Reducing healthcare costs

Dr. Viraj Peramuna

With the Government is facing an ever increasing healthcare budget and the economic experts looking into the possibility of reducing it even marginally in any areas of expenditure which will not seriously affect the services provided to the people, I like to focus attention of the Health authorities through the HealthWatch to a study done in the United States where cost-effective healthcare procedure had been found feasible through an-immuno-nutrition supplement procedure on patients to accelerate their recover, whereby reducing their hospital stay, thus cutting down on healthcare cost to the hospital.

In this IMPACT research done on 200 patients an approximate saving of $ 300,000 to the hospital had been made on an investment of $ 35,000 on the programme.

Here's the study in detail in a document Economic outcomes of specialized Nutrition, Infection protection the surgical and critical care published by Novartis for the medical profession.

Many medical intensive care unit patients experience hospital-acquired infections

.In 1995, the CDC found that the nosocomial infection rate in the U.S. was 5.28 infections per 100 patients.

.The infection rate among Intensive Care Unit (ICU) patients exceeds 19 infections per 100 patients.

. Medical ICU patients may be admitted to the ICU because of a septic event. Among tube-fed septic patients, the infection rate can be much higher. One study showed an infection rate of 64.8 infections per 100 patients.

Infections increase pain, suffering, hospital length of stay and the risk of dead

. Infections add stress, pain and suffering for patients as they recover, undergo treatments and procedures, and work to return to daily activity. Infections can even lead to functional disabilities that significantly reduce quality of life.

Patients who develop an infection while in the ICU stay in the ICU about five times longer than uninfected patients. This translates to about 16 extra days.

.Total hospital length of stay is also longer for patients who develop infections than for those who do not, especially if more than one infection develops.

. The risk of death increases up to 4-fold when a patient develops an infection. In fact, hospital-acquired infections kill 90,000 patients each year in the US.

. Infected patients use significantly more microbiology, radiology, pharmacy and room resources than in infected patients.

. These extra resources cost between $ 12,000 and $ 15,000 per infection.

. Scarce resources are being diverted away from other needs and used to cover the costs of these potentially preventable conditions.

Nosocomial infections remain problematic despite advances in infection prevention, diagnosis and treatment

. Hospitals currently control infections through prevention, effective diagnosis and treatment, optimal antibiotic utilization, and the prevention of transmission.

. Despite these strategies not all infections are prevented.

In fact, the US hospital-acquired infection rate remained stable in the two decades between 1975 and 1995.

. This observed stability may be due to a balance between headway made through new interventions and progress lost through the emergence of antibiotic-resistant bacteria.

By Preventing Infection, IMPACT could help prevent life-threatening conditions

. Infection can progress to more severe conditions, such as sepsis, severe sepsis, and multiple organ dysfunction syndrome (MODS), which can lead to death. The early use of IMPACT in appropriate patient populations can help prevent infection and subsequent more serious conditions.

Early use of IMPACT may help prevent the infection cascade

Cost-effective care

The benefits of using IMPACT translate to per-patient cost savings, even after factoring in the cost of IMPACT.

. By reducing the number of hospital-acquired infections, IMPACT reduces length of stay, the use of antibiotics, and the number of ventilator days required. Shorter length of stay increases the rate of bed turnover, allowing a hospital to treat more patients.

. In hospitals with an infection rate of 40% among medical ICU patients the use of IMPACT yields cost savings of about $11,500 per hospitalization, even after accounting for the $175 cost of supplying IMPACT.

. In fact, IMPACT pays for itself among medical ICU patients as long as the initial infection rate is greater than 0.6%

IMPACT can yield cost savings for hospitals and healthcare organisations

. With a cost savings of $11,500 per hospitalization, a hospital that administers IMPACT to 200 medical ICU patients could save over $2.3 million after an investment of only $35,000 in IMPACT products.

. In fact, IMPACT pays for itself in reduce use of pharmaceutical alone. If the infection rate among medical ICU patients is 40%, the number needed to treat with IMPACT to prevent one infection is about five.

The cost to supply IMPACT to five ICU patients and prevent one infection is $875.

Medications, including antibiotics, to treat one infection cost $10,949.

My experience with a centenarian

HEALTHY LIFE: He is there, on his favourite chair, looking at the horizon deep in thought. He has seen a lot happen in his life for hundred years now, and is definitely ready for some more years to come.

Meeting D. L. Senevirathne was a unique experience for me. Talking to him and getting to know him was even better.

Born in Malaysia (previously Malaya), in a family of six, he was the fourth member. He had done his schooling in Malaya where he had actively participated in sports, soccer being one of his favourites.

After coming back to his motherland later, with hard work, he became a well established man in Sri Lanka, as well as a man who was well loved by all relations and neighbours. On first look, Mr. Senevirathne looks healthy, happy and content. Any gross disability doesn't seem to have crippled his life.

Apart from the minor ailments which are part and parcel of life due to wear and tear of the body, he leads a life of very good quality. One of the best features of his life, is that he never had any disease such as diabetes, mellitus, hypertension (high blood pressure) or hypercholesterolaemia (increased cholesterol levels in the blood).

All these tests had been done on him a week before our meeting and all the results were within normal ranges. This was a significant finding since most of the people living today get at least one of these entities midway through life.

On our visit we also measured his blood pressure and further examined his cardiovascular and respiratory systems which revealed normal findings.

Mr. Senevirathne still recalls his important events of life with relative ease. It seems he hasn't lost his memory at all.

He is also well equipped with the knowledge of recent events in the local and international scene. He still remembers the day he met his wife and what qualities he liked in her. Thus the recent as well as the distant memory seems to be sound. Although a formal test on memory could not be done in the circumstances, with our basic findings, it could be concluded that he had an outstanding memory.

Mr. Senevirathne also has good attention and concentration. He still can do moderately complex arithmetic calculations in his mind. Although a scientific test on intelligence wasn't carried out, the conversation we had with him definitely revealed that his intelligence was of high level. Thus we could conclude that his cognitive functions were good, with just mild deterioration which was compatible with age.

A healthy life can be defined as a life which is enriched in all mental, physical and social aspects. Mr. Senevirathne seems to have made tremendous achievements, in all these aspects in life.

So, what are the positives that we can take from a person like this who has lived a century, to enrich our lives? On inquiry, we found out that physical exercise has been a regular feature of his routine day to day activities. He had walked at least one kilometre per day till his late eighties.

He also has actively participated in activities such as gardening, Shramadana campaigns. Religion also had been part and parcel of his life.

Mr. Senevirathne also has been a happy man, content with what he has got in life, with good interpersonal relationships. He has had a good family life and had brought up all his children up well. He not only taught them life skills, and gave them the right education, but also gave insight of how to live in this society as respectable individuals.

He has won hearts of many people, who even remember him today with gratitude. Today a lot of people are found to be not content with life. However factors such as good coping skills and certain personality traits may contribute towards longevity as demonstrated by Mr. D. L. Senevirathne's life.

On conclusion I would like to give the message which he gave for the future generation in this country. I felt that it summed up almost everything that anybody needs to know about leading a happy and content life, leading to longevity. As usual, it was simple and clear cut as most events in his life. It was, "love all".

Kelum Pelpola, Final Year Medical Student, Faculty of Medicine, Colombo.

Serious side of play and laughter

Play and laughter are not only fun and games, but also important factors that bring balance to an optimal wellness equation, it's important to understand the positive impact they have on our health. It is important for us to explore and experience the healthful and healing benefits of play and laughter.

The 'Health and Humour Journal' reported that there is scientific laboratory evidence, not speculator ideas, that the skeletal muscular system and the central nervous, respiratory, cardiovascular, immune and endocrine systems are responsive and active during the response of mirthful laughter.

The therapeutic value of humour and a few good side-slapping guffaws can help to increase blood oxygen levels, clear mucus, make us more alert and give our memory a boost. In other words, a laugh a day may keep the doctor away. Here are some other findings that may give you reasons to do something that tickles your funny bone today:

*Even though your blood pressure actually rises when you laugh heartily, afterward it gets lower.

*Laughter lowers levels of epinephrine (which is also called adrenaline), a hormone that responds to mental or physical stress. Lower levels of epinephrine can reduce blood pressure and help alleviate other cardio-vascular problems.

*A good laugh lowers secretions of the stress hormone called cortisol. Reduced cortisol levels helps the immune system to produce greater numbers of beneficial white blood cells and to function more normally.

*There are eighteen different smiles. The most revealing is the smile of enjoyment.

*When we look forward to going somewhere or doing something that makes us laugh, we have a physical phenomenon called an anticipatory response.

This is considered positive stress that results in healthier hormonal response.

Laughter expands the capillaries in our face. That's why we get such a cheery glow when we're having a real good time.

*The brain activity that stimulates laughter takes place in different lobes and it enhances alertness and memory.

*The term 'Fits of Laughter' is appropriate because we actually lose muscle control when we laugh long and hard.

*When it comes to stress-busting, fifteen minutes of hees and haws offer benefits similar to six to eight hours of Buddhist meditation.

Fun and games helps

* Cement social bonds

* Acts as a rehearsal for adulthood

* Prepare for unexpected situations

* Helps one become 'Cosmopolitan'

* Helps restrain aggressive impulses

* Teaches negotiation

* Develops the ability to gauge the intentions of others

(An extract from Vitality & Wellness)

Anti-cancer effect of aspirin

SUITABLE TREATMENT: Previous research has shown a possible anti-cancer effect for aspirin.

Now, new findings suggest that the drug achieves this by cutting off the tumor's blood supply, not just by blocking an enzyme called cyclooxygenase. While aspirin may not represent a suitable treatment for cancer, since many of the effects are only seen at very high doses, understanding how the drug works may lead to new therapies.

"Our work," senior investigator Dr. Helen M. Arthur told Reuters Health, "shows that the protective effects of aspirin against cancer may be partly due to the ability of aspirin to restrict the blood supply to a developing tumor, which limits tumor growth."

To investigate underlying processes, Arthur, from the University of Newcastle in the UK, and colleagues exposed blood vessel cells to aspirin or to drugs like Celebrex (celecoxib), which block various forms of cyclooxygenase.

In the Federation of American Societies for Experimental Biology (FASEB) Journal, the researchers report that aspirin, at doses well above what is typically used for pain control, caused death of the blood vessel cells.

At standard doses, aspirin did not affect the cells, but seemed to disrupt the surrounding proteins that provide a support structure for blood vessels.

Celebrex and the other drugs, which largely target just cyclooxygenase, did not show these effects.

"The next stage in this research is to discover the mechanism by which aspirin can do this, which will also help us to identify new drug targets to treat cancer," Arthur concluded.

NEW YORK (Reuters)