0
October 1987, Vol 44, No. 10 >
Article | October 1987

Clinical Neuroepidemiology: Title and subTitle BreakI. Diagnosis

W. T. Longstreth, Jr, MD, MPH; Thomas D. Koepsell, MD, MPH; Gerald van Belle, PhD
[+] Author Affiliations

Accepted for publication March 31, 1987.

Reprint requests to Division of Neurology, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Dr Longstreth).


Arch Neurol. 1987;44(10):1091-1099. doi:10.1001/archneur.1987.00520220087023
Text Size: A A A
Published online
Article
References
Comments

Neuroepidemiology, the study of neurologic diseases in populations,1-3 addresses important issues of disease frequency, causation, and prevention. But often it is of limited use to the clinician or investigator trying to determine the best way to diagnose and treat patients with neurologic problems. The discipline of clinical epidemiology applies the principles of classic epidemiology to questions of clinical care; the powerful techniques used to study populations are used to address questions for individual patients. Several books and articles recently have been written on clinical epidemiology,4-7 demonstrating how it is a "... numerate approach to the conduct of clinical research and clinical decision making,"8 and is "... the study of determinants and effects of clinical decisions."9 These works have mostly addressed an audience of general internists. The present article and two subsequent ones introduce the neurologist to some concepts of clinical epidemiology, using examples that are relevant to

REFERENCES

1 +
Schoenberg BS:  Neuroepidemiology: Incidents, incidence, and coincidence . Arch Neurol 1977;;34:261-265.
2 +
Capildeo R, Haberman S, Benjamin B, et al:  Why neuroepidemiology? Psychol Med 1983;;13:15-16.
3 +
Kurtzke JF:  Neuroepidemiology . Ann Neurol 1984;;16:265-277.
4 +
Fletcher RH, Fletcher SW, Wagner EH: Clinical Epidemiology: The Essentials . Baltimore, Williams & Wilkins, 1982;.
5 +
Feinstein AR: Clinical Epidemiology: The Architecture of Clinical Research . Philadelphia, WB Saunders Co, 1985;.
6 +
Sackett DL, Haynes RB, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Little Brown & Co, 1985;.
7 +
Weiss NS: Clinical Epidemiology: The Study of the Outcome of Illness . New York, Oxford University Press, 1986;.
8 +
Grufferman S, Kimm SYS:  Clinical epidemiology defined . N Engl J Med 1984;;311:541-542.
9 +
Spitzer WO:  Clinical epidemiology . J Chronic Dis 1986;;39:411-415.
10 +
Koran LM:  The reliability of clinical methods, data, and judgments . N Engl J Med 1975;;293:642-646, 695-701.
11 +
Fleiss JL: Statistical Methods for Rates and Proportions , ed 2. New York, John Wiley & Sons Inc, 1981;, pp 212-236.
12 +
Isaac S, Michael WB: Handbook in Research and Evaluation: A Collection of Principles, Methods and Strategies Useful in the Planning, Design, and Evaluation of Studies in Education and the Behavioral Sciences , ed 2. San Diego, EdITS, 1982;, pp 119-123.
13 +
Tomasello F, Mariani F, Fieschi C, et al:  Assessment of interobserver differences in the Italian multicenter study on reversible cerebral ischemia . Stroke 1982;;13;32-35.
14 +
Cohen J:  A coefficient of agreement for nominal scales . Educ Psychol Meas 1960;;20:37-46.
15 +
Sisk C, Ziegler DK, Zileli T:  Discrepancies in recorded results from duplicate neurological history and examination in patients studied for prognosis in cerebrovascular disease . Stroke 1970;;1:14-18.
16 +
McCance C, Watt JA, Hall DJ:  An evaluation of the reliability and validity of the plantar response in a psychogeriatric population . J Chronic Dis 1968;;21;369-374.
17 +
Van Gijn J, Bonke B:  Interpretation of plantar reflexes: Biasing effect of other signs and symptoms . J Neurol Neurosurg Psychiatry 1977;;40:787-789.
18 +
Landis JR, Koch GG:  Measurement of observer agreement for categorical data . Biometrics 1977;;33:159-174.
19 +
Heyman A, Wilkinson WE, Stafford JA, et al:  Alzheimer's disease: A study of epidemiological aspects . Ann Neurol 1984;;15:335-341.
20 +
Bland JM, Altman DG:  Statistical methods for assessing agreement between two methods of clinical measurement . Lancet 1986;;1:307-310.
21 +
Snedecor GW, Cochran WG: Statistical Methods , ed 7. Ames, Iowa State University Press, 1980;, pp 243-244.
22 +
 Department of Clinical Epidemiology and Biostatistics , McMaster University Health Sciences Centre:  Clinical disagreement: I. How often it occurs and why . Can Med Assoc J 1980;:123:499-504.
23 +
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre:  Clinical disagreement: II. How to avoid it and how to learn from one's mistakes . Can Med Assoc J 1980;;123:613-617.
24 +
Jacobs L, Gossman MD:  Three primitive reflexes in normal adults . Neurology 1980;;30:184-188.
25 +
Bowles AP, Asher SW, Pickett JB:  Tinel's sign and the diagnosis of the carpal tunnel syndrome, abstracted . Neurology 1982;;32:A80.
26 +
Heller L, Ring H, Costeff H, et al:  Evaluation of Tinel's and Phalen's signs in diagnosis of the carpal tunnel syndrome . Eur Neurol 1986;;25:40-42.
27 +
Yerby MS, van Belle G, Friel PN, et al:  Utility of serum prolactins in the diagnosis of epilepsy: Sensitivity, specificity, and predictive value . Neurology 1987;;37:1224-1226.
28 +
Swets JA, Pickett RM, Whitehead SF, et al:  Assessment of diagnostic technologies: Advanced measurement methods are illustrated in a study of computed tomography of the brain . Science 1979;;205:753-759.
29 +
Sandercock PAG, Allen CMC, Corston RN, et al:  Clinical diagnosis of intracranial hemorrhage using Guy's Hospital score . Br Med J 1985;;291:1675-1677.
30 +
Lewis RR, Padayachee TS, Gosling RG:  Ultrasound screening for internal carotid disease: II. Sensitivity and specificity of a single site periorbital artery test . Ultrasound Med Biol 1984;;10:17-25.
31 +
Johnston KW, Haynes RB, Douville Y, et al:  Accuracy of carotid Doppler peak frequency analysis: Results determined by receiver-operating characteristic curves and likelihood ratios . J Vasc Surg 1985;;2:515-523.
32 +
Sox HC:  Probability theory in the use of diagnostic tests: An introduction to critical study of the literature . Ann Intern Med 1986;;104:60-66.
33 +
Saito T:  An assessment of efficiency in potential screening for Wilson's disease . J Epidemiol Commun Health 1981;;35:274-280.
34 +
Goodin DS, Aminoff MJ:  Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1984;;1:837-839.
35 +
Kandalaft N, Diehl J, Neuwelt EA:  Nonneoplastic intracranial lesions simulating neoplasms on computed tomographic scan: Excellent sensitivity with limited specificity . JAMA 1982;;248:2166-2168.
36 +
Levin BE:  The clinical significance of spontaneous pulsations of the retinal vein . Arch Neurol 1978;;35:37-40.
37 +
Longstreth WT Jr, Clayson KJ, Chandler WL, et al:  Cerebrospinal fluid creatine kinase and neurologic recovery after cardiac arrest . Neurology 1984;;34:834-837.
38 +
Balla JI, Iansek R, Elstein A:  Bayesian diagnosis in presence of preexisting disease . Lancet 1985;;1:326-329.
39 +
Fagen TJ:  Nomogram for Bayes's theorem . N Engl J Med 1975;;293:257.
40 +
Chambers BR, Norris JW:  Clinical significance of asymptomatic neck bruits . Neurology 1985;;35:742-745.
41 +
Kurtzke JF:  The current neurologic burden of illness and injury in the United States . Neurology 1982;;32:1207-1214.
42 +
Albert A:  On the use and computation of likelihood ratios in clinical chemistry . Clin Chem 1982;;28:1113-1119.
43 +
Gruemer H-D, Miller WG, Chinchilli VM, et al:  Prediction of carrier status in Duchenne dystrophy by creatine kinase measurement . Am J Clin Pathol 1985;;84:655-658.
44 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
45 +
 Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre: How to read clinical journals: II. To learn about a diagnostic test . Can Med Assoc J 1981;;124:703-710.
46 +
Sheps SB, Schechter MT:  The assessment of diagnostic tests: A survey of current medical research . JAMA 1984;;252:2418-2422.
47 +
Nierenberg AA, Siegal AP: The rise and fall of the dexamethasone suppression test: Lessons for diagnostic-marker-test development and evaluation, abstracted. Read before the Annual Meeting of the Robert Wood Johnson Clinical Scholars Program, Scottsdale, Ariz, November 1985.
48 +
Moulin D, Paty DW, Ebers GC:  The predictive value of cerebrospinal fluid electrophoresis in 'possible' multiple sclerosis . Brain 1983;;106:809-816.
49 +
Moulin DE, Feasby TE, Ebers GC:  The predictive value of evoked potentials in 'possible' multiple sclerosis, abstracted . Neurology 1984;;34:78.
50 +
Zwiebel WJ, Strother CM, Austin CW, et al:  Comparison of ultrasound and IV-DSA for carotid evaluation . Stroke 1985;;16:633-643.
51 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic test and procedures: II. Principles and applications . Ann Intern Med 1981;;94;553-600.
52 +
O'Donnell TF, Pauker SG, Callow AD, et al:  The relative value of carotid noninvasive testing as determined by receiver operator characteristic curves . Surgery 1980;;87:9-17.
53 +
Galen RS, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnoses . New York, John Wiley & Sons Inc, 1975;, pp 131-134.
54 +
Hartz AJ:  Overlap index: An alternative to sensitivity and specificity in comparing the utility of a laboratory test . Arch Pathol Lab Med 1984;;108:65-67.
55 +
Lane RJ, Appleberg M, Stirling I, et al:  Radiological diagnosis of carotid ulceration . Aust NZ J Surg 1982;;52:168-170.
56 +
Ratcliff DA, Hames TK, Humpheries KN, et al:  The reliability of Doppler ultrasound techniques in the assessment of carotid disease . Angiology 1985;;36:337-340.
57 +
Langlois Y, Roederer GO, Chan A, et al:  Evaluating carotid artery disease: The concordance between pulsed Doppler/spectrum analysis and angiography . Ultrasound Med Biol 1983;;9:51-63.
58 +
Menken M, Sheps CG:  Undergraduate education in the medical specialties: The case of neurology . N Engl J Med 1984;;311:1045-1048.
59 +
Turney TM, Garraway WM, Sinaki M:  Neurologic examination in stroke rehabilitation: Adequacy of its description in clinical textbooks . Arch Phys Med Rehabil 1985;;66:92-94.
60 +
Ziegler DK:  Is the neurologic examination becoming obsolete? Neurology 1985;;35:559.
61 +
Wasson JH, Sox HC, Neff RK, et al:  Clinical prediction rules: Applications and methodological standards . N Engl J Med 1985;;313:793-799.
62 +
Kraaijeveld CL, van Gijn J, Schouten HJA, et al:  Interobserver agreement for the diagnosis of transient ischemic attacks . Stroke 1984;;15:723-725.
63 +
Shinar D, Gross CR, Mohr JP, et al:  Interobserver variability in the assessment of neurologic history and examination in the stroke data bank . Arch Neurol 1985;;42:557-565.
64 +
Van den Berg JH, Schouten HJA, Boomstra S, et al:  Interobserver agreement in assessment of ocular signs in coma . J Neurol Neurosurg Psychiatry 1979;;42:1163-1168.
65 +
Braakman R, Avezaat CJJ, Maas AIR, et al:  Interobserver agreement in the assessment of motor response of the Glasglow 'coma' scale . Clin Neurol Neurosurg 1977;;80:100-106.
66 +
Waddell G, Main CJ, Morris EW, et al:  Normality and reliability in the clinical assessment of backache . Br Med J 1982;;284:1519-1523.
67 +
Lindsay KW, Teasdale G, Knill-Jones RP, et al:  Observer variability in grading patients with subarachnoid hemorrhage . J Neurosurg 1982;;56:628-633.
68 +
Lindsay KW, Teasdale GM, Knill-Jones RP:  Observer variability in assessing the clinical features of subarachnoid hemorrhage . J Neurosurg 1983;;58:57-62.
69 +
Straue FA, Becka DR, Green MA, et al:  Reliability of clinical interpretation of the electroencephalogram . Clin Electrocephalogr 1975;;6:54-60.
70 +
Chikos PM, Fisher LD, Hirsch JH, et al:  Observer variability in evaluating extracranial carotid artery stenosis . Stroke 1983;;14:885-892.
71 +
Kohler T, Langlois Y, Roederer GO, et al:  Sources of variability in carotid Duplex examination: A prospective study . Ultrasound Med Biol 1985;;4:571-576.
72 +
Shinar D, Gross CR, Hier DB, et al:  Interobserver reliability in the interpretation of computed tomographic scans of stroke patients . Arch Neurol 1987;;44:149-155.
73 +
Von Arbin M, Britton M, de Faire U, et al:  Accuracy of bedside diagnosis in stroke . Stroke 1981;;12:288-293.
74 +
Farber JM, Shapiro BK, Palmer FB, et al:  The diagnostic value of the neurodevelopmental examination . Clin Pediatr 1985;;24:367-372.
75 +
Freeman RW, Bleeker ML, Comstock GW, et al:  Validation of self-administered questionnaire for study of peripheral neuropathy . Am J Epidemiol 1985;;121:291-300.
76 +
Eikelboom BC, Riles TR, Mintzer R, et al:  Inaccuracy of angiography in the diagnosis of carotid ulceration . Stroke 1983;;14:882-885.
77 +
Padayachee TS, Lewis RR, Gosling RG:  Ultrasound screening for internal carotid disease: I. The temporal artery occlusion test— which periorbital artery? Ultrasound Med Biol 1984;;10:13-16.
78 +
Lindstrom J:  An assay for antibodies to human acetylcholine receptor in serum from patients with myasthenia gravis . Clin Immunol Immunopathol 1977;;7:36-43.

First Page Preview

First page PDF preview

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 +
Schoenberg BS:  Neuroepidemiology: Incidents, incidence, and coincidence . Arch Neurol 1977;;34:261-265.
2 +
Capildeo R, Haberman S, Benjamin B, et al:  Why neuroepidemiology? Psychol Med 1983;;13:15-16.
3 +
Kurtzke JF:  Neuroepidemiology . Ann Neurol 1984;;16:265-277.
4 +
Fletcher RH, Fletcher SW, Wagner EH: Clinical Epidemiology: The Essentials . Baltimore, Williams & Wilkins, 1982;.
5 +
Feinstein AR: Clinical Epidemiology: The Architecture of Clinical Research . Philadelphia, WB Saunders Co, 1985;.
6 +
Sackett DL, Haynes RB, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Little Brown & Co, 1985;.
7 +
Weiss NS: Clinical Epidemiology: The Study of the Outcome of Illness . New York, Oxford University Press, 1986;.
8 +
Grufferman S, Kimm SYS:  Clinical epidemiology defined . N Engl J Med 1984;;311:541-542.
9 +
Spitzer WO:  Clinical epidemiology . J Chronic Dis 1986;;39:411-415.
10 +
Koran LM:  The reliability of clinical methods, data, and judgments . N Engl J Med 1975;;293:642-646, 695-701.
11 +
Fleiss JL: Statistical Methods for Rates and Proportions , ed 2. New York, John Wiley & Sons Inc, 1981;, pp 212-236.
12 +
Isaac S, Michael WB: Handbook in Research and Evaluation: A Collection of Principles, Methods and Strategies Useful in the Planning, Design, and Evaluation of Studies in Education and the Behavioral Sciences , ed 2. San Diego, EdITS, 1982;, pp 119-123.
13 +
Tomasello F, Mariani F, Fieschi C, et al:  Assessment of interobserver differences in the Italian multicenter study on reversible cerebral ischemia . Stroke 1982;;13;32-35.
14 +
Cohen J:  A coefficient of agreement for nominal scales . Educ Psychol Meas 1960;;20:37-46.
15 +
Sisk C, Ziegler DK, Zileli T:  Discrepancies in recorded results from duplicate neurological history and examination in patients studied for prognosis in cerebrovascular disease . Stroke 1970;;1:14-18.
16 +
McCance C, Watt JA, Hall DJ:  An evaluation of the reliability and validity of the plantar response in a psychogeriatric population . J Chronic Dis 1968;;21;369-374.
17 +
Van Gijn J, Bonke B:  Interpretation of plantar reflexes: Biasing effect of other signs and symptoms . J Neurol Neurosurg Psychiatry 1977;;40:787-789.
18 +
Landis JR, Koch GG:  Measurement of observer agreement for categorical data . Biometrics 1977;;33:159-174.
19 +
Heyman A, Wilkinson WE, Stafford JA, et al:  Alzheimer's disease: A study of epidemiological aspects . Ann Neurol 1984;;15:335-341.
20 +
Bland JM, Altman DG:  Statistical methods for assessing agreement between two methods of clinical measurement . Lancet 1986;;1:307-310.
21 +
Snedecor GW, Cochran WG: Statistical Methods , ed 7. Ames, Iowa State University Press, 1980;, pp 243-244.
22 +
 Department of Clinical Epidemiology and Biostatistics , McMaster University Health Sciences Centre:  Clinical disagreement: I. How often it occurs and why . Can Med Assoc J 1980;:123:499-504.
23 +
Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre:  Clinical disagreement: II. How to avoid it and how to learn from one's mistakes . Can Med Assoc J 1980;;123:613-617.
24 +
Jacobs L, Gossman MD:  Three primitive reflexes in normal adults . Neurology 1980;;30:184-188.
25 +
Bowles AP, Asher SW, Pickett JB:  Tinel's sign and the diagnosis of the carpal tunnel syndrome, abstracted . Neurology 1982;;32:A80.
26 +
Heller L, Ring H, Costeff H, et al:  Evaluation of Tinel's and Phalen's signs in diagnosis of the carpal tunnel syndrome . Eur Neurol 1986;;25:40-42.
27 +
Yerby MS, van Belle G, Friel PN, et al:  Utility of serum prolactins in the diagnosis of epilepsy: Sensitivity, specificity, and predictive value . Neurology 1987;;37:1224-1226.
28 +
Swets JA, Pickett RM, Whitehead SF, et al:  Assessment of diagnostic technologies: Advanced measurement methods are illustrated in a study of computed tomography of the brain . Science 1979;;205:753-759.
29 +
Sandercock PAG, Allen CMC, Corston RN, et al:  Clinical diagnosis of intracranial hemorrhage using Guy's Hospital score . Br Med J 1985;;291:1675-1677.
30 +
Lewis RR, Padayachee TS, Gosling RG:  Ultrasound screening for internal carotid disease: II. Sensitivity and specificity of a single site periorbital artery test . Ultrasound Med Biol 1984;;10:17-25.
31 +
Johnston KW, Haynes RB, Douville Y, et al:  Accuracy of carotid Doppler peak frequency analysis: Results determined by receiver-operating characteristic curves and likelihood ratios . J Vasc Surg 1985;;2:515-523.
32 +
Sox HC:  Probability theory in the use of diagnostic tests: An introduction to critical study of the literature . Ann Intern Med 1986;;104:60-66.
33 +
Saito T:  An assessment of efficiency in potential screening for Wilson's disease . J Epidemiol Commun Health 1981;;35:274-280.
34 +
Goodin DS, Aminoff MJ:  Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1984;;1:837-839.
35 +
Kandalaft N, Diehl J, Neuwelt EA:  Nonneoplastic intracranial lesions simulating neoplasms on computed tomographic scan: Excellent sensitivity with limited specificity . JAMA 1982;;248:2166-2168.
36 +
Levin BE:  The clinical significance of spontaneous pulsations of the retinal vein . Arch Neurol 1978;;35:37-40.
37 +
Longstreth WT Jr, Clayson KJ, Chandler WL, et al:  Cerebrospinal fluid creatine kinase and neurologic recovery after cardiac arrest . Neurology 1984;;34:834-837.
38 +
Balla JI, Iansek R, Elstein A:  Bayesian diagnosis in presence of preexisting disease . Lancet 1985;;1:326-329.
39 +
Fagen TJ:  Nomogram for Bayes's theorem . N Engl J Med 1975;;293:257.
40 +
Chambers BR, Norris JW:  Clinical significance of asymptomatic neck bruits . Neurology 1985;;35:742-745.
41 +
Kurtzke JF:  The current neurologic burden of illness and injury in the United States . Neurology 1982;;32:1207-1214.
42 +
Albert A:  On the use and computation of likelihood ratios in clinical chemistry . Clin Chem 1982;;28:1113-1119.
43 +
Gruemer H-D, Miller WG, Chinchilli VM, et al:  Prediction of carrier status in Duchenne dystrophy by creatine kinase measurement . Am J Clin Pathol 1985;;84:655-658.
44 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
45 +
 Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre: How to read clinical journals: II. To learn about a diagnostic test . Can Med Assoc J 1981;;124:703-710.
46 +
Sheps SB, Schechter MT:  The assessment of diagnostic tests: A survey of current medical research . JAMA 1984;;252:2418-2422.
47 +
Nierenberg AA, Siegal AP: The rise and fall of the dexamethasone suppression test: Lessons for diagnostic-marker-test development and evaluation, abstracted. Read before the Annual Meeting of the Robert Wood Johnson Clinical Scholars Program, Scottsdale, Ariz, November 1985.
48 +
Moulin D, Paty DW, Ebers GC:  The predictive value of cerebrospinal fluid electrophoresis in 'possible' multiple sclerosis . Brain 1983;;106:809-816.
49 +
Moulin DE, Feasby TE, Ebers GC:  The predictive value of evoked potentials in 'possible' multiple sclerosis, abstracted . Neurology 1984;;34:78.
50 +
Zwiebel WJ, Strother CM, Austin CW, et al:  Comparison of ultrasound and IV-DSA for carotid evaluation . Stroke 1985;;16:633-643.
51 +
Griner PF, Mayewski RJ, Mushlin AI, et al:  Selection and interpretation of diagnostic test and procedures: II. Principles and applications . Ann Intern Med 1981;;94;553-600.
52 +
O'Donnell TF, Pauker SG, Callow AD, et al:  The relative value of carotid noninvasive testing as determined by receiver operator characteristic curves . Surgery 1980;;87:9-17.
53 +
Galen RS, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnoses . New York, John Wiley & Sons Inc, 1975;, pp 131-134.
54 +
Hartz AJ:  Overlap index: An alternative to sensitivity and specificity in comparing the utility of a laboratory test . Arch Pathol Lab Med 1984;;108:65-67.
55 +
Lane RJ, Appleberg M, Stirling I, et al:  Radiological diagnosis of carotid ulceration . Aust NZ J Surg 1982;;52:168-170.
56 +
Ratcliff DA, Hames TK, Humpheries KN, et al:  The reliability of Doppler ultrasound techniques in the assessment of carotid disease . Angiology 1985;;36:337-340.
57 +
Langlois Y, Roederer GO, Chan A, et al:  Evaluating carotid artery disease: The concordance between pulsed Doppler/spectrum analysis and angiography . Ultrasound Med Biol 1983;;9:51-63.
58 +
Menken M, Sheps CG:  Undergraduate education in the medical specialties: The case of neurology . N Engl J Med 1984;;311:1045-1048.
59 +
Turney TM, Garraway WM, Sinaki M:  Neurologic examination in stroke rehabilitation: Adequacy of its description in clinical textbooks . Arch Phys Med Rehabil 1985;;66:92-94.
60 +
Ziegler DK:  Is the neurologic examination becoming obsolete? Neurology 1985;;35:559.
61 +
Wasson JH, Sox HC, Neff RK, et al:  Clinical prediction rules: Applications and methodological standards . N Engl J Med 1985;;313:793-799.
62 +
Kraaijeveld CL, van Gijn J, Schouten HJA, et al:  Interobserver agreement for the diagnosis of transient ischemic attacks . Stroke 1984;;15:723-725.
63 +
Shinar D, Gross CR, Mohr JP, et al:  Interobserver variability in the assessment of neurologic history and examination in the stroke data bank . Arch Neurol 1985;;42:557-565.
64 +
Van den Berg JH, Schouten HJA, Boomstra S, et al:  Interobserver agreement in assessment of ocular signs in coma . J Neurol Neurosurg Psychiatry 1979;;42:1163-1168.
65 +
Braakman R, Avezaat CJJ, Maas AIR, et al:  Interobserver agreement in the assessment of motor response of the Glasglow 'coma' scale . Clin Neurol Neurosurg 1977;;80:100-106.
66 +
Waddell G, Main CJ, Morris EW, et al:  Normality and reliability in the clinical assessment of backache . Br Med J 1982;;284:1519-1523.
67 +
Lindsay KW, Teasdale G, Knill-Jones RP, et al:  Observer variability in grading patients with subarachnoid hemorrhage . J Neurosurg 1982;;56:628-633.
68 +
Lindsay KW, Teasdale GM, Knill-Jones RP:  Observer variability in assessing the clinical features of subarachnoid hemorrhage . J Neurosurg 1983;;58:57-62.
69 +
Straue FA, Becka DR, Green MA, et al:  Reliability of clinical interpretation of the electroencephalogram . Clin Electrocephalogr 1975;;6:54-60.
70 +
Chikos PM, Fisher LD, Hirsch JH, et al:  Observer variability in evaluating extracranial carotid artery stenosis . Stroke 1983;;14:885-892.
71 +
Kohler T, Langlois Y, Roederer GO, et al:  Sources of variability in carotid Duplex examination: A prospective study . Ultrasound Med Biol 1985;;4:571-576.
72 +
Shinar D, Gross CR, Hier DB, et al:  Interobserver reliability in the interpretation of computed tomographic scans of stroke patients . Arch Neurol 1987;;44:149-155.
73 +
Von Arbin M, Britton M, de Faire U, et al:  Accuracy of bedside diagnosis in stroke . Stroke 1981;;12:288-293.
74 +
Farber JM, Shapiro BK, Palmer FB, et al:  The diagnostic value of the neurodevelopmental examination . Clin Pediatr 1985;;24:367-372.
75 +
Freeman RW, Bleeker ML, Comstock GW, et al:  Validation of self-administered questionnaire for study of peripheral neuropathy . Am J Epidemiol 1985;;121:291-300.
76 +
Eikelboom BC, Riles TR, Mintzer R, et al:  Inaccuracy of angiography in the diagnosis of carotid ulceration . Stroke 1983;;14:882-885.
77 +
Padayachee TS, Lewis RR, Gosling RG:  Ultrasound screening for internal carotid disease: I. The temporal artery occlusion test— which periorbital artery? Ultrasound Med Biol 1984;;10:13-16.
78 +
Lindstrom J:  An assay for antibodies to human acetylcholine receptor in serum from patients with myasthenia gravis . Clin Immunol Immunopathol 1977;;7:36-43.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


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.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
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.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems