Florence Nightingale began working on hospital reform even before she founded her famous school of nursing; hospitals were dangerous places for nurses as well as patients, and they urgently needed ...fundamental reform. She continued to work on safer hospital design, location, and materials to the end of her working life, advising on plans for children's, general, military, and convalescent hospitals and workhouse infirmaries. Florence Nightingale and Hospital Reform, the final volume in the Collected Works of Florence Nightingale, includes her influential Notes on Hospitals, with its much-quoted musing on the need of a Hippocratic oath for hospitals—namely, that first they should do the sick no harm. Nightingale's anonymous articles on hospital design are printed here also, as are later encyclopedia entries on hospitals. Correspondence with architects, engineers, doctors, philanthropists, local notables, and politicians is included. The results of these letters, some with detailed critiques of hospital plans, can be seen initially in the great British examples of the new "pavilion" design—at St. Thomas', London (a civil hospital), at the Herbert Hospital (military), and later at many hospitals throughout the UK and internationally. Nightingale's insistence on keeping good statistics to track rates of mortality and hospital stays, and on using them to compare hospitals, can be seen as good advice for today, given the new versions of "hospital-acquired infections" she combatted.
Spurred by ideals of individual liberty that took hold in the Western world in the late nineteenth century, psychiatrists and public officials sought to reinvent asylums as large-scale, totally ...designed institutions that offered a level of freedom and normality impossible in the outside world. This volume explores the “caged freedom” that this new psychiatric ethos represented by analyzing seven such buildings established in the Austro-Hungarian monarchy between the late 1890s and World War I.
In the last two decades of the Habsburg Empire, architects of asylums began to abandon traditional corridor-based plans in favor of looser formations of connected villas, echoing through design the urban- and freedom-oriented impulse of the progressive architecture of the time. Leslie Topp considers the paradoxical position of designs that promoted an illusion of freedom even as they exercised careful social and spatial control over patients. In addition to discussing the physical and social aspects of these institutions, Topp shows how the commissioned buildings were symptomatic of larger cultural changes and of the modern asylum’s straining against its ideological anchorage in a premodern past of “unenlightened” restraint on human liberty.
Working at the intersection of the history of architecture and the history of psychiatry, Freedom and the Cage broadens our understanding of the complexity and fluidity of modern architecture’s engagement with the state, with social and medical projects, and with mental health, psychiatry, and psychology.
Permeable Walls Mooney, Graham; Reinarz, Jonathan
Clio Medica Online,
2009, Letnik:
86
eBook, Book
Visiting relatives and friends in medical institutions is a common practice in all corners of the world. People probably go into hospitals as a visitor more frequently than they do as a patient. ...Permeable Walls is the first book devoted to the history of hospital and asylum visiting and deflects attention from medical history's more traditionally studied constituencies, patients and doctors.
This Viewpoint discusses regulation of nonprofit hospitals in a way that will advance their charitable purposes without eliminating their tax exemption status.
If a teaching hospital loses funding, what is the next option? Mergers of Teaching Hospitals in Boston, New York, and Northern California investigates the recent mergers of six of the nation's most ...respected teaching hospitals. The author explains the reasons why these institutions decided to change their governance and the factors that have allowed two of them to continue to operate while forcing the third to dissolve after only 23 months of operation. The case studies contained within this book rely on an impressive amount of research. Notably, instead of citing only published articles and books, the author includes information from numerous, extensive personal interviews with key participants in the various mergers. With this research the author not only presents to the reader a picture of why these mergers came about, but also investigates how the organizations have fared since joining together. The mergers are analyzed and compared in order to identify various methods of merger formation as well as ways in which other newly formed hospitals might accomplish a variety of important goals. Offering a spectacular account of some of the mergers that occurred in the health care field at the close of the twentieth century, these stories provide insight into academia's relationship with teaching hospitals and the challenges involved in bringing prestigious and powerful medical institutions together. The institutions discussed are Partners, the corporation which includes the Massachusetts General Hospital and the Brigham and Women's Hospital, New York-Presbyterian Hospital, the union of the New York and Presbyterian hospitals in New York City, and the UCSF Stanford, the merged teaching hospitals of the University of California, San Francisco and Stanford. This book will particularly appeal to professionals and academics interested in medicine, business, and organizational studies.
InAmerican Catholic Hospitals, Barbra Mann Wall chronicles changes in Catholic hospitals during the twentieth century, many of which are emblematic of trends in the American healthcare system.
Wall ...explores the Church's struggle to safeguard its religious values. As hospital leaders reacted to increased political, economic, and societal secularization, they extended their religious principles in the areas of universal health care and adherence to the Ethical and Religious Values in Catholic Hospitals, leading to tensions between the Church, government, and society. The book also examines the power of women--as administrators, Catholic sisters wielded significant authority--as well as the gender disparity in these institutions which came to be run, for the most part, by men. Wall also situates these critical transformations within the context of the changing Church policy during the 1960s. She undertakes unprecedented analyses of the gendered politics of post-Second Vatican Council Catholic hospitals, as well as the effect of social movements on the practice of medicine.
BackgroundIn CLARITY, cladribine tablets (CT) significantly reduced relapse rates in patients with relapsing multiple sclerosis. CLARITY Extension (EXT) compared the effects of 2 years’ additional CT ...treatment vs no additional treatment.ObjectiveAssess efficacy of 2 courses of CT or placebo (PBO) in CLARITY and 2 additional courses of CT or PBO in EXT.MethodsPatients receiving PBO in CLARITY were assigned to CT3.5 mg/kg; those treated with CT (3.5 or 5.25 mg/kg) were re-randomised 2:1 to CT3.5 mg/kg or PBO. Annualised relapse rates (ARR) and proportions qualifying relapse free (RF) were compared for CLARITY vs EXT within the same treatment groups: CT3.5 mg/kg in CLARITY and PBO in EXT (n=98); CT3.5 mg/kg in CLARITY and CT3.5 mg/kg in EXT (n=186); CT5.25 mg/kg in CLARITY and CT3.5 mg/kg in EXT (n=186); PBO in CLARITY and CT3.5 mg/kg in EXT (n=244).ResultsNo significant differences in ARR for CLARITY vs EXT except for PBO in CLARITY and CT3.5 mg/kg in EXT (0.26 vs 0.10, p<0.0001). The proportion RF was similar between CLARITY vs EXT across groups and >70%, except for PBO in CLARITY and CT3.5 mg/kg in EXT (58.0% vs 79.6%, p<0.0001).ConclusionsClinical benefits were maintained in patients who received CT in CLARITY and PBO in EXT demonstrating durable efficacy.
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