Inaccurate examination is typically done when both

 

 

 

 

Inaccurate results of urinalysis can arise from factors such as
disintegration of leukocytes and erythrocytes, proliferation of bacteria, bacterial
degradation of glucose, oxidation of bilirubin and a rise in pH due to ammonia
formed as a result of bacterial degradation of urea. In order to slow all these
processes down, appropriate storage of the urine is required which means that
the urine sample has to be stored in a closed containers and be refrigerated. The
hypothesis of the study is that 24 hour urine samples provide the most accurate
results of the chosen analyte. According to an article by Callens and Bartges
(2015), a urine sample should be evaluated within 30 minutes of being collected
and if this is not possible then it can be refrigerated for up to 24 hours as a
refrigerator does not alter urine pH. Other sources, however, mention that the
evaluation can be performed within 2 hours of collecting the sample.  

The microscopic examination
of urinalysis is performed on urine that has been centrifuged and then examined
under a microscope observing cells such as red blood cells or epithelial cells.
A microscopic examination is typically done when both the visual and chemical
examinations have provided abnormal results and further investigation is
required.

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 There are three main aspects of urinalysis;
visual examination, chemical examination and microscopic examination.  A visual examination is normally performed to
see the colour of the urine and the clarity of it. A chemical examination which
can be performed using a dipstick looks at things such as pH, protein or
glucose. The advantages of this is that it reduces time needed to make a
diagnosis and can also be used to diagnose a wide variety of conditions which
is why it is significant in today`s healthcare. The disadvantages are that the
test can sometimes give you a false positive or false negative. According to an
article published in Continuing Education in Anesthesia Critical Care & Pain (Volume 8
Issue 6, 2008), sensitivity and specificity are fundamental to understanding
the use of clinical tests. The term sensitivity refers to the “ability of the
test to correctly identify those with the disease” and specificity refers to “the
ability of the test to correctly identify those without the disease” (Continuing
Education in Anesthesia Critical Care & Pain, 2008).

One of the many
common tests performed in many healthcare settings is urinalysis. It is simply
just an analysis of a collected urine sample. Urinalysis is used to find the
cause or monitor urinary tract infections, bleeding in the urinary system, or
kidney or liver disease. It can also be used for diabetes.  Only small amounts of a sample are usually
required to be collected for testing and can either be performed in a
laboratory or right near the patient.

 

Although analysis using POCT is seen as a quick and easy
alternative to standard clinical laboratory testing, POCT devices used have
protocols and guidelines of use that must be adhered to in order to ensure the safety
of the patient. In every area of pathology laboratory, testing is subject to
regulation, inspection and accreditation including the POCT service. The aim of
this is to ensure a safe and reliable service with consistent and accurate
results for patients as well as making sure that the in vitro diagnostic
devices are fit for purpose and being utilised by a competent individual. A report
from the British In-Vitro Diagnostics Agency (BIVDA) in 1970 concluded that
hospital managers are more likely to be confident when using POCT devices
compared to clinicians as the managers concentrate more on factors such as
lower costs whereas clinicians have a better understanding of what can go wrong
in practice. Errors in transcription may occur when test results are written
into the patient`s note. Rushed and inappropriate decisions could lead to
patients being given the incorrect diagnosis which may result in litigation.  

Like any other diagnostic equipment in medicine, point of
care testing has its advantages and limitations. The cost per test is often
higher than when the same analysis is performed in a laboratory, however, the
impact of a rapid test can equalise this extra cost. The benefits of the rapid
tests have direct impacts to the patient as they can potentially reduce their
stay as an impatient or reduce inappropriate administration of prescriptions drugs.
Point of care testing can be competently performed by individuals with no experience
as long as they follow instructions, the use of POCT devices in setting such as
prison can reduce the cost of secure transport of prisoners to a hospital for
treatment and over the counter testing kits cut costs associated with the
National Health Services, for example fertility monitoring kits or pregnancy testing
kits. POCT devices can be used in management of both acute and chronic
conditions. For example bench top POCT analysers are used in rapid response
laboratory setting where the results give a baseline and the clinician can
monitor, refer or discharge the patients based on the results. When it comes to
chronic management, patients are able to do so at home by themselves which in
turn allows them to gain a better understanding of their own disease and the
management of it and also releases hospital resources for other patients. Analysis
shows that the 105 hospitals in England which provide pathology services
typically do around 1.2 billion tests per year at a cost of £2.2 billion (NHS
Improvement, 2017). Using POCT devices can save the NHS on costs as less
training programmes would be needed if people become aware of how to use the
hand held portable devices. The NHS expects to save at least £200 million by
2020-2021.

Point of care testing (POCT) also known as Near Patient is
the provision of diagnostic pathology testing service outside a laboratory and
is usually done closer to the patient. This type of testing can be carried out
by healthcare professionals in a hospital ward, clinic or a GP surgery or even
by the patient themselves. Point of care testing was derived from earlier technologies
as a way of making diagnosis much more patient centred, thus it is not a new
concept. For example urine dipstick testing and blood glucose meters were first
introduced in the 1970s and have been in healthcare for many years. Technological
advances over the years have widened both the testing range and the software available
to point of care testing devices with blood gas analyser manufacturers leading
the marketplace in terms of quality standards for POCT. Modern POCT now has a
variety of hand held devices and test kits, with some being available for
purchase directly by the patient such as a blood glucose machine, to more sophisticated
bench tops and portable analysers which provide a selection of tests in all
disciplines of pathology.

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