A group of researchers from 5 major medical centers found that eating a specific diet rich in nutrient-dense fruits and vegetables, whole grains and low fat dairy can be a powerful tool in lowering blood pressure.

The DASH DIET( Dietary Approaches to Stop Hypertension) was found in 1996 to lower blood pressure about the same as a blood pressure medication would, and since that time has quickly become one of the most often prescribed diets in clinical practice today.

The DASH Diet is recommended by the American Heart Association, in the USDA’s 2005 Dietary Guidelines for Americans, and is featured in the US High Blood Pressure Guidelines.

The DASH DIET Study 459 people were chosen to participate in the DASH DIET Study. They were randomly assigned to one of three different types:

·The “typical American diet”

·A diet with more fruits and vegetables, but otherwise similar to the typical American diet

·The “DASH diet” - rich in fruits, vegetables, and low-fat dairy products; moderate in fish, poultry, and nuts; and reduced in red meat, sweets, and sugar-sweetened drinks.

To assure they weren’t doing anything else that might lower their blood pressure, participants were asked not to make any major changes in the physical activity levels during the study.

Participants were weighed frequently to make sure their weight stayed constant; if someone gained or lost weight, they were given a bit less or more food to eat to get their weight back to what it was.

Salt/sodium intake was the same in all three diets - slightly lower than the U.S. average, but still higher than what most guidelines recommended.

The Results

Those who ate the typical American diet did not see a change in their blood pressure.

Those on the fruit and vegetable diet experienced a significant lowering of their systolic blood pressure - The upper number, which is a measurement of blood pressure in the arteries when the heart contracts to pump out blood - but little change in their diastolic pressure.

But the men and women who ate the DASH DIET for eight weeks experienced a significant drop in both their systolic and diastolic blood pressure readings. Changes occurred within a week of starting the DASH diet, stabilized within two weeks, and stayed lowered for the remainder of the eight weeks.

On average, blood pressure fell 5.5 mmHg (systolic) and 3.0 mmHg (diastolic) among all participants (including both those with normal blood pressure and those with hypertension).

In participants with high blood pressure, blood pressure dropped an average of 11.4 mmHg (systolic) and 5.5 mmHg (diastolic).

These improvements in blood pressure are about the same as what can be achieved with a single antihypertensive medication.

There were positive health outcomes of the DASH diet beyond lowering high blood pressure.

Most importantly, perhaps, the DASH diet lowered the study participants’cholesterol levels.

When blood cholesterol is high, cholesterol and other fatty substances collect on the walls of your blood vessels and in time restrict or block the flow of blood to your heart.

High cholesterol, which is generally caused by a diet high in saturated fats, is a major risk factor for heart disease.

The DASH diet is low in total and saturated fat.

People who ate the diet during the study, dropped their cholesterol 14 points. The “bad” cholesterol (LDL) fell 11 points. The level of good cholesterol (HDL) also fell by 3.7 points (this type of drop in HDL is seen when people reduce their overall fat intake). Combining all the effects (changes in blood pressure, LDL, and HDL), there was an important improvement in overall cardiac risk with the DASH DIET.

A later study was done at the Boston University Medical Center, which offered the DASH Diet in an online form to employees of a large US company.

Over 4,000 people enrolled in the DASH DIET program.

They received weekly email reminders to log in to the site for information on topics such as weight loss, exercise, reading food labels, grocery shopping and more.

They also were encouraged to track the changes they made to their diet, exercise, weight and blood pressure online.

After one year in the DASH DIET program, study participants had lost weight and lowered their blood pressure significantly.

They started eating more fruits and vegetables and moved from higher fat dairy products to lower fat versions.

After the success of the DASH DIET program, the researchers decided to offer the program to the general population online at DASH DIET

The reason the researchers think that the DASH DIET is perfect for all Americans is that it doesn’t take a whole lot of learning.

It deals with real foods that are easily found in every grocery store across America, and allows dieters to choose how they plan to meet their food servings goals with foods that they enjoy.

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My grandmother used to be up at the crack of dawn—not because she had to, but because her body clock had shifted to a different time frame with increasing age. My step-mother used to complain that after Dad retired, he woke up every morning before six. The connection seems inevitable—older people do not need as much sleep as younger folks do. While changes in sleep patterns may explain this situation to some extent, they do not address a fundamental problem–lack of sleep is not only unhealthy but potentially dangerous to the senior population.

a)The body chronically deprived of sleep is a walking time bomb. Consider some of these statistics from the National Sleep Research Project.

b)Seventeen hours of sustained wakefulness leads to a decrease in performance equivalent to a blood-alcohol level of 0.05%.

c)Research estimates that fatigue is involved in one in 6 road accidents. The 1989 Exxon Valdez oil spill off Alaska, the Challenger Space Shuttle disaster and the Chernobyl nuclear accident have all been attributed to human errors in which sleep deprivation played a role.

d)As well, sleep compromises the immune system; it decreases your resistance to infections. A study at San Diego’s Veteran Medical Center discovered that reducing a person’s nightly normal sleep time by half decreases the activity of T-cells—the cells that destroy bacteria, viruses and tumor cells.

e)Young adults who are sleep deprived may be increasing their risk for diseases that accompany old age.

f)A recent study at the University of Pittsburgh School of Medicine suggests that sleep deprivation in older adults can lead to earlier death. The study involved tests that measured EEG sleep assessments. Results showed that those with low percentages of REM sleep were at the greatest risk. REM is an active period of sleep characterized by interval brain activity and rapid bursts of eye movement. REM is the brain wave stage of dreaming sleep (the theta stage) that is characterized by increased creativity, memory, healing and integrative emotional experience (what is usually called the “Ah-ha!” moment of insight and connection). There is no doubt that REM sleep contributes to the development of human imagination and consciousness.

There are, however measures that one can adopt to promote restful sleep. Like anything else, proper sleep can be encouraged through the maintenance of familiar and soothing routines— a ritual that is sometimes referred to as “sleep hygiene.”

1. Exercise: An exercise routine (30-40 minutes) four to five times as week is excellent not only for sleep promotion, but for cardiovascular health, weight maintenance, osteoporosis and diabetes as well. It’s like killing 5 birds with one stone! Both aerobic and resistance training can increase energy expenditure and lean body mass. As well, exercise is a natural mood enhancer because repetitive movement helps the body release its natural store of endorphins—the good feeling hormone.

2. Alpha and Theta-Wave CDs and relaxation music: Listening to soothing music or CD’s that help entrain your brainwave activities can definitely help you access Alpha and Theta brainwave states more readily. New technology is providing us with more accessible ways to tap into our subconscious mind and allow us to mould our behavior and emotions inside out.

3. Reduced liquids: Cut down on liquids in the evening as this will prevent frequent bathroom visits that interrupt sleep.

4. Reduced caffeine: Do not consume caffeinated products after 2 in the afternoon. Double check your medication as well; some drugs also disturb sleep. Anti-depressants, for example, can disturb normal sleep patterns and some barbiturates suppress REM sleep which can be harmful over a long period. Decongestants can also act as stimulants and beta blockers are known to cause insomnia.

5. Turn digital clocks away from your line of vision. Studies show that even the tiny luminous rays from a digital alarm clock can be strong enough to disrupt a sleep cycle. The digital light turns off a “neural switch” in the brain, causing levels of a key sleep chemical to decline within minutes.

6. Hot Bath: Researchers who studied female insomniacs (aged 60-70) found that those who had a hot bath before sleep spent more time in deep, slow brainwave sleep.

7. Avoid heavy, late meals that sit heavily in your stomach.

8. A glass of hot milk just before bedtime will also give your brain the amino acid tryptophan which the body converts to sleep-inducing chemicals.

9. Consult a doctor or dentist if you have a problem with sleep apnea, which can be controlled by a simple plastic appliance that fits in the mouth.

10. Last but not least, for those who are sleepless because of unresolved issues or problems—learn to make amends where changes can be made and lean to walk away (mentally and perhaps physically) when things cannot be changed. Pray and place everything in the hands of the Universe. Know that you are more than your problems.

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Acetaminophen is the most popular painkiller in the US. It is best known by the brand name Tylenol but is sold under 97 different brand names. It is known as paracetamol in many parts of the world. It is also sold in combination with other drugs in more than 100 products.

During cold and flu season, people who take acetaminophen for arthritis are at risk for acetaminophen poisoning. Taking just twice the recommended dose of acetaminophen can cause acute liver failure. Unfortunately, this has already happened to an alarming number of people because it isn’t hard to do. Two years ago, more than 56,000 people visited the emergency room due to accidental acetaminophen overdoses and 100 people died from unintentionally taking too much. Worse yet, the numbers appear to be growing.

How Can This Happen?

This happens so easily because acetaminophen is found in many different products. If you are taking the maximum recommended dose of just two acetaminophen-containing products, you can easily take an overdose.

For example, the maximum recommended dose of acetaminophen per day is 4000 mg. That equals 8 extra strength acetaminophen pills per day. You might easily take that much for arthritis pain.

Now let’s say you get the flu and decide to take a Cold & Flu product for your aches and stuffiness. Many of them include acetaminophen as the primary ingredient for reducing fevers and aches and pains. So, that will dose you with 1000 mg of acetaminophen every 6 hours or another 4000 mg a day.

By taking both products at the maximum recommend dose, you put yourself at risk for acute liver failure.

The problem doesn’t end there. You might get a head ache and pop some Excedrin. That’s 500 mg more acetaminophen per dose. Maybe you are in a car accident or have some dental work done. Prescription narcotics like Vicodin and Percocet contain from 325 mg to 750 mg of acetaminophen inside each pill. That can quickly add up.

Other Acetaminophen Complications for People with Arthritis

For some people, arthritis is caused by suboptimal detoxification pathways. Such people do not have the level of enzymes necessary to carry out the sulfoxidation necessary for a body to properly process and detoxify acetaminophen. In these circumstances, even the recommended level of acetaminophen may cause acetaminophen poisoning.

Furthermore, this same pathway is necessary for detoxifying many of the chemicals we are exposed to in our environment and through our food. This means that our detoxification system can also be weakened through chemical exposure. Similarly, if we swamp our system with acetaminophen, we don’t have enough detoxification power left to fully deal with all the other assaults in our daily environment. If you have any known food sensitivities or chemical sensitivities, it is best to assume that your sulfoxidation pathways are already challenged enough, without adding the extra burden of acetaminophen in your system.

How to Avoid Acetaminophen Poisoning

Carefully read the label of any cold or flu medicine or painkiller that you are considering to ascertain how much acetaminophen it contains. Healthy young adults should never exceed 4000 mg/day total from all sources for short term use. For long-term use healthy young adults should never exceed 3250 mg/day, according to clinical pharmacist Sandra Dawson, RPh, MSHA who lectures on pain management in long term care.

People who are vulnerable to damage from acetaminophen should take no more than 2000 to 3000 mg per day, according to Dr William Lee of the University of Texas Southwestern Medical Center. This lower maximum dose includes the healthy elderly since liver and kidney function generally decline with age.

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The generally held medical standpoint is that there is no clear-cut treatment for stretch marks. We are not talking of major cosmetic surgery or otherwise radical intervention here, of course – those are definitely possible approaches, but highly expensive ones that are by no means free of inherent complications. Before one considers medical or surgical alternatives, it makes sense to examine the most favored home treatments.

These can at no time be viewed as anything more than preventive methods and possible damage control. No one should harbor the illusion that stretch marks can be made to disappear by ‘homegrown’ means. They can at best be minimized – which is a major step forward, considering that cosmetics are largely ineffectual in hiding them.

The best time for preventive measures is when stretch marks are just beginning to be visible. At this stage, the failing elasticity of the skin can be augmented with moisturizing agents such as cocoa butter and good quality vitamin E compounds such as almond oil. Another time-honored method of reducing stretch marks caused by obesity is exercising the affected area consistently. This would mean straight leg raises for stretch marks on the hips and thighs, stomach crunches if the belly is affected, etc.

Ongoing research will doubtlessly yield some workable home remedies for stretch marks. For instance, a compound developed on the basis of research conducted by the Duke University Medical Center reportedly seems to be able to replenish collagen in certain cases. The compound’s operative ingredient is vitamin C. No reliable surveys have been made as to its efficacy, but the fact that the world of science is seriously looking for over-the-counter remedies for stretch marks is encouraging.

The use of vitamin K and lavender oil has also been reported as at least marginally beneficial in controlling stretch marks.

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Children are taught to ‘Just Say NO to Drugs,” “Just Say No to sexual abuse, “Just Say No if a stranger asks you to do anything for any reason.”

“Just Say No” can mean many things to each individual. But what does “Abuse” mean? Does “Abuse” mean we will stop hitting/ spanking/paddling children as a form of discipline, because to the child being hit/spanked/paddled is abuse?

Or does ‘Just Say No to Abuse” mean we will enact more laws to protect only adults from physical abuse (a.k.a. battering or domestic violence)? Currently, every state has a law which states an adult hitting an adult is considered assault and battery. However, children are not protected by this same law. The most vulnerable, defenseless and trusting citizens in our country are not protected from assault and battery–all in the name of religion and allowing parents to raise their children as they choose. If we continue to abuse child society must deal with the aftermath one way or the other.

NO adult has the right to violate a child. Children are our greatest natural resource. Every child has the right to grow up and reach his/her greatest potential. As adults, it is our responsibility to protect children as they are the future of this world. We cannot afford to have these future leaders devoid of spiritual, mental, emotional and physical integrity.

Currently in twenty-two states teachers and other adults of authority are permitted to hit children with a wooden paddle for certain infractions in school. These infractions are left to the discretion of the adult in authority.

In 1997 Harvard Medical Center conducted a random telephone survey of families. Sixty-seven percent (67%) of the respondents stated they used hitting as physical discipline (physical abuse) with their child in the past week. Hitting a child in the guise of discipline is both a violation of the child’s sacred body boundaries, and a violation of power.

Sexual abuse of children is the worst form of abuse. Not only is sexual child abuse, a sexual and physical violation, it is an abuse of power. It is violence that does not require force. Another is using the victim, treating them in a way that they do not want or in a way that is not appropriate by a person with whom a different relationship is required. It is abuse because it does not take into consideration the needs or wishes of the child, rather, it meets the needs of the other person at the child’s expense. Studies reveal 62% of girls and 31% of boys are sexually abused by age 18. Finkelhor, David and J. Dziuba-Leatherman, “Victimization of Children.” American Psychologist Vol. 49:3 (1992): 173-183.

If “Just Say No to Abuse” means “NO” to any and all abusive behavior toward another human being, this concept then needs to be addressed on all levels of all relationships and all levels of society.

We are responsible for the outcome of our actions.

“Those who ignore the past are condemned to repeat it.” — Sartre

“We are not only responsible for what we do, but also, for what we don’t do.” — Voltaire

“The worst way you can choose is to choose no way at all.” — Friedrich II

“Every choice we make, every thought and feeling we have, is an act of power that has biological, environmental, social, personal and global consequences.” — Caroline Myss

“Those who look the other way, are part of the problem.” Dorothy M. Nedderpeyer, PhD

“Those who choose to remain in denial, are part of the problem.” Dorothy M. Neddermeyer, PhD

Unless, each person takes responsibility for the outcome of their actions abuse/domestic violence will continue to be an unresolved societal problem.

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As far as the cost of LASIK eye surgery is concerned, the only worldwide standard is that prices are quoted per eye. However, the cost depends on several factors and varies from one provider to another. A strong reason behind such a variation is that different providers perform different levels of pre-operative testing. A thorough pre-operative examination can avoid LASIK complications, and hence it’s imperative to determine if appropriate pre-operative testing is included in the quoted price.

The cost of equipment used for pre-operative testing and surgery also varies, and this reflects in the overall procedure fee. Computer-controlled scanners to determine the exact shape of the cornea, eye tracking device, tear film analysis, the laser used to make incisions, and all other pertinent equipment vary in cost from one medical center to another.

A few unscrupulous practitioners may advertise their services at a discounted price. Don’t be fooled if an ad says, “LASIK for $500 per eye”. The truth is that not all patients are eligible for a discounted price. A particular patient may require an extensive refractive surgery in the first place, or frequent follow ups after the surgery. Furthermore, it is typically the case that a discounted price does not include the essential pre-operative testing. Hence, make sure what features are being offered for the quoted price. Cases have been reported where medical institutes have been found guilty of misrepresenting the actual cost of LASIK eye surgery.

As the popularity for LASIK eye surgery rises, so does the incurred cost. A leading refractive industry newsletter reported that the average cost for LASIK eye surgery in the second quarter of 2005 was 1,965 USD. The study was based on a comprehensive research of various medical facilities, ranging from regional practitioners to nationwide networks. Most insurance companies do not cover LASIK eye surgery, since they consider it as a cosmetic procedure.

People are tempted to choose a surgeon that offers a discounted price. But that may be an act of foolishness. The smarter thing is to choose the best surgeon available who has experience of this procedure. There is no point risking your vision for the sake of a petty few dollars.

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Top executives and managers in other industries know it is not only acceptable, but necessary to benchmark with other industries to obtain process improvements. For example, a major hotel chain desires to improve guest services. This chain not only has other hotel chains to examine for comparisons, but also can and should look at theme parks or retail corporations. Instead of comparing hotels to hotels, the hotel’s guest service policies are compared with the guest service policies of theme parks, restaurants, and others. Valuable lessons are gleaned from this benchmarking process. While the industries may function very differently, their fundamental guest service processes are common and provide learning opportunities for all parties. Similarly, retailers have made major improvements in inventory acquisition, warehousing, distribution and tracking. Hospitals haven’t typically studied these processes, citing the “uniqueness” of the healthcare and hospital operations as the reason. As a result, many hospitals continue to practice outdated and non-integrated supply transactions, as opposed to making supply management a priority. Many,processes are similar enough across industries for healthcare managers to learn and adapt process improvements from others.

Even though healthcare downplays cross-industry benchmarking because of the uniqueness of healthcare, they also believe that healthcare-to-healthcare benchmarks are valid only with those organizations exactly alike in structure, size, scope, culture, affiliations, physical layout, etc., etc. For example, an outpatient clinic wants to improve its cardiac rehabilitation services but only wants to be benchmarked against clinics offering cardiac rehabilitation services that use Saturdays to deal with overflow, as they do. Healthcare systems also want to benchmark with other systems as opposed to stand-alone facilities. While it is important to determine the way others handle issues, using practice and environmental factors to eliminate potential benchmarking partners reduces the value and learning opportunities for the organizations doing the benchmarking.

Does a Twin Exist?

It is virtually impossible for a hospital to find an identical apple. There are approximately 5,800 hospitals in the United States. Focusing on, for example, only 500-bed, non-profits, can narrow this even further. Simply by adding a few more criteria … academic teaching hospital vs. not; location; managed care penetration; number of buildings; outpatient volumes; etc., simple mathematics shows that a hospital can eliminate all potential hospitals as benchmarking partners.

Requiring multiple and non-relevant criteria narrows the list of acceptable benchmarking partners. Hospitals are complex operations. There are an infinite number of differences among hospitals, and there isn’t one exactly like another. Eric Franz, Manager of Financial Services at OSF Saint Francis Medical Center in Peoria, Illinois, agrees. “There is no twin hospital out there,” says Franz. “It just doesn’t exist. We are unique and we want to be unique.” It makes no sense, then, for hospitals to proclaim their uniqueness while at the same time developing lists of criteria “acceptable” benchmarking partners must meet. For hospitals to use benchmarking effectively, they must accept the fact that their twin doesn’t exist. Then, they can use their resources to learn instead of wasting resources benchmarking their level of uniqueness. Apples-to-Apples

Misconstrued – The Benchmarking Poison

Consider this example of how the value of a benchmark decreases as the hospital attempts to narrowly define acceptable benchmarking partners: Apples-to-Apples: Benchmark the cost of medical transcription functions at hospitals. McIntoshes-to-McIntoshes: Benchmark the cost of medical transcription functions at hospitals with a centralized transcription department that out sources at least 60 percent of their transcriptions.

New England McIntoshes-to-New England McIntoshes: Benchmark the cost of medical transcription functions at a system-wide set of hospitals with a centralized transcription department that out sources at least 60 percent of their transcription, writing at least 40 different types of reports and an average TAT for History & Physicals of 24 hours. There should be at least three but no more than six hospitals in the system, located at least 10 miles apart, but within a radius of 124 miles.

Similar benchmarking “requirements” surface in many situations.

System-based hospitals only want to be compared to other systems, “preferably one with a similar structure and size”. Why? How will they know if their system structure is a competitive advantage if they don’t compare themselves to different structures or stand-alone hospitals? These highly selective criteria result in a less useful benchmark and less value for the facility that does the benchmarking. Attempting to “benchmark with a similar transcription department” in the above example obscures the impact in-house vs. outsource transcription; centralized vs. decentralized transcription; stand-alone vs. corporate systems has on turn-around time, cost, accuracy, etc., … the exact opposite result expected of a good benchmark.

Mirror, Mirror on the Wall

What do healthcare organizations learn from the search for and ultimately from their “twin” hospital? The search process teaches them that if they add enough criteria, they can reduce their learning pool and maintain the status quo because “there’s no one out there like me!”. If they happen to find a few “twin hospitals” to compare with, they’ll find that their solutions are similar … again reducing the learning opportunities (what can you learn from someone who’s just like you?). Getting an organization to recognize that the perceived “differences” likely point to improvement opportunities is difficult. How much more comforting is it to believe that “my costs could be lower except I have these corporate allocations, and a non-integrated information system, and a high managed care penetration”, than to come to grips with the fact that your costs are higher because of your choices (stand alone vs. corporate) and practices (allowing departments to purchase information systems that don’t interface).

It’s ridiculous to let truly minor differences eliminate cross-organization learning opportunities. According to Franz, there are enough similarities among hospitals to determine where improvements can be made. “The comparison hospitals we used for benchmarking were 80 to 85 percent similar, which is enough to get a good start on this process,” says Franz.

In addition to searching for twins, hospitals similarly search for best practices … thought by many managers to be the holy grail of process improvement. In the transcription example above, you can almost hear the manager thinking “… if I can find the best practice with respect to transcription, my problems will be solved”. The problem here is, similar to the twin hospital, there’s not a single “best practice” for most healthcare operations. A recent survey of hospitals found that many hospitals that had previously outsourced transcription were now bringing the function in-house; while in-house operations were looking for transcription vendors.

Why?

Changes in fit with their culture, their work force, and their environment. The “make” vs. “buy” decision is very dependent on the individual organization. So, while buying transcription services is a best practice for Hospital A, it might be a miserable failure for Hospital B. That is the job of the managers … to sort through their options, coalesce good ideas from multiple sources and come up with the most effective practice for their organization. One hospital cannot simply implement another hospital’s method without adaptation since the cultures, layouts and environments of each are different. Remember … hospitals claim to be unique and therefore they can’t be compared in a benchmark. Why then, would they willingly presume that someone outside their organization knows what the best practice is for them? Instead, a hospital must take bits and pieces from others’ most effective practices and formulate the most effective practice for their organization.

Who’s the Fairest of Them All?

The hospitals and healthcare systems that will be the “fairest in the land” are those who can avoid the common benchmarking mistakes. They will figure out WHAT they want to benchmark. If they want to improve costs, they will benchmark costs and not poison the “apples-to-apples” comparisons with non-relevant criteria such as payer mix, physical layouts, corporate structure, etc., on the way to determining their cost opportunities. The hospitals who use benchmarking as an effective tool will not waste their precious labor resources trying to find a twin hospital because they realize that reduces learning opportunities and encourages managers to think that the status quo is acceptable. Winnowing the list of acceptable learning partners narrows the value and usefulness of the benchmarking results.

The healthcare organizations that will benefit from benchmarking are the ones who realize that the relevant points of difference are driven by their own practices, structures and choices; and, they will make changes accordingly.

Hospitals who gather many effective practices and blend them into a strategy that meets the needs of their organization will benefit. These hospitals know that slavishly mimicking a process without consideration of their own culture, values and needs is managerial malpractice. Rather than comparing New England McIntoshes-to-New England McIntoshes, organizations who understand that the best use of benchmarking is to identify gaps in their performance, will be the ones who will learn from many others in the effort to find the most appropriate apples to improve their own unique processes and performance.

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Healthcare managers are discovering that a “best practice” imported from another organization is not a panacea. First, one size never fits all. Second, managers charged with process improvement often think of the search for a best practice as a one-time effort. In truth, performance improvement is always ongoing. That’s why smart organizations are intensifying the search for best practices with “knowledge communities” – groups of people who share a common interest and are committed to exchange information and solve common problems together on a continuing basis. Here’s how knowledge communities can make a difference in patient care and the organization’s bottom line.

Why the Search for “Best Practices” Fails

There are five approaches to best practice “search and implement” missions that strangle management. They all begin with a vague project to find a best practice without any certainty on search parameters or desired outcome. What usually happens is one of the following:

Scenario 1:

The manager cannot find a better performer that is similar to his or her own organization in terms of size, scope, structure, environment, trauma level, profitability, etc. Therefore, there is no one from whom to learn.

Scenario 2:

Hospitals that are insufficiently diverse swap best practices, which then become inbred rigidities or sacred cows. No innovation occurs because there is no diversity in the learning pool.

Scenario 3:

The manager searches and searches for the “holy grail” or elusive best practice. The search continues with no end in sight, and nothing is accomplished. Or, the best practice is found, but never implemented. Searching doesn’t bring results. Doing does.

Scenario 4:

The manager at Hospital A succeeds in finding a best practice. Hospital B has standardized on a single vendor for artificial knee implants. The manager copies the practice by standardizing on a single vendor from Hospital A. The result? The physicians revolt because no one was consulted! Or, by signing a two-year exclusive agreement to get a lower price, Hospital B misses out on new advances in orthopedic implants and the high-volume, well-respected surgeon defects. The moral? Best practices are not commodities. Mindlessly mimicking a best practice is a recipe for disaster. Adapt, evolve, customize!

Scenario 5:

The manager finds that the best practice in pharmacies is computerized order entry, which is extremely costly and challenging to implement. He or she is overwhelmed by the grand plan, freezes and does nothing, instead of taking incremental steps to arrive at the goal. Best practice should be about motivation, not intimidation.

So, what’s a manager to do?: Join a Knowledge Community

No two organizations have the same clientele, physicians or environment. It follows that knowledge management processes must be as different as the organizations that practice them. The process has to meet the specific needs of the organization and provide managers with experience and knowledge they can use for improvement.

Knowledge communities offer a concrete starting point – a first place for managers to turn when they want to customize a successful practice to the organization and make it an ongoing part of their management style. In discussions with other members of the community, they gather ideas, test hypotheses, solve common problems, compare implementation strategies, and build courage to change and leverage shared knowledge. Available anywhere, anytime through the Web and technology such as teleconferencing, knowledge communities are the 21st century version of the professional society networking experience.

As part of a knowledge community, Baystate Medical Center in Springfield, Massachusetts participates in telephone conferences with eight to ten similar hospitals across the country. Sally Kaufmann, Manager of Rehabilitation Services, explains, “The members of our knowledge community share information on clinical topics that are of interest to us as rehabilitation managers in an acute care setting. As a benchmarking group, we compare data on the types and volume of services we provide and the cost of providing care. And, when clinical questions arise, any member of the community can generate a question and email it to the knowledge community facilitator, who then generates a survey that helps compare information on the topic. For example, we just completed a series of discussions on using whirlpools in the treatment of wounds. The therapy has become somewhat controversial recently, which raised some uncertainty about our current whirlpool practice. Hospitals participating in the discussion completed a pre-conference call survey to compare our programs, followed by a live discussion of specific issues. I then arranged a follow-up call with a member of the network who turned out to be particularly expert in this area. She gave me some solid advice, which helped me create a packet of information for physicians who are referring patients to our whirlpool service. It alerts them to alternatives and recommends a new referral process that may or may not include whirlpool.”

Utah Valley Regional Medical Center in Provo, Utah, a division of Intermountain Healthcare, has been a member of a knowledge community for several years. Ron Liston, Director of Rehabilitation Services, reports, “Periodically, the knowledge community administrator runs a comparison of our hospital with some of our IHC sister hospitals, as well as hospitals throughout the U.S. For example, our inpatient rehabilitation program has been compared against similar units in terms of productivity, cost per unit per discharge and cost per patient day. If you’re the most expensive in the group, you can call the other hospitals and learn what they are doing to keep costs down. The procedure is simple. The knowledge community administrator schedules a time for a conference; you call in with a password, and you’re on the phone with ten of your peers all discussing your issue.”

Liston has participated in focused phone conferences concerning staffing mix and productivity. “Providing excellent outcomes while increasing staff productivity is always a challenge,” he says, “but when you share knowledge with ten other hospitals, someone always has a creative idea.” He in turn has shared IHC’s seven-on-seven-off staffing model which works well in a hospital that provides physical therapy seven days a week. IHC’s policy and procedure were posted on the knowledge community’s Web site, available for other members to learn from.

Small Steps to Big Goals

Incremental steps are the best way to improve, manage change and make a difference. Knowledge communities simplify the process of adapting and evolving a practice to fit the organization because managers can learn the incremental steps others took to arrive at the goal. Rather than searching for an elusive best practice or finding one too overwhelming to implement, managers can obtain practical information in digestible bite-size pieces. In Scenario 5, for example, a member of a knowledge community might learn that Pharmacy Manager X at Hospital A began by giving the physicians preprinted drug prescription forms. This approach worked well and eventually evolved into computerized order entry.

The healthcare industry has traditionally shied away from obtaining and utilizing external information from other healthcare systems and other industries. A knowledge community makes the process easy and comfortable because the member organizations are not competitors, but span the country. More importantly, a knowledge community expands the collective knowledge of the group and raises the bar for everyone.

“I highly recommend joining a knowledge community,” says Kaufmann. “Busy managers who do not have the time to research topics on the Internet or in the medical library can network with hospitals in different parts of the country. We learn what financial or clinical issues our peers are struggling with or have solved in creative ways. For newcomers, a knowledge community can seem a bit daunting, but once you get in the habit of sharing information, you realize that it’s a very valuable educational resource. It’s the perfect way to connect with peers on specific business and clinical issues. The time spent is well worth it in the long run.”

“Any organization that is small or lacks a solid peer group needs to belong to a formal or informal group to bounce ideas off each other, ask questions and get answers,” says Liston. “Sometimes we need to go beyond our own organization to learn how others are wrestling with problems that are similar across the industry. I can’t imagine being in a single hospital, or even a small group of hospitals, and not having instant access to peers to help deal with questions and concerns of daily operations. It’s not just for the benefit of hospital leadership. Department managers or senior physical therapists who are struggling with certain issues can get help from their counterparts in other organizations,” he added.

Solutions for Better Care

Knowledge communities are most successful when the sharing of information and experiences is accessible to the people (often department managers) who can effectively create change. Providing these people with readily accessible peer groups empowers them to learn from others to create solutions for themselves. This in turn expands the organization’s ability to change and improve. Everyone in the organization, not just a few executives, are now thinking about the kind of process improvement that will not only better the organization, but enhance the patients’ experience, which is what healthcare is all about.

Sidebar:

How to Advance or Doom Knowledge Management

Advance:

·Put knowledge where the action is, the front lines of the organization.

·Leverage internal and external peer-to-peer interactions to grow the collective knowledge of the group.

·Make historical knowledge available – easy to access, readily retrieved.

·Encourage a flexible, risk-taking culture to encourage positive change and growth.

·Maintain organizational curiosity for new ideas to germinate.

Doom:

·Focus on IT as the answer. IT may provide a shell to contain knowledge, but human intervention is necessary to actively manage knowledge exchange.

·Rely on written documents to transfer knowledge. Interactive sharing is to effective knowledge exchange.

·Breed a culture that inhibits action.

·Restrict or convolute access to knowledge.

·Decline to resource knowledge. Knowledge distribution, archival, use, interactions and access will not be valuable unless they are thoughtfully managed and facilitated with appropriate manpower.

·Refuse to participate. Asking for information from others without sharing ideas and information in return creates an unsatisfactory relationship.

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Low-carb diets can be advantageous in increased body weight , heart disease and treatment of diabetes according to new clinical studies .

Low carb diets still revolutionize the clinical practice of nutrition. Many scientists are now indicating low carb solutions for many disease states, according to Richard D. Feinman, Ph.D., professor of biochemistry at SUNY Downstate Medical Center in Brooklyn.

He also says “And practically speaking, some of the clinical results, particularly in diabetes, are quite remarkable.”

“I have seen many patients who were heading for disaster and who have turned their disease and their lives around simply by avoiding foods they cannot tolerate: carbohydrates.”

This simple, effective approach could reverse the epidemic of Type 2 diabetes,” says Mary Vernon, MD, FAAFP, CMD and President of the American Society of Bariatric Physicians, Known for her controlled carbohydrate challange with her patients for some time now.

“Thanks to the low-carb approach we’ve seen many patients reduce or completely eliminate drug therapy. Of course, it is up to a patient if they want to continue their medication, but they should at least be given a choice of a non-pharmacological approach.”

Low carb diets seem to have always had a metabolic foundation and although the news attention has concentrated mainly on the business side of the topic, science continues to dramatically move forward with it.

Some of the important findings about low-carb diets are:

* A restrained carbohydrate way of life is an efficient way to control Type 2 diabetes blood sugar. Patients are consistently able to lower or do away with disease.

* A third of overweight Americans who are trying to lose weight, are doing so by eating less carbs.

* More recent evidence to bear the weight of the benefits of a restrained carbohydrate way of life for heart risk factors such as low HDL and small LDL lipoprotein standard.

* A restrained carbohydrate way of life may be the best treatment for metabolic syndrome, a forerunner condition to diabetes and heart disease.

* Over 60 percent of Americans are overweight; 38 percent are actually doing something about it.

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Are you experiencing trouble with—relationships, on the job, in your family; or experience low self-esteem, panic attacks, anxiety, depression, alcohol/drug abuse, nightmares, suicidal thoughts or attempts, shame, guilt, baseless crying, angry outbursts, inability to recognize your feelings, mood swings, emotional shut down, numbing out, arthritis/joint pain, chronic/acute fear, headaches/ migraines, eating disorders, PMS, gastrointestinal/gynecological disorders, chronic fatigue syndrome, MS or fibromyalgia?

You are not alone. Many men and women experience this kind of pain. Many, if not most, do not know verbal, physical, sexual abuse/incest is the cause of their emotional/physical pain. The medical and psychiatric profession attributes these maladies to the person’s inadequacy for the rigors of adult life or genetic abnormalities.

Family violence research reveals sexual abuse is as high as 62% for females and 31% for males. An estimated 906,000 children were found to be victims of physical abuse or neglect in 2003. The national rate of victimization was 12.4 per 1,000 children. In 1997, Harvard Medical center conducted a random survey throughout the U.S. – the survey was focused on the use and prevalence of spanking as a form of discipline. The survey revealed 67% of families used spanking at least once a week for discipline. While spanking is a traditional mainstay for discipline and it is believed by some to be commanded in the Bible—specifically in the book of Proverbs—hitting/spanking is abuse to a child. We need to look at the experience of the child. That is what society did when laws were enacted regarding domestic violence—the victim is the one who knows if they were harmed—not what the abuser decides is abuse.

Tragically, when hitting involves children we are oblivious to that belief. Isn’t it tragic that if I hit a stranger I could be arrested, but if I hit my child with more force, it would be considered OK? Granted, we are mindful that bruises, lacerations, welts, etc. means the ‘discipline’ has gone too far.

Whether the verbal, physical or sexual abuse is mild or extreme; occurred once or several times is irrelevant, because the damage is incurred immediately. The damage is profound, extensive and pervasive—it is a soul injury. To fully understand and appreciate the depth of this emotional pain, I will quote one of my clients, “Even my blood hurts.” Time, money, pills, surgery, marriage, children, moving, jobs, divorce, perfectionism can not heal the pain.

Traditional psychiatric and medical practices treat symptoms—depression, panic attacks, anxiety, eating disorders, MS, lupus, cancer, Parkinson’s disease, etc. and ignore the core issue—what the person experienced. Traditional psychiatric and talk therapy does not focus on uncovering the core issue that prompted the person to have the emotional pain. Nor does traditional psychiatric and talk therapy focus on healing the emotional wound or the trauma trapped in muscles and tissue. Traditional psychiatric and talk therapy focuses on creating better coping mechanisms. Coping through life is not living life. Living life means one is free to accomplish their hearts desires—without experiencing fears, doubts, anxiety, panic or struggles with low self-esteem or feelings of inadequacy.

In order to heal completely—mind, boy, spirit—a multifaceted healing process specifically focused on verbal, physical and sexual abuse recovery and diligent work is the most effective; wherein the survivor can replenish their emotional and spiritual identity and empowerment.

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