What can art history offer medical humanities?

This article charts the emergence of visual medical humanities as a space of academic research, creative practice and lively critical debate, with a focus on how art historical scholarship has influenced the field's formation. Concentrating on developments over the past decade, it offers an overview of current scholarship while highlighting opportunities and challenges for the future. We begin with a survey of medical and health humanities handbooks and readers, noting that their engagement with art and visual culture is predominately limited to the contexts of therapy, clinical pedagogy and medical history. The main part of the article explores art historical scholarship in relation to three areas of significance for the medical humanities. First, we address art historical research that engages with medical history, identifying major topoi including the anatomical body, the doctor-patient encounter and the close relationship between clinical and artistic vision; we argue that this work has tended to presume, rather than explicitly articulate, its relationship to medical humanities and recommend that art historians wishing to engage more deeply with the medical humanities need to clearly communicate what their work brings to wider debates in the field. Second, we explore contemporary arts practices that mobilise health-related experiences, forms of care and practical activism: medical humanities, we argue, has much to gain from a critical engagement with contemporary (as well as historical) art. Third, we review three art history-led projects that are redefining the field and promoting new models for collaborative 'entanglement' across disciplines: Art HX: Visual and Medical Legacies of British Colonialism; Visualizing the Virus; and Confabulations: Art Practice, Art History, Critical Medical Humanities By arguing for the vital importance of attending to the critical complexities of art and visual culture, this article aims to enrich existing debates and provoke a new wave of visually engaged medical humanities scholarship.

Gender bias in the clinical management of women with angina: another look at the Yentl syndrome.

BACKGROUND: Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in primary care. METHODS: The study design is a cross-sectional survey of 1162 angina patients (552 women) managed in eight sentinel centers serving 15% of the population of Liverpool. Data were extracted by specially trained data managers. Analysis included directly age-standardized proportions and male/female adjusted odds ratios (AOR), adjusted for age, disease duration, physician consultation rate, and age at diagnosis. RESULTS: All aspects of care were higher for men with angina-previous myocardial infarction (MI) than for women with angina-previous MI. Risk factor recording was an absolute 8% higher (95% CI 1%-17%), secondary prevention 9% higher (95% CI 1%-17%), cardiac investigation 10% higher (95% CI 1%-20%), and revascularization 13% higher (95% CI 4%-22%). Men with angina-previous MI consistently received the highest level and women with angina the lowest level of risk factor recording (AOR 1.79, 95% CI 1.21-2.66), secondary prevention (AOR 2.24, 95% CI 1.47-3.40), cardiac investigation (AOR 2.21, 95% CI 1.56-3.13), and revascularization (AOR 4.67, 95% CI 3.03-7.18). The provision of care to men with angina alone and women with angina-previous MI fell between these two extremes. CONCLUSIONS: A gender-based clinical hierarchy operates in the clinical management of angina pectoris in primary care. The Yentl syndrome did not apply, however, as women with angina received less intensive clinical care than similar men irrespective of prior MI.

Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care.

BACKGROUND: Previous research suggests that women admitted to hospital with acute myocardial infarction (MI) are managed less intensively than men. Chronic stable angina is the commonest clinical manifestation of coronary heart disease in the community, but little information is available concerning its contemporary clinical management. The aim of this study is to assess the extent of gender differences in the clinical management of angina pectoris in primary care. METHODS: A cross-sectional survey undertaken in 8 sentinel centres serving 63,724 individuals in the city of Liverpool (15% of the city population). Aspects of clinical care assessed included: risk factor recording (smoking, cholesterol, blood pressure, body mass index); secondary prevention (aspirin, beta-blocker, statin); cardiac investigation (exercise ECG, perfusion scanning, angiography); and revascularisation (percutaneous coronary intervention, coronary artery bypass grafting). Male-to-female adjusted odds ratios (AOR) were calculated (adjusted for age, angina duration, age at diagnosis and previous MI) using logistic regression. RESULTS: 1,162 patients (610 men; 552 women) with angina were identified. Women were older than men (71 vs 67 years), with a shorter duration of angina (6 vs 7 years), and a lower prevalence of previous MI (25% vs 43%). Men were significantly more likely than women to undergo detailed risk factor assessment (AOR = 1.35, 95%CI 1.06 to 1.73); receive 'triple' secondary prevention with aspirin, beta-blockers and statins (AOR = 1.47, 95%CI 1.07 to 2.02); access exercise ECG testing (AOR = 1.31, 95%CI 1.02 to 1.68); angiography (AOR = 1.61, 95%CI 1.23 to 2.12); and undergo coronary revascularisation (AOR = 1.93, 95%CI 1.39 to 2.68). CONCLUSION: Systematic gender differences exist in the comprehensive clinical management of patients with angina in primary care.

Howse II cemented titanium metal-backed acetabular cups: poor 10-year results in 107 hips.

We report a retrospective clinical and radiographic review of 107 consecutive primary total hip replacements, using the cemented Howse II prosthesis. The review concentrates on the long-term performance of the acetabular cup, which was designed with a cylindrical titanium metal backing and a polyethylene liner. In all the hips in the series, this cup was used with a modular titanium straight femoral stem and a 32-mm diameter titanium head. At a mean follow-up of 9.8 (7-11) years, 28 hips had already been revised and 10 others were recognized as clinical or radiographic failures. The indication for revision in 26 of the hips was aseptic loosening and the mean time to revision was 7.2 (3.7-10.9) years This metal-backed cup has only 42% survival at 10 years, which seems to be related to certain of its design features. These include an inadequate thickness of polyethylene sterilized by gamma irradiation in air, a lack of mechanical bonding between the liner and its metal shell, and the high wear rate from the use of a 32-mm titanium femoral head.