Background and Purpose-The modified Rankin Scale (mRS) is a popular primary stroke outcome measure, but its usefulness is limited by suboptimal reliability (inter-rater agreement). Methods-We developed and tested the reliability of a simplified mRS questionnaire (smRSq) in 50 patients after stroke seen in outpatient clinics. Randomly chosen paired raters administered the smRSq within 20 minutes of each other and the ratings were blinded until the end of this study. Results-Agreement among the raters was 78%, the statistic was 0.72 (95% CI, 0.58 -0.86), and the weighted w statistic taking into account the extent of disagreement was 0.82 (95% CI, 0.72-0.92). The average time to administer the smRSq was 1.67 minutes. Conclusions-The smRSq appears to have very good reliability that is similar to that of a structured interview mRS and is considerably less time-consuming. (Stroke. 2010;41:1048-1050.)Key Words: clinometrics Ⅲ modified Rankin Scale Ⅲ outcome assessment R eliability (consistency) of measurements is of paramount importance in scientific research. 1 The modified Rankin Scale (mRS) 2 is a popular primary outcome measure in acute stroke trials, but its usefulness is limited by suboptimal reliability (inter-rater agreement). There is considerable variability in the reported reliability of the mRS. 3 A structured interview mRS that takes Ϸ15 minutes to administer was developed to help improve the mRS reliability. 4 In a recent systematic review the overall agreement between mRS raters without a standardized rating approach was 71%, the kappa () statistic was 0.46 (95% CI, 0.41-0.51), and the weighted kappa ( w ) statistic, taking into account the extent of all disagreements, was 0.90 (95% CI, 0.86 -0.94). 3 Using the structured interview mRS, the overall agreement was Ϸ73%, was 0.62 (95% CI, 0.56 -0.69), and w was 0.87 (95% CI, 0.75-1.00). 3,5,6 Inter-rater agreement was significantly improved with the structured interview mRS among raters with varied professional backgrounds, 7 which simulates a multicenter clinical trial. In an effort to simplify, standardize, and increase further the reliability of the mRS, we developed a simplified mRS questionnaire (smRSq) and tested it among raters with varied professional experiences. Materials and MethodsFour stroke faculty members with a total of 63 years experience applying the traditional unstructured mRS jointly created the smRSq (Figure). Using the key issues distinguishing between consecutive mRS categories, we created relatively simple questions that could be answered "yes" or "no" by patients or caregivers with little or no explanation. The key mRS issues were having no residual symptoms (0), being able to resume all prestroke activities (Յ1), being able to live independently (Յ2), being able to walk without assistance (Յ3), and not requiring constant supervision (Յ4).We screened patients for this study consecutively in 4 weekly clinics staffed by the stroke specialists and in 2 weekly resident continuity clinics at the Medical College of Georgia. Eligibility f...

Results from this real-world assessment of the economic burden of migraine suggest that migraine imposes a substantial direct and indirect cost burden in the United States. Compared to matched nonmigraine patients, migraine patients were more likely to have work loss and longer periods of work loss, leading to significantly higher indirect costs. Migraine patients also had higher levels of healthcare utilization, despite the relatively stable prevalence of migraine and the available acute and preventive treatment options for migraine management.

BACKGROUND: A variety of biologic therapies are currently used for the treatment of inflammatory autoimmune diseases, including rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). These diseases require long-term treatment, and information regarding the use and costs of biologic therapies can be valuable in making treatment and formulary decisions for clinicians and payers.

Cisplatin was one of the first chemotherapeutic agents to exhibit broad efficacy in solid tumors and it remains among the most widely used agents in the treatment of cancer. Its introduction inspired great efforts to design similarly effective platinum agents that overcome the three main limitations of cisplatin: toxicity, tumor resistance and poor oral bioavailability. However, 40 years after the initial discovery of cisplatin, only two platinum agents have garnered US FDA approval: carboplatin and oxaliplatin. Although hundreds of promising agents were tested in clinical trials during the 1990s, only oxaliplatin made it past clinical development. For a brief period, the economic cost of these unsuccessful efforts retarded further efforts to develop new agents. However, two exciting platinum agents have been brought to Phase III trials: satraplatin in hormone-refractory prostate cancer and picoplatin in small-cell lung cancer. If successful, they may inspire a new effort to bring better-designed platinum agents to market. This article reviews the clinical development of platinum agents to date and speculates on the role of platinum agents in the near future.