UpToDate® is a point-of-care clinical decision support system, recently subscribed by St. Charles, accessible for our caregivers via Epic or directly. It can be accessed from campus and also remotely as long as we create a user account while connected to the St. Charles network. That user account is also needed to accrue and claim CME credits using UpToDate.

If you already created the account, access it from uptodate.com/login. If you don't have that yet, here is how to do it:

1. Go to uptodate.com/login-register (or to uptodate.com/login and click Register). To be able to do it, you must be connected from campus or via the St. Charles VPN.
2. Complete the Registration. After that, you can use the new log-in information from anywhere.
3. UpToDate® is also available via the phone app (iOS | Android) using the same credentials. 

The account will be active and available six months after the last connection from the St. Charles network.

If you have any questions or need help with the use of UptoDate®, contact the Medical Library. We are UpToDate® Certified Trainers!

Grand Rounds - Nov. 20, 2020
"COVID-19 Update"

Speaker: 
Shira Shafir, PhD, MPH, Director, MPH for Health Professionals Department of Community Health Sciences Director of Field Internships Department of Epidemiology UCLA Fielding School of Public Health

Objectives

1. Describe the current state of the COVID-19 Coronavirus outbreak
2. Describe current best practices concerning personal protective equipment (PPE)
3. Understand the importance of social distancing measures and what they mean for health care professionals in practice
4. Understand the implications of a PHEIC (Public Health Emergency of International Concern)and a locally declared Public Health Emergency
5. Understand where to find additional information and resources as this outbreak continues to evolve

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].

"My life has always been an active one. I was born and raised on a farm in Iowa and have participated in sports regularly and, in my later life, I have walked at least two miles most days. Since age 43, I have been an avid downhill skier. In 2011, I moved to Bend, Oregon where there is, in the city limits, a butte (Pilot Butte) that is 500 feet high. I saw this as a challenge and was soon climbing the butte every day. It is one mile up and one mile back down. That is darn good exercise!

It was also 2011 that I heard the shocking news, “you have lung cancer, stage four.” I was 92 years old. The diagnosis was later changed to stage three, however, lymph nodes along my sternum were involved and surgery was no longer an option.

My treatment consisted of seven weeks of chemotherapy and radiation. The radiation was administered five days a week for the seven weeks; each visit I was zapped five times from different angles. During the seven weeks of treatment, I climbed the ol’ butte 14 times; I climbed to the top seven times; I could make it just halfway another seven times. The main side effects of the treatment for me was fatigue. I did my best to ignore this; Looking back, I think my positive attitude certainly helped me in my treatment.

The nine years since the completion of treatment, have been the best years of my life. There is something about having to go through the diagnosis and treatment of cancer that awakens a desire to make each day the best day of your life. Today and every day I say life is good and the best is yet to be. In the time since treatment, I have accomplished things that I never thought of doing in the past. In the past nine years since treatment, I have had the privilege of visiting Europe four times for at least a month each time. My desire to know Paris better has been fulfilled having lived on the left bank for an extended period. During these visits, I have spent more than five weeks in Italy. I also found time to paint an eight foot by seven foot mural on our dining room wall.

During my long, boring sessions of chemotherapy, I wrote a book; the story of my life. The book is titled, “How I Chose to Live My Life,” is 256 pages and includes more than 100 illustrations. I had a printer produce enough copies so that my grandchildren and great grandchildren could each have a copy.

My lifelong hobby has been wood carving. Somehow it felt necessary to do something fairly large. So, I carved a life-size carousel horse. I later carved another one that was made part of the “Art in Public Places” here in Bend. It hangs today at the entrance of the downtown parking structure.

Also since completing my treatment, I have had a season pass for our local ski mountain, Mount Bachelor. One year, I skied 44 days.

These accomplishments made me realize that life is not over when you are diagnosed with serious cancers. Rather, it is a time to take a new view of life and to make the most of it. My life is not over.

This year, I celebrated my 101st birthday by piloting a glider down from 5,000 feet (I have a pilot’s license)."

- Art Vinall, Bend resident, cancer survivor and World War II veteran

Did you know you can create search alerts using the Discovery Power Searcher? Save your recurrent searches and get new results delivered to your email inbox or an RSS reader. Here is how to do it: 

1. In the Search box, enter the topic you want to follow. You can use both the basic or the advanced search. Click on "Create alert" instead of "Search".
   1. If you want to receive the alerts via email, you will be prompted to sign in unless you are already identified. Once that is done, choose the settings you prefer and click on "Save alert". You will start receiving emails matching the criteria as soon as they are available. 
   2. Alternatively, you can subscribe to the search using a RSS reader. There is no need to sign in for that, and you simply need to copy the feed URL for the search and subscribe it on your favorite aggregator. Outlook supports RSS feeds, and here are also some other popular non-email-based readers: 
      • Feedly
      • Innoreader
      • Tiny Tiny RSS
      • Feeder

Follow the steps for email alerts using the tutorial  below:

Grand Rounds - Nov. 13, 2020
"Emerging Infectious Disease and Pandemics"

Speaker: 
Andrew Milsten, MD, MS, Associate Professor of Emergency Medicine, Fellowship Director Disaster Medicine and Emergency Management

Objectives

1. Review of the scope, epidemiology, background, and types of emerging infectious diseases
2. Discuss past pandemics and their implications for the future
3. Analyze how COVID-19 fits into the overall schema of disaster medicine and human 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.

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].

Important: to do this, you need to be logged in on PubMed (create an account).

You can perform different searches, select the relevant articles for each one, and send them to us at once for them to be retrieved:

1. In the search results page, select the relevant articles and send them to the Clipboard:

2. Keep performing all the searches you need, and repeat 1 for every article you need.

3. When you are ready to request the articles, click Clipboard below the Search field:

   

4. Click Save and download a file with the references. In format, choose Summary (text) or PMID.

   

5. Attach that file to an email and send it to [email protected].

6. Wait. We’ll get back to you as soon as we’ve retrieved all the articles!

Nov. 10, 2020

I know you are really tired of talking about COVID-19.  

Trust me, so am I.  

But what’s happening right now is highly concerning. We have 15 patients hospitalized with COVID-19 today, and over the weekend at times the number matched our previous record.  

It appears we have officially hit a third wave. But unlike the last two, we never reset back to zero hospitalized patients. Our number of inpatients has held steady in recent weeks until last Friday when it essentially doubled overnight.

We need to act now 

With the upcoming holidays, we are concerned that if people don’t act NOW to change their behavior our hospital system could become overwhelmed. As of today, we have the beds and the staff to take care of you, but your actions make a difference in helping to keep it that way.  

The virus is clearly still here and our choices are making a difference in how the disease finds places to thrive. We are seeing a fear-fatigue cycle of behavior. When we feel more afraid that the virus is circulating broadly in our communities, we pull back, isolate more and are better about wearing our masks.  

Sooner or later, fatigue sets in and we relax our standards, spend time with more people outside our normal bubbles and maybe don’t remember to wash our hands as frequently. It is becoming predictable. And while we are all exhausted by this pandemic, we know these next few months will be a crucial time to stay strong.  

Statewide, the highest number of cases continues to be in people ages 20-29. We also know from the Oregon Health Authority that most cases can be traced back to small, indoor social gatherings.

While we all know how difficult it is to remain isolated – especially now that the weather is turning colder and it’s harder to spend time together outdoors – it is still critically important.  

We have some advice as you start to make plans for the holidays:

• Keep it small – indoor gatherings should be immediate family only

• Keep it safe – if you choose to gather with those outside your immediate family, ask everyone to isolate for 14 days before the holiday and not to attend if they are feeling sick

• Make it special – use this time to create new traditions (hiking or snowshoeing instead of a big meal, making porch deliveries to those in need) and focus on the positives (no giant grocery bills or piles of dishes)

We understand that asking people not to gather for their traditional holiday celebrations is really hard. But we also know that Central Oregonians are strong. We will get through this by pulling together.

Please watch the latest from our #staystrongCO campaign featuring many of our local St. Charles providers to better understand what you can do to stay safe. We also encourage you to share these messages with your friends and family.

And if you’d like to know more about St. Charles’ ongoing response to COVID-19 along with other health system updates, we invite you to participate in our Town Hall event coming up on Nov. 19. You can register here. 

Sincerely,

Joe

Grand Rounds - Nov. 6, 2020
"Social Determinants of Health: Native-American Health During COVID-19"

Speaker: 
Erik Brodt, M.D., OHSU. Associate Professor of Family Medicine, School of Medicine.

Objectives

1. Define the social determinants of health.
2. Explain how inequities in neighborhood conditions, education, income and wealth, and sociopolitical climate affect health outcomes and health disparities.
3. Understand how differential access to wealth-building policies and structures (beyond income) creates unequal conditions for good health in communities across the United States.
4. Identify examples of effective local, regional, and national strategies for improving systems and policies that affect the social determinants of health.

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].

Grand Rounds - Oct. 23, 2020
"Creating and Sustaining a Highly-Reliable Health System for the Identification and Treatment of Severe Sepsis and Septic Shock"

Speaker: 
Russell B. Kerbel, MD, MBA, Medical Director, Sepsis Prevention for UCLA Health Assistant Professor of Medicine Division of Hospital Medicine David Geffen School of Medicine at UCLA.

Objectives

1. Describe the most recent concepts surrounding the pathophysiology of sepsis
2. Recognize the difference between the various existing sepsis definitions
3. Provide an overview of the landmark Sepsis Clinical Trials
4. List some tools used to recognize sepsis in the hospital
5. Identify the steps to create a high-reliability system to identify and treat sepsis

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].