Grand Rounds - June 2, 2023
"The Fungus Amungus: Mold Infections in Immunocompromised Hosts"

Speaker: Jeanina Smith, MD. Associate Professor (CHS), University of Wisconsin; Medical Director of Transplant Infectious Disease/.

Objectives

1. Describe the host and environmental factors impacting the epidemiology of invasive mold infections.
2. Interpret the results of fungal biomarkersfor the diagnosis of invasive mold infection.
3. Distinguish the relative advantages and disadvantages of the azole antifungal agents for treatment of invasive aspergillosis.

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.

Claim Credit

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].

In this guest editorial published in The Bulletin, Dr. Steve Gordon, president and CEO of St. Charles, reaffirms the health system’s commitment to reaching a contract agreement with the Oregon Nurses Association and shares his concern about a potential nurses’ strike.

Today, we received a notice from the ONA indicating plans to begin a strike of indefinite duration on June 12. While we will continue to bargain in good faith in sessions scheduled for next week, we want our patients and community to know that a strike will have significant impacts on the services we are able to provide.

At St. Charles Health System, caring for patients is the driving force behind everything we do. Our caregivers seek out this profession because they have a heart for service. That focus on putting patients first is what drew me to work in this organization and this region. 

You may be aware that the statewide Oregon Nurses Association has been authorized to call a strike on behalf of the approximately 900 nurses who work at the St. Charles Bend hospital campus. 

While we prefer to have conversations related to negotiations at the bargaining table and not in the press, we are at a point where we feel obligated to inform our community and patients about real concerns and possible limitations in health care services if we aren’t able to reach a resolution. We are seeking mediation and firmly believe a federal mediator could help us reach a full agreement – which would be the best possible outcome for our community. 

St. Charles leaders are committed to bargaining respectfully and in good faith to reach a fair contract agreement that includes generous wage increases and that ultimately preserves jobs, advances nursing practice and strengthens services for the future. 

In many ways, we agree with the fundamental issues ONA has identified in its yard signs and other advertising – recruit, retain and respect. Retaining and recruiting qualified health care professionals is an area we focus on every day. We are proud that our nurses are already among the highest paid in the state at an average wage of $108,000 a year, along with a generous benefits package. 

St. Charles did not cause our nation’s severe shortage of health care professionals. And we are proud that, despite this shortage, we have successfully hired 118 new registered nurses to the Bend hospital in the past year. We have created innovative recruitment programs, like a Nurse Residency program that will hire 40 new RNs this summer. We are working to grow our own health care professionals of the future. Central Oregon’s quality of life and St. Charles’ reputation for excellence help our recruitment efforts. Lawn signs, personal attacks and negative advertising do not. A strike would be devastating. 

Sadly, if the ONA walks away from negotiations, the impact will be felt throughout the region. 

As a physician, I can tell you that I have a deep and profound respect for all people who choose careers in health care. Caring for others is often a special calling that can be incredibly rewarding, but also difficult and disheartening at times. Our entire staff has been through one crisis after another during the past three years. I see, hear and understand where our nurses are coming from and am heartbroken many feel disrespected. We are listening and learning from our caregivers to rebuild our culture after three years of strain, while still navigating our nation’s ever-present, convoluted system of health insurance and regulation. We want to come together again as one team and I greatly hope our nurses see the progress we are making. I hope the ONA will stay with us at the bargaining table until we can reach an agreement.

As the only Level II trauma facility east of the Cascades in Oregon, we believe a strike will essentially result in a public health emergency for multiple counties. While we will do our best to put contingency plans and staffing into place, we also need patients to be prepared for long wait times, cancelations of planned procedures and an increased need for medical transport to hospitals in Portland, Seattle and Boise. These reductions in service will be necessary in order for us to preserve our core ability to maintain emergency care that cannot be delayed. 

We are asking for mediation. We are asking for open-minded, constructive conversation in contract negotiations. We are asking for the opportunity to continue our healing and to work toward positive solutions to complicated problems together. 

Dr. Steve Gordon
President and CEO
St. Charles Health System

Enduring Materials - Jun 1, 2023
"Eating Disorders in Children and Adolescents"

Speaker: Naghmeh Moshtael, MD. Kartini Clinic.

Objectives

1. Understand the importance of screening for eating disorders in children and adolescents.
2. Identify types of eating disorders: DSM-V criteria.
3. Monitor for medical stability in outpatient setting.
4. Identify the variability of presentation among children and adolescents.
5. Open forum for questions and discussion.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and Mosaic Medical. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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.

Claim Credit

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]. 

Every year, St. Charles puts out an Annual Report that’s intended to provide an update of the health system’s operations, community benefit and clinical impact on Central Oregon.

We just published our 2022 Annual Report, and I hope you’ll take a moment to check it out.

For me, two numbers in this report stand out as very clear reminders of why St. Charles is here and what it is we do every day.

One is that 162,855 unique patients received services at St. Charles hospitals in 2022, up 20% from 135,618 in 2019. Please note that those numbers don’t represent visits, but unique patients, which means 162,855 different people were helped.

That number includes not only local residents, but also people visiting Central Oregon, people from other parts of Oregon referred to St. Charles, and those passing through the region. Regardless of who they are, where they come from or why they sought care, each one of those 162,855 people needed St. Charles. And St. Charles was here for them. (If you’re wondering, the Central Oregon Health Council estimates the region’s population at about 264,000.)

The other statistic that jumped out at me was that 108,042 unique individuals received care from one of our St. Charles physicians or providers in 2022, up 19% from 2019. Again, these are unique individuals, not visits.

These folks came to us for care in a wide variety of specialties, including women’s health, oncology, anticoagulation, behavioral health, sleep care, heart and lung, home health, hospice, urgent care, family care, wound care, trauma care, and many points in between. In every case, they received the care they needed from one of more than 430 compassionate, highly trained physicians and providers.

I am incredibly proud to work alongside them and all of our St. Charles caregivers, who spend every day playing a vital role in providing fundamental, critical health services to our region and outstanding care to our patients. They are the backbone of our organization, and St. Charles could not play its indispensable role in the community without their passion, dedication and expertise.

These two numbers (and the 2022 Annual Report in general) are excellent reminders that everything we do is rooted in our central core mission: in a spirit of love and compassion, better health, better care, better value.

Sincerely,
Steve

After a decades-long career in cardiothoracic surgery, Dr. Angelo Vlessis retired earlier this year, closing a long and impactful chapter at St. Charles.

Over the past 25 years, Vlessis built the health system’s cardiac surgery program from the ground up, hiring and training the skilled staff that remains today.

“For the last 20+ years, he was synonymous with heart surgery in Central Oregon,” said Dr. Matthew Slater, St. Charles’ chief of cardiothoracic surgery, who met Vlessis during their residencies at Oregon Health & Science University in the early 1990s. “He was always a mentor to me.”

Growing up with a chemistry set and microscope, Vlessis was hooked on science from a young age. Although he initially pursued plant physiology, his interests turned to general surgery in graduate school. Cardiothoracic surgery stood out as the most exciting of the surgery specialties, he said, because the practice is peppered with more life-and-death situations.

“Every day or week, there were exciting moments,” Vlessis said. “People come in all the time half-dead, and you operate on them and have the opportunity to save them.”

After finishing his residency at the University of Michigan in 1997, Vlessis worked as an attending cardiothoracic surgeon at St. Vincent Medical Center in Portland. He did several rotations at St. Charles throughout the 1990s before settling in for his first long-term position in 1999. After a two-year return to Portland to work as a professor of cardiovascular surgery at OHSU, he returned to St. Charles in 2016, where he operated until his retirement.

“Without him, we wouldn’t really have a program,” Slater said. “It’s not just about doing the surgery. Dr. Vlessis had to build all the platforms to support it.”

Because Central Oregon is relatively isolated, Vlessis filled a gap in much-needed cardiothoracic care when he arrived. Among his roughly 7,000 patients through the years, some came from as far as northern California or southern Washington.

Part of his legacy, Slater said, is that Vlessis provided consistent care for so long. At many medical centers, quality of care ebbs and flows as physicians come and go, but that was not the case at St. Charles while Vlessis was on staff.

“His prolonged presence allowed the cardiac surgery program to grow and strengthen,” Slater said. “He’s built a really stable platform.”

Another significant mark Vlessis made in Central Oregon is the impact of his mitral valve repair practice. The mitral valve is vital for moving blood in the right direction through the heart, and some genetic conditions can cause it to malfunction. Many surgeons choose to replace the valve with an artificial one; Vlessis specialized in repairing the valve instead of replacing it.

As for the most rewarding part of his career? Vlessis said it’s when he runs into patients away from the operating table.

“Maybe I'll have dinner at a restaurant, and the waitress will notice my last name and say, ‘Oh, you operated on my dad. You saved his life. Thank you,’” he said. “The appreciation that you get in a smaller community … is probably the most rewarding part about working here.”

The orthopedic specialists and physical therapists at St. Charles Physical Therapy provide experienced, compassionate care that focuses on relieving pain, restoring mobility and returning people to the active, pain-free lifestyle they once enjoyed.

The health system is pleased to welcome two new providers, Lindsay Lund and Matt Onderdonk. With these additions, the St. Charles Physical Therapy clinic on Bend’s south side has appointments available and is accepting new patients, as well as all insurances.

“Joint pain, back pain and other types of musculoskeletal and orthopedic pain affect millions of Americans each year, and Central Oregon is no different. For years, we’ve been helping local people feel better, move better, prevent further injury and regain independence,” said Elisa Jadzak, manager of outpatient rehab for St. Charles.

“As the region has grown, we have worked hard to keep up with increasing demand for physical therapy services,” she continued. “With the addition of these providers, we’re improving access to the care that people need when they need it, and at a convenient location at the south end of Bend.”

Orthopedic and musculoskeletal conditions are typically caused by the aging process, normal wear and tear, overuse, sports injuries, trauma or disease, and the pain that results often limits the amount or type of activity a person can perform. The staff at St. Charles Physical Therapy offers a wide range of treatments for back and neck pain, sports- and work-related injuries, osteoporosis and other bone or muscle conditions.

“Our physical therapists are experts in movement, and they’ll examine you and develop a personalized treatment plan,” Jadzak said. “A physical therapist’s training never truly ends. As part of their work, they’re required to stay up to date on the most current, evidence-based techniques and they have expertise that spans the age continuum, from pre-adolescence and up.”

Here's a bit about the new providers at St. Charles Physical Therapy:

Lindsay Lund, DPT

Originally from Bainbridge Island, Wash., Lindsay received her undergraduate degree in biology from DePauw University in Indiana, where she played collegiate soccer. She obtained her doctorate in physical therapy from the University of Colorado and her Certified Manual Physical Therapy certification through the North American Institute of Manual Therapy. When she’s not working, she loves all things active and adventurous, including mountain biking, surfing, backpacking, fly fishing and more.

“My experience working in outpatient orthopedics has given me an opportunity to treat a diverse patient population, including athletes, kids, older adults, active military members and individuals with neurological conditions,” she said. “I like to focus on integrating manual therapy, therapeutic exercise and patient education in an effort to encourage patients and help them return to their desired lifestyle.”

Matt Onderdonk, DPT, OCS

A board-certified orthopedic specialist, Matt earned his degree in exercise and sport science at Oregon State University, then went on to get his doctorate in physical therapy at Eastern Washington University. Away from the clinic, he and his wife spend their time chasing their two kids around Central Oregon’s trails. (When he’s not doing that, Matt’s on his mountain bike or searching for his golf ball in the rough.)

“I have extensive experience in motor control and stability retraining, as well as certification through the Titleist Performance Institute for golf injury management and performance training,” he said. “A huge emphasis on my sessions with my patients is communicating goals and expectations. Whether my patients want to be able to get up out of bed or to the top of South Sister, I work to meet my patients where they are at and build toward their goals from there. Problem solving with my patients to find the best treatment strategy for the individual is crucial.”

To learn more about the expertise and services available at St. Charles Physical Therapy, check out these Frequently Asked Questions or call 541-706-5940 to speak to a physical therapist or to schedule an appointment.

(pictured above: Emma Vlossak surrounded by members of Bend Fire and Rescue)

“My only job right now is to breathe.”

That’s what Emma Vlossak told herself as she lay in a ditch off Alfalfa Market Road east of Bend, unable to move, after being struck by an SUV while riding her bike.

Now, nearly a year later, Vlossak is “alive, upright and can hold (her) children again” and, for that, she feels tremendous gratitude. 

Up until the day she was hit on her bike, Vlossak had experienced trauma primarily as part of a team that cares for patients with severe injuries. She spent 10 years as a trauma nurse, three years at St. Charles, serving in the emergency department, after that working as a house supervisor and as a nurse manager in the Neonatal Intensive Care Unit.

When she entered St. Charles Bend’s Emergency Department as a patient last June, Vlossak was surrounded by people she considers family.

“I got to experience being cared for by my family,” she said. “These are the people I was in the trenches with. From the moment the fire crew picked me up to the time I was in recovery, I was surrounded by and cared for by our medical community, who are also my work family. Our caregivers and the Bend Fire crews do not just show up to work, they are deeply committed to the health of our community.”

This week, Vlossak shared her story as part of the first Trauma Survivors Day event at St. Charles Bend, where approximately 50 people including surgeons, nurses, emergency responders, clerical staff and others had a chance to connect with people who had needed their care.

The goal is for Trauma Survivors Day to become an annual event and to kick off a new Trauma Survivors Support Network for Central Oregon.

Meeting former patients is an important opportunity for emergency caregivers to experience connection and closure, said Michelle Brenholdt, St. Charles’ director of Emergency and Trauma Services for Bend and Redmond.

“We are here when patients are having their worst day, but we don’t get to see them when they are back having their best day,” she said. “To meet a survivor, that’s what fills our cups, knowing we played a role in it.”

Connecting with trauma survivors “is like therapy for us,” said Trauma Medical Director Dr. Marika Gassner, who saw one of her former patients, Richard Macias, at the event.

“To see Rich walk in doing so well, it’s enormous,” she said.

Macias was excited to attend Trauma Survivors Day so he could thank all of his caregivers. He developed a relationship with them during his long recovery after falling from a roof late last year.

“It didn’t feel like strangers were taking care of me. The people here, they felt like an extended family," said Macias, who now has 11 plates and 86 screws in his new rib section.

“I just have so much appreciation for everyone,” he said. “I’m so glad I landed here.”

To learn more about the program or to sign up to take part, email the St. Charles Trauma Program.

Grand Rounds - May 19, 2023
"Intimate Partner Violence (IPV)"

Speaker: Joslyn W Fisher, MD, MPH. Associate Professor of Medicine and Medical Ethics, Baylor College of Medicine.

Objectives

1. Cite the epidemiology of intimate partner violence.
2. Identify those populations at risk for intimate partner violence while navigating cultural views and/or barriers.
3. Recognize the signs and symptoms of intimate partner violence.
4. Apply the appropriate strategies and interventions in the treatment of intimate partner violence.
5. Address the patient appropriately when the suspected perpetrator is present.

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.

Claim Credit

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 - May 12, 2023
"Chronic Kidney Disease"

Speaker: Golriz Jafari, MD. Olive View-UCLA Medical Center.

Objectives

1. Describe symptoms of chronic kidney disease.
2. Discuss the latest diagnostic tests and treatments.
3. Improve prevention of chronic kidney disease and preservation of kidney function.
4. Discuss indications and patient eligibility for kidney transplantation.
5. Indications of acute and chronic dialysis treatment.

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.

Claim Credit

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].

Ask a Nurse ... from St. Charles Health System on Vimeo.