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Clinical Applications

Sharon E. Straus, MD; Sumit R. Majumdar, MD; Finlay A. McAlister, MD

JAMA. 2002;288:1396-1398.

Stroke is a leading cause of morbidity and mortality in most developed nations. There is a significant body of evidence supporting strategies that target primary and secondary stroke prevention. This evidence cannot be broadly applied to all patients, and each patient's situation and values must be considered with regard to shared evidence-based decision making. Several models can be used to apply evidence to individual patients, including formal clinical decision analysis, decision aids, or simpler tools such as the likelihood of being helped vs harmed. Various programmatic models of providing patient care in stroke prevention may also be useful; these include specialized clinics or disease-management programs, anticoagulation management services, and self-testing and management of anticoagulation by patients.

Author Affiliations: Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario (Dr Straus); and Division of General Internal Medicine, University of Alberta, Edmonton (Drs Majumdar and McAlister).

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