DiversityNursing Blog

Written by James McIntosh

While many would rather not think about when someone might die, knowing how much longer a seriously ill person has left to live can be very useful for managing how they spend their final days. Researchers have now revealed eight signs in patients with advanced cancer associated with death within 3 days.

Diagnosis of an impending death can help clinicians, patients and their friends and family to make important decisions. Doctors can spare time and resources by stopping daily bloodwork and medication that will not make a short-term difference. Families will know if they still have time to visit their relatives.

"This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life," says study author Dr. David Hui.

"Upon further confirmation of the usefulness of these 'tell-tale' signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life."

The study, published in Cancer, follows on from the Investigating the Process of Dying Study - a longitudinal observational study that documented the clinical signs of patients admitted to an acute palliative care unit (APCU). During the study, the researchers identified five signs that were highly predictive of an impending death within 3 days.

For the new study, the researchers again observed the physical changes in cancer patients admitted to two APCUs - at the MD Anderson Cancer Center in Houston, TX, and the Barretos Cancer Hospital in Brazil.

Eight highly-specific physical signs were identified

A total of 357 cancer patients participated in the study. The researchers observed them and documented 52 physical signs every 12 hours following their admission to the APCUs. The patients were observed until they died or were discharged from the hospitals, with 57% dying during the study.

The researchers found eight highly-specific physical signs identifiable at the bedside that strongly suggested that a patient would die within the following 3 days if they were present. The signs identified were:

• Decreased response to verbal stimuli
• Decreased response to visual stimuli
• Drooping of "smile lines"
• Grunting of vocal cords
• Hyperextension of neck
• Inability to close eyelids
• Non-reactive pupils
• Upper gastrointestinal bleeding.

With the exception of upper gastrointestinal bleeding, all of these signs are related to deterioration in neurocognitive and neuromuscular function.

Neurological decline strongly associated with death

"The high specificity suggests that few patients who did not die within 3 days were observed to have these signs," the authors write. "These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process."

As the study is limited by only examining cancer patients admitted to APCUs, it is not known whether these findings will apply to patients with different types of illness. The findings are currently being evaluated in other clinical settings such as inpatient hospices.

On account of the relatively small number of patients observed for this study, the authors also suggest that their findings should be regarded as preliminary until validated by further research.

In the meantime, the authors of the study are working to develop a diagnostic tool to assist clinical decision-making and educational materials for both health care professionals and patients' families.

"Upon further validation, the presence of these telltale signs would suggest that patients [...] are actively dying," they conclude. "Taken together with the five physical signs identified earlier, these objective bedside signs may assist clinicians, family members, and researchers in recognizing when the patient has entered the final days of life."

Source: www.medicalnewstoday.com

Eve, an artificially-intelligent 'robot scientist' could make drug discovery faster and much cheaper, say researchers writing in the Royal Society journal Interface. The team has demonstrated the success of the approach as Eve discovered that a compound shown to have anti-cancer properties might also be used in the fight against malaria.

Robot scientists are a natural extension of the trend of increased involvement of automation in science. They can automatically develop and test hypotheses to explain observations, run experiments using laboratory robotics, interpret the results to amend their hypotheses, and then repeat the cycle, automating high-throughput hypothesis-led research. Robot scientists are also well suited to recording scientific knowledge: as the experiments are conceived and executed automatically by computer, it is possible to completely capture and digitally curate all aspects of the scientific process.

In 2009, Adam, a robot scientist developed by researchers at the Universities of Aberystwyth and Cambridge, became the first machine to independently discover new scientific knowledge. The same team has now developed Eve, based at the University of Manchester, whose purpose is to speed up the drug discovery process and make it more economical. In the study published today, they describe how the robot can help identify promising new drug candidates for malaria and neglected tropical diseases such as African sleeping sickness and Chagas' disease.

"Neglected tropical diseases are a scourge of humanity, infecting hundreds of millions of people, and killing millions of people every year," says Professor Steve Oliver from the Cambridge Systems Biology Centre and the Department of Biochemistry at the University of Cambridge. "We know what causes these diseases and that we can, in theory, attack the parasites that cause them using small molecule drugs. But the cost and speed of drug discovery and the economic return make them unattractive to the pharmaceutical industry.

"Eve exploits its artificial intelligence to learn from early successes in her screens and select compounds that have a high probability of being active against the chosen drug target. A smart screening system, based on genetically engineered yeast, is used. This allows Eve to exclude compounds that are toxic to cells and select those that block the action of the parasite protein while leaving any equivalent human protein unscathed. This reduces the costs, uncertainty, and time involved in drug screening, and has the potential to improve the lives of millions of people worldwide."

Eve is designed to automate early-stage drug design. First, she systematically tests each member from a large set of compounds in the standard brute-force way of conventional mass screening. The compounds are screened against assays (tests) designed to be automatically engineered, and can be generated much faster and more cheaply than the bespoke assays that are currently standard. This enables more types of assay to be applied, more efficient use of screening facilities to be made, and thereby increases the probability of a discovery within a given budget.

Eve's robotic system is capable of screening over 10,000 compounds per day. However, while simple to automate, mass screening is still relatively slow and wasteful of resources as every compound in the library is tested. It is also unintelligent, as it makes no use of what is learnt during screening.

To improve this process, Eve selects at random a subset of the library to find compounds that pass the first assay; any 'hits' are re-tested multiple times to reduce the probability of false positives. Taking this set of confirmed hits, Eve uses statistics and machine learning to predict new structures that might score better against the assays. Although she currently does not have the ability to synthesise such compounds, future versions of the robot could potentially incorporate this feature.

Professor Ross King, from the Manchester Institute of Biotechnology at the University of Manchester, says: "Every industry now benefits from automation and science is no exception. Bringing in machine learning to make this process intelligent -- rather than just a 'brute force' approach -- could greatly speed up scientific progress and potentially reap huge rewards."

To test the viability of the approach, the researchers developed assays targeting key molecules from parasites responsible for diseases such as malaria, Chagas' disease and schistosomiasis and tested against these a library of approximately 1,500 clinically approved compounds. Through this, Eve showed that a compound that has previously been investigated as an anti-cancer drug inhibits a key molecule known as DHFR in the malaria parasite. Drugs that inhibit this molecule are currently routinely used to protect against malaria, and are given to over a million children; however, the emergence of strains of parasites resistant to existing drugs means that the search for new drugs is becoming increasingly more urgent.

"Despite extensive efforts, no one has been able to find a new antimalarial that targets DHFR and is able to pass clinical trials," adds Professor King. "Eve's discovery could be even more significant than just demonstrating a new approach to drug discovery."

The research was supported by the Biotechnology & Biological Sciences Research Council and the European Commission.

Source: www.sciencedaily.com

By JEFF SHARLET

The photograph that Markisha McClenton posted on Instagram is a self-portrait, a close-up that is muted in dim light. She might be on her way to work. She might be coming home. Her workdays begin and end in the dark, and they are dark in between. She’s a lab technician in Jacksonville, Fla. Her specialty is blood. She has worked these dark hours since her son was 7. “Freedom,” she told me over the phone from her lab. That’s why she works these hours: The freedom to work at night and to raise her children during the days. To her, this is good fortune. She is smiling in this photo. But her eyes are midnight eyes, 3 a.m. eyes. Why take a photo at that hour? “People forget about us, the night shift,” she said. The #nightshift. That’s the hashtag she used. It’s how I found her.

I’ve been working at night myself for a long time now. Once it was out of choice, a preference for the quiet hours. More recently it was because I had no choice. Insomnia. One night, I was drinking my third cup of coffee — because when you can’t sleep, you might as well stop trying — and ignoring the deadline looming the next morning. Instead, I stared at the matrix on my phone, my own red eyes scanning a tiny sample of some 670,000 photographs under #nightshift. Most of them were people like me, awake when they didn’t want to be awake. And like me, they were looking at the screen in their hands, held up by the one in mine.

Night Life

This is the ghost world of #graveyardshift (#nightshift’s sister hashtag), whose workers file into Instagram every evening. These pictures may be clever or maudlin, silly or harrowing or sad. “Desperate” is a word that comes to mind, but so does “resigned.” And even “resistance.” Sometimes it’s in the form of a gag, a ridiculous pose; sometimes it’s in the form of a gaze so steady that it seems to warm the fluorescent panels framing so many of these pictures. The hashtag itself is a form of solidarity.

There are the warehouse workers who snap themselves letting a wisp of marijuana smoke slip from between their lips, little Instagram rebellions. There are the soldiers and sailors pulling a night shift for no good reason other than orders, photographing themselves and their comrades on the verge of sleep or already under. Cops in noirish black and white, their pictures framed to show a bit of badge. And nurses. A lot of nurses. Close-up, arm’s length, forced smiles, dead eyes. Scroll through #nightshift, and you’ll see some saints among them and some whose hands you hope will be more alive in an emergency than their ashen faces.

The #nightshift hashtag is especially well populated by the armed professions and the healing ones. Sometimes they are almost one and the same, as in the case of @armedmedic3153, a.k.a. Marcelo Aguirre, a paramedic in Newark and suburban New Jersey. He owns an AR-15, a ­9-millimeter­ and a shotgun, but the only thing he shoots on the night shift is his camera. He works nights so he can study days; he wants to be a doctor. Nights are good preparation for that: You get more serious cases. You learn on the job. A 12-hour course each night you’re on. Twenty-four hours if you take a double. After a while, the adrenaline that juices you when you’re new — when you’re still keeping a tally of the lives you’ve saved — disappears. You just do the job. “High speed and low drag,” Aguirre told me when I called. “Please ignore the siren,” he said. “We’re going to a call.” A stroke. Nothing to get excited about. Coffee sustains him. He stays clean. Some guys, he said, use Provigil, but that’s prescribed. “For shift-work disorder,” he said.

Markisha McClenton, the lab tech, told me that she no longer gets sleepy. “I program myself,” she said. She wouldn’t change her schedule now if she could. She likes working alone. There are nurses at the facility where she works, but they don’t often venture back to the lab. “They think it’s creepy,” she said. “At night.” Maybe it is: The long hours of the night shift are a reckoning with time.

“There’s people still struggling like I struggle,” a miner named Mike Tatum told me, explaining why he posts pictures and why he looks at them. “Working through the night, not sleeping next to your wife, missing your kids because they go to school before you get home.” Tatum likes to post pictures of the heavy machines used to dig coal from Wyoming strip mines. He drives a D-11 bulldozer. “I push dirt,” he said. Other machines dig the coal. Twelve hours of ‘dozing, four nights in a row. He came to this job — a good one, $30 an hour or more for as long as the coal lasts — after construction work dried up in California. “Nobody back home has really seen what we do out here,” he said. It’s a good job, he swears. He’s brought his 6-year-old boy out to see the machines. He’d be proud if his kids grew up to be miners. A good job. Rough on the back. But you’re just sitting. Driving the ‘dozer. Nobody bothers you. Hours without a word. “Pretty easy,” he said. Plenty of time to think. To make plans. Things he can do with his days, when he has days.

So far, this is enough to see him through the nights safely. “Quite a few fatalities the past year,” he observed. He heard about a man at another mine who drove a machine into the pit. “Maybe a suicide.” It didn’t seem like an accident; he had to drive through a couple of berms. “Splat,” Tatum said. “And a couple more like that.” He says other guys have died on the road, Highway 59. It’s a long drive out to the mines, and drug testing never stopped anyone from drinking, especially after the shift is over.

Pan out to take in some fraction of the 670,000 faces. Pay attention to the eyes, drooping or unnaturally wide. Is it fatigue? Or something more? Something less? Stay sane, and the night shift may seem like just another set of hours. Lose yourself to the loneliness, and the daylight leaks out of you. But something else can come in. A kind of calm. The kindness of dark hours.

When I was first drawn into this nighttime Insta­gram grid, I was looking for a distraction, for ­images to displace the thoughts that had agitated me to exhaustion. What I found instead was something that seemed descended from Walt Whitman’s “Democratic Vistas,” his great prose poem of an essay that was really a proposal for a new kind of literature, a way of speaking, a way of seeing. We shouldn’t mistake Instagram’s squares for the public one. But neither should we miss the quiet dig­nity afforded by gathering under this hashtag: the solidarity of recognition, of being seen.

“Nightwalkers,” Pierre Bell calls the men and women who find their peace after-hours. He’s new to the night himself, working as a nurse’s aide on the behavior unit at an assisted-living home in Akron, Ohio. “What’s behavior?” I asked. “Combative,” he said. “Lockdown. Spit, kick, hit, bite.” Sounds terrible, I said. It’s not, he told me, especially at night, when the anger subsides, and when the alarm I can hear beeping in the background is an event rather than a constant song. The other aide will get that one. Bell, a 28-year-old father of a 9-month-old, was sitting with the nightwalkers. The strange ones, the restless ones, the story­tellers. “Some were in wars,” he told me. “Some were teachers.” Sometimes they talk for hours. If they’re up, he’s up. It feels to him like a matter of courtesy. The behavior unit is his patients’ home. He’s only visiting. Trying out the night they live in.

And on his break, he can slip away. Take a snapshot, make a record of himself in this new country of the other hours, post it on Instagram as ­@piebell522.­ He took the one that caught my eye when he was in the bathroom. “I saw the dark behind me,” he said. “I thought it could be a picture.” A lovely one, as was the shot that followed hours later: Bell’s baby boy, the reason he works the night shift. Not for the money but for the days he can spend with his son, a handsome little guy with his father’s gentle eyes, but warmer in the golden sunlight of the morning.

Source: www.nytimes.com

By Laura Smith-Spark

Lawmakers on Tuesday voted in favor of a law that sets the stage for the United Kingdom to be the first country in the world to allow a pioneering in vitro fertilization technique using DNA from three people.

The technique could prevent mitochondrial diseases but also raises significant ethical issues.

The measure was passed in the House of Commons, 382 to 128, Speaker John Bercow said.

A further vote must be held in the UK's upper house, the House of Lords, before the measure can become law.

Passage of the law is opposed by Catholic and Anglican church leaders, in part because the process involves the destruction of an embryo.

One in 6,500 babies in the United Kingdom are thought to develop a serious mitochondrial disorder, which can lead to health issues such as heart and liver disease, respiratory problems, blindness and muscular dystrophy.

Problems with mitochondria, the "powerhouse" cells of the body, are inherited from the mother, so the proposed IVF treatment would mean an affected woman could have a baby without passing on mitochondrial disease.

But the cutting-edge IVF technique, which involves transferring nuclear genetic material from a mother's egg or embryo into a donor egg or embryo that's had its nuclear DNA removed, raises ethical questions.

The new embryo will contain nuclear DNA from the intended father and mother, as well as healthy mitochondrial DNA from the donor embryo -- effectively creating a "three-parent" baby.

The amount of donor DNA in the mitochondria will, however, be much less than the parental DNA in the nucleus, which determines the baby's characteristics.

Called an ethical watershed

The Church of England's national adviser on medical issues, the Rev. Dr. Brendan McCarthy, described the step as representing an ethical watershed and said more research and wider debate were needed.

"We accept in certain circumstances that embryo research is permissible as long as it is undertaken to alleviate human suffering and embryos are treated with respect. We have great sympathy for families affected by mitochondrial disease and are not opposed in principle to mitochondrial replacement," he said.

"Our view, however, remains that we believe that the law should not be changed until there has been further scientific study and informed debate into the ethics, safety and efficacy of mitochondrial replacement therapy."

Bishop John Sherrington, in a statement posted online by the Catholic Church in England and Wales, urged lawmakers not to rush into taking such a serious step.

"It seems extraordinary that a licence should be sought for a radical new technique affecting future generations without first conducting a clinical trial," he said. "There are also serious ethical objections to this procedure which involves the destruction of human embryos as part of the process."

The California-based Center for Genetics and Society, in an open letter to UK lawmakers last month, said that although the proposed goal was noble, "the techniques will in fact put women and children at risk for severe complications, divert resources from promising alternatives and treatments, and set a policy precedent that experimentation on future generations is an acceptable biomedical/fertility development."

Incurable diseases

A team at the Wellcome Trust Centre for Mitochondrial Research, led by professor Doug Turnbull and based at Newcastle University in northern England, has been leading the research into the pioneering IVF technique.

The center points out that mitochondrial diseases cannot be cured and that in many families, several people are affected.

A Wellcome Trust fact sheet states that "nuclear DNA is not altered, and so mitochondrial donation will not affect the child's appearance, personality or any other features that make a person unique -- it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease.

"The healthy mitochondria will also be passed on to any children of women born using the technique."

According to the latest estimates from the research team, published in The New England Journal of Medicine, almost 2,500 women of childbearing age in the UK are at risk of transmitting mitochondrial disease to their children, while in the United States, the number is more than 12,400.

This equates to an average of 152 births per year in the UK, and 778 births per year in the United States, the team said. 

In a Newcastle University news release, Turnbull said his team's findings had considerable implications for other countries considering the technique. Allowing it would give "women who carry these mutations greater reproductive choice," he said.

Source: www.cnn.com

The Food and Drug Administration has approved the use of an attention deficit/hyperactivity disorder drug to treat binge eating.

Should ADHD medication be prescribed to help cut compulsive overeating?

The drug, Vyvanse, is usually used for ADHD but it's been shown to help control binge-eating disorder, the FDA said.

"In binge-eating disorder, patients have recurrent episodes of compulsive overeating during which they consume larger amounts of food than normal and experience the sense that they lack control. Patients with this condition eat when they are not hungry and often eat to the point of being uncomfortably full," the FDA said in a statement.

"Patients may feel ashamed and embarrassed by how much they are eating, which can result in social isolation. Binge-eating disorder may lead to weight gain and to health problems related to obesity."

The drug is not approved for weight loss, and it's a Schedule II controlled substance because it has high potential for abuse and dependence. But any doctor can write a prescription for any approved drug for any use he or she sees fit.

"The concern in our country especially is the desperation to lose weight," said NBC's diet and nutrition editor Madelyn Fernstrom. "Everyone will say, 'Oh, I have binge eating disorder'. I think there's a huge potential for abuse in our country."

Source: www.nbcnews.com

By Chris Serico

Larry Stogner, a retiring news anchor for an ABC affiliate in North Carolina, stunned viewers on Friday when he revealed he has ALS.

"For nearly four decades, I have met you right here, usually at 6," the WTVD anchor said during a Jan. 23 broadcast, as a slideshow of his life and career appeared on a screen behind him. "Boy, we've seen a lot of change over those years, but we have to stop meeting this way. I am sure that in recent months, you've noticed a change in my voice; my speech, slower. Many of you were kind enough to email me ideas about what it might be, or just to show concern, and I truly appreciate that. As it turns out, I have ALS, Lou Gehrig's disease."

Stogner added that, last summer, he'd participated in an Ice Bucket Challenge video to help raise awareness and money for the cause. "Little did I know, it was about to change my life," he said. "There is no cure. My career in broadcast journalism is coming to an end."

Married with six children, Stogner joined WTVD in 1976. In addition to conducting one-on-one interviews with Barack Obama, John McCain and other prominent political figures, the Air Force veteran reported live from Raleigh-Durham and beyond — including a 2002 assignment in Afghanistan, according to his ABC11 bio.

In the final minute of the broadcast, Stogner called his WTVD position "the best job in the world," and shared plans to take two weeks of vacation with his wife before returning in early February to share "a few final thoughts and a more personal goodbye."

Flanked by four of his WTVD colleagues, he concluded, "And now more than ever, I say to you, for all those 39 years: Thanks for the company. Have a good night."

Source: www.today.com

Should the legal age for smoking be raised from 18 to 21? That’s the question being pondered by lawmakers in California, where a growing contingent of health advocates are seeking to make their state’s minimum smoking age the highest in the United States.

Known as Bill 151, the legislation, which was proposed by Democrat Senator Ed Hernandez last Thursday, is designed to limit tobacco smoking among young people. Hernandez says it’s about preventing people from becoming addicted to cigarettes when they’re most vulnerable.

“Tobacco companies are aware that people tend to become addicted to smoking if they start it at young age,” Hernandez said. “Senate Bill 151 proposes to increase the legitimate smoking age in California from 18 to 21 years in an offer to restrain tobacco smoking in children and teenagers.”

Hernandez has evidence to support his cause. According to the American Lung Association, nine in ten smokers take up the habit right around the time they reach age eighteen. Overall, it’s estimated that about 36,000 California children begin smoking each year.

Hernandez says it’s time to take a tougher approach when it comes to preventing young people from smoking. “We can no more bear to sit on the sidelines while huge tobacco markets to our children and gets another era of youngsters snared on an item that will at last kill them,” Hernandez said.

California is not the first state to make this venture. Utah, New Jersey, Maryland, and Colorado have all tried to raise the smoking age from 18 to 21, with every attempt ending in failure.

Source: www.activebeat.com

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.

Source: http://online.adu.edu

BY EMMANUELLE SALIBA

After a howling blizzard with hurricane-force winds socked Boston with 21 inches of snow on Tuesday, some nurses and doctors hitched rides with police or put on skis and snowshoes to get to work.

Kelli O'Laughlin, one of the doctor's at Brigham and Women's Hospital who skied to work, found her ride "fun" and "exhilarating." She told NBC's Miguel Almaguer that doctors have to come in to work because"the emergency department is one of those places where 24 hours a day, 7 days a week it's always going."

"Our sincerest thanks to all employees that have gone to extraordinary lengths to get to the hospital during the storm," wrote the hospital in an Instagram post along with a photo of pathology technician Vivian Chan on snowshoes.

Source: www.nbcnews.com

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.

Source: www.medicalnewstoday.com