Grand Rounds - February 2, 2024 "Hypertension Update 2024"
Speaker: Florian Rader, MD, MSc. Co-Director, Clinic for Hypertrophic Cardiomyopathy and Aortopathies; Associate Director, Non-invasive Laboratory; Hypertension Center, Cedars-Sinai Smidt Heart Institute.
Objectives
Identify and avoid common errors in the measurement of blood pressure.
List the latest guidelines for blood pressure management.
Evaluate how these guidelines direct care of individual patients.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
St. Charles’ Board of Directors has a new chairperson: Ann Rhoads, a 10-year resident of Bend.
Rhoads joined the Board in 2021 and spent the past year as Vice Chair, shadowing outgoing chairperson Jamie Orlikoff to better understand the role and its responsibilities. (Orlikoff will remain on the Board.)
Previously, Rhoads served on two St. Charles committees, one focused on investment and another on audit and compliance. She was a natural fit for those after her 33-year career as an audit professional with PricewaterhouseCoopers, she said.
“My background is in finance and accounting,” Rhoads said. “Serving on this Board appealed to me because of my interest in health care in and of itself, and how it’s being delivered.”
A former member of the local Volunteers in Medicine Board and a current member of the Tower Theatre Foundation Board, Rhoads also joined the St. Charles Board because of her commitment to giving back to the community she has called home for a decade.
“I have a very strong affinity for the fact that we have an excellent health system in Central Oregon that serves the community and is interested in making the community healthier,” she said. “When you live here and you see that every day, you want to be a part of it and help make sure it’s going to be around for a long time.”
After focusing on workforce and financial rebuilding in 2023, St. Charles is well-positioned, Rhoads said, to pursue initiatives within the Board’s three priority areas for 2024:
Sustainability: “We got our financial house in order last year,” she said. “Going forward, we can now really reinvest in the organization. We can make sure we’re providing the right services and the right number of beds for the communities we serve. And we’re prepared to do some fairly big things, like the Redmond Cancer Center. That’s an exciting place to be.”
People and culture: “At one point, we had more people leaving the organization than staying with us. But we’ve stabilized that. We’re on a positive upswing and we’re building the nursing staff back to where it needs to be,” Rhoads said. “We want people to be proud to work at St. Charles and to be happy in their jobs. We want to be a place with an irresistible culture, where people feel respected and valued for not just their skills but simply who they are.”
Safety and quality: “Obviously, safety is Job One for a hospital. We closely monitor the safety and quality of the care we provide and we’re working hard to develop new ways to improve,” she said. “We’re well on our way to where we need to be, but of course this is the kind of thing that needs constant attention, and it’s intertwined with having the right people in place and giving them the tools they need to do their jobs.”
Overall, Rhoads is looking forward to serving as Board Chair because she believes St. Charles’ future is as bright as ever.
“There have been bumps in the road, obviously,” she said, “but I feel like we’re on the right track.”
Lloyd Fobi, MBA, MEng Senior Vice President, Chief Information Digital Officer
Lloyd Fobi serves as the senior strategic information technology leader of St. Charles Health System. He holds a Master of Business Administration in entrepreneurial finance from Willamette University along with a master’s degree and a bachelor’s degree in engineering from Oregon State University.
Lloyd was formerly a member of the senior IT leadership team at MultiCare Health System based in Tacoma, Wash.
Body
Tom Foster, MBA Vice President, Strategic Initiatives and Transformation
Tom Foster works with the leadership team of St. Charles and our community partners to define and deploy strategic initiatives needed to grow, improve and transform the way health care services are provided to our patients and within our communities. He grew up in Bend, Oregon where his dad previously worked at St. Charles as a radiologist.
Tom has a Bachelor of Arts from Whitman College and a master’s in business administration from the Melbourne Business School in Australia. Prior to joining St. Charles, Tom worked as a consultant for Point B and Ernst & Young.
A major investment in training Madras and Prineville nurses over the past three months means more patients in Jefferson and Crook counties can get the care they need closer to home rather than transferring to Bend, Redmond or beyond.
St. Charles spent nearly $500,000 to train nurses at the two hospitals, giving them the additional breadth of knowledge they need to provide the same level of care patients receive at Intermediate Care Units (IMCU) in Bend and Redmond. IMCUs serve as an essential link in the health system, taking care of people who don’t need the long-term critical care of an Intensive Care Unit, but who need a higher level of care than is typically available in a Medical Services unit.
To provide IMCU care, nurses need to have a robust understanding of things like administering heart medications and advanced life support techniques.
“The skill set has always been there,” says Dr. Maggie King, chief medical officer at St. Charles Prineville. “We just expanded it.”
As an example, a patient with Type 1 diabetes who is experiencing diabetic ketoacidosis – a serious condition caused by lack of insulin – requires an insulin drip and, often, an overnight stay. That’s a treatment typically provided in IMCUs.
Before the new training, patients with diabetic ketoacidosis in the Madras and Prineville areas had to be taken to Bend or Redmond. Now, those patients can stay at their local hospital to get the treatment they need, saving them a trip across Central Oregon and keeping them closer to friends, families and other resources.
And to be clear, it’s not just diabetics who benefit. Any patient who needs hospital care, but not ICU-level care, can stay closer to home.
“It’s been a wonderful thing for our community,” says Kassidy Apperson, a registered nurse at St. Charles Prineville who was in the first cohort of IMCU trainees last summer.
The training took place in Bend over the course of three months, beginning with classroom instruction and then hands-on learning in patient-care units, said Todd Shields, vice president and hospital administrator for Madras and Prineville. Another cohort is scheduled to start in February.
IMCU-level care started in Madras and Prineville in August. Since then, more than 40 patients who would’ve previously transferred have been treated in the two hospitals, Shields said. This not only saves the patients and their families the hassle of moving hospitals, he said, it also frees up ambulances and emergency workers, as each transfer removes them from service for about three hours. Finally, keeping these patients close to home reduces patient load for caregivers in Bend and Redmond, opening space for people local to those towns.
Nurses in Madras and Prineville have greatly benefited from the training, too. “(We’ve) really seen from the staff this level of pride,” King said. “There is a stronger sense of capability in keeping patients here and a push to care for them locally.”
For caregivers who are wholly dedicated to doing what’s best for their patients, that’s a great feeling, said Apperson.
“Being able to keep (them) in the community … has been so good for our patients,” she said. “It’s just awesome.”
To kick off a new year, I want to tell you about a project that we’re really excited about at St. Charles – a project that aims to make Central Oregon healthier, now and for generations to come.
It’s called the Three Sisters Rural Track Program, and it’s a collaborative effort between St. Charles and our partners at Mosaic Community Health, Indian Health Services in Warm Springs and Oregon Health & Science University in Portland. Together, we are building a rural medicine residency program that will create a pipeline of uniquely trained doctors to Central Oregon.
This program – the first graduate medical education program in the region – will significantly transform access to health care in Jefferson, Crook and Deschutes counties and beyond, especially in outlying rural areas.
Why does this matter? Because rural communities across the United States are facing a critical shortage of primary care doctors. This shortage can force patients to drive long distances for care or visit Emergency Departments with routine health concerns. Even worse, they may forego medical care altogether.
Central Oregon is not immune to this shortage. In the tri-county area, we are expecting a shortage of at least 100 primary care doctors by 2030.
Which is precisely why we’ve prioritized the Three Sisters program, and a team of St. Charles caregivers has been working hard to bring it to life. Starting in July, residents will spend one year training at OHSU, and then two subsequent years in residency in Madras. These residents will complete core training and elective training at St. Charles, Mosaic Community Health and Indian Health Services in Warm Springs, giving them culturally inclusive, full-spectrum training in family medicine.
And here’s the long-term effect: Studies show that roughly 55% of physicians stay and practice within a 100-mile radius of their residency program site. Bringing them to Central Oregon to train significantly increases the chance they’ll choose to remain here, put down roots here, serve patients here and increase access to health care here.
That’s why I’m excited about this program, and I hope I’ve stirred some excitement in you, too. This is important, and the future of health care in the region is an issue that should matter not just to St. Charles, but to every person who lives here.
The St. Charles Foundation is raising funds for the Three Sisters program right now. If you’d like to invest in the future of health care in Central Oregon, you can donate through the Foundation’s website. To learn more about how you can help, please contact Angela Saraceno at [email protected].
A cancer treatment now available at St. Charles has the potential to transform cancer care for women in our community who have gynecologic cancer, according to Dr. Whitney Sumner, a radiation oncologist.
Dan Nicewonger and Dr. Whitney Sumner
For some types of gynecologic cancers, like cervical cancer, treatment using external beam radiation can limit the delivery of an effective dose due to damage to surrounding tissues as it passes through the skin and surrounding organs to get to the tumor or area that requires treatment.
This newly available treatment, called brachytherapy, reduces that risk by providing radiation from INSIDE the body. This reduces possible damage to skin, and nearby organs – and provides even more effective targeted treatment. It’s able to treat right at the site of the tumor with minimal spread of dose, according to Sumner.
Sumner has been working with physicist Dan Nicewonger and a team at St. Charles to bring this new treatment to St. Charles for more than a year. In December the team was able to treat their first patient and already have several more on the schedule. Before brachytherapy was available at St. Charles, patients would often travel for treatment or choose to forego radiation treatment all together.
For some patients with endometrial cancer, brachytherapy alone is the recommended therapy to reduce the risk of local recurrence. “External beam radiation therapy is too aggressive of a therapy for some of these early-stage patients – a lot of patients would forego any therapy or have to travel to Portland,” said Sumner.
Currently, St. Charles Bend is able to provide brachytherapy treatment to patients experiencing endometrial cancer, cervical cancer and other gynecologic cancers.
Nicewonger explains because the radiation is delivered through a closed system hollow tube inserted into the patient’s body, the patient never touches anything radioactive.
The patient does not feel or hear anything from the radiation source during treatment.
The radiation dose is delivered from a tiny radioactive source material, smaller than a rice grain, that travels along the hollow tube. The physicians are able to shift the direction and location of the dose allowing targeted treatment within a millimeter in accuracy.
“It’s actually kind of simple – it goes along a path and is very predictable,” said Nicewonger.
In the future, Sumner and Nicewonger would like to see brachytherapy also offered to treat skin cancer, prostate cancer and potentially gastrointestinal cancers. But for now, they are just excited to begin making a meaningful difference in the lives of many patients.
Sumner expects that they will treat about 25-30 patients a year, with each of those patients requiring about three to five treatments.
“Our hope and long term goal is to optimize our process and build on our expertise to become a destination for brachytherapy,” said Sumner.
For Sumner, this profession was a natural calling. As someone who always loved math and science, but also wanted to help people directly – radiation oncology, and particularly brachytherapy, is a perfect fit.
“How often do you get to use math and physics that are so profoundly interesting, in a way that has a real impact on this person sitting in front of you?” said Sumner. “I love this work. It means we get to keep our Central Oregon patients closer to where they feel comfortable to get the care they need.”
Grand Rounds - January 19, 2024 "The Difficulty with C‐Difficile: Guideline Updates and Optimal Identification and Treatment Strategies"
Speaker: Thomas C. Cesario, MD. Emeritus Dean and Professor of Medicine, Division of Infectious Disease, UCI School of Medicine.
Objectives
Describe the burden of disease on patients with CDI and the consequences of inappropriate diagnosis and treatment.
Recall the optimal sequencing of tests in the diagnosis of CDI, and apply that information to patient cases.
Identify present and emerging therapies and best practice in treating CDI.
Formulate a treatment plan for a patient with CDI .
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
