UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland.

BACKGROUND: The predecessor of today's Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery. METHOD: A literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript. RESULTS: Surgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe. CONCLUSIONS: On the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today.

Sentinel node biopsy and improved patient care.

Sentinel lymph node biopsy (SLNB) is based on the hypothesis that the sentinel lymph node (SLN) reflects the lymph-node status and a negative SLN might allow complete axillary lymph node dissection (ALND) to be avoided. Past and current sentinel lymph node clinical trials for breast carcinoma have addressed the prognostic and therapeutic benefits of this technique and as such, SLNB has become a standard of care for select breast cancer patients. This article reviews the history of SLNB as well as current guidelines and recent controversies.

Peabody's "Care of the Patient" and the Nature of Medical Science.

Francis W. Peabody's 1927 essay "The Care of the Patient" is widely quoted, yet few appreciate the subtlety of its interweaving of medical science with its more obvious humanistic elements. Understanding the essay in context requires a recapitulation of Peabody's life story, a review of earlier work that led up to the culminating lecture in 1926, and a detailed analysis of the thread of argument Peabody wove through the lecture. A better understanding of the essay shows how Peabody anticipated several important later developments in medical thought.

La Salpêtrière Hospital before Charcot: a visit described by Pedro González Velasco.

INTRODUCTION: Under Charcot's leadership, La Salpêtrière was transformed into one of the world's top neurology centres. However, there is little information regarding the patient care facilities which Charcot would have encountered upon his arrival in 1862. DEVELOPMENT: A paper published in 1860 by Spanish physician Pedro González Velasco following a visit to that famous hospital is a valuable testimony to the quality of patient care just prior to Charcot's arrival. Although it essentially praises the institution, the article also describes the largely unsatisfactory conditions endured by patients with severe mental disorders, epilepsy and paralysis, who were locked inside cages with simple straw pallets on the floor for beds and open holes for toilets. Rather than an alienist, Velasco was a well-known surgeon and passionate advocate of positivism. As a personal friend and hospital fellow of Jose Maria Esquerdo's, with similar political affiliations, he had first-hand knowledge of the struggle to improve neuropsychiatric care in Madrid. CONCLUSIONS: Publishing his paper ultimately provided Velasco with a pretext for denouncing the deplorable care conditions endured by similar patients in Hospital General de Madrid. Meanwhile, Charcot would go on to improve the living conditions of inpatients at La Salpêtrière and found the specialty of neurology.

To Sir, With Love.

In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the care for thousands of patients. His last station in Saudi Arabia made a huge impact on the country. I hope this article inspires others to write about their mentors who were important in their development as surgeons and physicians. Short biographies of these important figures will serve as a valuable historical record for generations to come.

Military medical advances resulting from the conflict in Korea, Part I: Systems advances that enhanced patient survival.

The Korean War started several years after the World War II had ended and no recognition of the threat or preparation was made for this possibility. The military and its medical service had been downsized after World War II and had to quickly ramp up to meet the surprise attack. The war provided the laboratory for trials and experimentation with the new technological developments of the era. The Korean conflict led to numerous advances in medical systems and patient care. The Mobile Army Surgical Hospital came of age, and was instrumental in saving many lives. Helicopters saw their first regular use as flying ambulances to take the injured to definitive care in a timely fashion. The national blood banking program was rapidly geared up and new techniques such as plastic bags for collection and delivery resulted. Body armor was developed that would allow mobility while offering protection and was widely used for the first time. Each of these systems improvements saved the lives of soldiers in combat and were soon to be used in the civilian sector to save and improve lives around the world.

Looking back 50 years in hospital administration.

Healthcare policy and hospital administration are dynamic and growing fields, oriented toward shaping the future. In an effort to understand where these fields have come from, as well as some of the re-occuring challenges faced, we conducted a retrospective analysis. Our research identified progress and major accomplishments, as well as issues that continue to challenge the field in five key areas: (1) the evolution of nursing, (2) funding and legislation, (3) hospital design, construction and technology, (4) patient care and infection control and (5) leadership. To explore these areas, a thematic content review was conducted on the 12 inaugural issues of Hospital Administration in Canada, a hospital administration periodical from 1962. All written content was reviewed, coded and categorized into major themes that represented the major hospital administration topics of 50 years ago. In this article, five prominent themes are explored and further illustrated using key stories and milestones from 1962.

The more things change, the more they stay the same.

In "Looking Back 50 Years in Hospital Administration," Graham and Sibbald identify five principal themes in the 1962 issues of Hospital Administration in Canada: the evolution of nursing, funding and legislation, hospital design, patient care and infection control and leadership. These themes are of course consistent with thematic concerns regarding healthcare in 2012; in some ways, this consistency over 50 years is disappointing, but not surprising. This commentary examines some of the specific themes.

The early clinical x-ray in the United States: patient experiences and public perceptions.

The first x-ray machines were large, loud, sparking, smelly, and ostentatious devices, prone to mishap and injury even when fully under the control of the physicians who, in droves, invested money and prestige in them. Their bizarre and sometimes overwhelming presentation in the clinic reinforced the contemporary public understanding of x-rays as fantastically potent yet ambiguously helpful. As one of the icons of the new scientific medicine, x-rays bore much of the public's expectations for a technological panacea, a belief that was reinforced by the spectacle of their generation and their undeniable effect on the body. A quarter century later, refinement of the technology had made irradiation safer and more effective, but also made the operation of the machines themselves almost undetectable. This "domestication" of x-ray machines underscored their failure as a modern-day heroic medicine, while reinforcing an emergent understanding of radiation as a subtle, cumulative, and insidious threat.

Sir Victor Horsley (1857-1916): lessons for the modern clinician.

Sir Victor Horsley is well known for his pioneering work as a neurological surgeon but his vital contributions to the regulation and advancement of the medical profession are less well understood. This archived literature review of The Horsley collection of papers (UCL Special Collections Library) documents Sir Victor's campaign for the autonomy of the stagnating medical profession of over a century ago. These lessons should empower modern clinicians to retain the professionalism they worry about losing.

Embedding economic relationships through social learning? The limits of patient and public involvement in healthcare governance in England.

The strategy for NHS modernization in England is privileging individual choice over collective voice in the governance of healthcare. This paper explores the tension between economic and democratic strands in the current reform agenda, drawing on sociological conceptions of embeddedness and on theories of reflexive governance. Building on a Polanyian account of the disembedding effects of the increasing commercialization of health services, we consider the prospects for re-embedding economic relationships in this field. An analysis is provided of the limits of the present legal and regulatory framework of Patient and Public Involvement (PPI) in establishing the democratic and pragmatist conditions of social learning necessary for effective embedding. We show how the attainment of reflexive governance in the public interest is dependent on such conditions, and on the capacities of patients and the public to contribute to debate and deliberation in decision making, including on fundamental policy questions such as how services are provided and by whom.

Evidence-based medicine: a brief historical analysis of conceptual landmarks and practical goals for care. / Medicina baseada em evidências: breve aporte histórico sobre marcos conceituais e objetivos práticos do cuidado.

Evidence-based medicine (EBM) is intended to improve the efficiency and quality of health services provided to the population and reduce the operational costs of prevention, treatment, and rehabilitation; the objective of EBM is to identify relevant issues and promote the social applicability of conclusions. This article underscores the importance of EBM in modern clinical teaching and social practices from the contributions of Archibald Cochrane and David Sackett to the development and dissemination of this paradigm in care and education during the twentieth century. EBM has helped broaden discussions on the relationships between teaching and medical practice, and has taken on an important role in curriculum reforms and training models and practices in health care.

A medicina baseada em evidências (MBE) pretende aumentar a eficiência e qualidade dos serviços de saúde prestados à população e diminuir os custos operacionais dos processos de prevenção, tratamento e reabilitação. Busca identificar problemas relevantes do paciente e promover a aplicabilidade social das conclusões. O artigo ressalta a importância da MBE para o ensino e para as práticas clínicas sociais da atualidade a partir da contribuição de Archibald Cochrane e David Sackett no desenvolvimento e na difusão desse paradigma assistencial e pedagógico durante o século XX. A MBE tem contribuído para ampliar a discussão sobre as relações entre ensino e prática da medicina, assumindo papel de destaque em reformas curriculares e modelos de formação no cuidado e práticas em saúde.

Soma Weiss, Alfred S. Reinhart, and the care of the patient.

Soma Weiss, a brilliant clinician, researcher, and teacher at Harvard Medical School, cared for Alfred S. Reinhart, who succumbed to subacute bacterial endocarditis in his final year at Harvard Medical School. Reinhart recorded his observations and experiences while a patient in the Thorndike Memorial Laboratory at the Boston City Hospital, and Weiss incorporated these in a paper some 10 years after Reinhart's death. In the tradition of Francis Weld Peabody, Weiss used Reinhart's memoir to emphasize the importance of listening to patients, of projecting sympathy, and of understanding and responding to their psychological needs.

Amphiaraos, the Healer and Protector of Attika.

Amphiaraos was an important and popular healing hero/god in Athens from the end of the fifth century BC, however, not much has been studied. This paper investigates the figure in various ways by examining different sources. In the sixth century BC and in to the fifth, Amphiaraos was an Argive warrior hero that came into war against Thebes. He then seems to have acquired a sanctuary in the Theban territory being a mantic hero. In the end of the fifth century BC, however, he is said to have swallowed up by the earth and sprang up again in a spring at Oropos. Between 420-414 BC, his sanctuary was set up by the Athenians at Oropos. But this time, he was venerated as a healing hero. In 420 BC, Asklepios was introduced to Athens in order to cure plague that went around from 430s BC. It seems that the Athenians benchmarked Asklepios to promote one more healing hero/god at their north eastern border. When Oropos was taken by their enemies, a substitute Amphiareion was established in Rhamnous, a deme close to Oropos. The Athenians also promoted a patriotic hero through the words of Euripides. Illustrated as having gone through the same process of sacrifice - death - commemoration, Amphiaraos was put in parallel with the Athenian mythical king Erechtheus. Through this parallel, Amphiaraos became a political figure that protected Athens from outside threats. Healing was, by the ancient Athenians, understood in a wide spectrum and was considered as a way to protect the polis.

Care, nurturance and morality: the role of visitors and the Victorian London children's hospital.

Visitors at the Hospital for Sick Children, Great Ormond Street, fulfilled an economic, social and marketing role at an institution which, in its earliest years, struggled against significant opposition from medical and charitable critics. Men and women from the respectable classes found a function that reflected well their philanthropic credentials, and that also opened up social and professional opportunities. The parents and families of the patients, however, found themselves marginalised by the hospital, and granted little scope to influence the hospital experience of their children or to interact with the supporters of the institution.