ADAMTS13 Activity: Screening Test Protocol.

Accurate estimation of ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif, member 13) activity level is necessary for diagnosis and management of thrombotic microangiopathies (TMA). In particular, it permits distinction between thrombotic thrombocytopenic purpura (TTP) and other TMAs, prompting disorder appropriate treatment. Manual and automated quantitative assays of ADAMTS13 activity are commercially available, some providing results within less than an hour, but they require specialist equipment and personnel and tend to only be available in specialized diagnostic facilities. Technoscreen ADAMTS13 Activity is a rapid, commercially available, semiquantitative screening test employing flow-through technology and an ELISA activity assay principle. It is a simple to perform screening tool, not requiring specialist equipment or personnel. The colored end point is compared to a reference color chart containing four color intensity indicators corresponding to ADAMTS13 activity levels of 0, 0.1, 0.4, or 0.8 IU/mL. Reduced levels detected in the screening test should be confirmed by quantitative assay. The assay lends itself to use in nonspecialized laboratories, remote, and point-of-care settings.

ADAMTS13 Activity Measurement by ELISA and Fluorescence Resonance Energy Transfer Assay.

Accurate estimation of ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif, member 13) activity level is crucial in the diagnostic setting of differentiation between thrombotic thrombocytopenic purpura (TTP) and other thrombotic microangiopathies. The original assays were too cumbersome and time-consuming for use in the acute situation, and treatment was often based on clinical findings alone, with confirmatory laboratory assays following days or weeks later. Rapid assays are now available that can generate results fast enough to impact on immediate diagnosis and management. Assays based on fluorescence resonance energy transfer (FRET) or chemiluminescence principles can generate results in less than an hour, although they require specific analytical platforms. Enzyme-linked immunosorbent assays (ELISA) can generate results in about 4 h, but do not require specialized equipment beyond ELISA plate readers that are in regular use in many laboratories. The present chapter describes principles, performance, and practical aspects of an ELISA and a FRET assay, for quantitative measurement of ADAMTS13 activity in plasma.

A multi-center evaluation of TECHNOSCREEN® ADAMTS-13 activity assay as a screening tool for detecting deficiency of ADAMTS-13.

BACKGROUND: Quantifying A disintegrin-like and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS-13) activity enhances thrombotic thrombocytopenic purpura (TTP) diagnosis but most assays are time consuming, technically demanding, and mainly available in reference centers. OBJECTIVE: Evaluate a simple, semiquantitative ADAMTS-13 activity screening test for early identification/exclusion of TTP. PATIENTS/METHODS: Plasma from 220 patients with suspected thrombotic microangiopathy at three reference centers were tested with TECHNOSCREEN® ADAMTS13 activity screening test in comparison with TECHNOZYM® ADAMTS-13 activity ELISA at two centers, and in-house fluorescence resonance energy transfer assay at the third center. The screening test indicates if ADAMTS-13 activity is at one of four level-indicator points: 0, 0.1, 0.4, or 0.8 IU/mL. RESULTS: Screen results were interpreted as binary data in that ADAMTS-13 activity was above or below the 0.1 IU/mL TTP clinical threshold. Combining all sites' data, the screen exhibited 88.7% sensitivity, 90.4% specificity, 74.6% positive predictive value, and 96.2% negative predictive value, comparable to published data for quantitative assays. Five samples with quantitative results below the threshold gave screen readings of 0.1 IU/mL and seven marginally above the threshold gave screen readings of zero. All would warrant plasma exchange while the level is quantified. Nine samples with normal/near normal results gave screens of zero and confirmatory quantifications would prompt early treatment withdrawal, as is current practice. One sample generated screen/quantitative results of 0.4/0.00 IU/mL respectively and was the only clear false-negative. CONCLUSIONS: The screening test provides more rapid ADAMTS-13 level evaluation than most currently available assays. Its simple operation renders it suitable for adoption in routine or specialist laboratory environments.

Oncology nursing: educating advanced practice nurses to provide culturally competent care.

More than 37 million persons or 12.4% of the U.S. population are older than 65 years. These numbers are expected to reach 71.5 million (20% of the population) by 2030. This older population is becoming more racially and ethnically diverse as the overall minority and culturally diverse populations increase. Although the incidence and mortality rates from several major cancers have declined due to advances in cancer care, these advances have lagged among the underserved and more vulnerable racially and culturally diverse populations. Moreover, the disparity between the gender and the racial mix of nurses and the overall population continues to widen. Thus, a growing need for professional nurses and advanced practice nurses with formal educational preparation in all areas of oncology nursing exists. This article (a) highlights significant cancer disparities among diverse populations, (b) describes how cultural belief systems influence cancer care and decision making, and (c) explicates the need to prepare advanced practice nurses for careers that include cancer care of diverse and vulnerable populations through formal oncology educational programs. The "Top 10" reasons for becoming an advanced practice nurse specializing in the oncologic care of patients from diverse and underserved populations are presented.

The lived experience of NCLEX failure.

Educators help coach, focus, and prepare students for the National Council Licensure Examination (NCLEX), but often fall short in providing support when graduates are not successful. Most research to date has focused solely on predicting failure, with little to no attention given to interventions after failure. This study presents the voices of unsuccessful candidates, their responses to failure, their perspectives of the factors that contributed to their failure, and the changes they made that led to subsequent success. The results demonstrate common themes related to the failure experience, successful remediation strategies for retesting, and recommendations for faculty interventions during this vulnerable period. Nurse educators have a responsibility to identify, inform, and intervene with students who are at high risk of failing the NCLEX, and this responsibility is executed capably. However, the role extends beyond graduation. The responsibility to help nursing graduates transition from failure to licensure is the final step of successful undergraduate nursing education.

Meeting the needs of the health system: a refresher course for registered nurses.

To address the shortage of nurses experienced by a healthcare system, faculty from a baccalaureate nursing program collaborated with the affiliated healthcare system members to offer a refresher course to facilitate the return of inactive nurses to the workforce. The program included didactic content, simulated laboratory experiences, and precepted clinical experiences on the employing units. This article describes the scope of the program and focuses on recommendations for future course implementation, including implementing a systematic evaluation of each participant's knowledge base at the beginning of the course and an extended course time frame to allow for greater integration of content.