SIMULATION-BASED TRAINING OF RAPID EVALUATION AND MANAGEMENT FOR ACUTE STROKE (STREAM) TRIAL (STREAM)
Bibliographic record
Abstract
Solitaireu2122 With the Intention For Thrombectomy Plus Intravenous t-PA Versus DIRECT Solitaireu2122 Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke(SWIFT DIRECT)Urs Fischer1, Vitor Mendes Pereira2, Johannes Kaesmacher1, Renu00e9 Chapot3, Adnan Siddiqui4, Jenny Bressan1, Melanie Schmidhalter1, Michael Froehler5, Christoph Cognard6, Stefanie Lerch1, Anthony Furlan7, Jeffrey L Saver8, Jan Gralla11University Hospital and University of Bern, Bern, Switzerland2University of Toronto, Canada3Alfried Krupp Krankenhaus, Essen, Germany 4University at Buffalo, USA5Vanderbilt University Medical Center, USA6University of Toulouse, France7UH Cleveland Medical Center, USA8University of California, USABACKGROUND Whether pre-treatment with intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) with stent retrievers is beneficial has become a matter of debate. In a patient-level pooled analysis of five randomized controlled studies (HERMES collaboration) the treatment effect size of MT did not differ between patients receiving IVT and those treated with MT alone. SWIFT DIRECT aims to determine, whether direct MT in patients with proximal vessel occlusion in the anterior circulation is non-inferior to IVT and MT.METHODS The international, multicentre, randomised-controlled, two-arm, open label, blinded endpoint (PROBE) trial SWIFT DIRECT will randomize 404 patients into the experimental arm (direct MT; 202) or control arm (bridging thrombolysis; 202). The trial will only be performed in patients with immediate access to MT. Main inclusion criteria are signed informed consent, age >18 and <86 years, confirmed ischaemic stroke, NIHSS u22658 and <30 and eligibility for IVT and MT. The primary outcome is functional independence (mRS) u22642 at 90 days. Main secondary outcomes are mortality, change in NIHSS score post randomization, time to reperfusion (TICI u22652b) and quality of life.RESULTS The recruitment started in October 2017. Eleven patients have been enrolled by 25.03.2018. Over 30 sites in Switzerland, Germany, Austria, France, Spain, Finland and Canada will participate in this clinical trial.CONCLUSIONS If direct MT in patients with large artery vessel occlusion in the anterior circulation is as safe and efficacious as IVT and MT, this would have a relevant impact on future stroke management.ClinicalTrials.gov Identifier: NCT03192332
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".