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Another view of the lab of the future.

Another view of the lab of the future

"Oh darn," cried Melissa, "this silly Robotech is not working again!" She was having a terrible time this morning-- a Monday, of course. On most days, the Robotechs quietly went about their chores separating the blood collected in the Sanguprobes into plasma and cells. But today was different.

Instead of inserting the Sanguprobes into the Computester blood analyzer in the usual orderly way, one Robotech was actually squashing the Sanguprobes so they could not be used. No blood was spilled inside the instrument; the Robotech was too smart to make that mistake.

In the bad old days leading up to the andromedaids epidemic, people had actually come in contact with blood, urine, and other body fluids. This was now all a thing of the past.

Andromedaids had been a disaster for the community. This retrovirus-caused disease had quickly established its hold on the old and frail, and antibiotics and anti-DNA replication drugs were of no help. At first, the route of infection could not be determined, but sexual contact was an unlikely route considering the advanced age of many of the patients. At last, investigators learned that the virus was carried by fungus spores that infected erythrocytes. A sure way to contract the disease was to come into contact with blood or urine from an infected patient.

After an elaborate and costly search, the World Congress of Demise Control (WCDC) found that the major culprit was Mexican tequila; it was just loaded with the virus-infected fungus. Victims of the disease lost functioning erythrocytes, then the bone marrow gave out. Bone marrow transplants extended the life of a few patients. Quixotically, however, the bone marrow reverted to a nonfunctioning state after a few months.

All efforts to develop a vaccine had been unsuccessful to date. The virus had chameleon-like properties--it could change the antigenicity of its outer protein coat and become unrecognizable to a previously effective antibody.

The only hope was to avoid contact with body fluids from possibly infected patients, and of course, no tequila! Congress banned the importation of all alcoholic drinks from Mexico, much to the consternation of the Mexican government.

The uniformly fatal andromedaids presented clinical laboratory workers with a specimen-handling dilemma. Transdermexanguinator, or Transex for short, represented an important breakthrough. It allowed collection of a 10 l blood sample into a closed container without the use of a needle or probe. The Transex was held in a fold of skin, under the arm, or against the inside of the cheek, and blood entered the Sanguprobe pods by transcapillary effusion. No more messy needles and blood to confront, thank goodness.

The Sanguprobes themselves were a work of genius. These variably sized, pliable, and unbreakable pods could be used for the collection of any body fluids --i.e., blood, urine, tears, CSF, etc. They emerged from the Transex fully identified. A microwave-emitting nanochip implanted in the patient's tooth did the job of coding each pod with the patient's name, demographics, and complete medical history.

Robotechs loaded the Sanguprobe pods into the Computester after compartmentalization of the leukocytes, erythrocytes, platelets, and plasma. Computesters were the latest in a stream of dry-reagent analyzers.

Two microdots of plasma were required for each determination: the specimen's internal blank and the test itself. The new light-emitting technology served its purpose well; the analyte testing modules were designed so that a specific frequency of light could be assigned to each test. A rainbow of results came from the dry-reagent pads within two to five milliseconds after the pods reached the Computester. After completion of the tests, a laser burst quickly vaporized the pods to elimiate any hazards. Because the pods were so small, heat dissipation was not a problem.

Blood specimens were assayed for the formed elements based on cell or particle size, chemical reactivity of cytoplasmic and nuclear proteins, and density. A clever cell sorter used this information to segregate and count normal and abnormal erythrocytes, platelets, and the several types of leukocytes.

A photoimage of unusual or bizarre cells was stored as a 3-D hologram for later review. With the hologram, it was possible to peer into the cell and examine the cytoskeleton. All kinds of new information was acquired about the biochemistry and cytoskeletal morphology of the various formed elements in blood.

The Robotechs reviewed the results from the Computester, and a human made a final check before the laboratory data went to the new 2-D high-intensity display screen above the patient's bed. The screen also displayed X-rays, ECGs, tomograms, body-section holograms, and other information. One could, for example, call up any page of the patient's Medomap for review. The old, hateful, illegible medical records were gone forever. Medomaps made everyone's life so much easier.

Patients were instructed to participate actively in their own health care as much as possible. The Truth in Medicine Act gave them the right to access their own Medomap and point out errors. They could also make suggestions and even demands for their care.

At times, patients' suggestions made taking care of them more difficult. Nevertheless, one famous patient, Julia Cousins, may have saved her own life by noting that surgery scheduled for her was actually meant for Julie Cousins, who was unrelated but in the hospital at the same time. Human error produced this slip and flawed the otherwise foolproof Medomap system. New protocols were evaluated to eliminate as much human input as possible.

Education of consumers on their health care led many more patients to supply input on their treatment schedules, surgery, drugs, and general care. As in the past, however, most patients were passive and trusting of the System and its directives.

The Megacenter Socratic Hospital and Teaching Center had about 3,000 beds, including 400 beds in the Organ Rejuvenation and Replacement Unit. Fortunately, the timely advent of elective euthanasia had taken pressure off the Megacenter to add still more beds. The rigid ProPay system initiated many years ago by the Government made cost control an everyday activity for the few humans that still worked at the Meg. The clinical laboratory was now nearly totally robotized and computerized. Two people did the work that required 20 a scant quarter-century ago.

The Robotechs actually performed most of the work. People were still required to monitor the Robotechs and the Computester, affectionately referred to by all as "that monster machine." Actually, the instrument was highly reliable, thanks to its self-diagnostic system for detecting failures and its internal redundancy. The analytical stations were all modular, and the Robotechs could perform simple repairs. The resident engineers kept the machinery in working order, while a different breed of robots, run by the laboratory computer, monitored the self-diagnostic components of the Robotechs and Computester.

The review of proficiency testing data was nearly always completed by the Robotechs; infrequently, some human intervention was needed. Proficiency testing was now in the zero-blunder mode, a development of the modern age. Allowable imprecision was set at 10 per cent of intraindividual variation, a scheme that was widely accepted and useful. Advanced algorithms were in use for recycling or saving specimens when prescribed proficiency testing conditions were not met.

In nearly all cases of partial Computester failure, the combined systems of self-diagnosis and component redundancy alerted the Robotechs to make adjustments or replacements, and real crises were averted. A "hard-down" had only occurred once in the eight years since the Computester was installed. A little mouse had sought warmth in the innards of the instrument and had become caught in the gears. The Robotechs could not handle that problem, so the repair engineers actually had to be called (theirs was a lonely existence).

Now in the fifth generation, the Robotechs were a great success in the laboratory. Earlier trials with Robotechs using the Transderm-exanguinators for specimen collection were a colossal failure.

The engineers on the Transex project had designed the devices to work with the Standard Human Model, where it performed admirably. Unfortunately, the designers had overlooked the problem of the many odd sizes and shapes of patients at the Meg, and the Robotechs could not adjust for these variations in applying the Transexes. As a consequence, the Robotechs were not allowed in the patient areas, but were confined to strictly technical tasks in well-defined surroundings. Patient care still required a good deal of human interaction.

Another approach to the difficulty caused by patients coming in different sizes was the eugenics program espoused by Franz Wilhelm Strauss. The goal was to produce only Standard Humans, but the program was a dismal failure and universally rejected. Strauss, not a Standard Human himself, committed Selbstmord after the demise of his lifelong dream.

Paper records had been rendered obsolete by the computer-driven Medomaps, photolaser imaging of documents, and large-volume computer archival storage on the new hyperdense magnetic-bubble medium. The effect on the laboratory was dramatic and in some ways frightening. It was hard to break the paper habit because documents and paper records had been the crutch, something that "we can always so back to."

Some distrust of the Central Meg Series-103 Hal-Computer remained, even though no one could remember the last time Hal had failed. In any case, the photolaser imaging machines could be used to restore any information that was inadvertently lost from Hal's archival bubble memory.

Voice-Transcribers had finally solved the fear-of-terminal problems of residents, attending physicians, nurses, and others. After a standardized voice profile had been recorded for each member of the health care team, it was possible to voice-transcribe notes, orders, remarks and other information directly into a Medomap.

Patients were also able to add information to their Medomap, such as past medical histories, comments about their health, intimate details of their personal lives, and quality control statements (their perceptions of the level of care they were receiving). The QC statements had a salutary effect on the medical staff. Clinicians did not want an excessive number of negative remarks recorded against them--it could slow their movement up the career ladder at the Meg.

The third-generation Artificial Intelligence-E diagnostic system made most of the diagnoses more accurately and far more quickly than the attending staff. Linking the Medomaps--with their textual, numerial, and analog information --and the AIE system was a crowning achievement. Most diagnostic problems became truly trivial.

New information on usual and unusual diseases was continually added to the database to make the AIE system even smarter--and extremely elaborate. Only the fastest computer could handle all the information from the 300-gigabyte database in a timely way. Fortunately, the new Krayon Computer measured up to the demanding task.

The total-body holograms, obtained with the hydrogen, phosphorus, and carbon magnetic resonance imaging system, had a tremendous impact. It was now possible to produce selective three-dimensional images of any body parts, even tiny blood vessels and nerves.

Diagnosis of occlusive vascular disease anywhere in the body was easy. Catheterization and angiography became quaint old pracices. Tiny tumors, breaks in nerves, small stones and other pathological lesions were all easily detected. The new noninvasive technology removed all risk for patients and eliminated all use of x-rays and ionizing nuclear radiation for diagnostic workups.

The comparator program on the Krayon that matched the patient's holographic data with that of the Standard Human proved more or less successful. Further work was needed on the program to capture the vagaries of human existence.

All textbooks in medicine, pathology, and related areas had disappeared from nearly everywhere except the habitats of crusty old professors who clung to the obsolete past. Hypertexts, containing computer-stored text and images on all subjects, were now in wide use. Updating them was an ongoing project of the World Library of Medicine.

It took some skill to use the Hypertexts, but the Insta-Learn machines at the Meg solved that problem nicely for everyone. Once a novice understood the tree algorithms of the Hypertexts, obtaining information was easy. Laser printers could produce hard copy in a few seconds.

Bioprobes to follow changes in the pathophysiology and biochemistry of acutely ill patients were common. Thus changes in key analytes, such as pH, blood gases, and electrolytes, could be monitored on a continuous basis in patients of all ages.

Bioprobe graphics were often displayed on the patient's bedside 2-D monitor. Life-threatening changes triggered alarms and help from members of the ward's health-care team. Generally, the probes were attached to the skin or mucous membranes. Owing to their tiny size, they could be placed inside easily accessible body cavities without discomfort to the patient. Tiny implanted transmitters eliminated the need for dangling, clumsy wires.

The Genetic Repair Facility at the Meg was an especially busy place. Now that the entire human genome had been mapped, it was possible to identify nucleotide base-sequence errors in the DNA strands of specific chromosomes and to use the new nucleotide Plasmidotool repair and insertion procedure to correct errors in somatic cells in tissue culture.

After the cultured cells were rendered immortal and nonmalignant with the new drug Lifagen, a clone of the cells was infused into the patient's bloodstream. Soon the new clone took hold in the appropriate organ of the body and produced the otherwise lacking protein or hormone. Thalassemia, cystic fibrosis, sickle cell anemia, Huntington's chorea, Tay-Sachs disease, diabetes mellitus, Duchenne dystrophy, and a number of other dreadful and/or fatal genetic diseases were eliminated.

Lifagen was a miracle drug: It fooled the immune system into preventing rejection of cells that had been coated with synthetic monopolylipid (the body still reacted normally to the invasion of foreign organisms, however). Lifagen changed the whole field of organ transplantation. The old and nephrotoxic anti-rejection drugs and the anaphylactoid protein agents were now relegated to history.

The new protocol called for infusing the organ to be transplanted with monopolylipid, thus making the gland transparent to the recipient's immune system. Excellent results were obtained with kidney, heart, heart-lung, and pancreas transplants. Liver and bone marrow transplants were somewhat less successful, for reasons that were unclear. Most patients had long-lasting liver transplants, but a few suffered acute rejection episodes. Perhaps in the latter, the fault lay with the combination of Lifagen and the monopolylipid infusion. Generally, livers from young donors were not rejected.

Infusion of Lifagen and monopolylipid into patients with autoimmune diseases also had a share of successes and failures. Patients with autoimmune hemolytic anemia did well, but those with rheumatoid arthritis and other collagen diseases occasionally took a turn for the worse following treatment.

Solid malignancies remained a riddle wrapped in a mystery inside an enigma. Much had been learned about tumor heterogeneity and immunology, but cancer was still the leading cause of death. Fatalities owing to hematological malignancies were rare, given the largely successful bona marrow ablation technique followed by cloned-cell transplantation and Lifagen treatment. Where were the keys that would finally unlock the puzzles hidden in the cancer problem?

The future was now. The Meg, its clinical laboratories, indeed all of medicine stood at the forefront of a huge technological wave. Computers, high tech procedures, automation, and rationalization of costs had changed everyone's life at the Meg. Solutions usually brought new questions, but one thing was certain: There was no going back!
COPYRIGHT 1988 Nelson Publishing
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Copyright 1988 Gale, Cengage Learning. All rights reserved.

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Author:Lott, John A.
Publication:Medical Laboratory Observer
Date:Mar 1, 1988
Previous Article:Financial management is more than monitoring a budget!
Next Article:Anatomy of a lab transition: retaking in-house control.

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