UNIT 1 PMLS PDF

EXPLORE In the Philippines, the practice of Medical Laboratory Science/ Medical Technology is defined in Republic Act (R.A.) No. 5527, also known as the Philippine Medical Technology Act of 1969. The said act defines the pra...

EXPLORE In the Philippines, the practice of Medical Laboratory Science/ Medical Technology is defined in Republic Act (R.A.) No. 5527, also known as the Philippine Medical Technology Act of 1969. The said act defines the practice of medical technology as an auxiliary branch of medicine which deals with examinations using various chemical, microscopic, bacteriologic, and other medical laboratory procedures or techniques that will aid the physician in diagnosis, study, and treatment of disease and in the promotion of health in general. EXPLAIN The Practice of Medical Technology Many definitions of Medical Technology have been published since its inception as a mainstream practice in the healthcare industry. Some of the earlier published definitions of the practice are presented below. Fagelson (1961): § Branch of medicine concerned with the performance of laboratory determinations and analyses used in the diagnosis and treatment of disease and the maintenance of health Walters (1966): § The health profession concerned with performing laboratory analyses in view of obtaining information necessary in the diagnosis and treatment of diseases as well as in the maintenance of good health Heinemann (1963): § Application of the principles of natural, physical, and biological sciences in laboratory procedures to aid in the diagnosis and treatment of diseases In the Philippines, the practice of Medical Technology is formally defined by Republic Act (R.A.) No. 5527, also known as the Philippine Medical Technology Act of 1969. R.A. 5527 is an act requiring the registration of medical technologists, defining their practices, and other purposes. Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 7  Practice of Medical Technology. Section 2 of the Philippine Medical Technology Act of 1969 states that a person shall be deemed to be in the practice of medical technology when for a fee, salary or other compensation or reward paid or given directly or indirectly through another any of the following professional services for the purpose of aiding the physician in the diagnosis, study and treatment of diseases and in the promotion of health in general: 1. Examination of tissues, secretions and excretions of the human body and body fluids by various electronic, chemical, microscopic, bacteriologic, hematologic, serologic, immunologic, nuclear, and other laboratory procedures and techniques either manual or automated; 2. Blood banking procedures and techniques; 3. Parasitologic, mycologic and microbiologic procedures and techniques; 4. Histopathologic and cytotechnology; provided that nothing in this paragraph shall inhibit a duly registered medical laboratory technician from performing histopathology techniques and procedures; 5. Clinical research involving patients or human beings requiring the use of and/or application of medical technology knowledge and procedures; 6. Preparations and standardization of reagents, standards, stains, and others, provided such reagents, standards, stains, and others are exclusively for the use of their laboratory; 7. Clinical laboratory quality control; 8. Collection and preservation of specimens; Conventionally, the profession of Medical Technology is practiced in a clinical laboratory, inside a blood bank, or in an anatomic laboratory. The traditional working sections of a clinical laboratory include clinical chemistry, hematology, serology, microbiology, clinical microscopy and parasitology. On the other hand, anatomic laboratories offer cytotechnology and histopathologic services. Depending on the structural organization of the hospital, a blood bank may be considered a section of the clinical laboratory or a separate department. The advent of technological advancements has also incorporated additional areas of discipline in the practice of Medical Technology. Advancements in the fields of biochemistry and molecular biology have led to the incorporation of molecular biology laboratories in the field of medical laboratory science. Molecular biology laboratories, which performs nucleic acid amplification tests and DNA-based assays, are often used in the detection of infectious diseases caused by viruses, bacteria, and other disease-causing microorganisms. The Laboratory Workers A. Medical Technologist According to section 2 of R.A. 5527, a medical technologist is a person who engages in the work of medical technology under the supervision of a pathologist or a licensed physician authorized by the Department of Health in places where there is no pathologist. Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 8  A medical technologist should have a degree in Bachelor of Science in Medical Technology (now known as Bachelor of Science in Medical Laboratory Science) or Bachelor of Science in Hygiene (now known as Bachelor of Science in Public Health). Moreover, he/ she should have passed the Board Examinations for Medical Technologists. B. Pathologist Section 2 of R.A. 5527 defines a pathologist as a duly registered physician who is specially trained in methods of laboratory medicine, or the gross and microscopic study and interpretation of tissues, secretions, and excretions of the human body and its functions in order to diagnose disease, follow its course, determine the effectivity of treatment, ascertain cause of death and advance medicine by means of research C. Medical Laboratory Technician A laboratory technician is a person certified and registered with the Board of Medical Technology as qualified to assist a medical technologist and/or qualified pathologist in the practice of medical technology D. Phlebotomist A phlebotomist is an individual trained to draw blood either for laboratory tests or for blood donations. In the Philippines, a medical technologist is required to be skilled in phlebotomy. Nowadays, phlebotomy is a skill confined not only to medical technologists but also to other health care practitioners as well, provided that they were given certification by a reputed certifying or training body. E. Blood Bank Technologists They are medical technologists who are specialized in the process of testing and preparation of blood and blood products for transfusion. F. Cytotechnologists Laboratory practitioners specialized in the preparation of cell slides for microscopic study and detection of cellular abnormalities G. Histotechnologists Histotechnologists are medical technologists who are specialized in preparation of solid tissue samples for examination under the microscope Roles of Medical Technology in Health Care A. Laboratory Diagnosis of Medical Conditions The laboratory procedures carried out by medical technologists involve examination of bodily fluids and samples that were collected from the patients. The findings from the laboratory examinations are oftentimes used by clinicians to evaluate the health status Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 9  of patients. The laboratory findings are indispensable tools used by physicians for either confirming or ruling out diagnosis of a suspected clinical condition. B. Monitoring of Treatments There are many laboratory examinations that are used for evaluating a treatment regimen. Laboratory values are often used by physicians to have an educated assessment on whether the treatment plan is helpful to the patient or not. Moreover, values are used to gauge if a treatment plan is efficient enough. Therefore, the laboratory findings are important in the establishment of the patient’s prognosis or the patient’s likelihood of surviving or recovering from a clinical condition. C. Prevention and Control of Diseases and Infection As mentioned earlier, medical technologists play an indispensable role in the detection of clinical conditions including infectious diseases. Detection and identification of infectious cases will significantly help in the isolation procedures which, in case, will prevent further spread of the disease in the community. D. Preparation of Safe Blood and Blood products Medical technologists, specifically blood bank technologists, are primarily responsible for the preparation of blood and blood products that are safe for transfusion. The technologists make sure that the products for transfusion are free from infectious diseases that can be transmitted via transfusion. Furthermore, they are also responsible for ensuring that the blood product to be transfused is compatible with the patient. E. Biological and Medical Research Medical Laboratory Science or Medical Technology, as an interdisciplinary profession, can carry collaborative research projects to detect problems and provide solutions, particularly in the fields of health care and public health. Examples of the impacts of the profession’s active role in research include discovering the growing resistance of microorganisms to antibiotics and the utilization of molecular- based technology for clinical applications. Professional Attitude of Medical Technologists Medical technologists are held to a high level of standard when it comes to their professional etiquette. Medical technologists are expected to conduct themselves in a manner that is appropriate to the dignity of the health care profession. In the Philippines, a licensed medical technologist’s professional conduct is governed by the Medical Technology Code of Ethics. Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 10  Medical Technology Code of Ethics As I enter into the practice of Medical Technology, I shall accept the responsibilities inherent to being a professional; I shall uphold the law and shall not engage in illegal work nor cooperate with anyone so engaged; I shall avoid associating or being identified with any enterprise of questionable character; I shall work and act in a strict spirit of fairness to employer, clients, contractors, employees and in a spirit of personal helpfulness and fraternity toward other members of the profession; I shall use only honorable means of competition for professional employment or services and shall refrain from unfairly injuring, directly or indirectly, the professional reputation, projects or business of a fellow medical technologist; I shall accept employment from more than one employer only when there is no conflict of interest; I shall perform professional work in a manner that merits full confidence and trust carried out with absolute reliability, accuracy, fairness and honesty; I shall review the professional work of other medical technologists, when requested, fairly and in confidence whether they are subordinates or employees, authors of proposals for grants or contracts, authors of technical papers or other publications or involved in litigation; I shall advance the profession by exchanging general information and experience with fellow medical technologists and other professionals and by contributing to the work of professional organizations; I shall restrict my praises, criticisms, views and opinions within constructive limits and shall not use the knowledge I know for selfish ends; I shall treat any information I acquired about individuals in the course of my work as strictly confidential, and may be divulged only to authorized persons or entities or with consent of the individual when necessary; I shall report any infractions of these principles of professional conduct to the authorities responsible of enforcement of applicable laws or regulations, or to the Ethics Committee of the Philippine Association of Medical Technologists as may be appropriate. To these principles, I hereby subscribe and pledge to conduct myself at all times in a manner befitting the dignity of my profession. Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 11  ELABORATE HISTORY OF THE MEDICAL TECHNOLOGY PROFESSION Early Beginnings Vivian Herrick traces the beginning of medical technology to as early as 1550 BC when the first documented records of parasites and parasitic infections were made. a. Ebers papyrus (1500 BC) § The oldest preserved Egyptian compilation of medical texts. § Contains the first accounted records of intestinal parasitic infection caused by Ascaris lumbricoides and Taenia species b. Sushruta (600 BC) § A Hindu physician who described diabetes as characterized by passage of large amount of urine. He further noted that the madhumeha (‘honey urine’) from diabetes patients is sweet in taste and can attract black ants. c. Hippocrates (300 BC) § A Greek physician considered as the “father of medicine” and author of the Hippocratic oath § Described four humors (body fluids) in the human body § He associated the four humors to certain human behaviours and further concluded that all diseases were due to imbalance of these four humors. § Four humors: Blood (sanguis) o Sanguine: Courageous, hopeful, playful, carefree Yellow bile (khole) o Choleric: Ambitious, leader-like, restless, easily angered Black bile (melaina khole) o Melancholic: Despondent, quiet, analytical, serious Phlegm (phlegma) o Phlegmatic: Calm, thoughtful, patient, peaceful § Concluded that the appearance of bubbles, blood, and pus in urine indicated kidney disease and chronic illnesses § Adopted a triad of drugs, surgery, and bloodletting in treating diseases and infection d. Galen (180 AD) § Described diabetes as “diarrhea of urine” and established the relationship between fluid intake and urine volume Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 12  Ruth Williams believe that medical technology began from the medieval period. e. Medieval Period (1098-1438) § Diagnosis by ‘water casting’ (uroscopy) was widely practiced. § Urinalysis became commonplace and was a practice that was followed with exaggerated zeal. Patients submitted their urine specimen in decorative flasks. § Physicians who failed to examine the urine samples were subjected to public beatings. Anna Fagelson prefers to date the beginnings of the profession in the 14th century. f. Alessandra Gillani (14th century) § Was hired at the University of Bologna by Mondino de’ Liuzzi, an Italian doctor, to perform some tests and other tasks in the laboratory. § Unfortunately, Gillani died from a laboratory-acquired disease in 1326 Onset of Modern Medical Technology a. Marcello Malphigi § Described as the ‘greatest’ of the early microscopists § Became renowned for his exploration of embryology and physiology of the glands and the viscera. § Regarded as the founding father of modern anatomic pathology b. Rudolf Virchow § Recognized as the father of microscopic pathology and is credited to have established the world’s first pathology laboratory § Was the first scientist/ physician of the time who emphasized the study of the manifestation of diseases and infections, which are visible at the cellular level by means of a microscope. c. Von Ziemssen (1886) § Established the first hospital-attached clinical laboratory in Munich, Germany § The clinical laboratory he established was described to be well-conceived with a chemical, a physical, and a bacteriological department, a working library, and rooms for practical courses and the examination of patients. Medical Technology in its Modern Onset in the United States It is crucial for us to understand the onset of medical technology in the United States as it is the Americans who brought the profession to the Philippines. a. Massachusetts General Hospital (MassGen, Training hospital of Harvard Medical School) § 1847: Established the position of “Chemist-Microscopist” whose duties included assisting at autopsies Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 13  § 1854: John Bacon Jr. was employed as the Chemist- Microscopist. However, he later suggested to separate the duties of the hospital microscopist and the hospital chemist. § 1855: Dr. Calvin Ellis became the hospital microscopist. He is the first in the hospital to significantly utilize the microscope in examination of specimens leading to a diagnosis. b. Dr. William Welch § 1878: Opened a teaching laboratory at Bellevue Medical College (New York University Medical School) after studying several German laboratories. § He gave the first laboratory course in pathology offered in an American Medical School § Became the first physician recruited to be a professor at the Johns Hopkins University in 1886 c. William Pepper Laboratory of Clinical Medicine (1895) § Established by the Hospital of the University of Pennsylvania § Considered by many as the first legitimate clinical science laboratory in the United States d. University of Michigan Hospital § Opened the first well-equipped chemical laboratory related to medicine, where Dr. Douglas (unspecified) was the first to give laboratory instructions. *Note: Cardona et al. (2015) reports this laboratory as the first clinical laboratory set-up in the U.S. e. Johns Hopkins Hospital § Opened its clinical laboratory in 1896 § 1898: Dr. William Osler, a Canadian physician and professor, established ward laboratories at the Johns Hopkins Hospital where routine tests were performed by attending physicians. f. Rockefeller Institute (1903) § Located in New York; Established its own clinical laboratory headed by Dr. Simon Flexner g. James Campbell Todd (1908) § Wrote a book entitled Clinical Diagnosis: A Manual of Laboratory Methods, which described the techniques and procedures of the laboratory tests available then Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 14  h. John Bernard Henry § Edited the book authored by Todd. The said book was later named as Henry’s Clinical Diagnosis and Management by Laboratory Methods. This book then became the fundamental source in the practice of laboratory medicine. i. Pennsylvania State Legislature (1915) § Passed a law requiring all hospitals and institutions to have complete laboratory facilities with full-time technicians, which gave laboratory services a chance to be fully recognized and widely utilized. j. World War I (1914-1918) § Produced a great demand for technicians § Physicians with knowledge on laboratory works began to teach their assistants to do some tests for them § Faced with reductions in medical staff because of America’s entry into World War I, hospitals started hiring and training women to become laboratory technicians. k. John Kolmer (1918) § Called for the development of a method that would certify medical technologists on a national scale § Published The Demand for and Training of Laboratory Technicians that included a description of the first formal training course in Medical Technology Despite the training of many technicians by the Army during the war and the laboratory courses offered by several medical schools, the demand for reliable, well-trained technicians greatly exceeded their availability. l. R.B.H Gradwohl (1920) § Proposed the establishment of schools for the proper training of laboratory technicians and for the organization of a laboratory examining board to pass on their qualifications for employment m. American Society for Clinical Pathology § Founded in 1922 with the objective of encouraging the maintenance of status of clinical pathologists § Also established the 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. § American Society for Clinical Laboratory Science: Originally formed as a subgroup of ASCP, helped in the recognition of non-physician clinical laboratory scientists as autonomous professionals. Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 15  n. University of Minnesota § Was the first to offer a degree program on medical technology in 1923 o. 1950’s § Medical technologists in the United States sought professional recognition from the government of their educational qualifications through licensure laws Medical Technology in the Philippines a. 1944 § During the onslaught of World War II, U.S. bases were set up in Leyte § Members of the U.S. healthcare team were brought to the country to serve their wounded soldiers and civilians. § 26th Medical Laboratory of the 6th Infantry of the US Army § The first clinical laboratory in the Philippines; Established on Quiricada Street, Sta. Cruz, Manila § Now known as Manila Public Health Laboratory § By February 1944, it provided a one-year training program to high school graduates to work as laboratory technicians b. June 1945 § Staff of the 6th US Army left the facility after endorsing the newly established clinical laboratory to the National Department of Health. However, the laboratory facilities were not fully utilized and was later non-operational. c. Dr. Pio de Roda § Filipino doctor who was a former staff of the 26th Medical Laboratory and a well-known bacteriologist § Preserved the remains of the laboratory with the help of Dr. Mariano Icasiano, who was the first City Health Officer of Manila § October 1, 1945: Dr. de Roda, with the help of Dr. Prudencio Sta. Ana, formally re-established the laboratory § 1947: Dr. de Roda and Dr. Sta. Ana offered a training program to high school and paramedical graduates who were interested in working as medical technicians § The training program was initially unsuccessful because no certificates were issued to the trainees and the duration of the training was not set. § Dr. de Roda recognized the problems and instructed Dr. Sta. Ana to prepare a formal syllabus d. Dr. de Roda, Dr. Sta. Ana, and Dr. Tirso Briones (1954) § Conducted a six-month training course with certification. (However, the project did not last long since formal education began in the same year) Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 16  Formal Medical Technology Education in the Philippines a. Philippine Union College (now the Adventist University of the Philippines) and Manila Sanitarium Hospital (now the Manila Adventist Medical Center) § 1954: Offered the first four-year Bachelor of Science in Medical Technology program in the Philippines § Founders credited for development of the first Medical Technology program include: § Dr. Willa Hilgert Hedrick: “Founder of medical technology education in the Philippines” With the help of Mrs. Antoinette McKelvey, prepared the course curriculum and established the first complete laboratory in microbiology, parasitology, and histopathology at the Manila Sanitarium Hospital § Dr. Reuben Magsaysay: The then president of the Philippine Union College § Rev. Warren: President of the North Philippine Mission of Seventh Day Adventist and director of the Bureau of Education § Dr. Jesse Umali § First student to graduate Medical Technology from the Philippine Union College in 1956 § Later pursued a career in medicine (OB-Gyne) b. University of Santo Tomas § 1957: Started offering medical technology as an elective subject to pharmacy students § 1961: Medical technology was recognized as an official program in UST with the first three years as a three-year academic course and the fourth year as an internship program c. Centro Escolar University § 1960: Began offering the Medical technology program, which was later granted a recognition permit by the Bureau of Education d. Far Eastern University § 1961: Started its School of Medical Technology, which was later formally approved by the Bureau of Education e. Saint Louis University § 1966: SLU started offering Bachelor of Science in Medical Technology § 1970: The Imelda R. Marcos Clinical Laboratory (now SLU Clinical Laboratories opened to offer training for SLU medical technology interns § 1971: BSMT was recognized and approved by MECS (Ministry of Education, Culture, and Sports) Property of and for the exclusive use of SLU. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited. 17