Grand Rounds - Apr. 7, 2023
"Update on the Fentanyl Crisis and the New Drug Screening Law"

Speaker: Michael D. Levine, MD, FACEP, FACMT. University of California, Los Angeles.

Objectives

1. Identify findings consistent with opioid toxicity.
2. Understand options for treatment of opioid toxicity.
3. Review options for medication-assisted therapy.
4. .

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].

Welcome

More than a century ago, the founders of St. Charles promised Central Oregon that this organization would care for all people, or it would care for none. Working to be a health system that is diverse, equitable, inclusive and accepting is our responsibility toward upholding that commitment to care for all.

IDEA (Inclusion Diversity Equity Acceptance) Council

St. Charles Health System has a commitment to diversity, equity, inclusion and belonging. The Inclusion, Diversity, Equity and Acceptance (IDEA) Council at St. Charles started as a grass-roots effort and has been in existence since 2017. The council was developed in response to a need for more diversity efforts within our health system. Since that time, the IDEA Council has identified diversity needs and has actively worked to provide more equitable, inclusive and diverse environments for all. The council implements actionable and measurable initiatives to address equity across our health system. The IDEA Core Council is comprised of caregivers, leaders, physicians and providers throughout our health system. The IDEA Council is supported by the three co-chairs, the manager of Caregiver Inclusion and Experience, executive leadership and our Chief Human Resources Officer as an avid supporter and sponsor. The council provides all staff the opportunity for ongoing training and dialogue at monthly General Council meetings, which are open to all within our system.

“St. Charles Health System consciously supports individuals from diverse backgrounds, viewpoints, race, abilities, gender and more to create a thriving work environment. We believe that a diverse work environment strengthens services to our community by providing unique and wide-ranging skills, compassion and knowledge. One of the exciting points in our journey at St. Charles has been our dedication to incremental growth toward advancing diversity, equity, inclusion and belonging.”

 

- Dr. Shilo Tippett, Behavioral Health Consultant, Nationally Certified Diversity Professional, Member of the Confederated Tribes of Warm Springs, Wasco/Tlingit Tribes

Our Journey Forward

In addition to our major growth and successes, we are excited by the many opportunities we have in front of us to continue to elevate diversity, equity, inclusion and belonging in our health system as well as the communities we serve. We will continue to evaluate, influence, and sometimes disrupt the status quo as we seek to create environments where all people are treated with cultural humility and respect. Our goal is to create a welcoming, loving and safe place for all.

After retiring from an executive job, Andrew and his wife moved to Central Oregon to enjoy the outdoor lifestyle. He has a wide range of interests, including snowboarding, creating handmade knives, fly fishing, bow hunting, pickleball, golf, and cooking. However, while on vacation on the East Coast, he suffered a serious injury while playing pickleball and needed surgery to repair his broken ulna and radius bones.

It was unsettling for him to think he may not be able to have full use of his right arm again. Instead of going to Boston for the procedure, Andrew decided to fly back home immediately with his arm in a cast and make an appointment at The Center. He saw Dr. Healy, who was able to perform surgery the following day. Andrew was impressed with Dr. Healy's expertise and quick action, which helped him get back on the road to recovery.

After the surgery, Andrew diligently followed Dr. Healy's advice and his physical therapist's exercises and stretches to ensure a successful recovery. Today, Andrew is back to enjoying all his favorite activities, thanks to the excellent care he received at The Center.

Signs of Parkinson's Disease

Parkinson's disease is a neurodegenerative disorder that affects the nervous system. The symptoms of Parkinson's disease usually develop gradually over time, and they may vary from person to person. Some of the most common signs of Parkinson's disease include:

1. Tremors: Tremors or shaking are often the first symptom of Parkinson's disease. The tremors usually start in one hand or arm and may spread to the other side of the body over time.

2. Bradykinesia: Bradykinesia is a slowness of movement that can affect a person's ability to perform simple tasks, such as buttoning a shirt or tying shoelaces.

3. Rigidity: Rigidity or stiffness in the limbs and trunk is another common symptom of Parkinson's disease. This stiffness can make movement difficult and may cause pain or discomfort.

4. Postural instability: Parkinson's disease can also affect a person's balance and coordination, making them more prone to falls.

5. Changes in speech: Parkinson's disease can cause changes in a person's voice, such as speaking softly or with a monotone voice.

6. Changes in handwriting: Parkinson's disease can cause a person's handwriting to become small and cramped, making it difficult to read.

7. Loss of smell: Some people with Parkinson's disease may experience a loss of smell, which can affect their ability to enjoy food.

It's important to note that not everyone with Parkinson's disease will experience all of these symptoms, and some people may experience additional symptoms not listed here. If you or someone you know is experiencing any of these symptoms, it's important to speak with a healthcare professional for an accurate diagnosis and treatment plan.

How do they test for Parkinson's Disease?

The diagnosis of Parkinson's disease is typically based on a combination of a person's medical history, physical examination, and neurological tests. There is no single test that can definitively diagnose Parkinson's disease, but doctors use a range of tests to evaluate a person's symptoms and rule out other possible conditions. Some of the common tests used to diagnose Parkinson's disease include:

1. A neurological exam involves assessing a person's motor function, reflexes, and coordination to look for signs of Parkinson's disease. The exam may also involve testing a person's sense of smell, vision, and cognition.

2. DaTscan is a type of brain imaging test that can help distinguish Parkinson's disease from other conditions that can cause similar symptoms. The test uses a small amount of radioactive material to show the activity of dopamine transporters in the brain.

3. Blood tests can help rule out other conditions that can cause similar symptoms to Parkinson's disease, such as thyroid dysfunction.

4. Imaging tests like MRI or CT scans can help rule out other conditions that can cause similar symptoms to Parkinson's disease.

5. A trial of Parkinson's medication can be helpful in confirming the diagnosis of Parkinson's disease. If a person's symptoms improve with Parkinson's medication, it may suggest that they have Parkinson's disease.

It's important to note that Parkinson's disease is a complex condition, and diagnosing it can be challenging. A neurologist or movement disorder specialist can provide a proper diagnosis and work with a person to develop an appropriate treatment plan.

The COVID-19 pandemic today is much different than it was in the spring of 2020, when St. Charles implemented a universal masking policy to decrease the risk of spread of the disease between caregivers, patients and visitors in our health care facilities. Over these past three years, the virus has evolved to cause less severe disease due to changes in the virus itself along with widespread population immunity and the availability of medications to reduce the risk of severe disease in those who are at high risk for developing severe disease.

As a result of these changes, and in alignment with the changing requirements of the Oregon Health Authority and Oregon’s Office of Occupational Safety and Health Administration, St. Charles will no longer require people to wear masks in public areas of the health system’s facilities beginning Monday, April 3. Masks will remain strongly recommended in our facilities as protection for the wearer and others. They will be required for people experiencing symptoms of a respiratory virus such as coughing and fever.

Also starting Monday, April 3, St. Charles will no longer require its caregivers to mask in most clinical settings. Caregivers will continue to be required to wear a mask in certain scenarios, including a request by a patient or if community transmission levels are high.

“Over the past three years, our caregivers have diligently worn masks in a selfless effort to keep themselves, other employees, and our patients safe. We are grateful to them for their care and their sacrifice, and we know the community is, too,” said St. Charles’ Chief Clinical Officer, Dr. Mark Hallett. “With OHA and Oregon-OSHA lifting their mask requirements, our team of experts has carefully considered the facts and feels comfortable that this is a safe step forward for our caregivers, patients and community.”

It is important to note that the SARS-CoV-2 virus that causes COVID infections continues to be a risk to the most vulnerable people in our communities. While transmission levels are currently lower than what they have been in the recent past, as future case levels may rise, so too will the risk of transmission to vulnerable patients and masking may be required during future outbreaks of COVID-19.

In the first quarter of 2023, I’ve been thinking a lot about numbers – though not always the numbers you might expect.

We’ve spent a lot of time over the past few years talking about them: Numbers of COVID patients in our hospitals. Numbers of vaccinations given. Numbers that make up our operating margin, revenues, expenses and costs of travel labor.

These are all important, no doubt about it.

But I have been reflecting on some different numbers that I believe better depict St. Charles’ impact on Central Oregon and illustrate our mission in action.

To provide the care our communities need, it takes more than 4,500 caregivers working side-by-side on the frontlines and behind the scenes. While I can’t possibly list all contributions from every department, I wanted to share a few that stand out.

In 2022 ...  

• We provided almost 100,000 patient visits in our Emergency Departments at all four hospitals – that’s a new patient every 13 minutes
• We provided more than 80,000 respiratory therapy procedures – a 70% increase from two years ago
• Our ambulatory clinics welcomed nearly 440,000 visits by people seeking care across a wide variety of specialties
• Our Food Services teams served more than 1 million meals across all campuses. That equates to a line of cafeteria trays side-by-side stretching from Redmond to Portland and back again
• We activated the trauma team nearly 1,000 times last year – or an average of three times per day
• The Lab team completed 1.2 million tests
• Our Pharmacy filled more than 102,000 prescriptions, up 28% from the year before
• Our Urgent Care teams provided 48,000 patient visits – an increase of more than 9,000 over the previous year 
• The Palliative Care team helped 1,500 patients through more than 3,000 visits
• More than 2,200 babies were born in Bend and Madras 
• We created and processed almost 2.8 million pounds of dirty linen – that’s roughly the same weight as nine blue whales! 

When I think about these statistics, I know that excellent patient care and the many services that support it simply isn’t possible without our incredible employees, physicians, providers and volunteers.

I am enormously proud to support them and to lead this great organization.

Sincerely,
Steve

Grand Rounds - Mar. 24, 2023
"Heart Disease in Women: A Global Threat Presents a Golden Opportunity"

Speaker: Malissa J. Wood, MD. Cathy E. Minehan Chair, Cardiovascular Disease in Women, Co-Director- MGH Corrigan Women’s Heart Health Program, Associate Chair for Diversity and Health Equity MGH, Chair ACC Board of Governors.

Objectives

1. Recognize the risk factors and perform an appropriate risk assessment for cardiovascular disease in women.
2. Order appropriate diagnostic testing.
3. Manage acute and chronic coronary artery disease in women.
4. Cite contributing factors of heart disease in women, such as age, ethnic background, and culture.

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].

St. Charles Health System is proud to support and partner with organizations across Central Oregon through its Community Benefit program. 

One such organization is Rimrock Trails Treatment Services, which provides professional mental health counseling and substance abuse treatment programs. Established in Prineville in 1990, Rimrock Trails initially opened as the first residential substance abuse treatment center for youth in Central Oregon. In the years since, it has expanded to provide comprehensive behavioral health services to individuals, families and couples of all ages. 

With outpatient treatment centers in Prineville, Redmond and Bend, Rimrock Trails is dedicated to improving the lives of its clients and creating lasting change through evidenced-based treatment in a safe, judgment-free atmosphere. The organization’s mental health therapists are dual-certified as addiction counselors, allowing them to provide integrated treatment for co-occurring mental health and substance use disorders.

Having provided specialized treatment to more than 17,000 people since its inception, Rimrock Trails is an invaluable community resource whose services are needed now more than ever.

“We are seeing a tremendous increase in the utilization of our outpatient counseling services, anywhere between an 8% and 37% increase month to month,” said Executive Director Erica Fuller, citing the COVID-19 pandemic and increasing use of social media, particularly among young people, as primary factors. “Clients are definitely coming in with a lot of trauma, social disconnection and loneliness.”

St. Charles has partnered with Rimrock Trails frequently over the years, supporting projects that provide basic-need items and enrichment activities for teens in the residential center. The health system will also sponsor upcoming events such as Kiefer’s Magical Birthday Bash, a family-friendly fundraiser happening March 31 in Prineville and April 1 in Redmond that is open to the public. Created in memory of Kiefer Leutschaft, the annual event raises money for mental health awareness programs and scholarship funds to help supplement treatment costs for clients who may be struggling to pay for services.

If you’d like to support or volunteer with Rimrock Trails or learn more about their services and events, visit their website at www.rimrocktrails.org.

The St. Charles Rheumatology clinic in Bend first opened its doors in 2015, offering comprehensive care for people with conditions such as rheumatoid arthritis, gout, osteoporosis, psoriatic arthritis and lupus.

Now, there’s good news for patients in the northern reaches of Central Oregon: The health system has expanded rheumatology services into Redmond, where people there and in Prineville, Madras, Sisters and points beyond can receive the care they need closer to home.

The new Redmond clinic will be serviced by Dr. Andrew Shaffer, who joined the rheumatology team last August. He’s currently taking appointments on Tuesdays and plans to add more clinic days in the near future.

Central Oregon has hundreds of rheumatology patients, partly due to its popularity as a retirement area; around 16% of Bend’s population is over the age of 65, according to U.S. Census Bureau data. The Bend rheumatology clinic will remain open, and the expansion to Redmond comes at a good time, as Deschutes Rheumatology closed its doors at the end of January.

“We've seen a pretty big spike in volume because of that. I'm confident that we have the capacity to accommodate all those patients, though,” said St. Charles’ chief of Rheumatology, Dr. Heather Hansen, who ran the department on her own for about seven years. She was joined by physician’s assistant Tianna Welch in September 2021 and Shaffer in 2022.

Dovetailing with the Redmond expansion, a new outpatient infusion clinic also recently opened on the Bend hospital campus. Previously, rheumatology patients needing an infusion had to go to the St. Charles Cancer Center. That option will remain, but the new outpatient clinic offers a more affordable and convenient place for infusions. It’s also in the same building as the Bend rheumatology clinic at 2600 NE Neff Road.

There is a “higher degree of physician supervision than you would have in a lot of freestanding infusion rooms,” said Hansen, who is also the director of outpatient infusion. Patients needing neurology, G.I. and other non-oncology treatments will also be able to receive infusions in the outpatient clinic. 

“The proximity to their rheumatology physician is wonderful and allows us to collaborate on visits,” said Jonnie Becker, administrative director of Surgical Services and Medical Specialties. “Having our own space allows us to develop our team [and] work together with the immediate team in service of our patients.”

Nationwide, Hansen said there’s a growing demand for rheumatology services. Millions of people in the United States suffer from some form of rheumatic disease, and rheumatology is one of the top specialties experiencing a provider shortage, she said.

“It is an ever-increasing need,” Becker said. “Our medicine continues to evolve and change and grow, and we're helping people to improve the quality of their life as they age.”

Grand Rounds - Mar. 17, 2023
"Adult ADHD – The Hidden and Preventable Cause of Death, Disaster, and Disability"

Speaker: Lisa Jacobs, MD, MBA.

Objectives

1. Consider the scope of preventable medical, financial, emotional, and vocational problems caused by ADHD.
2. Recognize the signs and symptoms of ADHD and how they appear in adulthood.
3. Choose evidence-based treatments.
4. Identify ways to improve quality of care delivered to adults with ADHD by targeting commonly comorbid medical and psychiatric issues.
5. Access the various pathways for treatment.
6. Consider societal and cultural factors that contribute to the accurate diagnosis and improved recognition of adult ADHD.
7. Reflect on the patient populations most affected by ADHD and consider how implicit bias may impact appropriate care of these 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.

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].