The purpose of A Manual of Laboratory and Diagnostic Tests, in this eighth edition, is to promote the delivery of safe, effective, and informed care for patients undergoing diagnostic tests and procedures and also to provide the clinician and student, educators and researchers, and others with a unique resource. This comprehensive manual provides a foundation for understanding diagnostic tests, from the relatively simple to the most complex, that are delivered to varied populations in varied settings. It describes the clinician's role in providing effective diagnostic services in depth, through affording the necessary information for quality care planning, individualized patient assessment, analysis of patient needs, appropriate interventions, patient education, patient follow-up, and timely outcome evaluation.
Potential risks and complications of diagnostic testing mandate that proper test protocols, interfering factors, follow-up testing, and collaboration among those involved in the testing process be a significant part of the information included in this text.
Organization of the Book
This book is organized into 16 chapters and 6 appendices. Chapter 1 outlines the clinician's role in diagnostic testing and includes interventions for safe, effective, informed pre-, intra, and post-test care. This chapter includes a Patient's Bill of Rights and Responsibilities, a model for the role of the clinical team in providing diagnostic care and services, test environments, reimbursement for diagnostic services, and the importance of communication as key to desired outcomes. The intratest section includes information about collaborative approaches facilitating family presence during invasive procedures; risk management; the collection, handling, and transport of specimens; infection control; controlling pain; comfort measures; administration of drugs and solutions; monitoring fluid intake and loss; using required equipment kits and supplies; properly positioning the patient for the procedure; managing the environment; and patient monitoring. The reader is referred back to Chapter 1, Diagnostic Testing, throughout the text for information about the clinician's role and diagnostic services. Chapters 2,3,4,5,6,7,8,9,10,11,12,13,14,15,16 focus upon specific categories of studies.
Studies are organized in a similar way for ease of use and include:
Introductory Information
- Background rationale
- Test purpose
- Interfering factors
- Description and method of the procedure and lab test completion
- Evidence-based outcomes
- Patient involvement
Reference Values
- Normal reference values
- Conventional and SI units
- Age-related values and critical values when applicable
Procedures
- Process of intratest care
- Method of specimen collection and handling for lab tests
- Method of diagnostic procedures
Clinical Implications
- Interpretation of abnormal findings
- Unexpected outcomes
- Disease patterns
- Clinical considerations for newborn, infant, child, adolescent, and older adult groups when appropriate
Interventions
- Pre- and post-test patient care
- Specific guidelines for each test phase
A bibliography at the end of each chapter, representing a composite of selected references from various disciplines, directs the clinician to information available beyond the scope of this book, and extensive appendices provide additional data for everyday practice.
New Information in the Eighth Edition
- Avian bird flu
- SARS
- Fetal predictive tests of abnormal development and fetal death
- Monkey pox virus
- Fetal alcohol syndrome
- Quarantine vs. isolation to prevent spread of disease
- Transdermal testing
- Brain tissue oxygen
- Right of the patient to truthful diagnosis and prognosis
- Blood test for TB
- D-dimer marker for pneumonia
- Skin test for cholesterol
- Tests for blood in stool
- Carotid intima media thickness, lipoprotein particle profile, and ischemic modified albumin
Tests have been updated and expanded to include the latest information.
- Updated information on tests for diabetes, cholesterol, renal failure, nuclear scans (eg, ProstaScint imaging and PET scans), biopsies (eg, MRI-guided breast, rectal biopsies to detect prostate cancer and site of origin of lower abdominal and retroperitoneal cancers), plus additional information on results of breast biopsies, genetic testing, and Pap tests.
- More on virtual colonoscopy and enteroscopy.
- Newly approved FDA home testing for drug abuse, HIV saliva and blood testing.
- Aftercare of gonorrhea.
- Updated information on eye tests.
- Diagnosis of endoscopic findings in colonoscopy and endoscopy of the upper GI tract.
- Updated information on newborn screening procedures.
- Updated appendices.
- Tissue (histology) biopsies and predictive markers for Rx response.
- New and updated tests for cardiovascular risk and disease.
- Breath tests for ulcers, alcohol, lactose, etc.
- Fertility tests.
- Expanded scope of magnetic resonance (FMR, MRI) scans.
- Updates on bioterrorism agents, detecting food poisoning, bioterrorism infections, smallpox, anthrax, plague, and hemorrhagic fever.
- Pre- and post-organ transplant testing.
- Expanded content on keeping records of diagnostic tests, use of proper forms, and standard report forms.
- Panels of multiple tests (eg, metabolic syndrome, syndrome X) in Chapter 6, Chemistry Studies.
- Expansion of the standardized model for each test.
Current Developments in Laboratory and Diagnostic Testing
New technologies foster new scientific modalities for patient assessment and clinical interventions. Thus, the clinician is provided a greater understanding of the long chain of events from diagnosis through treatment and outcomes. In a brief span of years, new and improved technologies have led to developments in x-ray scanners; digital and enhanced imaging; magnetic resonance (MR); positron emission tomography (PET) scans of the heart and brain; enhanced ultrasound and nuclear medicine procedures; newly discovered genetic mutation studies; new cancer markers for diagnosis and prognosis; sleep disorders tests; technology for fetal testing before birth; and postmortem testing after death. Many new technologies are faster, more patient friendly, more comfortable, and provide an equivalent or higher degree of accuracy (ie, HIV or hepatitis detection, monitoring for drug abuse or managing therapeutic drug levels). Saliva and breath testing is gaining ground as a mirror of body function, DNA, and emotional, hormonal, immune, and neurologic status, as well as providing clues about faulty metabolism. Noninvasive and minimally invasive testing (eg, using a swab to collect saliva from the mouth, procedures that require only one drop of blood), which is better suited for testing in environments such as the workplace, private home, and other nontraditional health care settings such as churches, is made possible by better collection methods and standardized collection techniques. Newest diagnostic lab technologies include hand-held nucleic acid detectors for specific bacteria and viruses, hand-held miniaturized chip-based DNA analyzers, reagent-less diagnostics that introduce the sample (hand, finger, ear lobe, etc.) to magnetic fields, and magnetic resonance spectroscopy (MRS). Noninvasive and minimally invasive diagnostics include infrared light to estimate glucose, rapid oral screen for HIV, proteinomics, and functional and molecular techniques.
A resurgence in the use of traditional, trusted diagnostic modalities, such as electroencephalogram (EEG), is being seen in certain areas. Diseases such as HIV, antibiotic-resistant strains of pathologic organisms (TB), and Type 2 diabetes are becoming more prevalent. In the workplace, thorough diagnostic testing is more common as applications are made for employment and disability benefits. Also, requirements for periodic monitoring of exposures to potentially hazardous workplace substances (chemicals, heavy metals), breathing and hearing tests, and TB and latex allergy testing require skill in administering and procuring specimens. The number of forensic identity DNA tests being performed has increased tremendously. Concurrently, consumer perceptions have shifted from implicit faith in the health care system to concerns regarding less control over choices for health care and more distrust of the system in general.
Managed care and its drive for control of costs for diagnostic services exert a tremendous effect on consumers' ability to access testing services care. This results in mixed access to services, depending upon approval or denial of coverage.
These trends—combined with a shift in diagnostic care from acute-care hospital settings to outpatient departments, physicians' offices, clinics, community-based centers, nursing homes, and sometimes even churches, stores, and pharmacies—challenge clinicians to provide standards-based, safe, effective, and informed care. Because the health care system is becoming a community-based model, the clinician's role is also changing. Updated knowledge and skills, flexibility, and a heightened awareness of the testing environment (point of care testing) are needed to provide diagnostic services in these settings.
Clinicians must also adapt their practice to changes in other areas. This includes developing, coordinating, and following policies and standards set forth by institutions, governmental bodies, and regulatory agencies. Being informed regarding ethical and legal implications such as informed consent, privacy, patient safety, the right to refuse tests, the right to truthful diagnoses and prognoses, end-of-life decisions, standards for quarantine to control infection, and trends in diagnostic research procedures adds another dimension to the clinician's accountability and responsibility. The consequences of certain types of testing (ie, HIV and genetic) and the implications of confidential versus anonymous testing must also be kept in mind. For example, anonymous tests do not require the individual to give his or her name, whereas confidential tests do require a name. This difference has implications in the requirements and process of agency reporting for all patients as well as for select groups of infectious disease incidence such as HIV.
Responding to these trends, the eighth edition of A Manual of Laboratory and Diagnostic Tests is a comprehensive, up-to-date diagnostic reference source that includes information about newer technologies, together with the time-honored, classic tests that continue to be an important component of diagnostic work. It meets the needs of clinicians, educators, researchers, students, and others whose work and study requires this type of resource or reference manual.
About the Authors
- Frances Talaska Fischbach: Associate Clinical Professor of Nursing, School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; Associate Professor of Nursing (Ret), School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, Marshall Barnett Dunning III BS, MS, PhD.
- Marshall B. Dunning: Professor of Medicine & Physiology: Department of Medicine, Division of Pulmonary/Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Director, Pulmonary Diagnostic Laboratory, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin.
Book Details
- Paperback: 1344 pages
- Publisher: Lippincott Williams & Wilkins; 8th edition (May 22, 2008)
- Language: English
- ISBN-10: 0781771943
- ISBN-13: 978-0781771948
- Product Dimensions: 9 x 6.1 x 1.7 inches