Nurses are an important part of the medical workforce. They provide crucial supplementary services and are primary caregivers in a lot of industries. As such, the demand for nurses is high, though there are variations according to different states. As the country’s population and access to medicine continues to grow, the demand for nurses does as well.
Written by James McIntosh
While violence intervention programs have demonstrated that they can be an effective way of preventing violent injury, little has been known about their financial implications. A new study now suggests that these interventions could save various sectors millions of dollars.
Researchers from Drexel University have analyzed the cost-benefit ratio of hospital-based violence intervention programs (HVIPs) and report that - as well as benefiting victims' lives - HVIPs can make costs savings of up to $4 million over a 5-year period in the health care and criminal justice sectors.
"This is the first systematic economic evaluation of a hospital-based violence intervention program, and it's done in a way that can be replicated as new evidence emerges about the programs' impacts across different sectors," states lead author Dr. Jonathan Purtle.
As a major cause of disability, premature mortality and other health problems worldwide, HVIPs have a crucial role to play in helping victims from experiencing further suffering.
The provision of case-management and counseling from combinations of medical professionals and social workers has been associated with not only reducing rates of aggressive behavior and violent re-injury but also improving education, employment and health care utilization for service users.
Many HVIPs still require a sustainable source of funding
Intervention typically begins in the period immediately after a violent injury has been sustained. Not only is this a critical moment in terms of physical health, but it can also be a time when victims may start thinking about retaliation or making changes in their lives.
"The research literature has poetically referred to the time after a traumatic injury as the 'golden hour,'" says study co-author Dr. Ted Corbin.
In 2009, around six programs were in operation and, as word of their success has spread, more and more HVIPs have been initiated.
Calculating the potential financial benefits of HVIPs is crucial, as for many of these programs a stable and sustainable source of funding does not exist. Instead, many rely on a variety of different financial sources such as insurance billing, institutional funding, local government funding and private grants.
For the study, published in the American Journal of Preventive Medicine, the researchers conducted a cost-benefit analysis simulation in order to estimate what savings an HVIP could make over 5 years in a hypothetical population of 180 violently injured patients. Of these, 90 would receive HVIP intervention and 90 would not.
Costs, rates of violent re-injury and violent perpetration incidents that a population would be estimated to experience were calculated by the authors using data from 2012.
The authors made a comparison between the estimated costs of outcomes that would most likely be experienced by the 90 hypothetical patients receiving HVIP intervention - including $350,000 per year costs of the HVIP itself - and the costs of outcomes predicted for 90 patients not receiving any HVIP intervention.
The net benefit of the interventions
A total of four different simulation models were constructed by the researchers to estimate net savings and cost-benefit ratios, and three different estimates of HVIP effect size were used.
Costs that were factored into the simulations included health care costs for re-injury, costs to the criminal justice system if the victims then became perpetrators and societal costs for potential loss of productivity.
Each simulation calculated that HVIPs produced cost savings over the course of 5 years. The simulation model that only included future health costs for the 90 individuals and their potential re-injury produced savings of $82,765. The simulation model including all costs incurred demonstrated savings of over $4 million.
Dr. Purtle acknowledges that estimated lost productivity costs may have been slightly high due to an assumption in their data that all individuals in the simulation were employed. However, he believes that there are also many social benefits to HVIPs that cannot be financially quantifiable:
"Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented."
The authors believe that the findings of their study could be useful in informing public policy decisions. By demonstrating that HVIPs can be financially beneficial, the study suggests that an investment in HVIPs is one that pays off for everyone concerned.
6. …but people still expect them to show up the second they ring the call bell.
7. Sometimes they’re working so hard, they can go entire shifts without eating, drinking water, or sitting.
Lunch break? What’s that?
8. Ditto going to the bathroom.
9. Some patients will incessantly hit on them.
10. Others will expose themselves for no clear medical reason.
“Your arm is broken… so why is your dick out?”
By SYDNEY LUPKIN
Seattle Children's Hospital hallways erupted in cheers and applause this weekend as the Seattle Seahawks played a nail-biter of a game against the Green Bay Packers and officially locked down their spot in Super Bowl XLIX.
And 8-year-old Maria Moore's room was no exception. The recovering leukemia patient watched the game while wearing her Seahawks hat and clutching her signed football. On the table next to her, she propped up a photo of herself with Seahawks quarterback Russell Wilson, who visited her at the hospital in November.
At one point, Maria was so bummed that her team appeared to be losing, she shed a little tear, her dad told ABC News. He told her not to worry, that Wilson and the Seahawks would come back. And they did.
"We were just totally shouting and applauding and hollering and giving high fives to each other," Thomas Moore told ABC News. "It was an amazing gave to watch. She was super excited."
Marie was diagnosed with acute lymphoblastic leukemia in September and initially didn't respond to chemotherapy, but the doctors at Seattle Children's and Fred Hutchinson Cancer Research Center helped get her treatment "recipe" just right, he said. Marie underwent a cord blood transplant on Jan. 2, and is in remission, but should be at the hospital a few more weeks, he said.
"We’ll probably be watching [the Super Bowl] from the hospital, but that's OK," he said. "As long as she's doing well, that’s fine by me."
Nearly every Tuesday, the team's star quarterback, Russell Wilson, visits Seattle Children's Hospital to meet with patients, said hospital spokeswoman Kathryn Bluher. So the team holds an extra special place in the hearts of patients and their families.
Wilson visited Maria the day after flying back from an East Coast game in November, and she was "all smiles," Moore said.
"It makes a bigger fan out of me. I really can't say enough," Moore said. "[Wilson] is a down to earth, really nice guy. He takes time talk to the kids, do pictures, sign some things."
After Sunday's win, patients at Seattle Children's Hospital took photos with "Congratulations" signs from their hospital beds to show their support.
"It takes their mind of things," Moore said. "It gives them something fun to think about."
By LIZ NEPORENT
Cathy Nichols and son Jason were front and center at the National Football League playoff game last Sunday to witness her beloved New England Patriots clinch a spot in this year’s Super Bowl.
The Fayette, Maine, resident, 59, had been diagnosed with terminal cancer just two days before the big game. She said it was the support of a close-knit community, and the generosity of the Patriots, that brought her to what she believed will be the last football game she will attend.
“My son and I are super fans and when I got the diagnosis, I told him we probably weren’t going to get to go to many more games,” Nichols told ABC News today. “Now, not only did I get to see them play, but I was at a playoff game; it was just unbelievable.”
Nichols’ worship of Tom Brady and all things Patriots is well known at Spruce Mountain High School in Jay, Maine, where she works as a special education teacher. So when she confided in several work friends about her illness, they immediately contacted a local sportscaster, who, in turn, reached out to the Patriots.
By Friday night, a team representative had called Nichols to offer her two tickets in the owner’s box to the playoff game.
Despite her rollercoaster of a week, Nichols said she was touched by the outpouring from friends and strangers alike.
“It isn't just the tickets, they’re doing fund-raisers and I’m getting calls from students and athletes I coached more than 25 years ago,” the former cheerleader coach said.
At Sunday’s game she not only had the best seats in the house, she was given field passes so she could watch the pregame warm-ups. Team owner Robert Kraft even called down to the field to make sure she was having a good time, before she returned to the box.
Nichols said she knows an invite to the Super Bowl was in the works but she put a stop to it. Doctors believe the disease may have already spread from her pancreases to her liver, she said, and she may only have six months to live. She doesn't feel strong enough to make the trip to Arizona for the February game.
But Nichols said she isn't bitter. Far from it.
“I am a very fortunate woman to have all this support and it makes me determined to be here as long as I can,” she said. “But I've lived a good life and I want to focus on quality of life over quantity.”
Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat.
Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."
During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness.
"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"
Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.
A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.
For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder.
On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."
Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves.
"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."
Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed.
Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.
Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him.
"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."
By Dan Kedmey
General Electric released images on Wednesday from its first clinical trial of a next generation body scanner that captures bones, blood vessels and organs in high-definition.
The patients ride into the chamber of the scanner, dubbed “Revolution CT,” where a fan-shaped beam of x rays passes down their bodies and a computer reconstructs a digital model of the body, slice-by-slice. The scanner can build an image of a heart in the time it takes for a single heartbeat, according to GE.
The snapshots below, provided by GE, may look like an artist’s rendering from an anatomy textbook. In fact, they were taken from living patients at West Kendall Baptist Hospital in south Florida, the first hospital to test the new scanner in the field.
By SYDNEY LUPKIN
A court will determine whether a 17-year-old girl, under something called the "mature minor doctrine," can be forced to undergo chemotherapy after she refused treatment for her cancer.
How do you feel about this?
The case will go to the Connecticut Supreme court this week to determine whether the teen, identified in court papers as Cassandra, has "the fundamental right to have a say about what goes on with your [her] body," attorney Michael Taylor, who represents the teen's mother, told ABC News. Taylor was appointed by the public defender's office, and Cassandra has her own court-appointed lawyer, but they've filed joint appeals.
Cassandra was diagnosed with Hodgkin's lymphoma in September, but decided she didn't want to complete the prescribed treatment, according to a court summary. Her mother supported this decision, but the Department of Children and Families stepped in and ordered her mother to comply with the doctor's treatment recommendation.
"It's really for all the reasons you might imagine," said Taylor, adding that he couldn't go into more detail.
Although chemotherapy is a drug that destroys cancer cells, its side effects include hair loss, nausea, pain and fertility changes, according to the National Cancer Institute.
Cassandra underwent two chemotherapy treatments in November and then ran away from home and refused to continue treatments, according to the court summary.
A court hearing ensued in which Cassandra's doctors testified, and she was removed from her mother's home and placed in state custody so that the state could make medical decisions for her.
She has been has been living at Connecticut Children's Medical Center and forced to undergo chemotherapy for about three weeks.
The Hartford Courant reported that Cassandra has an 80 to 85 percent chance of surviving her cancer if she continues with her chemotherapy.
The state Department of Children and Families issued the following statement:
"When experts -- such as the several physicians involved in this case -- tell us with certainty that a child will die as a result of leaving a decision up to a parent, then the Department has a responsibility to take action. Even if the decision might result in criticism, we have an obligation to protect the life of the child when there is consensus among the medical experts that action is required. Much of the improvements in Connecticut's child welfare system have come from working with families voluntarily to realize solutions to family challenges. Unfortunately that can't happen in every situation, especially when the life of a child is at stake."
"No one is disputing that it's very serious," Taylor said. He said there's "a good chance" Cassandra could survive her cancer with treatment, and "there's a good chance she could die if she doesn't. None of us disagree about that."
Taylor said they're trying to argue that because Cassandra is competent, she should be allowed to make this decision for herself through something called the "mature minor doctrine," which has been adopted in Illinois and a few other states but rejected in Texas. The doctrine holds that some children are mature enough to make key life decisions for themselves.
By MELENA RYZIK
Artists, it’s fair to say, usually don’t know much about bacteria. Vik Muniz is an exception. Mr. Muniz, the Brazilian-born photographer known for his unorthodox materials, has been working with the M.I.T. bioengineer and designer Tal Danino on a series of trompe l’oeil images of microscopic organisms: cancer cells, healthy cells and bacteria.
At first glance, they look like ornate and colorful patterns. In reality, they represent teeming, living things. Among his latest: a pink print that could pass for floral wallpaper. But it’s made up of liver cells infected with the Vaccinia virus, which is used to make the smallpox vaccine.
“Normally, patterns are soothing structures,” Mr. Muniz said, “and all of a sudden, there’s a lot of drama.”
The work now has another meaning. It will be used in a new online campaign, The Art of Saving a Life, sponsored by the Bill & Melinda Gates Foundation. The intent is to promote vaccination just in time for an international effort to raise funds to inoculate millions, especially in poor nations.
The campaign, to be released online on Wednesday, is the first time that the foundation has commissioned artists in the service of a cause. The global roster includes photographers (Annie Leibovitz, Sebastião Salgado, Mary Ellen Mark); writers (Chimamanda Ngozi Adichie); filmmakers (Luc Jacquet, director of the documentary “March of the Penguins”); and bands (Playing for Change).
The intent is that their work will spread virally — in the digital sense — and be shared on social media with the hashtag #VaccinesWork to inspire a dialogue and donations.
“We want to get the buzz and the conversation going, because it’s easy to take these important lifesaving tools for granted,” said Dr. Christopher Elias, president of the global development program at the Gates Foundation. Art, the foundation hopes, will serve as a reminder to people “who aren’t going to read the editorial in Science,” Dr. Elias said. If the program is successful, he said, it could serve as a model for other Gates Foundation projects.
The idea came from Christine McNab, a consultant to the foundation. In brainstorming new ways to promote vaccines, she considered “what makes me cry, what makes me think,” she said. “It’s films, it’s books, it’s galleries.”
Ms. McNab and her team invited the artists in and suggested which diseases or issues to address. But they had no control over what was created. Some artists were paid a small fee to cover expenses; some retained their copyright, and others donated their work.
Ms. Leibovitz snapped a black-and-white portrait of people involved in vaccine development. Fatoumata Diabaté, a photographer from Mali, captured the last phase of trials for an Ebola vaccine. The German painter Thomas Ganter paid tribute to the little-sung medical aides who administer the shots, with his oil on canvas of “The Unknown Health Worker.”
The project is timed to lead up to a Jan. 27 meeting of Gavi, the Vaccine Alliance, an international public-private partnership in Berlin. Some images will be displayed at the conference, which aims to raise $ 7.5 billion from donors for Gavi’s next phase of development. Separately, the Gates Foundation has funded many immunization-related grants, at a cost of millions — far greater, a spokeswoman said, than the budget for the art initiative, which she would not disclose.
As the project developed in the last year, the anti-vaccination movement, in the United States and other Western countries, only gained steam. Though the programs that the Art of Saving a Life supports are targeted elsewhere, “in some ways what we’re hoping for is not just a broader debate about vaccination and immunization, but a more informed debate,” Dr. Elias said.
Countering the anti-vaccination rhetoric was part of the reason that Alexia Sinclair, a photographer from Australia, participated, she said. “I have a young daughter, and it’s quite a hot topic here,” she said, adding that she thought that producing a work of art “allows the conversation to happen in a clearer way.”
After learning that the Chinese characters for smallpox mean “heavenly flowers” — because the pustules bloom on the body, and the sufferers eventually die — Ms. Sinclair, who makes historically-inspired tableaus, created a scene of an 18th-century doctor administering a vaccination, surrounded by grass and blossoms. It brings a fashion-y aesthetic to an ugly disease. “I wanted to create something that looked at smallpox, but did it in a way that didn’t repulse people,” she said.
In an era when viewers are image-saturated, the campaign’s success, and how to measure it, are an open question. “We’ll look at the metrics,” Dr. Elias said. But, he added, the project has already proved valuable inside the Gates Foundation, as a new perspective on old problems.
“The phenomenal response” from artists, he said, “suggests that we have tapped a set of interests and voices that we perhaps should’ve been paying attention to sooner.”
By Carolyn Gregoire
Having a family pet can be beneficial for child development in a number of ways, including keeping kids active and promoting empathy, self-esteem and a sense of responsibility. But dogs may be particularly beneficial for kids with autism, acting as a "social lubricant" that helps them build assertiveness and confidence in their interactions with others, according to new research from the University of Missouri.
The researchers surveyed 70 families with autistic children between the ages of eight and 18, all of whom were patients at the MU Thompson Center for Autism and Neurodevelopmental Disorders. Nearly 70 percent of the participating families had dogs, half had cats, and some owned other pets including fish, rodents, rabbits, reptiles and birds.
The study's lead author Gretchen Carlisle, a research fellow at the University of Missouri, observed that autistic children are were likely to engage socially in social situations where pets were present. While previous research has focused specially on the ways that dogs benefit the development of autistic children, Carlisle found that pets of any type were beneficial for the childrens' social skills.
"When I compared the social skills of children with autism who lived with dogs to those who did not, the children with dogs appeared to have greater social skills," Carlisle said in a statement. "More significantly, however, the data revealed that children with any kind of pet in the home reported being more likely to engage in behaviors such as introducing themselves, asking for information or responding to other people's questions. These kinds of social skills typically are difficult for kids with autism, but this study showed children's assertiveness was greater if they lived with a pet."
Carlisle observed the strongest attachments between the children and small dogs, although parents also reported strong attachments between their children and other pets, such as cats and rabbits.
“Dogs are good for some kids with autism but might not be the best option for every child,” Carlisle said. “Kids with autism are highly individual and unique, so some other animals may provide just as much benefit as dogs. Though parents may assume having dogs are best to help their children, my data show greater social skills for children with autism who live in homes with any type of pet.”
Carlisle's research joins a body of work demonstrating the benefits of animal interaction among autistic children. A 2013 review of studies found that specially trained dogs, horses and other animals can facilitate increased social interaction and improved communication among autistic children, as well as decreased stress and problem behavior.