The impact of MRI on stroke management and outcomes: a systematic review

Rationale, aims and objectives Magnetic resonance imaging ( MRI ) is widely used in stroke evaluation and is superior to computed tomography for the detection of acute ischaemia. We sought to evaluate the evidence that conventional MRI influences doctor management or patient outcomes in routine care. Methods We systematically searched PubMED , EMBASE and proceedings of the I nternational S troke C onference. Studies were included if they included patients presenting with possible stroke syndromes and they reported MRI results and resulting changes in management or outcome. Multiple reviewers determined inclusion/exclusion for each study, abstracted study characteristics and assessed study quality. Results Of 1813 articles screened, nine studies met inclusion criteria. None were randomized controlled trials, cohort studies or case‐control studies. We found little evidence that MRI affects outcomes – one single‐centre case series presented three patients. The remaining articles were studies of diagnostic tests or vignette‐based studies that described changes in doctor management attributed to MRI . In the studies that suggested MRI influenced management, it did so in two ways. First, MRI distinguished stroke from mimics (e.g. brain tumours), thus enabling more appropriate selection of therapies. Second, even when MRI confirmed a suspected stroke diagnosis, it sometimes provided information (on stroke mechanism, localization, timing or pathophysiology) that influenced management. Conclusions The impact of MRI on management and outcomes in stroke patients has been inadequately studied. Further research is needed to understand how MRI may productively affect stroke management and outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101764/1/jep12011-sup-0003-si.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101764/2/jep12011.pd

Neurosciences

This course sequence teaches the pathophysiology of common diseases of the nervous system (including visual, auditory, and vestibular systems), and the general principles underlying diagnosis and management. The specific goals are: ¶ To review clinically relevant neuroanatomy and neurophysiology. ¶ To learn a systematic approach to the localization of neurologic lesions. ¶ To learn a systematic approach for determining the likely general category of disease process responsible for a patient’s symptoms and signs, based primarily on localization and time course. ¶ To learn about some common symptom complexes and diseases of the nervous system, (including visual, auditory, and vestibular systems) with respect to clinical features, pathology, pathophysiology, approach to diagnosis, and approach to management.http://deepblue.lib.umich.edu/bitstream/2027.42/120533/1/medical_m2_curriculum_neurosciences-January10.zi

A Comparative Study of Prices and Wages in Royal Inscriptions, Administrative Texts and Mathematical Texts in the Old Babylonian Kingdom of Larsa

International audienceMathematical knowledge and practices in Ancient Mesopotamia vary according to the milieus under consideration. This paper deals with the numerical data—prices and wages—used in texts produced in different contexts and for different purposes. It focuses on the corpus of the kingdom of Larsa (Tell es-Senkereh), in southern Mesopotamia, for which we have a large number of texts of various genres for the Old Babylonian period (twentieth-eighteenth centuries BCE). Three different types of texts that mention prices and wages are taken into account: royal inscriptions, mathematical texts and administrative texts. A comparison between prices and wages recorded in royal inscriptions and those provided by administrative and economic texts show that kings wanted to control prices and claimed to pay high wages to their workers, by providing data which are different from those found in texts of practice. In contrast, collections of laws reflect the determination of the sovereign to act as a just king. The numerical values mentioned in these texts are similar to those in the administrative texts and the mathematical texts which also rely on real numerical values. Since mathematical problems were inspired by the organization of the work for large construction projects ordered by kings at the end of the third and beginning of the second millennia BCE, they also rely on real numerical values