Biomedical laboratory testing in detection and management of disease
Whole population screening
This involves a group of people who may be of the target to the condition, who are screened; the different process which will separate these targets into two groups. One of which the people do not have a chance of obtaining the target condition and thus are discharged from the screen and another which do. The group of people which have a higher chance of obtaining the target condition will have further choices of receiving advice, treatments, tests, and support.
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These processes take into account different factors including prevalence, sensitivity, and specificity. Prevalence is the number of individuals in a population who have the objective illness. Sensitivity is the screening’s ability to refer individuals who do have the objective illness, however, specificity is the screens ability to not refer individuals who don’t have the objective illness. (Illustration 1), displaying that out of a population of 20, 4 prevalent individuals are correctly referred for further processing (high sensitivity) and the rest of the population are correctly discharged (high specificity). Although, this is not always the case, due to this screening programme which may produce false positive and false negative results. A false positive result is where individuals are referred for further processing who do not have the target condition and a false negative result is where individuals who do have the target condition are not referred for further processing.
In diagnosing disease, where laboratory technician will go through the pre-analytic phase and post-analytic phase. These phases include deciding to perform the test, thus obtaining and analysing the specimen from the patient. Finally, the results of the tests are returned to the clinician, to which they return these results back to the patients. In the laboratory, a wide range of useful and reliable tests are undertaken. Prior to deciding which tests are done, critical questions should be answered as to which tests are most appropriate. For example, why is the test being ordered? and what are the consequences of not ordering the test? etc. Also, the need for thoughtful interpretation of the results from these tests contributes significantly to the diagnosing process.
In diabetes, the diagnostic criteria involve symptoms such as hyperglycaemia, unexplained weight loss, drinking a lot of water and producing an abnormal amount of diluted urine. Also, volumes of glucose concentration which is above 11.1mmol/l or volumes of fasting plasma glucose concentration which are above 7.0 mmol/l.
Diagnostic criteria for rheumatoid arthritis involve stiffness in joints, most commonly in the wrists, proximal interphalangeal joints, and metacarpophalangeal joints. Boggy swelling and subtle synovial thickening may be visible during a joint examination. Also, symptoms such as fatigue, weight loss, and low-grade fever can cause arthritis.
Monitoring diseases are the periodic measurement and the need for understanding that enables the management of prolonged diseases. It Includes a range of tests which are undertaken over long periods of time. These tests can be done before or after treatment to observe if the treatments are effective. Biomedical scientists need to have good monitoring practice, understanding and skill to accomplish the objectives set out for the management of different diseases. For example, monitoring heart diseases, ECG, stress tests, CAT and MRI scans are performed on the patient. Biopsy, bone scans, chest X-rays are tests which are performed on breast cancer patients.
Tests carried out on pathology disciplines
Prothrombin time (PT), this test is carried out by a lab technician whereby a thin needle is inserted into a clean area of skin on the upper arm of the body. Blood is then taken up through a blood vein, once done a bandaged is placed over the place the needle has been. This test is used to investigate if a person bleeds easily or has blood clots when they shouldn’t have. Measuring how quickly blood clot, by looking at set factors including if platelets are missing, broken or there is not enough of them.
Partial Thromboplastin Time (PTT), is similarly done the way a PT test is carried out, a needle is inserted into a vein and blood is collected into a tube and the nurse will cover the punctured area with a gauze pad. But a difference is a lab technician will add chemicals to the blood sample to make it blood clot. This test is used to measure the body’s blood clotting abilities and results would show how many seconds it takes to form a blood clot. A doctor may advise the patient to take this test if symptoms such as frequent nosebleeds or blood in the urine are seen.
Complete blood count (CBC), this is simply undertaken by inserting a needle into the skin to draw up blood and taking to the lab for assessment. During this time a biomedical scientist will check for both red and white blood cells, haemoglobin and platelets, to make sure the body has the correct range that is required. Also, this test could further check for anemia, to explain symptoms such as fever, bruises, or if medication or treatments are affecting the patient’s blood.
Rheumatoid Arthritis screening tests (RF and CCP). One of the screen tests is called Rheumatoid factor (RF), which detects the levels of this autoantibody, which causes the body to promote inflammation reactions, leading to issues with the body’s joints thus, enabling to diagnose diseases such as Rheumatoid arthritis (RA). Requiring the patients’ blood sample, which is collected by inserting a needle into the patient’s arm.
The other screen test is called cyclic citrullinated peptide antibody (CCP), whereby a sample of blood is taken by inserting a needle into a vein of the patient’s arm. This test is done as well as the RF test because it is more reliable than RF, as the CCP antibodies are able to signify the presence of rheumatoid arthritis (RA) and early diagnosis of RA.
Immunoglobulins (G, M, A) tests show information regarding infection or autoimmune disease. These immunoglobulins have very important roles in the defence and control against disease and are present in various parts of the body, for example, immunoglobulin M is found blood and is the first to attack and defend against the infection entering the body. These tests are carried out by, by inserting a needle into a vein and blood is withdrawn and collected into a syringe, which when done a cotton bud is covered over the area of puncture.
Autoimmune Hepatitis panel, is a series of tests which is undertaken if it is seen to believe that the patient has autoimmune liver disease, whereby the body’s immune system attacks healthy liver cells. These tests are also done by venepuncture, collecting blood into a vial or tube by inserting a sharp needle into the patient’s arm.
Types of non-biomedical investigations
Acupuncture is a type of treatment, whereby needles are inserted into a person’s body at a precise location, to various depths for around 5 to 30 minutes. Aiming to balance an individual’s energy and claiming to be able to boost wellbeing and may be able to sustain a variety of pain, this includes different kinds of painful headaches, blood pressure issues, osteoarthritis, knee, and neck pain. Benefits of this type of treatment are that there are a few side effects, performed correctly, safe and is a very effective type of treatment. However, some risks include that it can cause bleeding, bruising and soreness at the insertion sites. Also, could lead to serious side effect such as the risk of a collapsed lung.
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Another type of treatment which claims to be able to treat symptoms of different illnesses; homeopathy. This is created from a range of ideas, one of the main principles) is that this is a process which involves a type of dilution and succussion technique Hahnemann (1790). Homeopathy, enabling to treat physical conditions such as asthma, hay fever, and arthritis and psychological conditions such as depression, stress, and anxiety.
Naturopathy helps to improve an individual’s lifestyle by focusing on the significance of a healthy diet, clean fresh water, sunlight, exercise and stress management, thus being a more holistic view of treatment. Also, not just educating the patient but also the patient’s family as well in the importance of the previously noted focus points. Naturopathy works by using a range of non-invasive techniques including herbal and nutritional medicine, diet and lifestyle advice and tactile therapies. A migraine, headaches, depression, type 2 diabetes, and asthma are one of the few conditions that naturopathy heals.
Oriental medicine involves practitioners using a variety of techniques and mind and body practises to promote health and treat disease. This includes qi gong and tai chi (practices that combine specific movements, managing breathing and mental focus), cupping, herbs, and acupuncture. Holistically, treating an individual’s entire well-being, by largely focusing on a type of energy (qi) and being able to maintain and promote the flow of qi through a person’s body. Oriental medicine treats chronic problems (depression, arthritis, insomnia) and acute problems such as pain. Believed to be a working and safe healing process. This type of treatment, however, cannot be used by everyone, for example, pregnant women, elderly patients and for younger children.
Investigations carried out in diagnosing Liver Cancer
One type of biomedical testing is undertaking a biopsy, where a doctor is able to detect in the body where exactly is cancer. A pathologist in a laboratory examines the small sample of the tissue under a microscope, evaluating the tissue to diagnose the disease.
A doctor may use physical examination if they believe the patient may have cancer, by checking for lumps, swelling in the abdomen and alterations in liver and organs close by. They also may further look into the build-up of fluid in the abdomen and signs for yellowing and whites of the eyes. A doctor may also practise laparoscopy, where a person is under general anaesthetic, a small incision is made in the abdomen and a flexible camera is inserted so the doctor is able to see inside the body, particularly the liver.
A radiation oncologist may perform a bone scan where nuclear imagining tests detect for cancerous cells that may have spread to the bone. During which a radioactive substance is injected into the patients’ bloodstream to analyse if there is a tumour in the bones.
CAT and MRI scans are also other methods of investigating liver cancer, where both methods create a detailed image of the patient’s body. Both being able to detect the tumour’s size and produce clearer and further detailed images using a special dye called contrast medium. This medium is either injected into the persons’ bloodstream or provided as a liquid and swallowed. However, the CAT scan uses X-rays taken from different angles and MRI scans which use a magnetic field. (Illustration 2) showing a black and white cross-sectional image, producing a clear white mass showing tumour cells. However, (Illustration 3) shows are more colourful image and thus easier to identify where tumour cells have been destroyed (dark blue) after receiving treatment.
Oriental medicine can be used as some type of treatment of liver cancer, though, this is a more recent and modern technique, thus minimal scientific evidence has shown this to be effective. Huang et al. (2013) found that berbamine a chemical found in traditional Chinese medicine could kill liver cancer cells. Emphasising, oriental medicine could be used as a treatment for liver cancer patients.
Acupuncture is a technique which mainly focuses on treating long-lasting pain as an outcome of liver cancer. this is performed by infiltrating small thin needles into the patient’s body, whereby pain is relieved by a release of endorphin hormones; humans’ natural painkillers.
(Illustration 1), an image displaying a perfect screen, 100% sensitivity and 100% specificity of an imaginary population of 20 whereby 4 are prevalent.
(Illustration 2), a CAT scan displaying a cross-sectional image of a patient’s body. Evidencing liver cancer as white mass.
(Illustration 3), an MRI Scan displaying a 3D image of a primary liver cancer patient. Image C before treatment and image D after treatment
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