Medical Art Research Articles

John Lovejoy Elliott and the Social Settlement Movement

During the Progressive Era, American social settlements played a critical role in helping immigrants adjust to a new life that was puzzling, difficult, and often grueling. Settlements offered immigrants medical help, language classes, art and music lessons, day-care services — and sometimes a place where they could learn to be community leaders. Most often, it is the inspiring work of women reformers that one thinks of in connection with the important work of social settlements. Yet among the many prominent women, several men in the settlement movement were influential and extraordinary in their own right. John Lovejoy Elliott, founder and head worker of the Hudson Guild in New York City, was a prime example.Although Elliott held such impressive posts as President of the Board of Directors of the National Federation of Settlements (from 1919 to 1923) and was described by one of his contemporaries as “one of the great social workers and spiritual leaders of our time…. a kind of lay saint,” historically Elliott's work has been overshadowed by that of his more famous female counterparts. Yet one could argue that it is Elliott who created and put into practice a settlement house that best addressed the needs of immigrants and most helped the immigrant underclass achieve some independence and political power.Although John Lovejoy Elliott had a single focus (helping immigrants), female settlement head workers, such as Jane Addams, often pursued a dual goal. They were concerned about helping immigrants, but also were intent on giving college-educated, middle-class or upper-class young American women something to do with their lives. “We have in America,” wrote Addams, “a fast growing number of cultivated young people who have no recognized outlet for their active abilities.”

Contention/compression élastique

Lower limb treatment by contention/compression (C/C) is the cornerstone for treating and preventing chronic venous insufficiency (CVI), lymphoedema and thromboembolic diseases. Bandages and/or medical stockings are proposed in such treatment, owing to their proven or supposed mode of action on the haemodynamic disorders resulting from venous and lymphatic diseases. Nevertheless, complete knowledge of their therapeutic potential and precise evaluation of the patient's needs remain necessary to establish adequate prescription. However, this knowledge is not sufficient, because many uncertain factors should also be taken into account such as the technique for putting up the bandages by the patient himself or by an untrained nursing staff. This essay analyses the different theoretical, practical and psychological elements, with a view to better approach issues and solutions regarding a thousand-year-old therapy accepted by everyone but whose mode of action still very much (too much?) come under the so-called medical art.

Aesthetic Otoplasty

T he prominent rim of the auricle known as the helix takes a more or less curvilinear shape, starting at the helical root anteriorly and ending approximately at the level of the intertragal notch posteriorly. Many types of malformations of the auricle exist, with the prominent ear being one of the most commonly discussed deformities in the cosmetic literature. In many of these malformations, especially in the classic lop ear deformity, a deficient lateral overhang of the helix can exist. Creating a lateral overhang of the helix, or helical curl, that will persist has so far been an elusive endeavor in cosmetic otoplasty. Most surgeons have been satisfied with the helix’s mere prominence and relationship to the antihelix. This report calls attention to this helical flattening and presents a simple approach to obtaining a more natural appearance of the helical curl. This effect is achieved by excising a composite wedge(s) from the superior helical rim in a fashion that promotes an aesthetic tubular appearance of the helix.

Clinical diagnoses and autopsy findings: A retrospective analysis of 252 cases in Greece

Abstract Context.—Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science. Objective.—To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies. Design.—Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999–2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient. Results.—In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discorda...

Clinical Diagnoses and Autopsy Findings: A Retrospective Analysis of 252 Cases in Greece

Despite medical and technologic advances, clinicians may misdiagnose a patient's situation and the cause of death. Autopsy may be valuable in uncovering the most frequent diagnostic pitfalls and helping clinicians to learn and to develop the medical art and science. To compare the clinical diagnoses with postmortem findings and evaluate the frequency of diagnostic errors assessed by autopsies. Retrospective analysis of the protocols of 252 consecutive cases of adult patients autopsied in the Department of Forensic Medicine and Toxicology of Athens Medical School during the period 1999-2003. The outcome measures included concordance between diagnosis before death and at autopsy, sex, age, and length of hospitalization of the patient. In 73 cases (29%), the autopsy findings confirmed the clinical diagnosis and the cause of death suggested by the clinicians. In 45 cases (19%), the clinical diagnosis and the cause of death suggested by the clinicians were discordant with the autopsy findings. In 105 cases (42%), the autopsy requests did not include any suggestion about the cause of the patient's death. In 7 cases (3%), several diagnoses were suggested by the clinicians, and in 16 cases (6%), the comparison between clinical and postmortem diagnosis was not possible. The most frequently misdiagnosed diseases were coronary disease and pulmonary embolism. It is concluded from this study that autopsies may reveal unexpected findings that are of critical importance and that a continued emphasis on autopsy evaluation is necessary to improve the quality of patient care.

PINUS Association Symposium: ‘Medicine and the New Paradigms of Science’

PINUS Association Symposium: ‘Medicine and the New Paradigms of Science’

The Physician???s Art: Representations of Art and Medicine.

From early times, artists have been involved in the life and work of the physician in a variety of ways. Members of the medical professions have, in their turn, been central in shaping the visual canon of their profession, from the grandiose drama of the corpse anatomy theater to the intricately worked ivory and metal tools of their trade. "The Physician's Art" celebrates the diversity and achievements of such collaborations, looking beyond the traditional boundaries of art to the books and artifacts used by physicians since the fifteenth century and inviting us to ponder their role and that of medicine in the culture of their time and our own.Published as a companion catalogue to an exhibit of more than one hundred rare and remarkable medical art" objects that was curated by Julie V. Hansen at the Duke University Museum of Art, this richly illustrated book includes an introductory essay by distinguished art historian Martin Kemp. Demonstrating how the practice of medicine and our understanding of disease and the human body have gone hand in hand with the development of techniques in art - combined with such inventions as the camera and the microscope - this book presents works that range from the fifteenth century to the twentieth, from Europe to the Far East and Africa, from detailed medical illustrations to photographs of ivory manikins and an amputation saw.

Cardiopulmonary Exercise Testing and Prognosis in Chronic Heart Failure*: A Prognosticating Algorithm for the Individual Patient

The identification of individuals who are at high risk of chronic heart failure (HF) is a medical art of growing concern. Cardiopulmonary exercise stress testing (CPX) has become an important clinical tool to predict outcome. The value of peak oxygen consumption rests in the fact that it integrates elements of cardiac adaptations, and skeletal muscle, pulmonary, and endothelial dysfunctions more than other traditional prognostic indicators of chronic HF. Recently, exercise-related ventilatory abnormalities have gained attention, stimulating scientific debate and an innovative perspective. This review, through a critical examination of previous experiences, will focus on the prognostic application of CPX, defining a proficient outline of treatment for the individual patient.

Pediatric Psychology with a Postmodern Twist

Working collaboratively with children, families, health care professionals and other systems of care in order to help children who may have one or more of a wide range of chronic or acute illnesses or developmental disorders is one of many challenges facing pediatric psychologists and mental health practitioners from a variety of backgrounds who work in healthcare settings with and/or on behalf of children. Guiding ideas of postmodern therapies, along with knowledge of child development and familiarity with neurologically- and physiologically-based disorders, together, can provide a helpful framework for pediatric and family practitioners in their clinical work with, and on behalf of, children. Three case vignettes are provided to elucidate the concepts presented. The clinical work described here took place within the framework of outpatient services offered by the department of pediatric psychology in a large children’s medical hospital. Pediatric psychology is a field of study dedicated to exploring relationships among health, illness and behavior in children and youth and their families. These interests are not exclusive to pediatric psychologists. Other medical, allied health and mental health professionals, including developmental pediatricians, pediatric nurses, social workers, marital and family therapists (MFT’s), medical family therapists, recreational therapists, music and art therapists and counselors embrace similar interests and focus of work. As a specialized field, pediatric psychology is still a relatively young discipline, founded in 1968 (Seagull, 2000; Mullins, Hartman, Chaney, Balderon, & Hoff, 2003). The vast majority of pediatric psychologists identify themselves as utilizing a behavioral or cognitive-behavioral orientation to treatment (Mullins et al., 2003). While there is, within the field of pediatric psychology, widespread recognition of the importance of family approaches and of system-level thinking, this recog

Correction

Perceptive devotees of “Landmarks in Hepatology” may have been puzzled by the reference to the author's address in the opening paragraph that dealt the art versus the science of medicine, in the January 2004 article “Never Say Dye.” The author wishes to reassure readers that although he appreciates the artistic aspect of medicine, he still does his work in the Clinical Science Building of the Medical University of South Carolina (which the publisher inadvertently omitted from the address) and not a Medical Arts Building somewhere, as might be supposed.

Regulating Research and Experimentation: A View from the UK

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“

Commentary: Roentgenographic and Direct Observation of Experimental Lesions

Dr. Rossman is a Diplomate of the American Board of Endodontics, Clinical Associate Professor of Endodontic School of Dental Medicine, University of Pennsylvania and is Chairman Emeritus, I.B. Bender Division of Endodontics, Albert Einstein Medical Center, Philadelphia, PA. Address requests for reprints to Dr. Rossman, Medical Arts Building, 1601 Walnut St., Suite 1114, Philadelphia, PA 19102-2907.

La recherche clinique au sein des centres hospitaliers généraux… …ou comment faire de la science sans (le faire) savoir…Clinical research in community hospital in France

Medical research is an important part of medical art. From Hippocratis to hypothesis … resume research processes. Medical trials could be done or managed by community hospitals but it implies several collaborations with university structures. Even it is sometimes difficult to do, improvement of medical science and patient management through publications and communications are the ultimate goal of such trials ….

Transdisciplinary unifying implications of circadian findings in the 1950s.

A few puzzles relating to a small fraction of my endeavors in the 1950s are summarized herein, with answers to a few questions of the Editor-in-Chief, to suggest that the rules of variability in time complement the rules of genetics as a biological variability in space. I advocate to replace truisms such as a relative constancy or homeostasis, that have served bioscience very well for very long. They were never intended, however, to lower a curtain of ignorance over everyday physiology. In raising these curtains, we unveil a range of dynamics, resolvable in the data collection and as-one-goes analysis by computers built into smaller and smaller devices, for a continued self-surveillance of the normal and for an individualized detection of the abnormal. The current medical art based on spotchecks interpreted by reference to a time-unqualified normal range can become a science of time series with tests relating to the individual in inferential statistical terms. This is already doable for the case of blood pressure, but eventually should become possible for many other variables interpreted today only based on the quicksand of clinical trials on groups. These ignore individual differences and hence the individual's needs. Chronomics (mapping time structures) with the major aim of quantifying normalcy by dynamic reference values for detecting earliest risk elevation, also yields the dividend of allowing molecular biology to focus on the normal as well as on the grossly abnormal.

La recherche clinique au sein des centres hospitaliers généraux…: …ou comment faire de la science sans (le faire) savoir…

Medical research is an important part of medical art. From Hippocratis to hypothesis … resume research processes. Medical trials could be done or managed by community hospitals but it implies several collaborations with university structures. Even it is sometimes difficult to do, improvement of medical science and patient management through publications and communications are the ultimate goal of such trials ….

University of Nebraska College of Medicine, section on humanities and law, Department of Preventive and Societal Medicine.

The Section on Humanities and Law provides education, research, and service in health care ethics, health law, the history of medicine, and the medical arts and humanities. Originally established by volunteer attorneys in the 1920s as the Section of Medical Jurisprudence, this program was among the first in the country to require that all medical students receive training in the legal and ethical aspects of medicine. In 1980 the section became the Department of Jurisprudence and Humanities, and in 1989 it was renamed the Department of Preventive and Societal Medicine to reflect its expanded scope. Current sections include biostatistics, epidemiology, health services research and rural health policy, and humanities and law. Three full-time PhD members and one half-time JD member comprise the core faculty for the section on humanities and law, supplemented by MD, PhD, MS, and JD volunteers from the academic and professional communities. The Section plays a substantial role in the Integrated Clinical Experience of first- and second-year medical students. Topics include values and professionalism, confidentiality, informed consent, reproductive ethics, faith and medicine, death and dying, advance directives, income and health, environmental aspects of medical care, and medical mistakes. Film excerpts, guest speakers, role-playing, and other activities introduce topics in the large-group setting. Small-group sections make liberal use of standardized patients, enabling students to practice their approaches to difficult or delicate issues and learn from one another. Two ethics papers are required. Annual student feedback from the Integrated Clinical Experience forms the basis of continual revision of the ethics curriculum. Ratings on the ethics elements generally equal or exceed the ratings for other components. An emphasis on current student experience and immediate applicability has made the content more accessible. Ongoing challenges include the reluctance of many medical students to take “soft” topics seriously when confronted with overwhelming amounts of factual material to master. Fourth-year medical students may select a month-long rotation with the section and complete an independent study project in law, ethics, or medical humanities. Two new courses are offered online: the core ethics class for students in the Allied Health Professions (radiography, physical therapy, medical technology, etc.); and a self-directed study of physician-patient communication for residents. Graduate students in the School of Public Health may satisfy their ethics requirement with a course in Public Health Ethics, and a graduate-level course in Health Care Ethics is popular with students in many other programs. Faculty participation in the Medical Ethics Committee, Ethics Consultation Service, and Institutional Review Board presents opportunities for professional education. Campus departments often request guest lectures or grand rounds presentations. Additionally, a section-based Medical Humanities Interest Group serves the larger community. Plans for 2004 include a fourth-year medical student selective devoted to medicolegal issues, further evaluation and development of the online ethics courses, and development of an interdisciplinary study course on medical mistakes.

Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine.

The Program in Medical Humanities & Arts at the University of California, Irvine, College of Medicine has been in existence for five years. The program was implemented to enhance aspects of professionalism including empathy, altruism, compassion, and caring toward patients, as well as to hone clinical communication and observational skills. It contains elective or required curriculum across all four years of medical school and required curriculum in two residency programs, organized according to structural principles of horizontal coherence, vertical complexity, and patient care applications. The program emphasizes small-group, interdisciplinary teaching and faculty development, and is notable for learners' use of creative projects to reflect on patients and themselves. Evaluation of the program indicates a positive response among learners. More systematic studies point to increases in empathy and positive attitudes toward the humanities as tools for professional development as a result of exposure to the program curriculum. Future directions include closer collaboration with the University of California, Irvine, Schools of the Arts and Humanities, involvement of local artists and writers, and development of a graduation with distinction in humanities for medical students.

Perspective: cosmetic eyelid surgery from the patient's perspective.

Summit, New Jersey, U.S.A. Accepted February 10, 2003. Address correspondence and reprint requests to Dr. Joseph A. Mauriello, Jr., Medical Arts Center of Summit, 33 Overlook Road, Suite 104, Summit, NJ 07901, U.S.A. Presented in part as a Poster Presentation at the 2001 Annual Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, New Orleans, Louisiana, November 9–10, 2001.

The Anatomical Collection in Jena and the Influence of Carl Gegenbaur

The Museum anatomicum Jenense lodges the anatomical collection of the Friedrich Schiller University in Jena, an omnium-gatherum of medical dissecting art. The intermaxillary bone specimens remind of Goethe’s finding, which was the origin of systematic thinking on the basis of classifying the skeleton according to a certain norm (“type”) to which all the diversity could be reduced. The anatomical collection looks back upon a tradition of about 200 years. It all began with the art and natural produce chamber of the Duke of Saxony in Weimar. Three chambers — the osteological-zoological, the anatomical and the zootomical — form the pillars of a highly esteemed collection for the teaching of descriptive and comparative anatomy during the time of Gegenbaur and his successors. Gegenbaur not only supplemented the collection systematically but also started to use it intensively for scientific purposes. In the spirit of Darwin’s theory of evolution he cooperated closely with Ernst Haeckel and founded a new scientific school, which was continued by his disciples. Nowadays, the anatomical collection can not only be seen as the legacy of eminent preceding generations but also as a collection of high historic, scientific and pedagogic potential.

Spiritual Healing, Sick Kids and the Law: Inequities in the American Healthcare System

Main Street in Sarasota, Florida. A high-tech medical arts building rises from the east end, the county's historic three-story courthouse is two blocks to the west and sandwiched in between is the First Church of Christ, Scientist. A verse inscribed on the wall behind the pulpit of the church reads: “Divine Love Always Has Met and Always Will Meet Every Human Need.” This is the church where William and Christine Hermanson worshipped. It is just a few steps away from the courthouse where they were convicted of child abuse and third-degree murder for failing to provide conventional medical care for their seven-year-old daughter.This Article is about the intersection of “divine love” and “the best interests of the child.” It is about a pluralistic society where the dominant culture reveres medical science, but where a religious minority shuns and perhaps fears that same medical science. It is also about the struggle among different religious interests to define the legal rights of the citizenry.