The ties that bind past and present: Tony Robert-Fleury, Philippe Pinel and the Salpêtrière

Pinel Freeing the Insane from Their Chains (1876, Hôpital de la Salpêtrière, Paris) by Tony Robert-Fleury is one of the most famous depictions of the treatment of those suffering with a mental illness. The background of this life-size painting and the reasons for its commission are less well-known. Through the lenses of art history and forensic psychiatry, this article examines the creation of Robert-Fleury's painting in relation to the medical and political context of late nineteenth-century France, including its indebtedness to Jean-Martin Charcot's studies of hysteria. The article also highlights the enduring significance of the artwork and its continued relevance to the modern practices of forensic psychiatry

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The ‘Scientific Artworks’ of Doctor Paul Richer

This article examines the little-known sculptures of pathology created by Doctor Paul Richer (1849-1933) in the 1890s for the so-called Musée Charcot at the Hôpital de la Salpêtrière in Paris. Under the aegis of Doctor Jean-Martin Charcot (1825-1893), one of the founders of modern neurology, Richer was the head of the hospital’s museum of pathological anatomy, as well as the Salpêtrière’s resident artist. His ‘series of figural representations of the principal types of nervous pathology’ included busts of patients suffering from labioglosso-laryngeal paralysis and myopathy, as well as sculptures depicting individuals suffering from Parkinson’s Disease and juvenile hypothyroidism. These patient portraits were seen as objective, while also paradoxically providing an alternative to mechanical media such as the photograph and the cast by permitting the doctor’s intervention in not only controlling and animating the sitter, but also emphasizing the patient’s symptoms. This was a new kind of medical specimen: the ‘scientific artwork’, as they were called by a contemporary. This phrase, far from being an oxymoron, indicates the purposive collapse of the objective (‘scientific’) and subjective (‘artistic’) binary in Richer’s sculptures of pathology. Through a detailed examination of three of Richer’s works, this article problematizes the categories traditionally used to describe, analyse and understand medical imagery and complicates our understanding of the relationship between science and art at the end of the nineteenth century

A Hysterical Reading of Rodin's Gates of Hell

This paper offers a new reading of Auguste Rodin's most important sculpture, the Gates of Hell, by arguing that the artist engaged with the visual language of and the wider discourse on hysteria, which permeated not only the French popular and scientifi c press but also the culture at large in the last decades of the nineteenth century. Recently uncovered archival evidence reveals Rodin's strong ties to the family and intellectual circle of Doctor Jean-Martin Charcot of the Hôpital de la Salpêtrière, affording the sculptor exceptional exposure and access to the medical discourse on hysteria. Rodin assimilated and adapted the lexicon of hysterical postures for the fi gures that populate the Gates of Hell, using the 'great malady of the century' to suggest the modern human condition and thereby creating a new and potent sculptural idiom that we recognize today as idiosyncratic of Rodin-and distinctly modern. © 2013 Association of Art Historians