Journal Club Summary

Methodology Score: 4/5                   
Usefulness Score:  3/5
Berkhemer OA et al for the MR CLEAN Investigators.N Engl J Med. 2015 Jan;372(1):11-20.
This pragmatic, multicentre, block-randomized RCT in the Netherlands found that intraarterial treatment within 6 h + usual care was superior to usual treatment (generally IV thrombolytics) alone for patients with proximal anterior circulation clots (Primary outcome OR 1.67).  The JC attendees agreed that although lacking some descriptive information in regards to how patients were exactly treated both in hospital as well as pre-hospital, this is a practice-changing article for the neurology world, which will undoubtedly affect our emergency practice in the near future.  
By: Dr. Noam Katz (Presented January 2015)

Epi lesson: Explanatory versus Pragmatic Clinical Trials   

Trials of healthcare interventions are often described as either explanatory or pragmatic. Explanatory trials generally measure efficacy – the benefit a treatment produces under ideal conditions, often using carefully defined subjects in a research clinic. Pragmatic trials measure effectiveness – the benefit the treatment produces in routine clinical practice. Pragmatic trials generally reflect the reality of how the intervention will perform in everyday care. For more, see  
By: Dr. Ian Stiell