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April 13, 1994, Vol 271, No. 14 >
ARTICLE | April 13, 1994

Clinical Assessment of Stroke FREE

Larry B. Goldstein, MD; David B. Matchar, MD
[+] Author Affiliations

Reprint requests to Box 3651, Duke University Medical Center, Durham, NC 27710 (Dr Goldstein).


JAMA. 1994;271(14):1114-1120. doi:10.1001/jama.1994.03510380070041
Text Size: A A A
Published online
Article
References

STROKE is the most common serious neurological disorder seen in a general hospital.1 Each year, approximately 500 000 Americans have strokes. About 150 000 of these individuals die, making stroke the third leading cause of death and the major cause of disability among adults.2 Of long-term stroke survivors, approximately 15% require institutional care, 30% are dependent in activities of daily living, and 60% have decreased socialization outside the home.3 The estimated costs of stroke-related care and lost productivity was $18 billion for 1993.2 Thus, the costs of stroke are enormous in human and economic terms.

The clinical evaluation of stroke patients often does not receive the attention it deserves. The "therapeutic nihilism" of the past4 is disappearing as effective treatments are established by prospective clinical trials. For example, endarterectomy has been shown to be useful in the prevention of major stroke in selected patients with

REFERENCES

1 +
Adams RD, Victor M. Principles of Neurology . New York, NY: McGraw-Hill International Book Co; 1985;.
2 +
American Heart Association. 1993 Stroke Facts . Dallas, Tex: American Heart Association; 1992;.
3 +
Gresham GE, Phillips TF, Wolf PA, McNamara PM, Kannel WB, Dawber TR.  Epidemiologic profile of long-term stroke disability: the Framingham Study. Arch Phys Med Rehabil . 1979;;60:487-491.
4 +
Hachinski V, Norris JW. The Acute Stroke . Philadelphia, Pa: FA Davis Co Publishers; 1985;.
5 +
European Carotid Surgery Trialists' Collaborative Group.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet . 1991;;337:1235-1243.
6 +
North American Symptomatic Carotid Endarterectomy Trial Collaborators.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med . 1991;;325:445-453.
7 +
Mayberg MR, Wilson E, Yatsu F, et al.  Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA . 1991;;266: 3289-3294.
8 +
Sackett DL.  A primer on the precision and accuracy of the clinical examination. JAMA . 1992;; 267:2638-2644.
9 +
Sackett DL.  Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest . 1989;;95( (suppl) ):25-45.
10 +
Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L.  Clinical and instrumental evaluations of patients with ischemic stroke within the first six hours. J Neurol Sci . 1989;;91:311-322.
11 +
Bozzao L, Bastianello S, Fantozzi LM, Angeloni U, Argentino C, Fieschi C.  Correlation of angiographic and sequential CT finding in patients with evolving cerebral infarction. AJNR Am J Neuroradiol . 1989;;10:1215-1212.
12 +
Asplund K.  Clinimetrics in stroke research. Stroke . 1987;;18:528-530.
13 +
Shinar D, Gross CR, Mohr JP, et al.  Interobserver variability in the assessment of neurological history and examination in the Stroke Data Bank. Arch Neurol . 1985;;42:557-565.
14 +
Adams RJ, Meador KJ, Sethi KD, Grotta JC, Thomson DS.  Graded neurological scale for use in hemispheric stroke treatment protocols. Stroke . 1987;;18:665-669.
15 +
Olsen J, Simonsen K, Norgaard B, et al.  Reproducibility and utility of a simple neurological scoring system' for stroke patients (Copenhagen Stroke Scale). J Neurol Rehabil . 1988;;2:59-63.
16 +
Goldstein LB, Bertels C, Davis JN.  Interrater reliability of the NIH stroke scale. Arch Neurol . 1989;;46:660-662.
17 +
Cote R, Battista RN, Wolfson C, Boucher J, Adams J, Hachinski VC.  The Canadian Neurological Scale: validation and reliability assessment. Neurology . 1989;;39:638-643.
18 +
Brott T, Adams HP Jr, Olinger CP, et al.  Measurements of acute cerebral infarction: a clinical examination scale. Stroke . 1989;;20:864-870.
19 +
Lindenstrom E, Boysen G, Christiansen LW, Hansen BR, Nielsen PW.  Reliability of Scandinavian Neurological Stroke Scale. Cerebrovasc Dis . 1991;;1:103-107.
20 +
Gelmers HJ, Gorter K, De Weerdt CJ, Wiezer HJA.  Assessment of interobserver variability in a Dutch multicenter study on acute ischemic stroke. Stroke . 1988;;19:709-711.
21 +
Vogel H.  Influence of additional information on interrater reliability in the neurologic examination. Neurology . 1992;;42:2076-2081.
22 +
Suzuki I, Shimizu H, Ishijima B, Tani K, Sugishita M, Adachi N.  Aphasic seizure caused by focal epilepsy in the left fusiform gyrus. Neurology . 1992;; 42:2207-2210.
23 +
Lee H, Lerner A.  Transient inhibitory seizures mimicking crescendo TIAs. Neurology . 1990;;40:165-166.
24 +
Ross RT.  Transient tumor attacks. Arch Neurol . 1983;;40:633-636.
25 +
Britton M, Hindmarsh T, Murray V, Tyden SA.  Diagnostic errors discovered by CT in patients with suspected stroke. Neurology . 1984;;34:1504-1507.
26 +
Norris JW, Hachinski JW.  Misdiagnosis of stroke. Lancet . 1982;;1:328-331.
27 +
Ziegler DK, Hassanein R.  Prognosis in patients with transient ischemic attacks. Stroke . 1973;;4:666-673.
28 +
Werdelin L, Juhler M.  The course of transient ischemic attacks. Neurology . 1988;;38:677-680.
29 +
Barnett HJM.  Aspirin in stroke prevention: an overview. Stroke . 1990;;21( (suppl IV) ):IV40-IV43.
30 +
Gent M, Blakely JA, Easton JD, et al.  The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet . 1989;;1:1215-1220.
31 +
Hass WK, Easton JD, Adams HP Jr, et al.  A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med . 1989;;321:501-507.
32 +
Kraaijeveld CL, Van Gijn J, Schouten HJA, Staal A.  Interobserver agreement for the diagnosis of transient ischemic attacks. Stroke . 1984;;15:723-725.
33 +
Koudstaal PJ, Van Gijn J, Staal A, Duivenvoorden HJ, Gerritsma JGM, Kraaijeveld CL.  Diagnosis of TIA: improvement of interobserver agreement by a checklist in ordinary language. Stroke . 1986;;17:723-728.
34 +
Tomasello F, Mariani F, Fieschi C, et al.  Assessment of inter-observer differences in the Italian Multicenter Study on Reversible Cerebral Ischemia. Stroke . 1982;;13:32-35.
35 +
Calanchini PR, Swanson PD, Gotshall RA, et al.  Cooperative study of hospital frequency and character of transient ischemic attacks, IV: reliability of diagnosis. JAMA . 1977;;238:2029-2033.
36 +
von Arbin M, Britton M, De Faire U, Helmers C, Miah K, Murray V.  Validation of admission criteria to a stroke unit. J Chronic Dis . 1980;;33:215-220.
37 +
von Arbin M, Britton M, De Faire U, Helmers C, Miah K, Murray V.  Accuracy of bedside diagnosis in stroke. Stroke . 1981;;12:288-293.
38 +
Gross CR, Shinar D, Mohr JP, et al.  Interobserver agreement in the diagnosis of stroke type. Arch Neurol . 1986;;43:893-898.
39 +
Allen CMC.  Clinical diagnosis of the acute stroke syndrome. Q J Med . 1983;;52:515-523.
40 +
Panzer RJ, Feibel JH, Barker WH, Griner PF.  Predicting the likelihood of hemorrhage in patients with stroke. Arch Intern Med . 1985;;145:1800-1803.
41 +
WHO Task Force on Stroke and Other Cerebrovascular Disorders.  Stroke-1989: recommendations on stroke prevention, diagnosis, and therapy. Stroke . 1989;;20:1407-1431.
42 +
National Institute of Neurological Disorders and Stroke.  Classification of cerebrovascular diseases III. Stroke . 1990;;21:637-676.
43 +
Adams HPJr, Bendixen BH, Kappelle LJ,et al.  Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke . 1993;;24:35-41.
44 +
Lindmark B, Hamrin E.  Evaluation of functional capacity after stroke as a basis for active intervention. Scand J Rehabil Med . 1988;;20:103-109.
45 +
Poungvarin N, Viriyavejakul A, Komontri C.  Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction. BMJ . 1991;;302:1565-1567.
46 +
Caplan LR.  Diagnosis and treatment of ischemie stroke. JAMA . 1991;;266:2413-2418.
47 +
Sisk C, Ziegler DK, Zileli T.  Discrepancies in recorded results from duplicate neurological history and examination in patients studies for prognosis in cerebrovascular disease. Stroke . 1970;;1:14-18.
48 +
Oxbury JM, Greenhall RCD, Grainger KMR.  Predicting the outcome of stroke: acute stage after cerebral infarction. BMJ . 1975;;3:125-127.
49 +
Allen CMC.  Predicting the outcome of acute stroke: a prognostic score. J Neurol Neurosurg Psychiatry . 1984;;47:475-480.
50 +
Henley S, Pettit S, Todd-Pokropek A, Tupper A.  Who goes home? predictive factors in stroke recovery. J Neurol Neurosurg Psychiatry . 1985;; 48:1-6.
51 +
Fullerton KJ, Mackenzie G, Stout RW.  Prognostic indices in stroke. Q J Med . 1988;;66:147-162.
52 +
Tuthill JE, Pozen TJ, Kennedy FB.  A neurologic grading system for acute strokes. Am Heart J . 1969;;78:53-57.
53 +
Britton M, De Faire U, Miah K, Helmers C.  Prognostication in acute cerebrovascular disease: subjective assessment and test of a prognostic score. Acta Med Scand . 1980;;207:37-42.
54 +
Frithz G, Werner I.  Studies on cerebrovascular strokes, II: clinical findings and short-term prognosis in a stroke material. Acta Med Scand . 1976;; 199:133-140.
55 +
Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S.  The post-stroke hemiplegic patient, I: a method for evaluation of physical performance. Scand J Rehabil Med . 1975;;7:13-31.
56 +
Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE.  Stroke rehabilitation: analysis of repeated Barthel Index measures. Arch Phys Med Rehabil . 1979;;60:14-17.
57 +
Rothman ML, Hendrick S, Inui T.  The sickness impact profile as a measure of health status of non-cognitively impaired nursing home residents. Med Care . 1989;;27:S157-S167.
58 +
Granger CV, Gresham GE.  International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a conceptual basis for stroke outcome research. Stroke . 1990;;21( (suppl II) ):II66-II67.
59 +
Kinsella G, Ford B.  Acute recovery patterns in stroke patients. Med J Aust . 1980;;2:662-666.
60 +
Wade DT, Langton HR, Wood VA, Skilbeck CE, Ilsmail HM.  The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry . 1983;;46:521-524.
61 +
Wade DT, Wood VA, Hewer RL.  Recovery after stroke: the first three months. J Neurol Neurosurg Psychiatry . 1985;;48:7-13.
62 +
Loewen SC, Anderson BA.  Predictors of stroke outcome using objective measurement scales. Stroke . 1990;;21:78-81.
63 +
Duncan PW, Goldstein LB, Divine GW, Matchar DB, Feussner J.  Measurement of motor recovery after stroke: outcome assessment and sample size requirements. Stroke . 1992;;23:1084-1089.
64 +
Ford AB, Katz S.  Prognosis after strokes, I: a critical review. Medicine . 1966;;45:223-246.
65 +
Robinson RG, Kubos KL, Starr LB, Rao K, Price TR.  Mood disorders in stroke patients: importance of location of lesion. Brain . 1984;;107:81-93.
66 +
Robinson RG, Starr LB, Lipsey JR, Rao K, Price TR.  A two-year longitudinal study of poststroke mood disorders: in-hospital prognostic factors associated with six-month outcome. J Nerv Ment Dis . 1985;;173:221-226.
67 +
Jongbloed L.  Prediction of function after stroke: a critical review. Stroke . 1986;;17:765-776.
68 +
Glass TA, Matchar DB, Belyea M, Feussner JR.  Impact of social support on outcome in first stroke. Stroke . 1993;;24:64-70.
69 +
Howard G, Till JS, Toole JF, Matthews C, Truscott BL.  Factors influencing return to work following cerebral infarction. JAMA . 1985;;253:226-232.
70 +
Lincoln NB, Blackburn M, Ellis S, et al.  An investigation of factors affecting progress of patients on a stroke unit. J Neurol Neurosurg Psychiatry . 1989;;52:493-496.
71 +
Barer DH, Mitchell JRA.  Predicting the outcome of acute stroke: do multivariate models help. Q J Med . 1989;;70:27-39.
72 +
Prescott RJ, Garraway WM, Akhtar AJ.  Predicting functional outcome following acute stroke using a standard clinical examination. Stroke . 1982;; 13:641-647.
73 +
Wasson JH, Sox HC, Neff RK, Goldman L.  Clinical prediction rules: applications and methodological standards. N Engl J Med . 1985;;313:793-799.
74 +
Garraway WM, Whisnant JP, Drury I.  The changing pattern of survival following stroke. Stroke . 1983;;14:699-703.
75 +
Harrell FE, Lee KL, Matchar DB, Reichert TA.  Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep . 1985;;69:1071-1077.
76 +
Kramer MS, Feinstein AR.  Clinical biostatistics, LIV: the biostatistics of concordance. Clin Pharmacol Ther . 1983;;29:111-123.
77 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol . 1991;;44: 763-770.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Adams RD, Victor M. Principles of Neurology . New York, NY: McGraw-Hill International Book Co; 1985;.
2 +
American Heart Association. 1993 Stroke Facts . Dallas, Tex: American Heart Association; 1992;.
3 +
Gresham GE, Phillips TF, Wolf PA, McNamara PM, Kannel WB, Dawber TR.  Epidemiologic profile of long-term stroke disability: the Framingham Study. Arch Phys Med Rehabil . 1979;;60:487-491.
4 +
Hachinski V, Norris JW. The Acute Stroke . Philadelphia, Pa: FA Davis Co Publishers; 1985;.
5 +
European Carotid Surgery Trialists' Collaborative Group.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet . 1991;;337:1235-1243.
6 +
North American Symptomatic Carotid Endarterectomy Trial Collaborators.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med . 1991;;325:445-453.
7 +
Mayberg MR, Wilson E, Yatsu F, et al.  Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA . 1991;;266: 3289-3294.
8 +
Sackett DL.  A primer on the precision and accuracy of the clinical examination. JAMA . 1992;; 267:2638-2644.
9 +
Sackett DL.  Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest . 1989;;95( (suppl) ):25-45.
10 +
Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L.  Clinical and instrumental evaluations of patients with ischemic stroke within the first six hours. J Neurol Sci . 1989;;91:311-322.
11 +
Bozzao L, Bastianello S, Fantozzi LM, Angeloni U, Argentino C, Fieschi C.  Correlation of angiographic and sequential CT finding in patients with evolving cerebral infarction. AJNR Am J Neuroradiol . 1989;;10:1215-1212.
12 +
Asplund K.  Clinimetrics in stroke research. Stroke . 1987;;18:528-530.
13 +
Shinar D, Gross CR, Mohr JP, et al.  Interobserver variability in the assessment of neurological history and examination in the Stroke Data Bank. Arch Neurol . 1985;;42:557-565.
14 +
Adams RJ, Meador KJ, Sethi KD, Grotta JC, Thomson DS.  Graded neurological scale for use in hemispheric stroke treatment protocols. Stroke . 1987;;18:665-669.
15 +
Olsen J, Simonsen K, Norgaard B, et al.  Reproducibility and utility of a simple neurological scoring system' for stroke patients (Copenhagen Stroke Scale). J Neurol Rehabil . 1988;;2:59-63.
16 +
Goldstein LB, Bertels C, Davis JN.  Interrater reliability of the NIH stroke scale. Arch Neurol . 1989;;46:660-662.
17 +
Cote R, Battista RN, Wolfson C, Boucher J, Adams J, Hachinski VC.  The Canadian Neurological Scale: validation and reliability assessment. Neurology . 1989;;39:638-643.
18 +
Brott T, Adams HP Jr, Olinger CP, et al.  Measurements of acute cerebral infarction: a clinical examination scale. Stroke . 1989;;20:864-870.
19 +
Lindenstrom E, Boysen G, Christiansen LW, Hansen BR, Nielsen PW.  Reliability of Scandinavian Neurological Stroke Scale. Cerebrovasc Dis . 1991;;1:103-107.
20 +
Gelmers HJ, Gorter K, De Weerdt CJ, Wiezer HJA.  Assessment of interobserver variability in a Dutch multicenter study on acute ischemic stroke. Stroke . 1988;;19:709-711.
21 +
Vogel H.  Influence of additional information on interrater reliability in the neurologic examination. Neurology . 1992;;42:2076-2081.
22 +
Suzuki I, Shimizu H, Ishijima B, Tani K, Sugishita M, Adachi N.  Aphasic seizure caused by focal epilepsy in the left fusiform gyrus. Neurology . 1992;; 42:2207-2210.
23 +
Lee H, Lerner A.  Transient inhibitory seizures mimicking crescendo TIAs. Neurology . 1990;;40:165-166.
24 +
Ross RT.  Transient tumor attacks. Arch Neurol . 1983;;40:633-636.
25 +
Britton M, Hindmarsh T, Murray V, Tyden SA.  Diagnostic errors discovered by CT in patients with suspected stroke. Neurology . 1984;;34:1504-1507.
26 +
Norris JW, Hachinski JW.  Misdiagnosis of stroke. Lancet . 1982;;1:328-331.
27 +
Ziegler DK, Hassanein R.  Prognosis in patients with transient ischemic attacks. Stroke . 1973;;4:666-673.
28 +
Werdelin L, Juhler M.  The course of transient ischemic attacks. Neurology . 1988;;38:677-680.
29 +
Barnett HJM.  Aspirin in stroke prevention: an overview. Stroke . 1990;;21( (suppl IV) ):IV40-IV43.
30 +
Gent M, Blakely JA, Easton JD, et al.  The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet . 1989;;1:1215-1220.
31 +
Hass WK, Easton JD, Adams HP Jr, et al.  A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med . 1989;;321:501-507.
32 +
Kraaijeveld CL, Van Gijn J, Schouten HJA, Staal A.  Interobserver agreement for the diagnosis of transient ischemic attacks. Stroke . 1984;;15:723-725.
33 +
Koudstaal PJ, Van Gijn J, Staal A, Duivenvoorden HJ, Gerritsma JGM, Kraaijeveld CL.  Diagnosis of TIA: improvement of interobserver agreement by a checklist in ordinary language. Stroke . 1986;;17:723-728.
34 +
Tomasello F, Mariani F, Fieschi C, et al.  Assessment of inter-observer differences in the Italian Multicenter Study on Reversible Cerebral Ischemia. Stroke . 1982;;13:32-35.
35 +
Calanchini PR, Swanson PD, Gotshall RA, et al.  Cooperative study of hospital frequency and character of transient ischemic attacks, IV: reliability of diagnosis. JAMA . 1977;;238:2029-2033.
36 +
von Arbin M, Britton M, De Faire U, Helmers C, Miah K, Murray V.  Validation of admission criteria to a stroke unit. J Chronic Dis . 1980;;33:215-220.
37 +
von Arbin M, Britton M, De Faire U, Helmers C, Miah K, Murray V.  Accuracy of bedside diagnosis in stroke. Stroke . 1981;;12:288-293.
38 +
Gross CR, Shinar D, Mohr JP, et al.  Interobserver agreement in the diagnosis of stroke type. Arch Neurol . 1986;;43:893-898.
39 +
Allen CMC.  Clinical diagnosis of the acute stroke syndrome. Q J Med . 1983;;52:515-523.
40 +
Panzer RJ, Feibel JH, Barker WH, Griner PF.  Predicting the likelihood of hemorrhage in patients with stroke. Arch Intern Med . 1985;;145:1800-1803.
41 +
WHO Task Force on Stroke and Other Cerebrovascular Disorders.  Stroke-1989: recommendations on stroke prevention, diagnosis, and therapy. Stroke . 1989;;20:1407-1431.
42 +
National Institute of Neurological Disorders and Stroke.  Classification of cerebrovascular diseases III. Stroke . 1990;;21:637-676.
43 +
Adams HPJr, Bendixen BH, Kappelle LJ,et al.  Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke . 1993;;24:35-41.
44 +
Lindmark B, Hamrin E.  Evaluation of functional capacity after stroke as a basis for active intervention. Scand J Rehabil Med . 1988;;20:103-109.
45 +
Poungvarin N, Viriyavejakul A, Komontri C.  Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction. BMJ . 1991;;302:1565-1567.
46 +
Caplan LR.  Diagnosis and treatment of ischemie stroke. JAMA . 1991;;266:2413-2418.
47 +
Sisk C, Ziegler DK, Zileli T.  Discrepancies in recorded results from duplicate neurological history and examination in patients studies for prognosis in cerebrovascular disease. Stroke . 1970;;1:14-18.
48 +
Oxbury JM, Greenhall RCD, Grainger KMR.  Predicting the outcome of stroke: acute stage after cerebral infarction. BMJ . 1975;;3:125-127.
49 +
Allen CMC.  Predicting the outcome of acute stroke: a prognostic score. J Neurol Neurosurg Psychiatry . 1984;;47:475-480.
50 +
Henley S, Pettit S, Todd-Pokropek A, Tupper A.  Who goes home? predictive factors in stroke recovery. J Neurol Neurosurg Psychiatry . 1985;; 48:1-6.
51 +
Fullerton KJ, Mackenzie G, Stout RW.  Prognostic indices in stroke. Q J Med . 1988;;66:147-162.
52 +
Tuthill JE, Pozen TJ, Kennedy FB.  A neurologic grading system for acute strokes. Am Heart J . 1969;;78:53-57.
53 +
Britton M, De Faire U, Miah K, Helmers C.  Prognostication in acute cerebrovascular disease: subjective assessment and test of a prognostic score. Acta Med Scand . 1980;;207:37-42.
54 +
Frithz G, Werner I.  Studies on cerebrovascular strokes, II: clinical findings and short-term prognosis in a stroke material. Acta Med Scand . 1976;; 199:133-140.
55 +
Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S.  The post-stroke hemiplegic patient, I: a method for evaluation of physical performance. Scand J Rehabil Med . 1975;;7:13-31.
56 +
Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE.  Stroke rehabilitation: analysis of repeated Barthel Index measures. Arch Phys Med Rehabil . 1979;;60:14-17.
57 +
Rothman ML, Hendrick S, Inui T.  The sickness impact profile as a measure of health status of non-cognitively impaired nursing home residents. Med Care . 1989;;27:S157-S167.
58 +
Granger CV, Gresham GE.  International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a conceptual basis for stroke outcome research. Stroke . 1990;;21( (suppl II) ):II66-II67.
59 +
Kinsella G, Ford B.  Acute recovery patterns in stroke patients. Med J Aust . 1980;;2:662-666.
60 +
Wade DT, Langton HR, Wood VA, Skilbeck CE, Ilsmail HM.  The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry . 1983;;46:521-524.
61 +
Wade DT, Wood VA, Hewer RL.  Recovery after stroke: the first three months. J Neurol Neurosurg Psychiatry . 1985;;48:7-13.
62 +
Loewen SC, Anderson BA.  Predictors of stroke outcome using objective measurement scales. Stroke . 1990;;21:78-81.
63 +
Duncan PW, Goldstein LB, Divine GW, Matchar DB, Feussner J.  Measurement of motor recovery after stroke: outcome assessment and sample size requirements. Stroke . 1992;;23:1084-1089.
64 +
Ford AB, Katz S.  Prognosis after strokes, I: a critical review. Medicine . 1966;;45:223-246.
65 +
Robinson RG, Kubos KL, Starr LB, Rao K, Price TR.  Mood disorders in stroke patients: importance of location of lesion. Brain . 1984;;107:81-93.
66 +
Robinson RG, Starr LB, Lipsey JR, Rao K, Price TR.  A two-year longitudinal study of poststroke mood disorders: in-hospital prognostic factors associated with six-month outcome. J Nerv Ment Dis . 1985;;173:221-226.
67 +
Jongbloed L.  Prediction of function after stroke: a critical review. Stroke . 1986;;17:765-776.
68 +
Glass TA, Matchar DB, Belyea M, Feussner JR.  Impact of social support on outcome in first stroke. Stroke . 1993;;24:64-70.
69 +
Howard G, Till JS, Toole JF, Matthews C, Truscott BL.  Factors influencing return to work following cerebral infarction. JAMA . 1985;;253:226-232.
70 +
Lincoln NB, Blackburn M, Ellis S, et al.  An investigation of factors affecting progress of patients on a stroke unit. J Neurol Neurosurg Psychiatry . 1989;;52:493-496.
71 +
Barer DH, Mitchell JRA.  Predicting the outcome of acute stroke: do multivariate models help. Q J Med . 1989;;70:27-39.
72 +
Prescott RJ, Garraway WM, Akhtar AJ.  Predicting functional outcome following acute stroke using a standard clinical examination. Stroke . 1982;; 13:641-647.
73 +
Wasson JH, Sox HC, Neff RK, Goldman L.  Clinical prediction rules: applications and methodological standards. N Engl J Med . 1985;;313:793-799.
74 +
Garraway WM, Whisnant JP, Drury I.  The changing pattern of survival following stroke. Stroke . 1983;;14:699-703.
75 +
Harrell FE, Lee KL, Matchar DB, Reichert TA.  Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep . 1985;;69:1071-1077.
76 +
Kramer MS, Feinstein AR.  Clinical biostatistics, LIV: the biostatistics of concordance. Clin Pharmacol Ther . 1983;;29:111-123.
77 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol . 1991;;44: 763-770.

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CME Course for:


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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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