The manual is straightforward and easy to follow. Split into six chapters, the first three cover general information about the test, administration and interpretation. Appendixes A-C are used to convert the subtest raw scores to scaled scores, the subtest raw scores to percentile ranks, and to convert the sums ot the scaled scores to indexes and percentile ranks, respectively. The test itself only takes minutes to administer, however if the examinee appears fatigued or to lose interest at any point, it is suggested that the test be extended into another session at a later date.
I Conception and design: None; III Provision of study materials or patients: All authors; VI Manuscript writing: All authors; VII Final approval of manuscript: Von Willebrand disease VWD is the most common bleeding disorder, showing a broad variation in prevalence of 0. Diagnosis and treatment of VWD in these countries primarily occur through comprehensive treatment centers by following guidelines outlined by the Nordic Haemophilia Council.
Accordingly, assignment of VWD is based on comprehensive evaluation, including standardized bleeding score, traditional laboratory analysis and adoptive platelet function studies.
The correct classification of VWD types is crucial in determining both the bleeding risk and clinical management, although clinical severity is not always related to biological activity of VWF.
There are several developments in both diagnosis and clinical management of VWD. This review focuses on the novel aspects of VWD care in the Nordic countries, involving pure von Willebrand factor VWF concentrates as treatment options, as well as laboratory assay development, including the new VWF activity assays and comprehensive whole blood platelet function and global coagulation aspects.
The members are medical doctors who treat both pediatric and adult populations, and are involved in the laboratory. Inalso the Baltic states of Estonia, Lithuania and Latvia have been recently offered the opportunity to take part and network in the meetings.
The council has as the main aims of hosting Nordic meetings, establishing local guidelines and fostering scientific interactions in the geographical region. Erik von Willebrand in 1. Sincewhen the Nordic Guidelines on VWD were published 2some new developments in the following aspects have ensued: The main changes have included: We will address all these issues in this short report of Nordic perspective.
Organization of care in bleeding disorders During the same period, which has elapsed from our practical guidelines in 2the organization of care in bleeding disorders has been upgraded at the European level 3.
I the patient numbers: The estimated numbers are as follow: Data on type 2 VWD subtypes are available from 3 centers: To conclude, females gaining more than 5 points beyond the weakened hemostasis related to menorrhagia and bleeds during delivery, which can also occur without VWD, typically in platelet function defects and males gaining more than 3 points several sites of bleeds fulfill the criteria of VWD, assuming their laboratory assessment is compatible with this diagnosis 1.
The family history can be subjective in uncertain cases, and may need the objectivity of patient files. As an example, sometimes in deviation from true mucocutaneous and spontaneous bleeds, bleeds that do not associate with a bleeding disorder, need further assessment. These include local, such as surgical or postpartum bleeds, which due to arising complications may achieve the misconception of a bleeding phenotype among the family members.
The role of a coagulation expert in providing genetic and diagnostic counseling and clinical guidance, for the future clinical approach is very important 6. Upon appropriate bleeding phenotype, the clinical evaluation should be compared with the laboratory assessment. When there is concordance in both assessments, the diagnosis of VWD as the underlying bleeding disorder is clear.
The VWD subtyping needs more commitment Table 2. Sub-typing will rarely have an impact on the patient management, excluding type 2B and 2N, but family issues associated with genetic counseling should be the main motivation for the subtyping, unless this is performed within the setting of a research project.
In the subtype 2B the use of desmopressin is not recommended due to the risk of inefficacy and deepening thrombocytopenia by the release of functionally impaired VWF. One differential diagnostic issue is the recognition of mild hemophilia A versus type 2N VWD with the deficient FVIII binding, wherein the genotypic diagnosis will usually provide the definite answer.
Table 2 Characteristics and differential diagnosis of VWD types and subtypes Full table One clinical aim should also be the re-evaluation of historical diagnoses, to focus on the bleeding history, and remove any unnecessary concern of a bleeding disorder in the absence of significant bleeding tendency within a family and individuals.
The modestly low VWF levels alone may get improved during aging, and blood group O may in fact offer protection from thromboembolic diseases 78. The re-evaluation will assist to reach management decisions concerning the thrombotic risk or disorders, which increase in prevalence among the aging population or populations with many thrombotic risk factors and co-morbidities, including atrial fibrillation 7.
New laboratory perspectives The proper identification of VWD and differentiation of its major types are important for optimal treatment and require a panel of different VWF assays, including VWF activity. The Nordic centers collaborate because some tests, i.
FVIII binding assay are not available at all laboratories.The uses and limitations of the western blot (WB) and radioimmunoprecipitation assay (RIPA) techniques for study of feline immunodeficiency virus (FIV) and FeLV were evaluated.
Chiodi F, Bredberg-Råden U, Biberfeld G, Böttiger B, Albert J, Asjö B, Fenyö EM, Norrby E. The sensitivity and specificity of radioimmunoprecipitation assay (RIPA) and Western blot (WB) test were compared by use of a collection of sera, representing different categories of individuals.
Transcript of Ross Information Processing Assessment- Geriatric (RIPA-G) Two Supplementary Subtests About the RIPA-G Ten Subtests Scoring Continued Scoring Ross Information Processing Assessment- Geriatric (RIPA-G) Katherine Esquivel Christina Lloret It is an extension of the RIPA How to Cite.
Castaman, G., Hillarp, A. and Goodeve, A. (), Laboratory aspects of von Willebrand disease: test repertoire and options for activity assays and genetic analysis. Speech-language pathologists, neuropsychologists, psychologists, and other rehabilitation professionals can use the test.
The RIPA-G:2 subtests assess most aspects of geriatric cognitive-linguistic functioning: Immediate Memory, Temporal Orientation, Spatial Orientation, General Information, Situational Knowledge, Categorical Vocabulary, and.
Purpose of Test The purpose of the Ross Information Processing Assessment-Geriatric: Second Edition (RIPA-G:2) is to provide a comprehensive and norm-referenced cognitive-linguistic assessment instrument that is designed to identify, describe, and quantify cognitive-linguistic deficits in individuals ages 55 years and older.