And in reality, with community health centers absorbing the burden of medical care for the uninsured during the worst economic crisis since The Great Depression, does it make sense for the state to be reducing or eliminating funding and programs that support community health centers?
We, along with most other Californians, would say no.
[...]
By eliminating traditional clinic programs, in essence, millions of uninsured Californians would be left with nowhere to turn but to hospital emergency rooms. With approximately 60 percent of personal bankruptcies being the result of unmanageable medical bills, community health centers help keep people from delaying care and incurring more catastrophic and costly care that could lead to personal financial crisis.
In 2008, when the governor first proposed these reductions, the non-partisan Legislative Analysts Office reported that cuts to traditional clinic programs made little sense and would bear no net savings to the state. The analysts office asserted that the governors proposal would only put up more barriers to health care and cause more shifts to expensive venues where patients go to receive their health care.

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Detoxification has been a lengthy discussion ever since. Whether to detox or not, is up to you. Even though you are 'healthy' this does not mean that you don't need to detox. Sure our body does this on a continual basis, our kidneys and livers are constantly working by cleaning out all the pollutants (smoke, caffeine, chemical-based products etc) in our body. Detox strengthen our organs back to optimal function. Basically, this is done through fasting, therefore resting the organs and stimulating the liver by pushing away the toxins from the body. Nourishing the body with healthy nutrients is also done to maintain optimum health. It has been practiced for centuries around the world by different cultures. Although a lot of people want whole body detoxification, some wants to have a detox on a particular organ only, such as the kidney, liver or colon. During kidney cleansing, herbal supplements and juices are used to dissolve and wash out kidney stones; particular foods are consumed in liver cleansing causing the gall bladder and liver to remove fatty deposits and toxins out of the body. Colon cleansing on the other hand, gently flushes the colon with water providing a pathway for the release of toxins. There are also techniques used in whole body cleansing such as: Fasting. Water or juice fasting is applied for a period of time to lessen toxic loads in the body causing the body to heal itself and nourish inside out. Parasite cleaning. Right amount of pills or tinctures made out of bitter herbs are consumed to build an unreceptive environment for the parasites inside the body. Contrast Shower. The contrast among hot and cold water enhances circulation, helps in detoxifying thus having a stronger immune system. This also helps by bringing oxygen, nutrients and immune cells towards damaged and stressed tissue and flushes metabolic waste and other toxins. Sauna, yoga, exercise, raw food dieting and dry skin brushing also enhance the body's natural cleansing process. Other Detoxifying aids There are a number of safe products that helps in the cleansing process such as cleansing supplement packages (with easy-to-follow instructions), detox foot patches, commercially prepared detox teas, Epsom salts, high-class multivitamins for daily intake and antioxidants like Q10 and E that can be found at health food stores. Before and after side effects: As the procedures differ, so do the benefits. During the detox, you'll most likely feel the side effects that take place during the first few days such as headaches, feeling weak, sore muscles, cranky moods and unable to sleep soundly. There are also a number of positive side effects days after the cleansing process. You will feel energetic, mental clarity improved, skin is clearer, improved sleep, and have a positive attitude in life for a fresh start. Detoxification is safe and beneficial for our health. It is suggested that each one should at least have a short detoxification program yearly. However, children, nursing mothers, and patients with cancer, chronic degenerative illness and tuberculosis should consult their physician first for approval and supervision or find someone who is familiar with detox. If you decide to award your body with holiday, find a nutritional therapist who is familiar with detox. Here's how: You can call your friends who are into health foods and alteative medicines, ask them for a person who they can refer. Another way is to search in the yellow pages under nutrition or by looking for ads in health publication in your locality. Get the name of someone you found whose name appears in more than one place and check for his profile, like from which school he/she attended the training and if it's an accredited one. Also ask how long he's been in practice.

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Parks district already opens fields for naming, but is open to sponsorship of the entire park
By Matthew Graham / The Clackamas Review
Tue, Jun 16, 2009, Updated Jun 16, 2009
What do you think of names for the new park in Happy Valley: Happy Valley Park? Sunnyside Community Complex? How about Safeway Park.

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Schools throughout the majority of the nation now require physical education. In fact, forty-two states make physical education class mandatory to graduate. What is the result of the emphasis on physical fitness, besides taking a stab at the growing obesity issue among our young? A high occurrence of sports related accidents and even death. What happens to those students who are obese and required to participate in sports?
Imagine a three hundred and twenty seven pound student running up and down the court for twenty minutes in a hot gym without being given the opportunity for water breaks. The regular physical education teacher was out and the class was being supervised by an art teacher. Apparently the art teacher was in pretty good physical shape since he played basketball with the students. The three hundred twenty pound student continued playing and after twenty minutes, collapsed. He was rushed to a nearby hospital and was pronounced dead.
Another trend in schools right now is the frequency of substitute teachers. The student that has a health issue gives the regular teacher the doctors note excusing the student from activity, but the substitute teacher who doesnt physically see the requires the student to participate. This irresponsible supervision results in catastrophe.
How many more cases of students dying or suffering brain damage or spinal injuries do we have to read about? Pad all areas in the gym that a student has the potential to run in to. When a students skull slams into a concrete wall, it most certainly will be a devastating impact. Now that there is a lot more activity in the gym besides basketball, schools need to responsibly pad more than just a 12 foot backstop.
Patrick Conlon, president of SportsGraphics (the original wall pad company) says that his company has been making wall pads for schools for two and half decades. The common question his safety and image consultants hear is, what am I a liable to pad? I tell them that they need to adopt the prudent, reasonable standard of protecting their students. They will be safe with that premise. The amount of padding depends on the amount of usage in the gym. If the gym is used for kick ball, drills and cheerleading then you need to pad most of the gym, or at least the cement walls and any equipment, poles, columns etc. that protrude.
When athletic directors and administrator question what they are liable for, are they forgetting common sense? If it poses a threat; be proactive to prevent injuries. If school budgets are tight, educate parents on safety issues and let them see you going to extra measures to make your facilities as safe as possible. Raise the money for superior safety precautions; it will save lives, injuries and potentially millions in lawsuits.
For more information on how to make your facility and programs safer follow the risk management plan written by Dr. Richard p. Borkowski, EdD, CMAA in his most recent book Coaching for Safety, A risk Management Handbook for High School Coaches, published by ESD112. Also visit www.sportsgraphicsinc.com for wall padding, bleacher end-closures, crowd control barriers, sideliners, and other safety products manufactured specifically for high schools and middle schools.

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Roadblocks to Health Care
- Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care.
- Women are also more likely to report fair or poor health than men (9.5% versus 9.0%).
- Women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care.
A Patchy System of Health Insurance
- Twenty-one million women and girls went without health insurance in 2007, and another 14 million relied on coverage through the individual insurance market.
- Women are less likely to be employed full-time than men (52% versus 73%), making them less likely to be eligible for employer-based health benefits themselves.
The Failure of the Individual Insurance Market
- Important state and federal laws that protect individuals with employer-sponsored insurance do not apply to health insurance sold in the individual market.
- Data from e-health insurance show that there is a wide variation in premiums by state, by plan, and by age and gender of the policyholder.
- In particular, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
The Price of Access
- In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men.
- Women face a higher financial burden from medical care than men. Nearly one-third of women aged 50 to 64 are in households that have spent more than 10% of their income on health care, compared with one quarter of men of similar age.

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Targeting a $150-billion-a-year chink in the nations healthcare armor, Ingenix is shoring up its payment accuracy technology with the acquisition of AIM Healthcare Services, Inc.The all-cash transaction, which became effective June 1, gives the Eden Prairie, Minn.-based company access to AIMs INTELLIJET universal connectivity platform, AIM, based in Franklin, Tenn., uses that platform to offer claims management services for government and cvommercial payers of healthcare benefits and healthcare providers throughout the country.

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After stores in London pulled Red Bull from its shelves and Taiwanese authorities confiscated close to 18,000 cases of the popular energy drink, Hong Kong officials say they found traces of cocaine in samples of "Red Bull Cola," "Red Bull Sugar-free" and "Red Bull Energy Drink. "Officials at the Center for Food Safety said a laboratory analysis found tiny amounts, between 0. 1 and 0. 3 micrograms of the illegal drug per liter, and as a result the drink has now been taken off the shelves of major supermarkets.

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www.bigcatrescue.com.
Why its special: Big Cat Rescue is one of the worlds largest sanctuaries for big cats that have been saved from slaughterhouses and fur farms and retired from zoos, circuses and roadside attractions. More than 150 tigers, leopards, cougars, lions, bobcats, lynx, ocelots and others totaling 16 of the 35 species -- many of which are endangered or now extinct in the wild -- live in spacious, fenced-in
Access to the sanctuary is by guided tour only. Knowledgeable docents from a staff of more than 100 volunteers take groups of 10 to 15 visitors on a 90-minute tour along a winding, level trail of sand through the various cat habitats. As guests learn facts about each cat and their behaviors in the wild, they get a closer look than they would ever get at most zoos. Every cat housed here has a story, and the guides are eager to tell it -- like Nikita, the lioness found living on a concrete slab, chained to a wall by her drug-dealing owner. Or Natasha and Willow, a pair of Siberian lynx rescued from a fur farm where they lived in dirty metal sheds. As much as founder Carole Baskin adores her cats, shed be happier if her service were never needed.
Our biggest purpose here is to put ourselves out of business, says Baskin, who established the facility 15 years ago. What we really want to do is reduce the number of cats that suffer the fate of abandonment and abuse and to encourage protection of habitat and wildlife.

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I adapted this halibut recipe from a fabulous cookbook my sister just gave me called Fast Fish.

Fish:
Ingredients:
1-1.5 lbs halibut
Jar of olive tapenade- I've tried this recipe with both green and black tapenade. I liked the black better. You can also see recipe link for additions to the tapenade.
1 package of italian prosciutto




1. Preheat oven to 350 degrees.

2. Cut halibut into 3 x 3 inch squares (or as close as you can get to this.)

3. Place a piece of prosciutto on a cutting board, put the fish about 1 inch from the end, and then put 1 TBSP of the tapenade on top of the fish and wrap the ham around the top of the fish, tucking in any extra. Repeat with new pieces until fish is all wrapped up.

4. Place the wrapped pieces of fish in a baking dish and place dish in pre-heated oven. Cook until fish is to your liking- we like it on the softer side, but of course that is individual preference. I also like to broil for the last 5 minutes to crisp up the ham. Mmmmm.

We use smaller pieces for our 2 1/2 year old and he can just pick them up and take bites.

Quinoa:
Quinoa is a grain that is relatively higher in protein than many other grains. I love the texture, and also the fact that it is a whole grain but cooks in 15 minutes as opposed to 45 minutes for brown rice. It is common in Peruvian cuisine and can be used in any way that rice is used.

Ratio of 1 part quinoa to 2 parts water.

Rinse quinoa first, then place in pan with water as above. Boil. Turn to simmer and cook until water is absorbed, about 15 minutes. Should be fluffy and the little 'tail' should show on the grains.

Spinach:
We love fresh spinach but also always have several bags of frozen spinach for those times that we need to get dinner on the table quickly. Our 2 year old also prefers the frozen kind, I'm not quite sure why. For our garlic spinach we put 2 TBSP of olive oil in a pan with 3-4 cloves of pressed garlic or 3-4 squares of frozen garlic from Trader Joes. On low to medium heat cook garlic until it just starts to turn a golden color. Add bag of spinach, stir, cover, cook until hot, about 5-7 minutes depending upon your stove.

Tip:
If you have extra proscuitto, tear into small strips and wrap around pitted dates. Put them in the oven on a baking sheet until ham is crispy. I place a few of these on the plate as well but we also send them with our son to school for his snack.

Voilá, 20 min dinner, wheat and dairy free, well rounded. Delish.

In Health,
Dr.

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DANVILLE A Vermilion County prosecutor described 23-year-old Oluwatofunmi Kaiyewu's behavior as "erratic" and "unusual" in the moments before the medical student started swinging a machete like a baseball bat and charged police officers who fatally shot him three times in the chest and once in the head.
A police car tape shows Mr. Kaiyewu standing along Interstate 74 holding a machete after stop sticks brought his car to a halt following a three-county chase. But the tape doesn't show much more, because another police car arriving on the scene pulled in front of the Villa Grove car and blocked the camera's view.

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TUESDAY, May 12 (HealthDay News) — As the swine flu continues to spread across the United States — and most cases continue to be mild — federal health officials said Monday that theyre shifting their focus from individual cases of infection to trying to project what is likely to occur with the virus in the fall.
The U.S. Centers for Disease Control and Prevention is conducting field studies to strengthen our knowledge about how this new virus is spreading, who is most at risk for illness, how effective prevention measures are, antiviral treatment and so forth, Dr. Anne Schuchat, the CDCs interim deputy director for science and public health program, said during an afternoon teleconference.

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Two independent candidates have filed for seats on Berea City Council and two have filed to run for clerk of the Berea Municipal Court.
The filing deadline was 4 p.m. May 4 for independents.
The candidates will appear on the November ballot.
Running in Berea's Ward 2 will be former councilwoman Kathey S. Brown. She will face incumbent Nick Haschka, a Democrat. This will be rematch of the race two years ago. In Berea's Ward 3, incumbent Jim Maxwell filed for re-election. He will be unopposed.
Running against incumbent clerk of court Ray Wohl, a Democrat of Middleburg Heights, will be independents Jason T. Eisele and Mark Stephen Shearer. Both live in Strongsville.

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Are you familiar with Beta-sitosterol yet? If not you should be.
Beta-sitosterol is a naturally occurring phytosterol found in low concentrations in many of the fruits and vegetables that form part of a healthy diet, and has been found to be very beneficial for the prostate gland.
Studies show that from the age of 40, the prostate begins to grow. And as the severity increases, the quality of life decreases.
Beta-sitosterol is relatively more abundant in most nuts and seeds and especially rich in a few plants such as saw palmetto, stinging nettle, pygeum africanum, and pumpkin seeds. High levels are found in rice bran, wheat germ, corn oil, and soybeans.
Beta –Sitosterol For Prostate Health
Beta-Sitosterol may actually help you overcome prostate disease without having to undergo the use of dangerous drugs, debilitating and dangerous surgery, uncomfortable prostate biopsies, harmful radiation treatments and catastrophic microwave damage to your tissues.
Research into beta-sitosterol has shown beneficial effects against a wide variety of human ailments, including BPH.
Beta-sitosterol is the key ingredient in a prescription formulation in Europe, Azuprostat-beta-sitosterol, which has been demonstrated to improve prostate symptom scores and quality of life, and reduce urine volume and residual urine levels. It is also found in concentrated amounts in herbal supplements like Maximum Prostate which is available without a prescripition.
In fact Herbal extracts are sold in Germany and France by prescription only, under the names Harzal and Permixon. They are expensive and contain only a small fraction of the beta-sitosterol contained in a single capsule of Maximum Prostate.
Research also supports the fact that phytosterols, including beta-sitosterol, can reduce cholesterol levels. Beta sitosterol seems to reduce cholesterol absorption in the intestine by about 50% and may have additive effects with herbs and supplements that also lower cholesterol levels.
BPH
BPH is chronic problem characterized by an enlarged prostate gland. The swelling gland presses on the urethra and results in a multitude of problems with urination. BPH is a disease state of the prostate commonly seen in men fifty or older.
Benign prostatic hyperplasia is the most common of prostate problems experienced by men. It is more common among older men, because as a man ages, his prostate naturally enlarges. BPH can cause impotence and even urogenital problems.
Finally phytosterols derived from plants (those such as Beta-Sitosterol) have long been used for the medical treatment of benign prostatic hyperplasia (BPH) in Europe.

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HARRISBURG, Pa. -- Pennsylvania is the latest state to turn up a probable case of swine flu, although officials say the 2-year-old Philadelphia boy is fully recovered and has no known risk factors.
The state Department of Health said Wednesday that the boy became sick on March 23, several weeks before the current outbreak was recognized in the United States.
State health officials also say a case of swine flu can't be confirmed until it is tested by a Centers For Disease Control and Prevention lab in Atlanta.
The Philadelphia Department of Health only recently asked state health officials to review samples from the boy after concerns about swine flu surfaced.
Authorities have confirmed more than 90 swine flu cases in about 10 states.

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The chance of a swine influenza pandemic coming to Ball State University is minimal, but university leaders aren't going to let their guard down, administrators said Monday. Dr. Kent Bullis, medical director for Ball State's Amelia T. Wood Health Center, said the students who need to worry most about the swine flu are those who have a fever of at least 100.

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April 24, 2009
A new series of free talks on how to eat healthier, reduce stress, stop smoking and manage medication highlight the "Got Health?" series sponsored by the Center for Community Health and feature experts from the University of Rochester Medical Center. The talks will be offered from 6:30 to 8 p.m. Tuesdays, for five consecutive weeks beginning May 12. They and will be held at the Training Center of the Greater Rochester American Red Cross, 65 College Ave., between Goodman and Prince streets. Free parking is provided.

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Unlike the tsunami of 2004, the victims of the financial crisis arent so easy to visualize, said Wieczorek-Zeul, making it harder for governments to commit aid money.But there are victims. An estimated 200,000 to 400,000 children will die annually as a result of the crisis, she noted.
Zoellick stressed that for those in the developing world, the crisis isnt a matter of losing your financial cushions a matter of eating, of going to school. And the impact wont end when the crisis ends; it will be felt over a generation.
Responding to the crisis with economic isolationism and protectionism will only hurt everyone, especially the worlds poorest, Zoellick added.
Prime Minister Diogo warned that if we dont act, there is a potential for instability. Instability increases nervousness poverty increases conflict, said Geldof.
A number of panelists noted that the G20 meeting in London last month was the beginning of the basis for a new global architecture.
re living through an historic period, said Geldof. It could all still collapse. There must be new rules for a new world. We must include the most vulnerable on this planet.

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Using knowledge to create knowledge is the major concept of the emerging knowledge society. This way, knowledge becomes sustainable and a tool to realize the millennium goals. But to achieve this in the most effective way, we will have to make inventories of knowledge.
ICMCC (International Council on Medical Care Compunetics) is an international foundation operating as the knowledge centre for medical and care compunetics, making information on medicine and care available to patients using compunetics as well as distributing information on the use of compunetics in medicine and care to patients and professionals.
Knowledge is derived from the synthesis between information and experience. ICMCC is becoming the global guiding platform in bringing information and experience related to medical and care compunetics together, thus creating the necessary inventories of knowledge. As we are aiming at both the patient/citizen and the professional we also target and facilitate the shifting relationship between the two.

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I am currently an administrator, but I speak as a clinician with 33 years of experience in the Pennsylvania State hospital system. Having started as an aide many years ago, I’m happy to see the changes that we have been able to effect in Pennsylvania. In Pennsylvania, we concluded that the use of seclusion and restraint is a treatment failure rather than a treatment. Last year, the Commonwealth of Pennsylvania received the Innovations in American Government Award from the Ford Foundation through the Kennedy School of Government at Harvard for creative approaches in addressing issues of concern for human services. It was interesting that, with more than 1,600 applicants, this issue emerged as one of the 10 winners. I will describe where we were, what we did, and where we are. I should begin by saying there’s no magic solution.
In 1993, the Commonwealth of Pennsylvania operated 12 psychiatric hospitals with an inpatient population of 5,500 patients. During that year, just over 66,000 hours of seclusion were utilized throughout the system. In 2000, with the number of hospitals reduced to nine and the inpatient population at 3,000, the total hours of seclusion were 507. In that same period of time, we went from more than 100,000 hours to just 2,249 hours of restraint throughout the system. It was a dramatic reduction, and we believe that what we’re doing is working for us and for our patients.
Besides the decrease in the number of patients system-wide, you have to ask what made the difference. I will use Allentown State Hospital as a representative example of our facilities. It has 250 beds and is located in eastern Pennsylvania. At one point in its history, it was the highest user of seclusion and restraint throughout our system.
When I first worked at Allentown, it seemed to me that they had a “shoot ’em up, tie, ’em up, lock ’em up” philosophy. One of my very first experiences was responding to a situation in which a patient was very agitated. I saw the staff wrestling with a young female patient, who they then tied in four-point restraints on a bed and used sheets to tie her around her chest, waist, and knees. Then, they put the bed in a seclusion room and locked the door. I asked a nurse, “And now do you press a button so that this room drops into a basement or what?” My humor was wasted on her; she thought this was the standard of treatment.
Patients lived in locked day rooms. Care, custody, and control were the order of the day. We gave injections constantly, we had standing PRN orders (i.e., to be administered “as needed”), and patients who were not restrained were probably overmedicated. Before I went to Allentown, I had never seen a straightjacket, but I frequently saw them in use there. Some patients were living in them 24 hours a day, day after day. When we finally eliminated the use of straightjackets, we collected more than 200 from the various wards. For restraint, we used leather restraints, ambulatory restraints, and sheets. We had standing orders that gave nurses the opportunity to pick and choose whatever they wanted to use on the patients. This was only 6 years ago—this is not ancient history. We also used extensive “protective devices,” which were really by any other name a restraint. Patients were tied into wheelchairs or tied into their beds; wheelchairs were tied to walls to protect patients! from falling.
Seclusion was also a way of life. We had 27 seclusion rooms in use 24 hours a day, 7 days a week. Some patients literally lived in those rooms. A typical day-room scene was very barren: patients were inactive, some were in constant restraints, and there were a tremendous number of fights and assaults. Thus, that is pretty much the way it was.
The first catalyst for change occurred when we had a young woman die in restraints. She was in a restraining chair, in a straightjacket, in a seclusion room, when she had a seizure and died. This was the wake-up call that we needed to make significant changes. Staff injuries were very high; every time that staff had to intervene with patients and put their hands on them was another opportunity for those employees to be injured. We had to find ways to get us out of that staff injury mode. Of course, internal and external advocates, patients’ rights advocates, and changes in Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and Joint Commission regulations spurred us to move even faster throughout our system to reduce seclusion and restraint.
Fearing injury to self or others, staff adamantly asserted that if we didn’t have restraints or seclusion, we would have a lot more injuries. Staff also feared a loss of power, associated with a culture in which we maintain custody and control over patients. To address these issues, we embarked on five elements of change—the first one was leadership. We redefined the standard of care whereby seclusion and restraint became a focus coupled with reducing employee injuries. We used to call seclusion and restraint “special treatment procedures.” We now realize these were neither special nor a form of treatment—if anything, this was a safety issue.
We adopted a mission, vision, and value statement with emphasis on the individual patient’s dignity and respect. This approach may sound trite or naïve, but you need to involve the patient. We created a culture of support for patients and staff, in which the staff played the critical role. We expanded the parameters of active treatment, which I will describe later. We adopted a very simple but comprehensive philosophy of patient treatment: the more you do with patients, the less you have to do to them. This principle proves itself repeatedly as we work with the patients.
We began to say that anger is acceptable. We used to think any time a patient got angry, kicked a chair, or cursed at someone, we needed to resort to seclusion, restraint, or restriction. Everyone here has been angry at some time, and most of you haven’t been tied up for it. It’s normal to be angry or to get into arguments. We began to get staff to accept this. We began to accept some property damage with far more openness than we had in the past. Tolerance became the operative word. We began to tolerate more of what the patients were doing.
The next element we addressed was staff empowerment, which is critical to include all levels, especially the psychiatric aides. When we began this project, we chose one of our most difficult wards, with 35 women, many with borderline personality disorder. We involved the aides and the nursing staff on all shifts and listened to what they had to say. Listening was key, but then you must act on what you hear. We had to challenge the staff to speak up and to reassure them that their concerns were being heard. We had to convince them that we didn’t have the answers and that we trusted them to participate in the solutions. We also had to actively celebrate any successes. When we first started, we would acknowledge and celebrate any single shift of no seclusion or no restraint. We would have ice cream parties and pizza parties, and we would celebrate with the patients and the staff. The patients and the staff were in it together.
They began to want to do it more and more because of the recognition and the things we would do to celebrate. It is critically important to allow time for staff to be able to plan. We encouraged our staff to find a new way to intervene with patients physically. Some of them developed a psychiatric emergency response team process after reviewing a lot of literature and visiting a lot of other facilities. Initially, this team was the team who did the physical restraint. They would come in and apply the restraints. Now, what they do is work with patients in advance so that we don’t have to use restraints.
Training is the next big issue, especially sensitivity and attitudinal training. We taught and emphasized verbal de-escalation techniques. We focused on early recognition. We provided training in safe physical management, because we recognized that it would occasionally be used.
We revamped our entire treatment process and began to involve the patients. We began to listen to them just as much as staff for their input. We gave patients choices in their treatment programs. We use a college catalogue approach to treatment now. All treatment is off the wards now. The ward units are closed from 9 a.m. to 11 a.m. and from 1 p.m. to 3 p.m. every day. We treat the wards as the living area. Therefore, going out to treatment is like going to work for the patients, whether it’s individual psychotherapy, group activities, or rehabilitation workshops.
We have three tracks for patients who are involved. They choose the things they like based upon their needs. We began to do intensive patient satisfaction surveys, and we listened. With previous satisfaction surveys, staff would discount what patients said, assuming they didn’t know what was best for them. We implemented outcome measures on two levels: individual patient outcomes within a program as identified in the treatment plan and overall program outcome goals throughout the hospital.
We developed a patient council, with representatives from each unit. The council meets at least once a month with the hospital executive staff and identifies their concerns. They challenge the executive staff. They told us the food was lousy, so we accepted their challenge and began to eat meals with patients. In a short period of time, the meals changed: there was more choice, access to amenities like condiments and salad bars, many things we generally take for granted. When you see how patients experience their care, it can have a dramatic effect.
The final element is environment, the most important element of which is to reduce restrictions. This point cannot be overstated. Many of the controls, rules, and regulations that we have wear patients down. We reduced the control. We decorated and refurbished, making it more of a home-like environment. We redid the entire hospital, which was barren and sterile. Now, we have large-screen TVs, lazy-boy recliners, wall paper, flowers, and lamps. It is a beautiful environment. When we raised the patients’ level of expectation, they chose to maintain a nice environment and were much more willing to work with us. Seclusion rooms were converted into bedrooms and kitchenettes. We took all the doors off the seclusion rooms in the hospital and had a major hospital-wide celebration. It was a big ceremony—a rite of passage—no more seclusion.
Here are the results. At Allentown State Hospital, we went from 13,000 hours of seclusion in 1994 to zero hours, in the year 2000. We have had no seclusion for over 2 years now. We went from 20,000 hours of restraint to 99 hours last year. We went from 234 total patient injuries in 1992 to 141 in the year 2002.
In conclusion, what I am saying is that there is no magic. It is a quality improvement-and-training process, and it works. We put a big sign on the front lawn of the hospital stating that we were seclusion free. We bragged about it. The staff are now committed to this process. They see that conditions are so much better, and so is the quality of life for our patients.
Question: It may be feasible to do this in a State hospital; some may even argue that you cannot even do that in most State hospitals. But what about acute care facilities?
Answer: I don’t have much experience with acute care facilities, but I would say that the entire process of seclusion and restraint rests a lot in our attitude and our philosophy toward the treatment of patients. I do feel that we should never restrain a patient. There are times that patients have to be restrained for safety reasons. We still do it at Allentown for very short periods of time, just to regain control. It doesn’t go on for hours and days the way it used to go on. We receive patients from the acute care hospitals; they arrive at our door in restraints; and the first thing we do is take them off. We say, “We don’t use restraints at this hospital. What can we do to help you be safe and to help you not injure somebody else?” We involve the patients from the beginning, even though they are acutely sick at that time.
Question: Can you give some specific examples of reducing restrictions and controls? At my acute care hospital, restrictions or controls might involve visiting hours or times to go outsideto smoke.
Answer: Your situation is similar to the one at the State hospital. Smoking is a big issue and we used to restrict smoking. There were often concerns over smoking rules, which would cause patients to end up in seclusion and restraint. We built more courtyards and used more opportunities for patients to go and smoke, which reduced incidents of seclusion and restraint. With regard to a number of potential conflict areas, such as smoking, diet and food privileges, and visiting, we learned to address some issues after the fact rather than getting into a power struggle.
Question: It sounds like another very important issue is that everyone has to be on the same page. Everybody?
Answer: Yes, everybody.

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Hydrogen peroxide is a simple chemical compound composed of hydrogen and oxygen. This chemical is widely used as a disinfectant and a bleaching agent for fabrics and paper. More recently, however, it is being used as an ingredient to aid in the process of teeth whitening. The amount of hydrogen peroxide in the whitening compound or solution will determine how effective the process is. Most concentrations range from three to ten percent. The higher the percentage, the greater the potential effects.
How It Works
The teeth whitening process means that the hydrogen peroxide goes through the enamel material of the teeth and bleaches the dentine and pulp portions of the tooth. Studies done by the American Dental Association indicate that this process does not damage the enamel and is safe.
What The Process Wont Do
The teeth whitening process requires the hydrogen peroxide to go through the enamel to begin the bleaching. If it cannot go through the surface of a material, that means there will be no bleaching effect. If the hydrogen peroxide solution comes in contact with fillings, porcelain, ceramic or gold teeth or restorative work, then there is no change. On the other hand, if there is a porous material used such as cements or amalgams, the result can be one of making those materials softer and porous.
Side Effects
Like any process, there are side effects. These, however, are minor and temporary. Hydrogen peroxide strong enough to be used in the teeth whitening process can cause gums to become tender and teeth to be temperature sensitive.
What About Carbamide Peroxide?
While hydrogen peroxide and carbamide peroxide are related, they perform two very different functions. Carbamide peroxide is formulated to work slowly, providing more teeth whitening but taking longer than hydrogen peroxide. Solutions using carbamide peroxide have a longer shelf life. Hydrogen peroxide, on the other hand, breaks down immediately upon exposure to saliva and oxygen. This means that those solutions containing hydrogen peroxide have a shorter shelf life, but perform the teeth whitening process much more quickly.

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