Participation of medical technologists in the nutrition support team (NST)

In the nutrition support team (NST), medical technologists take a very important role in carrying out nutrition screening, nutrition assessment and nutrition monitoring. Medical technologists can look at the laboratory data of patients earlier than other NST staff. Using this advantage, the medical technologists can contribute to the NST. In addition, medical technologists join ward rounds together with other NST staff on a weekly basis. After discussion with all NST staff, medical technologists make a report on the nutrition assessment of patients and then sign their names to the report. The NST is a representative of medical treatment teams. All NST members should have equal levels of understanding of nutrition therapy. Therefore, medical technologists should not only look at the laboratory data of the patients, but also manage the patients through nutrition assessment and nutrition monitoring.     

Participation of the clinical laboratory in the nutrition support team

Recently, organization of the nutrition support team (NST) is progressing steadily in many hospitals in Japan. In our Yamagata University Hospital, NST services were started in March, 2004. As is well known, NST is a multidisciplinary team comprised of physicians, nurses, dietitians, pharmacists, social workers and medical technologists. Here, we report the participation of medical technologists and physicians belonging to our Clinical laboratory in NST activities. From our laboratory, two medical technologists and two physicians participate in the NST and provide the following services. Firstly, nutritional assessment of proteins in serum i.e. albumin, retinol binding protein (RBP) and transthyretin (TTR) is carried out, measured as part of routine work, and, especially, the data of RBP and TTR are applied to the assessment of nutrition status around the digestive surgical operations. They are also useful to assess the effect of dietary meal, immunonutrition "Impact", which improves the malnutrition status of the pre operative patient. Secondly, a weekly "malnutrition report", including numbers of patients with malnutrition in every ward, serial graphs, and detailed comments on their movements, is reported by e-mail to NST associated departments. This report is conveniently indicates the nutritional situation of inpatients in the hospital and aids consideration of countermeasures for malnutrition in the NST meeting. Thirdly, we medical technologists also participate in making rounds, where we state our opinions on a patient's data, and, if necessary, propose to the chief physician to request additional laboratory tests. We believe that these current activities of our laboratory as part of the NST will contribute to the development of our University NST, raising the quality of nutrition support services, and resulting in improvements of malnutrition and the quality of life of patients.     

Desirable medical technologists in a community support hospital

Recently, there have been marked advances in the technological strategies employed in medical examinations. The educational concept to nurture highly capable medical technologists is considered to be a priority issue by not only educators but also employers, even though the medical educational levels have markedly improved in every college and university. It is commonly acknowledged that the results of any examination in the clinical laboratory should be accurate and fed back to medical doctors as soon as possible. The business outline of medical technologists in our hospital is becoming more extensive because we act as a core hospital in the area, and so knowledge regarding many kinds of chemical and transfusion examinations is required in operations performed around the clock. Furthermore, medical doctors, clerical workers, nurses, and volunteers comprise a team of sophisticated workers in our hospital. To accomplish our daily work, character traits such as accuracy, honesty, perseverance, and ability to follow instruction manuals, are the most fundamental and valuable. To nurture a highly career-oriented medical technologist, we propose that the following should be focused on: self-responsibility, reduction of malpractices, economic profitability, brainstorming, education of subsequent generations, and the spirit of cooperativeness and reconciliation. Additionally, it is another basic requirement of competent medical technologists to learn to adapt to laboratory-based changes in their work throughout their career. In conclusion, how to adapt to any social demand and learn strategies in any era should be taught in college or university as well as after graduation because each hospital and institute has a different philosophy and requirements of newcomers. It is important for medical technologists and doctors to develop flexible ways of thinking, although we sometimes might accede to traditional ways.     

A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA

To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in a more rigorous academic environment adopting advances in medical informatics.     

Role and future aspects of hospital clinical laboratories in medical team approaches

The recent progress in medicine increases the routine works of the physicians or nurses and decreases the chances to obtain the new information on the laboratory medicine. Although the patients desire to know their test results in detail, it is likely to be difficult to obtain them from the physician in charge. Thereby, the quality of the medical services may be deteriorated. In these situations, needs of the medical team approaches in which the medical technologists (MTs) in the hospital laboratories participate are increasing. In Japan, there are a variety of medical team approaches in which MTs are involved. In our university hospital, MTs play important roles in the infection control team (ICT), in the nutrition support team (NST), in the educational class for the patients with diabetes mellitus, in the clinical research center, in the order-made medicine realizing project, in the infertility center and in the laboratory information room. In April 2010, the new payment system for the team approaches such as ICT or NST was established. In the future, the team approaches other than ICT or NST could be chosen for the subjects for the payment if they are recognized as important. The goal of the team approaches is to realize a patient-oriented medicine. MTs can reconfirm that they are working as one of the medical staffs through these team approaches. It is important to always find out a possibility of new team approaches.     

Development of measurement methods and contributions to medical care in the clinical laboratory

The level of professional interest in clinical chemistry shown by technologists tends to erode as the recent advances in automation of clinical laboratory tests have made it possible to obtain accurate data by simply using reagent kits. Therefore, the most of medical technologists have foolish preconceptions to be impossible for the development of the new measurement methods in the clinical laboratory. However, there should be many studies that medical technologist should perform. In this paper, I give an outline about practice of the chemical reagent development in the laboratory and the effect mainly on the HDL cholesterol (HDL-C) homogeneous method which we developed. Because homogenous methods can easily be performed by automated analyzers, they have been widely implemented not only in Japan, but also throughout the rest of the world. When compared to the precipitation methods requiring centrifugation, homogenous assays are superior because of the great savings in manpower, many more samples can be analyzed within a given time, smaller quantities of samples are required, assay times are shorter, and measurement accuracy is greater. The most important contribution of homogenous assays is that because measurement accuracy is higher, the degree of inter-laboratory differences has been markedly decreased, thus making it possible to establish international standards.     

From the perspective of a clinical laboratory physician

In Japan, self-monitoring of specific physical conditions is needed, and clinical laboratory testings have been increasingly performed outside of the hospital without the control and/or the supervision of medical doctors. Various items have been measured, which include not only body fat but biochemical markers, cellular analyses for malignancies, sexually transmitted bacterium and so on. Qualitative urinalyses for glucose and protein and for pregnancy, the reagents for which are purchased from pharmacy stores, have been estimated by the examinees themselves. Specimens for most other items described above are collected by examinees themselves, transported via mail or other media and measured in the commercial clinical laboratories. Quality assurance of sampling, transportation and measurement is essential. Therefore, a check-system not only by the owner or manager of the laboratories but also by the non-laboratory staff specialist is needed. Appropriate and exact informations regarding the results must be given to the examinees in consideration of their responsibility concerning the total processes, from preanalytical and analytical to postanalytical processes, of the measurement. Laboratory physicians and technologists should pay more attention to laboratory tests being performed by examinees and outpatients themselves, and participate more in improving and evaluating the usefulness of these tests.     

24-hour system of the blood transfusion services at the university hospital

Blood transfusion is an essential medical treatment, from the everyday use in surgery to the treatment of large-scale bleeding accompanying external injury. Securing sufficient quantities of blood product and ensuring safe storage are critical. A 24-hour system of blood transfusion inspection by medical technologists has been enforced in our hospital since April, 1999 to improve the safety of blood transfusion treatment at night and on weekends. The medical technologists in the clinical laboratory and the division of blood transfusion carried out examinations in combination. There were no clinical problems after blood transfusion, and a safe blood supply has been maintained. As for medical technologists not specializing in the division of blood transfusion, blood type and crossmatching tests could be confirmed by the introduction of the Micro Typing System without problem. The execution of regular study meetings and maintenance of the manual are necessary so that the medical technologists not specializing in blood transfusion can carry out examinations confidently. An examination system is effective, but the safety of the blood transfusion treatment at night and on weekends can not be 100% secured. It is important to improve the consciousness of the clinical staff who perform blood transfusion treatment with regular training.     

Education of medical technologists in North America

The increasing complexity of diseases and advancing medical technologies have recently raised the number of test items and their use. This has caused each department to ask for clinical support by medical technologists, including consultation services on clinical laboratory tests in Japan. Under these circumstances, we think it is necessary to consider a Japanese education system for medical technologists to foster people with advanced ability capable in providing adequate clinical support. It is important that we study medical technologist systems and education systems superior to than ours. Therefore, to investigate the state of the Japanese education system for medical technologists, we conducted a comparison between the medical technologist systems and education systems in foreign countries and those of Japan. The social background in which medical technologists are positioned, their scope of work, and the education systems overseas are different from Japan on many points and we were given many suggestions for what a system in Japan should be like.     

Education concerning pathological/cytological diagnosis at 4-year colleges

Recent students of clinical technologist training courses at 4-year colleges aiming to qualify as medical technologists or cytotechnologists have diverse future prospects, for the following reasons: (1) Abundant information can be easily obtained due to the advancement of IT, (2) 4-year college education is increasing available professions, and (3) graduate schools for laboratory medicine have been established, enabling acquisition of a degree. For departments of pathological/cytological diagnosis, cooperation with pathologists and clinicians based on a reliable relationship is important, and medical technologists, cytotechnologists, and pathologists are organically linked in performing tests. To strengthen this reliable relationship and broaden professions as medical care staff, not only students but also instructors have to consistently increase their level of consciousness and energy. In addition to the establishment of the current cytotechnologist education system, introduction of the 'qualification of senior cytotechnologist' established in other countries or 'pathologist's assistant (tentative name)' as a pathological specialist should be seriously considered. The established graduate schools in the field of laboratory medicine started to produce human resources capable of performing basic research based on the knowledge and techniques of laboratory and cytology tests, and were granted a degree. Many universities have established graduate courses combined with employment, and an increasing number of cytotechnologists have acquired specialized knowledge and perform research activities based on knowledge from their routine work.     

Analysis of on-call consultations with clinical pathologists--identification of customer's satisfaction

One aspect whereby effectiveness of clinical pathologists can be measured is customer service and satisfaction. Clinical pathologist should identify their customers, their processes and procedures to meet these needs to the customer's satisfaction. To identify customer's satisfaction, the records of on-call consultations with clinical pathologists were analyzed. Between January 1996 and December 1998, 1327 consultations were recorded, 40% of which were consultations from physicians, 50% from medical technologists. Physicians requested interpretation of laboratory data obtained, and clinical knowledge mainly concerning the microbiology and hematology during office hours. On holidays, physicians needed help performing emergency tests such as Gram stain and Wright-Giemsa stain. During office hours, medical technologists requested clinical information concerning patients in whom unreasonable data would be reported and the contact to the clinical side. Furthermore, technologists inquired about the methodology of laboratory tests during day duty on holidays. These results indicated that the clinical pathologist in our hospital could satisfy the customer(physicians and medical technologists), by providing 1) a wide range of clinical knowledge concerning not only the laboratory medicine but clinical medicine including therapeutics, 2) capability of performing emergency tests such as Gram stain and Wright-Giemsa stain, and 3) capability of interpreting the results obtained. Although these would not be adopted in every hospital, every clinical pathologist should examine his role in the hospital.     

Scientific support for emerging countries--introduction to activities of a company

Medical care cost per capita in developing countries is significantly low, only 1/100 of that of developed countries. In these countries, treatment comes first, without sufficient clinical testing. In emerging countries, on the other hand, economic growth increases medical care cost, enabling more clinical testing; however, in many cases, quality control is not sufficiently performed for economic and technical reasons. To promote evidence-based medical care, it is important to promote high-quality clinical testing in these countries. To do so, our company has provided 400 scientific documents in 17 languages. We have also held 49 scientific seminars in 10 countries, with more than 10,000 participants, to share the latest medical information. We especially focus on supporting the standardization and promotion of external quality control to improve the quality of clinical testing. To support the standardization of hematology testing in China, we set up an environment for the international standard method of blood cell counting, in 2002 for the organizer of an external quality assessment program, and in 2011 for an agency responsible for practical tests of medical equipments. We have also been supporting national external quality assessment programs since 1998, first in Thailand and now including the Philippines and Mongolia. For external quality assessment programs in these countries, we applied the approach shown by Japanese doctors and medical technologists in their effort for accuracy improvement. We believe the experience and knowledge of Japan can be utilized to support developing and emerging countries.     

Education of medical technology and graduate school in Japan

Now the education of medical technologists has reached the fourth turning point. The first turning point was the start of the two year education in 1958 and the second was the start of the three year education of medical Technologists in 1971 and the third was the start of the full-fledged university education in 2004 and, this time, the fourth turning point is the start of graduate school education of medical technology. From this situation, for education of graduate school, mind education that polishes personality practically is may be demanded, Therefore, human resource development with not only knowledge and technique as medical technologists but also with humanly nurtured sentiment is expected in the future.     

Promotion of the systematization of consistent education for medical technologists

Although only about 35 years have passed since the birth of medical technology, marked advances have been made in the clinical laboratory science field. However, the educational system for technologists attached importance only to the learning of techniques for a long period because special training schools primarily provided medical technologist education. With the passing of time, the need for advanced knowledge has increased, and a plan to change the education system for medical technologists to 4-year colleges was evaluated. In 1989, the Course of Laboratory Sciences as a 4-year system for medical technologist education was established in the Department of Medicine, Tokyo Medical & Dental University. The Doctoral Course of Graduate School (first term) was established in 1993 and the Doctoral Course of Graduate School(second term) in 1995. In 2001, these courses formed a graduate university as the Division of Biomedical Laboratory Sciences, the Graduate School of Allied Health Sciences. Thus, a consistent educational system for medical technologists was established. By March 2005, about 500 students had graduated from this division. Based on this experience, we produced a 4-stage developmental program and provide an advanced educational system for the promotion of the systematization of consistent medical technologist education.     

Gustatory neural circuitry in the hamster brain stem

The nucleus of the solitary tract (NST) and the parabrachial nuclei (PbN) are the first and second central relays for the taste pathway, respectively. Taste neurons in the NST project to the PbN, which further transmits taste information to the rostral taste centers. Nevertheless, details of the neural connections among the brain stem gustatory nuclei are obscure. Here, we investigated these relationships in the hamster brain stem. Three electrode assemblies were used to record the activity of taste neurons extracellularly and then to electrically stimulate these same areas in the order: left PbN, right PbN, and right NST. A fourth electrode, a glass micropipette, was used to record from gustatory cells in the left NST. Results showed extensive bilateral communication between brain stem nuclei at the same level: 1) 10% of 96 NST neurons projected to the contralateral NST and 58% received synaptic input from the contralateral NST; and 2) 12% of 43 PbN neurons projected to the contralateral PbN and 21% received synaptic input from the contralateral PbN. Results also showed extensive communication between levels: 1) as expected, the majority of 119 NST neurons, 82%, projected to the ipsilateral PbN, but 85% of the 20 NST neurons tested received synaptic input from the ipsilateral PbN, as did 59% of 22 NST neurons that did not project to the PbN; and 2) although few, 3%, of 119 NST cells projected to the contralateral PbN and 38% received synaptic input from the contralateral PbN. These results demonstrated that taste neurons in the NST not only project to, but also receive descending input from the bilateral PbN and that gustatory neurons in the NST and PbN also communicate with the corresponding nucleus on the contralateral side.     

Medical technologist as a member of infection control team

For the prevention of infection at institutions, an Anti-nosocomial Infection Committee or an Infection Control Team (ICT) is organized at each institution according to its scale. We report the present status of the ICT managed mainly by medical technologists engaged in microbiological examination (certified medical microbiological technologists) at Dokkyo University School of Medicine. Since this hospital is an educational hospital, the department of clinical laboratory medicine cooperates with the microbiological laboratory of the clinical laboratory in infection control education of medical workers (such as medical students, nursing students, physicians and nurses) in infection diagnosis, infection control/infection management. Since infection control is achieved by improvement in hygiene knowledge and its practice in all citizens, we also attached importance to publicity activities associated with microbiology for patients, their families, and all medical workers.     

Education in medical technology

This year the education of Medical Technologists has reached the third turning point. The first turning point was the start of the two-year education of health laboratory technicians in 1958 and the second turning point was the start of the three-year education of Medical Technologists in 1971 and, this time, the third turning point is the start of the full-fledged university education. All 20 national education facilities for Medical Technologists and 2 public junior colleges have started the university education from this year. Adding the existing universities, about a half of education facilities for Medical Technologists are universities. From this situation, human resource development with not only knowledge and technique as medical technologists but also with humanly nurtured sentiment is expected in the future. In such situation, I'd like to discuss the progress of education of Medical technologists for 53 years, the current educational situation, and the future education of Medical technologists including the direction of desirable course for the three-year educational facilities.     

Necessity of a 24-hour system of blood transfusion testing

The preventive effects of a 24-hour system of blood transfusion testing on mistyping of transfused blood was examined. Blood transfusion tests have been performed by blood transfusion technologists during working hours and by physicians at other times. In March 2000, we introduced a system in which technologists perform blood transfusion tests after working hours. Technologists of the Blood Transfusion Unit and Central Clinical Laboratory perform the test jointly, and column agglutination technology was introduced as the test method. A computer system setup exclusively for the testing was also introduced to perform computer cross-matching. Since transfusion error is likely to occur during emergency blood transfusion, a manual was established to prioritize safety. After introduction of the system, mistyping that may have been caused by inaccurate blood test results markedly decreased, confirming the usefulness of this system for prevention of mistyping. In addition, transfusion errors also decreased in wards and the improved system increased the safety of the entire medical care system. The frequency of mistyping was about 1% when physicians performed blood typing, showing the importance of clinical technologists for blood transfusion tests.     

What laboratories in hospitals should be?--report from a teaching hospital

The author gave personal opinions regarding what the clinical laboratory in a teaching hospital should be. It is very important to raise the level of medical care and maintain it in city hospitals. The success of teaching programs depends on a high level of medical care. The author would like to emphasize several policies for the management of the clinical laboratory: 1) establishment of routine works, considering that the field of the clinical laboratory is "from patient to patient", not "from receipt to report", 2) change of the position on medical care from one of support to one of connection, 3) use of intelligence and arts (technologies) that medical technologists and laboratory physicians have acquired through the practices of the clinical laboratory, for example, quality control, system making, objective analysis of data, high mobility, etc., and 4) teaching the methods of the clinical laboratory to young trainees and professionals. The clinical laboratory in a hospital should contribute to raising the level of medical care, and medical technologists and laboratory physicians should perform tasks with spirit, humility and responsibility as professionals.     

In a disaster, what should medical technologists at a university hospital do? What do they have?

"Disaster medicine" involves "cases that cannot be supported by the normal medical service system of the hospital because many injuries have occurred by an explosion/chemical pollution/radioactive pollution or a pandemic caused deliberately as well as natural disasters". In "disaster medicine", university hospitals should become the base for advanced medical services and wide area transportation. Also, the clinical laboratory/medical technologists of the university hospital should offer high quality laboratory analysis. On the other hand, one of the advantages of a university hospital is an experimental medicine laboratory (integrated universities also have a Department of Science and Department of Engineering). Development of testing equipment to cover all the functions necessary for disaster medicine may be a possibility. A system to conduct simple testing is expected at the actual location of the emergency, and an identification system must be established. "Emergency medicine" and "disaster medicine" have different aspects, but the essence is the same, and medical technologists must have knowledge/techniques to report and interpret results quickly. Because a university hospital is the core of logistical support, daily training is important.