Search

Background: The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care. Methods: The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre‐ and post‐interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct‐to‐center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke‐specific in situ simulation training. Primary outcome measure was the 'door‐to‐needle' time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre‐existing treatment algorithm. Results: The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre‐intervention (interquartile range [IQR] 25–43 min) to 33 min (IQR 23–39 min, p = 0.03) post‐intervention achieved by simulation‐experienced stroke teams. Concerning EVT, we found significantly shorter door‐to‐groin times in patients who were treated by teams with simulation experience as compared to simulation‐naive teams in the post‐interventional phase (−21 min, simulation‐naive: 95 min, IQR 69–111 vs. simulation‐experienced: 74 min, IQR 51–92, p = 0.04). Conclusion: An intervention combining workflow refinement and simulation‐based stroke team training has the potential to improve process times in acute stroke care. [ABSTRACT FROM AUTHOR]

The quest for improved hydrological models is one of the big challenges in hydrology. When discrepancies are observed between simulated and measured discharge, it is essential to identify which algorithms may be responsible for poor model behavior. Particularly in complex hydrological models, different process representations may dominate at different moments and interact with each other, thus highly complicating this task. This paper investigates the analysis of the temporal dynamics of parameter sensitivity as a way to disentangle the simulation of a hydrological model and identify dominant parameterizations. Three existing methods (the Fourier amplitude sensitivity test, the extended Fourier amplitude sensitivity test, and Sobol's method) are compared by applying them to a TOPMODEL implementation in a small mountainous catchment in the tropics. For the major part of the simulation period, the three methods give comparable results, while the Fourier amplitude sensitivity test is much more computationally efficient. This method is also applied to the complex hydrological model WaSiM-ETH implemented in the Weisseritz catchment, Germany. A qualitative model validation was performed on the basis of the identification of relevant model components. The validation revealed that the saturation deficit parameterization of WaSiM-ETH is highly susceptible to parameter interaction and lack of identifiability. We conclude that temporal dynamics of model parameter sensitivity can be a powerful tool for hydrological model analysis, especially to identify parameter interaction as well as the dominant hydrological response modes. Finally, an open source implementation of the Fourier amplitude sensitivity test is provided. [ABSTRACT FROM AUTHOR]