You can now log into your UpToDate account using your SCHS credentials from anywhere, and you no longer need to authenticate onsite every 90 days if you are using it off-campus! You can connect your UpToDate account to your SCHS login without losing your CME, bookmarks, or account settings. Please follow the instructions in this tip sheet.
New users can also now register for an account remotely or through the mobile app without having to first create an account while on campus or connected to the St. Charles VPN. Simply click Sign in with St. Charles Health on the UpToDate website, and enter your credentials when prompted.
Grand Rounds - April 11, 2025 "MS Pathways to Cures-Research Update"
Speaker: Bruce Bebo, MD. Executive Vice President, Research for the National MS Society.
Objectives
Recognizing that MS research has reshaped life for people with MS over the past 75 years and understanding the three interconnected pathways: Stop, Restore, and End.
Understanding the significance of the Pathways to Cures Research Roadmap and what it aims to achieve for MS research.
Analyzing the interconnections between the Stop, Restore, and End pathways and how they relate to each other in the context of overall progress toward MS cures.
Evaluating the success of the MS Society’s efforts in collaboration with over 30 MS organizations in driving forward the Pathways to Cures Roadmap.
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].
Grand Rounds - April 4, 2025 "It Takes Guts! Connecting the Brain, Gut, Diet & Microbiome"
Speaker: Joseph B. Weiss, MD. Clinical Professor of Medicine, Division of Gastroenterology,UCSD School of Medicine.
Objectives
Recognize that humans are complex superorganisms with close interactions between the brain, gut microbiome, and diet.
Define the human microbiome and recognize that genes are often transferred between organisms and influenced by epigenetic factors.
Describe the healthy human gastrointestinal tract as hosting trillions of microorganisms, most of which are commensal and beneficial.
Understand how the microbiome can be dramatically influenced by antibiotics, pharmaceuticals, and epigenetic factors.
Describe the multi-directional pathways between brain, gut microbes, and diet.
Recognize that recent advances in genomics, metabolomics, proteomics, transcriptomics, epigenetics, and technology have revolutionized the understanding of the role of the microbiome, diet, and gut in human health and disease.
Review that the information concerning probiotics is preliminary and has the potential to cause harm as well as benefit.
Advise patients to use probiotics as they would antibiotics, with caution and to monitor changes in health.
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].
Physician Associate Mandi Bryson went into family care medicine because she wanted to help people. “I love building relationships with patients,” said Bryson, who works at St. Charles' Bend East Family Care Clinic.
But in recent years, Bryson found herself tied to her computer more and more, due to increasing documentation requirements, inbox messages and phone calls to return. “There was a mental burden of all the stuff that you have to do that’s not taking care of the patient in front of you,” said Bryson. She found herself leaving the clinic about 6 p.m. and then spending an additional hour or two at home every night completing required documentation on the computer.
Last spring, the stress became so overwhelming that Bryson considered leaving the profession all together.
“I was desperate. The demands were so heavy, I was looking for other jobs. I knew I couldn’t continue to do this to myself. What was a life-giving job had become too much. I thought, ‘Either I get something that helps me, or I have to leave this work that I love,’” she said.
Bryson got help with the burdens of technology from an unlikely source - new artificial intelligence software called DAX. Not only has this technology cut charting time significantly, but it has also allowed Bryson and other physicians to better connect with patients during exams. That’s because the technology completes the documentation, allowing providers to focus all their attention on their patients.
“This has been a game changer. I’ve stopped applying to different jobs,” said Bryson, who says she is now leaving work by 5:30 p.m. with notes done and an empty inbox. “I love my work. There are still challenging aspects, but documentation isn’t one of them. I can focus more on the parts that bring me joy.”
She is one of approximately 55 primary care providers at St. Charles now using DAX and there are plans to bring the service to other clinical areas.
“DAX allows providers to get to do what called them to medicine in the first place – caring for patients,” said Dr. Matt Clausen, ambulatory chief medical informatics officer, who led the effort to bring DAX to St. Charles.
DAX is more than a transcription service; it uses artificial intelligence to summarize and provide accurate notation within a patient’s electronic health record. Physicians using DAX first get permission from patients to use the service – then, they pull the app up on their phone as they walk into a patient’s room. The provider conducts the exam with the patient as usual – but there is no need to take notes or sit by a computer. Instead, the physician can focus entirely on the patient while DAX listens in the background and fills in the patient’s chart. Providers review the notes to ensure accuracy, but it significantly cuts down the time spent charting.
Clausen says burnout among physicians has increased in the past few years and he believes that is directly linked to the demands of documentation. This AI tool was brought in specifically to help with burnout and the results have been overwhelmingly positive.
Before using DAX, 47% of St. Charles primary care providers said they were “definitely burning out” and experienced more than one symptom of burnout. After implementing the DAX program, that dropped to just 7 percent of providers. Physicians using the technology also reported higher job satisfaction (88%), that they are more likely to continue practicing medicine (75%), that they have better documentation quality (88%) and better work-life balance (75%).
“We are early adopters for this technology and we are already seeing it help us with recruitment and retention,” said Clausen.
But perhaps the most significant aspect of this technology is its impact on patients. Eighty-nine percent of patients said that their provider was more focused during their visit when they used DAX and 100% said their provider spent less time on the computer.
Dr. Nathan Thompson, a family care physician in Redmond, says doctors have a choice: Do I chart in the room and look at my computer or do I give my attention to the patient and try to remember everything they are saying to document later? “It’s a horrible tension,” he said.
Now, with DAX, that tension is gone.
He said documentation used to take him up to 20 minutes per patient before DAX. Now it’s down to minutes of review. For Thompson that means he now has time to volunteer coaching soccer at a local high school and he is more able to be present mentally, physically and emotionally to his family.
Thompson worried that some of his patients might be skeptical of the technology. “I worried a lot of people would not go for it, but it’s been the complete opposite. I am very grateful to our community for accepting it. I want them to know this is only something we use to be more present as humans. It’s allowing us to be more human in the room.”
Bryson agrees that her patients have also been very supportive of the technology.
“I’m hearing from patients, ‘you were really listening; it felt like you weren’t rushed; I’ve never had an appointment like this.’ It’s so nice to not have a computer between me and them,” she said. “St. Charles really offered something that helped me where I needed it most. Day-in and day-out, this is making a difference and I am very grateful for that.”
As a physician and as a parent, I’ve never seen a case of measles. I’m not alone. The World Health Organization declared measles eliminated in the United States in 2000, thanks largely to an extremely effective vaccination program.
Because of the Centers for Disease Control’s recommended childhood immunization schedule, measles has been an afterthought for decades in America — if families thought about it at all. For many, receiving the MMR vaccine, which stands for measles, mumps and rubella, has been as routine as getting dressed in the morning and brushing teeth at night.
However, measles remains a serious disease: Airborne and extremely infectious, it can cause severe illness, complications and even death. Before there was a widely available vaccine, an estimated 48,000 people were hospitalized and 400 to 500 people died of measles in the U.S. each year.
Because it is so contagious, measles is a significant community health problem, and I firmly believe community challenges require collective solutions. With that in mind, I hope you’ll watch this video:
Our Central Oregon health care community is small, but strong. Our providers often work across organizations on important issues that impact us all. A handful of local pediatricians meet regularly to discuss emerging public health concerns for our kids. When Dr. Suzanne Mendez, a pediatric hospitalist at St. Charles, said this group was concerned about measles and wanted to work together on messaging that would encourage curiosity and conversation between parents and providers, we jumped at the chance to help.
I want to personally thank Dr. Julie Ansbaugh of Central Oregon Pediatric Associates, Dr. Michelle Mills of Summit Health and Pediatric Nurse Practitioner Ellie Millan of Mosaic Community Health for joining Mendez and her fellow St. Charles physician, Dr. Carey Allen, in the video. And I want to thank COPA, Summit and Mosaic for their vital partnership as we all work together to ensure Central Oregon is a safe and healthy place to live.
Community challenges require collective solutions. Here it is in action.
Just one day old, Gracie Abbott was swaddled and cozy, taking turns snuggling in the arms of her dad, Brennan, and her mom, Teagan, in a private room in the Family Birthing Center at St. Charles Bend. These tender early moments were particularly sweet for the Abbotts, as Gracie came close to spending her first days of life in the hospital’s Neonatal Intensive Care Unit.
When Gracie was born, she had fluid in her lungs, struggled to breathe and her oxygen level was low. But thanks to a newly implemented treatment called Interpulmonary Percussive Ventilation (IPV), respiratory therapists were able to remove the fluid and Gracie was able to safely stay with her parents.
“Without that machine Gracie would’ve been in the NICU. It was pretty scary; it felt like we almost lost her,” said Brennan Abbott, a Prineville resident.
Gracie is one of 116 infants who received IPV therapy since the treatment was implemented at St. Charles in March of 2024. The treatment is now available for infants born in Bend and Madras. Of those 116, 60% (70 infants) were able to stay with their parents and avoided the NICU.
“We see this as a tremendous success,” said St. Charles neonatologist Dr. Sue Ann Smith. “When infants are able to stay with their mothers, there are so many benefits – I call it the ABCs. It helps attachment, breastfeeding and it helps keep costs down for families.”
It also keeps those NICU beds open for infants who are in greater need.
How IPV works
Blake Andrews, manager of respiratory therapy at St. Charles, explains that with IPV, a mask is placed on the infant and then a pulsating airflow is pushed into the lungs. These little jets of air help move fluid out of the airways.
“The small bursts of air get around and behind the fluid trapped in the lungs, forcing those secretions out,” said Andrews. “It’s a pretty short intervention for a pretty big outcome.”
IPV was already used with adult populations, but was rarely used on infants, explained Smith. After attending a training by a NICU doctor from Legacy Salmon Creek hospital, Smith thought it was worth bringing to St. Charles.
Smith says infants often get fluid in their lungs, as the womb is a fluid-filled environment. This is especially common with babies born via C-section, as the fluid is often pushed out of the lungs in the birth canal.
“Sometimes babies have trouble making the transition and retain fetal lung fluid or meconium,” said Smith. If a baby is struggling with fluid in the lungs, the first step is to use a CPAP machine, a device that uses mild air pressure and is commonly used to treat sleep apnea.
“We need to get the air in there to keep the lungs open between breaths,” said Smith.
If after 20 minutes the baby is still in distress, they used to be sent to the NICU, where they receive more intensive care and treatment by specialized caregivers. But now, respiratory therapists can use the IPV treatment. The treatment is used for 10 minutes and then if there’s no positive change, babies are moved to the NICU.
The therapy is also available at the Family Birthing Center at St. Charles Madras, which allows infants to stay in Madras rather than having to transfer to St. Charles Bend for the NICU.
“We really want our babies to get to stay with their mothers, so this is really exciting,” said Smith.
And for the Abbott family, keeping Gracie close by during her first few days of life meant the world.
“I wouldn’t have wanted to leave her. I’m so glad we got to stay together,” said Teagan Abbott.
At St. Charles, we provide specialized ambulatory pharmacy services designed to support patients with complex medication needs. Our pharmacists work closely with your care team at our St. Charles Family Care clinics to ensure safe, effective and convenient medication management—all in an outpatient setting.
Our services
Personalized consultations to optimize medication effectiveness and minimize side effects.
Support for conditions like diabetes, hypertension, heart disease and more.
Access to high-cost, high-touch medications with expert guidance.
Convenient vaccinations and health screenings.
Help navigating prescription costs and coverage.
Our experienced team provides one-on-one support, right at the clinic, to answer your questions and manage your medications. We work seamlessly with your provider to ensure continuity of care. Our goal is to improve your health while making medication management easier.
Body
Susan A. Ellings Rehabilitation Unit
Lives are changed for the better every day inside St. Charles’ inpatient rehabilitation unit, where patients recover from traumatic injuries and serious illnesses. This is a place where every step forward is a triumph as patients and families heal together.
But the current facility is outdated and too small to meet the needs of all those who could benefit from it. Thanks to the generosity of our community - including donors from our annual Saints Gala and individual contributions - we are well on our way to building a new, state-of-the-art, inpatient rehabilitation unit. The Susan A. Ellings Rehabilitation Unit, named by an anonymous donor in memory of a family friend who passed away in 2014, is set to begin construction in 2026. Susan's daughter, Julie Cox, a nurse who works at St. Charles said, “It's a true honor to see that my mom's legacy will live on through the walls of St. Charles and we are so grateful for the donation. She was such a treasure to this earth. I hope that her love for life and radiant joy serve as a beacon of positivity for those who need it and is felt by all who enter the unit."
Making room to heal
The current unit supports more than 350 patients every year and those patients experience tremendous success, with about 97% of them discharged home without readmission. But the demand is far higher than what the current unit can provide – with hundreds transferred to other programs outside of the region due to lack of space each year.
That’s why St. Charles is setting out to build a new, state-of-the-art, 23-bed unit. The new space will be designed with our patients, their families and our caregivers in mind to ensure we can care for our community now and into the future.
The new unit will include larger patient rooms to accommodate families and space for world-class services and new technology that will help patients re-learn activities like walking on the trails system in Central Oregon or cooking meals for themselves in an ADA accessible kitchen.
Patients spend an average of 12-14 days particpating in occupational therapy, physical therapy, speech therapy and orthotics appointments for 3 hours/day at least 5 days/week.
This spring more than 2,000 third graders throughout Central Oregon will learn about brain injury prevention and helmet safety through the Train Your Brain program taught by local athletic trainers, now part of St. Charles Health System. This program, formerly led by The Center Foundation, provides interactive assemblies and free multi-sport helmets to local elementary students.
“St. Charles is proud to continue this injury prevention program and to continue providing athletic trainers at eight local high schools, helping to ensure the safety and education of students in Central Oregon,” said Christy McLeod, Senior Vice President of Specialty Service Lines for St. Charles.
For 15 years, the Train Your Brain program has distributed more than 1,000 free helmets for local students every year, ensuring kids have proper head protection for activities such as bicycling, skateboarding, rollerblading and scooter riding. The 2025 program begins in April, just in time to prepare students for a safe and active summer.
The presentations include interactive demonstrations on injury prevention, helmet safety, proper fitting and care. A highlight of the assembly is the melon drop, which emphasizes the importance of wearing a helmet. Following the presentation, St. Charles caregivers and volunteers will properly fit free helmets for every student who needs one.
“Helmet safety is a simple yet crucial way to prevent serious head injuries in children,” said Stuart Schmidt, Athletic Training Program Manager at St. Charles. “Through the Train Your Brain program, we aim to instill lifelong safety habits in young students, empowering them to protect their brains while having fun. We also want to thank our school districts for recognizing the significance of this safety initiative and to our partners for making it possible to provide free helmets to every third grader in Central Oregon who needs one.”
To learn more about Train Your Brain and our athletic trainers, visit our webpage.
Grand Rounds - March 14, 2025 "Heads Up: Update on Headaches and Migraine"
Speaker: Stewart J. Tepper, MD. Professor of Neurology, Dartmouth Geisel School of Medicine.
Objectives
Utilize specific questions when obtaining a headache history.
Become familiar with the wide array of pill, nasal, and injection acute migraine therapies.
Become familiar with various headache prophylaxis options, including new CGRP Inhibitors.
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].
