Illustrating insanity: Allan McLane Hamilton, Types of Insanity, and physiognomy in late nineteenth-century American medicine.

This article examines the divisive reception history of American psychiatrist and neurologist Alexander McLane Hamilton's physiognomy publication, Types of Insanity (1883). By analyzing 23 book reviews published in late-nineteenth-century medical journals, the authors present a bibliographic case study that traces the mixed professional reactions to Hamilton's work, thus revealing the fraught nature of physiognomy in the American medical community. In effect, the authors argue that the interprofessional disagreements that emerged among journal reviewers indicate the nascent efforts of psychiatrists and neurologists to oppose physiognomy in the interest of professionalization. By extension, the authors emphasize the historical value of book reviews and reception literature. Often overlooked as ephemera, book reviews register the shifting ideologies, temperaments, and attitudes of an era's readership.

Dr. Vladimir Fortunato (1885-1938), once lauded but now obscure Russian-American medical model sculptor.

Arriving to the United States in 1921, Dr. Vladimir Fortunato (1885-1938) was a respected and celebrated figure responsible for creating striking medical models and anatomical sculptures. Although Dr. Fortunato was well connected and worked for some of the United States' most prestigious medical institutions, his legacy, achievements, and creations have all but vanished from the annals of American medical history. In an effort to establish a more defined profile of this obscure man's life and lifework, this article draws on scant information provided by a range of sources, including academic journal articles, obituaries, and physician autobiography. In the present-day era of digital imaging technologies, Dr. Fortunato's lifelike sculptures represent a bygone age of medical visualization that embraced both utility and beauty.

Prevalence of misdiagnosis of cellulitis: A systematic review and meta-analysis.

BACKGROUND: There is no gold standard test to accurately identify patients with cellulitis and therefore misdiagnosis is common. Using the clinical impression of a dermatology or an infectious disease specialist as a reference standard, we sought to determine the prevalence of misdiagnosis of cellulitis among nonspecialist physicians. METHODS: A systemic search was performed using MEDLINE, Cochrane Library, and EMBASE databases for studies reporting diagnostic accuracy of cellulitis. Inclusion criteria required dermatology or infectious disease consultation for all patients diagnosed with cellulitis by generalist physicians. We used random effects modeling to estimate the prevalence of misdiagnosis using consultant diagnosis as a reference standard. RESULTS: Eight studies contributed to the analysis. For the seven studies involving inpatients, the results were sufficiently homogeneous to justify pooling data. Of 858 inpatients initially diagnosed with cellulitis, 335 (39%, 95% confidence interval: 31-47) received an alternative diagnosis from the specialist. Heterogeneity was large (I2 = 74%) and the greatest contributor to between-study variance was the year of publication. Alternative diagnoses were mostly noninfectious (68%, 221/327), with stasis dermatitis (18%, 60/327) being the most common. An abscess was the most common alternative infectious diagnosis (10%, 32/327). DISCUSSION: Cellulitis is commonly misdiagnosed among inpatients, leading to unnecessary hospital admissions and antibiotic overuse. Most alternative diagnoses are noninfectious. Continuing medical education among general practitioners and urgent care providers will likely reduce cellulitis misdiagnoses.

Dr. Howard A. Kelly's The Stereo Clinic: health science pedagogy and the egalitarian future of 3D clinical visualization.

This article situates emerging three-dimensional (3D) visualization technologies in the health sciences within the broader historical context of the stereoscope. Although 3D visualization technologies enhance pedagogy and deepen student engagement, they are generally cost-prohibitive and therefore inaccessible for many institutions. In light of this issue, the authors consider the work of American gynecologist and founding member of The Johns Hopkins Hospital in Baltimore, Maryland, Dr. Howard Atwood Kelly (1858-1943). A monumental work, Kelly's The Stereo Clinic is a multivolume publication whose focal point was the stereoscope, an image-viewing device that can be seen as a prototype for present-day 3D technologies. Each installment presents a step-by-step overview of a specific surgical procedure using a didactic narrative and corresponding stereoscopic images that illustrate the clinical practices. Significantly, Kelly understood The Stereo Clinic as an egalitarian project that provided high-quality educational resources to students and practicing physicians who did not have access to world-class clinical suites and teaching institutions. Furthermore, he viewed The Stereo Clinic as a remedy to the commonplace frustrations of medical education, such as crowded surgical suites, and the hazards of in-person observation. The Stereo Clinic is an important case study because it reveals a medical profession at the turn of the twentieth century preoccupied with 3D visualization. Inventive clinicians such as Kelly did not only advocate for this technology on the strength of its pedagogical value; they also articulated the equalitarian nature of this medium and produced 3D technology accessible to a wide audience.

Crossing the Brooklyn Bridge: a health literacy training partnership before and during COVID-19.

BACKGROUND: A request for consumer health information training for public librarians led to the development of a specialized consumer health reference and health literacy training program by professional consumer health librarians from an academic medical center. Professional consumer health librarians created an interactive presentation aimed at improving public librarians' ability to respond to consumer health questions and provide vetted health resources. CASE PRESENTATION: Building on professional expertise, librarians at Weill Cornell Medicine developed a live class demonstration accompanied by a representative subject LibGuide to support public librarians who assist patrons with health questions. Skills involved in effectively communicating with patrons who are seeking consumer health information include conducting reference interviews, matching patrons' needs with appropriate resources, teaching useful Internet search methods, assessing health information, and understanding health literacy issues. Originally envisioned as two in-person live demonstrations, the team proactively adapted the program to respond to the stay-at-home social-distancing order put in place in response to the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: The team successfully led an in-person live training session followed by an adapted online training experience, the latter designed to complete the curricula while complying with city and state orders.

Vitamin deficiencies in pediatric eosinophilic esophagitis: A systematic review.

BACKGROUND: Nutritional deficiencies are seen in patients with food allergy. Low vitamin D levels have been found in patients with atopic conditions. Eosinophilic esophagitis (EoE) is a chronic immune antigen-mediated disease found to be highly associated in patients with atopic disease and treated with dietary elimination with recommendations to utilize a dietician to prevent nutritional deficiencies. Nonetheless, the relationship between EoE and vitamin deficiency remains unclear. We aimed to systematically review the evidence to support a possible association between vitamin deficiency and eosinophilic esophagitis. METHODS: Electronic searches were performed with keywords relating to EoE and vitamins among pediatric patients in MEDLINE, EMBASE, and The Cochrane Library. Summary estimates were calculated. Citations were reviewed against pre-defined criteria. (Inclusion: human subjects, aged 0-18, with eosinophilic esophagitis. Exclusion: adults over 18 years, non-English papers). RESULTS: The search yielded 1707 studies. Five of these studies with a total of 137 pediatric patients were included in the systematic review. Outcome measures were assessed at different points in EoE treatment across studies. The single common outcome measure across all included studies was vitamin D. Reported prevalence of low vitamin D varied in these studies (0%-52%). Vitamin D levels of children with EoE both pre- and post-intervention were low. CONCLUSIONS: There is limited published literature on vitamin deficiencies associated with EoE both pre- and post-intervention. The limited data on vitamin D suggest that insufficiency or deficiency may be present in these patients, but it remains unclear whether deficiency is caused by diet. More prospective, well-defined studies, in addition to routine reporting on dietary intake and nutritional status, are needed to make any conclusions or recommendations for screening.

Health science librarianship: An opportunity for nurses.

Health science librarianship may interest nurses inclined toward research, technology, and education. This article discusses the role of health science librarians as part of the clinical team.

Involvement of information professionals in patient- and family-centered care initiatives: a scoping review.

OBJECTIVE: The goal of this scoping review was to collect data on patient- and family-centered care (PFCC) programs and initiatives that have included the direct involvement of librarians and information professionals to determine how librarians are involved in PFCC and highlight opportunities for librarians to support PFCC programs. METHODS: Systematic literature searches were conducted in seven scholarly databases in the information, medical, and social sciences. Studies were included if they (1) described initiatives presented explicitly as PFCC programs and (2) involved an information professional or librarian in the PFCC initiative or program. Based on the definition of PFCC provided by the Institute for Patient- and Family-Centered Care, the authors developed a custom code sheet to organize data elements into PFCC categories or initiatives and outcomes. Other extracted data elements included how the information professional became involved in the program and a narrative description of the initiatives or programs. RESULTS: All included studies (n=12) identified patient education or information-sharing as an integral component of their PFCC initiatives. Librarians were noted to contribute to shared decision-making through direct patient consultation, provision of health literacy education, and information delivery to both provider and patient with the goal of fostering collaborative communication. CONCLUSIONS: The synthesis of available evidence to date suggests that librarians and information professionals should focus on patient education and information-sharing to support both patients or caregivers and clinical staff. The burgeoning efforts in participatory care and inclusion of patients in the decision-making process pose a unique opportunity for librarians and information professionals to offer more personalized information services.

Systematic review with meta-analysis on transplantation for alcohol-related liver disease: Very low evidence of improved outcomes.

BACKGROUND: Alcohol-related liver disease (ALD) is a leading cause of liver failure and indication for liver transplantation that arises in the setting of alcohol use disorder (AUD). Previous reviews of transplantation for ALD are limited in scope of outcomes and type of ALD studied. A comprehensive systematic review could improve use of transplantation in ALD and improve future research. We hypothesize that while transplanting ALD may improve mortality and relapse, findings will be limited by pre-specified causes of heterogeneity - assessment and treatment of AUD, definition of ALD, spectrum of ALD studied, assessment and rates of relapse, and study quality and bias. AIM: To optimize liver transplantation for ALD, understanding existing research to guide future research, we conducted a systematic review with meta-analysis. METHODS: We conducted a systematic review, comparing liver transplant to no-transplant in patients with ALD, with a primary outcome of both short- and long-term mortality and relapse. We performed a comprehensive search of MEDLINE, EMBASE, Web of Science, and The Cochrane Library databases for peer-reviewed journal articles comparing use of liver transplant in ALD to no-transplant. Two reviewers independently conducted screening, full text review, and data extraction according to the PRISMA guidelines. We report the quality of the evidence according to the GRADE criteria. RESULTS: We analyzed data from 10 studies. Of 1332 participants, 34.2% (456/1332) had undergone liver transplantation, while 65.8% (876/1332) had not. While random effects meta-analysis suggested transplant in comparison to no-transplant had an association of reduced mortality that did not reach statistical significance, relative risk (RR) = 0.51 (0.25-1.05), but not relapse risk, RR = 0.52 (0.18-1.53), significant heterogeneity limited these findings. When restricted to prospective data, transplant compared to no-transplant significantly reduced mortality, RR = 0.25 (0.13-0.46, P < 0.01), and relapse, RR = 0.25 (0.14-0.45, P < 0.01), with insignificant heterogeneity but persistent small-study effects. The overall quality of the evidence was Very Low. Heterogeneity analysis suggested that AUD assessment and treatment was often not reported while ALD, relapse assessment and rate, and data collection were institutionally rather than standardly defined. CONCLUSION: Systematic review of liver transplantation for ALD suggests reduced mortality and relapse in heterogeneous, institution-specific populations with inherent bias. To understand efficacy of transplanting ALD, our research approach must change.

Body of evidence: integrating Eduard Pernkopf's Atlas into a librarian-led medical humanities seminar.

BACKGROUND: Anatomical subjects depicted in Eduard Pernkopf's richly illustrated Topographische Anatomie des Menschen may be victims of the Nazi regime. Special collections librarians in the history of medicine can use this primary resource to initiate dialogs about ethics with medical students. CASE PRESENTATION: Reported here is the authors' use of Pernkopf's Atlas in an interactive medical humanities seminar designed for third-year medical students. Topical articles, illustrations, and interviews introduced students to Pernkopf, his Atlas, and the surrounding controversies. We aimed to illustrate how this controversial historical publication can successfully foster student discussion and ethical reflection. CONCLUSIONS: Pernkopf's Atlas and our mix of contextual resources facilitated thoughtful discussions about history and ethics amongst the group. Anonymous course evaluations showed student interest in the subject matter, relevance to their studies, and appreciation of our special collection's space and contents.

The Bellevue Classification System: nursing's voice upon the library shelves.

This article examines the inspiration, construction, and meaning of the Bellevue Classification System (BCS), created during the 1930s for use in the Bellevue School of Nursing Library. Nursing instructor Ann Doyle, with assistance from librarian Mary Casamajor, designed the BCS after consulting with library leaders and examining leading contemporary classification systems, including the Dewey Decimal Classification and Library of Congress, Ballard, and National Health Library classification systems. A close textual reading of the classes, subclasses, and subdivisions of these classification systems against those of the resulting BCS, reveals Doyle's belief that the BCS was created not only to organize the literature, but also to promote the burgeoning intellectualism and professionalism of early twentieth-century American nursing.

'Not a little lady was left'.

A look at dolls in nursing care in the 20th century. Editor's note: Looking Back features the work of scholars using primary-source visual and textual documents. The column seeks interesting historical photographs accompanied by brief essays that speak to each photograph's context and implications for contemporary nursing. See AJN's author guidelines at http://ajn.edmgr.com.