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DiversityNursing Blog

Violence Intervention Programs 'Could Save Hospitals Millions'

Posted by Erica Bettencourt

Wed, Jan 28, 2015 @ 10:46 AM

Written by James McIntosh

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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.


Topics: injury, violence, intervention, programs, financial, victims, saving money, nursing, health, healthcare, nurse, nurses, doctors, medical, patients, hospital, treatment, Money

3D-printed vertebra used in spine surgery

Posted by Erica Bettencourt

Mon, Aug 25, 2014 @ 01:21 PM

By Jason Lee

3d spine model 620

Surgeons in Beijing, China, have successfully implanted an artificial, 3D-printed vertebra replacement in a young boy with bone cancer. They say it is the first time such a procedure has ever been done.

During a five-hour operation, the doctors first removed the tumor located in the second vertebra of 12-year-old Minghao's neck and replaced it with the 3D-printed implant between the first and third vertebrae, reported earlier this month.

"This is the first use of a 3D-printed vertebra as an implant for orthopedic spine surgery in the world," said Dr. Liu Zhongjun, the director of orthopedics at No. 3 Hospital, Peking University, who performed the surgery.

The boy was playing football when he headed the ball and injured his neck, and it was later confirmed that he had a tumor, Minghao's mother said.

Prior to the surgery, the patient had been lying in the orthopedics ward for more than two months, and he could occasionally stand up, but only for a few minutes.

Normally, a diseased axis would be replaced by a standardized, hollow titanium tube, Liu told Reuters.

"Using existing technology, the patient's head needs to be framed with pins after surgery," as his head cannot touch the bed when he is resting for at least three months, he explained. "But with 3D printing technology, we can simulate the shape of the vertebra, which is much stronger and more convenient than traditional methods."

Five days after the surgery, Minghao still could not speak and had to use a writing board to communicate. However, doctors said at the time that he was in a good physical condition and they expected him to make a strong recovery.


Topics: surgery, spine, injury, technology, health, healthcare, patient, vertebra, 3D-printed

Injuries kept Lincoln woman from being a nurse, but sons carry out her dream

Posted by Erica Bettencourt

Fri, May 30, 2014 @ 10:58 AM

By Michael O'Connor

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Wet snowflakes fell on that day after Christmas 1973 as she glanced out the window.

Nancy Whittaker just wanted to return a few presents with her boyfriend, but her parents worried about her making the 40-mile trip from Beatrice to Lincoln. Maybe it was best if they made the drive another day, after the weather improved.

I'll be fine, Nancy told them before sliding into the front seat. Nancy, 17 at the time, sat in the middle of the bench seat, with her 19-year-old boyfriend, Paul Cramer, on her right, and his college roommate behind the wheel.

Nancy, a pretty and popular senior at Beatrice High School, planned to attend college and follow her dream of becoming a nurse.

She wanted a career, but her greatest hope — one she had wished for since she was little — was becoming a wife and mother. She wondered if Paul might be the man she would marry someday.

Nancy and the two others set out on their trip that winter day 40 years ago, but they never arrived in Lincoln.

In the years that followed, Nancy would face tough obstacles reaching her dreams. Though she wouldn't fulfill them all, she would reach most, including motherhood. And through her faith, courage and perseverance she would inspire her children to achieve one dream that fell from her grasp.

Before Nancy left on the trip that day, she spoke with her dad about a Christmas present she'd given him.

It was her senior picture in a wooden frame. She reminded him to hang it in his office at work.

There was Nancy, with her blue eyes and long blond hair, smiling in the photo.

Her father promised he'd take it to work, and gave her a hug and kiss.

Be careful, he told her.

* * *

Nancy and the others stopped to fill the white two-door Dodge with gas before heading north out of Beatrice on U.S. Highway 77 — a two-lane road in those days.

Seven miles north of Beatrice, the Dodge trailed a truck near the tiny town of Pickrell about 2:20 p.m. Newspaper stories and a sheriff's report indicate the car moved into the opposite lane. Paul caught a split-second glimpse of the oncoming sedan. He instinctively braced himself against the dashboard with his right arm and threw the other across Nancy's chest.

The two cars collided head-on, according to news reports. The other car carried a 75-year-old Kansas man and his wife, who both died in the crash.

Nancy's head smashed against the dash, crushing the middle third of her face. She broke a hip, her pelvis and jaw. Paul broke an ankle, nearly severed a finger and suffered a concussion and chest injury. His roommate also was injured.

In an emergency room in Beatrice, Nancy remembers hearing voices and her family doctor exclaim, “Oh, my God.”

Her face throbbed with pain, and she couldn't see.

You've been in a car accident, her father told her, but you will be OK.

Why can't I see, she asked.

Doctors are taking good care of you, her dad replied. They will figure that out.

Within hours of the crash, doctors transferred her by ambulance to a Lincoln hospital. A nurse Nancy knew sat in the back with her during the drive. The previous summer Nancy had worked as a nurse's aide and the woman had trained her.

The nurse held her hand, and though Nancy still could not see, she felt peaceful, as if the Lord held her in His arms.

In Lincoln, Nancy underwent the first of what would be nearly a dozen plastic surgeries to reconstruct her face. The surgeon who performed the first eight-hour operation told Nancy's family her facial bones were so shattered that it was like “stringing pearls” together.

As she lay in her hospital bed a day or two after the crash, Nancy had a question for her mother.

It wasn't about her eyes, or her face.

Will I still be able to have babies someday?

Her mother leaned over her bed and gently told her yes.

Nancy was relieved, but soon would learn devastating news.

Within a week of the accident, doctors told her what she had feared: She was permanently and completely blind. Her optic nerves were dead because injuries had cut off their blood supply.

Nancy felt the Lord would take care of her, but she was scared, and her mind raced.

How would she get around? How would she pick out clothes? How would she put on makeup?

Could she still go to college? What would her boyfriend, Paul, say?

He was recovering at a Beatrice hospital, and soon after Nancy learned about her blindness, he phoned.

He told Nancy he had fallen in love with her months before, and her blindness didn't change that.

“I love you,” he told her on the phone that day, “not what you can see.”

* * *

Nancy remembers a psychiatrist in the hospital telling her she had two choices: Compare her life now to her life before the accident and feel miserable, or move forward.

Nancy picked her path.

After finishing her senior year of high school, she enrolled part time at Nebraska Wesleyan University in Lincoln and moved into a dorm with a friend. Paul was a junior at the school.

She majored in psychology, knowing that without vision, a nursing career simply wouldn't work.

Some textbooks were on reel-to-reel tape, and Nancy listened to them in a study lounge. When she had to write a paper, she dictated sentences to her mom, who typed them. Her professors read test questions to her after class.

Nancy's relationship with Paul grew stronger during their college years, and they married on June 4, 1977.

In May 1981, eight years after she began taking classes half time, Nancy graduated.

When her name was called at the ceremony, she linked arms with Paul and walked across the stage.

The audience rose to its feet and erupted in applause.

* * *

In spring 1986, Nancy heard the words she had longed for: You're pregnant.

She had accepted her blindness because she knew the Lord would bless her and Paul in other ways. A baby, she thought, was that grace.

Nearly two years earlier she'd had a miscarriage, and she and Paul prayed that they would be blessed with another baby.

That baby was born two months premature in October 1986. Paul Andrew was small — 4 pounds, 2 ounces — but healthy.

Nancy remembers hearing his loud cries for the first time, as tears streamed down her face.

Her husband described the baby to her: blue eyes, light hair, a long body.

She held her child on her chest, stroking his hair, cheeks, nose and lips, tracing the outline of his face with her fingers.

He was beautiful.

* * *

Caring for a baby challenges any mom, and Nancy faced extra hurdles.

Plus, soon she no longer had just one son.

Two years and two days after the birth of her first son, Nancy delivered a second healthy boy, Daniel Whittaker.

Keeping her boys safe at home was a big test. She vacuumed constantly to make sure there wasn't a coin or paper clip on the floor her boys could put in their mouths.

Organization was the key for other duties.

Changing diapers and cleaning messy bottoms became a snap because Nancy knew just where to reach for a clean diaper and a wipe.

Her husband marked foods with a label in Braille, making it easy for Nancy to find the applesauce or baby cereal in the kitchen of their Lincoln home.

As her boys got older, she reminded them that mommy couldn't see them, so they needed to tell her if they left a room, and she could follow the sound of their voices.

Nancy, who left a phone company job to raise her family, regularly walked with her sons and a guide dog to a park and their school five blocks from home.

Every couple of years, Nancy visited her sons' grade school and talked about life as a blind person.

How do you get dressed, students asked. How do you walk without bumping into things?

Her sons listened proudly. Those talks helped them realize that blindness didn't stop their mom. It was simply part of her life, and she dealt with it.

As they grew, Nancy's sons learned that mom sometimes needed help, and she wasn't too proud to receive it.

She knew her way around the house but sometimes cut her forehead on an open cupboard. Her boys would dab the wound with soap and water and place a bandage on it.

Nancy always put on her own makeup, but if she smudged her mascara, her boys cleared it with a Q-tip.

When her boys were older, she'd ask them to read the labels on her medicine bottles.

Her sons never complained about helping. Nancy realized they carried a tender and caring nature, and that filled her and her husband with pride.

* * *

Nancy is now 58 and works as a phone interviewer for a university research office in Lincoln. Paul is 60, and the pair — whose relationship flowed from a teenage romance — will celebrate their 37th wedding anniversary next month.

And their boys are grown now.

Paul Andrew, 27, and Daniel, 25, knew their mom had to give up becoming a nurse, and looking back, they realize she channeled her caregiver instincts into raising them.

Her sons were struck by her ability to raise them despite not just her blindness but also her chronic asthma and other medical problems stemming from her car crash injuries.

They joined their mother on dozens of medical appointments while growing up, and saw how the nurses and doctors helped her. Both sons also liked the satisfaction of helping their mom, and how something as simple as them tending to a cut on her forehead made her feel better.

All of those experiences seeped in over the years and led both sons, even as teens, to begin thinking of health care careers.

Though Nancy never reached her dream of becoming a nurse, her sons followed that path.

Paul Andrew graduated last year from the University of Nebraska Medical Center and is a nurse at Immanuel Medical Center in Omaha.

On Friday, Dan walked across the stage at a Lincoln auditorium and received his nursing degree from UNMC. A smile broke across Nancy's face as they called his name.

Afterward in the lobby, Dan weaved through the crowd and found his mother. The 6-foot-4 Dan leaned down and hugged her, as his brother stood close.

For parents, college graduation signals the step into adulthood, although in a mother's mind, the little child never quite disappears.

That's how it is for Nancy.

As the crowd began breaking up, Dan stepped close and told her he loved her.

She reached up and touched the back of his neck with her hand.

He was beautiful.


Topics: injury, heartwarming, family, nurse

Group releases 'Golden Rules' of needlestick safety

Posted by Alycia Sullivan

Wed, Jun 26, 2013 @ 01:28 PM

As part of its ongoing mission to eliminate needlestick and sharps injuries in healthcare, the nonprofit organization Safe in Common has issued the "Top 10 Golden Rules of Safety." 

The list ( is predicated on making injuries a "never event," and dictates that personnel using or purchasing sharps consider the following rules:

• The design and activation of the safety mechanism is automatic and will not interfere with normal operating procedures and processes.

• The device is intuitive and requires no additional steps for use compared with an equivalent standard or conventional device.Needlestick Istock

• The contaminated, non-sterile sharp will be rendered safe prior to removal or exposure to the environment.

• Activation of the safety mechanism does not require the healthcare worker to undertake any additional steps during normal patient care processes or protocols.

• Activation of the safety mechanism will not create additional occupational hazards (such as aerosolization, splatter, exposure to other potentially infectious materials, etc.).

• Activation of the safety mechanism does not cause additional discomfort or harm to the patient.

• The device will be ergonomically designed for comfort, allowing for automatic one-handed use during all stages of patient procedure.

• The safer engineering control is available in sizes and iterations appropriate for all areas of use relevant to patient care needs.

• Disposal of the safety device will not increase waste disposal volumes but instead incorporates designs to reduce waste.

• The used safety device will provide convenient disposal and mitigate any risk of reuse or re-exposure of the non-sterile sharp.

The outline for the Top 10 Golden Rules of Safety was released at the annual Association for Professionals in Infection Control and Epidemiology convention in Ft. Lauderdale, Fla., earlier this month. Safe in Common gauged attendees’ opinions on safety devices during the conference. Of the 27 devices reviewed, only 9% received a perfect 10 and exactly half had a passing grade of 7 or higher. Some 41% had scores of 2 to 4.

Overall, the devices available at APIC scored well on two criteria:

• The safer engineering control is available in sizes and iterations appropriate for all areas of use relevant to patient care needs (95%).

• The used safety device will provide convenient disposal and mitigate any risk of reuse or re-exposure of the non-sterile sharp (86%).

Significant development effort remains in three essential criteria:

• Activation of the safety mechanism does not require the healthcare worker to undertake any additional steps during normal patient care processes or protocols (32%).

• The device is intuitive and requires no additional steps for use compared with equivalent standard or conventional devices (41%).

• The contaminated, non-sterile sharp will be rendered safe prior to removal or exposure to the environment (48%). 


Topics: injury, Safe in Common, Top 10 Golden Rules of Safety, sharps, needlestick, healthcare

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