.9% gross domestic products (GDP) in 2012, the highest of all OECD countries (OECD 2014). Yet according to a 2014 study conducted by the Commonwealth Fund, the US is ranked the very last in overall healthcare quality among 11 nations including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States (COMMONWEALTH 2014). Specifically, the US is last or near last on measures of access, efficiency, and equity (COMMONWEALTH 2014). Another major challenge the US healthcare system faces is the increase of aging population as a percentage of overall US population (Colwill et al. 2008). This demographic change thus will increase the demand for healthcare services and will certainly put more burdens to the healthcare providers. Compounding to this challenge is the coming of physician shortage projected by the American Association of Medical Colleges (AAMC), which estimated a substantial physician shortage ranging from 46,000 to 90,000 by the year of 2025 (AAMC 2016). Others also estimated the deficit of 35,000 to 44,000 adult general physicians by the year 2025 (Colwill et al. 2008). Furthermore, the current medical practice is outpaced by the rapid advancement of health science and technology. Moreover, the combined findings of low efficiency and high expenditure of the US health system has prompted the Institute of Medicine (IOM, now National Academy of Medicine) to call for the implementation of three aims of medicine in the future: “better care, better health, and lower costs” (Alper et al. 2013). Since medical practice is by-and-large a reflection of medical education, the improvement of US healthcare state would need to be started at the medical school level.

Having depicted the current state of US healthcare, now let us examine the current state of US medical education. We will pounder the following 4 salient points (efficiency, global perspective, teamwork, and advanced biotechnology) in assessing the current medical education for future physicians:

• Medical students are largely taught to be an individual patient advocate, rather than thinking critically about being steward of the entire health care system, particularly in terms of resources. This issue has prompted the IOM to call for lowering health care cost (Alper et al. 2013). Therefore we need to provide solution by educating students the efficient methods in healthcare delivery.

• Medical students are primarily taught in providing care: in making correct diagnosis and in prescribing right medication or surgical procedure, and not much about other determinants that are also significant for improving health. For example, population studies estimated that medical care contribute only about 10% of the variance in the final outcome of health, whereas a huge percentage (50%) of the outcome is dependent on behavior and social factors (Hershberger et al. 2014). Yet physicians and the healthcare system as a whole are playing little role in the other important contributing factors. This issue has prompted the Association of American Medical Colleges to call for the inclusion of public health in medical education curriculum (AAMC 2015). In fact, the University of Wisconsin School of Medicine has changed its name to “University of Wisconsin School of Medicine and Public Health” in 2005 to involve students in health promotion and disease prevention. Thus we need to provide medical education, with emphases on global perspective and promote holistic approach and resource stewardship in our future physicians.

• Medical students are predominantly taught to be excellent individual physicians, rather than being a team member of a large health care system. This issue has prompted the American Medical Association (AMA) to call for the promotion of teamwork concept (AMA 2015). To improve on this aspect, our medical curriculum should instill the teamwork concept into the daily practice of our future physicians.

• Rapid advancement of biomedical technology has occurred at a much faster pace than the current medical education and practice (Duda et al. 2014, Rietschel et al. 2015). A recent survey on genetic curricula in US and Canadian medical schools found that only 26% responders reported formal genetic teaching during 3rd and 4th year of school and most responders felt the amount of time spent on genetics was insufficient for future clinical practice in this era of genomic medicine (Plunkett-Rondeau et al. 2015). Not only medical educators felt the current medical education lagged behind in advanced technology training, students at Harvard Medical School expressed similar sentiment (Moskowitz et al. 2015). They felt that “our ability and capacity to train both new and experienced clinicians to manage the tremendous amount of data lag far behind the pace of the data revolution” and that “medical education at all levels must come to address data management and utilization issues as we enter the era of Big Data in the clinical domain” (Moskowitz et al. 2015). In addition, recent studies have pointed out that advanced technology useful to teach undergraduate medical knowledge and skills such as sonography and otolaryngology was underutilized (Day et al. 2015, Fung 2015). The participants of Translate 2014 meeting in Berlin Germany has reached a consensus on the rate-limiting factor for advancing translational medicine and made an urgent statement: “The pace of basic discoveries in all areas of biomedicine is accelerating. Yet translation of this knowledge into concrete improvements in clinical medicine continues to lag behind the pace of discovery” (Duda et al. 2014, Rietschel et al. 2015). Engineering indeed has great potential to enhance the healthcare quality in many ways (Hwang et al. 2015, Ricci 2017). Three recent biomedical articles published in 2015, randomly chosen as below, illustrate the current state of medical science advancements that are not universally taught in our medical schools:

One example is illustrated by 3-D Printing technology used in the treatment of tracheobronchomalacia. The biomedical engineers at the University of Michigan have successfully implanted customized patient-specific 3-D printed external airway splints in three infants suffered from tracheobronchomalacia, a life-threatening condition of excessive collapse of airways during respiration. As a result, this 3-D printed material eliminated the airway disease, strongly illustrating the biotechnology contribution to medicine (Morrison et al. 2015, Michalski and Ross 2014).

Another example is nanotechnology in gene editing to correct cystic fibrosis mutation. The Yale University scientists have derived a gene editing technique, which a synthetic molecule similar to DNA, called peptide nucleic acids (PNAs), and together with donor DNA are utilized to correct genetic defect in cystic fibrosis. Using biodegradable microscopic nanoparticles to facilitate the delivery of PNA/DNA to the target cells, the Yale researchers were able to trigger the “clamping” of PNA close to the mutation, leading to subsequent DNA repair and recombination pathway in these target cells, resulting the proper gene correction in both human airway cells and mouse nasal cells, as well as in nasal and lung tissues, significantly demonstrating the nanotechnology contribution to medicine (McNeer et al. 2015, Langer and Weissleder 2015).

Further example is a novel mobile phone video microscope utilized in parasitic infection detection. Researchers at the University of California at Berkeley and NIH have together produced a mobile phone automatic microscopic device which can be used by healthcare providers in low-resource areas of Afri...

Table of contents

• Cover
• Title Page
• Copyright Page
• Foreword
• Acknowledgments
• Preface
• Table of Contents
• 1. Engineering-Medicine: An Introduction
• 2. General Ethics in Engineering-Medicine
• 3. Ethics in the Era of Precision Medicine
• 4. Engineering Principles Overview
• 5. Engineering-Medicine Principles Overview
• 6. Economy of Engineering-Medicine Education: A Cost-Effectiveness Analysis
• 7. Invention and Innovation
• 8. Design Optimization
• 9. Problem-solving
• 10. Systems Integration
• 11. Efficiency
• 12. Precision
• 13. Big Data Analytics
• 14. Artificial Intelligence
• 15. Quality Management
• 16. Cellular and Molecular Basis of Human Biology
• 17. Systems Biology: An Introduction
• 18. Advanced Biotechnology
• 19. Biomedical Imaging: Magnetic Resonance Imaging
• 20. Biomedical Imaging: Molecular Imaging
• 21. Emerging Biomedical Imaging: Optical Coherence Tomography
• 22. Emerging Biomedical Imaging: Photoacoustic Imaging
• 23. Emerging Biomedical Analysis: Mass Spectrometry
• 24. Robotic Technology and Artificial Intelligence in Rehabilitation Medicine
• 25. Role of Academic Health Center Programs and Leadership in Enhancing the Impact of Engineering-Medicine
• 26. Environmental Protection
• Index
• About the Editors