Grand Rounds - May 5, 2023
"Ophthalmology for the Primary Care Provider"

Speaker: Ronald N. Gaster, MD, FACS. Clinical Professor, Ophthalmology UCLA and UC Irvine; Private Practice, Beverly Hills and Orange County, CA.

Objectives

1. Identify common eye problems seen by primary care physicians.
2. Evaluate patients with common eye complaints.
3. Utilize diagnostic techniques in the office/clinic of a primary care physicians.
4. Treat common eye disorders.
5. Know which eye disorders need to be referred to an ophthalmologist and how urgent the referral will be.

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].

Cancer Wise, Know Your Risk, a program designed to identify those at increased risk for cancer -- through personalized assessment, genetic testing and education.

Helping our community become more “Cancer Wise” includes:

• Expanded genetic testing, helping identify people with a greater risk for cancer and designing a personalized plan for medical management.
• Expanded community outreach so that everyone has equal access to testing and follow-up services. Where someone lives or what kind of insurance they have should not be a barrier to receiving the best cancer care possible.
• Promotion of lifestyle modification strategies for cancer prevention and risk reduction, with focus on healthy habits of nutrition, exercise and smoking cessation.

To learn more, call our Cancer Screening Coordinator at 541-706-5800.

St. Charles to focus on reducing loneliness, fostering belonging through funding priority

Effort coincides with U.S. Surgeon General initiative to combat loneliness

Today, St. Charles Health System is announcing a new focus for its Community Benefit funding: reducing feelings of loneliness and social isolation while fostering a sense of belonging among Central Oregonians. This priority funding area means that, for the next three years, St. Charles will direct thousands in grant funding to community organizations to target loneliness and isolation.

“We are increasingly seeing that loneliness and depression are root causes of a number of health problems and societal problems, and the pandemic has only exacerbated that issue,” said Molly Wells Darling, administrative director of Behavioral Health Services for St. Charles. “If we can help people feel less lonely by connecting with others and becoming part of a community, we know that Central Oregon will be healthier community.”

The announcement of this priority funding area comes alongside U.S. Surgeon General Vivek Murthy’s introduction of a new initiative to combat loneliness and isolation, writing in an op-ed in the New York Times that this must be a “top public health priority” for the country.

“We need to acknowledge the loneliness and isolation that millions are experiencing and the grave consequences for our mental health, physical health and collective well-being,” wrote Murthy.

St. Charles leadership believes access to mental health care is a major need in Central Oregon. As part of the Community Benefit program, the health system will partner with local organizations working to address loneliness, social isolation and belonging to capitalize on the energy that surrounds the subject. The Community Benefit department will dedicate grant dollars to groups that are trying to provide opportunities to decrease feelings of loneliness and social isolation in communities across the region. Exactly how that looks will be up to the individual communities, according to Carlos Salcedo, manager of community partnerships for St. Charles.

“Our hope is that each community will choose where to focus their time and energy around this issue. Maybe one will focus on older adults while another focuses on supporting youth or new parents finding community,” he said. “St. Charles may find itself supporting communities in a variety of ways, such as offering financial assistance for projects identified by the community or providing relevant research to enable people to move forward in redefining what it means to be part of a community in Central Oregon.”

Reducing feelings of loneliness and social isolation while fostering a sense of belonging was identified as a priority based on the 2023-2025 Community Health Needs Assessment, which brought together population health data, input from community members, community survey results and analysis of available community resources to address health needs.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, Prineville, Redmond, La Pine and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

Mahi Mahi Tacos with Creamy Cilantro Lime Sauce

Fresh and healthy, these tacos are packed with flavor!

Ingredients

2 fresh Mahi Mahi steaks, approx. 6 oz. each
8 white corn tortillas
3 Tbsp. extra virgin olive oil
2 cups shredded red cabbage
1 avocado, pitted and sliced
1/4 cup garlic powder
2 Tbsp. sea salt
1 Tbsp. brown or coconut sugar
1 Tbsp. parsley
1 tsp lemon pepper
1/2 tsp. ground cayenne pepper

Pico de Gallo

1 medium tomato, diced
½ white onion, chopped
1 jalapeno pepper, seeded and finely chopped
¼ cup chopped cilantro
Juice from 1 lime

Creamy Cilantro Lime Sauce

1/3 cup chopped cilantro
1 Tbsp. white vinegar
1/3 cup extra virgin olive oil
½ cup plain Greek yogurt
1 Tbsp. lime juice
2 cloves garlic, minced
1 tsp. sea salt

Instructions:

1. Combine Pico de Gallo ingredients in medium bowl, cover and place in fridge.
2. Prepare the creamy cilantro lime sauce by placing cilantro, vinegar, yogurt, lime juice, garlic and sea salt in a food processor. Pulse to combine. While processor is running on lowest setting, slowly add in olive oil. Pour into bowl, cover and refrigerate until the tacos are ready to assemble.
3. Warm the tortillas by heating a medium frying pan over medium-high heat. Add one tortilla at a time, flipping to warm both sides, about five minutes total. Wrap the warm tortillas in a clean dishcloth and set aside while you prepare the fish.
4. In small bowl, mix together garlic powder, salt, sugar, parsley, lemon pepper and cayenne pepper. Sprinkle each piece of fish liberally with seasoning mix. Pour oil in a fry pan and heat over medium-high heat until oil starts to shimmer. Gently place fish in pan. Reduce heat to medium and cook about 4-5 minutes. When bottom of fish gets golden brown, carefully flip to the other side and continue cooking another 4-5 minutes until cooked through, being careful not to overcook. Transfer to a plate with paper towel to remove any excess cooking oil.
5. To assemble tacos, start by breaking a piece of fish in half and placing it in a warm tortilla {It’s best if you stack two tortillas together to keep the taco from breaking apart in your hand}. Add the shredded cabbage, avocado slices and top with Pico de Gallo. Finish with a heavy drizzle of the creamy cilantro lime sauce. Enjoy!

I want to take a few minutes to talk about the effects of social isolation in the wake of the COVID-19 pandemic and what our health system is doing about it.

At St. Charles, we believe this is a major health need in Central Oregon – a need that was identified and confirmed through our recently completed triennial Community Health Needs Assessment (CHNA) for the regions served by each of our four hospitals.

You can read more about the importance of this new priority if you’d like. To summarize, the effects of the COVID-19 pandemic – the social isolation, separation from loved ones and so on – has led to an increase in the number of people experiencing feelings of loneliness, depression and other associated health issues. Social isolation compounds other health challenges our communities are already facing.

Every three years, St. Charles conducts the CHNA, and the resulting report helps guide the selection of a priority for the program. Past priorities include prevention of suicide and prevention of alcohol misuse. With a new CHNA complete, we now have a new priority for the next three years: fostering a sense of belonging and reducing feelings of loneliness.

Why does that priority matter? Because all profits at St. Charles are reinvested in our communities, and the CHNA helps guide that reinvestment. We reinvest in a number of different ways, one of which is partnering with local groups on prevention and ensuring people in Central Oregon have access to core health care services when they need them most. Since its inception, St. Charles has been contributing to programs that benefit our community, and we prioritize those that are taking care of underserved, disadvantaged populations throughout the region.

With our CHNA complete, we will once again be partnering with like-minded local organizations, this time with a focus on social isolation and related issues and awarding grants to groups working to address them. Look for more information about those grants in the coming months.

We also have other Community Benefit grants available: One for those providing basic needs such as shelter, food or safety; sponsorships for community events and/or fundraisers; and small grants for those seeking $500 or less. You can learn more about these opportunities here.

When people think about St. Charles, most think about hospitals, clinics, doctors and nurses. And with good reason! Taking care of Central Oregonians is what we do here, every single day.

But there are many ways to take care of people that don’t involve visiting our facilities, and our Community Benefit programs are an important part of our efforts to create America’s healthiest community, together.

Sincerely,
Steve

Neurological conditions such as traumatic brain injuries, Parkinson’s disease and cerebral palsy can be debilitating, potentially shrinking a person’s world.

Destination Rehab, based in Bend, strives to combat that effect by helping people with these conditions get outside via adaptive, accessible activities. In addition to one-on-one physical therapy, Destination Rehab offers programs packed with fitness and adventure, such as hiking and rock climbing. The programs give patients an opportunity to build a support system and reconnect with activities they enjoy, says Stephanie Odell, the donor journey coordinator at Destination Rehab.

“There’s a lot of meaningful connections that get created,” Odell said. “It's really showing them that they can go out and do it on their own and empowering them to get back into things that they love.

The non-profit organization offers three community programs:

• The Adventure group, which runs from May to October and takes participants outside for activities like kayaking, bird watching and hiking.
• Peak Fitness and Education, which provides year-round workout classes adapted to the needs of participants, ranging from yoga to boxing.
• Rock Climbing for Health, launched this year, meets fox six weeks at Bend Rock Gym.

In addition, Destination Rehab hosts a day-long event, Soar, packed with wellness and outdoor activities specifically created for people with physical challenges and disabilities. This year, Soar is set for Saturday, July 8.

Any patients over the age of 18 are welcome to join Destination Rehab. Some people find the program through physical therapy and stay for the engaging programs, Odell said, while thers come just for the programs – participants don’t need to be physical therapy patients to join.

Odell said she sees patients build confidence and take back their life, not letting their diagnosis define who they are.

“There's so much confidence building and independence building and social support,” she said.

International travel increases the risk of travel-related illnesses and other adverse health exposures. Different countries harbor risks that may make you vulnerable to serious illness. Travel medicine focuses on pre-travel preventive care and posttravel illness diagnosis and treatment. Pre-travel counseling is highly recommended for international travelers. Our providers will review your itinerary, planned activities and immunization history to create a comprehensive risk assessment to accurately evaluate risks specific to your travel destination.

These risks could include infectious and noninfectious travel-related illnesses, required immunizations, health regulations and safety issues. We will provide guidance for intervention strategies to ensure your health and safety while traveling and prevent the likelihood of becoming sick during your trip.

• Managing preexisting conditions that may be impacted by travel
• Prevention and treatment of traveler’s diarrhea
• Proactively preventing motion or altitude sickness, jet lag and blood clots
• Food and water precautions
• Risks of infections from mosquito-borne illnesses/ medication to prevent malaria
• Vaccination and yellow card certificate if traveling where yellow fever vaccine is recommended or required

Immunizations are recommended and even required for entry into some countries. Our specialists can provide these immunizations, including the vaccine for yellow fever, which previously had not been readily available locally.

Seeing us before your trip is an added benefit if you become sick after returning home. As an established patient, we’ll have access to your medical records and your travel itinerary.

Travel medicine providers understand global health trends and pathogens that pose a threat in different parts of the world. We can diagnose the following illnesses and discuss treatment options:

• Traveler’s diarrhea
• Hepatitis A
• Malaria
• Typhoid
• Yellow fever
• Japanese encephalitis
• And many others

We provide complete travel medical care for the entire family. Pre-travel appointments are in person and should be scheduled approximately four to eight weeks in advance of travel. However, timing can be different depending on required immunizations.

Please call to find out the recommended appointment schedule for your travel plans: 541-706-7734.

In basketball, there’s a big difference between shooting two free throws in practice and shooting two free throws in the final seconds of a game when your team is down by two, with fans screaming, hearts pounding and a championship on the line.

Similarly, there’s a big difference between practicing life-saving measures on a training manikin in a quiet classroom and practicing those same measures in a hectic and unpredictable situation with lives on the line.

Central Oregon Community College’s new medical simulation center can’t help you sink your pressure-packed free throws, but it will provide emergency health care providers across the region with incredibly lifelike training opportunities, narrowing the realism gap between classroom education and real-world trauma response.

“This is the next level of education that is going to help make people feel more prepared for these kinds of low-frequency, high-stress scenarios,” said Dr. Ryan Petersen, an emergency medicine specialist with St. Charles.

“The more ‘real life’ the scenarios are, the better the training, and part of that is the anxiety,” he continued. “That’s a hard thing to create, because when you feel like it’s fake, the anxiety is not really there. But when the manikin is crying and its eyes are rolling around or something, that’s when you feel like, ‘Wow, this is what’s going to be happening in reality.’”

The medical simulation center — colloquially known as a “sim” center — is a cutting-edge lab that provides experiential learning in specialty areas such as pediatric trauma, birth complications and mass casualty response. A partnership between COCC, St. Charles’ continuing medical education program and Cascades East Area Health Education Center, the sim center held its first training session for professionals and students in March.

That’s when Petersen, an emergency medicine specialist with St. Charles, ran a training on dealing with difficult airways. Afterward, he said every Central Oregonian will benefit from the innovative equipment and programming at the sim center because emergency response agencies from across the region will use it for training.

“I work closely with a number of fire and EMS organizations in the region, and a lot of the rural areas don’t have access to anything like this, so they’ll definitely benefit from it,” he said. “It’s just a great thing that St. Charles and COCC got together to provide this for the community.”

The center’s technology includes a high-fidelity birthing simulator with infant manikins and other innovative learning tools — purchased with a $350,000 grant from Oregon Health & Science University’s rural-focused Area Health Education Centers program — to be used by EMTs, paramedics, ER physicians, nurses and others from throughout the region’s rural-serving medical community.

“St. Charles is excited to build upon our relationship with Central Oregon Community College,” said Ellie Cuff, supervisor of continuing medical education at St. Charles. “This simulation center will provide a central location for training health care professionals from across Central and Eastern Oregon, and for preparing health care students to enter the workforce.”

The center, based in the college’s Cascades Hall, is being coordinated and taught in conjunction with COCC’s paramedicine department, led by David Schappe, EMT/paramedicine program director, who helped bring the simulation center to life.

March’s initial session prioritized training professionals in medically underserved communities. Attendees of the inaugural session included medical staff from AirLink Critical Care Transport, St. Charles and other health care entities — some traveling from as far away as Black Butte and Spray — as well as second-year COCC nursing students.

Petersen said he is excited to watch programs at the sim center grow and develop in the future.

“For my area of specialty, I’m just kind of touching the surface of what we can do. The scenarios you can run there are pretty much endless,” he said. “It went fantastically, and I think word is going to get out about what awesome training is available and it’s just going to get bigger and better.”

The simulation center’s trainings are being held quarterly, with the next session planned for June. For more information, contact Schappe at 541-383-7751 or [email protected].

After three years of life with COVID-19, the short- and long-term mental health effects of the pandemic continue to ripple through our community, as they will for years to come.

Specifically, the social isolation and separation from loved ones caused by the virus has led to feelings of loneliness, depression and other associated health issues for many people. As we navigate what our world will look like with COVID-19 circulating, we must find ways to reconnect and reunite as a community.

That’s why St. Charles Health System has chosen to focus efforts on reducing feelings of loneliness and social isolation while fostering a sense of belonging as its community benefit priority for the 2023-2025 funding cycle.

“Our previous priority focus of alcohol misuse prevention was sidelined due to the pandemic,” said Carlos Salcedo, manager of community partnerships for St. Charles. “This cycle we are going to focus more upstream in two ways: By addressing the many mental health conditions that begin with feelings of being alone or not fitting in. And by providing new ideas and outlets for individuals to join in community with one another.

“We have learned that engaging with the community is an effective way to help St. Charles meet its vision of creating America’s healthiest community, together and are excited to roll this work out,” Salcedo said.

The U.S. Centers for Disease Control and Prevention defines loneliness as the feeling of being alone, regardless of the amount of social contact, and social isolation as a lack of social connections. Social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated.

Loneliness has broader implications for our mental and physical health, too. It can lead to depression, a growing problem in the United States. Among older adults, loneliness increases the risk of developing dementia, slows down walking speeds, interferes with their ability to take care of themselves and increases their risk of heart disease and stroke. Loneliness is even associated with dying earlier. Among adolescents and young adults, loneliness increases the likelihood of headaches, stomach aches, sleep disturbances and compulsive internet use. Chronic loneliness is said to have similar impacts on health as smoking a pack of cigarettes a day.

“We are increasingly seeing that loneliness and depression are root causes of a number of health problems and societal problems, and the pandemic has only exacerbated that issue,” said Molly Wells Darling, administrative director of Behavioral Health Services for St. Charles. “If we can help people feel less lonely by connecting with others and becoming part of a community, we know that Central Oregon will be healthier community.”

St. Charles leadership believes access to mental health care is a major need in Central Oregon. As part of the Community Benefit program, the health system will partner with local organizations working to address loneliness, social isolation and belonging in an effort to capitalize on the energy that surrounds the subject. The Community Benefit department will dedicate grant dollars to groups that are trying to provide opportunities to decrease feelings of loneliness and social isolation in communities across the region. Exactly how that looks will be up to the individual communities, Salcedo said.

“Our hope is that each community will choose where to focus their time and energy around this issue. Maybe one will focus on older adults while another focuses on supporting youth or new parents finding community,” he said. “St. Charles may find itself supporting communities in a variety of ways, such as offering financial assistance for projects identified by the community or providing relevant research to enable people to move forward in redefining what it means to be part of a community in Central Oregon.”

Reducing feelings of loneliness and social isolation while fostering a sense of belonging was identified as a priority based on the most recent Community Health Needs Assessment, which brought together population health data, input from community members, community survey results and analysis of available community resources to address health needs.

May 1 Press Release

Team conference and discharge planning

Part of your rehabilitation program involves a weekly conference in which your doctor, therapists, psychologist, discharge planner, nurse case manager and nurse representative get together to discuss goals and the progress necessary for you to return home. Your rehabilitation team and physician will communicate your progress and the discharge planner or case manager will keep you informed of your discharge date and anticipated services you will need at home. If at any time you have questions or concerns, please do not hesitate to speak with members of your team.

Physiatry follow up

In addition to following up with your primary care provider, your physiatrist (doctor in the rehabilitation unit) may want to follow up with your care after your discharge. The physiatrist will determine what is needed for your condition and will make the appropriate recommendations.

Medical equipment and discharge follow up care

As part of your discharge plan, the social services specialist and/or RN case manager will order any medical equipment that is recommended by your physician and rehabilitation team. The social services specialist or case manager will arrange for the equipment and services by contacting the appropriate providers and will work with vendors to provide the right equipment and follow-up care based on your insurance coverage. The RN case manager will attempt to schedule follow-up appointments. If you or your family have any questions or preferences about the equipment or follow-up care, please discuss them with the social services specialist and case manager.

Home evaluations

We offer in home evaluations on a case by case basis for local patients. We are unable to offer transportation, so your family, friend, or caregiver will need to provide transportation to and from the hospital. If required, you will receive assistance to get in and out of the vehicle. During the home evaluation we will see how you will be able to function in your home at discharge. It also helps us to make appropriate equipment and home modification recommendations.