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Grand Rounds - Dec. 11, 2020
"Adrenal Insufficiency"

Speaker: Nairi Berner, MD, Assistant Clinical Professor, Endocrinology Chairperson, Inpatient Diabetes Management Committee University of California, Irvine

Objectives

  1. Explain with insight regarding the pathophysiology, diagnostic elements, testing algorithms and sometimes conflicting guidelines for therapy in the care of patients with adrenal insufficiency.
  2. Review the symptoms of cortisol and adrenal androgen deficiencies in the setting of both primary and secondary AI, symptoms only seen in primary AI, guidelines for laboratory testing, and to review the various treatment options, including systemic steroid, and how to use laboratory test and symptom assessment to guide titration of treatments.
  3. Explain management of associated hypothyroidism and the management of secondary diabetes insipidus will be reviewed.
  4. Explain consideration of special circumstances: management in the presence of pregnancy or in the perioperative setting.

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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Nursing Reference Center Plus is an evidence-based information resource designed to provide relevant clinical resources to nurses. It includes, among others:

  • Care plans
  • Quick lessons
  • Picture and video demonstrations
  • Management topics
  • Cultural competencies
  • Patient education

Topics can be downloaded, sent via email, and subscribed to be alerted when they update. See below a screenshot of the video Preoperative skin preparation using concentric circles, under the topic: Surgical Site Infection: Performing Interventions for Intraoperative Prevention.

Preoperative skin preparation using concentric circles: umbilicus

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Grand Rounds - Dec. 4, 2020
"Human Trafficking: Hiding in Plain Sight"

Speakers: 

  • Mellissa Withers, PhD, MHS, Director, APRU Global Health Program; Associate Professor USC, Institute on Inequalities in Global Health (Keck School of Medicine of USC)
  • Nita Belles, MTh, Executive Director, In Our Backyard; Regional Director, Oregonians Against Trafficking Humans (OATH)

Objectives

  1. Define types of human trafficking
  2. Explain the role of the healthcare provider in recognizing and responding to trafficking victims and survivor
  3. Specify how to report cases or suspected cases of human trafficking
  4. Outline the various types of cultural diversities (gender, age, race, religion, ethnicity, language, sexual orientation, socio-economic, etc.) that may relate human trafficking

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 [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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For as long as St. Charles has been paying for people to swim at the Madras Aquatic Center, Dr. Shilo Tippett has seen the benefits of the program firsthand.

There was the man with severe anxiety whose nighttime swims helped quiet his unease. And the decades-long smoker who went to the pool to replace her habit, which helped her re-envision herself as a healthy person engaged in healthy behaviors.

Tippett remembers a handful of kids who felt hopeless because, unlike many of their peers, they weren’t into sports. Trips to the MAC always lifted their mood, she said. And she smiles when she recalls a group of women who, individually, felt self-conscious about going to the pool on their own.

“We gave them all passes and now they all go together – or at least they were before the pandemic,” said Tippett, a clinical psychologist at St. Charles Family Care Madras. “We have an endless number of stories like that.”

Those stories are the direct result of the St. Charles swim voucher program, which gives providers across Madras the ability to refer patients to the MAC, a popular pool and recreation center on the east side of town. There, the patient can turn in their referral, and St. Charles will pay the fee to swim – currently $7 for two hours – out of its Community Benefit budget.

The program has existed in some form for several years, but St. Charles started tracking usage more closely in July of 2019. Since then, 112 different people have visited the MAC on referral from a health care provider, said Carlos Salcedo, manager of community partnerships for the health system.

“That’s 112 individuals who, through St. Charles, have been encouraged to exercise, to improve their health and to engage with the MAC and with their community,” Salcedo said. “The cost to engage in your own community is a huge hurdle for some people, and this eliminates that and gets them out of the house and into an active and social environment.” (Note: The MAC is currently closed until at least Dec. 18 because of COVID-19. Its reopening plan is available on its website.)

According to Tippett, the swim voucher program started about six years ago, shortly after she shadowed a provider in Redmond who was referring patients to the Cascade Swim Center there. She teamed up with Dr. Jinnell Lewis, a family care physician at the Madras clinic and avid swimmer, and the two approached the MAC with their idea.

“We went in and said, ‘We want to give swim passes to people,’” Tippett said. “The MAC’s director at the time was totally open to it, and the program just took off.”

Referrals to the pool are especially useful for patients who are overweight, who struggle with other forms of exercise, or who deal with chronic pain, depression and/or anxiety, Tippett said. By eliminating the cost of MAC access, the program makes it easier for many people to exercise, to interact with others and even just to leave their home. For residents of Warm Springs, the pool also offers a replacement for the hot springs and soaking pool at Kah-Nee-Ta Resort, which closed two years ago, Tippett said.

“It’s just so hopeful,” she said of the program. “I go to the pool, too, and I’m regularly running into people who tell me what a difference it has made in their lives. It’s amazing every time.”

St. Charles also sponsors the MAC through a $5,000 contribution from the St. Charles Foundation, said Marcus Thompson, St. Charles’ community advocate in Madras, and that allows the health system to hang a banner at the pool. But for Tippett, the swim voucher program is “where the rubber meets the road” in the partnership between the two organizations. “This gives us a way to directly help a patient who’s dealing with something that feels insurmountable,” she said. “What we’re actually doing here is improving people’s lives with this program.”

That’s also the goal of the Madras Aquatic Center Recreation District, which owns and operates the pool, said the group’s interim executive director, Courtney Snead.

“The MACRD is focused on holistic health, how we can be a good partner in the community and looking at our health outcomes as a whole – not just trying to get people into our pool and signed up for our programs,” Snead said. “I think this is just the beginning of a more robust conversation about health in our area and lots of opportunities for partnership, which is really exciting.”

That outlook aligns with Salcedo’s hopes for the swim voucher program. He has already expanded it to include non-St. Charles providers at Mosaic Medical and Madras Medical Group, and he is talking with MACRD officials about extending the program beyond the pool, into other rec district programs.

“What we want to do is move it out of the clinics and into the community,” he said. “We want to make this bigger and open it up more and make it even more inclusive, because the more attention it gets, the more people will use it.”

At St. Charles, the oft-repeated organizational vision is “Creating America’s healthiest community, together,” and it’s that final word – together – that is exemplified by the swim voucher program, said David Golda, vice president and administrator of St. Charles Madras.

“I have no doubt that St. Charles and the MAC recreation district have very similar missions as far as improving the health of the Madras-area community,” Golda said. “It’s certainly a natural partnership that’s already paying off, and this program is a great example of how something that seems so simple can have such a huge effect on people’s lives.”

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Each year, when the holidays roll around, I like to begin reflecting on the year that will soon come to an end.

This year, that reflection will happen in the massive shadow of COVID-19.

For most of us, it’s been a long, hard year for a lot of reasons. That’s true at St. Charles, too, where planning for and responding to the pandemic has taxed our caregivers, from the front lines of patient care to the administrative and support departments that help keep the health system running as smoothly as possible.

COVID-19 has changed the way we do our work. It has rewritten our policies and procedures and forced many of our people to work from home. It made us plan for the unthinkable in ways we couldn’t have envisioned just a year ago. It took a bite out of us financially.

And it is not done.

But behind the scenes, the silver linings shine brightly. Throughout the first half of the year, I was blown away by our caregivers’ openness to change, even when it came quickly and without warning. Day after day, our teams adapted to rapidly evolving circumstances, often putting in late nights and/or extra hours to do so.

Faced with shortages of masks, gowns and other protective equipment, our caregivers scoured the global supply chain for more, and our community hand-sewed and donated over 10,000 masks to us when we needed them most. Faced with concerns about our ability to care for a surge of COVID-19 patients, our caregivers quickly assessed our facilities and our workforce and built a plan to expand our capacity if needed.

With those issues addressed, we were able to get back to the business of caring for our communities. In 2020 alone:

We improved access to care in Prineville by expanding and upgrading the Family Care clinic and outpatient rehab facility there, and opening a new Immediate Care clinic.

We started offering virtual visits (via video, phone or electronic message) at many of our clinics, allowing patients to see their provider safely and in the comfort of their own home.

We opened the new Short Stay Unit in Bend, a state-of-the-art recovery space that will shorten wait times, increase safety and improve patient flow at the busy hospital.

We earned a spot on the 2020 Healthcare Equality Index as a “Top Performer” in promoting health care equality for our LGBTQ+ community and continued expanding our outreach to the local Spanish-speaking population.

We partnered with Portland’s Oregon Health & Science University to create what is believed to be the first graduate medical education program in Central Oregon, with residents based in Madras.

We continued our commitment to playing an active role in the communities we serve by providing health education, support for those who need it, scholarships for students and events that put the “fun” in fundraising.

We revived our efforts to envision the future of our Redmond hospital campus and to give it a more defined role within our health system so that it can fulfill its tremendous potential.

We identified our next priority focus for St. Charles’ community benefit efforts - prevention of the misuse of alcohol - which will drive some of our partnerships and education work in the coming years.

We were named one of the nation’s “Most Wired” health care organizations for our use of technology to help analyze health data and achieve meaningful clinical outcomes.

And finally, we redoubled our efforts to give back to the community and support local businesses after we received so much support during the early days of our COVID-19 response.

I can assure you, that’s just a portion of the amazing things that happened at St. Charles in 2020, even in the face of a global pandemic. And I hope it gives you an idea of why I am so proud to lead this organization and its 4,500 caregivers - now more than ever.

Around here, “creating America’s healthiest community, together” isn’t just a vision statement. It’s what we do every day.

Thank you for being a part of it.

Sincerely,
Joe

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The College of Healthcare Information Management Executives (CHIME) has recognized St. Charles as “Most Wired” in both the acute and ambulatory fields.

The CHIME Digital Health Most Wired program conducts an annual survey to assess how effectively health care organizations apply core and advanced technologies into their clinical and business programs to improve health and care in their communities.

St. Charles earned the 2020 CHIME Digital Health Most Wired recognition in the acute and ambulatory fields for having deployed technologies and strategies (such as population health and cost-of-care analytics, as well as patient portals) to help analyze data and achieve meaningful clinical and efficiency outcomes.

A total of 30,091 organizations were represented in the 2020 Digital Health Most Wired program, which this year included four separate surveys: domestic, ambulatory, long-term care and international. The surveys assessed the adoption, integration and impact of technologies in health care organizations at all stages of development, from early development to industry leading.

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Here are some resources on Mental Health gathered by the Medical Library.

Mental Health America: The State of Mental Health in America 2021

The report is a collection of data across all 50 states and the District of Columbia that seeks to answer the following questions:

  • How many adults and youth have mental health issues?
  • How many adults and youth have substance use issues?
  • How many adults and youth have access to insurance?
  • How many adults and youth have access to adequate insurance?
  • How many adults and youth have access to mental health care?
  • Which states have higher barriers to accessing mental health care?

On Suicide Prevention

Other Mental Health Resources for Physicians

Do you need help to retrieve an article, locate a resource, or do a literature search? Please contact the Medical Library!

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Nov. 24, 2020

During one of our St. Charles COVID-19 Incident Command calls last week, the dire situation we face became increasingly clear. On that day at that time, our Bend hospital was the only hospital in the state with any available ICU beds.  

Suddenly, the refrain I’ve been hearing from colleagues throughout the nation hit incredibly close to home. Our health care workers can no longer be considered the front line of this fight. We are now your last resort.  

You are on the front line.  

Your actions and choices can make the difference for yourself, your families and your loved ones. Because we simply may not have the beds and staff to care for you if we don’t stop the spread of the virus now. 

Please watch this latest message and share it with your friends and family. 

Your actions are more important than ever as COVID-19 is more prevalent in Central Oregon than at any other time during this pandemic. 

You can make a difference by choosing not to gather for Thanksgiving this year. Follow the advice and ideas we have received from several of our community members and have a virtual meal – share recipes with your loved ones and cook together from a distance. Make a new tradition by taking a piece of leftover pumpkin pie on a hike and eating it at the end of your climb. Take time to remember how much we still have to be grateful for – even in a year that has been fraught with challenges.  

More than anything, we need you to stay safe, stay home, wash your hands and if you do need to go out, wear a mask.  

And know that hope is on the horizon. Statewide, our hospitals are working on plans to distribute the first COVID-19 vaccines to health care workers and first responders in the coming weeks. We are starting to see the light at the end of this very long fight.  

Help us stay strong through the finish line.  

Sincerely,  

Joe  

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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!

 

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