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Grand Rounds - Sep 2, 2022
"HIV/AIDS Diagnosis, Management, and Care Updates"

Speaker: David J. Cennimo, MD, FACP, FAAP, FIDSA, AAHIVM. Associate Professor of Medicine and Pediatrics, Associate Dean of Education, Rutgers New Jersey Medical School.

 

 

Objectives

  1. Describe the HIV disease burden in the US and the recommendations for testing.
  2. Discuss and plan treatment with a patient newly diagnosed with HIV.
  3. Counsel on HIV transmission and risk mitigation including PrEP, PEP, U=U.
  4. Recognize new HIV treatment modalities.

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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Over 34 million people in the U.S. have diabetes and another 88 million are prediabetic. That means 1 in 3 people in America struggle with some form of the disease.

Two years ago, the Central Oregon Health Council awarded St. Charles a grant to purchase several continuous glucose monitors, which give diabetics an easy way to keep an eye on their blood sugar levels. (No more pricking fingertips!)

We launched a pilot program with 55 patients, and the results have been truly life-changing. Today, there are more than 200 St. Charles patients using the devices.

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“There were definitely a lot of people involved in this, and it just feels good knowing that I have such great colleagues to work with who were all willing to go above and beyond to learn what we were doing and understand the goal and help us improve. It’s nice to see that we can come together to make a more efficient process that will benefit the health system and, ultimately, our patients.”

Paulina, a coordinator on the Bend Ortho/Neuro floor who recently collaborated with several groups across the health system – including the Lean Improvement Office, Epic analysts, Wound Care nurses, the OR team, Environmental Services, Clinical Informatics, unit secretaries and more – to improve how the health system manages and tracks the use of rental wound vacuum-assisted closure (VAC) machines. Previously, Paulina was the only caregiver managing and tracking the machines, an extremely manual and time-consuming process. By incorporating Epic technology and working together to improve processes, the team was able to cut Paulina’s management time by half and increase the availability of VACs for patients.

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Workforce shortages, capacity concerns are rampant at Oregon hospitals

Over the past few weeks, you’ve likely seen a lot of headlines about hospitals’ capacity problems—including those at St. Charles. These problems are the result of many factors, chief among them short staffing and the inability to discharge patients.

Our state’s hospitals are as strained as they were at the peak of the Delta and Omicron surges. Patients are returning for much-needed care at the same time organizations can’t fill positions fast enough. This lost balance between supply and demand isn’t unique to health care, but it has the most serious consequences. This is especially true in Oregon, which has the lowest number of hospital beds per capita in the country. In “normal” times, this kind of efficiency is good. Right now, it’s disastrous.

As I write this, approximately 493 patients statewide are waiting to be moved from hospital beds to skilled nursing or assisted living facilities and another 224 are boarded in Emergency Departments, jeopardizing hospitals’ ability to admit patients who urgently need care. Recently, Salem Health—which has operated at more than 100% [BS1] capacity for more than a year—put ambulances on divert for the first time since 2008. In an interview on OPB’s Think Out Loud, CEO Cheryl Wolfe said the health system has since been “very, very close (to going on divert) multiple times because of the impact of not just the COVID patients, but also the number of ambulances coming to our Emergency Room.”

These aftershocks of the COVID-19 pandemic are rattling Oregon’s hospitals, demanding that we work with intensity and pace to find solutions. At St. Charles, we have a number of teams focused on initiatives to improve patient flow, bolster staffing and recruitment and ensure our caregivers have what they need to care for our patients.

We’re also partnering with the Oregon Association of Hospitals and Health Systems to ask the state of Oregon and the governor’s office to invest in short- and long-term solutions that will decompress the system. These include:

  • Declaring a staffing crisis in the state of Oregon
  • Expanding licensure both short- and long-term
  • Urging the state to join interstate staffing compacts, allowing nurses who are licensed in other states to work here (Oregon is one of only a handful of states not participating)
  • Allocating finances that will increase the availability of secondary care 

I know health care workers’ jobs are harder than they’ve ever been, which is why I take this work so personally and so seriously. These are challenges we have to overcome, for the good of our people, our organization and the communities we are proud to serve.

Sincerely,
Steve

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After two years in a virtual format due to COVID-19, Heaven Can Wait – the popular annual 5K walk/run and fundraiser for Sara’s Project – will return as an in-person event at 10:30 a.m. on Saturday, Oct. 2.

And that’s not all that’s new: This year, the event will start and end at Redmond High School’s stadium, with a course that takes participants through Redmond’s scenic Dry Canyon.

“It is our hope that bringing Heaven Can Wait to Redmond will provide a more central location for community members who have been touched by breast cancer to come together, wherever they are in their cancer journey,” said Anna Contreras, events and development specialist with St. Charles Foundation. “The Central Oregon community has been steadfast supporters of this event and St. Charles Foundation and event volunteers are thrilled to be bringing the walk to Redmond.”

Heaven Can Wait raises money for Sara’s Project, a fund of the St. Charles Foundation that helps provide vital support services to people in Central Oregon who are battling breast cancer. Over its 23-year existence, the event has raised approximately $100,000 annually for assistance to under-insured patients, as well as integrative therapies such as therapeutic massage, acupuncture, yoga, and reiki.

Heaven Can Wait has also become an important opportunity for the community to come together and celebrate cancer survivors while also remembering loved ones.

“It has been almost three years since the community last gathered to support this powerful event,” said Mari Shay, administrative director of cancer services for St. Charles. “This will be my first Heaven Can Wait, and I look forward to meeting more cancer survivors and our community partners as we stand together to support those who are battling breast cancer.”

To participate or volunteer in the 5K walk/run, register at HeavenCanWait.org. For questions related to the event, contact Anna Contreras at 541-788-2940 or [email protected].

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, La Pine, Madras, Prineville, Redmond 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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Heaven Can Wait: In-person, now in Redmond

The popular 5K walk/run raises money for Sara’s Project

After two years in a virtual format due to COVID-19, Heaven Can Wait – the popular annual 5K walk/run and fundraiser for Sara’s Project – will return as an in-person event at 10:30 a.m. on Sunday, Oct. 2.

And that’s not all that’s new: This year, the event will start and end at Redmond High School’s stadium, with a course that takes participants through Redmond’s scenic Dry Canyon.

“It is our hope that bringing Heaven Can Wait to Redmond will provide a more central location for community members who have been touched by breast cancer to come together, wherever they are in their cancer journey,” said Anna Contreras, events and development specialist with St. Charles Foundation. “The Central Oregon community has been steadfast supporters of this event and St. Charles Foundation and event volunteers are thrilled to be bringing the walk to Redmond.”

Heaven Can Wait raises money for Sara’s Project, a fund of the St. Charles Foundation that helps provide vital support services to people in Central Oregon who are battling breast cancer. Over its 23-year existence, the event has raised approximately $100,000 annually for assistance to under-insured patients, as well as integrative therapies such as therapeutic massage, acupuncture, yoga, and reiki.

Heaven Can Wait has also become an important opportunity for the community to come together and celebrate cancer survivors while also remembering loved ones.

“It has been almost three years since the community last gathered to support this powerful event,” said Mari Shay, administrative director of cancer services for St. Charles. “This will be my first Heaven Can Wait, and I look forward to meeting more cancer survivors and our community partners as we stand together to support those who are battling breast cancer.”

To participate or volunteer in the 5K walk/run, register at HeavenCanWait.org. For questions related to the event, contact Anna Contreras at 541-788-2940 or [email protected].

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Answers to 5 FAQs about monkeypox

The infection is spreading, but has not reached Central Oregon

Monkeypox is an infection caused by a virus that has historically been most common in some African countries. However, outbreaks have occurred in other areas, and the current outbreak is spreading monkeypox across the world.

Monkeypox has not reached Central Oregon, but St. Charles is seeing an uptick in questions about this disease. Here are answers to five questions we’re hearing most frequently:

1. How concerned should I be about monkeypox?

“As always, a good position on something like this is: Be aware, but don’t panic,” said Dr. Cynthia Maree, head of St. Charles’ Infectious Disease department. “The bad news is monkeypox is spreading. The good news is it doesn’t spread as easily as COVID-19, and right now, the risk of spread in public settings is very low.”

In July, the World Health Organization declared monkeypox a global health emergency, and last week, cases rose 20%. As of Aug. 17, there were more than 35,000 confirmed cases of monkeypox in 92 countries, and 12 deaths related to the disease, with 68 confirmed cases (and 48 presumptive cases) in Oregon.

2. How does monkeypox spread?

Monkeypox spreads primarily through close physical contact – specifically skin-to-skin contact with the rash or sores of an infected person.

It can also spread through:

  • Contact with contaminated bedding or clothing
  • Contact with bodily fluids
  • Respiratory droplets during extended face-to-face contact (more than three hours)

So far, the spread of monkeypox during the current outbreak has been driven primarily by close physical contact during sex between men. However, it is important to know that it can spread in other ways and among other communities.

3. Who can get monkeypox?

It has been erroneously reported that monkeypox only spreads among men who have sex with other men. This is not accurate. There is nothing about that specific community that puts its members at higher risk for contracting monkeypox. It just happens to be the first community affected by this particular outbreak.

“There is a lot of misinformation out there, so I want to reiterate: Monkeypox is not limited to one community or another,” Maree said. “Anyone can contract it, and anyone can spread it.”

4. How serious is monkeypox?

People with monkeypox get a rash that may be located on or near the genitals or anus, and could be on other areas like the hands, feet, chest, face or mouth. The rash can initially look like pimples or blisters and may be painful or itchy. Other symptoms can include fever, chills, swollen lymph nodes, exhaustion, muscle aches, back ache, headache and respiratory symptoms.

The U.S. Centers for Disease Control has more information, including photos of monkeypox rashes and sores, here.

Most people who contract the disease recover within two to four weeks, but it can be serious, especially for immunocompromised people, children, pregnant people and people living with HIV that is not virally suppressed. Twelve people have died during the current outbreak.

If you develop a new rash, bumps or sores, ask your health care provider about testing for monkeypox, especially if:

  • You’ve been in close contact with anyone with a known or suspected monkeypox infection.
  • You’ve had close physical contact with someone in a social network known to be experiencing the spread of monkeypox.
  • You’ve traveled in the past month to areas of the world where cases have been found.

5. Is there a vaccine for monkeypox?

JYNNEOS is an FDA-approved vaccine against monkeypox for those 18 years and older. Because supply is limited, vaccines are currently being offered to those with a known exposure and those who are most likely to be exposed.

Deschutes County has some vaccine available. Learn more here.

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Visitor Tips

  • Please check with your caregiver for specific patient and department visiting guidelines.
  • Nighttime visitors are requested to check in through the Emergency Department admitting area.
  • Lengthy stays can be tiring for a patient. We ask that visits be kept short.
  • Please help protect our patients’ privacy. Refrain from taking photos or videos in patient areas.

Visitor Guidelines

Visitor Parking

Designated parking is available for visitors near the main entrances. Signs are posted with instructions on the best place to park.

Locations and Maps

Tobacco Free Campus

All St. Charles Health System facilities are tobacco free inside and out. Tobacco use in any form – including cigarettes, cigars, pipes, chewing tobacco and e-cigarettes is not allowed by patients, visitors or caregivers within the hospital, at any of the entrances, parking lots or property owned or maintained by the health system. Your cooperation is greatly appreciated.

Oregon Tobacco Quit line 1-800-QUIT-NOW/Spanish 1-855-DEJELO-YA.

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Case Management/Discharge Planning/Social Work

Case management services are available to help you and your family cope with the stress of illness. The case management team will direct you to community resources and assist in planning for your care when you leave the hospital. To request this service, please contact your nurse.

Patient Experience

Your experience at St. Charles is very important to us. If you have experienced an issue and have concerns, we encourage you to first discuss the problem with the caregivers involved in your care or the care of your family member.

If you are unable to reach a satisfactory resolution to your concerns, please contact our Patient Experience Department to discuss:

Phone: (541) 706-6316
Email: [email protected]
Mail: St. Charles Health System
Attn: Patient Experience
2500 NE Neff Road, Bend, OR 97701

If you are unsatisfied with the response you receive from our Patient Experience Department, you may seek assistance outside of our hospital with the following organizations:

Oregon Health Authority, Health Care Regulation & Quality Improvement: 800-273-0557
Medicare (KEPRO-changing name to Acentra in Fall of 2024): 888-305-6759 

Spiritual Care Services

We offer spiritual care to patients and families with love, compassion and respect. You can request a chaplain by speaking to your caregiver.

Support Groups and Classes

St. Charles offers special classes and support groups for patients and their families. These classes can aid in recovery or help in the management of an illness or condition. For a current list of available subjects and schedules, please visit stcharleshealthcare.org.

MyChart

The St. Charles MyChart patient portal allows you to access your medical record or manage care for a family member, request prescription refills, make an appointment online, see test results or pay a bill online. Visit stcharleshealthcare.org/mychart or ask a caregiver for details.

Notary Public

Notary Public services are offered free of charge to patients. Check with Guest Services for availability. St. Charles notaries will only notarize advance directives and health-care related documents, such as requests for birth certificates. Neither wills nor power of attorney documents can be notarized due to liability.

Free Health Information

The St. Charles health information library is available to assist you in learning about your diagnosis or condition. We will assemble a packet of information for you upon request. Additional phone numbers and resources are available upon request, such as pharmacy, behavioral health, home health care, medical equipment, etc.

Billing

To ensure accurate and ethical billing practices, we have a hotline for patients, family members and the general public. Call 541-706-2630 if you feel any hospital billing practice may violate state or federal laws. Your concern can relate to any bill or billing practice. For general billing questions or concerns, call our Patient Financial Services Department at 541-706-7750. Financial assistance is available at St. Charles Health System. A list of financial counseling locations, as well as our Financial Assistance Program policy and application form, in English and Spanish, can be found here.


Patient Rights & Responsibilities

Nondiscrimination Notice

Section 504 Notice of Program Accessibility

  • St. Charles Health System and its patient care areas, including its hospitals and clinics, are accessible to and usable by disabled persons, including persons who are deaf, hard of hearing, or blind or who have other sensory impairments. Access features include:
  • Convenient off-street parking designated specifically for disabled persons
  • Curb cuts and ramps between parking areas and buildings
  • Level access into first floor with elevator access to all other floors
  • Fully accessible offices, meeting rooms, bathrooms, public waiting areas, cafeterias, patient treatment areas, including examining rooms and patient wards
  • A full range of assistive and communication aids provided to persons who are deaf, hard of hearing, or blind or with other sensory impairments. There is no additional charge for such aids. Some of these aids include:
    • Qualified sign language interpreters for persons who are deaf or hard of hearing
    • A 24-hour telecommunication device (TTY/TDD) which can connect the caller to all extensions within the facility and/or portable (TTY/TDD) units, for use by persons who are deaf, hard of hearing or speech impaired
    • Readers and taped material for the blind and large print materials for the visually impaired
    • Flash cards, alphabet boards and other communication boards
    • Assistive devices for persons with impaired manual skills If you require any of the aids listed above, please make your registration or nurse caregiver aware of your needs.

Interpretive Services/TDD

Interpretation services and Telecommunication Devices for the Deaf (TDD) are available for our patients. If you require language assistance, please contact your nurse or caregiver.


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St. Charles is a place of healing. Threats, abusive language and violence will not be tolerated.

Patient and caregiver safety are top priorities for St. Charles Health System. Thank you for working with us to provide a healing and respectful environment for all who enter.

Wristbands

For your safety, you may have one or more wristbands indicating patient information, any allergies or other concerns of note.

Preventing Infection

Proper hand hygiene is extremely effective at reducing the number of germs present on the skin and can help prevent infections that are difficult to treat. Everyone caring for you should practice the proper hand hygiene technique. If you see doctors, nurses or other health care providers fail to clean their hands with soap and water or use a waterless alcohol hand rub when entering your room to provide care, it’s OK to ask them to wash their hands.

Preventing Falls

We have a robust fall-prevention program that includes understanding that all patients have the potential to be at high risk for falls. If you are concerned about falling during your stay, please talk with your care provider.

Condition Help

Changes in a hospitalized patient’s condition can occur rapidly and family and visitors may be the first to detect these early changes. Each hospital room is equipped with a phone number that can be used by patients and visitors to call for medical help to respond to a patient’s urgent condition change.