PMLS 1 Lecture Topics 1 and 2 PDF

INTRODUCTION TO MEDICAL TECHNOLOGY MEDICAL TECHNOLOGY/MEDICAL LABORATORY SCIENCE The application of procedures, information and devices to develop highly sophisticated solutions to medical problems or issues as the prevention of disease or the promotion and mon...

INTRODUCTION TO MEDICAL TECHNOLOGY MEDICAL TECHNOLOGY/MEDICAL LABORATORY SCIENCE The application of procedures, information and devices to develop highly sophisticated solutions to medical problems or issues as the prevention of disease or the promotion and monitoring of good health. Refers to diagnostic or therapeutic application of science and technology to improve the management of health conditions. Combines the challenges of medicine, the basic sciences of biology and chemistry, and the clinical sciences into a very satisfying professional career; study and practice of diagnostic medicine. MEDICAL TECHNOLOGIST/CLINICAL LABORATORY SCIENTIST Are medical investigators, performing sophisticated analyses using state of the art instrumentation to generate accurate test results. Involved in all phases of sample analysis, direct and supervise laboratory operations, as well as, collaborate in the diagnosis, care, and treatment of patients. Perform complex chemical and biological, hematological, immunologic, microscopic, and bacteriological tests. Microscopically examine blood and other body fluids, make cultures of body fluids and tissue sample to determine the presence of bacteria, fungi, parasites, or other microorganisms; analyze sample for chemical content or a chemical reaction and determine concentrations of compounds such as blood glucose and cholesterol levels; type and cross match blood samples for transfusion. HISTORY OF MEDICAL TECHNOLOGY PROFESSION IN THE PHILIPPINES AND ABROAD Early Beginnings: In 460 BC, Hippocrates, a Greek physician regarded as the founder of scientific medicine, determined the correlation between anatomical and chemical laboratory findings and the causes of diseases. He adopted the triad of regimen with the use of drugs, surgery, and bloodletting in treating diseases and infection. Early 1550 BC, Vivian Herrick determined parasitic infection caused by Ascaris lumbricoides and Taenia species (published in a book by Ebers Papyrus). In the same year, Anenzona, an Arabian physician, proved that parasites are the etiological agent of skin diseases, such as scabies.  During the Medieval period (1098-1438), Professor Ruth Williams mentioned in the book “An Introduction to the Profession of Medical Technology” that Urinalysis was a fad. During this period, some doctors of dubious credentials in the Indian subcontinent recorded several observations and determined that urine of certain patients that attracted ants had a sweet taste. 14th century, Anna Falgelson – a prominent Italian physician at the University of Bologna employed Alexander Gillani to perform tasks considered to be that of a medical technologist. Unfortunately, Gillani died of a laboratory acquired infection. 17th century (1632-1723) – Anton Van Leeuwenhoek invented the first functional crude microscope. The first scientist to observe and describe the appearance of red blood cells and to differentiate bacteria based on their shape. In the 18th century, medical practitioners in North Africa and Southern Europe received classical medical education. Between 1821-1902, Rudolf Virchow was recognized as the Father of Microscopic Pathology. The first scientist/physician who emphasized the study of the manifestation of diseases and infections, which are visible by means of a microscope at the cellular level. Dr. Calvin Ellis, a microscopist at the Massachusetts General Hospital – the first to utilize the microscope in examining specimens in the process of evaluating disease and infections. Dr. William Occam – used laboratory findings as preliminary evidence in diagnosing and evaluating a patient’s disease. Baron Karl Von Humboldt – initiated and formulated the Apothecaries Act of 1815, formally used laboratory findings in the treatment of diseases and infections throughout England and Wales. The Act required instruction in anatomy, botany, chemistry, material medical, and “physic,” in addition to six months of practical working experience in a hospital. Medical Technology on its Modern Era in the United States: Emergence of clinical laboratories in the US occurred in the late 19th century. In 1858, all part-time clinicians were reinforced as teachers by whole time professional units applying the new laboratory methods to medical practice and medical teaching at the University College at Cambridge. United States – science was highly developed through medical education reforms. In 1871, Harvard University introduced reforms emphasizing on “learning by doing”, followed by the University of Pennsylvania and the University of Michigan.  Opening of John Hopkins School of Medicine – provided two years of instruction in the basic sciences. In the late 1870’s, William H. Welch and Michell Prudden along with their students – the first to apply clinical pathology to medical diagnosis. In 1878, Dr. William H. Welch established another laboratory at the Bellevue Hospital Medical College which he used for teaching and giving microscopical courses. In 1885, Dr. Welch became the first professor of pathology at John Hopkins University. In 1880, Dr. William Osler – a clinical professor at the University of Pennsylvania Hospital, introduced and used the microscope and blood counting machine in the hospital-based laboratory; however, these instruments were not well understood by physicians. A few years later, first laboratory was opened – the largest and best-equipped (chemical laboratory related to medicine) at the University of Michigan. Dr. Douglas was the first to give laboratory instructions. In 1887, the University Hospital in Philadelphia was established and built by Dr. Douglas with the help of Dr. Osler and Dr. George Dock and then later at the University Hospital in Ann Arbor. They ordered and mandated all patients to undergo routine laboratory examinations, including urinalysis and blood examinations. In 1896, the first clinical laboratory was opened by Dr. William Osler at John Hopkins Hospital (12x12 size room and was equipped at a cost of fifty dollars). According to Comac’s article, William Pepper Laboratory – a clinical laboratory had been opened at the University of Pennsylvania in 1896. In 1900, census of the US listed 100 male technicians – evidence that clinical laboratories had been established in 1896. This increased to 3,500 in 1920. In 1922, there were 3,035 hospitals that had clinical laboratories. 1908 – publication of a laboratory guide by Dr. James C. Todd – “Manual of Chemical Diagnosis” – later with Dr. Arthur Stanford published a book entitled “Clinical Diagnosis by Laboratory Methods” – edited by Davidson and Henry. This book became the reference for laboratories. 1911 – complete revolution in the development of laboratory science was formally approved by the Insurance Act as the basis of diagnosing diseases. Eventually in 1915, the State Legislature of Pennsylvania enacted a law requiring all hospitals and institutions to have complete laboratory facilities with full–time technicians. In 1940, US required a standard two-year curriculum on collegiate education with one-year actual training in the laboratory for the preparation on its practice. The said education led to a Bachelor of Science degree.  World War I was an important factor in the growth of the clinical laboratory and produced great demands for technicians. Medical Technology in the Philippines: World War II occurred from 1939-1945. On December 7, 1941 Pearl Harbor was invaded by Japan. Three days after, Japan invaded the Philippines causing wrath of the US to flare up. Sickness and death due to illness were rampant. In 1944, US bases were built in Leyte. US brought members of the healthcare team to the Philippines to resolve the health problems of soldiers and Filipinos. At the end of World War II, the first clinical laboratory in the Philippines “26 th Medical Laboratory of the 6th United States Army” was built and located at Quiricada Street, Sta. Cruz, Manila. February 1944, the 26th Medical Laboratory provided one year training to high school graduates to work as laboratory technicians. June 1945 – the staff of the 26th Medical Laboratory of the 6th US Army left the facility after endorsing the newly established Clinical Laboratory to the National Department of Health. Dr. Pio de Roda, a well-known Filipino bacteriologist, took the effort to preserve the remnants of the said laboratory with the help of Dr. Mariano C. Icasiano (the first City Health Officer of Manila). Dr. Mariano C. Icasiano, accepted the proposal of Dr. de Roda to establish a laboratory under the city health department. October 1, 1945 – a medical laboratory (Public Health Laboratory) was formally organized and re-established by Dr. Pio de Roda with the help of Dr. Prudencio Sta. Ana. 1947 – free training of medical technicians (who were high school graduates and paramedical graduates) started under Dr. de Roda and Dr. Prudencio Sta. Ana. 1954 – Dr. de Roda instructed Dr. Sta. Ana to prepare a syllabus for training medical technicians; a six-month training period was required and a certificate was issued to successful trainees. Dr. Tirso Briones later joined the two doctors. 1954 – The first four-year B.S. Medical Technology course was offered by Philippine Union College of Baesa, Caloocan, Rizal (now located in Silang, Cavite) through its sister company Manila Sanitarium Hospital. Dr. Jesse Umali, the first student who graduated, later went on to pursue studies in medicine and became an OB-gynecologist and owner of Omega Lab.  Dr. Willa Hilgert Hedrick – founder of Medical Technology Education in the Philippines and an American medical practitioner and missionary of the Seventh Day Adventist. Dr. Hedrick, with the help of Mrs. Antoinette McKelvey, prepared the course curriculum; established the first complete laboratory in Microbiology, Parasitology, and Histopathology at the Manila Sanitarium Hospital. 1957 – Dr. Antonio Gabriel and Dr. Gustavo Reyes of the UST Pharmacy offered an elective to pharmacy graduates leading to the Medical Technology course. 1960-1961 – The Bureau of Education officially approved the first three-year academic course and the year as an internship program. 1960 – Centro Escolar University delegated Purificacion Sunico-Suaco to work on offering the medical technology course. The recognition permit was later granted by the Bureau of Education and had its first batch of graduates two years later. 1961 – Far Eastern University started its school of Medical Technology. Followed by several colleges and universities throughout the country which began offering the Bachelor’s degree in Medical Technology.  NATURE AND SCOPE OF MEDICAL TECHNOLOGY/ MEDICAL LABORATORY SCIENCE (see SUBA et al, CHAPTER 1, pp. 18-21) The Multifaceted Nature of Medical Technology Substantial Procedural – a Procedure of Scientific Activities Medical Technology uses a wide range of technologies to diagnose certain diseases and infections. Such technologies include the use of an autoanalyzer in sophisticated tertiary category, flow cytometry in histopathology, and high- performance chromatography for drug analysis. All laboratory methods comprise scientific procedures, irrespective of whether the technology is conventional or automated. Investigative Complicity – a Paramount Field of Scientific Investigation Medical technology encompasses scientific inquiry of various societal health problems and involves a wide range of laboratory investigations. These laboratory investigations include drug testing to rule out drug addiction, molecular and nucleic acid analysis for genetic disease diagnosis, forensic investigation, and scientific research. Intermedical Procedural Interference – an Intervention in Medical Procedures In every aspect of medical procedures, a physician always resorts to the laboratory findings in giving the right prognosis of diseases and infections. For example, a bacterial infection mandates a microbiological analysis. Following this procedure, the assigned medical technologist may provide scientific findings supporting the use of specific antibiotics that may be prescribed by the physician. Assiduous Partner – an Explicit Application of Science and Technology Medical technology embraces the techniques and procedures laid down by science and technology. For example, the use of polymerase chain reaction is used for deoxyribonucleic acid (DNA) amplification. Similarly, use of high-performance liquid chromatography or an automated instrument to detect for presence of certain drugs is another example of practical application of medical technology procedure. Circumstantial Medical Evidences – Evidentiary Information in Medicine Medical technology services assist physicians and healthcare providers. The laboratory findings serve as proof of the medical findings and prognosis. For this purpose, medical technology is the clinical eye of physicians. One good example is when blood glucose determination has been conducted and the laboratory results reveal that the patient is hyperglycemic because the blood glucose concentration is above the upper limit of the reference values; it can then be established as evidentiary  information that the patient might be diabetic. Moreover, the finding of hyperglycemia is then correlated with the clinical manifestation as observed and diagnosed by the physician. Medical Technology as a Prelude to Biomedical Research Instrument Selection, Operation, Maintenance, and Troubleshootings It is mandatory in the field of medical technology that instrumentation must include the entire process of selection, operation, maintenance, and troubleshooting. The life- blood theory offers an explanation for this basic knowledge in instrumentation, especially in bioresearch, particularly in dealing with cell culture and stem cell therapy and management. A clinical laboratory cannot exist without these technologies. It is through these instrumentations that clinical laboratories can be of service to patients in need. Utilization of a Computerized Information System for Data Input, Retrieval, and Analysis Automation and computer literacy is the mantra of the present generation. Automation extends to clinical laboratories as well, especially those laboratories employing LIS where services are offered through networking. Quality Control, Quality Assurance, and Performance Improvement Quality control and assurance have been established in every aspect of clinical laboratory. It is usually carried out using a set of standard, control, and pooled sera for clinical chemistry purposes and is performed daily, weekly, or monthly depending on the working status of the instrument; viability of the reagents and chemicals; in case of a new procedure, especially when proposing bioresearch projects; or when the medical technologist is a new hire or the researcher is proposing the applicability of the proposed research procedure. Inventory Control A set of laboratory procedures are used for all bioresearch procedures. The inventory of procedures and instruments to be used control the entire flow of bioresearch. Without this inventory, one cannot ensure the projection of accurate and reliable results. For example, while culturing green algae, the inventory of materials and procedures to be used determine the feasible attainment of bioresearch objectives.  Clinical Trials Clinical trials are the most important concerns of bioresearch. Clinical trials are mandatory steps, especially during the process of proving that efficacy and effectiveness of the proposed vaccines or herbal plants, for example. These clinical trials are performed in clinical laboratories. Therefore, good instrumentation, component technologists, and standardized procedures are required. The Scope of Medical Technology Investigating Nosocomial Infections Patients typically contract a nosocomial infection during a prolonged hospital stay. The process of investigation is within the function of medical technology. The investigation is usually carried out by microbiological analysis through isolation and identification. Once the causative agents have been identified, the next step is to perform culture and susceptibility testing, which then help determine which broad- spectrum antibiotic may inhibit or kill the causative agents of infection. New Discoveries Through Research Scientific research offers innovative techniques and technology, which is pivotal to the role of Medical Technology. Including Medical Technology in Public Health Education Through Seminar/ Workshops As a health practitioner, the medical technologist imparts education as mandated by the Commission on Higher Education in Philippine setting or Ministry of Health in other Asian countries such as Hong Kong. Extending Services to Molecular Engineering Within the ambit of medical technology service function, it is noteworthy to mention that molecular genetics or molecular engineering such as gene therapy, diagnosis, and screening have been embraced in the field of medical technology. Pioneer in Laboratory Medical Diagnostic Services Medical technology employs diagnostic procedures. Evaluating the Efficacy of Drug Treatment Through Microbiological Analysis The department of microbiology deals with microbiology analysis, including the identification of microbes, through culture and staining morphology, biochemical properties and reaction, and performing quality control procedure or monitoring.  Engaging in Blood Donation and Bloodletting Services for the Public It is within the function of medical technology to screen blood donors, and perform cross matching and blood typing before blood transfusion. Laboratory Diagnosis Laboratory diagnosis involves a series of procedural methods that are performed in a clinical laboratory. It employs sophisticated methods or procedures, wherein the findings can be potential evidence in evaluating the health status of the patient. Biological and Medical Research So, in terms of scientific research, medical technology as a laboratory medicine, can provide solutions to health problems and issues. Prevention and Control of Diseases and Infection Medical technology serves as a clinical eye of a medical doctor, and provides information on the prevention and control of diseases and infection. Innovative Techniques and Technology Medical technology encompasses innovative techniques and technologies in laboratory diagnosis. It has pioneered new technologies and techniques to provide a wide spectrum of laboratory services.  ROLES OF MT/MLS PROFESSION IN THE DIAGNOSIS AND TREATMENT OF DISEASE (see SUBA et al, CHAPTER 2, pp. 32-33) Examination of Laboratory Specimens Registered medical technologists assigned to a clinical laboratory are equipped with technical skills and theoretical knowledge to examine samples of blood and other body fluids for the determination of blood chemical constituent concentrations (blood chemical constituent analysis); presence or absence of parasitic ova, larva, and adults (fecalysis); the detection of urine chemicals and formed elements (urinalysis); the identification of microbes and antibiotic reactions (microbiological analysis); the testing of blood compatibility (cross matching); the detection and identification of abnormality (histopathological analysis); the detection of antigen and antibody reaction in vitro (serological analysis); and the determination of blood formed element levels (hematological analysis). After performing laboratory examinations, the results are submitted to the chief pathologist for review before they are recorded and released. Setting and Implementing a Quality Control Program Every section in a clinical laboratory must have its own quality control program and implementation is usually done periodically. In addition, the quality control procedure in a school-based laboratory may include the standardization of solutions, calibration of instruments and apparatuses. Setting and Implementing Laboratory Safety Measures As a mandate, all registered medical technologists must set and practice laboratory safety measures in a clinical laboratory. This work is more transparent in a school-based laboratory than clinical laboratory because the students are affected to a greater extent, not being fully aware of the laboratory safety procedures. This is unlike in a clinical laboratory, where laboratory safety procedures are well disseminated to all practicing medical technologists through a work orientation session prior to their hiring and assuming their positions in the laboratory. Regular Calibration of Instruments and Equipment This is required to test the workability of the instruments. The instruments are calibrated by the supplier annually. They include the spectrophotometer, autoanalyzer, electrophoresis apparatus, autoclave, incubator in both school-based and hospital-based laboratories. It is necessary for the medical technologists to record the calibration period and the name and credentials of the person calibrating the instruments.  Operation of Laboratory Instruments Ranging from a Simple Microscope to Complex Automated Equipment These operations and manipulations of instruments are routine for medical technologists, whether it is part of their daily work or a case of troubleshooting. The onus is on the assigned medical technologist to report major issues, such as defective instruments, to the supplier’s technical team, and also to the pathologist or concerned program head. Conducting of Research Activities and Exploration of New Discoveries in the Field of Science and Biotechnology Research activities done by medical technologists assigned to a school-based laboratory are carried out for professional growth. They also assist medical technology students in doing their undergraduate thesis. The involvement of the medical technologists in research activities is usually supported by the institution, as the research outcome should benefit the entire institution concerned. Collection of Laboratory Specimens for Examination As a standard operating procedure in a clinical laboratory, the medical technologist should observe the right protocol in specimen collection and processing. Moreover, in a school-based setting, the collection of specimens is usually carried out by the students, but under the supervision of their professors who are also registered medical technologists. The specimens collected are usually the subject of the experimentation in a school-based laboratory, and these include blood, feces, urine, saliva, and microbial cultures. Precautionary measures are observed during such experimentation; the handling and management of laboratory specimens are monitored by the government agency affiliated with the concerned institution.