pmls prelim 1st yr.pdf

Hippocrates Father of Medicine, the author of "Hippocrate Oath" Galen A greek physician, described diabetes as "diarrhea of urine" 18th Century Mechanical techniques and cadaver dissections were used to provide a more objective and accurate diagnosis. 19th Century Physician began to use machine F...

Hippocrates Father of Medicine, the author of "Hippocrate Oath" Galen A greek physician, described diabetes as "diarrhea of urine" 18th Century Mechanical techniques and cadaver dissections were used to provide a more objective and accurate diagnosis. 19th Century Physician began to use machine For diagnosis or therapeutics Spirometer Measuring vital capacity of the lungs Sphygmomanometer measuring blood pressure The inventor of Spirometer: John Hutchinson (1846) 4 Humors / Fluids - Blood - Urine - Yellow bile - Black Bile In the mid-1800s laboratones designed for analyzing medical specimens were organized by chemical experts. Technical laboratories regulated by the Centers for Disease Control and Prevention (CDC) began to be used for medical diagnostics in the US by mid-1900 s In the early 20th century, improvements in basic sciences and integration of scientific and technological discoveries marked the advances in medical technology. Medical technologists also made impacts on various surgical procedures Further integration of technology with science ushered in new medical advancements such as the electron microscope, new medical imaging technologies, and prosthetic devices The adaptation of computers in medical researches led to the development of tomography and magnetic resonance imagingl (MRI) History of Medical Technology in The United States In 1895, the University of Pennsylvania's William Pepper Laboratory of Clinical Medicine was opened to highlight the service role of clinical laboratories In 1918 John Kolmer called for the development of a method that would certify medical technologists on a national scale. He published The Demand for and Training of Laboratory Technicians that included a description of the first formal training course in Medical Technology, In 1920, the administrative units of clinical laboratories in large hospitals were directed by a chief physician During this time, clinical laboratories consisted of of 4 to 5 divisions including clinical pathology bacteriology microbiology serology, and radiology, As clinical laboratories held more prominence in the delivery of laboratory tests, the need for technicians and technologists that would assist physicians became greater. In 1922 the American Society for Clinical Pathology (ASCP) was founded with the objective of encouraging the cooperation between physicians and clinical pathologists as well as maintaining the status of clinical pathologists ASCP also established in code of ethics for technicians and technologists stating that these allied health professionals should work under the supervision of a physician and refrain from making oral or written diagnosis and advising physicians on how patients should be treated The American Society for Clinical Laboratory Science (formerly American Society for Medical Technologists) was originally formed as sungroup of ASCP, helped in the recognition of nonphysician clinical laboratory scientists as autonomous professionals In the 1950s, medical technologists in the United States sought professional recognition from the government of their educational qualifications through licensure laws. History of Medical technology in The Philippines 16th century - Spanish Occupation Spanish empire had occupied Luzon and established Manila as their capital Hospital Real ○ the first hospital founded by the Spaniards in Cebu in 1565; transferred to Manila for military patients Along with Spanish occupiers, came the members of religious orders aiming to spread Catholic faith They established hospitals for the poor and institutions of higher learning for the population of mestizo and criollo elite. Early Hospitals (Spanish Occupation) San Lazaro Hospital (1578) for poor and lepers. Hospital de San Juan de Dios (1596) for poor Spaniards. Hospital de San jose in Cavite (1641) Hospital de Naturales Hospital de la Misericordia Hospital de San Pedro Martir Hospital de San Gabriel University of Sto. Tomas - Foundedby Dominicans in 1611 - organized Philippines first faculties of medicine and pharmacy in 1871 Scientific and Medical Journals Boletin de medicina de Manila (1886) Revista farmacêutica de Filipinas (1893) Crónicas de ciencias médicas (1895) The medicos titulares or provincial medical officers were first appointed in 1876 The board of Health and Charity was established in 1883 and expanded in 1886 The central board of vaccination has been producing and distributing lymph since 1806 and by 1898, there were 122 regular vaccinators in Manila and other major towns Laboratorio Municipal de Manila Established by Spanish colonial authorities in 1887, for lab exam of food, water and clinical samples Rarely used, only for outbreaks Gen. Antonio Luna Was employed in 1894 as a chemical expert in the said lab and pioneered environmental studies, water testing and forensics. By the end of Spanish colonial rule modern structures were emerging Toward the end of the century ○ Spanish authorities began applying the new knowledge of microbial causes of disease After the end of the Spanish- American War in 1898, Spain ceded the R ownership of the Philippines to the US. The success of the 1896 Philippine revolution was never recognized by Spain and the U S and this led to the Philippine- American war from 1899-1902 causing the Spanish health system to break down completely. American Occupation Lieutenant Colonel Henry Lippincott. chief surgeon for the Division of the Pacific and eight Army Corps converted the military hospital into the First Reserve Hospital in August 1898 after the fall of Manila. The First Reserve Hospital faltered when Charles R. MacVay II of the Medical Corps contracted typhoid fever and rapidly succumbed to the disease barely 2 months after beginning his work. Richard P.Strong performed autopsies and made cultures of blood, feces and urine July 1901 the Philippine Commission had established a Bureau of Government laboratories through the Philippine Commission Act No. 156 It consist initially of biological and chemical section, science library and serum lab for vaccine production and was located along Calle Herran The bio lab was expected to provide facilities for investigation of the causes, pathology and methods of diagnosing and combating diseases and perform routine biological works The chem lab investigated food, drug and plant composition and mineral resources Paul C. Freer Firstdirector of the bureau 1904 - an equipped lab was built ( with microscopes, incubators, sterilizers, microtomes glasswares, stains, chemicals and small animals) On The ground floor, a room was given over for preparation of culture media and steam provided for sterilizers and autoclaves The Building was destroyed during world war II and the location was now occupied by UP- Manila National Institutes of Health 1905 Bureau of Science was created Worked alongside the Army Board for the study of tropical diseases until disbanded in 1914 The Bureau of Science became an active center for scientific instruction and research The management was transferred to the American civil regime Each day they examined: 100 samples of body fluids and secretions In 1909 alone the lot received 101 specimens of blood, 900 urine specimens and 7000 fecal specimens they are concerned with Cholera Malaria tuberculosis Leprosy Dysentery Enteric fever Civilian Board of Health was changed to Bureau of Health 1899,the Board of health started a municipal lab under W.V.Calvert They worked on urinary analysis in cases of poisoning analysis of drinking water and detection of harmful adulterations of food and drinks Eddie Guy The first commissioner of the Board of Health Bacteriological department was added to municipal lab The bureau Was reorganized as the Philippine health service in 1915 and reverted back as the bureau of health in 1933 June 1927, the College of Public Health of the UP was formally opened with the Certificate in Public Health Program Originally called the School of Public Health and Welfare Bureau of health was reorganized in 1940 as the Department of Public Health and Welfare During this time, the Philippines was in the lead The bright public health landscape turned into gloom during World War II It aims to establish formal training of medical officers in the Philippine Health Service and was originally called the School of Sanitation and Public Health Japanese Occupation December 8, 1941 ○ surprise attack of Japan; just 10 hours after the attack on Pearl Harbor functions of the Medical laboratory during that time Routine water analysis Special examination of meat, food and dairy supplies Investigation of epidemics and epizootics Distribution of special reagents, solutions, culture media and diagnostics biologicals not furnished through routine channels On behalf of US army medical units, the lab performed special serological, bacteriological, pathological and chemical examinations Post-mortem examinations Collected and preserved pathological specimens of historical or educational value to the US Army Medical Department The 3d medical laboratory was the first lab unit to be deployed in the SWPA (Southwest Pacific Asia) having arrived in Australia on June 18,1942 It rendered theater-wide lab service and detached mobile units and advance sections into New Guinea Following the initial landings by US forces in Leyte on October 20,1944 and the successful occupation of the Philippine islands, the lab in SWPA then included the 3d, 5th and 8 th  Medical laboratories; these and 19"h Medical general Laboratory were transferred to the West Pacific Area Laboratory services were established during the early phases of operations in the Philippine Islands The detachment of the 19th Medical General Laboratory which landed on Leyte was joined by the 27th Medical Laboratory on Nov. 12, 1944, the latter setting up station in Tacloban The advance section of the 3d Medical Laboratory and the 363d Medical Composite Detachment operated on Leyte When the US force bypasses the major concentration of the Japanese to invade Luzon, the 26th Medical Laboratory arrived in Lingayen Gulf 12 days after the date of the invasion on Jan 9, 1945 It was the only lab unit in Luzon for the succeeding 6-month period 1944 - training of the high school graduates started 6th US army including the personnel of the 26th Medical Lab left the Philippines at the end of the WW II in June 1945 The lab was endorsed to the Department of Health but was neglected Spanish empire had occupied Luzon and established Dr. Alfredo Pio de Roda, who was among the dislocated staff of the 6th United States Army, took pain in preserving the remnants of 26th Medical Laboratory Dr. Mariano Icasiano - city health officer of Manila who was consulted by Dr.de Roda to organize a new medical laboratory at Quiricada Street, Sta. Cruz, Manila ( Manila Public Health Laboratory) Training program was later conducted in collaboration with Dr. Prudencio Sta. Ana. Trainees were mostly high school graduates and paramedical graduates No specific or definite periods of training and no certificates were issued thus Dr.de Roda instructed Dr. Sta Ana to prepare a 6-month formal syllabus Dr. Tirso Briones joined the two later in the training program 1954 - Formal 4-year course for Bachelor of Science in Medical Technology was approved by the Bureau of Private Education Manila Sanitarium and Hospital (MSH) - the first school of Medical Technology in the same year It was under the leadership of Mrs. Willa Hedrick, the wife of Dr. Elvin Hedrick The hospital started its medical internship and residency-training program in Loma Linda University in California, USA The school of Medtech as later absorbed by Philippine Union College (PUC), located in Baesa, Caloocan City Mr.Jesse Umali was the first graduate who later took a medical course at FEU and became a successful OB- gynecologist in the US School Year 1957-1958 Dr. Antonio Gabriel and Dr. Gustavo Reyes of the Faculty of Pharmacy of UST offered medical technology as an elective to 4th and 5th year Pharmacy students Rev Fr. Lorenzo Rodriguez offered it as a course in UST due to the popularity of the course Temporary permit issued on June 17, 1957 June 14, 1961 Full recognition for the BS Medical Technology course was given to UST Other schools followed with more than 120 schools offering medical technology in the. Philippines as to date UP offers a similar program but the title conferred is BS Public Health  Postgraduate studies offered by UST, Phill Women's University and University of San Agustin, LPU - MS Medical technology UP offers a similar postgraduate degree - MS Public Health\ Lyceum of Batangas 1970 Lyceum of batangas offered the BS medical technology program August 20, 1974 Full recognition was given to Lyceum of Batangas by the Department of Education (Government Recognition No. 138, S. 1974 with Julian Yballe as Director of Private Schools and Jose Manuel as Secretary of Education Programs: Bachelor of Science in Medical Technology Associate in Health Science Education (AHSE) /1998- 2006) Bachelor of Science in Medical Laboratory Science (2006-2011) Bachelor of Science in Medical Laboratory Science (2012) Diploma in Phlebotomy (2012). Historical Milestones in Medical Technology Timeline Anton Van Leeuwenhoek the father of Microbiology and known for his work on the improvement of the microscope 1796 Edward Jenner Discovered vaccination to establish immunity to smallpox; impact of contribution Immunology 1800 Marie Francois Xavier Bichat Identified organs. by their types of tissues, founding histology; impact of contribution Histology= 1835 Agostino Bassi produced disease in worms by injection of organic material-the beginning of bacteriology. 1857 Louis Pasteur Successfully produced immunity to rabies 1866 Gregor Mendel Enunciated his law of inherited characteristics from studies on plants 1870 Joseph Lister Demonstrated that surgical infections are caused by airborne organisms 1877 Robert Koch Presented the first pictures of bacilli (anthrax) and later tubercle bacilli 1886 Elie Metchnikoff Describe phagocytes in blood and their role in fighting infection Ernst Von Bergmann Introduced steam sterilization in surgery 1902 Karl Landsteiner identified and named blood group antigens the ABO 1906 August Von Wasserman Developed immunologic tests for syphilis Howard Ricketts Discovered microorganisms whose range lies between bacteria and viruses called rickettsiae 1929 Hans Fischer Worked out the structure of hemoglobin 1954 Jonas Salk Developed poliomyelitis vaccine 1973 James Westguard Introduced the westgard control rules into clinical laboratory quality control Baruch Samuel Blumberg (1980) introduced the Hepatitis B vaccine Kary Mulli (1985) developed the PCR Andre van Steirteahem (1992) introduced the intracytoplasmic sperm injection (TVT) James Thompson (1998) derived the first human A medical laboratory scientist, often known as a medical technologist or a clinical laboratory scientist is responsible for analyzing a wide range of biological material. Medical laboratory experts use sophisticated technology such as microscopes to perform complex tests on patient samples. The results of the tests performed by medical laboratory scientists are thought to account for 60 to 70% of all choices on a patient's diagnosis, treatment, hospital admission, and discharge. Examining and analyzing blood, body fluids, tissues, and cells Relaying test results to physicians Utilizing microscopes, cell counters, and other high- precision lab equipment Cross matching blood for transfusion Monitoring patient outcomes  Performing differential cell counts looking for abnormal cells to aid in the diagnosis of anemia and leukemia Establishing quality assurance programs to monitor and ensure the accuracy of test results Overseeing the work of a medical laboratory technician Cardinal RUles in Meftech 1. Mislabelling is a sin 2. Treat all specimen as a contagious a. PPE (mask, gloves, lab coats, hair net, booties, googles) 3. Treat patient as people not specimen Work environment Hospitals Clinics Forensic or public health laboratories Pharmaceutical industries Biotechnology firms Veterinary clinics Research institutions Their work hours may vary depending on the location, but labs are typically open 24 hours a day, seven days a week. This allows for scheduling flexibility. The majority of medical laboratory scientists work on their feet, analyzing test results in the lab. Becoming a laboratory scientists Completing a bachelor's degree in medical technology or clinical laboratory science. A bachelor's degree in a science or health related field (e.g. chemistry or microbiology) may also be considered. Completing a clinical laboratory program or internship through a hospital-based program or as part of their education National certification as a medical technologist (MT), clinical laboratory scientist (CLS), or medical laboratory scientist (MLS) Previous experience in a health care setting The vast majority of companies require medical laboratory scientists to be certified by an accrediting body, such as the American Society for Clinical Pathology (ASCP), Board of Certification (BOC). Medical laboratory scientists (MLS) can practice under the credentials of MLS(ASCP)CM after passing the credentialing exam. Licensure by state is also required After obtaining a high school diploma (or the equivalent), most will go on to obtain some level of higher education and training in order to become a medical laboratory scientist. Common higher education requirements for medical laboratory scientist jobs include: Successful medical lab scientists are good at communicating with a strong intellect and a passion for science and technology. Excellent eye-hand coordination, dexterity, and visual acuity are required to perform and analyze tests skilfully. Individuals who enjoy science and research but prefer to have little to no contact with patients would be a good fit for a career as a medical laboratory scientist. According to the Bureau of Labor Statistics, there is currently a shortage of medical lab technicians and scientists in many parts of the country, ensuring plenty of job opportunities and, in some cases, higher pay for graduates. Others may seek specializations to advance their careers. Typically, a medical lab technician will progress to a medical lab scientist with more training. The clinical laboratory Laboratory Organizational Divisions: Department of Pathology Anatomical Responsible for the analysis of tissues from the body including surgical specimens, frozen sections, biopsies, cytological specimens autopsies Anatomical Cytology: looking for abnormal cells (ie, cancer) Cytologic specimens (tissue & body fluids) Pap smears Histology Surgical specimens Frozen sections Biopsies Autopsies Cytogenetics Genetic testing (blood, amniotic fluid, tissue & bone marrow) Laboratory Organizational Divisions Department of Pathology continued Clinical Hematology/ Coagulation Chemistry Blood Bank Serology microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS) Clinical Laboratory Organizational Chart Clinical Laboratory Anatomical Cytology Histology Cytogenetics Clinical Hematology Coagulation Chemistry Blood bank Serology (immunology) Microbiology Urinalysis Phlebotomy Hematology RBCs, WBCs and platelets are counted and classified Most common body fluid analyzed is whole blood (blood as it comes from the client without removing any components) Whole blood is obtained using collection tube with an anticoagulant to prevent clotting ○ Lavender collection tubes ○ Anticoagulant EDTA (Ethylene Diamine tetraacetic acid ○ Requires immediate inversion of tube 8 times to activate Lab Section: Hematology The study of the formed (cellular) elements of the blood for the purpose of making a diagnosis Blood is analyzed as whole, plasma or serum Plasma: liquid portion of blood from a specimen that has not been allowed to clot; contains fibrinogen Serum: specimen allowed to clot; no fibrinogen Complete Blood Count (CBC) most common whole blood test White Blood Cell (WBC) Count ○ is a count of the actual number of white blood cells per volume of blood. White Blood Cell differential ○ looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. Red Blood Cell (RBC) count ○ is a count of the actual number of red blood cells per volume of blood Both increases and decreases can point to abnormal conditions. Hemoglobin ○ measures the amount of oxygen- carrying protein in the blood Hematocrit ○ measures the percentage of red blood cells in a given volume of whole blood Complete Blood Count (CBC) most common whole blood test continued: The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin Inside a red cell Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. Coagulation Studies in Hematology Coagulation Studies (clotting times) PT and PTT Light Blue collection tubes Anticoagulant used is sodium citrate Must be returned to the lab in 30 minutes Chemistry Study of components in the blood including enzymes, hormones, electrolytes, chemicals or poisons. Most automated area of the lab Tests performed on serum, plasma, urine and other body fluids Serum and plasma obtained by using the centrifuge ○ Must be completed within one hour of collection ○ Serum separator tubes contain gel ○ Must allow specimen to clot completely prior to centrifuge ○ Red, green, gray, dark blue collection tubes Chem 7 & Chem 17 most common tests to assess general health; gives your doctor important information about the current status of your kidneys, blood sugar, and electrolyte and acid/base balance Cardiac enzymes and drug screening also common Hema - Blood Cogos - to study Panelist Cholesterol Panel Sugar Panel Kidney Panel Liver Panel Heart Panel Pancreas panel Blood Bank Blood collection, storage and preparation for blood transfusion ○ Red-collection tubes additives will interfere ★ Blood typed and for blood group and Rh factor ★ Units (pints) collected and tested for presence of blood-borne pathogens; stored for transfusion ○ 42 days: how long most donated red blood cells can be stored ○ 5 days: how long most donated platelets can be stored ○ 1 year: how long frozen plasma can be stored ★ Autologous transfusion ○ Donate your own blood for personal transfusion if needed from upcoming surgery, usually beginning 3-5 weeks before procedure Most Common Test Type & Crossmatch ○ ABO, RH typing and compatibility Type & Screen ○ ABO, RH typing and antibody screen Group & type ○ ABO, RH typing Serology (immunology) Evaluates the body's immune response through the detection of antibodies to bacteria, fungi, parasites, and viruses and antibodies produced against body substances (autoimmunity) Most Common Tests ○ Anti-HIV Hepatitis B Surface Antigen ○ VDRL for syphilis ○ Western blot confirms HIV ○ HCG= pregnancy Red collection tubes Microbiology Identification of pathogens, effective antibiotic therapy and infection control Culture & Sensitivity most common procedure = ID pathogen & most effective antibiotic Bacteria is IDed based on morphology & gram stain reactions Types of Specimens ○ Blood ○ Sputum ○ Wounds ○ Feces ○ Urine ○ Gl tract ○ Throat Yellow collection tubes using sterile technique Most Common Tests ○ Blood culture  ○ Culture & Sensitivity ○ Gram stain ○ Ova & parasites Urinalysis Detects disorders and infections of the kidney and metabolic disorders such as Diabetes and liver disease through components present in the urine Urinalysis most common test Laboratory Managment Laboratory Director (Pathologist) ○ Credentials Medical doctor (MD) ⁃ ○ Functions anatomic pathology Clinical pathology Laboratory Manager (Administrator) - ○ Credentials Master's degree and 5 or more years of laboratory experience ○ Functions - Technical and administrative management Clinical Laboratory Personnel Medical Laboratory Scientist (MLS) ○ Bachelor of science degree (4 year) ○ Performs laboratory testing requiring independent Judgment ○ Minimal supervision Medical Laboratory Technician (MLT) ○ Associate degree (2 year) ○ Performs laboratory testing by protocol under supervision Phlebotomist (PBT) ○ High school diploma Phlebotomy training program Sample collection and processing Position Pathologist ○ BS ○ MD ○ RP Chief Medtech ○ BS ○ RMT ○ MA Section Head ○ BS ○ RMT ○ MA Staff on duty / charge ○ BS ○ RMT Medtechinician ○ BS - 65-74% ○ MedTechcian Interns Historical figures in healthcare Hippocrates (460-377 BC) Greek physician known as the "Father of Medicine Authored code of conduct for doctors known as the "Hippocratic Oath" that is the basis of medical practice tod Believed illness was not caused by evil spirits and stressed importance of good diet, fresh Anton van Leeuwenhoek (1632-1723) Invented the microscope lens that allowed visualization of organisms Scraped his teeth and observed the bacteria that causes tooth Benjamin Franklin (1706-1790) invented bifocals Found that colds could be passed from person to person Ephraim McDowell (1771 - 1830) Surgeon from Danville, Ky. Performed the first ovariectomy - (surgical removal of the ovary) - to remove a 22 pound tumor Edward Jenner (1749-1823) Developed a vaccination for smallpox in 1796 Rene Laennec (1781-1826) Invented the stethoscope in 1819 First stethoscope was made of wood Elizabeth Blackwell (1821-1910) First female physician in the United States in 1849 Florence Nightingale (1820-1910) Known as the "Founder of Modern Nursing" Established efficient and sanitary nursing units during the Crimean War in 1854 Invented the call bell system and use of dumbwaiters to deliver meals Louis Pasteur (1822-1895) Known as the "Father of Microbiology" His germ theory proved that microorganisms cause disease Proved that heat can be used to destroy germs through a process called pasteurization Created a vaccine for rabies in 1885 Founded the basic rules for Joseph Lister (1827-1912) Used carbolic acid on wounds to kill germs First doctor to use an antiseptic during surgery Clara Barton (1821-1912) Volunteer nurse for wounded soldiers during the Civil War After Civil War, established a bureau of records to search for missing men Campaigned for the USA to sign the Treaty of Geneva, which provided relief for sick and wounded soldiers Formed American Red Cross Robert Koch (1843-1910) Developed the culture plate method to identify pathogens Isolated the bacterium that causes tuberculosis Wilhelm Roentgen (1845-1923) Discovered roentgenograms (X-rays) in 1895 Let doctors see inside the body X-rayed wife's hand Sigmund Freud (1836-1939) Discovered the conscious and unconscious part of the mind His studies were the basis for psychology and psychiatry Sir Alexander Fleming (1881-1955) Discovered penicillin in 1928 which is considered one of the most important discoveries of the twentieth century Jonas Salk (1914-1995) Albert Sabin (1906 - 1993) Discovered polio vaccine Saved many people from this virus that paralyzed thousands of adults and children each year. Francis Crick (1916 - 2004) James Watson (1928 - ) Described the structure of DNA and how it carries genetic information in 1953 Built a three-dimensional model of the molecules of DNA Shared the Noble Prize in 1962 Christian Barnard (1922 - 2001) Performed first successful heart transplant in 1968 Robert Jarvik Creator of the first artificial heart On December 2, 1982, it was implanted into Barney Clark, who lived for the next 112 days The second patient, William Ben Carson (1951 ) Famous for his surgeries to separate Siamese twins Currently Director of Pediatric Neurosurgery at John Hopkins  He has refined hemispherectomy, a surgery on the brain Healthcare Technology & Medical Innovations What is healthcare technology? Application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives Top 10 Medical Innovations Some of the innovations that will optimize/change HC: 1. Next Generation of mRNA Vaccinology 2. PSMA-Targeted Therapy in Prostate Cancer 3. New Treatment for the Reduction of LDL 4. Novel Drug for Treatment of Type 2 Diabetes [One potential therapy is a once-weekly injectable dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide receptor agonist (GLP-1) that aims to control blood sugar.] 5. Breakthrough Treatment for Postpartum Depression 6. Targeted Medication for Hypertrophic Cardiomyopathy 7. Non-Hormonal Alternatives for Menopause 8. Implantable for Severe Paralysis 9. AI for Early Detection of Sepsis 10. Predictive Analytics and Hypertension Medical Innovations to Watch 1. Advancing mRNA technology 2. Patients embracing telehealth 3. Adapting to data integration and AI 4. Securing healthcare data 5. Creating new pharmaceutical products 6. Implementing 3D printing 7. Adjusting to wearables and in-home testing [More and more people are wearing Apple Watches and other wearable devices that can track steps taken, heartbeats, blood oxygen levels and sleep patterns. Physicians and advanced practice clinicians will need to incorporate the results from patients using these devices and others to monitor their health] Future of Health: Digital Innovations 1. Connected Digital Care- Remote patient monitoring is a key part of the “internet of health.” It will allow healthcare providers to monitor a wider range of patients. 2. AI - is playing an important role in the evolution of the internet of health because it has the ability to analyze and make sense of massive amounts of data, find patterns and make predictions. AI can also assist in managing care by providing decision support. 3. Real-World Patient Engagement In Healthcare - online communities where patients can share their experiences and support each other.  4. Increase Security For Digital And Health Data - adopting a data-centric approach, using encryption and employing AI for cybersecurity. A data-centric approach enables organizations to protect their data regardless of where it is stored—on the Internet, on servers or on end users’ devices. Using encryption to protect data at rest and in transit can also help protect digital and health data from cyberthreats. 5. Improving Telehealth Services - Some of the most common telehealth activities are remote patient monitoring, online doctor visits and virtual visits. For example, remote patient monitoring can be used to help patients with chronic diseases such as pain monitor their conditions. Medical Technologies Purpose / Application Prevention: Vaccines; Iodized Salt Screening: pap smear; mammography Diagnosis: ECG; Blood Tests Treatment: ARVs, Appendectomy Rehabilitation: Hearing Aid; Physiotherapy Material Nature Medical Nature Pharmaceuticals Biologics Medical devices Miscellaneous ○ Medical & surgical procedures ○ Support systems ○ Managerial systems Evolution of Medical Innovation Three mile-stone medical innovations: Vaccine: Small-pox vaccine 1796 Medical device: Hypodermic syringe 1844 Pharmaceutical: Arsphenamine: 1910 From Edward Jenner to Gavi Up to 20% of deaths in Europe were dues to smallpox in 19th century The last case of smallpox occurred in 1977. 2.5 million deaths each year are prevented. Between 80-90% of infants receive DPT vaccine Medical Devices From adhesive plaster to MRI 1844, Francis Rynd, first recorded subcutaneous injection. 1956, plastic disposable syringe patented 1.3 million/year deaths due to unsafe injections Auto-destruct syringes, prefilled syringes 1800-1850 First “modern” stethoscopes, laryngoscopes, ophthalmoscopes 1895 Discovered by german physicist wilhelm roentgen 1903 First electrocardiograph ○ Developed by dutch physician and physiologist Willem Einthoven (awarded the nobel prize in 1924 for his discovery 1927 First modern respirator ○ Devised by united states medical researcher Philip Drinker and his colleagues at harvard university 1928 First cardiac catheterization ○ Performed by werner foesmann on himself to show feasibility of technique for injecting drugs directly into the heart (co-recipient of the nobel prize in physiology or medicine in 1956) 1940 First metallic hip replacement surgery ○ Performed by United states surgeon Dr. Austin T. Moore 1945 First kidney dialysis machine ○ Invented by dutch-born physician Willem Kolif 1950 First artificial hip replacement (arthroplasty) ○ Performed by english surgeon sir john charnley 1951 First commercially available artificial heart valve ○ Invented by a united stats team led by electrical engineer Miles edwards 1952 First successful (external) cardiac pacemaker  ○ Developed by united states cardiologist Paul Zoll 1960 First totally internal pacemaker ○ Developed by united states electrical engineer Wilson Greatbatch 1970 First computerized axial tomography (ct) scanner ○ Developed by british electrical engineer Godfrey Hounsfield and South Africa born physicist Allen Cormack (jointly awarded the 1979 nobel prize for medicine) 1972 First laparoscopic procedure performed Pulse oximeter ○ Invented by japanese biomedical engineer Takuo Aoyagi 1976 First regulatory system for medical devices ○ Created by the united states government First position emission (PET) scanning of people ○ Performed by Abass Alavi, university of Pennsylvania 1977 First magnetic resonance imaging (MRI) device capable of a full body scan ○ Build by a united states team led by physician Raymond Damadian 1978 First multichannel cochlear implant ○ Invented by Australian bionics expert Graeme Clark 1982 First permanent artificial heart - Design by dutch-born physician Williem Kolif and colleagues 1985 First implantable cardioverter defibrillator ○ Invented by Polish cardiologist Michel Mirowski First Robot-assisted Surgical performed 1993 First european union regulatory system ○ Created for medical devices Development of most influential pharmaceuticals The future of healthcare innovations 1. Vaccines to prevent public health epidemics a. Vaccines to prevent public health epidemics such as ebola and meningococcal B get fast-tracked for approval so patients can receive them earlier 2. Genemoc directed clinical trials a. Genetic profiling of patients better matcher them to clinical trials, which increases their chance of benefiting from research studies 3. Gene editing using CRISPR a. Crispr is a therapy in which the human genome is altered in an effort to eliminate genetic-based disease. 4. Water purification systems for prevention of infectious diseases a. A self-sustainable processor turn solid waste and sewer sludge into safe drinking water for hundreds of thousands of people 5. Cell free fetal DNA testing a. A non-invasive diagnostic test has a tenfold better chance of diagnosing Down's syndrome in a fetus 6. Cancer screening via protein biomarker analysis a. A test that detects changes in the structure of certain blood proteins can diagnose many types of cancer with high accuracy 7. Naturally controlled artificial limbs  a. sensors pick up neutral codes sent by the brain and send them to computers to be deciphered and used to operate prosthetic limbs 8. First-ever treatment for HSDD a. A drug restores sexual desire in premenopausal women who have no medical-based explanation for their loss of libido 9. Frictionless remote monitoring a. Devices that allow health care providers to monitor patients from afar - such as needle-free glucose monitoring, which use biosensors on the skin to collect information on glucose levels. 10. Neurovascular stent retriever a. A new device, used alongside standard treatment for stroke, removes clots and results in speedier recovery for patients and a better chance for independence First human head transplant Head transplantation is considered to be an extraordinary and impossible surgical procedure This innovative surgery promises a life-saving procedure to individuals who suffer from a terminal disease, but whose head and brain are healthy. In 2017, Ren et al performed successfully a cephalosomatic anastomosis using a human cadaver Two surgical teams participate and work simultaneously in order to conduct the procedure. Ethics aside, the brain is a delicate organ, and the spinal cord, which connects to the brain, does not recover well after being cut. The longest-lived have made it only a few months. Though a few researchers have made headlines by claiming head transplants in humans are just around the corner, the hurdles are massive. Robotic nurse assistant There are nurses that are injured every year from having to move or lift patients in bed or after an emergency from a fall. The problem is very common and many of times there is not someone around that is strong enough to lift a patient immediately after one of these occurrences. There are many variations from a full robot such as RIBA (Robot for Interactive Body Assistance) developed by RIKEN and Tokai Rubber Industries and assisted hardware such as HAL (Hybrid Assistive Limb) robot suits delivered by Cyberdyne. RIBA is the first robot that can lift up or set down a real human from or to a bed or wheelchair. RIBA does this using its very strong human-like arms and by novel tactile guidance methods using high-accuracy tactile sensors. RIBA was developed by integrating RIKEN’s control, sensor, and information processing and TRI’s material and structural design technologies. A company by the name of HAL is a robotics device that allows a care worker to life a patient with more stability and strength and helps prevent injuries to our nurses. Anti-aging drugs The dream, or the nightmare, depending on how you take it, is living forever, or at least in the foreseeable future to 120+ years old. 2016 will be the year of a new anti-aging drug test that will enter trials which could see diseases like Alzheimer’s and Parkinson’s consigned to distant memory. Scientists now believe that it is possible to actually stop people growing old as quickly and help them live in good health well into their 110s and 120s. Electronic Underwear Preventing Bed Sores Having elderly grandparents that have died from complications due to bedsores is extremely unfortunate, as much of these issues could be prevented. When patients stay motionless for days, weeks, or months they develop painful open wounds due to lack of circulation and compressed skin. Long Lasting Batteries for Medical Devices and Wearables The need for power is evident in today’s world, for our houses, cars, and medical devices such as pacemaker batteries that typically need to be replaced with an expensive surgery. With the need for power-hungry devices comes innovation in the form of new technologies that will help provide the world with longer lasting, faster charging batteries. Aluminum-Ion Batteries: Chemistry Professor Hongjie Dai from Stanford University and his team say their aluminum-ion battery prototype can fully charge a phone in one minute and maintain its strength through thousands of recharge cycles — over seven times as many cycles as current phone batteries. Perhaps the battery’s most impressive quality is its flexibility, meaning it could work with any future devices that are curved or use bendable screens. Micro Supercapacitors: Rice’s micro super capacitors charge 50 times faster than batteries, discharge more slowly than traditional capacitors and match commercial super capacitors for both the amount of energy stored and power delivered. Foam Batteries: The future of batteries is 3D. Prieto is the first company to crack this with its battery that uses a copper foam substrate. This means these batteries will not only be safer, thanks to no flammable electrolyte, but they will also offer longer life, faster charging, five times higher density, be cheaper to make and be smaller than current offerings. Skin Power: Researches from the National University of Singapore have created a replacement for batteries all together would be an electrode used to harvest the current caused by friction on the skin and clothes. The result is enough power, from a finger tap on skin, to power 12 LED bulbs. The future could mean there are no need for batteries in wearables or smart clothes. Some weird & wonderful Surgical Procedures Rotationplasty: turning an ankle into knee Rotationplasty is an extraordinary form of reconstructive surgery that enables the ankle to be used as a knee joint. The procedure involves the surgical removal of the bottom of the femur, the knee, and the upper tibia. The lower part of the leg is then rotated 180 degrees and attached to the thigh. Put simply, the foot is attached to the knee backward. Once a prosthesis is fitted, the ankle of the foot functions as a knee. Rotationplasty is most commonly performed in children who have malignant bone tumors - such as osteosarcoma or Ewing sarcoma - near the knee that have not responded to other treatments. Often referred to as "tooth-in-eye" surgery, osteo-odonto-keratoprosthesis (OOKP) is just that - using a tooth to restore a patient's sight. OOKP involves using a patient's tooth to restore vision. The procedure involves the removal of a patient's canine or premolar tooth and the surrounding bone; the technique uses the patient's own tooth as the body is unlikely to reject it. A hole is then drilled in the tooth and a plastic lens is inserted. The lens-tooth structure is then implanted into the patient's cheek, where it grows new blood vessels over a few months. The structure is then removed from the cheek and implanted into the eye. Light is able to travel through the lens, restoring the patient's vision. Removing half of the brain: hemispherectomy The brain is the most complex organ of the human body, containing billions of nerve cells that act as the command center for physical and psychological functions. Hemispherectomy involves the partial or total removal or disconnection of one of the two hemispheres of the brain. It is considered a radical procedure, which can take as long as 12 hours to complete. One of the two hemispheres of the brain are removed or disconnected.  The procedure is usually performed on individuals who have neurological disorders that cause seizures on one side of the brain: epilepsy, perinatal stroke, hemimegalencephaly (where one side of the brain is larger than the other), Sturge-Weber-Dimitri disease (characterized by facial birthmarks, glaucoma, and seizures), and Rasmussen's encephalitis (inflammation of the cerebral cortex). Heterotopic heart transplant: two hearts may be better than one Heterotopic heart transplantation - also known as "piggyback" heart transplantation - involves implanting a healthy donor heart on the right side of the recipient's damaged heart. Both hearts are surgically attached, allowing blood from the damaged heart to flow into the new heart. The new heart can then pump blood around the body. AI technology in healthcare Many current efforts to incorporate artificial intelligence in healthcare are focused on clinical-decision support and uncovering useful insights from large collections of data. Healthcare organizations have accumulated so much data that it would be impossible to analyze it without AI. AI-enabled tools can sift through the large and complex data sets generated from electronic records, notes, images, sensors and devices to find trends that could improve patient care and help researchers develop better treatments for medical conditions. Although AI technology is still relatively new, there are many use cases that could benefit organizations across the healthcare industry. Blockchain in healthcare Blockchain technology in the healthcare industry offers a user-centered way for health information to be securely gathered, verified and shared. Most blockchain systems provide a transparent, distributed ledger of records that cannot be changed without the changes being recorded. The technology can be used to anonymize and safeguards patient data while also providing full transparency and interoperability across diverse, distributed and highly fragmented healthcare systems. Cloud computing in healthcare When most people think of cloud technology, they think of the cloud as a place to store data. Yet cloud environments do more than passive data storage. Cloud environments offer ways for healthcare organizations to build and customize applications that can automate how data moves through their information technology systems. Hybrid cloud environments in particular, offer security features that can help organizations maintain compliance with HIPAA and other regulations while giving them the flexibility they need to move data around to where it needs to go. This flexibility also provides healthcare providers with more options for updating existing legacy systems and workflows. Cloud adoption opens up opportunities for organizations to use AI and machine learning tools too, which can help uncover hidden patterns and insights that improve how care is delivered. Telehealth technology During the COVID19 pandemic, many providers pivoted to offering appointments through telemedicine. Many payers also adapted to these changes by offering equitable reimbursement for telemedicine and providing better billing options. Even after the pandemic subsides, the technology ecosystem that supports telemedicine will most likely persist due to the convenience and flexibility it provides. Patients, especially people who live in remote locations or who work outside of traditional business hours, appreciate having more options for connecting with clinicians whether they're using video software on a computer or a mobile app on their phones. Driving interoperability through technology Interoperability, which is a seamless exchange of data across systems and organizations, is crucial for driving digital transformation in the healthcare industry. It creates benefits for patients and providers by making relevant data easier to access without sacrificing security or privacy. When clinicians have to do less work to find the information they need, they have more time to focus on making the best decisions for their patients. Moreover, healthcare interoperability can lower the total cost of care by reducing the number of unnecessary or repeated tests as well as helping clinicians make diagnoses sooner. How do we apply healthcare technology Disease diagnosis and treatment: Using AI to process data, like medical images, and develop disease models can potentially help clinicians make diagnoses with more precision Medical imaging: Computers and AI models are particularly valuable in medical imaging because they can help turn pictures into numbers and detect trends Healthcare operations Many hospitals and healthcare systems are starting to build on improvements they've seen with electronic medical records and find other ways to systematically improve their operations. Cloud technology, analytics and mobile technology are just a few of the technologies organizations are using to optimize their digital infrastructure. Clinical research Life sciences organizations are using technology to transform how clinical trials are being performed. Smart devices, telehealth visits and sensors are being used to support decentralized trials that make data collection more efficient and convenient for the people who participate. Snapshot Disruptive innovation is the process by which a smaller company-usually with fewer resources-moves upmarket and challenger larger, established businesses. “Disruptive innovation” and “disruptive technology” are now part of the popular business lexicon, as a suggested by the dramatic growth in the number of articles using those phrases in recent years Summary Last 75 years of medical innovation have been more productive than rest of the recorded human history 21st. Century is the Era of innovation for innovation The Best is yet to come Miles to go.................................. Microscope an optical instrument that is used to observe tiny objects, often objects that cannot be seen at all with the unaided human eye (the “naked eye”). Types of Microscope Brightfield microscope ○ Used to observed morphology of microorganisms such as bacteria, protozoa, fungi, and algae in living (unstained) and nonliving (stained) state ○ Cannot observed microbes less than 0.2 um in diameter or thickness, such as spirochetes and viruses Darkfield Microscope ○ Unstained organisms are observed against a dark background ○ Useful for examining thin spirochetes ○ Slightly more difficult to operate than brightfield Phase-Contrast Microscope ○ Can be used to observe unstained living microorganisms Fluorescence Microscope  ○ Fluorescent dye attached to organism (e.g., acridine orange and Auramine ©) ○ Primarily an immunodiagnostic technique (immunofluorescence) ○ Used to detect presence of microbes in cells, tissues, and clinical specimens Transmission-Electron Microscope (TEM) ○ Specimen is viewed on a screen ○ Excellent resolution ○ Allows examination of cellular and viral ultrastructure ○ Specimen is nonliving ○ Reveals internal features of thin specimens Scanning Electron Microscope (SEM) ○ Specimen is viewed on a screen ○ Gives the illusion of depth (three-dimensions) ○ Useful for examining surface features of cells and viruses ○ Specimen is nonliving ○ Resolution is less than that of TEM Simple Microscope defined as a microscope containing only one magnifying lens. Compound Microscope a microscope that contains more than one magnifying lens  1. Magnification - The ratio of the apparent size of an object as seen through the microscope & the actual size of the object 2. Resolution/Resolving Power - The ability of the lens to clearly separate or distinguish two points of two lines individually in the image. - It is determined by the shortest wavelength of visible light & maximum numerical aperture 3. Numerical Aperture - A measurement of the ability of the condenser and the objective lens to gather light. - (magnification α numerical aperture) Scanner: 4X : 0.10 LPO : 10X : 0.25 HPO : 40X : 0.65 OIO : 100X : 1.25 4. Focal length - Thickness of the object that maybe seen at one time under focus. - (focal length 1/α numerical aperture) 5. Working distance - Distance between the front lens of the objective lens & the top of the cover glass when the specimen is in focus. - (working distance 1/α magnification) 6. Parfocal - Refers to quality of the objectives & eyepiece where practically no change in focus has to be made when objective is substituted for another 7. Refractive Index - Bending of light rays away from the objective lens when light passes from the glass of the microscope slide to the air Care of Microscope The microscope should be cleaned with lens paper before and after each use Other material such as laboratory tissue may scratch the lenses  It is especially important that lenses never be left with oil on them Transporting the Microscope A microscope should be left in a permanent position on a study laboratory table in an area where it will not get jammed. If the microscope must be moved, it should be held securely with one hand supporting the base and the other hand holding the arm. The microscope should be placed gently on tabletops, to avoid jarring Storage of Microscope When the microscope is not being used, it should be left with the low power objective in position The stage should be centered so that it does not project from either side of the microscope The microscope should be stored in a plastic dust cover. Precautions: Use the coarse adjustment only with the low power objective Use oil immersion oil with the oil immersion objective only Clean all oculars and objectives with lens paper after each use Move or transport the microscope with one hand under the base and the other hand gripping the arm. Avoid jarring or bumping the microscope. Store the microscope covered in a protected area.