The psychometric properties of the Hooper Vsual Organization Test (VOT) have not been well investigated Here the authors present internal consistency and interrater reliability coefficients, and an item analysis, using data from a sample (N = 281) of "cognitively impaired" and "cognitively intact" patients, and patients with undetermined cognitive status. Coefficient alpha for the VOT total sample was .882. An item analysis found that 26 of the 30 items were good at discriminating among patients. Also, the interrater reliabilities for three raters (.992), two raters (.988), and one rater (.977) were excellent. Therefore, the judgmental scoring of the VOT does not interfere significantly with its clinical utility. The authors conclude that the VOT is a psychometrically sound test.

Coefficient alpha and an item analysis were calculated for the 16-item Benton Visual Form Discrimination Test (VFDT) using a heterogeneous sample (N = 293) of mostly elderly medical patients who were suspected of having cognitive impairment. The total score reliability was .74. An item analysis found that 15 of the items were within established criteria for item difficulty, however, 5 items were found to be poor discriminators. Through the use of confidence intervals around observed scores, it was shown that the current classification criterion for the VFDT demands a higher reliability coefficient than what was found. Also, evidence for the test's insufficient level of difficulty is presented. It is difficult to recommend this test for clinical use.

Internal consistency reliabilities were calculated for the Tactual Performance Test blocks-per-minute scores for the Preferred Hand (n=298), Nonpreferred Hand (n=302), and Both Hands (n=314) trials, and Total Time. Reliabilities are reported for the total sample and three groups of normal, alcoholic, and undiagnosed patients sent for assessment. The reliabilities ranged from .6102 to .9232. Only three of the discriminate indexes were poor.

The present study investigated the types of inaccurate responses, i.e., Don't Know, Semantic, Visual (nonlinguistic), Phonological, Circumlocutory, and Perseverative, made on the Hooper Visual Organization Test by a heterogeneous sample of 68 brain-damaged and 63 substance abuse patients. The mean age of the brain-damaged and substance abuse groups were 46.0 (SD=13.5) and 43.7 (SD=12.9) yr., respectively. Analysis showed that the brain-damaged group made significantly more visual and perseverative responses than the substance abuse group. There was significantly more variance in the Visual responses than the Semantic responses for the brain-damaged group. The authors conclude that visuospatial ability is the primary factor for successful performance on this test.

Peripheral nerve blockade (PNB) is superior to neuraxial anesthesia and/or opioid therapy for perioperative analgesia in total knee replacement (TKR). Evidence on the safety of PNB in patients with coagulopathy is lacking. We describe the first documented account of continuous femoral PNB for perioperative analgesia in a patient with Von Willebrand Disease (vWD). Given her history of opioid tolerance and after an informative discussion, a continuous femoral PNB was planned for in this 34-year-old female undergoing TKR. A Humate-P intravenous infusion was started and the patient was positioned supinely. Using sterile technique with ultrasound guidance, a Contiplex 18 Gauge Tuohy needle was advanced in plane through the fascia iliaca towards the femoral nerve. A nerve catheter was threaded through the needle and secured without complications. Postoperatively, a levobupivacaine femoral catheter infusion was maintained, and twice daily Humate-P intravenous infusions were administered for 48 hours; enoxaparin thromboprophylaxis was initiated thereafter. The patient was discharged uneventfully on postoperative day 4. Given documentation of delayed, unheralded bleeding from PNB in coagulopathic patients, we recommend individualized PNB in vWD patients. Multidisciplinary team involvement is required to guide factor supplementation and thromboprophylaxis, as is close follow-up to elicit signs of bleeding throughout the delayed postoperative period.