Gram stains of positive blood cultures are the most important factor influencing appropriate therapy. The sooner appropriate therapy is initiated, the better. Therefore, it is reasonable to expect that the sooner Gram stains are performed, the better. To determine the value of timely Gram stains and whether improvement in Gram stain turnaround time (TAT) is feasible, we compared data for matched pairs of patients with cultures processed promptly (<1 hour TAT) with data for patients with cultures not processed promptly (> or =1 hour TAT) and then monitored TAT by control charting.In 99 matched pairs, average difference in time to detection of positive blood cultures within a pair of patients was less than 0.1 hour. For the less than 1 hour TAT group, the average TAT and crude mortality were 0.1 hour and 10.1%, respectively; for the 1 hour or longer TAT group, they were 3.3 hours and 19.2%, respectively (P < .0001 and P = .0389, respectively). After multifaceted efforts, we achieved significant improvement in the TAT for Gram stains.

Anosmia is a common sequela of TBI, although only a minority of patients are aware of this deficit. Further, anosmics demonstrated greater impairment in a variety of frontal-lobe mediated executive functions, as well as greater functional disability.

Memorial Medical CenterRehabilitation psychology embraces the scientist-practitioner model as its professional philosophy. This model's original intent was that the diagnosis and treatment of each individual case was to be regarded as a single and well-controlled experiment. Executing this ideal in rehabilitation has been problematic owing to practical, ethical, and technical concerns. Statistical process control (SPC), a robust, graphical analytic strategy developed in industry, is offered as a means to deploy single-subject designs on the front lines of rehabilitation. The history and construction of SPC control charts are presented followed by case examples relevant to rehabilitation practice (ambulation, depression, cognitive rehabilitation, agitation). SPC control charts are a time-tested, scientifically validated, and pragmatic tool to achieve and document patient outcomes.

To investigate the role of personality factors and stress coping in temporomandibular disorder (TMD), a chronic facial pain-dysfunction syndrome. Design/Participants: Descriptive cross-sectional study of 84 TMD and 79 orthodontic-periodontic contrast patients recruited from a 3-state region. Measures: Questionnaire consisting of validated measures of personality hardiness, microstressors ("hassles"), coping responses, neuroticism, dispositional optimism, depression, and pain perception. Results: Principal-components factor analysis (orthogonal and oblique rotations) suggested 4 conceptual factors: Escape-Neuroticism, Pain, Hardiness, and Problem Solving-Optimism. Linear discriminant analysis showed that these factors significantly distinguished TMD from non-TMD participants at a classification accuracy rate of 85%; this model was replicated in a cross-validation sample. Relative to contrast participants, TMD patients interpreted similar daily life events as more stressful and endorsed more use of nonadaptive coping responses. Conclusions: These findings support the assertion that psychological factors are important in the presentations of patients with TMD. Furthermore, TMD patients may present with a "negative stress coping" constellation distinguishing them from other chronic dental patients, suggesting a role for cognitivebehavioral interventions as part of the comprehensive rehabilitation plan. Despite 60 years of research, the role of psychological factors in the etiology of temporomandibular disorder (TMD) remains controversial. A chronic facial pain and dysfunction syndrome frequently treated within multidisciplinary pain rehabilitation programs, TMD consists of generalized pain of the head and neck, limited mandibular range of motion, clinically significant joint sounds on functional movement of the mandible, and radiographic evidence of change within the temporomandibular joints. Females are significantly more often diagnosed with

A study by Wiens, Bryan, and Crossen (1993) suggests the Wide Range Achievement Test-Revised (WRAT-R) Reading subtest and North American Adult Reading Test (NAART) are adequate predictors of Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ scores for a normal population. Although it is common practice to use reading scores to estimate premorbid IQ in clinical populations, the WRAT-R and NAART have not been compared using individuals with brain dysfunction. The current study cross-validated the Wiens et al. (1993) study using neurologically impaired populations: traumatic brain injury (n = 118), dementia (n = 37), and other neurologic impairments (n = 77). The results were generally consistent across all three groups: (a) the WRAT-R and NAART were equivalent and accurate estimates of average VIQ levels; (b) the WRAT-R and NAART were equivalent but underestimates of higher intelligence ranges; and (c) the WRAT-R is a more accurate estimate for lower VIQ ranges, although both are overestimates. This third finding is in contrast to Wiens et al.'s (1993) results that suggest the WRAT-R is an accurate estimate of lower IQ ranges for normals. It is concluded that the WRAT-R is the preferred measure of premorbid verbal intelligence for psychometric and clinical reasons.