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Besides the resources and services that the St. Charles Medical Library provides, by being an Oregon Licensed Health Professional, you also have access to an Oregon Health & Science University (OHSU) Library account. Interested? Here is the application form

The account includes access to the OHSU Library Access Medicine database. Unfortunately, it doesn't include offsite access to electronic resources, but you can always make a request to us, and we'll be happy to help to retrieve what you need. The OHSU print materials can also be accessed via interlibrary loan, so ask us if you find anything in their catalog you would like to check further.  

You can find more information on services and eligibility can be found on the OHSU website.

 

 

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Grand Rounds - May 7, 2021
"Nutrition for Cancer Patients: Initial Diagnosis Through Surgery and Treatment"

Speaker: Robert Martindale, MD, PhD. Professor of Surgery, Division of Gastrointestinal and General Surgery, School of Medicine,OHSU.

Objectives

  1. Become aware of the new data supporting focused nutrition in cancer therapy
  2. Review the basics of cancer cell metabolism and how nutrition alters metabolism
  3. Nutritionally address both patients for cure and palliative care to optimize outcome and improve quality of life

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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"I’m not necessarily teaching ICU skills. I’m just teaching them the St. Charles way of caring for patients. From our policies and our procedures to who to call and how to call them to where things are. It’s kind of nice – it becomes like a team nursing sort of experience, and sometimes I’ve even learned some stuff from those that I’ve precepted. Which is neat. We all have different backgrounds, so we all have different knowledge and skills. It's a nice collaboration."

- Renee, a registered nurse in the Bend ICU, on what she likes about precepting ICU nurses who are new to St. Charles

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A new 3D mammography machine in the Central Oregon Radiology Clinic at St. Charles Madras will be a “game-changer” for breast cancer screening in Jefferson County, says mammography technologist Stefanie Brown.

“The statistic that always jumps out at me is that one in eight women will develop breast cancer in her lifetime,” said Brown, who has worked at the Madras hospital since 2018. “In my family, we have at least eight women, and so I look at them and I know the odds are one of them will get breast cancer. As a family member and as a caregiver, I want them to get 3D mammograms.”

Until late April, Madras had a 2D mammography machine, which produces a flat image of the breast. Now, it has a 3D machine – made by the medical technology company Hologic – that creates 50 to 80 1-millimeter “slices” providers can flip through like the pages of a book. This gives providers a much clearer, more comprehensive look at the breast, which means they have a chance to catch cancer earlier, said LeeAnn Ford, mammography supervisor with Central Oregon Radiology Associates.

And with breast cancer, early detection is key: Women who are diagnosed early have a 98% or higher survival rate in the first five years.

“With a 2D image, you have a lot of superimposed breast tissue, so you’re kind of just watching for shadow changes,” Ford said. “With 3D, you’re actually seeing inside the tissue, so you can see little things hiding in there.”

Brown offered an analogy: “Imagine you have a big cotton ball and you put a Skittle in the middle of it, and that Skittle is the cancer. You can take a picture of the cotton ball and you won’t see the Skittle. But if you cut the cotton ball into thin slices, you’re going to find that cancer.”

In addition to earlier diagnoses, the 3D machine’s more detailed images mean more certainty for providers and fewer false positives, which translates to more peace of mind for patients. Patients with an inconclusive 2D mammogram may be asked to schedule a follow-up 3D mammogram, Brown said, and the wait between those appointments can be fraught with worry.

“For two weeks, they’re saying, ‘What is going on with me? Do I have cancer?’” she said. “There’s all this anxiety, when really it was just a clump of tissue that might’ve been more easily seen in a 3D image.”

Many women in Madras, Warm Springs and the surrounding areas have been driving to Redmond or beyond for 3D mammograms. The new machine means they can get the care they need closer to home, and it greatly reduces a barrier to breast cancer screening for people with transportation issues.

“3D technology has completely changed the world of mammography for the better, and I am so pleased that we are now able to offer this tremendous resource to our community with the partnership of our friends at Central Oregon Radiology Associates,” said David Golda, vice president and hospital administrator at St. Charles Madras. “I know we have people in the area who have been driving out of town for their mammograms, and I hope they’ll start coming to St. Charles Madras.”

To be clear, the patient’s experience doesn’t change much in the move from a 2D to a 3D mammogram, Ford said, although Madras is getting the “latest and greatest” technology with its machine: Hologic’s SmartCurve™ system, which conforms to the unique shape of a woman’s breast and replaces the flat plastic paddles of yore. “We still have to compress the breast. Compression is necessary to get the best results,” Ford said, “But this new system should provide a little more comfort.”

More comfort. Less travel. Clearer images. Earlier detection. Peace of mind. There are plenty of good reasons for people to get 3D mammograms in Madras. Brown performs them Mondays through Thursdays, and she hopes her schedule fills up soon.

“My aunt is a breast cancer survivor, and her story fuels my passion for this industry,” she said. “So the fact that we’re literally now offering the best care to our patients, I’m just so excited about it.”

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Gene Costanza has been through more than his share of life-changing experiences.

A police officer for more than 25 years, he has saved lives, watched people die and was nearly killed on duty — multiple times.

So Costanza, 66, knows how important it is to stay calm in a chaotic situation. And on May 14, 2020, it took everything he had to do exactly that.

“I woke up that morning and felt great for about five minutes. And then I started feeling a weird pressure in my chest, a bit more acutely than I’d been feeling a couple days before. I woke my wife up and jumped in the shower, and that’s when it really started to cook,” he said.

“It wasn’t long before I was seriously concerned that I was not going to live through this,” he continued. “I was doing whatever I could to stay calm and breathe. I was just trying to stay alive.”

Fortunately for Costanza, good help wasn’t far away. After arriving at St. Charles Bend, he was quickly taken to the Emergency Department, and then whisked away to the Cath Lab, where he could hear interventional cardiologist Dr. Nicholas Buss and his team of caregivers talking, both to him and to each other.

‘I WAS A PERSON’

“The way they were speaking to me, it wasn’t like I was a product. I was a person. They were speaking to me, the guy at the other end of this emergency,” Costanza said. “They’d ask me questions that needed to be answered. They’d tell me where they were going and what they were doing. I didn’t care what they were doing, but looking back, I certainly appreciate the level of communication and interaction, especially in an urgent environment.

“The teamwork that I could hear happening,” he said, “was incredible.”

The Heart One program at St. Charles Bend’s Heart and Lung Center is a coordinated effort to bring physicians, area hospitals and emergency responders together to ensure people who are having a heart attack receive care as quickly as possible. The Bend hospital has the lowest mortality rate for heart attack patients of all the hospitals in Oregon, in part because the time it takes for a heart attack patient to receive a stent once reaching the hospital — known as door-to-balloon time — is better than national averages.

The next thing Gene Costanza remembers is being wheeled out of the Cath Lab and being struck by the “everyday hero” nature of what he’d just experienced.

“I looked up at them and I said, ‘You guys just got up this morning, had breakfast, came into work and saved my life,’” he said. “How cool is that?”

The quality of care continued beyond the ED and Cath Lab. Costanza had great nurses, he said, and he struck up a conversation with the Environmental Services caregiver who cleaned his room.

“She loved working at St. Charles,” he said. “I left the hospital thinking, ‘Man, am I too old to go back to school and become a nurse?’”

LEAVING SOMETHING BEHIND

As a kid, Costanza started drawing as a way to avoid paying attention in school, he said. But he left art behind as he entered adulthood and started his police career, only to have his long-dormant passion reawakened one day at a conference in Arizona.

“I was in Scottsdale and I walked into an art gallery and came face-to-face with a massive painting of the Grand Canyon,” he said. “I went, ‘Oh no … I’ve got to learn how to paint. I’m disciplined enough now that maybe I can do this.’”

That was in the late 1980s. Since then he has spent much of his free time creating contemporary realist paintings of traditional subject matter, with a primary focus on natural landscapes. (You can see his work at genecostanza.com.)

So last year, when he got home from St. Charles and wanted to find a way to thank the people who cared for him, he turned to his art. Using his “broken top” of a heart as inspiration, he started working on a 30-by-60-inch oil painting of snowy Broken Top towering over brownish-green trees, a glistening creek and rustic fence posts.

He is finishing and framing “New Morning on Broken Top” now, with plans to mark the one-year anniversary of his heart attack by donating it to the St. Charles Foundation for placement in the Bend hospital.

“Me and a good buddy of mine spend hours talking about art and philosophy, why we’re driven to create, and about giving back and leaving something behind,” Costanza said. “The people who took care of me went above and beyond, and my hope is that this painting can hang there long after I’m gone.

“If I can do something that will raise the spirits of people who are sitting there waiting for a loved one or just passing by, I’d feel pretty good about that,” he continued. “Maybe even someone from the care team might notice it and remember saving my life. That’d be pretty cool.”

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A few weeks ago, I sent out a message explaining that we were in a race to vaccinate as many people as possible against COVID-19 before the new variants of the virus could catch up with us.

Unfortunately, as of this moment, it feels like we are losing the race.

Recently, Deschutes County recorded the highest number of positive COVID-19 cases in one week since the beginning of the pandemic. Nearly 600 new cases were reported in the tri-county region from April 18-24 – many of them in children and young adults.

At the same time, hospitalizations are increasing as well. Late last month, we had 36 COVID-19 positive patients in the Bend hospital. Because we have done such a great job of vaccinating our older population, the average age of our hospitalized critically ill patients has dropped by about 13 years. Unfortunately, with this recent wave of spread, and perhaps related to new variants, we are now seeing people in their 20s, 30s and 40s who are very sick with this virus and in need of intensive care.

We are once again faced with canceling some elective procedures for patients because we are simply out of hospital beds and staff to provide that care. These are patients who have already waited for months in many cases. They are in pain and suffering. We don’t want to delay their care – but the resurgence of COVID-19 cases means our resources are tapped.

Our St. Charles team of caregivers and providers started all but four days in the month of April with the Bend hospital at 90% capacity or higher. We have nurses, doctors, respiratory therapists, environmental services, food services caregivers and so many more who are working very hard to care for our community.

This is not the time to give up. We have tools that will give us that boost of energy to pull ahead in the race. Masking, handwashing and distancing remain absolutely critical – perhaps now more than ever.

And, the most important thing you can do today is get your COVID-19 vaccine. I know many of you already have taken this step, but we still have a long way to go to reach herd immunity. This is especially true in Jefferson and Crook Counties where vaccination rates are hovering around 30% of the population. Deschutes County is doing slightly better with about 43% of the population vaccinated.

But we are now at the point where we have more vaccine appointment slots available than we can fill. You can still visit www.centraloregoncovidvaccine.com to make an appointment at the tri-county mass vaccination clinic at the Deschutes County Fair & Expo Center. You are now able to pick a time that's most convenient for you – no more pre-registering or waiting to receive a link in an email. Just schedule and go. It's that easy.

If you have been hesitating, now is the time to get vaccinated.

Be a part of the solution. Help us win the race.

Sincerely,
Joe

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Grand Rounds - Apr. 30, 2021
"Physician Communication and Care Management: Leadership Strategies"

Speaker: Ian Jenkins, MD, SFHM. Chair, Patient Safety Committee, Associate Professor of Medicine, Division of Hospital Medicine. UCSD School of Medicine

Objectives

  1. Describe how mobile applications can be used through the cognitive rehabilitation process and beyond.
  2. Identify at least three ways mobile applications can address common executive function issues.
  3. Relate how mobile applications can benefit brain injury survivors at home, school, and work.

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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Grand Rounds - Apr. 23, 2021
"Clinical Connect"

Speakers:

  • Shilo Tippett, PhD. Behavioral Health Primary Care Consultant Outpatient, Msa Clinic
  • Ngocthuy Hughes, DO. General Surgery, St. Charles Surgical Specialists
  • Candy Picar, DNP. Chief Nursing Officer, Patient Care Support
  • James Reedy, RN, CNO, FACHE. Redmond Administration

Objectives

  1. Gain firsthand knowledge of providing health services to diverse patient populations
  2. Identity strategies of engaging patients of diverse backgrounds into their care
  3. Increase knowledge of supporting patient’s various needs from different representative populations

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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Grand Rounds - Apr. 16, 2021
"Medical Decision Making"

Speaker: Jennifer Blumenthal-Barby, PhD, MA. Cullen Associate Professor of Medical Ethics and Associate Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine

Objectives

  1. Identify some biases & heuristics that influence patients' judgment and decisionmaking
  2. Analyze the impact of those on the informed consent process
  3. Describe the ethical concerns with shaping patients' decisions

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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When you look at what has happened in our community over the last two weeks, it’s easy to feel frustrated.

Based on the spread of the COVID-19 virus, Deschutes County has once again moved into “high risk” territory, an Oregon Health Authority designation that triggers certain precautions like limiting capacity in restaurants. The change was based on the two-week period from March 21 through April 3, when the county reported 139.9 cases per 100,000 people.

Here at St. Charles, hospitalizations are also slowly ticking up. About two weeks ago, we had just three people in the hospital with COVID-19. Today, we have 13.

So many of us are heeding the “wash, mask and distance” mantra and have even been vaccinated. We are tired and we just want to know, “when does this end?”

I’m not sure anyone can reliably predict that, but I do want to share with you some encouraging news: while we are seeing an increase in COVID-19 cases, we are also seeing about 20 percent fewer hospitalizations than we’d expect due to the virus.

We think our vaccination campaign is starting to work.

As of today, almost 91,000 people have been vaccinated in Central Oregon, including more than 82% of our residents who are 80 and older. This is significant because in the early days of the pandemic, this group represented a disproportionate number of hospitalizations and deaths.

While this is certainly a move in the right direction, we must not let up on our efforts to get ourselves, family, friends and neighbors vaccinated. To achieve what we call “herd immunity,” we need at least 70% of our community to get vaccinated.

The good news is starting next week, it becomes easier and more straightforward than ever to schedule your appointment. On Monday, April 19, everyone in Oregon who is 16 and older is eligible to get a COVID-19 vaccine. There are no more complicated eligibility rules to decipher. If you’re 16 and older, it’s your turn. Please, sign up. To do that, go to centraloregoncovidvaccine.com. If you don’t have access to the internet, call 541-699-5109, but be prepared to wait, as call volumes are sometimes high.

The latest on the Johnson & Johnson COVID-19 vaccine

On the topic of COVID-19 vaccines, I also want to share with you what I know about the one made by Johnson & Johnson.

If you haven’t been following the news, the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) jointly announced that out of an abundance of caution, they are pausing the use of Johnson & Johnson’s COVID-19 vaccine. As a result, the community vaccination clinic at the Deschutes County Fair & Expo Center has stopped offering it.

In a joint media call Tuesday, officials from the agencies said they made the decision after six cases of a rare and severe type of blood clot occurred in women between the ages of 18 and 48 who also had low levels of platelets in their blood. One of the six women died and another is in critical condition.

Officials recommended the pause to allow them time to work together to understand these events and to provide more information to health care providers and vaccine recipients.

“These events appear to be extremely rare,” said Janet Woodcock, the acting FDA commissioner. “However, COVID-19 vaccine safety is a top priority of the federal government, and we take all reports of adverse events following vaccination very seriously.”

The Advisory Committee on Immunization Practices (ACIP)—an independent scientific expert committee that reviews immunization matters—convened Wednesday to review data on these initial cases but stopped short of deciding whether to resume use of the vaccine, citing the need for more information. The committee plans to meet again sometime within the next 10 days.

So, what do you do if you’ve already received the Johnson & Johnson vaccine?

For those of you who received the vaccine within the last two weeks, call your health care provider if you experience severe headaches, abdominal or leg pain and shortness of breath. These symptoms are different from the mild symptoms many people experience within a couple days of receiving the vaccine.

FDA and CDC officials have also stressed they are not seeing the same blood-clotting issue with the other two vaccines made by Pfizer and Moderna. So, if you’ve already scheduled your appointment for a vaccine, we strongly encourage you to keep it.

Widespread vaccination is still our best hope to end this pandemic.

Sincerely,
Joe

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