PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 LESSON 1: HISTORY OF MT/MLS IN A GLOBAL CONTEXT MEDICAL TECHNOLOGY IN ITS EARLIEST FORM (ANCIENT & MEDIEVAL TIMES) IN ANCIENT TIMES The evolution of MT/MLS can be traced to: ➔ The understanding of the concept of diseases and infections during ancient times. HIPPOCRATES (460-377 BC) ➔ A Greek physician ➔ Father of Medicine ➔ Known for Hippocratic Oath - the code of ethics for practicing physicians ➔ Described 4 humors (body fluids) in man: 1. Blood 2. Phlegm 3. Yellow Bile 4. Black Bile GALEN OF PERGAMON (129-216 AD) ➔ Greatest physician of ancient Rome ➔ Believed that human health requires equilibrium (balance) between the 4 humors. Hippocrates and Galen - both believed that the environment plays a huge part in the health of the human body. URINE ➔ A composite of the 4 humors ➔ Visual examination of urine at the bedside could diagnose illness URINALYSIS ➔ The study of urine ➔ Passed down from ancient times ➔ Oldest laboratory procedure ASTROLOGY, SUPERSTITION, & FOLKLORE ➔ Influenced ancient physicians in making diagnoses, but made credible observations about urine POLYURIA of diabetes ➔ Noted in ancient times ➔ Polyuria - the body makes more pee than normal Ren Marzo, BSMT 1D | Padayon! 600 BC ➔ a Hindu physician recorded the sweet taste of diabetic urine. 1674 ➔ diabetic urine had a taste similar to honey. Hindu doctors’ scientific observation ➔ Urine of certain individuals attracted ants, thus, the urine had a sweet taste. VIVIAN HERRICK ➔ Believes that MT can be traced back to 1550 BC ◆ When Taenia and Scaris (intestinal parasites) were mentioned. ◆ The Ebers Papyrus - has descriptions of the stages and treatment of hookworm infection transmissible in humans. ◆ Anenzoa - Arabian physician - proved that the etiological agent of skin diseases (e.g. scabies) is PARASITE. IN MEDIEVAL TIMES (1098 - 1438) URINALYSIS - became commonplace ➔ was a practice that was followed with exaggerated zeal (passion/interest). Doctors in Indian Subcontinent ➔ Recorded several observations in the urine of some patients: ➔ Urine of some patients that attracted ants had a sweet taste ◆ This was criticized by some medical professionals ◆ Mentioned in the book of Ruth Williams - “An Introduction to the Profession of Medical Technology” BLOOD LETTING ➔ Was means of curing most afflictions ➔ Patient was bled with leeches or by cutting a blood vessel. ➔ This practice ended during the enlightened age ◆ During the enlightened age - the study of blood and its cellular elements began. 1 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 Ren Marzo, BSMT 1D | Padayon! IN 14th CENTURY ❖ Anna Fagelson prefers to date MT from the 14th century. ➢ It is because Alessandra Gilliani was hired by a prominent Italian physician at the University of Bologna to perform certain tasks which were considered tasks of MedTechs. ➢ Alessandra Gilliani - died from laboratory-acquired infection. IN 17TH CENTURY ➔ Antonie Van Leeuwenhoek (1632 - 1723) ◆ Invented the first microscope ◆ First to describe RBC, to see protozoa, and to classify bacteria according to shape. practitioners) - under the license of Society of Apothecaries. IN 19TH CENTURY ➔ Physicians used therapeutics machines for diagnosis EARLY BREAKTHROUGHS OF MT Antonie van Leeuwenhoek (1660) Father of Microbiology Invented and work on the improvement of the microscope. Edward Jenner (1796) Father of Immunology Discovered the smallpox vaccine 1625 - development of the microscope was first described. 1673 - the microscope became available 1837 - a pioneering course in medical microscopy was first taught in Paris. Marie Francois Xavier Bichat (1800) Identified organs by their types of tissues Contributed to Histology IN 18TH CENTURY René Laënnac (1815) Invented stethoscope RUDOLF VIRCHOW ➔ The Father of Microscopic Pathology ➔ First to emphasize the study of the manifestation of disease and infections - that are visible only by microscope and Agostino Bassi (1835) First to expound the parasitic theory of infection DR. CALVIN ELLIS ➔ The first to utilize the microscope in examining specimens at the Massachusetts General Hospital Louis Pasteur (1857) Father of Modern Microbiology Discovered the principles of vaccination, microbial fermentation, etc. Produced immunity to rabies DR. WILLIAM OCCAM ➔ Used laboratory findings as preliminary evidence in diagnosing and evaluating a patient’s disease. Gregor Mendel (1866) Father of Genetics Developed the theory of inheritance APOTHECARIES ACT OF 1815 ➔ Intervened and paved the way for an uphaul of med. Treatment based on laboratory findings. ➔ Initiated by Baron Karl Von Humbledt ➔ It introduced compulsory apprenticeship and formal qualifications for apothecaries (general Joseph Lister (1870) Father of Modern Surgery Demonstrated the surgical infections are caused by airborne organisms Robert Koch (1876) Father of Clinical Microbiology 2 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 - Ren Marzo, BSMT 1D | Padayon! Presented the first pictures of bacilli (anthrax), and later tubercle bacilli Andre van Steirteghem (1992) IVF (intracytoplasmic sperm injection) Elie Metchnikoff (1886) Described phagocytes in blood and their role in fighting infection Dr. Leroy E. Hood (1992) Automated DNA sequencing technique Ernst von Bergmann (1886) Introduced steam sterilization in surgery Wilhelm Conrad Röentgen (1895) Discovered the X-ray by accident Karl Landsteiner (1902) Developed the ABO blood group system August von Wassermann (1906) Developed immunologic tests for syphilis Hans Fischer (1929) Structure of hemoglobin Willem J. Kolff (1943) Build the first hemodialysis machine Father of Artificial Organ A Team Led by Dr. Joseph E. Murray (1954) Performed the first successful kidney transplant Jonas Salk (1954) Developed poliomyelitis vaccine Dr. Godfrey Hounsfield (1971) Developed the first CT scanner James Westgard (1973) Westgard Rules for quality control in the clinical lab Dr. Raymond V. Damadian (1978) M.R.I. (Magnetic Resonance Imaging) Baruch Samuel Blumberg (1980) Hepatitis B Vaccine Kary Mullis (1985) Developed PCR (Polymerase Chain Reaction) James Thomson (1998) First human Stem Cell line HISTORY OF MEDTECH IN USA In the last half of 19th century: ❖ Dr. William H. Welch (1878) ➢ Father of American Pathology ➢ Set up the first pathology laboratory at Bellevue Hospital ❖ Dr. William Osler (1880) ➢ Clinical professor at the University of Pennsylvania Hospital ➢ Introduced and used the microscope and blood-counting machine ❖ Dr. Douglas (1887) ➢ Established a laboratory at the University Hospital in Philadelphia and at the Unversity Hospital in Ann Arbor, with the help of Dr. Osler and Dr. George Dock. ➢ Ordered patients to undergo routine laboratory examinations ❖ John Hopkins Hospital (1896) ➢ First clinical laboratory was opened ❖ 1911 ➢ Laboratory science was approved by the Insurance Act as the basis for diagnosing disease. ❖ World War 1 (1914-1918) ➢ Was an important factor in the growth of clinical laboratories with a demand for medical personnel in the military. ❖ State Legislature of Pennsylvania (1915) ➢ Enacted a law requiring all hospitals to have complete laboratory facilities with full-time technicians. ❖ Women’s Medical School & Women’s Hospital in Philadelphia (1921-1922) ➢ First formal laboratory course was formed. 3 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 ➢ ❖ ❖ 1920 ➢ 1922 ➢ ➢ Ren Marzo, BSMT 1D | Padayon! Record in the files of Registry of Medical Technologists ❖ There were 3,500 technicians recorded, and over half were women. 1928 ➢ ➢ ❖ ❖ ❖ To oversee and standardize the training programs for lab technicians. ASCP’s Board of Registry was created 2 years later: first certificates were awarded to more than 400 lab technicians HISTORY OF MEDTECH IN THE PHILIPPINES ❖ Pearl Harbor (WW2) ➢ Was invaded by Japan on December 7, 1941 1944 ➢ US bases were built in Leyte ➢ Allows US to bring members for their healthcare team in the Philippines January 9, 1945 ➢ 850 US ships of the 6th US Army began a round-about to Lingayen Gulf attempting to mislead the Japanese. ➢ 26th Medical Laboratory of the 6th US ■ ■ Located at 208 Quiricada Street, Sta. Cru, Manila Known as Public Health Laboratory - a division of the Manila Health Department Public Health Laboratory ➢ Was endorsed to National Department of Health (but later disregarded) ➢ Was formerly recognized by Dr. Pio de Roda and assisted by Dr. Mariano Icasiano - the Manila City Health Officer 1954 ➢ ➢ Later named: Laboratory Manila Public Health Training program was offered by Dr. Pio de Roda with Dr. Prudencia Sta. Ana Training was proved ineffective because of lack of motivation of trainees, no program was supposed to last a set of period of time, and no certificates Training began using a syllabus and it was to last 6 months Medical Technology - a formal education began HISTORY OF MEDTECH EDUCATION IN THE PHILIPPINES ❖ ❖ ❖ ❖ Army (left on June 1945) ❖ 1947 ➢ ➢ 3000 U.S. hospitals indicated an established department for the clinical laboratory. American Society for Clinical Pathology (ASCP) was established ■ ❖ ➢ ❖ ❖ ❖ ❖ Dr. Willa Hilgert Hedrick ➢ Founder of MedTech Education in the Philippines Philippine Union College ➢ Now Adventist University of the Philippines ➢ Offered a BS MedTech course in 1954 w/ the help of Manila Sanitarium Hospital (now: Manila Adventist Medical Hospital) Mr. Jesse Umali ➢ First student to graduate from MT Program in 1956 at Philippine Union College ➢ Now an OB-Gynecologist and owner of Omega Lab in Vitor Cruz, Manila Dr. Antonio Gabriel & Dr. Gustavo U. Reyes ➢ Offered an elective to pharmacy graduates leading to MT course in the University of Santo Tomas in 1957 Centro Escolar University (CEU) (1960) ➢ Offered MT Course Far Eastern University (FEU) (1961) ➢ Started its MT Education ➢ Dr. Horacio A. Ylagan - the technical director of the school Universidad de Zamboanga (former: Zamboanga A.E. Colleges) (1971) ➢ Offered BSMT program More than 130 colleges & universities offering undergraduate programs in Mt/MLS (2019) 4 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 ❖ ❖ Ren Marzo, BSMT 1D | Padayon! University of the Philippines (UP) ➢ Offers a similar course but the degree bein conferred in BS Public Health 8 universities are offering Master’s Courses in Medical Technology ❖ Medical Technology ➢ Designed to improve the detection, diagnosis, treatment, and monitoring of diseases. ➢ It links with many other disciplines for specific diagnostic or therapeutic purposes ➢ Nature is: LESSON 2: Defining the Practice of the Medical Technology/Clinical Laboratory Science Profession THE NATURE OF MEDICAL TECHNOLOGY ❖ ❖ ❖ ❖ Nature of Medical Technology ➢ Understand the connection between science and technology Science ➢ Study of the natural world and the interrelationship among biological, psychological, and social world. Principles of Medical Technology ➢ are dependent on developments in the scientific disciplines such as chemistry, electronics, optics, mechanics, etc. ➢ In order to develop utilizable biotechnology that will aid in the diagnosis of diseases. Technology ➢ Application of science that is considered beneficial to society ➢ 3 ways to define: ■ As a physical artifact, machine, or instrument ■ As an activity or a means to accomplish a goal ■ ➢ As knowledge (Howel, 1996) Is a design for instrumental action that reduces the uncertainty in the cause-effect relationships involved in achieving the desired outcome. (Rogers, 1983) Consists of physical elements: ➢ ■ Equipment, materials, or products Consists of intangible elements: ➢ ■ Knowledge, skills, procedures, principles, or information ➢ ■ Contextual ■ Interdisciplinary ■ Interdependent ■ Systems-based Dependent on the application, purpose, environment, and setting in which it is applied. ❖ Medical Technology as a clinical laboratory is multifaceted in nature, which is described as: 1. A Procedure of Scientific Activities (Substantial Procedure) ➔ All laboratory methods comprise scientific procedures, irrespective of whether the technology is conventional or automated. ➔ Follows scientific procedures A Paramount Field of Scientific Investigation (Investigative Complicity) ➔ MT encompasses scientific inquiry of various societal health problems ➔ It involves a wide range of laboratory investigations, which include: ◆ Drug testing ◆ Molecular & nucleic acid analysis ◆ Forensic investigation ◆ Scientific research An Intervention in Medical Procedures (Inter-medical Procedural Interference) ➔ MT serves as the “Clinical eye” in diagnosing and treating diseases An Explicit Application of Science and Technology (Assiduous Partner) ➔ MT embraces the techniques and procedures laid down by science and technology Evidentiary Information in Medicine (Circumstantial Medical Evidences) ➔ Laboratory findings serve as proof of the medical findings and prognosis. 2. 3. 4. 5. 5 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 SCOPE OF MEDICAL TECHNOLOGY 1. ➔ 2. ➔ ➔ 3. 4. 5. 6. ➔ ➔ 7. ➔ 8. ➔ ➔ ➔ Investigating Nosocomial Infections The process of investigation is within the function of medical technology involving microbiological analysis (culture and susceptibility testing) New Discoveries through Research Scientific Research offers innovative techniques and technology; and is pivotal to the role of medical technology as an applied science Trends include stem cell research and therapy isolation and identification of totipotent and pluripotent cells from cord blood. Public Health Education through Seminar/Workshops ➔ MT are updated on issues and concerns about health and illness through scientific seminars and workshops Extending Services to Molecular Engineering ➔ Molecular genetics/molecular engineering such as gene therapy, diagnosis, and screening has been embraced in the field of MT Pioneer in Laboratory Medical Diagnostic Services ➔ MT employs and pioneers diagnostic procedures Evaluating the Efficacy of Drug Treatment through Microbiological Analysis The department of microbiology performs varied tests that identify specific microbes in the sample Performing susceptibility testing to determine the efficacy of antibiotics or treatments Engaging in Blood Donation and Bloodletting Services for the Public MT’s function is to screen blood donors and perform cross-matching and blood typing before blood transfusion Laboratory Diagnosis LD involves a series of procedural methods that are performed in the clinical laboratory. One of the prioritized fields in laboratory medicine Employs sophisticated methods, wherein the findings can be potential evidence in evaluating the health status of the patients. Ren Marzo, BSMT 1D | Padayon! 9. ➔ Biological and Medical Research MT as a laboratory medicine can provide solutions to health problems ➔ MT can function with any biological discipline in scientific research projects, especially those related to evaluating the efficacy of plants 10. Prevention and Control of Diseases and Infection ➔ MT provides information on the prevention and control of disease and infection. ➔ Can be achieved through: ◆ Proper information dissemination (seminars, workshops, and conferences) 11. Innovative Techniques and Technology ➔ MT pioneers new technologies and techniques to provide a wide spectrum if laboratory services. DEFINITION OF MEDICAL TECHNOLOGY PRACTICE ❖ ❖ ❖ The application of principles of natural, physical, and biological sciences to the performances of laboratory procedures - which aid in the diagnosis and treatment of diseases (Heinemann, R.) A branch of medicine concerned with the performance of laboratory determinations and analyses. (Fagelson, A.) A health profession concerned w/ performing laboratory analyses in order to obtain information necessary for the diagnosis and treatment of disease. (Walters) IN THE PHILIPPINES ❖ The MT profession is governed and defined in section 2 of RA 5527 or the Medical Technology Act of 1969 R.A. 5527 ➔ An auxiliary branch of laboratory medicine that deals w/ the examination of tissues, secretion, and excretion of body fluids by various electronic, chemical, microscopic and other laboratory procedures. - which will aid the physician in the diagnosis, study, and treatment of disease. Section 2 of R.A. 5527 as amended by R.A. 6132, P.D. 498, and P.D. 1534 defines MT as follows: 6 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 ❖ Ren Marzo, BSMT 1D | Padayon! Section 2. A. Practice of Medical Technology ➢ A person shall be deemed to be in the practice of medical technology within the meaning of this act. ➢ Who shall for a fee, salary, or compensation or reward paid or given directly or indirectly through another ➢ Professional services for the purpose of aiding the physician in the diagnosis, study, and treatment of diseases: ■ Examination of tissues, secretions, and excretions of the body fluids by various electronic, chemical, microscopic, bacteriologic, hematologic, serologic, immunologic, nuclear and other laboratory procedures and techniques ■ Blood banking procedures and techniques ■ Parasitologic, microbiologic techniques ■ Histopathologic and cytotechnology (no one shall inhibit a duly registered MLT from performing such procedures ■ Clinical Research ■ Preparations and standardization of reagents, standards, stains, and others (exclusively use for laboratory) ■ Clinical laboratory quality control (deals with accuracy and precision) mycologic, procedures and and ■ ➢ Collection and preservation of specimens Provided that any person who has passed the board examination ■ Shall not be subject to the provision of the last 4 preceding paragraphs if the performance of such services is merely incidental to his profession. CODE OF ETHICS OF MEDICAL TECHNOLOGY 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 activities nor cooperate with anyone so engaged. I shall work and act in a strict spirit of fairness to employer, clients, contractors, employees, and in a strict 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, business or projects 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. 7 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 To these principles, I hereby subscribe and pledge to conduct myself at all times in a manner befitting the dignity of my profession. Ren Marzo, BSMT 1D | Padayon! ➔ ROLES & RESPONSIBILITIES OF MT PROFESSIONALS ➔ MT defined in R.A. 5527: ➔ Refers to a person who engages in the work of medical technology under the supervision of a pathologist or licensed physician 1. ➔ 2. ➔ 3. ➔ ➔ 4. ➔ ➔ 5. ➔ ➔ ➔ ➔ ➔ Perform Clinical Laboratory Testing Must be capable of performing the most basic to the most advanced laboratory tests Perform Special Procedures Are expected to perform special procedures in diagnosing diseases. Special procedures may include: ◆ Molecular diagnostics ◆ Nuclear diagnostics Ensure Accuracy and Precision of Results Should always be conscious of the accuracy and precision of both the testing process and its results. Accuracy and precision - impacts the interpretation of results Be Honest in Practice Must be honest at all times in the conduct of test procedures to come up w/ accurate and precise results. He should act according to the Medical Technology profession’s Code of Ethics and his pledged oath of practice Ensure Timely Delivery Results Must be aware of the urgency of delivering results on time, especially in cases that require urgent treatment. “STAT” - urgent/rush “ER” - emergency room “OR” - operating room Be alert to fully address the needs of the patient 7. ➔ Uphold Confidentiality One of the core duties within the medical practice is to ensure confidentiality of patient’s information ➔ Confidentiality requires keeping the patient’s personal health information private unless the patient consents to release it. 8. Collaborate with Other Health Care Professionals ➔ He is required to collaborate with other health care practitioners in order to build a well-functioning team. ➔ Collaboration - act of working together in order to achieve the desired outcome. 9. Conduct Research ➔ Practicing MT must also be engaged in research activities to update their skills ➔ Research can contribute to the discovery of new knowledge in the field of MT 10. Involvement in Health Promotion Programs ➔ MT is a multidisciplinary field, which consistently ventures into other areas of health care including HEALTH PROMOTION ➔ Must be actively involved in reaching out to the community DEFINING THE PRACTICE OF OTHER LAB PERSONNELS ❖ 6. ➔ ➔ ➔ Demonstrate Professionalism Must be able to perform his functions according to the Code of Ethics of Medical Technology. He should be aware of the laws and regulations governing the practice of MT; and Should not exploit its function beyond its boundaries Governing regulations: ◆ R.A. 5527 - Philippine Medical Technology Act of 1969 ◆ R.A. 4688 - Clinical Laboratory Act of 1966 ◆ R.A. 1517 - Blood Banking Act of 1956 ◆ R.A. 7719 - Blood Banking Act of 1995 National organizations: ◆ Philippine Association of Medical Technologists, Inc. (PAMET) ◆ Philippine Association of Schools of Medical Technology and Public Health, Inc. (PASMETH) PATHOLOGIST ➢ The head of clinical laboratory ➢ Who is specially trained in methods of lab medicine, or the gross and microscopic study and interpretation of tissues, secretions, and excretions of human body. ➢ A lab result w/o the signature ≠ valid 8 PMLSP 1 1ST SEM REVIEWER LESSONS 1, 2 AND 4 ❖ ❖ ❖ ❖ ❖ ❖ ❖ MEDICAL LABORATORY TECHNICIANS ➢ A person certified by and registered w/ the Board of Medical Technology ➢ Qualified to assist a medical technologist and/or pathologist ➢ Failed to pass the board examination, but obtained a general rating of at least 70% PHLEBOTOMIST ➢ Individual trained to draw blood or collect blood either for lab tests or for blood donations. ➢ It can be a skill confined not only to medtechs but to other health practitioners as well, provided that they are certified. ➢ Collects blood for analysis CYTOTECHNOLOGIST ➢ Who works w/ the pathologist to detect changes in body cells which may be important in the early diagnosis of diseases ➢ The Papanicolaou Test (Pap) and the H&E are the most commonly employed staining techniques ➢ Primarily done by examining microscopic slides of body cells for abnormalities or anomalies in structures, etc. HISTOTECHNOLOGIST ➢ Or histotechnician ➢ Responsible for the routine preparation, processing, and staining of biopsies and tissue specimens for microscopic examination by a pathologist. NUCLEAR MEDICAL TECHNOLOGIST ➢ Who works alongside nuclear physicians ➢ Apply their knowledge of radiation physics and safety regulations to limit radiation exposure, etc. deposited in the patient or patient’s specimen TOXICOLOGIST ➢ Studies the effects of toxic substances on the physiological functions of human beings, animals, and plants ➢ Also designs and conduct studies to determine physiological effects of various substances on living organisms. BLOOD BANK TECHNOLOGIST ➢ Specialized in the process of testing and preparing of blood for transfusion Ren Marzo, BSMT 1D | Padayon! ➢ ➢ ➢ Performs blood compatibility testing and blood collection and processing Specifically works in Blood Banks Can be a Phlebotomist CHARACTERISTICS OF MEDICAL LAB PRACTITIONERS 1. 2. 3. 4. 5. 6. 7. 8. Problem Solvers Focused Good Communication Skills Trustworthy Efficient and Self-reliant Dignified and Respectable Role Models Self-motivated 9