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The first request of 2023 came to the Medical Library on Jan. 1 at 9:43 am. It was an ask for the article Associations between several site of cancer and 10 types of exhaust and combustion products, whose parents are Siemiatycki et al. Congratulations!

The paper was born 11 pages long and, surprisingly, weighed 35 years. Here is a picture of the newborn abstract:

 

Note: thank you to Theresa Kramer for the idea!

 

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The end of the year is a good time to look back, celebrate our successes, recognize the challenges ahead and reflect on the journey of the past 12 months.

After COVID-19 dominated our activities at St. Charles in 2020 and 2021, 2022 was about accepting the virus as a part of normal life, incorporating it into the day-to-day care we provide and continuing to innovate and improve in areas across the health system.

When I think about what St. Charles has accomplished in 2022, I am enormously proud of our caregivers and physicians, our leadership and our organization as a whole. It takes incredible teamwork, laser focus and dedication to the communities we serve to push a regional health system forward in the midst of a pandemic and unprecedented financial challenges, and our team has done exactly that.

Here are just a few of the things we’ve done that come to mind:

This is, of course, just some of the good work happening across the health system – work that will continue in 2023 and beyond.

Thank you for your support of St. Charles.

Sincerely,
Steve

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St. Charles staff and patients have seen an uptick in scams related to medical equipment.

These scams usually take the form of an unsolicited call (or other communication) from someone claiming to be from St. Charles, Medicare, an insurance company or a durable medical equipment company, offering you a free or low-cost medical device as an insurance “benefit.” These calls may even display what appears to be a legitimate phone number on caller ID.

These callers are trying to get valuable information from you, such as your Social Security Number or your insurance information. Do not give them your personal information. Instead, hang up and call your provider’s office to find out if they need information from you.

Furthermore, don’t order medical equipment over the phone unless you are advised to do so by your provider, and refuse delivery of medical equipment unless it was ordered by your doctor.

If a caller urges you to order a piece of equipment now for future use, that is a red flag. Charging insurance for equipment before your doctor certifies it as medically necessary is illegal.

Frequently review your health plan’s Explanation of Benefits or Medicare Summary Notice to ensure all charges are appropriate. If you see charges you don’t recognize, call Medicare at 1-800-MEDICARE (1-800-633-4227) or your insurance company immediately.

If you believe you have been a victim of any kind of phone scam, please consider reporting it to the organizations below.

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Glenn Rodriguez, MD

Glenn Rodriguez, MD is a family medicine physician, medical educator and physician executive. Raised in Madras, he is a graduate of Stanford University and Case Western Reserve School of Medicine. Dr. Rodriguez completed his family medicine residency at Group Health Cooperative in Seattle, Washington and a visiting fellowship in geriatrics. His career includes roles as a clinician and physician leader with the Indian Health Service on the Navajo Nation, faculty member in the Oregon Health and Sciences University Department of Family Medicine and physician executive with Providence Health & Services, where he established the Providence Oregon Family Medicine Residency Program and served as Chief Medical Officer for the Oregon region. His special interests are in family medicine education, elder health care and efforts to create an exceptional primary care system in Oregon.

Reason for service: “The opportunity to help build accessible health care that works for everyone in Central Oregon.”

 

 

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Grand Rounds - Dec. 16, 2022
"Strong Body & Mind: Best Practices for Perioperative Care for Older Surgical Patients"

Speaker: Katie Schenning, MD, MPH, MCR. Associate Professor, Anesthesiology & Perioperative Medicine; Assistant Medical Director, Perioperative Medicine Clinic, Oregon Health & Science University.

 

 

Objectives

  1. Review the definition and prevalence of frailty and pre-existing cognitive impairment.
  2. Understand the importance of preoperative frailty and cognitive screening using formal tools.
  3. Describe the risk factors for postoperative delirium.
  4. Quantify the costs of frailty/postoperative neurocognitive disorders to a health system.
  5. Introduce delirium prevention pathways.
  6. Advocate for a coordinated, interdisciplinary approach to reversing frailty and preventing postoperative delirium in Central Oregon and SCHS.

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].

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Gingerbread Pancakes

These pancakes are an easy way to feed the family during the holidays.

Ingredients

  • 1⁄2 cup whole wheat flour
  • 1⁄2 cup all-purpose flour
  • 1⁄2 teaspoon salt
  • 1⁄2 teaspoon baking soda
  • 2 teaspoons pumpkin pie spice
  • 1 egg
  • 2 Tablespoons molasses
  • 1 Tablespoon vegetable oil
  • 1 cup low-fat buttermilk

Directions

  1. Mix dry ingredients in a bowl.
  2. In another bowl, beat egg. Stir in molasses, oil and buttermilk.
  3. Pour milk mixture into dry ingredients; stir together lightly.
  4. Lightly spray a large skillet or griddle with non-stick cooking spray or lightly wipe with oil. Heat skillet or griddle over medium-high heat (350 degrees in an electric skillet). For each pancake, pour about 1/4 cup of batter onto the hot griddle.
  5. Cook until pancakes are puffed and dry around edges. Turn and cook other side until golden brown.
  6. Refrigerate leftovers within 2 hours.

Notes

  • No pumpkin pie spice? Use 1/2 teaspoon cinnamon, 1/2 teaspoon dry ginger, and 1/8 teaspoon cloves or nutmeg.
  • No buttermilk? Place 1 Tablespoon of lemon juice or vinegar in measuring cup and fill to the 1 cup line with milk. Stir and let set to thicken slightly.  
  • To see if skillet is hot enough, sprinkle with a few drops of water. If drops skitter around, heat is just right.
  • Top with applesauce, fresh fruit or yogurt.
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St. Charles Health System joins Oregon hospitals in charging the state with violating civil rights of vulnerable patients

BEND, Ore. – In a move to protect the civil rights of vulnerable Oregonians, St. Charles Health System, based in Bend, Oregon, has joined Legacy Health, Providence Health & Services and PeaceHealth in a lawsuit against the Oregon Health Authority. The lawsuit, filed in September, aims to ensure the Oregon Health Authority fulfills its legal obligation to provide adequate mental health treatment capacity for civilly committed individuals.

The addition of St. Charles broadens the coalition, bringing representation from the largest health system east of the Cascades.

“Because the state is often refusing to take responsibility for civilly committed patients, we believe this patient population is not getting the care it deserves. The current situation is not good for the patients, our staff or the other patients we serve,” said Dr. Shane Coleman, clinical division director of psychiatry and behavioral health for St. Charles. “By joining this lawsuit, we hope OHA will hear our concerns and take action to build more capacity to serve these patients in an appropriate health care facility for the level of care they need.”

Under Oregon law, individuals who are a danger to themselves or others may be civilly committed by the state for involuntary treatment for up to 180 days. Acute care hospitals are often the first stop for many patients who require urgent care and short-term stabilization. Once that is achieved, the state is legally required to place these individuals in a facility that specializes in long-term treatment, such as secure treatment facilities or the Oregon State Hospital, and that can give them the appropriate and necessary care to enable them to regain their liberty.  

Rather than transfer these individuals to an appropriate facility, the state is confining them in community hospitals for weeks or months. Community hospitals are not equipped, staffed or designed to provide long-term mental health treatment. The behavioral health units in these hospitals are intended to serve the community as acute care facilities where patients in mental health crisis can be evaluated, stabilized and discharged to the next appropriate level of care. 

The Oregon Health Authority has not only failed in its responsibility to its most vulnerable population, but by relying on acute care hospitals, OHA has negatively affected the hospitals’ capacity to care for other patients experiencing acute mental health crises in their communities. Oregon is in the middle of an unprecedented mental health crisis, and community hospitals are desperately needed to treat and stabilize other vulnerable patients in crisis, many of whom are also struggling with substance abuse disorders and houselessness. 

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.

 

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Grand Rounds - Dec. 2, 2022
"Anticoagulation: The New, the Old, the Reversals"

Speaker: Kazuhide Matsushima, MD. Assistant Professor of Clinical Surgery, Division of Acute Care Surgery, LAC+USC Medical Center Keck School of Medicine of USC.

 

 

Objectives

  1. Cite the pros and cons of each anticoagulant drug.
  2. Differentiate between the various anticoagulant drugs.
  3. Follow the indications for appropriate use of reversal agents.
  4. Select the proper medication for the patient’s therapeutic needs, taking into consideration any socioeconomic barriers.
  5. Communicate the importance of following the medication instructions given while navigating any cultural, health literacy, and language barriers.

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].

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A “perfect storm” of respiratory viruses is brewing, straining resources at hospitals across Oregon and prompting health care officials to urge people to protect themselves against the flu, COVID-19 and respiratory syncytial virus (RSV).

The first wave of this storm has already hit children. Governor Kate Brown has issued an emergency declaration in response to a surge of pediatric cases and hospitalizations driven by RSV. Additionally, three hospitals in the Portland area have moved to crisis standards of care in response to the surge.

St. Charles has not done that, but we are seeing an increase of pediatric cases in our community. While it’s impacting bed capacity in our Bend hospital, children are still getting the care they need.

“There are many St. Charles caregivers working hard and working together for our youngest patients, including nurses, respiratory therapists, pharmacists, dieticians, social workers, the physicians and providers in our Emergency Departments and our Pediatric Hospitalists, and so many more,” said Dr. Steve Gordon, interim president and CEO of the health system. “Unique to St. Charles are our additional efforts minimizing transfers to Portland whenever possible because of the extra burden this places on Central Oregon families. Our region is incredibly fortunate to have such talented and compassionate people delivering clinical excellence for our children and their families.”

At the same time, flu and COVID-19 cases are starting to increase, as expected.

“Influenza numbers are rising rapidly,” Dr. Cynthia Maree, St. Charles’ infectious disease section chief, told The Bulletin this week. “Our hospitals are already strained. We’re seeing the number of visits going up to the emergency department and urgent care.”

Maree warned that this winter could bring “a perfect storm of having viruses affecting all ages of the spectrum.”

Health care officials are encouraging everyone to take steps to prevent and reduce the spread of respiratory viruses. For flu and COVID-19, that means taking the time to get vaccinated and using everyday preventive actions to stop the spread of germs:

  • Avoid close contact
  • Stay home when you are sick
  • Cover your mouth and nose when coughing or sneezing
  • Wash your hands.

Locally, you can get vaccinated at many places. Visit the St. Charles website to learn more about the flu and COVID-19 vaccines.

The basics on RSV

If your child is high risk and showing symptoms of RSV, reach out to their pediatrician. If you don’t have access to a pediatrician, call 211 for help finding one.

Those at greatest risk for severe illness from RSV include:

  • Premature infants
  • Infants, especially those 6 months and younger
  • Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
  • Children with weakened immune systems
  • Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include:

  • Runny nose
  • Decrease in appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties. Almost all children will have had an RSV infection by their second birthday.

There is no specific treatment for RSV infection, and most go away on their own within a week or two. Here are some steps you can take to relieve symptoms:

  • Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
  • Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids).
  • Talk to your health care provider before giving your child nonprescription cold medicines. Some medicines contain ingredients that are not good for children.

Learn more on the CDC's dedicated RSV site.

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Victoria Stephens was still recovering from surgery when she knew she wanted to find a way to give back to those who had helped her.

Her first goal was to thank the medical team in charge of her ovarian cancer treatment, led by Dr. Emily Berry at the St. Charles Cancer Center.

Stephens was immediately impressed with Dr. Berry’s manner and level of care when she sat down with her for the first time after her diagnosis.

“She told me, ‘My team and I are going to be beside you,’” Stephens said. “‘We’ll be at the end of the phone. We’re going to have open doors. And we’re going to help you get through this.’”

She was also thankful for the employees of the Cancer Center, where a simple smile could make a difference in someone’s difficult day.

“From the gal that checks you in early in the morning to the person who checks you out at night (and) the people who help you in between – the people in the infusion room – I would like to thank each and every one of them,” she said. “They are absolutely beautiful people.”

Stephens’ second goal was to give something tangible to the people who had been such a source of encouragement during her cancer journey – namely, the online community from all over the country who participated in live auctions through her family's Redmond antique store. When those folks learned of her diagnosis, they flooded her with support and kindness.

“Their prayers held me up a lot during this time,” she recalled. “It was very, very comforting to know that these people, most of whom I didn’t even know or see, reached out and held my hand, prayed for me, asked how I’m doing.”

Stephens settled on embroidering handmade pillows with the inspirational words and phrases that had always provided her strength and comfort, such as Joy, Hope, Be Thankful and Faith Over Fear. And then there was Courage, which was specifically inspired by the unexpected passing of her brother in the midst of her chemotherapy treatment. Her hope was that the pillows could give people something to hold on to if they needed encouragement, or pass on to someone going through a hard time.

With a little decorating help from her granddaughter, Stephens completed 11 pillows throughout the rest of her chemo treatment before she was declared cancer free in May of 2022.  The plan was to sell the pillows through live auctions, with 100% of the proceeds going to the St. Charles Foundation in dedication to Dr. Berry and her team.

The online auction took place on her birthday, and she hoped to get around $10 for each pillow. With her family and friends beside her, Stephens watched in shock as bidding wars erupted over each one, with some selling for as much as $300 to $600 each to the same members of her online community who had supported her through her health issues. By the end of the auction Stephens had raised $3,467 for the Cancer Center.

“I was so overwhelmed,” she said. “There wasn’t a dry eye in the building.”

Beyond donating to the center, Stephens hopes to spread awareness about ovarian cancer, which is one of the hardest cancers to detect due to its lack of symptoms in the early stages. Her own symptoms were initially misdiagnosed as a liver condition, and several months went by before a specialist at OHSU discovered that it was, in fact, Stage lll ovarian cancer.

She encourages women to advocate for themselves if something doesn’t feel right: “Women, if your stomach swells, if you’re feeling punky, please go get checked.”

For more information on the signs and symptoms of ovarian cancer and to learn if you might be at risk, visit www.ovarian.org.

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