Bibliographic record
Abstract
We read with interest the recent article by Kanji et al 1 reporting an audit of the management of blood pressure (BP) in acute stroke. Of particular note was their finding in patients with ischaemic stroke that nitroglycerin (or glyceryl trinitrate, GTN, 1-1.5 inches) paste caused a >15% reduction of BPover the first 24 hours on 60% of the occasions it was used. As a nitric oxide donor, GTN will lower BPthrough combined arterial and venous dilation. We have assessed the effect of daily GTN patches on BP in two small randomised controlled trials involving patients with acute stroke. These studies, involving 127 patients in total, found that GTN lowered 24 hour BP by an average of 6-8%, compatible with recommendations that BPshould not be reduced by more than 15% in acute stroke. Nitrates can cause profound falls in BP if patients are dehydrated or hypovolaemic and we always ensure that these states are treated prior to the administration of GTN. Use of GTN patches rather than paste offers several advantages: first, it reduces the variation in dosage seen with the use of topical application of ointment or paste; 4 second, treatment can be given once rather than thrice daily; and last, the onset of action will be more gradual, reducing the risk of sudden falls in BP. Transdermal preparations offer advantages over other routes of administration for the management of high BP in acute stroke; intravenous formulations such as labetalol or sodium nitroprusside require close monitoring in a high dependency environment while the administration of oral preparations cannot be guaranteed acutely since many patients are dysphagic and intolerant of nasogastric tubes. Sublingual nifedipine, reported as being used commonly in the study by Kanji and colleagues, 1 should never be used since the falls in BP are typically sudden, large and unsustained, the very qualities we wish to avoid in acute stroke.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.010 | 0.012 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".