The relationships among age, chronic conditions, and healthcare costs.
OBJECTIVE: To learn how age and chronic illness affect costs in the Veterans Affairs healthcare system. STUDY DESIGN: Veterans Affairs patients 65 years or older were identified from administrative data. We noted their healthcare utilization, cost, and diagnosis of any of 29 common chronic conditions (CCs). We examined how those 80 years or older differed from the younger patients. RESULTS: The Department of Veterans Affairs spent dollars 8.5 billion to treat 1.6 million older patients in fiscal year 2000. Age was less important than chronic illness in explaining cost differences. The oldest patients incurred a mean of dollars 1295 greater costs than the younger patients, primarily because they were more likely to have a high-cost CC. The oldest patients incurred higher total costs than the younger patients in only 14 of 29 groups defined by CC. Long-term care accounted for most of the extra cost of the oldest patients. When this cost was excluded, the oldest patients incurred only dollars 266 more cost than the younger patients. CONCLUSIONS: Growth in the population of the oldest patients will increase the number of individuals with CCs requiring long-term care. With its limited long-term care benefit, Medicare will avoid much of this financial consequence. In contrast, the financial risk of acute and long-term care gives the Department of Veterans Affairs an incentive to develop strategies to prevent CCs associated with long-term care. (+info)
Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during World War II.
Melioidosis, an infection caused by the gram-negative bacillus Burkholderia pseudomallei, is endemic to Southeast Asia and Northern Australia. Human infection is acquired through contact with contaminated water via percutaneous inoculation. Clinical manifestations range from skin and soft tissue infection to pneumonia with sepsis. We report a case of a man who was taken as a prisoner of war by the Japanese during World War II who presented with a nonhealing ulcer on his right hand 62 years after the initial exposure. (+info)
The mobile Army surgical hospital (MASH): a military and surgical legacy.
Operation Iraqi Freedom was perhaps the last military campaign that will ever utilize the services of a mobile Army surgical hospital (MASH). The Army has now essentially replaced the MASH with combat surgical hospitals (CSH) and forward surgical teams (FST). MASH units were designed as mobile, flexible, forward-deployed military hospitals, providing care for the wounded near the frontlines of the battlefield. These hospitals not only saved thousands of lives during war but also greatly influenced the delivery of trauma and critical care in civilian hospitals. The MASH was made popular by the television series of the 1970s, depicting the 4077th during the Korean War. Although a comical series, these television episodes provided viewers with a glimpse of life in a MASH during time of war. This article chronicles the history of the MASH from its inception during World War II to recent experiences in Operation Iraqi Freedom. (+info)
They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment.
During World War II, 36 conscientious objectors participated in a study of human starvation conducted by Ancel Keys and his colleagues at the University of Minnesota. The Minnesota Starvation Experiment, as it was later known, was a grueling study meant to gain insight into the physical and psychologic effects of semistarvation and the problem of refeeding civilians who had been starved during the war. During the experiment, the participants were subjected to semistarvation in which most lost >25% of their weight, and many experienced anemia, fatigue, apathy, extreme weakness, irritability, neurological deficits, and lower extremity edema. In 2003-2004, 18 of the original 36 participants were still alive and were interviewed. Many came from the Historic Peace Churches (Mennonite, Brethren, and Quaker), and all expressed strong convictions about nonviolence and wanting to make a meaningful contribution during the war. Despite ethical issues about subjecting healthy humans to starvation, the men interviewed were unanimous in saying that they would do it all over again, even after knowing the suffering that they had experienced. After the experiment ended, many of the participants went on to rebuilding war-torn Europe, working in the ministries, diplomatic careers, and other activities related to nonviolence. (+info)
The history of the College of Medicine and Tan Teck Guan Buildings.
For 60 years from 1926, the College of Medicine Building (COMB) was the centre of medical education in Singapore. The history of medical services and medical education is intimately intertwined, with the history of the COMB and the Tan Teck Guan Building. This article reviews the history of the 2 buildings. (+info)
The history of surgical teaching and the department of surgery.
Undergraduate surgical teaching in Singapore began 100 years ago, when the Medical School was founded. A significant step had been taken to enable local students to be trained in and to attain the diploma of Licentiate in Medicine and Surgery (LMS). Plans for postgraduate education were temporarily derailed when the Japanese occupied Singapore in 1942. Postgraduate surgical teaching received an official boost when the primary Australasian examinations were conducted in Singapore in 1957, providing a platform for surgical independence when the higher degree, the Master of Medicine (M Med) in Surgery, was established in 1970. Currently, the Joint Committee on Specialist Training, comprising the Division of Graduate Medical Studies, the Academy of Medicine, Singapore and the Ministry of Health, oversees the training of surgical specialists in Singapore. (+info)
The Oxford Biochemistry Department in wartime, 1939-45.
The work done in the Department of Biochemistry in Oxford during World War II is recounted. Reference is made to the research on burns, nutrition and malaria, but it is mainly concerned with the search for antidotes to mustard gas and lewisite. The discovery of a successful antidote to lewisite is described in some detail. (+info)